Karachi Institute of Heart Diseases

Karachi, Pakistan

Karachi Institute of Heart Diseases

Karachi, Pakistan
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PubMed | National Institute of Cardiovascular Diseases, University of Maryland Baltimore County, Tabba Heart Institute, Dow University of Health Sciences and 24 more.
Type: Journal Article | Journal: Journal of the American College of Cardiology | Year: 2016

Although epidemiological studies have reported positive associations between circulating urate levels and cardiometabolic diseases, causality remains uncertain.Through a Mendelian randomization approach, we assessed whether serum urate levels are causally relevant in type 2 diabetes mellitus (T2DM), coronary heart disease (CHD), ischemic stroke, and heart failure (HF).This study investigated 28 single nucleotide polymorphisms known to regulate serum urate levels in association with various vascular and nonvascular risk factors to assess pleiotropy. To limit genetic confounding, 14 single nucleotide polymorphisms exclusively associated with serum urate levels were used in a genetic risk score to assess associations with the following cardiometabolic diseases (cases/controls): T2DM (26,488/83,964), CHD (54,501/68,275), ischemic stroke (14,779/67,312), and HF (4,526/18,400). As a positive control, this study also investigated our genetic instrument in 3,151 gout cases and 68,350 controls.Serum urate levels, increased by 1 SD due to the genetic score, were not associated with T2DM, CHD, ischemic stroke, or HF. These results were in contrast with previous prospective studies that did observe increased risks of these 4 cardiometabolic diseases for an equivalent increase in circulating urate levels. However, a 1 SD increase in serum urate levels due to the genetic score was associated with increased risk of gout (odds ratio: 5.84; 95% confidence interval: 4.56 to 7.49), which was directionally consistent with previous observations.Evidence from this study does not support a causal role of circulating serum urate levels in T2DM, CHD, ischemic stroke, or HF. Decreasing serum urate levels may not translate into risk reductions for cardiometabolic conditions.


PubMed | National Institute of Cardiovascular Diseases, University of Pennsylvania, University of Karachi, Punjab Institute of Cardiology and 7 more.
Type: Journal Article | Journal: International journal of obesity (2005) | Year: 2016

Obesity is a complex disease caused by the interplay of genetic and lifestyle factors, but identification of gene-lifestyle interactions in obesity has remained challenging. Few large-scale studies have reported use of genome-wide approaches to investigate gene-lifestyle interactions in obesity.In the Pakistan Risk of Myocardial Infraction Study, a cross-sectional study based in Pakistan, we calculated body mass index (BMI) variance estimates (square of the residual of inverse-normal transformed BMI z-score) in 14131 participants and conducted genome-wide heterogeneity of variance analyses (GWHVA) for this outcome. All analyses were adjusted for age, age(2), sex and genetic ancestry.The GWHVA analyses identified an intronic variant, rs140133294, in the FLJ33544 gene in association with BMI variance (P-value=3.1 10(-8)). In explicit tests of gene lifestyle interaction, smoking was found to significantly modify the effect of rs140133294 on BMI (Pinteraction=0.0005), whereby the minor allele (T) was associated with lower BMI in current smokers, while positively associated with BMI in never smokers. Analyses of ENCODE data at the FLJ33534 locus revealed features indicative of open chromatin and high confidence DNA-binding motifs for several transcription factors, providing suggestive biological support for a mechanism of interaction.In summary, we have identified a novel interaction between smoking and variation at the FLJ33534 locus in relation to BMI in people from Pakistan.


PubMed | National Institute of Cardiovascular Diseases, University of Pennsylvania, University of Karachi, Punjab Institute of Cardiology and 6 more.
Type: | Journal: BMC medical genetics | Year: 2015

Multiple genetic variants have been reliably associated with obesity-related traits in Europeans, but little is known about their associations and interactions with lifestyle factors in South Asians.In 16,157 Pakistani adults (8232 controls; 7925 diagnosed with myocardial infarction [MI]) enrolled in the PROMIS Study, we tested whether: a) BMI-associated loci, individually or in aggregate (as a genetic risk score--GRS), are associated with BMI; b) physical activity and smoking modify the association of these loci with BMI. Analyses were adjusted for age, age(2), sex, MI (yes/no), and population substructure.Of 95 SNPs studied here, 73 showed directionally consistent effects on BMI as reported in Europeans. Each additional BMI-raising allele of the GRS was associated with 0.04 (SE = 0.01) kg/m(2) higher BMI (P = 4.5 10(-14)). We observed nominal evidence of interactions of CLIP1 rs11583200 (P(interaction) = 0.014), CADM2 rs13078960 (P(interaction) = 0.037) and GALNT10 rs7715256 (P(interaction) = 0.048) with physical activity, and PTBP2 rs11165643 (P(interaction) = 0.045), HIP1 rs1167827 (P(interaction) = 0.015), C6orf106 rs205262 (P(interaction) = 0.032) and GRID1 rs7899106 (P(interaction) = 0.043) with smoking on BMI.Most BMI-associated loci have directionally consistent effects on BMI in Pakistanis and Europeans. There were suggestive interactions of established BMI-related SNPs with smoking or physical activity.


Kazmi W.H.,Karachi Medical and Dental College | Rasheed S.Z.,Karachi Institute of Heart Diseases | Ahmed S.,Karachi Institute of Heart Diseases | Saadat M.,Universal Research Group | And 2 more authors.
Coronary Artery Disease | Year: 2012

Objectives: To determine the efficacy of cardiac shock wave therapy (CSWT) in the management of patients with end-stage coronary artery disease (CAD). Introduction: Patients with end-stage CAD have symptoms such as recurrent angina, breathlessness, and other debilitating conditions. End-stage CAD patients are usually those who have angina pectoris following a coronary artery bypass surgery or a percutaneous coronary intervention. These patients are refractory to optimal medical therapy and not fit for a redo procedure, and are often termed as 'no option' patients. Methods: We carried out a prospective cohort study to examine the effects of CSWT application in patients who had end-stage CAD and were no option patients. Characteristics such as angina class scores and functional status scores among cases (patients with end-stage CAD who received CSWT) and controls (patients with end-stage CAD who did not receive CSWT) were compared at baseline and at 6 months after CSWT therapy. Results: There were 43 patients in the case group and 43 patients in the control group. The mean age of the patients was 58.7±9.5 years in the case group and 56.6±11.6 years in the control group. Other characteristics such as the prevalence of diabetes, hypertension, coronary artery bypass graft and percutaneous coronary intervention were similar in both groups. Clinical results showed a significant improvement in exercise time between the cases and the controls 6 months after treatment with CSWT (20.1±15.7 min in cases vs. 10.1±4.2 min in controls; P<0.0001), and symptomatic improvement in the CCS class scores (1.95±0.80 in cases and 2.63±0.69 in controls; P<0.0001) and NYHA class scores (1.95±0.80 in cases vs. 2.48±0.59 in controls; P<0.001). In the control group, there was no improvement in angina class, functional class and exercise time. Conclusion: The present study shows that CSWT application to the ischemic myocardium in patients with refractory angina pectoris improved symptoms and reduced the severity of ischemic areas at 6 months after CSWT treatment compared with the baseline. No side effects were observed with this therapy. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Objective: Radial route of access is increasingly being used for coronary angiograms and intervention. However, radiation exposure of operators was not known in our set up with either transfemoral or transradial procedures. The objective of the study was to compare related peripheral arterial route radiation exposure of operators by assessing fluoroscopy time. The secondary objective was to determine the relationship of operator experience with fluoroscopy time. Methods: This observational study was conducted in a tertiary care center-Cardiovascular Institute of Karachi (Pakistan) during the period of July 1 st 2009 to September 30 th 2009. We studied 1016 consecutive adult patients referred for coronary angiography (CA) or percutaneous coronary intervention (PCI). Patients who underwent right heart catheterization or for valvuloplasty were excluded from the study. Out of these 1016 patients, 928 were diagnostic CAs (734 via femoral route [f-CA] and 194 via radial route [r-CA]) and 88 were PCI (64 via femoral route [f-PCI] and 24 via radial route [r-PCI]). Fluoroscopy time was recorded as a surrogate of radiation exposure. Statistical analysis was performed using unpaired t, Mann-Whitney U, Chi-square and ANOVA tests. Results: Mean fluoroscopy time was found to be significantly higher in patients who underwent r-CA (6.3±3.8 vs 4.0±2.9 min; p<0.001) and r-PCI (15.1±11.8 vs 10.3±7.4 min; p=0.02) as compared with those underwent f-CA and f-PCI. Mean fluoroscopy time of well experienced operators was also high in r-CAs (5.4±2.9 vs 4.2±3.5 min; p=0.004). Conclusion: Radial procedures are associated with longer fluoroscopy time that may result in high radiation exposure to radial operators. Even well experienced radial operators cannot minimize their fluoroscopy time to the level of well experienced femoral operators. © 2011 by AVES Yayi{dotless}nci{dotless}li{dotless}k Ltd.


Sultana R.,Karachi Institute of Heart Diseases
Journal of Ayub Medical College, Abbottabad : JAMC | Year: 2010

Hypertensive left ventricular hypertrophy (LVH) is associated with increased risk of arrhythmias and mortality. Objective was to investigate the prevalence of cardiac arrhythmias and LVH in systemic hypertension. In all subjects blood pressure was measured, electrocardiography and echocardiography was done. Holter monitoring and exercise test perform in certain cases. There were 500 hypertensive patients, 156 (31.2%) men and 344 (69%) women > 30 years of age in the study. Among them 177 (35.4%) were diabetic, 224 (45%) were dyslipidemia, 188 (37.6%) were smokers, and 14 (3%) had homocysteinemia. Duration of hypertension (HTN) was > or = 2 years). Mean systolic BP (SBP) was 180 +/- 20 mm Hg and diastolic BP (DBP) was 95 +/- 12 in male and female patients. Left ventricular mass index (LVMI) was 119.2 +/- 30 gm/m2 in male while 103 +/- 22 gm/m2 in female patients. Palpitation was seen in 126 (25%) male and 299 (59.8%) female patients. Atrial fibrillation was noted in 108 (21.6%) male and 125 (25%) female patients, 30 (6%) male and 82 (16.4%) female patients had atrial flutter. Ventricular tachycardia was noted in 37 (7.4%) male and 59 (11.8%) female patients. Holter monitoring showed significant premature ventricular contractions (PVC'S) in 109 (21.8%) male and 128 (25.69%) female patients while Holter showed atrial arrhythmias (APC'S) in 89 (17.8%) males and 119 (23.8%) females. Angiography findings diagnosed coronary artery disease in 119 (23.8%) with CAD male and 225 (45%) without CAD while 47 (9.4%) females presented with CAD and 109 (21.8%) without CAD. A significant association has been demonstrated between hypertension and arrhythmias. Diastolic dysfunction of the left ventricle, left atrial size and function, as well as LVH have been suggested as the underlying risk factors for supraventricular, ventricular arrhythmias and sudden death in hypertensives with LVH.


Sultana R.,Karachi Institute of Heart Diseases | Sultana N.,Karachi Institute of Heart Diseases | Ishaq M.,Karachi Institute of Heart Diseases | Samad A.,Karachi Institute of Heart Diseases
Journal of the Pakistan Medical Association | Year: 2011

Objective: To determine the incidence of Coronary Artery Ectasia (CAE) at our teaching hospital to describe the patients and angiographic characteristics. Methods: A retrospective analysis was conducted on all coronary angiograms performed at the catheterization laboratory of Karachi Institute of Heart Diseases, a tertiary care center, between the period of August 2006 and August 2008. A one year follow up was performed to look for primary and secondary endpoints. Data were collected from catheterization films, and medical records. Results: Five thousand coronary angiograms were performed during the periof of the study. A total of 140 (2.8%) angiograms showed coronary ectasia of both mixed and pure types. Pure ectasia with no coronary obstructive lesions was seen in 75 (1.5%). The left anterior descending artery (LAD) was the most commonly affected vessel (63%) followed by the right coronary artery (RCA) 25% and 10% patients had circumflex artery involvement. The primary composite endpoint showed 6 (4.2%) patients with non-ST elevation MI, 5 (3.6%) with ST elevation inferior wall myocardial infarction, 70 (50%) with unstable angina and 2 (1.4%) deaths due to pulmonary oedema. Secondary endpoints showed 50% of the patients still complaining of chest pain. Conclusion: Prevalence of Coronary ectasia in the population presenting to KIHD during the study period was 1.5%. Majority of patients were males, associated with dyslipidaemia, hypertension and smoking. CAE was associated with obstructive coronary artery disease in about 80% of cases. LAD was the most commonly affected vessel.


Farman M.T.,Karachi Institute of Heart Diseases | Sial J.A.,Karachi Institute of Heart Diseases | Khan N.U.,Karachi Institute of Heart Diseases | Rizvi S.N.H.,Karachi Institute of Heart Diseases | And 2 more authors.
Journal of the Pakistan Medical Association | Year: 2011

Objectives: To determine the outcome of Primary Precutaneous Coronary Intervention (PCI) in our setup and compare the results with the west. Methods: This study was conducted at a tertiary care teaching Hospital (National Institute of Cardiovascular Diseases Karachi, Pakistan) during January 1st, 2008 to December 31st, 2008. A total of 113 patients were enrolled who came with STEMI and agreed to go for Primary PCI. We excluded the patients who had history of Thrombolytic therapy within 24 hours, presented with Non ST-elevation Myocardial Infarction (NSTEMI) and coronary angiogram revealed significant left Main or equivalent disease. All Patients received Aspirin, Clopidogrel and Platelet Glycoprotein IIB IIIA Inhibitor. After Primary PCI patients were planned to follow at one month, 3 months and 6 months. Primary end point was to document death, MI, CABG and rehospitalization. Results: Out of 113 cases, 102 (90.3%) were male and 11 (9.7%) were female, Mean age was 51.2±11.7 years, 54 (47.8%) patients had Hypertension, 28 (24.8%) were Diabetics and 44 (38.9%) were Smokers. Immediate success was achieved in 111 (98.2%) cases. In hospital mortality was 5.3% (3.5% in cardiogenic shock, 1.7% in non-shock patients). Mean Door to Balloon time remained 98.4 minutes. Twelve patients were lost to follow up. Therefore at 6 months, out of 101 patients, 8 (7.9%) died, 5 (4.9%) underwent Coronary Artery Bypass Graft (CABG) surgery and 5 (4.9 %) had been re-hospitalized either for recurrent myocardial infarction or heart failure. Conclusion: Optimal results of primary percutaneous coronary intervention can be achieved for acute STEMI in a developing country at a tertiary care public sector hospital. The results are comparable and nearly similar to the west.

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