ABSTRACT
Background: Mitral stenosis (MS) is a common valvular heart disease. Thromboembolism is one of the most serious consequences of mitral stenosis, particularly when it is accompanied with atrial fibrillation (AF). When linked with Left atrial appendage inactivity (LAAI), patients with sinus rhythm (SR) are also at risk for this condition. In mitral stenosis, LAA inactivity determined by S-wave is an independent predictor of thromboembolism. The aim of the study was to evaluate the Prevalence and Echocardiographic Predictors of Left Atrial Appendage inactivity in patients of Mitral Stenosis.Material & Methods:Sixty MS patients were evaluated by transthoracic echocardiography (TTE) and all patients underwent transesophageal echocardiography (TEE). The annular systolic (S-wave) and diastolic (Em- and Am-waves) velocities were recorded by tissue Doppler imaging (TDI). LAA inactivity was defined as LAA emptying velocity <25 cm/second determined by pulse wave Doppler at the junction of LA & LAA (TEE). Patients were divided into three groups; group A I (n = 18). Sinus rhythm (SR) and LAA emptying velocity ?25 cm/sec, group A II (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 43 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% Cl =0.032-0.556). In patients with SR, the cutoff value of S-wave was 10 cm/sec for the prediction of the presence of inactive LAA (sensitivity: 92.3%, specificity: 95.3%).Conclusions:In individuals with severe mitral stenosis in sinus rhythm, there is a significant prevalence of left atrial appendage inactivity. The mean pressure gradient across the mitral valve, as well as S-wave are independent predictors of left atrial appendage inactivity. Inactivity of the left atrial appendage is an independent predictor of left atrial/left atrial appendage smoke and associated thrombus.
ABSTRACT
Objectives: Coronary collaterals appear to play important role in coronary artery disease morbidity and mortality. In this study it was intended to determine whether hypertension is associated with development of coronary collaterals in patients with severe coronary artery disease. Methods: This was an observational cross-sectional study carried out in the department of cardiology of National Institute of Cardiovascular Diseases, Dhaka, Bangladesh during the period from October 2010 to June 2011. A total of 334 patients were examined to include in the study. Among them 118 patient of severe coronary artery disease (CAD) were included who fulfilled the inclusion and exclusion criteria. From where 63 patients were CAD with hypertension (Group -I) and 55 patients were CAD without hypertension (Group -II). Based on Rentrop Grading the study patients were divided in two groups, patients with poor collaterals (Grade 0& 1) and good collaterals (Grade 2&3). Data compared the coronary collaterals in hypertensive patients with those without hypertension with severe coronary artery disease. Results: The data showed that good collateral circulations were higher with duration of hypertension. The difference were statistically significant in duration <5 years and duration >10 years in both groups (p<0.05). The pattern of vessel involvement in double vessel disease and triple vessel disease (p <.001) and dyslipidemia (p<0.004) appeared to be significant predictor of hypertension controlling for other factors in the model. People with hypertension are around four times more likely to have good collateral circulation, multiple vessel disease and around 12 times more likely to have dyslipidemia. Conclusion: It is concluded that the patients of hypertension develop higher grades of coronary collaterals which increases with duration of hypertension in patients of severe coronary artery disease. Involvements of coronary arteries were more extensive in patients of hypertension with coronary artery disease.