V. Mori, A. Mohanty, Anurag Yadav, A. Makhija, J. S. Sawhney, B. Kandpal, R. Passey, BS Vivek, S. Manchanda, R. Mantri
Introduction: In any given population, coronary artery diameter is highly variables. It has been postulated that Indians have an increased risk of coronary artery disease (CAD) due to smaller diameter of arteries in them. However, small diameter can be due to smaller body surface area (BSA). Hence, we tried to assess whether smaller coronary artery dimensions in Indians are due to their smaller BSA or not. Methodology: In this observational study, patients undergoing computed tomography coronary angiography and having normal angiogram were included in this study. Patients' coronary artery diameters in major epicardial vessels were measured and indexed to BSA. Analysis was done to assess for any significance compared to Caucasians. Results: A total of 250 patients were part of this study. The mean diameters of proximal left main (LM), distal LM, left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) were 4.27 ± 0.78, 4.26 ± 0.79, 3.47 ± 0.6, 2.99 ± 0.64, and 3.33 ± 0.63 mm, respectively. On indexing to BSA, the measurements in proximal LM, distal LM, LAD, LCX, and RCA were 2.31 ± 0.4, 2.31 ± 0.4, 1.89 ± 0.32, 1.62 ± 0.35, and 1.81 ± 0.34 mm/BSA, respectively. When they were compared to other Indian and Caucasian studies, the diameters were not found to be statistically significant. Conclusion: Thus, the authors conclude that Indians do not have an increased risk for CAD because of their smaller diameters, but it is because of their smaller BSA. This study helped us evaluate the reference range of major epicardial vessel diameters in Indian population.
{"title":"Coronary artery dimensions in normal adult Indian population by computed tomography coronary angiography","authors":"V. Mori, A. Mohanty, Anurag Yadav, A. Makhija, J. S. Sawhney, B. Kandpal, R. Passey, BS Vivek, S. Manchanda, R. Mantri","doi":"10.4103/jicc.jicc_19_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_19_21","url":null,"abstract":"Introduction: In any given population, coronary artery diameter is highly variables. It has been postulated that Indians have an increased risk of coronary artery disease (CAD) due to smaller diameter of arteries in them. However, small diameter can be due to smaller body surface area (BSA). Hence, we tried to assess whether smaller coronary artery dimensions in Indians are due to their smaller BSA or not. Methodology: In this observational study, patients undergoing computed tomography coronary angiography and having normal angiogram were included in this study. Patients' coronary artery diameters in major epicardial vessels were measured and indexed to BSA. Analysis was done to assess for any significance compared to Caucasians. Results: A total of 250 patients were part of this study. The mean diameters of proximal left main (LM), distal LM, left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) were 4.27 ± 0.78, 4.26 ± 0.79, 3.47 ± 0.6, 2.99 ± 0.64, and 3.33 ± 0.63 mm, respectively. On indexing to BSA, the measurements in proximal LM, distal LM, LAD, LCX, and RCA were 2.31 ± 0.4, 2.31 ± 0.4, 1.89 ± 0.32, 1.62 ± 0.35, and 1.81 ± 0.34 mm/BSA, respectively. When they were compared to other Indian and Caucasian studies, the diameters were not found to be statistically significant. Conclusion: Thus, the authors conclude that Indians do not have an increased risk for CAD because of their smaller diameters, but it is because of their smaller BSA. This study helped us evaluate the reference range of major epicardial vessel diameters in Indian population.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"36 1","pages":"119 - 122"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80007571","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}
Kirollos Philops, T. Naguib, M. Al-Daydamony, Ahmed S. Eldamanhory, Elshaimaa Elsadek Seaoud
Introduction: C-reactive protein (CRP) has come to prominence in the cardiovascular field with the inflammatory hypothesis of atherosclerosis. Many studies evaluated the role of CRP as a prognostic marker in ST-segment elevation myocardial infarction (STEMI). The aim of our work was to study the relation between admission CRP level and the angiographic severity of coronary artery disease in patients presenting with acute ST elevation myocardial infarction. Patients and Methods: Admission CRP was measured for 100 STEMI patients before primary percutaneous coronary intervention (PCI). Complexity of coronary lesion was assessed using both Syntax score and thrombolysis in myocardial infarction (TIMI) flow. Results: Syntax score was significantly higher in the 3rd CRP tertile (20.24 ± 5.6 and P = 0.000), TIMI 0 flow was the highest in the 3rd tertile (24% and P = 0.001). We found a significant positive correlation between Syntax score and CRP and a significant negative correlation between CRP and TIMI flow (P = 0.001 and 0.005, respectively). Receiver operating characteristic curve constructed to determine the sensitivity of admission CRP to determine intermediate to high risk SYNTAX score showed a level ≥8.4 mg/dl as 71% sensitive (area under the curve [AUC] =0.65 and a P = 0.02) and an admission CRP of ≥4.8 mg/dl to be 81% sensitive in determining no or faint antegrade flow (TIMI 0 and 1) (AUC = 0.71. P =0.001). Conclusion: There is a strong positive correlation between admission CRP and the syntax score and TIMI flow in STEMI patients undergoing primary PCI, thus adding CRP to the risk scoring systems used to assess STEMI patients before PPCI can help better risk stratify patients before going into the cath laboratory.
{"title":"The value of admission C-reactive protein in prediction of both SYNTAX score and thrombolysis in myocardial infarction flow in STEMI patients undergoing primary percutaneous coronary intervention","authors":"Kirollos Philops, T. Naguib, M. Al-Daydamony, Ahmed S. Eldamanhory, Elshaimaa Elsadek Seaoud","doi":"10.4103/jicc.jicc_39_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_39_21","url":null,"abstract":"Introduction: C-reactive protein (CRP) has come to prominence in the cardiovascular field with the inflammatory hypothesis of atherosclerosis. Many studies evaluated the role of CRP as a prognostic marker in ST-segment elevation myocardial infarction (STEMI). The aim of our work was to study the relation between admission CRP level and the angiographic severity of coronary artery disease in patients presenting with acute ST elevation myocardial infarction. Patients and Methods: Admission CRP was measured for 100 STEMI patients before primary percutaneous coronary intervention (PCI). Complexity of coronary lesion was assessed using both Syntax score and thrombolysis in myocardial infarction (TIMI) flow. Results: Syntax score was significantly higher in the 3rd CRP tertile (20.24 ± 5.6 and P = 0.000), TIMI 0 flow was the highest in the 3rd tertile (24% and P = 0.001). We found a significant positive correlation between Syntax score and CRP and a significant negative correlation between CRP and TIMI flow (P = 0.001 and 0.005, respectively). Receiver operating characteristic curve constructed to determine the sensitivity of admission CRP to determine intermediate to high risk SYNTAX score showed a level ≥8.4 mg/dl as 71% sensitive (area under the curve [AUC] =0.65 and a P = 0.02) and an admission CRP of ≥4.8 mg/dl to be 81% sensitive in determining no or faint antegrade flow (TIMI 0 and 1) (AUC = 0.71. P =0.001). Conclusion: There is a strong positive correlation between admission CRP and the syntax score and TIMI flow in STEMI patients undergoing primary PCI, thus adding CRP to the risk scoring systems used to assess STEMI patients before PPCI can help better risk stratify patients before going into the cath laboratory.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"4 1","pages":"127 - 132"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80827628","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}
R. Sane, Pramod Manohar, R. Mandole, G. Amin, P. Ghadigaonkar, D. Patil, Snehal Dongre, Rahul Jadhav, PrafullYanshwantrao
Background: Cardiovascular disease, commonly seen on a rise globally, is especially prevalent in the developing countries, whose numerous causes are improper diet and lifestyle. Ayurveda, the ancient medical practice, offers antidotes to major diseases. Its detoxification process, Panchakarma, boosts immunity, reduces stress, eliminates toxins from the body, etc., This study was conducted to establish the role of Ayurveda-based ischemia reversal program (IRP) in minimizing ischemic heart disease (IHD). Materials and Methods: A retrospective clinical study was conducted in cardiac hospital on patients, having a clinical evidence of IHD. During the 7-day study period, patients received, 14 IRP Panchakarma sessions comprising, Snehana, Svedana, and Gokshur Haridra Amalki Basti. In addition, the patients were given a calorie-controlled diet. The primary endpoint was change in the global longitudinal strain score as compared to baseline and secondary endpoint was reduced dependency on modern medicine with respect to weight, body mass index (BMI), left ventricular (LV) ejection fraction (EF), 6-min walk test, noninvasive cardiac output, and end diastolic volume. Results: Fifty-nine patients were involved in the study, belonging to 61.02 ± 11.47 years of age, with 74.58% being males. The primary endpoint, decreased from −10.26 ± 4.02, on day 1, to −10.99 ± 3.94, on day 7. Appreciable decrease was also observed for the abdominal girth, body weight, BMI, and dependency on modern medicines. Conclusion: This study revealed that IRP notably reduces heart disease, by influencing various parameters studied in this investigation. An increased EF, decreased LV mass, an improved 6-min walk test, decreased heart rate, normal systolic and diastolic blood pressures, and other parameters indicate an improvement in the existing disease of the heart.
{"title":"Impact of Ayurveda-based ischemia reversal program on reduction of resting myocardial ischemia studied with speckle-tracking global longitudinal strain imaging","authors":"R. Sane, Pramod Manohar, R. Mandole, G. Amin, P. Ghadigaonkar, D. Patil, Snehal Dongre, Rahul Jadhav, PrafullYanshwantrao","doi":"10.4103/jicc.jicc_38_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_38_21","url":null,"abstract":"Background: Cardiovascular disease, commonly seen on a rise globally, is especially prevalent in the developing countries, whose numerous causes are improper diet and lifestyle. Ayurveda, the ancient medical practice, offers antidotes to major diseases. Its detoxification process, Panchakarma, boosts immunity, reduces stress, eliminates toxins from the body, etc., This study was conducted to establish the role of Ayurveda-based ischemia reversal program (IRP) in minimizing ischemic heart disease (IHD). Materials and Methods: A retrospective clinical study was conducted in cardiac hospital on patients, having a clinical evidence of IHD. During the 7-day study period, patients received, 14 IRP Panchakarma sessions comprising, Snehana, Svedana, and Gokshur Haridra Amalki Basti. In addition, the patients were given a calorie-controlled diet. The primary endpoint was change in the global longitudinal strain score as compared to baseline and secondary endpoint was reduced dependency on modern medicine with respect to weight, body mass index (BMI), left ventricular (LV) ejection fraction (EF), 6-min walk test, noninvasive cardiac output, and end diastolic volume. Results: Fifty-nine patients were involved in the study, belonging to 61.02 ± 11.47 years of age, with 74.58% being males. The primary endpoint, decreased from −10.26 ± 4.02, on day 1, to −10.99 ± 3.94, on day 7. Appreciable decrease was also observed for the abdominal girth, body weight, BMI, and dependency on modern medicines. Conclusion: This study revealed that IRP notably reduces heart disease, by influencing various parameters studied in this investigation. An increased EF, decreased LV mass, an improved 6-min walk test, decreased heart rate, normal systolic and diastolic blood pressures, and other parameters indicate an improvement in the existing disease of the heart.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"124 1","pages":"106 - 110"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79215817","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}
Dibyasundar Mahanta, Jogendra Singh, Rudrapratap Mahapatra, R. Barik
Left main coronary artery dissection induced by the tip of the guide catheter (Razor blade effect) with or without extension into the adjacent aortic wall can result in no flow. It is being a life threatening, complication and must be time timely detected and treated by stenting or surgery. A 59-year-old male patient presented with crescendo angina having a history of stenting to left anterior descending coronary artery (LAD) using 3 mm × 23 mm drug-eluting stent 5 years back. Coronary angiogram revealed 100% instent re-stenosis of the LAD. Left circumflex (LCX) coronary artery had proximal chronic total occlusion with J-CTO score of ≥2.The dominant right coronary artery was normal. LMCA dissection was noticed like an invisible dragon from nowhere after stenting of the proximal LCX followed by abrupt retrograde extension into aorta, resulting in no flow in the left coronary artery. The true lumen of LMCA was re-wired, and timely bailout stenting from LMCA to LCX was performed.
导尿管尖端引起的左主干冠状动脉剥离(剃刀效应)不论是否延伸至邻近主动脉壁均可导致无血流。这是一种危及生命的并发症，必须及时发现并通过支架植入或手术治疗。59岁男性患者，5年前曾行3 mm × 23 mm药物洗脱支架植入左冠状动脉前降支(LAD)，以渐强型心绞痛就诊。冠状动脉造影显示前冠状动脉再狭窄100%。左旋冠状动脉近端慢性全闭塞，J-CTO评分≥2。右侧优势冠状动脉正常。在LMCA近端支架置入后，突然逆行延伸至主动脉，左冠状动脉无血流，发现LMCA夹层像一条看不见的龙，不知从哪里冒出来。重新连接LMCA真管腔，及时行LMCA至LCX救助支架置入。
{"title":"Guide catheter tip-induced type-II aortocoronary dissection bailed out by stenting the left main coronary artery","authors":"Dibyasundar Mahanta, Jogendra Singh, Rudrapratap Mahapatra, R. Barik","doi":"10.4103/jicc.jicc_33_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_33_21","url":null,"abstract":"Left main coronary artery dissection induced by the tip of the guide catheter (Razor blade effect) with or without extension into the adjacent aortic wall can result in no flow. It is being a life threatening, complication and must be time timely detected and treated by stenting or surgery. A 59-year-old male patient presented with crescendo angina having a history of stenting to left anterior descending coronary artery (LAD) using 3 mm × 23 mm drug-eluting stent 5 years back. Coronary angiogram revealed 100% instent re-stenosis of the LAD. Left circumflex (LCX) coronary artery had proximal chronic total occlusion with J-CTO score of ≥2.The dominant right coronary artery was normal. LMCA dissection was noticed like an invisible dragon from nowhere after stenting of the proximal LCX followed by abrupt retrograde extension into aorta, resulting in no flow in the left coronary artery. The true lumen of LMCA was re-wired, and timely bailout stenting from LMCA to LCX was performed.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"58 1","pages":"133 - 135"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81435161","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}
Bleeding following any injury is due to damaged blood vessel and is usually kept in check by a process called hemostasis. At times, this process may be abnormally affected by pathological factors or causes subsequently leading to thrombus formation and occlusion of blood vessels. It can affect either arteries or veins. The events in the pathogenesis of thrombosis occur in a vicious cycle. We report a case of 38-year-old male with multiple arterial thrombosis involving brachial artery, common carotid artery, and main pulmonary artery. He had raised hemoglobin, hematocrit, mean corpuscular volume, and mean corpuscular hemoglobin on presentation. He was successfully treated with injection alteplase (recombinant tissue plasminogen activator), injection enoxaparin, and dual oral antiplatelet therapy.
{"title":"Multiple arterial thrombosis","authors":"Sagar Mali, Chaudappa Shakapur","doi":"10.4103/jicc.jicc_48_20","DOIUrl":"https://doi.org/10.4103/jicc.jicc_48_20","url":null,"abstract":"Bleeding following any injury is due to damaged blood vessel and is usually kept in check by a process called hemostasis. At times, this process may be abnormally affected by pathological factors or causes subsequently leading to thrombus formation and occlusion of blood vessels. It can affect either arteries or veins. The events in the pathogenesis of thrombosis occur in a vicious cycle. We report a case of 38-year-old male with multiple arterial thrombosis involving brachial artery, common carotid artery, and main pulmonary artery. He had raised hemoglobin, hematocrit, mean corpuscular volume, and mean corpuscular hemoglobin on presentation. He was successfully treated with injection alteplase (recombinant tissue plasminogen activator), injection enoxaparin, and dual oral antiplatelet therapy.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"124 1","pages":"83 - 88"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72646531","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, S. Mohapatra, S. Dey, D. Chatterjee, A. De
Valvular pulmonary stenosis (PS) can present with cyanosis and right heart failure in older children and adults. Transcatheter balloon pulmonary valvuloplasty is a standard intervention for severe valvular PS in all age groups. Balloon dilatation in critical PS like presentation in older age groups has unique challenges in management. These cases are associated with right ventricular dysfunction, cyanosis, pulmonary edema, injury to right ventricular structure, and arrhythmia. Imaging is an essential component for diagnosis and management. We present two such cases of older children who presented with cyanosis and right ventricular dysfunction. Detailed imaging and team approach of care helped in managing the challenges of balloon pulmonary valvuloplasty in older sick substrates.
{"title":"Challenges in balloon pulmonary valvotomy for severe pulmonary stenosis presenting with cyanosis and ventricular dysfunction","authors":"A. Singhi, S. Mohapatra, S. Dey, D. Chatterjee, A. De","doi":"10.4103/jicc.jicc_46_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_46_21","url":null,"abstract":"Valvular pulmonary stenosis (PS) can present with cyanosis and right heart failure in older children and adults. Transcatheter balloon pulmonary valvuloplasty is a standard intervention for severe valvular PS in all age groups. Balloon dilatation in critical PS like presentation in older age groups has unique challenges in management. These cases are associated with right ventricular dysfunction, cyanosis, pulmonary edema, injury to right ventricular structure, and arrhythmia. Imaging is an essential component for diagnosis and management. We present two such cases of older children who presented with cyanosis and right ventricular dysfunction. Detailed imaging and team approach of care helped in managing the challenges of balloon pulmonary valvuloplasty in older sick substrates.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"6 1","pages":"139 - 142"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80584105","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}
Conventional angiography is poor in assessing type of plaque, plaque volume, disease extent, severity and features associated with optimization of percutaneous coronary intervention (PCI), whereas Intra-Vascular Ultra-Sound (IVUS) and optical coherence tomography (OCT) overcome these limitations by providing cross sectional images of vessel wall, and longitudinal extent of disease. OCT provides high-resolution images at the cost of limited penetration compared with IVUS with an axial spatial resolution of 10–20 μm versus 100–200 μm, lateral resolution of 20 μm versus 200 μm, and penetration depth 1–2.5 mm versus 10 mm, respectively. OCT measurements were proved to be nearer to the actual luminal areas whereas IVUS measurements were overestimated and were less reproducible in the phantom model. OCT and IVUS are proved to be a valid guidance for optimization of PCI. However, usefulness of OCT in day to day practice is very limited in the assessment of Left Main disease. Both imaging technologies have different distinct features, these are complementary and should be opted carefully for each patient based on pros and cons, and clinical indications of each technique.
{"title":"Current concepts of optical coherence tomography assessment of left main coronary artery during coronary interventions","authors":"S. Kasturi","doi":"10.4103/jicc.jicc_61_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_61_21","url":null,"abstract":"Conventional angiography is poor in assessing type of plaque, plaque volume, disease extent, severity and features associated with optimization of percutaneous coronary intervention (PCI), whereas Intra-Vascular Ultra-Sound (IVUS) and optical coherence tomography (OCT) overcome these limitations by providing cross sectional images of vessel wall, and longitudinal extent of disease. OCT provides high-resolution images at the cost of limited penetration compared with IVUS with an axial spatial resolution of 10–20 μm versus 100–200 μm, lateral resolution of 20 μm versus 200 μm, and penetration depth 1–2.5 mm versus 10 mm, respectively. OCT measurements were proved to be nearer to the actual luminal areas whereas IVUS measurements were overestimated and were less reproducible in the phantom model. OCT and IVUS are proved to be a valid guidance for optimization of PCI. However, usefulness of OCT in day to day practice is very limited in the assessment of Left Main disease. Both imaging technologies have different distinct features, these are complementary and should be opted carefully for each patient based on pros and cons, and clinical indications of each technique.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"22 1","pages":"89 - 105"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86039535","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}
Ankit Thukral, A. Kotwal, R. Gupta, A. Rastogi, S. Pande, S. Agarwal, S. Tewari
Introduction: Asymptomatic hypothyroidism is endemic in most regions of our country. We planned a study to observe the effect of thyroid-stimulating hormone (TSH) in otherwise asymptomatic for hypothyroidism patients, on outcome after coronary artery bypass grafting (CABG). Materials and Methods: This is a retrospective cohort study conducted between January 2017 and December 2019. A total of 449 patients undergoing CABG were included in the study. Patients with redo operations, combined procedures, and emergency operations were excluded from the study. The groups were formed on the level of TSH (normal, subclinical elevation, and clinical elevation) as follows: TSH normal (Group 1, n = 309), TSH subclinical elevation (Group 2, n = 122), and TSH clinical elevation (Group 3, n = 12). One-way ANOVA was used to analyze the groups. Results: There was an increase in the use of inotrope, appearance of atrial fibrillation, and use of intra-aortic balloon pump in Group 3 when compared to that in Groups 1 and 2, P = 0.0001. Higher mortality was observed in group 3 (25%) when compared to group 1 (2.91%) and group 2 (2.45%). There was no difference in the level of free T4, between groups. T3 was similar in TSH normal, TSH subclinical elevation, and clinical elevation group. TSH level of >10 mIU/l predicted mortality with a sensitivity of 91.7% and a specificity of 99.8% in predicting mortality. Conclusion: About 2.67% of the patients undergoing CABG had asymptomatic but clinical elevation of TSH, and it is associated with higher mortality.
{"title":"Elevated thyroid-stimulating hormone is a risk factor in coronary artery bypass grafting","authors":"Ankit Thukral, A. Kotwal, R. Gupta, A. Rastogi, S. Pande, S. Agarwal, S. Tewari","doi":"10.4103/jicc.jicc_42_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_42_21","url":null,"abstract":"Introduction: Asymptomatic hypothyroidism is endemic in most regions of our country. We planned a study to observe the effect of thyroid-stimulating hormone (TSH) in otherwise asymptomatic for hypothyroidism patients, on outcome after coronary artery bypass grafting (CABG). Materials and Methods: This is a retrospective cohort study conducted between January 2017 and December 2019. A total of 449 patients undergoing CABG were included in the study. Patients with redo operations, combined procedures, and emergency operations were excluded from the study. The groups were formed on the level of TSH (normal, subclinical elevation, and clinical elevation) as follows: TSH normal (Group 1, n = 309), TSH subclinical elevation (Group 2, n = 122), and TSH clinical elevation (Group 3, n = 12). One-way ANOVA was used to analyze the groups. Results: There was an increase in the use of inotrope, appearance of atrial fibrillation, and use of intra-aortic balloon pump in Group 3 when compared to that in Groups 1 and 2, P = 0.0001. Higher mortality was observed in group 3 (25%) when compared to group 1 (2.91%) and group 2 (2.45%). There was no difference in the level of free T4, between groups. T3 was similar in TSH normal, TSH subclinical elevation, and clinical elevation group. TSH level of >10 mIU/l predicted mortality with a sensitivity of 91.7% and a specificity of 99.8% in predicting mortality. Conclusion: About 2.67% of the patients undergoing CABG had asymptomatic but clinical elevation of TSH, and it is associated with higher mortality.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"74 1","pages":"66 - 70"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86880331","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}
K. Kumar, Joel Piedade, Venkatesh Malali, Srinidhi S. Hegde
Background: Coronary artery disease (CAD) has assumed epidemic proportions in the world. Accurate risk stratification and early invasive management when indicated can reduce morbidity and mortality substantially. The study aims to correlate left ventricular (LV) function assessed by global longitudinal strain (GLS) with the extent of CAD in patients with myocardial infarction (MI). Methods: The study was conducted in a tertiary care hospital in Southern India. A total of 105 patients admitted with a diagnosis of non ST-elevation MI were included. All patients had a detailed echocardiogram with the evaluation of LV GLS by two-dimensional speckle tracking echocardiography and ejection fraction by Simpson's method. Coronary angiogram was also done in all patients to study the coronary anatomy and the relation between CAD and LV GLS. Results: The mean age of study population was 53.9 years. Echocardiographic study revealed mean LV ejection fraction (LVEF) was 48.16 + 12.27. The mean LVEF in patients with single-vessel disease was 50.11 + 11.62; with two-vessel disease, it was 51.81 + 10.34, and in patients with triple-vessel disease, it was 41.5 + 11.8. The mean GLS in the abovementioned groups was − 15.6 + 3.33, −13.5 + 3.2, and − 11.02 + 4.14, respectively. The follow-up of patients also showed a considerably lower GLS in patients who suffered higher morbidity and mortality. Conclusion: LV GLS is a good noninvasive predictor of the burden of CAD on the angiogram and also a predictor of future cardiovascular events and mortality.
{"title":"Left ventricular global longitudinal strain by speckle tracking echocardiography as a noninvasive predictor in evaluation of myocardial infarction","authors":"K. Kumar, Joel Piedade, Venkatesh Malali, Srinidhi S. Hegde","doi":"10.4103/jicc.jicc_12_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_12_21","url":null,"abstract":"Background: Coronary artery disease (CAD) has assumed epidemic proportions in the world. Accurate risk stratification and early invasive management when indicated can reduce morbidity and mortality substantially. The study aims to correlate left ventricular (LV) function assessed by global longitudinal strain (GLS) with the extent of CAD in patients with myocardial infarction (MI). Methods: The study was conducted in a tertiary care hospital in Southern India. A total of 105 patients admitted with a diagnosis of non ST-elevation MI were included. All patients had a detailed echocardiogram with the evaluation of LV GLS by two-dimensional speckle tracking echocardiography and ejection fraction by Simpson's method. Coronary angiogram was also done in all patients to study the coronary anatomy and the relation between CAD and LV GLS. Results: The mean age of study population was 53.9 years. Echocardiographic study revealed mean LV ejection fraction (LVEF) was 48.16 + 12.27. The mean LVEF in patients with single-vessel disease was 50.11 + 11.62; with two-vessel disease, it was 51.81 + 10.34, and in patients with triple-vessel disease, it was 41.5 + 11.8. The mean GLS in the abovementioned groups was − 15.6 + 3.33, −13.5 + 3.2, and − 11.02 + 4.14, respectively. The follow-up of patients also showed a considerably lower GLS in patients who suffered higher morbidity and mortality. Conclusion: LV GLS is a good noninvasive predictor of the burden of CAD on the angiogram and also a predictor of future cardiovascular events and mortality.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"16 1","pages":"43 - 48"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87666529","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}
G. Kumar, Lakhan Parajiya, S. Avinash Pandi, V. Patel
Long-term sequelae following COVID-19 infection are not well established. Hence, COVID-19 sequelae are been studied extensively as cases are being followed up to reduce avoidable prolonged morbidity and mortality in the country. COVID-19 and currently available drugs for treatment are both reasons for a change in immune status of patients leading to reactivation or increase the chance of infection of common diseases like tuberculosis (TB), particularly in India. A case of post-COVID-19 disease (2 months back) presented with breathlessness and chest pain. On history, workup, and evaluation, the case was diagnosed with massive tubercular pericardial effusion suggesting reactivation of latent TB in a post-COVID-19 disease. Due to COVID-19 disease itself and possible immunomodulatory drugs used for treatment, reactivation of latent TB has to be considered in post-COIVD-19 disease with nonspecific presentation and unexplained prolonged clinical course of the disease. This case highlights the need of further follow-up of COVID-19 patients to understand the effects of disease on the immune system and the possibilities of opportunistic infections, especially after this second wave of COVID-19.
{"title":"Post-COVID-19 sequela: Massive tubercular pericardial effusion in immunocompromised patient","authors":"G. Kumar, Lakhan Parajiya, S. Avinash Pandi, V. Patel","doi":"10.4103/jicc.jicc_34_21","DOIUrl":"https://doi.org/10.4103/jicc.jicc_34_21","url":null,"abstract":"Long-term sequelae following COVID-19 infection are not well established. Hence, COVID-19 sequelae are been studied extensively as cases are being followed up to reduce avoidable prolonged morbidity and mortality in the country. COVID-19 and currently available drugs for treatment are both reasons for a change in immune status of patients leading to reactivation or increase the chance of infection of common diseases like tuberculosis (TB), particularly in India. A case of post-COVID-19 disease (2 months back) presented with breathlessness and chest pain. On history, workup, and evaluation, the case was diagnosed with massive tubercular pericardial effusion suggesting reactivation of latent TB in a post-COVID-19 disease. Due to COVID-19 disease itself and possible immunomodulatory drugs used for treatment, reactivation of latent TB has to be considered in post-COIVD-19 disease with nonspecific presentation and unexplained prolonged clinical course of the disease. This case highlights the need of further follow-up of COVID-19 patients to understand the effects of disease on the immune system and the possibilities of opportunistic infections, especially after this second wave of COVID-19.","PeriodicalId":100789,"journal":{"name":"Journal of Indian College of Cardiology","volume":"3 1","pages":"79 - 81"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76925252","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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