ABSTRACT
Patients having angina with normal epicardial coronary arteries are often considered to have coronary microvascular dysfunction that may result in coronary slow flow. Delayed Coronary Sinus Filling Time (CSFT) may represent transit time through coronary microcirculation.We evaluated CSFT in patients having angina with normal epicardial coronary arteries and compared it with control population. Methods: 31 patients having definite angina or probable angina with positive exercise tolerance test with normal epicardial coronary arteries in coronary angiogram (CAG) were included in the study group. 31 patients having normal epicardial coronary arteries in CAG during preoperative evaluation before surgical treatment for valvular and congenital heart diseases were in control group. CSFT, TIMI (Thrombolysis In Myocardial Infarction) frame count, cTIMI (Corrected TIMI) frame count and TMP (TIMI Myocardial Perfusion) score were assessed in CAG of both group and compared between groups. Results: Patients’ Mean±SD of age in study and control group were 48.84±9.50years and 46.71±5.53years respectively with no significant difference (p=0.569) and there was female preponderance (55% and 65%) in both groups. CSFT was significantly prolonged in study group (4.22±0.71sec vs. 3.65±0.25sec, P value 0.001) but TIMI frame count, cTIMI and TMP showed no significant difference between two groups (25.71±5.74 vs. 26.74±3.81, p= 0.552; 14.76±3.6 vs. 15.4±2.56, p=0.449; 2.54±0.5 vs. 2.61±0.49, p=0.326; respectively). Conclusion: We concluded that CSFT was significantly prolonged in patients having angina with normal epicardial coronary arteries which might be a marker for diagnosis of coronary microvascular disease.
ABSTRACT
ackground: Aims: To compare the anti ischaemic efficiency of antianginal thepapy using a combination of metoprolol, Long acting nitrate (LAN) & trimetazidine/ranolazine in patients with stable effort angina with impaired LV function. Methods: The study enrolled 200 patients (male & female) aged 55-70 years with stable effort induced angina (functional class II and III angina) documented coronary artery disease. When the patients taking metoprolol 50mg twice daily& LAN 2.6 mg twice daily continued to have angina, after that 120 patients received an additional 35mg of trimetazidine twice a day or ranolazine 500 mg twice daily & 80 patients had double antianginal thepapy –methoprolol & LAN. Treadmill exercise test and transthoracic echocardiography were performed at weeks (WO, & W12). Results: After 12 weeks, treadmill exercise showed there were significantly greater improvements in the triple antianginal group (metoprolol+ LAN+ trimetazidine / ranolazine): time to I mm ST segment depression, maximum ST segment depression, mean weekly number of angina attacks, mean weekly nitrate consumption, & grade of angina pain and transthoracic echocardiogram showed improved left ventricular systolic and diastolic function. Conclusion: Triple antianginal thepapy with metoprolol+ LAN+ trimetazidine/ ranolazine combinations produced significant improvement in exercise stress test & the symptoms of angina relative to double antianginal therapy(metoprolol+ LAN) as well as improved left ventricular function.
ABSTRACT
Background: Regression of ventricular hypertrophy is the restoration of normal ventricular structure and physiology after the hypertrophy has developed. It has been clearly demonstrated that once left ventricular hypertrophy (LVH) is diagnosed, it represents a strong blood pressure independent risk factor for cardiovascular morbidity and mortality. Aims and Objectives: The aim of this study is to compare the effectiveness of different anti-hypertensive agents in reducing LVH in Bangladeshi population. Methods: A prospective observational study was carried out to detect the regression of left ventricular hypertrophy in hypertensive Bangladeshi population using high resolution M-mode echocardiographic study in 110 patients with clinically diagnosed hypertension were included in this study but later 15 patients failed to attend clinic for subsequent follow up. Hence, total number of patient was 95; The mean age (±SD) of these patients were 42 ± 5 and male-female ratio was 8.5:1.5. Out of these 95 patients, 20 were included in Beta-blocker(BB) group, 14 in Angiotensin converting enzyme inhibitor(ACEi) group, 20 in Beta-blocker(BB) + Diuretic(DD), 14 were recruited in Angiotensin enzyme inhibitor(ACEi) + Diuretics(DD) and 13 in Beta-blocker and ACEi group and 14 in BB + ACEI + Diuretic group. We followed these patients after 8 weeks, 6 months, 1 year and 2 years in our clinic. A baseline M-mode echocardiography was done to document LVH. During this follow up, we have measured IVSd, PWd, LVIDd and LVIDs and statistically analyzed SD and P-value for each group by using SPSS software. The duration of study was from 01.07.2005 to 30.06.2008. Results: Comparison of Beta blocker alone and ACEi alone group for LVH regression showed a P value of 0.59. Although this figure did not show a statistically significant value if we increase number of patients in both group we would expect a statistically significant P value in favour of ACEi. BB plus diuretics was compared with ACEi plus Diuretics which showed P value of 0.85. We also compared BB plus ACEi group with BB plus ACEi plus DD for LVH regression which showed a P value of 0.79. Conclusion: Among three groups of anti-hypertensive drugs, angiotensin converting enzyme inhibitor(ACEi) alone has been found to be most effective as compared to Beta blockers when used alone than in combination groups with (Beta blocker plus ACEi plus Diuretics or Beta blocker plus ACEi). Although, these figure was not found statistically significant a clear benefit has been shown in all groups in terms of LVH regression and essentially if the power or size if this is increased a statistically significant value of LVH regression value may be observed in all these groups.
ABSTRACT
As bilateral approach is paramount in chronic total occlusions with retrograde flow, the use of two radial arteries,two femoral arteries or combination technique using one radial and one femoral artery will probably be increasingly reported in the near future. After puncture of opposite groin, a diagnostic 6 Fr catheter is used to intubate the ostium of the contralateral artery. By visualizing the distal vessel in multiple projections, contralateral injections help to direct the progression of the wire in the occluded segment towards the distal true lumen. and confirm the intraluminal position of the wire after the occluded segment. We are reporting a case with chronic total occlusion where we used bilateral femoral access and simultaneous contrast injection to visualize retrograde flow in LAD while opening CTO through ante-grade pathway.