हृदय रोग एवं निदान

Background: NT Pro-BNP is a blood marker secreted from myocardial. The main stimulus for cardiac NT Pro- BNP secretion is myocardial stretch. NT Pro-BNP is a significant risk factor for stroke of cardiac insufficiency and pulmonary embolism. Patients with normal levels of NT–pro-BNP have low risks for death. So, does atrial stretch occur when patients have atrial fibrillation? Whether atrial fibrillation accompanied by changes in atrial muscle stretch may lead to NT Pro-BNP increase is unknown. The purpose of this experiment is to explore the relationship between NT Pro-BNP and atrial fibrillation.

Hypothesis: Atrial fibrillation may cause changes in atrial muscle stretch. Change of myocardial stretch may lead to NT Pro-BNP secretion increase. We hypothesized that NT Pro-BNP might be increased in AF with or without LAD enlargement.

Methods: Atrial fibrillation may cause changes in atrial muscle stretch. Change of myocardial stretch may lead to NT Pro-BNP secretion increase. We hypothesized that NT Pro-BNP might be increased in AF with or without LAD enlargement.

Results: We draw the results that NT Pro-BNP have a statistical relationship with the occurrence of atrial fibrillation after adjusting age, gender, left atrial diameter, hypertension, diabetes, coronary heart diseases and cerebral infarction.

Conclusion: The NT Pro-BNP of AF group is significantly higher than that of non-AF group with or without left atrial enlargement.

Background: Data mining is making impressive breakthroughs in the field of medicine. Data mining can accomplish tasks such as classifying patients, finding associations between different features and exploring hidden patterns and trends in patient data that simplify and improve medical predictions. Optimization algorithms are used along with neural networks to mine datasets and classify them.

Methods: In this study, artificial neural networks were trained and optimized using various evolutionary optimization algorithms and then applied to classify 119 Egyptian patients with symptoms of coronary artery disease CAD.

Results: The mean age of the study population was 57.9 ± 11.162. The best optimization result was obtained by the PSOGSA algorithm, which correctly classified 97.2% of patients. This high classification rate also confirms that H. pylori IgG can be considered a factor of acute coronary syndrome (ACS).

Conclusion: Artificial neural networks can work as classifiers for patients with CAD. The high classification rates confirm that H. pylori infection is indeed a strong indicator for ACS. More approaches that use data mining in medicine should be investigated.

Background: Acute rheumatic fever and its chronic sequele remain significant cause of morbidity and mortality in Ethiopia. Pulmonary hypertension is a frequent complication of left heart disease arising from a wide range of cardiac disorders. Epidemiological data are scarce, especially in the pediatric population of developing countries, regarding the prevalence of pulmonary hypertension among patients with rheumatic heart disease.

Objective: To determine prevalence of pulmonary arterial hypertension and associated factors among patients with rheumatic heart disease in Jimma university medical center.

Method: A cross sectional study was conducted by including patients who were 18 years and less and had been diagnosed with rheumatic heart disease and have Echocardiography report from January 2014 to August 2017. Their medical record was reviewed to retrieve relevant data to answer the study objectives. Data was entered and analyzed using SPSS for windows version 20. Descriptive statistics of categorical variables will be presented by frequencies and percentage and mean, and standard deviations will be estimated for continuous variables. Chi square test was performed to identify association between independent variables and pulmonary arterial hypertension.

Results: A total of 247 medical record of children with rheumatic heart disease were reviewed. Pulmonary hypertension occurred in 149 (60.3%) of the children with a mean age at 10.73 ± 2.837 years. Majority of the children were from rural area 99 (66.4%) and 88 (59.1%) were females. The average Tricuspid valve pressure gradient was 51.17 ± 18.67 mmHg. Heart failure was the presenting illness in 103 (69.1%) of children with PAH, having a significant association (p ≤ 0.001). All associated comorbidities were more prevalent among those who have PAH, malnutrition being the commonest followed by pneumonia. Mitral valve was the most commonly involved valve alone or combined with aortic valve. Mixed Mitral and Aortic valve involvement was seen in 93 (62.4%) cases. Severity of Mitral Regurgitation, Mitral Stenosis and Aortic Regurgitation was found to have statistically significant association with p ≤ 0.05. Medications were almost the only treatment modality, given to 147 (98.6%) children and a single child got a surgical repair.

Conclusion and Recommendations: Rheumatic heart disease related pulmonary hypertension is still the major problem in the center and mitral valve is the commonest valve to be affected. Children with heart failure at presentation are at increased risk of having pulmonary hypertension. Only one patient was operated for underlying valvular lesion. Introduction of standard treatment practices and further study to assess the reasons for late presentation of children with rheumatic heart disease before the development of pulmonary hypertension is recommended.

Background: Treadmill test is an important non-invasive investigation in diagnosis of suspected cases of ischemic heart diseases. In this test, we try to examine the heart under increasing load especially if the resting electrocardiography is normal or non-diagnostic.

Objectives: To find the specificity and sensitivity of Treadmill test in diagnosis of ischemic heart diseases.

Patients and Methods: Fifty patients who had chest pain underwent exercise tolerance test and advised to do coronary angiography. They were divided into four groups according to the results of treadmill test and coronary angiography.

Results: During this study (50) patients (31 males and 19 females) presented with chest pain underwent treadmill test and coronary angiography all the patients were included in the study. The mean age of patients was 57.30 years, true positive group included 46 patients while the other groups false positive groups, true negative, and false negative included two, one and one patient respectively. The sensitivity of treadmill test was 97.7% and specificity was 33.3%.

Conclusion: Treadmill test is useful test for diagnosis of chest pain because it’s sensitive, non-invasive and cost effective.

Objectives: To measure Atherosclerotic Cardiovascular Disease (ASCVD) risks and parameters in patients with clinical ASCVD.

Materials and methods: This retrospective study was conducted in Cardiology Department of KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, a tertiary care center situated in North Karnataka, Belagavi, India. Data was collected from January 2018 to December 2018. A total 952 patients with clinical ASCVD aged >40 years who were on statin therapy were included in the study. The records of patients with ASCVD were evaluated for risk parameters based on ACC AHA cholesterol guidelines 2018.

Results: Out of 952 patients, consisting of 77% of the patients were males and 23% were females. The mean age was 62.45 ± 8.18 years. Most of the patients (43.7%) were aged between 61 to 70 years. Overall 51.37% of the patients had positive history of hypertensive treatment, followed by history of diabetes mellitus, prior revascularization, smoking, Congestive cardiac failure (CCF) and chronic kidney disease (CKD). None of the patient had heterozygous familial hypercholesterolemia. With regard to lipid abnormalities, majority of the patients (60.61%) had low high-density lipoprotein (HDL) followed by hypertriglyceridemia, elevated low-density lipoprotein (LDL) and hypercholesterolemia.

Conclusion: Most common risk factor for ASCVD is hypertension followed by diabetes, dyslipidemia and smoking. With incidence being higher in very high clinical ASCD compared to stable ASCVD.

Objectives: The aim of the study was to evaluate the association between stress hyperglycaemia and in hospital and 30-day mortality in patients with acute ST elevation myocardial infarction (STEMI).

Materials and methods: This one-year hospital based cross sectional study was performed in the Department of Cardiology, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi from January 2017 to December 2018. A total of 465 patients with STEMI were evaluated for ad-mission blood glucose levels and outcome.

Results: Out of 465 patients, 255 (54.84%) patients had elevated admission blood sugar levels (≥ 140 mg/dL). A total of 47 patients (10.10%) died out of which 34 died during hospitalization. Those who presented with serum blood glucose levels of more than 140 mg/dL had an advanced Killip class and a poorer outcome. Mortality was significantly higher in patients with admission blood glucose levels of >200 mg/dL (15.28% vs. 8.11% with 140 to 200 mg/dL and 7.62% with <140 mg/dL; p=0.046) irrespective of the diabetic status and the mean blood sugar level in patients who expired was significantly higher (227.09 ± 131.53 vs. 178.83 ± 96.02 g/dL; p=0.018). Also, non survivors had a greater degree of left ventricular dysfunction (40.11 ± 5.56 vs. 43.70 ± 4.61%; p<0.001) and lower mean systolic blood pressure (96.36 ± 30.75 vs. 123.17 ± 27.56 mm Hg; p<0.001) in comparison to survivors.

Conclusion: Based on univariate analysis stress hyperglycaemia on admission is a predictor of mortality and could be used in stratification of risk in patients with Acute STEMI.

Background: Rotational Atherectomy (RA) is a valuable tool for treating severely calcified complex coronary artery disease in the Cardiac Cath lab despite a lot of helpful techniques and devices, but this is under used now due to technique demands and non-superior outcomes. The aim of our study was to evaluate the procedural and clinical outcomes of patients with complex severely calcified lesions treated by RA in the current era.

Materials and methods: This retrospective study was conducted from February 2015 to February 2019. All consecutive patients who underwent RA for severely calcified lesions were included in the study. The angiographic and procedural parameters and clinical outcomes were analyzed.

Results: A total of 115 patients with complex, severely calcified coronary lesions who underwent RA were included in the study. Out of which 88% were male and 12% were female. The mean age at presentation was 65.6 ± 7.7 years. Most patients (83.4%) underwent RA in Left Anterior Descending artery (LAD) followed by Right Coronary Artery (RCA) (12.2%), Left Circumflex Artery (LCX) (3.5%) and Left Main (LM) (0.9%). The average length of calcium and coronary artery calcium score were 27 ± 10 mm and 3.84 ± 0.77 respectively. Eleven (9.5%) patients underwent RA for in-stent restenosis. There were two (1.74%) in-stent thrombosis, two (1.74%) patients had perforation and one (0.87%) patient had dissection. The In-hospital MACE was 3.5% and MACE at 23 months follow up was 6.09%.

Conclusion: RA in complex, severely calcified coronary lesions can achieve very low complication and low out of hospital major adverse cardiac event rates even in high-risk patients. The study results convince us to sustain and even broaden the use of this novel, but under used, device in this era.

Objective: The interest of ultrasound of the supra-aortic trunks (USAT) is proven in the preoperative assessment of coronary bypass grafting (CABG) but remains to be demonstrated for valve replacement (VR).

Materials and methods: We counted 666 patients who benefited from USAT as part of the preoperative assessment of a CABG or VR due to rheumatic heart disease from 2010 to 2017.

Results: Cardiovascular risk factors (CVRFs) were significantly more frequent (p<0.001) in patient undergoing CABG. There was a positive correlation (r=0.145) between coronary status and carotid status.

Discussion: Valvular disease patients should benefit from USAT based on CVRFs, history of stroke and coronary status.