Biomedical subjects
Publications and source records attributed to Ahmed Abdel Latif.
Ultrasonography can screen for abdominal aortic aneurysms (AAAs) safely, cheaply, and accurately. Once detected, an AAA can be monitored and repaired before it is likely to rupture. The US Preventive Services Task Force recently recommended a one-time screening for AAAs by ultrasonography for men age 65 to 75 years who have ever smoked. We should consider expanding the recommendations to include others at risk.
Transesophageal echocardiography (TEE) is commonly performed to detect the presence of a left atrial appendage (LAA) thrombus in the setting of an embolic event or before an anticipated electrical cardioversion for atrial fibrillation. The predictive value of transthoracic echocardiographic (TTE) findings in these patients has not been well defined. This study evaluated whether TTE findings can predict LAA thrombi using TEE as the gold standard for the identification of LAA thrombi. From November 1995 to March 2003, 10,753 patients underwent TEE to exclude LAA thrombi after embolic events or before cardioversion. Of these, 3,768 patients had complete TTE examinations performed <2 weeks before undergoing TEE. Demographics, TTE, and cardiac rhythm variables were analyzed using univariate and multivariate logistic regression to identify predictors of LAA thrombi diagnosed on subsequent TEE. LAA thrombi were identified by TEE in 199 patients (5.3%). Several TTE variables predicted LAA thrombi by TEE, including mitral stenosis, atrial fibrillation, tricuspid regurgitation, valvular prosthesis, left ventricular dysfunction, and right ventricular dysfunction. Mitral regurgitation was associated with a reduced risk for LAA thrombi (odds ratio 0.61, p = 0.003). A structurally normal heart in sinus rhythm (n = 247, 6.9%) had a 100% negative predictive value for LAA thrombi. In conclusion, several TTE variables were found to be predictive of LAA thrombi. The likelihood of LAA thrombi being found on TEE was infinitely small in the absence of these variables and the presence of sinus rhythm.
Abdominal aortic aneurysms (AAAs) are not only a danger in themselves, they also signify underlying vascular disease that warrants intensive cardiovascular risk reduction, especially smoking cessation. Aneurysmal size and the patient's fitness for surgery are the main determinants of timing and method of elective repair. The choice of open surgery vs endovascular repair depends on the patient's condition, preference, and life expectancy, and the surgeon's experience.
BACKGROUND: Postoperative (postop) atrial fibrillation (AF) occurs in up to 60% of patients after cardiac surgery, leading to longer hospital stays and increased healthcare costs. Recently, B-type natriuretic peptide (BNP) has been reported to predict occurrence of nonpostoperative AF. This study evaluates whether elevated preoperative (preop) plasma BNP levels predict the occurrence of postop AF. METHODS AND RESULTS: One hundred eighty-seven patients with no history of atrial arrhythmia who had a preoperative BNP level and had undergone cardiac surgery were identified. Their records were reviewed, and postoperative ECG and telemetry strips were analyzed for AF until the time of discharge. Postop AF was documented in 80 patients (42.8%). AF patients were older (68+/-11 versus 64+/-14 years, P=0.04), but there was no difference in sex distribution, hypertension, left ventricular (LV) function, LV hypertrophy (LVH), left atrial size, history of coronary artery disease (CAD), or beta-blocker use. Preop plasma BNP levels were higher in the postop AF patients (615 versus 444 pg/mL, P=0.005). After adjustment for age, sex, type of surgery, hypertension, LV function, LVH, left atrial size, CAD, and beta-blocker use, the odds ratios of postop AF according to increasing quartiles, compared with patients with lowest quartile, were 1.8, 2.5, and 3.7 (P(trend)=0.03). CONCLUSIONS: An elevated preop plasma BNP level is a strong and independent predictor of postop AF. This finding has important implications for identifying patients at higher risk of postop AF who could be considered for prophylactic antiarrhythmic or beta-blocker therapy.
Most long-term care residents with atrial fibrillation would be at high risk for embolic stroke based on age and comorbidities according to the criteria presented here. Additionally, they are theoretically excellent candidates for adjusted-dose warfarin treatment for atrial fibrillation. They are accessible for monitoring and tend to have less dietary variability, a controlled medication list, and supervised medication administration. Balancing these features is at least a moderate risk of severe bleeding from anticoagulation based on age, comorbidities, and polypharmacy. However, studies suggest that even those long-term care residents identified as ideal candidates for anticoagulation may not receive warfarin. Those residents who do receive warfarin may not be anticoagulated within the therapeutic range much of the time. This treatment pattern may expose older adults with a high stroke risk to dying from a cardioembolic stroke or to acquiring functional deficits that make them more dependent and lower their quality of life.
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