Echocardiographic Evaluation of Systolic Left Ventricular function in Acute Myocardial Infarction in 1st Week of Hospitalization

Objectives: To assess systolic left ventricular function determined by left ventricular ejection fraction (LVEF) with the help of Echocardiography and correlate with ECG findings in patients of AMI. Methods: One hundred (100) cases of acute myocardial infarction were studied in the Department of Cardiology, DMCH from July 2015 to December 2015. It was an observational study. All selected patients were interviewed with a preformed questionnaire and were observed up to 7 days in hospital. Echocardiography was done to assess left ventricular ejection fraction (LVEF) by applying Teichholz (cube) formula. Results: 83% of them were males and 17% of them were females. Mean age (±SD) was 52.24±11.59 years (range 34-82 years). The important risk factors among the study subjects, was hypertension (45%) (Male 40.96%; Female 64.7%) followed by Diabetes mellitus (33%) (Male 31.32%; Female 41.17%). Most of the admitted patients could reach in hospital within 4-12 hours of onset of symptoms and most of the patients of acute myocardial infarction had anterior wall involvement (37%). Mild systolic LV dysfunction (52.87%) was revealed in echocardiography among the survivors. Conclusion: The incidence of AMI was seen common among farmers who were mostly hypertensive. Systolic LV dysfunction was common in most patients where anterior wall involvement was present. Bangladesh J Medicine July 2022; 33(1) : 12-18

P5545Predictors of 10-year mortality and re-intervention in patients with multivessel coronary disease, reduced systolic left ventricular function, after complete revascularization by PCI or CABG

Introduction In patients with multivessel coronary disease, the decision on revascularization should be made through a heart team. Whether there is an optimal method and what are the predictors of mortality and repeated interventions is the subject of numerous studies. Purpose To determine what are the predictors of 10-year mortality and repeated interventions in patients with multivessel coronary disease and reduced systolic left ventricular function in which complete revascularization is done through percutaneous coronary intervention (PCI) and surgical aortocoronary bypass (CABG). Methods The survey included 178 patients who underwent elective revascularization of multivessel coronary disease in one center during 2008 through PCI or bypass, according to the heart team's decision. All subjects had a reduced left ventricular systolic function, ejection fraction less than 50%. The study excluded patients with acute coronary syndrome. The basic demographic and clinical characteristics of the subjects and risk factors were analyzed. Results Ten-year mortality was 31.4%, without a significant difference between the examined groups (in the PCI group 25 patients (30.5%) in the bypass group 30 (32.3%), p>0.05). In subjects with letal outcome during 10-year follow-up, lower hemoglobin levels in discharge, enlarged cardiac cavities, increased internal diameter of left ventricle in systole (LVIDs) and enlarged left atrium, lower systolic left ventricular function, higher EUROscore and higher NYHA class in discharge. The enlarged left ventricular diameter in systole (OR 2.28 (1.27–4.11), p=0.006) and the NYHA class (OR 2.49 (1.22–5.08), p=0.012) are independent predictors ten-year mortality. In the group of patients undergoing surgical revascularization, independent predictors of 10-year mortality are higher levels of uric acid (OR 1,006 (1,000–1,011), P=0,047) and lower serum hemoglobin at discharge (OR 0,959 (0,919–0,999), P=0.046), while in PCI group LVIDs (OR 2.89 (1.351–6.196), p=0.006). During the 10-year follow-up, repeated PCI was performed in 12 (14.5%) patients in the PCI group and in 3 (3.2%) patients in the CABG group, p=0.012. No surgical revascularization was performed during follow up. Diabetes mellitus is an independent predictor of reintervention in the PCI group (OR 4.12 (1.153–14.703), p=0.029). Conclusion Mortality predictors during ten years of follow-up in subjects following a revascularization of multivessel coronary disease, and with reduced left ventricular systolic function, are increased systolic left ventricular diameter and higher NYHA class in discharge. Reintervention is more commonly performed after PCI and the presence of diabetes mellitus is an independent predictor.

Can troponin-I be used as an independent predictor of cardiac dysfunction after supraventricular tachycardia in children with structural normal heart?

Introduction. Elevated cardiac troponin gives excellent accuracy in the identification of myocardial damage in children, but it can also be elevated in a series of other diseases. Case report. We presented two children thirteen years of age with a high serum level of troponin-I after an acute episode of supraventricular tachycardia. We analyzed troponin- I levels in correlation with the maximum heart rate, duration of tachycardia and systolic left ventricular function (ejection fraction and fractional shortening). Conclusion. Abnormal troponin level can be seen in children with sustained supraventricular tachycardia and normal heart. Caution is advised in diagnosing cardiac dysfunction in children with supraventricular tachycardia and elevated troponin levels.

Hemodialysis Effect on Systolic Left Ventricular Function in Stage V Chronic Kidney Disease Patients

Chronic kidney diasease (CKD) is one of world health problem with increased incidence. Kidney function impairment contribute to cardiovascular complication that has been the main cause of CKD patient death. The impairment of cardiovascular function mainly caused by decreased of systolic left ventricular function. Stage V CKD patients need renal replacement therapy such as hemodialysis. Hemodialysis known to has positive effect on cadiovascular function by decreasing volume overload and uremic toxin. Echocardiography is a non-invasive method to assess cardiovascular function i.e. systolic left ventricular function. The aim of this study is to describe the improvement of systolic left ventricular function in stage V CKD patients after going through hemodialysis. The subject of this study are 30 patients, ≥18 years old diagnosed with Stage V CKD and undergo routine hemodialysis in RSD dr. Soebandi Jember. The data analyzed with Wilcoxon test and shown significance (p=0,000). This study concludes there is a significant improvement on systolic left ventricular function in CKD patients before and after hemodialysis in RSD dr. Soebandi Jember. Keywords: Systolic Left Ventricular Function, Hemodialysis, Chronic Kidney Disease, Echocardiography

Cardiomyopathy Associated with Zinc Deficiency after Bariatric Surgery

Noncompliance with vitamin and mineral supplement protocol after bariatric surgery may lead to true-elements deficiency. Among them, zinc and selenium deficiencies were closely related to cardiac complications, such as myocardial fibrosis, heart failure, and arrhythmias.We describe a 30-year-old female, 6 weeks after delivery and 5 years after bariatric surgery, who was admitted to the cardiology department because of dyspnea and clinical evidence of heart failure, as well as an echocardiogram that demonstrated reduced systolic left ventricular function. Standard antifailure regimen shows mild benefit. Zinc supplements added to treatment lead to significant clinical and echocardiographic improvement.

Serial Case of Twiddler Syndrome

Background: Twiddler syndrome is an infrequent but potentially dangerous complication of device therapy for dysrhythmias. This syndrome results from manipulation of implanted pulse generator by the patient, leading to traction and subsequent lead dislodgement. It can also occur spontaneously. It has been increasingly reported with pacemaker or implantable cardioverter-defibrillators (ICDs). In this reports, we describe two patients with Twiddler syndrome with substantial retraction of their lead who denied any manipulation of their device.Case Illustration: The first patient was a 56 year-old man with single-chamber ICD due to dilated cardiomyopathy (DCM) with congestive heart failure and severe systolic left ventricular dysfunction (ejection fraction 18%). The dislodged lead causing rhythmical twitching of left pectoral muscles and abdominal pulsations. The second patient was a 69 year-old man with dual-chamber pacemaker due to total atrioventricular block with normal systolic left ventricular function (ejection fraction 70%). It manifested as dyspnea on effort, and he also underwent pacemaker implantation. They underwent primary devices implantation at April 2016 and reposition of generators and its leads in December 2016. The first and second patients denied of manipulating the generator of ICD or pacemaker and rotated their left arm and right arm, respectively, after implantation.Summary: Other unconscious arm abduction during sleep or increased muscular activity of the shoulder and arm might have led to repetitive motions within the pocket and dislodge the device. Adequate individualized patient and family education and regular evaluation every 6 month of the leads position with fluoroscopy or chest X-ray is advisable.

Intravenous immunoglobulins in children with new onset dilated cardiomyopathy

BackgroundDilated cardiomyopathy is a rare but serious disorder in children. No effective diagnostic or treatment tools are readily available. This study aimed to evaluate the efficacy of intravenous immunoglobulins in children with new onset dilated cardiomyopathy.Methods and resultsIn this retrospective cohort study, 94 children with new onset dilated cardiomyopathy were followed during a median period of 33 months. All patients with secondary dilated cardiomyopathy – for example, genetic, auto-immune or structural defects – had been excluded. Viral tests were performed in all patients and 18 (19%) children met the criteria for the diagnosis “probable or definite viral myocarditis”. Intravenous immunoglobulins were administered to 21 (22%) patients. Overall transplant-free survival was 75% in 5 years and did not differ between treatment groups. The treatment was associated with a higher recovery rate within 5 years, compared with non-treated children (70 versus 43%, log rank=0.045). After correction for possible confounders the hazard ratio for recovery with intravenous immunoglobulins was not significant (hazard ratio: 2.1; 95% CI: 1.0–4.6; p=0.056). Administration of intravenous immunoglobulins resulted in a greater improvement in the shortening fraction of the left ventricle.ConclusionIn our population of children with new onset dilated cardiomyopathy, of either viral or idiopathic origin, intravenous immunoglobulins were administered to a minority of the patients and did not influence transplant-free survival, but were associated with better improvement of systolic left ventricular function and with better recovery. Our results support the concept that children with new onset dilated cardiomyopathy might benefit from intravenous immunoglobulins.