Sanjida Ansari, Md Faisal Kabir, Khurshed Ahmed, S. Ahsan, Chaudhary Meskat Ahmed, Md Fakhrul Islam Khaled, Mausool Siraj, J. Nahar, S. Biswas, Rajan Karna, Mohammad Hashimul Ahsan, Rashedul Islam, Md. Harisul Hoque
Background: Heart failure (HF) is one of the most important health problems in terms of prevalence, morbidity, mortality and health service use. It affects around 2 to 3 % of the population. NYHA class can be used for the prioritization, triage and tailoring the HF management which is the foundation for the selection of therapies. The patient with higher NYHA class may need Mechanical Circulatory Support therapy or palliative care or hospice care. The identification of the patients with lower NYHA class helps to tailor vigorous drug therapy and close follow up program, the prognosis of these low risk patients maybe further improved. It is a simple tool for risk stratification in clinical practice. Objective: The principal objective of this study was to determine frequency of transition of NYHA class III / IV to NYHA class I / II / III of stage C & D HF with drugs in a tertiary level hospital. Methods: This was a crosssectional study. A total of 45 patients with stage C and D HF were enrolled in the study by consecutive sampling from October 2019 to September 2020. Detailed history including NYHA functional class of stage C and D HF, physical examination, relevant investigations and Echocardiography were done in all the subjects. The subjects were treated accordingly. The treatment response was assessed again with NYHA functional class on discharge. Result: Patients had mean age of 62 &60 and 54 & 54 years for NYHA class III & IV of stage C and D HF. Majority of the patients were male. Primary cause of HF for both stage were IHD followed by DCM and valvular heart disease. The clinical presentation of stage C & D HF was improved significantly on discharge. Haematological, biochemical, radiological and echocardiographic findings of NYHA class IV of stage C & D HF was more worst. Conclusion: There is statistically significant transition of NYHA class III of stage C and D HF to lower NYHA class but there is no statistically significant transition of NYHA class IV of stage C and D HF with pharmacotherapy in a tertiary level hospital. Higher NYHA class is associated with poor outcome of stage C & D HF patients. University Heart Journal 2022; 18(1): 14-21
背景:心力衰竭(HF)在患病率、发病率、死亡率和卫生服务使用方面是最重要的健康问题之一。它影响了大约2%到3%的人口。NYHA分类可用于心衰管理的优先级、分类和定制，这是选择治疗方法的基础。NYHA等级较高的患者可能需要机械循环支持治疗或姑息治疗或临终关怀。对低NYHA分级患者的识别有助于制定有力的药物治疗和严密的随访计划，这些低危患者的预后可能进一步改善。在临床实践中，它是一种简单的风险分层工具。目的:本研究的主要目的是确定三级医院C、D期心衰患者用药后NYHA III / IV级向NYHA I / II / III级转变的频率。方法:采用横断面研究。2019年10月至2020年9月，通过连续抽样，共有45例C期和D期HF患者入组研究。所有患者均进行了详细的病史，包括C期、D期心衰NYHA功能分级，体格检查、相关调查及超声心动图检查。受试者被相应地对待。出院时再次用NYHA功能分级评估治疗效果。结果:NYHA III级和IV级C期和D期HF患者的平均年龄分别为62岁和60岁，54岁和54岁。患者以男性居多。两期HF的主要原因均为IHD，其次为DCM和瓣膜性心脏病。C、D期心衰患者出院时临床表现明显改善。血液学、生化、影像学及超声心动图表现以C、D期心衰NYHAⅳ级最差。结论:三级医院经药物治疗的C期、D期心衰NYHA III级向低NYHA级转化有统计学意义，而C期、D期心衰NYHA IV级转化无统计学意义。较高的NYHA分级与C期和D期心衰患者预后不良相关。大学心脏杂志2022;(1): 18的程度
{"title":"Frequency of Transition of patients with NYHA class III / IV to NYHA class I / II / III of stage C and D Heart Failure with Pharmacotherapy in a Tertiary Level Hospital","authors":"Sanjida Ansari, Md Faisal Kabir, Khurshed Ahmed, S. Ahsan, Chaudhary Meskat Ahmed, Md Fakhrul Islam Khaled, Mausool Siraj, J. Nahar, S. Biswas, Rajan Karna, Mohammad Hashimul Ahsan, Rashedul Islam, Md. Harisul Hoque","doi":"10.3329/uhj.v18i1.57875","DOIUrl":"https://doi.org/10.3329/uhj.v18i1.57875","url":null,"abstract":"Background: Heart failure (HF) is one of the most important health problems in terms of prevalence, morbidity, mortality and health service use. It affects around 2 to 3 % of the population. NYHA class can be used for the prioritization, triage and tailoring the HF management which is the foundation for the selection of therapies. The patient with higher NYHA class may need Mechanical Circulatory Support therapy or palliative care or hospice care. The identification of the patients with lower NYHA class helps to tailor vigorous drug therapy and close follow up program, the prognosis of these low risk patients maybe further improved. It is a simple tool for risk stratification in clinical practice. \u0000Objective: The principal objective of this study was to determine frequency of transition of NYHA class III / IV to NYHA class I / II / III of stage C & D HF with drugs in a tertiary level hospital. \u0000Methods: This was a crosssectional study. A total of 45 patients with stage C and D HF were enrolled in the study by consecutive sampling from October 2019 to September 2020. Detailed history including NYHA functional class of stage C and D HF, physical examination, relevant investigations and Echocardiography were done in all the subjects. The subjects were treated accordingly. The treatment response was assessed again with NYHA functional class on discharge. \u0000Result: Patients had mean age of 62 &60 and 54 & 54 years for NYHA class III & IV of stage C and D HF. Majority of the patients were male. Primary cause of HF for both stage were IHD followed by DCM and valvular heart disease. The clinical presentation of stage C & D HF was improved significantly on discharge. Haematological, biochemical, radiological and echocardiographic findings of NYHA class IV of stage C & D HF was more worst. \u0000Conclusion: There is statistically significant transition of NYHA class III of stage C and D HF to lower NYHA class but there is no statistically significant transition of NYHA class IV of stage C and D HF with pharmacotherapy in a tertiary level hospital. Higher NYHA class is associated with poor outcome of stage C & D HF patients. \u0000University Heart Journal 2022; 18(1): 14-21","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"98 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78780033","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}
Kazi Alam Nowaz, A. Haque, Syeda Aleya Sultana, M. A. Malek, W. Rahman, M. Kamal, Md Sanaul Haque, J. Farjana, Md Noornabi Khondaker
Background: Coronavirus disease 2019 (COVID-19) has produced a significant health burden worldwide. Recent studies had shown that cardiac injury in COVID-19 is not uncommon and may leads to death. The aim of this study was to assess cardiac troponin in patients with COVID-19 and to evaluate the incidence of myocardial injury. Methods: A cross-sectional study was designed among 100 hospitalized patients with moderate to severe COVID-19 in Combined Military Hospital (CMH), Dhaka from January to April, 2021, after considering inclusion and exclusion criteria, study population was divided into two groups on the basis of normal and elevated troponin level. Results: Participants had mean age of 67.33 ± 7.63 years with 76% men. 42% population had elevation in troponin levels. Risk factors like age, Diabetes (DM), C-reactive protein (CRP), Lactate dehydrogenase (LDH), D- Dimer, Ferrtin level were more in elevated troponin group and statistically significant. Troponin levels significantly increased with increasing severity of COVID-19 staging (Kendall’s tau-b =0.479, p= 0.004) with reflected moderate positive correlation. Multivariate analysis was performed for association of COVID- 19 severity with elevated troponin separately after adjusting for other known confounding factors. Independent association between COVID-19 severity and troponin remained significant after that along with other acute phase reactants and inflammatory markers. Conclusion: COVID-19 can significantly leads to myocardial injury. This data suggested elevated troponin level is one of the determinants of clinical outcome in patients with COVID-19. University Heart Journal 2022; 18(1): 29-35
{"title":"Usefulness of Elevated Troponin to Predict Severity in Patients with COVID-19","authors":"Kazi Alam Nowaz, A. Haque, Syeda Aleya Sultana, M. A. Malek, W. Rahman, M. Kamal, Md Sanaul Haque, J. Farjana, Md Noornabi Khondaker","doi":"10.3329/uhj.v18i1.57877","DOIUrl":"https://doi.org/10.3329/uhj.v18i1.57877","url":null,"abstract":"Background: Coronavirus disease 2019 (COVID-19) has produced a significant health burden worldwide. Recent studies had shown that cardiac injury in COVID-19 is not uncommon and may leads to death. The aim of this study was to assess cardiac troponin in patients with COVID-19 and to evaluate the incidence of myocardial injury. \u0000Methods: A cross-sectional study was designed among 100 hospitalized patients with moderate to severe COVID-19 in Combined Military Hospital (CMH), Dhaka from January to April, 2021, after considering inclusion and exclusion criteria, study population was divided into two groups on the basis of normal and elevated troponin level. \u0000Results: Participants had mean age of 67.33 ± 7.63 years with 76% men. 42% population had elevation in troponin levels. Risk factors like age, Diabetes (DM), C-reactive protein (CRP), Lactate dehydrogenase (LDH), D- Dimer, Ferrtin level were more in elevated troponin group and statistically significant. Troponin levels significantly increased with increasing severity of COVID-19 staging (Kendall’s tau-b =0.479, p= 0.004) with reflected moderate positive correlation. Multivariate analysis was performed for association of COVID- 19 severity with elevated troponin separately after adjusting for other known confounding factors. Independent association between COVID-19 severity and troponin remained significant after that along with other acute phase reactants and inflammatory markers. \u0000Conclusion: COVID-19 can significantly leads to myocardial injury. This data suggested elevated troponin level is one of the determinants of clinical outcome in patients with COVID-19. \u0000University Heart Journal 2022; 18(1): 29-35","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":"85358285","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}
Mohammad Hasimul Ahasan, M. Mahmood, D. Adhikary, S. Ahsan, C. M. Ahmed, Md. Abu Salim, Khurshed Ahmed, Md Rasul Amin, Md Fakhrul Islam Khaled, C. Singha, Rashedul Islam, Sanjida Ansari, S. Biswas, Rajon Karna, S. Banerjee
Background: Thromboembolism is a major complication of atrial fibrillation. Vitamin K antagonist is the main oral anticoagulant which was used for prevention of thromboembolism in atrial fibrillation for many years. New oral anticoagulant drugs are emerging as alternatives to warfarin for the prevention of stroke in patients with non-valvular atrial fibrillation. Objective: The aim of the study was to compare safety and efficacy of dabigatran and rivaroxaban for prevention of thromboembolism in tertiary level hospital. Methodology: This Randomized controlled trial study was conducted in the Department of Cardiology in Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka. Patients were divided into two groups, in group A 37 patients were given dabigatran 110 mg twice daily and in group B 37 patients were given rivaroxaban 20 mg daily for 6 months duration. Data was collected according to the pre designed semistructured data collection sheet. Statistical analyses were carried out by using the Statistical Package for Social Sciences (SPSS) version 23.0 for Windows Software. Results: The mean CHADS2- VASC score (Risk of stroke) in rivaroxaban group and in dabigatran group was 3.95±1.37 and 3.74±1.42 respectively. There was no significant difference of CHADS2- VASC score between the two groups. Regarding outcome of 6th month follow up 2(5.4%) patients were lost to follow up in dabigatran group and 3(8.1%) in rivaroxaban group. Comparaing effectiveness and safety study we found that ischemic stroke rate with rivaroxaban group was higher than dabigatran group although statistically not significant. We also found higher bleeding rate in rivaroxaban group than dabigatran group although statistically not significant. Conclusion: Dabigatran is a safe and effective anticoagulant same as rivaroxaban for prevention of thromboembolism in the treatment of non valvular atrial fibrillation. University Heart Journal 2022; 18(1): 10-13
{"title":"Comparison of Safety and Efficacy Between Dabigatran and Rivaroxaban in Nonvalvular Atrial Fibrillation in Tertiary Level Hospital","authors":"Mohammad Hasimul Ahasan, M. Mahmood, D. Adhikary, S. Ahsan, C. M. Ahmed, Md. Abu Salim, Khurshed Ahmed, Md Rasul Amin, Md Fakhrul Islam Khaled, C. Singha, Rashedul Islam, Sanjida Ansari, S. Biswas, Rajon Karna, S. Banerjee","doi":"10.3329/uhj.v18i1.57874","DOIUrl":"https://doi.org/10.3329/uhj.v18i1.57874","url":null,"abstract":"Background: Thromboembolism is a major complication of atrial fibrillation. Vitamin K antagonist is the main oral anticoagulant which was used for prevention of thromboembolism in atrial fibrillation for many years. New oral anticoagulant drugs are emerging as alternatives to warfarin for the prevention of stroke in patients with non-valvular atrial fibrillation. \u0000Objective: The aim of the study was to compare safety and efficacy of dabigatran and rivaroxaban for prevention of thromboembolism in tertiary level hospital. \u0000Methodology: This Randomized controlled trial study was conducted in the Department of Cardiology in Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka. Patients were divided into two groups, in group A 37 patients were given dabigatran 110 mg twice daily and in group B 37 patients were given rivaroxaban 20 mg daily for 6 months duration. Data was collected according to the pre designed semistructured data collection sheet. Statistical analyses were carried out by using the Statistical Package for Social Sciences (SPSS) version 23.0 for Windows Software. \u0000Results: The mean CHADS2- VASC score (Risk of stroke) in rivaroxaban group and in dabigatran group was 3.95±1.37 and 3.74±1.42 respectively. There was no significant difference of CHADS2- VASC score between the two groups. Regarding outcome of 6th month follow up 2(5.4%) patients were lost to follow up in dabigatran group and 3(8.1%) in rivaroxaban group. Comparaing effectiveness and safety study we found that ischemic stroke rate with rivaroxaban group was higher than dabigatran group although statistically not significant. We also found higher bleeding rate in rivaroxaban group than dabigatran group although statistically not significant. \u0000Conclusion: Dabigatran is a safe and effective anticoagulant same as rivaroxaban for prevention of thromboembolism in the treatment of non valvular atrial fibrillation. \u0000University Heart Journal 2022; 18(1): 10-13","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79180709","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}
Suman Biswas, M. Mahmood, N. Sheikh, Md Fakhrul Islam Khaled, A. Bari, A. Abdullah, Rashedul Islam, Sanjida Ansari, Mohammad Safiuddin
Background: Left main coronary artery disease constitutes highest risk lesion subset of CAD population. Flow dynamics and pathophysiology in the left main coronary artery are different from that of the other coronary arteries. So traditional risk factors might interact differently with left main artery resulting in different clinical and angiographic characteristics compared to others. Anatomic pattern evaluation in left main coronary artery disease is important in deciding best management options. However, their pattern and profiles were variably shown in different studies with discrepant Results suggesting geographic variation and lead to evaluation of characteristics in our own population. Better understanding this specific problem might lead to further improvement in its management. Methods: It was an observational cross-sectional study. Ninety-one adult coronary artery disease patients over the period of one year who underwent invasive coronary angiogram were studied. Study subjects were divided into two groups after coronary angiogram: Left main (Group 1) and Non-left main (Group 2) CAD. Demographic data, risk factor profiles and angiographic patterns of both groups were compared to see if any statistically significant difference present or not. Results: The mean age and standard deviation in group 1 is 55.2±9.4 and in group 2 is 55.5±12.9; the comparative analysis showed no statistically significant difference. Most of the patients were male 69 (76%) and the comparative study showed statistically significant differences (p=0.046) which showed left main disease tended to be higher in male. Majority (64%) had BMI in normal range with no significant difference. Among the risk factors comparison, diabetes and family history of CAD showed significant association with the left main cohort (p<0.05). Non-ST elevated ACS was the most common presentation and significantly associated with the left main group (p<0.05). On coronary angiogram, there were 80 patients (87.92%) who had no left main artery involvement while 11 patients (12.08%) had left main disease. The comparative study of coronary artery involvement among the two groups reveals no statistically significant differences (p>0.05) but triple vessel disease was found more commonly than single and double vessel disease. Distal lesions (64%) were found more frequently than other types of left main stenosis followed by ostio-proximal lesion (36%). Conclusion: In the patients with left main coronary artery disease, male gender, diabetes mellitus, positive family history and presentation with non-ST elevation ACS were found to be significantly associated. Distal left main lesion and triple vessel disease were commonly found. University Heart Journal 2022; 18(1): 3-9
{"title":"Comparison of Clinical and Angiographic Profiles of Patients with or without Left Main Coronary Artery Disease","authors":"Suman Biswas, M. Mahmood, N. Sheikh, Md Fakhrul Islam Khaled, A. Bari, A. Abdullah, Rashedul Islam, Sanjida Ansari, Mohammad Safiuddin","doi":"10.3329/uhj.v18i1.57873","DOIUrl":"https://doi.org/10.3329/uhj.v18i1.57873","url":null,"abstract":"Background: Left main coronary artery disease constitutes highest risk lesion subset of CAD population. Flow dynamics and pathophysiology in the left main coronary artery are different from that of the other coronary arteries. So traditional risk factors might interact differently with left main artery resulting in different clinical and angiographic characteristics compared to others. Anatomic pattern evaluation in left main coronary artery disease is important in deciding best management options. However, their pattern and profiles were variably shown in different studies with discrepant\u0000Results suggesting geographic variation and lead to evaluation of characteristics in our own population. Better understanding this specific problem might lead to further improvement in its management.\u0000Methods: It was an observational cross-sectional study. Ninety-one adult coronary artery disease patients over the period of one year who underwent invasive coronary angiogram were studied. Study subjects were divided into two groups after coronary angiogram: Left main (Group 1) and Non-left main (Group 2) CAD. Demographic data, risk factor profiles and angiographic patterns of both groups were compared to see if any statistically significant difference present or not.\u0000Results: The mean age and standard deviation in group 1 is 55.2±9.4 and in group 2 is 55.5±12.9; the comparative analysis showed no statistically significant difference. Most of the patients were male 69 (76%) and the comparative study showed statistically significant differences (p=0.046) which showed left main disease tended to be higher in male. Majority (64%) had BMI in normal range with no significant difference. Among the risk factors comparison, diabetes and family history of CAD showed significant association with the left main cohort (p<0.05). Non-ST elevated ACS was the most common presentation and significantly associated with the left main group (p<0.05). On coronary angiogram, there were 80 patients (87.92%) who had no left main artery involvement while 11 patients (12.08%) had left main disease. The comparative study of coronary artery involvement among the two groups reveals no statistically significant differences (p>0.05) but triple vessel disease was found more commonly than single and double vessel disease. Distal lesions (64%) were found more frequently than other types of left main stenosis followed by ostio-proximal lesion (36%).\u0000Conclusion: In the patients with left main coronary artery disease, male gender, diabetes mellitus, positive family history and presentation with non-ST elevation ACS were found to be significantly associated. Distal left main lesion and triple vessel disease were commonly found.\u0000University Heart Journal 2022; 18(1): 3-9","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"105 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85893752","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 2022; 18(1): 1-2
《大学心脏学报》2022;18 (1): 1 - 2
{"title":"Covid and Clots in Veins: What’s Best to do","authors":"Akm Fazlur Rahman","doi":"10.3329/uhj.v18i1.57872","DOIUrl":"https://doi.org/10.3329/uhj.v18i1.57872","url":null,"abstract":"Abstract not available \u0000University Heart Journal 2022; 18(1): 1-2","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76784287","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}
Partha Pratim Saha, A. Choudhury, S. Ahsan, A. Momen, S. R. Patwary, N. Alam, Kofil Uddin, Pritha Sarkar, Heru Al Amin
Background: Radial artery spasm (RAS), one of the commonest complications in trans radial cardiac intervention, leads a variety range of adverse events. Different prevention strategies had been introduced and the use of sedation is one of them. Use of Fentanyl is common in cardiac interventions to achieve sedation and analgesia and also offers a potent vasodilatory effect. Objective: This study aimed to explore the role of fentanyl in the prevention of RAS in trans radial intervention. Methods: This observational analytic study was conducted in National Institute of Cardiovascular Diseases (NICVD) for a period of 1 year following approval of the protocol in the total of 260 patients who underwent coronary intervention through trans radial approach (Coronary Angiogram and or Percutaneous Coronary Intervention). They were categorized in 2 group- group I patients received intravenous fentanyl and group II patients didn’t receive fentanyl. Besides this, each patient received all treatments according to standard protocol of NICVD. RAS was identified by subjective and objective evidence. Patient is discomfort was quantified with a visual analogue scale. Results: The frequency of RAS was 17.70% in group I versus 30.80% in group II (p =0.014). Intravenous use of fentanyl significantly reduced radial artery spasm (p< 0.05). Bivariate logistic regression analysis showed use of fentanyl had lower odds to prevent radial artery spasm (odds ratio [OR]: 0.430, 95% confidence interval [CI]: 0.239 to 0.779). The number needed to treat to avoid 1 case of spasm was 8. Multivariate logistic regression analysis also revealed use of fentanyl was the strong predictor of RAS ([OR]: 0.370; 95% [CI]: .195-.703) as well as use of reprocessed sheath, smoking, catheter diameter 6Fr and visual analogue scale (VAS) Score during cannulation became independent predictaor of RAS. Patient discomfort in VAS score was 4.75±2.70 in Group I versus 5.33±2.64 in group II (p< 0 .05). Conclusion: In this study, use of fentanyl reduced the frequency of radial artery spasm and the procedure related level of patient discomfort. University Heart Journal 2022; 18(1): 54-60
{"title":"Effect of Intravenous Fentanyl to Prevent Radial Artery Spasm During Trans Radial Intervention","authors":"Partha Pratim Saha, A. Choudhury, S. Ahsan, A. Momen, S. R. Patwary, N. Alam, Kofil Uddin, Pritha Sarkar, Heru Al Amin","doi":"10.3329/uhj.v18i1.57881","DOIUrl":"https://doi.org/10.3329/uhj.v18i1.57881","url":null,"abstract":"Background: Radial artery spasm (RAS), one of the commonest complications in trans radial cardiac intervention, leads a variety range of adverse events. Different prevention strategies had been introduced and the use of sedation is one of them. Use of Fentanyl is common in cardiac interventions to achieve sedation and analgesia and also offers a potent vasodilatory effect. Objective: This study aimed to explore the role of fentanyl in the prevention of RAS in trans radial intervention. \u0000Methods: This observational analytic study was conducted in National Institute of Cardiovascular Diseases (NICVD) for a period of 1 year following approval of the protocol in the total of 260 patients who underwent coronary intervention through trans radial approach (Coronary Angiogram and or Percutaneous Coronary Intervention). They were categorized in 2 group- group I patients received intravenous fentanyl and group II patients didn’t receive fentanyl. Besides this, each patient received all treatments according to standard protocol of NICVD. RAS was identified by subjective and objective evidence. Patient is discomfort was quantified with a visual analogue scale. \u0000Results: The frequency of RAS was 17.70% in group I versus 30.80% in group II (p =0.014). Intravenous use of fentanyl significantly reduced radial artery spasm (p< 0.05). Bivariate logistic regression analysis showed use of fentanyl had lower odds to prevent radial artery spasm (odds ratio [OR]: 0.430, 95% confidence interval [CI]: 0.239 to 0.779). The number needed to treat to avoid 1 case of spasm was 8. Multivariate logistic regression analysis also revealed use of fentanyl was the strong predictor of RAS ([OR]: 0.370; 95% [CI]: .195-.703) as well as use of reprocessed sheath, smoking, catheter diameter 6Fr and visual analogue scale (VAS) Score during cannulation became independent predictaor of RAS. Patient discomfort in VAS score was 4.75±2.70 in Group I versus 5.33±2.64 in group II (p< 0 .05). \u0000Conclusion: In this study, use of fentanyl reduced the frequency of radial artery spasm and the procedure related level of patient discomfort. \u0000University Heart Journal 2022; 18(1): 54-60","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89231502","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}
Akm Rakibuzzaman, F. Sazzad, M. Wadud, Md Abdul Gafur, S. Islam, Israt Jahan, Md Azizul Islam Khan, Rampada Sarker
Background: Postoperative atrial fibrillation (POAF) often occurs in patients after coronary artery bypass graft surgery (CABG), both conventional and off pump ranges from 11% to 40%. Although often transient, self-limited, and benign, it may be associated with increased postoperative morbidity. The prevention of POAF has been associated with improved postoperative outcomes in terms of reduced medical treatment, laboratory tests, shorter nursing time, and hospital stay, even when uncomplicated. The present study was conducted to find out the effect of omega polyunsaturated fatty acid on the prevention of POAF after off pump CABG. Method: This cross-sectional study was conducted in the Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Sher-E-Bangla Nagar, Dhaka, between September 2017 and August 2018. Total 100 patients with sinus rhythm admitted for OPCAB were included in this study, and they were divided into two groups, Group A, 50 patients having omega-3 PUFA in the preoperative and postoperative period up to the fifth postoperative day (POD) and Group B, 50 patients not having omega-3 PUFA in the preoperative and postoperative period up to the fifth POD. Findings were compared between two groups preoperatively, postoperatively, up to 5 days, at discharge, and at one month after discharge. Results: Postoperative AF was significantly higher in group B in comparison to group A up to 5th POD. AF was present in a few patients during discharge and one month after discharge, but the differences were statistically not significant between groups. Total ICU stay was similar between the two groups, but the postoperative hospital stay was shorter in Group A, and the mean difference was statistically significant. Conclusion: This study concluded that perioperative oral omega-3 polyunsaturated fatty acid intake reduces the incidence of postoperative atrial fibrillation in patients undergoing off pump coronary artery bypass graft surgery. University Heart Journal 2022; 18(1): 36-43
{"title":"Effect of Omega-3 Polyunsaturated Fatty Acid on the Prevention of Atrial Fibrillation after Off-Pump Coronary Artery Bypass Grafting","authors":"Akm Rakibuzzaman, F. Sazzad, M. Wadud, Md Abdul Gafur, S. Islam, Israt Jahan, Md Azizul Islam Khan, Rampada Sarker","doi":"10.3329/uhj.v18i1.57878","DOIUrl":"https://doi.org/10.3329/uhj.v18i1.57878","url":null,"abstract":"Background: Postoperative atrial fibrillation (POAF) often occurs in patients after coronary artery bypass graft surgery (CABG), both conventional and off pump ranges from 11% to 40%. Although often transient, self-limited, and benign, it may be associated with increased postoperative morbidity. The prevention of POAF has been associated with improved postoperative outcomes in terms of reduced medical treatment, laboratory tests, shorter nursing time, and hospital stay, even when uncomplicated. The present study was conducted to find out the effect of omega polyunsaturated fatty acid on the prevention of POAF after off pump CABG. \u0000Method: This cross-sectional study was conducted in the Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Sher-E-Bangla Nagar, Dhaka, between September 2017 and August 2018. Total 100 patients with sinus rhythm admitted for OPCAB were included in this study, and they were divided into two groups, Group A, 50 patients having omega-3 PUFA in the preoperative and postoperative period up to the fifth postoperative day (POD) and Group B, 50 patients not having omega-3 PUFA in the preoperative and postoperative period up to the fifth POD. Findings were compared between two groups preoperatively, postoperatively, up to 5 days, at discharge, and at one month after discharge. \u0000Results: Postoperative AF was significantly higher in group B in comparison to group A up to 5th POD. AF was present in a few patients during discharge and one month after discharge, but the differences were statistically not significant between groups. Total ICU stay was similar between the two groups, but the postoperative hospital stay was shorter in Group A, and the mean difference was statistically significant. \u0000Conclusion: This study concluded that perioperative oral omega-3 polyunsaturated fatty acid intake reduces the incidence of postoperative atrial fibrillation in patients undergoing off pump coronary artery bypass graft surgery. \u0000University Heart Journal 2022; 18(1): 36-43","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"295 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85920320","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}
Acute type-A aortic dissection (ATAAD) is a dreadfully fatal cardiovascular emergency. The mortality rate among medically treated patients is 50% within two days. Surgery is the gold standard and urgent surgical treatment is indicated for all patients, except for those who are moribund or severely comorbid. However, early mortality after operation remains high (9–25%). We hereby present a case of 22 years young, male, Marfan patient with a family history of ATAAD treated successfully by us at Square Hospital Ltd by modified Bentall’s procedure with total arch replacement with Frozen Elephant Trunk (FET) technique. University Heart Journal 2022; 18(1): 65-70
{"title":"Modification of Frozen Elephant Trunk Technique for Acute Type-A Aortic Dissection - A Case Report","authors":"S. Gupta, P. Chanda, D. Adhikary","doi":"10.3329/uhj.v18i1.57884","DOIUrl":"https://doi.org/10.3329/uhj.v18i1.57884","url":null,"abstract":"Acute type-A aortic dissection (ATAAD) is a dreadfully fatal cardiovascular emergency. The mortality rate among medically treated patients is 50% within two days. Surgery is the gold standard and urgent surgical treatment is indicated for all patients, except for those who are moribund or severely comorbid. However, early mortality after operation remains high (9–25%). We hereby present a case of 22 years young, male, Marfan patient with a family history of ATAAD treated successfully by us at Square Hospital Ltd by modified Bentall’s procedure with total arch replacement with Frozen Elephant Trunk (FET) technique. \u0000University Heart Journal 2022; 18(1): 65-70","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79137214","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}
Saha Sk, M. Mahmood, D. Adhikary, S. Ahsan, C. M. Ahmed, H. Hoque, M. Muqueet, M. Zaman, A. Salim, F. I. Khaled, A. I. Joarder, Mrm Mandal, Mohammad Walidur Rahman, Azharul Islam, A. I. Akand, Fysal Faruq, S. Banerjee
Background: Amiodarone is the most effective antiarrhythmic medications available today for the treatment of both atrial and ventricular arrhythmias. It is an iodinated benzofuran derivative with demonstrated efficacy against a range of cardiac arrhythmias, including atrial fibrillation, paroxysmal supraventricular tachycardias, and life-threatening ventricular arrhythmias. Objective: To evaluation the status of amiodarone with therapeutic dose in Bangladeshi population. Materials and Methods: The quasi experimental study was conducted in the Department of Cardiology in Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka during April, 2019 to March, 2020 Patients got admitted in the Department of Cardiology, BSMMU, consecutive patients who had been treated with amiodarone for arrhythmia were included in this study. Patients without an amiodarone prescription were assumed and patients who will not give informed written consent were excluded in this study. Results: The most common adverse event was bradycardia or conduction disturbance (9.0%) followed by 4(2.2%) thyroid toxicity, 3(1.7%) hepatic toxicity, 2(1.1%) eye toxicity and 1(0.6%) pulmonary toxicity. In multi variable logistic regression, bradycardia or conduction disturbance, amiodarone daily dose (≥300 mg) and duration of amiodarone (>4 month) was found to be significantly (p<0.05) associated with adverse effects of amiodarone. Conclusion: The most common adverse event was bradycardia or conduction disturbance followed by thyroid toxicity, hepatic toxicity, eye toxicity and pulmonary toxicity. Bradycardia or conduction disturbance, amiodarone daily dose (≥300 mg) and duration of amiodarone (>4 month) was found to be significantly associated with adverse effects of amiodarone. University Heart Journal Vol. 17, No. 2, Jul 2021; 118-121
{"title":"Safety of Amiodarone in Ventricular Arrhythmia in Patients Admitted in Bangabandhu Sheikh Mujib Medical University","authors":"Saha Sk, M. Mahmood, D. Adhikary, S. Ahsan, C. M. Ahmed, H. Hoque, M. Muqueet, M. Zaman, A. Salim, F. I. Khaled, A. I. Joarder, Mrm Mandal, Mohammad Walidur Rahman, Azharul Islam, A. I. Akand, Fysal Faruq, S. Banerjee","doi":"10.3329/uhj.v17i2.54369","DOIUrl":"https://doi.org/10.3329/uhj.v17i2.54369","url":null,"abstract":"Background: Amiodarone is the most effective antiarrhythmic medications available today for the treatment of both atrial and ventricular arrhythmias. It is an iodinated benzofuran derivative with demonstrated efficacy against a range of cardiac arrhythmias, including atrial fibrillation, paroxysmal supraventricular tachycardias, and life-threatening ventricular arrhythmias. Objective: To evaluation the status of amiodarone with therapeutic dose in Bangladeshi population. Materials and Methods: The quasi experimental study was conducted in the Department of Cardiology in Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka during April, 2019 to March, 2020 Patients got admitted in the Department of Cardiology, BSMMU, consecutive patients who had been treated with amiodarone for arrhythmia were included in this study. Patients without an amiodarone prescription were assumed and patients who will not give informed written consent were excluded in this study. Results: The most common adverse event was bradycardia or conduction disturbance (9.0%) followed by 4(2.2%) thyroid toxicity, 3(1.7%) hepatic toxicity, 2(1.1%) eye toxicity and 1(0.6%) pulmonary toxicity. In multi variable logistic regression, bradycardia or conduction disturbance, amiodarone daily dose (≥300 mg) and duration of amiodarone (>4 month) was found to be significantly (p<0.05) associated with adverse effects of amiodarone. Conclusion: The most common adverse event was bradycardia or conduction disturbance followed by thyroid toxicity, hepatic toxicity, eye toxicity and pulmonary toxicity. Bradycardia or conduction disturbance, amiodarone daily dose (≥300 mg) and duration of amiodarone (>4 month) was found to be significantly associated with adverse effects of amiodarone. \u0000University Heart Journal Vol. 17, No. 2, Jul 2021; 118-121","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78044752","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}
Fysal Faruq, S. Ahsan, M. Mahmood, Mrm Mandal, Kamruzzaman Siddiki, A. G. Mostofa, Azharul Islam, A. I. Akand, Saha Sk, T. Parvin
Background: Data on the association between glycemic control after percutaneous coronary intervention (PCI) and clinical outcomes are limited and controversial in diabetic patients. Objective:The aim of the study was to assess the impact of good glycaemic control on three months clinical outcomes in diabetic acute coronary syndrome (ACS) patients undergoing PCI, from a Bangladesh health service perspective. Materials and methods:This prospective cohort study which was conducted in UCC, BSMMU included 346 consecutive diabetic ACS patients who underwent PCI at department of cardiology, BSMMU. Diabetic patients were categorized into two groups based on their 3 months HbA1c levels: 169 (48.84%) diabetics with good glycaemic control (HbA1c < 7%) and 177 (51.16%) diabetics with poor glycaemic control (HbA1c ≥7%).The outcome was major adverse cardiovascular events (MACEs), defined as cardiac death, myocardial infarction (MI), definite stent thrombosis, target vessel revascularization and stroke. Results: At 3 months follow up, patients with poor glycaemic control had a significantly higher incidence of MI (6.2% vs 1.2%; p=0.021). No other adverse events were found significantly different between the groups at 3 months of PCI. Conclusion:Good glycaemic control to obtain HbA1c level <7% in diabetic ACS patients undergoing coronary artery stenting may be beneficial in reducing the risk of MACEs and improvement of clinical outcome after PCI during 3 months follow up. University Heart Journal Vol. 17, No. 2, Jul 2021; 108-113
背景:关于糖尿病患者经皮冠状动脉介入治疗(PCI)后血糖控制与临床结果之间的关系的数据有限且有争议。目的:从孟加拉国卫生服务的角度，评估良好的血糖控制对接受PCI治疗的糖尿病急性冠脉综合征(ACS)患者三个月临床结局的影响。材料与方法:本前瞻性队列研究在BSMMU UCC进行，纳入346例连续在BSMMU心内科行PCI的糖尿病ACS患者。根据3个月HbA1c水平将糖尿病患者分为两组:169例(48.84%)血糖控制良好(HbA1c < 7%)和177例(51.16%)血糖控制不良(HbA1c≥7%)。结果是主要不良心血管事件(mace)，定义为心源性死亡、心肌梗死(MI)、明确的支架血栓形成、靶血管重建术和卒中。结果:在随访3个月时，血糖控制较差的患者心肌梗死发生率显著升高(6.2% vs 1.2%;p = 0.021)。PCI治疗3个月时，两组间未发现其他不良事件有显著差异。结论:随访3个月，行冠状动脉支架植入术的糖尿病ACS患者血糖控制良好，使HbA1c水平<7%，可能有利于降低mace发生风险，改善PCI术后临床预后。《大学心脏杂志》第17卷第2期，2021年7月;108 - 113
{"title":"Glycated Hemoglobin and short-term Prognosis in Patients with Acute Coronary Syndrome with Diabetes Mellitus: A Prospective Cohort Study","authors":"Fysal Faruq, S. Ahsan, M. Mahmood, Mrm Mandal, Kamruzzaman Siddiki, A. G. Mostofa, Azharul Islam, A. I. Akand, Saha Sk, T. Parvin","doi":"10.3329/uhj.v17i2.54366","DOIUrl":"https://doi.org/10.3329/uhj.v17i2.54366","url":null,"abstract":"Background: Data on the association between glycemic control after percutaneous coronary intervention (PCI) and clinical outcomes are limited and controversial in diabetic patients. Objective:The aim of the study was to assess the impact of good glycaemic control on three months clinical outcomes in diabetic acute coronary syndrome (ACS) patients undergoing PCI, from a Bangladesh health service perspective. Materials and methods:This prospective cohort study which was conducted in UCC, BSMMU included 346 consecutive diabetic ACS patients who underwent PCI at department of cardiology, BSMMU. Diabetic patients were categorized into two groups based on their 3 months HbA1c levels: 169 (48.84%) diabetics with good glycaemic control (HbA1c < 7%) and 177 (51.16%) diabetics with poor glycaemic control (HbA1c ≥7%).The outcome was major adverse cardiovascular events (MACEs), defined as cardiac death, myocardial infarction (MI), definite stent thrombosis, target vessel revascularization and stroke. Results: At 3 months follow up, patients with poor glycaemic control had a significantly higher incidence of MI (6.2% vs 1.2%; p=0.021). No other adverse events were found significantly different between the groups at 3 months of PCI. Conclusion:Good glycaemic control to obtain HbA1c level <7% in diabetic ACS patients undergoing coronary artery stenting may be beneficial in reducing the risk of MACEs and improvement of clinical outcome after PCI during 3 months follow up. \u0000University Heart Journal Vol. 17, No. 2, Jul 2021; 108-113","PeriodicalId":23424,"journal":{"name":"University Heart Journal","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84221314","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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