Goutom Chandra Bhowmik, Md Fakhrul Islam Khaled, T. Parvin, D. Osmany, M. Haque, A. G. Mostofa, P. Biswas, Arifuzzaman Noman, Amiruzzaman Sumon, S. Banerjee, M. Mamun, A. Hasan, C. M. Ahmed
Background: Left atrial appendage (LAA) is considered the “most lethal human appendage” as it causes significant mortality and morbidity in chronic rheumatic mitral stenosis patients due to cardiogenic cerebral infract. Presence of LAA dysfunction has been shown to be a strong predictor of thrombus formation and the risk of embolic event, even if no clot is found at the time of initial examination. LAA emptying velocity are measured by trans esophageal echocardiography (TEE) represent as a surrogate marker for left atrial(LA) function .LAA emptying velocities (contraction velocity) < 20cm/s are associated with risk of spontaneous echo contrast(SEC), LAA thrombus, and subsequent cardio embolic events. So early detection of low emptying velocity without SEC or LA thrombus can reduce mortality & morbidity related to cardio embolic stroke and also helps in further management procedure like cardio version etc. So we will compare LAA emptying velocity moderate versus severechronic rheumatic mitral stenosis patients in our population for further attention. Objective: To assess emptying velocity of LAA in patient with moderate versus severe chronic rheumatic mitral stenosis, from a Bangladesh health service perspective. Method: This was a cross sectional study which was conducted in UCC, BSMMU during the period of from February 2019 to September 2019 in Echo lab . Study Procedure: We were enrolled 33 CRHD with MS (moderate to severe) patients who underwent TEE and met inclusion & exclusion criteria. The purpose of the study was explained to each subject & informed written consent was obtained. After getting consent relevant history, physical examination and preprocedural investigation was obtained in predesigned structured data collection sheet. TEE was done with Vivid E9® machine. Pulse wave Doppler was position at the tip of the LAA and then emptying velocity of LAA moderate and severe were compared. Outcome measure: Among 33 patients, 3 patients were excluded due to outlier and inadequate data.. In chronic rheumatic mitral stenosis in moderate versus severe cases average LAA emptying velocities were significantly higher moderate CRHD with MS compare to severe CRHD with MS,(26.57±4.91;31.12±5.04), P=0.018. Conclusion:Appendicular emptying velocity of LAA significantly lower in severe CRHD with MS compare to moderate CRHD with MS and it has temporal relation with MS severity. It can be used as a reliable, simple and sami-invasive tool to early predict severity and prevent complication in CRHD with MS as well as for prophylactic measured taken. University Heart Journal 2022; 18(2): 73-79
{"title":"Comparison of the Appendicular Emptying Velocity of Left Atrium in patient with moderate versus severe chronic rheumatic mitral stenosis measured by pulsed wave Doppler in Transesophageal echocardiography","authors":"Goutom Chandra Bhowmik, Md Fakhrul Islam Khaled, T. Parvin, D. Osmany, M. Haque, A. G. Mostofa, P. Biswas, Arifuzzaman Noman, Amiruzzaman Sumon, S. Banerjee, M. Mamun, A. Hasan, C. M. Ahmed","doi":"10.3329/uhj.v18i2.62674","DOIUrl":"https://doi.org/10.3329/uhj.v18i2.62674","url":null,"abstract":"Background: Left atrial appendage (LAA) is considered the “most lethal human appendage” as it causes significant mortality and morbidity in chronic rheumatic mitral stenosis patients due to cardiogenic cerebral infract. Presence of LAA dysfunction has been shown to be a strong predictor of thrombus formation and the risk of embolic event, even if no clot is found at the time of initial examination. LAA emptying velocity are measured by trans esophageal echocardiography (TEE) represent as a surrogate marker for left atrial(LA) function .LAA emptying velocities (contraction velocity) < 20cm/s are associated with risk of spontaneous echo contrast(SEC), LAA thrombus, and subsequent cardio embolic events. So early detection of low emptying velocity without SEC or LA thrombus can reduce mortality & morbidity related to cardio embolic stroke and also helps in further management procedure like cardio version etc. So we will compare LAA emptying velocity moderate versus severechronic rheumatic mitral stenosis patients in our population for further attention. \u0000Objective: To assess emptying velocity of LAA in patient with moderate versus severe chronic rheumatic mitral stenosis, from a Bangladesh health service perspective. \u0000Method: This was a cross sectional study which was conducted in UCC, BSMMU during the period of from February 2019 to September 2019 in Echo lab . \u0000Study Procedure: We were enrolled 33 CRHD with MS (moderate to severe) patients who underwent TEE and met inclusion & exclusion criteria. The purpose of the study was explained to each subject & informed written consent was obtained. After getting consent relevant history, physical examination and preprocedural investigation was obtained in predesigned structured data collection sheet. TEE was done with Vivid E9® machine. Pulse wave Doppler was position at the tip of the LAA and then emptying velocity of LAA moderate and severe were compared. \u0000Outcome measure: Among 33 patients, 3 patients were excluded due to outlier and inadequate data.. In chronic rheumatic mitral stenosis in moderate versus severe cases average LAA emptying velocities were significantly higher moderate CRHD with MS compare to severe CRHD with MS,(26.57±4.91;31.12±5.04), P=0.018. \u0000Conclusion:Appendicular emptying velocity of LAA significantly lower in severe CRHD with MS compare to moderate CRHD with MS and it has temporal relation with MS severity. It can be used as a reliable, simple and sami-invasive tool to early predict severity and prevent complication in CRHD with MS as well as for prophylactic measured taken. \u0000University Heart Journal 2022; 18(2): 73-79","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"127 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75817390","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}
Khan daker Harun Rashid, D. Adhikary, S. Banerjee, T. Parvin, Abu Baqar Md Jamil, Md. Tufazzal Hossain, M. Das, A. Hasan, Md. Ashraf Uddin Sultan
Aim: The aim of the study was to determine if the tissue Doppler imaging (TDI)-derived myocardial acceleration during isovolumic contraction (IVA) of tricuspid lateral annulus could be used in early detection of RV systolic dysfunction in patients with mitral stenosis (MS), before the clinical signs of systemic venous congestion occur and to compare between IVA and conventional echocardiographic parameters in detecting early RV systolic dysfunction in patients with MS . Methods: Ninety-six patients with severe rheumatic MS without relevant regurgitation were enrolled in the study. Conventional echocardiographic parameters (mitral valve area, transmitral diastolic gradients, pulmonary artery pressure, RV fractional area change, pulmonary flow acceleration time, tricuspid annular plane systolic excursion) and TDI-derived systolic velocities of tricuspid annulus (isovolumic myocardial acceleration: IVA, peak myocardial velocity during isovolumic contraction: IVV, peak systolic velocity during ejection period: Sa and RV MPI) were recorded from all patients. Results: TDI-derived IVA, IVV, Sa were significantly decreased in patients with MS and RV MPI is increased in patients with MS. IVA was the only parameter which had a significant negative correlation with the traditional echocardiographic parameters and RV Tei index in patients with MS. Conclusion: TDI-derived right ventricular IVA may be used as an adjunctive, reliable, noninvasive parameter for the early detection of right ventricular systolic dysfunction in patients with MS but without signs of systemic venous congestion. RV IVA negatively correlate with RV MPI, positively correlate with IVV and Sa. RV IVA shows positive correlation with RVFAC and negative correlation with PAP, LA size. IVA shows no correlation with TAPSE. University Heart Journal 2022; 18(2): 80-86
{"title":"Comparison Between Isovolumic Acceleration and Conventional Echocardiograhic Parameters in Detecting Early Right Ventricular Systolic Dysfunction in Patients with Mitral Stenosis","authors":"Khan daker Harun Rashid, D. Adhikary, S. Banerjee, T. Parvin, Abu Baqar Md Jamil, Md. Tufazzal Hossain, M. Das, A. Hasan, Md. Ashraf Uddin Sultan","doi":"10.3329/uhj.v18i2.62676","DOIUrl":"https://doi.org/10.3329/uhj.v18i2.62676","url":null,"abstract":"Aim: The aim of the study was to determine if the tissue Doppler imaging (TDI)-derived myocardial acceleration during isovolumic contraction (IVA) of tricuspid lateral annulus could be used in early detection of RV systolic dysfunction in patients with mitral stenosis (MS), before the clinical signs of systemic venous congestion occur and to compare between IVA and conventional echocardiographic parameters in detecting early RV systolic dysfunction in patients with MS . \u0000Methods: Ninety-six patients with severe rheumatic MS without relevant regurgitation were enrolled in the study. Conventional echocardiographic parameters (mitral valve area, transmitral diastolic gradients, pulmonary artery pressure, RV fractional area change, pulmonary flow acceleration time, tricuspid annular plane systolic excursion) and TDI-derived systolic velocities of tricuspid annulus (isovolumic myocardial acceleration: IVA, peak myocardial velocity during isovolumic contraction: IVV, peak systolic velocity during ejection period: Sa and RV MPI) were recorded from all patients. \u0000Results: TDI-derived IVA, IVV, Sa were significantly decreased in patients with MS and RV MPI is increased in patients with MS. IVA was the only parameter which had a significant negative correlation with the traditional echocardiographic parameters and RV Tei index in patients with MS. \u0000Conclusion: TDI-derived right ventricular IVA may be used as an adjunctive, reliable, noninvasive parameter for the early detection of right ventricular systolic dysfunction in patients with MS but without signs of systemic venous congestion. RV IVA negatively correlate with RV MPI, positively correlate with IVV and Sa. RV IVA shows positive correlation with RVFAC and negative correlation with PAP, LA size. IVA shows no correlation with TAPSE. \u0000University Heart Journal 2022; 18(2): 80-86","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"311 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76891262","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. Das, Mohammad Safiuddin, S. Zaman, Khondoker Harun or Rashid, Mohammad Saiful Islam Chowdhury, A. Jamil, Md. Ashraf Uddin Sultan
Background and Objectives: Myocardial injury after percutaneous coronary intervention (PCI) occurs frequently and it is associated with an adverse clinical outcome. Mechanical factors have been implicated in this complication and the role of inflammation has not yet been clearly determined. We evaluated the effect of an inflammatory response during PCI on periprocedural myocardial injury. Subjects and Methods: This prospective observational study was conducted in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh over a period between July’2012 to June’2013. A total of 200 patients studied who underwent elective coronary stenting. For the exclusion of mechanical injury to the myocardium, we excluded those patients who developed complications during PCI. The inflammatory response to PCI was calculated as the difference between the peak postprocedural hs-CRP level and the preprocedural hs-CRP level . We divided the patients according to the median value of hs- CRP: Group I <3 mg/L and Group II >3 mg/L. Results: Postprocedural TnI elevation was were observed in 72 (36%) patients. The baseline clinical and angiographic characteristics were not difference between the two groups. The incidence of any TnI elevations was higher in the Group II than that in Group I (19.8% vs 42.6%, respectively, p<0.001). The incidences of TnI levels over 3 times the upper normal limit and 5 times the upper normal limit were also higher in Group II than in Group I (11.2% vs 21.7%, respectively, p=0.031, for a TnI level 3 times the upper normal limit, and 6.0% vs 13.9%, respectively, for a TnI level 5 times the upper normal limit. Multivariate analysis revealed that postprocedural hs- CRP elevation in high risk group were the significant independent predictors of postprocedural TnI elevation. Conclusion: Elevated hs-CRP levels were associated with a higher risk of postprocedural troponin elevation in patients undergoing uncomplicated PCI. These results emphasized the role of inflammation in the pathogenesis of periprocedural myocardial injury. Measuring of hs-CRP either preprocedural or postprocedural in high risk patients is useful for predicting early cardiovascular events. University Heart Journal 2022; 18(2): 87-92
{"title":"Prognostic role of hs-CRP before and after Percutaneous Coronary Intervention in Patients with Stable Angina Pectoris","authors":"M. Das, Mohammad Safiuddin, S. Zaman, Khondoker Harun or Rashid, Mohammad Saiful Islam Chowdhury, A. Jamil, Md. Ashraf Uddin Sultan","doi":"10.3329/uhj.v18i2.62687","DOIUrl":"https://doi.org/10.3329/uhj.v18i2.62687","url":null,"abstract":"Background and Objectives: Myocardial injury after percutaneous coronary intervention (PCI) occurs frequently and it is associated with an adverse clinical outcome. Mechanical factors have been implicated in this complication and the role of inflammation has not yet been clearly determined. We evaluated the effect of an inflammatory response during PCI on periprocedural myocardial injury. \u0000Subjects and Methods: This prospective observational study was conducted in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh over a period between July’2012 to June’2013. A total of 200 patients studied who underwent elective coronary stenting. For the exclusion of mechanical injury to the myocardium, we excluded those patients who developed complications during PCI. The inflammatory response to PCI was calculated as the difference between the peak postprocedural hs-CRP level and the preprocedural hs-CRP level . We divided the patients according to the median value of hs- CRP: Group I <3 mg/L and Group II >3 mg/L. \u0000Results: Postprocedural TnI elevation was were observed in 72 (36%) patients. The baseline clinical and angiographic characteristics were not difference between the two groups. The incidence of any TnI elevations was higher in the Group II than that in Group I (19.8% vs 42.6%, respectively, p<0.001). The incidences of TnI levels over 3 times the upper normal limit and 5 times the upper normal limit were also higher in Group II than in Group I (11.2% vs 21.7%, respectively, p=0.031, for a TnI level 3 times the upper normal limit, and 6.0% vs 13.9%, respectively, for a TnI level 5 times the upper normal limit. Multivariate analysis revealed that postprocedural hs- CRP elevation in high risk group were the significant independent predictors of postprocedural TnI elevation. \u0000Conclusion: Elevated hs-CRP levels were associated with a higher risk of postprocedural troponin elevation in patients undergoing uncomplicated PCI. These results emphasized the role of inflammation in the pathogenesis of periprocedural myocardial injury. Measuring of hs-CRP either preprocedural or postprocedural in high risk patients is useful for predicting early cardiovascular events. \u0000University Heart Journal 2022; 18(2): 87-92","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88300047","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}
J. Arzu, HN Ashiqur Rahmanh, Mohammad Daniel Selim, N. Apsara, N. Sheikh, Sheik Foyez Ahmed, C. M. Ahmed
A 31yrs old female teacher came to our emergency department with the complaints of severe retro sternal & compressive type chest pain radiated to the left arm, back and jaw. Pain was partially relieved by rest and associated with vomiting & nausea but no breathlessness. She also reported episodes of angina in previous couple of months. On admission, there was ST-segment elevation that last for few minutes and later progressively resolved. But troponin level was high. Patient was undergone Coronary angiogram and was diagnosed as stress induced cardiomyopathy (SICM), as Coronary Angiogram showed normal epicardialcoronary arteries. Serial ECG was carried out which showed resolved ST elevation. Holter monitoring showed severe ST-segment changes during an angina episode. She had no history of substance abuse or recreational drug use.Before discharge we started oral calcium antagonist and there wasn’t any further episode of angina or ST changes on follow up after two months. University Heart Journal 2022; 18(2): 125-127
{"title":"Prinzmetal Angina with Pan Hypopituitarism- A Case Report","authors":"J. Arzu, HN Ashiqur Rahmanh, Mohammad Daniel Selim, N. Apsara, N. Sheikh, Sheik Foyez Ahmed, C. M. Ahmed","doi":"10.3329/uhj.v18i2.62737","DOIUrl":"https://doi.org/10.3329/uhj.v18i2.62737","url":null,"abstract":"A 31yrs old female teacher came to our emergency department with the complaints of severe retro sternal & compressive type chest pain radiated to the left arm, back and jaw. Pain was partially relieved by rest and associated with vomiting & nausea but no breathlessness. She also reported episodes of angina in previous couple of months. On admission, there was ST-segment elevation that last for few minutes and later progressively resolved. But troponin level was high. Patient was undergone Coronary angiogram and was diagnosed as stress induced cardiomyopathy (SICM), as Coronary Angiogram showed normal epicardialcoronary arteries. Serial ECG was carried out which showed resolved ST elevation. Holter monitoring showed severe ST-segment changes during an angina episode. She had no history of substance abuse or recreational drug use.Before discharge we started oral calcium antagonist and there wasn’t any further episode of angina or ST changes on follow up after two months. \u0000University Heart Journal 2022; 18(2): 125-127","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"453 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80778269","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}
Background: The transfemoral approach is the commonest and most widely practiced access for Percutaneous coronary intervention (PCI). However, the less invasive operational access for PCI is growing substantially and gaining popularity over the conventional practice. Although, there is little known about the true benefits regarding access for the PCI in adult Bangladeshi patients requiring coronary revascularization. This systematic review was aimed to compile literature evidence for the alternative PCI access when compared with standard transfemoral practice in our country. Method: A scoping review according to the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guidelines was conducted. As there is a scarcity of published literature comparing transfemoral vs alternative PCI routes, this scoping review was not aimed to produce a critical appraisal rather an overview and map of synthesized evidence based on the available literature. Results: 498 articles were accessed from PubMed, BanglaJOL, and Web of Science databases. A total of seven articles were included for final analysis, comprising 1212 patients undergoing PCI at the different tertiary hospitals across the country. Among the included patients 834 PCI were performed via transfemoral access, 330 via transradial access, and 48 procedures were done via transulnar access. Conclusion: Alternative access for PCI is gaining popularity in adult Bangladeshi patients requiring coronary revascularization. It’s a rational approach for the selective population in coronary revascularization strategy. University Heart Journal 2022; 18(2): 106-117
背景:经股入路是经皮冠状动脉介入治疗(PCI)中最常见、应用最广泛的入路。然而，PCI的低侵入性操作通路正在大幅增长，并在传统实践中越来越受欢迎。虽然，对于需要冠状动脉重建术的孟加拉国成年患者进行PCI的真正益处知之甚少。本系统综述的目的是收集文献证据，证明替代性PCI通路与我国标准经股做法的比较。方法:根据系统评价和荟萃分析首选报告项目(PRISMA)指南进行范围评价。由于比较经股动脉与其他PCI路径的已发表文献较少，因此本综述的目的不是进行批判性评价，而是基于现有文献的综合证据的概述和图谱。结果:从PubMed、BanglaJOL和Web of Science数据库中共检索到498篇文章。共纳入7篇文章进行最终分析，其中包括在全国不同三级医院接受PCI治疗的1212名患者。在纳入的患者中，834例经股骨入路行PCI, 330例经桡骨入路行PCI, 48例经椎槽入路行PCI。结论:在孟加拉国需要冠状动脉重建术的成年患者中，PCI的替代途径越来越受欢迎。在冠状动脉血运重建策略中，选择人群是一种合理的方法。大学心脏杂志2022;18 (2): 106 - 117
{"title":"A Scoping Review of The Percutaneous Coronary Intervention: Practice Transformation for the Operational Access","authors":"F. Sazzad, Arifur Rahman","doi":"10.3329/uhj.v18i2.62733","DOIUrl":"https://doi.org/10.3329/uhj.v18i2.62733","url":null,"abstract":"Background: The transfemoral approach is the commonest and most widely practiced access for Percutaneous coronary intervention (PCI). However, the less invasive operational access for PCI is growing substantially and gaining popularity over the conventional practice. Although, there is little known about the true benefits regarding access for the PCI in adult Bangladeshi patients requiring coronary revascularization. This systematic review was aimed to compile literature evidence for the alternative PCI access when compared with standard transfemoral practice in our country. \u0000Method: A scoping review according to the Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA) guidelines was conducted. As there is a scarcity of published literature comparing transfemoral vs alternative PCI routes, this scoping review was not aimed to produce a critical appraisal rather an overview and map of synthesized evidence based on the available literature. \u0000Results: 498 articles were accessed from PubMed, BanglaJOL, and Web of Science databases. A total of seven articles were included for final analysis, comprising 1212 patients undergoing PCI at the different tertiary hospitals across the country. Among the included patients 834 PCI were performed via transfemoral access, 330 via transradial access, and 48 procedures were done via transulnar access. \u0000Conclusion: Alternative access for PCI is gaining popularity in adult Bangladeshi patients requiring coronary revascularization. It’s a rational approach for the selective population in coronary revascularization strategy. \u0000University Heart Journal 2022; 18(2): 106-117","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"414 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91461508","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}
Heru Al Amin, A. Choudhury, S. Ahsan, B. Dutta, M. M. Hossain, N. Alam, Kofil Uddin, Partha Pratim Saha
Background: Bed side ophthalmoscopic examination is a simple measure of diagnosis of diabetic retinopathy and has been shown to be a predictor of poor outcome in various cardiovascular conditions including coronary artery disease (CAD). Retinopathy lesions are fairly common findings in clinic settings and may predict risk of coronary heart disease (CHD). The present study was intended to find the relationship between diabetic retinopathy with the severity of coronary artery disease in patients with NSTEMI. Methods: This cross-sectional observational study was conducted in the Department of cardiology, National Institute of Cardiovascular Diseases and Hospital (NICVD), Dhaka, Bangladesh, from March 2019 to August 2020. A total of 120 DM with NSTEMI patients undergoing coronary angiogram and also fundoscopic examination with fundal photography during the index hospitalization were included in this study. Study subjects were divided into two groups on the basis of diabetic retinopathy (Group-I: NSTEMI with diabetic retinopathy ; Group- II: NSTEMI without diabetic retinopathy). Severity of coronary artery disease was determined by Gensini score and correlation between diabetic retinopathy and Gensini score was assessed. Results: Gensini score was significantly higher in patients with diabetic retinopathy than that in patients without diabetic retinopathy (62.2±27.7 vs. 43.3±25.3,p<0.001).Gensini score increased with increasing severity of diabetic retinopathy(P <0.001).The risk of having severe CAD in patient with diabetic retinopathy was 13.03 (95% CI =2.410-70.419) (P<0.003).A significant correlation between diabetic retinopathy and Gensini score was noted (p value <0.001) Conclusion: It may be concluded that presence and severity of diabetic retinopathy is associated with angiographically severe coronary artery disease in patient with non-ST elevation myocardial infarction (NSTEMI) and it may be considered as an independent predictor of severity of CAD. As is a bed side assessment, so before performing coronary angiography ,it appears to be additive for risk stratification. University Heart Journal 2022; 18(1): 50-53
背景:床侧眼科检查是诊断糖尿病视网膜病变的一种简单方法，已被证明是各种心血管疾病(包括冠状动脉疾病(CAD))预后不良的预测指标。视网膜病变是临床上相当常见的发现，可以预测冠心病(CHD)的风险。本研究旨在发现非stemi患者糖尿病视网膜病变与冠状动脉疾病严重程度之间的关系。方法:本横断面观察性研究于2019年3月至2020年8月在孟加拉国达卡国家心血管疾病研究所和医院(NICVD)心内科进行。本研究共纳入120例糖尿病合并NSTEMI患者，在指数住院期间接受冠状动脉造影和盆腔镜检查并盆腔摄影。研究对象根据糖尿病视网膜病变分为两组(一组:NSTEMI合并糖尿病视网膜病变;II组:无糖尿病视网膜病变的NSTEMI组)。通过Gensini评分确定冠状动脉病变的严重程度，并评估糖尿病视网膜病变与Gensini评分的相关性。结果:糖尿病视网膜病变组Gensini评分明显高于非糖尿病视网膜病变组(62.2±27.7∶43.3±25.3,p<0.001)。Gensini评分随糖尿病视网膜病变严重程度的增加而增加(P <0.001)。糖尿病视网膜病变患者发生严重冠心病的风险为13.03 (95% CI =2.410 ~ 70.419) (P<0.003)。结论:糖尿病视网膜病变的存在和严重程度与非st段抬高型心肌梗死(NSTEMI)患者血管造影显示的严重冠状动脉疾病相关，可作为CAD严重程度的独立预测因子。作为一项床边评估，在进行冠状动脉造影之前，它似乎是危险分层的补充。大学心脏杂志2022;18 (1): 50-53
{"title":"Association of Diabetic Retinopathy with Angiographic Severity of Coronary Artery Disease in Patients with Non- ST Elevation Myocardial Infarction","authors":"Heru Al Amin, A. Choudhury, S. Ahsan, B. Dutta, M. M. Hossain, N. Alam, Kofil Uddin, Partha Pratim Saha","doi":"10.3329/uhj.v18i1.57880","DOIUrl":"https://doi.org/10.3329/uhj.v18i1.57880","url":null,"abstract":"Background: Bed side ophthalmoscopic examination is a simple measure of diagnosis of diabetic retinopathy and has been shown to be a predictor of poor outcome in various cardiovascular conditions including coronary artery disease (CAD). Retinopathy lesions are fairly common findings in clinic settings and may predict risk of coronary heart disease (CHD). The present study was intended to find the relationship between diabetic retinopathy with the severity of coronary artery disease in patients with NSTEMI. \u0000Methods: This cross-sectional observational study was conducted in the Department of cardiology, National Institute of Cardiovascular Diseases and Hospital (NICVD), Dhaka, Bangladesh, from March 2019 to August 2020. A total of 120 DM with NSTEMI patients undergoing coronary angiogram and also fundoscopic examination with fundal photography during the index hospitalization were included in this study. Study subjects were divided into two groups on the basis of diabetic retinopathy (Group-I: NSTEMI with diabetic retinopathy ; Group- II: NSTEMI without diabetic retinopathy). Severity of coronary artery disease was determined by Gensini score and correlation between diabetic retinopathy and Gensini score was assessed. \u0000Results: Gensini score was significantly higher in patients with diabetic retinopathy than that in patients without diabetic retinopathy (62.2±27.7 vs. 43.3±25.3,p<0.001).Gensini score increased with increasing severity of diabetic retinopathy(P <0.001).The risk of having severe CAD in patient with diabetic retinopathy was 13.03 (95% CI =2.410-70.419) (P<0.003).A significant correlation between diabetic retinopathy and Gensini score was noted (p value <0.001) \u0000Conclusion: It may be concluded that presence and severity of diabetic retinopathy is associated with angiographically severe coronary artery disease in patient with non-ST elevation myocardial infarction (NSTEMI) and it may be considered as an independent predictor of severity of CAD. As is a bed side assessment, so before performing coronary angiography ,it appears to be additive for risk stratification. \u0000University Heart Journal 2022; 18(1): 50-53","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86182182","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. Abu Salim, M. Mahmood, D. Adhikary, S. K. Banerjee, Md. Harisul Hoque, M. Muqueet, Md Fakhrul I Khaled, Walidur Rahman, C. Singha, S. Saha, N. Fatema, Tarek Hasan, Ummel Kulsuma, Mehedi Hassan, Akm Fazlur Rahman
Background: Corona virus disease (COVID-19) has been associated with different cardiac complications including cardiac arrhythmias. Arrhythmias carries a great influence on the outcomes. The pathophysiology of these manifestations remain elusive. This study was aimed to observe the incidence and outcome of cardiac arrhythmia in patients with COVID-19 infection from July 2020 to May 2021. Method: We conducted an observational study of patients ³18 years of age with a clinical diagnosis of COVID -19 infection attending Bangabandhu sheikh Mujib Medical University (BSMMU) with and without cardiac arrhythmias from July 2020 to May 2021. Patients were labeled as having arrhythmia if they had sinus bradycardia (heart rate <40 bpm), A-V block, Atrial fibrillation (AF), atrial flutter (AFL), supraventricular tachycardia (SVT), nonsustained VT, sustained VT, ventricular fibrillation (VF). We excluded those patients presented with Acute Coronary syndrome & cardiogenic shock. Different clinical data including demographics, comorbidities (like Hypertension, Diabetes mellitus, Chronic kidney disease, IHD), baseline electrocardiographic and echocardiographic findings, antiviral therapy, use of any proarrhythmic drugs. Results: Data was collected from 2264 patients from BSMMU with COVID-19 infection. Among them 158 patients (6.97%) had cardiac arrhythmia, 78 (48.91%) had hypertension, 37 (23.41%) ischaemic heart disease, 31 (19.62%) diabetes, 14 (8.88%) had CKD. Out of 158 patients 53.79% had sinus bradycardia (heart rate £40bpm); 16(10.1%) had first degree AV block; 14 (8.86 %) had 2nd or 3rd degree AV block; 27 (17.08%) had AF; 7 (4.40%) had AFL; 6 (3.7%) had SVT; and 3 (1.89%) of had NSVT. Only one of S. bradycardia patient required temporary pacemaker. 80 (93.75%) did not require any specific treatment and 4 ( 6.25%) was ventilated. 14 (8.86%) had advance AV block, 11 (78.57%) was discharged, 1 (7.14%) required permanent pacemaker and 3 (21.42%) needed mechanical ventilation in addition to standard treatment. 40 (25.31%) had AF/AFL/SVT; all of them were treated with different antiarrhythmic drugs. 40.0% needed mechanical ventilation and 60.0% discharged safely. 3 (1.89%) had NSVT or VT, 2 (66.67%) of them needed mechanical ventilation and 1 (33.33%) was discharged safely. 87.32% patient was discharged safely and 16.4% was ventilated. Among 26 ventilated patients 15 (57.69%) was expired. Out of them 11 (68.75% of 16 patient) had atrial tachyarrhythmia, 2 (100% of 2 patient) had ventricular tachyarrhythmia and 2 (16.67% of 12 patient) had bradyarrhythmia. Conclusion: COVID-19 infection made a profound negative effect on the lives of millions of people across the world. More than 3 millions of people already died. Lots of patients of COVID-19 infection developed cardiac arrhythmia and was associated with high morbidity and mortality. Appropriate monitoring by ECG with accurate and early identification of arrhythmia is important for better management and outcome
{"title":"Cardiac Arrhythmias in Patients with COVID-19 Infection – A Single Center Study","authors":"Md. Abu Salim, M. Mahmood, D. Adhikary, S. K. Banerjee, Md. Harisul Hoque, M. Muqueet, Md Fakhrul I Khaled, Walidur Rahman, C. Singha, S. Saha, N. Fatema, Tarek Hasan, Ummel Kulsuma, Mehedi Hassan, Akm Fazlur Rahman","doi":"10.3329/uhj.v18i1.57883","DOIUrl":"https://doi.org/10.3329/uhj.v18i1.57883","url":null,"abstract":"Background: Corona virus disease (COVID-19) has been associated with different cardiac complications including cardiac arrhythmias. Arrhythmias carries a great influence on the outcomes. The pathophysiology of these manifestations remain elusive. This study was aimed to observe the incidence and outcome of cardiac arrhythmia in patients with COVID-19 infection from July 2020 to May 2021.\u0000Method: We conducted an observational study of patients ³18 years of age with a clinical diagnosis of COVID -19 infection attending Bangabandhu sheikh Mujib Medical University (BSMMU) with and without cardiac arrhythmias from July 2020 to May 2021. Patients were labeled as having arrhythmia if they had sinus bradycardia (heart rate <40 bpm), A-V block, Atrial fibrillation (AF), atrial flutter (AFL), supraventricular tachycardia (SVT), nonsustained VT, sustained VT, ventricular fibrillation (VF). We excluded those patients presented with Acute Coronary syndrome & cardiogenic shock. Different clinical data including demographics, comorbidities (like Hypertension, Diabetes mellitus, Chronic kidney disease, IHD), baseline electrocardiographic and echocardiographic findings, antiviral therapy, use of any proarrhythmic drugs.\u0000Results: Data was collected from 2264 patients from BSMMU with COVID-19 infection. Among them 158 patients (6.97%) had cardiac arrhythmia, 78 (48.91%) had hypertension, 37 (23.41%) ischaemic heart disease, 31 (19.62%) diabetes, 14 (8.88%) had CKD. Out of 158 patients 53.79% had sinus bradycardia (heart rate £40bpm); 16(10.1%) had first degree AV block; 14 (8.86 %) had 2nd or 3rd degree AV block; 27 (17.08%) had AF; 7 (4.40%) had AFL; 6 (3.7%) had SVT; and 3 (1.89%) of had NSVT. Only one of S. bradycardia patient required temporary pacemaker. 80 (93.75%) did not require any specific treatment and 4 ( 6.25%) was ventilated. 14 (8.86%) had advance AV block, 11 (78.57%) was discharged, 1 (7.14%) required permanent pacemaker and 3 (21.42%) needed mechanical ventilation in addition to standard treatment. 40 (25.31%) had AF/AFL/SVT; all of them were treated with different antiarrhythmic drugs. 40.0% needed mechanical ventilation and 60.0% discharged safely. 3 (1.89%) had NSVT or VT, 2 (66.67%) of them needed mechanical ventilation and 1 (33.33%) was discharged safely. 87.32% patient was discharged safely and 16.4% was ventilated. Among 26 ventilated patients 15 (57.69%) was expired. Out of them 11 (68.75% of 16 patient) had atrial tachyarrhythmia, 2 (100% of 2 patient) had ventricular tachyarrhythmia and 2 (16.67% of 12 patient) had bradyarrhythmia.\u0000Conclusion: COVID-19 infection made a profound negative effect on the lives of millions of people across the world. More than 3 millions of people already died. Lots of patients of COVID-19 infection developed cardiac arrhythmia and was associated with high morbidity and mortality. Appropriate monitoring by ECG with accurate and early identification of arrhythmia is important for better management and outcome","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"447 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77847507","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}
Jubair Mahmud Parvez, Md. Afzalur Rahman, A. Islam, M. Aziz, A. Mamun, M. Arefin, M. Azam
Introduction: Serum albumin as a biomarker of coronary artery disease (CAD) severity and mortality in patients with acute coronary syndrome (ACS) is presently a subject of growing interest. Evidences accumulated from the studies suggest a possible association between serum albumin and severity of CAD. Aim of the study: The aim of this study was to find the association between serum albumin level and severity of CAD in patients of ACS. Methods: The present cross-sectional analytical study was carried out in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, over a period of 1 year from July 2017 to June 2018. A total of 104 ACS patients undergoing coronary angiogram in the above-mentioned hospital during the index hospitalization within the specified time-frame were included in the study. Result: None of the demographic characteristics and traditional risk factors for CAD except age was found to be associated with severity of CAD. Friesinger Score was significantly higher in patients with low serum albumin than that in patients with normal serum albumin (8.84 ± 3.71 vs. 6.38 ± 3.02, p<0.001). Leman Score was also significantly higher in in the former group than that in latter group (12.48 ± 8.44 vs. 8.50 ± 4.94 mm, p = 0.004).The risk of having severe CAD in patients with low serum albumin was 5.46(95% CI = 2.141 – 13.925) (p < 0.001) times higher in terms of Friesinger score and 2.58(95% CI = 1.097 – 6.083) (p = 0.03) times higher in terms of Leaman score than that in patients with normal serum albumin. Spearman’s correlation revealed that the two variables serum albumin and Friesinger score, exhibit a significantly inverse correlation (r = -0.323, p = 0.001). Serum albumin demonstrated a significantly inverse correlation with Leaman score (r = -0.254, p = 0.009). Conclusion: The study concluded that serum albumin concentration was significantly associated with the severity of coronary artery disease with low serum albumin carrying at least two-fold higher risk of having severe CAD, as measured by the Friesinger and Leaman score, in patients with ACS. University Heart Journal 2022; 18(1): 44-49
简介:血清白蛋白作为急性冠脉综合征(ACS)患者冠状动脉疾病(CAD)严重程度和死亡率的生物标志物，目前越来越受到关注。从研究中积累的证据表明血清白蛋白与冠心病严重程度之间可能存在关联。研究目的:本研究的目的是发现ACS患者血清白蛋白水平与冠心病严重程度之间的关系。方法:本横断面分析研究在孟加拉国达卡国家心血管疾病研究所(NICVD)心内科进行，为期1年(2017年7月至2018年6月)。本研究共纳入104例指标住院时间内在上述医院行冠脉造影的ACS患者。结果:除年龄外，没有发现冠心病的人口统计学特征和传统危险因素与冠心病的严重程度相关。血清白蛋白低组的fresinger评分显著高于血清白蛋白正常组(8.84±3.71∶6.38±3.02,p<0.001)。前者的Leman评分也显著高于后者(12.48±8.44 mm比8.50±4.94 mm, p = 0.004)。低血清白蛋白患者发生严重冠心病的风险是正常血清白蛋白患者的5.46(95% CI = 2.141 ~ 13.925)倍(p < 0.001)， Leaman评分是正常血清白蛋白患者的2.58(95% CI = 1.097 ~ 6.083)倍(p = 0.03)。Spearman相关分析显示血清白蛋白与Friesinger评分呈显著负相关(r = -0.323, p = 0.001)。血清白蛋白与Leaman评分呈显著负相关(r = -0.254, p = 0.009)。结论:该研究得出血清白蛋白浓度与冠状动脉疾病的严重程度显著相关，在ACS患者中，通过Friesinger和Leaman评分测量，低血清白蛋白携带的严重CAD风险至少高出两倍。大学心脏杂志2022;18 (1): 44-49
{"title":"Association of Hypoalbuminaemia with the Angiographic Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome","authors":"Jubair Mahmud Parvez, Md. Afzalur Rahman, A. Islam, M. Aziz, A. Mamun, M. Arefin, M. Azam","doi":"10.3329/uhj.v18i1.57879","DOIUrl":"https://doi.org/10.3329/uhj.v18i1.57879","url":null,"abstract":"Introduction: Serum albumin as a biomarker of coronary artery disease (CAD) severity and mortality in patients with acute coronary syndrome (ACS) is presently a subject of growing interest. Evidences accumulated from the studies suggest a possible association between serum albumin and severity of CAD. Aim of the study: The aim of this study was to find the association between serum albumin level and severity of CAD in patients of ACS. \u0000Methods: The present cross-sectional analytical study was carried out in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, over a period of 1 year from July 2017 to June 2018. A total of 104 ACS patients undergoing coronary angiogram in the above-mentioned hospital during the index hospitalization within the specified time-frame were included in the study. Result: None of the demographic characteristics and traditional risk factors for CAD except age was found to be associated with severity of CAD. Friesinger Score was significantly higher in patients with low serum albumin than that in patients with normal serum albumin (8.84 ± 3.71 vs. 6.38 ± 3.02, p<0.001). Leman Score was also significantly higher in in the former group than that in latter group (12.48 ± 8.44 vs. 8.50 ± 4.94 mm, p = 0.004).The risk of having severe CAD in patients with low serum albumin was 5.46(95% CI = 2.141 – 13.925) (p < 0.001) times higher in terms of Friesinger score and 2.58(95% CI = 1.097 – 6.083) (p = 0.03) times higher in terms of Leaman score than that in patients with normal serum albumin. Spearman’s correlation revealed that the two variables serum albumin and Friesinger score, exhibit a significantly inverse correlation (r = -0.323, p = 0.001). Serum albumin demonstrated a significantly inverse correlation with Leaman score (r = -0.254, p = 0.009). \u0000Conclusion: The study concluded that serum albumin concentration was significantly associated with the severity of coronary artery disease with low serum albumin carrying at least two-fold higher risk of having severe CAD, as measured by the Friesinger and Leaman score, in patients with ACS. \u0000University Heart Journal 2022; 18(1): 44-49","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"180 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73950535","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}
R. Islam, S. Ahsan, Akm Fazlur Rahman, S. Zaman, Md Fakhrul Islam Khaled, Suman Biswas, Mohammad Hasimul Ahasan, Sanjida Ansari, Rajan Karna, Khurshed Ahmed, S. Habib, M. Rahman
Background: Optimal timing of PCI and comparative outcome between early invasive strategy and ischaemia guided delayed invasive strategy is still in debate in reducing long-term cardiovascular complications in NSTEMI. Objective: The aim of the study was to assess the impact of an early invasive strategy or ischaemia guided delayed invasive strategy on six months clinical outcomes in NSTEMI patients undergoing PCI, from a Bangladesh health service perspective. Materials and Method: It was an observational cross-sectional comparative study conducted in cardiology department of BSMMU from November 2019 to February 2021. Study procedure: This study enrolled 389 adult patients of NSTEMI who underwent PCI which met inclusion and exclusion criteria. Study subjects were divided into two groups: early and delayed groups. This study considered an early invasive strategy as - revascularization within 72h for patients presented with NSTEMI with high-risk features defined by a GRACE score > 140 and for those at lower risk with GRACE score <140; delayed ischaemia driven strategy as - revascularization after 72h, reserved for refractory, recurrent or severe exercise-induced ischaemia. Coronary angiogram (CAG) and PCI were performed by respective consultant according to current practice guidelines. After index PCI, patients were followed up at 06 months for MACEs (Myocardial re-infarction, target vessel revascularization, stroke, hospitalization due to ischaemic causes and cardiac death) and findings of 2 groups were compared. Results: At 6 months after index PCI, patients in the early group despite having worse initial presentation and higher GRACE score had better outcome in comparison with the delayed group who had a statistically significant higher incidence of cardiac death, MI, and target vessel revascularization (p=0.002, p=0.004 and p=0.031). However, incidence of stroke, major bleeding and hospitalization due to ischemia were not significantly different between the groups (p>0.05). Conclusion: Adoption of an early invasive strategy in NSTEMI patients undergoing PCI may be beneficial in reducing the risk of MACEs and associated with improved clinical outcome after PCI at 6 months follow-up. University Heart Journal 2022; 18(1): 22-28
{"title":"Six-month Outcome after Early Invasive Versus Delayed Ischaemia Driven Percutaneous Coronary Intervention in Non-ST Elevated Myocardial Infarction","authors":"R. Islam, S. Ahsan, Akm Fazlur Rahman, S. Zaman, Md Fakhrul Islam Khaled, Suman Biswas, Mohammad Hasimul Ahasan, Sanjida Ansari, Rajan Karna, Khurshed Ahmed, S. Habib, M. Rahman","doi":"10.3329/uhj.v18i1.57876","DOIUrl":"https://doi.org/10.3329/uhj.v18i1.57876","url":null,"abstract":"Background: Optimal timing of PCI and comparative outcome between early invasive strategy and ischaemia guided delayed invasive strategy is still in debate in reducing long-term cardiovascular complications in NSTEMI. \u0000Objective: The aim of the study was to assess the impact of an early invasive strategy or ischaemia guided delayed invasive strategy on six months clinical outcomes in NSTEMI patients undergoing PCI, from a Bangladesh health service perspective. \u0000Materials and Method: It was an observational cross-sectional comparative study conducted in cardiology department of BSMMU from November 2019 to February 2021. Study procedure: This study enrolled 389 adult patients of NSTEMI who underwent PCI which met inclusion and exclusion criteria. Study subjects were divided into two groups: early and delayed groups. This study considered an early invasive strategy as - revascularization within 72h for patients presented with NSTEMI with high-risk features defined by a GRACE score > 140 and for those at lower risk with GRACE score <140; delayed ischaemia driven strategy as - revascularization after 72h, reserved for refractory, recurrent or severe exercise-induced ischaemia. Coronary angiogram (CAG) and PCI were performed by respective consultant according to current practice guidelines. After index PCI, patients were followed up at 06 months for MACEs (Myocardial re-infarction, target vessel revascularization, stroke, hospitalization due to ischaemic causes and cardiac death) and findings of 2 groups were compared. \u0000Results: At 6 months after index PCI, patients in the early group despite having worse initial presentation and higher GRACE score had better outcome in comparison with the delayed group who had a statistically significant higher incidence of cardiac death, MI, and target vessel revascularization (p=0.002, p=0.004 and p=0.031). However, incidence of stroke, major bleeding and hospitalization due to ischemia were not significantly different between the groups (p>0.05). \u0000Conclusion: Adoption of an early invasive strategy in NSTEMI patients undergoing PCI may be beneficial in reducing the risk of MACEs and associated with improved clinical outcome after PCI at 6 months follow-up. \u0000University Heart Journal 2022; 18(1): 22-28","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85394417","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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