1.Coronary flow grade is independent predictor of improved left ventricularfunction in patients with acute myocardial infarction treated by primary PCI: a two-dimensional speckle tracking study
Batmyagmar Kh ; Surenjav Ch ; Amarjargal B ; Lkhagvasuren Z
Mongolian Medical Sciences 2016;178(4):23-28
Introduction
Coronary TIMI flow gradewas previously demonstrated to be related to outcome after acute myocardial
infarction. However, the relationship between coronary flow grade and left ventricular global longitudinal
strainin patients with acute myocardial infarction (AMI) treated by primary percutaneous intervention
(PCI) were unclear.
Goal
In this study, we aimed to reveal the relationship between coronary TIMI flow grade and LV GLS in
patients with AMI.
Materials and Methods
We prospectively selected patients with AMI who treated by primary PCI. Based on whether TIMI 3
flow achieved at the end of the procedure patients were divided into two groups. Group I (TIMI 3 flow
was achieved, n=367), Group II (TIMI 3 flow was not achieved, n=47). The LV GLS was assessed by
2dimensional speckle-tracking echocardiography (2D STE).
Results
A total of 413 patients (mean age 60±13, 84% male) were included and TIMI 3 flow was achieved in
367 patients (88%). LV GLS was significantly impaired in patients who had TIMI 3 flow not achieved
compared with TIMI 3 flow achieved group (-13.1±4.8% vs. -15.3±3.8%, p<0.001). Multiple linear
regression analysis which included age, gender, clinical, biochemical and angiographic variables
showed that coronary TIMI flow grade of culprit artery was independently associated with LV GLS. There
was negative correlation between coronary TIMI flow grade and LV GLS (Pearson’s r=-0.183, p<0.001).
Simple linear regression analysis revealed that coronary TIMI flow grade is directly associated with LV
GLS (β=-1.61, p<0.001) and which indicated that every 1 scale increase of final coronary TIMI flow
grade resulted -1.61% increase of LV GLS.
Conclusion
Our study demonstrated the coronary TIMI flow grade of the culprit artery was independently associated
with LV GLSin patients with AMI treated by primary PCI.
2. Results of the interventional treatment for acute myocardial infarction (year 2010-2014)
Lkhagvasuren Z ; Batmyagmar KH ; Bayaraa O
Innovation 2015;9(4):18-21
The Cardiovascular disease is leading the cause of mortality and morbidity and constantly increasingevery year for past decades. World wide 32 million people gets acute heart attack and 2.5 million deaths occur every year due to AMI. In Mongolia Cardiovascular disease is also leading the cause of mortality and morbidity. It is dramatically increasing every year, 479.4 per 10,000 population in 2012 was increased to 848.1 per 10,000 population in 2013. Dr.B.Jerardin, Prof.Z.Lkhagvasuren and his junior L.Jargalsaikhan jointly implanted first stent inMongolia in 2010. There is rapid development in interventional treatment skills since then. Since 2000 until 2014, total of 3791 coronary angioraphy, 1841 stent implantations was performed.This study has included the patients of last 5 years. Total of 898 patients who are treated with AMI during October 2010 to October 2014 at Third State Central Hospital were analyzed. 73.7% of the patients had left coronary artery disease and 26.3% had right coronary disease. Thisfinding was same with other local researchers study (Galtsog et al. 1987, D.Narantuya et al. 2001).59.4% of the occlusions were 75-99% stenosis, 23.5% had total occlusion. 62.9% of the LAD occlusionwere stenosis of over 75%. It demonstrated majority of the cases performed were high severe lesions.This also may be demonstrating that patients are receiving treatment in their late stage of the disease. Early stage complication such as mortality, restenosis was 3.5%, complication within following one month of after stent implantation was 9-13.1%. Overall mortality rate has decreased each year, 11.9% in 2010, 7.8% in 2012, 4.6% in 2013 relatively. General achievement is now 88.1%-95.4%, which is comparable to other countries.Implementation of coronary procedures in daily practice was one of the major achievements in thecardiovascular field in Mongolia. Patients from capital city are relatively been able to receive coronaryinterventional treatment within 12 hours of onset. However, patients arriving golden standard timingis not sufficient enough as well there are still major concerns for patients living in distant rural areas.
3.First Successful Endovascular Repair of Descending Thoracic Aortic Aneurysm In Mongolia
Lkhagvasuren Z ; Marcus HOWEL ; Tsegeenjav D ; Baasanjav N ; Burmaajav B
Mongolian Medical Sciences 2010;151(1):4-7
Endovascular repair of descending thoracic aortic aneurysm is an attractive approach. Candidates for endovascular repair should have an inner aortic diameter of 23-37 mm adjacent to the aneurysm without signifi cant thrombus or calcifi cation in these so called landing zones. They should have at least 2 cm of normal aorta both proximal and distal to the aneurysm to ensure adequate fi xationof the divece. Endografting of the descending thoracic aorta requires preoperative measurements of the diameter of the proximal and distal necks of the aneurysm, tratment length, and proximal and distal angulation. This information can be obtained from CT-ic angiography using three dimensional reconstruction.
4.Plasma level of Apolipoprotein A for coronary artery disease
Chinzorig D ; Lkhagvasuren Z ; Enebish D
Mongolian Medical Sciences 2016;175(1):4-8
IntroductionCoronary artery disease is a leading cause of death among men and women globally. Researchershave focused on apolipoproteins for coronary artery disease (CAD) than traditional lipid parameterssuch as total cholesterol, LDL-C and HDL-C. Measuring Apolipoprotein B (Apo-B) provides a directestimate of the total number of atherogenic particles. Also lipoprotein (a) [LP (a)] is super atherogeniclipoprotein that resembles the LDL containing apo-B in its structure and associated with development ofatherosclerosis and thrombogenesis.GoalTo determine some specifi c lipid markers such as apo-B, LP (a) and traditional lipid parameters forcoronary atherosclerosis and compare with healthy groupMaterials and MethodsHospital based case control study. The study included 42 patients undergoing coronary angiographywith >75% narrowing of main coronary arteries and 43 healthy controls. We collected data of traditionallipid parameters by “endpoint” method and apo-B, LP (a) by “immunoturbidometry method” from ROCHECOBAS 6000 analyzer series.ResultÀpo-Â and Lp(a) were 108.88±26.61 mg/dl, 19.50±24.86 mg/dl and signifi cantly higher in patientswith coronary artery disease (CAD) versus control group. Total cholesterol, especially LDL-C thatApo-B is major on its surface signifi cantly different in the study groups (p<0.05). Also, other lipoproteinthat containing apo-B, one of them is LP (a) were higher in the case group (p≤0.05) compared withhealthy controls. Logistic regression analysis showed that Apo-B were one of main risk factors for CAD(OR=1.024, p=0.013).ConclusionOur fi ndings suggest that LDL-C
5.Results of reperfusion treatment by percutaneous coronary intervention in acute myocardial infarction
Lkhagvasuren Z ; Bayaraa Т ; Batmyagmar KH ; Purevjargal L
Mongolian Medical Sciences 2016;176(2):11-14
BackgroundThe cardiovascular disease is leading cause of mortality and constantly increasing every year forpast decades. In 2014, cardiovascular diseases were the leading cause of NCD deaths (17.5 milliondeaths) [7] In Mongolia cardiovascular disease is also leading the cause of mortality and morbidity.It is increasing every year, 479.4 per 10000 population in 2012 was increased to 848.1 per 10000population in 2013 [1, 2].Dr.Jerardin, prof. Z.Lkhagvasuren implanted first stent in Mongolia in 2000. There is rapiddevelopment in interventional cardiology treatment since then.Material and MethodsSince 2011 until 2015, total of 4545 coronary angiography, 2322 stent implantation was performed.This study has included the patients of last 5 years. Total of 1257 patients who were treated with AMIduring 2011 to 2015 at the Third central State Hospital were analyzed.Results73.7% of the patients had left coronary artery disease and 26.3% had right coronary artery disease.Tis findings were similar with other local researcher’s study [3, 4].59.4% of the occlusions were 75-99% stenosis, 23.5% had total occlusion. 62.9% of LAD occlusionwere stenosis over 75%. It demonstrated majority of cases performed were high severe lesions. Thisalso may be demonstrating that patients are receiving treatment in their late stage of the disease.Every stage complication such as mortality, was 3.5%, complication such as restenosis followingone month of after stent implantation was 9-13.1%. Overall mortality rate has decreased each year,11.9% in 2011, 7.8% in 2012, and 4.6% in 2013 relatively. General achievement is now 88.1-95.4%,which is comparable to other countries.Conclusion1257 patients presented with acute myocardial infarction were studied: 880 (70, 0%) were male, 377(30, 0%) were female. Mean age of patients was 55, 08±1, 23; it was 75 patients had no risk factors,751 patients with 1-2 risk factors, 431 patients with 3 or more risk factors. Angiographic distributionof lesion shows 74, 4% had LAD disease, 64, 5% had RCA disease, 25, 8% had LCX lesion, 12, 9%had dialonal LCA lesion.
6. Correlation between the blood glucose level and food consumption of Elder people
Ariunjargal Z ; Zesemdorj O ; Erdenebat N ; Odsuren S ; Bat-Erdene N ; Lkhagvasuren TS ; Munkhtsetseg J ; Munkhzol M ; Odkhuu E
Innovation 2014;8(2):28-32
The increasing proportions of aged persons have been accompanied in the world. NCDs are often associated with older age groups. High blood glucose levels and unhealthy diet increase the risk of or cause most NCDs. In this study we aimed to determine correlation between the older people (60<) blood glucose level and food consumption. 1563 healthy elder people participated in this research. We measured blood glucose level in all subjects at the Nursing school’s Training and Research Center of health science university of Mongolia. Ulaanbaatar city, Orkhon aimag, Khovd aimag, Khentii aimag, Bulgan aimag, Dornogovi aimag, Tov aimags represented urban areas, while the rest of aimags and soums represented rural areas. The questionnaire was used to collect data on respondent’s social-economic status, fruit and vegetable consumption, physical activity, and their causes. In order to assess the diet pattern of the surveyed population, the respondents were asked about frequency of fruit and vegetable consumption, type of oil used in food, and amount of salt consumed daily. Simple regression analysis was performed to shown that significantly positive correlations between blood glucose and salt intake (р<0.001), The other composition are no significantly changes.
7. DEGREE OF CORONARY ATHEROSCLEROSIS IS ASSOCIATED WITH CHANGING CIRCULATING LEVELS OF ENDOTHELIN RECEPTOR TYPE A IN MONGOLIAN ADULTS
Purevjargal L ; Nandin G ; Ayurzana A ; Haliun N ; Shine-Od ; Uranchimeg D ; Avirmed A ; Enebish S ; Amgalanhaatar D ; Lkhagvasuren ; Erdenebayar.N
Innovation 2013;7(3-S):73-76
Background:The cardiovascular disease especially coronary artery disease is the leading cause of mortality in worldwide. There is lack of research study which evaluated stenosis of coronary atherosclerosis. It is known that coronary stenosis is highly connected to the levels of biomarkers. Coronary atherosclerosis correlated with endothelin receptor type A (EDNRA) levels in a group of patients suspected of having coronary artery disease.Objective:The goal of this study was to evaluate the relation between the coronary atherosclerosis and levels of EDNRAMethods:A total of 311 participants were involved in this study. A case-control study was used in the study. The baselines data were collected from the department of Angiography at the National Third Central Hospital and National lilood Transfusion and Research center. We have determined the degree of coronary atherosclerosis using the Angiography machine and Elisa were used for detecting the blood endothelin levels in all groups.Results:98 participants were diagnosed with stenosis and occlusion. The blood endothelin levels were estimated to 6.32±0.64 pg/ml which refer to () degree of coronary stenosis, the first degree of stenosis of coronary atherosclerosis is estimated to 5.56±0.22pg/ml, the second degree of stenosis of coronary atherosclerosis is estimated to 5.42J0.34 pg/ml, the third degree of stenosis of coronary atherosclerosis is estimated to 5.87 H). 13 pg/ml, the fourth degree of stenosis of coronary atherosclerosis is I'SlilllSltll lo 5.69±0.09 pg/ml, it was estimated to 5.88±0.13 pg/ml in control groups. Level of EDNRA (occupying one segment of coronary artery) was estimated to 5.77±0.08 pg/ml. two segment involvement was estimated to 5.72±0.16 pg/ml, three segment involvement 5.73±0.19 pg/ml. four segments involvement 5.50±0.25 pg/ml, respectively.Conclusion:The blood endothelin level and coronary artery stenosis were not correlated statistically significant in control group of the study. However, blood endothelin levels were increased in patients who tend to experience the coronary artery stenosis.
8.RESULT OF 7-YEAR STUDY ON RESTENOSIS AND THROMBOSIS IN AFTER PCI TREATMENT SETTING
Lkhagvasuren Z ; Narantuya D ; Batmyagmar Kh ; Erdembileg D ; Bayaraa T ; Byambatsogt L ; Erdenechimeg M
Innovation 2018;12(4):6-9
BACKGROUND. The aim of this study was to investigate the prognostic impacts of drug-eluting stents (DES) and bare-metal stents (BMS) in patients undergoing percutaneous coronary intervention (PCI) and risk factors of stent restenosis.
MATERIAL AND METHODS. We conducted a retrospective cohort study based on the Angiographic diagnostic and treatment Department of 3rd State Central Hospital of Mongolia. Patients who had undergone coronary stenting between 2000 and 2017 were recruited and monitored until the end of 2010.
RESULTS. Among a total of 4520 selected patients with a mean age of 58±7 years, 2125 subjects had BMS and 2395 subjects had DES. The incidence of stent restenosis and stent thrombosis were significantly lower in the DES (37; 1,5%) group as compared with the BMS (201; 9,4%) group. Patients who have stent restenosis presented comorbidities, such as diabetes 214(47,8%), hypertension 54(22,6%), prior PCI 21(8,2%), re-infarction 12(5,04%), chronic kidney disease 16(6,7%), hyperlipidemia 21(8,2%).
СONCLUSION. Implantation of DES was related to better outcomes than for BMS, in terms of reducing restenosis and stent thrombosis after PCI. STEMI patients who have co morbidities have greater risk of stent stenosis and thrombosis
9.Heart remodeling in children after endovascular and surgical сorrection of atrial septal defect
Baasanjav N ; Davaatseren Ts ; Lkhagvasuren Z ; Bayaraa T ; Damdinsuren Ts ; Ariuntsatsral E
Mongolian Medical Sciences 2018;185(3):18-22
The study of indices of heart remodeling was performed in children with secondary atrial septal defects (ASDs) after either endovascular or surgical repair of the defects. The data analysis showed that serious ASDs lead to diastolic left ventricular (LV) dysfunction. Recovery of LV function occurred during the first day following endovascular repair or after six months following surgical correction. Maximum reduction of dilatation of the right heart chambers after ASD repair is recorded in the early postoperative period and keeps during follow up, regardless of the method for the defect repair. We found a significant depression in mechanical activity of left atrium after surgical repair with the recovery one year after the procedure.
10.Evaluation of the Agatston Coronary Artery Calcium score using contrast enhanced CT-Coronary angiography
Badamsed Ts ; Lkhagvasuren Z ; Delgertsetseg D ; Batgerel O ; Dulamsuren T
Mongolian Medical Sciences 2023;203(1):3-7
Background:
In 1904, Monkeberg was first described about the coronary calcification which is the degenerative change that occurs with aging process, but the last decades many studies have been confirmed that coronary calcification was an active process same as the signaling pathways with bone mineralization. Coronary calcification increases the risk of myocardial infarction during bypass graft surgery and PCI (СМ СN. Shanahan, 1999).
Goal:
To evaluate Agatston Coronary Artery Calcium score using contrast enhanced CT-Coronary angiography.
Objectives:
1. To assess Agatston Coronary Artery Calcium score
2. Age and gender relationship of coronary calcification
Materials and Methods:
We evaluated total 215 patients who were admitted to the Reference center of Diagnostic Imaging named after R.Purev State Laureate, People’s physician and Honorary Professor of the Third State
Central Hospital awarded with the Red banner of the Labor diagnosed with the coronary calcification by contrast enhanced 64 slice CT (Philips Ingenuity CT 64) between 2020 to 2022. Patient’s age was
considered into 6 groups and coronary calcification was assessed by Agatston’s score. The result of our study determined by common statistical averages and errors and probabilities of the indicators
were determined by Student’s criteria.
Result:
When evaluating Agatston coronary artery calcium scoring by CT-coronary angiography, 11-400 Agatston score was predominantly in our study with p value of (P<0.001). Considering relationship of age and gender, coronary calcification occurs 42.3% of patients aged 50-69, male and female ratio was 1.7:1.
Conclusions
1. We established Agatston coronary calcification 11-400 was occurred in 66.96% of the patients.
2. Coronary calcification predominantly occurred in 65% patients aged 50-69 years.