Mohamed Faher Almahmoud

Electrocardiographic and Echocardiographic Left Ventricular Hypertrophy in the Prediction of Stroke in the Elderly.

INTRODUCTION It is unclear whether left ventricular hypertrophy (LVH) detected by electrocardiography (ECG-LVH) is equally predictive of heart failure as LVH detected by echocardiography (echo-LVH). METHODS This analysis included 4,008 white participants (41% men) aged 65 years or older from the Cardiovascular Health Study who were free of stroke and major intraventricular conduction defects. ECG-LVH was defined by the Cornell criteria from baseline ECG data and echo-LVH was calculated from baseline echocardiography measurements. Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between ECG-LVH and echo-LVH and adjudicated incident stroke events, separately. Harrells concordance indices (C-index) were calculated for the Framingham Stroke Risk Score with inclusion of ECG-LVH and echo-LVH, separately. RESULTS ECG-LVH was detected in 136 (3.4%) participants and echo-LVH was present in 208 (5.2%) participants. Over a median follow-up of 13 years, a total of 769 (19%; incidence rate = 15.4 per 1000 person-years) strokes occurred. In a multivariable Cox regression analysis adjusted for stroke risk factors and potential confounders, ECG-LVH (HR = 1.68; 95% CI = 1.23, 2.28) and echo-LVH (HR = 1.58; 95% CI = 1.17, 2.14) were associated with an increased risk of stroke. Similar values were obtained for the C-index when either ECG-LVH (C-index = .786) or echo-LVH (C-index = .786) were included in the Framingham Stroke Risk Score. CONCLUSION ECG-LVH and echo-LVH are able to be used interchangeably in stroke risk scores.

Resting heart rate and incident atrial fibrillation in the elderly.

Alterations in autonomic tone and/or sinus node dysfunction are common with aging. We hypothesized that older persons with low or high heart rates represent a population with subclinical abnormalities who are more likely to develop atrial fibrillation (AF).

Electrocardiographic Versus Echocardiographic Left Ventricular Hypertrophy in Prediction of Congestive Heart Failure in the Elderly.

Left ventricular hypertrophy (LVH) is an established risk factor for heart failure (HF) and is a component of the Framingham Heart Failure Risk Score (FHFRS). Whether LVH detected by electrocardiogram (ECG‐LVH) is equally predictive of HF as LVH detected by echocardiography (echo‐LVH) is unclear.

Left ventricular hypertrophy by ECG versus cardiac MRI as a predictor for heart failure

Objective To determine if there is a significant difference in the predictive abilities of left ventricular hypertrophy (LVH) detected by ECG-LVH versus LVH ascertained by cardiac MRI-LVH in a model similar to the Framingham Heart Failure Risk Score (FHFRS). Methods This study included 4745 (mean age 61±10 years, 53.5% women, 61.7% non-whites) participants in the Multi-Ethnic Study of Atherosclerosis. ECG-LVH was defined using Cornell voltage product while MRI-LVH was derived from left ventricular mass. Cox proportional hazard regression was used to examine the association between ECG-LVH and MRI-LVH with incident heart failure (HF). Harrells concordance C-index was used to estimate the predictive ability of the model when either ECG-LVH or MRI-LVH was included as one of its components. Results ECG-LVH was present in 291 (6.1%), while MRI-LVH was present in 499 (10.5%) of the participants. Both ECG-LVH (HR 2.25, 95% CI 1.38 to 3.69) and MRI-LVH (HR 3.80, 95% CI 1.56 to 5.63) were predictive of HF. The absolute risk of developing HF was 8.81% for MRI-LVH versus 2.26% for absence of MRI-LVH with a relative risk of 3.9. With ECG-LVH, the absolute risk of developing HF 6.87% compared with 2.69% for absence of ECG-LVH with a relative risk of 2.55. The ability of the model to predict HF was better with MRI-LVH (C-index 0.871, 95% CI 0.842 to 0.899) than with ECG-LVH (C-index 0.860, 95% CI 0.833 to 0.888) (p<0.0001). Conclusions ECG-LVH and MRI-LVH are predictive of HF. Substituting MRI-LVH for ECG-LVH improves the predictive ability of a model similar to the FHFRS.

Laser in infrapopliteal and popliteal stenosis 2 study (LIPS2): Long-term outcomes of laser-assisted balloon angioplasty versus balloon angioplasty for below knee peripheral arterial disease.

Laser‐assisted balloon angioplasty (LABA) has been shown to be more effective in achieving angiographic success for treatment for below knee peripheral artery disease (PAD) compared with balloon angioplasty alone(BA). However, long‐term outcomes of LABA compared with BA for popliteal and infrapopliteal PAD are unknown.

Isolated Mycobacterium kansasii wound infection and Osteomyelitis in an immunocompetent patient

Mycobacterium kansasii is a slow growing acid-fast non-tuberculosis mycobacterium. It most commonly causes pulmonary disease with tuberculosis-like manifestations. Mycobacterium kansasii-induced skin and soft tissue infections (SSTIs) are very uncommon, especially in the absence of obvious risk factors. In this report, we present a rare case of M. kansasii-associated SSTI complicated by tendonitis and osteomyelitis in an immunocompetent patient. This case highlights the importance of considering non-tuberculosis mycobacteria while investigating chronic, relapsing, non-healing SSTIs and osteomyelitis. Proper pharmacotherapy, along with surgical debridement, is the optimal management to avoid relapse and the production of resistant species.

FIBROBLAST GROWTH FACTOR-23 AND CARDIAC MRI INDICES OF MYOCARDIAL FIBROSIS IN THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS

Fibroblast growth factor-23 (FGF-23) is associated with myocardial fibrosis in animal studies. We examined the association between FGF-23 and Cardiac Magnetic Resonance Imaging (MRI) indices of myocardial fibrosis [i.e. Extracellular Volume Fraction (ECV)] using T1 mapping. A total of 6537 study