RÉSUMÉ
Background: The association between extent and severity of coronary artery disease (CAD) and renal artery stenosis (RAS) has been well established in many studies. The aim of this study was to assess the incidence and severity of RAS in patients with CAD. Methods: Coronary angiogram (CAG) and renal angiogram was done in standard protocol. A total of 95 patients was included in the study and divided into two groups according to the presence of significant renal artery stenosis. In Group I 45 patients were having normal or insignificant renal artery stenosis. In Group II 50 patients were having significant renal artery stenosis. All data were recorded systematically in preformed data collection form. Results: In Group I, most common CAG findings were single vessel disease (SVD) (91.1%), triple vessel disease (TVD) (2.2%) and double vessel disease (DVD) (6.7%). No patients in Group I had Left Main (LM) disease. In Group II, most common CAG findings were DVD (42.0%) followed by SVD 32.0%, TVD 26.0% and LM 8.0%. There is statistically significant difference in Vessels Score, Friesinger Score and Leaman Score between the groups (p<0.05). Conclusion: The study revealed significant association between atherosclerotic renal artery stenosis (RAS) and severity of coronary artery disease (CAD). This indicates significant atherosclerotic renal artery stenosis (RAS) predict the severity of coronary artery disease.
RÉSUMÉ
Background: Left ventricular (LV) filling pressure is an important predictor of short and long term outcome in patients with coronary artery disease. Non invasive assessment of this pressure by Doppler echocardiography provides valuable information regarding the prognosis of patient with ST-segment elevation myocardial infarction. Elevated filling pressure is associated with increased incidence of morbidly and mortality due to ventricular remodeling, neuro-hormonal activation & increased excitability. The aim of this study was to assess LV diastolic dysfunction and left ventricular filling pressure in patients of ST-segment elevation myocardial infarction to predict their in-hospital outcome. Methods: The prognostic cohort study was conducted in National Institute of Cardiovascular Diseases, Dhaka from May 2011 to November 2011. A total of 100 Patients with acute ST-segment elevation myocardial infarction who has received streptokinase therapy were enrolled by purposive sampling. In addition to normal 2D & M mode study, Pulsed wave Doppler assessment of mitral valve inflow patterns was done in apical 4-chamber view to see Peak early (E) and peak late (A) flow velocities, E/A ratio and deceleration time of early mitral flow velocity (DT). Tissue Doppler Imaging (TDI) assessment was done at the lateral mitral annulus in apical 4-chamber view to assess Mitral annular diastolic velocity (E′) and E/E′ ratio. Patients were divided into two groups based on Doppler echocardiography derived Left ventricular filling characteristics. In group I 50 patients with E/E′ ratio <15 and in group II 50 patients with E/E’ >15. Patients were followed up for next 7 days and in-hospital outcomes were compared between groups. Results: The mean age of group-I & II were 53.84 ± 9.2 & 55.14 ± 8.5 years respectively. Male female ratio was 8.9:1.1. Age, sex and risk factors between two groups were statistically insignificant. Regarding in-hospital out come in group-I were hospital stay 5.28 ± 1.06 days, heart failure 28%, arrhythmia 8% and mortality was 2%. On the other hand in group-II hospital stay was 6.04±1.07 days, heart failure 68%, and arrhythmia 24% & mortality was 6%. All these were statistically significant between two groups except mortality. Conclusion: From this study it may be concluded that, left ventricular filling pressure assessed by Doppler echocardiograph predicts in-hospital outcome after acute ST segment myocardial infarction and prognosis is worse with increased left ventricular filling pressure.