Left atrium volume as a surrogate marker of left ventricular diastolic dysfunction

Objective: To determine correlation between left atrial volume and left ventricular diastolic dysfunction

Methodology: This was a single center observational study conducted at Lady Reading Hospital, Peshawar. Patients above 18 years of both genders, who were in sinus rhythm and having no significant systolic dysfunction or significant mitral insufficiency on echocardiography, were included in the study, using purposive non-probability sampling technique. A total 339 patients underwent transthoracic echocardiography from July 2013 to June 2014. Detailed cardiac echocardiography was performed to determine left atrial volume, ejection fraction, E and A velocities, deceleration time and e've-locity, E/e

Results: A total of 339 patients were studied. Male were 61.9%. Mean age of study population was 58.42 +/- 10.48 years. Baseline characteristics of patients having some degree of diastolic dysfunction were; mean age 65.5 +/- 12.3, mean body mass index 25.2 +/- 2.5 kg/m2, mean ejection fraction 55.1 +/- 7.5%, hypertension 48.6%, diabetes mellitus 10.1% and left ventricular hypertrophy 38.6%. Echocardiographic findings in diastolic dysfunction patients were as follow: mean left atrial volume was 65.3 +/-10.1 ml, E/A 1.4 +/- 0.6, TDI e' was 6.7 +/-1.3 m/sec and TDI E/e' was 12.7 +/- 2.1. Increasing left atrial volume was well correlated with increasing severity of left ventricular diastolic dysfunction [y = +0.8, Spearman rank correlation]

Conclusion: Increase in left atrial volume is directly correlated with severity of diastolic dysfunction. Severity of diastolic dysfunction increases with increased left atrial volume

Clinical profile of patients with normal coronary angiogram

To observe the clinical and bio-chemical profile of patients having normal coronary angiogram following an abnormal stress test. This was a single center retrospective, descriptive study. Coronary angiograms done from July 2009 to December 2011 were retrieved and reviewed for normal coronary arteries. Clinical and bio-chemical profile of the patients having normal coronary angiogram was retrieved from hospital record. Patients, whose computerized data could not be retrieved from department database, were excluded from the study. Out of 8425 angiograms reviewed, 816[9.7%] were having normal coronary arteries. Mean age was 4 +/- 27.4 years. Females were 66.7%. Clinical and biochemical profile for normal coronary angiograms was as follows: smokers 59%, family history of premature coronary artery disease 41%, hyperlipidemia18.5% and hypertension 14%. Diabetes was present only in 2.1%. Among females: 11% were current users of oral contraceptives pills, 3.4% were post menopausal and 0.87% pregnant. Mean BMI was 25.4 +/- 5.2 and total cholesterol and triglyceride were 278 +/- 31mg/dl and 180 +/- 28mg/dl respectively. Normal coronary angiogram is infrequently observed in catheterization laboratories and mostly found in younger to middle aged females. Smoking is very common in such patients. Hyperlipidemia, hypertension, diabetes mellitus are not frequently present in these patients.

Correlation of functional class of dyspnea with left ventricular diastolic dysfunction

To correlate functional class of dyspnea with left ventricular diastolic dysfunction assessed by echocardiography. This was a single center descriptive study, conducted in Cardiology department Lady Reading Hospital Peshawar from March 2011 to October 2011. All male and female patients of any age with clinical diagnosis of heart failure with sinus rhythm and no to minimal mitral regurgitation were included in the study, using consecutive non-probability sampling technique. Six minute walk test was performed to place the patients in proper NYHA Class of dyspnea. Detailed echocardiographic study was performed to document left ventricular diastolic dysfunction. The data was analyzed on SPSS version 16. Spearman rank correlation coefficient was used to measure the strength of association between pairs of variables. P-value