Arun Maskey - Academia.edu (original) (raw)

Papers by Arun Maskey

Research paper thumbnail of Prevalence of Cardiac Murmurs and Acute Rheumatic Fever in Schoolchildren in Rural Nepal

Heart, Lung and Circulation, 2007

Research paper thumbnail of Does populational difference influence the size of adult human coronary arteries?

Journal of Experimental and Clinical Anatomy, 2017

Introduction: Many articles have measured the coronary artery size and compared with similar stud... more Introduction: Many articles have measured the coronary artery size and compared with similar studies to verify the differences between populations. This study also compares its finding with other identical studies with an attempt to integrate them to evaluate earlier conclusions made on population differences. Materials and Methods: Normal coronary angiograms from the preexisting database of patients who underwent cardiac catheterization were analyzed for their sizes using catheter tip as calibrating object. Results: The measurements of left main coronary artery, left anterior descending artery, circumflex artery (CX), and right coronary artery (RCA) were 2.53 ± 0.26 mm, 1.86 ± 0.19 mm, 1.77 ± 0.27 mm, and 1.80 ± 0.22 mm, respectively, after being adjusted to body surface area. Coronary vessel sizes were compared between Indians, Nepalese, and the Caucasians. The RCA was significantly larger in the Indians as compared to Nepalese and Caucasians whereas Nepalese left anterior descend...

Research paper thumbnail of Coronary Artery Disease prevalence in Heart Failure with Reduced Ejection Fraction

Nepalese Heart Journal, Nov 14, 2019

Background and Aims: Even though heart failure (HF) is a major global health problem, studies on ... more Background and Aims: Even though heart failure (HF) is a major global health problem, studies on the prevalence and etiology of HF in Nepal are scant. Coronary artery disease (CAD) has been reported to be the etiology in 18% of HF presentations to the emergency department of a tertiary cardiac center in Nepal 1. Present study evaluated the prevalence and characteristics of CAD in HF with reduced ejection fraction (HFrEF) with coronary angiography (CAG). Methods: In a prospective, observational study, conducted from June 2018 to May 2019, 95 patients with HFrEF undergoing CAG, at Shahid Gangalal National Heart Centre, were evaluated. Results: The mean age of the patients was 62.7±10.1 years, with 67% males. Obstructive CAD was present in 31(33%) with 48%, 39% and 13% having triple (TVD), single (SVD) and double vessel disease (DVD) respectively. Age ≥ 65 years, smokers, dyslipidemia, obesity, angina, indexed left ventricular end diastolic volume (iEDV), indexed LV systolic diameter (iLVIDs) and regional wall motion abnormality (RWMA) on echocardiography were predictors of CAD, among only which, smoking was the independent predictor of CAD. Conclusion: Our results suggest a lower prevalence of CAD in HFrEF than previously reported from developed countries, which may be due to a systematic angiography approach and exclusion of previous coronary events. We encourage clinicians to aggressively identify this co-morbidity as it has important treatment and prognostic implementations.

Research paper thumbnail of Association of Carotid Intima-Media Thickness With Angiographic Severity and Extent of Coronary Artery Disease

The American Journal of Cardiology, 2006

The present study examined the association between carotid intima-media thickness (IMT) and sever... more The present study examined the association between carotid intima-media thickness (IMT) and severity and extent of coronary artery disease (CAD). B-mode ultrasound and quantitative coronary angiography were used to assess carotid and coronary artery atherosclerosis in 108 patients with known or suspected CAD who had been referred for cardiac catheterization. Maximum and mean IMT values of carotid arteries were measured and expressed as mean aggregate values. To evaluate anatomic severity and extent of CAD, several quantitative coronary angiographically derived parameters were incorporated into indexes. These quantitative coronary angiographic measurements reflected CAD severity, extent, and overall "atheroma burden" and were calculated for the entire coronary tree and separately for different coronary segments (i.e., left main, proximal, mid, and distal segments). Maximum and mean IMT values were significantly correlated with CAD severity (p = 0.004 and 0.005, respectively), extent (p = 0.022 and 0.016, respectively), and atheroma burden (p = 0.008 for the 2 values). Further, carotid IMT was correlated with quantitative angiographic indexes for mid and distal segments but not with the proximal segments of coronary vessels. In conclusion, our study shows an association between carotid IMT and severity and extent of CAD as assessed by quantitative coronary angiography. Carotid IMT seems to be a weaker predictor of coronary atherosclerosis in the proximal parts of the coronary tree than in the mid and distal parts.

Research paper thumbnail of Screening for Hypertension in Asymptomatic Individuals in Nepal: An Expert Consensus Statement

Nepalese Heart Journal

Hypertension affects a substantial proportion of the general population in Nepal with prevalence ... more Hypertension affects a substantial proportion of the general population in Nepal with prevalence ranging from 20 to 30 percent. Early diagnosis and treatment are essential for undiagnosed hypertension and is possible through hypertension screening. The aim of this paper is to provide unified consensus recommendations for the effective screening of hypertension in Nepal. In two National Advisory expert consensus meetings, a total of 42 experts participated, discussed and voted on the key statements for formulating the consensus. Each key statement was scored on a Likert scale ranging from 1 to 9 and a mean score was calculated. The consensus statement was accepted if the mean score was seven or more with the voting of more than two-thirds of the experts. The main consensus recommendations are the following. First, screening for hypertension should start among adults from 18 years of age. Second, effective screening of hypertension can aid in the early diagnosis, control, and improve ...

Research paper thumbnail of Percutaneous transvenous mitral commissurotomy in elderly mitral stenosis patients. A retrospective study at shahid gangalal national heart centre, bansbari, kathmandu, Nepal

PubMed, Sep 1, 2013

Introduction: Percutaneous transvenous Mitral Commissurotomy (PTMC) has been shown to be a valid ... more Introduction: Percutaneous transvenous Mitral Commissurotomy (PTMC) has been shown to be a valid alternative to surgical therapy in selected patients with mitral stenosis. Though its efficacy in children and young adults is already established, its role in elderly patients is not well reported. We aimed to evaluate the efficacy of PTMC in elderly patients (≥60 years). Methods: All elderly patients who underwent PTMC from March 2008 to March 2013 were retrospectively reviewed. Mitral valve area and mean left atrial pressure before and after the procedure were compared. Results: During the study period 49 elderly patients underwent PTMC. Thirty eight were female and 11 male. Age ranged from 60 to 77 years with the mean age of 64.5±4.0 years. The mean mitral valve area increased from 0.9±0.1 cm(2) to 1.6±0.3 cm(2) whereas mean left atrial pressure decreased from 25.4±6.6 mmHg to 12.9±4.5. Successful results were observed in 41 (83.6%) patients. Unsuccessful results were due to suboptimal mitral valve area <1.5 cm(2) in 7 (14.25%) patients and post-procedure MR of more than moderate MR in 1(2%) patients. Unsuccessful PTMC was much more common in severe than in moderate mitral stenosis. Conclusions: Our study suggests that PTMC in elderly is a safe and effective procedure when performed in experienced centre by experienced operators.

Research paper thumbnail of Primary Percutaneous Coronary Intervention (PPCI) in acute myocardial infarction complicated with cardiogenic shock in a newly emerging cardiac center in Nepal

PubMed, Mar 1, 2009

Background: Acute myocardial infarction (AMI) is complicated by cardiogenic shock in 7~10% of pat... more Background: Acute myocardial infarction (AMI) is complicated by cardiogenic shock in 7~10% of patients. Mortality rate is exceedingly high and reaches 70-80% in those treated conservatively. Large thrombolytic trials demonstrate 60% mortality with most effective thrombolytic agent. Methods: In between September 2005 to August 2008 total PCI in Shahid Gangalal National Heart Center (SGNHC) in Nepal was 452. Among them primary PCI (PPCI) in AMI with cardiogenic shock was done in only 16 patients (3.5%). Results: This study showed in-hospital mortality of 50% (n = 8). Of 50% (n = 8) alive patients with cardiogenic shock who underwent PPCI, 6 patients are in routine follow-up over 12 months and 2 were doing well in subsequent 6 months but not in follow up after that. Conclusion: Primary PCI in AMI complicated by cardiogenic shock has lower mortality and improved outcome. High cost, high in-hospital mortality and lack of trained personnel are major limitations.

Research paper thumbnail of Contrast-induced Nephropathy Following Percutaneous Coronary Intervention at a Tertiary Cardiac Center in Nepal

Cureus, Sep 18, 2018

Background Contrast-induced nephropathy (CIN) is one of the leading causes of morbidity and morta... more Background Contrast-induced nephropathy (CIN) is one of the leading causes of morbidity and mortality including increased financial burden in high risk patients undergoing percutaneous coronary intervention (PCI). Methods This is an observational prospective study. We aimed to study the incidence of CIN in Nepalese populations and compare the outcome to international reprinted values with coronary artery disease (CAD) undergoing PCI. All consecutive patients with CAD undergoing PCI between February 2010 and July 2010 were enrolled in the study.

Research paper thumbnail of Left Ventricular Noncompaction

Journal of Nepal Medical Association, Apr 1, 2009

Left Ventricular Noncompaction(LVNC) is a genetic cardiac disease of emerging importance with a d... more Left Ventricular Noncompaction(LVNC) is a genetic cardiac disease of emerging importance with a distinct clinical and pathophysiological presentation. The most common clinical manifestations include heart failure, arrhythmias and embolic events, and in children it may be associated with facial dysmorphisms and Wolff-Parkinson-White syndrome. The diagnosis of LVNC, however, is often missed, most often as a consequence of ignorance of the condition. Echocardiography is considered the reference standard for the diagnosis of LVNC. Prognosis remains poor for patients with impaired systolic left ventricular function, as treatment options are very limited. Because of the familial association of LVNC, fi rst-degree relatives should be screened by Echocardiography.

Research paper thumbnail of An unusual presentation of acute coronary syndrome

DOAJ (DOAJ: Directory of Open Access Journals), Oct 1, 2010

Acute coronary syndrome in elderly can manifest with a variety of atypical presentation and may b... more Acute coronary syndrome in elderly can manifest with a variety of atypical presentation and may be associated with other comorbid conditions. We present an atypical presentation of ACS in an elderly left handed female presenting with sudden onset of slurred speech preceded by dizziness and vomiting. After through clinical examination and investigation she was managed as a case of non ST elevation myocardial infarction and ischaemic stroke.

Research paper thumbnail of Echocardiographic assessment of Diastolic Function in patients with Atrial Fibrillation

Nepalese heart journal, Nov 14, 2019

Background and Aims: Echocardiographic assessment of left ventricular diastolic function in patie... more Background and Aims: Echocardiographic assessment of left ventricular diastolic function in patients with atrial fibrillation is a challenge as loss of atrial kick (A wave), beat to beat variability and left atrium enlargement despite normal atrial pressure make usual guideline based estimation difficult and inaccurate. Hence adoption of additional echocardiography parameters are necessary which are tricky and have varied results. Hence the aim of this study was to study various aspects of diastolic function in patients with atrial fibrillation. Methods: It was a hospital based prospective cross-sectional observational study conducted at cardiology unit, National Academy of Medical Sciences, Kathmandu and Shahid Gangalal National Heart Center, Kathmandu from 1 st July 2018 to 30 th June 2019. Results: Total of 92 patients were studied. About one third (34.8%) had diastolic dysfunction. Ratio of E/e'(14.65 ± 2.21 Vs 7.66 ± 1.18) , E/Vp (1.57 ± 0.14 Vs 1.20 ± 0.11), isovolumetric relaxation time (53.06 ± 13.82ms Vs 89.33 ± 9.88ms) and deceleration time of pulmonary venous diastolic wave (203.09 ± 26.13ms Vs 292.25 ± 36.32ms) were significantly different in patients with diastolic dysfunction compared to patients without diastolic dysfunction with sensitivity of 90.6%, 84.4%, 81.2% and 78.1% respectively. Conclusion: Diastolic dysfunction is a common entity in patients with atrial fibrillation. Echocardiography parameters like E/e' ratio, isovolumetric relaxation time, E/Vp ratio and deceleration time of diastolic pulmonary wave were highly sensitive in detection of diastolic dysfunction.

Research paper thumbnail of Outcome of Percutaneous Transvenous Mitral Commisurotomy According to Age, Gender and Heart Rhythm

Journal of National Heart and Lung Society Nepal

Background: Percutaneous transvenous mitral commisurotomy (PTMC) is the recommended treatment in ... more Background: Percutaneous transvenous mitral commisurotomy (PTMC) is the recommended treatment in the severe mitral stenosis with mitral valve area ≤ 1.5 sq. cm and favourable mitral valve morphology without Left atrium (LA) clot. Methods: A retrospective study done for one year among all the patients who had undergone PTMC in 2016. Successful PTMC was defined as increase in Mitral valve area (MVA) more than or equal to 1.5 sq. cm or increase in area by more than 50% from baseline. Data was analyze using SPSS-20. Results: Three hundred thirty sex patients with mean age 34.08 ±12.0 of which male were 97 ( 26.9 %.) and female were 239 (71.1 %). There were 225 (67%) sinus rhythm (SR) and 111 (33%) atrial fibrillation (AF). The median Pre PTMC area and Left atrial (LA) Pressure were 0.9 sq cm and 24 mmHg respectively. The overall success of PTMC was in 289 (86%). The successful outcome in age categories less than 20 years, 20-40, 40-60 and more than 60 years in order are 39 (83%), 174 (8...

Research paper thumbnail of Assessment of Rheumatic Mitral Stenosis severity by Mitral Leaflet Separation Index

Nepalese Heart Journal, 2019

Background and Aims: Determining the severity of mitral stenosis (MS) is important for both progn... more Background and Aims: Determining the severity of mitral stenosis (MS) is important for both prognostic and therapeutic reasons. Measurement of Mitral valve area (MVA) by planimetry is gold standard and accurate but is highly operator dependent. Pressure Half Time (PHT) is affected by hemodynamic significance. In this Study we evaluated severity of mitral stenosis by mitral leaflet separation index (MLS index, MLSI). This new index could be useful surrogate measure of the MVA. Methods: This is a hospital based, cross-sectional observational study carried out in Shahid Gangalal National Heart Centre (SGNHC), Kathmandu, Nepal. Study included 82 patients with Rheumatic MS who had undergone echocardiographic examination from July 2018 to December 2018. The maximal separation of the mitral valve leaflet tips was measured from inner edge to inner edge in end diastole in the parasternal long axis and apical 4-chamber views. These two parameters were averaged to yield the MLSI. The index was...

Research paper thumbnail of Contrast Induced Nephropathy and its predictors after Primary Percutaneous Intervention

Nepalese Heart Journal, 2021

Background and Aims: Worldwide many patients are receiving intravascular contrast media (CM) duri... more Background and Aims: Worldwide many patients are receiving intravascular contrast media (CM) during interventional procedures. Contrast media are used to enhance visualization and guide percutaneous coronary interventions (PCI).1 However, the use of CM also carries the risk of complications and it is important to be aware of these complications. Complications with CM range from mild symptoms to life-threatening conditions like anaphylaxis, hypotension and renal dysfunction and contrast-induced nephropathy (CIN) is one of them which can have both short and long term consequences.2 This study aimed to know the incidence of CIN in our center and possible predictors associated with it. Methods: This is the single hospital based cross sectional observational study. Patients undergoing primary PCI were enrolled in the study. All the patients underwent thorough history taking and physical examination. Baseline required laboratory investigations were sent. Electrocardiogram and echocardiogr...

Research paper thumbnail of Variation of Age in Clinically Overt Mitral Stenosis Patients from Two Different Countries: A Cross-National Study

Nepal Journal of Science and Technology, 2000

Rheumatic mitral stenosis (MS) remains common in developing countries and the disease advances mo... more Rheumatic mitral stenosis (MS) remains common in developing countries and the disease advances more rapidly in underdeveloping areas. To compare the ages of clinically overt rheumatic MS patients from two different countries, retrospective data analysis was carried out from Institute of medicine, TUTH, Kathmandu,Nepal and Shanghai Medical University, Shanghai, PR China. The age of 63 patients (1 8M, 45F), involved from Nepal, ranged from 11 to 68 years and the age of 154 study subjects (53M, IOIF), involved from PR China,ranged from 10 to 79 years. Heart rhythm profile was recorded from the case history. Unpaired student's t-test was used to compare the ages of clinically overt MS patients from two countries and patients' ages were also compared according to the heart rhythm profile. The values of 50th and 95th percentile of age of study subjects from two different counties were separately calculated. P<0.05 was considered as the point of statistical significance. Clinica...

Research paper thumbnail of Comparision of Transthoracic and Transesophageal Echocardiography for the Detection of Left Atrial Thrombus in Rheumatic Mitral Valvular Disease

Journal of Nepal Medical Association, 2004

Transesophageal echocardiography (TEE) was performed in 114 patients with rheumatic mitral valvul... more Transesophageal echocardiography (TEE) was performed in 114 patients with rheumatic mitral valvulardisease and its results were compared with those of transthoracic echocardiography (TTE). Of 114 patients,LA thrombus was detected in 32 patients by TEE whereas TTE could detect LA thrombus in only 4 of them.Out of 32 cases, thrombus was located in left atrial appendage (LAA) in 20 (62%). TTE could detect LAAthrombus in only one patient. The procedure of TEE was well tolerated and there was no complication. Weconclude that TEE is superior to TTE in detection of LA cavity and LA appendage thrombus. Hence, TEEshould be a routine procedure to detect LA thrombus in patients with rheumatic mitral valvular diseaseprior to any surgical intervention.Key Words: Left atrial appendage (LAA), Transthoracic echocardiography (TTE),Transesophageal echocardiography (TEE)

Research paper thumbnail of Study of Leukocytes level as a prognostic marker in patients with organophosphate poisoning

Journal of Advances in Internal Medicine, 2018

Background : Elevated leukocytes level at admission is a common finding in patients with organoph... more Background : Elevated leukocytes level at admission is a common finding in patients with organophosphates poisoning. It has been suggested as a prognostic marker. Since early leukocytosis is frequent and mulifactorial in origin, we hypothesized that leukocytes level after 24 hours may be a better predictor of mortality.Objectives : To evaluate the prognostic value of leukocytes level at admission; and at 24-48 hours in organophosphate poisoning.Methods : A hospital based, retrospective, cohort study of patients with organophosphate poisoning was conducted in Manipal Teaching Hospital, Pokhara, Nepal. After obtaining ethical clearance from Institutional research committee, records of patients presenting with poisoning were reviewed. 103 records were considered eligible for study. Relevant data were collected in a preformed pro forma and statistical analyses were carried out.Results : Mean age of 103 participant was 29.4 (SD=11.68). Out of them 57% were females and 43% were males. T-t...

Research paper thumbnail of A Study on Cardiovascular Disease Pattern of Admitted Cases in Newly Emerged National Heart Centre

Journal of Nepal Medical Association, 2003

Cardiovascular disease is one of the global leading causes of death . Although indeveloped countr... more Cardiovascular disease is one of the global leading causes of death . Although indeveloped countries overall cardiovascular death is declining due to long term declineof rheumatic heart disease (RHD), cerebro vascular and hypertensive heart disease,heart disease is still the leading cause of death. In developing countries prevalence ofcoronary heart disease (CHD) is in increasing trend and cardiovascular disease patternis changing. Cardiovascular disease pattern of this region is revealed in this study.Total 300 study subjects, admitted from May 2000 to April 2001, 174 (58%) male and126 (42%) female and age ranged from 5 to 83 years were analyzed retrospectively.Proportionate distribution of all admitted cases was calculated and arranged inaccording with sequence order.Rheumatic heart disease was found the commonest, which constituted 27.3%, followedby coronary heart disease (21.7%) and hypertension (20.7%) respectively. Chronicobstructive pulmonary disease (COPD) with cor pulmonale...

Research paper thumbnail of Current Sta Tus of Rheuma Tic Fever and Rheuma Tic Heart Disease in Nepal

Journal of Nepal Medical Association, 2003

Rheumatic fever (RF) and rheumatic heart disease (RHD) are common inunderdeveloped, deprived and ... more Rheumatic fever (RF) and rheumatic heart disease (RHD) are common inunderdeveloped, deprived and depressed areas of the world. The progression of RHDis rapid in deprived communuties. Prevalence of RF and RHD has sharply declinedin affluent and developed countries, especially after the introduction of antibiotcs.RHD is a preventable disease. RHD is a leading cause of cardiovascular deaths indeveloping countries. The prevalence of RF and RHD varies from place to place. Indeveloping countries, young productive age groups are suffering from this diseasewhile in developed countries it is becoming geriatric disease due to the betterment ofliving standards and prompt awareness upon this disease. Studies and documentationof the current ststus of RF and RHD in Nepal is the present concern.1. Shahid Gangalal National Heart Centre.Address for correspondence : Dr. Yuba Raj Limbu, CardiologyShahid Gangalal National Heart CentreP.O.Box: 11360, Kathmandu, NepalEmail: yrlimbu@yahoo.comKey Words: Rh...

Research paper thumbnail of Percutaneous transvenous mitral commissurotomy in mitral stenosis and left atrial appendage clot patients in special conditions: Hospital-based study

Indian heart journal, Nov 1, 2016

Background: The percutaneous transvenous mitral commissurotomy is an important procedure for the ... more Background: The percutaneous transvenous mitral commissurotomy is an important procedure for the treatment of mitral stenosis. A lot of mitral stenosis cases have left atrial appendage clot which precludes the patient from the benefit of this procedure. The aim of the study was to study the feasibility and safety of the procedure in a patient with appendage clot in the setup of certain urgent conditions. Method: All cases of mitral stenosis with significant dyspnea and mitral valve area <1.5 cm 2 with left atrial appendage clot and a condition which would preclude the patient from continuing on anticoagulation and needed urgent intervention were included in the study. From January 2011 to December 2013, twenty patients coming to Shahid Gangalal National Heart Centre, Kathmandu were selected for the procedure with conventional sampling technique. Informed written consent was obtained from the patients explaining all possible complications. The approval of the study was taken from the ethical committee of the hospital. Result: Mean mitral valve area increased from 0.90 cm 2 (SD AE 0.14) to 1.5 cm 2 (SD AE 0.21) (p = 0.02). Left atrial mean pressure decreased from mean of 20 to 10 mmHg. Subjective improvement was reported in all. All of the patients had fulfilled criteria for successful PTMC. There was no mortality during hospital stay or in one-week follow-up period. There were no neurological complications or any need for emergency surgery. Conclusion: The immediate result of percutaneous transvenous mitral commissurotomy in selected cases of mitral stenosis with left atrial appendage clot is safe and acceptable in certain urgent situations in experienced hands.

Research paper thumbnail of Prevalence of Cardiac Murmurs and Acute Rheumatic Fever in Schoolchildren in Rural Nepal

Heart, Lung and Circulation, 2007

Research paper thumbnail of Does populational difference influence the size of adult human coronary arteries?

Journal of Experimental and Clinical Anatomy, 2017

Introduction: Many articles have measured the coronary artery size and compared with similar stud... more Introduction: Many articles have measured the coronary artery size and compared with similar studies to verify the differences between populations. This study also compares its finding with other identical studies with an attempt to integrate them to evaluate earlier conclusions made on population differences. Materials and Methods: Normal coronary angiograms from the preexisting database of patients who underwent cardiac catheterization were analyzed for their sizes using catheter tip as calibrating object. Results: The measurements of left main coronary artery, left anterior descending artery, circumflex artery (CX), and right coronary artery (RCA) were 2.53 ± 0.26 mm, 1.86 ± 0.19 mm, 1.77 ± 0.27 mm, and 1.80 ± 0.22 mm, respectively, after being adjusted to body surface area. Coronary vessel sizes were compared between Indians, Nepalese, and the Caucasians. The RCA was significantly larger in the Indians as compared to Nepalese and Caucasians whereas Nepalese left anterior descend...

Research paper thumbnail of Coronary Artery Disease prevalence in Heart Failure with Reduced Ejection Fraction

Nepalese Heart Journal, Nov 14, 2019

Background and Aims: Even though heart failure (HF) is a major global health problem, studies on ... more Background and Aims: Even though heart failure (HF) is a major global health problem, studies on the prevalence and etiology of HF in Nepal are scant. Coronary artery disease (CAD) has been reported to be the etiology in 18% of HF presentations to the emergency department of a tertiary cardiac center in Nepal 1. Present study evaluated the prevalence and characteristics of CAD in HF with reduced ejection fraction (HFrEF) with coronary angiography (CAG). Methods: In a prospective, observational study, conducted from June 2018 to May 2019, 95 patients with HFrEF undergoing CAG, at Shahid Gangalal National Heart Centre, were evaluated. Results: The mean age of the patients was 62.7±10.1 years, with 67% males. Obstructive CAD was present in 31(33%) with 48%, 39% and 13% having triple (TVD), single (SVD) and double vessel disease (DVD) respectively. Age ≥ 65 years, smokers, dyslipidemia, obesity, angina, indexed left ventricular end diastolic volume (iEDV), indexed LV systolic diameter (iLVIDs) and regional wall motion abnormality (RWMA) on echocardiography were predictors of CAD, among only which, smoking was the independent predictor of CAD. Conclusion: Our results suggest a lower prevalence of CAD in HFrEF than previously reported from developed countries, which may be due to a systematic angiography approach and exclusion of previous coronary events. We encourage clinicians to aggressively identify this co-morbidity as it has important treatment and prognostic implementations.

Research paper thumbnail of Association of Carotid Intima-Media Thickness With Angiographic Severity and Extent of Coronary Artery Disease

The American Journal of Cardiology, 2006

The present study examined the association between carotid intima-media thickness (IMT) and sever... more The present study examined the association between carotid intima-media thickness (IMT) and severity and extent of coronary artery disease (CAD). B-mode ultrasound and quantitative coronary angiography were used to assess carotid and coronary artery atherosclerosis in 108 patients with known or suspected CAD who had been referred for cardiac catheterization. Maximum and mean IMT values of carotid arteries were measured and expressed as mean aggregate values. To evaluate anatomic severity and extent of CAD, several quantitative coronary angiographically derived parameters were incorporated into indexes. These quantitative coronary angiographic measurements reflected CAD severity, extent, and overall &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;atheroma burden&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and were calculated for the entire coronary tree and separately for different coronary segments (i.e., left main, proximal, mid, and distal segments). Maximum and mean IMT values were significantly correlated with CAD severity (p = 0.004 and 0.005, respectively), extent (p = 0.022 and 0.016, respectively), and atheroma burden (p = 0.008 for the 2 values). Further, carotid IMT was correlated with quantitative angiographic indexes for mid and distal segments but not with the proximal segments of coronary vessels. In conclusion, our study shows an association between carotid IMT and severity and extent of CAD as assessed by quantitative coronary angiography. Carotid IMT seems to be a weaker predictor of coronary atherosclerosis in the proximal parts of the coronary tree than in the mid and distal parts.

Research paper thumbnail of Screening for Hypertension in Asymptomatic Individuals in Nepal: An Expert Consensus Statement

Nepalese Heart Journal

Hypertension affects a substantial proportion of the general population in Nepal with prevalence ... more Hypertension affects a substantial proportion of the general population in Nepal with prevalence ranging from 20 to 30 percent. Early diagnosis and treatment are essential for undiagnosed hypertension and is possible through hypertension screening. The aim of this paper is to provide unified consensus recommendations for the effective screening of hypertension in Nepal. In two National Advisory expert consensus meetings, a total of 42 experts participated, discussed and voted on the key statements for formulating the consensus. Each key statement was scored on a Likert scale ranging from 1 to 9 and a mean score was calculated. The consensus statement was accepted if the mean score was seven or more with the voting of more than two-thirds of the experts. The main consensus recommendations are the following. First, screening for hypertension should start among adults from 18 years of age. Second, effective screening of hypertension can aid in the early diagnosis, control, and improve ...

Research paper thumbnail of Percutaneous transvenous mitral commissurotomy in elderly mitral stenosis patients. A retrospective study at shahid gangalal national heart centre, bansbari, kathmandu, Nepal

PubMed, Sep 1, 2013

Introduction: Percutaneous transvenous Mitral Commissurotomy (PTMC) has been shown to be a valid ... more Introduction: Percutaneous transvenous Mitral Commissurotomy (PTMC) has been shown to be a valid alternative to surgical therapy in selected patients with mitral stenosis. Though its efficacy in children and young adults is already established, its role in elderly patients is not well reported. We aimed to evaluate the efficacy of PTMC in elderly patients (≥60 years). Methods: All elderly patients who underwent PTMC from March 2008 to March 2013 were retrospectively reviewed. Mitral valve area and mean left atrial pressure before and after the procedure were compared. Results: During the study period 49 elderly patients underwent PTMC. Thirty eight were female and 11 male. Age ranged from 60 to 77 years with the mean age of 64.5±4.0 years. The mean mitral valve area increased from 0.9±0.1 cm(2) to 1.6±0.3 cm(2) whereas mean left atrial pressure decreased from 25.4±6.6 mmHg to 12.9±4.5. Successful results were observed in 41 (83.6%) patients. Unsuccessful results were due to suboptimal mitral valve area <1.5 cm(2) in 7 (14.25%) patients and post-procedure MR of more than moderate MR in 1(2%) patients. Unsuccessful PTMC was much more common in severe than in moderate mitral stenosis. Conclusions: Our study suggests that PTMC in elderly is a safe and effective procedure when performed in experienced centre by experienced operators.

Research paper thumbnail of Primary Percutaneous Coronary Intervention (PPCI) in acute myocardial infarction complicated with cardiogenic shock in a newly emerging cardiac center in Nepal

PubMed, Mar 1, 2009

Background: Acute myocardial infarction (AMI) is complicated by cardiogenic shock in 7~10% of pat... more Background: Acute myocardial infarction (AMI) is complicated by cardiogenic shock in 7~10% of patients. Mortality rate is exceedingly high and reaches 70-80% in those treated conservatively. Large thrombolytic trials demonstrate 60% mortality with most effective thrombolytic agent. Methods: In between September 2005 to August 2008 total PCI in Shahid Gangalal National Heart Center (SGNHC) in Nepal was 452. Among them primary PCI (PPCI) in AMI with cardiogenic shock was done in only 16 patients (3.5%). Results: This study showed in-hospital mortality of 50% (n = 8). Of 50% (n = 8) alive patients with cardiogenic shock who underwent PPCI, 6 patients are in routine follow-up over 12 months and 2 were doing well in subsequent 6 months but not in follow up after that. Conclusion: Primary PCI in AMI complicated by cardiogenic shock has lower mortality and improved outcome. High cost, high in-hospital mortality and lack of trained personnel are major limitations.

Research paper thumbnail of Contrast-induced Nephropathy Following Percutaneous Coronary Intervention at a Tertiary Cardiac Center in Nepal

Cureus, Sep 18, 2018

Background Contrast-induced nephropathy (CIN) is one of the leading causes of morbidity and morta... more Background Contrast-induced nephropathy (CIN) is one of the leading causes of morbidity and mortality including increased financial burden in high risk patients undergoing percutaneous coronary intervention (PCI). Methods This is an observational prospective study. We aimed to study the incidence of CIN in Nepalese populations and compare the outcome to international reprinted values with coronary artery disease (CAD) undergoing PCI. All consecutive patients with CAD undergoing PCI between February 2010 and July 2010 were enrolled in the study.

Research paper thumbnail of Left Ventricular Noncompaction

Journal of Nepal Medical Association, Apr 1, 2009

Left Ventricular Noncompaction(LVNC) is a genetic cardiac disease of emerging importance with a d... more Left Ventricular Noncompaction(LVNC) is a genetic cardiac disease of emerging importance with a distinct clinical and pathophysiological presentation. The most common clinical manifestations include heart failure, arrhythmias and embolic events, and in children it may be associated with facial dysmorphisms and Wolff-Parkinson-White syndrome. The diagnosis of LVNC, however, is often missed, most often as a consequence of ignorance of the condition. Echocardiography is considered the reference standard for the diagnosis of LVNC. Prognosis remains poor for patients with impaired systolic left ventricular function, as treatment options are very limited. Because of the familial association of LVNC, fi rst-degree relatives should be screened by Echocardiography.

Research paper thumbnail of An unusual presentation of acute coronary syndrome

DOAJ (DOAJ: Directory of Open Access Journals), Oct 1, 2010

Acute coronary syndrome in elderly can manifest with a variety of atypical presentation and may b... more Acute coronary syndrome in elderly can manifest with a variety of atypical presentation and may be associated with other comorbid conditions. We present an atypical presentation of ACS in an elderly left handed female presenting with sudden onset of slurred speech preceded by dizziness and vomiting. After through clinical examination and investigation she was managed as a case of non ST elevation myocardial infarction and ischaemic stroke.

Research paper thumbnail of Echocardiographic assessment of Diastolic Function in patients with Atrial Fibrillation

Nepalese heart journal, Nov 14, 2019

Background and Aims: Echocardiographic assessment of left ventricular diastolic function in patie... more Background and Aims: Echocardiographic assessment of left ventricular diastolic function in patients with atrial fibrillation is a challenge as loss of atrial kick (A wave), beat to beat variability and left atrium enlargement despite normal atrial pressure make usual guideline based estimation difficult and inaccurate. Hence adoption of additional echocardiography parameters are necessary which are tricky and have varied results. Hence the aim of this study was to study various aspects of diastolic function in patients with atrial fibrillation. Methods: It was a hospital based prospective cross-sectional observational study conducted at cardiology unit, National Academy of Medical Sciences, Kathmandu and Shahid Gangalal National Heart Center, Kathmandu from 1 st July 2018 to 30 th June 2019. Results: Total of 92 patients were studied. About one third (34.8%) had diastolic dysfunction. Ratio of E/e'(14.65 ± 2.21 Vs 7.66 ± 1.18) , E/Vp (1.57 ± 0.14 Vs 1.20 ± 0.11), isovolumetric relaxation time (53.06 ± 13.82ms Vs 89.33 ± 9.88ms) and deceleration time of pulmonary venous diastolic wave (203.09 ± 26.13ms Vs 292.25 ± 36.32ms) were significantly different in patients with diastolic dysfunction compared to patients without diastolic dysfunction with sensitivity of 90.6%, 84.4%, 81.2% and 78.1% respectively. Conclusion: Diastolic dysfunction is a common entity in patients with atrial fibrillation. Echocardiography parameters like E/e' ratio, isovolumetric relaxation time, E/Vp ratio and deceleration time of diastolic pulmonary wave were highly sensitive in detection of diastolic dysfunction.

Research paper thumbnail of Outcome of Percutaneous Transvenous Mitral Commisurotomy According to Age, Gender and Heart Rhythm

Journal of National Heart and Lung Society Nepal

Background: Percutaneous transvenous mitral commisurotomy (PTMC) is the recommended treatment in ... more Background: Percutaneous transvenous mitral commisurotomy (PTMC) is the recommended treatment in the severe mitral stenosis with mitral valve area ≤ 1.5 sq. cm and favourable mitral valve morphology without Left atrium (LA) clot. Methods: A retrospective study done for one year among all the patients who had undergone PTMC in 2016. Successful PTMC was defined as increase in Mitral valve area (MVA) more than or equal to 1.5 sq. cm or increase in area by more than 50% from baseline. Data was analyze using SPSS-20. Results: Three hundred thirty sex patients with mean age 34.08 ±12.0 of which male were 97 ( 26.9 %.) and female were 239 (71.1 %). There were 225 (67%) sinus rhythm (SR) and 111 (33%) atrial fibrillation (AF). The median Pre PTMC area and Left atrial (LA) Pressure were 0.9 sq cm and 24 mmHg respectively. The overall success of PTMC was in 289 (86%). The successful outcome in age categories less than 20 years, 20-40, 40-60 and more than 60 years in order are 39 (83%), 174 (8...

Research paper thumbnail of Assessment of Rheumatic Mitral Stenosis severity by Mitral Leaflet Separation Index

Nepalese Heart Journal, 2019

Background and Aims: Determining the severity of mitral stenosis (MS) is important for both progn... more Background and Aims: Determining the severity of mitral stenosis (MS) is important for both prognostic and therapeutic reasons. Measurement of Mitral valve area (MVA) by planimetry is gold standard and accurate but is highly operator dependent. Pressure Half Time (PHT) is affected by hemodynamic significance. In this Study we evaluated severity of mitral stenosis by mitral leaflet separation index (MLS index, MLSI). This new index could be useful surrogate measure of the MVA. Methods: This is a hospital based, cross-sectional observational study carried out in Shahid Gangalal National Heart Centre (SGNHC), Kathmandu, Nepal. Study included 82 patients with Rheumatic MS who had undergone echocardiographic examination from July 2018 to December 2018. The maximal separation of the mitral valve leaflet tips was measured from inner edge to inner edge in end diastole in the parasternal long axis and apical 4-chamber views. These two parameters were averaged to yield the MLSI. The index was...

Research paper thumbnail of Contrast Induced Nephropathy and its predictors after Primary Percutaneous Intervention

Nepalese Heart Journal, 2021

Background and Aims: Worldwide many patients are receiving intravascular contrast media (CM) duri... more Background and Aims: Worldwide many patients are receiving intravascular contrast media (CM) during interventional procedures. Contrast media are used to enhance visualization and guide percutaneous coronary interventions (PCI).1 However, the use of CM also carries the risk of complications and it is important to be aware of these complications. Complications with CM range from mild symptoms to life-threatening conditions like anaphylaxis, hypotension and renal dysfunction and contrast-induced nephropathy (CIN) is one of them which can have both short and long term consequences.2 This study aimed to know the incidence of CIN in our center and possible predictors associated with it. Methods: This is the single hospital based cross sectional observational study. Patients undergoing primary PCI were enrolled in the study. All the patients underwent thorough history taking and physical examination. Baseline required laboratory investigations were sent. Electrocardiogram and echocardiogr...

Research paper thumbnail of Variation of Age in Clinically Overt Mitral Stenosis Patients from Two Different Countries: A Cross-National Study

Nepal Journal of Science and Technology, 2000

Rheumatic mitral stenosis (MS) remains common in developing countries and the disease advances mo... more Rheumatic mitral stenosis (MS) remains common in developing countries and the disease advances more rapidly in underdeveloping areas. To compare the ages of clinically overt rheumatic MS patients from two different countries, retrospective data analysis was carried out from Institute of medicine, TUTH, Kathmandu,Nepal and Shanghai Medical University, Shanghai, PR China. The age of 63 patients (1 8M, 45F), involved from Nepal, ranged from 11 to 68 years and the age of 154 study subjects (53M, IOIF), involved from PR China,ranged from 10 to 79 years. Heart rhythm profile was recorded from the case history. Unpaired student's t-test was used to compare the ages of clinically overt MS patients from two countries and patients' ages were also compared according to the heart rhythm profile. The values of 50th and 95th percentile of age of study subjects from two different counties were separately calculated. P<0.05 was considered as the point of statistical significance. Clinica...

Research paper thumbnail of Comparision of Transthoracic and Transesophageal Echocardiography for the Detection of Left Atrial Thrombus in Rheumatic Mitral Valvular Disease

Journal of Nepal Medical Association, 2004

Transesophageal echocardiography (TEE) was performed in 114 patients with rheumatic mitral valvul... more Transesophageal echocardiography (TEE) was performed in 114 patients with rheumatic mitral valvulardisease and its results were compared with those of transthoracic echocardiography (TTE). Of 114 patients,LA thrombus was detected in 32 patients by TEE whereas TTE could detect LA thrombus in only 4 of them.Out of 32 cases, thrombus was located in left atrial appendage (LAA) in 20 (62%). TTE could detect LAAthrombus in only one patient. The procedure of TEE was well tolerated and there was no complication. Weconclude that TEE is superior to TTE in detection of LA cavity and LA appendage thrombus. Hence, TEEshould be a routine procedure to detect LA thrombus in patients with rheumatic mitral valvular diseaseprior to any surgical intervention.Key Words: Left atrial appendage (LAA), Transthoracic echocardiography (TTE),Transesophageal echocardiography (TEE)

Research paper thumbnail of Study of Leukocytes level as a prognostic marker in patients with organophosphate poisoning

Journal of Advances in Internal Medicine, 2018

Background : Elevated leukocytes level at admission is a common finding in patients with organoph... more Background : Elevated leukocytes level at admission is a common finding in patients with organophosphates poisoning. It has been suggested as a prognostic marker. Since early leukocytosis is frequent and mulifactorial in origin, we hypothesized that leukocytes level after 24 hours may be a better predictor of mortality.Objectives : To evaluate the prognostic value of leukocytes level at admission; and at 24-48 hours in organophosphate poisoning.Methods : A hospital based, retrospective, cohort study of patients with organophosphate poisoning was conducted in Manipal Teaching Hospital, Pokhara, Nepal. After obtaining ethical clearance from Institutional research committee, records of patients presenting with poisoning were reviewed. 103 records were considered eligible for study. Relevant data were collected in a preformed pro forma and statistical analyses were carried out.Results : Mean age of 103 participant was 29.4 (SD=11.68). Out of them 57% were females and 43% were males. T-t...

Research paper thumbnail of A Study on Cardiovascular Disease Pattern of Admitted Cases in Newly Emerged National Heart Centre

Journal of Nepal Medical Association, 2003

Cardiovascular disease is one of the global leading causes of death . Although indeveloped countr... more Cardiovascular disease is one of the global leading causes of death . Although indeveloped countries overall cardiovascular death is declining due to long term declineof rheumatic heart disease (RHD), cerebro vascular and hypertensive heart disease,heart disease is still the leading cause of death. In developing countries prevalence ofcoronary heart disease (CHD) is in increasing trend and cardiovascular disease patternis changing. Cardiovascular disease pattern of this region is revealed in this study.Total 300 study subjects, admitted from May 2000 to April 2001, 174 (58%) male and126 (42%) female and age ranged from 5 to 83 years were analyzed retrospectively.Proportionate distribution of all admitted cases was calculated and arranged inaccording with sequence order.Rheumatic heart disease was found the commonest, which constituted 27.3%, followedby coronary heart disease (21.7%) and hypertension (20.7%) respectively. Chronicobstructive pulmonary disease (COPD) with cor pulmonale...

Research paper thumbnail of Current Sta Tus of Rheuma Tic Fever and Rheuma Tic Heart Disease in Nepal

Journal of Nepal Medical Association, 2003

Rheumatic fever (RF) and rheumatic heart disease (RHD) are common inunderdeveloped, deprived and ... more Rheumatic fever (RF) and rheumatic heart disease (RHD) are common inunderdeveloped, deprived and depressed areas of the world. The progression of RHDis rapid in deprived communuties. Prevalence of RF and RHD has sharply declinedin affluent and developed countries, especially after the introduction of antibiotcs.RHD is a preventable disease. RHD is a leading cause of cardiovascular deaths indeveloping countries. The prevalence of RF and RHD varies from place to place. Indeveloping countries, young productive age groups are suffering from this diseasewhile in developed countries it is becoming geriatric disease due to the betterment ofliving standards and prompt awareness upon this disease. Studies and documentationof the current ststus of RF and RHD in Nepal is the present concern.1. Shahid Gangalal National Heart Centre.Address for correspondence : Dr. Yuba Raj Limbu, CardiologyShahid Gangalal National Heart CentreP.O.Box: 11360, Kathmandu, NepalEmail: yrlimbu@yahoo.comKey Words: Rh...

Research paper thumbnail of Percutaneous transvenous mitral commissurotomy in mitral stenosis and left atrial appendage clot patients in special conditions: Hospital-based study

Indian heart journal, Nov 1, 2016

Background: The percutaneous transvenous mitral commissurotomy is an important procedure for the ... more Background: The percutaneous transvenous mitral commissurotomy is an important procedure for the treatment of mitral stenosis. A lot of mitral stenosis cases have left atrial appendage clot which precludes the patient from the benefit of this procedure. The aim of the study was to study the feasibility and safety of the procedure in a patient with appendage clot in the setup of certain urgent conditions. Method: All cases of mitral stenosis with significant dyspnea and mitral valve area <1.5 cm 2 with left atrial appendage clot and a condition which would preclude the patient from continuing on anticoagulation and needed urgent intervention were included in the study. From January 2011 to December 2013, twenty patients coming to Shahid Gangalal National Heart Centre, Kathmandu were selected for the procedure with conventional sampling technique. Informed written consent was obtained from the patients explaining all possible complications. The approval of the study was taken from the ethical committee of the hospital. Result: Mean mitral valve area increased from 0.90 cm 2 (SD AE 0.14) to 1.5 cm 2 (SD AE 0.21) (p = 0.02). Left atrial mean pressure decreased from mean of 20 to 10 mmHg. Subjective improvement was reported in all. All of the patients had fulfilled criteria for successful PTMC. There was no mortality during hospital stay or in one-week follow-up period. There were no neurological complications or any need for emergency surgery. Conclusion: The immediate result of percutaneous transvenous mitral commissurotomy in selected cases of mitral stenosis with left atrial appendage clot is safe and acceptable in certain urgent situations in experienced hands.