Indian Heart J
· 2026 Jun · PMID 42349716
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BACKGROUND: Sharma et al. reported important findings regarding optical coherence tomography (OCT)-based morphological characteristics of coronary in-stent restenosis (ISR). However, several methodological considerations...BACKGROUND: Sharma et al. reported important findings regarding optical coherence tomography (OCT)-based morphological characteristics of coronary in-stent restenosis (ISR). However, several methodological considerations require further discussion. MAIN TEXT: Key limitations include the cross-sectional design, absence of comparator groups, potential selection bias due to restrictive exclusion criteria, inadequate adjustment for confounding variables, and lack of standardized OCT interpretation with inter-observer variability assessment. CONCLUSION: Addressing these issues in future studies through longitudinal designs, broader inclusion criteria, standardized OCT protocols, and robust statistical analyses may improve the validity and clinical applicability of ISR research.
Sachdeva K, Kaur J, Kanwar A
… +13 more, Goyal A, Singal G, Batta A, Gupta A, Chhabra ST, Aslam N, Raien GS, Ahuja P, Gupta R, Arora J, Grover V, Wander GS, Mohan B
Indian Heart J
· 2026 Jun · PMID 42336100
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BACKGROUND: Infective endocarditis (IE) data from South Asia remain limited, particularly among people who inject drugs (PWID). North India faces a growing injection drug burden, yet comparative IE data between PWID and...BACKGROUND: Infective endocarditis (IE) data from South Asia remain limited, particularly among people who inject drugs (PWID). North India faces a growing injection drug burden, yet comparative IE data between PWID and non-PWID populations are scarce. METHODS: This retrospective cohort study with prospective long-term follow-up was conducted at a tertiary center in Ludhiana, Punjab, India. Patients meeting modified Duke criteria for definite IE (January 2017-December 2021) were compared between PWID (n = 62) and non-PWID (n = 101) groups. Multivariate logistic regression identified in-hospital mortality predictors. Five-year vital status was ascertained by telephone contact. RESULTS: PWID were younger (29.2 ± 7.5 vs. 45.0 ± 15.4 years, p = 0.001), predominantly male (98.4% vs. 64.4%), and had higher hepatitis C co-infection (54.8% vs. 5.9%). Blood culture positivity was greater in PWID (74.2% vs. 32.7%), with MRSA predominating (41.9% vs. 14.9%) and Pseudomonas as the second commonest PWID pathogen (16.1%). Tricuspid valve involvement dominated in PWID (71%), while mitral valve predominated in non-PWID (55.4%). In-hospital mortality was 22.7% with no between-group difference (p = 0.787). Septicemia (OR 5.25), left-sided valve involvement (OR 5.59), deranged liver function (OR 3.76), and congestive heart failure (OR 3.41) independently predicted mortality; PWID status did not. Among 92 contactable patients at five-year follow-up, cumulative mortality was 56.5%, without significant between-group difference (p = 0.33). CONCLUSIONS: IE in North India affects younger patients than Western cohorts. PWID-IE in North India shows distinct features including MRSA dominance and higher culture positivity, yet in-hospital and long-term mortality remain comparable between groups. High culture-negative rates and low surgical intervention warrant attention.
Indian Heart J
· 2026 Jun · PMID 42314796
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Hypertrophic cardiomyopathy (HCM) is a genetically determined myocardial disease in which symptoms are driven not simply by ventricular hypertrophy, but by a combination of dynamic left ventricular outflow tract obstruct...Hypertrophic cardiomyopathy (HCM) is a genetically determined myocardial disease in which symptoms are driven not simply by ventricular hypertrophy, but by a combination of dynamic left ventricular outflow tract obstruction (LVOTO), impaired diastolic filling and other factors.The therapy for HCM differs fundamentally from routine heart failure management and must be mechanism based. In obstructive HCM, the pharmacologic objective is to blunt hypercontractility, lengthen diastole, preserve loading conditions, and reduce the LVOT gradient. In non-obstructive HCM, management is focused on symptom control, heart-rate moderation, careful volume management, and treatment of arrhythmias and congestion. Non-vasodilating beta-blockers, non-dihydropyridine calcium-channel blockers, and disopyramide have constituted the foundation of medical therapy. The contemporary era has added sarcomere-directed treatment with cardiac myosin inhibitors, particularly mavacamten and aficamten, The present review provides a pragmatic algorithm for publication-level clinical use in contemporary practice.
Kapoor A, Bhagwat A, Nabar A
… +32 more, Yadav S, Rao BH, Lokhandwala Y, Gupta SB, Raut K, Mehta KK, Kane D, Rawal R, Vyas A, Shah MM, Vora A, Mehta A, Thomas JM, Arul AD, Makkar N, Namboodiri N, Bohora S, Padmanabhan D, Goyal K, Sathe S, Desai A, Gavali V, Makkar J, Naik N, Naik A, Yadav R, Gupta A, Roy D, Pal J, Tiwaskar M, Samavedam S, Divatia JV
Indian Heart J
· 2026 Jun · PMID 42269917
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UNLABELLED: Out-of-hospital cardiac arrest (OHCA) is a major public health challenge in India. Cardiopulmonary resuscitation (CPR) awareness, training, and bystander response rates remain critically low across the countr...UNLABELLED: Out-of-hospital cardiac arrest (OHCA) is a major public health challenge in India. Cardiopulmonary resuscitation (CPR) awareness, training, and bystander response rates remain critically low across the country. OBJECTIVE: This Indian Society of Electrocardiology position statement aims to promote nationwide CPR awareness, strengthen community response to sudden cardiac arrest (SCA) and improve survival in OHCA, with measures adapted to India-specific systems of care and bystander training. MAIN THEMES: The statement highlights the SCA burden, early recognition, rapid response, barriers to community CPR training in India, dispatcher-assisted CPR, and public access defibrillation (PAD). It emphasizes school-based CPR education, corporate social responsibility partnerships, legislative support, and development of a national CPR ecosystem. Role of digital innovations, mobile applications, virtual reality, mobile CPR training units, psychological barriers and the bystander effect are emphasized. CONCLUSION: The position statement advocates transforming CPR from a medical skill into a societal responsibility and improve OHCA survival in India.
Indian Heart J
· 2026 Jun · PMID 42269916
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Intracoronary thrombus is a hallmark of ST-segment elevation myocardial infarction (STEMI) and remains a major challenge during primary percutaneous coronary intervention (PPCI). Large thrombus burden is associated with...Intracoronary thrombus is a hallmark of ST-segment elevation myocardial infarction (STEMI) and remains a major challenge during primary percutaneous coronary intervention (PPCI). Large thrombus burden is associated with distal embolization, microvascular obstruction, no-reflow, stent thrombosis, and adverse clinical outcomes. Optimal management requires an individualized approach integrating pharmacological and mechanical strategies. This review summarizes the pathophysiology, angiographic assessment, and clinical implications of intracoronary thrombus in STEMI. Contemporary pharmacological therapies, including dual antiplatelet therapy, anticoagulation, glycoprotein IIb/IIIa inhibitors, and intracoronary thrombolytics, are discussed alongside mechanical approaches such as aspiration thrombectomy, mechanical thrombectomy devices, direct stenting, and deferred stenting. Current evidence from major clinical trials and guideline recommendations is reviewed to clarify the selective role of these therapies in modern practice. A practical stepwise management algorithm is proposed to assist interventional cardiologists in tailoring therapy according to thrombus burden, coronary flow, and lesion characteristics. Emerging technologies and future directions aimed at improving thrombus management and microvascular reperfusion are also highlighted. This manuscript is a narrative review of intracoronary thrombus management in acute coronary syndrome, particularly STEMI during PPCI. A structured literature search was performed in PubMed and Embase, along with major guideline documents and cardiovascular society recommendations. Studies published from 2000 to 2026 were included using keywords such as "STEMI," "intracoronary thrombus," "thrombectomy," and "no-reflow." Eligible evidence included randomized controlled trials, observational studies, meta-analyses, and guidelines, while chronic coronary syndromes and chronic total occlusion-related thrombus were excluded. No formal quality assessment or statistical synthesis was performed, and findings were synthesized qualitatively for clinical relevance.
Indian Heart J
· 2026 Jun · PMID 42252055
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BACKGROUND: Artificial intelligence (AI) is transforming cardiology across ECG interpretation, imaging, risk prediction, remote monitoring, and workflow automation. Cardiologists need governance models that preserve clin...BACKGROUND: Artificial intelligence (AI) is transforming cardiology across ECG interpretation, imaging, risk prediction, remote monitoring, and workflow automation. Cardiologists need governance models that preserve clinical judgment, reduce harm, and reflect Indian realities. METHODS: This narrative reviews policy documents (2018-February 2026) spanning the EU AI Act, WHO, OECD, ICMR, FDA GMLP, FUTURE-AI, CHAI, Joint Commission, and MLOps frameworks, alongside medico-legal, automation-bias, fairness, and cardiology-AI implementation studies. We compared these instruments in human-in-the-loop (HITL) oversight and identify gaps in high-risk domains such as echocardiography AI, CT-FFR, cath-lab decision support, and wearable-based rhythm monitoring in India. DISCUSSION: We propose practical HITL governance priorities for cardiology: local validation, calibrated alerting, explicit override pathways, bias surveillance, medico-legal accountability, and governance structures embedded within everyday cardiac workflows. CONCLUSIONS: Realizing meaningful human-in-the-loop oversight requires investment in governance infrastructure, workforce development, transparent performance metrics, and learning systems treating AI-related incidents as opportunities for continuous improvement.
Varghese DA, Guru S, Barik S
… +2 more, Behera A, Sahoo SK
Indian Heart J
· 2026 Jun · PMID 42248244
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STUDY OBJECTIVE: To compare the effectiveness and safety of high-dose versus low-dose intravenous nitroglycerin for hypertensive acute pulmonary edema in the emergency department. METHODS: This open-label, pragmatic, par...STUDY OBJECTIVE: To compare the effectiveness and safety of high-dose versus low-dose intravenous nitroglycerin for hypertensive acute pulmonary edema in the emergency department. METHODS: This open-label, pragmatic, parallel randomized controlled trial was conducted in the emergency department of a tertiary care centre in Eastern India. Adults presenting with hypertensive acute pulmonary edema (systolic blood pressure >160 mm Hg or mean arterial pressure >120 mm Hg) were randomized to receive either high-dose nitroglycerin infusion (starting at 100 μg/min, titrated up to 200 μg/min) or low-dose infusion (starting at 10 μg/min, titrated up to 100 μg/min), in addition to standard care including non-invasive ventilation and diuretics. The primary outcome was attainment of predefined clinical resolution endpoints at 3 and 6 h. Secondary outcomes included time to 25% reduction in systolic blood pressure, need for endotracheal intubation, and hypotension. RESULTS: Sixty-four patients were enrolled, with 32 assigned to each group. At 3 h, clinical resolution occurred in 28 of 32 patients (87.5%) in the high-dose group compared with 16 of 32 patients (53.3%) in the low-dose group (p = 0.003). Time to achieve a 25% reduction in systolic blood pressure was shorter in the high-dose group (p < 0.001). Two patients (6.2%) in the low-dose group required endotracheal intubation compared with none in the high-dose group. No episodes of hypotension were observed in either group. CONCLUSION: Among patients with hypertensive acute pulmonary edema, high-dose intravenous nitroglycerin achieved more rapid clinical resolution and blood pressure reduction than low-dose infusion, without an observed increase in adverse events.
Indian Heart J
· 2026 May · PMID 42155896
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OBJECTIVE: Balloon-expandable (BE) Myval transcatheter heart valve (THV) series demonstrated safety and efficacy in aortic stenosis (AS) in low, intermediate/high surgical risk patients. However, there is a limited compa...OBJECTIVE: Balloon-expandable (BE) Myval transcatheter heart valve (THV) series demonstrated safety and efficacy in aortic stenosis (AS) in low, intermediate/high surgical risk patients. However, there is a limited comparative data with other contemporary valves. The study aimed to compare the early clinical outcomes of next-generation BE Myval THV series with Sapien-3 THV and self-expandable (SE) valves in severe AS patients. METHODS: This retrospective study included 315 AS patients who underwent transcatheter aortic valve implantation (TAVI) with BE Myval THV series (n = 108), or BE Sapien-3 THV (n = 99) or SE valves (n = 108). Propensity-matching data (86 pairs) compared the clinical and hemodynamic outcomes at 30 days. RESULTS: No intraprocedural death/complications were reported post-TAVI. Aortic valve area was significantly improved in BE Myval THV series (0.57 ± 0.18 cm to 2.93 ± 0.49 cm) and SE valves (0.60 ± 0.23 cm to 2.66 ± 0.92 cm) cohorts from baseline to 30 days, and peak and mean aortic gradients were significantly (p < 0.0001) reduced. Permanent pacemaker implantations (PPI) requirement was 1.16% in BE Myval THV series, 4.65% in Sapien-3 THV and 10.47% in SE valves, whereas 3.49% death observed in SE valves, 2.33 % in Myval THV series and 1.19% in Sapien-3 THV at 30 days. SE valves had 13.04% moderate and severe paravalvular regurgitation (PVR), while Myval THV series and Sapien-3 THV cohort had none. CONCLUSION: Safety and efficacy outcomes were comparable among three cohorts, except for higher PPI rate in SE valves cohort. At 30 days, clinical outcomes showed acceptable rates of stroke and death. Valve hemodynamics were excellent, with low rate of PVR in Myval THV series cohort.
Singh V, Chaudhari L, Krishnappa D
… +2 more, Pandit BN, Padmanabhan D
Indian Heart J
· 2026 May · PMID 42155895
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BACKGROUND: Patients with rheumatic heart disease (RHD) are at high risk of stroke. Silent brain lesions (SBL) on brain MRI represent subclinical neurological injury, but their prevalence and predictors in RHD are not we...BACKGROUND: Patients with rheumatic heart disease (RHD) are at high risk of stroke. Silent brain lesions (SBL) on brain MRI represent subclinical neurological injury, but their prevalence and predictors in RHD are not well defined. METHODS: We conducted a prospective, single-center study of consecutive adults with RHD and moderate-to-severe mitral valve disease. Patients with a history of stroke, hypertension, diabetes, smoking, or ventricular dysfunction were excluded. All participants underwent a standardized protocol including clinical assessment, electrocardiography, echocardiography, and 3T brain MRI. RESULTS: Among 79 patients (mean age 44.3 ± 11.4 years, 69.6% female), SBL were present in 14 (17.7%). Most patients (81%; n = 64) had atrial fibrillation (AF). The prevalence of SBL was similar between those with AF and those in sinus rhythm (17.2% vs. 20%). There were no significant differences in age, gender, valve lesion type (stenosis vs. regurgitation), left atrial size, or the presence of LAA thrombus between patients with and without SBL. The majority of SBL (85.7%) were located in cortical regions. CONCLUSIONS: Silent brain lesions on MRI were detectable in 17.7% RHD patients with significant mitral valve disease, even in the absence of traditional stroke risk factors. We did not find any association between occurrence of these brain lesions and atrial fibrillation or left atrial enlargement. Alternative mechanisms like pro-thrombotic states or atrial cardiomyopathy may be responsible. These findings warrant further investigation into the clinical significance and management of subclinical brain injury in RHD.
Gulati P, Nath RK, Kuber D
… +3 more, Pandit BN, Rao S, Aggarwal P
Indian Heart J
· 2026 May · PMID 42150671
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AIM: Complete heart block (CHB) complicates a significant fraction of acute inferior wall ST-elevation myocardial infarctions (IW-STEMI) and is associated with high morbidity. Relationship between right coronary artery (...AIM: Complete heart block (CHB) complicates a significant fraction of acute inferior wall ST-elevation myocardial infarctions (IW-STEMI) and is associated with high morbidity. Relationship between right coronary artery (RCA) occlusion site and CHB recovery remains incompletely characterised in the primary percutaneous coronary intervention (PCI) era. The objective of this study was to evaluate whether the site of RCA occlusion (ostio-proximal/mid versus distal) independently predicts the rate and duration of CHB recovery following primary PCI in acute IW-STEMI. METHODS: This prospective observational study enrolled 100 patients with acute IW-STEMI with CHB who underwent primary PCI at a tertiary care centre in India. Patients were divided into Group 1 (ostio-proximal/mid RCA occlusion, n = 62) and Group 2 (distal RCA occlusion, n = 38). In-hospital serial electrocardiogram monitoring was performed till recovery/permanent pacing. RESULTS: The overall CHB recovery rate was 91%, with no significant difference between Group 1 (88.71%) and Group 2 (94.74%, p = 0.48). Median recovery time was 12 h in both groups (p = 0.21). Independent predictors of reduced recovery included wide complex escape rhythm and associated right ventricular myocardial infarction. Multivariate analysis identified wide QRS pattern, higher baseline creatinine, development of acute kidney injury and heart failure as independent factors delaying CHB recovery in this critical patient subset. CONCLUSION: Angiographic site of RCA occlusion does not independently predict CHB recovery after primary PCI. Prompt revascularization, metabolic status, and haemodynamic stability are key determinants of conduction recovery, supporting an expectant management strategy with serial electrocardiogram monitoring rather than early permanent pacing based solely on lesion location.
Bose A, Bahl A, Gupta A
… +2 more, Mehrotra S, Bhasin D
Indian Heart J
· 2026 May · PMID 42082103
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BACKGROUND: Relapse is an important problem in nonischemic dilated cardiomyopathy (DCM) patients with improved left ventricular ejection fraction (LVEF). This study aimed to determine the long-term outcomes of patients w...BACKGROUND: Relapse is an important problem in nonischemic dilated cardiomyopathy (DCM) patients with improved left ventricular ejection fraction (LVEF). This study aimed to determine the long-term outcomes of patients with non-ischemic dilated cardiomyopathy and improved ejection fraction and analyse the risk of relapse in patients being managed with medical therapy. METHODS: This was a single-centre, retrospective, observational study of all adult patients with non-ischemic DCM enrolled in a cohort. Patients with improved LVEF defined as LVEF <40% at baseline who showed improvement of LVEF to a level ≥40% with an absolute increase in LVEF of ≥10% while on medical therapy were included and followed-up till end of study period. RESULTS: Of the 548 patients in the non-ischemic DCM group, 131 (23.9%) had an improved LVEF. Of these, 72 (55%) patients had sustained improvement, while 59 (45%) relapsed during follow-up. In the relapsed group, 7 (11.9%) patients had discontinued drug therapy. Relapse occurred at a median duration of 57 months (range 8-224 months) after improvement of LVEF. Of the total patients who had improved LVEF, 3.8% relapsed by 1 year, 23.7% by 5 years and 37.4% by 10 years. CONCLUSION: In this non-ischemic DCM cohort 23.9% patients improved their LVEF. Of these, 45% relapsed. Risk of relapse persists over long-term with nearly 50% patients relapsing more than 5 years after their improvement in LVEF. Diabetes mellitus and higher left ventricular internal diameter in diastole at improvement were independent predictors of relapse.
OBJECTIVE: Immune-inflammatory processes play a central role in the progression of atherosclerosis. The objective of this study is to evaluate whether circulating microparticles (MPs) correlate with coronary artery disea...OBJECTIVE: Immune-inflammatory processes play a central role in the progression of atherosclerosis. The objective of this study is to evaluate whether circulating microparticles (MPs) correlate with coronary artery disease (CAD) severity defined by SYNTAX Score II in patients aged <45 and >45 years. METHODS: This single-centre, open-label, comparative study enrolled 80 patients with angiographically confirmed CAD (40 aged <45 years and 40 aged >45 years) between June 2023 and July 2024. Forty age- and sex-matched individuals with angiographically normal coronary arteries served as the control group. Blood samples were analysed for total MPs, endothelial MPs, platelet-derived MPs, and leukocyte markers (CD45, CD19, CD3, CD16). RESULTS: The study population included a younger cohort in Group I (<45 years; mean age 39 ± 5 years) and an older cohort in Group II (>45 years; mean age 63.9 ± 7.1 years). SYNTAX I and II scores were significantly higher in Group II compared with Group I. Circulating microparticles, including total, endothelial, platelet-derived, CD45, CD19, CD3, and CD16 microparticles, were significantly elevated in both CAD groups compared with controls, with higher levels observed in Group II. Significant positive correlations were observed between several microparticle subtypes and SYNTAX scores. ROC analysis demonstrated that total microparticles (AUC 0.836) and CD16 microparticles (AUC 0.856) were the strongest predictors of high SYNTAX II scores. CONCLUSIONS: Our study highlights the potential of MPs as biomarkers for early detection and risk stratification of CAD, supporting more personalised and effective treatment strategies.
OBJECTIVE: To assess the agreement between transthoracic echocardiography (TTE) and computed tomography coronary angiography (CT-CAG) for measurement of the left ventricular outflow tract diameter (LVOTd) in the paraster...OBJECTIVE: To assess the agreement between transthoracic echocardiography (TTE) and computed tomography coronary angiography (CT-CAG) for measurement of the left ventricular outflow tract diameter (LVOTd) in the parasternal long-axis orientation, and to explore anthropometric predictors of LVOTd in stable Indian adults. METHODS: In this prospective, single-centre study, hemodynamically stable adults in sinus rhythm undergoing outpatient CT-CAG were enrolled (October-December 2024). LVOTd was measured by TTE (parasternal long-axis view, mid-systole) and by CT in a matched long-axis orientation (anteroposterior diameter at the same anatomical level) by separate blinded readers. Agreement was assessed using intraclass correlation coefficients (ICC) and Bland-Altman analysis. RESULTS: Of 100 screened subjects, 91 were analysed (mean age 53.9 ± 8.7 years; 72.5% male; 84.6% health screening). Mean LVOTd was 1.94 ± 0.24 cm (CT-CAG) versus 1.88 ± 0.18 cm (TTE). The two modalities demonstrated good agreement for LVOTd (ICC 0.85; 95% CI 0.77-0.89). Bland-Altman analysis revealed a bias of 0.05 cm (limits of agreement 0.25 to 0.34 cm), with CT-CAG yielding larger values. Agreement diminished for derived parameters, being moderate for LVOT area (ICC 0.74) and modest for cardiac output (CO) (ICC 0.57; bias 0.5 L/min), indicating non-interchangeability for hemodynamic calculations. Body weight was the sole significant predictor of LVOTd (β = 0.004 cm/kg; R = 0.29; p = 0.04). CONCLUSIONS: In stable Indian adults, TTE and CT-CAG show good agreement for LVOTd measured in a comparable anatomical plane. Agreement diminishes for derived area and CO estimates. The weight-based model requires validation in larger, more diverse cohorts.
The Occlunix® septal occluder (OSO) is a new generation double disk occluder device for catheter closure of the secundum atrial septal defect (ASD). Fifty-six consecutive patients who underwent ASD device closure with th...The Occlunix® septal occluder (OSO) is a new generation double disk occluder device for catheter closure of the secundum atrial septal defect (ASD). Fifty-six consecutive patients who underwent ASD device closure with the OSO between February 2022 and April 2024 were evaluated in this single-center observational study. All procedures were done under transesophageal echocardiography guidance. The OSO was successfully deployed in all patients (technical success 100%). Fifty-five patients had complete closure of the intervened ASD after device closure (procedural success 98.2%). The sole patient with trivial intradevice shunt had complete seal of the defect at 1-month follow-up. There were no device related complications - cardiac, vascular or systemic. During the follow-up period of 32.2 ± 9.1 months, the device position was satisfactory in all, with no complications. The OSO was associated with lower procedural cost than one of the most used conventional ASD occluders used in the country.
Neurodevelopmental outcomes among survivors post-surgery for congenital heart disease (CHD) in India remain insufficiently characterized. Structured searches in PubMed and Google Scholar for studies on neurodevelopmental...Neurodevelopmental outcomes among survivors post-surgery for congenital heart disease (CHD) in India remain insufficiently characterized. Structured searches in PubMed and Google Scholar for studies on neurodevelopmental outcomes published between January 2000 and December 2025 identified six studies from India: five single-centre and one multicentric cohort. Across studies, early motor delay was reported in 14-33% of children and mental or cognitive delay in 15-24%. Risk factors included syndromic association, prolonged postoperative illness, and socioeconomic disadvantage. Long-term school-age, longitudinal, and regionally representative data remain sparse. Integration of structured neurodevelopmental follow-up into CHD care is needed.
Low-density lipoprotein cholesterol (LDL-C) is a key modifiable risk factor for atherosclerotic cardiovascular (CV) disease in patients with acute coronary syndrome (ACS). While high-intensity statins are foundational, m...Low-density lipoprotein cholesterol (LDL-C) is a key modifiable risk factor for atherosclerotic cardiovascular (CV) disease in patients with acute coronary syndrome (ACS). While high-intensity statins are foundational, many patients fail to reach guideline-recommended targets, leaving a high residual risk during the early post-ACS phase. Evidence from EVOPACS and EVACS trials demonstrates that early in-hospital proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) initiation achieves rapid, intensive LDL-C lowering, with over 90% of patients attaining targets of ≤1.4 mmol/L by discharge. Furthermore, the PACMAN-AMI and HUYGENS trials confirm that PCSK9i therapy promotes plaque regression and stabilisation by increasing fibrous cap thickness and reducing lipid-rich necrotic core content. Meta-analyses indicate significant reductions in major adverse CV events and ACS-related hospitalisations within 6-18 months. Early PCSK9i integration offers a potent, safe strategy to bridge lipid management gaps and optimize secondary prevention outcomes in high-risk populations, including those in India.