QRS duration and echocardiographic evidence of left ventricular dyssynchrony in patients with left ventricular systolic dysfunction

To determine the association between left ventricular [LV] dyssynchrony assessed by tissue Doppler imaging [TDI] in patients with left ventricular ejection fraction [LVEF] < 35% and prolonged ventricular depolarization on electrocardiography. A cross-sectional study. The Aga Khan University, Karachi, from June to September 2007. All patients with LVEF <35% were included. Apical 2-D images were obtained in 4 chamber and 2 chamber views. TDI pulse wave Doppler parameters were measured from these 2 color-coded images. Time interval between the onset of QRS complex and the peak systolic velocity per region was derived. Patients with valvular heart disease, mitral annular calcification, atrial fibrillation and paced rhythm were excluded. Fischer's exact test was used to determine the association between QRS duration and left ventricular dyssynchrony. A total of 60 patients were included. Twenty one patients had QRS duration of > 120 msec. Out of those 21 patients, a total of 6 patients [28.6%] had evidence of dyssynchrony on TDI. Five patients [23.8%] had dyssynchrony on the basis of basal septal and basal lateral velocity difference [p=0.045] and 6 patients [28.6%] had evidence of dyssynchrony based on basal anterior and basal inferior velocity difference [p=0.018]. Out of the remaining 39 patients with narrow QRS complex, only 2 patients [5.1%] had dyssynchrony on TDI. The study demonstrates a significant association between prolonged QRS duration and left ventricular dyssynchrony on TDI. Therefore, such patients should be screened for prolonged QRS duration on ECG before cardiac resynchronization therapy [CRT]

Percutaneous coronary intervention in unprotected left main coronary artery disease

Percutaneous coronary intervention for unprotected left main coronary artery disease is potentially an important intervention in surgically unstable patients. A detailed review of medical record and visual analysis of coronary angiography and PCI procedure was undertaken. The study was conducted at the Aga Khan University Hospital, from January 2003 to December 2007. Patients included in the study had unprotected > 70% left main stenosis with ongoing ischemia, considered unsuitable for surgical revascularization. A total of 9 patients were included with a mean age of 70.1 years. Six patients had cardiogenic shock. Eight patients had bifurcation lesion. Simultaneous kissing stenting technique was used in 4 patients. There were 4 in-hospital deaths while 5 patients were alive at discharge. All 4 patients who expired had cardiogenic shock. Four patients were alive at a mean follow-up of 17 months. PCI turned out to be an alternative therapeutic option for unprotected left main coronary artery disease when surgery is declined