Aim: Polymorphisms in cytochrome P450 (CYP) 2C19 and paraoxonase-1 (PON-1) genes are thought to be involved in clopidogrel high on treatment reactivity in ischemic heart disease (IHD) patients. Methods: A total of 240 patients with IHD were screened for CYP2C19 loss-of-function alleles (LOF; *2, *3) and PON-1 Q192R. Patients were classified as responders and nonresponders to clopidogrel based upon platelet aggregation studies. Genotyping of the CYP2C19 and PON-1 allele was carried out by PCR-RFLP. Results: Results showed that 14.3% of the patients were nonresponders, whereas 85.7% were responders to the clopidogrel therapy. CYP2C19*3 allele showed significant association with clopidogrel high on treatment reactivity in IHD patients. Conclusion: Result of our study demonstrate that IHD patients with CYP2C19*3 allele can face the problem of clopidogrel high on treatment reactivity in Punjabi Pakistani population.

Background: Tissue doppler derived systolic strain detects the subtle changes in left ventricular (LV) function. This new modality can detect LV dysfunction in severe rheumatic mitral regurgitation (MR) at earlier stages. The present study was conducted to compare tissue doppler derived peak systolic strain between patients with different severities of LV dysfunction in rheumatic severe MR and to look for the negative correlation between LV dysfunction and peak systolic strain. Subjects and methods: A descriptive correlational study was conducted from January 2017 to March 2018 at Punjab Institute of Cardiology, Lahore. Fifty healthy controls taken as group-I and 150 asymptomatic patients of rheumatic severe MR were divided into Group-II (with ejection fraction (EF) ≥60% and left ventricular end systolic dimension (LVESD) ≤40mm), Group-III (with EF≥ 60% and LVESD 41-50mm) and Group-IV (with EF <60%).Longitudinal peak systolic strain (PSS) of the groups were measured by tissue doppler imaging and compared. The correlation between systolic dysfunction and PSS was further studied. Results: Out of 200 subjects, 91(45.5%) were male and 109 (54.5%) female. Mean age of study subjects was 31± 9.5 years. Moving from group-I to group-IV, mean LVESD increased from 23.3±2.4 to 49.3±3.0, mean LVEDD (left ventricle end diastolic dimension) increased from 46.4±3.4to 64.0±3.6, ejection fraction decreased from 63.6±2.1to45.7±6.7 and average PSS decreased from 17.8±0.53 to 8.31±0.52.Significant difference was found in average PSS between these groups (p<0.001).There was a significant (p<0.001)negative correlation (correlation coefficient = -0.968) between average PSS and LV dysfunction (i.e. group number). Conclusion: Inrheumatic severe mitral regurgitation, tissue doppler derived peak systolic strain decreases with increase of LV dysfunction showing a significant negative correlation between the two.

Objective: To detect correlation between systolic tissue velocity and left ventricular systolic dysfunction in patients presenting with severe rheumatic mitral regurgitation (MR). Methodology: A comparative study was performed at Punjab Institute of Cardiology, Lahore between October 2016 and February 2018. Fifty eight controls and 192 patients with rheumatic severe MR were included. End systolic dimension (LVESD), end diastolic dimension (LVEDD) and ejection fraction (LVEF) of left ventricle (LV) were taken. Group-1 contained healthy controls. Groups II, III and IV contained the patients of severe MR with non-dilated LV (LVESD ≤40mm and LVEF ≥60%), dilated LV (LVESD ≤40mm and LVEF ≥60%) and decreased LVEF (LVEF<60%) respectively. Tissue doppler was used to measure peak systolic tissue velocity at medial annulus (SV-Med), lateral annulus (SV-Lat) and average velocity (SV-Avg) of each subject. Results: A total of 250 study subjects contained 45.2% (n=113) males and 54.8% (n=137) females. Mean age of the study subjects was 30.8± 9.1. Group-I consisted of 58 controls. There were 69, 67 and 56 subjects in groups II, III and IV respectively. Moving from group-I to group-IV, LVEF decreased from 63.9%±2.2 to 46.2±6.5, LVESD increased from 23.2±2.3 to 49.0±2.9 and LVEDD increased from 45.9±3.5 to 64.3±3.6 respectively. Average systolic tissue velocity (SV-Avg) progressively decreased from group-I being 9.64±0.22 to group-IV being 6.32±0.47. There was a significant negative correlation between LV dysfunction and SV-Avg (spearman’s rank coefficient -0.921, p<0.001). A positive correlation was also found between LVEF and SV-Avg in patients with severe MR only (pearson’s coefficient 0.859, p<0.001). Conclusion: A significant negative correlation exists between the peak tissue systolic velocity and left ventricular dysfunction in patients presenting with severe rheumatic mitral regurgitation. Key words: Mitral Regurgitation, Tissue Velocity, Left ventricular dysfunction

Introduction: Arrhythmic complications of acute myocardial infarction like ventricular arrhythmias are common and determine the clinical outcome. The associated risk factors like potassium level may help triage the patients to reduce mortality.Objective: Objectives were to determine the frequency of ventricular arrhythmias in acute myocardial infarction and to compare the frequency of ventricular arrhythmias in normokalemic and hypokalemic patients.