Publications by authors named "Sahar S Sheta"

4 Publications

  • Page 1 of 1

Fetal heart examination at the time of 13 weeks scan: a 5 years' prospective study.

J Perinat Med 2019 Oct;47(8):871-878

Fetal Medicine Unit, Department of Obstetrics and Gynecology, Cairo University, Cairo, Egypt.

Objective To evaluate our ability in classifying the fetal heart as normal or abnormal during the 1st trimester scan through fetal cardiac examination and determining the best time for this examination. Methods This was a prospective study performed on 3240 pregnant women to examine the fetal heart. Four chambers view and ventricular outflow tracts were mainly examined during the scan. We used grayscale and color mapping in the diagnosis. Color Doppler was used if additional information was needed, and all patients were rescanned during the 2nd trimester to confirm or negate our diagnosis. Results The cardiac findings were normal at both scans in 3108 pregnancies. The same cardiac abnormality was detected at both scans in 79 cases. In 36 cases there was false-positive diagnosis at the early scan; in 20 of these cases, there were mildly abnormal functional findings early in pregnancy with no abnormality found later. In 17 fetuses, there was discordance between the early and later diagnosis due to missed or incorrect diagnoses. The best time to do fetal heart examination during 1st trimester is between 13 and 13 + 6 weeks. Conclusion A high degree of accuracy in the identification of congenital heart disease (CHD) can be achieved by a 1st trimester fetal echocardiography.
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October 2019

Clinical Outcomes in 3343 Children and Adults With Rheumatic Heart Disease From 14 Low- and Middle-Income Countries: Two-Year Follow-Up of the Global Rheumatic Heart Disease Registry (the REMEDY Study).

Circulation 2016 Nov 4;134(19):1456-1466. Epub 2016 Oct 4.

From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University, Ontario, Canada (S.R., P.M., S.I., K.T., S.Y.); Department of Statistical Sciences, University of Cape Town, South Africa (K.M.); Department of Surgery, School of Medicine, College of Health Sciences, University of Nairobi, Kenya (S.O.); Cardiology Unit, Department of Medicine, Kenyatta National Teaching and Referral Hospital, Nairobi, Kenya (B.G.); Cardiology Unit, Department of Medicine, Mulago Hospital, Kampala, Uganda (C.M.); Uganda Heart Institute, Kampala (E.O., P.L.); Faculty of Medicine & Surgery, University of Sana'a, Al-Thawrah Cardiac Center, Yemen (M.M.A.-K.); Paediatric Cardiology Service, Windhoek Central Hospital, Namibia (C.H.-H.); Department of Paediatrics, Division of Paediatric Cardiology, Faculty of Medicine, Cairo University Children's Hospital, Egypt (S.S.S.); Department of Paediatrics and Child Health, Jimma University Hospital, Ethiopia (A.H., W.D.); Department of Internal Medicine, Faculty of Medicine, Addis Ababa, Ethiopia (D.Y.G., S.G.A., A.G.D., B.A.S., D.M.B.); Cardiothoracic Surgery Department, Al Shaab Teaching Hospital and Faculty of Medicine, Alzaiem Alazhari University, Khartoum, Sudan (A.E., A.S.I.); University Teaching Hospital, Department of Paediatrics and Child Health, University of Zambia, Lusaka (J.M.); Departments of Paediatrics and Medicine, Jos University Teaching Hospital, Nigeria (F.B.-T., C.C.Y., G.A.A., O.I., B.O.); Department of Paediatrics and Child Health, University of Limpopo, Polokwane, South Africa (C.S.); Department of Internal Medicine, University of Limpopo, Polokwane, South Africa (R.M.); Faculty of Medicine, Benha University, Cairo, Egypt (A.A.F.); Department of Paediatrics and Child Health, College of Medicine, University of Malawi, Blantyre (N.K.); Department of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Nigeria (M.U.S.); Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria (O.S.O., A.M.A.); Nigeria Ministry of Health, Umuahia, Abia State (O.S.O.); Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria (O.S.O., T.O.); Ahmed Gasim Teaching Hospital, Khartoum, Sudan (H.H.M.E.); Instituto Nacional de Saúde and Eduardo Mondlane University, Maputo, Mozambique (A.O.M.); Department of Cardiology, Dr. George Mukhari Hospital and Sefako Makgatho Health Sciences University, Tshwane, South Africa (P.M.); Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Nigeria (D.O.); and Paediatric Cardiology Unit, Department of Paediatrics, King Faisal Hospital, Kigali, Rwanda (J.M.).

Background: There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease or information on their predictors. We report the 2-year follow-up of individuals with rheumatic heart disease from 14 low- and middle-income countries in Africa and Asia.

Methods: Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for 2 years to assess mortality, congestive heart failure, stroke or transient ischemic attack, recurrent acute rheumatic fever, and infective endocarditis.

Results: Vital status at 24 months was known for 2960 (88.5%) patients. Two-thirds were female. Although patients were young (median age, 28 years; interquartile range, 18-40), the 2-year case fatality rate was high (500 deaths, 16.9%). Mortality rate was 116.3/1000 patient-years in the first year and 65.4/1000 patient-years in the second year. Median age at death was 28.7 years. Independent predictors of death were severe valve disease (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.80-3.11), congestive heart failure (HR, 2.16; 95% CI, 1.70-2.72), New York Heart Association functional class III/IV (HR, 1.67; 95% CI, 1.32-2.10), atrial fibrillation (HR, 1.40; 95% CI, 1.10-1.78), and older age (HR, 1.02; 95% CI, 1.01-1.02 per year increase) at enrollment. Postprimary education (HR, 0.67; 95% CI, 0.54-0.85) and female sex (HR, 0.65; 95% CI, 0.52-0.80) were associated with lower risk of death. Two hundred and four (6.9%) patients had new congestive heart failure (incidence, 38.42/1000 patient-years), 46 (1.6%) had a stroke or transient ischemic attack (8.45/1000 patient-years), 19 (0.6%) had recurrent acute rheumatic fever (3.49/1000 patient-years), and 20 (0.7%) had infective endocarditis (3.65/1000 patient-years). Previous stroke and older age were independent predictors of stroke/transient ischemic attack or systemic embolism. Patients from low- and lower-middle-income countries had significantly higher age- and sex-adjusted mortality than patients from upper-middle-income countries. Valve surgery was significantly more common in upper-middle-income than in lower-middle- or low-income countries.

Conclusions: Patients with clinical rheumatic heart disease have high mortality and morbidity despite being young; those from low- and lower-middle-income countries had a poorer prognosis associated with advanced disease and low education. Programs focused on early detection and the treatment of clinical rheumatic heart disease are required to improve outcomes.
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November 2016

Inhomogeneous Longitudinal Cardiac Rotation and Impaired Left Ventricular Longitudinal Strain in Children and Young Adults with End-Stage Renal Failure Undergoing Hemodialysis.

Echocardiography 2015 Aug 1;32(8):1250-60. Epub 2014 Dec 1.

Department of Pediatric Cardiology, Heart Center Cologne, University Hospital of Cologne, Cologne, Germany.

Background: Cardiac dysfunction frequently complicates the clinical course of patients with end-stage renal failure (ESRF). Recently, we observed abnormal longitudinal cardiac rotation (LR) among patients with ESRF. In this study, we sought to quantify LR mechanics in patients undergoing hemodialysis (HD).

Methods: Twenty-four subjects, 12 ESRF patients (58% male; age 17.5 ± 4.4 years) receiving HD, and 12 aged-matched controls, were prospectively studied. Patients underwent echocardiographic studies before and after HD. LR mechanics were quantified with two-dimensional speckle tracking echocardiography. Peak systolic left ventricular (LV) longitudinal strain and displacement measurements were obtained in all subjects.

Results: LR mechanics were successfully quantified in all subjects using 5 key echocardiographic features of LR. We identified two different inhomogeneous LR motion patterns in 41.7% of ESRF patients, characterized by a delayed timing of LR or increased segmental apical rotation. Inhomogeneous LR patterns were not found in controls. Timing of early-systolic counterclockwise LR increased after HD (P = 0.006). In patients, late-systolic clockwise LR occurred earlier (P = 0.043), and showed a significant prolongation after HD (P = 0.003). Longitudinal strain was significantly impaired in patients (P = 0.015), and further decreased after HD (P < 0.0001). Strong correlations were observed between strain and displacement parameters and LR mechanics.

Conclusions: Quantifying LR using speckle tracking echocardiography was feasible, easy, and reproducible. Inhomogeneous LR motion patterns were demonstrated in a large proportion of patients with ESRF. LV dysfunction seems the most important determinant of inhomogeneous LR. Further studies are required to validate these findings.
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August 2015

Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study).

Eur Heart J 2015 May 25;36(18):1115-22a. Epub 2014 Nov 25.

The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa

Aims: Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment.

Methods And Results: This prospective registry enrolled 3343 patients (median age 28 years, 66.2% female) presenting with RHD at 25 hospitals in 12 African countries, India, and Yemen between January 2010 and November 2012. The majority (63.9%) had moderate-to-severe multivalvular disease complicated by congestive heart failure (33.4%), pulmonary hypertension (28.8%), atrial fibrillation (AF) (21.8%), stroke (7.1%), infective endocarditis (4%), and major bleeding (2.7%). One-quarter of adults and 5.3% of children had decreased left ventricular (LV) systolic function; 23% of adults and 14.1% of children had dilated LVs. Fifty-five percent (n = 1761) of patients were on secondary antibiotic prophylaxis. Oral anti-coagulants were prescribed in 69.5% (n = 946) of patients with mechanical valves (n = 501), AF (n = 397), and high-risk mitral stenosis in sinus rhythm (n = 48). However, only 28.3% (n = 269) had a therapeutic international normalized ratio. Among 1825 women of childbearing age (12-51 years), only 3.6% (n = 65) were on contraception. The utilization of valvuloplasty and valve surgery was higher in upper-middle compared with lower-income countries.

Conclusion: Rheumatic heart disease patients were young, predominantly female, and had high prevalence of major cardiovascular complications. There is suboptimal utilization of secondary antibiotic prophylaxis, oral anti-coagulation, and contraception, and variations in the use of percutaneous and surgical interventions by country income level.
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May 2015