Browsing by Author "Majumder, A A S"
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Item Angiographic Comparison of Coronary Artery Disease between Diabetic Men and Women.(2013) Mamun, M S; Majumder, A A S; Ullah, M; Alam, SBackground: Cardiovascular diseases are the leading cause of death and morbidity in diabetic patients and this group is two to four times as likely to develop cardiovascular disease than the nondiabetic group, women being specially involved in this situation. In women , diabetes appear to be a stronger risk factor for the development of coronary heart disease than in men regardless of age ,menopausal status and whether or not the patient is insulin or non-insulin dependent. Objective of this study was to compare the angiographic extent of coronary artery disease between diabetic men and diabetic women. Method: This observational study was undertaken on 100 diabetic patients ( 50 women and 50 men) admitted inNational Institute of Cardiovascular disease (NICVD) during the period of July, 2006 to April ,2007.Diabetic women with coronary artery disease constitute the study group-I and diabetic men with coronary artery disease matched for age (±5 years) and risk factors , the study group-II . Coronary angiography was done in all patients & findings were analyzed. Segmental distribution method for coronary artery lesions was used to describe the distribution of atherosclerotis in coronary artery. Results: The mean age of group I was 51.02 ±8.93 years and that of the group II was 50.99± 9.83 years. In this study it was found that Diabetic women with coronary artery disease (CAD) had a higher coronary artery score, CAS (11.02±5.034) as compared to the diabetic men with CAD ( 8.04±4.866) (p<0.001). Diabetic women had also higher number of diseased vessels ( 78.67% vs 67.34%; p<0.01) and higher number of vessel score 3 ( 58% vs 34%; p<0.001). As compared to the diabetic men, diabetic women had a higher total number of coronary artery lesions (183 vs 136; p<0.001), a higher number of lesions per patient (3.66/ patients vs 2.72/patients; p<0.001) and a higher number of diffuse vessels (13.56% vs 8.91%;p<0.05). Conclusion: Diabetic women with coronary artery disease have more severe disease on coronary angiography as compared to diabetic men with coronary artery disease. The diffuse coronary artery involvement was also significantly higher in diabetic women than men.Item Association of Aortic Pulse Wave Velocity with the Severity of Coronary Artery Disease in Patients with Acute ST Elevation Myocardial Infarction.(2014) Razzaque, M A; Majumder, A A S; Rahman, M T; Islam, A K M M; Ullah, M; Rahman, M A; Khan, A R; Romel, S M ABackground: Arterial stiffness assessed noninvasively with aortic pulse wave velocity (PWV) has been associated with atherosclerosis in the coronary arteries and also cardiovascular mortality. The aim of this study was to evaluate the association between aortic PWV and severity of coronary artery disease (CAD) in patients with acute ST elevation myocardial infarction (STEMI). Methods: This cross sectional analytical study was conducted over 200 acute STEMI patients who were purposively selected and agreed to do coronary angiogram during index hospital admission. Assessment of aortic PWV was performed noninvasively with the commercially available SphygmoCor system using applanation tonometry with high fidelity micromanometer on the day before angiogram. Study subjects were subdivided into two groups on the basis of PWV. In group I: aortic PWV was d” 10 m/sec and in group II: aortic PWV was> 10 m/sec. One hundred patients were included in each group. Angiographic severity of CAD was assessed by vessel score, Friesinger score and Leaman score. Results: Vessel score 0 and 1 were significantly higher in group I (p<0.05) where vessel score 2 and 3 were significantly higher in group II (p<0.05).The mean PWV in the group with normal angiographic result was 8.10±2.9 m/sec, and in patients with single vessel disease it was 11.65±3.46m/sec. In those with double and triple vessel disease the mean value of PWV was found 13.85±3.80 and 15.70±4.66 m/sec respectively. The mean value of PWV increased in proportion with the number of vessel involved by CAD and the differences were statistically significant(p=0.001).The mean value of PWV was observed 8.5±2.3 and 12.5±3.7m/sec in insignificant and significant CAD respectively using Friesinger score and the difference was statistically significant (p<0.05).There was statistically significant positive linear relation between the values of PWV and vessel score(r=.62, p=0.01), Friesinger score(r=.64, p=0.01) and Leaman score(r=.45, p=0.01). Conclusion: Aortic PWV is associated with the extent and severity of CAD. This noninvasive, cheap, radiation free method may be considered as risk stratification tool beyond other investigations.Item Association of Left Atrial Spontaneous Echocardiographic Contrast with Inflammatory Markers in Mitral Stenosis Patients.(2014) Islam, M J; Majumder, A A S; Ali, M A; Dutta, B; Karmoker, K K; Imrana, F; Saha, J N; Razzaque, M A; Rahman, M A; Das, P R; Jannat, S; Islam, M SBackground: Spontaneous echocardiographic contrast (SEC) is a risk factor for left atrial thrombus formation and an important indicator of potential systemic embolism originated from heart. An established relation exists between the inflammatory status and the prothrombotic state. The present study was conducted to evaluate the association between left atrial spontaneous echocardiographic contrast with inflammatory markers in mitral stenosis patients. Methods: This observational analytical study was undertaken in the department of Cardiology, National Institute of Cardiovascular diseases (NICVD), Dhaka. A total of 70 patients with mitral stenosis were categorized into two groups: group I with left atrial SEC and group II without left atrial SEC. All patients underwent transthoracic as well as transoesophageal echocardiography. Complete blood count with ESR was done and neutrophil lymphocyte ratio was calculated. The high sensitive C-reactive protein (hs-CRP) was assayed. Results: The hs-CRP levels were significantly greater in the SEC-positive group (5.6±2.1vs 1.5±0.7, p=0.001). The mean ESR level was significantly greater in the SEC-positive group (32.6±15.5 mmvs15.8±4.7 mm).The neutrophil levels ((76.1±1.9 vs 63.7±3.3) were significantly greater in the SEC-positive group, and the lymphocyte levels (33.3±3.0 vs 21.5±1.3) were significantly greater in the SEC-negative group (p=0.001 for each). The neutrophil/lymphocyte (N/L) ratio was also significantly greater in the SEC-positive group (3.4±0.4 vs2.1±0.6, p=0.001).On multivariate analysis hs-CRP, neutrophil/lymphocyte ratio, raised ESR, mitral valve area and left atrial diameter were independent risk factors for SEC in patients with mitral stenosis. Conclusion: From this study it may be concluded that left atrial SEC is associated with raised inflammatory markers in majority of patients with mitral stenosis. So, SEC may be considered as a reflection of ongoing inflammatory process in patients with mitral stenosis.Item Bioabsorbable Vascular Scaffold: A Revolution in Coronary Intervention.(2014) Ullah, M; Islam, A K M M; Majumder, A A SSince the advent of percutaneous coronary angioplasty in 1977, immense experiment has been done to improve the outcome of the patients with coronary artery disease. Lot of trials have been done with angioplasty, bare metal stents, drug eluting stents, drug eluting balloons and other devices. Bioabsorbable vascular stents are relatively newcomers in this field with a lot of hope. We tried to update the latest status of Bioabsorbable vascular stents in this review, specially the short and midterm safety and efficacy and some of their limitations.Item Cardiac Stem Cell Therapy: An Overview.(2010) Islam, AKM M; Majumder, A A S; Doza, F; Rahman, M M; Jesmin, HCardiovascular diseases are the major causes of mortality and morbidity throughout the world. Treatment of these diseases is often incomplete, suboptimal and far from permanent cure. One of the reasons behind this is the nature of heart as a terminally differentiated organ. Preclinical and clinical research in the last few decades has put a challenge to this conventional belief regarding the inability of regeneration of the cardiomyocytes. Embryonic, foetal and a wide range of adult stem cells have been used so far. Differentiation of adult somatic cells has lead to breakthrough discovery of induced pleuripotent stem cells which may be a potential solution of controversy over embryonic stem cell issue. Stem cells specially those of bone marrow origin are already being used in a limited scale to treat acute myocardial infarction, chronic myocardial ischaemia and cardiomyopathy with efficacy, feasibility and safety. Mesenchymal stem cells and adult cardiac stem cells are on the way to bedside use. skeletal myoblasts have been associated with life-threatening ventricular arrhythmia. Stem cells combined with tissue engineering have produced prosthetic tissue valves, and hope for manufacturing whole heart ex vivo in near future. However, like other rapidly evolving modalities, there are more questions than answers. Exact indications, patient selection, cell selection, timing of therapy, efficacy of repeated therapies, co-administration of growth factors, and genetic modification of stem cells are yet to be determined with precision. International community is coming forward with enthusiasm and vigor to explore the enormous potential of stem cell therapy and regenerative medicine. Future research will hopefully facilitate more versatile application of stem cells in treating the life-threatening and disabling ailments of mankind.Item Carotid Duplex Ultrasound Findings in Patients with Coronary Artery Disease (CAD)- A Study in 50 Cases.(2008) Bari, M S; Kabir, M S; Ali, M A; Alam, S A N; Majumder, A A S; Islam, M NBackground: Patients with angina pectoris or myocardial infarction are more likely to experience stroke. Ischaemic stroke has been found to develop in approximately 2-5% of patients in the first 1- 2 weeks after myocardial infarction Methods: Fifty patients with coronary artery disease admitted to the National Institute of Cardiovascular Diseases (NICVD), Dhaka, were screened for presence of carotid atherosclerosis by duplex ultrasound study during the period of July 98 to August 98. Results: Carotid lesion were found in 34 patients (68%) and normal carotids found in 16 patients (32%). Age range of patients with and without carotid lesions was 56±5.39 yrs and 47±7.91 yrs respectively. Out of 34 patients, 30 were male (88.2%) and 4 were female (11.7%). 29 patients (85.3%) were smokers, 22 patients (64.7%) were hypertensive and 9 patients (26.4%) were diabetic. Dyslipidaemia was found in 16 patients (47%) and a history of transient ischaemic attack (TIA) was found in 10 patients (29.4%). A coexistent CAD on coronary (CAG) was found in 31 patients (91.1%). Conclusion: Cortaid duplex ultrasound study findings of atherosclerotic lesions in Carotid arteries are good predictors of CAD.Item A Case of Double RCA.(2013) Majumder, A A SItem A Case of Right Atrial Mass.(2012) Islam, A K M M; Begum, S A; Majumder, A A SItem A Case of Severe Tricuspid Stenosis of Rheumatic Origin.(2011) Rahman, M T; Das, M; Ullah, M; Rahman, Z; Hossain, A; Sayami, L A; Roy, S S; Majumder, A A STricuspid valve stenosis is a valvular heart disease which results in the narrowing of the orifice of the tricuspid valve of the heart. It’s relatively a rare condition. It is almost always caused by rheumatic fever and is generally accompanied by mitral stenosis.Other rare causes include carcinoid syndrome, endocarditis, endomyocardial fibrosis, lupus erythematosus, right atrial myxoma and congenital tricuspid atresia. Here we describe a patient with history of prior CMC presented with severe Tricuspid Stenosis with Tricuspid Regurgitation (Grade-IV), Mitral Restenosis (Severe), Mitral Regurgitation (grade-1+), Aortic Stenosis (Mild) and Aortic Regurgitation (Grade-2).Item Clinical Outcome and Echocardiographic Evaluation of Inferior Myocardial Infarction with Right Ventricular Involvement.(2012) Guha, B; Majumder, A A S; Chowdhury, M N A; Hossain, M M; Mandal, A KBackground : Acute right ventricular myocardial infarction complicates inferior wall myocardial infarction with an incidence of 14-84%. ECG is the cornerstone in initial diagnosis as it is cost effective and done easily. Echocardiographic analysis of the right ventricular involvement can shed light on the severity of the disease. Hence we aimed to study right ventricular infarction in acute inferior wall myocardial infarction using right precordial lead as well as echocardiography. Methods: Present study is based on the analysis of 100 patients admitted to Coronary care unit of the National Institute of Cardiovascular Diseases & Hospital during July 2010 to June 2011, with acute inferior wall myocardial infarction. 12 lead ECG with thorough physical examination was done along with right precordial mapping. ST ³ 1mm in V4R was initial diagnostic of right ventricular involvement followed by echocardiographic assessment of RV and LV within 24 hours. Results: A total of 50 patients showed right ventricular involvement with V4R being the sensitive lead. Echocardiography showed mean RVEF of patients with 29.5 % ± 9.5 in comparison of 44.9%±12.2 without right ventricular involvement. Right ventricular involvement presented with bradycardia (40%) and hypotension, 80% Kussmaul’s sign, 14% with complete heart block. Mortality in right ventricular involvement was 6 times higher than without right ventricular involvement (12 %). Conclusion: Clinical signs and symptomatology are not fully diagnostic of RVI in inferior wall acute MI. ECG can diagnose (using right precordial mapping) this condition very early. Echocardiography help to assess the right ventricular function high-risk groups for aggressive management like primary PCI. Early diagnosis will help in careful monitoring and management of such cases.Item Contrast Induced Nephropathy-A Collateral Damage to be Minimized.(2012) Majumder, A A S; Ullah, MItem Coronary Angiographic Profile in Patients with Conduction System Disorder Requiring Permanent Cardiac Pacing.(2011) Majumder, A A S; Ali, M A; Rashid, M T B ABackground: The association between conduction disturbances and atherosclerotic coronary artery disease has been investigated in a few small studies in the early 1970s and the study result was inconclusive. Thereafter some investigators found in their separate study that a group of patients with conduction disturbances that required permanent pacemaker who had coronary atherosclerotic disease that might be responsible for conduction disturbances. Method: 40 consecutive patients that required permanent pacemaker and 40 control patients were investigated. The coronary angiographic study was performed in both groups which included classification of pathological coronary anatomy, qualitative assessment of flow and stenosis severity. Results: The location of the lesions was found significantly different between two groups. 14 patients(35%) of 40 study patients had type IV lesion, whereas only 2 patients(5%) of 40 control patients had type IV lesion (p=0.001). Flow quality was found poor in more patients in study group specially that had type IV lesion. Severity of the lesions in the LAD & RCA was found identical in both groups. Conclusion: It may be concluded that the location of the lesions rather than diffuse coronary atherosclerosis might be responsible for a subset of patients with conduction disturbances that required permanent pacemaker.Item Coronary Angiographic Severity in Patients With Raised Plasma Homocysteine Level.(2009) Kabir, M S; Majumder, A A S; Bari, M S; Chowdhury, A W; Islam, A MBackground: Besides conventional classic risk factors of ischaemic heart disease other variables that have come under scrutiny for their potential contribution include estrogen deficiency, lipoprotein (a), plasma fibrinogen, plasminogen-activator inhibitor type I, endogenous tissue plasminogen activator (tPA), C-reactive protein and homocysteine. A number of studies have been undertaken worldwide shows strong correlation of raised fasting plasma homocysteine level with the development of atherosclerotic vascular diseases, myocardial infarction or increasing severity of coronary artery diseases. Objective: To find out the correlation of fasting plama homocysteine level with the severity of coronary artery disease in our population. Method: We undertook a study involving 100 patients of ischaemic heart disease (determined clinically & by non-invasive tests) in National Institute of Cardiovascular Diseases, Dhaka, Bangladesh, over the period of one year from January 2003 to December 2003. Out of 100 patients, 50 patients having normal homocysteine level were considered as control and another 50 patients having raised plasma homocysteine level were taken as cases. Result: Out of 50 patients, 20% had single vessel disease, 48% had double vessel disease and 32% had 3 vessel diseases. On the other hand in control group 10% patients had normal coronary artery disease, 40% had single vessel disease, 32% had double vessel disease and 18% had triple vessel disease. Conclusion: The study showed significant increase in number of coronary artery involvement by atherosclerotic lesions with increasing levels of plasma homocysteine level.Item Correlation of Heart Rate Variability and 24- hour Mean Heart Rate with TIMI Risk Score in Acute ST-Segment Elevation Myocardial Infarction.(2011) Chakrovortty, S K; Khan, M R; Kundu, S; Barua, S K; Dutta, B; Uddin, M N; Islam, A K M M; Majumder, A A SBackground: Thrombolysis In Myocardial Infarction (TIMI) risk score, heart rate variability (HRV) and 24hour mean heart rate all are important predictor of prognosis after ST segment elevation myocardial infarction(STEMI). Correlation among these factors has not been studied thoroughly. Methods: This study was conducted in NICVD (National Institute of Cardiovascular Diseases), Dhaka, from July 2008 to June 2009. Total 105 STEMI patients were included in the study. TIMI risk score were calculated and each patient under went 24hour Holter monitoring. SDNN for HRV and mean RR interval for mean heart rate were recorded. Results : Ninety one patients (mean age 53.9 ± 10.8 years), 86.7% were males and 14( mean age 59.8 ± 8.8 years), 13.3% were female. Stratification of subjects by TIMI risk score shows that nearly 60% had risk score in the range of 3 – 7, 17. % between 0 – 2 and 24% 8 or more than 8.SDNN and RR interval stratified by TIMI risk score demonstrates that both the variables decreases significantly with the increase of TIMI risk score. Among the TIMI risk groups SDNN values were 120.0 ± 19, 871.0 ± 20.5 and 40.9 ± 6.4 msec in mild, moderate and high risk group respectively(p=<0.001). Mean RR were 836.8 ± 121.0, 776.7 ± 130.3 and 649.7 ± 75.5 msec in low, intermediate and high risk group respectively(p<0.001). There was a significant correlation between depressed SDNN and high TIMI risk score (r=.893, p=.001). High TIMI risk score also showed a negative correlation with mean RR interval (r=-574, p<0.001). Mean RR and SDNN show a perfect linear relationship (r = 0.657, p < 0.001). Conclusion: It was observed that depressed heart rate variability and increased 24-hours mean heart rate correlates with high TIMI risk score after acute ST-elevation myocardial infarction.Item Device Based Therapy for Treatment of Hypertension.(2012) Majumder, A A S; Ullah, M; Rahman, ZItem Diagnostic and Therapeutic Value of Cardiac Scan: First Experience of Utility and Prosfect of MPI in Bangladesh.(2008) Azam, A; Majumder, A A S; Hossain, N; Ahsan, N A K; Jahan, W A; Sabur, A; Ahmed, S; Khan, J H; Chowdhury, A W; Mohibullah, A K MBackground: Cardiac Scan (MP-SPECT) is a widely utilized noninvasive imaging modality for diagnosis, prognosis, and risk stratification of coronary artery disease. In Bangladesh it is a recently introduced test and there is no study upon it. Considering this ground the study is perform on Bangladeshi patients. Methods: 100 referral patients underwent MPI for evaluation of perfusion status of myocardium. The patients either of suspected IHD or diagnosed case of IHD were referred from different cardiology unit or surgery unit of NICVD. Technetium 99m (99"Tc) isotopes and tetrofosmin used in the same day stress and rest protocol. Result: The commonest findings observed in this present analysis were the early age group patients mostly of female having DCM, but the later age group of patients are of both male and female having Angina Pectoris, OMI and ICM. The referral patients by cardiologists or cardiac surgeons are mostly limited to the pre therapeutic evaluation rather than diagnostic indication. The most common indication is the evaluation of myocardial viability and aim of subsequent treatment. Conclusion: Analysis of perfusion status, decision of subsequent treatment either by medicine or CABG, conform the usually described pattern in western literature.Item Echocardiographic assessment of Right Ventricular (RV) Function.(2012) Kundu, S K; Halder, D; Majumder, A A SItem Effect of Statin Therapy In Ventricular Arrhythmias In Patient With Acute Anterior Myocardial Infarction.(2013) Kawsar, S M; Majumder, A A S; Ali, M A; Ullah, M; Islam, A K M MBackground: Though statins are widely used in acute coronary syndrome (ACS), there is a paucity of information on the efficacy of high dose statin therapy in reducing the incidence of ventricular arrhythmias after acute myocardial infarction. Arrhythmias are relatively common in acute myocardial infarction (AMI) anterior, and sometimes progress to cardiac arrest. This study was planned to evaluate the role of high dose atorvastatin therapy in prevention of ventricular arrhythmias after acute anterior myocardial infarction. Methods: This study was conducted in NICVD from December 2010 to October 2011. Total 200 patients with newly diagnosed acute anterior myocardial infarction who received thrombolytic therapy were included in the study. They were divided into two groups. Group I (n=100) was selected for high dose atorvastatin therapy and group II (n=100) was selected for conventional doses of atorvastatin therapy. 24 hours Holter monitoring was performed 48 hours after hospital admission to evaluate arrhythmia. Results: Majority of the patients belonged to age range of 40 to 59 years with a male predominance. Patient characteristics regarding age, sex, drug use, risk factors for ventricular arrhythmia, body mass index, left ventricular ejection fraction were similar in two study groups. There was no electrolyte imbalance or renal impairment in any patient in either group. A significant difference in frequency of ventricular arrhythmias was found between the two groups. Ventricular premature beats were found in 66% patients in group I and 97% patients in group II (p=0.001) whereas non sustained ventricular tachycardia were observed in 0% and 4% in group I and group II respectively. Conclusion: High dose atorvastatin therapy is associated with lower frequency of ventricular arrhythmias after acute anterior myocardial infarction.Item Effect of Subvalvular Changes on Mitral Valve Leaflets Excursion after Percutaneous Transvenous Mitral Commissurotomy.(2015) Mannan, Md. Abdul; Majumder, A A S; Hossain, Solaiman; Shaha, Chandan Kumar; Khair, Md. Abul; Ullah, Mohammad; Rahman, Md. ToufiqurBackground: Aim of our study was to predict the effect of subvalvular changes on mitral valve leaflets excursion in a patient with mitral stenosis following percutaneous trans-venous mitral commissurotomy. Methods: Total of 60 patients of severe mitral stenosis were enrolled in the study. Transthoracic echocardiography was done on the day before percutaneous trans-venous mitral commissurotomy and 24-48 hours after percutaneous trans-venous mitral commissurotomy. Subvalvular area, anterior and posterior leaflets excursion were recorded. Results: Following percutaneous trans-venous mitral commissurotomy there were significant increase in anterior leaflet excursion from 1.8 ± 0.2 to 2.2 ± 0.2cm (p=<0.001), posterior leaflet excursion from 1.5±0.2to1.8 ± 0.2cm (p<0.001) . Subvalvular splitting areas was from 0.8 ± 0.2 to1.2 ± 0.2cm²(p=<0.001). Pulmonary arterial systolic pressure and left atrial diameter were significantly reduced respectively 55.6 ± 19.5 vs. 31.6 ± 9.5 mmHg,(p < 0.001) and 4.3 ± 0.6 cm vs. 3.8 ± 0.6 cm (p < 0.001). Post percutaneous trans-venous mitral commissurotomy subvalvular splitting area was found to be the predictor of increased excursion of both anterior and posterior mitral leaflets. Conclusion: percutaneous trans-venous mitral commissurotomy is associated with immediate significant changes in mitral valve morphology in terms of splitting of fused mitral commissures, increased valve leaflets excursion and splitting of the subvalvular structures. Post percutaneous trans-venous mitral commissurotomy subvalvular splitting area was found to be the predictor of increased excursion of both anterior and posterior mitral leaflets.Item Enhanced External Counterpulsation- A Review.(2010) Sayami, L A; Ullah, M; Rahman, M T; Rahman, Z; Roy, D; Majumder, A A S
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