Radiation exposure in different cardiac catheterization procedures in cath lab.

BACKGROUND: Interventional procedures render cardiologolists and their team members to high doses of radiations. This study was conducted to assess the radiation exposure in various cardiac catheterization procedures. METHODS: This descriptive cross sectional study was conducted at the catheterization laboratory of Lady Reading Hospital Peshawar from November 2008 to December 2009. Patients were categorized into four groups for procedures a. coronary angiography, b. percutaneous coronary intervention (PCI), c. permanent pacemakers (PPM) and d. percutaneous transvenous mitral commisurotomy (PTMC), two groups for operators (consultants and trainees), and three groups for various accesses (femoral, radial and sub-clavian). RESULTS: A total of 99 patients undergoing cardiac catheterization were studied. Coronary angiography was performed in 52 (52.5%) patients, PCI in 32 (32.3%)), pacemakers in 6 (6.1%), and PTMC in 9 (9.1%) patients. Consultants did 72 (72.7%) procedures and trainees did 27 (27.3%) procedures. Through radial access, 22 (22.2%) procedures were performed, 71 (71.7%) through femoral, and 6 (6.1%) through sub-clavian. The mean radiation dose for coronary angiography was (4907.862 +/- 15231.6358 microGym2), PCI (10375.16 +/- 16083.4385 microGym2), pacemakers (1406.823 +/- 785.489 microGym2), and PTMC (1157.91 +/- 760.437 microGym2). The mean radiation dose for radial (6147.33 +/- 8480.37 microGym2), femoral (6512.58 +/- 16566.73 microGym2), and sub-clavian was (1406.82 +/- 785.48 microGym2). While for various operators consultants (7489.5 +/- 16925.55 microGym2), and trainees (2475.25 +/- 1178.86 microGym2). The mean time for radial (8.59 +/- 7.28 min), femoral (6.95 +/- 6.43 min) and sub-clavian was (8.24 +/- 4.81 min). The mean time for coronary angiography (4.56 +/- 5.32 min), PCI (11.44 +/- 6.92 min), PPM (8.24 +/- 4.81 min), and PTMC (8.28 +/- 5.01 min). CONCLUSIONS: Radiation dose varies substantially across different groups by different operators and different routes.

Prevalence of hypertension among obese and non-obese patients with coronary artery disease.

BACKGROUND: Globally, obesity is now recognised as an epidemic. The degree of obesity is proportional to the rate of development of cardiovascular diseases, hence, resulting in a dramatic increase in morbidity and mortality. Apart from obesity, hypertension is another well recognised risk factor contributing to coronary artery disease (CAD). The precise prevalence of obesity-related hypertension varies with age, race and gender; and is yet unknown in our population. The objective of this study was to determine the prevalence of hypertension in obese and non-obese patients with diagnosed CAD. METHODS: This hospital based descriptive study was conducted in Cardiology Department of Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from 15th March 2007 to 30th May 2008. A total of 200 patients with diagnosed CAD were enrolled, 100 were found obese and 100 non-obese. RESULTS: Among these, a total of 111 (55.5%) were found to be hypertensive, 66 (59.46%) of these were obese and 45 (40.54%) non-obese (p=0.003). CONCLUSION: Obese patients with CAD had significantly more frequent hypertension.

Quantification of diagnostic accuracy using nitrate enhanced Tc-99m sestamibi gated myocardial SPECT in assessing myocardial viability: prospective analysis.

The aim of this prospective study was to assess myocardial viability with nitrate-enhanced Tc-99m sestamibi gated single-photon emission computed tomography in patients with known coronary artery disease. We enrolled 48 consecutive patients (39 men, 9 women) aged 24-82 years, with coronary artery disease and history of myocardial infarction. A Tc-99m sestamibi study was conducted at rest as baseline, followed by a nitrate-enhanced study the next day. Of 960 segments analyzed, 244 of 480 in the left anterior descending coronary artery territory showed viability on the baseline study, and 276 were viable according to the nitrate-enhanced study. Similarly, of 192 right coronary segments analyzed, 148 showed viability on the baseline study compared to 153 on the nitrate study. Of 288 left circumflex territory segments analyzed, 206 showed viability on the baseline study compared to 241 on the nitrate study. The overall improvement of viability with the nitrate study was 12.04%. On the gated studies, the overall improvement with nitrate was 2.02%. The gated study also allowed grading of wall motion and thickness. It was concluded that nitrate-augmented Tc-99m sestamibi myocardial imaging significantly improved the detection of hibernating myocardium, with gated images further improving the accuracy of detection in borderline cases.