Pipetting Samples and Test Tube

Theme 1:
Hypertension and Cardiovascular Diseases

List of Abstracts

  1. Proportion of Congenital Heart Disease Among Under Five Patient Admitted in Selected Child Hospital

  2. Frequency and Characteristics of Patients with Heart Failure with Preserved Ejection Fraction in a Tertiary Level Hospital of Bangladesh

  3. The Pattern of Cardiac Arrhythmias in Acute ST Elevated Myocardial Infarction and Their In-hospital Outcome

  4. Comparison Between Spironolactone and Eplerenone on LV Systolic Function in Patients with Chronic Heart Failure

  5. Association of Vitamin D Level with Severity of Angiographically Documented Coronary Artery Disease: Observations from Bangladeshi Patients

  6. A Comparative Study of Different Treadmill Scores to Diagnose Coronary Artery Disease Among Patients Attending Bangabandhu Sheikh Mujib Medical University

  7. An Unusual Atrial Septal Defect Producing Symptoms In a Young Lady

  8. What Makes Patients Delayed To Seek Medical Care After Myocardial Infarction: Experience From a Tertiary Hospital

  9. Echocardiographic assessment of rheumatic valvular disease and their complications in Bangabandhu Sheikh Mujib Medical University: a one year study

  10. Betel Nut Chewing Influences Vitamin-D Level

  11. Prevalence and Risk Factor Analysis of Stroke After Coronary Artery Bypass Graft Surgery

  12. Prediction of Coronary Artery Disease Severity by Using CHA2DS2-VASC-HSF Score in Patients With ST-Elevation Myocardial Infarction

  13. Apical Hypertrophic Cardiomyopathy: A Frequently Missed Fatal Diagnostic Entity

  14. Comparison of Risk Factors Between Young and Older Patients Presenting with Acute Myocardial Infarction

  15. Improvement of Left Ventricular Systolic Function After Percutaneous Coronary Intervention in Diabetic Patients with Non-ST Elevated Myocardial Infarction

  16. Association of Hypoalbuminaemia with The Angiographic Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome












Proportion of Congenital Heart Disease Among Under Five Patient Admitted in Selected Child Hospital

Ulfat Ara, Suvadra Mohonto Pretty, Sarder Mahmud Hossain

Department of Public Health, Northern University Bangladesh

Introduction: Most Congenital Heart Disease result from problems in the children’s heart development, the cause of which is unknown and related causes are including Genetics, Medication, Drinking and smoking during pregnancy, Diabetes, Rubella etc. Method: This cross-sectional study was done on 150 samples from July to October 2017. Non probability purposive sampling technique was applied. Data was collected by face to face interview from mothers and hospital records on a semi-structured, pretested questionnaire. Statistical Packages for Social Science (SPSS v 21.0) software was used for data analysis. Result: The study found that 64% children were boys and 36% were girls. Of them 64.1% belonged to 1day-12 months and 19.3% belonged to 13-24 months age group. The study revealed that 41% mother’s had primary level education, 36.0% father’s occupation was Job holder. And 31.3% monthly family income had BDT 20001-25000. The study revealed that most of the respondents (93.3%) visited antenatal care and rest did not. Of them 39.3% visited 3 times, 28% two times, 20.7% 4 times and 6% were visited antenatal care only one time. Among the respondents 82.7% taken necessary Vitamins and Minerals during their pregnancy time. The study found that 8% children admitted in the hospital with CHD. The study also revealed that 58% had positive family history of Heart disease. There was a significant association found between age of mother and CHD of children (p- 0.03). Conclusion: All efforts for early detection and treatment must be taken to avoid Congenital Heart Disease and its consequence in the society.









Frequency and Characteristics of Patients with Heart Failure with Preserved Ejection Fraction in a Tertiary Level Hospital of Bangladesh

Mohammad Walidur Rahman, Manzoor Mahmood, Dipal Krishna Adhikary, Harisul Hoque, Syed Ali Ahsan, Sajal Krishna Banerjee

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Introduction: Heart failure with preserved ejection fraction (HFpEF) has emerged as the predominant form of heart failure. It is believed that HFpEF occur in elderly, predominantly female patients, with multiple comorbidities. As data about HFpEF in Bangladesh is lacking, so the study was conducted to find out the frequency and characteristics of HFpEF patients in a tertiary level hospital. Method: This cross sectional study was conducted among 124 cases of heart failure, from December, 2017 to December, 2018 at the Department of Cardiology, BSMMU to estimate the frequency of HFpEF. According to 2016 European Society of Cardiology Guidelines, 30 HFpEF patients were included. Echocardiographic evaluation of left and right ventricular structure and function were done. Result: The frequency of HFpEF was 24.1%.  Mean (SD) age was 65.0 (10.1) years and 60% were male. Most of them had multiple comorbidities (Hypertension 80%, dyslipidemia 63.3%, diabetes mellitus 53.3%, coronary artery disease 36.6%, atrial fibrillation 26.6%, renal impairment 30% and anemia 55.1%). Breathlessness was the most common (100%) complaint, whereas bilateral lung base crepitations was the most frequent sign (96%). Arrhythmia was the most common (63.3%) finding in electrocardiography and 76.66% had pulmonary oedema in chest X ray. 96.1% patients had raised BNP or NT-pro-BNP level. Although mean LVEF was 60.4 (6.0%), subclinical LV systolic dysfunction was found in 66.6% of cases. Majority of the patients (51.7%) demonstrated structural remodeling of LV. Grade 1, 2, and 3 diastolic dysfunction were present in 13.8%, 58.6%, and, 10.3% cases respectively. In 17.2% cases grading was undefined. LA volume index was increased in 89.6% cases. Pulmonary hypertension and right ventricular systolic dysfunction were found in 43.3% and 10% cases respectively. Conclusion: This study has paved the way for characterization of HFpEF in Bangladesh but large scale epidemiological studies are needed.





The Pattern of Cardiac Arrhythmias in Acute ST Elevated Myocardial Infarction and Their In-hospital Outcome

Mohammad Khurshadul Alam, Manzoor Mahmood, Dipal Krishna Adhikary, Sajal K Banerjee

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Introduction: 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. Method: 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 and their in-hospital outcome were recorded in predesigned structured data collection sheet. Result: 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 and 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 and lengthening of hospital stay 8% each and death 2%. Conclusion: 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%.











Comparison Between Spironolactone and Eplerenone on LV Systolic Function in Patients with Chronic Heart Failure

Md Noornabi Khondoker

Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Background: 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. Method: 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. Result: After 6 months of treatment, ejection fraction was found higher in the eplerenonearm (40.3 ± 6.5 versus 38.3 ± 4.6%; P < 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 < 0.05) and left ventricular systolic diameter (48.7±4.0 in arm I versus 45.2±4.9 in arm II; P<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>0.05). Conclusion: 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.



Association of Vitamin D Level with Severity of Angiographically Documented Coronary Artery Disease: Observations from Bangladeshi Patients

Ashraf Ur Rahman

Department of Cardiology, National Institute of Cardiovascular Diseases, Sher-e-Bangla Nagar, Dhaka, Bangladesh

Introduction: Hypovitaminosis D may play unique role in the pathogenesis of Coronary Artery Disease (CAD), promoting accelerated atherosclerosis and subsequent cardiovascular events. Recent research has highlighted vitamin D deficiency as a novel cardiovascular risk marker, in addition to conventional and genetic risk factors. The objective of the study was to find out association between low vitamin D level and severity of coronary artery disease. Material and Method: It was a cross sectional study carried out among 102 patients undergoing elective coronary angiography due to CAD in National Institute of Cardiovascular Diseases (NICVD), Bangladesh from May 2016 to April 2017. Serum 25-hydroxyvitamin D level of each patient was measured and categorized as deficient, insufficient and normal if the value were <20, 20 to <30 and ≥30 ng/mL respectively. Coronary Angiogram (CAG) was done during index hospitalization. The severity of the CAD was assessed by vessel score and Gensini score. Result: Out of 102 patients, 75 (73.5%) patients had vitamin D level <30 ng/ml, while 27 (26.5%) patients had normal level (≥30 ng/ml). Female patients had lower vitamin D level than male (Mean 20.4± 8.3 ng/ml vs 26.0± 10.1 ng/ml) (p=0.017). Double or triple-vessel CAD were more frequent in those with 25(OH)D levels <30 ng/mL as compared to those with normal levels (≥30 ng/ml) (p<0.001). Moderate to severe CAD (Gensini score ≥36) was found in 64.1% of patients with vitamin D insufficiency and 75.0% of patients with vitamin D deficiency (p<0.001). Serum vitamin D level inversely correlated with both vessel score (r=-0.478, p<0.001) and Gensini score (r=-0.667, p<0.001). Multiple linear regression showed that vitamin D was associated with vessel score (β =-0.03, 95% CI=-0.05 to -0.02, p<0.001) and Gensini score, (β =-1.2, 95% CI=-1.6 to -0.8, p<0.001) adjusting for diabetes mellitus, dyslipidemia and body mass index in the model. Conclusion: Serum vitamin D levels are inversely associated with angiographic severity of CAD. Low vitamin D level may be an emerging, independent and reversible cardiovascular risk factor.







A Comparative Study of Different Treadmill Scores to Diagnose Coronary Artery Disease Among Patients Attending Bangabandhu Sheikh Mujib Medical University

Md. Mashiul Alam

Jahurul Islam Medical College and Hospital, Dhaka, Bangladesh

Introduction: Ischemic heart disease is increasing all over the world even in the developing countries like Bangladesh. The incidence rate of coronary artery disease is not limited to male gender as previously seen. Though Exercise Treadmill Test (ETT) is a well-accepted non-invasive investigation to diagnose coronary artery disease (CAD), it has a high false positive and false negative result if ST segment response alone is calculated for interpretation of the test. Accuracy of different treadmill scores in our population is largely unknown. Method: A cross-sectional study was carried out at University Cardiac Center in Bangabandhu sheikh Mujib Medical University  for stable chest pain to find out the accuracy of treadmill scores namely Duke Treadmill Score (DTS), Simple Treadmill Score (STS), Cleveland Clinic Score (CCS) and ST segment response to diagnose CAD. Total 130 patients including male and female who have undergone ETT were included according to inclusion and exclusion criteria. The accuracy of ST segment response and treadmill scores were calculated and compared with each other. Result: ETT scores had better sensitivity and specificity than ST segment response which was affected by work-up bias. Receiver Operator Characteristics (ROC) curve analysis showed all of the three scores have similar area under the curve (AUC) that means they have similar accuracy to diagnose CAD. Overall analysis showed accuracy of STS  is comparable to that of DTS , CCS  but considerably higher that ST segment response. STS can confidently predict normal and abnormal CAD like other two scores as well as high grade vessel involvement (p<0.05). Conclusion: Among the three treadmill scores DTS, STS and CCS have comparable predictive accuracy. STS has better sensitivity in female so it can be used to exclude female patients from undergoing invasive investigation. Though a prognostic ETT scores, CCS may have diagnostic role which needs to be validated further.








An Unusual Atrial Septal Defect Producing Symptoms In a Young Lady

Md. Mashiul Alam1, Md. Fakhrul Islam Khaled2

1Jahurul Islam Medical College and Hospital, Dhaka, Bangladesh, 2Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Introduction: Atria septal defect (ASD) is a common congenital heart disease among adults. ASD involving both middle and lower segment of inter-atrial septum is a rare anomaly and under reported in literature. We have presented a case of 37-year-old young lady who presented with fatigue, shortness of breath and palpitation where transthoracic echocardiography revealed combined secundum and primum ASD. Case Description: A 37-year-old young woman presented at out-patient department with shortness of breath, fatigue, palpitations for years. Precordial examination showed left parasternal heave, a grade 3/6 ejection systolic murmur over pulmonary area. Transthoracic echocardiogram revealed two defects in the atrial septum best shown in apical 4 chamber view. One defect was at the middle of IAS with adequate rim with a diameter around 15 mm. Another defect was present at the bottom of IAS with intact inter-ventricular septum and atrio-ventricular valves. Diameter of the latter defect was about 20 mm. Apart from these findings there was no other echocardiographic abnormality. Discussion: Atrial septal defect is a common congenital heart disease where defect may occur at various position of the atrial septum. Small portion of ASD may have multiple openings with in the septum. This fenestrated type ASD has openings with in the septum with some septal rim. Endocardial cushion defect which is often associated with Down syndrome in children has ASD primum associated with atrio-ventricular valve defect. It may have simultaneous opening in the middle of atrial septum along with ASD primum. Our case has two separate openings but no atrio-ventricular valve defect. There was no features suggestive of Down syndrome. ASD patients are asymptomatic in their early life and symptoms develop with age. When the ASD is closed before the age of 25 years and pulmonary arterial systolic pressure (PASP) is less than 40 mmHg long term prevention of death and disability is best achieved.









What Makes Patients Delayed To Seek Medical Care After Myocardial Infarction: Experience From a Tertiary Hospital

Md. Abdur Rafi

Rajshahi Medical College Hospital, Rajshahi, Bangladesh

Introduction: Delayed hospital presentation is a hindrance to the optimum clinical outcome of modern therapies of Myocardial infarction (MI). Shortening the pre-hospital delay is one of the major challenges for quality treatment of MI. This study thus aims at finding the factors associated with prolonged pre-hospital delay and the impact of this delay on in hospital treatment outcome of MI patients of Rajshahi, Bangladeshh. Method: This prospective cross sectional study was conducted in December 2018 in cardiology ward of a 1000 bed tertiary hospital of Bangladesh. Socio demographic data, clinical features and patients health seeking behavior was collected in a structured questionnaire from the patients diagnosed as STEMI or non-STEMI. Mean with standard deviation and median of pre hospital delay were calculated and compared between different groups. Patients were classified into two groups, those who admitted within 6 hours and those who admitted after 6 hours. I ² test and multivariate logistic regression were used to estimate the determinants associated with delayed hospital admission. Result: 337 patients was enrolled in the study and their mean (SD) pre-hospital time was 18.57 (26.96) hours. 39.5% patients admitted in the specialized hospital within 6 hours. In logistic regression, younger age (less than 40 years), lower or middle socio economic condition, absence of primary care center within 5 km, atypical symptoms, and referral from private hospitals were the main predictors of late hospital admission. On the other hand, severe chest pain, morning onset of symptoms and positive family history were associated with early hospital admission. Risk of in hospital death was three times higher who admitted after 6 hours. Conclusion: Delayed hospital admission after onset of MI is more common in Bangladesh compared to developed countries. Appropriate measures should be taken by policy makers to improve this situation.








Echocardiographic assessment of rheumatic valvular disease and their complications in Bangabandhu Sheikh Mujib Medical University: a one year study

Chayan Kumar Singha1, Md. Fakrul Islam Khaled1, Nilufar Fatema1, SME Mahbub1, Manzoor Mahmood1, Eshita Biswas2, Dipal Krishna Adhikary1, Sazal Krishna Banerjee1

1Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, 2Department of Internal Medicine, Dhaka National Medical College Hospital, Dhaka, Bangladesh

Introduction: Rheumatic heart disease (RHD) is a preventable disease but remains a major cause of morbidity and mortality in the developing countries including Bangladesh. The disease begins in childhood, has a progressive course and patients usually may require valve repair/replacement in future. About 15 million cases of RHD are reported worldwide, with 282,000 new cases and 233,000 deaths annually. In Bangladesh data is scarce regarding its prevalence, morbidity and mortality. This study was aimed to evaluate the frequency and echocardiographic pattern of valvular dysfunction and to explore the relationship between the severity of valvular dysfunction by age and sex of the patient. Method: This observational study was conducted in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from August 2018 to July 2019. Echocardiography was done in each patient with Vivid machine. Result:  Among 1350 echocardiography, 101 patients (7.5%) were diagnosed as RHD including post valve replacement patients. The mean age of the patients was 40 ±14 years and 64% were females. Mitral stenosis (MS) was the commonest lesion in 84.15 % (severe MS in 45.54%) followed by mitral regurgitation  in 66.33 %, tricuspid regurgitation in 57.43%, aortic regurgitation in 49.51% and aortic stenosis in 26.74%. The frequency of complications like pulmonary hypertension, atrial fibrillation and stroke was 67.33%, 18.81% and 3.96% respectively. History of Rheumatic fever was present in 10.89% patient. Conclusion: Mean age of patients in this study was higher than other contemporary studies and frequency of complications were also higher. Patients and their family member’s socioeconomic and educational background may influence this delay in the diagnosis and treatment of their disease.






Betel Nut Chewing Influences Vitamin-D Level

Mohammad Faisal Ibn Kabir, Md Harisul Hoque

Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Introduction: Betel nut chewing is a common addictive habit throughout Bangladesh especially in middle and older age group population. Likewise, vitamin D deficiency, is also common in Bangladesh, presumably more common in the same segment of the population. Hypovitaminosis-D is considered to be a risk factor for a number of metabolic and inflammatory disorders like metabolic syndrome, type 2 diabetes, and iscahemic heart disease; and serum vitamin-D level is a good indicator of the same (hypovitaminosis-D). Method: We hypothesized that chewing betel nut on a regular basis contributes to low serum vitamin-D level and hypovitaminosis-D. In this regard, peripheral blood vitamin-D concentrations were measured and examined in relation to age, sex, diet, smoking, and betel usage in a pilot study of 100 apparently healthy Bangladeshi individuals of 31 to 65 years of age accompanying indoor and OPD patients of the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University. Result: Independent determinants for serum vitamin-D level were gender, smoking, and betel quids per day. And among these, betel nut chewing is the most powerful independent determinant of low serum vitamin-D level (P≤0.05). Conclusion: Betel nut chewing is an independent determinant of low serum vitamin-D level, supporting the hypothesis that this habit could aggravate the effects of vitamin-D deficiency.














Prevalence and Risk Factor Analysis of Stroke After Coronary Artery Bypass Graft Surgery

Redoy Ranjan, Asit Baran Adhikary

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Background: Postoperative ischemic stroke is a major adverse effect following coronary artery bypass graft surgery (CABG). This study evaluates prevalence, risk factors, and clinical outcome of postoperative stroke in patients undergoing CABG surgery in Bangladesh. Method: This current study evaluates the predictors of postoperative stroke (n=19, 1.72%) in 1100 consecutive patients who underwent CABG in the year of July 2010 to June 2019 in a single surgeon practice. Predictors of postoperative ischemic stroke were identified by logistic regression analysis. Result: Risk factors analysis of stroke significantly correlates with recent MI (P=0.01), previous stroke or TIA (P<0.001), carotid artery stenosis (P<0.001), elderly age (P=0.008), hypertension (P<0.001), diabetes (P=0.001), atrial fibrillation (P<0.001), and severe left ventricular dysfunction (P=0.01). Moreover, postoperative ischemic stroke was significantly associated with longer postoperative stay (<0.001) as well as higher in-hospital mortality (P<0.001). Conclusion: Ischemic stroke after CABG surgery is associated with higher incidence of postoperative early morbidity and mortality. Furthermore, prevalence of postoperative stroke following CABG can be predicted and managed by preoperative as well as postoperative early evaluation and risk factors management.














Prediction of Coronary Artery Disease Severity by Using CHA2DS2-VASC-HSF Score in Patients With ST-Elevation Myocardial Infarction

Mohammad Abdur Rahim

Post graduate fellow, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh

Background: CHADS2 and CHA2DS2-VASc scores are widely used in clinical practice and include similar risk factors for the development of coronary artery disease (CAD). It is known that the factors comprising the newly defined CHA2DS2-VASC-HSF score promote atherosclerosis and associated with severity of CAD. Objective: To find out the association of the CHA2DS2-VASC-HSF score with the severity of CAD in patients with ST elevation myocardial infarction (STEMI). Method: 100 patients with STEMI were enrolled in this study after considering inclusion and exclusion criteria over a one year period from October, 2017 to September, 2018 in the Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka. Coronary angiogram was done within index hospitalization  and  coronary artery disease severity was assessed by SYNTAX and Gensini score system. Patients were divided into two groups on the basis of SYNTAX score. Patients  with SYNTAX score ≥23 assigned as group l and SYNTAX score <23 assigned as group II. The CHA2DS2-VASC-HSF score was calculated. Cut - off value of high CHA2DS2-VASC-HSF score was ≥4. Result: In this study mean age of study population was 51.8 ± 9.8, male patients were predominant (79%). Among the studied patients, highest percentage had history of smoking followed by hypertension, diabetes mellitus and family history of CAD in group I patients.  It was found that DM and family history of CAD and history of stroke/TIA were significantly higher in group I than group Il. An increasing trend of SYNTAX score was observed according to the CHA2DS2-VASc-HSF score. SYNTAX score was significantly higher in CHA2DS2-VASc-HSF score ≥4 than CHA2DS2-VASc-HSF score <4 (26.3±6.3 vs. 12.1±7.7, p<0.001). Patients with CHA2DS2-VASC-HSF score ≥4 had severe coronary artery disease than CHA2DS2-VASC-HSF score ˂4 assessed by SYNTAX score with 84.4% sensitivity and 81.9% specificity (AUC:0.83, 95% CI: 0.746-0.915, p<0.001). Conclusion: CHA2DS2-VASc-HSF score was positively correlated with the severity of CAD. This score could be considered as a predictor of coronary artery disease severity.







Apical Hypertrophic Cardiomyopathy: A Frequently Missed Fatal Diagnostic Entity

Md. Fakhrul Islam Khaled, Chayan Kumar Singha, Mohammad Walidur Rahman, Ananda Khanal, Manzoor Mahmood, Dipal Krishna Adhikary, Sajal Krishna Banerjee, SM EE Mahabub

Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Introduction: Apical hypertrophic cardiomyopathy (ApHCM) is a relatively rare form of hypertrophic cardiomyopathy that predominantly affects the apex of the left ventricle and typically has a nonobstructive physiology. The heterogeneity of its presentation and variability of its clinical course render apical hypertrophic cardiomyopathy a commonly missed or delayed diagnosis. Case series: Ten cases of ApHCM are described here. Most of them presented with typical ischemic chest pain, nonspecific chest pain, palpitation, and breathlessness. Physical examination was unremarkable. ECG showed diffuse symmetrical T wave inversion in both anterior and inferior leads and upright T in aVR. Echocardiogram was done several times in every case, which did not give any diagnostic clue. Almost all of them received anti-ischemic medications without any significant improvement. To rule out epicardial coronary artery pathology all 10 patients underwent coronary angiography which was also unremarkable. Then repeat echocardiography was done, which made the diagnosis of ApHCM, and 6 out of 10 patients had significant mid-cavity gradient. Conclusion: Despite earlier studies suggesting a more benign clinical course of ApHCM, recent studies report increased morbidity and mortality, which is comparable to the prognosis of other variants of hypertrophic cardiomyopathy such as hypertrophic obstructive cardiomyopathy. Thus, when formulating a differential diagnosis for chest pain, it is important to include structural heart disease including apical and other variants of hypertrophic cardiomyopathy as part of that differential and focused echocardiography should be done, as appropriate management can prevent these devastating sequelae. Furthermore, when screening tests such as echocardiography cannot adequately establish the diagnosis of ApHCM, then cardiac MRI or invasive hemodynamic testing may be considered to establish or refute the diagnosis.



















Comparison of Risk Factors Between Young and Older Patients Presenting with Acute Myocardial Infarction

Sharadindu Shekhar Roy, AKM Monwarul Islam, Md. Afzalur Rahman, Mohammad Arifur Rahman, Farhana Ahmed

Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh.

Abstract

Background: Acute myocardial infarction is less frequent in young adults than in older individuals. In recent years, the rate of acute myocardial infarction in young adults has begun to rise. Evidence reveals that increased cardiovascular risk starts to develop at young age. Objective: This study was aimed to compare the risk factors between young and older patients presenting with acute myocardial infarction. Method: The cross-sectional study was done in the Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh over a period of two years (from July, 2016 to June, 2018). We included 524 patients presenting with acute myocardial infarction (STEMI and NSTEMI). The patients were divided into young and older groups considering age. Age ≤ 55 years was considered as young and age >55 years was considered as older. Demographic, clinical, and laboratory data for the risk factors of all included patients were analyzed to compare between two groups. Result: Out of 524 patients, 167 (31.8%) were young and 357 (68.2%) were old. Compared to those in the older group, the young patients were more likely to be male (80.2% vs. 61.2%, p<0.001), have a higher BMI (mean BMI=26.4±3.8 kg/m2 vs. 24.1 ± 2.1 kg/m2, p=0.02), a higher waist circumference (mean WC=92.7± 6.1 cm vs. 86.8 ± 3.9 cm, p=0.04) and have family history of premature coronary artery disease (45.8% vs. 34.1%, p=0.01). Current smokers were found more in young group than in older group ((71.8% vs. 60%, p=0.007). On the other hand, older patients were more likely to have hypertension ((40.8% vs. 68.4%, p, <0.001), diabetes ((57.8% vs. 67.3%, p, <0.001) and dyslipidemia ((20,6% vs. 35.7%, p<0.001).  Conclusion: The young patients presenting with acute myocardial infarction have different risk factor profile compared to the older patients with smoking, obesity, presence of family history of premature coronary artery disease and male sex being particularly prevalent in the young. Diabetes, hypertension and dyslipidemia were found to be more prevalent in older patients.





Improvement of Left Ventricular Systolic Function After Percutaneous Coronary Intervention in Diabetic Patients with Non-ST Elevated Myocardial Infarction

MSI Tipu Chowdhury, Harisul Hoque,  Manzoor Mahmood, Fakhrul Islam Khaled, Md Ashraf Uddin Sultan, SM Mustafa Zaman

Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh


Address of correspondance: Dr. MSI Tipu Chowdhury, Resident, Department of  Cardiology, Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh. Email: dr.tipuchowdhury@gmail.com

Abstract

Background: Long term mortality is higher in patients with  Non-ST-segment  elevated  myocardial  infarction (NSTEMI) than those with  STEMI.  In diabetic patients with NSTEMI are at high risk for subsequent  cardiovascular events. But, the widespread  use  of  drug  eluting stents (DES) will further improve outcomes in patients with diabetes undergoing early percutaneous coronary intervention (PCI). Objective: The aim of the study was to determine  the  changes  in left ventricular (LV) systolic function after successful PCI in NSTEMI diabetic patients compared with non-diabetic patients. Method: From July 2017 to June 2018, this comparative clinical study was carried out in the Department of Cardiology, University Cardiac Center, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. 30 diabetic and 34 non-diabetic patients with NSTEMI undergoing percutaneous coronary intervention were included in the study. Successful PCI with drug eluting stent was performed for all patients. 2-Dimensional echocardiography was done at baseline, at discharge following PCI and 3 months thereafter to measure the LV systolic functions and compare them between diabetics and non-diabetics at all levels of evaluation to assess the outcome of intervention. Result: At baseline LVEF was somewhat lower in diabetic group than that in non-diabetic group. Number of segments with abnormal wall motion (WMA) was higher in the diabetics compared to the non-diabetics. While the LVEDD, LVIDd and LVIDs were significantly greater in the former group than those in the latter group, the LVESV was no different between the groups. At discharge, no significant improvement was observed in either group following PCI in terms of LVEF, number of segments with WMA, LVIDd and LVIDs. However, both LVEDV and LVESV reduced effectively in both groups with decrease of LVESV being more marked in the non-diabetics compared to that in diabetics (p = 0.018). However, 3 months  after  PCI,   LVEF improved  8.4±1.2%  in dibetics and 7.9±1.2%  in non dibetics but the difference of this improvement  between two  groups  was not statiscally significant (p = 0.631). Similarly baseline to 3 months after  PCI  LVIDs  decreses in diabetics 5.7±1.9% and in non diabetics 4.8±1.1%  but the difference between these two groups was not significant (p = 0.201). Diabetic patients more often required 2 stents (p = 0.30), although the diameter and length of the stents did not differ between the study groups. Conclusion: Our study demonstrated that improvement of the parameters of left ventricular systolic function after using of drug eluting stent in diabetic patients with NSTEMI was not inferior to the non diabetic group under same condition. So, indications of PCI with drug eluting stent may be extended in diabetic patient with NSTEMI.








Association of Hypoalbuminaemia with The Angiographic Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome

Jubair Mahmud Parvez, Md. Afzalur Rahman, A. K. M. Monwarul Islam, Mustafizul Aziz

Department of Cardiology, National Institute of Cardiovascular Diseases, Faculty of Medicine Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh

Background & Objective: Serum albumin as a biomarker of coronary artery disease (CAD) severity and mortality in patients with acute coronary syndrome (ACS) is presently a subject of growing interest. Evidences accumulated from the studies suggest a possible association between serum albumin and severity of CAD. The present study was intended to find the association between serum albumin level and severity of CAD in patients of ACS. Materials and method: The present cross-sectional analytical study was carried out in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, over a period of 1 year from July 2017 to June 2018. A total of 104 ACS patients undergoing coronary angiogram in the above-mentioned hospital during the index hospitalization within the specified time-frame were included in the study. The exposure and outcome variables were serum albumin and severity of CAD respectively. Serum albumin level was termed low if it fell below 3.5 gm/dl and  considered as group I and normal if it was ≥ 3.5 gm/dl considered as group II. Severity of coronary artery disease was determined by Friesinger score and Leaman score with Friesinger score > 8 and Leaman score ≥ 9 being considered as severe disease. Associations of traditional risk factors (smoking habit, diabetes mellitus, hypertension, dyslipidaemia, family history of IHD and overweight or obesity) with severity of CAD were investigated. Result: None of the demographic characteristics and traditional risk factors for CAD except age was found to be associated with severity of CAD. Friesinger Score was significantly higher in patients with low serum albumin  than that in patients with normal serum albumin (8.84 ± 3.71 vs. 6.38 ± 3.02, p<0.001). Leman Score was also significantly higher in in the former group than that in  latter group (12.48 ± 8.44 vs. 8.50 ± 4.94 mm, p = 0.004).The risk of having severe CAD in patients with low serum albumin was 5.46(95% CI = 2.141 – 13.925) (p < 0.001) times higher in terms of Friesinger score and 2.58(95% CI = 1.097 – 6.083) (p = 0.03)  times higher in terms of Leaman score than that in patients with normal serum albumin. Spearman’s correlation revealed that the two variables serum albumin and Friesinger score, exhibit a significantly inverse correlation (r = -0.323, p = 0.001). Serum albumin demonstrated a significantly inverse correlation with Leaman score (r = -0.254, p = 0.009). Conclusion: The study concluded that serum albumin concentration was significantly associated with the severity of coronary artery disease with low serum albumin carrying at least two-fold higher risk of having severe CAD, as measured by the Friesinger and Leaman score, in patients with ACS.

 

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