Cardiovascular Journal

Permanent URI for this collection

https://imsear.searo.who.int/handle/123456789/150287

Editor: Dr Mohammad Ullah Firoze

ISSN: 2071– 0917
Frequency: Half-yearly

Language: English

Open Access Peer-reviewed journal

Web site: https://www.banglajol.info/index.php/CARDIO

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Now showing 1 - 20 of 254

Acute Coronary Syndrome in the Young - Risk Factors and Angiographic Pattern.
(2010) Haque, A F M S; Siddiqui, A R; Rahman, S M M; Iqbal, S A; Fatema, N N; Khan, Z
Coronary artery disease (CAD) is a worldwide health epidemic. Acute coronary syndrome is a potentially life-threatening condition and patient may die or become disabled in the prime of life. There is documented evidence that South Asian people develop CAD at a higher rate and also at an early age. If the affected individual is 40 yrs old or below, the tragic consequences are catastrophic. Methods: It was a retrospective observational study to find out the pattern of acute coronary syndrome in the young (40 years old or less) in a military hospital (CMH Dhaka) from July 2007 to July 2008 and to analyze the risk factors and the angiographic characteristics of coronary vessels. Consecutive 64 young patients including both male and female admitted into this hospital were the study subjects. Out of these patients 53 were males and 11 were females. Among these patients coronary risk factors and angiographic pattern were studied. 64 older patients with Acute coronary syndrome (age more than 40 years) were also studied. Results: Out of 64 young patients 15.6% patients presented to this hospital as UA, 9.37% presented as Non-Q MI, 28.12% Acute Anterior MI, 14.06% Acute Anteroseptal MI, 26.56% Acute Inferior MI, 6.25% Acute Infero-posterior MI. Smoking was the most common risk factor among these young patients. 64.06 % patients were smoker. Dyslipidaemia was present among 50 % patients, 37.55 % were hypertensive, 15.62% were diabetic, and 15.62 % were obese. SVCAD was the most common lesion and it was 53.12 %. 26.56% patients had DVCAD and TVCAD was present among 20.31 % patients. In the older group (more than 40 years) most common risk factor was dyslipidaemia (71.88%) and smoking was present among 48.43% patients. Conclusion: Young patients have a different risk factor profile in comparison with older patients. Smoking is a strong and quite common coronary risk factor in the young ACS patients who are 40 years or less. Risk factor identification and control is very crucial in the primary and secondary prevention in young patients with CAD.
Acute Massive Pulmonary Embolism (AMPE): From Therapeutic to Protective Management - A Case Report.
(2011) Reza, A Q M; Attawar, Sandeep G; Munwar, S; Siddique, A B; Talukder, S U; Hasan, A; Islam, A H M W
Acute Myocardial Infarction after Dog Bite: A Case Report.
(2009) Rahman, A; Khan, A; Hasnayeen, S M; Islam, A K M M
Acute myocardial infarction (AMI) after dog bite is rare. Capnocytophaga canimorsus , a Gramnegative, commensal organism of canine buccal cavity may cause bacterimia and sepsis. Hypotensioninduced stasis, septic emboli to the coronary artery, endothelial dysfunction and plaque vulnerability induced by acute inflammation may lead to acute coronary syndrome in this situation. Isolation of the bacteria may be challenging due to fastidious nature of the organism. Management is as per standard protocol. However, appropriate antibiotic therapy is crucial. Like many other parts of the world, dog bite is endemic in Bangladesh. The case presented here reminds us of the need for preparedness to deal with myocardial infarction associated with dog bite effectively.
After Whom the Instruments Named.
(2014) Hosain, Suman Nazmul
Innovation in surgery plays a very important role of easing the task of the surgeons. Some instruments used in cardiac surgery today were designed by legendary surgeons from the past. These useful articles bear the names of their inventors. There hasn’t been much documentation on the development of cardiothoracic surgical instruments. The historian claims that first known surgical instruments were developed as early as 10,000 BC! Hippocrates had reportedly developed different surgical instruments made of copper, iron, bronze, and brass. Renowned Muslim surgeon of middle age Al-Zahrawi devised many surgical instruments. Some surgeons developed instruments based on their own anatomical size and others for “new” operations that required more delicate instrumentation to perform them. Cardiothoracic surgeons also have adopted instruments innovated, designed and used by colleagues belonging to other surgical specialty. This article would explore a few of these legendary innovators, illuminating the drive that led these legends to design the surgical instruments we continue to use in our surgical practices even today.
Angiographic Comparison of Coronary Artery Disease between Diabetic Men and Women.
(2013) Mamun, M S; Majumder, A A S; Ullah, M; Alam, S
Background: 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.
Anomalous Origin of Left Coronary Artery from Pulmonary Trunk in an Adult Patient –A Rare Occurrence.
(2008) Chowdhury, A W; Muttalib, M A; Baqui, M A; Dutta, S; Alam, M M; Shakawatullah, M; Mondol, D K; Islam, S S; Shahidullah, M S; Kamal, A H M
Anomalous origin of coronary arteries is a rare cause of cardiac disease. One of the very rare coronary anomalies is origin of left main coronary artery from pulmonary trunk. Most of these patients die in the first year of life and only 10-15% survive in adulthood. We are reporting a rare case of anomalous origin of left coronary artery from pulmonary artery who survives into sixth decade of life.
Antibiotic Sensitivity Pattern of Bacterial Isolates from Different Clinical Specimens: Experience at NICVD, Dhaka.
(2012) Shahidullah, M S; Yusuf, M A; Khatun, Z; Ara, U K M N; Mitul, M T
Background: Infectious diseases are among the leading causes of death and sometimes curable. Bacteria are the most common etiology in hospitalized patients. The objective of this study was to evaluate the incidence of bacterial infections and their pattern of susceptibility to antibiotics in moderate and severe infections in patients admitted at NICVD hospital. Methodology: The study was performed in the apical teaching hospital of Bangladesh situated at Dhaka in the first half of 2012. Patients admitted in medical wards and medical ICU, suffering from moderate and severe infections were studied. Clinical evaluation, routine and specific investigations were done in each case. Microbiological samplings were tried on day 1, after completion of antibiotic therapy or in between as required. Aerobic bacterial culture and sensitivity tests were done. Result: A total of 274 cases were studied of which male (67.5%) were predominant than female (32.5%). The highest number of patients were in the age group of 30-60 years (53.6%) followed by 10- 30 years (24.5%) and more than 60 years (12.8%). The mean age with standard deviation was 39.15±19.07 years (range 1-90 years). Most common isolated bacteria was the Pseudomonas species (14.2%) followed by Escherichia coli (13.5%), Staphylococcus saprophyticus (6.9%) and Staphylococcus aureus (2.2%). From these specimens Pseudomonas species (31.5%) was isolated mostly from pus. E. coli was found most commonly in pus (16.3%) and urine (14.1%). Staph saprophyticus (13.0%) and Staphylococcus aureus (4.3%) were both found most commonly in pus. Pseudomonas species was 100% resistant to Penicillin, Amoxycillin and Vancomycin. It was found that Pseudomonas species was still more than 90% sensitive only to Imipenem. Escherichia coli was more than 80% sensitive to only Imipenem and Amikacin. Staphylococcus aureus was sensitive to only Imipenem and Cephalexin. Conclusion: In this study Pseudomonas species and Escherichia coli are the most common isolated bacteria in this Institution. Most of the antibiotics are resistant to these two bacteria.
Aortic Valve Replacement by Pulmonary Autogrbft: Technical Advances and Follow-up.
(2011) Aftabuddin, M; Khan, O S; Rama, A A; Acar, C; Pavee, A; Grandjbakhch, I
Background: Autograft is the best choice of graft material in every place especially in cardiac surgery to avoid all type of anti-coagulant related hazard, immunological reactions and considering cost involvement. Study was designed on the basis of above facts. Methods: All patients underwent surgery with standard Cardiopulmonary By-pass under moderate hypothermia using median stemotomy incision. Aortic valve was excised and the right and left coronary buttons were fashioned. Also the pulmonary root was excised. A running suture technique was used to insert the autograft in to the aortic annulus. A pulmonary homograft made by pericardium with three pulmonary valves of appropriate size (22-29 mm) was then inserted. Results: Between July 2001 to July 2002, 30 patients underwent the modified Ross Procedure at La- Pitie Salpitriere Hospital, Paris, France. Out of 30 patients 16 were male and 14 were female with the mean age of 29 years. Indication of operation was aortic stenosis in 6 cases, aortic insufficiency in 9 cases and mixed aortic valve lesion in 15 cases. The mean intra operative cross clamp time was 120 minutes (range: 70-170 minutes), mean cardiopulmonary bypass time was 150 minutes (range: 110- 195 minutes). Postoperativee chocardiogramsr evealed no significant pulmonary or aortic valvular dysfunction. Three patients, early in the series required reopening for post operative bleeding. Overall a mean of 2.5 units of bloods (0-10) were transfused per patient. Atrial fibrillation occurred in 2 patients which wsre managed accordingly. Among 30 patients, there was one perioperative death (3%), one patient was lost to follow-up and one patient refused to late post operative echocardiography. Twenty four caseso ut of the twenty seven patients available for functional follow-up were in NYHA class I, 2 patients in NYHA class II and one patient in NYHA class III. Conclusions: Pulmonary autografts in aortic position give good short-term result but for its long {erm effrcacy and safety needs more study.
Aorto-bi-Femoral Bypass for Aorto-Iliac Occlusive Disease: Recent Experience at the National Institute of Cardiovascular Diseases (NICVD).
(2011) Bashar, A H M; Hossain, G M M; Hakim, E; Mondol, N C; Sabah, M N; Hossain, M F; Dey, N K; Samad, S; Mamun, A A; Haroon, K; Islam, M F; Khan, A K; Ferdous, S; Rahman, M; Beg, A K; Alam, S A N
Background & Objectives: Aorto-bi-femoral bypass is one of the most important surgical strategies in vascular surgical practice. The procedure is employed in surgical revascularization for both stenotic and aneurysmal diseases involving the aorto-iliac segment. The present study was carried out to analyze our recent experiences with this procedure for aorto-iliac occlusive diseases (AIOD) at the National Institute of Cardiovascular Diseases (NICVD). Materials and Methods: Over a period of 3 years (April 2008 to March 2011), a total of 47 patients underwent aorto-bi-femoral or aorto-bisiliac bypass grafting for AIOD using a Y-graft prosthesis. The mean age of the patients was 46.4 years (range 25-75 years). Thirty eight of the patients were male and the remaining 9 were female. A retroperitoneal approach was used in 27 patients. In the remaining 20 patients, the operation was done using a transperitoneal approach. A Gelatin-coated Dacron Y-graft prosthesis was used in 43 (5 of which were silver-coated prosthesis) patients while PTFE (Polytetrafluoroethylene) prosthesis was used in the remaining 4 patients. The operation was carried out under epidural anesthesia with sedation in most cases. Results: The operation was well-tolerated in all patients. There was no intraoperative mortality in this series. Two patients died in the immediate post-operative period- one due to myocardial infarction and the other due to acute renal shut-down leading to renal failure accounting for a mortality rate of 4.3%. Wound infection and lymphorrhoea at the groin incision site were the two main immediate post-operative complications. There was no incidence of graft infection in this series. Twelve patients were available for post-operative follow-up up to 2 years. Out of them, 5 patients returned with occluded grafts 8-23 months after the operation. Three of these patients underwent graft excision with re-do Y-graft bypass. The remaining two were treated with extra-anatomic bypass (Axillobifemoral). Conclusions: Aorto-bi-femoral bypass is an effective surgical strategy for occlusive diseases involving the abdominal aorta and the iliac arteries. The procedure is well-tolerated with a low incidence of early post-procedural complications and graft failure. However, poor adherence of the patients to follow-up remains a significant obstacle for evaluating the long-term outcome of this procedure.
Aorto-bi-Femoral Bypass for Juxtarenal Aortic Occlusion in a Patient with Multiple Co- Morbidities: Report of a Challenging Case.
(2014) Bashar, A H M; Samad, S; Hossain, A S M I; Sabah, M N; Hasan, K; Alauddin, M
Aorto-bi-femoral bypass for aorto-iliac occlusive disease is a fairly common procedure in vascular surgical practice. The procedure, despite its extensive nature, is generally well tolerated particularly by those having an infrarenal type of aortic occlusion. Patients having a juxtarenal aortic occlusion require a considerably more expeditious surgery necessitating maneuvers to protect the renal arteries. Surgical risk increases significantly in those having multiple co-morbid conditions. We report here a successful case of aorto-bi-femoral bypass for juxtarenal aortic occlusion in a patient having multiple co-morbid conditions like ischemic heart disease, occluded right renal artery with chronic kidney disease, severe malnutrition, hypertension and chronic obstructive pulmonary disease
Aspects of Infection in Intensive Care Unit - Prevention and Control.
(2008) Hassan, M K; Akhter, H; Chowdhury, M M G; Haq, N; Ahsan, N A K
Intensive Care Unit (ICU) is the most vulnerable area in the hospital premises. Hospital acquired infections in critically ill patients as well as of transmission of infections from a patient to another patient or to the health care workers or vice versa can occur in ICU. ICUs combine physicians, nurses and allied health professionals to manage patients with life threatening single or multiple organ system failure, including stabilization after surgical interventions. It is a continuous management including monitoring, diagnosis, and support of failing vital functions as well as the treatment of the underlying disease. Here we have to discuss the source of infection and their effective control measurement in intensive care unit. Ventilator associated pneumonia (VAP) as well with other sources is most common nosocomial infection having 33% mortality in ICU.
Assessment of Acute Kidney Injury in Patients Undergoing Elective Coronary Angiography and Percutaneous Coronary Intervention.
(2012) Alam, A B M M; Moniruzzaman, M; Alam, M B; Islam, N; Khatoon, F; jahan, N; Ali, Z; Chowdhury, N U
Background: CIN has gained increased attention in the clinical setting, particularly during cardiac intervention but also in many other radiological procedures in which iodinated contrast media are used. There is at present good clinical evidence from well-controlled randomized studies that CIN is a common cause of acute renal dysfunction. Methodology: This was a prospective study conducted among the patients who underwent coronary angiography and percutaneous coronary intervention in the Department of Cardiology, Dhaka Medical College Hospital during January 2010 to December 2010. A total of 111 patients age range from 25 to 75 years were included in the study. Serum creatinine level at baseline and at the end of 48 hours was done in all these patients. Study population was divided into two groups according to development of acute kidney injury (AKI). Group-I = AKI, Group II = Not developed AKI. Results: AKI developed 11.7% of the study patient. DM and Preexisting renal insufficiency were significantly higher in group I patients. HTN was (61.5% Vs 44.9%) higher in group I but not significantly. History of ACE inhibitor/ARB, NSAID intake and LVEF <40% were significantly higher in group I patients. The mean±SD volume of CM (Contrast Media) were 156.9±44.8 ml and 115.4±30.0 ml in group I and group II respectively, which was significant. The mean±SD of serum creatinine after 48-72 hours of CAG/PCI was 1.4±0.37 mg/dl and 1.1±0.2 mg/dl in group I and group II respectively. The serum creatinine level increased significantly (p<0.05) after 48-72 hours of CAG/PCI in group I. In group II, S. creatinine level increased but not significant (p>0.05). Impaired renal function was found 76.9% and 2.0% in group I and group II respectively. DM, HTN, preexisting renal insufficiency, ACE inhibitor/ARB, NSAIDs, contrast volume (>150 ml), eGFR (<60 ml/min/ 1.73m2) and LVEF (<40%) are significantly (p0.05) associated for CIN development, Conclusion: CIN is an iatrogenic but preventable disorder results from the administration of contract media. Although rare in the general population, CIN occurs frequently in patients with underlying renal dysfunction and diabetes. In patients with pre angiographic normal renal function, the prevalence is low but in pre-existing renal impairment it may pose a serious threat. Thus risk factors are synergistic in their ability to predispose to the development of CIN. A careful risk-benefit analysis must always be performed prior to the administration of contrast media to patients at risk for CIN.
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 A
Background: 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.
Association of Atherosclerotic Renal Artery Stenosis with Coronary Artery Disease.
(2015) Krishna, Kanta Sen; Mahboob, Ali; Amal, Kumar Choudhury; Pradip, Kumar Karmakar; Md., Khale quzzamam; Akhtaruzzaman, Md; Ulubbi, Salahuddin; Rahman, Md. Arifur; Shaheeen, Md. Kabir; Badiuzzaman, Md; Islam, Sharafat Nurul; Roy, Bithi Rani
Background: The association between extent and severity of coronary artery disease (CAD) and renal artery stenosis (RAS) has been well established in many studies. The aim of this study was to assess the incidence and severity of RAS in patients with CAD. Methods: Coronary angiogram (CAG) and renal angiogram was done in standard protocol. A total of 95 patients was included in the study and divided into two groups according to the presence of significant renal artery stenosis. In Group I 45 patients were having normal or insignificant renal artery stenosis. In Group II 50 patients were having significant renal artery stenosis. All data were recorded systematically in preformed data collection form. Results: In Group I, most common CAG findings were single vessel disease (SVD) (91.1%), triple vessel disease (TVD) (2.2%) and double vessel disease (DVD) (6.7%). No patients in Group I had Left Main (LM) disease. In Group II, most common CAG findings were DVD (42.0%) followed by SVD 32.0%, TVD 26.0% and LM 8.0%. There is statistically significant difference in Vessels Score, Friesinger Score and Leaman Score between the groups (p<0.05). Conclusion: The study revealed significant association between atherosclerotic renal artery stenosis (RAS) and severity of coronary artery disease (CAD). This indicates significant atherosclerotic renal artery stenosis (RAS) predict the severity of coronary artery disease.
Association of Creatinine Clearance Rate and Coronary Angiographic Severity in Patients with Coronary Artery Disease.
(2015) Hossain, Mofazzal; Khan, H I Lutfur Rahman; Chowdhury, Abdul Wadud; Abdullah, Abu Sadique; Amin, Md Gaffar; Alam, Mohammad Sarwar; Kabir, S M Eftar Jahan; Khan, Afrin Tunaggina; Faruk, Chowdhury Omar
Background: In epidemiological studies and clinical trials renal function has been shown to be an independent predictor of coronary artery disease (CAD). We conducted this study to find out the association between creatinine clearance rate (CCr) and coronary angiographic severity in patients with (CAD). Method: It was a cross sectional study carried out in the department of Cardiology, Dhaka Medical College Hospital, Dhaka during the period of April, 2011 to March, 2012. All the patients with Ischaemic heart disease (IHD) admitted in the department of Cardiology who fulfill the inclusion and exclusion criteria and underwent coronary angiogram were taken as sampling population. Sampling technique was purposive and sample size was 118. By Cockcroft-Gault formula, CCr was estimated from serum creatinine. Coronary angiographic severity of coronary artery disease was assessed by vessel score and stenosis score. Statistical analysis was carried out by descriptive statistics, correlation coefficient test and one way ANOVA test. Level of significance was set at 0.05. Results: Mean CCr among study subjects was 72.57 ± 17.78 ml/min. Vessel score showed 18.6% had normal coronaries, 37.3% single vessel disease, 31.4% double vessel disease and 12.7% triple vessel disease. There was significant positive relationship between serum creatinine and vessel score, and also negative relationship between CCr and vessel score. The study also showed significant negative correlation between CCr and stenosis score. Conclusion: Angiographic severity of coronary artery disease is associated with degree of renal dysfunction. Decreased creatinine clearance is associated with more extensive CAD.
Association of Glycosylated Haemoglobin Level with the Severity of Coronary Artery Disease in NSTEMI Diabetic Patients.
(2015) Salim, Mahmod Mohammad; Fazila-Tun-Nesa, Malik; Arif Rahman, Mohammad; Hossain, Mohammad Delwar; Masum, Mandal Md Raihan
Background: Relation between diabetes mellitus and ischemic heart disease is well established. But the effect of HbA1C on severity of coronary artery disease remains uncertain in non-ST elevation myocardial infarction and diabetic patient. Objective of our study was to know the relationship of HbA1C with the severity of coronary artery disease. Methods: In this cross sectional analytical study a total of 104 NSTEMI diabetic patients were enrolled by purposive sampling. They were divided into two groups according to the level of HbA1C, Group-I patients having HbA1C<7% and Group-II patients having HbA1C >7%. Vessel score and Gensini score was calculated from coronary angiogram and compared between groups. Results: Single vessel disease were significantly higher in group-I compared to Group-II( 38.5% vs 7.7% in Group-I vs Group-II,p<0.05). Double vessel disease were higher in group-II compared to Group-I but the difference was statistically not significant (42.3% vs 48.1% in Group-I vs Group-II respectively (p>0.05). Triple vessel disease were significantly higher in group-II compared to Group- I (19.2% vs 44.4% in Group-I vs Group-II,p<0.05). Mean Vessel score was higher in Group-II compared to Group-I(1.73 ± 0.86 vs 2.50 ±0.70 in Group-I vs Group-II, p<0.05). Mean Gensini score was higher in Group-II compared to Group-I (44.6 ± 38.4 vs 76.9 ± 44.6 in Group-I vs Group-II, p<0.05). There were significant positive linear correlation between HbA1C and Vessels score and Gensini score (p<0.05). Conclusion: This study may be concluded that the presence of HbA1C >7% are associated with of severe coronary artery disease in NSTEMI with diabetes mellitus
Association of GRACE Risk Score with Angiographic Severity of Coronary Artery Disease in patients with ST Elevation Myocardial Infarction.
(2015) Saha, Tapash; . Khalequzzaman, Md; Akanda, Md. Abdul Kader; Saha, Simu; Tushar, Asif Zaman; Ahmed, Rashid; Saha, Gouranga Kumar; Ullah, Mohammad
Background: Clinical guidelines recommend that optimal management of acute coronary syndrome should include patient risk stratification. Predicting the anatomical extension of coronary artery disease is also potentially useful for clinical decision. The objective of our study is to determine whether the GRACE risk score correlates with the angiographic extent and severity of coronary artery disease in patients with ST elevation myocardial infarction. Methodology: 50 patients diagnosed with Acute Myocardial Infarction were included as sample by purposive sampling method. GRACE risk score for each patient was calculated and the patients were divided into groups according to the GRACE risk score: low risk (<108); intermediate risk (109-140). The severity of the coronary artery disease was assessed by vessel score and Gensini score. Relation between Grace score and Gensini score was evaluated. Results: Mean GRACE score of study population was 128.3±22.7. Mean Gensini score was 23.88±17. Mean Gensini score were 15.47±10.4, 27.75±9.26 and 31.52±16.91 in low GRACE risk group, intermediate group and high risk group respectively and the difference of mean Gensini score was statistically significant (p=0.006). In our study correlation co-efficient between GRACE risk score and Gensini score was r=0.17 (p=0.04). Multiple regression analysis showed that age more than 50 years (p=0.02), ST segment deviation (p=0.01), smoking (p=0.02), hypertension (p=0.01) were able to independently predict patients with severe CAD. Conclusion: Our study demonstrates that the GRACE risk score carries a significant positive correlation with the coronary artery disease severity in patients with STEMI.
Association of Hypertension on Development of Coronary Collaterals in Severe Coronary Artery Disease.
(2015) Hossain, Solaiman; Majumder, Abdullah Al Shafi; Ullah, Mohammad; Shaha, Chandan Kumar; Mannan, Md Abdul
Objectives: Coronary collaterals appear to play important role in coronary artery disease morbidity and mortality. In this study it was intended to determine whether hypertension is associated with development of coronary collaterals in patients with severe coronary artery disease. Methods: This was an observational cross-sectional study carried out in the department of cardiology of National Institute of Cardiovascular Diseases, Dhaka, Bangladesh during the period from October 2010 to June 2011. A total of 334 patients were examined to include in the study. Among them 118 patient of severe coronary artery disease (CAD) were included who fulfilled the inclusion and exclusion criteria. From where 63 patients were CAD with hypertension (Group -I) and 55 patients were CAD without hypertension (Group -II). Based on Rentrop Grading the study patients were divided in two groups, patients with poor collaterals (Grade 0& 1) and good collaterals (Grade 2&3). Data compared the coronary collaterals in hypertensive patients with those without hypertension with severe coronary artery disease. Results: The data showed that good collateral circulations were higher with duration of hypertension. The difference were statistically significant in duration <5 years and duration >10 years in both groups (p<0.05). The pattern of vessel involvement in double vessel disease and triple vessel disease (p <.001) and dyslipidemia (p<0.004) appeared to be significant predictor of hypertension controlling for other factors in the model. People with hypertension are around four times more likely to have good collateral circulation, multiple vessel disease and around 12 times more likely to have dyslipidemia. Conclusion: It is concluded that the patients of hypertension develop higher grades of coronary collaterals which increases with duration of hypertension in patients of severe coronary artery disease. Involvements of coronary arteries were more extensive in patients of hypertension with coronary artery disease.
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 S
Background: 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.
Atrial Fibrillation: Current Perspective.
(2009) Ahmed, R; Schamp, D J

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