Bangladesh Heart Journal 2019-09-21T13:10:22+00:00 HI Lutfur Rahman Khan Open Journal Systems <p>Official journal of Bangladesh Cardiac Society, Dhaka, Bangladesh</p> Characteristics of Disease Profile of Hospitalized Patients Referred to the Department of Cardiology in a Tertiary Care Hospital 2019-09-21T13:10:22+00:00 MZ Alam MS Hossain MA Basit SJ Hoque AKM Mohibullah <p><strong>Objectives</strong>: Cardiology consultation for hospitalized patients is a common and sometimes mandatory practice in every country. This is because of increased morbidity and mortality of cardiac cases that also has other co-morbidities. We conducted this study to know the pattern of disease profile and the idea of requesting doctors about the cardiac diseases from the cases they referred to the department of Cardiology.</p> <p><strong>Methods</strong>: This prospective observational study was carried out in BIRDEM General Hospital, Shahbag, Dhaka from July to December 2017. We followed every case till the final and confirmed diagnoses were made. All the relevant collected data were compiled on a master data sheet. All findings were expressed as frequency with percentage and analysis were done using SPSS for windows version 22.0.</p> <p><strong>Results</strong>: This study revealed that majority of the referred cases to the department of cardiology was routine (84.4%) and non-cardiac (57%). Non-cardiac cases were referred mainly for the fitness of general anesthesia (GA) (18.4%). But among the critical cases (14.0%), mostly were cardiac (9.1%). Among all the cardiac cases, Hypertension (8.8%) got the highest referral followed by Acute Myocardial Infarction (AMI) (3.8%) and Dilated Cardiomyopathy (DCM) (3.8%).</p> <p><strong>Conclusions</strong>: Hospitalized patients were referred to the department of Cardiology differs according to the requesting unit. The surgical units referred their cases to get the cardiac clearance for a major surgery and the medical units referred for typical cardiac emergencies like AMI.</p> <p>Bangladesh Heart Journal 2019; 34(1) : 1-4</p> 2019-06-25T00:00:00+00:00 ##submission.copyrightStatement## SYNTAX Score on Procedural Outcome among Patient Undergoing Primary Percutaneous Coronary Intervention 2019-09-21T13:10:20+00:00 Md Shariful Islam Md Afzalur Rahman Abdul Wadud Chowdhury Mohsin Ahmed Kajal Kumar Karmakar Mohammad Ullah Firoz Mohammad Arifur Rahman Md Mosharul Haque Mohammad Sadaqul Islam Sikdar Ashrafuzzaman Tamal Abul khair Md Rezawanul Islam Muhammad Ruhul Amin Abeeda Tasnim Reza F Aaysha Cader <p><strong>Background</strong>: Limited contemporary data exist regarding the impact of SYNTAX score on procedural outcomes undergoing primary percutaneous coronary intervention(PCI) in acute STEMI patients.</p> <p><strong>Objectives</strong>: To evaluate the significance of the SYNTAX score for predicting procedural outcome after primary PCI in patient with acute STEMI.</p> <p><strong>Methods</strong>: This perspective observational study was conducted in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from September, 2015 to September, 2016. 42 patients with acute STEMI who underwent primary PCI were considered for the study. But 2 patients were excluded from the study due to failure of primary PCI. The patients were divided into two groups: Group I (low Syntax score d”22) and Group II (high Syntax score &gt; 22). The Syntax score of all patients were calculated from an initial coronary angiogram before primary PCI. Procedural outcome was observed in between two groups.</p> <p><strong>Results</strong>: Among study patients 57.5% were in SYNTAX score d”22 (Group I) and 42.5% were in SYNTAX score &gt;22 (Group II). Among traditional cardiovascular risk factors diabetes was significantly more prevalent in the Group II than Group I ( 82.4% vs 34.8%, p  0.003). Angiographic profile revealed maximum (69.6% vs 17.6%) culprit lesion in LAD artery in Group I and maximum culprit lesion (64.7% vs 21.7%) in RCA in Group II, these were the statistically significant between Group I and Group II (P&lt;0.05). The high SYNTAX score group had lower ejection fraction (47.8±5.1 vs. 54.4±4.3, p= 0.04), lower TIMI flow 3 rate (76.47% vs 91.3%, p= 0.03 ) greater rate of MACE (29.4% vs. 4.3%, p=0.041), lower procedural success rate ( 76.47 vs. 91.3%, p= 0.046) compared to the low SYNTAX score group. ROC curve showed 77% sensitivity and 32% specificity for SYNTAX score when cut off value was 22 Performance test of SYNTEX score in the setting of Primary PCI outcome showed positive predictive value 83%.</p> <p><strong>Conclusions</strong>: SYNTAX score was an independent variable that can predict procedural outcomes</p> <p>Bangladesh Heart Journal 2019; 34(1) : 5-10</p> 2019-06-25T00:00:00+00:00 ##submission.copyrightStatement## Performance of EuroSCORE II in Predicting Early Mortality after Mitral, Aortic or Mitral & Aortic Valve Surgery Patients in National Heart Foundation Hospital and Research Institute 2019-09-21T13:10:19+00:00 Ahsan Uddin Mahmud Md Faizus Sazzad Mohammed Armane Wadud Iftakher Raja Chowdhury Mohammad Hafizur Rahman Haroon Rasheed Chowdhury Noel Cipriyan Gomes Sohel Reza Choudhury Quamrul Islam Talukdar Prasanta Kumar Chanda Farooque Ahmed <p><strong>Background</strong>: Preoperative risk assessment before cardiac surgery to predict mortality become literally important and practicing worldwide, whereas EuroSCORE II is most updated and popular. So we examined the hypothesis that Performance of EuroSCORE II in predicting early mortality after Mitral, Aortic or mitral &amp; aortic valve surgery patients in National Heart Foundation Hospital and Research Institute.</p> <p><strong>Objectives</strong>: To compare Euro SCORE II predicted early mortality and observed early mortality in a sample of patients of National Heart Foundation Hospital who underwent for Mitral, Aortic or Mitral &amp; Aortic valve surgery. Methods: An observational prospective study was done in Department of cardiac surgery, National Heart Foundation Hospital and Research Institute who underwent for Mitral, Aortic or Mitral &amp; Aortic valve surgery in the period of July 2016 to March 2018. Sample size was 356 and all inclusion criteria full filled. Patients were divided into 3 group (low, medium &amp; high) depending on the score. Model discrimination and calibration were assessed additive and logistic EuroSCORE and EuroSCORE II.</p> <p><strong>Results</strong>: The in hospital mortality of this series was 2.8% (10 out of 356) and the predicted mortality was 2.73% (95% CI 1.02-4.38) by the EuroSCORE II, 2.15% (95% CI 0.68- 3.72) by the additive method and 2.25% (95% CI 0.74-3.86) by the logistic EuroSCORE. The model’s discriminatory power also good and useful as indicated by an area under ROC curve of 0.779 in EuroSCORE II model, 0.675 in additive method and 0.696 in logistic method that means EuroSCORE II method can predict the outcome with 77% accuracy, additive method with 67% accuracy and the logistic method does that with 69% accuracy.</p> <p><strong>Conclusion</strong>: EuroSCORE II was validated and performed well on National Heart Foundation patients and could be recommended as a simple risk stratification system to estimate the probability of early mortality in patients scheduled for valve surgery in Bangladesh.</p> <p>Bangladesh Heart Journal 2019; 34(1) : 11-24</p> 2019-06-25T00:00:00+00:00 ##submission.copyrightStatement## Evaluation of Blood Lactate Level as Predictor of Early Adverse Outcome after Cardiac Surgery under Cardiopulmonary Bypass 2019-09-21T13:10:17+00:00 MAK Azad KS Islam MA Quasem <p><strong>Background</strong>: We examined the hypothesis that high blood lactate level in intensive care unit patient after adult cardiac surgery under cardiopulmonary bypass is associated with early adverse outcome. The objective of this study was to evaluate whether high blood lactate level after cardiac surgery is a predictor of the early outcome after adult cardiac surgery under cardiopulmonary bypass.</p> <p><strong>Methods</strong>: This prospective observational study was carried out in the department of Cardiac Surgery at National Institute of Cardiovascular Disease (NICVD), Dhaka from July, 2013 to April 2014. A total number of 100 patients who underwent cardiac operation with cardiopulmonary bypass were enrolled in this study as per inclusion and exclusion criteria. Patients were divided into two groups according to their blood lactate level 6 hours after transferintensive care unit. Peroperative variables and postoperative variables were observed and recorded during the hospital course of patient. Categorical variables were analyzed by Chi- Square test and Fisher’s exact test and continuous variables were analyzed by ‘t’ test. Multiple Binary Logistic Regression Analysis of predictors for each of the outcome variables was done.</p> <p><strong>Results</strong>: Blood lactate levels ≥3mmol/L 6 hours after transfer to intensive care unit were present in 57(57%) patients. Multiple logistic regression analysis showed higher blood lactate level was an independent predictor for early postoperative low output syndrome (OR 9.073, 95% CI 2.819 – 29.207, p = &lt; .0001), pulmonary complication (OR 5.734, 95% CI 1.814 – 18.122, p = .003), neurological deficits (OR 9.725, 95% CI 1.111 - 85.147, p = .040), renal dysfunction (OR 7.393, 95% CI 1.855-29.469, p = .005), arrhythmia (OR 10.512, 95% CI 1.902 – 58.108, p = .007) and wound infection (OR 7.742, 95% CI 1.418 - 42.259, p = .018).</p> <p><strong>Conclusions</strong>: High blood lactate level 6 hours after transfer to intensive care unit is an independent predictor for worse outcomes in adult patients after cardiac surgery under cardiopulmonary bypass.</p> <p>Bangladesh Heart Journal 2019; 34(1) : 25-30</p> 2019-06-25T00:00:00+00:00 ##submission.copyrightStatement## Pattern and Prevalence of Dyslipidemia among Patients with Acute Coronary Syndrome Admitted in a Tertiary Level Hospital 2019-09-21T13:10:16+00:00 Dilshad Parvin Sunil Krishna Baul SM Rahat Hossain Swati Munshi Md Hadiuzzaman Kaniz Fatema <p><strong>Background</strong>: The leading cause of mortality in men and women worldwide is coronary artery disease (CAD). For hospitalization in our country, acute coronary syndrome (ACS) is a major reason. Dyslipidemia is found one of the most important modifiable risk factors for CAD.</p> <p><strong>Aim</strong>: The aim of the study was to determine the pattern and prevalence of dyslipidemia among patients with ACS admitted in National Institute of Cardiovascular Diseases (NICVD), Dhaka.</p> <p><strong>Subjects and methods</strong>: One thousand (1000) patients with ACS were included and classified according to clinical presentation, the findings on the admission electrocardiogram (ECG) and the results of serial cardiac troponin levels, into myocardial infarction(MI), either STelevation or non ST- elevation MI, and unstable angina(UA) subgroups. In the other group 500 healthy subjects were included as controls. All subjects were subjected determination lipid profile. ECG and Troponin- I were done for diagnosis and follow up of the patients.</p> <p><strong>Results</strong>: In patients with ACS, high levels of TC (&gt;200 mg/dl) were found in 60.67%,high levels of LDL (&gt; 130 mg/dl) were found in 58%, high levels of TG (&gt;150 mg/ dl) were found in 63.33%, however, low levels of HDL (&lt; 40 mg/dl) were found in 66%. There was a statistically significant elevation in TC, LDL, TG serum levels in patients with ACS compared to control subjects (p&lt;0.05) while the HDL was significantly low in ACS patient compared to control subjects (p &lt;0.05). TC/HDL &gt; 5 and TG/HDL&gt; 4 were significantly higher in patients with ACS than controls. There was no significant difference between MI and UA patients regarding all lipid profile parameters. TC, LDL, TG were significantly higher in males than in females while HDL was significantly higher in females compared to males. Also TC/HDL and TG/HDL ratios were significantly higher in males compared to females. All lipid components were significantly more prevalent in males than in females except TG where there was no significant difference between males and females. Stepwise regression analysis of lipid parameters revealed that TC/HDL and TG/HDL ratios were independent risk factors for ACS.</p> <p><strong>Conclusion</strong>: Dyslipidemia is one the major risk factors which is widely prevalent in patients with ACS and is more prevalent in males than in females. We recommend paying more attention to serum lipids and other modifiable risk factors for prevention of ACS and more studies about them as risk factors of atherosclerosis and its impact on other systems is advised.</p> <p>Bangladesh Heart Journal 2019; 34(1) : 31-36</p> 2019-06-25T00:00:00+00:00 ##submission.copyrightStatement## Fractional Flow Reserve (FFR) guided Percutaneous Coronary Intervention (PCI) to Avoid Inappropriate Stenting in Patient with Angiographically Significant Stenotic Coronary Artery Lesion–Our Experiences at Apollo Hospitals Dhaka 2019-09-21T13:10:14+00:00 AHM Waliul Islam Shams Munwar Azfar Hossain AQM Reza Sahabuddin Talukder Tamzeed Ahmed Kazi Atiqur Rahman <p><strong>Background</strong>: Importance of Physiological study by Fractional Flow Reserve (FFR) in the management of patient with coronary artery disease (CAD is well established.</p> <p><strong>Objective</strong>: Angiographic-guided percutaneous coronary intervention (PCI) is a common practice in Bangladeshi interventional era. Data on Pre-PCI physiological study by Fractional Flow Reserve (FFR) in our patient is not available. Therefore, our primary aim was to perform pre-PCI FFR to assess the angiographically significant coronary stenosis and thus to avoid inappropriate stenting.</p> <p><strong>Methods</strong>: Total 22 patients (Male 20, Female 2) were enrolled in this observational non-randomized prospective cohort. Patient who had angiographically significant lesion, planned for physiological study by pre-PCI FFR. Cut off value for FFR were clinically significant only if Pd/Pa ratio &lt;0.75 and differed stenting if &gt; 0.76-0.80 or above.</p> <p><strong>Results</strong>: In the studied patient population, FFR done in total 27 vessels of 22 patients. Among the vessel wise FFR distribution were in LAD 67%(18), LCX 14.8%(4), RCA 14.8%(4) and Ramus Intermedius 3.7% (1). FFR was nonsignificant (&lt;0.75) in 59% (13) patients and significant (&gt;0.75) were in 41%(9) patients.</p> <p><strong>Conclusion</strong>: In this single center, very preliminary observational prospective cohort of non-randomized study, we found, that FFR is an important aid to perform PCI in patient with angiographically significant coronary lesion, and to avoid inappropriate stenting of insignificant stenosis by physiological study. Thus, to reduce cost and untoward effects of inappropriate stenting.</p> <p>Bangladesh Heart Journal 2019; 34(1) : 37-43</p> 2019-06-25T00:00:00+00:00 ##submission.copyrightStatement## Effects of Controling of Post Operative Hypergycemia (Stress Induced Hyperglycemia) in Adult Non-Diabetic Patients Undergoing Mitral Valve Replacement Surgery Under Cardiopulmonary Bypass 2019-09-21T13:10:13+00:00 Md Armane Wadud Syed Tanvir Ahmed Shahnoor Aziz Ibrahim Khalilullah CM Shaheen Kabir <p><strong>Objectives</strong>: The objective of this study was to see whether there is an association between high blood glucose levels after operation under CPB and post operative morbidity and mortality.</p> <p><strong>Methodology</strong>: This cohort study was carried out in the Department of Cardiac Surgery at National Institute of Cardiovascular DiseaseS (NICVD), Sher-e-Bangla Nagar, Dhaka from January, 2012 to December, 2013 for a period of twenty four (24) months. A total number of 110 patients who underwent MVR operation with CPB were enrolled in this study as per inclusion and exclusion criteria. Patients were divided into two groups according to their post operative blood glucose levels, recorded with in first 60 hrs after mitral valve replacement surgery under cardiopulmonay bypass. Patients having blood glucose level of less than 10.1 mmol/L (unexposed) and patients having blood lactate level of 10.1 mmol/L or more (exposed) were grouped. Post operative variables were observed and recorded during the hospital course of the patient.</p> <p><strong>Result</strong>: A total number of 110 patients were enrolled in this study. Blood glucose levels lower than or equal to10 mmol/L after MVR were present in 55(50%) patients (Group A) Blood glucose levels higher than 10 mmol/L after MVR were present in 55(50%) patients. Postoperative morbidity was higher in this group ( Group B) than in the patients who had peak blood glucose levels of less than or equal to 10 mmol/L MVR (p 0.001). Postoperative ICU stay was prolonged in patients with elevated levels of blood glucose after MVR under CPB compared with of patients with lower blood glucose levels (p 0.001). Other common morbidities are neurological complication (p 0.04), renal dysfunction (p 0.01) , wound infection (p 0.04), post-operative hospital stay ( p0.004). also higher in group B patient, as well as mortality.</p> <p><strong>Conclusions</strong>: Blood glucose concentration of 10.1 mmol/ L or higher after MVR under CPB is an important issues related to postoperative morbidity and mortality.</p> <p>Bangladesh Heart Journal 2019; 34(1) : 44-51</p> 2019-06-25T00:00:00+00:00 ##submission.copyrightStatement## Management of Diabetic Foot Ulcer in a Tertiary Level Hospital-Faridpur 2019-09-21T13:10:11+00:00 AL Gaddafi DK Das G Faruque Z Islam MA Rahman FN Jui KM Walid A Biswas <p>A descriptive type of cross sectional study among 210 diabetic patients with foot ulcer was carried out in Diabetic Association Medical College during the period of May 2016 to April 2017 and were categorized based on Meggitt-Wagner system to find out the complications, management, below knee amputation rate and mortality rate. The aim of this study was to practise a profile of diabetic foot ulcer (DFU), complications and its management to assess the outcome of the surgical interventions. Majority of the patients were male 112(53%), and most of them 116 patients (55.23%) presented within Wegner grade - 2 and grade-3 diabetic foot ulcers. The duration of diabetes more than 10 years was 116 (55%). 99 (47%) patients out of 210 patients developed diabetic neuropathy. 76 (36%) patients presented with CKD. Lack of awareness about diabetes mellitus and its lower limb complications, poor compliance to the treatment, poorly controlled blood sugar levels, delay in diagnosis, and late presentation to the tertiary care center, associated habit of smoking are all factors which lead to incidence of DFU at an earlier age than that seen in other studies. After admission of diabetic foot ulcer patients, diabetic foot ulcer is classified according to Wagner grading and treated the diabetic foot ulcer patients as the using protocol ’!1.Assesment whether it was conservative or surgical. 2. Optimal blood sugar control. 3. Systemic antibiotic. 4. Moist wound environment. 5. Offloading such as total contact casting. 6. Improves peripheral arterial circulation due to lack of vascularity. 7. Surgical debridement or minor amputation or major amputation. In case of G-4 or G-5 patients, ischemia was treated before debridement or amputation so that vascular circulation improved in the ulcer area and then healing potential was fastened.</p> <p>Bangladesh Heart Journal 2019; 34(1) : 52-57</p> 2019-06-25T00:00:00+00:00 ##submission.copyrightStatement## Peripheral Vascular Intervention: A Review 2019-09-21T13:10:10+00:00 Mohsin Ahmed Abul Hasan Muhammed Bashar Abdullah Al Gaddafi <p>The prevalence of peripheral artery disease (PAD) continues to increase worldwide. It is important to identify patients with PAD because of the increased risk of myocardial infarction, stroke, and cardiovascular death and impaired quality of life because of a profound limitation in exercise performance.Lower extremity PAD affects approximately 10% of population, with 30% to 40% of these patients presenting with claudication symptoms. Peripheral arterial disease is common, but the diagnosis frequently is overlooked because of subtle physical findings and lack of classic symptoms. Screening based on the ankle brachial index using doppler ultrasonography may be more useful than physical examination alone. Noninvasive modalities to locate lesions include duplex scanning, computed tomography angiogram, magnetic resonance angiography and invasive modalities peripheral angiogram is the gold standard. Major risk factors for peripheral arterial disease are cigarette smoking, diabetes mellitus, older age (older than 40 years), hypertension, hyperlipidemia, and hyperhomocystinemia. Intermittent claudication may be improved by risk-factor modification, exercise, and pharmacologic therapy. Based on available evidence, a supervised exercise program is the most effective treatment. Effective drug therapies for peripheral arterial disease include aspirin (with or without dipyridamole), clopidogrel, cilostazol, and pentoxifylline. By contrast, critical limb ischemia (CLI) is considered the most severe pattern of peripheral artery disease. It is defined by the presence of chronic ischemic rest pain, ulceration or gangrene attributable to the occlusion of peripheral arterial vessels. It is associated with a high risk of major amputation, cardiovascular events and death. The management of CLI should include an exercise program, guideline-based medical therapy to lower the cardiovascular risk. Most of the cases, revascularization is indicated to save limbs; an “endovascular first” approach and lastly surgical approach, if all measures were failed. The choice of the intervention is dependent on the anatomy of the stenotic or occlusive lesion; percutaneous interventions are appropriate when the lesion is focal and short but longer lesions must be treated with surgical revascularisation to achieve acceptable long-term outcome.</p> <p>Bangladesh Heart Journal 2019; 34(1) : 58-67</p> 2019-06-25T00:00:00+00:00 ##submission.copyrightStatement## Carotid body Tumour with Hypoglossal Nerve Palsy- A Case Report 2019-09-21T13:10:09+00:00 Kaisar Haroon Tania Taher Shafiul Alam Naila Huq Sk Sader Hossain <p><strong>Objective</strong>: Carotid body tumour is a rare tumour. This is a case report of carotid body tumour of the right side involving the right hypoglossal nerve with MRI appearance and pathological features. The objective is to present a case of Hypoglossal nerve palsy due to carotid body tumour involving the right carotid artery bifurcation.</p> <p><strong>Method</strong>: A 18-year old male presented with a welldefined swelling of his right neck, increasing hoarseness, and left ward tongue deviation on protrusion present for two years CT neck and MRI were done. The tumour was identified and the patient underwent surgery. His Histopathology report commented it to be carotid body tumour.</p> <p><strong>Result</strong>: The patient showed significant improvement after surgery. His tongue deviation improved and his hoarseness of voice had been begun to improve.</p> <p><strong>Conclusion</strong>: Carotid body tumours are benign lesion mimicking other pathology. High level of suspicision, imaging and careful resection is important for avoiding complications.</p> <p>Bangladesh Heart Journal 2019; 34(1) : 68-72</p> 2019-06-25T00:00:00+00:00 ##submission.copyrightStatement##