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Fulltext Transradial coronary angioplasty and stenting--immediate results and 3-month clinical follow-up in the first 50 patients performed at the National Heart Institute

Pillay D, Lam KH, Muda MN, Hamid Z

Med J Malaysia, 2000 Dec;55(4):467-72.
PMID: 11221159

Aim: To explore the safety and feasibility of coronary angioplasty and stenting via the radial artery in a heterogenous group of patients and to report the immediate and 3-month clinical follow-up.
Background: The use of the transradial approach for coronary angiography was first described by Lucien Campeau in 1989. Based on the favorable initial results, this technique has gained widespread acceptance worldwide. Ferdinand Kiemeneij’s work in transradial angioplasty and stenting has taken invasive cardiology into the exciting new era of “minimally invasive coronary intervention”.
Methods and results: Fifty consecutive patients underwent Transradial Percutaneous Transluminal Coronary Angioplasty (PTCA) with or without stenting from mid March 98 – December 98. The right radial approach was utilized in 41 patients (80%) while the left in 9 patients. Ninety percent of the procedures was done on an adhoc basis. Diabetes mellitus was present in 38% of patients. Eighty percent of the patients had unstable angina pectoris and 60% had a prior history of acute myocardial infarction. The commonest vessel involved was the LAD (41%) and type B lesions predominated (54%). PTCA was successful in 96%. One patient had a total LAD occlusion, which could not be wired, and another developed severe spasm during catheter manipulation. The latter ad successful PTCA via the right femoral route Stents were utilized in 57% of patients. The commonest indication for stenting was suboptimal PTCA results (89%) and dissection (14%). There was no stent embolization and all stents were successfully deployed (100%). One patient developed acute stent thrombosis necessitating repeat PTCA and another patient sustained an acute anteroseptal myocardial infarction 5 days post procedure as a result of subacute stent thrombosis and died. Two patients had successful primary PTCA. There was no bleeding or vascular complications. 60% of patients were treated on an outpatient basis. At 3-months follow up 1 patient required CABG’s for disease progression. Three patients had absent radial pulses without adverse consequence. No patient required repeat PTCA at follow up.
Conclusion: In summary, adhoc PTCA and stenting is safe and feasible in our patient population. A study on the cost effectiveness of the procedure compared to conventional femoral PTCA is warranted.

Matched MeSH terms: Myocardial Ischemia/therapy*
Fulltext Effect of diaphragmatic breathing on heart rate variability in ischemic heart disease with diabetes

Kulur AB, Haleagrahara N, Adhikary P, Jeganathan PS

Arq. Bras. Cardiol., 2009 Jun;92(6):423-9, 440-7, 457-63.
PMID: 19629309

BACKGROUND: Reduced heart rate variability is associated with an unfavorable prognosis in patients with ischemic heart disease and diabetes. Whether change in breathing pattern can modify the risk factor in these patients has not been definitely proved.
OBJECTIVE: To evaluate the effect of diaphragmatic breathing on heart rate variability (HRV) in ischemic heart disease patients with diabetes.
METHODS: Study population consisted of 145 randomly selected male patients of which 45 had ischemic heart disease (IHD), 52 had IHD and diabetes (IHD-DM) and the remaining 48 had IHD and diabetic neuropathy (IHD-DN). HRV was assessed by 5 minute-electrocardiogram using the time domain method. The intervention group was divided into compliant and non-compliant groups and follow-up recording was carried out after three months and one year.
RESULTS: Baseline recordings showed a significant decrease in HRV in ischemic heart disease (IHD) patients with or without diabetes (p<0.01). IHD patients had higher HRV than IHD patients with diabetes (p<0.01) or diabetic neuropathy (p<0.01). Increase in HRV was observed in patients who practiced diaphragmatic breathing for three months (IHD-DM: p<0.01; IHD-DN: p<0.05) and for one year (IHD-DM: p<0.01; IHD-DN: p<0.01). The HRV significantly decreased after one year in non-compliant patients. The regular practice of diaphragmatic breathing also improved the glycemic index in these patients.
CONCLUSION: The regular practice of diaphragmatic breathing significantly improves heart rate variability with a favorable prognostic picture in ischemic heart disease patients who have diabetes. These effects seem to be potentially beneficial in the management of IHD patients with diabetes.

Matched MeSH terms: Myocardial Ischemia/therapy*
Does tax-based health financing offer protection from financial catastrophe? Findings from a household economic impact survey of ischaemic heart disease in Malaysia

Sukeri S, Mirzaei M, Jan S

Int Health, 2017 01;9(1):29-35.
PMID: 28028130 DOI: 10.1093/inthealth/ihw054

BACKGROUND: Malaysia is an upper-middle income country with a tax-based health financing system. Health care is relatively affordable, and safety nets are provided for the needy. The objectives of this study were to determine the out-of-pocket health spending, proportion of catastrophic health spending (out-of-pocket spending >40% of non-food expenditure), economic hardship and financial coping strategies among patients with ischaemic heart disease (IHD) in Malaysia under the present health financing system.
METHODS: A cross-sectional study was conducted at the National Heart Institute of Malaysia involving 503 patients who were hospitalized during the year prior to the survey.
RESULTS: The mean annual out-of-pocket health spending for IHD was MYR3045 (at the time US$761). Almost 16% (79/503) suffered from catastrophic health spending (out-of-pocket health spending ≥40% of household non-food expenditures), 29.2% (147/503) were unable to pay for medical bills, 25.0% (126/503) withdrew savings to help meet living expenses, 16.5% (83/503) reduced their monthly food consumption, 12.5% (63/503) were unable to pay utility bills and 9.0% (45/503) borrowed money to help meet living expenses.
CONCLUSIONS: Overall, the economic impact of IHD on patients in Malaysia was considerable and the prospect of economic hardship likely to persist over the years due to the long-standing nature of IHD. The findings highlight the need to evaluate the present health financing system in Malaysia and to expand its safety net coverage for vulnerable patients.

Matched MeSH terms: Myocardial Ischemia/therapy*
Cryopreserved mesenchymal stromal cell treatment is safe and feasible for severe dilated ischemic cardiomyopathy

Chin SP, Poey AC, Wong CY, Chang SK, Teh W, Mohr TJ, et al.

Cytotherapy, 2010;12(1):31-7.
PMID: 19878080 DOI: 10.3109/14653240903313966

Bone marrow (BM) mesenchymal stromal cells (MSC) represent a novel therapy for severe heart failure with extensive myocardial scarring, especially when performed concurrently with conventional revascularization. However, stem cells are difficult to transport in culture media without risk of contamination, infection and reduced viability. We tested the feasibility and safety of off-site MSC culture and expansion with freeze-controlled cryopreservation and subsequent rapid thawing of cells immediately prior to implantation to treat severe dilated ischemic cardiomyopathy.

Matched MeSH terms: Myocardial Ischemia/therapy*
Admissions with atrial fibrillation in a multiracial population in Kuala Lumpur, Malaysia

Freestone B, Rajaratnam R, Hussain N, Lip GY

Int J Cardiol, 2003 Oct;91(2-3):233-8.
PMID: 14559136

BACKGROUND: There are established differences in cardiovascular disease in different racial groups. Worldwide, the literature regarding the clinical epidemiology of atrial fibrillation in non-white populations is scarce.
OBJECTIVES: To document the prevalence of atrial fibrillation (AF) in the multiracial population of Malaysia, and to describe the clinical features and management of these patients.
SETTING: Busy city centre general hospital in Kuala Lumpur, Malaysia, over a 1-month period.
SUBJECTS: One-thousand four hundred and thirty-five acute medical admissions, of whom 40 patients (2.8%) had AF.
RESULTS: Of 1435 acute medical admissions to Kuala Lumpur General Hospital over the 4-week study period, 40 had AF (21 male, 19 female; mean age 65 years). Of these, 18 were Malay, 16 Chinese and six Indian. Nineteen patients had previously known AF (seven with paroxysmal AF) and 21 were newly diagnosed cases. The principal associated medical conditions were ischaemic heart disease (42.5%), hypertension (40%) and heart failure (40%). Dyspnoea was the commonest presentation, whilst stroke was the cause of presentation in only two patients. Investigations were under-utilised, with chest X-ray and echocardiography in only 62.5% of patients and thyroid function checked in 15%. Only 16% of those with previously diagnosed AF were on warfarin, with a further three on aspirin. Anticoagulant therapy was started in 13.5% of patients previously not on warfarin, and aspirin in 8%. Records of contraindications to warfarin were unreliable, being identified in only 25%. For those with known AF, 58% were on digoxin. For new onset AF, digoxin was again the most common rate-limiting treatment, initiated in 38%, whilst five patients with new onset AF were commenced on amiodarone. DC cardioversion was not used in any of the patients with new onset AF.
CONCLUSION: Amongst acute medical admissions to a single centre in Malaysia the prevalence of AF was 2.8%. Consistent with previous similar surveys in mainly western (caucasian) populations, standard investigations in this Malaysian cohort were also inadequate and there was underuse of anticoagulation, medication for ventricular rate control and cardioversion to sinus rhythm.

Matched MeSH terms: Myocardial Ischemia/therapy