Pakistan Journal of Cardiovascular Intervention <p><strong>Pakistan Journal of Cardiovascular Intervention (PJCVI)</strong> is biannual, open access, peer-reviewed journal of the Pakistan Society of interventional cardiology. The journal publishes original research, reviews, short communication, case studies, commentaries and editorials focusing on interventional procedures and techniques. PJCVI provides a platform for determined cardiologists to stay relevant in diagnosing and analyzing, researching, and managing patients with cardiovascular disease and its allied complications.</p> <p><br />The field of interventional cardiology is briskly evolving with innovation and technological progress. The profile of interventional cardiology has risen to the extent that it is now one of the most dynamic subspecialties in mainstream medical practice with the help of experts in molecular biology, biomedical engineering, biophysics and imaging technology. The journal will provide a platform for annotation, discussion and new findings.</p> en-US Thu, 25 Apr 2024 00:00:00 +0000 OJS 60 Transcatheter Aortic Valve Replacement(TAVR) in a patient with multiple comorbidities, prioritizing minimally invasive intervention over surgical valve replacement <p><strong>Background: </strong>Severe aortic stenosis (AS) poses a significant clinical challenge, particularly in patients with multiple co-morbidities where conventional surgical intervention may carry prohibitively high peri-operative risks. Transcatheter Aortic Valve Replacement (TAVR) has emerged as a promising alternative for such patients, offering a minimally invasive approach with potentially favorable outcomes. This report aims to present a case illustrating the successful application of TAVR in managing severe AS in a high-risk patient with multiple co-morbidities.</p> <p><strong>Case Presentation: </strong>The patient in question is a 56-year-old female with a complex medical history, including ulcerative colitis and prolonged steroid use. During hospitalization for abdominal complaints unrelated to cardiovascular symptoms, diagnostic workup incidentally revealed severe asymptomatic aortic stenosis. The patient's clinical presentation was further complicated by the presence of multiple co-morbidities, rendering her unfit for traditional surgical aortic valve replacement (SAVR) due to the high peri-operative risk associated with her medical condition.</p> <p><strong>Management and Results: </strong>After careful consideration, it was decided that TAVR would be the preferred intervention. Post-procedure, the patient's recovery was uneventful, with no immediate complications observed.</p> <p><strong>Conclusion:</strong> This case report highlights the importance of TAVR and the expertise required to perform this procedure in treating severe aortic stenosis in high risk patients such as in our case with favorable outcomes.</p> Ayesha Shad, Asma Gulshan, Asaad Akbar Khan Copyright (c) 2024 The Author Thu, 25 Apr 2024 00:00:00 +0000 Transradial Approach to Coronary Angiography and Percutaneous Intervention in Patients with Dextrocardia with Situs Inversus. <p><strong>Background: </strong>Patients with dextrocardia pose unique challenges in coronary angiography and percutaneous intervention due to variations in coronary artery anatomy. Accessing and manipulating coronary arteries in these patients require careful consideration due to their mirror-image anatomy. Radial artery access has emerged as a potential solution, but its efficacy and feasibility in dextrocardia patients need further exploration.</p> <p><strong>Case Presentation: </strong>We present a case of a patient with dextrocardia and situs inversus who underwent coronary angiography and percutaneous intervention. The patient's anomalous coronary artery anatomy posed challenges in accessing and engaging the target vessel using conventional techniques. Radial artery access was chosen, and an AR catheter (Amplatz right) was utilized to navigate the anomalous right coronary artery. Additionally, mirror-image fluoroscopy techniques were employed to facilitate catheter manipulation.</p> <p><strong>Management &amp; Results: </strong>Proper preparation and utilization of radial artery access enabled successful diagnostic and therapeutic coronary interventions in the patient with dextrocardia. The AR catheter proved to be instrumental in accessing the anomalous coronary anatomy, overcoming the technical difficulties associated with conventional catheters. Mirror-image fluoroscopy provided valuable guidance during catheter manipulation, enhancing procedural success.</p> <p><strong>Conclusion: </strong>The transradial approach represents a viable option for coronary angiography and percutaneous intervention in patients with dextrocardia. Careful consideration of coronary anatomy variations, along with appropriate catheter selection and imaging techniques, can facilitate successful procedures in this unique patient population. Further studies are warranted to validate the efficacy and safety of this approach in a larger cohort of dextrocardia patients.</p> Tarique Ahmed, I-Chung Cheni, Chi-Hung Huang, Hseng Long Ye, Yen-Yu Lu, You-Chun Huang, Chang Chia Hsiu, Chen Yu Chen Copyright (c) 2024 The Author Thu, 25 Apr 2024 00:00:00 +0000 Improving quality of life and muscle strength with resistance training in non-ischemic congestive heart failure patients <p><strong>Background: </strong>Patients with congestive heart failure often experience difficulties in daily activities, muscle weakness, and psychological distress, impacting their overall quality of life. While exercise is known to benefit heart failure patients, its specific impact on non-ischemic congestive heart failure remains underexplored. This study aimed to assess the effectiveness of resistance exercise in improving outcomes for patients with non-ischemic congestive heart failure.</p> <p><strong>Methodology: </strong>An interventional study was conducted involving 30 participants diagnosed with chronic heart failure. Participants were randomly assigned to resistance training programs. Baseline and 4-week assessments included the 6-minute walk test, maximal strength test, and questionnaires assessing quality of life, depression, and anxiety.</p> <p><strong>Results: </strong>Analysis of the resistance exercise intervention revealed significant improvements in muscle strength and quality of life among participants. Statistical analysis yielded p-values &gt;0.05.</p> <p><strong>Conclusion: </strong>Resistance training demonstrated significant benefits for patients with non-ischemic congestive heart failure, including increased muscle strength, VO2 max, and improved quality of life</p> Mahnoor Shabbir, Neha Sarfraz, Muhammad Anas Manzoor, Ahsan Hayat, Daud Sulaiman Copyright (c) 2024 The Author Thu, 25 Apr 2024 00:00:00 +0000 Comparison of Left Ventricular Systolic Function between Thrombolysed and Non-thrombolysed patients presenting with ST-Elevation Myocardial Infarction to a Tertiary Care Hospital <p><strong>Background:</strong> ST elevation myocardial infarction (STEMI) is a critical condition that requires prompt intervention to minimize myocardial damage and improve outcomes. Understanding the impact of thrombolysis on left ventricular systolic function in comparison to non-thrombolysed patients is crucial for optimizing treatment strategies and improving patient care in the post-STEMI period. This study aims to contribute valuable insights into the management of STEMI patients by evaluating the differences in left ventricular systolic function between thrombolysed and non-thrombolysed patients.</p> <p><strong>Methodology:</strong> This cohort study was conducted through non-probability consecutive sampling at Emergency Department, Faisalabad Institute of Cardiology, Faisalabad. Informed consent was obtained from attendant of patients. Demographic profile was also obtained including name, age, sex, h/o diabetes, IHD, smoking, family history and duration of pain. Two groups were formed on the basis of timing of presentation. Thrombolysed group consisted of patients who presented within 12 hours of onset of symptoms with ST-elevation on surface ECG and got thrombolytic. Non-Thrombolysed group consisted of patients presenting after 12 hours and didn’t get thrombolytic. Transthoracic echocardiography using Biplane Simpson’s method of these patients was done at the time of discharge and 6 weeks post discharge to assess Left ventricular systolic function. Data so collected was entered in predesigned Performa.</p> <p><strong>Results:</strong> In this study the mean age of the patients was 54.03±10.163 years with male to female ratio of 3.17:1. Mean value of LV systolic function among non-thrombolysed group patients was 31.58±10.53 while the mean value of LV systolic function among thrombolysed group patients was 47.77±9.24. The thrombolysis group showed better outcome than to non thrombolysed group.</p> <p><strong>Conclusion:</strong> According to the present study results it can be said that the non-thrombolytic patients showed significantly higher risk in terms of LV systolic dysfunction at 6 weeks post-discharge period as compared with the thrombolysed patients after ST elevation MI.</p> Muhammad Asim Saddique, Shahid Abbas Copyright (c) 2024 The Author Thu, 25 Apr 2024 00:00:00 +0000 Clinical Outcomes of Unprotected Left Main Stem Stenting: An Observational Single-Centre Study <p><strong>Objective:</strong> Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has become a common treatment approach for patients with unprotected left main stem (LMS) disease. This procedure involves the use of stents to open up blockages in the left main coronary artery, a critical vessel that supplies blood to a large portion of the heart. This study aims to know the clinical outcomes of percutaneous intervention (PCI) with drug eluting stents (DES) in patients with unprotected left main stem disease.</p> <p><strong>Methodology:</strong> This single-centre, prospective, observational study was conducted on 133 patients, who underwent PCI using DES to an unprotected LMS at Kuwait teaching Hospital Peshawar, between 2018 to 2022. Patients were followed in OPD and clinics or they were traced through calls at monthly and yearly intervals, after the procedure. A team, which comprised of a cardiac interventionist and a cardiac surgeon, scrutinised patients for the eligibility of either procedure. Ethical Committee approval was granted by the Institutional Ethics committee.</p> <p><strong>Results:</strong> At 1month follow up, the composite end point occurred in 13 (11.58%) patients, whereas individual secondary end points including death from all-cause mortality was reported in 5 (4.7%), stroke in 1 (0.9 %), MI in 4 (3.73 %) and repeat vascularisation in 3 (2.25%) patients. The annual incidence of composite end point occurred in 27.58%patients, whereas individual secondary end points including death from all-cause mortality was reported in 10 (8.27%), stroke in 3 (2.25 %), MI in 09 (6.76%) and repeat vascularisation in 11 (10.3%) patients.</p> <p><strong>Conclusion:</strong> PCI to LMS can be performed safely in centres having no cardiac surgery backup and newer imaging modalities with results comparable to the centres having the luxury of such facilities, provided that operators are skilled enough with sufficient expertise and knowledge.</p> Muhammad Abdur Rauf, Jehandad Khan, Mehmood ul Hssan, Sarmad Raza, Imad Uddin, Samiullah Copyright (c) 2024 The Author Thu, 25 Apr 2024 00:00:00 +0000 Incidence in the Contrast induce nephropathy with CTO PCI in Diabetic patients <p><strong>Background:</strong> The incidence of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) with chronic total occlusion (CTO) in diabetic patients is not well established. The purpose of this study was to determine the incidence of CIN after CTO PCI in diabetic patients.</p> <p><strong>Methodology:</strong> The study conducted in department of cardiology HMC Peshawar from Jan 2019 to Jan 2023 in this retrospective study involving 818 patients who underwent CTO PCI at a single center. Data were collected from medical records. The primary outcome was the incidence of CIN. Secondary outcomes included major adverse cardiac events (MACE) and mortality. Multivariate logistic regression was used to assess the association between diabetes and CIN.</p> <p><strong>Results:</strong> A total of 818 patients were included in this study. Of these, 616 (75.4%) were male and 202 (24.6%) were female. The mean age of the patients was 62.5 ± 11.1 years. The prevalence of diabetes was 49.6%. The overall incidence of CIN was 5.9%. The incidence of CIN was significantly higher in diabetic patients (10.2%) than in non-diabetic patients (2.9%; p &lt;0.001). The incidence of MACE at 30 days was significantly higher in diabetic patients than in non-diabetic patients (7.0% vs. 4.2%; p = 0.022). The 30-day mortality rate was also significantly higher in diabetic patients than in non-diabetic patients (3.9% vs. 1.2%; p = 0.002).</p> <p><strong>Conclusion:</strong> The incidence of CIN after CTO PCI is significantly higher in diabetic patients compared to non-diabetic patients. Appropriate preventive measures should be taken to reduce the risk of CIN in this population.</p> shahsawar, Adnan Khan, Jasia Bukhari, Faziullah , Shafiullah Copyright (c) 2024 The Author Thu, 25 Apr 2024 00:00:00 +0000 Heart Team: Single Tertiary Centre Real World Experience <p><strong>Background:</strong> The primary reasons for referral included coronary artery disease, valvular heart disease, a combination of both, and cases with structural abnormalities. Treatment decisions varied, with a significant portion undergoing percutaneous coronary intervention or coronary artery bypass grafting surgery. The study underscores the importance of a structured multidisciplinary heart team in providing optimal care to cardiac patients, emphasizing the need for local implementation of such an approach to enhance patient outcomes. The objective is to share multidisciplinary heart team experience in a tertiary care hospital and discuss its structure and function for the management of cardiac patients.</p> <p><strong>Methodology:</strong> It is a Retrospective cross-sectional observational study conducted at the Peshawar Institute of Cardiology from 1st January 2021 to 31st December 2022. Both inpatient and outpatient referred consecutive patients with cardiovascular diseases were discussed in weekly multidisciplinary heart team meetings. Data was collected retrospectively for each patient from the coordinator and hospital management information system.</p> <p><strong>Results:</strong> A total number of 389 patients were discussed in 89 multidisciplinary heart team meetings over a period of two years. The mean age of patients was 58 ± 11.8 years, with 72.5% males and 27.5% females. Coronary artery disease was the most common reason for referral, i.e., 350 patients (89.97%), 17 (4.37%) patients had valvular heart disease, 08 (2.1%) had both coronary artery disease and valvular disease, and 14 (3.4%) were cases involving structural abnormalities. One hundred and forty-two (36.5%) patients decided to undergo percutaneous coronary intervention, 147 (37.7%) had coronary artery bypass grafting surgery decision, 17 (4.3%) patients were sent for valvular surgery, 08 (2.05%) patients were referred for both CABG and valvular surgery, and 15% had individualized percutaneous procedures or were deferred further procedures following non-invasive or invasive assessments.</p> <p><strong>Conclusion:</strong> A multidisciplinary heart team approach should be at the core of managing cardiac patients at an institute. In order to provide standard care to our patients, setting up a robust, structured multidisciplinary heart team and implementing its basic principles is possible at our local level.</p> Muhammad Ishaq Khan, Abid Ullah, Shah Zeb, Shama Ayaz, Rafiullah Jan, Mohammad Waleed Copyright (c) 2024 The Author Thu, 25 Apr 2024 00:00:00 +0000