Browsing by Author "Shakya, Smriti"
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Publication Impact of Thrombus Burden in Patients with Acute Coronary Syndrome during the Hospital Stay: A Cross-Sectional Study at a Tertiary Center in Nepal(Institute of Medicine, Tribhuvan University, 2025) Bhusal, Khem Raj; Shrestha, Hemant; Devkota, Surya; Thapa, Sanjeev; Manandhar, Bhawani; Khanal, Raja Ram; Shakya, Smriti; Thapa, Shovit; Jha, Suchit; Miya, Madeena; Sah, Sangam; Upadhayaya, Prajjwal; Gajurel, Ratna ManiAbstract: Introduction Acute coronary syndrome (ACS) is the leading cardiovascular (CV) cause of mortality and necessitates prompt diagnosis and treatment. Luminal thrombus secondary to coronary plaque rupture is considered as the underlying mechanism for ACS. Intracoronary thrombus burden was a strong predictor for adverse outcomes including stent thrombosis, myocardial re-infarction, and mortality. Methods This study was done in consecutively taken 72 patients presenting with acute coronary syndrome. Angiographic grading of intracoronary thrombus was done according to TIMI thrombus grading. Information on Cardiovascular risk factors and comorbidities was obtained and analysis was done with respect to Thrombus Grade. Adverse cardiovascular outcomes during hospital stay, length of hospital stay and in-hospital mortality were analyzed with respect to thrombus grade. Results Among 72 patients studied, the mean age was 58.93 (± 14.22 years) ranging from 30 years to 91 years. Males were 36.1% while 63.9% were females. Regarding the comorbidities, 62.5% were Hypertensive, 34.7% were Diabetic, 6.9% had hypothyroidism, 2.8% had chronic kidney disease and 5.6% had chronic obstructive pulmonary diseas, 38.9% were active smokers, 15.3% were former smokers, 34.7% were alcohol consumer, 5.6% were tobacco consumer and 1.4% were substance abuser. Among the participants, 6.9% had prior history of MI and 4.2% had prior history of stroke. High thrombus burden was associated with longer duration of hospital stay (p-value=0.026). Conclusion High Thrombus burden was significantly associated with longer duration of hospital stay because of being sicker due to higher cardiovascular events in high thrombus group. Cardiovascular complications were significantly higher in high thrombus burden group.Publication Left Atrial Enlargement as a Predictor of Atrial Fibrillation in Rheumatic Mitral Valve Disease: An Echocardiography-based Retrospective Cross-sectional Study(Nepal Health Research Council, 2023) Anil, Suryabanshi; Timilsina, Binita; Shakya, Smriti; Khanal, Shambhu; Yadav, Vijay; Joshi, AmirAbstract Background: Rheumatic heart disease is a major cause of cardiovascular morbidity and mortality in developing nations and is a leading cause of hospital admission due to cardiac problems in our country. This study will evaluate the association between left atrial size and the occurrence of atrial fibrillation and describe the clinical characteristics along with complications related to Rheumatic Mitral valve disease. Methods: A retrospective cross-sectional study was conducted at a tertiary care center from January 2018 to December 2019. Reports of 207 patients admitted to medical and/or surgical wards with echocardiographic diagnosis of rheumatic mitral valve disease with or without atrial fibrillation were reviewed. Data were collected, entered, and analyzed using the Statistical Package for the Social Science version 25.0. Results: Among 207 patients, atrial fibrillation was present in 90 (43.5%) patients. Atrial fibrillation was higher in patients with mixed mitral valvular lesions compared to isolated mitral stenosis or mitral regurgitation. Univariate and multivariate analysis revealed left atrial size [aOR=1.067, 95% CI: 1.023 – 1.113, P= 0.002] and age [aOR = 1.073, 95% CI: 1.042 – 1.105, P<0.001] as an independent predictor of atrial fibrillation. Conclusions: Larger left atrium was an independent predictor of atrial fibrillation. Besides this, atrial fibrillation was associated with increasing age, mixed mitral valvular lesion, and moderately reduced left ventricular ejection fraction, but not associated with gender and mitral stenosis severity. Left atrial clot was significantly higher in patients with atrial fibrillation than in sinus rhythm. Keywords: Atrial fibrillation; left atrium; mitral valve; rheumatic heart diseases.