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Sökning: WFRF:(Bytyci Ibadete)

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1.
  • Ahmeti, Artan, et al. (författare)
  • Prognostic value of left atrial volume index in acute coronary syndrome : A systematic review and meta-analysis
  • 2021
  • Ingår i: Clinical Physiology and Functional Imaging. - : John Wiley & Sons. - 1475-0961 .- 1475-097X. ; , s. 128-135
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: In the absence of mitral valve disease, increased left atrial volume (LAV) is a marker of diastolic dysfunction and long-standing elevated left ventricle (LV) pressure. The aim of this study was to assess the role of increased baseline LAV in predicting clinical outcome of patients presenting with acute coronary syndrome (ACS).Methods: We systematically searched all electronic databases up to September 2020 in order to select clinical trials and observational studies, which assessed the predictive role of LAV indexed (LAVI) on clinical outcome in patients with ACS. Primary clinical endpoints were as follows: major adverse cardiac events (MACE), all-cause mortality and hospitalization. Secondary endpoints were in-hospital complications.Results: A total of 2,705 patients from 11 cohort studies with a mean follow-up 18.7 +/- 9.8 months were included in the meta-analysis. Patients with low LAVI had low risk for MACE (15.9% vs. 33.7%; p < .01), long-term all-cause mortality (9.14% vs. 18.1%; p < .01), short-term mortality (3.31% vs. 9.38%; p = .02) and lower hospitalization rate (11.6% vs. 25.5%; p < .01) compared to patients with increased LAVI. Atrial fibrillation and cardiogenic shock as in-hospital events were lower (p < .05 for all) in patients with low LAVI but ventricular fibrillation/tachycardia was not different between groups (p = .14).Conclusion: Increased LAVI is an independent predictor of outcome in patients with ACS. Thus, assessment of LA index in these patients is important for better risk stratification and guidance towards optimum clinical management.
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2.
  • Fetahu, Albenita, et al. (författare)
  • Obesity and uncontrolled diabetes predict depression in hf patients
  • 2021
  • Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 10:23
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and aim: Heart failure (HF) is a clinical syndrome associated with poor quality of life and prognosis, and premature mortality. The aim of this study was to assess the prevalence of depression and its risk factors in HF patients.Methods: The study included 151 HF patients (mean age of 66.6 ± 11 years, 52.3% female). Based on ejection fraction (EF), the study cohort was divided into the following two groups: group-I: HFpEF patients (EF ≥ 50%, n = 47) and group-II: HFrEF patients (EF < 40%, n = 104). For the enrolled patients, demographic, clinic and echocardiographic indices, and depression scale results were collected.Results: The patients with HF and depression were older, mostly females, more obese, and had a higher glycemic level and higher NYHA functional class compared with the patients without depression (p < 0.05 for all). The left ventricle (LV) and left atrial (LA) dimensions were larger, and EF was lower, in patients with depression compared to those without depression (p < 0.05 for all), while the right ventricle (RV) measurements did not differ (p > 0.05). The same parameters remained significantly different when the patients were divided into HFpEF and HFrEF. The depression scale correlated with glycemic level (r = 0.51, p = 0.01), obesity (rpb = 0.53, p = 0.001), age (r = 0.47, p = 0.02), and severity of NYHA class (rpb = 0.54, p = 0.001). On a multivariate model, BMI ≥ 30 kg/m2, OR 1.890 (1.199 to 3.551; 0.02) glycemic level ≥ 8.5 mmol/L, OR 2.802 (1.709 to 5.077; p = 0.01), and NYHA class > 2, OR 2.103 (1.389 to 4.700; p = 0.01), proved to be the most powerful independent predictors of depression, in the group as a whole. Obesity and uncontrolled diabetes predicted depression, irrespective of EF.Conclusions: In this modest cohort of HF patients, obesity and uncontrolled diabetes were independent predictors of depression, irrespective of LV systolic function. This emphasizes the important role of medical education for better control of such risk factors.
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3.
  • Haliti, Edmond, et al. (författare)
  • Ventricular septal defect associated with aortic regurgitation and ascending aortic aneurysm : a case report
  • 2023
  • Ingår i: Journal of Medical Case Reports. - : BioMed Central (BMC). - 1752-1947. ; 17:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Ventricular septal defect (VSD) is one of the most common congenital cardiac anomalies. Patients with perimembranous VSD may have aortic regurgitation (AR) secondary to prolapse of the aortic cusp.Case presentation: We present a case of 23-year-old White man with VSD, AR and ascending aortic aneurysm. The patient presented to outpatient clinic with weakness and gradual worsening shortness of breath for the past 5 years. Clinical examination revealed regular heart rhythm and loud continuous systolic-diastolic murmur (Lewin’s grade 6/6), heard all over the precordium, associated with a palpable thrill. The ECG showed right axis deviation, fractionated QRS in V1 and signs of biventricular hypertrophy. The chest X-ray showed cardiomegaly. Transthoracic and transesophageal echocardiograms showed a perimembranous VSD with moderate restrictive shunt (Qp/Qs = 1.6), aortic regurgitation (AR), and ascending aortic aneurysm. Other clinical and laboratory findings were within normal limits.Conclusions: Perimembranous VSD, may be associated with aortic regurgitation and ascending aortic aneurysm as secondary phenomenon if it is not early diagnosed and successfully treated.
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4.
  • Abdelsayed, Mena, et al. (författare)
  • Left Ventricular Contraction Duration Is the Most Powerful Predictor of Cardiac Events in LQTS : A Systematic Review and Meta-Analysis
  • 2020
  • Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 9:9
  • Forskningsöversikt (refereegranskat)abstract
    • Background: Long-QT syndrome (LQTS) is primarily an electrical disorder characterized by a prolonged myocardial action potential. The delay in cardiac repolarization leads to electromechanical (EM) abnormalities, which adds a diagnostic value for LQTS. Prolonged left ventricular (LV) contraction was identified as a potential risk for arrhythmia. The aim of this meta-analysis was to assess the best predictor of all EM parameters for cardiac events (CEs) in LQTS patients. Methods: We systematically searched all electronic databases up to March 2020, to select studies that assessed the relationship between echocardiographic indices—contraction duration (CD), mechanical dispersion (MD), QRS onset to peak systolic strain (QAoC), and the EM window (EMW); and electrical indices— corrected QT interval (QTC), QTC dispersion, RR interval in relation to CEs in LQTS. This meta-analysis included a total of 1041 patients and 373 controls recruited from 12 studies. Results: The meta-analysis showed that LQTS patients had electrical and mechanical abnormalities as compared to controls—QTC, WMD 72.8; QTC dispersion, WMD 31.7; RR interval, WMD 91.5; CD, WMD 49.2; MD, WMD 15.9; QAoC, WMD 27.8; and EMW, WMD −62.4. These mechanical abnormalities were more profound in symptomatic compared to asymptomatic patients in whom disturbances were already manifest, compared to controls. A CD ≥430 ms had a summary sensitivity (SS) of 71%, specificity of 84%, and diagnostic odds ratio (DOR) >19.5 in predicting CEs. EMW and QTC had a lower accuracy. Conclusions: LQTS is associated with pronounced EM abnormalities, particularly prolonged LV myocardial CD, which is profound in symptomatic patients. These findings highlight the significant role of EM indices like CD in managing LQTS patients.
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5.
  • Bajraktari, Artan, et al. (författare)
  • High Coronary Wall Shear Stress Worsens Plaque Vulnerability : A Systematic Review and Meta-Analysis
  • 2021
  • Ingår i: Angiology. - : Sage Publications. - 0003-3197 .- 1940-1574. ; 72:8, s. 706-714
  • Forskningsöversikt (refereegranskat)abstract
    • Aim: The aim of this meta-analysis is to assess the impact of wall shear stress (WSS) severity on arterial plaque vulnerability.Methods: We systematically searched electronic databases and selected studies which assessed the relationship between WSS measured by intravascular ultrasound and coronary artery plaque features. In 7 studies, a total of 615 patients with 28 276 arterial segments (median follow-up: 7.71 months) were identified. At follow-up, the pooled analysis showed high WSS to be associated with regression of plaque fibrous area, weighted mean difference (WMD) −0.11 (95% CI: −0.20 to −0.02, P = .02) and fibrofatty area, WMD −0.09 (95% CI: −0.17 to −0.01, P = .02), reduction in plaque total area, WMD −0.09 (95% CI: −0.14 to −0.04, P = .007) and increased necrotic core area, and WMD 0.04 (95% CI: 0.01-0.09, P = .03) compared with low WSS. Dense calcium deposits remained unchanged in high and low WSS (0.01 vs 0.02 mm2; P > .05). High WSS resulted in profound remodeling (40% vs 18%, P < .05) and with more constructive remodeling than low WSS (78% vs 40%, P < .01).Conclusions: High WSS in coronary arteries is associated with worsening plaque vulnerability and more profound arterial wall remodeling compared with low WSS.
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6.
  • Bajraktari, Artan, et al. (författare)
  • The Relationship between Coronary Artery Wall Shear Strain and Plaque Morphology : A Systematic Review and Meta-Analysis
  • 2020
  • Ingår i: Diagnostics (Basel). - : MDPI. - 2075-4418. ; 10:2
  • Forskningsöversikt (refereegranskat)abstract
    • Background and Aim: Arterial wall shear strain (WSS) has been proposed to impact the features of atherosclerotic plaques. The aim of this meta-analysis was to assess the impact of different types of WSS on plaque features in coronary artery disease (CAD).Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar, and the Cochrane Central Registry, from 1989 up to January 2020 and selected clinical trials and observational studies which assessed the relationship between WSS, measured by intravascular ultrasound (IVUS), and plaque morphology in patients with CAD.Results: In four studies, a total of 72 patients with 13,098 coronary artery segments were recruited, with mean age 57.5 +/- 9.5 years. The pooled analysis showed that low WSS was associated with larger baseline lumen area (WMD 2.55 [1.34 to 3.76, p < 0.001]), smaller plaque area (WMD 1.16 [-1.84 to -0.49, p = 0.0007]), lower plaque burden (WMD -12.7 [-21.4 to -4.01, p = -0.04]), and lower necrotic core area (WMD -0.32 [-0.78 to 0.14, p = 0.04]). Low WSS also had smaller fibrous area (WMD -0.79 [-1.88 to -0.30, p = 0.02]) and smaller fibro-fatty area (WMD 0.22 [-0.57 to 0.13, p = 0.02]), compared with high WSS, but the dense calcium score was similar between the two groups (WMD -0.17 [-0.47 to 0.13, p = 0.26]). No differences were found between intermediate and high WSS.Conclusions: High WSS is associated with signs of plaque instability such as higher necrotic core, higher calcium score, and higher plaque burden compared with low WSS. These findings highlight the role of IVUS in assessing plaque vulnerability.
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7.
  • Bajraktari, Gani, et al. (författare)
  • Complete revascularization for patients with multivessel coronary artery disease and ST-segment elevation myocardial infarction after the COMPLETE trial : a meta-analysis of randomized controlled trials
  • 2020
  • Ingår i: IJC Heart & Vasculature. - : Elsevier. - 2352-9067. ; 29
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The recently published COMPLETE trial has demonstrated that patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), who underwent successful percutaneous coronary intervention (PCI) of both culprit and non-culprit (vs. culprit-only) lesions had a reduced risk of major adverse cardiac events (MACE), but not of cardiovascular or total mortality. The aim of this meta-analysis was to assess the efficacy of complete revascularization on cardiovascular or total mortality reduction using available randomized controlled trials (RCTs) including the COMPLETE trial, in hemodynamically stable STEMI patients with MVD. Methods: PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov databases search identified 10 RCTs of 7033 patients with STEMI and MVD which compared complete (n = 3420) vs. only culprit lesion (n = 3613) PCI for a median 27.7 months follow-up. Random effect risk ratios were used to estimate for efficacy and safety outcomes. Results: Complete revascularization reduced the risk of MACE (10.4% vs.16.6%; RR = 0.59, 95% CI: 0.47 to 0.74, p < 0.0001), CV mortality (2.87% vs. 3.72%; RR = 0.73, 95% CI: 0.56 to 0.95, p = 0.02), reinfarction (5.1% vs. 7.1%; RR = 0.67, 95% CI: 0.52 to 0.86, p = 0.002), urgent revascularization (7.92% vs.17.4%; RR = 0.47, 95% CI: 0.30 to 0.73, p < 0.001), and CV hospitalization (8.68% vs.11.4%; RR = 0.65, 95% CI: 0.44to 0.96, p = 0.03) compared with culprit only revascularization. All-cause mortality, stroke, major bleeding events, or contrast induced nephropathy were not affected by the revascularization strategy. Conclusion: The findings of this meta-analysis suggest that in patients with STEMI and MVD, complete revascularization is superior to culprit-only PCI in reducing the risk of MACE outcomes, including cardiovascular mortality, without increasing the risk of adverse safety outcomes.
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8.
  • Bajraktari, Gani, et al. (författare)
  • Left atrial structure and function predictors of recurrent fibrillation after catheter ablation : a systematic review and meta-analysis
  • 2020
  • Ingår i: Clinical Physiology and Functional Imaging. - : John Wiley & Sons. - 1475-0961 .- 1475-097X. ; 40:1, s. 1-13
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Catheter ablation (CA) has become a conventional treatment for atrial fibrillation (AF), but remains with high recurrence rate. The aim of this meta-analysis was to determine left atrial (LA) structure and function indices that predict recurrence of AF.Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to September 2017 in order to select clinical trials and observational studies which reported echocardiographic predictors of AF recurrence after CA. Eighty-five articles with a total of 16 126 patients were finally included.Results: The pooled analysis showed that after a follow-up period of 21 +/- 12 months, patients with AF recurrence had larger LA diameter with weighted mean difference (WMD: 2 center dot 99 ([95% CI 2 center dot 50-3 center dot 47], P<0 center dot 001), larger LA volume index (LAVI) maximal and LAVI minimal (P<0 center dot 0001 for both), larger LA area (P<0 center dot 0001), lower LA strain (P<0 center dot 0001) and lower LA total emptying fraction (LA EF) (P<0 center dot 0001) compared with those without AF recurrence. The most powerful LA predictors (in accuracy order) of AF recurrence were as follows: LA strain <19% (OR: 3 center dot 1[95% CI, -1.3-10 center dot 4], P<0 center dot 0001), followed by LA diameter >= 50 mm (OR: 2 center dot 75, [95% CI 1 center dot 66-4 center dot 56,] P<0 center dot 0001), and LAVmax >150 ml (OR: 2 center dot 25, [95% CI, 1.1-5 center dot 6], P = 0 center dot 0002).Conclusions: Based on this meta-analysis results, a dilated left atrium with diameter more than 50 mm and volume above 150 ml or myocardial strain below 19% reflect an unstable LA that is unlikely to hold sinus rhythm after catheter ablation for atrial fibrillation.
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9.
  • Bajraktari, Gani, et al. (författare)
  • Long-Term Outcomes of Patients with Unprotected Left Main Coronary Artery Disease Treated with Percutaneous Angioplasty versus Bypass Grafting : A Meta-Analysis of Randomized Controlled Trials
  • 2020
  • Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 9:7
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Aim: Treatment of patients with left main coronary artery disease (LMCA) with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The aim of this meta-analysis was to compare the long-term clinical outcomes of patients with unprotected LMCA treated randomly by PCI or CABG. Methods: PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov database searches identified five randomized trials (RCTs) including 4499 patients with unprotected LMCA comparing PCI (n= 2249) vs. CABG (n= 2250), with a minimum clinical follow-up of five years. Random effect risk ratios were used for efficacy and safety outcomes. The study was registered in PROSPERO. The primary outcome was major adverse cardiac events (MACE), defined as a composite of death from any cause, myocardial infarction or stroke. Results: Compared to CABG, patients assigned to PCI had a similar rate of MACE (risk ratio (RR): 1.13; 95% CI: 0.94 to 1.36;p= 0.19), myocardial infarction (RR: 1.48; 95% CI: 0.97 to 2.25;p= 0.07) and stroke (RR: 0.87; 95% CI: 0.62 to 1.23;p= 0.42). Additionally, all-cause mortality (RR: 1.07; 95% CI: 0.89 to 1.28;p= 0.48) and cardiovascular (CV) mortality (RR: 1.13; 95% CI: 0.89 to 1.43;p= 0.31) were not different. However, the risk of any repeat revascularization (RR: 1.70; 95% CI: 1.34 to 2.15;p< 0.00001) was higher in patients assigned to PCI. Conclusions: The findings of this meta-analysis suggest that the long-term survival and MACE of patients who underwent PCI for unprotected LMCA stenosis were comparable to those receiving CABG, despite a higher rate of repeat revascularization.
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10.
  • Bajraktari, Gani, et al. (författare)
  • Non-inferiority of 1 month versus longer dual antiplatelet therapy in patients undergoing PCI with drug-eluting stents : a systematic review and meta-analysis of randomized clinical trials
  • 2022
  • Ingår i: Therapeutic Advances in Chronic Disease. - : Sage Publications. - 2040-6223 .- 2040-6231. ; 13
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: The aim of this meta-analysis was to evaluate the safety of 1-month dual antiplatelet therapy (DAPT) followed by aspirin or a P2Y12 receptor inhibitor, after percutaneous coronary intervention (PCI) with drug-eluting stents (DES), based on the available evidence.Methods: PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL, and ClinicalTrials.gov database search identified four RCTs of 26,431 patients who underwent PCI with DES and compared 1-month versus >1-month DAPT. The primary endpoint was major bleeding and co-primary endpoint stent thrombosis, and secondary endpoints included all-cause mortality, cardiovascular death, myocardial infarction (MI), stroke, and major adverse clinical events (MACE).Results: Compared with >1-month DAPT, the 1-month DAPT was associated with a similar rate of major bleeding (OR = 0.74, 95%CI: 0.51–1.07, p = 0.11, I2 = 67%), stent thrombosis (OR = 1.10, 95%CI: 0.82–1.47, p = 0.53, I2 = 0.0%), similar risk for all-cause mortality (OR = 0.89, 95%CI: 0.77–1.04, p = 0.14, I2 = 0%), CV death (OR = 0.80, 95% CI: 0.55–1.60, p = 0.24, I2 = 0.0%), MI (OR = 1.02, 95% CI: 0.88–1.19, p = 0.78, I2 = 0.0%), and stroke (OR = 0.76, 95% CI: 0.54–1.08, p = 0.13, I2 = 29%). The risk of MACE was lower (OR = 0.84, 95% CI: 0.73–0.98, p = 0.02, I2 = 39%) in the 1-month DAPT compared with the >1-month DAPT. Only patients with stable CAD had lower risk of MACE with 1-month DAPT (OR = 0.81, 95% CI: 0.67–0.98, p = 0.03, I2 = 21%) compared with >1-month DAPT.Conclusion: This meta-analysis proved the non-inferiority of 1-month DAPT followed by aspirin or a P2Y12 receptor inhibitor compared with long-term DAPT in patients undergoing PCI with DES.
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11.
  • Bajraktari, Gani, et al. (författare)
  • Radial Access for Coronary Angiography Carries Fewer Complications Compared with Femoral Access : A Meta-Analysis of Randomized Controlled Trials
  • 2021
  • Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 10:10
  • Forskningsöversikt (refereegranskat)abstract
    • Background and Aim: In patients undergoing diagnostic coronary angiography (CA) and percutaneous coronary interventions (PCI), the benefits associated with radial access compared with the femoral access approach remain controversial. The aim of this meta-analysis was to compare the short-term evidence-based clinical outcome of the two approaches. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) comparing radial versus femoral access for CA and PCI. We identified 34 RCTs with 29,352 patients who underwent CA and/or PCI and compared 14,819 patients randomized for radial access with 14,533 who underwent procedures using femoral access. The follow-up period for clinical outcome was 30 days in all studies. Data were pooled by meta-analysis using a fixed-effect or a random-effect model, as appropriate. Risk ratios (RRs) were used for efficacy and safety outcomes.Results: Compared with femoral access, the radial access was associated with significantly lower risk for all-cause mortality (RR: 0.74; 95% confidence interval (CI): 0.61 to 0.88; p = 0.001), major bleeding (RR: 0.53; 95% CI:0.43 to 0.65; p ˂ 0.00001), major adverse cardiovascular events (MACE)(RR: 0.82; 95% CI: 0.74 to 0.91; p = 0.0002), and major vascular complications (RR: 0.37; 95% CI: 0.29 to 0.48; p ˂ 0.00001). These results were consistent irrespective of the clinical presentation of ACS or STEMI. Conclusions: Radial access in patients undergoing CA with or without PCI is associated with lower mortality, MACE, major bleeding and vascular complications, irrespective of clinical presentation, ACS or STEMI, compared with femoral access.
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12.
  • Banach, Maciej, et al. (författare)
  • The association between daily step count and all-cause and cardiovascular mortality : a meta-analysis
  • 2023
  • Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press. - 2047-4873 .- 2047-4881. ; 30:18, s. 1975-1985
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: There is good evidence showing that inactivity and walking minimal steps/day increase the risk of cardiovascular (CV) disease and general ill-health. The optimal number of steps and their role in health is, however, still unclear. Therefore, in this meta-analysis, we aimed to evaluate the relationship between step count and all-cause mortality and CV mortality.Methods and results: We systematically searched relevant electronic databases from inception until 12 June 2022. The main endpoints were all-cause mortality and CV mortality. An inverse-variance weighted random-effects model was used to calculate the number of steps/day and mortality. Seventeen cohort studies with a total of 226 889 participants (generally healthy or patients at CV risk) with a median follow-up 7.1 years were included in the meta-analysis. A 1000-step increment was associated with a 15% decreased risk of all-cause mortality [hazard ratio (HR) 0.85; 95% confidence interval (CI) 0.81-0.91; P < 0.001], while a 500-step increment was associated with a 7% decrease in CV mortality (HR 0.93; 95% CI 0.91-0.95; P < 0.001). Compared with the reference quartile with median steps/day 3967 (2500-6675), the Quartile 1 (Q1, median steps: 5537), Quartile 2 (Q2, median steps 7370), and Quartile 3 (Q3, median steps 11 529) were associated with lower risk for all-cause mortality (48, 55, and 67%, respectively; P < 0.05, for all). Similarly, compared with the lowest quartile of steps/day used as reference [median steps 2337, interquartile range 1596-4000), higher quartiles of steps/day (Q1 = 3982, Q2 = 6661, and Q3 = 10 413) were linearly associated with a reduced risk of CV mortality (16, 49, and 77%; P < 0.05, for all). Using a restricted cubic splines model, we observed a nonlinear dose-response association between step count and all-cause and CV mortality (Pnonlineraly < 0.001, for both) with a progressively lower risk of mortality with an increased step count.Conclusion: This meta-analysis demonstrates a significant inverse association between daily step count and all-cause mortality and CV mortality with more the better over the cut-off point of 3967 steps/day for all-cause mortality and only 2337 steps for CV mortality.
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13.
  • Batalli, Arlind, et al. (författare)
  • Different determinants of exercise capacity in HFpEF compared to HFrEF
  • 2017
  • Ingår i: Cardiovascular Ultrasound. - : BioMed Central. - 1476-7120. ; 15:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Quality of life is as important as survival in heart failure (HF) patients. Controversies exist with regards to echocardiographic determinants of exercise capacity in HF, particularly in patients with preserved ejection fraction (HFpEF). The aim of this study was to prospectively examine echocardiographic parameters that correlate and predict functional exercise capacity assessed by 6 min walk test (6-MWT) in patients with HFpEF.METHODS: In 111 HF patients (mean age 63 ± 10 years, 47% female), an echo-Doppler study and a 6-MWT were performed in the same day. Patients were divided into two groups based on the 6-MWT distance (Group I: ≤ 300 m and Group II: >300 m).RESULTS: Group I were older (p = 0.008), had higher prevalence of diabetes (p = 0.027), higher baseline heart rate (p = 0.004), larger left atrium - LA (p = 0.001), longer LV filling time - FT (p = 0.019), shorter isovolumic relaxation time (p = 0.037), shorter pulmonary artery acceleration time - PA acceleration time (p = 0.006), lower left atrial lateral wall myocardial velocity (a') (p = 0.018) and lower septal systolic myocardial velocity (s') (p = 0.023), compared with Group II. Patients with HF and reduced EF (HFrEF) had lower hemoglobin (p = 0.007), higher baseline heart rate (p = 0.005), higher NT-ProBNP (p = 0.001), larger LA (p = 0.004), lower septal s', e', a' waves, and septal mitral annular plane systolic excursion (MAPSE), shorter PA acceleration time (p < 0.001 for all), lower lateral MAPSE, higher E/A & E/e', and shorter LVFT (p = 0.001 for all), lower lateral e' (p = 0.009), s' (p = 0.006), right ventricular e' and LA emptying fraction (p = 0.012 for both), compared with HFpEF patients. In multivariate analysis, only LA diameter [2.676 (1.242-5.766), p = 0.012], and diabetes [0.274 (0.084-0.898), p = 0.033] independently predicted poor 6-MWT performance in the group as a whole. In HFrEF, age [1.073 (1.012-1.137), p = 0.018] and LA diameter [3.685 (1.348-10.071), p = 0.011], but in HFpEF, lateral s' [0.295 (0.099-0.882), p = 0.029], and hemoglobin level [0.497 (0.248-0.998), p = 0.049] independently predicted poor 6-MWT performance.CONCLUSIONS: In HF patients determinants of exercise capacity differ according to severity of overall LV systolic function, with left atrial enlargement in HFrEF and longitudinal systolic shortening in HFpEF as the the main determinants.
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14.
  • Berisha, Gëzim, et al. (författare)
  • Impaired left atrial reservoir function in metbolic syndrome predicts symptoms in HFpEF patients
  • 2015
  • Ingår i: International Cardiovascular Forum Journal. - : Barcaray Publishing. - 2410-2636 .- 2409-3424. ; 4, s. 37-42
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Aim. The Metabolic Syndrome (MetS) has been shown to be independently associated with increased risk for incident heart failure (HF) and coronary artery disease. The aim of this study was to investigate the additional effect of MetS on LA dysfunction in a group of patients with HF and preserved ejection fraction (HFpEF) and its relationship with symptoms.Methods. This study included 194 consecutive patients (age 62 ± 9 years) with stable HFpEF. LV dimensions, ejection fraction (EF), mitral annulus peak systolic excursion (MAPSE), myocardial velocities (s’, e’ and a’), LA dimensions and volumes were measured. Total LA emptying fraction (LA EF) was measured by Simpson rule volumes. Based on the NCEP-ATP III criteria, patients were divided into two groups; MetS (n=95) and non-MetS (n=108) and were compared with 34 age and gender matched controls.Results. Age and gender were not different between patients and control neither between MetS and non-Met. LV dimensions, EF and longitudinal function indices were also not different. The MetS patients had higher LV mass index (p=0.038), lower septal and lateral e’ (p=0.003 and p=0.001, respectively) velocities, larger LA minimal volume (p=0.007) and lower LA EF (p<0.001) compared with the non-MetS patients. Age, LA EF and MetS independently predicted the NYHA class.Conclusions. Despite no difference in LV systolic function, patients with HFpEF and MetS have worse LA emptying fraction, compared with HFpEF and non-MetS patients. In addition, LA reservoir function impairment and MetS independently predict patients limiting symptoms, thus add to a better understanding of HFpEF.
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15.
  • Berisha-Muharremi, Venera, et al. (författare)
  • Diabetes Is the Strongest Predictor of Limited Exercise Capacity in Chronic Heart Failure and Preserved Ejection Fraction (HFpEF)
  • 2022
  • Ingår i: Frontiers in Cardiovascular Medicine. - : Frontiers Media S.A.. - 2297-055X. ; 9
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Aim: Type 2 diabetes mellitus (T2DM) is a known risk factor in patients with heart failure (HF), but its impact on phenotypic presentations remains unclear. This study aimed to prospectively examine the relationship between T2DM and functional exercise capacity, assessed by the 6-min walk test (6-MWT) in chronic HF.Methods: We studied 344 chronic patients with HF (mean age 61 ± 10 years, 54% female) in whom clinical, biochemical, and anthropometric data were available and all patients underwent an echo-Doppler study and a 6-MWT on the same day. The 6-MWT distance divided the cohort into; Group I: those who managed ≤ 300 m and Group II: those who managed >300 m. Additionally, left ventricular (LV) ejection fraction (EF), estimated using the modified Simpson's method, classified patients into HF with preserved EF (HFpEF) and HF with reduced EF (HFrEF).Results: The results showed that 111/344 (32%) patients had T2DM, who had a higher prevalence of arterial hypertension (p = 0.004), higher waist/hips ratio (p = 0.041), higher creatinine (p = 0.008) and urea (p = 0.003), lower hemoglobin (p = 0.001), and they achieved shorter 6-MWT distance (p < 0.001) compared with those with no T2DM. Patients with limited exercise (<300 m) had higher prevalence of T2DM (p < 0.001), arterial hypertension (p = 0.004), and atrial fibrillation (p = 0.001), higher waist/hips ratio (p = 0.041), higher glucose level (p < 0.001), lower hemoglobin (p < 0.001), larger left atrium (LA) (p = 0.002), lower lateral mitral annular plane systolic excursion (MAPSE) (p = 0.032), septal MAPSE (p < 0.001), and tricuspid annular plane systolic excursion (TAPSE) (p < 0.001), compared with those performing >300 m. In the cohort as a whole, multivariate analysis, T2DM (p < 0.001), low hemoglobin (p = 0.008), atrial fibrillation (p = 0.014), and reduced septal MAPSE (p = 0.021) independently predicted the limited 6-MWT distance. In patients with HFpEF, diabetes [6.083 (2.613–14.160), p < 0.001], atrial fibrillation [6.092 (1.769–20.979), p = 0.002], and septal MAPSE [0.063 (0.027–0.184), p = 0.002], independently predicted the reduced 6-MWT, whereas hemoglobin [0.786 (0.624–0.998), p = 0.049] and TAPSE [0.462 (0.214–0.988), p = 0.041] predicted it in patients with HFrEF.Conclusion: Predictors of exercise intolerance in patients with chronic HF differ according to LV systolic function, demonstrated as EF. T2DM seems the most powerful predictor of limited exercise capacity in patients with HFpEF.
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16.
  • Bielecka-Dabrowa, Agata, et al. (författare)
  • Association of statin use and clinical outcomes in heart failure patients : a systematic review and meta-analysis
  • 2019
  • Ingår i: Lipids in Health and Disease. - : BioMed Central (BMC). - 1476-511X. ; 18:1
  • Forskningsöversikt (refereegranskat)abstract
    • Background: The role of statins in patients with heart failure (HF) of different levels of left ventricular ejection fraction (LVEF) remains unclear especially in the light of the absence of prospective data from randomized controlled trials (RCTs) in non-ischemic HF, and taking into account potential statins’ prosarcopenic effects. We assessed the association of statin use with clinical outcomes in patients with HF.Methods: We searched PubMed, EMBASE, Scopus, Google Scholar and Cochrane Central until August 2018 for RCTs and prospective cohorts comparing clinical outcomes with statin vs non-statin use in patients with HF at different LVEF levels. We followed the guidelines of the 2009 PRISMA statement for reporting and applied independent extraction by multiple observers. Meta-analyses of hazard ratios (HRs) of effects of statins on clinical outcomes used generic inverse variance method and random model effects. Clinical outcomes were all-cause mortality, cardiovascular (CV) mortality and CV hospitalization.Results: Finally we included 17 studies (n = 88,100; 2 RCTs and 15 cohorts) comparing statin vs non-statin users (mean follow-up 36 months). Compared with non-statin use, statin use was associated with lower risk of all-cause mortality (HR 0.77, 95% confidence interval [CI], 0.72–0.83, P < 0.0001, I2 = 63%), CV mortality (HR 0.82, 95% CI: 0.76–0.88, P < 0.0001, I2 = 63%), and CV hospitalization (HR 0.78, 95% CI: 0.69–0.89, P = 0.0003, I2 = 36%). All-cause mortality was reduced on statin therapy in HF with both EF < 40% and ≥ 40% (HR: 0.77, 95% Cl: 0.68–0.86, P < 0.00001, and HR 0.75, 95% CI: 0.69–0.82, P < 0.00001, respectively). Similarly, CV mortality (HR 0.86, 95% CI: 0.79–0.93, P = 0.0003, and HR 0.83, 95% CI: 0.77–0.90, P < 0.00001, respectively), and CV hospitalizations (HR 0.80 95% CI: 0.64–0.99, P = 0.04 and HR 0.76 95% CI: 0.61–0.93, P = 0.009, respectively) were reduced in these EF subgroups. Significant effects on all clinical outcomes were also found in cohort studies’ analyses; the effect was also larger and significant for lipophilic than hydrophilic statins.Conclusions: In conclusion, statins may have a beneficial effect on CV outcomes irrespective of HF etiology and LVEF level. Lipophilic statins seem to be much more favorable for patients with heart failure.
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17.
  • Bielecka-Dabrowa, Agata, et al. (författare)
  • Left ventricular diastolic dysfunction as predictor of unfavorable prognosis after ESUS
  • 2021
  • Ingår i: Journal of Multidisciplinary Healthcare. - : Dove Medical Press. - 1178-2390. ; 14, s. 617-627
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Identification of echocardiographic, hemodynamic and biochemical predictors of unfavorable prognosis after embolic strokes of undetermined etiology (ESUS) in patients at age <65.Patients and Methods: Out of 520 ischemic stroke patients we selected 64 diagnosed with ESUS and additional 36 without stroke but with similar risk profile. All patients underwent echocardiography, non-invasive assessment of hemodynamic parameters using SphygmoCor tonometer and measurements of selected biomarkers. Follow-up time was 12 months.Results: Nine percent of patients died, and recurrent ischemic stroke occurred in 9% of patients only in the ESUS group. Atrial fibrillation (AF) occurred in 10% of patients and the ESUS group had a significantly poorer outcome of AF in the first 2 months after hospitalization. The outcome of re-hospitalization was 28% in the ESUS group and 17% in the control group. In the multivariate analysis mean early diastolic (E’) mitral annular velocity (OR 0.75, 95% CI: 0.6–0.94; p=0.01) was significantly associated with cardiovascular hospitalizations. The only independent predictor of recurrent stroke was the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion (E/E’) (OR 0.75, 95% CI: 0.6–0.94; p=0.01). E/E’ was independently associated with composite endpoint (death, hospitalization and recurrent stroke) (OR 1.90, 95% CI 1.1–3.2, p=0.01).Conclusion: The indices of diastolic dysfunction are significantly associated with unfavorable prognosis after ESUS. There is a robust role for outpatient cardiac monitoring especially during the first 2 months after ESUS to detect potential AF.
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18.
  • Bytyci, Ibadete, et al. (författare)
  • Alcohol Septal Ablation versus Septal Myectomy Treatment of Obstructive Hypertrophic Cardiomyopathy : A Systematic Review and Meta-Analysis
  • 2020
  • Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 9:10
  • Forskningsöversikt (refereegranskat)abstract
    • Surgical myectomy (SM) and alcohol septal ablation (ASA) are two invasive therapies for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM), despite medical therapy. This meta-analysis aims to compare the efficacy of the two procedures. We searched all electronic databases until February 2020 for clinical trials and cohorts comparing clinical outcomes of ASA and SM treatment of patients with HOCM. The primary endpoint was all-cause mortality, cardiovascular (CV) mortality, sudden cardiac death (SCD), re-intervention, and complications. Secondary endpoints included relief of clinical symptoms and drop of left ventricular outflow tract (LVOT) gradient. Twenty studies (4547 patients; 2 CTs and 18 cohorts) comparing ASA vs. SM with a mean follow-up of 47 ± 28.7 months were included. Long term (8.72 vs. 7.84%, p = 0.42) and short term (1.12 vs. 1.27%, p = 0.93) all-cause mortality, CV mortality (2.48 vs. 3.66%, p = 0.26), SCD (1.78 vs. 0.76%, p = 0.20) and stroke (0.36 vs. 1.01%, p = 0.64) were not different between procedures. ASA was associated with lower peri-procedural complications (5.57 vs. 10.5%, p = 0.04) but higher rate of re-interventions (10.1 vs. 0.27%; p < 0.001) and pacemaker dependency (12.4 vs. 4.31%, p = 0.0004) compared to SM. ASA resulted in less reduction in LVOT gradient (−47.8 vs. −58.4 mmHg, p = 0.01) and less improvement of clinical symptoms compared to SM (New York Heart Association (NYHA) class III/IV, 82.4 vs. 94.5%, p < 0.001, angina 53.2 vs. 84.2%, p = 0.02). Thus, ASA and SM treatment of HOCM carry a similar risk of mortality. Peri-procedural complications are less in alcohol ablation but re-intervention and pacemaker implantations are more common. These results might impact the procedure choice in individual patients, for the best clinical outcome.
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19.
  • Bytyçi, Ibadete, et al. (författare)
  • Carotid Atherosclerosis in Predicting Coronary Artery Disease : A Systematic Review and Meta-Analysis
  • 2021
  • Ingår i: Arteriosclerosis, Thrombosis and Vascular Biology. - : Lippincott Williams & Wilkins. - 1079-5642 .- 1524-4636. ; 41:4, s. e224-e237
  • Forskningsöversikt (refereegranskat)abstract
    • Objective: This meta-Analysis aims to compare the relationship between phenotypic manifestation of coronary and carotid atherosclerosis using available imaging techniques. Approach and Results: We searched all electronic databases until October 2020 for studies which reported relationship between carotid and coronary atherosclerosis. The primary end point was correlation between carotid intima-media thickness (CIMT) and carotid plaque features (calcification and lipid-rich necrotic core) with coronary artery disease (CAD). Secondary end points included carotid pathology that predicts CAD. Eighty-nine papers with 22 683 patients comparing carotid and coronary atherosclerosis were included in the analysis. CIMT was increased linearly with severity of CAD irrespective of its significance (P<0.001), mono versus 2 vessel disease (P=0.003), and 2 versus multivessel disease (P<0.001). Carotid plaque presence and calcification were less, and lipid-rich necrotic core was highly prevalent in nonsignificant versus significant CAD (P<0.001, P=0.03, P<0.001, respectively). Moderate correlation was found between CIMT and severity of CAD (r=0.60, P<0.001) and the number of diseased vessels (r=0.49, P<0.001). There was a moderate correlation between carotid and coronary stenosis (r=0.53, P<0.001) and between carotid and coronary calcification (r=0.61, P<0.001). CIMT ≥1.0 mm with a summary sensitivity of 77% and summary specificity of 72% and respective values of 80% and 67% for carotid plaque were the best predictors of CAD, irrespective of the technique used for its diagnosis. Conclusions: These results support the concept that atherosclerosis affects both carotid and coronary systems, although not always in identical phenotypic manner. These findings highlight the beneficial examination of carotid arteries whenever CAD is suspected.
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20.
  • Bytyçi, Ibadete, et al. (författare)
  • Compromised left atrial function and increased size predict raised cavity pressure : a systematic review and meta-analysis
  • 2019
  • Ingår i: Clinical Physiology and Functional Imaging. - : John Wiley & Sons. - 1475-0961 .- 1475-097X. ; 39:5, s. 297-307
  • Forskningsöversikt (refereegranskat)abstract
    • Aim: This meta-analysis assesses left atrial (LA) cavity and myocardial function measurements that predict pulmonary capillary wedge pressure (PCWP).Methods: PubMed-MEDLINE, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry were searched up to December 2018 for studies on the relationship of LA diameter, LA indexed volume (LAVI max, LAVI min), peak atrial longitudinal (PALS), peak atrial contraction (PACS) strain and total emptying fraction (LAEF) with PCWP. Eighteen studies with 1343 patients were included. sensitivity and specificity (with 95% CI) for evaluation of diagnostic accuracy and the best cut-off values for different LA indices in predicting raised PCWP were estimated using summary receiver operating characteristic analysis.Results: The pooled analysis showed association between PCWP and LA diameter: Cohen's d = 0 center dot 87, LAVI max: d = 0 center dot 92 and LAVI min: d = 1 center dot 0 (P<0 center dot 001 for all). A stronger correlation was found between PCWP and PALS: d = 1 center dot 26, and PACS: d = 1 center dot 62, total EF d = 1 center dot 22 (P<0 center dot 0001 for all). PALS <= 19% had a summary sensitivity of 80% (65-90) and summary specificity of 77% (52-92), positive likelihood ratio (LR+) 3 center dot 74, negative likelihood ratio (LR-) DOR > 15 center dot 1 whereas LAVI >= 34 ml m(-2) had summary sensitivity of 75% (55-89) and summary specificity 77% (57-90), with LR+ >3, LR- 0 center dot 32 and DOR >10 center dot 1.Conclusions: Compromised LA myocardial function and increased size predict raised cavity pressure. These results should assist in optimum follow-up of patients with fluctuating LA pressure.
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21.
  • Bytyci, Ibadete, et al. (författare)
  • Efficacy and safety of colchicine in patients with coronary artery disease : a systematic review and meta-analysis of randomized controlled trials
  • 2022
  • Ingår i: British Journal of Clinical Pharmacology. - : British Pharmacological Society. - 0306-5251 .- 1365-2125. ; 88:4, s. 1520-1528
  • Forskningsöversikt (refereegranskat)abstract
    • Aims: Inflammation plays a central role in the pathogenesis and clinical manifestations of atherosclerosis. Randomized controlled trials have investigated the potential benefit of colchicine in reducing cardiovascular (CV) events in patients with coronary artery disease (CAD) but produced conflicting results. The aim of this meta-analysis was to evaluate the efficacy and safety of colchicine in patients with CAD.Methods: We systematically searched selected electronic databases from inception until 10 December 2020. Primary clinical endpoints were: major adverse cardiac events; all-cause mortality; CV mortality; recurrent myocardial infarction; stroke; hospitalization; and adverse medication effects. Secondary endpoints were short-term effect of colchicine on inflammatory markers.Results: Twelve randomized controlled trials with a total of 13 073 patients with CAD (colchicine n = 6351 and placebo n = 6722) were included in the meta-analysis. At mean follow-up of 22.5 months, the colchicine group had lower risk of major adverse cardiac events (6.20 vs. 8.87%; P <.001), recurrent myocardial infarction (3.41 vs. 4.41%; P =.005), stroke (0.40 vs. 0.90%; P =.002) and hospitalization due to CV events (0.90 vs. 2.87%; P =.02) compared to the control group. The 2 patient groups had similar risk for all-cause mortality (2.08 vs. 1.88%; P =.82) and CV mortality (0.71 vs. 1.01%; P =.38). Colchicine significantly reduced high-sensitivity C-reactive protein (−4.25, P =.001) compared to controls but did not significantly affect interleukin (IL)-β1 and IL-18 levels.Conclusion: Colchicine reduced CV events and inflammatory markers, high-sensitivity C-reactive protein and IL-6, in patients with coronary disease compared to controls. Its impact on cardiovascular and all-cause mortality requires further investigation.
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22.
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23.
  • Bytyci, I. Ibadete, et al. (författare)
  • Left atrial size as predictor of recurrences after catheter ablation in paroxysmal atrial fibrillation : a systematic review and meta-analysis
  • 2017
  • Ingår i: European Journal of Heart Failure. - : European Society of Cardiology. - 1388-9842 .- 1879-0844. ; 19:S1, s. 80-80
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Aim: Left atrial (LA) enlargement is associated with paroxysmal atrial fibrillation (PAF) incidence and outcome. The predictive role of the LA size in AF treatment with catheter ablation is still controversial. The aim of this meta-analysis was to analyze the potential association between LA diameter in patients with PAF undergoing ablation and AF recurrence after ablation.Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to December 2016 in order to select clinical trial and observational studies, which assessed the predictive role of LA diameter in AF recurrence after catheter-ablation. 2962 patients from 16 studies with paroxysmal AF (PAF) were included.Results: The pooled analysis showed that after a follow-up period of 19. 66± 8.31 months, patients with AF recurrence had larger LA size compared with those without AF recurrence, with a weighted mean difference (WMD) 2.31 ([95% CI 1.27 to 3.34], P < 0.0001). LA diameter ≥40 mm predicted AF recurrence HR:1.04 [95% CI 1.00 to 1.08], P=0.04), but the best cut-off value, in all included patients, was ≥50mm HR:3.08 [95% CI 1.47 to 6.49], P=0.003).Conclusions: Enlarged left atrium in patients with PAF undergoing catheter ablation predicts recurrences. The diameter more than 50 mm is the best cut-off of the recurrences of AF, but diameter of 40 mm also can predict recurrences in these patients.
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24.
  • Bytyci, Ibadete, et al. (författare)
  • Improved Left Atrial Function in CRT Responders : A Systematic Review and Meta-Analysis
  • 2020
  • Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 9:2
  • Forskningsöversikt (refereegranskat)abstract
    • Cardiac resynchronization therapy (CRT) is associated with reverse left atrial (LA) remodeling. The aim of this meta-analysis was to assess the relationship between clinical response to CRT and LA function changes. We conducted a systematic search of all electronic databases up to September 2019 which identified 488 patients from seven studies. At (mean) 6 months follow-up, LA systolic strain and emptying fraction (EF) were increased in CRT responders, with a -5.70% weighted mean difference (WMD) [95% confidence interval (CI) -8.37 to -3.04, p < 0.001 and a WMD of -8.98% [CI -15.1 to -2.84, p = 0.004], compared to non-responders. The increase in LA strain was associated with a fall in left ventricle (LV) end-systolic volume (LVESV) r = -0.56 (CI -0.68 to -0.40, p < 0.001) and an increase in the LV ejection fraction (LVEF) r = 0.58 (CI 0.42 to 0.69, p < 0.001). The increase in LA EF correlated with the fall in LVESV r = -0.51 (CI -0.63 to -0.36, p < 0.001) and the increase in the LVEF r = 0.48 (CI 0.33 to 0.61, p = 0.002). The increase in LA strain correlated with the increase in the LA EF, r = 0.57 (CI 0.43 to 0.70, p < 0.001). Thus, the improvement of LA function in CRT responders reflects LA reverse remodeling and is related to its ventricular counterpart.
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25.
  • Bytyci, Ibadete, et al. (författare)
  • Left atrial compliance index predicts exercise capacity in patients with heart failure and preserved ejection fraction irrespective of right ventricular dysfunction
  • 2019
  • Ingår i: Echocardiography. - : Wiley-Blackwell. - 0742-2822 .- 1540-8175. ; 36:6, s. 1045-1053
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Aim: Predictors of exercise capacity in heart failure (HF) with preserved ejection fraction (HFpEF) remain of difficult determination. The aim of this study was to identify predictors of exercise capacity in a group of patients with HFpEF and right ventricle (RV) dysfunctionMethods: In 143 consecutive patients with HFpEF (age 62 ± 9 years, LV EF ≥45) and 41 controls, a complete echocardiographic study was performed. In addition to conventional measurements, LA compliance was calculated using the formula: [LAV max − LAV min/LAV min × 100]. Exercise capacity was assessed using the six‐minute walking test (6‐MWT). Tricuspid annular plane systolic excursion (TAPSE) < 1.7 cm was utilized to categorize patients with RV dysfunction (n = 40) from those with maintained RV function (n = 103).Results: Patients with RV dysfunction were older (P = 0.002), had higher NYHA class (P = 0.001), higher LV mass index (P = 0.01), reduced septal and lateral MAPSE (all P < 0.001), enlarged LA (P = 0.001) impaired LA compliance index (P < 0.001) and exhibited a more compromised 6‐MWT (P = 0.001). LA compliance index correlated more closely with 6‐MWT (r = 0.51, P < 0.001) compared with the other LA indices (AP diameter, transverse diameter and volume indexed; r = −0.30, r = −0.35 and r = −0.38, respectively). In multivariate analysis, LA compliance index <60% was 88% sensitive and 61% specific (AUC 0.80, CI = 0.67–0.92 P = 0.001) in predicting exercise capacity.Conclusion: An impairment in LA compliance was profound in patients with HFpEF and RV dysfunction and seems to be most powerful independent predictor of limited exercise capacity.
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26.
  • Bytyci, Ibadete, et al. (författare)
  • Left atrial emptying fraction predicts limited exercise performance in heart failure patients
  • 2014
  • Ingår i: IJC Heart and Vessels. - : Elsevier. - 2214-7632. ; 4, s. 203-207
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: We aimed in this study to assess the role of left atrial (LA), in addition to left ventricular (LV) indices, in predicting exercise capacity in patients with heart failure (HF). Methods: This study included 88 consecutive patients (60 ± 10 years) with stable HF. LV end-diastolic and end-systolic dimensions, ejection fraction (EF), mitral and tricuspid annulus peak systolic excursion (MAPSE and TAPSE), myocardial velocities (s′, e′ and a′), LA dimensions, LA volume and LA emptying fraction were measured. A 6-min walking test (6-MWT) distance was performed on the same day of the echocardiographic examination. Results: Patients with limited exercise performance (≤ 300 m) were older (p = 0.01), had higher NYHA functional class (p = 0.004), higher LV mass index (p = 0.003), larger LA (p = 0.002), lower LV EF (p = 0.009), larger LV end-systolic dimension (p = 0.007), higher E/A ratio (p = 0.03), reduced septal MAPSE (p < 0.001), larger LA end-systolic volume (p = 0.03), larger LA end-diastolic volume (p = 0.005) and lower LA emptying fraction (p < 0.001) compared with good performance patients. In multivariate analysis, only the LA emptying fraction [0.944 (0.898–0.993), p = 0.025] independently predicted poor exercise performance. An LA emptying fraction < 60% was 68% sensitive and 73% specific (AUC 0.73, p < 0.001) in predicting poor exercise performance. Conclusion: In heart failure patients, the impaired LA emptying function is the best predictor of poor exercise capacity. This finding highlights the need for routine LA size and function monitoring for better optimization of medical therapy in HF.
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27.
  • Bytyci, Ibadete, et al. (författare)
  • Left atrial stiffness predicts cardiac events in patients with heart failure and reduced ejection fraction : The impact of diabetes
  • 2021
  • Ingår i: Clinical Physiology and Functional Imaging. - : John Wiley & Sons. - 1475-0961 .- 1475-097X. ; 41:2, s. 208-216
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The aim of this study was to investigate the relationship between diabetes mellitus (DM) and left atrial (LA) remodelling in a group of patients with heart failure and reduced ejection fraction (HFrEF), and their combined impact on cardiac events (CE).Methods: This study included 136 consecutive HFrEF patients (65 +/- 11 years), 36 had DM, and 86 had increased LA stiffness (LASt). All patients underwent complete conventional and tissue Doppler echocardiographic measurements were made including LA volumes and function. LASt was calculated using the formula: LASt = E/e' ratio / PALS.Results: At 55 +/- 37 months follow-up, free survival from CE was 69% in patients without DM and 44.4% in those with DM (p < .0001). The CE free survival was lower in patients with increased LASt compared to normal LASt, (50 versus. 80%, p < .001), irrespective of the presence of DM (27 versus. 71%, p < .001).The best cut-off value of LASt for predicting CE in the group as a whole was >= 0.82% [81% sensitivity, 72% specificity and AUC 0.82 (p < .001)]. LASt >= 0.82% also predicted CE in no DM patients [78% sensitivity, 71% specificity and AUC 0.80 (p < .001)] and was a stronger predictor in DM patients [85% sensitivity, 71% specificity and AUC = 0.847 (p < .001)].Conclusion: High LA stiffness is associated with poor clinical outcome in patients with HFrEF. Diabetes has an additional incremental value in determining clinical outcome in those patients.
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28.
  • Bytyci, Ibadete, et al. (författare)
  • Left atrial strain increases in CRT responders : a systematic review and meta-analysis
  • 2018
  • Ingår i: European Heart Journal. - : OXFORD UNIV PRESS. - 0195-668X .- 1522-9645. ; 39, s. 422-422
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • Background and aim: Impaired left atrial (LA) strain is associated with myocardial fibrosis and carries poor prognosis, especially arrhythmia. Cardiac resynchronization therapy (CRT) is associated with reserved LA remodeling and reduced arrhythmia. The aim of this meta-analysis was to assess the relationship between CRT and LA function improvement.Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar and the Cochrane Central Registry, up to February 2018 in order to select clinical trials and observational studies, which assessed the predictive value of LA strain of CRT response. The left ventricular end-systolic volume (LVESV) reduction ≥15 ml and/or LV ejection fraction (EF) increase ≥10% were the documented criteria for assessment of CRT response.Results: A total of 299 patients (181 responders and 118 non-responders to CRT) from 5 observational studies, with mean follow-up period of 6 months were included in this meta-analysis. The pooled analysis showed no difference between baseline LA strain in the two groups with weighted mean difference (WMD) 1.07% [95% CI -2.37 to 4.51, P=0.54, Figure 1]. After the follow-up period, LA strain in the CRT responders significantly increased, WMD 27.7% [95% CI 23.1 to 32.6, P<0.001, Figure 2, a)], but not in the non-responders, WMD -34.5 [95% CI -38.4 to -30.6, p<0.001, Figure 2, b)].Conclusions: Improvement of LA strain in CRT responders reflects LA reserve remodeling. These results support the importance of LA function in patients treated by CRT for heart failure.
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29.
  • Bytyci, Ibadete, et al. (författare)
  • Left atrial volume index predicts response to cardiac resynchronisation therapy : a systematic review and meta-analysis
  • 2022
  • Ingår i: Archives of Medical Science. - Poznan, Poland : Termedia. - 1734-1922 .- 1896-9151. ; 18:4, s. 930-938
  • Forskningsöversikt (refereegranskat)abstract
    • Introduction: In responders, cardiac resynchronisation therapy (CRT) results in improved left ventricular (LV) function and reduced atrial arrhythmia. The aim of this meta-analysis was to assess the potential relationship between the left atrium (LA) volume and CRT response.Material and methods: We systematically searched all electronic databases up to August 2018 in order to select clinical trials and observational studies that assessed the predictive value of LA volume index (LAVI) of CRT response. Left ventricular end-systolic volume (LVESV) reduction ≥ 15 ml and/ or LV ejection fraction (EF) increase ≥ 10% were the documented criteria for positive CRT response.Results: A total of 2191 patients recruited in 10 studies with mean follow-up duration of 10.5 months were included in this meta-analysis. The pooled analysis showed that CRT responders had lower baseline LAVI compared to non-responders, with a weighted mean difference (WMD) of -5.89% (95% CI: -9.47 to -3.22, p < 0.001). At follow-up, LAVI fell in the CRT responders (WMD -4.36%, 95% CI: -3.54 to -5.17, p < 0.001) compared to non-responders (WMD 1.45 %, 95% CI: -0.75 to 3.65, p = 0.20). The mean change of LAVI in the CRT responders was related to the fall in LVESV, β = -1.02 (-1.46 to -0.58), p < 0.001 and the increase in LVEF, β = 2.02 (1.86 to 4.58), p = 0.001. A baseline LAVI < 34 ml/m2 predicted CRT response with summary sensitivity 0.80% (0.53-0.95), specificity 0.74% (0.53-0.89), and odds ratio > 11.Conclusions: Baseline LAVI predicts CRT response, and its reduction reflects devise-related LA remodelling. These results emphasis the role of LAVI assessment as an integral part of cardiac function response to CRT.
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30.
  • Bytyci, Ibadete, et al. (författare)
  • Left ventricular myocardial and cavity velocity disturbances are powerful predictors of significant coronary artery stenosis
  • 2022
  • Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 11:20
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Aim: Dobutamine stress echocardiography (DSE) is a well-established noninvasive investigation for significant coronary artery disease (CAD). The aim of this study was to evaluate the accuracy of cardiac Doppler parameters in predicting CAD.Methods: We prospectively studied 103 consecutive patients with suspected CAD based on typical symptoms; 59 proved to have CAD, and 44 patients proved to have no-CAD (n = 44). All patients underwent a complete stress Doppler echocardiographic examination. Total isovolumic time (T-IVT) as a marker of cavity dyssynchrony and wall motion score index (WMSI) were also calculated.Results: At peak dobutamine stress, the compromised LV longitudinal excursion (MAPSE), systolic septal and lateral velocities (s’), and diastolic indices were more pronounced in the CAD patients compared with those without CAD, but LV dimension did not differ between groups (p > 0.05). The WMSI was higher and t-IVT more prolonged in patients with CAD (p < 0.01 for both). Similarly, the changes were more pronounced in patients with significant CAD compared with insignificant CAD. On multivariate model, Δ mean s’, OR 2.016 (1.610 to 3.190; p < 0.001), Δ E velocity OR 2.502 (1.179 to 1.108; p < 0.001), Δ t-IVT 2.206 (1.180 to 2.780; p < 0.001) and Δ WMSI OR 1.911 (1.401 to 3.001; p = 0.001) were the most powerful independent predictors of the presence of CAD, particularly when significant (>75%). Δ mean s’ < 5.0 was 85% sensitive, 89% specific with AUC 0.92. Respective values for Δ E velocity <6.0 cm/s were 82%, 90% and 0.91; for Δ t-IVT > 4.5, 78%, 77% and 0.81 and for Δ FT ≥ 150 ms, 76%, 78% and 0.84 in predicating significant CAD. WMSI ≥ 0.7 was 75% sensitive, 77% specific with AUC of 0.81 in predicting significant CAD. The accuracy of DSE was higher in significant CAD compared to insignificant CAD (80% vs. 74%; p = 0.03).Conclusions: Compromised LV longitudinal systolic function, lower delta E wave, prolonged t-IVT, and increased WMSI were the most powerful independent predictors of the presence and significance of CAD. These finding strengthen the role of comprehensive DSE analysis in diagnosing ischemic disturbances secondary to significant CAD.
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31.
  • Bytyci, Ibadete, et al. (författare)
  • Longitudinal myocardial function is more compromised in cardiac syndrome X compared to insignificant CAD : Role of stress echocardiography and calcium scoring
  • 2022
  • Ingår i: Clinical Physiology and Functional Imaging. - : John Wiley & Sons. - 1475-0961 .- 1475-097X. ; 42:1, s. 35-42
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Aim: The aim of this study was to assess the nature of myocardial dysfunction in the cardiac syndrome X (CSX) and insignificant coronary artery disease (ICAD) using dobutamine stress echocardiography (DSE) and coronary calcium scoring (CAC).Methods: We prospectively studied 35 consecutive patients who complained of exertional angina, had ≥1 mm ST shift on exercise stress test but normal or no obstructive CAD (<50%) on angiography. Patients were divided into CSX (n = 27) with normal arteries and ICAD (n = 8) with insignificant stenosis.Results: CSX patients had more females, lower calcium score and less prevalent cardiac risk factors compared to ICAD (p < 0.05 for all). At peak stress, MAPSE and TAPSE failed to increase in both groups. LV septal and lateral s’ increased in the two groups but the increment increase was less in CSX than ICAD (p < 0.05) while other diastolic indices did not differ between groups (p > 0.05 for all). CAC correlated modestly with LV and RV systolic velocities: septal s' (r = −0.65, p < 0.001) lateral s' (r = −0.35, p = 0.04) and right s' (r = −0.53, p = 0.005) in CSX, while in ICAD patients only with RV s' (r = −0.58, p = 0.02). On multivariate model, only septal s' OR 1.816 (1.1090–3.820, p = 0.04) proved the most powerful independent predictor of CAC.Conclusions: Compromised LV longitudinal systolic velocities were more pronounced and calcium score as a surrogate for atherosclerosis was lower in CSX than ICAD. These findings strengthen the evidence for different pathogenesis of CSX compared to ICAD, with microvascular disease in the former and calcification in the latter.
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32.
  • Bytyçi, Ibadete, et al. (författare)
  • Percutaneous coronary intervention is not superior to optimal medical therapy in chronic coronary syndrome : a meta-analysis
  • 2023
  • Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 12:4
  • Forskningsöversikt (refereegranskat)abstract
    • (1) Background and Aim: Conflicting evidence exists regarding the benefits of percutaneous coronary intervention (PCI) on survival and symptomatic relief of patients with chronic coronary syndrome (CCS) compared with optimal medical therapy (OMT). This meta-analysis is to evaluate the short- and long-term clinical benefit of PCI over and above OMT in CCS. (2) Methods: Main endpoints were major adverse cardiac events (MACEs), all-cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), urgent revascularization, stroke hospitalization, and quality of life (QoL). Clinical endpoints at very short (≤3 months), short- (<12 months), and long-term (≥ 12 months) follow-up were evaluated. (3) Results: Fifteen RCTs with a total of 16,443 patients with CCS (PCI n = 8307 and OMT n = 8136) were included in the meta-analysis. At mean follow-up of 27.7 months, the PCI group had similar risk of MACE (18.2 vs. 19.2 %; p < 0.32), all-cause mortality (7.09 vs. 7.88%; p = 0.56), CV mortality (8.74 vs. 9.87%; p = 0.30), MI (7.69 vs. 8.29%; p = 0.32), revascularization (11.2 vs. 18.3%; p = 0.08), stroke (2.18 vs. 1.41%; p = 0.10), and hospitalization for anginal symptoms (13.5 vs. 13.9%; p = 0.69) compared with OMT. These results were similar at short- and long-term follow-up. At the very short-term follow-up, PCI patients had greater improvement in the QoL including physical limitation, angina frequency, stability, and treatment satisfaction (p < 0.05 for all) but such benefits disappeared at the long-term follow-up. (4) Conclusions: PCI treatment of CCS does not provide any long-term clinical benefit compared with OMT. These results should have significant clinical implications in optimizing patient's selection for PCI treatment.
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33.
  • Bytyci, Ibadete, et al. (författare)
  • Prevalence of statin intolerance : a meta-analysis
  • 2022
  • Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 43:34, s. 3213-3223
  • Tidskriftsartikel (refereegranskat)abstract
    • AIMS: Statin intolerance (SI) represents a significant public health problem for which precise estimates of prevalence are needed. Statin intolerance remains an important clinical challenge, and it is associated with an increased risk of cardiovascular events. This meta-analysis estimates the overall prevalence of SI, the prevalence according to different diagnostic criteria and in different disease settings, and identifies possible risk factors/conditions that might increase the risk of SI. METHODS AND RESULTS: We searched several databases up to 31 May 2021, for studies that reported the prevalence of SI. The primary endpoint was overall prevalence and prevalence according to a range of diagnostic criteria [National Lipid Association (NLA), International Lipid Expert Panel (ILEP), and European Atherosclerosis Society (EAS)] and in different disease settings. The secondary endpoint was to identify possible risk factors for SI. A random-effects model was applied to estimate the overall pooled prevalence. A total of 176 studies [112 randomized controlled trials (RCTs); 64 cohort studies] with 4 143 517 patients were ultimately included in the analysis. The overall prevalence of SI was 9.1% (95% confidence interval 8.0-10%). The prevalence was similar when defined using NLA, ILEP, and EAS criteria [7.0% (6.0-8.0%), 6.7% (5.0-8.0%), 5.9% (4.0-7.0%), respectively]. The prevalence of SI in RCTs was significantly lower compared with cohort studies [4.9% (4.0-6.0%) vs. 17% (14-19%)]. The prevalence of SI in studies including both primary and secondary prevention patients was much higher than when primary or secondary prevention patients were analysed separately [18% (14-21%), 8.2% (6.0-10%), 9.1% (6.0-11%), respectively]. Statin lipid solubility did not affect the prevalence of SI [4.0% (2.0-5.0%) vs. 5.0% (4.0-6.0%)]. Age [odds ratio (OR) 1.33, P = 0.04], female gender (OR 1.47, P = 0.007), Asian and Black race (P < 0.05 for both), obesity (OR 1.30, P = 0.02), diabetes mellitus (OR 1.26, P = 0.02), hypothyroidism (OR 1.37, P = 0.01), chronic liver, and renal failure (P < 0.05 for both) were significantly associated with SI in the meta-regression model. Antiarrhythmic agents, calcium channel blockers, alcohol use, and increased statin dose were also associated with a higher risk of SI. CONCLUSION: Based on the present analysis of >4 million patients, the prevalence of SI is low when diagnosed according to international definitions. These results support the concept that the prevalence of complete SI might often be overestimated and highlight the need for the careful assessment of patients with potential symptoms related to SI.
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34.
  • Bytyci, Ibadete, et al. (författare)
  • Speckle Tracking-Derived Left Atrial Stiffness Predicts Clinical Outcome in Heart Failure Patients with Reduced to Mid-Range Ejection Fraction
  • 2020
  • Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 9:5
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Aim: Left atrial stiffness (LASt) is an important marker of cardiac function, especially in patients with heart failure (HF); it explains symptoms on the basis of pressure transfer to the pulmonary circulation. The aim of this study was to evaluate the relationship between LASt and cardiac events (CE) in HF patients with reduced to mid-range ejection fraction.Methods: The study included 215 consecutive ambulatory HF patients with ejection fraction (EF) < 50% (162 HF reduced EF and 53 HF mid-range EF) of mean age 66 +/- 11 years and 24.4% females. Peak LA strain (PALS) was measured by speckle tracking echocardiography and E/e' recorded from the apical four-chamber view. Non-invasive LASt was calculated using the equation: LASt = E/e' ratio/PALS. Documented cardiac events (CE) were HF hospitalization and cardiac death.Results: During a median follow up of 41 +/- 34 months, 65 patients (30%) had CE. In multivariate analysis model, only raised LV filling pressure (E/e') (OR = 0.292, (95% CI 0.099 to 0.859), p = 0.02), peak pulmonary artery pressure (PAP) (OR = 1.050 (1.009 to 1.094), p = 0.01), PALS (OR = 0.932 (0.873 to 0.994), p = 0.02) and LASt (OR = 3.781 (1.144 to 5.122), p = 0.001) independently predicted CE. LASt >= 0.76% was the most powerful predictor of CE, with 80% sensitivity and 73% specificity (AUC 0.82, CI = 0.73 to 0.87, p < 0.001) followed by PALS <= 16%, with 74% sensitivity and 72% specificity (AUC 0.77, CI = 0.71 to 0.84, p < 0.001). These results were consistent irrespective of EF (p < 0.05).Conclusion: In this cohort of ambulatory HFrEF and HFmrEF patients, LASt proved the most powerful predictor of clinical outcome.
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35.
  • Bytyci, Ibadete, et al. (författare)
  • Stride Length Predicts Adverse Clinical Events in Older Adults : A Systematic Review and Meta-Analysis
  • 2021
  • Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 10:12
  • Forskningsöversikt (refereegranskat)abstract
    • Background: This meta-analysis aims to estimate the power of walking stride length as a predictor of adverse clinical events in older adults. Methods: We searched all electronic databases until April 2021 for studies reporting stride length and other spatial gait parameters, including stride velocity, stride width, step width and stride variability, and compared them with clinical outcomes in the elderly. Meta-analyses of odds ratios (ORs) of effects of stride length on clinical outcomes used the generic inverse variance method and random model effects. Clinical outcomes were major adverse events (MAEs), physical disability and mortality. Results: Eleven cohort studies with 14,167 patients (mean age 75.4 ± 5.6 years, 55.8% female) were included in the analysis. At 33.05 months follow up, 3839 (27%) patients had clinical adverse events. Baseline stride length was shorter, WMD −0.15 (−0.19 to −0.11, p < 0.001), and stride length variability was higher, WMD 0.67 (0.33 to 1.01, p < 0.001), in fallers compared to non-fallers. Other gait parameters were not different between the two groups (p > 0.05 for all). Short stride length predicted MAE OR 1.36 (95% CI; 1.19 to 1.55, p < 0.001), physical disability OR 1.26 (95% CI; 1.11 to 1.44, p = 0.004) and mortality OR 1.69 (95% CI; 1.41 to 2.02, p < 0.001). A baseline normalized stride length ≤ 0.64 m was more accurate in predicting adverse clinical events, with summary sensitivity 65% (58–71%), specificity 72% (69–75%) and accuracy 75.5% (74.2–76.7%) compared to stride length variability 5.7%, with summary sensitivity 66% (61–70%), specificity 56% (54–58%) and accuracy 57.1% (55.5–58.6%). Conclusion: The results of this meta-analyses support the significant value of stride length for predicting life-threatening clinical events in older adults. A short stride length of ≤0.64 m accurately predicted clinical events, over and above other gait measures.
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36.
  • Bytyci, Ibadete, 1983- (författare)
  • The important role of left atrial function parameters in clinical practice
  • 2021
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The aim of this thesis is to evaluate the role of left atrial function in clinical practice based on the following studies:1)    Determining left atrial (LA) structure and myocardial function measurements that predict pulmonary capillary wedge pressure (PCWP).2)    Identifying predictors of exercise capacity in patients with HFpEF and right ventricle (RV) dysfunction.3)    Evaluating the relationship between LA stiffness (LASt) and cardiac events in HF patients with reduced to mid-range ejection fraction.4)    Investigating the relationship between DM and LA remodelling in a group of patients with HF and reduced ejection fraction (HFrEF), and their combined impact on cardiac events. Study IMethods: This is a meta-analysis study. All electronic databases were searched up to December 2018 for studies on the relationship of LA diameter, LA volumes, peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS) and total emptying fraction (LAEF) with PCWP. Eighteen studies with 1343 patients were included. Summary sensitivity and specificity (with 95% CI) for evaluation of diagnostic accuracy and the best cut-off values for different LA indices in predicting raised PCWP were estimated using summary receiver operating characteristic analysis. Results: The pooled analysis showed association between PCWP and LA diameter: Cohen’s d = 0.87, LAVI max: d = 0.92 and LAVI min: d = 1.0 (p < 0001 for all). A stronger correlation was found between PCWP and PALS: d = 1.26, and PACS: d = 1.62, total EF d = 1.22 (p < 00001 for all). PALS ≤ 19% had a summary sensitivity of 80% (65 - 90) and summary specificity of 77% (52 - 92), and diagnostic odds ratio (DOR) > 15.1, whereas LAVI ≥ 34 ml/m2 had summary sensitivity of 75% (55 - 89) and summary specificity 77% (57 - 90), and DOR > 10.1 in predicting elevated PCWP. Conclusion: Compromised LA myocardial function and increased size predict raised cavity pressure. These results should assist in optimizing the follow-up clinical management of patients with fluctuating LA pressure. Study IIMethods: In 143 consecutive patients with HFpEF (age 62 ± 9 years, LV EF ≥45) and 41 controls, a complete echocardiographic study was performed. In addition to conventional measurements, LA compliance was calculated using the formula: [LAV max - LAV min/LAV min × 100]. Exercise capacity was assessed using the six-minute walking test (6-MWT). Tricuspid annular plane systolic excursion (TAPSE) < 1.7 cm was used to categorize patients with RV dysfunction (n = 40) from those with maintained RV function (n = 103).Results: Patients with RV dysfunction were older (p=0.002), had higher NYHA class (p= 0.001), higher LV mass index (p = 0.01), reduced septal and lateral MAPSE (p < 0.001 for all), enlarged LA (p = 0.001) impaired LA compliance index (p < 0.001) and exhibited a more compromised 6-MWT (p = 0.001). LA compliance index correlated more closely with 6-MWT (r = 0.51, p < 0.001) compared with the other LA indices (AP diameter, transverse diameter and volume indexed; r = -0.30, r = -0.35 and r = -0.38, respectively). In multivariate analysis, LA compliance index < 60% was 88% sensitive and 61% specific AUC = 0.80 (CI = 0.67 - 0.92; p = 0.001) in predicting exercise capacity.Conclusion: Impaired LA compliance was profound in patients with HFpEF and RV dysfunction and seems to be the most powerful independent predictor of limited exercise capacity. Study IIIMethods: This study included 215 consecutive ambulatory heart failure (HF) patients with ejection fraction (EF) < 50% (162 HF reduced EF (HFrEF) and 53 HF mid-range EF HFmrEF)) of mean age 66 ± 11 years and 24.4% were females. Peak LA strain (PALS) was measured by speckle tracking echocardiography and E/e' recorded from the apical four-chamber view. Non-invasive left atrial stiffness (LASt) was calculated using the equation: LASt = E/e' ratio/PALS. Documented cardiac events (CE) were HF hospitalization and cardiac death.Results: During a median follow up of 41 ± 34 months, 65 patients (30%) had CE. In multivariate analysis model, only raised LV filling pressure (E/e'), OR=2.292, (95% CI 2.099 to 2.859; p= 0.02), peak pulmonary artery pressure (PAP), OR = 1.050 (1.009 to 1.094; p= 0.01), PALS (OR = 0.932 (0.873 to 0.994; p = 0.02) and LASt OR = 3.781 (1.144 to 5.122; p = 0.001) independently predicted CE. LASt ≥ 0.76% was the most powerful predictor of CE, with 80% sensitivity, 73% specificity and AUC = 0.82, (CI = 0.73 to 0.87; p < 0.001) followed by PALS ≤ 16%, with 74% sensitivity, 72% specificity and AUC=0.77, (CI = 0.71 to 0.84; p < 0.001). These results were consistent irrespective of EF (p < 0.05). Conclusion: In a cohort of ambulatory HFrEF and HFmrEF patients, left atrial stiffness proved the most powerful predictor of clinical outcome. Study IVMethods. This study included 136 consecutive HFrEF patients (65 ± 11 years), 36 had DM and 86 had increased LA stiffness (LASt). All patients underwent complete conventional and tissue Doppler echocardiographic examinations and measurements were made including LA volumes and function. LASt was calculated using the formula: LASt = E/e’ratio / LA strain.Results. At 55 ± 37 months follow-up, free survival from CE was 69% in patients without DM and 44.4% in those with DM (p < 0.0001). The CE free-survival was lower in patients with increased LASt compared to normal LASt, (50 vs. 80%; p < 0.001), irrespective of the presence of DM (27 vs. 71%, p <0 .001). The best cut-off LASt value for predicting CE in the group as a whole was ≥ 0.82% [81% sensitivity, 72% specificity and AUC 0.82 (p < 0.001)]. LASt ≥ 0.82% also predicted CE in patients without DM [78% sensitivity, 71% specificity and AUC 0.80 (p < 0.001)] and was the strongest predictor in DM patients [85% sensitivity, 71% specificity and AUC = 0.847 (p < 0.001)].Conclusion. High LA stiffness is associated with poor clinical outcome in patients with heart failure and reduced ejection fraction. Diabetes has an additional incremental value in determining clinical outcome in those patients.
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37.
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38.
  • Dini, Frank Lloyd, et al. (författare)
  • Acute pericarditis as a major clinical manifestation of long COVID-19 syndrome
  • 2023
  • Ingår i: International Journal of Cardiology. - : Elsevier. - 0167-5273 .- 1874-1754. ; 374, s. 129-134
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The long COVID-19 syndrome has been recently described and some reports have suggested that acute pericarditis represents important manifestation of long COVID-19 syndrome. The aim of this study was to identify the prevalence and clinical characteristics of patients with long COVID-19, presenting with acute pericarditis.Methods: We retrospectively included 180 patients (median age 47 years, 62% female) previously diagnosed with COVID-19, exhibiting persistence or new-onset symptoms ≥12 weeks from a negative naso-pharyngeal SARS CoV2 swamp test. The original diagnosis of COVID-19 infection was determined by a positive swab. All patients had undergone a thorough physical examination. Patients with suspected heart involvement were referred to a complete cardiovascular evaluation. Echocardiography was performed based on clinical need and diagnosis of acute pericarditis was achieved according to current guidelines.Results: Among the study population, shortness of breath/fatigue was reported in 52%, chest pain/discomfort in 34% and heart palpitations/arrhythmias in 37%. Diagnosis of acute pericarditis was made in 39 patients (22%). Mild-to-moderate pericardial effusion was reported in 12, while thickened and bright pericardial layers with small effusions (< 5 mm) with or without comet tails arising from the pericardium (pericardial B-lines) in 27. Heart palpitations/arrhythmias (OR:3.748, p = 0.0030), and autoimmune disease and allergic disorders (OR:4.147, p = 0.0073) were independently related to the diagnosis of acute pericarditis, with a borderline contribution of less likelihood of hospitalization during COVID-19 (OR: 0.100, p = 0.0512).Conclusion: Our findings suggest a high prevalence of acute pericarditis in patients with long COVID-19 syndrome. Autoimmune and allergic disorders, and palpitations/arrhythmias were frequently associated with pericardial disease.
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39.
  • Gryglewska-Wawrzak, Katarzyna, et al. (författare)
  • Diagnostic usefulness of spiroergometry and risk factors of long COVID in patients with normal left ventricular ejection fraction
  • 2023
  • Ingår i: Journal of Clinical Medicine. - 2077-0383. ; 12:12
  • Tidskriftsartikel (refereegranskat)abstract
    • The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic has brought forth various clinical manifestations and long-term complications, including a condition known as long COVID. Long COVID refers to a persistent set of symptoms that continue beyond the acute phase of the disease. This study investigated the risk factors and the utility of spiroergometry parameters for diagnosing patients with long COVID symptoms. The 146 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with normal left ventricular ejection fraction and without respiratory diseases were included and divided into two groups: the group demonstrating long COVID symptoms [n = 44] and the group without long COVID symptoms [n = 102]. The clinical examinations, laboratory test results, echocardiography, non-invasive body mass analysis, and spiroergometry were evaluated. ClinicalTrials.gov Identifier: NCT04828629. Patients with long COVID symptoms had significantly higher age [58 (vs.) 44 years; p < 0.0001], metabolic age [53 vs. 45 years; p = 0.02)], left atrial diameter (LA) [37 vs. 35 mm; p = 0.04], left ventricular mass index (LVMI) [83 vs. 74 g/m2, p = 0.04], left diastolic filling velocity (A) [69 vs. 64 cm/s, p = 0.01], the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion (E/E’) [7.35 vs. 6.05; p = 0.01], and a lower ratio of early to late diastolic transmitral flow velocity (E/A) [1.05 vs. 1.31; p = 0.01] compared to the control group. In cardiopulmonary exercise testing (CPET), long COVID patients presented lower forced vital capacity (FVC) [3.6 vs. 4.3 L; p < 0.0001], maximal oxygen consumption measured during incremental exercise indexed per kilogram (VO2max) [21 vs. 23 mL/min/kg; p = 0.04], respiratory exchange ratio (RER) [1.0 vs. 1.1; p = 0.04], forced expiratory volume in one second (FEV1) [2.90 vs. 3.25 L; p = 0.04], and a higher ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC%) [106 vs. 100%; p = 0.0002]. The laboratory results pointed out that patients with long COVID symptoms also had a lower rate of red blood cells (RBC) [4.4 vs. 4.6 × 106/uL; p = 0.01]; a higher level of glucose [92 vs. 90 mg/dL; p = 0.03]; a lower glomerular filtration rate (GFR) estimate by Modification of Diet in Renal Disease (MDRD) [88 vs. 95; p = 0.03]; and a higher level of hypersensitive cardiac Troponin T (hs-cTnT) [6.1 vs. 3.9 pg/mL; p = 0.04]. On the multivariate model, only FEV1/FVC% (OR 6.27, 95% CI: 2.64–14.86; p < 0.001) independently predicted the long COVID symptoms. Using the ROC analysis, the FEV1/FVC% ≥ 103 was the most powerful predictor of spiroergometry parameters (0.67 sensitive, 0.71 specific, AUC of 0.73; p < 0.001) in predicting the symptoms of long COVID. Spiroergometry parameters are useful in diagnosing long COVID and differentiating it from cardiovascular disease.
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40.
  • Henein, Michael Y., et al. (författare)
  • Biomarkers predict in-hospital major adverse cardiac events in covid-19 patients : A multicenter international study
  • 2021
  • Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 10:24
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The COVID-19 pandemic carries a high burden of morbidity and mortality worldwide. We aimed to identify possible predictors of in-hospital major cardiovascular (CV) events in COVID-19.Methods: We retrospectively included patients hospitalized for COVID-19 from 10 centers. Clinical, biochemical, electrocardiographic, and imaging data at admission and medications were collected. Primary endpoint was a composite of in-hospital CV death, acute heart failure (AHF), acute myocarditis, arrhythmias, acute coronary syndromes (ACS), cardiocirculatory arrest, and pulmonary embolism (PE).Results: Of the 748 patients included, 141(19%) reached the set endpoint: 49 (7%) CV death, 15 (2%) acute myocarditis, 32 (4%) sustained-supraventricular or ventricular arrhythmias, 14 (2%) cardiocirculatory arrest, 8 (1%) ACS, 41 (5%) AHF, and 39 (5%) PE. Patients with CV events had higher age, body temperature, creatinine, high-sensitivity troponin, white blood cells, and platelet counts at admission and were more likely to have systemic hypertension, renal failure (creatinine ≥ 1.25 mg/dL), chronic obstructive pulmonary disease, atrial fibrillation, and cardiomyopathy. On univariate and multivariate analysis, troponin and renal failure were associated with the composite endpoint. Kaplan–Meier analysis showed a clear divergence of in-hospital composite event-free survival stratified according to median troponin value and the presence of renal failure (Log rank p < 0.001).Conclusions: Our findings, derived from a multicenter data collection study, suggest the routine use of biomarkers, such as cardiac troponin and serum creatinine, for in-hospital prediction of CV events in patients with COVID-19.
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41.
  • Henein, Michael Y., et al. (författare)
  • Combined Cardiac Risk Factors Predict COVID-19 Related Mortality and the Need for Mechanical Ventilation in Coptic Clergy
  • 2021
  • Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 10:10
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Aims: The clinical adverse events of COVID-19 among clergy worldwide have been found to be higher than among ordinary communities, probably because of the nature of their work. The aim of this study was to assess the impact of cardiac risk factors on COVID-19-related mortality and the need for mechanical ventilation in Coptic clergy. Methods: Of 1570 Coptic clergy participating in the COVID-19-Clergy study, serving in Egypt, USA and Europe, 213 had the infection and were included in this analysis. Based on the presence of systemic arterial hypertension (AH), participants were divided into two groups: Group-I, clergy with AH (n = 77) and Group-II, without AH (n = 136). Participants’ demographic indices, cardiovascular risk factors, COVID-19 management details and related mortality were assessed. Results: Clergy with AH were older (p < 0.001), more obese (p = 0.04), had frequent type 2 diabetes (DM) (p = 0.001), dyslipidemia (p = 0.001) and coronary heart disease (CHD) (p = 0.04) compared to those without AH. COVID-19 treatment at home, hospital or in intensive care did not differ between the patient groups (p > 0.05 for all). Clergy serving in Northern and Southern Egypt had a higher mortality rate compared to those from Europe and the USA combined (5.22%, 6.38%, 0%; p = 0.001). The impact of AH on mortality was significant only in Southern Egypt (10% vs. 3.7%; p = 0.01) but not in Northern Egypt (4.88% vs. 5.81%; p = 0.43). In multivariate analysis, CHD OR 1.607 ((0.982 to 3.051); p = 0.02) and obesity, OR 3.403 ((1.902 to 4.694); p = 0.04) predicted COVID-19 related mortality. A model combining cardiac risk factors (systolic blood pressure (SBP) ≥ 160 mmHg, DM, obesity and history of CHD) was the most powerful independent predictor of COVID-19-related mortality, OR 3.991 ((1.919 to 6.844); p = 0.002). Almost the same model also proved the best independent multivariate predictor of mechanical ventilation OR 1.501 ((0.809 to 6.108); p = 0.001). Conclusion: In Coptic clergy, the cumulative impact of risk factors was the most powerful predictor of mortality and the need for mechanical ventilation.
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42.
  • Henein, Michael Y., et al. (författare)
  • Obesity Strongly Predicts COVID-19-Related Major Clinical Adverse Events in Coptic Clergy
  • 2021
  • Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 10:13
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Aims: The Coptic clergy, due to their specific work involving interaction with many people, could be subjected to increased risk of infection from COVID-19. The aim of this study, a sub-study of the COVID-19-CVD international study of the impact of the pandemic on the cardiovascular system, was to assess the prevalence of COVID-19 among Coptic priests and to identify predictors of clinical adverse events. Methods: Participants were geographically divided into three groups: Group-I: Europe and USA, Group II: Northern Egypt, and Group III: Southern Egypt. Participants' demographic indices, cardiovascular risk factors, possible source of infection, number of liturgies, infection management, and major adverse events (MAEs), comprising death, or mechanical ventilation, were assessed. Results: Out of the 1570 clergy serving in 25 dioceses, 255 (16.2%) were infected. Their mean age was 49.5 +/- 12 years and mean weekly number of liturgies was 3.44 +/- 1.0. The overall prevalence rate was 16.2% and did not differ between Egypt as a whole and overseas (p = 0.23). Disease prevalence was higher in Northern Egypt clergy compared with Europe and USA combined (18.4% vs. 12.1%, p = 0.03) and tended to be higher than in Southern Egypt (18.4% vs. 13.6%, p = 0.09). Ten priests (3.92%) died of COVID-19-related complications, and 26 (10.2) suffered a MAE. The clergy from Southern Egypt were more obese, but the remaining risk factors were less prevalent compared with those in Europe and USA (p = 0.01). In multivariate analysis, obesity (OR = 4.180; 2.479 to 12.15; p = 0.01), age (OR = 1.055; 0.024 to 1.141; p = 0.02), and systemic hypertension (OR = 1.931; 1.169 to 2.004; p = 0.007) predicted MAEs. Obesity was the most powerful independent predictor of MAE in Southern Egypt and systemic hypertension in Northern Egypt (p < 0.05 for both). Conclusion: Obesity is very prevalent among Coptic clergy and seems to be the most powerful independent predictor of major COVID-19-related adverse events. Coptic clergy should be encouraged to follow the WHO recommendations for cardiovascular disease and COVID-19 prevention.
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43.
  • Ibrahimi, Pranvera, et al. (författare)
  • Global dyssynchrony correlates with compromised left ventricular filling and stroke volume but not with ejection fraction or QRS duration in HFpEF
  • 2014
  • Ingår i: International Cardiovascular Forum Journal. - : Barcaray International Publishing. - 2410-2636 .- 2409-3424. ; 1:3, s. 147-151
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Aim: Mechanical global left ventricular (LV) dyssynchrony reflected as prolonged total isovolumic time(t-IVT) has been introduced as a potential mechanism behind compromised stroke volume in heart failure (HF). It has alsobeen shown to be superior to other markers of dyssynchrony in predicting response to cardiac resynchronization therapy(CRT), but its application in HF with preserved ejection fraction (HFpEF) remains unknown. The aim of this study was toassess the role of t-IVT in explaining symptoms in HFpEF.Methods: In 55 symptomatic HFpEF patients (age 60±9 years, NYHA class II-IV; LV EF ≥45%) and 24 age and gendermatched controls, a complete Doppler echocardiographic study was performed including mitral annulus peak systolicexcursion (MAPSE) and myocardial velocities as well as LV filling, outflow tract velocity time integral (VTI) and stroke volumemeasurements. Global LV dyssynchrony was assessed by t-IVT [in s/min; calculated as: 60 - (total ejection time + total fillingtime)], Tei index (t-IVT/ejection time) and pre-ejection time difference between LV and RV.Results: Patients had reduced lateral and septal MAPSE (p=0.009 and p=0.01, respectively) lower lateral and septal s’(p=0.002 and p=0.04, respectively) and e’ (p<0.001, for both) velocities and higher E/e’ ratio (p=0.01) compared to controls.They also had longer t-IVT (p<0.001), higher Tei index (p=0.04), but similar pre-ejection time difference and LVEF to controls.T-IVT correlated with LV filling time (r=0.44, p<0.001), stroke volume (r=-0.41; p=0.002), MAPSE (lateral: r=-0.36, p=0.007 andseptal: r=-0.31; p=0.02), but not with LV mass index, LVEF, E/e’ ratio or QRS duration.Conclusion: Patients with HFpEF have exaggerated global mechanical dyssynchrony shown by prolonged t-IVT, comparedwith healthy age and gender matched controls. The relationship between t-IVT, LV filling and stroke volume suggests anassociation, more important than with ejection fraction or electrical dyssynchrony. These results support the importance ofthe individualistic approach for optimum HFpEF patient management.
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44.
  • Perçuku, Luan, et al. (författare)
  • Exaggerated systolic hypertensive response to exercise predicts cardiovascular events : a systematic review and meta-analysis
  • 2019
  • Ingår i: Polish Archives of Internal Medicine. - : Medycyna Praktyczna. - 0032-3772 .- 1897-9483. ; 129:12, s. 855-863
  • Forskningsöversikt (refereegranskat)abstract
    • INTRODUCTION: The pathophysiology of exaggerated systolic hypertensive response to exercise (SHRE) is not fully understood, with contradictory data on its role in predicting cardiovascular (CV) events. OBJECTIVES: The aim of this review and meta-analysis was to assess the association of SHRE with CV clinical outcomes in healthy normotensive individuals. PATIENTS AND METHODS: We searched PubMed (MEDLINE), Cochrane Library, RefWorks, and Google Scholar to identify clinical studies that reported data on CV event rates and outcomes for patients with SHRE on exercise stress testing. Sensitivity and specificity analysis for assessing the diagnostic accuracy of the SHRE cutoff associated with CV events was estimated using hierarchical summary receiver operating characteristic analysis. RESULTS: We included 8 studies with 47 188 participants and a median follow-up of 19.3 years. Exaggerated SHRE was found in patients with composite events (CV mortality and coronary artery disease; hazard ratio [HR], 1.363; 95% CI, 1.135-1.604; P < 0.001), in those with coronary artery events (HR, 1.532; 95% CI, 1.240-1.893; P < 0.001), and in those with CV mortality (HR, 1.286; 95% CI, 1.075-1.539; P = 0.006), as compared with individuals with normal response. An exercise systolic blood pressure of 196 mm Hg predicted CV events with a sensitivity of 62% (54%-69%) and specificity of 75% (60%-86%), with a positive likelihood ratio of less than 3 and a strong correlation (r = -0.71). CONCLUSIONS: Our study supports the clinical relevance of exaggerated SHRE as a predictor of composite and individual CV clinical outcome. These findings should be considered as thought-provoking evidence for better stratification and, consequently, for optimal management of this high-risk population.
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45.
  • Percuku, L., et al. (författare)
  • The exaggerated systolic hypertensive response to exercise predicts cardiovascular events : a systematic review and meta-analysis
  • 2018
  • Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 39, s. 869-869
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Exercise stress testing is mainly used for the assessment of coronary artery disease (CAD), with blood pressure (BP) measurements routinely obtained during the test. In healthy individuals, the increased cardiac output with exercise is associated with perpetual increase in systolic BP (SBP). The pathophysiology of exaggerated hypertensive response to exercise (HRE is not fully understood and the role of HRE in predicting cardiovascular (CV) events is contradictory.Aim: The aim of this meta-analysis therefore, was to analyze the role of HRE in predicting CV clinical outcomes in healthy normotensive subjects.Methods: We searched Pubmed-MEDLINE, Cochrane Library, Refworks and Google Scholar aiming to find clinical studies which reported data on CV event rate and outcomes (including mortality) for patients who underwent exercise testing and had HRE. Sensitivity and specificity (with 95% CI) analysis for assessing the diagnostic accuracy of HRE cut-off that predicts CV events was estimated using hierarchical summary receiver operating characteristic analysis.Results: Eight studies with 47,188 participants were included with a median follow-up duration of 19.3 months. Significantly higher HRE was found in patients with composite events (HR = 1.363 [1.135–1.604]; p<0.001), in those who developed coronary artery events (HR = 1.532 [1.240–1.893]; p<0.001) and CV mortality (HR = 1.286 [1.075–1.539]; p=0.006) compared to normal response patients. An exercise systolic BP of 196 mmHg predicted CV events with sensitivity of 62% (54–69%) and specificity of 75% (60–86%) with positive likelihood ratio (LR+) <3 and strong correlation (r=-0.71).Conclusion: This meta-analysis supports the clinical relevance of exaggerated blood pressure response to exercise (systolic BP >196 mmHg) as a predictor of composite and CV clinical outcome. These findings should be taken as a thought provoking evidence for finding better stratification of such patients and consequently optimum management for this risky group.
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46.
  • Poniku, Afrim, et al. (författare)
  • Smoking and hypertriglyceridemia predict st-segment elevation myocardial infarction in Kosovo patients with acute myocardial infarction
  • 2024
  • Ingår i: Clinics and Practice. - : MDPI. - 2039-7275 .- 2039-7283. ; 14:3, s. 1149-1158
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Myocardial infarction (MI), presented as ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI), is influenced by atherosclerosis risk factors. Aim: The aim of this study was to assess the patterns of presentation of patients with acute MI in Kosovo. Methods: This was a cross-sectional study conducted at the University Clinical Center of Kosovo, which included all patients hospitalized with acute MI over a period of 7 years. Results: Among the 7353 patients admitted with acute MI (age 63 ± 12 years, 29% female), 59.4% had STEMI and 40.6% had NSTEMI. The patients with NSTEMI patients less (48.3% vs. 54%, p < 0.001), but more of them had diabetes (37.8% vs. 33.6%, p < 0.001), hypertension (69.6% vs. 63%, p < 0.001), frequently had a family history of coronary artery disease (CAD) (40% vs. 38%, p = 0.009), and had more females compared to the patients with STEMI (32% vs. 27%, p < 0.001). The patients with NSTEMI underwent less primary percutaneous interventions compared with the patients with STEMI (43.6% vs. 55.2%, p < 0.001). Smoking [1.277 (1.117–1.459), p ˂ 0.001] and high triglycerides [0.791 (0.714–0.878), p = 0.02] were independent predictors of STEMI. Conclusions: In Kosovo, patients with STEMI are more common than those with NSTEMI, and they were mostly males and more likely to have diabetes, hypertension, and a family history of CAD compared to those with NSTEMI. Smoking and high triglycerides proved to be the strongest predictors of acute STEMI in Kosovo, thus highlighting the urgent need for optimum atherosclerosis risk control and education strategies.
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47.
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48.
  • Shenouda, Rafik B., et al. (författare)
  • Early Recovery of Left Ventricular Function After Revascularization in Acute Coronary Syndrome
  • 2020
  • Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 9:1
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to assess the accuracy of echocardiographic techniques in detecting the early recovery of left ventricular (LV) function after revascularization in acute coronary syndrome (ACS). In 80 consecutive patients with ACS (age 55.7 ± 9.4 years, 77% male, 15% with CCS Angina III), an echocardiographic examination of left ventricle regional wall motion abnormalities (LV RWMA), peak systolic strain rate (PSSR), peak systolic strain (PSS) and end systolic strain (ESS) was performed before and after percutaneous intervention (PCI). Of the 80 patients, one vessel stenosis (>70%) was present in 53 (66%), two vessel disease in 12 (15%) and multivessel disease in 15 patients (19%). In total, 51% of patients had hypertension, 40% diabetes and 23% dyslipidemia. After PCI, regional PSS, ESS and PSSR of their segments subtended by the culprit vessel improved; left anterior descending-LAD, circumflex-LCx and right coronary-RCA (p<0.05 for all) as well as global S and SR (p < 0.05 for all). In univariate analysis, hypertension (HTN) (β = −0.294 (−0.313–0.047), p = 0.009, smoking β = −0.244 (−0.289–0.015) =0.03, WMA β = −0.317 (−0.284–0.014), p = 0.004 and the number of diseased vessels β = −0.256 (−0.188– 0.054) p=0.03 were predictors of delta global SR. In multivariate analysis, only HTN β = 0.263 (0.005–3.159) and the number of diseased vessels β =0.263 (0.005 - 3.159), p=0.04) predicted delta global SR. In ACS, the echocardiographic regional myocardial deformation is accurate in detecting early recovery of LV myocardial function after culprit lesion revascularization. Also, the findings of this study support the current practice regarding the crucial importance of proximal epicardial vessel PCI treatment on LV function compared to more distal lesions.
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49.
  • Shenouda, Rafik B., et al. (författare)
  • Reduced regional strain rate is the most accurate dysfunction in predicting culprit lesions in patients with acute coronary syndrome
  • 2020
  • Ingår i: Clinical Physiology and Functional Imaging. - : John Wiley & Sons. - 1475-0961 .- 1475-097X. ; 40:1, s. 21-29
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Aim: Predicting culprit lesions in acute coronary syndrome (ACS) could be a challenge. The aim of this study was to assess the accuracy of regional wall motion abnormalities (RWMA) using various echocardiographic techniques and ECG changes in predicting the culprit coronary lesion in a group of patients with ACS.Methods: In 80 consecutive patients with ACS (age 55·7 ± 9·4 years, 77% male, 15% with CCS Angina III), an echocardiographic examination of left ventricle (LV) RWMA, tissue Doppler imaging (TDI) and speckle tracking myocardial strain and strain rate (SR) were performed before intervention.Results: Of the 80 patients, one‐vessel stenosis (>70%) was present in 53 (66%), two‐vessel disease in 12 (15%) and multivessel disease in 15 patients (19%). About 51% of patients had hypertension, 40% diabetes and 23% dyslipidaemia. There was no relationship between individual segmental RWMA and SR. Mean regional SR, but not peak strain, correlated with culprit lesion branch: left anterior descending – LAD (r = 0·35, P = 0·005), circumflex LCx (r = 0·32, P = 0·03) and right coronary RCA (r = 0·37, P = 0·01). Only ECG changes in the LAD territory (r = 0·26, P = 0·04) correlated with the culprit lesion. SR of LAD territories ≤−0·74 was 71% sensitive and 70% specific (AUC = 0·70, CI = 0·67–0·93, P = 0·01), SR of LCx territories of ≤−0·67 was 75% sensitive and 63% specific (AUC = 0·72, CI = 0·58–0·87, P = 0·02) and SR of RCA territories ≤−0·83 was 73% sensitive and 71% specific (AUC = 0·80, CI = 0·66–0·93, P = 0·001) in predicting significant stenosis. SR was more accurate than all other techniques in predicting the culprit lesion.Conclusion: In ACS, mean regional speckle tracking SR is more sensitive than peak strain, TDI, ECG changes and wall motion abnormalities in detecting significant coronary artery stenosis.
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50.
  • Shenouda, Rafik B., 1971-, et al. (författare)
  • Strain rate changes during stress echocardiography are the most accurate predictors of significant coronary artery disease in patients with previously treated acute coronary syndrome
  • 2023
  • Ingår i: Diagnostics. - : MDPI. - 2075-4418. ; 13:10
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Aims: Dobutamine stress echocardiography (DSE) is a well-established non-invasive investigation for the detection of ischemic myocardial dysfunction. The aim of this study was to evaluate the accuracy of myocardial deformation parameters measured by speckle tracking echocardiography (STE) in predicting culprit coronary artery lesions in patients with prior revascularization and acute coronary syndrome (ACS). Methods. We prospectively studied 33 patients with ischemic heart disease, a history of at least one episode of ACS and prior revascularization. All patients underwent a complete stress Doppler echocardiographic examination, including the myocardial deformation parameters of peak systolic strain (PSS), peak systolic strain rate (SR) and wall motion score index (WMSI). The regional PSS and SR were analyzed for different culprit lesions. Results. The mean age of patients was 59 ± 11 years and 72.7% were males. At peak dobutamine stress, the change in regional PSS and SR in territories supplied by the LAD showed smaller increases compared to those in patients without culprit LAD lesions (p < 0.05 for all). Likewise, the regional parameters of myocardial deformation were reduced in patients with culprit LCx lesions compared to those with non-culprit LCx lesions and in patients with culprit RCA legions compared to those with non-culprit RCA lesions (p < 0.05 for all). In the multivariate analysis, the △ regional PSS (1.134 (CI = 1.059–3.315, p = 0.02)) and the △ regional SR (1.566 (CI = 1.191–9.013, p = 0.001)) for LAD territories predicted the presence of LAD lesions. Similarly, in a multivariable analysis, the △ regional PSS and the △SR predicted LCx culprit lesions and RCA culprit lesions (p < 0.05 for all). In an ROC analysis, the PSS and SR had higher accuracies compared to the regional WMSI in predicting culprit lesions. A △ regional SR of −0.24 for the LAD territories was 88% sensitive and 76% specific (AUC = 0.75; p < 0.001), a △ regional PSS of −1.20 was 78% sensitive and 71% specific (AUC = 0.76, p < 0.001) and a △ WMSI of −0.35 was 67% sensitive and 68% specific (AUC = 0.68, p = 0.02) in predicting LAD culprit lesions. Similarly, the △ SR for LCx and RCA territories had higher accuracies in predicting LCx and RCA culprit lesions. Conclusions. The myocardial deformation parameters, particularly the change in regional strain rate, are the most powerful predictors of culprit lesions. These findings strengthen the role of myocardial deformation in increasing the accuracy of DSE analyses in patients with prior cardiac events and revascularization.
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