Indian heart journal最新文献_第3页

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 接受紧急经皮冠状动脉血运重建术的 STE-ACS 患者梗死床袢是否重要？对院内病程前瞻性资料库的评估。

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian heart journal

Pub Date : 2024-09-01 DOI: 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.

背景：有关冠状动脉袢循环（CCC）在ST段抬高急性冠状动脉综合征（STE-ACS）患者中的作用的数据有限。本研究旨在评估CCC和接受原发性经皮冠状动脉介入治疗（pPCI）的CCC患者的院内病程：研究纳入了连续接受经皮冠状动脉介入治疗的 STE-ACS 患者。良好 CCC 的定义是 Rentrop 侧支评分（RCS）为 2-3。对CCC良好和不良患者的临床特征、血管造影模式和住院过程进行比较：在 4,683 例患者中，平均年龄为 55.6±11 岁，78.8% 为男性。499例（10.7%）患者的CCC良好。术中慢血流/无复流（SF/NR）率为29.9%对20.5%（P结论：STE-ACS患者良好CCC的血管造影证据有限。良好的 CCC 与 MVD 患病率较高、血栓负担较重以及术前 LVEDP 较低有关，导致术中 SF/NR 发生率较高。然而，CCC好和CCC差的患者之间的CACO没有显著差异。

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引用次数: 0

A groundbreaking electrocardiographic observation: “Isoelectric horizontal ST-segment with sharp ST-T angle” a novel sign for acute coronary syndrome 开创性的心电图观察："等电位水平 ST 段与尖锐 ST-T 角 "是急性冠状动脉综合征的新征兆。

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian heart journal

Pub Date : 2024-09-01 DOI: 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).

连续的疑似急性冠状动脉综合征（ACS）病例被分为三组：第 1 组（ST-压低）、第 2 组（T-倒置）和第 3 组（其余病例）。第 3 组又分为等电位水平 ST 段与尖锐 ST-T 角（IHST）阳性组和 IHST 阴性组。他们接受了连续的高敏肌钙蛋白-I检测。ACS发生率为77.96%，第1、2和3组（IHST阳性、IHST阴性）患者的ACS发生率分别为33.02%、15.96%和（15.04%、35.96%）。在检测 ACS 方面，IHST 的灵敏度高于 T-倒置，特异性高于 ST-压低。IHST征的存在可额外检测出15.04%的ACS。在第 3 组（p = 0.008）和所有 ACS 病例（p = 0.048）中，IHST 的存在具有显著性。

引用次数: 0

Long-term outcomes of percutaneous coronary intervention in patients with prior coronary artery bypass graft - A retrospective experience 既往冠状动脉旁路移植患者经皮冠状动脉介入治疗的长期疗效--回顾性经验。

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian heart journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ihj.2024.07.009

Anil Kumar Boddu, Bijulal S, Krishnamoorthy Km, Ajit Kumar Vk

Objective

To evaluate the long-term clinical outcomes of percutaneous coronary intervention (PCI) in patients who had previously undergone coronary artery bypass grafting (CABG).

Method

A total of 219 patients who had a history of CABG and underwent PCI at tertiary care centre were retrospectively enrolled in this study. Clinical endpoints such as major adverse cardiac events (MACE; cardiac death, non-fatal myocardial infarction [MI], and target vessel revascularization), any death, cardiac death, MI, target vessel revascularization (TVR), and target lesion revascularisation (TLR) were reported at long-term follow-up.

Results

About 66.6 % patients were treated on the native vessel, and 24.2 % on grafts vessel. In all, 360 stents [83.3 % drug-eluting stent (DES) and 16.6 % bare metal stent (BMS)] were implanted. Diabetes mellitus (p = 0.03), LVEF<55 % for PCI (p = 0.04), stent type [BMS (p < 0.001) and DES (p < 0.001)] and chronic kidney disease [(CKD) p < 0.01] were appeared to be the significant predictors of mortality. Age at CABG>50 years (p = 0.04), stent type [BMS (p = 0.03) and DES (p < 0.01)] and CKD (p < 0.01) as independent predictors for MACE. Higher event rate was reported in graft-vessel PCI group as compared to native-vessel PCI group: ISR (p < 0.01), TLR (p = 0.01), mortality (p = 0.04), MACE (p < 0.01) and MI (p = 0.05). Mortality (p < 0.001), MACE (p < 0.001) and MI (p < 0.001) were significantly lower in DES vs. BMS groups.

Conclusion

Native-vessel PCI was associated with better clinical outcomes than graft-vessel PCI that also with the use of DES as the first choice in patients with a history of CABG.

目的评估曾接受过冠状动脉搭桥术（CABG）的患者接受经皮冠状动脉介入治疗（PCI）的长期临床效果：本研究回顾性纳入了 219 名曾接受过 CABG 并在三级医疗中心接受了 PCI 治疗的患者。结果：约66.6%的患者接受了PCI治疗：结果：约66.6%的患者在原生血管接受治疗，24.2%在移植物血管接受治疗。总共植入了360个支架[83.3%为药物洗脱支架（DES），16.6%为裸金属支架（BMS）]。糖尿病（P=0.03）、LVEF50岁（P=0.04）、支架类型[BMS（P=0.03）和DES（P结论：与移植物血管PCI相比，原生血管PCI具有更好的临床疗效，对于有CABG病史的患者来说，DES也是首选。

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引用次数: 0

Drug abuse and ACS in the very young (less than 30 years): Demographic, clinical and angiographic profile 年轻人（30 岁以下）的药物滥用与 ACS：人口统计学、临床和血管造影概况。

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian heart journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ihj.2024.10.003

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

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.

目的：确定急性冠状动脉综合征（ACS）年轻患者的发病率、药物滥用类型、临床和血管造影情况：结果：n = 153；n = 17 在第 1 组，其中 35.29 % 饮用鸦片，17.64 % 饮用能量饮料，17.64 % 饮用乳清蛋白补充剂，17.64 % 吸食大麻，5.88 % 吸食海洛因和痉丙氧芬，23.52 % 滥用多种药物。STEMI、单血管疾病和城市户籍患者占多数。在前瞻性（28.20%）与回顾性（5.30%）时间框架内，发现药物滥用呈上升趋势（P = 0.011）：结论：药物滥用的上升趋势令人担忧，它可能是年轻人发生 ACS 的一个可改变的风险因素。需要制定严格的法规来遏制这一威胁。

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引用次数: 0

Gender differences in the management and outcomes of acute coronary syndrome in indians: A systematic review and meta-analysis 印度人急性冠状动脉综合征管理和预后的性别差异：系统回顾和荟萃分析。

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian heart journal

Pub Date : 2024-09-01 DOI: 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.

背景：全球数据显示，急性冠状动脉综合征（ACS）结果存在性别差异，但这些数据并未对印度数据进行分析。之前没有系统综述和荟萃分析（SRM）涉及印度女性急性冠脉综合征患者的性别偏差这一重要方面。因此，本SRM旨在填补这一知识空白：方法：在电子数据库中搜索关于 ACS 的研究，比较印度女性和男性心血管疾病的表现、接受的治疗和结果。主要结果是评估 30 天死亡和主要不良心血管事件（MACE）的性别差异。次要结果是评估发病、治疗和死亡率方面的性别差异。SRM 已在 PROSPERO 注册（CRD42023477286）：结果：从初步筛选的 3753 篇文章中，分析了来自 9 项研究（61185 名患者）的数据。患有 ACS 的女性糖尿病[比值比 (OR) 1.65(95%CI:1.33-2.04);P2=95%] 和高血压[OR2.06(95%CI:1.88-2.25);P2=42%]患病率较高。女性吸烟率明显较低[OR 0.05（95%CI：0.03-0.07）；P2=87%]。女性非 ST 段抬高型心肌梗死（NSTEMI）患者明显较多[OR 1.92(95%CI:1.66-2.21);P2=0%] 。诊断性血管造影[OR 0.64(95%CI:0.56-0.74);P2=46%] 和经皮冠状动脉介入治疗[OR0.71(95%CI:0.55-0.92);P=0.01;I2=92%]在女性中明显较低。女性的 30 天死亡率[危险比（HR）2.26（95%CI：2.01-2.55）；P2=6%]、1 年死亡率[HR2.41（95%CI：1.89-3.P2=53%]、院内死亡[HR1.88(95%CI:1.19-2.96);P=0.007;I2=92%]、卒中[HR1.84(95%CI:1.34-2.52);P2=0%]和MACE结局[OR2.05(95%CI:1.78-2.35);PC结论：我们的研究表明，印度女性ACS患者的预后更差。糖尿病和高血压的发病率较高、PCI的使用率较低以及药物治疗的积极性较低可能是部分原因。

{"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":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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); <em>p</em> < 0.001; I<sup>2</sup> = 95 %] and hypertension [OR2.06(95%CI:1.88–2.25); <em>p</em> < 0.001; I<sup>2</sup> = 42 %]. Smoking was significantly lower in women [OR 0.05(95%CI:0.03–0.07); <em>p</em> < 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); <em>p</em> < 0.001; I<sup>2</sup> = 0 %]. Diagnostic angiography [OR 0.64(95%CI:0.56–0.74); <em>p</em> < 0.001; I<sup>2</sup> = 46 %] and percutaneous coronary interventions [OR0.71(95%CI:0.55–0.92); <em>p</em> = 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); <em>p</em> < 0.001; I<sup>2</sup> = 6 %], 1-year mortality [HR2.41(95%CI:1.89–3.07); <em>p</em> < 0.001; I<sup>2</sup> = 53 %], in-hospital death [HR1.88(95%CI:1.19–2.96); <em>p</em> = 0.007; I<sup>2</sup> = 92 %], stroke [HR 1.84 (95%CI:1.34–2.52); <em>p</em> < 0.001; I<sup>2</sup> = 0 %] and MACE outcomes [OR 2.05 (95%CI:1.78–2.35); <em>p</em> < 0.001]. Use of aspirin, clopidogrel, beta-blockers and nitrates were significantly lower in women.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"76 5","pages":"Pages 333-341"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Outcomes of mitral transcatheter edge to edge repair with MitraClip™ – An Indian single center experience 使用 MitraClip™ 进行二尖瓣经导管边缘至边缘修补术的结果 - 印度单中心经验。

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian heart journal

Pub Date : 2024-09-01 DOI: 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 MitraClip^TM. 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.

目的评估MitraClip™（雅培血管公司）经导管边缘到边缘修补术（TEER）对有症状的高手术风险印度二尖瓣返流（MR）患者的治疗效果：中重度或重度原发性或继发性二尖瓣反流并被视为手术风险高的患者接受 MitraClip™ 治疗。数据通过病历回顾性收集。主要结果是技术成功率，次要结果是≤2+MR缩小和30天后功能改善：2018年11月至2023年8月期间，64名患者接受了MitraClip治疗。平均年龄为（70.0±12.1）岁，64%为男性。欧洲评分 II 和 STS 评分预测的二尖瓣修复死亡率平均值分别为 5.8 ± 4.5% 和 4.0 ± 3.8%。MR病因56.3%为原发性，40.6%为继发性，3.1%为混合性。除一名患者外，所有患者都成功植入了该装置，技术成功率为 98.4%。每位患者平均使用 1.5 ± 0.6 个夹子，42.2% 的患者使用了一个以上的夹子。二尖瓣平均梯度为 3.5 ± 1.6 mmHg。91.8%的受试者的MR严重程度达到≤2+，类似比例的受试者在30天后达到纽约心脏协会功能分级I级或II级：结论：对于有明显 MR 症状的印度高危患者，MitraClip™ TEER 的技术成功率很高。90%以上的受试者的 MR 严重程度明显减轻，功能得到改善。

{"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":"<div><h3>Objective</h3><div>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).</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":"76 5","pages":"Pages 315-320"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Long-term outcome of variety of techniques used to stabilize left ventricular lead in difficult coronary sinus anatomy- A single centre experience 在冠状动脉窦解剖困难的情况下采用各种技术稳定左心室导联的长期效果--单中心经验。

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian heart journal

Pub Date : 2024-09-01 DOI: 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.

导言：困难的冠状窦（CS）解剖可能导致左心室（LV）导联置入困难和导联移位，从而导致心脏再同步化治疗（CRT）无反应：在这项回顾性研究中，我们研究了 2014 年 1 月至 2021 年 12 月期间由单一操作者植入的设备的 CRT 参数，这些设备采用了不同的标签外技术来放置/稳定左心室导联。我们记录了每位患者用于稳定左心室导联的技术、基线和随访时的 CRT 参数：在研究期间植入的 133 个 CRT 中，有 23 名患者（17.29%）需要使用标签外技术。11/23（47.82%）和7/23（30.43%）例患者分别使用了支架和导丝保留技术。两名患者使用冠状动脉支架固定左心室导线以防止移位。两名患者的 CS 狭窄，需要进行球囊扩张，一名患者的后外侧静脉迂曲，使用冠状动脉支架将其拉直。在中位随访 44 个月（范围：06 -114 个月）时，有 6/23 个左心室导联（26.08%）出现技术故障，无法捕获。在这 6 名患者中，分别有 4 名和 2 名患者使用了支架和导丝保留技术：结论：尽管这些技术在植入时具有可接受的参数，但在长期随访中可能会导致左心室导联无法捕获，尤其是支架和导丝保留技术。在CS解剖困难的情况下，应首选更好的左心室导联，如主动固定导联和传导系统起搏（His束/左束支起搏）。

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引用次数: 0

Use of strain imaging to detect subtle myocardial involvement in post COVID-19 patients: An Indian perspective 使用应变成像检测科维德-19 后患者心肌的细微受累情况：印度视角。

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian heart journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ihj.2024.09.003

Deepak Tomar , Aditya Kapoor , Zia Hashim , Kamlesh Raut , Arpita Katheria , Harshit Khare , Ankit Sahu , Roopali Khanna , Sudeep Kumar , Naveen Garg , Satyendra Tewari

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.

背景：该研究评估了全球纵向应变成像（GLS）在COVID-19临床康复患者中检测细微心肌功能障碍的能力：该研究评估了全球纵向应变成像（GLS）在COVID-19临床康复患者中检测细微心肌功能障碍的效果：所有患者（n=101，76% 为男性，平均年龄（55.45±11.14）岁）和对照组（n=30）均接受了临床评估和超声心动图检查，包括 GLS 评估：结果：患者和对照组的糖尿病、高血压和血脂异常患病率相当。COVID后患者的平均GLS明显低于对照组（分别为-16.21 ± 1.96 vs -18.49 ± 1.64，P = 0.004），与对照组相比，COVID后患者GLS>-18%的比例明显更高（分别为43% vs 22.58%，P =0.001）。患者组的 RV 游离壁纵向应变（RVFLS）也较低（22.35 ± 4.69 vs 24.19 ± 4.11，P =0.004），21.7% 的 COVID-19 后患者有病理性 RV FWLS（> -20%），对照组为 6.6%。重度 COVID-19 后患者的平均 GLS 明显低于对照组（即 -14.25 ± 1.92 vs -16.63 ± 1.61 vs -17.63 ± 1.91，重度、中度和轻度 COVID-19 患者的 P <0.0001）。在进行回归分析时，COVID-19 的严重程度（OR 7.762）是 GLS 受损的重要预测因素：结论：尽管总体 LVEF 正常，但 COVID-19 后康复患者的 LV GLS 和 RV FWLS 明显低于重度 COVID-19 感染者，与临床康复无关。这项研究重申了斑点追踪超声心动图的重要性，它是检测COVID-19康复后患者亚临床心肌功能障碍的重要成像方式。

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引用次数: 0

Association of non-HDL cholesterol with plaque burden and composition of culprit lesion in acute coronary syndrome. An intravascular ultrasound-virtual histology study 急性冠状动脉综合征患者非高密度脂蛋白胆固醇与斑块负荷和罪魁祸首病变组成的关系。血管内超声-虚拟组织学研究。

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian heart journal

Pub Date : 2024-09-01 DOI: 10.1016/j.ihj.2024.10.004

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

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。

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引用次数: 0

Clopidogrel resistance and its effect on clinical outcomes in acute coronary syndrome 氯吡格雷耐药性及其对急性冠状动脉综合征临床疗效的影响

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Indian heart journal

Pub Date : 2024-07-01 DOI: 10.1016/j.ihj.2024.07.003

Heemanshu Lodhi , Keshavamurthy Ganapathy Bhat , Vivek Singh Guleria , Ratheesh Kumar Janardhana Pillai , Ribhu Goel , Nitin Sharma , Anuka Sharma , Varun Sharma

Aim

The genetic polymorphism of CYP2C19 influences clopidogrel metabolism and resistance. Aim was to assess the association between CYP2C19 loss of function variation, clopidogrel resistance based on platelet reactivity units and clinical outcomes.

Methods

A total of 668 patients of Acute Coronary Sundrome (ACS) who underwent Percutaneous Coronary Intervention (PCI) were subjected to genetic screening and 143 patients undrewent platelet function test to study the association between drug metabolization and its effects based on platelet reactivity unit values.

Results

Clopidogrel resistance with CYP2C 19 loss of function variation was noted in 54.64% of patients. Clinical outcomes, such as target vessel revascularization, target lesion revascularization, in-stent restenosis, and stent thrombosis, were also studied.

Conclusion

CYP2C19 loss of function variation is strongly associated with clopidogrel resistance and adverse clinical outcomes.

受 CYP2C19 基因多态性影响的氯吡格雷耐药性是研究接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者临床疗效的一项挑战。共有 668 名患者接受了基因筛查，143 人进行了血小板功能检测，以研究药物代谢与基于血小板反应性单位值的药物作用之间的关联。在接受 PCI 治疗 6 个月后，54.64% 的患者出现了氯吡格雷耐药并伴有功能丧失变异。研究还对靶血管再通、靶病变再通、支架内再狭窄和支架血栓等临床结果进行了分析。这项研究强调了基因多态性、氯吡格雷耐药性和 PCI 后不良临床结果之间的关联。

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引用次数: 0