Pakistan Heart Journal最新文献

{"title":"Fluoroscopy versus Transthoracic Echocardiography for Detection of Mitral Valve Calcification in Patients Undergoing Percutaneous Mitral Balloon Valvuloplasty","authors":"Romana Awan, M. N. Mengal, Zia Yaqoob, M. F. Khanzada, Mahlika Ahmad, Muhammad Ashar, Areeb Ahmed Khan","doi":"10.47144/phj.v56i2.2416","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2416","url":null,"abstract":"Objectives: Rheumatic heart disease remains a significant problem in developing countries, with mitral stenosis (MS) being a frequent manifestation. The objective of this study was to compare transthoracic echocardiographic (TTE) findings of mitral valve calcification with fluoroscopy.\u0000Methodology: This cross-sectional study was conducted at the department of adult cardiology, National Institute of Cardiovascular Diseases (NICVD) Karachi. All patients were candidates for percutaneous mitral balloon valvuloplasty (PMBV), aged between 15 to 65 years of either gender. Patients who underwent TTE were subjected to fluoroscopy before PMBV. The Kappa coefficient was calculated to assess the agreement between the two modalities. An appropriate t-test or Mann-Whitney U test was applied, and a p-value ≤ 0.05 was taken as the criterion for statistical significance.\u0000Results: A total of 160 patients were included in this study with a mean age of 34.01± 12.32 years, 119 (74.4%) were between 18 to 40 years of age, and 108 (67.5%) were female. Calcification was observed in 40.6% (65) on echocardiography and 50.6% (81) of the patients on fluoroscopy. A substantial agreement was observed between the two modalities with a Kappa coefficient of 0.75 for the detection of calcification.\u0000Conclusion: No significant difference was observed in the detection of calcification on echocardiography and fluoroscopy, along with a substantial agreement between the two modalities for the detection of calcification. Echocardiography can be a less invasive alternative to fluoroscopy for the detection of calcification before PMBV.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48218755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of ST-Segment Elevation Myocardial Infarction in a Cohort of Cardiogenic Shock Patients Undergoing Primary Percutaneous Coronary Intervention","authors":"Rajesh Kumar, K. Khan, Kubbra Rahooja, Kalsoom Chachar, Muhammad Qasim Khan, Ahsan T. Ali, Ali Bin Naseer, Abdul Basit, M. Rasool, Uroosa Safdar, Abiha Urooj, A. Hussain, M. Ishaq, Anesh Wadhwa, Fawad Farooq, Sohail Q Khan, J. Sial","doi":"10.47144/phj.v56i2.2578","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2578","url":null,"abstract":"Objectives: The objective of this study was to investigate the immediate and short-term mortality rates among patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS) who underwent primary percutaneous coronary intervention (PCI). Methodology: This observational study was conducted at a tertiary care cardiac center in Pakistan. We included consecutive patients diagnosed with STEMI complicated by CS who underwent primary PCI. We analyzed the clinical characteristics, management strategies, and in-hospital as well as short-term follow-up outcomes of the patients. Results: A total of 200 patients were included in the study, of which 74.5% (149) were male, and the mean age was 57.96 ± 12.52 years. The majority of patients were classified as Killip class III (64.0%, 128), while the remaining were classified as Killip class IV. On arrival, arrhythmias were observed in 37.5% (75) of the patients, 27.5% (55) were in cardiac arrest and 84.5% (169) required intubation. Intra-aortic balloon pump (IABP) placement was performed in 31.5% (63) of the patients, and temporary pacemakers (TPM) were placed in 18.5% (37). The in-hospital mortality rate was found to be 10.5% (21). During a mean follow-up period of 177 days (141.5-212.5), a cumulative major adverse cardiovascular event (MACE) was observed in 48% (96) of the patients, with an all-cause mortality rate of 28% (56). Additionally, re-infarction occurred in 7.5% (15) of the patients, and re-hospitalization due to heart failure was noted in 23.5% (47) of the patients. Conclusion: Our study revealed an in-hospital mortality rate of 10.5% following primary PCI in patients with CS. At approximately six months after the acute event, nearly half of the patients experienced MACE, with a notable mortality rate of 28%. These findings highlight the critical nature of CS and emphasize the need for further research and interventions to improve outcomes in this high-risk patient population.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45964619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of NOACS in Extremes of Body Weight","authors":"S. Raza, H. N. Tun","doi":"10.47144/phj.v56i2.2579","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2579","url":null,"abstract":"Certain physiological phenomena in our body lead to severe changes in body weight leading to obesity. If needed, currently, there is no specific regimen for using novel oral anticoagulants (NOACs) in obese patients. It has been found that fixed doses of NOACs bring out more drug exposure to lower BMI patients, whereas it brings out lesser blood drug levels in patients with higher BMI.1\u0000When researchers evaluated NOACs in patients with atrial fibrillation (AF) or venous thromboembolism (VTE), most randomized trials did not exclude body weight from the studies. Hence, the subgroup analysis of these trials showed no considerable difference in outcomes in obese patients.2 The International Society on Thrombosis and Haemostasis showed that NOACs are safer in patients with a body weight of ≤ 120 kg (BMI ≤40 kg/m2)  at the usual dose as compared to patients with a body weight of >120 kg (BMI >40 kg/m2).2\u0000Several retrospective studies have shown suboptimal plasma concentrations (in 20%-28% of obese patients studied) with dabigatran and rivaroxaban compared to apixaban.3 Dose reduction is recommended for apixaban if body weight is ≤ 60 kg (in addition to age and renal function). Reduction in the dose of edoxaban is recommended due to the pharmacokinetic property of high systemic exposure in low body weight patients.4\u0000For patients with body weight > 120 kg or BMI > 40 kg/m2, it is suggested to use rivaroxaban and apixaban, while dabigatran, edoxaban, and betrixaban should be avoided.5\u0000For patients with a body weight <60 kg, renal function should be assessed before adjusting the dose of NOACs. These patients overestimate renal function due to lower body muscle mass. Old age and frailty should also be considered, as these factors are related to bad outcomes in patients with low body weight.6 It is suggested to use apixaban (after taking a renal impairment and age into consideration) and edoxaban with caution in low-body weight patients.7 Dabigatran serves as a less-than-ideal drug for low-body weight patients due to high systemic exposure. No conclusive data is available for rivaroxaban.8\u0000Due to a lack of clinical interest in this population subset of extreme body weight changes, we need more data, which leads to the need for more extensive work in this domain, revealing clear answers in the future.\u0000References\u0000\u0000Abarca-Gómez L, Abdeen ZA, Hamid ZA, Abu-Rmeileh NM, Acosta-Cazares B, Acuin C, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627-42.\u0000Antonopoulos AS, Oikonomou EK, Antoniades C, Tousoulis D. From the BMI paradox to the obesity paradox: the obesity-mortality association in coronary heart disease. Obes Rev. 2016;17(10):989-1000.\u0000Lavie CJ,  Milani  RV, Ventura    Obesity  and  cardiovascular  disease:  risk  factor,  paradox,  and  impact  of  weight  loss. J  Am","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44162185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Arterial Disease in Patients of Aortic Stenosis and Associated In-Hospital Complications after Surgical Management","authors":"Salman Abbas, M. N. Khan, N. Soomro, Khalid Naseeb, Shams Rehan, Haris Majeed","doi":"10.47144/phj.v56i2.2485","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2485","url":null,"abstract":"Objectives: This study aimed to determine the frequency of coronary artery disease (CAD) and its complications following surgical management in patients with aortic stenosis (AS).\u0000Methodology: This descriptive case series included 113 patients, both male and female, aged between 40 and 80 years, diagnosed with severe AS. All patients underwent coronary angiography prior to surgical management to assess the presence of CAD. Postoperatively, patients were monitored during their hospital stay for up to 72 hours, and complications such as major bleeding, acute kidney injury (AKI), stroke, and mortality were recorded.\u0000Results: The study included 113 patients with a mean age of 55.4±12.4 years, of whom 63 (55.8%) were male. Positive family history of CAD was found in 24 (21.2%) patients. CAD was observed in 65 (56.6%) patients. In-hospital complications were as follows: major bleeding occurred in 7 (6.2%) patients, AKI in 13 (11.5%), stroke in 10 (8.8%), and mortality in 3 (2.7%) patients. Mortality rates were 4.7% vs. 0% (p=0.125), stroke rates were 14.1% vs. 2% (p=0.026), and AKI rates were 17.2% vs. 4.1% (p=0.023) for patients with and without CAD, respectively.\u0000Conclusion: The prevalence of CAD was found to be high in more than half of the patients with severe AS. The presence of CAD was associated with an increased risk of mortality and complications such as stroke and AKI. It is crucial to identify the underlying risk factors for CAD in this patient population in order to effectively address the burden of the disease and optimize management strategies accordingly.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47358656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiarrhythmic Drugs vs. Ablation for Atrial Fibrillation","authors":"G. Irfan","doi":"10.47144/phj.v56i2.2583","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2583","url":null,"abstract":"Summary: \u0000Atrial fibrillation (AF) is a common and potentially life-threatening cardiac arrhythmia that affects millions of individuals worldwide. The treatment landscape for AF has traditionally comprised antiarrhythmic drugs (AADs), which aim to restore and maintain normal heart rhythm. However, over the past two decades, catheter ablation has emerged as an alternative therapeutic approach in the management of AF. This article systematically compares the effectiveness, safety, and long-term outcomes of AADs and catheter ablation as treatment strategies for atrial fibrillation. \u0000Introduction: \u0000Atrial fibrillation (AF) is characterized by disorganized electrical activity in the atria, causing irregular and often rapid heart rhythm. Over the years, pharmacological therapy with antiarrhythmic drugs (AADs) has been the mainstay of AF treatment. Nonetheless, catheter ablation has gained significant momentum due to its ability to directly target the arrhythmogenic substrate within the heart.1 \u0000Efficacy: \u0000 \u0000Antiarrhythmic Drugs: Various classes of AADs inhibit specific ion channels or receptors to normalize cardiac electrical conduction. While AADs can effectively restore sinus rhythm in many patients, their long-term success in maintaining sinus rhythm is modest, with recurrence rates ranging from 40% to 60% within one year.2 \u0000Catheter Ablation: Ablation procedures selectively target and destroy the abnormal electrical pathways contributing to AF. In well-selected patients, catheter ablation has demonstrated higher efficacy rates than AADs, particularly in paroxysmal AF, with success rates reaching 70-80% or more after a single procedure.2 \u0000 \u0000Safety Profile: \u0000 \u0000Antiarrhythmic Drugs: Although generally well-tolerated, AADs have notable adverse effects, including pro-arrhythmia, organ toxicity, and drug-drug interactions. These side effects often limit their usage or require careful patient monitoring.3 \u0000Catheter Ablation: While catheter ablation is generally safe, it has a finite risk of procedural complications, such as vascular injury, cardiac perforation, and stroke. Nonetheless, the overall complication rate is low, ranging from 1% to 5%, and is further decreasing with advancements in technology and operator experience.3 \u0000 \u0000Quality of Life and Symptom Control: \u0000 \u0000Antiarrhythmic Drugs: Effective rate control with AADs can significantly improve symptom burden and quality of life in patients with persistent or permanent AF.4 \u0000Catheter Ablation: Successful ablation procedures can offer long-term freedom from AF symptoms, eliminating or reducing the dependence on AADs and their associated side effects.4 \u0000 \u0000Long-Term Outcomes: \u0000 \u0000Antiarrhythmic Drugs: AAD therapy is often lifelong, and patients may require multiple medication adjustments due to loss of efficacy or intolerable side effects. However, AADs remain a treatment option for patients with contraindications for ablation or in those who prefer medical management.4 \u0000Catheter Ablation: Successful abl","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45524075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of Serum ADMA Levels as a Biomarker for Assessing Cardiovascular Risk in Patients with Coronary Heart Disease: A Study from a Tertiary Care Hospital in Pakistan","authors":"Faisal Shehzad Roomi, Syed Qaisar Abbas, M. H. Raza","doi":"10.47144/phj.v56i2.2554","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2554","url":null,"abstract":"Objectives: The diagnostic potential of serum asymmetric dimethylarginine (ADMA) levels as a biomarker for cardiovascular risk has been investigated in various populations, but no such study has been reported in Pakistan. This study aimed to assess the diagnostic efficiency of serum ADMA levels in detecting cardiovascular risk in patients with coronary heart disease (CHD).\u0000Methodology: A cross-sectional study was conducted at the Chaudhry Pervaiz Elahi Institute of Cardiology (CPEIC), Wazirabad, Pakistan, using a consecutive sampling technique to ensure randomization. One hundred individuals were divided into two groups (CHD patients and healthy controls), and blood samples were collected between January 2022 and November 2022. Serum ADMA levels were measured using an enzyme-linked immunosorbent assay (ELISA), and statistical analysis was performed to determine the area under the receiver operating characteristic (ROC) curve (AUC).\u0000Results: The mean age of CHD patients' serum samples was 58.6 ± 7.39 years (p<0.001) compared to 42.26 ± 14.4 years (p<0.001) in healthy controls. The mean ADMA concentration in the serum of CHD patients was determined as 1.37 ± 0.26 µmol/L (p<0.001) compared to 0.812 ± 0.207 µmol/L (p<0.001) in healthy controls. The AUC on the ROC curve was determined as 0.95, indicating high diagnostic accuracy. ADMA's sensitivity, specificity, and overall accuracy were determined as 82%, 88%, and 85%, respectively.\u0000Conclusion: In conclusion, serum ADMA levels demonstrate a promising potential as a biomarker for assessing cardiovascular risk. The findings of this study suggest that ADMA measurements could be utilized as a diagnostic tool in CHD patients, aiding in the identification and management of cardiovascular risk in the Pakistani population. Further research is warranted to validate these findings and explore the utility of ADMA in more extensive and diverse cohorts.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45889747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ticagrelor versus Clopidogrel, Drug of Choice for the Prevention of Stent Thrombosis after Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials","authors":"M. Ishaq, Nimra Ashraf, G. Chand, S. Khatti, Abdul Mueed, Ahmed Raheem","doi":"10.47144/phj.v56i2.2520","DOIUrl":"https://doi.org/10.47144/phj.v56i2.2520","url":null,"abstract":"Objectives: The objective of this meta-analysis of randomized controlled trials was to compare the efficacy of ticagrelor versus Clopidogrel for preventing stent thrombosis (ST) following percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS).\u0000Methodology: A comprehensive literature search was conducted using MEDLINE/PubMed, EMBASE, Web of Science, and the Cochrane Library. The inclusion criteria involved selecting randomized controlled trials that included patients with ACS undergoing PCI, comparing the use of ticagrelor and Clopidogrel, having a follow-up period of at least 30 days, and reporting data on ST. The meta-analysis was performed using the R statistical software version 4.1.1, and the \"meta\" package was utilized. The Mantel-Haenszel method was employed to calculate the relative risk (RR) and corresponding 95% confidence interval (CI) for comparing the risk of ST between the two treatment groups.\u0000Results: A total of seven randomized controlled trials were included in the analysis, comprising a population of 28,609 patients with ACS who were randomized to receive either ticagrelor or Clopidogrel in a ratio of 12,116:16,493. The cumulative rate of ST was found to be 2.2% (185/8,423) in the ticagrelor group and 2.7% (347/12,851) in the clopidogrel group. The meta-analysis revealed a significant decrease in the rate of ST with ticagrelor compared to Clopidogrel, demonstrating a relative risk of 0.71 (95% CI: 0.59 to 0.85). No heterogeneity was detected among the included studies, as indicated by an I2 value of 0% and a p-value of 0.463.\u0000Conclusion: In conclusion, the findings of this meta-analysis suggest that ticagrelor is a significantly more effective P2Y12 inhibitor than Clopidogrel for preventing ST following PCI in patients with ACS. These results support using ticagrelor as the preferred antiplatelet therapy in this patient population.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49173744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrocardiogram Changes in Patients with Positive Troponin I Presenting with Non-ST-Elevation Myocardial Infarction","authors":"Raheela Khowaja, A. Khowaja, Waqar Khan, A. Ammar, M. Khursheed, J. Sial","doi":"10.47144/phj.v56i1.2385","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2385","url":null,"abstract":"Objectives: Unlike “ST-segment elevation myocardial infarction (STEMI)”, there is a wide spectrum of ECG changes for Non-STEMI (NSTEMI) patients with varying prognostic implications. Therefore, the purpose of this study was to determine the frequency of ECG changes in patients with positive high-sensitive troponins (hs-cTn) presenting with NSTEMI.\u0000Methodology: This Cross sectional study included 282 patients with positive hs-cTn diagnosed with NSTEMI. Standard 12-lead ECG was performed for all the patients. The clinical profile and ECG changes such as ST elevation in aVR, T wave inversion, and ST depression were noted.\u0000Results: Out of 282 patients, 68.1% (192) were male, mean age was 58.5 ± 10.6 years, 56.7% (160) were hypertensive, and 39.7% (112) were diabetic. The ECG was normal in 8.2% (23) while, 64.5% (182) had ST-depression, out of which 1.1% (2) had ST-depression of <1mm, 78% (142) had ST-depression of 1-2mm, and remaining 20.9% (38) had ST-depression of >2mm. T-wave inversions were observed in 45.7% (129). ST-elevation of ≥1 mm in lead aVR was noted in 19.1% (54) patients.\u0000Conclusion: A considerable number of NSTEMI patients with positive hs-cTn showed no specific ECG changes. ST-depression followed by T wave inversion and ST-elevation in aVR were the most commonly observed ECG findings in these patients. Considering the prognostic implications and association of these changes with the severity of diseases, prompt decision-making regarding invasive management strategy could be helpful in improving the outcomes of these patients.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43061065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Transmitral Commissurotomy - Clinical and Echocardiographic Follow-up in Severe Mitral Stenosis","authors":"Bella Khan, Romana Awan, Saba Hussain, T. Saghir, Yasir Paracha","doi":"10.47144/phj.v56i1.2400","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2400","url":null,"abstract":"Objectives: To study the long term clinical and echocardiographic outcomes of percutaneous Trans mitral balloon commissurotomy (PTMC) performed in patients with severe mitral stenosis.\u0000Methodology: Total 103 patients were enrolled in this study. Their PTMC procedure was performed between the years 2015 to 2019. Those patients who returned for follow-up in the year 2021 were enrolled. At the time of follow-up their clinical and echocardiographic parameters were recorded.\u0000Results: The mean age was 27.44±6.26 years and 97 (94.2%) of them were female. Mitral valve area was improved significantly, planimetry; 0.813±1.39 vs. 1.288±0.21cm2 and PHT; 0.871±0.13 vs. 1.336±0.19 cm2 between baseline and follow-up, respectively. Pressure gradient across mitral valve also improved 7.233±2.81 vs. 14.407±0.92 mmHg between baseline and follow-up, respectively. Pulmonary artery pressures were also reduced significantly 24±0.27 vs. 55±2.41 mmHg as well as the right ventricular systolic pressures 24.4±2.94 vs. 62.34±10.98 mmHg between baseline and follow-up, respectively. At follow-up, 70.9% had NYHA I class, 16.5% had NYHA II class, 11.7% had NYHA III class, and 1% had NYHA IV class compared to 6.8%, 5.8%, 33.9%, and 53.4% pre-procedure, respectively.\u0000Conclusion: Long term follow-up of patients after PTMC showed satisfactory outcomes both clinically, as evident from improvement in NYHA functional class, and from echocardiographic stand point with sustained increase in mitral valve area over the period of years. Overall the results of PTMC performed in patients with severe mitral stenosis are satisfactory.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42777246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nocturnal Blood Pressure Assessment, an Entity of High Prognostic Value, Not Utilized to Its Potential in Clinical Practice","authors":"Imran Hameed","doi":"10.47144/phj.v56i1.2469","DOIUrl":"https://doi.org/10.47144/phj.v56i1.2469","url":null,"abstract":"Hypertension, a disease of epidemic proportion, is assessed by measuring blood pressure (BP). Various methods are employed, the most common being “clinic blood pressure measurement (CBPM).” However, environment and technical errors can confound it. Other methods include home blood pressure measurement (HBPM), which shows readings of awake time only, and 24-hour ambulatory blood pressure monitoring (ABPM). A recent technique that causes less sleep disturbance is “timed HBPM.” Blood pressure is a 24-hour phenomenon, and prognostically night time blood pressure, being more important, must be assessed properly. Besides providing the precise mean of 24-hour blood pressure, it extends knowledge regarding many other parameters of clinical importance like dipping pattern and morning surge etc. For nocturnal BP assessment, 24-hour ABPM and time-triggered HBPM are utilized. The importance of nocturnal blood pressure assessment for diagnostic and prognostic evaluation of various cardiovascular and non-cardiovascular conditions would be highlighted in this review article.","PeriodicalId":42273,"journal":{"name":"Pakistan Heart Journal","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45390130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}