Nepalese Heart Journal 2019-11-22T10:22:17+00:00 Dr Dipanker Prajapati Open Journal Systems <p>Nepalese Heart Journal (NHJ) is a biannual, peer-reviewed, open-access, international medical journal. NHJ publishes original research and critical reviews dealing with all disciplines of cardiovascular Medicine. It is the official journal of the Cardiac Society of Nepal and is published twice a year (May and November). Each issue of NHJ publishes Original Articles, Review Articles, Case Reports, Editorials and Letters to the Editor. From time to time invited articles, editorials and review of selected topics will be published. Authors do not have to pay for the submission, processing or publication of articles in NHJ.</p> <p>The Nepalese Heart Journal aims to facilitate a common portal for publication of wide ranging topics in cardiovascular research and clinical works. It aims to provide easy dissemination of research works to a variety of health workers and researchers.</p> <p>The journal can also be viewed on its own website at <a title="NHJ" href="" target="_self"></a></p> Rheumatic Heart Disease in school going children: A cross-sectional epidemiological profile of Jajarkot, Nepal 2019-11-22T10:21:57+00:00 Prakash Raj Regmi Urmila Shakya Ajay Adhikaree Jigyasa Regmi Paudyal <p><strong>Background and Aims:</strong> Rheumatic Heart Disease (RHD) is the most common heart disease among children and young&nbsp;adults in Nepal. Identifying the prevalence of RHD is important in planning RHD prevention program. There are few studies&nbsp;on RHD conducted among children of unreached population of Nepal. This study aimed to determine the epidemiological&nbsp;status of RHD among school going children living in rural and underdeveloped community of Jajarkot, Nepal.</p> <p><strong>Methods:</strong> This is a cross-sectional study of 6,147 school going children of age group 5 to 16 years from 24 randomly&nbsp;selected schools of Jajarkot in the month of May, 2018. A team of cardiologists from Nepal Heart Foundation examined&nbsp;the children. Diagnosis of RHD was confirmed by echocardiography. Selected socio-demographic data were collected. All&nbsp;positive cases were reviewed by senior cardiologist. Information obtained were analyzed. Frequency and percentage for the&nbsp;categorical data were calculated. Prevalence was reported as cases per thousand school children.</p> <p><strong>Results:</strong> The overall prevalence of RHD was 7.32 per 1000 schoolchildren. Borderline RHD was 1.30 per 1000 and definite&nbsp;RHD 6.02 per 1000. On severity scale, mild RHD was 6.18, moderate RHD 0.81 and severe RHD 0.33 per 1000 respectively.&nbsp;Prevalence of RHD varied with age, sex, ethnicity, and severity. RHD was found higher among males, 10-16 years age group&nbsp;and underprivileged children.</p> <p><strong>Conclusion:</strong> Jajarkot is found to be a RHD endemic zone in Nepal where prevention efforts should be initiated urgently.</p> 2019-11-14T01:45:34+00:00 ##submission.copyrightStatement## Cardiac Resynchronization Therapy- Single center experience in Nepal 2019-11-22T10:21:59+00:00 Roshan Raut Man Bahadur KC Sujeeb Rajbhandari Murari Dhungana Mukunda Sharma Surakshya Joshi Prashant Bajracharya <p><strong>Background and Aims:</strong> Cardiac resynchronization therapy (CRT) has become an established treatment modality for&nbsp;patients with advanced heart failure. CRT abbreviates the dysynchronus heart failure mainly by correcting left ventricular&nbsp;dysynchrony. In the last three years, CRT has been regularly done in Shahid Gangalal National Heart Center(SGNHC) which&nbsp;has provided us the platform to report the outcome of CRT, for the first time in Nepal. The aim of this study is to review the&nbsp;recent clinical experience and outcome of CRT in our centre.</p> <p><strong>Methods:</strong> All consecutive patients who underwent CRT at SGNHC from July, 2016 to July, 2019 were reviewed retrospectively.</p> <p><strong>Results:</strong> Altogether 42 patients underwent CRT. Mean age was 65±11 years (range 43 to 84). Coronary sinus cannulation&nbsp;was successful in 41 patients. In one patient, LV lead delivery was unsuccessful. Thus, procedural success was obtained in&nbsp;95% (40 out of 42) patients. LV lead dislodgement occurred in three patients (7%). Coronary sinus dissection occurred in&nbsp;two patients (5%). Biventricular (BiV) paced QRS was significantly narrower compared to baseline QRS (127ms Vs 162ms,&nbsp;p&lt;0.01). During mean follow up of 12±10 months (range 1 to 30 months), there was significant improvement in the clinical&nbsp;outcomes: NYHA class (1.8 Vs 2.9, p&lt;0.01), LVEF (22.3 Vs 27.5, p&lt;0.01), left ventricle internal diameter in systole (LVIDs),&nbsp;(57 Vs 60.5 mm, p&lt;0.01). The CRT responder rate was 86%. Super-responder was observed in 12% of patients.</p> <p><strong>Conclusion:</strong> In SGNHC, Cardiac resynchronization therapy is emerging as a routine treatment strategy with a reasonable&nbsp;efficacy and safety outcome.</p> 2019-11-14T01:46:35+00:00 ##submission.copyrightStatement## Evaluation of left ventricular systolic function by Myocardial Deformation Imaging in asymptomatic HIV patients 2019-11-22T10:22:01+00:00 Kunjang Sherpa Ram Kishor Sah Arun Maskey Rabi Malla Deewakar Sharma Sujeeb Rajbhandari Man Bahadur KC Rikesh Tamrakar Sushil Shakya Birat Krishna Timilsina Anish Hirachan Prabha Chapagain Koirala Ajay Adhikari Shaneez Nazmy <p><strong>Background and Aims:</strong> Despite improvements in clinical care, evidence from both industrialized and developing&nbsp;countries indicates that the prevalence of subclinical cardiac dysfunction in individuals with well-controlled HIV infection&nbsp;may approach 50% and represent a newly recognized comorbid condition. The aim of our study was to reveal abnormalities&nbsp;in cardiac function using conventional transthoracic echocardiography and left ventricular strain imaging in HIV infected&nbsp;patients without cardiovascular disease.</p> <p><strong>Methods:</strong> This was a hospital based, single center descriptive cross-sectional comparative study conducted in National&nbsp;Academy of Medical Sciences (NAMS), Bir Hospital which included HIV patients with baseline examination including a patient&nbsp;medical history, clinical examination, baseline CD4 count, viral load and a standardized transthoracic echocardiography and&nbsp;strain imaging examination and the findings were compared among age and sex frequency matched healthy adult population.</p> <p><strong>Results:</strong> Our study enrolled 142 patients out of which 95 HIV positive patients (mean age 36.7±9.2 years with 58% female)&nbsp;and 47 healthy control (mean age 33.7±8 years with 57.4% female). The median duration of HIV diagnosis was 7 years&nbsp;(IQR 2, 10) and median CD4 count was 464 cells/mm3 (IQR 259,750). There was no significant difference in conventional&nbsp;echocardiographic parameters between two groups except for transmitral E velocity that was lower in HIV group (P value of&nbsp;0.001). The HIV population has lower mean global longitudinal strain (GLS) value of -19.92% ± 2.54 SD compared to the&nbsp;healthy control population with mean of -21.39% ± 1.54 SD(P value of 0.001) and patients with CD4 count less than 300 cell/mm3 had GLS value significantly lower than -18% (P value of 0.05).</p> <p><strong>Conclusion:</strong> HIV infected population without established cardiovascular disease have subclinical left ventricular&nbsp;dysfunction revealed by GLS imaging technique.</p> 2019-11-14T00:00:00+00:00 ##submission.copyrightStatement## Echocardiographic assessment of Diastolic Function in patients with Atrial Fibrillation 2019-11-22T10:22:03+00:00 Ajay Adhikaree Rabi Malla Ram Kishor Sah Arun Maskey Sujeeb Rajbhandari Deewakar Sharma Binayak Gautam Shaneez Najmy <p><strong>Background and Aims:</strong> Echocardiographic assessment of left ventricular diastolic function in patients with atrial&nbsp;fibrillation is a challenge as loss of atrial kick (A wave), beat to beat variability and left atrium enlargement despite normal&nbsp;atrial pressure make usual guideline based estimation difficult and inaccurate. Hence adoption of additional echocardiography&nbsp;parameters are necessary which are tricky and have varied results. Hence the aim of this study was to study various aspects of&nbsp;diastolic function in patients with atrial fibrillation.</p> <p><strong>Methods:</strong> It was a hospital based prospective cross-sectional observational study conducted at cardiology unit, National&nbsp;Academy of Medical Sciences, Kathmandu and Shahid Gangalal National Heart Center, Kathmandu from 1st July 2018 to 30th&nbsp;June 2019.</p> <p><strong>Results:</strong> Total of 92 patients were studied. About one third (34.8%) had diastolic dysfunction. Ratio of E/e’(14.65 ± 2.21&nbsp;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&nbsp;deceleration time of pulmonary venous diastolic wave (203.09 ± 26.13ms Vs 292.25 ± 36.32ms) were significantly different&nbsp;in patients with diastolic dysfunction compared to patients without diastolic dysfunction with sensitivity of 90.6%, 84.4%,&nbsp;81.2% and 78.1% respectively.</p> <p><strong>Conclusion:</strong> Diastolic dysfunction is a common entity in patients with atrial fibrillation. Echocardiography parameters like&nbsp;E/e’ ratio, isovolumetric relaxation time, E/Vp ratio and deceleration time of diastolic pulmonary wave were highly sensitive&nbsp;in detection of diastolic dysfunction.</p> 2019-11-14T01:49:59+00:00 ##submission.copyrightStatement## Etiological spectrum of Heart Failure in a tertiary health care facility of Central Nepal 2019-11-22T10:22:04+00:00 Mahesh Bhattarai Rakesh Kumar Shah Nayan Kamal Sainju Buna Bhandari Sumir Keshari Damber Bahadur Karki <p><strong>Background and Aims:</strong> High-income countries have reported common causes of heart failure as ischaemic heart&nbsp;diseases, hypertension, valvular heart diseases, and cardiomyopathies. There are limited data available about epidemiology of&nbsp;heart failure in low-income countries like Nepal. The main objective of this study is to explore etiological spectrum of heart&nbsp;failure in Nepal.</p> <p><strong>Methods:</strong> This cross-sectional study was conducted at the cardiology department of Kathmandu Medical College from&nbsp;April 15, 2019, to July 15, 2019. Data were collected from patients diagnosed as heart failure following the European Society&nbsp;of Cardiology criteria and having left ventricular ejection fraction less than 50% and classified into Heart failure with midrange&nbsp;or reduced ejection fraction. Diastolic heart failure, Cor-pulmonale, and stroke were excluded. The data were entered&nbsp;and analyzed in Statistical Package for Social Sciences 20.0 using descriptive and inferential statistics.</p> <p><strong>Results:</strong> Among 132 heart failure patients (mean age: 63.9±13.9 years), around two-thirds (65.2%) had heart failure with&nbsp;reduced ejection fraction (ejection fraction of less than 40%) and one third (34.8%) had heart failure with mid-range ejection&nbsp;fraction (40 to 49%). Dilated cardiomyopathy was the leading cause of heart failure among nearly half (47.7%) of study&nbsp;participants, followed by valvular heart disease (19.7%), hypertensive heart disease (14.4%) and ischaemic heart disease&nbsp;(13.6%). Almost half of the study participants with dilated cardiomyopathy had severe left ventricular systolic dysfunction.&nbsp;(p&lt;0.05).</p> <p><strong>Conclusion:</strong> Dilated cardiomyopathy was the most prevalent cause of heart failure, followed by valvular heart disease in&nbsp;our study.</p> 2019-11-14T01:50:49+00:00 ##submission.copyrightStatement## Coronary Artery Disease prevalence in Heart Failure with Reduced Ejection Fraction 2019-11-22T10:22:06+00:00 Shaneez Najmy Rajan Paudel Ajay Adhikari Reeju Manandhar Chandra Mani Adhikari Ram Kishor Sah Rabi Malla Arun Maskey Deewakar Sharma Sujeeb Rajbhandari <p><strong>Background and Aims:</strong> Even though heart failure (HF) is a major global health problem, studies on the prevalence&nbsp;and etiology of HF in Nepal are scant. Coronary artery disease (CAD) has been reported to be the etiology in 18% of HF&nbsp;presentations to the emergency department of a tertiary cardiac center in Nepal1. Present study evaluated the prevalence and&nbsp;characteristics of CAD in HF with reduced ejection fraction (HFrEF) with coronary angiography (CAG).</p> <p><strong>Methods:</strong> In a prospective, observational study, conducted from June 2018 to May 2019, 95 patients with HFrEF undergoing&nbsp;CAG, at Shahid Gangalal National Heart Centre, were evaluated.</p> <p><strong>Results:</strong> The mean age of the patients was 62.7±10.1 years, with 67% males. Obstructive CAD was present in 31(33%)&nbsp;with 48%, 39% and 13% having triple (TVD), single (SVD) and double vessel disease (DVD) respectively. Age ≥ 65 years,&nbsp;smokers, dyslipidemia, obesity, angina, indexed left ventricular end diastolic volume (iEDV), indexed LV systolic diameter&nbsp;(iLVIDs) and regional wall motion abnormality (RWMA) on echocardiography were predictors of CAD, among only which,&nbsp;smoking was the independent predictor of CAD.</p> <p><strong>Conclusion:</strong> Our results suggest a lower prevalence of CAD in HFrEF than previously reported from developed countries,&nbsp;which may be due to a systematic angiography approach and exclusion of previous coronary events. We encourage clinicians&nbsp;to aggressively identify this co-morbidity as it has important treatment and prognostic implementations.</p> 2019-11-14T01:51:36+00:00 ##submission.copyrightStatement## Association of Carotid Intima Media Thickness with the severity of Coronary Artery Disease in patients undergoing Coronary Artery Bypass Graft Surgery in a tertiary care center 2019-11-22T10:22:08+00:00 Binayak Gautam Kunjang Sherpa Rajan Poudel Pragati Shrestha Deewakar Sharma Ram Kishor Sah Rabi Malla Arun Maskey Man Bahadur K.C Sujeeb Rajbhandari <p><strong>Background and Aims:</strong> Atherosclerosis is an inflammatory process involving arteries in various organs. Carotid intima&nbsp;medial thickness (CIMT) can be useful noninvasive tool to detect atherosclerosis for diagnosis of significant cardiovascular&nbsp;disease. We aim to study the association of CIMT with severity of Coronary Artery Disease (CAD).</p> <p><strong>Methods:</strong> This was a cross sectional, observational study conducted in 81 patients with mean age of 59.9± 8.5 years&nbsp;with a diagnosis of CAD undergoing coronary artery bypass graft (CABG) surgery. The CIMT was measured with B-mode&nbsp;ultrasound in all patients and association with severity of CAD was measured.</p> <p><strong>Results:</strong> The prevalence of increased CIMT in our study group was 31% and carotid plaque was 69%. Presence of carotid&nbsp;plaque was significantly associated with severe grade CAD stenosis (t = 4, p &lt; 0.001) and presence of Chronic Total Occlusion&nbsp;(CTO) (p = 0.028). There was no significant correlation between mean CIMT and severity of CAD expressed as mean&nbsp;percentage stenosis (r = 0.179, p = 0.11) but patients with CTO had higher mean CIMT value than non-CTO group (0.86 ±&nbsp;0.21 Vs 0.73 ± 0.18; p = 0.027). We found that diabetic population had greater mean CIMT values than nondiabetic population&nbsp;(0.82 ± 0.21 Vs 0.72 ± 0.17; p = 0.017) and higher prevalence of carotid plaque (p = 0.02). Similarly, females were more likely&nbsp;to have increased CIMT than males (p=0.004).</p> <p><strong>Conclusion:</strong> We found that increased CIMT was associated with presence of CTO. Presence of carotid plaque was&nbsp;associated with severe grading of CAD and CTO. Carotid ultrasound can be useful noninvasive modality to predict presence&nbsp;of significant CAD.</p> 2019-11-14T01:52:21+00:00 ##submission.copyrightStatement## Assessment of Rheumatic Mitral Stenosis severity by Mitral Leaflet Separation Index 2019-11-22T10:22:09+00:00 Rajan Paudel Ram Kishor Sah Man Bahadur KC Deewakar Sharma Arun Maskey Rabi Malla Sujeeb Rajbhandari Prabha KC Rikesh Tamrakar Binayak Gautam Kunjang Sherpa <p><strong>Background and Aims:</strong> Determining the severity of mitral stenosis (MS) is important for both prognostic and&nbsp;therapeutic reasons. Measurement of Mitral valve area (MVA) by planimetry is gold standard and accurate but is highly&nbsp;operator dependent. Pressure Half Time (PHT) is affected by hemodynamic significance. In this Study we evaluated severity&nbsp;of mitral stenosis by mitral leaflet separation index (MLS index, MLSI). This new index could be useful surrogate measure&nbsp;of the MVA.</p> <p><strong>Methods:</strong> This is a hospital based, cross-sectional observational study carried out in Shahid Gangalal National Heart&nbsp;Centre (SGNHC), Kathmandu, Nepal. Study included 82 patients with Rheumatic MS who had undergone echocardiographic&nbsp;examination from July 2018 to December 2018. The maximal separation of the mitral valve leaflet tips was measured from&nbsp;inner edge to inner edge in end diastole in the parasternal long axis and apical 4-chamber views. These two parameters were&nbsp;averaged to yield the MLSI. The index was compared with mitral valve area determined by planimetry method and PHT.</p> <p><strong>Results:</strong> Of the 82 study subjects, majority were females 72 (85.4%). The mean age of study patients was 37.33±11.56&nbsp;years. 30.5% had mild MS by planimetry, 31.7% had moderate MS and 37.8% had severe MS. There was a very strong&nbsp;correlation between MLS index and MVA by planimetry ( r = 0.89, p&lt;0.001) and MVA by PHT (r=0.95, p&lt;0.001). MLS&nbsp;index less than 0.73 cm can predict severe MS with 93.2% sensitivity and 89.3% specificity. On the other hand MLS index&nbsp;more than 1.035cm can predict mild MS with 70% sensitivity and 89.3% specificity. Strong correlation exists between MLS&nbsp;index and MV severity in presence atrial fibrillation (AF) (r=0.879) for planimetry and (r=0.835) for PHT and in presence of&nbsp;coexisting mitral regurgitation (MR) (r=0.89) for planimetry and (r=0.86) for PHT.</p> <p><strong>Conclusion:</strong> MLSI has a strong correlation with MVA by planimetry and PHT. So, it can be used as a reliable method to&nbsp;assess severity of mitral stenosis and is a simple and easily obtainable. It has good correlation even in presence of AF and MR.</p> 2019-11-14T01:53:08+00:00 ##submission.copyrightStatement## Study of clinical profile and indications of Permanent Pacemaker Insertion in Nepali population presenting to tertiary care centre in Nepal 2019-11-22T10:22:11+00:00 Shovit Thapa Ratna Mani Gajurel Chandra Mani Poudel Hemant Shrestha Sanjeev Thapa Surya Devkota Parash Koirala Surya Pathak <p><strong>Background and Aims:</strong> Although pacemaker implantation has been done regularly in Nepal for the last 20 years,&nbsp;there is no large scale published data of pacemaker implantations. Manmohan Cardiothoracic Vascular and Transplant Centre&nbsp;(MCVTC) have been providing uninterrupted permanent pacemaker implantation services since its inception. This led us an&nbsp;opportunity to report the data regarding permanent pacemaker implantations in MCVTC.</p> <p><strong>Methods:</strong> Hospital records of all patients who had undergone PPI at MCVTC between Shrawan 2070 – Ashad 2075/ July&nbsp;2013- June 2018 (5 years) were searched for and all available data were retrospectively analyzed.</p> <p><strong>Results:</strong> A total of 277 cases underwent PPI at MCVTC in 5 years. Out of these 165 (59.5%) were male with male to female&nbsp;ratio of 1.47. The mean age was 65.82±16.10 years with 3 (1.1%) cases of &lt;20 years of age and almost 70% of cases aged &gt;60&nbsp;years. Dual chamber units were implanted in 49 (17.7%) cases. Only 13 women (11.6%) received dual chamber pacemaker&nbsp;compared with 36 men (21.8%) (P = 0.029). The most common indication for PPI was complete atrioventricular block 165&nbsp;(59.6%) followed by sick sinus syndrome 65 (23.5%). Hypertension 84 (30.3%) was the most common co morbidity present.&nbsp;Complication occurred in 5.4% of cases with wound infection as commonest complication and single mortality due to postoperative&nbsp;complications post-RV repair.</p> <p><strong>Conclusion:</strong> Single chamber pacemaker was the most commonly used pacemaker. Dual chamber pacemaker was more&nbsp;common in younger patients. Complete heart block was the most common indication. Permanent pacemaker insertion was&nbsp;effective and relatively safe procedure in MCVTC with few complications.</p> 2019-11-14T01:53:57+00:00 ##submission.copyrightStatement## Study of clinical profile and outcomes of Percutaneous Coronary Intervention in ST Elevation Myocardial Infraction 2019-11-22T10:22:13+00:00 Parash Koirala Ratna Mani Gajurel Chandra Mani Poudel Hemant Shrestha Surya Devkota Sanjeev Thapa Shovit Thapa Surya Pathak <p><strong>Background and Aims:</strong> Percutaneous Coronary Intervention (PCI) is the preferred method of revascularization in&nbsp;Acute ST Elevation Myocardial Infarction (STEMI). Our aim was to study the clinical profile and outcomes of patients who&nbsp;underwent PCI for STEMI at tertiary cardiac centre of Nepal.</p> <p><strong>Methods:</strong> It is a retrospective, single centre study, performed at Tribhuvan University, Manmohan Cardiothoracic Vascular&nbsp;and Transplant Centre, Kathmandu, Nepal. All patients who underwent PCI for STEMI from November 2015 to July 2018&nbsp;were enrolled in this study. All the data were collected from hospital registry and cath lab records.</p> <p><strong>Results:</strong> The Study showed that out of 232 patients who presented with STEMI, 74.5% were male with average age of&nbsp;57.39 years. The mean time of presentation after onset of symptom/s was 17.5 hours. About 66% patients presented in less&nbsp;than 12 hours of symptoms onset, 21% presented at 12-24 hours of symptoms onset and 13% patients presented late. Primary&nbsp;PCI was done in 87% of patients. Almost all patients (98.2%) underwent coronary artery stenting with drug eluting stents.&nbsp;Multivessel PCI during index procedure was done in 7 patients. TIMI III flow following PCI was achieved in 97% cases.&nbsp;Average LVEF at discharge was 44.73%. There were 8 deaths, all after Primary PCI. In-hospital mortality rates for patients&nbsp;presenting with and without cardiogenic shock were 38.46% and 1.59% respectively. The overall mortality rate was 3.98%.</p> <p><strong>Conclusion:</strong> This study has reemphasized that PCI is effective in the management of STEMI cases in Nepal with improving&nbsp;mortality rates and decreasing complications. Minimizing the delayed presentation after the onset of symptoms should be one&nbsp;of the prime focuses for effective management of STEMI.</p> 2019-11-14T01:54:56+00:00 ##submission.copyrightStatement## High dose versus low dose Aspirin after Percutaneous Coronary Intervention in Coronary Artery Disease 2019-11-22T10:22:14+00:00 Rajib Rajbhandari Rikesh Tamrakar Yuba Raj Limbu Satish Singh Sanjay Singh KC <p><strong>Background and Aims:</strong> Patients with Coronary artery disease who undergo percutaneous coronary intervention (PCI)&nbsp;are prescribed with maintenance aspirin dose that vary between 75 mg to 300 mg daily. The objective of this study is to&nbsp;evaluate the effects of high dose versus low dose aspirin doses prescribed on hospital discharge in PCI.</p> <p><strong>Methods:</strong> All the patients who had undergone PCI at our hospital from 2017 February to October 2017 were enrolled in&nbsp;the study. They were divided into two groups receiving low dose (&lt;200mg) aspirin and high dose (&gt;200mg) aspirin. Patients&nbsp;were interviewed on phone after completion of one year for the possible complications and new ischemic events during the&nbsp;follow up period.</p> <p><strong>Results:</strong> Among 150 patients selected 101 fulfilled the criteria and sixty patients (59.4%) were discharged on low-dose&nbsp;aspirin 75-150mg and 41 patients (40.6%) were discharged on high-dose aspirin of 300mg. The mean age in low aspirin&nbsp;group was 59.8±13.19 years and 49.4±10.7 years in high aspirin group. Although high aspirin dose patients did not complain&nbsp;of epigastric pain more often, upper GI bleeding was significantly higher in high aspirin group 7.5% vs 11.1% (p&lt;0.05).&nbsp;One patient in high aspirin group had hemorrhagic stroke while low aspirin group had none. One patient in high aspirin had&nbsp;sudden cardiac death at home. Clinically, there was no significant difference in new ischemic events during follow up period.</p> <p><strong>Conclusion:</strong> In patients with coronary artery disease undergoing PCI, discharge on high-dose rather than low-dose aspirin&nbsp;may increase the rate of bleeding without providing additional ischemic benefit.</p> 2019-11-14T01:55:46+00:00 ##submission.copyrightStatement## Profile of Non-Diabetic patients with Microalbuminuria in Acute Coronary Syndrome: A hospital based study 2019-11-22T10:22:16+00:00 Navaraj Paudel Abhishek Maskey Dipesh Karki Sushant Katwal Namrata Thapa <p><strong>Background and Aims:</strong> Microalbuminuria (MA) (urinary albumin excretion of 30-299 mg/d in a 24 hours collection&nbsp;or 30-299 μg/mg creatinine in a spot collection) is well accepted marker of micro and macrovascular damage in patients with&nbsp;diabetes mellitus and is considered as a surrogate marker for endothelial dysfunction in diabetic and non-diabetic patients. This&nbsp;study has been undertaken to investigate the prevalence of microalbuminuria among non-diabetic Acute Coronary Syndrome&nbsp;(ACS) patients.</p> <p><strong>Methods:</strong> A hospital based cross-sectional study of 100 consecutive non-diabetic ACS patients was done. Traditional risk&nbsp;factors (like smoking, hypertension, dyslipidemia, obesity) of coronary artery disease were studied for the association with&nbsp;microalbuminuria in study subjects. Investigations were carried out in all the cases as per proforma and entered in the SPSS&nbsp;software for analysis.</p> <p><strong>Results:</strong> The prevalence of microalbuminuria in non-diabetic ACS patients in the study was 73% which was statistically&nbsp;significant (p=0.04). A statistically significant higher prevalence of microalbuminuria was seen with different presentations&nbsp;of ACS; being highest (81.96%) in NSTEMI followed by STEMI (63.15%) and Unstable Angina (55%). It was found to be&nbsp;significant with the history of smoking (81.25%, p=0.013) and hypertension (82.25%, p=0.013). No significant association was&nbsp;found with age, body mass index (BMI) and dyslipidemia. A statistically significant higher prevalence of microalbuminuria&nbsp;was seen with increasing number of risk factors.</p> <p><strong>Conclusion:</strong> There is increased prevalence of microalbuminuria in ACS patents. MA was associated with statistically&nbsp;higher number of cases with history of smoking and hypertension and presence of increasing number of risk factors.</p> 2019-11-14T01:56:31+00:00 ##submission.copyrightStatement## Anesthesia for Off Pump Coronary Artery Bypass Surgery in a Patient with Brain Tumor 2019-11-22T10:22:17+00:00 Sarwan K S Rawat Battu Kumar Shrestha Rajiv Juneja Yatin Mehta Naresh Trehan <p>The outcome after off pump coronary artery bypass grafting (OPCAB) surgery has been promising. These good outcomes&nbsp;relate to the benefits of avoiding extra corporeal circulation. Some of the reported advantages include a lower incidence of&nbsp;renal complications, pulmonary complication, adverse neurological event, reduced transfusions requirement and attenuation&nbsp;of the systemic inflammatory response. If the patient has associated preoperative complicated neurological issues, then&nbsp;perioperative management will be more challenging and requires extensive care and precautions.We present a case with&nbsp;symptomatic meningioma and unstable angina who underwent successful urgent OPCAB surgery without further neurological&nbsp;deterioration.</p> 2019-11-14T01:57:07+00:00 ##submission.copyrightStatement##