Objective: To compare the left ventricular ejection fraction on echocardiograph, cardiac magnetic resonance imaging and single-photon emission computed tomography scan in heart failure patients. Study Design: This was a prospective cross-sectional study. Place and Duration of Study: Tertiary Cardiac Care Center of Rawalpindi, Pakistan, from Nov 2021 to Apr 2022. Methodology: This was a prospective cross-sectional study conducted from November 2021 to April 2022 at a tertiary cardiac care center of Rawalpindi. Thirty (n=30) heart failure patients of either gender with reduced ejection fraction were selected by consecutive sampling technique and were analyzed to quantify their left ventricular ejection fraction (LVEF) using Echo, CMR and SPECT scan. All three modalities were used to measure LVEF in these patients and were compared accordingly. Results: The LVEF measured by Cardiac Magnetic Resonance Imaging, Single Photon Emission Computed Tomography Scan and Echocardiography was in the range of 15% to 67%. The mean LVEF was 37.2±14.2 by CMR, 37.17±14.1 by SPECT and 38±12.3 by Echo. The mean LVEF determined by SPECT was slightly lower while that determined by Echocardiography was slightly higher. The measured p-value of LVEF by the three modalities, however, indicated statistically difference (p-value <0.05). Conclusion: Although the literature shows diversity in results of these modalities, CMR is considered the standard reference for assessment of LVEF when interpreted by an expert observer. We in our study found that all three modalities are complimentary to each other and can be used interchangeably depending upon the availability of the equipment and reporting expertise of the observers.

Objective: To evaluate the patterns of left ventricular hypertrophy (LVH) and late gadolinium enhancement (LGE) inhypertrophic cardiomyopathy. Study Design: Analytical cross-Sectional Study. Place and Duration of Study: Tertiary Cardiac Care Center, Rawalpindi Pakistan from 01 June 2020 to 30 Dec 2021. Methodology: This study was carried out at a tertiary cardiac care center retrospectively from 1 June 2020 to 31 December 2021. Patients having LV hypertrophy due to aortic stenosis, hypertension, athlete’s heart, and infiltrative disorders were excluded from study. Cases were included using nonprobability consecutive sampling. Sample size estimated by taking 0.2- 0.5 % (1 in 200-500) prevalence of hypertrophic cardiomyopathy using open epi sample size calculator was (n=38) taking 99.99% confidence interval. For the purpose of study all patients with confirmed HCM undergoing CMR during given period were included in study.Approval from the ethical review committee with IERB (IERB letter # 9/2/R&D/2022/179) was sought. CMR was performed using MRI 3 Tesla. Data analysis was done on SPSS version-26. Quantitative variables were expressed as Mean±SD. Qualitative variables were expressed as frequencies and percentages. ANOVA and student t-test (95% CI and 5% margin of error) was applied to compare the study variables. p-vale <0.05 was considered statistically significant. Results: Majority 77(86.7%) of patients were males. Most common pattern of involvement for LV hypertrophy was asymmetrical septal hypertrophy in 47 (52.8%) followed by apical HCM in 29(32.6%). LVOT obstruction was observed in 30(33.7%) of patients. Mean maximum LV wall thickness was 22mm±5.47. Conclusion: Our study shows association, between the extent of Late Gadolinium Enhancement and LV wall thickness, myocardial mass index in HCM patients.

Objective: To determine the spectrum of arrhythmias during initial 48 hours of AMI and their impact on the in-hospital outcome. Study Design: Analytical Cross-sectional study. Place and Duration of Study: This study was conducted at a Tertiary Cardiac Center of Rawalpindi Pakistan from Jun 2021 till Jan 2022. Methodology: A total of (n=150) patients of Acute Myocardial Infarction (AMI) undergoing immediate or early revascularization and meeting the inclusion and exclusion criteria were included in the study. They were monitored for arrhythmias during initial 48 hours of hospitalization and their in-hospital outcomes were noted on a predesigned Performa.Chi square test applied for arrhythmia association with adverse outcome at 95% confidence interval and 5% margin of error. Results: This study comprised (n=117; 78%) males and (n=33; 22%) females. Mean age was 62.9 years. ST elevation MI(STEMI) constituted (n=127; 84.7%) and Non-ST Elevation MI (NSTEMI) (n=23;15.3%) of total patients. Arrhythmias documented in overall (n=122;81.3%) patients, 81.8% (n=104) in STEMI and (n=18; 77.2%) in NSTEMI. Sinus tachycardia(n=52;34.7%) was most common rhythm followed by accelerated idioventricular rhythm (n=20;13.4%) and sinus bradycardia12.7% (n=19). In-hospital mortality was (n=25;16.7%) with p-value=0.009, mostly in patients with ventricular tachycardia/ventricular fibrillation, atrial fibrillationand complete heart block. Other outcomes included (n=23;14.7%) acute left ventricular failure, (n=9; 6%) cardiogenic shock (n=5;3.3%) acute stent thrombosis, (n=2; 1.3%) cerebrovascular accident (CVA)and (n=31; 20.7%) prolonged hospitalization (p-value 0.05). Conclusion: Arrhythmias are common in acute myocardial infarction during initial 48 hours of presentation with sinus tachycardia being most common followed by accelerated idioventricular rhythm and sinus bradycardia. Arrhythmias are associated with increased in-hospital mortality and adverse outcome.

Objective: To determine the prevalence of Echocardiographically-recognizable Mitral Annular Disjunction in patients of Myxomatous Mitral Valve Disease/Mitral Leaflet Prolapse. Study design: Analytical Cross sectional . Place & Duration of study: Armed Forces Institute of Cardiology/National Institute of Heart Disease (AFIC/NIHD),Rawalpindi Pakistan from Jul 2021 to Sep 2021. Methodology: A total (n=45) diagnosed patients of Myxomatous Mitral Valve disease, were included through non-probability consecutive sampling. Mitral Annular Disjunction (MAD) was assessed by 2D TTE imaging as the distance between the point of insertion of the posterior leaflet into the left atrial wall (upper boundary of the disjunction) and the link between the left atrium and the left ventricle myocardium (lower border of the disjunction)at end-systole in parasternal long axis view. A distance equal to or greater than 2mm was used as a threshold for diagnosing the presence of MAD. The data analysis was done with the help of computer software programme SPSS version 24. Results: Total number of patients were 45 patients with males being 32 (71.11%) while females being 13 (28.88%), with a mean age of 30.24 + 5.21 years. MAD was present in 26 (57.8%) of the patients with mean length of 2.88mm + 2.77 mm. Patients with MAD had more chest pain, palpitations and dyspnoea than those without MAD. Mitral regurgitation was more severe in patients with MAD than without. The MAD severity correlated with the presence of Non Sustained Ventricular Tachycardia. Conclusion: MAD is not an uncommon finding in patients having myxomatous mitral valve disease/mitral valve prolapse........