ABSTRACT
Background: Left ventricular (LV) filling pressure is an important predictor of short and long term outcome in patients with coronary artery disease. Non invasive assessment of this pressure by Doppler echocardiography provides valuable information regarding the prognosis of patient with ST-segment elevation myocardial infarction. Elevated filling pressure is associated with increased incidence of morbidly and mortality due to ventricular remodeling, neuro-hormonal activation & increased excitability. The aim of this study was to assess LV diastolic dysfunction and left ventricular filling pressure in patients of ST-segment elevation myocardial infarction to predict their in-hospital outcome. Methods: The prognostic cohort study was conducted in National Institute of Cardiovascular Diseases, Dhaka from May 2011 to November 2011. A total of 100 Patients with acute ST-segment elevation myocardial infarction who has received streptokinase therapy were enrolled by purposive sampling. In addition to normal 2D & M mode study, Pulsed wave Doppler assessment of mitral valve inflow patterns was done in apical 4-chamber view to see Peak early (E) and peak late (A) flow velocities, E/A ratio and deceleration time of early mitral flow velocity (DT). Tissue Doppler Imaging (TDI) assessment was done at the lateral mitral annulus in apical 4-chamber view to assess Mitral annular diastolic velocity (E′) and E/E′ ratio. Patients were divided into two groups based on Doppler echocardiography derived Left ventricular filling characteristics. In group I 50 patients with E/E′ ratio <15 and in group II 50 patients with E/E’ >15. Patients were followed up for next 7 days and in-hospital outcomes were compared between groups. Results: The mean age of group-I & II were 53.84 ± 9.2 & 55.14 ± 8.5 years respectively. Male female ratio was 8.9:1.1. Age, sex and risk factors between two groups were statistically insignificant. Regarding in-hospital out come in group-I were hospital stay 5.28 ± 1.06 days, heart failure 28%, arrhythmia 8% and mortality was 2%. On the other hand in group-II hospital stay was 6.04±1.07 days, heart failure 68%, and arrhythmia 24% & mortality was 6%. All these were statistically significant between two groups except mortality. Conclusion: From this study it may be concluded that, left ventricular filling pressure assessed by Doppler echocardiograph predicts in-hospital outcome after acute ST segment myocardial infarction and prognosis is worse with increased left ventricular filling pressure.
ABSTRACT
ABSTRACT: Background: Expenditure on industry products (mostly drugs and devices) has spiraled over the last 15 years and accounts for substantial part of healthcare expenditure. The enormous financial interests involved in the development and marketing of drugs and devices may have given excessive power to these industries to influence medical research, policy, and practice. Material and methods: Review of the literature and analysis of the multiple pathways through which the industry has directly or indirectly infiltrated the broader healthcare systems. We present the analysis of the industry influences at the following levels: (i) evidence base production, (ii) evidence synthesis, (iii) understanding of safety and harms issues, (iv) cost-effectiveness evaluation, (v) clinical practice guidelines formation, (vi) healthcare professional education, (vii) healthcare practice, (viii) healthcare consumer‘s decisions. Results: We located abundance of consistent evidence demonstrating that the industry has created means to intervene in all steps of the processes that determine healthcare research, strategy, expenditure, practice and education. As a result of these interferences, the benefits of drugs and other products are often exaggerated and their potential harms are downplayed, and clinical guidelines, medical practice, and healthcare expenditure decisions are biased. Conclusion: To serve its interests, the industry masterfully influences evidence base production, evidence synthesis, understanding of harms issues, cost-effectiveness evaluations, clinical practice guidelines and Healthcare professional education and also exerts direct influences on professional decisions and health consumers. There is an urgent need for regulation and other action towards redefining the mission of medicine towards a more objective and patient-, population- and society-benefit direction that is free from conflict of interests.