ABSTRACT
Background: Operator dependent two-dimensional (2D) echocardiography is a noninvasive test to assess myocardial hypokinesia. Inter observer variability is more as it is subjective. Objective evidence of 2D global longitudinal strain (2D GLS) and strain rate imaging are getting popularity. Methods: This cross sectional study was done on 20 patients who came for dobutamine stress echo (DSE) in the department of cardiology of BSMMU, Dhaka from 1st February 2019 to 31st July 2019. 2D GLS was done before and just after DSE. Results: DSE findings revealed 6 patients had viable LAD, 9 had viable LCX and 6 had viable RCA, 9 had nonviable LAD, 2 had nonviable LCX and 3 had nonviable RCA territories. Difference in Post-systolic strain rate (SRps) in myocardial segments supplied by LAD at baseline peak stress in patients who had normal and nonviable LAD (-21% to. -23%, p=0.98) and (-6%to – 7%, p= 2.87) which were not significant. At peak exercise there was a trend towards greater SRps in viable territory of LAD in compared with baseline and peak stress (-1% to -16%, P = 0.05) which was significant. SRps in myocardial segments supplied by LCX at baseline and peak stress in patients who have normal and nonviable LCX (-20% to. -21%, p=0.82) and (-5%to – 5%, p=1.18) which had similar result as LAD territory. At peak exercise there was a trend towards greater SRps in viable territory of LCX compared with baseline and peak stress (-12% to -15%, P = 0.06). There was no significant difference in SRps in myocardial segments supplied by RCA at baseline and peak stress in patients who had normal and nonviable RCA (-23% to. -24%, p=1.72) and (-4%to – 5%, p=2.10). At peak exercise there was a trend towards greater SRps in viable territory of RCA compared with baseline and peak stress (-10% to -15%, P = 0.04). Conclusion: Results of subjective interpretation of DES has compared with objective evidence 2D GLS on peak stress which has similarity. It was a small study. Future large study is needed to establish these findings.
ABSTRACT
Rheumatic heart disease & rheumatic fever is important public health issue. overall incidence and prevalence of acute rheumatic fever is in downtrend in Bangladesh. But exact incidence & prevalence of chronic rheumatic heart disease (CRHD) is unknown. Objective: We wanted to find out prevalence of CRHD among adult patients undergoing echocardiography in a tertiary level hospital of Bangladesh. Methods: The study was conducted in the department of cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka between January 2018 to December 2018. Echocardiography was done with VividE9® machine. Patients who underwent echocardiography for various indication on indoor and outdoor basis were screened for this study. Among them 1000 male & female patients, age between 18-65 years who had their echo done by the investigators were enrolled for analysis. CRHD was defined as per latest echocardiography guideline. Frequency & pattern of CRHD were calculated. Results: Out of 1000 patients 74 cases were diagnosed as CRHD (7.4%), among them 52 patients were female. Mitral stenosis (MS) was found in 28.3% cases, Isolated mitral regurgitation (MR) in 5.4%, MS with MR in 18.9%, Aortic stenosis (AS) in 8.1%, Aortic regurgitation (AR) in 10.85%, AS with AR in 13.5%, involvement of both aortic & mitral valve in 27%, involvement of mitral, aortic & tricuspid valve in 1.3%. Conclusion: Findings of the study will help to set public health programs for primary & secondary prevention of CRHD. Further population-based study is required to know the exact prevalence of the disease.