Association of Serum Omentin-1, Chemerin, and Leptin with Acute Myocardial Infarction and its Risk Factors.

OBJECTIVE: To determine the association of serum omentin-1, chemerin, and leptin with acute myocardial infarction (AMI) and its risk factors among individuals admitted with AMI to the coronary care unit (CCU). METHODS: The current case-control study was conducted at the CCU of King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia (KSA), in 2016-2018. A total of 122 AMI patients admitted to CCU, and 52 BMI and age-matched healthy subjects, between 30 and 65 years of age, were included. RESULTS: Chemerin and omentin-1 are independent predictors of the incidence of MI. Furthermore, serum omentin-1 was significantly lowered while chemerin and hsCRP levels were found to be significantly raised among the individuals with AMI compared to the healthy subjects, and no notable change was found in the serum leptin level. Serum omentin-1, chemerin, and leptin were significantly correlated with weight, BMI, waist circumference in patients, and control subjects. Binary logistic regression analysis displayed that the occurrence of MI is positively correlated with fasting plasma glucose (FPG), TC, TG, LDL-C, hsCRP, and chemerin and in a negative manner with HDL-C, and omentin. The chemerin and omentin-1 were also linked with the MI in multiple logistic regression analysis. CONCLUSIONS: The present results indicated that the serum omentin levels were significantly lowered while chemerin and hsCRP levels were found to be markedly raised among patients. No change was found in serum leptin levels. Serum chemerin and omentin-1 levels were independently associated with the MI. It appears that these parameters may be used to assess the risk spectrum of CAD.

Prevalence of hypothyroidism in a cohort of Saudi women with heart failure and effect on systolic and diastolic function.

OBJECTIVE: To determine the prevalence of hypothyroidism in a cohort of Saudi women with heart failure; to define the demographic variables associated with heart failure; and the impact of hypothyroidism on systolic function in relation to non-hypothyroidism group. METHODS: The cross-sectional cohort study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, and comprised all women diagnosed with heart failure who were seen in the Cardiology outpatients clinic between February 2010 and March 2013. All of them were subjected to complete medical history and clinical examination, including complete cardiac clinical examination, electrocardiogram, echocardiography, blood pressure reading as well as thyroid examination. Laboratory tests were performed for thyroid stimulating hormone, total cholesterol, triglycerides, low-density lipoprotein and high-density lipoprotein. RESULTS: Of the 111 patients, 37 (33.3%) had hypothyroidism (p<0.001), and 16(14.4%) of them showed subclinical hypothyroidism. The mean value for thyroid stimulating hormone was 4.79+/-4.98U/L. There was a significant negative correlation between thyroid stimulating hormone and ejection fraction. CONCLUSIONS: There was close relation between hypothyroidism and heart failure. Further large-scale studies are recommended for early detection of hypothyroidism.

Serum Vitamin D and Vaspin Levels Among Patients with Acute Myocardial Infarction and Their Association with Risk Factors.

Purpose: The current study investigated and compared serum levels of vitamin D (VD) and vaspin in AMI patients and healthy subjects and correlated these biomarkers with other biochemical risk factors for AMI. Patients and Methods: The research was carried out at King Abdulaziz University Hospital (KAUH) in Jeddah. Blood samples and additional information were gathered from 110 admitted AMI patients in the Intensive Coronary Care Unit (ICCU) (ages 40-65 years) and 50 adult, healthy volunteers whose BMI and age were similar to those of the patients. Results: AMI patients had significantly lower vaspin (p < 0.001) and VD levels (p < 0.001) than the control group. Fasting plasma glucose (FPG), hemoglobin A1C (HbA1c), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels were shown to be significantly different between AMI patients and controls. Among the AMI patients, 15 (13.6%) had deficient serum VD levels (≤20 ng/mL), 60 (54.5%) had insufficient levels (>20 - <30 ng/mL), and 35 (31.8%) had sufficient levels (≥30 ng/mL). In healthy subjects, VD levels were deficient in 4(8%), insufficient in 13 (26%), and sufficient in 33 (66%). VD insufficiency was more prevalent in AMI patients compared to the healthy group (54.5% vs 26%; p < 0.001). In AMI patients, serum vaspin was found to be related to age and HbA1c in the control group. VD did not show a significant correlation with any variable in AMI patients and healthy subjects. Serum vaspin (p = 0.89) and VD levels (p = 0.29) did not differ significantly between female and male control groups. Conclusion: Compared to the healthy group, AMI patients showed significantly lower vaspin and VD levels. Additionally, AMI patients had a higher prevalence of VD deficiency and insufficiency, suggesting its possible role in the occurrence of AMI.

A Case-based Implementation of Heart Failure Therapies, a Consensus Pathway by the Saudi Heart Failure Working Group.

The implementation of guideline-directed medical therapy (GDMT) in heart failure (HF) has many challenges in real-world clinical practice. The consensus document is written considering the variability of the clinical presentation of HF patients. HF medical therapies need frequent dose adjustment during hospital admission or when patients develop electrolyte imbalance, acute kidney injury, and other acute illnesses. The paper describes clinical scenarios and graphs that will aid the managing physicians in decision-making for HF therapy optimization.

Strategic Recommendations to Bridge the Gaps in Awareness, Diagnosis and Prevention of Heart Failure in the Middle East Region and Africa.

Objective: With the increasing burden of heart failure (HF) in the Middle East Region and Africa (MEA), it is imperative to shift the focus to prevention and early detection of cardiovascular diseases. We present a broad consensus of the real-world challenges and strategic recommendations for optimising HF care in the MEA region. Method: To bridge the gaps in awareness, prevention, and diagnosis of HF, an assembly of experts from MEA shared their collective opinions on the urgent unmet needs. Results: Lack of awareness in the community, high prevalence of risk factors, poor accessibility and affordability of care and diagnostics are the major barriers for delayed or missed diagnosis of HF in MEA. Enhancing patient awareness, through digital or social media campaigns, alongside raising knowledge of healthcare providers and policymakers with training programmes, can pave the way for influencing policy decisions and implementation of robust HF programmes. Multicountry registries can foster development of guidelines factoring in local challenges and roadblocks for HF care. Region-specific guidelines including simplified diagnostic algorithms can provide a blueprint of care for early detection of at-risk patients and facilitate efficient referral, thus mitigating clinician "therapeutic inertia." Multidisciplinary care teams and HF clinics with expanded role of nurses can streamline lifestyle modification and optimum control of dyslipidaemia, blood pressure, and glycaemia through guideline-recommended prevention therapies such as sodiumglucose co-transporter-2 inhibitors-thus supporting pleiotropic effects in high-risk populations. Conclusion: Development of regional guidelines, enhancing awareness, leveraging digital technology, and commitment for adequate funding and reimbursement is pivotal for overcoming structural and health system-related barriers in the MEA region.

Value of ambulatory blood pressure measurement in diagnosing hypotension in hypertensive diabetic patients with medication-controlled BP.

BACKGROUND: Hypotension is a common clinical finding in diabetic patients on anti-hypertensive medications. In the absence of clearly defined and documented hypotensive episodes, clinicians are faced with the challenge of modifying antihypertensive medication in potentially symptomatic diabetic patients. OBJECTIVE: To determine the value of ambulatory blood pressure monitor (ABPM) in diagnosing hypotensive episodes in hypertensive diabetic patients with medication-controlled blood pressure. PATIENTS AND METHODS: The records of all hypertensive diabetic patients with medication-controlled were obtained between 2017 and 2018. Patients' demographic data, comorbid conditions, hypotensive symptoms and echocardiography results were obtained and compared to office-based blood pressure and ABPM. RESULTS: Of 926 patients screened in the department of medicine outpatient clinics, 231 patients had diabetes and hypertension and were taking antihypertension medications, so only 86 patients were recruited. Using 24 h ABPM, hypotensive events were documented in 65 (75.6%) patients without correlated hypotensive symptoms in the patient sheet. Patients who had hypotensive episodes recorded by ABPM tended to have these between 5 and 10 a.m. and were significantly older - 60.71 versus 58.76 (P = .022) - and more likely to have lower ejection fractions by echocardiography 46.31 versus 62.85 (EF) (P < .001). CONCLUSION: In treated hypertensive diabetic patients with antihypertensive medication, ABPM may be beneficial in capturing bouts of asymptomatic (silent) hypotension readings that occur in the out-of-hospital setting. Diabetic patients with controlled hypertension based on office reading showed a significant number of asymptomatic hypotensive readings detected with ambulatory BP monitoring that can have a role in following up such patients.

Effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure.

INTRODUCTION: It is proposed that access to administering intravenous furosemide outside the hospital can contribute to lowering hospital admissions for heart failure. This study aims to evaluate the effect of outpatient furosemide infusion protocol in preventing hospitalization for patients with decompensating heart failure. This constitutes designing a viable clinical pathway in hospitals using a multidisciplinary heart failure program. METHODS: A prospective interventional study testing the effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure was conducted on 150 decompensating heart failure patients requiring hospital admission. Only 105 patients met the criteria and subsequently enrolled in the study. Each patient was administered intravenous furosemide infusion one or more times according to the protocol and depending on their symptoms of decompensation. Patients were referred for admission at any point once there is no improvement of their medical condition, or referred to heart failure clinic when clinical picture improved as observed by the treating team. RESULTS: In total, 14 of 105 patients who received intravenous furosemide infusion did not respond to diuretic infusion protocol and required hospital admission while 91 patients responded to same protocol and did not require admission, P value was statistically significant in three laboratory test measures of potassium (<0.001), urea (0.004), and creatinine (0.008). Heart failure with reduced ejection fraction was observed in 70 (76.9%) responders with a mean ejection fraction of 23% and in 9 (64.3%) non-responders with mean ejection fraction of 19.9%. CONCLUSION: Outpatient intravenous furosemide infusion protocol is effective in preventing hospitalization for decompensating heart failure and a viable clinical pathway for heart failure programs.

Using Atlanta Heart Failure Questionnaire in ambulatory heart failure patients with preserved ejection fraction HFPEF.

OBJECTIVES: The present study uses the Atlanta Heart Failure Questionnaire as a tool to evaluate and design a tailored education material for ambulatory heart failure patients with preserved ejection fraction, highlighting the strengths and weakness toward the planning of education programs. METHODS: A total of 450 patients were screened; 112 patients were recruited, and 27-item was used to evaluate the usefulness of this questionnaire. All patients received education by a dedicated medical education about the nature of the disease, risk factors and management including prevention of complications. Descriptive statistics were used for assessing the sample characteristics. RESULTS: In the assessment of patient disease knowledge, in a 7-item questionnaire, the most well-understood item was correctly identified in 95% patients, whereas the least-understood item was identified in 1.8% of patients. In the assessment of patient management knowledge, in a 6-item questionnaire, the most well-understood item was correctly identified in 50% of patients and the least-understood item was identified in 10% of patients. In the assessment of patient medication intake knowledge, in a 3-item questionnaire, the most well-understood item was correctly identified in 97.3% of patients and the least-understood item was identified in 26.6% of patients. CONCLUSION: For a disease not fully understood, the study has concluded the usefulness of Atlanta Heart Failure Questionnaire for filling the gaps, setting a base line and follow-up in the process of educating ambulatory heart failure patients with preserved ejection fraction HFPF.

Health Care Delivery for Heart Failure Patients During The COVID-19 Pandemic; A Consensus of The Saudi Heart Failure Working Group (SAUDI-HF).

The Coronavirus disease 2019 (COVID-19) pandemic led to global and national rapid health system changes to treat the affected patients and prevent the spread of the virus. The social distancing, redirecting resources, and nationwide lockdown led to the cancellation of non-urgent hospital visits and interruption of continuity of care for patients with chronic cardiac conditions such as heart failure (HF). This consensus document addresses the domains of health care delivery that are affected by the pandemic. It explains the current situation of health care delivery to heart failure patients and further recommendation on how to overcome this. Thus, maintaining quality and continuity of care to the HF population.

Echocardiographic and Clinical Correlates of Ejection Fraction Among 2000 Patients with Heart Failure in Western Saudi Arabia.

INTRODUCTION: Heart failure (HF) affects about 320,000 Saudi individuals and is associated with a considerable negative impact on the patients' quality of life. In literature, there is a lack of data about the echocardiographic abnormalities of HF patients in Saudi Arabia. AIM OF WORK: To describe the echocardiographic findings of HF patients in Western Saudi Arabia. METHODOLOGY: This was a retrospective record review study conducted on 2000 patients with chronic HF in Saudi Arabia. Demographic, clinical and echocardiographic data were collected and compared among patients with HF with reduced ejection fraction (HFrEF), ie, EF≤40%; HF with mid-range EF (HFmrEF), ie, EF=41-49%; and HF with preserved EF (HFpEF), ie, EF≥50%. RESULTS: Among the 2000 patients studied, females constituted 46.3% of the sample. About 52% of females had HFpEF, whilst 70% of males had HFrEF (p<0.0001). Diastolic dysfunction occurred in 98% of HFpEF versus 78% of HFrEF (p<0.0001). Patients with HFrEF had higher left-ventricular diastolic (LVd) volume (1536 versus 826), higher left-ventricular systolic (LVs) volume (1660 vs 772), higher left atrial volume (1344 vs 875), higher aortic root dimension (1144 vs 929) and lower fractional shortening (FS) (267 vs 1213) than patients with HFpEF (p<0.0001). CONCLUSION: HFpEF was more common among females and was associated with higher rates of diastolic dysfunction and higher FS. HFrEF was prevalent among males and associated with higher LVd, LVs, left atrium volume and aortic root dimensions.

Effects of a structured heart failure program on quality of life and frequency of hospital admission in Saudi Arabia.

OBJECTIVE:  To compare the quality of life (QOL) and frequency of hospital admission (FHA) in the past 4 months between congestive heart failure (CHF) patients involved in a structured heart failure program (HFP) compared with waitlisted controls. METHODS:   This study, employing an ex-post-facto comparative cross-sectional design, involved 80 patients with CHF (40 in the HFP and 40 controls). Those in the HFP had been enrolled for at least 4 months. Controls were waiting to be enrolled in the program. Participants completed a questionnaire assessing demographic, social/cultural, psychological, and CHF-related physical health characteristics, along with the primary dependent variables, QOL and FHA. Bivariate and multivariate analyses assessed differences between those in the HFP and controls. RESULTS:    Congestive heart failure patients in the HFP were significantly less likely than the control group to score below the median on heart failure-specific QOL, controlling for other variables (OR=0.83, 95% CI: 0.82-0.95, p=0.007). Those in the HFP were also significantly less likely than controls to be hospitalized within the past 4 months (OR=0.78, 95% CI: 0.69-0.88, p less than 0.001). Multivariate analyses indicated that CHF patients in the HFP were 95% less likely than controls to be admitted to the hospital during that period, independent of other risk factors for hospital admission. CONCLUSIONS:  Involvement by patients with CHF in a structured HFP at King Abdulaziz University in Jeddah, Kingdom of Saudi Arabia, is associated with significantly higher quality of life and lower likelihood of being hospitalized compared to CHF patients not involved.

Dietary Adherence of Saudi Males to the Saudi Dietary Guidelines and Its Relation to Cardiovascular Diseases: A Preliminary Cross-Sectional Study.

Cardiovascular disease (CVD) is a major public health problem in Saudi Arabia. Dietary intake plays a major role in CVD incidence; however, the dietary intake status in Saudi nationals with CVD is unknown. We aimed to investigate whether the dietary patterns of Saudi males, using the Saudi dietary guidelines adherence score, in parallel with the measurement of a selective number of cardiovascular disease-related biomarkers, are contributing factors to CVD risk. Demographics, dietary adherence score, and blood biomarker levels were collected for 40 CVD patients and forty non-CVD patients. Fasting blood glucose (p = 0.006) and high-density lipoprotein levels (p = 0.03) were significantly higher in CVD patients. The adherence score to the Saudi dietary guidelines was not significantly different between the CVD and non-CVD patients; however, the specific adherence scores of fruit (p = 0.02), olive oil (p = 0.01), and non-alcoholic beer (p = 0.02) were significantly higher in the non-CVD patients. The differences in CVD family history (p = 0.02) and adherence scores to specific groups/foods between the CVD and non-CVD patients may contribute to CVD risk in Saudi males. However, as the sample size of this study was small, further research is required to validate these findings.

Saudi Heart Association (SHA) guidelines for the management of heart failure.

Heart failure (HF) is the leading cause of morbidity and mortality worldwide and negatively impacts quality of life, healthcare costs, and longevity. Although data on HF in the Arab population are scarce, recently developed regional registries are a step forward to evaluating the quality of current patient care and providing an overview of the clinical picture. Despite the burden of HF in Saudi Arabia, there are currently no standardized protocols or guidelines for the management of patients with acute or chronic heart failure. Therefore, the Heart Failure Expert Committee, comprising 13 local specialists representing both public and private sectors, has developed guidelines to address the needs and challenges for the diagnosis and treatment of HF in Saudi Arabia. The ultimate aim of these guidelines is to assist healthcare professionals in delivering optimal care and standardized clinical practice across Saudi Arabia.

Hospitalization rate and outcomes in patients with left ventricular dysfunction receiving hemodialysis.

INTRODUCTION: Left ventricular dysfunction (LVD) is characterized as left ventricular ejection fraction (EF) below half of the systolic capacity of the left ventricle. Patients on hemodialysis have higher risk of developing LVD than the general population. Our aim was to assess hospitalization rate and outcomes in hemodialysis patients with LVD. PATIENTS AND METHODS: All patients ≥18 years old, who started hemodialysis therapy at King Abdulaziz University Hospital between January 2011 and December 2011, were identified using medical records of hemodialysis unit. Patients were then divided into three groups, according to their EF results prior to the initiation of hemodialysis, as patients with EF <40%, EF between 40% and 49%, and EF ≥50%. Patients were then followed for 5 years by reviewing their hospital records to assess their outcomes, hospital admissions, and length of hospital stay. RESULTS: Analysis included 333 patients. Patients with EF <40% were 40, 36 patients with EF 40%-49%, and 257 patients had an EF >50%. Patients with EF <50% were significantly older than patients with EF >50% (P=0.002). Diabetes mellitus and hypertension were more prevalent in patients with EF <40% and EF 40%-49% when compared with patients with EF >50% (P<0.001, P=0.002). The average length of stay between the three groups was significantly different (P=0.007). Intensive care unit admissions were significantly different when comparing the three groups (P=0.013) and was found to be an independent risk factor for mortality in our patients. Half of the patients with EF <40% and 44% of patients with EF of 40%-49% died compared with only 27% of patients with EF >50% (P=0.002). However, Kaplan-Meier analysis showed no significant difference in the survival time among the three groups (P=0.845). CONCLUSION: Mortality and morbidity increased in patients with LVD on hemodialysis compared with patients with normal EF.

An audit of in-hospital cardiopulmonary resuscitation in a teaching hospital in Saudi Arabia: A retrospective study.

OBJECTIVES: Data reflecting cardiopulmonary resuscitation (CPR) efforts in Saudi Arabia are limited. In this study, we analyzed the characteristics, and estimated the outcome, of in-hospital CPR in a teaching hospital in Saudi Arabia over 4 years. METHODS: A retrospective, observational study was conducted between January 2009 and December 2012 and included 4361 patients with sudden cardiopulmonary arrest. Resuscitation forms were reviewed. Demographic data, resuscitation characteristics, and survival outcomes were recorded. RESULTS: The mean ± standard deviation age of arrested patient was 40 ± 31 years. The immediate survival rate was 64%, 43% at 24 h, and 30% at discharge. The death rate was 70%. Respiratory type of arrest, time and place of arrest, short duration of arrest, witnessed arrest, the use of epinephrine and atropine boluses, and shockable arrhythmias were associated with higher 24-h survival rates. A low survival rate was found among patients with cardiac types of arrest, and those with a longer duration of arrest, pulseless electrical activity, and asystole. Comorbidities were present in 3786 patients with cardiac arrest and contributed to a poor survival rate (P < 0.001). CONCLUSIONS: The study confirms the findings of previously published studies in highly developed countries and provides some reflection on the practice of resuscitation in Saudi Arabia.

Association analyses based on false discovery rate implicate new loci for coronary artery disease.

Genome-wide association studies (GWAS) in coronary artery disease (CAD) had identified 66 loci at 'genome-wide significance' (P < 5 × 10-8) at the time of this analysis, but a much larger number of putative loci at a false discovery rate (FDR) of 5% (refs. 1,2,3,4). Here we leverage an interim release of UK Biobank (UKBB) data to evaluate the validity of the FDR approach. We tested a CAD phenotype inclusive of angina (SOFT; ncases = 10,801) as well as a stricter definition without angina (HARD; ncases = 6,482) and selected cases with the former phenotype to conduct a meta-analysis using the two most recent CAD GWAS. This approach identified 13 new loci at genome-wide significance, 12 of which were on our previous list of loci meeting the 5% FDR threshold, thus providing strong support that the remaining loci identified by FDR represent genuine signals. The 304 independent variants associated at 5% FDR in this study explain 21.2% of CAD heritability and identify 243 loci that implicate pathways in blood vessel morphogenesis as well as lipid metabolism, nitric oxide signaling and inflammation.