Background and aims: One important residual CVD risks is elevated level of lipoprotein a (Lp(a)). High Lp(a) level is atherogenic. It’s higher prevalence in South Asian population is important because of a higher prevalence of premature coronary artery disease in younger population of this region. Lp(a) testing is underutilized. Knowing elevated levels in an individual may help address and control traditional risk factors of ASCVD in such patients. Methods: This study was an observational, prospective study carried out in the department of internal medicine, Pokhara Academy of Health Sciences(POAHS), Nepal. The study was started on 17th September 2023 and completed on 16th March 2024. The details of history and the physical examination of cases were recorded in the proforma designated for the study. Baseline data were recorded including age, sex, presence of risk factors like diabetes mellitus(DM), hypertension(HTN), dyslipidemia, smoking, history of CAD (coronary artery disease) and coronary revascularization, family history of premature CAD, lab parameters like blood glucose, lipid profiles, Lp(a), ECG, echocardiography, coronary angiography. Statistical analysis was carried out with the help of the latest version of SPSS. Results: The mean age was 48.52 years (SD=9.06). Majority were (56%) male patients. 42 cases (84%) were dyslipidemics and 26 (52%) were hypertensives, 10 cases (20%) had family history of coronary artery disease in first degree relatives, 10(20%) had coronary artery disease, eight (16%) had DM, two (4%) were smokers. Elevated Lp(a) (>/=50mg/dl) was found in 14(28%) of total cases. Of total cases, Lp(a) was <20mg/dl in 30 (60%), 20-49mg/dl in 6(12%) and thus Lp(a) >/=20 mg/ dl was observed in 40% of cases. Conclusion: The prevalence of elevated Lp(a) in Nepalese patients with traditional risk factors of ASCVD is high. These findings from our study may carry important implications for clinical practice in Nepal. Performing targeted screening in high-risk individuals may help redefine risk category and may help in aggressively managing traditional risk factors

Background: The increase in hypertension in developing countries has been brought about by the increasing prevalence of risk factors, such as increased alcohol consumption, smoking, obesity, physical inactivity, and low fruit and vegetable intake. This study was conducted to assess gender differences in the prevalence of behavioural risk factors of hypertension. Methods: Study design was cross-sectional survey. Adults residing in the Parsauni Rural Municipality, were the study population. In-person interview was done using WHO STEPs questionnaire among 596 samples selected via PPS technique. Height, weight, waist circumference, and hip circumference were measured by health personnel following standard technique. BMI and waist–hip ratio were calculated using standard formula. The data was analyzed using SPSS version 20 (IBM SPSS). Results: Out of 596 respondents, a higher proportion of women were past smokers (13.9%), and a higher proportion of males were current tobacco users (14.2%). Only 38.5% of respondents attempted to quit smoking, of which 3.0% were female. Similarly, 29.0% were past and 20.1% were current alcohol users. Only 40.8% and 56.0% of respondents were involved in vigorous-intensity and moderate-intensity physical activity, respectively. Only 41.6% and 8.6% of respondents consumed vegetables and fruits daily, respectively. There was no association of alcohol consumption, physical activity, or fruit and vegetable consumption with respondents’ sex. The odds of diagnosed hypertension were high among females (1.242, p = 0.034). Due to the cross-sectional design, causal relationships cannot be established. Conclusions: Behaviour-related health risks such as physical inactivity, low fruit and vegetable consumption, tobacco and alcohol use, overweight and obesity, and high-risk waist-to-hip ratios are high in community people.

Transcatheter aortic valve implantation is the most preferred treatment for aortic stenosis in elderly patients at high surgical risk. We share our experience with Transcatheter aortic valve implantation utilizing a balloon-expandable Myval transcatheter heart valve in a patient diagnosed with a bicuspid aortic valve, exhibiting low-flow, low-gradient severe aortic stenosis, along with annular calcification that extends to the left ventricular outflow tract and horizontal aorta.

Background and Aims: To determine the frequency of multi-vessel disease among patients with First ST-Elevation Myocardial Infarction and to identify the cutoff value of N Terminal-Pro Brain Natriuretic Peptide (NT-proBNP) for diagnosis of multi-vessel disease. Methodology: A descriptive cross-sectional study was conducted in the Department of Cardiology at a tertiary care hospital from September 2021 to February 2022. The study included 150 patients who presented to the emergency room with first ST-elevation myocardial infarction and preserved ejection fraction. NT-proBNP levels were tested within 12 hours of hospital admission. The severity of coronary artery disease was assessed by the number of vessels affected labeled, the luminal diameter narrowing and the syntax score. Results: The mean age of participants was 60.60±11.1 years. 76% were men, 53.3% of the participants had hypertension, 44% had type 2 diabetes, and 14% were smokers. The mean BMI of the patients was 27.86±3.86. The mean ejection fraction of the patients was 50±4.5.Single-vessel disease was present in 47 (31%) and 103 (69%) had multi-vessel disease. The mean NT-proBNP level in single-vessel disease was 561.34 pg/mL, and in multi-vessel disease, it was 1640.65 pg/mL. Raised levels of NT-proBNP were significantly associated with the severity of coronary artery disease. (P-value <0.05). The optimal cut-off value of NTpro-BNP for ruling out multiple vessel disease was 947.50 pg/mL at 81% of sensitivity.Conclusion: Pro-BNP is a valuable biomarker in assessing the severity of coronary artery disease in STEMI patients. Its levels have been shown to correlate with the degree of CAD severity including multi-vessel involvement.

Background: Hypertension is the leading cause of cardiovascular disease and premature death worldwide. Left ventricular hypertrophy (LVH), a measure of hypertensive target organ damage in the heart is associated with increased morbidity, mortality and development of arrhythmias. This study was designed to identify the more accurate ECG criteria for identifying LVH taking LVH by echocardiography as reference. Methods: A cross sectional study was conducted at Shahid Gangalal National Heart Centre. A total of 252 patients were included. A 12-lead ECG and Echocardiography were done. Analysis done by SPSS 25. Stata-14 software was used for ROC (Receiver operating characteristics) comparison and P<0.05 considered statistically significant. Results: Sensitivity, specificity, PPV, NPV and accuracy of Sokolow-Lyon criteria in diagnosis LVH was 41.8%, 80.8%, 67.1%, 59.7% and 61.9% respectively. The results of the test parameters taking Cornell Voltage criteria to detect LVH was 65.6%, 73.1%, 69.6% 69.3% and 69.4%. Likewise, the test parameters of cornell voltage duration measurement was 57.4%, 84.6%, 77.8%, 67.9% and 71.4% respectively. Similarly results of the test parameters by Romhilt-Estes system was 36.9%, 88.5%, 75%, 59.9% and 63.5% respectively. Area under the curve (AUC) of Sokolow-Lyon index, Cornell voltage criteria, Cornell voltage duration measurement and Romhilt- Estes system was 0.613, 0.693, 0.71 and 0.627 respectively. Conclusion: In our study Cornell Voltage duration measurement criteria had a higher sensitivity and higher AUC to detect LVH. The different ECG criteria must be integrated with the clinical scenario. Isolated interpretation of LVH using a single ECG criteria has a low diagnostic value

Biomedical research is an ever evolving field. The integrity and impact of research work depends heavily upon transparent reporting. It is crucial for Nepalese Heart Journal to emphasize the significance of adhering to robust reporting guidelines. These guidelines are not just a checklist of items like requisites but now they are the foundation of scientific publications that assure clarity, reproducibility, and credibility.

Background and Aims: Anemia is a frequently encountered comorbid illness in heart failure and is associated with poor clinical outcomes. There are limited studies done in Nepal to evaluate its prevalence among patients diagnosed with heart failure. Hence, this study was aimed to find out the prevalence of anemia and associated factors among patients with heart failure at Birat Medical College Teaching Hospital.
 Methods: A hospital based cross sectional study was conducted from 1st July 2022 to 30 February 2023 among consecutively selected 100 patients at Birat Medical College Teaching Hospital. Socio-demography, clinical features and laboratory parameters to evaluate anemia were obtained. Ethical clearance was taken from the Institutional Review Committee of institute. Collected data was entered in Microsoft Excel and analyzed by Statistical Package for Social Sciences version 23. Frequency, mean, percentage were calculated and chi square test at 0.05% level of significance was used to find the association.
 Results: The prevalence of anemia was 65%. Out of 100 patients, majority had iron deficiency anemia (40%), followed by anemia of chronic disease (10%). Thirty three percent had iron deficiency without anemia. Female patients 36(75%) and patients with chronic obstructive pulmonary disease (COPD) 15(93.8%) had significantly higher prevalence of anemia (p value <0.05).
 Conclusions: Nearly two third of heart failure patients had anemia among which iron deficiency anemia was the commonest. Female and patients with COPD had higher prevalence of anemia.

Background and Aims: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is an important tool for risk stratification in cardiac surgery. Updated EuroSCORE II (ESC II) is widely regarded as essential for risk stratification and several studies validate its efficacy, but these are fewer in Southern Asia and none in Nepal. Aim of this study was to compare the predicted versus observed early mortality in adults undergoing major cardiac surgeries in Nepalese population. Methods: A prospective observational study was conducted from September 2019 to May 2021 at Manmohan Cardiothoracic Vascular and Transplant Center. Calibration and discrimination of scoring system were main parameters analyzed in total sample and subgroups. Discrimination were observed by plotting receiver operating characteristic (ROC) curves and calculating area under curve (AUC). Two sample t test, McNemar’s test, Fisher’s exact t test and Chi square test were used to derive P value. Results: In this study, 249 patients were evaluated. Poor mortality prediction was shown by statistically significant p value <0.05 across all surgical groups. AUC for total cases, CABG and valve surgeries were 0.835, 0.766, 0.82 respectively. Conclusion The present study underpredicted mortality but displayed good discrimination for overall cardiac surgeries, with excellent discrimination in valve surgeries. As current sample is not entirely comparable to parent study, weak calibration could be attributed to it as etiology was mostly rheumatic with poorer cardiopulmonary reserve in this study versus degenerative etiology in original study.

Background and Aims: Pericardial effusion is a common finding in every day clinical practice. It is caused by a range of local and systemic disorders, many of which could be idiopathic. Pericardial effusions can be acute or chronic. The etiology of pericardial effusion varies in different parts of the world and is related to the relative prevalence of different diseases. Methods: This is a retrospective study where data from all the cases admitted with pericardial effusion in the SGNHC from January 2021 to December 2022 were included. Altogether 218 cases diagnosed with pericardial effusion established by Echocardiograpy were included. Evaluation for the cause of pericardial effusion was done. Iatrogenic (cardiac surgery, catheterization) and post-traumatic cases and age <15 years were excluded. Demographic profile, common causes, the presentation and the clinical outcome of the patients were documented. Results: Majority of patients were aged between 56-75 years. Most common etiology of pericardial effusion was tuberculosis (56%) followed by heart failure (11%), Hypothyroidism (6.4%) and malignancy (5.6%). Tachycardia was the most common ECG finding in 152 (69.7%) followed by Low voltage ECG in 96 (44%). The most common clinical feature was breathlessness in 85% followed by tachycardia in 56% of the patient. Conclusion: Tuberculosis, Heart Failure and Hypothyroidism were the common causes of Pericardial effusion with male predominance. Breathlessness was the most common presenting symptom.

Background: Heart failure is a leading cause of hospital admissions each year. In Nepal also the incidence of heart failure is increasing. Acute decompensated heart failure carries a poor prognosis. Most patients respond to intravenous loop diuretics but a substantial proportion of patients are resistant to them and may need additional diuretic agents like metolazone by the principle of “sequential nephron blockade”.
 Methods: In a hospital-based cross-sectional comparative study, we assigned 68 patients with acute decompensated chronic heart failure patients to receive furosemide at 1 mg/kg twice daily or furosemide at 1 mg/kg twice daily plus metolazone 5mg/day. The primary end-points were daily weight loss, negative water balance (difference between urine output and fluid intake) and symptomatic improvement on NYHA grading.
 Results: There were 55% males and 45% females in total. There was a significant difference (p-value =0.003) in mean weight loss observed between the two groups on day three, i.e., 0.971±0.6 kg and 1.5±0.78 kg in furosemide group and furosemide plus metolazone group respectively. Mean negative water significantly more in the combination group on day two (450±230.94 ml vs 750.59±416.92 ml) with p-value <0.001 and day three (780.88±352.48 ml vs 504.38±292.46 ml) with p-value 0.001. There was no significant change in symptoms on the basis of NYHA grading between the two groups, duration of hospital stay and adverse events like hypotension, acute kidney injury and dyselectrolytemia.
 Conclusion: Among patients with acute decompensated chronic heart failure, treatment with combination of furosemide and metolazone was found to be more effective than furosemide alone without significant increase in adverse effects.