20 results found
<jats:p> We evaluated the potential pathogenic hazard of sphygmomanometer blood pressure cuffs (BPCs) in a hospital setting. Prospectively, the presence of bacterial organisms on 120 BPCs in 14 medical wards and outpatient clinics in a district general hospital in London was assessed. Swabs taken from the inner aspect of the cuffs were cultured using standard microbiological techniques. Bacterial organisms were found in 85% (102) of the 120 BPCs assessed. The highest rates of contamination were found in the outpatients department (90%). There were differences in the most common bacterial species isolated between the samples obtained from the outpatient clinics and the wards, with coagulase-negative Staphylococcus and diphtheroids being the most prevalent species in the wards and outpatient clinics, respectively. These findings highlight the necessity to eliminate this potential risk of infection. </jats:p>
Salmasi A-M, Strano A, 2012, Angiology in Practice, Publisher: Springer Science & Business Media, ISBN: 9789401154062
Both these instances of misclassification are issues of external validity and raise the question of what should be the 'gold standard' for measurement of the presence of coronary atheroma. In clinical practice the usual answer to this question is ...
Salmasi A-M, Iskandrian A, 2012, Cardiac Output and Regional Flow in Health and Disease, Publisher: Springer Science & Business Media, ISBN: 9789401118484
This book will be useful both to the cardiologists as well as to physicians in other fields of surgery and medicine and to their trainees. Readers will find this book an interesting and a useful reference on the topic of cardiac output.
Salmasi A-M, Nicolaides AN, 2012, Occult Atherosclerotic Disease Diagnosis, Assessment and Management, Publisher: Springer Science & Business Media, ISBN: 9789401134040
There are no statistical figures available on the incidence of occult atherosclerotic disease in the "non risky" general public and this is definitely an area that needs further investigation.
Salmasi A-M, Salmasi H, Rawlins S, et al., 2010, Atrial Septal Aneurysm and Patent Foramen Ovale Are Less Prevalent in the Indo-Asian Than in the Caucasian or Afro-Caribbean Population, Angiology, Vol: 61, Pages: 205-210, ISSN: 0003-3197
<jats:p> Atrial septal aneurysm (ASA) and patent foramen ovale (PFO) are not uncommon during routine echocardiographic scanning and were reported to be associated with stroke, transient ischemic attacks, and migrainous headache. To assess the prevalence of ASA and PFO according to ethnicity, we retrospectively studied 887 consecutive referrals to a General Cardiology and Hypertension clinics. All participants underwent trans-thoracic echocardiography (TTE). In some patients, the TTE was repeated using bubble contrast. Results: Atrial septal aneurysm was detected in 70 participants (7.9%) and PFO in 18 (2%). Atrial septal aneurysm, PFO, or their combination was detected in 12% of the Caucasian patients, 15% of the Afro-Caribbean, and 3.7% of the Indo-Asian patients. Conclusions: There was a lower prevalence of ASA and PFO and their combination in Indo-Asians and a higher rate in Afro-Caribbeans than in Caucasians. The higher prevalence in the Afro-Caribbean participants may contribute to the high incidence of stroke in black participants. </jats:p>
Salmasi A-M, Frost P, Dancy M, 2006, Is glycated haemoglobin a sensitive index to identify left ventricular dysfunction two months after acute myocardial infarction in normotensive subjects?, Int J Cardiol, Vol: 110, Pages: 67-73, ISSN: 0167-5273
BACKGROUND: Glycated haemoglobin concentration (HbA1c) is a marker of glucose metabolism. Glucose intolerance is associated with a high incidence of left ventricular (LV) dysfunction after acute myocardial infarction (AMI). This study was carried out in order to relate HbA1c to LV function two months following AMI in 171 normotensive patients who were not previously known to have had diabetes mellitus. METHODS: Oral glucose tolerance test (GTT) and HbA1c. Echo and Doppler-cardiography were used to measure the E/A (peak velocity of the early filling/atrial contraction waves) at rest and at peak isometric exercise (IME), deceleration time (DT) of E wave, LV ejection fraction (LVEF), LV mass index and diastolic LV function. RESULTS: GTT was diabetic in 20, impaired in 35 and normal in 116 subjects. HbA1c was >6.0% (cut off level for high risk subjects) in 76 patients (67%) with impaired relaxation (E/A<1) during IME and in 30 patients (27%) with restrictive LV filling (identified by E/A=1-2, DT<140 ms). The sensitivity and specificity of HbA1c to predict underlying impaired LV relaxation were 68% and 37%, respectively, and to predict restrictive LV filling were 27% and 98%, respectively. Whereas in univariate analysis, DT.3 was linearly related to HbA1c only (p=0.0002), multiple regression analysis showed that HbA1c was related to LVEF, DT and E/A but not to LVH, LVMI, smoking habit, age, gender and creatinine kinase level during admission for AMI. CONCLUSION: At 2 months after admission for AMI, HbA1c is related to systolic and diastolic LV function but not to LVMI or LVH. HbA1c is a sensitive predictor of impaired relaxation but highly specific to rule out underlying non-restrictive LV filling.
Salmasi A-M, Rawlins S, Dancy M, 2005, Left ventricular hypertrophy and preclinical impaired glucose tolerance and diabetes mellitus contribute to abnormal left ventricular diastolic function in hypertensive patients., Blood Press Monit, Vol: 10, Pages: 231-238, ISSN: 1359-5237
BACKGROUND: Impaired left ventricular diastolic function is not uncommon in patients with either diabetes mellitus or hypertension. This study was carried out to assess the contribution of left ventricular hypertrophy, high blood pressure, preclinical impaired glucose tolerance and diabetes mellitus to left ventricular diastolic function in patients attending a hypertension clinic. METHODS: Echocardiography, 24-h ambulatory blood pressure monitoring and oral glucose tolerance tests were carried out in 152 consecutive hypertensive patients who had no evidence of ischaemic heart disease and were not known to be diabetic. From echocardiography, E/A (peak velocity of early/atrial filling waves of the transmitral flow) at rest and at peak standardized isometric exercise using handgrip, left ventricular mass index and deceleration time of the E wave were derived. RESULTS: Patients with impaired glucose tolerance and diabetes mellitus had lower E/A than the euglycaemic subjects both at rest (P=0.0073) and during isometric exercise (P<0.0001). E/A significantly reduced during isometric exercise in patients with impaired glucose tolerance and diabetes but not in euglycaemic patients. Deceleration time was shortened with a worsening degree of glucose intolerance in all the patients (P=0.0005), in those with left ventricular hypertrophy (P=0.0006) and in those without left ventricular hypertrophy (P=0.033). When adjusted for age, gender, race, body mass index, smoking history, ambulatory blood pressure findings, cholesterol and triglyceride levels and antihypertensive medications taken, E/A at isometric exercise was related to results of glucose tolerance tests and was inversely proportional to left ventricular mass index (P<0.0001). No significant differences were found whether patients were taking antihypertensive medications or not. CONCLUSION: In hypertensive patients, left ventricular diastolic function is determined by left ventricular mass index and the status of
Salmasi A-M, Al-Bahrani LJ, Alimo A, et al., 2005, Combination of site of infarct, unrecognized glucose intolerance, and reinfarction after acute myocardial infarction in normotensive subjects is determinant of the development of subsequent systemic hypertension: a pilot study., Am J Hypertens, Vol: 18, Pages: 1294-1299, ISSN: 0895-7061
BACKGROUND: The natural history of hypertension in healthy normotensive subjects has been described in the Framingham population. We aim to study the rate of progression to hypertension in normotensive subjects after acute myocardial infarction (AMI). METHODS: One hundred seventy-three consecutive normotensive subjects admitted to the Coronary Care Unit with AMI were studied retrospectively with prospective follow-up 4 years after AMI. All the patients who were not known to be diabetic on admission (n = 150) underwent glucose tolerance test (GTT) at 2 months after AMI. RESULTS: Among the 15 patients (8.7%) who developed hypertension, GTT was abnormal in 75% (diabetes = 3, impaired glucose tolerance = 9). There were significantly more Indo-Asians and fewer whites in the hypertensive than in the normotesive patients but they were similar in age and gender, creatinine kinase level, and rate of thrombolysis during admission for AMI. Multiple regression analysis showed that progression to hypertension was a function of the presence of anterior AMI on admission (P = .0297), abnormal GTT (P = .0156), and subsequent MI on follow-up (P = .0122), but was independent of age, gender, smoking habit, body weight, previous MI, thrombolysis, creatinine kinase level, subsequent development of heart failure, and intake of beta-adrenergic blockade or angiotensin-converting enzyme (ACE) inhibitor. Of the hypertensive patients, 47% (n = 7) died compared to 8% (n = 13) of the normotensive subjects (P < .0001). CONCLUSIONS: Progression to hypertension in normotensive subjects after AMI is determined by a combination of the site of the infarct, GTT 2 months after AMI, and subsequent development of a second MI. Systemic hypertension after AMI is associated with a high mortality.
Salmasi AM, Dancy M, 2005, Glucose intolerance: the hidden danger in hypertensives!, Int Angiol, Vol: 24, Pages: 207-214, ISSN: 0392-9590
Both systemic hypertension and abnormalities of glucose metabolism are independent recognised risk factors for the development of cardiovascular morbidity and mortality, but their effects become additive when they coexist. Hypertension and glucose intolerance increase arterial stiffness and lead to cardiac structural and functional changes such as left ventricular hypertrophy and diastolic dysfunction of the left ventricle. Oral glucose tolerance tests have shown that 58% of patients with systemic hypertension who have no cardiac history and who are not known to have diabetes, suffer from unrecognised abnormalities of glucose metabolism i.e. either diabetes or impaired glucose tolerance. Using the fasting plasma glucose level and/or glycated haemoglobin concentration to diagnose glucose intolerance in patients with systemic hypertension is insufficient because of their low sensitivity for the diagnosis of diabetes and their inability to identify impaired glucose tolerance. It is important to recognise abnormalities of glucose metabolism early in patients with systemic hypertension in order to implement appropriate management and avoid further complications. Failure to identify glucose intolerance results in serious underestimation of the cardiovascular risk of these patients and denies patients primary preventative measures, which are based on risk assessment. All patients referred to Hypertension Clinics for the management of raised blood pressure should therefore be investigated by glucose tolerance test.
Salmasi A-M, Dancy M, 2005, The glucose tolerance test, but not HbA(1c), remains the gold standard in identifying unrecognized diabetes mellitus and impaired glucose tolerance in hypertensive subjects., Angiology, Vol: 56, Pages: 571-579, ISSN: 0003-3197
The objective of this study was to compare the value of the oral glucose tolerance test (GTT), glycated hemoglobin concentration (HbA(1c)), and fasting plasma glucose (FPG) for identifying unrecognized diabetes mellitus (DM) and impaired glucose tolerance (IGT) in hypertensive subjects. One hundred forty-four consecutive subjects who were not known to have DM and who were attending the Hypertension Clinic underwent 24-hour ambulatory blood pressure (BP) monitoring. A GTT and an HbA(1c) measurement were also carried out. Abnormal results from GTT were found in 94 patients (65%). Results from FPG were not different between those with DM and IGT but were significantly higher than in the euglycemic subjects. The FPG was between 110-125 mg/dL (6.1-6.9 mmol/L) in 31% (n = 20) of patients with IGT and in 53% (n = 16) of those with DM. With use of the previously published criteria to diagnose DM of FPG > or = 103 mg/dL (5.7 mmol/L) and HbA(1c) > or = 5.9%, 33% of our diabetic subjects and 75% of those with IGT would have been misclassified as euglycemic. The previously reported cut-off point for HbA(1c) of >6.1% to diagnose DM was present in 77% of our patients with DM and in 14% (n = 9) of the patients with IGT. Multiple regression analysis showed that an abnormal result from GTT was independent of the level of clinical or ambulatory BP, nocturnal BP dip, cholesterol level, smoking history, race, or class of antihypertensive medication taken. FPG levels or HbA(1c), or their combination, are not accurate enough to identify DM or IGT in patients attending a hospital Hypertension Clinic. A GTT may be required in these patients to reliably identify those with DM or IGT.
Salmasi A-M, Frost P, Dancy M, 2005, Left ventricular diastolic function in normotensive subjects 2 months after acute myocardial infarction is related to glucose intolerance., Am Heart J, Vol: 150, Pages: 168-174
BACKGROUND: Both glucose intolerance and myocardial infarction are independently associated with impaired left ventricular (LV) function. This study was carried out to relate LV diastolic function in normotensive subjects 2 months after acute myocardial infarction (AMI) to glucose tolerance status. METHODS: Left ventricular ejection fraction (LVEF), LV mass index, peak velocity of the early phase/atrial contraction wave, deceleration time of E wave, and isovolumic relaxation time were measured during echocardiograph/Doppler cardiography in 200 normotensive patients 2 months after AMI. Twenty-nine patients were known to be diabetic on admission with AMI. Glucose tolerance test was carried out in the 171 patients who are not known to be diabetic. RESULTS: Independent of LVEF, restrictive LV filling (peak velocity of the early phase/atrial contraction wave > 1 but < 2 associated with deceleration time of E wave < or = 140 milliseconds) was found in 72% of the known-diabetic patients, 70% of the 20 preclinical diabetic patients, 23% of the 35 patients with impaired glucose tolerance, 13% of the 15 patients with stress hyperglycemia, and 7% of the euglycemic patients (P < .01). In the rest of these patients, LV filling was nonrestrictive. No significant difference was observed in LVEF and LV mass index between patient groups. CONCLUSION: Independent of LVEF, the pattern of abnormal LV filling in normotensive subjects 2 months after AMI is a function of the severity of glucose intolerance, restrictive in the majority of the diabetic patients and nonrestrictive in the majority of the euglycemic patients, impaired glucose tolerance, and stress hyperglycemia. After AMI, abnormal LV filling occurs even in the absence of detectable systolic dysfunction or left ventricular hypertrophy.
Salmasi A-M, Alimo A, Dancy M, 2004, Prevalence of unrecognized abnormal glucose tolerance in patients attending a hospital hypertension clinic., Am J Hypertens, Vol: 17, Pages: 483-488, ISSN: 0895-7061
BACKGROUND: Diabetes mellitus (DM) and impaired glucose tolerance (IGT) are not uncommonly associated with hypertension. Fasting blood glucose level is still recognized as an indicator of DM. METHODS: We studied 99 consecutive patients who were not known to be diabetic patients and with no cardiac history, who were attending our Hypertension Clinic for investigation and management of uncontrolled blood pressure (BP). Oral glucose tolerance test (GTT) was carried out and area under the curve for the GTT (AUC-glucose) was calculated. All patients underwent 24-h ambulatory BP monitoring. RESULTS: The GTT was abnormal in 58 patients (58%), indicating IGT in 18, impaired fasting glucose in 16, and DM in 24. The fasting and 120-min glucose level and AUC-glucose in patients with DM on GTT was higher (P <.0001) than in those with IGT/IFG and in the latter was higher than those with normal GTT. Multiple regression analysis showed that abnormal GTT was independent of the following: level of clinic or ambulatory BP; presence or absence of nocturnal BP dip; cholesterol, sodium, and potassium levels; smoking history; alcohol intake; prior treatment for hypertension; and ethnicity. These results were also independent of antihypertensive medications taken. No significant difference was found in glucose level during GTT, AUC-glucose, or age among the groups of patients receiving diuretics only, those receiving diuretics and beta-blockers, and those not receiving any of these agents. CONCLUSIONS: The prevalence of glucose abnormalities in hypertensive patients attending a hospital hypertension clinic is sufficiently high to warrant screening for DM and IGT, and fasting glucose levels are not accurate enough for this purpose. All patients attending such a clinic should undergo a GTT.
Salmasi A-M, Jepson E, Grenfell A, et al., 2003, The degree of albuminuria is related to left ventricular hypertrophy in hypertensive diabetics and is associated with abnormal left ventricular filling: a pilot study., Angiology, Vol: 54, Pages: 671-678, ISSN: 0003-3197
The association of albuminuria and left ventricular (LV) hypertrophy (LVH) in diabetics aggravates the prognosis. The authors studied the relation between LVH and the degree of albuminuria in diabetics and investigated the relationship of albuminuria to LV filling. A comparison was made between 30 hypertensive diabetics, 10 of whom had microalbuminuria (MIC) and 20 had macroalbuminuria (MAC), and 18 diabetics who were normotensive and normalbuminuric (NOR). LV mass index (LVMI) and LV ejection fraction (LVEF) were measured during echocardiography. LV filling pattern at rest and at peak standardized isometric exercise (IME) using handgrip was assessed by measuring E/A (peak velocity of the early/atrial filling waves) of the transmitral flow during Doppler and echocardiography. Each patient underwent a stress ECG test. LVMI was higher in MAC (132.3 +/- 55.4) than in MIC (115.6 +/- 32.5) or NOR (90.0 +/- 31.8) (p<0.01). There were more patients in MAC with LVH (n = 13) and abnormal filling (n = 9 at rest and 16 with IME) than in MIC (LVH = 5, abnormal filling = 1 at rest and 10 during IME) or NOR (LVH = 3, abnormal filling = 1 at rest and 9 during IME) (p < 0.02). LVMI was not related to LVEF. Although blood pressure was not different between MAC and MIC groups, it was significantly higher than in the NOR group. This study suggests that a high degree of albuminuria in hypertensive diabetics is associated with greater value for LVMI and an increased incidence of LVH independent of blood pressure level or systolic LV function. LVH is associated with abnormal LV filling. The degree of albuminuria may predict LVMI and LVH, which are associated with abnormal LV filling. This association of abnormal LV filling with albuminuria in hypertensive diabetic patients may account for their high risk of cardiovascular events.
Salmasi A-M, Alimo A, Jepson E, et al., 2003, Age-associated changes in left ventricular diastolic function are related to increasing left ventricular mass., Am J Hypertens, Vol: 16, Pages: 473-477, ISSN: 0895-7061
Isometric exercise (IME) produces significant hemodynamic changes in the cardiovascular system. We have used IME to study the effect of age on diastolic left ventricular (LV) function in 100 normal volunteers. The E/A ratio (peak velocity of early/atrial filling phases), deceleration time (DT), and isovolumic relaxation time (IVRT) of the transmitral flow were assessed during echocardiography with pulsed-Doppler ultrasound at rest and at peak IME using handgrip. LV mass index (LVMI) and LV ejection fraction (LVEF) were also calculated. Both E/A and IVRT reduced significantly with increasing age. The LVEF decreased (P <.0001), whereas LVMI increased (P <.05) with advancing age. The LVEF was inversely related to LVMI (P <.05). An inverse relationship was noted between E/A and LVMI (P <.01) during IME. The contribution of the atrial contraction to the total diastolic flow increased significantly with advancing age (P <.02) and increased from 0.29 +/- 0.04 at rest to 0.34 +/- 0.08 during IME (P <.0001). It is concluded that with progressing age, the left ventricle becomes stiffer resulting in a reduction in early filling and a compensatory increase in flow due to atrial contraction. A progressive increase in LVMI, which accompanies aging may contribute to stiffening of the left ventricle and deterioration in diastolic function of the left ventricle. This is exaggerated by IME.
Salmasi AM, Dorĕ C, Dancy M, 1996, Effects of age on aortic blood velocity at rest and during exercise in patients with coronary artery disease., Clin Auton Res, Vol: 6, Pages: 99-106, ISSN: 0959-9851
The effect of age on aortic blood velocity has been studied in 100 patients with angiographically-documented coronary artery disease, 500 of whom were receiving beta-adrenergic blocking agents. Using continuous-wave Doppler ultrasound, the aortic blood velocity signals, both at rest and at maximal-tolerated supine exercise, were obtained. From the Doppler signals the peak velocity (Vp), stroke distance (Sd; the velocity-time integral) and minute distance (Md = Sd x heart rate) were calculated. The measurements were repeated 6 weeks after coronary artery bypass grafting (CABG), performed in 30 patients. No relationship with age (p < 0.01) was found for any of the indices, either at rest or during exercise, except for the resting Md in patients not on beta-blockers, (p < 0.02). No difference in the slope of the relationship with age was found between patients on or not on beta-blockers, except for the resting Md (p < 0.02). Following CABG, a significant age relationship with Vp, Sd and Md was restored, during both resting and exercise, suggesting improvement of systolic left ventricular function following myocardial revascularization. In conclusion, the normal age relationships of the derivatives of aortic blood velocity Doppler ultrasound signals were not seen in patients with coronary artery disease, irrespective of whether they were on or off beta-blockers. The relationship changed following myocardial revascularization, suggesting their dependence on systolic left ventricular function.
SALMASI AM, ABRAHAM R, ALKUTOUBI A, et al., 1994, EXERCISE-INDUCED INVERTED U WAVE IN ASYMPTOMATIC HIGH-RISK SUBJECTS - A PRELIMINARY-STUDY, ANGIOLOGY, Vol: 45, Pages: 789-795, ISSN: 0003-3197
SALMASI AM, BELCARO G, NICOLAIDES AN, 1991, IMPAIRED VENOARTERIOLAR REFLEX AS A POSSIBLE CAUSE FOR NIFEDIPINE-INDUCED ANKLE EDEMA, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 30, Pages: 303-307, ISSN: 0167-5273
SONECHA TN, NICOLAIDES AN, SALMASI AM, et al., 1990, NONINVASIVE DETECTION OF CORONARY-ARTERY DISEASE IN PATIENTS PRESENTING WITH CLAUDICATION, INTERNATIONAL ANGIOLOGY, Vol: 9, Pages: 79-83, ISSN: 0392-9590
SALMASI AM, SALMASI S, NICOLAIDES AN, 1990, DOPPLER ULTRASOUND IN ASSESSING SYSTOLIC LEFT-VENTRICULAR FUNCTION IN CARDIOVASCULAR PATIENTS, INTERNATIONAL ANGIOLOGY, Vol: 9, Pages: 29-37, ISSN: 0392-9590
Salmasi A-M, Nicolaides AN, 1989, Cardiovascular Applications of Doppler Ultrasound
Real-time calculation of ultrasonic pulsatility index. Medical and Biological Engineering and Computing 19: 28 Gill R W 1979 Performance of the mean frequency Doppler demodulator. Ultrasound in Medicine and Biology 5: 237-247 Gill R W ...
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