Prognosis of Zero Coronary Artery Calcium Score in Symptomatic Patients of South Asian Descent - an Experience from a Tertiary Care Center in Pakistan.

Introduction: The absence of CAC in asymptomatic individuals is associated with a very low incidence of cardiovascular events. Of symptomatic patients, 1-2% with zero CAC score have non-calcified coronary artery atherosclerosis, and at least one third of cardiovascular events occur in individuals with zero CAC. South Asians (SA) have proportionally higher case fatality rates for CVD, relatively younger age of presentation, and accelerated rate of atherosclerosis when compared with other ethnic groups.

Clinical characteristics and long-term outcome of patients with bioprosthetic mitral valve- Experience from a South Asian country.

Objectives: Due to rheumatic heart disease, young people are more likely to develop valvular heart disease in developing countries. In countries like Pakistan, surgeons implant more bioprosthetic mitral valves (MVs) in younger patients. However, bioprosthetic valves degenerate rapidly in younger people, leading to bioprosthetic MV dysfunction (BMVD).

Biventricular Endomyocardial Fibrosis in a Patient With Chronic Myeloid Leukemia-Classical Imaging Diagnosis Not to Be Missed.

• EMF is frequently detected at a late stage when symptoms of heart failure manifest. • CMR is a robust tool for the noninvasive assessment of EMF. • Multimodality imaging helps detect early stages and monitor disease progression.

Mitral leaflet separation index correlation with mitral stenosis severity, a reliable easy 2-d echocardiography technique.

Objectives: To evaluate accuracy of mitral leaflet separation index for the determination of mitral stenosis severity in patients with rheumatic mitral stenosis.

Methods: The prospective, cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from March 2021 to February 2022, and comprised patients with rheumatic mitral stenosis detected on echocardiography. The best end-diastole parasternal long axis and apical four-chamber views were acquired and Mitral leaflet separation was measured as the distance between the inner edges of the tip of mitral leaflets.

Case report: Aorto-left atrial fistula-A rare complication of native aortic valve endocarditis.

Background: Aorto-cavitary fistula is a rare complication of infective endocarditis. Multimodal imaging is commonly required to assess the severity and extent of infection because of the complex pathology of the valvular and paravalvular apparatus in endocarditis.

Case Presentation: We present an unusual case of a middle-aged man with recent history of meningoencephalitis who developed infective endocarditis complicated by ruptured abscess in inter-valvular fibrosa between aortic and mitral valve resulting in free communication or fistula formation between aorta and left atrium.

Double-chambered left ventricle: diagnosis by CMR and review of the literature.

Background: A double-chambered left ventricle (DCLV) is an extremely rare congenital malformation. The exact prevalence of DCLV is not known, although studies have reported prevalence of 0.04-0.

Clinical presentation, diagnostic features on cardiac magnetic resonance imaging and outcome of patients with cardiac amyloidosis presenting to a tertiary care setting.

Cardiac amyloidosis is a rare disease which is under diagnosed in this region. This study was aimed to assess the clinical presentation, cardiac magnetic resonance (CMR) imaging findings and prognosis of patients with cardiac amyloidosis in Pakistani population presenting to a tertiary care setting. A total of eight patients were included with the confirmed diagnosis of cardiac amyloidosis on CMR, after reviewing the CMR data of Aga Khan University Hospital from January 2011 to August 2019.

Severe mixed mitral valve disease due to massive mitral annular calcification: A case report and literature review.

We present an unusual case of massive mitral annular calcification (MAC) leading to severe mixed mitral valve disease, viz severe mitral regurgitation and severe mitral stenosis. To our knowledge, severe mixed mitral valve disease secondary to MAC is extremely rare. The patient (a 65-year-old lady) presented with worsening shortness of breath and signs of congestive heart failure.

Clinical features, cardiac magnetic resonance imaging findings and outcome of patients with suspected myocarditis.

Myocarditis is largely underdiagnosed due to subclinical symptoms and non-availability of diagnostic techniques necessitating high index of suspicion and early disease identification. This study aimed to assess the clinical presentation, cardiac magnetic resonance (CMR) imaging findings and prognosis of these patients. After reviewing the CMR data of Aga Khan University Hospital from January 2011 to December 2019, a total of 24 patients were included in the study with the confirmed diagnosis of myocarditis on CMR.

Features on cardiac magnetic resonance imaging and accuracy of echocardiographic findings for diagnosing constrictive pericarditis.

Constrictive pericarditis is a rare disease with a difficult diagnosis. Cardiac magnetic resonance (CMR) imaging data of Aga Khan University Hospital from January 2011 to March 2020 was retrospectively reviewed and patients with the diagnosis of constrictive pericarditis were included. A total of 22 patients were included with the mean age of 46±16 years and majority 17(77%) were male.

COVID-19 BBIBP-CorV vaccine and transient heart block - A phenomenon by chance or a possible correlation - A case report.

Importance: Bradyarrhythmia during COVID19 illness carries prognostic significance. Electrophysiological side effects of COVID19 vaccine remain largely unknown. It is imperative to report nature of cardiovascular side effects of the vaccine.

Prognostic significance of ischaemic electrocardiographic changes during stress testing in patients with normal nuclear myocardial perfusion imaging.

Objective: To evaluate cardiovascular outcomes in patients with normal nuclear myocardial perfusion imaging, but ischaemic electrocardiogram changes during pharmacological or exercise stress tests.

Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of patients who underwent either pharmacological or exercise stress myocardial perfusion scan and had a normal scan with ischaemic electrocardiogram changes between January 2013 and December 2014. All cardiac events, including angina, myocardial infarction, heart failure, coronary revascularisation and cardiac death, as well as non-cardiac deaths were noted.

Clinical Characteristics, Cardiac Magnetic Resonance Features, and Outcomes of Patients with Dilated Cardiomyopathy - An Experience from a South Asian Country.

Objectives: The objectives of the study were to evaluate the clinical presentation, cardiac magnetic resonance (CMR) features, and outcomes of patients with dilated cardiomyopathy (DCM).

Material And Methods: A retrospective study was conducted at a tertiary care center of Pakistan. All patients who underwent CMR for further evaluation of DCM during the period of 2011-2019 and in whom CMR confirmed the diagnosis of DCM, were included in the study.

Patterns of Left Ventricular Hypertrophy and Late Gadolinium Enhancement on Cardiac MRI in Patients with Hypertrophic Cardiomyopathy and their Prognostic Significance - An Experience from a South Asian Country.

Objectives: Cardiac magnetic resonance (CMR) imaging is very pertinent in the diagnosis and risk stratification of patients with hypertrophic cardiomyopathy (HCM). We aimed to assess the patterns of left ventricular (LV) hypertrophy, late gadolinium enhancement (LGE), and their prognostic significance in HCM patients in Pakistani population, as no such data are available from Pakistan.

Material And Methods: This was a retrospective, single center study.

Diffuse breast uptake of technetium-99m tetrofosmin during myocardial perfusion imaging in a lactating mother.

Myocardial perfusion imaging (MPI) is a useful modality to rule out myocardial ischaemia in patients presenting with chest pain. In nursing mothers imaging with radioisotope is usually avoided but under certain circumstances it is unavoidable. We present the case of a 45-year-old woman with chest pain, who underwent MPI for assessment of ischaemia.

Prognostic Significance of CMR Findings in Patients with Known Coronary Artery Disease - Experience from a South Asian Country.

Objectives: South Asians (SA) have a higher burden of coronary artery disease (CAD) and are known to have a worse prognosis compared to other ethnicities. Therefore, it is imperative to improve the risk stratification of SA patient with CAD and to seek out newer prognostic markers beyond the conventional echocardiography.The aim of this study was to investigate whether variables obtained by cardiac magnetic resonance (CMR) improve risk stratification of South Asian patients with known CAD.

Cardiac Magnetic Resonance Evaluation of Cardiac Masses in Patients with Suspicion of Cardiac Masses on Echo or Computed Tomography.

Objectives: In recent years, cardiac magnetic resonance (CMR) imaging has emerged as an important tool in the identification and characterization of cardiac masses. No imaging data on cardiac masses are available from Pakistan. We aimed to review the clinical presentation, CMR findings, and outcome of patients referred for CMR due to suspicion of cardiac masses on echocardiogram or computed tomography (CT).

Role of carbonated water technique to enhance Tc-99m tetrofosmin myocardial perfusion imaging by reducing subdiaphragmatic artefacts.

Objective: Myocardial perfusion imaging (MPI) with single-photon emission computed tomography (SPECT) is confounded by the extracardiac artefacts cause by hepatobiliary clearance of the radiotracers. Various techniques have been evaluated to lessen those artefacts. In this study, we endeavoured to determine the effect of carbonated water in reducing such infracardiac artefact so to improve MPI image quality, sensitivity and specificity.

The Frequency of Left Atrial Thrombus on Transthoracic Echocardiogram in Patients with Mitral Stenosis.

Background Patients with mitral stenosis (MS) are more prone to develop left atrial (LA) thrombus. This cross-sectional study was conducted to determine the frequency of LA thrombus on transthoracic echocardiography (TTE) in patients with MS. Methods In this study, we included patients diagnosed with MS undergoing TTE at the echocardiography department of the National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan.

Making prescriptions "talk" to stroke and heart attack survivors to improve adherence: Results of a randomized clinical trial (The Talking Rx Study).

Background: We developed and tested the effectiveness of a tailored health information technology driven intervention: "Talking Prescriptions" (Talking Rx) to improve medication adherence in a resource challenged environment.

Methods: We conducted a parallel, randomized, controlled, assessor-blinded trial at the Aga Khan University (AKU), Karachi, Pakistan. Adults with diagnosis of cerebrovascular accident (CVA) or coronary artery disease (CAD) diagnosed least one month before enrollment, on anti-platelets and statins, with access to a mobile phone were enrolled.

Cardiac magnetic resonance imaging in a young patient with left ventricular spongiform cardiomyopathy: A case report and review of literature.

Left ventricular spongiform or non compaction cardiomyopathy is one of the rarer forms of cardiomyopathy with a reported prevalence of 0.014-0.05% in adults.

Myocarditis mimicking acute coronary syndrome - the role of cardiac magnetic resonance imaging in the diagnosis.

Myocarditis is an inflammatory disease of myocardium with a wide range of clinical presentations. Myocarditis may mimic acute coronary syndrome (ACS) and adequate differential diagnosis is not possible by conventional tests. Cardiac magnetic resonance (CMR) has emerged as a leading imaging modality in the diagnosis of myocarditis in such patients.

Treatment of a Rare Vascular Complication of Coronary Stenting in an Octagenarian.

The ability of drug-eluting stent (DES) to inhibit intimal proliferation has resulted in a massive increase in their usage over the years. However, it is known that the application of DES can alter the normal cascade of vascular healing, resulting in delayed endothelialisation with risk of vascular complications. Coronary artery aneurysms (CAN) are defined as more than 50% dilatation of the coronary artery compared to the reference vessel diameter with the reported incidence after percutaneous intervention (PCI) being only around 0.

Clinical features, management and outcome of patients with constrictive pericarditis - Experience from a third world country.

Objectives: To study the clinical features, management and outcome of patients with constrictive pericarditis, at a tertiary care hospital of Pakistan.

Design: Descriptive study.

Material & Method: All consecutive patients with the final diagnosis of constrictive pericarditis, admitted at Aga Khan University Hospital Karachi, during the year 2005 to 2015 were included in the study.