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Article ; Online: The impact of discontinuation of sacubitril-valsartan and shifting to angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in patients with heart failure with reduced ejection fraction.

Amin, Osama A / Alaarag, Ahmed F

2021 Volume 25, Issue 3, Page(s) 163–169

Abstract: Objective: Many trials confirmed the role of sacubitril-valsartan in the treatment of patients with heart failure with reduced ejection fraction (HFrEF). However, there is no sufficient data to register the effect of compulsory discontinuation of ... ...

Abstract	Objective: Many trials confirmed the role of sacubitril-valsartan in the treatment of patients with heart failure with reduced ejection fraction (HFrEF). However, there is no sufficient data to register the effect of compulsory discontinuation of sacubitril-valsartan, either because of finan-cial shortage or adverse effects, and shifting to the standard therapy, including angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). Methods: The patients with HFrEF (LVEF ≤35%) were included in the study. They received treatment with sacubitril-valsartan as a replacement for an ACEI or ARB. The patients were divided into two groups: the compliant group (n=111). The non-compliant group (n=82), whose members discontinued sacubitril-valsartan after ≥5 months but <6 months since their enrollment in the study. Results: Initially, 199 patients with HFrEF were included in the study. All the patients were started treatment with sacubitril-valsartan in addition to the evidence-based standard therapy of heart failure. Six patients were excluded at the first follow-up visit (at 6 months). The remaining 193 patients showed initial improvement of the New York Heart Association (NYHA) class, the end-diastolic volume (EDV), and the left ventricular ejection fraction (LVEF). Five patients were excluded at the 12 months' follow-up visit. The other 188 patients were divided into two groups: Group I (n=108) patients were compliant on sacubitril-valsartan for 12 months; Group II (n=80) patients were compliant on sacubitril-valsartan for ≥5 months, but stopped it at <6 months, and were shifted to ACEI or evidence-based ARB. Group II (n=80) patients showed worsening of their NYHA class, compared to the 6 months' follow-up visit (p=0.001). LVEF and EDV were also shown to be worsened in these patients when we compared them to the values of the 6 months' follow-up appointment with p=0.001 for both parameters. Conclusion: The discontinuation of sacubitril-valsartan in patients with HFrEF leads to deterioration of the LVEF as well as worsening of the functional class. The decline in LVEF and NYHA functional class occurs despite being compliant with the optimal conventional therapy with ACEI or evidence-based ARB.
MeSH term(s)	Aminobutyrates ; Angiotensin Receptor Antagonists/therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Biphenyl Compounds ; Drug Combinations ; Heart Failure/drug therapy ; Humans ; Stroke Volume ; Tetrazoles/therapeutic use ; Valsartan ; Ventricular Function, Left
Chemical Substances	Aminobutyrates ; Angiotensin Receptor Antagonists ; Angiotensin-Converting Enzyme Inhibitors ; Biphenyl Compounds ; Drug Combinations ; Tetrazoles ; Valsartan (80M03YXJ7I) ; sacubitril and valsartan sodium hydrate drug combination (WB8FT61183)
Language	English
Publishing date	2021-02-16
Publishing country	Turkey
Document type	Journal Article
ZDB-ID	2278670-3
ISSN	2149-2271 ; 2149-2263
ISSN (online)	2149-2271
ISSN	2149-2263
DOI	10.14744/AnatolJCardiol.2020.39267
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Article ; Online: Blood pressure variability in patients with angina and non-obstructive coronary artery disease.

Alaarag, Ahmed / Amin, Osama

Journal of human hypertension

2021 Volume 35, Issue 12, Page(s) 1074–1080

Abstract: There is a real challenge in the management of ischemia with non-obstructive coronary artery disease. So, we need to study the mechanisms of persistent angina and non-obstructive coronary artery (ANOCA) patients. One of those possible mechanisms is blood ...

Abstract	There is a real challenge in the management of ischemia with non-obstructive coronary artery disease. So, we need to study the mechanisms of persistent angina and non-obstructive coronary artery (ANOCA) patients. One of those possible mechanisms is blood pressure variability (BPV). We aimed to study the relation between BPV and angina in patients with non-obstructive coronary artery disease. Our study included 150 patients with chest pain and positive non-invasive stress test suggestive of myocardial ischemia and normal coronary angiography or non-obstructive coronary artery disease. We used an ambulatory blood pressure monitoring device. We found a positive correlation between BPV as measured by average real variability (ARV) as well as standard deviation (SD) parameters and the severity of anginal symptoms with P values for all parameters was 0.001 except day systolic SD P-value was 0.021. We performed a regression analysis for all statistically significant parameters. We found that 24H diastolic ARV, day diastolic ARV, night diastolic ARV, 24H diastolic SD, day diastolic SD, and night diastolic SD were independent predictors of the severity of angina with P-values (0.015, 0.007, 0.011, 0.037, 0.014, and 0.029), respectively. We concluded that short-term BPV represented by ARV and SD had a consistent association with angina in patients with non-obstructive coronary artery disease. The diastolic parameters of ARV and SD were independent predictors of the severity of angina with non-obstructive coronary artery disease.
MeSH term(s)	Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Coronary Artery Disease/complications ; Coronary Artery Disease/diagnosis ; Diastole ; Female ; Humans ; Pregnancy ; Systole
Language	English
Publishing date	2021-01-07
Publishing country	England
Document type	Journal Article
ZDB-ID	639472-3
ISSN	1476-5527 ; 0950-9240
ISSN (online)	1476-5527
ISSN	0950-9240
DOI	10.1038/s41371-020-00475-3
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Article ; Online: The blood pressure variability in patients with cryptogenic stroke.

Alaarag, Ahmed / Abdelkhalek, Hazem / Amin, Osama

The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology

2022 Volume 74, Issue 1, Page(s) 68

Abstract: Background: Increased nighttime BP variability (BPV) was associated with stroke. Left atrial (LA) enlargement is the default clinical hallmark of structural remodeling that often occurs in response to LA pressure and volume overload. Blood pressure has ... ...

Abstract	Background: Increased nighttime BP variability (BPV) was associated with stroke. Left atrial (LA) enlargement is the default clinical hallmark of structural remodeling that often occurs in response to LA pressure and volume overload. Blood pressure has proven to be an essential determinant of LA enlargement. We aimed to evaluate the influence of BPV as a risk factor for cryptogenic stroke and highlight the importance of including the (APBM) in the workup for those patients and test the relation between BPV and LA remodeling in these patients, which could be used as a clue to add APM monitoring to their workup. Also, LA remodeling may be a substrate for occult atrial fibrillation (AF). We included Group I (108 consecutive patients with cryptogenic ischemic stroke) and Group II (100 consecutive adult participants without a history of stroke or any structural heart disease). We measured the maximal LA volume index (Max LAVI) and minimal LA volume index (Min LAVI). We calculated the left atrial ejection fraction (LAEF). All the participants were subjected to ABPM. Results: In our prospective, cross-sectional cohort study, the patients in Group I had statistically significantly higher Min LAVI and Max LAVI and Less LA EF than Group II, with a P value of (0.001, 0.001, and 0.008), respectively. The Group I patients had higher BPV as measured by SD parameters than patients in Group II, with a P value of 0.001 for all SD parameters. The BPV parameters, as measured by SD parameters, were positively related to the LA remodeling parameters in both groups. After adjusting all variables, we found that age, night systolic SD, and night diastolic SD parameters were independent predictors of LA remodeling. Conclusions: The patients with cryptogenic stroke had higher short-term BPV, Min LAVI, and Max LAVI but lower LA EF. Careful monitoring of BPV may be of value for both primary and secondary preventions of ischemic stroke.
Language	English
Publishing date	2022-09-24
Publishing country	Germany
Document type	Journal Article
ISSN	2090-911X
ISSN (online)	2090-911X
DOI	10.1186/s43044-022-00305-6
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Article ; Online: Correction: The blood pressure variability in patients with cryptogenic stroke.

Alaarag, Ahmed / Abdelkhalek, Hazem / Amin, Osama

The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology

2022 Volume 74, Issue 1, Page(s) 73

Language	English
Publishing date	2022-10-03
Publishing country	Germany
Document type	Published Erratum
ISSN	2090-911X
ISSN (online)	2090-911X
DOI	10.1186/s43044-022-00313-6
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Article ; Online: The safety of Ramadan Fasting following Percutaneous Coronary Intervention.

Amin, Osama A / Alaarag, Ahmed

BMC cardiovascular disorders

2020 Volume 20, Issue 1, Page(s) 489

Abstract: Background: This work aimed to assess the safety of Ramadan Fasting following the Percutaneous Coronary Intervention.: Methods: In our two centers' Prospective Cohort Study, We included 303 patients who had successful Percutaneous Coronary ... ...

Abstract	Background: This work aimed to assess the safety of Ramadan Fasting following the Percutaneous Coronary Intervention. Methods: In our two centers' Prospective Cohort Study, We included 303 patients who had successful Percutaneous Coronary Intervention before the first day of Ramadan. We advised the patients that recent Percutaneous Coronary Intervention could be a valid excuse for not fulfilling Ramadan Fasting. However, many patients intended to fast the following Ramadan, and we included them in the fasting Group I. We added the patients who decided not to fast the following Ramadan as a control Group II. We followed all the patients during Ramadan and for 6 months after Ramadan. Results: The demographic data of both groups and the complexity of the coronary anatomy showed no statistically significant difference. Group I (n = 153) showed a statistically significant difference in the incidence of Major Adverse Cardiac Events compared to Group II with a P value (0.005). The logistic multivariate regression analysis showed that the duration from index PCI till the start of RF, SYNTAX score > 22, and Complex procedure were independent predictors of Major Adverse Cardiac Events in the fasting Group I with {P = 0.001, OR (2.302), P = 0.026, OR (2.419), and P = 0.032 OR (1.952)}, respectively. Major Adverse Cardiac Events in Group I occurred mainly during Ramadan Fasting, with 19 patients having Major Adverse Cardiac Events during Ramadan and four patients during the remaining of the follow-up period. The Receiver Operating Characteristic curve analysis showed the decline of the incidence of Major Adverse Cardiac Events after 90 days from Percutaneous Coronary Intervention till the start of Ramadan Fasting with Sensitivity and specificity (90% and 65%), respectively. Conclusions: We suggest that low-risk patients with a normal systolic function who underwent Percutaneous Coronary Intervention may safely fast Ramadan. At the same time, Ramadan Fasting during the first 3 months following the Percutaneous Coronary Intervention may not be safe.
MeSH term(s)	Aged ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/therapy ; Egypt ; Fasting/adverse effects ; Female ; Humans ; Islam ; Male ; Middle Aged ; Patient Safety ; Percutaneous Coronary Intervention/adverse effects ; Prospective Studies ; Religion and Medicine ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2020-11-19
Publishing country	England
Document type	Journal Article ; Multicenter Study
ZDB-ID	2059859-2
ISSN	1471-2261 ; 1471-2261
ISSN (online)	1471-2261
ISSN	1471-2261
DOI	10.1186/s12872-020-01784-8
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Book ; Online: How to Leverage High Altitude Platforms in Green Computing?

Abderrahim, Wiem / Amin, Osama / Shihada, Basem

2023

Abstract: Terrestrial data centers suffer from a growing carbon footprint that could contribute with $14\%$ to global CO2 emissions by 2040. High Altitude Platform (HAP) is a promising airborne technology that can unleash the computing frontier in the ... ...

Abstract	Terrestrial data centers suffer from a growing carbon footprint that could contribute with $14\%$ to global CO2 emissions by 2040. High Altitude Platform (HAP) is a promising airborne technology that can unleash the computing frontier in the stratospheric range by hosting a flying data center. HAP systems can endorse the sustainable green operation of data centers thanks to the naturally low atmospheric temperature that saves cooling energy and its large surface that can host solar panels covering energy requirements. Throughout this article, we define the operation limitations of this innovative solution and study the energy-efficiency-related trade-offs. Then, we shed light on the significance of the scalability of the data center-enabled HAP architecture by investigating potential bottlenecks and proposing different deployment scenarios to avoid network congestion. We also highlight the importance of the management agility of the data center-enabled HAP system by defining effective management techniques that yield high-performing data centers. Our results demonstrate that deploying a single data center-enabled HAP can save $12\%$ of the electricity costs.
Keywords	Electrical Engineering and Systems Science - Systems and Control
Publishing date	2023-05-08
Publishing country	us
Document type	Book ; Online
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Article ; Online: The Safety of The Directly Acting Antiviral Treatment For Hepatitis C Virus According To The Egyptian National Program Protocol In Patients With Midrange Ejection Fraction.

Alaarag, Ahmed Farouk / Hamam, Ahmed Mohamed / Amin, Osama Ahmed

Global heart

2021 Volume 16, Issue 1, Page(s) 3

Abstract: Background: The Egyptian National Committee of Viral Hepatitis program is the leading national hepatitis C virus (HCV) management program globally. However, limited data is available about the effect of the new directly acting antiviral agents on the ... ...

Abstract	Background: The Egyptian National Committee of Viral Hepatitis program is the leading national hepatitis C virus (HCV) management program globally. However, limited data is available about the effect of the new directly acting antiviral agents on the cardiovascular system. Objectives: Our study aimed to assess the safety of the relatively new directly acting antiviral agents approved by the National Health Committee in Egypt to treat patients infected with hepatitis C virus who have midrange left ventricular ejection fraction. Methods: This multicenter study included 400 successive patients with an ejection fraction (40-49%) from May 2017 to December 2019. We classified them into two groups: Group I (Child A), who received Sofosbuvir and Daclatasvir for twelve weeks, and Group II (Child B), who received Sofosbuvir, Daclatasvir, and Ribavirin for twelve weeks. Patients were evaluated for their symptoms, ejection fraction, brain natriuretic peptide, lipid profile, fasting blood glucose, fasting insulin, Homeostatic Model Assessment of Insulin Resistance levels, and Holter monitoring (just before the start of treatment and within three days after completing therapy). Results: We found New York Heart Association Class, ejection fraction, brain natriuretic peptide, premature ventricular contractions burden, as well as highest and lowest heart rate did not show a statistically significant difference in both groups after treatment. The treatment did not cause bradycardia or non-sustained ventricular tachycardia. Fasting blood glucose and fasting insulin levels declined, with improved insulin resistance after treatment in both groups. Both low and high-density lipoprotein cholesterol increased after treatment in Group II. Conclusions: Both regimens of directly acting antiviral agents used in Egypt to treat chronic hepatitis C virus infection are safe in patients with New York Heart Association Class I and II with midrange left ventricular ejection fraction (40-49%). There are beneficial metabolic changes following HCV clearance as an improvement of insulin resistance.
MeSH term(s)	Antiviral Agents/therapeutic use ; Child ; Drug Therapy, Combination ; Egypt/epidemiology ; Hepacivirus ; Hepatitis C/drug therapy ; Hepatitis C, Chronic/drug therapy ; Humans ; Multicenter Studies as Topic ; Stroke Volume ; Treatment Outcome ; Ventricular Function, Left
Chemical Substances	Antiviral Agents
Language	English
Publishing date	2021-01-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2629633-0
ISSN	2211-8179 ; 2211-8160
ISSN (online)	2211-8179
ISSN	2211-8160
DOI	10.5334/gh.906
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Article ; Online: Codfish vertebra sign.

Amin, Osama S M

BMJ case reports

2017 Volume 2017

MeSH term(s)	Absorptiometry, Photon ; Aged ; Female ; Humans ; Low Back Pain/etiology ; Lumbar Vertebrae/diagnostic imaging ; Magnetic Resonance Imaging ; Osteoporosis, Postmenopausal/diagnostic imaging ; Sacrum/diagnostic imaging
Language	English
Publishing date	2017-02-28
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2016-219119
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Article ; Online: Malignant middle cerebral artery infarction.

Amin, Osama S M

BMJ case reports

2017 Volume 2017

MeSH term(s)	Coma/etiology ; Fatal Outcome ; Headache ; Humans ; Infarction, Middle Cerebral Artery/diagnostic imaging ; Infarction, Middle Cerebral Artery/etiology ; Male ; Middle Aged ; Papilledema/etiology ; Stroke/complications ; Time Factors ; Tomography, X-Ray Computed ; Vomiting/etiology
Language	English
Publishing date	2017-04-24
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2016-219117
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Article ; Online: Relationship of QTc Interval Prolongation with Acute Ischemic Stroke.

Amin, Osama Shukir Muhammed / Sheikhbzeni, Aso Sabir / Siddiq, Abbas Nariman

Medical archives (Sarajevo, Bosnia and Herzegovina)

2020 Volume 74, Issue 3, Page(s) 195–198

Abstract: Introduction: Many electrocardiographic (ECG) changes have been observed after strokes. We analyzed the QTc interval prolongation following stroke.: Aim: The study aimed to assess if the prolongation in QTc interval is related to the occurrence of ... ...

Abstract	Introduction: Many electrocardiographic (ECG) changes have been observed after strokes. We analyzed the QTc interval prolongation following stroke. Aim: The study aimed to assess if the prolongation in QTc interval is related to the occurrence of acute ischemic stroke. Methods: This cross-sectional study was conducted from July to December 2018. We included 100 consecutive patients with first-ever ischemic stroke who were admitted to our emergency department, who were age-matched and gender-matched with a control group of 100 non-stroke patients that visited our outpatients department for diseases other than cerebrovascular or cardiovascular ones. A single 12-lead resting ECG examination was done in all patients at the time of their emergency department admission. Results: No significant difference between the two groups regarding the age distribution and mean age was found. 56.5% of the sample were males but the difference was not significant between both gender groups. The main presenting symptoms of stroke cases were right-sided weakness (47%), left-sided weakness (36%), and right-sided weakness and aphasia (10%). 34% of the cases had prolonged QTc interval while none of the controls had a prolonged interval (p-value<0.001). No significant difference was observed among stroke patients concerning gender (p-value=0.584). Conclusion: Our findings support many previous studies on the brain-heart interaction during acute ischemic strokes and reinforce previous conclusions that assessment of the QTc interval might aid to stratify morbidity and mortality risks in patients with acute ischemic stroke. To accomplish the acute stroke effects on QTc interval prolongation, we need further larger size analytic studies.
MeSH term(s)	Aged ; Aged, 80 and over ; Case-Control Studies ; Cross-Sectional Studies ; Electrocardiography ; Female ; Humans ; Ischemic Stroke/complications ; Ischemic Stroke/physiopathology ; Long QT Syndrome ; Male ; Middle Aged ; Muscle Weakness/etiology
Language	English
Publishing date	2020-08-01
Publishing country	Bosnia and Herzegovina
Document type	Journal Article ; Observational Study
ZDB-ID	128782-5
ISSN	1986-5961 ; 0025-8083 ; 0350-199X
ISSN (online)	1986-5961
ISSN	0025-8083 ; 0350-199X
DOI	10.5455/medarh.2020.74.195-198
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