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Piayda K, Hellhammer K, Veulemans V, Afzal S, Heidari H, Jung C, Kelm M, Zeus T. Performance of the Corevalve Evolut R and PRO in severely calcified anatomies: a propensity-score matched analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Corevalve Evolut R and PRO belong to the newer generation of self-expandable valves and are increasingly used to treat patients with severe aortic stenosis. Over the years, technical advancements and increasing experience with the procedure itself are responsible for excellent clinical and hemodynamic results. Patients with severely calcified native aortic valve anatomies still pose a special task to the implanting team since the risk for intraprocedural complications might be increased.
Purpose
To evaluate the hemodynamic and clinical performance of the CoreValve Evolut R and PRO in patients with severely calcified native aortic valve anatomies.
Methods
Baseline characteristics, imaging data and procedural outcome of patients undergoing transfemoral transcatheter aortic valve implantation with the CoreValve Evolut R and PRO from 09/2015 to 03/2018 were prospectively collected. Patients underwent high-resolution multisclice computed tomography (MSCT). A pre-specific threshold of 600 Hounsfield units was set to account for the hyperdensity of the applied contrast medium and to enable comparability with MSCT thresholds, derived by non-contrast enhanced MSCT scans. Patients were divided by the extent of calcification into a severely calcified anatomy group (men >2062AU, woman >1377AU) or a not severely calcified anatomy group (men <2062AU, woman <1377AU). Propensity score matching with the variables log EuroSCORE, LVOT calcium load and the cover index in a 1:2 fashion was performed and clinical and hemodynamic results in accordance with VARC II were collected.
Results
Ninety-eight patients with severely calcified anatomies (SC) could be identified and were matched with 196 patients with lower calcified (LC) anatomies. Patients with severely calcified anatomies were older (SC: 83.1 years vs. LC: 80.3 years, p<0.001) and had a smaller aortic valve area (SC: 0.63cm2 vs. LC: 0.70cm2, p=0.028). The mean implantation depth did not differ (SC 5.4mm±2.4 vs. LC: 5.1±2.2, p=0.554). Pre-dilatation was more often performed in the SC group (SC: 30.6% vs. LC: 15.8%, p=0.003) and the stroke/TIA rate did not differ (SC: 5.1% vs. LC: 3.5%, p=0.532). In SC patients, a permanent pacemaker implantation was significantly more often needed (SC: 28.5% vs. LC:7.6%, p<0.001). The mean pressure gradient after the procedure was effectively reduced (SC: 7.1mmHg±3.9 vs. LC: 7.8±3.7mmHg, p=0.477). No aortic regurgitation (AR) was more often present in patients with SC anatomies (SC: 72.5% vs. LC: 85.2%, p=0.011). The aortic regurgitation index numerically differed between groups without reaching statistical significance (SC: 24.1±7.1 vs. LC: 27.3±6.7, p=0.067).
Conclusion
The CoreValve Evolut R and PRO show a good clinical safety profile and excellent hemodynamic results even in patients with severely calcified anatomies. In those patients, a permanent pacemaker implantation was more often necessary.
Funding Acknowledgement
Type of funding source: None
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Khanum N, Rehman B, Parvaiz M, Chuadhary M, Javed N, Khan A, Afzal S, Naheed R, Mohsin J. Size discrepancy of residual tumor between post chemotherapy sonography and on post excision histopathology after Neo adjuvant chemotherapy and its impact on 5 years disease free survival. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30632-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ijaz Khan M, Hayat T, Afzal S, Imran Khan M, Alsaedi A. Theoretical and numerical investigation of Carreau-Yasuda fluid flow subject to Soret and Dufour effects. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 186:105145. [PMID: 31760305 DOI: 10.1016/j.cmpb.2019.105145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Newtonian fluids can be categorized by a single coefficient of viscosity for specific temperature. This viscosity will change with temperature; it doesn't change with strain rate. Just a small group of liquids show such steady consistency. A fluid whose viscosity changes subject to relative flow velocity is called non-Newtonian liquids. Here we have summarized a result for the flow of Carreau-Yasuda fluid over a porous stretchable surface. Mixed convection is considered. Modeling of energy expression is performed subject to Soret and Dufour effects. METHOD The nonlinear PDE's are changed to ODE's through suitable transformations and then solved for numerical solutions via Built-in shooting method (bvp4c). RESULTS Variation of important variables is studied on the concentration, temperature and velocity fields. Tabular representation for study of skin friction and heat transfer rate is presented for important variables. Our results show that velocity decreases versus higher estimations of Weissenberg number, porosity parameter, buoyancy ratio and mixed convection parameter. Temperature decays via Weissenberg number and porosity parameter. Increase in concentration is noticed through higher Soret number and porosity parameter. Skin friction and heat transfer rate (Nusselt number) boosts versus larger porosity parameter and Prandtl number respectively while it decays against Weissenberg number and Dufour and Eckert number.
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Choudhury H, Cheng X, Afzal S, Prakash A, Tatarchuk B, Elbashir N. Understanding the deactivation process of a microfibrous entrapped cobalt catalyst in supercritical fluid Fischer-Tropsch Synthesis. Catal Today 2020. [DOI: 10.1016/j.cattod.2019.01.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Veulemans V, Hellhammer K, Maier O, Klein K, Afzal S, Piayda K, Jung C, Westenfeld R, Kelm M, Zeus T. P3742Transcatheter aortic valve implantation in large annuli: incidence and predictors of specific adverse events with the largest self-expanding device. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The recently released largest self-expanding transcatheter aortic valve device (STHV-34) is characterized by good results but nevertheless demands an experienced team for the implantation in large annuli.
Purpose
Looking at multi slice computed tomography (MSCT) and procedural data, we tried to identify characteristics that could explain intraprocedural VARC-2 and valve specific non-VARC-2 events.
Methods
We performed a single center retrospective analysis in 80 patients treated with STHV-34. STHV-34 patients were separated into subjects without events (NE, n=43, 54%) and the following adverse events: resheathing/-capture processes (RS/C, n=19, 24%), valve dislodgments (VD, n=21; 26%), infolding (IF, n=6, 8%) and complete dislocation with bail-out valve-in-valve implantation (ViV, n=3, 4%). Events were further categorized in non-VARC-2 and VARC-2. The analysis sought for underlying anatomical conditions and defined risk factors by multivariate analysis.
Results
Primary device success was reached in 96% and immediate postprocedural absence of moderate-to-severe aortic regurgitation was 100%. We identified specific anatomical conditions predisposing for non-VARC-2 and VARC-2 events: RS/C: annular calcium load<1600 AU (OR 47 [CI 1.4–216], p=0.0004). IF: peripheral kinking (RR 5.0 [CI 1.0–24], p=0.0478) and previous RS/C maneuvers (83%). ViV: annular ellipticity index (NS 1.2±0.1 vs. ViV 1.4±0.1, p=0.0049), aortic angulation (AA) angle (NS 54.0±7.0° vs. ViV 61.7±1.5°, p=0.0240) and LVOT-AO angle (NS 149.1±18.9° vs. ViV 130.3±3.5°, p=0.0470).
Conclusion
We confirm high procedural success for the largest currently available STHV-34. The incidence of intraprocedural non-VARC-2 and VARC-2 events are associated with anatomical characteristics that may influence valve selection and implantation strategy.
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Hellhammer K, Piayda K, Veulemans V, Afzal S, Hennig I, Makosch M, Polzin A, Kelm M, Zeus T. P5583Micro-movement during transcatheter aortic valve implantation with a contemporary self-expandable prosthesis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Precise positioning of the prosthesis is a crucial step during transcatheter aortic valve implantation. In some cases, contemporary self-expandable prostheses show micro-movement (MM) during the final phase of release.
Purpose
We aimed to establish a definition for MM, evaluated the incidence of MM using the CoreValve Evolut RTM, investigated potential risk factors for MM and the associated clinical outcomes.
Methods
MM was defined as movement of the prosthesis of at least 1.5 mm from its position directly before release compared to its final position. Patients were grouped according to the occurrence (+MM) or absence (-MM) of MM. Baseline characteristics, imaging data and outcome parameters in accordance with the updated valve academic research consortium (VARC-2) criteria were retrospectively analyzed.
Results
We identified 258 eligible patients. MM occurred in 31.8% (n=82) of cases with a mean magnitude of 2.8±2.2 mm in relation to the left coronary cusp and 3.0±2.1 mm to the non-coronary cusp. Clinical and hemodynamic outcomes were similar in both groups. The mean pressure gradient was effectively reduced after TAVI (-MM vs. +MM: 7±3.4 mmHg vs. 8±3.9 mmHg, p=0.326) with consistency over a follow-up period of at least three months (-MM vs. +MM: 6.7±3.7 mmHg vs. 7.9±8.4 mmHg, p=0.168). At three months follow-up most of the patients presented with no aortic regurgitation (-MM vs. +MM: 64% vs. 67.9%, p=0.569). Mild aortic regurgitation was observed in 34.2% of the -MM group and in 29.5% of the +MD group (p=0.414). Moderate aortic regurgitation occurred in 1.9% of all patients with no differences between groups (-MM vs. +MM: 1.9% vs. 2.6%, p=0.662). Patients with MM presented with a more symmetric calcification pattern (-MM vs. +MM: 27.3% vs. 40.2%; p=0.037) and a larger aortic valve area (-MM vs. +MM: 0.6 cm2 ± 0.3 vs. 0.7 cm2 ± 0.2; p=0.014), which was found to be a potential risk factor for the occurrence of MM in a multivariate regression analysis (OR 3.5; 95% CI: 1.1–10.9; p=0.032)
Conclusion
MM occurred in nearly one third of patients and did not affect clinical and hemodynamic outcome. A larger aortic valve area was the only independent risk factor for the occurrence of MM.
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Afzal S, Veulemans V, Hellhammer K, Piayda K, Nijhof N, Polzin A, Kelm M, Zeus T. P2467Fusion imaging (Anatomical Intelligence) enables automated left atrial appendage sizing in real-time a single center pilot study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and purpose
Percutaneous left atrial appendage occlusion (LAAO) depicts an alternative treatment for patients with atrial fibrillation who are deemed for long-term oral anticoagulation therapy. In order to perform a successful LAAO accurate sizing of left atrial appendage (ostium, landing zone and depth) for device selection is essential. Echo-Fluoro fusion imaging in real-time offers with its latest prototype a patient-specific segmented automated 3D heart model and sizing of left atrial appendage (LAA). We therefore aimed to evaluate the automated segmented LAA sizing by comparing to 2D transesophageal (TOE) and MSCT measurements as gold standard.
Methods
We studied prospectively data of 8 consecutive patients who were admitted to our clinic for left atrial appendage closure. MSCT was performed preprocedural and analyzed with commercially available 3mensio software (Pie medical imaging). 2D TOE measurements and automated segmentation of the LAA and sizing were performed during the procedure by a highly experienced team of periinterventional cardiac imaging specialist and structural heart disease interventionalist who were blinded to the prior MSCT analysis. Dimension of ostium, landing zone (10 mm into the LAA parallel to the ostial plane at the level of the left circumflex for Amplatzer device) and depth (perpendicular to the ostial plane) were obtained in different TOE views according to instructions for use of Amulet Occluder. In order to generate an automated 3 D heart model, a high-quality 3D TOE image of the LAA volume and surrounding structures was acquired. After successful ECG-gated segmentation a 3 D heart model was generated. Automated LAA sizing followed in real-time. All measurements were taken into consideration before device selection. A Kruskal Wallis test was used to compare mean ranks of independent samples. A concordance analysis according to Kendall W was carried out to investigate reliability.
Results
The mean age of the patients was 82,6±4.15 years and half of the patients were female. All procedures were conducted successfully. The mean values of ostium and landing zone were comparable in TOE, automated sizing and MSCT sizing (ostium: 23,78±2,15 mm vs 25,71±5,25 mm vs 27,35±3,3 mm; (p=0,175); landing zone 22,13±3,18 mm vs 23,57±3,31 mm vs 24,00±3,51 mm; (p=0,377)). Furthermore, a significant concordance between the measurements was shown (ostium W= 0,991; p=0.045, landing zone W=0,835, p=0.014).
Conclusion
Automated LAA sizing acquired by fusion imaging may be an elegant real-time alternative for precise LAA Occluder device selection and needs to be investigated further.
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Veulemans V, Hellhammer K, Afzal S, Maier O, Westenfeld R, Jung C, Kelm M, Zeus T, Polzin A. P2274Single-center experience with different regimes of antiplatelet therapy and oral anticoagulation in transcatheter aortic valve replacement. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Antithrombotic therapy in transcatheter aortic valve replacement (TAVR) is highly controversial. Dual antiplatelet therapy (DAPT) for 3–6 months with aspirin and clopidogrel is the current recommendation. Whereas in patients with indication for OAC several regimes were described, ranging from OAC monotherapy to dual and even triple therapy. Besides vitamin K antagonists (VKA), non-Vitamin K oral anticoagulants (NOAC) are frequently used in TAVR patients with indication for permanent OAC.
Purpose
We therefore aimed to evaluated different antithrombotic regimes and their impact on outcome.
Methods
We performed a single center retrospective analysis in 1160 patients treated by transfemoral approach (TF TAVR). Primary endpoints were 30-day mortality, stroke and bleeding according to VARC-2 criteria. Secondary endpoint was all-cause mortality at 1 year.
Results
In 1160 patients with TF TAVR, a broad range of regimes occurred in clinical practice. The majority of patients were on DAPT (637 patients, 55.0%), followed by VKA + clopidogrel (186 patients, 16%). Other patients received OAC mono (98 patients; 9%), triple therapy (93 patients; 8%), NOAC mono (31 patients; 3%), single antiplatelet therapy (SAPT, 40 patients; 4%) or NOAC + clopidogrel (31 patients, 3%).
All-cause mortality 30 days after TF TAVR differed between the regimens. (SAPT/OAC+SAPT/N-OAC+DAPT 0.0% vs DAPT 3.6% vs OAC 10.2% vs. NOAC 1.3% vs NOAC+SAPT 0.3%; pANOVA<0.0001). Severe bleeding events were comparable (SAPT 5.0% vs DAPT 2.4% vs OAC 7.1% vs NOAC 1.3% vs OAC+SAPT 3.2% vs NOAC+SAPT 0.0% vs. N-OAC+SDPT 4.3%; pANOVA=0.15). Stroke rates were comparable in all subcohorts as well (SAPT 5.0% vs DAPT 3.0% vs OAC 7.1% vs NOAC 2.7% vs OAC+SAPT 1.6% vs NOAC+SAPT 0.0% vs. N-OAC+DAPT 1.1%; pANOVA=0.13). Only 2 hemorrhagic strokes (5.6%) appeared under DAPT and OAC mono respectively, whereas all others were of thromboembolic origin (94.4%). Surprisingly, all-cause mortality at one-year after TF TAVR was higher in OAC patients compared to all other used regimes (logrankoverallp=0.0012).
Conclusion
Data from our retrospective analysis indicate that a variety of different antithrombotic regimes occur even in a single centre analysis. All-cause mortality was enhanced in patients with oral anticoagulation. Therefore, clinical trials need to investigate if this is only explained by additional atrial fibrillation.
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Maier O, Hellhammer K, Boenner F, Afzal S, Spieker M, Zeus T, Horn P, Westenfeld R, Kelm M, Veulemans V. P1857Risk calculator for prediction of iatrogenic atrial septal defect persistence following percutaneous mitral valve repair. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The rising number of new percutaneous interventions for left-sided heart disease leads to increased occurrence of iatrogenic atrial septal defect (iASD). The percutaneous mitral valve repair (PMVR) for severe, symptomatic mitral regurgitation (MR) also requires intraprocedural puncture of the interatrial septum. In some cases iASD is persisting and becomes haemodynamically relevant with enhanced right heart overload due to significant left-to-right-shunting.
Purpose
This study aimed to evaluate pre- and periprocedural factors that may favour persistence and haemodynamic relevance of iASD in patients after PMVR.
Methods
In 2015, 75 consecutive patients with severe MR (age 74.8±10.5y) and following PMVR were enrolled. After 12 months, 57 patients completed their follow up (FU) including clinical conditions, transthoracic echocardiography (TTE), and cardiovascular magnetic resonance (CMR) whenever feasible. We evaluated the impact of comorbidities as well as intraprocedural, haemodynamic and functional characteristics that may favour persistence of iASD by multivariate analysis. Haemodynamic relevance of iASD was defined as right heart overload with predominantly significant enlargement of the right atrium (RA), impairment of right heart function as defined by fractional area shortening (FAC), and ratio of pulmonary to systemic blood flow (Qp/Qs>1) when available.
Results
18 out of 57 patients (32%) showed a persistent iASD (+iASD), being associated with a specific combination of comorbidities as well as pre-procedural and periprocedural factors that can be summarised by a multifactorial iASD risk calculator (+iASD vs. -iASD: 6.3±2.9 vs. 3.9±2.7; p=0.0058). 11 iASD (61%) became haemodynamically relevant (+hd iASD) with a significant right heart overload (RA area +hd iASD vs. -hd iASD: baseline 23.1±4.1 vs. 23.2±4.3; FU 30.7±6.3 vs. 20.1±4.6; p<0.0001), reduced RV function (FAC +hd iASD vs. -hd iASD: baseline 41.0±10.3 vs. 29.9±7.2; FU 25.3±7.2 vs. 29.1±13.2; p<0.0156) and left-to-right shunting (Qp/Qs -iASD vs. +hd iASD vs. -hd iASD: 1.0±0.3 vs. 1.7±0.4 vs. 0.8±0.1 L/min; p=0.0011).
Conclusion
This study shows for the first time, that persistence of iASD can be predicted by pre- and periprocedural factors using a risk calculator that may additionally guide careful follow up imaging and therapeutic action after PMVR to avoid development of progressive heart failure.
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Afzal S, Schulz PS, Veulemans VV, Kleinebrecht LK, Balzer JB, Westenfeld RW, Horn PH, Rassaf TR, Polzin AP, Nijhof NN, Kelm MK, Zeus TZ, Hellhammer KH. P1756Safety and efficacy of real-time fusion of echocardiography and fluoroscopy during MitraClip implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Moid M, Afzal S, Rahim N, Ali T, Iffat W, Bashir L, Naz S. High performance liquid chromatographic method validation for determination of rosuvastatin calcium in tablet dosage forms. PAKISTAN JOURNAL OF PHARMACEUTICAL SCIENCES 2018; 31:1577-1582. [PMID: 30058551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A precise, sensitive and quick High Performance Liquid Chromatographic (HPLC) method for the determination of rosuvastatin calcium in bulk and tablet dosage forms has been validated. The chromatographic scheme involved: Sil-20A auto sampler, LC-20A pump, SPD-20A UV/visible detector with separation attained by C18 column at 40ºC temperature through a mobile phase of acetonitrile and buffer (50:50) at a flow rate of 1.0ml/min. The method is precise (%RSD for intra-day and inter-day extended between 1.06-1.54% and 0.103-1.78%) and linear (r2=0.9997). Limit of detection and quantification (LOD & LOQ) of the adopted method were 0.78 and 1.56μg/ml. The proposed HPLC method was established to be sensitive, precise and swift that can be proficiently adopted in quality control/quality assurance laboratories for predictable investigation of the bulk and oral solid dosage forms of rosuvastatin calcium.
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Winsløw U, Nordestgaard B, Afzal S. 血浆中25-羟基维生素D水平偏高,且罹患非黑色素瘤皮肤癌的风险较高:97,849名受试者参加的一项孟德尔随机化研究. Br J Dermatol 2018. [DOI: 10.1111/bjd.16762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Winsløw U, Nordestgaard B, Afzal S. High plasma 25-hydroxyvitamin D and high risk of nonmelanoma skin cancer: a Mendelian randomization study of 97 849 individuals. Br J Dermatol 2018. [DOI: 10.1111/bjd.16750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Winsløw U, Nordestgaard B, Afzal S. High plasma 25-hydroxyvitamin D and high risk of nonmelanoma skin cancer: a Mendelian randomization study of 97 849 individuals. Br J Dermatol 2018; 178:1388-1395. [DOI: 10.1111/bjd.16127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2017] [Indexed: 11/28/2022]
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Kobylecki CJ, Wium-Andersen MK, Afzal S, Nordestgaard BG. Response. Acta Psychiatr Scand 2018; 137:80. [PMID: 29090736 DOI: 10.1111/acps.12831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wium-Andersen MK, Kobylecki CJ, Afzal S, Nordestgaard BG. Association between the antioxidant uric acid and depression and antidepressant medication use in 96 989 individuals. Acta Psychiatr Scand 2017; 136:424-433. [PMID: 28845530 DOI: 10.1111/acps.12793] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE In the last decade, several studies have suggested that depression is accompanied by increased oxidative stress and decreased antioxidant defenses. We tested the hypothesis that high levels of the antioxidant uric acid are associated with lower risk of hospitalization with depression and use of prescription antidepressant medication. METHOD We examined plasma levels of the antioxidant uric acid in 96 989 individuals from two independent cohort studies. Logistic regression and Cox proportional hazards regression models were multivariable adjusted for age, gender, alcohol, smoking, income, body mass index, C-reactive protein, hemoglobin, triglycerides, cardiovascular disease, diabetes, and intake of meat and vegetables. Results were performed separately in each study and combined in a meta-analysis. RESULTS In both studies, high uric acid was associated with lower risk of hospitalization as in-patient or out-patient with depression and antidepressant medication use. A doubling in uric acid was associated with an effect estimate of 0.57 (95% CI 0.49-0.65) and 0.77 (0.73-0.81) for hospitalization with depression and antidepressant medication use. The association was consistent across strata of all covariates. Results were attenuated in Cox regression analyses with less statistical power. CONCLUSION High plasma levels of uric acid were associated with low risk of depression hospitalization and antidepressant medication use.
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Afzal S, Begum N, Zhao H, Fang Z, Lou L, Cai Q. Influence of endophytic root bacteria on the growth, cadmium tolerance and uptake of switchgrass (Panicum virgatumL.). J Appl Microbiol 2017; 123:498-510. [DOI: 10.1111/jam.13505] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/30/2022]
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Afzal S, Veulemans V, Balzer J, Rassaf T, Hellhammer K, Polzin A, Kelm M, Zeus T. Safety and efficacy of transseptal puncture guided by real-time fusion of echocardiography and fluoroscopy. Neth Heart J 2016; 25:131-136. [PMID: 27966185 PMCID: PMC5260626 DOI: 10.1007/s12471-016-0937-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Aims Visual guidance through echocardiography and fluoroscopy is crucial for a successful transseptal puncture (TSP) in a prespecified region of the fossa ovalis. The novel EchoNavigator system Release II (EchoNav II, Philips Healthcare, Andover, Massachusetts, USA) enables the real-time fusion of fluoroscopic and echocardiographic images. We evaluated this new imaging method in respect to safety and efficacy of TSP during MitraClip implantation and left atrial appendage closure. Methods Forty-four patients before (−EchoNav) and 44 patients after (+EchoNav) the introduction of real-time fusion were included in our retrospective, single-centre study. The primary endpoint was the occurrence of adverse events due to TSP. Secondary endpoints were successful puncture at the prespecified region and time until TSP (min). Results In both groups TSP was performed successfully in the prespecified region and no adverse events occurred during or due to the accomplishment of TSP. Time until TSP was significantly reduced in the +EchoNav group in comparison with the EchoNav group (18.48 ± 5.62 min vs. 23.20 ± 9.61 min, p = 0.006). Conclusions Real-time fusion of echocardiography and fluoroscopy proved to be as safe and successful as standard best practice for TSP. Moreover, efficacy was improved through significant reduction of time until TSP.
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Mortensen M, Nordestgaard B, Afzal S, Falk E. ACC/AHA guidelines superior to ESC/EAS guidelines for primary prevention with statins: The Copenhagen general population study. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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45
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Afzal S, Tybjærg-Hansen A, Jensen G, Nordestgaard B. Body mass index and mortality over 3 decades. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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46
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Afzal S, Sattar MA, Johns EJ, Abdulla MH, Akhtar S, Hashmi F, Abdullah NA. Interaction between irbesartan, peroxisome proliferator-activated receptor (PPAR-γ), and adiponectin in the regulation of blood pressure and renal function in spontaneously hypertensive rats. J Physiol Biochem 2016; 72:593-604. [DOI: 10.1007/s13105-016-0497-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 06/08/2016] [Indexed: 01/30/2023]
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47
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Ur-Rehman A, Gul S, Abbasi MA, Nafeesa K, Akhtar MN, Khan KM, Ahmad I, Afzal S. Synthesis and Evaluation of some New 5-Substituted-1,3,4- oxadiazol-2yl-4-(morpholin-4yl Sulfonyl)benzyl Sulfides as Antibacterial Agent. TROP J PHARM RES 2015. [DOI: 10.4314/tjpr.v14i11.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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48
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Rasool S, Rehman A, Abbasi MA, Gul S, Akhtar MN, Ahmad I, Afzal S. Synthesis of N'-Substituted-2-(5-(4-Chlorophenyl)-1,3,4- oxadiazol-2-ylthio)acetohydrazide Derivatives as Suitable Antibacterial Agents. TROP J PHARM RES 2015. [DOI: 10.4314/tjpr.v14i6.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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49
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Kobylecki C, Afzal S, Davey Smith G, Nordestgaard B. Genetically high plasma vitamin C, intake of fruit and vegetables, and risk of ischemic heart disease and all-cause mortality: A mendelian randomization study. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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50
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Siddiqa A, Rehman A, Abbasi MA, Rasool S, Khan KM, Ahmad I, Afzal S. Synthesis and antibacterial evaluation of 2-(1,3- Benzodioxol-5-ylcarbonyl)arylsulfonohydrazide derivatives. TROP J PHARM RES 2014. [DOI: 10.4314/tjpr.v13i10.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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