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1. Hypertensive disorders in women with peripartum cardiomyopathy: insights from the ESC EORP PPCM Registry

Author

Jackson, Alice M., Petrie, Mark C., Frogoudaki, Alexandra, Laroche, Cécile, Gustafsson, Finn, Ibrahim, Bassem, Mebazaa, Alexandre, Johnson, Mark R., Seferovic, Petar M., Regitz‐Zagrosek, Vera, Mbakwem, Amam, Böhm, Michael, Prameswari, Hawani Sasmaya, Abdel Gawad, Doaa Ahmed Fouad, Goland, Sorel, Damasceno, Albertino, Karaye, Kamilu, Farhan, Hasan Ali, Hamdan, Righab, Maggioni, Aldo P., Sliwa, Karen, Bauersachs, Johann, Meer, Peter, Favaloro, R., Favaloro, L., Carballo, M., Peradejordi, M., Renedo, M.F., Absi, D., Bertolotti, A., Ratto, R., Talavera, M.L., Gomez, R., Lockwood, S., Barton, T., Austin, M‐A., Arstall, M., Aldridge, E., Chow, Y.Y., Dekker, G., Mahadavan, G., Rose, J., Wittwer, M., Hoppe, U., Sandhofer, A., Bahshaliyev, A., Gasimov, Z., Babayev, A., Niftiyev, P., Hasanova, I., AlBannay, R., AlHaiki, W., Husain, A., Mahdi, N., Kurlianskaya, A., Lukyanchyk, M., Shatova, O., Troyanova‐Shchutskaia, T., Anghel, L., De Pauw, M., Gevaert, S., De Backer, J., De Hosson, M., Vervaet, P., Timmermans, P.J., Janssen, A., Yameogo, N.V., Kagambega, L.J., Cumyn, A., Caron, N., Cote, A‐M., Sauve, N., Nkulu, D. Ngoy, Lez, D. Malamba, Yolola, E. Ngoy, Krejci, J., Poloczkova, H., Ersboll, A., Gustafsson, F., Elrakshy, Y., Hassanein, M., Hammad, B., Eldin, O. Nour, Fouad, D., Salman, S., Zareh, Z., Abdeall, D., Elenin, H. Abo, Ebaid, H., El Nagar, A., Farag, S., Saed, M., El Rahman, Y H Abd, Ibrahim, B.S., Abdelhamid, M., Hanna, R.N. W., Youssef, G., Awad, R., Botrous, O.L. I., Halawa, S. Ibrahim, Nasr, G., Saad, A., El Tahlawi, M., Abdelbaset, M., El‐saadawy, M., El‐shorbagy, A., Shalaby, G., Anttonen, O., Tolppanen, H., Hamekoski, S., Menez, T., Noel, A., Lamblin, N., Mouquet, F., Coulon, C., Groote, P., Langlois, S., Schurtz, G., Cohen‐Solal, A., Mebazaa, A., Fournier, M‐C., Louadah, B., Akrout, N., Logeart, D., Leurent, G., Jovanova, S., Arnaudova‐Dezulovicj, F., Livrinova, V., Bauersachs, J., Hilfiker‐Kleiner, D., Berliner, D., Jungesblut, M., Koenig, T., Moulig, V.A., Pfeffer, T.J., Böhm, M., Kindermann, I., Schwarz, V., Schmitt, C., Swojanowsky, P., Pettit, S., Petrie, M., McAdam, M., Patton, D., Bakhai, A., Krishnamurthy, V., Lim, L., Clifford, P., Bowers, N., Clark, A. L., Witte, K., Cullington, D., Oliver, J., Simms, A., Mcginlay, M., McDonagh, T., Shah, A. M., Amin‐Youssef, G., De Courcey, J., Martin, K., Shaw, S., Vause, S., Wallace, S., Malin, G., Wick, C., Nikolaou, M., Rentoukas, I., Chinchilla, H., Andino, L., Iyengar, S., Chandra, S., Yadav, D.K., Babu, R. Ravi, Singh, A.K., Kumar, S., Karunamay, B.B., Chaubey, S.K., Dhiman, S.R., Jha, V.C., Singh, S.K., Kodati, D., Dasari, R., Sultana, S., Dewi, T.I., Prameswari, H. Sasmaya, Al‐Farhan, H.A., Al‐Hussein, A., Yaseen, I.F., Al‐Azzawi, Falah, Al‐Saedi, Ghazi, Mahmood, G.M., Mohammed, M.K., Ridha, A.F., Shotan, A., Vazan, A., Goland, S., Biener, M., Senni, M., Grosu, A., Martin, E., Esposti, D. Degli, Bacchelli, S., Borghi, C., Metra, M., Sciatti, E., Orabona, R., Sani, F., Brunetti, N.D., Sinagra, G., Bobbo, M., D'Agata Mottolese, B., Gesuete, V., Rakar, S., Ramani, F., Kamiya, C., Barasa, A., Ngunga, M., Bajraktari, G., Hyseni, V., Lleshi, D., Pllana, E., Pllana, T., Noruzbaeva, A., Ismailov, F., Mirrakhimov, E., Abilova, S., Lunegova, O., Kerimkulova, A., Osmankulova, G., Duishenalieva, M., Kurmanbekova, B., Turgunov, M., Mamasaidova, S., Bektasheva, E., Kavoliuniene, A., Muckiene, G., Vaitiekiene, A., Celutkiene, J., Balkevicine, L., Barysiene, J., Chee, K.H., Damasceno, A., Machava, M., Veldhuisen, D.J., Meer, P., Berg, M., Roos‐Hesselink, J., Hagen, I., Baris, L., Hurtado, P., Ezeonu, P., Isiguzo, G., Obeka, N., Onoh, R., Asogwa, F., Onyema, C., Otti, K., Ojji, D., Odili, A., Nwankwo, A., Karaye, K., Ishaq, N., Sanni, B., Abubakar, H., Mohammed, B., Sani, M., Kehinde, M., Mbakwem, A., Afolabi, B., Amadi, C., Kilasho, M., Qamar, N., Furnaz, S., Gurmani, S., Kayani, M.G.A. Mahmood, Munir, R., Hussain, S., Malik, S., Mumtaz, S., Saligan, J.R., Rubis, P., Biernacka‐Fijalkowska, B., Lesniak‐Sobelga, A., Wisniowska‐Smialek, S., Kasprzak, J.D., Lelonek, M., Zycinski, P., Jankowski, L., Grajek, S., Oko‐Sarnowska, Z., Rutkowska, A. Bartczak, Kaluzna‐Oleksy, M., Plaskota, K., Demkow, M., Dzielinska, Z., Henzel, J., Kryczka, K., Moiseeva, O., Irtyuga, O., Karelkina, E., Zazerskaya, I., Seferovic, P.M., Milinkovic, I., Živkovic, I., Ristic, A.D., Milasinovic, D., Kong, W. KF, Tan, L.K., Tan, J.L., Thain, S., Poh, K.K., Yip, J., Sliwa, K., Azibani, F., Hovelmann, J., Viljoen, C., Briton, O., Zamora, E., Orcajo, N. Alonso, Carbonell, R., Pascual, C., Muncharaz, J. Farre, Alonso‐Pulpon, L., Cubero, J. Segovia, Urquia, M. Taibo, Garcia‐Pavia, P., Gomez‐Bueno, M., Cobo‐Marcos, M., Briceno, A., Galvan, E. De Teresa, Garcia‐Pinilla, J.M., Robles‐Mezcua, A., Morcillo‐Hildalgo, L., Elbushi, A., Suliman, A., Ahamed, N., Jazzar, K., Murtada, M., Schaufelberger, M., Goloskokova, V., Hullin, R., Yarol, N., Arrigo, M., Cavusoglu, Y., Eraslan, S., Fak, A.S., Enar, S. Catirli, Sarac, L., Cankurtaran, B., Gumrukcuoglu, H., Ozturk, F., Omagino, J., Mondo, C., Lwabi, P., Ingabire, P., Nabbaale, J., Nyakoojo, W., Okello, E., Sebatta, E., Ssinabulya, I., Atukunda, E., Kitooleko, S., Semu, T., Salih, B.T., Komaranchath, A.M., Almahmeed, W.A.R., Gerges, F., Farook, F.S. Mohamed, Albakshy, F., Mahmood, N., Wani, S., Freudenberger, R., Islam, N., Quinones, J., Sundlof, D., Beitler, C., Centolanza, L., Cornell, K., Huffaker, S., Matos, L., Marzo, K., Paruchuri, V., Patel, D., Abdullaev, T., Alyavi, B., Mirzarakhimova, S., Tsoy, I., Bekbulatova, R., and Uzokov, J.

Abstract

Aims: \ud Hypertensive disorders occur in women with peripartum cardiomyopathy (PPCM). How often hypertensive disorders co-exist, and to what extent they impact outcomes, is less clear. We describe differences in phenotype and outcomes in women with PPCM with and without hypertensive disorders during pregnancy.\ud \ud Methods: \ud The European Society of Cardiology PPCM Registry enrolled women with PPCM from 2012-2018. Three groups were examined: 1) women without hypertension (‘PPCM-noHTN’); 2) women with hypertension but without pre-eclampsia (‘PPCM-HTN’); 3) women with pre-eclampsia (‘PPCM-PE’). Maternal (6-month) and neonatal outcomes were compared.\ud \ud Results: \ud Of 735 women included, 452 (61.5%) had PPCM-noHTN, 99 (13.5%) had PPCM-HTN and 184 (25.0%) had PPCM-PE. Compared to women with PPCM-noHTN, women with PPCM-PE had more severe symptoms (NYHA IV in 44.4% and 29.9%, p

Published
2021

2. Modeling of mineral-melt interfaces : an atomic scale view on partially molten rocks

Author

Gurmani, S. and 3.3 Chemistry and Physics of Earth Materials, 3.0 Geodynamics and Geomaterials, Departments, GFZ Publication Database, Deutsches GeoForschungsZentrum

Subjects
Transport Properties, Olivine, Molecular Dynamic Simulation, 550 - Earth sciences
Abstract

Partial melting is an important geological process in the deep Earth that affects physical, chemical and rheological properties of rocks. The effect of partial melting on mantle dynamics depends on both the amount of melt and how it is distributed within the crystalline matrix. A few percent of melt have potentially large effect on the physical properties of rocks. In this work, atomic scale simulations are used to study the structure and transport properties of ultrathin melt films between olivine grains, which is a simple model system of partially molten peridotite. The model system consists of 0.8 to 7.0 nm thick layers of magnesium silicate melt with a composition close to MgSiO3 (enstatite) confined between Mg2SiO4 forsterite crystals. We examine how the atomic structure, the chemistry and the self-diffusion coefficients vary across the interface and investigate their dependence on the thickness of the melt layer and the crystal orientation. The particle interactions are represented by an advanced ionic model. From the particle trajectories, we derive various properties, like charge densities, cation coordinations, chemical compositions, and self-diffusion coefficients. Interfacial layers of up to 2~nm thickness show distinctly different physical behavior than the bulk melt and the bulk mineral. The simulation results indicate that for crystal orientations with higher surface energy, the self-diffusion coefficients of all ionic species in the melt decrease at constant melt layer thickness. By increasing the melt layer thickness between the crystals, the average mobility of ions in the melt is increased. On the interfacial part the charge mobility of all species decreases due to solid-like ordering between atoms. For modeling the petrophysical behavior of partially molten rocks, the effective diameter for the conducting channels is reduced by up to two nanometers, which effects the rheological and transport properties of partially molten rocks, especially in the presence of ultra-thin melt films in well-wetted systems. In the latter case, the electrical conductivity of the confined melt in a partially molten rock could be reduced up to a factor of two due to interfacial effects. A slight difference is observed in the interfacial properties due to change in chemical composition, pressure and temperature conditions. When calcium is added to the system, the self-diffusion coefficients of all species slightly change. At different pressure and temperature, a huge difference is observed in the self-diffusion coefficients. Freezing of the system and confinement effect is clearly observed at 2000 K with pressure of 10 GPa, and at 2400 K with 10 GPa pressure. Non-equilibrium molecular dynamics simulations with constant shear rate are performed on this system showing complex rheological behavior in the vicinity of interfaces. A dependence of the viscosity on shear rate is observed which constitutes non- Newtonian behavior of the melt at the high shear rates accessible to molecular dynamics. The viscosity calculated from non-equilibrium molecular dynamics simulations is found to be somewhat higher then the viscosity calculated from equilibrium molecular dynamics simulations. The viscosity at the lowest modeled shear rate is in good agreement with the experimental viscosity., Das partielle Aufschmelzen von Gestein ist ein wichtiger geologischer Prozess in der tiefen Erde, der seine physikalischen, chemischen und rheologischen Eigenschaften beeinflusst. Die Wirkung von partiell geschmolzenem Gestein auf die Manteldynamik hängt sowohl von der Menge der Schmelze als auch von ihrer Verteilung in der kristallinen Matrix ab. Einige wenige Prozent Schmelzanteil können einen großen Einfluss auf die physikalischen Eigenschaften des Gesteins haben. In dieser Arbeit werden Simulationen auf atomarer Ebene durchgeführt, um die Struktur und Transporteigenschaften ultradünner Schmelzfilme zwischen Olivinkörnern zu untersuchen, die ein einfaches Modellsystem für partiell geschmolzenen Peridotit darstellen. Das Modellsystem besteht aus 0.8 bis 7.0 nm dicken Schichten von Magnesiumsilikatschmelze mit einer Zusammensetzung in der Nähe von MgSiO3 (Enstatit), die seitlich von Forsterit-Kristallen (Mg2SiO4) begrenzt werden. Wir untersuchen die Änderung der atomaren Struktur, der chemischen Zusammensetzung und der Selbstdiffusionskoeffizienten entlang eines Profils senkrecht zur Grenzfläche sowie ihre Abhängigkeit von der Dicke der Schmelzschicht und der Orientierung der Kristalle. Die Wechselwirkung zwischen den Atomen wird durch ein erweitertes ionisches Modell beschrieben. Aus den atomaren Trajektorien erhalten wir verschiedene Eigenschaften wie die Ladungsdichte, Koordinationszahlen der Kationen, die chemische Zusammensetzung und Selbstdiffusionskoeffizienten. Grenzflächenschichten von bis zu 2 nm Dicke weisen ein deutlich anderes physikalischen Verhalten auf als ausgedehnte Schmelzen und Mineralien. Die Ergebnisse der Simulationen zeigen, dass für Kristallorientierungen mit höherer Oberflächenenergie die Selbstdiffusionskoeffizienten aller Ionen in der Schmelze bei konstanter Dicke der Schmelzschicht niedriger sind. Mit wachsender Dicke der Schmelzschicht zwischen den Kristallen erhöht sich die durchschnittliche Mobilität der Ionen in der Schmelze. Nahe der Grenzfläche ist die Ladungsmobilität niedriger, da sich dort eine festkörperartige Anordnung der Atome ausbildet. Für die Modellierung des gesteinsphysikalischen Verhaltens von partiell geschmolzenem Gestein ergibt sich, dass der effektive Durchmesser von leitenden Kanälen um bis zu 2 nm verringert ist, was sich auf die Rheologie und die Transporteigenschaften von partiell geschmolzenem Gestein auswirkt, besonders in Anwesenheit von ultradünnen Schmelzfilmen in gut benetzten Systemen. In diesem Fall könnte sich die elektrische Leitfähigkeit der seitlich eingeschlossenen Schmelze in partiell geschmolzenem Gestein aufgrund von Grenzflächeneffekten um einen Faktor von bis zu 2 verringern. Bei den Grenzflächeneigenschaften werden bei Änderung der chemischen Zusammensetzung, des Drucks und der Temperatur kleine Unterschiede beobachtet. Wird Calcium zum System hinzugefügt, ändern sich die Selbstdiffusionskoeffizienten aller Ionen leicht. Bei unterschiedlichen Druck- und Temperaturbedingungen werden stark veränderte Selbstdiffusionskoeffizienten beobachtet. Ein Einfrieren des Systems und ein Einschließungseffekt sind deutlich sichtbar bei 2000 K und einem Druck von 10 GPa, ebenso bei 2400 K und 10 GPa. Auch Nicht- Gleichgewichts-Molekulardynamik mit einer konstanten Scherrate wurde mit diesem System durchgeführt. Sie zeigt ein kompliziertes rheologisches Verhalten in der Nähe der Grenzflächen an. Es wird eine Abhängigkeit der Viskosität von der Scherrate beobachtet, was ein nicht-Newtonsches Verhalten der Schmelze bei den hohen Scherraten darstellt, die mit molekulardynamischen Simulationen erreicht werden können. Die mit Hilfe von Nicht-Gleichgewichts- Molekulardynamik berechnete Viskosität ist etwas größer als die mit Hilfe von Gleichgewichts-Molekulardynamik bestimmte. Die Viskosität, die sich mit der niedrigsten modellierten Scherrate ergibt, stimmt gut mit der experimentell bestimmten Viskosität überein.

Published
2012

8. Thromboembolic events in peripartum cardiomyopathy: results from the ESC EORP PPCM registry

Author

Tromp, Jasper, Jackson, Alice M, Abdelhamid, Magdy, Fouad, Doaa, Youssef, Ghada, Petrie, Mark C, Bauersachs, Johann, Sliwa, Karen, van der Meer, Peter, Gale, C P, Beleslin, B., Budaj, A., Chioncel, O., Dagres, N., Danchin, N., Emberson, J., Erlinge, D., Glikson, M., Gray, A., Kayikcioglu, M., Maggioni, A P, Nagy, V K, Nedoshivin, A., Petronio, A-S, Roos-Hesselink, J., Wallentin, L., Zeymer, U., Bauersachs, J., Sliwa, K., Boehm, M., Johnson, M., Hilfiker-Kleiner, D., Mbakwem, A., Mebazaa, A., Mouquet, F., Petrie, M., Pieske, B., Regitz-Zagrosek, V., Schaufelberger, M., Seferovic, P M, Tavazzi, L., van der Meer, P., Van Spaendonck-Zwarts, K., Favaloro, R., Favaloro, L., Carballo, M., Peradejordi, M., Renedo, M F, Absi, D., Bertolotti, A., Ratto, R., Talavera, M L, Gomez, R., Lockwood, S., Barton, T., Austin, M-A, Arstall, M., Aldridge, E., Chow, Y Y, Dekker, G., Mahadavan, G., Rose, J., Wittwer, M., Hoppe, U., Sandhofer, A., Bahshaliyev, A., Gasimov, Z., Babayev, A., Niftiyev, P., Hasanova, I., AlBannay, R., AlHaiki, W., Husain, A., Mahdi, N., Kurlianskaya, A., Lukyanchyk, M., Shatova, O., Troyanova-Shchutskaia, T., Anghel, L., De Pauw, M., Gevaert, S., De Backer, J., De Hosson, M., Vervaet, P., Timmermans, P J, Janssen, A., Yameogo, N V, Kagambega, L J, Cumyn, A., Caron, N., Cote, A-M, Sauve, N., Nkulu, D Ngoy, Lez, D Malamba, Yolola, E Ngoy, Krejci, J., Poloczkova, H., Ersboll, A., Gustafsson, F., Elrakshy, Y., Hassanein, M., Hammad, B., Eldin, O Nour, Fouad, D., Salman, S., Zareh, Z., Abdeall, D., Elenin, H Abo, Ebaid, H., El Nagar, A., Farag, S., Saed, M., El Rahman, Y H Abd, Ibrahim, B S, Abdelhamid, M., Hanna, R N W, Youssef, G., Awad, R., Botrous, O L I, Halawa, S Ibrahim, Nasr, G., Saad, A., El Tahlawi, M., Abdelbaset, M., El-Saadawy, M., El-Shorbagy, A., Shalaby, G., Anttonen, O., Tolppanen, H., Hamekoski, S., Menez, T., Noel, A., Lamblin, N., Coulon, C., de Groote, P., Langlois, S., Schurtz, G., Cohen-Solal, A., Fournier, M-C, Louadah, B., Akrout, N., Logeart, D., Leurent, G., Jovanova, S., Arnaudova-Dezulovicj, F., Livrinova, V., Berliner, D., Jungesblut, M., Koenig, T., Moulig, V A, Pfeffer, T J, Böhm, M., Kindermann, I., Schwarz, V., Schmitt, C., Swojanowsky, P., Pettit, S., McAdam, M., Patton, D., Bakhai, A., Krishnamurthy, V., Lim, L., Clifford, P., Bowers, N., Clark, A L, Witte, K., Cullington, D., Oliver, J., Simms, A., Mcginlay, M., McDonagh, T., Shah, A M, Amin-Youssef, G., De Courcey, J., Martin, K., Shaw, S., Vause, S., Wallace, S., Malin, G., Wick, C., Nikolaou, M., Rentoukas, I., Chinchilla, H., Andino, L., Iyengar, S., Chandra, S., Yadav, D K, Babu, R Ravi, Singh, A K, Kumar, S., Karunamay, B B, Chaubey, S K, Dhiman, S R, Jha, V C, Singh, S K, Kodati, D., Dasari, R., Sultana, S., Dewi, T I, Prameswari, H Sasmaya, Al-Farhan, H A, Al-Hussein, A., Yaseen, I F, Al-Azzawi, Falah, Al-Saedi, Ghazi, Mahmood, G M, Mohammed, M K, Ridha, A F, Shotan, A., Vazan, A., Goland, S., Biener, M., Senni, M., Grosu, A., Martin, E., Esposti, D Degli, Bacchelli, S., Borghi, C., Metra, M., Sciatti, E., Orabona, R., Sani, F., Brunetti, N D, Sinagra, G., Bobbo, M., D'Agata Mottolese, B., Gesuete, V., Rakar, S., Ramani, F., Kamiya, C., Barasa, A., Ngunga, M., Bajraktari, G., Hyseni, V., Lleshi, D., Pllana, E., Pllana, T., Noruzbaeva, A., Ismailov, F., Mirrakhimov, E., Abilova, S., Lunegova, O., Kerimkulova, A., Osmankulova, G., Duishenalieva, M., Kurmanbekova, B., Turgunov, M., Mamasaidova, S., Bektasheva, E., Kavoliūnienė, Aušra, Muckienė, Gintarė, Vaitiekienė, Audronė, Čelutkienė, Jelena, Balkevičienė, Laura, Barysienė, Jūratė, Chee, K H, Damasceno, A., Machava, M., van Veldhuisen, D J, van den Berg, M., van Hagen, I., Baris, L., Hurtado, P., Ezeonu, P., Isiguzo, G., Obeka, N., Onoh, R., Asogwa, F., Onyema, C., Otti, K., Ojji, D., Odili, A., Nwankwo, A., Karaye, K., Ishaq, N., Sanni, B., Abubakar, H., Mohammed, B., Sani, M., Kehinde, M., Afolabi, B., Amadi, C., Kilasho, M., Qamar, N., Furnaz, S., Gurmani, S., Kayani, M G A Mahmood, Munir, R., Hussain, S., Malik, S., Mumtaz, S., Saligan, J R, Rubis, P., Biernacka-Fijalkowska, B., Lesniak-Sobelga, A., Wisniowska-Smialek, S., Kasprzak, J D, Lelonek, M., Zycinski, P., Jankowski, L., Grajek, S., Oko-Sarnowska, Z., Rutkowska, A Bartczak, Kaluzna-Oleksy, M., Plaskota, K., Demkow, M., Dzielinska, Z., Henzel, J., Kryczka, K., Moiseeva, O., Irtyuga, O., Karelkina, E., Zazerskaya, I., Milinkovic, I., Živkovic, I., Ristic, A D, Milasinovic, D., Kong, W Kf, Tan, L K, Tan, J L, Thain, S., Poh, K K, Yip, J., Azibani, F., Hovelmann, J., Viljoen, C., Briton, O., Zamora, E., Orcajo, N Alonso, Carbonell, R., Pascual, C., Muncharaz, J Farre, Alonso-Pulpon, L., Cubero, J Segovia, Urquia, M Taibo, Garcia-Pavia, P., Gomez-Bueno, M., Cobo-Marcos, M., Briceno, A., Galvan, E De Teresa, Garcia-Pinilla, J M, Robles-Mezcua, A., Morcillo-Hildalgo, L., Elbushi, A., Suliman, A., Ahamed, N., Jazzar, K., Murtada, M., Goloskokova, V., Hullin, R., Yarol, N., Arrigo, M., Cavusoglu, Y., Eraslan, S., Fak, A S, Enar, S Catirli, Sarac, L., Cankurtaran, B., Gumrukcuoglu, H., Ozturk, F., Omagino, J., Mondo, C., Lwabi, P., Ingabire, P., Nabbaale, J., Nyakoojo, W., Okello, E., Sebatta, E., Ssinabulya, I., Atukunda, E., Kitooleko, S., Semu, T., Salih, B T, Komaranchath, A M, Almahmeed, W A R, Gerges, F., Farook, F S Mohamed, Albakshy, F., Mahmood, N., Wani, S., Freudenberger, R., Islam, N., Quinones, J., Sundlof, D., Beitler, C., Centolanza, L., Cornell, K., Huffaker, S., Matos, L., Marzo, K., Paruchuri, V., Patel, D., Abdullaev, T., Alyavi, B., Mirzarakhimova, S., Tsoy, I., Bekbulatova, R., and Uzokov, J.

Published
2023

9. Valvular Heart Disease Care in Pakistan: Impact of the Multidisciplinary Valve Heart Team.

Author

Bhatti S, Rehman S, Usman M, Iqbal Z, Atif U, Gurmani S, Hussain W, Memon R, Awan AB, Mangi AJ, Karim M, Qamar N, Saghir T, and Hakeem A

Abstract

Background: Patients with complex valvular heart disease (VHD) should be evaluated by a multidisciplinary heart team (HT). In low- and middle-income countries, referral practices are more variable, permitting any physician to refer patients directly to a cardiac surgeon without prior formal evaluation by a cardiologist with expertise in VHD., Objectives: The goal of the study was to examine the demographics of VHD patients seen in a large heart valve center in a low- and middle-income country and to assess the impact of the multidisciplinary HT in patients referred for valve surgery., Methods: Over a 20-month period, all patients with VHD seen in the National Institute of Cardiovascular Diseases (Karachi, Pakistan) outpatient cardiovascular surgery clinic were referred to the heart valve center and assessed by a multidisciplinary HT. The multidisciplinary HT developed individualized plans for each patient., Results: A total of 2,003 patients (52.8% female, mean age: 43.9 ± 14.4 years) were enrolled. Rheumatic heart disease was identified as the predominant cause of mitral valve disease, whereas bicuspid valve was the most common cause of significant aortic stenosis. All patients had been referred for valve surgery. Based on the HT's evaluation, 1,521 patients (76%) were deemed suitable for surgery, 335 patients (17%) were recommended for medical therapy, and 147 patients (7%) were considered candidates for transcatheter treatments. Notably, the HT reclassified the management strategies for 24% of the patients, all of whom had initially been referred for surgical intervention., Conclusions: The integration of collaborative decision-making through a multidisciplinary HT led to individualized and tailored treatment strategies, with a significant proportion of patients receiving alternative interventions or medical management instead of surgery., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Published
2024
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10. Prospective Pakistan Registry of Echocardiographic Screening in Asymptomatic Pregnant Women.

Author

Bhatti S, Naz S, Gurmani S, Yasmin H, Atif U, Karim M, Ahmed S, Zehra K, Hakeem A, and Qamar N

Abstract

Background: Cardiovascular diseases are the primary cause of nonobstetric morbidity and mortality in pregnant women worldwide. Pakistan's high maternal and neonatal mortality rates underscore the need for effective screening protocols to detect cardiovascular diseases during pregnancy., Objectives: The objective of this study was to assess the prevalence and factors associated with structural heart disease among pregnant women without active cardiorespiratory symptoms (no symptoms or symptoms attributed to pregnancy) attending routine antenatal appointments., Methods: Obstetric patients without known heart disease attending routine antenatal visits were enrolled between February 2023 and March 2024. All patients had a standardized limited transthoracic echocardiogram. Left ventricular ejection fraction was quantified using biplane Simpson's method. Multivariable binary logistic regression analysis was performed to identify determinants of left ventricular systolic dysfunction (LVSD)., Results: We enrolled 15,068 pregnant women (mean age 26.2 ± 5.1 years) of which 32.4% were primiparous and 0.9% had multifetal gestations. Screening occurred in the first trimester in 1.6% of patients and in the third trimester in 69.4%. structural heart disease was observed in 569 patients (3.8%): 338 (2.2%) with LVSD, 188 (1.2%) with valvular heart disease and 68 (0.5%) with congenital heart disease. Logistic regression analysis identified pregnancy-induced hypertension, tachycardia, and valvular heart disease as factors associated with LVSD., Conclusions: In a large cohort of pregnant women in Pakistan undergoing routine antenatal echocardiographic screening, almost 4% had structural heart disease. Notably, 2.2% of women had LVSD without active cardiorespiratory symptoms. In select populations, screening can help facilitate early cardiac diagnosis and referral to cardio-obstetrics care. (Prospective Pakistan Registry of Echocardiographic Screening in Asymptomatic Pregnant Women [PRESAP]; NCT06004544)., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Published
2024
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11. Mitral leaflet separation index correlation with mitral stenosis severity, a reliable easy 2-d echocardiography technique.

Author

Hussain S, Tipoo Sultan FA, Naz M, Gurmani S, and Rasheed S

Subjects
Male, Female, Humans, Adult, Middle Aged, Mitral Valve diagnostic imaging, Prospective Studies, Cross-Sectional Studies, Severity of Illness Index, Echocardiography, Mitral Valve Stenosis diagnostic imaging
Abstract

Objectives: To evaluate accuracy of mitral leaflet separation index for the determination of mitral stenosis severity in patients with rheumatic mitral stenosis., Methods: The prospective, cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from March 2021 to February 2022, and comprised patients with rheumatic mitral stenosis detected on echocardiography. The best end-diastole parasternal long axis and apical four-chamber views were acquired and Mitral leaflet separation was measured as the distance between the inner edges of the tip of mitral leaflets. Pearson correlation coefficient was computed for mitral leaflet separation index and mitral valve area. Receiver operating characteristic curve was used to determine the cut-off value of the mitral leaflet separation indexto categorise mitral stenosis. Data was analysed using SPSS 19., Results: Of the 277 patients, 205(74%) were females and 72(26%) were males. The overall mean age was 39.93±11.22 years. The mean mitral leaflet separation index value was 7.65±2.23. The correlation was significant and strong between mitral leaflet separation index and mitral valve area on planimetry (p<0.001), and was significant and moderate when measured by pressure half-time (p< 0.001). Mitral leaflet separation index cut-off value <8.625mm and <8.25mmcould predict severe mitral stenosis with 84% and 86.3% sensitivity and 84.6% and 78.3% specificity on planimetry and pressure half-time, respectively., Conclusions: The mitral leaflet separation index was found to be an independent, reliable and simple measure for assessing mitral stenosis severity.

Published
2024
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12. Initial Experience of Transthoracic Echocardiography at a Newly Operational Satellite Center in Hyderabad, Pakistan.

Author

Balouch IJ, Qamar N, Baqai L, Naz M, Gurmani S, and Karim M

Abstract

Introduction Transthoracic echocardiography (TTE) is the primary noninvasive imaging modality for quantitative and qualitative evaluation of cardiac anatomy and function. The Hyderabad satellite center of National Institute of Cardiovascular Diseases (NICVD), Pakistan has recently started its operations, including TTE; therefore, it is imperative to assess the initial experience for the process improvement of the center. Therefore, the aim of this clinical audit was to review our initial experience of TTE at this newly operational satellite center. Methods In this clinical audit, we reviewed the records of patient undergone TTE at the echocardiography department of NICVD Hyderabad satellite center from May 2018 to October 2018. Demographic characteristics, clinical history, indications for the TTE, and echocardiographic diagnoses were reviewed. Results A total of 2,177 TTE procedures were performed during the study period of six months out of which 68.7% (1,496) were performed in male patients. Mean age of the patients was 50.83 ± 12.44 years with 48.2% (1,050) patients above 50 years of age. The most frequent indication for the procedure was cardiomyopathy, 54.1% (1,177), among other indications, native valve regurgitation was in 49.8% (1,085), ischemic heart disease in 23.2% (504), heart murmurs in 17.3% (377), cardiac masses in 14.3% (312), pericardial disease in 8.5% (184), pulmonary disease in 7.3% (160), infective endocarditis in 6.4% (139), aortic and major disease in 6.3% (138), and native valve stenosis in 5.4% (177) of the patients. Procedures were performed before coronary artery revascularization in 2.2% (47) and for prosthetic valve assessment in 1.7% (38) patients. The TTE was normal in 36.6% (796) patients, while the most frequent diagnosis was cardiomyopathy, 53.8% (1,172), among the other TTE findings valvular heart disease was in 21.8% (475), ischemic heart disease (IHD) in 21.6% (470), pericardial disease in 8.0% (175), and congenital heart disease (CHD) in 1.4% (30) patients. Conclusion This clinical audit showed the effective use of TTE as a noninvasive imaging modality for quantitative and qualitative evaluation of cardiac anatomy and function at a newly operational satellite center of a resource-limited country with normal TTE findings in only 36.6% of the patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2019, Balouch et al.)

Published
2019
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