Cardiovascular Journal

Utility of 3D mapping in Electrophysiology-Less Time with Greater Success in Difficult Accessory Pathway Ablation

2023-08-20T06:45:56+00:00

This is a challenging case of Wolff–Parkinson–White syndrome which was located in the right posteroseptum region. Patient had a previous unsuccessful attempt at ablation. It is often difficult to precisely locate this type of accessory pathway. A repeat procedure using 3D electroanatomic mapping, the electroanatomic geometry of the heart was created. The accessory pathway potential was identified and the accessory pathway was successfully ablated in minimum amount of time. In this case report showed that the advanced three-dimensional cardiac mapping system plays a very important role in guiding clinicians in order to precisely locate and safely ablate this type of challenging accessory pathway.

Cardiovasc j 2023; 16(1): 47-52

Cardiac Rehabilitation in Coronary Artery Disease: Improving Outcomes and Adherence

2023-08-15T02:04:22+00:00

Cardiac rehabilitation (CR) is a program that aims to improve the cardiovascular health of patients with coronary artery disease (CAD) through a multidisciplinary approach. CR typically includes exercise training, risk factor modification, psychosocial support, and education. Studies have shown that CR can improve exercise capacity, reduce angina symptoms, enhance overall quality of life, and reduce the risk of recurrent cardiovascular events. Despite the benefits of CR, adherence remains a challenge, and many patients with CAD do not participate in these programs. Strategies to improve adherence to CR include patient education, personalized goal setting, motivational interviewing, and peer support. Encouraging and supporting patients with CAD to participate in CR programs is crucial for the secondary prevention and long-term management of their condition.

While CR programs are effective, access to these programs may be limited for some patients, particularly those in underserved communities or rural areas. Tele-rehabilitation, which uses technology to provide remote delivery of CR services, has shown promise in increasing access to CR for patients who may not have access to traditional in-person programs.

Overall, CR is a vital component of the management of CAD, and its benefits extend beyond cardiovascular health to include improvements in overall quality of life. It is important to raise awareness about the importance of CR and to work towards increasing access to these programs for all patients with CAD.

Cardiovasc j 2023; 16(1): 40-46

Remembering Christiaan Barnard in Philately

2023-08-21T05:03:26+00:00

Christiaan Barnard is famous for his legendary operation of first ever successful human heart transplantation performed on December 3, 1967 at the Groote Schuur hospital Cape Town, South Africa. The operation captured the World public imagination as no surgical procedure had ever before or since. Christian Barnard, a little known surgeon from apartheid South Africa suddenly became the focus of media attention. The Groote Schuur team captured the headlines of the world’s leading newspapers. However, forgotten are the names of those innumerable surgeons, cardiologists, basic scientists and researchers whose research works paved the pathway to transplant success. It may be difficult to estimate the level of world’s interest about the action of Christiaan Barnard and his team. One example is a commemorative postal stamp published to honor him by countries from different parts of the world. They include Bhutan, St. Helena, Romania, Commonwealth of Dominica, Mozambique and Republic of Congo and others. Yemen Arab Republic printed a series of stamps honoring Dr. Christiaan Barnard. African country Guine Bissau printed a beautiful stamp and first day coverportraying Barnard and a beautiful image of a little girl on a hospital bed with the teddy bear in her arms.Latin American country Paraguay gave Dr. Barnard a distinct honor by portraying him on a series along with Reverend Martin Luther King & President John F Kennedy. Christiaan Barnard was among the most celebrity surgeons of the world. Many countries have printed commemorative stamps to respect and celebrate his achievement. Ironically, many of these countries lack even the basic cardiac surgical facilities.

Cardiovasc j 2023; 16(1): 53-55

Historic photos related to Cardiac Surgery in Bangladesh

2023-08-16T06:57:23+00:00

Abstract not available

Cardiovasc j 2023; 16(1): 56-58

Early Outcome of Off-Pump Versus Conventional Coronary Artery Bypass Grafting Surgery in Patients with Multivessel Coronary Artery Disease in a Specialized center in Bangladesh

2023-08-13T06:26:50+00:00

Background: Both off-pump (OPCAB) and on pump arrest heart coronary artery bypass surgery (CABG) are frequently performed in department of cardiac surgery, NICVD, Dhaka, Bangladesh. Both types of procedures have advantages and disadvantages. This study was conducted to analyze early post-operative outcome following both types of CABG on patients with multivessel coronary artery disease.

Methods: Between 1^st September 2019 to 28^th February 2021, a cross-sectional study was performed with total 60 patients. 30 patients underwent Off Pump coronary artery bypass grafting (OPCAB)(Group A) and 30 patients underwent Conventional Coronary Artery Bypass (CCAB) (Group B) surgery. Preoperative, peroperative and post-operative variables were recorded and analyzed with appropriate statistical tools and p ≤ 0.05 considered statistically significant.

Results: Fifty-five male i.e., 91.67% and five female i.e., 8.33% of total patients were participated in this study. Mostly were within forty-five to sixty-four years age group. Preoperative risk factors, family history and drug history had no significant difference (p>0.05). Mean ± SD number of bypass conduits given in each group almost similar and no statistically significant arrhythmia in terms of atrial fibrillation (AF), ventricular tachycardia (VT) and premature ventricular contraction (PVC) were found preoperatively (p>0.05). New onset of early post-operative ECG changes was found in 3 patients of group A and 9 in group B (10 % vs 30%). AF and PVC found in group B significantly (p<0.05) higher than group A. Immediate post-operative troponin I was higher in group B (p = 0.001). Mean ± SD duration of mechanical ventilation, inotropic supports, ICU stay, bleeding and blood transfusion and serum creatinine were significantly higher in group B (p <0.05). Overall immediate and follow up post-operative morbidities were higher in group B than A (p<0.05).

Conclusion: Although on pump arrest heart CABG still stands gold standard, in our study we found OPCAB is better than conventional method.

Cardiovasc j 2023; 16(1): 1-8

The Role of HEART Score in Predicting Major Adverse Cardiac Events in Patients with Possible Acute Coronary Syndrome Presenting to the Emergency Department

2023-08-05T03:02:10+00:00

Introduction: Acute coronary syndrome is very challenging & sometimes very confusing to diagnose. The HEART score was designed to be a prognostic prediction model, using information from the patient’s history, ECG, age, risk factors, and troponin level at the initial emergency department. This study was conducted to assess the role of HEART score in predicting major adverse cardiac events in patients with possible acute coronary syndrome presenting to the emergency department.

Methods: This prospective observational study was conducted among 453 patients presented with acute coronary syndrome (ACS) at the Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from January 2023 to June 2023 to assess the role of HEART score in predicting major adverse cardiac events (MACE) in patients with possible acute coronary syndrome. The study population was divided into two groups depending on HEART score. MACE was observed between these two groups.

Results: Mean age of the respondents was 53.45±11.23 years where 77.7% of them were male. 55% had smoking habit, 36% had history of Diabetes Mellitus, and 38% had history of HTN. Among the respondents 62.9 % was improved. 11.03 % respondents developed heart failure, 14.34% recurrent ischemic pain, 7.9% of recurrent MI, 2.8 % cardiogenic shock, and 0.88 % cases of death. HEART score as predictor was statistically significant (X2=69.7, df=1, p<0.05), indicated to distinguish between major adverse cardiac events and no major cardiac events.

Conclusion: Almost one third of respondents with high HEART score had heart failure and recurrent ischemic pain. There was statistically significant difference in incidence of major adverse cardiac events between high and low HEART score groups. The HEART score can be used to predict risk for major adverse cardiac events effectively in patients with suspected ACS. This can help us to determine needs for urgent treatment and hospitalization among the patients who present with suspected ACS.

Cardiovasc j 2023; 16(1): 9-16

Comparison of Early Postoperative Outcome Between Intermittent Intravenous Heparin versus Continuous Heparin Infusion after Initial Bolus Dose during Off-Pump Coronary Artery Bypass Surgery

2023-08-14T07:44:00+00:00

Background: Heparin is an anticoagulant used invariably in all cardiac surgery. Heparin dosing and its reversal is determined by monitoring Activated Clotting Time (ACT). Surgery under cardiopulmonary bypass requires much more heparin than off-pump cardiac operations. Intermittent heparin dosing after initial bolus dose is widely practiced to maintain ACT level 200- 300 seconds in OPCAB. Fluctuation of ACT level from this range may causes adverse postoperative outcome. This study was aimed to compare early postoperative outcome between intermittent heparin dose and continuous heparin infusion after initial bolus dose during OPCAB.

Methods: This comparative cross-sectional study was carried out in National Institute of Cardiovascular Diseases (NICVD) from January 2019 to December 2020. Total 110 patients were enrolled by purposive sampling and divided into 2 groups: group-A where 55 patients received intermittent heparin after initial bolus dose and group-B where 55 patients received continuous heparin infusion after initial bolus dose. Data were analyzed by statistical package for social science (SPSS) version 26.0 and p value <0.05 was considered significant.

Results: Baseline ACT level of group-A was 87.04±5.51 seconds and group-B was 87.31±5.74 seconds, which was not significant (p = 0.800). After bolus dose of Heparin, ACT level of group-A was 252.02 ± 25.131 seconds and group-B was 259.04 ± 12.645 seconds. Difference between the groups was not significant (p = 0.068). Mean maintenance ACT was 326.34±22.774 seconds in group-A and 258.67±12.285 seconds in group-B patient, which was significant (p<0.001). Peroperatively 29% from group-A and 11% from group-B developed arrhythmia. Postoperative mean Troponin I level in group-A was 5.78± 1.15 and group-B was 5.32± 1.05 ng/dl, which is significant (p = 0.030). Postoperative blood loss was significantly higher in group-A than group-B (986.36± 398.31 vs 852.73±241.22, p=0.036). There was significantly better reduction of arrhythmia and ischemia in postoperative and on discharge ECG finding in group-B patients (p=0.002). On discharge echocardiography 31% from group-A and 13% from group-B had regional wall motion abnormality, which is significant (p=0.018). But there was no significant difference in LVEF% (52.65±5.99 vs 53.85±5.77, p = 0.287). There was only one mortality which was from group-A. The patient was suffering from critical left main disease and developed postoperative arrhythmia and low output syndrome.

Conclusion: Early postoperative outcome of continuous heparin infusion is better than intermittent intravenous heparin after initial bolus dose during Off-pump coronary artery bypass surgery. So, during OPCAB use of continuous heparin infusion after bolus dose is eminent time worthy.

Cardiovasc j 2023; 16(1): 17-23

Use of the Left Ventricular Internal Dimension at End-Diastole and the Mitral Valve E-Point Septal Separation Ratio in the Prediction of the Left Ventricular Systolic Function

2023-08-16T05:12:08+00:00

Background: Rapid assessment of left ventricular ejection fraction (LVEF) may be critical among emergency department (ED) patients. This study examined the predictive relationship between bedside Left Ventricular Internal Dimension at End-Diastole and the Mitral Valve E-Point Septal Separation (EPSS) Ratio to the quantitative calculated LVEF.

Methods: A prospective observational study was conducted on a sequential convenience sample of patients, receiving comprehensive Transthoracic Echocardiography (TTE). The current study recruited 100 patients who presented to the Cardiology Clinic of Lab Aid Cardiac Hospital. Echocardiographic examinations were performed to obtain 2D guided M-mode measurements of the LVIDd & EPSS in addition to calculation of conventional, quantitative LVEF. All the measurements were done in the Para-sternal long-axis view.

Results: It was found that LVEF determined by EPSS has very significant negative correlation with Calculated LVEF (r=—.766, p<0.001). LVEF determined by LVIDd/EPSS has also very significant positive correlation with calculated LVEF (r=.806, p<0.001), but correlation of LVIDd/EPSS was significantly higher than correlation of LVEF with only EPSS. LVIDd/EPSS <7 is strongly predictive of reduced LVEF<50% (P<.001). An LVIDd/EPSS <6 mm is evidence of reduced LVEF < 40%, (P<.001). Of note LVIDd/ EPSS <4 mm correlates with severely decreased function, with an estimated LVEF of <30% (P <.001). As was shown by the results of the linear regression analysis, most significant determinant of LVEF was LVIDd/EPSS (R=.806, p<0.001) The results of the linear regression analysis indicated that the LVIDd/EPSS was an independent predictor of the LVEF (P<0.001). Measurements of LVIDd/EPSS were significantly associated with the calculated measurements of LVEF from comprehensive TTE.

Conclusion: The LVIDd/EPSS may allow certain clinicians, especially beginners and emergency department physicians, to assess the LVEF when other methods are not available or questionable.

Cardiovasc j 2023; 16(1): 24-31

Impact of Serum Free Triiodothyronine level in Predicting the Degree of Myocardial Injury In Patients With Acute ST Segment Elevation Myocardial Infarction

2023-08-15T03:25:50+00:00

Background: Acute myocardial infarction is one of the leading causes of death across the world. Acute ST-segment elevation myocardial infarction (STEMI) occurs from occlusion of one or more coronary arteries that supply blood to the heart. This abrupt disruption of blood flow is due to plaque rupture, erosion, fissuring or dissection resulting in obstructing thrombus. This transmural myocardial ischemia results in myocardial injury or necrosis, systolic and diastolic impairment. The cardiovascular system is very sensitive to thyroid hormones and a wide spectrum of cardiac changes have long been recognized in overt thyroid dysfunction. In the form of free T3 (FT3) as biologically active thyroid hormone, has various effects on the cardiovascular system, including upregulating effective myocardial contractile function, decreasing systemic vascular resistance, as well as improving endothelial function and promoting angiogenesis. In severe illness of non-thyroidal origin, including acute STEMI, thyroid hormone system may be rapidly down regulated. So the decrease in FT3 level may lead to decreased cardiovascular protection in patients with AMI.

Methods: Total 110 patients with STEMI were approached for this study according to the inclusion and exclusion criteria. Patient were divided into two groups- low serum FT3 level (<3.5 pmol/L) in group A and normal serum FT3 level ( >3.5 pmol/L) in group B.

Results: Among 110 patients in our study 40 (36%) were in the low FT3 group ( Group A) and 70( 64%) were in normal FT3 group ( Group B). Serum troponin-I values were significantly higher in Group A (13.9±11.0 ) than in group B ( 9.7±8.9 ) with p value .027. Wall motion abnormality was present in 39(97.5%) Vs 60(85.7%) patients with p value 0.047. LVEF was significantly lower in group A (41.08±6.55) than group B (44.47±6.99) with a p value of .014.

Conclusion: As Low FT3 level in acute STEMI was associated with significantly lower left ventricular ejection (LVEF) and higher levels of cardiac biomarker, preferably troponin I, inclusion of serum FT3 may be a predictor for myocardial injury in STEMI.

Cardiovasc j 2023; 16(1): 32-39