Youssef, G., "What is new in resistant hypertension", CardioPractice: European Society of Cardiology, 2025. what_is_new_in_resistant_hypertension_.pdf
van der Zande, J. A., S. Siromakha, P. N. J. Peters, G. Youssef, L. Galian-Gay, M. Ladouceur, G. Wells, J. J. M. Takkenberg, K. M. Veen, K. P. Ramlakhan, et al., "Valve replacement during pregnancy: literature review including new data from the Registry Of Pregnancy And Cardiac disease III.", European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, vol. 67, issue 7, 2025. Abstract

OBJECTIVES: Heart valve replacement during pregnancy is sometimes unavoidable, and the need for anticoagulation further complicates these procedures. Our study describes cases of valve replacement in pregnancy enrolled in the Registry Of Pregnancy And Cardiac disease (ROPAC) III and gives an overview of the published literature.

METHODS: We performed a systematic review with new data from the ROPAC III and data available in the literature. ROPAC III is a global, prospective, observational registry that included pregnant women with 1 or more prosthetic valves between January 2018 and April 2023. Electronic databases were searched for studies enrolling pregnant women who underwent valve replacement during pregnancy with a fetus in utero. The primary outcomes were maternal and fetal death. Mixed-effect logistic regression models were used to identify predictors for maternal and fetal mortality.

RESULTS: A valve replacement was performed in 11 pregnancies. The mother and fetus died in 1 case, and in 2 cases, reversible postoperative complications occurred. We found 74 cases in the literature and calculated an overall maternal and fetal death rate of 9% and 34%, respectively. All maternal deaths occurred in women with a replacement of a prosthetic valve in mitral position. We found valve replacement in the 1st trimester (OR 10.0) and acute malfunctioning of an existing prosthetic valve (OR 19.7) as predictors for maternal mortality, and replacement of an existing prosthetic valve (OR 4.8) as predictor for fetal mortality.

CONCLUSIONS: Valve replacement during pregnancy carries a high maternal and fetal death, especially in women who need a replacement of an existing prosthetic valve.

Youssef, G., T. E. H. Mohamed, M. A. Abdel Raouf, A. S. F. Tammam, and A. A. Gabr, "Early Versus Late Post Cesarean Section Warfarin Initiation and Increased Risk of Maternal Complications in Patients With Mechanical Heart Valves: A Randomized, Open-Label Pilot Study.", Korean circulation journal, vol. 55, issue 2, pp. 151-160, 2025. Abstractkorean_circulation_j.pdf

BACKGROUND AND OBJECTIVES: The timing of the reinstitution of warfarin after cesarean section (CS) delivery was not adequately addressed in the literature. This study aims to evaluate the risks of early versus late initiation of warfarin post-CS in patients with mechanical heart valves.

METHODS: This randomized, open-label cohort study included 114 pregnant women with mechanical heart valves planned to be delivered by CS at or after 28 weeks of gestation. Patients were randomly divided into two groups: Day-2-group, where warfarin was started on day 2, and Day-5-group, where warfarin was started on day 5 after CS. Maternal postoperative bleeding complications, mechanical valve thrombosis, need for blood transfusion or reoperation, and maternal mortality were identified.

RESULTS: Ten women (8.8%) had 11 bleeding complications, of whom 2 patients (20%) had intraperitoneal hemorrhage (none in Day-2-group and 2 in Day-5-group), 3 patients (30%) had subcutaneous hematoma (none in Day-2-group and 3 in Day-5-group), and 6 patients (60%) had sub-rectus hematoma (3 in Day-2-group and 3 in Day-5-group). No mechanical valve thrombosis, other thromboembolic events, or in-hospital maternal mortality were reported.

CONCLUSION: Despite the small number of events, the bleeding risk was lower in the group with early post-CS warfarin introduction than in the group with late warfarin introduction in patients with prosthetic heart valves.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04855110.

Rezk, H., G. Youssef, K. Said, I. Mandour, and M. A. Hamid, "Abdominal Congestion as a Predictor of Worsening Renal Function in Patients With Acute Decompensated Heart Failure.", Journal of the Saudi Heart Association, vol. 36, issue 1, pp. 60-69, 2024. Abstract

BACKGROUND: Worsening renal function is a frequent finding in patients with acute decompensated heart failure (ADHF) and is a powerful independent prognostic factor for adverse outcomes. The link between abdominal congestion and worsening renal function in such patients is not yet fully addressed.

OBJECTIVE: To evaluate the role of abdominal congestion in the early prediction of worsening renal function in hospitalized patients with acute decompensated heart failure.

METHODS: This was a prospective study that enrolled 100 patients with a diagnosis of ADHF and received intravenous diuretic therapy. Intra-abdominal pressure (IAP), splenic Doppler impedance indices and serum prouroguanylin were measured on admission, 24 h after admission and on discharge. Patients were then divided into 2 groups: those who developed WRF (WRF group), and those who did not (non-WRF group). Worsening renal function was defined as an increase in serum creatinine level ≥0.3 mg/dL above baseline admission value. Intrabdominal pressure was measured transvesically using standard Foley catheter. Splenic Doppler impedance indices (resistivity and pulsatility indices) were measured using splenic Doppler ultrasound.

RESULTS: Among recruited patients (age: 54.73 ± 13.1 years, 72% are male), there was a significant decline in IAP (6.67 mmHg vs 8.36 mmHg, p = 0.001) and significant rise in splenic resistivity index (0.69 vs 0.67, p = 0.002) before discharge compared to admission values. The median level of serum prouroguanylin before discharge showed significant decline compared to admission level (29.2 vs 34.6 ng/l, p = 0.006). WRF developed in 37 (37%) patients. Independent predictors of WRF during hospitalization were high splenic arterial resistivity index 24 h after admission, high intra-abdominal pressure (≥8 mmHg) 24 h after admission, and low LVEF on admission.

CONCLUSION: In ADHF patients receiving diuretic therapy, transvesical measurement of intra-abdominal pressure and splenic resistivity index by splenic Doppler early after admission can help to identify patients at increased risk of WRF near discharge.

Taha, H. S. E., G. Youssef, M. M. Shaker, M. Ghalab, H. Sayed, S. Abdulla, M. Thabet, and A. Moustafa, "Pattern of cardiovascular admission diagnoses during the month of Ramadan: a single center experience", European Heart Journal Supplement, vol. 25, 2023.
Elraouf, M. A., A. A. Gabr, T. El Husseiny, A. S. F. Tammam, and G. Youssef, "Oral Anticoagulation Dose and Risk of Postpartum Bleeding Complications after Cesarean Section in Patients with Mechanical Heart Valve Prosthesis", European Chemical Bulletin, vol. 12, issue 7, pp. 1-6, 2023.
Tromp, J., A. M. Jackson, M. A. Hamid, D. Fouad, G. Youssef, M. C. Petrie, J. Bauersachs, K. Sliwa, and P. van der Meer, "Thromboembolic events in peripartum cardiomyopathy: Results from the ESC EORP PPCM registry.", European journal of heart failure, vol. 25, issue 8, pp. 1464-1466, 2023.
Yehia, H., G. Youssef, M. Gamil, M. Elsaeed, and K. H. A. L. E. D. SADEK, "Electrocardiographic substrates of arrhythmias in patients with end-stage and chronic kidney diseases: a case-control study", The Egyptian Heart Journal, vol. 75, issue 1, pp. 13, 2023.
Marzouk, D., H. El Deeb, Y. Baghdady, and G. Youssef, "Correlation between central aortic stiffness indices and cardiac mechanics in hypertensive patients: new insights from speckle tracking echocardiography imaging", European heart journal , vol. 43, issue Supplement 2, 2022.
Youssef, G., M. Mohamed, M. A. Hamid, and D. El Remisy, "Reasons behind high rate of non-compliance to scheduled office visits in hypertensive patients: results from the Egyptian registry of specialized hypertension clinics.", The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology, vol. 74, issue 1, pp. 45, 2022. Abstract

BACKGROUND: Hypertensive patients' compliance to the clinic's follow-up visits is associated with a better blood pressure control. The aim of this study was to detect the reasons of non-compliance to office visits in Egyptian hypertensive patients.

RESULTS: This is an observational, prospective, cross-sectional research study where patients were enrolled from the registry of the specialized hypertension clinics of 9 university hospitals. Those who attended less than 3 office visits, throughout the registry period, were considered non-compliant and were contacted through the phone. A simple questionnaire was prepared, which included questions about the reasons of non-compliance to follow up. There were 3014 patients eligible for inclusion in this study but only 649 patients (21.5%) completed the questionnaire. Patients claimed that the reasons of non-compliance to the follow up visits in the specialized hypertension clinics were as follows: 444 patients (68.4%) preferred to follow up elsewhere mostly in pharmacies, 53 patients (8.2%) claimed that the healthcare service was unsatisfactory, 94 patients (14.5%) were asymptomatic, and 110 patients (16.9%) said that the clinic was far from their homes. Despite non-compliance to office visits, 366 patients (59.2%) were compliant to their antihypertensive medications and 312 (48.1%) patients were compliant to salt restriction. About 34% of patients used herbs, mainly hibiscus, as adjuvant to their antihypertensive medications.

CONCLUSIONS: Reasons for non-compliance to office visits in hypertensive patients were either patient-related, or healthcare-related. To improve patients' compliance, physicians need to educate their patients about hypertension, patients need to follow their doctors' instructions as regard medications, salt restriction and scheduled office visits, and governments need to provide better and cheaper healthcare services.