Résumé
Aims The prevalence of premature coronary artery disease (CAD) in India is two to three times more than other ethnic groups. Untreated heterozygous familial hypercholesterolemia (FH) is one of the important causes for premature CAD. As the age advances, these patients without treatment have 100 times increased risk of cardiovascular (CV) mortality resulting from myocardial infarction (MI). Recent evidence suggests that one in 250 individuals may be affected by FH (nearly 40 million people globally). It is indicated that the true global prevalence of FH is underestimated. The true prevalence of FH in India remains unknown. Methods A total of 635 patients with premature CAD were assessed for FH using the Dutch Lipid Clinical Network (DLCN) criteria. Based on scores, patients were diagnosed as definite, probable, possible, or no FH. Other CV risk factors known to cause CAD such as smoking, diabetes mellitus, and hypertension were also recorded. Results Of total 635 patients, 25 (4%) were diagnosed as definite, 70 (11%) as probable, 238 (37%) as possible, and 302 (48%) without FH, suggesting the prevalence of potential (definite + probable) FH of about 15% in the North Indian population. FH is more common in younger patients, and they have lesser incidence of common CV risk factors such as diabetes, hypertension, and smoking than the younger MI patients without FH (26.32% vs.42.59%; 17.89% vs.29.44%; 22.11% vs.40.74%). Conclusion FH prevalence is high among patients with premature CAD admitted to a cardiac unit. To detect patients with FH, routine screening with simple criteria such as family history of premature CAD combined with hypercholesterolemia, and a DLCN criteria score >5 may be effectively used.
Résumé
Doppler echocardiographic characteristics of 57 normally functioning Sorin prosthetic valves (a tilting valve) in the mitral position were studied in the early postoperative period. The three valve sizes (in mm) studied were: 25 (n = 15), 27 (n = 32) and 29 (n = 10). The mean gradients (mmHg) and the valve area (Sq cm) calculated by pressure half time method) for the three valve sizes were 3.46 +/- 1.69 and 2.49 +/- 0.26; 3.46 +/- 1.25 and 2.57 +/- 0.44; and 3.2 +/- 1.23 and 2.55 +/- 0.41; respectively. There was no significant difference in gradients and valve area between the three sizes, variations in pressure half time and therefore the calculated valve area was large. Color Doppler evaluation revealed a bifid nonturbulent jet directed anteriorly towards the interventricular septum. 12 patients (20%) had mild valvar and 7 (12%) had paravalvar mitral regurgitation (mild in 5 and moderate in 2) without any associated prosthetic valve dysfunction. The paravalvar regurgitation persisted in all the 5 patients restudied at 5-12 months postoperatively. Sorin prosthetic valves have similar gradients and valve area when compared to other disc valves. The incidence of of paravalvar regurgitation was slightly higher in our series. The limitations of Doppler derived gradients and area of prosthetic valve are discussed.