Ahmed Bendary
Benha University, Cardiology, Faculty Member
IMPORTANCE Rheumatic heart disease (RHD) remains a public health issue in low-and middle-income countries (LMICs). However, there are few large studies enrolling individuals from multiple endemic countries. OBJECTIVE To assess the risk... more
IMPORTANCE Rheumatic heart disease (RHD) remains a public health issue in low-and middle-income countries (LMICs). However, there are few large studies enrolling individuals from multiple endemic countries. OBJECTIVE To assess the risk and predictors of major patient-important clinical outcomes in patients with clinical RHD. DESIGN, SETTING, AND PARTICIPANTS Multicenter, hospital-based, prospective observational study including 138 sites in 24 RHD-endemic LMICs. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality. Secondary outcomes were cause-specific mortality, heart failure (HF) hospitalization, stroke, recurrent rheumatic fever, and infective endocarditis. This study analyzed event rates by World Bank country income groups and determined the predictors of mortality using multivariable Cox models. RESULTS Between August 2016 and May 2022, a total of 13 696 patients were enrolled. The mean age was 43.2 years and 72% were women. Data on vital status were available for 12 967 participants (94.7%) at the end of follow-up. Over a median duration of 3.2 years (41 478 patient-years), 1943 patients died (15% overall; 4.7% per patient-year). Most deaths were due to vascular causes (1312 [67.5%]), mainly HF or sudden cardiac death. The number of patients undergoing valve surgery (604 [4.4%]) and HF hospitalization (2% per year) was low. Strokes were infrequent (0.6% per year) and recurrent rheumatic fever was rare. Markers of severe valve disease, such as congestive HF (HR, 1.58 [95% CI, 1.50-1.87]; P < .001), pulmonary hypertension (HR, 1.52 [95% CI, 1.37-1.69]; P < .001), and atrial fibrillation (HR, 1.30 [95% CI, 1.15-1.46]; P < .001) were associated with increased mortality. Treatment with surgery (HR, 0.23 [95% CI, 0.12-0.44]; P < .001) or valvuloplasty (HR, 0.24 [95% CI, 0.06-0.95]; P = .042) were associated with lower mortality. Higher country income level was associated with lower mortality after adjustment for patient-level factors. CONCLUSIONS AND RELEVANCE Mortality in RHD is high and is correlated with the severity of valve disease. Valve surgery and valvuloplasty were associated with substantially lower mortality. Study findings suggest a greater need to improve access to surgical and interventional care, in addition to the current approaches focused on antibiotic prophylaxis and anticoagulation.
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Background: Heart failure (HF) is a major public health concern globally and in Egypt. Understanding the prevalence of different etiologies and management practices in Egyptian HF patients is crucial for targeted healthcare strategies.... more
Background: Heart failure (HF) is a major public health concern
globally and in Egypt. Understanding the prevalence of different
etiologies and management practices in Egyptian HF patients is
crucial for targeted healthcare strategies. This study aimed to
assess the prevalence of different etiologies and management
practices in a contemporary cohort of Egyptian patients with HF.
Methods: This cross-sectional, multi-center observational study
was conducted over 12 months at Agouza Police Hospital and
Benha University Hospital, including 503 Egyptian HF patients.
Data collection involved patient interviews, clinical
examinations, and reviews of medical records and diagnostic
tests. Results: This study comprised 70% males and 30%
females, with an average age of 61 years. The primary etiologies
of HF were ischemic heart disease (68.8%), hypertension (23%),
and valvular heart disease (5.2%). The mean left ventricular
ejection fraction (LVEF) was 45% ± 12. Pharmacological
therapy included ACEIs/ARBs (79.9%), ARNI (10.9%), Betablockers (95.4%), MRAs (86.8%) and SGLT2 inhibitors
(84.9%). A total of 94.4% of patients exhibited ECG
abnormalities, and 34.3% had abnormal chest X-rays.
Conclusion: Ischemic heart disease and hypertension constituted
the most common causes of HF. A significant percentage of
patients received ACEIs/ARBs, Beta-blockers, MRAs, and
SGLT2 inhibitors. The study highlights the need for tailored
management strategies in the Egyptian context, considering the
specific etiological patterns and treatment practices observed.
globally and in Egypt. Understanding the prevalence of different
etiologies and management practices in Egyptian HF patients is
crucial for targeted healthcare strategies. This study aimed to
assess the prevalence of different etiologies and management
practices in a contemporary cohort of Egyptian patients with HF.
Methods: This cross-sectional, multi-center observational study
was conducted over 12 months at Agouza Police Hospital and
Benha University Hospital, including 503 Egyptian HF patients.
Data collection involved patient interviews, clinical
examinations, and reviews of medical records and diagnostic
tests. Results: This study comprised 70% males and 30%
females, with an average age of 61 years. The primary etiologies
of HF were ischemic heart disease (68.8%), hypertension (23%),
and valvular heart disease (5.2%). The mean left ventricular
ejection fraction (LVEF) was 45% ± 12. Pharmacological
therapy included ACEIs/ARBs (79.9%), ARNI (10.9%), Betablockers (95.4%), MRAs (86.8%) and SGLT2 inhibitors
(84.9%). A total of 94.4% of patients exhibited ECG
abnormalities, and 34.3% had abnormal chest X-rays.
Conclusion: Ischemic heart disease and hypertension constituted
the most common causes of HF. A significant percentage of
patients received ACEIs/ARBs, Beta-blockers, MRAs, and
SGLT2 inhibitors. The study highlights the need for tailored
management strategies in the Egyptian context, considering the
specific etiological patterns and treatment practices observed.
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Background: Venous thromboembolism (VTE) is a common and potentially lethal disorder that manifests mainly as deep vein thrombosis (DVT) of the extremities or pulmonary embolism (PE) and occurs because of genetic and environmental risk... more
Background: Venous thromboembolism (VTE) is a common and potentially lethal disorder that manifests mainly as deep vein thrombosis (DVT) of the extremities or pulmonary embolism (PE) and occurs because of genetic and environmental risk factors. Aim of the study: To evaluate the genetic markers Factor V Leiden (G1691A), Prothrombin gene (PT G20210) and methylene tetra hydro folate reductase (MTHFR C677T) polymorphisms in high-risk patients with venous thromboembolism in Benha University Hospital. Patients and Methods: The study consisted of 20 patients of both sexes divided into three groups lower limb DVT group, isolated PE group and DVT complicated by PE group. A venous blood sample collected from patients was used to detect Factor V Leiden (G1691A), Prothrombin gene (G20210A) and methylene tetra hydro folate reductase (MTHFR C677T) polymorphisms by real time polymerase chain reaction (PCR) genotyping. Results: We found that the highest genotyping frequency was FVL G1691A polymorphism found in 8 patients (72.7.0%) of included patients with thrombophilic gene polymorphisms, the lowest frequency was F2 G20210A polymorphism found in 2 patients (18.0%) and 5 patients (45%) had MTHFRC677T polymorphism of included patients with thrombophilic gene polymorphisms. FVL G1691A had the highest percentage of 3 patients (25.0%) in lower limb DVT group then MTHFRC677T 2 patients (16.7%) and the lowest percentage was prothrombin G20210A one patient (8.3%). FVL G1691A and MTHFRC677T had an equal percentage in pulmonary thromboembolism group, 2 patients (40.0%) having each polymorphism which is higher than prothrombin G20210A (0.0%) that wasn't detected in this group. FVL G1691A had the highest percentage, 3 patients (100.0) in DVT and pulmonary embolism group while prothrombin G20210A and MTHFRC677T had an equal percentage, one patient (33.3%) having each polymorphism. The genotyping frequency of these polymorphisms had no statistically significant difference between VTE subgroups. Conclusion: The present study performed a review of genetic variants associated with venous thromboembolism for understanding the underlying etiology and our results give a strategy of diagnostic evaluations for the individuals at high risk of venous thromboembolism.
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Background In percutaneous coronary intervention (PCI) procedures for patients with unprotected left main coronary artery (ULMCA) lesions, intravascular ultrasonography (IVUS) guidance has shown potential for enhancing clinical outcomes.... more
Background
In percutaneous coronary intervention (PCI) procedures for patients with unprotected left main coronary artery (ULMCA) lesions, intravascular ultrasonography (IVUS) guidance has shown potential for enhancing clinical outcomes. However, studies confirming its superiority to conventional angiographic-guided PCI remain few. This study aimed to assess if IVUS-guided PCI for patients with unprotected LMCA stenosis improves clinical outcomes compared to angiographic-guided PCI.
Methods
This randomized clinical study enrolled 181 patients with ULMCA lesions scheduled for drug-eluting stent implantation. Patients were split into 90 in the IVUS-guided group and 91 in the conventional group. Procedural characteristics, clinical outcomes, and the incidence of major adverse cardiovascular event (MACE) were evaluated for all patients. The risk reduction associated with IVUS-guided PCI was evaluated using a multivariate Cox regression analysis.
Results
Patients who underwent IVUS demonstrated significantly higher pre-dilatation before stenting (88.9% vs. 72.5%, P = 0.005), post-dilatation balloon diameter (4.46 ± 0.48 vs. 4.21 ± 0.49, P < 0.001), stent diameter (3.9 ± 0.4 vs. 3.7 ± 0.3, P = 0.002), and pressure for post dilatation (18 ± 3 vs. 16 ± 2, P = 0.001). Regarding 12-month outcomes, patients who underwent IVUS demonstrated significantly lower MACE (3.3% vs. 18.7%, P < 0.001) than those who underwent the conventional method. Multivariate Cox regression analysis revealed that IVUS was related to 84.4% risk reduction of 1-year MACE (HR = 0.156, 95% CI = 0.044–0.556, P = 0.004).
Conclusion
Compared to angiographic-guided PCI, IVUS-guided PCI resulted in improved clinical results and a markedly reduced risk of MACE in patients with ULMCA lesions.
In percutaneous coronary intervention (PCI) procedures for patients with unprotected left main coronary artery (ULMCA) lesions, intravascular ultrasonography (IVUS) guidance has shown potential for enhancing clinical outcomes. However, studies confirming its superiority to conventional angiographic-guided PCI remain few. This study aimed to assess if IVUS-guided PCI for patients with unprotected LMCA stenosis improves clinical outcomes compared to angiographic-guided PCI.
Methods
This randomized clinical study enrolled 181 patients with ULMCA lesions scheduled for drug-eluting stent implantation. Patients were split into 90 in the IVUS-guided group and 91 in the conventional group. Procedural characteristics, clinical outcomes, and the incidence of major adverse cardiovascular event (MACE) were evaluated for all patients. The risk reduction associated with IVUS-guided PCI was evaluated using a multivariate Cox regression analysis.
Results
Patients who underwent IVUS demonstrated significantly higher pre-dilatation before stenting (88.9% vs. 72.5%, P = 0.005), post-dilatation balloon diameter (4.46 ± 0.48 vs. 4.21 ± 0.49, P < 0.001), stent diameter (3.9 ± 0.4 vs. 3.7 ± 0.3, P = 0.002), and pressure for post dilatation (18 ± 3 vs. 16 ± 2, P = 0.001). Regarding 12-month outcomes, patients who underwent IVUS demonstrated significantly lower MACE (3.3% vs. 18.7%, P < 0.001) than those who underwent the conventional method. Multivariate Cox regression analysis revealed that IVUS was related to 84.4% risk reduction of 1-year MACE (HR = 0.156, 95% CI = 0.044–0.556, P = 0.004).
Conclusion
Compared to angiographic-guided PCI, IVUS-guided PCI resulted in improved clinical results and a markedly reduced risk of MACE in patients with ULMCA lesions.
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Background: Non-ST Segment Elevation Acute Coronary Syndrome (NSTE-ACS) patients often present with complex cardiac pathophysiology, including coronary slow flow phenomenon (CSFP) and diastolic dysfunction (DD). This study aimed to better... more
Background: Non-ST Segment Elevation Acute Coronary Syndrome (NSTE-ACS) patients often present with complex cardiac pathophysiology, including coronary slow flow phenomenon (CSFP) and diastolic dysfunction (DD). This study aimed to better understand the short-term alterations and indicators of improved diastolic function in CSFP patients presenting with NSTEMI. Methods: This prospective research was conducted on 100 NSTE-ACS patients undergoing coronary angiography. Echocardiographic measures were employed to determine diastolic function, and the TIMI frame count approach was employed to determine the presence of CSFP. At the start of the study and after three months, clinical and angiographic data were gathered. Results: The mean age of the studied patients was 46 ±4 years. Significant improvements were noted in several diastolic function parameters at three months. At three months, there were significantly lower percentages of average E/Em > 14 (2% vs. 16%, p < 0.001), LAVI > 34 mL/m2 (46% vs. 76%, p < 0.001), lateral Em < 10 (61% vs. 76%, p < 0.001), and TR velocity (41% vs. 76%, p < 0.001) compared to baseline. Kaplan Meier analysis was done to calculate MACE-free survival. It showed that at 1.5 months, the MACE-free survival was 97.8% and 92.7% in those with improved and non-improved diastolic dysfunction, respectively. Conclusion: Our study shows the positive impact of diagnosing CSFP in NSTE-ACS patients, as it may lead to improved diastolic function over a relatively short period.
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Background: Fragmented QRS (fQRS) on the ECG is a straightforward, affordable, and widely accessible indicator of myocardial fibrosis and scarring. Aim: This study aimed to assess the predictive value of (fQRS) in diagnosing myocardial... more
Background: Fragmented QRS (fQRS) on the ECG is a straightforward, affordable, and widely accessible indicator of myocardial fibrosis and scarring. Aim: This study aimed to assess the predictive value of (fQRS) in diagnosing myocardial ischemia. It evaluated its incremental prognostic significance in patients having single-photon emission computed tomography (SPECT) for exercise-induced myocardial ischemia. Methods: This observational case-control research was executed on 206 patients who underwent exercise myocardial perfusion SPECT for suspected stable chronic CAD. All patients were subjected to demographic, clinical, and laboratory data, electrocardiography, echocardiography, and SPECT myocardial perfusion imaging. The existence of fQRS was determined based on electrocardiographic criteria. Multivariate logistic regression analysis was applied to predict myocardial ischemia, and the incremental prognostic value of fQRS was determined utilizing hierarchical regression analysis. Results: The patients had a mean age of 53 ±10 years, and more than one-quarter (28.2%) had fQRS. Patients with myocardial ischemia (Group I) had a greater prevalence of fQRS than the control group fQRS (42.3% vs. 23.4%, P = 0.009). In multivariate analysis, fQRS significantly predicted myocardial ischemia (OR = 2.298, 95% CI = 1.102-4.792, P = 0.026). Furthermore, compared to traditional risk factors and a combination of conventional risk factors and STT alterations, the fQRS demonstrated an added predictive value (Global X 2 = 34.612). Conclusions: Fragmented QRS complex is a promising ECG marker significantly associated with myocardial ischemia. Its inclusion in risk assessment models enhances predictive accuracy, aiding early CAD diagnosis and risk stratification in patients with stable chronic coronary artery disease
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Background Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2•1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches,... more
Background Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2•1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13•0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings Of 63 093 individuals in the FHSC registry, 11 848 (18•8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50•2%) of 11 476 included individuals were female and 5720 (49•8%) were male. Sex data were missing for 372 (3•1%) of 11 848 individuals. Median age at registry entry was 9•6 years (IQR 5•8-13•2). 10 099 (89•9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10•1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5•2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92•4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48•0%] of 415). 3414 (31•6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72•4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5•00 mmol/L (IQR 4•05-6•08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life.
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Background: Chronic ischemic heart disease is the primary cause of acute and chronic heart failure. Cardiac failure due to exacerbated coronary heart disease occurs in 1 of every 4 cases. Variable degrees of heart failure are present in... more
Background: Chronic ischemic heart disease is the primary cause of acute and chronic heart failure. Cardiac failure due to exacerbated coronary heart disease occurs in 1 of every 4 cases. Variable degrees of heart failure are present in two-thirds of coronary patients who undergo conventional percutaneous coronary intervention (PCI). In an attempt to lower the occurrence of acute kidney injury and contrast-induced nephropathy, the current study aimed to evaluate the effects of PCI using the new dynamic coronary roadmap (DCR) system on the contrast medium volume. Methods: This observational study enrolled 80 patients undergoing PCI for chronic coronary syndromes. Patients were assigned to 2 equal groups. Group I consisted of patients who underwent the DCR technique (the DCR group), and Group II was composed of patients who underwent the normal PCI technique without DCR (the normal group). The patients had detailed history taking, comprehensive clinical examinations, the DCR system, and PCI. Results: Group II demonstrated significantly higher contrast medium volume (179 ± 62 vs 37 ± 11 mL; P < 0.001), fluoroscopy time (12 ± 3 vs 6 ± 2 min; P < 0.001), air kerma (744 ± 85 vs 285 ± 60 mGy; P < 0.001), and dose area product (47 ± 5 vs 36 ± 7 Gy/cm 2). In contrast, Group I had a significantly higher estimated glomerular filtration rate post-PCI (P = 0.015). Conclusions: Contrast volume and fluoroscopy time can be reduced by using DCR during PCI.
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Background Cardiac dysfunction associated with anthracyclines is a significant side effect of chemotherapy, and early detection is crucial. We aimed to assess the diagnostic value of combining global longitudinal strain (GLS) with... more
Background Cardiac dysfunction associated with anthracyclines is a significant side effect of chemotherapy, and early detection is crucial. We aimed to assess the diagnostic value of combining global longitudinal strain (GLS) with biomarkers for the early detection of anthracycline-related cardiac dysfunction. Methods In a prospective cohort study, 80 consecutive adult patients (mean age 51 ± 11 years; 68.8% females) were screened and underwent 2D echocardiographic assessments and biomarker assessments [high-sensitivity troponin-I (hs-Troponin-I) and NT-pro brain natriuretic peptide (NT-proBNP)] before and after anthracycline-based chemotherapy's initial regimen. The patients were followed up for 12 weeks to monitor for the development of cardiotoxicity. Results Ten patients (12.5%) developed cardiotoxicity at the end of the 12-week follow-up. Baseline values of hs-Troponin-I and NT-proBNP were significantly higher in patients who developed cardiotoxicity compared to those who did not, with a similar pattern observed at the 3-week follow-up. Receiver operating characteristic (ROC) curve analysis demonstrated that a cutoff value of baseline hs-Troponin-I > 11 ng/L, NT-proBNP > 90.1 pg/mL, 3-week left ventricular ejection fraction (LVEF) ≤ 52%, 3-week GLS ≥ − 14.5%, 3-week hs-Troponin-I > 13.1 ng/L, and 3-week NT-proBNP > 118.1 pg/mL predicted the occurrence of cardiotoxicity with high sensitivity (range 83-94%) and specificity (range 77-92%). Conclusion Combination of GLS with biomarkers had a high diagnostic value in early identification of anthracycline-related cardiac dysfunction, with an estimated diagnostic accuracy of over 85%. This information could potentially help in the identification of patients at high risk of developing cardiac dysfunction, allowing for earlier management.
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Background Intravascular imaging modalities such as intravascular ultrasound (IVUS) and, more recently, optical coherence tomography (OCT) improved the visualization of coronary anatomy and plaque pathology. We aimed to compare the... more
Background Intravascular imaging modalities such as intravascular ultrasound (IVUS) and, more recently, optical coherence tomography (OCT) improved the visualization of coronary anatomy and plaque pathology. We aimed to compare the procedural and short-term outcomes between IVUS-guided and OCT-guided percutaneous coronary interventions (PCIs) in patients with acute coronary syndrome (ACS). Methods In the present retrospective study, we reviewed the data of 50 patients who had IVUS-guided PCI and 50 patients who had OCT-guided PCI for ACS between January 2020 and June 2021. Intravascular imaging was done before and after stenting. Both groups were compared in terms of minimal luminal area (MLA), stent dimensions, final minimal stent area (MSA) and stent expansion as well as negative angiographic outcomes. Patients were followed for six months to record major adverse cardiac events (MACE). Results The patients' mean age was 57 ± 13 years with male predominance (78%). The radiation time and dose were significantly higher among IVUS group. Pre-stenting MLA was significantly higher in IVUS group (2.63 mm vs. 2.22 mm in OCT, P = 0.013). Stent expansion was significantly higher among OCT group (97% vs. 93% in IVUS group, P = 0.001) with no significant difference between both groups regarding MSA [mm 2 ] (8.88 ± 2.87 in IVUS vs. 8.1 ± 2.76 in OCT, P = 0.169). No significant difference between both groups was noted regarding contrast volume, edge dissection, tissue prolapse, and no reflow. The rates of six-month MACE were significantly higher in the IVUS group. Conclusions OCT-guided PCI in ACS is safe and is associated with similar MSA to that of IVUS-guided PCI. Future randomized trials are needed to confirm these findings.
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Background Till the moment of this document writing, no Egyptian consensus is there to guide selection of additional antithrombotic in stable patients with established CVD. Despite use of lifestyle measures and statins, those patients... more
Background Till the moment of this document writing, no Egyptian consensus is there to guide selection of additional antithrombotic in stable patients with established CVD. Despite use of lifestyle measures and statins, those patients with established CVD still face a considerable burden of residual risk. Main body With the evolvement of evidence-based medicine, there have been a lot of recommendations to use additional antithrombotic medications to maximize protection for those patients. Accordingly, the Egyptian Society of Cardiology working group of thrombosis and prevention took the responsibility of providing an expert consensus on the current recommendations for using antithrombotic medications to maximize protection in stable patients with established CVD. For stable patients with established CVD, in addition to proper lifestyle measures and appropriate dose statins, we recommend long-term aspirin therapy. In patients who are unable to take aspirin and in those with a history of gastrointestinal bleeding, clopidogrel is a reasonable alternative. Conclusions For some stable atherosclerotic CVD patients who are at high risk of cardiovascular events and at low risk for bleeding, a regimen of rivaroxaban and aspirin might be taken into consideration.
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Background: Background: Acute myocardial infarction (AMI) pathophysiology is mediated by systemic, intraplaque myocardial inflammatory processes that occur mainly due to coronary artery thrombosis in an atherosclerotic plaque area. The... more
Background: Background: Acute myocardial infarction (AMI) pathophysiology is mediated by systemic, intraplaque myocardial inflammatory processes that occur mainly due to coronary artery thrombosis in an atherosclerotic plaque area. The G-protein-coupled chemokine receptor (Ccr6) is displayed on the surface of many types of leukocytes, that have been found in atherosclerotic plaques. It is a novel mediator of inflammation and immune response. Objectives: To determine CCR6 lymphocyte expression in AMI patients and its association with disease severity using the Gensini scoring system. Methods: 25 AMI patients and 25 controls underwent flow cytometry to determine the percentage of circulating CCR6+ lymphocytes. To forecast AMI and determine how CCR6 expression relates to it, multivariate logistic regression analysis was used. Results and Discussion: There was a higher percentage of CCR6+ lymphocyte expression in AMI patients than in controls. In addition, CCR6 showed a significant posi...
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Background Knowledge of the frequency of precipitating factors for acute heart failure (AHF) is important (either new-onset heart failure [NOHF] or worsening heart failure [WHF]), as this can guide strategies for prevention and treatment.... more
Background Knowledge of the frequency of precipitating factors for acute heart failure (AHF) is important (either new-onset heart failure [NOHF] or worsening heart failure [WHF]), as this can guide strategies for prevention and treatment. Most data come only from Western Europe and North America; nevertheless, geographic differences do exist. We set out to study the prevalence of precipitating factors of AHF and their connection to patient characteristics and in-hospital and long-term mortality in patients from Egypt hospitalized for decompensated HF. Using the ESC-HF-LT Registry which is a prospective, multicenter, observational study of patients confessed to cardiology centers in the nations of Europe and the Mediterranean, patients presenting with AHF were recruited from 20 centers all over Egypt. Enrolling physicians were requested to report possible precipitants from among several predefined reasons. Results We included 1515 patients (mean age 60 ± 12 years, 69% males). The mea...
Background: Acute myocardial infarction (AMI) pathophysiology is mediated by systemic, intraplaque myocardial inflammatory processes that occur mainly due to coronary artery thrombosis in an atherosclerotic plaque area. The... more
Background: Acute myocardial infarction (AMI) pathophysiology is mediated by systemic, intraplaque myocardial inflammatory processes that occur mainly due to coronary artery thrombosis in an atherosclerotic plaque area. The G-protein-coupled chemokine receptor (Ccr6) is displayed on the surface of many types of leukocytes, that have been found in atherosclerotic plaques. It is a novel mediator of inflammation and immune response.
Objectives: To determine CCR6 lymphocyte expression in AMI patients and its association with disease severity using the Gensini scoring system.
Methods: 25 AMI patients and 25 controls underwent flow cytometry to determine the percentage of circulating CCR6+ lymphocytes. To forecast AMI and determine how CCR6 expression relates to it, multivariate logistic regression analysis was used.
Results and discussion: There was a higher percentage of CCR6+ lymphocyte expression in AMI patients than in controls. In addition, CCR6 showed a significant positive correlation with the Gensini score (GS) in the AMI group then with the degree of coronary artery disease (CAD).
Conclusion: The chemokine receptor Ccr6 is an independent biomarker for AMI and mayplay a role as a mediator of T lymphocyte recruitment, which is associated with coronary lesion destabilization.
Objectives: To determine CCR6 lymphocyte expression in AMI patients and its association with disease severity using the Gensini scoring system.
Methods: 25 AMI patients and 25 controls underwent flow cytometry to determine the percentage of circulating CCR6+ lymphocytes. To forecast AMI and determine how CCR6 expression relates to it, multivariate logistic regression analysis was used.
Results and discussion: There was a higher percentage of CCR6+ lymphocyte expression in AMI patients than in controls. In addition, CCR6 showed a significant positive correlation with the Gensini score (GS) in the AMI group then with the degree of coronary artery disease (CAD).
Conclusion: The chemokine receptor Ccr6 is an independent biomarker for AMI and mayplay a role as a mediator of T lymphocyte recruitment, which is associated with coronary lesion destabilization.
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Background: Many studies on the cardiovascular complications linked to energy drinks consumption imply that their effect on endothelial function might be a causal factor in subsequent cardiac events. Aim: This research investigated... more
Background: Many studies on the cardiovascular complications linked to energy drinks consumption imply that their effect on endothelial function might be a causal factor in subsequent cardiac events.
Aim: This research investigated whether energy drinks consumption could cause acute endothelial function impairment as surrogated by flow-mediated dilation in healthy young adults.
Subjects and methods: This observational study was done in Benha University Hospital in the period from July 2021 to June 2022, and included 50 healthy young adults for analyzing the normal endothelial function before and after consuming a single popular energy drink (ED) can, to assess its effect on endothelial function. All subjects underwent full history taking, clinical examination, Electrocardiogram, and flow-mediated vasodilation (FMD) measurements.
Results: We included 50 healthy adults (mean age 24.02 ±2.69 years, 56% males). Regarding flow-mediated dilation parameters mean (SD) of pre-cuff brachial a diameter 90 m after ED was 3.82 ±0.43 mm (percent change= 4.66%, P < 0.001) while mean of post-cuff brachial a diameter 90 m after ED was 4.06 ± 0.40 mm (percent change= 2.11%, P=0.001), and relative FMD 90 m After ED was 6.43 ± 2.69 (percent change= -15.75%, P= 0.040). Regarding Hemodynamic changes, there was a statistically significant difference before and after energy drink consumption regarding systolic, diastolic blood pressures, and heart rate (P < 0.001 for all).
Conclusion: The young healthy participants who consumed energy drinks exhibited a considerable high heart rate, systolic and diastolic blood pressures, and a considerable decline in endothelial function.
Aim: This research investigated whether energy drinks consumption could cause acute endothelial function impairment as surrogated by flow-mediated dilation in healthy young adults.
Subjects and methods: This observational study was done in Benha University Hospital in the period from July 2021 to June 2022, and included 50 healthy young adults for analyzing the normal endothelial function before and after consuming a single popular energy drink (ED) can, to assess its effect on endothelial function. All subjects underwent full history taking, clinical examination, Electrocardiogram, and flow-mediated vasodilation (FMD) measurements.
Results: We included 50 healthy adults (mean age 24.02 ±2.69 years, 56% males). Regarding flow-mediated dilation parameters mean (SD) of pre-cuff brachial a diameter 90 m after ED was 3.82 ±0.43 mm (percent change= 4.66%, P < 0.001) while mean of post-cuff brachial a diameter 90 m after ED was 4.06 ± 0.40 mm (percent change= 2.11%, P=0.001), and relative FMD 90 m After ED was 6.43 ± 2.69 (percent change= -15.75%, P= 0.040). Regarding Hemodynamic changes, there was a statistically significant difference before and after energy drink consumption regarding systolic, diastolic blood pressures, and heart rate (P < 0.001 for all).
Conclusion: The young healthy participants who consumed energy drinks exhibited a considerable high heart rate, systolic and diastolic blood pressures, and a considerable decline in endothelial function.
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Background: Infection with Helicobacter pylori (HP) is the most prevalent infection worldwide, particularly in underdeveloped nations. It is reported to be associated with many extra gastrointestinal manifestations. Objective: The current... more
Background: Infection with Helicobacter pylori (HP) is the most prevalent infection worldwide, particularly in underdeveloped nations. It is reported to be associated with many extra gastrointestinal manifestations.
Objective: The current work aimed to study the prevalence of HP infection among patients with acute myocardial infarction (AMI). Patients and Methods: This cross-sectional study included STEMI and NSTEMI patients admitted with AMI in the CCU of the Cardiology Department at Benha University Hospital, Egypt.
Results: The prevalence of HP among the studied patients was 72%. Our study showed that those with positive HP Ig-G had considerably lower triglycerides than those with negative HP Ig-G. No significant differences were observed regarding hemoglobin, TLC, platelets, serum creatinine, blood urea, ALT, AST, total cholesterol, HDL, and LDL. In patients with positive HP Ig-G, significant negative correlations were observed between ejection fraction (EF) and blood urea, serum creatinine, and AST.
Conclusion: In this study, HP is related to the incidence of MI. The elimination of HP prevents the onset of CAD and associated consequences.
Objective: The current work aimed to study the prevalence of HP infection among patients with acute myocardial infarction (AMI). Patients and Methods: This cross-sectional study included STEMI and NSTEMI patients admitted with AMI in the CCU of the Cardiology Department at Benha University Hospital, Egypt.
Results: The prevalence of HP among the studied patients was 72%. Our study showed that those with positive HP Ig-G had considerably lower triglycerides than those with negative HP Ig-G. No significant differences were observed regarding hemoglobin, TLC, platelets, serum creatinine, blood urea, ALT, AST, total cholesterol, HDL, and LDL. In patients with positive HP Ig-G, significant negative correlations were observed between ejection fraction (EF) and blood urea, serum creatinine, and AST.
Conclusion: In this study, HP is related to the incidence of MI. The elimination of HP prevents the onset of CAD and associated consequences.
Research Interests:
Heart failure (HF) is the most common cardiovascular cause of hospitalization in patients over 60 years, affecting about 64.3 million patients worldwide. Few studies have investigated the role of sodium glucose cotransporter inhibitors... more
Heart failure (HF) is the most common cardiovascular cause of hospitalization in patients over 60 years, affecting about 64.3 million patients worldwide. Few studies have investigated the role of sodium glucose cotransporter inhibitors (SGLT2Is) in patients with HF without and without diabetes. Thus, we conducted our meta-analysis to further investigate the role of SGLT2I role in patients with HF without and without diabetes. PubMed, Scopus, Web of Science, and Embase were searched. All clinical trials that compared the effect of SGLT2Is versus placebo on patients with HF were included. Dichotomous data were extracted, pooled as risk ratio (RR) with 95% confidence interval (CI), and analyzed using RevMan version 5.3 for windows using the Mantel-Haenszel method. A total of 13 randomized clinical trials were included for analysis, with a total number of 75,287 patients. SGLT2Is significantly lowered the risk of hospitalization for HF in patients with (RR = 0.68, 95% CI 0.63 to 0.74) and without diabetes (RR = 0.75, 95% CI 0.62 to 0.89). Furthermore, they lowered the mortality risk in both patients with diabetes with statistical significance (RR = 0.87, 95% CI 0.77 to 0.99), yet without statistical significance in patients without diabetes (RR = 0.93, 95% CI 0.70 to 1.23). Further analyses for serious adverse events were conducted, and SGLT2I showed a significant lower risk in patients with diabetes (RR = 0.94, 95% CI 0.90 to 0.98) and without diabetes (RR = 0.72, 95% CI 0.38 to 1.39). in patients with diabetes, SGLT2Is significantly reduced cardiovascular mortality, HHF, and serious adverse events. However, in patients without, despite showing a significant reduction in HHF, SGLT2I reduced cardiovascular mortality or serious adverse events but without statistical significance.
Research Interests:
Aims To use quality indicators to study the management of ST-segment elevation myocardial infarction (STEMI) in different regions. Methods and results Prospective cohort study of STEMI within 24 h of symptom onset (11 462 patients, 196... more
Aims To use quality indicators to study the management of ST-segment elevation myocardial infarction (STEMI) in different regions. Methods and results Prospective cohort study of STEMI within 24 h of symptom onset (11 462 patients, 196 centres, 26 European Society of Cardiology members, and 3 affiliated countries). The median delay between arrival at a percutaneous cardiovascular intervention (PCI) centre and primary PCI was 40 min (interquartile range 20–74) with 65.8% receiving PCI within guideline recommendation of 60 min. A third of patients (33.2%) required transfer from their initial hospital to one that could perform emergency PCI for whom only 27.2% were treated within the quality indicator recommendation of 120 min. Radial access was used in 56.6% of all primary PCI, but with large geographic variation, from 76.4 to 9.1%. Statins were prescribed at discharge to 98.7% of patients, with little geographic variation. Of patients with a history of heart failure or a documented l...
Background: Non alcoholic fatty liver disease is regarded the most relevant liver disease of the twenty-first century, affecting at least one third of the general population. NAFLD is associated with increased mortality due to... more
Background: Non alcoholic fatty liver disease is regarded the most relevant liver disease of the twenty-first century, affecting at least one third of the general population. NAFLD is associated with increased mortality due to cardiovascular disease (CVD) and cancer. The carotid intimal media thickness (CIMT), mean platelet volume (MPV) and endocan level, could be markers for generalised atherosclerotic burden and endothelial dysfunction. Aims: To evaluate the association between non alcoholic fatty liver disease and early atherosclerosis by measuring CIMT, mean platelet volume (MPV) and endocan level, as markers of endothelial dysfunction, in NAFLD patients. Methods: This cross –sectional study included 50 patients who divided into two groups; group I included 25 subjects with NAFLD and group II included 25 healthy subjects. Complete blood count with mean platelet volume (MPV), Liver profile, Lipid profile, Fasting blood glucose level and 2 hour postprandial, Kidney function test, ...
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Background and Aims : Small interfering RNA molecules (siRNA) e.g., Inclisiran represent an attractive alternative to monoclonal antibodies for Proprotein convertase subtilisin/kexin type 9 (PCSK9) lowering. These molecules offer profound... more
Background and Aims : Small interfering RNA molecules (siRNA) e.g., Inclisiran represent an attractive alternative to monoclonal antibodies for Proprotein convertase subtilisin/kexin type 9 (PCSK9) lowering. These molecules offer profound lowering of (intra- and extracellular) PCSK9 at a lower-dose frequency and potentially at a lower cost. Inclisiran has undergone phase 1, 2, and 3 evaluation all within the context of the ORION trials, with good efficacy and safety. Considering that Egypt is a middleincome country with a burdened economy, concerns are raised on which patients would benefit from this expensive medication. Therefore, the Egyptian Association for Vascular biology and Atherosclerosis (EAVA) took the responsibility of providing the 1st Egyptian consensus on the use of Inclisiran in clinical practice. Methods: EAVA analyzed the data that would enable us to obtain clear indications for the use of Inclisiran. Results: Dyslipidemia represents a major atherosclerotic risk factor in Egypt. Among Egyptian patients with acute coronary syndromes, it has been estimated that the prevalence of dyslipidemia is 48%, and that of ‘atleast- possible’ FH is 17%. Reaching low-density lipoprotein cholesterol (LDL-C) goals is difficult as well. Conclusions: We recommend the use of Inclisiran in addition to statins ± ezetimibe in patients with either [1]. established ASCVD or [2]. FH with one of the following: another major risk factor, eGFR &lt; 30 ml/min,or veryhigh risk DM, who didn’t reach LDL-C goals and/or with true statin intolerance.
Research Interests:
Background In recent years, attention has shifted to the role of right ventricular (RV) dysfunction in prediction of clinical outcome among patients with septic shock. However, very few studies have correlated RV dysfunction with survival... more
Background In recent years, attention has shifted to the role of right ventricular (RV) dysfunction in prediction of clinical outcome among patients with septic shock. However, very few studies have correlated RV dysfunction with survival early in the course of sepsis. In the period from September 2021 to July 2022, we included a total number of 248 patients within 24 h of their presentation with sepsis. All patients were subjected to a comprehensive echocardiographic study to evaluate different parameters of RV function and LV systolic and diastolic functions. We aimed primarily to study the predictive value of RV dysfunction on 30-day all-cause mortality rates and ventilator-free days. Results Almost half of study population (48.4%) showed evidence of RV dysfunction (in isolation or with LV dysfunction), with 25.4% showing evidence of isolated RV dysfunction. Patients with RV dysfunction had a significantly higher APACHE 2 (P < 0.001) score and 30-day all-cause mortality rates ...
Research Interests:
Background Heart failure (HF) is the most common cardiovascular causes of hospitalization in people over 60 years affecting about 64.3 million people worldwide. Few studies have investigated sodium glucose like transporter-2 inhibitors... more
Background Heart failure (HF) is the most common cardiovascular causes of hospitalization in people over 60 years affecting about 64.3 million people worldwide. Few studies have investigated sodium glucose like transporter-2 inhibitors (SGLT-2I) role in diabetic and non-diabetic patients with HF. Objective We conducted our meta-analysis to further investigate SGLT-2I role in diabetic and non-diabetic HF patients. Methods PubMed, Scopus, web of science, and Embase were searched. All clinical trials that compared the effect of SGLT2 inhibitors versus placebo on heart failure patients were included. Dichotomous data were extracted, pooled as risk ratio (RR) with 95% confidence interval, and analyzed via RevMan version 5.3 for windows using Mantel Haenszel (M-H) method. Results Twelve randomized clinical trials were included for analysis with a total number of 69024 patients. SGLT2I significantly lowered the risk of hospitalization for heart failure (HHF) in diabetic (RR=0.68, 95% CI 0....
Research Interests:
BACKGROUND Testing of factor Xa inhibitors for the prevention of cardiovascular events in patients with rheumatic heart disease-associated atrial fibrillation has been limited. METHODS We enrolled patients with atrial fibrillation and... more
BACKGROUND Testing of factor Xa inhibitors for the prevention of cardiovascular events in patients with rheumatic heart disease-associated atrial fibrillation has been limited. METHODS We enrolled patients with atrial fibrillation and echocardiographically documented rheumatic heart disease who had any of the following: a CHA 2 DS 2 VASc score of at least 2 (on a scale from 0 to 9, with higher scores indicating a higher risk of stroke), a mitral-valve area of no more than 2 cm 2 , left atrial spontaneous echo contrast, or left atrial thrombus. Patients were randomly assigned to receive standard doses of rivaroxaban or dose-adjusted vitamin K antagonist. The primary efficacy outcome was a composite of stroke, systemic embolism, myocardial infarction, or death from vascular (cardiac or noncardiac) or unknown causes. We hypothesized that rivaroxaban therapy would be noninferior to vitamin K antagonist therapy. The primary safety outcome was major bleeding according to the International Society of Thrombosis and Hemostasis. RESULTS Of 4565 enrolled patients, 4531 were included in the final analysis. The mean age of the patients was 50.5 years, and 72.3% were women. Permanent discontinuation of trial medication was more common with rivaroxaban than with vitamin K antagonist therapy at all visits. In the intention-to-treat analysis, 560 patients in the rivaroxaban group and 446 in the vitamin K antagonist group had a primary-outcome event. Survival curves were nonproportional. The restricted mean survival time was 1599 days in the rivaroxaban group and 1675 days in the vitamin K antagonist group (difference, −76 days; 95% confidence interval [CI], −121 to −31; P&lt;0.001). A higher incidence of death occurred in the rivaroxaban group than in the vitamin K antagonist group (restricted mean survival time, 1608 days vs. 1680 days; difference, −72 days; 95% CI, −117 to −28). No significant between-group difference in the rate of major bleeding was noted. CONCLUSIONS Among patients with rheumatic heart disease-associated atrial fibrillation, vitamin K antagonist therapy led to a lower rate of a composite of cardiovascular events or death than rivaroxaban therapy, without a higher rate of bleeding. (Funded by Bayer; INVICTUS ClinicalTrials.gov number, NCT02832544.
Research Interests:
Research Interests:
Background: Low dose dopamine use in acute decompensated heart failure (ADHF) still lacks evidence. Our objective was to establish the value of low dose dopamine in ADHF patients with preserved ejection fraction in prevention of... more
Background: Low dose dopamine use in acute decompensated heart failure (ADHF) still lacks evidence. Our objective was to establish the value of low dose dopamine in ADHF patients with preserved ejection fraction in prevention of glomerular filtration rate (GFR) deterioration, duration of hospital stay, 6 months cardiovascular (CV) mortality &amp; rehospitalization. Methods: One hundred ADHF patients with preserved ejection fraction admitted to Benha&amp;Alzaytoon cardiology departments were randomized into 2 groups, each composed of 50 patients: group A received conventional ADHF treatment + low dose dopamine &amp;group B received only conventional ADHF treatment. Patients of both groups were observed for duration of hospital stay, GFR changes, 6 months cardiovascular (CV) mortality &amp; re-hospitalization. Results: Low dose dopamine in &quot;group A&quot; failed to prevent deterioration of GFR assessed by delta GFR from admission to discharge (-9.20 ml /min± 12.76 for group A versus-5.42 ml/min ± 8.30 for group B, p value =0.083). It caused significant shortening in duration of hospital stay (3.9 days ± 1.41 for group A versus 4.76 days ± 1.33 for group B, p value =0.02). Low dose dopamine affected daily urinary output (UOP). It caused highly significant increase in UOP (2072 ml urine/day ± 404.08 for group A versus 1689.78 ml urine/day ± 193.02 for group B, p value&lt;0.001). It also caused highly significant body weight loss assessed by weight loss from admission to discharge (-1.374 kg weight loss ± 0.46 in group A versus-0.872 kg weight loss ± 0.41 in group B , p value&lt;0.001). It failed to achieve significant change regarding 6 months endpoints (8 rehospitalizations &amp; 2 CV deaths in group A versus 9 re-hospitalizations &amp;1 CV death in group B, p value =1). Conclusion: Low dose dopamine has no significant effect on reno-protection, morbidity &amp; mortality of ADHF with preserved ejection fraction but it adds diuretic, decongestive effect&amp; shortens the duration of hospital stay without increased risk of worsening renal functions.
Research Interests:
Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with... more
Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0–100%), fibrinolysis (18.8%; 0–100%), and no reperfusion therapy (9.0%; 0–75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5–5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8–97.5%) for the performance of reperfusion therap...
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Background Egypt is the most populous country in Middle East and North Africa and has one of the highest rates of the cardiovascular (CV) deaths in the region. Despite governmental primary preventive efforts, very little is known about... more
Background Egypt is the most populous country in Middle East and North Africa and has one of the highest rates of the cardiovascular (CV) deaths in the region. Despite governmental primary preventive efforts, very little is known about the prevalence and characteristics of premature coronary artery disease (CAD) among Egyptian patients with Acute Coronary syndrome (ACS). Methods From November 2015 to August 2018, data were collected from 3224 patients with ACS in 30 coronary care centers covering 11 governorates across Egypt, spanning the Mediterranean coast, Nile Delta, and Upper Egypt, with focus on premature CAD (defined as ACS before age 55 years in males and 65 years in females). Results The prevalence of premature CAD was 51%. They were significantly more females (35% versus 16%, P<0.001) with significantly higher level of education. Risk factors' (RFs) distribution showed a significantly higher prevalence of Type-1 Diabetes Mellitus (6% versus 4%, P=0.005), obesity (42...
Research Interests:
To use quality indicators to study the management of ST-segment elevation myocardial infarction (STEMI) in different regions. Methods and results Prospective cohort study of STEMI within 24 h of symptom onset (11 462 patients, 196... more
To use quality indicators to study the management of ST-segment elevation myocardial infarction (STEMI) in different regions. Methods and results Prospective cohort study of STEMI within 24 h of symptom onset (11 462 patients, 196 centres, 26 European Society of Cardiology members, and 3 affiliated countries). The median delay between arrival at a percutaneous cardiovascular intervention (PCI) centre and primary PCI was 40 min (interquartile range 20-74) with 65.8% receiving PCI within guideline recommendation of 60 min. A third of patients (33.2%) required transfer from their initial hospital to one that could perform emergency PCI for whom only 27.2% were treated within the quality indicator recommendation of 120 min. Radial access was used in 56.6% of all primary PCI, but with large geographic variation, from 76.4 to 9.1%. Statins were prescribed at discharge to 98.7% of patients, with little geographic variation. Of patients with a history of heart failure or a documented left ventricular ejection fraction ≤40%, 84.0% were discharged on an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and 88.7% were discharged on beta-blockers. Conclusion Care for STEMI shows wide geographic variation in the receipt of timely primary PCI, and is in contrast with the more uniform delivery of guideline-recommended pharmacotherapies at time of hospital discharge.
Research Interests:
Aims To determine the current state of the use of reperfusion and adjunctive therapies and in-hospital outcomes in European Society of Cardiology (ESC) member and affiliated countries for patients with ST-segment elevation myocardial... more
Aims To determine the current state of the use of reperfusion and adjunctive therapies and in-hospital outcomes in European
Society of Cardiology (ESC) member and affiliated countries for patients with ST-segment elevation myocardial infarction
(STEMI) complicated by cardiogenic shock (CS).
Methods
and results
ESC EurObservational Research Programme prospective international cohort study of admissions with STEMI within 24 h of
symptom onset (196 centres; 26 ESC member and 3 affiliated countries). Of 11 462 patients enrolled, 448 (3.9%) had CS.
Patients with compared to patients without CS, less frequently received primary percutaneous coronary intervention
(PCI) (65.5% vs. 72.2%) and fibrinolysis (15.9% vs. 19.0), and more often had no reperfusion therapy (19.0% vs. 8.5%).
Mechanical support devices (intraaortic ballon pump 11.2%, extracoporeal membrane oxygenation 0.7%, other 1.1%)
were used infrequently in CS. Bleeding definition academic research consortium 2–5 bleeding complications (10.1% vs.
3.0%, P,0.01) and stroke (4.2% vs. 0.9%, P,0.01) occurred more frequently in patients with CS. In-hospital mortality
was 10-fold higher (35.5% vs. 3.1%) in patients with CS. Mortality in patients with CS in the groups with PCI, fibrinolysis,
and no reperfusion therapy were 27.4%, 36.6%, and 62.4%, respectively.
Conclusion In this multi-national registry, patients with STEMI complicated by CS less frequently receive reperfusion therapy than
patients with STEMI without CS. Early mortality in patients with CS not treated with primary PCI is very high.
Therefore, strategies to improve clinical outcome in STEMI with CS are needed.
Society of Cardiology (ESC) member and affiliated countries for patients with ST-segment elevation myocardial infarction
(STEMI) complicated by cardiogenic shock (CS).
Methods
and results
ESC EurObservational Research Programme prospective international cohort study of admissions with STEMI within 24 h of
symptom onset (196 centres; 26 ESC member and 3 affiliated countries). Of 11 462 patients enrolled, 448 (3.9%) had CS.
Patients with compared to patients without CS, less frequently received primary percutaneous coronary intervention
(PCI) (65.5% vs. 72.2%) and fibrinolysis (15.9% vs. 19.0), and more often had no reperfusion therapy (19.0% vs. 8.5%).
Mechanical support devices (intraaortic ballon pump 11.2%, extracoporeal membrane oxygenation 0.7%, other 1.1%)
were used infrequently in CS. Bleeding definition academic research consortium 2–5 bleeding complications (10.1% vs.
3.0%, P,0.01) and stroke (4.2% vs. 0.9%, P,0.01) occurred more frequently in patients with CS. In-hospital mortality
was 10-fold higher (35.5% vs. 3.1%) in patients with CS. Mortality in patients with CS in the groups with PCI, fibrinolysis,
and no reperfusion therapy were 27.4%, 36.6%, and 62.4%, respectively.
Conclusion In this multi-national registry, patients with STEMI complicated by CS less frequently receive reperfusion therapy than
patients with STEMI without CS. Early mortality in patients with CS not treated with primary PCI is very high.
Therefore, strategies to improve clinical outcome in STEMI with CS are needed.
Research Interests:
Heart failure (HF) is the most common cardiovascular cause of hospitalization in patients over 60 years, affecting about 64.3 million patients worldwide. Few studies have investigated the role of sodium glucose cotransporter inhibitors... more
Heart failure (HF) is the most common cardiovascular cause of hospitalization in patients over 60 years, affecting about 64.3 million patients worldwide. Few studies have investigated the role of sodium glucose cotransporter inhibitors (SGLT2Is) in patients with HF without and without diabetes. Thus, we conducted our meta-analysis to further investigate the role of SGLT2I role in patients with HF without and without diabetes. PubMed, Scopus, Web of Science, and Embase were searched. All clinical trials that compared the effect of SGLT2Is versus placebo on patients with HF were included. Dichotomous data were extracted, pooled as risk ratio (RR) with 95% confidence interval (CI), and analyzed using RevMan version 5.3 for windows using the Mantel-Haenszel method. A total of 13 randomized clinical trials were included for analysis, with a total number of 75,287 patients. SGLT2Is significantly lowered the risk of hospitalization for HF in patients with (RR = 0.68, 95% CI 0.63 to 0.74) and without diabetes (RR = 0.75, 95% CI 0.62 to 0.89). Furthermore, they lowered the mortality risk in both patients with diabetes with statistical significance (RR = 0.87, 95% CI 0.77 to 0.99), yet without statistical significance in patients without diabetes (RR = 0.93, 95% CI 0.70 to 1.23). Further analyses for serious adverse events were conducted, and SGLT2I showed a significant lower risk in patients with diabetes (RR = 0.94, 95% CI 0.90 to 0.98) and without diabetes (RR = 0.72, 95% CI 0.38 to 1.39). in patients with diabetes, SGLT2Is significantly reduced cardiovascular mortality, HHF, and serious adverse events. However, in patients without, despite showing a significant reduction in HHF, SGLT2I reduced cardiovascular mortality or serious adverse events but without statistical significance.
Research Interests:
Heart failure (HF) is the most common cardiovascular cause of hospitalization in patients over 60 years, affecting about 64.3 million patients worldwide. Few studies have investigated the role of sodium glucose cotransporter inhibitors... more
Heart failure (HF) is the most common cardiovascular cause of hospitalization in patients over 60 years, affecting about 64.3 million patients worldwide. Few studies have investigated the role of sodium glucose cotransporter inhibitors (SGLT2Is) in patients with HF without and without diabetes. Thus, we conducted our meta-analysis to further investigate the role of SGLT2I role in patients with HF without and without diabetes. PubMed, Scopus, Web of Science, and Embase were searched. All clinical trials that compared the effect of SGLT2Is versus placebo on patients with HF were included. Dichotomous data were extracted, pooled as risk ratio (RR) with 95% confidence interval (CI), and analyzed using RevMan version 5.3 for windows using the Mantel-Haenszel method. A total of 13 randomized clinical trials were included for analysis, with a total number of 75,287 patients. SGLT2Is significantly lowered the risk of hospitalization for HF in patients with (RR = 0.68, 95% CI 0.63 to 0.74) and without diabetes (RR = 0.75, 95% CI 0.62 to 0.89). Furthermore, they lowered the mortality risk in both patients with diabetes with statistical significance (RR = 0.87, 95% CI 0.77 to 0.99), yet without statistical significance in patients without diabetes (RR = 0.93, 95% CI 0.70 to 1.23). Further analyses for serious adverse events were conducted, and SGLT2I showed a significant lower risk in patients with diabetes (RR = 0.94, 95% CI 0.90 to 0.98) and without diabetes (RR = 0.72, 95% CI 0.38 to 1.39). in patients with diabetes, SGLT2Is significantly reduced cardiovascular mortality, HHF, and serious adverse events. However, in patients without, despite showing a significant reduction in HHF, SGLT2I reduced cardiovascular mortality or serious adverse events but without statistical significance.
Research Interests:
Research Interests:
Background: In recent years, attention has shifted to the role of right ventricular (RV) dysfunction in prediction of clinical outcome among patients with septic shock. However, very few studies have correlated RV dysfunction with... more
Background: In recent years, attention has shifted to the role of right ventricular (RV) dysfunction in prediction of clinical outcome among patients with septic shock. However, very few studies have correlated RV dysfunction with survival early in the course of sepsis. In the period from September 2021 to July 2022, we included a total number of 248 patients within 24 h of their presentation with sepsis. All patients were subjected to a comprehensive echocardiographic study to evaluate different parameters of RV function and LV systolic and diastolic functions. We aimed primarily to study the predictive value of RV dysfunction on 30-day all-cause mortality rates and ventilator-free days. Results: Almost half of study population (48.4%) showed evidence of RV dysfunction (in isolation or with LV dysfunction), with 25.4% showing evidence of isolated RV dysfunction. Patients with RV dysfunction had a significantly higher APACHE 2 (P < 0.001) score and 30-day all-cause mortality rates (P = 0.003) compared to those without RV dysfunction. A significant association was reported between 30-d mortality and dysfunction status (P = 0.025). Those with no dysfunction had lower mortality (14.1%) than in those with RV dysfunction only (33.3%), LV dysfunction only (20%), and RV + LV dysfunction (31.6%). No significant difference was observed in ventilator free days according to dysfunction status (P = 0.081). A multivariate logistic regression analysis showed that RV dysfunction was among the significant independent predictors for 30-day mortality (OR 2.01, 95% CI 1.07-3.81, P = 0.031), controlling for the effect of age and gender. Conclusions: In a cohort of ICU patients with early sepsis, RV dysfunction is found to be common and predictive of 30-day mortality irrespective to the LV function.
Research Interests:
Background Elevation of low-density lipoprotein cholesterol (LDL-c) is still a hugely unmet need in the reduction of atherosclerotic cardiovascular disease. In the published CardioRisk project in Egypt, up to 71% of female participants... more
Background
Elevation of low-density lipoprotein cholesterol (LDL-c) is still a hugely unmet need in the reduction of atherosclerotic cardiovascular disease. In the published CardioRisk project in Egypt, up to 71% of female participants had dyslipidemia. Control of LDL-c levels and thus improvement of hyperlipidemia is quite often very difficult. With the introduction of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, the decrease of significant cardiac adverse events, the patient control rate, and the death rate have all been improved. Inhibition of the formation of PCSK9 through inclisiran, which is a novel method of reducing LDL-c and is only given twice per year, seems alluring. After revision of published data, we analyzed the potential advantages of the use of inclisiran.
Conclusion
The Egyptian Association for Vascular Biology and Atherosclerosis (EAVA) analyzed the data necessary for obtaining clear indications for the usage of inclisiran. We propose the addition of inclisiran to statins with or without ezetimibe for patients with documented atherosclerotic cardiovascular disease (ASCVD) or similar risk, familial hypercholesterolemia (FH) with another major risk factor, and very high and high risk diabetes mellitus, who did not reach LDL-c goals and/or with true statin intolerance. Inclisiran is also recommended as upfront therapy, with triple combination, in extreme risk subjects such as those with post acute coronary syndromes (ACS).
Elevation of low-density lipoprotein cholesterol (LDL-c) is still a hugely unmet need in the reduction of atherosclerotic cardiovascular disease. In the published CardioRisk project in Egypt, up to 71% of female participants had dyslipidemia. Control of LDL-c levels and thus improvement of hyperlipidemia is quite often very difficult. With the introduction of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, the decrease of significant cardiac adverse events, the patient control rate, and the death rate have all been improved. Inhibition of the formation of PCSK9 through inclisiran, which is a novel method of reducing LDL-c and is only given twice per year, seems alluring. After revision of published data, we analyzed the potential advantages of the use of inclisiran.
Conclusion
The Egyptian Association for Vascular Biology and Atherosclerosis (EAVA) analyzed the data necessary for obtaining clear indications for the usage of inclisiran. We propose the addition of inclisiran to statins with or without ezetimibe for patients with documented atherosclerotic cardiovascular disease (ASCVD) or similar risk, familial hypercholesterolemia (FH) with another major risk factor, and very high and high risk diabetes mellitus, who did not reach LDL-c goals and/or with true statin intolerance. Inclisiran is also recommended as upfront therapy, with triple combination, in extreme risk subjects such as those with post acute coronary syndromes (ACS).
Research Interests:
BACKGROUND Testing of factor Xa inhibitors for the prevention of cardiovascular events in patients with rheumatic heart disease-associated atrial fibrillation has been limited. METHODS We enrolled patients with atrial fibrillation and... more
BACKGROUND Testing of factor Xa inhibitors for the prevention of cardiovascular events in patients with rheumatic heart disease-associated atrial fibrillation has been limited. METHODS We enrolled patients with atrial fibrillation and echocardiographically documented rheumatic heart disease who had any of the following: a CHA 2 DS 2 VASc score of at least 2 (on a scale from 0 to 9, with higher scores indicating a higher risk of stroke), a mitral-valve area of no more than 2 cm 2 , left atrial spontaneous echo contrast, or left atrial thrombus. Patients were randomly assigned to receive standard doses of rivaroxaban or dose-adjusted vitamin K antagonist. The primary efficacy outcome was a composite of stroke, systemic embolism, myocardial infarction, or death from vascular (cardiac or noncardiac) or unknown causes. We hypothesized that rivaroxaban therapy would be noninferior to vitamin K antagonist therapy. The primary safety outcome was major bleeding according to the International Society of Thrombosis and Hemostasis. RESULTS Of 4565 enrolled patients, 4531 were included in the final analysis. The mean age of the patients was 50.5 years, and 72.3% were women. Permanent discontinuation of trial medication was more common with rivaroxaban than with vitamin K antagonist therapy at all visits. In the intention-to-treat analysis, 560 patients in the rivaroxaban group and 446 in the vitamin K antagonist group had a primary-outcome event. Survival curves were nonproportional. The restricted mean survival time was 1599 days in the rivaroxaban group and 1675 days in the vitamin K antagonist group (difference, −76 days; 95% confidence interval [CI], −121 to −31; P<0.001). A higher incidence of death occurred in the rivaroxaban group than in the vitamin K antagonist group (restricted mean survival time, 1608 days vs. 1680 days; difference, −72 days; 95% CI, −117 to −28). No significant between-group difference in the rate of major bleeding was noted. CONCLUSIONS Among patients with rheumatic heart disease-associated atrial fibrillation, vitamin K antagonist therapy led to a lower rate of a composite of cardiovascular events or death than rivaroxaban therapy, without a higher rate of bleeding. (Funded by Bayer; INVICTUS ClinicalTrials.gov number, NCT02832544.
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Background: Successful chronic total occlusion (CTO) Percutaneous Coronary Intervention (PCI) demonstrates significant clinical benefits, but comparative outcomes between antegrade and retrograde approaches are still lacking in Egypt.... more
Background: Successful chronic total occlusion (CTO) Percutaneous Coronary Intervention (PCI) demonstrates significant clinical benefits, but comparative outcomes between antegrade and retrograde approaches are still lacking in Egypt. Results: We enrolled 152 patients in the period from December 2018 to May 2021. They were referred for CTO-PCI procedures at the National Heart Institute's catheterization laboratory. The studied population was categorized into two groups: The first group: patients with an antegrade approach. The second group: patients with a retrograde approach. The highest percentage of CTO vessels affected was RCA (43.4%). The mean duration of CTO was 12 months with a J CTO score of 3. Approximately more than three-fifth (90.1%) of the studied population had technical success. The technical success was higher in the retrograde group (96.1%) compared to 84.0% of that in the antegrade group (P= 0.012). Technical success was (92.6% & 98.0%) in epicardial and septal collaterals, respectively, with no statistically significant difference. Mean of total procedure time (min.) was 140 ±55 while mean of total contrast volume (ml) used was 301 ±107 while median of Total radiation dose (mGy) was 11925. Conclusions: In our institution, the retrograde approach is safer and more effective than antegrade CTO-PCI but involves longer procedure duration, greater radiation exposure, and more contrast material usage. Septal collateral channels were more secure than epicardial collateral channels for the retrograde approach.
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Purpose We aimed to compare the procedural and short-term outcomes between IVUS guided and OCT guided percutaneous coronary interventions in patients presenting with acute coronary syndrome (ACS). Methods In the present retrospective... more
Purpose We aimed to compare the procedural and short-term outcomes between IVUS guided and OCT guided percutaneous coronary interventions in patients presenting with acute coronary syndrome (ACS). Methods In the present retrospective study, we reviewed the data of 50 patients who had IVUS-guided PCI and 50 patients who had OCT-guided PCI for ACS between January 2021 and June 2021. Intravascular imaging was done before and after stenting. Both groups were compared in terms of minimal luminal area (MLA), stent dimensions, final minimal stent area (MSA) and stent expansion as well as negative angiographic outcomes. Patients were followed for six months to record MACE. Results The mean age of analyzed patients was 57 ± 13 years with male predominance (78%). The radiation time and dose were significantly higher among IVUS group. Pre-stenting MLA was significantly higher in IVUS group (2.63mm vs 2.22 mm in OCT, P = 0.013). Stent expansion was significantly higher among OCT group (97% vs 9...
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Background: The use of intravenous nitroglycerin by intermittent bolus doses in hypertensive acute heart failure patients (AHF) is still unclear. Aim and Objectives: This study aimed to determine intermittent bolus nitroglycerin's... more
Background: The use of intravenous nitroglycerin by intermittent bolus doses in hypertensive acute heart failure patients (AHF) is still unclear. Aim and Objectives: This study aimed to determine intermittent bolus nitroglycerin's effect on the use of resources, admissions to intensive care unit (ICU), hospital length of stay (LOS), and safety. Patients and Methods: This prospective, randomized, parallel, single-blind clinical study, which included patients diagnosed with hypertensive AHF, was conducted from May 2019 to October 2020 at Benha University Hospital. Two hundred patients were recruited and randomly allocated into two groups, each composed of 100 patients. Results: The prevalence of hypertension and chronic obstructive pulmonary disease patients was significantly higher in patients given intermittent boluses of nitroglycerin than in standard therapy (88.0 vs. 77.0%, P = 0.041) and (27.0 vs. 15.0%, P = 0.037), respectively. Dyslipidemia was significantly lower in patients on intermittent doses of nitroglycerin than those on standard infusion therapy (30 vs. 66%, P < 0.001). The median initial troponin was significantly higher in group I compared to group II (0.145 vs. 0.065 ng/ml, P < 0.001). Conclusion: Nitroglycerin intravenous boluses were associated with fewer ICU admissions and a shorter LOS in the hospital as opposed to ordinarily infusion therapy. In addition, the mean mechanical ventilation duration was slightly shorter. Finally, continuous nitroglycerin infusion use in AHF management is being questioned.
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Background: Diabetic ketoacidosis (DKA) is the most common acute hyperglycemic complication of diabetes. According to a recent report DKA affects approximately 8 per 1000 diabetics annually. It is associated with significant morbidity and... more
Background: Diabetic ketoacidosis (DKA) is the most common acute hyperglycemic complication of diabetes. According to a recent report DKA affects approximately 8 per 1000 diabetics annually. It is associated with significant morbidity and mortality, with a worldwide mortality rate of 2-10%. Objective: The aim of the work was to assessment of QTc interval prolongation among patients with DKA. Patients and Methods: This prospective observational cohort study included 100 patients who were diagnosed with DKA. The mean age of patients was 37.29±11.63 years, and 53% of them were males. All patients were subjected to detailed history taking, full clinical examination, laboratory investigations and 12-lead ECG. Results: Frequency of Prolonged QTmaxc amongst studied patients was 59%. Mean QTmaxc declined significantly after treatment to be 414.6±44.1ms compared to 482.45±63.56ms before treatment with p<0.0001 and Frequency of prolonged QTmaxc was significantly decreased with treatment fr...
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Correlation analysis showed that there is not any correlation between the values of AVC and BAC (p¼0.877). Ă Conclusions: Vascular calcifications including breast artery calcification and aortic calcification are related with each other... more
Correlation analysis showed that there is not any correlation between the values of AVC and BAC (p¼0.877). Ă Conclusions: Vascular calcifications including breast artery calcification and aortic calcification are related with each other and poor cardiovascular outcomes. Aortic valvular calcification is more frequent in patients with BAC but the severity of AVC is not correlated with BAC severity.
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A 48-year-old man with history of diabetes mellitus presented with acute progressive chest pain of 12-hour duration. ECG showed evidence of anterior ST-segment elevation myocardial infarction. He underwent primary PCI (door to device... more
A 48-year-old man with history of diabetes mellitus presented with acute progressive chest pain of 12-hour duration. ECG showed evidence of anterior ST-segment elevation myocardial infarction. He underwent primary PCI (door to device time: 60 minutes) with implantation of two overlapping drug-eluting stents (2.5 × 18 mm distally and 2.75 × 22 mm proximally) to the left anterior descending artery (LAD). The patient’s chest pain disappeared, and he was hemodynamically stable with blood pressure of 130/80 mmHg. Angiography showed satisfactory stent results, but minor contrast extravasation was observed in the distal LAD segment (Fig. 1; Supplementary Video 1, Supplemental digital content 1, http://links.lww.com/MCA/A346).
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Research Interests:
Heart failure with reduced ejection fraction (HFrEF) represents a significant public health burden associated with incremental health care costs. Given the limitations associated with pharmacological autonomic regulation therapy (ART),... more
Heart failure with reduced ejection fraction (HFrEF) represents a significant public health burden associated with incremental health care costs. Given the limitations associated with pharmacological autonomic regulation therapy (ART), device-based autonomic neuromodulation is on the horizon now for ART in those patients. This systematic review aimed primarily to determine the effect of ART by devices on functional status and quality of life (QOL) in patients with HFrEF. We performed a meta-analysis of five randomized controlled trials (1074 patients) comparing ART by devices versus optimal medical therapy (OMT) in HFrEF. We assessed pooled estimates of odds ratio (OR) for improvement in New York Heart Association (NYHA) class and mean differences (MD) in 6-minute hall walk distance (6-MHWD), Minnesota Living with Heart Failure Questionnaire (MLHFQ) score, N-terminal pro b-type natriuretic peptide (NT-proBNP) levels, and left ventricular end-systolic volume index (LVESVi) with their...
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Background Heart failure (HF) is the most common cardiovascular causes of hospitalization in people over 60 years affecting about 64.3 million people worldwide. Few studies have investigated sodium glucose like transporter-2 inhibitors... more
Background
Heart failure (HF) is the most common cardiovascular causes of hospitalization in people over 60 years affecting about 64.3 million people worldwide. Few studies have investigated sodium glucose like transporter-2 inhibitors (SGLT-2I) role in diabetic and non-diabetic patients with HF.
Objective
We conducted our meta-analysis to further investigate SGLT-2I role in diabetic and non-diabetic HF patients.
Methods
PubMed, Scopus, web of science, and Embase were searched. All clinical trials that compared the effect of SGLT2 inhibitors versus placebo on heart failure patients were included. Dichotomous data were extracted, pooled as risk ratio (RR) with 95% confidence interval, and analyzed via RevMan version 5.3 for windows using Mantel Haenszel (M-H) method.
Results
Twelve randomized clinical trials were included for analysis with a total number of 69024 patients. SGLT2I significantly lowered the risk of hospitalization for heart failure (HHF) in diabetic (RR=0.68, 95% CI 0.63–0.74) and non-diabetic patients (RR=0.75, 95% CI 0.62–0.89). Also, it significantly lowered mortality risk in both diabetic (RR=0.87, 95% CI 0.77–0.99) and non-diabetic patients (RR=0.93, 95% CI 0.70–1.23). Further analyses for serious adverse events were conducted, and SGLT-2I showed a significant lower risk in diabetic (RR=0.94, 95% CI 0.90–0.98) and non-diabetic patients (RR=0.72, 95% CI 0.38–1.39), yet with no observed difference over placebo in the risk of stroke.
Conclusion
SGLT2 inhibitors showed a favorable effect in lowering cardiovascular mortality, HHF, and stroke in diabetic patients with heart failure. In non-diabetic patients, they significantly reduce HHF, yet with no difference on cardiovascular mortality and stroke. Therefore, more trials are needed to establish their effect in non-diabetic patients.
Heart failure (HF) is the most common cardiovascular causes of hospitalization in people over 60 years affecting about 64.3 million people worldwide. Few studies have investigated sodium glucose like transporter-2 inhibitors (SGLT-2I) role in diabetic and non-diabetic patients with HF.
Objective
We conducted our meta-analysis to further investigate SGLT-2I role in diabetic and non-diabetic HF patients.
Methods
PubMed, Scopus, web of science, and Embase were searched. All clinical trials that compared the effect of SGLT2 inhibitors versus placebo on heart failure patients were included. Dichotomous data were extracted, pooled as risk ratio (RR) with 95% confidence interval, and analyzed via RevMan version 5.3 for windows using Mantel Haenszel (M-H) method.
Results
Twelve randomized clinical trials were included for analysis with a total number of 69024 patients. SGLT2I significantly lowered the risk of hospitalization for heart failure (HHF) in diabetic (RR=0.68, 95% CI 0.63–0.74) and non-diabetic patients (RR=0.75, 95% CI 0.62–0.89). Also, it significantly lowered mortality risk in both diabetic (RR=0.87, 95% CI 0.77–0.99) and non-diabetic patients (RR=0.93, 95% CI 0.70–1.23). Further analyses for serious adverse events were conducted, and SGLT-2I showed a significant lower risk in diabetic (RR=0.94, 95% CI 0.90–0.98) and non-diabetic patients (RR=0.72, 95% CI 0.38–1.39), yet with no observed difference over placebo in the risk of stroke.
Conclusion
SGLT2 inhibitors showed a favorable effect in lowering cardiovascular mortality, HHF, and stroke in diabetic patients with heart failure. In non-diabetic patients, they significantly reduce HHF, yet with no difference on cardiovascular mortality and stroke. Therefore, more trials are needed to establish their effect in non-diabetic patients.
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Background and Aims : Small interfering RNA molecules (siRNA) e.g., Inclisiran represent an attractive alternative to monoclonal antibodies for Proprotein convertase subtilisin/kexin type 9 (PCSK9) lowering. These molecules offer profound... more
Background and Aims : Small interfering RNA molecules (siRNA) e.g.,
Inclisiran represent an attractive alternative to monoclonal antibodies for
Proprotein convertase subtilisin/kexin type 9 (PCSK9) lowering. These
molecules offer profound lowering of (intra- and extracellular) PCSK9 at a
lower-dose frequency and potentially at a lower cost. Inclisiran has undergone
phase 1, 2, and 3 evaluation all within the context of the ORION
trials, with good efficacy and safety. Considering that Egypt is a middleincome
country with a burdened economy, concerns are raised on which
patients would benefit from this expensive medication. Therefore, the
Egyptian Association for Vascular biology and Atherosclerosis (EAVA) took
the responsibility of providing the 1st Egyptian consensus on the use of
Inclisiran in clinical practice.
Methods: EAVA analyzed the data that would enable us to obtain clear
indications for the use of Inclisiran.
Results: Dyslipidemia represents a major atherosclerotic risk factor in
Egypt. Among Egyptian patients with acute coronary syndromes, it has
been estimated that the prevalence of dyslipidemia is 48%, and that of ‘atleast-
possible’ FH is 17%. Reaching low-density lipoprotein cholesterol
(LDL-C) goals is difficult as well.
Conclusions: We recommend the use of Inclisiran in addition to statins ±
ezetimibe in patients with either [1]. established ASCVD or [2]. FH with
one of the following: another major risk factor, eGFR < 30 ml/min,or veryhigh
risk DM, who didn’t reach LDL-C goals and/or with true statin intolerance.
Inclisiran represent an attractive alternative to monoclonal antibodies for
Proprotein convertase subtilisin/kexin type 9 (PCSK9) lowering. These
molecules offer profound lowering of (intra- and extracellular) PCSK9 at a
lower-dose frequency and potentially at a lower cost. Inclisiran has undergone
phase 1, 2, and 3 evaluation all within the context of the ORION
trials, with good efficacy and safety. Considering that Egypt is a middleincome
country with a burdened economy, concerns are raised on which
patients would benefit from this expensive medication. Therefore, the
Egyptian Association for Vascular biology and Atherosclerosis (EAVA) took
the responsibility of providing the 1st Egyptian consensus on the use of
Inclisiran in clinical practice.
Methods: EAVA analyzed the data that would enable us to obtain clear
indications for the use of Inclisiran.
Results: Dyslipidemia represents a major atherosclerotic risk factor in
Egypt. Among Egyptian patients with acute coronary syndromes, it has
been estimated that the prevalence of dyslipidemia is 48%, and that of ‘atleast-
possible’ FH is 17%. Reaching low-density lipoprotein cholesterol
(LDL-C) goals is difficult as well.
Conclusions: We recommend the use of Inclisiran in addition to statins ±
ezetimibe in patients with either [1]. established ASCVD or [2]. FH with
one of the following: another major risk factor, eGFR < 30 ml/min,or veryhigh
risk DM, who didn’t reach LDL-C goals and/or with true statin intolerance.
Research Interests:
Background: Little is known about the outcomes of cardiovascular interventions and therapeutics in cancer patients. Understanding these outcomes can improve cancer patients' risk stratification, survival, and quality of life. Here, we... more
Background: Little is known about the outcomes of cardiovascular interventions and therapeutics in cancer patients. Understanding these outcomes can improve cancer patients' risk stratification, survival, and quality of life. Here, we sought to assess the reporting of outcome data of cancer patients in major cardiovascular medicine trials. Methods: We conducted a literature search of clinical trials, published in the four highest-impact, general cardiology journals (Journal of the American College of Cardiology [JACC], European Heart Journal [EHJ], Circulation, and JAMA Cardiology) between 2014 and 2019. We used the keywords "random*" OR "Controlled" OR "trial" OR "RCT". After screening to exclude irrelevant results, we inspected the full methods, results, and supplementary materials of retrieved trials. Results: Data analysis showed that among the retrieved 754 trials, 38 studies initially excluded cancer patients in their eligibility criteria, while 629 results did not report any results on cancer. Further, 44 studies reported on cancer as a safety outcome in previously non-cancer patients. Only 43 (5.7%) trials reported subgroup analysis results for cancer patients in terms of the primary outcome. Among the latter, 23 trials (53.5%) included patients with CAD, while 6 (14%) and 9 (21%) enrolled patients with heart failure and atrial fibrillation, respectively. The median number of included cancer patients in those studies was 58 (interquartile range: 4 to 167) in comparison to a median sample size of 1,258 (IQR: 220 to 8,480). Conclusion: Cancer patients often do not receive adequate attention in cardiovascular medicine trials. Whenever possible, investigators are encouraged to pre-specify subgroup analyses for cancer patients. This can be achieved by promoting research training in cardiooncology, collaborations between cardiologists and oncologists and increasing the recruitment of cancer patients to cardiovascular medicine trials.
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Background: Data on the treatment and outcomes of ST-segment elevation myocardial infarction (STEMI) care in middle-income countries (MIC) are scarce. Methods: In this meta-analysis, we included prospective, national STEMI registries,... more
Background: Data on the treatment and outcomes of ST-segment elevation myocardial infarction (STEMI) care in middle-income countries (MIC) are scarce. Methods: In this meta-analysis, we included prospective, national STEMI registries, from MIC, that enrolled patients between years 2000 and 2020 and were published in peer reviewed journals. A comparator group of large representative STEMI registries from the U.S. and European countries was used as a high income country (HIC) comparator. Country income category was defined according to the World Bank classification. Relevant publications were identified by searching MEDLINE, Embase, and Cochrane Libraries. Results: Thirty-five registries representing 18 MIC countries (90,770 patients) and 5 registries representing HIC (51,278 patients) were included. The main results of the analysis are displayed in Table 1. As compared to HIC, in MIC: (1) prehospital delays were very long, particularly in lower-MIC; (2) the proportion of patients that did receive reperfusion therapy was low, only one third of patients received primary percutaneous intervention; (3) in-hospital mortality was 2% higher. A subgroup analysis comparing MIC registries before and after 2010 demonstrated only a modest improvement. Conclusion: The quality and outcomes of STEMI care in MIC remains suboptimal. Significant systems of care improvements tailored to the MIC financial and cultural landscape will be required to meaningfully improve clinical outcomes.