Michael Henein - Academia.edu (original) (raw)

Papers by Michael Henein

Atherosclerosis, 2021

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

The Annals of Thoracic Surgery, 2011

Background. We aimed to compare conventional echocardiographic versus speckle tracking-derived pa... more Background. We aimed to compare conventional echocardiographic versus speckle tracking-derived parameters in predicting postoperative left ventricular (LV) dysfunction and clinical outcomes after successful mitral valve repair in patients with mitral regurgitation. Methods. In 147 consecutive patients in sinus rhythm with severe MR, two-dimensional echocardiography and speckle-tracking imaging for global longitudinal, circumferential, and radial strains and strain rates were performed within 30 days before successful mitral valve repair. Echocardiography was repeated within 7 days in all patients, and more than 3 months after surgery in 112 patients. Clinical events were evaluated for 21 ؎ 17 months. Results. Multivariate linear regression analysis showed that preoperative LV systolic dimension (p ‫؍‬ 0.004) and volume (p ‫؍‬ 0.001) were independent determinants of immediate postoperative LV ejection fraction. Preoperative LV end-systolic dimension (p ‫؍‬ 0.004), LV ejection fraction (p ‫؍‬ 0.017), and circumferential strain (p ‫؍‬ 0.029) were independent predictors of late follow-up LV ejection fraction. By Cox regression analysis, preoperative end-systolic LV dimension (hazard ratio 1.26 for every 1 mm, 95% confidence interval 1.11 to 1.44, p < 0.001) was the only predictor of hospital admission for heart failure. The best cutoff values of LV end-systolic dimension (>41 mm) and volume (>85 mL) for predicting postoperative severe LV dysfunction (ejection fraction < 0.35) identified patients at high risk for event-free survival, but those of speckletracking parameters did not. Conclusions. Preoperative LV remodeling parameters, such as LV end-systolic dimension and volume, are superior to speckle tracking-derived deformation parameters in predicting LV dysfunction and clinical events after successful mitral valve repair in patients with severe mitral regurgitation.

Journal of Clinical Medicine

Background: The COVID-19 pandemic carries a high burden of morbidity and mortality worldwide. We ... more Background: The COVID-19 pandemic carries a high burden of morbidity and mortality worldwide. We aimed to identify possible predictors of in-hospital major cardiovascular (CV) events in COVID-19. Methods: We retrospectively included patients hospitalized for COVID-19 from 10 centers. Clinical, biochemical, electrocardiographic, and imaging data at admission and medications were collected. Primary endpoint was a composite of in-hospital CV death, acute heart failure (AHF), acute myocarditis, arrhythmias, acute coronary syndromes (ACS), cardiocirculatory arrest, and pulmonary embolism (PE). Results: Of the 748 patients included, 141(19%) reached the set endpoint: 49 (7%) CV death, 15 (2%) acute myocarditis, 32 (4%) sustained-supraventricular or ventricular arrhythmias, 14 (2%) cardiocirculatory arrest, 8 (1%) ACS, 41 (5%) AHF, and 39 (5%) PE. Patients with CV events had higher age, body temperature, creatinine, high-sensitivity troponin, white blood cells, and platelet counts at admis...

International Journal of Molecular Sciences

Coronary artery ectasia (CAE) is frequently encountered in clinical practice, conjointly with ath... more Coronary artery ectasia (CAE) is frequently encountered in clinical practice, conjointly with atherosclerotic CAD (CAD). Given the overlapping cardiovascular risk factors for patients with concomitant CAE and atherosclerotic CAD, a common underlying pathophysiology is often postulated. However, coronary artery ectasia may arise independently, as isolated (pure) CAE, thereby raising suspicions of an alternative mechanism. Herein, we review the existing evidence for the pathophysiology of CAE in order to help direct management strategies towards enhanced detection and treatment.

Journal of Clinical Medicine, 2022

The COVID-19 pandemic is a global health issue that has so far affected over 250 million people w... more The COVID-19 pandemic is a global health issue that has so far affected over 250 million people worldwide [...]

The International Journal of Cardiovascular Imaging, 2013

Post-operative atrial fibrillation (AF) is a common and serious complication in patients undergoi... more Post-operative atrial fibrillation (AF) is a common and serious complication in patients undergoing aortic valve replacement (AVR). Speckle tracking echocardiography (STE) has recently enabled the quantification of longitudinal myocardial left atrial (LA) deformation dynamics. Our aim was to investigate LA preoperative mechanical function in patients undergoing AVR for aortic stenosis using STE and determine predictors of post-operative AF. 76 patients with aortic stenosis in sinus rhythm, undergoing AVR, were prospectively enrolled. Conventional echocardiographic parameters, and peak atrial longitudinal strain (PALS) were measured in all subjects the day before surgery. PALS values were obtained by averaging all segments in the 4- and 2-chamber views (global PALS). All patients received biological valve prostheses and a standard postoperative care. Postoperative AF occurred in 15 patients (19.7 %). On univariate analysis among all clinical and echocardiographic variables, global PALS showed the highest diagnostic accuracy (HR 6.55 p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001; AUC of 0.89) with a cut-off value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;16.9 %, having sensitivity and specificity of 86 and 91 %, respectively, in predicting postoperative AF. LA volume indexed and E/e&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; ratio had lower diagnostic accuracy (AUC 0.76 and 0.51, respectively). On multivariate analysis global PALS remains a significant predictor of postoperative AF (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001). STE analysis of LA myocardial deformation is considered a promising tool for the evaluation of LA subclinical dysfunction in patients undergoing AVR, giving a potentially better risk stratification for the occurrence of postoperative AF.

Critical Care Medicine, 2012

Objective-Dengue continues to cause significant global morbidity and mortality. Severe disease is... more Objective-Dengue continues to cause significant global morbidity and mortality. Severe disease is characterized by cardiovascular compromise from capillary leakage. Cardiac involvement in dengue has also been reported, but has not been adequately studied. Setting-Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam. Design-Seventy-nine patients aged 8-46 years with different dengue severity grades were studied using echocardiography including tissue Doppler imaging. The patients were split into severity grades: dengue, dengue with warning signs and severe dengue. Changes in cardiac functional parameters and haemodynamic indices were monitored over the hospital stay. Measurements and Main Results-Patients with severe dengue had worse cardiac function compared to dengue, in the form of left ventricular (LV) systolic dysfunction with increased Left myocardial performance index (LMPI) (0.58 (0.26-0.80) vs. 0.38 (0.22-0.70), P=0.006). Septal myocardial systolic velocities (S′) were reduced, (6.4 (4.8-10) vs. 8.1 (6-13) cm/s, P=0.01) as well as right ventricular (RV) systolic (11.4 (7.5-17) vs. 13.5 (10-17) cm/s, P=0.016), and diastolic (E′) velocities (13 (8-23) vs. 17 (12-25) cm/s, P=0.0026). In the severe group, these parameters improved from hospital admission to discharge; septal S′ to 8.8 (7-11) cm/s (P=0.002), RV S′ to 15.0 (11.8-23) cm/s, (P=0.003) and diastolic velocity E′ to 21 (11-25) cm/s (P=0.002). Patients with cardiac impairment were more likely to have significant pleural effusions. Conclusions-Patients with severe dengue have evidence of systolic and diastolic cardiac impairment, with septal and right ventricular wall being predominantly affected.

Circulation, 2005

Background— Aortic valve replacement (AVR) is the established treatment for severe aortic stenosi... more Background— Aortic valve replacement (AVR) is the established treatment for severe aortic stenosis. In response to the long-term results of aortic homografts, stentless porcine valves were introduced as an alternative low-resistance valve. We conducted a randomized trial comparing a stentless with a stented porcine valve in adults with severe aortic stenosis. Methods and Results— The primary outcome was change in left ventricular mass index (LVMI) measured by transthoracic echocardiography and, in a subset, by cardiovascular MR. Measurements were taken before valve replacement and at 6 and 12 months. Patients undergoing AVR with an aortic annulus ≤25 mm in diameter were randomly allocated to a stentless (n=93) or a stented supra-annular (n=97) valve. There were no significant differences in mean LVMI between the stentless versus stented groups at baseline (176±62 and 182±63 g/m 2 , respectively) or at 6 months (142±49 and 131±45 g/m 2 , respectively), although within-group changes f...

American Heart Journal, 1999

Background Decreased heart rate variability (HRV), indicating derangement in cardiac autonomic co... more Background Decreased heart rate variability (HRV), indicating derangement in cardiac autonomic control, has been reported in patients with chronic heart failure. However, the independent and incremental prognostic value of HRV over clinical data and measures of left ventricular dysfunction has been less thoroughly investigated. This study was designed to evaluate the predictive value of HRV and Poincaré plots as assessed

Archives of Clinical and Biomedical Research

Background and Aims: In contrast to priests, the life style of monks is almost similar, irrespect... more Background and Aims: In contrast to priests, the life style of monks is almost similar, irrespective of their order and specifics of religious practices. The aim of this study was to assess the cardiac risk factors in Coptic priests and monks and their impact on post-acute COVID-19. Methods: Of 1519 clergy, participating in the COVID-19-Clergy study, serving in Europe and Egypt, 257 had the infection and were included in this analysis. Clergy were divided into priests (n=204) and monks (n=53). Participants' demographic indices, cardiovascular risk factors, management details and post-acute COVID-19 duration were assessed. The impact of geographic differences of life style were also analysed. Results: Priests were more obese (p=0.001), had more type 2 diabetes (DM) (p=0.001), arterial hypertension (AH) (p<0.001), dyslipidemia (p=0.001) and lower prevalence of infection (p<0.001) compared to monks. Their symptoms' duration was more prolonged (p<0.001), had frequent post-acute COVID (p<0.001) and had greater need for hospital treatment (p=0.04). In a sub-analysis, priests serving in Europe had higher prevalence of AH, DM, obesity, CHD, dyslipidemia, longer symptoms duration and more frequent post-acute COVID compared to monks

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Arch Clin Biomed Res 2022; 6 (2): 364-377, 2022

Heart and Vessels

Background Transthyretin cardiac amyloidosis (ATTR-CA) is today more frequently recognized but th... more Background Transthyretin cardiac amyloidosis (ATTR-CA) is today more frequently recognized but the rate of progression of cardiac dysfunction is not well established. The aim of this study is to investigate the nature of cardiac structure and function changes, over time, in a retrospective cohort of ATTR-CA patients. Methods Fifty-one patients with ATTR-CA (mean age 78 ± 7 years, 30 females) were compared with 20 patients with heart failure but no amyloidosis (HFnCA) (mean age 76 ± 7 years, 5 females), all with septal thickness > = 14 mm. All patients underwent DPD scintigraphy and an echocardiogram (Echo 2) which was compared with a previous echocardiographic examination (Echo 1), performed at least 3 years before. Results Over the follow-up period, the interventricular septal thickness (IVST) and relative wall thickness (RWT) in ATTR-CA increased from 16 (4) to 18 (5) mm and from 0.51 (0.17) to 0.62 (0.21) respectively, p 0.45 (AUC = 0.77) and RELAPS > 2.0 (AUC 0.86) both ...

Circulation, Oct 28, 2008

<jats:p> <jats:bold>Objective:</jats:bold> Hypertrophic cadiomyopathy (HCM) res... more <jats:p> <jats:bold>Objective:</jats:bold> Hypertrophic cadiomyopathy (HCM) results in exertional symptoms due to limited cardiac output that improve after removal of the left ventricular outflow tract (LVOT) obstruction. We aimed to assess the effect of pharmacological stress on LV asynchrony in a group of patients with HCM limited by exertional breathlessness. </jats:p> <jats:p> <jats:bold>Methods:</jats:bold> We studied 17 normal controls (aged 58 ± 12 years) and 37 HCM patients (aged 54 ± 15 years, 13 female) with septal thickness >15 mm using Doppler echocardiography, at rest and at peak dobutamine stress. Stress end points were symptoms, >20 mmHg drop in systolic blood pressure, arrhythmia, or maximum dobutamine infusion of 40μcg/kg/min. Ventricular asynchrony was assessed by total isovolumic time and Tei index. </jats:p> <jats:p> <jats:bold>Results:</jats:bold> At rest: LVOT velocity was raised in HCM patients compared to normals (2.0 ± 0.9 v 1.0 ± 2.4, p<0.001, respectively). Total isovolumic time was not significantly different between HCM and normals (10.6 ± 4.4 v 12 ± 2 s/min, respectively), and Tei index was not significantly different between HCM and normals (0.6 ± 0.1 v 0.54 ± 0.2, p=NS, respectively). At peak stress: LVOT velocities increased in HCM compared to normals (4.3 ± 1.7 v 1.7 ± 1.0 m/s, p<0.005, respectively) due to systolic anterior movement of the mitral valve. Total IVT decreased in both HCM and normals (6.3 ± 5.2 v 5 ± 2 s/min,p<0.005, compared to resting values, respectively) as did Tei index (0.24 ± 0.04 v 0.23 ± 0.06, p<0.01, respectively). Total LV filling time decreased in HCM but increased in normals (HCM rest v stress: 29.6 ± 4.5 v 27.5 ± 4.5 s/min, p< 0.05; normals rest v stress 28 ± 4 v 33 ± 3 s/min, p<0.005). QRS duration increased with stress in HCM patients (rest v stress: 103 ± 28 v 110 ± 26 ms, p<0.01), but decreased in normals (rest v stress. 91 ± 9 v 87 ± 8 ms, p=NS). </jats:p> <jats:p> <jats:bold>Conclusion:</jats:bold> Stress results in LV outflow tract obstruction in HCM patients, resulting in known pathophysiological consequences– mitral regurgitation and raised left atrial pressure. In addition, increased ventricular asynchrony compromises filling time. The historical benefit from DDD pacing in this condition may be explained on the basis of LV resynchronisation rather than simply drop in outflow tract gradient. </jats:p>

TEACH - Journal of Christian Studies

We attempted to study the hitherto unexplained phenomenon of the sung “a”, for one note, at the e... more We attempted to study the hitherto unexplained phenomenon of the sung “a”, for one note, at the end of an “A” melody. We encountered this issue during singing the word “Alleluia” in the Coptic musical culture. We found that the transmission from “A” to “a” serves as an intermediary step before continuing to the “L”. It may also be an adopted habit by some singers, rather than a consistently inherited musical design with a clear pattern. However, further research is encouraged to decipher this phenomenon.

Cardiac failure review, 2015

Diastolic phases are also influenced by the electrical pattern of activation (depolarisation) and... more Diastolic phases are also influenced by the electrical pattern of activation (depolarisation) and repolarisation. QRS broadening, irrespective of bundle branch block (BBB) is associated with delayed activation and delayed inward motion. This is reflected in delayed segmental outward motion with post-ejection shortening, the combination of the two results in delayed onset and shortened early diastolic filling of the left ventricle. 6 The same pattern is seen in coronary artery disease, particularly in

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Aims: To investigate the hypothesis that changes in the ECG over time may be an important and rea... more Aims: To investigate the hypothesis that changes in the ECG over time may be an important and read-ily available marker of prognostic value in patients with heart failure. Methods: 112 elderly patients (81 men) with stable heart failure, a mean (SD) age of 73.3 (4.4) years, left ventricular ejection fraction 38 (17)%, and peak oxygen consumption 15.1 (4.7) ml/kg/min had ECG measurements on two occasions a minimum of 12 (5) months apart. Results: During the subsequent follow up period (mean 27 (17) months) 45 patients died. QRS duration (p = 0.001) and heart rate (p = 0.03) at baseline were found by Cox proportional hazard method analysis to predict adverse outcomes in these patients. Of the changes in ECG parameters between the first and second visit, broadening of QRS duration (p = 0.001) predicted mortality. On Kaplan-Meier sur-vival analysis, patients with < 5 % change in QRS duration had fewer end points than patients with 5–20 % change. A> 20 % increase in QRS duration wa...

Monaldi Archives for Chest Disease

Accurate assessment of cardiovascular (CV) risk is essential for clinical decision making. Serum ... more Accurate assessment of cardiovascular (CV) risk is essential for clinical decision making. Serum uric acid has been proposed as a novel additional CV risk.

Journal of Clinical Medicine, 2021

Background and Aim: In patients undergoing diagnostic coronary angiography (CA) and percutaneous ... more Background and Aim: In patients undergoing diagnostic coronary angiography (CA) and percutaneous coronary interventions (PCI), the benefits associated with radial access compared with the femoral access approach remain controversial. The aim of this meta-analysis was to compare the short-term evidence-based clinical outcome of the two approaches. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) comparing radial versus femoral access for CA and PCI. We identified 34 RCTs with 29,352 patients who underwent CA and/or PCI and compared 14,819 patients randomized for radial access with 14,533 who underwent procedures using femoral access. The follow-up period for clinical outcome was 30 days in all studies. Data were pooled by meta-analysis using a fixed-effect or a random-effect model, as appropriate. Risk ratios (RRs) were used for efficacy and safety outcomes.Results: Comp...