Background: The study was aimed to evaluate gender difference and age & gender specific interaction of in-hospital outcomes of patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: This was a prospective cohort study of 1748 patients with STEMI undergoing primary PCI. The study was dichotomised according to gender to evaluate the difference in the outcome. The study was further stratified based on an age cut-off of 75 years to examine the age-specific gender relationship in survival outcomes. Independent variables for in-hospital mortality were analysed through logistic regression. Results: There were 314 (17.96%) females with an average age of 60.80 years and 1434 (82.03%) males with an average age of 54.87 years. The prevalence of diabetes (24.8% vs. 13.2%) and hypertension (33.1% vs. 12.9%) was significantly higher in female patients compared to male patients, whereas the significantly higher number of male patients were smokers. On multivariate analysis, odds of female gender OR ¼ 3.54 (1.37e9.17), killip class >2 OR ¼ 3.05 (1.97e4.71) and baseline creatinine OR ¼ 2.27 (1.22e4.23) were found as significant predictors of in-hospital mortality. The crude odds ratio of 2.35 (1.49e3.72) and adjusted OR of 2.05 (1.27e3.30) for female mortality was significant among patients aged <75-years. While patients with ≥75-years of age, the mortality difference was insignificant. Conclusion: Although the incidence of STEMI was higher in male compared to female patients, female patients had two-fold higher in-hospital mortality than male. Female gender was an independent predictor for in-hospital mortality in patients <75-years of age. Keywords: Primary percutaneous coronary intervention, ST elevation myocardial infarction, Coronary artery disease, Gender, Acute coronary syndrome

Abstract

Objective: To analyze and compare various cardiovascular disease risk scores in Western Indian patients undergoing Coronary angiogram (CAG). Methods: In this prospective cross-sectional study, 1213 patients who underwent conventional coronary angiography; clinical risk profile and biochemical investigations were evaluated prior to undergoing CAG. Apart from the demographic information, 10-year absolute risk of having a major cardiovascular event (cardiovascular death, myocardial infarction or stroke) was calculated for each patient using various available Traditional Risk Scores (TRS). The population was divided in low, intermediate and high-risk categories for each of these scores. Results: Traditional cardiovascular risk factors like hypertension (41.8%) and diabetes mellitus-II (26.9%) were the two most prevalent risk factors in our study population. A higher risk value for all these TRS was more likely to be associated with obstructive coronary artery disease (OCAD) on CAG. Patients with high risk (≥20% for 10-year) QRESEARCH (QRISK3) score category had higher number of patients with obstructive CAD (49.6%) as compared to high risk category of risk score for those with high Global Registry of Acute Coronary Events (GRACE) score (46.6%) or risk Framingham (FRS CHD) score (29.2%) and risk atherosclerotic cardiovascular disease (ASCVD) score (30.1%) (P < 0.0001). A higher TRS was more likely to be associated with obstructive CAD, with the highest predictability being with QRISK3 (QRISK3 score 60.9%, GRACE score 54.9%, FRS-CHD score 34% and ASCVD score 42.1% respectively; P < 0.0001). A substantial study population (27.4%) cannot be identified using any of these TRS and hence a need of indigenous or modified risk scores is proposed. Conclusion: QRISK3 score was most efficacious for predicting obstructive CAD in our Indian study population on CAG. A higher risk score also correlated with the number of vessels involved on coronary angiogram. A substantial obstructive CAD patient could not be identified using traditional risk scores hence need for an indigenous or modified score.

ABSTRACT

Background: Electrocardiographic diagnosis of causes of supraventricular tachycardia (SVT) is sometimes difficult and application of routine algorithms can lead to misdiagnosis in as many as 37 % of patients. ST segment depression may be useful in diagnosing the nature of SVT. Methods: We reviewed surface electrocardiogram (ECG) characteristics of 300 patients having SVT with 1:1 AV relationship and correlated findings with electrophysiology study (EPS) findings. Final diagnosis of AVNRT (Atrioventricular nodal reentrant tachycardia), Orthodromic AVRT (atrioventricular reentrant tachycardia) and atrial tachycardia (AT) was correlated with ECG parameters like heart rate, ST segment depressions and QRS morphology. Results: Out of 300 patients, majority patients included in study, were having AVNRT or AVRT. ST depression predicted AVRT if the ST depression was ≥ 2 mm (overall sensitivity of 38.3 % and specificity of 93.8 % to predict AVRT) and was downsloping in morphology (sensitivity of 36.9 % and specificity of 94.7 % to predict AVRT). At heart rates ≥214 beats per minute (bpm) as measured by 7 small squares of ECG at 25 mm/s, downsloping ST depression ≥2 mm had a sensitivity 37.9 % of and specificity of 89.2 % to predict AVRT. At heart rate <214 bpm, downsloping ST depression ≥2 mm had sensitivity of 37.2 % and specificity of 96.5 % to predict AVRT. Downsloping ST depression of ≥2 mm helps to differentiate AVNRT from AVRT. Conclusion: A downsloping ST segment depression ≥2 mm predicted SVT being an AVRT and can be used as a useful criteria in diagnosing the tachycardia.

Abstract

Introduction Ductal stenting in late presenters with transposition of great arteries with intact ventricular septum retrains the left ventricle before arterial switch operation. However, the experience is limited for its efficacy and safety. This study aims to highlight the efficacy and safety of ductal stenting for retraining the left ventricle. Methods: Eight children with transposition of great arteries-intact ventricular septum and regressed left ventricle underwent ductal stenting. Serial echocardiographic measurements of left ventricle shape, mass, volume, free wall thickness, and function were done, and arterial switch operation was performed once the left ventricle was adequately prepared. Post-operative outcome in terms of duration of mechanical ventilation, ICU stay, and improvement in left ventricle function were monitored. Results: The procedure was successful in all patients. Babies were divided into two groups on basis of age at ductal stenting (group 1 age less than 90 days and group 2 age more than 90 days) and were evaluated for the degree of left ventricle retraining as evidenced by echocardiographic parameters and post-operative variables. The left ventricle posterior wall thickness and mass index after ductal stenting increased significantly in both the groups. Postoperatively, one baby of group two expired after seven days due to severe left ventricle dysfunction. Rest babies had an uneventful post-operative ICU stay with no statistical difference in the duration of invasive mechanical ventilation or ICU stay. On six-month follow-up, all surviving babies were doing well with normal left ventricle function. Conclusion: Ductal stenting is a good alternative measure as compared to surgical procedures for left ventricle retraining in transposition of great arteries with regressed left ventricle.

Introduction: Limited real-world data exist regarding cardiovascular outcomes in post-COVID-19 individuals following discharge, particularly within the Asian Indian population. This study aims to explore the association between prior COVID-19 history and in-hospital outcomes in acute myocardial infarction patients.

Methods: Hospital database was searched for the patients who were diagnosed with Acute myocardial infarction (AMI) and were grouped according to absence (Group-A) or presence (Group-B) of history of severe COVID-19 hospitalization at least 3 months prior to the index event of AMI. Study primary endpoint was defined as major adverse cardiovascular events (MACE) comprising of Re-AMI, stroke, death (3P) and acute decompensated heart failure (4P), which were analyzed between these 2 study groups.

Results: Of 10,581 consecutive patients of AMI, 5.33% (n=564/10,581) patients had prior history of severe SARS-CoV-2 hospitalization beyond 3 months of index AMI. Past severe Covid-19 patients presenting with AMI were more likely to be younger (59.12+11.23 years vs. 52.01+10.05 years) and younger than 40 years of age. Patients in Group B demonstrated a notably higher prevalence of diabetes, hypertension, higher Killip class, and lower presenting LVEF compared to Group A. In-hospital cardiac arrest, stroke, heart failure and all-cause death were significantly higher in Group B patients. Higher unadjusted odds ratio for in hospital death OR=5.78 (2.56-10.23), 3-P MACE OR=2.33 (1.23-8.65) and 4-P MACE OR=2.58 (1.36-5.43) were found in patients with prior history of COVID-19. After adjusting for comorbidities, the ratio for in-hospital MACE was found to be non-significant.

Conclusion: Conventional risk factors and presence of comorbidities in individuals with prior history of COVID-19 hospitalization increased the risk of both 3P and 4P MACE during AMI.

Abstract

Background: Unprovoked venous thromboembolism is a poorly understood entity. Clinical risk factors and future outcomes are not well recognized in this subgroup of patients. Various pathogenic mechanisms like inflammation and athero-thrombosis have been put forth but remain investigative. Our study aimed to determine the clinical profile and predictors of mortality in patients with idiopathic pulmonary embolism.

Methods: Our single centre observational study included 510 consecutive patients with symptomatic unprovoked venous thromboembolism. Pulmonary embolism (PE) patients were initially categorized based on the presence or absence of deep vein thrombosis (DVT). Subsequently, the patients were further sub-grouped according to mortality, and the association between clinical parameters and death was evaluated through regression analysis.

Results: The in-hospital mortality of patients with unprovoked pulmonary embolism was 15.9% and 25.76% at three year follow up. Significantly higher number of patients with diabetes, hypertension, dyslipidaemia, lower TAPSE (tricuspidannular plane systolic excursion) and PASP (pulmonary arterial systolic pressure) were found in mortality patients compared to survivor patients. On regression analysis we found significant association of higher odds of age OR=1.1 (1.05-1.23), diabetes OR=2.47 (1.28-4.79), hypertension OR=2.25 (1.19=4.26) and lower odds of thrombolysis OR=0.38 (0.11-0.59) with mortality. On Kaplan Meier survival analysis, the log value of <0.05 showed significantly higher mortality in patients who were not thrombolyzed.

Conclusion: Various short and long-term predictors of mortality exist for pulmonary embolism. Cardiovascular risk factors play a mediating role in venous thromboembolism and also serve as predictors for long-term mortality. Therefore, modifying these risk factors can potentially result in a reduction in long-term mortality.

ABSTRACT

Background: The optimal treatment for ischemic mitral regurgitation (IMR) in patients of non-ST elevation myocardial infarction (NSTEMI) is a debated topic.

Objective: To evaluate the long term outcome on patients with NSTEMI and IMR, particularly emphasizing the comparison of treatments in those with moderate to severe MR.

Methods: We enrolled patients with NSTEMI and classified non/trivial to mild regurgitation as insignificant IMR and moderate to severe regurgitation as significant IMR. Furthermore, patients with substantial IMR were assessed for long-term clinical outcomes with respect to different management strategies. A test was considered statistically significant based on the probability value p<0.05.

Results: From a total of 4,189 patients of NSTEMI, significant IMR was found in 7.21% of patients. A significantly higher number of patients with death (1.21% vs. 13.24%, p<0.0001), cardiogenic shock (0.46% vs. 13.24%, p<0.0001) and heart failure (1.03% vs. 11.59%, p<0.0001) were found during hospitalization in patients with significant IMR. At a 2-year follow-up, a higher event rate was observed in the significant IMR group. Patients with significant IMR re-vascularized either by percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or CABG+ mitral valve (MV) surgery showed substantial improvement in MR grade ( 32.65% vs. 6% vs. 16.98%, p<0.0001) and LVEF (27.55% vs. 1% vs. 1.89%, p<0.0001) at 1 year follow up and significantly improved outcomes were identified compared to refused revascularization and medical management group with (-5.10% vs. 15% vs. 13.21%, p=0.04) mortality, (-33.67% vs. 61% vs. 73.58%, p<0.0001) readmission, and (-15.31% vs. 27% vs. 33.96%, p=0.01) heart failure at 2 years follow up.

Conclusion: Higher mortality and admission rates were observed in patients with significant IMR compared to those with in-significant IMR. Notably, significant IMR patients who underwent PCI, CABG, or CABG+MV surgery showed improved outcomes compared to non-revascularized counterparts.

Abstract

Aims and objectives: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia (SVT). Prolonged PR interval(>200 ms) on baseline electrocardiogram (ECG) is uncommon in such patients. The aim of the current study was to evaluate the incidence, clinical, electrophysiological characteristics, and outcomes of patients with baseline prolongation of PR interval undergoing radio-frequency ablation (RFA) for AVNRT.

Methods: Over 10 years, out of the total number of 1435 patients with diagnosed AVNRT, 16 patients had prolonged PR intervals at baseline. All underwent elective RFA. A retrospective analysis of clinical, and electrophysiological characteristics and outcomes was done. The PR interval and atria-ventricular block cycle length values were compared with those patients with a normal interval at baseline and had undergone a successful slow pathway modification for AVNRT.

Results: Out of 1435 patients with AVNRT, 16 (0.9 %) patients had baseline PR prolongation on ECG. The mean(+SD) age of the study population was 62.9 + 15.9 years. 10 (62.5 %) were males. The average PR interval was 264.2 + 24.1 ms. Slow fast AVNRT was seen in all. The anatomical site of success for ablation was the lower part of Koch's triangle in all patients. During ablation, a good sustained junctional rhythm was noted in all, with no AV (Atrioventricular) block or PR prolongation noted during ablation in any of the patients. PR interval decreased by more than 20 ms in 10 (62.5 %) patients. AVBCL (AV node block cycle length) increased on an average of 58.7 ms post-ablation. Only one patient developed AV block on follow-up.

Conclusion: A prolonged PR interval on baseline ECG is uncommon in patients with AVNRT. In these patients, slow pathway modification can be done safely and effectively. AVBCL (AV node block cycle length) increases immediately post-ablation. The risk of AV block though low persists on follow-up.

Abstract

Aims

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) affects vital organs and causes vascular injury. There are concerns that this injury may have long-term consequences on the cardiovascular system after recovery from COVID-19. We investigated the incidence and predictors of new-onset hypertension at 1-year follow-up post-COVID-19 disease.

Methods

In this prospective observational study, 393 patients hospitalised and diagnosed with COVID-19 disease at a tertiary cardiac care hospital during 27th March 2021 to 27th May 2021. Eligible 248 patients whose baseline characteristics, laboratory findings, treatment and outcome data were received systematically. Patients were followed up at 1 year of COVID-19 disease recovery.

Results

We found that 32.3% of the population had new onset of hypertension at 1 year follow-up post-COVID-19 disease recovery. More hypertensive patients had severe computed tomography (CT) score severity (28.7 vs 14.9%; P 0.02). More number of patients in the hypertensive group were treated with steroids (73.8% vs 39%; p < 0.0001) during hospital stay. In-hospital complications were higher (12.5 vs 4.2%; P 0.03) in the hypertensive group. Patients who developed new-onset hypertension had statistically significantly higher baseline values of serum ferritin and C-reactive protein (CRP) (P 0.02 and 0.03 respectively). Vascular age was found 12.5 ± 3.96 years more than chronological age in hypertensive patients.

Conclusion

New onset of hypertension was detected in 32.3% of patients at one-year follow-up post-COVID-19 disease recovery. Severe inflammation at the time of admission and severe CT severity score were associated with the development of new onset of hypertension on follow-up.

Keywords

Baroreflex

Endothelial injury

Hypertension

Inflammation

Post covid outcome

Aims

To study the respiratory variation of right atrial (RA) pressures at baseline and during atrioventricular nodal reentry tachycardia (AVNRT).

Methods

Of the 23 patients screened, 16 participants with typical AVNRT were included in the study. After ensuring adequate hydration, baseline RA pressures were measured as the height of ‘a’ and ‘v’ waves. The patients were asked to take deep breaths, and the measurements were taken in both inspiration and expiration.

Results

Of the 16 participants, 14(87.5%) showed a normal fall in the height of ‘a’ and ‘v’ waves with inspiration, 1(6.25%) showed no change and 1(6.25%) showed a rise in height at baseline, p <0.01. During induced AVNRT, the ‘a’ and ‘v’ wave heights increased in 8(50%), remained same in 6(37.5%) and showed a normal fall in 2(12.5%), p = 0.07 for ‘a’ waves and p = 0.09 for ‘v’ waves. When the magnitude and direction of change in ‘a’ and ‘v’ wave height at baseline was compared with AVNRT, it showed a significant difference with 13(81.25%) participants demonstrating positive Pseudo-Kussmaul's sign, p <0.01. Mean age was numerically higher in those with a more considerable inspiratory rise in RA pressures but was not statistically significant, χ²(2) = 3.1, p = 0.21.

Conclusions

Pseudo-Kussmaul's sign does occur in a substantial number of patients during AVNRT. Clinical appreciation of this phenomenon is possible in half to three-fourth of patients, provided the mean RA pressures are low enough for the variation to be visible in the neck.

Keywords: Atrioventricular nodal reentry tachycardia, Kussmaul's sign, supraventricular tachycardia, jugular venous pressure

Objective: Takayasu arteritis is a rare, chronic, inflammatory disease that primarily affects the aorta and its major branches. It mainly affects young females, and it can cause significant morbidity and mortality if untreated. The aim of this study was to evaluate the demographic profile, clinical manifestations, diagnostic features, angiographic findings in patients with aortoarteritis (Takayasu arteritis).

Methods: We enrolled prospectively 116 patients with Takayasu arteritis who came to Cardiology OPD at tertiary cardiac care hospital. We looked for constitutional symptoms, heart-related symptoms, systemic hypertension, neurological symptoms and upper & lower limb fatigue and claudication. We evaluated our patients using different diagnostic criteria: clinical, ACR criteria and Indian Takayasu Activity score. We also studied the angiographic profile and lesion characteristics in these patients, based on peripheral and coronary angiograms.

Results: We studied patients consisted of 14 male patients (12.1%) and 102 female patients (87.9%). Type V Takayasu arteritis was most common type (36.2%). Fatigue (60%) was most common cardinal symptom followed by myalgia (30%) and arthralgia (10%). About 43% of patients had neurological symptoms. Systemic hypertension (67%) was the most common manifestation of renal involvement. 110(95%) of the patients met clinical criteria and 105(91%) patients had American College of Rheumatology (ACR) score ≥3. Angiographic evidence of left renal artery stenosis was more (20%) than right renal artery stenosis (15%). bilateral renal artery involvement was found in 29% of patients.

Conclusion: Type V Takayasu arteritis was most common type (36.2%) of total study population. Hypertension and subclavian artery involvement both were seen in 2/3rd of population. Angiographic evidence of right and left renal artery stenosis was seen in 15% and 20% respectively, while bilateral renal artery involvement was found in 29% of patients.

Take home message: Takayasu arteritis rarely involves the coronary arteries. Angiographic evidence of right and left renal artery stenosis was observed in 15% and 20% of patients, respectively, with bilateral renal artery involvement found in 29% of patients.

Key words: Clinical presentation, aorta, renal artery, coronary artery,  Takayasu aortoarteritis

Abstract

Objective: The advent of 3D transesophageal echocardiography (TEE) was supposed to facilitate more accurate etiological diagnosis of prosthetic valve dysfunction as compared to 2D TEE; however, data to support the same is sparse especially in Asian Indians.

Methods: This was a prospective, open- label study of 50 consecutive patients with prosthetic valve dysfunction who were eligible for the study. All patients underwent both 2D and 3D TEE for assessment of prosthetic valve dysfunction apart from their demographics, clinical evaluation, laboratory assessment and fluoroscopy.

Results: Of 50 patients, 12 had aortic valve prosthetic dysfunction and 38 patients had mitral valve prosthesis dysfunction. Of these, 10 were male and remaining 40 were female patients. Overall, 41 (82%) patients had subtherapeutic prothrombin time at the time of presentation. Thrombus in situ was visualized in 34% of patients with 3D TEE as compared to 2D TEE (4%) (p=0.004). Pannus formation was observed in 20% of patients with 3D TEE as compared to 2D TEE, which could not identify pannus formation in any patient (p=0.03).  In 34% of patients, normal motion of leaflets could be seen using 3D TEE as compared to 30% of patients by 2D TEE.

Conclusion: Compared to 2D TEE, 3D TEE imaging offers superior capabilities in assessing prosthetic valve dysfunction, particularly when evaluating thrombus and pannus formation. Additionally, both modalities show nearly similar effectiveness in assessing leaflet motion.

Key words: 3D echocardiography, prosthetic valve, prosthetic valve dysfunction

Abstract

Context: 

Pulmonary hypertension (PH) is a condition characterized by an increase in pulmonary artery pressure, leading to morbidity and poor survival. In India, the high prevalence of certain diseases contributes to the burden of PH. To address this, this study provides epidemiological data and clinical characteristics of pulmonary artery hypertension.

Materials and Methods: 

A cross-sectional study was conducted at a tertiary cardiac care hospital, recruiting 964 patients with severe pulmonary arterial hypertension (PAH). Patient data were obtained through a detailed history and physical examination, including 12-lead electrocardiogram, two-dimensional echocardiography, coronary angiography, right heart catheterization, and hematological and serological investigations.

Results: 

The majority of patients (28.94%) were in the age group of 31–40 years, with a female preponderance in PAH disease. Idiopathic PAH (IPAH) was the most common type, accounting for 69.78% of all cases. The most common comorbid conditions were hypertension (48.55%) and Type-2 diabetes mellitus (44.81%). Dyspnea on exertion (98.34%) and edema of extremities (91.18%) were the most common symptoms. The mean survival rate was 50.98 months, with Type 1 PAH having the worst survival rate of 47.56 months. The statistical analysis showed a significant association between smoking and PAH.

Conclusion: 

This study provides epidemiological data and clinical characteristics of PAH patients in India, emphasizing the need for early diagnosis, prompt management, and smoking cessation programs. The high prevalence of IPAH and female preponderance was also observed in this study. These findings can help in the development of targeted interventions and management strategies for PH patients in India.

Abstract:

Objective: Cancer treatment-related cardiac dysfunction (CTRCD) is a significant concern for patients undergoing chemotherapy. The aim of the present study was to study the accuracy and value of longitudinal strain in prediction of left ventricular dysfunction (LVD) in cancer patients undergoing cancer therapy.

Methods: This was a prospective observational study conducted among 183 adult patients undergoing chemotherapy between 2018 and 2020. Patients with congenital or acquired valvular disease, prior myocardial infarction, coronary revascularization, or cardiac surgery were excluded. The patients were evaluated using a detailed history, clinical examination and echocardiography at baseline, 1 month, 3 months, and 6 months after chemotherapy. Speckle-tracking strain analysis was used to evaluate left ventricular (LV) global longitudinal strain (GLS), circumferential strain (GCS), and radial strain (GRS). LVD was defined as >15% decrease in GLS, GCS, or GRS from baseline to 6 months. Accuracy of longitudinal strain in prediction of LVD was studied using ROC analysis.

Results:  Of the 183 patients, 59% were male, and 54.1% were between 46-60 years of age. Breast cancer was the most common malignancy (10.9%). The most common chemotherapy regimen was doxorubicin + paclitaxel (9.9%). At baseline, the mean GLS, GCS, and GRS were -18.6 (1.03)%, -20.4 (1.11)%, and 39.9 (6.09)%, respectively. At the 6-month follow-up, 27 (14.8%) patients had LVD. The incidence of LVD was higher (51.48%) in patients who received doxorubicin-containing regimens compared to non-doxorubicin-containing regimens (P <0.0001). GLS has good accuracy in prediction of LVD at 6 months of follow-up (88.37%).

Conclusions:  The incidence of LV dysfunction was higher (51.48%) in patients who received doxorubicin-containing regimens. GLS is different in LVD vs non LVD and the accuracy of GLS is more in prediction of LVD development during 6-month follow-up (88.37%).

Abstract

Objective: Fragmented QRS (fQRS), as defined by additional spikes in the QRS complex of a 12-lead electrocardiogram (ECG), is a marker of scarred myocardium. In patients with coronary artery disease (CAD), fQRS is a predictor of heart failure (HF) and other major adverse cardiac events (MACE). The study was aimed to evaluate the role of fQRS in prediction of HF in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

Methods: In a prospective, non-randomized, small observational study, we enrolled 188 consecutive patients with STEMI undergoing primary PCI. Patients were grouped according to the presence or absence of fQRS and their in-hospital, 1 and 6-month MACE outcomes were assessed.

Results: Of the 188 patients, fQRS were noted in 92 (48.94%) patients. Patients with fQRS were more likely to have Killip class II/III/IV. Patients with fQRS had a significantly higher corrected QT interval, lower left ventricular ejection fraction (LVEF), and higher N-terminal pro brain natriuretic peptide (NT-pro BNP) at 24 hours and 48 hours compared to patients without fQRS. The in-hospital (P=0.001), 30-day (P=0.03) and 6-month (p=0.01) MACE were higher in patients with fQRS. On logistic multiple analysis, fQRS in anterior leads (OR=3.70, CI=1.68-10.02, p=0.001), fQRS in more than 2 leads (OR=5.20, CI=1.51-12.83, p=0.01), NT-proBNP (OR=1.05, CI=1.03-1.08, p=0.02) and Killip class II/III/IV were found to be significant predictors for HF hospitalization.

Conclusion:  Our findings suggest that fQRS can be a predictor for HF in patients with STEMI and provide a simple and readily available technique for predicting prognosis. Larger studies are required to validate these findings.

Key words: ST-elevation myocardial infarction, fragmented QRS, heart failure, NT-proBNP, primary percutaneous coronary intervention

Abstract

Introduction: Acute Myocardial injury defined by increased troponin I level is associated with poor in-hospital outcomes and cardiovascular complications in patients with COVID-19. The current study was designed to determine the implications and clinical outcome of myocardial injury in COVID-19.

Methods: This retrospective study included hospitalized COVID-19 patients. Myocardial injury was defined by high sensitivity Troponin I (hs-TNI)≥26ng/l. Cardiac biomarkers, inflammatory markers and clinical data were systemically collected and analyzed. Hazard ratio for in-hospital mortality and logistic regression for predictors of acute myocardial injury were analyzed.

Results: Of the 1821 total patients with COVID-19, 293(16.09%) patients died and 1528 (83.91%) patients survived. Patients who died had significantly higher association with presence of cardiovascular risk factors, severe CTSS ( CT severity score ) and myocardial injury as compared to survived group. 628 (34.5%) patients had evidence of myocardial injury and they had statistically significant association with cardiovascular risk factors, in-hospital mortality, procalcitonin; higher hospital, and ICCU stay. We found significant hazard ratio of diabetes (HR=2.66, (CI:1.65-4.29)), Severe CT score (HR=2.81, (CI:1.74-4.52)), hs-TNI≥26 ng/l (HR=4.68, (CI:3.81-5.76)) for mortality. Severe CTSS score (OR=1.95, CI: 1.18-3.23, P=0.01) and prior CVD history (OR=1.65, CI:1.00-2.73, P=0.05) were found significant predictors of myocardial injury in regression analysis.

Conclusion: Almost one third of hospitalized patients had evidence of acute myocardial injury during hospitalization. Acute myocardial injury is associated with higher hospital and ICCU stay, mortality, higher in-hospital infection which indicates more severe disease and the poor in-hospital outcomes.

Keywords: Acute Myocardial Injury; COVID-19; High-Sensitivity Troponin I; Mortality.

Cardiorenal syndrome (CRS) is a complex interdependent relationship between the heart and kidneys, prevalent in hospitalized patients with acute decompensated heart failure (ADHF). The main aim of this study is to evaluation of cardiac and renal function, treatment factors, and outcomes in view of mortality and persistent renal dysfunction in acute decompensated heart failure (cardio renal syndrome type 1) patients. We studied 100 patients hospitalised with ADHF and acute kidney injury (AKI). Patients were evaluated clinically, biochemically, ultrasonographically, and echocardiographically to assess demographics, etiologic and risk factors, cardiac and renal function, and outcomes in view of mortality and persistent renal dysfunction. The study monitored the patients until discharge and follow up with three months to one year. Record information about functional improvement, worsening symptoms, and mortality. The majority of the patients were males (72%), with dyspnea being the most common symptom (92%) followed by decreased urinary output (82%). The mean age of the patients was 62.60 years. Low level of Mean arterial pressure (MAP) 18.97 (95% CI 4.59 to 78.37, P 0.0001), estimated glomerular filtration rate (eGFR) 0.92(95% CI 0.87 to 0.99; P 0.02), maximum creatinine 3.08 (95% CI 1.67 to 5.67, P 0.0001), maximum level of urea 1.02(95% CI, P 0.001), lower Left ventricular ejection fraction (LVEF) 1.05 (95% CI 0.15 to 0.84, P 0.04) were independently predictors of in-hospital mortality. CRS-1 is associated with increased risk of mortality (25%), residual renal dysfunction (16%) at one year follow up. Persistent renal dysfunction, renal replacement therapy possibly improves for the treating persistent renal dysfunction, and recurrent HHF (more than 2 admissions) post hospitalisation index within twelve months were predictors of mortality (25%) at one-year.

Abstract Introduction: Despite having clinical relevance, arterial stiffness is neglected and not routinely used parameter for evaluation of atherosclerosis. This study aimed to investigate the predictive role of simple non-invasive echocardiographic index of aortic stiffness aortic velocity propagation (AVP), Framingham risk score (FHS) and QRISK3 score for presence and severity of CAD. Methods: This cross-sectional comparative study included 250 patients who required conventional coronary angiogram for stable CAD. The relationship of AVP, FHS and QRISK3 score with CAD were evaluated using spearman’s correlation, logistic regression analysis and ROC curve. Results: On logistic regression analysis, AVP, FHS and QRISK3 were found significant predictors for the presence and severity of CAD. Inverse correlation between AVP and presence of CAD, number of coronary vessels involved and severity of CAD was observed with P=0.001. AVP value≤78 cm/s predicted presence of CAD with 86.4% sensitivity and 84.6% specificity (P≤0.0001, AUC=0.948) and≤39 cm/s predicted severe CAD (Syntax score>22) with 66.7% sensitivity and 97.9% specificity (P≤0.0001, AUC=0.868). FHS value>10 predicted the presence of CAD with a sensitivity of 33.9% and specificity of 91 % (P=0.01, AUC=0.644). QRISK3value>13.4 predicted presence of CAD with 57.1% sensitivity and 87% specificity (P≤0.0001, AUC=0.788). Conclusion: Arterial stiffness parameter AVP is inversely associated with the presence and severity of CAD. AVP and QRISK3 score may be used as a simple bedside tool for risk stratification of patients suspected of having atherosclerotic CAD. Keywords: Aortic Velocity Propagation, Framingham Risk Score, QRISK3, Coronary Artery Disease

Background and Aim: Coronavirus disease 2019 (COVID‑19) pneumonia is associated with a hyper‑inflammatory syndrome which may cause life‑threatening acute respiratory distresssyndrome. The aim of thisstudy wasto evaluate the safety and efficacy of an anti‑inflammatory agent, tocilizumab (TCZ), a monoclonal antibody that targets the interleukin 6 receptor. Materials and Methods: We included 53 patients admitted between April and July 2020 with COVID‑19 pneumonia who received TCZ. Patients received one intravenous infusion of TCZ, dosed at 8 mg/kg, up to a maximum dose of 800 mg. All patients were evaluated with clinical, laboratory, and radiological parameters. Results: Out of 53 patients 28 (52.8%) had severe disease and 25 (47.2%) had the moderate disease. The mean age was 55 years. The most common presenting symptom was fever (73%; n = 39). C‑reactive protein (CRP), neutrophil‑lymphocyte ratio (NLR), d‑dimer, and ferritin levels were elevated at baseline. After TCZ administration CRP, ferritin and NLR levels reduced significantly whereas d‑dimer levels did not fall. Pulmonary fibrosis may be observed later in the course of the disease. All the mortality occurred in patients who had severe disease on presentation. There was no difference in outcomes according to gender, diabetic status, and presence of preexisting cardiac disease. Conclusion: Overall, TCZ administration is safe and effective in improving clinical and laboratory parameters with a possible reduction in the need for ventilatory care and duration of intensive care unit stay, particularly in patients with moderate severe acute respiratory syndrome coronavirus‑ 2 disease. However, our results should be considered preliminary and should be interpreted with caution as they stem from an uncontrolled series.

Abstract:

Objective: Patients with rheumatic mitral stenosis, despite having normal left ventricular ejection fraction (LV EF), have ventricular dysfunction in the form of impaired longitudinal excursion. Tissue Doppler velocity is a useful indicator for assessment of long-axis ventricular shortening and lengthening.

The aim  of our study was to evaluate the effect of percutaneous balloon mitral valvuloplasty (PBMV) on LV function in rheumatic MS and to study echocardiographic parameters with M-Mode and Tissue Doppler Imaging pre PBMV, post PBMV and on follow-up to determine predictors of LV function.

Methods: We analysed 52 patients with severe mitral stenosis with normal LV EF, who underwent PBMV at our institute. Baseline parameters of LV function were compared with immediate post PBMV and at three months follow up.

Results: The mean age of the patients was 33.73 (10.87) years with female preponderance. The mean mitral valve area before PBMV was 0.92 (0.13) cm² which increased to 1.65 (0.21) cm² after PBMV  and at 3 month it was 1.61 (0.23) cm² (p<0.001). LVEF before PBMV by modified Simpson’s method was 55.45 (8.44)% and after PBMV, it was 55.58 (3.46)% and at 3 month it was 56.62 (2.46)% (p>0.05). Mitral valve E’ was 8.71 (1.54) cm/s which increased to 10.13 (1.68) cm/s post PBMV and at 3 month it was 10.83 (1.34) cm/s (p<0.001).. Mitral annular systolic velocity (MASV), before PBMV was 7.90 (0.96) cm/s which increased to 9.31 (1.68) cm/s after PBMV and at 3 month it was 10.13 (0.96) cm/s (p<0.001). Myocardial performance index (MPI) before PBMV was 0.54 (0.48) which decreased post PBMV to 0.47 (0.06) and at 3 month it was 0.38 (0.04) (p=0.01). Pre PBMV MPI value <0.48 predicted improvement in LV function (sensitivity: 81%, specificity: 58.1%).

 Conclusion: Thus, PBMV leads to improvement in LV function in patients with severe MS with normal LV EF.

Abstract

Objective: The advancement in percutaneous transluminal coronary angioplasty (PTCA) has led to it becoming the predominant mode of revascularization. Post PTCA adverse events in the form of stent thrombosis, recurrent ischemia, unplanned revascularization, recurrent hospitalization etc. result in morbidity as well as mortality. Biomarkers predicting such outcomes can be useful in initiating more aggressive medical therapy and greater modification of risk factors. This study was undertaken to study the predictive significance of periprocedural plasma fibrinogen levels for coronary stenting outcomes.

Methods: 80 patients diagnosed as either chronic stable angina (CSA), unstable angina (UA), Non ST Elevation Myocardial Infarction (NSTEMI) or late presentation ST Elevation Myocardial Infarction (STEMI) undergoing planned PTCA were included in study. Patients were evaluated for clinical history, electrocardiogram (ECG), two dimensional echocardiography (2D-echo) and cardiac biomarkers (Creatinine Phosphokinase-MB isomer (CK-MB) and Troponin I). Serum fibrinogen level was measured 24 hours prior to PTCA along with routine pre-operative investigations; and also 24 hours after coronary stenting. Patients were followed for six months. Outcome measure was taken to be freedom from cardiac related adverse events, including rehospitalization, unplanned repeat revascularization, definite stent thrombosis, transient ischemic attack, stroke and all-cause mortality.

Results:  Fibrinogen level ≥393 mg/dL, 24 hours prior to percutaneous transluminal coronary angioplasty, was associated with higher major adverse cardiac and cerebrovascular events (MACCE) rates (60%) as compared to those with fibrinogen level <393 mg/dL (3.6%).  Fibrinogen level ≥427 mg/dL 24 hours after percutaneous transluminal coronary angioplasty, was associated with higher major adverse cardiac and cerebrovascular events rates (65%) as compared to those with fibrinogen level <427 mg/dL (6.7%).

Conclusion: The current study demonstrates that higher baseline and post procedural fibrinogen, is an independent predictor of 6 months major adverse cardiac and cerebrovascular events after elective percutaneous coronary intervention.

Key words:  Coronary stent outcomes, major adverse cardiac and cerebrovascular events, plasma fibrinogen, stent diameter

Abstract

Background: Despite improvement in the surgical procedure and strictly following the guidelines for mitral valve replacement (MVR), left ventricular dysfunction still occurs. Novel echocardiographic indices can predict development of LV (left ventricle) dysfunction post MVR. LV-GLS (global longitudinal strain) derived from speckle tracking echocardiography, has been proposed as a novel measure to better depict latent LV dysfunction.

Methods:

A total of 100 patients with severe MR (mitral regurgitation) planned for MVR were included. Speckle tracking echocardiography was performed at baseline and at follow up post MVR. ROC (Receiver operating characteristics) curve was plotted to derive the cutoff value of LV-GLS for prediction of LV dysfunction post MVR. Univariate and multi variate regression was analyzed to predict the independent predictors of LV dysfunction after MVR.

Results: LV-GLS was decreased from baseline data (-19.9 vs. -17.7) in patients with LVEF

Conclusion: A GLS value of less than -19% was demonstrated as an independent predictor of short term LV dysfunction after mitral valve surgery, LVESD ≥40mm was also verified additional parameter to predict the LV dysfunction post MVR.

Abstract

Introduction: Intra-aortic balloon pump (IABP) is widely used as a mechanical support device. Current evidence after the IABP-SHOCK II trial is ambiguous. We evaluated the impact of IABP on hemodynamic parameters (Cardiac Output (CO), Cardiac Power Output (CPO) and Systemic Vascular Resistance (SVR)) measured at 6 and 24 hours in patients presenting with cardiogenic shock (CS) with Acute Coronary Syndrome (ACS) amongst Asian Indians.

Methods: The efficacy of IABP was evaluated in patients presenting with CS in open-label, prospective, randomized (for randomization every alternate patient presented to an emergency was given IABP support), consecutive 60 patients in ACS with CS with group A (N=30) comprising of those with IABP and Group B without IABP (n=30).

Results: Both the groups were matched for baseline characteristics. The revascularization rate was 85% and only the culprit vessel was addressed during the study. Total 9 (15%) patients were managed medically and did not undergo revascularization. The mean changes in Systemic vascular resistance (SVR), cardiac output (CO) and cardiac power output (CPO) after 24 hours in patients with and without IABP showed no statistical difference except for the lower mean dose use of dobutamine in Group A (with IABP) vs Group B (without IABP) (4.08 (1.41) vs. 7.92 (2.52) mcg/kg/min, p<0.0001).

Conclusion: The use of IABP in Asian Indians with CS in ACS did not provide any improvement in hemodynamic parameters.

Key words: cardiogenic shock, intra-aortic balloon pump, vasopressors

Introduction: Our study objects to determine the diagnostic accuracy of two-dimensional speckle tracking echocardiography (2DSTE) in predicting presence and severity of coronary artery disease (CAD). Methods: Patients with stable angina pectoris with normal left ventricular function (>50%) undergoing coronary angiography were enrolled and subjected to speckle tracking echocardiography. Global longitudinal peak systolic strain was measured and correlated to the results of coronary angiography for each patient. Results: Number of male (P=0.001), diabetes (P=0.01) and smoking (P=0.01) patients were significantly higher in the CAD group compared to non-CAD patients. Global longitudinal peak systolic strain (GLPSS) was significantly (P=0.0001) lower in CAD patients in comparison to non- CAD patients. GLPSS showed significantly lower in patients with Syntax score (SS)≥22 in comparison to SS<22. Cut-off value -19 for GLPSS could be used to predict the presence of significant CAD with 80.6% sensitivity and 76.5% specificity (area under curve (AUC) -0.83, P=0.0001). The mean GLPSS value decreased as the number of diseased coronary vessels increased (P=0.0001). The optimal cut-off value of -16 GLPSS with a sensitivity of 76.7% and specificity of 83.3% [AUC 0.84, P<0.0001] was found significant to predict CAD severity. Multivariate regression of GLPSS and another risk factor for predicting significant CAD, GLPSS showed OR=1.55 (CI-1.36-1.76) P=0.0001 for predicting the presence of CAD. Conclusion: 2DSTE can be used as a non-invasive screening test in predicting presence, extent and severity of significant CAD patients with suspected stable angina pectoris.

Objective: Aorto-iliac occlusive disease (AIOD) is a common atherosclerotic disease causing significant morbidity. Transatlantic intersociety consensus for the management of peripheral arterial disease (TASC II) recommends endovascular therapy (ET) for better management of patients with lesions type A and B. With the advent of endovascular therapy, type C and D lesions management is becoming more feasible with endovascular therapy than open surgery for aorto-iliac occlusive disease. We aimed to evaluate patients with AIOD and to describe short-term outcome of endovascular treatment for such lesions.

Methods: Patients with aorto-iliac occlusive diseases who underwent endovascular therapy were enrolled in the study. Their demographic data and risk factors were recorded. Patients were followed at 3 and 6 months and their primary patency rate and symptom status were recorded.

Results: We enrolled 100 patients with a mean age of 59.77 (8.75) years with the majority of patients being male. The most common presentation was claudication (59%) followed by rest pain (31%) and gangrene (20%). The majority of patients had Transatlantic inter-society consensus (TASC) II type A (44%) and type B (31%) lesions; 15% of patients had types C lesions and the remaining 10% patients had type D lesions. Access site hematoma and contrast-induced nephropathy were present in 7% and 5% of patients respectively. Stent patency rate was 97% and 95% at 3 and 6 months follow up respectively.

Conclusion:  Endovascular therapy in aorto-iliac occlusive disease is a safe, effective, and low-cost treatment option with a high patency rate and symptomatic improvement in the short-term.

Context: In patients with rheumatic heart disease (RHD), left atrial appendage (LAA) dilation and thrombus formation is widely known. LAA thrombus formation is a risk factor for stroke even in patients with sinus rhythm. The aim of this study was to determine an association between LAA structure and function with respect to thrombus formation and differences in LAA size and velocity between patients with sinus rhythm and those with atrial fibrillation (AF).

Materials and Methods: We prospectively studied LAA structure and function in 120 patients with RHD by transthoracic echocardiography and/or transesophageal echocardiography by measuring left atrial (LA) dimension, LA area, LAA_max/min, LAA ejection fraction (EF), and LAA emptying velocity.

Results: Four out of 48 patients with sinus rhythm had LAA thrombus. In 72 patients with AF, 32 had LAA thrombus. Patients with LAA thrombus had lower mean LAA EF and emptying velocity both variables P-value is same (P<0.0001 and P<0.0001) Patients with LAA thrombus had increased mean LAA max and LAA min as compared to LAA max and LAA min in patients without LAA thrombus (P 0.008 for mean LAA max and P<0.0001 for LAA min respectively). Patients with AF with LAA thrombus had greater LAA_max compared to that in patients with AF without LAA thrombus (P < 0.0001). Doppler demonstrated a recognizable sawtooth LAA outflow velocity pattern in 32 of 36 (88.9%) patients with LAA thrombus versus 32 of 84 (38.1%) patients without LAA thrombus.
Conclusions: We conclude that LAA contractility is reduced in RHD with LAA thrombus, and loss of both contractility and LAA dilation is associated with increased risk of thrombus formation and hence the risk of stroke.

Keywords: Atrial fibrillation, left atrial appendage, rheumatic heart disease

Context: To study the demographics and clinical profile of patients with acute pulmonary embolism (PE) and impact of management as per risk stratification on outcome of patients with acute PE.

Materials and Methods: Prospective observational study of demographics, clinical profile, risk stratification, management, and outcome of patients presenting with acute PE from August 2016 to July 2017.

Results: One hundred and fifty patients who were detected to have acute pulmonary thromboembolism with a mean age of 45.08 years, with 70% being males, were included in the study. There were 6 (4%) patients in high-risk group, 69 (46%) patients in intermediate-high subgroup, 39 (26%) patients in intermediate-low subgroup and 36 (24%) patients in low-risk group as per the ESC 2019 guidelines using sPESI score, shock/hypotension, right ventricle (RV) dysfunction and cardiac marker elevation. 72 patients (52%) had antecedent deep vein thrombosis (DVT) of which 60 patients has proximal, whereas 12 patients had distal DVT. One hundred and forty-seven patients (98%) had moderate-to-severe TR, 117 patients (78%) had evidence of right atrium/RV dysfunction and 27 patients (18%) had evidence of thrombus in the heart. Computed tomography pulmonary angiogram showed middle pulmonary artery thrombus/dilatation in 63 patients (42%), saddle thrombus in 18 patients (12%), partial thrombus in the left pulmonary artery (LPA) and right pulmonary artery (RPA) in 84 (56%) and 75 (50%) patients, respectively. Majority (86%) of patients with tenecteplase; 9 (10.3%) patients with streptokinase and 3 (3.4%) was thrmobolysed with alteplase.

Conclusion: PE can present with unexplained dyspnea and atypical chest pain, among other signs and symptoms. Early diagnosis, risk stratification, and guideline-directed prompt management can lead to favorable outcome.

Keywords: Pulmonary embolism, risk stratification, simplified PESI score

Introduction: Quantitative analysis of cardiac biomarkers, troponin I and CPK-MB, estimates the extent of myocardial injury while extent of benefit from coronary collateral circulation (CCC) to protect myocardium during acute myocardial infarction (AMI) needs validation. We analysed if the extent of collaterals had impact on baseline biomarkers at the time of coronary angiogram.

Methods: We analysed 3616 consecutive patients who presented with AMI and underwent invasive coronary angiography (CAG) with intent to revascularisation with biomarkers assessment at the time of CAG. CCC to Infarct related artery (IRA) were graded as per Rentrop grading viz. poorly-developed CCC (Grade 0/1 as Group A) and well-developed CCC (Grade 2/3 as Group B).

Results: Both groups (A and B) were matched for demographics, traditional risk factors, SYNTAX 1 Score, time to CAG from onset of angina and eGFR. 36.59% of patients had Non-ST segment elevation myocardial infarction (NSTEMI) as compared to 63.41% ST -segment elevation infarction (STEMI). Overall Troponin I (P=0.01, P=0.01) and CPK MB (P=0.00, P=0.002) values were lower in group B in both NSTEMI and STEMI groups respectively. Troponin I and CPK-MB were significantly lower in group B [with NSTEMI for SVD (Single vessel disease) (P=0.05) and DVD (Double vessel disease) (P=0.04),but not for TVD (Triple vessel disease) and with STEMI in SVD (P=0.01), DVD (P=0.01) and TVD (P=0.001)].

Conclusion: Patients with well-developed coronary collaterals had a lower rise in biomarkers in AMI as compared to those with poor collaterals amongst both NSTEMI and STEMI groups

Background: The optimal treatment for congenital aortic stenosis (AS) remains in debate over the past three decades of practice with both balloon aortic valvuloplasty (BAV) and surgical aortic valvotomy. BAV has been the palliative therapy with AS in most centers. The present study aimed to provide role and short-term outcomes of BAV in AS patients.

Methods: We enrolled 58 patients aged ≤20 years of AS from July 2017 to November 2019. All patients were evaluated by echocardiography at 1, 3, and 6 months.

Results: From the total of 58 patients, there were 38 male and 20 female patients. BAV could be successfully completed in 56 patients (96.5%). Pre-BAV mean left ventricle systolic pressure (LVSP) was 187.85 ± 53.75 mmHg and transaortic gradient (TAG) was 90.67 ± 42.77 mmHg. LVSP and TAG were reduced significantly (P = 0.0001) post procedure (133.85 ± 41.33 mmHg and 28.11 ± 23.22 mmHg, respectively). Echocardiographic parameters such as V max, aortic valve (AV) G max, and AV G mean were significantly decreased post procedure and AVA was increased significantly post procedure. Ten (17.86%) patients had developed significant (more than or equal to moderate) aortic regurgitation post procedure (17.24%). About 66% of our patients had no complication post procedure. At 1, 3, and 6-month follow–up, AV G max and G mean and V max increased but were not statistically significant.

Conclusion: BAV via transarterial route in pediatric population with significant AS is safe, effective palliation with good immediate and midterm follow-up results with minimum complications. We did not face any major complications except for development of variable degrees of aortic regurgitation and access site complications.

Keywords: Aortic stenosis, balloon aortic valvuloplasty, surgical aortic intervention

Context: Rheumatic heart disease (RHD) predominantly affects adults. However, in developing countries like India, it is the most common acquired heart disease in children. The prevalence of RHD also varies from the region to region in the same country due to the differences in educational, economic, and social status as well as health-care facilities of the region. 

Aim: The aim of the study is to establish and discuss the spectrum of RHD in children from Western India and to explore the relationship between severity of valvular lesion by the age and sex of the children with RHD. 

Methods: Echocardiographic findings of children (N = 820) ≤18 years with RHD seen at our institute from January 2018 to December 2018 were retrospectively analyzed. RHD was screened by echocardiography. All the echocardiogram were analyzed for the pattern and severity of various valve lesions and associated abnormalities.

Results: Eight hundred and twenty children had a diagnosis of RHD. Maximum patients [476 (57.1%)] were from the age group of 13–18 years without any gender difference (418 male and 402 female). Mitral regurgitation (MR) was the most common lesion found in 81.46% children. Aortic regurgitation (AR) was seen in 29.76%, mitral stenosis (MS) was found in 20.48%, tricuspid regurgitation was seen in 66.83%, and aortic stenosis (AS) was found in 0.73% children. AR was found more common in males as compared to females (P = 0.0004). Majority of patients (69.5%) had single mitral valve involvement. Four hundred and eight patients (49.8%) had severe MR, 122 patients (14.9%) had severe MS, 62 patients (7.6%) had severe aortic regurgitation, and 2 (0.2%) patients had severe AS at the time of first presentation. Pulmonary hypertension was found in 69% of children. Children with MS and AS were older than those without MS and AS (P = 0.0001). 

Conclusion: Majority of children had severe valvular lesion and pulmonary hypertension at the time of first presentation. RHD is the leading cause of heart failure in children with requirement of surgical/catheter intervention and long-term medical management.

Keywords: Echocardiography, pediatric cardiology, rheumatic heart disease

Context: Percutaneous balloon mitral valvuloplasty (PBMV) is often used to treat suitable Mitral stenosis (MS) of rheumatic etiology. This study evaluated the efficacy of measurement of mitral valve regurgitation by 2D echocardiography (2DE). The study also evaluated 3D echocardiography as compared to 2DE for assessment of Mitral valve anatomy and geometry both pre-PBMV and post-PBMV.

Materials and Methods: This was prospective, observational single Centre study in which 60 patients of severe mitral stenosis suitable for PBMV were enrolled. The data collection of each patient included demographics, pre-PTBMV and postPTBMV functional class, electrocardiogram (ECG), 2DE & RT3DE both pre and post-PTBMV with special focus on real time 2DE and 3DE assessment of MV anatomy and MV Regurgitation. Post-PBMV, MV Regurgitation and anatomy were assessed in catheterization laboratory using 2DE and RT3DE.

Results: There were 32 (53%) females and 28 (47%) males. The mean Pre-PBMV LA Area by 2D Echo (31.38±7.66) and 3D Echo (29.38±7.93) were concordant (p=0.16). Majority patients 24(40%) had mild mitral regurgitation (MR) and only 2(3.3%) had moderate MR before PTBMV. Values of mobility, calcification and subvalvular pathology detected by 2D and 3D Echocardiography showed statistically significant difference (P=0.04 and <0.0001). No significant difference was found in thickness of valve (P=0.29). Higher grades of MR were picked by RT3DE as compared to 2DE.

Conclusions: Transthoracic and transesophageal real-time 3D echocardiography (RT3DE) were better in assessing subvalvular pathology, mobility calcification of MV and post-PBMV MR. There was no difference between 2DE and RT3DE for assessment of MV thickness.

Key words: Real-time 3D Echocardiography; Rheumatic mitral valve stenosis; Balloon mitral valvuloplasty.

Background

Various inotropic agents/vasopressors combinations are used in patients of cardiogenic shock. We performed this study to observe hemodynamic effects of various inotrope/vasopressor combinations in patients with NSTEMI cardiogenic shock (CS) at tertiary cardiac centre

Methods and materials

Of 3832 NSTEMI, we studied 59 consecutive such patients with CS who hadn't undergone revascularization in the first 24 h in a prospective, open label, observational study. Group 1 comprised of background Dopamine with Noradrenaline titration(N = 38), Group 2 had background Dobutamine and Noradrenaline titration(N = 15) and Group 3 comprised of triple combination of Dopamine, Noradrenaline & Adrenaline(N = 6).

Results

The mean change in hemodynamic parameters between these groups from baseline to 24 h showed no statistical difference. Cardiac output(CO), mean arterial pressure(MAP), central venous pressure(CVP) and cardiac power output(CPO) in group 2 were favorable at 6 and 24 h compared to baseline but mean change was insignificant as compared to others. In group 3, the increase in MAP was significant. IABP use did not change CO, CPO or SVR in any group except lower dosages of Dobutamine (49%) in IABP group. Lower in-hospital mortality in group 2 compared to others (P = 0.004) may be reflective of sicker patients in group 1 and 3.

Conclusion

The mean changes in hemodynamic parameters were not significant between all groups. All regimes of inotropes when selected as per clinical indication in CS with ACS resulted in similar hemodynamic effects. The mortality difference may not truly be reflective of regimes rather reflect sicker patients in the higher mortality group.

Keywords

NSTEMI Cardiogenic shock In-hospital mortality

Background: Neutrophil gelatinase associated lipocalin (NGAL), an acute phase protein expressed in endothelial cells and macrophages in atherosclerotic plaques, may be involved in development of atherosclerosis via endothelial dysfunction, inflammatory processes and matrix degradation leading to atherosclerotic plaque instability by modulating the activity of metalloproteinase 9. Our aim was to correlate urine NGAL with complexity and severity of angiographic lesions in patients of STEMI.

Methods and Materials: We prospectively included 50 STEMI patients who underwent primary angioplasty. Urine NGAL, other inflammatory markers and biochemical parameters were measured on admission. According to SYNTAX score the STEMI patients were divided into two groups: Low SYNTAX score (≤ 22), intermediate- high SYNTAX score (>22).

Results: In our study, majority of STEMI patients (76%) had lower NGAL level (<50 ng/ml). Urine NGAL level showed significant increased trend as duration of angina increases (p=0.011). NGAL was significantly reversely correlated with LVEF (p= 0.04). Patients with deranged renal function (creatinine ≥ 1.5 mg/dl) had significantly higher NGAL values (≥50 ng/ml p=0.011). Although in STEMI, NGAL was not significantly correlated with number of vessels involved, but patients with high SYNTAX score (>22) had significant higher NGAL values (≥50 ng/ml p=0.012).

Conclusion: NGAL is a novel biomarker which predicts severity and complexity of angiographic lesions in patients of STEMI.

Key words: Atherosclerosis; biomarker; coronary artery disease; Neutrophil gelatinase associated lipocalin.

Background

The cause-effect of conduction disturbance in chronic lesion of coronary arteries is complicated. This study was designed to evaluate coexistent CAD in patients with symptomatic bradyarrhythmia to find common anatomic basis for conduction disturbances and its relationship to conventional coronary risk factors.

Methods

In this prospective observational study, 929 patients who admitted for symptomatic bradyarrhythmia requiring permanent pacemaker implantation were included. All included patients underwent coronary angiography and were divided into groups based on angiographic findings. Association between conduction disturbances and these groups were analyzed.

Results

A total of 929 patients with mean age of 63.1 years were included in our study. We found age ≥50 years, male sex, presence of diabetes and hypertension as statistically significant predictors of abnormal coronary angiography. Obstructive CAD (≥50% stenosis) was found in 34.4% patients. Prevalence of single vessel disease, double vessel disease and triple vessel disease was 15.3%, 10.2% and 8.9% respectively. Severe coronary obstruction (≥90% obstruction) was found in 16.25% patients. Revascularization was advised in three fourth of cases of obstructive CAD. Approximately two third of patients didn’t have significant obstruction in coronaries supplying the conduction system. Type 4 was the commonest anatomy in obstructive CAD. SA Nodal artery was found more diseased in patients of SSS with p value of 0.01.

Conclusion

Obstructive CAD was found in one third of patients undergoing PPI. Age ≥50 years, male sex, diabetes and hypertension were found significantly correlated with presence of CAD and may act as important markers for the judgment of further coronary evaluation.

Keywords

Atrioventricular block

Coronary artery disease

Sick sinus syndrome

Permanent pacemaker implantation

Background

Chronic kidney disease (CKD) is an independent risk factor for the development of coronary artery disease. We evaluated outcomes amongst patients of CKD undergoing percutaneous coronary intervention (PCI) as assessed on severity of CKD based on estimated glomerular filtration rate (eGFR) at the time of PCI.

Method and materials

We analyzed 100 consecutive CKD patients who underwent PCI and were followed up for 1 year; an observational, prospective, open-label study. Multivariate and Receiver operator characteristics (ROC) analysis was used to determine the cut point ofeGFR for predicting 4-P major adverse cardiac events (MACE) outcomes defined as the composite of Cardiovascular (CV) mortality, heart failure hospitalization (HHF), repeat revascularization and non-fatal MI over 1 year follow up.

Results

According to eGFR cut-off value derived from ROC, patients were divided in to two groups based on eGFR cut-off of 36.25 mL/min/1.73 m². Majority of patients (79%) were in Group 1 (eGFR >36.25 mL/min/1.73 m²). Group 2 had Lower HbA1C, hemoglobin and elevated level of urea as compared to group:1 (p=0.002,<0.0001 respectively). All-cause mortality had trend forbeing higher (6.3 vs. 19%) in group:2, but statistically non-significant (p = 0.17). Lower baseline LVEF (39 ± 10.08%) across the cohort was independent predictor of higher risk for HHF. eGFR <36.25 mL/mim/1.73 m² was the most robust predictor of MACE, carrying a 3-fold increase in risk of 4-P MACE with significant association (0.69, CI 0.59 to 0.78, p = 0.0009).

Conclusions

Lower baseline eGFR was associated with higher incidence of 4 P MACE with best cut-off being eGFR <36.25 mL/min/1.73 m². Lower Baseline LVEF was independent predictor from HHF across the cohort.

Keywords

ACS

Chronic kidney disease

MACE

Percutaneous coronary angioplasty

Introduction During pregnancy, liver dysfunction is more frequent than expected and may require specialized care. For the early diagnosis, it is important to determine if changes in liver physiology may develop into liver disease. Liver disease during pregnancy may require intervention from a hepatologist for adequate monitoring of mother-fetus health outcomes. This study was aimed to evaluate the clinical profile and predictors of maternal mortality in patients with liver diseases among Asian-Indian-females.

Methods We conducted a prospective, open-label, consecutive all-comers study of 2,663 pregnant Asian Indian women admitted in the hospital, which included 92 with liver dysfunction. The medical aspects of the pregnancy were then followed prospectively with laboratory and clinical data during the hospital stay and analyzed. The current study was approved by the Institutional Ethical Committee.

Results We found that 92 out of 2,663 patients had liver dysfunction with a prevalence of 3.45%. Fifty-four (58.7%) patients had icterus followed by fever in 23 (25.0%), hypertension in 22 (23.9%), central nervous system manifestations in 21 (22.8%), abdominal pain in 19 (20.6%), vomiting in 19 (20.6%), and pruritus in six (6.5%). Predictors of maternal mortality were icterus (p = 0.04), hepatomegaly (p = 0.04), presenting serumbilirubin greater than 10 milligram% (mg%) (p = 0.008). The most common etiology was acute viral hepatitis (45.6%), followed by a hypertensive disorder of pregnancy (29.3%), acute fatty liver of pregnancy (1.1%), cholestatic jaundice (9.8%), hyperemesis gravidarum (2.2%), septicemic hepatitis (3.3%), dengue immunoglobulin M (IgM), and plasmodium vivax malaria antigen positive in (2.2%) each. Four patients (4.3%) were leptospira IgM reactive and had co-infection with hepatitis E virus. There was one patient (1.1%) with underlying chronic liver disease. Idiopathic liver disease was present in 5.4% of patients.

Conclusion Liver disease is relatively common in Indian pregnant women. It is associated with high maternal and perinatal mortality, even in a tertiary referral center. When managing pregnancy in a tertiary care center, for adequate follow-up of the disease and to prevent adverse consequences for mother and child, it is important to discard liver alterations early. For this purpose, liver disease during pregnancy needs early diagnosis for proper management. Furthermore, it is difficult to manage patients with preexisting liver disease, and it may require specialized intervention from a hepatologist and a gastroenterologist.

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Background: With COVID‑19 cases rising, despite CT chest being of value in diagnosis and prognostication in COVID‑19, its role in mild or asymptomatic suspected COVID‑19, before RT‑PCR test is lacking.

Method: This is a retrospective observational study involving asymptomatic or mildly symptomatic clinically suspected COVID‑19 infection in a high endemicity area. Of 2532 HRCT chest database, 376 eligible cases were analyzed for clinico‑radiological correlation for CT findings based CORADS and CT severity score between positive vs negative group.

Results: Of 376, 186 (48.46%) had COVID‑19 features on HRCT in mild and asymptomatic suspected patients. 98 (26.06%) had CO‑RARDS ‑ 5, 88 (23.40%) had CO‑RADS ‑ 4. 48 (12.76%), 128 (34.04%), 14 (3.72%) had CO‑RADS score of 3,2,1, respectively. Positive CT findings were more likely beyond 3 days of symptoms compared to those presenting earlier {days: (Mean) 4.2 vs 2.76} Positive CT was significantly associated with patients with anosmia and dyspnea. The common presenting symptoms were Fever 196 (52.12%) and followed by sore throat in 173 (46.01%). The common HRCT findings were Ground glass opacity (GGO) (74.60%), followed by Lymphadenopathy (LN) (27.92%). LN which was more prevalent in symptomatic patients {99/343 (28.86%) vs {6/33 (18.18%)} asymptomatics (P: 0.04)}. Consolidation was significantly more in asymptomatics with COPD (P: 0.004). 6 (3.22%) patients had CT score >17/25.

Conclusion: Chest HRCT picked 48.46% positive cases in mildly symptomatic and asymptomatic patients of which 3.22% had severe involvement (>17). Being a noninvasive, rapid, sensitive, low risk of cross infection with high reproducibility, chest CT is worth evaluating as screening modality even in asymptomatic and mildly symptomatic clinically suspected COVID‑19. Key words: COVID‑19; high resolution CT; sars‑cov‑2; screening

Background and aim: CFR and RR are important indicator of disease pandemic. As of now no data is available about cross-states analysis of these. We aimed to evaluate CFR and RR of COVID-19 across majorly affected States in India. 

Method: We observed and compared data of confirmed COVID-19 cases, number of deaths, number of recovered/discharged cases and calculated CFR and RR across majorly affected States/UT in India from official database of Government of India, State Government official bulletin, accurate database worldometer. 

Results: The data showed that Gujarat, Madhya Pradesh, West Bengal reported highest CFR on 8th April, 22nd April, 6th May, 1st June 2020 (95% CI 4.91 – 6.99). Kerala showed encouraging recovery rates 24.32%, 70.31%, 93.24%, 45.81% on 8th and 22nd April, 6th May and 1st June 2020 respectively. India had an average estimated weekly Recovery rate of newly discharged/recovered cases was 32.68% from 19th March to 1st June 2020. (95% CI 20- 45.4%). (The Recovery rate across India was 80.83% as on 22nd September 2020.). 

Conclusion: The CFR of a disease varies greatly in different regions of the same Country and is influenced by numerous factors such as health control policies, medical standards, and detection efficiency and protocols apart from number of screening tests done. This comparison discusses need of evaluating policies with optimal reporting of medical history of affected persons when comparing COVID-19 case and fatality rates in different regions of the Country.

Keywords: Case fatality rate (CFR), COVID-19, India, recovery rate (RR), prevalence, SARS-COV-2

ABSTRACT Context: Catheter‑directed thrombolysis (CDT) is a novel mode of thrombolysis where thrombolytic agents are directed through catheter to a specific area of interest; hence, low‑dose thrombolytic agent will be required to produce satisfactory thrombolysis results. This will subsequently decrease the bleeding complications. With this postulation, a study was conducted to compare the outcome of CDT versus systemic thrombolysis (ST) in patients with massive and submassive pulmonary embolism (PE). Methods: The present study prospectively included the cases of massive and submassive (high‑risk) PE and randomly distributed 25 patients into two groups each: Group A underwent CDT, whereas Group B underwent ST. The outcomes of both the groups were studied including mortality and bleeding complications, and patients were followed up for 6 months. At the end of the study, data were analyzed, and outcomes of both the groups were compared. Results: Baseline characteristics were similar in both the groups. The success rate was 90.4% in Group A (CDT) and 75% in Group B (ST) among patients with massive PE (P = 0.95). The mortality rate was numerically higher in the ST group (12%) than in the CDT group (8%). Bleeding complications were higher in the ST group (20%) than in the CDT group (8%). Conclusion: CDT was found to be noninferior to ST with respect to primary outcomes of mortality and success rate of thrombolysis. CDT had lower occurrence of bleeding episodes. CDT can be considered viable alternative to ST in patients with high bleeding risk. Keywords: Catheter-directed thrombolysis, pulmonary embolism, systemic thrombolysis

Background: Device closure of atrial septal defect (ASD) is a treatment of choice in selected patients with a suitable defect. We aimed to evaluate short- and intermediate-term outcomes with device closure in special reference to complications in Western Indian population. Materials and Methods: The present prospective observational study enrolled 184 patients with ASD who underwent Device closure. All patients were followed at 15–30 days (short) and 3–12 months (intermediate). Results: Device closure of ASD was done successfully in 180 (97.83%) patients. Systolic (P = 0.02), diastolic (P = 0.007), and mean PA (P = 0.0001) pressure were significantly decreased at postprocedure. Residual defect was resolved in 94.2% of patients by 6 months. Preprocedural Pulmonary artery hypertension was found in 36 (19.56%) patients and was reduced in 15 (8.15%) patients postprocedure and in 10 (5.43%) patients at 1 year. Residual shunt was reported in 34% of patients which was resolved in all by 6 months. At postprocedure and follow–up, patients were developed minor complications included (0.5%) moderate MR, 1 (0.5%) lower respiratory tract infection, and 3 (1.6%) local site hematoma. Eleven (5.98%) major complications involved arrythmia (2.17%), infective endocarditis(0.54%), LAA perforation (0.54%), cardioembolic shock (0.54%), device embolization (0.54%), sudden cardiac arrest (0.54%), intraprocedural acute coronary syndrome (0.54%), and cardiac tamponade (0.54%). Conclusion: Device closure appears to be best available option at the present time. Careful attention to the details of the technique is mandatory to achieve a successful outcome in order to avoid complication related to procedure. Patients of all ages experience reduction in pulmonary artery pressure after percutaneous device closure of ASD. Keywords: Amplatzer device, atrial septum defect, device closure

Abstract Background: The coronary collaterals have been ascribed as a potential alternative source of myocardial perfusion to the extent that some suggest it as a “natural bypass”! We proposed to evaluate the impact of the extent of collaterals on left ventricle ejection fraction among Asian Indians presenting with acute coronary syndrome. Methods: This was a retrospective, all-comers study performed on consecutive 3614 patients presenting with the acute coronary syndrome. Angiograms were evaluated for collaterals graded according to Rentrop’s classification among group A (grades 0 and 1) and group B (grades 2 and 3) collaterals. Results: Patients were matched for traditional cardiovascular risk factors in groups A and B as well as for ST elevation myocardial infarction and non-ST elevation myocardial infarction subgroups in both the groups. Grades 2 and 3 collaterals were significantly (P=0.04) higher in patients with non-ST elevation myocardial infarction—266/1319 (20.17%), as compared to ST elevation myocardial infarction—group 400/2295 (17.43%). Left ventricle ejection fraction on presentation was better preserved in group A as compared to group B in those with double-vessel disease and triple-vessel disease patients with non-ST elevation myocardial infarction, whereas it was better in single-vessel disease and triple-vessel disease patients with ST elevation myocardial infarction. The inverse correlation (r =−0.111, P=0.000) existed between left ventricle ejection fraction and grades of collaterals. Conclusion: Patients with the single-vessel disease were more likely to have poor coronary collateral as compared to double-vessel disease/triple-vessel disease. Despite higher grade coronary collateral among Asian Indians presenting with acute coronary syndrome, both non-ST elevation myocardial infarction and ST elevation myocardial infarction patients with triple-vessel disease had significantly lower left ventricle ejection fraction. This paradoxically brings out worse left ventricle ejection fraction on presentation in those with double-vessel disease and triple-vessel disease with ST elevation myocardial infarction and single-vessel disease and triple-vessel disease with STelevation myocardial infarction despite higher grade of coronary collateral representing as “Asian Indian Paradox” in our cohort. Keywords Coronary collaterals, acute coronary syndrome, left ventricular ejection fraction, non-ST elevation myocardial infarction, ST elevation myocardial infarction

Abstract

Introduction: To evaluate the efficacy/safety profile of the Abluminus DES+ over 2-years follow-up in the "real-world" scenario in diabetics as compared to non-diabetics.

Methods: In prospective, all-comers, open-label registry conducted at 31 sites, patients were analyzed for 1 & 2-year outcomes with the primary endpoint defined as 3P-MACE of CV death, target vessel related myocardial infarction (TV-MI), ischemia-driven target lesion revascularization (TLR)/target vessel revascularization (TVR) apart from Stent thrombosis (ST).

Results: Of 2500 patients of PCI with 3286 Abluminus-DES+, 1641 (65.64%) were non-diabetics while859 (34.36%) were diabetics. The 3-P MACE for the cohort at 1 & 2 years were 2.9%, and 3.16%; TLR/TVR - 1.4% at both the intervals for 2493 patients at 2 yrs. follow-up. TV-MI & ST were 0.36% and0.56% at 1st and 2nd year respectively. The 3P-MACE was lower in non-diabetics at 1 & 2 years (2.3%vs 4.2%; 2.4% vs 4.7% respectively). For components of MACE, CV mortality (0.9 vs 1.9% at 1 yr ; 1.0vs 2.1% at 2 years) was significant (P < 0.05) while TLR (1.1 vs 1.9% at 1 yr. & 1.1 vs 2.1% at 2 yrs.) and TV-MI (0.9 vs 1.9% at 1 yr. & 1 vs 2.1% at 2 years) were similar for diabetics and non-diabetics so was ST (P > 0.05).

Conclusion: Abluminus-DES+ showed excellent 2-year safety and efficacy with low 3-P MACE which was higher in diabetics driven by higher CV death but similar TLR, TV-MI and ST.

bjective: The study aimed to evaluate clinical and angiographic profile of Asian Indians presenting withsustained ventricular tachycardia (VT) in STEMI to derive predictors of in hospital mortality and outcomes. Methods: This was a prospective, open label, all comersstudy of 200 consecutive patients who presented with sustained VT in the setting of STEMI in a tertiary care center of western India from January 2016 to December 2018.Clinical and the angiographic profile of all patients were analyzed and correlated with outcomes especially with in hospital mortality.

Results: Of 200 patients, 156(78%) were male and 44(22%) were female. Mean age of patients was 55.63±11.68years.Among the traditional risk factors, smoking and hypertension (63% and 63.5%) was the most prevalent and had the highest odds ratio of 1.41(95% CI 0.61 to 3.26; P 0.42 and 2.67 (95% CI 1.04 to 6.87; P0.04) consecutively. 48.5% of the patients had LAD as culprit artery, 38.5% of the patients had RCA as culprit artery. Hence Non- LCX culprit vessel had an OR of 1.41(95% CI 0.40 to 5.02; P 0.6).79% patients were hemodynamically unstable1.51(95% CI 0.62 to 3.7; P 0.37)at the time of VT, 21% patients were hemodynamically stable. In hospital mortality was 15% (30/200) and all these patients hadhemodynamically unstable at VT (p value< 0.0001).Prolonged QTc interval was significantly (p value <0.001) higher in mortality patients (470.13±36.76 msec) ascompared to the discharged patients(444.53±18.58 msec) with OR of 2.16(95% CI 0.83 to 0.98; P <0.0001)

Conclusion: The predictors of in hospital mortality due to VT in STEMI amongst Asian Indians were smoking and hypertension with lowest OR 0.69 and 0.37.Hemodynamically unstable VT, non-LCX culprit vessel and prolonged QTc with highest OR 2.16 for prolonged QTc.

Abstract

Background:

Fibrinolytic therapy is an important reperfusion strategy, especially when primary percutaneous coronary interventions cannot be offered to ST-elevation myocardial infarction patients. Given that failed reperfusion after fibrinolytic therapy is common, it is pragmatic that the predictors, outcomes, and angiographic profiles of patients with failed thrombolysis are carefully scrutinized.

Methods: We prospectively studied clinical variables and outcomes over 30 months in 243 ST-elevation myocardial infarction patients who received fibrinolytics as primary treatment. Logistic regression analysis was used to identify predictors of failed thrombolysis.

Results: Failed thrombolysis occurred in 38.68% of patients with a mean window period of 6.58  1.42 h, and 55.32% of patients with failed thrombolysis had Killip class >I on presentation. Risk factors such as diabetes mellitus (55.32%), dyslipidemia (60.64%) and obesity (77.66%) were frequently associated with failed thrombolysis; 73.40% of patients with failed thrombolysis had Thrombolysis in Myocardial Infarction flow grade 0/1 in the infarct-related artery, and 58.51% of such patients needed a rescue percutaneous coronary intervention. The mean Thrombolysis in Myocardial Infarction risk score was 5.46  2.77 in failed thrombolysis patients, with mortality of 4.25% at the 6-month follow-up.

Conclusion: Non-resolution of presenting symptoms and ST changes on electrocardiography at 90 min served as the earliest indicators of failed thrombolysis, with a significant angiographic correlation. Clinical variables such as delayed presentation (>6 h), dyspnea, Killip class >I, cardiogenic shock, Thrombolysis in Myocardial Infarction score, and conventional risk factors including diabetes mellitus, dyslipidemia, and obesity represented cluster of predictors of failed thrombolysis.

Aims: Patent ductus arteriosus (PDA) is one of the most commonly seen congenital heart diseases prevalent today. The aim of this study is to evaluate the safety and efficacy of transcatheter closure of hypertensive ductus at long-term follow-up. 

Materials and Methods: Transcatheter closure was attempted in 52 patients with hypertensive ductus arteriosus. A lateral or right anterior oblique view aortogram was done to locate and delineate PDA. All the patients underwent clinical examination, electrocardiography, chest X-rays, and echocardiography before discharge and at 1, 6, and 12 months after the procedure and yearly thereafter. 

Results: The mean age of patients at procedure was 7.98 ± 4.79 (11 months–17 years), and the mean weight was 17.72 ± 10.81 (4–47) kg. Transcatheter closure of hypertensive ductus was successful in 50 (96.15%) patients. The mean preprocedural pulmonary artery pressure was 81.38 ± 17.31 (range: 55–113) mmHg which decreased to 29.65±8.63 (19-38) mmHg at follow up. The most commonly used device was Amplatzer duct occluder in 63% of the patients followed by Amplatzer muscular ventricular septal defect occluder in 37% of the patients. There were two procedural failures, namely aortic obstruction and left pulmonary artery stenosis, which were managed uneventfully. There were no procedural deaths or device embolization. At median follow-up of 86 months, all the patients are well with no complications. 

Conclusion: The long-term results suggested that transcatheter closure of PDA with severe pulmonary hypertension in pediatric patients is safe and effective with minimal complications.

Patients with inflammatory bowel disease (IBD) are at an increased risk of ischemic heart disease. However, there is limited evidence on how their outcomes after percutaneous coronary intervention (PCI) compare with those without IBD. All PCI-related hospitalizations from the National Inpatient Sample from 2004 to 2015 were included, stratified into 3 groups: no-IBD, Crohn's disease (CD), and ulcerative colitis (UC). We assessed the association between IBD subtypes and in-hospital outcomes. A total of 6,689,292 PCI procedures were analyzed, of which 0.3% (n = 18,910) had an IBD diagnosis. The prevalence of IBD increased from 0.2% (2004) to 0.4% (2015). Patients with IBD were less likely to have conventional cardiovascular risk factors and more likely to undergo PCI for an acute indication, and to receive bare metal stents. In comparison to patients without IBD, those with IBD had reduced or similar adjusted odds ratios (OR) of major adverse cardiovascular and cerebrovascular events (CD OR 0.69, 95% confidence interval (CI) 0.62 to 0.78; UC OR 0.75, 95% CI 0.66 to 0.85), mortality (CD: OR 0.94, 95% CI 0.79 to 1.11; UC OR 0.35, 95% CI 0.27 to 0.45) or acute cerebrovascular accident (CD: OR 0.73, 95% CI 0.60 to 0.89; UC: OR 0.94, 95% CI 0.77 to 1.15). However, IBD patients had an increased odds for major bleeding (CD: OR 1.42 95% CI 1.23 to 1.63, and UC: OR 1.35 95% CI 1.16 to 1.58). In summary, IBD is associated with a decreased risk of in-hospital post-PCI complications other than major bleeding that was significantly higher in this group. Long term follow-up is required to evaluate the safety of PCI in IBD patients from both bleeding and ischemic perspectives.

Context: Heterotaxy syndrome is a disorder that involves abnormal lateralization of the abdominal viscera, thoracic organs, and cardiac atria. The objective was to compare the frequency of morphologic profile of congenital heart defects associated with right isomerism and left isomerism in the Western Indian population.

Materials and Methods: This cross-sectional observational study was conducted by the Department of Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India, from January 2016 to April 2018. All children presenting to the hospital with suspected congenital heart defect were included in the study. Echocardiography-based sequential segmental analysis was used; various cardiac defects were noted for patients with right isomerism (RAI) and left isomerism (LAI).

Results: Occurrence of heterotaxy in our screening population is 0.12%. A total of 93 children had atrial heterotaxy (M: F; 1.06:1), with 65 (69.89%) having RAI and 28 (30.11%) having LAI. Most common lesions associated with RAI included complete atrioventricular septal defect (n = 43, 66.2%), and pulmonary outflow tract obstruction (n = 35, 53.84%). LAI was associated with atrial septal defect (n = 24, 85.7%) ventricular septal defect (n = 23, 82.1%).

Conclusion: Heterotaxy encompasses a wide spectrum of congenital cardiac defects. The frequency of various defects associated with RAI and LAI in Western India is compared here to those as reported in the Western world.

Context: No-flow phenomenon during percutaneous coronary intervention (PCI) is a complex and multifactorial phenomenon with often devastating complications during PCI, especially in acute coronary syndrome (ACS) settings. There is paucity of data on serological predictors of the same.

Materials and Methods: This was an open-label, all-comers, observational, prospective study done on 175 patients covering the whole spectrum of coronary artery disease, undergoing PCI at the center. On admission detailed clinical history , general and systemic examination and laboratory investigations in form of hemoglobin, blood urea, serum creatinine, serum sodium, serum potassium, random blood sugar, electrocardiogram(ECG) and tropinin T were also done. Post procedure creatinine protein kinase MB (CPK MB) was done after 24 hrs, and thrombolysis in myocardial infarction (TIMI) flow was assessed during PCI in all patients by the operating interventional cardiologist.

Results: The mean value of NT-proBNP among patients with TIMI flow <3 was 3384.43 ± 1837.48 pg/ml, whereas among patients with TIMI flow 3, it was 894.64 ± 580.90 pg/ml. The difference between the two groups was statistically significant (P < 0.001), with TIMI flow 3 Group showing significantly lower mean NT-proBNP values as compared to the TIMI flow <3 category. There was no significant correlation between the mean NT-proBNP levels in various TIMI flow, that is, 0 and 2. In each quartile of NT-proBNP, there was a marked difference in the quartile value of the two TIMI <3 and TIMI 3 categories. Presence of angiographic thrombus was significantly associated with no-flow phenomenon.

Conclusion: Our study shows that higher NT-proBNP levels in patients with ACS who undergo PCI have higher likelihood of developing no-flow phenomenon during PCI.

Abstract

Objective: This study aims to describe temporal trends, characteristics, and clinical outcomes of patients with more than one unplanned readmission within 30 and 180 days after admission with percutaneous coronary intervention (PCI). 

Background: There is limited understanding of multiple readmissions after PCI. 

Methods: Patients undergoing PCI between 2010 and 2014 in the U.S. Nationwide Readmission Database were evaluated for unplanned readmissions at 30 and 180 days after discharge. Trends in multiple readmissions, characteristics of patients, and causes of first readmissions are described. 

Results: A total of 2,324,194 patients were included in the analysis of 30-day unplanned readmissions and 1,327,799 patients in the analysis of 180-day unplanned readmission. The proportions of patients with a single readmission and multiple readmissions within 30 days were 8.5 and 1.0% and at 180 days were 15.4 and 9.1%, respectively. Common reasons for first readmission among patients with multiple readmissions were coronary artery disease, including angina, heart failure, and acute myocardial infarction. Factors associated with multiple readmissions were discharge against medical advice, discharge to care home, renal failure, and liver failure. The total cost of multiple readmissions is significant, with an increase from ~$20,000 for no readmission to over $60,000 at 30-day follow up and $86,000 at 180-day follow up. 

Conclusions: Multiple readmissions are rare within 30 days after PCI but increase to nearly 1 in 10 patients at 180 days, and 20–25% of patients who have multiple readmissions are readmitted for the same cause as for the first and second readmissions.

Abstract The present paper reports differences between office blood pressure (BP) measurement (OBPM) and ambulatory blood pressure measurement (ABPM) in a large multi-centre Indian all comers’ population visiting primary care physicians. ABPM and OBPM data from 27,472 subjects (aged 51 ± 14 years, males 68.2%, treated 45.5%) were analysed and compared. Patients were classified based on the following hypertension thresholds: systolic BP (SBP) ≥ 140 and/or diastolic BP (DBP) ≥90 mmHg for OBPM, and SBP ≥ 130 and/or DBP ≥ 80 mmHg for 24-h ABPM, and SBP ≥ 120 and/or DBP ≥ 70 mmHg for night-time ABPM and SBP ≥ 135 and/or DBP ≥ 85 mmHg for daytime ABPM, all together. White coat hypertension (WCH) was seen in 12.0% (n = 3304), masked hypertension (MH) in 19.3% (n = 5293) and 55.5% (n = 15,246) had sustained hypertension. Isolated night-time hypertension (INH) was diagnosed in 11.9% (n = 3256). Untreated subjects had MH relatively more often than treated subjects (23.0% vs. 14.8%, p < 0.0001; respectively). Females had higher relative risk (RR) of having WCH than males (RR 1.16 [CI 95, 1.07–1.25], p < 0.0001). Whereas, males had higher RR of MH than females (RR 1.09 [CI 95, 1.02–1.17] p < 0.01). INH subjects had lower average systolic and diastolic dipping percentages (0.7 ± 6.6/ 2.2 ± 7.9 vs. 9.0 ± 7.3/11.9 ± 8.5, p < 0.001) than those without INH. In conclusion, for diagnosis of hypertension there was a contradiction between OBPM and ABPM in approximately one-third of all patients, and a substantial number of patients had INH. Using ABPM in routine hypertension management can lead to a reduction in burden and associated costs for Indian healthcare.

Background: Drug-eluting stents (DESs) have been shown to reduce the risk of restenosis and other adverse cardiac events after percutaneous coronary intervention (PCI) as compared with bare-metal stents (BMSs). However, the superiority of DES over BMS has been questioned in large vessels. We evaluated the risks and benefits of the use of DES versus BMS in patients who undergo stenting of large coronary arteries (≥3.5 mm) up to 1-year follow-up. 

Materials and Methods: This was a prospective study carried out in all-comer patients enrolled between January 2015 and December 2015. The patients with the variable indication for PCI, multivessel involvement, prior revascularization, and adjuvant drugs such as GP IIb–IIIa inhibitors were included in the study. However, patients who did not provide written informed consent and received both DES and BMS were excluded from the study. The clinical outcomes were evaluated at 1 year. 

Results: A total of 266 lesions (240 patients) in the large coronary arteries were stented, of which 130 lesions were treated with BMS and 136 lesions were treated with DES. At 1-year follow-up, target lesion revascularization/target vessel revascularization (P = 0.6492) and all-cause death (P = 0.7098) did not differ significantly between the two groups. In addition, no significant difference was found in patients requiring medical management (P = 0.3937) as well as number of asymptomatic patients (P = 0.2027). 

Conclusions: At 1-year follow-up, BMSs and DESs showed similar clinical outcomes in large coronary arteries. Hence, the use of BMS in large coronary arteries (≥3.5 mm) should not be discouraged unless clinically indicated.

Keywords: Bare-metal stent, drug-eluting stent, large coronary artery, percutaneous coronary intervention

Context: The main aim of the study is to find out efficacy, outcomes, and complications of thrombolytic therapy and surgery for obstructive prosthetic heart valve thrombosis (PHVT).
Materials and Methods: This was a prospective, observational study done on 130 patients with PHVT, from January 2016 to December 2017. Baseline details, clinical investigations, echocardiography, and fluoroscopy were done. In fibrinolytic therapy, group agents used were streptokinase and urokinase. Out of 130, 115 patients were followed for up to 6 months after the discharge.

Results: Majority of the patients were females (66.9%). Sixty-five (50%) patients were in the New York Heart Association Class III, whereas 55 (42.3%) and 10 (7.7%) patients were in Class IV and II, respectively. Nearly 34.6% patients had AF, and remaining 63.1% had sinus rhythm. Out of 130 patients, 26 (20%) patients had single-leaflet valve and 103 (79.2%) patients had bileaflet valve, and only one patient had ball and cage type of the valve. Out of 130 patients, 81 (62.3%) patients received fibrinolytic therapy as the first-line therapy and 49 (37.7%) patients underwent surgery initially. In fibrinolytic therapy group, three patients underwent surgery due to failed fibrinolytic therapy. Fifty-three patients (65.5%) had complete hemodynamic and clinical success without any complications; 28 patients (34.5%) had failure. Of 130 patients, 49 patients underwent surgery as the initial treatment. In the surgical group, three patients died out of 52 patients; mortality rate was 5.80%.
Conclusion: Surgery should be offered to patients with contraindications for fibrinolytic therapy as in case of recurrent PHVT surgery offers better outcome with lesser recurrences when compared with fibrinolytic therapy.

Keywords: Prosthetic heart valve thrombosis, surgery, thrombolytic therapy, treatment

Background: The risk of myocardial infarction (MI) is high in patients with diabetes mellitus. The study aimed to evaluate the risk factors focusing on presenting glycated hemoglobin (HBA1C) and the angiographic profile of diabetic patients with ST elevation myocardial infarction (STEMI) and in-hospital 3-point major adverse cardiac event (MACE). 

Materials and Methods: Two hundred consecutive diabetic patients presenting with STEMI were enrolled for prospective observational study. Each patient underwent investigations including HbA1C, electrocardiogram, echocardiography, and coronary angiography with SYNTAX 1 SCORE (SS1) with intent to early revascularization. Continuous variables were compared using the unpaired Student's t-test. A receiver operator characteristic analysis was performed to determine a cutoff point for HbA1c value for predicting disease severity and prognosticate in-hospital 3-point MACE using multivariate analysis after normalizing the confounders. 

Results: Of the total 200 patients, 70 (35%) had single-vessel disease, 58 (29%) had the double-vessel disease, while 72 (36%) had triple-vessel disease. Among these patients, left main coronary artery was involved in 22 (11%) of patients. Hypertension (73.8% vs. 60%), obesity (35.4% vs. 18.4%), and left ventricular (LV) dysfunction (13.7% vs. 2.9%) were risk factors associated with disease severity with an odds ratio of 1.88 (95% confidence interval [CI]: 1.01–3.49; P = 0.04), 2.4 (95% CI: 1.19–4.84; P = 0.01), and 5.46 (95% CI: 1.23–24.29; P = 0.03), respectively. Receiver operating characteristic analysis of HbA1c with respect to 3P-MACE of in-hospital death, recurrent MI, and CV stroke revealed HBA1C <8.9 g% as cutoff for lower MACE as compared to those with >8.9 g% (95% CI: 0.66–0.79; P = 0.0004) with 65% sensitivity and 76.7% specificity. HbA1c >7.9 g% were more likely to have multivessel disease and SS1 >33. Patients with surgical site infection >33 were more likely to be hypertensive and had severe LV dysfunction and higher 3P MACE. 

Conclusion: Diabetic Asian Indian patients with STEMI with HbA1c >7.9 g% were more likely to have a multivessel disease and SYNTAX 1 Score >33. There was a significant association between presenting HbA1c >7.9 g% and disease severity and higher 3-P MACE among presenting with HbA1c >8.9 g%.

Keywords: Glycated hemoglobin A, major adverse cardiac event, ST-elevation myocardial infarction, SYNTAX score

Background: Prosthetic heart valve thrombosis (PHVT) is a potentially fatal complication of heart valve replacement with mechanical prostheses mainly due to thrombosis.

Aim: The study aimed to evaluate the clinical profile of the patients presenting with PHVT undergoing fibrinolytic therapy and analyzing patients with respect to New York Heart Association (NYHA) functional class on presentation and its association with outcome of fibrinolytic therapy.

Settings & design: This was prospective, observational study conducted from June, 2016 to April, 2017. Total 133 patients with prosthetic heart valve thrombosis were included.

Materials and methods: Routine blood investigations included complete hemogram, liver and renal function tests. Prothrombin time with INR was done on admission. The diagnosis of PHVT was assessed by fluoroscopy and/or echocardiography (transthoracic/transesophageal). Follow-up at 6 months was scheduled for all patients.

Statistical analysis: Parametric values between two groups were performed using the independent sample t-test or chi-square test, as appropriate. Univariate and multivariate logistic regression was used to find out factors associated with outcome.

Results: All patients received fibrinolytic therapy in which 108 (81.2%) were treated with streptokinase and 25 (18.8%) were treated with urokinase. On presentation, 48.9% patients were in NYHA class III, 41.4% in NYHA class IV and 9.77% in NYHA class II. Fibrinolytic therapy was successful in 105 patients (78.9%) and it failed in 28 patients (21.1%). Mortality in NYHA class II was 0%, NYHA class III was 4.6% and in NYHA class IV was 23.6%. During 6 months follow up prosthetic heart valve thrombosis recurred in 12 (11.43%) patients.

Conclusion: From our single centre experience, fibrinolytic therapy is fairly effective first line therapy for prosthetic heart valve thrombosis and NYHA functional class on presentation can predict the outcome of fibrinolytic therapy.

Aim: Atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) are the most common forms of paroxysmal regular supraventricular tachycardias. 

Materials & methods: The clinical, ECG and electrophysiological findings of 121 patients with narrow QRS tachycardia were evaluated prospectively. 

Results: A total of 75 (62%) of the patients had AVNRT while 46 (38%) had AVRT. Pounding sensation in the neck (40 vs 15.2%; p = 0.004), presynope (26.7 vs 56.5%; p = 0.001) identifiable P wave after QRS complex (25.3 vs 73.9%; p = 0.001), pseudo r′/s waves (45.3 vs 4.3%; p = 0.001), limb leads ST-T changes (34.7 vs 60.9%; p = 0.004) were the significant changes observed. A total of 94.7% of AVNRT and 87% of AVRT could be diagnosed correctly considering both clinical and ECG criteria. Conclusion: Pounding sensation in the neck and presyncope along with ECG features like identifiable P wave after QRS complex, pseudo r′/s waves and limb lead ST-T changes very accurately differentiate AVNRT and AVRT.

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Background

Recent heart failure studies have associated lower baseline natriuretic peptide levels with improved morbidity/mortality outcomes during pharmaceutical treatment, and better clinical outcomes during neuromodulation (NM) with carotid nerve plexus stimulation for HFrEF when NT-proBNP < 1600 pg/ml. Whether baseline NT-proBNP is associated with HFrEF responsiveness to NM using vagus nerve stimulation (VNS) has not been examined. Hence, we evaluated the interaction of baseline NT-proBNP with changes in symptoms and function that occurred during chronic VNS in the ANTHEM-HF study.

Methods

A repeated measures, generalized-estimating, equations model evaluated the relationship of baseline NT-proBNP values above and below 1600 pg/ml to symptomatic and functional responses in ANTHEM-HF.

Results

Median (interquartile range; maximum) NT-proBNP was 868 (322, 1875; 14,656) pg/ml (N = 58). Heart rate (HR), HR variability (SDNN), 6-minute walk distance, MLWHF mean score, and NYHA improved significantly, independent of baseline NT-proBNP. While there was a statistical interaction between baseline NT-proBNP and better LVEF improvement during VNS, LVEF improved overall in the study cohort (N = 60; 32 ± 7 to 37 ± 10%; p = 0.0042), and in those patients whose baseline NT-proBNP was below the median baseline NT-proBNP value (n = 29; 36 ± 6 to 42 ± 10%; p < 0.0025)] or above this value (n = 29; 29 ± 7 to 32 ± 9%; p < 0.05).

Conclusions

In ANTHEM-HF, overall symptomatic and functional improvement during chronic VNS was independent of baseline NTproBNP. These are preliminary and hypothesis-generating findings, and the reason for a differing interaction between baseline NT-proBNP and response to CNPS and VNS remains unclear. It is anticipated that the ongoing ANTHEM-HFrEF Pivotal Study of VNS will provide additional insight

Objective

The objective of the study is to identify the predominant determinants of arterial stiffness as assessed by pulse-wave-velocity (PVW) amongst various 24-hour ambulatory blood pressure monitoring (ABPM) parameters in Indian hypertensive subjects.

Method

Subjects of both genders between 18-60 years with hypertension and who were either drug naïve or on stable anti-hypertensive treatment for at least three months were included in the study. All subjects underwent clinical evaluation with a medical history, biochemical investigations, and assessment of arterial stiffness by PWV along with 24-hour ABPM.

Results

We found the males were younger than females amongst hypertensive cohort (41.53 ± 10.89 years vs. 52.2 ± 5.17 years, respectively; p=0.001) and had shorter duration of hypertension (41.42 ± 49.14 months vs. 87.8 ± 74.55 months, respectively; p=0.012) and had lower 24-hour average pulse pressure (aPP; 49.1 ± 7.8 mm Hg vs. 57.83 ± 8.92 mm Hg, respectively; p=0.001) at baseline. Younger people (<40-years) as compared to those >40-years of age had the lower carotid-femoral (cf) PWV (972.8 ± 125.0 cm/sec vs. 1165.0 ± 208.4 cm/sec, respectively; p=0.001) and average brachial-ankle (ba) PWV (1413.7 ± 160.4 cm/sec and 1640.0 ± 227.1 cm/sec, respectively; p=0.001). Bivariate analysis revealed that amongst all the 24-hour ABPM parameters, 24-hour aPP had the strongest correlation (r=0.414, p=0.003) with arterial stiffness as assessed by PWV. Also, statistically significant correlation was found in age group <40 years between cf-PWV and both 24-hour aPP (r=0.54, p=0.025) as well as night-time aPP (r=0.59, p=0.013)

Conclusion

We conclude that 24-hour aPP showed the strongest correlation with arterial stiffness parameters and best correlated with arterial stiffness variables amongst 24-hour ABPM parameters, especially amongst subjects <40 years of age. The pulsatile blood pressure (BP) was a better predictor of aortic PWV than the continuous part of BP.

Aims: The aim of this study is to evaluate the safety and efficacy of transcatheter device closure of perimembranous ventricular septal defects in pediatric patients at long-term follow-up.

Materials and methods: We prospectively studied 376 patients with perimembranous VSDs between September 2008 and December 2015 who underwent percutaneous closure at our center. Transthoracic echocardiography (TTE) and electrocardiogram were done before and after the procedure in all the patients. All patients were subjected to follow-up evaluation at 1, 3, 6, 12 months, and annually thereafter with TTE and electrocardiogram.

Results: A total of 376 patients (210 males and 166 females) underwent transcatheter closure of perimembranous VSD. Mean age of patients was 8.67 ± 3.02 (range 3-18 years) and mean weight was 21.15 ± 8.31 (range 8-65 kg). The procedure was carried out successfully in 98.93% of patients with no reported mortality. Rhythm disturbances occurred in 8.5% of patients after the procedure which included three cases of complete atrioventricular block.

Conclusion: This study shows that in experienced hands transcatheter closure of perimembrnous VSD is safe and effective at long-term follow-up. With minimal morbidity and no mortality, the transcatheter is an effective alternative to surgical closure in selected patients.

Abstract

Aims: 

Patent ductus arteriosus (PDA) is among the most prevalent congenital heart diseases in current times. The aim of this study is to evaluate contemporarily the safety and efficacy of transcatheter device closure of PDA at long-term follow-up.

Materials and Methods: 

Transcatheter closure of PDA was attempted in 205 children between 2008 and 2015 using the Amplatzer duct occlude (ADO). Ductal anatomy was accurately delineated on lateral and right anterior oblique view on aortic angiogram. All children underwent complete clinical evaluation, electrocardiography, chest X-rays, and echocardiography prior to discharge and at 1-month, 6-month, and annual follow-up thereafter.

Results: 

Of a total of 205 cases, 64% were females; the mean age was 7.92 ± 3.61 years (1–17 years), while the mean weight was 16.68 ± 10.82 (5–41 kg). ADOs-I were used in all the cases. The procedure was successful in 99.03% of patients with excellent results. Two patients required surgical closure due to device-induced aortic obstruction and left pulmonary stenosis. There were no cases of procedural deaths, device embolization, device infection, and infective endocarditis. All children fared well at a median follow-up of 94 months with no complications.

Conclusion: 

The long-term data showed that percutaneous transcatheter closure of PDA using ADO was safe and effective in pediatric population with minimal complications

Context: 

The main aim of the study is to find out efficacy, outcomes, and complications of thrombolytic therapy and surgery for obstructive prosthetic heart valve thrombosis (PHVT).

Materials and Methods: 

This was a prospective, observational study done on 130 patients with PHVT, from January 2016 to December 2017. Baseline details, clinical investigations, echocardiography, and fluoroscopy were done. In fibrinolytic therapy, group agents used were streptokinase and urokinase. Out of 130, 115 patients were followed for up to 6 months after the discharge.

Results: 

Majority of the patients were females (66.9%). Sixty-five (50%) patients were in the New York Heart Association Class III, whereas 55 (42.3%) and 10 (7.7%) patients were in Class IV and II, respectively. Nearly 34.6% patients had AF, and remaining 63.1% had sinus rhythm. Out of 130 patients, 26 (20%) patients had single-leaflet valve and 103 (79.2%) patients had bileaflet valve, and only one patient had ball and cage type of the valve. Out of 130 patients, 81 (62.3%) patients received fibrinolytic therapy as the first-line therapy and 49 (37.7%) patients underwent surgery initially. In fibrinolytic therapy group, three patients underwent surgery due to failed fibrinolytic therapy. Fifty-three patients (65.5%) had complete hemodynamic and clinical success without any complications; 28 patients (34.5%) had failure. Of 130 patients, 49 patients underwent surgery as the initial treatment. In the surgical group, three patients died out of 52 patients; mortality rate was 5.80%.

Conclusion: 

Surgery should be offered to patients with contraindications for fibrinolytic therapy as in case of recurrent PHVT surgery offers better outcome with lesser recurrences when compared with fibrinolytic therapy.

Background: The Coronary Slow Flow Phenomenon (CSFP) is sometimes seen amongst patients presenting with ACS, in particular unstable angina and rarely with Normal Epicardial Coronaries (NECA). The study attempts to identify predictors of CSFP in patients with classical angina and normal epicardial coronaries in Asian Indians. Materials and Methods: This was a prospective, open label, observational study of 3000 consecutive patients undergoing invasive coronary angiography that was carried out a tertiary level cardiac care center between August 2016 to December 2018. After identifying the prevalence of CSFP using the corrected TFC method in allcomers, equal numbers of controls were analyzed for detailed evaluation for traditional risk factors, history, clinical examination, and laboratory investigation. Results: CSFP was more prevalent in men than in women (P=0.007). Histories of smoking and hypertension were more prevalent in CSFP patients than in NECA patients statistically significant (50% vs 20%; p 0.02) and (66.7% vs 33.3%, P 0.009) with Odds Ratio (OR) of 4(95% CI 1.27 to 12.58; P 0.02) for smoking and 4(95% CI 1.37 to 11.7; P0.01) for hypertension. Presence of LV dysfunction (16.7% versus 10%, P 0.45) with OR 0.56(95% CI 0.12 to 2.57; P 0.45), high level of hemoglobin in CSFP group (14.17±1.45 vs 11.95±1.38 mg/dl; p <0.0001), high level of LDL-c (153.77±13.02 vs 92.37±11.45 mg/dl; p <0.0001) and low HDL-C (33.93±6.71 vs 55.60±5.78mg/dl; p <0.0001) were also independent predictors of CSFP. Amongst single vessel CSFP, LAD was most common vessel (40.4%). Conclusion: Prevalence of CSFP amongst Asian Indians is 1%. High LDL-c, Low HDL-c level, Smoking, elevated hemoglobin and Hypertension are independent predictors of CSFP.

Abstract
Introduction: Radial cannulation is needed in perioperative management of many patients requiring invasive hemodynamic monitoring during surgery and may be not only time consuming and at times difficult to attain in untrained centers.

Objectives: Comparative evaluation of safety and efficacy of Radial Arterial Cannulation using Conventional blind palpation technique with Ultrasound guided Technique perioperatively –Raccuet Study.

Materials and Methods: This randomized controlled, prospective, single blind comparative study was conducted on 142 adult ASA I to IV patients of either sex, scheduled for elective major surgery requiring general anesthesia of which 71 patients underwent radial cannulation by classical palpatory method (group P) and the other 71 underwent radial cannulation under ultrasound guidance (Group U). All procedures were evaluated using Siemens Acuson X500 ultrasound machine with 5-13Hz linear array transducer. All patients were evaluated for efficacy
by measuring time to cannulation (TTC), mean time to first attempt cannulation (mTFA), and number of attempts for cannulation (NA). Safety was assessed by evaluating incidence of hematoma and spasm in both the groups. Statistical analysis was done using (SPSS) Version 22.0. Independent t test and Mann Whitney test have been used for carrying out significant P value.

Results: Patients were demographically similar in both the groups. TTC in group U (37.97±18.14sec) was significantly less than that in Group P (58.38±21.45sec) (P =0.007).mTFA was 34.81±15.77 seconds in group U compared with 55.58±19.29 seconds with group P (P=0.01). There was trend towards lower NA in group U as compared to group P (P=0.06).Incidence of hematoma formation and vasospasm were similar amongst both groups but study was underpowered to evaluate the same. 

Conclusion: Ultrasound guided radial artery cannulation improves the success rate of cannulation in lesser time with similar complication rates as compared to classical palpatory method of cannulation.

Abstract

The present paper reports trends in office blood pressure (BP) measurement (OBPM) and ambulatory blood pressure measurement (ABPM) with age in a large multi-center Indian all comers’ population visiting primary care physicians. ABPM and OBPM data from 27 472 subjects (aged 51 ± 14 years, males 68.2%, treated 45.5%) were analyzed and compared. Individual differences between OBPM and ABPM patterns were compared for patients according to 10-year age categories. Results showed that systolic (S) BP values started to increase with age from the age of 40, BP variability (SD) increased from the age of 30 years. Diastolic (D) BP values started to decrease from the age of 50 years. Mean OBPM values were higher than daytime ABPM values (all P < .001) in all age-groups. The prevalence of white coat hypertension (WCH) and masked hypertension (MH) was based on OBPM and daytime, 24-hour, and night time average BPs together. WCH decreased with age from 15.1% and 12.4% in treated and untreated subjects at the youngest age to 7.2% and 6.9% in the oldest age, respectively. MH prevalence was higher for untreated than for treated subjects but remained similar for all age-groups (range of 18.6%-21.3%). The prevalence of reverse dippers increased with age from the youngest to oldest group with 7.3%-34.2% (P < .001 for trend). Dippers prevalence decreased from 42.5% to 17.9% from the youngest to oldest age-groups, respectively (P < .001 for trend). These findings confirm that BP patterns show clear differences in trends with age, particularly regarding night time BP.

Abstract

Background

Myocardial infarction is among the leading causes of morbidity and mortality in young adults around the world.

Objectives

In the YOUTH (Young Myocardial Infarction Study of the Western Indians) registry, we aimed to evaluate risk factor profile and angiographic outcomes of reperfusion therapies of infarct-related artery in young western Indians (≤40 years) having ST-segment elevation myocardial infarction.

Methods

A total of 1,179 consecutive patients aged ≤40 years who presented with ischemic heart disease from June 2012 to December 2014 were enrolled in the YOUTH registry. A total of 787 patients with ST-segment elevation myocardial infarction were further evaluated. Categorical data was assessed using chi-square test, whereas continuous data was assessed using Student's t test. Regression analysis was performed to investigate the strength of association.

Results

In the YOUTH registry, the study population was predominantly male (93%) with tobacco consumption as major prevalent risk factor (49.7%). Of 787 patients, 451 (57.31%) were thrombolyzed, 326 (41.42%) did not receive any reperfusion therapy, and 10 patients (1.27%) underwent primary angioplasty. Younger age, window period <6 h, and lower lipoprotein (a) level were observed in patients with a recanalized infarct-related artery. Regression analysis showed window period of thrombolysis as strongest predictor (odds ratio: 1.790, 95% confidence interval: 1.144–2.802; p < 0.011) of successful reperfusion. Patients (n = 235) being thrombolyzed in a window period of <6 h, had higher rate of infarct-related artery recanalization (77%) as compared to those with ≥6 h window period (23%). In-hospital mortality was 0.38% (n = 3), whereas bleeding complication was noted only in 1 patient.

Conclusions

We herewith conclude that acute short-term outcome is favorable in young ST-segment elevation myocardial infarction patients, particularly in those who had received timely thrombolytic therapy. Though tobacco consumption was a major contributor of risk in young adults, prevalence of other risk factors was low in young Western Indians.

Abstract

Background

Myocardial infarction is among the leading causes of morbidity and mortality in young adults around the world.

Objectives

In the YOUTH (Young Myocardial Infarction Study of the Western Indians) registry, we aimed to evaluate risk factor profile and angiographic outcomes of reperfusion therapies of infarct-related artery in young western Indians (≤40 years) having ST-segment elevation myocardial infarction.

Methods

A total of 1,179 consecutive patients aged ≤40 years who presented with ischemic heart disease from June 2012 to December 2014 were enrolled in the YOUTH registry. A total of 787 patients with ST-segment elevation myocardial infarction were further evaluated. Categorical data was assessed using chi-square test, whereas continuous data was assessed using Student's t test. Regression analysis was performed to investigate the strength of association.

Results

In the YOUTH registry, the study population was predominantly male (93%) with tobacco consumption as major prevalent risk factor (49.7%). Of 787 patients, 451 (57.31%) were thrombolyzed, 326 (41.42%) did not receive any reperfusion therapy, and 10 patients (1.27%) underwent primary angioplasty. Younger age, window period <6 h, and lower lipoprotein (a) level were observed in patients with a recanalized infarct-related artery. Regression analysis showed window period of thrombolysis as strongest predictor (odds ratio: 1.790, 95% confidence interval: 1.144–2.802; p < 0.011) of successful reperfusion. Patients (n = 235) being thrombolyzed in a window period of <6 h, had higher rate of infarct-related artery recanalization (77%) as compared to those with ≥6 h window period (23%). In-hospital mortality was 0.38% (n = 3), whereas bleeding complication was noted only in 1 patient.

Conclusions

We herewith conclude that acute short-term outcome is favorable in young ST-segment elevation myocardial infarction patients, particularly in those who had received timely thrombolytic therapy. Though tobacco consumption was a major contributor of risk in young adults, prevalence of other risk factors was low in young Western Indians.

ABSTRACT

Background:

Almost every indoor patient requires some form of intravenous (IV) fluids and its infusion rate should be proper as recommended for best treatment outcomes. To overcome the same, a simple, quick and easily applicable new method for drip drop rate calculation is proposed, which is user-friendly at bedside and doesn’t require mathematical skills or help.

Methods:

Author compared this novel innovative method (IM) of IV fluid drip drop rate method for both regular macro and micro drop infusion set against conventional mathematical calculation method (MC) of infusion in various IV fluid indoor orders and assessed for time-to-initiation of treatment (TI) required and its accuracy. Ten resident doctors and ten nursing staff participated to grade both conventional and novel methods by using pre-printed forms of various parameters like time consumption, comfort level, accuracy and applicability in ward and these both methods were scored on a scale of 1 to 10.

Results:

Conventional method (CM) required 14.23±1.10seconds, while novel method (IM) required average 3.63±0.73seconds for calculation of drop rate. Average grading for conventional method was 3.63±0.49 and for novel method was 7.84±0.6 out of 10.

Conclusions:

Novel method of IV fluid drip drop rate formula is easy, quick and superior in comparison to conventional method and it doesn’t require any additional instrumental help. It is good alternative to conventional formula for IV drip drop rate calculation in absence of infusion pump.

Introduction: Epidemiologic studies have shown a strong association between Vitamin D deficiency and cardiovascular risk factors, myocardial infarction, and all-cause cardiovascular mortality. The purpose of this study was to determine the clinical implications of serum Vitamin D levels in an unselected cohort of acute coronary syndrome (ACS) patients at the time of hospital admission. 

Methods: This was a prospective observational study which enrolled a total of 310 patients from December 2015 to March 2018. The consecutive in-hospital patients with ACS diagnosed by the typical history of angina, electrocardiography changes, with or without cardiac enzymes were included in the study. The primary endpoint of the study was all-cause death during hospitalization. The secondary endpoint was the in-hospital incidence of major adverse cardiac events (MACEs). 

Results: The number of patients with diabetes and dyslipidemia was significantly higher in the Vitamin D-deficient group (46.7%, P = 0.04 and 45.4%, P = <0.001, respectively). The blood glucose, hemoglobin A1C, low-density lipoprotein, and total cholesterol were significantly higher in Vitamin D-deficient group (P = 0.045, 0.048, 0.013, and 0.024, respectively). There was no any relation of mortality and MACE between normal Vitamin D and Vitamin D deficiency patients. 

Conclusion: Vitamin D deficiency and insufficiency were common in patients with the ACS. In the current study, ACS patients with diabetes and dyslipidemia were strongly associated with Vitamin D deficiency, but there was no correlation between Vitamin D deficiency and ACS outcomes.

Keywords: Acute coronary syndrome, diabetes, dyslipidemia, Vitamin D deficiency

Abstract

Context: 

Hyperuricemia is associated with idiopathic left atrium/left ventricular clot, and its association with other intracardiac tumors is not clear.

Aim: 

The study aimed to establish if there is an association of intracardiac mass with high urate level.

Settings and Design: 

This prospective study included 440 individuals, of which 330 were consecutive all comers with intracardiac mass detected on echocardiography from June 2016 to December 2017, who were compared with 110 randomly selected healthy controls undergoing echocardiography during the same without intracardiac mass in a ratio of 3:1.

Materials and Methods: 

Imaging modalities such as transesophageal echocardiography, cardiac computerized tomography, and/or cardiac magnetic resonance imaging were done to analyze the intracardiac mass. Both the groups were analyzed for serum uric acid (SUA) levels at the time of detection of intracardiac mass.

Statistical Analysis Used: 

Univariate analysis was done for continuous variables using Student's t-test, whereas the Chi-square test was used for the categorical data. Logistic regression analysis was performed with the presence of a mass with SUA as the dependent variable.

Results: 

Among a total of 440 patients, 330 were cases and 110 were controls with the mean age of 47.52 ± 16.02 years (18–77 years) versus 45.23 ± 14.10 (18–73 years) years with male:female ratio of nearly 3:2 in both the groups. Mean SUA in cases was significantly higher than controls (7.60 ± 0.93 vs. 4.52 ± 1.20 mg%) (P < 0.001 with 7.6 [95% confidence interval (CI): 7.5–7.7] and 4.52 [95% CI: 4.3–4.74]) with linear logistic regression coefficient of 0.64. There was no significant difference in SUA levels among different types of intracardiac mass (P = 0.31).

Conclusion: 

Hyperuricemia is associated with all comers of intracardiac mass with a regression coefficient of 0.64 irrespective of the nature of mass.

Introduction: The proportion of patients visiting emergency department with chest pain indicative of non‐ST‐segment elevation acute coronary syndrome (NSTE-ACS) is increasing. The current risk assessment of patients with NSTE-ACS may calculate patients risk for recurrent events but may fail to identify patients with severe coronary artery disease (CAD). The present study aimed to identify predictors of the extent and severity of CAD for prognosis of NSTE-ACS patients undergoing early angiography.

Methods: A total of 215 patients with NSTE-ACS were enrolled randomly and followed up between April-2015 and February-2017 at a tertiary healthcare center. The coronary angiography was performed. Patients were divided into two groups: high-risk coronary anatomy (HRCA) and low-risk coronary anatomy (LRCA). Patients were analyzed for baseline, demographic, clinical characteristics, and cardiovascular risk factors, during hospitalization and 30 days post discharge.

Results: Among 215 enrolled patients, 90 (mean age: 52.22 ± 10.24 year) and 125 (mean age: 57.78 ± 8.83 year) patients were in the LRCA and HRCA group, respectively. The presence of previous heart failure [Odds Ratio (OR): 3.95, 95% confidence interval (CI): 1.11-14.10; P = 0.03], chronic renal failure [OR: 5.11, 95% CI: 1.12-23.22; P = 0.03] and peripheral vascular disease [OR: 3.38, 95% CI: 1.09- 10.42; P = 0.03] were significant independent predictors of HRCA. Additionally, Grace score >140 was the significant predictor of 30 days mortality [OR: 5.85; P = 0.02] and major adverse cardiac and cerebral events [MACCE; OR: 6.23, 95% CI: 2.22-17.50; P = 0.001].

Conclusions: The extent and severity of CAD in NSTE-ACS patients can be predicted by assessing HRCA through clinical parameters. However, the correlation of HRCA with 30 days MACCE and mortality was modest

Ventricular septal rupture (VSR) is an uncommon but potentially lethal complication of acute myocardial infarction (MI). Its prompt recognition is essential to permit timely institution of corrective measures. The present study was undertaken to assess the diagnostic accuracy of a novel and unique angiographic sign, the ‘winking coronary sign (WCS)’, for recognizing post-MI VSR. The WCS is defined as partial transient occlusion of the infarct-related culprit artery overlying the site of VSR during ventricular systole with near normal filling in the diastole. A total of 56 patients with post-MI VSR (mean age 60.9 ± 9.9 years, 75% male) were compared with 73 age- and sex-matched acute MI patients without VSR. The extent of coronary artery disease was not different between the two groups, but higher number of patients in the VSR group had thrombolysis in MI grade 3 flow (57.1% vs 34.5%, P 0.01). The WCS was observed in 67.9% of the patients with VSR but in none of the patients without VSR (p < 0.0001), yielding a sensitivity of 67.9% and specificity of 100% for this sign for diagnosing underlying VSR. This demonstrates the potential utility of the WCS for diagnosing VSR in patients in whom the VSR has developed in the time frame between the echocardiography and angiography or has been missed during the initial clinical and/or echocardiographic evaluation.

Abstract

Background/introduction: Nutritional studies have indicated a critical role of dietary habits in development of cardiovascular diseases (CVD).

Aim: We aimed to compare the risk of coronary artery disease (CAD) in habitual 'breakfast skippers' with those of 'habitual breakfast eaters' in Western part of India. We also planned to compare the cardiometabolic profiles of both the groups.

Design: In this prospective, case-control study of 1607 individuals; 980 were patients of CAD (cases) undergoing various cardiac interventions for revascularisation and other 627 were healthy individuals (controls) who were free from CAD.

Methods: Details of demographics and classical risk factors were collected for all the participants. Subjects were categorized as 'breakfast eater' or 'breakfast skippers' according to their response to the questionnaire. Logistic regression and correlation analysis were performed to assess the independent risk of all the factors and their inter-variable association.

Results: Significantly (P < 0.05) high prevalence of classical risk factors and breakfast skipping habit was found in cases when compared with controls. Diabetes showed the highest odds ratio (7.296; 95% confidence interval (CI) 4.825-11.030; P < 0.0001) for CAD, followed by hypertension (3.756; 95% CI 2.891-4.881; P < 0.0001) and habits of smoking/tobacco/alcohol consumption (1.914; 95% CI 1.528-2.398; P < 0.0001) and breakfast skipping 1.348 (95% CI 1.076-1.689; P < 0.0001). Breakfast skipping emerged as stronger risk factor than obesity and sedentary life style in Indians and showed close association with presence of hypertension.

Abstract

Aims: The aim of this study was to identify better selection criteria for subjecting patients of rheumatic heart disease (RHD) to preoperative coronary angiography (CAG) based on indigenous scoring system (SERENE-CAG [Selecting Patients Of Rheumatic Heart Disease Undergoing Valve Surgery For Presurgical Coronary Angiography]).

Methods: This prospective study included all consecutive 798 patients of RHD patients undergoing preoperative CAG from January 2016 to December 2017 over a duration of 2 years. Multivariate logistic regression analysis was performed with the presence of significant CAD [coronary artery disease] as the dependent variable with traditional risk factors of CAD. An additive score was developed using coefficient derived logistic regression for those variables that were significant. Receiver-operator curve analysis was performed to assess the ability of this score to predict diseased vs normal CAG.

Results: A total of 798 patients had a mean age of 51.7 ± 12.5 years. Significant CAD requiring revascularization along with valve surgery was identified in 50 (6.26%) patients. Male gender was found as significant predictors of CAD with odds ratio 2.6. A SERENE CAG SCORE of >2.8 resulted in sensitivity of 80% and specificity of 36.9% of predicting CAD in RHD patients with positive and negative predictive value of 7.8% and 96.5%, respectively.

Conclusion: The prevalence of CAD in RHD patients is low. Patient risk can be minimized by exploring noninvasive modalities for screening of CAD and by more appropriate selection of patients for invasive coronary angiogram. Using threshold SERENE-CAG score of >2.8 would result in deferring 34.6% of normal angiograms.

Background: Drug-eluting stents (DES) represent a significant improvement in the treatment of coronary artery disease as they decrease restenosis rates by approximately 50% compared with bare-metal stents. The study aimed to evaluate clinical, etiological factors and angiographic characteristics associated with occurrence of In-stent restenosis in of Bare metal (BMS) vs. Drug eluting stents. Methods and Results: The study included 200 patients of percutaneous coronary angioplasty during October 2014 to June 2016.Mean age of patients was 58.06±8.79 years with 140 (70%) were males and 60 (30%) were females. BMSand DES ISR (44.1% vs 56.3%) were diabetic (DM), (61% vs 84.4%) were hypertensive, (77.9% vs 56.3%) were dyslipidemic, (46.3% vs 21.9%) were smokers consecutively. Amongst the above risk factors, Diabetes (p-value 0.01) and smoking (p-value 0.028) were the two factors which had statistically significant correlation with severity of In-stent restenosis(ISR). Patients with BMS had more Non Focal ISR 98 (79.03%) than focal ISR 38 (50%) and the difference was statistically significant (p value <0.001). There was statistically significant difference (p =<0.05) between the stent diameter and the severity of ISR with less than 2.5 mm Diameter stents associated with more Non focal ISR. Conclusion: ES appears to reduce restenosis and clinical end points and to be more cost effective than BMS. Patientrelated factors (i.e. sex, Diabetes, smoking) are important variables that affect restenosis and, hence, the appropriate selection of devices and patients is crucial.

Abstract

Purpose: To assess combined data from seventeen randomized controlled trials studying effect of anthocyanin consumption on levels of various lipids and inflammatory markers with meta-analysis approach.

Methods: Various databases, namely, PubMed, MEDLINE, EMBASE, and Cochrane Trial Register were used to identify randomized controlled trials (RCTs) investigating an association between anthocyanins and lipid profile and inflammatory markers. Heterogeneity was assessed using Q and I² statistics and data was expressed using mean difference with 95% confidence interval.

Results: Statistically significant reduction in triglyceride [mean difference (MD) = -9.16, 95% CI: -14.02 to -4.31 mg/dL, I² = 33.54%, P = 0.149], low density lipoprotein [MD = -8.86, 95% CI: -11.17 to -20.02 mg/dL, I² = 37.75%, P = 0.098], and apolipoprotein B [MD = -7.13, 95% CI: -8.66 to -5.59 mg/dL, I² = 20.42%, P = 0.287] levels and increase in high-density lipoprotein [MD = 1.67, 95% CI: 0.8 to 2.54 mg/dL, I² = 44.88%, P = 0.053] and apolipoprotein A-1 [MD = 6.1, 95% CI: 4.51 to 7.69 mg/dL, I² = 6.95%, P = 0.358] levels were observed with anthocyanin supplementation. Levels of inflammatory markers were found to reduce [TNF-∞ - MD = -1.98, 95% CI: -2.40 to -1.55 pg/mL, I² = 0%, P = 0.975; IL-6 - MD = 1.17, 95% CI: 0.8 to 1.53 pg/mL, I² = 0%, P = 0.825; hs-CRP - MD = 0.164, 95% CI: -0.06 to 0.39 mg/dL, I² = 0%, P = 0.569]. Though the effect on TC, IL-6, and hs-CRP was positive, it was nonsignificant in nature.

Conclusion: Anthocyanin supplementation significantly improves lipid profile and inflammatory status. However, future trials with sufficient sample size are recommended to substantiate the findings especially for the parameters showing nonsignificant improvement.

Abstract

Background: 

Three-dimensional (3D) echocardiography (echo) and transesophageal echo images enable visualization of valvular anatomy from unique orientations with improved spatial relationships not previously seen with two-dimensional (2D) echo.

Materials and Methods: 

Patients who fulfilled the criteria had undergone detailed evaluation of prosthetic valve dysfunction. Prosthetic valve dysfunction patients with stable hemodynamic were included and 3D echo findings were compared with 2D echo.

Results: 

A total of 10 males and 25 females were evaluated in the study. Two females and one male had bioprosthetic, three males and two females had tilting disc valve, while 21 females and six males had bileaflet mechanical valve. 3D echo had shown abnormal motion of leaflets in seven male and 21 female patients compared to 2D echo. Abnormal valvular calcification was demonstrated in a total of 23 patients on 3D echo. Valve sewing-ring integrity and motion were found abnormal in two male and two female patients in 3D echo. Prosthetic valve dehiscence and thrombus were better seen in five and 15 patients, respectively, on 3D echo. On 3D echo, pannus was better seen in one male and two females. 3D echo defined exact site and size of vegetation better than 2D echo in two female patients.

Conclusions: 

Real-time 3D imaging allows clinically useful visualization of prosthetic valve components such as leaflets, rings, and struts of all prosthetic valves, irrespective of position. “En face” view of the valve has proven useful in the assessment of prosthetic valve endocarditis, paravalvular regurgitation, and prosthesis dysfunction. 3D echo imaging plays an important role in device closure

Abstract

Objective: 

Congenital heart disease (CHD) is very common disease, and it is the major cause of childhood mortality and morbidity. Not much of Indian data are available particularly from the western part of the country. There are needs to further explicate the spectrum and epidemiology of the CHD.

Materials and Methods: 

This retrospective study collected data of the paediatric patients received in our institute from January 2016 to June 2017. All simple and complex congenital anomalies diagnosed on echocardiography were included in our study.

Results: 

Of total 22,275 cases, CHDs were diagnosed in 9728 cases with a male-to-female ratio of 1:0.6. Most CHDs (62.77%) were diagnosed between 1 month and 6 years of age. Incidence of cyanotic CHD was 27.14% and acyanotic CHDs was 72.86% with a ratio of cyanotic-to-acyanotic CHD being 1:2.7. Ventricular septal defect (26.24%) was the most common acyanotic CHD found followed by 2089 patients of atrial septal defect. Tetralogy of Fallot (13.57%) was the most common cyanotic CHD found followed by double-outlet right ventricle in 276 patients (2.84%).

Conclusions: 

Ours is the largest Indian study till date in this spectrum which yielded new data on the epidemiology, incidence, and prevalence of CHD. Majority of the patients with CHD had acyanotic CHD with most common anomaly being ventricular septal defect. Tetralogy of Fallot was the most common cyanotic defect. This study will increase awareness in the people with a family history of CHD and health-care providers and will assist in early diagnosis.

Abstract

Aims

We compared various components of blood pressure and arterial stiffness of healthy control with those of coronary artery disease (CAD) patients using BP+ machine™.

Methods

In this prospective, case-control study, total 585 individuals of both the genders were enrolled. The study population consisted of 277 controls (healthy siblings of diseased subjects not having CAD – group A) and 308 CAD patients (group B). Age and sex adjusted regression and receiver operative curve (ROC) analysis was performed to assess the strength of association of these parameters.

Results

We found that mean systolic blood pressure (SBP) (137.14 ± 22.49 vs. 129.26 ± 19.86), central systolic blood pressure (CSBP) (130.78 ± 21.89 vs. 117.53 ± 17.98), augmentation index (AI) (108.55 ± 44.98 vs. 49.38 ± 21.03) and pulse rate variability (98.82 ± 231.09 vs. 82.86 ± 208.77) were significantly (p < 0.05) higher in CAD population as compared to healthy counterparts. Left ventricular contractibility as measured by dP/dt was significantly lower in CAD patients. All these parameters were significantly abnormal in CAD as compared to healthy control population irrespective of the gender of the patient except for SBP in females. Both – odds ratio (1.108; 95% CI: 1.081–1.135; p < 0.0001) and ROC analysis (AUC: 0.937; 95% CI: 0.919–0.956; p < 0.0001) showed AI as the strongest predictor of CAD, closely followed by CSBP.

Conclusion

Central aortic blood pressure parameters such as AI and CSBP measured noninvasively with BP+ machine could be the effective predictors of CAD in Asian Indians

Abstract Background: Socio-economic status isknown to possess an inverse relationship with cardiovascular disease risk. Aims: We aimed to investigate the prevalence of cardiovascular disease risk factors in children and adolescents of Western India and examine its association with the socio-economic status of the population. Materials and Methods: In this cross sectional, observational study,3543 children and adolescents of 4-18 years of age were enrolled. Blood pressure (BP), body mass index (BMI) and anthropometric parameters were recorded according to the standardized protocols. Details of socio-economic status (SES), physical activity and stress were obtained from a questionnaire for each individual. Based on the SES, study population was divided into– group I (low-middle SES) and group II (high SES). Results: Overall, the prevalence of prehypertension, hypertension, sedentary life style and type A personality was 14.6%, 33.9%, 58.2%, 53.7% respectively. Obesity was observed in 13.4% and 22.3% of the individuals were malnourished. Prevalence of hypertension (35.21 vs 28.53%), obesity (7.44% vs 2.1%), high waist circumference (WC-58.82±20.34 vs 53.78±15.74) andhigh mid-arm circumference (MAC-21.87±5.3 vs 20.11±5.77) weresignificantly higher in group II as compared to group Ipopulation. Conclusion: The study observation suggests deadly coexistence of hypertension, obesity, sedentary life style and stress in Gujarati Asian Indian children and adolescents. These risk factor prevalence was more in population from high socio-economic class.These observations would contribute in development of appropriate preventive public health policy to efficiently manage these health and social issues early in life.