University Heart Journal 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. Academic and Research Cell, Department of Cardiology, University Cardiac Centre, BSMMU en-US University Heart Journal 1998-9261 Authors are required to transfer their copyright to the University Heart Journal. Blood Lipids: How much low is low enough? <p>Abstract not available</p> <p>University Heart Journal Vol. 16, No. 1, Jan 2020; 1-2</p> Manzoor Mahmood Harisul Hoque ##submission.copyrightStatement## 2020-01-02 2020-01-02 16 1 1 2 10.3329/uhj.v16i1.44814 Comparison of In-Hospital Outcomes Between Patients With or Without Acute Kidney Injury Developed After Hospitalization Following Acute Coronary Syndrome <p><strong>Background</strong>: Acute Kidney Injury (AKI), a common complication of acute coronary syndromes (ACS), is associated with higher mortality and longer hospital stays. ACS patients with renal impairment during hospitalization are associated with adverse in-hospital outcomes in the form of heart failure, cardiogenic shock, arrhythmia, dialysis requirement and mortality.</p> <p><strong>Objective</strong>: To compare the in-hospital adverse outcomesof patients with ACS with or without AKI.</p> <p><strong>Materials and Methods</strong>: This prospective comparative study was conducted in the Department of Cardiology, BSMMU, Dhaka, during the period of August 2017 to July 2018. A total of 70 eligible patients were included in this study of which 35 patients were included in group A (ACS with AKI) and 35 patients were included in group B (ACS without AKI). AKI was diagnosed, on the basis of increased serum creatinine level 0.3mg/dL from baseline within 48 hours after hospitalization. They were subjected to electrocardiography, blood test for serum creatinine (on admission, 12 hours, 48 hours and at the time of discharge), lipid profile, 2-D echocardiography along with serum troponin, CK MB and electrolytes.</p> <p><strong>Results</strong>: It was observed that mean age was 58.0±8.5 years in group A and 55.6±12.3 years in group B. Heart failure was more common in group A than in Group B (74.3% vs 34.2% p=0.001 respectively) and arrhythmia was more common in group A than in Group B (100% vs 74.2% respectively). 7(20%) patients of group A required dialysis. The mean duration of hospital stay was significantly higher in Group A than in the Group B (9.4±2.3 vs 7.2±0.6; p=0.001) days. Multiple logistic regression analysis revealed that heart failure, cardiogenic shock, duration of hospital stay were found to be the independently significant predictors of outcome of the patients with AKI with odds ratio being 5.53 (p=0.001), 4.353 (p=0.001) and 6.92 (p=0.001)</p> <p><strong>Conclusion</strong>: This study shows that, heart failure, cardiogenic shock, arrhythmia, dialysis requirement, were more common in the patients with AKI (group A) than in the patients without AKI (group B). The duration of hospital stays were longer in patients with AKI (group A) than in the patients without AKI (group B). Therefore, an important research target is the identification of high-risk patients with ACS experiencing AKI, thereby appropriate medication and follow-up should be implemented.</p> <p>University Heart Journal Vol. 16, No. 1, Jan 2020; 3-10</p> Md Sajjad Safi Msi Tipu Chowdhury Tanjima Parvin Khurshed Ahmed Md Ashraf Uddin Sultana Sajal Krishna Banerjee ##submission.copyrightStatement## 2020-01-02 2020-01-02 16 1 3 10 10.3329/uhj.v16i1.44815 Comparison of pre and post Global longitudinal Strain imaging in thrombolytic and primary percutaneous coronary intervention in acute ST elevation Anterior Myocardial infarction <p>Abstract not available</p> <p>University Heart Journal Vol. 16, No. 1, Jan 2020; 11-15</p> Mohammad Rayhan Masum Mandal Syed Ali Ahsan Harisul Hoque Mohammad Faisal Ibn Kabir Khurshed ahmed Fakrul Islam Khaled Smear E Mahbub Nilufar Fatema ##submission.copyrightStatement## 2020-01-02 2020-01-02 16 1 11 15 10.3329/uhj.v16i1.44816 The Pattern of Cardiac Arrhythmias in Acute ST Elevated Myocardial Infarction and their in-hospital Outcome <p><strong>Background</strong>: Acute myocardial infarction (AMI) is a major cause of death worldwide with arrhythmia being the most common determinant in the post-infarction period. Identification and management of arrhythmias at an early period of acute MI has both short term and long term significance.</p> <p><strong>Objective:</strong> The aim of the study is to evaluate the pattern of arrhythmias in acute STEMI in the first 48 hours of hospitalization and their inhospital outcome.</p> <p><strong>Methods</strong>: A total of 50 patients with acute STEMI were included in the study after considering the inclusion and exclusion criteria. The patients were observed for the first 48 hours of hospitalization for detection of arrhythmia with baseline ECG at admission and continuous cardiac monitoring in the CCU. The pattern of the arrhythmias during this period &amp; their in-hospital outcome were recorded in predesigned structured data collection sheet.</p> <p><strong>Result</strong>: The mean age was 53.38 ± 10.22 years ranging from 29 to 70 years. Most of the patients were male 42(84%). Majority of the patients had anterior wall ( anterior, antero-septal &amp; extensive anterior) myocardial infarction (54%). Sinus tachycardia in isolation was the most common arrhythmia observed in 36.8% of patients followed by sinus bradycardia (22.8%), ventricular tachycardia (19.3%), ventricular ectopic (12.3%),first degree AV block (5.3%), complete heart block and atrial ectopic 1.7% each. Tachyarrhythmias were more common in anterior wall myocardial infarction, whereas bradyarrhythmias were more common in inferior wall myocardial infarction. Among studied patients, 72% had favourable outcome , followed by acute left ventricular failure 10%, cardiogenic shock &amp; lengthening of hospital stay 8% each and death 2%.</p> <p><strong>Conclusion</strong>: The commonest arrhythmias encountered were sinus tachycardia followed by sinus bradycardia, ventricular tachycardia, ventricular ectopic, AV block and atrial ectopic. The incidence of mortality was 2%.</p> <p>University Heart Journal Vol. 16, No. 1, Jan 2020; 16-21</p> Mohammad Khurshadul Alam Manzoor Mahmood Dipal Krishna Adhikary Fakhrul Islam Khaled Msi Tipu Chowdhury Amanat Hasan Sami Nazrul Islam Md Ashraf Uddin Sultan Sajal Krishna Banerjee ##submission.copyrightStatement## 2020-01-02 2020-01-02 16 1 16 21 10.3329/uhj.v16i1.44817 Role of serum β2m in predicting severity of Coronary artery disease <p><strong>Background</strong>: Coronary artery disease is the principal cause of disability and mortality worldwide. Its prevalence is increasing around world. It is about 75% of deaths occurring in developing countries like Bangladesh. It is very important to know about the inflammatory risk factors of coronary artery disease for early assessment of coronary artery disease. Serumβ<sub>2</sub>-microglobulin (²2m) is a newly identified biomarker that has been found to increase in patients with coronary artery disease. Aims: To determine the role of â2m in predicting the severity of coronary artery disease.</p> <p><strong>Methods</strong>: This cross-sectional study was carried out in Department of Cardiology and Laboratory Medicine, BSMMU, Shahbag, Dhaka during March 2017 to February 2018. Total seventy four patients who underwent coronary angiography as per criteria where included in this study. Serum β<sub>2</sub>-microglobulin (²2m)was done before angiography procedure by indirect ELISA method and severity of coronary artery disease was assessed by extent of diseased coronary vessels and SYNTAX score.</p> <p><strong>Results</strong>: β<sub>2</sub>-microglobulin level was found higher (≥3/ml) in coronary artery disease patients which was statistically significant (p&lt;0.001).β<sub>2</sub>-microglobulin was also correlated with number of diseased coronary vessels (r=0.562, p&lt;0.001). Mean â2m level was found 4.48±0.95 μg/ml with range from 3-6.1 μg/ml and the mean SYNTAX score was found 16.27±08.99 with the range from 1 to 44. Pearson’s correlation coefficient was done between â2m level and SYNTAX score. Then the result is r=0.547 and p&lt;0.001. Therefore, there was a positive correlation between â2m level and SYNTAX score. The area under the receiver-operator characteristic (ROC) curves ²2m cut off value of 3.6 with 81.4% sensitivity and 86.7% specificity as the value for identifying the coronary artery disease.</p> <p><strong>Conclusion</strong>: Our study revealed that β<sub>2</sub>-microglobulin effectively correlates with the severity of coronary artery disease. So it may be used as a reliable marker for assessment of coronary artery disease severity.</p> <p>University Heart Journal Vol. 16, No. 1, Jan 2020; 22-27</p> Zebun Nessa Sheuly Ferdoushi Md Fakhrul Islam Khaled Saiful Islam Nasrin Jahan Dipal K Adhikary Khaleda Kahnam - Mahejabeen Tuhin Sultana Debatosh Paul ##submission.copyrightStatement## 2020-01-02 2020-01-02 16 1 22 27 10.3329/uhj.v16i1.44818 Angiographic Severity of Coronary Artery Disease among Patients with Non-ST Elevated Acute Coronary Syndrome having Fragmented-QRS in ECG <p>Fragmented QRS (f-QRS) complex in 12 lead ECG may develop in the background of acute coronary syndrome (ACS). This study was aimed to evaluate the angiographic severity of CAD among non-ST ACS patients having f-QRS in the ECG.This cross-sectional observational study was conducted in Cardiology department of BSMMU. Total 52 non-ST ACS patients who underwent invasive coronary angiography (CAG) were included in two groups according to presence or absence of f-QRS complex. 25 patients were included in f-QRS group and 27 in non-f-QRS group. After CAG, severity of CAD was assessed and compared by number of vessel involvement and degree of vessel stenosis. Patients’ demographic parameters were same in both groups. Depending on the number of vessel involvement, it was found that among f-QRS patient group, highest percentage had triple vessel (32%) followed by double vessel (28%) and single vessel (24%) disease and 16% patient had normal or non-critical epicardial coronary arteries. Among non-f QRS group, highest percentage had normal or non-critical lesions (40.7%) followed by double vessel (25.9%), single vessel (22.2%) and triple vessel disease (7.4%). In conclusion, this study revealed that presence of f-QRS in ECG is associated with more severe form of CAD and once the finding is observed, the particular patient should be targeted for aggressive management.</p> <p>University Heart Journal Vol. 16, No. 1, Jan 2020; 28-32</p> Md Abu Raihan Ferdous Mrm Mandal Faisal Ibn Kabir Md Rasul Amin Syed Ali Ahsan Sm Ear E Mahbub Akm Mohiuddin Bhuiyan Md Mukhlesur Rahman ##submission.copyrightStatement## 2020-01-02 2020-01-02 16 1 28 32 10.3329/uhj.v16i1.44819 Effect of PCI on QTC Dispersion in Patients with Angina <p><strong>Background</strong>:‘Coronary heart disease (CHD) is now the leading cause of death worldwide; it is on the rise and has become a true pandemic that respects no borders. For the diagnosis of coronary artery disease, the 12 leads electrocardiogram (ECG) is the most readily available noninvasive test by which, in addition of diagnosis, localizing and estimating the size of myocardial ischemia can be determined. Abnormally high QT dispersion has been correlated with risk of arrhythmic death in various cardiac diseases including CAD. An increase in QTd is reported to predict the occurrence of life-threatening ventricular tachyarrhythmias and sudden cardiac death in patients with ischemic heart disease.</p> <p><strong>Materials and Methods</strong>: This Cross sectional analytical study was conducted in Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka from January 2013 to December 2013. A total of 100 consecutive patients with angina based on predefined enrollment criteria were included in the study. .All patients were evaluated by history, clinical examination, biochemical analysis, and coronary angiogram (CAG) which was performed during index hospital admission. PCI was done only if the vessel was significantly stenosed.i,e. for LMCA - e”50%, for LAD, LCX and RCA it was e”70% as significant stenosis. Severity of stenosis of the involved vessels were categorized as severe( e”90%) and moderate(&lt;90%).</p> <p><strong>Results</strong>: Among the study population 76 (76%) patients were male and 24 (24%) patients were female. The left anterior descending artery (LAD) group comprised 37 patients and there were significant differences between before and after PCI QTc dispersion (90.5±38.9 vs 70.4±39.6 ms, p=0.001). The left circumflex artery (LCX) group was comprised of 6 patients and there were significant differences between before and after PCI QTc dispersion (62.2±41.9 vs 50.2±37.2 ms, p=0.001). The right coronary artery (RCA) group consisted of 18 patients, there being significant differences between before and after PCI QTc dispersion (84.9±40.7 vs 69.1±41.5 ms, p=0.001)</p> <p><strong>Conclusion</strong>: PCI reduces QTc dispersion significantly among patients with angina. This QTc dispersion change is not influenced by sex, smoking, beta-blockers, hypertension, diabetes, renal impairment, stable or unstable angina but it depends upon the severity of coronary artery stenosis, involvement of coronary vessel and number of vessels.Reduction of QTc dispersion is a good sign of successful PCI that indicates successful reperfusion which carries an excellent prognostic value of revascularization.Further long term follow up will establish it.</p> <p>University Heart Journal Vol. 16, No. 1, Jan 2020; 33-39</p> Md Shafiqul Islam Shekhar Kumar Mondal Jafrin Jahan Minhaj Arefin Nishat Ahmed Pinaki Ranjan Das MG Azam ##submission.copyrightStatement## 2020-01-02 2020-01-02 16 1 33 39 10.3329/uhj.v16i1.44820 Echocardiographic Imaging of Intracardiac Thrombus and Evaluated its Underlying cause along Therapeutic Implications: A Review <p>Abstract not available</p> <p>University Heart Journal Vol. 16, No. 1, Jan 2020; 40-42</p> Mostashirul Haque Mohammad Faisal Ibn Kabir Md Rasul Amin Md Fakhrul Islam Khaled Rayhan Masum Mandal S M Mustafa Zaman Harisul Hoque Fazlur Rahman Choudhury Meshkat Ahmed ##submission.copyrightStatement## 2020-01-02 2020-01-02 16 1 40 42 10.3329/uhj.v16i1.44842 Coronary Microvascular Dysfunction: An Update <p>Structural and functional abnormalities of the microcirculation can impair myocardial perfusion which is called coronary microvascular dysfunction and the resulting ischemia is known as microvascular ischaemia. Most of the researches have focused on the epicardial coronary arteries while addressing angina pectoris. Although the importance of the coronary microcirculation in maintaining appropriate myocardial perfusion has been recognized for several decades, the substantial morbidity of coronary microvascular dysfunction (CMD) has not been appreciated until recently. It is not possible to diagnose of microvascular angina clinically with the current knowledge. Resting or exercise electrocardiogram is nondiagnostic. Imaging with speckle tracking in echocardiography may reveal focal diastolic and/or systolic dysfunction. Other noninvasive investigations includes, Contrast stress echocardiography, 99Tc-sestamibi imaging, cardiovascular magnetic resonance (CMR),Nuclear magnetic resonance spectroscopy may show some degree of abnormality. Invasive methods like intracoronary adenosine and acetylecholine test may guide us to diagnose CMD. No guideline directed medical therapy is still available for the CMD. Risk factors modification like smoking cessation and weight-loss may improve endothelial dysfunction and CMD. Beta blockers, calcium channel blockers, Angiotensin converting enzyme inhibitors and statin are now used in different clinical condition related to microvascular angina. After these medical treatment patient with microvascular angina have higher risk of MACE compared with people without angina. So, physicians must be aware of this potentially fatal but under recognized clinical entity.</p> <p>University Heart Journal Vol. 16, No. 1, Jan 2020; 43-49</p> Sm Mustafa Zaman Harisul Hoque Khurshed Ahmed Md Mukhlesur Rahman Msi Tipu Chowdhury Md Abu Jamil Md Fakhrul Islam Khaled ##submission.copyrightStatement## 2020-01-02 2020-01-02 16 1 43 49 10.3329/uhj.v16i1.44843