Hazem M. Warda - Academia.edu (original) (raw)
Papers by Hazem M. Warda
QJM: An International Journal of Medicine, Dec 1, 2018
Journal of the American College of Cardiology
Journal of the American College of Cardiology
QJM: An International Journal of Medicine, 2018
Background: Coronary artery disease (CAD) is the leading cause of death among individuals with ty... more Background: Coronary artery disease (CAD) is the leading cause of death among individuals with type 2 diabetes (T2DM). T2DM accelerates atherosclerosis alongside classical risk factors such as dyslipidemia and hyperglycemia. This study aims to investigate the association of hyperglycemia and dyslipidemia with CAD in outpatients with T2DM undergoing coronary angiography. Methods: 100 individuals referred to coronary angiography were evaluated for glucose disturbances. After exclusion of those with pre-diabetes, 74 individuals with T2DM were studied for BMI, blood pressure, fasting plasma glucose, HbA1c, lipids, HOMA, Framingham risk score, number of clinically significant coronary lesions (stenosis > 50%). Results: Among T2DM subjects, those with CAD (n ¼ 56) had worse glycemic control (fasting glucose 162.36 69.8 vs. 143.4 6 48.9 mg/dL, p ¼ 0.004; HbA1c 8.03 þ 1.91 vs. 7.59 þ 1.55%, p ¼ 0.03), lower HDL (39.2 þ 13.2 vs. 44.4 þ 15.9 mg/dL, p ¼ 0.003), and higher triglycerides (140 [106-204] vs. 121 [78.5-184.25] mg/ dL, p ¼ 0.002), reached more often therapeutic goals for LDL (63.4% vs. 51.4%, p ¼ 0.037) and less often goals for HDL (26.6% vs. 37.3%, p ¼ 0.04), when compared to CAD-free individuals (n ¼ 18). In T2DM subjects HbA1c tertiles were associated with progressively higher number of significant coronary lesions (median number of lesions 2 [A1c < 6.8%]; 2.5 [A1c 6.8-8.2%]; 4 [A1c > 8.2%]; p ¼ 0.01 for trend). Conclusions: Classic risk factors such as glycemic control and lipid profile were associated with presence of CAD in T2DM subjects undergoing coronary angiography. Glycemic control is progressively associated with number and extent of coronary lesions in patients with T2DM.
Biochemistry & molecular biology journal, Mar 19, 2019
QJM: An International Journal of Medicine, 2018
In our study there was a significantly higher (p ¼ 0.019) total procedural time used in the radia... more In our study there was a significantly higher (p ¼ 0.019) total procedural time used in the radial group (33.50 6 9.04 versus 28.50 6 14.24), a significantly higher (p ¼ 0.005) fluoroscopy time used in the radial group (18.15 6 5.24 versus 13.30 6 5.09), a significant higher amount of dye used in the TRA vs TFA group (180.00 6 52.31 versus 155.00 6 45.59). Conclusion: The current study concluded that TRA is an effective and safe approach for the management of acute STEMI including over 55 years old patients, TRA shows less bleeding, less local vascular complications, less hospital stay and less costs than TFA if performed by experienced operators. Finally, femoral access doesn't increase morbidity and mortality, and is still needed in less experienced centers.
Journal of the American College of Cardiology, 2018
Background: The Combo stent is a drug eluting stent with abluminal sirolimus in a bioabsorbable p... more Background: The Combo stent is a drug eluting stent with abluminal sirolimus in a bioabsorbable polymer and luminal anti-CD34 for endothelial progenitor capture and rapid endothelialization. This property may permit shorter period of dual antiplatelet therapy (DAPT) in patients at high bleeding risk (HBR). We examined 1-year outcomes in patients with and without HBR from the MASCOT registry. Methods: MASCOT was a prospective all-comer study across 61 centers (n=2614) and patients were enrolled if Combo stent placement was attempted. DAPT was given per local guidelines and adherence monitored. Primary endpoint was 1-year target lesion failure (TLF), composite of cardiac death, non-fatal myocardial infarction (MI), or target lesion revascularization. Results: The study population included 66.0% patients (n=1714) with at least 1 HBR characteristic (Figure). Compared to non-HBR, HBR patients were older, with greater prevalence of heart failure, polyvascular atherosclerosis and acute MI presentation, whereas prevalence of diabetes and hypertension were lower. Procedurally stent length and diameter were similar between the groups. At 1-year, non-significant differences were noted in TLF, however major bleeding was significantly greater in HBR patients (Figure). Conclusion: In the MASCOT registry HBR patients treated with Combo DES had statistically non-significant differences in ischemic outcomes to non-HBR patients, a finding that needs to be confirmed in future randomized trials.
International Journal of Cardiology, 2008
Diabetes mellitus (DM) is a strong predictor of in-stent restenosis. This may be due to a higher ... more Diabetes mellitus (DM) is a strong predictor of in-stent restenosis. This may be due to a higher level of vascular inflammation. We hypothesized that diabetic patients will benefit from dexamethasone-eluting stents, since local inflammation and consequently neointimal growth are suppressed and no systemic side effects will occur. Methods: 21 consecutive patients with DM with 32 lesions were treated with dexamethasone-eluting stents. Excluded were patients with triple vessel disease, bifurcation lesions, previous revascularization of the culprit vessel, and reference diameter smaller than 2.5 or larger than 3.75 mm. MACE (death, myocardial infarction, and revascularization) was counted at 12 months. At 6 months, angiographic follow-up was performed. Results: Of the patients, 38% had insulin-dependent DM. Lesion type was type A/B1 in 56% and B2/C in 44%. Lesion length was 15.7 ± 8.4 mm and the reference diameter was 2.83 ± 0.53 mm. Event-free survival at 12 months was 62%. Any revascularization procedure was performed in 33% and target lesion revascularization in 24% of the patients. At 6 months in-stent late loss was 1.07 ± 0.64 mm. Binary restenosis occurred in 28.1% of the lesions. The event-free survival in insulin-dependent DM was worse compared to non-insulin-dependent DM (92.1 vs. 37.8%; p b 0.01). Patients with insulin-dependent DM had higher in-stent late loss compared to non-insulin-dependent DM patients (1.44 ± 0.83 vs. 0.83 ± 0.51 mm; p b 0.01). Conclusion: Treatment with dexamethasone-eluting stents in patients with DM is associated with a relatively high restenosis rate. Our data suggest a differential effect of dexamethasone-eluting stents in insulin-dependent compared to non-insulin-dependent DM.
Journal of the American College of Cardiology, 2021
Journal of Hypertension, 2018
of clinical outcomes, but systolic BPV and diastolic BPV did not predict clinical event. In survi... more of clinical outcomes, but systolic BPV and diastolic BPV did not predict clinical event. In survival analysis, there was also no association between systolic/ diastolic BPV and the composite clinical outcomes. Conclusions: In contrast with other clinical entity, these fi ndings suggest that visit-to-visit BPV is not associated with clinical outcomes in heart failure patients.
Journal of the Egyptian Society of Cardio-Thoracic Surgery, 2018
Background: Current surgical technique to fix the tricuspid valve regurgitation carry a high perc... more Background: Current surgical technique to fix the tricuspid valve regurgitation carry a high percentage (up to 37%) of recurrence of severe tricuspid valve regurgitation in mid-term follow up. There is a need for anatomically and physiologically correct Tricuspid annulus device. Our ring is developed in the way that mimics the normal anatomy & physiology of Tricuspid annulus. The aim of this study is to test three prototypes and choose the proper prototype that is tested and suitable to conform well to the normal shape of the tricuspid annulus with no distortion of the movement during the different phases of the cardiac cycle. Methods: We used an acute open heart model in sheep as an animal model to test three prototypes. We used adult sheep (6 males and 6 females), body weight 60e70 Kg, age: 1e3 years old. We followed the protocol of open heart model in animals. Results: Post Prototype implantation, Tricuspid valve leaflet coaptation was verified with no induced tricuspid regurgitation. On the other hand, there was no ring distortion or ring material fracture. All the three prototypes conformed well to the normal shape of the tricuspid annulus with no distortion of the movement during the different phases of the cardiac cycle (both in systole and diastole). Conclusions: All the three tested prototypes seemed to be effective and reproducible.
Journal of the American College of Cardiology, 2021
Journal of Hypertension, 2018
of clinical outcomes, but systolic BPV and diastolic BPV did not predict clinical event. In survi... more of clinical outcomes, but systolic BPV and diastolic BPV did not predict clinical event. In survival analysis, there was also no association between systolic/ diastolic BPV and the composite clinical outcomes. Conclusions: In contrast with other clinical entity, these fi ndings suggest that visit-to-visit BPV is not associated with clinical outcomes in heart failure patients.
Journal of the Egyptian Society of Cardio-Thoracic Surgery, 2018
Background: Current surgical technique to fix the tricuspid valve regurgitation carry a high perc... more Background: Current surgical technique to fix the tricuspid valve regurgitation carry a high percentage (up to 37%) of recurrence of severe tricuspid valve regurgitation in mid-term follow up. There is a need for anatomically and physiologically correct Tricuspid annulus device. Our ring is developed in the way that mimics the normal anatomy & physiology of Tricuspid annulus. The aim of this study is to test three prototypes and choose the proper prototype that is tested and suitable to conform well to the normal shape of the tricuspid annulus with no distortion of the movement during the different phases of the cardiac cycle. Methods: We used an acute open heart model in sheep as an animal model to test three prototypes. We used adult sheep (6 males and 6 females), body weight 60e70 Kg, age: 1e3 years old. We followed the protocol of open heart model in animals. Results: Post Prototype implantation, Tricuspid valve leaflet coaptation was verified with no induced tricuspid regurgitation. On the other hand, there was no ring distortion or ring material fracture. All the three prototypes conformed well to the normal shape of the tricuspid annulus with no distortion of the movement during the different phases of the cardiac cycle (both in systole and diastole). Conclusions: All the three tested prototypes seemed to be effective and reproducible.
![Research paper thumbnail of Corrigendum to “Dexamethasone-eluting stents for the prevention of in-stent restenosis: Evidence for a differential effect in insulin-dependent and non-insulin-dependent diabetic patients” [Int. J. Cardiol. 124 (2008) 166–171]](https://attachments.academia-assets.com/88127252/thumbnails/1.jpg)
](International Journal of Cardiology, 2019
![Research paper thumbnail of Corrigendum to “Dexamethasone-eluting stents for the prevention of in-stent restenosis: Evidence for a differential effect in insulin-dependent and non-insulin-dependent diabetic patients” [Int. J. Cardiol. 124 (2008) 166–171]](https://attachments.academia-assets.com/88127212/thumbnails/1.jpg)
](International Journal of Cardiology, 2019
Journal of the American College of Cardiology, 2021
The COMBO biodegradable polymer sirolimus-eluting stent includes endothelial progenitor cell capt... more The COMBO biodegradable polymer sirolimus-eluting stent includes endothelial progenitor cell capture (EPC) technology for rapid endothelialization, which may offer advantage in acute coronary syndromes (ACS). We sought to analyze the performance of the COMBO stent by ACS status and ACS subtype. The COMBO collaboration (n = 3614) is a patient-level pooled dataset from the MASCOT and REMEDEE registries. We evaluated outcomes by ACS status, and ACS subtype in patients with ST segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) versus unstable angina (UA). The primary endpoint was 1-year target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. Secondary outcomes included stent thrombosis (ST). We compared 1965 (54%) ACS and 1649 (46.0%) non-ACS patients. ACS presentations included 40% (n = 789) STEMI, 31% (n = 600) NSTEMI, and 29% (n = 576) UA patients. Risk of 1-year TLF was gre...
The American Journal of Cardiology
International Journal of Cardiology
QJM: An International Journal of Medicine, Dec 1, 2018
Journal of the American College of Cardiology
Journal of the American College of Cardiology
QJM: An International Journal of Medicine, 2018
Background: Coronary artery disease (CAD) is the leading cause of death among individuals with ty... more Background: Coronary artery disease (CAD) is the leading cause of death among individuals with type 2 diabetes (T2DM). T2DM accelerates atherosclerosis alongside classical risk factors such as dyslipidemia and hyperglycemia. This study aims to investigate the association of hyperglycemia and dyslipidemia with CAD in outpatients with T2DM undergoing coronary angiography. Methods: 100 individuals referred to coronary angiography were evaluated for glucose disturbances. After exclusion of those with pre-diabetes, 74 individuals with T2DM were studied for BMI, blood pressure, fasting plasma glucose, HbA1c, lipids, HOMA, Framingham risk score, number of clinically significant coronary lesions (stenosis > 50%). Results: Among T2DM subjects, those with CAD (n ¼ 56) had worse glycemic control (fasting glucose 162.36 69.8 vs. 143.4 6 48.9 mg/dL, p ¼ 0.004; HbA1c 8.03 þ 1.91 vs. 7.59 þ 1.55%, p ¼ 0.03), lower HDL (39.2 þ 13.2 vs. 44.4 þ 15.9 mg/dL, p ¼ 0.003), and higher triglycerides (140 [106-204] vs. 121 [78.5-184.25] mg/ dL, p ¼ 0.002), reached more often therapeutic goals for LDL (63.4% vs. 51.4%, p ¼ 0.037) and less often goals for HDL (26.6% vs. 37.3%, p ¼ 0.04), when compared to CAD-free individuals (n ¼ 18). In T2DM subjects HbA1c tertiles were associated with progressively higher number of significant coronary lesions (median number of lesions 2 [A1c < 6.8%]; 2.5 [A1c 6.8-8.2%]; 4 [A1c > 8.2%]; p ¼ 0.01 for trend). Conclusions: Classic risk factors such as glycemic control and lipid profile were associated with presence of CAD in T2DM subjects undergoing coronary angiography. Glycemic control is progressively associated with number and extent of coronary lesions in patients with T2DM.
Biochemistry & molecular biology journal, Mar 19, 2019
QJM: An International Journal of Medicine, 2018
In our study there was a significantly higher (p ¼ 0.019) total procedural time used in the radia... more In our study there was a significantly higher (p ¼ 0.019) total procedural time used in the radial group (33.50 6 9.04 versus 28.50 6 14.24), a significantly higher (p ¼ 0.005) fluoroscopy time used in the radial group (18.15 6 5.24 versus 13.30 6 5.09), a significant higher amount of dye used in the TRA vs TFA group (180.00 6 52.31 versus 155.00 6 45.59). Conclusion: The current study concluded that TRA is an effective and safe approach for the management of acute STEMI including over 55 years old patients, TRA shows less bleeding, less local vascular complications, less hospital stay and less costs than TFA if performed by experienced operators. Finally, femoral access doesn't increase morbidity and mortality, and is still needed in less experienced centers.
Journal of the American College of Cardiology, 2018
Background: The Combo stent is a drug eluting stent with abluminal sirolimus in a bioabsorbable p... more Background: The Combo stent is a drug eluting stent with abluminal sirolimus in a bioabsorbable polymer and luminal anti-CD34 for endothelial progenitor capture and rapid endothelialization. This property may permit shorter period of dual antiplatelet therapy (DAPT) in patients at high bleeding risk (HBR). We examined 1-year outcomes in patients with and without HBR from the MASCOT registry. Methods: MASCOT was a prospective all-comer study across 61 centers (n=2614) and patients were enrolled if Combo stent placement was attempted. DAPT was given per local guidelines and adherence monitored. Primary endpoint was 1-year target lesion failure (TLF), composite of cardiac death, non-fatal myocardial infarction (MI), or target lesion revascularization. Results: The study population included 66.0% patients (n=1714) with at least 1 HBR characteristic (Figure). Compared to non-HBR, HBR patients were older, with greater prevalence of heart failure, polyvascular atherosclerosis and acute MI presentation, whereas prevalence of diabetes and hypertension were lower. Procedurally stent length and diameter were similar between the groups. At 1-year, non-significant differences were noted in TLF, however major bleeding was significantly greater in HBR patients (Figure). Conclusion: In the MASCOT registry HBR patients treated with Combo DES had statistically non-significant differences in ischemic outcomes to non-HBR patients, a finding that needs to be confirmed in future randomized trials.
International Journal of Cardiology, 2008
Diabetes mellitus (DM) is a strong predictor of in-stent restenosis. This may be due to a higher ... more Diabetes mellitus (DM) is a strong predictor of in-stent restenosis. This may be due to a higher level of vascular inflammation. We hypothesized that diabetic patients will benefit from dexamethasone-eluting stents, since local inflammation and consequently neointimal growth are suppressed and no systemic side effects will occur. Methods: 21 consecutive patients with DM with 32 lesions were treated with dexamethasone-eluting stents. Excluded were patients with triple vessel disease, bifurcation lesions, previous revascularization of the culprit vessel, and reference diameter smaller than 2.5 or larger than 3.75 mm. MACE (death, myocardial infarction, and revascularization) was counted at 12 months. At 6 months, angiographic follow-up was performed. Results: Of the patients, 38% had insulin-dependent DM. Lesion type was type A/B1 in 56% and B2/C in 44%. Lesion length was 15.7 ± 8.4 mm and the reference diameter was 2.83 ± 0.53 mm. Event-free survival at 12 months was 62%. Any revascularization procedure was performed in 33% and target lesion revascularization in 24% of the patients. At 6 months in-stent late loss was 1.07 ± 0.64 mm. Binary restenosis occurred in 28.1% of the lesions. The event-free survival in insulin-dependent DM was worse compared to non-insulin-dependent DM (92.1 vs. 37.8%; p b 0.01). Patients with insulin-dependent DM had higher in-stent late loss compared to non-insulin-dependent DM patients (1.44 ± 0.83 vs. 0.83 ± 0.51 mm; p b 0.01). Conclusion: Treatment with dexamethasone-eluting stents in patients with DM is associated with a relatively high restenosis rate. Our data suggest a differential effect of dexamethasone-eluting stents in insulin-dependent compared to non-insulin-dependent DM.
Journal of the American College of Cardiology, 2021
Journal of Hypertension, 2018
of clinical outcomes, but systolic BPV and diastolic BPV did not predict clinical event. In survi... more of clinical outcomes, but systolic BPV and diastolic BPV did not predict clinical event. In survival analysis, there was also no association between systolic/ diastolic BPV and the composite clinical outcomes. Conclusions: In contrast with other clinical entity, these fi ndings suggest that visit-to-visit BPV is not associated with clinical outcomes in heart failure patients.
Journal of the Egyptian Society of Cardio-Thoracic Surgery, 2018
Background: Current surgical technique to fix the tricuspid valve regurgitation carry a high perc... more Background: Current surgical technique to fix the tricuspid valve regurgitation carry a high percentage (up to 37%) of recurrence of severe tricuspid valve regurgitation in mid-term follow up. There is a need for anatomically and physiologically correct Tricuspid annulus device. Our ring is developed in the way that mimics the normal anatomy & physiology of Tricuspid annulus. The aim of this study is to test three prototypes and choose the proper prototype that is tested and suitable to conform well to the normal shape of the tricuspid annulus with no distortion of the movement during the different phases of the cardiac cycle. Methods: We used an acute open heart model in sheep as an animal model to test three prototypes. We used adult sheep (6 males and 6 females), body weight 60e70 Kg, age: 1e3 years old. We followed the protocol of open heart model in animals. Results: Post Prototype implantation, Tricuspid valve leaflet coaptation was verified with no induced tricuspid regurgitation. On the other hand, there was no ring distortion or ring material fracture. All the three prototypes conformed well to the normal shape of the tricuspid annulus with no distortion of the movement during the different phases of the cardiac cycle (both in systole and diastole). Conclusions: All the three tested prototypes seemed to be effective and reproducible.
Journal of the American College of Cardiology, 2021
Journal of Hypertension, 2018
of clinical outcomes, but systolic BPV and diastolic BPV did not predict clinical event. In survi... more of clinical outcomes, but systolic BPV and diastolic BPV did not predict clinical event. In survival analysis, there was also no association between systolic/ diastolic BPV and the composite clinical outcomes. Conclusions: In contrast with other clinical entity, these fi ndings suggest that visit-to-visit BPV is not associated with clinical outcomes in heart failure patients.
Journal of the Egyptian Society of Cardio-Thoracic Surgery, 2018
Background: Current surgical technique to fix the tricuspid valve regurgitation carry a high perc... more Background: Current surgical technique to fix the tricuspid valve regurgitation carry a high percentage (up to 37%) of recurrence of severe tricuspid valve regurgitation in mid-term follow up. There is a need for anatomically and physiologically correct Tricuspid annulus device. Our ring is developed in the way that mimics the normal anatomy & physiology of Tricuspid annulus. The aim of this study is to test three prototypes and choose the proper prototype that is tested and suitable to conform well to the normal shape of the tricuspid annulus with no distortion of the movement during the different phases of the cardiac cycle. Methods: We used an acute open heart model in sheep as an animal model to test three prototypes. We used adult sheep (6 males and 6 females), body weight 60e70 Kg, age: 1e3 years old. We followed the protocol of open heart model in animals. Results: Post Prototype implantation, Tricuspid valve leaflet coaptation was verified with no induced tricuspid regurgitation. On the other hand, there was no ring distortion or ring material fracture. All the three prototypes conformed well to the normal shape of the tricuspid annulus with no distortion of the movement during the different phases of the cardiac cycle (both in systole and diastole). Conclusions: All the three tested prototypes seemed to be effective and reproducible.
International Journal of Cardiology, 2019
International Journal of Cardiology, 2019
Journal of the American College of Cardiology, 2021
The COMBO biodegradable polymer sirolimus-eluting stent includes endothelial progenitor cell capt... more The COMBO biodegradable polymer sirolimus-eluting stent includes endothelial progenitor cell capture (EPC) technology for rapid endothelialization, which may offer advantage in acute coronary syndromes (ACS). We sought to analyze the performance of the COMBO stent by ACS status and ACS subtype. The COMBO collaboration (n = 3614) is a patient-level pooled dataset from the MASCOT and REMEDEE registries. We evaluated outcomes by ACS status, and ACS subtype in patients with ST segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) versus unstable angina (UA). The primary endpoint was 1-year target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. Secondary outcomes included stent thrombosis (ST). We compared 1965 (54%) ACS and 1649 (46.0%) non-ACS patients. ACS presentations included 40% (n = 789) STEMI, 31% (n = 600) NSTEMI, and 29% (n = 576) UA patients. Risk of 1-year TLF was gre...
The American Journal of Cardiology
International Journal of Cardiology