Publications by authors named "Ragab A Mahfouz"

34 Publications

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000507792DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7506217PMC
August 2020

Resting Left Ventricular Dyssynchrony and Mechanical Reserve in Asymptomatic Normotensive Subjects with Early Type 2 Diabetes Mellitus.

Pulse (Basel) 2020 Aug 2;8(1-2):47-56. Epub 2020 Jun 2.

Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

Background: Most diabetic patients have silent ischemia and cardiac dysfunction that is usually observed in the late phase of the disease when it becomes clinically obvious. We hypothesized that left ventricular dyssynchrony (LVdys) (or dispersion) is an early marker of myocardial involvement in asymptomatic early type 2 diabetes mellitus (T2DM) patients. Therefore, we aimed to detect early markers of myocardial dysfunction in early T2DM using LVdys and left ventricular mechanical reserve (LVMR).

Methods: We examined 91 consecutive subjects with early T2DM with speckle tracking imaging to evaluate LVdys and with dobutamine stress to evaluate LVMR (defined as left ventricular mechanical reserve global longitudinal strain [LVMR] ≥2%). Our patients were divided into two groups according to LVdys: group 1 with LVdys ( = 49), and group 2 without LVdys ( = 42).

Results: We found that 49 (54%) subjects in our cohort had resting LVdys (standard deviation of tissue synchronization of the 12 left ventricular segments [Ts-SD-12] ≥34.2 ms). GLS and strain rate were comparable at rest between patients with and without LVdys. On the other hand, LVMR was blunted in those with LVdys ( < 0.001). We found that HbA1c, high-sensitivity C-reactive protein, and left atrial volume index were inversely correlated with LVMR. Multivariate analysis showed that LVdys was the strongest predictor ( < 0.001) of blunted LVMR. Using receiver operating characteristic curve analysis, we found that a Ts-SD-12 ≥36.5 ms was the best cutoff value to predict blunted LVMR (area under the curve = 0.89, < 0.001).

Conclusion: The LVdys (Ts-SD-12) cutoff ≥36.5 ms was the optimal value for prediction of impaired LVMR and might be an early marker of subclinical cardiac dysfunction and risk stratification of subjects with asymptomatic early T2DM with preserved left ventricular ejection fraction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000506712DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7506294PMC
August 2020

Relation between left atrial strain and exercise tolerance in patients with mild mitral stenosis: An insight from 2D speckle-tracking echocardiography.

Echocardiography 2020 09 10;37(9):1406-1412. Epub 2020 Aug 10.

Cardiology Department, Zagazig University Hospitals, Zagazig, Egypt.

Background: Mild mitral stenosis (MS) is a progressive disease but unfortunately, its clinical course is still unclearly studied. We aimed to study the left atrial (LA) deformation in such patients and how it is related to exercise intolerance.

Methods: Seventy-five patients with mitral valve area of 1.81 ± 0.13 cm and 40 healthy control subjects were enrolled. All participants had sinus rhythm, and they underwent conventional echocardiography and LA strain analysis with speckle-tracking study. The following parameters were obtained: left atrial reservoir strain (LAS-s), LA conduit strain (LAS-e), and LA contraction strain (LAS-a). All participants underwent symptoms limited stress ECG using modified Bruce protocol.

Results: Comparing with control subjects, patients with mild MS had significant lower LAS-s value (P < .01) and LAS-e (<0.03). Patients with exercise intolerance (METs < 8) had lower LAS-s (P < .001), LAS-e (P < .01), and LAS-a (P < .05) values compared to those with METs ≥ 8. We found that METs was significantly related to LAS-s (P < .001), brain natriuretic peptide (P < .001), and Δ TAPSE (P < .03). Multivariate analysis showed that LAS-s was an independent predictor of reduced exercise capacity. With ROC analysis, LAS-s ≤ 26.5% was the optimal value for prediction of exercise intolerance in patients with mild MS.

Conclusion: A significant percentage of patients with mild mitral stenosis had exercise intolerance. We found that LAS-s was significantly associated with exercise capacity in patients with mild MS. Hence, we thought that LA deformation could be of great value in the follow-up of patients with mild MS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.14818DOI Listing
September 2020

Relation of microvascular dysfunction and exercise tolerance in patients with heart failure with preserved ejection fraction.

Echocardiography 2020 08 26;37(8):1192-1198. Epub 2020 Jul 26.

Department of Cardiology, Zagazig Faculty of Medicine, Zagazig, Egypt.

Purpose: We aimed to investigate the association of coronary flow reserve (CFR) with exercise tolerance (ET) in subjects with heart failure with preserved ejection fraction (HFpEF).

Materials And Methods: Seventy-seven patients with HFpEF were recruited for the study and compared with 30 healthy matched age and sex controls. All subjects underwent comprehensive echocardiographic evaluation. Exercise tolerance was assessed using 6-minute walking test (6 MWT). CFR was calculated with adenosine stress transthoracic Doppler echocardiography.

Results: Out of 77 patients with HFpEF, 51 (66%) had CFR < 2.0. Patients with CFR < 2.0 had lower 6 MWT distance (P < .001), increased E/e' ratio (P < .001), when compared to HFpEF patients with CFR ≥ 2.0 and controls. In subjects with HFpEF, CFR was significantly correlated with 6 MWTD (P < .001) and inversely correlated with E/e" (P < .01). With univariate analysis, the results showed that left ventricular mass index, left atrial volume index, E/e', and CFR were independent predictors for reduced exercise tolerance, whereas at multivariate analysis, reduced CFR was the only independent predictor (P < .001) for both reduced exercise tolerance in patients with HFpEF.

Conclusion: The current study demonstrated that reduced CFR was an independent predictor for reduced exercise tolerance in patients with HFpEF. We supposed that microvascular dysfunction has an important role in pathogenesis and clinical course in subjects with HFpEF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.14799DOI Listing
August 2020

Fragmented QRS complex is an independent predictor of plaque burden in patients at intermediate risk of coronary artery disease.

Indian Heart J 2019 Sep - Oct;71(5):394-399. Epub 2019 Nov 21.

Cardiology Department, Zagazig University Hospital, Algammah Street, Egypt.

Objective: We aimed to evaluate the relationship between fragmented QRS complex and plaque burden in patients presented with typical chest pain and deemed to have intermediate pretest probability of CAD using coronary computed tomography angiography (CCTA).

Methods: We studied electrocardiograms (ECGs) obtained from 172 subjects (47.5 ± 9.5 years, 125 were men) presented with chest pain and had intermediate pretest probability for CAD. The presence was found and evaluation of CAD was performed with CCTA.

Results: Seventy four (43%) of the study cohort had CCTA-documented CAD. Meanwhile the frequency of fQRS in our cohort was (57%). 70 (71.4%) patients with fQRS had CAD compared with only 4 (5.4%) patients without fQRS (p < 0.001). The number of leads with fQRs was correlated with the calcium score (p < 0.005), segment stenosis score, segment involvement score, total plaque score (TPS), and E/e ratio (p < 0.001, for all). Multivariate analysis demonstrated that fQRS was a strong independent predictor for CAD (or = 2.15, p < 0.001). ROC analysis showed that the number of leads ≥3 was the optimal number for predicting CAD (AUC = 0.89, sensitivity 88%, and specificity 83%, p < 0.001).

Conclusion: Fragmented QRS was seen more often in patients with high plaque burden. We suggest that fQRS might provide a useful noninvasive prognosticator for subjects with intermediate pretest probability of CAD for further investigation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ihj.2019.11.254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013196PMC
August 2020

Ventricular Dyssynchrony based on echocardiographic variables and exercise tolerance After right ventricular pacing: Impact of alternative septal lead locations.

Echocardiography 2020 02 15;37(2):310-316. Epub 2020 Jan 15.

Department of Cardiology, Zagazig University Hospital, Zagazig, Egypt.

Objective: We investigated the impact of alternative locations of right ventricular (RV) pacing on left ventricular function and its relation to exercise capacity.

Methods: Fifty patients who received a single lead pacemaker were divided according to RV pacing site into group 1 "high septum" (n = 15), group 2 "mid-septum" (n = 25), and group 3 "low septum" (n = 10) using a documented fluoroscopic method. Dyssynchrony parameters were obtained using different echocardiographic parameters. Their exercise tolerance was evaluated after 6 months of pacemaker implantation using 6 minutes walk test (6 MWT).

Results: We found a lesser degree of dyssynchrony in mid-location and high location compared with low location pacing (radial dyssynchrony: P < .001; maximum temporal difference: P < .01; inter-ventricular mechanical delay: P < .05, standard deviation of time-to-peak strain by tissue Doppler: P < .05). Sm was significantly increased 6 months following pacemaker implantation in group 1 and group 2 in contrast to group 3 patients (P < .05). Importantly, E/e' increased significantly (P < .001) in patients with low septal location pacing. Furthermore, 6 MWT distance was significantly improved (P < .001) in favor of groups 1 and 2. Importantly, the intra-ventricular dyssynchrony with speckle tracking was considerably less in group 1 and 2 patients. Tps-SL ≤ 120 ms was the optimal value to predict improvement in functional capacity following high to mid-septal pacing locations.

Conclusion: There was significant improvement of functional capacity after RV pacing in high and mid-septal locations compared with low septal location. This was associated with a lesser degree of dyssynchrony in favor with mid- to high septal location.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.14585DOI Listing
February 2020

Right ventricular mechanics and exercise capacity in patients with microvascular angina: The impact of microvascular function.

Echocardiography 2020 01 16;37(1):71-76. Epub 2019 Dec 16.

Cardiology Department, Zagazig University Hospitals, Zagazig University, Zagazig, Egypt.

Objectives: We planned to assess the right ventricular mechanics in subjects with typical chest pain and angiographically normal coronary arteries (microvascular angina [MVA]) and to search for an association between right ventricular mechanics, coronary flow reserve, and exercise tolerance.

Methods: Seventy-one patients with MVA (mean age of 48.5 ± 7.9 years, 63% female) and 30 healthy control subjects were recruited. Right ventricular mechanics were calculated utilizing speckle tracking imaging. The exercise capacity was assessed by metabolic equivalents (METs). Coronary flow reserve (CFR) was calculated as the ratio between hyperemic (in response to intravenous adenosine) diastolic peak flow velocity and the basal diastolic peak velocity.

Results: Coronary flow reserve (a surrogate marker of microvascular dysfunction) was diminished in MVA patients compared with the control group (2.41 ± 0.35 vs 3.35 ± 0.5; P < .03). Patients with lower right ventricular global longitudinal strain (RVGLS) and right ventricular global longitudinal strain rate (RVGLSr) had a considerably lower CFR (P < .001) and a significantly lower MET (P < .001) than patients with normal RV mechanics. Right ventricular global longitudinal strain and RVGLSr were significantly correlated with both CFR and METs in subjects with MVA. Receiver operating characteristic (ROC) curve analysis demonstrated that RVGLS ≤ -14.5 was the best cutoff value for the prediction of impaired exercise tolerance in patients with MVA.

Conclusion: We suggested that impaired right ventricular mechanics in subjects with microvascular angina was associated with reduced exercise capacity. Moreover, right ventricular mechanics is significantly correlated with coronary flow reserve. Henceforth, right ventricular mechanics might be of value for both risk stratification and follow-up in cases with microvascular dysfunction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.14563DOI Listing
January 2020

Association between fragmented QRS and exercise intolerance in hypertensive patients: the relation with coronary flow.

Blood Press 2019 04 22;28(2):124-130. Epub 2019 Jan 22.

a Cardiology Department , Zagazig University Hospital , Zagazig , Egypt.

Objective: We aimed to investigate the relation between the presence of fragmented QRS (FQRS) and exercise intolerance as assessed by 6 minute walking test (6MWT) and its association with coronary flow reserve (CFR).

Methods: One hundred and twenty patients with hypertension (age: 47.3 + 6.9) who were never treated and without left ventricular hypertrophy underwent 6MWT. Echocardiographic examination was obtained for all patients. CFR was calculated as the hyperemic to baseline mean velocity ratio (hyperemia was induced by intravenous adenosine 0.14 mg/kg/min). Patients were stratified into one group with FQRS and another group without FQRS. Forty-eight normotensive subjects with a mean age of 45.7 + 5.3 were recruited and served as a control group.

Results: The frequency of FQRS was 49% in hypertensive patients versus 2% in control subjects. Patients with FQRS had higher systolic blood pressure (p < .05; <.01), a significant lower 6MWTD (p < .001), increased LAVI (p <.05), increased E/e' ratio (p < .01) and lower CFR (p < .001) compared with those without FQRS and controls. FQRS was inversely correlated with CFR (-0.531; p < .001) and 6 MWTD (-0.415; p < .001) and positively correlated with E/e' (0.352, p < .02) and LAVI (0.296; p < .05). By a multivariate regression analysis, FQRS (OR = 6.13; p < .001) and CFR (OR = 3.28; p < .001) were the only two independent predictors for decreased 6 MWTD in hypertensive patients. Importantly the ≥3 cutoff number of leads was found to be the best predictor of CFR < 2.0 in hypertensive patients.

Conclusion: FQRS is frequent and an independent predictor of reduced exercise tolerance in hypertensive patients. More so, it is significantly associated with decreased CFR and left ventricular diastolic dysfunction. In light of these findings, fragmented QRS might be considered a simple marker for risk stratification of hypertensive patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08037051.2019.1569462DOI Listing
April 2019

Right ventricular dyssynchrony and functional capacity before and after percutaneous balloon mitral valvuloplasty in patients with mitral stenosis: Determinants and clinical impact.

Echocardiography 2019 02 19;36(2):297-305. Epub 2018 Dec 19.

Cardiology Department, Zagazig University Hospital, Zagazig, Egypt.

Objective: We aimed to investigate the utility of right ventricular (RV) dyssynchrony to assess functional capacity utilizing 6-minute walking test distance (6MWTD) and to measure brain natriuretic peptide levels (BNP) in patients with mitral stenosis (MS) and to study its value to predict adverse outcome following percutaneous balloon mitral valvuloplasty (PBMV).

Methods: A total of 108 patients with moderate to severe MS (26.5 ± 7.5 years) were included in this study. All were candidates for PBMV. RV strain curves were obtained using two-dimensional speckle-tracking echocardiography, and standard deviation (SD) of 4 segments without RV apex (-SD4) was also assessed. 6MWT and BNP were before and after 12 months following PBMV.

Results: RV-SD4 was significantly prolonged in patients with MS compared with controls (P < 0.001). Patients with 6MWTD ≤300 m had a significantly increased RV-SD4 (P < 0.001) and had higher BNP values (P < 0.03) compared with those with 6MWTD >300 m. RV-SD4 showed a strong correlation with 6MWT and BNP level. RV-SD4 was the strongest independent predictor of adverse outcome following PBMV (P < 0.0001). Receiver operating characteristic analysis showed that RV-SD4 ≥24 ms was the cutoff value which predicts the adverse outcome following PBMV. A considerable improvement of mean 6MWT with significant reduction of BNP levels after 12 months of follow-up (P < 0.001) in subjects with RV dyssynchrony <24 ms.

Conclusion: Right ventricular dyssynchrony is a useful predictor of functional status, as assessed with 6MWTD and BNP level in patients with MS. Furthermore, it might be considered as an independent predictor of adverse outcome following PMBV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.14227DOI Listing
February 2019

Determinants and impact of masked hypertension in offspring of patients with diabetes: relation with coronary flow and cardiac function.

Blood Press 2019 02 18;28(1):57-63. Epub 2018 Dec 18.

a Cardiology Department , Zagazig University Hospital , Zagazig , Egypt.

Objective: We aimed to evaluate the prevalence, determinants and clinical impact of masked hypertension in offspring of patients with diabetes. Masked hypertension was defined according to guidelines as daytime ambulatory blood pressure monitoring "ABPM" ≥135/85 mmHg and clinic BP <140/90 mmHg.

Methods: 100 nondiabetic offspring of patients with diabetes and 60 offspring of healthy people were enrolled; 24-h ABPM was applied to evaluate mean 24-h systolic/diastolic blood pressure "BP", daytime, nighttime and night dipping readings. Left ventricular parameters and coronary flow reserve of the left anterior descending artery (induced by adenosine 0.14 mg/kg/min) was calculated in all offspring.

Results: 29% of offspring of patients with diabetes had masked hypertension compared to only 3.3% offspring in healthy people (p < 0.001). Compared with those without masked hypertension, offspring with masked hypertension had a significantly reduced coronary flow reserve (p < 0.001), significantly higher E/e' (p < 0.01), [a surrogate marker of left ventricular filling pressure], more microalbuminuria (p < 0.01), and higher values of high-sensitive C-reactive protein "CRP" (p < 0.001). Multivariate regression analysis showed that, fasting blood glucose, and high-sensitive CRP, were independently associated with masked hypertension, whilst daytime systolic BP and non-dipping systolic BP were the strongest predictors for masked hypertension. Logistic regression analysis revealed that masked hypertension was independently associated with reduced coronary flow reserve (p < 0.0001) and diastolic dysfunction (p < 0.001).

Conclusion: Masked hypertension is prevalent in offspring of patients with diabetes and significantly associated with reduced coronary flow reserve and left ventricular diastolic dysfunction. These findings suggest that offspring of patients with diabetes constitute a high risk group and deserve close follow up, mainly with the use of ABPM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08037051.2018.1524261DOI Listing
February 2019

Interatrial septal fat thickness and left atrial stiffness are mechanistic links between nonalcoholic fatty liver disease and incident atrial fibrillation.

Echocardiography 2019 02 12;36(2):249-256. Epub 2018 Dec 12.

Cardiology Department, Zagazig University Hospital-Egypt, Zagazig, Egypt.

Background And Aim: Recently, a clear evidence suggests that nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of incident atrial fibrillation (AF). Yet, the underlying pathogenesis is speculative. Thereby, we aimed to investigate the hypothesis that, interatrial thickness (IAST) and left atrial stiffness (LASt) might have mechanistic links between NAFLD and AF.

Methods: Echocardiography and speckle-tracking assessment of left atrial function, transient elastography (TE) of the liver, basal ECG, and Holter monitoring were performed in 180 patients with (NAFLD) and 80 subjects without NAFLD.

Results: Patients with NAFLD had higher values of IAST (P < 0.001), LASt (<0.001), and E/e' ratio (<0.003) compared with controls. IAST was correlated with LASt (r = 0.413; P < 0.001). 15.6% of patients with NAFLD had AF. More so, patients with increased IAST/LASt had a higher incidence of AF (25%) vs 3.8% in those with normal IAST/LASt. The LASt and IAST increased significantly in those with AF compared with those without (P < 0.001). Patients who experienced AF had higher values (P < 0.01) of TE (kPa). The degree of liver stiffness TE (kPa) was correlated with both IAST and LASt (r = 461, r = 0.535; P < 0.001). Furthermore, multivariate regression analysis showed that LASt and IAST were independent predictors of incident AF in subjects with NAFLD.

Conclusions: Our data suggest that increased IAST and LASt index are independently associated with incident atrial fibrillation in patients with NAFLD. Increased IAST and LASt index might provide mechanistic links between NAFLD and incident atrial fibrillation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.14229DOI Listing
February 2019

Association of morning blood pressure surge with carotid intima-media thickness and cardiac dysfunction in patients with cardiac syndrome-X.

Blood Press 2018 10 23;27(5):297-303. Epub 2018 May 23.

a Cardiology Department , Zagazig University Hospital , Zagazig , Egypt.

Background & hypothesis: We hypothesized that exaggerated morning blood pressure surge, may contribute in cardiac dysfunction and arterial stiffness in patients with cardiac syndrome X. Thus we investigated the impact of morning blood pressure surge on cardiac function and carotid intima-media thickness in subjects with cardiac syndrome X.

Methods: We studied patients with cardiac syndrome X using ambulatory blood pressure monitoring and investigated the association of morning blood pressure surge with carotid intima thickness, left atrial volume index and left ventricular filling (E/e'). Seventy patients with cardiac syndrome X were enrolled for the study and compared with 70 age and sex matched controls.

Results: Patients with cardiac syndrome X were stratified based on the systolic morning blood pressure surge value of control subjects to patients with exaggerated blood pressure surge (n = 42) and those with normal morning blood pressure surge (n = 28). Basal heart rate (p < .05), high sensitive C-reactive protein (p < .01), left atrial volume index (p < .01), E/e' (p < .01); carotid intima-media thickness (p < .001) and percentage of detected plaque (p < .005) were significantly higher in patients with exaggerated morning blood pressure surge group than those with morning blood pressure surge group. Morning blood pressure surge was significantly correlated with carotid intima-media thickness, high sensitive C-reactive protein, left atrial volume index and E/e' ratio in patients with cardiac syndrome X. In multivariate analysis, exaggerated morning blood pressure surge was the only independent predictor of increased carotid intima-media thickness (OR = 2.379; p < .001), and diastolic dysfunction (OR = 2.464; p < .001) in patients with cardiac syndrome X.

Conclusion: Our data suggest that excessive morning blood pressure surge is an independent predictor for arterial stiffness and diastolic dysfunction in patients with cardiac syndrome X.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08037051.2018.1476056DOI Listing
October 2018

Redo Scoring for Prediction of Success of Redo-Percutaneous Balloon Mitral Valvuloplasty in Patients with Mitral Restenosis.

J Heart Valve Dis 2017 09;26(5):537-546

Cardiology Department, Zagazig University Hospital, Zagazig, Egypt.

Background: Echocardiographic predictors of redo-percutaneous balloon mitral valvuloplasty (redo-PBMV) have not been well studied, and indications are based mainly on Wilkins score. The study aim was to evaluate the immediate results of redo-PMBV and to introduce a simplified redo-score to predict the success of redo-PBMV.

Methods: Two cohorts of symptomatic patients (derivation group, n = 218; validation group, n = 100) who had undergone redo-PBMV at a mean of 8.1 ± 2.9 years after a first successful PBMV were enrolled in the study. The mean Wilkins scores were 8.5 ± 1.7 in the derivation group and 8.4 ± 1.8 in the validation group. PBMV was performed using a multi-track technique. Independent echocardiographic predictors of outcome were assigned a points value: mitral valve area ≤1.0 cm2 (2 points), posterior mitral valve leaflet length (PMVL)/anterior mitral valve leaflet length (AMVL) ratio ≤1/2 (2 points), doming distance ≤12 mm (3 points), mitral annular calcification (mild = 1 point; moderate = 2 points; severe = 3 points), commissural status (no fusion = 0 points; uni-fusion = 2 points; bi-fusion = 3 points) and chordal length ≤10 mm (2 points).

Results: The minimum score was 5 and the maximum was 13. A receiver operating curve analysis showed the redo score to be highly significant in predicting redo-PBMV immediate results. The cut-off value of redo score to predict a favorable outcome was ≤8, with a sensitivity of 96% and specificity of 85% in the derivation cohort, and a sensitivity of 95% and specificity of 83% in the validation cohort. A Wilkins score ≤8 had a sensitivity of 71% and a specificity of 59% in the derivation cohort, while sensitivity was 70% and specificity 62% in the validation cohort.

Conclusions: The described scoring system was significantly more predictive than the Wilkins score, and was particularly valuable in predicting outcome in patients with a prior PBMV. It may serve as a satisfactory scoring system for correctly selecting patients with mitral restenosis for PBMV.
View Article and Find Full Text PDF

Download full-text PDF

Source
September 2017

Association between left atrial stiffness and aortic plaque thickness in hypertensive patients with stroke.

Echocardiography 2018 07 6;35(7):949-956. Epub 2018 Apr 6.

Neurology Department, Zagazig University Hospital, Zagazig, Egypt.

Objective: Our aim was to investigate the relation between left atrial stiffness (LASt) and thoracic aortic plaque thickness in hypertensive patients with stroke.

Method: A total of 97 hypertensive patients were recruited (age: 59.2 ± 7.5 years), including 56 consecutive patients with undefined stroke and 41 age-matched hypertensive patients without stroke. Left atrial strain and stiffness were measured using speckle tracking echo. Thoracic aortic plaque detection and evaluation was performed using transesophageal echocardiography.

Results: Hypertensive patients with stroke, when compared with those without stroke, had a significantly higher LASt value (P < .001). The percentage of plaque 1-4 mm thickness were comparable in both groups (23.2% vs 21.9%; P > .05). While the percentage of plaque ≥4 mm thickness was much higher in hypertensive patients with stroke (71.4% vs 4.9%; P < .001). LASt was considerably increased in hypertensive group with paroxysmal atrial fibrillation (PAF) when compared to hypertensive group without PAF (P < .01). A significant positive correlation was found between the LASt and plaque thickness (P < .001). Multivariate analysis showed that LASt was the strongest independent predictor for ≥4 mm aortic plaque thickness (Hazard ratio = 6.153; P < .001). With receiver operating characteristic (ROC) curve analysis, LASt > 0.63 was the best cutoff value in predicting aortic plaque thickness ≥ 4 mm.

Conclusion: Left atrial stiffness was significantly associated with aortic plaque thickness ≥ 4 mm, in hypertensive patients with stroke. These finding prevailed the importance of LASt in risk stratification of hypertension.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.13877DOI Listing
July 2018

Ventricular dyssynchrony as a marker of latent carditis in children with acute rheumatic fever: A tissue Doppler imaging.

Echocardiography 2017 Nov 25;34(11):1667-1673. Epub 2017 Oct 25.

Department of Cardiology, Zagazig University Hospital, Zagazig, Egypt.

Objective: We aimed to investigate the hypothesis that the presence of left ventricular (LV) dyssynchrony in children with acute rheumatic fever (ARF) children may be a predictor of latent rheumatic carditis.

Methods: Eighty-nine children with ARF and 45 healthy control children were included the study. LV dyssynchrony was investigated by color-coded tissue Doppler imaging.

Results: LV dyssynchrony parameters including Ts-SD-12, Ts-12, Ts-SD-6, and Ts-6 were found to be prolonged in children with ARF than in controls (P < .001). We found that 45.2% in children with ARF without carditis had LV dyssynchrony (Ts-SD-12 ≥ 34.4 ms), while 63.4% in children with ARF with carditis had LV dyssynchrony. Follow-up analysis demonstrated that children with arthritis and without dyssynchrony had no adverse events (recurrent rheumatic activity, development of valvular diseases; heart failure and atrial fibrillation), while those with LV dyssynchrony had events rate of 40.9% (P < .001). Likewise, children with carditis had event rates of 63.4%. Ts-SD-12 was found to be correlated with hs-CRP (r = .63; P < .001). Receiver-operating characteristic (ROC) curve analysis showed that a Ts-SD-12 ≥ 36.5 was the optimal cutoff value in predicting unfavorable outcome in patients with ARF, with a sensitivity of 95% and specificity of 82%.

Conclusions: We found that children with ARF without any evidence of carditis had a significant LV systolic dyssynchrony spite of normal EF. LV dyssynchrony in those children had a significant event rates on follow-up. These results highlighted the incremental value of LV dyssynchrony as a marker of subclinical carditis in children with ARF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.13720DOI Listing
November 2017

Atrial dyssynchrony and left atrial stiffness are risk markers for cryptogenic stroke in patients with patent foramen ovale.

Echocardiography 2017 12 29;34(12):1888-1894. Epub 2017 Sep 29.

Neurology Department, Zagazig University Hospital, Zagazig, Egypt.

Objective: The clinical and echocardiographic parameters associated with the risk predictors of cryptogenic stroke (CS) in patients with patent foramen ovale (PFO) still diverse and with a great debate. We hypothesized that left atrial stiffness (LASt) and atrial dyssynchrony may increase the risk of CS in patients with PFO.

Methods: A total of 129 consecutive patients presented without clinical reasoning of stroke were recruited. Transesophageal echocardiographic assessment was performed to investigate the presence of PFO. PFO was identified in 52% (group I) and absent in 48% (group II). Utilizing speckle-tracking imaging LASt and atrial dyssynchrony was evaluated among patients with PFO (group I) vs those without PFO (group II).

Results: LASt was significantly increased in group I patients compared with group II (P < .001). Likewise patients with PFO had a significant LA dyssynchrony compared with those in group II (P < .001). Interatrial dyssynchrony and left atrial dyssynchrony were correlated with LASt (r = .47 and 0.51, respectively; P < .001). Cardiac arrhythmias were significantly encountered in group I patients (at presentation and with Holter monitoring) P < .001. Besides significantly increase in atrial dyssynchrony and in LASt in patients with arrhythmias compared with those without (P < .001). ROC analysis revealed that LASt index ≥ 0.61 and LA dyssynchrony ≥ 23.5 predicts cardiac arrhythmias in CS patients with PFO with (AUC: 0.85 and 0.87, respectively, P < .001).

Conclusion: In conclusion, we demonstrated that LASt and atrial dyssynchrony might be risk markers of cryptogenic stroke in patients with PFO.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.13721DOI Listing
December 2017

Ventricular dyssynchrony in pregnant women: A tissue Doppler study.

Echocardiography 2017 Jul 10;34(7):968-972. Epub 2017 Jul 10.

Cardiology Department, Zagazig University Hospital, Zagazig, Egypt.

Objective: The aim of the study was to assess the left ventricular (LV) synchronicity in pregnant women and to identify the main determinants of LV dyssynchrony in asymptomatic pregnant women.

Methods: One hundred sixty-seven pregnant women consecutively and 48 age-matched nonpregnant controls were enrolled. For the assessment of LV systolic dyssynchrony, the standard deviation of the time from QRS onset to peak systolic (Tps-LV- standard deviation [SD]) velocity and the maximal difference of the time from QRS onset to peak systolic velocity (Tps-LV) from 12 segments at the apical views. For the LV diastolic dyssynchrony, the standard deviation of the time from QRS onset to peak diastolic (Tpe-LV-SD) velocity and the maximal difference of the time from QRS onset to peak diastolic velocity (Tpe-LV) were calculated.

Results: Both systolic and diastolic dyssynchrony indexes were significantly higher in pregnant women than in the normal controls (Tps-LV; P<.01, Tps-LV-SD; P<.03, Tpe-LV, P<.05 and Tpe-LV-SD; P<.02). A total of 28 (16.8%) of the pregnant women had a dyssynchrony index above the accepted value for LV dyssynchrony (>34.4 msec). There was a significant correlation between LV dyssynchrony indexes with, multiparty, multifetal pregnancies, systolic blood pressure in pregnant women with LV dyssynchrony. Additionally LV dyssynchrony was significantly associated with elevated E/e" and brain natriuretic peptide (BNP).

Conclusions: Both systolic synchronicity and diastolic synchronicity were affected in pregnant women compared to nonpregnant women. LV dyssynchrony was significantly correlated with age, multiparity, and BNP level. Early detectable changes in systolic and diastolic synchrony may be present in pregnant women at higher risk of peripartum cardiomyopathy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.13579DOI Listing
July 2017

Coronary flow reserve in mitral stenosis before and after percutaneous balloon mitral valvuloplasty.

Int J Cardiovasc Imaging 2017 Sep 4;33(9):1371-1376. Epub 2017 Apr 4.

Cardiology Department, Zagazig University Hospital, Zagazig, Egypt.

We aimed to evaluate the coronary flow reserve (CFR) before and after percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral stenosis (MS) and its association to clinical events. A prospective study included 45 patients with mitral stenosis candidate for PBMV (age 38 ± 19 years, 27 were females) and 20 with matched age and sex, healthy controls were included in the study. Noninvasive CFR was measured using transthoracic echocardiography and utilizing adenosine stress echocardiography (0.14 mg/kg/min) before PMBV, and one weak post PBMV using multi-tract balloon valvuloplasty technique. CFR was significantly lower in patients with MS compared to controls (P < 0.001). Moreover the CFR was significantly increased post-PBMV (P < 0.001) associated with significant increase in LVEF% (P < 0.05), decrease in systolic pulmonary artery pressure (P < 0.001), significant increase in TAPSE (P < 0.001). CFR was significantly correlated with the degree of change (Δ) in MVA, TAPSE, LVEF%, mean mitral PG and sPAP (r = 0.77, P < 0.001, r = 0.63; P < 0.001; r = 0.42; P < 0.05; r = -0.81; P < 0.001 and r = -0.65; P < 0.001). Mitral valve stenosis was associated with significantly impaired coronary flow reserve that significantly improved after PMBV. The improved CFR values were significantly correlated with the gain in the MVA and the improvement in the functions of both left and right ventricles.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10554-017-1121-3DOI Listing
September 2017

Longitudinal function and ventricular dyssynchrony are restored in children with pulmonary stenosis after percutaneous balloon pulmonary valvuloplasty.

Int J Cardiovasc Imaging 2017 Apr 10;33(4):533-538. Epub 2016 Dec 10.

Cardiology Department, Zagazig University Hospitals, Zagazig, Egypt.

The aim of this study was to evaluate the impact of balloon pulmonary valvuloplasty on longitudinal ventricular dysfunction and cardiac dyssynchrony in children with congenital moderately severe pulmonary stenosis (PS). Forty-eight children with congenital moderately severe valvular pulmonary stenosis and 36 age-matched normal children were included. Successful percutaneous balloon pulmonary valvuloplasty was performed for children with PS. Longitudinal Cardiac function and myocardial synchrony was assessed by echocardiography with tissue Doppler imaging (TDI). Mitral annular plane excursion (MAPSE), tricuspid annular plane excursion (TAPSE), left ventricular systolic wave (LVs), right ventricular systolic wave (RVs) and myocardial synchrony was assessed by echocardiography with TDI. TAPSE, RVs, TAPSE/MAPSE ratio and RVs/LVs ratio were significantly lower in children with PS compared to control subjects: (P < 0.001, P < 0.001, P < 0.001 and P < 0.001). All these parameters were significantly improved after balloon valvuloplasty in children with PS. Intra& inter-ventricular dyssynchrony were significantly increased in PS patients than in control group, (P < 0.03, <0.001 and 0.02 respectively). All these variables were significantly reduced after pulmonary valvuloplasty. In children with valvular PS, balloon valvuloplasty restored longitudinal function and cardiac Synchrony. This gives good insights for the importance of early intervention in children with PS to prevent the progression for cardiac deformation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10554-016-1036-4DOI Listing
April 2017

Association of aortic stiffness to brain natriuretic peptide in children before and after device closure of patent ductus arteriosus.

J Saudi Heart Assoc 2015 Jan 21;27(1):23-30. Epub 2014 Jun 21.

Congenital Unit, Cardiology Department, Zagazig University Hospital, Egypt.

Objectives: We evaluated the influence of device closure for patent ductus arteriosus (PDA) on the aortic stiffness index (ASI) and brain natriuretic peptide (BNP) and their association with cardiac function.

Patients And Methods: ASI and echocardiography assessment before and after treatment (16 ± 9 months) in 48 children with PDA (mean age 10 ± 4.5) and 52 control children (mean age 9.7 ± 4.6). BNP level was measured pre-closure for all children, and was measured six months after closure only for children with PDA.

Results: ASI was higher in PDA patients than in controls (P < 0.001). ASI correlated with age (P < 0.05), LVEF% (P < 0.01), E/E' (<0.03), pulmonary artery pressure (P < 0.001), and BNP (P < 0.001). ASI and BNP significantly decreased after closure (P < 0.001). ASI and BNP were independent predictors for post-closure systolic dysfunction (P < 0.001and <0.005, respectively). Receiver operating curve (ROC) analysis showed that ASI ⩾ 13.5, BNP level ⩾75 pg/ml and basal mean pulmonary artery pressure (PAP) ⩾ 23 were powerful predictors for post-closure systolic function.

Conclusion: ASI is significantly associated with BNP and basal PAP in children with PDA. After device closure, aortic distensibility improved significantly and was associated with significant improvement in both systolic and diastolic functions. ASI can be used for monitoring the course of patients with PDA, and may give opportunities for early intervention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsha.2014.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274303PMC
January 2015

Relation of left atrial stiffness to insulin resistance in obese children: Doppler strain imaging study.

Echocardiography 2015 Jul 1;32(7):1157-63. Epub 2014 Nov 1.

Cardiology Department, Zagazig University Hospital, Zagazig, Egypt.

Background: The main objective of the study was to assess the strain measures (peak systolic longitudinal strain [LAS] and stiffness index [LASt]) and their relation to insulin resistance in obese children.

Methods And Results: Eighty obese children (body mass index was 28.2 ± 3.1) and 60 age-matched healthy nonobese children were recruited. Conventional, tissue Doppler imaging LAS and LASt were measured for all children using 2D speckle tracking imaging (2DSI). Insulin resistance was assessed for obese children. Mean LAS was lower, and mean LASt was higher in obese children as compared to control group (11.3 + 2.2 vs. 38.2 + 11.6, P < 0.001, and 1.12 ± 0.23 vs. 0.21 ± 0.11, P < 0.001, respectively). LASt was significantly correlated with insulin resistance (P < 0.0001), and a value of >1.0 of LASt was the best cutoff value which can predict insulin resistance in obese children with a sensitivity of 92% and specificity of 86%.

Conclusions: LAS and LASt differed significantly in obese and nonobese children, in spite of normal left ventricular systolic and diastolic functions. LAS and LASt were associated with insulin resistance in obese children.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.12824DOI Listing
July 2015

Relationship of epicardial fat thickness with endothelial and cardiac functions in children with family history of type 2 diabetes mellitus.

Echocardiography 2015 Jan 25;32(1):28-33. Epub 2014 Mar 25.

Cardiology Department, Zagazig University Hospital, Zagazig, Egypt.

Objective: We hypothesized that many of the pathophysiological mechanisms that cause atherosclerotic disease may be present in early childhood in children with family history of type 2 diabetes. We aimed to investigate the relation of epicardial fat thickness (EFT) with flow-mediated dilatation (FMD) and diastolic function in children with family history of type 2 diabetes mellitus.

Methods: We measured EFT, FMD, in 209 children (mean age 8.6 + 3.2 years). Children were classified into 2 groups: 109 children with a family history of type 2 diabetes (group at risk) and 100 healthy children with age and body mass index matched and without parental history of diabetes constituted the control group.

Results: Epicardial fat thickness was significantly increased in group at risk compared with control children (P < 0.001), while FMD was significantly lower in group at risk versus controls (P < 0.001). EFT was inversely correlated with FMD (r = -0.46; P < 0.001), while it was positively correlated with E/E' (r = 0.48; P < 0.001) and hsCRP (r = 0.39; P < 0.001). Receiver-operating characteristic curve analysis revealed a cutoff value of 5 mm for EFT can predict endothelial dysfunction in children with family history of DM area under the curve (AUC = 0.852) with a specificity of 92.2% and a sensitivity of 77.4%.

Conclusion: Our results suggest that children with family history of type 2 diabetes bear considerably impaired FMD% and diastolic dysfunction associated with increased EFT, that reflecting process that promote the development of cardiovascular disease (CVD).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.12595DOI Listing
January 2015

Left ventricular restrictive filling pattern and the presence of contractile reserve in patients with low-flow/low-gradient severe aortic stenosis.

Echocardiography 2015 Jan 25;32(1):65-70. Epub 2014 Mar 25.

Cardiology Department, Zagazig University Hospitals, Zagazig, Egypt.

Objective: We sought to study diastolic function in patients with low-flow/low-gradient aortic stenosis (LF/LGAS) and to clarify the relationship between contractile reserve on dobutamine stress echocardiography (DSE) and the restrictive filling pattern on echocardiography in patients with LF/LGAS.

Patients And Methods: Thirty patients with LF/LG severe AS were divided into 2 groups. Group I included 14 patients with contractile reserve on DSE. Group II included 16 patients with no contractile reserve on DSE. Diastolic function was studied in all patients using baseline echo Doppler study.

Results: No significant difference was found between both groups regarding baseline left ventriculae end-diastolic dimension (LVEDD), ejection fraction (EF), stroke volume, aortic valve area (AVA), mean transaortic pressure gradient, septal thickness or posterior wall thickness, P > 0.05. Transmitral E/A ratio was 1.3 ± 0.5 compared to 2.6 ± 0.7, respectively, deceleration time (DT) was 160 ± 31 compared to 120 ± 15 ms, isovolumic relaxation time (IVRT) was 81 ± 22 compared to 53 ± 18 ms, S/D ratio was 1.2 ± 0.3 compared to 0.8 ± 0.2, respectively, (P < 0.001 for all).Three patients in group I had restrictive pattern of diastolic dysfunction compared to 12 in group II (P < 0.003). DSE data in both groups showed a peak SV of 64 ± 11 mL compared to 50 ± 7 mL (P < 0.005), peak EF was 42 ± 9 compared to 34 ± 11% (P < 0.03). Peak stress mean transaortic pressure gradient was 39 ± 9 compared to 22 ± 10 mmHg, respectively, P < 001.

Conclusion: Restrictive filling pattern of diastolic dysfunction on baseline echo Doppler study may predict lack of contractile reserve in patients with LF/LG severe AS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.12586DOI Listing
January 2015

Delayed blood pressure recovery ratio and its relation to endothelial function and left ventricular diastolic function in prediabetics.

Echocardiography 2014 Aug 20;31(7):858-64. Epub 2013 Dec 20.

Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.

Background: Endothelial function plays a key role in determining the clinical manifestations of established atherosclerotic lesions and has shown to be associated with suppressed sympathetic tone. Abnormal heart rate recovery (HRR) and systolic blood pressure (SBP) response during recovery has been found to have diagnostic role for detecting cardiovascular risk.

Aim: To investigate whether with abnormal HRR and delayed SBP recovery ratio after exercise could predict endothelial dysfunction in prediabetic subjects.

Methods: Ninety-two prediabetic patients underwent brachial artery flow-mediated dilatation (FMD) test and a maximal exercise stress test. Seventy-eight healthy subjects served as a control group. HRR at 1 minute (HRR1 ) and SBP recovery ratio (SBPRR3 ) was defined as the SBP at minute 3 of recovery divided by SBP at peak exercise. Left ventricular diastolic function was assessed utilizing both conventional and tissue Doppler echocardiography.

Results: Flow-mediated dilatation was significantly decreased in prediabetics versus controls (P < 0.0001). Isovolumetric relaxation time and E/E' were significantly increased in prediabetics (P < 0.01 and <0.001). Delayed SBPRR3 was significantly correlated with impaired endothelial function and (E/E') in prediabetics (r = 0.62, P < 0.001 and r = 0.56, P < 0.001, respectively). Stepwise linear regression analysis revealed that HRR1 and SBPRR3 were significant predictors of endothelial dysfunction (r = 0.61, r(2) = 0.37, P < 0.01 and r = 0.51; r(2) = 27; P < 0.0001).

Conclusions: Abnormal HRR1 and delayed SBP response detected during recovery imply a significant correlation with impaired endothelial function and diastolic dysfunction in prediabetics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.12489DOI Listing
August 2014

Associations of fractional pulse pressure to aortic stiffness and their impact on diastolic function and coronary flow reserve in asymptomatic diabetic patients with normal coronary angiography.

Cardiol J 2013 ;20(6):605-11

Cardiology Department, Faculty of Medicine, Zagazig University, Egypt.

Background: We aimed to assess the relation of fractional pulse pressure (PPf) to aortic stiffness index and their impact on coronary flow reserve (CFR) and left ventricular diastolic function in asymptomatic diabetic patients.

Methods: One hundred and thirty five consecutive asymptomatic diabetic patients (aged 48.8 ± 7.84 years), were included. CFR was calculated noninvasively using transthoracic echo-Doppler assessment with hyperemia induced by infusion of dipyridamole at a rate of 0.56 mg/kg over 4 min. PPf was calculated as pulse pressure divided by mean arterial pressure (SBP - DBP/MAP), while diastolic function was evaluated by means of transmitral flow and tissue Doppler imaging. Aortic stiffness indices (ASI) were measured as previously described.

Results: Diabetic patients with low CFR (n = 52) compared with those with normal CFR (n = 83) exhibited significantly increased PPf (75.2 ± 11.4 vs. 64.5 ± 6.7, p < 0.001). PPf was significantly correlated with ASI (r = 0.520, p < 0.001), E/Em ratio (r = 0.425,p < 0.001) and left atrial volume index (r = 0.462, p < 0.001). CFR was negatively correlated with both PPf (r = -0.68, p < 0.0001). After applying multivariate linear regression analysis,after correction for cardiovascular risk factors, importantly, PPf and ASI remained significant predictors of CFR (p < 0.0001 and p < 0.001, respectively).

Conclusions: PPf was significantly correlated to ASI in asymptomatic diabetic patients. Likewise, increased PPf was associated with impaired CFR and subclinical diastolic dysfunction in diabetic patients. PPf could be utilized as a simple non-invasive predictor of occult atherosclerosis and diastolic dysfunction in diabetic patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/CJ.2013.0160DOI Listing
August 2014

Usefulness of the Global Echo-Doppler Score (GEDS) in selection of patients with mitral stenosis for percutaneous balloon mitral valvuloplasty.

Cardiol J 2014 25;21(2):152-7. Epub 2013 Jun 25.

Department of Cardiology, Faculty of Medicine, Zagazig Univeristy Hospital, Egypt.

Background: We aimed to create a novel modified score by combining anatomic and hemodynamic Doppler-echocardiographic measures for selection of suitable patients with mitral stenosis for percutaneous balloon mitral valvuloplasty (PBMV) and its impact in prediction of outcome.

Methods: 262 consecutive patients candidate for PBMV were enrolled. Wilkins score and a global score based on anatomical parameters (Wilkins score, posterior to anterior mitral leaflet ratio [PMVL/AMVL ratio]; left atrial diameter [LAD]) and hemodynamic parameters (mitral regurgitation [MR]; atrioventricular compliance [CN]; systolic pulmonary artery pressure [SPAP]) were assessed. Patients were classified into two groups according to their outcomes.

Results: Global Echo-Doppler Score (GEDS) for patients with favorable vs. those with unfavorable outcomes was (5.0 ± 0.9 vs. 8.9 ± 1.3; p < 0.001). Sensitivity, specificity, and accuracy of a GEDS ≥ 7 for prediction of cardiac events were 97.5%, 88%, and 97.5%, respectively. The area under the receiver operating characteristic curve was 0.95 (p < 0.001). The correlation coefficient was 0.852 (p < 0.0001) for GEDS 0.531 (p < 0.002), for Wilkins score 0.315 (p < 0.02), for PMVL/AMVL 0.460 (p < 0.01), for LAD; MR: Pre-PBMV (r = 0.348, p < 0.03); CN [mL/mm Hg] (r = 0.579, p < 0.01) and SPAP [mm Hg] (r = 0.499, p < 0.01). In the regression analysis, GEDS, Wilkins score, and LAD were entered into the model. The regression coefficient (r = 0.695) of GEDS was much higher than those of the other 2 factors.

Conclusions: GEDS is an independent predictor of PBMV success and clinical outcome and may be formulated in a scoring system that would help to identify the proper timing and best candidates for PBMV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5603/CJ.a2013.0086DOI Listing
April 2016

Impact of atrioventricular compliance on clinical outcome of patients undergoing successful percutaneous balloon mitral valvuloplasty.

Echocardiography 2013 Nov 6;30(10):1187-93. Epub 2013 Jun 6.

Cardiology Department, Zagazig University Hospital, Zagazig, Egypt.

Objective: We aimed to assess the impact of atrioventricular compliance (Cn) on the clinical outcome, after successful percutaneous balloon mitral valvuloplasty (PBMV).

Methods And Results: Using Doppler echocardiography Cn was estimated from the equation that has been previously validated. Mitral valve area (MVA), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery pressure (PAP), and degree of tricuspid regurgitation (TR) severity were evaluated before, immediately, and every 6 months with a median duration of 32 months after successful PBMV in 150 consecutive patients. An immediate drop in PAP and significant improvement of right ventricle (RV) function was observed after PBMV. Cn was negatively correlated pre and post-PBMV, with the degree of pulmonary artery systolic pressure (PAPs), TAPSE (P < 0.0001). Patients with Cn ≤ 3.75 mL/mmHg had higher incidence of adverse outcome (developing atrial fibrillation [AF], worsening RV function, progressive left atrial dilation, and redo intervention). Multivariate regression analysis showed that the Cn was the strongest independent predictor of PAPs and RV function before and after successful PBMV (P < 0.0001). Cn ≤ 3.75 mL/mmHg was the cutoff value for prediction of clinical events at follow-up.

Conclusions: Atrioventricular compliance was significantly lower in patients with mitral stenosis (MS) with unfavorable outcome after successful PBMV. The RV function and pulmonary hypertension were significantly correlated with the degree of Cn. This suggests a significant role of Cn in patients with MS, providing a good insight for intervention and utilizing Cn as a noninvasive hemodynamic index for risk stratification and proper timing for intervention in patients with MS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.12256DOI Listing
November 2013

Relation of coronary flow reserve and diastolic function to fractional pulse pressure in hypertensive patients.

Authors:
Ragab A Mahfouz

Echocardiography 2013 Oct 10;30(9):1084-90. Epub 2013 May 10.

Professor of Cardiology, Faculty of Medicine, Zagazig University, Egypt.

Fractional pulse pressure (PPf), is thought to more directly reflect arterial stiffness than pulse pressure. Our aim was to evaluate the relationship between coronary flow reserve (CFR), left ventricular diastolic function (LVDf) and PPf in hypertensive patients with normal coronary arteries. Out of 109 hypertensive patients (aged 52.8 ± 9.4 years), with normal coronary angiography, CFR was calculated successfully in 106 patients. CFR was calculated using transthoracic echo Doppler assessment with hyperemia induced by infusion of dipyridamole at a rate of 0.56 mg/kg over 4 minutes, while diastolic function was evaluated by means of transmitral flow and tissue Doppler imaging. PPf was calculated as pulse pressure divided by mean arterial pressure [Systolic blood pressure - Diastolic blood pressure/Mean arterial pressure (SBP - DBP/MAP)], Hypertensive patients with low CFR (n = 54) compared with those with normal CFR (n = 52) exhibited significantly increased PPf (75.2 ± 11.4 vs. 61.5 ± 6.7 P < 0.001). Moreover, patients with higher PPf had significantly decreased transmitral E/A ratio (P < 0.01), as well as increased E/Em ratio (P < 0.01). In hypertensives with low CFR, PPf was negatively correlated with CFR (r = -0.815, P < 0.0001). After applying multivariate linear regression analysis, PPf turned out to be a powerful independent predictor of CFR. Receiver operating characteristic (ROC) analysis revealed that a PPf of ≥0.63 was the best cutoff value for prediction of CFR <2.0 and E/Em ≥ 8 (AUC = 0.916 and 0.929 respectively; P < 0.001). Increased PPf was associated with impaired CFR and diastolic dysfunction in hypertensive patients with normal coronary arteries. PPf could be used as a simple non-invasive index for assessment of coronary microcirculation in hypertensives with normal coronary arteries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.12241DOI Listing
October 2013

The relation of aortic stiffness and in-stent restenosis in patients undergoing percutaneous coronary stenting.

Echocardiography 2013 May 10;30(5):582-7. Epub 2012 Dec 10.

Cardiology Department, Zagazig University Hospital, Egypt.

Background: There is a suggestion that increased aortic stiffness can be the early manifestations of the atherosclerosis process and is related to decrease coronary flow after coronary stenting. We aimed to evaluate whether aortic stiffness could predict occurrence of in-stent restenosis (ISR) and its relation to coronary flow reserve (CFR) after coronary artery stenting.

Methods And Results: The study population included 126 patients with single vessel coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) with bare-metal stenting and at least 12 months of follow-up. All patients underwent noninvasive aortic stiffness index (ASI) assessment before stenting and coronary flow assessment 1 month after stenting. Clinical ISR was observed in 29 (23%) patients, whereas 97 patients remained free of signs or symptoms of recurrent ischemia. ASI was significantly higher in patients with coronary artery disease versus control subjects, and it is significantly increased in patients with restenosis versus those without restenosis (P < 0.0001 and P < 0.001, respectively). There was a significant negative correlation between ASI and CFR (P = 0.0001). The ASI was significantly correlated with C-reactive protein (r = 0.395, P < 0.03). On univariate and multivariate analysis, ASI was the strongest predictor of restenosis (OR 6.8, 95% CI 2.6-13.5).

Conclusions: Increased aortic stiffness was an independent predictor of poststenting impaired coronary flow and occurrence of ISR in patients undergoing PCI. Evaluation of aortic stiffness may represent a useful screening tool to stratify patients according to future risk of restenosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/echo.12078DOI Listing
May 2013

Impact of pulmonary artery stiffness on right ventricular function and tricuspid regurgitation after successful percutaneous balloon mitral valvuloplasty: the importance of early intervention.

Authors:
Ragab A Mahfouz

Echocardiography 2012 Nov 17;29(10):1157-63. Epub 2012 Aug 17.

Cardiology Department, Zagazig University Hospital, Zagazig, Egypt.

Aims: We assessed impact of pulmonary artery stiffness (PAS) on the long-term right ventricular (RV) function and tricuspid regurgitation (TR) changes after percutaneous balloon mitral valvuloplasty (PBMV).

Methods And Results: Using Doppler echocardiography, PAS was calculated by dividing maximal frequency shift of pulmonary flow by the acceleration time, and mitral area, RV function, and degree of TR severity were evaluated before, immediately after, 6 months, and 12 months after successful PBMV in 81 consecutive patients. Compared with control subjects patients with mitral stenosis (MS) had significant higher PAS (P < 0.001). The PAS was significantly lower in patients with progressive RV function improvement and regression of TR (P < 0.001). PAS was significantly correlated with the degree of pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion (TAPSE), and E/E'm ratio (P < 0.0001, <0.0001, and < 0.001, respectively). Multivariate regression analysis showed that the PAS is an independent predictor of TR regression and sustained RV functional improvement after successful PBMV (P < 0.0001).

Conclusions: The changes in RV function and TR after successful PBMV were significantly correlated with the degree of PAS. Despite a sustained increase in mitral valve area, some patients showed no regression of TR, and progressive RV dysfunction suggests a significant role of PAS on RV function and the degree of TR regression in patients with MS suggests that PBMV must be performed early, utilizing PAS as a noninvasive parameter for proper timing for PBMV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1540-8175.2012.01785.xDOI Listing
November 2012