Indian heart journal最新文献

Background: Sotatercept, a first-in-class activin signaling inhibitor, represents a paradigm shift in pulmonary arterial hypertension (PAH) by directly targeting pulmonary vascular remodeling. We conducted a meta-analysis of randomized controlled trials (RCTs) to quantify its efficacy and safety.

Methods: We systematically searched PubMed, Embase, and Cochrane Central from inception to October 2025 for RCTs comparing sotatercept with placebo in PAH. The primary outcome was trial-defined clinical worsening (CW). Secondary outcomes included all-cause mortality, multicomponent improvement (MCI), attainment of low-risk status, serious adverse events (SAEs), and bleeding. Data were pooled using a Mantel-Haenszel random-effects model. Risk of bias was assessed with RoB 2.0, certainty of evidence using GRADE, and trial sequential analysis (TSA) was performed to assess conclusiveness.

Results: Four RCTs comprising 921 patients (sotatercept n = 483; placebo n = 438) were included. Sotatercept significantly reduced clinical worsening (OR 0.18, 95 % CI 0.12-0.27) with minimal heterogeneity and TSA-confirmed conclusiveness. All-cause mortality showed a favorable but non-significant trend (OR 0.63, 95 % CI 0.33-1.20). Sotatercept significantly increased MCI (OR 4.68, 95 % CI 1.94-11.31) and attainment of low-risk status (OR 2.77, 95 % CI 1.49-5.17), with moderate heterogeneity. SAEs were reduced (OR 0.72, 95 % CI 0.53-0.99), while bleeding risk was increased, predominantly minor mucocutaneous events (OR 2.84, 95 % CI 1.94-4.15).

Conclusion: Sotatercept markedly reduces clinical worsening and improves multidimensional outcomes in PAH with an acceptable safety profile, supporting its role as a disease-modifying therapy.

Introduction: Systemic hypertension is a major contributor to global cardiovascular morbidity and mortality. Effective management combines pharmacological and lifestyle interventions. Pranayama, a yogic breathing technique, may modulate cardiovascular function, but its impact on hypertension remains uncertain.

Methods: A systematic review and meta-analysis following PRISMA guidelines (PROSPERO: CRD42024597502) included RCTs from PubMed, Cochrane Library, Scopus, and ClinicalTrials.gov up to April 2025. We assessed Risk of bias using Cochrane RoB 2, and pooled effects were reported as standardized mean differences (SMDs) with 95 % confidence intervals (CIs).

Results: Seven RCTs (683 participants) showed a significant reduction in the primary outcome, heart rate (SMD = -0.43; 95 % CI: -0.52 to -0.34; I² = 0 %). Systolic BP decreased significantly under fixed-effects (SMD = -0.72), while diastolic BP and HRV improvements were modest.

Conclusion: Pranayama lowers heart rate and may modestly reduce blood pressure, supporting its role as a safe, adjunctive therapy pending larger standardized trials.

Background: Management of late presenters with cyanotic congenital heart disease (CCHD) and reduced pulmonary blood flow is challenged by multi-system derangements from longstanding hypoxia in addition to anatomic factors. Balloon pulmonary valvuloplasty (BPV) is a potentially viable palliative option for selected patients with severely stenotic pulmonary valve and are unsuitable for definitive surgical repair METHODS: A retrospective chart review was conducted (2002-2024, age >12 years). BPV was considered for those with a significant component of valvular pulmonary stenosis (PS) on echocardiography. A strategy of stepwise dilation using progressively larger balloon sizes, andmonitoring pulmonary artery pressures between each dilation, was adapted.

Results: Thirty patients [TOF (n = 13), DORV/DILV (n = 7/2), single ventricle/Unbalanced AVCD (n = 3), and corrected transposition (n = 5)] with median age: 20.5 years (IQR: 14.0-26.8), weight: 49 kg (IQR: 44.1-57.7) underwent BPV. The fluoroscopy and procedure times were 17.8 min (IQR:12.7-25.7) and 71 ± 26 min (mean ± SD), respectively. The balloon-to-annulus ratio was 1.01 (0.96-1.2). Saturation improved significantly from 76.7 ± 9.6 % to 90.2 ± 4.4 %. Complications included transient arrhythmias in five patients and fatal re-perfusion pulmonary edema during repeat BPV in one. At a median follow-up of 51 months (IQR: 26.75-139.25 months), majority of patients demonstrated sustained symptomatic relief. Seven patients underwent corrective surgery, and four required repeat BPV.

Conclusion: In a selected subgroup of anatomically suited patients with CCHD and PS, stepwise dilatation of the pulmonary valve resulted in improved oxygenation and symptomatic relief, which was sustained on follow-up, making it an attractive low-resource option for palliation, particularly in resource constrained LMIC settings.

Background: Early, non-invasive detection of coronary artery disease (CAD) is a significant challenge. Given the anatomical and pathophysiological parallels between retinal and coronary microvasculature, retinal arteriovenous (AV) ratio may serve as a surrogate marker of CAD. This study aimed to evaluate correlation between retinal AV ratio and CAD severity as assessed by SYNTAX score in patients with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS), using artificial intelligence (AI)-based retinal image analysis.

Methods: In this prospective study, 332 participants were enrolled: 110 with ACS, 120 with CCS, and 102 angiographically normal controls. Retinal fundus imaging was analyzed using AI models (VC-Net and SegFormer) to compute AV ratio. Coronary angiography was performed, and SYNTAX scores were calculated. Correlations between AV ratio and SYNTAX score were assessed, and a machine learning model (RETFound + RBF Kernel Ridge Regression) was developed to predict SYNTAX categories from retinal data.

Results: Mean AV ratios were similar across CCS (0.624 ± 0.11), ACS (0.620 ± 0.12), and controls (0.650 ± 0.10; p = 0.153). In CCS patients, a significant inverse correlation was observed between AV ratio and SYNTAX score (r = -0.344; p < 0.001), which remained after adjustment (r = -0.300; p = 0.002). AI model accurately classified patients into SYNTAX risk categories (94.1 % accuracy).

Conclusion: Retinal AV ratio is significantly associated with CAD severity in CCS patients. An AI-based tool can automatically derive AV Ratio and provide rapid, non-invasive estimate of coronary disease burden, showing promise for risk stratification. This approach warrants further validation in larger cohorts.

Background: Amongst the various risk factors for, cardiovascular diseases (CVDs), the impact of migration is often underappreciated and underexplored. The aim of the study was to look into the CVD profiles of migrant industrial workers and to explore the impact of duration migration on CVD risk-factors.

Methods: This was an observational, prospective and a multi-center study which recruited migrant industrial workers working across 23 industries from the organized sector in Ludhiana. Age-adjusted regression models were prepared to determine if duration of migration was an independent risk factor for adverse CV health.

Results: A total of 11,151 migrant workers (9,158, 82.1 % males) were included in the analysis. The mean age of the cohort was 35.00 ± 10.89 years, with the majority (40.6 %, n = 4528) belonging to the <30 years age group. The prevalence of hypertension, diabetes and obesity in the cohort was 19.73 %,4.0 % and 25.9 % respectively. Duration since migration emerged as an independent risk factor for adverse CV health. Age-adjusted models revealed the independent risk of developing obesity, hypertension and diabetes beyond 3, 6 and 12 years since migration respectively [OR = 2.332, 1.401 & 3.462 respectively; p < 0.005 for all].

Conclusions: The overall age-adjusted prevalence of hypertension was higher amongst migrant workers compared to national average and state wise data for hypertension reflecting the aggravated risk in this cohort. Duration of migration emerged to be an independent predictor of CVD risk with a threshold effect for developing obesity emerging earliest at 3 years since migration.

Objective: To study the prevalence of LV systolic dysfunction measured using GLS in patients of CKD with normal LVEF and correlation of GLS with the biochemical parameters and to determine the incidence of all-cause mortality and its correlation with GLS.

Patients and methods: This study included 100 CKD patients of all stages, enrolled from July 2022 to June 2023. Global Longitudinal Strain (GLS) was calculated using speckle tracking echocardiography following relevant investigations. Patients were followed for one year to determine the incidence of all-cause mortality and its correlation with GLS.

Results: Males were the predominant gender (66 %). The mean age of patients was 52yrs (±13.59). Maximum patients (47 %) were in ESRD stage (stage 5 CKD), followed by stage 4 CKD (29 %). Abnormal GLS (>-16 %) was prevalent in 98 % of study population. Mean GLS was -11 % ± 2.74. Patients with LVGLS ≥ -11 % were more likely to have higher prevalence of co-morbidities. Statin use was more prevalent in those patients with LVGLS ≥ -11 % (p = 0.029). In the median follow up of 1-year all-cause mortality was 22 % (n = 21), however there was no significant correlation of mortality with GLS.

Conclusion: Patients with abnormal LVGLS (≥-11 %) had more comorbidities. Abnormal global longitudinal strain (GLS > -16 %) was prevalent in 98 % of the study population. The higher prevalence compared to other studies may be related to the lesser use of nephroprotective and cardioprotective drugs (e.g., ACEI/ARB in only 28 %); however, abnormal GLS was not correlated with mortality.

Background: Direct oral anticoagulants (DOACs) are increasingly preferred over vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF), including valvular (VAF) and non-valvular (NVAF). This network meta-analysis aimed to evaluate and compare the efficacy and safety of different DOACs versus VKAs in patients with AF.

Methods: A Bayesian network meta-analysis was conducted to estimate odds ratios (ORs) with 95 % credible intervals (CrIs).

Results: 43 RCTs were included (30 VAF, 13 NVAF). Dabigatran (OR 0.77, 95 % CrI 0.68-0.87) demonstrated the strongest reduction in ischemic stroke/systemic embolism, followed by apixaban (0.81, 0.73-0.91). All DOACs were associated with reduced risk of hemorrhagic stroke.

Conclusion: DOACs, particularly apixaban and dabigatran, showed superior efficacy and safety compared with VKAs, with apixaban emerging as the most favorable overall option. However, these findings are derived from indirect rather than direct head-to-head comparisons among DOACs and VKAs and should therefore be interpreted with caution.