Indian Heart Journal[JOURNAL]
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200 papers
Percutaneous coronary intervention (PCI) in patients of rheumatoid arthritis(RA): A systematic review and meta-analysis.
Piplani S, Kostojchin A, Kong S … +13 more , Sharma A, Brown D, Jelic V, Chaturvedi S, Reddy V, Chang Pieri K, Akpan E, Simpson T, Xiao W, Sakellakis M, Sharma A, Jain P, Radulovic M
Indian Heart J · 2025 · PMID 39710047 · Full text
AIM: The present study aims to investigate the outcomes of Percutaneous coronary intervention (PCI) in patients with Rheumatoid arthritis (RA). METHODS: A systemic search was conducted from electronic databases (PubMed/M...
AIM: The present study aims to investigate the outcomes of Percutaneous coronary intervention (PCI) in patients with Rheumatoid arthritis (RA). METHODS: A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 15th September 2023. All statistical analyses were conducted using Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported in the odds ratio (OR) and the corresponding 95 % confidence interval (CI). RESULTS: Eight observational studies were selected to conduct the analysis. A statistically significant increase in major adverse cardiovascular event (MACE) was seen in RA patients after undergoing PCI as compared to the control group (OR = 1.18 (1.16, 1.21); p < 0.00001; I2 = 0 %). There was no significant difference found in the long-term revascularization outcome between the RA and non-RA patients (OR = 1.18 (0.81, 1.71); p = 0.39; I2 = 93 %). Survival rates of all-cause mortality in the long-term outcome were statistically insignificant among the two groups (OR = 1.21 (0.84, 1.74); p = 0.31; I2 = 99 %). CONCLUSION: Percutaneous coronary intervention is an important intervention to reduce morbidity and mortality but special precautions and attention should be made when it comes to patients with RA. Different precautions such as close monitoring for medication interaction, and tailored post-procedural care are essential in reducing morbidity and mortality.
ANti-Thrombotic strAtegy for the management of nonocclusive thRombus with ST-segment elevation myocardial infarCtion in young pAtients - ANTARTICA study.
Jariwala P, Punjani A, Boorugu H … +2 more , Gude D, Jariwala A
Indian Heart J · 2025 · PMID 39710046 · Full text
INTRODUCTION: Various cardiovascular thrombo-embolic clinical entities use combined ATS for prevention and treatment. After PCI, AF patients are typically prescribed DOAC, DAPT/SAPT, as component of ATS to minimize strok...
INTRODUCTION: Various cardiovascular thrombo-embolic clinical entities use combined ATS for prevention and treatment. After PCI, AF patients are typically prescribed DOAC, DAPT/SAPT, as component of ATS to minimize stroke risk and treat pulmonary embolism and venous thromboembolism. Some small observational studies have shown that a combined ATS can clear small thrombi in LV dysfunction and/or apical aneurysms. Therefore, we present a practical, cost-effective, and proof-of-concept ATS for non-occlusive significant coronary thrombus in young, clinically stable STEMI patients based on the aforementioned experiences. METHODS: We retrospectively reviewed 145 stable STEMI cases with nonocclusive thrombus and thrombolysis in myocardial infarction flow 2/3 who received dabigatran and clopidogrel (ATS arm). They were compared to 147 comparable patients who received standard-of-care PCI (Control arm). At presentation and 6-months after ATS, NYHA functional class and LVEF were measured in all subjects. All the patients in the ATS arm underwent CT-CAG at 6-months. We examined significant safety outcomes like hemorrhage, reinfarction, and cardiac mortality. RESULTS: The primary angiographic outcome demonstrated complete resolution of the thrombus in all the cases of ATS arm. In the ATS arm, the clinical secondary outcome showed a greater improvement in NYHA class, from 3.53 to 1.07, compared to the control group's 3.6 to 1.49 (p = 0.013). Also, the secondary echocardiographic outcome demonstrated a significant improvement in LVEF from a mean of 45.1 %-49.2 % in the ATS arm vs. 44.0 %-44.9 % in the control arm (p < 0.001). Clinical safety indicated TIMI bleeding and reinfarction reductions. There was no mortality in either arm. CONCLUSION: Delaying PCI and treating STEMI patients with antithrombotic drugs reduced no-reflow, distal embolization, and intraprocedural thrombotic events. The medical intervention improved myocardial preservation alone.
Clinical profile and immediate outcomes of balloon mitral valvotomy in low gradient rheumatic mitral stenosis.
Malviya A, Mishra A, Kapoor M … +2 more , Fanai V, Kamal VK
Indian Heart J · 2024 · PMID 39615623 · Full text
OBJECTIVES: The objective of this study was to assess the clinical, hemodynamic characteristics and immediate outcomes of Percutaneous Balloon Mitral Valvotomy (PBMV) in low gradient severe rheumatic mitral stenosis (LGM...
OBJECTIVES: The objective of this study was to assess the clinical, hemodynamic characteristics and immediate outcomes of Percutaneous Balloon Mitral Valvotomy (PBMV) in low gradient severe rheumatic mitral stenosis (LGMS) with normal cardiac index. BACKGROUND: The optimal management of LGMS remains incompletely understood. METHODS: We examined 200 consecutive patients with severe rheumatic mitral stenosis (MS) who underwent PBMV between January 2014 and March 2020. RESULTS: Of the 149 patients (who satisfied inclusion criteria), 51 (34.2 %) had LGMS. The mean diastolic pressure gradient (DPG) was 8.70 ± 1.34 mm of Hg in LGMS as compared to 16.2 ± 4.3 mm of Hg in HGMS (p < 0.001). Patients of LGMS were older (39.5 ± 9.7 vs.34.9 ± 11.0 years, p = 0.012), had lower baseline heart rate (76.8 ± 9.5 vs 81.9 ± 12.5, p = 0.010), higher Mitral valve area (MVA) (1.16 ± 0.19 vs 0.99 ± 0.21 cm,p < 0.001),higher Wilkins score (5.8 ± 1.7 vs 4.9 ± 1.5, p = 0.002) and elevated left ventricular end diastolic pressure (LVEDP) (9.2 ± 2.8 vs 5.8 ± 1.2 mm of Hg,p=<0.001) but lower Pulmonary artery systolic pressure (PASP) (53.1 ± 14.5 vs 62.6 ± 17.8 mm of Hg, p = 0.001) and left atrial (LA) pressure (18.0 ± 3.1vs 22.0 ± 4.4 mm of Hg,p=<0.001). Although, the procedural success rate of PBMV was comparable between LGMS and HGMS (92.2 % vs 96.9 % p = 0.231) but increment in MVA and fall in DPG were significantly higher in HGMS in comparison to LGMS (p-value<0.05). CONCLUSIONS: Significant MS may have "low" gradients during catheterization and yet be symptomatic, and thus low gradients cannot be alone used as a marker of disease severity. LGMS with normal CI is characterized by unique clinical and hemodynamic features. The immediate outcome of PBMV is comparable to HGMS but the hemodynamic parameters to monitor the success of PBMV are significantly different.
Influenza vaccine in cardiovascular disease: Current evidence and practice in India.
Roy A, Yadav S
Indian Heart J · 2024 · PMID 39613096 · Full text
Influenza is a common trigger for cardiovascular events. Temporal association studies of influenza and cardiovascular events have well documented this phenomenon. More recently, randomised clinical trials of influenza va...
Influenza is a common trigger for cardiovascular events. Temporal association studies of influenza and cardiovascular events have well documented this phenomenon. More recently, randomised clinical trials of influenza vaccine have shown the benefit of immunisation in reducing recurrent cardiovascular events, especially in patients with acute coronary syndrome. Despite this overwhelming benefit, its uptake in India is very low. This could be due to a lack of awareness and paucity of evidence of its benefit in tropical countries like India, where the influenza season is variable and spread throughout the year. In this review, we explore these aspects of influenza and cardiovascular diseases and discuss the way ahead.
Incidence of infective endocarditis in patients with hypertrophic cardiomyopathy.
Somendra S, Mehrotra S, Barwad P … +2 more , Gupta H, Bahl A
Indian Heart J · 2024 · PMID 39586399 · Full text
BACKGROUND: Data on the incidence of infective endocarditis (IE) in patients with hypertrophic cardiomyopathy (HCM) is sparse. This study evaluated a HCM cohort with aim to study the incidence of IE in these patients. ME...
BACKGROUND: Data on the incidence of infective endocarditis (IE) in patients with hypertrophic cardiomyopathy (HCM) is sparse. This study evaluated a HCM cohort with aim to study the incidence of IE in these patients. METHODS: All patients entering the HCM cohort from May 2003 to June 2022 of a tertiary care hospital with at least one follow-up visit were included and followed up till June 2023. This was a retrospective cohort analysis. Only individuals who were diagnosed with IE after entry into the cohort were included. RESULTS: The study cohort consisted of 529 HCM patients with a total follow up duration of 3244.6 years. The mean and median follow-up durations were 6.1 ± 4.7 and 5.3 (range 31 days to 20.1) years respectively. Three (0.57 %) patients in the cohort developed IE. Incidence of IE in HCM patients was 0.92/1000 patient years. Two patients had left ventricular outflow tract obstruction while one had non-obstructive HCM. None of the patients with isolated mid-cavity gradients developed IE. The incidence of IE in the obstructive and nonobstructive groups was 1.39 and 0.55 per 1000 patient years respectively. Two had vegetations on mitral valve while one had vegetations on aortic valve. Both patients with mitral valve endocarditis developed severe residual mitral regurgitation and heart failure. CONCLUSIONS: IE is a rare complication in HCM patients with an incidence of 0.92/1000 patient years. However, when it occurs, IE is associated with high morbidity and mortality.
National experience of alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy: A long-term multicenter retrospective study.
Shloido E, Popov K, Chernyshov S … +1 more , Kashtanov M
Indian Heart J · 2024 · PMID 39581261 · Full text
OBJECTIVES: Hypertrophic cardiomyopathy (HCM) is a widespread disease with an incidence of 1:200 in the general population and its surgical and interventional treatment is well-developed in western countries. This study...
OBJECTIVES: Hypertrophic cardiomyopathy (HCM) is a widespread disease with an incidence of 1:200 in the general population and its surgical and interventional treatment is well-developed in western countries. This study is focusing on outcomes of HCM patients after alcohol septal ablation in Russian Federation. METHODS: We conducted a multicenter registry to evaluate outcomes of obstructive hypertrophic cardiomyopathy (oHCM) patients after ASA. Our study was focused on the following outcomes: (i) 30-day mortality, (ii) 30-day permanent pacemaker implantations, (iii) a residual obstruction occurrence, (iv) final maximal left ventricular outflow tract gradient, (v) long-term mortality, (vi) final heart failure functional class, (vii) freedom from sudden cardiac death. We conducted secondary analysis to assess outcomes in patients with single versus repeated ASA. The mean follow-up was 71 ± 47 months. RESULTS: A total of 597 consecutive patients (54.9 % female) were enrolled in the Russian Alcohol Septal Reduction (RASA) registry from three interventional groups. The mean age was 56 ± 14 years. Thirty-day mortality rate was 0.7 % (4 patients). Permanent pacemakers were implanted in 42 (7 %) cases in 30-days follow-up. The resting LVOT gradient reduced from 64 ± 28 to 20 ± 13 mmHg (p < 0.0001), and the mean NYHA class decreased from 2.3 ± 0.7 to 1.3 ± 0.5 (p < 0.001). Long-term survival rates were as follows: 97.4 (95%CI: 96.2-98.7) %, 93.2 (95%CI: 91.0-95.3) %, 84.9 (95%CI: 80.7-89.4) % at 1-, 5-, 10-year follow-up, respectively. Patients after repeated ASA. had similar long-term survival comparing to those who underwent single ASA (weighted log rank p value = 0.254). Heart failure class in the long-term and final gradient at the last follow-up were not statistically different between groups under study (p > 0.05). CONCLUSIONS: In our registry, alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy was safe in the short- and long-term follow-up. Outcomes of patients underwent repeated ASA were non-inferior to those after single ASA.
Hypertonic saline in acute decompensated heart failure (HSHF).
Agrawal S, Abhishek Batta S, Rao T … +1 more , Selvam S
Indian Heart J · 2024 · PMID 39579977 · Full text
Hypertonic saline with high dose furosemide improves refractory heart failure. In this case series of 10 patients of refractory acute decompensated heart failure, effect of HSS with furosemide was compared with furosemid...
Hypertonic saline with high dose furosemide improves refractory heart failure. In this case series of 10 patients of refractory acute decompensated heart failure, effect of HSS with furosemide was compared with furosemide alone. Patients responded to the therapy better, with faster decongestion, without significant adverse effects or worsening renal function. Hence an adequately powered, randomized study is required to assess the veracity of findings in this case series of hypertonic saline in diuretic resistant acute decompensated heart failure on optimal therapy. Based on present study, hypertonic saline looks like a promising option in the management of refractory heart failure.
Current practices and knowledge of home blood pressure monitoring among people with hypertension: Insights from a Multicentric study from North India.
Batta A, Singhania A, Sharma S … +14 more , Gautam S, Singla A, Kalsi H, Mahendru D, Singh S, Goyal I, Ghosh H, Uppal A, Dhand N, Bansal N, Chaudhary A, Wander GS, Ramakrishnan S, Mohan B
Indian Heart J · 2024 · PMID 39579976 · Full text
OBJECTIVES: Hypertension (HTN) management guidelines recommend home blood pressure monitoring (HBPM) as an important tool for BP control. Limited data exists on HBPM epidemiology among people with HTN and their caregiver...
OBJECTIVES: Hypertension (HTN) management guidelines recommend home blood pressure monitoring (HBPM) as an important tool for BP control. Limited data exists on HBPM epidemiology among people with HTN and their caregivers in the Indian context. METHODS: The current study was conducted across three North Indian centres to evaluate the prevalence, training and technique of HBPM among people with HTN and their caregivers. People with diagnosed HTN (>3 months duration) and their caregivers, were screened and their HBPM use was evaluated. HBPM practices were assessed by observing participants measuring BP using a pre-validated, structured 16-point observational checklist. HBPM knowledge was assessed using a 19-point self-administered questionnaire based on the most recent AHA guidelines. Responses were graded and classified based on quartiles. RESULTS: A total of 2750 participants were screened, of which 2588 (2070 from urban and 518 from rural areas) were included. A total of 468 (18.1 %) were using HBPM. The proportion of respondents using HBPM was 20.5 % (424/2070) in urban, and 8.5 % (44/518) in rural areas. Only 24.7 % (n = 116) of the 468 participants (236 patients and 232 caregivers) using HBPM at home recalled ever receiving training from any healthcare workers. The majority (75.2 %, 352/468) of participants reported learning HBPM themselves through observation, videos, and reading. In HBPM practice assessment, 15.9 % of people with HTN (37/232) vs 5.9 % caregivers (14/236) scored excellent (score >75 %). In HPBM knowledge assessment, 0.4 % of people with HTN (1/232) vs no caregivers scored excellent. HPBM practices were better than knowledge, with mean scores of 62.3 ± 13.1 % and 40.1 ± 16.2 % respectively. Higher education level was associated with improved patient knowledge (p = 0.041), but not practices (p = 0.225). CONCLUSIONS: There is need for more robust training on HBPM to enable people from all backgrounds to better manage their HTN, especially in rural areas. Education is not a barrier to learning good HBPM technique.
Attainment of low-density lipoprotein cholesterol goals in patients undergoing coronary revascularization in the contemporary clinical practice.
Bansal M, Kasliwal RR, Chandra P … +4 more , Kapoor R, Chouhan N, Bhan A, Trehan N
Indian Heart J · 2024 · PMID 39571932 · Full text
This study aimed to assess the effectiveness of current lipid-lowering therapy in achieving low-density lipoprotein cholesterol (LDL-C) goals in Indian patients undergoing coronary revascularization. Consecutive subjects...
This study aimed to assess the effectiveness of current lipid-lowering therapy in achieving low-density lipoprotein cholesterol (LDL-C) goals in Indian patients undergoing coronary revascularization. Consecutive subjects (n = 1275, mean age 60.0 ± 9.7 years, 87.2 % men) with newly diagnosed coronary artery disease and undergoing coronary revascularization during the period 1 Jan 2023 to 31 Dec 2023 were included. After a median follow-up of 99 days (interquartile range 91-109 days), the mean LDL-C was 63.9 ± 24.3 mg/dL with 67.5% and 29.9% of subjects having LDL-C <70 mg/dL and <50 mg/dL, respectively. These proportions were 70.8% and 32.1% for patients treated with high-intensity statin therapy (rosuvastatin 20-40 mg/d or atorvastatin 40-80 mg/d). Among patients treated with rosuvastatin 40 mg/d and ezetimibe 10 mg/d, 53.3% achieved LDL-C <50 mg/dL. These findings underscore the need for greater usage of combination lipid-lowering therapy and agents with high LDL-C lowering efficacy.
Psychological problems and burnout among healthcare workers: Impact of non-pharmacological lifestyle interventions.
Gupta MD, Kunal S, Mp G … +9 more , Chalageri E, Kumar D, Singh V, Bansal A, Batra V, Yusuf J, Tomar R, Gupta A, Gupta A
Indian Heart J · 2024 · PMID 39571931 · Full text
OBJECTIVE: To evaluate role of rajyoga meditation (RYM) versus stress management counselling (SMC) in addressing burnout syndrome and resultant improvement in electrocardiogram (ECG) so as to automate burnout prediction...
OBJECTIVE: To evaluate role of rajyoga meditation (RYM) versus stress management counselling (SMC) in addressing burnout syndrome and resultant improvement in electrocardiogram (ECG) so as to automate burnout prediction from raw ECG data with machine learning (ML). METHODS: Healthcare providers were assigned to two groups: RYM (n = 100) or SMC (n = 102). Subjects in RYM received rajyoga for 3 months including one week offline and thereafter, virtual mode. SMC group received counselling for 1 day in offline mode and thereafter, received positive thoughts on a weekly basis. All subjects were assessed for psychological (depression, anxiety, stress scale-21 (DASS-21) and burnout syndrome (Mini Z questionnaire) along with 12-lead ECG at baseline after 4 weeks, and after 12 weeks. Based on response on question 3 of the Mini-Z questionnaire, participants were classified either as burnout or satisfied. RESULTS: RYM group showed significant reduction in depression, anxiety, and stress in comparison to SMC group. Burnout results display significant reduction in the RYM group in comparison to SMC group. Reduction in burnout and enhancement in satisfaction from visit-1 to visit-3: burnout visit-1 (27.2 %), visit-2 (23.8 %), visit-3 (19.3 %) and, satisfaction visit-1 (72.8 %), visit-2 (76.2 %), and visit-3 (80.7 %). ML algorithms could identify burnout patients using the raw ECG data with time-series features based classifier performing better than Ultra Short HRV features based ML classifier model. CONCLUSION: AI based early diagnosis of heart's healthy status using ECG analysis may prevent development of cardiovascular disorder in the long run.
Community-level knowledge, attitudes, and practices regarding cardiovascular diseases and modifiable risk factors in India.
Singh K, Kondal D, Mohan D … +8 more , Gandral M, Rajan S, Mohan V, Ali MK, Narayan KV, Huffman MD, Prabhakaran D, Tandon N
Indian Heart J · 2024 · PMID 39547572 · Full text
BACKGROUND: Assessment of knowledge, attitudes, and practices regarding cardiovascular diseases (CVD) and cardiovascular risk factors (CVRF) is critical to inform CVD prevention strategies, but limited community-level da...
BACKGROUND: Assessment of knowledge, attitudes, and practices regarding cardiovascular diseases (CVD) and cardiovascular risk factors (CVRF) is critical to inform CVD prevention strategies, but limited community-level data exist from developing countries. OBJECTIVE: To assess the knowledge, attitudes, and practices regarding CVD and CVRF and acceptability of non-physician health workers and text-message based reminders to guide CVD prevention strategies in India. METHODS: We conducted a telephone-based survey nested in the on-going Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) cohort in Delhi and Chennai, India between January 2021 to February 2021. We randomly selected people with CVRF, but no established CVD and those with existing CVD from the CARRS cohort (n = 502 participants) and assessed their 1) knowledge of CVD symptoms and risk factors, 2) attitude towards non-physician health workers (NPHW) facilitated care and text-messages for healthy lifestyle, and 3) practices regarding monitoring of CVRF. We performed logistic regression analyses to investigate the factors associated with KAP. RESULTS: We interviewed 502 participants (283 with CVRF and 219 with CVD); 45.8 % were female, and mean age (SD) was 48.1 (11.2) years. The knowledge of heart attack symptoms, stroke symptoms, and CVRF (>75 % correct answers) were: 12.9 %, 20.7 %, and 17.3 %, respectively. Individuals with CVRF had 2.5 times lower knowledge of CVD symptoms compared to those with existing CVD. Acceptability of NPHW-facilitated care and text-messages for healthy lifestyle was 60 % and 84 %, respectively. CONCLUSION: The knowledge of CVD symptoms and risk factors is below optimal levels, particularly among individuals at high risk of CVD, unskilled workers, those with lower levels of education and income. Innovative use of NPHW along with mHealth tools could potentially offer solutions to reduce the burden of CVD.
Morphological characterization of coronary plaques in young indian patients with acute coronary syndrome: A multicentric study.
Kaul U, Sethi R, Roy S … +7 more , Goel PK, Chouhan NS, Vijayvergiya R, Narang M, Priyadarshini, Baruah DK, Mathew R
Indian Heart J · 2024 · PMID 39500441 · Full text
OBJECTIVES: The prevalence of atherosclerosis and acute coronary syndrome (ACS) is increasing in young Indians (18-50 years of age). However, the characteristics of atherosclerotic plaques in such individuals are poorly...
OBJECTIVES: The prevalence of atherosclerosis and acute coronary syndrome (ACS) is increasing in young Indians (18-50 years of age). However, the characteristics of atherosclerotic plaques in such individuals are poorly understood, presenting distinct challenges for the management of ACS. This study aims to analyze plaque characteristics in young Indian patients with ACS who underwent percutaneous coronary intervention (PCI) using optical coherence tomography (OCT) imaging. METHODS: This was a prospective, multicentric, non-interventional study on patients aged 18-50 years presenting with ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction, or unstable angina, and were scheduled to undergo OCT-guided PCI. Major adverse cardiac events (MACE) were assessed post-procedure and at the 6-month and 12-month follow-ups. RESULTS: The study included 100 ACS patients (mean age = 43.6 ± 5.2 years), with 51% presenting with STEMI. Pre-PCI OCT assessment showed that fibrous plaques (75%) were most common followed by plaques containing macrophages (27%), microchannels (20%), and calcified nodules (14%). In addition, plaque rupture, plaque erosion, and lipid-rich plaques, along with red, white, and mixed thrombi, were observed in 31%, 25%, 24%, 21%, 14%, and 17% (total thrombus occurrence = 52%) of the patients, respectively. At 12 months, the MACE (coronary artery bypass graft) rate was 1%. CONCLUSIONS: Young Indian patients with ACS displayed a range of plaque morphologies identified through pre-PCI OCT. Among these, fibrous plaques were the most prominent type, followed by plaques containing macrophages. Additionally, plaque rupture, plaque erosion, and lipid-rich plaques were also observed in this population.
A groundbreaking electrocardiographic observation: "Isoelectric horizontal ST-segment with sharp ST-T angle" a novel sign for acute coronary syndrome.
Patel MM, Patel SG, Patel JK … +6 more , Patel DM, Prajapati PJ, Patel HD, Prajapati JS, Patel LB, Patel MV
Indian Heart J · 2024 · PMID 39396759 · Full text
Consecutive suspected acute coronary syndrome (ACS) cases were categorized into three groups: Group-1 (ST-depression), Group-2 (T-inversion), and Group-3 (remaining cases). Group-3 was subclassified into isoelectric hori...
Consecutive suspected acute coronary syndrome (ACS) cases were categorized into three groups: Group-1 (ST-depression), Group-2 (T-inversion), and Group-3 (remaining cases). Group-3 was subclassified into isoelectric horizontal ST-segment with sharp ST-T-angle (IHST) positive and IHST negative groups. They underwent serial high-sensitive Troponin-I testing. ACS incidence was 77.96 %, with 33.02 %, 15.96 %, and (15.04 %, 35.96 %) of patients in Groups 1, 2, and 3 (IHST positive, IHST negative), respectively. The presence of IHST exhibited higher sensitivity than T-inversion and greater specificity than ST-depression in detecting ACS. The presence of IHST sign additionally detected 15.04 % of ACS. The presence of IHST was significant among group-3 (p = 0.008) as well as the overall ACS cases (p = 0.048).
Drug abuse and ACS in the very young (less than 30 years): Demographic, clinical and angiographic profile.
Chhabra ST, Kaur G, Kapoor S … +14 more , Kapila A, Kaur G, Jain P, Kumar P, Bansal N, Bansal M, Gupta A, Batta A, Singal G, Goyal A, Tandon R, Aslam N, Mohan B, Wander GS
Indian Heart J · 2024 · PMID 39395631 · Full text
AIM: To identify incidence, type of drug abuse study clinical and angiographic profile in very young population presenting with acute coronary syndrome (ACS). MATERIALS AND METHODS: All consecutive patients less than 30...
AIM: To identify incidence, type of drug abuse study clinical and angiographic profile in very young population presenting with acute coronary syndrome (ACS). MATERIALS AND METHODS: All consecutive patients less than 30 years with ACS included and segregated into Group 1 and 2 (with and without drug abuse respectively) RESULT: n = 153; n = 17 in group 1 of whom 35.29 % consumed opium, 17.64 % energy drinks, 17.64 % whey protein supplements, 17.64 % inhaled marijuana, 5.88 % heroin and spasmoproxyvon and 23.52 % multi-substance abusers. STEMI, Single vessel disease and urban domicile were predominant. Rising trends of drug abuse were identified in prospective (28.20 %) versus retrospective (5.30 %) timeframe (p = 0.011). CONCLUSION: Rising trends of drug abuse, a potentially modifiable risk factor of ACS in the young are alarming. Strict regulations are needed to curb this menace.
Long-term outcome of variety of techniques used to stabilize left ventricular lead in difficult coronary sinus anatomy- A single centre experience.
Barwad P, Kaur N, Sihag BK … +1 more , Naganur SH
Indian Heart J · 2024 · PMID 39393567 · Full text
INTRODUCTION: Difficult coronary sinus (CS) anatomy may lead to difficulty in optimal left ventricular (LV) lead placement and lead displacements leading to nonresponse to cardiac resynchronization therapy (CRT). METHODS...
INTRODUCTION: Difficult coronary sinus (CS) anatomy may lead to difficulty in optimal left ventricular (LV) lead placement and lead displacements leading to nonresponse to cardiac resynchronization therapy (CRT). METHODS: In this retrospective study, we studied the CRT parameters of devices implanted by single operator during the time period from January 2014 till December 2021, where different off-label techniques were used to place/stabilize LV lead. The technique used to stabilize LV lead, CRT parameters at baseline and follow up were noted for each patient. RESULTS: Out of 133 CRTs implanted during the study period, 23 patients (17.29 %) required off-label techniques. Stylet and guidewire retaining techniques were used in 11/23 (47.82 %) and 7/23 (30.43 %) patients respectively. In two patients, LV lead was jailed using coronary stent to prevent displacement. Two patients had CS stenosis and required balloon dilation while one patient had tortuous posterolateral vein which was straightened using a coronary stent. There was technical failure of 6/23 LV leads (26.08 %) with loss of capture, at a median follow up of 44 months (Range: 06-114 months). Out of these 6 patients, stylet and guidewire retaining techniques were used in 4 and 2 patients respectively. CONCLUSION: Despite having acceptable parameters at implantation, these techniques particularly stylet and guidewire retention, may lead to non-capture of LV lead on long term follow ups. Better LV leads like active fixation leads and conduction system pacing (His Bundle/left bundle branch pacing) should be preferred in difficult CS anatomy.
Gender differences in the management and outcomes of acute coronary syndrome in indians: A systematic review and meta-analysis.
Dutta D, Mahajan K, Verma L … +2 more , Gupta G, Sharma M
Indian Heart J · 2024 · PMID 39389261 · Full text
BACKGROUND: Gender differences in acute coronary syndrome (ACS) outcomes have been noted in global data, which however did not analyse Indian data. No prior systematic review and meta-analysis (SRM) has addressed this im...
BACKGROUND: Gender differences in acute coronary syndrome (ACS) outcomes have been noted in global data, which however did not analyse Indian data. No prior systematic review and meta-analysis (SRM) has addressed this important aspect of gender bias in Indian women with ACS. Hence this SRM aimed to address this knowledge gap. METHODS: Electronic databases were searched for studies in ACS comparing cardiovascular disease presentation, treatment received and outcomes in women and men from India. Primary outcomes were to evaluate gender-differences in 30-day death and major adverse cardiovascular events (MACE). Secondary outcomes were to evaluate gender-differences in presentation, management and mortality. The SRM is registered with PROSPERO (CRD42023477286). RESULTS: From initially screened 3753 articles, data from 9 studies (61,185 patients) were analysed. Women with ACS had higher prevalence of diabetes [Odds ratio (OR) 1.65(95%CI:1.33-2.04); p < 0.001; I = 95 %] and hypertension [OR2.06(95%CI:1.88-2.25); p < 0.001; I = 42 %]. Smoking was significantly lower in women [OR 0.05(95%CI:0.03-0.07); p < 0.001; I = 87 %]. Non-ST elevation myocardial infarction (NSTEMI) was significantly higher in women [OR 1.92(95%CI:1.66-2.21); p < 0.001; I = 0 %]. Diagnostic angiography [OR 0.64(95%CI:0.56-0.74); p < 0.001; I = 46 %] and percutaneous coronary interventions [OR0.71(95%CI:0.55-0.92); p = 0.01; I = 92 %] were significantly lower in women. Women had significantly higher 30-day mortality [Hazard ratio (HR)2.26(95%CI:2.01-2.55); p < 0.001; I = 6 %], 1-year mortality [HR2.41(95%CI:1.89-3.07); p < 0.001; I = 53 %], in-hospital death [HR1.88(95%CI:1.19-2.96); p = 0.007; I = 92 %], stroke [HR 1.84 (95%CI:1.34-2.52); p < 0.001; I = 0 %] and MACE outcomes [OR 2.05 (95%CI:1.78-2.35); p < 0.001]. Use of aspirin, clopidogrel, beta-blockers and nitrates were significantly lower in women. CONCLUSION: Our study highlights worse outcomes in Indian women with ACS. Higher burden of diabetes and hypertension, decreased used of PCI and lesser aggressive pharmacotherapy may be some of the contributing factors.
Association of non-HDL cholesterol with plaque burden and composition of culprit lesion in acute coronary syndrome. An intravascular ultrasound-virtual histology study.
Reddy S, Rao K R, Kashyap JR … +9 more , Kadiyala V, Kumar S, Dash D, Uppal L, Kaur J, Kaur M, Reddy H, Rather IIG, Malhotra S
Indian Heart J · 2024 · PMID 39389260 · Full text
OBJECTIVE: Lipids play key role in coronary atherosclerosis. The role of non-high-density lipoprotein cholesterol (non-HDL-C) in atherosclerotic plaques using intravascular imaging remains unclear. This study aimed to as...
OBJECTIVE: Lipids play key role in coronary atherosclerosis. The role of non-high-density lipoprotein cholesterol (non-HDL-C) in atherosclerotic plaques using intravascular imaging remains unclear. This study aimed to assess its relationship with coronary plaque features using intravascular ultrasound (IVUS) in acute coronary syndrome (ACS). METHODS: A total of 601 patients divided into two groups: normal non-HDL-C≤130 mg/dl (n = 410) and high non-HDL cholesterol >130 mg/dl (n = 191). IVUS performed before coronary intervention. RESULTS: Mean age 53.18 ± 12.29 years. No significant differences in hypertension, diabetes, and smoking between groups. Plaque burden was significantly higher among normal versus high non-HDL-C groups (79.59 ± 9.98 % vs. 81.61 ± 5.39 %; p = 0.001). At minimal luminal site, fibrofatty percentage was higher in normal non-HDL-C group (p = 0.027), while necrotic core greater in high non-HDL-C group (p = 0.033). Segmental analysis, necrotic core was significantly higher in percentage (p = 0.006) and volumes (p = 0.011) in normal versus high non-HDL-C groups. Total cholesterol (r = 0.099, p = 0.015), LDL-C (r = 0.081, p = 0.046), triglycerides (r = 0.083, p = 0.041),and non-HDL-C (r = 0.099, p = 0.015) positively correlated with plaque burden. Total cholesterol (r = 0.115, p = 0.005), LDL-C (r = 0.107, p = 0.009), and non-HDL-C (r = 0.105, p = 0.010) positively correlated with necrotic core volume. Linear regression analysis showed age and non-HDL-C as predictors of higher plaque burden. Multiple linear regression analysis; age, body mass index, and non-HDL-C were predictors of larger necrotic core volume. CONCLUSION: Non-HDL-C levels were positively associated with plaque burden, measure of extent of atherosclerosis. It is closely associated with and is a predictor of necrotic core volume; a marker of plaque vulnerability. This IVUS study demonstrates potential role of non-HDL-C in causation of plaque in ACS.
Do collaterals to infarct bed in STE-ACS patients undergoing emergent percutaneous coronary revascularization matter? An assessment of a prospective pool for in-hospital course.
Kumar R, Khan NU, Mir A … +12 more , Naseeb K, Ali G, Ashok A, Kumar M, Urooj A, Safdar U, Hussain A, Ishaq M, Saghir T, Sial JA, Hakeem A, Karim M
Indian Heart J · 2024 · PMID 39389259 · Full text
BACKGROUND: Limited data exist on the role of coronary collaterals circulation (CCC) in patients with ST-elevation acute coronary syndrome (STE-ACS). This study aimed to assess CCC and the in-hospital course of patients...
BACKGROUND: Limited data exist on the role of coronary collaterals circulation (CCC) in patients with ST-elevation acute coronary syndrome (STE-ACS). This study aimed to assess CCC and the in-hospital course of patients with CCC undergoing primary percutaneous coronary intervention (pPCI). METHODS: The study included consecutive STE-ACS patients undergoing pPCI. Good CCC was defined as Rentrop collateral score (RCS) of 2-3. Patients with good and poor CCC were compared regarding clinical characteristics, angiographic patterns, and hospital course. RESULTS: In the sample of 4683 patients, mean age was 55.6 ± 11 years, and 78.8 % were male. Good CCC was observed in 499 (10.7 %) patients. The rate of intra-procedure slow-flow/no-reflow (SF/NR) was 29.9 % vs. 20.5 % (p < 0.001), and the rate of composite adverse clinical outcomes (CACO) was 21.2 % vs. 19 % (p = 0.225) for patients with good and poor CCC, respectively. Multivariable analysis identified left ventricular end-diastolic pressure (LVEDP), multi-vessel disease (MVD), and thrombus grade ≥4 as independent predictors of good CCC, with adjusted odds ratios of 0.98 [0.97-0.99], 1.69 [1.35-2.10], and 3.45 [2.64-4.52], respectively. In propensity-matched cohorts, the intra-procedure SF/NR rate was 29.9 % vs. 26.9 % (p = 0.292), and the rate of CACO was 21.2 % vs. 23.4 % (p = 0.403) for patients with good and poor CCC, respectively. CONCLUSION: Angiographic evidence of good CCC in STE-ACS patients was limited. Good CCC was associated with a higher prevalence of MVD, high thrombus burden, and low pre-procedure LVEDP, resulting in a higher incidence of intra-procedure SF/NR. However, the CACO did not differ significantly between patients with good and poor CCC.
Use of strain imaging to detect subtle myocardial involvement in post COVID-19 patients: An Indian perspective.
Tomar D, Kapoor A, Hashim Z … +8 more , Raut K, Katheria A, Khare H, Sahu A, Khanna R, Kumar S, Garg N, Tewari S
Indian Heart J · 2024 · PMID 39362598 · Full text
BACKGROUND: The study assessed Global longitudinal strain imaging (GLS) to detect subtle myocardial dysfunction among patients clinically recovered from COVID-19. METHODS: All patients (n = 101 76 % males, mean age 55.45...
BACKGROUND: The study assessed Global longitudinal strain imaging (GLS) to detect subtle myocardial dysfunction among patients clinically recovered from COVID-19. METHODS: All patients (n = 101 76 % males, mean age 55.45 ± 11.14 years), and controls (n = 30), underwent clinical assessment and echocardiography, including GLS assessment. RESULTS: The prevalence of diabetes mellitus, hypertension and dyslipidemia was comparable amongst patients and controls. The average GLS was significantly lesser in post COVID patients (-16.21 ± 1.96 vs -18.49 ± 1.64 respectively, p = 0.004) and significantly higher proportion of post COVID patients had GLS > -18 % (43 % vs 22.58 % respectively, p = 0.001) as compared to controls. The RV free wall longitudinal strain (RVFLS) was also lower in the patient group (22.35 ± 4.69 vs 24.19 ± 4.11, p = 0.004) and 21.7 % post COVID-19 patients had pathological RV FWLS (> -20 %) vs controls (6.6 %). Average GLS was significantly lesser in severe post COVID patients (viz -14.25 ± 1.92 vs -16.63 ± 1.61 vs -17.63 ± 1.91, p < 0.0001, respectively among severe, moderate and mild COVID-19 patients. On performing regression analysis, severity of COVID-19 (OR 7.762) was a significant predictor of impaired GLS. CONCLUSION: Despite normal global LVEF, post COVID-19 recovered patients had significantly lower LV GLS and RV FWLS with severe COVID-19 infection, regardless of having a clinical recovery. This study reiterates the importance of speckle tracking echocardiography as an important imaging modality for detection of subclinical myocardial dysfunction in the post COVID-19 recovered patients.
Outcomes of mitral transcatheter edge to edge repair with MitraClip™ - An Indian single center experience.
Satish S, Subban V, Vijayachandra Y … +8 more , Oomman A, Arumugam G, Senthil H, Kethavath H, Pulindram KD, Kar S, Kodali S, Chandrasekaran K
Indian Heart J · 2024 · PMID 39343237 · Full text
OBJECTIVE: To evaluate the outcomes of transcatheter edge-to-edge repair (TEER) with MitraClip™ (Abbott Vascular) in symptomatic high surgical risk Indian patients with significant mitral regurgitation (MR). METHODS: Pat...
OBJECTIVE: To evaluate the outcomes of transcatheter edge-to-edge repair (TEER) with MitraClip™ (Abbott Vascular) in symptomatic high surgical risk Indian patients with significant mitral regurgitation (MR). METHODS: Patients with moderately severe or severe primary or secondary MR and deemed high surgical risk were treated with MitraClip™. The data were collected retrospectively from medical records. The primary outcome was technical success, and secondary outcomes were ≤2+ MR reduction and improvement in functional capacity at 30 days. RESULTS: Between November 2018 and August 2023, 64 patients were treated with MitraClip. The mean age was 70.0 ± 12.1 years and 64 % were males. The mean EuroScore II and STS score predicted mortality for mitral valve repair were 5.8 ± 4.5 % and 4.0 ± 3.8 % respectively. MR etiology was primary in 56.3 %, secondary in 40.6 % and mixed in 3.1 %. The device was implanted successfully in all but one patient with technical success rate of 98.4 %. The average number of clips per patient was 1.5 ± 0.6 and 42.2 % patients received more than one clip. The mean mitral valve gradient was 3.5 ± 1.6 mmHg. The MR severity of ≤2+ was achieved in 91.8 % of the subjects and similar proportion were in New York Heart Association Functional Class I or II at 30 days. CONCLUSION: In high-risk Indian patients with symptomatic significant MR, TEER with MitraClip™ was achieved with a high technical success rate. It was associated with significant reduction in MR severity and improvement in functional capacity in >90 % of the subjects.
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