Background & Objectives: Acute cor onar y syndr ome (ACS) is an emerging cardiac problem in the young population in Asia and Nepalese population is not an exception to this. Early ACS in young age imparts huge familial and social economic burden. Early identification and proper management strategy is still a challenging problem in developing countries like Nepal where there are limited coronary intervention centers. The study was conducted with objective to study the clinical spectrum, etiologies, coronary angiographic characteristics and their clinical outcomes. Materials & Methods: This is a cross-sectional study carried out in a tertiary hospital in central Nepal. Forty patients with acute coronary syndrome with age less than 40 years were enrolled in the study. Results: Majority of the patients were males with male: female=1.8:1. Twenty six (65%) patients were having ST segment elevation myocardial infarction followed by non-ST elevation myocardial infarction in nine (22.50%) patients and unstable angina in five (12.50%). patients. The most common risk factors were smoking, systemic hypertension, diabetes mellitus and dyslipidemia. Majority were having single vessel disease. Twenty (50%) patients had undergone primary angioplasty followed by thrombolysis in seven patients and the rest were managed medically because of late presentation. In-hospital major adverse cardiac events and mortality were higher among STEMI than NSTEMI and unstable angina. Conclusion: Acute coronary syndrome in the young is increasing in the Nepalese population. This group of population should be well educated and made aware of the potential coronary risk factors and their modification.

BackgroundIncrease in left ventricular filling pressure (FP) and diastolic dysfunction are established consequences of progressive aortic stenosis (AS). However, the impact of elevated FP as detected by pretranscatheter aortic valve replacement (TAVR) echocardiogram on long-term outcomes after TAVR remains unclear.ObjectiveTo understand the impact of elevated FP in patients with severe AS who undergo TAVR.MethodsThis was a retrospective study of all patients who underwent TAVR between 1 January 2014 and 31 December 2017. The presence of elevated FP was determined in accordance with the latest guidelines using the last available comprehensive echocardiogram prior to TAVR.ResultsOf 983 patients who were included in our study, 422 patients (43%) were found to have elevated FP and 561 patients (57%) had normal FP prior to TAVR. Patients with elevated FP had a mean age of 81.2±8.6 years and were more likely to be males (62%), diabetic (41% vs 35%, p=0.046), and have a higher prevalence of atrial fibrillation (Afib) (53% vs 39%, p<0.001). The 5-year all-cause mortality after TAVR was significantly higher in patients with elevated FP when compared with patients with normal FP (32% vs 24%, p=0.006). The presence of elevated FP, history of Afib and prior PCI emerged as independent predictors of long-term mortality after TAVR.ConclusionElevated FP is associated with increased mortality in patients with severe AS undergoing TAVR. Assessment of FP should be incorporated into the risk assessment of AS patients to identify those who may benefit from early intervention.

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Introduction: Cardiac injury is known to occur in patients with COVID19 infection and is associated with a poor prognosis. However, there is limited data assessing the survival outcomes in hospitalized COVID19 patients with new-onset cardiomyopathy (NOC). We studied the impact of NOC on short and long term mortality in hospitalized COVID19 patients. Methods: We reviewed all cases of hospitalized COVID19 patients from the Cleveland Clinic COVID19 registry from 18 th March, 2020 to 18 th May, 2021 who received an in-hospital echocardiogram and had any prior echocardiogram to compare. The mean interval between the in-hospital and prior echocardiogram was 2.8 years. NOC was defined as a reduction in left ventricular ejection fraction (LVEF) of > 10% with a new LVEF of < 53%. The 30-day and 1-year mortality of patients with NOC were analyzed. Results: Of the 1537 hospitalized COVID19 patients receiving echocardiogram, 907 with a prior echocardiogram were included, of which 77 (8.5%) had NOC. Out of the 907 patients, 229 (25.2%) died within 30-days and 519 (57.2%) died within one year. It was found that patients with NOC had higher 30-day mortality than those without NOC (24.2% vs 36.4%, p=0.0078). However, the 1-year mortality was similar in the two groups (41.4% vs 45.3%, p=0.21). Conclusions: We found that NOC in hospitalized COVID19 patients was associated with higher 30-day mortality, however, it did not adversely impact the 1-year survival. Our findings suggest that although NOC is associated with worse short-term outcomes, long-term survival was primarily driven by the underlying disease process rather than the NOC.

Introduction: New-onset cardiomyopathy (NOC) has been seen in hospitalized patients with COVID19 infection. Such NOC was associated with increased 30-day mortality. Long-term follow-up to assess the reversibility of such cardiomyopathy is lacking. We studied the follow-up echocardiograms in such patients and assessed the reversibility of their cardiomyopathy. Methods: We reviewed all cases of hospitalized COVID19 patients from the Cleveland Clinic COVID19 registry from 18 th March, 2020 to 18 th May, 2021. Patients who received an in-hospital echocardiogram and had echocardiogram prior to and post COVID19 hospitalization were selected for the study. NOC was defined as a reduction in left ventricular ejection fraction (LVEF) of > 10% with a new LVEF of < 53%. Cardiomyopathy was considered reversible if the follow-up echocardiogram showed an improvement in LVEF, with new LVEF >53%. The mean interval between the in-hospital and follow-up echocardiogram was 5.6 months. Results: Of the 1537 hospitalized COVID19 patients receiving echocardiogram, 907 had a prior echocardiogram, of which 77 (8.5%) had NOC. Patients with NOC were significantly more likely to be females and have chronic kidney disease. Of the 77 patients with NOC, 35 (45.5%) had follow-up echocardiograms. Of these, only 13 (37.1%) had reversible cardiomyopathy while 22 (62.9%) had persistently decreased LVEF. Conclusions: Our study highlights the lack of follow-up echocardiograms for patients with NOC and a persistence in decreased left ventricular systolic function in those that received one. All patients with NOC and COVID19 infection should receive follow-up echocardiography to guide their management.