Compare wall motion score at 6 weeks in patients with short and normal deceleration time on day 1 after acute MI

Objective: To compare wall motion score at 6weeks in patients with short and normal deceleration time on day 1 after acute MI

Study Design: Cohort study

Setting: Cardiology Department Sheikh Zayed Hospital Lahore

Sample Size: 100 patients

Sample Technique: Non probability convenient sampling

Data Collection Procedure: In my study I evaluated 100 patients with acute MI on day 1 and at six weeks post MI. All patients were treated with streptokinase and heparin. Echocardiography was performed using Vivid I ultrasound machine [GE medical system]. Patients were divided in two equal groups depending on deceleration time, group A [DT <150 ms] and group B [DT >150 ms] on day 1 post MI .Their wall motion score ,left ventricular volumes and ejection fraction were compared at base line and at six weeks

Results: Patients with short DT showed higher wall motion score [29 +/- 3 vs 20 +/- 2.5] higher left ventricular volumes [LVEDV 98 +/- 21 vs 77 +/- 8, LVESV 64 +/- 13 vs 38 +/- 6 ] and lower ejection fraction [37 +/- 5 vs 50 +/- 4] at base line. Also, at 6 weeks, patients with short DT showed less improvement in wall motion score [27 +/- 2 vs 17 +/- 6] and ejection fraction [39 +/- 5 vs 53 +/- 5] compared to patients with normal deceleration time

Conclusion: Patients with short deceleration time have larger infarcts[high WMS], poorer left ventricular systolic function and are at higher risk of ventricular remodeling compared to patients with normal deceleration time. DT measured post MI is a reliable and noninvasive short term predictor of outcome after MI

Effects of coronary artery bypass grafting on QT dispersion

Abnormal dispersion of QT interval [QTd] measured as the interlead variability of QT, reflects an in homogeneity of ventricular action potential. This is increased in coronary artery disease [CAD] due to ischemia of myocardium

Aims and Objectives: To determine / investigate the values of QT dispersion in our population. To investigate whether there is any short term influence of coronary artery bypass grafting [CABG] on QT dispersion, evaluated early [7 days] after surgery

Design of study: Single center observational study

Site of study: Department of Cardiology and Cardiothoracic Surgery, Shaikh Zayed Hospital, Lahore

Patients and Methods: A total of 50 consecutive patients, who underwent CABG in Shaikh Zayed Hospital, were included in the study. All the patients were given the standard therapeutic treatment for the management of ischemic heart disease [IHD]. Biochemical lab data including complete blood count, blood sugar level, serum electrolytes, urea and creatinine was collected and assessed for any abnormality before the operation. A twelve lead electrocardiogram [ECG] was recorded during a resting period in all patients planned for CABG 24 hours before surgery. ECG was repeated 48 hours after operation and at the time of discharge from the hospital. QT interval was calculated from the onset of QRS complex to the point of return of 'T' wave to isoelectric line or to the nadir between 'T' wave and 'U' wave, in cases where a 'U' wave was present. QT dispersion was measured as the difference between maximum and minimum QT from the 12 lead ECG

Results: The mean QTd in healthy individuals was [53.60+/-19.56 ms] [p=0.000]. There was significant reduction in QTd from 24 hours before CABG to 48 hours and seven days after CABG [74.80+/-28.59 ms] [p=0.000] vs. [46.40+/-17.82 ms] [p=0.000] and [33.20+/-15.44 ms] [p=0.000] respectively

Conclusion: There is a significant reduction of QTd early after CABG. It seems that QTd is a simple non-invasive and a reliable mode for detecting coronary ischemia and also for evaluating the effects of revascularization

Abnormal ankle brachial index and the presence of significant coronary artery disease

To determine the association between an abnormal ankle brachial index [ABI] and the presence of significant coronary artery disease [CAD] on coronary angiography. Cross-sectional, observational study. The study was carried out at Sheikh Zayed Hospital, Lahore, from July to October 2007. A series of 41 patients undergoing coronary angiography in Sheikh Zayed Hospital were selected and their ABI were calculated before the diagnostic coronary angiography. ABI calculations and coronary angiography reporting were done by separate individuals and data was analysed using SPSS 12.0. All patients undergoing diagnostic coronary angiography were included in the study except for those having peripheral arterial disease documented by lower extremity revascularization, lower extremity ulceration and lower extremity amputation. Proportion were compared using chi-square test with significance at p <0.05. Out of the 41 patients 31 male [76%] and 10 female [24%], 3 patients [7.31%] had ABI <0.9 and all 3 had triple vessel disease. Ten patients [24%] had ABI 0.91-0.99 and 2 [20%] of them had single vessel disease. Two [20%] had double vessel disease and 6 [60%] had triple vessel disease. Twenty four patients [58%] had ABI of 1.00-1.28 and 8 [33%] of these had single vessel disease, 3 [12%] had double vessel disease and 13 [55%] had triple vessel disease, while 4 patients had normal coronaries. A total of 22 patients were found to have triple vessel disease and only 3 [13.6%] of these 22 patients had an ABI <0.9 which is statistically not significant [p=0.07]. This study was not able to establish a direct association between ABI and significant CAD as only 3 patients out of 22 with triple vessel disease had an ABI <0.9. However, an approximately log linear relationship was noted between ABI and CAD risk which means that not only the average CAD risk increased exponentially at values < 1.0 but also that the CAD risk continued to decline as ABI values increased above 1.0

Heart rate variability in early phase of acute myocardial infarction and convalescence

This study was done to evaluate the degree of change in autonomic activity, manifested as heart rate variability [HRV], from acute phase of MI to convalescent period of AMI. Design: Single center, observational prospective study. Place and Duration of Study: Department of Cardiology, Shaikh Zayed Hospital, Lahore. The study was completed in one year from June 2000 to July 2001. Subjects and Thirty consecutive patients presenting within 24 hours of an ST segment elevation AMI with or without thrombolysis were included. First 24 hour Holter recording was done within 24-36 hours after AMI and the second was done before discharge. The mean hospital stay was 7.07 +/- 2.56 days. Mean duration between the two recordings was 5.47 +/- 2.36 days. The mean standard deviation of normal sinus interval [SDNN] was 65.07 +/- 25.11msec and 63-97 +/- 23.38msec; mean standard deviation of averaged sinus beats for 5 minutes segments of entire recording [SDANN] was 51.27 +/- 18.57msec and 55.83 +/- 19.65msec and mean SDDN index was 34.57 +/- 17.15msec and 30.57 +/- 14.89msec during early phase of acute MI and pre-discharge recordings respectively. There was no statistically significant difference in HRV between early phase of acute myocardial infarction and of pre-discharge recordings. HRV may be monitored for risk stratification at any time post AMI prior to discharge

Efficacy and tolerability of fluvastatin in hypercholesterolemic Pakistani patients

The efficacy, safety and tolerability of fluvastatin was assessed in a group of 25 Pakistani subjects maintained on a lipid-lowering diet and having baseline total cholesterol > 240 mg/dl. Fluvastatin was given in a dose of 20 mg/day for 6 weeks and the subjects reassessed. 20 patients completed the trial. These included 14 diabetics, 6 hypertensive and 9 with ischemic heart disease. There was a mean reduction of total cholesterol of 17.5 percent for the whole group [basal value 293.5 +/- 5.11 SEM vs. 6 week value 240.5 +/- 7.29 SEM] which was highly significant [p < 0.001]. The diabetic group was analyzed separately and showed a mean reduction of total cholesterol of 14.5 percent [basal value 288.7 +/- 3.62 vs. 6 week value 246.2 +/- 9.39 SEM] which was also significant [p=0.001]. The drug was well tolerated with only one subject complaining of myalgia. There was no incidence of significant rise in CPK, SGOT, or creatinine and the drug was not withdrawn in any subject

Study of efficacy of enalapril in the treatment of Pakistani patients with heart failure

A randomized, prospective, open-ended study of 20 Pakistani patients with moderate-to-severe heart failure [NYHA class II and III] was carried out. Patients had to have global left ventricular [LV] dysfunction with ejection fraction [LVEF] <35%. The patients were randomized into two groups, C and E. Group C patients [N=9] were optimized on conventional therapy i.e. diuretic, digoxin and nitrates whereas group E patients [N=11] had enalapril added to this therapy and increased gradually. The subjects were followed for a period of 12 to 120 weeks with a mean of 58 weeks. Serial tests were done at 12 weekly intervals. These included echocardiography, exercise stress test, urea, creatinine, sodium and potassium. Showed a significant improvement in NYHA class in group E. 10 of the 11 patients in this group improved by one class while only 1 out of 9 patients improved by one class in group C. There was a highly significant [p< 0.001] increase in exercise time in group e from 417 sacs to 730 while there was an insignificant increase in group C. Hemodynamic measurements showed a significant fall in heart rate in group E from 90 bpm to 83 bpm [p=0.01] but an insignificant fall in group C from 94 bpm to 86 bpm. Systolic and diastolc blood pressure [BP] fell in both groups [121/81 vs 108/74 in group C and 117/77 vs 110/72 in group E] but only the fall in systolic BP in group E was significant [p=0.05]. Echocardiography showed significant improvement in left ventricular systolic [p=0.001] and diastolic [p< 0.05] dimensions and LVEF [p< 0.001] in group E while there was no significant change in group C. In addition, digoxin usage fell significantly in group C. Cough was more prevalent in group E, this did not reach significance levels. Other side effects were not significantly different between the two groups serial blood tests also did not show any significant difference. In conclusion, the addition of enalapril to conventional therapy in Pakistani patients of moderate-to-severe heart failure significantly improved NYHA class, exercise capacity, LV dimensions and LVEF. In addition, it also reduced the need for other anti-heart failure medications and was generally well tolerated

echocardiographic evaluation of left ventricular systolic functions in hypertensive patients

A total of 30, consecutive, hypertensive patients, equally divided between the two sexes, were evaluated by M mode and 2-D echocardiography. They were divided into four groups; Group A - Left ventricular [L.V.] mass < 100 g/m2. Group B LV mass = 101 - 125 g/m2. Group C - LV mass = 126 - 150 g/m2. Group D - LV mass> 150 g/m2. All patients [n=7] in group A had normal LV Systolic function as determined by E-point-to-septal separation [E.P.S.S.], Ejection Fraction [E.F.] and Fractional Shortening [F.S.] excepting one patient with a minimally increased E.P.S.S. Of 11 patients in group B, eight [72.5%] showed increased E.P.S.S. whereas only one of these eight patients had reduction in E.F. and F.S. as well. The other three patients had normal E.P.S.S. E.F. and F.S. Group C consisted of six patients. All [100%] of these had increased E.P.S.S. but normal E.F. and F.S. Group D also had six patients, Of these four [66%] had prolonged E.P.S.S. whereas three of these four patients had reduced E.F. or F.S. as well. The other two patients had normal E.P.S.S. and F.S. In Conclusion, this study suggests a direct correlation of increasing LV mass with progressive LV systolic dysfunction in hypertensive patients. Also, increased E.P.S.S. appears as the first abnormality of LV systolic function before reduction in E.F. or F.S

Coronary risk profile study

Coronary risk profile screening was performed in 251 consecutive patients with myocardial infarction and unstable angina admitted to the Coronary Care Unit of Shaikh Zayed Hospital during a 15 month period. There were more males than females, 209 [83.3%] vs 42 [16.7%]. Moreover males began to suffer the disease at a younger age; 41.1% being under 50 years of age as compared to only 21.4% females. Sedentary life style [62.2%], HDL cholesterol less than 35mg/dI [58.7%], and total cholesterol/HDL-C ratio more than 5 [59.7%], were the most common risk factors for both sexes. A large number of males gave the history of current smoking [56.9%] whereas only 2.3% of females were smokers. In women the prevalence of hypercholesterolemia [57.1%], hypertension [57%] and diabetes mellitus [38%] was higher compared with men [28%, 14.3% and 18.2%, respectively]. Family history of ischemic heart disease [IHD] was reported by 30.6% of patients. Hypertriglyceridemia and hyperuricemia were found in 16.7% and 37% cases respectively. Eleven percent patients were free of the major risk factors reviewed. This study shows that hypercholesterolemia, hypertension and diabetes mellitus are not the most common predisposing factors of IHD in our male patients. Instead low HDL-C, total cholesterol/HDL-C>5 and sedentary life style appear more important. Moreover, there is a high prevalence of smoking in our patients. These findings indicate the need for educating the public regarding the importance of regular exercise and a more effective antismoking campaign in Pakistan