The Journal of Cardiovascular Diseases

Frequency of risk factors associated with peri-procedural myocardial infarction during elective coronary angioplasty in a tertiary care hospital

Tue, 30 Dec 2025 00:00:00 +0000

BACKGROUND: Peri-procedural myocardial infarction (PMI) is a relatively common complication following coronary angioplasty; however, reports vary regarding its incidence and prognostic significance. In this study, we assessed the occurrence, underlying mechanisms, risk factors, and clinical implications of PMI by analyzing a large dataset.

OBJECTIVE: Determining the prevalence of PMI during elective coronary angioplasty and to compare the frequency of contributing factors in patients with and without PMI.

METHODOLOGY: This descriptive case series was carried out at Mayo Hospital, Lahore from 03-03-2022 to 03-09-2022. Total 126 patients of age between 18 to 70 years of both genders undergoing elective coronary angioplasty were enrolled. Non-probability consecutive sampling technique was done. Patients with hemodynamic instability, patient with renal failure, liver failure, severe anemia, or bleeding diathesis. Patients with raised levels of cardiac troponin at admission (rising trend). Patients with on-going ACS and patients who have had previous coronary angioplasty or CABG done were excluded from the study.

RESULTS: Total 126 participants were enrolled in which 87 (69.0%) males and 39 (31.0%) females with mean age of 52.81± 12.468 years. Overall PMI was present in 06/126 (4.8%) participants. PMI was found in 5 (83.3 %) males and 1 (16.67%) female. Total 6 patients of peri-procedural myocardial infarction were belonging to 58-77 years of age group. In our study, comparison of frequency of contributing factors diabetes mellitus, active smoking, history of dyslipidemia & CAD, Obesity (BMI> 30 kg/m2), presentation of patients with ACS in the last 12 months and Echo findings regarding LVEF < 40% had insignificant p value of >0.05.

CONCLUSION: One of the frequent complications of elective coronary angioplasty is peri-procedural MI which is associated with an increased rate of major cardiovascular adverse events.

Left Atrial size assessment on ECG in patients with Mitral Stenosis using P Wave parameters and taking Transthoracic Echo as Gold Standard

Tue, 30 Dec 2025 00:00:00 +0000

BACKGROUND: Left atrial enlargement (LAE) is a key indicator of cardiovascular risk, including atrial fibrillation and stroke. While transthoracic echocardiography (TTE) is the gold standard for measuring LA size, electrocardiography (ECG) provides a simpler, non-invasive screening option. So, aim of the study is to evaluate the diagnostic accuracy and correlation between left atrial enlargement characteristics on ECG (P-wave) and the severity of mitral stenosis, as assessed by left atrial diameter measurements obtained through transthoracic echocardiography (TTE).

Objective: To assess the Left Atrial size assessment on ECG in patients with Mitral Stenosis using P Wave parameters and taking Transthoracic Echo as Gold Standard

MATERIAL AND METHODS: This cross-sectional study was conducted over six months at People’s University of Medical and Health Sciences for Women, Nawabshah. A total of 132 patients with suspected or diagnosed rheumatic mitral stenosis, aged 18–65 years, were enrolled based on predefined inclusion and exclusion criteria. A 12-lead ECG, focusing on lead II, were used to measure P-wave duration, amplitude, and area calculated as ½ × P-wave duration × amplitude, averaged over three cardiac cycles. Transthoracic echocardiography (TTE) was performed in the left lateral decubitus position, and LA diameter was measured at end-systole from the apical four-chamber view. LA enlargement was defined as a diameter ?40 mm.

RESULTS: The study included 132 patients (56.1% males, 43.9% females) with a mean age of 50 ± 3.06 years and average LV ejection fraction of 53.03 ± 6.61%. A strong correlation was found between P-wave area on ECG and LA diameter (r = 0.987, R² = 0.975), indicating that P-wave area explains 97.5% of LA size variability. A P-wave area ?4 ms·mV showed 85.42% sensitivity and 66.67% specificity, while amplitude >2.5 mm had 71.9% sensitivity and 63.9% specificity. P-wave duration >120 ms offered 76% sensitivity and 69.4% specificity. These results suggest ECG is a useful adjunct but not a standalone tool for detecting LA enlargement.

CONCLUSION

ECG-derived P-wave indices, particularly P-wave area, show a strong correlation with LA diameter and offer moderate diagnostic accuracy for detecting LA enlargement. While not definitive alone, ECG can serve as a valuable non-invasive screening tool in clinical practice.

Comparison of Outcome of Normal Versus Raised Cardiac Troponin in Patients with Supraventricular Tachyarrhythmia

Tue, 30 Dec 2025 00:00:00 +0000

Background: Acute coronary syndromes encompass a wide range of clinical disorders, spanning from unstable angina pectoris to acute ST-elevation myocardial infarction. Chest pain is typically the primary manifestation of atherosclerotic heart disease. However, accurately determining the origin of chest pain can be difficult, particularly in the emergency department, due to the vague manner in which some patients describe their symptoms. ¹

Objective: To evaluate the results of patients with supraventricular tachyarrhythmia who have normal levels of cardiac troponin with those who have elevated levels. Supraventricular tachycardia (SVT) is the predominant category of abnormal heart rhythms in adults.

Materials and Methods: Total 234 patients were enrolled from the Department of Emergency. The participants were categorized into two groups i.e, Group-A consists of individuals with normal troponin levels and Group-B consists of individuals with elevated troponin levels. The primary diagnosis of tachyarrhythmia were encompass supraventricular tachycardia (SVT) and were verified using a 12-lead ECG. The analysis of cTnI levels was done using the identical immunoassay techniques (cTnI-Ultra Siemens) at the exact same facility. Cardiac troponin I (cTnI) levels were assessed upon admission and again 6 hours later. The study measured the occurrences of readmission for heart failure and myocardial infarction. The determination of qualitative data such as gender, heart failure admission, and myocardial infarction was accomplished through the utilization of frequency and percentages. On the other hand, the determination of quantitative data such as age, blood pressure, and troponin levels was achieved by employing mean and standard deviation. The chi-square test was employed to compare the outcome in both groups. A p-value less than or equal to 0.05 was considered statistically significant.

Results: In Group-A (Normal Troponin Level), the mean age of participants was 46.96 ± 12.06, while in Group-B (Raised Troponin Level), the mean age was 56.97 ± 11.38. The current research included 133 males, accounting for 56.8% of the total enrollment, and 101 females, accounting for 43.2%. Upon admission, the research participants' vital signs were recorded. In group A, the heart rate (bpm) was measured to be 88.11±30.21, while in group B it was 90.23±28.43. The systolic blood pressure (mmHg) in group A was 143.22±5.00, whereas in group B it was 147.67±9.78. The SaO2 levels were observed to be 63.21±00 in group A and 60.89±0.56 in group B, with p-values of 0.001 and 0.000 respectively. After 30 days, the follow-up assessment of the research participants found that there was one case (0.9%) of re-admission for myocardial infarction in both Group A (Normal Troponin Level) and Group B (Raised Troponin Level). The p-value of 0.751 indicated that this difference was not statistically significant. The re-admission rate for heart failure (HF) was 0% in Group-A (Normal Troponin Level), but it was 4.30% in Group-B (Normal Troponin Level), with a significant p-value of 0.03.

Conclusion: Elevated levels of cardiac troponin may not reliably indicate the occurrence of complications such as readmission for myocardial infarction and heart failure in individuals with supraventricular tachycardia. Physicians should exercise caution when interpreting troponin test results for this particular group of patients.

Prevalence of Depression and Anxiety Among Patients with Acute Coronary Syndrome

Latif ullah, Hafiz ur Rehman — Tue, 30 Dec 2025 00:00:00 +0000

Abstract

Objective: To determine the prevalence of depression and anxiety among patients with Acute Coronary Syndrome (ACS) at Saidu Group of Teaching Hospitals, Swat, Pakistan, and to identify the associated sociodemographic and clinical factors.

Methodology: A cross-sectional study was conducted between April 12, 2025, and October 12, 2025, with 190 ACS patients enrolled. Depression was assessed using the Beck Depression Inventory (BDI), with a score greater than 17 indicating depression. Anxiety was assessed using the Beck Anxiety Inventory (BAI), with a score greater than 0 indicating anxiety. Statistical analysis was performed using chi-square tests to examine associations between psychological conditions and sociodemographic factors.

Results: The study revealed that 44% of ACS patients had depression, and 42% exhibited anxiety. The mean age of patients was 51.7 years (SD = 12.3), and 63% of the participants were male. Significant associations were found between depression and older age (p-value = 0.03), with 58% of patients in the 46-60 age group showing depression. Diabetes and smoking were also linked to higher rates of depression and anxiety. The chi-square test revealed a significant relationship between age and depression (chi2 = 6.74, p-value = 0.03).

Conclusion: The study highlights the high prevalence of depression and anxiety among ACS patients in Pakistan, underscoring the need for integrated mental health care in cardiovascular treatment. Early screening and intervention for psychological distress in ACS patients are essential to improve patient outcomes. Future studies should explore the effectiveness of combined physical and mental health interventions.

Keywords: Acute Coronary Syndrome, Depression, Anxiety, Comorbidities, Mental Health

Outcomes of Coronary Artery Bypass Surgery in Patients with Reduced Left Ventricular Function and Hibernating Myocardium

Amer Iqbal, Saira Gull, Husnain Raza, Ayela Qamar — Tue, 06 Jan 2026 00:00:00 +0000

Abstract

Objective:
The medium-term functional recovery of the left ventricle (LV) and overall prognosis following coronary artery bypass grafting (CABG) in patients with markedly reduced ventricular function and hibernating myocardium (HM) remains insufficiently defined. This study prospectively investigated postoperative outcomes in patients with severe LV impairment and evidence of myocardial hibernation.

Methods:
A total of 120 consecutive patients with significant LV dysfunction and HM, confirmed through dobutamine stress echocardiography and rest-redistribution thallium-201 imaging, were included. The mean age was 60 ± 9 years (range 31–77), and the mean preoperative ejection fraction (LVEF) was 28 ± 9% (range 25–40%). LV function was evaluated by echocardiography intraoperatively, before discharge, at three months, one year, and annually thereafter. Predictors of survival were analyzed using univariate and multivariate statistical methods.

Results:
Early mortality was 1.6% (n=2), and 12.5% (n=15) died during late follow-up, predominantly from heart failure. Actuarial survival was 80 ± 6% at five years and 60 ± 9% at eight years. LVEF improved significantly following surgery (from 28 ± 9% to 40 ± 2%, p < 0.01), although this early gain progressively diminished over time, with mean LVEF decreasing to 33 ± 9% at three months, 32 ± 8% at one year, and 30 ± 9% at eight years. Patients who showed minimal early recovery of LV function experienced a more rapid decline in EF and more frequent recurrence of heart failure. Freedom from heart failure was 82 ± 5% at four years and 60 ± 8% at eight years. Advanced preoperative NYHA class and older age independently predicted poorer long-term survival, whereas preoperative angina and use of arterial grafts did not significantly affect long-term outcomes.

Conclusion:
CABG in patients with hibernating myocardium and severely depressed LV function results in meaningful early improvement in ventricular performance and generally favorable overall prognosis. However, the functional benefit tends to diminish over time. Older age, advanced heart failure at presentation, and limited perioperative improvement in LVEF are associated with less favorable long-term outcomes.

Keywords:
Coronary artery bypass grafting; Hibernating myocardium; Left ventricular dysfunction; Ischemic cardiomyopathy; Postoperative outcomes; Long-term survival; Ventricular function recovery