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Appropriateness Use Criteria of Trans-Thoracic 2D-Echocardiography Among Adult Patients in the Philippine General Hospital
Danielle Louis Villanueva,
Marion Patricio,
Jose Donato Magno,
Felix Eduardo Punzalan
Issue:
Volume 4, Issue 2, June 2020
Pages:
27-33
Received:
6 March 2020
Accepted:
23 March 2020
Published:
14 April 2020
Abstract: Background: There is an increasing utilization rate and clinical importance of performing echocardiography especially in a tertiary referral center such as the UP-PGH. An appropriate use criteria (AUC) in echocardiography is essential to improve clinical outcomes while preserving hospital and patient resources. Methods: We reviewed the echocardiographic requests of patients referred for transthoracic 2d-echocardiography. Echocardiography indication were documented mainly using the echocardiography order/request form. The echocardiography indications were adjudicated by at least two investigators. If there was more than one indication that fit into the AUC 2011, the most appropriate one was retained. Results: A total of 1006 echocardiographic requests were included in this study. The patients were predominantly males (68.2%) and with a mean age of 56.27 16.89. majority of the referrals came from the medicine wards (37.3%). The top three cardiac diagnosis are: Heart Failure (25.9%), Acute Coronary Syndrome (20.7%) and Hypertension (15.5%). Of the top 15 most common indications, 11 were appropriate while 2 were maybe appropriate, and 2 were rarely appropriate. The three most common specific indication is the evaluation for heart failure (21.4%), the search for a cardiac etiology for a particular symptom (14.3%) and the initial evaluation of a suspected hypertensive heart disease (9.9%). The most common rarely appropriate indication is the routine perioperative evaluation of ventricular function (5.5%). Majority of the echocardiography requests have appropriate indications (87.9%). Conclusion: This is the first application of the AUC to the transthoracic 2d-echo here in the Philippines. The transthoracic 2D-echocardiography done in the Philippine General Hospital have mostly appropriate indications.
Abstract: Background: There is an increasing utilization rate and clinical importance of performing echocardiography especially in a tertiary referral center such as the UP-PGH. An appropriate use criteria (AUC) in echocardiography is essential to improve clinical outcomes while preserving hospital and patient resources. Methods: We reviewed the echocardiogr...
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The Degree of Retinopathy Correlates with the Presence of Silent Myocardial Ischemia in Diabetic Patients
Ehab El-Hefny,
Abdel Mageed Tag El-Din,
Ayman Sadek,
Eslam Abbas
Issue:
Volume 4, Issue 2, June 2020
Pages:
34-46
Received:
28 February 2020
Accepted:
16 March 2020
Published:
21 April 2020
Abstract: Background: Silent myocardial ischemia is a major component of the total ischemic burden for patients with ischemic heart disease. The disease is more prevalent in diabetic patients than their peers, and early detection of the high-risk group would play an integral role in the prevention of sudden cardiovascular accidents that are common in these patients. Methods: A prospective cohort study including asymptomatic 53 diabetic patients with diabetic retinopathy who suffer no ischemic cardiac symptoms was conducted. The presence and degree of diabetic retinopathy were evidenced using fundus examination and optical coherence tomography. All the enrolled patients underwent stress-resting 99mTc SestaMIBI myocardial perfusion scintigraphy to detect the ischemic burden. The relation between diabetic retinopathy and silent myocardial ischemia was stratified using statistical analysis. Results: A total of 13 diabetic patients (24.5%) have silent myocardial ischemia in the form of regional myocardial perfusion abnormalities. The strongest predictors of abnormal tests were the presence of moderate to severe retinopathy, comorbid hypertension and diabetic duration for more than 10 years. Conclusion: Silent myocardial ischemia affects one in four asymptomatic diabetic patients suffering from diabetic retinopathy. The presence of comorbid risk factors such as high-grade retinopathy, hypertension and/or long diabetic duration surge the incidence and considered additional predictors of the disease.
Abstract: Background: Silent myocardial ischemia is a major component of the total ischemic burden for patients with ischemic heart disease. The disease is more prevalent in diabetic patients than their peers, and early detection of the high-risk group would play an integral role in the prevention of sudden cardiovascular accidents that are common in these p...
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The Use of a Modified Blood Pressure Device to Detect Atrial Fibrillation in Outpatients
Haroldas Razvadauskas,
Laima Jankauskienė,
Albinas Naudžiūnas
Issue:
Volume 4, Issue 2, June 2020
Pages:
47-51
Received:
6 March 2020
Accepted:
24 March 2020
Published:
21 April 2020
Abstract: The prevalence and integration of self-monitoring devices is increasing across healthcare systems, [1] and this is leading to patients taking greater responsibility for their health and well-being. Our aim was to compare two groups of patients with reoccurring atrial fibrillation (AF) and their ability to detect AF with the Microlife BP A6 device. The groups were divided according to being symptomatic or asymptomatic for AF. Method: The study was conducted for 3 years. The patients were selected from Kaunas clinical hospital in Kaunas, Lithuania. In total, 60 people took part in the study. The major criterion for inclusion was based on patients having AF upon arrival. During the period of hospitalisation, they were restored to having sinusoidal rhythm (SR). There were two groups of patients in the study. The first group had clear symptoms during the onset of rhythm disturbance and the second group was asymptomatic. All patients under the age of 18 years and those who did not sign the agreement to participate were excluded from the study. The patients were contacted every 6 months by phone call and a questionnaire was filled. The statistical analysis was performed using SPSS 23 and Microsoft Office Excel 2007 software. The results were deemed statistically significant when p<0.05. Results: There is a statistical difference between the symptomatic and asymptomatic AF patients as compared to how useful they found the device and its effect on anxiety (p<0.05). There was no statistical difference between the two groups on how frequently they used the device. The research also shows that there was no difference based on gender, education levels. Conclusion: There is a statistically significant portion of AF asymptomatic patients that find the Microlife BP A6 “very useful” and an anxiety reliever as compared to patients that are symptomatic for the condition. Both groups have statistically equally poor adherence in using the device at home.
Abstract: The prevalence and integration of self-monitoring devices is increasing across healthcare systems, [1] and this is leading to patients taking greater responsibility for their health and well-being. Our aim was to compare two groups of patients with reoccurring atrial fibrillation (AF) and their ability to detect AF with the Microlife BP A6 device. ...
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Use of Bromocriptine for the Treatment of Peripartum Cardiomyopathy: A Meta-Analysis of Randomized Controlled Trials
Danielle Louis Villanueva,
Lauren Kay Evangelista,
Cristina Espanillo-Villanueva,
John Anonuevo
Issue:
Volume 4, Issue 2, June 2020
Pages:
52-58
Received:
6 March 2020
Accepted:
1 April 2020
Published:
21 April 2020
Abstract: Background Peripartum cardiomyopathy is a rare, pregnancy associated cause of left ventricular heart failure in previously healthy women. It remains an important cause of cardiac-related maternal morbidity and mortality worldwide. Half of the patients will recover left ventricular function after 6 months. However, in the remainder of patients who do not recover cardiac function, they will require advanced heart failure therapies. Bromocriptine, a dopamine agonist which inhibits prolactin release, has demonstrated improvement in left ventricular recovery and clinical outcome. We sought to determine the effect of adding Bromocriptine to standard heart failure therapy on the improvement and recovery of left ventricular function and cardiovascular mortality of these patients. Inclusion Criteria. Studies were included if they satisfied the following criteria:1) Randomized Controlled Trials; 2) Pregnant patients who fulfilled the criteria for diagnosis of peripartum cardiomyopathy and 3) Reported data on improvement in left ventricular ejection fraction and clinical outcomes. Methods. Using PUBMED, Clinical Key, Science Direct, Scopus, and Cochrane databases, a search for eligible studies was conducted from June to December 31, 2018. The quality of each study was evaluated using the Cochrane Risk of Bias Tool. The primary outcome of interest is on the effect of Bromocriptine on the improvement of left ventricular function and clinical outcomes among these patients. Review Manager 5.3 was utilized to perform analysis of random effects for continuous outcomes. Results. We identified 2 randomized controlled trials of 116 pregnant patients diagnosed with peripartum cardiomyopathy, showing that among those who received Bromocriptine on top of standard heart failure therapy, there is a significant improvement in the left ventricular ejection fraction at 6 months [mean difference 15.14 (95% CI, 6.53 to 23.75) p <0.05] compared to standard heart failure therapy alone. It was also observed that those who received Bromocriptine had better clinical outcomes. Conclusion. The addition of Bromocriptine on top of standard heart failure therapy significantly improved the left ventricular ejection fraction of patients with peripartum cardiomyopathy at 6-months post-partum. This novel therapy may be considered to improve the management of these patients.
Abstract: Background Peripartum cardiomyopathy is a rare, pregnancy associated cause of left ventricular heart failure in previously healthy women. It remains an important cause of cardiac-related maternal morbidity and mortality worldwide. Half of the patients will recover left ventricular function after 6 months. However, in the remainder of patients who d...
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Two Dimensional Speckle Tracking Echocardiography Assessment of Left Ventricular Remodeling in Patients After Myocardial Infarction
Moustafa Kamal Eldin Ibrahim,
Khalied Ahmad Emam El-khashab,
Tamer Mosaad Elsaed Ragab
Issue:
Volume 4, Issue 2, June 2020
Pages:
59-66
Received:
26 March 2020
Accepted:
10 April 2020
Published:
30 April 2020
Abstract: Background: Adverse left ventricular remodelling (LVR), defined as progressive ventricular dilatation, distortion of chamber shape, myocardial hypertrophy, and deteriorating function, which if uninterrupted leads to congestive heart failure (CHF) and a poor clinical outcome, begins in some patients with acute myocardial infarction (AMI) even after successful percutaneous coronary intervention (PCI). Aims: This study aims at evaluating the value of speckle tracking echocardiography in predicting LVR after successful PCI in AMI patients. Materials and Methods: Eighty-four acute myocardial infarction patients. A thorough physical examination, electrocardiography (ECG) and a complete echocardiographic assessment, including speckle tracking study, was performed two days after PCI and then a follow up echocardiography with speckle tracking study was done two months afterwards. Patients were then divided into two groups based on the presence of remodelling (R+, R-). RESULTS: at baseline study global longitudinal strain (GLS) (-11.14±0.5 VS -16.78±0.4, P<0.0001), longitudinal strain rate (LSr) (-1.01±0.05 VS -1.07±0.04, P<0.0001), culprit longitudinal strain (CulLS) (-9.74±0.59 VS -15.68±0.49, P<0.0001), culprit longitudinal strain rate (CulLSr) (-0.95±0.05 VS -1.02±0.04, P<0.0001) were all lower in group R+ than in R-. In the follow up study, all strain parameters studied were significantly lower in the R+ group than R- group. The most sensitive and specific parameters were the GLS and CulLS (sensitivities of 91.7% and 95.8% respectively) and (specificities of 95% and 96.7% respectively). CONCLUSION: Our findings show that impaired indices LV deformation detected two days after successful PCI for AMI may provide predictive value in detecting LV remodelling.
Abstract: Background: Adverse left ventricular remodelling (LVR), defined as progressive ventricular dilatation, distortion of chamber shape, myocardial hypertrophy, and deteriorating function, which if uninterrupted leads to congestive heart failure (CHF) and a poor clinical outcome, begins in some patients with acute myocardial infarction (AMI) even after ...
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Study of Prevalence, Risk Factors and Angiographic Profile of Patients with Myocardial Bridges in a Tertiary Care Hospital, Dhaka, Bangladesh
Solaiman Hossain,
Moeen Uddin Ahmed,
Md. Abdul Mannan,
Md. Shahimur Parvez,
Debasish Debnath,
Md. Mahidur Rahman,
Anup Kumar Das
Issue:
Volume 4, Issue 2, June 2020
Pages:
67-70
Received:
28 March 2020
Accepted:
23 April 2020
Published:
15 May 2020
Abstract: Background: Band of Myocardial tissue overlying a segment of an epicardial coronary artery is termed myocardial bridge (MB). The aim of this study was to identify the prevalence, risk factors and angiographic profile of patients with myocardial bridge in a tertiary care hospital, Dhaka, Bangladesh. Materials and Methods: This retrospective observational study included a total of 1480 patients with suspected coronary artery disease admitted to Enam Medical College and Hospital, Savar, Dhaka, Bangladesh for coronary angiography between April 2016 to June 20019 of them 43 cases were found to have myocardial bridge. Coronary compression was defined as a maximum systolic luminal compression ≥50%. In this population, 43 patients had systolic luminal compression ≥50%, and all 43 patients were selected for the study to determine the prevalence and risk factors of MB and recorded coronary angiogram was reviewed to see the angiographic location of MB, length of MB and number of vessels involved. Results: In this study incidence of MB was 2.9%. The risk factors associated with MB hypertension were 33 (76.74%), diabetes mellitus 28 (65.11%), hyperlipidaemia 18 (41.86%), family history of CAD 15 (34.88%), smoking history 22 (51.16%). Located of MB in LAD were 34 (79.06%), LCX 07 (16.27%) and RCA 02 (4.65%). The MB were in single vessel 38 (88.37%) and double vessels 05 (11.62%). MBs with atherosclerotic stenosis in LAD were 18 (41.86%), LCX 02 (4.65%), RCA 01 (2.32%) and severity of MB stenosis were in LAD 50 -70% were 27 (62.79%), >70% were 07 (16.27%), LCX 50-70% were 06 (13.95%) and >70% was 01 (2.32%) and RCA 50-70% was 02 (4.65%). The length of MBs segment <10 mm were 06 (13.95%), 10-20 mm were 25 (58.19%) and >20 mm were 12 (27.90%). Conclusion: In this study the prevalence of MB was 2.91%, commonly presented with chronic stable angina. The most risk factors of myocardial bridges were hypertension, diabetes mellitus, hyperlipidaemia, family history and smoking history. In coronary angiography most of the patient of MB was present in association of acute coronary syndrome with documented coronary artery disease and was mainly located in LAD mid segment and the length of MB was mostly 10-20 mm. Further large numbers of case are needed to validate the result of the study.
Abstract: Background: Band of Myocardial tissue overlying a segment of an epicardial coronary artery is termed myocardial bridge (MB). The aim of this study was to identify the prevalence, risk factors and angiographic profile of patients with myocardial bridge in a tertiary care hospital, Dhaka, Bangladesh. Materials and Methods: This retrospective observat...
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Pattern of Structural Heart Disease and Predictors of Mortality Among Affected Children Seen at the Niger Delta University Teaching Hospital Bayelsa State
Chika Onyinyechi Duru,
Immaculata Ima Tunde-Oremodu,
Onyaye Kunle-Olowu
Issue:
Volume 4, Issue 2, June 2020
Pages:
71-79
Received:
21 April 2020
Accepted:
8 May 2020
Published:
28 May 2020
Abstract: Paediatric structural heart diseases are an important cause of morbidity and mortality especially in developing countries where late presentation and delayed diagnosis and treatment is common. The aim of this study was to describe the pattern of structural heart diseases in children seen in the Paediatric Cardiology Unit of a tertiary hospital in Bayelsa State Nigeria and identify the predictors of mortality among those who died over the study period. It was a retrospective review of cases seen in the paediatric cardiology unit and subsequently followed up over a 7-year period (1st April 2013 to 31st March 2020). Sociodemographic data, clinical features and echocardiographic findings as well as details of their outcome were documented. Data was imputed into an Excel spread sheet and analyzed using SPSS 22.0. Binary logistic regression was performed to determine the risk factors for mortality. Of the 175 children seen by the Cardiology Unit over the study period, 92 (52.6%) had structural heart diseases. The mean age of the children was 39.4±56.2 months with a male: female ratio of 1.6:1. Congenital heart diseases (CHD) were noted in 92% of cases with Atrial septal defects (ASD), followed by Ventricular Septal defects (VSD) and Patent Ductus Arteriosus (PDA) being the most prevalent CHD seen. The combination of ASD/VSD/PDA was the most common multiple structural defect noted. Acquired heart diseases including Rheumatic heart disease and Dilated cardiomyopathy were reported in 8% of cases. Mortalities were recorded in 20 children (21.7%) with most of the deaths occurring as a result of intractable heart failure. Mortality was significantly associated with the third birth order (OR-4.63; p-0.021), fast breathing (OR-2.15; p-0.006), presence of heart failure (OR-3.16; p-0.026), failure to thrive (OR-2.93; p-0.036), use of cardiac medications (OR-6.91; 0.0013) and CHD with multiple structural defects (OR-11.44; p-0.006).
Abstract: Paediatric structural heart diseases are an important cause of morbidity and mortality especially in developing countries where late presentation and delayed diagnosis and treatment is common. The aim of this study was to describe the pattern of structural heart diseases in children seen in the Paediatric Cardiology Unit of a tertiary hospital in B...
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