Nabil Farag
Ain Shams University, Cardiology, Faculty Member
- Current position: • Professor of Cardiology, Ain Shams University. • Chairman, Cardiology Department Dar Al Fouad... moreCurrent position:
• Professor of Cardiology, Ain Shams University.
• Chairman, Cardiology Department Dar Al Fouad Hospital in collaboration
with Cleveland Clinic, USA
• Ex-President of the PVD working group, Egyptian Society of Cardiolog
• Fellow European Society of Cardiology(ESC)
• Fellow of the Society for Cardiovascular Angiography and Intervention(SCAI)edit
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Atrial fibrillation (AF), show to be a common postoperative complication, observed after coronary artery bypass grafting (CABG) During the first 7 postoperative days in 7–40% of patients. Some studies conclude that off-pump coronary... more
Atrial fibrillation (AF), show to be a common postoperative complication, observed after coronary artery bypass grafting (CABG) During the first 7 postoperative days in 7–40% of patients. Some studies conclude that off-pump coronary artery bypass (OPCABG) may decrease the incidence of AF, whereas the combination of CABG with heart valve replacement may result in more frequent postoperative atrial fibrillation. The aim of our study was to compare the early postoperative AF incidence rate during ICU stay in three groups of patients: after CABG, OPCABG, and CABG combined with valve replacement. Material and methods During the period from January 2009 till January 2012. Clinical profile of 650 patients were included in a prospective study , factors having potential influence on postoperative AF did not show any significant differences between the groups. The presence of arrhythmia history was the reason of excluding 42 patients from the statistical analysis. 525 cases after conventional CABG, 96 after OPCABG, and 29 after CABG combined with valve surgery were analyzed. Results Atrial fibrillation occurred during the postoperative ICU stay in 9.8% of patients after CABG, in 10.2% after OPCABG, and in 21% after CABG combined with valve replacement. There was no significant difference between CABG and OPCABG groups ( P = 0.965 ). We observed a statistically significant increase of the early postoperative atrial fibrillation incidence rate in patients after CABG combined with valve replacement, when compared with both CABG + OPCABG groups ( P = 0.005 ). Conclusions (1) Atrial fibrillation is a common postoperative complication after myocardial revascularization procedures which prolong ICU stay. (2) The study did not show that the incidence of postoperative AF is influenced by the technique of coronary artery bypass grafting: with or without CPB. (3) The prevalence of postoperative AF increase when CABG is combined with valve replacement.
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Background Dual antiplatelet therapy with aspirin and a thienopyridine is used to prevent thrombotic complications of acute coronary syndrome (ACS) and percutaneous coronary interventions (PCI). Ticagrelor is an oral, reversible inhibitor... more
Background Dual antiplatelet therapy with aspirin and a thienopyridine is used to prevent thrombotic complications of acute coronary syndrome (ACS) and percutaneous coronary interventions (PCI). Ticagrelor is an oral, reversible inhibitor of the adenosine diphosphate receptor P2Y12 with a faster onset and more potent platelet inhibition than clopidogrel. A study was needed to evaluate the efficacy and safety of generic ticagrelor in Egyptian patients. Results This multicenter study included 830 patients aged above 40 years and diagnosed with ACS, with or without ST segment elevation during the preceding 6 months. They received generic ticagrelor (Thrombolinta, Global Napi Pharmaceutical Company, Egypt) (180 mg loading dose, 90 mg twice daily thereafter), added to aspirin 75–100 mg daily. The mean age of our study population was 57.5 (8.3) years and 38.3% were females. Hypertension, diabetes mellitus, dyslipidemia and previous coronary revascularization were present in 70.7%, 59.2%, ...
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Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with... more
Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0–100%), fibrinolysis (18.8%; 0–100%), and no reperfusion therapy (9.0%; 0–75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5–5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8–97.5%) for the performance of reperfusion therap...
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Research Interests: Cardiology, Treatment Outcome, Egypt, Medicine, Humans, and 15 moreInternal Medicine, Female, Male, Middle Aged, C reactive protein, Percutaneous Coronary Intervention, Myocardial Infarction, Time Factors, Biological markers, Troponin, Upper Extremity, Ischemic Preconditioning, Troponin T, Cardiovascular medicine and haematology, and Inflammation Mediators
AimsTo assess the proportion of patients with heart failure and reduced ejection fraction (HFrEF) who are eligible for sacubitril/valsartan (LCZ696) based on the European Medicines Agency/Food and Drug Administration (EMA/FDA) label, the... more
AimsTo assess the proportion of patients with heart failure and reduced ejection fraction (HFrEF) who are eligible for sacubitril/valsartan (LCZ696) based on the European Medicines Agency/Food and Drug Administration (EMA/FDA) label, the PARADIGM‐HF trial and the 2016 ESC guidelines, and the association between eligibility and outcomes.Methods and resultsOutpatients with HFrEF in the ESC‐EORP‐HFA Long‐Term Heart Failure (HF‐LT) Registry between March 2011 and November 2013 were considered. Criteria for LCZ696 based on EMA/FDA label, PARADIGM‐HF and ESC guidelines were applied. Of 5443 patients, 2197 and 2373 had complete information for trial and guideline eligibility assessment, and 84%, 12% and 12% met EMA/FDA label, PARADIGM‐HF and guideline criteria, respectively. Absent PARADIGM‐HF criteria were low natriuretic peptides (21%), hyperkalemia (4%), hypotension (7%) and sub‐optimal pharmacotherapy (74%); absent Guidelines criteria were LVEF>35% (23%), insufficient NP levels (30%...
Research Interests: Medicine, Heart Failure, Humans, Internal Medicine, Enalapril, and 15 moreUnited States, Registries, Registry, Prognosis, Ejection Fraction, Food and Drug Administration, GuideLine, Eligibility, Lcz, United States Food and Drug Administration, Tetrazoles, Neprilysin, Sacubitril, Cardiovascular medicine and haematology, and Angiotensin Receptor Antagonists
Hypertriglyceridemia (HTG) is a very common, yet underappreciated problem in clinical practice. Elevated triglyceride (TG) levels are independently associated with atherosclerotic cardiovascular disease (ASCVD) risk. Furthermore, severe... more
Hypertriglyceridemia (HTG) is a very common, yet underappreciated problem in clinical practice. Elevated triglyceride (TG) levels are independently associated with atherosclerotic cardiovascular disease (ASCVD) risk. Furthermore, severe HTG may lead to acute pancreatitis. Although LDL-guided statin therapy has improved ASCVD outcomes, residual risk remains. Recent trials have demonstrated that management of high TG levels, in patients already on statin therapy, reduces the rate of major vascular events. Few guidelines were issued, providing important recommendations for HTG management strategies. The goal of treatment is to reduce the risk of ASCVD and acute pancreatitis. The management stands on lifestyle modification, detection of secondary causes of HTG and pharmacological therapy, when indicated. In this guidance we review the causes and classification of HTG and summarize the current methods for risk estimation, diagnosis and treatment. The present guidance provides a focused u...
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Background Numerous epidemiological investigations and randomized clinical studies have determined that dyslipidemia is a major contributor to atherosclerotic cardiovascular disease (ASCVD). Consequently, the management of serum... more
Background Numerous epidemiological investigations and randomized clinical studies have determined that dyslipidemia is a major contributor to atherosclerotic cardiovascular disease (ASCVD). Consequently, the management of serum cholesterol and low-density lipoprotein levels has become a central objective in the effort to prevent cardiovascular events. Main body Many guidelines were issued by different organizations and societies to define patient risk and establish important recommendations for management strategies. Newer cholesterol-lowering agents (non-statin drugs) are described, and their use is directed primarily to secondary prevention in patients at very high risk of new ASCVD. Conclusion The present guidance summarizes the current methods for risk estimation and outlines the most recent data on lipid management in a simple user-friendly format, to improve physician awareness and help implement guidelines in the daily practice.
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Background Although multiple studies have addressed the efficacy of bypass surgery in patients with stable angina, there are relatively few studies that have evaluated the optimal timing, risk of hospital mortality, and long-term outcome... more
Background Although multiple studies have addressed the efficacy of bypass surgery in patients with stable angina, there are relatively few studies that have evaluated the optimal timing, risk of hospital mortality, and long-term outcome for patients with bypass surgery performed in ...
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Objective: Early treatment of acute ischemia of the heart by performing immediate percutaneous coronary intervention (PCI) to restore blood flow in patients with the clinical presentation of an acute coronary syndrome and more... more
Objective: Early treatment of acute ischemia of the heart by performing immediate percutaneous coronary intervention (PCI) to restore blood flow in patients with the clinical presentation of an acute coronary syndrome and more specifically with ST-elevation myocardial infarction (STEMI) can save lives. This study aims to identify the mean time (door to balloon time and first contact to balloon time) to primary PCI for STEMI patients and to assess the percentage of primary PCI and its success rate in Egypt.Methods: A registry study of patients presenting to cardiac centers in Egypt was designed, where patients’ basic characteristics, the treatment strategy, and the door to balloon time and the first contact to balloon time were assessed.Results: One thousand six hundred fifty STEMI patients with a mean age of 57 years were included in the study. Immediate transfer for primary PCI was the most used treatment strategy, representing 74.6% of all treatment strategies used. The door to ba...
Background: The current expert view of the PCSK9 inhibitors&#39; use in Egypt is still ambiguous. Main body: Hyperlipidemia is an important, if not the most important, risk factor for the occurrence of atherosclerosis worldwide. Egypt... more
Background: The current expert view of the PCSK9 inhibitors&#39; use in Egypt is still ambiguous. Main body: Hyperlipidemia is an important, if not the most important, risk factor for the occurrence of atherosclerosis worldwide. Egypt is the most populous country in the Middle East and North Africa and has &gt; 15% of the cardiovascular deaths in the region. The burden of dyslipidemia as seen in the recently published CardioRisk project conducted throughout Egypt shows a high prevalence of dyslipidemia as a risk factor that is still reaching up to 71% in female participants. Reaching the targets for LDL lowering, and thus control of hyperlipidemia, is quite often very difficult especially with the update of the last ESC guidelines. With the advent of PCSK9 inhibitors, the control rate of patients, reduction of cardiac major adverse events, and mortality have been improved. However, Egypt is not considered a rich country on the grounds of annual income, and this raises a concern on which patients would benefit from these expensive medications. Revising the randomized control trials, we analyzed the data that would enable us to control LDL in those patients, at risk, to obtain simple clear indications for the use of these rather expensive medications.
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This analysis evaluates gender differences in the Egyptian cohort of patients hospitalized for acute heart failure (AHF) in the European Society of Cardiology Heart Failure Long-Term Registry. From April 2011 to September 2014, 1634... more
This analysis evaluates gender differences in the Egyptian cohort of patients hospitalized for acute heart failure (AHF) in the European Society of Cardiology Heart Failure Long-Term Registry. From April 2011 to September 2014, 1634 patients hospitalized with AHF were enrolled by 20 hospitals all over Egypt. Of these patients, 1112 (68%) patients were male and 522 (32%) were female. Women presented with a higher admission systolic blood pressure and resting heart rate. Compared with men, women had a higher body mass index (32.5 ± 9.0 vs. 29.3 ± 4.9, P < 0.001), more frequent atrial fibrillation (34.7% vs. 22.4%, P < 0.001), and anaemia defined by haemoglobin < 12 g/dL (83.1% vs. 58.4%, P < 0.001). Women were more likely to present with heart failure with preserved ejection fraction (29.7% vs. 10.6%, P < 0.001). Women had more frequent diabetes mellitus (48.1% vs. 41.6%, P < 0.05) and hypertension (48.7% vs. 39.3%, P < 0.001) than had men, whereas smoking was rar...
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ABSTRACT
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ABSTRACT Nitric oxide (NO) from the endothelium, produced by oxidation of l-arginine to L-citruline for the action at the endothelial nitric oxide synthase (eNOS), is considered an important atheroprotective factor. The Glu298Asp (G894T)... more
ABSTRACT Nitric oxide (NO) from the endothelium, produced by oxidation of l-arginine to L-citruline for the action at the endothelial nitric oxide synthase (eNOS), is considered an important atheroprotective factor. The Glu298Asp (G894T) polymorphic variant of the eNOS gene has been implicated in the development of coronary artery disease (CAD). We investigated the association between occurrence of CAD documented by angiography and the G894T polymorphism of the NOS3 gene in Chilean individuals. A total of 112 unrelated patients with diagnosis of CAD and 72 controls were included in this study. G894T gene polymorphism was analyzed by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). The frequency of TT homozygous genotype for G894T polymorphism was 7% in CAD patients and 1% in the control group. However, the genotype distribution and allele frequencies were not significantly different between CAD and control subjects (P&amp;gt;0.05). Moreover, the odds ratio for CAD associated with the T variant failed to reach statistical significance (OR=1.5; 95% CI: 0.87-2.59, P&amp;gt;0.05). These findings suggest that the G894T polymorphism of the eNOS gene was not associated with CAD in Chilean individuals.
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Research Interests: Algorithms, Risk, Treatment Outcome, Risk assessment, Comorbidity, and 15 moreHumans, Smoking, Female, Male, Clinical Sciences, Aged, Middle Aged, Myocardial Infarction, Circulation, Disease Progression, Risk Assessment, Coronary Artery Disease, Severity of Illness Index, Metabolic Syndrome X, and Cardiovascular medicine and haematology
Research Interests: Cardiology, Israel, Electrocardiography, Multivariate Analysis, Humans, and 15 moreDerivation, Female, Male, Acute Myocardial Infarction, Coronary Bypass Surgery, Coronary Angiography, Myocardial Infarction, Hospital Mortality, Coronary artery bypass surgery, Disease Management, Coronary Care Unit, Mortality rate, Cohort Studies, National Survey, and Cardiovascular medicine and haematology
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Research Interests: Medication Adherence, Treatment Outcome, Middle East, Lipids, Humans, and 15 moreFemale, Male, Hypercholesterolemia, LDL-cholesterol, Clinical Sciences, Aged, Middle Aged, Questionnaires, Arabs, Adult, Coronary heart disease, Health surveys, Angiology, Guideline Adherence, and quality assurance in health care
5. K Inoue and J Hung, Percutaneous transvenous mitral commissurotomy: the Far East experience. In: (2nd ed.),E Topol, Editor, Textbook of Interventional Cardiology, WB Saunders, Philadelphia, PA (1994), p. 1226. ... 1 Dr. Saleh's... more
5. K Inoue and J Hung, Percutaneous transvenous mitral commissurotomy: the Far East experience. In: (2nd ed.),E Topol, Editor, Textbook of Interventional Cardiology, WB Saunders, Philadelphia, PA (1994), p. 1226. ... 1 Dr. Saleh's address is: 8 Mofehtar El ...
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Elective percutaneous coronary intervention (PCI) is associated with troponin release in approximately one third of cases.(1) Troponin release is a sensitive and specific marker of myocyte necrosis and infarction resulting from a form of... more
Elective percutaneous coronary intervention (PCI) is associated with troponin release in approximately one third of cases.(1) Troponin release is a sensitive and specific marker of myocyte necrosis and infarction resulting from a form of ischemia/reperfusion injury, ...
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A simple experimental method is presented in this paper to evaluate the frequency dependent rubber mount stiffness and damping characteristics by utilizing the measured complex frequency response function from impact test and by... more
A simple experimental method is presented in this paper to evaluate the frequency dependent rubber mount stiffness and damping characteristics by utilizing the measured complex frequency response function from impact test and by least-squares polynomial curve fitting the data ...
Research Interests: Mechanical Engineering, Architecture, Vibration Control, Classical Physics, Structural Acoustics, and 11 moreRubber, Frequency Dependence, Dynamic Response, Frequency Response Function, Caoutchouc, Curve fitting, Impact Test, Experimental Method, Applied Acoustics, Damping coefficient Wood, and Resonant Frequency
Atrial fibrillation (AF) is a common complication of cardiothoracic surgery (CTS). Existing evidence about the potential protective role of angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) for post-CTS AF... more
Atrial fibrillation (AF) is a common complication of cardiothoracic surgery (CTS). Existing evidence about the potential protective role of angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) for post-CTS AF has been limited and conflicting. In this single-blind, open-label, randomized prospective pilot study, we evaluated the potential protective role of irbesartan (an ARB) in post-coronary artery bypass graft (CABG) AF. A total of 100 consecutive patients undergoing CABG were randomly assigned to irbesartan (n = 50) versus no irbesartan (n = 50) for 5 days prior to the scheduled surgery. Data were collected for imaging studies, laboratory values, and peri-operative details. Patients were monitored post-operatively for in-hospital AF episodes. Unadjusted and adjusted logistic regression analysis was performed to assess the effect of irbesartan on the incidence of post-CABG AF. A total of 14 patients developed AF during their post-operative hospital stay. The incidence of AF in patients who received irbesartan was 6% (n = 3) compared with 22% (n = 11) in patients who did not receive irbesartan (p = 0.021). Univariate logistic regression analysis identified irbesartan and age as statistically significant variables. An adjusted multivariate logistic model identified irbesartan as an important protective factor against development of post-CABG AF (adjusted odds ratio [OR] 0.20; 95% confidence interval [CI] 0.04, 0.94; p = 0.04). Increasing age (adjusted OR 1.09, 95% CI 1.01, 1.17; p = 0.03) was also identified as an independent risk factor for development of post-CABG AF. Pretreatment with irbesartan tends to have a significant protective effect against the occurrence of AF during the post-operative period in patients undergoing CABG.