Hypertension is the most important public health problem in developing countries and one of the major risk factors for cardiovascular diseases, and it has been reported that hypertension is in part an inflammatory disorder and several workers have reported elevated levels of CRP in hypertensive individuals. The main aim of the present study was to evaluate the association between blood pressure and serum CRP levels across the range of blood pressure categories including prehypertension. A total of 104 patients and 63 control subjects were included in the present study. The level of CRP in the serum samples was estimated by a high sensitivity immunoturbidometric assay. Standard unpaired student's 't' test was used for comparison of hs-CRP levels between hypertensive patients and normotensive control subjects and between patient groups with different grades of hypertension and different durations of hypertensive histories. The mean serum hs-CRP level in hypertensive patients was 3.26 mg/L compared with 1.36 mg/L among normotensive control subjects (P<0.001). On comparison with normotensive control subjects, the hs-CRP levels vary significantly both with grades and duration of hypertension, with most significant difference found in patients with prehypertension (P<0.001), followed by Stage-I (P=0.01) and Stage-II(P=0.02) hypertensives. Significant difference in hs-CRP levels was also found in patients with shorter duration of hypertensive history (≤ 1year) when compared with those with ≥5 years of hypertensive history (P<0.01). Our study reveals a graded association between blood pressure and CRP elevation in people with hypertension. Individuals with prehypertension or with shorter duration of hypertension (≤1 Year) had significantly a greater likelihood of CRP elevation in comparison to chronic stage-I or stage-II hypertensives.

The prevalence of metabolic syndrome was determined in clinic-based 1,517 hypertensive patients. All traits were present in 1.1% men and 12.8% women. Combination of different three traits were present as follows; hypertension with high triglyceride and low HDL (men 29.4% vs. women 51.8%), hypertension with high blood glucose and low HDL (men 13.5% vs. women 29.8%), hypertension with high glucose and high triglyceride (men 18.1% vs. women 18.1%), hypertension with high blood glucose and large waist (men 2.7% vs. women 25.7%), hypertension with high triglyceride and large waist (men 3.4% vs. women 39.3%) and hypertension with low HDL and large waist (men 2.5% vs. women 70.6%). This study shows that the metabolic syndrome is highly prevalent among hypertensive patients especially women.

not available University Heart Journal 2022; 18(2): 71

Distorted terminal portion of QRS complex on initial electrocardiogram in ST segment elevation myocardial infarction is a strong predictor of in hospital adverse outcome This observational prospective study was carried out in the department of cardiology, BSMMU, Dhaka from July 2014 to June 2015 to analyse admission ECG in patients of STEMI based on terminal portion of QRS complex and find out inhospital death, heart failure, cardiogenic shock and recurrent myocardial infarction, with GRACE scoring assessment. Total 60 patients with STEMI (age 54.33±10.37, 55M/5/F) were included in this study after analysing the selection criteria. We defined two ECG groups according to absence of distortion of terminal QRS (Group-I) and presence of distorted terminal QRS (Group-II) in two or more adjacent leads. Group-II further divided into pattern-A – J point originating at ³50% of height of R wave in leads with qR configuration and pattern B- S wave is absent in leads with RS configuration. Global Registry of Acute Coronary Events (GRACE) risk score was evaluated and compared in between two groups. Out of 60 patients of STEMI, 30 patients had distortion of QRS complex. There were 7 deaths, 16 heart failure, 3 cardigenic shock and no recurrent myocardial infarction. Hospital mortality and heart failure were found to be significantly higher in distorted QRS group (1 vs. 6 patients p=0.04; 4 vs. 12 patients p=0.02; respectively), cardiogenic shock of both groups did not show significant difference (0 vs. 3 patients p=0.075). Multiple logistic regression analysis using hospital mortality as dependable variable and all studied risk factors were independent variables, QRS distortion on admission ECG and Killip class were only variable found to be statistically significant (OR=7.25, p value < 0.05 ; OR=16.25, p value< 0.05 respectively). GRACE risk score was significantly high in distorted QRS group and low in without QRS distorted group (6 vs 15 patients p=0.014; 6 vs 16 patients p=0.007; respectively). Intermediate GRACE score did not show any statistically significant difference between two groups (p=0.77). Careful analysis of ECG which is simple, cheap, universally available bed side investigation may offer important prognostic information in patients with STEMI and would help in deciding which patients should go urgent myocardial revascularization procedure. Assessment of GRACE risk scoring is strongly encourage in everyday clinical practice as it provides reliable identification of STEMI patients who are at high risk of death. Bangladesh Medical Res Counc Bull 2022; 48(3): 211-218

No abstract

Background and Objectives: Myocardial injury after percutaneous coronary intervention (PCI) occurs frequently and it is associated with an adverse clinical outcome. Mechanical factors have been implicated in this complication and the role of inflammation has not yet been clearly determined. We evaluated the effect of an inflammatory response during PCI on periprocedural myocardial injury. Subjects and Methods: This prospective observational study was conducted in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh over a period between July’2012 to June’2013. A total of 200 patients studied who underwent elective coronary stenting. For the exclusion of mechanical injury to the myocardium, we excluded those patients who developed complications during PCI. The inflammatory response to PCI was calculated as the difference between the peak postprocedural hs-CRP level and the preprocedural hs-CRP level . We divided the patients according to the median value of hs- CRP: Group I <3 mg/L and Group II >3 mg/L. Results: Postprocedural TnI elevation was were observed in 72 (36%) patients. The baseline clinical and angiographic characteristics were not difference between the two groups. The incidence of any TnI elevations was higher in the Group II than that in Group I (19.8% vs 42.6%, respectively, p<0.001). The incidences of TnI levels over 3 times the upper normal limit and 5 times the upper normal limit were also higher in Group II than in Group I (11.2% vs 21.7%, respectively, p=0.031, for a TnI level 3 times the upper normal limit, and 6.0% vs 13.9%, respectively, for a TnI level 5 times the upper normal limit. Multivariate analysis revealed that postprocedural hs- CRP elevation in high risk group were the significant independent predictors of postprocedural TnI elevation. Conclusion: Elevated hs-CRP levels were associated with a higher risk of postprocedural troponin elevation in patients undergoing uncomplicated PCI. These results emphasized the role of inflammation in the pathogenesis of periprocedural myocardial injury. Measuring of hs-CRP either preprocedural or postprocedural in high risk patients is useful for predicting early cardiovascular events. University Heart Journal 2022; 18(2): 87-92

Background: Coronary heart disease is a global health problem and a major cause of death in both developed and developing countries. Clinical importance of hyponatremia in ST-elevated acute myocardial infarction (STEMI) is an important topic of study among present researchers. Objective: To assess the outcomes and prognostic implications of early development of hyponatremia inhospitalized acute ST-elevated myocardial infarction patients. Methods: This is a prospective observational study performed in the department of Cardiology, Combined Military Hospital (CMH), Dhaka from July 2018 to June 2019. A purposive sampling technique was used on 82 patients with ST-elevated acute myocardial infarction admitted in CCU and treated with thrombolysis. They were evaluated for serum sodium level at admission and at 48 hours after admission. Here sodium concentration <135 mmol/L is defined as Hyponartemia. Fourty one patients with hyponatremia were included in Group-I and 41 patients with normal sodium level were included in Group-II. Then the in-hospital outcome variables were analyzed. Results: Among the study population 86.58% were male and 13.42% were female. Age range was 25 years to 74 years. Considering risk factors highest percentage of study population in group- I had hypertension (60.97%) followed by dyslipidemia (51.21%), diabetes mellitus (51.21%), history of smoking (53.60%), and family history of Coronary Artery Disease (CAD) (31.14%). There were five outcome variables such as heart failure, cardiogenic shock, arrhythmia, duration of hospital stay and death. 10 patients died in Group-I and 2 patients died in Group-II. Among the outcome variables death, heart failure and hospital stay was more in Group-I and was statistically significant. hospital outcome of study population according to serum sodium level. Considering in hospital outcome heart failure occurred in 14 patients (p= .001), arrhythmia developed in 17 patients (p=0.108), cardiogenic shock occurred in 9 patients (p=0.354) and death occurred in 10 patients (p=0.002). P-Value of heart failure and death was statistically significant. Conclusion: Early developed hyponatremia in patients with ST-elevated acute myocardial infarction was an independent predictor of prognosis. It has been found that heart failure, duration of hospital stay and death was more in hyponatremic patients and prognosis worsen with increasing severity of hyponatremia. Plasma sodium level may serve as a simple marker to identify patients at high risk. University Heart Journal Vol. 17, No. 1, Jan 2021; 16-21

Background: Isovolumic myocardial acceleration (IVA) is a new tissue Doppler parameter in the assessment of systolic function of both right and left ventricles. It remains unaffected with the changes in pre-and after load with in the physiological range. With the advent of newer parameter like IVA, better assessment are naturally expected. Thus it creates a fertile ground where upon many studies are being done as it chosen here. The aim of study was to assess the effect of MS severety on LV systolic function using IVA. Methods: In this cross sectional study, considering all ethical issues, data were collected from 96 patient (Isolated mitral stenosis and mitral valve area <2cm2) and 32 healthy control subjects. In addition to standard echocardiographic methods TDI (tissue Doppler imaging) were performed to assess LV function in all participants. Results: This study showed a clear female preponderence (76%) of mitral stenosis and most of them belonging to age group 21-39 years. All TDI derived LV systolic (IVV, Sm and IVA) velocities were significanty decreased in patients with mitral stenosis, compared to the healthy control (P<.001, for all). However IVA was not different when the degree of MS was evaluated (P=.056). In addition IVA was not correlated with MVA (r=+0.196. P= 0.056). Conclusions: Isovolumic myocardial acceleration was more accurate and consistent than conventional echocardiography in assessing subclinical left ventricular systolic dysfunction, IVA showed that left ventricular function is impaired with mitral stenosis regardless of severety of the disease. So this new echo parameter can be a good supplement to the existing 2D scoring system to detect systolic dysfunction in rheumatic mitral stenosis. University Heart Journal Vol. 17, No. 1, Jan 2021; 42-46