Objectives: To compare the frequency of severe mitral regurgitation after percutaneous mitral balloon valvuloplasty (PMBV) via Inoue balloon and multi-track balloon technique in our population. Methodology: In this retrospective observational study which was conducted at a tertiary care cardiac center of Karachi, Pakistan between 2015 and 2020 on Hospital registry of PMBV patients. Data were categorized in to two groups, Inoue balloon or multi-track balloon technique. Post procedure echocardiographic and catheterization parameters and in-hospital outcomes and complications, including severe MR, were compared between two groups. Results: Out of 470 PMBV procedures, 286 (60.9%) were performed with multi-track and 184 (39.1%) with Inoue balloon. Improvement in mitral value area was significantly higher with multi-track as compared to Inoue balloon (0.66±0.31 cm2 vs. 0.56±0.29 cm2; p<0.001). Severe MR was not significant, 3.5% (10/286) vs. 4.3% (8/184); p=0.639 for multi-track and Inoue balloon. One patient in Inoue balloon group and two patients in multi-track group required emergency valve surgery. Stroke was observed in two patients of multi-track group and two patients from the same group developed tamponade. No in-hospital mortality was observed. Conclusion: Post-procedure severe MR is a significant and frequent complication. Rate of post procedure severe MR are similar for PMBV via Inoue balloon and multi-track balloon. Both methods are equally effective with equal success rate.
Objectives: To determine the pattern of coronary artery diseases (CAD) in patients under 40 years of age with acute coronary syndrome (ACS) presenting at Hyderabad Satellite Center of National Institute of Cardiovascular Disease (NICVD), Pakistan. Methodology: This cross-sectional study was conducted at cardiology department of the NICVD, Hyderabad Satellite Center. Both male and female patients, between 18 to 40 years of age, diagnosed with acute coronary syndrome (ACS), and undergone coronary angiography were included in this study. Angiographic patterns in terms of extent of the disease (number of diseased vessels and localization of lesion) were assessed. Results: Total of 220 young patients included. Patients were predominantly male (91.8%) with the mean age of 35.3 ± 5 years. Smoking was observed 30.5% followed by hypertension (24.5%) and positive family history of CAD (19.1%). A majority of the patients (79.1%) were diagnosed as with ST-elevation myocardial infarction (STEMI) with anterior wall myocardial infarction (MI) as the most common (57.3%) type of MI. Most of the patients (70%) had single vessel diseases (SVD) with left anterior descending artery (LAD) as the most commonly diseases vessel (53.6%). Nine (4.1%) patients had significant left main disease and 6.4% had non-obstructive CAD. Conclusion: The common clinical presentation of ACS in younger patients is STEMI. Smoking is the commonest risk factor followed by hypertension and family history of CAD. More than 2/3rd of the young patients are expected to have single vessel diseases with LAD as the most commonly diseased vessel.
Objectives: Left ventricular diastolic dysfunction (LVDD) is a prevalent condition among patients with non-insulin dependent diabetes mellitus (NIDDM). The aim of this study was to determine the frequency of the LVDD in patients with NIDDM at a tertiary care cardiac center of Karachi, Pakistan. Methodology: This descriptive cross-sectional study included NIDDM patients without history of ischemic heart disease, on anti-hypertensive medication, diagnosed with valvular heart disease, congenital heart disease, arrhythmias, chronic respiratory illness, or with clinically overt heart failure (HF) or history of HF or concomitant systolic dysfunction. Transthoracic echocardiography was performed and LVDD was diagnosed. Results: A total of 114 patients with NIDDM of less than five years were included in this study. Most of the patients were 41 to 60 years of age with mean age of the 52.23±10.85 years. Out of 114 cases, 58(50.9%) were male. Frequency of LVDD was observed to be 61.4% (70/114). With respect to age groups, rate of LVDD was high in above 60 years of age patients that is 90% (18/20) and it was observed 64.9% (24/37) in 51 to 60 years of age. Rate of LVDD was also high in male patients than female with frequency of 70.7% (41/58) vs. 51.8% (29/56). Conclusion: A significant number of patients with NIDDM were found to have LVDD. Increased frequency of LVDD was observed to be associated with male gender and increased age of the patients.
Background: Gestational diabetes (GD) is identified as a risk factor for increasing the onset of cardiovascular disorders (CVD). However, it is not clear whether this risk is linked with the intercurrent pathogenesis of type 2 diabetes mellitus. Thus, it is essential to identify markers and risk factors responsible for the pathogenesis of CVD and develop therapeutic strategies to decrease the cardiovascular health burden in affected women. Objective: The present study aims to evaluate the effect of GD on the future onset of CVD and assess the impact of type 2 diabetes mellitus in this context. Study Design: A cohort study was conducted in Karachi Institute of Heart Diseases Karachi Pakistan from June 2017 to June 2018. A total of 227 females who give birth to at least one kid were included in this study. Females with previous history of cardiovascular disorders and any other chronic disorders were excluded from this study. Using a biennial questionnaire behavioral, life style characters and health outcomes were evaluated. Multivariable Cox model was used to measure hazardous risk and ratio for cardiovascular disorders with 95 % confidence interval. Results: In this study, 11.8% of participants were diagnosed with gestational diabetes with a mean age of 31.6 ± 2.6 years. 28% of women with GD were developed hypertension later on compared to the non-GD participants (8%), indicating a positive association between GD and hypertension. A multivariate Cox analysis revealed that women with GD had a 28% increased risk of incidence of hypertension as compared to the non-GD group (HR. 1.24 [95% CI 1.13 – 1.65); P<0.01). Conclusion: Females with GD are at higher risk for developing CVD later in their life. This association might be due to obesity and sedentary lifestyle.
Aim: The purpose of this study was to predict the patient’s death due to sudden cardiac arrest with left ventricular dysfunction by analyzing the value of BNP Study design: Prospective longitudinal study Place and duration: This study was conducted at Karachi institute of heart diseases Karachi, Pakistan from Feb 2020 to Feb 2021 Methodology: This cross sectional study was conducted from Feb 2020 to Feb 2021 on 70 patients who were pin pointed with acute STEMI complicated by left ventricular systolic failure and hospitalized in our hospital. A total of 70 patients who were recognized with STEMI, 48 of whom got primary PCI, and 17 of whom received thrombolytic treatment. Results: The average age of the patients was 57.6 years and the range being from 35 to 80 years. Male patients constituted 73.3 percent of the study. It was discovered a mean of NYHA of 2.5, an average Killip classification of 2.8 and an average TIMI score of 8.1. A 90-day follow-up showed that 48 patients survived out of which 7 were reported to have a life-threatening arrhythmia and 12 had sickle cell disease. When ROC curve was shown, Pro-BNP indicated Sc.D. and unanticipated cardiac death was forecasted which also stipulated an AUC of 0.76, while the AUC was 69.6 percent of the ROC curve of the same neuropeptide in evaluating accuracy in prediction of VT, by. A Kaplan-Meier analysis reveals that an increase in pro-BNP over 3.2ng/ml has a significant predictive influence on SCD [OR 0.748 (CI 95 percent: 0.07-0.932), p-value .039] Conclusion: BNP levels in individuals with ischemic cardiomyopathy after an acute MI are a significant, independent predictor of sudden death. Keywords: BNP levels, ischemic cardiomyopathy, sudden death, myocardial infarction
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