University Heart Journal 2020-10-12T06:31:59+00:00 Professor Harisul Hoque Open Journal Systems The University Heart Journal is the English Language, official “six-monthly peer reviewed” publication of the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh. It provides a forum for exchange of information on all aspects of cardiovascular medicine including education. Management of ACS patients in COVID 19 Pandemic is another Challenge 2020-10-12T06:31:40+00:00 Jahanara Arzu Md Harisul Hoque <p>&nbsp;Abstract not available</p> <p>University Heart Journal Vol. 16, No. 2, Jul 2020; 50-51</p> 2020-10-11T09:07:25+00:00 ##submission.copyrightStatement## Pilot study of Stem Cell Therapy in Heart Failure Patients 2020-10-12T06:31:41+00:00 M Mustafa Zaman Md Fakhrul Islam Khaled Bishnu Pada Dey Masuda Begum Sayed Mainuddin Ahmed Md Azharul Islam Sajal Krishna Banerjee Md Harisul Hoque <p><strong>Introduction</strong>: Chronic heart failure with reduced ejection fraction is a major complication of diseases involving myocardium. Despite numerous pharmacological interventions and invasive therapeutic techniques, therapeutic options for end stage heart failure remain limited to left ventricular assist device &amp; organ transplantation. Regenerative medicine may bring hope here.</p> <p><strong>Method</strong>: This pilot study was carried out at the Department of cardiology in collaboration with department of haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from October 2017 to March 2018. Considering inclusion &amp; exclusion crieteria ten (10) patients were taken in stem cell group and ten (10) patients in control group. Patients in the control arm received standard of care in accordance with practice guidelines for heart failure management (GDMT). Patients in the cell therapy arm received, in addition to standard of care, bone marrow–derived cardiopoietic stem cells (G-CSF) meeting quality release criteria. Baseline clinical and echocardiographic data were obtained and recorded in pre-formed data sheet. Close liaison was maintained with all patients and followed up after 30 days &amp; after 3 months and for any complication. The absolute change in 6 MWD from baseline to 30 days, 3 months &amp; 6 months improved significantly in the both groups. But significant improvement was found at 6 months follow up of 6MWD between the two groups (300±28 vs 375±25, p= 0.04). Baseline BORG scale was similar in the control group and the SCT group (8.1±0.56 and 8.3±0.67 respectively, P= 0.45). The absolute change in BORG scale from baseline to 30 days, 3 months &amp; 6 months improved significantly in the both groups. But improvement was not statistically significant in between the two groups (p= 0.32, 0.45, 0.23 respectively). Echocardiographic observation also revealed a similar baseline LVIDd, LVEF level in the control group and the SCT group which was not statistically significant (p = 0.45, 0.52 respectively). Gradual improvement in LVIDd were found at 30 days, 3 months, 6 months follow up observation but statistically significant absolute change was found only at 6 months follow up in between groups (62.4±1.8 vs 56±2.4, p=0.03). Baseline LVEF were less than 30% in both control &amp; SCT group (29.5±0.8% &amp; 28.7±1.3% respectively). The echocardiographic evaluation also revealed a significant increase in LVEF at 6 months (34% ±1.6 and 40% ± 2.5%, p = 0.04) of follow-up in between group but not at 30 days &amp; 3 months follow up.</p> <p>University Heart Journal Vol. 16, No. 2, Jul 2020; 52-58</p> 2020-10-11T09:13:17+00:00 ##submission.copyrightStatement## FVC, FEV1, FEV1/FVC % and their Relationship with EF% in Patients with Chronic Heart Failure 2020-10-12T06:31:44+00:00 Rono Mollika Shelina Begum Md Harisul Hoque Khandaker Nadia Afreen Elora Sharmin Sheikh Foyez Ahmed <p><strong>Background</strong>: Chronic heart failure (CHF) causes multiple lung complications and lung functions are reduced in CHF patients.</p> <p><strong>Objective</strong>: To observe FVC, FEV<sub>1</sub>, FEV<sub>1</sub>/FVC% and their relationship with EF% in patients with chronic heart failure.</p> <p><strong>Methods</strong>: This cross sectional study was conducted in the Department of Physiology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, during 2016. For this, 60 diagnosed stable male, aged 35-65 years CHF patients were randomly selected from the Cardiology Department of BSMMU, Dhaka. On the basis of staging of the disease (Stage C) and New York Heart Association (NYHA) functional classification, the study subjects were divided into two groups, 30 patients of NYHA Class- I and 30 patients of NYHA class –II. Thirty (30) apparently healthy Age, Sex and BMI matched subjects were taken as control. To assess the ventilatory function, Forced vital capacity (FVC), Forced expiratory volume in 1<sup>st</sup> &nbsp;second (FEV<sub>1</sub>), Forced expiratory ratio (FEV<sub>1</sub>/FVC%) of all subjects were measured by a portable Digital Spirometer. Again, Ejection fraction (EF%) ranged (≥35% to ≤50%) were measured by Echocardiogram to observe left ventricular function of the heart. For statistical analysis, Independent sample‘t’ test and Pearson’s correlation co-efficient test was performed by using SPSS for windows version-16 &amp; p≤0.05 was accepted as level of significance.</p> <p><strong>Results</strong>: The mean percentage of predicted values of FVC and FEV<sub>1</sub> were significantly lower but FEV<sub>1</sub>/FVC% was significantly higher in CHF patients comparison to the healthy control. All the study variables were significantly lower in patients of NYHA class–II as compared to patients of NYHA class–I. 73.33% CHF patients had restrictive, 10.00% small airway obstruction and 16.67% combined restrictive and small airway obstruction feature. In addition, FVC and FEV<sub>1</sub> (p&lt;0.05) was positively and FEV<sub>1</sub>/FVC% (p&lt;0.05) negatively correlated with EF% in chronic heart failure patients.</p> <p><strong>Conclusion</strong>: Left ventricular dysfunction may be silently associated with decrease ventilatory function mainly restrictive type of pulmonary disorder.</p> <p>University Heart Journal Vol. 16, No. 2, Jul 2020; 59-64</p> 2020-10-11T09:13:36+00:00 ##submission.copyrightStatement## Comparison between Spironolactone and Eplerenone on LV Systolic Function in Patients with Chronic Heart Failure 2020-10-12T06:31:48+00:00 Md Noornabi Khondokar Khurshed Ahmed Mohammad Ashraf Hossain Rakibulh Rashed Mohamed Mausool Siraj Mohammad Walidur Rahman Sajal Krishna Banerjee Syed Ali Ahsan F Rahman SM Mustafa Zaman Md Harisul Hoque <p><strong>Background</strong>:Chronic heart failure (CHF) is the most common and prognostically unfavorable outcome of many diseases of the cardiovascular system. Clinical trials have demonstrated mortality and morbidity benefits of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure. These studies have used either eplerenone or spironolactone as the MRA. Eplerenone is a selective aldosterone antagonist expected to have a lower incidence of hormonal side effects than spironolactone. The present study is designed to compare these two drugs in chronic heart failure patients as no head to head trial between these two drugs is found regarding improvement of systolic function, tolerability and safety. The aim of this study is to compare the effects of eplerenone and spironolactone on LV systolic function in patients with chronic heart failure in a single center.</p> <p><strong>Methods</strong>:It was a randomized clinical trial single blind study. A total of 224 cases of chronic heart failure with reduced ejection fraction and NYHA class III or IV were selected by random sampling, from July 2017 to June 2018. Each patient was randomly allocated into either of the two arms, and was continued receiving treatment with either spironolactone (Arm-I) or eplerenone(Arm-II). Each patient was evaluated clinically, biochemically and echocardiographically at the beginning of treatment (baseline) at 1 month and at the end of 6th month. Echocardiography was performed to find out change in left ventricular systolic function.</p> <p><strong>Result</strong>: After 6 months of treatment, ejection fraction was found higher in the eplerenonearm (40.3 ± 6.5 versus 38.3 ± 4.6%; P &lt; 0.05). Ejection fraction (EF) changes were 6.2% in eplerenone group and 4.1% in spironolactonearm. A significant reduction in left ventricular end-systolic volume (21.9±2.5 in group I versus 14.9±5.7 in group II; P &lt; 0.05) and left ventricular systolic diameter (48.7±4.0 in arm I versus 45.2±4.9 in arm II; P&lt;0.05) occurred after 6 months of treatment. But no significant differences were observed in left ventricular end-diastolic volume (187.8±37.4 versus 184.5±33.9; P=0.101) and left ventricular diastolic diameter (60.1±4.5 versus 61.0±4.9; P=0.0818) between arms. Assessment of blood pressure six months after treatment shows, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were improved in both arms but difference between two arms were statistically non-significant (p&gt;0.05).</p> <p><strong>Conclusion</strong>: In this study, the improvement in systolic function was more in eplerenone arm, which also had fewer adverse side effects when compared to spironolactone arm. So, it can be concluded that eplerenone can be advised in patient with chronic heart failure in addition to other drugs that are used to treat heart failure.</p> <p>University Heart Journal Vol. 16, No. 2, Jul 2020; 65-70</p> 2020-10-11T09:31:14+00:00 ##submission.copyrightStatement## A Pilot Study of Serum Parathyroid Hormone in Acute Coronary Syndrome 2020-10-12T06:31:50+00:00 Md Harisul Hoque SM Mustafa Zaman Khurshid Ahmed Md Faisal Ibne Kabir Nilufar Fatema <p>Acute coronary syndrome (ACS) is the public health issue as it is the single most common cause of death in the world. Role of vitamin D in cardiovascular health is of much interest at present. Experimental, as well as, some observational studies suggest that vitamin D and its metabolites are integrally related to blood pressure and the rennin-angiotensin system. Vitamin D insufficiency affects almost 50% of the population worldwide. Few studies have been carried out to determine the prevalence of hypovitaminosis D in Bangladesh . 30 Patient with ACS were included in this study who had admitted in the department of Cardiology of Bangabandhu Sheikh Mujib Medical University (BSMMU) patient with in first 48 hours of the onset of chest pain. This study was conducted from 1<sup>st</sup> &nbsp;July’18 to 30<sup>th</sup> &nbsp;June’19 (One year) by Purposive sampling. Data analysis was carried out by using the statistical package for Social Science (SPSS) version 20.0 windows software. Baseline characteristics have been compared using the independent sample student t-test test where appropriate. The student t-test was used to assess the correlation between PTH levels. p-value &lt;0.05 was taken as significant. We found an association between elevated PTH levels and ACS.</p> <p>University Heart Journal Vol. 16, No. 2, Jul 2020; 71-77</p> 2020-10-11T09:30:16+00:00 ##submission.copyrightStatement## Healing Rates of Venous Leg Ulcer Using Four Layer Bandage and Short Stretch Bandage- A Comparative Study in Aspect of Bangladesh 2020-10-12T06:31:51+00:00 Rakibul Hasan Md Saif Ullah Khan Mainul Mahmud Samaresh Chandra Saha Sourav Bhowmick <p><strong>Background</strong>: Chronic venous leg ulcer is one of the common medical conditions encounter by the vascular surgeons in Bangladesh. Many of these patients develop venous leg ulcer as a sequel of the disease. In advance chronic venous disease such as development of ulcer, single or multilayer dressings are usually used.</p> <p><strong>Objective</strong>: To find out a compression therapy (single layer crepe/short stretch bandage and multilayer/four layer bandage) in patients with venous leg ulcer. Materiel &amp; Methods: This study was conducted on 200 patients with in last two years, march 2017 to february 2019 at Bangabandhu Sheikh Mujib Medical University (BSMMU), Department of vascular surgery. In which 100 patients with venous leg ulcer where treated with four layer bandage and another 100 patients with same condition were treated with single layer crepe bandage. Before application of bandage, proper history of patient was taken and duplex scan was done. The primary outcome was measured by time duration of ulcer healing. Secondary outcome included incidence and number of adverse events in every patient. Results: Healing time of venous ulcers was accessed with periodic interval. The four layer bandage was associated with significantly shorter time of healing. P value reached from unpaired t-test. Primary outcome shows 68% of patients who received four layer bandages achieved healing within one month. On the other hand, 12% of patients who received single layer/crepe bandage did so.</p> <p><strong>Conclusion</strong>: Four layer bandages heals venous leg ulcer more rapidly than the single layer crape bandage. These data suggest that the benefits observed the consistent despite prognosis is different. Patients with large ulcers have poor healing prognosis regardless of its treatment modalities.</p> <p>University Heart Journal Vol. 16, No. 2, Jul 2020; 78-85</p> 2020-10-11T00:00:00+00:00 ##submission.copyrightStatement## Hepatic Venous Duplex as an Alternative Non- invasive Diagnostic Tool for Diagnosis of Pulmonary Hypertension 2020-10-12T06:31:53+00:00 Md Harisul Hoque SM Mustafa Zaman Khurshid Ahmed Sajal Krisna Banerjee Md Faisal Ibne Kabir Nilufar Fatema <p>Pulmonary hypertension is a hemodynamic disorder defined by abnormally high pulmonary artery pressure that affects the arteries in your lungs and the right side of your heart. In this study, hepatic venous duplex will be done to diagnose and quantify the PH. So that Patients can avoid unnecessary invasive right heart catheterization. This practical demonstration is the key to enrich our experience and knowledge in the field of PH. Objectives of this study was to assess PH status by Hepatic venous Duplex (HVD) as well by right heart catheterization and to compare them. This study was conducted in the Department of Cardiology, BSMMU, Shahbagh, Dhaka extending from July 2018 to December 2019. Total 100 (One hundred) subjects were enrolled in this study. It was an Observational study and includes the subjects between 18 years to 45 years of age. Results of this study shows very close proximity to that of Right heart catheterization. Hemodynamic changes in Hepatic venous duplex study could be used as an alternative diagnostic tool for evaluating moderate to severe pulmonary hypertension. This method could counteract the weakness of the currently used diagnostic methods and improve the accuracy of assessing pulmonary hypertension when combined with other methods.</p> <p>University Heart Journal Vol. 16, No. 2, Jul 2020; 86-91</p> 2020-10-11T00:00:00+00:00 ##submission.copyrightStatement## Objective Evidence of Pulsus Alternans by Echocardiography in Acute Severe Heart Failure 2020-10-12T06:31:55+00:00 Nilufar Fatema Rayhan Masum Mandal Jahanara Arzu SM Ahsan Habib Khurshed Ahmad Fazlur Rahman Sajal Krisna Banerjee Chaudhury Meshkat Ahmed Md Harisul Hoque <p>Acute coronary syndrome may leads to heart failure. Severity of heart failure is identified by NYHA classification clinically. Color Doppler echocardiography is the key investigation to identify the acute systolic heart failure. For the quantification of systolic heart failure diagnosis, Ejection fraction (EF) can be measured by Simpson method. EF &gt; 30% is defined as severe systolic heart failure. Pulsus alternans is found in severe heart failure patients. Pulsus alternans is a poor prognostic sign of severe heart failure patients in acute MI setting. This cross sectional observation study was aimed to identify the objective evidence of Pulsus alternance noninvasively by Echocardiography. Color Doppler echocardiography was done 100 acute coronary syndrome with heart failure NYHA III and IV patients in department of Cardiology, BSMMU, from July 2018 to June 2019. Age 18 to 70 yrs, male is 79 and female is 21. Pulsus alternans was found in 32 patients, 39 had low volume and 29 had normal volume pulse. 50% patients had ST depression and T inversion and diagnosed as case of Unstable Agina or Non STEMI, 44 had STEMI and 7 had developed new onset of LBBB. 87 Patients who have EF &lt; 30 % was marked as Severe LV systolic dysfunction. Among them, 3 had mild, 14 had moderate and rest 70 had severe Mitral regurgitation. 38 (43.67%) patients had Doppler alternans in severe LV systolic dysfunction group. P value for Doppler alternans is 0.039 which is significant. Doppler alternans by Echocardiography in Severe LV systolic dysfunction patients showed 49% sensitivity and 78% specificity. 38 patients had Severe RV systolic dysfunction by M- mode echo measurement of TAPSE&lt;10 mm. 22 (57.89%) had Doppler alternans across Tricuspid valve in case of severe RV systolic dysfunction. Sensitivity of Doppler alternans by Doppler Echocardiography in TV severe RV systolic dysfunction is 51% and specificity for it is 82%.</p> <p>University Heart Journal Vol. 16, No. 2, Jul 2020; 92-98</p> 2020-10-11T00:00:00+00:00 ##submission.copyrightStatement## Rivaroxaban versus Warfarin for Prevention of Thromboembolism in Bangladeshi Patients with Non-Valvular Atrial Fibrillation 2020-10-12T06:31:57+00:00 Golam Sodruddin Md Mukhlesur Rahman SM Ahsan Habib MSI Tipu Chowdhury Adnan Bashar Md Harisul Hoque Abdul Wadud Chowdhury Najnin Akter Shah Md Zakir Hossain Sajal Krishna Banerjee <p><strong>Background</strong>: The use of Warfarin reduces the rate of ischemic stroke in patients with atrial fibrillation but requires frequent monitoring and dose adjustment. Rivaroxaban, an oral factor Xa inhibitor, may provide more consistent and predictable anticoagulant effects than Warfarin.</p> <p><strong>Methods</strong>: In this Open comparison trial, the researchers compared Rivaroxaban (at a daily dose of 20 mg or 15 mg daily in patient with a creatinine clearance of 30-49 ml/min ) with dose adjusted Warfarin (target INR 2.0 to3.0) in 2,846 patients with nonvalvular atrial fibrillation and CHA2DS2-VASc Score 2 or more. The primary efficacy outcome was stroke or systemic embolism and primary safety outcome was major or minor bleeding. This research was designed to determine whether Rivaroxaban have more efficacy and safety than Warfarin for the primary outcomes.</p> <p><strong>Results</strong>: Total follow-up period was 6 months. Risk factors and co-morbidities were similar in both groups. Baseline investigations were also similar. Age and sex of both groups were matched. The rate of ischaemic stroke was 1.8% in Rivaroxaban group, as compared with 2.18% in the Warfarin group (p 0.479, nonsignificant). The rate of haemorrhagic stroke was 0.53% in Rivaroxaban group, as compared with 1.36 % in the Warfarin group (p 0.026, significant). Systemic embolism was 0.08% in Rivaroxaban group, as compared with 0.15 % in the Warfarin group (p 0.561, non-significant). The rate of major bleeding was 0.4% in Rivaroxaban group and 0.53 % in the Warfarin group (p 0.361, non-significant). The rate of minor bleeding was 2.10% in Rivaroxaban group, as compared with 2.33% in the Warfarin group (p 0.681, non-significant).</p> <p><strong>Conclusions</strong>: Rivaroxaban have similar efficacy and better safety profile than Warfarin in patients with nonvalvular atrial fibrillation in Bangladeshi population.</p> <p>University Heart Journal Vol. 16, No. 2, Jul 2020; 99-105</p> 2020-10-11T00:00:00+00:00 ##submission.copyrightStatement## Assessment of Cardiology Trainees in the Workplace 2020-10-12T06:31:43+00:00 Manzoor Mahmood Harisul Hoque Chaudhury Meshkat Ahmed Sajal Krishna Banerjee <p>Assessment is a systematic procedure for measuring a trainee’s progress or level of achievement against defined criteria, in order to make a judgement about the trainee. It includes traditional exam-style questions, multiple choice questions (MCQs), viva voce examinations, assessments of performance carried out in real time. The purpose of assessment include diagnosing learning needs, motivating learners and to determine entry to a course or profession. Traditional examinations are often used to measure the candidates to recall previously learned knowledge, but may not correlate well with a person’s workplace based performance. Workplace based assessments (WBA) are much better suited to providing an indication of actual performance in the workplace.</p> <p>University Heart Journal Vol. 16, No. 2, Jul 2020; 106-110</p> 2020-10-11T00:00:00+00:00 ##submission.copyrightStatement## Lifestyle Modification in Cardiac Patient in COVID 19 Pandemic Time 2020-10-12T06:31:46+00:00 Ariful Islam Joarder AKM Imtiaz Akand Sharmin Ahmed Md Azharul Islam SM Ear E Mahabub Dipal Krishna Adhikary Md Mostashirul Haque Mohammed Rayhan Masum Mandal Md Fakhrul Islam Khaled Shah Md Zakir Hossain Md Harisul Hoque <p>Abstract not available</p> <p>University Heart Journal Vol. 16, No. 2, Jul 2020; 111-114</p> 2020-10-11T00:00:00+00:00 ##submission.copyrightStatement##