National Institute of Cardiovascular Diseases

Dhaka, Bangladesh

National Institute of Cardiovascular Diseases

Dhaka, Bangladesh

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Budera P.,Charles University | Straka Z.,Charles University | Osmancik P.,Charles University | Vanek T.,Charles University | And 8 more authors.
European Heart Journal | Year: 2012

AimsSurgical ablation procedure can restore sinus rhythm (SR) in patients with atrial fibrillation (AF) undergoing cardiac surgery. However, it is not known whether it has any impact on long-term clinical outcomes.Methods and resultsThis multicentre study randomized 224 patients with AF scheduled for valve and/or coronary surgery: group A (left atrial surgical ablation, n 117) vs. group B (no ablation, n 107). The primary efficacy outcome was the SR presence (without any AF episode) during a 24 h electrocardiogram (ECG) after 1 year. The primary safety outcome was the combined endpoint of death/myocardial infarction/stroke/renal failure at 30 days. A Holter-ECG after 1 year revealed SR in 60.2 of group A patients vs. 35.5 in group B (P = 0.002). The combined safety endpoint at 30 days occurred in 10.3 (group A) vs. 14.7 (group B, P = 0.411). All-cause 1-year mortality was 16.2 (A) vs. 17.4 (B, P = 0.800). Stroke occurred in 2.7 (A) vs. 4.3 (B) patients (P = 0.319). No difference (A vs. B) in SR was found among patients with paroxysmal (61.9 vs. 58.3) or persistent (72 vs. 50) AF, but ablation significantly increased SR prevalence in patients with longstanding persistent AF (53.2 vs. 13.9, P < 0.001).ConclusionSurgical ablation improves the likelihood of SR presence post-operatively without increasing peri-operative complications. However, the higher prevalence of SR did not translate to improved clinical outcomes at 1 year. Further follow-ups (e.g. 5-year) are warranted to show any potential clinical benefit which might occur later. © 2012 The Author.


Hindricks G.,University of Leipzig | Pokushalov E.,State Research Institute of Circulation Pathology | Urban L.,National Institute of Cardiovascular Diseases | Taborsky M.,Na Homolce Hospital | And 2 more authors.
Circulation: Arrhythmia and Electrophysiology | Year: 2010

Background-Current methods for detecting atrial fibrillation (AF) have limited diagnostic yield. Continuous monitoring with automatic arrhythmia detection and classification may improve detection of symptomatic and asymptomatic AF and subsequent patient treatment. The study purpose was to quantify the performance of the first implantable leadless cardiac monitor (ICM) with dedicated AF detection capabilities. Methods and Results-Patients (n=247) with an implanted ICM (Reveal XT, Medtronic Inc, Minneapolis, Minn) who were likely to present with paroxysmal AF were selected. A special Holter device stored 46 hours of subcutaneously recorded ECG, ICM markers, and 2 surface ECG leads. The ICM automatic arrhythmia classification was compared with the core laboratory classification of the surface ECG. Of the 206 analyzable Holter recordings collected, 76 (37%) contained at least 1 episode of core laboratory classified AF. The sensitivity, specificity, positive predictive value, and negative predictive value for identifying patients with any AF were 96.1%, 85.4%, 79.3%, and 97.4%, respectively. The AF burden measured with the ICM was very well correlated with the reference value derived from the Holter (Pearson coefficient=0.97). The overall accuracy of the ICM for detecting AF was 98.5%. Conclusions-In this ICM validation study, the dedicated AF detection algorithm reliably detected the presence or absence of AF and the AF burden was accurately quantified. The ICM is a promising new diagnostic and monitoring tool for the clinician to treat AF patients independently of symptoms. Long-term studies are needed to evaluate the clinical benefits of the technology. Clinical Trial Registration-clinicaltrials.gov Identifier NCT00680927. © 2010 American Heart Association, Inc.


Purerfellner H.,Public Hospital Elisabethinen | Pokushalov E.,State Research Institute of Circulation Pathology | Sarkar S.,Medtronic | Koehler J.,Medtronic | And 3 more authors.
Heart Rhythm | Year: 2014

Background Frequent premature atrial contractions and sick sinus syndrome are primary causes of inappropriate atrial fibrillation (AF) detection in insertable cardiac monitors (ICMs). Objective The study aimed to validate an algorithm designed to reduce inappropriate AF detection on the basis of the identification of a single P wave during the cardiac cycle. Methods The original detection algorithm looks for evidence of AF based on differences in the pattern of R-R intervals over a 2-minute period. The improved algorithm reduces evidence for AF detection if P waves are detected. The algorithm was validated by using Holter data, which collected 2 leads of surface electrocardiogram and continuously uplinked ICM electrocardiogram over a 46-hour period. ICM detections were compared with Holter annotations to compute episode and duration detection performance. Results Valid Holter recordings (8442 hours) were analyzed from 206 patients. True AF was observed in 76 patients, yielding 482 true AF episodes ≥2 minutes in duration and 1191 hours of AF. The algorithm correctly identified 97.8% of the total AF duration and 99.3% of the total sinus or non-AF rhythm duration. The algorithm detected 85% (90% per-patient average) of all AF episodes ≥2 minutes in duration, and 55% (78% per-patient average) of the detected episodes had AF. AF was found in 95% of the detected episodes >1 hour. The improved algorithm reduced inappropriate episodes and duration by 46% and 55%, respectively, while also reducing appropriate episodes and duration by 2% and 0.1%, respectively. Conclusion An improvement in the ICM algorithm for AF detection incorporating P-wave information substantially reduced inappropriately detected episodes and duration, with minimal reduction in sensitivity for detecting AF. © 2014 Heart Rhythm Society.


Islam A.K.M.M.,Jessore Medical College | Majumder A.A.S.,National Institute of Cardiovascular Diseases
Indian Heart Journal | Year: 2016

Rheumatic fever (RF) and rheumatic heart disease (RHD) are the most-common cardiovascular disease in young people aged <25 years, globally. They are important contributors to cardiovascular morbidity and mortality in Bangladesh. Classical risk factors, i.e. poverty, overcrowding, ignorance, and insufficient health care services were responsible for the high incidence and prevalence of these diseases over the last century. In concert with the progresses in socioeconomic indicators, advances in health sectors, improved public awareness, and antibiotic prophylaxis, acute RF came into control. However, chronic RHD continues to be prevalent, and the actual disease burden may be much higher. RHD predominantly affects the young adults, seriously incapacitates them, follows a protracted course, gets complicated because of delayed diagnosis and is sometimes maltreated. The treatment is often palliative and expensive. Large-scale epidemiological and clinical researches are needed to formulate evidence-based national policy to tackle this important public health issue in future. © 2015 Cardiological Society of India.


Mujtaba S.H.,National Institute of Cardiovascular Diseases | Ashraf T.,National Institute of Cardiovascular Diseases | Anjum Q.,International Medical Center
Asia-Pacific Journal of Public Health | Year: 2013

The objective of this study was to evaluate enhancement in the knowledge of general practitioners (GPs), from the urban cities in the province of Sindh, Pakistan, regarding blood pressure measurement through workshop. This was a quasi-experimental study that involved GPs from 5 cities of Sindh province, Pakistan. The GPs were required to complete a pretested self-administered questionnaire before and after the workshop session. The questionnaire included few demographic variables and 17 questions based on the American Heart Association recommendations. The mean pretest and posttest scores were compared using Student's t test. A total of 350 GPs returned completed questionnaires, with a preponderance of males (n = 264, 75.4%) than females (n = 86, 24.6%). The mean correct responses increased significantly after the workshop session from 8 ± 2.1 to 14 ± 2.5 (P =.01). The knowledge of GPs was almost doubled after the workshop and was significantly different for variables such as qualification, affiliation with teaching hospital, and number of years of practice (P =.001). This survey, a representation of GPs from the Sindh province, indicated a significant doubling in knowledge after the workshop, proving that continuing medical education sessions play an important role in increasing awareness and staying updated. © 2013 APJPH.


Monwarul Islam A.K.M.,National Institute of Cardiovascular Diseases | Majumder A.A.S.,National Institute of Cardiovascular Diseases
Indian Heart Journal | Year: 2013

Coronary artery disease (CAD) is an increasingly important medical and public health problem, and is the leading cause of mortality in Bangladesh. Like other South Asians, Bangladeshis are unduly prone to develop CAD, which is often premature in onset, follows a rapidly progressive course and angiographically more severe. The underlying pathophysiology is poorly understood. Genetic predisposition, high prevalence of metabolic syndrome and conventional risk factors play important role. Lifestyle related factors, including poor dietary habits, excess saturated and trans fat, high salt intake, and low-level physical activity may be important as well. Some novel risk factors, including hypovitaminosis D, arsenic contamination in water and food-stuff, particulate matter air pollution may play unique role. At the advent of the new millennium, we know little about our real situation. Largescale epidemiological, genetic and clinical researches are needed to explore the different aspects of CAD in Bangladesh. © 2013, Cardiological Society of India. All rights reserved.


Monwarul Islam A.K.M.,National Institute of Cardiovascular Diseases | Majumder A.A.S.,National Institute of Cardiovascular Diseases
Indian Heart Journal | Year: 2012

Hypertension (HTN) is an increasingly important medical and public health problem. In Bangladesh, approximately 20% of adult and 40-65% of elderly people suffer from HTN. High incidence of metabolic syndrome, and lifestyle-related factors like obesity, high salt intake, and less physical activity may play important role in the pathophysiology of HTN. The association of angiotensin-converting enzyme (ACE) gene polymorphism and low birth weight with blood pressure has been studied inadequately. Studies have found relationship between mass arsenic poisoning and HTN. Hypovitaminosis D presumably plays role in the aetiopathogenesis of HTN in Bangladeshi population. South Asians appear to respond to antihypertensive therapy in a similar manner to the Whites. The latest National Institute for Health and Clinical Excellence guideline advocates a calcium-channel blocker as step 1 antihypertensive treatment to people aged ≥ 55 years and an ACE inhibitor or a low-cost angiotensin-II receptor blocker for the younger people. Calcium-channel blockers and beta-blockers have been found to be the most commonly prescribed antihypertensive drugs in Bangladesh. Non-adherence to the standard guidelines and irrational drug prescribing are likely to be important. On the other hand, non-adherence to antihypertensive treatment is quite high. At the advent of the new millennium, we are really unaware of our real situation. Large-scale, preferably, nation-wide survey and clinical research are needed to explore the different aspects of HTN in Bangladesh. © 2012, Cardiological Society of India. All rights reserved.


Habib S.,National Institute of Cardiovascular Diseases
JPMA. The Journal of the Pakistan Medical Association | Year: 2012

The case of a 60 year old male patient, diagnosed with rheumatoid arthritis presenting with recurrent massive pericardial effusion, and unresponsive to treatment of rheumatoid arthritis is documented. Pericardial biopsy proved Tuberculous pericarditis with positive fluid culture for Mycobacterium Tuberculosis. Anti-tuberculous treatment was started along with corticosteroids. Follow up after three months showed no evidence of pericardial effusion.


Aziz K.U.,National Institute of Cardiovascular Diseases
Journal of the College of Physicians and Surgeons Pakistan | Year: 2015

The prevalence of essential hypertension is alarmingly increasing in Pakistani population inspite of the demographics being of lower BMI and nutrition. In this review, the possible factors responsible for this increase are identified by reviewing the population studies conducted in Pakistan. The prevalence rate is about 3 - 4% in childhood and steeply rises near the middle age. The factors peculiar to Pakistan were increased genetic susceptibility, environmental factors such as gender, females gender, urbanization, obesity and sedentary life styles particularly in middle age, cultural practices promoting sedentary life style in female.


Kovacikova L.,National Institute of Cardiovascular Diseases | Skrak P.,National Institute of Cardiovascular Diseases | Dobos D.,National Institute of Cardiovascular Diseases | Zahorec M.,National Institute of Cardiovascular Diseases
Pediatric Cardiology | Year: 2014

Noninvasive ventilation is effective in respiratory failure from various etiologies. This study aimed to analyze the efficacy of noninvasive positive pressure ventilation (NPPV) in pediatric cardiac patients. NPPV was used (1) as an alternative means of respiratory support in patients with hypoxemic or hypercarbic respiratory failure or with signs of respiratory distress that were considered to require intubation; or (2) as a preventive measure in patients with high risk for extubation failure. Between 2008 and 2011, there were 107 episodes of NPPV use in 82 patients. Their median age was 57 days (range 1 day to 18 years), and weight was 4.1 kg (range 1.7-68). Within the first hour of NPPV, partial pressure of carbon dioxide/fraction of inspired oxygen (PaO 2/FiO2) was significantly increased, and arterial pCO 2, and respiratory rate were decreased. This decrease in respiratory rate and increase in PaO2/FiO2 continued during the first 24 h of therapy, and pCO2 was decreased during the first 6 h. In 59.8 % of cases, NPPV was successfully used without the need for tracheal intubation. The Aristotle Basic Complexity score, presence of infection, residual cardiac defect, and pH <7.36 in the first hour were independent predictors of NPPV failure. We conclude that NPPV improved oxygenation and decreased respiratory effort in pediatric cardiac patients, 59.8 % of whom eventually did not receive intubation. A high-complexity surgical score, presence of infection, residual cardiac defect, and pH <7.36 in the first hour are predictors of NPPV failure, which occurs in most patients >24 h after the onset of therapy. © 2013 Springer Science+Business Media.

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