Abdulrahman Almoghairi - Academia.edu (original) (raw)

Papers by Abdulrahman Almoghairi

Research paper thumbnail of Improvement of mitral regurgitation after transcatheter aortic valve implantation (TAVI)

Journal of the Saudi Heart Association, 2012

ABSTRACT Objectives To assess the change in mitral regurgitation (MR) severity after transcathete... more ABSTRACT Objectives To assess the change in mitral regurgitation (MR) severity after transcatheter aortic valve implantation (TAVI). Background Mitral regurgitation (MR) is frequently present in patients with calcific aortic stenosis (AS). Following surgical aortic valve replacement, improvement in MR is reported in 27–82% of the patients. The changes in MR severity following TAVI are unknown. Methods From April 2009 to January 2011, 57 patients with severe symptomatic aortic stenosis underwent TAVI [40 cases Edwards Sapien valve (Edwards Lifesciences Inc, Irvine CA), and 17 cases the CoreValve ReValving System]. Transthoracic echocardiography was performed before and 3 months after successful TAVI procedure. MR was assessed by expert readers and by color flow mapping and was graded as none (grade 0), mild (grade 1), moderate (grade 2), moderately severe (grade 3) or severe (grade 4). Results The mean MR grade was 1.7 ± 1.0 and 0.9 ± 0.7 pre- and post-TAVI respectively (p value < 0.001). MR pretreatment was grade 0–1, grade 2, and grade 3–4 in 69%, 19%, and 12% of the patients, respectively. Six patients out of 7 ( 85%) with grade 3–4 demonstrated improvement (4 patients (57%) improved to mild, and 2 patients (28%) to moderate MR). Seven patients out of 11 (63%) with grade 2 demonstrated an improvement to grade 0–1. There was no association between the improvement of MR and the type of valve used. Conclusions MR improved significantly after TAVI for severe AS. Further study with careful echocardiographic evaluation of the mitral valve prior to TAVI may help to predict which patients should experience an improvement in their MR.

Research paper thumbnail of Lessons from the SYNTAX trial

Journal of the Saudi Heart Association, 2010

Despite the fact that CABG is the standard of care for patients with multivessel coronary arterie... more Despite the fact that CABG is the standard of care for patients with multivessel coronary arteries and/or left main stem stenosis, PCI has become a rival to CABG in patients with multivessel coronary artery disease or left main disease. However, the need for repeat revascularization, in-stent stenosis and thrombosis remain the achilis heal of PCI. SYNTAX trial randomized patients with left main disease and/or three-vessel disease to PCI with TAXus stent or CABG with the concept that PCI is not inferior to CABG. At 1 and 2 years follow up, MACCE was significantly increased in PCI patients mainly attributed to increased rate of repeat revascularization; however, stroke was significantly more with CABG. The composite safety endpoint of death/stroke/MI was comparable between the 2 groups. Therefore the criterion for non-inferiority was not met. What we learn from SYNTAX is that multi disciplinary team approach should be the standard of care when recommending treatment in more complex coronary artery disease. SYNTAX makes interventionists and surgeons come together, it may set the benchmark for MVD revascularization. PCI and CABG should be considered complementary rather than competitive revascularization strategies. There is no substitute for sound clinical judgment that takes into account the patient's overall clinical profile, functionality, co-morbidities, as well as the patient's coronary anatomy. The SYNTAX Score should be utilized to decide on treatment of patients with LM/MVD. Patients with low and intermediate score can be treated with PCI or CABG with equal results. Those with high score do better with CABG. SYNTAX trial showed that 66% of patients with 3VD or LMD are still best treated with CABG. In the remaining 1/3 of patients with low syntax score, PCI may be considered as an alternative to surgery. Finally, medical treatment should be optimized in patients going for CABG.

Research paper thumbnail of Surgical treatment of functional mitral regurgitation in dilated cardiomyopathy

Journal of the Saudi Heart Association, 2011

Functional mitral regurgitation is a significant complication of end-stage cardiomyopathy. Dysfun... more Functional mitral regurgitation is a significant complication of end-stage cardiomyopathy. Dysfunction of one or more components of the mitral valve apparatus occurs in 39-74% and affects almost all heart failure patients. Survival is decreased in subjects with more than mild mitral regurgitation irrespective of the aetiology of heart failure. The goal of treating functional mitral regurgitation is to slow or reverse ventricular remodelling, improve symptoms and functional class, decrease the frequency of hospitalization for congestive heart failure, slow progression to advanced heart failure (time to transplant) and improve survival. This article reviews the role of mitral valve surgery in patients with heart failure and dilated cardiomyopathy.

Research paper thumbnail of Very delayed coronary stent fracture: A case report

Journal of the Saudi Heart Association, 2011

A stent fracture is an emerging complication of the coronary stents. There are numerous risk fact... more A stent fracture is an emerging complication of the coronary stents. There are numerous risk factors for stent fractures; which include forceful exaggerated motion in the atrioventricular groove seen in right coronary artery, long stent, an ostial lesion at the point of maximum curvature in a tortuous vessel, stent over-expansion, stent overlapping with different size stents, complex lesion after stenting of a totally occluded vessel, Cypher stent and a highly mobile segment causing high mechanical stress. Furthermore, chronic stretch at specific vessel sites as bends may lead to late occurrence of fracture.

Research paper thumbnail of Allergic reaction to abciximab with atypical manifestations

Journal of the Saudi Heart Association, 2011

Abciximab (ReoPro, Eli Lilly and Company, Indianapolis, Indiana) is an intravenous agent that had... more Abciximab (ReoPro, Eli Lilly and Company, Indianapolis, Indiana) is an intravenous agent that had been approved for treatment of acute coronary syndrome undergoing coronary interventions. It is a chimeric monoclonal antibody fragment that binds to the glycoprotein IIb/IIIa receptor with a potential for the development of an immune response to variable portions within the antigen binding site following its administration.

Research paper thumbnail of Significance of lactic acid accumulation after exposure to iodinated contrast media in diabetic patients receiving metformin

Journal of the Saudi Heart Association, 2013

Research paper thumbnail of Incidence of clopidogrel resistance in Saudi population, a pilot observation study

Journal of the Saudi Heart Association, 2012

Research paper thumbnail of The clinical significance of cardiac troponins in medical practice

Journal of the Saudi Heart Association, 2011

Troponins are regulatory proteins that form the cornerstone of muscle contraction. The amino acid... more Troponins are regulatory proteins that form the cornerstone of muscle contraction. The amino acid sequences of cardiac troponins differentiate them from that of skeletal muscles, allowing for the development of monoclonal antibody-based assay of troponin I (TnI) and troponin T (TnT). Along with the patient history, physical examination and electrocardiography, the measurement of highly sensitive and specific cardiac troponin has supplanted the former gold standard biomarker (creatine kinase-MB) to detect myocardial damage and estimate the prognosis of patients with ischemic heart disease. The current guidelines for the diagnosis of non-ST segment elevation myocardial infarction are largely based on an elevated troponin level. The implementation of these new guidelines in clinical practice has led to a substantial increase in the frequency of myocardial infarction diagnosis.

Research paper thumbnail of Do We Need Premedication Before Coronary Angiography? A Controlled Clinical Trial

Cardiology Research, 2011

Background: Premedication with benzodiazepines has been thought to reduce patient anxiety, pain p... more Background: Premedication with benzodiazepines has been thought to reduce patient anxiety, pain perception, and non-catheter-induced coronary spasms and may increase procedure-related complications. We used to routinely provide premedication with diazepam and chlorpheniramine before cardiac catheterization procedures. However the benefi ts of such a treatment are not well established here. Therefore, we designed this study to test whether the routine use of premedication during coronary angiography is needed.

Research paper thumbnail of Use of combination of mitral clip and CGMP-specific phosphodiesterase type 5 inhibitor as bridge for cardiac transplantation

Journal of the Saudi Heart Association, 2013

Research paper thumbnail of Efficacy of a single dose intravenous heparin in reducing sheath-thrombus formation during diagnostic angiography: A randomized controlled trial

Journal of the Saudi Heart Association, 2012

Background: Femoral arterial sheath thrombosis and distal embolization are well-recognized compli... more Background: Femoral arterial sheath thrombosis and distal embolization are well-recognized complications of cardiac catheterization but the occlusion is extremely rare. Heparinized saline flushes are used during diagnostic coronary angiography to prevent thrombus formation within the sheath lumen. However, the use of prophylactic intravenous heparin following the femoral arterial sheath insertion is controversial. The aim of this study is to evaluate the effectiveness of 2000 units of intravenous heparin bolus in comparison to a saline placebo on the thrombus formation within the arterial sheath during the diagnostic coronary angiography.

Research paper thumbnail of SHA 061. Efficacy of a single dose intravenous heparin during diagnostic angiography in reducing sheath thrombus formation: A randomized controlled trial

Journal of the Saudi Heart Association, 2011

Journal of the Saudi Heart Association, Volume 23, Issue 3, Pages 188, July 2011, Authors:Abdulra... more Journal of the Saudi Heart Association, Volume 23, Issue 3, Pages 188, July 2011, Authors:Abdulrahman M. Almoghairi; Hussein S. Alamri; Mohamed A. Alotaibi; Aziz Alanazi; Abdullah A. Alghamdi; Ali S. Almasood.

Research paper thumbnail of Monitoring Metformin in Cardiac Patients Exposed to Contrast Media Using Ultra–High-Performance Liquid Chromatography Tandem Mass-Spectrometry

Therapeutic Drug Monitoring, 2011

There is no evidence that the use of contrast media (CM) in diabetic patients with serum creatini... more There is no evidence that the use of contrast media (CM) in diabetic patients with serum creatinine <130 μmole/L leads to metformin accumulation and subsequent lactic acidosis. Therefore, the objective of this investigation was to monitor cardiac patients for the effects of CM on their metformin plasma concentration and serum creatinine clearance (ClCr). Metformin plasma concentrations were measured by a new, fully validated specific, precise, and accurate ultra-high-performance liquid chromatography tandem mass-spectrometric assay. The detection was performed using positive electrospray ionization in the multiple reaction monitoring mode. Fifty patients with serum creatinine levels <130 μmole/L were monitored for the effect of CM exposure on metformin concentration and ClCr. Pharmacokinetic parameters were calculated in 8 of these patients, and metformin accumulation was monitored in 10 patients before and after their exposure to CM. Linear response (r ≥ 0.998) was observed over the range of 5-2000 ng/mL of metformin, with the lower limit of quantification of 2.3 ng/mL. The intraday and interday precision (relative standard deviation) values were <13%, and the accuracy (relative error) was <-10% for metformin concentrations. The assay was sensitive to follow the pharmacokinetics of metformin in humans during a dosing interval after an oral dose at steady state. Metformin pharmacokinetic parameters were estimated in 8 patients exposed to CM. The mean C(max) of 1.9 ± 0.6 mg/L was attained at 4.1 ± 1.9 hours. There was no evidence of any drug accumulation or altered elimination due to the exposure to CM in the current population. ClCr showed no significant difference (P > 0.05) before (92.8 ± 11.3 mL/min) and after 48 hours (90.5 ± 10.5 mL/min) of exposure to CM. Our data suggest that the recommendation to withhold metformin in diabetic patients during CM exposure could be revised to withholding the drug only in patients with moderate to severe renal dysfunction.

Research paper thumbnail of Significance of lactic acid accumulation after exposure to iodinated contrast media in diabetic patients receiving metformin

Journal of the Saudi Heart Association, 2013

Research paper thumbnail of Incidence of clopidogrel resistance in Saudi population, a pilot observation study

Journal of the Saudi Heart Association, 2012

Research paper thumbnail of Do We Need Premedication Before Coronary Angiography? A Controlled Clinical Trial

Cardiology Research, 2011

Background: Premedication with benzodiazepines has been thought to reduce patient anxiety, pain p... more Background: Premedication with benzodiazepines has been thought to reduce patient anxiety, pain perception, and non-catheter-induced coronary spasms and may increase procedure-related complications. We used to routinely provide premedication with diazepam and chlorpheniramine before cardiac catheterization procedures. However the benefi ts of such a treatment are not well established here. Therefore, we designed this study to test whether the routine use of premedication during coronary angiography is needed.

Research paper thumbnail of Use of combination of mitral clip and CGMP-specific phosphodiesterase type 5 inhibitor as bridge for cardiac transplantation

Journal of the Saudi Heart Association, 2013

Research paper thumbnail of Efficacy of a single dose intravenous heparin in reducing sheath-thrombus formation during diagnostic angiography: A randomized controlled trial

Journal of the Saudi Heart Association, 2012

Background: Femoral arterial sheath thrombosis and distal embolization are well-recognized compli... more Background: Femoral arterial sheath thrombosis and distal embolization are well-recognized complications of cardiac catheterization but the occlusion is extremely rare. Heparinized saline flushes are used during diagnostic coronary angiography to prevent thrombus formation within the sheath lumen. However, the use of prophylactic intravenous heparin following the femoral arterial sheath insertion is controversial. The aim of this study is to evaluate the effectiveness of 2000 units of intravenous heparin bolus in comparison to a saline placebo on the thrombus formation within the arterial sheath during the diagnostic coronary angiography.

Research paper thumbnail of SHA 061. Efficacy of a single dose intravenous heparin during diagnostic angiography in reducing sheath thrombus formation: A randomized controlled trial

Journal of the Saudi Heart Association, 2011

Journal of the Saudi Heart Association, Volume 23, Issue 3, Pages 188, July 2011, Authors:Abdulra... more Journal of the Saudi Heart Association, Volume 23, Issue 3, Pages 188, July 2011, Authors:Abdulrahman M. Almoghairi; Hussein S. Alamri; Mohamed A. Alotaibi; Aziz Alanazi; Abdullah A. Alghamdi; Ali S. Almasood.

Research paper thumbnail of Left Main Approach for Retrieval of Retained Guidewire Fragment

Journal of Cardiac Surgery, 2012

Entrapment and detachment of guide wire fractures during percutaneous coronary intervention (PCI)... more Entrapment and detachment of guide wire fractures during percutaneous coronary intervention (PCI) are very rare, but can lead to life-threatening complications such as embolization, thrombus formation, and perforation. Surgical extraction of the remnant fragments is recommended if the percutaneous retrieval is not possible. We present a case of remnant guide wire into the left anterior descending artery (LAD) and aorta that led to acute coronary thrombosis following primary angioplasty. Surgical retrieval was possible only through a left main (LM) approach.

Research paper thumbnail of Improvement of mitral regurgitation after transcatheter aortic valve implantation (TAVI)

Journal of the Saudi Heart Association, 2012

ABSTRACT Objectives To assess the change in mitral regurgitation (MR) severity after transcathete... more ABSTRACT Objectives To assess the change in mitral regurgitation (MR) severity after transcatheter aortic valve implantation (TAVI). Background Mitral regurgitation (MR) is frequently present in patients with calcific aortic stenosis (AS). Following surgical aortic valve replacement, improvement in MR is reported in 27–82% of the patients. The changes in MR severity following TAVI are unknown. Methods From April 2009 to January 2011, 57 patients with severe symptomatic aortic stenosis underwent TAVI [40 cases Edwards Sapien valve (Edwards Lifesciences Inc, Irvine CA), and 17 cases the CoreValve ReValving System]. Transthoracic echocardiography was performed before and 3 months after successful TAVI procedure. MR was assessed by expert readers and by color flow mapping and was graded as none (grade 0), mild (grade 1), moderate (grade 2), moderately severe (grade 3) or severe (grade 4). Results The mean MR grade was 1.7 ± 1.0 and 0.9 ± 0.7 pre- and post-TAVI respectively (p value < 0.001). MR pretreatment was grade 0–1, grade 2, and grade 3–4 in 69%, 19%, and 12% of the patients, respectively. Six patients out of 7 ( 85%) with grade 3–4 demonstrated improvement (4 patients (57%) improved to mild, and 2 patients (28%) to moderate MR). Seven patients out of 11 (63%) with grade 2 demonstrated an improvement to grade 0–1. There was no association between the improvement of MR and the type of valve used. Conclusions MR improved significantly after TAVI for severe AS. Further study with careful echocardiographic evaluation of the mitral valve prior to TAVI may help to predict which patients should experience an improvement in their MR.

Research paper thumbnail of Lessons from the SYNTAX trial

Journal of the Saudi Heart Association, 2010

Despite the fact that CABG is the standard of care for patients with multivessel coronary arterie... more Despite the fact that CABG is the standard of care for patients with multivessel coronary arteries and/or left main stem stenosis, PCI has become a rival to CABG in patients with multivessel coronary artery disease or left main disease. However, the need for repeat revascularization, in-stent stenosis and thrombosis remain the achilis heal of PCI. SYNTAX trial randomized patients with left main disease and/or three-vessel disease to PCI with TAXus stent or CABG with the concept that PCI is not inferior to CABG. At 1 and 2 years follow up, MACCE was significantly increased in PCI patients mainly attributed to increased rate of repeat revascularization; however, stroke was significantly more with CABG. The composite safety endpoint of death/stroke/MI was comparable between the 2 groups. Therefore the criterion for non-inferiority was not met. What we learn from SYNTAX is that multi disciplinary team approach should be the standard of care when recommending treatment in more complex coronary artery disease. SYNTAX makes interventionists and surgeons come together, it may set the benchmark for MVD revascularization. PCI and CABG should be considered complementary rather than competitive revascularization strategies. There is no substitute for sound clinical judgment that takes into account the patient's overall clinical profile, functionality, co-morbidities, as well as the patient's coronary anatomy. The SYNTAX Score should be utilized to decide on treatment of patients with LM/MVD. Patients with low and intermediate score can be treated with PCI or CABG with equal results. Those with high score do better with CABG. SYNTAX trial showed that 66% of patients with 3VD or LMD are still best treated with CABG. In the remaining 1/3 of patients with low syntax score, PCI may be considered as an alternative to surgery. Finally, medical treatment should be optimized in patients going for CABG.

Research paper thumbnail of Surgical treatment of functional mitral regurgitation in dilated cardiomyopathy

Journal of the Saudi Heart Association, 2011

Functional mitral regurgitation is a significant complication of end-stage cardiomyopathy. Dysfun... more Functional mitral regurgitation is a significant complication of end-stage cardiomyopathy. Dysfunction of one or more components of the mitral valve apparatus occurs in 39-74% and affects almost all heart failure patients. Survival is decreased in subjects with more than mild mitral regurgitation irrespective of the aetiology of heart failure. The goal of treating functional mitral regurgitation is to slow or reverse ventricular remodelling, improve symptoms and functional class, decrease the frequency of hospitalization for congestive heart failure, slow progression to advanced heart failure (time to transplant) and improve survival. This article reviews the role of mitral valve surgery in patients with heart failure and dilated cardiomyopathy.

Research paper thumbnail of Very delayed coronary stent fracture: A case report

Journal of the Saudi Heart Association, 2011

A stent fracture is an emerging complication of the coronary stents. There are numerous risk fact... more A stent fracture is an emerging complication of the coronary stents. There are numerous risk factors for stent fractures; which include forceful exaggerated motion in the atrioventricular groove seen in right coronary artery, long stent, an ostial lesion at the point of maximum curvature in a tortuous vessel, stent over-expansion, stent overlapping with different size stents, complex lesion after stenting of a totally occluded vessel, Cypher stent and a highly mobile segment causing high mechanical stress. Furthermore, chronic stretch at specific vessel sites as bends may lead to late occurrence of fracture.

Research paper thumbnail of Allergic reaction to abciximab with atypical manifestations

Journal of the Saudi Heart Association, 2011

Abciximab (ReoPro, Eli Lilly and Company, Indianapolis, Indiana) is an intravenous agent that had... more Abciximab (ReoPro, Eli Lilly and Company, Indianapolis, Indiana) is an intravenous agent that had been approved for treatment of acute coronary syndrome undergoing coronary interventions. It is a chimeric monoclonal antibody fragment that binds to the glycoprotein IIb/IIIa receptor with a potential for the development of an immune response to variable portions within the antigen binding site following its administration.

Research paper thumbnail of Significance of lactic acid accumulation after exposure to iodinated contrast media in diabetic patients receiving metformin

Journal of the Saudi Heart Association, 2013

Research paper thumbnail of Incidence of clopidogrel resistance in Saudi population, a pilot observation study

Journal of the Saudi Heart Association, 2012

Research paper thumbnail of The clinical significance of cardiac troponins in medical practice

Journal of the Saudi Heart Association, 2011

Troponins are regulatory proteins that form the cornerstone of muscle contraction. The amino acid... more Troponins are regulatory proteins that form the cornerstone of muscle contraction. The amino acid sequences of cardiac troponins differentiate them from that of skeletal muscles, allowing for the development of monoclonal antibody-based assay of troponin I (TnI) and troponin T (TnT). Along with the patient history, physical examination and electrocardiography, the measurement of highly sensitive and specific cardiac troponin has supplanted the former gold standard biomarker (creatine kinase-MB) to detect myocardial damage and estimate the prognosis of patients with ischemic heart disease. The current guidelines for the diagnosis of non-ST segment elevation myocardial infarction are largely based on an elevated troponin level. The implementation of these new guidelines in clinical practice has led to a substantial increase in the frequency of myocardial infarction diagnosis.

Research paper thumbnail of Do We Need Premedication Before Coronary Angiography? A Controlled Clinical Trial

Cardiology Research, 2011

Background: Premedication with benzodiazepines has been thought to reduce patient anxiety, pain p... more Background: Premedication with benzodiazepines has been thought to reduce patient anxiety, pain perception, and non-catheter-induced coronary spasms and may increase procedure-related complications. We used to routinely provide premedication with diazepam and chlorpheniramine before cardiac catheterization procedures. However the benefi ts of such a treatment are not well established here. Therefore, we designed this study to test whether the routine use of premedication during coronary angiography is needed.

Research paper thumbnail of Use of combination of mitral clip and CGMP-specific phosphodiesterase type 5 inhibitor as bridge for cardiac transplantation

Journal of the Saudi Heart Association, 2013

Research paper thumbnail of Efficacy of a single dose intravenous heparin in reducing sheath-thrombus formation during diagnostic angiography: A randomized controlled trial

Journal of the Saudi Heart Association, 2012

Background: Femoral arterial sheath thrombosis and distal embolization are well-recognized compli... more Background: Femoral arterial sheath thrombosis and distal embolization are well-recognized complications of cardiac catheterization but the occlusion is extremely rare. Heparinized saline flushes are used during diagnostic coronary angiography to prevent thrombus formation within the sheath lumen. However, the use of prophylactic intravenous heparin following the femoral arterial sheath insertion is controversial. The aim of this study is to evaluate the effectiveness of 2000 units of intravenous heparin bolus in comparison to a saline placebo on the thrombus formation within the arterial sheath during the diagnostic coronary angiography.

Research paper thumbnail of SHA 061. Efficacy of a single dose intravenous heparin during diagnostic angiography in reducing sheath thrombus formation: A randomized controlled trial

Journal of the Saudi Heart Association, 2011

Journal of the Saudi Heart Association, Volume 23, Issue 3, Pages 188, July 2011, Authors:Abdulra... more Journal of the Saudi Heart Association, Volume 23, Issue 3, Pages 188, July 2011, Authors:Abdulrahman M. Almoghairi; Hussein S. Alamri; Mohamed A. Alotaibi; Aziz Alanazi; Abdullah A. Alghamdi; Ali S. Almasood.

Research paper thumbnail of Monitoring Metformin in Cardiac Patients Exposed to Contrast Media Using Ultra–High-Performance Liquid Chromatography Tandem Mass-Spectrometry

Therapeutic Drug Monitoring, 2011

There is no evidence that the use of contrast media (CM) in diabetic patients with serum creatini... more There is no evidence that the use of contrast media (CM) in diabetic patients with serum creatinine <130 μmole/L leads to metformin accumulation and subsequent lactic acidosis. Therefore, the objective of this investigation was to monitor cardiac patients for the effects of CM on their metformin plasma concentration and serum creatinine clearance (ClCr). Metformin plasma concentrations were measured by a new, fully validated specific, precise, and accurate ultra-high-performance liquid chromatography tandem mass-spectrometric assay. The detection was performed using positive electrospray ionization in the multiple reaction monitoring mode. Fifty patients with serum creatinine levels <130 μmole/L were monitored for the effect of CM exposure on metformin concentration and ClCr. Pharmacokinetic parameters were calculated in 8 of these patients, and metformin accumulation was monitored in 10 patients before and after their exposure to CM. Linear response (r ≥ 0.998) was observed over the range of 5-2000 ng/mL of metformin, with the lower limit of quantification of 2.3 ng/mL. The intraday and interday precision (relative standard deviation) values were <13%, and the accuracy (relative error) was <-10% for metformin concentrations. The assay was sensitive to follow the pharmacokinetics of metformin in humans during a dosing interval after an oral dose at steady state. Metformin pharmacokinetic parameters were estimated in 8 patients exposed to CM. The mean C(max) of 1.9 ± 0.6 mg/L was attained at 4.1 ± 1.9 hours. There was no evidence of any drug accumulation or altered elimination due to the exposure to CM in the current population. ClCr showed no significant difference (P > 0.05) before (92.8 ± 11.3 mL/min) and after 48 hours (90.5 ± 10.5 mL/min) of exposure to CM. Our data suggest that the recommendation to withhold metformin in diabetic patients during CM exposure could be revised to withholding the drug only in patients with moderate to severe renal dysfunction.

Research paper thumbnail of Significance of lactic acid accumulation after exposure to iodinated contrast media in diabetic patients receiving metformin

Journal of the Saudi Heart Association, 2013

Research paper thumbnail of Incidence of clopidogrel resistance in Saudi population, a pilot observation study

Journal of the Saudi Heart Association, 2012

Research paper thumbnail of Do We Need Premedication Before Coronary Angiography? A Controlled Clinical Trial

Cardiology Research, 2011

Background: Premedication with benzodiazepines has been thought to reduce patient anxiety, pain p... more Background: Premedication with benzodiazepines has been thought to reduce patient anxiety, pain perception, and non-catheter-induced coronary spasms and may increase procedure-related complications. We used to routinely provide premedication with diazepam and chlorpheniramine before cardiac catheterization procedures. However the benefi ts of such a treatment are not well established here. Therefore, we designed this study to test whether the routine use of premedication during coronary angiography is needed.

Research paper thumbnail of Use of combination of mitral clip and CGMP-specific phosphodiesterase type 5 inhibitor as bridge for cardiac transplantation

Journal of the Saudi Heart Association, 2013

Research paper thumbnail of Efficacy of a single dose intravenous heparin in reducing sheath-thrombus formation during diagnostic angiography: A randomized controlled trial

Journal of the Saudi Heart Association, 2012

Background: Femoral arterial sheath thrombosis and distal embolization are well-recognized compli... more Background: Femoral arterial sheath thrombosis and distal embolization are well-recognized complications of cardiac catheterization but the occlusion is extremely rare. Heparinized saline flushes are used during diagnostic coronary angiography to prevent thrombus formation within the sheath lumen. However, the use of prophylactic intravenous heparin following the femoral arterial sheath insertion is controversial. The aim of this study is to evaluate the effectiveness of 2000 units of intravenous heparin bolus in comparison to a saline placebo on the thrombus formation within the arterial sheath during the diagnostic coronary angiography.

Research paper thumbnail of SHA 061. Efficacy of a single dose intravenous heparin during diagnostic angiography in reducing sheath thrombus formation: A randomized controlled trial

Journal of the Saudi Heart Association, 2011

Journal of the Saudi Heart Association, Volume 23, Issue 3, Pages 188, July 2011, Authors:Abdulra... more Journal of the Saudi Heart Association, Volume 23, Issue 3, Pages 188, July 2011, Authors:Abdulrahman M. Almoghairi; Hussein S. Alamri; Mohamed A. Alotaibi; Aziz Alanazi; Abdullah A. Alghamdi; Ali S. Almasood.

Research paper thumbnail of Left Main Approach for Retrieval of Retained Guidewire Fragment

Journal of Cardiac Surgery, 2012

Entrapment and detachment of guide wire fractures during percutaneous coronary intervention (PCI)... more Entrapment and detachment of guide wire fractures during percutaneous coronary intervention (PCI) are very rare, but can lead to life-threatening complications such as embolization, thrombus formation, and perforation. Surgical extraction of the remnant fragments is recommended if the percutaneous retrieval is not possible. We present a case of remnant guide wire into the left anterior descending artery (LAD) and aorta that led to acute coronary thrombosis following primary angioplasty. Surgical retrieval was possible only through a left main (LM) approach.