Muhamad Ali SK Abdul Kader

Serdang Hospital

Background In the Asian population, the presence of the CYP2C19 loss-of-function (LOF) allele is a known genetic variation. This allele is associated with a reduced capacity to metabolize clopidogrel into its active forms through the CYP2C19 enzyme, resulting in diminished platelet inhibition and an elevated risk of recurrent cardiovascular events....

Aims Heart failure (HF) is a growing health problem, yet there are limited data on patients with HF in Malaysia. The Malaysian Heart Failure (MY‐HF) Registry aims to gain insights into the epidemiology, aetiology, management, and outcome of Malaysian patients with HF and identify areas for improvement within the national HF services. Methods and r...

Background Acute coronary syndrome has remained Malaysia's leading cause of death for the past 15 years, with a more than 50% increase in the last ten years. There is limited published literature focusing on this population. Hence, we aim to assess the clinical risk factors, angiographic profile, and outcome of young patients (aged ≤ 40 years) with...

Dyslipidaemia is highly prevalent in the Malaysian population and is one of the main risk factors for atherosclerotic cardiovascular disease (ASCVD). Low-density lipoprotein cholesterol (LDL-C) is recognised as the primary target of lipid-lowering therapy to reduce the disease burden of ASCVD. Framingham General CV Risk Score has been validated in...

The no-reflow phenomenon is a complication of percutaneous coronary intervention resulting in poor myocardial perfusion and is associated with significant morbidity and mortality. It is vital for cardiologist to recognise this phenomenon as it is clinically significant. We reported two cases of no reflow phenomenon occurred in the same day and disc...

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Novartis Corporation Sdn Bhd Background Heart failure is a debilitating disease associated with multiple comorbidities and poor prognosis. Dyslipidemia, is the top 5 most common comorbidities, including HF patients. Nonetheless, the lipid profiles in HF popu...

Funding Acknowledgements Type of funding sources: None. Background Although clopidogrel is the basic drug for antiplatelet therapy in patients with coronary artery disease (CAD). However, loss of function (LOF) allelic variants located within the CYP2C19 gene may reduce the production of clopidogrel active metabolites and weaken the antiplatelet e...

Funding Acknowledgements Type of funding sources: None. Background Previous studies have shown that the prevalence of cardiovascular diseases is related to the patient's age and gender differences, but the effect of age on platelet function remains controversial. Platelet function should be tested and its efficacy correlates with the age of patien...

MyHF Registry: Shedding light on lipid profiles and In-hospital outcomes for heart failure patients

Background Estimation of the economic burden of heart failure (HF) through a complete evaluation is essential for improved treatment planning in the future. This estimation also helps in reimbursement decisions for newer HF treatments. This study aims to estimate the cost of HF treatment in Malaysia from the Ministry of Health’s perspective. Mater...

Case Summary: A 55-year-old gentleman with hypertension, dyslipidaemia and history of anterior STEMI was staged for percutaneous coronary intervention to left circumflex artery (LCx) stenosis. His echocardiogram showed preserved left ventricular ejection fraction with lateral wall hypokinesia. Diagnostic angiogram revealed 90 degrees angulation of...

Background Clopidogrel is an antiplatelet drug used to treat coronary artery disease (CAD) to reduce blood clotting by inhibiting platelet activity. However, many patients experience ischemic events due to changes in clopidogrel metabolism attributed to various genetic and non-genetic factors. CYP2C19 is one of the important genes responsible for t...

Background: Paclitaxel-coated balloons (PCBs) are a preferred treatment option for coronary in-stent restenosis. To date, data from randomized trials of alternative drug coatings are lacking. The aim of the randomized Malaysian and German-Swiss randomized trials was to investigate a novel sirolimus-coated balloon (SCB) compared with a PCB in in-st...

The global evolution of the SARS-CoV-2 virus is known to all. The diagnosis of SARS-CoV-2 pneumonia is expected to worsen, and mortality will be higher when combined with myo-cardial injury (MI). The combination of novel coronavirus infections in patients with MI can cause confusion in diagnosis and assessment, with each condition exacerbating the...

Background: Left atrial pressure (LAP) can be calculated from Nagueh formula as LAP = 1.24(mitral E/e') + 1.9 where E is mitral inflow early velocity and e' is mitral annular early diastolic velocity. Right atrial pressure (RAP) is commonly estimated from diameter and respiratory collapsibility of inferior vena cava (IVC). RAP is used for volume st...

Background: Rate-pressure product (RPP) of peak heart rate and peak systolic blood pressure during exercise treadmill test (ETT) reflects the exertional stress on the heart. Objective: We aimed to assess the relationship between RPP and severity of coronary artery disease (CAD). Materials and Methods: We retrospectively studied 20 patients who were...

Background: Pulmonary artery pressure is commonly calculated from simplified Bernoulli equation involving peak velocity of tricuspid regurgitation (TRVmax). This calculation requires right atrial pressure (RAP) to be typically estimated from size and collapsibility of inferior vena cava (IVC) with inspiration and this estimation has its difficultie...

Global Longitudinal Strain Corresponds to Number of Coronary Vessels Diseased even among Patients with Reduced Left Ventricular Ejection Fraction

Background: Duke treadmill score (DTS) (sum of exercise duration, ST segment deviation and angina index) from exercise treadmill test (ETT) is validated for prediction of severe coronary artery disease (CAD). Rate-pressure product (RPP) (of peak heart rate and peak systolic blood pressure) is another composite score from ETT reflecting the exercise...

The coronavirus disease-2019 (COVID-19) pandemic has become a major global health problem. COVID-19 is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and exhibits pulmonary and extrapulmonary effects, including cardiovascular involvement. There are several attempts to identify drugs that could treat COVID-19. Moreover, many...

Background: The aim of this subanalysis of the REDUCE (Short-term Dual Antiplatelet Therapy in Patients with ACS Treated with the COMBO Dual-therapy Stent) trial was to evaluate differences between non-ST-elevation MI/unstable angina (NSTEMI/UA) patients and ST-elevation MI (STEMI) patients in terms of patient characteristics, procedures and outcom...

Background Warfarin is an anticoagulant with wide inter-individual variations in drug responses monitored based on the International Normalized Ratio (INR). It is commonly prescribed for atrial fibrillation (AF) and stroke. Oral anticoagulants (e.g., warfarin) reduce the risk of getting a stroke but increase the risk of hemorrhage. The proton nucle...

Objectives The aim of this randomized controlled trial was to investigate a novel sirolimus-coated balloon (SCB) compared with the best investigated paclitaxel-coated balloon (PCB). Background There is increasing clinical evidence for the treatment of coronary de novo disease using drug-coated balloons. However, it is unclear whether paclitaxel re...

Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited disorder characterised by a genetic defect resulting in mutation of the sarcomere and consequently myocardial dysfunction. It has a prevalence of 1 in 500 and an important cause of sudden cardiac death. HCM has several variations, with asymmetric septal hypertrophy being most prev...

Case history: 30 years old lady, a beautician presented to private hospital with sudden onset of headache and left sided weakness. Computed tomography angiography (CTA) of the brain revealed acute right temporal lobe intracerebral haematoma with right Sylvian fissure subarachnoid haemorrhage and right middle cerebral artery aneurysm. She underwent...

Background: Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited disorder characterised by a genetic defect resulting in mutation of the sarcomere and consequently myocardial dysfunction. It has a prevalence of 1 in 500 and an important cause of sudden cardiac death. HCM has several variations, with asymmetric septal hypertrophy be...

Introduction: There is scarcity of big data on Heart Failure (HF) in the Asean region in the current era of guideline directed medical therapy (GDMT). Malaysia Heart Failure (MYHF) Registry was set up in 2019 to advance fundamental understanding of the burden, morbidity and mortality among Malaysian patients with HF Objective: This analysis is to d...

Research on the suffering of chronic diabetic patients T1DM, T2DM. The body's resistance to insulin secretions. The disease has evolved over time and has complications including the retinopathy, heart disease and pressure, renal insufficiency, infections and diabetic foot, peripheral neuropathy, liver, and mental state disorders, Our work was the k...

Background: A new generation P2Y12 receptor inhibitor (ticagrelor) is recommended in current therapeutic guidelines to treat patients with coronary heart disease (CHD). However, it is unknown if ticagrelor is more effective than clopidogrel in elderly patients. Therefore, a systematic review was done to assess the effectiveness and safety of ticag...

Cardiac Implantable Electronic Device (CIED) is a term that encompasses pacemakers for bradyarrhythmia treatment, implantable cardioverter defibrillators (ICDs) for tachyarrhythmia management, and cardiac resynchronisation therapy (CRT) for heart failure with left bundle branch block (LBBB). To determine the demographic details, indications, type...

BACKGROUND Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited disorder characterised by a genetic defect resulting in mutation of the sarcomere and consequently myocardial dysfunction 1. It has a prevalence of 1 in 500 and an important cause of sudden cardiac death 2. HCM has several variations, with asymmetric septal hypertrophy...

Complete Heart Block rarely occurs in young patients and its presence should warrant extensive investigations to rule out reversible causes that can potentially be treated and avoid permanent pacemaker implantation. This 29 years old gentleman was referred to us from a district hospital for complete heart block in failure for temporary pacemaker in...

Scimitar Syndrome usually has benign outcome but when it is associated with pulmonary arterial hypertension, it can leads to congestive cardiac failure and mortality. This 70 years old lady was diagnosed to have Scimitar Syndrome at 60 years old during her admission for left neck of femur fracture. She underwent Computed Tomography Pulmonary Angiog...

Real world diagnostic investigations pattern in patients hospitalized for HF: Interim review of National Malaysia Heart Failure (MYHF) Registry Heart Failure (HF) contributes to 6-10% of acute hospital admissions in Malaysia. Effective management of HF is challenging and timely assessment of patients would be important to achieve optimal care. E...

Background: Two-dimensional speckle tracking Doppler echocardiography detects left ventricular myocardial deformation, expressed as global longitudinal shortening (GLS), that is not otherwise detectable by conventional eyeball regional wall motion assessment. Objective: We aimed to assess if GLS could detect coronary artery disease (CAD) by number...

Background: Two-dimensional speckle tracking Doppler echocardiography detects left ventricular myocardial deformation not otherwise detectable by visual regional wall motion assessment. This deformation can be expressed numerically as global longitudinal shortening (GLS). Objective: We aimed to assess if GLS could be used to detect severe coronary...

Background: Duke treadmill score (DTS) (a composite of exercise duration, ST segment deviation and chest pain severity) renders exercise treadmill test (ETT) more objective and predicts severity of coronary artery disease (CAD). Another ETT composite is the rate-pressure product (RPP) (of peak heart rate and peak systolic blood pressure) which refl...

Background: Pulmonary artery pressure measurements are integral to management of pulmonary hypertension. Echocardiographic methods typically make use of blood velocity of tricuspid regurgitation or if tricuspid regurgitation is absent, from other parameters such as acceleration time of blood in the right ventricular outflow tract (RVOT). Objective:...

Background: Guidance of antiplatelet therapy and compliance assessment is of great importance for patients with acute coronary syndrome (ACS) and directly affects patients in the short and long term. P2Y12 receptor inhibitors are the main antiplatelet drugs to prevent clotting events for ACS patients. Ticagrelor is the first choice based on myocard...

Background Ticagrelor is an oral antiplatelet drug that can reversibly bind to the platelet P2Y12 receptor. Ticagrelor is metabolized mainly by CYP3A4 and produces a rapid blood concentration-dependent platelet inhibitory effect. Unlike other P2Y12 receptor antagonists, many clinical features of ticagrelor are not related to P2Y12 receptor antagoni...

Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity....

Clopidogrel is a widely-used antiplatelet drug. It is important for the treatment and prevention of coronary heart disease. Clopidogrel can effectively reduce platelet activity and therefore reduce stent thrombosis. However, some patients still have ischemic events despite taking the clopidogrel due to the alteration in clopidogrel metabolism attri...

The unique characteristics of patients with acute coronary syndrome in the Asia-Pacific region mean that international guidelines on the use of dual antiplatelet therapy (DAPT) cannot be routinely applied to these populations. Newer generation P2Y12 inhibitors (i.e. ticagrelor and prasugrel) have demonstrated improved clinical outcomes compared wit...

Purpose: We aimed to evaluate the efficacy and safety of use of the Fasting Algorithm for Singaporeans with Type 2 Diabetes (FAST) during Ramadan. Methods: We performed a prospective, multicenter, randomized controlled trial. The inclusion criteria were age ≥21 years, baseline glycated hemoglobin (HbA1c) level ≤9.5%, and intention to fast for ≥1...

Funding Acknowledgements This research was funded by Universiti Sains Malaysia Introduction Clopidogrel is a widely used P2Y12 antiplatelet drug. Patient"s compliance to clopidogrel is crucial to achieve therapeutic outcome and prevent thromboembolic events. While measuring serum level of clopidogrel and/or its active metabolite may indicate compl...

The product of clinical scientific research was encouraging based on scientific foundations to reduce heart disease, especially heart failure, the most important topic of the research. We dealt with all aspects that affect the patient, the ability to correct diagnosis, treatment protocol, management, and the new technique, and the most widespread g...

Percutaneous ASD Closure Guided by Transthorasic Echocardiogram (TTE) - First reporting centre in Malaysia

2 CRC, Hospital Pulau Pinang, 1.0 BACKGROUND Acetylsalicylic acid (ASA), or Aspirin acts by irreversibly inhibiting the cyclooxygenase (COX) enzyme and hence, suppressing the production of prostaglandins and thromboxanes which leads to inhibition of platelet aggregration. ASA is the mainstay of treatment in coronary artery disease (CAD) patients1,...

Aims: The optimal duration of DAPT in ACS patients treated with DES is still unclear. Methods and results: REDUCE is a prospective, open label, multicenter, investigator-initiated study that randomised 1496 ACS patients after treatment with COMBO to either 3 (n=751) or 12-month (n=745) of DAPT. Primary study endpoint was a composite of all cause...

Background Warfarin is prescribed as an oral anticoagulant to treat/prevent thromboembolism in conditions such as atrial fibrillation. As there is a narrow therapeutic window, treatment with warfarin is challenging. Pharmacometabonomics using nuclear magnetic resonance (NMR) spectroscopy may provide novel techniques for the identification of novel...

The importance of networking for the management of acute coronary syndrome (ACS) has been emphasised in the 2012 guidelines by the European Society of Cardiology (ESC) on ST-segment elevation myocardial infarction (STEMI). In Penang, the ACS referral network has the Penang General Hospital (PGH), a percutaneous coronary intervention (PCI)-capable h...

The aim of this article is to highlight the philosophy of research methodology as view from Islamic civilization. Scfentific research has no central focus in our modern terms apart from further dominance of nature, refining our materialistic gain and maximizing the control of wealth, improving our health and live a life fuH of sensual pleasure with...

Clinical guidelines for the treatment of patients with non‐ST‐segment elevation myocardial infarction (NSTEMI) recommend an invasive strategy with cardiac catheterization, revascularization when clinically appropriate, and initiation of dual antiplatelet therapy regardless of whether the patient receives revascularization. However, although patient...

Summary 1. Lengths of admission in the CCU/ICU were similar across the ACS spectrum. 2. The use of DAPT was high (at least 96% for STEMI and more than 95% for NSTEMI). The use of statin was more than 90% for across the ACS spectrum. 3. The use of beta blockers upon discharge was 69.9% for STEMI, 72.3% for NSTEMI, and 71.8% for UA. Compared to the p...

Objectives: The aim of this randomized controlled trial was to investigate a novel sirolimus-coated balloon (SCB) compared with the best investigated paclitaxel-coated balloon (PCB). Background: Treatment of coronary in-stent restenosis (ISR) remains challenging. PCBs are an established treatment option outside the United States with a Class I,...

Background Coronary artery disease (CAD) claims lives yearly. Nuclear magnetic resonance (¹H NMR) metabolomics analysis is efficient in identifying metabolic biomarkers which lend credence to diagnosis. We aimed to identify CAD metabotypes and its implicated pathways using ¹H NMR analysis. Methods We analysed plasma and urine samples of 50 stable...