Noninvasive CT coronary angiography is a promising coronary imaging technique. In spite of the unprecedented temporal and spatial resolution and the inability to perform therapeutic interventions in the same session multi-detector computed tomography (MDCT) has been considering a promising alternative, non invasive tool for coronary artery imaging due to its high sensitivity and specificity for the detection of significant coronary artery stenosis. To evaluate the diagnostic accuracy of 64-slice MDCT for assessing haemodynamically significant stenoses of the coronary arteries in comparison with the conventional standard cardiac angiography. Fifty patients scheduled for conventional coronary angiography at the department of Radiology and Imaging, United Hospital, Dhaka were enrolled between July 2007 and June 2008. All patients underwent both conventional and MDCT angiography within mean 10.70 days. Overall sensitivity of 64-slice MDCT for the detection of stenosis ≤50%, stenosis >50%, and stenosis >75% was 90.0%, 83.8%, and 80.7%, respectively, and specificity was 96.5%, 98.4%, and 98.3% respectively and accuracy was 96.0 %, 96.5%, and 96.6% respectively. Contrast-enhanced 64-slice MDCT allows the identification of coronary stenosis with excellent accuracy. Measurements of stenosis derived by MDCT correlated well with conventional angiogram. A major limitation is the insufficient ability of CT to exactly quantify the degree of stenosis.
Background: Worldwide primary angioplasty is a recommended strategy of reperfusion in patient with acute myocardial infarction as because it ensures reperfusion of the infarct-related vessels more than 90% where as, with thrombolytics it is only 60-70%. Methods: It is a retrospective observational study includes all patients treated with primary angioplasty at United Hospital from Between6. Written consent must be taken from the patients or patient's relative.7. We have ongoing program to analysis outcomes. Study population:Inclusion criteria-1. Patient presented with chest pain, ECG changes suggestive of STEMI 2. Duration of pain < 12hours 3. All age group 4. Both sexes Underwent Primary PCI as a reperfusion strategyExclusion criteria 1. patient presented with cardiogenic shock 2. Chest pain > 12hours Medications and technique:All patients got aspirin 300mg and 600mg clopidogrel, GTN-oral/IV, 5000units IV heparin at Emergency Department immediacy after diagnosis. In Cath lab 10,000 units IV Heparin before initiation of PCI was given, some times more Cardiovas Journal heparin needed to keep ACT .300. We used intracoronary GTN, Adenosine if there was slow flow or no flow. IV GPIIb/IIIa receptor blockers bolus followed by IV infusion no flow or slow or huge thrombus burden. We did not use distal protection device. Following PCI 3-6 doses of LMWH subcutaneously given routinely if there is no bleeding episodes. Introducing sheath were removed 2 hours after completion of GPIIb/IIIa receptor blockers or 6 hours after completion of the procedure.From emergency patients were shifted directly to the cath-lab. Both arterial and venous femoral access was achieved immediately. TPM was implanted if bradycardia or heart block present at presentation. We used aspiration thrombectomy catheter before ballooning if there was thrombus burden. Pre-dilatation with balloon was done if lesion morphology were complex and critical after thrombus aspiration. In our protocol we did angioplasty to the infarct related artery then staged PCI or CABG. Most of the cases we put DES stents except when clinical condition demand BMS. We routinely did post dilatation after stent implantation. Results:Total 237 Discussion:There is no question that primary PCI, when available, is the treatment of choice. 7 But in our country it is not a widely used reperfusion strategy due to lack facilities. Only a few centers at Dhaka city are performing primary PCI but mostly during the office hours. But in our centre we have Primary PCI facilities 24hours a day, 365days a year. Study population was mostly male like all over the world. Regarding age we had younger age group, mean age 55.8± 11.5yrs, another study at USA showing their mean age 61±.13yrs. 8 Lowest age in our series was 28yrs. Risk factors analysis showed HTN is the most common it was 58.4%, it is also like other studies. A study at USA described HTN as the most common risk factor. 8 Primary PCI holds a survival advantage if it can be performed in a timely fashion. The principle that "time ...
IntroductionClopidogrel and aspirin are at the base of treatment in conditions like arterial thrombosis and after patients have undergone percutaneous coronary intervention. But frequently found CYP2C19*2 and CYP2C19*17 polymorphisms and some variants of the ITGB3 gene cause alteration in the therapeutic effectiveness of this drug.MethodsOne thousand cardiovascular patients were recruited for each drug under study. Their blood was collected to analyze the genotype using PCR-RFLP and T-ARMS-PCR method for clopidogrel and aspirin respectively. The PCR products for clopidogrel were screened with agarose gel electrophoresis and then digested with SmaIfor CYP2C19*2 and Nsil-HF for CYP2C19*17. The digested products of clopidogrel and the ARMS-PCR product of aspirin were run on 2% AGE to analyze the polymorphisms.ResultsIn our outcome, the percentage of hetero and mutant homozygous people in CYP2C19*2 polymorphism (loss-of-function allele) was 64.1% and for CYP2C19*17 (gain-of-function allele) was 22.3%. For ITGB3 polymorphism, it was found that 84.1% of them belonged to the homozygous group while 15.6% was heterozygous and only 0.3% were mutant homozygous patients.ConclusionOur study findings were quite compatible with the results of some other studies in other ethnic groups. This phenomenon suggested for modification of dose or application of alternative generics in patients who are under the risk of therapeutic failure or toxicity produced by these drugs.
Ventricular septal rupture is a rare complication of acute myocardial infarction with important hemodynamic consequences. Without a rapid diagnosis and correction by surgical intervention, the short-term mortality of these patients is higher than 90%. Early diagnosis is based on clinical examination and transthoracic echocardiography. Transcatheter closure of ventricular septal rupture in selected patients may save lives. We report a patient with ventricular septal rupture in acute myocardial infarction that was closed by an Amplatzer device. DOI: http://dx.doi.org/10.3329/cardio.v7i2.22264 Cardiovasc. j. 2015; 7(2): 150-152
Introduction: Antithrombotic agents are the basic therapeutic option for patients with arterial thrombosis who underwent percutaneous coronary intervention (PCI). In Bangladesh, aspirin and clopidogrel are frequently prescribed as antithrombotics or platelet inhibitors. Studies reported the genetic polymorphisms of CYP2C19*2, CYP2C19*17, and ITGB3 cause an alteration of the pharmacodynamic and pharmacokinetic profile of aspirin and clopidogrel. Therefore, we aimed to assess the prevalence of CYP2C19*2, CYP2C19*17, and ITGB3 polymorphisms among Bangladeshi patients with cardiovascular disease (CVD) who underwent PCI. Methods: Here we assessed a total of 1,000 CVD patients (male 782 and female 218) who underwent PCI and were treated with clopidogrel and/or aspirin. We performed genotyping of patients treated with clopidogrel and aspirin by polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) and tetra-primer amplification refractory mutation system PCR (T-ARMS-PCR) methods. The PCR products of clopidogrel-treated patients were screened with agarose gel electrophoresis and then digested with SmaI and NsiI-HF for CYP2C19*2 and CYP2C19*17, respectively. We genotyped aspirin-treated patients with T-ARMS-PCR for missense rs5918 (PlA1/A1) polymorphism of the ITGB3 gene. Then we ran the digested PCR products on 2% agarose gel electrophoresis to detect the mentioned polymorphisms. Results: Among the clopidogrel-treated patients, we observed 64.1% polymorphism (hetero + mutant) of CYP2C19*2 (loss-of-function allele) and 22.7% (hetero + mutant) of CYP2C19*17 (gain-of-function allele). On the other hand, among the aspirin-treated patients, polymorphisms of ITGB3 were 84.1% homozygous (PlA1/A1), 15.6% heterozygous (PlA1/A2), and 0.3% mutant homozygous. Conclusion: In the present study, we observed a high prevalence of genetic polymorphisms of CYP2C19 and ITGB3 genes. Therefore, we recommend genotyping of CVD patients before prescribing clopidogrel or aspirin to prevent coagulation. Based on the genotyping study, the adjustment of doses or alternative generics might require to avoid therapeutic failure or toxicity in some cases.
Background: Now a days mitral balloon valvoplasty(PTMC) is an alternative to closed surgical mitral commissurotomy (CMC) for the treatment of selectcd patients with rheumatic mitral stenosis. To compare between the total echo score (Wilkin’s score) total echocardiographic commissural morphology score (TC) for outcome and as a predictors of complications of both procedures. Method: We carried out a prospective well matched comparative observational study on 123 patients of symptomatic mitral and three patients were rejected due to procedural complications and technical failure. Result: Age ranges were 12 55 years, mean (±SD) age was 28.83+9.33 years. Out of 120 patients, 41 (34.2%) were male and 79 (65.8%) were female. Before procedure, 29 (48.3 %) and 32 (53.3 %) patients were in NYHA class III.Total Wilkins score was in the range of 4 10. Mean (±SD) of total Wilkins score were 6.43+1.53 and 6.30+1.33. Good commissural morphology (score 0 1) were present in 38 (63.5%) and 36 (60%) and bad commissural morphology (score 2 3) were present in 22 (26.7 %) and. 24 (40 %) in both groups respectively. Mitral valve area increased from a mean (±SD) of 0.80±0.16 and 0.79±0.15 to 1.94 ±0.24 and 1.92 + 0.26cm2. in PTMC and CMC groups respectively. Transmitral mean and peak pressure gradient also decreased significantly in both the individual procedures but no statistically significant difference between the procedures. NYHA class improved by class 1 or more in most patients in both groups. There were 2 (3.33 %) cases of cardiac temponade due cardiac perforation in PTMC group, of which one need repair and CMC and another was managed conservatively. There were also 3 (5 %) patients in PTMC and I (1. 66 %) patient in CMC developed peripheral thromboembolism and one patient (1.66%) developed arteriovenous fistula in PTMC group. Mitral regurgitation grade III, developed in 3 (5%) patients and one patient (1.66%) in PTMC and CMC respectively having no statistical significance. Conclusion: Total Wilkin’s score and total commissural morphology score were found to be most important preprocedural variable associcated with the outcome and as a predictors of post procedural complications Keywords: PTMC, CMC, Mitral stenosis, Rheumatic heart diseaseDOI: http://dx.doi.org/10.3329/cardio.v1i1.8202 Cardiovasc. j. 2008; 1(1) : 34-43
IntroductionSuccessful revascularization of the epicardial coronary artery can be achieved in over 90% of percutaneous coronary intervention procedures. However, post procedural microvascular obstruction, despite the presence of normal epicardial flow, remains an important limitation which substantially reduces the beneficial effects of percutaneous coronary intervention. In this review article, a number of different methods available to diagnose microvascular obstruction after percutaneous coronary intervention are outlined. We also discussed the various pharmacological and mechanical strategies to reduce the occurrence of microvascular obstruction. In this regard, pretreatment with antiplatelet therapy remains crucial. In urgent percutaneous coronary intervention for acute myocardial infarction, available data suggest that manual thrombus aspiration device is beneficial in reducing the occurrence of procedure-related microvascular obstruction and possibly improve long-term clinical outcomes.In the setting of ST-segment elevation myocardial infarction (STEMI), urgent PCI restores coronary perfusion, reduces myocardial damage, and improves survival. Over the last decade, the paradigm has shifted from epicardial artery patency to microvascular perfusion Distal embolization of atherosclerotic and/or thrombotic materials is most likely the predominant pathophysiological mechanism leading to post-PCI microvascular obstruction Other proposed contributing factors include coronary spasm, dissection, endothelial dysfunction, and inflammation. The relative contribution of these factors may differ in different clinical settings. Microvascular obstruction after PCI is associated with adverse long-term clinical outcomes, including higher risk of death and myocardial infarction. As a result, various pharmacological and nonpharmacological strategies have been evaluated to prevent post-PCI microvascular obstruction. Recently, lesion composition determined by IVUS(necrotic core and thin-cap fibroatheroma) MSCT has been shown to be of predictive value for occurrence of post-PCI microvascular obstruction.
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