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Matson H, Llewellyn EA. Retrospective evaluation of the utility of shock index to determine the presence of congestive heart failure in dogs with myxomatous mitral valve disease (2019-2021): 98 cases. J Vet Emerg Crit Care (San Antonio) 2024; 34:231-237. [PMID: 38809224 DOI: 10.1111/vec.13379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/22/2023] [Accepted: 02/07/2023] [Indexed: 05/30/2024]
Abstract
OBJECTIVES To calculate the shock index (SI) in dogs with myxomatous mitral valve disease (MMVD) and to evaluate its use to predict the presence of congestive heart failure (CHF). DESIGN Retrospective study. SETTING Small animal university veterinary teaching hospital. ANIMALS Ninety-eight dogs with MMVD and 20 healthy dogs as part of a control group. INTERVENTIONS Heart rate (HR) and systolic blood pressure (SBP) were recorded, and SI was calculated by dividing HR by SBP for each dog. MEASUREMENTS AND MAIN RESULTS The mean (SD) HR, SBP, and SI were 123/min (32.6), 147 mm Hg (21.5), and 0.86 (0.3), respectively, for dogs with MMVD and 98/min (20.9), 145 mm Hg (18.7), and 0.68 (0.13), respectively, for control dogs. Dogs with MMVD had a significantly higher HR compared with control dogs (P < 0.01), and an elevation in HR was seen as the severity of MMVD increased. Dogs in stage B2 and C/D MMVD had a significantly higher SI value compared with control dogs (P = 0.04 and P < 0.01, respectively). SI was significantly higher in dogs in stage C/D MMVD compared with dogs in stage B2 MMVD (P < 0.01). Ten of 98 (10%) dogs had an arrhythmia. HR, SBP, and SI were not significantly different between dogs with and without arrhythmias (P = 0.13, P = 0.57, and P = 0.07, respectively), but significantly more dogs with CHF had an arrhythmia (P = 0.01). SI (area under the curve [AUC]: 0.98) and HR (AUC: 0.95) were excellent indicators for the presence of CHF. An optimal SI cutoff value ≥1.1 had 92% sensitivity and 95% specificity for predicting the presence of CHF, and an optimal HR cutoff value of ≥157/min had 92% sensitivity and 93% specificity for the prediction of CHF. CONCLUSIONS When there are compatible clinical signs, SI values ≥1.1 may suggest the presence of CHF in dogs with MMVD.
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Affiliation(s)
- Hannah Matson
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, UK
| | - Efa A Llewellyn
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, UK
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Rali AS, Inampudi C, Zalawadiya S, Shah A, Teuteberg JJ, Stewart GC, Cantor RS, Deng L, Jacobs JP, Kirklin JK, Stevenson LW. Changing Strategy Between Bridge to Transplant and Destination LVAD Therapy After the First 3 Months: Analysis of the STS-INTERMACS Database. J Card Fail 2024; 30:552-561. [PMID: 37898382 DOI: 10.1016/j.cardfail.2023.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) have been implanted as bridge to transplantation (BTT), bridge to candidacy (BTC) or destination therapy (DT) on the basis of relative and absolute contraindications to transplantation. Multiple factors may lead to changes in the strategy of support after LVAD implantation. METHODS Based on INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) 2012-2020 data, 11,262 patients survived to 3 months on continuous-flow LVADs with intent of BTT or DT. Preimplant characteristics and early events post-LVAD were analyzed in relation to changes in BTT or DT strategy during the next 12 months. RESULTS Among 3216 BTT patients at 3 months, later transplant delisting or death without transplant occurred in 536 (16.7%) and was more common with age, profiles 1-2, renal dysfunction, and independently for prior cardiac surgery (HR 1.25, 95% CI 1.04-1.51; P = 0.02). Post-LVAD events of infections, gastrointestinal bleeding, stroke, and right heart failure as defined by inotropic therapy, predicted delisting and death, as did in-hospital location at 3 months (HR 1.67, 95% CI 1.20-2.33; P = 0.0024). Of 8046 patients surviving to 3 months with the intent of destination therapy, 750 (9.3%) subsequently underwent listing or transplantation, often with initial histories of acute HF (HR 1.70, 95% CI 1.27-2.27; P = 0.0012) or malnutrition-cachexia (1.73, 95% CI 1.14-2.63; P = 0.0099). Multiple gastrointestinal bleeding events (≥ 4) with LVAD increased transition from BTT to DT (HR 4.22, 95% CI 1.46-12.275; P = 0.0078) but also from DT to BTT (HR 5.17, 95% CI 1.92-13.9; P = 0.0011). CONCLUSIONS Implant strategies change over time in relation to preimplant characteristics and adverse events post implant. Preimplant recognition of factors predicting later change in implant strategy will refine initial triage, whereas further reduction of post-LVAD complications will expand options, including eventual consideration of heart transplantation.
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Affiliation(s)
- Aniket S Rali
- Division of Cardiovascular Diseases, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chakradhari Inampudi
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Sandip Zalawadiya
- Division of Cardiovascular Diseases, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ashish Shah
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey J Teuteberg
- Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Garrick C Stewart
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Luqin Deng
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey P Jacobs
- Department of Surgery, University of Florida, Gainesville, Florida
| | - James K Kirklin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lynne W Stevenson
- Division of Cardiovascular Diseases, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
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Asim M, El-Menyar A, Chughtai T, Al-Hassani A, Abdelrahman H, Rizoli S, Al-Thani H. Shock Index for the Prediction of Interventions and Mortality in Patients With Blunt Thoracic Trauma. J Surg Res 2023; 283:438-448. [PMID: 36434840 DOI: 10.1016/j.jss.2022.10.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 09/21/2022] [Accepted: 10/16/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Shock index (SI) is a bedside simple scoring tool; however, it has not yet been tested in blunt thorax trauma (BTT). We sought to evaluate the prognostic value of SI for chest interventions (thoracostomy tube or thoracotomy), blood transfusion, and mortality in patients with BTT. We hypothesized that high SI is associated with worse outcomes in patients with BTT. METHODS We conducted a retrospective analysis of all BTT patients (chest Abbreviated Injury Score [AIS] > 1) hospitalized in a level 1 trauma center between 2011 and 2020. Patients with AIS >1 for head or abdominal injuries and patients undergoing open reduction and internal fixation surgery or penetrating injuries were excluded. Patients were categorized into two groups (low SI <0.80 versus high SI ≥0.80) based on the receiver operating characteristic curve analysis. Multivariable regression analysis was performed to identify the predictors of mortality. RESULTS A total of 1645 patients were admitted with BTT; of them, 24.5% had high SI. The mean age was 39.2 ± 15.2 y, and most were males (91%). Patients with high SI were younger, had sustained severer injuries, and required more chest interventions (P = 0.001), blood transfusion (P = 0.001), and massive transfusion protocol activation (P = 0.001) compared with low SI group. The overall in-hospital mortality rate was 2.6%, which was more in the high SI group (8.2% versus 0.8%; P = 0.001). SI significantly correlated with age (r = -0.281), injury severity score (r = 0.418), Glasgow Come Score on arrival (r = -0.377), Trauma and Injury Severity Score (r = -0.144), Revised Trauma Score (r = -0.219), serum lactate (r = 0.434), blood transfusion units (r = 0.418), and chest AIS (r = 0.066). SI was an independent predictor of mortality (odds ratio 3.506; 95% confidence interval 1.389-8.848; P = 0.008), and this effect persisted after adjustment for chest intervention (odds ratio 2.923; 95% confidence interval 1.146-7.455; P = 0.02). CONCLUSIONS The present study highlights the prognostic value of SI as a rapid bedside tool to predict the use of interventions and the risk of mortality in patients with BTT. The study findings help the emergency physicians for early and appropriate risk stratification and triaging of patients with BTT.
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Affiliation(s)
- Mohammad Asim
- Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Talat Chughtai
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Ammar Al-Hassani
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | | | - Sandro Rizoli
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Hassan Al-Thani
- Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
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Heidarpour M, Sourani Z, Vakhshoori M, Bondariyan N, Emami SA, Fakhrolmobasheri M, Seyedhossaini S, Shafie D. Prognostic utility of shock index and modified shock index on long-term mortality in acute decompensated heart failure; Persian Registry of cardioVascular diseasE/Heart Failure (PROVE/HF) study. Acta Cardiol 2022; 78:217-226. [PMID: 35098893 DOI: 10.1080/00015385.2022.2030554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Shock index (SI) and modified SI (MSI) are used for prognosis in patients with cardiovascular diseases (CVDs), especially myocardial infarction. However, the utility of these indices in heart failure(HF) is less frequently investigated. We aimed to evaluate the long-term prognostic capability of SI and MSI among Iranian HF patients. METHODS This retrospective cohort study was implemented in the context of the Persian Registry Of cardioVascular diseasE/HF (PROVE/HF). A total of 3896 acute decompensated HF (ADHF) patients were enrolled from March 2016 to March 2020. SI and MSI were assessed at admission. Receiver operating characteristic (ROC) and Kaplan-Meier curves were used to define optimum SI and MSI cut-off points and depict mortality during follow-up, respectively. The association of CVD death according to different SI and MSI cut-off points and quartiles was assessed through univariate and multivariate regression hazard models. RESULTS Mean age of participants was 70.22 ± 12.65 years (males: 62.1%). We found 0.66 (sensitivity:62%, specificity: 51%) and 0.87 (sensitivity: 61%, specificity: 51%) as optimised cut-off points for SI and MSI, respectively. Mean follow-up was 10.26 ± 7.5 months and 1110 (28.5%) deaths occurred during this time. Multivariate adjusted models revealed patients had SI ≥ 0.66 or within the third and fourth quartiles had higher likelihood of mortality compared to reference group (hazard ratio(HR): 1.58, 95%CI: 1.39-1.80, p < 0.001, HR: 1.38,95%CI:1.14-1.66, p = 0.001 and HR:2.00,95%CI:1.68-2.38, p < 0.001, respectively). MSI outcomes were similar (MSI ≥ 0.87: HR: 1.52,95%CI: 1.34-1.72, p < 0.001, third quartile (0.89 ≤ MSI < 1.00):HR:1.23,95%CI:1.009-1.50, p = 0.041, fourth quartile (MSI ≥ 1.00): HR: 1.80,95%CI: 1.53-2.13, p < 0.001). Kaplan-Meier curves showed patients with higher SI and MSI cut-off values and quartiles had lower survival rates. CONCLUSION Higher SI and MSI values were associated with increased mortality risk, and these two bedside indices could be appropriately considered for long-term prognosis in ADHF patients.
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Affiliation(s)
- Maryam Heidarpour
- Department of Endocrinology, Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Sourani
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrbod Vakhshoori
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Niloofar Bondariyan
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sayed Ali Emami
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Fakhrolmobasheri
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Davood Shafie
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Gökçek K, Gökçek A, Demir A, Yıldırım B, Acar E, Alataş ÖD. In-hospital mortality of acute pulmonary embolism: Predictive value of shock index, modified shock index, and age shock index scores. Med Clin (Barc) 2021; 158:351-355. [PMID: 34404518 DOI: 10.1016/j.medcli.2021.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The shock index (SI), modified shock index (MSI), and age shock index (ASI) have been reported to predict adverse outcomes in patients with different acute cardiovascular conditions. This study aimed to investigate the association between these indexes and in-hospital mortality in patients with acute pulmonary embolism. METHODS The medical records of all adult patients who were hospitalized with acute pulmonary embolism between June 2014 and June 2019, were examined. Collected data included vital signs, demographic characteristics, comorbidities, and laboratory values on presentation. The predictive value of SI, MSI, ASI, and pulmonary embolism severity index (PESI) for predicting in-hospital mortality were compared by C-statistics. RESULTS A total of 602 consecutive patients (mean age 66.7±13.2 years, 55% female) were included, and 62 (10.3%) of the patients died during their in-hospital course. The admission SI, MSI, ASI, and PESI were significantly higher in the deceased patients. After adjusting for other factors, the SI, MSI, PESI, and ASI were independent predictors of in-hospital mortality. The prognostic performance of ASI (C-statistics 0.74) was better than MSI (C-statistics 0.71), SI (C-statistics 0.68), and PESI (C-statistics 0.65). CONCLUSION The ASI may be used to identify patients at risk for in-hospital mortality following acute pulmonary embolism.
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Affiliation(s)
- Kemal Gökçek
- Muğla Sitki Koçman University, Faculty of Medicine, Department of Emergency Medicine, Muğla, Turkey.
| | - Aysel Gökçek
- Muğla Sitki Koçman University, Faculty of Medicine, Department of Cardiology, Muğla, Turkey
| | - Ahmet Demir
- Muğla Sitki Koçman University, Faculty of Medicine, Department of Emergency Medicine, Muğla, Turkey
| | - Birdal Yıldırım
- Muğla Sitki Koçman University, Faculty of Medicine, Department of Emergency Medicine, Muğla, Turkey
| | - Ethem Acar
- Muğla Sitki Koçman University, Faculty of Medicine, Department of Emergency Medicine, Muğla, Turkey
| | - Ömer Doğan Alataş
- Muğla Sitki Koçman University, Faculty of Medicine, Department of Emergency Medicine, Muğla, Turkey
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El-Menyar A, Abdelrahman H, Al-Thani H, Mekkodathil A, Singh R, Rizoli S. The FASILA Score: A Novel Bio-Clinical Score to Predict Massive Blood Transfusion in Patients with Abdominal Trauma. World J Surg 2020; 44:1126-1136. [PMID: 31748887 PMCID: PMC7223809 DOI: 10.1007/s00268-019-05289-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Early identification of patients who may need massive blood transfusion remains a major challenge in trauma care. This study proposed a novel and easy-to-calculate prediction score using clinical and point of care laboratory findings in patients with abdominal trauma (AT). Methods Patients with AT admitted to a trauma center in Qatar between 2014 and 2017 were retrospectively analyzed. The FASILA score was proposed and calculated using focused assessment with sonography in trauma (0 = negative, 1 = positive), Shock Index (SI) (0 = 0.50–0.69, 1 = 0.70–0.79, 2 = 0.80–0.89, and 3 ≥ 0.90), and initial serum lactate (0 ≤ 2.0, 1 = 2.0–4.0, and 2 ≥ 4.0 mmol/l). Outcome variables included mortality, laparotomy, and massive blood transfusion (MT). FASILA was compared to other prediction scores using receiver operating characteristics and areas under the curves. Bootstrap procedure was employed for internal validation. Results In 1199 patients with a mean age of 31 ± 13.5 years, MT, MT protocol (MTP) activation, exploratory laparotomy (ExLap), and hospital mortality were related linearly with the FASILA score, Injury Severity Score, and total length of hospital stay. Initial hemoglobin, Revised Trauma Score (RTS), and Trauma Injury Severity Score (TRISS) were inversely proportional. FASILA scores correlated significantly with the Assessment of Blood Consumption (ABC) (r = 0.65), Revised Assessment of Bleeding and Transfusion (RABT) (r = 0.63), SI (r = 0.72), RTS (r = − 0.34), and Glasgow Coma Scale (r = − 0.32) and outperformed other predictive systems (RABT, ABC, and SI) in predicting MT, MTP, ExLap, and mortality. Conclusions The novel FASILA score performs well in patients with abdominal trauma and offers advantages over other scores. Electronic supplementary material The online version of this article (10.1007/s00268-019-05289-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, P.O Box 3050, Doha, Qatar. .,Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
| | - Ahammed Mekkodathil
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, P.O Box 3050, Doha, Qatar
| | - Rajvir Singh
- Department of Surgery, Biostatistician, Hamad General Hospital, Doha, Qatar
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar
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El-Menyar A, Al Habib KF, Zubaid M, Alsheikh-Ali AA, Sulaiman K, Almahmeed W, Amin H, AlMotarreb A, Ullah A, Suwaidi JA. Utility of shock index in 24,636 patients presenting with acute coronary syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 9:546-556. [PMID: 31702396 DOI: 10.1177/2048872619886307] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Shock index is a bedside reflection of integrated response of the cardiovascular and nervous systems. We aimed to evaluate the utility of shock index (heart rate/systolic blood pressure) in patients presenting with acute coronary syndrome (ACS). METHODS We analyzed pooled data from seven Arabian Gulf registries; these ACS registries were carried out in seven countries (Qatar, Bahrain, Kuwait, UAE, Saudi Arabia, Oman and Yemen) between 2005 and 2017. A standard uniform coding strategy was used to recode each database using each registry protocol and clinical research form. Patients were categorized into two groups based on their initial shock index (low vs. high shock index). Optimal shock index cutoff was determined according to the receiver operating characteristic curve (ROC). Primary outcome was hospital mortality. RESULTS A total of 24,636 ACS patients met the inclusion criteria with a mean age 57±13 years. Based on ROC analysis, the optimal shock index was 0.80 (83.5% had shock index <0.80 and 16.5% had shock index ≥0.80). In patients with high shock index, 55% had ST-elevation myocardial infarction and 45% had non-ST-elevation myocardial infarction. Patients with high shock index were more likely to have diabetes mellitus, late presentation, door to electrocardiogram >10 min, symptom to Emergency Department > 3 h, anterior myocardial infarction, impaired left ventricular function, no reperfusion post-therapy, recurrent ischemia/myocardial infarction, tachyarrhythmia and stroke. However, high shock index was associated significantly with less chest pain, less thrombolytic therapy and less primary percutaneous coronary intervention. Shock index correlated significantly with pulse pressure (r= -0.52), mean arterial pressure (r= -0.48), Global Registry of Acute Coronary Events score (r =0.41) and Thrombolysis In Myocardial Infarction simple risk index (r= -0.59). Shock index ≥0.80 predicted mortality in ACS with 49% sensitivity, 85% specificity, 97.6% negative predictive value and 0.6 negative likelihood ratio. Multivariate regression analysis showed that shock index was an independent predictor for in-hospital mortality (adjusted odds ratio (aOR) 3.40, p<0.001), heart failure (aOR 1.67, p<0.001) and cardiogenic shock (aOR 3.70, p<0.001). CONCLUSIONS Although shock index is the least accurate of the ones tested, its simplicity may argue in favor of its use for early risk stratification in patients with ACS. The utility of shock index is equally good for ST-elevation myocardial infarction and non-ST-elevation acute coronary syndrome. High shock index identifies patients at increased risk of in-hospital mortality and urges physicians in the Emergency Department to use aggressive management.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Medicine, Weill Cornel Medical College, Doha, Qatar.,Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Khalid F Al Habib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, KSA
| | - Mohammad Zubaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | | | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain
| | - Ahmed AlMotarreb
- Department of Cardiology, Faculty of Medicine, Sana'a University, Yemen
| | - Anhar Ullah
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, KSA
| | - Jassim Al Suwaidi
- Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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