Elsayed Abo-salem | University of Cincinnati (original) (raw)

Papers by Elsayed Abo-salem

Journal of the American College of Cardiology, 2015

Acta cardiologica, 2014

One third of patients hospitalized for acute decompensated heart failure (ADHF) develop a worseni... more One third of patients hospitalized for acute decompensated heart failure (ADHF) develop a worsening renal function (WRF) that is associated with increased in-hospital morbidity and mortality. However, previous investigations have not evaluated the various etiologies of WRF and its impact on prognosis. A retrospective chart review was performed of patients admitted with ADHF who had a rise of serum creatinine ≥ 0.3 mg/dl on admission or during their hospital stay. The chart notes were reviewed for the suggested etiology of WRF. Cases were defined as ADHF associated WRF (ADHF-WRF) when there was no other explanation for WRF, plus an objective evidence of hypervolemia. Cases with WRF after 48 hours of a negative fluid balance were classified as diuresis-associated WRF (DA-WRF). ICD-9 codes identified 319 admissions with ADHF complicated with WRF. Fifty admissions were excluded. The most common causes of WRF were ADHF-WRF (43.1%) and DA-WRF (42.8%). Other causes included nephrotoxins (5...

Journal of Cardiac Surgery, 2015

We report a case of pulmonary vein stenosis following a standalone minimally invasive surgical ab... more We report a case of pulmonary vein stenosis following a standalone minimally invasive surgical ablation for atrial fibrillation. The etiology, diagnosis, and management of this complication are the subject of this review. doi: 10.1111/jocs.12579 (J Card Surg 2015;30:619-621).

Journal of the American College of Cardiology, 2015

Journal of the American College of Cardiology, 2015

Journal of the American College of Cardiology, 2015

Clinical Cardiology, 2014

Patients with chronic kidney disease (CKD) are at increased risk of life-threatening cardiovascul... more Patients with chronic kidney disease (CKD) are at increased risk of life-threatening cardiovascular arrhythmias. Although these arrhythmias are usually secondary to structural heart diseases that are commonly associated with CKD, a significant proportion of cases with sudden cardiac death have no obvious structural heart disease. This study aims to explore the relationship of cardiac repolarization in patients with CKD and worsening kidney function. There is cardiac repolarization abnormalities among patients with chronic kidney disease. This was a retrospective, chart-review study of admissions or clinic visits to a university hospital between 2005 and 2010 by patients with a diagnosis of CKD. Inclusion criteria selected patients who had 12-lead surface electrocardiography (ECG), renal function tests within 24 hours, and transthoracic echocardiography within 6 months. Cases with a documented etiology for the corrected Qt (Qtc) interval prolongation including structural heart disease, QT prolonging drugs, or relevant disease conditions, were excluded. Our sample size was 154 ECGs. Two-thirds of patients with CKD had QTc interval prolongation, and about 20% had a QTc interval >500 ms. QTc interval was significantly different and increased with each successive stage of CKD using the Bazett (P < 0.006) or Fridericia (P = 0.03) formula. QTc interval correlated significantly with serum creatinine (P = 0.01). These finding were independent of age, gender, potassium, and calcium concentrations. The progression of CKD resulted in a significant delay of cardiac repolarization, independent of other risk factors. This effect may potentially increase the risk of sudden cardiac death, and may also increase the susceptibility of drug-induced arrhythmia.

Journal of the American Geriatrics Society, 2011

The incidence of heart failure is higher in African-American men than in the general population. ... more The incidence of heart failure is higher in African-American men than in the general population. 6 This racial disparity has been attributed to the higher prevalence and worse severity of hypertension in this cohort. A contributing factor may be the higher prevalence of cardiac amyloidosis from TTR misfolding. 7 In the Beta-blocker Evaluation of Survival Trial, 10% of African-American participants aged 60 and older were found to be carriers of the mutant TTR allele v122I. This mutation, which results in misfolded TTR proteins that are precursors to the amyloid deposits, has an age-dependent penetrance and rarely manifests before the age of 60. Accordingly, it has been found to contribute to cardiac function decline and high mortality after the age of 65. 8 Recently, pharmacological therapies have been developed that stabilize the TTR protein, preventing it from forming intermediate forms that have a strong tendency to misfold and subsequently deposit in the myocardium. 9 Such therapies are preventive in nature and ideally would be initiated before irreversible cardiovascular structural and functional changes.

Journal of the American Geriatrics Society, 2010

Journal of the American College of Cardiology, 2014

background:Acute kidney injury (AKI) is a common complication among patients with acute heart fai... more background:Acute kidney injury (AKI) is a common complication among patients with acute heart failure (AHF) (30%) and is associated with increased in-hospital mortality and readmission. Limited data are available about the impact of left ventricular systolic function on the prognosis of these patients.

Journal of Cardiac Surgery, 2013

Trials to maintain sinus rhythm in patients with atrial fibrillation (AF) and refractory symptoms... more Trials to maintain sinus rhythm in patients with atrial fibrillation (AF) and refractory symptoms have been complicated by lack of success or intolerance of medications. Experience with minimally invasive AF surgery is relatively new, and early results have been promising. However, the study populations and techniques were heterogeneous, and the follow-up periods were short in many series. We present a single center experience through a retrospective review of medical records of patients who had minimally invasive AF surgery. The surgical techniques addressed several possible mechanisms of AF and causes of recurrence, including pulmonary vein isolation, underlying substrates modification, ligament of Marshall interruption, ganglion plexus ablation, and left atrial appendage exclusion. Thirty-three cases were identified. The mean duration of follow-up was 23.2 months, and 58.6% were maintained in a sinus rhythm and were off antiarrhythmic drugs at the end of the follow-up period. Cases with persistent AF had a lower success rate. Results with minimally invasive surgery are suboptimal at two years of follow-up, particularly for patients with persistent AF.

Circulation, 2014

Introduction: The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent i... more Introduction: The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent implantation (DES) is not certain. The AHA/ACC guidelines recommend 12 months of DAPT based on observational trials. Recently, several large randomized controlled trials (RCT) suggested a noninferiority of shorter duration of DAPT and other trials showed a benefit from extended duration of DAPT after 12 months of DES implantation. Methods: Pub-Med databases were searched for RCTs comparing the continued use of DAPT to shorter duration of DAPT (aspirin alone) for variable durations beyond 3 months of DES implantation. Our analysis was limited to trials with clinical outcomes. Odds ratio (OR) and 95% confidence intervals (CI) were calculated using fixed and random-effects models. Subgroup analyses were performed for second generation DES and for trials comparing 12 months of DAPT vs. earlier interruption or longer duration of DAPT. Results: We identified 10 RCTs including 32,136 subjects randomized to continued use of DAPT vs. aspirin alone for variable durations after 3 months of DES implantation. There was no significant heterogeneity among studies (Q test P > 0.1). Compared to shorter DAPT, longer DAPT resulted in a significant reduction in stent thrombosis (0.3% vs. 0.7%, P < 0.01) and myocardial infarction (1.3% vs. 2%, P < 0.01), and a significant increase in major bleeding (0.8% vs. 0.4%, P < 0.01). There was no difference in cardiac deaths or stroke. All-cause deaths were slightly lower with shorter DAPT compared to longer DAPT (OR 0.8, 95% CI 0.7 to 0.99, P = 0.04). A small number of subjects were included between 3 and 6 months after DES implantation. Conclusion: DAPT continued beyond 6 months after second generation DES implantation decreases stent thrombosis and myocardial infarction, but increases major bleeding and all-causes mortality compared to shorter DAPT (aspirin alone). There was no difference in cardiac mortality or stroke.

Cardiovascular Therapeutics, 2014

This review aims to clarify the underlying risk of arrhythmia associated with the use of macrolid... more This review aims to clarify the underlying risk of arrhythmia associated with the use of macrolides and fluoroquinolones antibiotics. Torsades de pointes (TdP) is a rare potential side effect of fluoroquinolones and macrolide antibiotics. However, the widespread use of these antibiotics compounds the problem. These antibiotics prolong the phase 3 of the action potential and cause early after depolarization and dispersion of repolarization that precipitate TdP. The potency of these drugs, as potassium channel blockers, is very low, and differences between them are minimal. Underlying impaired cardiac repolarization is a prerequisite for arrhythmia induction. Impaired cardiac repolarization can be congenital in the young or acquired in adults. The most important risk factors are a prolonged baseline QTc interval or a combination with class III antiarrhythmic drugs. Modifiable risk factors, including hypokalemia, hypomagnesemia, drug interactions, and bradycardia, should be corrected. In the absence of a major risk factor, the incidence of TdP is very low. The use of these drugs in the appropriate settings of infection should not be altered because of the rare risk of TdP, except among cases with high-risk factors.

European Journal of Cardio-Thoracic Surgery, 2005

In this review the efficacies of the alternative sources of energy (radiofrequency-microwave and ... more In this review the efficacies of the alternative sources of energy (radiofrequency-microwave and cryo ablation; group I) and the classical &amp;amp;amp;amp;#39;cut and sew&amp;amp;amp;amp;#39; Cox-Maze III (group II), which claims a 97-99% sinus rhythm (SR) success rate, were evaluated in the surgical treatment of atrial fibrillation (AF). A computerized search in the PubMed and Medline database was conducted. Only original, English written, clinical manuscripts on the surgical treatment of atrial fibrillation using an alternative source of energy or the classical &amp;amp;amp;amp;#39;cut and sew&amp;amp;amp;amp;#39; Cox-Maze III technique, citing the clinical outcome, including the postoperative sinus rhythm, were included. The data included in this review were the number and percentage of treated patients, gender distribution, the type of arrhythmia and surgery, postoperative morbidity, pacemaker implantation rate, 30-day mortality, survival- and sinus rhythm conversion rates. Mean values for age, left atrial diameter, preoperative duration of AF and left ventricular ejection fraction were also recorded. Forty-eight studies were included comprising 3832 patients; 2279 in group I and 1553 in group II. The mean duration of AF, left atrial diameter and LVEF were 5.4 vs. 5.5 years (p=0.90), 55.5 vs. 57.8 mm (p=0.23) and 57 vs. 58% (p=0.63). The postoperative SR rates for group I and II were 78.3 vs. 84.9% (p=0.03). However, the &amp;amp;amp;amp;quot;cut and sew&amp;amp;amp;amp;quot; Cox-Maze III was conducted in younger patients (55.0 vs. 61.2 years; p=0.005), more often to treat paroxysmal (22.9 vs. 8.0%; p=0.05) and lone AF (19.3 vs. 1.6%). Alternative sources of energy were predominantly used to treat permanent AF (92.0%), almost always as a concomitant surgical procedure (98.4%) and increasingly in combination with non-mitral valve surgery (18.5%). After correction for these variations, the postoperative SR conversion rates for group I and II did not differ significantly anymore (p=0.260). We could not identify any significant difference in the postoperative SR conversion rates between the classical &amp;amp;amp;amp;#39;cut and sew&amp;amp;amp;amp;#39; and the alternative sources of energy, which were used to treat atrial fibrillation.

Journal of the American College of Cardiology, 2015

Acta cardiologica, 2014

One third of patients hospitalized for acute decompensated heart failure (ADHF) develop a worseni... more One third of patients hospitalized for acute decompensated heart failure (ADHF) develop a worsening renal function (WRF) that is associated with increased in-hospital morbidity and mortality. However, previous investigations have not evaluated the various etiologies of WRF and its impact on prognosis. A retrospective chart review was performed of patients admitted with ADHF who had a rise of serum creatinine ≥ 0.3 mg/dl on admission or during their hospital stay. The chart notes were reviewed for the suggested etiology of WRF. Cases were defined as ADHF associated WRF (ADHF-WRF) when there was no other explanation for WRF, plus an objective evidence of hypervolemia. Cases with WRF after 48 hours of a negative fluid balance were classified as diuresis-associated WRF (DA-WRF). ICD-9 codes identified 319 admissions with ADHF complicated with WRF. Fifty admissions were excluded. The most common causes of WRF were ADHF-WRF (43.1%) and DA-WRF (42.8%). Other causes included nephrotoxins (5...

Journal of Cardiac Surgery, 2015

We report a case of pulmonary vein stenosis following a standalone minimally invasive surgical ab... more We report a case of pulmonary vein stenosis following a standalone minimally invasive surgical ablation for atrial fibrillation. The etiology, diagnosis, and management of this complication are the subject of this review. doi: 10.1111/jocs.12579 (J Card Surg 2015;30:619-621).

Journal of the American College of Cardiology, 2015

Journal of the American College of Cardiology, 2015

Journal of the American College of Cardiology, 2015

Clinical Cardiology, 2014

Patients with chronic kidney disease (CKD) are at increased risk of life-threatening cardiovascul... more Patients with chronic kidney disease (CKD) are at increased risk of life-threatening cardiovascular arrhythmias. Although these arrhythmias are usually secondary to structural heart diseases that are commonly associated with CKD, a significant proportion of cases with sudden cardiac death have no obvious structural heart disease. This study aims to explore the relationship of cardiac repolarization in patients with CKD and worsening kidney function. There is cardiac repolarization abnormalities among patients with chronic kidney disease. This was a retrospective, chart-review study of admissions or clinic visits to a university hospital between 2005 and 2010 by patients with a diagnosis of CKD. Inclusion criteria selected patients who had 12-lead surface electrocardiography (ECG), renal function tests within 24 hours, and transthoracic echocardiography within 6 months. Cases with a documented etiology for the corrected Qt (Qtc) interval prolongation including structural heart disease, QT prolonging drugs, or relevant disease conditions, were excluded. Our sample size was 154 ECGs. Two-thirds of patients with CKD had QTc interval prolongation, and about 20% had a QTc interval &amp;amp;amp;amp;amp;amp;gt;500 ms. QTc interval was significantly different and increased with each successive stage of CKD using the Bazett (P &amp;amp;amp;amp;amp;amp;lt; 0.006) or Fridericia (P = 0.03) formula. QTc interval correlated significantly with serum creatinine (P = 0.01). These finding were independent of age, gender, potassium, and calcium concentrations. The progression of CKD resulted in a significant delay of cardiac repolarization, independent of other risk factors. This effect may potentially increase the risk of sudden cardiac death, and may also increase the susceptibility of drug-induced arrhythmia.

Journal of the American Geriatrics Society, 2011

The incidence of heart failure is higher in African-American men than in the general population. ... more The incidence of heart failure is higher in African-American men than in the general population. 6 This racial disparity has been attributed to the higher prevalence and worse severity of hypertension in this cohort. A contributing factor may be the higher prevalence of cardiac amyloidosis from TTR misfolding. 7 In the Beta-blocker Evaluation of Survival Trial, 10% of African-American participants aged 60 and older were found to be carriers of the mutant TTR allele v122I. This mutation, which results in misfolded TTR proteins that are precursors to the amyloid deposits, has an age-dependent penetrance and rarely manifests before the age of 60. Accordingly, it has been found to contribute to cardiac function decline and high mortality after the age of 65. 8 Recently, pharmacological therapies have been developed that stabilize the TTR protein, preventing it from forming intermediate forms that have a strong tendency to misfold and subsequently deposit in the myocardium. 9 Such therapies are preventive in nature and ideally would be initiated before irreversible cardiovascular structural and functional changes.

Journal of the American Geriatrics Society, 2010

Journal of the American College of Cardiology, 2014

background:Acute kidney injury (AKI) is a common complication among patients with acute heart fai... more background:Acute kidney injury (AKI) is a common complication among patients with acute heart failure (AHF) (30%) and is associated with increased in-hospital mortality and readmission. Limited data are available about the impact of left ventricular systolic function on the prognosis of these patients.

Journal of Cardiac Surgery, 2013

Trials to maintain sinus rhythm in patients with atrial fibrillation (AF) and refractory symptoms... more Trials to maintain sinus rhythm in patients with atrial fibrillation (AF) and refractory symptoms have been complicated by lack of success or intolerance of medications. Experience with minimally invasive AF surgery is relatively new, and early results have been promising. However, the study populations and techniques were heterogeneous, and the follow-up periods were short in many series. We present a single center experience through a retrospective review of medical records of patients who had minimally invasive AF surgery. The surgical techniques addressed several possible mechanisms of AF and causes of recurrence, including pulmonary vein isolation, underlying substrates modification, ligament of Marshall interruption, ganglion plexus ablation, and left atrial appendage exclusion. Thirty-three cases were identified. The mean duration of follow-up was 23.2 months, and 58.6% were maintained in a sinus rhythm and were off antiarrhythmic drugs at the end of the follow-up period. Cases with persistent AF had a lower success rate. Results with minimally invasive surgery are suboptimal at two years of follow-up, particularly for patients with persistent AF.

Circulation, 2014

Introduction: The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent i... more Introduction: The optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent implantation (DES) is not certain. The AHA/ACC guidelines recommend 12 months of DAPT based on observational trials. Recently, several large randomized controlled trials (RCT) suggested a noninferiority of shorter duration of DAPT and other trials showed a benefit from extended duration of DAPT after 12 months of DES implantation. Methods: Pub-Med databases were searched for RCTs comparing the continued use of DAPT to shorter duration of DAPT (aspirin alone) for variable durations beyond 3 months of DES implantation. Our analysis was limited to trials with clinical outcomes. Odds ratio (OR) and 95% confidence intervals (CI) were calculated using fixed and random-effects models. Subgroup analyses were performed for second generation DES and for trials comparing 12 months of DAPT vs. earlier interruption or longer duration of DAPT. Results: We identified 10 RCTs including 32,136 subjects randomized to continued use of DAPT vs. aspirin alone for variable durations after 3 months of DES implantation. There was no significant heterogeneity among studies (Q test P > 0.1). Compared to shorter DAPT, longer DAPT resulted in a significant reduction in stent thrombosis (0.3% vs. 0.7%, P < 0.01) and myocardial infarction (1.3% vs. 2%, P < 0.01), and a significant increase in major bleeding (0.8% vs. 0.4%, P < 0.01). There was no difference in cardiac deaths or stroke. All-cause deaths were slightly lower with shorter DAPT compared to longer DAPT (OR 0.8, 95% CI 0.7 to 0.99, P = 0.04). A small number of subjects were included between 3 and 6 months after DES implantation. Conclusion: DAPT continued beyond 6 months after second generation DES implantation decreases stent thrombosis and myocardial infarction, but increases major bleeding and all-causes mortality compared to shorter DAPT (aspirin alone). There was no difference in cardiac mortality or stroke.

Cardiovascular Therapeutics, 2014

This review aims to clarify the underlying risk of arrhythmia associated with the use of macrolid... more This review aims to clarify the underlying risk of arrhythmia associated with the use of macrolides and fluoroquinolones antibiotics. Torsades de pointes (TdP) is a rare potential side effect of fluoroquinolones and macrolide antibiotics. However, the widespread use of these antibiotics compounds the problem. These antibiotics prolong the phase 3 of the action potential and cause early after depolarization and dispersion of repolarization that precipitate TdP. The potency of these drugs, as potassium channel blockers, is very low, and differences between them are minimal. Underlying impaired cardiac repolarization is a prerequisite for arrhythmia induction. Impaired cardiac repolarization can be congenital in the young or acquired in adults. The most important risk factors are a prolonged baseline QTc interval or a combination with class III antiarrhythmic drugs. Modifiable risk factors, including hypokalemia, hypomagnesemia, drug interactions, and bradycardia, should be corrected. In the absence of a major risk factor, the incidence of TdP is very low. The use of these drugs in the appropriate settings of infection should not be altered because of the rare risk of TdP, except among cases with high-risk factors.

European Journal of Cardio-Thoracic Surgery, 2005

In this review the efficacies of the alternative sources of energy (radiofrequency-microwave and ... more In this review the efficacies of the alternative sources of energy (radiofrequency-microwave and cryo ablation; group I) and the classical &amp;amp;amp;amp;#39;cut and sew&amp;amp;amp;amp;#39; Cox-Maze III (group II), which claims a 97-99% sinus rhythm (SR) success rate, were evaluated in the surgical treatment of atrial fibrillation (AF). A computerized search in the PubMed and Medline database was conducted. Only original, English written, clinical manuscripts on the surgical treatment of atrial fibrillation using an alternative source of energy or the classical &amp;amp;amp;amp;#39;cut and sew&amp;amp;amp;amp;#39; Cox-Maze III technique, citing the clinical outcome, including the postoperative sinus rhythm, were included. The data included in this review were the number and percentage of treated patients, gender distribution, the type of arrhythmia and surgery, postoperative morbidity, pacemaker implantation rate, 30-day mortality, survival- and sinus rhythm conversion rates. Mean values for age, left atrial diameter, preoperative duration of AF and left ventricular ejection fraction were also recorded. Forty-eight studies were included comprising 3832 patients; 2279 in group I and 1553 in group II. The mean duration of AF, left atrial diameter and LVEF were 5.4 vs. 5.5 years (p=0.90), 55.5 vs. 57.8 mm (p=0.23) and 57 vs. 58% (p=0.63). The postoperative SR rates for group I and II were 78.3 vs. 84.9% (p=0.03). However, the &amp;amp;amp;amp;quot;cut and sew&amp;amp;amp;amp;quot; Cox-Maze III was conducted in younger patients (55.0 vs. 61.2 years; p=0.005), more often to treat paroxysmal (22.9 vs. 8.0%; p=0.05) and lone AF (19.3 vs. 1.6%). Alternative sources of energy were predominantly used to treat permanent AF (92.0%), almost always as a concomitant surgical procedure (98.4%) and increasingly in combination with non-mitral valve surgery (18.5%). After correction for these variations, the postoperative SR conversion rates for group I and II did not differ significantly anymore (p=0.260). We could not identify any significant difference in the postoperative SR conversion rates between the classical &amp;amp;amp;amp;#39;cut and sew&amp;amp;amp;amp;#39; and the alternative sources of energy, which were used to treat atrial fibrillation.