Bangladesh Heart Journal 2020-07-14T13:29:07+00:00 HI Lutfur Rahman Khan Open Journal Systems <p>Official journal of Bangladesh Cardiac Society, Dhaka, Bangladesh</p> Association of Increased Arterial Stiffness with Severity of Coronary Artery Disease in Patients With Non-ST- Segment Elevation Myocardial Infarction 2020-07-14T13:29:07+00:00 ABM Nizam Uddin Abdullah Al Shafi Majumder Md Abdul Kader Akanda Shahana Zaman Mohammad Anowar Hossain Ashiqur Rahman Khan Muhammed Aminur Razzaque Pinaki Ranjan Das Md Zahidul Islam Kazi Ashraful Alam <p><strong>Objective</strong>: Cardiovascular diseases (CVDs) have become the single largest cause of death worldwide. The scenario is same in Bangladesh. Increased arterial stiffness has been associated with increased risk of CVD. A noninvasive assessment of arterial stiffness may serve as a useful adjunct to the cardiovascular risk stratification and risk management and it would be of value for the examination of larger populations. So, this study was designed to demonstrate the association between CVD and arterial stiffness.</p> <p><strong>Methods</strong>: This cross sectional study was conducted in the National Institute of Cardiovascular Disease, Dhaka over a period of ten months starting from January 2014. Patients were purposively selected from those who were admitted in NICVD with acute Non-ST- Segment Elevation Myocardial Infarction (NSTEMI). A total of 80 patients were included in the study. Study patients were divided into two groups on the basis of aortic augmentation pressure (AP), augmentation index (Aix) and augmentation index corrected at heart rate 75/min (AIx@75). Assessment of coronary angiography was performed and severity was assessed by several scoring systems.</p> <p><strong>Results</strong>: Significant positive correlation was found between AIx@75 and vessel score (r= 0.70, p=0.001), Friesinger score (r=0.66, p=0.001) and Leaman score (r= 0.69, p=0.001). Logistic regression analysis showed that increased AIx@75 is significantly associated with severe Coronary Artery Disease (CAD) (OR being 5.54).</p> <p><strong>Conclusion</strong>: The results indicate that AP, AIx and AIx@75 are predictors of severity of CAD. It may be considered as a recommended test for the evaluation of cardiovascular risk.</p> <p>Bangladesh Heart Journal 2019; 34(2) : 73-79</p> 2019-12-12T00:00:00+00:00 ##submission.copyrightStatement## Association of Serum Vitamin D with Acute Myocardial Infarction in Young Patients (≤40 Years) 2020-07-14T13:29:05+00:00 ABM Imam Hosen Abdul Wadud Chowdhury Khondker Md Nurus Sabah Mohammad Gaffar Amin Mohsin Ahmed Azizul Haque Mohammed Nizam Uddin Biswanath Sarker Khandaker Abu Rubaiyat Md Noor E Khuda Md Mesbahul Islam <p><strong>Background</strong>: Coronary heart disease (CHD) is the leading cause of death worldwide, with acute myocardial infarction (AMI) being the most severe manifestation. Recent evidence suggests that vitamin D deficiency (moderate/severe) is an important risk factor for coronary artery disease.</p> <p><strong>Objectives</strong>: Considering paucity of the literature focusing young MI, the study was planned to assess the relation of different grades of low serum vitamin D with AMI in young patients admitted in a tertiary care hospital.</p> <p><strong>Methods</strong>: This Hospital based case-control study was conducted in the department of cardiology in Dhaka Medical College Hospital (DMCH) over 1-year period. Patients with acute MI in young age (≤40 years) admitted in the CCU of DMCH were approached for inclusion in the study. Total 120 subjects (60 cases and 60 controls) were studied. Patients with acute MI were considered as cases and similar number of age and sex matched apparently healthy individual were included as controls. All study population were subjected to relevant investigations and detailed history along with socio-demographic data were collected. Serum vitamin D levels were categorized as severe vitamin D deficiency as a level &lt;10ng/ml, moderate vitamin D deficiency at a level 10-20 ng/ml, vitamin D insufficiency as 21-29 ng/ml and a level of ≥30ng/ml was considered as normal. Serum 25(OH) vitamin D assay was performed for cases and controls using chemiluminescence immunoassay. Vitamin D status (normal/insufficiency vs moderate/severe deficiency) was studied among cases and controls. All necessary information were recorded in a pretested case record form. Statistical analyses were done by SPSS 22.</p> <p><strong>Results</strong>: Mean age of cases and controls were 35.31±4.84 and 33.83±5.11 years respectively. Vitamin D deficiency (moderate/severe) was present in 86.7% cases and 46.7% controls and the difference was statistically significant (P&lt;0.001). Among 60 cases of acute MI, 83% patients had acute ST segment elevated myocardial infarction and 17% patients had acute non-ST segment elevated myocardial infarction. Vitamin D deficient (moderate/severe) subjects were more likely to develop AMI than subjects who had normal/insufficient vitamin D levels in blood (OR 7.42, 95%CI 3.18-18.28, P&lt;0.001). And among all the usual coronary risk factors, vitamin D deficiency (moderate/ severe), Hypertension, Family history of premature CAD and smoking were significantly associated with increased incidence of acute MI (STEMI and NSTEMI) (P value&lt;0.05 in all cases).</p> <p><strong>Conclusion</strong>: Vitamin D deficiency (moderate/severe) is associated with increased incidence of acute MI in young age (≤40 years).</p> <p>Bangladesh Heart Journal 2019; 34(2) : 80-85</p> 2019-12-12T00:00:00+00:00 ##submission.copyrightStatement## Comparison of Vascular Complications in Patients with Percutaneous Coronary Intervention by Trans-radial and Trans-femoral Approach 2020-07-14T13:29:02+00:00 ABM Riaz Kawsar Mir Jamal Uddin Abdul Momen Tariq Ahmed Chowdhury Kajal Kumar Karmoker Samir Kumar Kundu Md Monsurul Hoque Sharadindu Shekhar Roy Anup Kumar Howlader Mohammad Abdul Matin <p><strong>Background and Objective</strong>: Trans-radial approach of coronary catheterization has been increasingly used as an alternative to transfemoral approach due to less vascular complications, earlier ambulation and improved patient comfort. The aim of the study was to compare procedural and post procedural vascular complications in patients with percutaneous coronary intervention by trans-radial and transfemoral approach.</p> <p><strong>Methods</strong>: This observational comparative study was conducted in the National Institute of Cardiovascular Diseases between June 2015 to May 2016. A total of 180 patients were categorized into two groups according to the approach of the percutaneous coronary intervention (PCI). Group I comprising 90 patients who underwent trans-radial PCI and group II consists of 90 patients who underwent transfemoral PCI. Patients with an abnormal Allen’s test, acute coronary syndrome, history of coronary artery bypass surgery, chronic renal insufficiency or older age (&gt;75 years) were excluded.</p> <p><strong>Results</strong>: Patient demographics were the same in both groups. The mean procedural time in min (37.44±5.13 vs 34.14±4.42, p=0.004) and fluoroscopy time in min (21.62±4.11 vs 17.55±2.78, p=0.02) were more in TR-PCI group but the mean haemostasis time in min (7.58±1.11 vs 15.59±3.33, p=0.005) and ambulation time in hour (0.00±0.00 vs 15.59±3.33, p=&lt;0.001) were more in TF-PCI group. Significant arterial spasm following puncture (6.7% vs 0%, p=0.01) were found in trans-radial group but access site bleeding during procedure (2.2% vs 8.9%, p=0.04) were more in TF-PCI group. After the procedure major hematoma (0% vs 4.4%, p=0.04), minor hematoma (5.7% vs 14.4%, p=0.04) and ecchymosis (4.4% vs 13.3%) were significant in TF-PCI group but vessel occlusion (5.7% vs 0%, p=0.02) were significant in TR-PCI group. The mean hospital stays, day (1.64±0.42 vs 2.54±0.62) were more in TF-PCI group.</p> <p><strong>Conclusion</strong>: TR-PCI is safe in respect of procedural and post procedural vascular complications. Trans-radial procedure leads to improved quality of life after the procedure and thus gives much comfort to the patient. It also shortened mean duration of hospital stay. So, trans-radial approach is an attractive alternative to conventional transfemoral approach.</p> <p>Bangladesh Heart Journal 2019; 34(2) : 86-91</p> 2019-12-12T00:00:00+00:00 ##submission.copyrightStatement## Early Outcome of Coronary Artery Bypass Graft Surgery in Patients with Preoperative Elevated Level of HbA1c with Diabetes Mellitus 2020-07-14T13:28:59+00:00 Syed Monirul Islam Md Abul Quashem ASM Iftekher Hossain Rehana Pervin AYM Shahidullah Towfique Ahmed Nazma Khalil <p><strong>Introduction</strong>: Diabetes mellitus has been associated with an increased risk of adverse outcome after coronary artery bypass graft surgery. HbA1c is a reliable measure of long-term glucose control. It is unknown whether adequacy of diabetic control, measured by hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting. The predictive role of HbA1c on short term outcomes after coronary artery bypass graft surgery has not been evaluated. Diabetes mellitus has become a major health issue and contributes to morbidity and mortality from coronary artery disease. The purpose of this study is to determine the predictive role of preoperative elevated HbA1c on post-operative outcome in CABG patients.</p> <p><strong>Objectives</strong>: This study evaluates the early postoperative outcomes of CABG in terms of mortality and major postoperative morbidities like deep sternal wound infection, sepsis, stroke, renal failure, bleeding, arrhythmia, and mediastinitis in patients with preoperative elevated level of HbA1c. Methods: This prospective study was done in National Institute of Cardiovascular Diseases (NICVD). Patients of coronary artery disease (CAD) with DM referred for CABG were enrolled for the study. Total 60 patients were allocated into two groups. Among them 30 patients with preoperative HbA1c of &lt;7% and another 30 patients with preoperative HbA1c of &gt; 7 % underwent CABG surgery from January, 2009 to December, 2010. The early postoperative outcomes were compared between two groups. Both groups were matched with no significant difference that could influence the postoperative outcome.</p> <p><strong>Results</strong>: In-hospital mortality was high in patients with preoperative elevated level of HbA1c. An elevated hemoglobin A1c level predicted in-hospital mortality after CABG surgery. Our study revealed that HbA1c greater than 7 % was associated with increase in mortality. For each unit increase hemoglobin A1c , there was a significantly increase risk of myocardial infarction and deep sternal wound infection. By using receiver operating characteristic value thresholds, renal failure, cerebrovascular accident and deep sternal wound infection occurred more commonly in patients with elevated hemoglobin A1c. Morbidity, infections and the composite outcomes occurred more commonly in patients with elevated HbA1c.</p> <p><strong>Conclusion</strong>: Elevated HbA1c is strongly associated with adverse events after coronary artery bypass graft surgery. Preoperative HbA1c measurement may allow for more accurate risk stratification in patients undergoing coronary artery bypass graft surgery.</p> <p>Bangladesh Heart Journal 2019; 34(2) : 92-99</p> 2019-12-12T00:00:00+00:00 ##submission.copyrightStatement## Association of Risk Factors with Coronary Angiographic Findings of Female Patients with Acute Myocardial Infarction at a Tertiary Hospital of Bangladesh 2020-07-14T13:28:57+00:00 Jinnat Fatema Saira Safa AKM Manzur Murshed Prabir Kumar Das Ashish Dey Biplob Bhattacharjee Anisul Awal <p><strong>Background</strong>: Coronary artery disease (CAD) is the leading cause of mortality and morbidity of women in developed and developing country. Although women in low and middle income countries have worse situation they are least studied. Cardiovascular risk factors assessment and their correlation with angiographic severity in female patients is essential to take preventive strategy and timely intervention.</p> <p><strong>Aim</strong>: The aim of this study was to evaluate the major risk factors of coronary artery disease and to study the relation of those cardiovascular risk factors with coronary angiographic findings in female patients with AMI .</p> <p><strong>Methods</strong>: This was a cross-sectional observational study carried out in the department of Cardiology, Chittagong Medical College Hospital (CMCH) from January 2017 to December 2017. One hundred and fifty consecutive female patients diagnosed as acute myocardial infarction (AMI) who subsequently underwent coronary angiography (CAG) during the study period were included in the study. Data regarding demographic, clinical &amp; laboratory features were recorded. Severity of CAG findings was assessed by Gensini score.</p> <p><strong>Results</strong>: The mean age of the study population was 53.19(±10.71) years. Hypertension was the commonest cardiovascular risk factor (78%) in this study followed by obesity (68%), dyslipidaemia (62%) and diabetes mellitus (57.3%). About 80% patients had clustering of ≥3 risk factors. Proportion of patients having STsegment elevation myocardial infarction (STEMI) and non ST-segment elevation myocardial infarction (NSTEMI) were 47% and 53% respectively. Thrombolytic was the most frequently used treatment modality for the management of STEMI patients. Double Vessel Disease, type B lesion with Gensini score ≥20 were the most common CAG findings. Triple vessel disease and severe CAD (Gensini score ≥20) were more in women with three or more risk factors. A significant (p&lt;0.05) linear correlation was found between Gensini score and age, triglyceride level and total cholesterol level. Other factors, including, obesity, family history, hypertension, diabetes mellitus, menopausal status were found to be more prevalent among severe coronary artery disease on CAG but the differences were not statistically significant (p&gt;0.05).</p> <p><strong>Conclusion</strong>: The present study showed a significant relation of having multiple cardiovascular risk factors with developing more aggressive angiographic findings. It also revealed that Bangladeshi female patients of AMI had clusters of cardiovascular risk factors and presence of multiple risk factors is a predictor of severe coronary artery disease.</p> <p>Bangladesh Heart Journal 2019; 34(2) : 100-110</p> 2019-12-12T00:00:00+00:00 ##submission.copyrightStatement## Frequency and Predictors of Radial Artery Occlusion after Coronary Procedure through Transradial Approach: A Vascular Doppler-guided Study 2020-07-14T13:28:55+00:00 Mohammad Abdul Matin Mir Jamal Uddin Abdul Momen Mustafizul Aziz Abeeda Tasnim Reza Fathima Aayesha Cader Ashraf Ur Rahman Forhad Karim Majumder ABM Riaz Kawsar Shubra Chakraborty <p><strong>Background</strong>: Although transradial approach (TRA) has better outcome and reduced vascular complications, radial artery occlusion (RAO) is now a major concern as it limits future radial artery use for further TRA, for use as a conduit during CABG, for invasive hemodynamic monitoring and for creation of arteriovenous fistula for hemodialysis in CKD patients. Vascular doppler study is the most accurate method for evaluation of RAO and yet this is not practiced in our population.</p> <p><strong>Objectives</strong>: To detect the frequency and identify the predictors of RAO after coronary procedure through TRA. <em>Methods</em>: This cross-sectional analytical study was done in the department of cardiology, NICVD from July-2015 to June- 2016 by including a total 125 patients undergoing coronary procedures (CAG and/or PCI) through TRA. Vascular doppler study of the radial artery were performed before and one day after the procedure. RAO was defined as an absence of antegrade flow and monophasic flow on doppler study. Univariate and multivariate logistic regression analysis were done to evaluate the predictors of RAO.</p> <p><strong>Results</strong>: On the day after the procedure, radial artery vascular doppler examination revealed RAO in 12 (09.6%) patients. On univariate analysis female gender (p= 0.038), diabetes mellitus (p= 0.024), prolonged hemostatic compression for more than 02 hours after sheath removal (p= 0.003) were identified as predictors of RAO. Interestingly hypertension, low BMI, smaller radial artery diameter and use of reprocessed sheath were not identified as predictors of RAO. On multivariate analysis diabetes mellitus (p= 0.016), prolonged hemostatic compression for more than 02 hours after sheath removal (p= 0.004) were found as independent predictors for RAO.</p> <p><strong>Conclusion</strong>: Frequency of RAO was 09.6% after coronary procedure through TRA. Diabetes mellitus and hemostatic compression after sheath removal for more than two hours were identified as independent predictors of RAO. Strategies should be taken from patient selection for TRA to end of hemostatic compression removal to prevent RAO.</p> <p>Bangladesh Heart Journal 2019; 34(2) : 111-117</p> 2019-12-12T00:00:00+00:00 ##submission.copyrightStatement## Pattern of Non-Communicable Diseases among the Admitted Patients in a District Level Hospital of Bangladesh 2020-07-14T13:28:52+00:00 Md Mahfuzur Rahman Muhammad Anwarul Kabir Maria Mehjabin <p><strong>Background</strong>: Non-communicable Diseases (NCD), particularly cardiovascular diseases, cancer, diabetes and chronic respiratory disease, have emerged as the leading threat to mankind worldwide. Likewise in Bangladesh, an increasing trend of incidence of NCDs has been observed and already they have become major public health concern. Hence, we aimed to study the pattern of NCDs among the admitted patients at an Upazila Health Complex (UHC) in Bangladesh.</p> <p><strong>Methods</strong>: In this retrospective study, data of in-hospital patients admitted from January 2018 to June 2018 in UHC, Chhagalnaiya, Feni was analyzed. Data on age, gender, occupation, hospital admission/discharge and diagnosis of disease was obtained from the hospital register. Diseases were categorized into NCD or communicable disease using the World Health Organization’s International Classification of Diseases (ICD) coding system.</p> <p><strong>Results</strong>: 1,367 adult patients with different diseases were admitted into the medical ward over the study period of six months (mean age 57.4 ± 17.9 years; 61.3% male and 38.7% female). There were 904 cases of various NCDs constituting 66.1% of total admissions. The number of cases of NCDs was two times more compared to CDs (ratio 2:1). In all six months, admissions due to NCDs were significantly higher compared to communicable diseases CDs (p = 0.0001). Among the admissions due to NCDs, more than half (51.3%) were aged between 50 to 69 years. In terms of pattern of disease, cardiovascular diseases were the number one cause for hospital admission followed by endocrine disorders.</p> <p><strong>Conclusion</strong>: This study found that the burden of NCDs has increased among the admitted patients in an UHC. These findings could be useful to draw the attention of health authorities to adopt preventive strategies against NCDs even at Upazila level.</p> <p>Bangladesh Heart Journal 2019; 34(2) : 118-121</p> 2019-12-12T00:00:00+00:00 ##submission.copyrightStatement## Role of Exercise Tolerance Test in the Screening of Suspected Myocardial Ischemia in Bangladeshi Patients 2020-07-14T13:28:50+00:00 Anisur Rahman Khan AKM Azad Hossain - Md Akteruzzaman Sabina Jesmin Md Salahuddin Ulubbi Khandker Md Nurus Sabah Md Asadul Millat Md Fazlul Karim Md Atiqur Rahman Md Robiul Islam Sarker <p><strong>Background</strong>: Ischemic Heart Disease (IHD) is preventable and reversible if early screening and elimination of the risk factors like life style modification and dietary intervention can be done. Exercise Tolerant Test (ETT) has become an important diagnostic tool to evaluate patient with suspected or known case of ischemic heart disease.</p> <p><strong>Objective</strong>: To determine the frequency of IHD among subjects who presented with chest pain and to identify the common indications for ETT.</p> <p><strong>Methodology</strong>: It was a cross-sectional study; the data was collected from ETT Unit of Mugda Medical College Hospital, Dhaka, Bangladesh using standard Bruce protocol.</p> <p><strong>Result</strong>: Out of 200 patients, there were 124(61%) male and 78(39%) female who presented in the cardiology department for ETT. Common indications for ETT were evaluation of chest pain 180(90%), followed by general check-up 14(7%), post-PCI evaluations 4(2%) and post- CABG evaluation 2(1%).Presenting complaints were typical angina 12(6%), shortness of breath 56(28%), nonspecific chest pain 82(41%), chest compression 46(23%) and others 4(2%). Exercise ECG showed no ST changes in 138(69%) patients. The most common risk factors were hypertension, diabetes, smoking and obesity. Majority of the subjects 136(68%) were test negative whereas 42 (21%) were test positive and 22(11%) were test equivocal.</p> <p><strong>Conclusions</strong>: It is concluded that most of the subjects presenting with the suspected symptoms of myocardial ischemia were negative for IHD, and so why we advocate the use of ETT as a screening tool in patients who presents with features simulating angina. This will prevent unnecessary hospital admission.</p> <p>Bangladesh Heart Journal 2019; 34(2) : 122-126</p> 2019-12-12T00:00:00+00:00 ##submission.copyrightStatement## Use of Suture tightening automated device COR-KNOT® for minimally invasive heart valve surgery: Our initial experience in Bangladesh 2020-07-14T13:28:48+00:00 Md Faizus Sazzad Nusrat Ghafoor Siba Pada Roy Swati Munshi Feroza Khanam Prasanta Kumar Chanda Armane Wadud Sirajul Islam Farooque Ahmed Masoom Siraj Ti Lian Kah Theodoros Kofidis <p><strong>Background</strong>: COR-KNOT® (LSI Solutions, New York, NY, USA) is an automated suture securing device has not been well known. We report a case series for first automated knotting device used for minimally invasive heart valve surgery in Bangladesh. Method and</p> <p><strong>Results</strong>: To overcome the challenge of knot securing via a Key-Hole surgery we have used CORKNOT ®. The newest device is capable of remotely and automatically secure sutures and simultaneously can cut and remove the excess suture tails. We covered the spectrum of heart valve surgery: There was one case of bioprosthetic aortic valve replacement, one case of mitral valve repair, one case of bioprosthetic mitral valve replacement, one case of failed mitral valve repair with COR-KNOT® explantation followed by mechanical mitral valve replacement and one case of redo-mitral valve replacement. Average length of hospital stays was 5 ± 1days. There was one reopening, one post-operative atrial fibrillation. No wound infection and no 30day mortality.</p> <p><strong>Conclusion</strong>: We conclude, COR-KNOT® is a safe and effective tool to reduce the duration of operation. Clinical outcome of heart valve surgery with COR-KNOT® is comparable with other methods of suture tying methods.</p> <p>Bangladesh Heart Journal 2019; 34(2) : 127-131</p> 2019-12-12T00:00:00+00:00 ##submission.copyrightStatement## Robert H. Goetz: A Heritage of Coronary Artery Bypass Surgery 2020-07-14T13:28:46+00:00 - Md Anisuzzaman Nazmul Hossain <p>Robert H. Goetz performed the first successful clinical coronary artery bypass operation on May 2, 1960. He used a nonsuture technique to connect the right internal mammary artery to the coronary artery by means of a modified Payr’s cannula made of tantalum. The patency of the anastomosis was demonstrated angiographically and the patient remained free of angina pectoris for 1 year. It was an important and brave step forward, a step that was far ahead of its time. But unfortunately, his pioneering work was not appreciated properly.</p> <p>Bangladesh Heart Journal 2019; 34(2) : 132-136</p> 2019-12-12T00:00:00+00:00 ##submission.copyrightStatement## Peripheral Vascular Disease: A Contemporary Review 2020-07-14T13:28:43+00:00 Abul Hasan Muhammad Bashar Mohsin Ahmed <p>Peripheral Vascular Disease (PVD) is an emerging public health problem in Bangladesh that has tremendous social and economic implications. Unfortunately, there is a general lack of adequate understanding about this disease among primary care physicians and common people. This is why patients present late to vascular care which poses significant difficulties in the treatment and increases cost burden. Late presentation also increases the rate of limb loss. Treatment of PVD is rapidly evolving with the advent of endovascular modalities. The article provides a review of the basic aspects of PVD as well as the present status of care.</p> <p>Bangladesh Heart Journal 2019; 34(2) : 137-145</p> 2019-12-12T00:00:00+00:00 ##submission.copyrightStatement## Thoracic Endovascular Aortic Repair (TEVAR): A Case Report 2020-07-14T13:28:41+00:00 GM Mokbul Hossain AHM Bashar Mohammad Enamul Hakim Md Fidah Hossain Nirmal Kanti Dey Abdullah Al Mamun Swadesh Ranjan Sarker Ashfaq Arif Naresh Chandra Mandal <p>Thoracic aortic aneurysm (TAA) is generally a disease of the elderly which remains mostly asymptomatic. It is often detected incidentally with imaging studies of the chest done for other reasons. We present a 55year-old smoker, normotensive and non-diabetic male patient who was diagnosed as a case of TAA and treated by endovascular means with thoracic endovascular aortic repair (TEVAR) technique. Due to small caliber femoral artery, thoracic endograft was deployed through a Dacron graft conduit of 10 mm diameter which was anastomosed to the common iliac artery. It was a hybrid procedure done in cardiac catheterization laboratory under general anesthesia. Completion angiogram revealed good technical success with no endoleak or neurological deficit. Patient improved symptomatically after TEVAR.</p> <p>Bangladesh Heart Journal 2019; 34(2) : 146-150</p> 2019-12-12T00:00:00+00:00 ##submission.copyrightStatement## Prof. Md. Sadequzzaman 2020-07-14T13:28:39+00:00 Abdullah Al Shafi Majumder <p>Abstract not available</p> <p>Bangladesh Heart Journal 2019; 34(2) : 151</p> 2019-12-12T00:00:00+00:00 ##submission.copyrightStatement##