AMAL RASSLAN - Academia.edu (original) (raw)
Papers by AMAL RASSLAN
Topology - Recent Advances and Applications [Working Title]
Let (∁) signify a simplicial complex, the topological connectivity of ∁ is donated by ζ (∁), whic... more Let (∁) signify a simplicial complex, the topological connectivity of ∁ is donated by ζ (∁), which equals ∁+2; where ζ is a function from the class of graphs to the set Z^+={0,1,2,…,∞}. Suppose that the function ζ possesses the following characteristics: 1. ζ(K_0 )=0 2. For any graph G(V,E), there exists, an edge {x,y} in G such that ζ(G(V,E)-{x,y})≥ζ(G(V,E)) where, (G(V,E) -{x,y}) means: to remove the edge {x,y} from the graph G(V,E)), and ζ(G(V,E)-Δ({x,y}))≥ζ(G(V,E))-1 where, (G(V,E)-Δ ({x,y}) is equal to remove the vertices x,y and all their neighbors. then μ(Γ(G(V,E))≥ζ(G(V,E)) Let〖 ζ〗_0 denote the maximal function ζ that satisfying the aforementioned constraints. Eli Berger [4] proved that μ(Γ(G(V,E))≥ζ_0 (G(V,E)) for trees and for complements of chordal graphs. Kazuhiro Kawamura [3] proved the same theorem for chordal graphs, and Yousef Methkal Abd Algani [1] proved it for circular-arc graph: Let G(V,E) be a circular-arc graph, if ζ_0 (G(V,E))≤2,then μ(Γ(G(V,E)))≤2. In the cur...
European Heart Journal - Cardiovascular Imaging, 2012
Idiopathic pulmonary arterial hypertension (IPAH) prognosis depends on the capability of the righ... more Idiopathic pulmonary arterial hypertension (IPAH) prognosis depends on the capability of the right ventricle (RV) to preserve its function in face of increased afterload. We hypothesize that, as for the left ventricle, right intra-ventricular (IVD) dyssynchrony may have a negative effect on the overloaded RV. The aim of the study was to assess right IVD by incorporating activation times of longitudinal deformation across all RV segments, representing the longitudinal deformation the major contribution to chamber contraction. Methods: Eighty patients with IPAH (52 female subjects), without right bundle branch block, were consecutively enrolled. All patients underwent WHO functional evaluation, 6-minutes walking test, right heart catheterization and a comprehensive echocardiographic examination within 24 hours from invasive procedure. RV longitudinal myocardial deformation was assessed by using 2D Speckle Tracking Echocardiography (2DSTE). We defined RV dyssynchrony, next called RV-SD4, as the standard deviation (SD) of the time-intervals between QRS onset and peak longitudinal systolic strain of mid and basal segments of the RV free wall and the inter-ventricular septum. Results: Patients with IPAH showed regional abnormalities of RV function in terms of time to peak of longitudinal systolic strain as expressed by RV-SD4. Multivariate regression analysis revealed that QRS duration, RV end-diastolic area and pulmonary vascular resistances (PVR) were independent predictors of RV-SD4 (r2 =0,36; p=,0.00001). Actuarial rates of patients who experienced clinical worsening (CW) were 25% at 6 months, 32% and 48% at 1 and 2 years respectively. Event-free survivors had better WHO functional class, 6-minutes walking distance, hemodynamic status, morphological and functional echocardiographic parameters. Multivariate analysis showed cardiac index (unit 0.5, HR 0.36, CI 95% 0.23-0.57), RV fractional area change (unit 5, HR 0.79, CI 95% 0.67-0,93) and RV-SD4 (unit 5, HR 1.06 CI 95% 1.00-1.13) as independent predictors of CW (x 2 =46.8, p=000001). The optimal ROC-derived RV-SD4 cutoff value as indicator of CW was ≥ 23 (Sensibility 92%, Specificity 67%). Conclusions: Our findings suggest that right intra-ventricular dyssynchrony can be accurately described by the 2DSTE derived measure RV-SD4. That index of RV dyssynchrony can help to distinguish non invasively those IPAH patients with a worse clinical and hemodynamic profile and could be considered among independent predictors of clinical worsening.
European Heart Journal - Cardiovascular Imaging, 2013
Purpose: Cardiac deconditioning due to immobilization is a risk factor for cardiovascular disease... more Purpose: Cardiac deconditioning due to immobilization is a risk factor for cardiovascular disease. The physiology of cardiac adaptation to deconditioning has not been fully elucidated. The purpose of the present study was to assess the effects of 21-days of strict headdown (-6 degrees) bed-rest (BR) deconditioning on left ventricular (LV) dimensions and mass measured by MRI. Methods: Ten healthy men (mean age 32+6) were enrolled; the experiment was conducted at DLR (Koln, Germany) as part of the European Space Agency BR studies. Steady-state free precession MRI images (7mm thickness, no gap, no overlap) were obtained (Symphony 1.5T, Siemens) in a stack of short-axis views from LV base to LV apex, before (PRE), at the end of BR (HDT20), and four days after the BR conclusion (POST). Endocardial and epicardial semi-automated contouring was performed using freely available software (Segment). Results: At HDT20, significant reductions in LV mass (16%), end-diastolic (26%) and endsystolic (27%) volumes and stroke volume (27%) were observed, while ejection fraction did not change. These changes were accompanied by a measured decrease (14%) in plasma and blood volume (by gas-rebreathing technique), as well as by a significant reduction (14%) in VO2max aerobic power, measured using a graded cycle ergometer test protocol to volitional fatigue, at one day after the BR conclusion, while expiratory exchange ratio did not change. At POST, LV volumes were restored, while LV mass was still trending towards control values. Conclusions: Cardiac adaptation to deconditioning affected LV mass and dimensions, as a combined result of LV remodeling and fluids loss, accompanied by worsening in aerobic power. This should be taken into account in patients with cardiovascular diseases, when immobilized in bed, to proper adjust the therapy, or to define appropriate physical exercises when possible, in order to avoid further complications.
EDULEARN proceedings, Jul 1, 2022
Journal of the American College of Cardiology, 2015
background: Intra-aortic balloon (IABP) when applied in all patients with acute anterior ST eleva... more background: Intra-aortic balloon (IABP) when applied in all patients with acute anterior ST elevation myocardial infraction (STEMI) treated by primary percutaneous coronary intervention (PPCI) and in patients with shock was not beneficial. aim: Evaluation of the effects of IABP on coronary flow, myocardial perfusion and left ventricular systolic function in patients with acute anterior STEMI and suboptimal PPCI angiographic outcome. methods: Fifty five patients with acute anterior STEMI had suboptimal PPCI outcome according to TIMI grade and myocardial blush grades (MBG). 27 were treated by IABP and 28 served as a control group. TIMI and MBG grade were evaluated before and after PPCI. Flow in the LAD was evaluated using Trans thoracic Doppler (TTE) with and without pumping. Left ventricular systolic function was valuated by TTE, early after PPCI and at discharge. LVEF, LAD wall motion score index (LAD-WMSI) and LV WMSI (LV-WMSI) were measured. Results: IABP doubled diastolic LAD flow. LVEF at admission was lower in the IABP group compared to controls but both were similar at discharge. IABP increased LVEF by more than 5 % in 70% of patients treated with IABP. Patients who increased their LVEF were younger, and had lower prevalence of smoking 32% vs. 80%, obesity 11% vs. 40%, renal failure 0 % vs. 40%, KILLIP class 1.75 vs. 2.7 and had lower prevalence of previous PCIs. TIMI and MBG grades after PPCI were higher in these patients, and higher prevalence of single LAD disease. During pumping, diastolic velocity and integrals were higher in those with improved LVEF. conclusion: In anterior STEMI and suboptimal PPCI, TTE Doppler helped in monitoring effects of IABP on LAD flow, allowed optimizing flow augmentation and thus improved LV systolic function in 70% of the patients.
Cardiology Research, 2014
Background: Diastolic dysfunction precedes systolic dysfunction in patients with coronary artery ... more Background: Diastolic dysfunction precedes systolic dysfunction in patients with coronary artery disease. The aim of the study was to evaluate the effects of left ventricular (LV) wall motion abnormality (WMA) on diastolic LV and right ventricular (RV) function at rest and after stress. Methods: Fifty-nine subjects, 15 with LV-WMA (abnormal group) and 44 without (normal group), underwent dobutamine stress echocardiography (DSE) studies, in addition to evaluation of LV and RV diastolic function before and after DSE. Results: Resting mitral flow parameters were similar. DSE increased peak A-wave velocities in both groups, and mitral color slope only in normal subjects. After DSE, E-wave peak velocities and mitral color slope were higher in normal subjects, P < 0.05. At rest and after DSE systolic and diastolic pulmonary vein velocities were similar in both groups; however, DSE increased these velocities only in normal subjects, P < 0.05. Regional E-wave peak velocities of LV were higher at rest in normal subjects, P < 0.05. Both LV and RV, regional peak E-wave velocities were not affected by DSE. After DSE, regional Awave peak velocities increased in all (P < 0.01), except at the lateral region (P = 0.07). DSE increased trans-tricuspid velocities in both groups, P < 0.05. Resting A-wave velocities were higher in normal subjects, P < 0.01. Conclusions: Global LV early diastolic filling parameters were not affected by LV-WMA at rest. LV-WMA blunted the response after stress. RV E-wave velocities increased after DSE, and were not affected by LV-WMA. LV-WMA reduced regional LV-E' velocities at rest but not the reserve. A-wave velocities were not affected by WMA and increased after DSE.
Heart International, 2010
In the presence of severe stenosis, coronary artery flow may be reduced at rest. Recent advances ... more In the presence of severe stenosis, coronary artery flow may be reduced at rest. Recent advances in echocardiography have made noninvasive sampling of velocities in the left anterior descending coronary artery (LAD) possible. The aim of our study was to evaluate feasibility and capability of transthoracic Doppler to detect severe stenosis of the LAD. The study population consisted of 42 subjects with suspected coronary artery disease scheduled for coronary angiography. All had complete transthoracic echocardiography and Doppler sampling of LAD velocities. Quantitative coronary angiography was performed within 24 hours of the echocardiogram. Correlations between LAD velocity profile, measurements and calculations, and the angiographic results were performed. Six subjects had LAD occlusion, 10 had severe (>80% diameter) LAD stenosis, and 26 had normal or non-occlusive LAD disease. In all six subjects with LAD occlusion, distal LAD velocities were not detectable, while in the other 36 subjects, LAD velocities were recorded indicating the vessels were patent. In the 10 subjects with severe LAD stenosis, the diastolic/systolic velocity ratio was <1.5, while in those with nonsignifi cant LAD disease, the diastolic/systolic velocity ratio was >1.5 (P<0.005). Diastolic LAD flow was 21.8±13 mL/min in the presence of severe stenosis as compared to 48.5±20 mL/min in subjects without severe stenosis (P<0.0013). LAD velocities had high sensitivity and specificity for the prediction of severe angiographic stenosis. Thus transthoracic Doppler measurement of LAD velocities is feas ible and can predict the presence of severe LAD stenosis or occlusion.
Echocardiography, 2013
Function of the microcirculation after primary percutaneous coronary intervention (PCI) is dynami... more Function of the microcirculation after primary percutaneous coronary intervention (PCI) is dynamic and contributes to unpredictability of recovery of left ventricular (LV) systolic function. This study was conducted to evaluate sequential Doppler velocity parameters of the left anterior descending coronary artery (LAD) in predicting recovery of global and regional LV systolic function. Thirty-five consecutive patients, 24 males, age 59 ± 12 years, with acute anterior ST-elevation myocardial infarction (STEMI) who had primary PCI were studied. Thrombolysis in myocardial infarction (TIMI) and myocardial blush grades were evaluated. Transthoracic echocardiographic (TTE) studies, evaluation of left ventricular ejection fraction (LVEF), LAD territory wall-motion score index (WMSI), and sampling of LAD Doppler velocities up to 6 hours post-PCI, 48 hours postprocedure, and predischarge were performed. Thrombolysis in myocardial infarction grade before PCI averaged 0.86 ± 1.19 and post-PCI 2.89 ± 0.32, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05. Myocardial blush grade before PCI was 0.41 ± 0.98 and after PCI 2.22 ± 0.93, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05. Diastolic velocity deceleration time (DDT) in the LAD early after PCI was less than 600 ms in 16 subjects. Immediately after PCI, in subjects with DDT &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 600 ms, LVEF was 38.5 ± 6% and predischarge 49.2 ± 8.7%, P = 9.77 × 10−5 and LAD-WMSI decreased from 2 ± 0.38 to 1.4 ± 0.48, P = 0.000163. In subjects with DDT &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 600 ms LAD-WMSI did not change significantly. Early and minimal LAD-DDT correlated with improvement in LV systolic function, r = 0.6, whereas post-PCI blush grade had lower correlation with LVEF, r = 0.39. Global and regional LV systolic function after PCI in acute anterior MI can be predicted by LAD-DDT better than by post-PCI myocardial blush.
The main goal of the research was to find out the connectivity between various representations of... more The main goal of the research was to find out the connectivity between various representations of sets and attempt to clarify source of error when passing from one representation to another. A questionnaire which focused on the inclusion relation between sets, by switching this relation from the verbal, formal and verbal-logical to the visual representation, i.e., to Venn diagrams, was distributed to 120 pre-service teachers who had been learning a basic course in set theory, from two colleges of education. Our findings highlight the fact that the verbal representation was the easiest, in other words, the students succeeded more in switching from the verbal and the verbal-logical to the visual representation, more than in switching from the formal representation to the visual one. Moreover, the main sources of errors were: Non identification of the problem variable or subject; adding new condition enlarges the set; Partial visual attribution to Venn diagrams and the inclusion relati...
Archives of Emergency Medicine and Intensive Care
Background: Primary percutaneous coronary artery intervention (PCI) in patients with acute ST-ele... more Background: Primary percutaneous coronary artery intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI) leads to myocardial salvage. Objectives: To test whether shorter periods to primary PCI improve coronary flow, myocardial perfusion and left ventricular systolic function. Methods: 170 patients with acute anterior STEMI treated by primary PCI were evaluated. Time periods from onset of chest pain to first medical contact (FMC) and from FMC to primary PCI (FMC-PCI) and from pain to primary PCI (Pain-PCI) were recorded. Results: Patients with pain-PCI<300 min, tended to achieve TIMI grade III more frequently (51%vs 33%), p=0.06 and more frequent MBG≥2, (53% vs 36%), p=0.08. Partial ST-elevation resolution was achieved more frequently in patients with pain-PCI<180min (87% vs 65%), p<0.05. Lower peak troponin levels were found in patients with pain-PCI<300 min (49.2±45.2 vs 84.2 ±43 ng/ml), p=0.03. In patients with pain-PCI< 180min, left ventricular ejection fraction (LVEF) increased by 10±8% vs 5.5±5%, p<0.05. In patients with pain-FMC < 90 and < 120 min the increase in LVEF was larger than in others, p<0.05. FMC-PCI less< 180min was associated with larger increase in LVEF, p<0.05. Conclusion: Decreasing pain to PCI intervals, improves myocardial perfusion and LVEF.
The Israel Medical Association journal : IMAJ, 2008
BACKGROUND The temporal behavior of the coronary microcirculation in acute myocardial infarction ... more BACKGROUND The temporal behavior of the coronary microcirculation in acute myocardial infarction may affect outcome. Diastolic deceleration time and early systolic flow reversal derived from coronary artery blood flow velocity patterns reflect microcirculatory function. OBJECTIVES To assess left anterior descending coronary artery flow velocity patterns using Doppler transthoracic echocardiography after primary percutaneous coronary intervention, in patients with anterior AMI. METHODS Patterns of flow velocity patterns of the LAD were obtained using transthoracic echocardiography-Doppler in 31 consecutive patients who presented with anterior AMI. Measurements were done at 6 hours, 36-48 hours, and 5 days after successful PPCI. Measurements of DDT and pressure half times (Pt%), as well as observation for ESFR were performed. RESULTS In the first 2 days following PPCI, the average DDT (600 +/- 340 msec) was shorter than on day 5 (807 +/- 332 msec) (P < 0.012), FVP in the first 2 da...
Microcirculatory function in patients with acute myocardial infarction (MI) and primary angioplas... more Microcirculatory function in patients with acute myocardial infarction (MI) and primary angioplasty (PCI) is dynamic and affects coronary flow. Although, TIMI and myocardial blush grades provide se...
The main goal of the research was to find out the connectivity between various representations of... more The main goal of the research was to find out the connectivity between various representations of sets and attempt to clarify source of error when passing from one representation to another. A questionnaire which focused on the inclusion relation between sets, by switching this relation from the verbal, formal and verbal-logical to the visual representation, i.e. to Venn diagrams, was distributed to 120 pre-service teachers who had been learning a basic course in set theory, from two colleges of education. Our findings highlight the fact that the verbal representation was the easiest, in other words, the students succeeded more in switching from the verbal and the verbal-logical to the visual representation, more than in switching from the formal representation to the visual one. Moreover, the main sources of errors were: Non identification of the problem variable or subject; adding new condition enlarges the set; Partial visual attribution to Venn diagrams and the inclusion relatio...
OBJECTIVES Phototherapy has been reported to reduce coronary blood flow in neonates but without a... more OBJECTIVES Phototherapy has been reported to reduce coronary blood flow in neonates but without affecting gross measures of cardiac function. The aim of our current study was to evaluate earlier, more sensitive changes in cardiac function during phototherapy. METHODS Nineteen neonates with jaundice treated with phototherapy had Doppler echocardiographic evaluation, before, during and after phototherapy and were compared to 25 matched controls. Sensitive measures for cardiac performance in this study included left ventricular dimension, ventricular Doppler parameters and regional function assessment. RESULTS Phototherapy was associated with a significant increase in heart rate. In addition, atrioventricular valve closure to opening interval decreased significantly during phototherapy while ventricular ejection times tended to decrease. However, left and right ventricular filling parameters and outflow velocity parameters, longitudinal tissue-Doppler annular velocities and myocardial ...
Discrete Mathematics Letters
In this note, we answer the following question: in how many ways one can color a 1 × n chessboard... more In this note, we answer the following question: in how many ways one can color a 1 × n chessboard using colors from the set {1, 2,. .. , m} such that the color i occurs a multiple of ti number of times for all i = 1, 2,. .. , m?
Topology - Recent Advances and Applications [Working Title]
Let (∁) signify a simplicial complex, the topological connectivity of ∁ is donated by ζ (∁), whic... more Let (∁) signify a simplicial complex, the topological connectivity of ∁ is donated by ζ (∁), which equals ∁+2; where ζ is a function from the class of graphs to the set Z^+={0,1,2,…,∞}. Suppose that the function ζ possesses the following characteristics: 1. ζ(K_0 )=0 2. For any graph G(V,E), there exists, an edge {x,y} in G such that ζ(G(V,E)-{x,y})≥ζ(G(V,E)) where, (G(V,E) -{x,y}) means: to remove the edge {x,y} from the graph G(V,E)), and ζ(G(V,E)-Δ({x,y}))≥ζ(G(V,E))-1 where, (G(V,E)-Δ ({x,y}) is equal to remove the vertices x,y and all their neighbors. then μ(Γ(G(V,E))≥ζ(G(V,E)) Let〖 ζ〗_0 denote the maximal function ζ that satisfying the aforementioned constraints. Eli Berger [4] proved that μ(Γ(G(V,E))≥ζ_0 (G(V,E)) for trees and for complements of chordal graphs. Kazuhiro Kawamura [3] proved the same theorem for chordal graphs, and Yousef Methkal Abd Algani [1] proved it for circular-arc graph: Let G(V,E) be a circular-arc graph, if ζ_0 (G(V,E))≤2,then μ(Γ(G(V,E)))≤2. In the cur...
European Heart Journal - Cardiovascular Imaging, 2012
Idiopathic pulmonary arterial hypertension (IPAH) prognosis depends on the capability of the righ... more Idiopathic pulmonary arterial hypertension (IPAH) prognosis depends on the capability of the right ventricle (RV) to preserve its function in face of increased afterload. We hypothesize that, as for the left ventricle, right intra-ventricular (IVD) dyssynchrony may have a negative effect on the overloaded RV. The aim of the study was to assess right IVD by incorporating activation times of longitudinal deformation across all RV segments, representing the longitudinal deformation the major contribution to chamber contraction. Methods: Eighty patients with IPAH (52 female subjects), without right bundle branch block, were consecutively enrolled. All patients underwent WHO functional evaluation, 6-minutes walking test, right heart catheterization and a comprehensive echocardiographic examination within 24 hours from invasive procedure. RV longitudinal myocardial deformation was assessed by using 2D Speckle Tracking Echocardiography (2DSTE). We defined RV dyssynchrony, next called RV-SD4, as the standard deviation (SD) of the time-intervals between QRS onset and peak longitudinal systolic strain of mid and basal segments of the RV free wall and the inter-ventricular septum. Results: Patients with IPAH showed regional abnormalities of RV function in terms of time to peak of longitudinal systolic strain as expressed by RV-SD4. Multivariate regression analysis revealed that QRS duration, RV end-diastolic area and pulmonary vascular resistances (PVR) were independent predictors of RV-SD4 (r2 =0,36; p=,0.00001). Actuarial rates of patients who experienced clinical worsening (CW) were 25% at 6 months, 32% and 48% at 1 and 2 years respectively. Event-free survivors had better WHO functional class, 6-minutes walking distance, hemodynamic status, morphological and functional echocardiographic parameters. Multivariate analysis showed cardiac index (unit 0.5, HR 0.36, CI 95% 0.23-0.57), RV fractional area change (unit 5, HR 0.79, CI 95% 0.67-0,93) and RV-SD4 (unit 5, HR 1.06 CI 95% 1.00-1.13) as independent predictors of CW (x 2 =46.8, p=000001). The optimal ROC-derived RV-SD4 cutoff value as indicator of CW was ≥ 23 (Sensibility 92%, Specificity 67%). Conclusions: Our findings suggest that right intra-ventricular dyssynchrony can be accurately described by the 2DSTE derived measure RV-SD4. That index of RV dyssynchrony can help to distinguish non invasively those IPAH patients with a worse clinical and hemodynamic profile and could be considered among independent predictors of clinical worsening.
European Heart Journal - Cardiovascular Imaging, 2013
Purpose: Cardiac deconditioning due to immobilization is a risk factor for cardiovascular disease... more Purpose: Cardiac deconditioning due to immobilization is a risk factor for cardiovascular disease. The physiology of cardiac adaptation to deconditioning has not been fully elucidated. The purpose of the present study was to assess the effects of 21-days of strict headdown (-6 degrees) bed-rest (BR) deconditioning on left ventricular (LV) dimensions and mass measured by MRI. Methods: Ten healthy men (mean age 32+6) were enrolled; the experiment was conducted at DLR (Koln, Germany) as part of the European Space Agency BR studies. Steady-state free precession MRI images (7mm thickness, no gap, no overlap) were obtained (Symphony 1.5T, Siemens) in a stack of short-axis views from LV base to LV apex, before (PRE), at the end of BR (HDT20), and four days after the BR conclusion (POST). Endocardial and epicardial semi-automated contouring was performed using freely available software (Segment). Results: At HDT20, significant reductions in LV mass (16%), end-diastolic (26%) and endsystolic (27%) volumes and stroke volume (27%) were observed, while ejection fraction did not change. These changes were accompanied by a measured decrease (14%) in plasma and blood volume (by gas-rebreathing technique), as well as by a significant reduction (14%) in VO2max aerobic power, measured using a graded cycle ergometer test protocol to volitional fatigue, at one day after the BR conclusion, while expiratory exchange ratio did not change. At POST, LV volumes were restored, while LV mass was still trending towards control values. Conclusions: Cardiac adaptation to deconditioning affected LV mass and dimensions, as a combined result of LV remodeling and fluids loss, accompanied by worsening in aerobic power. This should be taken into account in patients with cardiovascular diseases, when immobilized in bed, to proper adjust the therapy, or to define appropriate physical exercises when possible, in order to avoid further complications.
EDULEARN proceedings, Jul 1, 2022
Journal of the American College of Cardiology, 2015
background: Intra-aortic balloon (IABP) when applied in all patients with acute anterior ST eleva... more background: Intra-aortic balloon (IABP) when applied in all patients with acute anterior ST elevation myocardial infraction (STEMI) treated by primary percutaneous coronary intervention (PPCI) and in patients with shock was not beneficial. aim: Evaluation of the effects of IABP on coronary flow, myocardial perfusion and left ventricular systolic function in patients with acute anterior STEMI and suboptimal PPCI angiographic outcome. methods: Fifty five patients with acute anterior STEMI had suboptimal PPCI outcome according to TIMI grade and myocardial blush grades (MBG). 27 were treated by IABP and 28 served as a control group. TIMI and MBG grade were evaluated before and after PPCI. Flow in the LAD was evaluated using Trans thoracic Doppler (TTE) with and without pumping. Left ventricular systolic function was valuated by TTE, early after PPCI and at discharge. LVEF, LAD wall motion score index (LAD-WMSI) and LV WMSI (LV-WMSI) were measured. Results: IABP doubled diastolic LAD flow. LVEF at admission was lower in the IABP group compared to controls but both were similar at discharge. IABP increased LVEF by more than 5 % in 70% of patients treated with IABP. Patients who increased their LVEF were younger, and had lower prevalence of smoking 32% vs. 80%, obesity 11% vs. 40%, renal failure 0 % vs. 40%, KILLIP class 1.75 vs. 2.7 and had lower prevalence of previous PCIs. TIMI and MBG grades after PPCI were higher in these patients, and higher prevalence of single LAD disease. During pumping, diastolic velocity and integrals were higher in those with improved LVEF. conclusion: In anterior STEMI and suboptimal PPCI, TTE Doppler helped in monitoring effects of IABP on LAD flow, allowed optimizing flow augmentation and thus improved LV systolic function in 70% of the patients.
Cardiology Research, 2014
Background: Diastolic dysfunction precedes systolic dysfunction in patients with coronary artery ... more Background: Diastolic dysfunction precedes systolic dysfunction in patients with coronary artery disease. The aim of the study was to evaluate the effects of left ventricular (LV) wall motion abnormality (WMA) on diastolic LV and right ventricular (RV) function at rest and after stress. Methods: Fifty-nine subjects, 15 with LV-WMA (abnormal group) and 44 without (normal group), underwent dobutamine stress echocardiography (DSE) studies, in addition to evaluation of LV and RV diastolic function before and after DSE. Results: Resting mitral flow parameters were similar. DSE increased peak A-wave velocities in both groups, and mitral color slope only in normal subjects. After DSE, E-wave peak velocities and mitral color slope were higher in normal subjects, P < 0.05. At rest and after DSE systolic and diastolic pulmonary vein velocities were similar in both groups; however, DSE increased these velocities only in normal subjects, P < 0.05. Regional E-wave peak velocities of LV were higher at rest in normal subjects, P < 0.05. Both LV and RV, regional peak E-wave velocities were not affected by DSE. After DSE, regional Awave peak velocities increased in all (P < 0.01), except at the lateral region (P = 0.07). DSE increased trans-tricuspid velocities in both groups, P < 0.05. Resting A-wave velocities were higher in normal subjects, P < 0.01. Conclusions: Global LV early diastolic filling parameters were not affected by LV-WMA at rest. LV-WMA blunted the response after stress. RV E-wave velocities increased after DSE, and were not affected by LV-WMA. LV-WMA reduced regional LV-E' velocities at rest but not the reserve. A-wave velocities were not affected by WMA and increased after DSE.
Heart International, 2010
In the presence of severe stenosis, coronary artery flow may be reduced at rest. Recent advances ... more In the presence of severe stenosis, coronary artery flow may be reduced at rest. Recent advances in echocardiography have made noninvasive sampling of velocities in the left anterior descending coronary artery (LAD) possible. The aim of our study was to evaluate feasibility and capability of transthoracic Doppler to detect severe stenosis of the LAD. The study population consisted of 42 subjects with suspected coronary artery disease scheduled for coronary angiography. All had complete transthoracic echocardiography and Doppler sampling of LAD velocities. Quantitative coronary angiography was performed within 24 hours of the echocardiogram. Correlations between LAD velocity profile, measurements and calculations, and the angiographic results were performed. Six subjects had LAD occlusion, 10 had severe (>80% diameter) LAD stenosis, and 26 had normal or non-occlusive LAD disease. In all six subjects with LAD occlusion, distal LAD velocities were not detectable, while in the other 36 subjects, LAD velocities were recorded indicating the vessels were patent. In the 10 subjects with severe LAD stenosis, the diastolic/systolic velocity ratio was <1.5, while in those with nonsignifi cant LAD disease, the diastolic/systolic velocity ratio was >1.5 (P<0.005). Diastolic LAD flow was 21.8±13 mL/min in the presence of severe stenosis as compared to 48.5±20 mL/min in subjects without severe stenosis (P<0.0013). LAD velocities had high sensitivity and specificity for the prediction of severe angiographic stenosis. Thus transthoracic Doppler measurement of LAD velocities is feas ible and can predict the presence of severe LAD stenosis or occlusion.
Echocardiography, 2013
Function of the microcirculation after primary percutaneous coronary intervention (PCI) is dynami... more Function of the microcirculation after primary percutaneous coronary intervention (PCI) is dynamic and contributes to unpredictability of recovery of left ventricular (LV) systolic function. This study was conducted to evaluate sequential Doppler velocity parameters of the left anterior descending coronary artery (LAD) in predicting recovery of global and regional LV systolic function. Thirty-five consecutive patients, 24 males, age 59 ± 12 years, with acute anterior ST-elevation myocardial infarction (STEMI) who had primary PCI were studied. Thrombolysis in myocardial infarction (TIMI) and myocardial blush grades were evaluated. Transthoracic echocardiographic (TTE) studies, evaluation of left ventricular ejection fraction (LVEF), LAD territory wall-motion score index (WMSI), and sampling of LAD Doppler velocities up to 6 hours post-PCI, 48 hours postprocedure, and predischarge were performed. Thrombolysis in myocardial infarction grade before PCI averaged 0.86 ± 1.19 and post-PCI 2.89 ± 0.32, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05. Myocardial blush grade before PCI was 0.41 ± 0.98 and after PCI 2.22 ± 0.93, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05. Diastolic velocity deceleration time (DDT) in the LAD early after PCI was less than 600 ms in 16 subjects. Immediately after PCI, in subjects with DDT &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 600 ms, LVEF was 38.5 ± 6% and predischarge 49.2 ± 8.7%, P = 9.77 × 10−5 and LAD-WMSI decreased from 2 ± 0.38 to 1.4 ± 0.48, P = 0.000163. In subjects with DDT &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 600 ms LAD-WMSI did not change significantly. Early and minimal LAD-DDT correlated with improvement in LV systolic function, r = 0.6, whereas post-PCI blush grade had lower correlation with LVEF, r = 0.39. Global and regional LV systolic function after PCI in acute anterior MI can be predicted by LAD-DDT better than by post-PCI myocardial blush.
The main goal of the research was to find out the connectivity between various representations of... more The main goal of the research was to find out the connectivity between various representations of sets and attempt to clarify source of error when passing from one representation to another. A questionnaire which focused on the inclusion relation between sets, by switching this relation from the verbal, formal and verbal-logical to the visual representation, i.e., to Venn diagrams, was distributed to 120 pre-service teachers who had been learning a basic course in set theory, from two colleges of education. Our findings highlight the fact that the verbal representation was the easiest, in other words, the students succeeded more in switching from the verbal and the verbal-logical to the visual representation, more than in switching from the formal representation to the visual one. Moreover, the main sources of errors were: Non identification of the problem variable or subject; adding new condition enlarges the set; Partial visual attribution to Venn diagrams and the inclusion relati...
Archives of Emergency Medicine and Intensive Care
Background: Primary percutaneous coronary artery intervention (PCI) in patients with acute ST-ele... more Background: Primary percutaneous coronary artery intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI) leads to myocardial salvage. Objectives: To test whether shorter periods to primary PCI improve coronary flow, myocardial perfusion and left ventricular systolic function. Methods: 170 patients with acute anterior STEMI treated by primary PCI were evaluated. Time periods from onset of chest pain to first medical contact (FMC) and from FMC to primary PCI (FMC-PCI) and from pain to primary PCI (Pain-PCI) were recorded. Results: Patients with pain-PCI<300 min, tended to achieve TIMI grade III more frequently (51%vs 33%), p=0.06 and more frequent MBG≥2, (53% vs 36%), p=0.08. Partial ST-elevation resolution was achieved more frequently in patients with pain-PCI<180min (87% vs 65%), p<0.05. Lower peak troponin levels were found in patients with pain-PCI<300 min (49.2±45.2 vs 84.2 ±43 ng/ml), p=0.03. In patients with pain-PCI< 180min, left ventricular ejection fraction (LVEF) increased by 10±8% vs 5.5±5%, p<0.05. In patients with pain-FMC < 90 and < 120 min the increase in LVEF was larger than in others, p<0.05. FMC-PCI less< 180min was associated with larger increase in LVEF, p<0.05. Conclusion: Decreasing pain to PCI intervals, improves myocardial perfusion and LVEF.
The Israel Medical Association journal : IMAJ, 2008
BACKGROUND The temporal behavior of the coronary microcirculation in acute myocardial infarction ... more BACKGROUND The temporal behavior of the coronary microcirculation in acute myocardial infarction may affect outcome. Diastolic deceleration time and early systolic flow reversal derived from coronary artery blood flow velocity patterns reflect microcirculatory function. OBJECTIVES To assess left anterior descending coronary artery flow velocity patterns using Doppler transthoracic echocardiography after primary percutaneous coronary intervention, in patients with anterior AMI. METHODS Patterns of flow velocity patterns of the LAD were obtained using transthoracic echocardiography-Doppler in 31 consecutive patients who presented with anterior AMI. Measurements were done at 6 hours, 36-48 hours, and 5 days after successful PPCI. Measurements of DDT and pressure half times (Pt%), as well as observation for ESFR were performed. RESULTS In the first 2 days following PPCI, the average DDT (600 +/- 340 msec) was shorter than on day 5 (807 +/- 332 msec) (P < 0.012), FVP in the first 2 da...
Microcirculatory function in patients with acute myocardial infarction (MI) and primary angioplas... more Microcirculatory function in patients with acute myocardial infarction (MI) and primary angioplasty (PCI) is dynamic and affects coronary flow. Although, TIMI and myocardial blush grades provide se...
The main goal of the research was to find out the connectivity between various representations of... more The main goal of the research was to find out the connectivity between various representations of sets and attempt to clarify source of error when passing from one representation to another. A questionnaire which focused on the inclusion relation between sets, by switching this relation from the verbal, formal and verbal-logical to the visual representation, i.e. to Venn diagrams, was distributed to 120 pre-service teachers who had been learning a basic course in set theory, from two colleges of education. Our findings highlight the fact that the verbal representation was the easiest, in other words, the students succeeded more in switching from the verbal and the verbal-logical to the visual representation, more than in switching from the formal representation to the visual one. Moreover, the main sources of errors were: Non identification of the problem variable or subject; adding new condition enlarges the set; Partial visual attribution to Venn diagrams and the inclusion relatio...
OBJECTIVES Phototherapy has been reported to reduce coronary blood flow in neonates but without a... more OBJECTIVES Phototherapy has been reported to reduce coronary blood flow in neonates but without affecting gross measures of cardiac function. The aim of our current study was to evaluate earlier, more sensitive changes in cardiac function during phototherapy. METHODS Nineteen neonates with jaundice treated with phototherapy had Doppler echocardiographic evaluation, before, during and after phototherapy and were compared to 25 matched controls. Sensitive measures for cardiac performance in this study included left ventricular dimension, ventricular Doppler parameters and regional function assessment. RESULTS Phototherapy was associated with a significant increase in heart rate. In addition, atrioventricular valve closure to opening interval decreased significantly during phototherapy while ventricular ejection times tended to decrease. However, left and right ventricular filling parameters and outflow velocity parameters, longitudinal tissue-Doppler annular velocities and myocardial ...
Discrete Mathematics Letters
In this note, we answer the following question: in how many ways one can color a 1 × n chessboard... more In this note, we answer the following question: in how many ways one can color a 1 × n chessboard using colors from the set {1, 2,. .. , m} such that the color i occurs a multiple of ti number of times for all i = 1, 2,. .. , m?