Ashraf Reda | Menoufiya University (original) (raw)

Papers by Ashraf Reda

European Journal of Heart Failure, 2021

To perform a comprehensive characterization of acute heart failure (AHF) with preserved (HFpEF), ... more To perform a comprehensive characterization of acute heart failure (AHF) with preserved (HFpEF), versus mildly reduced (HFmrEF) versus reduced ejection fraction (HFrEF).

European Heart Journal, 2019

Background Egypt is the most populous country in Middle East and North Africa and has one of the ... more Background Egypt is the most populous country in Middle East and North Africa and has one of the highest rates of the cardiovascular (CV) deaths in the region. Despite governmental primary preventive efforts, very little is known about the prevalence and characteristics of premature coronary artery disease (CAD) among Egyptian patients with Acute Coronary syndrome (ACS). Methods From November 2015 to August 2018, data were collected from 3224 patients with ACS in 30 coronary care centers covering 11 governorates across Egypt, spanning the Mediterranean coast, Nile Delta, and Upper Egypt, with focus on premature CAD (defined as ACS before age 55 years in males and 65 years in females). Results The prevalence of premature CAD was 51%. They were significantly more females (35% versus 16%, P<0.001) with significantly higher level of education. Risk factors' (RFs) distribution showed a significantly higher prevalence of Type-1 Diabetes Mellitus (6% versus 4%, P=0.005), obesity (42...

JACC. Heart failure, 2018

This study compared the performance of major heart failure (HF) risk models in predicting mortali... more This study compared the performance of major heart failure (HF) risk models in predicting mortality and examined their utilization using data from a contemporary multinational registry. Several prognostic risk scores have been developed for ambulatory HF patients, but their precision is still inadequate and their use limited. This registry enrolled patients with HF seen in participating European centers between May 2011 and April 2013. The following scores designed to estimate 1- to 2-year all-cause mortality were calculated in each participant: CHARM (Candesartan in Heart Failure-Assessment of Reduction in Mortality), GISSI-HF (Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico-Heart Failure), MAGGIC (Meta-analysis Global Group in Chronic Heart Failure), and SHFM (Seattle Heart Failure Model). Patients with hospitalized HF (n = 6,920) and ambulatory HF patients missing any variable needed to estimate each score (n = 3,267) were excluded, leaving a final ...

European Journal of Echocardiography, 2003

Background:. Valsalva maneuver was used to differentiate normal from pseudonormal mitral flow pat... more Background:. Valsalva maneuver was used to differentiate normal from pseudonormal mitral flow pattern. Doppler tissue imaging (DTI), differentiates normal from abnormal diastolic function. Aim of the Work: Assessment of Valsalva maneuver as a mean to differentiate pseudonormal from normal mitral flow pattern (MFP), using pulsed-wave DTI Patients and Methods: sixty patients with dilated cardiomyopathy (EF<40%), sinus rhythm and pseudonormalized MFP were selected. Transmitral flow velocity curve (MFVC), before and during Valsalva maneuver was recorded. Peak early mitral filling (Em), peak atrial filling (Am) and Em/Am were measured before and during Valsalva. After Valsalva patients were classified into two groups. Group I included 24 patients with Em/Am <1 and group II, 36 patients with Em/Am >1. Pulsed-wave DTI was recorded at septal, lateral, inferior and anterior aspect of the mitral annulus from apical 4 and 2 chamber views. The mean peak early velocity (Ea), Peak atrial (Aa), and Ea/Aa of the 4 sites were measured from DTI derived velocity curve for each patient. The results were compared with the MFP. Results: Valsalva maneuver was able to detect a hidden relaxation abnormality in 40% of patients where Em/Am became <1 with significantly prolonged deceleration time (DT), and isovolumetric relaxation time (IVRT). However, 60% of patients the Em/Am remained >1 with slightly prolonged DT and IVRT. Pulsed-wave DTI detected relaxation abnormality in all patients. They had Ea/Aa 0.79±0.11, prolonged DT and IVRT. Group 1 had higher EF (36.71% vs. 32.87%), higher Ea (6.1±0.68 vs 5.3±0.1cm/s), lower Aa (7.9±2.012 vs 8.1±1.91 cm/s) and higher Ea/Aa ratio (0.77 vs 0.65) than group II patients. These data may denote that it was a progression of diastolic dysfunction with or without a hemodynamic factor that was responsible for the persistence of pseudonormalized pattern during Valsalva. Conclusion: Patient uncoperation, less sensitivity, and specificity are the major limitations Valsalva maneuver in assessment of patients with pseudonormalized MFP.Doppler tissue imaging is a simple noninvasive bedside technique with less load dependence. it can be used in combination with MFP for better understanding and assessment of diastolic dysfunctionin those patients. 156 Echocardiographic diastolic dysfunction parameters and mitral regurgitation are predictors of pulmonary hypertension in left ventricular dysfunction.

European Journal of Echocardiography, 1999

European Journal of Echocardiography, 2011

Bicuspid aortic valve and associated congenital cardiac malformations in children LJ. Gong; ZK. Y... more Bicuspid aortic valve and associated congenital cardiac malformations in children LJ. Gong; ZK. Ye; ZW. Zeng; MY. Xia; Y. Zhong; Y. Yao Fuwai cardiovascular hospital, Beijing, China, People's Republic of Objectives: To determine the clinical morphology of congenital bicuspid aortic valves (BAV) and its relationship with congenital cardiac malformations in children. Methods: 252 patients (age,18 years old) with BAV who were identified by transthoracic echocardiography were included. All patients were divided into two groups, group 1 was ≤3 y, and group 2 was .3 y. To estimate the frequency of BAV associated with other cardiac malformations in all patients and to analyze BAV and the frequency of major congenitally cardiac malformations by age and sex roughly. Results: The mean age of the patients was 3y (1 day-17.9 years), males 188 (67.4%), females 64 (32.5%). R-L phenotype (absence of the inter coronary commissure) was the most common(71.4%), both in patients with isolated BAV (58.9%) and in those with additional pathology. L-N phenotype was rarely (1.6%), and 2 of 4 patients with this pattern had no other structural abnormality. The majority of patients with coarctation (82.4 %) and left heart obstructive lesions (80%) had R-L phenotype, non-left heart defects (79.8 %) had R-L phenotype. The difference between the numbers of aortic stenosis(AS) and aortic regurgitation(AR) of BAV patients was not remarkable. AR was observed in 20.2% of BAV patients. In R-L phenotype,most patients associated with AS(80.6%, P,0.05). Compared with the other two BAV types, patients with R-N phenotype were more likely to have at least moderate AR(78.4%, P,0.05) or AS and AR (74%, P,0.05). In male group: intracardiac shunt, coarctation and congenital mitral valve disease were common than female in ,3y group. In group2: Intracardiac shunt and congenital mitral valve disease were most common in male. BAV in conjunction with aortic coarctation was associated with a lower prevalence of valve stenosis and regurgitation. In group 1, inracardiac shun, coarctation and congenital mitral valve disease were common in male than female. In group 2, intracardiac shunt and congenital mitral valve disease were most common in male group than female, but the prevalence of coarctation was not too high. Most aortic coarctation tended to be younger boys. Conclusions: Different morphologies of BAV were associated with different cardiac abnormalities, especially left-heart obstructive lesions. The AS was most often observed in patients with R-L phenotype. Most of AR and/or both of AS and AR could be observed in patients with R-N phenotype. Boys with BAV had higher risk of aortic coarctation and congenital mitral valve abnormalities than girls in ≤3 years group, but this difference decreased between sex in .3 years group.

European Journal of Echocardiography, 1999

European Journal of Echocardiography, 1999

Clinical Research in Cardiology

New England Journal of Medicine, 2012

Background The effect of intensified platelet inhibition for patients with unstable angina or myo... more Background The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. Methods In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75 mg daily). In a secondary analysis involving 2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel. Results At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel group (hazard ratio in the prasugrel group, 0.91; 95% confidence interval [CI], 0.79 to 1.05; P = 0.21). Similar results were observed in the overall population. The prespecified analysis of multiple recurrent ischemic events (all components of the primary end point) suggested a lower risk for prasugrel among patients under the age of 75 years (hazard ratio, 0.85; 95% CI, 0.72 to 1.00; P = 0.04). Rates of severe and intracranial bleeding were similar in the two groups in all age groups. There was no significant between-group difference in the frequency of nonhemorrhagic serious adverse events, except for a higher frequency of heart failure in the clopidogrel group. Conclusions Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed.

Pharmacological Research, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Atherosclerosis, 2016

Objectives: The study is focused on police officers whose occupation is deemed highly stressful. ... more Objectives: The study is focused on police officers whose occupation is deemed highly stressful. We aimed to assessed whether stress was related to metabolic syndrome (MetS) and its components, and to the presence of coronary artery plaque.

Atherosclerosis, 2019

abdominal aortic malondialdehyde (MDA) levels in the hypercholesterolemia rat model induced by sh... more abdominal aortic malondialdehyde (MDA) levels in the hypercholesterolemia rat model induced by shortening. Methods: A total of 19 stored biological material samples in the form of Wistar abdominal aortic organs were divided into 5 groups, namely the negative control group (C-) only received standard food, positive control group (C +) were given a high-fat diet and standard food, the T1 group was given standard food, high-fat diet, and probiotics at a dose of 1.65x cfu/kg, T2 group given standard food, high-fat diet, and probiotic dose 5.5x cfu/kg, T3 group given standard food, high-fat diet, and probiotics dose 1.65x cfu/ kg. This treatment was given for 10 weeks then the data obtained were analyzed using the Kruskal Wallis test with Mann-Whitney post hoc. Results: The mean of MDA levels were C-group (1.78 ± 0.11 nmol/gram), T3 group (2.20 ± 0.06 nmol/gram), T2 group (3.46 ± 0.16 nmol/gram), T1 group (4.02 ± 0.02 nmol/gram), and C + group (5.23 ± 0.51 nmol/gram). The data analysis showed a significant difference in abdominal aortic MDA levels (p <0.05). Conclusions: There is an effect of probiotics on MDA levels in the abdominal aorta in hypercholesterolemic rats model induced by shortening.

European Journal of Echocardiography, 2003

Background: Hypertension is a multifaceted, multifactorial disease. It has a polygenetic bases. I... more Background: Hypertension is a multifaceted, multifactorial disease. It has a polygenetic bases. Intact endothelium plays a central role in vasomotion and blood pressure control. Aim of the work: was to assess endothelial mediated vasodilatation as an indicator of endothelial function in normotensive healthy siblings of hypertensive patients. Methods: Forty healthy normotensive siblings of hypertensive patients with mean age 29.4±4.3, and no other risk factors.Twenty age and sex comparable healthy control individuals were selected. After full history, clinical examination, and laboratory investigation echocardiographic examination was done and left ventricular mass index was calculated (LVMI). Duplex ultrasonsgraphy of the right brachial artery was done through a previously well defined segment. Peak flow velocity (PFV), and brachial artery diameter were measured by pulsed wave and B-mode ultrasonography 30 sec before inflation (D1), of a pneumatic tourniquet to a pressure of 250 mmHg for 3-5 minutes at the forearm proximal to the site of arterial scanning and 90 sec after deflation (D2). After 15 minutes for vessel recovery a second resting scan was taken and the diameter of the brachial artery (D3), was measured then nitroglycerin spray 400 ?g was given sublingually and the measurements were repeated after 3-5 minutes (D4). Simultaneous electrocardiographic recording was done for timing. Percentage flow mediated dilatation (FMD) and nitroglycerine mediated dilatation (NMD), were calculated as D2-D1/D1X100 and D4-D3/D3X100. Results: normotensive healthy siblings of hypertensive patients had a significantly higher LVMI (P<0.05)and a significantly lower percentage FMD compared to normotensive healthy controls (P<0.05). There was no significant difference as regard to percentage NMD between siblings and controls (P>0.05). Because FMD is endothelial dependent response, the impaired percentage FMD means that normtensive, risk factors free siblings of hypertensive patients had endothelial dysfunction Conclusion: healthy normotensive siblings of hypertensive patients had endothelial dysfunction. It may play a role in the pathogenesis of hypertension and may have a genetic bases. 428 Peripheral endothelial function and left ventricular hypertrophy in patients with essential hypertension.

Journal of Public Health in Africa (JPHiA), 2021

Background: Little are known about the prevalence of atherosclerosis risk factors in Egyptian pat... more Background: Little are known about the prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndromes (ACS). Objective: Describe the prevalence of these risk factors with focus on gender-specific data and patients with premature presentation. Methods: From November 2015 to August 2018, data were collected from 3224 patients with ACS in 30 coronary care centers covering 11 governorates across Egypt, with focus premature ACS. Results: The vast majority were males (74%) and the most prevalent age group was (56-65 years) representing 37% of whole study population. Among female patients, 92% were post-menopausal. The prevalence of premature ACS was 51%. Forty five percent of total males and 69.6% of total females with ACS had premature presentation (P<0.001). Abdominal obesity was the most prevalent risk factor (66%). Nearly half of the entire study patients were current smokers (48%). We showed a high prevalence of documented dyslipidemia
(48%) as well. Early invasive management
strategy was employed in 65% of patients
with no significant gender disparity noticed.
Vascular access for coronary angiography
was most commonly femoral (80% of time).
Emergent percutaneous coronary intervention
(PCI) was attempted in 53% of
patients. Thrombolytic therapy (using
Streptokinase) was used in 24% of included
participants.
Conclusion: Among Egyptian patients
with ACS, premature presentation is common
with greater male preponderance.
Abdominal obesity is the most prevalent
risk factor followed by hypertension. Most
traditional risk factors (apart from smoking)
were more prevalent in women than men.

Journal of Cachexia, Sarcopenia and Muscle, 2022

The Lancet, 2022

BACKGROUND Homozygous familial hypercholesterolaemia (HoFH) is a rare inherited disorder resultin... more BACKGROUND Homozygous familial hypercholesterolaemia (HoFH) is a rare inherited disorder resulting in extremely elevated low-density lipoprotein cholesterol levels and premature atherosclerotic cardiovascular disease (ASCVD). Current guidance about its management and prognosis stems from small studies, mostly from high-income countries. The objective of this study was to assess the clinical and genetic characteristics, as well as the impact, of current practice on health outcomes of HoFH patients globally. METHODS The HoFH International Clinical Collaborators registry collected data on patients with a clinical, or genetic, or both, diagnosis of HoFH using a retrospective cohort study design. This trial is registered with ClinicalTrials.gov, NCT04815005. FINDINGS Overall, 751 patients from 38 countries were included, with 565 (75%) reporting biallelic pathogenic variants. The median age of diagnosis was 12·0 years (IQR 5·5-27·0) years. Of the 751 patients, 389 (52%) were female and 362 (48%) were male. Race was reported for 527 patients; 338 (64%) patients were White, 121 (23%) were Asian, and 68 (13%) were Black or mixed race. The major manifestations of ASCVD or aortic stenosis were already present in 65 (9%) of patients at diagnosis of HoFH. Globally, pretreatment LDL cholesterol levels were 14·7 mmol/L (IQR 11·6-18·4). Among patients with detailed therapeutic information, 491 (92%) of 534 received statins, 342 (64%) of 534 received ezetimibe, and 243 (39%) of 621 received lipoprotein apheresis. On-treatment LDL cholesterol levels were lower in high-income countries (3·93 mmol/L, IQR 2·6-5·8) versus non-high-income countries (9·3 mmol/L, 6·7-12·7), with greater use of three or more lipid-lowering therapies (LLT; high-income 66% vs non-high-income 24%) and consequently more patients attaining guideline-recommended LDL cholesterol goals (high-income 21% vs non-high-income 3%). A first major adverse cardiovascular event occurred a decade earlier in non-high-income countries, at a median age of 24·5 years (IQR 17·0-34·5) versus 37·0 years (29·0-49·0) in high-income countries (adjusted hazard ratio 1·64, 95% CI 1·13-2·38). INTERPRETATION Worldwide, patients with HoFH are diagnosed too late, undertreated, and at high premature ASCVD risk. Greater use of multi-LLT regimens is associated with lower LDL cholesterol levels and better outcomes. Significant global disparities exist in treatment regimens, control of LDL cholesterol levels, and cardiovascular event-free survival, which demands a critical re-evaluation of global health policy to reduce inequalities and improve outcomes for all patients with HoFH. FUNDING Amsterdam University Medical Centers, Location Academic Medical Center; Perelman School of Medicine at the University of Pennsylvania; and European Atherosclerosis Society.

Objective The aim was to screen lipid profile in pregnancy and assess the association between sec... more Objective The aim was to screen lipid profile in pregnancy and assess the association between second trimester maternal lipid profile and gestational outcome. Background Major changes in lipid profile occur during normal pregnancy and significant association with gestational complications could be confirmed. Materials and methods This cohort study included 94 women with maternal lipid profile assessed during the second trimester (16–18 weeks). Serial antenatal visits were conducted to record the development of maternal gestational hypertension (GH), preeclampsia (PE), gestational diabetes mellitus (GDM), and low birth weight. Results Lipid profile components in pregnancy are higher than normal references. Meanwhile, GH was the most common complication in the study affecting 13 (13.8%) patients followed by PE in eight (8.5%) patients, GDM in seven (7.4%) patients, and lastly low birth weight in four (4.3%) neonates. A positive association between second trimester lipid profile compon...

European Journal of Heart Failure, 2021

To perform a comprehensive characterization of acute heart failure (AHF) with preserved (HFpEF), ... more To perform a comprehensive characterization of acute heart failure (AHF) with preserved (HFpEF), versus mildly reduced (HFmrEF) versus reduced ejection fraction (HFrEF).

European Heart Journal, 2019

Background Egypt is the most populous country in Middle East and North Africa and has one of the ... more Background Egypt is the most populous country in Middle East and North Africa and has one of the highest rates of the cardiovascular (CV) deaths in the region. Despite governmental primary preventive efforts, very little is known about the prevalence and characteristics of premature coronary artery disease (CAD) among Egyptian patients with Acute Coronary syndrome (ACS). Methods From November 2015 to August 2018, data were collected from 3224 patients with ACS in 30 coronary care centers covering 11 governorates across Egypt, spanning the Mediterranean coast, Nile Delta, and Upper Egypt, with focus on premature CAD (defined as ACS before age 55 years in males and 65 years in females). Results The prevalence of premature CAD was 51%. They were significantly more females (35% versus 16%, P<0.001) with significantly higher level of education. Risk factors' (RFs) distribution showed a significantly higher prevalence of Type-1 Diabetes Mellitus (6% versus 4%, P=0.005), obesity (42...

JACC. Heart failure, 2018

This study compared the performance of major heart failure (HF) risk models in predicting mortali... more This study compared the performance of major heart failure (HF) risk models in predicting mortality and examined their utilization using data from a contemporary multinational registry. Several prognostic risk scores have been developed for ambulatory HF patients, but their precision is still inadequate and their use limited. This registry enrolled patients with HF seen in participating European centers between May 2011 and April 2013. The following scores designed to estimate 1- to 2-year all-cause mortality were calculated in each participant: CHARM (Candesartan in Heart Failure-Assessment of Reduction in Mortality), GISSI-HF (Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico-Heart Failure), MAGGIC (Meta-analysis Global Group in Chronic Heart Failure), and SHFM (Seattle Heart Failure Model). Patients with hospitalized HF (n = 6,920) and ambulatory HF patients missing any variable needed to estimate each score (n = 3,267) were excluded, leaving a final ...

European Journal of Echocardiography, 2003

Background:. Valsalva maneuver was used to differentiate normal from pseudonormal mitral flow pat... more Background:. Valsalva maneuver was used to differentiate normal from pseudonormal mitral flow pattern. Doppler tissue imaging (DTI), differentiates normal from abnormal diastolic function. Aim of the Work: Assessment of Valsalva maneuver as a mean to differentiate pseudonormal from normal mitral flow pattern (MFP), using pulsed-wave DTI Patients and Methods: sixty patients with dilated cardiomyopathy (EF<40%), sinus rhythm and pseudonormalized MFP were selected. Transmitral flow velocity curve (MFVC), before and during Valsalva maneuver was recorded. Peak early mitral filling (Em), peak atrial filling (Am) and Em/Am were measured before and during Valsalva. After Valsalva patients were classified into two groups. Group I included 24 patients with Em/Am <1 and group II, 36 patients with Em/Am >1. Pulsed-wave DTI was recorded at septal, lateral, inferior and anterior aspect of the mitral annulus from apical 4 and 2 chamber views. The mean peak early velocity (Ea), Peak atrial (Aa), and Ea/Aa of the 4 sites were measured from DTI derived velocity curve for each patient. The results were compared with the MFP. Results: Valsalva maneuver was able to detect a hidden relaxation abnormality in 40% of patients where Em/Am became <1 with significantly prolonged deceleration time (DT), and isovolumetric relaxation time (IVRT). However, 60% of patients the Em/Am remained >1 with slightly prolonged DT and IVRT. Pulsed-wave DTI detected relaxation abnormality in all patients. They had Ea/Aa 0.79±0.11, prolonged DT and IVRT. Group 1 had higher EF (36.71% vs. 32.87%), higher Ea (6.1±0.68 vs 5.3±0.1cm/s), lower Aa (7.9±2.012 vs 8.1±1.91 cm/s) and higher Ea/Aa ratio (0.77 vs 0.65) than group II patients. These data may denote that it was a progression of diastolic dysfunction with or without a hemodynamic factor that was responsible for the persistence of pseudonormalized pattern during Valsalva. Conclusion: Patient uncoperation, less sensitivity, and specificity are the major limitations Valsalva maneuver in assessment of patients with pseudonormalized MFP.Doppler tissue imaging is a simple noninvasive bedside technique with less load dependence. it can be used in combination with MFP for better understanding and assessment of diastolic dysfunctionin those patients. 156 Echocardiographic diastolic dysfunction parameters and mitral regurgitation are predictors of pulmonary hypertension in left ventricular dysfunction.

European Journal of Echocardiography, 1999

European Journal of Echocardiography, 2011

Bicuspid aortic valve and associated congenital cardiac malformations in children LJ. Gong; ZK. Y... more Bicuspid aortic valve and associated congenital cardiac malformations in children LJ. Gong; ZK. Ye; ZW. Zeng; MY. Xia; Y. Zhong; Y. Yao Fuwai cardiovascular hospital, Beijing, China, People's Republic of Objectives: To determine the clinical morphology of congenital bicuspid aortic valves (BAV) and its relationship with congenital cardiac malformations in children. Methods: 252 patients (age,18 years old) with BAV who were identified by transthoracic echocardiography were included. All patients were divided into two groups, group 1 was ≤3 y, and group 2 was .3 y. To estimate the frequency of BAV associated with other cardiac malformations in all patients and to analyze BAV and the frequency of major congenitally cardiac malformations by age and sex roughly. Results: The mean age of the patients was 3y (1 day-17.9 years), males 188 (67.4%), females 64 (32.5%). R-L phenotype (absence of the inter coronary commissure) was the most common(71.4%), both in patients with isolated BAV (58.9%) and in those with additional pathology. L-N phenotype was rarely (1.6%), and 2 of 4 patients with this pattern had no other structural abnormality. The majority of patients with coarctation (82.4 %) and left heart obstructive lesions (80%) had R-L phenotype, non-left heart defects (79.8 %) had R-L phenotype. The difference between the numbers of aortic stenosis(AS) and aortic regurgitation(AR) of BAV patients was not remarkable. AR was observed in 20.2% of BAV patients. In R-L phenotype,most patients associated with AS(80.6%, P,0.05). Compared with the other two BAV types, patients with R-N phenotype were more likely to have at least moderate AR(78.4%, P,0.05) or AS and AR (74%, P,0.05). In male group: intracardiac shunt, coarctation and congenital mitral valve disease were common than female in ,3y group. In group2: Intracardiac shunt and congenital mitral valve disease were most common in male. BAV in conjunction with aortic coarctation was associated with a lower prevalence of valve stenosis and regurgitation. In group 1, inracardiac shun, coarctation and congenital mitral valve disease were common in male than female. In group 2, intracardiac shunt and congenital mitral valve disease were most common in male group than female, but the prevalence of coarctation was not too high. Most aortic coarctation tended to be younger boys. Conclusions: Different morphologies of BAV were associated with different cardiac abnormalities, especially left-heart obstructive lesions. The AS was most often observed in patients with R-L phenotype. Most of AR and/or both of AS and AR could be observed in patients with R-N phenotype. Boys with BAV had higher risk of aortic coarctation and congenital mitral valve abnormalities than girls in ≤3 years group, but this difference decreased between sex in .3 years group.

European Journal of Echocardiography, 1999

European Journal of Echocardiography, 1999

Clinical Research in Cardiology

New England Journal of Medicine, 2012

Background The effect of intensified platelet inhibition for patients with unstable angina or myo... more Background The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. Methods In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75 mg daily). In a secondary analysis involving 2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel. Results At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel group (hazard ratio in the prasugrel group, 0.91; 95% confidence interval [CI], 0.79 to 1.05; P = 0.21). Similar results were observed in the overall population. The prespecified analysis of multiple recurrent ischemic events (all components of the primary end point) suggested a lower risk for prasugrel among patients under the age of 75 years (hazard ratio, 0.85; 95% CI, 0.72 to 1.00; P = 0.04). Rates of severe and intracranial bleeding were similar in the two groups in all age groups. There was no significant between-group difference in the frequency of nonhemorrhagic serious adverse events, except for a higher frequency of heart failure in the clopidogrel group. Conclusions Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed.

Pharmacological Research, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Atherosclerosis, 2016

Objectives: The study is focused on police officers whose occupation is deemed highly stressful. ... more Objectives: The study is focused on police officers whose occupation is deemed highly stressful. We aimed to assessed whether stress was related to metabolic syndrome (MetS) and its components, and to the presence of coronary artery plaque.

Atherosclerosis, 2019

abdominal aortic malondialdehyde (MDA) levels in the hypercholesterolemia rat model induced by sh... more abdominal aortic malondialdehyde (MDA) levels in the hypercholesterolemia rat model induced by shortening. Methods: A total of 19 stored biological material samples in the form of Wistar abdominal aortic organs were divided into 5 groups, namely the negative control group (C-) only received standard food, positive control group (C +) were given a high-fat diet and standard food, the T1 group was given standard food, high-fat diet, and probiotics at a dose of 1.65x cfu/kg, T2 group given standard food, high-fat diet, and probiotic dose 5.5x cfu/kg, T3 group given standard food, high-fat diet, and probiotics dose 1.65x cfu/ kg. This treatment was given for 10 weeks then the data obtained were analyzed using the Kruskal Wallis test with Mann-Whitney post hoc. Results: The mean of MDA levels were C-group (1.78 ± 0.11 nmol/gram), T3 group (2.20 ± 0.06 nmol/gram), T2 group (3.46 ± 0.16 nmol/gram), T1 group (4.02 ± 0.02 nmol/gram), and C + group (5.23 ± 0.51 nmol/gram). The data analysis showed a significant difference in abdominal aortic MDA levels (p <0.05). Conclusions: There is an effect of probiotics on MDA levels in the abdominal aorta in hypercholesterolemic rats model induced by shortening.

European Journal of Echocardiography, 2003

Background: Hypertension is a multifaceted, multifactorial disease. It has a polygenetic bases. I... more Background: Hypertension is a multifaceted, multifactorial disease. It has a polygenetic bases. Intact endothelium plays a central role in vasomotion and blood pressure control. Aim of the work: was to assess endothelial mediated vasodilatation as an indicator of endothelial function in normotensive healthy siblings of hypertensive patients. Methods: Forty healthy normotensive siblings of hypertensive patients with mean age 29.4±4.3, and no other risk factors.Twenty age and sex comparable healthy control individuals were selected. After full history, clinical examination, and laboratory investigation echocardiographic examination was done and left ventricular mass index was calculated (LVMI). Duplex ultrasonsgraphy of the right brachial artery was done through a previously well defined segment. Peak flow velocity (PFV), and brachial artery diameter were measured by pulsed wave and B-mode ultrasonography 30 sec before inflation (D1), of a pneumatic tourniquet to a pressure of 250 mmHg for 3-5 minutes at the forearm proximal to the site of arterial scanning and 90 sec after deflation (D2). After 15 minutes for vessel recovery a second resting scan was taken and the diameter of the brachial artery (D3), was measured then nitroglycerin spray 400 ?g was given sublingually and the measurements were repeated after 3-5 minutes (D4). Simultaneous electrocardiographic recording was done for timing. Percentage flow mediated dilatation (FMD) and nitroglycerine mediated dilatation (NMD), were calculated as D2-D1/D1X100 and D4-D3/D3X100. Results: normotensive healthy siblings of hypertensive patients had a significantly higher LVMI (P<0.05)and a significantly lower percentage FMD compared to normotensive healthy controls (P<0.05). There was no significant difference as regard to percentage NMD between siblings and controls (P>0.05). Because FMD is endothelial dependent response, the impaired percentage FMD means that normtensive, risk factors free siblings of hypertensive patients had endothelial dysfunction Conclusion: healthy normotensive siblings of hypertensive patients had endothelial dysfunction. It may play a role in the pathogenesis of hypertension and may have a genetic bases. 428 Peripheral endothelial function and left ventricular hypertrophy in patients with essential hypertension.

Journal of Public Health in Africa (JPHiA), 2021

Background: Little are known about the prevalence of atherosclerosis risk factors in Egyptian pat... more Background: Little are known about the prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndromes (ACS). Objective: Describe the prevalence of these risk factors with focus on gender-specific data and patients with premature presentation. Methods: From November 2015 to August 2018, data were collected from 3224 patients with ACS in 30 coronary care centers covering 11 governorates across Egypt, with focus premature ACS. Results: The vast majority were males (74%) and the most prevalent age group was (56-65 years) representing 37% of whole study population. Among female patients, 92% were post-menopausal. The prevalence of premature ACS was 51%. Forty five percent of total males and 69.6% of total females with ACS had premature presentation (P<0.001). Abdominal obesity was the most prevalent risk factor (66%). Nearly half of the entire study patients were current smokers (48%). We showed a high prevalence of documented dyslipidemia
(48%) as well. Early invasive management
strategy was employed in 65% of patients
with no significant gender disparity noticed.
Vascular access for coronary angiography
was most commonly femoral (80% of time).
Emergent percutaneous coronary intervention
(PCI) was attempted in 53% of
patients. Thrombolytic therapy (using
Streptokinase) was used in 24% of included
participants.
Conclusion: Among Egyptian patients
with ACS, premature presentation is common
with greater male preponderance.
Abdominal obesity is the most prevalent
risk factor followed by hypertension. Most
traditional risk factors (apart from smoking)
were more prevalent in women than men.

Journal of Cachexia, Sarcopenia and Muscle, 2022

The Lancet, 2022

BACKGROUND Homozygous familial hypercholesterolaemia (HoFH) is a rare inherited disorder resultin... more BACKGROUND Homozygous familial hypercholesterolaemia (HoFH) is a rare inherited disorder resulting in extremely elevated low-density lipoprotein cholesterol levels and premature atherosclerotic cardiovascular disease (ASCVD). Current guidance about its management and prognosis stems from small studies, mostly from high-income countries. The objective of this study was to assess the clinical and genetic characteristics, as well as the impact, of current practice on health outcomes of HoFH patients globally. METHODS The HoFH International Clinical Collaborators registry collected data on patients with a clinical, or genetic, or both, diagnosis of HoFH using a retrospective cohort study design. This trial is registered with ClinicalTrials.gov, NCT04815005. FINDINGS Overall, 751 patients from 38 countries were included, with 565 (75%) reporting biallelic pathogenic variants. The median age of diagnosis was 12·0 years (IQR 5·5-27·0) years. Of the 751 patients, 389 (52%) were female and 362 (48%) were male. Race was reported for 527 patients; 338 (64%) patients were White, 121 (23%) were Asian, and 68 (13%) were Black or mixed race. The major manifestations of ASCVD or aortic stenosis were already present in 65 (9%) of patients at diagnosis of HoFH. Globally, pretreatment LDL cholesterol levels were 14·7 mmol/L (IQR 11·6-18·4). Among patients with detailed therapeutic information, 491 (92%) of 534 received statins, 342 (64%) of 534 received ezetimibe, and 243 (39%) of 621 received lipoprotein apheresis. On-treatment LDL cholesterol levels were lower in high-income countries (3·93 mmol/L, IQR 2·6-5·8) versus non-high-income countries (9·3 mmol/L, 6·7-12·7), with greater use of three or more lipid-lowering therapies (LLT; high-income 66% vs non-high-income 24%) and consequently more patients attaining guideline-recommended LDL cholesterol goals (high-income 21% vs non-high-income 3%). A first major adverse cardiovascular event occurred a decade earlier in non-high-income countries, at a median age of 24·5 years (IQR 17·0-34·5) versus 37·0 years (29·0-49·0) in high-income countries (adjusted hazard ratio 1·64, 95% CI 1·13-2·38). INTERPRETATION Worldwide, patients with HoFH are diagnosed too late, undertreated, and at high premature ASCVD risk. Greater use of multi-LLT regimens is associated with lower LDL cholesterol levels and better outcomes. Significant global disparities exist in treatment regimens, control of LDL cholesterol levels, and cardiovascular event-free survival, which demands a critical re-evaluation of global health policy to reduce inequalities and improve outcomes for all patients with HoFH. FUNDING Amsterdam University Medical Centers, Location Academic Medical Center; Perelman School of Medicine at the University of Pennsylvania; and European Atherosclerosis Society.

Objective The aim was to screen lipid profile in pregnancy and assess the association between sec... more Objective The aim was to screen lipid profile in pregnancy and assess the association between second trimester maternal lipid profile and gestational outcome. Background Major changes in lipid profile occur during normal pregnancy and significant association with gestational complications could be confirmed. Materials and methods This cohort study included 94 women with maternal lipid profile assessed during the second trimester (16–18 weeks). Serial antenatal visits were conducted to record the development of maternal gestational hypertension (GH), preeclampsia (PE), gestational diabetes mellitus (GDM), and low birth weight. Results Lipid profile components in pregnancy are higher than normal references. Meanwhile, GH was the most common complication in the study affecting 13 (13.8%) patients followed by PE in eight (8.5%) patients, GDM in seven (7.4%) patients, and lastly low birth weight in four (4.3%) neonates. A positive association between second trimester lipid profile compon...

Atherosclerosis, 2024

Background and Aims: In Egypt, some studies, including the CardioRisk and CEPHEUS, highlight the ... more Background and Aims: In Egypt, some studies, including the CardioRisk and
CEPHEUS, highlight the prevalence of dyslipidemia and the suboptimal
achievement of LDL-C therapeutic targets. As PCSK-9 based therapies emerging,
evaluating current practices and goal attainment in lipid-lowering therapy in
Egypt is crucial.
Methods: This observational cross-sectional study investigated lipid-lowering
therapy (LLT) usage in primary and secondary cardiovascular prevention across
Egypt. Patients, aged 18 or above and on stable LLT for at least 2 months, were
enrolled during routine clinic visits. Data was collected via an electronic case
report form (eCRF). The study aimed to understand the prescription patterns and
LLT's role in achieving LDL-C goals as per the 2019 ESC/EAS guidelines, focusing
on patients with stabilized LLT.
Results: In the period from September 2022 to October 2023, we enrolled 702
patients in the phase-I of the study (mean age 60
11 years, 47% females). Fifty
one percent were taking LLT for primary prevention, and 49% for secondary
prevention. Ninety nine percent of the total population were on statins (53%
high-intensity, 46% moderate-intensity, and 0.4% low-intensity statins). Generic
forms of statins were used in 64% of cases. Combination therapy with Ezetimibe
was used in 45% of cases. Only 1.1% of cases were on PCSK-9 based therapy (all
of them were receiving monoclonal antibodies). Regression analysis showed that
old age, female gender, and low CV risk category were significant independent
predictors for not using high-intensity statins. According to 2019 ESC guidelines,
percentages of patients achieving their risk-based goals were 28%, 37%, 71%,
and 41% in the very high-risk, high-risk, moderate-risk, and low risk categories
respectively.
Conclusions: Egyptian clinical practices still don't fully align with guidelines for
managing cholesterol. There's a need for increased use of non-statin lipidlowering
treatments, even alongside optimized statin therapy