Background: Elevated high sensitivity C-reactive protein (hs-CRP) has been well known as a biomarker reflecting inflammatory process for prediction of ischemic events among patients with coronary artery disease. Relatively small studies have identified a heightened and sustained inflammatory response after percutaneous coronary intervention (PCI) to be a predictor of periprocedural events after coronary angioplasty and a marker of increased restenosis risk among patients undergoing coronary stenting. Embolization of atherosclerotic and thrombotic debris can induce myocardial necrosis during PCI. This study was designed to evaluate whether pre procedural hs-CRP level is associated with procedure related distal microembolization producing myocardial injury (assessed by CK-MB level) after PCI.Methods: A total of 310 patients with chronic stable angina and unstable angina, who would undergo elective PCI were evaluated in National Institute of Cardiovascular Disease (NICVD), Dhaka with a view to evaluate the relationship between preprocedural hs-CRP and rise of CK-MB level, before and after PCI. Patients were divided in 2 groups according to hs-CRP: Group I = hs-CRP <3 mg/ L, Group II = hs-CRP >3 mg/L.Results: A total of 310 patients were divided into two groups: Normal CRP group (n = 131) and elevated CRP group (n= 179). Following PCI, CK-MB level rose from baseline in both groups. In normal CRP group, there was no significant elevation of CK-MB level after PCI (Pre-procedural vs. Post-procedural: 18.6 ± 5.4 vs. 29.1 ± 5.6 mg/L, p= ns). In elevated CRP group, there was significant elevation of CK-MB level after PCI (Preprocedural vs. Post-procedural: 19.1 ± 6.7 vs. 52.46 ± 9.4 mg/L, p < 0.01). The mean rise of CK-MB level was higher in group II than group I (33.06±11.62U/L vs. 11.52±9.60 U/L). The findings were statistically significant between the study groups (p>0.05). Also there was a positive linear correlation between preprocediral hsCRP level and rise of CKMB (r=0.22) following procedure and it was statistically significant (p<0.05). Multivariate logistic regression analysis was done among traditional predictors of PCI outcome including advanced age (>50 years), female gender, diabetes mellitus, BMI, hypertension, smoking, dylipidaemia, type C lesion, multiple stents, post dilatation and hsCRP. After removing the effects of the all other variables, hs- CRP was independent predictor of periprocedural myocardial injury during PCI, assessed by CK-MB elevation with OR 1.57 and p=0.001.Conclusion: The inflammatory activity, as represented by hs-CRP level, is associated with procedure related microvascular injury as assessed by CK-MB elevation after PCI. Measurement of hs-CRP levels could provide a rationale for risk stratification before coronary intervention and may be a useful tool to target aggressive antiaggregatory or anti-inflammatory therapy to patients that are exposed to the highest risk for ischemic complications. As distal microembolization is a determinant of short and long term mortality after PCI, specific strategies may be developed to minimize myocardial injury in subjects with elevated hs-CRP level.Bangladesh Heart Journal 2015; 30(1) : 5-12

Background: Spontaneous echocardiographic contrast (SEC) is a risk factor for left atrial thrombus formation and an important indicator of potential systemic embolism originated from heart. An established relation exists between the inflammatory status and the prothrombotic state. The present study was conducted to evaluate the association between left atrial spontaneous echocardiographic contrast with inflammatory markers in mitral stenosis patients. Methods: This observational analytical study was undertaken in the department of Cardiology, National Institute of Cardiovascular diseases (NICVD), Dhaka. A total of 70 patients with mitral stenosis were categorized into two groups: group I with left atrial SEC and group II without left atrial SEC. All patients underwent transthoracic as well as transoesophageal echocardiography. Complete blood count with ESR was done and neutrophil lymphocyte ratio was calculated. The high sensitive C-reactive protein (hs-CRP) was assayed. Results: The hs-CRP levels were significantly greater in the SEC-positive group (5.6±2.1vs 1.5±0.7, p=0.001). The mean ESR level was significantly greater in the SEC-positive group (32.6±15.5 mmvs15.8±4.7 mm).The neutrophil levels ((76.1±1.9 vs 63.7±3.3) were significantly greater in the SEC-positive group, and the lymphocyte levels (33.3±3.0 vs 21.5±1.3) were significantly greater in the SEC-negative group (p=0.001 for each). The neutrophil/lymphocyte (N/L) ratio was also significantly greater in the SEC-positive group (3.4±0.4 vs2.1±0.6, p=0.001).On multivariate analysis hs-CRP, neutrophil/lymphocyte ratio, raised ESR, mitral valve area and left atrial diameter were independent risk factors for SEC in patients with mitral stenosis. Conclusion: From this study it may be concluded that left atrial SEC is associated with raised inflammatory markers in majority of patients with mitral stenosis. So, SEC may be considered as a reflection of ongoing inflammatory process in patients with mitral stenosis. DOI: http://dx.doi.org/10.3329/cardio.v7i1.20797 Cardiovasc. j. 2014; 7(1): 24-30

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Emerging evidence links an elevated baseline inflammatory status to adverse outcome among patients undergoing percutaneous coronary intervention (PCI). Baseline inflammation measured by high sensitivity C-reactive protein hsCRP may prove useful for identification of high risk patients requiring adjunctive therapies. This prospective study was carried out in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka, during October 2012 to September 2013.Two hundred consecutive patients with CSA and UA undergoing PCI were included in the study. Study patients were divided into two groups on the basis of hsCRP levels. In Group I hsCRP levels were elevated, that is ≥3 mg/L and in Group II hsCRP levels were normal, that is < 3 mg/L, with 100 patients in each group. Following the procedure in-hospital outcome of study patients were observed. Increased incidence (44%) of adverse in-hospital outcome was found in Group I (44% Vs. 11%). Higher incidence of post procedural angina (17%), peri-procedural myocardial infarction (6%) and peri-procedural myocardial injury (10%) was observed in this group. Nonsignificant rate of acute myocardial infarction, significant arrhythmia, acute LVF, cardiogenic shock and death were found in elevated hsCRP Group. Overall Major Adverse Cardiac Events (6% Vs. 0%) were found in pre-procedural elevated hsCRP group. High sensitivity C-reactive protein remained independently predictive of adverse in-hospital outcome, with 95% CI of RR 1.4 -4.4 and p<001. The present study concludes that the hsCRP is an important and independent predictor of adverse in hospital outcome.

Background: Uncontrolled blood pressure (BP) is a major healthcare issue and responsible for high risk of cardiovascular disease (CVD) mortality and morbidity. Physicians of Bangladesh had been using amlodipine and Olmesartan combination for a long period of time but have very limited evidence-based information regarding the efficacy and safety of this combination. The aim of this study was to evaluate the efficacy and safety of fixed dose combination of olmesartan/amlodipine in hypertensive patients. Methods: This open-label, non-randomized, non-comparative observational study was conducted in different centers of Bangladesh during the period from January 2020 to November 2020. In total 443 Bangladeshi adult patients with hypertension were selected as the study population. Proper written consent was taken from all the participants before collecting data. Inter-group differences in the baseline characteristics were compared using analysis of variance (ANOVA). Two-tailed p-values of less than 0.05 were considered to be statistically significant. Statistical analyses were conducted by using SPSS for Windows, version 25 (SPSS Inc., Chicago, IL, USA). Results: Among all the participants, more than 70% were above 46 years of age and 55% were male. More than 60% of them were either overweight or obese. Among them, dyslipidemia, diabetes, and Chronic renal failure (CRF) was found among 14.22%, 28.44%, and 4.29% participants respectively Mean systolic (SBP) and diastolic blood pressures (DBP) were reduced to 36.61 and 18.69 mm of Hg respectively after 12 weeks of therapy. Besides these, the targeted SBP was achieved among 92% and targeted DBP was achieved among 98.3% of participants after 12 weeks. Achievement of BP goal in respect to Body mass index (BMI) of the patient (P-value 0.019), family history of hypertension (P-value 0.028), and dose of the drug in initial visit (P-value 0.001) was found statistically significant. There was no discontinuation of study medication due to intolerance or adverse events. Conclusion: Olmesartan/Amlodipine is an effective combination for reducing the blood pressure along with achievement of BP goal. Future studies on Olmesartan/Amlodipine in Bangladesh could be conducted with a longer treatment duration to examine the maintenance of effect and long-term safety.