Abu Tarek Iqbal, Salehuddin, Ayub, Jashimuddin Sada, Khurshed Ahmed
Introduction: Cardiovascular diseases is a major health burden in developing countries like Bangladesh. Patients with acute coronary syndrome(ACS) are at risk for death, myocardial infarction or recurrent ischaemic events. Comorbidity like DM plays a significant role in the outcome of such patients. So the objective of the present study was to see the coronoary angiographic(CAG) findings among diabetic and nondiabetic patients in our context. Methods: Patients presenting with the symptoms of ACS in the Department of Cardiology in a tertiary care center were selected for ECG and cardiac troponin 1. Then according to the defined criteria they was selected for the study. These patients were followed up to their hospital stay period. History of the patient, physical examination and necessary investigations was done. ACS patients were divided into two groups. 1. ACS with DM and 2. ACS without DM. CAG was done among those patients with ACS. Finally CAG findings in two groups were compared systematically. Data were analyzed by SPSS 20. Results: Among the 200 patients total male were 80.5% and total female were 19.5%). Male to female ratio was 5:1. Regarding age distribution it was found matched in both groups. Most patients were at age group 41-50 and 51-60 years which was 31% and 45% respectively. Regarding presence of hypertension in both groups, diabetic group had more hypertensive patients(81%) than the nondiabetic(71%) group (p-0.098). Regarding analysis of CAG findings in diabetic and non diabetic groups LMCA involvement was 16% and 12%, LAD 32% and 28%, LCX 22% and 23%, RCA 23% and 20% and triple vessel was 15% and 14% respectively. Only 5(2.5%) patients were found not to having any lesion. Conclusions: ACS with or without DM has variable CAG findings. So special care should be taken when dealing with such cases. University Heart Journal Vol. 15, No. 1, Jan 2019; 34-36
{"title":"A Comparative Study of Coronary Angiographic Data between Diabetic and Non-Diabetic Patients with Acute Coronary Syndrome","authors":"Abu Tarek Iqbal, Salehuddin, Ayub, Jashimuddin Sada, Khurshed Ahmed","doi":"10.3329/UHJ.V15I1.41444","DOIUrl":"https://doi.org/10.3329/UHJ.V15I1.41444","url":null,"abstract":"Introduction: Cardiovascular diseases is a major health burden in developing countries like Bangladesh. Patients with acute coronary syndrome(ACS) are at risk for death, myocardial infarction or recurrent ischaemic events. Comorbidity like DM plays a significant role in the outcome of such patients. So the objective of the present study was to see the coronoary angiographic(CAG) findings among diabetic and nondiabetic patients in our context. Methods: Patients presenting with the symptoms of ACS in the Department of Cardiology in a tertiary care center were selected for ECG and cardiac troponin 1. Then according to the defined criteria they was selected for the study. These patients were followed up to their hospital stay period. History of the patient, physical examination and necessary investigations was done. ACS patients were divided into two groups. 1. ACS with DM and 2. ACS without DM. CAG was done among those patients with ACS. Finally CAG findings in two groups were compared systematically. Data were analyzed by SPSS 20. Results: Among the 200 patients total male were 80.5% and total female were 19.5%). Male to female ratio was 5:1. Regarding age distribution it was found matched in both groups. Most patients were at age group 41-50 and 51-60 years which was 31% and 45% respectively. Regarding presence of hypertension in both groups, diabetic group had more hypertensive patients(81%) than the nondiabetic(71%) group (p-0.098). Regarding analysis of CAG findings in diabetic and non diabetic groups LMCA involvement was 16% and 12%, LAD 32% and 28%, LCX 22% and 23%, RCA 23% and 20% and triple vessel was 15% and 14% respectively. Only 5(2.5%) patients were found not to having any lesion. Conclusions: ACS with or without DM has variable CAG findings. So special care should be taken when dealing with such cases. \u0000University Heart Journal Vol. 15, No. 1, Jan 2019; 34-36","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74076202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cm Mosabber Rahman, Alauddin, S. Vaidya, Debasish Das, Arif Ulla Bhuiyan, R. Hoque, M. M. Rahman
Amplatzer septal occluder is widely used by the cardiac interventionists as an effective alternative to traditional surgery for atrial septal defects. However, although rare, device may embolize during or after procedure due to several reasons. We report a case of device embolization into the descending thoracic aorta during percutaneous closure of ASD in a 14-year-old girl which was successfully retrieved by emergency surgery at Department of Cardiac Surgery, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University, Bangladesh. University Heart Journal Vol. 15, No. 1, Jan 2019; 37-39
{"title":"Successful Retrieval of Embolized Amplatzer Septal Occluder from Descending Thoracic Aorta: A Surgical Emergency.","authors":"Cm Mosabber Rahman, Alauddin, S. Vaidya, Debasish Das, Arif Ulla Bhuiyan, R. Hoque, M. M. Rahman","doi":"10.3329/UHJ.V15I1.41445","DOIUrl":"https://doi.org/10.3329/UHJ.V15I1.41445","url":null,"abstract":"Amplatzer septal occluder is widely used by the cardiac interventionists as an effective alternative to traditional surgery for atrial septal defects. However, although rare, device may embolize during or after procedure due to several reasons. We report a case of device embolization into the descending thoracic aorta during percutaneous closure of ASD in a 14-year-old girl which was successfully retrieved by emergency surgery at Department of Cardiac Surgery, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University, Bangladesh. \u0000University Heart Journal Vol. 15, No. 1, Jan 2019; 37-39","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89626596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. A. Islam, Faruque, F. Rahman, H. Hoque, N. Fatema
Streptokinase therapy for acute myocardial infarction reduces early mortality and improves outcomes. Failure of reperfusion after streptokinase therapy for acute myocardial infarction is common and indicates a poor prognosis. We investigated the clinical consequences of non-resolution of the ST segment after thrombolytic therapy for acute ST-elevation myocardial infarction, in 80 consecutive patients admitted to a coronary care unit. Failed thrombolysis was defined as <50% ST-segment resolution at 90 minutes after the start of thrombolytic treatment. Outcomes were measured in terms of in hospital adverse events and mortality at 6 weeks. Thrombolysis was successful, in terms of ST-segment resolution, in 59 patients (73.75%). After adjustment for other factors, ST resolution was the only independent predictor of an uncomplicated recovery in hospital. ST-segment resolution is a useful marker of successful thrombolysis and relates to clinical outcome. Average hospital stay was 2 days greater in non resolved ST-segment group than in ST-segment resolved group. At 6 weeks overall early mortality was much lower in the ST segment resolution group (1.7% versus 57.1% with P value of <0.001). So, non resolution of ST-segment in electrocardiogram following thrombolytic therapy in acute STEMI has paramount importance. If assessed routinely it might assist, along with other clinical markers, in the identification of high risk patients. University Heart Journal Vol. 15, No. 1, Jan 2019; 3-7
{"title":"Clinical Impacts of ST- Segment Non-Resolution after Thrombolysis for Myocardial Infarction","authors":"S. A. Islam, Faruque, F. Rahman, H. Hoque, N. Fatema","doi":"10.3329/UHJ.V15I1.41439","DOIUrl":"https://doi.org/10.3329/UHJ.V15I1.41439","url":null,"abstract":"Streptokinase therapy for acute myocardial infarction reduces early mortality and improves outcomes. Failure of reperfusion after streptokinase therapy for acute myocardial infarction is common and indicates a poor prognosis. We investigated the clinical consequences of non-resolution of the ST segment after thrombolytic therapy for acute ST-elevation myocardial infarction, in 80 consecutive patients admitted to a coronary care unit. Failed thrombolysis was defined as <50% ST-segment resolution at 90 minutes after the start of thrombolytic treatment. Outcomes were measured in terms of in hospital adverse events and mortality at 6 weeks. Thrombolysis was successful, in terms of ST-segment resolution, in 59 patients (73.75%). After adjustment for other factors, ST resolution was the only independent predictor of an uncomplicated recovery in hospital. ST-segment resolution is a useful marker of successful thrombolysis and relates to clinical outcome. Average hospital stay was 2 days greater in non resolved ST-segment group than in ST-segment resolved group. At 6 weeks overall early mortality was much lower in the ST segment resolution group (1.7% versus 57.1% with P value of <0.001). So, non resolution of ST-segment in electrocardiogram following thrombolytic therapy in acute STEMI has paramount importance. If assessed routinely it might assist, along with other clinical markers, in the identification of high risk patients. \u0000University Heart Journal Vol. 15, No. 1, Jan 2019; 3-7","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86976096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Hoque, Khurshed Ahmed, Mrm Mandal, F. Kabir, A. Salam, N. Fatema
This prospective study aimed to investigate the efficacy of ivabradine and nebivolol in treatment of stable angina pectoris (SAP) patients with mild left ventricular dysfunction. Heart rate decreased (78±6) to (65±5) in Group: A and ( 77± 7) to (70 ± 5) in Group: B. There was no change in Blood pressure reduction in Group:A but significant BP reduction in Nebivolol group. Chest pain was reduced by Ivabradine but in Group : B, chest pain decreased in long term after 6 weeks time. After 6 months’ treatment LVEF for the 15 patients of nebivolol group (50%; Group: A) improved by (48 ± 6.5) to (51 ± 3.2), (p>0.05) and for the 15 patients of Ivabradine group (50%; Group: B) (47 ± 5.4) to (51 ± 2.3), (p>0.05). Ivabradine can be considered as first choice in patient with tachycardia induced angina as this agent for reducing heart rate as well as chest pain. The hypertensive patient with tachycardia may be treated by Nebivolol. Among patients in which effective treatment could not be achieved at maximum nebivolol doses, more effective results were obtained in this study with Ivabradine. University Heart Journal Vol. 15, No. 1, Jan 2019; 8-11
{"title":"Comparison of the efficacy of Ivabradine and Nebivolol as Mono Therapy in the Treatment of Stable Angina Pectoris Patients with Mild Left Ventricular Dysfunction","authors":"H. Hoque, Khurshed Ahmed, Mrm Mandal, F. Kabir, A. Salam, N. Fatema","doi":"10.3329/UHJ.V15I1.41438","DOIUrl":"https://doi.org/10.3329/UHJ.V15I1.41438","url":null,"abstract":"This prospective study aimed to investigate the efficacy of ivabradine and nebivolol in treatment of stable angina pectoris (SAP) patients with mild left ventricular dysfunction. Heart rate decreased (78±6) to (65±5) in Group: A and ( 77± 7) to (70 ± 5) in Group: B. There was no change in Blood pressure reduction in Group:A but significant BP reduction in Nebivolol group. Chest pain was reduced by Ivabradine but in Group : B, chest pain decreased in long term after 6 weeks time. After 6 months’ treatment LVEF for the 15 patients of nebivolol group (50%; Group: A) improved by (48 ± 6.5) to (51 ± 3.2), (p>0.05) and for the 15 patients of Ivabradine group (50%; Group: B) (47 ± 5.4) to (51 ± 2.3), (p>0.05). Ivabradine can be considered as first choice in patient with tachycardia induced angina as this agent for reducing heart rate as well as chest pain. The hypertensive patient with tachycardia may be treated by Nebivolol. Among patients in which effective treatment could not be achieved at maximum nebivolol doses, more effective results were obtained in this study with Ivabradine. \u0000University Heart Journal Vol. 15, No. 1, Jan 2019; 8-11","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89518885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Md Golam Morshed, M. Azam, M. Arefin, K. S. Hussain, J. Jahan, N. Ahmed, M. M. Rahman
Background: Now-a-days primary percutaneous coronary intervention (pPCI) is being increasingly done in our country as the treatment of acute ST elevation myocardial infarction (STEMI). Time until treatment is paramount in the management of STEMI. But the time delay to pPCI how much influencing the outcome in our setting is mostly unknown.So we evaluated the influence of total ischemic time on myocardial reperfusion and short term clinical outcome in patients with STEMI treated with primary PCI. Materials and methods: This prospective observational study was conducted from August 2016 to March 2017in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka. Forty-eight (48) acute STEMI patients were selected by purposive sampling based on inclusion and exclusion criteria dividing into two groups as early treatment group (group-A) in whom pain to pPCI time was <6 hours and late treatment group (group-B) in whom pain to pPCI time was 6-12 hours. Angiographic (TIMI flow grade 3 & MBG 3) & short term clinical outcome (MACE, heart failure, major bleeding, minor bleeding, cardiogenic shock, significant arrhythmia, instent thrombosis) were observed and compared between these two groups. Results: The relationship between total ischemic time and 30-day mortality & morbidity were assessed and compared with early and late pPCI group. The overall 30-day mortality rate was 4.2%, heart failure was 6.2%, cardiogenic shock was 4.2%, major bleeding was 2.1% and minor bleeding was 14.6%. Mortality and morbidity were higher in longer ischemic time group than shorter ischemic time group. In multivariate regression analysis, the factors independently influencing the adverse short term outcome were advance age (OR 1.51, 95% CI 1.105 to 4.101, p=0.03), hypertension (OR 2.44, 95% CI 1.102 to 4.281, p=0.02), diabetes mellitus (OR 2.51, 95% CI 1.200 to 4.987, p=0.02), anterior MI (OR 1.38, 95% CI 1.001 to 2.872, p=0.03), multivessel disease (OR 2.35, 95% CI 1.010 to 5.371, p=0.02), pain to door time (OR 1.66, CI 1.099 to 2.2.722, p=0.04), and total ischemic time (OR 2.67, 95% CI 1.122 to 5.784, p=0.02). Even after correction for predictive baseline and procedural variables of the univariate analysis, longer total ischemic time was the most significant independent predictor (OR 2.67, p=0.02) of short term adverse outcome of primary PCI. The current status of time delay in our country revealed symptom onset to door time was 5.6±2.4 hours, door to balloon time was 1.9±1.1 hours and total ischemic time was 7.3±2.6 hours. Conclusion: According to this study finding, there is prognostic implication of time delay in patients with STEMI undergoing primary PCI. Therefore, all efforts should be made to shorten total ischemic time, including reduction in patient related delays, to improve clinical outcome of STEMI patients. University Heart Journal Vol. 14, No. 2, Jul 2018; 77-82
背景:目前，经皮冠状动脉介入治疗(pPCI)在我国作为急性ST段抬高型心肌梗死(STEMI)的治疗越来越多。治疗前的时间对STEMI的治疗至关重要。但pPCI的时间延迟在多大程度上影响我们的结果是未知的。因此，我们评估心肌缺血总时间对经PCI治疗STEMI患者心肌再灌注及短期临床预后的影响。材料与方法:本前瞻性观察性研究于2016年8月至2017年3月在达卡国家心血管疾病研究所(NICVD)心内科进行。根据纳入和排除标准，采用有目的抽样的方法，将48例急性STEMI患者分为疼痛至pPCI时间<6小时的早期治疗组(a组)和疼痛至pPCI时间为6-12小时的晚期治疗组(b组)。观察两组的血管造影(TIMI血流3级和MBG 3级)和短期临床结果(MACE、心力衰竭、大出血、小出血、心源性休克、明显心律失常、血栓形成)并进行比较。结果:比较早期和晚期pPCI组总缺血时间与30天死亡率和发病率的关系。30天总死亡率为4.2%，心力衰竭为6.2%，心源性休克为4.2%，大出血为2.1%，小出血为14.6%。缺血时间较长组死亡率和发病率高于缺血时间较短组。在多因素回归分析中，影响短期不良预后的独立因素有:年龄较大(OR 1.51, 95% CI 1.105 ~ 4.101, p=0.03)、高血压(OR 2.44, 95% CI 1.102 ~ 4.281, p=0.02)、糖尿病(OR 2.51, 95% CI 1.200 ~ 4.987, p=0.02)、前路心肌梗死(OR 1.38, 95% CI 1.001 ~ 2.872, p=0.03)、多血管疾病(OR 2.35, 95% CI 1.010 ~ 5.371, p=0.02)、疼痛至闭门时间(OR 1.66, CI 1.099 ~ 2.2.722, p=0.04)和总缺血时间(OR 2.67, p=0.03)。95% CI 1.122 ~ 5.784, p=0.02)。即使对单变量分析的预测基线和程序变量进行校正后，较长的总缺血时间仍是首次PCI短期不良结局最显著的独立预测因子(OR 2.67, p=0.02)。我国时间延迟现状显示，症状发生至门时间为5.6±2.4小时，门至球囊时间为1.9±1.1小时，总缺血时间为7.3±2.6小时。结论:根据本研究发现，STEMI患者行首次PCI治疗的时间延迟对预后有影响。因此，应尽一切努力缩短总缺血时间，包括减少患者相关延迟，以改善STEMI患者的临床预后。《大学心脏杂志》2018年7月第14卷第2期;77 - 82
{"title":"Impact of Time Delay on Short Term Outcome of Primary Percutaneous Coronary Intervention (PCI) in Bangladeshi Population","authors":"Md Golam Morshed, M. Azam, M. Arefin, K. S. Hussain, J. Jahan, N. Ahmed, M. M. Rahman","doi":"10.3329/UHJ.V14I2.40287","DOIUrl":"https://doi.org/10.3329/UHJ.V14I2.40287","url":null,"abstract":"Background: Now-a-days primary percutaneous coronary intervention (pPCI) is being increasingly done in our country as the treatment of acute ST elevation myocardial infarction (STEMI). Time until treatment is paramount in the management of STEMI. But the time delay to pPCI how much influencing the outcome in our setting is mostly unknown.So we evaluated the influence of total ischemic time on myocardial reperfusion and short term clinical outcome in patients with STEMI treated with primary PCI. \u0000Materials and methods: This prospective observational study was conducted from August 2016 to March 2017in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka. Forty-eight (48) acute STEMI patients were selected by purposive sampling based on inclusion and exclusion criteria dividing into two groups as early treatment group (group-A) in whom pain to pPCI time was <6 hours and late treatment group (group-B) in whom pain to pPCI time was 6-12 hours. Angiographic (TIMI flow grade 3 & MBG 3) & short term clinical outcome (MACE, heart failure, major bleeding, minor bleeding, cardiogenic shock, significant arrhythmia, instent thrombosis) were observed and compared between these two groups. \u0000Results: The relationship between total ischemic time and 30-day mortality & morbidity were assessed and compared with early and late pPCI group. The overall 30-day mortality rate was 4.2%, heart failure was 6.2%, cardiogenic shock was 4.2%, major bleeding was 2.1% and minor bleeding was 14.6%. Mortality and morbidity were higher in longer ischemic time group than shorter ischemic time group. In multivariate regression analysis, the factors independently influencing the adverse short term outcome were advance age (OR 1.51, 95% CI 1.105 to 4.101, p=0.03), hypertension (OR 2.44, 95% CI 1.102 to 4.281, p=0.02), diabetes mellitus (OR 2.51, 95% CI 1.200 to 4.987, p=0.02), anterior MI (OR 1.38, 95% CI 1.001 to 2.872, p=0.03), multivessel disease (OR 2.35, 95% CI 1.010 to 5.371, p=0.02), pain to door time (OR 1.66, CI 1.099 to 2.2.722, p=0.04), and total ischemic time (OR 2.67, 95% CI 1.122 to 5.784, p=0.02). Even after correction for predictive baseline and procedural variables of the univariate analysis, longer total ischemic time was the most significant independent predictor (OR 2.67, p=0.02) of short term adverse outcome of primary PCI. The current status of time delay in our country revealed symptom onset to door time was 5.6±2.4 hours, door to balloon time was 1.9±1.1 hours and total ischemic time was 7.3±2.6 hours. \u0000Conclusion: According to this study finding, there is prognostic implication of time delay in patients with STEMI undergoing primary PCI. Therefore, all efforts should be made to shorten total ischemic time, including reduction in patient related delays, to improve clinical outcome of STEMI patients. \u0000University Heart Journal Vol. 14, No. 2, Jul 2018; 77-82","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77203667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rasul Amin, A. Razzak, G. Hasan, A. A. Hai, Chayan Kumar Singho, S. E. Mahbub, F. Kabir, Haque Ma, Elora Sharmin
Background: The stiffness of the large elastic arteries increase the morbidity and mortality. Objective: The purpose of the present study was to estimate the risk of aortic stiffness among end stage renal disease patients under maintenance haemodialysis. Methodology: This case-control study was carried out in the Department of Nephrology at National Institute of Kidney Diseases and Urology (NIKDU), Dhaka and National Institute of Cardiovascular Disease and Hospital (NICVD), Dhaka, Bangladesh from January 2013 to December 2014 for a period of two (02) years. Chronic kidney disease in stage 5 [CKD-5(D)] patients older than 18 years on maintenance haemodialysis (MHD) for more than 3 months were designated as case group and age and sex matched non CKD patients were considered as control group. Serum calcium, serum albumin, serum phosphate and iPTH were estimated by semi-automated biochemistry analyzer from the Department of Biochemistry of NIKDU, Dhaka and NICVD, Dhaka. Plain X-ray abdomen in lateral view was performed for all patients. Result: A total number of 100 patients were enrolled for this study of which 50 patients were in end stage renal disease (ESRD) group and the rest 50 patients were in non-CKD group. Mean (±SD) aortic stiffness index was significantly higher (P<0.001) among ESRD population (3.27±1.70) compared to non CKD group of population (2.00±0.73). Mean (±SD) serum calcium (corrected) level was significantly high (P<0.001) in ESRD patients (9.79±0.87) compared to non CKD group of population (9.13±0.70). Mean (±SD) serum phosphate level was significantly higher (P<0.001) in ESRD patients (5.71±0.96) compared to non CKD group of population (4.20±0.59). However, mean (±SD) iPTH level showed no significant difference between ESRD (25.33±51.98) and non CKD group of population (38.53±19.52). Conclusion: In conclusionaortic stiffness is significantly higher among ESRD subjects. University Heart Journal Vol. 14, No. 2, Jul 2018; 67-70
{"title":"Risk Estimation of Aortic Stiffness in Patients with End Stage Renal Disease under Maintenance Haemodialysis","authors":"Rasul Amin, A. Razzak, G. Hasan, A. A. Hai, Chayan Kumar Singho, S. E. Mahbub, F. Kabir, Haque Ma, Elora Sharmin","doi":"10.3329/UHJ.V14I2.40285","DOIUrl":"https://doi.org/10.3329/UHJ.V14I2.40285","url":null,"abstract":"Background: The stiffness of the large elastic arteries increase the morbidity and mortality. Objective: The purpose of the present study was to estimate the risk of aortic stiffness among end stage renal disease patients under maintenance haemodialysis. \u0000Methodology: This case-control study was carried out in the Department of Nephrology at National Institute of Kidney Diseases and Urology (NIKDU), Dhaka and National Institute of Cardiovascular Disease and Hospital (NICVD), Dhaka, Bangladesh from January 2013 to December 2014 for a period of two (02) years. Chronic kidney disease in stage 5 [CKD-5(D)] patients older than 18 years on maintenance haemodialysis (MHD) for more than 3 months were designated as case group and age and sex matched non CKD patients were considered as control group. Serum calcium, serum albumin, serum phosphate and iPTH were estimated by semi-automated biochemistry analyzer from the Department of Biochemistry of NIKDU, Dhaka and NICVD, Dhaka. Plain X-ray abdomen in lateral view was performed for all patients. \u0000Result: A total number of 100 patients were enrolled for this study of which 50 patients were in end stage renal disease (ESRD) group and the rest 50 patients were in non-CKD group. Mean (±SD) aortic stiffness index was significantly higher (P<0.001) among ESRD population (3.27±1.70) compared to non CKD group of population (2.00±0.73). Mean (±SD) serum calcium (corrected) level was significantly high (P<0.001) in ESRD patients (9.79±0.87) compared to non CKD group of population (9.13±0.70). Mean (±SD) serum phosphate level was significantly higher (P<0.001) in ESRD patients (5.71±0.96) compared to non CKD group of population (4.20±0.59). However, mean (±SD) iPTH level showed no significant difference between ESRD (25.33±51.98) and non CKD group of population (38.53±19.52). \u0000Conclusion: In conclusionaortic stiffness is significantly higher among ESRD subjects. \u0000University Heart Journal Vol. 14, No. 2, Jul 2018; 67-70","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89583318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. S. Salekin, F. Sazzad, S. A. Nahian, Sumsul Arif Mohammad Musa, Mohammed Rabbikul Alam, D. I. Choudhury, A. B. Adhikary
Coronary artery disease is increasing in developing countries. Revascularization surgery in such patients with amenable coronary anatomy is a valid option. Coronary artery bypass grafting in patients with low ejection fraction (EF <35%) is very challenging although it is performing successfully in department of Cardiac Surgery of Bangabandhu Sheikh Mujib Medical University now a days. The purpose of this study is to evaluate the safety and effectiveness of off pump coronary artery bypass grafting for EF e”35% and EF <35% and also to compare between pre and postoperative echocardiographic findings in this two groups. The preoperative, at discharge, 1 month and 3 month postoperative follow up data of total 60 patients in two groups ( EF e”35% and <35%) who underwent isolated off pump coronary artery bypass grafting between July 2012 – June 2014 was evaluated. In group 1 preoperative LVIDd and LVIDs was 54.86±3.45 mm and 45.23 ±4.13mm and LVEF was 42.7±4.66. Postoperatively at 3 month follow up the LVIDd 45.43±5.03 mm, LVIDs 34.7±5.33 mm and LVEF 53.46±5.06. The improvement of mean LVIDd and LVIDs is statistically significant (p<0.001) and (p<0.05) respectively. But improvement of LVEF is not statistically significant (p>0.05). Similarly in group 2 patients preoperative LVIDd, LVIDs and LVEF is 67.06±3.67mm, 59.1±4.35mm and 29.26±4.25. Postoperatively at 3 months follow up of this group the LVIDd, LVIDs and LVEF is changed to 57.56±4.96 mm, 48.3±5.53 mm and 38.93±6.03. The improvement of mean LVIDd and LVIDs is statistically significant (p<0.001) and (p<0.05) respectively. And the improvement of LVEF is also statistically significant (p<0.001). Significant improvement in terms of CCS grade and NYHA class was also observed specially in <35% ejection fraction group at 3moths follow up. We concluded that off pump coronary artery bypass grafting can be safely performed to the patients with normal and poor left ventricular ejection. Hence we recommended that off-pump CABG can be safely carry out in case of <35% ejection fraction patients. University Heart Journal Vol. 14, No. 2, Jul 2018; 53-61
{"title":"Short Term Outcome of Off Pump Coronary Artery Bypass Grafting in Patients with Low Ejection Fraction","authors":"M. S. Salekin, F. Sazzad, S. A. Nahian, Sumsul Arif Mohammad Musa, Mohammed Rabbikul Alam, D. I. Choudhury, A. B. Adhikary","doi":"10.3329/uhj.v14i2.40283","DOIUrl":"https://doi.org/10.3329/uhj.v14i2.40283","url":null,"abstract":"Coronary artery disease is increasing in developing countries. Revascularization surgery in such patients with amenable coronary anatomy is a valid option. Coronary artery bypass grafting in patients with low ejection fraction (EF <35%) is very challenging although it is performing successfully in department of Cardiac Surgery of Bangabandhu Sheikh Mujib Medical University now a days. The purpose of this study is to evaluate the safety and effectiveness of off pump coronary artery bypass grafting for EF e”35% and EF <35% and also to compare between pre and postoperative echocardiographic findings in this two groups. The preoperative, at discharge, 1 month and 3 month postoperative follow up data of total 60 patients in two groups ( EF e”35% and <35%) who underwent isolated off pump coronary artery bypass grafting between July 2012 – June 2014 was evaluated. In group 1 preoperative LVIDd and LVIDs was 54.86±3.45 mm and 45.23 ±4.13mm and LVEF was 42.7±4.66. Postoperatively at 3 month follow up the LVIDd 45.43±5.03 mm, LVIDs 34.7±5.33 mm and LVEF 53.46±5.06. The improvement of mean LVIDd and LVIDs is statistically significant (p<0.001) and (p<0.05) respectively. But improvement of LVEF is not statistically significant (p>0.05). Similarly in group 2 patients preoperative LVIDd, LVIDs and LVEF is 67.06±3.67mm, 59.1±4.35mm and 29.26±4.25. Postoperatively at 3 months follow up of this group the LVIDd, LVIDs and LVEF is changed to 57.56±4.96 mm, 48.3±5.53 mm and 38.93±6.03. The improvement of mean LVIDd and LVIDs is statistically significant (p<0.001) and (p<0.05) respectively. And the improvement of LVEF is also statistically significant (p<0.001). Significant improvement in terms of CCS grade and NYHA class was also observed specially in <35% ejection fraction group at 3moths follow up. We concluded that off pump coronary artery bypass grafting can be safely performed to the patients with normal and poor left ventricular ejection. Hence we recommended that off-pump CABG can be safely carry out in case of <35% ejection fraction patients. \u0000University Heart Journal Vol. 14, No. 2, Jul 2018; 53-61","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79190936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Alam, M. M. Rahman, T. Parvin, Khurshed Ahmed, S. Zaman, S. Banerjee, S. Ahsan, H. Hoque, P. Bajracharya, R. Rashed
Background: Ischemic heart disease is increasing all over the world even in the developing countries like Bangladesh. The incidence rate of coronary artery disease is escalating very rapidly among both male and female population in our country. Though exercise treadmill test (ETT) is a well accepted non-invasive investigation to diagnose Coronary Artery Disease (CAD), it has a high false positive and false negative result if ST segment response alone is calculated for interpretation of the test. Accuracy of different treadmill scores in our population is largely unknown. Clevelan Clinic Score is a prognostic ETT score which is validated for prognostic indication but may have some diagnostic value as well. Objective: To know the diagnostic role of Cleveland Clinic Score, currently which has only prognostic implication. Method: A Cross-Sectional study was carried out on patients attending University Cardiac Center in Bangabandhu Sheikh Mujib Medical University (BSMMU) for stable chest pain to find out the accuracy of Cleveland Clinic Scores (CCS) in comparison to other diagnostic treadmill scores namely Duke Treadmill Score (DTS) and Simple Treadmill Score (STS).Total 130 persons including male and female who have undergone ETT were included according to inclusion and exclusion criteria. Coronary angiogram reports were collected after the procedure was performed as per clinical practice. The accuracy of ST segment response & different treadmill scores were calculated and compared with each other. Result: ETT scores had better sensitivity and specificity than ST segment response which was affected by workup bias more. CCS, DTS and STS have 83.3% & 60.9%; 71.4% & 71.7%; 64.3% & 78.3% sensitivity & specificity, respectively. Receiver Operator Characteristics (ROC) curve analysis showed all of the three scores have similar area under curve (AUC) that means they have similar accuracy to diagnose CAD. But they have different sensitivity and specificity for different cut off value. Overall analysis showed accuracy of STS (83.9%) is comparable to that of DTS (83.3%), CCS (77%) . Conclusion: Among the three treadmill scores Cleveland Clinic Score has comparable predictive accuracy when compared with DTS, STS. Though a prognostic ETT score, CCS may have diagnostic role which need to be validated further. University Heart Journal Vol. 14, No. 2, Jul 2018; 62-66
{"title":"Cleveland Clinic Socre – What is the Role of a Novel Prognostic Treadmil Score to Diagnose Coronary Artery Disease?","authors":"M. Alam, M. M. Rahman, T. Parvin, Khurshed Ahmed, S. Zaman, S. Banerjee, S. Ahsan, H. Hoque, P. Bajracharya, R. Rashed","doi":"10.3329/uhj.v14i2.40284","DOIUrl":"https://doi.org/10.3329/uhj.v14i2.40284","url":null,"abstract":"Background: Ischemic heart disease is increasing all over the world even in the developing countries like Bangladesh. The incidence rate of coronary artery disease is escalating very rapidly among both male and female population in our country. Though exercise treadmill test (ETT) is a well accepted non-invasive investigation to diagnose Coronary Artery Disease (CAD), it has a high false positive and false negative result if ST segment response alone is calculated for interpretation of the test. Accuracy of different treadmill scores in our population is largely unknown. Clevelan Clinic Score is a prognostic ETT score which is validated for prognostic indication but may have some diagnostic value as well. \u0000Objective: To know the diagnostic role of Cleveland Clinic Score, currently which has only prognostic implication. Method: A Cross-Sectional study was carried out on patients attending University Cardiac Center in Bangabandhu Sheikh Mujib Medical University (BSMMU) for stable chest pain to find out the accuracy of Cleveland Clinic Scores (CCS) in comparison to other diagnostic treadmill scores namely Duke Treadmill Score (DTS) and Simple Treadmill Score (STS).Total 130 persons including male and female who have undergone ETT were included according to inclusion and exclusion criteria. Coronary angiogram reports were collected after the procedure was performed as per clinical practice. The accuracy of ST segment response & different treadmill scores were calculated and compared with each other. \u0000Result: ETT scores had better sensitivity and specificity than ST segment response which was affected by workup bias more. CCS, DTS and STS have 83.3% & 60.9%; 71.4% & 71.7%; 64.3% & 78.3% sensitivity & specificity, respectively. Receiver Operator Characteristics (ROC) curve analysis showed all of the three scores have similar area under curve (AUC) that means they have similar accuracy to diagnose CAD. But they have different sensitivity and specificity for different cut off value. Overall analysis showed accuracy of STS (83.9%) is comparable to that of DTS (83.3%), CCS (77%) . \u0000Conclusion: Among the three treadmill scores Cleveland Clinic Score has comparable predictive accuracy when compared with DTS, STS. Though a prognostic ETT score, CCS may have diagnostic role which need to be validated further. \u0000University Heart Journal Vol. 14, No. 2, Jul 2018; 62-66","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"190 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79544984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pritam Kumar Gachchhadar, M. Mahmood, D. Adhikary, M. Chowdhury, A. Sultan, Mrm Mandal, K. M. Iqbal, S. Banerjee
Background: As acute occlusion of the left main (LM) artery causes life-threatening hemodynamic deterioration and malignant arrhythmias, resulting in an adverse outcome, a rapid diagnosis and subsequent urgent revascularization with percutaneous coronary intervention (PCI) or coronary bypass surgery is very important in this subset of patients. The 12-lead electrocardiogram (ECG) is a crucial tool in the diagnosis and risk stratification of acute coronary syndrome (ACS). Unlike other 11 leads, lead aVR has been long neglected until recent years. Objective: To determine the accuracy of 12-lead electrocardiography in predicting left main and/or triplevessel disease in patients with non-ST elevation acute coronary syndrome (NSTE- ACS). Methodology: This cross sectional observational study carried out among patients presenting with non-ST elevation acute coronary syndrome at Cardiac Emergency Department or CCU of BSMMU. This study was conducted from May 2017 to April 2018. A total of 36 patients meeting the eligibility criteria were consecutively included. Data collection was carried out by using a questionnaire. Informed written consent was obtained from the hospital authority. Analysis of data was finally done with Statistical Package for Social Science program 17 version of computer on the basis of different variables. Result: As ST-segment elevation in lead aVR is a continuous variable, a suitable cut-off for ST- elevation in lead aVR was found out for diagnosing LM and/or triple vessel disease (TVD) using ROC curve. The cut-off value was 0.75 mm which gave us an optimum sensitivity of 88.5% and a specificity of 80% with an area under the curve being 0.892(95% CI = 0.785-1.000), p < 0.001. The area under the curve demonstrated that 89.2% of the LM and/or TVD were correctly diagnosed with ST elevation e” 0.75 mm in lead aVR in patients with non-ST segment elevation acute coronary syndrome. The positive predictive value was commendably high (92%) and negative predictive value was no less (72.7%) with an overall diagnostic accuracy of 86%. Conclusion: From the findings of the study it can be concluded that ST- segment elevation e”0.75 mm in lead aVR in patients of non-ST segment elevation acute coronary syndrome had optimum sensitivity and specificity with an appreciably high overall diagnostic accuracy. The ST- segment elevation e”0.75 mm in lead aVR in patients with non-STE-ACS can differentiate LM and/or triple vessel disease with fair degree of accuracy. University Heart Journal Vol. 14, No. 2, Jul 2018; 71-76
背景:由于左主干(LM)动脉急性闭塞会导致危及生命的血流动力学恶化和恶性心律失常，导致不良后果，因此对这类患者进行快速诊断并随后通过经皮冠状动脉介入治疗(PCI)或冠状动脉搭桥手术进行紧急血运重建术非常重要。12导联心电图(ECG)是急性冠状动脉综合征(ACS)诊断和危险分层的重要工具。与其他11种导联不同，导联aVR一直被忽视，直到最近几年。目的:探讨12导联心电图预测非st段抬高急性冠脉综合征(NSTE- ACS)患者左主干和/或三支血管病变的准确性。方法学:本横断面观察研究在心脏急诊科或BSMMU CCU的非st段抬高急性冠状动脉综合征患者中进行。该研究于2017年5月至2018年4月进行。符合入选标准的患者共36例。数据收集采用问卷调查。已取得医院管理局的知情书面同意。最后在不同变量的基础上，使用Statistical Package for Social Science program 17版本的计算机对数据进行分析。结果:由于aVR导联ST段抬高是一个连续变量，找到了适合的aVR导联ST段抬高的截断值，用于诊断LM和/或三支血管病变(TVD)。截断值为0.75 mm，最佳灵敏度为88.5%，特异性为80%，曲线下面积为0.892(95% CI = 0.785-1.000)， p < 0.001。曲线下面积显示，在非ST段抬高急性冠状动脉综合征患者中，89.2%的LM和/或TVD被正确诊断为ST段抬高0.75 mm。阳性预测值非常高(92%)，阴性预测值也不低于(72.7%)，总体诊断准确率为86%。结论:本研究结果表明，非ST段抬高急性冠状动脉综合征患者aVR导联ST段抬高0.75 mm具有最佳的敏感性和特异性，总体诊断准确率较高。非ste - acs患者aVR导联ST段抬高0.75 mm，可以相当准确地区分LM和/或三支血管疾病。《大学心脏杂志》2018年7月第14卷第2期;71 - 76
{"title":"Significance of ST Segment Elevation in Lead aVR in Patients with Non-ST Elevation Acute Coronary Syndrome","authors":"Pritam Kumar Gachchhadar, M. Mahmood, D. Adhikary, M. Chowdhury, A. Sultan, Mrm Mandal, K. M. Iqbal, S. Banerjee","doi":"10.3329/UHJ.V14I2.40286","DOIUrl":"https://doi.org/10.3329/UHJ.V14I2.40286","url":null,"abstract":"Background: As acute occlusion of the left main (LM) artery causes life-threatening hemodynamic deterioration and malignant arrhythmias, resulting in an adverse outcome, a rapid diagnosis and subsequent urgent revascularization with percutaneous coronary intervention (PCI) or coronary bypass surgery is very important in this subset of patients. The 12-lead electrocardiogram (ECG) is a crucial tool in the diagnosis and risk stratification of acute coronary syndrome (ACS). Unlike other 11 leads, lead aVR has been long neglected until recent years. \u0000Objective: To determine the accuracy of 12-lead electrocardiography in predicting left main and/or triplevessel disease in patients with non-ST elevation acute coronary syndrome (NSTE- ACS). Methodology: This cross sectional observational study carried out among patients presenting with non-ST elevation acute coronary syndrome at Cardiac Emergency Department or CCU of BSMMU. This study was conducted from May 2017 to April 2018. A total of 36 patients meeting the eligibility criteria were consecutively included. Data collection was carried out by using a questionnaire. Informed written consent was obtained from the hospital authority. Analysis of data was finally done with Statistical Package for Social Science program 17 version of computer on the basis of different variables. \u0000Result: As ST-segment elevation in lead aVR is a continuous variable, a suitable cut-off for ST- elevation in lead aVR was found out for diagnosing LM and/or triple vessel disease (TVD) using ROC curve. The cut-off value was 0.75 mm which gave us an optimum sensitivity of 88.5% and a specificity of 80% with an area under the curve being 0.892(95% CI = 0.785-1.000), p < 0.001. The area under the curve demonstrated that 89.2% of the LM and/or TVD were correctly diagnosed with ST elevation e” 0.75 mm in lead aVR in patients with non-ST segment elevation acute coronary syndrome. The positive predictive value was commendably high (92%) and negative predictive value was no less (72.7%) with an overall diagnostic accuracy of 86%. \u0000Conclusion: From the findings of the study it can be concluded that ST- segment elevation e”0.75 mm in lead aVR in patients of non-ST segment elevation acute coronary syndrome had optimum sensitivity and specificity with an appreciably high overall diagnostic accuracy. The ST- segment elevation e”0.75 mm in lead aVR in patients with non-STE-ACS can differentiate LM and/or triple vessel disease with fair degree of accuracy. \u0000University Heart Journal Vol. 14, No. 2, Jul 2018; 71-76","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73798098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract not available University Heart Journal Vol. 14, No. 2, Jul 2018; 45
《大学心脏杂志》2018年7月第14卷第2期;45
{"title":"The link between Cardiovascular Disease and Stroke","authors":"M. Mahmood, H. Hoque","doi":"10.3329/UHJ.V14I2.40281","DOIUrl":"https://doi.org/10.3329/UHJ.V14I2.40281","url":null,"abstract":"Abstract not available \u0000University Heart Journal Vol. 14, No. 2, Jul 2018; 45","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83121257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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