Indian heart journal最新文献

Hypertonic saline with high dose furosemide improves refractory heart failure. In this case series of 10 patients of refractory acute decompensated heart failure, effect of HSS with furosemide was compared with furosemide alone. Patients responded to the therapy better, with faster decongestion, without significant adverse effects or worsening renal function. Hence an adequately powered, randomized study is required to assess the veracity of findings in this case series of hypertonic saline in diuretic resistant acute decompensated heart failure on optimal therapy. Based on present study, hypertonic saline looks like a promising option in the management of refractory heart failure.

Background: Data on the incidence of infective endocarditis (IE) in patients with hypertrophic cardiomyopathy (HCM) is sparse. This study evaluated a HCM cohort with aim to study the incidence of IE in these patients.

Methods: All patients entering the HCM cohort from May 2003 to June 2022 of a tertiary care hospital with at least one follow-up visit were included and followed up till June 2023. This was a retrospective cohort analysis. Only individuals who were diagnosed with IE after entry into the cohort were included.

Results: The study cohort consisted of 529 HCM patients with a total follow up duration of 3244.6 years. The mean and median follow-up durations were 6.1 ± 4.7 and 5.3 (range 31 days to 20.1) years respectively. Three (0.57 %) patients in the cohort developed IE. Incidence of IE in HCM patients was 0.92/1000 patient years. Two patients had left ventricular outflow tract obstruction while one had non-obstructive HCM. None of the patients with isolated mid-cavity gradients developed IE. The incidence of IE in the obstructive and nonobstructive groups was 1.39 and 0.55 per 1000 patient years respectively. Two had vegetations on mitral valve while one had vegetations on aortic valve. Both patients with mitral valve endocarditis developed severe residual mitral regurgitation and heart failure.

Conclusions: IE is a rare complication in HCM patients with an incidence of 0.92/1000 patient years. However, when it occurs, IE is associated with high morbidity and mortality.

Influenza is a common trigger for cardiovascular events. Temporal association studies of influenza and cardiovascular events have well documented this phenomenon. More recently, randomised clinical trials of influenza vaccine have shown the benefit of immunisation in reducing recurrent cardiovascular events, especially in patients with acute coronary syndrome. Despite this overwhelming benefit, its uptake in India is very low. This could be due to a lack of awareness and paucity of evidence of its benefit in tropical countries like India, where the influenza season is variable and spread throughout the year. In this review, we explore these aspects of influenza and cardiovascular diseases and discuss the way ahead.

Objectives: Hypertrophic cardiomyopathy (HCM) is a widespread disease with an incidence of 1:200 in the general population and its surgical and interventional treatment is well-developed in western countries. This study is focusing on outcomes of HCM patients after alcohol septal ablation in Russian Federation.

Methods: We conducted a multicenter registry to evaluate outcomes of obstructive hypertrophic cardiomyopathy (oHCM) patients after ASA. Our study was focused on the following outcomes: (i) 30-day mortality, (ii) 30-day permanent pacemaker implantations, (iii) a residual obstruction occurrence, (iv) final maximal left ventricular outflow tract gradient, (v) long-term mortality, (vi) final heart failure functional class, (vii) freedom from sudden cardiac death. We conducted secondary analysis to assess outcomes in patients with single versus repeated ASA. The mean follow-up was 71 ± 47 months.

Results: A total of 597 consecutive patients (54.9 % female) were enrolled in the Russian Alcohol Septal Reduction (RASA) registry from three interventional groups. The mean age was 56 ± 14 years. Thirty-day mortality rate was 0.7 % (4 patients). Permanent pacemakers were implanted in 42 (7 %) cases in 30-days follow-up. The resting LVOT gradient reduced from 64 ± 28 to 20 ± 13 mmHg (p < 0.0001), and the mean NYHA class decreased from 2.3 ± 0.7 to 1.3 ± 0.5 (p < 0.001). Long-term survival rates were as follows: 97.4 (95%CI: 96.2-98.7) %, 93.2 (95%CI: 91.0-95.3) %, 84.9 (95%CI: 80.7-89.4) % at 1-, 5-, 10-year follow-up, respectively. Patients after repeated ASA. had similar long-term survival comparing to those who underwent single ASA (weighted log rank p value = 0.254). Heart failure class in the long-term and final gradient at the last follow-up were not statistically different between groups under study (p > 0.05).

Conclusions: In our registry, alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy was safe in the short- and long-term follow-up. Outcomes of patients underwent repeated ASA were non-inferior to those after single ASA.

Objectives: Hypertension (HTN) management guidelines recommend home blood pressure monitoring (HBPM) as an important tool for BP control. Limited data exists on HBPM epidemiology among people with HTN and their caregivers in the Indian context.

Methods: The current study was conducted across three North Indian centres to evaluate the prevalence, training and technique of HBPM among people with HTN and their caregivers. People with diagnosed HTN (>3 months duration) and their caregivers, were screened and their HBPM use was evaluated. HBPM practices were assessed by observing participants measuring BP using a pre-validated, structured 16-point observational checklist. HBPM knowledge was assessed using a 19-point self-administered questionnaire based on the most recent AHA guidelines. Responses were graded and classified based on quartiles.

Results: A total of 2750 participants were screened, of which 2588 (2070 from urban and 518 from rural areas) were included. A total of 468 (18.1 %) were using HBPM. The proportion of respondents using HBPM was 20.5 % (424/2070) in urban, and 8.5 % (44/518) in rural areas. Only 24.7 % (n = 116) of the 468 participants (236 patients and 232 caregivers) using HBPM at home recalled ever receiving training from any healthcare workers. The majority (75.2 %, 352/468) of participants reported learning HBPM themselves through observation, videos, and reading. In HBPM practice assessment, 15.9 % of people with HTN (37/232) vs 5.9 % caregivers (14/236) scored excellent (score >75 %). In HPBM knowledge assessment, 0.4 % of people with HTN (1/232) vs no caregivers scored excellent. HPBM practices were better than knowledge, with mean scores of 62.3 ± 13.1 % and 40.1 ± 16.2 % respectively. Higher education level was associated with improved patient knowledge (p = 0.041), but not practices (p = 0.225).

Conclusions: There is need for more robust training on HBPM to enable people from all backgrounds to better manage their HTN, especially in rural areas. Education is not a barrier to learning good HBPM technique.

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.

This study aimed to assess the effectiveness of current lipid-lowering therapy in achieving low-density lipoprotein cholesterol (LDL-C) goals in Indian patients undergoing coronary revascularization. Consecutive subjects (n = 1275, mean age 60.0 ± 9.7 years, 87.2 % men) with newly diagnosed coronary artery disease and undergoing coronary revascularization during the period 1 Jan 2023 to 31 Dec 2023 were included. After a median follow-up of 99 days (interquartile range 91-109 days), the mean LDL-C was 63.9 ± 24.3 mg/dL with 67.5% and 29.9% of subjects having LDL-C <70 mg/dL and <50 mg/dL, respectively. These proportions were 70.8% and 32.1% for patients treated with high-intensity statin therapy (rosuvastatin 20-40 mg/d or atorvastatin 40-80 mg/d). Among patients treated with rosuvastatin 40 mg/d and ezetimibe 10 mg/d, 53.3% achieved LDL-C <50 mg/dL. These findings underscore the need for greater usage of combination lipid-lowering therapy and agents with high LDL-C lowering efficacy.

Objective: To evaluate role of rajyoga meditation (RYM) versus stress management counselling (SMC) in addressing burnout syndrome and resultant improvement in electrocardiogram (ECG) so as to automate burnout prediction from raw ECG data with machine learning (ML).

Methods: Healthcare providers were assigned to two groups: RYM (n = 100) or SMC (n = 102). Subjects in RYM received rajyoga for 3 months including one week offline and thereafter, virtual mode. SMC group received counselling for 1 day in offline mode and thereafter, received positive thoughts on a weekly basis. All subjects were assessed for psychological (depression, anxiety, stress scale-21 (DASS-21) and burnout syndrome (Mini Z questionnaire) along with 12-lead ECG at baseline after 4 weeks, and after 12 weeks. Based on response on question 3 of the Mini-Z questionnaire, participants were classified either as burnout or satisfied.

Results: RYM group showed significant reduction in depression, anxiety, and stress in comparison to SMC group. Burnout results display significant reduction in the RYM group in comparison to SMC group. Reduction in burnout and enhancement in satisfaction from visit-1 to visit-3: burnout visit-1 (27.2 %), visit-2 (23.8 %), visit-3 (19.3 %) and, satisfaction visit-1 (72.8 %), visit-2 (76.2 %), and visit-3 (80.7 %). ML algorithms could identify burnout patients using the raw ECG data with time-series features based classifier performing better than Ultra Short HRV features based ML classifier model.

Conclusion: AI based early diagnosis of heart's healthy status using ECG analysis may prevent development of cardiovascular disorder in the long run.

Background: Assessment of knowledge, attitudes, and practices regarding cardiovascular diseases (CVD) and cardiovascular risk factors (CVRF) is critical to inform CVD prevention strategies, but limited community-level data exist from developing countries.

Objective: To assess the knowledge, attitudes, and practices regarding CVD and CVRF and acceptability of non-physician health workers and text-message based reminders to guide CVD prevention strategies in India.

Methods: We conducted a telephone-based survey nested in the on-going Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) cohort in Delhi and Chennai, India between January 2021 to February 2021. We randomly selected people with CVRF, but no established CVD and those with existing CVD from the CARRS cohort (n = 502 participants) and assessed their 1) knowledge of CVD symptoms and risk factors, 2) attitude towards non-physician health workers (NPHW) facilitated care and text-messages for healthy lifestyle, and 3) practices regarding monitoring of CVRF. We performed logistic regression analyses to investigate the factors associated with KAP.

Results: We interviewed 502 participants (283 with CVRF and 219 with CVD); 45.8 % were female, and mean age (SD) was 48.1 (11.2) years. The knowledge of heart attack symptoms, stroke symptoms, and CVRF (>75 % correct answers) were: 12.9 %, 20.7 %, and 17.3 %, respectively. Individuals with CVRF had 2.5 times lower knowledge of CVD symptoms compared to those with existing CVD. Acceptability of NPHW-facilitated care and text-messages for healthy lifestyle was 60 % and 84 %, respectively.

Conclusion: The knowledge of CVD symptoms and risk factors is below optimal levels, particularly among individuals at high risk of CVD, unskilled workers, those with lower levels of education and income. Innovative use of NPHW along with mHealth tools could potentially offer solutions to reduce the burden of CVD.