Publications by authors named "Sahrai Saeed"

71 Publications

First phase ejection fraction in aortic stenosis: A useful new measure of early left ventricular systolic dysfunction.

J Clin Ultrasound 2021 Sep 10. Epub 2021 Sep 10.

Cardiothoracic Centre, Guy's and St. Thomas' Hospitals, London, UK.

In aortic stenosis (AS), a left ventricular (LV) ejection fraction (EF) <50% or symptoms are class I indications for aortic valve intervention. However, an EF <50% may be too conservative since subendocardial fibrosis may already have developed. An earlier marker of LV systolic dysfunction is therefore needed and first phase EF (EF1) is a promising new candidate. It is the EF measured over early systole to the point of maximum transaortic blood flow. It may be low in the presence of preserved total LV EF since the heart may compensate by recruiting myosin motors in later systole. The EF1 is inversely related to the grade of AS and directly related to markers of subendocardial fibrosis like late gadolinium enhancement on cardiac magnetic resonance scanning. A reduced EF1 (<25%) predicts adverse clinical events better that total EF and global longitudinal strain. We suggest that it is worth exploring as an indication for surgery in patients with asymptomatic severe AS.
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http://dx.doi.org/10.1002/jcu.23063DOI Listing
September 2021

The impact of age and 24-h blood pressure on arterial health in acute ischemic stroke patients: The Norwegian stroke in the young study.

J Clin Hypertens (Greenwich) 2021 Sep 7. Epub 2021 Sep 7.

Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden.

The impact of age and 24-h ambulatory blood pressure (ABPM) on arterial stiffness and carotid intima-media thickness (cIMT) in ischemic stroke patients younger than 60 years of age is poorly explored. A total of 385 acute ischemic stroke patients (aged 49.6±9.7 years, 68% men) were prospectively included and grouped in younger (15-44 years, n = 93) and middle-aged (45-60 years, n = 292). Arterial stiffness was measured by carotid-femoral pulse wave velocity (PWV), and cIMT by carotid ultrasound. 24-h ABPM was recorded. The middle-aged stroke patients had higher prevalence of smoking, hypertension, diabetes mellitus, metabolic syndrome and hypercholesterolemia, and had higher PWV and cIMT (all p < .05). In multivariable linear regression analyses adjusted for sex, BMI, smoking, diabetes mellitus, total cholesterol, high-density lipoprotein cholesterol, triglycerides, eGFR, systolic BP and concomitant antihypertensive treatment, 1SD (4.4 years) higher age was associated with higher PWV (β = 0.44,R = 0.46, p < .001) in the younger group, and with higher mean cIMT (β = 0.16, R = 0.21, p = .01) in the middle-aged group. In the middle-aged group, 24-h pulse pressure had a significant association with PWV (β = 0.18, R = 0.19, p = .009), while the association with cIMT was attenuated (β = 0.13, R = 0.16, p = .065). 24-h diastolic BP was associated with higher cIMT in the middle-aged group (β = 0.24, p < .001, R = 0.23), but not with PWV in either age groups. Among ischemic stroke patients < 60 years, higher age was associated with increased arterial stiffness for patients up to age 44 years, and with cIMT in middle-aged patients. 24-h pulse pressure was associated with arterial stiffness, and 24-h diastolic BP was associated with cIMT only in middle-aged patients.
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http://dx.doi.org/10.1111/jch.14361DOI Listing
September 2021

Burden of VSD associated aortic valve cusp prolapse with aortic regurgitation and the impact of early surgery on clinical outcomes in South Asia.

Pak J Med Sci 2021 Sep-Oct;37(5):1259-1261

Yaso Emmanuel, Cardiovascular Department, Guy's and St Thomas' Hospital, London, UK.

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http://dx.doi.org/10.12669/pjms.37.5.4845DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8377939PMC
September 2021

Long-term echocardiographic follow-up of a patient with constrictive pericarditis treated with antituberculosis drugs and pericardiectomy.

BMJ Case Rep 2021 Aug 26;14(8). Epub 2021 Aug 26.

Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.

A middle-aged man presented to the Department of Medicine of our hospital due to exertional dyspnoea, ascites and peripheral oedema. He was later transferred to the Department of Heart Disease as his echocardiography indicated constrictive pericarditis, confirmed by cardiac MRI and cardiac catheterisation. After a thorough investigation, his constrictive pericarditis was assumed to be caused by tuberculosis. He was treated with antituberculosis therapy followed by successful surgical subtotal pericardiectomy, leading to immediate improvement of haemodynamics, regression of symptoms and recovery of cardiac function. The patient remained stable at 5-year echocardiographic follow-up with no evidence of diastolic dysfunction.
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http://dx.doi.org/10.1136/bcr-2021-244665DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8395355PMC
August 2021

Antithrombotic therapy in COVID-19.

Pak J Med Sci 2021 Jul-Aug;37(4):931-932

Øyvind Bleie MD, PhD, FESC Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.

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http://dx.doi.org/10.12669/pjms.37.4.4607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8281169PMC
July 2021

Ventricular-arterial coupling: definition, pathophysiology and therapeutic targets in cardiovascular disease.

Expert Rev Cardiovasc Ther 2021 Aug 21;19(8):753-761. Epub 2021 Jul 21.

Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.

Introduction: The heart and arterial system are equally affected by arteriosclerosis/atherosclerosis. There is a constant interaction between the left ventricular (LV) function and the arterial system, termed ventricular-arterial coupling (VAC), which reflects the global cardiovascular efficiency. VAC is traditionally assessed by echocardiography as the ratio of effective arterial elastance (E) over end-systolic elastance (E) (E/E). However, the concept of VAC is evolving and new methods have been proposed such as the ratio of pulse wave velocity (PWV) to global longitudinal strain (GLS) and myocardial work index.

Area Covered: This clinical review presents the hemodynamic background of VAC, its clinical implications and the impact of therapeutic interventions to normalize VAC. The review also summarizes the detrimental effects of cardio-metabolic risk factors on the aorta and LV, and provides an update on arterial load and its impact on LV function. The narrative review is based upon a systemic search of the bibliographic database PubMed for publications on VAC.

Expert Opinion: Newer methods such as PWV/GLS-ratio may be a superior marker of VAC than the traditional echocardiographic E/E in predicting target organ damage and its association with clinical outcomes. Novel anti-diabetic drugs and optimal antihypertensive treatment may normalize VAC in high-risk patients.
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http://dx.doi.org/10.1080/14779072.2021.1955351DOI Listing
August 2021

Acute Myocardial Injury in a Patient with Attention Deficit Hyperactivity Disorder and History of Substance Abuse: A Multimodality Imaging Point of View.

J Cardiovasc Dev Dis 2021 Jun 7;8(6). Epub 2021 Jun 7.

Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway.

Both cannabis and amphetamine are the most commonly used illegal substances worldwide and are associated with a number of adverse cardiovascular effects including transient coronary vasospasm. Here, we present the case of a 39-year-old male admitted to our institution with a 6-h history of severe chest pain and ST-segment elevation on the ECG. Coronary angiography on admission showed normal coronary arteries. The patient had a 14-year history of substance abuse, primarily amphetamine and cannabis, and was prescribed lisdexamfetamin (Aduvanz) for attention deficit hyperactivity disorder (ADHD) for the past 2 years. A cardiac magnetic resonance (CMR) the following day showed widely distributed focal lesions of late gadolinium enhancement in mid- and sub-epicardial myocardium in the anterior, lateral and inferior walls, suggestive of chronic fibrotic lesions. There was no sign of acute myocardial edema. No viral cause was identified during a thorough investigation, including negative SARS-COV-2 and endomyocardial biopsy. Substance-abuse-induced coronary vasospasm leading to ST-segment elevation, myocardial damage with a rise and fall of cardiac TnT, as well as a slightly reduced left ventricular ejection fraction (48%) and regional wall motion abnormalities on echocardiography, was the most likely diagnosis.
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http://dx.doi.org/10.3390/jcdd8060067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227692PMC
June 2021

Acute Myocardial Infarction Due to Microvascular Obstruction in a Young Woman Who Recently Recovered from COVID-19 Infection.

J Cardiovasc Dev Dis 2021 Jun 5;8(6). Epub 2021 Jun 5.

Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway.

Although cardiovascular complications are common in hospitalized COVID-19 patients, those with milder cases who recovered at home are less studied. Here, we report the case of a young woman who recently recovered from COVID-19 at home. A week after recovery, she was admitted to our institution with acute chest pain, signs of ischemia on the electrocardiogram and elevated cardiac troponins. Coronary angiography showed normal epicardial coronary arteries, but the cardiac magnetic resonance showed transmural late gadolinium enhancement (LGE) in the mid-ventricular level of the lateral wall. The findings were strongly suggestive of a minor transmural myocardial infarction. This case report highlights the role of multimodality imaging in detecting cardiac injury in COVID-19 patients as well as the fact that mild COVID-19 cases who recovered at home are also exposed to thromboembolic events during the convalescent period.
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http://dx.doi.org/10.3390/jcdd8060066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227931PMC
June 2021

Dobutamine stress echocardiography for low gradient aortic stenosis: current practice in Poland.

Kardiol Pol 2021 ;79(5):491-492

Cardiothoracic Centre, Guy's and Saint Thomas' Hospital, London, United Kingdom.

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http://dx.doi.org/10.33963/KP.2021.0014DOI Listing
June 2021

The cardiovascular complications in COVID-19: Focus on acute cardiac injury.

Pak J Med Sci 2021 May-Jun;37(3):908-912

Ronak Rajani Cardiothoracic Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom. School of Biomedical Engineering and Imaging Sciences, King's College London, United Kingdom.

At the end of 2019 a novel coronavirus was identified in Wuhan, China. The disease caused by the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) was designated COVID-19 (corona virus disease 2019) by the World Health Organization in early 2020. Up to 80% of patients with COVID-19 experience mild symptoms with severe or critical disease occurring in the remaining 20%. Severe disease is manifested by the development of pneumonia, hypoxia and radiographic lung involvement while critical disease indicates multiorgan involvement with significant respiratory or cardiac compromise. The current estimated case fatality rate from COVID-19 is approximately 1%. Epidemiological studies have shown that advanced age, male gender, previous chronic lung disease, cardiovascular and kidney disease, obesity and diabetes are risk factors for the severity of disease course. In the current focused review, we present an overview of the acute cardiovascular complications of COVID-19, their detection and impact upon prognosis.
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http://dx.doi.org/10.12669/pjms.37.3.4063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8155435PMC
June 2021

Basal septal hypertrophy in hypertension; about time to introduce an objective and reproducible quantification.

J Hypertens 2021 Jul;39(7):1316-1318

Department of Cardiology, Oslo University Hospital, Rikshospitalet.

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http://dx.doi.org/10.1097/HJH.0000000000002844DOI Listing
July 2021

Usefulness of Stress Echocardiography in Assessment of Dynamic Left Ventricular Obstructions: Case Series and Review of the Literature.

Cardiology 2021;146(4):441-450. Epub 2021 May 18.

Department of Internal Medicine, Ålesund Hospital, Ålesund, Norway.

Dynamic left ventricular outflow tract obstruction (DLVOTO) or midcavity obstruction in patients with structurally normal hearts is not uncommon in routine clinical practice and can cause significant symptoms mimicking coronary artery disease or heart failure. Although exercise echocardiography is the gold standard for assessing DLVOTO, dobutamine stress echocardiography (DSE) may be valuable diagnostic modality in patients who are unable to exercise or have an uninterpretable 12-lead electrocardiogram. We provide an updated overview of the relevant literature regarding prevalence, pathophysiology, clinical significance, and prognostic impact of DLVOTO and midcavity obstruction in structurally normal hearts. We also present a clinical series of 4 cases of DLVOTO and midcavity obstruction documented by DSE and discuss the value of different kinds of modern stress imaging modalities involving: (1) contrast-enhanced DSE to assess myocardial perfusion and inducible ischemia; (2) adenosine stress echocardiography to assess coronary flow reserve/microvascular dysfunction; and (3) functional imaging with deformation echocardiography to assess subclinical myocardial dysfunction in patients with structurally normal heart and without significant coronary disease. Based upon our own experiences and a critical review of the current literature, we will then present a practical guidance for management of DLVOTO and midcavity obstruction.
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http://dx.doi.org/10.1159/000516188DOI Listing
August 2021

The influence of left ventricular geometry on myocardial work in essential hypertension.

J Hum Hypertens 2021 May 5. Epub 2021 May 5.

Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia.

We sought to investigate echocardiography-derived myocardial work in hypertensive patients with different left ventricular (LV) geometric patterns. This cross-sectional study included 211 hypertensive patients (74 with normal LV geometry, 53 with concentric remodeling, 46 with eccentric LV hypertrophy (LVH) and 38 with concentric LVH) who underwent complete two-dimensional echocardiographic examination including two-dimensional speckle-tracking echocardiography. Pressure-strain curve was used to determine parameters of myocardial work. Our findings showed that multidirectional LV strain was lower in patients with eccentric and concentric LVH than in those with normal LV geometry and concentric remodeling. Global myocardial work index and global constructive work were higher in patients with eccentric and concentric LVH than in those with normal LV geometry and concentric remodeling. Global wasted work and global efficacy work were similar between groups with different LV geometry. E/e' and LV mass index were associated with global myocardial work index and global constructive work independently of clinical and echocardiographic parameters. In conclusion, myocardial work was higher in patients with eccentric and concentric LVH than in patients with normal LV geometry and concentric remodeling. Increased blood pressure in patients with concentric LVH in comparison with other LV geometric patterns has significant impact on the final result. LV geometry has significant impact on myocardial work in hypertensive patients.
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http://dx.doi.org/10.1038/s41371-021-00543-2DOI Listing
May 2021

Arterial stiffness and COVID-19: A bidirectional cause-effect relationship.

J Clin Hypertens (Greenwich) 2021 06 5;23(6):1099-1103. Epub 2021 May 5.

University of Milano-Bicocca, Milano and Policlinico di Monza, Monza, Italy.

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http://dx.doi.org/10.1111/jch.14259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206945PMC
June 2021

Exercise testing in patients with aortic stenosis: clinically useful.

Pol Arch Intern Med 2021 04 29;131(4):324-325. Epub 2021 Apr 29.

Cardiothoracic Centre, Guy’s and Saint Thomas’ Hospital, London, United Kingdom

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http://dx.doi.org/10.20452/pamw.15978DOI Listing
April 2021

Characteristics of the 24-hour ambulatory blood pressure monitoring in a COVID-19 survivor.

Future Cardiol 2021 Apr 20. Epub 2021 Apr 20.

Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.

COVID-19 infection primarily causes severe pneumonia complicated by acute respiratory distress syndrome and multiorgan failure requiring a ventilator support. We present a case of a 55-year-old male, admitted with COVID-19. He was obese but had no other medical conditions. His blood pressure was measured by his general physician on several occasions in the past, all values being normal (<140/90 mmHg). He developed multiorgan failure, requiring vasopressor and ventilator support for 17 days. A prone positioning improved the arterial oxygenation, and reduced the need for supplemental oxygen. After recovery, he showed persistently elevated blood pressure and sinus tachycardia both in clinic and out-of-clinic. The activation of the renin-angiotensin-aldosterone and sympathetic systems, volume-overload, hyperreninemia and cytokine storm might have contributed to the exaggerated cardiovascular response.
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http://dx.doi.org/10.2217/fca-2020-0235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056747PMC
April 2021

New antidiabetic therapy and HFpEF: light at the end of tunnel?

Heart Fail Rev 2021 Apr 11. Epub 2021 Apr 11.

Clinica Medica, University of Milan-Bicocca, Milan, Italy.

New antidiabetic therapy that includes sodium-glucose co-transporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 receptor (GLP-1R) agonists, and dipeptidyl peptidase 4 (DPP-4) inhibitors showed significant benefit on cardiovascular outcomes in patients with and without type 2 diabetes mellitus, and this was particularly confirmed for SGLT2 inhibitors in subjects with heart failure (HF) with reduced ejection fraction (HFrEF). Their role on patients with HF with preserved ejection fraction (HFpEF) is still not elucidated, but encouraging results coming from the clinical studies indicate their beneficial role. The role of GLP-1R agonists and particularly DPP-4 inhibitors is less clear and debatable. Findings from the meta-analyses are sending positive message about the use of GLP-1R agonists in HFrEF therapy and revealed the improvement of left ventricular (LV) diastolic function in HFpEF. Nevertheless, the relevant medical societies still consider their effect as neutral or insufficiently investigated in HF patients. The impact of DPP-4 inhibitors in HF is the most controversial due to conflicting data that range from negative impact and increased risk of hospitalization due to HF, throughout neutral effect, to beneficial influence on LV diastolic dysfunction. However, this is a very heterogeneous group of medications and some professional societies made clear discrepancy between saxagliptin that might increase risk of HF hospitalization and those DPP-4 inhibitors that have no effect on hospitalization. The aim of this review is to summarize current clinical evidence about the effect of new antidiabetic medications on LV diastolic function and their potential benefits in HFpEF patients.
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http://dx.doi.org/10.1007/s10741-021-10106-9DOI Listing
April 2021

Metastatic tumor of the interventricular septum mimicking myocardial calcification: The role of multimodality imaging.

Echocardiography 2021 05 9;38(5):774-776. Epub 2021 Mar 9.

Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.

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http://dx.doi.org/10.1111/echo.14991DOI Listing
May 2021

Sex differences in transaortic flow rate and association with all-cause mortality in patients with severe aortic stenosis.

Eur Heart J Cardiovasc Imaging 2021 Aug;22(9):977-982

Department of Cardiology, Royal Brompton Hospital, London, UK.

Aims: It is not known whether transaortic flow rate (FR) in aortic stenosis (AS) differs between men and women, and whether the commonly used cut-off of 200 mL/s is prognostic in females. We aimed to explore sex differences in the determinants of FR, and determine the best sex-specific cut-offs for prediction of all-cause mortality.

Methods And Results: Between 2010 and 2017, a total of 1564 symptomatic patients (mean age 76 ± 13 years, 51% men) with severe AS were prospectively included. Mean follow-up was 35 ± 22 months. The prevalence of cardiovascular disease was significantly higher in men than women (63% vs. 42%, P < 0.001). Men had higher left ventricular mass and lower left ventricular ejection fraction compared to women (both P < 0.001). Men were more likely to undergo an aortic valve intervention (AVI) (54% vs. 45%, P = 0.001), while the death rates were similar (42.0% in men and 40.6% in women, P = 0.580). A total of 779 (49.8%) patients underwent an AVI in which 145 (18.6%) died. In a multivariate Cox regression analysis, each 10 mL/s decrease in FR was associated with a 7% increase in hazard ratio (HR) for all-cause mortality (HR 1.07; 95% CI 1.03-1.11, P < 0.001). The best cut-off value of FR for prediction of all-cause mortality was 179 mL/s in women and 209 mL/s in men.

Conclusion: Transaortic FR was lower in women than men. In the group undergoing AVI, lower FR was associated with increased risk of all-cause mortality, and the optimal cut-off for prediction of all-cause mortality was lower in women than men.
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http://dx.doi.org/10.1093/ehjci/jeab045DOI Listing
August 2021

Coronavirus disease 2019 and cardiovascular complications: focused clinical review.

J Hypertens 2021 07;39(7):1282-1292

University of Milano-Bicocca, Milano and Policlinico di Monza, Monza, Italy.

The coronavirus disease 2019 (COVID-19) may cause not only an acute respiratory distress syndrome (ARDS) but also multiple organ damage and failure requiring intensive care and leading to death. Male sex, advanced age, chronic lung disease, chronic kidney disease and cardiovascular disease, such as hypertension, diabetes and obesity have been identified as risk factors for the COVID-19 severity. Presumably, as these three cardiovascular risk factors are associated with a high prevalence of multiorgan damage. In the present focused clinical review, we will discuss the cardiovascular complications of COVID-19 including acute cardiovascular syndrome (acute cardiac injury/COVID cardiomyopathy, thromboembolic complications and arrhythmias) and post-COVID-19 sequelae. Preliminary data shows that the cause of acute cardiovascular syndrome may be multifactorial and involve direct viral invasion of the heart and vascular system, as well as through the immune and inflammation-mediated systemic cytokine storm. COVID-19 survivors may also show persistently elevated blood pressure and sinus tachycardia at rest. Furthermore, poor diabetic control, persistent renal damage and cerebral sequelae, such as persistent cognitive and neuropsychiatric alterations are also frequently reported. A particular attention should be paid towards cardiovascular protection in COVID-19 patients who develop acute cardiovascular syndromes during hospitalization, and/or permanent/semipermanent sequelae after recovery from COVID-19. These conditions may require careful clinical assessment, treatment and close follow-up to avoid short-term and long-term complications.
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http://dx.doi.org/10.1097/HJH.0000000000002819DOI Listing
July 2021

Hypertension and COVID-19: Ongoing Controversies.

Front Cardiovasc Med 2021 17;8:639222. Epub 2021 Feb 17.

Department of Cardiology, University of Milan-Bicocca, Milan, Italy.

Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic responsible for millions of deaths around the world. Hypertension has been identified as one of the most common comorbidities and risk factors for severity and adverse outcome in these patients. Recent investigations have raised the question whether hypertension represents a predictor of outcome in COVID-19 patients independently of other common comorbidities such as diabetes, obesity, other cardiovascular diseases, chronic kidney, liver, and pulmonary diseases. However, the impact of chronic and newly diagnosed hypertension in COVID-19 patients has been insufficiently investigated. The same is true for the relationship between blood pressure levels and outcomes in COVID-19 patients. It seems that the long discussion about the impact of angiotensin-converting enzyme inhibitors (ACEI) and blockers of angiotensin I receptors (ARB) on severity and outcome in COVID-19 is approaching an end because the large number of original studies and meta-analyses discarded the initial findings about higher prevalence of ACEI/ARB use in patients with unfavorable outcomes. Nevertheless, there are many controversies in the relationship between hypertension and COVID-19. The aim of this review article is to provide a clinical overview of the currently available evidence regarding the predictive value of hypertension, the effect of blood pressure levels, the impact of previously known and newly diagnosed hypertension, and the effect of antihypertensive therapy on the severity and outcomes in COVID-19 patients.
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http://dx.doi.org/10.3389/fcvm.2021.639222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925389PMC
February 2021

Predictors of true-severe classical low-flow low-gradient aortic stenosis at resting echocardiography.

Int J Cardiol 2021 07 1;335:93-97. Epub 2021 Mar 1.

Department of Cardiology, Kepler University Hospital, Medical Faculty Johannes Kepler University Linz, Krankenhausstrasse 9, 4020 Linz, Austria; Paracelsus Medical University Salzburg, Salzburg, Austria.

Background: Classical low-flow, low-gradient (LF/LG) aortic stenosis (AS) is subclassified into a true-severe (TS) and a pseudo-severe (PS) subform using low-dose dobutamine stress echocardiography (DSE). In clinical practice a resting peak jet velocity (Vmax) >3.5 m/s or a mean transvalvular gradient (MPG) >35 mmHg suggests the presence of TS classical LF/LG AS, but there is no data to support this. The aim of this study was therefore to investigate whether a resting Vmax >3.5 m/s or MPG >35 mmHg reliably predicted diagnosis of TS classical LF/LG AS.

Methods: One hundred (100) consecutive patients with classical LF/LG AS were prospectively recruited. All patients underwent DSE for subcategorization. The impact of Vmax and MPG for the presence of the TS subform were analyzed.

Results: TS classical LF/LG AS was diagnosed in 72 patients. Resting Vmax and resting MPG predicted true-severity with an ROC-AUC of 0.737 (95%CI: 0.635-0.838; p < 0.001) and 0.725 (95%CI: 0.615-0.834; p < 0.001), respectively. The optimal positive predictive values (PPV) for the diagnosis of TS classical LF/LG AS were obtained with a resting Vmax >3.5 m/s or resting MPG >35 mmHg. In a multivariate logistic regression analysis, Vmax >3.5 m/s was independently associated with a 5.33-fold odds-ratio of TS classical LF/LG AS (OR 5.33; 95%CI: 1.34-21.18, p = 0.018).

Conclusions: TS classical LF/LG AS can be reliably predicted by a resting Vmax >3.5 m/s or a resting MPG >35 mmHg. Further imaging for subclassification is not needed in this situation.
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http://dx.doi.org/10.1016/j.ijcard.2021.02.070DOI Listing
July 2021

The electrocardiogram: Still a useful marker for LV fibrosis in aortic stenosis.

J Electrocardiol 2021 Mar-Apr;65:82-87. Epub 2021 Jan 26.

Cardiothoracic Centre, Guy's and Saint Thomas' Hospital, London, UK.

Left ventricular (LV) strain on the electrocardiogram (ECG) (down-sloping, convex ST-segment depression with asymmetric T-wave inversion in leads V5 and V6) reflects fibrosis as a result of subendocardial ischemia. It is associated with a significantly increased risk of cardiovascular events independent of the presence of LV hypertrophy on the echocardiogram or cardiac magnetic resonance (CMR) scan. Ongoing studies of early aortic valve replacement in asymptomatic patients with severe aortic stenosis are using ECG changes as a marker of possible fibrosis shown by midwall late gadolinium enhancement on CMR. However, until these studies report, it is still reasonable to respond to LV strain on the ECG by tightening control of systemic hypertension and consider intervention in cases where indications are otherwise in borderline.
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http://dx.doi.org/10.1016/j.jelectrocard.2021.01.008DOI Listing
July 2021

The clinical significance and prognostic value of right ventricular wall tension in moderate or severe tricuspid regurgitation.

Future Cardiol 2021 Feb 3. Epub 2021 Feb 3.

Cardiothoracic Center, Guy's & St Thomas' NHS Foundation Trust, London, UK.

We aim to explore the determinants of right ventricular wall tension (RV WT [RV base-to-apex length multiplied by systolic pulmonary artery pressure] and association with all-cause mortality in patients with moderate-to-severe tricuspid regurgitation.  Of total, 180 patients (71 ± 15years, 54% females) were included. An increased RV WT was defined as >3300 mmHgxmm. Patients with increased RV WT (n = 85, 47%) were more likely to be male and taller than patients with normal RV WT. In a multivariable-adjusted model, increased RV WT was associated with a 2.6-fold higher risk of all-cause mortality (HR: 2.59, 95% CI: 1.65-4.06). In patients with significant tricuspid regurgitation, an increased RV WT was common, and associated with a 2.6-fold higher risk of all-cause mortality. Male sex was the only independent determinant.
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http://dx.doi.org/10.2217/fca-2020-0176DOI Listing
February 2021

Impact of transcatheter aortic valve implantation on left ventricular function recovery, mass regression and outcome in patients with aortic stenosis: protocol of the TAVI-NOR prospective study.

BMJ Open 2021 01 20;11(1):e039961. Epub 2021 Jan 20.

Department of Heart Disease, Haukeland University Hospital, Bergen, Norway

Introduction: Transcatheter aortic valve implantation (TAVI) is a widely used treatment option as an alternative to surgical aortic valve replacement in patients with severe aortic stenosis (AS) at high or intermediate surgical risk. TAVI improves symptoms, induces reverse left ventricular (LV) remodelling and increases overall survival. However, a careful patient selection is essential to achieve better outcome. Evidence on LV functional recovery and LV mass regression after TAVI based on contemporary registry data is scarce. The impact of TAVI on the arterial vasculature is also less explored.

Method And Analyses: This is a study of 600 consecutive patients with AS who underwent a TAVI at Haukeland University Hospital, Bergen, Norway. Demographics, clinical data, arterial haemodynamics and echocardiographic parameters were prospectively collected. In the present paper, we describe the design, major scientific objectives and echocardiography imaging protocol of the TAVI-NOR (TAVI in western NORway) study. The main objectives are: To explore the impact of TAVI on cardiac structure and function in patients with severe AS, identify the echocardiographic predictors of reverse LV remodelling, assess survival benefits according to baseline risk profile, evaluate long-term therapeutic success as reflected by reduction in valvular-arterial impedance and to investigate the impact of various types of blood pressure response immediately after TAVI on clinical outcome.

Ethics And Dissemination: The study was approved by the Regional Committees for Medical and Health Research Ethics (REK vest, ref. number 33814) and the Institutional Data Protection Services. Patients' consent was waived. The study findings will be disseminated via peer-reviewed publications and presentation in national and international scientific meetings and conferences.

Trail Registration Number: The study was registered in the international database: ClinicalTrials.gov, Identifier: NCT04417829.
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http://dx.doi.org/10.1136/bmjopen-2020-039961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818832PMC
January 2021

The prevalence and Covariates of Stroke in Khyber Pakhtunkhwa; From a European Perspective.

Pak J Med Sci 2021 Jan-Feb;37(1):1-3

Jukka Putaala MD, PhD. Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

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http://dx.doi.org/10.12669/pjms.37.1.3815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794126PMC
January 2021

The value of multimodality imaging in hypertensive heart disease.

J Hypertens 2021 05;39(5):1040-1043

Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.

Hypertensive heart disease (HHD) includes left ventricular (LV) functional and structural remodeling. For a long time, this involved only LV diastolic dysfunction and LV hypertrophy. However, development of imaging technique enabled more detailed insights into LV mechanics. Its impairment seems to be the first step in the cascade of HHD. Tissue characterization, obtained by cardiac magnetic resonance, opened a completely new chapter in the assessment of HHD. We report a case of a 47-year-old man who was referred to our department for a newly detected heart failure. CT angiography excluded relevant coronary disease and cardiac magnetic resonance revealed focuses of fibrosis in interventricular septum, in addition severely dilated LV with severely reduced ejection fraction. Considering the fact that the patient had longstanding uncontrolled arterial hypertension and that other causes of cardiac remodeling and dysfunction were excluded, we hypothesized that the multimodality imaging approach enabled prompt diagnosis of HHD.
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http://dx.doi.org/10.1097/HJH.0000000000002726DOI Listing
May 2021

Cardiovascular risk assessment in South and Middle-East Asians living in the Western countries.

Pak J Med Sci 2020 Nov-Dec;36(7):1719-1725

Peter M Nilsson, Department of Clinical Sciences, Lund University, Skane University Hospital, Malmo, Sweden.

Nearly a quarter of the world population lives in the South Asian region (India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan, and the Maldives). Due to rapid demographic and epidemiological transition in these countries, the burden of non-communicable diseases is growing, which is a serious public health concern. Particularly, the prevalence of pre-diabetes, diabetes and atherosclerotic cardiovascular disease (CVD) is increasing. South Asians living in the West have also substantially higher risk of CVD and mortality compared with white Europeans and Americans. Further, as a result of global displacement over the past three decades, Middle-Eastern immigrants now represent the largest group of non-European immigrants in Northern Europe. This vulnerable population has been less studied. Hence, the aim of the present review was to address cardiovascular risk assessment in South Asians (primarily people from India, Pakistan and Bangladesh), and Middle-East Asians living in Western countries compared with whites (Caucasians) and present results from some major intervention studies. A systematic search was conducted in PubMed to identify major cardiovascular health studies of South Asian and Middle-Eastern populations living in the West, relevant for this review. Results indicated an increased risk of CVD. In conclusion, both South Asian and Middle-Eastern populations living in the West carry significantly higher risk of diabetes and CVD compared with native white Europeans. Lifestyle interventions have been shown to have beneficial effects in terms of reduction in the risk of diabetes by increasing insulin sensitivity, weight loss as well as better glycemic and lipid control.
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http://dx.doi.org/10.12669/pjms.36.7.3292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674869PMC
November 2020

Covariables of Myocardial Function in Women and Men with Increased Body Mass Index.

High Blood Press Cardiovasc Prev 2020 Dec 24;27(6):579-586. Epub 2020 Oct 24.

Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.

Introduction: Sex-difference in types of cardiac organ damage has been reported in subjects with increased body mass index (BMI). However less is known about sex-differences in left ventricular (LV) myocardial function assessed by global longitudinal strain (GLS) in these subjects.

Methods: 493 subjects (mean age 47 ± 9 years, 61% women) with BMI > 27.0 kg/m and without known cardiac disease underwent 24-hour (24h) ambulatory blood pressure (BP) recording, body composition analysis, carotid-femoral pulse wave velocity (PWV) measurement and echocardiography. LV peak systolic GLS was measured by two-dimensional speckle tracking echocardiography and LV ejection fraction (EF) by biplane Simpson's method. Insulin sensitivity was assessed by homeostatic model of insulin resistance (HOMA-IR).

Results: Women had higher prevalence of increased waist circumference (99% vs. 82%), lower prevalence of hypertension (59 vs. 74%), and lower serum triglycerides (1.3 ± 0.7 vs. 1.7 ± 0.9 mmol/L) and carotid-femoral PWV (7.3 ± 1.6 vs. 7.7 ± 1.6 m/s) compared to men (all p < 0.05). Women also had higher (more negative) GLS compared to men (- 19.9 ± 3.0 vs. - 18.6 ± 3.0%, p < 0.001), while EF did not differ between sexes. In multivariable linear regression analyses, lower GLS in women was associated with higher waist circumference and PWV and with lower EF (all p < 0.05). In men, lower GLS was associated with higher waist circumference and HOMA-IR, and with lower EF (all p < 0.05).

Conclusions: Among subjects with increased BMI, GLS was higher in women than men. Lower GLS was associated with abdominal obesity in both sexes, and with impaired glucose metabolism in men, and with higher arterial stiffness in women.

Trial Registration: https://www.clinicaltrials.gov NCT02805478, first registered 20.06.16.
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http://dx.doi.org/10.1007/s40292-020-00418-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661414PMC
December 2020

The role of cardiac magnetic resonance in diagnosis of cardiac sarcoidosis.

Heart Fail Rev 2021 May 6;26(3):653-660. Epub 2020 Oct 6.

Center for Nuclear Medicine Clinical Center of Serbia, Belgrade, Serbia.

Sarcoidosis is a systemic granulomatous disease with a high prevalence of cardiac involvement in autopsic studies. Cardiac sarcoidosis is associated with increased cardiovascular morbidity and mortality. Endomyocardial biopsy is a specific technique, but unfortunately not sensitive enough. Non-invasive cardiac imaging has an important role in the evaluation of patients with suspected or confirmed cardiac sarcoidosis. Echocardiography remains the first choice imaging technique because of its availability and low cost. However, this method could not provide tissue characterization or evaluation of disease activity level. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has essential role in diagnosis and monitoring of patients with suspected or confirmed cardiac sarcoidosis. Nevertheless, more recently it has been shown that cardiac magnetic resonance (CMR) might provide useful information about cardiac sarcoidosis. Hybrid imaging approach that includes PET-CMR and PET-CT is particularly interesting for diagnosis, assessment of activity and follow-up in these patients. Diagnostic algorithm in sarcoidosis patients should include clinical data, hybrid imaging and biopsy. Use of different CMR sequences such as cine imaging, late gadolinium enhancement, T1 and T2 mapping, as well as strain imaging, may significantly contribute to diagnosis and monitoring of patients with cardiac sarcoidosis. However, validation of these techniques and particularly T1 and T2 mapping in sarcoidosis patients in large studies is necessary. This review aimed to summarize current knowledge about clinical usefulness of CMR in patients with cardiac sarcoidosis.
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http://dx.doi.org/10.1007/s10741-020-10035-zDOI Listing
May 2021
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