One of the important complications which causes the increase of mortality and economic burden on patient is the ischemic MR. Its main pathophysiology is the remodeling of the LV after MI which causes the hemodynamic load and heart failure. However, the data on relationship between ischemic MR and duration of heart failure is very few. We prospectively studied 300 patients who admitted for acute myocardial infarction in our hospital. All patients were assessed by echocardiography and graded MR as mild, moderate, and severe according to regurgitant jet area which is less than 20%, 20 – 40%, and more than 40% of the left atrial area, respectively. The median duration of follow up was 1 year (range 6-12 months). Mild and moderate or severe ischemic MR was present in 40.2 and 6.4% of patients respectively. The hazard ratios for HF were 2.9 (95% condence interval (CI), 1.9–4.3; P<.001) and 3.7 (95% condence interval (CI), 2.1-6.5; P<.001) in patients with mild and moderate or severe ischemic MR respectively, with compared to patients without ischemic MR, after adjusting for ejection fraction and other clinical variables like age, sex, Killip class, previous infarction, hypertension, diabetes mellitus, anterior wall infarction, ST elevation infarction and coronary revascularization. In patients with mild ischemic MR, the adjusted hazard ratio for death was 1.1 (95% CI 0.7-1.7; P=.42), where as in moderate or severe ischemic MR it was 2.1 (95% CI 1.3-3.5; P=.02).

Depending upon hemodynamic status and right ventricular dysfunction, In-hospital mortality of acute pulmonary embolism ranging from 0 to 50%. By assessing right ventricular function, we can predict the outcomes in patients with acute pulmonary embolism. In patients with acute pulmonary embolism (PE), right ventricular (RV) failure causes death due to a mismatch between RV systolic function and increased RV afterload. The aim of our study was to know whether the ratio of tricuspid annular plane systolic excursion (TAPSE)to pulmonary arterial systolic pressure (PASP) would predict adverse outcomes. This study was a retrospective analysis of a single Centre Pulmonary embolism register. After the conrmation of PE, patients taken a formal transthoracic echocardiography within 48 hours were included in this study. A 7- day composite outcome of death or hemodynamic deterioration was the primary end point of this study. The secondary endpoints of this study were 7- and 30- day all-cause mortality. A total of 67 patients were included; 14 met the primary composite outcome. In univariate analysis, the TAPSE/PASP was associated with our primary outcome [odds ratio = 0.027, 95% condence interval (CI) 0.010–0.087; P < 0.0001], which was signicantly better than either TAPSE or PASP alone (P = 0.018 and P < 0.0001, respectively). For predicting adverse outcome in PE, a TAPSE/PASP cut-off value of 0.4 was identied as the optimal value. Echocardiographic ratio of tricuspid annular plane systolic excursion to pulmonary arterial systolic pressure is superior in prediction of adverse outcome in acute PE. And also, it may improve risk stratication and identication of the patients that will suffer short-term deterioration after acute PE.

Objective: To study the epidemiology and clinical silhouette, risk prole, angiographic patterns, management, and long term outcomes of Corononary artery disease presenting as an ACS(cute coronary syndrome) in young individuals of age less than 40 years presenting to our tertiary care centre. Methods: We incorporated 251 patients aged less than 40 years who presented with ACS (STEMI or NSTEMI/UA) to the department of cardiology Coimbatore Medical College, Coimbatore. Results: 251 young patients aged 40 years or less who presented with ACS were included in the study. Smoking turned out to be the most deadly risk factor and was associated with the most number of cases present in 68% of cases. Next in line was diabetes (54%) and family history (48%) of cases. 54% patients were reported to be having signicant depression.Hypertension (44%)and dyslipidemia (40%) were also seen in a large proportion of cases. Most of the cases presented as STE-ACS (80%) and other presented as NSTE-ACS(20%). Out of 251 patients 178 patients underwent CAG, of all the patients undergoing Coronary angiogram most recurring angiographic prole was that of being Single vessel disease (65%) mostly involving the LAD. There was in-hospital mortality of 4 patients, one of which had presented with concomitant diabetic ketoacidosis. Most common complication of the patients was Cardiogenic shock which occurred in 22% of the patients, while 18% of them had post MI period complicated by Arrhythmias. Conclusions: STE-ACS was the most common presentation of ACS in the young population. Smoking was the most common risk factor. The majority of the patients had single-vessel disease. Our study concluded that modiable risk factors are the most penetrative factors which could be dealt with in an ideational manner to reduce the relative risk of CAD in young

Myocardial infarction causes variable degrees of left ventricular (LV) systolic and diastolic dysfunctions. The ejection fraction (EF) and transmitral ow are the frequently used method for evaluating the systolic and diastolic functions respectively with considerable limitations. The MPI is a single independent parameter, capable of estimating both systolic and diastolic performance combined and lacks such limitations. We enrolled 100 patients presented with a rst acute STEMI who have undergone Thrombolysis. Echocardiography was done within 24 h of chest pain with measurement of MPI. The LV MPI was calculated as (isovolumic contraction time ''ICT” + relaxation time ''IRT”)/Ejection time ''ET”. simultaneously, clinical and echocardiographic variables were analyzed and CHF was dened as Killip class >=II. Results: Early in-hospital HF occurred in 38 of patients (38%). Ejection fraction was found to have a highly signicant negative correlation with the development of in-hospital HF (p = .0001), while MPI was found to have a highly signicant positive correlation (p = .0001). Acut-off point of MPI > 0.72 showed a very high specicity (93.6%) and sensitivity (77.3%) for identifying patients with HF. On the other hand, a cut-off point of EF <=32% has shown 93.4% specicity and 57.5% sensitivity for HF prediction. Conclusions: The MPI might be a strong predictor of in-hospital HF after acute ST elevation M

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