Objective: To ascertain the effect of duration of hemodialysis on left ventricular hypertrophy in patients with chronic kidney disease. Design: It was a cross sectional observational study. Study Settings: Department of Cardiology, Shaikh Zayed Hospital Lahore over a period of 6 months from January 2021 to June 2021. Material and Methods: This study was conducted, between February and September 2021, by recruiting 200 patients undergoing hemodialysis. Demographic and clinical data were recorded. Blood samples were taken for investigation. Body surface area was calculated using Du Bois Formula. To calculate LVM, Echocardiography (Echo) was done by using 2D M-mode in the standard manner. At the end of data collection, data was entered and analyzed using SPSS v.21. Single and multiple linear regression analysis were used to calculate impact of duration and other confounding variable on LVM. Results: The mean age of the participants was 46.77±13.263. About 58.5% (117) were males and 41.5% (83) were females. Prevalence of LVH was 171(85.5%). The mean LVM for males and females was 248.44±26.67g and 182.88±22.43g respectively. Most of the participants (47.0%) were receiving HD for 25-36 months followed by 26.0%, 15.0%, 12.0% for 13-24 months, 3-12 months,37-48 months respectively. LVH was found to be strongly positively correlated with duration of dialysis. Increasing duration of HD was associated with an increased likelihood of exhibiting LVH. Conclusion: The study concluded that there exist significantly strong relationship between increased duration of hemodialysis in CKD patients with frequency of left ventricular hypertrophy. So, in future practice it is recommended to focus on CKD patients undergoing hemodialysis with regard to duration of hemodialysis and expected frequency of left ventricular hypertrophy and its timely management. Keywords: Chronic kidney disease, Left ventricular hypertrophy, Left ventricular mass index, Haemodialysis.

Objective: To establish the correlation between IMT (presence and severity) of carotid and femoral artery detected on Doppler study and presence of subclinical CAD in asymptomatic patients for early detection of CAD and risk stratification by a non-invasive method. Methodology: This cross-sectional analytic study was conducted in the Cardiology department of Mayo Hospital Lahore for a period of 1 year. One hundred and twenty asymptomatic subjects with and without conventional risk factors for CAD were included The thickness of the intima-media of carotid and the femoral artery was assessed by high-resolution B mode Ultrasonography. The patients enrolled in our study underwent coronary angiography. Data was entered and analyzed through SPSS (Statistical package for social science) version 16. Results: There were a total of 120 patients with a male-to-female ratio of 1.8:1 The mean age of patients was 32.40 ± 10.74 years, minimum age of patients was 20years while the maximum age was 40 years. Most of our patients were overweight, smokers, and had established family history of heart disease. Most of the patients had a single-vessel disease and had severe CAD at the time of presentation. There were 93 patients whose IMT was >0.8 mm. There were 16 patients whose CMIT was <0.8 mm. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of B-mode USG (using CIMT and FA-IMT) were calculated as 85.32%, 72.73%, 96.88%, 33.33% and 84.17% respectively for CMIT. For FA-IMT sensitivity, specify, PPV, NPV and Diagnostic accuracy of B-mode USG was 84.4%, 54.55%, 94.85%, 26.09% and 81.67% respectively. Conclusion: The increased IMT is a predictor of coronary vascular disease, measured non-invasively with B-mode ultrasound. It can be used to predict future cardiovascular events and risk stratification. If patients are diagnosed in the earlier stages then timely treatment can prevent or regress the progression of the disease.

Objective: To determine the frequency of acute kidney injury in patients presenting with acute ST elevation myocardial infarction and to compare the frequency of in-hospital mortality between patients presenting with acute ST elevation myocardial infarction with versus without acute kidney injury at a tertiary care hospital. Design: It was a descriptive case series. Study Settings: Department of Cardiology, Shaikh Zayed Hospital Lahore-Pakistan over a period of 6 months from January 2021 to June 2021. Material and Methods: A total of 128 patients of both genders aged between 18-70 years presenting with in first 12 hours of acute STEMI at emergency ward of cardiology department were included in this descriptive case series study. An informed written consent was taken from all the participants. All these patients were managed as per standard departmental protocols. Renal function was assessed within 30 minutes of presentation and then after 72 hours of admission and acute kidney injury was labelled if there was ≥0.5 mg/dl increase in serum creatinine level from baseline. These patients were followed till discharge and death of the patient during hospital stay was noted. It was then compared between patients with versus without acute kidney injury. Results: The patients had mean age of 53.8±11.3 years. There were 86 (67.2%) males and 42 (32.8%) females with a male to female ratio of 2.1:1. 97 (75.8%) patients were obese, 65 (50.8%) patients were diabetic and 87 (68.0%) patients were hypertensive. 72 (56.3%) patients were active smokers. 25 (19.5%) patients with acute STEMI developed acute kidney injury while 10 (7.8%) patients died during hospital stay. The frequency of in-hospital mortality was significantly higher in acute STEMI patients with AKI as compared to those without AKI (24.0% vs. 3.9%; p-value=0.004). When compared similar difference was noted in in-hospital mortality between acute STEMI patients with versus without AKI across various subgroups based on age, gender, BMI, diabetes, hypertension, smoking, ASA status, thrombolysis and need for PCI. Conclusion: A substantial proportion of patients presenting with acute ST-segment elevation myocardial infarction developed acute kidney injury that was associated with increased frequency of mortality among such patients which warrants routine monitoring of renal function among patients presenting with acute ST-segment elevation myocardial infarction and consideration of cases positive of AKI at higher risk of mortality so that risk stratification and anticipated management may improve the outcome of such patients in future practice. Keywords: Acute ST Elevation Myocardial Infarction, Acute Kidney Injury, In-Hospital Mortality.

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Background: Rheumatic heart disease has a strong association with mitral valve stenosis. Atrial fibrillation is one of the most common complications of this condition and is a poor prognostic factor. Early detection and prompt management of atrial fibrillation can help to improve the quality of life and increase the life expectancy of the patients. We carried out this study to investigate the significance of left atrial volumetric changes in mitral stenosis and its correlation with atrial fibrillation. Methodology: We audited the data of 60 patients of rheumatic heart disease who had mitral valve stenosis. The patients were randomized into atrial fibrillation (Group A) and normal sinus rhythm (Group B). We conducted this cross-sectional analytical study at Cardiology Department, Mayo Hospital, Lahore, from 1st February 2017 to 31st January 2018. We only included those patients who consented to be a part of this study and fulfilled our predefined inclusion criteria. Left atrial volume was measured by prolate ellipse method and biplane methods on echocardiography. The Data was analyzed on SPSS v20. Results: Sixty patients were included in the study. Among the subjects, thirty-six (60%) were males, and twenty-four (40%) were females. Atrial fibrillation was noted in 43.33% of the patients of mitral valve stenosis. There was a marked difference in the mean volume of the left atrium among the two groups. We observed that the mean area of the mitral valve for Group A patients was larger than that of patients in Group B. Our study showed an inverse correlation between left atrial volume and mitral valve area among Group A patients. Conclusion: Patients of mitral stenosis are at an increased risk of developing atrial fibrillation if the left atrial volume is increasing. All patients with mitral stenosis should have routine echocardiography & measurement of left atrial volumes, so that proper treatment can be started if the left atrial volume is increasing, to prevent atrial fibrillation.