Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center: A single center experience

AbstractBackgroundDiseases of the heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide with rheumatic heart disease (RHD) being the dominant form of valvular heart disease (VHD) in developing nations. The current study was undertaken at a tertiary care cardiac center with the objective of establishing the incidence and patterns of VHD by Echocardiography (Echo).MethodsAmong the 136,098 first-time Echocardiograms performed between January 2010 and December 2012, an exclusion criterion of trivial and functional regurgitant lesions yielded a total of 13,289 cases of organic valvular heart disease as the study cohort.ResultsIn RHD, the order of involvement of valves was mitral (60.2%), followed by aortic, tricuspid and pulmonary valves. Mitral stenosis, predominantly seen in females, was almost exclusively of rheumatic etiology (97.4%). The predominant form of isolated MR was rheumatic (41.1%) followed closely by myxomatous or mitral valve prolapse (40.8%). Isolated AS, more common in males, was the third most common valve lesion seen in 7.3% of cases. Degenerative calcification was the commonest cause of isolated AS (65.0%) followed by bicuspid aortic valve (BAV) (33.9%) and RHD (1.1%). Multiple valves were involved in more than a third of all cases (36.8%). The order of involvement was MS + MR > MS + AR > MR + AR > AS + AR > MR + AS > MS + AS. Overall, 9.7% of cases had organic tricuspid valve disease.ConclusionRHD contributed most to the burden of VHD in the present study with calcific degeneration, myxomatous disease and BAV being the other major forms of VHD. Multiple valves were affected in more than a third of all cases

Comparative study of high sensitivity troponin T and heart-type fatty acid-binding protein in STEMI patients

AbstractAim and backgroundHeart-type fatty acid-binding proteins (H-FABP) which are detected within 2–3h of acute myocardial infarction are involved in uptake of free fatty acids in the myocardium. Our aim in the present study is to compare window periods of H-FABP to high sensitivity troponin T (hs-Trop T) in acute ST elevation myocardial infarction (STEMI).Methods160 STEMI diagnosed patient’s serum samples are analyzed for hs-Trop T and H-FABP. Different window periods of chest pain onset (<3h, 3–6h and >6h) are compared with complications, in-hospital mortality and statistically analyzed.ResultsFrom 160 patients, 53 (33%) cases are presented in <3h, 75 (47%) in 3–6, and 32 (20%) after >6h respectively. Accordingly sensitivity of hs-Trop T was 92%, 94% and 97% while H-FABP was 75%, 88% and 84%, respectively. Overall sensitivity was 94% and 82% respectively. Statistically significant difference between mean hs-Trop T values with respect to window period <3, 3–6 and >6h was 0.21, 0.35 and 0.80ng/ml respectively, p value<0.0001. No significant difference in H-FABP values was observed.Hs-Trop T positively correlated with age (r=0.153, P=0.05), window period (r=0.363, P<0.0001), TIMI score (r=0.208, P=0.008), ejection fraction (r=0.191, P=0.008), serum H-FABP (r=0.229, P=0.004), and serum hs-CRP (r=0.326, p<0.001). There was a statistically significant difference of mean hs-Trop T values with or without in hospital mortality (0.35 vs. 0.85ng/ml, respectively, p=0.008).No significant correlation to age, TIMI score, ejection fraction and hs-CRP values for H-FABP was observed.ConclusionIt appears that hs-Trop T is a more sensitive marker than H-FABP in early hours of AMI and higher hs-Trop T predicts increase in-hospital mortality