Journal of National Heart Foundation of Bangladesh
Journal of National Heart Foundation of Bangladesh welcomes contribution from all branches of cardiovascular diseases in the form of original articles, review articles, case reports, images in cardiac medicine and surgery and introduction of techniques in “How To Do It’ section. The articles submitted are subject to peer review and editorial revision. The author(s) should disclose any conflict of interest if any during submission and also state that the submitted article have not been published in whole or in part except abstracts or accepted for publication in any other journal. Authors must conform to the uniform requirements for manuscripts submitted to biomedical journals (N Engl J Med 1991; 324:424-8). Manuscripts may be submitted in hard copies (Three copies) and an electronic copy with a covering letter addressed to National Professor Brig (Rtd.) Abdul Malik, Editor-in-chief, Editorial Board, Journal of National Heart Foundation of Bangladesh. Manuscripts may also be submitted electronically to nhfresearch@yahoo.com. Tables, figures and text should be included in the same file if possible. However, photographs and/or figures and signed copyright statement by all the authors need to be sent separately as hard copy. Registered letters should be mailed to Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Plot no. 7/2, Section 2, Mirpur, Dhaka -1216, Bangladesh. Manuscripts submitted only by post should also be accompanied with an electronic copy of the same on a compact disc. Preparation of manuscript Type the manuscript on white bond paper, 216 x 279 mm (8/2 x 11 in.) or ISO A4 (212 x 297 mm), with margins of at least 25 mm (1 in.). Type only on one side of the paper. Use double spacing throughout, including title page, abstract, text, acknowledgments, references, tables, and legends for illustrations. Begin each of the following sections on separate pages: title page, abstract and key words, text, acknowledgments, references, individual tables, and legends. Number pages consecutively, beginning with the title page. Type the page number in the upper or lower right-hand corner of each page. Title page The title page should carry (a) the title of the article, which should be concise but informative; (b) first name, middle initial, and last name of each author, with highest academic degree(s) and institutional affiliation; (c) name of department(s) and institution(s) to which the work should be attributed; (d) disclaimers, if any; (e) name and address of author responsible for correspondence about the manuscript; (f) name and address of author to whom requests for reprints should be addressed or statement that reprints will not be available from the author; (g) source(s) of support in the form of grants, equipment, drugs, or all of these; and (h) a short running head or foot line of no more than 40 characters (count letters and spaces) placed at the foot of the title page and identified. Authorship All persons designated as authors should qualify for authorship. The order of authorship should be a joint decision of the coauthors. Each author should have participated sufficiently in the work to take public responsibility for the content. Authorship credit should be based only on substantial contributions to (a) conception and design, or analysis and interpretation of data; and to (b) drafting the article or revising it critically for important intellectual content; and on (c) final approval of the version to be published. Conditions (a), (b), and (c) must all be met. Participation solely in the acquisition of funding or the collection of data does not justify authorship. General supervision of the research group is also not sufficient for authorship. Any part of an article critical to its main conclusions must be the responsibility of at least one author. A paper with corporate (collective) authorship must specify the key persons responsible for the article; others contributing to the work should be recognized separately (see Acknowledgments). Editors may require authors to justify the assignment of authorship. Abstract and Key Words The second page should carry a 250 words structured abstract. The abstract should state the purposes of the study or investigation, basic procedures (selection of study subjects or laboratory animals; observational and analytical methods), main findings (give specific data and their statistical significance, if possible), and the principal conclusions. Below the abstract provide, and identify as such, 3 to 10 key words or short phrases that will assist indexers in cross-indexing the article and may be published with the abstract. Text The text of observational and experimental articles should be divided into sections with the headings Introduction, Methods, Results, and Discussion. Long articles may need subheadings within some sections to clarify their content, especially the Results and Discussion sections. Introduction State the purpose of the article. Summarize the rationale for the study or observation. Give only strictly pertinent references, and do not review the subject extensively. Do not include data or conclusions from the work being reported. Methods Describe your selection of the observational or experimental subjects (patients or laboratory animals, including controls) clearly. Identify the methods, apparatus (manufacturer's name and address in parentheses), and procedures in sufficient detail to allow other workers to reproduce the results. Give references to established methods, including statistical methods; provide references and brief descriptions for methods that have been published but are not well known; describe new or substantially modified methods, give reasons for using them, and evaluate their limitations. Identify precisely all drugs and chemicals used, including generic name(s), dose(s), and route(s) of administration. Ethics When reporting experiments on human subjects indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) or with the Helsinki Declaration of 1975, as revised in 1983: Do not use patients' names, initials, or hospital numbers, especially in any illustrative material. When reporting experiments on animals indicate whether the institution's or the National Research Council's guide for, or any national law on, the care and use of laboratory animals was followed. Statistics Describe statistical methods with enough detail to enable a knowledgeable reader with access to the original data to verify the reported results. When possible, quantify findings and present them with appropriate indicators of measurement error or uncertainty (such as confidence intervals). Avoid sole reliance on statistical hypothesis testing, such as the use of P values, which fails to convey important quantitative information. Specify any general-use computer programs used. Put general descriptions of methods in the Methods section. When data are summarized in the Results section specify the statistical methods used to analyze them. Restrict tables and figures to those needed to explain the argument of the paper and to assess its support. Use graphs as an alternative to tables with many entries; do not duplicate data in graphs and tables. Avoid nontechnical uses of technical terms in statistics, such as "random" (which implies a randomizing device), "normal," "significant," "correlations," and "sample." Define statistical terms, abbreviations, and most symbols. Results Present your results in logical sequence in the text, tables, and illustrations. Do not repeat in the text all the data in the tables or illustrations; emphasize or summarize only important observations. Discussion Emphasize the new and important aspects of the study and the conclusions that follow from them. Do not repeat in detail data or other material given in the Introduction or the Results section. Include in the Discussion section the implications of the findings and their limitations, including implications for future research. Relate the observations to other relevant studies. Link the conclusions with the goals of the study but avoid unqualified statements and conclusions not completely supported by your data. Avoid claiming priority and alluding to work that has not been completed. State new hypotheses when warranted, but clearly label them as such. Recommendations, when appropriate, may be included. Acknowledgments At an appendix to the text one or more statements should specify (a) contributions that need acknowledging but do not justify authorship, such as general support by a departmental chairman; (b) acknowledgments of technical help; (c) acknowledgments of financial and material support, specifying the nature of the support; (d) financial relationships that may pose a conflict of interest. Authors are responsible for obtaining written permission from persons acknowledged by name, because readers may infer their endorsement of the data and conclusions. Technical help should be acknowledged in a paragraph separate from those acknowledging other contributions. References References should be written in Vancouver style. Number references consecutively in the order in which they are first mentioned in the text. Identify references in text, tables, and legends by Arabic numerals in parentheses. References cited only in tables or in legends to figures should be numbered in accordance with a sequence established by the first identification in the text of the particular table or illustration. Try to avoid using abstracts as references; "unpublished observations" and "personal communications" may not be used as references, although references to written, not oral, communications may be inserted (in parentheses) in the text. Include among the references papers accepted but not yet published; designate the journal and add "In press." Information from manuscripts submitted but not yet accepted should be cited in the text as "unpublished observations" (in parentheses). The references must be verified by the author(s) against the original documents. Tables Type each table double-spaced on a separate sheet. Do not submit tables as photographs. Number tables consecutively in the order of their first citation in the text and supply a brief title for each. Give each column a short or abbreviated heading. Place explanatory matter in footnotes, not in the heading. Explain in footnotes all nonstandard abbreviations that are used in each table. For footnotes use the following symbols, in this sequence: *, t, +, §, II, , * tt. Identify statistical measures of variations such as standard deviation and standard error of the mean. Do not use internal horizontal and vertical rules. Be sure that each table is cited in the text. If you use data from another published or unpublished source obtain permission and acknowledge fully. The use of too many tables in relation to the length of the text may produce difficulties in the layout of pages. Illustrations Submit three complete sets of figures. Figures should be professionally drawn and photographed; freehand or typewritten lettering is unacceptable. Instead of original drawings, roentgenograms, and other material send sharp, glossy black-and white photographic prints, usually 127 X 173 mm (5 x 7 in.), but no larger than 203 x 254 mm (8 x 10 in.). Letters, numbers, and symbols should be clear and even throughout and of sufficient size that when reduced for publication each item will still be legible. Titles and detailed explanations belong in the legends for illustrations, not on the illustrations themselves. Each figure should have a label pasted on its back indicating the number of the figure, author's name, and top of the figure. Do not write on the back of figures or scratch or mar them by using paper clips. Do not bend figures or mount them on cardboard. If photographs of persons are used, either the subjects must not be identifiable or their pictures must be accompanied by written permission to use the photograph. Figures should be numbered consecutively according to the order in which they have been first cited in the text. If a figure has been published acknowledge the original source and submit written permission from the copyright holder to reproduce the material. Permission is required irrespective of authorship or publisher, except for documents in the public domain. For illustrations in color the journal requires color negatives, positive transparencies, or color prints. Legends for Illustrations Type legends for illustrations double-spaced, starting on a separate page, with Arabic numerals corresponding to the illustrations. When symbols, arrows, numbers, or letters are used to identify parts of the illustrations, identify and explain each one clearly in the legend. Units of measurement Measurements of length, height, weight, and volume should be reported in metric units (meter, kilogram, or liter) or their decimal multiples. Temperatures should be given in degrees Celsius. Blood pressures should be given in millimeters of mercury. All hematologic and clinical-chemistry measurements should be reported in the metric system in terms of the International System of Units (SI). Abbreviation and symbols Use only standard abbreviations. Avoid abbreviations in the title and abstract. The full term for which an abbreviation stands should precede its first use in the text unless it is a standard unit of measurement. The Editor reserves the customary right to style and if necessary shortens the material accepted for publication and to determine the priority and time of publication. Editor assumes that work based on honest observations.
From aVR Elevation to Recovery: Emergency LM–LAD Stenting and TAP to LCX in Acute Left Main Occlusion
Abstract Background: Acute left main (LM) coronary artery occlusion is a rare but catastrophic cause of ST-segment elevation myocardial infarction (STEMI), frequently associated with cardiogenic shock and high mortality. Prompt diagnosis and rapid revascularization are critical. Case Presentation: A 58-year-old diabetic and hypertensive male presented with severe chest pain for 8 hours. ECG revealed significant ST-segment deviations with ST elevation in aVR, suggestive of LM or proximal multivessel ischemia. Primary PCI strategy was undertaken. Coronary angiography demonstrated a normal RCA but complete occlusion of the left coronary system immediately distal to the LM bifurcation. The patient became acutely hemodynamically unstable following contrast injection. Intervention: Emergency PCI was performed with IVUS guidance. The LAD and LCX were successfully wired. LM-to-LAD stenting was performed as the main strategy, followed by TAP (T and Protrusion) technique for LCX access. Kissing balloon inflation (KBI) and a final proximal optimization technique (POT) were executed, achieving optimal stent expansion and bifurcation geometry. TIMI 3 flow was restored in both LAD and LCX. Outcome: The patient stabilized hemodynamically with excellent angiographic results and no immediate complications. Conclusion: This case highlights the importance of recognizing ST elevation in aVR as an indicator of potential LM occlusion and demonstrates that IVUS-guided LM bifurcation PCI using a TAP strategy with KBI and POT can achieve rapid and effective revascularization in critically unstable patients. Urgent mechanical revascularization remains essential in the management of acute LM STEMI.
Copyright (c) 2026 Journal of National Heart Foundation of Bangladesh
Upfront Two-Stent Strategy, The DK Crush technique. Our experience in NHFH
Bifurcation lesions pose a significant challenge in percutaneous coronary intervention (PCI), occurring in 15-20% of all PCIs. The key strategic choice is between the default Provisional (1-Stent) strategy and the Upfront (2-Stent) strategy. The Upfront Two-Stent Strategy (U2SS) is indicated for complex true bifurcations (Medina 1,1,1), large myocardium at risk (especially distal Left Main), and for proactive Side Branch (SB) protection. The Double Kissing (DK) Crush technique is the most studied two-stent strategy, demonstrating superior outcomes over provisional stenting in complex Left Main bifurcations. The procedure's key differentiator is the first Kissing Balloon Inflation (KBI) immediately after SB stent crushing, which ensures easier and more reliable final SB re-wiring. Landmark evidence from the DKCRUSH-V trial showed that DK Crush significantly reduced Target Lesion Failure (TLF) and Stent Thrombosis (ST) compared to Provisional Stenting in Unprotected Left Main Bifurcation. The DKCRUSH X long-term analysis confirmed a durable benefit with a 29% relative reduction in TLF over a six-year period for complex true bifurcations (Hazard Ratio: 0.71). The DK Crush technique is associated with the lowest rate of Major Adverse Cardiac Events (MACE) compared to other techniques, making it the Gold Standard for superior long-term outcomes in complex bifurcation lesions. Results: A total of 1443 cases of upfront two-stent strategy was performed in NHFH over last 5 years of which 352(24.4%) were DK Crush technique. Among the DK Crush cases 91.20% were LM bifurcation lesions. Rotablation were used in 9% of DK Crush cases and IVUS and OCT in 63.10% of cases. 12.5% of these cases underwent symptoms driven check CAG which revealed an ISR rate of 5.4%. Total death were 9.4% with 1.4% in-hospital death. Among the total deaths 24.2% were of non-cardiac causes. Conclusion: Key Takeaways Provisional stenting remains the default strategy for *simple* bifurcations. For *complex, true bifurcations* (esp. Left Main, large SB, long lesion), an upfront two-stent strategy is superior. The DK Crush technique is a reliable and evidence-based strategy , demonstrating lower adverse events in these high-risk patients. Procedural success hinges on meticulous adherence to al steps, especially the "Double Kiss."
Cardiovascular-Kidney Metabolic Syndrome
Cardiovascular–Kidney–Metabolic (CKM) syndrome describes an integrated pathophysiological continuum characterized by the coexistence of metabolic dysfunction, renal impairment, and cardiovascular disease. Recognizing CKM syndrome at an early stage is vital, as the combined effects of these interrelated disorders significantly worsen patient outcomes. We aim to summarize the latest evidence regarding CKM syndrome and to highlight emerging therapeutic strategies that support comprehensive risk reduction for affected individuals. This is a review, drawing upon recent clinical trials, updated guidelines, and epidemiological data. The development and progression of CKM syndrome are driven by intersecting mechanisms, including overactivation of the renin-angiotensin-aldosterone system (RAAS), chronic inflammation, oxidative stress, and metabolic dysregulation. Patients who present early metabolic abnormalities are at a heightened risk for rapid deterioration of renal function and increased rates of cardiovascular events. Integrated management approaches that emphasize early screening, lifestyle modification, optimization of glycemic control and blood pressure, alongside RAAS-targeted therapies, have shown to improve clinical outcomes in these patients. CKM syndrome necessitates a unified, multisystem approach for both prevention and treatment. Early identification of at-risk individuals and the timely incorporation of appropriate therapeutic interventions can significantly reduce the incidence of renal and cardiovascular complications. It is essential to strengthen multidisciplinary care pathways to effectively mitigate the long-term burden associated with this syndrome.
Clinical Profile and Outcomes of ACS Patients in Bangladesh: Insights from a National Facility-Based Registry
Introduction One-third of annual deaths in Bangladesh are from cardiovascular diseases. Acute Coronary Syndrome (ACS) has various presentations, severity, and treatment options. Information obtained from the ACS registry will help in improved patient management and appropriate planning. This prospective observational study aimed to understand treatment and outcomes, and their associated factors, among Bangladeshi adult ACS patients by establishing a facility-based registry. Methods The national ACS registry was established in six tertiary-level hospitals—equally representing government and private facilities—across the metropolitan cities of Dhaka, Sylhet, and Chattagram, in collaboration with the Non-communicable Disease Control Programme (NCDC) of the Directorate General of Health Services, Ministry of Health. Patients admitted with a diagnosis of ACS in the selected hospitals were interviewed and their medical records were reviewed. An Android-based app was developed to collect information on socio-demographic characteristics, ACS risk factors, presenting features, treatment-seeking behavior, provided management, in-hospital complications, and immediate outcomes. The long-term outcomes were collected via telephonic follow-up after a minimum of 6 months passed from enrollment. Results A total of 29,029 patients were enrolled in the registry, and 28,645 had a confirmed diagnosis of ACS; 41.6% STEMI, 38.7% NSTEMI, and 20.7% unstable angina. The majority were male (68.3%), with a mean age of 56.4 ± 12.1 years, and 79% were aged ≥46 years. On admission, 58.1% were hypertensive and 46.4% were diabetic; 60.7% reported a history of tobacco use, and 27.3% had a family history of heart disease. Almost all patients (98.5%) were symptomatic, most commonly presenting with excessive sweating (87.8%) and chest pain or discomfort (73.1%). One-quarter of patients initially sought care at secondary-level or lower public health facilities or private chambers; 8.8% did not receive an initial loading dose of antiplatelet therapy at first contact facility. The majority (75.9%) were treated conservatively with medical management; reperfusion therapy was used infrequently in hospitals below the tertiary level. During initial hospital stay, 32.3% of patients experienced at least one complication, and in-hospital mortality was 1.4%. To date, 78.% of enrolled patients have been contacted by telephone after an average of 10 months; 92.2% were successfully followed up; 86.6% were alive, and 14.5% required rehospitalization. Most of the deaths reported at long-term follow-up were attributed to cardiovascular causes. Conclusion Under-reporting of NSTEMI was presumed, which demands further research. The provision of cardiac marker testing and safe-affordable thrombolytics at primary healthcare facilities are recommended in addition to the awareness rising to control the rising burden of acute coronary syndrome and its complications in Bangladesh.
Drug-Coated Balloon Angioplasty in In-Stent Restenosis and Small-Vessel Coronary Disease: Insights from a Bangladeshi Cohort
Background: Drug-eluting stents (DES) remain the cornerstone of percutaneous coronary intervention; however, their limitations include in-stent restenosis (ISR) and suboptimal performance in de-novo small-vessel disease. Drug-coated balloons (DCB) offer a metal-free alternative, delivering antiproliferative therapy directly to the vessel wall. Data from South Asia on DCB outcomes are limited. Objectives: To evaluate the safety and efficacy of DCB angioplasty in patients with chronic coronary syndrome (CCS) presenting with either ISR or de-novo small-vessel lesions. Methods: In this prospective observational study conducted at the National Institute of Cardiovascular Diseases (NICVD), Dhaka, from January 2023 to July 2024, 110 consecutive CCS patients underwent DCB angioplasty. Patients were followed for 12 months to assess major adverse cardiac events (MACE) and target lesion revascularization (TLR). Results: Among 110 patients, 42 (38.2%) had ISR lesions and 68 (61.8%) had de-novo small-vessel lesions. Angiographic success was achieved in 93.6% and procedural success in 91.8% of cases. Over one-year follow-up, MACE occurred in 5.5% (n = 6), TLR in 2.7% (n = 3), death in 1.8% (n = 2), and myocardial infarction in 0.9% (n = 1). MACE and TLR rates were numerically higher in the ISR subgroup but did not reach statistical significance (MACE 9.5% vs 2.9%, p = 0.32; TLR 4.8% vs 1.5%, p = 0.327). Conclusion: Drug-coated balloon angioplasty demonstrated excellent procedural success and favorable one-year outcomes in both ISR and small-vessel coronary disease. These findings suggest that DCB represents a safe and effective revascularization strategy for CCS patients in the Bangladeshi population. Keywords: Drug-coated balloon, In-stent restenosis, Small-vessel coronary disease, Chronic coronary syndrome, Bangladesh.
Cardiovascular genomics: the advanced frontier of CVD management
Cardiovascular genomics: the advanced frontier of CVD management Prof. Dr. Prabir Kumar Das FCPS, MD, FACC,FCSI Former HOD, Dept. of Cardiology, Ctg. Medical College & Secretary General, Chattogram Heart Foundation Abstract Cardiovascular genomics are specialized field that explore the role of genetics in the development and progression of cardiovascular diseases. About 10-15% of all non communicable diseases are familial and inherited conditions following Mandolin or monogenic inheritance pattern. These includes congenital heart disease, aortic and arterial disease, inherited cardiomyopathies, inherited arrhythmias and cardiac conduction defects, atrial fibrillation, familial hypercholesterolemia, systemic hypertension, pulmonary hypertension and some rare CV diseases. Understanding the genetic basis of rare and common CVDs has advanced substantially over the last 25 years. With the advent of sequencing of human genome by next generation sequencing(NGS) technique in 2000,it emerged as a preferred method of complete elucidation of genetic cause of single gene disorders .CV genomic medicine offers opportunity to review and organize management and prevention of wide ranging inherited and familial CV conditions..It encompasses personalized medicine targeting specific individuals; precision medicine targeting specific molecular disease and evidence-based medicine with most upto date top validated evidences. Several NGS based diagnostic multi-gene panels now available for confirmation of disease causing specific gene mutation or pathogenic variants in major inherited CV conditions. Genomic laboratories offer this service and developed specific genotype-phenotype databases. High risk screening allows earlier diagnosis, risk stratification, aggressive treatment and improved outcome. DNA-editing technology through application of CRISPR-Cas9 can be used to edit genes within living organisms enabling correction of monogenic conditions. For polygenic CVD whole genome sequencing at birth may allow primordial prevention with assessment of genetic determinants of lifetime risk for CVD. At present use of genomics has gone beyond screening, diagnosis and risk prediction into therapeutics. Evaluating genomic information now forms part of routine clinical workflow for inherited cardiac conditions in improving diagnostic decision-making, screening of relatives, and guiding decisions on therapy.
Hybrid SPECT MPI and FDG PET in Post-MI Cardiac Care: Bridging Imaging and Intervention for Precision Revascularization in Coronary Artery Disease
Introduction: Ischemic heart disease remains a major health burden in Bangladesh, with many post–myocardial infarction (MI) patients presenting late and often undergoing revascularization without prior assessment of myocardial viability. The introduction of hybrid 99mTc-MIBI SPECT MPI and 18F-FDG Cardiac PET has opened new possibilities for evidence-based, individualized post-MI management. This dual tracer imaging approach enables simultaneous evaluation of perfusion and metabolism, allowing more accurate identification of viable myocardium and supporting optimized revascularization strategies tailored to patient needs. Objective: To evaluate the role of hybrid SPECT–FDG PET in guiding post-MI management and improving patient outcomes. Methods: We retrospectively analyzed 75 post-MI patients (27–75 years; 71M/4F) who underwent MPI and FDG PET at INMAS Dhaka (Dec 2020–Dec 2024). Clinical data, coronary angiography, EF%, cardiac biomarkers, and perfusion–metabolism defect patterns were evaluated. Treatment strategies (medical, PCI, or CABG) were correlated with viability findings and outcomes. Result: Among 75 patients, comorbidities included hypertension (55%), diabetes (53%), dyslipidemia (25%), and CKD (9%). CAG revealed triple-vessel disease in 67%, double-vessel in 20%, and single-vessel in 13%. A mismatch pattern consistent with hibernating myocardium was observed in 18% of patients, while the remainder showed matched (scar), mismatched, or reverse mismatch (stunned myocardium) patterns across the LAD, LCX, and RCA territories. Based on integrated clinical and imaging assessment, 23 patients (30.7%) underwent CABG, 11 (14.7%) PCI, and 41 (54.6%) received optimal medical therapy. Baseline EF on Echo was 34.7 ± 7.6%, which improved to 43.2 ± 6.6% following imaging-guided PCI or CABG. Mortality was higher among those who deferred, delayed or declined the recommended management strategy. Conclusion: Hybrid SPECT MPI and FDG PET effectively identify viable myocardium and support evidence-based revascularization decisions. Integrating these modalities into routine cardiovascular care can optimize patient selection, reduce unnecessary interventions, and improve clinical outcomes.
Aortic root enlargement before and after adaptation of roof technique and arch modification
Background- A very small root and annulus is a challenge for aortic valve replacement, that needs extensive aortic annular enlargement. Previously with the “Y” incision aortic root enlargement technique of Bo-Yang we could enlarge the aortic annulus by 1-2 valve size safely. After adoption of newer modification of with the “roof” technique and arch modification we now can enlarge the aortic root to upsize 3-5 valve sizes. Methods and materials – We have operated on 15 patients from January 2023 to July 2025 by Y incision Bo Yang technique. Among them in first 6 patients aortic root enlargement was done by Y incision / rectangular patch Bo- Yang technique and we implant 21mm prosthetic valve in 19mm or 18mm aortic root. In remaining 15 patients we adopted the Y incision Bo Yang with roof technique and arch modification and implant 25mm prosthetic valve in 19mm aortic root. All the peri-operative data were collected and stored for statistical analysis. Conclusion – In our experience aortic annular enlargement by “Y” incision with newer modifications improved survivals without increasing perioperative complications. Patients treated with a larger valve had notably reduced morbidity, increased the quality of life and better long-term survivals.
Assessment of Knowledge, Attitude, and Practice among Bangladeshi Adults on Tobacco Consumption: A Cross-Sectional Study
Background: Tobacco use continues to be a leading preventable cause of morbidity and mortality in Bangladesh. This study assessed the levels of knowledge, attitudes, and practices (KAP) regarding tobacco among Bangladeshi adults to inform control efforts. Methods: A cross-sectional survey was conducted with 2,842 adults aged 18–64 years from urban and rural areas across all eight divisions of Bangladesh. Information on sociodemographic details, knowledge of the health risks of smoking, smokeless tobacco, and second-hand smoking, attitudes toward tobacco’s health effects, tobacco use behaviors, quit attempts and methods, duration of use, and exposure to second-hand smoke were collected. Descriptive statistics with 95% confidence intervals (CI) were used. Results: Knowledge of health risks associated with tobacco use was high. Among smokers, 98.8% recognized cancer, 95.2% lung diseases, 91.5% heart disease, and 82.9% stroke as potential outcomes. For smokeless tobacco (SLT) users, 97.4% identified mouth cancer, 91.2% gum disease, and 89.7% tooth decay. Knowledge of second-hand smoke dangers was also high: lung cancer (94.5%), increased risk of heart disease (85.8%), and stroke (80.5%). Attitude scores showed strong support for tobacco avoidance. Despite this, the prevalence of tobacco use was 19.2% for smoking and 17.9% for smokeless tobacco users. Among smokers, 81.5% used cigarettes and 24.7% used bidis, and 79.2% of smokeless tobacco users used Jarda. Overall, 34.0% used either smoking or smokeless tobacco, with 3.1% dual users. Second-hand smoke exposure was more common in public places (78.9%) than in workplaces (47.9%) or inside homes (29.3%). Conclusions: While knowledge and attitudes toward the health risks of tobacco are high, the rates of smoking and smokeless tobacco use remain considerable, with frequent daily consumption, limited use of proven cessation methods, and high exposure to second-hand smoke in public places, highlighting gaps in the enforcement of smoke-free policies.
Sterilization and Asepsis in Cathlab: Responsibilities of the Nursing Staff
Aims: To highlight the crucial role of nursing staff in maintaining sterilization and aseptic conditions in the cardiac catheterization laboratory (cathlab) to prevent infections and ensure patient and personnel safety. Methods: Emphasizing on maintaining an aseptic environment through hand hygiene, use of personal protective equipment (caps, masks, gowns, gloves), regular cleaning protocols, and safe equipment sterilization. Education and ongoing training of nursing and technical staff on theoretical and practical asepsis principles were highlighted. Universal Precautions were underscored as essential for managing all patients, including those with known blood-borne infections, alongside adherence to single-use device policies and appropriate reuse regulations. Discussion: Nurses in the cathlab play a pivotal role in infection prevention by maintaining a sterile field and ensuring all aseptic protocols are followed. Vigilance in hand washing, gowning, gloving, and environmental cleanliness is essential. Regular inspection, team communication, and training foster a culture of safety and compliance. Managing exposure risks, such as needlestick injuries, and advocating for hepatitis B vaccination among staff further protect healthcare workers and patients. Conclusion: The dedicated efforts of nursing staff in adhering to sterilization and aseptic protocols in the cathlab significantly reduce infection rates and enhance procedural safety. Ongoing education, strict compliance, and teamwork are vital to sustaining a safe clinical environment for invasive cardiac procedures.
Comparison of long-term outcomes between NCB and NCSB in heavily calcified CAD after rotablation
Introduction: Scoring balloons are an important calcium modification tool. Its use after rotablation results in better clinical outcomes. The aim of this study was to compare clinical outcome between use of non-complaint balloon and non-complaint scoring balloon after rotablation. Methods: This prospective observation study was carried in the department of cardiology at National Heart Foundation Hospital & Research Institute from January 2015 to May 2025. All patients with heavily calcified lesion undergoing rotablation during this period were included in this study. After rotablation, lesions were prepared either with non-complaint balloon (NCB) or non-complaint scoring balloon (NCSB). Initially in person and subsequently telephonic follow-up was done. Results: A total of 421 patients with heavily calcified lesion underwent rotablation. Of them, in 311 patients (73.9%) NCB was used for lesions preparation and in 110 patients (26.1%) NCSB was used. Mean follow-up was 53.18 ± 36.43 months and median follow-up was 52 months. Among patients in whom lesions were prepared with NCSB- 92.7% (102) were doing well; in- hospital death was 3.6% (4); follow-up death was 2.7% (3), MACCE (major adverse cardiac and cerebrovascular events) was 6.4% and lost to follow-up was 0.9% (1). In contrarily, among patients in whom lesions were prepared with NCB- 68.2% (212) were doing well; in- hospital death was 2.6% (8); follow-up death was 21.5% (67), MACCE was 25.7% and lost to follow-up was 7.7% (24). Conclusion: In comparison to NCB, non-complaint scoring balloon usage had better long-term clinical outcome after rotablation. Key words: Heavily calcified lesions, non-complaint balloon, non-complaint scoring balloon, rotablation, clinical outcome.
Intravascular Imaging and Physiology: Cathlab Technicians & Nurses Perspectives
Method: Intravascular imaging and physiological assessment tools are integral to the catheterization laboratory (Cathlab) for improving the diagnosis and treatment of cardiovascular diseases. Modalities such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) deliver high-resolution, real-time images of coronary artery anatomy and plaque characteristics. Complementary physiological tools, including fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), virtual fractional flow reserve (vFFR), and quantitative flow ratio (QFR), quantify blood flow and lesion severity, supporting comprehensive disease evaluation. Cathlab nurses and technicians are pivotal in operating, maintaining, and troubleshooting these advanced systems during interventions, ensuring accurate setup and smooth procedural flow for optimized patient care. Discussion: For Cathlab teams, particularly nurses and technicians, a thorough understanding of these intravascular imaging and physiological modalities is essential. Their expertise facilitates both procedural assistance and the interpretation of clinical data critical to patient management. The integration of imaging and physiological data enables tailored interventions, enhancing treatment precision and patient outcomes. The frontline experience of nurses and technicians is vital to maintaining procedural efficiency, patient safety, and the seamless incorporation of emerging intravascular techniques in clinical practice. Conclusion: The ongoing evolution of intravascular imaging and physiological assessment technologies marks a transformative phase in cardiovascular care within Cathlabs. Sustained education, efficiency and adaptability are crucial to upholding high standards of care, enhancing procedural efficiency, and ensuring patient safety in this specialized environment.
Effect of Ramadan Fasting on Blood Pressure among Health Care Workers in a Specialized Hospital in Bangladesh
Background Each year, hundreds of millions of adult Muslims around the world refrain from eating and drinking during daylight hours for one month during Ramadan. The lifestyle changes in Ramadan, including intermittent dietary restriction, result in various physiological and metabolic alterations. This study aimed to assess the effect of Ramadan fasting on blood pressure. Methods This longitudinal study was conducted among adult Muslim healthcare workers of the National Heart Foundation Hospital and Research Institute who fasted for at least 20 days during Ramadan. Of 416 enrolled before Ramadan, 306 attended the follow-up visit immediately after Ramadan. Individuals with cardiovascular diseases, other than hypertension, and chronic kidney disease were excluded. Socio-demographic characteristics, smoking status, and medical history were collected at baseline. Blood pressure, body weight, and body water composition were measured at both visits. Blood pressure was measured three times using an automated oscillometric device, and the average of the last two readings was recorded. Body water composition was assessed using a bioelectrical impedance analyzer. Paired data, including changes in systolic and diastolic blood pressure (SBP and DBP), were analyzed using paired t-tests and Wilcoxon signed-rank test. Mixed-effects regression models were applied to assess the effect of Ramadan fasting on SBP and DBP while controlling for potential covariates. A principal component ‘body composition’ was used to avoid multicollinearity between BMI, fat mass, and body water. Results The mean age of the participants was 31.4±8.6 years; two-thirds (67.7%) were female. Before Ramadan, mean SBP was 104.6 mmHg (95% CI: 102.9, 106.3) and DBP was 70.0 mmHg (95% CI: 68.9, 71.1). After Ramadan, mean SBP decreased to 102.3 mmHg (95% CI: 100.8, 103.7), while DBP slightly increased to 70.4 mmHg (95% CI: 69.4, 71.3). In the mixed-effects regression model adjusted for age, sex, smoking and hypertension status, and body composition, the decline in SBP remained significant (-1.6 mmHg, 95% CI: -2.6, -0.5, p=0.004), while DBP showed a small but significant increase (0.9 mmHg, 95% CI: 0.2, 1.5, p=0.01). A significant interaction was observed between Ramadan fasting and hypertension status for both SBP and DBP (βSBP = −5.4, 95% CI: −9.0 to −1.8, p = 0.003; βDBP = −3.4, 95% CI: −5.9 to −0.8, p = 0.01), indicating that the effect of Ramadan fasting was more pronounced in hypertensive patients. Conclusion Ramadan fasting was associated with a small but significant reduction in systolic BP and a modest rise in diastolic BP. Notably, hypertensive participants experienced larger decreases in both SBP and DBP, indicating potential cardiovascular benefits of fasting for hypertensive persons.
The role of ‘Power’ in transformative CVD prevention
Power has long been recognized in health promotion as a fundamental force that shapes people’s access to resources, participation in decision-making, and influence over the conditions that determine their health. To advance prevention more broadly, cardiovascular disease (CVD) prevention in particular, we need to explicitly consider how power dynamics operate at structural, institutional, and interpersonal levels. Doing so allows us to identify whose interests shape prevention agendas, whose knowledge is valued, and whose needs are prioritized within health systems. Traditional models of CVD prevention often reproduce existing power imbalances by privileging the perspectives of policymakers and health professionals, while social, cultural, and community voices remain marginalized. We need to shift these dynamics by redistributing power toward individuals and communities, particularly those most at risk for CVD, to foster more inclusive and responsive prevention efforts. Emphasizing shared decision-making, participatory frameworks, and the co-production of strategies can enhance both equity and sustainability. This perspective foregrounds agency, empowerment, and collaboration in reimagining prevention to address not only biological risk factors but also the broader social determinants of health. By acknowledging and reconfiguring power relations, we can develop prevention strategies that are just, relevant, and aligned with the lived realities of diverse populations.
How Do I harvest Internal Mammary Artery in Minimally Invasive Coronary Artery Bypass Surgery?
Introduction: Left internal mammary artery (LIMA/IMA) is considered as the gold standard, in terms of conduit selection during coronary artery bypass grafting (CABG). Harvesting of IMA, as a result takes a significant part during CABG. IMA harvesting during minimal invasive (MICS) procedure is even more crucial. Methods: in this article we have tried to emphasize how we can harvest IMA with very less effort, minimum injury to the vessel and chest wall, avoidance of clipping, minimum blood loss, minimum spasm etc. Conclusion: We have tried to show how we can effectively harvest IMA by change of some of harvesting tools, few patient/table positions, use of different endotracheal tubes etc.
Data, Power, and People: Toward Inclusive and Community-Led Governance in Health Research
Equitable research begins by examining who holds power in the research process, how that power is exercised, and whose voices are excluded or marginalized. Globally, visible minority and Indigenous communities have historically experienced research that was extractive, harmful, or conducted without meaningful participation or consent, shaping understandable mistrust toward academic institutions. Addressing these imbalances requires more than ethical intentions. It requires structured approaches that embed equity into how data is collected, governed, interpreted, and shared. Data governance offers a practical pathway for this transformation. Frameworks such as FAIR (Findable, Accessible, Interoperable, and Reusable), OCAP (Ownership, Control, Access, and Possession), CARE (Collective Benefit, Authority to Control, Responsibility, and Ethics), and EGAP (Evidence in Governance and Politics), along with models like Bruhn’s spectrum, outline principles that balance access, accountability, autonomy, and community rights. When implemented collaboratively, these approaches reposition communities as partners and decision-makers rather than subjects of inquiry. Ethical data governance therefore strengthens research relationships by promoting equity, transparency, and inclusion, while preventing the reproduction of past hierarchies.
SCAD Unexpected cause of NSTEMI in a 50 year old male: SCAD
Spontaneous coronary-artery dissection (SCAD) has emerged as an important cause of myocardial infarction in young people. Although SCAD is uncommon, awareness of both the disease and its angiographic appearance has improved. Accurate and rapid diagnosis is paramount because the management of acute myocardial infarction caused by SCAD differs vastly from that of atherosclerotic myocardial infarction. The use of endocoronary imaging such as IVUS and optical coherence tomography is necessary in case of diagnostic doubt (especially in SCAD type 2 and 3). The optimal management of SCAD remains unclear. A conservative approach should be the preferred strategy. Here we report a case of a 50-year-old male patient who presented with chest pain for 7 days with the diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI). Coronary angiography showed a type 1 SCAD of the obtuse marginal & right coronary artery. The patient was discharged under medical treatment.