Md. Sahadat Hossain, P. Das, S. Ahsan, B. Bhattacharjee, A. Awal, Sandipan Das, I. Mahmud, S. Dhar, A. Bashiruddin, Partha Bhattacharyya, Debabrata Bhattacharya
Background: In acute myocardial infarction (AMI) the extent of the coronary artery lesion is evaluated by coronary angiogram (CAG). Recent evidences suggest that, ratio of triglyceride and high-density lipoprotein cholesterol (TG/HDL-C) could be a non-invasive marker for the prediction of the extent of coronary artery lesion. The aim of this study was to evaluate the association between TG/HDL-C ratio and the extent of coronary artery lesion assessed by coronary CAG among AMI patients. Objective: The aim of this study was to assess relationship between TG to HDL-C ratio and extent of coronary artery lesion in AMI patients. Materials & Method: This cross-sectional study was carried out in the Department of Cardiology, Chittagong Medical College Hospital in 224 admitted AMI patients. Blood samples were taken within 24 hours of admission following AMI for fasting lipid profile assessment, (total cholesterol (TC), HDL-C, low-density lipoprotein cholesterol (LDL-C) and TG). Each patient was underwent CAG within 2 to 6 weeks of the events and angiographic findings were classified according to presence of significant stenosis, number of vessel involved and Gensini score. Results: The subjects consisted of 197 males and 27 females with a mean age of 51.24 (±11.22) years. Mean value of TC was 185.74 (±41.96) mg/ dL, TG was 222.17 (±99.05) mg/dL, HDL-C was 38.92 (±5.46) mg/dL, LDL-C was 127.99 (±36.94) mg/dL, TG/HDL-C was 5.91 (±2.99), median Gensini score was 28 (Range:1-146). Analysis of receiver operating characteristic curves showed that only TG/HDLC and TG were useful for detecting high Gensini score (score >42), with the former more area under the curve (AUC: 0.611; 95% CI: 0.531-0.691; p=0.008). The TG/HDL-C was an independent predictive factor (Odds ratio: 2.706; 95% CI: 1.397-5.242; p = 0.003) for the presence of significant coronary artery lesion on CAG. Linear regression analysis revealed that, age and TG/HDL-C ratio significantly predicted Gensini score. Conclusion: TG and HDL-C ratio was independently associated with extent of coronary artery lesion. Bangladesh Heart Journal 2021; 36(2): 82-88
{"title":"Triglyceride to High Density Lipoprotein Cholesterol Ratio in Acute Myocardial Infarction And Its Relationship with Angiographic Severity","authors":"Md. Sahadat Hossain, P. Das, S. Ahsan, B. Bhattacharjee, A. Awal, Sandipan Das, I. Mahmud, S. Dhar, A. Bashiruddin, Partha Bhattacharyya, Debabrata Bhattacharya","doi":"10.3329/bhj.v36i2.56033","DOIUrl":"https://doi.org/10.3329/bhj.v36i2.56033","url":null,"abstract":"Background: In acute myocardial infarction (AMI) the extent of the coronary artery lesion is evaluated by coronary angiogram (CAG). Recent evidences suggest that, ratio of triglyceride and high-density lipoprotein cholesterol (TG/HDL-C) could be a non-invasive marker for the prediction of the extent of coronary artery lesion. The aim of this study was to evaluate the association between TG/HDL-C ratio and the extent of coronary artery lesion assessed by coronary CAG among AMI patients. Objective: The aim of this study was to assess relationship between TG to HDL-C ratio and extent of coronary artery lesion in AMI patients.\u0000Materials & Method: This cross-sectional study was carried out in the Department of Cardiology, Chittagong Medical College Hospital in 224 admitted AMI patients. Blood samples were taken within 24 hours of admission following AMI for fasting lipid profile assessment, (total cholesterol (TC), HDL-C, low-density lipoprotein cholesterol (LDL-C) and TG). Each patient was underwent CAG within 2 to 6 weeks of the events and angiographic findings were classified according to presence of significant stenosis, number of vessel involved and Gensini score.\u0000Results: The subjects consisted of 197 males and 27 females with a mean age of 51.24 (±11.22) years. Mean value of TC was 185.74 (±41.96) mg/ dL, TG was 222.17 (±99.05) mg/dL, HDL-C was 38.92 (±5.46) mg/dL, LDL-C was 127.99 (±36.94) mg/dL, TG/HDL-C was 5.91 (±2.99), median Gensini score was 28 (Range:1-146). Analysis of receiver operating characteristic curves showed that only TG/HDLC and TG were useful for detecting high Gensini score (score >42), with the former more area under the curve (AUC: 0.611; 95% CI: 0.531-0.691; p=0.008). The TG/HDL-C was an independent predictive factor (Odds ratio: 2.706; 95% CI: 1.397-5.242; p = 0.003) for the presence of significant coronary artery lesion on CAG. Linear regression analysis revealed that, age and TG/HDL-C ratio significantly predicted Gensini score.\u0000Conclusion: TG and HDL-C ratio was independently associated with extent of coronary artery lesion.\u0000Bangladesh Heart Journal 2021; 36(2): 82-88","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130824244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. M, Azad Mak, P. Biswas, M. A, Choudhury Nah, Shahreen K, B. A, Sarmin S
Left atrial appendage aneurysm is a rare heart defect; Most often diagnosed incidentally but may be potentially hazardous when presented with a systemic embolization or arrhythmia. So early diagnosis and treatment is indicated. We have successfully operated two cases of left atrial aneurysm in recent past and sharing our experiences through this case reports. Bangladesh Heart Journal 2021; 36(2): 158-163
{"title":"Aneurysm of Left Atrial Appendage: Report of two repaired cases","authors":"S. M, Azad Mak, P. Biswas, M. A, Choudhury Nah, Shahreen K, B. A, Sarmin S","doi":"10.3329/bhj.v36i2.56043","DOIUrl":"https://doi.org/10.3329/bhj.v36i2.56043","url":null,"abstract":"Left atrial appendage aneurysm is a rare heart defect; Most often diagnosed incidentally but may be potentially hazardous when presented with a systemic embolization or arrhythmia. So early diagnosis and treatment is indicated. We have successfully operated two cases of left atrial aneurysm in recent past and sharing our experiences through this case reports.\u0000Bangladesh Heart Journal 2021; 36(2): 158-163","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129673433","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}
K. K. Karmoker, B. Dutta, M. B. Rashid, M. A. Alam, Abm Riaz Kawsar, Khandaker Aisha Siddika, Mohammad Walidur Rahman
Background: Spontaneous coronary artery dissection (SCAD) is frequently underdiagnosed and often considered as a rare cause of acute coronary syndrome (ACS). Although it predominantly affects young women in the peripartum period, it can also occur in men. Most of the reported dissections have occurred in the left anterior descending coronary artery. The optimal treatment modalities are yet to be defined. Case Summary: A 50- year-old man who presented to us at National Institute of Cardio-Vascular Diseases (NICVD), Dhaka with an acute Non-ST-elevation myocardial infarction secondary to a spontaneous dissection of the Left anterior descending coronary artery. Due to ongoing chest pain, percutaneous coronary intervention (PCI) was done with drug eluting stent (DES) successfully, and the patient was discharged from the hospital on medical therapy. Conclusion: All clinicians should remain vigilant and aware of this condition, as patient outcomes and treatment guidelines differ substantially from conventional atherosclerotic ACS. Although initial conservative strategy is preferred strategy in SCAD management but timely intervention is warranted in selected cases. Bangladesh Heart Journal 2021; 36(2): 151-157
{"title":"A Case Report on Spontaneous Coronary Artery Dissection Managed by Percutaeneous Coronary Intervention (PCI)","authors":"K. K. Karmoker, B. Dutta, M. B. Rashid, M. A. Alam, Abm Riaz Kawsar, Khandaker Aisha Siddika, Mohammad Walidur Rahman","doi":"10.3329/bhj.v36i2.56042","DOIUrl":"https://doi.org/10.3329/bhj.v36i2.56042","url":null,"abstract":"Background: Spontaneous coronary artery dissection (SCAD) is frequently underdiagnosed and often considered as a rare cause of acute coronary syndrome (ACS). Although it predominantly affects young women in the peripartum period, it can also occur in men. Most of the reported dissections have occurred in the left anterior descending coronary artery. The optimal treatment modalities are yet to be defined. Case Summary: A 50- year-old man who presented to us at National Institute of Cardio-Vascular Diseases (NICVD), Dhaka with an acute Non-ST-elevation myocardial infarction secondary to a spontaneous dissection of the Left anterior descending coronary artery. Due to ongoing chest pain, percutaneous coronary intervention (PCI) was done with drug eluting stent (DES) successfully, and the patient was discharged from the hospital on medical therapy.\u0000Conclusion: All clinicians should remain vigilant and aware of this condition, as patient outcomes and treatment guidelines differ substantially from conventional atherosclerotic ACS. Although initial conservative strategy is preferred strategy in SCAD management but timely intervention is warranted in selected cases.\u0000Bangladesh Heart Journal 2021; 36(2): 151-157","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127833100","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}
Coronary artery disease (CAD) is one of the leading causes of death in our patient population. In the era of cardiovascular intervention, Percutaneous coronary intervention (PCI) is one of the most important modalities in treating these group of patients. Several CAD risks factors and co-morbid conditions are key responsible factor of procedural success. High bleeding risk (HBR) patients undergoing PCI is not an uncommon phenomenon. Incidences and prevalence of HBR patients with CAD and their management by PCI is not well addressed in our literature. PCI in HBR patients carries potential risk of intracranial hemorrhage (ICH) and lifethreatening bleeding. Therefore, careful pre-PCI assessment of possible risk or threats of post-PCI complications in patients with HBR are deem necessitate to understand. We recommend forming multicenter common consensus and to form a guideline in treating HBR patient by PCI. Thus, to reduce post procedural complication and subsequent improvement of mortality and morbidity in HBR patients undergoing PCI in both ST segment elevated myocardial infarction (STEMI) and as well as non-STEMI. Bangladesh Heart Journal 2021; 36(2): 133-138
{"title":"High Bleeding Risk (HBR) patients Percutaneous Coronary Intervention-a Challenge to Deal with","authors":"A. Islam, A. Reza, S. Munwar, S. Talukder","doi":"10.3329/bhj.v36i2.56039","DOIUrl":"https://doi.org/10.3329/bhj.v36i2.56039","url":null,"abstract":"Coronary artery disease (CAD) is one of the leading causes of death in our patient population. In the era of cardiovascular intervention, Percutaneous coronary intervention (PCI) is one of the most important modalities in treating these group of patients. Several CAD risks factors and co-morbid conditions are key responsible factor of procedural success. High bleeding risk (HBR) patients undergoing PCI is not an uncommon phenomenon. Incidences and prevalence of HBR patients with CAD and their management by PCI is not well addressed in our literature. PCI in HBR patients carries potential risk of intracranial hemorrhage (ICH) and lifethreatening bleeding. Therefore, careful pre-PCI assessment of possible risk or threats of post-PCI complications in patients with HBR are deem necessitate to understand. We recommend forming multicenter common consensus and to form a guideline in treating HBR patient by PCI. Thus, to reduce post procedural complication and subsequent improvement of mortality and morbidity in HBR patients undergoing PCI in both ST segment elevated myocardial infarction (STEMI) and as well as non-STEMI.\u0000Bangladesh Heart Journal 2021; 36(2): 133-138","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124045035","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 Mustafizur Rahman, M. M. Hossain, A. Tushar, A. Mamun, Md. Nazmul Haq, Kanak Jyoti Mondol
Pharmacological therapy is mostly employed in the management of supraventricular tachyarrhythmias in different part of the world including Bangladesh. However, Radiofrequency catheter ablation has been found to be highly effective and safe in the treatment of such tachyarrhythmias. Objective: The current study is aimed at sharing our experiences of 842 patients who presented with Supraventricular tachycardias and were diagnosed by EPS and treated with Radiofrequency catheter ablation. Methods: This descriptive study has been carried out in the cardiac electro physiology Department of NICVD, Dhaka, Bangladesh from 2nd January 2015 to 31st December, 2020. Electrophysiology study(EPS) was carried out to identity and diagnose the mechanism of different SVTs in 842 consecutive patients. RF catheter ablation was used to interrupt the tachycardia circuit. Results: Out of a total 842 patients who underwent Electrophysiology study, 435 were found to have atrioventricular nodal re-entry tachycardia (AVNRT) as underlying mechanism and 391 were having accessory pathway responsible for the reentry mechanism; of these accessory mediated tachycardia, 250 patients were manifested accessory pathway (WPWS); 141 were concealed accessory pathway (out of them 365 were presented with orthodromic and 26 as antidromic reciprocating tachycardia); moreover among the accessory pathway 231 patients were found having left sided accessory pathway whereas 155 having right sided pathway; 12 patients were having focal atrial tachycardia and 4 were found atrial flutter as the underlying cause for SVT. Radiofrequency catheter ablation was used with an overall success rate of 95%, recurrence rate of 2% without any significant complication. Complication: One patient developed pulmonary thrombo-embolism, 6 patients developed DVT of right lower limb, 4 patients developed complete heart block. Conclusion: RF catheter ablation is safe and highly effective mode of treatment of different types of supraventricular tachyarrhythmias which is emerging and becoming popular in our country. Bangladesh Heart Journal 2021; 36(2): 68-73
{"title":"Radiofrequency Catheter Ablation for Supraventricular Tachycardias: A Six-Year Single Centre Experience at NICVD","authors":"Md Mustafizur Rahman, M. M. Hossain, A. Tushar, A. Mamun, Md. Nazmul Haq, Kanak Jyoti Mondol","doi":"10.3329/bhj.v36i2.56031","DOIUrl":"https://doi.org/10.3329/bhj.v36i2.56031","url":null,"abstract":"Pharmacological therapy is mostly employed in the management of supraventricular tachyarrhythmias in different part of the world including Bangladesh. However, Radiofrequency catheter ablation has been found to be highly effective and safe in the treatment of such tachyarrhythmias.\u0000Objective: The current study is aimed at sharing our experiences of 842 patients who presented with Supraventricular tachycardias and were diagnosed by EPS and treated with Radiofrequency catheter ablation.\u0000Methods: This descriptive study has been carried out in the cardiac electro physiology Department of NICVD, Dhaka, Bangladesh from 2nd January 2015 to 31st December, 2020. Electrophysiology study(EPS) was carried out to identity and diagnose the mechanism of different SVTs in 842 consecutive patients. RF catheter ablation was used to interrupt the tachycardia circuit.\u0000Results: Out of a total 842 patients who underwent Electrophysiology study, 435 were found to have atrioventricular nodal re-entry tachycardia (AVNRT) as underlying mechanism and 391 were having accessory pathway responsible for the reentry mechanism; of these accessory mediated tachycardia, 250 patients were manifested accessory pathway (WPWS); 141 were concealed accessory pathway (out of them 365 were presented with orthodromic and 26 as antidromic reciprocating tachycardia); moreover among the accessory pathway 231 patients were found having left sided accessory pathway whereas 155 having right sided pathway; 12 patients were having focal atrial tachycardia and 4 were found atrial flutter as the underlying cause for SVT. Radiofrequency catheter ablation was used with an overall success rate of 95%, recurrence rate of 2% without any significant complication. Complication: One patient developed pulmonary thrombo-embolism, 6 patients developed DVT of right lower limb, 4 patients developed complete heart block.\u0000Conclusion: RF catheter ablation is safe and highly effective mode of treatment of different types of supraventricular tachyarrhythmias which is emerging and becoming popular in our country.\u0000Bangladesh Heart Journal 2021; 36(2): 68-73","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116024041","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. M. Hossain, M. Rahman, A. Tushar, A. Mamun, Md. Nazmul Haq, Kanak Jyoti Mondol
Background: Catheter ablation can be curative in patients with drug-refractory tachyarrhythmias. 3D electro anatomical mapping (EAM) is an established tool facilitating catheter ablation. This system is particularly valuable for mapping complex arrhythmias, which provide excellent assistance to catheter navigation, reduces fluoroscopy exposure, and also allow for the accurate placement of catheters. The Rhythmia Mapping System (RMS, Boston Scientific) is a novel system that allows for ultra-fast, high-density 3D mapping. Aim of this Study: The aim of this study was to find out the result of a high-density 3D mapping for the ablation of complex Cardiac Arrhythmias and to share our experiences. Methods: A total number of 44 patients of different tachyarrhythmias were scheduled for catheter ablation by Rhythmia Mapping System in National Institute of Cardiovascular Diseases, Bangladesh from 3rd February’2018 to 18th July’2019. During and after, the procedure all the cases were evaluated for different procedure parameters, acute success and in-hospital success. Results: Among the patients (28/44 male) 13 (25.55%) cases were atrial fibrillation, 6 (16.64%) cases were atrial flutter, 6 (16.64%) cases were atrial tachycardia, 2 (4.55%) cases were ventricular tachycardia, 11 (25%) cases were PVC and 6 (16.64%) cases were accessory pathway. The mean age was 38±4.5 years. In 25 (56.82%) of tachyarrhythmia patients, the mechanism was macro reentry/micro reentry, while in 19 (43.18%) cases the mechanism was increased automaticity. In all cases, the tachycardias were adequately mapped & proper identification of focus was done during the index procedure with the ultra-high density 3-D Rhythmia Mapping System (RMS). These all were successfully terminated by radiofrequency ablation, except one, which was one of the two cases of Ventricular tachycardia. With this system our study samples had a success rate of 98% with arrhythmia elimination. In patients of atrial fibrillation, all 4 pulmonary veins isolation were done. The mean mapping time was 28.6 ± 17 minutes, and the mean radiofrequency ablation time to arrhythmia termination was 3.2± 2.6 minutes. During our study only two out of 44 patients developed complications. One of the patients with atrial fibrillation developed cardiac tamponade and the other patient with PVC originating from Aortic cusp developed ischemic stroke. Fortunately, they were both managed accordingly. During hospital discharge, all the patients were free of tachyarrhythmia and were in sinus rhythm. Conclusions: This new automated ultrahigh-resolution mapping system allows accurate diagnosis of tachyarrhythmia circuits. Ablation of the focus resulted in high acute success. Bangladesh Heart Journal 2021; 36(2): 98-104
背景:导管消融术可以治愈药物难治性心动过速。三维电解剖映射(EAM)是一种成熟的导管消融工具。该系统对于复杂心律失常的定位特别有价值，它为导管导航提供了极好的帮助，减少了透视暴露，并且还允许导管的准确放置。心律失常映射系统(RMS, Boston Scientific)是一种新颖的系统，可以实现超快速、高密度的3D映射。目的:本研究的目的是了解高密度三维成像在复杂心律失常消融中的应用结果，并分享我们的经验。方法:2018年2月3日至2019年7月18日，孟加拉国国家心血管疾病研究所心律失常测绘系统安排44例不同速性心律失常患者进行导管消融。在手术期间和手术后，对所有病例进行不同手术参数、急性成功率和院内成功率的评估。结果:28/44例男性患者中，房颤13例(25.55%)，心房扑动6例(16.64%)，房性心动过速6例(16.64%)，室性心动过速2例(4.55%)，室性心动过速11例(25%)，副通路6例(16.64%)。平均年龄38±4.5岁。25例(56.82%)速性心律失常患者的机制为宏观再入/微观再入，19例(43.18%)速性心律失常患者的机制为自动性增强。在所有病例中，在索引过程中，使用超高密度3-D心律失常测绘系统(RMS)对心动过速进行了充分的映射和适当的焦点识别。所有这些都通过射频消融术成功终止，除了一个，这是两个室性心动过速病例中的一个。使用该系统，我们的研究样本消除心律失常的成功率为98%。房颤患者4条肺静脉全部隔离。平均定位时间28.6±17分钟，射频消融至心律失常终止平均时间3.2±2.6分钟。在我们的研究中，44例患者中只有2例出现并发症。1例房颤患者发生心包填塞，另1例起源于主动脉尖的PVC患者发生缺血性脑卒中。幸运的是，他们都得到了相应的管理。出院时，所有患者均无快速心律失常，窦性心律正常。结论:这种新的自动化超高分辨率制图系统可以准确诊断快速性心律失常电路。病灶消融术的急性成功率很高。孟加拉国心脏杂志2021;36 (2): 98 - 104
{"title":"High Density 3D Mapping and Ablation of Complex Cardiac Arrhythmias: Our Experience in NICVD","authors":"M. M. Hossain, M. Rahman, A. Tushar, A. Mamun, Md. Nazmul Haq, Kanak Jyoti Mondol","doi":"10.3329/bhj.v36i2.56035","DOIUrl":"https://doi.org/10.3329/bhj.v36i2.56035","url":null,"abstract":"Background: Catheter ablation can be curative in patients with drug-refractory tachyarrhythmias. 3D electro anatomical mapping (EAM) is an established tool facilitating catheter ablation. This system is particularly valuable for mapping complex arrhythmias, which provide excellent assistance to catheter navigation, reduces fluoroscopy exposure, and also allow for the accurate placement of catheters. The Rhythmia Mapping System (RMS, Boston Scientific) is a novel system that allows for ultra-fast, high-density 3D mapping.\u0000Aim of this Study: The aim of this study was to find out the result of a high-density 3D mapping for the ablation of complex Cardiac Arrhythmias and to share our experiences.\u0000Methods: A total number of 44 patients of different tachyarrhythmias were scheduled for catheter ablation by Rhythmia Mapping System in National Institute of Cardiovascular Diseases, Bangladesh from 3rd February’2018 to 18th July’2019. During and after, the procedure all the cases were evaluated for different procedure parameters, acute success and in-hospital success.\u0000Results: Among the patients (28/44 male) 13 (25.55%) cases were atrial fibrillation, 6 (16.64%) cases were atrial flutter, 6 (16.64%) cases were atrial tachycardia, 2 (4.55%) cases were ventricular tachycardia, 11 (25%) cases were PVC and 6 (16.64%) cases were accessory pathway. The mean age was 38±4.5 years. In 25 (56.82%) of tachyarrhythmia patients, the mechanism was macro reentry/micro reentry, while in 19 (43.18%) cases the mechanism was increased automaticity. In all cases, the tachycardias were adequately mapped & proper identification of focus was done during the index procedure with the ultra-high density 3-D Rhythmia Mapping System (RMS). These all were successfully terminated by radiofrequency ablation, except one, which was one of the two cases of Ventricular tachycardia. With this system our study samples had a success rate of 98% with arrhythmia elimination. In patients of atrial fibrillation, all 4 pulmonary veins isolation were done. The mean mapping time was 28.6 ± 17 minutes, and the mean radiofrequency ablation time to arrhythmia termination was 3.2± 2.6 minutes. During our study only two out of 44 patients developed complications. One of the patients with atrial fibrillation developed cardiac tamponade and the other patient with PVC originating from Aortic cusp developed ischemic stroke. Fortunately, they were both managed accordingly. During hospital discharge, all the patients were free of tachyarrhythmia and were in sinus rhythm.\u0000Conclusions: This new automated ultrahigh-resolution mapping system allows accurate diagnosis of tachyarrhythmia circuits. Ablation of the focus resulted in high acute success.\u0000Bangladesh Heart Journal 2021; 36(2): 98-104","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126645158","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}
Mohsin Ahmed, M. Islam, A. Islam, Mohammad Arifur Rahman, Kazi Abul Fazal Ferdous, CM Khudrate E Khuda, Bikash Chandra Das, M. N. Uddin
Background: Obesity is now becoming a global epidemic. It is most of the times associated with hypertension, diabetes mellitus (DM), metabolic syndrome and dyslipidemia which are known risk factors for coronary artery disease (CAD). Coronary arteriosclerosis comprises a series of inflammatory responses at cellular and molecular level, whose reactions are stronger in obese patients. The objective of this study was to observe the association of obesity and raised inflammatory markers with CAD. Method: This cross-sectional study was carried out in the Department of Cardiology, Dhaka Medical College Hospital, Dhaka, Bangladesh, involving 668 patients of ischemic heart disease who underwent coronary angiography (CAG) from January 2017 to December 2017. Obesity was defined as body-mass index (BMI) ≥30.0 kg/m2. C-reactive protein (CRP) was measured as the inflammatory marker, and was considered as high if >10 mg/L. CAD was classified on the basis of CAG findings: insignificant if stenosis is <50% and significant if stenosis is ≥50%; and single-vessel, double-vessel, triple-vessel disease and normal coronaries according to number of vessels involved. Chi square test was used to analyze the categorical variables, and Pearson’s correlation coefficient was used to test the relationship between CRP and BMI in CAD patients. p values of <0.05 were considered as statistically significant. Results: Demographic characteristics like age, sex and educational status did not differ significantly between obese and non-obese patients. Risk factors for CAD were similar between obese and non-obese, as well as, between high-CRP (>10 mg/L) and non-high CRP (≤10 mg/L) groups, however, DM, hypertension and dyslipidaemia were significantly more common in obese and high-CRP groups than in non-obese and non-high CRP groups. Raised CRP was significantly more common in obese than in non-obese patients (56.9% vs. 47.9%, p=0.04). Significant positive correlation was found between CRP and BMI (r=0.228; p=0.001). Triple-vessel CAD was found significantly more commonly in obese group than in non-obese group (29.3% vs 24.4%, p=0.04), whereas normal coronaries were more common in nonobese than in obese counterpart. Obesity, high CRP (>10 mg/L), DM, and high HbA1c (≥6.5%) were found significant predictors of severe CAD (p <0.5) in multivariate logistic regression analysis. Conclusion: Obesity is associated with raised inflammatory marker in patients with CAD, and a significant positive association exists between obesity and inflammation and CAD. Future studies are needed to explore the impact of type of obesity and inflammation on CAD. Bangladesh Heart Journal 2021; 36(1): 9-16
{"title":"Association of Obesity and C-Reactive Protein with Coronary Artery Disease","authors":"Mohsin Ahmed, M. Islam, A. Islam, Mohammad Arifur Rahman, Kazi Abul Fazal Ferdous, CM Khudrate E Khuda, Bikash Chandra Das, M. N. Uddin","doi":"10.3329/bhj.v36i1.55512","DOIUrl":"https://doi.org/10.3329/bhj.v36i1.55512","url":null,"abstract":"Background: Obesity is now becoming a global epidemic. It is most of the times associated with hypertension, diabetes mellitus (DM), metabolic syndrome and dyslipidemia which are known risk factors for coronary artery disease (CAD). Coronary arteriosclerosis comprises a series of inflammatory responses at cellular and molecular level, whose reactions are stronger in obese patients. The objective of this study was to observe the association of obesity and raised inflammatory markers with CAD.\u0000Method: This cross-sectional study was carried out in the Department of Cardiology, Dhaka Medical College Hospital, Dhaka, Bangladesh, involving 668 patients of ischemic heart disease who underwent coronary angiography (CAG) from January 2017 to December 2017. Obesity was defined as body-mass index (BMI) ≥30.0 kg/m2. C-reactive protein (CRP) was measured as the inflammatory marker, and was considered as high if >10 mg/L. CAD was classified on the basis of CAG findings: insignificant if stenosis is <50% and significant if stenosis is ≥50%; and single-vessel, double-vessel, triple-vessel disease and normal coronaries according to number of vessels involved. Chi square test was used to analyze the categorical variables, and Pearson’s correlation coefficient was used to test the relationship between CRP and BMI in CAD patients. p values of <0.05 were considered as statistically significant.\u0000Results: Demographic characteristics like age, sex and educational status did not differ significantly between obese and non-obese patients. Risk factors for CAD were similar between obese and non-obese, as well as, between high-CRP (>10 mg/L) and non-high CRP (≤10 mg/L) groups, however, DM, hypertension and dyslipidaemia were significantly more common in obese and high-CRP groups than in non-obese and non-high CRP groups. Raised CRP was significantly more common in obese than in non-obese patients (56.9% vs. 47.9%, p=0.04). Significant positive correlation was found between CRP and BMI (r=0.228; p=0.001). Triple-vessel CAD was found significantly more commonly in obese group than in non-obese group (29.3% vs 24.4%, p=0.04), whereas normal coronaries were more common in nonobese than in obese counterpart. Obesity, high CRP (>10 mg/L), DM, and high HbA1c (≥6.5%) were found significant predictors of severe CAD (p <0.5) in multivariate logistic regression analysis.\u0000Conclusion: Obesity is associated with raised inflammatory marker in patients with CAD, and a significant positive association exists between obesity and inflammation and CAD. Future studies are needed to explore the impact of type of obesity and inflammation on CAD.\u0000Bangladesh Heart Journal 2021; 36(1): 9-16","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"227 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114414674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Raha, S. Biswas, Sorower Hossain, Salahuddin Rahaman, Khan Muhammad Fahim Bin Enayet, K. Hasan
Introduction: In cardiac surgery, anaemia itself or combined with other risk factors has been found to be a major predictor for adverse outcome both preoperatively and postoperatively and even during extracorporeal circulation, but data about the specific tolerance of Coronary Artery Bypass Graft (CABG) patients for anaemia are conflicting and may in part be confounded by the effects of bypass surgery. Objectives: This study was performed in the National Institute of Cardiovascular Diseases (NICVD) to observe whether the early outcomes of Off-Pump CABG (OPCAB)were affected by pre-operative haematocrit levels. Methods: A total of 200 patients who underwent isolated OPCAB between January 2015 and December 2020 were retrospectively selected and purposively allocated into two groups: a)100 patients having preoperative anaemia and b) 100 patients without preoperative anaemia. Preoperative, per-operative and early post-operative variables were recorded, compiled and compared. Results: Preoperative characteristics were homogenously distributed between two groups other than haemoglobin level. Female patients had lower haemoglobin in each group. More patients of anaemic group required intraoperative and postoperative blood transfusion. The amount of blood loss and transfused blood products was also higher in anaemic patients. The ventilation time, length of ICU and post-operative hospital stay were significantly higher among anaemic patients. Among the post-operative complications, only the incidence of renal dysfunction was significantly higher among anaemic patients. Conclusion:This study has showed that anaemic patients undergoing OPCAB had an increased risk of postoperative adverse events. Importantly, the extent of preexisting comorbidities substantially affected perioperative anaemia tolerance. Therefore, preoperative risk assessment, optimization and subsequent therapeutic strategies, such as blood transfusion, should take into account both the individual level of preoperative haemoglobin and the extent of concomitant risk factors. Bangladesh Heart Journal 2021; 36(1) : 47-54
{"title":"The Impact of Preoperative Anaemia on Early Outcomes after Off-pump Coronary Artery Bypass Grafting","authors":"S. Raha, S. Biswas, Sorower Hossain, Salahuddin Rahaman, Khan Muhammad Fahim Bin Enayet, K. Hasan","doi":"10.3329/bhj.v36i1.55517","DOIUrl":"https://doi.org/10.3329/bhj.v36i1.55517","url":null,"abstract":"Introduction: In cardiac surgery, anaemia itself or combined with other risk factors has been found to be a major predictor for adverse outcome both preoperatively and postoperatively and even during extracorporeal circulation, but data about the specific tolerance of Coronary Artery Bypass Graft (CABG) patients for anaemia are conflicting and may in part be confounded by the effects of bypass surgery.\u0000Objectives: This study was performed in the National Institute of Cardiovascular Diseases (NICVD) to observe whether the early outcomes of Off-Pump CABG (OPCAB)were affected by pre-operative haematocrit levels.\u0000Methods: A total of 200 patients who underwent isolated OPCAB between January 2015 and December 2020 were retrospectively selected and purposively allocated into two groups: a)100 patients having preoperative anaemia and b) 100 patients without preoperative anaemia. Preoperative, per-operative and early post-operative variables were recorded, compiled and compared. Results: Preoperative characteristics were homogenously distributed between two groups other than haemoglobin level. Female patients had lower haemoglobin in each group. More patients of anaemic group required intraoperative and postoperative blood transfusion. The amount of blood loss and transfused blood products was also higher in anaemic patients. The ventilation time, length of ICU and post-operative hospital stay were significantly higher among anaemic patients. Among the post-operative complications, only the incidence of renal dysfunction was significantly higher among anaemic patients.\u0000Conclusion:This study has showed that anaemic patients undergoing OPCAB had an increased risk of postoperative adverse events. Importantly, the extent of preexisting comorbidities substantially affected perioperative anaemia tolerance. Therefore, preoperative risk assessment, optimization and subsequent therapeutic strategies, such as blood transfusion, should take into account both the individual level of preoperative haemoglobin and the extent of concomitant risk factors.\u0000Bangladesh Heart Journal 2021; 36(1) : 47-54","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"166 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126945924","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}
Pinaki Das, M. A. Razzaque, RA Ahmed, Shafiqul Islam, R. Barman, A. Khan, M. Mamunuzzaman, A. Uddin, Abdul Kader Akanda, M. Azam
Background: Noninvasive assessment of arterial stiffness with aortic pulse wave velocity (PWV) may serve as a useful adjunct to the cardiovascular risk stratification and risk management. The aim of this study was to evaluate the association between aortic PWV and severity of coronary artery disease (CAD) in patients with non-STsegment elevation myocardial infarction (NSTEMI). Methods: This cross sectional analytical study was conducted over 100 NSTEMI patients who were purposively selected and agreed to do coronary angiogram during index hospital admission. PWV was assessed noninvasively using the SphygmoCor® system on the day before coronary angiogram (CAG). Study subjects were divided into two groups on the basis of PWV. In group I: PWV was ≤10 m/sec and in group II: PWV was > 10 m/sec. Fifty patients in each group. Angiographic severity of CAD was assessed by vessel score, Friesinger score and Leaman score. Results: Vessel score 2 and 3 were significantly (p<0.05) higher in group II and vessel score 0 and 1 were significantly (p<0.05) higher in group I. The mean PWV in the group with normal angiographic results was 8.21±1.8 m/sec, and in patients with single-vessel disease it was 9.88±2.02 m/sec. In those with double and triple vessel disease the mean PWV was found 11.95±2.61 m/sec and 14.37±2.96 m/sec respectively. There was a significant difference of the mean value of PWV among the vessel involvement group (p=0.001). Normal and low Friesinger score were significantly (p<0.05) higher in group I patients. Intermediate and high Friesinger score were significantly (p<0.05) higher in group II patients. Increased PWV was significantly associated with the presence and severity of CAD in NSTEMI. This association showed a positive linear relation between the values of PWV and vessel score (r=0.65, p=0.01), Friesinger score (r=0.61, p=0.01), and Leaman score (r=0.36, p=0.01). Conclusion: From this study it may be stated that arterial stiffness, as measured by the aortic PWV, is an independent predictor of the presence and extent of CAD. Measurements of aortic PWV in NSTEMI can detect high risk patients requiring an early invasive strategy over a delayed invasive strategy. Bangladesh Heart Journal 2021; 36(1) : 38-46
{"title":"Association of Aortic Pulse Wave Velocity with the Severity of Coronary Artery Disease in Patients with Non-ST-Segment Elevation Myocardial Infarction","authors":"Pinaki Das, M. A. Razzaque, RA Ahmed, Shafiqul Islam, R. Barman, A. Khan, M. Mamunuzzaman, A. Uddin, Abdul Kader Akanda, M. Azam","doi":"10.3329/bhj.v36i1.55516","DOIUrl":"https://doi.org/10.3329/bhj.v36i1.55516","url":null,"abstract":"Background: Noninvasive assessment of arterial stiffness with aortic pulse wave velocity (PWV) may serve as a useful adjunct to the cardiovascular risk stratification and risk management. The aim of this study was to evaluate the association between aortic PWV and severity of coronary artery disease (CAD) in patients with non-STsegment elevation myocardial infarction (NSTEMI). Methods: This cross sectional analytical study was conducted over 100 NSTEMI patients who were purposively selected and agreed to do coronary angiogram during index hospital admission. PWV was assessed noninvasively using the SphygmoCor® system on the day before coronary angiogram (CAG). Study subjects were divided into two groups on the basis of PWV. In group I: PWV was ≤10 m/sec and in group II: PWV was > 10 m/sec. Fifty patients in each group. Angiographic severity of CAD was assessed by vessel score, Friesinger score and Leaman score. Results: Vessel score 2 and 3 were significantly (p<0.05) higher in group II and vessel score 0 and 1 were significantly (p<0.05) higher in group I. The mean PWV in the group with normal angiographic results was 8.21±1.8 m/sec, and in patients with single-vessel disease it was 9.88±2.02 m/sec. In those with double and triple vessel disease the mean PWV was found 11.95±2.61 m/sec and 14.37±2.96 m/sec respectively. There was a significant difference of the mean value of PWV among the vessel involvement group (p=0.001). Normal and low Friesinger score were significantly (p<0.05) higher in group I patients. Intermediate and high Friesinger score were significantly (p<0.05) higher in group II patients. Increased PWV was significantly associated with the presence and severity of CAD in NSTEMI. This association showed a positive linear relation between the values of PWV and vessel score (r=0.65, p=0.01), Friesinger score (r=0.61, p=0.01), and Leaman score (r=0.36, p=0.01). Conclusion: From this study it may be stated that arterial stiffness, as measured by the aortic PWV, is an independent predictor of the presence and extent of CAD. Measurements of aortic PWV in NSTEMI can detect high risk patients requiring an early invasive strategy over a delayed invasive strategy.\u0000Bangladesh Heart Journal 2021; 36(1) : 38-46","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116354236","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 Rafiur Rahman, Asma Akter, A. Mohiuddin, Sayedur R Khan, J. Kabir
Anomalous origin of the coronary arteries is a very rare phenomenon and is seen only in less than 1% of the general population. Single coronary artery (SCA) is a congenital anatomic abnormality identified by a single coronary ostium giving rise to one coronary artery. Our case presented at 40 years with intermittent chest discomfort, effort intolerance and a history of getting Streptokinase one month back due to AMI (Inferior). Diagnosis was confirmed with elective conventional coronary angiography and coronary CT angiography as an extremely rare variant of the left main coronary artery (LMCA) branching off from the right coronary artery (RCA) and then following a pre-pulmonic course. We did Off Pump CABG surgery with four grafts and discharged the patient uneventfully with guidelinedirected medical therapy with a beta-blocker, statin, and dual antiplatelet agents and the patient is on follow up. Bangladesh Heart Journal 2021; 36(1) : 61-66
{"title":"Anomalous Origin of Left Main Coronary Artery from Right Coronary Artery in A Patient Presenting with Inferior Wall Myocardial Infarction: A Case Report","authors":"Mohammad Rafiur Rahman, Asma Akter, A. Mohiuddin, Sayedur R Khan, J. Kabir","doi":"10.3329/bhj.v36i1.55519","DOIUrl":"https://doi.org/10.3329/bhj.v36i1.55519","url":null,"abstract":"Anomalous origin of the coronary arteries is a very rare phenomenon and is seen only in less than 1% of the general population. Single coronary artery (SCA) is a congenital anatomic abnormality identified by a single coronary ostium giving rise to one coronary artery. Our case presented at 40 years with intermittent chest discomfort, effort intolerance and a history of getting Streptokinase one month back due to AMI (Inferior). Diagnosis was confirmed with elective conventional coronary angiography and coronary CT angiography as an extremely rare variant of the left main coronary artery (LMCA) branching off from the right coronary artery (RCA) and then following a pre-pulmonic course. We did Off Pump CABG surgery with four grafts and discharged the patient uneventfully with guidelinedirected medical therapy with a beta-blocker, statin, and dual antiplatelet agents and the patient is on follow up.\u0000Bangladesh Heart Journal 2021; 36(1) : 61-66","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123107158","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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