Post-coronary Artery Bypass Graft Patients Research Articles

Panic disorder in general medical practice- A narrative review.

The under-or misdiagnosis, and symptomatic treatment of the panic disorder (PD), despite high prevalent medical illness, is common among non-psychiatric physicians. The non-psychiatrist physician’s role is vital in the care of PD as most patients initially approach general medical settings for medical help, including primary care. However, a significant proportion is undiagnosed and undergoes either unnecessary investigation, misdiagnosed, or mismanaged even among post-Coronary Artery Bypass Grafting patients, which profoundly affects the patients functioning and quality of life. This article aims to provide overviews of relevant epidemiological aspects, presenting features across medical specialties with respective diagnostic dilemmas, assessment, and management of the PD in their general medical settings, including emergency visits. Apart from psychiatrists, this will also assist non-psychiatrist physicians across all medical specialties, including general practitioners, to understand, identify, and provide the first line evidence-based pharmacotherapy and address the unmet need of patients with PD in their day-to-day busy clinical practice. This paper also provides a referral guide for non-psychiatrist physicians to refer to psychiatrists for further management after their first-line management.

Department of veterans affairs post-coronary artery bypass graft patients’ atrial fibrillation: 10-year outcomes

Aim: This Department of Veterans Affairs’ (VA) research project evaluated the impact of postoperative atrial fibrillation (POAF) upon 10-year outcomes for coronary artery bypass grafting (CABG) patients. Methods: Veterans enrolled in the “Randomized On-/Off-pump Bypass” (ROOBY) trial with new-onset POAF post-CABG were compared to those without POAF with respect to 10-year atrial fibrillation (AF) and mortality rates. Multivariable logistic regression examined whether AF was independently associated with 10-year survival after holding other preoperative risk factors constant. Results: Of the 2203 ROOBY veterans enrolled at 18 VA medical centers from 2002 to 2008, 100 patients with preoperative AF (n = 93) or unknown post-CABG POAF status (n = 7) were excluded. The POAF rate was 26.2% (n = 551/2103). The POAF patients were older and had more co-morbidities than the non-POAF patients (n = 1552). The AF rate among 10-year ROOBY POAF survivors was 18.9% (n = 64/338) compared to 5.8% (n = 61/1048) for non-POAF patients; P < 0.001. Compared to non-POAF patients’ 10-year survival of 70%, the ROOBY POAF veterans’ 10-year survival rate was 63%. Baseline risks inversely associated with 10-year survival included age, chronic obstructive pulmonary disease, serum creatinine > 1.5, peripheral vascular disease, and smoking. Holding these factors constant, POAF was not independently associated with 10-year survival. Conclusion: Post-CABG, ROOBY POAF veterans had higher rates of 10-year AF, which was negatively associated with 10-year survival; however, this association was not significant. Given that POAF may adversely impact 10-year AF rates, additional investigation appears warranted to improve future POAF patients’ care.

Non-invasive Ischaemia Testing in Patients With Prior Coronary Artery Bypass Graft Surgery: Technical Challenges, Limitations, and Future Directions.

Coronary artery bypass graft (CABG) surgery effectively relieves symptoms and improves outcomes. However, patients undergoing CABG surgery typically have advanced coronary atherosclerotic disease and remain at high risk for symptom recurrence and adverse events. Functional non-invasive testing for ischaemia is commonly used as a gatekeeper for invasive coronary and graft angiography, and for guiding subsequent revascularisation decisions. However, performing and interpreting non-invasive ischaemia testing in patients post CABG is challenging, irrespective of the imaging modality used. Multiple factors including advanced multi-vessel native vessel disease, variability in coronary hemodynamics post-surgery, differences in graft lengths and vasomotor properties, and complex myocardial scar morphology are only some of the pathophysiological mechanisms that complicate ischaemia evaluation in this patient population. Systematic assessment of the impact of these challenges in relation to each imaging modality may help optimize diagnostic test selection by incorporating clinical information and individual patient characteristics. At the same time, recent technological advances in cardiac imaging including improvements in image quality, wider availability of quantitative techniques for measuring myocardial blood flow and the introduction of artificial intelligence-based approaches for image analysis offer the opportunity to re-evaluate the value of ischaemia testing, providing new insights into the pathophysiological processes that determine outcomes in this patient population.

Abstract 14072: Long-Term Mortality Following 59253 Patients Who Underwent Coronary Artery Bypass Surgery in New South Wales, Australia: A Statewide Population-Linkage Study From 2001-2018

Purpose: To describe changes in long-term mortality following coronary artery bypass graft (CABG) in New South Wales (NSW), Australia, from 2001-2018. Methods: Patients who underwent CABG were identified from the NSW Admission-Patient-Data-Collection registry linked to the NSW death registry and were stratified into six, 3-year groups. Changes in comorbidities and procedural techniques over time were determined. Primary outcome was death (end of follow-up: 31-December-2018). Secondary outcome was time to first percutaneous coronary intervention (PCI) post-CABG, with death as the competing event. Outcomes analyses using Cox regression were adjusted for baseline and procedural differences and geographical clustering. Results: A total 59253 patients underwent CABG during the study period. From 2001-03 to 2016-18, procedural numbers fell (11875 vs 7606); however patient complexity increased (Charlson comorbidity index [CCI]>0: 40% vs 55%) as did male patients (77% vs 83%). During a median (interquartile range) follow-up of 7.7yrs (3.8-12.1yrs), 16,484 (27.8%) patients died. Factors associated with increased long-term mortality included older age (>75 vs ≤60: hazard ratio [HR]=6.69, 95% confidence interval [CI]=6.33-7.08), female sex (HR=1.06, 95%CI=1.02-1.11), acute myocardial infarction (HR=1.86, 95%CI=1.80-1.92), atrial fibrillation (HR=1.38, 95%CI=1.29-1.47), valvular heart disease (HR=1.84, 95%CI=1.56-2.18), and CCI (per-1-score increase: HR=1.31, 95%CI=1.26-1.35). Multivariable survival analysis showed that, compared to 2001-03, the risk of death reduced from 2004-06 to 2016-18: HR=0.96, 95%CI=0.93-1.00 to HR=0.61, 95%CI=0.54-0.70, respectively. Multivariable time-to-PCI analysis with death as the competing event showed no significant difference over the years. Conclusion: Between 2001 and 2018, though CABG volume has decreased, proportionally more males and higher comorbid patients had CABG in recent years. Female sex and other major comorbidities were expectedly related to an increased association with mortality. Overall, mortality has fallen significantly over time, with no significant trend of PCI undertaken over time in these post CABG patients.

Quality of life following Minimally Invasive Direct Coronary Artery Bypass Grafting (MIDCABG) versus Conventional Open-Heart Coronary Artery Bypass Grafting (CABG): A 3-year data from a single centre

Introduction: In Malaysia, MIDCABG started in 3 centers developing the technique. As the technique is gaining traction in the country, this study aims to compare the quality of life following MIDCABG compared with conventional CABG in one of the centers actively developing this technique. Methods: A retrospective cohort study was performed involving 30 post CABG patients which consists of 15 MIDCABG and 15 conventional CABG from January 2015 to May 2018. 15 from 21 post-MIDCABG patients were included and selected, based on EuroSCORE II less than 5. Modified Post-Operative Quality of Recovery Scale was used to assess and compare the quality of life following respective approaches. Data were analyzed using SPSS version software and comparison using mean rank with p 0.05. Conclusion: There is no significant difference in quality of recovery following MIDCABG compared to conventional CABG. Modified PostOPQRS system can be a useful assessment tool to evaluate the impact of an intervention in relation of quality of life.

Strain and strain rate echocardiographic imaging predict occurrence of atrial fibrillation in post-coronary artery bypass grafting patients

BackgroundAtrial fibrillation (AF) occurs very frequently after coronary artery bypass grafting (CABG); it occurs in about 20–edictors can be used for the dedicatio40% of patients. It is associated with several adverse events. This study aimed to extrapolate a predictor for postoperative atrial fibrillation (POAF) occurrence which is reproducible and simple to be a part of routine echocardiography screening before CABG. This study included 89 patients scheduled for isolated coronary artery bypass surgery. History, clinical examination, and complete 2D echocardiography with LA speckle tracking analysis were done preoperatively. Patients were then followed up post-surgery for incidence of AF till discharge from the hospital. The patients were divided into 2 groups according to POAF occurrence.ResultsPatients who developed postoperative AF had older age (P = 0.0032) and longer hospital stay (P = 0.021) and higher stroke incidence but statistically non-significant (14.3% vs 3.3%). The POAF patients showed less peak atrial longitudinal strain (PALS) value than non-POAF patients. The left atrial strain rate values showed a significant difference with the lower left atrial systolic strain rate and less negative (higher) early diastolic strain rate and late diastolic strain rate. After multivariate logistic regression analysis, the independent predictors for POAF were PALS (OR 0.770, 95% CI 0.627–0.946), late LA diastolic strain rate (LASRa) (OR 3.476, 95% CI 1.207–12.186), and age (OR 1.181, 95% CI 1.011–1.379).ConclusionPreoperative LA global strain assessed by 2D speckle tracking analysis could be helpful as a predictor for AF post-CABG surgery, and identification of these patients may reduce its morbidity and mortality. The study suggested PALS value less than 29.8 to be a predictor for the occurrence of POAF.

The Occurrence of Postoperative Residual Curarization among Post-Coronary Artery Bypass Graft Patients in a Surgical Intensive Care Unit of a Tertiary Hospital

BACKGROUND: Intermediate-acting muscle relaxants have gained favor in fast-track cardiac anesthesia since these are associated with early extubation. However, postoperative residual curarization (PORC) still occur in the post anesthesia care unit. This study aims to determine the occurrence of PORC among post-coronary artery bypass graft (CABG) patients in the surgical intensive care units (SICU) of the Philippine Heart Center. METHODS: A cross-sectional study was undertaken among 60 patients for elective CABG surgery. Within an hour from SICU arrival, Train of Four (TOF) ratio was obtained and a value of <0.7 signified the presence of PORC. RESULTS: 57 out of 60 (95%) were found to have PORC. Patients without PORC were significantly warmer (36.4oC vs 34.8oC, p-value=0.019) upon SICU arrival compared to those with PORC. The duration of ventilatory support was significantly longer in those with PORC (510 min vs 305 mins, p-value=0.021). The rocuronium induction dose and duration of infusion did not differ between those with and without PORC while the use of reversal drug was seen to significantly prevent its occurrence (p-value=0.003). CONCLUSION: This study showed a high incidence of PORC among post-CABG patients in the SICU with the current practice of Rocuronium infusion during surgery. The use of muscle relaxant reversal drug was seen to significantly prevent the development of PORC while higher body temperature upon SICU arrival was observed in patients that did not develop PORC. This study was also able to show that the development of PORC prolonged post-operative mechanical ventilatory support hindering the goals of fast-track cardiac surgery.

Comparing efficacy of ibutilide and amiodarone for cardioversion in atrial fibrillation after coronary artery bypass grafting- A prospective and randomized study

Ibutilideis less frequently used drug for atrial fibrillation (AF) in postoperative coronary artery bypass grafting (CABG) patients as compare to amiodarone. We therefore investigated the comparative efficacy of ibutilde and amiodarone for cardioversion in atrial fibrillation after CABG.To compare the efficacy of ibutilide and amiodarone for cardioversion of AF in post CABG patients.Narayana Multispeciality Hospital, Jaipur.Single center, randomized, double blind, comparative prospective study.Total 80 post CABG patients who developed AF were divided into two groups (Group A) Ibutilde and (Group B) Amiodarone respectively. The cardioversion time and cardioversion rate were measured.Unpaired t-test, Paired t-test, Chi square test / Fisher exact test. P value <0.05The cardioversion rate at 4hrs in group A was 42.5% and in group B was 50% (p value > 0.001). At 24 hrs cardioversion rate in group A was 95% and in group B was 87.5% (p value > 0.001). The mean time of conversion to sinus rhythm in group A was 382.85 minutes and in group B was 492.30 minutes. (p value= 0.235)Ibutilide was as effective as amiodarone for restoration of sinus rhythm in postoperative coronary bypass grafting patients who developed atrial fibrillation in their postoperative intensive care unit stay. Ibutilide may be superior to amiodarone in terms of hemodynamics and systemic side effects.

The role of cardiac rehabilitation after Streptococcus agalactiae Infective Endocarditis with Septic Embolic Complication in an Elderly Patient: Case Report

Introduction. In the past, Streptococcus agalactiae was known to be associated with invasive infections in pregnant women and newborns. More recently, given a more appropriate antibiotic prophylaxis and treatment, the incidence among pregnant women and infants diminished. However, an increasing number of cases with infective endocarditis with Streptococcus agalactiae has been reported in the recent years in older patients with underlying comorbidities. Case report. An 80-year-old female patient presented with dyspnea, weight loss, fever, fatigue, chills, dry cough and bilateral lower limb edema. The work-up revealed complicated infective endocarditis with Streptococcus agalactiae on the native aortic valve with severe aortic regurgitation as a result of the valvular destruction and a metastatic spleen abscess. Antibiotic treatment was started with resolution of the fever and chills. The patient however developed congestive heart failure due to the valvular regurgitation. A decision was made to proceed urgently with aortic valve replacement and splenectomy, which were performed at the same time, followed by a good recovery. Results and discussion. An increasing number of cases with IE with GBS in elderly patients has been reported in the recent years, with high rate of complications and mortality. The underlying comorbidities are important risk factors for S. agalactiae IE. Considering our case, a patient in her eighties with significant abdominal surgical history and multiple medical conditions could be a typical host. Recovery after cardiac surgery is one of the most important indications of physical training. This includes patients post-coronary artery bypass grafting, after valve prosthetic replacement, after surgery for congenital diseases and after heart transplantation. Early mobilization is particularly important in avoiding immobility and cardiac deconditioning. Conclusions. Despite the fact that mortality in Group B Streptococcus endocarditis is 40%, a combined medical and surgical strategy individualized to the specific situation of each patient have led to a positive outcome in a number of cases. We present such a combined treatment approach in a case of complicated infective endocarditis with metastatic spleen abscess in an elderly patient. The aortic valve replacement and splenectomy were performed at the same time. Keywords: endocarditis, septic emboli, valve replacement, splenectomy

Active Cycle Breathing Technique Terhadap Fungsional Paru Pasien Post CABG (Laporan Kasus Berbasis Bukti)

Coronary Artery Bypass Graft (CABG) is an operative action in cases of coronary heart disease (CHD) by cutting and replacing clogged coronary arteries from healthy vessels taken from the legs, arms, or chest. The main clinical problem that arises in post-CABG patients is decreased lung functional capacity, this is due to shortness of breath, pain, decreased thoracic expansion, sputum retention, and decreased pulmonary ventilation. Active Cycle of Breathing Technique (ACBT) is a physiotherapy modality that can be applied in cardiovascular cases. ACBT is a series of exercises that include breathing exercises, coughing exercises, and exercises to expand the chest. To determine the effectiveness of ACBT in increasing lung functional capacity in Post CABG patients, an electronic database search was performed, namely Pubmed, Cochrane, and Google Schoolar. From the search results, 6 articles were selected that met the criteria, namely 1 article on Pubmed and 5 articles on Google scholar. Based on the results of the research that has been presented, it can be concluded that ACBT can increase the functional capacity of the lungs in post CABG patients as evidenced by the evaluation of the results of the 6 minutes walking test, borg scale, and breath holding time.

Faktor yang Memengaruhi Kualitas Hidup Pasien Paska Bedah Pintas Arteri Koroner

Coronary Artery Bypass Grafting (CABG) is aimed to improve the quality of life among post-CABG patients, there exist a large number of patients having a low level of quality of life. The study aimed to analyze factors that influenced the quality of life among post-CABG patients. The descriptive study was conducted using cross-sectional analysis with a consecutive sampling of 80 post CABG patients in Hasan Sadikin Hospital from 20 May-30 June 2019. Data were analyzed using multivariate linear regression. The independent variables in this study included age, gender, education level, pain, mental health, social support, spiritual well-being, and cardiac rehabilitation. The data were collected using three questionnaires which included Short-Form 36 (SF-36) to measure patient-reported pain, mental health, and the quality of life; Multidimensional Scale of Perceived Social Support (MSPSS) to provide information about the role of social support; and Spirituality Index of Well Being (SIWB) designed to measure the spiritual well-being of the patients. The results showed four factors had significantly influenced the quality of life among patients after CABG. The factors included age (p-value<0,001; r=0,521), pain level (p-value<0,001; r=0,666), mental health (p-value<0,001; r=0,426), and social support (p-value<0,001; r=0,345). Pain factor had the most significant effect on the patients (r=0,497). Pain could cause a stress response that influenced the recovery stage which eventually impacted the quality of life. This study implies that the management of post-CABG patients could be performed by applying pain and stress management in discharge planning.

Challenges experienced by post coronary artery bypass grafting patients: A qualitative study from Peshawar, Khyber Pakhtunkhwa, Pakistan.

To explore the experiences of post-coronary artery bypass grafting patients in Pakistan. The qualitative, descriptive, phenomenological study was conducted at the Lady Reading Hospital, Peshawar, Pakistan, from May 2018 to April 2019, and comprised patients having undergone coronary artery bypass grafting. Data was collected through semi-structured interviews that included probing questions. Codes, categories and themes were framed through extensive thematic analysis. Of the 14 patients, 11(78.6%) were male with a mean age of 50.81±5.61 years and 3(21.4%) were female with a mean age of 63.33±6.02 years. Four main themes were generated; challenges, perceptions about coronary artery bypass grafting, coping with the challenges, and perceptions about nurses and doctors. The subjects were of the view that they were affected with certain types of physical, psychological and financial challenges. These encounters affected the patients post-procedure in almost every aspect of their lives and made it difficult for them to carry out activities on a daily basis. Further, coping strategies varied from individual to individual. Patients after coronary artery bypass grafting were found to encounter issues related to physical, psychological and social spheres. Care for such patients must be planned in a way to avoid such challenges.

Predicting adverse cardiovascular outcomes in post-coronary artery bypass grafting patients using novel ECG frequency analysis of the QRS complex.

BackgroundA novel metric called Layered Symbolic Decomposition frequency (LSDf) has been shown to be an independent predictor of ventricular arrhythmia and mortality in patients receiving implantable cardioverter‐defibrillator (ICD) devices. This novel index studies the fragmentation of the QRS complex. However, its generalizability to predict cardiovascular events for other cardiac procedures is unknown. Herein, we investigated the applicability of LSDf as a predictive measure for major adverse cardiovascular events (MACE) in patients receiving coronary artery bypass grafting (CABG).Methods and ResultsOne hundred ninety‐five patients had high‐resolution ECG recorded prior to CABG surgery in 2012/2013 and were followed for a mean duration of 7.32 ± 0.32 years for postoperative cardiovascular outcomes. These outcomes were described as a modified composite of MACE defined as hospitalization for heart failure, ventricular tachycardia, ventricular fibrillation, and cardiovascular death including stroke and cardiac arrest. One hundred seventy‐two patients were included for analysis and 18 patients experienced a postoperative cardiovascular outcome. These patients had significantly increased age (71.3 vs. 64.6 years, p = .007), prolonged QRS duration (113.22 vs. 97.35 ms, p = .003), reduced left ventricular ejection fraction (42.7% vs. 56.5%, p < .001), and lower LSDf percent (13.5% vs. 16.9%, p = .002). Patients with an LSDf below 13.25% were 4.8 (OR 1.7–13.5, p < .001) times more likely to experience a MACE and up to 19.4 (OR 4.2–90.3, p < .001) times more likely to experience a MACE when older than 70 years and an ejection fraction below 50%.ConclusionLayered Symbolic Decomposition frequency may be an applicable metric to predict long‐term cardiovascular outcomes in patients with ischemic heart disease.

Algorithm for Recanalization of Chronic Totally Occluded (CTO) Native Coronary Arteries Through a Diseased or Occluded Saphenous Vein Graft in Post Bypass Patients.

Chronic total occlusion (CTO) desobstruction of a native coronary artery in a post coronary artery bypass graft (CABG) patient can be a challenging procedure. In principle, the 3 basic approaches of recanalization of occluded native coronary arteries can be used: antegrade wire escalation (AWE), antegrade dissection re-entry (ADR) and a retrograde technique. On the other hand, a previous implanted saphenous vein graft (SVG) – even when occluded – can be used as a conduit for retrograde access. Moreover, access through a graft might be less complex compared to the use of septal or epicardial collaterals. If the graft is still open or has a tapered stump, this should be considered as a suitable conduit. Literature on recanalization of occluded native coronary arteries trough a diseased or occluded SVG is limited. A flowchart with an algorithm in post CABG patients is proposed and illustrated by 3 clinical cases.

EFFECT OF DIABETES MELLITUS ON GRAFT DISEASE PATTERN AFTER CORONARY ARTERY BYPASS GRAFT SURGERY IN SYMPTOMATIC PATIENTS DETECTED BY MULTI SLICE CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY

ABSTRACT Background: Surgical revascularization of the coronary arteries is one of the most frequent surgical procedures performed worldwide. Although the procedure is one of the major successes of modern medicine, it does not treat the disease underlying the symptoms (atherosclerosis), but only the clinical presentation of coronary artery disease. Multi detector computed tomography (MDCT) accuracy in coronary artery bypass grafting (CABG) patency and stenosis assessment is excellent compared with angiography. Its safety advantages have led to rapidly increasing usage in both native and grafted vessel evaluation. Objective: To evaluate the impact of diabetes mellitus on the patency of arterial and venous grafts after coronary artery bypass surgery assessed by multi slice CT coronary angiography. Patients and methods: One hundred post CABG patients were included, and divided into two groups: Group A (sixty diabetic patients) from which thirty two had NIDDM (53.3% of diabetic patients), twenty eight (46.6% of diabetic patients) had IDDM, and group B (forty non diabetic patients). Patients subjected to our study were symptomatic with recurrent typical chest pain or angina equivalent. All included patients had sinus rhythm, heart rate less than 70 bpm, weight less than 150 kg and serum creatinine <1.5 mg/dl. Patients were investigated by Seimens Somatom Definition Flash 64- dual source MDCT at least 12 months after the surgery. Results: The most common risk factor in our studied population was hypertension affecting 55% of studied population followed by smoking which was prevalent at 54% of studied population. Comparison of the number of diseased grafts in the two study groups according to hypertension showed a statistically significant difference in group A (diabetic group). Comparison of the number of diseased grafts in the two study groups according to dyslipidemia showed a statistically significant difference in group A. Comparison of the number of diseased grafts in the two study groups according to smoking showed a statistically significant difference in group B (non- diabetic group). 101 arterial grafts had been evaluated for patency, 96 LIMA and 5 radial arteries. There were 59 LIMA in diabetic patients and 37 LIMA in non-diabetic patients evaluated. There was no statistically significant LIMA occlusion in group A and group B. In our study, 141 venous grafts were evaluated for patency: 83 venous grafts in diabetic patients, and 58 venous grafts in non-diabetic patients. Comparison of the two study groups as regards patency of venous grafts showed a statistically significant in group A , and revealed also more occluded grafts at diabetic group. There was a statistically significant graft occlusion with longer duration of diabetes mellitus and higher glycosylated hemoglobin HbA1c. Conclusion: Multi-slice CT coronary angiography has an important role in evaluation patency of coronary grafts after coronary artery bypass surgery. Graft occlusions were more common among diabetics compared with non-diabetics. Diabetes was associated with lower vein graft patency but similar arterial graft patency in comparison to non-diabetics. Uncontrolled diabetes mellitus and long duration of disease was found to be a significant predictor for graft occlusion.

A Comparison of Scoring Systems for Predicting HIT in CABG Patients

Heparin induced thrombocytopenia is seen in patients with exposure to unfractionated heparin or low molecular weight heparin products. Surgical patients are at the highest risk for heparin induced thrombocytopenia (HIT) and patients undergoing coronary artery bypass graft (CABG) surgery have the second highest risk for developing heparin antibodies leading to HIT. Eight percent of heparin treated patients develop antibodies and 1-5% develop HIT; of these, 30-50% develop thrombosis along with the thrombocytopenia with a 20-30% morbidity and mortality rate. There are three different scoring systems typically used to determine the probability of HIT. These include the 4T score (most commonly used), HIT Expert Probability (HEP) score, and the Lillo-Le Louet (LLL) model scoring system (used exclusively for post-CABG patients). To date there have been limited studies done to compare the various scoring systems specifically in post CABG patients. The purpose of this study was to determine which scoring system was best at predicting the probability of HIT in a CABG patient. This is a single institution retrospective chart review of all patients between 2017-2019 who underwent CABG surgery. A total of 165 patients were studied and the patients who had HIT workup done were selected for further evaluation. Patient charts were reviewed to document initial platelet counts and post-CABG surgery platelet counts. Platelet counts were followed and documented for up to post-op day #15, if available. Review also included identification of new cases of arterial or venous thrombosis. For each patient that had HIT work-up, the HIT probability score was calculated by three different methods (4T score, HEP score, and LLL score). Sensitivity and specificity of the scoring systems was calculated. ANOVA test was used to determine if there was a difference between the three scoring systems and paired T-test was used to assess between the scoring systems. A total of 37 patients were studied and paired-T tests were used to compare between the scoring systems. There were a total of 6 patients with confirmed HIT based on a positive serotonin release assay (SRA) and 31 patients who had a negative work-up for HIT. The PPV of 4T, HEP, LLL was 0.545, 0.545, 0.667 respectively. Specificity was highest for LLL model: 0.912 and 0.861 for both HEP and 4T. ANOVA test determined in patients with a definitive HIT diagnosis that there was no difference among the 3 tests (p value=0.47792); however there was a difference between the scoring systems when the patients tested negative for HIT (p value= 0.00001). Furthermore, when individually comparing LLL to either 4T or HEP there was a significant difference in both true HIT and non-HIT patients p-value &amp;lt;0.03. These findings suggest that LLL is a better predictor of HIT in patients with CABG and it is especially superior in ruling out HIT in comparison to 4T and HEP. This further goes to support using LLL over 4T score in patients with CABG to help improve predictability of HIT. LLL is a simple calculation similar to 4T score and hence we should utilize it more often in our CABG patients. Disclosures No relevant conflicts of interest to declare.

Quality of Life among Post CABG Patients

Introduction: Coronary artery bypass grafting (CABG) surgery is one among the most common proceduresperformed in the world, and it is one of the possible treatments for coronary artery disease (CAD). Althoughthe effectiveness of coronary artery bypass grafting (CABG) is being evaluated in terms of mortality,complications or recurrence of symptoms, empirical studies assessing the change in patients quality of life(QOL) after CABG need to be studied as findings keep changing as time progress. A systematic analysisof how well the patient is considering a multiple variable need to be studied which has greater impact inimproving the overall performance of the patients after CABG.Aim: Aim of the study is to assess the quality of life among post coronary artery bypass grafting (CABG)patients.Method: A quantitative approach with a descriptive design using a non-probability convenience samplingtechnique was used to collect data from 101 post CABG patients. The setting used for the study was CVTSOPDs at AIMS, Kochi. A standardized quality of life questionnaire (SF-36) along with a semi-structuredquestionnaire to assess socio-demographic and clinical data.Results: The study result showed that the majority of samples (97%) had good QOL with mean score of69.22. PCS (96%) showed higher value than MCS (68. 3). A significant association found between QOL andsocio-demographic variables like occupation (p=0.018).Conclusion: Overall QOL improved one year after CABG.

The Effect of Aerobic-resistance Training on Plasma Levels of bFGF in Coronary Artery Disease After CABG

Background and Aim: Coronary Heart Disease (CAD) is one of the most important causes of mortality. Exercise activities after coronary artery bypass surgery increase the density of myocardial capillaries called angiogenesis and improve cardiovascular function. The aim of the present study was to determine the effect of aerobic-resistance training on plasma basic fibroblast grown factor levels in post-coronary artery bypass grafting patients. Methods &amp; Materials: The sample consisted of 30 men aged 45-60 years who underwent bypass surgery. They were randomly divided into experimental (n=15) and control (n=15) groups. The experimental group performed aerobic resistance training for eight weeks (3 sessions per week) and the control group did not. Blood samples were taken 24 hours before the start of the first training session and 48 hours after the last training session while all subjects were fasting. In vitro ELISA method was used to measure BFGF. Independent and paired t-test and Shapiro-Wilk test were used to analyze the data at the significant level of 0.05 in SPSS v. 21. Ethical Considerations: This study was registered (Ethics Code: IR.IAU.NEYSHABUR.REC.1398.01) in the Ethics Committee of Islamic Azad University, Neishabour Branch, and with Clinical Trial Code: IRCTID:IRCT20191228045919N1. Results: Eight weeks of aerobic-resistance training significantly increased bFGF levels in the exercise group compared to the control group (P=0.002). Also, pre and post changes in the experimental group showed a significant increase in plasma bFGF levels (P=0.002), which was not significant in the control group (P=0.758). Conclusion: According to the results, it may be concluded that combined (aerobic resistance) exercise may increase angiogenesis and capillary density in post-CABG patients by increasing plasma bFGF levels

Role of Computerized Tomography in Evaluation of Coronary Bypass Grafts—Special Reference to Women

AbstractComputerized tomography-coronary angiography (CT-CAG) is gaining popularity as an alternative to conventional CAG to evaluate grafts in a post-coronary artery bypass graft (post-CABG) patient, since it is a noninvasive procedure and is less influenced by cardiac motion. The primary challenge is to image a rapidly beating heart. With introduction of 64-slice scanner, the coronary imaging became a possibility with acceptable accuracy. In recent years, with the development of 128,256 and 320 multislice CT scanners, further enhancement in the temporal and spatial resolution is achieved due to lesser influence of the respiratory and cardiac motion, enhancing the accuracy of the lesion assessment in the grafts and the native vessels. Achieving low heart rate and artifact-free image acquisition, proper reconstruction, and image interpretation are challenges to the radiologists and the technicians involved in coronary imaging. Women pose special subset because of smaller sized coronary vessels, interference due to breast shadows, low-referrals, and gender-specific reluctance to accept the procedure itself. Cardiologists and radiologists caring for these patients must be familiar with the pros and cons of CT-CAG and gender-specific challenges.

Effect of an 8-week endurance rehabilitation exercise on apoptosis in cardiac patients

Aims: Exercise training is one of the nonpharmacological treatments for heart diseases. The aim of this study was to investigate the effect of 8-week endurance rehabilitation training on apoptosis among cardiac patients. Subjects and Methods: Sixteen postcoronary artery bypass grafting patients, having examined by specialists, were randomly assigned to control (n = 8) and experimental groups (n = 8). The experimental group completed a training protocol including running on a treadmill at 55%–70% of their maximum heart rate for 8 weeks. Blood sampling was performed after 12–14 h of fasting and before and after the 8-weeks training to measure biochemical variables. The measurement of Bax and B-cell lymphoma-2 (Bcl-2) was conducted using the ELISA kit. The data analysis was carried out using the independent sample t-test at P ≤ 0.05. Results: The results showed a significant difference between the participants' mean Bax (P = 0.011) and Bcl-2 (P = 0.015) values after the intervention for both the groups. Likewise, the difference between the ratios of Bcl-2/Bax values after the intervention was significant for both the groups (P = 0.023). Conclusions: According to the findings of the study, it seems that the endurance rehabilitation training exercises could have a protective effect against apoptosis.