Samir Rafla - Academia.edu (original) (raw)

Papers by Samir Rafla

The aim of this study was to determine the impact of chronic obstructive pulmonary ... more The aim of this study was to determine the impact of chronic obstructive pulmonary disease treatment on the clinical condition of patients with heart failure. Forty Patients were enrolled in this study with chronic obstructive pulmonary disease co-existent with heart failure (EF <50%). All patients enrolled in this study were males (100%). Most of the studied patients (40%) were aged between 61 and 70 years old. Definition of COPD: when FEV1 was less than 70%. About smoking: 25 patients stopped smoking (62.5%), and 15 patients didn't stop smoking (37.5%). Risk factors: 34 patients (pts) (85%) suffered from systolic hypertension, 18 pts (45%) suffered from diabetes, and 28 pts (70%) had dyslipidemia. All patients were smokers (97.5%) except 1 patient was passively smoking and 17 patients were NYHA class III (42.5%), 23 patients were NYHA class II. Average weight and height of studied patients was 88.1 ± 14.7kg and 172.5 ± 7.7cm respectively. Mean body mass index (weight/ (height) 2) was 29.2 ± 6kg/m2. ECG findings: Among studied patients, ischemic changes in ECG were present in 37 cases (92.5%). Improvement of COPD is associated with improvement of heart failure. Cessation of smoking is the best marker of possible improvement of both diseases. The use of sympathomimetics as inhalers or tablets had no deleterious effect on cardiac function.

Journal of Cardiology & Cardiovascular Therapy, Jun 4, 2019

Background: P wave dispersion (PWD) constitutes a relatively recent contribution to the field of ... more Background: P wave dispersion (PWD) constitutes a relatively recent contribution to the field of non-invasive electrophysiology. PWD is defined as the difference between maximum P wave duration (P max) and minimum P wave duration (P min) recorded from multiple surface ECG leads. Methods: The effect of thrombolytic therapy on P wave dispersion was studied in 30 patients (pts) with acute STEMI. Pts received thrombolytic therapy (Streptokinase). Pts were divided into 2 groups; group A: Pts with successful thrombolytic therapy (23) and group B: Pts with failed thrombolytic therapy (7). P wave duration maximum (P max) and minimum (P min) and dispersion were measured. The normal PWD is 28 ms + 10. The incidence of arrhythmia was recorded. Results: PWD was higher in pts with STEMI than normal range. PWD on admission was positively related to age, ST deviation score, CK-MB, Troponin, left atrial size, ejection fraction, and inversely related to beta blocker use before admission and not related to heart rate. No significant difference between sites of infarction as regards PWD. After thrombolytic therapy; PWD and P max were higher in group B than group A: (Gr A 34 + 6 vs Gr B 47 + 10 ms, P < 0.006). Arrhythmias during the duration of stay in the ICU were atrial fibrillation in one, ventricular fibrillation in one and V tachycardia in three. Three pts died. Conclusion: PWD is correlated with success of thrombolytic therapy and with other parameters as LA size and EF.

ALEXMED ePosters (Online), 2023

Research Square (Research Square), Sep 16, 2022

Background: Pacing from the apex of the RV is not considered optimal. This work aimed to assess a... more Background: Pacing from the apex of the RV is not considered optimal. This work aimed to assess and compare RV and LV pacing concerning LV function and dyssynchrony. Thirty-six patients who presented with indications for pacemakers were divided into three groups: 12 had LV pacing (lead was inserted from coronary sinus to lateral vein, the same procedure used in resynchronization pacing); 12 had RV pacing group (apical pacing only, not septal or out ow). 12 had Dual-chamber pacing. Control group: Twelve healthy subjects were included in this study. Results: RV pacing group: During the post-implantation period, the distance of the 6-MWT improved signi cantly, P= 0.006. The cardiac output (COP) during the preimplantation period and at the six-month follow-up (P= 0.003). The t-IVT (Total isovolumic time) variables at the pre-and post-implantation periods at six months (P= 0.005). LV pacing group: The comparison of the 6-MWT distance and the quality of life (QOL) score in the post-implantation period and at six months revealed a highly signi cant difference (improvement) Also in the median values of the PAP (RAP = Right atrial pressure), COP, MPI (MPI = Myocardial performance index), t-IVT, and Z (Z ratio = sum of the left ventricular ejection and lling times divided by RR interval) (P= 0.000). Conclusions: RVP seems to have less detrimental effects on LV synchrony and LV function. For those patients indicated for conventional pacemaker indications with normal or mildly impaired LV function with EF > 35%, RVA (right ventricular apical) pacing is still the gold standard pacing site.

Zenodo (CERN European Organization for Nuclear Research), Dec 3, 2022

Background: Aortic valvular calcification (AVC) and carotid arterial disease (CaAD) have a high p... more Background: Aortic valvular calcification (AVC) and carotid arterial disease (CaAD) have a high prevalence in elderly patients (pts). Aim of the work: To study the severity and relation of carotid plaques and coronary atherosclerotic lesions (CAD) in pts with calcific aortic sclerosis/stenosis. Methods: The study included 70 patients, 50 who had Aortic valve calcification (AVC) or stenosis, which was detected in TTE (systolic gradient more than 10 mmHg). The 20 other patients had Aortic valve thickening only or mild calcification (systolic gradient less than 10 mmHg). Risk factors were recorded. Results: Compared with pts with aortic valve thickening only, AVC was associated with significantly higher incidence of carotid plaques.. In the presence of aortic valve calcification/stenosis, there was 86% (43/50) incidence of carotid plaques or stenosis (0.002) and 75% incidence of coronary heart disease or LV hypertrophy p=0.037. IMT was abnormal in 80% and 40% in the two groups (P=0.01). Those with as systolic gradient > 35 mmHg (total 15), 12 patients, had carotid stenosis > 30% in (80%). Those with less AS (55 patients) had carotid stenosis > 30% in 2 only; p=0.0001. Conclusions: We found that aortic valve calcific stenosis with systolic gradient above 35 mmHg is associated with incidence of carotid stenosis in most patients (80%). This is new parameter to our knowledge. Thus carotid study is recommended in this level of stenosis.

Zenodo (CERN European Organization for Nuclear Research), Dec 2, 2022

Background: Sudden death in athletes is a major concern; the predictors and value of prior invest... more Background: Sudden death in athletes is a major concern; the predictors and value of prior investigations remain to be settled. The work aims at studying electrocardiograms (ECG) in competitive athletes to define incidence of abnormalities and any relevant associations. Methods: The study included hundred persons engaged in competitive sports for duration not less than 6 months; with training at least 3 days per week and at least two hours per day. Full history especially questioning for syncope, tachycardias or chest pain was obtained as well as family history of sudden death or coronary disease; examination for BP, any cardiac murmurs or arrhythmia. ECG was done for all plus echo Doppler in some cases. Results: During the period from 1/1/2015 to 1/10/2016, 100 athletes were screened by ECG, 54 played isotonic sport while 46 were on isometric sport. Types of sports: isometric (static) (body builders) 46. Isotonic (dynamic) 54 (Bicycling 6, Football 15, Tennis 3, Basketball 16, Volleyball 8, Swimming 4, Boxing 2). Echo was done in 15, increase in LV size was found in 5 (Diastolic diameter up to 61mm). Follow up by telephone questionnaire was done for all, 5 persons were reexamined after months, no abnormal events were found. Results: Data given total then in isometric (static) group then isotonic (dynamic) group then P value respectively: LV hypertrophy by voltage criteria 18%, 24%, 10.9%, p 0.087. Early repolarization in 5%, 9.3%, 0%, P 0.06. RSR' in V1 (and V2 in some cases) 14%, 20%, 6.5%, P 0.047. Inverted T 3%, 3.7%, 2%, P =1. Total ECG changes of any form 43%, 59%, 23.9%, P 0.001. The significance of finding more ECG changes in isometric (static) athletes is not clear but clinically did not show any effect. Correlation between the 18 athletes with ECG LVH and echocardiography: only 5 of the 18 showed increased diameters by echo but within accepted athletic heart criteria. Two of body builders confessed of taking doping drugs (male hormones) but no clinical abnormal signs were detected. No long QT was found. Discussion: We did not find cases of hypertrophic cardiomyopathy, valvular heart disease, arrhythmogenic syndromes or congenital heart disease. Conclusions: Routine ECG for all competitive athletes is not recommended, it is only indicated if persons have symptoms as syncope or chest pain or tachyarrhythmia.

Journal of cardiovascular disease research, 2021

World Journal of Cardiovascular Diseases, 2021

Background: Right ventricular (RV) dysfunction could develop during exercise in patients with bot... more Background: Right ventricular (RV) dysfunction could develop during exercise in patients with both hypertension and left ventricular diastolic dysfunction and may contribute to the patient symptoms. The objective is to assess RV function, both at rest and during exercise in patients with hypertension and left ventricular diastolic dysfunction. Methods: We included 30 patients with hypertension and resting LV diastolic dysfunction. The systolic function of the right ventricle was assessed by TAPSE (Tricuspid Annular Plane Systolic Excursion) and S, while E/A ratio, annular lateral E', E/E' and E'/A' were used to measure diastolic function. The global function of the right ventricle was assessed by measuring the right indexed myocardial performance. The dimensions and pulmonary pressures were also measured. Results: The following parameters of RV systolic function were increased significantly with exercise: TAPSE (P = 0.0054), S' (P = 0.0045). Moreover, the following diastolic parameters of the RV increased significantly with exercise: E/E' (P = 0.05), A' (P = 0.04). The global RV function showed also a significant increase (P = 0.0011). The three RV dimensions as well as the pulmonary artery pressures also increased during exercise (P = 0.000004, 0.001, and 0.00000064 respectively). In addition, the presence of resting LV grade II DD predicted significantly higher pulmonary pressures during exercise (P = 0.006). The advanced resting grade of LVDD predicted significantly the presence of advanced grade of RVDD with exercise (P = 0.037). Conclusions: Some patients who have both hypertension and LV diastolic dysfunction showed structural and functional changes of the right ventricle at rest. However, all patients had RV functional changes during exercise.

The Egyptian Heart Journal, Mar 1, 2014

Chest, Oct 1, 1993

nodes.'"' Dissemination to lymph nodes in the neck, hilus of the lungs, and mediastinum can be de... more nodes.'"' Dissemination to lymph nodes in the neck, hilus of the lungs, and mediastinum can be demonstrated at autopsy in 18.2 percent, 14.6 percent, and 2.8 percent, respectively,' hut they are not clinically relevant. Hematogenous dissemination through the venous vessels is common and the most common metastatic deposits occur in the skeleton, the liver, lungs, and adrenals and only rarely in other organs, such as the brain, skin, or digestive tract.'"" Although metastasis to the lung increases in incidence with the extension of the metastatic spread and can he found at autopsy in 49 percent of cases, they are apparent in most cases only on microscopic analysis and very rarely produce clinical pulmonary disease." The presentation of a prostatic carcinoma with a SCVS, as in this patient, is an absolutely exceptional finding. We have not been able to find any previous reference in classic textbooks or in reviewing articles' •'•'•" and we have not found reference in the MED-LINE database. The treatment of the SVCS in this patient is also worthy of discussion: chemotherapy was not believed to he a good initial treatment due to its expected limited and belated responses; antifibrinolytic agents were not included due to the long-lasting course of the venous osbstmction. Radiation therapy and surgical decompression were considered, but the presence of chronic pulmonary disease and the advanced age of the patient led us to initiate androgen deprivation as first-choice therapy, and this proved to he very effective. Although carcinoma of the prostate is a very uncommon cause of SVCS, it should be considered in patients with mediastinal lymphadenopathy and a protracted course. This is not academic, since metastatic prostatic carcinoma is a treatable disease where an appropriate treatment can, at least temporarily, decrease the size of the lymph node metastasis, control the symptoms of the disease, improve the performance and, ultimately, prolong the life of the patient.

Research Square (Research Square), Dec 2, 2022

Background: Pacing from the apex of the RV is not optimal. This study aimed to assess and compare... more Background: Pacing from the apex of the RV is not optimal. This study aimed to assess and compare RV and LV pacing of LV function and dyssynchrony. Thirty-six patients who presented with indications for pacemakers were studied. We divided them into three groups: 12 had LV pacing (lead was inserted from coronary sinus to lateral vein, the same procedure used in resynchronization pacing); 12 had RV pacing group (apical pacing only, not septal or out ow). Twelve had Dual-chamber pacing. Control group: Twelve healthy participants were included in this study. Results: During the post-implantation period, the distance of the 6-MWT improved signi cantly, P= 0.006. Cardiac output (COP) during the preimplantation period and at the six-month follow-up (P= 0.003). The IVT (isovolumic time) variables at six months' pre-and post-implantation periods (P= 0.005). LV pacing group: The comparison of the 6-MWT distance and the quality of life (QOL) score in the post-implantation period and at six months revealed a highly signi cant difference (improvement) as well as in the median values of the PAP (RAP = Right atrial pressure), COP, MPI (MPI = myocardial performance index), IVT, and Z (Z ratio = sum of the left ventricular ejection and lling times divided by RR interval) (P= 0.000). Conclusions: RVP seems to have fewer detrimental effects on LV synchrony and LV function. For those patients indicated for conventional pacemaker indications with normal or mildly impaired LV function with EF > 35%, RVA (right ventricular apical) pacing is still the gold standard pacing site.

Background New imaging modalities such as IVUS had improved results of stenting of the unprotecte... more Background New imaging modalities such as IVUS had improved results of stenting of the unprotected left main coronary artery (UPLM). The results of stenting UPLM without these new modalities but with meticulous care need to be studied more. Methods We analyzed data from 120 patients with UPLMD of > 50% subjected to stenting. All were stented by drug-eluting stents and followed for six months. Results 92 patients (77.3%) presented with ACS, of which 65 patients (54.6%) had no Previous Intervention, and 27 patients (22.7%) had a previous PCI. Left ventricular ejection fraction significantly correlates with complication, at 6 months follow up; all 16 patients with reported complications (100%) had baseline LVEF of < 40% (P-value = 0.023). Syntax score: 11 patients (55%) with a high score of more than 32 had adverse events, P = 0.004. Residual syntax shows a less significant correlation with a mean value of 7.3 in the complication group versus 4.9 in the other group (P = 0.016). F...

International Journal of Clinical Cardiology

There are major advances and achievements in devices used in electrophysiology diagnosis and trea... more There are major advances and achievements in devices used in electrophysiology diagnosis and treatment. This short summary is collection of recent publications around this subject.

Journal of Cardiology, 2021

Arrhythmias in COVID-19 patients are associated with hypoxia, myocardial ischemia, cytokines, inf... more Arrhythmias in COVID-19 patients are associated with hypoxia, myocardial ischemia, cytokines, inflammation, electrolyte abnormalities, pro-arrhythmic or QT-prolonging medications, and underlying heart conditions such as severe congestive heart failure, inherited arrhythmia syndromes, or congenital heart conditions. In the pediatric population, multisystem inflammatory syndrome can lead to cardiac injury and arrhythmias. In addition, arrhythmias and cardiac arrests are most prevalent in the critically ill intensive care unit COVID-19 patient population. This review presents an overview of the association between COVID-19 and arrhythmias by detailing possible pathophysiological mechanisms, existing knowledge of pro-arrhythmic factors, and results from studies in adult and pediatric COVID-19 populations, and the clinical implications.

Journal of Cardiology and Cardiovascular Medicine, 2020

This is demonstration of selected ECGs for learning or for exams; guided by lessons from great te... more This is demonstration of selected ECGs for learning or for exams; guided by lessons from great teachers as Prof. Hein Wellens MD. Here we provide advanced examples with comment and analysis.