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Does severe vitamin D deficiency predict significant coronary artery disease?
Coronary artery disease / Indian Heart Journal 69S (2017) S11–S36
Methods: It is a single center prospective study carried out at Institute of Cardiology, Rajiv Gandhi Government General Hospital from January 2017 to June 2017 on 112 enrolled patients aged between 35 and 75 years. Twelve lead surface ECG was taken at 12 h to identify AV nodal conduction blocks recovery pattern and culprit artery identification. However, coronary angiogram was done for all patients to identify the culprit artery and angioplasty performed, if necessary, before discharged. Results: Out of 112 patients, 62% were male and 58% were female patients (50% were aged between 60 and 75 years, 32% were aged 40 and 60 years and 18% were aged between 30 and 40 years). Diabetes and systemic hypertension contributed to major risk factor in females, whereas apart from diabetes, smoking and stress were additional major risk factors in males. First degree AV block was seen in 46% patients, second degree AV block Mobitz type I in 18% and Mobitz type II in 4% of patients. Third degree AV Block was seen in 32% of patients. About 90% of the patients with first degree AV block reverted to sinus rhythm within 24 h. 41% of the patients with second degree AV Block progressed to complete heart block requiring temporary pacing second to third day of admission, more so in failed thrombolytic therapy. Remaining formed the regression from complete AV block to sinus rhythm and it happened in 4–5 days. About 80% of the patients presenting with third degree AV Block who were put on temporary pacing were weaned off in 4–5 days. Only two patients required temporary pacing beyond 6 days and they had associated sick sinus syndrome. They underwent permanent single chamber pacing VVI mode and angioplasty electively at a later date. Conclusion: Inferior wall myocardial infarction produced varying degree of conduction blocks, which persisted maximum up to 6 days. First degree AV block recovered early and formed major group. Second degree AV block was least common and it is transient either due to progression or regression of conduction blocks. Proximity and severity of occlusion of culprit artery and the presence of collaterals determine the duration of conduction blocks. Success of thrombolysis is also an added determinant.
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correlation between CIMT, PS and complexity of CAD as determined by SS II. Methods: A total of 165 patients were included. All demographic, clinical data, biochemical tests, 2D Echo and coronary angiography of the study subjects were done. Mean CIMT and PS were calculated for all the subjects. The correlation between various parameters was done using Pearson correlation coefficient. Results: Weak correlation was observed with CIMT and moderate correlation with PS with SS I, SS II percutaneous coronary intervention (PCI), SS II coronary artery bypass grafting (CABG). The sensitivity of CIMT (>0.55) in predicting high SS II PCI was 97.7% and PS (>2.5) was 60.47% and the specificities were 6.33% and 70.89%, respectively. CIMT (>0.55) has got better sensitivity while PS (>2.5) has got better specificity. The sensitivity of CIMT (>0.55) in predicting high SS II CABG is 97.59% and PS (>2.5) is 61.45% and the specificities are 6.10% and 70.73%, respectively. CIMT (>0.55) has got better sensitivity while PS (>2.5) has got better specificity. For CIMT cut off >0.75, the sensitivity for predicting high SS II PCI was 58.1% and SSII CABG was 61.4% and the specificities were 59.5% and 62.2% respectively. The overall diagnostic accuracy of CIMT (>0.75) SSII PCI and SSII CABG was 58.78% and 61.81%, respectively. Conclusion: SS I, SS II PCI, SS II CABG showed weak correlation with CIMT and moderate correlation with PS. CIMT (>0.55) has got better sensitivity while PS (>2.5) has got better specificity in predicting high SS II PCI and CABG. For high SS II PCI and CABG during univariate analysis, mean CIMT, PS and low-density lipoprotein (LDL) were statistically significant. In multivariate analysis, only PS had shown statistically significant association. Conflicts of interest The authors have none to declare. https://doi.org/10.1016/j.ihj.2017.09.034
ABS149 Conflicts of interest The authors have none to declare. https://doi.org/10.1016/j.ihj.2017.09.033
ABS122 Correlation of carotid intima-media thickness and plaque score with SYNTAX II score in patients with coronary artery disease: An observational study K. Ravikiran ∗ , P.V. Ramachandra Raju, Amar N. Patnaik, Y.S. Arun Kumar Reddy, G. Ramesh, J. Mohanrao Star Hospital, Hyderabad, India E-mail address: [email protected] (K. Ravikiran). Background: Early non-invasive detection of coronary artery disease (CAD) in asymptomatic subjects is crucial. Carotid ultrasonography is effective in assessing atherosclerotic lesions. Carotid intima media thickness (CIMT) and plaque score (PS) have been shown to correlate well with presence of CAD. On the other hand, SYNTAX and SYNTAX II score were introduced to estimate the complexity of the lesions. Aim of this study was to find out the
Does severe vitamin D deficiency predict significant coronary artery disease? J. Mohan Rao, A.N. Patnaik, K.A. Pankaj, P.V.R.C. Raju, G. Ramesh, K.J. Babu, K. Naveen Krishna ∗ , K.V. Aniket, Ravi Kiran Star Hospitals, India E-mail address: [email protected] (K. Naveen Krishna). Background: Low vitamin D status has been shown to be associated with cardiovascular disease; however, its value in predicting severe coronary artery disease (CAD) is not well-studied. The available data is scanty and conflicting. The aim of this study was to look at any possible association between blood levels of serum vitamin D and the severity of CAD. Material and methods: A total of 220 patients undergoing coronary angiography for chest pain and a positive stress test for inducible ischemia were included prospectively in this study. Blood samples were collected for vitamin D levels (25-OH-vitamin D) in all patients before the angiogram. Significant CAD was defined as at least one vessel showing diameter stenosis with >70%, while severe CAD as left main and/or Triple vessel disease, as evaluated by coronary angiography. Those who had taken vitamin D supplements in the recent past were excluded from the study. Results: A total of 220 patients were included in this study from February 2015 to January 2016, out of which 148 (67.3%) were
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Coronary artery disease / Indian Heart Journal 69S (2017) S11–S36
males. The mean age was 59.2 ± 9.4 years (range 34–78 years). The mean vitamin D levels were 18.7 ± 8.7 ng/ml. Normal vitamin D levels >30 ng/ml, insufficiency (21–29 ng/ml) or mild deficiency (<20 ng/ml) and severe deficiency (<10 ng/ml) were observed in 62 (28.1%), 62 (28.1%), 64 (29%) and 32 (14.5%), respectively. Of the total 96 patients with serum vitamin levels <20 ng/ml 30 (31.2%) had either left main/triple vessel disease and 52 (54.7%) had one or 2 vessel-disease. However, the corresponding figures in the sub-set with <10 ng/ml vitamin D levels were 12 (37.5%) and 21 (65%). Conclusion: Severe vitamin D deficiency is a significant predictor of severe CAD including left main and triple vessel disease. Conflicts of interest The authors have none to declare. https://doi.org/10.1016/j.ihj.2017.09.035
ABS150 Identification of conventional and emerging risk factors of atherosclerotic coronary heart disease among women Kaushal Gandhi ∗ , R.R. Mantri, Rajneesh Jain, Rajiv Passey, J.P.S. Sawhney, Bhuwanesh Kandpal, Aman Makhija, B.S. Vivek Sir Ganga Ram Hospital, New Delhi, India E-mail address: [email protected] (K. Gandhi). Background: Coronary heart disease (CHD) has been considered as a disease predominantly affecting men and for a long-time, woman were not included in cardiovascular research programs. There is paucity of data regarding the prevalence of risk factors of CHD, especially the emerging risk factors in women from India. The present study is aimed to identify the relative importance of the conventional as well as some emerging risk factors (homocysteine, lipoprotein (a), hsCRP) in women with atherosclerotic CHD. Methods: This is a prospective, cross sectional, observational study, which was carried out in 200 suspected CHD female patients (100 patients with CHD, mean age – 63.38 years and 100 patients with normal coronaries, mean age – 55.60 years), who underwent coronary angiography. Patients were evaluated for conventional risk factors like diet, exercise, tobacco use, diabetes, hypertension, dyslipidemia, psychosocial risk factors and newer risk factors. The risk factors in women with CHD were compared with age matched women with normal coronaries. Logistic regression was used to estimate the odd ratios along with the accuracy parameters. Results: Prevalence of diabetes mellitus (52% vs 17%), hypertension (63% vs 31%), dyslipidemia (73% vs 25%), BMI >23 kg/m2 (96% vs 64%), central obesity (68% vs 4%), psychosocial stress (43% vs 12%) was higher in CHD group as compared to controls. Consumption of tobacco was minimal (2% vs 0%). The prevalence of other risk factors like intake of fruits/vegetables (37% vs 69%), physical activity (28% vs 88%) was lower in the CHD group vs controls. Among emerging risk factors, lipoprotein (a) level (59% vs 3%), hsCRP (90% vs 6%), homocysteine level (46% vs 14%) were higher in CHD group as compared to controls. Conclusions: This study of 200 women who underwent coronary angiography demonstrated a higher prevalence of both conventional and emerging risk factors in Indian women with CHD.
Conflicts of interest The authors have none to declare. https://doi.org/10.1016/j.ihj.2017.09.036
ABS151 A retrospective observational study of Syntax Score in young patients (<45 years) with acute ST elevation myocardial infarction Harsh Tilwani ∗ , Niraj Chaudhari, Vijay Kumar, Prashant Upasani, Ramesh Arora, Purshotam Lal Metro Heart Institute, Sector 12, Noida, Uttar Pradesh, India E-mail address: [email protected] (H. Tilwani). Background: Acute myocardial infarction below 45 years of age constitutes a specific subset of population having different risk factors and clinical features as compared to older patients. Pattern of coronary artery involvement and clinical outcome also varies suggesting different underlying pathophysiology. The cut-off age of 45 has been used in most studies to define young patients with coronary artery disease (CAD) and myocardial infarction (MI). There are many studies regarding the angiographic profile in these young patients with acute MI but less data is available regarding the Syntax Score in these young patients. Also there is not much data regarding particular age limit above which the Syntax Score increases in these group of patients. So this study was undertaken to assess the Syntax Score this group of patients, at a tertiary care hospital in north India. Materials and methods: Study area: The study was conducted at the Department of Cardiology at a tertiary care hospital in north India. Study population: 101 young patients between 18 and 45 years of age having ST elevation myocardial infarction (STEMI) who had undergone coronary angiography with or without prior thrombolytic therapy have been included in this study. We divided our patients into three age groups less than 25 years, 26–35 years and more than 35 years. Sample size: The study included 101 cases over a period of two years from June 2015 to May 2017. Data collection and tools: Data was collected from available hospital records as per the proforma sheet, which had information about the patients presenting complaints, gender, family history, treatment history (thrombolytic therapy given or not), personal habits (smoking, alcohol, substance abuse), lab reports (fasting lipid profile, HbA1c levels, homocystiene levels, protein C & S), type of STEMI on ECG, 2D echo findings, coronary angiography findings accordingly as having single vessel disease (with the specific artery involved), double vessel disease and triple vessel disease (with the specific arteries involved), complete total occlusion, non-critical CAD, and patients having normal coronaries on coronary angiography. Syntax Score: Syntax Score was calculated with the help of Syntax Score calculator from the website syntaxscore.com. Syntax Score was assessed and compared for each of the age groups. Data analysis: All the statistical analysis was performed using SPSS version 20. The clinical profile of patients was analyzed by chi-square test for qualitative variables and student t test for quantitative variables. 5% probability level was considered as statistically significant i.e., p < 0.05.
Methods: It is a single center prospective study carried out at Institute of Cardiology, Rajiv Gandhi Government General Hospital from January 2017 to June 2017 on 112 enrolled patients aged between 35 and 75 years. Twelve lead surface ECG was taken at 12 h to identify AV nodal conduction blocks recovery pattern and culprit artery identification. However, coronary angiogram was done for all patients to identify the culprit artery and angioplasty performed, if necessary, before discharged. Results: Out of 112 patients, 62% were male and 58% were female patients (50% were aged between 60 and 75 years, 32% were aged 40 and 60 years and 18% were aged between 30 and 40 years). Diabetes and systemic hypertension contributed to major risk factor in females, whereas apart from diabetes, smoking and stress were additional major risk factors in males. First degree AV block was seen in 46% patients, second degree AV block Mobitz type I in 18% and Mobitz type II in 4% of patients. Third degree AV Block was seen in 32% of patients. About 90% of the patients with first degree AV block reverted to sinus rhythm within 24 h. 41% of the patients with second degree AV Block progressed to complete heart block requiring temporary pacing second to third day of admission, more so in failed thrombolytic therapy. Remaining formed the regression from complete AV block to sinus rhythm and it happened in 4–5 days. About 80% of the patients presenting with third degree AV Block who were put on temporary pacing were weaned off in 4–5 days. Only two patients required temporary pacing beyond 6 days and they had associated sick sinus syndrome. They underwent permanent single chamber pacing VVI mode and angioplasty electively at a later date. Conclusion: Inferior wall myocardial infarction produced varying degree of conduction blocks, which persisted maximum up to 6 days. First degree AV block recovered early and formed major group. Second degree AV block was least common and it is transient either due to progression or regression of conduction blocks. Proximity and severity of occlusion of culprit artery and the presence of collaterals determine the duration of conduction blocks. Success of thrombolysis is also an added determinant.
S15
correlation between CIMT, PS and complexity of CAD as determined by SS II. Methods: A total of 165 patients were included. All demographic, clinical data, biochemical tests, 2D Echo and coronary angiography of the study subjects were done. Mean CIMT and PS were calculated for all the subjects. The correlation between various parameters was done using Pearson correlation coefficient. Results: Weak correlation was observed with CIMT and moderate correlation with PS with SS I, SS II percutaneous coronary intervention (PCI), SS II coronary artery bypass grafting (CABG). The sensitivity of CIMT (>0.55) in predicting high SS II PCI was 97.7% and PS (>2.5) was 60.47% and the specificities were 6.33% and 70.89%, respectively. CIMT (>0.55) has got better sensitivity while PS (>2.5) has got better specificity. The sensitivity of CIMT (>0.55) in predicting high SS II CABG is 97.59% and PS (>2.5) is 61.45% and the specificities are 6.10% and 70.73%, respectively. CIMT (>0.55) has got better sensitivity while PS (>2.5) has got better specificity. For CIMT cut off >0.75, the sensitivity for predicting high SS II PCI was 58.1% and SSII CABG was 61.4% and the specificities were 59.5% and 62.2% respectively. The overall diagnostic accuracy of CIMT (>0.75) SSII PCI and SSII CABG was 58.78% and 61.81%, respectively. Conclusion: SS I, SS II PCI, SS II CABG showed weak correlation with CIMT and moderate correlation with PS. CIMT (>0.55) has got better sensitivity while PS (>2.5) has got better specificity in predicting high SS II PCI and CABG. For high SS II PCI and CABG during univariate analysis, mean CIMT, PS and low-density lipoprotein (LDL) were statistically significant. In multivariate analysis, only PS had shown statistically significant association. Conflicts of interest The authors have none to declare. https://doi.org/10.1016/j.ihj.2017.09.034
ABS149 Conflicts of interest The authors have none to declare. https://doi.org/10.1016/j.ihj.2017.09.033
ABS122 Correlation of carotid intima-media thickness and plaque score with SYNTAX II score in patients with coronary artery disease: An observational study K. Ravikiran ∗ , P.V. Ramachandra Raju, Amar N. Patnaik, Y.S. Arun Kumar Reddy, G. Ramesh, J. Mohanrao Star Hospital, Hyderabad, India E-mail address: [email protected] (K. Ravikiran). Background: Early non-invasive detection of coronary artery disease (CAD) in asymptomatic subjects is crucial. Carotid ultrasonography is effective in assessing atherosclerotic lesions. Carotid intima media thickness (CIMT) and plaque score (PS) have been shown to correlate well with presence of CAD. On the other hand, SYNTAX and SYNTAX II score were introduced to estimate the complexity of the lesions. Aim of this study was to find out the
Does severe vitamin D deficiency predict significant coronary artery disease? J. Mohan Rao, A.N. Patnaik, K.A. Pankaj, P.V.R.C. Raju, G. Ramesh, K.J. Babu, K. Naveen Krishna ∗ , K.V. Aniket, Ravi Kiran Star Hospitals, India E-mail address: [email protected] (K. Naveen Krishna). Background: Low vitamin D status has been shown to be associated with cardiovascular disease; however, its value in predicting severe coronary artery disease (CAD) is not well-studied. The available data is scanty and conflicting. The aim of this study was to look at any possible association between blood levels of serum vitamin D and the severity of CAD. Material and methods: A total of 220 patients undergoing coronary angiography for chest pain and a positive stress test for inducible ischemia were included prospectively in this study. Blood samples were collected for vitamin D levels (25-OH-vitamin D) in all patients before the angiogram. Significant CAD was defined as at least one vessel showing diameter stenosis with >70%, while severe CAD as left main and/or Triple vessel disease, as evaluated by coronary angiography. Those who had taken vitamin D supplements in the recent past were excluded from the study. Results: A total of 220 patients were included in this study from February 2015 to January 2016, out of which 148 (67.3%) were
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Coronary artery disease / Indian Heart Journal 69S (2017) S11–S36
males. The mean age was 59.2 ± 9.4 years (range 34–78 years). The mean vitamin D levels were 18.7 ± 8.7 ng/ml. Normal vitamin D levels >30 ng/ml, insufficiency (21–29 ng/ml) or mild deficiency (<20 ng/ml) and severe deficiency (<10 ng/ml) were observed in 62 (28.1%), 62 (28.1%), 64 (29%) and 32 (14.5%), respectively. Of the total 96 patients with serum vitamin levels <20 ng/ml 30 (31.2%) had either left main/triple vessel disease and 52 (54.7%) had one or 2 vessel-disease. However, the corresponding figures in the sub-set with <10 ng/ml vitamin D levels were 12 (37.5%) and 21 (65%). Conclusion: Severe vitamin D deficiency is a significant predictor of severe CAD including left main and triple vessel disease. Conflicts of interest The authors have none to declare. https://doi.org/10.1016/j.ihj.2017.09.035
ABS150 Identification of conventional and emerging risk factors of atherosclerotic coronary heart disease among women Kaushal Gandhi ∗ , R.R. Mantri, Rajneesh Jain, Rajiv Passey, J.P.S. Sawhney, Bhuwanesh Kandpal, Aman Makhija, B.S. Vivek Sir Ganga Ram Hospital, New Delhi, India E-mail address: [email protected] (K. Gandhi). Background: Coronary heart disease (CHD) has been considered as a disease predominantly affecting men and for a long-time, woman were not included in cardiovascular research programs. There is paucity of data regarding the prevalence of risk factors of CHD, especially the emerging risk factors in women from India. The present study is aimed to identify the relative importance of the conventional as well as some emerging risk factors (homocysteine, lipoprotein (a), hsCRP) in women with atherosclerotic CHD. Methods: This is a prospective, cross sectional, observational study, which was carried out in 200 suspected CHD female patients (100 patients with CHD, mean age – 63.38 years and 100 patients with normal coronaries, mean age – 55.60 years), who underwent coronary angiography. Patients were evaluated for conventional risk factors like diet, exercise, tobacco use, diabetes, hypertension, dyslipidemia, psychosocial risk factors and newer risk factors. The risk factors in women with CHD were compared with age matched women with normal coronaries. Logistic regression was used to estimate the odd ratios along with the accuracy parameters. Results: Prevalence of diabetes mellitus (52% vs 17%), hypertension (63% vs 31%), dyslipidemia (73% vs 25%), BMI >23 kg/m2 (96% vs 64%), central obesity (68% vs 4%), psychosocial stress (43% vs 12%) was higher in CHD group as compared to controls. Consumption of tobacco was minimal (2% vs 0%). The prevalence of other risk factors like intake of fruits/vegetables (37% vs 69%), physical activity (28% vs 88%) was lower in the CHD group vs controls. Among emerging risk factors, lipoprotein (a) level (59% vs 3%), hsCRP (90% vs 6%), homocysteine level (46% vs 14%) were higher in CHD group as compared to controls. Conclusions: This study of 200 women who underwent coronary angiography demonstrated a higher prevalence of both conventional and emerging risk factors in Indian women with CHD.
Conflicts of interest The authors have none to declare. https://doi.org/10.1016/j.ihj.2017.09.036
ABS151 A retrospective observational study of Syntax Score in young patients (<45 years) with acute ST elevation myocardial infarction Harsh Tilwani ∗ , Niraj Chaudhari, Vijay Kumar, Prashant Upasani, Ramesh Arora, Purshotam Lal Metro Heart Institute, Sector 12, Noida, Uttar Pradesh, India E-mail address: [email protected] (H. Tilwani). Background: Acute myocardial infarction below 45 years of age constitutes a specific subset of population having different risk factors and clinical features as compared to older patients. Pattern of coronary artery involvement and clinical outcome also varies suggesting different underlying pathophysiology. The cut-off age of 45 has been used in most studies to define young patients with coronary artery disease (CAD) and myocardial infarction (MI). There are many studies regarding the angiographic profile in these young patients with acute MI but less data is available regarding the Syntax Score in these young patients. Also there is not much data regarding particular age limit above which the Syntax Score increases in these group of patients. So this study was undertaken to assess the Syntax Score this group of patients, at a tertiary care hospital in north India. Materials and methods: Study area: The study was conducted at the Department of Cardiology at a tertiary care hospital in north India. Study population: 101 young patients between 18 and 45 years of age having ST elevation myocardial infarction (STEMI) who had undergone coronary angiography with or without prior thrombolytic therapy have been included in this study. We divided our patients into three age groups less than 25 years, 26–35 years and more than 35 years. Sample size: The study included 101 cases over a period of two years from June 2015 to May 2017. Data collection and tools: Data was collected from available hospital records as per the proforma sheet, which had information about the patients presenting complaints, gender, family history, treatment history (thrombolytic therapy given or not), personal habits (smoking, alcohol, substance abuse), lab reports (fasting lipid profile, HbA1c levels, homocystiene levels, protein C & S), type of STEMI on ECG, 2D echo findings, coronary angiography findings accordingly as having single vessel disease (with the specific artery involved), double vessel disease and triple vessel disease (with the specific arteries involved), complete total occlusion, non-critical CAD, and patients having normal coronaries on coronary angiography. Syntax Score: Syntax Score was calculated with the help of Syntax Score calculator from the website syntaxscore.com. Syntax Score was assessed and compared for each of the age groups. Data analysis: All the statistical analysis was performed using SPSS version 20. The clinical profile of patients was analyzed by chi-square test for qualitative variables and student t test for quantitative variables. 5% probability level was considered as statistically significant i.e., p < 0.05.