It is well known that chronic kidney disease (CKD) is associated with significant morbidity and mortality, predominantly due to cardiovascular complications. Recent literature report pulmonary hypertension (PH) as a common accompaniment of CKD and in majority of these cases, secondary causes of PH are not evident. In this study, we looked at the prevalence and possible risk factors of PH in stage 5 CKD patients with a special focus on unexplained PH. In this cross-sectional study, 100 stage 5 CKD patients [50 each on maintenance hemodialysis (HD) and conservative management] were included. After baseline investigations participants underwent two-dimensional transthoracic echocardiogram. The routine method of PH diagnosis based on modified Bernoulli’s formula was complemented with an alternate method based on pulmonary artery acceleration time (PAAT). Detailed workup for secondary causes was carried out in patients with PH. The prevalence of PH in the study population was 89% (56% mild, 35% moderate, and 9% severe). Asymptomatic left ventricular diastolic and systolic dysfunction were noted in 54% and 20%, respectively. Significant association with PH was found with the duration of CKD, systolic and diastolic Blood pressure, hemoglobin, transferrin saturation, maintenance HD, and dialysis vintage. In sharp contrast to the existing data this study showed a very high prevalence of PH though severe PH was present only in 9%. The inclusion of PAAT-based method enabled the detection of more cases of PH. Further evaluation carried out for common secondary causes did not show significant abnormalities except for a sizeable proportion with asymptomatic left ventricular dysfunction.

OBJECTIVESObjectives of this study were to evaluate right ventricular function using two dimensional speckle tracking echocardiography among patients who were admitted with acute myocardial infarction and treated with primary angioplasty, association between right ventricular strain global longitudinal strain and major adverse cardiovascular events and to analyse the angiographic results of all patients. METHODSThis was a prospective observational study conducted in 200 consecutive patients admitted with acute inferior wall myocardial infarction and treated with primary angioplasty. Right ventricular global longitudinal strain was measured by two dimensional speckle tracking echocardiography and angiographic results of all patients were recorded. All patients were followed up till discharge / death. Categorical data were compared using Chi-square test or Fisher’s exact test. Logistic regression was done to find out the major adverse cardiovascular outcomes predictive by RVGLS. P < 0.05 was considered statistically significant. RESULTS200 patients were enrolled for the study of which were 102 (51%) patients and 98 (49 %) patients were males and females respectively. Patients with low RVGLS had higher incidence of left ventricular dysfunction(P=0..006) ,low TAPSE and S’(P<0.001) ,angiographic triple vessel disease(p<0.001),arrhythmias(p=0.02) ,right heart failure(P<0.001),target lesion revascularisation(P=0.029) and prolonged hospital stay(P<0.001).In multivariate analysis , arrhythmias (P=0.046 ,OR - 2.05, CI 0.93-8.10) ad target lesion revascularisation were the two major adverse cardiovascular events predictive by RVGLS. CONCLUSIONRVGLS could be used a prognostic marker in patients admitted with acute inferior wall infarction, categorise the risk and might assist the interventionist in planning an earliest therapeutic strategy.

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