Research (Cardiology)

Original Articles

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TRANSVENOUS ARTERIAL DUCT STENTING IN CYANOTIC PATIENTS WITH PULMONARY ATRESIA AND VENTRICULAR SEPTAL DEFECT
Bhavesh Thakkar, Abhishek Raval, Tarun Madan, Nilesh Oswal, Rhshikesh Umalkar, Komal Shah, Bhumika Maheriya Progress in Pediatric Cardiology
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We aimed to study the feasibility and outcomes of transvenous approach for arterial duct stenting in patients with pulmonary atresia-ventricular septal defect. Duct-dependent hypoxic patients with pulmonary atresia-ventricular septal defect and the confluent pulmonary artery branches were enrolled for ductal stenting and followed-up regularly. Twenty-three patients, with median age of 25 days (1 to 545 days) and weight of 2.8 kg (2.1 to 7.2 kg) were enrolled. Mean baseline arterial oxygen saturation was 69.38 ± 8.04%. Median right pulmonary artery and left pulmonary artery Z-scores were − 1.53 (− 4.19 to 2.48) and − 1.08 (− 8.03 to 3.0) respectively. Mean narrowest ductal diameter was 1.81 ± 0.57 mm and length was 13.63 ± 3.52 mm. Total 26 stents with mean diameter of 4.23 ± 0.29 mm and length of 14.88 ± 3.65 mm were deployed. Post-stenting mean arterial oxygen saturation increased significantly from baseline-value to 89.44 ± 4.86% (p < 0001). One patient suffered pulmonary edema. At median follow-up of 8 months (3 to 10 months), mean arterial oxygen saturation (78.82 ± 8.49%) was significantly higher than baseline value of 69.38 ± 8.04% (p = 0.0004). Median right and left pulmonary artery Z-scores were 0.39 (− 2.76 to 2.88) and − 0.02 (− 2.06 to 3.86) respectively. Five patients required re-intervention (shunt in 2 and angioplasty in 3 patients). Three patients died, one due to sepsis and another two with worsened cyanosis. Transvenous ductal stenting is an effective palliation in patients with pulmonary atresia-ventricular septal defect obviating the limitations of arterial approach.

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HIGH DENSITY LIPOPROTEIN CHOLESTEROL AS A RISK FACTOR OF CORONARY ARTERY DISEASES IN YOUNG WESTERN INDIAN: A COMPARISON WITH OTHER LIPID MARKERS
Jagjeet K.Deshmukh, Jayesh S.Prajapati, Komal H.Shah, Krutika H.Patel, Subhash D. Chaudhari, Pooja M.Vyas, Alok Shinde, Saurabh R.Bagga (National Journal of Laboratory Medicine. 2016 Oct, Vol-5(4): IO01-IO05)
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Introduction: Dyslipidemia – a modifiable risk factor of coronary artery diseases (CAD) is often subjected to ethnic variations. Different communities are known topossess different pattern of lipid abnormalities and study of it is highly required in order to form various preventive strategies. Aim: To compare the prevalence of dyslipidemias in healthy control versus young CAD patients from Western India. We also seek to assess the strength of each associated dyslipidemia and propose a most suited risk factor for this community. Materials and Methods: In this single centric, prospective and case control study 200 subjects (100 patients with CAD & 100 healthy volunteer) were enrolled. Fasting blood sample were collected from the antecubital vein of the subjects under sterile conditions. Lipid profile parameterssuch as total cholesterol (TC), triglyceride (TG), total lipid (TL), low density lipoprotein (LDL), high density lipoprotein (HDL), and very low density lipoprotein cholesterol (V... the strength of association of an individual risk factor. Significance was taken as two tailed p<0.05. Results: There was equal number of patients divided in case and control group. In all 65 males and 35 females and, 59 males and 41 females in case and control group respectively (p=0.47). The distribution of cardiovascular risk factors was significantly (p<0.05; BMI: 23.96 ± 4.37 vs 22.65 ± 4.55; diabetes: 10% vs 2%; hypertension: 41% vs 11%; Smoking: 11% vs 1%) higher in CAD patients as compared to control population. The level of HDL was significantly lower in cases, whereas all other lipid parameters except LDL were higher in cases as compared to control (p<0.05). Odds ratio analysis showed that low HDL levels 11.76 (95% CI 4.69 to 29.49) is the strongest associate of CAD amongst all other lipids in Western Indian population. Conclusion: The study results conclude that in young CAD patients from western India the role of low HDL is significant as compared to other dyslipidemias.

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DIAGNOSTIC ACCURACY OF COMPUTED TOMOGRAPHY ANGIOGRAPHY AS COMPARED TO CONVENTIONAL ANGIOGRAPHY IN PATIENTS UNDERGOING NONCORONARY CARDIAC SURGERY.
Hasit Joshi, Ronak Shah, Jayesh Prajapati, Vipin Bhangdiya, Jayal Shah, Yogini Kandre, Komal Shah HEART VIEWS Jul-Sep 16 Issue 3 / Vol 17/ Page : 88-91
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To compare the diagnostic accuracy of multi‑slice computed tomography (MSCT) angiography with conventional angiography in patients undergoing major noncoronary cardiac surgeries. Materials and Methods: We studied fifty major noncoronary cardiac surgery patients scheduled for invasive coronary angiography,29 (58%) female and 21 (42%) male. Inclusion criteria of the study were age of the patients less than or equal to 40 years, having low or intermediate probability of coronary artery disease (CAD), left ventricular ejection fraction (LVEF) greater than 35%, and patient giving informed consent for undergoing MSCT and conventional coronary angiography. The patients with LVEF <35%, high pretest probability of CAD, and hemodynamically unstable were excluded from the study.Results: The diagnostic accuracy of CT coronary angiography was evaluated regarding true positive, true negative values. The overall sensitivity and specificity of CT angiography technique was 100% (95% confidence interval [CI]: 39.76%–100%) and91.30% (95% CI: 79.21%–97.58%). The positive (50%; 95% CI: 15.70%–84.30%) and negative predictive values (100%; 95% CI:91.59%–100%) of CT angiography were also fairly high in these patients. Conclusion: Our study suggests that this non-invasive technique may improve perioperative risk stratification in patients undegoing non-cardiac surgery

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APOLIPOPROTEIN B / APOLIPOPROTEIN A – I RATION A BETTER DIAGNOSTIC MARKER OF CORONARY HEART DISEASE THAN CONVENTIONAL LDL / HDL RATIO.
Jayesh S.Prajapati, Jagjeet K.Deshmukh, Krutika H. Patel, Komal H.Shah, Hasit J. Joshi, Ranajeet More, Sibasis S. Sahoo National Journal of Laboratory Medicine. 2016 Jul, Vol-5(3): BO01-BO05
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Introduction: Apolipoprotein B (Apo B) and apolipoprotein A-I (Apo-I) are cholesterol transporters playing an important role in lipid metabolism. Apo B and A-I represent the total atherogenic and non-atherogenic particles respectively. Hence, their ratio – Apo B/A-I has been strongly associated with various cardiovascular events. Aim: To compare the diagnostic efficacy of apolipoproteins with conventional lipids for coronary heart disease. Materials and Methods: There were 295 individuals with or without coronary heart disease were enrolled in the study. The demographic details along with clinical investigations of serum lipid parameters, Apo B and Apo A-I levels were obtained and recorded. Study Design: It was a single centre, prospective observational study of 295 individuals of both the genders (235 males and 60 females) with or without coronary artery disease. Statistical Analysis: A comparison of parametric values between two groups was performed using student’s t-test. Non-parametric analysis of the continuous data was performed using Mann-Whitney U test. Significance was taken as two tailed p less than 0.05. Results: In study population, 221(74.92%) had coronary heart disease (CHD) and 74(25.08%) were normal. Statistically significant differences were found in the levels of apo B/apo A-I ratio (p=0.009), and Apo A-I (p≤0.001) between two groups. The other lipid parameters and ratios such as cholesterol, triglyceride, HDL-C, LDL-C, nonHDL-C cholesterol, VLDL, Total lipid, Apo-B, LDL-C/HDL-C and TC/HDL-C were not found to be significant. Conclusion: The present study shows that Apo B/A-I possesses superior diagnostic efficacy for coronary heart disease as compared to conventional lipid parameters and could be effectively used in clinical practice

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NOVEL INDEXES FOR DIAGNOSING METABOLIC SYNDROME IN APPARENTLY HEALTHY GUJARATI ASIAN INDIANS: A CROSS – SECTIONAL STUDY.
Dr. Hasit Joshi, Dr. Komal Shah, Ms. Priyanka Patel, Dr Jayesh Prajapati, Dr. Meena Parmar, Dr. Dhaval Doshi, Dr. Shardul Chaurushia
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Background: We aimed to compare the diagnostic accuracy of four novel indexes—triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio, weight height ratio (WHtR), lipid accumulation product (LAP) and visceral adiposity index (VAI) with conventional components of metabolic syndrome (MetS) in order to identify a single index for the diagnosis of MetS in Gujarati Indian population.

Methods: This observational and cross sectional study involved a total of 3329 healthy adults of 18–79 years of age. Demographic and clinical data such as body mass index, waist circumference, blood pressure were measured along with the levels of lipids and fasting blood glucose.

Results: The overall prevalence of MetS was 34.32%, which was almost double in older individuals (45.5% vs. 20.8%) and slightly higher in males (37% vs. 31.2%). In comparison to individual components of MetS, three novel indexes—VAI, LAP and TG/HDL-C ratio showed superior diagnostic efficacy yielding an area under curve of 0.856, 0.821 and 0.821 respectively. The optimal cut-offs for VAI, LAP and TG/HDL Ratios for male, females, young and old population are (79.71, 88.12, 75.42, 87.4), (35.62, 34.73, 35.88, 34.7) and (2.249, 3.16, 2.49, 2.79) respectively. The diagnostic effectiveness of novel markers was unaffected by the age and gender of an individual. However, the efficacy of WHtR was comparable with the other conventional markers.

Conclusion: Three novel markers—LAP, VAI and TG/HDL-C ratio could be effectively used as a single ‘Surrogate marker’ for screening of asymptomatic Gujarati Asian Indians with MetS.

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ACCURACY OF DIFFERENT IMAGING MODALITIES PRIOR TO BIVENTRICULAR REPAIR IN TETRALOGY OF FALLOT.
Abhishek Raval, Nilesh Oswal, Bhavesh Thakkar, Rajiv Garg, Komal Shah, Iva Patel Internet Journal of Medical Update. 2016 January;11(1):3-11
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The aim of the present study was to determine the diagnostic accuracy ofnon-invasive tests in patients with Tetralogy of Fallot prior to biventricular repair, and theneed of invasive angiocardiography in specific subgroups. A retrospective analysis wasperformed for paediatric patients with Tetralogy of Fallot who underwent biventricularrepair in three consecutive months. Patients were divided into two groups according totheir age: below and above 5 years. We compared the findings of different imagingmodalities (e.g. echocardiography, multi-detector Computed Tomography (CT) andinvasive angiocardiography) to intraoperative findings to determine their accuracies indifferent subgroups. Results showed that echocardiography is reliable for preoperativeimaging, especially in younger children (sensitivity=71.43%) and its findings are‘moderately’ concordant with intraoperative findings (kappa=0.439). For patients above 5years of age, its sensitivity (29.41%) declines and findings are ‘poorly’ concordant withintraoperative findings (kappa=0.093). With addition of multi-detector CT, the findings ofnon-invasive means are ‘perfectly’ concordant with the intraoperative findings (kappa=1)in children below 5 years and ‘moderately’ concordant with those (kappa=0.4) in childrenabove 5 years. The findings of CT are ‘moderately’ concordant with those of invasiveangiocardiography (kappa=0.4). Tetralogy of Fallot patients below 5 years can directly besubjected to surgery with work-up including detailed echocardiography only. If anatomy isnot clearly delineated, CT helps and invasive angiocardiography is not essential. In patientsabove 5 years, CT has an important role in defining anatomy. The need for catheterizationis limited to hemodynamic evaluation of prior shunt and embolization of aorto-...

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AGE AND SEX SPECIFIC REFERENCE INTERVALS FOR MODIFIABLE RISK FACTORS OF CARDIOVASCULAR DISEASES FOR GUJARATI ASIAN INDIANS.
Sibasis Sahoo, Komal H. Shah, Ashwati R. Konat, Kamal H. Sharma, and Payal Tripathi International Journal of Chronic Diseases Volume 2015 (2015), Article ID 394798, 9 pages
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Objective. We aimed to establish age and sex specific percentile reference data for cardiovascular risk factors such as lipids, sugar, blood pressure, and BMI in apparently healthy and disease-free Gujarati population. Methods. In this cross-sectional study, we enrolled 3265 apparently healthy and disease-free individuals of both genders residing in Gujarat state. Fasting samples of blood were used for biochemical estimations of lipids and sugar. The measurement of BMI and blood pressure was also done according to the standard guidelines. Age and gender specific 5th, 25th, 50th, 75th, 90th, and 95th percentiles were obtained. Results. The mean values of lipids, sugar, blood pressure, and BMI were significantly () higher in males as compared to female population. Age-wise distribution trends showed increase in the risk factors from the 2nd decade until the 5th to 6th decade in most of the cases, where loss of premenopausal protection in females was also observed. Specific trends according to gender and age were observed in percentile values of various parameters. Conclusion. The outcome of current study will contribute significantly to proposing clinically important reference values of various lipids, sugar, blood pressure, and BMI that could be used to screen the asymptomatic Gujarati Indian population with a propensity of developing dyslipidemia, diabetes, blood pressure, and obesity.

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INCIDENCE AND ASSOCIATES OF RENAL ARTERY STENOSIS IN PATIENTS UNDERGOING PERIPHERAL AND CORONARY ANGIOGRAPHY.
Hasit Joshi, Jayesh Prajapati, Ronak Shah, Pavan Roy, Vipin Bhangdiya, Komal Shah and Priyanka Patel International Journal of Biomedical and Advance Research 2015; 6(08): 558-563.
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Objectives: Increasing prevalence of renal artery stenosis (RAS) in coronary artery disease (CAD) patients has been reported by many. We aimed to study the incidence and risk factors of renal artery disease in patients undergoing coronary angiography (CAG) and/or peripheral angiography (PAG). Methods: Data of 2209 consecutive patients undergoing CAG and/or PAG followed by renal angiography was collected from January-June 2013. Pervasiveness of risk factors such as hypertension, diabetes, dyslipidemia, smoking, family history and incidence of CAD were studied. Significant difference in profiles of patients with or without compelling atherosclerotic renal artery stenosis (ARAS) was tested by chi-square and unpaired t-test. Results and conclusion: Of 2209 patients, the prevalence of RAS in the study population was 6.11%. Mean age of the RAS patient group was 57.17 ± 10.82 years. Advancing age, hypertension, diabetes, smoking and dyslipidemia were found to be strongly associated with RAS. Patients with significant CAD had increased chances to develop ARAS. Ageing and presence of risk factors were closely associated with significant ARAS and hence they could be used in effectively predicting the presence of RAS in patients undergoing routine CAG and/or PAG.

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TRANSCATHETER DEVICE CLOSURE OF PERIMEMBRANOUS VENTRICULAR SEPTAL DEFECT IN CHILDREN TREATED WITH PROPHYLACTIC ORAL STEROIDS: ACUTE AND MID-TERM RESULTS OF A SINGLE CENTER, PROSPECTIVE, OBSERVATIONAL STUDY.
Bhavesh Thakkar, Nehal Patel, Shomu Bohora, Dharmin Bhalodiya, Tarandeep Singh, Tarun Madan, Saurin Shah, Vishal Poptani and Anand Shukla Cambridge University Press 2015
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Background and Objective: Although transcatheter closure of perimembranous ventricular septal defect is emerging as an accepted, viable alternative, conduction disturbances still remain a major concern. Although steroid treatment has shown encouraging results with complete recovery, efficacy of prophylactic use of steroids is still speculative. We aim to study the mid-term outcome of perimembranous ventricular septal defect closure in children who received prophylactic oral steroids. Materials and methods: A prospective study was designed and antegrade device closure was attempted in eligible children who met the following inclusion criteria: age 3–18 years and weight greater than 10 kg, defect diameter less than or equal to 12 mm, and symptomatic, haemodynamic changes or history of infective endocarditis. Prophylactic steroid protocol consisted of 2 weeks oral prednisolone (1 mg/kg/day) initiated immediately after the procedure, and in the event of bradyarrhythmia it was escalated to 2 mg/kg. Patients were regularly followed-up at 1, 6, and 12 months and then annually. Patients with post-procedure heart block underwent Holter monitoring after a minimum of 1 year interval. Results: Between May, 2007 and August, 2012, successful device closure was accomplished in 290/297 patients. Mean age and weight were 9±3.12 years and 21±8.27 kg, respectively. The defect measured 5±1.38 mm on echocardiography. Mean fluoroscopy time was 12.98±8.64 minutes. Eight patients with major complications included one each with device embolisation, haemolysis, severe aortic regurgitation, and five with bradyarrhythmias, including complete atrioventricular block in three, Mobitz II in one, and bifascicular block in one. Patients with complete atrioventricular block responded to high-dose ...

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PREVALENCE AND PREDICTORS OF METABOLIC SYNDROME IN YOUNG ASYMPTOMATIC GUJARATI POPULATION.
Sharad R. Jain, Komal H. Shah, Himanshu N. Acharya, Kaushik Barot and Kamal H. Sharma International Journal of Chronic Diseases Volume 2015 (2015), Article ID 365217
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Background. Metabolic syndrome is a cluster of risk factors leading to the development of atherosclerotic cardiovascular diseases. We aimed to evaluate the prevalence of metabolic syndrome (MS) and its predictors in young and apparently healthy Gujarati individuals. Methods. This population based cross-sectional study involved a total of 1500 healthy adults of 20–40 years of age. Demographic details and clinical data such as body mass index (BMI), waist circumference (WC), and blood pressure were measured along with the estimations of lipoprotein (a), total cholesterol (TC), triglyceride (TG), total lipid, LDL/HDL ratio, TC/HDL ratio, and fasting blood glucose (FBS). Results. Overall in young Gujarati population (20–40 years) prevalence rates of MS were 16.0% (male: 21.5%; female: 10.8%) where the metabolic abnormalities increased with advanced age as 9.56% of the young population (20–30 years) had MS, in contrast to the 24.57% in the old (31–40 years). Odds ratio analysis had indicated BMI (1.120; 95% CI: 1.077–1.163; ) as the strongest risk factor for MS closely followed by advancing age (1.100; 95% CI: 1.061–1.139; ) levels. Conclusion. Prevalence of metabolic syndrome in young Gujarati population reinforces the need for early life style intervention and awareness programs in this ethnic group.

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PREVALENCE AND PROFILES OF DYSLIPIDEMIA IN APPARENTLY HEALTHY ADULT GUJARATI POPULATION.
Sibasis S. Sahoo , Tarun Madan , Kamal H. Sharma , Sharad R. Jain , Komal H. Shah , Yogini A. Kandre Healthline Journal Volume 6 Issue 1 (January – June 2015)
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Introduction : Circulating lipids and lipoproteins are long being recognized as risk factors for developing cardiovascular diseases (CVD). Objective : To evaluate the prevalence and profiles of dyslipidemia in young and asymptomatic Gujarati population. Method : In this cross sectional study we had randomly selected 1440 individuals of the both the genders who were of 20- 40 years of age and disease free. Individuals having history of any medications for diabetes, hypertension and CVD were excluded from the study. The remaining healthy individuals underwent detained physical examinations and tests of lipid profiles. Results :  In the overall population, the prevalence of low HDL-C (36.53%) and high lipoprotein (a) (32.15%) were most common lipid abnormalities found. We have observed that except for lipoprotein (a) (28.4% Vs35.66%),the males were more dyslipidemic than females (p<0.001). Age-wise distribution showed that younger individuals (20-29 years) were having superior lipid profile as compared to their older counterparts (30-40 years) (p less than 0.001). In population having lipoprotein (a) abnormality (32.15%), the low HDL-C (33.7%) was highly prevalent. Conclusion : Thus it is concluded that the young Gujarati population is highly susceptible to develop lipoprotein (a) and HDL-C abnormalities and this information could be used to design the preventive polices for future CVD events.

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DO CIRCULATING BLOOD CELL TYPES CORRELATE WITH MODIFIABLE RISK FACTORS AND OUTCOMES IN PATIENTS WITH ACUTE CORONARY SYNDROME (ACS)?
Kamal H. Sharma, Komal H. Shah, Iva Patel, Alap K. Patel, Subhash Chaudhari Indian Heart Journal
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Aims: Atherosclerosis is an inflammatory process with different cardiovascular risk factors(CVRFs) contributing to its pathogenesis. We aimed to evaluate the specific relationshipbetween circulating blood leukocytes, troponin I and CVRFs.Methods: We prospectively enrolled 959 patients with evidence of acute coronary syndromeeither in form of unstable angina or STEMI or NSTEMI. Details demographic characteristics,CVRF and biochemical parameters such as total white blood cells (WBC), neutrophil,lymphocytes, platelet, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR),and troponin I were collected.Results: The results indicated that patients having either hypertension, diabetes or smoking habit had significantly higher levels of total WBC ( p = 0.013), neutrophil ( p = 0.029), NLR ( p = 0.029) and PLR ( p = 0.009). The level of troponin I was unaffected by these risk factors. Significant association of hypertension was found with total WBC ( p = 0.0392), lymphocytes ( p = 0.0384) and PLR ( p = 0.0027), whereas in diabetes and females all other leukocyte subtypes were significantly altered except for platelet and troponin I. Smokers had higher level of total WBC count ( p = 0.0033) and PLR ( p = 0.0464). No relationship between CVRFs and leukocytes was observed in males. The age independent effect was observed with PLR, whereas association with total WBC, lymphocytes, NLR, platelet was specific in older population. In younger patients NLR ( p = 0.0453) is more likely to be elevated. Mortality was significantly associated with changes in the leukocytes but not with the CVRF presence.

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AGE RELATED DIFFERENCES OF NOVEL ATHEROSCLEROTIC RISK FACTORS AND ANGIOGRAPHIC PROFILE AMONG GUJARATI ACUTE CORONARY SYNDROME PATIENTS.
Jayesh Prajapati, Hasit Joshi, Sibasis Sahoo,Kapil Virpariya, Meena Parmar, Komal Shah Journal of Clinical and Diagnostic Research. 2015 Jun, Vol-9(6): OC05-OC09
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Context: Although numerous risk factors have been established to predict the development of acute coronary syndrome (ACS), the risk factor profile may be different between the younger and older individuals. Aim: To analyse the frequency and pattern of atherogenic risk factors and angiographic profiles in age-stratified Gujarati patients with ACS. Materials and Methods : ACS patients undergoing coronary angiography at U.N. Mehta Institute of Cardiology and Research, Gujarat, India between January 2008 and December 2012 were classified in to two age groups with 40y as cut-off. Patients were assessed for conventional risk factors (diabetes mellitus, dyslipidaemia, hypertension, smoking, obesity), novel risk factors (high sensitivity C-reactive protein, lipoprotein (a), homocysteine), and angiographic profiles.The statistical difference between two age groups was determined by Student’s t-test for continuous variables and Chi-square or Fisher’s exact test for categorical variables. Results: A total of 200 patients, 100 patients less than or equal to 40 y of age and 100 patients more than 40 y of age, were evaluated. Older patients had higher frequency of hypertension (32 vs. 16%, p=0.008), while family history of coronary artery disease was more common among younger patients (19 vs. 9%, p=0.041). The incidence of diabetes, dyslipidaemia, smoking and tobacco chewing did not vary significantly between the two groups. Total cholesterol and low-density lipoprotein cholesterol levels were significantly higher in the younger group (p less than 0.05). Lipoprotein (a), homocysteine and high-sensitivity C reactive protein levels were comparable between two age groups. Multi-vessel coronary artery disease was more common among older group. The most commonly affected coronary artery was the left ...

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TISSUE DOPPLER IMAGING IN RHEUMATIC MITRAL VALVE DISEASE PATIENTS FOR THE ASSESSMENT OF LEFT VENTRICULAR FUNCTION.
Mona S Jain, Kamal H Sharma, Nikhil D Jadhav, Komal H Shah, Ashwati Konat American Journal of Advanced Medical & Surgical Research, 2015;1(1):3-8.
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The aim of the study is to investigate whether the Tissue doppler imaging (TDI) technique is advantageous in evaluation of LV systolic function in patients with rheumatic mitral valve disease in comparison to Simpson’s method of conventional echocardiography. In this prospective, crosssectional study,60 age and sex matched individuals were enrolled into two groups (30 in each group) -healthy controls (Group 1) and the patients of rheumatic mitral valve disease (Group 2). In addition to the standard Echocardiographic assessment methods, both the groups underwent the tissue Doppler evaluation,in order to assess the LV function. Student’s t-test was used to compare continuous variable whereas chi-square test was used for the categorical variables. Myocardial performance index (MPI) assessed by conventional echocardiography and tissue doppler method were significantly (<0.001) lower in group 1 (0.39 ± 0.03) as compared to group 2 (0.46 ± 0.02) subjects. Peak systolic myocardial velocity (13.73 ± 2.51 vs 7.8 ± 1.42), early diastolic (16.4 ± 2.99 vs 8.03 ± 1.47) and late diastolic myocardial velocities (11.17 ± 2.04 vs 7.56 ± 1.38) were significantly higher in group 1 than in group 2. The strain and strain rate of base lateral, mid and apical LV free wall, apical-, mid- and base septal were significantly (p<0.05) lower in group 2 as compared to group 1. Tissue Doppler imaging (TDI) can be useful in the detection of subclinical LV dysfunction in patients of rheumatic mitral valve disease. Myocardial strain offers an objective mean to quantify global and regional LV function and to improve the accuracy and reproducibility of conventional echocardiographic studies.

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PREVALENCE AND PREDICTORS OF UNDIAGNOSED HYPERTENSION IN AN APPARENTLY HEALTHY WESTERN INDIAN POPULATION.
Anand N. Shukla, Tarun Madan, Bhavesh M. Thakkar, Meena M. Parmar, and Komal H. Shah Advances in Epidemiology Volume 2015 (2015), Article ID 649184, 5 pages
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This epidemiological study was designed to evaluate the prevalence of undetected hypertension in an apparently healthy western Indian population having no history of major illness. 3629 individuals of 18 years of age were included in the study. Hypertension (HTN) was defined as systolic blood pressure (SBP) 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg and prehypertension (PHTN) as SBP ≥ 120–139 mmHg or DBP ≥ 80–89 mmHg, but without HTN. The prevalence of undiagnosed HTN in the total population was 26% and was 11% and 40% in the young (40-year) and old (40-year) populations, respectively. The prevalence of PHTN, 40% in the overall population, was nearly the same in the young (39%) and the old population (42%). The risk factor most strongly associated with PHTN and HTN was obesity, showing the highest odds ratio in the overall (PHTN 2.14; 95% CI 1.20–3.81; HTN 2.72; 95% CI 1.53–4.85), the young (PHTN 2.29; 95% CI 1.25–4.21; HTN 2.92; 95% CI 1.59–5.35), and the old (PHTN 1.13; 95% CI 0.65–1.96; HTN 1.38; 95% CI 0.79–2.4) populations. Hypertension is a major risk factor for cardiovascular diseases which must not be ignored, especially in the western Indian population.

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CARDIOVASCULAR DISEASE RISK FACTOR ESTIMATION IN GUJARATI ASIAN INDIAN POPULATION USING FRAMINGHAM RISK EQUATION.
Sibasis Sahoo, Komal Shah, Anand Shukla, Jayesh Prajapati, Pratik Shah NATIONAL JOURNAL OF MEDICAL RESEARCH Volume 4│Issue 4│Oct – Dec 2014
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Introduction: Framingham 10 years risk estimation tools are potentially a cost-effective strategy for cardiovascular disease (CVD) prevention in developing countries. The current investigation was designed to predict CVD risk in healthy and asymptomatic Gujarati Asian Indians. Methods: It was observational study of 2483 individuals of Gujarat state having no past or present history of major illness including CVD. The study cohort was stratified into three groups of low-, intermediate- and high risk of CVD according to the Framingham 10 years risk calculator and the contributing factors for higher CVD risk were studied. Results : Out of 2483 individuals, (65.4%) had low risk of CVD event followed by 21.95% having intermediate and 12.65% showing high risk. The low level of HDL-C (85.03%), hypertension (63.69%) and elevated TC (60.83%) and LDL-C (60.83%) were found to be the main contributors for CVD risk. In high risk males the levels of TC (58.45%) and LDL-C (58.1%) were significantly elevated (p<0.0001), whereas levels of HDL-C (92.25%) markedly low in this subset of population, whereas in females hypertension (100%) and abnormalities of lipids (TC – 83.33%, LDL-C – 86.67%) were the contributors. The CVD risk increased with age in both the genders where maximum risk was found at the population being in the 60-69 years (male – 45.07%; female – 46.67%) of the age. Conclusion: Higher risk in Gujarati Asian Indian community is mainly attributed by dyslipidemias and hypertension. Both of them being modifiable risk factors, the life style modification is highly advocated in this ethnic group.

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PATIENT PROFILE AND RESULTS OF PER-CUTANEOUS TRANS-VENOUS MITRAL COMMISSUROTOMY IN MITRAL RESTENOSIS FOLLOWING PRIOR PER-CUTANEOUS TRANS-VENOUS MITRAL COMMISSUROTOMY VS SURGICAL COMMISSUROTOMY.
Kamal H. Sharma, Sharad Jain, Anand Shukla, Shomu Bohora, Bhavesh Roy, Gaurav D. Gandhi, A.J. Ashwal indian heart journal 66 (2014) 164-168
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Background: Patients with mitral restenosis who have undergone prior PTMC or surgical commissurotomy have increased. Predictors of outcome of repeat PTMC in either subgroup of patients may be different. Aims and objectives: Aim was to assess and compare the immediate results of PTMC in patients who had undergone a prior PTMC or surgical commissurotomy. Methods and results: This is a single center, prospective, open label study. Of 70 patients in study, 44 (62.85%) patients had prior history of PTMC and 26 (37.15%) had prior surgical commissurotomy (closed/open). Average time from the initial procedure was 8.88 +/- 5.36 years overall, 6.75 +/- 3.38 for patients with prior PTMC and 16.73 +/- 3.67 for patients with prior surgical commissurotomy. Prior PTMC group had 75% female, patients with prior surgical commissurotomy were older (44 +/- 7 vs 33.57 +/- 9.1 years, p = 0.001), had higher NYHA class (III/IV in 100% vs 86.36%, p = 0.006.), higher atrial fibrillation (73.1% vs 25% p less than 0.0001) and higher Wilkins’ score (greater than 8 in 88.46% vs 68.18%, p = 0.05). Successful PTMC was lower (65.4% vs 84.1%) in patients with prior surgical commissurotomy, though statistically not significant (p = 0.07). After PTMC, mitral valve area, PA systolic pressure, LA

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DOES THE CLINICAL PROFILE OF GUJARATI PATIENTS WITH TAKAYASU’S AORTOARTERITIS DIFFER FROM OTHER INDIANS?
Sharad R Jain, Kamal H Sharma, Rajiv Garg and Nikhil Jadhav Internet Journal of Medical Update. 2014 July;9(2):4-8
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Takayasu’s aortoarteritis is a well-known yet rare form of large vessel vasculitis. It is a chronic inflammatory diseas, which has remained an enigma since it was first described a century ago. The present study was done to document the demographic profile, clinical course, complications and survival of 30 consecutive patients with aortoarteritis in the Gujarati population of western India. The study used non-invasive (color doppler, CT and MR angiography) and invasive techniques (conventional angiography) to document the vessels involved. The study showed almost equal incidence of disease in males and females in the Gujarati population unlike in other studied populations. Incidence of type-III aortoarteritis was the most common and left renal involvement was found to be significantly more common than right renal involvement in the present study. There was no mortality during the study period.

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COST-EFFECTIVENESS ANALYSIS OF NEBIVOLOL AND METOPROLOL IN ESSENTIAL HYPERTENSION: A PHARMACOECONOMIC COMPARISION OF ANTIHYPERTENSIVE EFFICACY OF BETA BLOCKERS.
Rachna S. Patel, Kamal H. Sharma, Nitisha A. Kamath, Nirav H. Patel, Ankita M. Thakkar Indian J Pharmacol. 2014 Sep-Oct; 46(5): 485–489.
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Objective: To estimate and compare the cost-effectiveness and safety of nebivolol with sustained-release metoprolol in reducing blood pressure by 1 mm of Hg per day in hypertensive patients. Materials and Methods : This was a prospective, randomized, open label, observational analysis of cost-effectiveness, in a questionnaire-based fashion to compare the cost of nebivolol (2.5 mg, 5 mg, 10 mg) and sustained released metoprolol succinate (25 mg, 50 mg, 100 mg) in hypertensive patients using either of the two drugs. A total of 60 newly detected drug naïve hypertensive patients were considered for the comparison, of which 30 patients were prescribed nebivolol and the other 30 were prescribed metoprolol succinate as per the recommended dosage. Based on the data, statistical analysis was carried out using GraphPad Prism 5 and MS Excel Spreadsheet 2007. Results: The cost of reducing 1 mm of Hg blood pressure per day with nebivolol was 0.60, 0.70, and 1.06 INR, whereas that of metoprolol succinate was 0.93, 1.18, and 1.25 INR at their respective equivalent doses, hence significantly lower with the nebivolol group as compared to the metoprolol group (P < 0.05). Conclusions: This pharmacoeconomic analysis shows that nebivolol is more cost-effective as compared to metoprolol when the cost per reduction in blood pressure per day is considered. This may affect the patients economically during their long-term use of these molecules for the treatment of hypertension.

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ASSOCIATION OF HIGH DENSITY LIPOPROTEIN WITH PLATELET TO LYMPHOCYTE AND NEUTROPHIL TO LYMPHOCYTE RATIO IN CORONARY ARTERY DISEASE PATIENTS.
Jayesh H. Prajapati, Sibasis Sahoo, Tushar Nikam, Komal H. Shah, Bhumika Maheriya, and Meena Parmar Journal of Lipids Volume 2014 (2014), Article ID 686791, 8 pages
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Background : We aimed to evaluate a relationship between platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) with high density lipoprotein (HDL) cholesterol levels in coronary artery disease (CAD) patients. Methods : A total of 354 patients with angiographically confirmed coronary blockages were enrolled in the study. Hematological indices and lipid profiling data of all the patients were collected. Results: We have observed significant association between HDL and PLR (P=0.008) and NLR (P=0.009); however no significant relationship was obtained with HDL and isolated platelet (P=0.488), neutrophil (P=0.407), and lymphocyte (P=0.952) counts in CAD patients. The association was subjected to gender specific variation as in males PLR (P=0.024) and NLR (P=0.003) were highly elevated in low HDL patients, whereas in females the elevation could not reach the statistically significant level. The PLR (217.47 versus 190.3;P=0.001 ) and NLR (6.33 versus 5.10;P=0.001 ) were significantly higher among the patients with acute coronary syndrome. In young patients the PLR (P=0.007) and NLR (P=0.001) were inversely associated with HDL, whereas in older population only NLR (P=0.005) had showed a significant association. Conclusions: We conclude that PLR and NLR are significantly elevated in CAD patients having low HDL levels.

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ARE GUJARATI ASIAN INDIANS ‘OLDER’ FOR THEIR ‘VASCULAR AGE’ AS COMPARED TO THEIR ‘CHRONOLOGICAL AGE’?.
Kamal H Sharma, Sibasis Sahoo, Alap K Patel, Nikhil D Jadhav, Meena M Parmar, Komal H Shah, Krutika H Patel QJM – An International Journal of Medicine (2014) DOI: 10.1093/qjmed/hcu158
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Background: South Asians are known to carry higher burden of cardiovascular diseases as compared to their Caucasian counterparts. Aim: The current study was designed to evaluate whether vascular age is advanced for Gujarati Asian Indians as matched to their chronological age in apparently healthy, asymptomatic population. We have also assessed the contributing risk factors for premature vascular ageing. Design : It was cross sectional study of 2483 individuals of Gujarat state in Western India having no past or present history of major illness including CVD. Methods : The vascular age of the population was calculated using Framingham vascular age calculator. A relationship between risk factor prevalence and vascular ageing was evaluated using univariate analysis of variance. Results : The mean chronological age of the study population was 46.8 (±10.35) years whereas mean vascular age was 53.34 (±16.05) years, and the difference (6.54±9.5) between both was statistically significant (p<0.0001). Contributory risk factors for advanced vascular age apart from chronological age (75.4%) and male gender (66.2%) were the presence of dyslipidemia (60.4%) hypertension (57.34%) and increased waist circumference (male 39.7%, female 29%). Results of regression analysis showed that vascular age progression was highly associated with blood pressure (19.9, 95% CI: 14.34-27.63), followed by smoking (15.23, 95% CI: 8.4-27.59), and blood sugar (12.97, 95% CI: 3.48-48.25). Conclusions: The Gujarati Asian Indians are subjected to premature vascular ageing and henceforth routine screening for vascular age and risk factors prevalence is strongly advocated in this ethnic group.

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CLINICAL AND ANGIOGRAPHIC FOLLOW-UP OF CORONARY ARTERY FISTULA INTERVENTIONS IN CHILDER: TECHNIQUES AND CLASSIFICATION REVISITED.
Bhavesh Thakkar, Nehal Patel, Vishal Poptani, Tarun Madan, Tarandip Saluja, Anand Shukla, Nilesh Oswal and Arvind Bisnoi Cardiology in the Young / FirstView Article pp 1-11
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Background : Transcatheter closure of coronary artery fistula has emerged as a safe and effective alternative to surgery. However, follow-up angiographic data after closure of the coronary artery fistula is extremely limited. We report our clinical and angiographic follow-up of children who underwent either transcatheter or surgical closure. Methods : Clinical profile, echocardiography parameters, and closure technique were retrospectively reviewed from the hospital charts. Since 2007, 15 children have been intervened and followed up with electrocardiography, echocardiography, and angiography. Results: A total of 15 children (six girls), with mean age of 6.7±5.4 years and weighing 16.3±9.8 kg, underwent successful closure (transcatheter=13, surgical=2) without periprocedural complication. Coronary artery fistula arose from the right (n=7) and left coronary artery (n=8) and drained into the right atrium or the right ventricle. Transcatheter closure was carried out using a duct occluder. Of the patients, two underwent surgical closure of the fistula on a beating heart. At 31.8±18.7 months follow-up, all the children were asymptomatic and had no evidence of myocardial ischaemia or infarction. However, follow-up angiography revealed thrombotic occlusion of fistula with the patent parent coronary artery in those having branch coronary artery fistula, and five of seven patients with parent coronary artery fistula had near-complete occlusion of fistula extending into the native coronary artery. Conclusions: Follow-up angiography revealed a high incidence of parent artery occlusion when the fistula was arising from the native artery and not from one of its branches. Coronary artery fistula intervention of the parent coronary artery fistula always carries the potential risk of ischaemia, unless ...

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THE OBESITY PARADOX IN THE DISTRIBUTION OF DYSLIPIDEMIA IN OBESE VERSUS NON-OBESE PATIENTS OF CAD IN GUJARATI POPULATION.
Kamal H Sharma, Sanjay J Vaghani, Gaurav D Gandhi, Nikhil D Jadav, Sandarbh P Patel, Meena M Parmar, Komal H Shah Indian Association of Preventive and Social Medicine, Health Line Journal, VOLUME: 5 ISSUE: 1 January-June 2014
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Background: Cardiovascular diseases (CVD) are the major cause of morbidity and mortality in developing countries. Risk factors for CVD like hypertension, diabetes, dyslipidemia and smoking contribute significantly to atherosclerosis and consequently to CVD. The aim of this study was to observe distribution of these risk factors in Gujarati coronary artery disease (CAD) patients over the entire spectrum of BMI and to look for existence of obesity paradox. Methods : This randomized and crosssectional study was done in September, 2010 on 818 subjects. Subjects of established CAD were evaluated by pretested proforma, physical examinations and, tests of lipid profiles, blood sugar levels. Results: The proportion of hypertension, was significantly higher in More than 30 BMI group than BMI less than 25 and 25-30 group (p value less than 0.0001). Diabetes and dyslipidemia were non-significantly higher in BMI 25-30 than BMI less than 25 and more than 30 showing possible effect of obesity paradox. In females, effect of obesity paradox was found in high cholesterol content which was statistically significant (p=0.0465) and low HDL was highest in BMI with less than 25 than those with BMI with 25-30 and more than 30 (p=0.1341). The same effect was observed with LDL also but in a non-significant (p=0.6556) fashion. The results found in male population were similar to the females in case of high cholesterol and LDL. Though statistically insignificant the age related dyslipidemia distribution also showed existence of obesity paradox. Conclusions: In females, high cholesterol was more in BMI less than 25 than BMI 25-30 and more than 30 group. Same effect was found in males also but did not reach statistically significant level.

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ASSOCIATION BETWEEN ANDROGENETIC ALOPECIA AND CORONARY ARTERY DISEASE IN YOUNG MALE PATIENTS.
Kamal H Sharma, Anchal Jindal International Journal of Trichology / Jan-Mar 2014 / Vol-6 / Issue-1
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Background : Several studies have demonstrated an association between androgenetic alopecia (AGA) and cardiovascular disease. Still controversies exist regarding the association.Are they truly associated? Objective< Strong> : The purpose of the present study was to assess the prevalence of AGA and establish its association in young (<45 years) Asian Indian Gujarati male patients having coronary artery disease (CAD). Materials and Methods : Case‑control prospective multicentric study was carried out on 424 men. Case group consisted of 212 male subjects having CAD (Group 1) and another 212, either sibling or first degree male relative of the case subjects (having no evidence of CAD) were considered as the control group (Group 2). Age, total cholesterol, incidence of diabetes mellitus, and hypertension were similar in both groups. The degree of alopecia was assessed using the Norwood‑Hamilton scale for men. Statistical analysis was performed using Chi‑square test. Results: AGA was found in 80 (37.73%) young CAD patients (Group 1), whereas 44 (20.7%) of patients had alopecia in the control group (Group 2). There was statistically significant association between male AGA and CAD (P = 0.001). Odds ratio was 2.70 (95% confidence interval [CI], 1.72 ± 4.26). Statistically significant association was found between high grade baldness (Grades IV‑VII) and CAD in young men (P < 0.05). Odds ratio = 2.36 (95% CI, 1.108 ± 5.033). There is statistically significant association of AGA in young Asian Gujarati male with CAD and the prevalence of AGA in young CAD patient is 37.73%. Conclusions: This study implies early onset AGA in male is independently associated with CAD, though mechanisms need to be investigated.

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NOVEL ATHEROSCLEROTIC RISK FACTORS AND ANGIOGRAPHIC PROFILE OF YOUNG GUJARATI PATIENTS WITH ACUTE CORONARY SYNDROME.
Jayesh Prajapati, Sharad Jain, Kapil Virpariya, Jayesh Rawal, Hasit Joshi,Kamal Sharma, Bhavesh Roy, Ashok Thakkar Journal of the association of physicians of india • vol 62 • published July, 2014
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Objectives: In this study we aimed to analyse the frequency of atherosclerotic risk factors with focus to novel risk factors for coronary artery disease and angiographic profile in young (≤ 40 years) acute coronary syndrome (ACS) patient with healthy controls in Gujarat, India. Methods : Between January 2008 and December 2012, 109 consecutive young patients aged ≤ 40 years old, diagnosed to have ACS were included in the study. All ACS patients underwent diagnostic coronary angiography. An equivalent age and sex matched population without coronary disease with similar risk factors without tobacco considered a control group. All angiographic patients were evaluated for conventional risk factors for coronary artery disease like diabetes mellitus, hypertension, smoking, obesity as well as novel atherogenic risk factors like high sensitivity C-reactive protein (Hs-CRP), Lipoprotein(a) [LP(a)], homocysteine, apolipoprotein A1 (ApoA1) and B (ApoB). Results: In a study group, out of 109 young patients, 90 (82.6%) patients were presented to our hospital as ST-segment elevation myocardial infarction (STEMI), 10 (9.2%) presented as known non- ST-elevation myocardial infarction (NSTEMI) and 9 (8.3%) presented as unstable angina (UA). Serum cholesterol, triglycerides, LDL, LP(a) and lipid tetrad index were significantly higher in the study group whereas the HDL levels significantly lower as compared to the control group. Conclusions: A quite common risk factors of premature CAD are smoking, high Hs-CRP, high LP(a), hyperhomocysteinaemia and positive family history in the young ACS. Most common presentation of ACS in young was STEMI. On angiography, single vessel involvement was the most common finding.

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CLINICAL PROFILE OF PEDIATRIC PATIENTS WITH LONG QT SYNDROME MASQUERADING AS SEIZURES.
Bhavesh Thakkar, Anand Shukla, Tarandeep Singh, Saurin Shah, Shomu Bohora, Jayal Shah, Tarun Madan The Indian Journal of Pediatrics January 2014
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Objective : To study the clinical profile of patients with long QT syndrome presenting as seizures. Methods : Retrospective analysis of six pediatric patients admitted at authors’ institute between October 2008 and January 2013 with seizures and a presumptive diagnosis of long QT syndrome (LQTS) was done. The diagnosis was made on the basis of updated Schwartz diagnostic criteria. Clinical data, investigation profile and follow up of patients was recorded in a standard format and analysed. Results: All the 6 patients in the study were boys with a mean age of 10.3 ± 2.8 y at the time of diagnosis. The lag period between symptom onset and diagnosis was 5.6 ± 3.14 y. All patients had history of seizures with a history of precipitating event in 4 patients. Average baseline QTc interval was 556 ± 41.31 ms. Mean Schwartz score was 6.66 ± 1.16. Polymorphic VT was documented in 4 patients. After initiating standard treatment with betablockers, nicorandil, spironolactone or pacemaker, all the six patients were asymptomatic at a mean follow up period of 17.5 mo, with no recurrence of seizures. Conclusions: LQTS can cause seizures due to prolonged ventricular arrhythmias in high risk subgroup. Children, who present with LQTS and seizures, generally have a precipitating event causing seizures, and they respond well to drug therapy.

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ONE YEAR CLINICAL OUTCOMES OF BIOMATRIX™-BIOLIMUS A9™ ELUTING STENT: THE E-BIOMATRIX MULTICENTER POST MARKETING SURVEILLANCE REGISTRY IN INDIA.
Ashwin B. Mehta, Praveen Chandra, Jamshed Dalal, Prabhakar Shetty, Devang Desai, K. Chocklingam, Jayesh Prajapati, pramod Kumar, Vilas Magarkar, Apurva Vasawada, B.K. Goyal, Viveka Kumar, V. Suryaprakash Rao, Ramesh Babu, Pritesh Parikh, Upendra Kaul, Ar
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Objectives: The e-BioMatrix is a post marketing multicenter registry with an objective to evaluate the 2 year clinical safety and efficacy outcomes in patients treated with BioMatrix™ – Biolimus A9™ (BA9™) drug eluting stents (DES). Background : Drug-eluting stents still have late-stage disadvantages that might be attributable to the permanent polymer. BioMatrix a new generation DES containing anti-proliferative drug Biolimus A9™ incorporating a biodegradable abluminal coating that leaves a polymer-free stent after drug release enhancing strut coverage while preventing neointimal hyperplasia.Methods : This interim analysis consists of a total of 1189 patients with 1418 lesions treated with BioMatrix stent who entered this multicenter registry in India. We analyzed the incidence of major adverse cardiac events (MACE) and stent thrombosis (ST) at 1, 6, and 12 months with an extended follow-up of 2 years. Recommended antiplatelet regimen included clopidogrel and aspirin for 12 months. Results: The mean age was 57.6 ± 10.9 years, 81.8% were males, comorbidity index was 1.20 ± 1.33, 68% presented with acute coronary syndrome, 49% had hypertension and 40.8% had diabetes mellitus. One-year clinical follow-up was completed in 987 patients at the time of interim analysis. The incidence of MACE is 0.45 for 1544 person-year follow-up. There were only 03 cases of ST (01 late ST) reported during this time. Conclusions: This registry demonstrates excellent one-year clinical safety and efficacy of BioMatrix stents. The 1-year result shows that BioMatrix stent may be a suitable alternative as compared to contemporary DESs which are currently available in the market for simple as well complex disease.

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RESPONSE OF BLOOD PRESSURE AFTER PERCUTANEOUS TRANSLUMINAL RENAL ARTERY ANGIOPLASTY AND STENTING.
Jayesh S Prajapati, Sharad R Jain, Hasit Joshi, Shaurin Shah, Kamal Sharma, Sibasis Sahoo, Kapil Virparia and Ashok Thakkar World J Cardiol. 2013 July 26; 5(7): 247-253
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Aim : To evaluate the short and intermediate term outcome of percutaneous transluminal renal artery angioplasty (PTRA) and stenting particularly on blood pressure (BP) control and renal function and to evaluate predictors of poor BP response after successful PTRA and stenting.Methods : We conducted a prospective analysis of all patients who underwent PTRA and stenting in our institute between August 2010 to September 2012. A total number of 86 patients were underwent PTRA and renal stenting. Selective angiography was done to confirm at least 70% angiographic stenosis. The predilatation done except few cases with critical stenosis, direct stenting was done in the rest of cases. All patients received aspirin 325 mg orally, and clopidogrel 300 mg orally within 24 h before the procedure. Heparin was used as the procedural anticoagulant agent. Optimal results with TIMI-III flow obtained in all cases. Following stent placement, aspirin 150 mg orally once daily was continued for a minimum of 12 mo and clopidogrel 75 mg orally once daily for at least 4 wk. The clinical, radiological, electrocardiography, echocardiography and treatment data of all patients were recorded. The BP measurement, serum creatinine and glomerular filtration rate (GFR) were recorded before the procedure and 1 and 6 mo after PTRA. Results: A total of 86 patients were included in the study. The mean age of study population was 55.87 ± 11.85 years old and 67 (77.9%) of patients were male. There was a significant reduction in both systolic and diastolic BP at 1 mo after the procedure: 170.15 ± 20.10 mmHg vs 146.60 ± 17.32 mmHg and 98.38 ± 10.55 mmHg vs 89.88 ± 9.22 mmHg respectively (P = 0.0000). The reduction in BP was constant throughout the follow-up period and was evident 6 mo after the procedure: ...

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EFFECTS OF IMPLICATION OF TIME MANAGEMENT PRINCIPLES ON EFFICIENCY PARAMETERS IN THE CARDIAC CATHETERIZATION LABORATORY.
Kamal Sharma, Anchal Jindal healthline pISSN 2239-337X/eISSN 2320-1525 Volume 4 Issue 1 January-June 2013
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Context : With the increasing incidence of Coronary Artery disease in developing countries and availability of fewer resources and manpower, optimal Operating Room management is the key factor for patient care.Aims: To evaluate the effect of time management principles on efficiency parameters in the cardiac cath-lab.Methods and Materials : Prospective interventional study was carried out on patients admitted for procedures at the cath lab amongst eight cardiologists during April 2009 to June 2009. The control period was from January 2009 to March 2009. Parameters like start time tardiness, case cancellation rate, turn over time, waiting time of the operator in the waiting area of the cath-lab and patients’ waiting since hospitalization for operative slot was evaluated after the implementation of time management steps and compared with control group. Unpaired t-test was used for statistical analysis. P< 0.05 was considered as statistically significant.Results: Total number of the patients were 430 (Mean + SD, 73.75+83.63) and 590 (75+52.59) for study group and for control group respectively. Implementation of operating room (OR) management principles resulted in improvement of OR efficiency parameters reaching statistically significant reduction in start-time tardiness (P=0.023), case cancellation rate (P=0.031), turnover time (P=0.0113) and patient waiting time (P=0.025) while reduction in cardiologist waiting time did not reach statistically significant level (P=0.15).Conclusions: Implementation of OR management principles in cath-lab resulted in improvement of most of the efficiency parameters in patient management.

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EFFICACY AND SAFETY OF TENECTEPLASE IN PULMONARY EMBOLISM.
Anand N. Shukla, Bhavesh Thakkar, Ashwal A. Jayaram, Tarun H. Madan, Gaurav D. Gandhi International Urology and Nephrology December 2013, Volume 45, Issue 6, pp 1629-1635
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Pulmonary embolism (PE) is a relatively common life-threatening cardiovascular condition associated with significant morbidity and mortality. We present the efficacy and safety data of weight-adjusted tenecteplase in 30 consecutive patients of acute PE. 30 patients (22 male, 8 female) with acute PE were included in the study and divided into three groups: (1) Acute PE complicated by shock stage and/or persistent hypotension (12 patients). (2) RV dilatation and/or dysfunction without hypotension (14 patients). (3) Severe hypoxemia without hypotension and RV dysfunction (4 patients). Predominant symptoms were dyspnoea, cough, chest pain, syncope and haemoptysis, noted in 100 % (30), 40 % (12), 54 % (16), 32 % (9) and 10 % (3) of patients respectively. RV dilatation and dyskinesia were present in 86 %, septal paradoxical movement in 73 % and inferior venacava collapse absent in 53 % of patients respectively. 12 patients presented with acute PE and cardiogenic shock, 14 patients showed RV dilatation and dysfunction with systolic BP more than 90 mmHg and four patients were having RV dilation without dysfunction but severe hypoxemia. There was significant reduction in right ventricular systolic pressure and improvement in right ventricular dysfunction. Our study shows that tenecteplase is very effective and safe in the treatment of PE with minimal risk of bleeding in high risk group and intermediate risk and even in selective low risk category group of patients. However, in view of small number of patients in study group, a large multicentre randomized study would be required to draw a firm conclusion regarding the thrombolysis in low risk category patient.

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PREVALENCE AND PREDICTORS OF RENAL ARTERY STENOSIS IN PATIENTS UNDERGOING PERIPHERAL AND CORONARY ANGIOGRAPHY.
Anand N. Shukla, Tarun H. Madan, Ashwal A. Jayaram, Vivek B. Kute, Jayesh R. Rawal, A. P. Manjunath, Satyam Udhreja International Urology and Nephrology December 2013, Volume 45, Issue 6, pp 1629-1635
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Background : Renal artery stenosis is a potential cause of secondary hypertension, ischemic nephropathy and end-stage renal disease. Atherosclerosis is by far the most common etiology of renal artery stenosis in elderly. We investigated whether the presence of significant atherosclerotic renal artery stenosis (ARAS) with luminal diameter narrowing ≥50 % could be predicted in patients undergoing peripheral and coronary angiography.Methods : The records of 3,500 consecutive patients undergoing simultaneous renal angiography along with peripheral and coronary angiography were reviewed. The patients with known renal artery disease were excluded.Results: Prevalence of ARAS was 5.7 %. Significant ARAS (luminal diameter narrowing ≥50 %) was present in 139 patients (3.9 %). Hypertension with altered serum creatinine and triple-vessel CAD were associated with significant renal artery stenosis in multivariate analysis. No significant relationship between the involved coronary arteries like left anterior descending, left circumflex, right coronary artery and ARAS was found. Only hypertension and altered serum creatinine were associated with bilateral ARAS. Extent of CAD or risk factors like diabetes, hyperlipidemia or smoking did not predict the unilateral or bilateral ARAS.Conclusions: Prevalence of ARAS among the patients in routine cardiac catheterization was 5.7 %. Hypertension is closely associated with significant ARAS. Significant CAD in the form of triple-vessel disease and altered renal function tests are closely associated with ARAS. They predict the presence of significant renal artery stenosis in patients undergoing routine peripheral and coronary angiography. Moreover, hypertension and altered renal functions predict bilateral ARAS.

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EVALUATION OF HYPONATREMIA IN HEART FAILURE PATIENTS ADMITTED IN CRITICAL CARE UNIT: SINGLE CENTRE EXPERIENCE.
Dr. J.R. Rawal, Dr. H.S. Joshi, Dr. S.R. Jain, Dr. B.H. Roy, Dr. R.V. Ainchwar, Dr. S.R. Shah, Dr. G.D. Gandhi, Dr. S.D. Chaudhri Indian Journal of Applied – Basic Medical Sciences (2013), Volume 15B (21) JULY-13
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Background and Objectives : Hyponatremia is a very common electrolyte disturbance in hospitalized patients of heart failure. Clinical profile of such patients with hyponatremia and common co-morbidities are subjects of current study where we made an attempt to evaluate severity, symptoms and in hospital outcome of such patients.Methods : All patients presented to intensive coronary care unit (ICCU) with decompensated congestive cardiac failure (CCF) during three months period in 2012 were included in the study.Results: Out of total 1184 ICCU admissions, 650 were presented with decompensated heart failure. Serum sodium levels less than 135 mmol/L was found in 334 patients while severe hyponatremia less than 110 mmol/L was seen in 5.3%. Symptomatology ranged from mild irritability and intractable vomiting to seizures and unresponsiveness on neurologic evaluation. Male preponderance (64.40%) was noted. Common co-morbidities were hypertension (64.22%), Diabetes mellitus (32.41%), Ischemic Heart Disease (67.42%) and valvular heart disease (10.5%). Two diuretic molecules were co-administered in (39.70%). Females tolerated different grades of hyponatremia better than males with fewer symptoms and less mortality.Conclusions: Hyponatremia is more common in male patients presenting with CCF however, female patients with CCF have less mortality and fewer symptoms. There is a direct relation of serum sodium concentration and in hospital mortality.

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EFFECT OF ORAL SILDENAFIL ON RESIDUAL PULMONARY ARTERIAL HYPERTENSION IN PATIENTS FOLLOWING SUCCESSFUL PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY (PBMV): SHORT TERM RESULTS IN 12 PATIENTS.
Dr. J.R. Rawal, Dr. H.S. Joshi, Dr. B.H. Roy, Dr. R.V. Ainchwar, Dr. S.S. Sahoo, Dr. A.P. Rawal, Dr. R.A. Shah Indian Journal of Applied – Basic Medical Sciences (2013), Volume 15B (21) JULY-13
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Residual pulmonary arterial hypertension is frequently associated with continued symptoms and morbidities of right ventricular (RV) failure even after successful Percutaneous Balloon Mitral Valvuloplasty. (PBMV): Vasodilators and diuretics may further add to the agony of patients by causing systemic hypotension and hypoperfusion of other organs. Inhaled nitric oxide (NO) and oral sildenafil has been effective in ameliorating symptoms of primary pulmonary hypertension (PPH). Use of oral sildenafil in secondary pulmonary arterial hypertension (PAH) is still investigational. Few favorable reports are noted in recent literature. Our aim is to evaluate the effectiveness of oral sildenafil in patients symptomatic of residual pulmonary arterial hypertension (PAH) by decreasing (RV) after load with maintaining systemic perfusion pressure, oral sildenafil will reduce symptoms and improve effort tolerance in residual PAH patients.

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EARLY VASCULAR HEALING WITH BIODEGRADABLE POLYMER COATED SIROLIMUS-ELUTING CORONARY STENT IMPLANTATION:ASSESSED BY OPTICAL COHERENCE TOMOGRAPHY RESULTS AT 4-MONTH FOLLOW-UP.
Abhyankar A, Prajapati J, Reddy S. Minerva Cardioangiol. 2013 Jun;61(3):313-22.
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Aim: The aim of this study was to evaluate the strut apposition and neointimal coverage of Supralimus-Core stent struts at 4 months after implantation using optical coherence tomography (OCT).Methods: The Supralimus-Core OCT study is a retrospective, single-center study evaluating strut apposition and neointimal coverage with OCT at 4 months after stent implantation. A total of 12 patients, who had 15 stents implanted were included in the study. The OCT was obtained using a C7-XR FD-OCT (frequency-domain OCT) intravascular imaging system. Strut apposition, neointimal hyperplasia (NIH) thickness and stent coverage on each stent strut were evaluated.Results: A total of 2870 struts and 1950 frames were analyzed from 15 stents. Average stent length was 29.3 mm. Average reference vessel diameter was 2.64 mm. Among 12 patients, 3 (25.0%) patients were with diabetes, 4 (26.7%) type B2 and 10 (66.7%) type C lesions. The apposed and covered struts were 2787 (97.11%), whereas malapposed and covered struts were 3 (0.10%), apposed and uncovered 49 (1.71%) and malapposed and uncovered 31 (1.08%). Mean NIH thickness was 155.1±55.2 µm.Conclusions: The present study suggests that Supralimus-Core stent has a favorable vascular healing pattern at 4 months after stent implantation in terms of stent-strut coverage and strut apposition. This information indicates that the Supralimus-Core stent is a promising solution for decreasing late stent restenosis and preventing stent thrombosis.

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PERVENTRICULAR DEVICE CLOSURE OF ISOLATED MUSCULAR VENTRICULAR SEPTAL DEFECT IN INFANTS: A SINGLE CENTRE EXPERIENCE.
Bhavesh Thakkar, Nehal Patel, Shaunak Shah, Vishal Poptani, Tarun Madan, Chirag Shah, Anand Shukla, Vaishali Prajapati Indian Heart Journal Volume 64, Issue 6, November–December 2012, Pages 559–567
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Objectives: To evaluate prospective single centre experience of mid-term safety and efficacy of perventricular device closure of isolated large muscular ventricular septal defect (mVSD) in high-risk infants.Background : Surgical closures of large mVSD in infants represent a challenge with significant morbidity.Methods : Between August 2008–2010, perventricular closure was attempted in 24 infants of 6.01 ± 2.37 months age and 4.27 ± 0.56 kg weight under TEE guidance.Results: The device was successfully deployed in 21/24 infants. Size of mVSD was 8.42 ± 1.46 mm (6.1–12 mm). Mean procedure time was 28.8 ± 11.7 min. The closure rate was 84% immediately and 100% at 6 months. Four patients suffered major complications: 2-died, 1-esophageal perforation, 1-persistent CHB. At 26.23 ± 6.63 months follow-up two patients were symptomatic: 1-required device retrieval, 1-died of severe gastroenteritis.Conclusions: Perventricular device closure of isolated mVSD appears feasible option at mid-term follow-up and may either substitute or complement the conventional surgical technique in selected cases depending on institutional paediatric cardiac surgery performance.

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EVALUATION OF COMPLIANCE AND BLOOD PRESSURE REDUCTION IN PATIENTS TREATED WITH AMLODIPINE AND METOPROLOL SINGLE PILL COMBINATION VS. ITS INDIVIDUAL COMPONENTS.
Patel PB, Anand IS and Sharma K International journal of research in pharmacy and chemistry 1(3),579-586; 2011
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The objective of study is to compare the efficacy of single pill combination containing Metoprolol and Amlodipine (Metoprolol/Amlodipine 25/2.5) to its individual components in patients having hypertension in Gujarat region. We conducted this study at multicentre and this was open-label, and prospective in patient with Hypertension (140-180 mmHg/90-114 mmHg) in 3 centers from one city. Patients having hypertension were treated with one of three treatments (Metoprolol/Amlodipine 25/2.5, Amlodipine 5mg, Metoprolol 50mg) and treated for 12 weeks with three follow up visits to record BP and clinical status. At baseline, treatment groups were balanced; mean (standard deviation, SD) sitting BP was 159.7 (±5.35)/102.4 (±3.85) mmHg. The greatest reduction in BP from baseline to 12 weeks was seen in the SPC group (14.46/10.08mmHg; p<0.05). The remaining group demonstrated a significant decline from baseline (p<0.05): Amlodipine 5, -11.66/-8.72; Metoprolol 50, -9.18/-7.46. Reduction in BP by SPC however was not statistically superior to monotherapies. Responder rates (sitting DBP less than 90 mmHg or reduction more than or equal to 10 mmHg) were 92 % in SPC group. There were no reports of SAEs related to study medications. There were not any discontinuations reported in three groups due to adverse events. Blood pressure reduction from combining drugs from two different classes can be predicted on the basis of additive effects. SPC of Metoprolol and Amlodipine (25/2.5) is more effective as comparison with doubling dose of single individual drug in achieving target BP levels in patients with mild to moderate hypertension.

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EFFECT OF FIXED DOSE COMBINATIONS OF METOPROLOL AND AMLODIPINE IN ESSENTIAL HYPERTENSION: MARS – A RANDOMIZED CONTROLLED TRIAL.
Devi P, Xavier D, Sigamani A, Pandey S, Thomas T, Murthy S, Sharma K, Bosco B, Mehta K, Joshi S, Gupta R, Singh G, Hiremath J, Ds C, Nambiar A, Pais P. Blood Press Suppl. 2011 Dec;2:5-12.
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Aim : To compare two strengths of a fixed drug combination (FDC) containing metoprolol XL and amlodipine (metoprolol/amlodipine 50/5; and metoprolol/amlodipine 25/2.5) with its components in hypertension. Methods : We conducted this multicentre, randomized, open-label, trial in Indian patients with hypertension (140-180 mmHg/90-114 mmHg) in 11 centres from nine cities. Eligible patients (n = 402) were randomized into one of five treatment groups (metoprolol XL 50 mg + amlodipine 5 mg, metoprolol XL 25 mg + amlodipine 2.5 mg, metoprolol XL 50 mg, metoprolol XL 25 mg or amlodipine 5 mg) and treated for 8 weeks with five follow-up visits to record blood pressure (BP) and clinical status. Results: At baseline, treatment groups were well balanced; mean +/- SD BP was 154.87 +/- 11.91/96.63 +/- 6.97 mmHg. The greatest reduction in BP from baseline to 8 weeks was seen in the high-dose FDC group (23.61/14.91 mmHg; p<0.001). The remaining 4 groups too demonstrated a significant reduction (p< 0.001): low-dose FDC – 22.29/ – 14.66; metoprolol 50, – 23.17/ – 13.37; metoprolol 25,- 18.41/ 12.50 and amlodipine 5, – 23.01/- 13.08. BP reductions by FDCs, however, were not statistically superior to monotherapies. Responder rates (sitting diastolic BP< 90 mmHg or reduction > or =10 mmHg) were 93% in the high-dose FDC group and 97% in the low-dose FDC group, and control rates (sitting BP < 140/90 mmHg) were 66% and 58%, respectively. These rates were higher than that seen in individual components. There were no reports of serious adverse events related to study medications. One each from the low-dose FDC and metoprolol 25 mg group discontinued because of adverse events. Conclusions: FDCs of metoprolol and amlodipine are effective and safe in mild to moderate hypertension.