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Bendary A, Elsaed A, Tabl MA, Ahmed ElRabat K, Zarif B. Intravascular ultrasound-guided percutaneous coronary intervention for patients with unprotected left main coronary artery lesions. Coron Artery Dis 2024; 35:171-178. [PMID: 38451558 DOI: 10.1097/mca.0000000000001356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
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.
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Affiliation(s)
- Ahmed Bendary
- Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt
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Dharmayat KI, Vallejo-Vaz AJ, Stevens CA, Brandts JM, Lyons AR, Groselj U, Abifadel M, Aguilar-Salinas CA, Alhabib K, Alkhnifsawi M, Almahmeed W, Alnouri F, Alonso R, Al-Rasadi K, Ashavaid TF, Banach M, Béliard S, Binder C, Bourbon M, Chlebus K, Corral P, Cruz D, Descamps OS, Drogari E, Durst R, Ezhov MV, Genest J, Harada-Shiba M, Holven KB, Humphries SE, Khovidhunkit W, Lalic K, Laufs U, Liberopoulos E, Roeters van Lennep J, Lima-Martinez MM, Lin J, Maher V, März W, Miserez AR, Mitchenko O, Nawawi H, Panayiotou AG, Paragh G, Postadzhiyan A, Reda A, Reiner Ž, Reyes X, Sadiq F, Sahebkar A, Schunkert H, Shek AB, Stroes E, Su TC, Subramaniam T, Susekov A, Vázquez Cárdenas A, Huong Truong T, Tselepis AD, Vohnout B, Wang L, Yamashita S, Al-Sarraf A, Al-Sayed N, Davletov K, Dwiputra B, Gaita D, Kayikcioglu M, Latkovskis G, Marais AD, Thushara Matthias A, Mirrakhimov E, Nordestgaard BG, Petrulioniene Z, Pojskic B, Sadoh W, Tilney M, Tomlinson B, Tybjærg-Hansen A, Viigimaa M, Catapano AL, Freiberger T, Hovingh GK, Mata P, Soran H, Raal F, Watts GF, Schreier L, Bañares V, Greber-Platzer S, Baumgartner-Kaut M, de Gier C, Dieplinger H, Höllerl F, Innerhofer R, Karall D, Lischka J, Ludvik B, Mäser M, Scholl-Bürgi S, Thajer A, Toplak H, Demeure F, Mertens A, Balligand JL, Stephenne X, Sokal E, Petrov I, Goudev A, Nikolov F, Tisheva S, Yotov Y, Tzvetkov I, Hegele RA, Gaudet D, Brunham L, Ruel I, McCrindle B, Cuevas A, Perica D, Symeonides P, Trogkanis E, Kostis A, Ioannou A, Mouzarou A, Georgiou A, Stylianou A, Miltiadous G, Iacovides P, Deltas C, Vrablik M, Urbanova Z, Jesina P, Tichy L, Hyanek J, Dvorakova J, Cepova J, Sykora J, Buresova K, Pipek M, Pistkova E, Bartkova I, S|ulakova A, Toukalkova L, Spenerova M, Maly J, Benn M, Bendary A, Elbahry A, Ferrières J, Ferrieres D, Peretti N, Bruckert E, Gallo A, Valero R, Mourre F, Aouchiche K, Reynaud R, Tounian P, Lemale J, Boccara F, Moulin P, Charrières S, Di Filippo M, Cariou B, Paillard F, Dourmap C, Pradignac A, Verges B, Simoneau I, Farnier M, Cottin Y, Yelnik C, Hankard R, Schiele F, Durlach V, Sultan A, Carrié A, Rabès JP, Sanin V, Schmieder R, Ates S, Rizos CV, Skoumas I, Tziomalos K, Rallidis L, Kotsis V, Doumas M, Skalidis E, Kolovou G, Kolovou V, Garoufi A, Koutagiar I, Polychronopoulos G, Kiouri E, Antza C, Zacharis E, Attilakos A, Sfikas G, Koumaras C, Anagnostis P, Anastasiou G, Liamis G, Adamidis PS, Milionis H, Lambadiari V, Stabouli S, Filippatos T, Mollaki V, Tsaroumi A, Lamari F, Proyias P, Harangi M, Reddy LL, Shah SAV, Ponde CK, Dalal JJ, Sawhney JP, Verma IC, Hosseini S, Jamialahmadi T, Alareedh M, Shaghee F, Rhadi SH, Abduljalal M, Alfil S, Kareem H, Cohen H, Leitersdorf E, Schurr D, Shpitzen S, Arca M, Averna M, Bertolini S, Calandra S, Tarugi P, Casula M, Galimberti F, Gazzotti M, Olmastroni E, Sarzani R, Ferri C, Repetti E, Giorgino F, Suppressa P, Bossi AC, Borghi C, Muntoni S, Cipollone F, Scicali R, Pujia A, Passaro A, Berteotti M, Pecchioli V, Pisciotta L, Mandraffino G, Pellegatta F, Mombelli G, Branchi A, Fiorenza AM, Pederiva C, Werba JP, Parati G, Nascimbeni F, Iughetti L, Fortunato G, Cavallaro R, Iannuzzo G, Calabrò P, Cefalù AB, Capra ME, Zambon A, Pirro M, Sbrana F, Trenti C, Minicocci I, Federici M, Del Ben M, Buonuomo PS, Moffa S, Pipolo A, Citroni N, Guardamagna O, Lia S, Benso A, Biolo GB, Maroni L, Lupi A, Bonanni L, Rinaldi E, Zenti MG, Masuda D, Mahfouz L, Jambart S, Ayoub C, Ghaleb Y, Kasim NAM, Nor NSM, Al-Khateeb A, Kadir SHSA, Chua YA, Razman AZ, Nazli SA, Ranai NM, Latif AZA, Torres MTM, Mehta R, Martagon AJ, Ramirez GAG, Antonio-Villa NE, Vargas-Vazquez A, Elias-Lopez D, Retana GG, Encinas BR, Macias JJC, Zazueta AR, Alvarado RM, Portano JDM, Lopez HA, Sauque-Reyna L, Gomez Herrera LG, Simental Mendia LE, Aguilar HG, Cooremans ER, Aparicio BP, Zubieta VM, Gonzalez PAC, Ferreira-Hermosillo A, Portilla NC, Dominguez GJ, Garcia AYR, Arriaga Cazares HE, Gonzalez Gonzalez JR, Mendez Valencia CV, Padilla Padilla FG, Prado RM, De los Rios Ibarra MO, Arjona Villica~na RD, Acevedo Rivera KJ, Carrera RA, Alvarez JA, Amezcua Martinez JC, Barrera Bustillo MDLR, Vargas GC, Chacon RC, Figueroa Andrade MH, Ortega AF, Alcala HG, Garcia de Leon LE, Guzman BG, Gardu~no Garcia JJ, Garnica Cuellar JC, Gomez Cruz JR, Garcia AH, Holguin Almada JR, Herrera UJ, Sobrevilla FL, Rodriguez EM, Sibaja CM, Medrano Rodriguez AB, Morales Oyervides JC, Perez Vazquez DI, Reyes Rodriguez EA, Osorio MLR, Saucedo JR, Tamayo MT, Valdez Talavera LA, Vera Arroyo LE, Zepeda Carrillo EA, Galema-Boers A, Weigman A, Bogsrud MP, Malik M, Shah S, Khan SA, Rana MA, Batool H, Starostecka E, Konopka A, Lewek J, Bielecka-Dąbrowa A, Gach A, Jóźwiak J, Pajkowski M, Romanowska-Kocejko M, Żarczyńska-Buchowiecka M, Hellmann M, Chmara M, Wasąg B, Parczewska A, Gilis-Malinowska N, Borowiec-Wolna J, Stróżyk A, Michalska-Grzonkowska A, Chlebus I, Kleinschmidt M, Wojtecka A, Zdrojewski T, Myśliwiec M, Hennig M, Medeiros AM, Alves AC, Almeida AF, Lopes A, Guerra A, Bilhoto C, Simões F, Silva F, Lobarinhas G, Gama G, Palma I, Salgado JM, Matos LD, Moura MD, Virtuoso MJ, Tavares M, Ferreira P, Pais P, Garcia P, Coelho R, Ribeiro R, Correia S, Sadykova D, Slastnikova E, Alammari D, Mawlawi HA, Alsahari A, Khudary AA, Alrowaily NL, Rajkovic N, Popovic L, Singh S, Rasulic I, Petakov A, Lalic NM, Peng FK, Vasanwala RF, Venkatesh SA, Raslova K, Fabryova L, Nociar J, Šaligova J, Potočňáková L, Kozárová M, Varga T, Kadurova M, Debreova M, Novodvorsky P, Gonova K, Klabnik A, Buganova I, Battelino T, Bizjan BJ, Debeljak M, Kovac J, Mlinaric M, Molk N, Sikonja J, Sustar U, Podkrajsek KT, Muñiz-Grijalvo O, Díaz-Díaz JL, de Andrés R, Fuentes-Jiménez F, Blom D, Miserez EB, Shipton JL, Ganokroj P, Futema M, Ramaswami U, Alieva RB, Fozilov KG, Khoshimov SU, Nizamov UI, Abdullaeva GJ, Kan LE, Abdullaev AA, Zakirova DV, Do DL, Nguyen MNT, Kim NT, Le TT, Le HA, Santos R, Ray KK. Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study. Lancet 2024; 403:55-66. [PMID: 38101429 DOI: 10.1016/s0140-6736(23)01842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 12/17/2023]
Abstract
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. FUNDING Pfizer, Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron.
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Allam H, Kamal M, Bendary M, Osama A, El Eleimy HA, Bendary A. The diagnostic value of global longitudinal strain combined with cardiac biomarkers on early detection of anthracycline-related cardiac dysfunction. J Echocardiogr 2023; 21:165-172. [PMID: 37453981 DOI: 10.1007/s12574-023-00618-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/02/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
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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Affiliation(s)
- Hager Allam
- Cardiology Department, Faculty of Medicine, Benha University, Banha, Egypt
| | - Marwa Kamal
- Cardiology Department, Faculty of Medicine, Benha University, Banha, Egypt
| | - Mohamed Bendary
- Biostatistics and Cancer Epidemiology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Amira Osama
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Benha University, Banha, Egypt
| | - Hiam Abdallah El Eleimy
- Department of Internal Medicine (hematology unit), Faculty of Medicine, Benha University, Banha, Egypt
| | - Ahmed Bendary
- Cardiology Department, Faculty of Medicine, Benha University, Banha, Egypt.
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Abushouk AI, Sayed A, Ghanem E, Hassanin A, Mentias A, Bendary A, Ghobrial J, Kapadia S. Africa on the Global Stage: Analyzing 30 Years of African-Led Clinical Trials in Cardiovascular Medicine. Circ Cardiovasc Qual Outcomes 2023; 16:e009895. [PMID: 37555326 DOI: 10.1161/circoutcomes.122.009895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Affiliation(s)
- Abdelrahman I Abushouk
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, OH (A.I.A., A.M., J.G., S.K.)
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT (A.I.A.)
| | - Ahmed Sayed
- Faculty of Medicine, Ain Shams University, Cairo, Egypt (A.S.)
| | - Esraa Ghanem
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt (E.G.)
| | - Ahmed Hassanin
- Faculty of Medicine, Alexandria University, Egypt (A.H.)
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock (A.H.)
| | - Amgad Mentias
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, OH (A.I.A., A.M., J.G., S.K.)
| | | | - Joanna Ghobrial
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, OH (A.I.A., A.M., J.G., S.K.)
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, OH (A.I.A., A.M., J.G., S.K.)
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Abdelmonaem M, Abushouk A, Reda A, Arafa S, Aboul-Enein H, Bendary A. IVUS-guided versus OCT-guided PCI among patients presenting with acute coronary syndrome. Egypt Heart J 2023; 75:49. [PMID: 37314624 DOI: 10.1186/s43044-023-00377-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/08/2023] [Indexed: 06/15/2023] Open
Abstract
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 [mm2] (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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Affiliation(s)
| | - Abdelrahman Abushouk
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ahmed Reda
- Cardiology Department, Ain Shams University, Cairo, Egypt
| | - Sherif Arafa
- Cardiology Department, Mansoura University, Mansoura, Egypt
| | | | - Ahmed Bendary
- Cardiology Department, Benha University, Benha, Egypt.
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Bendary A, Zarif B, Badran HM, Shokry K, Kabil H. Boosting protection for patients with non-acute cardiovascular disease: a focus on antithrombotic regimen (a consensus expert opinion from the Egyptian Society of Cardiology working group of thrombosis and prevention). Egypt Heart J 2023; 75:40. [PMID: 37155111 PMCID: PMC10167059 DOI: 10.1186/s43044-023-00364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/02/2023] [Indexed: 05/10/2023] Open
Abstract
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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Affiliation(s)
- Ahmed Bendary
- Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt.
| | | | - Hala Mahfouz Badran
- Cardiology Department, Faculty of Medicine, Menofia University, Shibin El Kom, Egypt
| | - Khaled Shokry
- Cardiology Department, Military Medical Academy, Cairo, Egypt
| | - Hamza Kabil
- Cardiology Department, Faculty of Medicine, Damietta University, Damietta, Egypt
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Bendary A, Hassanein M, Bendary M, Smman A, Hassanin A, Elwany M. Correction: The predictive value of precipitating factors on clinical outcomes in hospitalized patients with decompensated heart failure: insights from the Egyptian cohort in the European Society of Cardiology Heart Failure long-term registry. Egypt Heart J 2023; 75:18. [PMID: 36913033 PMCID: PMC10011260 DOI: 10.1186/s43044-023-00346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Affiliation(s)
- Ahmed Bendary
- Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt.
| | | | - Mohamed Bendary
- Biostatistics Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Smman
- Alexandria University Students' Hospital, Alexandria, Egypt
| | - Ahmed Hassanin
- Division of Cardiology, University of Arkansas for Medical Sciences, Arkansas, NY, USA
| | - Mostafa Elwany
- Cardiology Department, Alexandria University, Alexandria, Egypt
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Bendary A, Hassanein M, Bendary M, Smman A, Hassanin A, Elwany M. The predictive value of precipitating factors on clinical outcomes in hospitalized patients with decompensated heart failure: insights from the Egyptian cohort in the European Society of Cardiology Heart Failure long-term registry. Egypt Heart J 2023; 75:16. [PMID: 36884155 PMCID: PMC9995627 DOI: 10.1186/s43044-023-00342-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/25/2023] [Indexed: 03/09/2023] Open
Abstract
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 mean LVEF was 38 ± 11%. Seventy-seven percent of the total population had HFrEF, 9.8% had HFmrEF, and 13.3% had HFpEF. The commonly reported precipitating factors for AHF hospitalization among study population were as follows (in decreasing order of frequency): infection in 30.3% of patients, acute coronary syndrome/myocardial ischemia (ACS/MI) in 26%, anemia in 24.3%, uncontrolled hypertension in 24.2%, atrial fibrillation (AF) in 18.3%, renal dysfunction in 14.6%, and non-compliance in 6.5% of patients. HFpEF patients had significantly higher rates of AF, uncontrolled hypertension, and anemia as precipitants for acute decompensation. ACS/MI were significantly more frequent in patients with HFmrEF. WHF patients had significantly higher rates of infection and non-compliance, whereas new-onset HF patients showed significantly higher rates of ACS/MI and uncontrolled hypertension. One-year follow-up revealed that patients with HFrEF had a significantly higher rate of mortality compared to patients with HFmrEF and HFpEF (28.3%, 19.5, and 19.4%, P = 0.004). Patients with WHF had a significantly higher rates of 1-year mortality when compared to those with NOHF (30.0% vs. 20.3%, P < 0.001). Renal dysfunction, anemia, and infection were independently connected to worse long-term survival. CONCLUSIONS Precipitating factors of AHF are frequent and substantially influence outcomes after hospitalization. They should be considered goals for avoiding AHF hospitalization and depicting those at highest risk for short-term mortality.
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Affiliation(s)
- Ahmed Bendary
- Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt.
| | | | - Mohamed Bendary
- Biostatistics Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Smman
- Alexandria University Students' Hospital, Alexandria, Egypt
| | - Ahmed Hassanin
- Division of Cardiology, University of Arkansas for Medical Sciences, Arkansas, NY, USA
| | - Mostafa Elwany
- Cardiology Department, Alexandria University, Alexandria, Egypt
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Hasan MT, Awad AK, Shih M, Attia AN, Aboeldahab H, Bendary M, Bendary A. Meta-Analysis on the Safety and Efficacy of Sodium Glucose Cotransporters 2 Inhibitors in Patients With Heart Failure With and Without Diabetes. Am J Cardiol 2023; 187:93-99. [PMID: 36459753 DOI: 10.1016/j.amjcard.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 12/02/2022]
Abstract
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.
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Affiliation(s)
| | - Ahmed K Awad
- Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
| | | | | | - Heba Aboeldahab
- Biomedical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, Egypt
| | - Mohamed Bendary
- Epidemiology and Biostatistics Department, Cairo University, Cairo, Egypt
| | - Ahmed Bendary
- Cardiology Department, Benha University, Cairo, Egypt
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Elserafy AS, Bendary A, Elbahry A, Farag E, Mostafa T, Sanad O, Elkersh A, Selim M, Ragy H, Khamis H, Abdo W, Reda A. The Egyptian Association of Vascular Biology and Atherosclerosis (EAVA) Perspectives on the Usage of Inclisiran. Cardiol Ther 2022; 11:461-471. [PMID: 36053454 PMCID: PMC9652189 DOI: 10.1007/s40119-022-00277-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/16/2022] [Indexed: 11/02/2022] Open
Abstract
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).
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Affiliation(s)
| | - Ahmed Bendary
- Department of Cardiology, Benha University, Behna, Egypt.
| | - Atef Elbahry
- Cardiology Unit, Port Foad Centre, Port Foad, Egypt
| | - Elsayed Farag
- Department of Cardiology, Zagazig University, Zagazig, Egypt
| | - Tamer Mostafa
- Department of Cardiology, Zagazig University, Zagazig, Egypt
| | - Osama Sanad
- Department of Cardiology, Benha University, Behna, Egypt
| | - Ahmed Elkersh
- Department of Cardiology, Menufiya University, Menufiya, Egypt
| | - Mohammed Selim
- Department of Cardiology, National Heart Institute, Cairo, Egypt
| | - Hany Ragy
- Department of Cardiology, National Heart Institute, Cairo, Egypt
| | - Hazem Khamis
- Department of Cardiology, MTI University, Cairo, Egypt
| | - Waleed Abdo
- Department of Cardiology, Menufiya University, Menufiya, Egypt
| | - Ashraf Reda
- Department of Cardiology, Menufiya University, Menufiya, Egypt
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Bendary A, Said H, Elemary M, Mahrous M. Right ventricular function as a predictor of short-term mortality in patients with sepsis and septic shock: an observational study. Egypt Heart J 2022; 74:78. [PMID: 36264521 PMCID: PMC9584025 DOI: 10.1186/s43044-022-00316-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
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.
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Affiliation(s)
- Ahmed Bendary
- Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt.
| | - Hany Said
- Cardiology Department, Ahmed Maher Hospital, Cairo, Egypt
| | - Metwally Elemary
- Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Mohamed Mahrous
- Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt
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Awad AK, Tarek Hasan M, Shih M, N Attia A, Aboeldahab H, Bendary M, Bendary A. Safety and efficacy of SGLT2 inhibitors in diabetic and non-diabetic heart failure patients, a meta-analysis of randomized controlled trials. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
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.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A K Awad
- Ain Shams University, Faculty of Medicine , Cairo , Egypt
| | - M Tarek Hasan
- Al-Azhar University, Faculty of Medicine , Cairo , Egypt
| | - M Shih
- New giza university , Cairo , Egypt
| | - A N Attia
- Kasr Alainy Faculty of medicine , Cairo , Egypt
| | - H Aboeldahab
- Medical Research Institute, Alexandria University, Biomedical Informatics and Medical Statistics , Alexandria , Egypt
| | - M Bendary
- Cairo University, Epidemiology and Biostatistics Department , Cairo , Egypt
| | - A Bendary
- Benha University, Cardiology Department , cmairo , Egypt
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Reda A, Shawky A, Elbahry A, Bendary A, Elkersh A, Farag E, Ashraf M. Egyptian atherosclerosis and vascular biology association consensus on the use of sodium glucose cotransporter-2 inhibitors in heart failure with reduced ejection fraction. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hassanin A, Bendary A, Abushouk A, Govil N, Al-Seykal I, Jin C, Naidu SS. QUALITY AND OUTCOMES OF STEMI CARE IN MIDDLE INCOME COUNTRIES COMPARED TO HIGH INCOME COUTNRIES A META-ANALYSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vallejo-Vaz AJ, Stevens CA, Lyons AR, Dharmayat KI, Freiberger T, Hovingh GK, Mata P, Raal FJ, Santos RD, Soran H, Watts GF, Abifadel M, Aguilar-Salinas CA, Alhabib KF, Alkhnifsawi M, Almahmeed W, Alnouri F, Alonso R, Al-Rasadi K, Al-Sarraf A, Al-Sayed N, Araujo F, Ashavaid TF, Banach M, Béliard S, Benn M, Binder CJ, Bogsrud MP, Bourbon M, Chlebus K, Corral P, Davletov K, Descamps OS, Durst R, Ezhov M, Gaita D, Genest J, Groselj U, Harada-Shiba M, Holven KB, Kayikcioglu M, Khovidhunkit W, Lalic K, Latkovskis G, Laufs U, Liberopoulos E, Lima-Martinez MM, Lin J, Maher V, Marais AD, März W, Mirrakhimov E, Miserez AR, Mitchenko O, Nawawi H, Nordestgaard BG, Panayiotou AG, Paragh G, Petrulioniene Z, Pojskic B, Postadzhiyan A, Raslova K, Reda A, Reiner Ž, Sadiq F, Sadoh WE, Schunkert H, Shek AB, Stoll M, Stroes E, Su TC, Subramaniam T, Susekov AV, Tilney M, Tomlinson B, Truong TH, Tselepis AD, Tybjærg-Hansen A, Vázquez Cárdenas A, Viigimaa M, Wang L, Yamashita S, Kastelein JJ, Bruckert E, Vohnout B, Schreier L, Pang J, Ebenbichler C, Dieplinger H, Innerhofer R, Winhofer-Stöckl Y, Greber-Platzer S, Krychtiuk K, Speidl W, Toplak H, Widhalm K, Stulnig T, Huber K, Höllerl F, Rega-Kaun G, Kleemann L, Mäser M, Scholl-Bürgi S, Säly C, Mayer FJ, Sablon G, Tarantino E, Nzeyimana C, Pojskic L, Sisic I, Nalbantic AD, Jannes CE, Pereira AC, Krieger JE, Petrov I, Goudev A, Nikolov F, Tisheva S, Yotov Y, Tzvetkov I, Baass A, Bergeron J, Bernard S, Brisson D, Brunham LR, Cermakova L, Couture P, Francis GA, Gaudet D, Hegele RA, Khoury E, Mancini GJ, McCrindle BW, Paquette M, Ruel I, Cuevas A, Asenjo S, Wang X, Meng K, Song X, Yong Q, Jiang T, Liu Z, Duan Y, Hong J, Ye P, Chen Y, Qi J, Liu Z, Li Y, Zhang C, Peng J, Yang Y, Yu W, Wang Q, Yuan H, Cheng S, Jiang L, Chong M, Jiao J, Wu Y, Wen W, Xu L, Zhang R, Qu Y, He J, Fan X, Wang Z, Chow E, Pećin I, Perica D, Symeonides P, Vrablik M, Ceska R, Soska V, Tichy L, Adamkova V, Franekova J, Cifkova R, Kraml P, Vonaskova K, Cepova J, Dusejovska M, Pavlickova L, Blaha V, Rosolova H, Nussbaumerova B, Cibulka R, Vaverkova H, Cibickova L, Krejsova Z, Rehouskova K, Malina P, Budikova M, Palanova V, Solcova L, Lubasova A, Podzimkova H, Bujdak J, Vesely J, Jordanova M, Salek T, Urbanek R, Zemek S, Lacko J, Halamkova H, Machacova S, Mala S, Cubova E, Valoskova K, Burda L, Bendary A, Daoud I, Emil S, Elbahry A, Rafla S, Sanad O, Kazamel G, Ashraf M, Sobhy M, El-Hadidy A, Shafy MA, Kamal S, Bendary M, Talviste G, Angoulvant D, Boccara F, Cariou B, Carreau V, Carrie A, Charrieres S, Cottin Y, Di-Fillipo M, Ducluzeau PH, Dulong S, Durlach V, Farnier M, Ferrari E, Ferrieres D, Ferrieres J, Gallo A, hankard R, Inamo J, Lemale J, Moulin P, Paillard F, Peretti N, Perrin A, Pradignac A, Rabes JP, Rigalleau V, Sultan A, Schiele F, Tounian P, Valero R, Verges B, Yelnik C, Ziegler O, Haack IA, Schmidt N, Dressel A, Klein I, Christmann J, Sonntag A, Stumpp C, Boger D, Biedermann D, Usme MM, Beil FU, Klose G, König C, Gouni-Berthold I, Otte B, Böll G, Kirschbaum A, Merke J, Scholl J, Segiet T, Gebauer M, Predica F, Mayer M, Leistikow F, Füllgraf-Horst S, Müller C, Schüler M, Wiener J, Hein K, Baumgartner P, Kopf S, Busch R, Schömig M, Matthias S, Allendorf-Ostwald N, Fink B, Böhm D, Jäkel A, Koschker AC, Schweizer R, Vogt A, Parhofer K, König W, Reinhard W, Bäßler A, Stadelmann A, Schrader V, Katzmann J, Tarr A, Steinhagen-Thiessen E, Kassner U, Paulsen G, Homberger J, Zemmrich C, Seeger W, Biolik K, Deiss D, Richter C, Pantchechnikova E, Dorn E, Schatz U, Julius U, Spens A, Wiesner T, Scholl M, Rizos CV, Sakkas N, Elisaf M, Skoumas I, Tziomalos K, Rallidis L, Kotsis V, Doumas M, Athyros V, Skalidis E, Kolovou G, Garoufi A, Bilianou E, Koutagiar I, Agapakis D, Kiouri E, Antza C, Katsiki N, Zacharis E, Attilakos A, Sfikas G, Koumaras C, Anagnostis P, Anastasiou G, Liamis G, Koutsogianni AD, Karányi Z, Harangi M, Bajnok L, Audikovszky M, Márk L, Benczúr B, Reiber I, Nagy G, Nagy A, Reddy LL, Shah SA, Ponde CK, Dalal JJ, Sawhney JP, Verma IC, Altaey M, Al-Jumaily K, Rasul D, Abdalsahib AF, Jabbar AA, Al-ageedi M, Agar R, Cohen H, Ellis A, Gavishv D, Harats D, Henkin Y, Knobler H, Leavit L, Leitersdorf E, Rubinstein A, Schurr D, Shpitzen S, Szalat A, Casula M, Zampoleri V, Gazzotti M, Olmastroni E, Sarzani R, Ferri C, Repetti E, Sabbà C, Bossi AC, Borghi C, Muntoni S, Cipollone F, Purrello F, Pujia A, Passaro A, Marcucci R, Pecchioli V, Pisciotta L, Mandraffino G, Pellegatta F, Mombelli G, Branchi A, Fiorenza AM, Pederiva C, Werba JP, Parati G, Carubbi F, Iughetti L, Iannuzzi A, Iannuzzo G, Calabrò P, Averna M, Biasucci G, Zambon S, Roscini AR, Trenti C, Arca M, Federici M, Del Ben M, Bartuli A, Giaccari A, Pipolo A, Citroni N, Guardamagna O, Bonomo K, Benso A, Biolo G, Maroni L, Lupi A, Bonanni L, Zenti MG, Matsuki K, Hori M, Ogura M, Masuda D, Kobayashi T, Nagahama K, Al-Jarallah M, Radovic M, Lunegova O, Bektasheva E, Khodzhiboboev E, Erglis A, Gilis D, Nesterovics G, Saripo V, Meiere R, Upena-RozeMicena A, Terauda E, Jambart S, Khoury PE, Elbitar S, Ayoub C, Ghaleb Y, Aliosaitiene U, Kutkiene S, Kasim NA, Nor NS, Ramli AS, Razak SA, Al-Khateeb A, Kadir SH, Muid SA, Rahman TA, Kasim SS, Radzi AB, Ibrahim KS, Razali S, Ismail Z, Ghani RA, Hafidz MI, Chua AL, Rosli MM, Annamalai M, Teh LK, Razali R, Chua YA, Rosman A, Sanusi AR, Murad NA, Jamal ARA, Nazli SA, Razman AZ, Rosman N, Rahmat R, Hamzan NS, Azzopardi C, Mehta R, Martagon AJ, Ramirez GA, Villa NE, Vazquez AV, Elias-Lopez D, Retana GG, Rodriguez B, Macías JJ, Zazueta AR, Alvarado RM, Portano JD, Lopez HA, Sauque-Reyna L, Herrera LG, Mendia LE, Aguilar HG, Cooremans ER, Aparicio BP, Zubieta VM, Gonzalez PA, Ferreira-Hermosillo A, Portilla NC, Dominguez GJ, Garcia AY, Cazares HE, Gonzalez JR, Valencia CV, Padilla FG, Prado RM, De los Rios Ibarra MO, Villicaña RD, Rivera KJ, Carrera RA, Alvarez JA, Martinez JC, de los Reyes Barrera Bustillo M, Vargas GC, Chacon RC, Andrade MH, Ortega AF, Alcala HG, de Leon LE, Guzman BG, Garcia JJ, Cuellar JC, Cruz JR, Garcia AH, Almada JR, Herrera UJ, Sobrevilla FL, Rodriguez EM, Sibaja CM, Rodriguez AB, Oyervides JC, Vazquez DI, Rodriguez EA, Osorio ML, Saucedo JR, Tamayo MT, Talavera LA, Arroyo LE, Carrillo EA, Isara A, Obaseki DE, Al-Waili K, Al-Zadjali F, Al-Zakwani I, Al-Kindi M, Al-Mukhaini S, Al-Barwani H, Rana A, Shah LS, Starostecka E, Konopka A, Lewek J, Bartłomiejczyk M, Gąsior M, Dyrbuś K, Jóźwiak J, Gruchała M, Pajkowski M, Romanowska-Kocejko M, Żarczyńska-Buchowiecka M, Chmara M, Wasąg B, Parczewska A, Gilis-Malinowska N, Borowiec-Wolna J, Stróżyk A, Woś M, Michalska-Grzonkowska A, Medeiros AM, Alves AC, Silva F, Lobarinhas G, Palma I, de Moura JP, Rico MT, Rato Q, Pais P, Correia S, Moldovan O, Virtuoso MJ, Salgado JM, Colaço I, Dumitrescu A, Lengher C, Mosteoru S, Meshkov A, Ershova A, Rozkova T, Korneva V, Yu KT, Zafiraki V, Voevoda M, Gurevich V, Duplyakov D, Ragino Y, Safarova M, Shaposhnik I, Alkaf F, Khudari A, Rwaili N, Al-Allaf F, Alghamdi M, Batais MA, Almigbal TH, Kinsara A, AlQudaimi AH, Awan Z, Elamin OA, Altaradi H, Rajkovic N, Popovic L, Singh S, Stosic L, Rasulic I, Lalic NM, Lam C, Le TJ, Siang EL, Dissanayake S, I-Shing JT, Shyong TE, Jin TC, Balinth K, Buganova I, Fabryova L, Kadurova M, Klabnik A, Kozárová M, Sirotiakova J, Battelino T, Kovac J, Mlinaric M, Sustar U, Podkrajsek KT, Fras Z, Jug B, Cevc M, Pilcher GJ, Blom D, Wolmarans K, Brice B, Muñiz-Grijalvo O, Díaz-Díaz JL, de Isla LP, Fuentes F, Badimon L, Martin F, Lux A, Chang NT, Ganokroj P, Akbulut M, Alici G, Bayram F, Can LH, Celik A, Ceyhan C, Coskun FY, Demir M, Demircan S, Dogan V, Durakoglugil E, Dural IE, Gedikli O, Hacioglu A, Ildizli M, Kilic S, Kirilmaz B, Kutlu M, Oguz A, Ozdogan O, Onrat E, Ozer S, Sabuncu T, Sahin T, Sivri F, Sonmez A, Temizhan A, Topcu S, Tuncez A, Vural M, Yenercag M, Yesilbursa D, Yigit Z, Yildirim AB, Yildirir A, Yilmaz MB, Atallah B, Traina M, Sabbour H, Hay DA, Luqman N, Elfatih A, Abdulrasheed A, Kwok S, Oca ND, Reyes X, Alieva RB, Kurbanov RD, Hoshimov SU, Nizamov UI, Ziyaeva AV, Abdullaeva GJ, Do DL, Nguyen MN, Kim NT, Le TT, Le HA, Tokgozoglu L, Catapano AL, Ray KK. Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC). Lancet 2021; 398:1713-1725. [PMID: 34506743 DOI: 10.1016/s0140-6736(21)01122-3] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally. METHODS Using FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases. FINDINGS Of the 61 612 individuals in the registry, 42 167 adults (21 999 [53·6%] women) from 56 countries were included in the study. Of these, 31 798 (75·4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84·2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46·2 years (IQR 34·3-58·0); median age at diagnosis of familial hypercholesterolaemia was 44·4 years (32·5-56·5), with 40·2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17·4% (2·1% for stroke and 5·2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81·1%) were receiving statins and 3691 (21·2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol was 5·43 mmol/L (IQR 4·32-6·72) among patients not taking lipid-lowering medications and 4·23 mmol/L (3·20-5·66) among those taking them. Among patients taking lipid-lowering medications, 2·7% had LDL cholesterol lower than 1·8 mmol/L; the use of combination therapy, particularly with three drugs and with proprotein convertase subtilisin-kexin type 9 inhibitors, was associated with a higher proportion and greater odds of having LDL cholesterol lower than 1·8 mmol/L. Compared with index cases, patients who were non-index cases were younger, with lower LDL cholesterol and lower prevalence of cardiovascular risk factors and cardiovascular diseases (all p<0·001). INTERPRETATION Familial hypercholesterolaemia is diagnosed late. Guideline-recommended LDL cholesterol concentrations are infrequently achieved with single-drug therapy. Cardiovascular risk factors and presence of coronary disease were lower among non-index cases, who were diagnosed earlier. Earlier detection and greater use of combination therapies are required to reduce the global burden of familial hypercholesterolaemia. FUNDING Pfizer, Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Daiichi Sankyo, and Regeneron.
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Reda A, Bendary A, Elbahry A, Farag E, Mostafa T, Khamis H, Wadie M, Bendary M, Abdoul Azeem B, Salah R. Prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndromes; final data of the nationwide cross-sectional CardioRisk project. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Little are known about the prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndromes (ACS). Objective: To describe the prevalence of these risk factors with focus on gender-specific data and patients with premature presentation.
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, with focus premature ACS.
Results
The vast majority were males (74%) and the most prevalent age group was (56–65 years) representing 37% of whole study population. Among female patients, 92% were post-menopausal. The prevalence of premature ACS was 51%. Forty five percent of total males and 69.6% of total females with ACS had premature presentation (P<0.001). Abdominal obesity was the most prevalent risk factor (66%). Nearly half of the entire study patients were current smokers (48%). We showed a high prevalence of documented dyslipidemia (48%) as well. Early invasive management strategy was employed in 65% of patients with no significant gender disparity noticed. Vascular access for coronary angiography was most commonly femoral (80% of time). Emergent percutaneous coronary intervention (PCI) was attempted in 53% of patients. Thrombolytic therapy (using Streptokinase) was used in 24% of included participants.
Conclusion
Among Egyptian patients with ACS, premature presentation is common with greater male preponderance. Abdominal obesity is the most prevalent risk factor followed by hypertension. Most traditional risk factors (apart from smoking) were more prevalent in women than men.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZeneca Table 1. Premature Atherosclerosis subgroupTable 2. Geographic distribution of risk factors
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Affiliation(s)
- A Reda
- Faculty of medicine Menoufia university, Cardiology, Menoufia, Egypt
| | - A Bendary
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - A Elbahry
- Cardiology center, Port Fouad, Egypt
| | - E Farag
- Zagazig University Hospitals, Cardiology, Zagazig, Egypt
| | - T Mostafa
- Zagazig University Hospitals, Cardiology, Zagazig, Egypt
| | - H Khamis
- 6th October University, Cardiology, Cairo, Egypt
| | - M Wadie
- Mansoura University, Cardiology, Mansoura, Egypt
| | - M Bendary
- Cairo University, National Cancer Institute, Biostatistics, Cairo, Egypt
| | | | - R Salah
- Benha Faculty of Medicine, Benha, Egypt
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Reda A, Elserafy AS, Farag E, Mostafa T, Farag N, Elbahary A, Sanad O, Tabl MA, Bendary A, Elkersh A, Ashraf M, Attia I, Beshay M, Ragy H, Selim M, Khamis H. Egyptian Association of Vascular Biology and Atherosclerosis Consensus on The Usage of SGLT2 Inhibitors in Heart Failure. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab069.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aims
Analysis of SGLT2i data from DAPA-HF and EMPEROR- reduced trials to put a simplified consensus statement on the use of these glucose lowering agents in patients with established heart failure.
Methods and Results
Sixty experts in the field of cardiology revised the literature of the SGLT2i in heart failure, their recommended indications, and their contraindications. Data from DAPA-HF and EMPEROR-reduced trials were tabulated and statistically analysed. SGLT2 inhibitors investigated initially for their glucose lowering capability, have shown a significant benefit in chronic heart failure eit reduced ejection fraction (HFrEF).
Conclusions
We recommend early use of dapagliflozin 10 mg, or empagliflozin 10 mg in patients suffering from symptomatic chronic HFrEF, whether the patient is diabetic or non, to improve heart failure hospitalization, death, symptoms, and decline of renal function.
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Affiliation(s)
- Ashraf Reda
- Department of Cardiology, Menoufia University, Menoufia, Egypt
| | | | - Elsayed Farag
- Department of Cardiology, Zagazig University, Zagazig, Egypt
| | - Tamer Mostafa
- Department of Cardiology, Zagazig University, Zagazig, Egypt
| | - Nabil Farag
- Department of Cardiology, Ain Shams University, Cairo, Egypt
| | | | - Osama Sanad
- Department of Cardiology, Banha University, Banha, Egypt
| | | | - Ahmed Bendary
- Department of Cardiology, Banha University, Banha, Egypt
| | - Ahmed Elkersh
- Department of Cardiology, Menoufia University, Menoufia, Egypt
| | - Mohamed Ashraf
- Department of Cardiology, National heart institute, Cairo, Egypt
| | - Ihab Attia
- Department of Cardiology, Ain Shams University, Cairo, Egypt
| | - Morad Beshay
- Department of Cardiology, Menoufia University, Menoufia, Egypt
| | - Hany Ragy
- Department of Cardiology, National heart institute, Cairo, Egypt
| | - Mohammed Selim
- Department of Cardiology, National heart institute, Cairo, Egypt
| | - Hazem Khamis
- Department of Cardiology, October University, 6th of October, Egypt
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Reda A, Bendary A, Elserafy AS, Ashraf M, Dawood E, Emil S, Elbahry A, Sanad O, Bendary M, Elhadidy A, Rafla S, Tabl MA, Khamis H, Kazamel G, Kamal S, Naguib T, Sobhy M. Clinical Characteristics, Laboratory Profiles, And Treatment Modalities for Familial Hypercholesterolemia in Egypt. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab069.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
The aim of the Familial Hypercholesterolemia Research Collaboration (FHRC) is to collect date about the clinical, laboratory phenotypes, and treatment strategies of patients with FH all over the world. We present the Egyptian data of this international registry.
Methods and Results
An online electronic case report form (e-CRF) was prepared to collect data matching the protocol of the FHSC of the European Atherosclerosis Soci- ety (EAS). From August 2017 to March 2021, a total of 228 cases with FH (46% males, mean age 48 ± 14 years) were enrolled. About 71% of whom came from urban areas. The mean Body Mass Index (BMI) was 30 ± 4.9 kg/m2. The most commonly reported concomitant risk factor was hypertension (39%), followed by smoking (22%), and then DM (18%). Median time from diagnosis to enrolment was 7 (range 0.5-20) years. The vast majority (99.1%) were diagnosed based on the Dutch Lipid Clinic criteria, with 14%, 11% and 75% in the definite, probable, and possible categories respectively. Genetic test was performed in only 1 patient, in which the defect was heterozygous FH (defective ApoB). Mean baseline levels for total cholesterol was 316±86 mg/dl, median (ranges) for triglycerides was 190 (38-1400) mg/dl, for LDL-C was 237±77 mg/dl and for HDL-C was 47±14 mg/dl. Importantly, the mean Lp(a) was 42±12 mg/dl. All but one patient received lipid lowering therapy. Statins were prescribed in 226 out of 228 patients enrolled (99.1%). Statin prescriptions were equally distributed between Atorvastatin and Rosuvastatin (41% for each). Forty five percent received monotherapy and 56% received combination therapy (most commonly with Ezetimibe [55.7%], then with Fibrates [7.9%], then with proprotein con- vertase subtilisin/kexin type 9 (PCSK-9 inhibitors) [2.6%], and finally with Omega-3 fatty acids [0.9%]). Only one patient received lipoprotein apheresis.
Conclusion
The Egyptian part of the FHRC, to the best of our knowledge, is the first FH registry in Egypt. Our data show that the e-CRF system is feasible and reliable. The phenotype of enrolled FH cases showed higher female preponderance, very high lipoprotein levels, and unfortunately inadequate therapeutic interventions (with un- derutilization of PCSK-9 inhibitors). This is a call to action in order to mitigate these management gaps for this high-risk group.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Mohamed Bendary
- Biostatistics department, National Cancer Institute, Cairo University
| | | | - Samir Rafla
- Cardiology department, Alexandria University
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19
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Reda A, Bendary A, Elbahry A, Farag E, Mostafa T, Khamis H, Wadie M, Bendary M, Abdoul Azeem B, Salah R. Prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndrome: final data of the nationwide cross-sectional 'CardioRisk' project. J Public Health Afr 2021; 11:1368. [PMID: 33623654 PMCID: PMC7893316 DOI: 10.4081/jphia.2020.1368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 01/26/2021] [Indexed: 12/16/2022] Open
Abstract
Background Little are known about the prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndromes (ACS). Objective Describe the prevalence of these risk factors with focus on gender-specific data and patients with premature presentation. 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, with focus premature ACS. Results The vast majority were males (74%) and the most prevalent age group was (56-65 years) representing 37% of whole study population. Among female patients, 92% were post-menopausal. The prevalence of premature ACS was 51%. Forty five percent of total males and 69.6% of total females with ACS had premature presentation (P<0.001). Abdominal obesity was the most prevalent risk factor (66%). Nearly half of the entire study patients were current smokers (48%). We showed a high prevalence of documented dyslipidemia (48%) as well. Early invasive management strategy was employed in 65% of patients with no significant gender disparity noticed. Vascular access for coronary angiography was most commonly femoral (80% of time). Emergent percutaneous coronary intervention (PCI) was attempted in 53% of patients. Thrombolytic therapy (using Streptokinase) was used in 24% of included participants. Conclusion Among Egyptian patients with ACS, premature presentation is common with greater male preponderance. Abdominal obesity is the most prevalent risk factor followed by hypertension. Most traditional risk factors (apart from smoking) were more prevalent in women than men.
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Affiliation(s)
- Ashraf Reda
- Cardiology Department, Faculty of Medicine, Menofia University
| | - Ahmed Bendary
- Cardiology Department, Faculty of Medicine, Benha University
| | | | - Elsayed Farag
- Cardiology Department, Faculty of Medicine, Zagazig University
| | - Tamer Mostafa
- Cardiology Department, Faculty of Medicine, Zagazig University
| | - Hazem Khamis
- Cardiology Department, Faculty of Medicine, October University
| | - Moheb Wadie
- Cardiology Department, Faculty of Medicine, Mansoura University
| | - Mohamed Bendary
- Biostatistics Department, National Cancer Institute, Cairo University
| | | | - Rehab Salah
- Faculty of Medicine, Benha University, Egypt
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20
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Sayed A, Almotawally S, Wilson K, Munir M, Bendary A, Ramzy A, Hirji S, Ibrahim Abushouk A. Minimally invasive surgery versus transcatheter aortic valve replacement: a systematic review and meta-analysis. Open Heart 2021; 8:openhrt-2020-001535. [PMID: 33455914 PMCID: PMC7813322 DOI: 10.1136/openhrt-2020-001535] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has recently been approved for use in patients who are at intermediate and low surgical risk. Moreover, recent years have witnessed a renewed interest in minimally invasive aortic valve replacement (miAVR). The present meta-analysis compared the outcomes of TAVR and miAVR in the management of aortic stenosis (AS). We conducted an electronic search across six databases from 2002 (TAVR inception) to December 2019. Data from relevant studies regarding the clinical and length of hospitalisation outcomes were extracted and analysed using R software. We identified a total of 11 cohort studies, of which seven were matched/propensity matched. Our analysis demonstrated higher rates of midterm mortality (≥1 year) with TAVR (risk ratio (RR): 1.93, 95% CI: 1.16 to 3.22), but no significant differences with respect to 1 month mortality (RR: 1.00, 95% CI: 0.55 to 1.81), stroke (RR: 1.08, 95% CI: 0.40 to 2.87) and bleeding (RR: 1.45, 95% CI: 0.56 to 3.75) rates. Patients undergoing TAVR were more likely to experience paravalvular leakage (RR: 14.89, 95% CI: 6.89 to 32.16), yet less likely to suffer acute kidney injury (RR: 0.38, 95% CI: 0.21 to 0.69) compared with miAVR. The duration of hospitalisation was significantly longer in the miAVR group (mean difference: 1.92 (0.61 to 3.24)). Grading of Recommendations Assessment, Development and Evaluation assessment revealed ≤moderate quality of evidence in all outcomes. TAVR was associated with lower acute kidney injury rate and shorter length of hospitalisation, yet higher risks of midterm mortality and paravalvular leakage. Given the increasing adoption of both techniques, there is an urgent need for head-to-head randomised trials with adequate follow-up periods.
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Affiliation(s)
- Ahmed Sayed
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Karim Wilson
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Malak Munir
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Bendary
- Faculty of Medicine, Cardiology, Benha University, Benha, Egypt
| | - Ahmed Ramzy
- Faculty of Medicine, Cardiology, Benha University, Benha, Egypt
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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21
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Shaheen S, Wafa A, Mokarab M, Zareef B, Bendary A, Abdelhameed T, Rashwan A, Seleem M, Elmasry M, Abdelhady Y, Abdelrazik G, Ibrahim A, Ghareeb M, Aly K, Saraya M, Wadie M, Youssef M. Presentation, management, and outcomes of STEMI in Egypt: results from the European Society of Cardiology Registry on ST elevation myocardial infarction. Egypt Heart J 2020; 72:35. [PMID: 32607863 PMCID: PMC7326745 DOI: 10.1186/s43044-020-00069-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/10/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Apart from few small single-center studies, there are limited data about STEMI patients in Egypt. Nineteen Egyptian centers (with and without PCI facilities) participated in this registry with 1356 patients who were compared to 7420 patients from other ESC countries. The aims of this study were to describe the characteristics of patients with STEMI, to assess STEMI management patterns particularly the current use of reperfusion therapies, to evaluate the organization of STEMI networks across Egypt, to evaluate in-hospital patient outcome, and to compare Egyptian patients with other ESC countries.
Results
Compared to other ESC countries, Egyptian patients were younger (mean age 55.4 ± 11.3 vs. 62.9 ± 12.4; p < 0.001 and 4.36% vs. 19.41%% were ≥ 75 years old; p < 0.001) with fewer females (18.44% vs. 25.63%; p < 0.001). Egypt had longer median time between symptoms onset and first medical contact: 120.0 (60.0; 240.0) vs.100.0 (50.0; 240.0) p < 0.001. Self-presentation rather than EMS presentation was the mode of admission in 86.06% in Egypt vs. 25.83% in EU countries (p < 0.001). On qualifying ECG, anterior STEMI was in 57.08% in Egypt vs. 45.98% in other countries (p < 0.001). Initial reperfusion therapy was 49.12%, 43.07%, and 7.26% for primary PCI, thrombolytic therapy and no reperfusion in Egypt vs. 85.42%, 7.26%, and 7.82% for EU countries, respectively. In-hospital mortality was 4.65% in Egypt vs. 3.50% in other countries p 0.040 and was 18.87% in no reperfusion vs. 2.10% in primary PCI vs. 4.97% in thrombolysis (p < 0.001) among Egyptians. Patients were discharged on aspirin in 98.61%, clopidogrel in 91.07%, ticagrelor in 7.31%, DAPT in 97.69%, beta blockers in 82.83%, ACE inhibitors in 84.76%, MRAs in 10.01%, and statins in 99.77%.
Conclusion
Compared to other ESC countries, Egyptian STEMI patients were younger, more frequently current smokers and diabetics, and had longer time between symptoms onset and first medical contact with more self-presentation rather than EMS presentation. Thrombolytic therapy is still a common reperfusion therapy in Egypt while primary PCI was offered to half of the patients. In-hospital mortality was significantly higher in Egypt and was highest among no reperfusion patients and lowest among PPCI patients.
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Farag E, Bendary A, Bendary M, Ibrahim I, Abomandour H. Association between non-fasting atherogenic index and anatomical complexity of coronary artery disease in patients with chronic coronary syndrome. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Bendary A, Ramzy A, Bendary M, Salem M. Transcatheter aortic valve replacement in patients with severe aortic stenosis and active cancer: a systematic review and meta-analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with severe aortic stenosis (AS) and concomitant active cancer (AC) are considered high-risk patients and usually are not allowed to undergo surgical valve replacement. Transcatheter aortic valve replacement (TAVR) may be an attractive option for them; however, little is known about the outcomes of TAVR in this subset of complex patients.
Methods and results
In this meta-analysis, Medline, Cochrane Library and Scopus databases were searched (anytime up to April 2019) for studies evaluating the outcomes of TAVR in patients with or without AC. We assessed pooled estimates (with their 95% confidence intervals [CIs]) of the risk ratio (RR) for the all-cause mortality at the 30-day and 1-year follow-ups, a 4-point safety outcome (any bleeding, stroke, need for a pacemaker and acute kidney injury) and a 2-point efficacy outcome (device success and residual mean gradient [mean difference]). Three studies (5162 patients) were included. Of those patients, a total of 368 patients (7.1%) had AC. Apart from a significantly higher need for a postprocedural pacemaker (RR 1.29, 95% CI: 1.06–1.58, P=0.01), TAVR in AC patients resulted in similar outcomes for safety and efficacy at the 30-day follow-up compared to those without AC. Patients with AC experienced similar rates of the all-cause mortality at the 30-day follow-up compared to those without (RR 0.92, 95% CI: 0.53 to 1.59, P=0.76); however, the all-cause mortality was significantly higher in patients with AC at the 1-year follow-up (RR 1.71, 95% CI: 1.26 to 2.33, P=0.0006). This mortality difference was independent of cancer stage (advanced or limited) at the 30-day follow-up but not at the 1-year follow-up; only patients with limited cancer stages showed similar all-cause mortality rates compared to those without cancer at the 1-year follow-up (RR 1.22, 95% CI: 0.79 to 1.91, P=0.37).
Conclusion
TAVR in patients with AC is associated with similar 30-day and potentially worse 1-year outcomes compared to those in patients without AC. The 1-year all-cause mortality appears to be dependent on the cancer stage. Involving a specialized oncologist who usually considers cancer stage in the decision-making process and applying additional preoperative scores such as frailty indices might refine the risk assessment process among these patients.
All-cause mortality (cancer vs no)
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Bendary
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - A.R Ramzy
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - M.B Bendary
- Cairo University, Biostatistics, National Cancer institute, Cairo, Egypt
| | - M.S Salem
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
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Bendary A, Mansour A, Kabil H, Mostafa S. Time-to-reperfusion in ST-segment elevation myocardial infarction undergoing inter-hospital transfer using WhatsApp smartphone application. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aim
Current guidelines recommend that patients with ST-elevation myocardial infarction (STEMI) receive primary percutaneous coronary intervention (PCI) with a door-to-balloon (D2B) time of 90 minutes. This time frame has been difficult to achieve in developing countries. We aimed to test the hypothesis that using WhatsApp for inter-hospital transfer in STEMI primary PCI would result in shorter D2B time through avoiding emergency department (ED) waiting.
Methods
In the period from May 2018 to April 2019, 300 patients with STEMI treated with primary PCI were prospectively enrolled in a multi-center observational study covering 3 PCI-capable centers in our city. Patients were categorized into 3 groups: G-1; Self-presenting to the ED, G-2; Transferred by ambulance to the ED and G-3; those transferred from non-PCI capable centers directly to catheterization laboratory (bypassing the ED as possible) after the team was pre-activated through an ECG image sent using WhatsApp. The primary endpoint was between-groups difference in total ischemic and D2B times.
Results
All groups were matched regarding baseline criteria. WhatsApp use was associated with significantly shorter D2B time (166.5±33.8 vs 157.8±29.6 vs 120.8±35.2 minutes in groups 1, 2 and 3 respectively, P<0.001) and shorter total ischemic time (258.9±33.9 vs 249.6±29.4 vs 212.7±35.4 minutes in groups 1, 2 and 3 respectively, P<0.001). Linear regression showed that WhatsApp referral significantly reduces ED waiting time by about 20.4 minutes (95% CI −21.6 to −19.3 minutes, P<0.001).
Conclusion
Using WhatsApp for inter-hospital transfer in primary PCI is associated with significantly shorter D2B times.
Key time intervals among study groups
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Bendary
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - A.M Mansour
- Mataria Teaching Hospital, Cardiology, Cairo, Egypt
| | - H.K Kabil
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - S.M Mostafa
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
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25
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Hassanin A, Hassanein M, Bendary A, Maksoud MA. Demographics, clinical characteristics, and outcomes among hospitalized heart failure patients across different regions of Egypt. Egypt Heart J 2020; 72:49. [PMID: 32789717 PMCID: PMC7426340 DOI: 10.1186/s43044-020-00082-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022] Open
Abstract
Background Regional level data on hospitalized heart failure (HHF) patients in Egypt is scarce. The aim of this study was to compare the demographics, clinical characteristics, and outcomes of HHF patients from four distinct geographical regions of Egypt. Results Study participants were part of the European Society of Cardiology Heart Failure Long Term (ESC-HF-LT) Registry, which enrolled patients from April 2011 to February 2014. A total of 1661 HHF patients from Egypt were enrolled, of whom 1645 were eligible for analysis: 914 from Alexandria, 249 from Cairo, 409 from the Delta region, and 73 from Upper Egypt. The mean age ranged from 52.2 to 62.8 years and differed significantly between the 4 groups (P < 0.01). Females represented one-third of the cohort (P = 0.5 between groups). The prevalence of obesity, diabetes, and hypertension also varied significantly across the groups (P < 0.01). The most common etiology of heart failure (HF) was ischemic heart disease. HF with reduced systolic function was the leading type of HF in the 4 groups (P = 0.6). The most common valvular abnormality in all regions was mitral regurgitation. For patients with prior history of HF, community-acquired infection was the most common reason for a HF exacerbation in all 4 groups. In-hospital mortality ranged from 2.9 to 7.7% in the 4 groups (P = 0.06). Only Alexandria and Delta groups provided reliable 1-year follow-up data, given low patient retention in Cairo and Upper Egypt groups. At one-year, 32% of patients from Alexandria compared to 22.6% from Delta were re-hospitalized for HF (P < 0.01). Mortality at 1 year was also significantly higher in Alexandria compared to Delta, 31.8 vs 13.2% respectively (P < 0.01). Conclusions HHF patients from different geographic regions of Egypt differed significantly in their demographics, clinical characteristics, and outcomes. Those differences underscore the importance of region-specific HF prevention and management strategies.
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Affiliation(s)
- Ahmed Hassanin
- Westchester Medical Center, New York Medical College, Valhalla, USA.
| | | | | | - Madiha Abdel Maksoud
- Colorado School of Public Health, University of Colorado School of Medicine, Aurora, USA
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26
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Reda A, Elserafy AS, Farag E, Mostafa T, Farag N, Elbahry A, Sanad O, Bendary A, Elkersh A, Selim M, Beshay M, Khamis H. Egyptian Association of Vascular Biology and Atherosclerosis (EAVA) consensus on the usage of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Egypt Heart J 2020; 72:23. [PMID: 32424543 PMCID: PMC7235146 DOI: 10.1186/s43044-020-00058-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/27/2020] [Indexed: 01/02/2023] Open
Abstract
Background The current expert view of the PCSK9 inhibitors’ use in Egypt is still ambiguous. Main body Hyperlipidemia is an important, if not the most important, risk factor for the occurrence of atherosclerosis worldwide. Egypt is the most populous country in the Middle East and North Africa and has > 15% of the cardiovascular deaths in the region. The burden of dyslipidemia as seen in the recently published CardioRisk project conducted throughout Egypt shows a high prevalence of dyslipidemia as a risk factor that is still reaching up to 71% in female participants. Reaching the targets for LDL lowering, and thus control of hyperlipidemia, is quite often very difficult especially with the update of the last ESC guidelines. With the advent of PCSK9 inhibitors, the control rate of patients, reduction of cardiac major adverse events, and mortality have been improved. However, Egypt is not considered a rich country on the grounds of annual income, and this raises a concern on which patients would benefit from these expensive medications. Revising the randomized control trials, we analyzed the data that would enable us to control LDL in those patients, at risk, to obtain simple clear indications for the use of these rather expensive medications. Conclusion We recommend the use of PCSK9 inhibitors in addition to statins ± ezetimibe in patients with ASCVD, by definition at very high risk; patients with ASCVD at very high risk who do not tolerate appropriate doses of at least three statins; and familial hypercholesterolaemia patients with clinically diagnosed ASCVD, at very high cardiovascular risk.
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Affiliation(s)
- Ashraf Reda
- Cardiology Department, Faculty of Medicine, Menofia University, Menofia, Egypt.
| | | | - Elsayed Farag
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Tamer Mostafa
- Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nabil Farag
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Atef Elbahry
- Cardiology Unit, Port Fouad Centre, Port Fouad, Egypt
| | - Osama Sanad
- Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed Bendary
- Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt.
| | - Ahmed Elkersh
- Cardiology Department, Faculty of Medicine, Menofia University, Menofia, Egypt
| | | | - Morad Beshay
- Cardiology Department, Faculty of Medicine, Menofia University, Menofia, Egypt
| | - Hazem Khamis
- Cardiology Department, Faculty of Medicine, 6th of October University, Cairo, Egypt
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Bendary A, Bendary M, Salem M. Autonomic regulation device therapy in heart failure with reduced ejection fraction: a systematic review and meta-analysis of randomized controlled trials. Heart Fail Rev 2020; 24:245-254. [PMID: 30317416 DOI: 10.1007/s10741-018-9745-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
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 95% confidence intervals (CIs) at 6-month follow-up. Compared to OMT alone, ART by devices in HFrEF significantly improves NYHA class (OR 2.26, 95% CI 1.33 to 3.83, P = 0.003), increases 6-MHWD (MD 45.53 m, 95% CI 30.61 to 60.45, P < 0.00001), improves MLHFQ score (MD - 10.59, 95% CI - 20.62 to - 0.57, P = 0.04) with neutral effect on NT-proBNP levels (MD - 236.5 pg/ml, 95% CI - 523.86 to 50.87, P = 0.11) and LVESVi (MD - 1.01 ml/m2, 95% CI - 4.49 to 2.47, P = 0.57). We concluded that device-based neuromodulation therapy significantly improves functional status and quality of life in patients with HFrEF.
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Affiliation(s)
- Ahmed Bendary
- Cardiology Department, Benha Faculty of Medicine, Benha University, Benha, 13518, Egypt.
| | - Mohamed Bendary
- Department of Biostatistics, National Cancer Institute, Cairo University, Giza, Egypt
| | - Mohamed Salem
- Cardiology Department, Benha Faculty of Medicine, Benha University, Benha, 13518, Egypt
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Bendary A, Magdy M, Mady A, Abushouk AI, Salem M. Nightmare in interventional cardiology: type-V coronary perforation during primary percutaneous coronary intervention in a patient with anterior ST-segment elevation myocardial infarction. Coron Artery Dis 2020; 31:567-568. [PMID: 32271237 DOI: 10.1097/mca.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ahmed Bendary
- Cardiology Department, Benha Faculty of Medicine, Benha University, Egypt
| | - Mohamed Magdy
- Cardiology Department, Benha Faculty of Medicine, Benha University, Egypt
| | - Amro Mady
- Cardiology Department, Benha Faculty of Medicine, Benha University, Egypt
| | | | - Mohamed Salem
- Cardiology Department, Benha Faculty of Medicine, Benha University, Egypt
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29
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Tawfik W, El-Sherif A, Bendary A, Mahros M, Salem M. Impact of global longitudinal strain on left ventricular remodeling and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI). Echocardiography 2020; 37:570-577. [PMID: 32240553 DOI: 10.1111/echo.14648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/02/2020] [Accepted: 03/12/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Predicting left ventricle (LV) remodeling is important for outcome prediction in patients with ST-segment elevation myocardial infarction (STEMI). Novel echocardiographic techniques may be beneficial for those patients. OBJECTIVES We hypothesized that the semiautomated calculation of baseline global longitudinal strain (GLS) can predict LV remodeling and 6-month clinical outcomes in these patients. METHODS During the period from March to December 2018, 130 patients with successful reperfusion of STEMI were prospectively included. Within 48 hours, patients underwent a baseline GLS study with follow-up study at 6 months. Patients were divided into two groups: group I: patients who showed adverse LV remodeling and group II: patients who did not. The endpoint was a composite of cardiovascular mortality, readmission due to heart failure, and urgent revascularization. RESULTS The mean baseline GLS changed from -13.1 ± 3.5% for group I and -16.8 ± 3.1% for group II, to -10.2 ± 4.7% and -12.6 ± 3.1%, respectively, at 6-month follow-up. ROC analysis demonstrated a cutoff value of baseline GLS > -12.5% predicted LV remodeling with 64.5% sensitivity and 89% specificity (AUC 0.797, 95% CI 0.690-0.904). Multivariate logistic regression analysis model using 6-month MACEs occurrence as a dependent factor showed baseline GLS value> -12.5% to be the only significant independent predictor MACEs occurrence (OR 0.704, 95% CI 0.597-0.829, P < .001). Linear regression analysis showed that for every point estimate deterioration of baseline GLS, there was a significant corresponding 2.55 mL increase in LVEDV at 6-month follow-up (CI -4.501 to -0.612, P = .01). CONCLUSION GLS measurement can predict remodeling and adverse clinical events in STEMI patients.
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Affiliation(s)
- Wael Tawfik
- Cardiology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Amr El-Sherif
- Cardiology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed Bendary
- Cardiology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Mohammed Mahros
- Cardiology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Mohamed Salem
- Cardiology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
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30
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Reda A, Ashraf M, Bendary A, Kazamel G, Rafla S, Bendary M, Elbahry A, Shawky A, Sanad O, Farag E, Elkersh A, Beshay M, Elghwaby H, Mustafa T. Trends in Early Invasive Management of Egyptian Patients with Acute Coronary Syndrome; Data from The Cross-Sectional Cardiorisk Project. ATHEROSCLEROSIS SUPP 2020. [DOI: 10.1016/j.atherosclerosissup.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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31
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Bendary A, Ramzy A, Bendary M, Salem M. Transcatheter aortic valve replacement in patients with severe aortic stenosis and active cancer: a systematic review and meta-analysis. Open Heart 2020; 7:e001131. [PMID: 32201582 PMCID: PMC7066604 DOI: 10.1136/openhrt-2019-001131] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/16/2020] [Accepted: 02/20/2020] [Indexed: 12/29/2022] Open
Abstract
Background Patients with severe aortic stenosis and concomitant active cancer (AC) are considered high-risk patients and usually are not allowed to undergo surgical valve replacement. Transcatheter aortic valve replacement (TAVR) may be an attractive option for them; however, little is known about the outcomes of TAVR in this subset of complex patients. Methods and results In this meta-analysis, Medline, Cochrane Library and Scopus databases were searched (anytime up to April 2019) for studies evaluating the outcomes of TAVR in patients with or without AC. We assessed pooled estimates (with their 95% CIs) of the risk ratio (RR) for the all-cause mortality at the 30-day and 1-year follow-ups, a 4-point safety outcome (any bleeding, stroke, need for a pacemaker and acute kidney injury) and a 2-point efficacy outcome (device success and residual mean gradient (mean difference)). Three studies (5162 patients) were included. Of those patients, a total of 368 (7.1%) had AC. Apart from a significantly higher need for a postprocedural pacemaker (RR 1.29, 95% CI 1.06 to 1.58, p=0.01), TAVR in patients with AC resulted in similar outcomes for safety and efficacy at the 30-day follow-up compared with those without AC. Patients with AC experienced similar rates of the all-cause mortality at the 30-day follow-up compared with those without (RR 0.92, 95% CI 0.53 to 1.59, p=0.76); however, the all-cause mortality was significantly higher in patients with AC at the 1-year follow-up (RR 1.71, 95% CI 1.26 to 2.33, p=0.0006). This mortality difference was independent of cancer stage (advanced or limited) at the 30-day follow-up but not at the 1-year follow-up; only patients with limited cancer stages showed similar all-cause mortality rates compared with those without cancer at the 1-year follow-up (RR 1.22, 95% CI 0.79 to 1.91, p=0.37). Conclusion TAVR in patients with AC is associated with similar 30-day and potentially worse 1-year outcomes compared with those in patients without AC. The 1-year all-cause mortality appears to be dependent on the cancer stage. Involving a specialised oncologist who usually considers cancer stage in the decision-making process and applying additional preoperative scores such as frailty indices might refine the risk assessment process among these patients. PROSPERO registration number CRD42019120416.
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Affiliation(s)
- Ahmed Bendary
- Cardiology, Benha University Faculty of Medicine, Benha, Egypt
| | - Ahmed Ramzy
- Cardiology, Benha University Faculty of Medicine, Benha, Egypt
| | - Mohamed Bendary
- Biostatisitcs, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed Salem
- Cardiology, Benha University Faculty of Medicine, Benha, Egypt
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Bendary A, Magdy M, Abdoul Aal S, Rashid H. Central-to-peripheral systolic blood pressure different phenotypes and relation to accuracy of daily used cuff devices. Arterial Hypertension 2019. [DOI: 10.5603/ah.a2019.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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33
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Bendary A, Mansour A, Mostafa S, Kabeel H. Time-to-reperfusion in ST-segment elevation myocardial infarction undergoing interhospital transfer using WhatsApp smartphone application. Cardiometry 2019. [DOI: 10.12710/cardiometry.2019.15.5662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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34
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Reda A, Ashraf M, Bendary A, Elbahry A, Farag E, Bendary M, Tabl MA, Mostafa T, Wadie M, Selim M. P5487Premature coronary artery disease among Egyptian patients with acute coronary syndrome; data from the cross-sectional cardio-risk project. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
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% versus 33%, P<0.001) and smoking (50% versus 47%, P<0.001) in patients with premature CAD when compared to others. Interestingly, rates of documented dyslipidemia were similar between groups (49% versus 47%, P=0.45) with no significant difference in low density lipoprotein-cholesterol levels (131.7±48.5 versus 130.2±45.2 mg/dl, P=0.4). Patients with premature CAD tended to present more frequently with ST-elevation myocardial infarction (STEMI) (50% versus 46%, P=0.035), with higher rates of treatment using primary percutaneous coronary intervention compared to others (48% versus 44%, P=0.04). They were also significantly less likely to receive Coronary Artery Bypass Graft (4% versus 6.5%, P=0.003).
Conclusion
Prevalence of premature CAD is high among Egyptian patients with ACS, due to noticeably larger burden of traditional CV RFs especially smoking and possibly familial hypercholesterolemia. Much effort is still needed in screening for early detection of RFs of atherosclerosis together with more widespread adoption of diagnostic scores for FH such as Dutch Lipid Network criteria.
Acknowledgement/Funding
AstraZeneca
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Affiliation(s)
- A Reda
- Menoufia faculty of medicine, Cardiology, Menoufia, Egypt
| | - M Ashraf
- National Heart Istitute, Giza, Egypt
| | - A Bendary
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - A Elbahry
- Cardiology center, Cardiology, Port Foad, Egypt
| | - E Farag
- Zagazig University Hospitals, Cardiology, Zagazig, Egypt
| | - M Bendary
- National Cancer Institute, Cairo University, Biostatistics, Giza, Egypt
| | - M A Tabl
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - T Mostafa
- Zagazig University Hospitals, Cardiology, Zagazig, Egypt
| | - M Wadie
- Mansoura University, Cardiology, Mansoura, Egypt
| | - M Selim
- National Heart Istitute, Giza, Egypt
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Bendary A, Afifi M, Tawfik W, Mahros M, Ramzy A, Salem M. P617Early global longitudinal strain predicts late infarct size in patients with anterior ST-segment elevation myocardial infarction treated with a primary percutaneous coronary intervention. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Late infarct size (IS) after STEMI is a determinant of subsequent mortality. Late Gadolinium enhancement in cardiac magnetic resonance imaging (LGE-CMRI) is the gold standard for IS measurement, however, it is not readily accessible in many areas.
Aims
To evaluate the value of early baseline 2D-echocardiographic global longitudinal strain (GLS) for prediction of late IS after STEMI.
Methods
From October 2017 to July 2018, we studied 100 patients with their 1st anterior STEMI treated with a PPCI. Baseline GLS calculation was performed within 48 hours of admission. The average value of the 9 segments supplied by the LAD was assessed separately (anterior GLS). Infarct size was assessed 3 months later using LGE-CMRI, and large infarcts were defined as ≥20% LV myocardium covered by scar.
Results
Based on CMRI, patients were divided into 2 groups; 57 patients with large infarcts (group I) and 43 patients with small infarcts (group II). Both groups were matched in all baseline demographics and risk factors. There was a good and significant correlation between GLS and the degree of myocardium affected by scar (r=−0.840, P<0.001). This correlation was even higher for anterior GLS (r=−0.867, P<0.001). ROC analysis showed a cut-off point of GLS (−13%) that identified large late IS with a sensitivity and specificity of 66.7% and 88.4% respectively (AUC= 0.85). For anterior GLS, the cut-off point was −9.6% (Sensitivity 94%, specificity 86%, AUC= 0.9).
Baseline 2D-GLS & Late LGE-CMRI
Conclusion
Baseline GLS significantly predicts and correlates well with late IS after anterior STEMI.
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Affiliation(s)
- A Bendary
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - M Afifi
- Benha Faculty of Medicine, Radiology, Benha, Egypt
| | - W Tawfik
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - M Mahros
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - A Ramzy
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - M Salem
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
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Shaheen SM, Wafa A, Mokarab M, Zareef B, Bendary A, Ahmed T, Rashwan A, Selim M, Elmasry M, Abelhady Y, Abdelrazik G, Ibrahim A, Gharib M, Aly K, Wadie M. P4627Presentation, management, and outcomes of STEMI in Egypt: results from the European Society of Cardiology registry on ST elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Apart from few small single-center studies there are limited data about STEMI patients in Egypt.
Patients and methods
The European Society of Cardiology (ESC) Registry on ST Elevation Myocardial Infarction is a prospective, multicenter and observational registry. Nineteen Egyptian centers (with and without PCI facilities) participated in this registry with 1356 patients who were compared to 7420 patients from other ESC countries. Patient recruitment started from March 2016 to February 2018.
Aims of the study
The aims of this study was to describe the characteristics of patients with STEMI, to assess STEMI management patterns, to evaluate in-hospital patient outcome and to compare Egyptian patients with other ESC countries.
Results
Compared to other ESC countries, Egyptian patients were younger (mean age 55.4±11.3 vs. 62.9±12.4; P<0.001 and 4.3% vs. 19.4%% were ≥75 years old; P<0.001) with fewer females (18.4% vs. 25.6%; P<0.001). Fewer Egyptian patients had history of myocardial infarction (7.9% vs. 12.6%; P<0.001), chronic heart failure (2.0% vs. 11.5%; P<0.001), but Egyptians had higher prevalence of current smoking (59.0% vs. 42.8% p<0.001), Diabetes mellitus (40.7% vs. 21.9%, p<0.001). Egypt had longer median time between symptoms onset and first medical contact: 120.0 (60.0; 240.0) vs. 100.0 (50.0; 240.0) p<0.001. Self-presentation rather than EMS presentation was the mode of admission in 86.0% in Egypt vs. 25.8% in EU countries (p<0.001). On qualifying ECG, anterior STEMI was in 57.0% in Egypt vs. 45.9% in other countries (p<0.001). Initial reperfusion therapy was 49.1%, 43.0% and 7.2% for Primary PCI, thrombolytic therapy and no reperfusion in Egypt vs. 85.4%, 7.2% and 7.8% for EU countries, respectively. Thrombolysis when given was in the CCU/ICU rather than EMS or ER in 97.2% in Egypt vs. 43.7% in other countries. Compared to thrombolytic therapy, patients who were treated with primary PCI had less Cerebrovascular accident (0.75% vs. 1.3%; P<0.001), killip Class IV (3.0% vs. 5.9%; P<0.001) or AF (2.5% vs. 3.6%; P 0.008). In hospital mortality was 4.6% in Egypt vs. 3.5% in other countries P 0.040 and was 18.7% in No reperfusion vs. 2.1% in Primary PCI vs. 4.9% in Thrombolysis (P<0.001) among Egyptians. Patients were discharged on Aspirin in 98.6%, Clopidogrel in 91.0%, Ticagrelor in 7.1%, DAPT in 97.6%, Beta Blockers in 82.8%, ACE inhibitors in 84.7%, MRAs in 10.0%, and Statins in 99.7%.
Conclusion
Egyptian STEMI patients were younger, more frequently obese, smokers and diabetics had significantly longer delay between symptoms onset and first medical contact with more self-presentation rather than the recommended EMS presentation. Primary PCI was offered to only half of the patients. In hospital mortality was significantly higher and was highest among non-reperfused patients. National plans for primary and secondary prevention are urgently needed in Egypt.
Acknowledgement/Funding
This registry was funded by the ESC. The Egyptian Society of Cardiology was given a grant of €12000 to help with the implementation of this national E
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Affiliation(s)
- S M Shaheen
- Ain Shams University Hospital, Department of Cardiology, Cairo, Egypt
| | - A Wafa
- Mansoura University, Cardiology, Mansoura, Egypt
| | - M Mokarab
- Al-Azhar University, Cardiology, Cairo, Egypt
| | - B Zareef
- Enaya hospital, Cardiology, Cairo, Egypt
| | - A Bendary
- Benha Faculty of Medicine, Benha, Egypt
| | - T Ahmed
- Assiut University, Assiut, Egypt
| | - A Rashwan
- Fayoum General Hospital, Cardiology, fayoum, Egypt
| | - M Selim
- National Heart Institute, Cairo, Egypt
| | | | | | | | - A Ibrahim
- Helwan University, Cardiology, Badr, Egypt
| | - M Gharib
- Nasr City Insurance Hospital, Cardiology, Cairo, Egypt
| | - K Aly
- Ain Shams University Hospital, Department of Cardiology, Cairo, Egypt
| | - M Wadie
- Mansoura University, Cardiology, Mansoura, Egypt
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Zeymer U, Ludman P, Danchin N, Kala P, Maggioni AP, Weidinger F, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy VK, Nedoshivin A, Petronio AS, Roos-Hesselink J, Wallentin L, Zeymer U, Weidinger F, Zeymer U, Danchin N, Ludman P, Sinnaeve P, Kala P, Ferrari R, Maggioni AP, Goda A, Zelveian P, Weidinger F, Karamfilov K, Motovska Z, Zeymer U, Raungaard B, Marandi T, Shaheen SM, Lidon RM, Karjalainen PP, Kereselidze Z, Alexopoulos D, Becker D, Quinn M, Iakobishvili Z, Al-Farhan H, Sadeghi M, Caporale R, Romeo F, Mirrakhimov E, Serpytis P, Erglis A, Kedev S, Balbi MM, Moore AM, Dudek D, Legutko J, Mimoso J, Tatu-Chitoiu G, Stojkovic S, Shlyakhto E, AlHabib KF, Bunc M, Studencan M, Mourali MS, Bajraktari G, Konte M, Larras F, Lefrancq EF, Mekhaldi S, Laroche C, Maggioni AP, Goda A, Shuka N, Pavli E, Tafaj E, Gishto T, Dibra A, Duka A, Gjana A, Kristo A, Knuti G, Demiraj A, Dado E, Hasimi E, Simoni L, Siqeca M, Sisakian H, Hayrapetyan H, Markosyan S, Galustyan L, Arustamyan N, Kzhdryan H, Pepoyan S, Zirkik A, Von Lewinski D, Paetzold S, Kienzl I, Matyas K, Neunteufl T, Nikfardjam M, Neuhold U, Mihalcz A, Glaser F, Steinwender C, Reiter C, Grund M, Hrncic D, Hoppe U, Hammerer M, Hinterbuchner L, Hengstenberg C, Delle Karth G, Lang I, Weidinger F, Winkler W, Hasun M, Kastner J, Havel C, Derntl M, Oberegger G, Hajos J, Adlbrecht C, Publig T, Leitgeb MC, Wilfing R, Jirak P, Ho CY, Puskas L, Schrutka L, Spinar J, Parenica J, Hlinomaz O, Fendrychova V, Semenka J, Sikora J, Sitar J, Groch L, Rezek M, Novak M, Kramarikova P, Stasek J, Dusek J, Zdrahal P, Polasek R, Karasek J, Seiner J, Sukova N, Varvarovsky I, Lazarák T, Novotny V, Matejka J, Rokyta R, Volovar S, Belohlavek J, Motovska Z, Siranec M, Kamenik M, Kralik R, Raungaard B, Ravkilde J, Jensen SE, Villadsen A, Villefrance K, Schmidt Skov C, Maeng M, Moeller K, Hasan-Ali H, Ahmed TA, Hassan M, ElGuindy A, Farouk Ismail M, Ibrahim Abd El-Aal A, El-sayed Gaafar A, Magdy Hassan H, Ahmed Shafie M, Nabil El-khouly M, Bendary A, Darwish M, Ahmed Y, Amin O, AbdElHakim A, Abosaif K, Kandil H, Galal MAG, El Hefny EE, El Sayed M, Aly K, Mokarrab M, Osman M, Abdelhamid M, Mantawy S, Ali MR, Kaky SD, Khalil VA, Saraya MEA, Talaat A, Nabil M, Mounir WM, Mahmoud K, Aransa A, Kazamel G, Anwar S, Al-Habbaa A, Abd el Monem M, Ismael A, Amin Abu-Sheaishaa M, Abd Rabou MM, Hammouda TMA, Moaaz M, Elkhashab K, Ragab T, Rashwan A, Rmdan A, AbdelRazek G, Ebeid H, Soliman Ghareeb H, Farag N, Zaki M, Seleem M, Torki A, Youssef M, AlLah Nasser NA, Rafaat A, Selim H, Makram MM, Khayyal M, Malasi K, Madkour A, Kolib M, Alkady H, Nagah H, Yossef M, Wafa A, Mahfouz E, Faheem G, Magdy Moris M, Ragab A, Ghazal M, Mabrouk A, Hassan M, El-Masry M, Naseem M, Samir S, Marandi T, Reinmets J, Allvee M, Saar A, Ainla T, Vaide A, Kisseljova M, Pakosta U, Eha J, Lotamois K, Sia J, Myllymaki J, Pinola T, Karjalainen PP, Paana T, Mikkelsson J, Ampio M, Tsivilasvili J, Zurab P, Kereselidze Z, Agladze R, Melia A, Gogoberidze D, Khubua N, Totladze L, Metreveli I, Chikovani A, Eitel I, Pöss J, Werner M, Constantz A, Ahrens C, Zeymer U, Tolksdorf H, Klinger S, Sack S, Heer T, Lekakis J, Kanakakis I, Xenogiannis I, Ermidou K, Makris N, Ntalianis A, Katsaros F, Revi E, Kafkala K, Mihelakis E, Diakakis G, Grammatikopoulos K, Voutsinos D, Alexopoulos D, Xanthopoulou I, Mplani V, Foussas S, Papakonstantinou N, Patsourakos N, Dimopoulos A, Derventzis A, Athanasiou K, Vassilikos VP, Papadopoulos C, Tzikas S, Vogiatzis I, Datsios A, Galitsianos I, Koutsampasopoulos K, Grigoriadis S, Douras A, Baka N, Spathis S, Kyrlidis T, Hatzinikolaou H, Kiss RG, Becker D, Nowotta F, Tóth K, Szabó S, Lakatos C, Jambrik Z, Ruzsa J, Ruzsa Z, Róna S, Toth J, Vargane Kosik A, Toth KSB, Nagy GG, Ondrejkó Z, Körömi Z, Botos B, Pourmoghadas M, Salehi A, Massoumi G, Sadeghi M, Soleimani A, Sarrafzadegan N, Roohafza H, Azarm M, Mirmohammadsadeghi A, Rajabi D, Rahmani Y, Siabani S, Najafi F, Hamzeh B, Karim H, Siabani H, Saleh N, Charehjoo H, Zamzam L, Al-Temimi G, Al-Farhan H, Al-Yassin A, Mohammad A, Ridha A, Al-Saedi G, Atabi N, Sabbar O, Mahmood S, Dakhil Z, Yaseen IF, Almyahi M, Alkenzawi H, Alkinani T, Alyacopy A, Kearney P, Twomey K, Iakobishvili Z, Shlomo N, Beigel R, Caldarola P, Rutigliano D, Sublimi Saponetti L, Locuratolo N, Palumbo V, Scherillo M, Formigli D, Canova P, Musumeci G, Roncali F, Metra M, Lombardi C, Visco E, Rossi L, Meloni L, Montisci R, Pippia V, Marchetti MF, Congia M, Cacace C, Luca G, Boscarelli G, Indolfi C, Ambrosio G, Mongiardo A, Spaccarotella C, De Rosa S, Canino G, Critelli C, Caporale R, Chiappetta D, Battista F, Gabrielli D, Marziali A, Bernabò P, Navazio A, Guerri E, Manca F, Gobbi M, Oreto G, Andò G, Carerj S, Saporito F, Cimmino M, Rigo F, Zuin G, Tuccillo B, Scotto di Uccio F, Irace L, Lorenzoni G, Meloni I, Merella P, Polizzi GM, Pino R, Marzilli M, Morrone D, Caravelli P, Orsini E, Mosa S, Piovaccari G, Santarelli A, Cavazza C, Romeo F, Fedele F, Mancone M, Straito M, Salvi N, Scarparo P, Severino P, Razzini C, Massaro G, Cinque A, Gaudio C, Barillà F, Torromeo C, Porco L, Mei M, Iorio R, Nassiacos D, Barco B, Sinagra G, Falco L, Priolo L, Perkan A, Strana M, Bajraktari G, Percuku L, Berisha G, Mziu B, Beishenkulov M, Abdurashidova T, Toktosunova A, Kaliev K, Serpytis P, Serpytis R, Butkute E, Lizaitis M, Broslavskyte M, Xuereb RG, Moore AM, Mercieca Balbi M, Paris E, Buttigieg L, Musial W, Dobrzycki S, Dubicki A, Kazimierczyk E, Tycinska A, Wojakowski W, Kalanska-Lukasik B, Ochala A, Wanha W, Dworowy S, Sielski J, Janion M, Janion-Sadowska A, Dudek D, Wojtasik-Bakalarz J, Bryniarski L, Peruga JZ, Jonczyk M, Jankowski L, Klecha A, Legutko J, Michalowska J, Brzezinski M, Kozmik T, Kowalczyk T, Adamczuk J, Maliszewski M, Kuziemka P, Plaza P, Jaros A, Pawelec A, Sledz J, Bartus S, Zmuda W, Bogusz M, Wisnicki M, Szastak G, Adamczyk M, Suska M, Czunko P, Opolski G, Kochman J, Tomaniak M, Miernik S, Paczwa K, Witkowski A, Opolski MP, Staruch AD, Kalarus Z, Honisz G, Mencel G, Swierad M, Podolecki T, Marques J, Azevedo P, Pereira MA, Gaspar A, Monteiro S, Goncalves F, Leite L, Mimoso J, Manuel Lopes dos Santos W, Amado J, Pereira D, Silva B, Caires G, Neto M, Rodrigues R, Correia A, Freitas D, Lourenco A, Ferreira F, Sousa F, Portugues J, Calvo L, Almeida F, Alves M, Silva A, Caria R, Seixo F, Militaru C, Ionica E, Tatu-Chitoiu G, Istratoaie O, Florescu M, Lipnitckaia E, Osipova O, Konstantinov S, Bukatov V, Vinokur T, Egorova E, Nefedova E, Levashov S, Gorbunova A, Redkina M, Karaulovskaya N, Bijieva F, Babich N, Smirnova O, Filyanin R, Eseva S, Kutluev A, Chlopenova A, Shtanko A, Kuppar E, Shaekhmurzina E, Ibragimova M, Mullahmetova M, Chepisova M, Kuzminykh M, Betkaraeva M, Namitokov A, Khasanov N, Baleeva L, Galeeva Z, Magamedkerimova F, Ivantsov E, Tavlueva E, Kochergina A, Sedykh D, Kosmachova E, Skibitskiy V, Porodenko N, Namitokov A, Litovka K, Ulbasheva E, Niculina S, Petrova M, Harkov E, Tsybulskaya N, Lobanova A, Chernova A, Kuskaeva A, Kuskaev A, Ruda M, Zateyshchikov D, Gilarov M, Konstantinova E, Koroleva O, Averkova A, Zhukova N, Kalimullin D, Borovkova N, Tokareva A, Buyanova M, Khaisheva L, Pirozhenko A, Novikova T, Yakovlev A, Tyurina T, Lapshin K, Moroshkina N, Kiseleva M, Fedorova S, Krylova L, Duplyakov D, Semenova Y, Rusina A, Ryabov V, Syrkina A, Demianov S, Reitblat O, Artemchuk A, Efremova E, Makeeva E, Menzorov M, Shutov A, Klimova N, Shevchenko I, Elistratova O, Kostyuckova O, Islamov R, Budyak V, Ponomareva E, Ullah Jan U, Alshehri AM, Sedky E, Alsihati Z, Mimish L, Selem A, Malik A, Majeed O, Altnji I, AlShehri M, Aref A, AlHabib K, AlDosary M, Tayel S, Abd AlRahman M, Asfina KN, Abdin Hussein G, Butt M, Markovic Nikolic N, Obradovic S, Djenic N, Brajovic M, Davidovic A, Romanovic R, Novakovic V, Dekleva M, Spasic M, Dzudovic B, Jovic Z, Cvijanovic D, Veljkovic S, Ivanov I, Cankovic M, Jarakovic M, Kovacevic M, Trajkovic M, Mitov V, Jovic A, Hudec M, Gombasky M, Sumbal J, Bohm A, Baranova E, Kovar F, Samos M, Podoba J, Kurray P, Obona T, Remenarikova A, Kollarik B, Verebova D, Kardosova G, Studencan M, Alusik D, Macakova J, Kozlej M, Bayes-Genis A, Sionis A, Garcia Garcia C, Lidon RM, Duran Cambra A, Labata Salvador C, Rueda Sobella F, Sans Rosello J, Vila Perales M, Oliveras Vila T, Ferrer Massot M, Bañeras J, Lekuona I, Zugazabeitia G, Fernandez-Ortiz A, Viana Tejedor A, Ferrera C, Alvarez V, Diaz-Castro O, Agra-Bermejo RM, Gonzalez-Cambeiro C, Gonzalez-Babarro E, Domingo-Del Valle J, Royuela N, Burgos V, Canteli A, Castrillo C, Cobo M, Ruiz M, Abu-Assi E, Garcia Acuna JM. The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry. European Heart Journal - Quality of Care and Clinical Outcomes 2019; 6:100-104. [DOI: 10.1093/ehjqcco/qcz042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/24/2019] [Indexed: 12/20/2022]
Abstract
Abstract
Aims
The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI.
Methods and results
Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristics of patients with STEMI. Other objectives include to assess management patterns and in particular the current use of reperfusion therapies and to evaluate how recommendations of most recent STEMI European guidelines regarding reperfusion therapies and adjunctive pharmacological and non-pharmacological treatments are adopted in clinical practice and how their application can impact on patients’ outcomes. Patients will be followed for 1 year after admission.
Conclusion
The ESC ACCA-EAPCI EORP ACS STEMI registry is an international registry of care and outcomes of patients hospitalized with STEMI. It will provide insights into the contemporary patient profile, management patterns, and 1-year outcome of patients with STEMI.
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Affiliation(s)
- Uwe Zeymer
- Hospital of the City of Ludwigshafen, Medical Clinic B and Institute of Heart Attack Research, Ludwigshafen on the Rhine, Germany
| | - Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, UK
| | - Nicolas Danchin
- Cardiology Department, Georges Pompidou European Hospital, Paris, France
| | - Petr Kala
- Internal Cardiology Department, University Hospital Brno, Czech Republic
| | - Aldo P Maggioni
- EURObservational Research Programme, ESC, Sophia Antipolis, France
- ANMCO Research Center, Florence, Italy
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Reda A, Ashraf M, Soliman M, Ragy H, El Kersh A, Abdou W, Mostafa T, Hassan M, Farag E, Khamis H, Wadie M, Elbahry A, Salama S, Kazamel G, Sadaka M, Mostafa M, Abd El-Bary A, Sanad O, Rafla S, Abd El-Hady Y, Selim M, Farag N, El-Ghawaby H, El-Araby H, Emil S, Beshay M, Shawky A, Yusef M, Abd El-Ghany M, Gamal A, Baghdady Y, Mostafa T, Zahran M, El Rabat K, Bendary A, El Shorbagy A. The pattern of risk-factor profile in Egyptian patients with acute coronary syndrome: phase II of the Egyptian cross-sectional CardioRisk project. Cardiovasc J Afr 2019; 30:87-94. [PMID: 30720847 DOI: 10.5830/cvja-2018-074] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/10/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Egypt is the most populous country in the Middle East and North Africa and has more than 15% of the cardiovascular deaths in the region, but little is known about the prevalence of traditional risk factors and treatment strategies in acute coronary syndrome (ACS) patients across Egypt. METHODS From November 2015 to August 2017, data were collected from 1 681 patients with ACS in 30 coronary care centres, covering 11 governorates across Egypt, spanning the Mediterranean coast, Nile Delta and Upper Egypt, with a focus on risk factors and management strategies. RESULTS Women constituted 25% of the patients. Premature ACS was common, with 43% of men aged less than 55 years, and 67% of women under 65 years. Most men had ST-elevation myocardial infarction (STEMI) (49%), while a larger percentage of women had unstable angina and non-ST-elevation myocardial infarction (NSTEMI) (32% each; p < 0.001). Central obesity was present in 80% of men and 89% of women, with 32% of men and women having atherogenic dyslipidaemia. Current smoking was reported by 62% of men and by 72% of men under 55 years. A larger proportion of women had type 2 diabetes (53 vs 34% of men), hypertension (69 vs 49%), dyslipidaemia, and obesity (71 vs 41%) (p < 0.001 for all). There were no gender differences in most diagnostic and therapeutic procedures, but among STEMI patients, 51% of men underwent primary percutaneous coronary intervention compared to 46% of women (p = 0.064). CONCLUSIONS Central obesity and smoking are extremely prevalent in Egypt, contributing to an increased burden of premature ACS, which warrants tailored prevention strategies. The recognised tendency worldwide to treat men more aggressively was less pronounced than expected.
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Affiliation(s)
- Ashraf Reda
- Department of Cardiology, Faculty of Medicine, Menofia University, Menofia, Egypt.
| | - Mohamed Ashraf
- National Heart Institute, Ministry of Health, Giza, Egypt
| | - Mahmoud Soliman
- Department of Cardiology, Faculty of Medicine, Menofia University, Menofia, Egypt
| | - Hany Ragy
- National Heart Institute, Ministry of Health, Giza, Egypt
| | - Ahmed El Kersh
- Department of Cardiology, Faculty of Medicine, Menofia University, Menofia, Egypt
| | - Waleed Abdou
- National Heart Institute, Ministry of Health, Giza, Egypt
| | - Tamer Mostafa
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammed Hassan
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Elsayed Farag
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hazem Khamis
- Department of Cardiology, Faculty of Medicine, October University, Cairo, Egypt
| | - Moheb Wadie
- Department of Cardiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Atef Elbahry
- Cardiology Unit, Port Foad Centre, Port Foad, Egypt
| | - Sameh Salama
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ghada Kazamel
- National Heart Institute, Ministry of Health, Giza, Egypt
| | - Mohammed Sadaka
- Department of Cardiology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Morsy Mostafa
- Department of Cardiology, Faculty of Medicine, Menofia University, Menofia, Egypt
| | - Akram Abd El-Bary
- Critical Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Osama Sanad
- Department of Cardiology, Faculty of Medicine, Banha University, Banha, Egypt
| | - Samir Rafla
- Department of Cardiology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Yaser Abd El-Hady
- Department of Cardiology, Faculty of Medicine, Bany Swef University, Egypt
| | - Mohammed Selim
- National Heart Institute, Ministry of Health, Giza, Egypt
| | - Nabil Farag
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Helmy El-Ghawaby
- Department of Cardiology, Faculty of Medicine, Bany Swef University, Egypt
| | - Hosam El-Araby
- Department of Cardiology, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Sameh Emil
- Cardiology Unit, Maady Military Hospital, Cairo, Egypt
| | - Morad Beshay
- Department of Cardiology, Faculty of Medicine, Menofia University, Menofia, Egypt
| | - Ahmed Shawky
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Yusef
- Department of Cardiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Awni Gamal
- Department of Cardiology, Faculty of Medicine, Menofia University, Menofia, Egypt
| | - Yaser Baghdady
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Taymour Mostafa
- Department of Cardiology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohammed Zahran
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Khaled El Rabat
- Department of Cardiology, Faculty of Medicine, Banha University, Banha, Egypt
| | - Ahmed Bendary
- Department of Cardiology, Faculty of Medicine, Banha University, Banha, Egypt
| | - Amany El Shorbagy
- Department of Physiology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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Bendary A, Alkhazragy H, Sabry A, Osama M, Elrabbat K. Accelerated dobutamine stress echocardiography protocol versus the standard one in the assessment of coronary artery disease. Int J Cardiovasc Acad 2019. [DOI: 10.4103/ijca.ijca_22_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bendary A, Afifi M, Tawfik W, Mahros M, Ramzy A, Salem M. The predictive value of global longitudinal strain on late infarct size in patients with anterior ST-segment elevation myocardial infarction treated with a primary percutaneous coronary intervention. Int J Cardiovasc Imaging 2018; 35:339-346. [PMID: 30430328 DOI: 10.1007/s10554-018-1498-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/07/2018] [Indexed: 01/30/2023]
Abstract
Late infarct size (IS) after ST segment elevation myocardial infarction (STEMI) is a determinant of subsequent mortality. Late Gadolinium enhancement in cardiac magnetic resonance imaging (LGE-CMRI) is the gold standard for IS measurement, however, it is not readily accessible in many areas. We aimed to evaluate the value of early baseline 2D-echocardiographic global longitudinal strain (GLS) for the prediction of late IS after STEMI. From October 2017 to July 2018, we studied 100 patients with their 1st anterior STEMI treated with primary percutaneous coronary intervention. Baseline GLS calculation was performed within 48 h of admission. In addition, the average value of the nine segments supplied by the LAD was assessed separately (anterior GLS). Infarct size was assessed 3 months later using LGE-CMRI, and large infarcts were defined as ≥ 20% LV myocardium covered by scar. Based on CMRI, we defined two groups; 57 patients with large infarcts (group I) and 43 patients with small infarcts (group II). Both groups were matched in all baseline demographics and risk factors. There was a good and significant correlation between GLS and late IS (r = - 0.840, P < 0.001). This correlation was even higher for anterior GLS (r = - 0.867, P < 0.001). ROC analysis showed a cut-off point of GLS (- 13%) that identified large late IS with a sensitivity and specificity of 66.7% and 88.4% respectively (AUC = 0.85). For anterior GLS, the cut-off point was - 9.6% (Sensitivity 94%, specificity 86%, AUC = 0.9). We concluded that baseline GLS significantly predicts late IS after anterior STEMI.
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Affiliation(s)
- Ahmed Bendary
- Cardiology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt.
| | - Mohamed Afifi
- Radiology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Wael Tawfik
- Cardiology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Mohamed Mahros
- Cardiology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed Ramzy
- Cardiology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Mohamed Salem
- Cardiology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
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Bendary A, Tawfik W, Mahrous M, Salem M. P849Early global longitudinal strain predicts 30-day outcome in patients with preserved ejection fraction after reperfusion of ST-elevation myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Bendary
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - W Tawfik
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - M Mahrous
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - M Salem
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
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Bendary A, Tawfik W, Mahrous M, Salem M. P3456Impact of ST segment resolution on 30-day outcome in patients with preserved ejection fraction after reperfusion of ST-elevation myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Bendary
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - W Tawfik
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - M Mahrous
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - M Salem
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
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Bendary A, Tawfik WAEL, Mahrous M, Salem M. P6436Fibrinolytic therapy in patients with ST-segment elevation myocardial infarction: Accelerated versus standard Streptokinase infusion regimen; a randomized clinical study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Bendary
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | | | - M Mahrous
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - M Salem
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
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Bendary A, El-Husseiny M, Aboul Azm T, Abdoul Moneim A. The predictive value of R-wave peak time on no-reflow in patients with ST-elevation myocardial infarction treated with a primary percutaneous coronary intervention. Egypt Heart J 2018; 70:415-419. [PMID: 30591765 PMCID: PMC6303363 DOI: 10.1016/j.ehj.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022] Open
Abstract
Background Coronary no-reflow (NR) is a dreadful complication of primary percutaneous coronary intervention (pPCI) that is seen in nearly 50% of cases. A great effort is being done to discover simple tools that could predict such a complication. We aimed primarily to study the predictive power of R-wave peak time (RWPT) on NR. Methods From October 2017 to March 2018, we enrolled 123 patients with STEMI treated with pPCI at Benha University Hospital and National Heart Institute. We measured RWPT from infarct-related artery (IRA) leads and assessed the development of NR in all finally included 100 patients (after exclusions). Results Based on occurrence of NR, patients were divided into 2 groups; Group I (n = 39) with NR and group II (n = 61) without NR. Smoking, DM, HTN, longer reperfusion times and higher thrombus burden were significantly associated with NR. Both pre- and postprocedural RWPT were significantly higher in group I than Group II. Preprocedural RWPT > 46 ms predicted NR with a sensitivity and specificity of 79.5% and 86.9% respectively (AUC 0.891, 95% CI 0.82-0.962, P < 0.001). In adjusted multivariate analysis, preprocedural RWPT was found to be among independent predictors for NR (OR: 26.2, 95% CI: 6.5-105.1, P < 0.001). The predictive power of preprocedural RWPT was statistically non-inferior to ST-resolution (STR)% (difference between area under curves = 0.029, P = 0.595). Conclusion RWPT is strongly associated with and significantly predicts the development of NR. This association was statistically non-inferior to the well-known association between STR% and NR.
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Affiliation(s)
- Ahmed Bendary
- Benha Faculty of Medicine, Cardiology Department, Benha University, Egypt
| | | | - Tarek Aboul Azm
- Benha Faculty of Medicine, Cardiology Department, Benha University, Egypt
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Bendary A, Tawfeek W, Mahros M, Salem M. Impact of ST-segment resolution on clinical outcome in patients with ST-segment elevation myocardial infarction and preserved left ventricular function. Ann Noninvasive Electrocardiol 2018; 23:e12562. [PMID: 29856099 DOI: 10.1111/anec.12562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/29/2018] [Accepted: 04/10/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients with successful reperfusion and preserved left ventricular ejection fraction (LVEF) after ST-segment myocardial infarction (STEMI)have always been thought to have low risk for adverse events. Great interest is focused on finding simple, noninvasive tools to refine risk stratification among them. OBJECTIVES We hypothesized that degree of ST-segment resolution (STR) after STEMI can identify high-risk group among patients with LVEF ≥ 50% following STEMI. METHODS During the period from January to July 2017, patients with successful reperfusion of STEMI and LVEF ≥ 50% were prospectively included. Patients were divided into two groups based on the percent of ST segment resolution using single lead STR method; group I (complete STR ≥ 70%) and group II (partial STR 50%-70%). The endpoint was a composite of cardiovascular mortality, re-hospitalization for heart failure and urgent revascularization at 30-day. RESULTS After exclusion, 110 patients were left for final analysis. No significant differences in all baseline characteristics were found between both groups. The primary endpoint occurred in seven patients (12.7%) of group I versus 17 patients (30.9%) of group II (Relative risk = 2.43, 95%CI = 1.1-5.4, p = 0.021) driven by a significant reduction in rates of re-hospitalization due to heart failure. A multivariate logistic regression analysis showed incomplete STR to be a significant independent predictor for 30-dayMACEs (OR 3.25, 95% CI1.2-8.83, p = 0.02) even after adjustment for location of infarction. CONCLUSION Complete STR predicts 30-day outcome in patients with preserved LVEF following successful reperfusion of STEMI.
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Affiliation(s)
- Ahmed Bendary
- Cardiology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Wael Tawfeek
- Cardiology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Mohamed Mahros
- Cardiology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Mohamed Salem
- Cardiology Department, Benha Faculty of Medicine, Benha University, Benha, Egypt
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Bendary A, Tawfek W, Mahros M, Salem M. Primary PCI versus Pharmaco-Invasive Strategy in Patients with ST-Elevation Myocardial Infarction; a Randomized Clinical Study. J Cardiovasc Dis Res 2018. [DOI: 10.5530/jcdr.2018.1.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Bendary A, Tawfeek W, Mahros M, Salem M. The predictive value of global longitudinal strain on clinical outcome in patients with ST-segment elevation myocardial infarction and preserved systolic function. Echocardiography 2018; 35:915-921. [PMID: 29569273 DOI: 10.1111/echo.13866] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) is fundamental for risk stratification after ST-segment elevation myocardial infarction (STEMI). However, it lacks discrimination power within normal range. Novel echocardiographic deformation parameters may be of benefit for those with post-MI preserved LVEF. OBJECTIVES We hypothesized that semiautomated calculation of baseline global longitudinal strain (GLS) can identify high-risk group among patients with LVEF ≥ 50% following STEMI. METHODS During the period from January to July 2017, 110 patients with successful reperfusion of STEMI and LVEF ≥ 50% were prospectively included. Within 48 hours, patients underwent a baseline GLS study with follow-up study at 30 days. The endpoint was a composite of cardiovascular mortality, rehospitalization for heart failure, and urgent revascularization. RESULTS Mean GLS value changed from -16 ± 4% at baseline to -12 ± 4% at 30-day follow-up (P < .001). At 30 days, cardiovascular mortality was reported in 4.5%, 11.8% were rehospitalized due to heart failure, and 5.4% underwent urgent revascularization. ROC curve analysis showed that a cutoff baseline GLS value >-12.65% predicted 30-day MACEs with a sensitivity and specificity of 77.8% and 83.7%, respectively (AUC 0.784, 95% CI 0.646-0.921, P < .001). An adjusted multivariate logistic regression analysis revealed that baseline GLS value >-12.65% to be the only significant independent predictor for occurrence of MACEs (OR 19.54, 95% CI 6.3-61.1, P < .001). CONCLUSION Early GLS calculation predicts 30-day outcome in patients with preserved LVEF following reperfusion of STEMI.
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Affiliation(s)
- Ahmed Bendary
- Benha Faculty of Medicine, Cardiology Department, Benha University, Benha, Egypt
| | - Wael Tawfeek
- Benha Faculty of Medicine, Cardiology Department, Benha University, Benha, Egypt
| | - Mohammed Mahros
- Benha Faculty of Medicine, Cardiology Department, Benha University, Benha, Egypt
| | - Mohamed Salem
- Benha Faculty of Medicine, Cardiology Department, Benha University, Benha, Egypt
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Bendary A, Wagdy B, Azm T, Sanad O. Elevated high-sensitivity C-reactive protein after percutaneous coronary intervention in patients with stable coronary artery disease: A proof-of-concept study. Res Cardiovasc Med 2018. [DOI: 10.4103/rcm.rcm_14_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bendary A, Tawfik W, Mahrous M, Salem M. Fibrinolytic therapy in patients with ST-segment elevation myocardial infarction: Accelerated versus standard Streptokinase infusion regimen. J Cardiovasc Thorac Res 2017; 9:209-214. [PMID: 29391934 PMCID: PMC5787333 DOI: 10.15171/jcvtr.2017.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 12/24/2017] [Indexed: 11/09/2022] Open
Abstract
Introduction: Timely fibrinolysis for acute ST-segment elevation myocardial infarction (STEMI) reduces infarct size and hence preserves LV function and reduces mortality. Optimal regimen of streptokinase (SK) infusion in such patients is a matter of interest. The current study aimed to compare efficacy and safety of accelerated SK infusion regimen in patients with STEMI versus the standard one.
Methods: One hundred consecutive STEMI patients were randomly allocated into one of 2 groups: group I (50 patients) who received accelerated SK regimen (1.5 million units over 30 minutes) and group II (50 patients) received standard SK regimen (1.5 million units over 60 minutes). Efficacy was evaluated non-invasively using clinical (chest pain), ECG (resolution of ST segment) and laboratory tests (earlier and higher peaking of cardiac troponin I). Safety was evaluated by assessment of multiple in-hospital adverse events.
Results: Both groups were statistically matched in all baseline criteria. There was a significant difference between both groups regarding each parameter of successful reperfusion in favor of accelerated regimen. When all these parameters were combined, 31 patients (62%) had successful reperfusion in group I versus 19 patients (38%) in group II (P = 0.016). We did not report any significant difference between both groups regarding in-hospital mortality, in-hospital heart failure, major bleeding, hypotension or allergic reaction to SK. Mean pre-discharge ejection fraction was higher in group I than group II (50.9 ± 6.6% versus 47.3 ± 4.6%, P = 0.002).
Conclusion: Accelerated regimen of SK infusion is safe and effective method of reperfusion in patients with STEMI.
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Affiliation(s)
- Ahmed Bendary
- Cardiology Department, Benha University Hospital, Benha Faculty of Medicine, Egypt
| | - Wael Tawfik
- Cardiology Department, Benha University Hospital, Benha Faculty of Medicine, Egypt
| | - Mohamed Mahrous
- Cardiology Department, Benha University Hospital, Benha Faculty of Medicine, Egypt
| | - Mohamed Salem
- Cardiology Department, Benha University Hospital, Benha Faculty of Medicine, Egypt
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Sanad O, Al-Keshk E, Ramzy A, Tabl MA, Bendary A. Characteristics of coronary artery ectasia and its association with carotid intima-media thickness and high sensitivity C-reactive protein. ATHEROSCLEROSIS SUPP 2017. [DOI: 10.1016/j.atherosclerosissup.2017.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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