ABSTRACT
Objective: To determine the validity of electrocardiographic QT interval in predicting left ventricular diastolic dysfunction in patients with suspected heart failure using echocardiogram as the gold standard
Study Design: Cross-sectional validation study
Place and Duration of Study: AFIC-NIHD, Rawalpindi, from December 2012 to June 2013
Methodology: Patients with suspected heart failure undergoing 12-lead electrocardiogram and echocardiography were inducted. All electrocardiograms were analyzed by a single trained reader unaware of the echocardiographic findings. QTc interval was calculated according to the published guidelines. All patients underwent a complete M mode, 2 dimensional, Doppler, and tissue Doppler echocardiography using aiE33 ultrasound system and diastolic dysfunction was calculated
Results: Three hundred patients were studied. Descriptive statistics of age was 61.42 years +/- 10.43. Of all the patients 218 patients [72.7%] were male and 82 patients were female [27.3%]. Mean QT interval [msec] was 427.29 +/- 54.69. One hundred and eighty patients [60.0%] had diastolic dysfunction and 120 patients [40%] had no diastolic dysfunction. The sensitivity of electrocardiographic QTc interval in predicting diastolic dysfunction was 71.11% and specificity was 88.11%
Conclusion: Prolonged electrocardiographic QTc interval in patients with suspected heart failure is a useful tool in predicting diastolic dysfunction
ABSTRACT
Background and Objectives: atrial fibrillation [AF] is the most common arrhythmia occurring post cardiac surgery and is associated with significant morbidity, increased overall hospital stay and cost. Anecdotal observations suggest very low incidence in Pakistani patients undergoing cardiac surgery particularly coronary artery bypass graft surgery [CABG]. The objective of this study was to assess the prevalence, morbidity and mortality of post cardiac surgery AF
Methods: a prospective study of 201 consecutive patients undergoing cardiac surgery at a tertiary care center. Clinical characteristics and perioperative data was collected and analyzed. Patients were followed for presence or absence of atrial fibrillation till hospital discharge
Results: the overall incidence of AF post cardiac surgery was 6.9%. AF occurred in 9 of 187 patients undergoing CABG alone, 3 of 12 patients undergoing valve replacement and 2 of 2 undergoing combined procedures. Increased left atrial [LA] size had significant association with post cardiac surgery AF [p = 0.01] as did the use of dopamine and epinephrine post operatively [p = 0.03 and 0.002 respectively]. In addition, significant association was also noted for valvular surgery [p = <0.001]. Multiple logistic regression analysis revealed that increased LA size [odds ratio 0.08, 95% CI 0.008-0.99, p = 0.04] was the only independent predictor of post cardiac surgery AF with borderline significance for concomitant valvular surgery [odds ratio 0.89, 95% CI 0.79-0.99, p = 0.05]. Mean hospital stay was significantly longer and overall cost was significantly higher in patients who developed AF [p = <0.001] in addition to higher overall mortality [p =0.025]
Conclusions: the incidence of AF post cardiac surgery was quite low in this study cohort. The occurrence of atrial fibrillation, albeit for short duration, was associated with higher all-cause mortality, significantly longer hospital stay and higher overall cost