Mian Yousuf

University of Cincinnati, Cincinnati, Ohio, United States

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Publications (9)32.07 Total impact

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    ABSTRACT: Although the use of computed tomography angiography (CTA) is considered "appropriate" to distinguish ischemic vs nonischemic etiology in patients with cardiomyopathy under the current clinical practice guideline, the evidence to support this has not been evaluated in larger scale studies. Thus, we conducted a meta-analysis of available studies published by October 2010 to address this question. Studies evaluating the diagnostic accuracy of CTA versus invasive coronary angiography (as the gold standard) for significant coronary artery disease (CAD) detection (ischemic cardiomyopathy) in patients with no known history of CAD with significantly depressed left ventricular function (ejection fraction; EF < 35%) were selected for the meta-analysis. Sensitivity, specificity, positive, and negative likelihood ratios were calculated on per patient and per segment basis using random effects model (DerSimonian-Laird Method) for computing summary estimates and receiver operator curve (ROC) analysis for evaluating overall diagnostic accuracy. Six studies comprising 452 patients met the selection criteria for the meta-analysis. The pooled patient population was 62 ± 3 years old, with 29% females, 16% diabetics, and 43% with a history of hypertension. Mean EF was 32% ± 1%. The pooled summary estimate of sensitivity of CTA for diagnosis of ischemic cardiomyopathy was 98% [95% confidence interval (CI); 94% to 99%] and specificity was 97% (CI 94% to 98%), yielding a negative likelihood ratio of 0.06 (CI 0.02 to 0.13) and positive likelihood ratio of 20.85 (CI 12 to 36). There was no significant heterogeneity between studies for these estimates. The receiver operator curve analysis showed a robust discriminate diagnostic accuracy of ischemic etiology with an area under curve of 0.99 (P < .00001). CTA appears as a clinically applicable accurate diagnostic modality to exclude ischemic etiology in patients with cardiomyopathy of undetermined cause and this further supports the appropriateness of the use of CTA to determine the cause of new onset cardiomyopathy of unknown etiology.
    Journal of Nuclear Cardiology 02/2011; 18(3):407-20. DOI:10.1007/s12350-011-9346-3 · 2.65 Impact Factor
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    ABSTRACT: Heart transplant (HT) recipients demonstrate limited exercise capacity compared to normal patients, very likely for multiple reasons. In this study we hypothesized that left atrial volume (LAV), which is known to predict exercise capacity in patients with various cardiac pathologies including heart failure and hypertrophic cardiomyopathy is associated with limited exercise capacity of HT recipients. We analyzed 50 patients [age 57 ±2 (SEM), 12 females] who had a post-HT echocardiography and cardiopulmonary exercise test (CPX) within 9 weeks time at clinic follow up. The change in LAV (ΔLAV) was also computed as the difference in LAV from the preceding one-year to the study echocardiogram. Correlations among the measured parameters were assessed with a Pearson's correlation analysis. LAV (n = 50) and ΔLAV (n = 40) indexed to body surface area were 40.6 ± 11.5 ml·m-2 and 1.9 ± 8.5 ml·m-2·year-1, data are mean ± SD, respectively. Indexed LAV and ΔLAV were both significantly correlated with the ventilatory efficiency, assessed by the VE/VCO2 slope (r = 0.300, p = 0.038; r = 0.484, p = 0.002, respectively). LAV showed a significant correlation with peak oxygen consumption (r = -0.328, p = 0.020). Although our study is limited by a retrospective study design and relatively small number of patients, our findings suggest that enlarged LAV and increasing change in LAV is associated with the diminished exercise capacity in HT recipients and warrants further investigation to better elucidate this relationship.
    Journal of Cardiothoracic Surgery 11/2010; 5(1):113. DOI:10.1186/1749-8090-5-113 · 1.03 Impact Factor
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    ABSTRACT: Unexplained exertional dyspnea is a common and perplexing clinical problem. Myocardial ischemia and left ventricular systolic dysfunction are important cardiac causes, but are often not detected in these patients. Recently, exercise-induced left ventricular diastolic dysfunction and exercised-induced pulmonary hypertension have emerged as common alternative mechanisms. While conventional exercise treadmill echocardiography effectively diagnoses left ventricular systolic dysfunction and myocardial ischemia, it has limited ability to detect exercise-induced diastolic dysfunction or pulmonary hypertension. The latest advances in exercise echocardiography, including utilization of tissue Doppler imaging and harmonic imaging, make noninvasive evaluation of both conventional and alternative cardiac causes of exertional dyspnea possible. These advancements, when coupled with newly designed supine exercise platforms for bicycle exercise echocardiography (BE), facilitate the detection of exercise-induced diastolic dysfunction and pulmonary hypertension. Moreover, BE using supine ergometry additionally permits the dynamic evaluation of valvular function and interatrial shunting and detection of pulmonary arteriovenous fistula, uncommon but important causes of unexplained exertional dyspnea. Therefore, we propose that because of its superior diagnostic capabilities, BE should be included as part of a comprehensive cardiac evaluation of patients with unexplained exertional dyspnea.
    Clinical Cardiology 06/2009; 32(6):302-6. DOI:10.1002/clc.20593 · 2.23 Impact Factor
  • Medicine &amp Science in Sports &amp Exercise 05/2009; 41(Supplement 1). DOI:10.1249/01.MSS.0000355715.76305.78 · 4.46 Impact Factor
  • Mian Atif Yousuf · Stephen Adjei · Brent Kinder
    Chest 05/2009; 135(4):1098-101. DOI:10.1378/chest.08-2164 · 7.13 Impact Factor
  • Medicine &amp Science in Sports &amp Exercise 05/2009; 41(Supplement 1):222. DOI:10.1249/01.MSS.0000355234.10067.92 · 4.46 Impact Factor
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    ABSTRACT: Myocardial abscess of the left ventricular free wall in the absence of infective endocarditis (IE) is very unusual. Most cases are discovered during autopsies and are due to Gram-positive cocci.(1,2) We present a rare case of Klebsiella pneumoniae causing myocardial abscess of the left ventricular free wall. The patient had no evidence of valvular endocarditis or bacteremia, and the abscess was discovered during coronary artery bypass grafting surgery (CABG).
    The Journal of thoracic and cardiovascular surgery 03/2009; 139(3):e34-5. DOI:10.1016/j.jtcvs.2008.07.056 · 3.99 Impact Factor
  • Journal of Cardiac Failure 08/2008; 14(6). DOI:10.1016/j.cardfail.2008.06.371 · 3.07 Impact Factor
  • Journal of Cardiac Failure 08/2008; 14(6). DOI:10.1016/j.cardfail.2008.06.353 · 3.07 Impact Factor