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Comparison of anti-thrombotic strategies using Bivalirudin, Heparin plus Eptifibatide, and Unfractionated Heparin Monotherapy for acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI): A single-center observational stu 比伐鲁定、肝素联合依替巴肽和肝素单药治疗急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)的抗血栓策略比较:一项单中心观察研究
Pub Date : 2021-06-28 DOI: 10.3329/uhj.v17i2.54364
A. G. Mostofa, T. Parvin, Mrm Mandal, P. Biswas, Goutom Chandra Bhowmik, Fysal Faruq, S. Ahsan
Objective: To determine and compare the incidence of in-hospital and 30-day hemorrhagic complication and major adverse cardiac events (MACEs) as evidence of safety and efficacy using three different anti- thrombotic strategies using Bivalirudin, Heparin plus Eptifibatide (GPI: GP IIb/IIIa inhibitor), and Unfractionated Heparin (UFH) monotherapy in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) in a tertiary care cardiac hospital. Background: UFH or Heparin plus Eptifibatide or Bivalirudin is the most commonly used antithrombotic regimen to improve peri and post-PCI clinical outcomes in a patient undergoing PCI for ACS. Among them, the most effective and optimal antithrombotic regimen for preventing ischemic complications while limiting bleeding risk in ACS patients undergoing PCI is still far from being clear. Methods: 324 ACS patients ( age >18 years and ≤75 years) who underwent PCI from May 2018 to May 2019 at UCC, BSMMU, Dhaka were consecutively enrolled in the study and were divided into three groups according to antithrombotic. The choice of Anti-thrombotic strategy was at the discretion of the operator(s) and the patient’s affordability. Group-A: 107 patients received Bivalirudin as intravenous (I/V) bolus of 0.75 mg/ kg, followed by an infusion of 1.75 mg/kg/hr up to 4 hours. Group-B: 111 patients received UFH as an I/ V bolus of 70-100 U/kg (targeted ACT: 250-300 s). Group-C: 106 patients were administered UFH plus Eptifibatide as per the standard hospital guidelines. Dual antiplatelet (DAPT) loading as Aspirin 300 mg plus P2Y12 inhibitors ( Clopidogrel 600 mg or Prasugrel 60 mg or Ticagrelor 180 mg) was given in all patients before the procedure. The maintenance dose of DAPT was continued for at least one month and patients were followed telephonically up to 30 days. The outcome measures were in-hospital and 30-day hemorrhagic complication and MACEs [death, MI, stroke, stent thrombosis and target-vessel revascularization (TVR)] Results: In-hospital outcome: Patients treated with Bivalirudin as compared with UFH had a significantly lower incidence of QMI lesions (0% vs.6%; p=0.038) and major bleeding (0% vs. 7%; p=0.021). The bleeding rate was also significantly lower in Bivalirudin arm as compared with Heparin plus GPI arm (0% vs. 6%; p=0.038). However, the incidence of cardiac death, stent thrombosis, TVR were no differences among the three groups. 30-day outcome: There was only one NQMI in the bivalirudin group as opposed to 8% in the heparin group (p=0.041). No other adverse effects were found significantly different among the study groups. Conclusion: In this perspective, observational study of ACS patients undergoing PCI in a single-center showed that Bivalirudin monotherapy is safer than other contemporary antithrombotic strategies. In terms of efficacy, Bivalirudin is non inferior to Heparin plus Eptifibatde but superior to UFH monotherapy. University Heart Journal Vol. 17, No. 2, Jul 2
目的:确定并比较在三级心脏医院接受经皮冠状动脉介入治疗(PCI)的急性冠脉综合征(ACS)患者使用比伐鲁定、肝素加依替巴肽(GPI: GP IIb/IIIa抑制剂)和未分割肝素(UFH)单药治疗三种不同的抗血栓策略的安全性和有效性,以确定住院和30天出血并发症和主要心脏不良事件(mace)的发生率。背景:UFH或肝素加依替巴肽或比伐鲁定是最常用的抗血栓治疗方案,可改善ACS患者行PCI术前后的临床结果。其中,对于行PCI的ACS患者预防缺血性并发症同时限制出血风险的最有效、最佳的抗栓方案尚不明确。方法:将2018年5月至2019年5月在达卡UCC、BSMMU、UCC行PCI治疗的324例ACS患者(年龄bb0 ~ 18岁,≤75岁)连续纳入研究,根据抗血栓性分为三组。抗血栓策略的选择取决于操作者和患者的承受能力。a组:107例患者接受比伐鲁定静脉注射(I/V),剂量为0.75 mg/kg,随后1.75 mg/kg/hr输注,持续4小时。b组:111例患者接受UFH作为I/ V剂量70-100 U/kg(靶向ACT: 250-300 s)。c组:106例患者按照标准医院指南给予UFH加依替巴肽。所有患者在手术前给予双重抗血小板(DAPT)负荷,即阿司匹林300 mg加P2Y12抑制剂(氯吡格雷600 mg或普拉格雷60 mg或替格瑞180mg)。DAPT维持剂量至少持续一个月,并对患者进行电话随访至30天。结果指标为住院和30天出血并发症和mace[死亡、心肌梗死、卒中、支架血栓形成和靶血管重建术(TVR)]结果:住院结果:与UFH相比,比伐鲁定治疗的患者QMI病变发生率显著降低(0% vs.6%;P =0.038)和大出血(0% vs. 7%;p = 0.021)。比伐鲁定组的出血率也显著低于肝素加GPI组(0% vs 6%;p = 0.038)。但三组心脏性死亡、支架内血栓形成、TVR发生率均无差异。30天结果:比伐鲁定组只有1例NQMI,而肝素组为8% (p=0.041)。研究小组之间没有发现其他明显不同的不良反应。结论:从这个角度来看,对接受PCI的ACS患者进行的单中心观察性研究表明,比伐鲁定单药治疗比其他当代抗血栓治疗策略更安全。在疗效方面,比伐鲁定不逊于肝素加依替菲巴特,但优于UFH单药治疗。《大学心脏杂志》第17卷第2期,2021年7月;91 - 98
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引用次数: 1
Correlation between Insulin Resistance and LVEF in non Diabetic Chronic Heart Failure Patients admitted in a Tertiary Care Hospital 三级医院非糖尿病性慢性心力衰竭患者胰岛素抵抗与LVEF的关系
Pub Date : 2021-06-28 DOI: 10.3329/uhj.v17i2.54365
Azharul Islam, M. Mahmood, Khurshed Ahmed, S. Banerjee, S. Ahsan, C. M. Ahmed, A. I. Akand, Saha Sk, Fysal Faruq, Kamruzzman Siddiki, Akm Fazlur Rahman, F. I. Khaled, S. Zaman, F. Yeasmin, P. Akter, H. Hoque
Background: Insulin resistance is a well-established composite index of systemic inflammatory and metabolic disorders. A wide variety of methods like, HOMA-IR (Homeostatic model assessment insulin resistance), FGIR (Fasting glucose insulin ratio), ISI-Composite (an index of whole body insulin sensitivity), QUICKI (quantitative insulin sensitivity check index) etc are available for assessing IR. Objective: To find out the correlation between insulin resistance and LVEF in non diabetic chronic heart failure patients. Methodology: This cross sectional study was carried out in the Department of Cardiology in Bangabandhu Sheikh Mujib Medical University, Shahbagh, Dhaka from February, 2019 to June, 2020. Patients admitted with chronic heart failure with reduced ejection fraction were included in this study. Patients with diabetic, prediabetic and patient who did not give written informed consent were excluded in this study. Results: LVEF 25-29% was 16 patients out of which 10(66.7%) had significant insulin resistance. LVEF 30- 34% was found in 28 patients, among them 16(41.0%) had no insulin resistance. LVEF 35-39% was found in 19 patients out of which 18(46.2%) had no insulin resistance. The difference was statistically significant (p<0.05). A negative correlation (r=-0.340; p=0.006) was found between insulin resistance and LVEF. Conclusion: Majority non diabetic chronic heart failure patients had no insulin resistance. Significant negative correlation was found between insulin resistance and LVEF. University Heart Journal Vol. 17, No. 2, Jul 2021; 99-102
背景:胰岛素抵抗是一个公认的全身性炎症和代谢紊乱的综合指标。评估胰岛素抵抗的方法有HOMA-IR(稳态模型评估胰岛素抵抗)、fgil(空腹葡萄糖胰岛素比率)、ISI-Composite(全身胰岛素敏感性指数)、QUICKI(胰岛素敏感性定量检查指数)等。目的:探讨非糖尿病性慢性心力衰竭患者胰岛素抵抗与LVEF的关系。方法:本横断面研究于2019年2月至2020年6月在达卡沙赫巴格的Bangabandhu Sheikh Mujib医科大学心内科进行。入院的慢性心力衰竭伴射血分数降低的患者纳入本研究。糖尿病患者、糖尿病前期患者和未给予书面知情同意的患者被排除在本研究之外。结果:16例患者LVEF 25-29%,其中10例(66.7%)有明显的胰岛素抵抗。28例患者LVEF 30 ~ 34%,其中16例(41.0%)无胰岛素抵抗。19例患者LVEF 35 ~ 39%,其中18例(46.2%)无胰岛素抵抗。差异有统计学意义(p<0.05)。负相关(r=-0.340;p=0.006)。结论:非糖尿病性慢性心力衰竭患者多数不存在胰岛素抵抗。胰岛素抵抗与LVEF呈显著负相关。《大学心脏杂志》第17卷第2期,2021年7月;99 - 102
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引用次数: 0
Correlation of Serum Vitamin-D Level with Coronary Angiographic Severity In Patients with Acute Coronary Syndrome 急性冠脉综合征患者血清维生素d水平与冠脉造影严重程度的相关性
Pub Date : 2021-06-28 DOI: 10.3329/uhj.v17i2.54367
Kamruzzaman Siddiki, H. Hoque, Mukhlesur Rahman, F. I. Khaled, Fysal Faruq, M. Alam, A. Kabir, Sayed Nazmul Islam, Azharul Islam, S. Zaman
Background: Acute Coronary Syndrome includes to a group of conditions compatible with acute myocardial ischemia and/or infarction that are usually due to an abrupt reduction in coronary blood flow. In the last decade vitamin-D deficiency as a predisposing factor for coronary artery disease is in growing interest. Prospective studies give conflicting results regarding correlation of serum vitamin D level with coronary angiographic severity in patients with acute coronary syndrome. Objective: To study the correlation between serum vitamin-D level with coronary angiographic severity in patients with acute coronary syndrome. Methodology: This cross sectional observational study was done between November 2018 and October 2019. Total 71 patients with diagnosis of first incident of acute coronary syndrome in department of cardiology, BSMMU who were underwent coronary angiogram included in this study considering the inclusion and exclusion criteria. Vitamin D was measured by chemiluminescent immunoassay after collection of venous blood at Department of Biochemistry, BSMMU. Angiographic severity was assessed by using Gensini score. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Results: The mean age was found 55.9±10.7 years with a range from 36 to 82 years. Majority (83.1%) patients were male. The male-female ratio was 4.9:1. Thirty (42.3%) of the patients had STEMI, 28(39.4%) had NSTEMI and 13(18.3%) had unstable angina. Negative correlation (r=-0.479; p=0.001) was found between serum vitamin D level and Gensini score in patients with acute coronary syndrome. Conclusion: In this study found that serum vitamin-D level is inversely correlated with angiographic severity in patients with acute coronary syndrome. University Heart Journal Vol. 17, No. 2, Jul 2021; 103-107
背景:急性冠脉综合征包括一组与急性心肌缺血和/或梗死相一致的疾病,通常是由于冠状动脉血流量突然减少。在过去的十年中,维生素d缺乏作为冠状动脉疾病的一个易感因素越来越引起人们的兴趣。关于急性冠脉综合征患者血清维生素D水平与冠状动脉造影严重程度的相关性,前瞻性研究给出了相互矛盾的结果。目的:探讨急性冠脉综合征患者血清维生素d水平与冠脉造影严重程度的相关性。方法:本横断面观察性研究于2018年11月至2019年10月进行。根据纳入和排除标准,本研究共纳入71例在BSMMU心内科首次诊断为急性冠状动脉综合征并行冠状动脉造影的患者。在北京医科大学生物化学系采集静脉血,用化学发光免疫法测定维生素D。采用Gensini评分评估血管造影严重程度。使用Statistical Package for Social Sciences version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA)进行统计分析。结果:36 ~ 82岁,平均年龄55.9±10.7岁。大多数患者为男性(83.1%)。男女比例为4.9:1。STEMI 30例(42.3%),NSTEMI 28例(39.4%),不稳定型心绞痛13例(18.3%)。负相关(r=-0.479;急性冠脉综合征患者血清维生素D水平与Gensini评分之间存在显著性差异(p=0.001)。结论:本研究发现急性冠脉综合征患者血清维生素d水平与血管造影严重程度呈负相关。《大学心脏杂志》第17卷第2期,2021年7月;103 - 107
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引用次数: 0
The Context of StichTrial: Viable or not viable Does it matter before revascularization? StichTrial的背景:可行或不可行在血运重建术之前重要吗?
Pub Date : 2021-06-28 DOI: 10.3329/uhj.v17i2.54361
C. M. Ahmed, A. Sultan
Abstract not available University Heart Journal Vol. 17, No. 2, Jul 2021; 79-80
《大学心脏杂志》第17卷第2期,2021年7月;79 - 80
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引用次数: 1
Assessment of left Ventricular Longitudinal Function in Different Hypertensive Left Ventricular Geometry 不同高血压左心室几何形态左心室纵向功能的评价
Pub Date : 2020-12-21 DOI: 10.3329/uhj.v17i1.50877
Md Nur Uddin Tareq, C. M. Ahmed, S. Mahmud, K. Haque
Background: Hypertension remains as the major risk factor for cardiovascular diseases. Hypertensive left ventricular hypertrophy was shown to be associated with increased morbidity and mortality. Left ventricular radial function (Ejection fraction) tends to remain normal in hypertensive patients, particular attention should be given to longitudinal function along with diastolic function. Left ventricular longitudinal function may vary across different hypertensive LV geometry with different prognosis. Results: Of the total 214 study subjects, 109 (50.9%) were Cases and 105 (49.1%) were Controls. The mean ages of cases and controls were 52.66 (± 10.96) and 50.21 (± 10.91) years respectively. Left ventricular ejection function (LVEF) was almost identical in both groups [mean LVEF in case 68.7 % (± 6.9) Vs control 68.7(± 5.4), (p 0.947)]. Among the cases 43% had concentric hypertrophy (CH), 20% had eccentric hypertrophy (EH), 20% had concentric remodeling (CR), while normal geometry constituted the least 16.5%. Mean systolic mitral annular velocity (Vs) and mean early diastolic velocity (Ve) assesed by pulse wave tissue doppler imaging were observed to be significantly decreased in cases compared to their control counterpart (11.46 ± 1.26 vs. 15.41 ± 1.00 cm/sec, p < 0.001 and 13.80 ± 2.37 vs. 16.76 ± 2.67 cm/sec, p < 0.001. There was significant reduction of Vs in concentric hypertrophy and eccentric hypertrophy (11.31 ± 1.41 and 12.27 ± 2.14). (p <0.001 and <0.005). Among cases 55 (50.5%) and among controls 17 (16%) had diastolic dysfunction. Mean systolic mitral annular velocity (Vs) in patients with diastolic dysfunction (12.42 ± 1.90 cm/sec) was significantly lower than that in patients without diastolic dysfunction (13.86 ± 2.30 cm/sec) (p < 0.001). Conclusion: Radial function (LVEF) remains normal in patients with systemic hypertension as compared to controls. LVH is common among hypertensive and concentric hypertrophy is the commonest geometry. LV longitudinal systolic function as assessed by systolic mitral annular velocity (Vs) by DTI was significantly reduced in hypertensives and CH is the most severely affected with EH at intermediate risk. Diastolic dysfunction is also common but almost alaways accompanied by impairment of LV longitudinal systolic function. University Heart Journal Vol. 17, No. 1, Jan 2021; 31-37
背景:高血压仍然是心血管疾病的主要危险因素。高血压左心室肥厚被证明与发病率和死亡率增加有关。高血压患者左心室径向功能(射血分数)趋于正常,尤其应注意纵向功能和舒张功能。不同左室几何形状的高血压患者左室纵向功能不同,预后也不同。结果:214例研究对象中,病例109例(50.9%),对照组105例(49.1%)。病例和对照组的平均年龄分别为52.66(±10.96)岁和50.21(±10.91)岁。两组左心室射血功能(LVEF)几乎相同[病例平均LVEF 68.7%(±6.9)Vs对照组平均LVEF 68.7(±5.4),(p 0.947)]。同心型肥厚(CH)占43%,偏心型肥厚(EH)占20%,同心型重塑(CR)占20%,正常几何形态占最少16.5%。脉搏波组织多普勒成像测量的平均收缩二尖瓣环速度(Vs)和平均早期舒张速度(Ve)与对照组相比显著降低(11.46±1.26 Vs 15.41±1.00 cm/sec, p < 0.001)和13.80±2.37 Vs 16.76±2.67 cm/sec, p < 0.001)。同心型肥厚和偏心型肥厚的Vs值分别为11.31±1.41和12.27±2.14。(p <0.001和<0.005)。其中55例(50.5%)和对照组17例(16%)存在舒张功能不全。舒张功能不全患者的平均收缩期二尖瓣环速度(Vs)(12.42±1.90 cm/sec)显著低于无舒张功能不全患者(13.86±2.30 cm/sec) (p < 0.001)。结论:与对照组相比,全身性高血压患者的桡骨功能(LVEF)保持正常。LVH在高血压中很常见,同心肥大是最常见的几何形状。高血压患者的左室纵向收缩功能(以DTI的收缩二尖瓣环速度(v)评估)显著降低,而CH在中等风险时受EH影响最严重。舒张功能障碍也很常见,但几乎总是伴有左室纵向收缩功能的损害。《大学心脏杂志》第17卷第1期,2021年1月;31-37
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引用次数: 0
Association of GRACE Risk Score with Angiographic Severity of Coronary Artery Disease in Patients with Non ST-elevation Acute Coronary Syndrome 非st段抬高急性冠状动脉综合征患者GRACE风险评分与冠状动脉疾病血管造影严重程度的关系
Pub Date : 2020-12-21 DOI: 10.3329/uhj.v17i1.50879
Md. Estakur Rahman, -. Mohammad Safiuddin, S. Habib, C. M. Ahmed, S. Banerjee
Background: Due to the wide spectrum of risk for death and recurrent events among patients with NSTE-ACS, management guidelines emphasise the importance of early risk stratification. In addition to prognostic assessment, predicting the anatomical extension of coronary artery disease is potentially useful for clinical decision. The aim of the study is to determine whether the GRACE risk score correlates with the angiographic extent and severity of coronary artery disease in patients with non ST-elevation ACS Methods: A total of 50 patients with non-ST-elevation acute coronary syndrome were enrolled to the study. Based on the GRACE risk score classification system, the patients were divided into low (<108), intermediate (109-140), and high (>140) risk groups. All patients underwent coronary angiography within five days after admission. The severity of the coronary artery disease was assessed by Gensini score. Relation between Grace score and Gensini score was evaluated. Results: Mean Gensini score were 12.20 ± 13.60, 34.52 ± 13.50 and 48.41 ± 14.56 in low group, intermediate group and high GRACE risk group respectively and the difference of mean Gensini score was statistically significant (p<0.001). A GRACE score of 135 was identified as the optimal cut-off to predict severe CAD (sensitivity = 82.4% and specificity = 75.8%). In our study correlation co-efficient between GRACE risk score and Gensini score was r=0.66 (p<0.001). Conclusion: The study demonstrates that the GRACE risk score has significant positive correlation with coronary artery stenosis in patients with non-ST-elevation acute coronary syndrome. University Heart Journal Vol. 17, No. 1, Jan 2021; 38-41
背景:由于NSTE-ACS患者的死亡和复发事件风险范围广,管理指南强调早期风险分层的重要性。除了预后评估外,预测冠状动脉病变的解剖扩展对临床决策也有潜在的帮助。本研究的目的是确定GRACE风险评分是否与非st段抬高ACS患者冠状动脉病变的血管造影程度和严重程度相关。方法:共纳入50例非st段抬高急性冠脉综合征患者。根据GRACE风险评分分类系统,将患者分为低风险组(140)。所有患者均在入院后5天内行冠状动脉造影。采用Gensini评分评价冠状动脉病变的严重程度。评价Grace评分与Gensini评分的关系。结果:低危组、中危组和高危组Gensini评分均值分别为12.20±13.60、34.52±13.50、48.41±14.56,Gensini评分均值差异有统计学意义(p<0.001)。GRACE评分135被确定为预测严重CAD的最佳截止值(敏感性= 82.4%,特异性= 75.8%)。在本研究中,GRACE风险评分与Gensini评分的相关系数为r=0.66 (p<0.001)。结论:本研究表明GRACE风险评分与非st段抬高急性冠状动脉综合征患者冠状动脉狭窄有显著正相关。《大学心脏杂志》第17卷第1期,2021年1月;38-41
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引用次数: 0
Relying on ST Segment Depression alone to Predict Ischemic Heart Disease- How Far We can Go ? 单靠ST段凹陷预测缺血性心脏病——我们能走多远?
Pub Date : 2020-12-21 DOI: 10.3329/uhj.v17i1.50874
M. Alam, M. M. Rahman, T. Parvin, Khurshed Ahmed, S. Habib, Md Fakhrul Islam Khaled, Md. Azharul Islam, Md Ahasanul Kabir Shahin, Kamruzzaman Siddiki, Md Al Amin
Introduction: Ischemic heart disease (IHD) or coronary artery disease (CAD) has become predominant cause of death across the world and frequently stable angina, which is the most common presentation of this disease, gives hard time to reach a proper diagnosis due to duality of non-invasive testing. While Exercise Treadmill Test (ETT) is an inexpensive non-invasive modality which may have many output depending on method of interpretation, ST segment depression is much utilized but traditionally less perfect than available treadmill scores. We have compared its accuracy to Duke Treadmill Score (DTS), Simple Treadmill Score (STS) and Cleveland Clinic Score (CCS) among Bangladesh people to generate a local insight. Objective: To estimate and compare accuracy of ST segment response, DTS, Simple Treadmill Score and Cleveland Clinic Score to predict CAD. Method: In a cross-sectional study total 130 patients who had visited at a medical university with stable chest pain were selected according to predefined inclusion and exclusion criteria over one year. After taking proper history and physical examination their ETT report and Coronary Angiogram (CAG) finding, which were done according to indication defined by their consultants. ETT interpretation as ST segment response and treadmill scores were compared with gold standard test for CAD that is CAG. Accuracy of STdepression and treadmill scores were calculated by the formula “Accuracy = TP+TN / Total Sample”. Result: Among the total sample (n=130) male and female were 93 & 37, respectively. Nearly half of male sample fell into 5th decade and around same portion of female sample was in 4th decade. About 58%, 28% & 14% patients came with typical, atypical & non-cardiac chest pain. As calculated with above mentioned formula accuracy of ST segment response alone to diagnose IHD came about 68.4% (p value 0.004). Similarly DTS, STS and CCS had 83.3%, 83.9% and 77.2% accuracy, respectively (p value 0.000). Conclusion: During ETT relying on ST segment depression alone to diagnose CAD is significantly less accurate than treadmill scores namely, Duke Treadmill Score, Simple treadmill Score or Cleveland Clinic Score. Applying any of these treadmill scores during exercise test interpretation can identify ischemic heart disease patients with more accuracy. University Heart Journal Vol. 17, No. 1, Jan 2021; 10-15
简介:缺血性心脏病(IHD)或冠状动脉疾病(CAD)已成为世界各地死亡的主要原因,而稳定型心绞痛是这种疾病最常见的表现,由于非侵入性检查的双重性,使其难以得到正确的诊断。虽然运动跑步机测试(ETT)是一种廉价的非侵入性方法,根据解释方法可能有许多输出,但ST段抑郁被广泛利用,但传统上不如可用的跑步机评分完美。我们将其准确性与杜克跑步机评分(DTS)、简单跑步机评分(STS)和克利夫兰诊所评分(CCS)在孟加拉国人中的准确性进行了比较,以获得当地的见解。目的:评价和比较ST段反应、DTS、简单跑步机评分和克利夫兰临床评分预测冠心病的准确性。方法:在横断面研究中,根据预先确定的纳入和排除标准,选择130例在一年内就诊的医科大学稳定胸痛患者。在进行了适当的病史和体格检查后,他们的ETT报告和冠状动脉血管造影(CAG)发现是根据他们的顾问定义的适应症完成的。将ETT解释为ST段反应和跑步机评分与CAD的金标准测试(CAG)进行比较。STdepression和跑步机评分的准确性按公式“准确率= TP+TN /总样本”计算。结果:总样本(n=130)中,男性93例,女性37例。近一半的男性样本处于第5个十年,大约相同比例的女性样本处于第4个十年。约58%,28%和14%的患者出现典型,非典型和非心源性胸痛。根据上述公式计算,单纯ST段反应诊断IHD的准确率约为68.4% (p值0.004)。DTS、STS和CCS的准确率分别为83.3%、83.9%和77.2% (p值0.000)。结论:在ETT中,仅依靠ST段凹陷来诊断CAD的准确性明显低于跑步机评分,即Duke treadmill Score、Simple treadmill Score或Cleveland Clinic Score。在运动测试解释中应用这些跑步机评分可以更准确地识别缺血性心脏病患者。《大学心脏杂志》第17卷第1期,2021年1月;10 - 15
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引用次数: 0
Echocardiographic Assessment of the Effect of Mitral Stenosis Severity on Left Ventricular Systolic Function Using Isololumic Myocardial Acceleration 超声心动图评价二尖瓣狭窄严重程度对左心室收缩功能的影响
Pub Date : 2020-12-21 DOI: 10.3329/uhj.v17i1.50880
Md Hasanul Islam, D. Adhikary, T. Parvin, R. Barman, Mahbubur Rahman, Md. Ashraf Uddin Sultan, M. Chowdhury, Md. Harisul Hoque
Background: Isovolumic myocardial acceleration (IVA) is a new tissue Doppler parameter in the assessment of systolic function of both right and left ventricles. It remains unaffected with the changes in pre-and after load with in the physiological range. With the advent of newer parameter like IVA, better assessment are naturally expected. Thus it creates a fertile ground where upon many studies are being done as it chosen here. The aim of study was to assess the effect of MS severety on LV systolic function using IVA. Methods: In this cross sectional study, considering all ethical issues, data were collected from 96 patient (Isolated mitral stenosis and mitral valve area <2cm2) and 32 healthy control subjects. In addition to standard echocardiographic methods TDI (tissue Doppler imaging) were performed to assess LV function in all participants. Results: This study showed a clear female preponderence (76%) of mitral stenosis and most of them belonging to age group 21-39 years. All TDI derived LV systolic (IVV, Sm and IVA) velocities were significanty decreased in patients with mitral stenosis, compared to the healthy control (P<.001, for all). However IVA was not different when the degree of MS was evaluated (P=.056). In addition IVA was not correlated with MVA (r=+0.196. P= 0.056). Conclusions: Isovolumic myocardial acceleration was more accurate and consistent than conventional echocardiography in assessing subclinical left ventricular systolic dysfunction, IVA showed that left ventricular function is impaired with mitral stenosis regardless of severety of the disease. So this new echo parameter can be a good supplement to the existing 2D scoring system to detect systolic dysfunction in rheumatic mitral stenosis. University Heart Journal Vol. 17, No. 1, Jan 2021; 42-46
背景:等容心肌加速(IVA)是评价左、右心室收缩功能的一种新的组织多普勒参数。它不受负荷前后变化的影响,在生理范围内。随着IVA等新参数的出现,人们自然期望更好的评估。因此,它创造了一个肥沃的土壤,许多研究都在这里选择进行。研究目的是通过IVA评估MS严重程度对左室收缩功能的影响。方法:在横断面研究中,考虑到所有伦理问题,收集96例(孤立性二尖瓣狭窄且二尖瓣面积<2cm2)患者和32名健康对照者的资料。除了标准超声心动图方法TDI(组织多普勒成像)评估所有参与者的左室功能。结果:本研究显示二尖瓣狭窄明显以女性为主(76%),且多集中在21-39岁年龄组。与健康对照组相比,二尖瓣狭窄患者所有TDI衍生的左室收缩期(IVV、Sm和IVA)速度均显著降低(P< 0.05)。(对所有人)。而在评价多发性硬化症程度时,IVA差异无统计学意义(P= 0.056)。此外,IVA与MVA无相关性(r=+0.196)。P = 0.056)。结论:在评估亚临床左室收缩功能障碍时,等容积心肌加速比常规超声心动图更准确和一致,IVA显示二尖瓣狭窄导致左室功能受损,无论疾病严重程度如何。因此,这种新的回声参数可以很好地补充现有的二维评分系统来检测风湿性二尖瓣狭窄患者的收缩功能障碍。《大学心脏杂志》第17卷第1期,2021年1月;42-46
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引用次数: 0
Correlation between Abnormal Signal-Averaged ECG and Left Ventricular Ejection Fraction in Patients of Acute Myocardial Infarction within Seven Days of Sustaining the Infarction. 急性心肌梗死患者维持7天内异常平均心电图信号与左室射血分数的相关性
Pub Date : 2020-12-21 DOI: 10.3329/uhj.v17i1.50873
Mohammad Abdul Malek, S. Iqbal, A. Haque, Sayeda Aleya Sultana, Md Wali ur Rahman, M. M. Rahman
Objective: This study sought to evaluate the correlation of left ventricular ejection fraction (LVEF) with Signal – Average Electrocardiogram (SAECG) in patient with acute myocardial infarction. Background: Post MI risk stratification is still a debatable issue. Appropriate investigation to ascertain the patient at risk of sudden cardiac death is sometimes difficult. Abnormalities in the SAECG have been determined to be independent predictors of risk of developing ventricular arrhythmias in patients convalescing from myocardial infarction. Correlation of LVEF with SAECG will identify the small group of patient at risk of fatal arrhythmia. Method: This observational study was carried out in the cardiology center, Combined Military Hospital, Dhaka cantonment during the period of January 2010 to January 2011. Patient with first acute myocardial infarction within 7 days of sustaining acute myocardial infarction were included in the study. All three parameters of SAECG (Total QRS duration, Low Amplitude Signal (LAS) under 40μvolt, Root - mean -square (RMS) voltage of last 40 msec) were recorded, and basing on the results, patients were grouped into normal or abnormal SAECG. Result: A total of 106 patients of acute MI were studied. Mean age of the patients were 54(SD±10.5) years (range 34 to 90 years). Only 13(12%) patients were female with male to female ratio of 7.15:1. 32% patients were thrombolysed & abnormal SAECG was more in patients who were thrombolysed (p value<0.05) but logistic regression analysis showed no significant association. Smoking had significant association with abnormal SAECG by univariate analysis (p value<0.05) but logistic regression analysis showed no significant association with smoking and sex (p value >0.05). 46% patients had inferior/inferoposterior myocardial infarction. Abnormal SAECG was more among patients with inferior MI (p <0.05). Mean LVEF was 45.81% (SD±9.68). Correlation of LV function was assessed by both Pearson’s correlation and Ç2 test but no significant association was seen. Logistic regression analysis showed the similar result. Conclusion: In our study, no correlation was found between abnormal signal-averaged ECG and left ventricular ejection fraction following acute myocardial infarction. Further large, multi center study with more selective variables is required to find out any association of SAECG and LV ejection fraction. University Heart Journal Vol. 17, No. 1, Jan 2021; 3-9
目的:探讨急性心肌梗死患者左室射血分数(LVEF)与信号平均心电图(SAECG)的相关性。背景:心肌梗死后的风险分层仍然是一个有争议的问题。适当的调查以确定病人是否有心源性猝死的危险有时是困难的。SAECG异常已被确定为心肌梗死恢复期患者室性心律失常风险的独立预测因子。LVEF与SAECG的相关性将确定一小部分有致死性心律失常风险的患者。方法:本观察性研究于2010年1月至2011年1月在达卡军营陆军联合医院心脏科中心进行。研究对象为持续急性心肌梗死后7天内首次发生急性心肌梗死的患者。记录SAECG总QRS持续时间、40μv低幅值信号(LAS)、最后40 msec均方根电压(RMS) 3个参数,并根据结果将患者分为SAECG正常和异常两组。结果:对106例急性心肌梗死患者进行了研究。患者平均年龄54(SD±10.5)岁(34 ~ 90岁)。女性13例(12%),男女比例为7.15:1。溶栓组32%,溶栓组SAECG异常较多(p值0.05)。46%的患者有下/后段心肌梗死。下壁心肌梗死患者SAECG异常较多(p <0.05)。平均LVEF为45.81% (SD±9.68)。通过Pearson相关和Ç2检验评估左室功能的相关性,但未见显著相关性。Logistic回归分析结果相似。结论:在我们的研究中,心电图异常信号平均与急性心肌梗死后左室射血分数无相关性。需要进一步的大型、多中心、更多选择性变量的研究来发现SAECG与左室射血分数的关联。《大学心脏杂志》第17卷第1期,2021年1月;3 - 9
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引用次数: 0
Acute Myocardial Infarction in a Young Lady with Mitral Stenosis – Uncommon Presentation of a Common Problem 年轻女性二尖瓣狭窄的急性心肌梗死-常见问题的罕见表现
Pub Date : 2020-12-21 DOI: 10.3329/uhj.v17i1.50886
A. Bhuiyan, A. Hasan, M. M. Rahman, Partha Pratim Saha
Chronic rheumatic heart disease is the major contributor of valvular heart disease in this subcontinent. It can affect all the four valves. Among them mitral valve is affected most of the time. Involvement of the mitral valve could be presented in various nonspecific way like chest pain, palpitation, shortness of breath, difficulty in swallowing, change in voice and so on. There are few causes behind the chest pain. Myocardial infraction is one of the important cause. University Heart Journal Vol. 17, No. 1, Jan 2021; 76-78
慢性风湿性心脏病是南亚次大陆瓣膜病的主要诱因。它可以影响所有四个瓣膜。其中二尖瓣受影响最多。二尖瓣受累可表现为胸痛、心悸、呼吸短促、吞咽困难、声音改变等多种非特异性表现。胸痛的原因很少。心肌梗死是其中一个重要原因。《大学心脏杂志》第17卷第1期,2021年1月;76 - 78
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引用次数: 0
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University Heart Journal
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