Aim Coronary interventions are increasingly being performed via the radial rather than femoral route because of the lower complication rate. Compression devices such as the TR band are used to achieve hemostasis after the procedure. At present, there are no clear protocols for the deflation of the band. In this study we compared two protocols (early deflation with increased intervals vs. late deflation with smaller intervals) in terms of total time to band removal and complications, and patient and staff satisfaction. Methods All patients who underwent a transradial coronary procedure and had a TR band fitted were enrolled into the study. The TR band was applied using the patent hemostasis method (2 ml air pushed in after the radial pulse appears on pulse oximetry after full occlusion with 16 ml air). Patients were randomly assigned to either protocol. Protocol 1 involved removal of 2 ml of air starting 1 hour after the sheath removal and then removal of 2 ml every 30 minutes until the band came off. Protocol 2 involved removal of 4 ml of air 2 hours after the sheath removal and then further 4 ml of air every 15 minutes until the band came off. Patient and staff satisfaction was measured with a visual analogue scale. Results A total of 174 patients were recruited (mean age, 60 ± 11 years; 127 male, 47 female). The baseline characteristics including total heparin dose and type of procedure, in the two arms were the same. Protocol 2 ( n = 84) was associated with a significantly lower time to TR band removal as compared to protocol 1 ( n = 90; 201 ± 43 min vs. 274 ± 54 min; p < 0.001). There was no difference in complications such as bleeding or hematoma formation between the two groups. Patient satisfaction was the same between the two groups. However, the staff preferred protocol 1 ( p = 0.01). Conclusion A protocol of delayed initiation of TR band deflation followed by quick deflations is associated with a lower time to band removal with no increase in bleeding complications or patient satisfaction. However, the staff preferred longer intervals between deflations.

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Background & Purpose Pulmonary hypertension (PH) in sickle cell disease (SCD) is an important risk factor for complications including sudden death. In this study, we aimed to determine the prevalence of PH and correlate the echocardiographic parameters and general laboratory data with markers of hemolysis and serum NT pro-brain natriuretic peptide [BNP] concentrations in Omani SCD patients. Methods A cohort of 163 SCD patients [Mean age 25.4±8.4 years], in steady state was prospectively screened for PH with Doppler echocardiography (defined as a tricuspid regurgitation jet flow velocity of ≥ 2.5 m/sec and/or mean pulmonary artery pressure [mPAP] ≥25 mmHg). After a written informed consent, all patients were investigated with a complete blood count, renal chemistry, hemolytic parameters including LDH, haptoglobin, liver function tests, coagulation studies, HPLC studies including HbS and HbF level estimations, X ray Chest, ECG, ABG, Pulmonary function tests, Pulse oximetry, and Serum NT pro-BNP levels. Results In the evaluable patient cohort of 116 subjects [63 females, 53-males], the prevalence of PH was 5.2%. No statistically significant differences were detected in Hb levels, ECG, chest radiography, pulmonary function tests between patients with and without PH. However, plasma NT pro-BNP levels were significantly correlated with PAH [r=0.934, p<0.000], TRV jet [r=.671, p<0.000], Abnormal ECHO [r=0.672, p<0.000], and direct Bilirubin levels [r=0.278,p<0.009] in SCD patients. Furthermore, in SCD patients with PH, there was a statistically significant increase in plasma NT pro-BNP levels [ p<0.001], ALT [p<0.02], S. Creatinine [p=0.045] and Total bilirubin [p<0.0001] and direct Bilirubin levels [p<0.0001][Table]. Conclusions Serum NT pro-BNP is a strong indicator of PH in SCD patients. Doppler ultrasound echocardiography is a useful initial screen for PH in SCD patients. The correlation between PH and hemolytic markers suggests an implication in the pathogenesis of PH. Disclosures: No relevant conflicts of interest to declare.

Objectives:The aim of this study was to determine the prevalence of pulmonary hypertension [PH] and correlate it with the laboratory markers of hemolysis and serum NT-pro brain natriuretic peptide [BNP] concentrations in Sickle cell disease [SCD] patients from Oman.Methods: A cohort of 115 SCD patients was investigated with complete blood counts, blood chemistry, Serum NT-proBNP levels, imaging studies and cardiac evaluation with a 12-lead electrocardiogram and Doppler echocardiogram. They were prospectively screened for pulmonary hypertension [PH] with echocardiography, defined as a tricuspid regurgitation flow velocity of > or =2.5 m/sec.Results: Amongst the 73 evaluable patients, those with PH [n=7] had a median age of 32 years with an interquartile range (IQR) of 25.5-34 years, and a prevalence of 9.6%. No statistically significant differences were detected in the haematological parameters, serum blood chemistry and ECG parameters in patients with and without PH. However, in the PH patients, there was an increased plasma NT pro-BNP levels [p<0.006], and serum CRP levels [p<0.003][Mann Whitney U test]. Furthermore, the differences in the indirect bilirubin levels were statistically significant for one tailed comparison [p<0.04, Mann Whitney U test]. The serum NT-pro BNP levels were also significantly correlated with PH[r=0.368, p<0.025]. Conclusions:The median age of PH patients was decade higher with median serum NT-pro BNP levels being two-fold higher and significantly correlated with PH. The significant correlation between serum indirect bilirubin and PH may implicate haemolytic parameters in the pathogenesis of PH.