Impaired Renal Function is Associated with Severe Coronary Artery Disease in Chronic Stable Angina Patients.

Background: Cardiovascular disease is the leading cause of morbidity and mortality in renal impaired patients. Many of the patients of chronic kidney disease die of cardiovascular disease before requiring dialysis. Cardiovascular disease in renal impaired patient is potentially preventable and treatable. The aim of this study was to evaluate the association between renal impairment and coronary artery disease severity in chronic stable angina patients. Methods: 110 patients with chronic stable angina who got admitted for coronary angiography were included in the study. They were divided into impaired renal function group (with estimated glomerular filtration rate [eGFR] <90 ml/min/1.73m2) and normal renal function group (eGFR e” 90 ml/min/1.73m2) on the basis of eGFR. The severity of the CAD was assessed by angiographic Vessel score and Gensini score. Results: Mean Gensini score was significantly high in impaired renal function group (42.30±24.9 vs 25.65±17.9, p <0.05). There was significant negative correlation between eGFR and vessel score (r=-0.30, p <0.05) and between eGFR and Gensini score (r =-0.65, P <0.05). In multivariate logistic regression analysis, after adjustment of factors eGFR remain independent predictors of severe CAD (P=0.002, OR -5.73). Conclusion: Impaired renal function, assessed by eGFR is associated with angiographic severe coronary artery disease in chronic stable angina patients and this association is independent of conventional cardiovascular risk factors.

High Fibrinogen Level is An Independent Predictor of Presence and Severity of Coronary Artery Disease.

Background: Fibrinogen has been identified as an independent risk factor for cardiovascular disease and associated with traditional cardiovascular risk factors. Few reports have so far investigated the relationship between fibrinogen levels and the extent of coronary artery disease (CAD) as evaluated by coronary angiography. Therefore the current study was carried out to evaluate the relationship between fibrinogen levels and the extent of CAD as evidenced by coronary angiography. Method: A total of 210 patients having ischemic heart disease including chronic stable angina, unstable angina, non-ST elevated myocardial infarction & ST elevated myocardial infarction were evaluated in National Institute of Cardiovascular Disease (NICVD), Dhaka with a view to find out the relationship between fibrinogen levels and the extent of CAD undergoing coronary angiography. Patients were divided in 3 groups according to fibrinogen levels: Group I = fibrinogen levels <400 mg/dl, Group II = fibrinogen levels (400-600) mg/dl, Group III = fibrinogen levels > 600 mg/dl. In this study, angiographic severity was assessed by vessel score, stenosis score and lesion morphology and tries to find out their relationship with angiographic severity and fibrinogen level. Result: Using a prospective analytic design we studied 210 patients who were divided into 3 groups : Vessel score in Group I, Group II & Group III were 1.14 ± 0.56, 2.24 ± 0.58, & 3.00 ± 0.65 respectively which was statistically significant (p < 0.01) and Stenosis score in group- I, group- II & group- III were 6.00 ± 4.19, 18.72 ± 4.94, & 32.41 ± 15.75 respectively which was statistically significant (p < 0.01). Regarding morphology of the lesions, complex lesions in group I, group II & group III were 21%, 32% & 39% respectively (statistically significant; p < 0.01). Conclusion: High fibrinogen level is independently and significantly associated with more severe coronary artery disease. Serum fibrinogen can be used as a new and even simpler tool for risk stratification in acute coronary syndrome.

Mitral Annular Calcification is Associated with Severe Coronary Artery Disease in Patients Under 65 Years Old.

Background: Mitral annular calcification (MAC) is degenerative, fibrous calcification of the mitral valve annulus. It is more common in people over 70 years old. It is a marker of increased cardiovascular risk which occurs in a graded fashion by MAC severity. The aim of this study was to evaluate the association of Mitral annular calcification with severity of coronary artery disease (CAD) in patients under 65 years old. Methods: A total of 140 patients with IHD were enrolled by purposive sampling. Study populations were divided into MAC group and non MAC group. MAC was detected by Trans-thoracic echocardiography as an intense echo-producing structure located at the junction of the atrio-ventricular groove and posterior mitral leaflet in parasternal long axis view. MAC is measured in millimeters from the leading anterior to the trailing posterior edge and quantified as mild to moderate (1 to 4 mm) and severe (>4 mm) considering its thickness. Assessment of angiographic severity of CAD was done in the same hospital stay by Vessel score, Friesinger score and Leaman score. Results: Patients of MAC and non MAC groups were similar in terms of age and sex. Smoking (p=0.001) and family history of IHD (p=0.03) were significantly higher in MAC group. Anterior MI was significantly higher in MAC group (p=0.03). Left main and TVD were significantly higher in MAC group (p=0.001, p=0.01) whereas normal vessels were more in non MAC group (p=0.001). Intermediate and high Friesinger score (e”5) were significantly higher in MAC group whereas low Friesinger score (<5) were more in non MAC group. There was significant (p=0.01) positive correlation between MAC and CAD severity in terms of vessel score (r=0.76) Friesinger score (r=0.75) and Leaman score(r=0.42). Multivariate logistic regression analysis showed that MAC was independent predictors of significant CAD (p=0.02, OR= 2.84). Conclusion: Echocardiographically detected mitral annual calcification (MAC) can be an independent predictor of significant coronary artery disease. There is positive correlation between severity of MAC and severity of CAD. Cheap, available and radiation free nature of the echocardiographic detection of MAC may be a marker of significant CAD.

Relationship between Baseline White Blood Cell count and C-reactive protein with Angiographic severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome.

Inflammation has been shown to play a role in atherosclerosis and acute coronary syndrome. This study was carried out to evaluate the relationship between baseline white blood cell (WBC) count and C-reactive protein (CRP) with angiographic severity of coronary artery disease in patients with acute coronary syndrome and to identify those subsets of patients with acute coronary syndrome who may need to undergo invasive or conservative strategies. Method: A total of 100 patients with acute coronary syndrome including unstable angina, non-ST elevated myocardial infarction & ST elevated myocardial infarction were evaluated in National Institute of Cardiovascular Disease (NICVD), Dhaka with a view to correlate angiographic findings, C-reactive protein and WBC count. Results: This study observed that either raised WBC count or raised CRP independently and combination of both WBC count and CRP elevation were significantly associated with more severe coronary artery disease. Either raised WBC count or raised CRP or combination of raised WBC count and CRP were significant predictor of multivessel disease and high stenosis score. Conclusion: Elevation of WBC count and CRP in patients with acute coronary syndrome are associated with severe coronary disease. WBC count and CRP can be used as a new and even simpler tool for risk stratification in acute coronary syndrome.

Study of complications in hypertensive patients having irregular treatment.

One hundred cases of hypertensive complications due to irregular drug-therapy were studied in medicine units of Dhaka Medical College Hospital for the period of one year from February 7, 1989 to February 6, 1990. Among those stroke had headed the list (48%) manifesting in various ways e.g. cerebral haemorrhage with focal neurological signs--hemiplegia, hemiperesis, aphasia etc. Hypertension associated with varying degrees of cardiac ischaemias and heart failure was seen in 14% and 10% cases respectively. Highest incidence of complications was seen in 1-5 years after detection of hypertension with mean age of 55 +/- 18.70 years. Out of 48 cases of strokes, smoker were 41 (75.92%). Regarding reasons of noncompliance of drugs, personal carelessness was the prominent one (47%). Among the risk-factors for atherosclerosis family history tops the list (66%). Diabetes coexists with hypertension in 13% cases. Ocular complications were seen in 06% cases of malignant hypertension with variable retinal changes.

Metabolic and hormonal profile of the offsprings of conjugal diabetics.

Oral glucose tolerance response to blood glucose, serum immunoreactive insulin (IRI) and plasma free fatty acid (FFA) levels were studied on 159 offsprings of both parent diabetics (connubials). Fasting serum cholesterol, triglyceride, phospholipid and total lipids were also measured in these subjects. We detected 6 diabetics out of 159 connubials at the time of our study. FFA level in 6 diabetic connubials were higher all time intervals than 153 non-diabetics connubials. Fasting and one hour post glucose response were less in 6 diabetic connubial but two hours post glucose IRI response to both 6 diabetic connubials and 153 non-diabetic connubials were same indicating a delayed insulin secretion in response to oral glucose level in 6 diabetic connubials.

Hypertension in Secretariate population of Bangladesh.

A total of 8,172 persons constituting 98.6% of the total Secretariate Population of Bangladesh were screened for elevated blood pressure. One thousand and ninety cases (13.3%) showed diastolic blood pressure of 90 mmHg or above. Those with diastolic blood pressure of 95 or above constituted 3.7% of the population. More than two-thirds of the latter group (71.6%) remained undetected indicating that vast majority of our hypertensive population remains undiagnosed and untreated. It is recommended that the misconception regarding symptomatic hypertenson should be removed by adequate emphasis on the preventive value of the control of hypertension on cardiovascular and cerebrovascular complication. A plea has also been made for a large-scale survey to determine the extent of the problem in Bangladesh.

Mebendazole and pyrantel pamoate as broad-spectrum anthelmintics.

The efficacy of mebendazole and pyrantel pamoate was studied in two groups of 59 and 58 cases, respectively, of patients with polyparasitosis. Mebendazole had a cure rate of 96%, 82.2%, 71.4% and 66.6% in A. lumbricoides, hookworm, T. trichiura and S. stercoralis, respectively, while the corresponding figures for pyrantel pamoate were 92.6%, 85.7%, 19.4% and 0%. Pyrantel pamoate is considered to have no significant effect on T. trichiura and S. stercoralis. None of the drugs had any effect on T. saginata. Both drugs have been found to be equally effective against enterobiasis by various authors. It is recommended that pyrantel pamoate be the drug of choice in cases of multiple parasitic infections excluding T. trichiura and S. stercoralis whereas those with one or both of these in addition to others should be treated with mebendazole. Mebendazole can be prescribed for patients with clinical evidence of helminthic infections even where stool examination is not possible as it covers almost the whole range of common helminthic infections. The only limitation for poorer patients however is its cost. Pyrantel pamoate has a wider applicability for the poorer patients in spite of the fact that it is ineffective against trichurids and S. stercoralis.