Nidal Asaad

Hamad Medical Corporation

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Jassim Al Suwaidi

Hamad Medical Corporation

143

Wael Almahmeed

Cleveland Clinic

Alawi Alsheikh‐Ali

Mohammed Bin Rashid University of Medicine and Health Sciences

Ahmed Al‐Motarreb

Sana'a University

Khalid F. AlHabib

King Saud University

Kadhim Sulaiman

Royal Hospital

Rajvir Singh

Hamad Medical Corporation

Prashanth Panduranga

Royal Hospital

Haitham Amin

Assiut University

Awad Al‐Qahtani

Hamad Medical Corporation

Cooperative Institutions

Hamad Medical Corporation

209

Hamad General Hospital

Weill Cornell Medical College in Qatar

King Saud University

Centro de Investigación en Red en Enfermedades Cardiovasculares

Qatar University

Inserm

University College London

Cleveland Clinic

Institute of Cardiology

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Insulin Resistance the Link between T2DM and CVD: Basic Mechanisms and Clinical Implications

Current Vascular Pharmacology (2017)

Muhammad Abdul‐Ghani Amin Jayyousi Ralph A. DeFronzo Nidal Asaad Jassim Al Suwaidi

Insulin resistance (IR) is a cardinal feature of type 2 diabetes mellitus (T2DM). It also is associated with multiple metabolic abnormalities which are known cardiovascular disease (CVD) risk factors. Thus, IR not only contributes to the development of hyperglycemia in T2DM patients, but also to the elevated CVD risk. Improving insulin sensitivity is anticipated to both lower the plasma glucose concentration and decrease CVD risk in T2DM patients, independent of glucose control. We review the molecular mechanisms and metabolic consequences of IR in T2DM patients and discuss the importance of addressing IR in the management of T2DM.

Metabolic control analysis

Metabolic disease

10.2174/1570161115666171010115119

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Correlations between Resting Electrocardiogram Findings and Disease Profiles: Insights from the Qatar Biobank Cohort

Journal of Clinical Medicine (2024)

Fatima Qafoud Khalid Kunji Mohamed Elshrif Asma Althani Amar M Salam

Background: Resting electrocardiogram (ECG) is a valuable non-invasive diagnostic tool used in clinical medicine to assess the electrical activity of the heart while the patient is resting. Abnormalities in ECG may be associated with clinical biomarkers and can predict early stages of diseases. In this study, we evaluated the association between ECG traits, clinical biomarkers, and diseases and developed risk scores to predict the risk of developing coronary artery disease (CAD) in the Qatar Biobank. Methods: This study used 12-lead ECG data from 13,827 participants. The ECG traits used for association analysis were RR, PR, QRS, QTc, PW, and JT. Association analysis using regression models was conducted between ECG variables and serum electrolytes, sugars, lipids, blood pressure (BP), blood and inflammatory biomarkers, and diseases (e.g., type 2 diabetes, CAD, and stroke). ECG-based and clinical risk scores were developed, and their performance was assessed to predict CAD. Classical regression and machine-learning models were used for risk score development. Results: Significant associations were observed with ECG traits. RR showed the largest number of associations: e.g., positive associations with bicarbonate, chloride, HDL-C, and monocytes, and negative associations with glucose, insulin, neutrophil, calcium, and risk of T2D. QRS was positively associated with phosphorus, bicarbonate, and risk of CAD. Elevated QTc was observed in CAD patients, whereas decreased QTc was correlated with decreased levels of calcium and potassium. Risk scores developed using regression models were outperformed by machine-learning models. The area under the receiver operating curve reached 0.84 using a machine-learning model that contains ECG traits, sugars, lipids, serum electrolytes, and cardiovascular disease risk factors. The odds ratio for the top decile of CAD risk score compared to the remaining deciles was 13.99. Conclusions: ECG abnormalities were associated with serum electrolytes, sugars, lipids, and blood and inflammatory biomarkers. These abnormalities were also observed in T2D and CAD patients. Risk scores showed great predictive performance in predicting CAD.

10.3390/jcm13010276

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Validation of the Canada Acute Coronary Syndrome Risk Score for Hospital Mortality in the Gulf Registry of Acute Coronary Events‐2

Clinical Cardiology (2015)

Hussam AlFaleh Alawi Alsheikh‐Ali Anhar Ullah Khalid F. AlHabib Ahmad Hersi

Several risk scores have been developed for acute coronary syndrome (ACS) patients, but their use is limited by their complexity. The new Canada Acute Coronary Syndrome (C-ACS) risk score is a simple risk-assessment tool for ACS patients. This study assessed the performance of the C-ACS risk score in predicting hospital mortality in a contemporary Middle Eastern ACS cohort.The C-ACS score accurately predicts hospital mortality in ACS patients.The baseline risk of 7929 patients from 6 Arab countries who were enrolled in the Gulf RACE-2 registry was assessed using the C-ACS risk score. The score ranged from 0 to 4, with 1 point assigned for the presence of each of the following variables: age ≥75 years, Killip class >1, systolic blood pressure <100 mm Hg, and heart rate >100 bpm. The discriminative ability and calibration of the score were assessed using C statistics and goodness-of-fit tests, respectively.The C-ACS score demonstrated good predictive values for hospital mortality in all ACS patients with a C statistic of 0.77 (95% confidence interval [CI]: 0.74-0.80) and in ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome patients (C statistic: 0.76, 95% CI: 0.73-0.79; and C statistic: 0.80, 95% CI: 0.75-0.84, respectively). The discriminative ability of the score was moderate regardless of age category, nationality, and diabetic status. Overall, calibration was optimal in all subgroups.The new C-ACS score performed well in predicting hospital mortality in a contemporary ACS population outside North America.

Killip class

10.1002/clc.22446

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Impact of Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptors Blockers on Mortality in Acute Heart Failure Patients with Left Ventricular Systolic Dysfunction in the Middle East: Observations from the Gulf Acute Heart Failure Registry (Gulf CARE)

Current Vascular Pharmacology (2017)

Ibrahim Al‐Zakwani Kadhim Sulaiman Jawad Al‐Lawati Alawi Alsheikh‐Ali Prashanth Panduranga

To evaluate the impact of Angiotensin-Converting Enzyme Inhibitors (ACEIs)/ Angiotensin Receptors Blockers (ARBs) on in-hospital, 3- and 12-month all-cause mortality in Acute Heart Failure (AHF) patients with left ventricular systolic dysfunction in 7 countries of the Middle East.Data was analysed from 2,683 consecutive patients admitted with AHF and Left Ventricular Ejection Fraction (LVEF) (<40%) from 47 hospitals from February to November 2012. Analyses were evaluated using univariate and multivariate statistics. The overall mean age of the cohort was 58±15, 72% (n=1,937) were males, 62% (n=1,651) had coronary artery disease, 57% (n=1,539) were hypertensives and 47% (n=1,268) had diabetes. Overall cumulative mortality at inhospital, 3- and 12-month follow-up was 5.8% (n=155), 12.6% (n=338) and 20.4% (n=548), respectively. Adjusting for demographic and clinical characteristics as well as medication in a multivariate logistic regression model, ACEIs were associated with lower risk of in-hospital mortality (adjusted odds ratio (aOR), 0.48; 95% Confidence Interval (CI): 0.25 to 0.94; p=0.031). At 3-month follow-up, both ACEIs (aOR, 0.64; 95% CI: 0.43 to 0.95; p=0.025) and ARBs (aOR, 0.34; 95% CI: 0.18 to 0.62; p<0.001) were associated with lower risk of mortality. Additionally, at 12-month follow-up, those prescribed ACEIs (aOR, 0.71; 95% CI: 0.53 to 0.96; p=0.027) and ARBs (aOR, 0.47; 95% CI: 0.31 to 0.71; p<0.001) were still associated with lower risk of mortality.ACEIs and ARBs treatments were associated with lower mortality risk during admission and up to 12-month of follow-up in Middle East AHF patients with left ventricular systolic dysfunction.

10.2174/1570161115666170817164420

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Incidence and impact of cardiorenal anaemia syndrome on all‐cause mortality in acute heart failure patients stratified by left ventricular ejection fraction in the Middle East

ESC Heart Failure (2018)

Mohammed Al‐Jarallah Rajesh Rajan Ibrahim Al‐Zakwani Raja Dashti Bassam Bulbanat

Abstract Aims This study aims to evaluate the incidence and impact of cardiorenal anaemia syndrome (CRAS) on all‐cause mortality in acute heart failure (AHF) patients stratified by left ventricular ejection fraction (LVEF) status in the Middle East. Methods and results Data were analysed from 4934 consecutive patients admitted to 47 hospitals in seven Middle Eastern countries (Saudi Arabia, Oman, Yemen, Kuwait, United Arab Emirates, Qatar, and Bahrain) with AHF from February to November 2012. CRAS was defined as AHF with estimated glomerular filtration rate of <60 mL/min and low haemoglobin (<13 g/dL for men or <12 g/dL for women). Analyses were performed using univariate and multivariate statistical techniques. The overall mean age of the cohort was 59 ± 15 years, 62% ( n = 3081) were men, and 27% ( n = 1319) had CRAS. Co‐morbid conditions were common including hypertension ( n = 3014; 61%), coronary artery disease ( n = 2971; 60%), and diabetes mellitus ( n = 2449; 50%). A total of 79% ( n = 3576) of the patients had AHF with reduced ejection fraction (HF r EF) (LVEF < 50%). CRAS patients were associated with major bleeding (1.29% vs. 0.6%; P = 0.017), blood transfusion (10.1% vs. 3.0%; P < 0.001), higher re‐admission rate for AHF at 3 months' follow‐up (27.6% vs. 18.8%; P < 0.001) and at 12 months' follow‐up (34.3% vs. 26.2%; P < 0.001). Multivariate logistic regression demonstrated that patients with CRAS were associated with higher odds of all‐cause mortality during hospital admission [adjusted odds ratio (aOR), 2.10; 95% confidence interval (CI): 1.34–3.31; P = 0.001], at 3 months' follow‐up (aOR, 1.48; 95% CI: 1.07–2.06; P = 0.018), and at 12 months' follow‐up (aOR, 1.45; 95% CI: 1.12–1.87; P = 0.004). Stratified analyses showed that CRAS patients with HF r EF were associated with higher odds of all‐cause mortality during hospital admission (aOR, 2.03; 95% CI: 1.20–3.45; P = 0.009) and at 12 months' follow‐up (aOR, 1.42; 95% CI: 1.06–1.89; P = 0.019) but not at 3 months' follow‐up (aOR, 1.43; 95% CI: 0.98–2.09; P = 0.063). However, in AHF patients with preserved ejection fraction (LVEF ≥ 50%), CRAS was not associated with higher odds of all‐cause mortality not only during hospital admission (aOR, 2.15; 95% CI: 0.84–5.55; P = 0.113) but also at 3 months' follow‐up (aOR, 1.87; 95% CI: 0.93–3.76; P = 0.078) and at 12 months' follow‐up (aOR, 1.59; 95% CI: 0.91–2.76; P = 0.101). Conclusions The incidence of CRAS was 27%. CRAS was associated with higher odds of all‐cause mortality in AHF patients in the Middle East, especially in those with HF r EF.

Univariate analysis

10.1002/ehf2.12351

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Baseline characteristics, management practices, and long-term outcomes of Middle Eastern patients in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2)

Annals of Saudi Medicine (2012)

Khalid F. AlHabib Kadhim Sulaiman Ahmed Al‐Motarreb Wael Almahmeed Nidal Asaad

Limited data are available on patients with acute coronary syndromes (ACS) and their long-term outcomes in the Arabian Gulf countries. We evaluated the clinical features, management, in-hospital, and long-term outcomes of in such a population.A 9-month prospective, multicenter study conducted in 65 hospitals from 6 countries that also included 30 day and 1-year mortality follow-up.ACS patients included those with ST-elevation myocardial infarction (STEMI) and non-ST-elevation acute coronary syndrome (NSTEACS), including non-STEMI and unstable angina. The registry collected the data prospectively.Between October 2008 and June 2009, 7930 patients were enrolled. The mean age (standard deviation), 56 (17) years; 78.8% men; 71.2% Gulf citizens; 50.1% with central obesity; and 45.6% with STEMI. A history of diabetes mellitus was present in 39.5%, hypertension in 47.2%, and hyperlipidemia in 32.7%, and 35.7% were current smokers. The median time from symptom onset to hospital arrival for STEMI patients was 178 minutes (interquartile range, 210 minutes); 22.3% had primary percutaneous coronary intervention (PCI) and 65.7% thrombolytic therapy, with 34% receiving therapy within 30 minutes of arrival. Evidence-based medication rates upon hospital discharge were 68% to 95%. The in-hospital PCI was done in 21% and the coronary artery bypass graft surgery in 2.9%. The in-hospital mortality was 4.6%, at 30 days the mortality was 7.2% , and at 1 year after hospital discharge the mortality was 9.4% ; 1-year mortality was higher in STEMI (11.5%) than in NSTEACS patients (7.7%; P<.001).Compared to developed countries, ACS patients in Arabian Gulf countries present at a relatively young age and have higher rates of metabolic syndrome features. STEMI patients present late, and their acute management is poor. In-hospital evidence-based medication rates are high, but coronary revascularization procedures are low. Long-term mortality rates increased severalfold compared with in-hospital mortality.

Baseline (sea)

10.5144/0256-4947.2012.9

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Impact of Chronic Kidney Disease on the Presentation and Outcome of Patients Hospitalized With Atrial Fibrillation: Insights From Qatar

Angiology (2017)

Imtiaz Salim Jassim Al Suwaidi Hajar AlBinali Rajvir Singh Awad Al‐Qahtani

Atrial fibrillation (AF) with coexistent chronic kidney disease (CKD) is poorly described in the literature. We compared the presenting symptoms, clinical characteristics, treatment, and outcome of patients hospitalized with AF with and without CKD in a large clinical registry. Data of patients hospitalized with AF between 1991 and 2012 in Qatar were analyzed. Of 5201 patients hospitalized for AF, 264 (5.1%) had CKD. Patients with AF and CKD were older with higher prevalence of other comorbidities and left ventricular dysfunction and were more likely to present with shortness of breath and chest pain compared with patients with AF alone who were more likely to present with palpitation. The crude in-hospital mortality was 3 times higher in patients with dual disease. On multivariable adjustments, CKD was an independent predictor of mortality (odds ratio: 2.84; 95% confidence interval: 1.33-6.08, P = .001). Further studies are warranted to try to reduce the increased mortality observed in this high-risk population.

10.1177/0003319717717849

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Citations (2)

OP-003: SHORT AND LONG-TERM MORTALITY ASSOCIATED WITH VENTRICULAR ARRHYTHMIA IN PATIENTS HOSPITALIZED WITH ACUTE CORONARY SYNDROME. FINDINGS FROM THE GULF RACE REGISTRY-2

International Journal of Cardiology (2011)

Ahmad Hersi Khalid F. AlHabib Hussam Al Faleh S. Alsaif Kadhim Sulaiman

10.1016/s0167-5273(11)70115-2

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Chronic obstructive airway disease among patients hospitalized with acute heart failure; clinical characteristics, precipitating factors, management and outcome: Observational report from the Middle East

Acute Cardiac Care (2015)

Hadi Khafaji Kadhim Sulaiman Rajvir Singh Khalid F. AlHabib Nidal Asaad

The purpose of this study was to report the prevalence, clinical characteristics, contributing factors, management and outcome of patients with chronic obstructive pulmonary disease (COPD) among patients hospitalized with heart failure (HF).Data were derived from Gulf Care (Gulf acute heart failure registry), a prospective multicenter study of 5005 consecutive patients hospitalized with acute heart failure during February to November 2012 in seven Middle Eastern countries. Data were described and compared for demographics, management and outcomes.The prevalence of COPD among HF patients was 10%. COPD patients were older, more likely to be female and to have diabetes, hypertension, chronic kidney disease and sleep apnea (P = 0.001 for all) when compared to non-COPD patients. Contributing factors for hospitalization were systemic infection and atrial arrhythmias in COPD patients compared to acute coronary syndrome, uncontrolled hypertension and anemia in the non-COPD patients. Left-ventricular ejection fraction was higher in COPD patients; while BNP levels were comparable between the two groups. Non-invasive ventilation was used more frequently among COPD patients compared to non-COPD patients (P = 0.001). On multivariate logistic regression analysis, COPD was not associated with increased risk in-hospital and one-year death among acute heart failure (AHF) population and β blockers treatment appear to have neutral mortality effect in COPD patients with HF.COPD have distinct cardiovascular risk profile and precipitating factors for hospitalization with HF when compared to non-COPD patients. COPD history had no impact on the short-term and one-year mortality.

10.1080/17482941.2016.1203438

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Immediate and one-year outcome of patients presenting with Acute Coronary Syndrome complicated by stroke: Findings from the 2ndGulf Registry of Acute Coronary Events (Gulf RACE-2)

BMC Cardiovascular Disorders (2012)

Jassim Al Suwaidi Khalid A. Habib Nidal Asaad Rajvir Singh Ahmad Hersi

Stroke is a potential complication of acute coronary syndrome (ACS). The aim of this study was to identify the prevalence, risk factors predisposing to stroke, in-hospital and 1-year mortality among patients presenting with ACS in the Middle East. For a period of 9 months in 2008 to 2009, 7,930 consecutive ACS patients were enrolled from 65 hospitals in 6 Middle East countries. The prevalence of in-hospital stroke following ACS was 0.70%. Most cases were ST segment elevation MI-related (STEMI) and ischemic stroke in nature. Patients with in-hospital stroke were 5 years older than patients without stroke and were more likely to have hypertension (66% vs. 47.6%, P = 0.001). There were no differences between the two groups in regards to gender, other cardiovascular risk factors, or prior cardiovascular disease. Patients with stroke were more likely to present with atypical symptoms, advanced Killip class and less likely to be treated with evidence-based therapies. Independent predictors of stroke were hypertension, advanced killip class, ACS type –STEMI and cardiogenic shock. Stroke was associated with increased risk of in-hospital (39.3% vs. 4.3%) and one-year mortality (52% vs. 12.3%). There is low incidence of in-hospital stroke in Middle-Eastern patients presenting with ACS but with very high in-hospital and one-year mortality rates. Stroke patients were less likely to be appropriately treated with evidence-based therapy. Future work should be focused on reducing the risk and improving the outcome of this devastating complication.

Stroke

Killip class

Angiology

10.1186/1471-2261-12-64

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Citations (22)