Hany Eteiba - Academia.edu (original) (raw)

Papers by Hany Eteiba

This prospective observational study aimed to assess the impact of employment status and deprivat... more This prospective observational study aimed to assess the impact of employment status and deprivation on quality of life 12 months after percutaneous coronary intervention (PCI). Patients completed a questionnaire at baseline and at 1 year follow-up including a health utility score (EQ-5D), symptoms and employment status. Deprivation was assessed using the Carstairs' deprivation category based on area postcodes. The majority (79.6%) of patients of working age returned to work within 12 months. Unemployment was associated with a lower quality of life (QoL) at baseline (0.49 (0.32) vs 0.61 (0.27), p=0.002) and less improvement in QoL 1 year after PCI (0.15 (0.37) vs 0.26 (0.31), pb0.012). Furthermore, unemployed patients had significantly less improvement in chest pain score (p=0.002) and breathlessness (pb0.001). Unemployed patients from the most deprived areas had lowest QoL at follow-up and least improvement in QoL at 1 year. Unemployment and deprivation are associated with poor...

International Journal of Cardiology, 2017

Persistence or recurrence of angina after successful percutaneous coronary intervention (PCI) rep... more Persistence or recurrence of angina after successful percutaneous coronary intervention (PCI) represent an important clinical issue involving from one fifth to one third of patients undergoing myocardial revascularization at one-year follow-up. A systematic approach to this syndrome is strongly needed. Precision medicine is particularly important in addressing angina after successful PCI because of the multiple underlying causes. Restenosis or coronary atherosclerosis progression explain symptom recurrence after successful PCI in some patients, while functional causes, including vasomotor abnormalities of epicardial coronary arteries and/or coronary microvascular dysfunction, explain symptoms in the remaining patients. In this review, we summarize the mechanisms of persistent or recurrent angina after PCI, proposing a diagnostic algorithm and a systematic therapeutic approach.

MD Conference Express, 2011

Radiology, Feb 1, 2019

To investigate the prognostic value of circumferential left ventricular (LV) strain measured by u... more To investigate the prognostic value of circumferential left ventricular (LV) strain measured by using cardiac MRI for prediction of major adverse cardiac events (MACE) following an acute ST-segment-elevation myocardial infarction (STEMI). Materials and Methods: Participants with acute STEMI were prospectively enrolled from May 11, 2011, to November 22, 2012. Cardiac MRI was performed at 1.5 T during the index hospitalization. Displacement encoding with stimulated echoes (DENSE) and feature tracking of cine cardiac MRI was used to assess circumferential LV strain. MACE that occurred after discharge were independently assessed by cardiologists blinded to the baseline observations. Results: A total of 259 participants (mean age, 58 years 6 11 [standard deviation]; 198 men [mean age, 58 years 6 11] and 61 women [mean age, 58 years 6 12]) underwent cardiac MRI 2.2 days 6 1.9 after STEMI. Average infarct size was 18% 6 13 of LV mass and circumferential strain was 213% 6 3 (DENSE method) and 224% 6 7 (feature-tracking method). Fifty-one percent (131 of 259 participants) had presence of microvascular obstruction. During a median follow-up period of 4 years, 8% (21 of 259) experienced MACE. Area under the curve (AUC) for DENSE was different from that of feature tracking (AUC, 0.76 vs 0.62; P = .03). AUC for DENSE was similar to that of initial infarct size (P = .06) and extent of microvascular obstruction (P = .08). DENSEderived strain provided incremental prognostic benefit over infarct size for prediction of MACE (hazard ratio, 1.3; P , .01). Conclusion: Circumferential strain has independent prognostic importance in study participants with acute ST-segment-elevation myocardial infarction. Published under a CC BY 4.0 license.

International Journal of Cardiology, Aug 1, 2021

Aim: Coronary angiography is indicated in many patients with known or suspected angina for the in... more Aim: Coronary angiography is indicated in many patients with known or suspected angina for the investigation of coronary artery disease (CAD). However, up to half of patients with symptoms of ischaemia have no obstructive coronary arteries (INOCA). This large subgroup includes patients with suspected microvascular angina (MVA) and/or vasospastic angina (VSA). Clinical guidelines relating to the management of patients with INOCA are limited. Uncertainty regarding the diagnosis of patients with INOCA presents a health economic challenge, both in terms of healthcare resource utilisation and of quality-of-life impact on patients. Methods: A cost-effectiveness analysis of the introduction of stratified medicine into the invasive management of INOCA, based on clinical and resource-use data obtained in the CorMicA trial, from a UK NHS perspective. The intervention included an invasive diagnostic procedure (IDP) of coronary vascular function during coronary angiography to define clinical endotypes to target with linked medical therapy. Outcomes of interest were mean total cost and QALY gain between treatment groups, and the incremental cost-effectiveness ratio. We undertook probabilistic sensitivity and scenario analyses. Results: The incremental cost per QALY gained at 12 months was £4500 (£2937, £33264). Compared with a willingness-to-pay (WTP) threshold of £20,000 per QALY, the use of the IDP test is cost-effective. At this WTP threshold there is a 96% probability of the IDP being cost-effective, based on the uncertainty described by bootstrap analysis. Conclusions: The burden of INOCA, particularly in women, is known to be significant. These findings provided new evidence to inform this unmet clinical need.

Heart, Apr 1, 2015

Background Displacement encoding with stimulated echoes (DENSE) encodes myocardial tissue displac... more Background Displacement encoding with stimulated echoes (DENSE) encodes myocardial tissue displacement into the phase of the MRI image, thus allowing direct quantification of myocardial displacement at multiple cardiac phases. Strain-encoded CMR with DENSE has high spatial (3.2 × 3.2 × 8 mm) and temporal resolution (32.5 ms phase). We aimed to measure myocardial strain values with DENSE in healthy adults across a broad age range at 1.5 Tesla. Methods Healthy volunteers with no prior medical history (including cardiovascular health problems or medication) were enrolled and underwent CMR at 1.5T (Magnetom Avanto, Siemens Healthcare, Erlangen, Germany). Mid-left ventricular short axis and horizontal long axis DENSE sequences were

$Research paper thumbnail of Percutaneous coronary intervention versus medical therapy in patients with angina and grey-zone fractional flow reserve values: a randomised clinical trial$

International Journal of Cardiology, Oct 1, 2013

F emale, 18-year-old, monozygotic twins, had cardiac evaluations as a result of the suspicion of ... more F emale, 18-year-old, monozygotic twins, had cardiac evaluations as a result of the suspicion of hypertrophic cardiomyopathy (HCM). Each was asymptomatic with active normal lifestyle. Both twins had normal 2-dimensional echocardiograms, which did not identify wall thickening in any segment of the left ventricular (LV) chamber (Figure). Mild systolic anterior motion of the mitral valve (associated with normal LV outflow tract velocities) and mitral regurgitation were present in both patients. LV end-diastolic cavity dimensions (40 and 34 mm, respectively) and left atrial dimension (20 and 28 mm, respectively) were similar. In each twin, 12-lead ECGs were abnormal but showed different patterns. Twin 1 had minor ST-T abnormalities and Twin 2 showed distinctively deep and narrow Q-waves in leads II, III, AVF, and V4-V6 (Figure). Of note, cardiac magnetic resonance (CMR) imaging identified a virtually identical pattern of asymmetric LV wall thickening confined to the anterior free wall, undetected by echocardiography and measured at 16 mm in both twins (Figure). Therefore, because CMR imaging is more reliable than echocardiography in the definition of wall thickness in the anterolateral LV free wall, 1 only CMR imaging permitted recognition of LV hypertrophy (ie, the HCM phenotype) and ultimately the correct diagnosis in these twins.

Journal of the American College of Cardiology, Oct 1, 2019

MD conference express, Jun 1, 2015

European Heart Journal, Jan 23, 2020

Aims Endothelin-1 (ET-1) is a potent vasoconstrictor peptide linked to vascular diseases through ... more Aims Endothelin-1 (ET-1) is a potent vasoconstrictor peptide linked to vascular diseases through a common intronic gene enhancer [(rs9349379-G allele), chromosome 6 (PHACTR1/EDN1)]. We performed a multimodality investigation into the role of ET-1 and this gene variant in the pathogenesis of coronary microvascular dysfunction (CMD) in patients with symptoms and/or signs of ischaemia but no obstructive coronary artery disease (CAD).

Minerva cardiology and angiology, May 1, 2022

BACKGROUND Intravascular lithotripsy (IVL) is a novel alternative to rotational atherectomy (RA) ... more BACKGROUND Intravascular lithotripsy (IVL) is a novel alternative to rotational atherectomy (RA) for the modification of heavily calcified coronary stenoses prior to percutaneous coronary intervention (PCI). We compare the real-world resource utilisation and associated costs of PCI with adjunctive RA and IVL. METHODS We compared the resource utilisation, in-lab consumable costs and procedural data of 120 patients who underwent PCI with IVL from the Disrupt-CAD II study (NCT03328949) to 60 patients who underwent PCI with RA at the Golden Jubilee National Hospital, Glasgow. The RA patients were consecutive and selected on the basis of being deemed suitable for IVL by an independent interventional cardiologist experienced in the use of both techniques. RESULTS PCI with IVL was associated with significantly lower costs than PCI with RA (mean difference £398 [95% CI, £181-£615]; p<0.001). Considering between-group differences, the IVL group used 4.02 fewer balloons (p<0.001), 3.03 fewer guidewires (p<0.001), 0.52 fewer guide catheters (p=0.001), 0.22 fewer guide extensions (p=0.004) and 1.03 fewer drug eluting stents (DES) (p<0.001) per case than the RA group. The IVL group had shorter procedural duration (mean difference 13.3 min [95% CI, 3.6-23.0]; p=0.008) but longer fluoroscopy times (mean difference 4.4 min [95% CI, 1.7-7.1]; p=0.002). CONCLUSIONS In this indirect comparison, we found that the higher initial device costs of IVL may be offset by a lower overall resource utilisation. Further research is required to confirm this, and future randomised trials should include a formal health economic analysis.

European Heart Journal, Aug 10, 2015

Aims To assess the prognostic significance of infarct core tissue characteristics using cardiac m... more Aims To assess the prognostic significance of infarct core tissue characteristics using cardiac magnetic resonance (CMR) imaging in survivors of acute ST-elevation myocardial infarction (STEMI). Methods and results We performed an observational prospective single centre cohort study in 300 reperfused STEMI patients (mean + SD age 59 + 12 years, 74% male) who underwent CMR 2 days and 6 months post-myocardial infarction (n ¼ 267). Native T1 was measured in myocardial regions of interest (n ¼ 288). Adverse remodelling was defined as an increase in left ventricular (LV) end-diastolic volume ≥20% at 6 months. All-cause death or first heart failure hospitalization was a pre-specified outcome that was assessed during follow-up (median duration 845 days). One hundred and sixty (56%) patients had a hypo-intense infarct core disclosed by native T1. In multivariable regression, infarct core native T1 was inversely associated with adverse remodelling [odds ratio (95% confidence interval (CI)] per 10 ms reduction in native T1: 0.91 (0.82, 0.00); P ¼ 0.061). Thirty (10.4%) of 288 patients died or experienced a heart failure event and 13 of these events occurred post-discharge. Native T1 values (ms) within the hypo-intense infarct core (n ¼ 160 STEMI patients) were inversely associated with the risk of all-cause death or first hospitalization for heart failure post-discharge (for a 10 ms increase in native T1: hazard ratio 0.730, 95% CI 0.617, 0.863; P , 0.001) including after adjustment for left ventricular ejection fraction, infarct core T2 and myocardial haemorrhage. The prognostic results for microvascular obstruction were similar. Conclusion Infarct core native T1 represents a novel non-contrast CMR biomarker with potential for infarct characterization and prognostication in STEMI survivors. Confirmatory studies are warranted. ClinicalTrials.gov identifier NCT02072850.

Diagnostics

Assessing coronary physiology after stent implantation facilitates the optimisation of percutaneo... more Assessing coronary physiology after stent implantation facilitates the optimisation of percutaneous coronary intervention (PCI). Coronary artery disease (CAD) patterns can be characterised by the pullback pressure gradient (PPG) index. The impact of focal vs. diffuse disease on physiology-guided incremental optimisation strategy (PIOS) is unknown. This is a sub-study of the TARGET-FFR randomized clinical trial (NCT03259815). The study protocol directed that optimisation be attempted for patients in the PIOS arm when post-PCI FFR was <0.90. Overall, 114 patients (n = 61 PIOS and 53 controls) with both pre-PCI fractional flow reserve (FFR) pullbacks and post-PCI FFR were included. A PPG ≥ 0.74 defined focal CAD. The PPG correlated significantly with post-PCI FFR (r = 0.43; 95% CI 0.26 to 0.57; p-value < 0.001) and normalised delta FFR (r = 0.49; 95% CI 0.34 to 0.62; p-value < 0.001). PIOS was more frequently applied to vessels with diffuse CAD (6% focal vs. 42% diffuse; p-val...

Abstracts

Volcano Corporation which manufacture pressure wires. He is an employee of Biosensors Internation... more Volcano Corporation which manufacture pressure wires. He is an employee of Biosensors International. S.W. has worked as a consultant for Abbott Vascular. A.E.A. holds US government Cooperative Research and Development Agreements with Siemens, Bayer, and Circle CVI. A.E.A. and L.H. have pending patents and invention reports related to perfusion quantification. None of these companies have had any involvement with this study. None of the other authors have any potential conflicts of interest. Acknowledgements We thank the staff and patients who supported this study and the British Heart Foundation. Aims Patients with suspected ischaemic symptoms but no obstructive coronary arteries (INOCA), have uncertain management and suboptimal clinical outcomes. We prospectively investigated the associations between multiparametric CMR imaging, clinical endotypes, and health status, in patients with suspected INOCA. Methods and results Patients were assessed using functional coronary angiography including guidewire-based measurement of coronary flow reserve, index of microcirculatory resistance, and acetylcholine vasoreactivity testing. CMR imaging included native-T1 mapping, stress perfusion myocardial blood flow quantification, and late gadolinium enhancement. The primary outcome was the association between reduced myocardial perfusion reserve (MPR <2.0) and INOCA endotypes as classified by invasive coronary function testing. Patient reported outcome measures were recorded independent of the CMR findings. One hundred and fifty-one patients underwent functional coronary angiography, 124 underwent CMR, and 108(71% female, age 60±10 years) had complete data. The endotypes were: microvascular angina n=57(53%), vasospastic angina n=19(18%), mixed n=18(17%), non-cardiac chest pain n=14 (13%). MPR was associated with angina severity (0.03 unit increase in MPR per 10 unit increase in SAQ summary score, 95% confidence interval (CI) 0.00,0.07, p=0.048) and quality of life (0.04 unit increase in MPR per 0.1 unit increase in EQ-5D score, 95% CI 0.01,0.06, p=0.007). Reduced MPR occurred in 79(73%) patients. MBF did not discriminate between endotypes. Myocardial scar occurred in 10(9%) patients (n=5 myocardial infarction; n=5 non-ischaemic pattern). Conclusions MPR correlated with angina severity and healthrelated quality of life and reduced MPR and myocardial scar were prevalent. CMR appears to be diagnostically useful in symptomatic patients with no obstructive CAD.

Journal of the American Heart Association

Background The objective of the GNOCCI (Glasgow Natural History Study of Covered Stent Coronary I... more Background The objective of the GNOCCI (Glasgow Natural History Study of Covered Stent Coronary Interventions) Study was to report the incidence and outcomes of coronary artery perforations over an 18‐year period at a single, high‐volume percutaneous coronary intervention center. We considered both the temporal trends and long‐term outcomes of covered stent deployment. Methods and Results We evaluated procedural and long‐term clinical outcomes following coronary perforation in a cohort of 43,343 consecutive percutaneous coronary intervention procedures. Procedural major adverse cardiac events were defined as a composite of death, myocardial infarction, stroke, target vessel revascularization, or cardiac surgery within 24 hours. A total of 161 (0.37%) procedures were complicated by coronary perforation of which 57 (35%) were Ellis grade III. Incidence increased with time over the study period ( r =0.73; P <0.001). Perforation severity was linearly associated with procedural mortal...

Journal of the American College of Cardiology

JACC: Cardiovascular Imaging, 2022

This study compared the prognostic value of a noncontrast CMR risk score for the composite of all... more This study compared the prognostic value of a noncontrast CMR risk score for the composite of all-cause death, nonfatal myocardial infarction, and new congestive heart failure. A cardiovascular magnetic resonance (CMR) risk score including left ventricular ejection fraction (LVEF), myocardial infarct (MI) size, and microvascular obstruction (MVO) was recently proposed to risk-stratify patients with ST-segment elevation myocardial infarction (STEMI). The Eitel CMR risk score and GRACE (Global Registry of Acute Coronary Events) score were used as a reference (Score 1: acute MI size ≥19% LV, LVEF ≤47%, MVO >1.4% LV and GRACE score). MVO was replaced by intramyocardial hemorrhage (IMH) in Score 2 (acute MI size ≥19% LV, LVEF ≤47%, IMH, and GRACE score). Score 3 included only LVEF ≤45%, IMH, and GRACE score. There were 370 patients in the derivation cohort and 234 patients in the validation cohort. In the derivation cohort, the 3 scores performed similarly and better than GRACE score to predict the 1-year composite endpoint with C-statistics of 0.83, 0.83, 0.82, and 0.74, respectively. In the validation cohort, there was good discrimination and calibration of score 3, with a C-statistic of 0.87 and P = 0.71 in a Hosmer-Lemeshow test for goodness of fit, on the 1-year composite outcome. Kaplan-Meier curves for 5-year composite outcome showed that those with LVEF ≤45% (high-risk) and LVEF >45% and IMH (intermediate-risk) had significantly higher cumulative events than those with LVEF >45% and no IMH (low-risk), log-rank tests: P = 0.02 and P = 0.03, respectively. The HR for the high-risk group was 2.3 (95% CI: 1.1-4.7) and for the intermediate-risk group was 2.0 (95% CI: 1.0-3.8), and these remained significant after adjusting for the GRACE score. This noncontrast CMR risk score has performance comparable to an established risk score, and patients with STEMI could be stratified into low risk (LVEF >45% and no IMH), intermediate risk (LVEF >45% and IMH), and high risk (LVEF ≤45%). (A Trial of Low-dose Adjunctive alTeplase During prIMary PCI [T-TIME]; NCT02257294) (Detection and Significance of Heart Injury in ST Elevation Myocardial Infarction [BHF MR-MI]; NCT02072850).

$Research paper thumbnail of Post-stenting fractional flow reserve vs coronary angiography for optimization of percutaneous coronary intervention (TARGET-FFR)$

European Heart Journal, 2021

Aims A fractional flow reserve (FFR) value ≥0.90 after percutaneous coronary intervention (PCI) ... more Aims A fractional flow reserve (FFR) value ≥0.90 after percutaneous coronary intervention (PCI) is associated with a reduced risk of adverse cardiovascular events. TARGET-FFR is an investigator-initiated, single-centre, randomized controlled trial to determine the feasibility and efficacy of a post-PCI FFR-guided optimization strategy vs. standard coronary angiography in achieving final post-PCI FFR values ≥0.90. Methods and results After angiographically guided PCI, patients were randomized 1:1 to receive a physiology-guided incremental optimization strategy (PIOS) or a blinded coronary physiology assessment (control group). The primary outcome was the proportion of patients with a final post-PCI FFR ≥0.90. Final FFR ≤0.80 was a prioritized secondary outcome. A total of 260 patients were randomized (131 to PIOS, 129 to control) and 68.1% of patients had an initial post-PCI FFR <0.90. In the PIOS group, 30.5% underwent further intervention (stent post-dilation and/or additional...