Publications by authors named "Mohamed El-Shetry"

2 Publications

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The interplay between atrial fibrillation and acute myocardial infarction.

Br J Hosp Med (Lond) 2021 Feb 27;82(2):1-9. Epub 2021 Feb 27.

Department of Cardiology, Zagazig University, Zagazig, Egypt.

Atrial fibrillation is the most frequently occurring supraventricular arrhythmia in patients presenting with acute myocardial infarction. It is associated with worse outcomes when it coexists with acute myocardial infarction and results in increased morbidity and mortality. Both conditions are closely related to each other and share similar pathophysiological pathways. The management of atrial fibrillation in patients with acute myocardial infarction is challenging since triple antithrombotic therapy is indicated, but this results in a markedly increased risk of bleeding events and mortality. This review addresses the interactions between both conditions including common risk factors, possible mechanisms through which acute myocardial infarction contributes to development of atrial fibrillation and vice versa, and the problem of using anticoagulation in the management of these patients.
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February 2021

Blood Pressure Variability and Atrial Fibrillation in Patients with Acute ST Segment Elevation Myocardial Infarction: The Relation with Left Atrial Electromechanical Delay - A 1-Year Follow-Up Study.

Pulse (Basel) 2020 Aug 10;8(1-2):57-65. Epub 2020 Jun 10.

Cardiology Department, Zagazig University Hospital, Zagazig, Egypt.

Purpose: To investigate the association between 24-h blood pressure variability (BPV) and atrial electromechanical delay (EMD) in patients with ST segment elevation myocardial infarction (STEMI) who developed new-onset atrial fibrillation (NOAF).

Materials And Methods: A total of 175 STEMI patients (age 56.6 ± 10.5 years) who underwent primary percutaneous coronary intervention were subjected to in-hospital 24-h ambulatory BP monitoring, comprehensive echocardiography, and assessment of atrial EMD. The parameters of BPV analyzed were: (a) 24-h standard deviation (SD), (b) the coefficient of variation, and (c) the average of the daytime and nighttime SDs weighted for the duration of the daytime and nighttime interval (SD.

Results: Based on the median of BPV index (SD) = 9.5 mm Hg of all participants, patients were stratified into low and high variability groups (SD: 7.1 ± 1.5 vs.13.5 ± 2.9; < 0.001). Of the 175 patients with STEMI, 29 (16.7%) patients developed NOAF; 26 (28.9%) were in the high variability group and 3.5% were in the low variability group ( < 0.001). Echocardiographic data showed that the left atrial volume index ( < 0.01) and E/e' ratio ( < 0.001) were significantly higher in patients with high BPV. Inter and intra-atrial EMD were significantly increased in the high variability group compared to the low variability group ( < 0.001). With multiple linear analysis, there was significant correlation between SD and intra-left atrial and inter-atrial EMD ( < 0.001 and <0.01, respectively). Cox regression analysis revealed that SD and intra-atrial EMD were independent predictors for NOAF in patients with STEMI (OR = 3.75 and 02.72, respectively; < 0.001). ROC analysis revealed that SD ≥12.8 was the optimal cut-off value for predicting NOAF during follow-up.

Conclusions: Short-term BPV was associated with NOAF during the 1-year follow-up in patients with STEMI. In addition, BPV was correlated significantly with atrial EMD. Herein, BPV was predicted to be an early predictor of NOAF in patients with STEMI.
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August 2020