Role of exercise echocardiography in decision making of balloon valvuloplasty in moderate mitral valve stenosis

Assessment of value of exercise echocardiography using in patients with rheumatic moderate mitral valve stenosis in interventional decision making [percutenous balloon mitral valvuloplasty]. 30 patients with moderate mitral stenosis were participated in the study. All patients were subjected to exercise echocardiography and were divided into two groups. Group I: 20 patients with good exercise tolerance and group II: 10 patients with poor exercise tolerance and mitral valvuloplasty was done, and then reevaluated with exercise echocardiography one month after valvuloplasty. In group [I] mean pressure gradient across mitral valve at peak of exercise was ranged between 12 and 16 mmHg with mean of 134.78 +/- 1.33 mmHg, while in group[II] mean pressure gradient across mitral valve at peak of exercise was ranged between 17 and 20 mmHg with mean of 18.30 +/- 1.25 mmHg. In group [I] pulmonary artery pressure at peak of exercise ranged between 25 and 40 mmHg with mean of 30.00 +/- 5.38 mmHg, while in group [II] it was ranged between 35 and 40 mmHg with mean of 39.00 +/- mmHg at peak of exercise. All members of group II had subvalvular affection [high score] and 50% of them had high score for calcification with poor exercise tolerance while non of group I had subvalvular affection and only 10% of them had law calcific score]. Exercise echocardiography plays an important role in evaluating true symptomatic patients and assesses the hemodynamic severity in patients with moderate mitral stenosis

N-terminal pro-brain natriuretic peptide on admission as a predictor of short term outcomes and angiographic success in patients with acute ST-elevation myocardial infraction treated with primary angioplasty

Increased levels of N-terminal pro-brain natrituretic peptide [NT-pro BNP] are now recognized as a new and useful biochemical marker that is predictive of clinical outcomes in patients with congestive heart failure [CHF] and short-term death in patients with acute coronary syndromes, However, an association between an increased circulating level of this biomarker and clinical outcomes in patients following acute myocardial infarction AMI has not been fully delineated. Thus, the purpose of this study was to test whether NT-pro BNP obtained on admission can predict short-term outcome as well as the angiographic success of procedures in patients with ST-segment elevation myocardial infarction [STEMI] treated with primary percutaneous coronary intervention [PCI]. A prospective study of 60 consecutive patients with [STEMI] of onset within 24 hs who underwent [PCI] was conducted. Blood samples for plasma concentration of NT-pro BNP were collected following vascular puncture. Univariate analysis demonstrated that the 30-day composite major adverse clinical outcomes [MACO] [advanced killip score > 3, functional class >/= 3 of CHF. and 30 day mortality] were strongly associated with elevated NT-pro BNP [>243 pg/ml] [P=<0.001], unsuccessful reperfusion [final thrombolysis in myocardial infarction 243 [P=<0.001], LVEF <45% [P=<0.001], DM [P=<0.01] unsuccessful reperfusion [P=<0.002], and age [>/= 60 years] [P=<0.05] are independent predictors of 30 day MACO, Additionally, elevation of NT-pro BNP, together with advanced killip score and unsuccessful reperfusion, are significant independent predictors of increased 30- day mortality [all P values =<0.005], furthermore serum NT pro -BNP >100 pico g/ml was found to be a sensitive predictor of no-reflow phenomenon [P=<0.04]. Increased NT-pro BNP level on admission was the most independent predictor of 30 day MACO and angiographic success in patients with STEMI undergoing primary PCI

Insulin resistance as a predictor of restenosis in patients with type II diabetes mellitus undergoing coronary angioplasty and stent implantation

Hyperinsulinaemia is an independent risk factor for ischemic heart disease and induces greater vascular smooth muscle cell proliferation in experimental models. Restenosis after coronary stenting is neointimal tissue proliferation. The rationale of this study is to asses the predictive value of insulin resistance for in-stent restenosis in patients with type II diabetes mellitus. The study population included forty patients [20 diabetic and 20 non diabetic] undergoing percutaneous coronary intervention PCI with stenting and all patients were followed up for 6 months and Homeostasis model assessment insulin resistance [HOMA-IR] were done for assessment of insulin resistance. All clinical, angiographic, procedural, Doppler echocardiographic and laboratory variables were analyzed for all patients in multivariate analysis. Angiographic in-stent restenosis occurred in 14/20 [70%] diabetic patients with no significant difference compared to 13/20 [65%] non-diabetic patients. Multivariate regression analysis showed that HOMA-IR were an independent predictor for restenosis after coronary stenting [HOMA IR p=0.001 for non-diabetic and p=0.025 for diabetics]. HOMA-IR and fasting insulin can be used as a predictor for in stent restenosis in both diabetic and non-diabetic patients