Validity of electrocardiographic QT Interval in predicting left ventricular diastolic dysfunction in patients with suspected heart failure

Objective: To determine the validity of electrocardiographic QT interval in predicting left ventricular diastolic dysfunction in patients with suspected heart failure using echocardiogram as the gold standard

Study Design: Cross-sectional validation study

Place and Duration of Study: AFIC-NIHD, Rawalpindi, from December 2012 to June 2013

Methodology: Patients with suspected heart failure undergoing 12-lead electrocardiogram and echocardiography were inducted. All electrocardiograms were analyzed by a single trained reader unaware of the echocardiographic findings. QTc interval was calculated according to the published guidelines. All patients underwent a complete M mode, 2 dimensional, Doppler, and tissue Doppler echocardiography using aiE33 ultrasound system and diastolic dysfunction was calculated

Results: Three hundred patients were studied. Descriptive statistics of age was 61.42 years +/- 10.43. Of all the patients 218 patients [72.7%] were male and 82 patients were female [27.3%]. Mean QT interval [msec] was 427.29 +/- 54.69. One hundred and eighty patients [60.0%] had diastolic dysfunction and 120 patients [40%] had no diastolic dysfunction. The sensitivity of electrocardiographic QTc interval in predicting diastolic dysfunction was 71.11% and specificity was 88.11%

Conclusion: Prolonged electrocardiographic QTc interval in patients with suspected heart failure is a useful tool in predicting diastolic dysfunction

Coronary artery disease in the elderly

The objective of our study is to assess the severity of coronary artery disease in the elderly and predict the safety outcome of coronary angiography. A cross sectional observational study. AFIC/NIHD Rawalpindi. February 2011 and August 2011. The study population included 100 elderly patients [age>60 years] undergoing coronary angiography. Coronary angiography data were obtained from the Siemens Queries software system, which maintains the database including detailed angiographic findings of all patients at this institution. Significant lesions were defined as those with >70% diameter narrowing of coronary arteries [>50% for the left main coronary artery]. We attempted to quantify the "severity of CAD" by ascertaining the prevalence of high-risk coronary anatomy [HRCA, defined as >50% stenosis of the left main coronary artery and/or significant three-vessel coronary artery disease]. More than 70% stenosis in more than one coronary artery was considered as severe coronary artery disease. Our study cohort comprised of 100 consecutive subjects 82 [82.0%] men and 18 [18.0%] women with a mean age of 78.6 years [Range 70 years - 94 years]. 77 patients [77.0%] had severe coronary artery disease; 50 with triple vessel coronary artery disease [TVCAD] 1 with TVCAD with Left Main Stem Disease, 26 had double coronary artery disease [DVCAD]. 12 patients [12.0%] had moderate coronary artery disease with single vessel involvement [SVCAD], 6 patients [6.0%] had subcritical coronary artery disease with < 60% stenosis in any of the vessel while only 5 patients [5%] had a normal coronary angiogram. Patients of elderly age group have more severe CAD and coronary angiography is a relatively safe procedure.

Procedural analysis of patients with stent thrombosis [ST]

To analyze the procedural details of patients presenting as ST and undergoing PCI. Descriptive study. Armed Forces Institute of Cardiology - National Institute of Heart Diseases [AFIC-NIHD] from Jan 2007 to Dec 2010. A descriptive, single center study done at AFIC Rawalpindi from Jan 2007 to Dec 2010. During this period patients with prior stenting who presented to AFIC E/R with acute ischaemic symptoms with ECG changes and had angiographically confirmed ST were studied. Their procedural details [index PCI and ST procedure] were analyzed. Over this four year study period, 7694 coronary angioplasties were carried out and 12871 stents [10633 DES and 2238 BMS] were implanted. Amongst these, 32 patients [28 males and 4 females] later had angiographically confirmed ST and were treated with PCI. Mean age was 51.57 years. Dual antiplatelet therapy [DAPT] non-compliance was not a contributory factor in our study. Coronary distribution involved in ST included 20 cases of LAD, 7 of LCX and 5 of RCA territory. Thirteen [40%] patients had overlapping stents, 11 [34.4%] had direct stenting. Average diameter of stents with ST was 2.86 mm and the average length was 24.17 mm. Incidence of ST was higher in BMS as compared to DES [p0.003]. Of these 32 patients, 14 [43.75%] were treated with further stenting whereas 18 [56.25%] underwent POBA only. Telephonic follow up after second PCI was possible in only 15 cases, out of which five [33.33%] deaths were reported on the day of thrombotic procedure. ST has a high mortality and there was an overall higher frequency of ST in BMS compared to DES. Acute and subacute ST were mainly related to BMS whereas late ST was more common in DES. However PCI technique i.e direct stenting and overlapping stents, was a major predictor of stent thrombosis

Relationship between BMI and severity of coronary artery disease in female population of Pakistani origin

Objective: To assess relationship between BMI and severity of coronary artery disease in female population of Pakistani origin

Design: Cross sectional observational study

Place and Duration of Study: Armed Forces Institute of Cardiology-National Institute of Heart Diseases [AFIC-NIHD], 1st February 2010 to 31st August 2010 Patients and Methods: The study population included 132 female patients undergoing coronary angiography. Obesity was classified according to the BMI using the National Institutes of Health [NIH] criteria as Normal [BMI 21-24 kg/m2], overweight [BMI 25-29 kg/m2], obesity class I [BMI 30-34 kg/m2], Obesity class II [BMI 35 to 39 kg/m2 and obesity class III [BMI 40 or above kg/m2]. Coronary angiography data were obtained from the Siemens Queries software system, which maintains the database including detailed angiographic findings of all patients at this institution. Significant lesions were defined as those with>70% diameter narrowing of coronary arteries [>50% for the left main coronary artery]. We attempted to quantify the "severity of CAD" by ascertaining the prevalence of high-risk coronary anatomy [HRCA, defined as>50% stenosis of the left main coronary artery and/or significant three-vessel coronary artery disease]

Results: Comparing overall obese [BMI >/= 30] vs. non obese groups, a statistically significant low prevalence of HRCA was encountered in the obese group [26 of 56, 46.4% vs. 54 of 76, 79.5% p<0.05] We concluded that obesity is associated with less severe coronary artery disease in women population of Pakistani origin

Relationship between BMI and severity of coronary artery disease in female population of Pakistani origin

To assess relationship between BMI and severity of coronary artery disease in female population of Pakistani origin. Cross sectional observational study. Armed Forces Institute of Cardiology - National Institute of Heart Diseases [AFIC-NIHD], 1st February 2010 to 31st August 2010. The study population included 132 female patients undergoing coronary angiography. Obesity was classified according to the BMI using the National Institutes of Health [NIH] criteria as Normal [BMI 21-24 kg/m2], overweight [BMI 25-29 kg/m2], obesity class I [BMI 30-34 kg/m2], Obesity class II [BMI 35 to 39 kg/m2 and obesity class III [BMI 40 or above kg/m2]. Coronary angiography data were obtained from the Siemens Queries software system, which maintains the database including detailed angiographic findings of all patients at this institution. Significant lesions were defined as those with >70% diameter narrowing of coronary arteries [>50% for the left main coronary artery]. We attempted to quantify the "severity of CAD" by ascertaining the prevalence of high-risk coronary anatomy [HRCA, defined as >50% stenosis of the left main coronary artery and/or significant three-vessel coronary artery disease]. Comparing overall obese [BMI >/= 30] vs. non obese groups, a statistically significant low prevalence of HRCA was encountered in the obese group [26 of 56, 46.4% vs. 54 of 76, 79.5% p < 0.05]. We concluded that obesity is associated with less severe coronary artery disease in women population of Pakistani origin