RESUMEN
Background: Assessment of risk factors or prognostic markers is essential to determine the adverse outcome related to acute myocardial infarction (AMI). The aim of the present study was to examine the role of random blood glucose as prognostic marker for assessment of severity of AMI.Methods: This prospective study was conducted on 79 patients with onset symptoms of AMI. All the patients both diabetics and non-diabetics underwent serum blood glucose estimation in the hospital. Primary endpoint of the study was all cause mortality till day 90 follow-up. The secondary end points were composite of death, reinfarction and heart failure till day 90.Mortality rate is higher in the diabetics as compared to nondiabetics.Results: The mean age group was 55.9 years. Males (86%) outnumbered females (14%). The mean BMI was 22.3±2.83. The mean random blood glucose in the study population was 138±92.9 mg/dl (7.7±5.15 mol). Of total 79 patients, 5 were diabetics, of them 2 (40%) died. Among 79 patients, 16 patients were died during 3 months following the qualifying event, 7 had heart failure and 4 had reinfarction.Conclusions: In patients with AMI, hyperglycemia should consider as one of the important prognostic marker to determine the adverse cardiovascular events.
RESUMEN
BACKGROUND: Pulmonary arterial hypertension (PAH) is a life threatening disease for which phosphodiesterase-5 inhibitor sildenafil is recently approved. We aimed to evaluate the efficacy and safety of tadalafil, a long acting congener of sildenafil, in treatment of PAH related to previous left to right shunt lesions. METHODS: In this blinded, cross over study, 11 patients with severe PAH related to congenital left to right shunt lesions (Eisenmenger syndrome) were randomly assigned to tadalafil (20 mg daily) or placebo for 4 weeks period, separated by a wash out period of at least 2 weeks. They were symptomatic with a six minute walk distance (6MWD)>or=50 m. The change in 6MWD, echo-Doppler determined pulmonary artery systolic pressure (PASP), WHO Class and modified Borg Dyspnea Index (BDI) were assessed after each therapy. RESULTS: Eight patients who completed the study protocol were analyzed. Tadalafil was associated with a significant increase in 6MWD (mean 409.25 SD 40.25 m vs 319.37 SD 42.39 m, p<0.0001), reduction in PASP (88.75 SD 23.26 mmHg vs 109.5 SD 23.78 mmHg, p<0.0001), improvement in BDI (4.62 SD 2.56 vs 6.37 SD 2.61, p=0.021) and WHO Class (6 patients vs 2 patients), compared to placebo. Tadalafil was well tolerated with no significant untoward effects. CONCLUSIONS: Tadalafil, in patients with PAH related to previous congenital left to right shunt lesions, lead to a significant improvement in exercise capacity (6MWD), PASP and WHO Class with reduced perceived exertion and was well tolerated.