Study on correlation of obesity with short-term prognosis in acute myocardial infarction.

BACKGROUND: Obese patients with established coronary artery disease have reduced mortality compared to normal or low body mass index (BMI) patients. The reason for the relation is not yet clearly understood. We sought to evaluate the association of BMI and waist circumference (WC) at the time of presentation in patients with myocardial infarction (MI) with one-year adverse cardiac events. METHODS: In this prospective cohort study, we included consecutive patients with acute MI admitted to a tertiary care hospital during a period of one year. Upon admission, BMI and WC were measured. Patients were followed-up for a period of one year and the primary composite outcome of death or non-fatal MI was correlated with BMI and WC categories. RESULTS: There were 703 patients (males 559 (79.5%)). Combined non-fatal MI and death at one year was 128 (18.2%). Incidence of primary outcome was 25.0% in low BMI group, 19.9% in normal BMI group, 13.1% in overweight group, 13.4% in class I obese, and 11.1% in class II obese groups. In univariate analysis, the inverse correlation was significant (p value=0.007). In one-year follow-up period, 12.8% in high and 20.8% in normal WC groups had primary outcome (p value=0.01). Both BMI and WC lost their predictive value in multivariate analysis. CONCLUSIONS: Low BMI and normal WC were associated with a worse short-term outcome in patients with acute MI. Neither BMI nor WC independently predicted cardiac events or death after acute MI.

Correlation of pulmonary capillary wedge pressure with left atrial pressure in patients with mitral stenosis undergoing balloon valvotomy.

AIMS: We sought to evaluate the correlation between PCWP and LAP and to compare transmitral gradients obtained with LAP and PCWP in MS, before and after balloon mitral valvotomy (BMV). METHODS: Consecutive patients with MS for BMV were included in this prospective cohort study. Simultaneous PCWP and LAP were recorded followed by simultaneous left atrium-left ventricular (LA-LV) and pulmonary capillary wedge pressure-left ventricular (PCWP-LV) gradients before and after BMV. RESULTS: There were 30 patients with a mean age of 41 yrs (males 10 (33.3%), females 20 (66.7%)). There was no significant difference between mean LAP and mean PCWP before BMV (21.3mmHg and 22.3mmHg, respectively) or after BMV (15.3mmHg and 17.3mmHg, respectively). There was excellent correlation between mean PCWP and mean LAP before BMV (r=0.95) (p<0.001) and after BMV (r=0.85) (p<0.001). The phasic components of the pressures (a and v waves) of LAP and PCWP also showed good correlation before and after BMV. Further, transmitral gradients assessed by LA-LV and PCWP-LV pressures showed excellent correlation before BMV (r=0.95) (p<0.001) and after BMV (r=0.95) (p<0.001). CONCLUSION: In patients with MS undergoing balloon valvotomy, PCWP shows good correlation with LAP. Transmitral gradients obtained with PCWP and LAP also correlate well after correction of phase lag in PCWP tracing. Hence, PCWP can be used for reliable measurement of transmitral gradient.

Prognostic significance of coronary sinus filling time in patients with angina and normal coronaries at one year follow up.

BACKGROUND: Coronary sinus filling time (CSFT) has been proposed as a simple method for assessment of coronary microvascular function in patients with angina and normal coronaries. But its correlation with inducible ischemia and prognostic significance in predicting future cardiovascular events has not been studied. The present study assessed the prognostic significance of CSFT during one year of follow up. METHODS: We compared coronary sinus filling time of patients with angina and normal coronaries with that of control population. Control group was formed by those patients with supraventricular arrhythmia undergoing radiofrequency ablation and having normal coronaries. Baseline treadmill test (TMT) parameters like workload, duration and Duke Score were assessed. Patients were followed up for one year and a composite of cardiovascular mortality and non-fatal myocardial infarction was analyzed. Number of patients presenting to emergency or outpatient department with recurrent chest pain symptoms during one year follow up was considered for secondary outcome analysis. Coronary sinus filling time was analyzed with respect to cardiovascular events, repeat hospitalization for recurrent angina and TMT parameters. RESULTS: Total 72 patients and 16 controls were studied. Mean CSFT value in the study group was 5.31 ± 1.03 sec and in the control group was 4.16 ± 0.72 sec and the difference was significant (p value = 0.0001). No correlation was found between baseline and repeat TMT parameters with CSFT. There was no cardiovascular mortality or hospitalization for non-fatal MI during one year follow up. But patients with frequent emergency or outpatient department visits with chest pain had a high CSFT compared with asymptomatic patients (p value = 0.005). CONCLUSION: Coronary sinus filling time may be used as a simple marker of microvascular dysfunction in patients with angina and normal coronaries. Patients with recurrent chest pain symptoms after one year follow up were found to have high CSFT compared to asymptomatic patients.