Coronary Artery Disease

i n d i a n h e a r t j o u r n a l 6 4 ( 2 0 1 2 ) S 2 3 eS 4 8

Available online at www.sciencedirect.com

journal homepage: www.elsevier.com/locate/ihj

64th Annual CSI Conference and SAARC Cardiac Congress DECEMBER 06e09, 2012, NEW DELHI, INDIA Coronary Artery Disease Poster Presentations Study of relationship between carotid intimamedia thickness and syntax score in patients with coronary artery disease P. Vishwakarma*, S. Chandra**, R. Sethi**, A. Puri**, S.K. Dwivedi**, V.S. Narain**, R.K. Saran** * Senior Resident; **Faculty; Department of Cardiology, King George’s Medical University, Lucknow, India

Aim & objectives: Previous studies have demonstrated a relationship between carotid artery ultrasound (carotid-US) findings and the complexity of coronary artery disease (CAD). We aimed to examine the relationship between carotid-US findings and the severity of the Syntax score. Material & methods: A total of 61 consecutive patients underwent sequential carotid-US and first coronary angiography for stable CAD. Carotid-US was used to determine the mean common carotid artery intima-media thickness (mean IMT) and the plaque score (PS). CAD severity was graded by Syntax score. Results: The prevalence of low (0e22), intermediate (23e32), and high (33) Syntax score patients were 82.8, 10.4, and 6.8%, respectively. The median values of the mean IMT and the PS were 0.9 and 3.2, respectively. The Syntax score was correlated with the mean IMT and the PS. The odds ratios associated with the mean IMT and the PS for prediction of an intermediate or the high Syntax score were 1.18 and 1.30, respectively and p value was 0.04 and 0.01, respectively. Conclusions: Carotid-US parameters have predictive value for the Syntax score. In addition, the PS and the mean IMT showed excellent negative predictive value for the presence of complex coronary artery lesions. Name of Corresponding Author: Dr Pravesh Vishwakarma; Designation: Senior Resident; Address for Correspondence: Department of Cardiology, King George Medical University, Chowk, Lucknow, UP; PIN: 226003; Mobile: þ918756104004; Email: dr.pvishwakarma@ gmail.com

The author underlined is the Presenting author. http://dx.doi.org/10.1016/j.ihj.2012.10.020

A study of the incremental value of measurement of the index of microcirculatory resistance over fractional flow reserve in the assessment of coronary artery lesions of intermediate severity Raghuram A. Krishnan, Harikrishnan G., Harikrishnan S., Sanjay G., Bijulal S., Krishnamoorthy K.M., Sivasankaran S., Abhilash K.P., Ajitkumar V.K., Jaganmohan Tharakan Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India Introduction: The coronary microvasculature controls total coronary resistance and is the key to regulating myocardial blood flow. The index of microcirculatory resistance (IMR) is a new measure of microvasculature function using a pressure sensor/thermistor-tipped guidewire. The potential advantages of IMR over current methods for evaluating the microcirculation are the ease of performance and interpretation, its quantitative nature, independence of the epicardial vessel and reproducibility. Aims: To measure the index of microcirculatory resistance (IMR) and Fractional flow reserve (FFR) in patients with intermediate coronary artery disease and to evaluate for any incremental value in the measurement of IMR along with FFR in routine cath lab practice. Methods: The study group included patients with intermediate coronary artery lesions who were subjected to functional assessment with intravenous adenosine. Patients with recent ACS and those with contraindications for adenosine were excluded. In each of these patients, Fractional flow reserve (FFR), coronary flow Reserve (CFR) and index of microcirculatory resistance (IMR) were calculated. Further QCA analysis was performed and compared to FFR values. IMR >30 was considered significant for microvascular dysfunction. A lesion with FFR 50years) were found to have a significantly elevated. A significant value of IMR was not found in diabetics and hypertensives. In patients with 60 years, time periods 12 hrs. In each group both males and females were studied separately. Patients further subdivided into streptokinase and tenecteplase group. All patients underwent coronary angiography after stabilization to look for recanalization of IRA with defined as TIMI 111 flow. Failed thrombolysis defined as TIMI 0/1 flow. Analysis of data revealed recanalization of IRA significantly higher in early thrombolysed group, younger age group & tenecteplase group with no significant gender difference. Conclusion: Factors associated with failed thrombolysis include delayed presentation, older age group and use of streptokinase over tenecteplase with no significant gender difference. Name of Corresponding Author: Dr Amit Kumar Singhal; Designation: DM Cardiology Registrar Final Year; Address for Correspondence: Department of Cardiology, Second floor, Emergency Building, LTMMC & LTMGH, Sion, Mumbai ,400022. Telephone: 022-4076381; Mobile: 09769342552; Email: [email protected]

S26


Profile of young patients with acute myocardial infarction Irfan Khan, Snehil Mishra, Brijesh Agrawal, Pranjal Patil, Rajendra Chavan, Dhirender Singh, Vinay Kumar, Pritesh Punjabi, Sohan Sharma, Sachin M. Mukhedkar, Madhusudan A. Yemul, Sandeep N. Patil, Jaywant M. Nawale, Ajay S. Chaurasia TNMC and BYL Nair Ch. Hospital, Mumbai, India Aims & objectives: The objective of this study was to evaluate the profile of young patients with acute myocardial infarction and their risk factors. Materials & methods: 75 consecutive patients admitted to our hospital with mean age of 34 yrs (range 18-40 yrs) were reviewed, all these patients had underwent thrombolysis, serial EKG, echocardiography and later coronary angiography. Results: Of these 75 patients.50 patients were of anterior wall myocardial infarction and 25 patients were of inferior wall myocardial infarction. 90% patients were males, and 10% patients were females. Family history of Ischemic Heart Disease was positive in 35% of patients. Most common risk factor among these subjects was smoking (64%) followed by stress and abnormal body mass index, traditional risk factors were found in only 40% of patients. Other risk factors like Hyperhomocystinemia was detected in 28% of patients with 16% of our patients having Lipoprotein a in the high quartile. Also on coronary angiography, 70% of patients had recanalised coronary arteries. Among patients with significant lesions, majority of these patients were found to have single vessel coronary artery disease rather than multivessel coronary artery disease. The complication rate in this population was comparable to the general population. Conclusions: 1) Smoking is the most common cause of acute myocardial infarction in the young; 2) In addition to traditional risk factors, novel risk predictors are needed for risk estimation in young MI patients, particularly Indians; 3) Abnormal plaque hemodynamics might be more relevant rather than systemic cause particularly in young MI patients. Name of Corresponding Author: Irfan Khan; Designation: Senior Resident, Department of Cardiology; Address for Correspondence: Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai 400008; Telephone: 022-23081758; Fax: 022-23542540; Mobile: 9920373501; Email: [email protected]

A prospective study to relate gastrointestinal distress with depression and quality of life in cardiovascular disease patients S. Gupta, K. Parikh, P. Bhatt Care Institute of Medical Sciences, Ahmedabad, India Objectives: Aim of the present study was to determine the correlation of gastric distress with depression, and quality of life in patients with cardiovascular disease (CVD). Methods: In this prospective study conducted at Care Institute of Medical Sciences (CIMS), Ahmedabad, India, a total of 644 CVD patients with either effort angina, unstable angina, myocardial infarction and left ventricular dysfunction were enrolled. All patients were assessed using Montgomery-Asberg Depression Rating Scale (MADRS) for depression and Hospital Anxiety and Depression Scale (HADS) for anxiety. SF-36 form assessed Quality of Life (QoL). Gastric distress was assessed with complains such as

abdominal pain, vomiting, constipation, gas, abdominal tenderness and others. Results: From a total of 644 patients, 560 were males and 84 were females with a mean age of 58.710.22 years who underwent coronary artery angiography (21.98%), percutaneous transluminal coronary angioplasty (40.29%) and coronary artery bypass graft (37.33%). As per MARDS score, 247 patients (38.35%) had depression (MADRS score >6) and 205 patients (31.83%) had anxiety (HADS score >8). GI distress was depicted in 58.97% patients. Most common GI distress symptoms reported were abdominal pain (32.81%), constipation (33.12%) and gas (34.07%). Mean MADRS score (7.35.12 v/s 3.385.36) and HADS score (7.483.24 v/s 3.943.34) were significantly higher in patients with GI complains. QoL as assessed by Physical Component Summary scores (68.4226.23 v/s 75.6826.17) and Mental Component Summary scores (71.0423.62 v/s 79.8223.54) were significantly lower in patients with GI distress as compared to subjects without GI distress. Conclusion: A strong association exists between GI distress and affective disorders affecting Quality of Life in CVD patients. Name of Corresponding Author: Dr.Satya Gupta; Designation: MD.DM; Director, CIMS hospital, Interventional Cardiologist; Address for Correspondence: CIMS Hospital, Science City Road, Ahmedabad380061; Mobile:09925045780; Email: [email protected]

“Delicate Heart syndrome” e A rare Cause of Acute Myocardial Infarction in young Y. Vijayachandra Reddy, M. Ramanathan Apollo Hospitals, Chennai Acute Myocardial Infarction (MI) in young is being increasingly recognized nowadays. Non-atherosclerotic causes of MI are, however, very rare. We present a case report of a young patient with an extremely rare cause of MI. A 28 year gentleman with no known comorbidites, came walking to the emergency room (ER) with history of slip and fall from his bike following sudden braking, with only minor injury to his right thigh. Clinical evaluation revealed stable vitals and he was advised X ray hip and thigh; while waiting in the radiology department, he had cardiorespiratory arrest. CPR was started and he was shifted to ER. He was in frank pulmonary edema and was intubated and ventilated. ECG monitor revealed VF; he was defibrillated and CPR continued along with high-dose inotropes. ST elevation was noted on monitor. Initial ECG revealed Atrial fibrillation with J-ST elevations in inferolateral leads. Next ECG revealed sinus tachycardia with J-ST elevations in inferior and anterior leads. Echo revealed RWMA of LAD territory, severe LV systolic dysfunction (LVEF 30%) with normal valves, pericardium and aorta. Initial trauma evaluation including CT Brain, chest and abdomen with contrast angiography was negative with normal coronaries & aorta. He had cardiac arrest again in CT room, was resuscitated, and shifted straight to cardiac cath lab for emergency IABP (intraaortic balloon counter pulsation) insertion and proceed. Coronary angiography (CAG) revealed very short left main with thrombus and intimal flap in ostial LAD and embolic occlusion of distal LAD, distal diagonal and OM branches. The thrombus was seen getting distally embolised during the next coronary injection leaving no residual lesion; hence, stenting was not done. He was started on antiplatelets and anticoagulants. He improved well,


was extubated in 2 days and was discharged in 1 week. At the time of discharge, echo showed LVEF of 50%. He remained asymptomatic. On follow up at 7 months, his LV function was normal, repeat CAG was normal. OCT (Optical Coherence Tomography) was normal with no evidence of dissection in LMCA or ostial LAD. Conclusion: Coronary intimal dissection flap following minor chest trauma (delicate heart syndrome) with MI & catastrophic presentation is very rare. The clinical, ECG, CAG features, the potential pitfalls in diagnosis & the management will be discussed. Name of Corresponding Author: Dr. Y. Vijayachandra Reddy, Designation: Senior Consultant and interventional cardiologist; Address for Correspondence: No 1, Lady Madhavan road, Opp. ICICI ATM, Ayyappan Kovil street, Mahalingapuram, Chennai e 600 034; Telephone: 044 28172083; Fax: þ91 44 2829 4429; Mobile: 09841032624; Email: [email protected]

Aspirin and clopidogrel resistance in Indian patients with Coronary Artery Disease (CAD) and their genetic association Mahajan P.V.1, Arya V.1, Mohanty A.2, Saraf A.1, Bhargava M.1and Sawhney J.P.S.2 1

Department of Hematology, Sir Ganga Ram Hospital, New Delhi, India; Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, India

2

Aims/objectives: Combination therapy with clopidogrel and low dose aspirin is the current standard of care in the management of patients with Coronary Artery Disease (CAD). Inadequate platelet response is seen in patients treated with conventional doses of clopidogrel (4-30%) and aspirin ( 60 yrs age with CCDP 1, if fluoroscopic coronary calcium is detected then 93.3% of cases we can detect the significant coronary lesion with 64.3% of cases localizing the site of lesion to the site of coronary calcium. This information may helpful for management of CAD (PCI or Rotablation or CABG) before CAG. Name of Corresponding Author: Dr.A.Sivaramakrishna; Designation: Senior resident; Address for Correspondence: Nims, hyderabad; Mobile: 09985872926; Email: [email protected]

Clinical & angiographic profile in young patients with acute coronary syndrome Abhishek Wadkar, Amit Singal, Chandrakant Upadhyay, Deepak Bohra, Anup Taksande, Hetan Shah, Ajay Mahajan, Pratap Nathani LTMMC & LTMGH Mumbai, India The incidence of CAD is rising globally. ACS is the severe and life threatening form of its presentation. This study attempts of shower some light on the clinical epidemiological and angiographic profile of young patients with ACS. 200 patients younger than 40 yrs age undergoing coronary angiography for ACS were studied from 2010 to 2012. 186 were males (93%) & 14 were females (7%). Amongst ACS events, most common was AWMI (123) followed by IWMI (23) rest were NSTEMI (30) or Unstable angina (24). Smoking was the most common associated risk factor present in 92 patients, 52 patients were tobacco chewers, 39 patients had systemic HTN, 28 patients were diabetic, 17 patients had dyslipidemia, 27 patients were regular alcoholic, family history of CAD was present in 12 patients. CAG analysis showed that LAD was the most common involved artery (105). 67 patients had recanalised LAD, 38 patients had LAD stenotic lesion warranting revascularization procedure. Recanalised RCA was present in 16 patients, RCA stenotic lesion was present in 11 patients. Recanalised artery on CAG did not correlate with good LVEF. Double vessel disease was present in 25 patients (LADþRCA: 11, LADþLCX: 13, LCXþ RCA 1) Triple vessel disease was present in 11 patients. Thrombus in artery during CAG was seen in 9 patients (LAD: 7, PDA: 1, Left main:1). Patients having thrombus during CAG received GP2ba

S29

inhibitors after CAG, were discharged on oral anticoagulants, check angiography later showed resolution of thrombus. Conclusion: ACS in young patients is generally responds favorably to thrombolytic therapy. Smoking was the most common etiological factor for young ACS. AWMI was the most common MI in young patients, with LAD being the culprit vessel. Recanalised coronaries were commonly seen in thrombolysed patients. Name of Corresponding Author: Dr Abhishek Laxman Wadkar; Designation: DM Cardiology Registrar, Final Year; Address for Correspondence: Department of Cardiology, Second Floor, Emergency Building, LTMMC & LTMGH, Sion, Mumbai,400022; Telephone: 022-24049023 Ext: 3805, 3806; Mobile: 9820556837. Email: [email protected]

Conduction system disturbances in STEMI Abhishek Wadkar, Anuj Sathe, Pankaj Patil, Anup Taksande, Kseavan S Hetan Shah, Ajay Mahajan, Pratap Nathani LTMMC & LTMGH, Mumbai, India 400 patients admitted to ICCU with STEMI at a tertiary care centre of LTMG Hospital in city of Mumbai in western India over 6 months from July 2011 to December 2011 were studied. The distribution of anterior wall MI was 71% (284 cases), inferior wall MI 29% (116 cases). The conduction system disturbance was seen 156 patients (39%) In IWMI out of 116 cases 93 cases had some form of conduction system disturbance on presentation. The distribution of conduction system abnormality was as follows: Most common conduction system abnormality was first degree AV block (54%), followed by Wenkebach phenomenon (23%), new onset RBBB was seen (5%). Third degree AV block (18%). Nearly all 1st degree AV blocks resolved within 48 hrs with or without thrombolysis. 40% of second degree AV block resolved within 12 hrs of thrombolysis, remaining resolved within 48 hrs. Third degree AV Block was more common when patient had associated RVMI. RVMI was seen in 17 out of 21 patients with CHB. Out of 21 patients with CHB 12 resolved within 12 hrs of thrombolysis, 5 resolved after 48 hrs. In 2 patients CHB resolved only after successful angioplasty. In 2 patients CHB persisted even after successful PTCA 1 patient died another required permanent pacemaker implantation 63 patients out of 284 cases of AWMI had conduction system disturbance on admission. The distribution of conduction system abnormality was as follows: The most common was LAHB seen in (45%) followed by RBBB (18%), followed by bifascicular block 16% (RBBBþLAHB). CHB was seen in 12 cases. 5 out of 12 cases with CHB with AWMI died within 1 hour of admission despite thrombolysis, 3 patients regained sinus rhythm after successful angioplasty. 2 patients died after angioplasty, 2 patients required CABG with permanent pacemaker implantation. Conclusion: Conduction system abnormalities were more common but transient with IWMI than AWMI. CHB with IWMI generally responds fovorably to pharmacotherapy. CHB in AWMI have higher mortality respond poorly to pharmacotherapy. Name of Corresponding Author: Dr Abhishek Laxman Wadkar; Designation: DM Cardiology Registrar, Final Year; Address for Correspondence: Department of Cardiology, Second Floor, Emergency Building, LTMMC & LTMGH, Sion, Mumbai,400022; Telephone: 022-24049023 Ext:3805, 3806. Mobile: 9820556837; Email: [email protected]

S30


Association of C-reactive protein in acute coronary syndrome M.L. Ali, P.K. Ray, Ayush Kumar TATA MOTORS HOSPITAL, TELCO, JAMSHEDPUR, India Aims and objects: The incidence of coronary artery disease is increasing in India. So we are need of a tool to assess the severity and prognosis of these acute coronary syndromes. The role of plaque rupture and inflammation has been already established in acute coronary syndromes. C-reactive protein is a prototypical acute phase reactant, whose levels are increased proportional to the extent of inflammation. This study is done to measure the C-reactive protein levels in acute coronary syndrome patients and to determine its significance in prognosis. Methods: We studied 50 patients with acute coronary syndromes (STEMI and UA/NSTEMI). Serum C-reactive protein levels were measured at admission by qualitative method. Patients were followed up in hospital for mortality and complications. Results: There were 40 male and 10 female patients. Mean age for males was 52.2 years and for females was 64.2 years. STEMI was seen in 34 patients and 16 patients had UA/NSTEMI. CRP were elevated in 36 patients, out of which 30 patients with complications (p< 0.01). And among 14 patients in whom CRP were not elevated, only two patients met with complications. Conclusion: Raised CRP levels are independent markers of adverse outcomes. Plasma CRP levels on admission serves to identify high risk patients in the setting of acute coronary syndromes. The effective risk stratification provided may be of specific value for early therapeutic decision making and patient treatment in the heterogeneous population of patients presenting with acute coronary syndromes. Name of Corresponding Author: Dr. Ayush Kumar; Designation: Sr. Medical Officer; Address for Correspondence: Flat No. 211-E, Adharshila Homes, Near Sahara Garden City, Adityapur-2 Jamshedpur; Mobile: 09263632034; Email: [email protected]

Correlation between ECG and angiogram findings in localization of lesion in patients with acute STEMI G.S.R. Murty MD, DM, C.V. Rao MD, DM, P.V.V.N.M. Kumar MD, DM, B.C. Chandra Mouli Aim of the study: The aim of the study is “To correlate ECG and Angiogram findings in localization of lesion in patients with acute STEMI”. Materials and methods: Inclusion criteria: The study includes 100 patients presenting with STEMI of any age and sex. The ECG showing the most pronounced ST-segment deviation before initiation of reperfusion therapy was evaluated and correlated with the exact occlusion site as determined by coronary angiography. Exclusion criteria: Patients with complete left bundle branch block, left ventricular hypertrophy (Sokolow index), ECG signs of an old MI or previous cardiac surgery were excluded. Results: Total no of cases were 100. Average age group of the pts 5610yrs. Males:females was 2:1. Anterior wall MI accounts for 71% & Inferior wall MI of 29%. Of the anterior wall MI patients 40% had lesion proximal to S1D1, 25% between S1 & D1, 35% had distal to S1D1. STV1 was predominantly seen in pts with lesion

proximal to S1D1 Lesion (68%) than with lesions between S1 & D1 (44%) and distal to S1D1 (24%). STin I & aVL was significantly seen more in pts with lesion proximal to S1D1 (58% & 71%) & between S1D1 (72% & &72%) than in pts with distal S1D1 lesion (8% & 4%). STin aVR, cRBBB, STin aVL > aVR was significantly correlating only in pts with lesion proximal to S1D1. ST in II, III, aVF was significantly correlating in pts with lesion proximal to S1D1 (71%, 78%, 75%) and between S1D1 (56%, 72%, 67%) than in pts with distal to S1D1 lesion (4%, 4%, 4%). ST in III > II was seen in more number and correlates better in pts with lesion between S1 & D1 (72%). STaVR, STaVL >aVR, cRBBB are good predictors of lesion proximal to S1D1 lesion with sensitivity of 75%, 42%, 17% respectively and specificity and positive predictive of 100% each and respectively. Absence STV1, STaVL, STaVR, STin II, III, aVF are good predictors of lesion distal to S1D1. Out of total 29 pts with inferior wall MI 83% were due to RCA involvement (of which 75% are due to proximal RCA & 25% due to distal occlusion) and 17% due to LCX lesion. There is no statistically significant difference in ST in II, III, aVF in RCA or LCX group. ST in III > II, ST in aVL significantly correlates well in pts with RCA Lesion (100%) than with LCX lesion (0%). ST in II > III, ST in aVL significantly correlates with pts with LCX (100%) lesion than with RCA (0%) lesion. S: R in aVL >3 or < 3, ST in V3: ST in III (1.2) show no significant difference in localisation of RCA/LCX. Posterior wall involvement (ST V1, V2, V3) was seen equally in both pts with RCA & LCX lesion (41% & 40%). Presence of ST in V3R, V4R significantly correlates well in pts with RCA (55%) than in pts with LCX lesion (0%). Presence of ST in V3R, V4R significantly correlates well in pts with proximal RCA (84%) than distal RCA lesion (16%). There is no significant difference in involvement of posterior, inferior wall in pts with RCA lesion or LCX lesion. Conclusion: ECG predictors for proximal to S1 LAD lesion are ST in V1, ST in aVR, ST in aVL > aVR, cRBBB. ST II, III, aVF and ST V5 are good predictors of lesion proximal to D1 lesion with a sensitivity of 75%, 17% and specificity of 70%,97% respectively. Absence STV1, STaVL, STaVR, STin II, III, aVF are good predictors of lesion distal to S1D1. In Inferior wall MI ST in II, III, aVF doesn’t help in localization of lesion. ST in V3R, V4R has good correlation with RCA lesion i.e. mainly proximal RCA in Inferior wall MI with a sensitivity of 67%, Specificity and positive predictive value of 100%. ST in aVL >1mm is good predictor of RCA lesion in inferior wall MI with sensitivity of 83%, specificity and positive predictive value of 100%. Combination of both ST in V3R, V4R and ST in aVL >1mm do not have an added advantage when considered individually. ST in aVL is a good predictor of LCX lesion in inferior wall MI. STV3:STIII doesn’t show any correlation in localization of lesion in Inferior wall MI. Name of the Correpondense Author: Dr. B C Chandra Mouli; Designation: MD(DNB )Cardiology; Address for Correspondence: Care Hospital , H.No: 10-50-11/5, A S Raja Complex, Ramanagar, Visakhapatnam 530002; Fax: 0891-2714015 Phone: 0891-3041444 Mobile: 9676752962; Email: [email protected], [email protected]

Correlation of 64 slice computed tomographic coronary angiographic findings in patients with suspected ischaemic chest pain and negative or non diagnostic treadmill test D. Ameta*, S. Chandra**, R. Sethi**, A. Puri**, S.K. Dwivedi**, V.S. Narain**, R.K. Saran**, M Goyal*, D. Kumar*


*Senior resident, **Faculty, Department of cardiology, KGMU, Lucknow, India Aims and objectives: To assess the usefulness of Computed Tomographic (CT) coronary angiography (CAG) for lesion assessment and risk stratification in patients with atypical chest pain, with negative or inconclusive Treadmill Test (TMT). Material and methods: Heterogeneous group of consecutive patients presenting with atypical chest pain were screened by TMT using standard Bruce protocol. TMT negative or inconclusive reported patients were further evaluated by CT CAG. TMT positive patients were excluded from the study. Patients with significantly abnormal CT angiograms were further investigated by invasive CAG. An assessment of the correlation between CT CAG findings was done with invasive CAG. Results: A total of 46 patients were screened for the study, out of which, 26, who had negative or inconclusive TMT were enrolled in the study. The mean age of patients was 49 years and there were 20 (77%) males. Out of 26 patients, 16 (62%) had negative TMT and 10 (38%) had inconclusive TMT. A total of 11 (42%) patients had obstructive coronary artery disease (CAD) (>50% stenosis) on CT CAG, of whom all had obstructive CAD on invasive CAG. 4 (25%) patients with negative TMT and 7 (70%) patients with inconclusive TMT had obstructive CAD. In these 11 patients, there were total 20 significant segment stenosis on CT CAG. Out of these, all 9 segments with >70% stenosis on CT CAG had obstructive CAD on invasive CAG and in 11 segments with 50-70% stenosis, only 2 (18%) had obstructive CAD on invasive CAG. Conclusion: In our study, CT CAG was found to be of incremental value in triaging patients of atypical chest pain with negative or inconclusive TMT. The CT CAG can be used in such patients for excluding CAD. Also in patients with obstructive CAD, detected on CT CAG, clinically significant stenotic lesions have a good correlation with invasive CAG. Name of Corresponding Author: Dr Deepak Ameta, KGMU, Lucknow; Designation: Senior Resident (DM); Address for Correspondence: Room No 417, Resident Hostel, KGMU campus, Chowk, Lucknow; Mobile 08853529852: Email: [email protected]

Study of prevalence and correlation of erectile dysfunction and impaired flow mediated dilatation in patients of coronary artery disease undergoing coronary angiography G. Chaudhary*, S. Chandra** R. Sethi**, A. Puri**, S.K. Dwivedi**, V.S. Narain, R.K. Saran** * Senior Resident, **Faculty, Department of cardiology, King George’s Medical University, lucknow, India

Aims and objective: Previous studies have demonstrated a association between erectile dysfunction (ED) and coronary artery disease (CAD). We studied the prevalence and correlation of flow mediated dilatation (FMD) and erectile dysfunction (ED) in patients with coronary artery disease (CAD) who underwent coronary angiography. Material and methods: Consecutive 150 patients undergoing coronary angiography were evaluated for ED and FMD. ED was evaluated using International index of erectile function (IIEF-5) self administered questionnaire. ED was defined according to IIEF score, No ED having score of: 22-25, Mild erectile dysfunction: 1721, Mild to moderate erectile dysfunction: 12-16, Moderate erectile

S31

dysfunction 8-11, Severe erectile dysfunction: 5-7. Severity of CAD was grouped as single vessel disease or less and double vessel disease or more. FMD was measured as percentage change in brachial artery diameter after induced ischemia. ED was correlated with extent of CAD and percentage change FMD. Temporal association of ED and CAD was also evaluated. Results: In the study population mean age was 56.67 years. ED present in 66.0% (n ¼99), of which severe ED present in 25.1% and moderate ED in 15.3%. Patients with lower IIEF score had triple or double vessel CAD (p-value 0.04). Patients with impaired FMD, 30.4% had severe ED, while severe ED was present in 20% in those with FMD > 5.5 (p-value 0.02). ED preceded CAD in 55.0% and CAD preceded ED in only 12.8% of subjects. Conclusions: Impairment in FMD can predict the presence of ED and its severity. Severity of ED correlates to severity of CAD, also ED presents few years before CAD and therefore provides a window for modification of factors responsible. Name of Corresponding Author: Dr Gaurav chaudhary; Designation: Senior Resident; Address for Correspondence: Department of cardiology, King George Medical university, Chowk , Lucknow; Mobile: 9936062507; Email: [email protected]

Clinical and angiographic profile of coronary ectasia Mahesh Ghogare, Abhishek Wadkar, Abhay Tidke, Anup R. Taksande, Hetan Shah, Ajay U. Mahajan, Pratap J. Nathani LTMMC and LTMGH Sion, Mumbai, India Coronary ectasia can present clinically as chronic stable angina (CSA) or acute coronary syndrome (ACS). Out of a total number of 1500 patients who underwent coronary angiography in our institute between March 2011 to May 2012, 36 were found to have coronary ectasia. (Male: 30, Female: 6, mean age 565 years). Analysis of risk factors revealed that 26 (72%) patients had hypertension, diabetes mellitus and dyslipidemia were present in 22 (61%) each while 12 (33%) patients were smokers. Thirty (83%) patients had abnormal resting electrocardiogram (ECG) and 18 (50%) had positive exercise ECG. Mean Left ventricular ejection fraction was 45 5%. 24 (66.6%) of them had obstructive coronary artery disease (CAD); out of which 16 presented with ACS and 8 with CSA. 6 had non obstructive CAD; of which 2 presented with ACS and 4 as CSA. 6 patients did not have CAD but presented with CSA. Out of 6 patients who had acute myocardial infarction there was ECG correlation with ectatic vessel in 4 patients (66%). Distribution of ectasia was with a modification of Markis classification. Commonest type was Type II (61%) with right coronary artery being most commonly affected vessel (66%) followed by left anterior descending artery (50%) and left circumflex artery (39%). Left main coronary artery was not affected. To conclude majority of the patients in our study had obstructive CAD with traditional risk factors for atherosclerosis, indicating that coronary ectasia is most commonly associated with atherosclerosis and is not benign. Name of Corresponding Author: Dr Mahesh Subhash Ghogare; Designation: DM Cardiology Registrar Final Year; Address for Correspondence; Department of Cardiology, Second floor, Emergency Building, LTMMC & LTMGH, Sion, Mumbai, 400022; Telephone: 022-4076381; Mobile: 09028170123; Email: [email protected]

S32


Clinical and angiographic profile of patients with coronary slow flow Mahesh Ghogare, Anuj Sathe, Pankaj Patil, Anup R. Taksande, Hetan Shah, Ajay U. Mahajan, Pratap J. Nathani LTMMC and LTMGH Sion, Mumbai, India The coronary slow flow phenomenon is an angiographic finding characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease, and is an important clinical entity because it may be the cause of angina at rest or during exercise and acute myocardial infarction. Endothelial dysfunction and microvascular dysfunction have been suggested as underlying mechanisms. We aimed to study a subset within this group who showed the phenomenon of slow coronary flow (SCF) as evidenced by a slow antegrade progression of the dye on the coronary arteriogram to see if this could be used as a marker of myocardial ischemia. This observational study included 250 patients being evaluated for suspected coronary artery disease and found to have normal coronary angiograms during July 2011 to June 2012. SCF was seen in 43 of these patients (17.5%) while the remaining 207 (82.5%) had normal coronary flow (NCF), as detected by the corrected thrombolysis in myocardial infarction (TIMI) frame count method (TIMI frame count more than 2 SD of normal). 37 of the 43 patients (86.04%) in the SCF group had classical angina as compared with only 48 of the 207 patients (23.19%) in the NCF group (p