BACKGROUND: Sotatercept, a first-in-class activin signaling inhibitor, represents a paradigm shift in pulmonary arterial hypertension (PAH) by directly targeting pulmonary vascular remodeling. We conducted a meta-analysi...BACKGROUND: Sotatercept, a first-in-class activin signaling inhibitor, represents a paradigm shift in pulmonary arterial hypertension (PAH) by directly targeting pulmonary vascular remodeling. We conducted a meta-analysis of randomized controlled trials (RCTs) to quantify its efficacy and safety. METHODS: We systematically searched PubMed, Embase, and Cochrane Central from inception to October 2025 for RCTs comparing sotatercept with placebo in PAH. The primary outcome was trial-defined clinical worsening (CW). Secondary outcomes included all-cause mortality, multicomponent improvement (MCI), attainment of low-risk status, serious adverse events (SAEs), and bleeding. Data were pooled using a Mantel-Haenszel random-effects model. Risk of bias was assessed with RoB 2.0, certainty of evidence using GRADE, and trial sequential analysis (TSA) was performed to assess conclusiveness. RESULTS: Four RCTs comprising 921 patients (sotatercept n = 483; placebo n = 438) were included. Sotatercept significantly reduced clinical worsening (OR 0.18, 95 % CI 0.12-0.27) with minimal heterogeneity and TSA-confirmed conclusiveness. All-cause mortality showed a favorable but non-significant trend (OR 0.63, 95 % CI 0.33-1.20). Sotatercept significantly increased MCI (OR 4.68, 95 % CI 1.94-11.31) and attainment of low-risk status (OR 2.77, 95 % CI 1.49-5.17), with moderate heterogeneity. SAEs were reduced (OR 0.72, 95 % CI 0.53-0.99), while bleeding risk was increased, predominantly minor mucocutaneous events (OR 2.84, 95 % CI 1.94-4.15). CONCLUSION: Sotatercept markedly reduces clinical worsening and improves multidimensional outcomes in PAH with an acceptable safety profile, supporting its role as a disease-modifying therapy.
Chidambaram Y, Saravana Kumar P, Gunasekar S
… +11 more, Kundoor LR, Kuppusamy M, Kasi M, Chandrasekaran AM, Shanmugasundaram S, Ramesh S, Sadagopan T, Naik N, Roy A, Prabhakaran D, Senguttuvan NB
INTRODUCTION: Systemic hypertension is a major contributor to global cardiovascular morbidity and mortality. Effective management combines pharmacological and lifestyle interventions. Pranayama, a yogic breathing techniq...INTRODUCTION: Systemic hypertension is a major contributor to global cardiovascular morbidity and mortality. Effective management combines pharmacological and lifestyle interventions. Pranayama, a yogic breathing technique, may modulate cardiovascular function, but its impact on hypertension remains uncertain. METHODS: A systematic review and meta-analysis following PRISMA guidelines (PROSPERO: CRD42024597502) included RCTs from PubMed, Cochrane Library, Scopus, and ClinicalTrials.gov up to April 2025. We assessed Risk of bias using Cochrane RoB 2, and pooled effects were reported as standardized mean differences (SMDs) with 95 % confidence intervals (CIs). RESULTS: Seven RCTs (683 participants) showed a significant reduction in the primary outcome, heart rate (SMD = -0.43; 95 % CI: -0.52 to -0.34; I = 0 %). Systolic BP decreased significantly under fixed-effects (SMD = -0.72), while diastolic BP and HRV improvements were modest. CONCLUSION: Pranayama lowers heart rate and may modestly reduce blood pressure, supporting its role as a safe, adjunctive therapy pending larger standardized trials.
BACKGROUND: Management of late presenters with cyanotic congenital heart disease (CCHD) and reduced pulmonary blood flow is challenged by multi-system derangements from longstanding hypoxia in addition to anatomic factor...BACKGROUND: Management of late presenters with cyanotic congenital heart disease (CCHD) and reduced pulmonary blood flow is challenged by multi-system derangements from longstanding hypoxia in addition to anatomic factors. Balloon pulmonary valvuloplasty (BPV) is a potentially viable palliative option for selected patients with severely stenotic pulmonary valve and are unsuitable for definitive surgical repair METHODS: A retrospective chart review was conducted (2002-2024, age >12 years). BPV was considered for those with a significant component of valvular pulmonary stenosis (PS) on echocardiography. A strategy of stepwise dilation using progressively larger balloon sizes, andmonitoring pulmonary artery pressures between each dilation, was adapted. RESULTS: Thirty patients [TOF (n = 13), DORV/DILV (n = 7/2), single ventricle/Unbalanced AVCD (n = 3), and corrected transposition (n = 5)] with median age: 20.5 years (IQR: 14.0-26.8), weight: 49 kg (IQR: 44.1-57.7) underwent BPV. The fluoroscopy and procedure times were 17.8 min (IQR:12.7-25.7) and 71 ± 26 min (mean ± SD), respectively. The balloon-to-annulus ratio was 1.01 (0.96-1.2). Saturation improved significantly from 76.7 ± 9.6 % to 90.2 ± 4.4 %. Complications included transient arrhythmias in five patients and fatal re-perfusion pulmonary edema during repeat BPV in one. At a median follow-up of 51 months (IQR: 26.75-139.25 months), majority of patients demonstrated sustained symptomatic relief. Seven patients underwent corrective surgery, and four required repeat BPV. CONCLUSION: In a selected subgroup of anatomically suited patients with CCHD and PS, stepwise dilatation of the pulmonary valve resulted in improved oxygenation and symptomatic relief, which was sustained on follow-up, making it an attractive low-resource option for palliation, particularly in resource constrained LMIC settings.
Mohan B, Batta A, Sharma S
… +17 more, Satija T, Arora GP, Ramanathan S, Singhania A, Sharma S, Kishore N, Soni RK, Singal G, Gupta A, Tandon R, Goyal A, Chhabra ST, Aslam N, Shivashankar R, Singh K, Sharma M, Wander GS
BACKGROUND: Amongst the various risk factors for, cardiovascular diseases (CVDs), the impact of migration is often underappreciated and underexplored. The aim of the study was to look into the CVD profiles of migrant ind...BACKGROUND: Amongst the various risk factors for, cardiovascular diseases (CVDs), the impact of migration is often underappreciated and underexplored. The aim of the study was to look into the CVD profiles of migrant industrial workers and to explore the impact of duration migration on CVD risk-factors. METHODS: This was an observational, prospective and a multi-center study which recruited migrant industrial workers working across 23 industries from the organized sector in Ludhiana. Age-adjusted regression models were prepared to determine if duration of migration was an independent risk factor for adverse CV health. RESULTS: A total of 11,151 migrant workers (9,158, 82.1 % males) were included in the analysis. The mean age of the cohort was 35.00 ± 10.89 years, with the majority (40.6 %, n = 4528) belonging to the <30 years age group. The prevalence of hypertension, diabetes and obesity in the cohort was 19.73 %,4.0 % and 25.9 % respectively. Duration since migration emerged as an independent risk factor for adverse CV health. Age-adjusted models revealed the independent risk of developing obesity, hypertension and diabetes beyond 3, 6 and 12 years since migration respectively [OR = 2.332, 1.401 & 3.462 respectively; p < 0.005 for all]. CONCLUSIONS: The overall age-adjusted prevalence of hypertension was higher amongst migrant workers compared to national average and state wise data for hypertension reflecting the aggravated risk in this cohort. Duration of migration emerged to be an independent predictor of CVD risk with a threshold effect for developing obesity emerging earliest at 3 years since migration.
BACKGROUND: Early, non-invasive detection of coronary artery disease (CAD) is a significant challenge. Given the anatomical and pathophysiological parallels between retinal and coronary microvasculature, retinal arteriov...BACKGROUND: Early, non-invasive detection of coronary artery disease (CAD) is a significant challenge. Given the anatomical and pathophysiological parallels between retinal and coronary microvasculature, retinal arteriovenous (AV) ratio may serve as a surrogate marker of CAD. This study aimed to evaluate correlation between retinal AV ratio and CAD severity as assessed by SYNTAX score in patients with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS), using artificial intelligence (AI)-based retinal image analysis. METHODS: In this prospective study, 332 participants were enrolled: 110 with ACS, 120 with CCS, and 102 angiographically normal controls. Retinal fundus imaging was analyzed using AI models (VC-Net and SegFormer) to compute AV ratio. Coronary angiography was performed, and SYNTAX scores were calculated. Correlations between AV ratio and SYNTAX score were assessed, and a machine learning model (RETFound + RBF Kernel Ridge Regression) was developed to predict SYNTAX categories from retinal data. RESULTS: Mean AV ratios were similar across CCS (0.624 ± 0.11), ACS (0.620 ± 0.12), and controls (0.650 ± 0.10; p = 0.153). In CCS patients, a significant inverse correlation was observed between AV ratio and SYNTAX score (r = -0.344; p < 0.001), which remained after adjustment (r = -0.300; p = 0.002). AI model accurately classified patients into SYNTAX risk categories (94.1 % accuracy). CONCLUSION: Retinal AV ratio is significantly associated with CAD severity in CCS patients. An AI-based tool can automatically derive AV Ratio and provide rapid, non-invasive estimate of coronary disease burden, showing promise for risk stratification. This approach warrants further validation in larger cohorts.
OBJECTIVE: To study the prevalence of LV systolic dysfunction measured using GLS in patients of CKD with normal LVEF and correlation of GLS with the biochemical parameters and to determine the incidence of all-cause mort...OBJECTIVE: To study the prevalence of LV systolic dysfunction measured using GLS in patients of CKD with normal LVEF and correlation of GLS with the biochemical parameters and to determine the incidence of all-cause mortality and its correlation with GLS. PATIENTS AND METHODS: This study included 100 CKD patients of all stages, enrolled from July 2022 to June 2023. Global Longitudinal Strain (GLS) was calculated using speckle tracking echocardiography following relevant investigations. Patients were followed for one year to determine the incidence of all-cause mortality and its correlation with GLS. RESULTS: Males were the predominant gender (66 %). The mean age of patients was 52yrs (±13.59). Maximum patients (47 %) were in ESRD stage (stage 5 CKD), followed by stage 4 CKD (29 %). Abnormal GLS (>-16 %) was prevalent in 98 % of study population. Mean GLS was -11 % ± 2.74. Patients with LVGLS ≥ -11 % were more likely to have higher prevalence of co-morbidities. Statin use was more prevalent in those patients with LVGLS ≥ -11 % (p = 0.029). In the median follow up of 1-year all-cause mortality was 22 % (n = 21), however there was no significant correlation of mortality with GLS. CONCLUSION: Patients with abnormal LVGLS (≥-11 %) had more comorbidities. Abnormal global longitudinal strain (GLS > -16 %) was prevalent in 98 % of the study population. The higher prevalence compared to other studies may be related to the lesser use of nephroprotective and cardioprotective drugs (e.g., ACEI/ARB in only 28 %); however, abnormal GLS was not correlated with mortality.
BACKGROUND: Direct oral anticoagulants (DOACs) are increasingly preferred over vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF), including valvular (VAF) and non-valvular (NVAF). This networ...BACKGROUND: Direct oral anticoagulants (DOACs) are increasingly preferred over vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF), including valvular (VAF) and non-valvular (NVAF). This network meta-analysis aimed to evaluate and compare the efficacy and safety of different DOACs versus VKAs in patients with AF. METHODS: A Bayesian network meta-analysis was conducted to estimate odds ratios (ORs) with 95 % credible intervals (CrIs). RESULTS: 43 RCTs were included (30 VAF, 13 NVAF). Dabigatran (OR 0.77, 95 % CrI 0.68-0.87) demonstrated the strongest reduction in ischemic stroke/systemic embolism, followed by apixaban (0.81, 0.73-0.91). All DOACs were associated with reduced risk of hemorrhagic stroke. CONCLUSION: DOACs, particularly apixaban and dabigatran, showed superior efficacy and safety compared with VKAs, with apixaban emerging as the most favorable overall option. However, these findings are derived from indirect rather than direct head-to-head comparisons among DOACs and VKAs and should therefore be interpreted with caution.
BACKGROUND: A small aortic annulus presents unique hemodynamic challenges during transcatheter aortic valve replacement (TAVR), increasing the risk of prosthesis-patient mismatch (PPM) and suboptimal valve performance. T...BACKGROUND: A small aortic annulus presents unique hemodynamic challenges during transcatheter aortic valve replacement (TAVR), increasing the risk of prosthesis-patient mismatch (PPM) and suboptimal valve performance. This study aimed to compare the efficacy and safety of self-expanding valves (SEVs) versus balloon-expandable valves (BEVs) in patients with a small aortic annulus. METHODS: A systematic search using 4 databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, was conducted from inception to June 1, 2025. Studies comparing clinical outcomes of SEVs and BEVs in patients with a small aortic annulus were included. RESULTS: Thirty-eight studies involving 19,421 participants were included. No significant difference in all-cause mortality was observed between SEVs and BEVs from in-hospital to 5-year follow-up. SEVs were associated with a significantly lower risk of PPM at discharge (OR 0.34, 95 % CI 0.28-0.42), 30 days (OR 0.31, 95 % CI 0.21-0.47), and 1 year (OR 0.25, 95 % CI 0.15-0.42). However, SEVs were associated with a higher risk of in-hospital paravalvular leakage (PVL) (OR 1.95, 95 % CI 1.39-2.74), moderate-to-severe PVL (OR 2.48, 95 % CI 1.91-3.22), and permanent pacemaker implantation (PPI) both in-hospital and at 30 days. These findings remained consistent across sensitivity analyses limited to new-generation valves and propensity score-matched or randomized studies. CONCLUSIONS: SEVs offer favorable hemodynamic advantages and lower risks of PPM and valve dysfunction compared to BEVs, with no difference in survival. However, these benefits must be weighed against the increased risks of PVL and PPI. Individualized valve selection remains essential to optimizing outcomes in TAVR patients.
BACKGROUND: India has a high burden of premature cardiovascular disease, with early-onset hypertension being a key driver. However, real-world data on hypertension management in young Indian adults remain limited. OBJECT...BACKGROUND: India has a high burden of premature cardiovascular disease, with early-onset hypertension being a key driver. However, real-world data on hypertension management in young Indian adults remain limited. OBJECTIVES: To evaluate physician practices in diagnosing and treating hypertension among Indian adults aged 18-45 years, with a focus on guideline concordance, lifestyle interventions, and comorbidity-specific treatment choices. METHODS: A nationwide, web-based survey of 3,289 physicians was conducted from December 2022 to August 2023 using a 22-point questionnaire. An additional module collected anonymized data on 8,195 hypertensive patients. Analyses included descriptive statistics and logistic regression to assess factors associated with BP control (<130/80 mmHg). RESULTS: Most physicians (66 %) managed over five young hypertensive patients monthly. While lifestyle advice was commonly given (>80 %), no structured programs or adherence tracking were used. Monotherapy was initiated in 49 % of cases, with β-blockers prescribed in 32 %, despite guidelines favoring dual therapy with ARBs, ACE inhibitors, or CCBs. Only 27 % of physicians reported BP control in >50 % of their patients. Among patients, 65 % achieved target BP; 34.6 % had target organ damage. Positive predictors of BP control included male gender, private-sector care, and fruit/vegetable intake, while longer disease duration and target organ damage were associated with poorer control. CONCLUSIONS: Hypertension management in young Indian adults shows substantial deviations from global guidelines. Overuse of monotherapy, β-blockers, and lack of structured lifestyle support underscore the need for practice transformation to improve long-term cardiovascular outcomes.
BACKGROUND: In-stent restenosis (ISR), a complication after percutaneous coronary intervention (PCI), involves neointimal hyperplasia and neoatherosclerosis. With the rise of drug-eluting stents (DES), Optical Coherence...BACKGROUND: In-stent restenosis (ISR), a complication after percutaneous coronary intervention (PCI), involves neointimal hyperplasia and neoatherosclerosis. With the rise of drug-eluting stents (DES), Optical Coherence Tomography (OCT) has become essential for evaluating ISR morphology and guiding treatment decisions. OBJECTIVES: This study aimed to investigate the morphological patterns and clinical features of ISR in an Indian cohort using OCT, identify common morphological characteristics, and explore their relationship with ISR duration. METHODS: A cross-sectional observational study at a tertiary care center in New Delhi included 50 patients with angiographically confirmed ISR. OCT was used to assess qualitative and quantitative parameters of restenotic lesions, including neointimal patterns, minimal lumen area (MLA), minimal stent area (MSA), lipid content, and calcium burden. The correlation between ISR duration (early vs. late) and OCT features was also analyzed. RESULTS: The mean age was 58.08 ± 9.68 years, with 74 % male participants. Most patients (80 %) had late ISR. Hypertension (66 %) and diabetes (44 %) were the most common comorbidities, and chronic stable angina was the most frequent presentation (60 %). OCT findings showed heterogeneous neointima in 64 %, stent under-expansion in 42 %, and calcification in 82 %. Late ISR had a significantly larger neointimal area, though no other features correlated significantly with ISR duration. CONCLUSIONS: Neoatherosclerosis, especially heterogeneous neointima, is the primary morphological cause of ISR in this cohort. Stent under-expansion is a key contributor. OCT is valuable for diagnosing and planning ISR interventions. Larger studies are needed for broader conclusions and standardized management.
β-blockers have evolved from being foundational cardiovascular agents to precision therapies across diverse clinical scenarios. Their journey from early non-selective to β1-selective and vasodilatory molecules reflects a...β-blockers have evolved from being foundational cardiovascular agents to precision therapies across diverse clinical scenarios. Their journey from early non-selective to β1-selective and vasodilatory molecules reflects advances in understanding adrenergic modulation in cardiovascular continuum. β-blockers remain integral in managing hypertension, chronic coronary syndromes, arrhythmias, and heart failure. Their pharmacodynamic attributes such as β1-selectivity, inverse agonism, sympathoinhibition, and vasodilation allow personalized use in patients with comorbidities like diabetes, asthma or chronic kidney disease. Among contemporary agents, bisoprolol and nebivolol exemplify next generation β-blockers with high β1-selectivity, favourable tolerability, and cardioprotective effects beyond blood pressure and heart rate control. Global and national guidelines recommend them for angina relief, secondary prevention post-MI, and rate control in tachyarrhythmias. In Indian context, prescribing trends highlight bisoprolol among the most prescribed β-blockers, reflecting its clinical trust and relevance. Regional experiences affirm the value of β-blockers in optimizing cardiovascular outcomes across the Indian subcontinent.
BACKGROUND: Cerebral embolic protection devices (CEPD) have been designed to prevent embolization to the cerebral circulation during transcatheter aortic valve replacement (TAVR). However, the efficacy and safety of CEPD...BACKGROUND: Cerebral embolic protection devices (CEPD) have been designed to prevent embolization to the cerebral circulation during transcatheter aortic valve replacement (TAVR). However, the efficacy and safety of CEPD in stroke prevention in TAVR remains uncertain. METHODS: PubMed, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) comparing CEPD vs. control for patients undergoing TAVR. Risk ratios (RR) with 95 % confidence intervals (CI) were pooled with a random-effects model. RESULTS: Our meta-analysis included eight RCTs with 11,596 patients, of whom 5946 (51 %) were randomized to the CEPD group. There was no significant difference in the incidence of any stroke (3.51 % vs. 3.64 %; RR 0.91; 95 % CI 0.75-1.1; p = 0.33; I = 0 %) between groups. Similarly, CEPD did not significantly reduce the incidence of all-cause mortality (0.82 % vs. 0.67 %; RR 1.13; 95 % CI 0.74-1.74; p = 0.57; I = 0 %) CONCLUSIONS: Among patients undergoing TAVR, CEPD did not significantly reduce stroke incidence or all-cause mortality.
OBJECTIVES: Validation of the complete and shortened RAQ to detect coronary heart disease (CHD) in a tertiary care hospital. METHODS: In this prospective observational study, 239 patients aged 40-75 years with chest pain...OBJECTIVES: Validation of the complete and shortened RAQ to detect coronary heart disease (CHD) in a tertiary care hospital. METHODS: In this prospective observational study, 239 patients aged 40-75 years with chest pain, referred for TMT from the cardiology OPD were subjected to RAQ and SRAQ, followed by a treadmill test (TMT). We used the treadmill test with the Bruce/modified Bruce protocol as the gold standard to assess RAQ and SRAQ. RESULTS: The RAQ had 44.3 % sensitivity, 72.6 % specificity, 59 % accuracy, 60 %, and 58.4 % positive and negative predictive values, 1.62, 0.77 positive and negative likelihood ratios, respectively. SRAQ had 87.8 % sensitivity, 27.4 % specificity, 56.5 % accuracy, 52.9 % and 70.8 % positive and negative predictive values, 1.21 and 0.44 positive, and negative likelihood ratios, respectively, to detect CHD. The sensitivity of RAQ and SRAQ was higher in women. CONCLUSION: Both RAQ and SRAQ have poor accuracy in diagnosing CHD in the Indian population. Alternate tools are needed for determining the population burden of CHD in India.
Implantable Cardioverter Defibrillators (ICDs) have undergone substantial evolution since the 1980s, with the aim of decreasing sudden cardiac death, whilst minimising device related complications. Traditional transvenou...Implantable Cardioverter Defibrillators (ICDs) have undergone substantial evolution since the 1980s, with the aim of decreasing sudden cardiac death, whilst minimising device related complications. Traditional transvenous ICDs (TV-ICDs), though comprehensive and effective, are associated with risks with having leads inside the veins and heart. The emergence of the subcutaneous ICD (S-ICD) offered a solution for patients without a pacing indication, significantly reducing the risks of complications acutely and long term. The absence of pacing and need for specific ECG requirements limit its usability for all ICD patients. The extravascular ICD (EV-ICD) has attempted to provide a solution using a substernal lead position and warrants further investigation into its usability. Recent innovations of modular ICD therapy, combining the S-ICD with a leadless pacemaker, that communicate to deliver painless anti-tachycardia pacing and single chamber pacing could be the comprehensive solution. This review examines the strengths and limitations of these ICD technologies, drawing on current available data in 2025. We critically appraise the literature and discuss perspectives on recent evidence in ICD studies. As technology advances, the selection of the type of ICD should be guided by the risk and benefit, particularly with the perceived lower benefit from more modern medical management and programming. Patients should be fully informed of the risks and benefits of devices that they are being offered, guided by evidence. With the expanding capabilities of modern ICDs and remote monitoring, the future of ICD therapy maybe increasingly customisable and tailored for the individual.
A multicenter observational study of 2059 PCI patients compared the ultrathin-strut BDP-EES (Eternia) with the DP-EES (Xience) over 24 months. Patients in the Eternia group were older with more chronic total occlusions....A multicenter observational study of 2059 PCI patients compared the ultrathin-strut BDP-EES (Eternia) with the DP-EES (Xience) over 24 months. Patients in the Eternia group were older with more chronic total occlusions. MACE rates were 3.7 % (Xience) vs 3.8 % (Eternia; p = 0.939), with no significant differences in mortality, TVR, or stent thrombosis. No definite or probable stent thrombosis was reported in either group, and possible thrombosis rates were low (0.3 % vs 0.4 %). These findings suggest that biodegradable and durable polymer platforms offer similar long-term performance. The Eternia stents demonstrated equivalent safety and efficacy to Xience stents at 24 months.
The ASPIRE-STEMI study prospectively evaluated 236 patients with ST-elevation myocardial infarction undergoing percutaneous revascularization to validate Age-Shock Index (Age-SI) and Age-Modified Shock Index (Age-MSI) as...The ASPIRE-STEMI study prospectively evaluated 236 patients with ST-elevation myocardial infarction undergoing percutaneous revascularization to validate Age-Shock Index (Age-SI) and Age-Modified Shock Index (Age-MSI) as alternatives to the GRACE score for predicting in-hospital major adverse cardiovascular events (MACE) and all-cause mortality. For MACE (n = 60), optimal cut-offs yielded sensitivities/specificities of 76.7 %/67 % (Age-SI ≥ 36.95), 85 %/56.2 % (Age-MSI ≥45.64), and 60 %/81.9 % (GRACE ≥127.5). For all-cause mortality (n = 17), optimal cut-offs yielded sensitivity/specificity of 82.4 %/83 % (Age-SI ≥46.83), 77 %/89 % (Age-MSI ≥67.35), and 94 %/76.7 % (GRACE ≥127.5). While each index independently predicted in-hospital outcomes, Age-SI and Age-MSI offer simple, bedside risk stratification in Indian STEMI patients post-PCI.
BACKGROUND: Fractional Flow Reserve (FFR) helps to assess the functional significance of a coronary stenosis accurately, particularly in triple vessel disease (TVD) where other modalities are ineffectual. There is dearth...BACKGROUND: Fractional Flow Reserve (FFR) helps to assess the functional significance of a coronary stenosis accurately, particularly in triple vessel disease (TVD) where other modalities are ineffectual. There is dearth of data using FFR in TVD. In this study, we assessed outcome of FFR guided management in a spectrum of TVD. METHODS: A prospective observational study was conducted at four tertiary care hospitals of the armed forces between Aug 2019 and Aug 2023. Patients diagnosed with intermediate TVD on coronary angiogram (CAG) were included in the study. Initial treatment strategy based on CAG was noted. Treatment was reformulated based on FFR findings. Primary end points of death, myocardial infarction, repeat revascularization and stroke were evaluated at 3, 6 and 12 months. RESULTS: 145 patients were studied. 60 % presented with acute coronary syndrome (ACS). None of the mild stenosis (30-50 %) were found to be FFR positive in any of the vessels. 4.8 % lesions in LAD, 6.2 % lesions in LCx and 2.8 % lesions in RCA were found to be functionally non-significant despite having >70 % stenosis. Post FFR treatment variation was seen in 8.3 % in PCI group and surgery was averted in 33.3 % of CABG group. All-cause mortality was 3.5 %, 1.4 % had stroke and 1.4 % of patients required repeat revascularization. 83.5 % of all patients remained asymptomatic post intervention at 12 months follow-up. CONCLUSIONS: FFR guided management lead to change of plan in a substantial 15.2 % of patients when compared to CAG based management. FFR negativity in LAD was the main reason for majority of TVD patients ending up with PCI instead of CABG.
Mohan B, Batta A, Sharma S
… +17 more, Satija T, Arora GP, Ramanathan S, Singhania A, Sharma S, Kishore N, Soni RK, Singal G, Gupta A, Tandon R, Goyal A, Chhabra ST, Aslam N, Shivashankar R, Singh K, Sharma M, Wander GS
BACKGROUND: Cardiovascular diseases (CVDs) in industrial workers are a significant but overlooked public health problem, and present study was planned to assess the prevalence of risk factors related to CVDs in industria...BACKGROUND: Cardiovascular diseases (CVDs) in industrial workers are a significant but overlooked public health problem, and present study was planned to assess the prevalence of risk factors related to CVDs in industrial workers, so that active interventions can be undertaken to decrease disease burden. METHODOLOGY: This cross-sectional, field-based survey was conducted among industrial workers in Ludhiana, following approval from the Institutional Ethics Committee. Random sampling of industries from the two industrial clusters was conducted, involving the collection of data on demography, migration status, anthropometric measurements, and cardiovascular risk factors by a trained task force. Quantitative data were described in terms of frequencies, range, and mean ± SD, whereas categorical data were compared by Chi square (χ2) test. A probability value less than 0.05 was considered statistically significant. RESULTS: Mean age of the industrial workers (n = 15527) was 34.95 ± 10.96 years, and 72 % of the workforce were from outside Punjab. On screening, 22 % (n = 3395) of the study population were hypertensive, and 4.1 % (n = 644) were diabetic (DM). Out of the hypertensives, 15 % (n = 503) were previously known to have hypertension (HT), whereas 85 % (n = 2892) were newly diagnosed during the study. Among previously known HT, 56 % had uncontrolled HT, and 45 % had uncontrolled diabetic status. Alcohol intake, chewing tobacco and smoking were the most common behavioral risk factors, whereas HT and DM were the most common Cardiovascular disease-related risk factors in the study population. Prevalence of HT and DM was found to be higher in native industrial workers as compared to the migrant workers. Age ≥30 years, male gender, substance abuse (alcohol and smoking) and increased BMI were significantly associated with HT and DM. CONCLUSIONS: Screening of the industrial workforce for cardiovascular risk factors is imperative to decrease the risk of CVDs, and it requires a multifaceted approach that combines workplace interventions, policy changes, and individual-level support.