Publications by authors named "Mohamed Effat"

Background: Evaluating the severity of aortic stenosis (AS) can be challenging, particularly in patients with low-gradient (LG, Δp < 40 mmHg) AS.

Objective: This study aims to improve the accuracy of assessing severity of AS using a novel functional index- Aortic Valve Coefficient (AVC). The AVC is defined as ratio of mean transvalvular pressure-drop (Δp) to the proximal dynamic pressure (1/2 × blood density × V; V: left ventricular outflow tract peak velocity).

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  • The hyperaemic stenosis resistance (HSR) index is a new measure that combines pressure drop and blood flow to provide a better assessment of coronary artery disease severity compared to traditional methods like fractional flow reserve (FFR) and coronary flow reserve (CFR).
  • This study analyzed data from 853 patients with chronic coronary syndromes to evaluate HSR's diagnostic and prognostic value, finding it to more accurately identify inducible ischaemia and predict long-term target vessel failure.
  • The results suggest HSR can help determine which obstructed vessels may benefit from treatment, reinforcing its potential as a superior tool in clinical practice for managing coronary artery disease.
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  • The microvascular resistance reserve (MRR) is a new index used to evaluate how well the coronary circulation can dilate, particularly in patients with coronary artery disease (CAD), and its assessment may require special considerations for women.
  • This study aimed to evaluate how effective the MRR is for diagnosis and prognosis in women compared to men, using data from the ILIAS Registry.
  • Results showed that MRR is a significant predictor of major adverse cardiac events (MACE) for both sexes, with similar correlations and cut-off values for predicting outcomes in women and men.
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  • This study evaluates the prognostic value of coronary pressure and flow parameters in patients who did not undergo revascularization due to borderline readings.
  • It included 1,971 blood vessels, and found that abnormal pressure and flow metrics significantly predicted long-term risks of target vessel failure (TVF), myocardial infarction (MI), and cardiac death over five years.
  • The study concluded that both resting and hyperemic conditions are important independent factors in predicting cardiac events, with their abnormal flow readings providing additional prognostic information.
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  • Microvascular resistance (MR) is important in assessing patient outcomes after coronary procedures, but its changes and links to target vessel failure (TVF) haven’t been thoroughly studied before.
  • This research analyzed data from the ILIAS registry, focusing on the relationship between MR changes and TVF outcomes in post-percutaneous coronary intervention (PCI) patients, involving 295 vessels from 828 patients.
  • Findings showed that an increase in MR post-PCI was linked to higher rates of TVF, indicating that patients with less severe baseline conditions might have worse outcomes if MR increases after the procedure.
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Background And Aims: The management of chronic coronary syndrome (CCS) is informed by studies predominantly including men. This study investigated the relationship between patients sex and different endotypes of CCS, including sex-specific clinical outcomes.

Methods: In patients with CCS undergoing coronary angiography, invasive Fractional Flow Reserve (FFR) and Coronary Flow Reserve (CFR) were measured.

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  • The study focuses on the microvascular resistance reserve (MRR) as a way to evaluate the vasodilator capacity of the coronary microcirculation while considering the effects of epicardial disease.
  • It involved 1,481 patients and found a good correlation between MRR and coronary flow reserve (CFR), indicating MRR’s potential as a reliable measure.
  • MRR was associated with major adverse cardiac events (MACE) and target vessel failure (TVF) over five years, suggesting it could be a better diagnostic tool than other measures in patients with significant epicardial coronary artery disease.
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The prognostic value of abnormal resting Pd/Pa and coronary flow reserve (CFR) after fractional flow reserve (FFR)-guided revascularisation deferral according to sex remains unknown. From the ILIAS Registry composed of 20 hospitals globally from 7 countries, patients with deferred lesions following FFR assessment (FFR > 0.8) were included.

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Objective: The aim of this study is to evaluate the diagnostic and prognostic value of non-hyperaemic Pd/Pa and to determine its additional value when combined with the gold standard hyperaemic pressure ratio (FFR) to guide revascularization.

Methods: In a large, multi-center, retrospective registry, we included a total of 2141 patients with a clinical indication for coronary angiography providing physiological data in 2726 vessels. A classification was made based on the FFR (cut-off value: 0.

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Background Intracoronary physiologic indexes such as coronary flow reserve (CFR) and left ventricular ejection fraction (LVEF) have been regarded as prognostic indicators in patients with coronary artery disease. The current study evaluated the association between intracoronary physiologic indexes and LVEF and their differential prognostic implications in patients with coronary artery disease. Methods and Results A total of 1889 patients with 2492 vessels with available CFR and LVEF were selected from an international multicenter prospective registry.

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Background: Coronary microvascular dysfunction (CMD) is an important contributor to angina syndromes. Recently, two distinct endotypes were identified using combined assessment of coronary flow reserve (CFR) and minimal microvascular resistance (MR), termed structural and functional CMD.

Aims: We aimed to assess the relevance of the combined assessment of CFR and MR in patients with angina and no obstructive coronary arteries.

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Background: Coronary pressure indices such as fractional flow reserve are the standard for guiding elective revascularization. However, considering additional coronary flow parameters could further individualize and optimize the decision on revascularization. We aimed to investigate the potentially differential prognostic associations of elective percutaneous coronary intervention (PCI) according to coronary flow properties represented by coronary flow reserve (CFR), coronary flow capacity (CFC), and baseline CFC (bCFC).

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Objectives: The aim of this study was to demonstrate the clinical implications of combined assessment of fractional flow reserve (FFR) and coronary flow reserve (CFR).

Background: Combined assessment of FFR and CFR allows detailed characterization of pathophysiology in chronic coronary syndromes. Data on the clinical implications of distinct FFR and CFR patterns are limited, leading to uncertainty regarding their relevance.

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Objectives: The authors sought to evaluate comparative prognosis between deferred versus performed percutaneous coronary intervention (PCI) according to coronary flow reserve (CFR) values of patients with intermediate fractional flow reserve (FFR).

Background: For coronary stenosis with intermediate FFR, the prognostic value of PCI remains controversial. The prognostic impact of PCI may be different according to CFR in patients with intermediate FFR.

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Background In the absence of obstructive coronary stenoses, abnormality of noninvasive stress tests (NIT) in patients with chronic coronary syndromes may indicate myocardial ischemia of nonobstructive coronary arteries (INOCA). The differential prognosis of INOCA according to the presence of coronary microvascular dysfunction (CMD) and incremental prognostic value of CMD with intracoronary physiologic assessment on top of NIT information remains unknown. Methods and Results From the international multicenter registry of intracoronary physiologic assessment (ILIAS [Inclusive Invasive Physiological Assessment in Angina Syndromes] registry, N=2322), stable patients with NIT and nonobstructive coronary stenoses with fractional flow reserve >0.

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This case highlights the importance of having constrictive pericarditis (CP) as a differential diagnosis in unexplained sign and symptoms of right-sided heart failure. This case portrays challenges in diagnosing CP caused by certain rheumatologic diseases despite advances in diagnostic modalities, clinical suspicion remains the most important tool for this diagnosis.

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Background: The current pressure-based coronary diagnostic index, fractional flow reserve (FFR), has a limited efficacy in the presence of microvascular disease (MVD). To overcome the limitations of FFR, the objective is to assess the recently introduced pressure drop coefficient (CDP), a fundamental fluid dynamics-based combined pressure-flow index.

Methods: We hypothesize that CDP will result in improved clinical outcomes in comparison to FFR.

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Pectus excavatum is the most common congenital chest wall deformity. Its effects on cardiopulmonary function, exercise capacity, and body image are variable across affected patients. Management practices for pectus deformity vary considerably, but most authors agree on the need for surgical correction if pectus index is >3.

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A 47-year-old woman presented with atypical chest pain and a troponin level of 30.15 ng/dl. A detailed diagnostic work-up did not detect an acute myocardial infarction but revealed the presence of heterophile antibodies.

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Objectives: We investigated the role of a new intravascular ultrasound (IVUS)-guided stenting strategy versus angiography on optimal stent expansion (OSE) and procedural outcomes in patients with positive lesion remodeling.

Background: There are no IVUS criteria on how to achieve OSE.

Methods: A total of 100 patients were assigned to a new IVUS-guided stenting strategy (IVUS group) versus angiography-guided stenting (Angio group).

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Warfarin is one of the most commonly used anticoagulants in the management of thromboembolic events. Herein we report a rare case of warfarin induced leukocytoclastic vasculitis in a patient with history of rheumatic heart disease and a mechanical mitral valve prosthesis who presented with heart failure and palpable purpura. Upon clinical suspicion of cutaneous small vessel vasculitis, a comprehensive laboratory panel was performed.

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Coronary artery fistulae (CAF) are rare congenital or acquired in which a connection forms between one of the coronary arteries and a heart chamber or with other vessels. This paper describes three cases of CAF along with their initial presentation, imaging findings and management. The first case is a rare form of CAF in which the left circumflex coronary artery fistula empty into left ventricle.

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The incidence of acute myocardial infarction in the setting of acute pancreatitis is very rare. The recognition of such complex diagnosis may be clinically challenging, as the symptoms of both conditions are often indistinguishable. We report a case in which we encountered both conditions concurrently, and hypothesize that the ambient inflammatory and pro-thrombotic milieu of acute pancreatitis resulted in acute coronary thrombosis despite the absence of significant coronary atherosclerosis.

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Background: Transient receptor potential vanilloid 2 is a calcium channel activated by probenecid. Probenecid is a Food and Drug Administration-approved uricosuric drug that has recently been shown to induce positive lusitropic and inotropic effects in animal models through cardiomyocyte transient receptor potential vanilloid 2 activation. The aim of this study was to test the hypothesis that oral probenecid can improve cardiac function and symptomatology in patients with heart failure with reduced ejection fraction and to further elucidate its calcium-dependent effects on myocyte contractility.

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