Hassanein, M., A. Tageldien, H. Badran, H. Samir, W. E. Elshafey, M. Hassan, M. Magdy, O. Louis, T. Abdel-Hameed, and M. A. Hamid, "Current status of outpatient heart failure management in Egypt and recommendations for the future.", ESC heart failure, vol. 10, issue 5, pp. 2788-2796, 2023. Abstract

Heart failure (HF) represents one of the greatest healthcare burdens worldwide, and Egypt is no exception. HF healthcare programmes in Egypt still require further optimization to enhance diagnosis and management of the disease. Development of specialized HF clinics (HFCs) and their incorporation in the healthcare system is expected to reduce HF hospitalization and mortality rates and improve quality of care in Egypt. We conducted a literature search on PubMed on the requirements and essential infrastructure of HFCs. Retrieved articles deemed relevant were discussed by a panel of 10 expert cardiologists from Egypt and a basic HFC model for the Egyptian settings was proposed. A multidisciplinary team managing the HFC should essentially be composed of specialized HF cardiologists and nurses, clinical pharmacists, registered nutritionists, physiotherapists, and psychologists. Other clinical specialists should be included according to patients' needs and size and structure of individual clinics. HFCs should receive patients referred from primary care settings, emergency care units, and physicians from different specialties. A basic HFC should have the following fundamental investigations available: resting electrocardiogram, basic transthoracic echocardiogram, and testing for N-terminal pro-B-type natriuretic peptide. Fundamental patients' functional assessments are assessing the New York Heart Association functional classification and quality of life and conducting the 6 min walking test. guideline-directed medical therapy should be implemented, and device therapy should be utilized when available. In the first visit, once HF is diagnosed and co-morbidities assessed, guideline-directed medical therapy should be started immediately. Comprehensive patient education sessions should be delivered by HF nurses or clinical pharmacists. The follow-up visit should be scheduled during the initial visit rather than over the phone, and time from the initial visit to the first follow-up visit should be determined based on the patient's health status and needs. Home and virtual visits are only recommended in limited and emergency situations. In this paper, we provide a practical and detailed review on the essential components of HFCs and propose a preliminary model of HFCs as part of a comprehensive HF programme model in Egypt. We believe that other low-to-middle income countries could also benefit from our proposed model.

Elborae, A., M. Hassan, M. A. Meguid, K. Bakry, A. Samir, E. Brilakis, H. Kandil, and A. ElGuindy, "Self-Apposing Stents in Coronary Chronic Total Occlusions: A Pilot Study.", Heart, lung & circulation, vol. 33, issue 4, pp. 500-509, 2024. Abstract

OBJECTIVES: This pilot study assessed the 12-month angiographic and clinical outcomes of self-apposing (SA) stents in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

BACKGROUND: Self-apposing (SA) stents may decrease incomplete strut apposition and stent strut coverage that are common after CTO PCI.

METHODS: We compared 20 patients who underwent CTO PCI using SA drug-eluting stents (DESs) with 20 matched control patients who underwent CTO PCI using balloon-expandable (BE)-DESs. All patients were followed up clinically for 12 months and had coronary angiography with optical coherence tomography at the end of the follow-up period. The primary end points were stent strut malapposition and strut coverage. The secondary end point was composite major adverse cardiovascular events (MACEs) at 12 months.

RESULTS: Both groups had high prevalence of diabetes mellitus, and most of the treated lesions were complex, with 62% having a J-CTO score of ≥3. All CTO PCI techniques were allowed for recanalisation, and 75% of the procedures were guided by intravascular ultrasound. At 12 months, the SA-DES group had fewer malapposed struts (0% [interquartile range (IQR) 0%-0%] vs 4.5% [IQR 0%-20%]; p<0.001) and uncovered struts (0.08% [IQR 0%-1.6%] vs 8.2% [IQR 0%-16%]; p<0.001). However, they showed significantly higher rates of MACEs due to clinically-driven target lesion revascularisation (45% vs 15%; p=0.038).

CONCLUSIONS: In this pilot study, compared with conventional BE-DESs, SA-DESs used in CTO PCI were associated with fewer malapposed and uncovered stent struts but also with significantly higher rates of in-stent restenosis and MACEs, mainly caused by clinically driven target lesion revascularisation.

Shehata, A., A. Nasser, A. Mohsen, A. A. Samaan, A. Mostafa, and M. Hassan, "Prevalence and characteristics of patent foramen ovale in a sample of Egyptian population: a computed tomography study.", The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology, vol. 76, issue 1, pp. 73, 2024. Abstract

BACKGROUND: The reported prevalence of patent foramen ovale (PFO) in the general population is variable. It ranges between 8.6 and 42% according to the population studied and the imaging technique used. We aim to prospectively assess the prevalence and characteristics of PFO and interatrial septum (IAS) abnormalities as well as the related clinical manifestations in a sample of Egyptian population.

RESULTS: This study comprised 1000 patients who were referred for CT coronary angiography (CTCA). Mean age was 52.5 ± 10.9 years. The prevalence of PFO among the studied population was 16.3%; closed PFO (grade I) 44.2%, open PFO (grade II) 50.9%, and open PFO with jet (grade III) 4.9%. Anatomical high-risk PFO features-defined as the presence of at least 2 or more of the following (diameter ≥ 2 mm, length ≥ 10 mm, septal aneurysm "ASA", or redundant septum)-were found in 51.5% of PFOs' population. Other IAS abnormalities as redundant septum (8.6%), ASA (5.3%), Bachmann's bundle (4.5%), microaneurysm (2.6%), and atrial septal defect (ASD) (0.4%) were detected. There was a lower rate of coexistence of ASA with PFO (p = 0.031). Syncope was significantly higher in patients with PFO compared to those without PFO (6.7% vs. 1.6%, p = 0.001). Stroke, transient ischaemic attacks (TIA), and dizziness were similar in both groups. TIA, dizziness, and syncope were significantly higher in patients with IAS abnormalities including PFO compared to those without IAS abnormalities. Syncope was also significantly higher in PFO with high-risk anatomical features compared to those with non-high-risk PFO population (p = 0.02).

CONCLUSION: The prevalence of PFO in our study was approximately 16.3%, almost half of them showed anatomical high-risk features for stroke. Dizziness, syncope and TIA were significantly higher in patients with IAS abnormalities including PFO.

Samaan, A. A., A. Mostafa, S. L. Wahba, M. Kerlos, A. A. Elamragy, K. Shelbaya, Y. Elsobky, and M. Hassan, "Validation of angiography-derived Murray law-based quantitative flow reserve (μQFR) against pressure-derived instantaneous wave-free ratio for assessing coronary lesions, a single-center study in Egypt.", The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology, vol. 76, issue 1, pp. 113, 2024. Abstract

BACKGROUND: Instantaneous wave-free ratio (iwFR) is a well-validated method for functional evaluation of intermediate coronary lesions. A recently developed Murray law-based QFR (µQFR) allows wire-free FFR estimation using a high-quality single angiographic projection. We aim to determine the diagnostic accuracy of µQFR as compared to wire-based iwFR for physiological assessment of coronary lesions in a sample of Egyptian patients.

RESULTS: Over a one-year period, patients who previously underwent iwFR assessment of an intermediate coronary stenosis (40-90%) were retrospectively included. μQFR analysis was then performed offline using a dedicated artificial intelligence (AI)-aided computation software. All the measurements were performed blinded to iwFR results, and the agreement between iwFR and μQFR values was tested. Forty-nine patients (mean age 57.9 ± 9 years, 72.9% males) were included. Mean value of iwFR and μQFR was 0.90 ± 0.075 and 0.79 ± 0.129, respectively. There was a significant moderate positive linear correlation between μQFR and iwFR (r = 0.47, p = 0.001; 95% CI 0.22-0.68) with moderate-to-substantial agreement between the two methods (Kappa 0.6). In assessing the diagnostic accuracy of μQFR, the receiver operating characteristic (ROC) curve yielded an area under the curve (AUC) of 0.84 (95% CI 0.717-0.962) for predicting functionally significant lesions defined as iwFR < 0.89. The sensitivity and specificity of μQFR < 0.8 for detecting physiological significance of coronary lesions were 89% and 74% with positive and negative predictive values of 70 and 91%, respectively.

CONCLUSION: µQFR has good diagnostic accuracy for predicting functionally significant coronary lesions with moderate correlation and agreement with the gold standard iwFR. Angiography-derived µQFR could be a promising tool for improving the utilization of physiology-guided revascularization.

El-Damaty, A., M. Sayed, M. El-Maghawry, H. Kandil, and M. Hassan, "Utility of Cardiac Magnetic Resonance in Assessing Arrhythmic Risk in Patients With Nonischemic Cardiomyopathy Undergoing Biventricular Pacing.", Pacing and clinical electrophysiology : PACE, vol. 47, issue 11, pp. 1528-1538, 2024. Abstract

BACKGROUND: Nonischemic cardiomyopathy (NICM) is responsible for approximately one-third of heart failure and is associated with significant morbidity and mortality. Recent data suggested the lack of mortality reduction from adding a defibrillator to cardiac resynchronization therapy (CRT) in all patients with NICM. Myocardial fibrosis detected by cardiac magnetic resonance late gadolinium enhancement (CMR-LGE) can help risk stratify patients who would benefit from adding a defibrillator to CRT in this patient population.

OBJECTIVES: We aim to assess the relationship between the presence of myocardial fibrosis detected by CMR-LGE and the rate of major arrhythmic events (MAE) that included sustained ventricular tachycardia (VT), appropriate cardiac resynchronization therapy-defibrillator (CRT-D) intervention, ventricular fibrillation (VF), and sudden cardiac death (SCD) in patients with NICM undergoing CRT and to compare all-cause mortality and heart failure improvement between patients receiving cardiac resynchronization therapy-pacing (CRT-P) versus those receiving CRT-D based on the presence of myocardial fibrosis.

METHODS: All consecutive patients with NICM satisfying a guideline-directed indication for CRT implantation were included in the study after excluding patients who refused to consent, patients with acute decompensated heart failure, and those contraindicated for a cardiac magnetic resonance (CMR). Patients were divided into two groups based on the presence of fibrosis in cardiac MRI: the LGE/CRT-D group and the No LGE/CRT-P group. They were then followed for 1 year.

RESULTS: Sixty patients were enrolled. Sixteen patients (26.6%) developed MAE during the study duration, among those patients, seven had myocardial fibrosis (receiving CRT-D as per protocol), while nine had no myocardial fibrosis (receiving CRT-P as per protocol), (41.2% vs. 20.9%, p = 0.045). The presence of CMR-LGE, regardless of the extent and distribution, predicted MAE with an odds ratio of 2.6 (CI = 1.78-8.9, p = 0.04). The presence of ≥7.5% of myocardial fibrosis by CMR was associated with 54% sensitivity and 100% specificity for MAE in the study population. All-cause mortality was significantly higher in the No LGE/CRT-P group versus the LGE/CRT-D group (15 [34.9%] vs. 2 [11.8%], p = 0.076).

CONCLUSION: In patients with NICM candidates for biventricular pacing, the presence of LGE on CMR, irrespective of the extent or segmental pattern, is independently associated with an MAE and is associated with worse heart failure outcomes. However, the absence of LGE did not rule out MAE, and implanting CRT-P based on lack of fibrosis may result in higher all-cause mortality.

Hassan, M., "CANTOS: A breakthrough that proves the inflammatory hypothesis of atherosclerosis", Global Cardiology Science and practice, vol. 1, pp. 1-8 , 2018.
Conway, J., O. Miera, R. Kirk, and M. Hassan, "World-Wide Experience of a Durable Centrifugal Flow Pump in Pediatric Patients", Seminars in Thoracic and Cardiovascular surgery, vol. 30, issue 3, pp. 327 - 335, 2018.
Mahmoud, H., M. Hassan, M. Nagy, A. Amin, A. ElGuindy, K. Wagdy, and M. Yacoub, "A novel method to measure mitral valve area in patients with rheumatic mitral stenosis using three-dimensional transesophageal echocardiography: Feasibility and validation", Echocardiography, vol. 35, pp. 368 - 374, 2018.
Hassan, M., K. Wagdy, A. Kharabish, P. Philip, A. N. A, A. ElGuindy, A. ELFaramawy, M. F. Elmahdy, H. Mahmoud, and M. H. Yacoub, "Validation of Noninvasive Measurement of Cardiac Output Using Inert Gas Rebreathing in a Cohort of Patients With Heart Failure and Reduced Ejection Fraction", Circulation Heart Failure, vol. 10, issue 3, pp. e003592 1-8, 2017. circulation_hf_dr._mohamed_hassan.pdf
Wagdy, K., A. Samaan, S. Romeih, W. Simry, A. Afifi, and M. Hassan, "Giant left atrial appendage aneurysm compressing the left anterior descending coronary artery.", Echocardiography (Mount Kisco, N.Y.), vol. 33, issue 11, pp. 1790-1792, 2016 Nov. Abstractecho13296.pdf

Left atrial appendage aneurysm (LAAA) is a rare congenital structural heart disease. It is often diagnosed by echocardiography; however, other imaging modalities can add to its diagnosis and its potential effects on the surrounding structures. A 16-year-old boy presented with dyspnea and palpitation. Transthoracic echocardiography showed a large LAAA communicating with the LA through a narrow neck with impaired left ventricular (LV) systolic function. Multidetector cardiac tomography showed that the LAAA is compressing the left anterior descending artery. The LAAA was surgically resected followed by improvement of the LV systolic function.

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