Coronary artery disease (CAD) is the leading cause of mortality and morbidity both in developed and developing countries. Percutaneous recanalization of occluded coronary artery is one of the treatment options and reinfarction and restenosis negatively affect the outcome following procedure. Although various factors including fibrinogen are suspected as risk factors for this but its role in adverse outcome after stent implantation is controversial. The aim of this study was to determine the impact & relation of periprocedural fibrinogen level on outcome after coronary stent implantation. This prospective study was conducted in the Department of Cardiology, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University (BSMMU), Hospital, Dhaka over a period of one year between July 2016 to June 2017. Total 53 patients of chronic stable angina (CSA) undergoing elective PTCA followed by stenting were included in this study as per inclusion and exclusion criteria. Plasma fibrinogen level was measured by collecting venous blood samples at three timed points in relation to stenting – 24 h before, 24 h after and 72 h after stenting. Recurrence of angina, myocardial infarction, repeat revascularization (either PCI or Cardiac surgery), and death were considered as adverse outcome during follow up at 1, 3 and 6 months after intervention. During the 6 months follow up period 1 (one) patient developed UA (at 1 month), 2 developed MI (1 at 3 month and 1 at 6 month) and 2 died (1 at 3 month and 1 at 6 month). Patients were grouped on the basis of four outcomes: favorable outcome (those who did not develop any of the four outcomes) and unfavorable or adverse outcome (those who developed any of the four outcomes). The mean age of study population was 53.92 years and 39 (73.6%) were male. Regarding cardiovascular risk factors, 43.4% patients had diabetes mellitus, 88.6% had dyslipidaemia, 56.6% were non-smokers. Baseline plasma fibrinogen level were significantly higher in patients who developed complications following PCI than those who did not develop the complications (394.4 ± 16.0 Vs 271.5 ± 21.8 mg/dl) & remained high after 24 hours and 72 hours following PCI (p < 0.001). Angiographic profiles of the study population reveals 84.9% LAD, 16.9% RCA & 15% LCX involvement but there was no association of post-PCI adverse outcomes with vessels involved, number of stents deployed and types of stents used (p > 0.05). Study showed that the risk of developing unfavorable outcome following PCI in patients with pre-PCI & post-PCI high serum fibrinogen was estimated to be 5.7 times & 12 times higher than those who have had serum fibrinogen lower than 350 mg/ dl respectively (p = 0.023 & 0.025 respectively). High serum fibrinogen can therefore be used as a marker for predicting adverse outcome following PCI. University Heart Journal Vol. 17, No. 2, Jul 2021; 122-127
Introduction: Chronic heart failure with reduced ejection fraction is a major complication of diseases involving myocardium. Despite numerous pharmacological interventions and invasive therapeutic techniques, therapeutic options for end stage heart failure remain limited to left ventricular assist device & organ transplantation. Regenerative medicine may bring hope here. Method: This pilot study was carried out at the Department of cardiology in collaboration with department of haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from October 2017 to March 2018. Considering inclusion & exclusion crieteria ten (10) patients were taken in stem cell group and ten (10) patients in control group. Patients in the control arm received standard of care in accordance with practice guidelines for heart failure management (GDMT). Patients in the cell therapy arm received, in addition to standard of care, bone marrow–derived cardiopoietic stem cells (G-CSF) meeting quality release criteria. Baseline clinical and echocardiographic data were obtained and recorded in pre-formed data sheet. Close liaison was maintained with all patients and followed up after 30 days & after 3 months and for any complication. The absolute change in 6 MWD from baseline to 30 days, 3 months & 6 months improved significantly in the both groups. But significant improvement was found at 6 months follow up of 6MWD between the two groups (300±28 vs 375±25, p= 0.04). Baseline BORG scale was similar in the control group and the SCT group (8.1±0.56 and 8.3±0.67 respectively, P= 0.45). The absolute change in BORG scale from baseline to 30 days, 3 months & 6 months improved significantly in the both groups. But improvement was not statistically significant in between the two groups (p= 0.32, 0.45, 0.23 respectively). Echocardiographic observation also revealed a similar baseline LVIDd, LVEF level in the control group and the SCT group which was not statistically significant (p = 0.45, 0.52 respectively). Gradual improvement in LVIDd were found at 30 days, 3 months, 6 months follow up observation but statistically significant absolute change was found only at 6 months follow up in between groups (62.4±1.8 vs 56±2.4, p=0.03). Baseline LVEF were less than 30% in both control & SCT group (29.5±0.8% & 28.7±1.3% respectively). The echocardiographic evaluation also revealed a significant increase in LVEF at 6 months (34% ±1.6 and 40% ± 2.5%, p = 0.04) of follow-up in between group but not at 30 days & 3 months follow up. University Heart Journal Vol. 16, No. 2, Jul 2020; 52-58
Background: Heart failure is a clinical syndrome which occurs due to structural or functional abnormalities characterized by inability of heart to fill or eject blood. Mostly all types of cardiac diseases may lead to heart failure with reduced ejection fraction (HFREF). Despite high volume prescribers of beta blockers patients does not achieve recommended target heart rate. Objective: To assess the efficacy of ivabradine as adjunct therapy with beta blockers in systolic heart failure and left ventricular systolic dysfunction. Methodology: This single center, open labelled, randomized study included 113 patients in sinus rhythm with HFrEF and left ventricular systolic dysfunction from outpatient department of Cardiology, 250 Bed Sadar General Hospital, Kishoreganj, Bangladesh from January to December-2020. Ivabradine was initiated in 45% patients with SR. Patients with LVEF < 35% by Teichholz method, NHYA class II-III, sinus rhythm and resting HR >70 bpm, already on bisoprolol 5 mg were divided into 2 groups; Group 1 (n= 56) patients were uptitrated to bisoprolol 10 mg and Group 2 (n= 57) patients received ivabradine 5 mg b.i.d in addition to bisoprolol 5 mg. Blood samples for NTproBNP level, an ECG, echocardiogram, NYHA functional class, systolic and diastolic BP were taken at baseline and at the end of 6 months follow-up in both groups. Results: After 6 months HR decreased significantly from 94.82±7.03 to 68.75±5.35 bpm (p < 0.0001), with more patients in NHYA functional Class I than Class II and III and decrease in BNP level from 969.8.3±348.9 to 348.6±230.2 pg/ml (p < 0.0001) in group 2 patients. A significant increase in LVEF was observed with the addition of ivabradine from 31.40±5.37 to 41.68±5.33 % (p < 0.0001). However, mean systolic and diastolic blood pressure was not affected by the addition of ivabradine. Conclusion: This study concludes that patients with HFrEF demonstrated good tolerability, efficacy and NYHA functional class with the combination .....
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