University Heart Journal

Transcatheter Aortic Valve Implantation (TAVI)

SM Mustafa Zaman, Chayan Kumar Singha — Wed, 22 Nov 2023 00:00:00 +0000

Abstract not available

University Heart Journal 2023; 19(1): 1-4

The Link between Major Depressive Disorder & Chronic Coronary Syndrome - A Literature Review

Wed, 22 Nov 2023 00:00:00 +0000

Depression is prevalent among patients with coronary artery disease and has significant consequences. Occurrence of depression after a new diagnosis of stable angina is common and affects nearly 1 in 5 individuals. There have been several biological mechanisms by which depression may be related to coronary artery disease. As compared with nondepressed patients, those with depression have increased catecholamine levels,elevated resting heart rate, and decreased heart rate variability. . Behavioral characteristics of patients with depression include poor medication adherence, lower exercise tolerance,physical inactivity, poor dietary habits,and tobacco use. Although depression and its impact have been well documented in post-MI patients, much less is known about its significance in patients with chronic coronary syndrome(CCS).Despite the fact that CCS is the most common manifestation of coronary artery disease,sothere is a huge gap in the field of knowledge correlating CCS and depression.

University Heart Journal 2023; 19(1): 26-30

Coronary Angiographic Findings between Diabetic and nondiabetic Patients in Coronary Artery Disease: A Comparative Study

Wed, 22 Nov 2023 00:00:00 +0000

Background & Objectives: Coronary artery disease (CAD) accounts for the major risk factor of mortality in diabetes. Coronary angiography is the “gold-standard” technique for diagnosing and evaluating CAD.

Material and Methods: The present study was undertaken at Border Guard hospital, Dhaka between the periods of November - 2017 to December 2021. Percutaneous coronary angiography (CAG) was performed in 204 consecutive patients with suggestive of ischaemic chest pain. The population consisted of 88 cases which are diabetic and 116 cases nondiabetic Results: We observed angiographic lesion among both groups comparing site & number of vessel(s) involvement and also average percentage of stenosis. The presence of coronary risk factors was not significantly different between the two populations. Total positive angiographic lesion was (61.5%) in both groups. Among the Diabetes mellitus patients positive CAG finding (69.3%). The recognized lesions were single vessel disease (SVD) 23 (26.1%), double vessel disease (DVD) 14 (15.9%), triple vessel disease (TVD) 24 (27.3%) percentage of vessel stenosis 82.63%. On the other hand, total positive angiographic lesion was 70 (53.4%) in non-diabetic group; among them single vessel disease (SVD) 30 (25.9%), double vessel disease (DVD) 15(12.9%), triple vessel disease (TVD) 17 (14.7%). No diffuse lesions was found and average vessel stenosis was 78.03%. The results of the angiographic finding suggest that diabetic patients have a higher incidence of coronary heart disease (CHD), DVD, TVD, diffuse lesion & marked stenosis of coronary vessel than non-diabetic patient. Conclusion: CAD in diabetics had considerably higher percent of severe and unpredictable presentation. This increased frequency of complex lesion morphology is more difficult to treat by definitive intervention like percutaneous transluminal coronary angioplasty (PCI) & coronary artery bypass graft (CABG). Diabetics have a higher risk factor profile and poor clinical outcome. Early diagnosis and appropriate management will reduce the risk of complication after the onset of disease.

University Heart Journal 2023; 19(1): 5-9

In Hospital Outcome of Pharmaco-invasive Therapy versus Primary PCI In ST-segment elevation Myocardial Infarction in Dhaka, Bangladesh

Syed Dawood Md Taimur, Saidur Rahman Khan — Wed, 22 Nov 2023 00:00:00 +0000

Background & Objectives: In many low middle income countries (LMIC), it is difficult to treat patients with ST-segment elevation Myocardial Infarction (STEMI) with timely PPCI. Thus, many undergo fibrinolysis. Whether early fibrinolysis followed by timely coronary angiography provides a clinical outcome similar to that of primary percutaneous coronary intervention (PPCI) after acute STEMI in LMIC settings remains a question. In this observational study we primarily aimed to compare in-hospital outcomes of primary PCI versus pharmaco-invasive strategy (immediate fibrinolysis followed by coronary angiography with possible PCI within 3-24 hours) for reperfusion in eligible patients with STEMI at a tertiary cardiac care center.

Methods: This prospective observational study was done in Ibrahim Cardiac Hospital & Research Institute, Dhaka from April 2022 to July 2022 where consecutive patients presenting with STEMI were enrolled and divided into two groups: those who underwent primary PCI (Group-I) and those who underwent immediate fibrinolysis with subsequent coronary angiography with PCI within 3 to 24 hours (Group-II). The main outcomes analyzed were all-cause death, cardiogenic shock, acute left ventricular failure, life threating arrhythmia, acute stent thrombosis, CVD, Contrast induced nephropathy (CIN), re-infarction, target-vessel revascularization, and major bleeding up to 7 days.

Results: A total 122 patients presented with acute STEMI, 61 in each group. One group underwent primary PCI and another group treated with fibrinolysis by tenecteplase. The mean age of the studied patients was 53.86±9.72 years (range 18-75 years). Eighteen percent of patients presented with Extensive Anterior MI,19.7% showed Anterior MI, 21.3% showed Antero-septal MI, 21.3% showed Inferior MI, 9.8% showed Inferior with posterior and 3.3% showed Lateral MI. 35.5% had Single vessel disease, 31.1% had double vessel disease,28.7% had triple vessel disease, LM with LAD was 0.8% and 0.8% had recanalized infarct related artery in both groups overall. In group-I 45.9% of PPCI were undertaken in LAD and 32.8% patient. of group-II was done PCI in LAD. There were no significant differences between two groups in primary outcome and mortality.

Conclusion: Immediate fibrinolysis followed by coronary angiography within 3-24 hours resulted in similar short-term outcomes in patients with STEMI compared to PPCI. Our study suggests that, compared with PPCI, fibrinolysis performed in the hospital setting is associated with similar mortality rates, acute CVD, CIN and acute left ventricular failure in with PPCI than STEMI.

University Heart Journal 2023; 19(1): 10-14

Correlation Between B line in Lung Ultrasound and Plasma NT-proBNP Level in Patients with Acute Heart Failure

Wed, 22 Nov 2023 00:00:00 +0000

Background: Acute heart failure (AHF) is a major cause of morbidity and mortality worldwide. Although this is a common cause of dyspnoea, its diagnosis still represents a challenge. Lung ultrasound (LUS) is an emerging point-of-care diagnostic tool.

Objective: The aim of the study was to assess the Correlation between B line in lung ultrasound and plasma NT-proBNP level in patients with acute heart failure & thus to assess the predictive value of B line in patients with suspected acute heart failure.

Materials and Method: Crosssectional observational study conducted in cardiology department of BSMMU from October 2020 to September 2021. Study procedure: 36 patients presenting with of shortness of breath or heart failure diagnosis were enrolled meeting inclusion and exclusion criteria. The number of B-lines by Lung Ultrasound was measured. Correlation between number of B-lines on lung ultrasonography and NT-proBNP level were analyzed. Results: There is a positive correlation between the number of B-lines and the NT-proBNP levels (r=0.55, p< 0.01) in acute heart failure patients.

Conclusion: Patients presenting with acute shortness of breath with raised NTproBNP level, B line detection &quantification by lung ultrasound can be used as a tool for a faster diagnosis and decision-making on lung congestion in acute heart failure.

University Heart Journal 2023; 19(1): 15-19

Rate of Cardiotoxicity in Childhood Acute Lymphoblastic Leukemia Treated with Daunorubicin Using Echocardiography and Troponin I

Wed, 22 Nov 2023 00:00:00 +0000

Background and Aim: Acute lymphoblastic leukemia (ALL) is the commonest malignancy in childhood. Childhood ALL Survivors have a lifelong increased risk for cardiovascular morbidity and mortality compared to the general population, mainly caused by chemotherapy with daunorubicin. The aim of the study is to detect the rate of daunorubicin induced cardiotoxicity in children with acute lymphoblastic leukemia during induction phase chemotherapy.

Meterials & Methods : This prospective observational study was conducted in the department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU) on 40 newly diagnosed patients of ALL aged between 1 to17.9 years who got daunorubicin during induction. Complete blood count and echocardiography were done and troponin I was measured in all patients before and after completion of induction period.

Result: Of the 40 patients, 8 patients (20%) had developed cardiotoxicity evidenced by reduction of left ventricular ejection fraction (LVEF) in echocardiography. Baseline LVEF was 68.80±5.98% which was then reduced to 65.32±7.07% after induction phase of chemotherapy (p=0.023). No significant alteration of troponin I was seen (P= 0.581) between baseline and after completion of induction. Total WBC count and hemoglobin had a significant difference (P<0.05) between baseline and after induction period. Male patients had a greater risk of developing cardiotoxicity than females but statistically was not significant (P=0.643). There was no significant association between age of the patients and cardiotoxicity (P=0.112).Cardiotoxicity was seen higher in patient with initial high WBC count (p=0.039). Echocardiography also reveled increased tendency of mitral regurgitation and left ventricular hypertrophy after induction phase chemotherapy.

Conclusion: This study showed the rate of cardiotoxicity was 20% in ALL patients treated with daunorubicin. It also found that LVEF was decreased during therapy.Echocardiography can be used to detect early cardiotoxicity induced by daunorubicin.

University Heart Journal 2023; 19(1): 20-25

A Case of Infective Endocarditis Caused by Rapidly Growing Non-tuberculous Mycobacterium after Cardiac Catheterization

Wed, 22 Nov 2023 00:00:00 +0000

Endocarditis caused by non-tuberculous mycobacterium is rare and often missed without appropriate blood cultures. It does not respond to standard antitubercular treatment and is also resistant to many other antibiotics. The course of the disease may be indolent and often results in a fatal outcome. Here we report a case of Nontuberculous mycobacterial endocarditis of the native aortic valve in an immunocompetent patient following coronary angiography. The case highlights an unfortunate intervention – related nosocomial infection and the difficulties in chemotherapeutic options for this organism, particularly in the presence of marrow suppression and acute interstitial nephritis.

University Heart Journal 2023; 19(1): 31-34