Relationship between Myocardial Performance Index and the Severity of Coronary Artery Disease Assessed with SYNTAX Score in Chronic Stable Angina Patients in Bangladesh.

Although improvement in the risk scoring, there are patients with chronic stable angina identified as low risk who experience CAD events, as well as, patients deemed high risk remained free of CAD events. Invasive coronary angiogram is the gold standard method for assessment of extent and severity of CAD. However, search for additional noninvasive tool that may aid in risk discrimination is going on. Myocardial performance index (MPI) is emerging as one of them. To assess the relationship between Myocardial Performance Index and severity of coronary artery disease assessed with SYNTAX Score in chronic stable angina. This cross-sectional study was conducted during the period of January, 2015 to December, 2015 among the patients of chronic stable angina undergoing elective coronary angiogram. Total 90 patients were enrolled by purposive sampling. All the data were recorded in structured questionnaire. Coronary angiogram with SYNTAX scoring was done during index hospital admission. Doppler study was done 1 day prior to CAG to measure MPI. The mean age was found 45.5±26.1 years varied from 36 to 68 years. Male female ratio was 1.9:1. A negative significant correlation (r= -0.792; p=0.001) was found between ejection fraction (EF) and myocardial performance index (MPI). Regarding the association between risk factors with MPI status, the mean MPI was found 0.65±0.10 in diabetes mellitus and 0.57±0.10 in without diabetes mellitus. Mean MPI was significantly higher in diabetes mellitus, others risk factors are not significantly associated with MPI status. Majority (38.9%) patient's SYNTAX score belonged to 0-22, 28(31.1%) was SYNTAX 23-32 score and 27(30.0%) was SYNTAX ≥33 score. The mean MPI was found 0.51±0.04 in low SYNTAX, 0.61±0.03 in intermediate SYNTAX and 0.74±0.07 in high SYNTAX score. The mean MPI was significantly (p<0.05) elevated with increased SYNTAX score. A positive significant correlation (r=0.985; p=0.001) was found between MPI with SYNTAX score. Higher value of SYNTAX score (>22) had a 2.29 times increase (95% CI 0.16 to 33.70%) in odds of having CAD. A subject with diabetes mellitus had 1.52 times increase (95%CI 2.02 to 21.54%) in odds having CAD. Others factors are not significantly associated with CAD in Multiple regression models. The MPI value is independently associated with the extent and severity of CAD. The MPI value measured by Doppler is a cheap, radiation free, available noninvasive method and may be considered as an additional risk stratification tool beyond other investigations.

First Cardiac Magnetic Resonance Experience in Bangladesh: A Case of Arrhythmogenic Right Ventricular Dysplasia.

Arrhythmogenic right ventricular dysplasia (ARVD) is a progressive degeneration and replacement of the right ventricular (RV) myocardial tissue by fat and fibrosis and produce clinical condition. Desmosome gene mutations are only the causative state for ARVD hereditary disorder. The arrhythmogenic right ventricular cardiomyopathy incidence is about 1/1000-5000. Mostly young people and athletes are bearing the clinical presentations include presyncope, syncope, ventricular tachycardias or ventricular fibrillation leading to cardiac arrest. We report about the first case of Cardiac magnetic resonance (CMR) imaging to diagnose a case Arrhythmogenic right ventricular dysplasia (ARVD) of a 34-year-old male from Savar, Dhaka, Bangladesh who was referred to cardiac emergency for the evaluation recurrent dizzy spells.

Comparative efficacy of subcutaneous versus oral methotrexate in active rheumatoid arthritis.

This prospective study was conducted in rheumatology clinic under the department of medicine of Bangabandhu Sheikh Mujib Medical University from December 2004 to December 2005 to asses the efficacy, safety and compliance of subcutaneous methotrexate (MTX) in active rheumatoid arthritis (RA) patients. A total of 92 active rheumatoid arthritis patients according to American College of Rheumatology (ACR) criteria were recruited for the trial for six months. Among them 46 cases belonged to injectable MTX group and 46 cases belonged to oral MTX group. Mean±SD age of patients was 45.54±12.42 vs. 44.63±13.99 years in subcutaneous group and oral group respectively. In the subcutaneous group 41 were female and 5 male; in the oral group 34 were female and 12 male. Mean duration of the disease was 49.74 months in subcutaneous group and 49 months in oral group. RA test was positive in 35 cases in both groups whereas Rose Waaler test was positive in 19 patients in subcutaneous group and 14 patients in oral group. At 24 week, response rate of ACR 20 was significantly higher in subcutaneous MTX than oral MTX group (93% vs. 80%, p=0.02). Similarly ACR 50 response was significantly higher in subcutaneous MTX than in oral group (89% vs. 72%, p=0.03). ACR 70 response was not significantly higher in SCMTX group then oral group (11% vs. 9 %, p=0.72). Adverse effects were relatively less in subcutaneous MTX and most common side effects were nausea (37% vs. 63%), vomiting (11% vs. 30%), dyspepsia (29% vs. 48%), dizziness (4l% vs. 52%) and alopecia (72% vs. 85%). The results of the study demonstrated that subcutaneous MTX was significantly more effective than oral MTX at the same dosage in active Rheumatoid arthritis patients with no increase in side effects.

Aetiology and risk stratification of patients presenting with atrial fibrillation.

Atrial fibrillation (AF) is the most common sustained arrhythmia in the World, occurring in approximately 0.4% of the general population. The purpose of the present study was to see the aetiology, presenting symptoms and risk stratification of hospital admitted patients with atrial fibrillation. It was conducted in the department of cardiology, University Cardiac Centre, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2008 to January 2009. A total of 100 patients with atrial fibrillation were enrolled in this study. Out of them, male were 40(40%) and female 60(60%); age range 22-79 years. Most common presenting symptoms were palpitation (80%) & dyspnoea (70%). Chronic rheumatic heart disease (CRHD) (63%) was found in most cases followed by IHD (13%), hypertension (11%). Among CRHD, mitral stenosis was 50%, and mixed mitral valve disease was 8%. Risk stratification of patients with AF for future thromboembolism revealed high risk factors were present in 60% cases, moderate in 25% cases, and weaker risk factors in 15% cases. According to CHADS2 score, most of the patients belonged to moderate risk group (47%) and 32% in low risk group. Chronic rheumatic heart disease is one of the major causes of atrial fibrillation in hospital admitted patients & risk stratification revealed that most of the patients were in risk for future stroke.

Balloon mitral valvuloplasty: immediate and short term haemodynamic and clinical outcome.

This prospective study was carried out in the Department of Cardiology, University Cardiac Center, Banghabandhu Sheikh Mujib Medical University, Dhaka, to evaluate the short term clinical and haemodynamic outcome of Balloon mitral valvuloplasty in mitral stenosis. Total 100 patients underwent percutaneous mitral commissurotomy out of which 60 cases had pure mitral stenosis and 40 patients had concomitant other nonsignificant valvular disease. Mitral valve dilatation increases in mitral valve area from 0.5+/-0.22 to 1.80+/-0.41 cm2. Mitral valve mean pressure gradient decline from 24.0+/-6.48 mm of Hg to 6.1+/-3.0 mm of Hg: mean left arterial pressure decline from 21.40+/-4.80 mm of Hg to 6.50+/-2.82 mm of Hg (p<0.001). The pulmonary artery systolic pressure decreased from 78.7+/-20.34 mm of Hg to 30.18+/-10.8 mm of Hg (p<0.001). Procedural success, as defined final mitral valve area>1.5 cm2 or>50% increase in area, was achieved in 95% patients. Serious complications occurred in 2(2%) patients and no death occurred in the study. Minor complications such as vasovagal reaction (03%), balloon rupture without sequelae (1%), hypotension, Seizure etc. during the procedure were also noted. Although percutaneous transvenous mistral commissurotomy appears to be effective at relieving the hemodynamic effects of rheumatic mitral stenosis, it is not without risk. In properly selected patients, however, it appears to have low morbidity and mortality. The overall results of this study demonstrate that the short term clinical and haemodynamic outcome of the procedure were excellent and the incidence of related complications were reasonable.