Cardiology Commons^™

An Assessment Of The Diagnostic Value In Syncope Workup: A Retrospective Study, Ashan T. Hatharasinghe, Kayvon Etebar, Ryan Wolsky, Hossein Akhondi, Napatkamon Ayutyanont

HCA Healthcare Journal of Medicine

Background

Patients with syncope often undergo costly testing, despite current guidelines and data supporting the contrary.

Objective

To determine the diagnostic value through positivity rate of electrocardiogram (EKG), computed tomography (CT) of the brain, magnetic resonance imaging (MRI) of the brain, transthoracic echocardiogram, nuclear and pharmacologic cardiac stress test, tilt table test and carotid ultrasound in patients diagnosed with syncope.

Methods

This is a retrospective study of 10,036 adults presenting to the emergency department or hospitalized with a primary diagnosis of syncope at 8 acute care facilities in the southwest United States from January 1, 2019, to December 31, 2019. …

Accuracy Of Routine 2d Echocardiography To Estimate Pda Type And Dimension And Predict Device Selection For Successful Pda Occlusion, Mohammed Omar Galal, Zaheer Ahmed, Arif Hussain, Masroor Sharfi, Yahia El Mahdi, Fayzah El Khattab, Amjad Alkouatli, Riad Abou Zahr

Journal of the Saudi Heart Association

Background: Assessment of the shape and dimensions of PDA is usually done angiographically and in the majority of cases need arterial access. Our aim was to evaluate the value of routine 2 D echocardiography (ECHO) in predicting type, dimensions of PDA and to anticipate device size to be used during the intervention. Material and Methods: The charts of all patients who underwent transcatheter closure of PDA between January 2015 and December 2020 were reviewed. Their pre-procedure ECHO and catheterization details at the time of device closure were analyzed. Results: Total of 139 patients were reviewed and 8 were excluded because …

Thyroidectomy In Mechanical Circulatory Support - A Salvage Treatment For Thyrotoxicosis-Induced Cardiogenic Shock: Case Series, Rody G. Bou Chaaya, Lauren M. Saint, Onyedika J. Ilonze Md, Mph

The VAD Journal

Amiodarone is frequently used to treat arrhythmias in patients supported with left ventricular assist devices. Long term amiodarone use can cause hyperthyroidism ultimately leading to cardiomyopathy and sometimes thyrotoxicosis-induced cardiogenic shock (CS). We describe two cases of thyrotoxicosis-induced CS rescued by successful thyroidectomy under mechanical circulatory support (MCS) – one with a Heartmate III (Abbott Laboratories) and another supported with veno-arterial extracorporeal membrane oxygenation (V-A ECMO). In refractory CS, the initiation of V-A ECMO as a bridge to recovery is critical. In thyrotoxicosis-induced CS that is refractory to medical therapy requiring MCS, thyroidectomy is feasible, and a growing body of …

Zwolle Risk Score For Safety Assessment Of Same-Day Discharge After Primary Percutaneous Coronary Intervention, Jehangir Ali Shah, Bashir Ahmed Solangi, Mahesh Kumar Batra, Kamran Ahmed Khan, Ghazanfar Ali Shah, Gulzar Ali, Mehwish Zehra, Muhammad Hassan, Muhammad Zubair, Musa Karim

Journal of the Saudi Heart Association

Objectives: The Zwolle risk score (ZRS) has been considered to be a useful tool for the systematic evaluation of patients for early discharge after primary percutaneous coronary intervention (PCI). Therefore, aim of this study was to evaluate the clinical utility of ZRS for the same-day discharge strategy after primary PCI at a tertiary care cardiac center of Karachi, Pakistan. Methods: This study was conducted at a tertiary care cardiac center between August 2019 and July 2020. Patients discharged within 24 hours (same-day) of the primary PCI procedure were included. Patients were stratified as high- and low-risk based on ZRS score; …

Multiple Migrated Superior Vena Cava Stents With Cardiac Injury - A Stepwise Open Cardiotomy Strategy To Mitigate Potential Fatality, Fayaz Mohammed Khazi, Samer Badr Eddin Alhashimi, Motaz Yousef Majthoob, Ayman Saleh, Ayman Al-Sibaie, Obaid Aljassim

Journal of the Saudi Heart Association

Iatrogenic injuries with migrated interventional stents can sometimes be life-threatening. The interventional retrieval management is generally the treatment of choice, as surgical procedures carry a high mortality risk with only a few cases reported. We report a patient with two stents migrated into the right atrium from superior vena cava resulting in cardiac perforation. She was successfully treated using pericardiocentesis followed by surgical intervention with rapid postoperative resolution of symptoms. The technique presented here substantiates the steps for a safe and effective removal of these multiple displaced stents with minimal postprocedural complications.

The Role Of Coronary Artery Disease In Demand Mediated Myocardial Infarction: A Retrospective Study From A Community Hospital, Amr Salama, Nikhil Mehta, Abdullah Abdullah, Ruth Kouides, Jeremiah Depta, Ryan Hoefen, Richard Alweis

Advances in Clinical Medical Research and Healthcare Delivery

Type 2 Myocardial Infarction (T2MI) is an increasingly recognized clinical entity due to the availability of highly sensitive troponin assays for patients admitted due to common medical diagnoses. However, there is little epidemiological data on the significance and long-term prognosis of T2MI, which occurs secondary to an increase in myocardial oxygen demand and/or a decrease in myocardial blood flow. Arrhythmia, hypoxia, and sepsis are the major etiologies for T2MI. Therefore, sepsis was the identified area of interest for the study giving how common it is in a community hospital. We studied the cardiac workup of patients with elevated troponin in …

The First Pediatric Heart Transplantation In Saudi Arabia Bridged By Berlin Heart (Excor) Ventricular Assist Device, Abdullah A. Alghamdi Md, Msc, Frcsc, Hatem Elmontaser Md, Ahmed A. Arifi Md, Joao Dantas Msn, Muayed A. Al-Zaibag Md

Journal of the Saudi Heart Association

Pediatric patients on the waiting list for heart transplantation incur the highest risk of death for any organ transplantation. Berlin Heart EXCOR provides a reliable support as a bridge to heart transplantation or recovery for all pediatric age groups. We report the first successful experience of Berlin Heart EXCOR mechanical circulatory support and heart transplantation in pediatric patients in Saudi Arabia. The purpose of this report is to highlight the clinical events and share lessons learned from this endeavor.

Angioplasty Of Anomalous Coronaries Arising From The Opposite Sinus With An Inter-Arterial Course, Is It Safe?, Rania Hammami, Imtinene Ben Mrad, Amine Bahloul, Salma Charfeddine, Rym Gribaa, Houssem Thabet, Emna Allouche, Aymen Ben Abdessalem, Majed Hassine, Leila Abid, Samir Kammoun, Hassen Ibn Hadj Amor

Journal of the Saudi Heart Association

Background: The coronary artery with an interarterial course CAIAC is the most threatening coronary anomaly, especially if it concerns the left coronary. Percutaneous coronary intervention PCI is scarcely described given its low prevalence and lack of long-term outcome data. Therefore, we assessed through this case series the feasibility and safety of PCI in this population. Methods This is an observational multicentric study including patients with CAIAC arising from the opposite sinus of Valsalva. The primary endpoints were immediate angiographic success and target lesion revascularization. Results During the period of the study, we performed 27235 PCI in six Cath labs, 26 …

Study Of Safety And Efficacy Of Novel Sirolimus-Eluting Stent Incorporating Properties Of Drug Coating Balloon Among Real World Patients Focusing Among Younger Population ( Under 35 Years), Santosh Kumar Sinha, Umeshwar Pandey, Mahmodullah Razi, Awadesh K. Sharma, Puneet Aggarwal, Mohit Sachan, Praveen Shukla, Ramesh Thakur

Journal of the Saudi Heart Association

Objective- Aim of study was to evaluate safety and efficacy of abluminal Mitigator DES+ Sirolimus Eluting Stent (Envision Scientific, Surat, India) incorporating novel technology of fusion coating of bioresorbable polymer on both abluminal surface of stent and exposed parts of balloon among real world patients specially focusing younger patients ( < 35 years). Method- 1293 patients received Mitigator DES+ at LPS Institute of Cardiology, Kanpur, India. Primary outcome was target lesion failure (TLF)- composite of cardiovascular death, target vessel myocardial infarction (TVMI), and target lesion revascularization (TLR) and secondary end points including peri-procedural device failure (failure of stent delivery, change of stent, stent fracture), target vessel failure (TVF), and patient oriented composite end point (POCE)- composite of all deaths, MI, and revascularization and stent thrombosis (ST) at 1-year follow-up. Result- Younger population comprised of 374(29%) patients. Various indications of interventions were STEMI (n=614, 47.4%), NSTEMI (n=416, 32.2%), UA (n=161, 12.5%), and CCS (n=102, 7.9%). TLF at 1 year in overall population was 3.5% which was driven by TVMI and TLR in 1.3% and 1.1% patients respectively. POCE was observed in 9.5% mainly contributed by any revascularization (3.9%). Failure of stent delivery (1.1%) and edge dissection (0.5%) caused stent failure (2.2%). Definite and probable ST was observed in 1% and 0.8% patients respectively. Young patients showed insignificantly lower TLF, TVF, ST and POCE and significantly lower device failure (1.3% vs. 2.6%, p=0.04) when compared to patients >35 years. Conclusion- Mitigator DES+™ is safe among real world patients especially young population.

The Covid-19 Pandemic Surge And Impact On Rheumatic Valvular Heart Disease Patient Care, Prashanth Kulkarni, Manjappa Mahadevappa

Journal of the Saudi Heart Association

The COVID-19 crisis has surged worldwide putting immense stress on the health care services, leading to institutions deferring elective procedures and struggling to triage the emergency care of the cardiac patient. This has affected the management of the rheumatic valvular heart disease patient especially, in developing countries, potentially placing these patients at enormous risk for complications like congestive cardiac failure, stroke and death. In this article, we explore the COVID-19 pandemic and its impact on rheumatic valvular heart disease patient care. We try to provide a framework that addresses the procedural considerations of interventions like percutaneous transluminal mitral commissurotomy (PTMC), …

Stent Or Shunt, What Could Be Better For Children With Duct Dependent Pulmonary Circulation?, Ghassan A. Shaath, Abdulraouf Mz Jijeh, Mohammed Fararjeh, Fahad Alhabshan, Mansour B. Almutairi, Ahmed Alomrani, Omar Tamimi

Journal of the Saudi Heart Association

Background: Systemic to pulmonary shunt (Shunt) is offered for children with duct dependent pulmonary circulation to augment pulmonary flow. Recently patent ductus arteriosus (PDA) stent (Stent) is widely used as an alternative method. We aimed to compare post intervention outcomes in children underwent either procedure. Methods: Infants under 3 months who had an initial palliation by Shunt or Stent were retrospectively reviewed between 2008-2016, then followed till the second intervention or 1 year whichever earlier. Results: 187 patients (110 Shunt and 77 Stent) were included. Initial weight and pulmonary artery (PA) branches size were similar between the groups. Shunt patients …

A Rare Presentation Of An Acute Type A Aortic Dissection Obscured Due To The Simultaneous Presence Of Acute Pancreatitis, Amrin M. Kharawala, Nirav Brahmbhatt, Huzefa Bhopalwala, Nakeya Dewaswala, Adnan Bhopalwala, Waqas Ghumman, Robert Dean Chait

HCA Healthcare Journal of Medicine

Introduction

Acute pancreatitis (AP) and acute aortic dissection (AAD) are medical emergencies that must be promptly recognized to avoid the development of life-threatening complications. Both of these diseases can present with chest or epigastric pain which can radiate to the back, thus, early suspicion based on clinical presentation and risk factors is essential. We present the case of a 56-year-old patient initially diagnosed with AP who was later found to have an AAD.

Clinical Findings

A 56-year-old man with a history of alcohol abuse presented with 1 day of diffuse abdominal pain, nausea and vomiting. His lipase was 3,909 U/L …

Underlying Coronary Microvascular Disease May Lead To Underestimation Of Global Longitudinal Strain Differences, Neelesh Gupta, Mohammed Elkhazendar, Rajeev Gupta

Journal of the Saudi Heart Association

No abstract provided.

Radiolucent Mechanical Valve: Chest Radiography Conundrum, Mohamad S. Alabdaljabar, Genya Turgul, Adelaide M. Arruda-Olson, Jeffrey B. Geske

Journal of the Saudi Heart Association

No abstract provided.

Diagnostic Accuracy Of Dobutamine Stress Echocardiography For Detection Of Cardiac Allograft Vasculopathy In Orthotopic Heart Transplant Patients, Mohammed Mahmoodurrahman, Josef Marek, Talal Al Otaibi, Vera Maria Cury Salemi, Najmeddine Echahidi, Jehad Al Buraiki, Bahaa M. Fadel, Dania Mohty

Journal of the Saudi Heart Association

Objective Cardiac allograft vasculopathy is one of the leading causes of late graft failure and subsequent death in orthotopic heart transplant. Although invasive coronary angiography is the gold standard modality for detection of cardiac allograft vasculopathy, dobutamine stress echocardiography has been recently frequently used as an alternative. Our aim was to evaluate the diagnostic performance of dobutamine stress echocardiography for detection of cardiac allograft vasculopathy in transplant patients. Methods A retrospective analysis was conducted using a total of 150 dobutamine stress echocardiographic exams that were performed on 99 patients in our institution, with paired coronary angiogram and no acute rejection, …

Should Covid Vaccination Be Required In Heart Transplantation & Left Ventricular Assist Device Implantation?, Mustafa M. Ahmed, Manjula G. Ananthram, Susan M. Joseph

The VAD Journal

This letter to the editor does not have an abstract.

Complications After Surgical Repair Of Congenital Heart Disease In Infants. An Experience From Tertiary Care Center, Farrukh Javed, Nabil Abdulrahman Aleysae, Abdulmajid Yahya Al-Mahbosh, Amal Ali Zubani, Ali Mohammed Atash, Hanan Bin Salem, Mohamed Abdallah, Omaima Alkhatib, Ashraf Abu-Adas, Maymoona Abdelmouz Hrays, Nawal Ali Alqarni, Alla Felemban, Saad Abdullah Alsaedi, Ahmed Abdullah Jamjoom

Journal of the Saudi Heart Association

Objectives. This study aimed to describe the incidence and spectrum of postoperative complications in infants who underwent their first cardiac surgery for the repair of congenital heart diseases. Methods. This is a single-center retrospective study. Data of infants admitted to King Faisal Specialist Hospital & Research Center; Jeddah; Saudi Arabia, from January 2015 to December 2019 who underwent the first cardiac procedure for congenital heart disease at an age of less than 3 months, were analyzed. The primary outcome is the prevalence and spectrum of postoperative complications during hospitalization. Data were analyzed by using descriptive and analytical statistics using SAS …

Simultaneous Bicarotid And Microscope-Assisted Coronary Revascularization As An Individual Surgical Strategy, Andrey N. Semchenko

Journal of the Saudi Heart Association

A 59-year-old man presented with complaints of giddiness caused by changes in body position, an unsteady gait, daily episodes of vision loss, breathlessness, and chest pain flowing minor physical exertion. Computed tomography revealed an occlusion of the right common carotid artery, a critical stenosis of the left common carotid artery, and a significant stenosis of the left internal carotid artery. A coronarography detected a stenosis of the left main trunk and a triple coronary artery obstructive disease. A simultaneous aortic-bicarotid bifurcation prosthesis and coronary artery bypass grafting were performed. The patient showed a satisfactory postoperative outcome.

Iatrogenic Withdrawal Syndrome In The Pediatric Cardiac Intensive Care Unit: Incidence, Risk Factors And Outcome, Eiad Habib, Abdul Hakim Almakadma, Mohieddin Albarazi, Somiya Jaimon, Rayd Almehizia, Abdullah Al Wadai, Raja Abouelella

Journal of the Saudi Heart Association

Objectives: Critically ill children and neonates routinely receive opioids and benzodiazepines for analgesia and sedation in the pediatric intensive care unit (PICU). Prolonged opioid therapy often leads to tolerance and is associated with iatrogenic withdrawal syndrome (IWS) when opioids and benzodiazepines are weaned or discontinued. Our aim is to study the incidence, risk factors and outcome of IWS following use of a withdrawal protocol on pediatric patients after cardiac surgery. Methods: We prospectively included all postoperative pediatric patients who developed IWS after being assessed by the Withdrawal Assessment Tool (WAT-1) score (WAT-1 ≥3) over 9 months. Unit-based withdrawal management protocol …

Integrating Patient-Reported Outcomes Into Clinical Genetic Testing For Familial Hypercholesterolemia, Rachele M. Hendricks-Sturrup, Robert Block, Christine Y. Lu

Journal of Patient-Centered Research and Reviews

Patient-reported outcomes (PROs) and PRO measures (PROMs) are often used to help clinicians and researchers understand patients’ personal concerns, feelings, experiences, and perspectives following the implementation of an intervention. Notably, PROs and PROMs can inform health systems, health policy, and payers on the utility of clinical genetic testing based on each patient’s personal values, perspectives, and potential health behaviors subsequent to testing. In this topic synopsis, we discuss the underexplored role of and implications for PROs and PROMs following genetic testing for familial hypercholesterolemia (FH), an autosomal dominant genetic disorder of cholesterol metabolism that can lead to highly premature fatal …

Conference Proceedings: Select Abstracts Presented At 2021 Advocate Aurora Health Scientific Day

Journal of Patient-Centered Research and Reviews

Abstracts published within this supplement were presented at the 47th annual Advocate Aurora Health Scientific Day, held virtually on May 26, 2021. This research symposium provides a forum for disseminating results from studies conducted by faculty, fellows, residents, and other allied health professionals associated with Midwest-based health system Advocate Aurora Health, which publishes the Journal of Patient-Centered Research and Reviews.

Mental Health Or Cardiac Health. Is There A Reason To Choose? Cardiac Arrhythmias Induced By Atomoxetine And Methylphenidate, Gabriel Cismaru, Viorel Lupu

Journal of Mind and Medical Sciences

The current treatment of Attention Deficit Disorder and Attention Deficit with Hyperactivity consists mainly in the administration of Straterra (Atomoxetine) Concerta and Ritalin (Methylphenidate). The FDA warned that the products might increase systolic, diastolic blood pressure, and lead to ventricular arrhythmias. Arrhythmic events and sudden cardiac death were described in adults with preexistent heart disease. However, studies on children have failed to demonstrate a clear association between the arrhythmic events and these drugs, as demonstrated in adults. What should the attitude of the pediatric psychiatrist be towards the administration of these products? What examination should be made by the psychiatrist …

Therapeutic Efficacy Of Mesenchymal Stem Cells For Cardiovascular Diseases, Dragana Radoje Miloradovic, Dragica Radoje Pavlovic, Miodrag Bozidar Stojkovic, Sanja Bratislav Bojic, Vladislav Bogdan Volarevic, Marina Milosav Gazdic Jankovic, Biljana Tomislav Ljujic

Journal of Mind and Medical Sciences

Despite the improvements in pharmacological and surgical treatments, cardiovascular diseases (CVDs) are the number one cause of death worldwide. During the last two decades, the search for new therapies has been revolutionized with the growing knowledge of stem cell biology. Due to their huge differentiation capacity and paracrine effects, mesenchymal stem cells (MSCs) are a promising tool for the treatment of CVDs. The encouraging outcomes of preclinical studies using MSCs as a treatment for diseased myocardium have set the scene for worldwide clinical trials. In this review, we overview either complete or ongoing clinical trials using MSCs for the therapy …

Stemi In A Young Patient With Covid-19; Too Great A Burden?, Naman Upadhyay, Md, Gillian Naro, Md, Med, Gregary Marhefka, Md

The Medicine Forum

Myocardial infarcts (MIs) can be especially devastating when their pathogenesis stems from a coronary artery occlusion by an intracoronary thrombus (ICT). ICTs are most frequently a result of an underlying atherosclerotic plaque rupture, however, can also be a result of emboli, vasospasm, hypercoagulable states, among other etiologies. Patients suffering from the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appear to be in both a hypercoagulable and proinflammatory state resulting in an increased risk of clot formation, endothelial damage, and plaque destabilization, thus increasing the ICT burden in infected patients.1 The literature does reflect an increase in ICT ST-segment elevation …

Acute Mitral Regurgitation Presenting With Right Upper Lobe Opacification, John Wallis, Md, Mark Decaro, Md

The Medicine Forum

We describe a rare entity in which acute mitral regurgitation causes asymmetric findings on chest radiograph. The patient presented with rapid-onset respiratory failure from flash pulmonary edema. She had unilateral infiltrates on chest radiograph, which evoked infectious etiology. However, we identified a flail mitral valve leaflet, for which the patient received an emergent mitral valve replacement. Fortunately, she made a full recovery. We discuss the mechanism of the asymmetric chest radiograph findings, which we were able to confirm using a transesophageal echocardiogram.

Effusive-Constrictive Pericarditis Due To Poorly Differentiated Carcinoma Of The Mediastinum, John Wallis, Md, Naman Upadhyay, Md, Fred Karaisz, Md, Mark Decaro, Md, René Alvarez, Md

The Medicine Forum

A 33-year-old male developed subacute effusiveconstrictive pericarditis with recurrent pleural effusions and mediastinal lymphadenopathy. He was found to have poorly differentiated carcinoma of the mediastinum that led to constrictive physiology not amenable to medical or surgical management, ultimately requiring hospice. This case was remarkable for its rare etiology and presentation.

Experience Treating Electrical Storm Using An Ultrasound Guided Stellate Ganglion Blockade, Thomas A. Nicholas Iv, Levi Zehr, Han-Jun Wang, Daniel R. Anderson, Steven J. Lisco

Graduate Medical Education Research Journal

Introduction: Electrical storm is a life-threatening condition in an often medically complex patient population. Pharmacologic ultrasound-guided stellate ganglion blockade is a treatment option in combination with maximized systemic antiarrhythmic medications. There is an emerging body of case reports supporting stellate ganglion block efficacy and safety for this condition.

Methods: Retrospective study on ultrasound-guided stellate ganglion blocks for electrical storm investigating patient clinical characteristics, immediate and long-term outcomes, and procedure related complications.

Results: Four (75% men) critically ill patients maximized on standard antiarrhythmic therapy underwent six bedside ultrasound-guided stellate ganglion block procedures. All blocks were unilateral left-sided, two patients underwent repeat …

Cardiac Tamponade On Ecpella: A Case Report Of A Unique Hemodynamic Picture, Naveed Akhtar, Parth Savsani, Maya Guglin, Roopa Rao

The VAD Journal

Extracorporeal membrane oxygenation is rapidly becoming a preferred therapy for short-term hemodynamic support in cardiogenic shock, along with the use of devices such as Impella (Abiomed, Andover, MA). The two together can create unique hemodynamics resulting in altered presentation of common hemodynamic conditions such as tamponade. We present a case of a patient with fulminant myocarditis requiring veno-arterial extracorporeal membrane oxygenation and Impella support. The patient later developed a pericardial effusion with atypical tamponade physiology which masked the left ventricular systolic function recovery. We further highlight the complex hemodynamics of cardiac tamponade in patients with such mechanical circulatory support and …

The Effect Of Untraditional Lipid Parameters In The Development Of Coronary Artery Disease: Atherogenic Index Of Plasma, Atherogenic Coefficient And Lipoprotein Combined Index, Ersin Çelik, Ahmet Rıfkı Çora, Kadir Burhan Karadem

Journal of the Saudi Heart Association

Objective: In this study, we investigated the usability of atherogenic indices of patients who underwent coronary artery bypass surgery (CABG) due to coronary artery disease and patients without CAD as risk factors and markers for cardiovascular disease (CVD). Methods: The data of 150 patients who underwent CABG, and 155 patients who underwent coronary angiography and was not diagnosed with CAD were analysed retrospectively. Demographic data and plasma lipid values were collected. The relationship between these ratios and CVD was investigated via univariate logistic regression analysis performed by creating atherogenic indices. Results: The data of 125 patients who underwent CABG between …

Sensitivity And Specificity Of Pulmonary Artery Pressure Measurement In Echocardiography And Correlation With Right Heart Catheterization, Muhammad Adil Soofi, Muhammad Azam Shah, Ammar Mohammed Alqadhi, Abdulla Mofareh Alanazi, Waleed M. Alshehri, Amir Umair

Journal of the Saudi Heart Association

Objective: Echocardiography is helpful in assessment of pulmonary hemodynamic, however its correlation with Right heart catheterization (RHC) is conflicting. We conducted a study to evaluate sensitivity and specificity of pulmonary hemodynamic parameters measured in echocardiography. Furthermore its correlation with the values measured in RHC was assessed. Method: Retrospective, cross-sectional study conducted at King Fahad medical City, Riyadh, Saudi Arabia. 95 adult patients referred for right heart catheterization were enrolled in the study. All the patients had echocardiography and RHC within one week of each other. Result: Diabetes mellitus, hypertension and dyslipidemia were present among 55%, 66% and 41% of patients …