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R K Saran

Publications and source records attributed to R K Saran.

58 records · Page 4Linked to original sources
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Predischarge dobutamine induced distant wall motion abnormalities after acute myocardial infarction predict multivessel disease.

Presence of multivessel coronary artery disease (MVD) identifies a high risk subgroup after acute myocardial infarction (AMI). Dobutamine stress echocardiography (DSE) has recently emerged as a promising non invasive test to detect the presence and extent of coronary artery disease. Forty six consecutive patients (38 males, 8 females; mean age 48.6 +/- 10.4 years) of Q-wave acute myocardial infarction were subjected to submaximal treadmill test (TMT) and dobutamine stress echocardiography to see their ability to predict multivessel coronary artery disease as detected by coronary angiography before hospital discharge. Dobutamine infusion was started at 5 micrograms/kg/min to a maximum of 40 micrograms/kg/min, to achieve 70 percent of the age predicted heart rate. Appearance of new regional wall motion abnormality was interpreted as positive DSE for MVD. Mean peak infusion dose of dobutamine used in the study was 28.56 +/- 5.67 micrograms/kg/min. In none of the patients, the test had to be terminated due to side effects. The sensitivity and specificity of DSE to predict MVD was 80 percent and 93.7 percent, respectively as compared to 45 percent and 86 percent for submaximal TMT. Thus, DSE in patients of AMI before hospital discharge is a safe procedure with fairly accurate prediction of multivessel coronary artery disease.

Adult↗
PubMedDate not supplied

Improvement in contractility of infarct zone after dobutamine infusion predicts good (TIMI II or III) flow in infarct related artery.

Eighteen patients of 'Q' wave acute myocardial infarction (AMI) (age 50 +/- 6.2 years), underwent dobutamine stress echocardiography (DSE) before hospital discharge (7.2 +/- 1.3 days after AMI) to find out the correlation between response of infarct zone to dobutamine infusion and TIMI grade flow in infarct related artery (IRA). The aim of study was to test the hypothesis that infarct zone which shows improvement in contractility after dobutamine infusion has viable myocardial tissue and would have good flow (TIMI II or III) in IRA. Echocardiographically, improvement in contractility in the centre of infarct zone by at least 1 grade (on a scale of 4) was termed as positive response on DSE. The mean dose of dobutamine was 19.4 micrograms/kg/min. Ten patients had positive response on DSE; 8 of them had good antegrade flow in IRA. Eight patients had no improvement in contractility of infarct zone on DSE; 6 of them had poor flow in IRA. Clinical markers of reperfusion (relief of chest pain, early ST settlement, peak CPK-MB levels), age of patient, site of AMI, time to thrombolysis, resting left ventricular ejection fraction, wall motion score of the infarct zone and presence of collaterals were not significantly different in patients with good or poor flow in IRA. Thus, improvement in contractility of infarct zone after dobutamine infusion can predict good flow (TIMI II or III) in IRA with 80 percent sensitivity, 75 percent specificity, 80 percent diagnostic accuracy, 80 percent positive predictive value and 75 percent negative predictive value.

Adult↗
PubMedDate not supplied

Antitubercular treatment does not prevent constriction in chronic pericardial effusion of undetermined etiology: a randomized trial.

Patients of chronic exudative pericardial effusion are frequently treated with antitubercular treatment on presumptive grounds in developing countries, in a hope to prevent constrictive pericarditis. To assess the impact of antitubercular treatment on development of constrictive pericarditis in chronic large exudative pericarditis effusion of undetermined etiology, 25 patients above 12 years of age, with large pericarditis effusion beyond 12 weeks duration, were randomized in a prospective 2:1 fashion, to receive either 3-drug antitubercular treatment (group A) or placebo (group B) for six months. End points studied were, development of pericardial thickness as diagnosed by CT scan and constrictive pericarditis as diagnosed by cardiac catheterization. Twenty-one patients (14 in group A and 7 in group B) completed the study protocol. In all, five (23.8%) patients developed constrictive pericarditis/pericardial thickening. Histopathological examination of pericardiectomy specimens in over five patients were negative for tubercular pathology. Pericardial effusion resolved completely in another 10 (47.8%) patients. There was no significant difference in both the groups in development of constrictive pericarditis/pericardial thickening (group A: n = 3, 21.4% and group B: n = 2, 29.6%, p = NS). On multivariate analysis, development of constrictive pericarditis/pericardial thickening was associated with recurrent tamponade (p = 0.01), presence of tamponade at admission (p = 0.07) and haemorrhagic pericardial effusion (p = 0.08). Thus, antitubercular treatment does not prevent the development of constrictive pericarditis in patients of large chronic pericardial effusion of undetermined etiology.

Adult↗