National Institute Of Cardiovascular Diseases Research Articles

Evaluating Types of TAPVR on Echocardiography and CT Angiography in Paediatric Patients Admitted in Tertiary Care Hospital: A Comparative Study

Objective: To evaluate the types of TAPVR on Echocardiography and CT Angiography in Paediatric Patients Study design: A comparative study Place and Duration: Pediatric cardiology department and CT Angiography department of the National Institute of Cardiovascular Diseases (NICVD) Karachi from January 2019 to December 2021 Methodology: Patients who have TAPVR confirmed by CT angiography and detected by echocardiography were included in the research. Cases having anomalies in the systemic veins were eliminated. Demographic variables (age, gender, weight, etc.), echocardiographic results (such as type of TAPVR, obstructive and non-obstructive), and CT angiography findings were collected for the study using a preset structured proforma. We evaluated the diagnostic disparity between the two modalities. Results: In the present study there were 107 patients, 67.3% were male gender, 56.1% with age less than 6 months, the median age was 6 months, median weight was 4.5 kg. On echocardiography, there were 83.2% non-obstructive, 47.7% supracardiac and 36.4% cardiac TAPVR. On CT angiography, there were 66.4% were non-obstructive, 53.3% supracardiac and 23.4% cardiac TAPVR. Of the associated cardiac diseases, in common 86.9% were found with atrial septal defect, 13.1% were persistent left superior vena cava, 12.1% were patent ductus arteriosus, 8.4% were a ventricular septal defect, 6.5% were of pulmonary atresia, and 3.7% were complete endocardial cushion defect. Conclusion: As compared to echocardiography, CT angiography is more reliable for the detection of obstructive and mixed types of TAPVR. Detection of the supracardiac type of TAPVR is also almost the same as on echocardiography and CT angiography. As compared to CT angiography, echocardiography over diagnoses the non-obstructive type of TAPVR. CT angiogram is also useful in detecting other associated lesions such as heterotaxy, abnormal coronaries, presence of bilateral superior vena cava and coronary sinus. Keywords: TAVPR, echocardiography, CT angiography, cardiac disorders

Efficacy of Primary Percutaneous Coronary Intervention (PCI) Performed Through a Transradial Approach in Patients with ST- Segment Elevation Myocardial Infarction (STEMI) at a Tertiary Care Cardiac Center

Objective of Study: The study aimed to evaluate the clinical outcomes, safety, and efficacy of primary percutaneous coronary intervention (PCI) performed through a transradial approach in patients with ST- Segment elevation myocardial infarction (STEMI) at a tertiary care cardiac center. Place of Study: The study was conducted at the National Institute of Cardiovascular Diseases, Karachi, Pakistan Duration of Study: The study was conducted over a period of six months, from April, 2022 to September, 2022. Methods: A total of 250 consecutive patients who underwent primary PCI through a transradial approach were included in the study. Demographic, clinical, procedural, and angiographic data were collected. The primary outcome measure was the incidence of major adverse cardiovascular events (MACE), including death, myocardial infarction, target vessel revascularization, and stroke at 30 days and six months' post-procedure. Secondary outcomes included procedural success, access site complications, and door-to-balloon time. Results: The mean age of participants was 58.7 ± 10.2 years, with 72.8% being male. The procedural success rate was 96.4%. The incidence of MACE at 30 days and six months was 5.6% and 8.8%, respectively. Access site complications were observed in 2.8% of patients, and the mean door-to-balloon time was 81.3 ± 25.6 minutes. Multivariate analysis identified diabetes mellitus and triple-vessel disease as independent predictors of MACE. Conclusion: Primary PCI through a transradial approach at a tertiary care cardiac center in Karachi, Pakistan, demonstrated high procedural success rates, favorable clinical outcomes, and a low incidence of access site complications. This approach may be considered a safe and effective treatment option for patients with acute coronary syndromes. Keywords: primary percutaneous coronary intervention, transradial approach, ST- segment elevation myocardial infarction, major adverse cardiovascular events, tertiary care cardiac center, access site complications, door-to-balloon time

Association of Serum Vit D level with in-Hospital Outcome in Patients with Acute Myocardial Infarction

Background: Low Vitamin D (Vit D) level is associated with disease severity amongst critical acute myocardial infarction (AMI) patients. This leads to the hypothesis that Vit D plays a role in the emergence of cardiac risk factors, contributing to worsening AMI patients' short- and long-term prognoses. Therefore, there is still unclear data showing the potential impact of Vit D insufficiency or deficiency on the morbidity and mortality of AMI patients. So far, there has been no research conducted in Pakistan examining whether or not Vit D status are association to the outcome of hospitalization for coronary artery disease. Objective: The objective of the study is to examine the relationship between Vit D status on hospital admission and subsequent mortality and morbidity among patients with acute myocardial infarction. Study Design: Cross sectional observational study Study Setting: This study was conducted in the department of Interventional Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi from Ist August 2022 to 31st January 2023. Methodology: Total 250 subjects were enrolled in the study and divided in to two groups. Group A with normal Vit D (30ng/ml or above) and Group B included lower Vit D level than 30ng/ml, all patients were suffering from AMI. Baseline demographic characteristics, including age, and gender (male/female), was recorded. The patients were tested for Vit D status and distributed in their respective groups. The history, complications, and clinical data were included. The stay in the hospital and any adverse outcomes that appeared during the stay were also recorded. The clinical results include HDL, TG, and troponin I of every patient were noted for the clinical correlation of AMI patients with adequate and deficiency of Vit D level. All the data was collected in the form of a questionnaire. The statistical analysis was done by using SPSS version 20. Results: Participants' mean ages were 53.8 and 5.9 years old. Group A (patients with low Vit D status) averaged 59.6 years of age, whereas Group B (58.9 years) had normal Vit D status. The analysis showed a statistically non- significant (p>0.05) difference in average age between the groups. There were 250 patients, with male 43.6% and female 56.4%. Men (63.2%) and women (36.8%) were in Group A. There were 71.4% males and 28.6% females in Group B. We found out the 137(60.6%) significant adverse hospital outcomes (p<0.001) in Group B and had a more significant proportion of patients with diabetes mellitus and who had smoked (p = 0.002 and 0.001, respectively). In a multivariate logistic regression smoking, diabetes, Troponin I and low vitamin showed the significant risk association (p<0.001). Practical Implication: There is still a lack of conclusive evidence on the relationship between vitamin D insufficiency or deficiency and the morbidity and mortality of AMI patients. Until far, there has been no research in Pakistan linking serum vitamin D levels to in-hospital outcomes for patients suffering from acute myocardial infarction. Conclusion: The research shows an association between low Vit D status, adverse outcomes, and clinical parameters after AMI. A low blood Vit D level is independently associated to an increased risk of developing severe clinical outcomes during hospitalization, including death after an AMI. Keyword: Vit D, AMI, Vit D deficiency, low Vit D, Cardiovascular disease

Neurological consequences and short–term outcome of children with diagnosis of cyanotic congenital heart diseases at a Tertiary Care Cardiac Setup of Pakistan: A single center study.

Objective: To determine the neurological consequences and short–term outcome of children with diagnosis of cyanotic congenital heart diseases (CHDs) at a tertiary care cardiac setup of Pakistan. Study Design: Single Center Observational Cohort study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Period: November 2021 to October 2022. Material & Methods: A total of 80 children of both genders, aged between 1 month to 12 years with known cyanotic CHD as per 2D transthoracic echocardiography were admitted in Pediatric Cardiology Department of NICVD, Karachi and were considered. At the time of enrollment, demographic characteristics along with presenting complaints were noted. Necessary baseline laboratory and radiological investigations were ordered and clinical neurological examination was done. Children were discharged and short term outcomes were labeled after 3 months follow up. Results: In a total of 80 children with cyanotic CHDs, most common underlying diagnosis was tetralogy of fallot, found in 41 (51.3%) children. The CT brain revealed ischemic infarct, brain abscess and gross oedema as the most frequent observations revealed in 47 (58.8%), 40 (50.0%) and 37 (46.3%) children. Surgical management of underlying neurological abnormality was advised in 23 (28.8%) children. After 3 months follow-up, complete recovery was observed among 43 (53.8%) children. CT findings at the time of enrollment as haemorrhagic infarct (p<0.001), brain abscess (p=0.001) and atrophic changes (p=0.032) were significantly associated with incomplete recovery. Surgery as a mode of treatment for the underlying neurological disease was associated with good recovery outcomes (p<0.001). Conclusion: Most common underlying diagnosis among children with cyanotic CHDs was tetralogy of fallot. CT findings at the time of enrollment as haemorrhagic infarct, brain abscess and atrophic changes, as well as hypotonia, down going plantars and developmental delay at the time of presentation were significantly linked with incomplete recovery.

Role of Troponin-I in Predicting Length of ICU Stay in Post-Cardiac Surgery Patients

The cardiac surgery procedures are associated with a release of enzyme troponin from the heart muscles. These troponin levels can be used to predict the post-operative outcomes. Objective: To find out the relationship between troponin I levels and length of ICU stay after open heart surgery. Methods: A total of 200 patients’ data were collected from January to August 2022 at the cardiac surgery department of National Institute of Cardiovascular Diseases, Karachi. The study was conducted after the approval of Ethical Research Committee. Demographic characteristics of patients, procedure details and post-operative course was taken into account for this study. The troponin I levels were sent 12 hours after the surgery and their effect on ICU stay was studied. Results: The post-operative troponin levels were divided into different sets. There were 61% patients with troponin- I levels less than 9 ng/ml, 28% patients with troponin-I levels between 9 – 18 ng/ml and 11% patients with troponin-I levels of more than 18ng/ml. There was no difference in ICU stay between patients having troponin levels < 18ng/ml. They were all stable and their ICU stay comprised of 24 hours only. Whereas, in the group of patients having troponin levels > 18 ng/ml, the ICU stay was prolonged, extending to 48 - 72 hours. Conclusions: Serum Troponin levels can be used to predict the length of ICU stay. Higher Troponin levels > 18 ng/ml are associated with a prolonged ICU stay of more than 24 hours

Association of Waist and Hip Ratio with the Angiographicc Severity of Coronary Artery Disease in Patients with Non ST Segment Elevation Myocardial Infarction

Background: Coronary artery disease and obesity cardiomyopathy, and cardiac autonomic neuropathy are the most prevalent types of cardiac involvement in the comorbid. Obesity has a two- to fourfold greater risk of developing coronary artery disease. Stroke and other cerebrovascular occurrences fare poorly for those with obesity and diabetes. Hospital, autopsy, epidemiological, longitudinal research, and other studies have all demonstrated the increasing prevalence of cardiomyopathy in diabetes and obese individuals Objective: the objective of the study is to association of waist and hip ratio with the angiographic severity of coronary artery disease in patients with non-ST segment elevation myocardial infarction Study Design: Cross sectional observational study Study Setting: This study was conducted in the department of Interventional Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi from Ist August 2022 to 31st January 2023. Methodology: Total 120 subjects were enrolled in the study and divided in to two groups. Group I consisted of 60 patients with normal WHR, and group II consisted of 60 patients with elevated WHR. The history and anthropometric measurements were noted using a pre-designed structured form, including demographic data and a profile of potential risk factors. Three universal criteria for diagnosing myocardial infarction were used to confirm the presence of non-ST segment elevation myocardial infarction. Each participant's signed permission was obtained before any data was collected. The patient's waist and hip circumferences were measured the day before the CAG. At least two cardiologists engaged per patient's therapy or the clinical context while evaluating the angiogram results. Visual estimation (in at least two orthogonal views) was used to estimate the vessel and Gensini scores to determine the degree of coronary artery disease on angiograms. The statistical analysis was done by using SPSS version 20. Results: Patients in Group II had a considerably higher mean body mass index and anthropometric status than those in Group I. The average WHR of the participants in the study is listed in order of increasing vascular involvement. For those with normal angiogram results, the average WHR was 0.98. There was a statistically significant difference (p<0.01) in the mean WHRs of those with single-vessel disease and the value of mean is gradually increased in scoring 1, 2 and 3. The WHR positively correlated with the severity of CAD as measured by vessel score (r=0.45). In addition, a positive connection (r=0.63) between WHR and CAD severity, as measured by the Gensini score. Multivariate logistic regression analysis of odds ratio (OR) for subject characteristics likely to cause coronary artery disease severity. Practical implication: In addition, there is only one local study, which provides scant information, and worldwide data is scant and conflicting about the relationship of the ratio of waist to hip with severe coronary artery disease (CAD). The incidence of obesity and coronary artery disease in Pakistan is much higher than in Western countries; thus, this study will offer more information regarding the relationship based on local data. Conclusion: The current study found that in individuals with non-ST-segment elevation myocardial infarction, increasing WHR was substantially correlated with the angiographic severity of coronary artery disease Keyword: WHR, BMI, Waist circumference, Cardiovascular disease

Frequency and Clinical Profile of Cardiac Arrhythmias and its Immediate Outcome in Children at Tertiary Care Hospital

Objective: To determine the frequency and clinical profile of arrhythmia and its immediate outcome in children presenting to a tertiary care center. Study Design: A cross-sectional study. Duration and place of study: July 2021 to June 2022, the National Institute of Cardiovascular Diseases, Karachi. Methodology: A total of 100 children of both gender , ranging in age from 1 day to 18 years, who presented with the symptoms of syncope, decreased or increased heart rate, chest discomfort, breathlessness were included in this study. Children who presented with cardiac arrhythmias had varying proportions of several criteria of relevance, such as clinical characteristics, age and gender distribution. In patients with unexplained arrhythmias or syncope, a thorough history, general physical exam, and cardiac examinations—including 12-lead electrocardiograms, 2-D echocardiograms, and Holter studies—were conducted. Results: A total of 100 children were included in this study among them 70 children presented with tachyarrhythmia and 30 children presented with bradycardia. The average age was 8.13± 4.45 years. Among the tachyarrythmias group the most frequent initial symptoms recorded in 45 (64.28%) and 15 (21.42%) youngsters, respectively, were palpitation and chest pain. A total of 19 (27.14%) children were discovered to have acyanotic CHDs. SVT was found to be the most common type of arrhythmia in 25 (30.1%) children, followed by ventricular tachycardia and atrial fibrillation in 15 (21.42%) and 10 (14.28%) of the same age groups. A total of 3 (4.28%) of the hospitalized children died. Among the bradycardia group 80% of children were found with complete heart block, 53.3% syncope, 26.7% were asymptomatic, and 20% were with multiple findings of irritability, poor feeding, breathlessness, and syncope. 20% of them developed LV dysfunction. Conclusion: The most frequent presenting symptoms were palpitations and chest discomfort. The other most common types of arrhythmia were supraventricular tachycardia, atrial fibrillation, ventricular tachycardia and bradycardia. Children's hospital stays were generally short and the therapy for arrhythmias had favorable overall results, however, 4.28% of children in the tachyarrhythmia’s group died of heart failure, while there was no expiry in the bradycardia group. Keywords: Arrhythmias, palpitations, supraventricular and ventricular tachycardia, bradycardia and heart Block

Impact of Cardiopulmonary Bypass Time and Aortic Cross Clamp Time on Immediate PostOperative Outcomes in Patients with Congenital Heart Disease Undergoing Open Heart Surgery

Objective: to find out the impact of cardiopulmonary bypass time (CPBT) and aortic cross-clamp time (ACCT) on immediate post-operative outcomes in patients with congenital heart disease (CHD) undergoing open heart surgery at a tertiary care centre.
 Study Design: Prospective longitudinal study.
 Place and Duration of the Study: Department of Paediatric, Cardiac Intensive Care Unit, National Institute of Cardiovascular Diseases (NICVD), Karachi Pakistan, from Jul to Dec 2021.
 Methodology: We enrolled 104 patients of both genders up to any age with CHD undergoing open heart surgeries. At the time of admission, age, gender, body weight, presence of cyanosis and types of CHDs were noted. Duration of mechanical ventilation, pediatric cardiac intensive care unit (PCICU) stay, and mortality was recorded. Baseline characteristics and postsurgery parameters were compared about CPBT and ACCT.
 Results: Of 104 patients, 58(55.8%) were males. Overall, the mean age was 7.9±5.1 years. Cyanosis was noted in 34(32.7%) cases. Mean CPBT was 74.6±42.9 minutes, while the mean ACCT was 43.5±29.5 minutes. Most types of CHDs were noted to be tetralogy of Fallot (ToF) 28(26.9%). An increase in the duration of CPBT and ACCT was found to have a significant association with post-surgical morbidity (p<0.001).
 Conclusion: Increased cardiopulmonary bypass time and aortic cross-clamp time were found to have a significant association with post-surgical morbidity and outcomes among cases undergoing open heart surgeries for congenital heart diseases.

Management Pattern of Chronic venous Disease in Bangladesh

Introduction: Chronic venous disease (CVD) is mostly underdiagnosed diseasewhich may progress to chronic venous insufficiency and venous ulcer thus extensive treatment. CVD may affect negatively into patient’sgood well-beingwhich can create burdens on their life and also healthcare resources. Bangladesh has very minimum awareness on CVD. Materials and Methods: This was a cross-sectional study was carried out in department of vascular surgery of National Institute of Cardiovascular disease. we randomly choose 60 patients with chonic venous disease (CVD) and evaluate their characteristics and prevalence of several types along with the management pattern. Data collection started from May 2021 for next 6 months. Results: The patients of this survey were aged between 24 to 70 years and the Mean±SD age was 43.6±12.2. 78.3% of total study population were male, 33.3% were businessman and 10% were housewife. 66.6% patients were having low socio-economic condition. C2 varicose veins were highly prevalent among the study population ( 35%) & lowest prevalence of C4b lipodermatosclerosis or atrophie blanche (11.7%). Male were predominantly more prevalent to having CVD, 78.33% (n47), (p <0.001). Among all the patient 68.3% patient were exposed to smoking. All the patient were managed predominantly by compression therapy mainly are of moderate pressure (66.7%,) 80% of total patients got treated by oral MPFF therapy. Conclusion: : Patients having CVD, invariably presented with the complains of heaviness of leg and unexplained leg swelling and Varicose vein were highly prevalent irrespective of sex. Compression therapy has been remained the mainstay of treatment in tertiary level hospital NICVD along with oral MPFF therapy. Medicine Today 2023 Vol.35(1): 31-33

A Prospective Comparison of Ultrasound Guided Versus Palpation Method for Radial Artery Catheter Placement

Objectives: The objective of this study was to assess the effectiveness of ultrasound guided vs. conventional palpation method for radial artery cannulation in the operating room for patients undergoing elective open-heart operations. Methodology: This prospective observational study was carried at the National Institute of Cardiovascular Disease (NICVD) in Karachi and Sukkur. All cannulation procedures were performed by anesthesia residents (R-1). Two equal sized independent groups of patients based on radial artery cannulation technique, either ultrasound guided (USG) or conventional palpation method (CPM) were recruited. Artery cannulation success along with number of attempts, total duration, number of additional operators, need for change of site, and complications were recorded. Results: A total of 70 patients were recruited in each of the group, mean patient age was 52.43±13.53 years vs. 50.71 ± 14.1 years; p=0.605 with proportion of male patients as 65.7% (46) vs. 77.1% (54); p=0.290, for USG and CPM, respectively. Artery cannulation success rate was 74.3% (52) vs. 80% (56); p=0.569, mean number of attempts was 1.71±1.05 vs. 1.51±0.89; p=0.391, mean total duration was 7.76±3.78 minutes vs. 5.42 ± 8.2 minutes; p=0.131, mean number of additional operators was 0.74±0.44 vs. 0.89±0.32; p=0.128, need for change of site was 11.4% (8) vs. 2.9% (2); p=0.356, and complications were observed in 8.6% (6) vs. 2.9% (2); p=0.614 for USG and CPM, respectively. Conclusion: In this observational study, no significant differences were observed in the effectiveness of USG and CPM for radial artery cannulation when performed by newly inducted anesthesia residents.

Clinical features and echocardiographic findings in children with ebstein’s anomaly: A descriptive case-series of 48 cases.

Objective: To determine the clinical features and echocardiographic findings among children presenting with Ebstein’s anomaly (EA). Study Design: Descriptive Case-series. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi Pakistan. Period: July 2021 to June 2022. Material & Methods: Children of both genders aged above 1 month up to 18 years, having echocardiographic confirmed EA were analyzed. Demographic data along with clinical features, presenting symptoms and echocardiographic findings were noted in all case. Results: In a total of 48 cases of EA, 38 (79.2%) were female. The mean age was 8.4±4.21 years. Cyanosis, exertional dyspnea, easy fatigue ability and exercise intolerance were the most frequent symptoms reported in 31 (64.6%), 27 (56.3%), 26 (54.2%) and 24 (50.0%) patients respectively. Arrhythmias and heart failure were the most frequent clinical features noted in 29 (60.4%) patients each. Small atrial septal defect (ASD) was noted in 27 (56.3%) patients while ventricular septal defect in 19 (39.6%) cases. There were 11 (22.9%) patients who presented timely with diagnosis of EA while 37 (77.1%) patients had late diagnosis. Conclusion: Majority of the patients with Ebstein’s anomaly were female. Cyanosis, exertional dyspnea, easy fatigue ability and exercise intolerance were the most frequent symptoms whereas arrhythmias and heart failure were the most frequent clinical features observed. ASD was the most commonly noted associated CHDs observed in almost half of the Ebstein’s anomaly case. Almost 3/4th of the patients had late diagnosis.

Observation of Post-Operative Support among LAVI and AF after MVR in Patients with Mitral Valve Disease

Introduction: Mitral valve disease is a common heart condition that may require mitral valve replacement (MVR) surgery. One of the potential complications after MVR is the development of atrial fibrillation (AF). Left atrial volume index (LAVI) is a measure of left atrial size that has been linked to the development of AF in patients with mitral valve disease. The present study aimed to observe the post-operative support needed by patients after MVR surgery, particularly those with elevated LAVI and the incidence of post-operative AF. Methods: This prospective observational study was conducted at the Department of Cardiac Surgery, National institute of cardiovascular diseases (NICVD), Sher-e-Bangla Nagar, Dhaka, Bangladesh. The study duration was 1 year, from Mar, 2018 to Feb, 2019. During this period, a total of 60 patients who underwent Mitral Valve Replacement (MVR) for mitral valve diseases at the study hospital were included in the study following the inclusion and exclusion criteria through a purposive sampling method. The 60 patients were divided in two equal groups, Group A, consisting of 30 Patients who had Left Atrial Volume Index of ≥ 39 ml/m2 after operation, while group B had been comprised of 30 patients who had Left Atrial Volume Index of < 39 ml/m2 after operation. Result: Around 23.33% of participants in both groups were aged 21-30, while 40% of Group A and 36.66% of Group B were aged 31-40. In terms of BMI, 53.33% of Group A and 46.66% of Group B had a normal BMI, while 40% and 43.33% were overweight, and 6.66% and 10% were obese, respectively. Specifically, 23.33% of participants in Group A developed post-operative AF, while only 6.66% of participants in Group B developed it. The p-value for this comparison was 0.015. The results demonstrate that Group B had significantly smaller LA diameter, LA volume, LAVI, LVIDS, and LV ejection fraction compared to Group A at all three measurements post-operation (p<0.05). However, there was no significant ...

In Hospital Outcome Among Smoker and Nonsmoker Patients Presented with ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Objective: To determine the association between smoking and in-hospital outcomes in patients presented with ST-Elevation Myocardial Infarction undergoing primary percutaneous coronary intervention (PCI). Methodology: This prospective cohort study was conducted at Department of Cardiology, National Institute of Cardiovascular Disease (NICVD), Karachi, from November 9, 2020 to May 8, 2021. All the patients (current smoker, ex-smoker and non-smoker) with age 18 years to 85 years, both gender, patients diagnosed with STEMI in accordance with operational definition and underwent primary PCI were included. Patients diagnosed with ST-Elevation Myocardial Infarction were divided into two groups, expose (smoker) and unexposed (nonsmoker). Before PPCI demographic detail were noted and body mass index was calculated after management of STEMI then PCI was performed. In hospital outcome i.e. heart failure, in-hospital mortality and transient ischemic attack were assessed within 30 days of hospital stay after PCI. All the collected data were entered into the proforma. Results: Mean ±SD of age in exposed group was 56.5±11.8 and non-exposed group was 57.7±12.1 years. In group wise distribution of gender, 82 (70.7%) males and 34 (29.3%) females were enrolled in exposed group and 80 (68.9%) males and 36 (31.1%) females were included in non-exposed group. Risk of heart failure and transient ischemic attack were 1.4 and 5.0 times more likely in exposed as compared to unexposed with [Relative Risk 1.444 and 5.0 respectively. While risk of mortality was 0.2 times less likely in exposed as compared to unexposed with [Relative Risk 0.222] and P value was found to be as significant i.e. (P=0.030). Conclusion: It is to be concluded that significant risk of heart failure and transient ischemic attack were noted in exposed as compared to unexposed and vice versa in case of mortality, but we cannot rule out residual confounders.

Frequency of Arrhythmias in ST-Segment Elevation Myocardial Infarction Patients During Primary Percutaneous Coronary Intervention (PPCI) Till 48 hours Post PPCI in NICVD

Objective: To determine the frequency of arrhythmias in patients with acute ST-segment elevation myocardial infarction primary percutaneous coronary intervention (PPCI) till 48 hours post PPCI in admitted at national institute of cardiovascular diseases (NICVD), Karachi. Material & Methods: This was a hospital based clinical study conducted at NICVD through convenience sampling technique for the period of 6 months from 1st September 2021 to 31st March, 2022. All the adult (age more than 18 years) male and female, presented with acute ST-segment elevation myocardial infarction, and eligible for PPCI were included in this study. Cardiac arrhythmias during 48 hours post-PPCI were evaluated and documented. SPSS v. 26 was used for data entry and analysis. Results: A total of 285 patients were included for final analysis. The overall mean age ± SD was 56.56±13.07 years. Most of the patients were belongs to age group II (age ≥55 years) as compare to age group I (age <55 years), 50.87% and 49.12%, respectively. The overall incidence of arrhythmias was 16.6% among them most of the arrhythmias were observed during the first 24 hours of PPCI (72.22%). Ventricular arrhythmias were most common as compare to atrial arrhythmias (61.11%). There was an insignificant association observed in relation to gender and incidence of arrhythmias, p 0.236. Patients having age ≥55 were significantly associated with occurrence of arrhythmias, p <0.001. Conclusion: Frequency of cardiac arrhythmias is higher during early hours of after PPCI. Among them, ventricular arrhythmias were more common as compare to atrial arrhythmias. Older patients (age >55 years) were significantly associated with increased incidence of cardiac arrhythmias as compare to younger age group (age <55 years). Keywords: Cardiac arrhythmias, STEMI, primary PCI, time duration, in-hospital incidence, South Asia

Frequency of Attention-Deficit Hyperactivity Disorder (ADHD) in Patients with Congenital Heart Diseases (CHD) at NICVD Karachi, Pakistan

Background: The study aimed to assess the frequency and impact of attention-deficit hyperactivity disorder (ADHD) on behavior, social-emotional development, intelligence, and overall quality of life among school-aged children with congenital heart diseases (CHD). Methodology: A descriptive cross-sectional study was undertaken at the National Institute of Cardiovascular Diseases (NICVD) between July 2021 to August 2021. A total of 100 CHD patients aged 6 to 18 were assessed using the non-probability purposive sampling technique. The data was collected using a questionnaire comprising SNAP-IV 26 Scale that is a screening tool for ADHD. The collected data was entered and analyzed by using Statistical Package for Social Sciences (SPSS) v 24.0. The statistical analysis was carried out with a confidence interval set at 95% and no p-value was determined as a threshold of statistical significance, owing to the qualitative nature of the data. Result: The study comprises n=100 CHD patients, aged 6 to 18 with the mean age ± standard deviation of 11.18 ± 3.914, and males and females stratifiable into 56% and 44% respectively. The ADHD screening identified n=22 (22%) subjects as highly suspected of having ADHD with no statistically significant gender difference (n=10 females vs. n=12 males). The study revealed Ventricular Septal Defect (VSD) to be the most common (28%) congenital heart defect across the in-patient and out-patient settings. VSD is followed by Atrial Septal Defect (ASD) at 24%, Tetralogy of Fallot (TOF) at 22%, Atrioventricular Septal Defect (AVSD) at 19%, and Aortic Stenosis (AS) in 7% of the patients. Out of the 25% facing comorbidities, hypertension dominated the subset of 23%. Conclusion: This study suggests that children with CHD are at an increased risk of developing ADHD, the hyperactive and the combined subtype in particular, compared to the healthy population. About 22 percent of the subjects manifested a typical clinical picture of an ADHD patient with mostly living a ‘somewhat difficult’ life. Keywords: Children, Congenital Heart Disease, CHD, Attention-Deficit Hyperactivity Disorder, ADHD, Ventricular Septal Defect, VSD, Atrial Septal Defect, ASD

The Trends of Pharmacological Therapy in one Month Post Myocardial Infarction Patients

Guideline recommended treatment has an important impact on the mortality and morbidity of post myocardial infarction patients. Objective: To assess the frequency of appropriate drug with its appropriate dosage of guideline recommended pharmacological therapy, prescribed by physician, in patients with Myocardial Infarction (MI). The cross sectional study conducted at National Institute of Cardiovascular Disease, Karachi from 1st January 2020 to 30th June 2020. Methods: Total 160 patients who came to hospital for follow-up after one month of Myocardial infarction were included in the study. Prescription was considered appropriate if the patient has taken at-least 5 out of 6 medications. At least 5 out of 6 along with its goal dose was considered as appropriate dosage. Descriptive statistics were calculated. Stratification was done. Chi-square test was applied post stratification and p-value ≤ 0.05 was considered as significant. Results: There were 103 male and 57 female patients. The mean age was 53.36 ± 8.10 years. Number of drugs used was found appropriate in 96.3% patients but the doses of drugs used was found appropriate in only 5.6% patients. Conclusions: The present study revealed that the majority of the physicians prescribed the recommended number of the drugs used; however, the doses of drugs used were not always according to the guidelines. It is important for cardiology physicians to understand the importance of guideline recommended pharmacological intervention among patients with a one-month history of MI.

Outcomes of Patients who Received Bailout Thrombectomy for Primary Percutaneous Coronary Intervention

Objective: The purpose of this study was to compare outcomes among patients undergoing primary percutaneous coronary intervention with and without bailout thrombectomy. Study Design: Observational/ cross sectional study. Place and Duration: This observational/cross sectional study was conducted at Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan in the period from March,2022 to August, 2022. Methods: Total 140 patients of both gender had ST elevation myocardial infarction were presented for primary percutaneous coronary intervention. Patients were included after getting informed written consent for detailed demographics such as gender, age, comorbidities and history of CAD. We divided patients into two groups. Group I received only PPCI in 70 cases and 70 cases of group II received only PPCI with bailout thrombectomy. After PPCI comma results of both groups were compared. To analyzation of data, we use SPSS 18.0. Results: Among all presented cases, 80 (57.1%) were male patients and 60 (42.9%) were females. The patients mean age in group I was 53.17±11.62 years and in group II mean age was 55.9±10.94 years. Diabetes mellitus was the most common comorbidity found among both groups 35(50%) in group I and 27(38.6%) in group II followed by hypertension 21(30%) in group I and 24(34.3%) in group II. Family history of coronary artery disease (CAD) in group I was 19(27.1%) and in group II was 23(32.9%).There was no significance difference found in both groups in terms of mortality. There was significant higher number of renal impairment, stroke, heart failure, excess bleeding and renal infarction in group II as compared to group I with p value<0.05. Hospital stay was also higher in group II as compared to group I with p value<0.04. Conclusion: It is determined that patients who underwent bailout thrombectomy for percutaneous coronary intervention (PCI) had a significant risk of comorbidities. Between the two groups, there was no discernible variation in mortality. Those who underwent bailout thrombectomy, however, had higher rates of post-procedure stroke and renal impairment. Keywords, Bailout thrombectomy, Outcomes, ST-segment elevated myocardial infarction, PPCI.

Association of Diabetic Retinopathy with Angiographic Severity of Coronary Artery Disease in Patients with Non-ST Elevation Myocardial Infarction

Background: Bed side ophthalmoscopic examination is a simple measure of diagnosis of diabetic retinopathy and has been shown to be a predictor of poor outcome in various cardiovascular conditions including coronary artery disease (CAD). Retinopathy lesions are fairly common findings in clinic settings and may predict risk of coronary heart disease (CHD). The present study was intended to find the relationship between diabetic retinopathy with the severity of coronary artery disease in patients with NSTEMI. Methods: This cross-sectional observational study was conducted in the Department of cardiology, National Institute of Cardiovascular Diseases and Hospital (NICVD), Dhaka, Bangladesh, from March 2019 to August 2020. A total of one hundred twenty DM with NSTEMI patients undergoing coronary angiogram and also fundoscopic examination with fundal photography during the index hospitalization were included in this study. Study subjects were divided into two groups on the basis of diabetic retinopathy (Group-I: NSTEMI with diabetic retinopathy ; Group- II: NSTEMI without diabetic retinopathy). Severity of coronary artery disease was determined by Gensini score and correlation between diabetic retinopathy and Gensini score was assessed. Results: Gensini score was significantly higher in patients with diabetic retinopathy than that in patients without diabetic retinopathy (62.2±27.7 vs. 43.3±25.3,p<0.001).Gensini score increased with increasing severity of diabetic retinopathy(P <0.001).The risk of having severe CAD in patient with diabetic retinopathy was 13.03 (95% CI =2.410-70.419) (P<0.003).A significant correlation between diabetic retinopathy and Gensini score was noted (p value <0.001) Conclusion: It may be concluded that Presence and severity of diabetic retinopathy is associated with angiographically severe coronary artery disease in patient with non-ST elevation myocardial infarction (NSTEMI) and it may be considered as an independent predictor of severity of CAD.As is a bed side assessment ,so before performing coronary angiography ,it appears to be additive for risk stratification. J Inv Clin Cardiol 2023; 5(1): 7-13

Comparison of In-Hospital Complications among Patients with Right Ventricular Infarction

Background: Patients with right ventricular infarction is a critical condition and may cause adverse cardiac events.
 Objective: The purpose of the present study was to compare the in-hospital complications among patients with right ventricular infarction based on TIMI risk score.
 Methodology: This prospective observational study was conducted in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from May 2007 to April 2008 for a period of one year. All the patients who were admitted into the coronary care unit of NICVD with acute inferior myocardial infarction with or without anterior myocardial infarction were selected as study population. Inclusion Criteria were patients admitted in CCU (NICVD) with acute inferior myocardial infarction with right ventricular infarction. Patients were categorized into two groups according to the extent of TIMI risk score. Patients with low TIMI risk score (0 to 3) were included in Group I and patients with high TIMI risk-score (4 to 14) were include in group II. Patients were followed up in their hospital stay to see the incidence of major cardiac events.
 Results: A total number of 60 patients with right ventricular infarction of which 30 consecutive patients with low TIMI risk score (0 to 3) were in Group I and 30 consecutive patients with high TIMI risk score (4 to 14) were in Group II. In-hospital mortality was 18.3% in the study populations and it was significantly higher in group II (33.3%) than group (3.3%). The next most common complication is cardiogenic shock followed by complete heart block, Cardiac arrest, VT and 2nd degree heart block.
 Conclusion: In conclusion the in-hospital mortality in the study populations is significantly higher in group II than group I
 Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):143-146

Demographic Characteristics of Patients Presented with Acute Heart Failure in ST-Elevation Myocardial Infarction

Background: Acute Heart Failure in ST-Elevation Myocardial Infarction can occur in different age and gender.
 Objective: The purpose of the present study was to see the demographic characteristics of patients presented with acute heart failure in ST-elevation myocardial infarction.
 Methodology: This case-control study was conducted in the Department of Cardiology at National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from February 2007 to July 2007. The patients admitted in the NICVD with ST-elevation acute myocardial infraction (STEMI) during study period were selected as study population. Patients presented with acute heart failure and patients developed acute heart failure within 24 hours of hospital admission were designed as case group. Patients with no feature of heart failure within 24 hours of hospital admission were designed as control group.
 Results: A total 186 patients with acute ST-elevation myocardial infarction were screened. Among them 60 patients were finally selected for this study. Of whom 30 were cases (patients with acute heart failure) and 30 were control (patients without heart failure). Patients needed severe cardiac massage and/or underwent DC shock at admission or before collection of blood sample for BNP testing were also excluded. About 70.0% of the cases and 60.0% of the controls were aged more than 50 years. About 80.0% cases of the subjects, both cases and control, were male and rests 20.0% cases were females. Male and female ratio was 4:1.
 Conclusion: In conclusion most of the patients are in the elder age group and male gender.
 Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):126-129