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Objectives: Due to rheumatic heart disease, young people are more likely to develop valvular heart disease in developing countries. In countries like Pakistan, surgeons implant more bioprosthetic mitral valves (MVs) in younger patients. However, bioprosthetic valves degenerate rapidly in younger people, leading to bioprosthetic MV dysfunction (BMVD). This study aims to evaluate the clinical characteristics and long-term outcomes of patients with bioprosthetic MV replacement (MVR) at a tertiary care hospital in a South Asian country. Material and Methods: This is a retrospective observational study, conducted at a tertiary care hospital. We included a total of 502 patients who underwent bioprosthetic MVR from the year 2006 to 2020. Clinical and surgical characteristics along with transthoracic echocardiographic findings (pre-surgery and recent most follow-up studies) were noted. Follow-up data were also collected. Results: Out of 502 patients, 322 (64%) were female, mean age at the time of surgery was 49.42 ± 14.56 years. Mitral regurgitation was more common, found in 279 (55.6%) patients followed by mitral stenosis in 188 (37.5%) patients. MVR was done as an elective procedure due to the New York Heart Association (NYHA) II to IV symptoms at the time of surgery in 446 (88.8%) patients. In the mean follow-up of 6.59 ± 2.99 years, BMVD was observed in 183 (36.5%) patients. However, re-do MV surgery was done in only 49 (9.8%) patients. Patients were divided into two groups based on normal functioning bioprosthetic MV and BMVD. Comparing the two groups, individuals with normal functioning bioprosthetic MV had a mean age of 51.6 ± 14.27 years, while those with BMVD had a mean age of 45.639 ± 14.33 years at the time of index surgery (P = 0.000). There were more long-term complications including heart failure (n = 16, 8.74%), atrial fibrillation (n = 11, 6.01%), and death (n = 6, 3.28%) in the BMVD group which were statistically significant. Conclusion: This study is distinct because it demonstrates the outcomes of bioprosthetic valve replacement in a relatively younger South Asian population. Due to rapid degeneration of bioprosthetic valve in younger patients, significant number of patients developed BMVD along with poor long-term clinical outcomes, even at a short follow-up period of <10 years. These findings are similar to international data and signify that mechanical MVR may be a more reasonable alternative in younger patients. [ABSTRACT FROM AUTHOR]

Objectives: This retrospective observational study aimed to evaluate the correlation between visually estimated left ventricular ejection fraction (LVEF) via 2D echocardiography (ECHO) and quantitatively measured LVEF via cardiovascular magnetic resonance imaging (CMR). Methodology: The study was conducted at Aga Khan University Hospital, involving patients who underwent both 2D ECHO and CMR within a maximum interval of three months between the two studies. LVEF was visually estimated by experienced cardiologists on 2D ECHO and quantitatively calculated on CMR. Results: Among 127 patients meeting inclusion criteria, comparisons between visually estimated LVEF ranges on ECHO and LVEF on CMR consistently showed highly significant differences (p < 0.0001), with ECHO underestimating LVEF. The mean difference between visually estimated average LVEF by ECHO and calculated LVEF by CMR was 4.9 ± 7.0. Subgroup analysis revealed consistent findings across patients with coronary artery disease (CAD) and those with dilated or hypertrophic cardiomyopathy. Conclusion: Despite a significant difference, the observed discrepancy in LVEF values between visually estimated ECHO and quantitatively measured CMR remains small. Thus, visually estimated LVEF by experienced readers retains its reliability as a method for diagnosing and managing patients in routine clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: To assess the knowledge about valvular heart disease among the patients who are already diagnosed with rheumatic valvular heart disease (RVHD). Methodology: In this cross-sectional study was conducted at the outpatient of a tertiary care cardiac centre. We included consecutive patients of either gender between 18 to 60 years of age with the established diagnosis of RVHD. Their knowledge and awareness regarding the disease itself and regarding its primary and secondary prevention and treatment options was assessed with the help of a structured self-developed questionnaire. Results: Among the study sample of 505 patients, 255 (50.5%) were male and overall mean age was 37.3 ± 10.9 years. A majority (90.3%) of the patients had household income of = PKR 40,000 and 35.3% were illiterate. More than 41% were not aware of their diagnosis, 40% were aware of childhood infection as the cause of RVHD. About 40% of the patients could not recall history of fever/sore throat in past. About 19.8% of the patients considered percutaneous transvenous mitral commissurotomy as complete cure for RVHD and 46.3% of the patients were not aware of a prophylactic treatment. Only 33.9% considered the need to maintain good dental hygiene as part of the prophylactic treatment. Conclusion: High incidence of lack of awareness regarding their disease and its prophylaxis in our study population is alarming. To improve the RHD awareness, sessions and seminars should be arranged in the general population. Further studies are required to identify the cause and hence identifying measures to improve awareness. [ABSTRACT FROM AUTHOR]

Objective: To determine the association of dryness of eyes with rheumatoid arthritis severity., Methods: The cross-sectional, observational study was conducted at the Jinnah Medical College Hospital, Karachi, from December 2020 to May 2021, and comprised adult patients of either gender with rheumatoid arthritis who were diagnosed on the basis of clinical and serological investigations. Data was collected using a structured pre-tested questionnaire. Ocular Surface Disease Index questionnaires with Tear Film Breakup Time were used to assess the severity of dry eyes. Disease Activity Score-28 with erythrocyte sedimentation rate was used to assess the severity of rheumatoid arthritis. Association between the two was explored. Data was analysed using SPSS 22., Results: Of the 61 patients, 52(85.2%) were females and 9(14.8%) were males. The overall mean age was 41.7±12.8 years, with 4(6.6%) aged <20 years, 26(42.6%) aged 21-40 years, 28(45.9%) aged 41-60 years and 3(4.9%) aged >60years. Further, 46(75.4%) subjects had sero-positive rheumatoid arthritis, 25(41%) had high severity, 30(49.2%) had severe Occular Surface Density Index score and 36(59%) had decreased Tear Film Breakup Time. Logistic Regression analysis showed there were 5.45 times higher odds of having severe disease among the people with Occular Surface Density Index score >33 (p=0.003). In patients with positive Tear Film Breakup Time, there were 6.25 higher odds of having increased disease activity score (p=0.001)., Conclusions: Disease activity scores of rheumatoid arthritis were found to have strong association with dryness of eyes, high Ocular Surface Disease Index score and increased erythrocyte sedimentation rate.