Pub Date : 2024-11-03DOI: 10.1016/j.ihj.2024.11.001
Upendra Kaul, Rishi Sethi, Sanjeeb Roy, P K Goel, Nagendra Singh Chouhan, Rajesh Vijayvergiya, Manish Narang, Priyadarshini, D K Baruah, Rony Mathew
Objectives: The prevalence of atherosclerosis and acute coronary syndrome (ACS) is increasing in young Indians (18-50 years of age). However, the characteristics of atherosclerotic plaques in such individuals are poorly understood, presenting distinct challenges for the management of ACS. This study aims to analyze plaque characteristics in young Indian patients with ACS who underwent percutaneous coronary intervention (PCI) using optical coherence tomography (OCT) imaging.
Methods: This was a prospective, multicentric, non-interventional study on patients aged 18-50 years presenting with ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction, or unstable angina, and were scheduled to undergo OCT-guided PCI. Major adverse cardiac events (MACE) were assessed post-procedure and at the 6-month and 12-month follow-ups.
Results: The study included 100 ACS patients (mean age = 43.6 ± 5.2 years), with 51% presenting with STEMI. Pre-PCI OCT assessment showed that fibrous plaques (75%) were most common followed by plaques containing macrophages (27%), microchannels (20%), and calcified nodules (14%). In addition, plaque rupture, plaque erosion, and lipid-rich plaques, along with red, white, and mixed thrombi, were observed in 31%, 25%, 24%, 21%, 14%, and 17% (total thrombus occurrence = 52%) of the patients, respectively. At 12 months, the MACE (coronary artery bypass graft) rate was 1%.
Conclusions: Young Indian patients with ACS displayed a range of plaque morphologies identified through pre-PCI OCT. Among these, fibrous plaques were the most prominent type, followed by plaques containing macrophages. Additionally, plaque rupture, plaque erosion, and lipid-rich plaques were also observed in this population.
{"title":"Morphological characterization of coronary plaques in young indian patients with acute coronary syndrome: A multicentric study.","authors":"Upendra Kaul, Rishi Sethi, Sanjeeb Roy, P K Goel, Nagendra Singh Chouhan, Rajesh Vijayvergiya, Manish Narang, Priyadarshini, D K Baruah, Rony Mathew","doi":"10.1016/j.ihj.2024.11.001","DOIUrl":"10.1016/j.ihj.2024.11.001","url":null,"abstract":"<p><strong>Objectives: </strong>The prevalence of atherosclerosis and acute coronary syndrome (ACS) is increasing in young Indians (18-50 years of age). However, the characteristics of atherosclerotic plaques in such individuals are poorly understood, presenting distinct challenges for the management of ACS. This study aims to analyze plaque characteristics in young Indian patients with ACS who underwent percutaneous coronary intervention (PCI) using optical coherence tomography (OCT) imaging.</p><p><strong>Methods: </strong>This was a prospective, multicentric, non-interventional study on patients aged 18-50 years presenting with ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction, or unstable angina, and were scheduled to undergo OCT-guided PCI. Major adverse cardiac events (MACE) were assessed post-procedure and at the 6-month and 12-month follow-ups.</p><p><strong>Results: </strong>The study included 100 ACS patients (mean age = 43.6 ± 5.2 years), with 51% presenting with STEMI. Pre-PCI OCT assessment showed that fibrous plaques (75%) were most common followed by plaques containing macrophages (27%), microchannels (20%), and calcified nodules (14%). In addition, plaque rupture, plaque erosion, and lipid-rich plaques, along with red, white, and mixed thrombi, were observed in 31%, 25%, 24%, 21%, 14%, and 17% (total thrombus occurrence = 52%) of the patients, respectively. At 12 months, the MACE (coronary artery bypass graft) rate was 1%.</p><p><strong>Conclusions: </strong>Young Indian patients with ACS displayed a range of plaque morphologies identified through pre-PCI OCT. Among these, fibrous plaques were the most prominent type, followed by plaques containing macrophages. Additionally, plaque rupture, plaque erosion, and lipid-rich plaques were also observed in this population.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583118","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 : 2024-10-11DOI: 10.1016/j.ihj.2024.10.005
Maitri M Patel, Sumantkumar G Patel, Jigar K Patel, Dhruvkumar M Patel, Poojan J Prajapati, Harsh D Patel, Jayesh S Prajapati, Lalitkumar B Patel, Mukundkumar V Patel
Consecutive suspected acute coronary syndrome (ACS) cases were categorized into three groups: Group-1 (ST-depression), Group-2 (T-inversion), and Group-3 (remaining cases). Group-3 was subclassified into isoelectric horizontal ST-segment with sharp ST-T-angle (IHST) positive and IHST negative groups. They underwent serial high-sensitive Troponin-I testing. ACS incidence was 77.96 %, with 33.02 %, 15.96 %, and (15.04 %, 35.96 %) of patients in Groups 1, 2, and 3 (IHST positive, IHST negative), respectively. The presence of IHST exhibited higher sensitivity than T-inversion and greater specificity than ST-depression in detecting ACS. The presence of IHST sign additionally detected 15.04 % of ACS. The presence of IHST was significant among group-3 (p = 0.008) as well as the overall ACS cases (p = 0.048).
{"title":"A groundbreaking electrocardiographic observation: \"Isoelectric horizontal ST-segment with sharp ST-T angle\" a novel sign for acute coronary syndrome.","authors":"Maitri M Patel, Sumantkumar G Patel, Jigar K Patel, Dhruvkumar M Patel, Poojan J Prajapati, Harsh D Patel, Jayesh S Prajapati, Lalitkumar B Patel, Mukundkumar V Patel","doi":"10.1016/j.ihj.2024.10.005","DOIUrl":"https://doi.org/10.1016/j.ihj.2024.10.005","url":null,"abstract":"<p><p>Consecutive suspected acute coronary syndrome (ACS) cases were categorized into three groups: Group-1 (ST-depression), Group-2 (T-inversion), and Group-3 (remaining cases). Group-3 was subclassified into isoelectric horizontal ST-segment with sharp ST-T-angle (IHST) positive and IHST negative groups. They underwent serial high-sensitive Troponin-I testing. ACS incidence was 77.96 %, with 33.02 %, 15.96 %, and (15.04 %, 35.96 %) of patients in Groups 1, 2, and 3 (IHST positive, IHST negative), respectively. The presence of IHST exhibited higher sensitivity than T-inversion and greater specificity than ST-depression in detecting ACS. The presence of IHST sign additionally detected 15.04 % of ACS. The presence of IHST was significant among group-3 (p = 0.008) as well as the overall ACS cases (p = 0.048).</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464240","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}
Aim: To identify incidence, type of drug abuse study clinical and angiographic profile in very young population presenting with acute coronary syndrome (ACS).
Materials and methods: All consecutive patients less than 30 years with ACS included and segregated into Group 1 and 2 (with and without drug abuse respectively) RESULT: n = 153; n = 17 in group 1 of whom 35.29 % consumed opium, 17.64 % energy drinks, 17.64 % whey protein supplements, 17.64 % inhaled marijuana, 5.88 % heroin and spasmoproxyvon and 23.52 % multi-substance abusers. STEMI, Single vessel disease and urban domicile were predominant. Rising trends of drug abuse were identified in prospective (28.20 %) versus retrospective (5.30 %) timeframe (p = 0.011).
Conclusion: Rising trends of drug abuse, a potentially modifiable risk factor of ACS in the young are alarming. Strict regulations are needed to curb this menace.
{"title":"Drug abuse and ACS in the very young (less than 30 years): Demographic, clinical and angiographic profile.","authors":"Shibba Takkar Chhabra, Gurleen Kaur, Samir Kapoor, Aastha Kapila, Gagandeep Kaur, Prannav Jain, Pankaj Kumar, Namita Bansal, Mamta Bansal, Anshuman Gupta, Akash Batta, Gautam Singal, Abhishek Goyal, Rohit Tandon, Naved Aslam, Bishav Mohan, Gurpreet Singh Wander","doi":"10.1016/j.ihj.2024.10.003","DOIUrl":"https://doi.org/10.1016/j.ihj.2024.10.003","url":null,"abstract":"<p><strong>Aim: </strong>To identify incidence, type of drug abuse study clinical and angiographic profile in very young population presenting with acute coronary syndrome (ACS).</p><p><strong>Materials and methods: </strong>All consecutive patients less than 30 years with ACS included and segregated into Group 1 and 2 (with and without drug abuse respectively) RESULT: n = 153; n = 17 in group 1 of whom 35.29 % consumed opium, 17.64 % energy drinks, 17.64 % whey protein supplements, 17.64 % inhaled marijuana, 5.88 % heroin and spasmoproxyvon and 23.52 % multi-substance abusers. STEMI, Single vessel disease and urban domicile were predominant. Rising trends of drug abuse were identified in prospective (28.20 %) versus retrospective (5.30 %) timeframe (p = 0.011).</p><p><strong>Conclusion: </strong>Rising trends of drug abuse, a potentially modifiable risk factor of ACS in the young are alarming. Strict regulations are needed to curb this menace.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464241","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 : 2024-10-10DOI: 10.1016/j.ihj.2024.10.001
Parag Barwad, Navjyot Kaur, Bhupendra K Sihag, Sanjeev H Naganur
Introduction: Difficult coronary sinus (CS) anatomy may lead to difficulty in optimal left ventricular (LV) lead placement and lead displacements leading to nonresponse to cardiac resynchronization therapy (CRT).
Methods: In this retrospective study, we studied the CRT parameters of devices implanted by single operator during the time period from January 2014 till December 2021, where different off-label techniques were used to place/stabilize LV lead. The technique used to stabilize LV lead, CRT parameters at baseline and follow up were noted for each patient.
Results: Out of 133 CRTs implanted during the study period, 23 patients (17.29 %) required off-label techniques. Stylet and guidewire retaining techniques were used in 11/23 (47.82 %) and 7/23 (30.43 %) patients respectively. In two patients, LV lead was jailed using coronary stent to prevent displacement. Two patients had CS stenosis and required balloon dilation while one patient had tortuous posterolateral vein which was straightened using a coronary stent. There was technical failure of 6/23 LV leads (26.08 %) with loss of capture, at a median follow up of 44 months (Range: 06-114 months). Out of these 6 patients, stylet and guidewire retaining techniques were used in 4 and 2 patients respectively.
Conclusion: Despite having acceptable parameters at implantation, these techniques particularly stylet and guidewire retention, may lead to non-capture of LV lead on long term follow ups. Better LV leads like active fixation leads and conduction system pacing (His Bundle/left bundle branch pacing) should be preferred in difficult CS anatomy.
{"title":"Long-term outcome of variety of techniques used to stabilize left ventricular lead in difficult coronary sinus anatomy- A single centre experience.","authors":"Parag Barwad, Navjyot Kaur, Bhupendra K Sihag, Sanjeev H Naganur","doi":"10.1016/j.ihj.2024.10.001","DOIUrl":"10.1016/j.ihj.2024.10.001","url":null,"abstract":"<p><strong>Introduction: </strong>Difficult coronary sinus (CS) anatomy may lead to difficulty in optimal left ventricular (LV) lead placement and lead displacements leading to nonresponse to cardiac resynchronization therapy (CRT).</p><p><strong>Methods: </strong>In this retrospective study, we studied the CRT parameters of devices implanted by single operator during the time period from January 2014 till December 2021, where different off-label techniques were used to place/stabilize LV lead. The technique used to stabilize LV lead, CRT parameters at baseline and follow up were noted for each patient.</p><p><strong>Results: </strong>Out of 133 CRTs implanted during the study period, 23 patients (17.29 %) required off-label techniques. Stylet and guidewire retaining techniques were used in 11/23 (47.82 %) and 7/23 (30.43 %) patients respectively. In two patients, LV lead was jailed using coronary stent to prevent displacement. Two patients had CS stenosis and required balloon dilation while one patient had tortuous posterolateral vein which was straightened using a coronary stent. There was technical failure of 6/23 LV leads (26.08 %) with loss of capture, at a median follow up of 44 months (Range: 06-114 months). Out of these 6 patients, stylet and guidewire retaining techniques were used in 4 and 2 patients respectively.</p><p><strong>Conclusion: </strong>Despite having acceptable parameters at implantation, these techniques particularly stylet and guidewire retention, may lead to non-capture of LV lead on long term follow ups. Better LV leads like active fixation leads and conduction system pacing (His Bundle/left bundle branch pacing) should be preferred in difficult CS anatomy.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406377","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 : 2024-10-09DOI: 10.1016/j.ihj.2024.10.006
Rajesh Kumar, Naveed Ullah Khan, Ayaz Mir, Khalid Naseeb, Gulzar Ali, Arti Ashok, Mukesh Kumar, Abiha Urooj, Uroosa Safdar, Aisha Hussain, Muhammad Ishaq, Tahir Saghir, Jawaid Akbar Sial, Abdul Hakeem, Musa Karim
Background: Limited data exist on the role of coronary collaterals circulation (CCC) in patients with ST-elevation acute coronary syndrome (STE-ACS). This study aimed to assess CCC and the in-hospital course of patients with CCC undergoing primary percutaneous coronary intervention (pPCI).
Methods: The study included consecutive STE-ACS patients undergoing pPCI. Good CCC was defined as Rentrop collateral score (RCS) of 2-3. Patients with good and poor CCC were compared regarding clinical characteristics, angiographic patterns, and hospital course.
Results: In the sample of 4683 patients, mean age was 55.6 ± 11 years, and 78.8 % were male. Good CCC was observed in 499 (10.7 %) patients. The rate of intra-procedure slow-flow/no-reflow (SF/NR) was 29.9 % vs. 20.5 % (p < 0.001), and the rate of composite adverse clinical outcomes (CACO) was 21.2 % vs. 19 % (p = 0.225) for patients with good and poor CCC, respectively. Multivariable analysis identified left ventricular end-diastolic pressure (LVEDP), multi-vessel disease (MVD), and thrombus grade ≥4 as independent predictors of good CCC, with adjusted odds ratios of 0.98 [0.97-0.99], 1.69 [1.35-2.10], and 3.45 [2.64-4.52], respectively. In propensity-matched cohorts, the intra-procedure SF/NR rate was 29.9 % vs. 26.9 % (p = 0.292), and the rate of CACO was 21.2 % vs. 23.4 % (p = 0.403) for patients with good and poor CCC, respectively.
Conclusion: Angiographic evidence of good CCC in STE-ACS patients was limited. Good CCC was associated with a higher prevalence of MVD, high thrombus burden, and low pre-procedure LVEDP, resulting in a higher incidence of intra-procedure SF/NR. However, the CACO did not differ significantly between patients with good and poor CCC.
{"title":"Do collaterals to infarct bed in STE-ACS patients undergoing emergent percutaneous coronary revascularization matter? An assessment of a prospective pool for in-hospital course.","authors":"Rajesh Kumar, Naveed Ullah Khan, Ayaz Mir, Khalid Naseeb, Gulzar Ali, Arti Ashok, Mukesh Kumar, Abiha Urooj, Uroosa Safdar, Aisha Hussain, Muhammad Ishaq, Tahir Saghir, Jawaid Akbar Sial, Abdul Hakeem, Musa Karim","doi":"10.1016/j.ihj.2024.10.006","DOIUrl":"10.1016/j.ihj.2024.10.006","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist on the role of coronary collaterals circulation (CCC) in patients with ST-elevation acute coronary syndrome (STE-ACS). This study aimed to assess CCC and the in-hospital course of patients with CCC undergoing primary percutaneous coronary intervention (pPCI).</p><p><strong>Methods: </strong>The study included consecutive STE-ACS patients undergoing pPCI. Good CCC was defined as Rentrop collateral score (RCS) of 2-3. Patients with good and poor CCC were compared regarding clinical characteristics, angiographic patterns, and hospital course.</p><p><strong>Results: </strong>In the sample of 4683 patients, mean age was 55.6 ± 11 years, and 78.8 % were male. Good CCC was observed in 499 (10.7 %) patients. The rate of intra-procedure slow-flow/no-reflow (SF/NR) was 29.9 % vs. 20.5 % (p < 0.001), and the rate of composite adverse clinical outcomes (CACO) was 21.2 % vs. 19 % (p = 0.225) for patients with good and poor CCC, respectively. Multivariable analysis identified left ventricular end-diastolic pressure (LVEDP), multi-vessel disease (MVD), and thrombus grade ≥4 as independent predictors of good CCC, with adjusted odds ratios of 0.98 [0.97-0.99], 1.69 [1.35-2.10], and 3.45 [2.64-4.52], respectively. In propensity-matched cohorts, the intra-procedure SF/NR rate was 29.9 % vs. 26.9 % (p = 0.292), and the rate of CACO was 21.2 % vs. 23.4 % (p = 0.403) for patients with good and poor CCC, respectively.</p><p><strong>Conclusion: </strong>Angiographic evidence of good CCC in STE-ACS patients was limited. Good CCC was associated with a higher prevalence of MVD, high thrombus burden, and low pre-procedure LVEDP, resulting in a higher incidence of intra-procedure SF/NR. However, the CACO did not differ significantly between patients with good and poor CCC.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400147","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 : 2024-10-09DOI: 10.1016/j.ihj.2024.10.002
Deep Dutta, Kunal Mahajan, Lokesh Verma, Gunjan Gupta, Meha Sharma
Background: Gender differences in acute coronary syndrome (ACS) outcomes have been noted in global data, which however did not analyse Indian data. No prior systematic review and meta-analysis (SRM) has addressed this important aspect of gender bias in Indian women with ACS. Hence this SRM aimed to address this knowledge gap.
Methods: Electronic databases were searched for studies in ACS comparing cardiovascular disease presentation, treatment received and outcomes in women and men from India. Primary outcomes were to evaluate gender-differences in 30-day death and major adverse cardiovascular events (MACE). Secondary outcomes were to evaluate gender-differences in presentation, management and mortality. The SRM is registered with PROSPERO (CRD42023477286).
Results: From initially screened 3753 articles, data from 9 studies (61,185 patients) were analysed. Women with ACS had higher prevalence of diabetes [Odds ratio (OR) 1.65(95%CI:1.33-2.04); p < 0.001; I2 = 95 %] and hypertension [OR2.06(95%CI:1.88-2.25); p < 0.001; I2 = 42 %]. Smoking was significantly lower in women [OR 0.05(95%CI:0.03-0.07); p < 0.001; I2 = 87 %]. Non-ST elevation myocardial infarction (NSTEMI) was significantly higher in women [OR 1.92(95%CI:1.66-2.21); p < 0.001; I2 = 0 %]. Diagnostic angiography [OR 0.64(95%CI:0.56-0.74); p < 0.001; I2 = 46 %] and percutaneous coronary interventions [OR0.71(95%CI:0.55-0.92); p = 0.01; I2 = 92 %] were significantly lower in women. Women had significantly higher 30-day mortality [Hazard ratio (HR)2.26(95%CI:2.01-2.55); p < 0.001; I2 = 6 %], 1-year mortality [HR2.41(95%CI:1.89-3.07); p < 0.001; I2 = 53 %], in-hospital death [HR1.88(95%CI:1.19-2.96); p = 0.007; I2 = 92 %], stroke [HR 1.84 (95%CI:1.34-2.52); p < 0.001; I2 = 0 %] and MACE outcomes [OR 2.05 (95%CI:1.78-2.35); p < 0.001]. Use of aspirin, clopidogrel, beta-blockers and nitrates were significantly lower in women.
Conclusion: Our study highlights worse outcomes in Indian women with ACS. Higher burden of diabetes and hypertension, decreased used of PCI and lesser aggressive pharmacotherapy may be some of the contributing factors.
{"title":"Gender differences in the management and outcomes of acute coronary syndrome in indians: A systematic review and meta-analysis.","authors":"Deep Dutta, Kunal Mahajan, Lokesh Verma, Gunjan Gupta, Meha Sharma","doi":"10.1016/j.ihj.2024.10.002","DOIUrl":"10.1016/j.ihj.2024.10.002","url":null,"abstract":"<p><strong>Background: </strong>Gender differences in acute coronary syndrome (ACS) outcomes have been noted in global data, which however did not analyse Indian data. No prior systematic review and meta-analysis (SRM) has addressed this important aspect of gender bias in Indian women with ACS. Hence this SRM aimed to address this knowledge gap.</p><p><strong>Methods: </strong>Electronic databases were searched for studies in ACS comparing cardiovascular disease presentation, treatment received and outcomes in women and men from India. Primary outcomes were to evaluate gender-differences in 30-day death and major adverse cardiovascular events (MACE). Secondary outcomes were to evaluate gender-differences in presentation, management and mortality. The SRM is registered with PROSPERO (CRD42023477286).</p><p><strong>Results: </strong>From initially screened 3753 articles, data from 9 studies (61,185 patients) were analysed. Women with ACS had higher prevalence of diabetes [Odds ratio (OR) 1.65(95%CI:1.33-2.04); p < 0.001; I<sup>2</sup> = 95 %] and hypertension [OR2.06(95%CI:1.88-2.25); p < 0.001; I<sup>2</sup> = 42 %]. Smoking was significantly lower in women [OR 0.05(95%CI:0.03-0.07); p < 0.001; I<sup>2</sup> = 87 %]. Non-ST elevation myocardial infarction (NSTEMI) was significantly higher in women [OR 1.92(95%CI:1.66-2.21); p < 0.001; I<sup>2</sup> = 0 %]. Diagnostic angiography [OR 0.64(95%CI:0.56-0.74); p < 0.001; I<sup>2</sup> = 46 %] and percutaneous coronary interventions [OR0.71(95%CI:0.55-0.92); p = 0.01; I<sup>2</sup> = 92 %] were significantly lower in women. Women had significantly higher 30-day mortality [Hazard ratio (HR)2.26(95%CI:2.01-2.55); p < 0.001; I<sup>2</sup> = 6 %], 1-year mortality [HR2.41(95%CI:1.89-3.07); p < 0.001; I<sup>2</sup> = 53 %], in-hospital death [HR1.88(95%CI:1.19-2.96); p = 0.007; I<sup>2</sup> = 92 %], stroke [HR 1.84 (95%CI:1.34-2.52); p < 0.001; I<sup>2</sup> = 0 %] and MACE outcomes [OR 2.05 (95%CI:1.78-2.35); p < 0.001]. Use of aspirin, clopidogrel, beta-blockers and nitrates were significantly lower in women.</p><p><strong>Conclusion: </strong>Our study highlights worse outcomes in Indian women with ACS. Higher burden of diabetes and hypertension, decreased used of PCI and lesser aggressive pharmacotherapy may be some of the contributing factors.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400148","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: Lipids play key role in coronary atherosclerosis. The role of non-high-density lipoprotein cholesterol (non-HDL-C) in atherosclerotic plaques using intravascular imaging remains unclear. This study aimed to assess its relationship with coronary plaque features using intravascular ultrasound (IVUS) in acute coronary syndrome (ACS).
Methods: A total of 601 patients divided into two groups: normal non-HDL-C≤130 mg/dl (n = 410) and high non-HDL cholesterol >130 mg/dl (n = 191). IVUS performed before coronary intervention.
Results: Mean age 53.18 ± 12.29 years. No significant differences in hypertension, diabetes, and smoking between groups. Plaque burden was significantly higher among normal versus high non-HDL-C groups (79.59 ± 9.98 % vs. 81.61 ± 5.39 %; p = 0.001). At minimal luminal site, fibrofatty percentage was higher in normal non-HDL-C group (p = 0.027), while necrotic core greater in high non-HDL-C group (p = 0.033). Segmental analysis, necrotic core was significantly higher in percentage (p = 0.006) and volumes (p = 0.011) in normal versus high non-HDL-C groups. Total cholesterol (r = 0.099, p = 0.015), LDL-C (r = 0.081, p = 0.046), triglycerides (r = 0.083, p = 0.041),and non-HDL-C (r = 0.099, p = 0.015) positively correlated with plaque burden. Total cholesterol (r = 0.115, p = 0.005), LDL-C (r = 0.107, p = 0.009), and non-HDL-C (r = 0.105, p = 0.010) positively correlated with necrotic core volume. Linear regression analysis showed age and non-HDL-C as predictors of higher plaque burden. Multiple linear regression analysis; age, body mass index, and non-HDL-C were predictors of larger necrotic core volume.
Conclusion: Non-HDL-C levels were positively associated with plaque burden, measure of extent of atherosclerosis. It is closely associated with and is a predictor of necrotic core volume; a marker of plaque vulnerability. This IVUS study demonstrates potential role of non-HDL-C in causation of plaque in ACS.
目的:血脂在冠状动脉粥样硬化中起着关键作用。利用血管内成像技术,非高密度脂蛋白胆固醇(non-HDL-C)在动脉粥样硬化斑块中的作用仍不清楚。本研究旨在使用血管内超声(IVUS)评估非高密度脂蛋白胆固醇与急性冠状动脉综合征(ACS)冠状动脉斑块特征的关系:共有 601 名患者,分为两组:非高密度脂蛋白胆固醇正常值≤130 毫克/分升(410 人)和非高密度脂蛋白胆固醇高值>130 毫克/分升(191 人)。冠状动脉介入治疗前进行 IVUS:平均年龄(53.18±12.29)岁。各组之间在高血压、糖尿病和吸烟方面无明显差异。非高密度脂蛋白胆固醇正常组和高非高密度脂蛋白胆固醇组的斑块负荷明显更高(79.59±9.98% vs. 81.61±5.39%;P=0.001)。在最小管腔部位,非高密度脂蛋白胆固醇正常组的纤维脂肪比例更高(P=0.027),而非高密度脂蛋白胆固醇高组的坏死核心更高(P=0.033)。分段分析显示,非高密度脂蛋白胆固醇正常组和高非高密度脂蛋白胆固醇组坏死核心的百分比(p=0.006)和体积(p=0.011)均明显高于非高密度脂蛋白胆固醇高组。总胆固醇(r=0.099,p=0.015)、低密度脂蛋白胆固醇(r=0.081,p=0.046)、甘油三酯(r=0.083,p=0.041)和非高密度脂蛋白胆固醇(r=0.099,p=0.015)与斑块负荷呈正相关。总胆固醇(r=0.115,p=0.005)、低密度脂蛋白胆固醇(r=0.107,p=0.009)和非高密度脂蛋白胆固醇(r=0.105,p=0.010)与坏死核心体积呈正相关。线性回归分析显示,年龄和非高密度脂蛋白胆固醇是较高斑块负荷的预测因素。多元线性回归分析显示,年龄、体重指数和非高密度脂蛋白胆固醇是预测较大坏死核心体积的因素:结论:非高密度脂蛋白胆固醇水平与衡量动脉粥样硬化程度的斑块负荷呈正相关。结论:非高密度脂蛋白胆固醇水平与斑块负荷正相关,斑块负荷是衡量动脉粥样硬化程度的指标,非高密度脂蛋白胆固醇水平与坏死核心体积密切相关,是预测坏死核心体积的指标;坏死核心体积是斑块脆弱性的标志。这项IVUS研究证明了非高密度脂蛋白胆固醇在ACS斑块成因中的潜在作用。
{"title":"Association of non-HDL cholesterol with plaque burden and composition of culprit lesion in acute coronary syndrome. An intravascular ultrasound-virtual histology study.","authors":"Sreenivas Reddy, Raghavendra Rao K, Jeet Ram Kashyap, Vikas Kadiyala, Suraj Kumar, Debabrata Dash, Lipi Uppal, Jaspreet Kaur, Manpreet Kaur, Hithesh Reddy, Imran Ibni Gani Rather, Samir Malhotra","doi":"10.1016/j.ihj.2024.10.004","DOIUrl":"10.1016/j.ihj.2024.10.004","url":null,"abstract":"<p><strong>Objective: </strong>Lipids play key role in coronary atherosclerosis. The role of non-high-density lipoprotein cholesterol (non-HDL-C) in atherosclerotic plaques using intravascular imaging remains unclear. This study aimed to assess its relationship with coronary plaque features using intravascular ultrasound (IVUS) in acute coronary syndrome (ACS).</p><p><strong>Methods: </strong>A total of 601 patients divided into two groups: normal non-HDL-C≤130 mg/dl (n = 410) and high non-HDL cholesterol >130 mg/dl (n = 191). IVUS performed before coronary intervention.</p><p><strong>Results: </strong>Mean age 53.18 ± 12.29 years. No significant differences in hypertension, diabetes, and smoking between groups. Plaque burden was significantly higher among normal versus high non-HDL-C groups (79.59 ± 9.98 % vs. 81.61 ± 5.39 %; p = 0.001). At minimal luminal site, fibrofatty percentage was higher in normal non-HDL-C group (p = 0.027), while necrotic core greater in high non-HDL-C group (p = 0.033). Segmental analysis, necrotic core was significantly higher in percentage (p = 0.006) and volumes (p = 0.011) in normal versus high non-HDL-C groups. Total cholesterol (r = 0.099, p = 0.015), LDL-C (r = 0.081, p = 0.046), triglycerides (r = 0.083, p = 0.041),and non-HDL-C (r = 0.099, p = 0.015) positively correlated with plaque burden. Total cholesterol (r = 0.115, p = 0.005), LDL-C (r = 0.107, p = 0.009), and non-HDL-C (r = 0.105, p = 0.010) positively correlated with necrotic core volume. Linear regression analysis showed age and non-HDL-C as predictors of higher plaque burden. Multiple linear regression analysis; age, body mass index, and non-HDL-C were predictors of larger necrotic core volume.</p><p><strong>Conclusion: </strong>Non-HDL-C levels were positively associated with plaque burden, measure of extent of atherosclerosis. It is closely associated with and is a predictor of necrotic core volume; a marker of plaque vulnerability. This IVUS study demonstrates potential role of non-HDL-C in causation of plaque in ACS.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400146","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: The study assessed Global longitudinal strain imaging (GLS) to detect subtle myocardial dysfunction among patients clinically recovered from COVID-19.
Methods: All patients (n = 101 76 % males, mean age 55.45 ± 11.14 years), and controls (n = 30), underwent clinical assessment and echocardiography, including GLS assessment.
Results: The prevalence of diabetes mellitus, hypertension and dyslipidemia was comparable amongst patients and controls. The average GLS was significantly lesser in post COVID patients (-16.21 ± 1.96 vs -18.49 ± 1.64 respectively, p = 0.004) and significantly higher proportion of post COVID patients had GLS > -18 % (43 % vs 22.58 % respectively, p = 0.001) as compared to controls. The RV free wall longitudinal strain (RVFLS) was also lower in the patient group (22.35 ± 4.69 vs 24.19 ± 4.11, p = 0.004) and 21.7 % post COVID-19 patients had pathological RV FWLS (> -20 %) vs controls (6.6 %). Average GLS was significantly lesser in severe post COVID patients (viz -14.25 ± 1.92 vs -16.63 ± 1.61 vs -17.63 ± 1.91, p < 0.0001, respectively among severe, moderate and mild COVID-19 patients. On performing regression analysis, severity of COVID-19 (OR 7.762) was a significant predictor of impaired GLS.
Conclusion: Despite normal global LVEF, post COVID-19 recovered patients had significantly lower LV GLS and RV FWLS with severe COVID-19 infection, regardless of having a clinical recovery. This study reiterates the importance of speckle tracking echocardiography as an important imaging modality for detection of subclinical myocardial dysfunction in the post COVID-19 recovered patients.
{"title":"Use of strain imaging to detect subtle myocardial involvement in post COVID-19 patients: An Indian perspective.","authors":"Deepak Tomar, Aditya Kapoor, Zia Hashim, Kamlesh Raut, Arpita Katheria, Harshit Khare, Ankit Sahu, Roopali Khanna, Sudeep Kumar, Naveen Garg, Satyendra Tewari","doi":"10.1016/j.ihj.2024.09.003","DOIUrl":"10.1016/j.ihj.2024.09.003","url":null,"abstract":"<p><strong>Background: </strong>The study assessed Global longitudinal strain imaging (GLS) to detect subtle myocardial dysfunction among patients clinically recovered from COVID-19.</p><p><strong>Methods: </strong>All patients (n = 101 76 % males, mean age 55.45 ± 11.14 years), and controls (n = 30), underwent clinical assessment and echocardiography, including GLS assessment.</p><p><strong>Results: </strong>The prevalence of diabetes mellitus, hypertension and dyslipidemia was comparable amongst patients and controls. The average GLS was significantly lesser in post COVID patients (-16.21 ± 1.96 vs -18.49 ± 1.64 respectively, p = 0.004) and significantly higher proportion of post COVID patients had GLS > -18 % (43 % vs 22.58 % respectively, p = 0.001) as compared to controls. The RV free wall longitudinal strain (RVFLS) was also lower in the patient group (22.35 ± 4.69 vs 24.19 ± 4.11, p = 0.004) and 21.7 % post COVID-19 patients had pathological RV FWLS (> -20 %) vs controls (6.6 %). Average GLS was significantly lesser in severe post COVID patients (viz -14.25 ± 1.92 vs -16.63 ± 1.61 vs -17.63 ± 1.91, p < 0.0001, respectively among severe, moderate and mild COVID-19 patients. On performing regression analysis, severity of COVID-19 (OR 7.762) was a significant predictor of impaired GLS.</p><p><strong>Conclusion: </strong>Despite normal global LVEF, post COVID-19 recovered patients had significantly lower LV GLS and RV FWLS with severe COVID-19 infection, regardless of having a clinical recovery. This study reiterates the importance of speckle tracking echocardiography as an important imaging modality for detection of subclinical myocardial dysfunction in the post COVID-19 recovered patients.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371740","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 : 2024-09-28DOI: 10.1016/j.ihj.2024.09.002
Sai Satish, Vijayakumar Subban, Yerramareddy Vijayachandra, Abraham Oomman, Ganapathy Arumugam, Hemalatha Senthil, Hema Kethavath, Kamala Devi Pulindram, Saibal Kar, Susheel Kodali, Krishnaswamy Chandrasekaran
Objective: To evaluate the outcomes of transcatheter edge-to-edge repair (TEER) with MitraClip™ (Abbott Vascular) in symptomatic high surgical risk Indian patients with significant mitral regurgitation (MR).
Methods: Patients with moderately severe or severe primary or secondary MR and deemed high surgical risk were treated with MitraClip™. The data were collected retrospectively from medical records. The primary outcome was technical success, and secondary outcomes were ≤2+ MR reduction and improvement in functional capacity at 30 days.
Results: Between November 2018 and August 2023, 64 patients were treated with MitraClipTM. The mean age was 70.0 ± 12.1 years and 64 % were males. The mean EuroScore II and STS score predicted mortality for mitral valve repair were 5.8 ± 4.5 % and 4.0 ± 3.8 % respectively. MR etiology was primary in 56.3 %, secondary in 40.6 % and mixed in 3.1 %. The device was implanted successfully in all but one patient with technical success rate of 98.4 %. The average number of clips per patient was 1.5 ± 0.6 and 42.2 % patients received more than one clip. The mean mitral valve gradient was 3.5 ± 1.6 mmHg. The MR severity of ≤2+ was achieved in 91.8 % of the subjects and similar proportion were in New York Heart Association Functional Class I or II at 30 days.
Conclusion: In high-risk Indian patients with symptomatic significant MR, TEER with MitraClip™ was achieved with a high technical success rate. It was associated with significant reduction in MR severity and improvement in functional capacity in >90 % of the subjects.
{"title":"Outcomes of mitral transcatheter edge to edge repair with MitraClip™ - An Indian single center experience.","authors":"Sai Satish, Vijayakumar Subban, Yerramareddy Vijayachandra, Abraham Oomman, Ganapathy Arumugam, Hemalatha Senthil, Hema Kethavath, Kamala Devi Pulindram, Saibal Kar, Susheel Kodali, Krishnaswamy Chandrasekaran","doi":"10.1016/j.ihj.2024.09.002","DOIUrl":"10.1016/j.ihj.2024.09.002","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the outcomes of transcatheter edge-to-edge repair (TEER) with MitraClip™ (Abbott Vascular) in symptomatic high surgical risk Indian patients with significant mitral regurgitation (MR).</p><p><strong>Methods: </strong>Patients with moderately severe or severe primary or secondary MR and deemed high surgical risk were treated with MitraClip™. The data were collected retrospectively from medical records. The primary outcome was technical success, and secondary outcomes were ≤2+ MR reduction and improvement in functional capacity at 30 days.</p><p><strong>Results: </strong>Between November 2018 and August 2023, 64 patients were treated with MitraClip<sup>TM</sup>. The mean age was 70.0 ± 12.1 years and 64 % were males. The mean EuroScore II and STS score predicted mortality for mitral valve repair were 5.8 ± 4.5 % and 4.0 ± 3.8 % respectively. MR etiology was primary in 56.3 %, secondary in 40.6 % and mixed in 3.1 %. The device was implanted successfully in all but one patient with technical success rate of 98.4 %. The average number of clips per patient was 1.5 ± 0.6 and 42.2 % patients received more than one clip. The mean mitral valve gradient was 3.5 ± 1.6 mmHg. The MR severity of ≤2+ was achieved in 91.8 % of the subjects and similar proportion were in New York Heart Association Functional Class I or II at 30 days.</p><p><strong>Conclusion: </strong>In high-risk Indian patients with symptomatic significant MR, TEER with MitraClip™ was achieved with a high technical success rate. It was associated with significant reduction in MR severity and improvement in functional capacity in >90 % of the subjects.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345934","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}
Transfemoral Trans-catheter Aortic Valve Replacement (TF-TAVR) is a safe alternative to surgical aortic valve replacement (SAVR). Protamine is used to reverse heparin and reduce post-TAVR bleeding, but concerns about risks like valve thrombosis and stroke remain. This systematic review and meta-analysis, following PRISMA guidelines, found no statistically significant difference in major bleeding complications between the protamine and control groups [(3.0 % vs. 14.4 %); RR: 0.56; P = 0.16]. No differences were noted in life-threatening bleeding, blood transfusions, 30-day mortality, or stroke. Protamine appears safe post-TAVR without increasing stroke risk, but its effectiveness in reducing bleeding needs further investigation through a multicentric randomized study.
经口经导管主动脉瓣置换术(TF-TAVR)是外科主动脉瓣置换术(SAVR)的安全替代方案。原胺用于逆转肝素并减少TAVR术后出血,但对瓣膜血栓和中风等风险的担忧依然存在。这项系统回顾和荟萃分析遵循了 PRISMA 指南,发现在大出血并发症方面,丙胺组和对照组之间没有统计学意义上的显著差异[(3.0 % vs. 14.4 %);RR:0.56;P = 0.16]。在危及生命的出血、输血、30 天死亡率或中风方面没有差异。TAVR术后使用普罗胺似乎是安全的,不会增加中风风险,但其减少出血的效果还需要通过多中心随机研究进行进一步调查。
{"title":"Safety and efficacy of protamine after transcatheter aortic valve replacement.","authors":"Lakshmi Durga Kumaraguruparan, Asuwin Anandaram, Kamalakkannan G Sambandam, Yogapriya Chidambaram, Bharath Raj Kidambi, Gautam Ganesan Karthikeyan, Madhesh Kasi, Rizwan Suliankatchi Abdulkader, Sankaran Ramesh, Vadivelu Ramalingam, Ravindran Rajendran, Nagendra Boopathy Senguttuvan","doi":"10.1016/j.ihj.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.ihj.2024.09.001","url":null,"abstract":"<p><p>Transfemoral Trans-catheter Aortic Valve Replacement (TF-TAVR) is a safe alternative to surgical aortic valve replacement (SAVR). Protamine is used to reverse heparin and reduce post-TAVR bleeding, but concerns about risks like valve thrombosis and stroke remain. This systematic review and meta-analysis, following PRISMA guidelines, found no statistically significant difference in major bleeding complications between the protamine and control groups [(3.0 % vs. 14.4 %); RR: 0.56; P = 0.16]. No differences were noted in life-threatening bleeding, blood transfusions, 30-day mortality, or stroke. Protamine appears safe post-TAVR without increasing stroke risk, but its effectiveness in reducing bleeding needs further investigation through a multicentric randomized study.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345935","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}