Correlation Of Global Longitudinal Systolic Strain With Severity Of Coronary Artery Disease In Non-Stelevation Acute Coronary Syndrome Having Normal Ejection Fraction.

BACKGROUND: In patients of non-ST-elevation acute coronary syndrome (NSTEACS), the global longitudinal peak systolic strain (GLPS) has been used to detect the presence of coronary artery disease (CAD) before left ventricular ejection fraction (LVEF) is affected. We tried to find out the correlation between the GLPS and severity of CAD in such patients. METHODS: A descriptive correlational study was conducted from March 2018 to January 2020 at Jinnah Hospital Lahore. Two hundred and sixteen patients of NSTEACS with EF of ≥60% were included. Patients were divided according to angiographic results into those having non-significant, one-vessel, two-vessel or three-vessel disease. These four groups were compared regarding left ventricular end-systolic dimension (LVESD), left ventricular end-diastolic dimension (LVEDD), LVEF, global longitudinal peak systolic strains in apical long axis view (GLPS-APLEX), in apical 4-chamber view (GLPS-A4C), in apical 2-chamber view (GLPS-A2C) and average of these (GLPS-AVG). All these parameters were also compared between patients having and those not having left main coronary artery (LMCA) disease. RESULTS: Out of 216 patients, males and females were 124(57.4%) and 92 (42.6%) respectively. There were 28 (13.0%), 83 (38.4%), 62 (28.7%) and 43 (19.9%) patients who had non-significant, one-vessel, two-vessel and three-vessel CAD respectively. With increase in severity of CAD, GLPS-AVG progressively decreased from nonsignificant CAD being 20.6±0.7 to three-vessel CAD being 16.1±0.7. There was a significant negative correlation between severity of CAD and all of the GLPS-APLEX, GLPS-A4C, GLPSA2C and GLPS-AVG (p<0.001 in all). GLPS-AVG was significantly low in patients having LMCA disease (16.5±0.7) than those not having LMCA disease (18.2±1.5) with p-value of <0.001. All other types of GLPSs showed the similar trend. CONCLUSIONS: Global longitudinal peak systolic strain has a significant negative correlation with severity of coronary artery disease in non-ST-elevation acute coronary syndrome having normal ejection fraction.

Frequency And Predictors Of Radial Artery Spasm During Coronary Angiography/Percutaneous Coronary Intervention.

BACKGROUND: Coronary angiography is the gold standard test for diagnosis coronary artery disease. It can be performed via various intra-arterial routes, i.e., femoral, radial, brachial, ulnar, or axillary arteries. Trans-Radial access for coronary angiography is a good approach with less major vascular complications, increased patient comfort and early mobilization and less hospital stay but is associated with radial artery spasm as the major complication affecting the success of the procedure. METHODS: This study was a descriptive cross-sectional study. It enrolled one hundred and thirty-six (136) consecutive patients who underwent the procedure of coronary angiography/PCI over a 6-month period. The study included both in and outpatients undergoing coronary angiography/PCI. Coronary angiography/Percutaneous coronary intervention was done via trans radial approach and the study participants were observed for development of radial artery spasm using clinical and angiographic parameters. Data was entered and analysed using SPSS-19. RESULTS: The frequency of radial artery spasm was 13.24% (n=18). Radial artery spasm was statistically significant in females (p<0.05), those who had severe pain during radial artery puncture (p<0.001) and those who had unsuccessful first attempt during radial artery puncture (p<0.001). No statistically significant association was found between radial artery spasm and other predictors such as age, hypertension and diabetes mellitus. CONCLUSIONS: Radial artery spasm is a common complication during trans radial approach for coronary angiography/percutaneous coronary intervention particularly in females, those who have unsuccessful first attempt and those who have severe pain during radial artery puncture.

Systolic Strain Rate In Left Ventricular Dysfunction Caused By Rheumatic Chronic Severe Mitral Regurgitation.

BACKGROUND: In rheumatic severe mitral regurgitation, earlier detection of left ventricular dysfunction is very necessary in order to refer the patients for surgery at appropriate time. This study tried to find a correlation between conventional parameters of left ventricular dysfunction with systolic strain rate. METHODS: A descriptive correlational study conducted from September 2016 to March 2018. One hundred and ninety-two patients of severe rheumatic MR and fifty-eight healthy controls were included. Left ventricular ejection fraction (LVEF), end diastolic dimension (LVEDD) and end systolic dimension (LVESD) were measured. Healthy controls were taken as group-I and patients were divided into group-II (ejection fraction ≥60% and LVESD ≤40 mm), group-III (ejection fraction ≥60% and LVESD ≤41-50 mm), and group-IV (ejection fraction <60%). Systolic strain rate at medial wall (SSR-med), at lateral wall (SSR-lat) and average of both (SSR-avg) were also measured by tissue doppler method for each study subject. RESULTS: Out of 250 study subjects, males were 113 (45.2%) and females were 137 (54.8%). Means of the age, LVEF, LVEDD and LVESD were 30.8±9.1, 60.0±8.3, 58.5±7.8 and 37.4±9.9 respectively. Group I, II, III and IV contained 58, 69, 67 and 56 subjects respectively. Comparing these groups, mean LVEF progressively decreased from 63.9%±2.2 in group-I to 46.2±6.5 in group-IV while means of LVEDD and LVESD progressively increased from 45.9±3.5 and 23.2±2.3 in group-I to 64.3±3.6 and 49.0±2.9 in group-IV respectively. Average systolic strain rate (SSR-avg) decreased progressively from 1.57±0.06 in group-I to 0.83±0.08 in group-IV. All the strain rates, i.e., SSRmed, SSR-lat and SSR-avg showed significant negative correlation with left ventricular dysfunction, i.e., the group number (p<0.001). CONCLUSIONS: Systolic strain rate measured by tissue doppler method have significant negative correlation with left ventricular dysfunction in patients having rheumatic chronic severe mitral regurgitation.

Usefulness Of Neutrophils To Lymphocytes Ratio For Predicting Troponin-I Elevation In Patients Presenting With Suspected Nste-Acute Coronary Syndrome.

BACKGROUND: Most of the admissions to the coronary care unit are patients who are having Non- ST-segment elevation acute coronary syndrome (NSTE-ACS). Inflammation has an important role in the pathogenesis of the acute coronary syndrome. Inflammatory marker such as Leukocyte counts & most importantly Neutrophils to Lymphocyte Ratio (NLR) has been found an important predictor of cardiovascular events. Few studies show the diagnostic role of Neutrophils to Lymphocyte ratio in the patient presenting with NSTE-ACS. The objective of this study was to determine the diagnostic role of Neutrophils to Lymphocytes ratio to predict the elevation of Troponin-I in patients presenting with suspected NSTE-acute coronary syndrome. METHODS: This was a Descriptive Case Series study, conducted in Cardiology department Ayub Teaching Hospital/Ayub Medical College Abbottabad, from 15th May 2017 to30th December 2018. A total of 203 patients with suspected NSTE-ACS were inducted in the study by non-probability, consecutive sampling. RESULTS: Results of this study shown a strong correlation between Neutrophils to Lymphocyte ratio (NLR) & rise in Troponin-I levels. Furthermore, results shown that at 4th quartile of Neutrophils to Lymphocyte ratio (NLR) there is high Specificity (97.8%) and very high positive predictive of value 96.7% for predicting the rise in Troponin-I levels. CONCLUSION: We concluded that there is a strong correlation between rising Neutrophils to Lymphocyte ratio (NLR) and cardiac Troponin-I elevation in patients presenting with suspected NSTE-acute coronary syndrome. Therefore, this parameter can be used to predict the rise in troponin level in patients presenting with suspected NSTE-ACS.

Association Of Degree Of St Segment Depression With Inhospital Mortality In Patients With Non-St Elevation Myocardial Infarction.

BACKGROUND: Ischemic heart disease is responsible for approximately 1/3 of all global deaths, making it a leading cause of cardiovascular mortality. Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) which is an acute event in spectrum of coronary artery disease is a potentially lifethreatening emergency, makes up for the majority of admissions to a cardiac unit with one-year mortality rate of 23.5%. The objective of this study was to determine the association of degree of ST segment depression on hospital mortality in patients presenting with Non-ST segment elevation myocardial infarction (NSTEMI). METHODS: This descriptive case-series was carried out in the department of Cardiology, Punjab Institute of Cardiology Lahore. Using Non-probability purposive sampling technique, a total of 250 patients of age between 30-75 years of either gender, who reported during the study period, with NSTEMI were inducted in this study.. RESULTS: In our study, 33.2% (n=83) patients were between 30-50 years and 66.8% (n=167) patients were between 51-75 years of the age. Mean age was 54.64±9.69 years. 43.2% (n=108) patients were male and 56.8% (n=142) were females. Frequency of in-hospital mortality was 4.4% (n=11). Mortality increased with increasing degree of ST segment depression on admission Electrocardiogram (ECG).. CONCLUSIONS: In patients admitted with Non-ST segment elevation myocardial infarction (NSTEMI), degree of ST segment depression on admission ECG predicts In-Hospital mortality.

Procedural Outcomes Of Primary Percutaneous Coronary Intervention In Elderly Patients With Stemi.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death worldwide, and coronary artery disease (CAD) is the most prevalent manifestation associated with high mortality and morbidity. Older age is independent predictor of cardiovascular mortality and death. Elderly may experience high rates of complications following acute STEMI. Optimal reperfusion strategy in elderly following STEMI remains under debate due to their exclusion from trials evaluating various treatment modalities. Primary PCI has emerged as treatment of choice in patients presenting with acute STEMI in a certain window period. The rationale of this study is to help us determine the outcome of primary PCI in the local elderly population. METHODS: The study was designed as descriptive cross-sectional study and was carried out at AFIC, NIHD hospital Rawalpindi over a six months period. A total of 105 adults with STEMI were included in study. Data was analysed using SPSS-19.0. RESULTS: Total 105 patients were included in the study according to the inclusion criteria of the study. There were 102 (97.1%) patients who successfully achieved TIMI II flow post Primary PCI.. CONCLUSIONS: We concluded that outcome of primary PCI in local elderly population is favourable which leads to a consensus that primary PCI should be offered to every elderly patient presenting to tertiary care hospital with well-equipped Cath lab and experienced staff.