Bashir Ahmed, Khalil Ahmed Shaikh, Jehangir Ali Shah, Rajesh Kumar, Kamran Ahmed Khan, Mahesh Kumar Batra, Ambreen Nisar, Tahir Saghir, Nadeem Qamar
Objectives: This study aimed to assess the association of left ventricular end-diastolic pressure (LVEDP) with the extent and severity of coronary artery diseases (CAD) in individuals undergoing primary percutaneous coronary intervention (PCI) at a tertiary care cardiac center in Karachi, Pakistan. Methodology: This descriptive cross-sectional study included consecutive patients undergoing primary PCI. LVEDP was assessed with the help of a multipurpose catheter. The Association of LVEDP with the extent and severity of CAD was assessed. Results: LVEDP was stratified as ≤15 mmHg, 15-25 mmHg, and >25 mmHg. Out of 498 patients included in this study, 76.3% (380) were male, and mean age was 53.7±11.7 years. Mean LVEDP was 19.35±6.17 mmHg. Burden of diseases was found to be significantly associated with LVEDP level (p<0.001) with mean LVEDP of 18.5±5.6 mmHg, 19.5±6 mmHg, and 21.4±7.2 mmHg among patients with single, two and three-vessel disease respectively. Proportion of three-vessel diseases was 15.5% (37/239), 22.5% (47/209), and 36% (18/50) at LVEDP ≤15 mmHg, 15-25 mmHg, and >25 mmHg, respectively. Conclusion: There was a strong inverse relationship between LVEDP and initial TIMI flow grade (p=0.013) and a positive relationship between LVEDP and total length of the lesion (p=0.002). In conclusion, increased LVEDP was found to be associated with increased burden and extent of coronary artery disease, poor initial TIMI flow grade, and longer length of lesion.
{"title":"Left Ventricular End-Diastolic Pressure and Extent of Coronary Artery Disease in Patients Undergoing Primary Percutaneous Coronary Intervention","authors":"Bashir Ahmed, Khalil Ahmed Shaikh, Jehangir Ali Shah, Rajesh Kumar, Kamran Ahmed Khan, Mahesh Kumar Batra, Ambreen Nisar, Tahir Saghir, Nadeem Qamar","doi":"10.47144/phj.v56i3.2481","DOIUrl":"https://doi.org/10.47144/phj.v56i3.2481","url":null,"abstract":"Objectives: This study aimed to assess the association of left ventricular end-diastolic pressure (LVEDP) with the extent and severity of coronary artery diseases (CAD) in individuals undergoing primary percutaneous coronary intervention (PCI) at a tertiary care cardiac center in Karachi, Pakistan. Methodology: This descriptive cross-sectional study included consecutive patients undergoing primary PCI. LVEDP was assessed with the help of a multipurpose catheter. The Association of LVEDP with the extent and severity of CAD was assessed. Results: LVEDP was stratified as ≤15 mmHg, 15-25 mmHg, and >25 mmHg. Out of 498 patients included in this study, 76.3% (380) were male, and mean age was 53.7±11.7 years. Mean LVEDP was 19.35±6.17 mmHg. Burden of diseases was found to be significantly associated with LVEDP level (p<0.001) with mean LVEDP of 18.5±5.6 mmHg, 19.5±6 mmHg, and 21.4±7.2 mmHg among patients with single, two and three-vessel disease respectively. Proportion of three-vessel diseases was 15.5% (37/239), 22.5% (47/209), and 36% (18/50) at LVEDP ≤15 mmHg, 15-25 mmHg, and >25 mmHg, respectively. Conclusion: There was a strong inverse relationship between LVEDP and initial TIMI flow grade (p=0.013) and a positive relationship between LVEDP and total length of the lesion (p=0.002). In conclusion, increased LVEDP was found to be associated with increased burden and extent of coronary artery disease, poor initial TIMI flow grade, and longer length of lesion.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136343178","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}
Systemic blood pressure, recorded by various parameters, always shows variation. This is known as ‘variability’, an entity not assessed routinely. Research has shown greater prognostic importance of it than routine parameters. Various intrinsic and extrinsic factors modulate it. Depending on the interval of successive readings, blood pressure variability is of five types, with different non-invasive methods utilized for recording. It is calculated by various statistical parameters, the most common being standard deviation, but average real variability is the most accurate and easily applied. Clinical evidence is increasing rapidly, indicating variability as a prognostic marker for stroke, ischemic heart disease, renal failure, cognitive dysfunction, heart failure, and mortality. Therapeutic measures for the control of variability have also been forwarded. The paucity of clinical application of blood pressure variability is the stimulus to narrate this review, especially for physicians managing hypertensive patients.
{"title":"Variability: The Hallmark of Blood Pressure Measurement – Types, Assessment and Prognostic Significance","authors":"Imran Hameed","doi":"10.47144/phj.v56i3.2617","DOIUrl":"https://doi.org/10.47144/phj.v56i3.2617","url":null,"abstract":"Systemic blood pressure, recorded by various parameters, always shows variation. This is known as ‘variability’, an entity not assessed routinely. Research has shown greater prognostic importance of it than routine parameters. Various intrinsic and extrinsic factors modulate it. Depending on the interval of successive readings, blood pressure variability is of five types, with different non-invasive methods utilized for recording. It is calculated by various statistical parameters, the most common being standard deviation, but average real variability is the most accurate and easily applied. Clinical evidence is increasing rapidly, indicating variability as a prognostic marker for stroke, ischemic heart disease, renal failure, cognitive dysfunction, heart failure, and mortality. Therapeutic measures for the control of variability have also been forwarded. The paucity of clinical application of blood pressure variability is the stimulus to narrate this review, especially for physicians managing hypertensive patients.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136343749","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}
Objectives: This study was aimed to explore the association of ABO gene variants with coronary artery disease. Methodology: This was a case-control study. Cases and controls were individuals with greater than 50% and less than 30% stenosis, respectively. One hundred thirty-eight samples were obtained, with 69 cases and 69 controls. The operator completed a proforma regarding demographics, medical history, and blood group. The bench work included blood typing, followed by blood genotyping by DNA extraction, PCR, and then Sanger's sequencing. The single nucleotide polymorphisms (SNPs) selected for the ABO gene were rs8176746 and rs8176719. Results: The results show that 68.1% of the participants were male cases, compared to 49.27% controls. The frequency of patients belonging to the old age group (60-75 years) was 65.21% in cases and 34.78% in controls. A+ was the most prevalent group in cases, with 33.33%, followed by 24.6% B+, 23.2% O+, and 4.3% AB+. Patients with Rh-ve groups were rare. On the contrary, 33.33% of patients were O+ in controls. A chi-square test showed that the A+ blood group was significantly associated with CAD, having a p-value of 0.01. Although blood genotypes did not show a significant p-value, the odds of having genotype AA was 1.35 times higher in cases compared to the controls. Conclusion: This study shows that the A+ group is significantly associated with CAD. The data obtained through Sanger’s sequencing determined the genetic variants of blood groups, but no statistically significant association was found between them and CAD.
{"title":"Unraveling Coronary Artery Disease vulnerability in patients with ABO gene polymorphism: A Case-Control Study in Pakistan perspective","authors":"Saadia Saad, Syed Tousif Ahmed, Ambrina Khatoon, Jawaid Ansari, Asaad Javaid Mirza","doi":"10.47144/phj.v56i3.2601","DOIUrl":"https://doi.org/10.47144/phj.v56i3.2601","url":null,"abstract":"Objectives: This study was aimed to explore the association of ABO gene variants with coronary artery disease. Methodology: This was a case-control study. Cases and controls were individuals with greater than 50% and less than 30% stenosis, respectively. One hundred thirty-eight samples were obtained, with 69 cases and 69 controls. The operator completed a proforma regarding demographics, medical history, and blood group. The bench work included blood typing, followed by blood genotyping by DNA extraction, PCR, and then Sanger's sequencing. The single nucleotide polymorphisms (SNPs) selected for the ABO gene were rs8176746 and rs8176719. Results: The results show that 68.1% of the participants were male cases, compared to 49.27% controls. The frequency of patients belonging to the old age group (60-75 years) was 65.21% in cases and 34.78% in controls. A+ was the most prevalent group in cases, with 33.33%, followed by 24.6% B+, 23.2% O+, and 4.3% AB+. Patients with Rh-ve groups were rare. On the contrary, 33.33% of patients were O+ in controls. A chi-square test showed that the A+ blood group was significantly associated with CAD, having a p-value of 0.01. Although blood genotypes did not show a significant p-value, the odds of having genotype AA was 1.35 times higher in cases compared to the controls. Conclusion: This study shows that the A+ group is significantly associated with CAD. The data obtained through Sanger’s sequencing determined the genetic variants of blood groups, but no statistically significant association was found between them and CAD.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136343750","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}
Muhammad Sarim Ansari, G. Irfan, Z. Mumtaz, F. Qadir, Maqsood Alam, S. Shaikh, A. Mueed
Objectives: The study aimed at assessing the outcome of pulmonary vein isolation (PVI) using second-generation cryoballoon, Arctic Front Advance, Medtronic (CB-Adv) as a rhythm control strategy for drug-resistant paroxysmal atrial fibrillation (PAF) in a cardiac tertiary care center of Pakistan. Methodology: Fifty patients had PVI with CB-Adv for symptomatic drug-resistant PAF at the National Institute of Cardiovascular Diseases, Karachi, Pakistan, during 2017-2022. Patients were followed-up in the clinic on the 1st, 3rd, and 6th month after the ablation. Twenty-four hours of Holter monitoring of electrocardiogram was obtained on each visit. We conducted a retrospective chart review after approval from the ethical review committee. We collected all the patients' demographic and clinical data, procedural results, and reports of Holter monitoring. The primary outcome was successful PVI and freedom from atrial tachyarrhythmia (Ata) on a 6-month follow-up. Results: We enrolled all 50 patients (34 male, 68%; mean age 55.14 ± 7.94 years) treated with PVI using CB-Adv. The mean duration of symptoms was 30.28 ± 13.48 months. PVI with CB-Adv was found to be curative in 49 patients (98%). Following the procedure, pericardial effusion was found in one patient (2%), whereas one patient (2%) had a retroperitoneal hematoma. On a six-month follow-up, only one patient (2%) had a recurrence of Ata, which was PAF. Conclusion: Our experience of PVI with CB-Adv has shown a high success rate of the procedure for rhythm control in patients who have PAF, which is resistant to antiarrhythmic drugs (AADs).
目的:本研究旨在评估在巴基斯坦心脏第三级保健中心使用第二代冷冻球囊，Arctic Front Advance, Medtronic (CB-Adv)作为耐药阵发性心房颤动(PAF)的节律控制策略的肺静脉隔离(PVI)的结果。方法:2017-2022年期间，巴基斯坦卡拉奇国家心血管疾病研究所的50例PVI患者因症状性耐药PAF接受CB-Adv治疗。术后1、3、6个月随访。每次就诊均进行24小时动态心电图监测。经伦理审查委员会批准后，我们进行了回顾性的图表审查。我们收集了所有患者的人口学和临床数据、手术结果和动态心电图监测报告。在6个月的随访中，主要结果是PVI成功和房性心动过速(Ata)的自由。结果:我们纳入了所有50例患者(男性34例，68%;平均年龄55.14±7.94岁)。平均症状持续时间30.28±13.48个月。合并CB-Adv的PVI患者有49例(98%)可治愈。手术后，1例(2%)患者发现心包积液，而1例(2%)患者出现腹膜后血肿。在6个月的随访中，只有1名患者(2%)复发了Ata，即PAF。结论:我们的PVI合并CB-Adv的经验表明，对于抗心律失常药物(AADs)耐药的PAF患者，该程序的心律控制成功率很高。
{"title":"Five-Year Experience of Second-Generation Cryoballoon Ablation for Paroxysmal Atrial Fibrillation from a Tertiary Cardiac Care Center of Pakistan: A Retrospective Chart Review","authors":"Muhammad Sarim Ansari, G. Irfan, Z. Mumtaz, F. Qadir, Maqsood Alam, S. Shaikh, A. Mueed","doi":"10.47144/phj.v56i2.2514","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2514","url":null,"abstract":"Objectives: The study aimed at assessing the outcome of pulmonary vein isolation (PVI) using second-generation cryoballoon, Arctic Front Advance, Medtronic (CB-Adv) as a rhythm control strategy for drug-resistant paroxysmal atrial fibrillation (PAF) in a cardiac tertiary care center of Pakistan.\u0000Methodology: Fifty patients had PVI with CB-Adv for symptomatic drug-resistant PAF at the National Institute of Cardiovascular Diseases, Karachi, Pakistan, during 2017-2022. Patients were followed-up in the clinic on the 1st, 3rd, and 6th month after the ablation. Twenty-four hours of Holter monitoring of electrocardiogram was obtained on each visit. We conducted a retrospective chart review after approval from the ethical review committee. We collected all the patients' demographic and clinical data, procedural results, and reports of Holter monitoring. The primary outcome was successful PVI and freedom from atrial tachyarrhythmia (Ata) on a 6-month follow-up.\u0000Results: We enrolled all 50 patients (34 male, 68%; mean age 55.14 ± 7.94 years) treated with PVI using CB-Adv. The mean duration of symptoms was 30.28 ± 13.48 months. PVI with CB-Adv was found to be curative in 49 patients (98%). Following the procedure, pericardial effusion was found in one patient (2%), whereas one patient (2%) had a retroperitoneal hematoma. On a six-month follow-up, only one patient (2%) had a recurrence of Ata, which was PAF.\u0000Conclusion: Our experience of PVI with CB-Adv has shown a high success rate of the procedure for rhythm control in patients who have PAF, which is resistant to antiarrhythmic drugs (AADs).","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48122710","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. I. Bhatti, Madiha Imdad, Gulzar Ali, N. Khan, Shakir Zada, Shueeta Kumari
Objectives: Acute kidney injury (AKI) is frequently present co-morbid condition in patients admitted with acute heart failure (AHF). This study aimed to determine the frequency of in-hospital mortality in AHF patients presenting with AKI. Methodology: This descriptive case series of AHF patients with AKI was conducted at a tertiary care cardiac hospital in Karachi, Pakistan. In accordance with the “Risk, Injury, Failure, Loss, and End‐Stage Renal Disease (RIFLE) scale," the AKI was defined as a 3.0‐fold increase in serum creatinine (sCr) or sCr > 4.0 mg/dL within 48 hours. All the patients were followed for seven days in order to assess the outcome variable, i.e., in-hospital mortality. Results: A total of 149 patients were included with a mean age of 59.7 ± 11.03 years, and 80 (53.7%) patients were male. Hypertensive patients were 59.1% (88) of the sample, and 38.9% (58) of the patients were diabetics. In-hospital mortality was found in 11 (7.4%) patients. The mortality rate was 14.1% vs. 2.4%; p=0.008 among patients >60 and 40 to 60 years, respectively. The mortality rate was 12.5% vs. 3.5%; p=0.038 among diabetic and non-diabetic patients. Similarly, the mortality rate was 11.4% vs. 1.6%, p=0.022, among hypertensive and non-hypertensive patients. Conclusion: It is to conclude that AKI in AHF patients carries a significant burden of in-hospital mortality. The mortality rate was significantly higher for patients with older age and co-morbid conditions such as hypertension and diabetes.
{"title":"In-hospital Mortality in Heart Failure Patients with Acute Kidney Injury","authors":"K. I. Bhatti, Madiha Imdad, Gulzar Ali, N. Khan, Shakir Zada, Shueeta Kumari","doi":"10.47144/phj.v56i2.2543","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2543","url":null,"abstract":"Objectives: Acute kidney injury (AKI) is frequently present co-morbid condition in patients admitted with acute heart failure (AHF). This study aimed to determine the frequency of in-hospital mortality in AHF patients presenting with AKI.\u0000Methodology: This descriptive case series of AHF patients with AKI was conducted at a tertiary care cardiac hospital in Karachi, Pakistan. In accordance with the “Risk, Injury, Failure, Loss, and End‐Stage Renal Disease (RIFLE) scale,\" the AKI was defined as a 3.0‐fold increase in serum creatinine (sCr) or sCr > 4.0 mg/dL within 48 hours. All the patients were followed for seven days in order to assess the outcome variable, i.e., in-hospital mortality.\u0000Results: A total of 149 patients were included with a mean age of 59.7 ± 11.03 years, and 80 (53.7%) patients were male. Hypertensive patients were 59.1% (88) of the sample, and 38.9% (58) of the patients were diabetics. In-hospital mortality was found in 11 (7.4%) patients. The mortality rate was 14.1% vs. 2.4%; p=0.008 among patients >60 and 40 to 60 years, respectively. The mortality rate was 12.5% vs. 3.5%; p=0.038 among diabetic and non-diabetic patients. Similarly, the mortality rate was 11.4% vs. 1.6%, p=0.022, among hypertensive and non-hypertensive patients.\u0000Conclusion: It is to conclude that AKI in AHF patients carries a significant burden of in-hospital mortality. The mortality rate was significantly higher for patients with older age and co-morbid conditions such as hypertension and diabetes.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45512713","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}
Syncope is a frequently encountered condition in the emergency room, with vagal syncope being the most prevalent form. However, overlapping symptoms can pose diagnostic challenges when distinguishing between vagal syncope and symptomatic sinus node dysfunction. A comprehensive history and careful evaluation of hemodynamics and electrocardiogram findings are crucial for accurate differentiation. Vagal syncope is typically associated with an upright posture, and supine syncope is considered atypical. In this case report, we describe an intriguing instance of supine vagal syncope, highlighting the importance of correct diagnosis to avoid unnecessary pacemaker implantation.
{"title":"A Case of Recurrent Syncope: To Pace or not to Pace is the Question?","authors":"F. Hussain, Aman Qureshi, I. Ahmed, A. Khan","doi":"10.47144/phj.v56i2.2387","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2387","url":null,"abstract":"Syncope is a frequently encountered condition in the emergency room, with vagal syncope being the most prevalent form. However, overlapping symptoms can pose diagnostic challenges when distinguishing between vagal syncope and symptomatic sinus node dysfunction. A comprehensive history and careful evaluation of hemodynamics and electrocardiogram findings are crucial for accurate differentiation. Vagal syncope is typically associated with an upright posture, and supine syncope is considered atypical. In this case report, we describe an intriguing instance of supine vagal syncope, highlighting the importance of correct diagnosis to avoid unnecessary pacemaker implantation.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46083304","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}
Hypertension poses a significant global burden due to low adherence to antihypertensive medications. Hypertension treatment aims to bring blood pressure within physiological ranges and reduce the risk of cardiovascular disease and organ damage associated with high blood pressure. It is estimated that around 1.13 billion people have hypertension, accounting for 13% of all fatalities worldwide. The World Health Organization aims to reduce this number by 25% by 2025 compared to the baseline year of 2010.1,2 Despite the availability of effective antihypertensive medications and decreased main risk factors, achieving optimal blood pressure control remains challenging for various reasons, including apparent drug resistance and poor compliance.3,4 One of the contributing factors to poor blood pressure control is the difficulty in predicting which antihypertensive medication will be most effective for a specific patient. An individualized approach to hypertension treatment, considering risk factors, pharmacokinetic properties, genetic phenotypes, and other patient-specific characteristics, holds promise. Pharmacogenomics and other 'omics' technologies can help identify genetic signals indicative of a favorable or unfavorable response to specific antihypertensive drugs. By conducting research in this field, we can better understand how to optimize blood pressure response using different classes of antihypertensive medications.4 Pharmacogenetics studies the genetic basis of medication response variability, particularly the influence of genetic factors on drug metabolism. In recent years, simple nucleotide polymorphisms (SNPs) have emerged as the primary genetic variation markers. High-throughput genotyping approaches can detect SNPs, which are widespread throughout the genome, often involve substitutions, and rarely result in mutations. SNPs in drug-metabolizing enzymes have been reliable indicators for dose-related treatment decisions. Genetic studies conducted over the past two decades have identified various genetic polymorphisms associated with hypertension, including changes in the number of tandem repeats, microsatellites, single nucleotide polymorphisms (SNPs), and insertions/deletions (I/D). These studies have also revealed significant inter-individual variability in responsiveness to antihypertensive medications, highlighting the importance of pharmacogenomic research and the potential for individualized pharmacological therapy. Genetic factors may contribute to a 30-50% increase in blood pressure.5 A comprehensive approach is required to advance personalized medicine, incorporating data and insights from genomic, genetic, and proteomic sciences. This applies to both approved medications and therapeutic candidates in various stages of clinical trials. Personalized medicine aims to administer the right drug to the right patient at the right time and dosage. By embracing this concept, we can significantly improve hypertension treatment outcomes.6 Th
由于对抗高血压药物的依从性低，高血压在全球范围内造成了巨大负担。高血压治疗旨在将血压控制在生理范围内，降低与高血压相关的心血管疾病和器官损伤的风险。据估计，约有11.3亿人患有高血压，占全球死亡人数的13%。世界卫生组织的目标是到2025年，与2010年的基准年相比，将这一数字减少25%。1,2尽管有有效的降压药物，主要风险因素也有所减少，但由于各种原因，实现最佳血压控制仍然具有挑战性，包括明显的耐药性和依从性差。3，4导致血压控制不佳的因素之一是难以预测哪种降压药物对特定患者最有效。考虑到风险因素、药代动力学特性、遗传表型和其他患者特定特征，高血压治疗的个性化方法有望实现。药物基因组学和其他“组学”技术可以帮助识别指示对特定降压药物的有利或不利反应的遗传信号。通过在该领域进行研究，我们可以更好地了解如何使用不同类别的降压药物来优化血压反应。4药物遗传学研究药物反应变异的遗传基础，特别是遗传因素对药物代谢的影响。近年来，单核苷酸多态性（SNPs）已成为主要的遗传变异标记。高通量基因分型方法可以检测SNPs，SNPs在整个基因组中广泛存在，通常涉及替换，很少导致突变。药物代谢酶中的SNPs一直是剂量相关治疗决策的可靠指标。在过去二十年中进行的遗传学研究已经确定了与高血压相关的各种遗传多态性，包括串联重复序列、微卫星、单核苷酸多态性（SNPs）和插入/缺失（I/D）数量的变化。这些研究还揭示了抗高血压药物反应性的显著个体间差异，突出了药物基因组研究的重要性和个体化药物治疗的潜力。遗传因素可能导致血压升高30-50%。5需要一种综合的方法来推进个性化医学，结合基因组、遗传和蛋白质组科学的数据和见解。这适用于已批准的药物和临床试验各个阶段的候选治疗药物。个性化医疗旨在在正确的时间和剂量给正确的患者服用正确的药物。通过接受这一概念，我们可以显著改善高血压治疗结果。6高血压个性化治疗的目标是确定降低患者血压的最有效药物。相反，一种相反的观点认为，个体化治疗有助于消除药物不良反应和使用无效药物的风险。依从性问题进一步强调了改进高血压治疗的必要性。因此，根据个体患者特征定制医疗方法和治疗计划的个性化医学，7抗高血压药物基因组学研究旨在通过确定影响抗高血压反应变异性的遗传因素来改善接受治疗的高血压患者的心血管疾病（CVD）结果。尽管这些遗传变量约占人群血压变异的50%，但造成这种变异的很大一部分的特定基因尚未确定。这种情况的复杂性归因于不同基因座的等位基因通过各种途径的影响，以及环境因素对血压表型表现的影响。有证据支持这样一种假设，即遗传学可能会导致人们对降压药物反应的个体差异。通过整合遗传信息，药物基因组学可以为个性化治疗方法提供见解。然而，还需要进一步的研究来揭示所涉及的特定基因和途径。提高我们对降压反应变异性的遗传基础的理解，对于优化高血压治疗具有巨大潜力。在药物基因组学的推动下，个性化医学可以彻底改变高血压的管理并提高患者的预后。 2022年；55（2）：200-1.Shahbaz SAZ，Nazar MS，Umar A，Tariq MA，ul Haq I，Junaid M.普通人群高血压意识评估
{"title":"Pharmacogenomics and the Concept of Personalized Medicine for the Management of Hypertension","authors":"K. Ashiq, Sana Ashiq, N. Mustafa","doi":"10.47144/phj.v56i2.2553","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2553","url":null,"abstract":"Hypertension poses a significant global burden due to low adherence to antihypertensive medications. Hypertension treatment aims to bring blood pressure within physiological ranges and reduce the risk of cardiovascular disease and organ damage associated with high blood pressure. It is estimated that around 1.13 billion people have hypertension, accounting for 13% of all fatalities worldwide. The World Health Organization aims to reduce this number by 25% by 2025 compared to the baseline year of 2010.1,2 Despite the availability of effective antihypertensive medications and decreased main risk factors, achieving optimal blood pressure control remains challenging for various reasons, including apparent drug resistance and poor compliance.3,4 One of the contributing factors to poor blood pressure control is the difficulty in predicting which antihypertensive medication will be most effective for a specific patient. An individualized approach to hypertension treatment, considering risk factors, pharmacokinetic properties, genetic phenotypes, and other patient-specific characteristics, holds promise.\u0000Pharmacogenomics and other 'omics' technologies can help identify genetic signals indicative of a favorable or unfavorable response to specific antihypertensive drugs. By conducting research in this field, we can better understand how to optimize blood pressure response using different classes of antihypertensive medications.4 Pharmacogenetics studies the genetic basis of medication response variability, particularly the influence of genetic factors on drug metabolism. In recent years, simple nucleotide polymorphisms (SNPs) have emerged as the primary genetic variation markers. High-throughput genotyping approaches can detect SNPs, which are widespread throughout the genome, often involve substitutions, and rarely result in mutations. SNPs in drug-metabolizing enzymes have been reliable indicators for dose-related treatment decisions.\u0000Genetic studies conducted over the past two decades have identified various genetic polymorphisms associated with hypertension, including changes in the number of tandem repeats, microsatellites, single nucleotide polymorphisms (SNPs), and insertions/deletions (I/D). These studies have also revealed significant inter-individual variability in responsiveness to antihypertensive medications, highlighting the importance of pharmacogenomic research and the potential for individualized pharmacological therapy. Genetic factors may contribute to a 30-50% increase in blood pressure.5 A comprehensive approach is required to advance personalized medicine, incorporating data and insights from genomic, genetic, and proteomic sciences. This applies to both approved medications and therapeutic candidates in various stages of clinical trials. Personalized medicine aims to administer the right drug to the right patient at the right time and dosage. By embracing this concept, we can significantly improve hypertension treatment outcomes.6\u0000Th","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45941712","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}
Rahid Ullah, J. Ali, Adil Bilal, Daud Ahmad Jan, A. Rahim, W. Sajjad
Objectives: Right ventricular infraction has prognostic significance in the setting of acute “inferior wall myocardial infarction (IWMI)”, this research is intended to determine the frequency of “right ventricular infarction (RVI)” in patients with acute IWMI. Methodology: This descriptive cross-sectional study took place at a tertiary care hospital in Peshawar, Pakistan. The study included consecutive patients who were diagnosed with acute IWMI. The presence of RVI was determined based on specific ECG findings showing >1.0mm ST segment elevation on right-sided chest leads. Results: In a sample of 150 patients, 87 (58%) were male. The average age of the patients was 61 ± 10.7 years. Among the patients, 111 (74%) had hypertension, 64 (42.7%) were diabetic, and 45 (30%) were smokers. A body mass index (BMI) exceeding 25 kg/m2 was observed in 83 (55.3%) patients. RVI was observed in 62 (41.3%) of the patients. The occurrence of RVI did not show statistically significant differences between males and females (41.4% vs. 41.3%; p=0.989), hypertensive and non-hypertensive individuals (41.4% vs. 41.0%; p=0.964), diabetics and non-diabetics (42.2% vs. 40.7%; p=0.855), smokers and non-smokers (42.2% vs. 41.0%; p=0.885), and patients with BMI ≤25 kg/m2 and >25 kg/m2 (41.8% vs. 41.0%; p=0.920), respectively. Conclusion: Based on the research findings, it can be concluded that RVI is a relatively common occurrence in patients with acute IWMI, as it was observed in more than 40% of the patients studied. However, no statistically significant association exists between RVI and various demographic and clinical factors.
目的:右室梗死对急性下壁心肌梗死(IWMI)有预后意义，本研究旨在确定急性下壁心肌梗死(IWMI)患者发生右室梗死(RVI)的频率。方法:这项描述性横断面研究在巴基斯坦白沙瓦的一家三级保健医院进行。该研究包括被诊断为急性IWMI的连续患者。RVI的存在是根据特定的心电图表现来确定的，显示右侧胸导联ST段升高>1.0mm。结果:在150例患者中，87例(58%)为男性。患者平均年龄61±10.7岁。其中高血压111例(74%)，糖尿病64例(42.7%)，吸烟45例(30%)。83例(55.3%)患者体重指数(BMI)超过25 kg/m2。62例(41.3%)患者出现RVI。RVI的发生在男性和女性之间无统计学差异(41.4%比41.3%;P =0.989)，高血压和非高血压个体(41.4% vs. 41.0%;P =0.964)，糖尿病患者和非糖尿病患者(42.2% vs. 40.7%;P =0.855)，吸烟者和非吸烟者(42.2% vs. 41.0%;p=0.885)， BMI≤25 kg/m2和>25 kg/m2的患者(41.8% vs. 41.0%;分别p = 0.920)。结论:根据研究结果，RVI在急性IWMI患者中较为常见，超过40%的研究患者出现RVI。然而，RVI与各种人口统计学和临床因素之间没有统计学上的显著关联。
{"title":"Frequency of Right Ventricular Infarction in Patients with Acute Inferior Wall Myocardial Infarction Presenting At a Tertiary Care Hospital, Peshawar","authors":"Rahid Ullah, J. Ali, Adil Bilal, Daud Ahmad Jan, A. Rahim, W. Sajjad","doi":"10.47144/phj.v56i2.2372","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2372","url":null,"abstract":"Objectives: Right ventricular infraction has prognostic significance in the setting of acute “inferior wall myocardial infarction (IWMI)”, this research is intended to determine the frequency of “right ventricular infarction (RVI)” in patients with acute IWMI.\u0000Methodology: This descriptive cross-sectional study took place at a tertiary care hospital in Peshawar, Pakistan. The study included consecutive patients who were diagnosed with acute IWMI. The presence of RVI was determined based on specific ECG findings showing >1.0mm ST segment elevation on right-sided chest leads.\u0000Results: In a sample of 150 patients, 87 (58%) were male. The average age of the patients was 61 ± 10.7 years. Among the patients, 111 (74%) had hypertension, 64 (42.7%) were diabetic, and 45 (30%) were smokers. A body mass index (BMI) exceeding 25 kg/m2 was observed in 83 (55.3%) patients. RVI was observed in 62 (41.3%) of the patients. The occurrence of RVI did not show statistically significant differences between males and females (41.4% vs. 41.3%; p=0.989), hypertensive and non-hypertensive individuals (41.4% vs. 41.0%; p=0.964), diabetics and non-diabetics (42.2% vs. 40.7%; p=0.855), smokers and non-smokers (42.2% vs. 41.0%; p=0.885), and patients with BMI ≤25 kg/m2 and >25 kg/m2 (41.8% vs. 41.0%; p=0.920), respectively.\u0000Conclusion: Based on the research findings, it can be concluded that RVI is a relatively common occurrence in patients with acute IWMI, as it was observed in more than 40% of the patients studied. However, no statistically significant association exists between RVI and various demographic and clinical factors.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48989783","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}
Romana Awan, M. N. Mengal, Zia Yaqoob, M. F. Khanzada, Mahlika Ahmad, Muhammad Ashar, Areeb Ahmed Khan
Objectives: Rheumatic heart disease remains a significant problem in developing countries, with mitral stenosis (MS) being a frequent manifestation. The objective of this study was to compare transthoracic echocardiographic (TTE) findings of mitral valve calcification with fluoroscopy. Methodology: This cross-sectional study was conducted at the department of adult cardiology, National Institute of Cardiovascular Diseases (NICVD) Karachi. All patients were candidates for percutaneous mitral balloon valvuloplasty (PMBV), aged between 15 to 65 years of either gender. Patients who underwent TTE were subjected to fluoroscopy before PMBV. The Kappa coefficient was calculated to assess the agreement between the two modalities. An appropriate t-test or Mann-Whitney U test was applied, and a p-value ≤ 0.05 was taken as the criterion for statistical significance. Results: A total of 160 patients were included in this study with a mean age of 34.01± 12.32 years, 119 (74.4%) were between 18 to 40 years of age, and 108 (67.5%) were female. Calcification was observed in 40.6% (65) on echocardiography and 50.6% (81) of the patients on fluoroscopy. A substantial agreement was observed between the two modalities with a Kappa coefficient of 0.75 for the detection of calcification. Conclusion: No significant difference was observed in the detection of calcification on echocardiography and fluoroscopy, along with a substantial agreement between the two modalities for the detection of calcification. Echocardiography can be a less invasive alternative to fluoroscopy for the detection of calcification before PMBV.
{"title":"Fluoroscopy versus Transthoracic Echocardiography for Detection of Mitral Valve Calcification in Patients Undergoing Percutaneous Mitral Balloon Valvuloplasty","authors":"Romana Awan, M. N. Mengal, Zia Yaqoob, M. F. Khanzada, Mahlika Ahmad, Muhammad Ashar, Areeb Ahmed Khan","doi":"10.47144/phj.v56i2.2416","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2416","url":null,"abstract":"Objectives: Rheumatic heart disease remains a significant problem in developing countries, with mitral stenosis (MS) being a frequent manifestation. The objective of this study was to compare transthoracic echocardiographic (TTE) findings of mitral valve calcification with fluoroscopy.\u0000Methodology: This cross-sectional study was conducted at the department of adult cardiology, National Institute of Cardiovascular Diseases (NICVD) Karachi. All patients were candidates for percutaneous mitral balloon valvuloplasty (PMBV), aged between 15 to 65 years of either gender. Patients who underwent TTE were subjected to fluoroscopy before PMBV. The Kappa coefficient was calculated to assess the agreement between the two modalities. An appropriate t-test or Mann-Whitney U test was applied, and a p-value ≤ 0.05 was taken as the criterion for statistical significance.\u0000Results: A total of 160 patients were included in this study with a mean age of 34.01± 12.32 years, 119 (74.4%) were between 18 to 40 years of age, and 108 (67.5%) were female. Calcification was observed in 40.6% (65) on echocardiography and 50.6% (81) of the patients on fluoroscopy. A substantial agreement was observed between the two modalities with a Kappa coefficient of 0.75 for the detection of calcification.\u0000Conclusion: No significant difference was observed in the detection of calcification on echocardiography and fluoroscopy, along with a substantial agreement between the two modalities for the detection of calcification. Echocardiography can be a less invasive alternative to fluoroscopy for the detection of calcification before PMBV.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48218755","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}
Muhammad Umer Mukhtar, Sarmad Zahoor, M. Abid, Zi Rehman, M. A. Aslam, H. M. Jehangir, Samar Firdous
Non-alcoholic fatty liver disease (NAFLD) is a prevalent condition that affects a significant portion of the global population and imposes a heavy clinical and economic burden. Recent studies have provided substantial evidence linking NAFLD to cardiac electrical abnormalities, including atrial and ventricular arrhythmias, heart blocks, conduction delays, and ECG changes. These cardiac electrical disturbances play a significant role in cardiac diseases that are the leading cause of death in NAFLD patients. This paper aims to provide an update on the proposed mechanisms underlying arrhythmogenesis in NAFLD and summarize the latest research findings in this field. Managing NAFLD requires a comprehensive approach that includes treating the underlying liver condition and regular ECG monitoring to detect and address any potential cardiac complications. Meta-analyses are recommended for future research further to elucidate the association between NAFLD and cardiac arrhythmias. Understanding and effectively managing the cardiac implications of NAFLD will contribute to improved patient care and outcomes.
{"title":"Association of Non-Alcoholic Fatty Liver Disease with Cardiac Arrhythmias and Cardiac Conduction Defects: A Review of the Literature","authors":"Muhammad Umer Mukhtar, Sarmad Zahoor, M. Abid, Zi Rehman, M. A. Aslam, H. M. Jehangir, Samar Firdous","doi":"10.47144/phj.v56i2.2236","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2236","url":null,"abstract":"Non-alcoholic fatty liver disease (NAFLD) is a prevalent condition that affects a significant portion of the global population and imposes a heavy clinical and economic burden. Recent studies have provided substantial evidence linking NAFLD to cardiac electrical abnormalities, including atrial and ventricular arrhythmias, heart blocks, conduction delays, and ECG changes. These cardiac electrical disturbances play a significant role in cardiac diseases that are the leading cause of death in NAFLD patients. This paper aims to provide an update on the proposed mechanisms underlying arrhythmogenesis in NAFLD and summarize the latest research findings in this field. Managing NAFLD requires a comprehensive approach that includes treating the underlying liver condition and regular ECG monitoring to detect and address any potential cardiac complications. Meta-analyses are recommended for future research further to elucidate the association between NAFLD and cardiac arrhythmias. Understanding and effectively managing the cardiac implications of NAFLD will contribute to improved patient care and outcomes.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47644053","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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