Ahmed Kharabish - Academia.edu (original) (raw)

Papers by Ahmed Kharabish

Research paper thumbnail of Assessment of segmental agreement of T2 mapping versus triple inversion recovery in detection of acute myocardial edema

Egyptian Journal of Radiology and Nuclear Medicine

Background There are some limitations using the different sequences of clinical cardiac magnetic ... more Background There are some limitations using the different sequences of clinical cardiac magnetic resonance (cardiac MR) in detection of edema in patients presenting with acute myocardial injury. The purpose of this study is to evaluate the myocardial segmental agreement between the different edema sequences: T2 mapping and turbo inversion recovery magnitude (TIRM) in detection of acute myocardial edema. Results Thirty-seven patients presented with acute infarction were sent to cardiac MR to assess myocardial edema. All cardiac MR studies were scanned using cine, TIRM, and late gadolinium enhancement (LGE) in short axis views (SAX). Position of the T2 mapping slices were copied from the TIRM. The left ventricle (LV) was divided into apical, mid, and basal segments per visualization of the papillary muscles. Edema mass was assessed separately in each segment as well as the total edema mass in both the TIRM and T2 mapping. Twenty-four patients of whom 12.5% had multi-territorial corona...

Research paper thumbnail of Revisiting the pathogenic role of insulin resistance in Duchenne muscular dystrophy cardiomyopathy subphenotypes

Cardiovascular Endocrinology & Metabolism

Introduction Duchenne muscular dystrophy (DMD) is known to impact the subepicardial layer of the ... more Introduction Duchenne muscular dystrophy (DMD) is known to impact the subepicardial layer of the myocardium through chronic inflammation. Recent animal studies have shown predominant subendocardial involvement in rats with DMD. The primary outcome parameter was to determine by cardiovascular MRI (CMR) if two differential patterns of myocardial involvements exist in DMD; the secondary outcome parameters were to correlate the observed pattern with metabolic markers such as insulin resistance measures. Methods Forty patients with DMD were screened using CMR to determine which of them had predominantly subendocardial dysfunction (SENDO group), or subepicardial/midmyocardial involvement (SEPMI group). Patients were subjected to body mass index measurement, serum creatinine kinase, serum lactate dehydrogenase enzyme, fasting glucose-insulin ratio (FGIR), full lipid profile, left ventricular ejection fraction (LVEF), left ventricle E/E´ ratio (the ratio of early mitral inflow velocity to average early diastolic velocities of the basal septum and mitral annulus) for left ventricle diastolic function, and myocardial layer strain discriminating echocardiography (MLSD-STE). Results: 26 patients displayed SENDO while 34 displayed SEPMI. SENDO group displayed overt insulin resistance; (FGIR (SENDO: 7 ± 1 vs. SEPMI: 5 ± 1, P < 0.001). FGIR was negatively correlated with Subendocardial Global Longitudinal Strain (ENDO-LS) with r = −0.75. Conclusion DMD does not seem to influence the heart uniformly; DMD cardiomyopathy probably has two separate phenotypes with different mechanisms. Insulin resistance might be implicated in its pathogenesis and its reversal may help to slow disease progression.

Research paper thumbnail of CMR is fast and feasible in patients aged 3 to 8 years without general anesthesia or sedation

Research paper thumbnail of Cardiac MRI T1 mapping and extracellular volume application in hypertrophic cardiomyopathy

Egyptian Journal of Radiology and Nuclear Medicine, 2021

Background Hypertrophic cardiomyopathy (HCM) is one of the commonest inheritable cardiac disorder... more Background Hypertrophic cardiomyopathy (HCM) is one of the commonest inheritable cardiac disorders. Being a global disease with diffuse myocardial fibrosis, it has a wide range of adverse outcomes ending with sudden cardiac death. Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) has become a reference standard for visualization of focal myocardial fibrosis. In the setting of less severe or more diffuse fibrosis, LGE is unlikely to reveal the presence of abnormal tissue given the lack of normal myocardium as a reference. Direct measurement of myocardial T1 time (T1 mapping) may improve these methodologic problems of LGE CMR in the setting of diffuse retention of gadolinium-based contrast material. So, we aim at this study to evaluate the clinical application of CMRI native and post-contrast T1 relaxation in assessing diffuse myocardial fibrosis non-invasively in hypertrophic cardiomyopathy. Results There was a significant difference between the percent of fibro...

Research paper thumbnail of The Egyptian Collaborative Cardiac Genomics (ECCO-GEN) Project: defining a healthy volunteer cohort

npj Genomic Medicine

The integration of comprehensive genomic and phenotypic data from diverse ethnic populations offe... more The integration of comprehensive genomic and phenotypic data from diverse ethnic populations offers unprecedented opportunities toward advancements in precision medicine and novel diagnostic technologies. Current reference genomic databases are not representative of the global human population, making variant interpretation challenging, especially in underrepresented populations, such as the North African population. To address this, the Egyptian Collaborative Cardiac Genomics (ECCO-GEN) Project launched a study comprising 1000 individuals free of cardiovascular disease (CVD). Here, we present the first 391 Egyptian healthy volunteers recruited to establish a pilot phenotyped control cohort. All individuals underwent detailed clinical investigation, including cardiac magnetic resonance imaging (MRI), and were sequenced using a targeted panel of 174 genes with reported roles in inherited cardiac conditions. We identified 1262 variants in 27 cardiomyopathy genes of which 15.1% were no...

Research paper thumbnail of Assessment of aortic annulus dimensions for transcatheter aortic valve replacement (TAVR) with high-pitch dual-source CT: Comparison of systolic high-pitch vs. multiphasic data acquisition

European Journal of Radiology

Research paper thumbnail of Intraindividual validation of 4D flow measurement against 2D flow measurements in complex flow patterns in routine clinical cardiovascular magnetic resonance of bicuspid aortic valve

Egyptian Journal of Radiology and Nuclear Medicine

Background Comparing four-dimensional flow against two-dimensional flow measurements in patients ... more Background Comparing four-dimensional flow against two-dimensional flow measurements in patients with complex flow pattern is still lacking. This study aimed to compare four-dimensional against the two-dimensional flow measurement in patients with bicuspid aortic valve and to test potentials of four-dimensional operator-dependent sources of error. Results The two- and four-dimensional flow data sets of sixteen patients with bicuspid aortic valve and eighteen healthy subjects were studied. Flow analyses were performed by two observers blindly. Patients with bicuspid aortic valve mean differences between the two- and four-dimensional measurements in both observers were − 8 and − 4 ml, respectively. Four-dimensional measurements resulted in systematically higher flow values than the two-dimensional flow in bicuspid aortic valve patients. The upper and lower limits of agreement between the two- and four-dimensional measurements by both observers were + 12/− 28 ml and + 14/− 21 ml, respe...

Research paper thumbnail of Congenital biscuspid aortic valve in pediatric and early adults: Does valvular phenotype affect other parameters?

The Egyptian Journal of Radiology and Nuclear Medicine

Abstract Aim of the study Our study is a prospective study aiming to assess congenital bicuspid a... more Abstract Aim of the study Our study is a prospective study aiming to assess congenital bicuspid aortic valve using cardiac MRI and to detect a relationship between the leaflet fusion pattern and other functional parameters including valvular regurge, stenosis and pressure gradient. Patients and methods This prospective study included 114 cases 104 of them had bicuspid aortic valve, diagnosed by echocardiography while the rest (10 cases) were normal control cases. All functional and morphological cardiovascular abnormalities were recorded as well as any associated congenital diseases. Two different radiologists read the MRI blindly to each other. Results Patients age ranged from 40 days up to 20 years with 62 patients being in the pediatric age group ( We found 54 cases (53.8%) of 1-RL morphology, 34 cases (32.7%) of 1-RN morphology, 8 cases (7.7%) of 0-AP and 6 cases (5.8%) of 0-Lateral. Aortic stenosis and regurgitation were found in 80.75% of cases. Aortic stenosis was the most common valvular lesion being more evident in the 1-RN valve type. Aortic regurge was more predominant in the pediatric age group with no predilection for a specific valve phenotype. Left ventricular function was normal in most of our cases with only 10 cases showing impairment due to long standing valvular lesion. Thirty-eight cases (36.5%) had associated aortic dilatation. Twenty-six patients (25%) showed associated aortic coarctation. Intra cardiac shunts (24 patients 23%) were the second most common associated anomaly after coarctation. Most of the associated congenital anomalies were found with the 1-RL valve morphology type. Other associated congenital anomalies were detected in 44 patients (42.3%). Conclusion Cardiac Magnetic resonance should be performed for patients with bicuspid aortic valve to determine the valve phenotype, function and aortopathy for risk stratification and surgical management. Patients with RL type should be properly imaged to detect associated congenital anomalies.

Research paper thumbnail of Mid-term follow-up of pulmonary regurgitation in repaired asymptomatic TOF patients by transannular patch: A prospective cardiac MRI study

The Egyptian Journal of Radiology and Nuclear Medicine

The long-term outcome of Tetralogy of Fallot (TOF) surgical repair in developing countries is sti... more The long-term outcome of Tetralogy of Fallot (TOF) surgical repair in developing countries is still unknown. Therefore the aim of the study was the quantification of pulmonary regurgitation (PR) and right ventricular functions using cardiac magnetic resonance (CMR) in order to follow up midterm post transannular patch repair of asymptomatic TOF patients. Methods: We prospectively studied 37 asymptomatic corrected TOF patients (aged 18 years or less), aged at surgery was of median, min/max of (19, 8/48 months). Cardiac functions were assessed using routine steady state free precession techniques. PR quantification was performed using the routine velocity encoding phase contrast in the main pulmonary artery. Results: Four patients had mild PR, 26 had moderate PR and seven had severe PR, with a median value of PR% in CMR amounting to 29% (max: 75% and min: 13%). Indexed right ventricle enddiastolic volume amounted to (mean ± SD) 130 ± 38 ml, and indexed right ventricle end-systolic volume amounted to 63 ± 26 ml. Conclusion: Accurate quantitative assessment of PR in the mid and long-term course of TOF patients is paramount. CMR has to be introduced as a new modality in Egypt in the follow up course of asymptomatic TOF patients.

Research paper thumbnail of Relation between fragmented QRS complex to the right ventricular volumes and fraction of pulmonary regurgitation in patients with repaired tetralogy of Fallot

Progress in Pediatric Cardiology

Abstract Patients with repaired tetralogy of Fallot (TOF) have not uncommonly fragmented QRS comp... more Abstract Patients with repaired tetralogy of Fallot (TOF) have not uncommonly fragmented QRS complexes (fQRS) on surface electrocardiogram. We suggested that the right heart hemodynamics might be correlated with both the number of leads showing fQRS (fQRS extent) and the QRS duration. A retrospective analysis of the magnetic resonance imaging (MRI) derived data of 30 patients following total correction of TOF was performed. The number of leads showing fragmentation (fQRS extent) as well as the QRS duration were assessed and tested for correlation with the right ventricular volumes and severity of pulmonary regurgitation (PR) as detected by MRI. Twenty-one patients had fQRS in at least 2 consecutive leads. fQRS correlated with larger right ventricular volumes and lower ejection fraction. fQRS in 5 leads was an accurate parameter in identifying an indexed right ventricular end diastolic volume >150 ml/m2 with a sensitivity of 87.5% and a specificity of 85.7%. Moreover, it was the most accurate parameter in detecting a PR fraction > 45%. To conclude, assessment of fQRS extent and duration is a simple, available, and an accurate parameter in identifying patients with significant right ventricular hemodynamic changes in repaired TOF patients.

Research paper thumbnail of Emergency Repair of a Perforated Mycotic Aneurysm with a Self-made Pericardial Tube-graft

The Thoracic and Cardiovascular Surgeon Reports

A 63-year-old female with a history of kidney transplantation was admitted for emergency repair o... more A 63-year-old female with a history of kidney transplantation was admitted for emergency repair of a perforated mycotic aneurysm of the right subclavian artery (RSA) in combination with a paravertebral and posterior mediastinal abscess. After resection of the aneurysm and after radical local debridement, orthotopic repair was performed with a self-made pericardial tube graft from the brachiocephalic bifurcation to the thoracic outlet. The paravertebral and posterior mediastinal abscess was drained. The postoperative course was uneventful. Using a self-made readily available pericardial neo-tube enlarges the armamentarium of handling complex infective surgical scenarios and presents a smart alternative to alloplastic vascular reconstruction.

Research paper thumbnail of Can myocardial remodeling be a useful surrogate predictor of myocardial iron load? A 3D echocardiographic multicentric study

Pediatric blood & cancer, Jan 6, 2018

The relationship between myocardial iron load and eccentric myocardial remodeling remains an unde... more The relationship between myocardial iron load and eccentric myocardial remodeling remains an under-investigated area; it was thought that remodeling is rather linked to fibrosis. This study aims to determine whether or not measures of remodeling can be used as predictors of myocardial iron. For this purpose, 60 patients with thalassemia were studied with 3D echocardiography and myocardial relaxometry (T2*) by Cardiac MRI. 3D derived sphericity index was significantly higher in patients with myocardial iron load. It was correlated with T2* with a 100% sensitivity and specificity (cut-off value of 0.34) to discriminate between patients with and without myocardial iron overload.

Research paper thumbnail of Pacemaker-led complication mimicking a Type A aortic dissection

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2018

Research paper thumbnail of CMRI morphological and functional changes of the heart in myocarditis and dilated cardiomyopathy in acute pediatric heart failure

Journal of Cardiovascular Magnetic Resonance

Background Our purpose is to find morphological and functional changes of the heart in acute hear... more Background Our purpose is to find morphological and functional changes of the heart in acute heart failure presentation using cardiac magnetic resonance (CMRI) in pediatric group in order to differentiate between dilated cardiomyopathy (DCM) and myocarditis as a cause of acute heart failure.

Research paper thumbnail of PLATFORM at 90 days: Evaluating the clinical utility of FFRCT

Global Cardiology Science and Practice

The advancement that took place in assessing fractional flow reserve (FFR) using various competin... more The advancement that took place in assessing fractional flow reserve (FFR) using various competing modalities led to numerous research trials to evaluate the clinical impact of each. Among those trials is the recently published PLATFORM study. The data was designed to compare two clinical scenarios; a combination of computed fluid dynamics with computed tomographic angiography (CTA-guided strategy) in non-obstructive coronary artery disease (CAD) on one arm, compared to the standard practice representing the other clinical arm. The study’s results were evaluated for further evidence and clinical insights.

Research paper thumbnail of Congenital biscuspid aortic valve in pediatric and early adulthood: Is there a relationship between the valvular leaflet fusion pattern and other functional parameters

Journal of Cardiovascular Magnetic Resonance, 2016

Research paper thumbnail of Delayed Myocardial Enhancement in Pediatric Hypertrophic Cardiomyopathy: Correlation with LV Function, Echocardiography, and Demographic Parameters

Pediatric Cardiology, 2017

Our aim was (1) to detect the presence of fibrosis by Cardiac magnetic resonance imaging (CMR) in... more Our aim was (1) to detect the presence of fibrosis by Cardiac magnetic resonance imaging (CMR) in the pediatric age group. (2) Correlate CMR findings with demographic data, LV function, and other echocardiographic parameters. We studied 40 pediatric patients diagnosed as HCM by echocardiography. All patients were subjected to clinical examination (in which the NYHA classification was determined for each patient), echocardiography, and CMR. CMR was done on a 1.5T Philips Achieva scanner in SSFP with delayed myocardial enhancement (DE-MRI). All demographic and functional parameters as well as pressure gradient across left ventricular outflow tract (LVOT) were correlated with the percentage of myocardial enhancement. We studied 13 female and 27 male patients from 45 days up to 18 years. The mean percentage of DE-MRI was 9.7 ± 9%. We found significant correlation between the NYHA classification and the pressure gradient across the LVOT (P = &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) as well as the percentage of DE-MRI (P = 0.004). The percentage of DE-MRI showed positive correlation with LV myocardial mass index (P = 0.042). It didn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;t correlate with any other demographic or LV functional cardiac parameters. A good positive correlation was detected between the percentage of DE-MRI and the severity of pressure gradient across LVOT measured by echocardiography (r = 0.69 and P = &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). We found a significant correlation between the percentage of DE-MRI in children with HCM and the pressure gradient across LVOT, NYHA classification, and LV myocardial mass. This may help in the further management of those patients, planning for follow-up, and prognosis of the disease.

Research paper thumbnail of Inert Gas Rebreathing for Non-Invasive Quantification of Cardiac Output: Validation Against Cardiac Catheterization and Magnetic Resonance Imaging

Journal of Cardiac Failure, 2016

three-vessel disease, less frequent post-PCI TIMI grade 3 flow, and higher level of hs-CRP than t... more three-vessel disease, less frequent post-PCI TIMI grade 3 flow, and higher level of hs-CRP than those without HF. GLS was as accurate [area under the ROC curve (AUC) 0.753, 95% CI 0.665-0.842] to predict post-MI in-hospital HF as LVEF (AUC 0.735, 95% CI 0.640-0.830). The GLS cutoff of −11.45% achieved a sensitivity of 71.8% and a specificity of 70.5% for prediction of in-hospital CHF. Multivariate logistic regression analysis showed that GLS, RVSP, and hs-CRP were independent predictors of in-hospital HF and GLS was the most powerful predictor [adjusted OR 1.306, 95% CI 1.113-1.532, P = .001] (Table 1). Patients with post-discharge HF were older and showed poorer GLS, LSant, and LVEF, higher E/E' ratio, and more severe MR than those without HF. In multivariate logistic regression analysis, age and LSant were independent predictors of post-discharge HF even if GLS didn't show statistical significance (Table 1). Conclusion: GLS is an independent predictor of HF following anterior wall STEMI, especially HF during index hospitalization. LSant can be a predictor of postdischarge HF instead of GLS.

Research paper thumbnail of Intraindividual validation of ventricular volume measurement by aortic and pulmonary arterial flow measurements in routine clinical cardiovascular magnetic resonance of congenital heart disease

Progress in Pediatric Cardiology, 2016

Abstract Introduction To validate right and left ventricular stroke volume (RVSV & LVSV) meas... more Abstract Introduction To validate right and left ventricular stroke volume (RVSV & LVSV) measurements by forward flow stroke volume from aortic (AoSV) and pulmonary arterial (MPASV) measurements during routine cardiovascular magnetic resonance (CMR) in congenital heart disease (CHD). Methods Retrospectively studied CMR of 147 consecutive patients (median age 22years, range 0.5–64years) with CHD. Patients with ventricular septal defects, mitral valve regurgitation or severe tricuspid-valve-regurgitation were excluded. 126 LVSV were compared to the AoSV. 99 RVSV were compared to the MPASV. Ventricular SV was determined using a routine standard stack of cine axial slices. Arterial forward flow SV was determined using a routine standard phase-velocity quantitative flow sequence. Results AoSV correlated with LVSV by (r 2 =0.9, p 2 =0.8, p Conclusion Measured ventricular SV correlates closely with SV, assessed by CMR flow measurement in the originating great artery in CMR of CHD.

Research paper thumbnail of Cardiovascular magnetic resonance is successfully feasible in many patients aged 3 to 8years without general anesthesia or sedation

Journal of Clinical Anesthesia, 2016

Patients younger than 8 years are usually examined by cardiovascular magnetic resonance (CMR) und... more Patients younger than 8 years are usually examined by cardiovascular magnetic resonance (CMR) under general anesthesia (GA) or sedation without intubation. Therefore, we sought to study the feasibility of CMR in patients aged 3 to 8years without GA or sedation. Data sets of 71 consecutive patients aged 3 to 8years were studied retrospectively. The total cohort was divided into 2 groups: a no-GA or sedation without intubation group (no-GA or sedation) and a GA or sedation without intubation group (GA or sedation). The patients&amp;amp;#39; age, scan durations for each group, successfully answered clinical question, and number of sequences per study were compared between both groups. Scan duration in the no-GA or sedation group (n=44) was 35± 20minutes, and that in the GA or sedation group (n=27) was 60± 31minutes (P&amp;amp;lt;.001). The percentage of successful reports was 95% (42/44) in the no-GA or sedation group and 89% (24 of 27) in the GA or sedation group (P=.29). CMR in patients aged 3 to 8years is usually successfully feasible without GA or sedation.

Research paper thumbnail of Assessment of segmental agreement of T2 mapping versus triple inversion recovery in detection of acute myocardial edema

Egyptian Journal of Radiology and Nuclear Medicine

Background There are some limitations using the different sequences of clinical cardiac magnetic ... more Background There are some limitations using the different sequences of clinical cardiac magnetic resonance (cardiac MR) in detection of edema in patients presenting with acute myocardial injury. The purpose of this study is to evaluate the myocardial segmental agreement between the different edema sequences: T2 mapping and turbo inversion recovery magnitude (TIRM) in detection of acute myocardial edema. Results Thirty-seven patients presented with acute infarction were sent to cardiac MR to assess myocardial edema. All cardiac MR studies were scanned using cine, TIRM, and late gadolinium enhancement (LGE) in short axis views (SAX). Position of the T2 mapping slices were copied from the TIRM. The left ventricle (LV) was divided into apical, mid, and basal segments per visualization of the papillary muscles. Edema mass was assessed separately in each segment as well as the total edema mass in both the TIRM and T2 mapping. Twenty-four patients of whom 12.5% had multi-territorial corona...

Research paper thumbnail of Revisiting the pathogenic role of insulin resistance in Duchenne muscular dystrophy cardiomyopathy subphenotypes

Cardiovascular Endocrinology & Metabolism

Introduction Duchenne muscular dystrophy (DMD) is known to impact the subepicardial layer of the ... more Introduction Duchenne muscular dystrophy (DMD) is known to impact the subepicardial layer of the myocardium through chronic inflammation. Recent animal studies have shown predominant subendocardial involvement in rats with DMD. The primary outcome parameter was to determine by cardiovascular MRI (CMR) if two differential patterns of myocardial involvements exist in DMD; the secondary outcome parameters were to correlate the observed pattern with metabolic markers such as insulin resistance measures. Methods Forty patients with DMD were screened using CMR to determine which of them had predominantly subendocardial dysfunction (SENDO group), or subepicardial/midmyocardial involvement (SEPMI group). Patients were subjected to body mass index measurement, serum creatinine kinase, serum lactate dehydrogenase enzyme, fasting glucose-insulin ratio (FGIR), full lipid profile, left ventricular ejection fraction (LVEF), left ventricle E/E´ ratio (the ratio of early mitral inflow velocity to average early diastolic velocities of the basal septum and mitral annulus) for left ventricle diastolic function, and myocardial layer strain discriminating echocardiography (MLSD-STE). Results: 26 patients displayed SENDO while 34 displayed SEPMI. SENDO group displayed overt insulin resistance; (FGIR (SENDO: 7 ± 1 vs. SEPMI: 5 ± 1, P < 0.001). FGIR was negatively correlated with Subendocardial Global Longitudinal Strain (ENDO-LS) with r = −0.75. Conclusion DMD does not seem to influence the heart uniformly; DMD cardiomyopathy probably has two separate phenotypes with different mechanisms. Insulin resistance might be implicated in its pathogenesis and its reversal may help to slow disease progression.

Research paper thumbnail of CMR is fast and feasible in patients aged 3 to 8 years without general anesthesia or sedation

Research paper thumbnail of Cardiac MRI T1 mapping and extracellular volume application in hypertrophic cardiomyopathy

Egyptian Journal of Radiology and Nuclear Medicine, 2021

Background Hypertrophic cardiomyopathy (HCM) is one of the commonest inheritable cardiac disorder... more Background Hypertrophic cardiomyopathy (HCM) is one of the commonest inheritable cardiac disorders. Being a global disease with diffuse myocardial fibrosis, it has a wide range of adverse outcomes ending with sudden cardiac death. Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) has become a reference standard for visualization of focal myocardial fibrosis. In the setting of less severe or more diffuse fibrosis, LGE is unlikely to reveal the presence of abnormal tissue given the lack of normal myocardium as a reference. Direct measurement of myocardial T1 time (T1 mapping) may improve these methodologic problems of LGE CMR in the setting of diffuse retention of gadolinium-based contrast material. So, we aim at this study to evaluate the clinical application of CMRI native and post-contrast T1 relaxation in assessing diffuse myocardial fibrosis non-invasively in hypertrophic cardiomyopathy. Results There was a significant difference between the percent of fibro...

Research paper thumbnail of The Egyptian Collaborative Cardiac Genomics (ECCO-GEN) Project: defining a healthy volunteer cohort

npj Genomic Medicine

The integration of comprehensive genomic and phenotypic data from diverse ethnic populations offe... more The integration of comprehensive genomic and phenotypic data from diverse ethnic populations offers unprecedented opportunities toward advancements in precision medicine and novel diagnostic technologies. Current reference genomic databases are not representative of the global human population, making variant interpretation challenging, especially in underrepresented populations, such as the North African population. To address this, the Egyptian Collaborative Cardiac Genomics (ECCO-GEN) Project launched a study comprising 1000 individuals free of cardiovascular disease (CVD). Here, we present the first 391 Egyptian healthy volunteers recruited to establish a pilot phenotyped control cohort. All individuals underwent detailed clinical investigation, including cardiac magnetic resonance imaging (MRI), and were sequenced using a targeted panel of 174 genes with reported roles in inherited cardiac conditions. We identified 1262 variants in 27 cardiomyopathy genes of which 15.1% were no...

Research paper thumbnail of Assessment of aortic annulus dimensions for transcatheter aortic valve replacement (TAVR) with high-pitch dual-source CT: Comparison of systolic high-pitch vs. multiphasic data acquisition

European Journal of Radiology

Research paper thumbnail of Intraindividual validation of 4D flow measurement against 2D flow measurements in complex flow patterns in routine clinical cardiovascular magnetic resonance of bicuspid aortic valve

Egyptian Journal of Radiology and Nuclear Medicine

Background Comparing four-dimensional flow against two-dimensional flow measurements in patients ... more Background Comparing four-dimensional flow against two-dimensional flow measurements in patients with complex flow pattern is still lacking. This study aimed to compare four-dimensional against the two-dimensional flow measurement in patients with bicuspid aortic valve and to test potentials of four-dimensional operator-dependent sources of error. Results The two- and four-dimensional flow data sets of sixteen patients with bicuspid aortic valve and eighteen healthy subjects were studied. Flow analyses were performed by two observers blindly. Patients with bicuspid aortic valve mean differences between the two- and four-dimensional measurements in both observers were − 8 and − 4 ml, respectively. Four-dimensional measurements resulted in systematically higher flow values than the two-dimensional flow in bicuspid aortic valve patients. The upper and lower limits of agreement between the two- and four-dimensional measurements by both observers were + 12/− 28 ml and + 14/− 21 ml, respe...

Research paper thumbnail of Congenital biscuspid aortic valve in pediatric and early adults: Does valvular phenotype affect other parameters?

The Egyptian Journal of Radiology and Nuclear Medicine

Abstract Aim of the study Our study is a prospective study aiming to assess congenital bicuspid a... more Abstract Aim of the study Our study is a prospective study aiming to assess congenital bicuspid aortic valve using cardiac MRI and to detect a relationship between the leaflet fusion pattern and other functional parameters including valvular regurge, stenosis and pressure gradient. Patients and methods This prospective study included 114 cases 104 of them had bicuspid aortic valve, diagnosed by echocardiography while the rest (10 cases) were normal control cases. All functional and morphological cardiovascular abnormalities were recorded as well as any associated congenital diseases. Two different radiologists read the MRI blindly to each other. Results Patients age ranged from 40 days up to 20 years with 62 patients being in the pediatric age group ( We found 54 cases (53.8%) of 1-RL morphology, 34 cases (32.7%) of 1-RN morphology, 8 cases (7.7%) of 0-AP and 6 cases (5.8%) of 0-Lateral. Aortic stenosis and regurgitation were found in 80.75% of cases. Aortic stenosis was the most common valvular lesion being more evident in the 1-RN valve type. Aortic regurge was more predominant in the pediatric age group with no predilection for a specific valve phenotype. Left ventricular function was normal in most of our cases with only 10 cases showing impairment due to long standing valvular lesion. Thirty-eight cases (36.5%) had associated aortic dilatation. Twenty-six patients (25%) showed associated aortic coarctation. Intra cardiac shunts (24 patients 23%) were the second most common associated anomaly after coarctation. Most of the associated congenital anomalies were found with the 1-RL valve morphology type. Other associated congenital anomalies were detected in 44 patients (42.3%). Conclusion Cardiac Magnetic resonance should be performed for patients with bicuspid aortic valve to determine the valve phenotype, function and aortopathy for risk stratification and surgical management. Patients with RL type should be properly imaged to detect associated congenital anomalies.

Research paper thumbnail of Mid-term follow-up of pulmonary regurgitation in repaired asymptomatic TOF patients by transannular patch: A prospective cardiac MRI study

The Egyptian Journal of Radiology and Nuclear Medicine

The long-term outcome of Tetralogy of Fallot (TOF) surgical repair in developing countries is sti... more The long-term outcome of Tetralogy of Fallot (TOF) surgical repair in developing countries is still unknown. Therefore the aim of the study was the quantification of pulmonary regurgitation (PR) and right ventricular functions using cardiac magnetic resonance (CMR) in order to follow up midterm post transannular patch repair of asymptomatic TOF patients. Methods: We prospectively studied 37 asymptomatic corrected TOF patients (aged 18 years or less), aged at surgery was of median, min/max of (19, 8/48 months). Cardiac functions were assessed using routine steady state free precession techniques. PR quantification was performed using the routine velocity encoding phase contrast in the main pulmonary artery. Results: Four patients had mild PR, 26 had moderate PR and seven had severe PR, with a median value of PR% in CMR amounting to 29% (max: 75% and min: 13%). Indexed right ventricle enddiastolic volume amounted to (mean ± SD) 130 ± 38 ml, and indexed right ventricle end-systolic volume amounted to 63 ± 26 ml. Conclusion: Accurate quantitative assessment of PR in the mid and long-term course of TOF patients is paramount. CMR has to be introduced as a new modality in Egypt in the follow up course of asymptomatic TOF patients.

Research paper thumbnail of Relation between fragmented QRS complex to the right ventricular volumes and fraction of pulmonary regurgitation in patients with repaired tetralogy of Fallot

Progress in Pediatric Cardiology

Abstract Patients with repaired tetralogy of Fallot (TOF) have not uncommonly fragmented QRS comp... more Abstract Patients with repaired tetralogy of Fallot (TOF) have not uncommonly fragmented QRS complexes (fQRS) on surface electrocardiogram. We suggested that the right heart hemodynamics might be correlated with both the number of leads showing fQRS (fQRS extent) and the QRS duration. A retrospective analysis of the magnetic resonance imaging (MRI) derived data of 30 patients following total correction of TOF was performed. The number of leads showing fragmentation (fQRS extent) as well as the QRS duration were assessed and tested for correlation with the right ventricular volumes and severity of pulmonary regurgitation (PR) as detected by MRI. Twenty-one patients had fQRS in at least 2 consecutive leads. fQRS correlated with larger right ventricular volumes and lower ejection fraction. fQRS in 5 leads was an accurate parameter in identifying an indexed right ventricular end diastolic volume >150 ml/m2 with a sensitivity of 87.5% and a specificity of 85.7%. Moreover, it was the most accurate parameter in detecting a PR fraction > 45%. To conclude, assessment of fQRS extent and duration is a simple, available, and an accurate parameter in identifying patients with significant right ventricular hemodynamic changes in repaired TOF patients.

Research paper thumbnail of Emergency Repair of a Perforated Mycotic Aneurysm with a Self-made Pericardial Tube-graft

The Thoracic and Cardiovascular Surgeon Reports

A 63-year-old female with a history of kidney transplantation was admitted for emergency repair o... more A 63-year-old female with a history of kidney transplantation was admitted for emergency repair of a perforated mycotic aneurysm of the right subclavian artery (RSA) in combination with a paravertebral and posterior mediastinal abscess. After resection of the aneurysm and after radical local debridement, orthotopic repair was performed with a self-made pericardial tube graft from the brachiocephalic bifurcation to the thoracic outlet. The paravertebral and posterior mediastinal abscess was drained. The postoperative course was uneventful. Using a self-made readily available pericardial neo-tube enlarges the armamentarium of handling complex infective surgical scenarios and presents a smart alternative to alloplastic vascular reconstruction.

Research paper thumbnail of Can myocardial remodeling be a useful surrogate predictor of myocardial iron load? A 3D echocardiographic multicentric study

Pediatric blood & cancer, Jan 6, 2018

The relationship between myocardial iron load and eccentric myocardial remodeling remains an unde... more The relationship between myocardial iron load and eccentric myocardial remodeling remains an under-investigated area; it was thought that remodeling is rather linked to fibrosis. This study aims to determine whether or not measures of remodeling can be used as predictors of myocardial iron. For this purpose, 60 patients with thalassemia were studied with 3D echocardiography and myocardial relaxometry (T2*) by Cardiac MRI. 3D derived sphericity index was significantly higher in patients with myocardial iron load. It was correlated with T2* with a 100% sensitivity and specificity (cut-off value of 0.34) to discriminate between patients with and without myocardial iron overload.

Research paper thumbnail of Pacemaker-led complication mimicking a Type A aortic dissection

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2018

Research paper thumbnail of CMRI morphological and functional changes of the heart in myocarditis and dilated cardiomyopathy in acute pediatric heart failure

Journal of Cardiovascular Magnetic Resonance

Background Our purpose is to find morphological and functional changes of the heart in acute hear... more Background Our purpose is to find morphological and functional changes of the heart in acute heart failure presentation using cardiac magnetic resonance (CMRI) in pediatric group in order to differentiate between dilated cardiomyopathy (DCM) and myocarditis as a cause of acute heart failure.

Research paper thumbnail of PLATFORM at 90 days: Evaluating the clinical utility of FFRCT

Global Cardiology Science and Practice

The advancement that took place in assessing fractional flow reserve (FFR) using various competin... more The advancement that took place in assessing fractional flow reserve (FFR) using various competing modalities led to numerous research trials to evaluate the clinical impact of each. Among those trials is the recently published PLATFORM study. The data was designed to compare two clinical scenarios; a combination of computed fluid dynamics with computed tomographic angiography (CTA-guided strategy) in non-obstructive coronary artery disease (CAD) on one arm, compared to the standard practice representing the other clinical arm. The study’s results were evaluated for further evidence and clinical insights.

Research paper thumbnail of Congenital biscuspid aortic valve in pediatric and early adulthood: Is there a relationship between the valvular leaflet fusion pattern and other functional parameters

Journal of Cardiovascular Magnetic Resonance, 2016

Research paper thumbnail of Delayed Myocardial Enhancement in Pediatric Hypertrophic Cardiomyopathy: Correlation with LV Function, Echocardiography, and Demographic Parameters

Pediatric Cardiology, 2017

Our aim was (1) to detect the presence of fibrosis by Cardiac magnetic resonance imaging (CMR) in... more Our aim was (1) to detect the presence of fibrosis by Cardiac magnetic resonance imaging (CMR) in the pediatric age group. (2) Correlate CMR findings with demographic data, LV function, and other echocardiographic parameters. We studied 40 pediatric patients diagnosed as HCM by echocardiography. All patients were subjected to clinical examination (in which the NYHA classification was determined for each patient), echocardiography, and CMR. CMR was done on a 1.5T Philips Achieva scanner in SSFP with delayed myocardial enhancement (DE-MRI). All demographic and functional parameters as well as pressure gradient across left ventricular outflow tract (LVOT) were correlated with the percentage of myocardial enhancement. We studied 13 female and 27 male patients from 45 days up to 18 years. The mean percentage of DE-MRI was 9.7 ± 9%. We found significant correlation between the NYHA classification and the pressure gradient across the LVOT (P = &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) as well as the percentage of DE-MRI (P = 0.004). The percentage of DE-MRI showed positive correlation with LV myocardial mass index (P = 0.042). It didn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;t correlate with any other demographic or LV functional cardiac parameters. A good positive correlation was detected between the percentage of DE-MRI and the severity of pressure gradient across LVOT measured by echocardiography (r = 0.69 and P = &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). We found a significant correlation between the percentage of DE-MRI in children with HCM and the pressure gradient across LVOT, NYHA classification, and LV myocardial mass. This may help in the further management of those patients, planning for follow-up, and prognosis of the disease.

Research paper thumbnail of Inert Gas Rebreathing for Non-Invasive Quantification of Cardiac Output: Validation Against Cardiac Catheterization and Magnetic Resonance Imaging

Journal of Cardiac Failure, 2016

three-vessel disease, less frequent post-PCI TIMI grade 3 flow, and higher level of hs-CRP than t... more three-vessel disease, less frequent post-PCI TIMI grade 3 flow, and higher level of hs-CRP than those without HF. GLS was as accurate [area under the ROC curve (AUC) 0.753, 95% CI 0.665-0.842] to predict post-MI in-hospital HF as LVEF (AUC 0.735, 95% CI 0.640-0.830). The GLS cutoff of −11.45% achieved a sensitivity of 71.8% and a specificity of 70.5% for prediction of in-hospital CHF. Multivariate logistic regression analysis showed that GLS, RVSP, and hs-CRP were independent predictors of in-hospital HF and GLS was the most powerful predictor [adjusted OR 1.306, 95% CI 1.113-1.532, P = .001] (Table 1). Patients with post-discharge HF were older and showed poorer GLS, LSant, and LVEF, higher E/E' ratio, and more severe MR than those without HF. In multivariate logistic regression analysis, age and LSant were independent predictors of post-discharge HF even if GLS didn't show statistical significance (Table 1). Conclusion: GLS is an independent predictor of HF following anterior wall STEMI, especially HF during index hospitalization. LSant can be a predictor of postdischarge HF instead of GLS.

Research paper thumbnail of Intraindividual validation of ventricular volume measurement by aortic and pulmonary arterial flow measurements in routine clinical cardiovascular magnetic resonance of congenital heart disease

Progress in Pediatric Cardiology, 2016

Abstract Introduction To validate right and left ventricular stroke volume (RVSV & LVSV) meas... more Abstract Introduction To validate right and left ventricular stroke volume (RVSV & LVSV) measurements by forward flow stroke volume from aortic (AoSV) and pulmonary arterial (MPASV) measurements during routine cardiovascular magnetic resonance (CMR) in congenital heart disease (CHD). Methods Retrospectively studied CMR of 147 consecutive patients (median age 22years, range 0.5–64years) with CHD. Patients with ventricular septal defects, mitral valve regurgitation or severe tricuspid-valve-regurgitation were excluded. 126 LVSV were compared to the AoSV. 99 RVSV were compared to the MPASV. Ventricular SV was determined using a routine standard stack of cine axial slices. Arterial forward flow SV was determined using a routine standard phase-velocity quantitative flow sequence. Results AoSV correlated with LVSV by (r 2 =0.9, p 2 =0.8, p Conclusion Measured ventricular SV correlates closely with SV, assessed by CMR flow measurement in the originating great artery in CMR of CHD.

Research paper thumbnail of Cardiovascular magnetic resonance is successfully feasible in many patients aged 3 to 8years without general anesthesia or sedation

Journal of Clinical Anesthesia, 2016

Patients younger than 8 years are usually examined by cardiovascular magnetic resonance (CMR) und... more Patients younger than 8 years are usually examined by cardiovascular magnetic resonance (CMR) under general anesthesia (GA) or sedation without intubation. Therefore, we sought to study the feasibility of CMR in patients aged 3 to 8years without GA or sedation. Data sets of 71 consecutive patients aged 3 to 8years were studied retrospectively. The total cohort was divided into 2 groups: a no-GA or sedation without intubation group (no-GA or sedation) and a GA or sedation without intubation group (GA or sedation). The patients&amp;amp;#39; age, scan durations for each group, successfully answered clinical question, and number of sequences per study were compared between both groups. Scan duration in the no-GA or sedation group (n=44) was 35± 20minutes, and that in the GA or sedation group (n=27) was 60± 31minutes (P&amp;amp;lt;.001). The percentage of successful reports was 95% (42/44) in the no-GA or sedation group and 89% (24 of 27) in the GA or sedation group (P=.29). CMR in patients aged 3 to 8years is usually successfully feasible without GA or sedation.