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Article ; Online: Advanced Heart Failure Therapies in The Eastern Mediterranean Region: Current Status, Challenges, and Future Directions.

Bader, Feras / Manla, Yosef / Ghalib, Hussam / AlMatrooshi, Nadya / Khaliel, Feras / Skouri, Hadi

2024 , Page(s) 102564

Abstract: While there has been a global decrease in rates of heart failure (HF) prevalence between 1990 and 2019, the Eastern Mediterranean region (EMR) is experiencing an increase. In 2019, approximately 1,229,766 individuals lived with moderate to severe HF in ... ...

Abstract	While there has been a global decrease in rates of heart failure (HF) prevalence between 1990 and 2019, the Eastern Mediterranean region (EMR) is experiencing an increase. In 2019, approximately 1,229,766 individuals lived with moderate to severe HF in the EMR. Despite the growth in the utilization of advanced heart failure (AHF) therapies in the EMR in the past two decades, current volumes are yet to meet the growing AHF burden in the region. Heart Transplantation (HT) volumes in EMR have grown from 9 in the year 2000 to 179 HTs in 2019. However, only a few centers provide the full spectrum of AHF therapies, including durable mechanical circulatory support (MCS) and HT. Published data on the utilization of left ventricular assist devices (LVAD) in the EMR are scarce. Notably, patients undergoing LVAD implantation in the EMR are on average, 13 years younger, and have a higher likelihood of presenting with critical cardiogenic shock, as compared to their counterparts in the Western world. Furthermore, AHF care in the region is hampered by the paucity of multidisciplinary HF programs, inherent costs of AHF therapies, limited access to short and long-term MCS, organ shortage, and lack of public awareness and acceptance of AHF therapeutics. All stakeholders in the EMR should work together to strategize tackling the challenging AHF burden in the region.
Language	English
Publishing date	2024-04-08
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	441230-8
ISSN	1535-6280 ; 0146-2806
ISSN (online)	1535-6280
ISSN	0146-2806
DOI	10.1016/j.cpcardiol.2024.102564
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Article: Red Flags in Acute Myocarditis.

Hashmani, Shahrukh / Manla, Yosef / Al Matrooshi, Nadya / Bader, Feras

Cardiac failure review

2024 Volume 10, Page(s) e02

Abstract: Acute myocarditis is an inflammatory disease of the heart that may occur in the setting of infection, immune system activation or exposure to certain drugs. Often, it is caused by viruses, whereby the clinical course is usually benign; however, it may ... ...

Abstract	Acute myocarditis is an inflammatory disease of the heart that may occur in the setting of infection, immune system activation or exposure to certain drugs. Often, it is caused by viruses, whereby the clinical course is usually benign; however, it may also present with rapidly progressive fulminant myocarditis, which is associated with high morbidity and mortality. This review highlights the critical red flags - from the clinical, biochemical, imaging and histopathological perspectives - that should raise the index of suspicion of acute myocarditis. We also present an illustrative case of a young female patient with rapidly progressive cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation as a bridge to orthotopic heart transplantation. The patient showed no clinical or echocardiographic recovery signs and eventually underwent orthotopic heart transplantation. Furthermore, we elaborate on the classifications of acute myocarditis based on clinical presentation and histopathology classifications, focusing on identifying key red flags that will inform early diagnosis and appropriate management in such challenging cases.
Language	English
Publishing date	2024-02-09
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2960293-2
ISSN	2057-7559 ; 2057-7540
ISSN (online)	2057-7559
ISSN	2057-7540
DOI	10.15420/cfr.2023.02
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Article ; Online: Letter to the Editor on Global Impact of the Covid-19 Pandemic on Solid Organ Transplantation.

Manla, Yosef / Badarin, Firas Al / Bader, Feras

Transplantation proceedings

2022 Volume 54, Issue 7, Page(s) 2042–2043

MeSH term(s)	Humans ; COVID-19/epidemiology ; Pandemics ; SARS-CoV-2 ; Organ Transplantation/adverse effects
Language	English
Publishing date	2022-06-24
Publishing country	United States
Document type	Letter
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2022.06.003
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Article: Polypharmacy in cardiorenal syndrome patients.

Hashmani, Shahrukh / Madhyastha, Rakesh / El Nekidy, Wasim / Atallah, Bassam / Bader, Feras / Attallah, Nizar

Clinical nephrology

2023 Volume 99, Issue 3, Page(s) 141–148

Abstract: Cardiorenal syndrome (CRS) is a term defined as complex interactions between concomitant cardiac and renal dysfunction in which disease of one organ initiates, perpetuates, and/or accelerates the decline in the other. It accounts for a third of ... ...

Abstract	Cardiorenal syndrome (CRS) is a term defined as complex interactions between concomitant cardiac and renal dysfunction in which disease of one organ initiates, perpetuates, and/or accelerates the decline in the other. It accounts for a third of presentations with heart failure and is associated with poor clinical outcomes. Polypharmacy (defined as using five or more medications) is common in CRS patients and is associated with worst clinical outcomes. The risk for polypharmacy increases to several fold with associated comorbidities, poses risks to the overall health of the patient, and enhances non-compliance to essential medications. Deprescribing non-essential medications, coordination between multiple specialties to mitigate the risk of polypharmacy, pharmacist- and nurse-led clinics to improve adherence to medications, use of polypills and telemonitoring are various methods to reduce polypharmacy. In this paper, we highlight different strategies to prevent polypharmacy and improve compliance and adherence to essential medications.
MeSH term(s)	Humans ; Deprescriptions ; Cardio-Renal Syndrome ; Polypharmacy ; Heart Failure ; Comorbidity
Language	English
Publishing date	2023-01-12
Publishing country	Germany
Document type	Journal Article
ZDB-ID	185101-9
ISSN	0301-0430
ISSN	0301-0430
DOI	10.5414/CN110989
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Article ; Online: Anticoagulation practices and complications associated with Impella® support at an advanced cardiac center in the Middle East gulf region.

Hisham, Mohamed / Ghalib, Hussam H / Kakar, Vivek / Kumar, G Praveen / Bader, Feras / Atallah, Bassam

Journal of thrombosis and thrombolysis

2023 Volume 56, Issue 1, Page(s) 164–174

Abstract: Anticoagulation during Impella® support is a challenge due to its complications and inconsistent practice across the globe. This observational, retrospective chart review included all patients with Impella® support at our advanced cardiac center at a ... ...

Abstract	Anticoagulation during Impella® support is a challenge due to its complications and inconsistent practice across the globe. This observational, retrospective chart review included all patients with Impella® support at our advanced cardiac center at a quaternary care hospital in the Middle East gulf region. The study was conducted over six years (2016-2022), a time period during which manufacturer recommendations for purge solution, anticoagulation protocols as well as Impella® place in therapy and utilization were all evolving. We aimed to evaluate the efficacy of different anticoagulation practices and association with complications and outcomes. Forty-one patients underwent Impella® during the study period, including 25 patients with support for more than 12 h, and are the focus of our analysis. Cardiogenic shock (n = 25, 60.9%) was the primary indication for Impella®, followed by facilitating high-risk PCI (n = 15, 36.7%) and left ventricular afterload reduction in patients undergoing veno-arterial extracorporeal membrane oxygenation (n = 1, 2.4%). Our overall Impella® usage evolved over the years from a primary use to facilitate a high-risk PCI to the recent more common use of LV unloading in cardiogenic shock. No patients experienced device malfunction and the incidence of other complications including ischemic stroke and bleeding were comparable to those reported in the literature (12.2% and 24% respectively). The 30-day all-cause mortality of 41 patients was 53.6%. In line with the evolving recommendations and evidence, we observed an underutilization of non-heparin-based purge solutions and inconsistent management of anticoagulation in the setting of both Impella® and VA ECMO which necessitates more education and protocols.
MeSH term(s)	Humans ; Anticoagulants/adverse effects ; Blood Coagulation ; Heart-Assist Devices/adverse effects ; Percutaneous Coronary Intervention ; Retrospective Studies ; Shock, Cardiogenic/therapy ; Treatment Outcome
Chemical Substances	Anticoagulants
Language	English
Publishing date	2023-04-25
Publishing country	Netherlands
Document type	Journal Article ; Observational Study
ZDB-ID	1230645-9
ISSN	1573-742X ; 0929-5305
ISSN (online)	1573-742X
ISSN	0929-5305
DOI	10.1007/s11239-023-02807-9
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Article ; Online: Transcatheter aortic valve replacement in a patient with critical bicuspid aortic stenosis and cardiogenic shock: case report.

El Tahlawy, Walid / Bader, Feras / Traina, Mahmoud Idris / Edris, Ahmad

European heart journal. Case reports

2022 Volume 6, Issue 3, Page(s) ytac101

Abstract: Background: Cardiogenic shock (CS) is associated with significant morbidity and mortality (27-51%). Little is known about the feasibility and safety of emergency transcatheter aortic valve replacement (TAVR) for critical aortic stenosis (AS) in acute ... ...

Abstract	Background: Cardiogenic shock (CS) is associated with significant morbidity and mortality (27-51%). Little is known about the feasibility and safety of emergency transcatheter aortic valve replacement (TAVR) for critical aortic stenosis (AS) in acute myocardial infarction (AMI) with CS. Case summary: A 57-year-old male with history of tobacco dependence and diabetes mellitus presented with acute posterior ST-segment elevation myocardial infarction and CS. The patient initially underwent successful primary percutaneous intervention to an anomalous circumflex artery coming off the right cusp. It was noted to have advanced CS out of proportion to his coronary anatomy. Echocardiographic assessment noted critical AS. Heart team decided to perform percutaneous aortic balloon valvuloplasty under support of extracorporeal membrane oxygenation. Percutaneous aortic balloon valvuloplasty was performed and was complicated by severe aortic regurgitation (AR). A balloon-expandable transcatheter heart valve was then placed with resolution of AR and stabilization of the patient. Then, the patient was subsequently decannulated within a week then was able to go home after 47 days (32 days intensive care unit). His course was notable for a minor stroke due to initial period of hypotension and CS. He was extubated and remained hospitalized for several weeks participating in rehabilitation. Follow-up echo showed a well-seated and functioning transcatheter heart valve. His left ventricular systolic function improved from 21% to 45%. Conclusion: Emergency TAVR is feasible and can be performed in a patient with AMI and CS. Early initiation of mechanical support allowed the patient to receive definitive treatment. The multidisciplinary heart team is essential and reflected in the ultimate outcome of our patient.
Language	English
Publishing date	2022-03-14
Publishing country	England
Document type	Case Reports
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/ytac101
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Article ; Online: Worldwide and Country-Specific Impact of the COVID-19 Pandemic on Heart Transplantation Volumes: A Longitudinal Analysis of 2020 and 2021.

Manla, Yosef / Badarin, Firas Al / Bader, Nour / Lee-St John, Terrence / Mehra, Mandeep R / Bader, Feras

Current problems in cardiology

2023 Volume 48, Issue 11, Page(s) 101870

Abstract: COVID-19 pandemic hampered operational efficiency of heart transplant (HT) programs worldwide. Little is known about the global and country-specific changes in HT volumes during the pandemic years 2020-2021. We aimed to describe the global and country- ... ...

Abstract	COVID-19 pandemic hampered operational efficiency of heart transplant (HT) programs worldwide. Little is known about the global and country-specific changes in HT volumes during the pandemic years 2020-2021. We aimed to describe the global and country-level impact of the COVID-19 pandemic on HT volumes in 2020-2021. This is a cross-sectional study of the Global Observatory on Donation and Transplantation, including the years 2019-2021. Among 60 countries that reported HT data in the years 2019-2020, we analyzed 52 countries with ≥1 transplant during each year. Overall, the number of HTs decreased during 2020 by 9.3% (1.82 to 1.65 PMP). While 75% (n = 39/52) of countries experienced a decrease in HT volumes in 2020, volumes were maintained/increased in the remaining countries. Countries with maintained HT volumes had a higher organ donation rate in 2020 compared to those with decreased volumes (P = 0.03), the only significant predictor of change in HT volumes (P = 0.005). In 2021, a 6.6% recovery from the previous year's drop in global HT rate was noticed, reaching 1.76 HT PMP. Only 1 in 5 countries with reduced volumes in 2020 recovered their baseline volumes in 2021. Only 30.8% of countries with maintained volumes in 2020 had continued growth in HT volumes in 2021. The latter group encompassed the United States of America, the Netherlands, Poland, and Portugal. Further work should define underlying causes of this heterogeneity in HT volume during the pandemic. Identifying policies and practices that helped certain countries mitigate the effect of the pandemic on HT activities may help other countries during similar health crises in the future.
MeSH term(s)	Humans ; United States/epidemiology ; COVID-19/epidemiology ; Pandemics ; Cross-Sectional Studies ; Heart Transplantation ; Tissue and Organ Procurement
Language	English
Publishing date	2023-06-10
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	441230-8
ISSN	1535-6280 ; 0146-2806
ISSN (online)	1535-6280
ISSN	0146-2806
DOI	10.1016/j.cpcardiol.2023.101870
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Article: Clinical and Haemodynamic Effects of Arteriovenous Shunts in Patients with Heart Failure with Preserved Ejection Fraction.

Soliman, Medhat / Attallah, Nizar / Younes, Houssam / Park, Woo Sup / Bader, Feras

Cardiac failure review

2022 Volume 8, Page(s) e05

Abstract: The arteriovenous shunt (AVS) is the most commonly used vascular access in patients receiving regular haemodialysis. The AVS may have a significant haemodynamic impact on patients with heart failure. Many studies have sought to understand the effect of ... ...

Abstract	The arteriovenous shunt (AVS) is the most commonly used vascular access in patients receiving regular haemodialysis. The AVS may have a significant haemodynamic impact on patients with heart failure. Many studies have sought to understand the effect of AVS creation or closure on heart structure and functions, most of which use non-invasive methods, such as echocardiography or cardiac MRI. Data are mainly focused on heart failure with reduced ejection fraction and there are limited data on heart failure with preserved ejection fraction. The presence of an AVS has a significant haemodynamic impact on the cardiovascular system and it is a common cause of high-output cardiac failure. Given that most studies to date use non-invasive methods, invasive assessment of the haemodynamic effects of the AVS using a right heart catheter may provide additional valuable information.
Language	English
Publishing date	2022-02-25
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2960293-2
ISSN	2057-7559 ; 2057-7540
ISSN (online)	2057-7559
ISSN	2057-7540
DOI	10.15420/cfr.2021.12
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Article: Early Identification and Management of Heart Failure in Patients with Diabetes Mellitus in the United Arab Emirates: A Call to Action.

Al Badarin, Firas / Yasine, Lina / Hijazi, Rabih / Khalaf, Susan Abu / Al Mahmeed, Wael / Manla, Yosef / Bader, Feras

Journal of the Saudi Heart Association

2023 Volume 35, Issue 2, Page(s) 192–199

Abstract: Heart failure (HF) is a common and serious complication of diabetes mellitus (DM) that remains widely under-recognized. Multidisciplinary management protocols for patients with concurrent DM and HF are not widely utilized in the Middle East/Gulf region, ... ...

Abstract	Heart failure (HF) is a common and serious complication of diabetes mellitus (DM) that remains widely under-recognized. Multidisciplinary management protocols for patients with concurrent DM and HF are not widely utilized in the Middle East/Gulf region, particularly in the United Arab Emirates. Since early identification of patients with DM and HF will likely lead to initiation of therapies known to prevent adverse cardiovascular events and subsequently improve patient prognosis, we aim to highlight the importance of early recognition of HF in diabetic patients. We will also describe existing management challenges in the region, especially the lack of multidisciplinary care and emphasize the role of newer anti-diabetic therapies in preventing and treating HF. Most importantly, this call-to-action proposes a collaborative approach to the care of diabetic patients with HF involving primary care physicians, endocrinologists, and cardiologists.
Language	English
Publishing date	2023-08-05
Publishing country	Saudi Arabia
Document type	Journal Article ; Review
ZDB-ID	2515647-0
ISSN	1016-7315
ISSN	1016-7315
DOI	10.37616/2212-5043.1342
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Article ; Online: Temporal Trends in Brain-Death Organ Donation in Asia: Results From the Global Observatory on Donation and Transplantation.

Manla, Yosef / AlSindi, Fahad / Attallah, Nizar / Badarin, Firas Al / Ghalib, Hussam / Bader, Feras

Transplantation proceedings

2022 Volume 54, Issue 2, Page(s) 233–236

Abstract: Background: Organ shortage is the main limiting factor for further dissemination of organ transplantation therapies; implementation of brain-death (BD) criteria for organ donation purposes is essential for overcoming this limitation. Investigating and ... ...

Abstract	Background: Organ shortage is the main limiting factor for further dissemination of organ transplantation therapies; implementation of brain-death (BD) criteria for organ donation purposes is essential for overcoming this limitation. Investigating and characterizing the effects of this intervention on organ availability and subsequent orthotopic organ transplantation in Asia, the world's most populous continent, should shed light on a global issue. The aim of this study was to describe temporal trends in brain-death donors (BDDs) and deceased-donor transplants (DDTs) in the Asian continent. Methods: We used data from the Global Observatory on Donation and Transplantation (GODT), the world's most comprehensive source of data relating to organ donation and transplantation activities. Available data on the number of BDDs and DDTs in 48 Asian countries was collated and analyzed for the years 2000-2019. Results: The number of BDDs in Asia increased progressively, from 25 BBDs in 2000 to 5357 in 2019. The number of DDTs increased concomitantly, albeit with an initial decline between 2004 and 2008, with an exponential increase in the number of kidney and liver transplants, followed by heart and lung transplants. Data from the latest year with complete data (2019) demonstrated 25,557 deceased-donor organs were transplanted, representing a >3-fold increase in the number of transplanted organs compared with the nadir in 2008. Conclusion: Although the Asian continent has noticed a rapid increase in BD transplantation activities during the past 2 decades, it is self-evident that further dissemination and adoption of BD donation are fundamental to reducing organ shortage gap.
MeSH term(s)	Asia ; Brain Death ; Humans ; Organ Transplantation ; Tissue Donors ; Tissue and Organ Procurement
Language	English
Publishing date	2022-01-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2021.12.031
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