R. S. Venkata Subrahmanyasarma, Gopalakrishna Koduru, Raghuram Palaparti, Sarada Srinivas Chowdary Parvathaneni, Purnachandra Rao Koduru, Somasekhar Ghanta, Dasarath Boppana, Y. Ramakishore, Manohar Reddy Paluru, Prasad Maganti, Y. Sasidhar
Abstract Long-segment chronic total occlusion in femoropoplitial segment can be effectively treated with self-expandable stent especially when there are flow-limiting dissections created either while wiring the lesion or while predilating the lesions. Distortion of a self-expandable stent can during the procedure; hence, proper care should be taken in Plaque modification before stent deployment. Distortion can cause retention of the stent markers. Understanding the problem, the hardware we are using can guide us in bailing out the situation and also improving the long-term outcomes of the extremities.
{"title":"Distortion of the Self-Expandable Stent and Retained Stent Marker: A Rare Complication during Peripheral Angioplasty","authors":"R. S. Venkata Subrahmanyasarma, Gopalakrishna Koduru, Raghuram Palaparti, Sarada Srinivas Chowdary Parvathaneni, Purnachandra Rao Koduru, Somasekhar Ghanta, Dasarath Boppana, Y. Ramakishore, Manohar Reddy Paluru, Prasad Maganti, Y. Sasidhar","doi":"10.4103/jicc.jicc_37_22","DOIUrl":"https://doi.org/10.4103/jicc.jicc_37_22","url":null,"abstract":"Abstract Long-segment chronic total occlusion in femoropoplitial segment can be effectively treated with self-expandable stent especially when there are flow-limiting dissections created either while wiring the lesion or while predilating the lesions. Distortion of a self-expandable stent can during the procedure; hence, proper care should be taken in Plaque modification before stent deployment. Distortion can cause retention of the stent markers. Understanding the problem, the hardware we are using can guide us in bailing out the situation and also improving the long-term outcomes of the extremities.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135887084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-01DOI: 10.4103/1561-8811.383634
N. Khanna, Vinay Krishna, C. Manjunath, S. Tyagi, R. Jindal, M. Chadha, B. H. Natesh, G. Warawdekar, S. Wangnoo, H. Chopra, Priya Jagia, R. Bagarhatta, Amar Singh Suri, Asokan Parayaru Kottayil, R. Vijayvergiya, R. Puri, P. Gupta, V. Mehta, Jasjit S. Suri
Peripheral arterial disease (PAD) is one of the underdiagnosed and undertreated vascular diseases despite its significant burden in India. In India, the etiological aspects, diagnostic approaches, treatment modalities, and other preventive measures probably vary in different regions. Therefore, this consensus was developed that provides a unified approach for physicians to effectively diagnose and manage PAD in India. In this consensus, we identify that the prevalence of PAD varies from 5% to 25% in Indian setting. Both atherosclerotic and non-atherosclerotic risk factors may underlie PAD. Asymptomatic PAD remains the most common presentation of the disease. The detailed clinical history, physical changes in the lower leg skin, and examination of peripheral pulses can provide clues to the diagnosis. Ankle-brachial index and Duplex ultrasound are advised as the initial choice of diagnostic measures. Besides control of risk factors such as hypertension, diabetes, dyslipidemia, and smoking, pharmacological treatment with anti-platelet and antithrombotic drugs is advised. By efficacy, ticagrelor is considered equivalent to clopidogrel and cilostazol is advised in intermittent claudication. In the revascularization of tibio-pedal lesions, endovascular therapy is effective and arterial bypass with vein graft may be needed in difficult and extensive revascularization scenarios. In these lesions, prosthetic grafts must be avoided. Diabetic foot ulcer management is challenging as foot care among diabetics is poor. In limb, salvation should always be a priority with avoidance of amputation if possible. Stem cell therapy has been successful in PAD which can be advised to “no-option” patients to prevent amputation. Physicians should undertake effective screening of PAD and be considered “PAD Clinics” in India.
{"title":"The Indian consensus statement for the management of lower extremity peripheral artery disease","authors":"N. Khanna, Vinay Krishna, C. Manjunath, S. Tyagi, R. Jindal, M. Chadha, B. H. Natesh, G. Warawdekar, S. Wangnoo, H. Chopra, Priya Jagia, R. Bagarhatta, Amar Singh Suri, Asokan Parayaru Kottayil, R. Vijayvergiya, R. Puri, P. Gupta, V. Mehta, Jasjit S. Suri","doi":"10.4103/1561-8811.383634","DOIUrl":"https://doi.org/10.4103/1561-8811.383634","url":null,"abstract":"Peripheral arterial disease (PAD) is one of the underdiagnosed and undertreated vascular diseases despite its significant burden in India. In India, the etiological aspects, diagnostic approaches, treatment modalities, and other preventive measures probably vary in different regions. Therefore, this consensus was developed that provides a unified approach for physicians to effectively diagnose and manage PAD in India. In this consensus, we identify that the prevalence of PAD varies from 5% to 25% in Indian setting. Both atherosclerotic and non-atherosclerotic risk factors may underlie PAD. Asymptomatic PAD remains the most common presentation of the disease. The detailed clinical history, physical changes in the lower leg skin, and examination of peripheral pulses can provide clues to the diagnosis. Ankle-brachial index and Duplex ultrasound are advised as the initial choice of diagnostic measures. Besides control of risk factors such as hypertension, diabetes, dyslipidemia, and smoking, pharmacological treatment with anti-platelet and antithrombotic drugs is advised. By efficacy, ticagrelor is considered equivalent to clopidogrel and cilostazol is advised in intermittent claudication. In the revascularization of tibio-pedal lesions, endovascular therapy is effective and arterial bypass with vein graft may be needed in difficult and extensive revascularization scenarios. In these lesions, prosthetic grafts must be avoided. Diabetic foot ulcer management is challenging as foot care among diabetics is poor. In limb, salvation should always be a priority with avoidance of amputation if possible. Stem cell therapy has been successful in PAD which can be advised to “no-option” patients to prevent amputation. Physicians should undertake effective screening of PAD and be considered “PAD Clinics” in India.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"42 1","pages":"1 - 20"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73811523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
De Winter syndrome is a rare electrocardiographic (ECG) pattern that makes the diagnosis of ST-segment elevation myocardial infarction (STEMI) very challenging. Our case indicates that the early identification and diagnosis of such ECGs and timely reperfusion therapy of de Winter syndrome as an STEMI equivalent are required to improve the prognosis of such patients.
{"title":"De Winter's pattern: An unusual electrocardiographic pattern to recognize","authors":"Manish Ruhela, R. Ola, R. Bagarhatta","doi":"10.4103/jicc.jicc_51_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_51_21","url":null,"abstract":"De Winter syndrome is a rare electrocardiographic (ECG) pattern that makes the diagnosis of ST-segment elevation myocardial infarction (STEMI) very challenging. Our case indicates that the early identification and diagnosis of such ECGs and timely reperfusion therapy of de Winter syndrome as an STEMI equivalent are required to improve the prognosis of such patients.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"19 11","pages":"87 - 89"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91440593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Higher thrombus load and poorer outcomes have been reported in coronavirus disease 2019 (COVID-19) patients with ST-segment elevation myocardial infarction (STEMI). The presence of antibodies to the COVID-19 infection has been linked to excess thrombus. This retrospective study compared the thrombus burden and outcomes in STEMI during primary angioplasty in myocardial infarction (PAMI) between the two groups with Sars antibody positive (SAP) and Sars antibody negative (SAN). Materials and Methods: Consecutive STEMI patients undergoing PAMI from November 2020 to July 2021 admitted to this single center were included. All patients were ruled out for an active infection by a negative rapid antigen and subsequently by reverse transcription polymerase chain reaction test. Participants were divided into SAP and SAN groups based on COVID-19 antibody results performed with the Roche kit. The primary aim was to compare thrombus load, coronary risk factors, and demographic characteristics between SAP and SAN patients and the secondary aim was to compare the inhospital and 30-day mortality between the two groups after primary percutaneous coronary intervention (PPCI). Results: The study included 261 consecutive STEMI patients (≥18 years; average age: 60.32 + 11.5 [standard deviation]). COVID antibody test results were available for 177 patients (36 SAP and 141 SAN), and these patients were included in the analysis; 144 were male, and 33 were female. There was no significant difference in baseline demographic characteristics between the two groups. Inflammatory markers, such as C-reactive protein (P = 0.479), troponin-T (P = 0.466), or D-dimer (P = 0.681) levels, and thrombus load status (G0 to G5) were not statistically significantly different (P = 0.344) between the two groups. Two patients in the SAP group and none in the SAN group (P = 0.005) died. The 30-day mortality rate (one patient in each group; P = 0.272) was not statistically significantly different between the two groups. Conclusion: Positive COVID-19 antibody levels in the blood did not produce changes in thrombus load and presentation in STEMI PAMI patients. The inhospital mortality rates and 30-day mortality rates were not affected by the antibody levels to COVID-19 infection.
{"title":"Severe acute respiratory syndrome Coronavirus 2 antibodies in ST-segment elevation myocardial infarction patients and its impact on thrombus in the coronaries","authors":"P. Jayagopal, R. Omnath","doi":"10.4103/jicc.jicc_40_22","DOIUrl":"https://doi.org/10.4103/jicc.jicc_40_22","url":null,"abstract":"Objective: Higher thrombus load and poorer outcomes have been reported in coronavirus disease 2019 (COVID-19) patients with ST-segment elevation myocardial infarction (STEMI). The presence of antibodies to the COVID-19 infection has been linked to excess thrombus. This retrospective study compared the thrombus burden and outcomes in STEMI during primary angioplasty in myocardial infarction (PAMI) between the two groups with Sars antibody positive (SAP) and Sars antibody negative (SAN). Materials and Methods: Consecutive STEMI patients undergoing PAMI from November 2020 to July 2021 admitted to this single center were included. All patients were ruled out for an active infection by a negative rapid antigen and subsequently by reverse transcription polymerase chain reaction test. Participants were divided into SAP and SAN groups based on COVID-19 antibody results performed with the Roche kit. The primary aim was to compare thrombus load, coronary risk factors, and demographic characteristics between SAP and SAN patients and the secondary aim was to compare the inhospital and 30-day mortality between the two groups after primary percutaneous coronary intervention (PPCI). Results: The study included 261 consecutive STEMI patients (≥18 years; average age: 60.32 + 11.5 [standard deviation]). COVID antibody test results were available for 177 patients (36 SAP and 141 SAN), and these patients were included in the analysis; 144 were male, and 33 were female. There was no significant difference in baseline demographic characteristics between the two groups. Inflammatory markers, such as C-reactive protein (P = 0.479), troponin-T (P = 0.466), or D-dimer (P = 0.681) levels, and thrombus load status (G0 to G5) were not statistically significantly different (P = 0.344) between the two groups. Two patients in the SAP group and none in the SAN group (P = 0.005) died. The 30-day mortality rate (one patient in each group; P = 0.272) was not statistically significantly different between the two groups. Conclusion: Positive COVID-19 antibody levels in the blood did not produce changes in thrombus load and presentation in STEMI PAMI patients. The inhospital mortality rates and 30-day mortality rates were not affected by the antibody levels to COVID-19 infection.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"20 1","pages":"76 - 81"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75055337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Long-standing aortic stenosis (AS) leads to elevated left ventricular (LV) pressure and as a consequence develops LV hypertrophy and increased myocardial fibrosis. The LV ejection fraction (LVEF) remains often preserved until the late stages of disease, but subtle LV dysfunction can be present in patients of severe AS. Transcatheter aortic valve replacement (TAVR) has become the primary method of aortic valve replacement for intermediate and high surgical risk patients with AS. In this study, we aimed to see if TAVR in patients with severe AS can result in the improvement of systolic functions. Subjects and Methods: We retrospectively studied the data of 52 consecutive symptomatic patients with severe symptomatic AS who underwent TAVR at our center. Echocardiography was performed at baseline and 6 months after the procedure to evaluate change in LVEF. Results: Fifty-two patients were retrospectively evaluated. The mean LVEF before TAVR was 49.52 ± 13.44. The mean LVEF after TAVR was 52.02 ± 10.95. That means there was a significant increase in LVEF after TAVR as compared to LVEF before TAVR (P = 0.008 using Wilcoxon signed-rank test). Conclusion: In this article, we conclude that, in AS patients, the removal of afterload by TAVR significantly improves cardiac functions as assessed by LVEF.
{"title":"Change in left ventricular ejection fraction after transcatheter aortic valve replacement in severe aortic stenosis","authors":"Shailesh Singh, A. Khan, Katyayni Singh","doi":"10.4103/jicc.jicc_19_22","DOIUrl":"https://doi.org/10.4103/jicc.jicc_19_22","url":null,"abstract":"Background: Long-standing aortic stenosis (AS) leads to elevated left ventricular (LV) pressure and as a consequence develops LV hypertrophy and increased myocardial fibrosis. The LV ejection fraction (LVEF) remains often preserved until the late stages of disease, but subtle LV dysfunction can be present in patients of severe AS. Transcatheter aortic valve replacement (TAVR) has become the primary method of aortic valve replacement for intermediate and high surgical risk patients with AS. In this study, we aimed to see if TAVR in patients with severe AS can result in the improvement of systolic functions. Subjects and Methods: We retrospectively studied the data of 52 consecutive symptomatic patients with severe symptomatic AS who underwent TAVR at our center. Echocardiography was performed at baseline and 6 months after the procedure to evaluate change in LVEF. Results: Fifty-two patients were retrospectively evaluated. The mean LVEF before TAVR was 49.52 ± 13.44. The mean LVEF after TAVR was 52.02 ± 10.95. That means there was a significant increase in LVEF after TAVR as compared to LVEF before TAVR (P = 0.008 using Wilcoxon signed-rank test). Conclusion: In this article, we conclude that, in AS patients, the removal of afterload by TAVR significantly improves cardiac functions as assessed by LVEF.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"91 1","pages":"82 - 86"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90505122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prabhakaran Dorairaj, S. Manickam, Sumithra Raju, Abishek Chandrasekhar
Background: Apolipoprotein B (Apo B) is an important predictor of the risk of atherosclerotic cardiovascular disease over and above low-density lipoprotein cholesterol (LDL-C), especially in statin-treated patients. Assays of Apo B are not available widely. Objectives: The objective of this study is to derive the Apo B from a lipid profile, using a regression equation and a neural network and compare the results, to compare LDL-C measured by direct assay and a Friedewald equation derived LDL-C in their efficacy to predict Apo B, to determine the effect of lower levels of LDL-C on the prediction models, and to develop an android app “Apo B Calculator” which will calculate the Apo B and also give the predictive accuracy of the result. Methodology: Eight hundred and eighty-five persons were split into a training set and a validation set. Both the regression equation and neural network methods were applied on the training set of 442 patients and the best regression equation and neural network predictive model for Apo B were derived. This was then applied on the validation set of 443 patients to test the R2 of the models. Results: The regression equation Apo B = 25.199 + 0.266 (LDL) + 0.062 (triglycerides level [TGL]) + 0.248 (non-high-density lipoprotein cholesterol) was the best predictor of Apo B when directly measured LDL-C was used. The predictive accuracy of the neural network was lesser than the regression equation (75% vs. 87.4% at 95% confidence interval [CI]). The regression equation for the Friedewald equation derived LDL-C was Apo B = 25.077 + 0.528 friedewald equation (F. LDL) +0.138 (TGL) and was comparable with the neural network (86.4% vs. 85% at 95% CI). The overall efficacy of both the direct assay and Friedewald equation-derived LDL-C were nearly the same (87.4% vs. 86.4% at 95% CI). There was a linear decline in the predictive accuracy of both methods at diminishing LDL-C levels. At lower levels of LDL-C (<70 mg/dl), the accuracy of the Friedewald equation derived LDL-C was a better predictor of Apo B (70% vs. 59.8%). With this data, we developed an android app “Apo B Calculator” which will calculate the Apo B from a directly measured or Friedewald equation derived LDL-C. The app will also mention the predictive accuracy of the results. Conclusions: The regression equation derived from directly measured LDL-C and Friedewald equation derived LDL-C, and the neural network using the Friedewald equation showed near similar efficacy in predicting the Apo B value (87.4%, 86.4%, and 85%). A regression equation using a Friedewald formula is a better predictor of Apo B at LDL-C levels <70 mg/dl. The app “Apo B Calculator” can predict the Apo B from both directly measured and Friedewald equation derived LDL-C and give the predictive accuracy for the method – This will help the clinician to know the Apo B and also the predictive accuracy of such calculated value.
背景:载脂蛋白B (Apo B)是动脉粥样硬化性心血管疾病风险的重要预测因子，高于低密度脂蛋白胆固醇(LDL-C)，特别是在他汀类药物治疗的患者中。载脂蛋白B的测定方法并不广泛。目的:本研究的目的是获得从血脂Apo B,使用回归方程和神经网络和比较结果,比较低密度来衡量直接测定和Friedewald方程推导出低密度的疗效预测Apo B,以确定较低水平的影响低密度的预测模型,并开发一个android应用“Apo B计算器”计算Apo B也会给预测结果的准确性。方法:885人被分为训练集和验证集。将回归方程和神经网络方法应用于442例患者的训练集，推导出最佳的Apo B回归方程和神经网络预测模型。然后将其应用于443例患者的验证集，以测试模型的R2。结果:当直接测定LDL- c时，回归方程Apo B = 25.199 + 0.266 (LDL) + 0.062(甘油三酯水平[TGL]) + 0.248(非高密度脂蛋白胆固醇)是Apo B的最佳预测因子。神经网络的预测准确率低于回归方程(75% vs. 87.4%， 95%置信区间[CI])。Friedewald方程导出的LDL- c回归方程为Apo B = 25.077 + 0.528 Friedewald方程(F. LDL) +0.138 (TGL)，与神经网络相当(86.4% vs. 85%， 95% CI)。直接测定法和Friedewald方程导出的LDL-C的总体疗效几乎相同(95% CI为87.4% vs. 86.4%)。当LDL-C水平降低时，两种方法的预测准确性均呈线性下降。在LDL-C水平较低(<70 mg/dl)时，Friedewald方程推导出的LDL-C的准确性能更好地预测载脂蛋白B (70% vs. 59.8%)。有了这些数据，我们开发了一个安卓应用程序“载脂蛋白B计算器”，它将计算载脂蛋白B直接测量或弗里德瓦尔德方程导出的LDL-C。该应用程序还会提到预测结果的准确性。结论:直接测量LDL-C的回归方程和Friedewald方程导出的LDL-C，使用Friedewald方程的神经网络预测Apo B值的效果接近(87.4%，86.4%和85%)。使用Friedewald公式的回归方程可以更好地预测LDL-C水平<70 mg/dl时载脂蛋白B的水平。应用程序“载脂蛋白B计算器”可以预测从直接测量和弗里德瓦尔德方程推导出的LDL-C的载脂蛋白B，并给出预测精度的方法-这将有助于临床医生知道载脂蛋白B和预测精度的计算值。
{"title":"An android app “Apolipoprotein B Calculator” calculates Apolipoprotein B using regression analysis and neural network – Using the friedewald equation is the same as directly measured low-density lipoprotein cholesterol and better at low-density lipoprotein levels","authors":"Prabhakaran Dorairaj, S. Manickam, Sumithra Raju, Abishek Chandrasekhar","doi":"10.4103/jicc.jicc_34_22","DOIUrl":"https://doi.org/10.4103/jicc.jicc_34_22","url":null,"abstract":"Background: Apolipoprotein B (Apo B) is an important predictor of the risk of atherosclerotic cardiovascular disease over and above low-density lipoprotein cholesterol (LDL-C), especially in statin-treated patients. Assays of Apo B are not available widely. Objectives: The objective of this study is to derive the Apo B from a lipid profile, using a regression equation and a neural network and compare the results, to compare LDL-C measured by direct assay and a Friedewald equation derived LDL-C in their efficacy to predict Apo B, to determine the effect of lower levels of LDL-C on the prediction models, and to develop an android app “Apo B Calculator” which will calculate the Apo B and also give the predictive accuracy of the result. Methodology: Eight hundred and eighty-five persons were split into a training set and a validation set. Both the regression equation and neural network methods were applied on the training set of 442 patients and the best regression equation and neural network predictive model for Apo B were derived. This was then applied on the validation set of 443 patients to test the R2 of the models. Results: The regression equation Apo B = 25.199 + 0.266 (LDL) + 0.062 (triglycerides level [TGL]) + 0.248 (non-high-density lipoprotein cholesterol) was the best predictor of Apo B when directly measured LDL-C was used. The predictive accuracy of the neural network was lesser than the regression equation (75% vs. 87.4% at 95% confidence interval [CI]). The regression equation for the Friedewald equation derived LDL-C was Apo B = 25.077 + 0.528 friedewald equation (F. LDL) +0.138 (TGL) and was comparable with the neural network (86.4% vs. 85% at 95% CI). The overall efficacy of both the direct assay and Friedewald equation-derived LDL-C were nearly the same (87.4% vs. 86.4% at 95% CI). There was a linear decline in the predictive accuracy of both methods at diminishing LDL-C levels. At lower levels of LDL-C (<70 mg/dl), the accuracy of the Friedewald equation derived LDL-C was a better predictor of Apo B (70% vs. 59.8%). With this data, we developed an android app “Apo B Calculator” which will calculate the Apo B from a directly measured or Friedewald equation derived LDL-C. The app will also mention the predictive accuracy of the results. Conclusions: The regression equation derived from directly measured LDL-C and Friedewald equation derived LDL-C, and the neural network using the Friedewald equation showed near similar efficacy in predicting the Apo B value (87.4%, 86.4%, and 85%). A regression equation using a Friedewald formula is a better predictor of Apo B at LDL-C levels <70 mg/dl. The app “Apo B Calculator” can predict the Apo B from both directly measured and Friedewald equation derived LDL-C and give the predictive accuracy for the method – This will help the clinician to know the Apo B and also the predictive accuracy of such calculated value.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"13 1","pages":"69 - 75"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78118132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Sathyamurthy, Sasikala Subramanian, K. Kirubakaran, S. Vijayashankar
Left ventricular non compaction (LVNC) cardiomyopathy is rare. Associated valvular lesions are still remote and they can complicate the underlying myocardial dysfunction. Echocardiographic diagnosis is well established. We are reporting a case of LVNC who presented with class III NYHA due to mitral valve prolapse with severe mitral regurgitation and severe LV dysfunction who was successfully operated and found asymptomatic with near normal LV function during 18 months follow up. This report is to stress that surgical management is feasible when indicated in cases of LVNC with acceptable outcomes.
{"title":"Left ventricular noncompaction associated with mitral valve prolapse and severe mitral regurgitation","authors":"I. Sathyamurthy, Sasikala Subramanian, K. Kirubakaran, S. Vijayashankar","doi":"10.4103/jicc.jicc_56_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_56_21","url":null,"abstract":"Left ventricular non compaction (LVNC) cardiomyopathy is rare. Associated valvular lesions are still remote and they can complicate the underlying myocardial dysfunction. Echocardiographic diagnosis is well established. We are reporting a case of LVNC who presented with class III NYHA due to mitral valve prolapse with severe mitral regurgitation and severe LV dysfunction who was successfully operated and found asymptomatic with near normal LV function during 18 months follow up. This report is to stress that surgical management is feasible when indicated in cases of LVNC with acceptable outcomes.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"15 1","pages":"90 - 92"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80571216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: As countries around the globe enforce social distancing and self-isolation to fight the COVID-19 pandemic, telemedicine is emerging as a critical tool to connect physicians and other healthcare professionals with patients dealing with chronic cardiovascular conditions. Technology assisted healthcare delivery is virtually imperative especially in India with a large part belonging to rural and remote regions. The Information and Communication technology (ICT) which is the fundamental part of this technology is the ability to locally connect to a global network. The current pandemic caused by corona has highlighted the importance of this technology even more with patients showing apprehension to go to hospitals for routine check-ups. The emergence of Internet of Things (IoT) has further ensured that a continuum in care can be maintained, with patients having the opportunity to have wearable devices at their homes and using the Telemedicine platform for transmission of medical data from these devices for consultations. Methods: Literary search on the various applications of Telemedicine in healthcare with specific reference to Cardiology. Results: This article highlights our experience in the utilization of this technology for various cardiac conditions, comprehending the challenges of this technology at the practical level and the impact of making healthcare deliver accessible and cost-effective. Conclusions: Information and communication technology (ICT) and the advent of Internet of Things for Medical Devices (IoT-MD) has empowered telemedicine as a powerful model for healthcare delivery in an effective manner. Immense data generated from these devices have further encouraged development of algorithms based on Artificial Intelligence thereby improving clinical effectiveness and ensuring continuity of care. Though possibilities of improving clinical efficacy and healthcare outcomes through AI are enormous, we need to be aware of the associated risks and challenges and try to minimize those through multidisciplinary research, and renewed legal and ethical policies.
{"title":"Telemedicine - Application in cardiology","authors":"Krishnam Raju, Prasad Sistla","doi":"10.4103/jicc.jicc_80_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_80_20","url":null,"abstract":"Background: As countries around the globe enforce social distancing and self-isolation to fight the COVID-19 pandemic, telemedicine is emerging as a critical tool to connect physicians and other healthcare professionals with patients dealing with chronic cardiovascular conditions. Technology assisted healthcare delivery is virtually imperative especially in India with a large part belonging to rural and remote regions. The Information and Communication technology (ICT) which is the fundamental part of this technology is the ability to locally connect to a global network. The current pandemic caused by corona has highlighted the importance of this technology even more with patients showing apprehension to go to hospitals for routine check-ups. The emergence of Internet of Things (IoT) has further ensured that a continuum in care can be maintained, with patients having the opportunity to have wearable devices at their homes and using the Telemedicine platform for transmission of medical data from these devices for consultations. Methods: Literary search on the various applications of Telemedicine in healthcare with specific reference to Cardiology. Results: This article highlights our experience in the utilization of this technology for various cardiac conditions, comprehending the challenges of this technology at the practical level and the impact of making healthcare deliver accessible and cost-effective. Conclusions: Information and communication technology (ICT) and the advent of Internet of Things for Medical Devices (IoT-MD) has empowered telemedicine as a powerful model for healthcare delivery in an effective manner. Immense data generated from these devices have further encouraged development of algorithms based on Artificial Intelligence thereby improving clinical effectiveness and ensuring continuity of care. Though possibilities of improving clinical efficacy and healthcare outcomes through AI are enormous, we need to be aware of the associated risks and challenges and try to minimize those through multidisciplinary research, and renewed legal and ethical policies.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"47 1","pages":"49 - 63"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75937915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Srinivas Bhyravavajhala, Y. Kishore, M. Harish Reddy, A. Panda
Background: In post-ST-segment elevation myocardial infarction (STEMI) patients, the indices of repolarization on electrocardiogram (ECG) have shown promise for the prediction of death and malignant arrhythmias. In our study, we analyzed prospectively, in patients with STEMI undergoing reperfusion therapy, the acute effects of the reperfusion on the Tpeak-Tend (TpTe) and its predictive value for 30-day mortality, ventricular arrhythmias, and heart failure. Materials and Methods: We studied 75 STEMI patients aged 18–80 years admitted to Nizam's Institute of Medical Sciences, Hyderabad, over 6 months. ECGs were taken before and 90 min after reperfusion. TpTe interval was measured before (pre-TpTe) and after reperfusion (post-TpTe). 24-h Holter monitoring was recorded within 72 h of reperfusion to look for any arrhythmias. Patients were followed up for a period of 30 days, and all the major adverse cardiac events (MACE) if any, were noted. Results: In the primary percutaneous transluminal coronary angioplasty (PTCA) group, the mean change in TpTe after intervention was 19.7 ± 16.7 ms, whereas in thrombolysis group, it was 10.7 ± 13.8; and the difference was statistically significant (P < 0.05), suggesting the superiority of primary PTCA compared to thrombolysis. When pre-TpTe interval was compared between who survived (69) and who succumbed (09), higher values were seen in patients who succumbed to death (115 ± 5.48) versus (88 ± 16.5) (P < 0.05). Pre-TpTe value of 105 had 100% sensitivity and 83% specificity in predicting mortality. Conclusion: Primary PTCA was superior to thrombolysis in reducing the TpTe interval and MACE events. The pre-TpTe interval could predict 30-day mortality and ventricular arrhythmias in the immediate and late period after revascularization in STEMI.
{"title":"Prognostic value of T peak-T end interval on surface ECG in patients undergoing reperfusion therapy for ST segment myocardial infarction","authors":"Srinivas Bhyravavajhala, Y. Kishore, M. Harish Reddy, A. Panda","doi":"10.4103/jicc.jicc_63_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_63_21","url":null,"abstract":"Background: In post-ST-segment elevation myocardial infarction (STEMI) patients, the indices of repolarization on electrocardiogram (ECG) have shown promise for the prediction of death and malignant arrhythmias. In our study, we analyzed prospectively, in patients with STEMI undergoing reperfusion therapy, the acute effects of the reperfusion on the Tpeak-Tend (TpTe) and its predictive value for 30-day mortality, ventricular arrhythmias, and heart failure. Materials and Methods: We studied 75 STEMI patients aged 18–80 years admitted to Nizam's Institute of Medical Sciences, Hyderabad, over 6 months. ECGs were taken before and 90 min after reperfusion. TpTe interval was measured before (pre-TpTe) and after reperfusion (post-TpTe). 24-h Holter monitoring was recorded within 72 h of reperfusion to look for any arrhythmias. Patients were followed up for a period of 30 days, and all the major adverse cardiac events (MACE) if any, were noted. Results: In the primary percutaneous transluminal coronary angioplasty (PTCA) group, the mean change in TpTe after intervention was 19.7 ± 16.7 ms, whereas in thrombolysis group, it was 10.7 ± 13.8; and the difference was statistically significant (P < 0.05), suggesting the superiority of primary PTCA compared to thrombolysis. When pre-TpTe interval was compared between who survived (69) and who succumbed (09), higher values were seen in patients who succumbed to death (115 ± 5.48) versus (88 ± 16.5) (P < 0.05). Pre-TpTe value of 105 had 100% sensitivity and 83% specificity in predicting mortality. Conclusion: Primary PTCA was superior to thrombolysis in reducing the TpTe interval and MACE events. The pre-TpTe interval could predict 30-day mortality and ventricular arrhythmias in the immediate and late period after revascularization in STEMI.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"11 1","pages":"64 - 68"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85418341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Singhi, Sandip Sardar, D. Chatterjee, Arpan Chakravorty
{"title":"Mitral prosthetic valve dehiscence: Role of three-dimensional transesophageal echocardiogram in management","authors":"A. Singhi, Sandip Sardar, D. Chatterjee, Arpan Chakravorty","doi":"10.4103/jicc.jicc_3_22","DOIUrl":"https://doi.org/10.4103/jicc.jicc_3_22","url":null,"abstract":"","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"45 1","pages":"43 - 45"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78915310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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