Indian heart journal最新文献

Background: Valvular inflammation plays an important role in the progression of Rheumatic Heart Disease. We report the association between inflammatory markers and use of Benzathine Penicillin G in patients with Rheumatic mitral valve disease.

Methods: The levels of inflammatory cytokines; IL-1β, IL-6, TNF-α and inflammatory marker hs- CRP were measured using ELISA method in 32 patients with RHD receiving Benzathine Penicillin as secondary prophylaxis and 31 patients not receiving secondary prophylaxis, in a case-control study. The severity and type of valvular dysfunction were assessed with echocardiogram.

Results: The median level of IL-1β was significantly lower in patients on BPG (0.95 pg/ml vs. 5.47 pg/ml) p < 0.002. The median levels of IL-6, TNF-α and hs-CRP were not significantly different between study groups. The adjusted odds of raised IL-1β were lower in patients on BPG (odds ratio 0.40, 95 % C.I. 0.11, 1.45) p 0.16. There was a trend of inverse association between the use of BPG and mitral stenosis (odds ratio 0.42, 95 % C.I. (0.12, 1.46) p 0.17.

Conclusion: Patients with RHD on BPG had lower levels of IL-1β and a trend toward a lower prevalence of mitral stenosis. Role of IL-1β in progression of incompetent to stenotic mitral valve dysfunction needs to be explored in future studies.

Background: No/slow flow after percutaneous intervention(PCI) for acute coronary syndromes (ACS) is common. Whether a comprehensive intravascular ultrasound (IVUS) analysis of atherosclerotic plaque can define characteristics which predict suboptimal flow following PCI is largely unknown.

Objectives: To identify IVUS correlates of suboptimal flow in patients with ACS undergoing PCI.

Materials & methods: We performed a prospective multicentre, investigator initiated study. Patients with ACS, who underwent IVUS guided PCI were enrolled. Clinical, angiographic and imaging characteristics of patients who developed suboptimal flow after PCI were analysed and compared with patients with normal flow.

Results: Between October 2021 and August 2022, we enrolled 187 patients (195 lesions) with ACS who underwent IVUS guided PCI. Mean age of patients was 58 ± 10.4 years; Incidence of slow/no reflow in our study was 14/195 (7.2 %). Presentation as ST elevation myocardial infarction, presence of angiographically complex lesion type (type B2/C) and pre procedural TIMI flow 0 were significantly more in patients who developed suboptimal flow after PCI. Pre PCI plaque attenuation length (9.51 mm Vs 4.35 mm p = 0.037), lesion site positive remodelling (Odds ratio 6.4 : 95 % CI; 1.1-38.4 p = 0.042) were predictors of slow flow.Post PCI length of plaque prolapse (9.73 mm Vs 6.58 mm p = 0.029) correlated with slow flow.

Conclusions: Plaque characteristics on IVUS in patients with ACS helps to identify patients who may develop suboptimal flow following PCI.

Objectives: High thrombus burden during Primary Percutaneous Coronary Intervention begets poor outcomes; there are several lacunas in the management of those patients.- The purpose of this study is to analyse the long-term outcomes of patients undergoing primary percutaneous coronary intervention with high thrombus burden, treated with intracoronary thrombolysis as an adjunctive therapy.

Methods: In this prospective observational study, 108 consecutive primary percutaneous coronary intervention patients with high thrombus burden were stratified into two groups basing on whether they received intracoronary thrombolytic agent before stent implantation. The primary outcome is Net Adverse Clinical Events. Secondary outcomes include Major Adverse Cardiac Events, and all other individual components of the Net Adverse Clinical Events when analysed separately.

Results: The primary outcome events occurred in 21 patients (26%) in the Primary stent group (n=80), whereas it occurred in 2 patients (6%) in the primary intra-coronary thrombolysis group (n=28), this study shows that there is no difference in primary endpoints in both groups (26% Vs 7%, p-value - 0.042, Hazard ratio - 2.56; 95% CI - 0.76 - 8.57), however Kaplan-Meier event-free survival curves show that both the curves are well separated apart even at the end of the one year of follow - up.

Conclusion: There is no difference in the primary outcome events in both groups, however there was a consistent increase in events in the primary stent group over the one-year follow-up period. These findings suggest the need for a larger randomized clinical trial to confirm and further elucidate these results.

Industry's influence on clinical trials is well known and extends to various aspects beyond funding, including industry-affiliated authors and industry-affiliated analysts. An area of potential concern is presentation of analyzed data that does not appear favorable to the desired study outcome. Such important data are at times not accorded prominence in discussion. The present article analyses such concerns in data presentation in the landmark trials of two cardiac devices the use of which has increased markedly in recent years (DanGer Shock trial and COAPT trial). It is seen that important data that did not appear favorable to the intended study outcome were relegated mostly to Supplement Section, where they are likely to receive less attention, with little discussion allocated in the text.

Cardiovascular disease (CVD) is a major driver of mortality and declining health worldwide. Cardiovascular diseases (CVD) is the most common cause of morbidity and mortality globally. Although dyslipidemia, smoking, diabetes, hypertension and obesity are some well-known causes of CVD, the overlapping genetic pathways between other diseases and those affecting cardiovascular health have been overlooked. In the past decade, mutations in TET2, DNMT3A, ASXL1, and JAK2 are found to cause clonal hematopoiesis of intermediate potential (CHIP), a disease associated with age-related haematological malignancies without the presence of cytopenias or dysplasia. Coronary artery disease, heart failure, aortic stenosis, and arrhythmias have been shown to be associated with the presence of CHIP mutations. Addressing the association between CHIP could significantly reduce residual risk patients with CVD. The link between CHIP and CVD can potentially be addressed through inhibitors of inflammasomes, antagonists in the interleukin pathway, or direct antagonists of CHIP mutations.

Background: Cardiac catheterization via the trans-radial approach (TRA) has shown several advantages over the trans-femoral approach (TFA) but with a concern of higher radiation exposure. Considering the growing experience with TRA, this study compares patient's radiation during coronary angiography using TRA versus TFA.

Methods: This study included consecutive patients undergoing coronary angiogram over a year at tertiary hospital performed by experienced operators through radial or femoral access. Parameters compared between the two routes included fluoroscopy time (FT), cineangiography time (CT), cini-sequences (CS), and patient radiation exposure quantified by Air Kerma (AK) and Dose Area Product (DAP).

Results: A total of 910 patients were studied, with 461 (50.6 %) undergoing coronary angiography (CAG) via TFA and 449 (49.4 %) via TRA. The mean age was similar between the femoral (54.07) and radial groups (53.7) years (p = 0.33), with slightly lesser proportion of males in the femoral group (74.62 % vs 79.73 %; p = 0.06). The mean (SD) DAP and AK were 15.71 (7.05) Gy·cm² and 258.3 (99.9) mGy for the femoral group, compared to 20.76 (9.48) Gy·cm² and 352.2 (151.5) mGy for the radial group (both p < 0.001). The mean (SD) FT, CT, and CS were 1.32 (0.94) minutes, 40.4 (9) seconds, and 5.93 (1.22) for the femoral group, compared to 2.19 (1.67) minutes, 44 (10) seconds, and 6.17 (1.26) for the radial group (all p < 0.01).

Conclusion: Coronary angiography via TRA is associated with increased patient's radiation. Future studies should investigate strategies to reduce radiation exposure in trans-radial procedures.

It is not well-known if valve replacement outcomes differ in patients with sarcoidosis, especially in aortic valve intervention, where the pressure gradients are physiologically high. In this retrospective study, we included all patients who underwent surgical/transcatheter aortic valve replacement from the Nationwide Readmission Database (2016-2019), and then divided them into those with and without sarcoidosis. Logistic and cox proportional hazard regression models were used. In-hospital mortality, stroke, acute kidney injury, paravalvular leak, 30-day pacemaker implantation, and 30-day heart failure readmission were similar in patients with and without sarcoidosis. Thus, sarcoidosis did not affect the clinical outcomes in patients undergoing aortic valve replacement. Further prospective studies are needed in this patient subgroup to support clinical decision-making.

Angiotensin Receptor Neprilysin Inhibitor (ARNI) has not shown to be promising in Heart failure with preserved LVEF. Role of ARNI in Right ventricular systolic dysfunction with preserved LVEF needs to be evaluated. We took 50 patients with isolated RV systolic dysfunction and divided them into two groups of 25 patients each- Conventional treatment and ARNI in addition to conventional treatment. We found that the ARNI group showed a significant improvement in NYHA class, all the echo parameters of RV size, RV function and NT-pro BNP levels at 4 weeks and 12 weeks.

Background: Various studies have documented gender differences in the management and outcomes of acute myocardial infarction (AMI) in developed countries. Gender differences in the management of AMI in India is not known.

Objectives: To document the gender differences in the management and outcomes of AMI in India.

Methods: The current study was a nationwide retrospective, multicenter, cross-sectional study including all consecutive AMI patients admitted from 15th March to 15th June in the year 2020 using a historical control of all cases of AMI admitted during the corresponding period in the year 2019.

Results: There were only 9018 females (21.6 %) among the 41832 patients with AMI in the study. Females were older and were more likely to present with non ST-elevation MI than men (41.6 % vs. 33.2 %). Significantly fewer number of females underwent primary percutaneous coronary intervention (29.5 % vs 31.2 % p value < 0.001), thrombolysis (32.9 % vs 34.7 %, p value < 0.001), pharmaco-invasive therapy (18.6 % vs 20.7 % p value 0.001). Females had higher in-hospital mortality (7.07%vs 4.07 %, p < 0.001), length of hospital stay (3.9 ± 2.98 days vs 3.8 ± 2.88 days, p < 0.001) and complications of AMI [cardiogenic shock (8.6 % vs 6.3 %), mechanical complications (4.6 % vs 3.8 %), heart failure (13.9%vs 11.7 %) and malignant arrhythmias (3.4%vs2.8 %)] than males.

Conclusions: Differences between gender in the presentation, management, and outcomes of acute MI are prevalent in India. Women with acute MI presented at older age, had higher in-hospital mortality and complications, and received revascularization therapy less often compared to men.