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Background: The presence of ischemic ECG changes on admission has been shown to predict outcome, the relationship between the extent of ECG changes and the risk of cardiac events is still ill defined. The severity of ST-segment depression on admission ECG has a strong association with adverse in-hospital outcome in patients with non ST-segment elevation acute coronary syndrome. The study was done to observe the extent of ST-segment depression and in-hospital outcome in patients with non ST-segment elevation acute coronary syndrome. Methods: This study was conducted in the Department of Cardiology in NICVD Dhaka, from January 2006 to December 2007. Considering inclusion and exclusion criteria, a total of 183 patients were evaluated. All the patients were evaluated clinically after admission. ECG, blood biochemistry and echocardiography were done. Patients were categorized into three groups according to the extent of ST- segment depression. Results: In this study, analysis of the baseline parameters revealed no statistically significant difference among the three groups of patients (p>0.05). Mean sum of the ST-segment depression analysis was done and all mean values were more in group III patients. 41.0% patients developed complications during the study period. Acute LVF (22.9%) was the most common complication followed by arrhythmia (11.5%), cardiogenic shock (4.4%) and STEMI (2.2%). All the complications were more in group III patients. During this period 6% patients died and more death (12.3%) was observed in group III patients. Conclusion: The amount of ST-segment depression is a powerful predictor of adverse in-hospital outcome in patients with non ST-segment elevation acute coronary syndrome. [ABSTRACT FROM AUTHOR]

Background: Inferior myocardial infarction complicated by right ventricular infarction is associated with a greater risk of in-hospital mortality and cardiovascular related complications. Early risk stratification of patients with right ventricular infarction is crucial for appropriate management and reduction of adverse cardiac events. The development of TIMI risk score has provided a useful tool to quickly and easily stratify patients with right ventricular infarction. We conducted this study to evaluate the prognostic value of TIMI Risk Score analysis in patients with right ventricular infarction. Methods: This observational study was conducted in the department of Cardiology in NICVD, Dhaka, from July 2006 to June 2008. Considering inclusion and exclusion criteria, a total of 60 patients with right ventricular infarction were evaluated. All the patients were evaluated clinically and ECG was done after admission. Patients were categorized into two groups by TIMI risk scoring. Patients with low TIMI risk score(0-3) were in Group-I and patients with high TIMI risk score(4-14) were in Group-II. Results: The study revealed no statistically significant difference among the patients of two groups (p>0.05) in relation to sex, weight, risk factors and presenting complaints. Analysis revealed statistically significant difference among the patients of two groups (p<0.05) in relation to age, duration of chest pain, clinical parameters, Killip class of heart failure and LVEF. Regarding inhospital outcome, 51.7% patients developed complications during the study period and all the complications were more in group II patients with high TIMI risk score(4-14). Death (18.3%) was the most common complication followed by cardiogenic shock (15.0%), complete heart block(6.6%),cardiac arrest(6.6%),VT(3.3%)and 2nd degree heart block(1.6%). Conclusion: This study indicates that on admission - TIMI risk score analysis can identify patients with right ventricular infarction at higher risk for in-hospital mortality and morbidity. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the immediate impact of Percutaneous Transvenous Mitral Commissurotomy (PTMC) on RV function in patients with mitral stenosis (MS). Methods: This study was conducted in the National Institute Cardiovascular Diseases, Dhaka for a period of one year starting from October 2008 to September 2009. A total of 50 consecutive patients (Case group) with mitral stenosis were selected after considering inclusion and exclusion criteria that subsequently undergone PTMC. The control group (n=50) consisted of age and sex matched healthy individual (having no ECG or echocardiographic evidence of structural or functional cardiovascular disease). Healthy control group was taken because there was no data about RV function in our population. Control group used to compare with baseline characteristics of case group. Results: Immediately after PTMC (24 to 48 hours) mitral valve area increased from 0.8± 0.1 to 2.0 ± 0.2 (p <0.001) and RV outflow tract fractional shortening (RVOTfs % ) increased from 54.9 ± 4.6 to 74.9 ± 4.8% (p <0.001). There was a significant decrease in systolic pulmonary artery pressure from 47.7 ± 7.9 mmHg to 28.2 ± 5.9 mmHg (p <0.001), in the RV Tei index from 0.5 ± 0.1 to 0.3 ± 0.1 (p <0.001 ), in myocardial acceleration during isovolumic contraction (IVA) at the lateral tricuspid annulus from 0.4 ± 0.1 m/s² to 0.3 ± 0.0 m/s² (p <0.001). The RVEF (%) did not exhibit any significant change from pre-PTMC figure (p = 0.538). Conclusion: After successful PTMC the parameters of infundibular and global RV function as assessed by RVOTfs and Tei index showed significant improvement and significant decrease in RV contractility as assessed by IVA was observed. Further work using larger numbers of patients is needed to confirm our findings and to assess their utility in patient follow-up and management. [ABSTRACT FROM AUTHOR]

Background: Inflammation has been shown to play a role in atherosclerosis and acute coronary syndrome. This study was carried out to evaluate the relationship between baseline white blood cell (WBC) count and C-reactive protein (CRP) with angiographic severity of coronary artery disease in patients with acute coronary syndrome and to identify those subsets of patients with acute coronary syndrome who may need to undergo invasive or conservative strategies. Method: A total of 100 patients with acute coronary syndrome including unstable angina, non-ST elevated myocardial infarction & ST elevated myocardial infarction were evaluated in National Institute of Cardiovascular Disease (NICVD), Dhaka with a view to correlate angiographic findings, C-reactive protein and WBC count. Results: This study observed that either raised WBC count or raised CRP independently and combination of both WBC count and CRP elevation were significantly associated with more severe coronary artery disease. Either raised WBC count or raised CRP or combination of raised WBC count and CRP were significant predictor of multivessel disease and high stenosis score. Conclusion: Elevation of WBC count and CRP in patients with acute coronary syndrome are associated with severe coronary disease. WBC count and CRP can be used as a new and even simpler tool for risk stratification in acute coronary syndrome. [ABSTRACT FROM AUTHOR]