A clinical study of arrhythmias associated with acute coronary syndrome: a hospital based study of a high risk and previously undocumented population

Background: ACS represents a global epidemic. Arrhythmia in ACS is common. Careful investigation may lead to further improvement of prognosis. Retrospectively analyzed the year- round data of our center. Study was undertaken to analyze the incidence, frequency and type of arrhythmias in ACS. This is to aid timely intervention and to modify the outcome. Identification of the type of arrhythmia is of therapeutic and prognostic importance.Methods: This cross sectional analytical study was conducted in the Department of Cardiology, Apollo Hospitals Dhaka, from January 2019 to January 2020 with ACS patients. Enrolled consecutively and data analyzed.Results: There were 500 patients enrolled considering inclusion and exclusion criteria. Sample was subdivided into 3 groups on the type of ACS. Group-I with UA, Group-II with NSTE - ACS and Group-III with STE - ACS. Different types of arrhythmia noted. Types of arrhythmia were correlated with type of ACS. 500 patients included. Mean age 55.53±12.70, 71.6% male and 28.4% female. 60.4% hypertensive, 46.2% diabetic, 20.2% positive family history of CAD, 32.2% current smoker, 56.4% dyslipidaemic and 9.6% asthmatic. 31.2% UA, 39.2% NSTE-ACS and 29.6% STE-ACS. Type of arrhythmias noted. 22% sinus tachycardia, 20.2% sinus bradycardia, 9% atrial fibrillation, 5.2% ventricular ectopic, 4.8% supra ventricular ectopic, 2.8% bundle branch block, 2.2% atrio-ventricular block, 1% broad complex tachycardia, 0.4% narrow complex tachycardia, 0.2% sinus node dysfunction and 32.2% without any arrhythmia. Significant incidences of arrhythmia detected - respectively 29.8%, 39.2% and 31%, p<0.001.Conclusions: In conclusion, arrhythmias in ACS are common. More attention should be paid to improve their treatment and prognosis.

Multivessel Percutaneous Coronary Intervention in Patients with Acute ST-segment Elevation Myocardial Infarction in Same Sitting.

Background: Aim of the study was to evaluate the primary procedural success of Multivessel Percutaneous coronary intervention in patients with acute ST-segment elevated myocardial infarction at the same sitting. Methods: Total 23 (13.4%) patients were enrolled in this very preliminary study, among the total 171 patients who had primary PCI at our center from Jan 2010 to February 2015. Among them, Male: 20 and Female: 3. Total 52 stents were deployed in 46 territories. Mean age were for both male and female were 54 yrs. Associated coronary artery disease risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, positive family history for coronary artery disease and Smoking. Results: Among the study group; 17(74%) were Dyslipidemic, 11(47.8%) were hypertensive; 8(34.8%) patients were Diabetic, positive family history 4(17.4%) and 9(39%) were all male smoker. Female patients were more obese (BMI: M 26: F 27). Common diagnosis at admission based on ECG evidence was; Inferior wall myocardial infarction: 12 (52.2%), Anterior wall myocardial infarction 9(39.1%) and lateral 2(8.7%). Common stented territory was left anterior descending artery 9(39.1%), right coronary artery 7(30.4%), and left circumflex artery 7(30.4%). Stent used: Bare metal stent 3 (5.7%), DES: 49 (94.2%). Among the different drug eluting stents, Everolimus 26 (52%), Sirolimus 8(15.4%) and Zotarolimus 9(17.3%), Paclitaxel 2 (3.8%), Biolimus 2 (3.8%), Genous 2 (3.8%). Conclusion: In the current prospective non randomized study, we found that the multivessel primary PCI for ST elevation myocardial infarction with non-culprit vessel are suitable for PCI at the same sitting with better in-hospital and 1 yr survival outcome.

Spontaneous Coronary Artery Dissection of LM and LM- LAD artery in Peripartum or Postpartum Women with Acute Myocardial Infarction.

Spontaneous coronary artery dissection (SCAD) is a very rare condition which may result in sudden coronary occlusion, acute myocardial infarction and sudden cardiac death. It usually occurs in young women during pregnancy or postpartum period and in most cases it involves a single coronary artery. The exact etiology is unknown. The prognosis of SCAD is uncertain and optimal treatment is unknown. Early diagnosis and treatment are key for survival, and when identified early, mortality rate is reduced.

Bioabsorbable Vascular Scaffolds Eluting with Everolimus: for Percutaneous Coronary Intervention of Patients with de-novo Coronary Artery Lesion: Our Experiences at a Tertiary Hospital.

Background: Aim of the study was to evaluate the primary procedural success of percutaneous coronary intervention (PCI) of de-novo coronary artery lesion by using Bioabsorbable Vascular Scaffold (BVS) ABSORB stents eluting Everolimus. Methods: Total 16 patients were enrolled in this very preliminary study of BVS absorb. Among them, Male: 11 and Female: 5. Total 20 stents were deployed. Mean age were for Male: 56 yrs, for Female: 60 yrs. Associated coronary artery disease (CAD) risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive family history (FH) for CAD and Smoking. Patients were followed up clinically. Results: Among the study group; 13 (81%) were Dyslipidemic, 10(62.5%) were hypertensive; 6 (37.5%) patients were Diabetic, FH 3(18.75%), and 2(18%) were all male smoker. Female patients were more obese [Body Mass Index (BMI) M 25: F 27] and developed CAD in advance age. A common stented territory was for left anterior descending artery (LAD): 6 (37.5%), left circumflex artery (LCX) 5 (25%), right coronary artery (RCA) 6(37.5%). One patient had both LCX and LAD stenting. Total 3 patients had double/overlapping stent in RCA lesion. Territory wise distributions of BVS ABSORB stent were for LAD 6(30%), RCA 9 (45%), and LCX 5 (25%). There was no periprocedural or postprocedural complication. Conclusion: BVS ABSORB Everolimus eluting vascular scaffold showed favorable clinical outcome without any major cardiac events (acute or late stent thrombosis, MI or death) over a period of 9 month. Thus, BVS ABSORB would be favorable alternative to other available drug eluting metallic stents.

Unprotected Left Main Coronary Artery Percutaneous Coronary Intervention-Our Experiences at a Tertiary Hospital.

Background: Aim of the study was to evaluate the primary procedural success of percutaneous coronary intervention of unprotected left main coronary artery stenosis using either Bare-metal stents or drug eluting stent. Methods: Total 33 patients were enrolled in this very preliminary non-randomized prospective cohort study. Among them, Male: 25 and Female: 8. Total 35 stents were deployed. Mean age were for Male: 59 yrs, for Female: 62 yrs. Associated coronary artery diseases risk factors were dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive family history for coronary artery diseases and smoking. Results: Among the study group; 26 (78%) were Dyslipidemic, 24(70%) were hypertensive; 17 (51.5%) patients were Diabetic, 11(33%) were smoker and 7(21%) patients had family history of Ischaemic heart disease. Female patients were more obese (BMI M 26: F 27) and developed coronary artery diseases in advance age. Common stented territory were left main: 20 (60%), Left main to left anterior descending artery 7 (22%) and Left main to left circumflex artery 6 (18%). Average length and diameter of stent was 3.5 and 18 mm respectively. Stent used: Bare Metal Stent 5 (15%), Drug Eluting Stent: 28 (85%). Among the different Drug Eluting Stents, Everolimus eluting stents were 11 (39.3%), Sirolimus eluting 10(35.7%), Paclitaxel eluting 3 (10.7%), Biolimus eluting 3 (10.7%) and Zotarolimus eluting1 (3.6%). In the present study, overall survival outcome was 94% (31 patient), mortality of cardiac cause 3% (1 patient) and 1 patient (3%) died of hepatocellular carcinoma. Conclusion: Our study has shown that percutaneous coronary intervention of the unprotected left main is a safe and effective alternative to Coronary Artery Bypass Graft (CABG).

Slender Percutaneous Coronary Intervention (“Slender PCI”) via Transradial approach by using 5Fr Guide Catheter- An Updated Single Center Experiences.

Background: Aim of the study was to evaluate the primary procedural success of slender PCI via transradial approach using either Bare-metal stents (BMS) or Drug Eluting Stent (DES). Methods: Total 10 patients were enrolled in this very preliminary study. Among them, Male: 8 and Female: 2. Clinical presentation were Ant MI: 4 (40%), Inf. MI: 2 (20%), Angina II-III: 3 (30%), and NSTEMI: 1 (10%). Total 10 stents were deployed. Mean age were for Male: 44yrs, for Female: 55yrs . Associated CAD risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive FH for CAD and Smoking (all male). Results: Among the study group; 9 (90%) were Dyslipidemic, 5 (50%) were hypertensive; 6 (60%) patients were Diabetic, FH 6 (6%) and 8(63%) were all male smoker. Female patients were more obese (BMI M 24: F 27) and developed CAD in advance age. Common stented territory were LAD: 5 (50%) followed by RCA: 3 (30%) and LCX: 2 (20%). Average length and diameter of stent for LAD, RCA and LCX were 3.25, 3.16, 2.5 and 21.4, 20.3, 20 respectively. Stent used: BMS 3 (30%), Everolimus 5 (50%), Sirolimus 1(10%) and Zotarolimus 1(0.75%). Less contrast used (49.5ml), reduced radiation exposure (4727Gym2) and less fluoroscopy time (193 sec) with overall no procedural complication were observed. Conclusion: Our study has shown that the slender PCI via radial artery with a 5F guide catheter is safe with no procedural complication. It is also associated with less radiation exposure, less fluoroscopy time, good backup support and quick mobilization of patient.

Patency of Multiple stents/Overlapping Stents in Single Artery Territory in Bangladeshi Patient: An Updated Single Center Experiences.

Background: Coronary artery disease (CAD) in Bangladeshi population is diffuse in nature with small caliber arteries. Now a day, these are treated, by PCI with stent deployment, often multiple in a single coronary artery. However, long term data on In-stent re-stenosis (ISR) in multiple or overlapping stent in single coronary artery in these patients is not yet available. Therefore, the aim of our present study was to assess long-term outcome of stent patency or the development of ISR of varieties stent in single vessel territory. Methods: Patients were prospectively selected from, who underwent coronary angiogram at our hospital for further evaluation of their previous PTCA in the 3-36 months preceding the study for the quantifying period of 2007-2011. Total 51 patients (male: 42, Female: 9) who had multiple stents in one coronary artery were included in this study. Average age was Male: 57; Female:61. Average study period was 3.1 ± 2.4yrs. Results: Our results show that, among the total studied population 82.4% (42) were male and 17.6% (9) were female. Total 114 stent were deployed in 54 vessels of 51 patients. Territory wise distribution of deployed stent was LAD 52(45.6%), RCA 42 (36.8%) and LCX 20(17.5%). Stent used were BMS 45(39.5%), DES 69(60.5%). Re-look Coronary Angiogram (CAG) revealed that Significant ISR (ISR>60%) developed in BMS 8(17.8%) and DES 8(11.5%). Among the different DES the development of significant ISR were in Sirolimus 1(3.2%), Paclitaxel 4(16%), Everolimus 3 (30%). Conclusion: Our study has shown that deployment of multiple stents in a single artery territory (either separately or as overlapping) is safe and has reasonably lower degree of ISR, even when BMS was used. As a whole BMS shows higher degree of ISR than to DES for an average period of follow up of 3.1 yrs.

Tran-Radial Percutaneous Coronary Intervention (PCI) is Safe and Alternative to Conventional Trans-Femoral Approach: Our Experiences at Apollo Hospitals Dhaka.

Background: Aim of the study was to assess the safety of the trans-radial Percutaneous coronary intervention (PCI) than conventional Trans-femoral approach by using either Bare-metal stents (BMS) and or Drug Eluting Stent (DES) like Sirolimus-eluting or Paclitaxel-eluting stent. Also to see its safety in regards of procedural time, quick mobilization, less complication and less radiation exposure. Methods: Total 117 patients were randomized from a total of 538 patients who had PCI at our center in the quantifying period. Total 130 stent deployed in 117 patients. Among the patients, Male: 100 and Female:17 . Mean age were for Male: 55yrs, for Female:57yrs . Associated Coronary artery disease (CAD) risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive FH for CAD and Smoking (all male). Results: Our study shows 21.7% had trans-radial PCI. Among the study group; 72 (61.5%) were Dyslipidemic, 75 (64.1%) were hypertensive: 47(40.2%) patients were Diabetic, FH 29 (24.8%) and 33(33%) were all male smoker. Female patients were more obese (BMI M 27: F 29) and developed CAD in advance age. Common stented territory were LAD 51 (43.6%) followed by RCA 41 (35%) and LCX 27(23%). Average length and diameter of stented vessel were almost same in all territory. Territory wise multiple or overlapping stenting was done in LAD 3 (6 stents), RCA 1(2stents), LCX 4 (10 stents). Stent used: BMS 37 (28.5%), Sirolimus 41(31.5%), Paclitaxel 27 (21%), Everolimus 22 (16.9%), Biolimus 2 (1.5%) and Zotarolimus 1(0.75%). Less Procedural time, reduced radiation exposure, no procedural complication and overall better patient comfort were observed. Conclusion: Our study has revealed that trans-radial PCI is safe with reduced radiation exposure, quick mobilization of patient and no procedural complication in all the case, indicates it can be done routinely as an alternative to conventional Trans-femoral approach.

Evaluation of Efficacy and Tolerability of Perindopril 8 mg in Bangladeshi Hypertensive Patients: Results from an Open-label, Observational, Multi-center Study (CONTROL).

Background: The CONTROL (COversyl in Newly diagnosed stage-II & unconTROlled hypertensive patients triaL) was performed with an objective to evaluate the blood pressure (BP) lowering efficacy and tolerability of Perindopril 8mg in newly diagnosed stage II patients and uncontrolled hypertensive patients among Bangladeshi population. Methods: This was an open-label, observational, multi-center study conducted in consultation centers for out-patients located in different cities of Bangladesh. Adults, aged above 18 years with newly diagnosed stage-II hypertension or uncontrolled hypertension, were recruited. Patients were treated with Perindopril 4mg daily for first 1 week, afterwards uptitrated to Perindopril 8 mg daily and continued treatment for 12 weeks. Patients were followed-up at week-1, week-4, week-8 and week-12. Results: In total, 245 patients were enrolled. Among them, 88 were newly diagnosed stage-II (Group- I) and 157 were uncontrolled (Group-II) hypertensive patients. Male and female distribution was 57% and 43% respectively. Mean age of patients was 54.5 ±11.7 years. After 12 weeks treatment, there was a significant reduction in BP from baseline (p<0.001) in overall population as well as in Group I and in Group II. In overall population, the mean BP reduction was -31/-15 mmHg (from 163.7/96.8 mmHg to 132.4/81.7 mmHg. In Group I, the reduction was -33/-16 mmHg (from 166.5/98.2 mmHg to 133.4/82.0 mmHg) and in Group II, -30/-14 mmHg (from 159.3/ 95.6 mmHg to 129.1/81.6 mmHg). 10 patients (4.1%) had to discontinue the treatment due to adverse effects. Dry cough (2%) and hypotension (1.2%) were the main cause of discontinuation. Perindopril 8mg was well tolerated as indicated by the high proportion of physicians (81%) reporting ‘good’ to ‘excellent’ tolerability at week 12. Conclusion: This study suggests that Perindopril 8mg is effective and safe in the treatment of hypertension in Bangladeshi patients.

Study on Primary Percutaneous Coronary Intervention (PCI) in Patient with Acute Myocardial Infarction: in-hospital and 30-days Survival Outcome.

Objective: Aim of our study was to evaluate the safety and survival outcome of Primary PCI (pPCI) in patients with Acute Myocardial infarction in our hospital setting. Methods: Total 30 (Female 5; Male 25) patients were enrolled in this study who were brought in to our hospital with STEMI. Average age was, Male 56, Female 52. Primary PCI was performed after transferring patient from Emergency Department (ED) to Cardiac Catheterization laboratory. Cardiovascular risk factors among the studied population were Dyslipidemia, Diabetes Mellitus, Hypertension, Smoking and Family History. Results: Primary PCI either with Bare Metal Stent (BMS) or Drug Eluting Stent (Sirolimus-eluting stent or Paclitaxel stent) were performed in total 13 LAD lesion and 15 RCA lesion and 2 LCX lesion. BMS used were 66.7%, Sirolimus 20% and Paclitaxel-eluting stent 13.3%. Total 2 patients expired but due to hemorrhagic CVA and refractory heart failure. At presentation, ECG evidenced diagnosis were Acute Anterior Wall MI : 12 (40%), Inferior MI: 16 (53%), Infero-Posterior MI: 2 (6.7%). Our study showed that Primary PCI increases the higher survival outcome 28 (93.3%) out of 30 patients with acute MI. Conclusion: Our present study revealed that revascularization by Primary PCI showed safety and better percentage of In-hospital and 30-days survival outcome in patients with Acute myocardial infarction in our hospital setting.

Incidence and Prevalence of Atherosclerotic Renal Artery Stenosis (RAS) in Patients with Coronary Artery Disease (CAD).

Background: Aim of our present study was to evaluate the extent of Renal Artery Stenosis(RAS) in patients with Coronary Artery disease (CAD) in context of Bangladesh demographic distribution. Methods: Total 100 patients with renal artery disease were randomized from a pool of 1200 patients who were underwent routine diagnostic coronary angiogram for the evaluation of extent of their CAD. Renal arteries were studied at the same time. Among the patients, Male: 64 and Female:36 . Mean age were for Male:62yrs , for Female: 58 yrs . Associated CAD risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive FH for CAD and Smoking. Results: Our study results show 100 patients (12% of the sample) had RAS lesion out of total 1200 patient who underwent routine CAG. Sex distribution is male 64 (64%), Female 36 (36%). Among the study group; 79 (79%) were hypertensive; 57 (57%) were Dyslipidemic, 54 (54%) patients were Diabetic, 27 (27%) were smoker (all male) and 18(18%) were having positive FH for CAD. Female patients were more obese and developed CAD in advanced age (male: 53.5 Versus Female:64 yrs). We found that the Prevalence’s of RAS is more in patients with TVD (43%), followed by DVD (10%) and SVD (10%), Minor to mod CAD (14%) and angiographically normal coronaries (23%). Significant (>50% Stenosis) Left renal artery stenosis were found in 27 patient and 23 had significant Right renal artery stenosis. Total 8 patents had significant both renal artery stenosis. Conclusion: Renal artery stenosis is one of the most important peripheral vascular disease, needing to be diagnosed early and subsequent intervention to keep continuity of renal blood flow. In the present study, we found that the significant association of Renal Artery Stenosis in patients with CAD. Incidence of RAS is more in patients with TVD. Therefore, we recommend routine Renal angiogram during coronary angiography.

Percutaneous Coronary Intervention (PCI) in Patients with Chronic Total Occlusion (CTO): A Single Center Experiences.

Background: Aim of the study was to evaluate the primary in-hospital success and 30-days survival outcome of PCI in patients with CTO lesions, using either Bare-metal stents (BMS) or Drug Eluting Stent (DES) like Sirolimus-eluting or Paclitaxel-eluting stent in our hospital setting. Methods: Total 50 patients were randomized as per the definition of CTO, from a total of 400 patients who had PCI at our center in the quantifying period. After the guidewire crossing and the balloon dilation, measurement of the culprit lesion was done by using Siemens QCA measuring system. Among the patients, Male: 41 and Female: 9. Mean age were for Male: 53.3yrs, for Female: 64.4 yrs. Associated CAD risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive FH for CAD and Smoking. Results: Our study results show 50 patients (12.5%) had CTO lesion out of total 400 PCI procedures. Sex distribution in male 41 (82%), Female 9 (18%). Among the study group; 38 (76%) were Dyslipidemic, 31 (62%) were hypertensive; 20 (40%) patients were Diabetic, 9 (22%) were all male smoker, 5 (10%) were having positive FH for CAD. Female patients were more obese and developed CAD in advance age (male: 53.5 Versus Female: 64.4 yrs). Average diameter of stented vessel was greater in RCA than LAD and LCX. We found that the incidences of CTO lesions were more in LAD territory 20 (40%) followed by RCA 17 (34%) and LCX 13(26%). Single vessel Disease (SVD) in 45 (90%) patients was more common type of CTO lesion followed by Double vessel disease (DVD) in 5(10%). Post procedural, in-hospital and 30 days survival out comer was 100% in our present study. Conclusion: Our study has revealed that PCI in patients with CTO lesions has increased inhospital and 30 days survival outcome, are treated with BMS or DES. The incidence of CTO lesion is more common in male than in female. Female are developing heart disease in advance age and are more obese.

Percutaneous Balloon Aortic Valvuloplasty (Pbav) in a Child With Congenital Severe Aortic Stenosis –A Case Report.

A 8 years old boy presented with shortness of breath, cough and palpitation and subsequently diagnosed as a case of severe aortic stenosis with bicuspid aortic valve. Percutaneous balloon aortic valvuloplasty (PBAV) was done and he became asymptomatic. Post procedure his aortic valve area and aortic systolic pressure increased, transaortic pressure gradient decreased. So good result, lower cost, elimination of drawbacks of thoracotomy and cardiopulmonary bypass suggest in children percutaneous balloon aortic valvuloplasty should be the treatment of choice for patients with severe aortic stenosis.

Noninvasive Estimation of PCWP with Doppler Transmitral Flow Velocity Pattern in Patients with Coronary Artery Disease.

Background: Pulmonary capillary wedge pressure is an important clinical marker of cardiac function. Recent studies have demonstrated Doppler transmitral flow velocity pattern could be useful in assessing PCWP no invasively in patient with known heart disease. Objective: The aims of the study were to correlate the Pulmonary Capillary Wedge Pressure (PCWP) estimated by Doppler echocardiography with that obtained at cardiac catheterization and to evaluate the feasibility and accuracy of Doppler echocardiographic data. Method: All patients underwent simultaneous cardiac catheterization and were studied by Doppler echocardiography. Mitral flow velocity variables & maximal left atrial volume (MLAV) were correlated with invasive PCWP by both single & multilinear regression analysis. Result: A statistically significant negative correlation of deceleration time (r=-0.483; p=0.001) and ejection fraction (r=-0.334; p=0.01) and a statistically significant positive correlation of peak E wave (r=0.345; p=0.01) and deceleration rate (r=0.651; p=0.001 were found with catheter derived PCWP. Multiple regression analysis was used to derive an equation for noninvasive estimation of PCWP. Equation. With 2-D Echo + Mitral flow variables: PCWP = 1.43 X DR + 1.32 X E/A – 0.024 X DT + .02 X MLAV + 9.2. Conclusion: The correlation coefficient between measured and estimated PCWP from the equation was (r=0.678). Data indicated that in patients with CAD the noninvasive assessment of transmitral flow velocity pattern by Doppler echocardiography could predict PCWP with a clinically meaningful degree of accuracy.

Risk Factors Analysis and Angiographic Profile in Postmenopausal Women with Coronary Artery Disease.

Background : Postmenopausal women are at greater risk for coronary artery disease (CAD) than premenopausal women. This may be due to deprivation of estrogen, which acts directly and indirectly on the vasculature. In light of this finding the aim of the study was to find the relation of serum estrogen level with severity of atherosclerotic lesion and number of risk factors in CAD among postmenopausal women. Methods: One hundred postmenopausal women undergoing coronary angiography (CAG) were studied. Among them 50 patients with estrogen level <25 pg/ml constituted study Group I and another 50 postmenopausal women with >25 pg/ml constituted study Group II. Serum estrogen level was measured by radioimmunoassay. Other important risk factors like dyslipidaemia, diabetes mellitus, hypertension, family history of CAD, smoking and waist circumference were evaluated between the 2 groups of patients. CAG findings were analyzed by eye estimation and by Gensini score. Results: All the risk factors were significantly higher in Group I patients than that of Group II. Among the risk factors hypertension was most prevalent (64%) in Group I and dyslipidaemia (40%) in Group II. Multivariate regression analysis showed that serum estrogen was a strong and an independent predictor of CAD (p=0.001) when considered with other standard risk factors. Association between the angiographic severity of CAD and serum estrogen level were evaluated and negative correlation was observed, i.e. lower the serum estrogen level higher the vessel score. Conclusion: In postmenopausal women serum estrogen level is a strong & an independent predictor of CAD. It is also found that low estrogen group of postmenopausal women with CAD have more severe atherosclerotic lesions in comparison to the group with normal estrogen level.

Percutaneous Coronary Intervention in Chronic Total Occlusion – In Hospital Outcome.

Background- Although a total coronary occlusion is identified approximately in one third of the diagnostic cardiac catheterizations, still an attempted revascularization of total occlusion accounts for less than 8% of all percutaneous coronary interventions (PCI). Percutaneous Coronary Intervention (PCI) of chronic total occlusion (CTO) is one of the major challenges in interventional cardiology. It is now an well-accepted revascularization procedure. Methods: It was a prospective observational study conducted in National Institute of Cardiovascular Diseases, Dhaka, from July 2004 to June 2005. 50 consecutive patients with chronic total occlusion undergoing PCI were included in the study. Patients were observed during procedure and during the hospital stay. Result: The mean age of the patients was 46.7 ± 9.3 and 48.0% were in the age range of 45-54 years. 24 patients had post MI angina, 20 patients had chronic stable angina and 6 patients had unstable angina. Technical success was in 98% cases and procedural success was in 94% cases. One patient developed vessel perforation and was treated by prolonged balloon inflation. There was no death or STEMI and only 2 patients developed NSTEMI. Conclusion: In our study with the use of available facilities PCI in CTOs was possible with a high success rate. But dealing of more complicated lesion will require more improved technology and hardware. A study with larger number of patients and longer duration of follow up to determine the efficacy of the procedure in improving morbidity and mortality is needed.

Ventricular Septal Defect as a Complication of Blunt Chest Trauma: A Rare Occurrence and First Case-Report in Bangladesh.

Traumatic ventricular septal defect (VSD) is a very uncommon condition, especially in association with blunt chest trauma. A healthy young adult was diagnosed as a case of VSD one week after a road-traffic accident. History and other medical records suggest it was an acquired post-traumatic VSD. Thus, all patients of blunt chest trauma deserve close cardiac evaluation.

Role of Mitral Annular Systolic Velocity in The Evaluation of Left Atrial Appendage Function in Mitral Stenosis.

Background : Mitral stenosis (MS) is the most common valvular heart disease. Thromboembolism is one of the most important complications of MS, especially when it is associated with atrial fibrillation (AF).Patients with sinus rhythm (SR) are also sussceptible to this complication when it is associated with left atrial appendage (LAA) dysfunction .LAA dysfunction is an independent predictor of thromboembolism in mitral stenosis. Objectives: To investigate whether there is a relation between mitral annular velocities obtained by Doppler tissue imaging (DTI) and LAA function determined by transoesophageal echocardiography (TEE) and to determine if the annular velocities can predict the presence of the inactive LAA in MS. Methods: Sixty MS patients were evaluated by transthoracic echocardiography and all patients underwent transesophageal echocardiography. The annular systolic (S-wave) and diastolic (Emand Am-waves) velocities were recorded. Inactive LAA was defined as LAA emptying velocity <25 cm/sec. Patients were divided into three groups; group AI (n = 18): sinus rhythm (SR) and LAA emptying velocity e”25 cm/sec, group AII (n =22): SR and LAA emptying velocity <25cm/sec and group B (n = 20): atrial fibrillation. Results: Thrombus was detected in 14 patients and spontaneous echo contrast (SEC) was detected in 48 patients. Both S-wave and peak LAA emptying velocities were decreasing, while SEC frequency and density were increasing from group A to group B. There was a positive correlation between LAA emptying vs. S-wave and LAA emptying vs. Am velocities (p < 0.001, r = 0.708 and p< 0.001, r=0.495). Multivariate regression analysis showed that only S-wave is the independent predictor of inactive LAA (p = 0.001, odds ratio = 0.133, 95% CI = 0.032–0.556). In patients with SR, the cutoff value of S-wave was 14 cm/sec for the prediction of the presence of inactive LAA (sensitivity: 92.3%, specificity: 95.3%). Conclusions: S-wave is an independent predictor of inactive LAA and a useful parameter in estimating inactive LAA in MS with SR..

Correlation between microalbuminuria and angiographic severity of coronary artery disease.

Microalbuminuria has emerged as an important risk factor of considerable prognostic importance for cardiovascular events. Little is known about its impact on the angiographic profile among coronary artery disease patients. The primary aim of the study was to investigate the relationship of microalbuminuria and angiographic severity of coronary artery disease. This was a cross-sectional study conducted in NICVD, a tertiary-care cardiac center in Dhaka, Bangladesh. For this purpose, 72 patients aged 25 to 70 years, who underwent elective coronary angiogram were studied. Urinary albumin to creatinine ratio was used as a measure of microalbuminuria. Angiographic severity of coronary artery disease was measured by number of major vessels involved (vessel score), stenosis score, extent score and number of type B and C lesions. All parameters of angiographic severity were significantly higher in microalbuminuric patients. Spearman's rank correlation coefficient showed significant positive correlation between albumin to creatinine ratio and different parameters of angiographic severity. In multivariate logistic regression analysis odds ratio of having triple vessel coronary artery disease in microalbuminuric patients was 5.6 (95% CI, 1.4 - 22). Microalbuminuria was found to correlate positively and independently with angiographic severity of coronary artery disease.