Pub Date : 2024-05-01DOI: 10.1016/j.ihj.2024.06.008
Background
Acute pulmonary embolism (APE) is the third most common cause of vascular death. Data on APE from India and other low-and middle-income countries is sparse.
Objectives
Study the clinical characteristics, prognostic factors, in-hospital mortality (IMH) and 12 months mortality of patients with APE in India.
Methods
We prospectively enrolled 186 consecutive patients diagnosed with APE between November 2016 and November 2021 in Madras Medical College Pulmonary Embolism Registry (M-PER). All patients had electrocardiography and echocardiography. High risk patients and selected intermediate risk patients underwent fibrinolysis.
Results
75 % of our patients were below 50 years of age. 35 % were women. The mean time to presentation from symptom onset was 6.04 ± 10.01 days. 92 % had CT pulmonary angiography. Intermediate risk category (61.3 %) was the more common presentation followed by high risk (26.9 %). Electrocardiography showed S1Q3T3 pattern in 56 %. 76 % had right ventricular dysfunction and 12.4 % had right heart thrombi(RHT) by echocardiography. 50.5 % received fibrinolysis. Patients with RHT received fibrinolysis more frequently (78.3 % vs 46.6 %; p = 0.007). In-hospital mortality (IHM) was 15.6 %. Systemic arterial desaturation and need for mechanical ventilation independently predicted IHM. Ten patients (5.3 %) were lost to follow up. One year mortality was 26.7 % (47/176). One year mortality of patients discharged alive was similar among high, intermediate and low risk groups(14.8 % vs 1.9 % vs 10.5 %; p = 0.891).
Conclusions
Patients with PE are often young and present late in India. The in-hospital and 12 months mortality were high. Low and intermediate risk groups had a high post discharge mortality similar to high risk patients.
背景:急性肺栓塞(APE)是血管性死亡的第三大常见原因。印度和其他中低收入国家关于急性肺栓塞的数据很少:研究印度 APE 患者的临床特征、预后因素、院内死亡率(IMH)和 12 个月死亡率:我们在马德拉斯医学院肺栓塞登记处(M-PER)前瞻性地登记了 2016 年 11 月至 2021 年 11 月期间确诊为 APE 的 186 例连续患者。所有患者均进行了心电图和超声心动图检查。高危患者和部分中危患者接受了纤维蛋白溶解术:75%的患者年龄在50岁以下。女性占 35%。从症状出现到就诊的平均时间为 6.04 ± 10.01 天。92% 的患者接受了 CT 肺血管造影检查。中危(61.3%)是最常见的表现,其次是高危(26.9%)。56%的患者心电图显示为S1Q3T3型。超声心动图显示,76%的患者存在右心室功能障碍,12.4%的患者存在右心血栓(RHT)。50.5%的患者接受了纤维蛋白溶解治疗。RHT患者接受纤维蛋白溶解的比例更高(78.3% vs 46.6%;P = 0.007)。院内死亡率 (IHM) 为 15.6%。全身动脉饱和度降低和需要机械通气可独立预测院内死亡率。10名患者(5.3%)失去了随访机会。一年死亡率为 26.7%(47/176)。高危、中危和低危组患者出院后一年的死亡率相似(14.8% vs 1.9% vs 10.5%;P = 0.891):印度的 PE 患者通常比较年轻,发病时间较晚。结论:印度的 PE 患者多为年轻人,发病时间较晚,院内死亡率和 12 个月死亡率较高。低危和中危组出院后的死亡率与高危患者相似。
{"title":"Fibrinolysis and clinical outcomes in acute pulmonary embolism. Madras medical college pulmonary embolism (M-PER) registry from India","authors":"","doi":"10.1016/j.ihj.2024.06.008","DOIUrl":"10.1016/j.ihj.2024.06.008","url":null,"abstract":"<div><h3>Background</h3><p>Acute pulmonary embolism (APE) is the third most common cause of vascular death. Data on APE from India and other low-and middle-income countries is sparse.</p></div><div><h3>Objectives</h3><p>Study the clinical characteristics, prognostic factors, in-hospital mortality (IMH) and 12 months mortality of patients with APE in India.</p></div><div><h3>Methods</h3><p>We prospectively enrolled 186 consecutive patients diagnosed with APE between November 2016 and November 2021 in Madras Medical College Pulmonary Embolism Registry (M-PER). All patients had electrocardiography and echocardiography. High risk patients and selected intermediate risk patients underwent fibrinolysis.</p></div><div><h3>Results</h3><p>75 % of our patients were below 50 years of age. 35 % were women. The mean time to presentation from symptom onset was 6.04 ± 10.01 days. 92 % had CT pulmonary angiography. Intermediate risk category (61.3 %) was the more common presentation followed by high risk (26.9 %). Electrocardiography showed S1Q3T3 pattern in 56 %. 76 % had right ventricular dysfunction and 12.4 % had right heart thrombi(RHT) by echocardiography. 50.5 % received fibrinolysis. Patients with RHT received fibrinolysis more frequently (78.3 % vs 46.6 %; <em>p</em> = 0.007). In-hospital mortality (IHM) was 15.6 %. Systemic arterial desaturation and need for mechanical ventilation independently predicted IHM. Ten patients (5.3 %) were lost to follow up. One year mortality was 26.7 % (47/176). One year mortality of patients discharged alive was similar among high, intermediate and low risk groups(14.8 % vs 1.9 % vs 10.5 %; <em>p</em> = 0.891).</p></div><div><h3>Conclusions</h3><p>Patients with PE are often young and present late in India. The in-hospital and 12 months mortality were high. Low and intermediate risk groups had a high post discharge mortality similar to high risk patients.</p></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0019483224000816/pdfft?md5=9271347d815e3c7376e6f40a9c133cb4&pid=1-s2.0-S0019483224000816-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327473","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}
Pub Date : 2024-05-01DOI: 10.1016/j.ihj.2024.06.012
Objective
To evaluate paroxysmal atrial fibrillation (AF) prevalence in Indian adults who completed 24-Hour Holter monitoring.
Methods
A total of 23,847 patients (36.9 % women) were analyzed for AF duration using a software algorithm.
Results
AF was diagnosed in 4153 (17.4 %) patients with a median AF duration of 13 min and 55 s.
Conclusion
AF prevalence was high and largely untreated. The short duration of AF episodes indicates a low likelihood of detection during clinical visits, highlighting its potential underestimation in Indian healthcare.
{"title":"Prevalence of atrial fibrillation on a 24-hour Holter in adult Indians","authors":"","doi":"10.1016/j.ihj.2024.06.012","DOIUrl":"10.1016/j.ihj.2024.06.012","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate paroxysmal atrial fibrillation (AF) prevalence <strong>in Indian adults who completed 24-Hour Holter monitoring.</strong></p></div><div><h3>Methods</h3><p>A total of 23,847 patients (36.9 % women) were analyzed for AF duration using a software algorithm.</p></div><div><h3>Results</h3><p>AF was diagnosed in 4153 (17.4 %) patients with a median AF duration of 13 min and 55 s.</p></div><div><h3>Conclusion</h3><p>AF prevalence was high and largely untreated. The short duration of AF episodes indicates a low likelihood of detection during clinical visits, highlighting its potential underestimation in Indian healthcare.</p></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0019483224000853/pdfft?md5=089ea16496c1eeed636b0ced7957883b&pid=1-s2.0-S0019483224000853-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327474","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}
Pub Date : 2024-05-01DOI: 10.1016/j.ihj.2024.04.004
Heart failure (HF) is emerging as a major public health problem both in high- and low - income countries. The mortality and morbidity due to HF is substantially higher in low-middle income countries (LMICs). Accessibility, availability and affordability issues affect the guideline directed therapy implementation in HF care in those countries. This call to action urges all those concerned to initiate preventive strategies as early as possible, so that we can reduce HF-related morbidity and mortality. The most important step is to have better prevention and treatment strategies for diseases such as hypertension, ischemic heart disease (IHD), type-2 diabetes, and rheumatic heart disease (RHD) which predispose to the development of HF. Setting up dedicated HF-clinics manned by HF Nurses, can help in streamlining HF care. Subsidized in-patient care, financial assistance for device therapy, use of generic medicines (including polypill strategy) will be helpful, along with the use of digital technologies.
{"title":"Heart failure, the global pandemic: A call to action consensus statement from the global presidential conclave at the platinum jubilee conference of cardiological society of India 2023","authors":"","doi":"10.1016/j.ihj.2024.04.004","DOIUrl":"10.1016/j.ihj.2024.04.004","url":null,"abstract":"<div><p>Heart failure (HF) is emerging as a major public health problem both in high- and low - income countries. The mortality and morbidity due to HF is substantially higher in low-middle income countries (LMICs). Accessibility, availability and affordability issues affect the guideline directed therapy implementation in HF care in those countries. This call to action urges all those concerned to initiate preventive strategies as early as possible, so that we can reduce HF-related morbidity and mortality. The most important step is to have better prevention and treatment strategies for diseases such as hypertension, ischemic heart disease (IHD), type-2 diabetes, and rheumatic heart disease (RHD) which predispose to the development of HF. Setting up dedicated HF-clinics manned by HF Nurses, can help in streamlining HF care. Subsidized in-patient care, financial assistance for device therapy, use of generic medicines (including polypill strategy) will be helpful, along with the use of digital technologies.</p></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0019483224000579/pdfft?md5=21a02c9842145731941b3f3129ec1880&pid=1-s2.0-S0019483224000579-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140764688","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}
Pub Date : 2024-05-01DOI: 10.1016/j.ihj.2024.06.005
Background
We report the impact of capacity building and teleconsultation on change in the thrombolysis rates and one-year mortality in patients with STEMI using a hub and the spoke model of STEMI care.
Methods
Twenty secondary care public hospitals were linked with a teaching hospital as a hub centre and the impact of the intervention on change in ischemic time, thrombolysis rates and all-cause in-hospital and one-year mortality was compared.
Results
29 patients with STEMI were treated during pre-intervention from April 2020 to June 2020 and 255 patients during the post-intervention period from July 2020 to Oct 2021 in spoke centres. 245 patients were reported to a hub centre during the study period. The thrombolysis rate was significantly higher in the spoke centres after intervention (65.5%vs. 27.5 % p < 0.001) and was also significantly higher than in patients treated in a hub centre (65.5 % vs. 45.7 % p < 0.01). The in-hospital mortality was significantly lower in patients treated at spoke centres compared to those treated at the hub centre (7.8 % vs. 15.5 % < 0.003). The significant difference in mortality rate continued at one year (11.0 % vs.18.4 % p < 0.01). The median time from symptoms to thrombolytic therapy was significantly lower in STEMI patients treated in spoke centres compared to a hub centre (230 min vs. 356 min p < 0.001).
Conclusion
The hub and spoke model of STEMI care is effective in increasing thrombolysis rate, and decreasing in-hospital and one-year mortality rate.
背景我们报告了能力建设和远程会诊对 STEMI 患者溶栓率和一年死亡率变化的影响,采用的是 STEMI 护理的 "中心-轮辐 "模式。结果干预前(2020 年 4 月至 2020 年 6 月)有 29 名 STEMI 患者在辐式中心接受治疗,干预后(2020 年 7 月至 2021 年 10 月)有 255 名患者在辐式中心接受治疗。在研究期间,有 245 名患者向中心报告。干预后,轮辐中心的溶栓率明显较高(65.5% vs. 27.5 % p < 0.001),也明显高于在枢纽中心接受治疗的患者(65.5% vs. 45.7 % p < 0.01)。在辐射中心接受治疗的患者的院内死亡率明显低于在中心接受治疗的患者(7.8% vs. 15.5% <0.003)。一年后,死亡率仍有明显差异(11.0% 对 18.4% p <0.01)。与枢纽中心相比,在辐条中心接受治疗的 STEMI 患者从出现症状到接受溶栓治疗的中位时间明显缩短(230 分钟 vs. 356 分钟 p < 0.001)。
{"title":"Impact of capacity building and tele ECG based decision support on change in thrombolysis rate and inhospital and one year mortality in patients with STEMI, using hub and spoke model; multi-phasic intervention trial","authors":"","doi":"10.1016/j.ihj.2024.06.005","DOIUrl":"10.1016/j.ihj.2024.06.005","url":null,"abstract":"<div><h3>Background</h3><p>We report the impact of capacity building and teleconsultation on change in the thrombolysis rates and one-year mortality in patients with STEMI using a hub and the spoke model of STEMI care.</p></div><div><h3>Methods</h3><p>Twenty secondary care public hospitals were linked with a teaching hospital as a hub centre and the impact of the intervention on change in ischemic time, thrombolysis rates and all-cause in-hospital and one-year mortality was compared.</p></div><div><h3>Results</h3><p>29 patients with STEMI were treated during pre-intervention from April 2020 to June 2020 and 255 patients during the post-intervention period from July 2020 to Oct 2021 in spoke centres. 245 patients were reported to a hub centre during the study period. The thrombolysis rate was significantly higher in the spoke centres after intervention (65.5%vs. 27.5 % <em>p</em> < 0.001) and was also significantly higher than in patients treated in a hub centre (65.5 % vs. 45.7 % <em>p</em> < 0.01). The in-hospital mortality was significantly lower in patients treated at spoke centres compared to those treated at the hub centre (7.8 % vs. 15.5 % < 0.003). The significant difference in mortality rate continued at one year (11.0 % vs.18.4 % <em>p</em> < 0.01). The median time from symptoms to thrombolytic therapy was significantly lower in STEMI patients treated in spoke centres compared to a hub centre (230 min vs. 356 min <em>p</em> < 0.001).</p></div><div><h3>Conclusion</h3><p>The hub and spoke model of STEMI care is effective in increasing thrombolysis rate, and decreasing in-hospital and one-year mortality rate.</p></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0019483224000786/pdfft?md5=b9a05afaa1127f87d1be9229d5afe7e2&pid=1-s2.0-S0019483224000786-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141413369","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}
Pub Date : 2024-05-01DOI: 10.1016/j.ihj.2024.06.002
Aim
The present study compared the safety, efficacy, and tolerability of the new fixed-dose combination (FDC) of telmisartan 40 mg + bisoprolol 5 mg (TBP) tablets with the existing comparator FDC telmisartan 40 mg + metoprolol succinate ER 50 mg (TMS) tablets in patients with stage 1 and stage 2 hypertension.
Methodology
The multicentric, double-blind, parallel-group, comparative, prospective, phase-III clinical study involved 264 subjects with stage 1 and stage 2 hypertension from 10 centres across India. The selected subjects were randomized into two groups: group A received the TMS and group B received the new FDC TBP. The primary endpoint was the mean change in seated systolic blood pressure (SeSBP) and seated diastolic blood pressure (SeDBP) from baseline to week 12 in both the control and study arms. The secondary endpoint was achieving the target of SeSBP <140 mmHg and SeDBP <90 mmHg from baseline to week 12 in both groups. Safety and tolerability parameters were evaluated in both groups based on adverse effects (AEs) reported by the patients and the physician.
Results
Both treatment groups exhibited a reduction in BP after 2 weeks of treatment, which was sustained until 12 weeks. The mean change in SeSBP and SeDBP at weeks 2, 6, and 12 compared to the previous visit showed statistical significance (p < 0.001) in all cases for both groups A and B. The mean changes in SeSBP and SeDBP from baseline to study end were numerically higher in group B than in group A. The mean difference in SeSBP from baseline to study end was significantly higher in group B compared to group A (p = 0.029). By week 12, 88.28 % and 89.84 % of subjects in group B achieved SeSBP <140 mmHg and SeDBP <90 mmHg respectively, while 86.71 % and 91.40 % of subjects in group A achieved the same targets. Reported AEs were mostly mild to moderate in both treatment groups, and no serious AEs or deaths were reported. Tolerability was rated as ‘excellent’ by 93.75 % of subjects in group B and 91.40 % of subjects in group A.
Conclusion
Both the new FDC TBP and the existing comparator TMS combination therapy have comparable efficacy, tolerability, and safety for the management of stage 1 and stage 2 hypertension.
{"title":"Comparison of the efficacy, safety, and tolerability of the FDC of telmisartan + bisoprolol with telmisartan + metoprolol succinate ER combination therapy for stage 1 and stage 2 hypertension: A double-blind, multicentric, phase-III clinical study","authors":"","doi":"10.1016/j.ihj.2024.06.002","DOIUrl":"10.1016/j.ihj.2024.06.002","url":null,"abstract":"<div><h3>Aim</h3><p>The present study compared the safety, efficacy, and tolerability of the new fixed-dose combination (FDC) of telmisartan 40 mg + bisoprolol 5 mg (TBP) tablets with the existing comparator FDC telmisartan 40 mg + metoprolol succinate ER 50 mg (TMS) tablets in patients with stage 1 and stage 2 hypertension.</p></div><div><h3>Methodology</h3><p>The multicentric, double-blind, parallel-group, comparative, prospective, phase-III clinical study involved 264 subjects with stage 1 and stage 2 hypertension from 10 centres across India. The selected subjects were randomized into two groups: group A received the TMS and group B received the new FDC TBP. The primary endpoint was the mean change in seated systolic blood pressure (SeSBP) and seated diastolic blood pressure (SeDBP) from baseline to week 12 in both the control and study arms. The secondary endpoint was achieving the target of SeSBP <140 mmHg and SeDBP <90 mmHg from baseline to week 12 in both groups. Safety and tolerability parameters were evaluated in both groups based on adverse effects (AEs) reported by the patients and the physician.</p></div><div><h3>Results</h3><p>Both treatment groups exhibited a reduction in BP after 2 weeks of treatment, which was sustained until 12 weeks. The mean change in SeSBP and SeDBP at weeks 2, 6, and 12 compared to the previous visit showed statistical significance (<em>p</em> < 0.001) in all cases for both groups A and B. The mean changes in SeSBP and SeDBP from baseline to study end were numerically higher in group B than in group A. The mean difference in SeSBP from baseline to study end was significantly higher in group B compared to group A (<em>p</em> = 0.029). By week 12, 88.28 % and 89.84 % of subjects in group B achieved SeSBP <140 mmHg and SeDBP <90 mmHg respectively, while 86.71 % and 91.40 % of subjects in group A achieved the same targets. Reported AEs were mostly mild to moderate in both treatment groups, and no serious AEs or deaths were reported. Tolerability was rated as ‘excellent’ by 93.75 % of subjects in group B and 91.40 % of subjects in group A.</p></div><div><h3>Conclusion</h3><p>Both the new FDC TBP and the existing comparator TMS combination therapy have comparable efficacy, tolerability, and safety for the management of stage 1 and stage 2 hypertension.</p></div><div><h3>Trial registry name</h3><p>Clinical Trials Registry of India (CTRI)</p></div><div><h3>Trial registration no</h3><p>CTRI/2021/11/037,926</p></div><div><h3>Protocol no</h3><p>MLBTL/05/2021</p></div><div><h3>Protocol url</h3><p><span><span>https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=62069&EncHid=&userName=bisoprolol</span><svg><path></path></svg></span></p></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0019483224000750/pdfft?md5=ec2c77a9c028415128a47dbccdef593b&pid=1-s2.0-S0019483224000750-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141317056","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}
Pub Date : 2024-05-01DOI: 10.1016/j.ihj.2024.06.011
Objective
To investigate the association between three-dimensional (3-D) left ventricular ejection fraction (LVEF) and various speckle tracking echocardiographic (STE) strain parameters in non-ischemic left bundle branch block (LBBB) patients with major adverse cardiovascular events (MACE) during a one-year follow-up phase.
Method
A total of 50 patients with non-ischemic LBBB were assessed using various parameters of 3-D echocardiography. They were compared with their same-age and sex control group and then followed up with repeat 3-D echocardiography for MACE for one year.
Results
Composite outcomes were seen in (n = 11 [22 %], including cardiovascular mortality (n = 2 [4.0 %]) and hospitalization for heart failure (n = 9 [18.0 %]). Mean values of the left ventricle (LV) global longitudinal (GLS), circumferential (GCS), and radial (GRS) strains were −14.4 ± 5.6, −14.3 ± 5.8, and 15.3 ± 5.9 respectively in the study cases. Initial GLS values were significantly impaired among those who had clinical events (−9.2 vs −15.9). Also, significant worsening of GLS (p value < 0.001) was seen in patients with composite outcomes on follow-up. Cut-off values in receiver operating characteristic analyses for composite outcomes were: GLS more than −13.5, GCS more than −12.5, and GRS less than 14.5. Intra-class correlations for both intra-observer and inter-observer variability were found to be good.
Conclusion
Impaired LV GLS and low 3-D LVEF are significantly associated with the occurrence of MACE in patients with non-ischemic LBBB. This strong association of LV GLS with outcomes can aid in risk stratification, prognostication, and clinical decision-making in non-ischemic LBBB.
{"title":"Assessment of three-dimensional (3-D) left ventricular ejection fraction and speckled tracking echocardiographic strain parameters in non-ischemic left bundle branch block (LBBB) patients and their association with cardiovascular events – A prospective observational study","authors":"","doi":"10.1016/j.ihj.2024.06.011","DOIUrl":"10.1016/j.ihj.2024.06.011","url":null,"abstract":"<div><h3>Objective</h3><p>To investigate the association between three-dimensional (3-D) left ventricular ejection fraction (LVEF) and various speckle tracking echocardiographic (STE) strain parameters in non-ischemic left bundle branch block (LBBB) patients with major adverse cardiovascular events (MACE) during a one-year follow-up phase.</p></div><div><h3>Method</h3><p>A total of 50 patients with non-ischemic LBBB were assessed using various parameters of 3-D echocardiography. They were compared with their same-age and sex control group and then followed up with repeat 3-D echocardiography for MACE for one year.</p></div><div><h3>Results</h3><p>Composite outcomes were seen in (<em>n</em> = 11 [22 %], including cardiovascular mortality (<em>n</em> = 2 [4.0 %]) and hospitalization for heart failure (<em>n</em> = 9 [18.0 %]). Mean values of the left ventricle (LV) global longitudinal (GLS), circumferential (GCS), and radial (GRS) strains were −14.4 ± 5.6, −14.3 ± 5.8, and 15.3 ± 5.9 respectively in the study cases. Initial GLS values were significantly impaired among those who had clinical events (−9.2 vs −15.9). Also, significant worsening of GLS (<em>p</em> value < 0.001) was seen in patients with composite outcomes on follow-up. Cut-off values in receiver operating characteristic analyses for composite outcomes were: GLS more than −13.5, GCS more than −12.5, and GRS less than 14.5<strong>.</strong> Intra-class correlations for both intra-observer and inter-observer variability were found to be good.</p></div><div><h3>Conclusion</h3><p>Impaired LV GLS and low 3-D LVEF are significantly associated with the occurrence of MACE in patients with non-ischemic LBBB. This strong association of LV GLS with outcomes can aid in risk stratification, prognostication, and clinical decision-making in non-ischemic LBBB.</p></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0019483224000841/pdfft?md5=0be4f749fc53b6cef525e35bd22b9058&pid=1-s2.0-S0019483224000841-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327472","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}
Pub Date : 2024-05-01DOI: 10.1016/j.ihj.2024.06.010
Background
Non-communicable diseases are important causes of morbidity and mortality throughout the world.
Methods
A community-based cross-sectional study conducted in 10 Indian states using multi-stage random sampling procedures. Information was collected on socio-economic and demographic particulars, anthropometric measurements such as height, weight and waist circumference, fasting blood glucose and blood pressure was measured. One day 24-h dietary recall was done for foods and nutrient intakes. Bivariate and multivariate step-wise logistic regression analyses was done.
Results
The prevalence of overweight/obesity among rural adults was 23.4 % (95 % CI: 22.9–23.9), while age adjusted prevalence of pre-diabetes was 8.4 % (95 % CI: 8.1–8.7) and diabetes was 6.8, (95 % CI 6.7–7.1), respectively. The prevalence of diabetes was lowest in Uttar Pradesh, West Bengal and Odisha (3–4%) and higher in Kerala and Tamil Nadu (12–15 %). The odds of diabetes was 5.5 times more among elderly, 1.3 times higher among Christians and among high income groups, and 2 times among overweight (CI: 1.50–2.50), obese (CI: 1.61–2.76) and abdominal obesity (OR; 1.57; CI: 1.29–1.91) and 1.6 times more among hypertensives. The odds of diabetes were high among those consuming the lower tertiles of carbohydrates, pulses, milk and milk products and folic acid.
Conclusion
the age-adjusted prevalence of diabetes and pre-diabetes was 6.8 % and 8.4 % respectively and the odds of diabetes was high among elderly, among high socio-economic groups, overweight/obese subjects and among hypertensives. Also, knowledge about symptoms of diabetes was low. There is a need to improve awareness for early diagnosis and treatment for control of diabetes and hypertension.
{"title":"Overweight/obesity, pre-diabetes, diabetes and its association with hypertension and other factors among rural adults (≥18 years) in India","authors":"","doi":"10.1016/j.ihj.2024.06.010","DOIUrl":"10.1016/j.ihj.2024.06.010","url":null,"abstract":"<div><h3>Background</h3><p>Non-communicable diseases are important causes of morbidity and mortality throughout the world.</p></div><div><h3>Methods</h3><p>A community-based cross-sectional study conducted in 10 Indian states using multi-stage random sampling procedures. Information was collected on socio-economic and demographic particulars, anthropometric measurements such as height, weight and waist circumference, fasting blood glucose and blood pressure was measured. One day 24-h dietary recall was done for foods and nutrient intakes. Bivariate and multivariate step-wise logistic regression analyses was done.</p></div><div><h3>Results</h3><p>The prevalence of overweight/obesity among rural adults was 23.4 % (95 % CI: 22.9–23.9), while age adjusted prevalence of pre-diabetes was 8.4 % (95 % CI: 8.1–8.7) and diabetes was 6.8, (95 % CI 6.7–7.1), respectively. The prevalence of diabetes was lowest in Uttar Pradesh, West Bengal and Odisha (3–4%) and higher in Kerala and Tamil Nadu (12–15 %). The odds of diabetes was 5.5 times more among elderly, 1.3 times higher among Christians and among high income groups, and 2 times among overweight (CI: 1.50–2.50), obese (CI: 1.61–2.76) and abdominal obesity (OR; 1.57; CI: 1.29–1.91) and 1.6 times more among hypertensives. The odds of diabetes were high among those consuming the lower tertiles of carbohydrates, pulses, milk and milk products and folic acid.</p></div><div><h3>Conclusion</h3><p>the age-adjusted prevalence of diabetes and pre-diabetes was 6.8 % and 8.4 % respectively and the odds of diabetes was high among elderly, among high socio-economic groups, overweight/obese subjects and among hypertensives. Also, knowledge about symptoms of diabetes was low. There is a need to improve awareness for early diagnosis and treatment for control of diabetes and hypertension.</p></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S001948322400083X/pdfft?md5=45ce98c0c78d7e919e7b9fc9aafb56a9&pid=1-s2.0-S001948322400083X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141440446","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}
Pub Date : 2024-05-01DOI: 10.1016/j.ihj.2024.06.006
Residual Syntax Score (RSS) is derived from Syntax Score to quantify the burden of residual coronary artery disease after percutaneous coronary intervention (PCI). As data is limited, we report predictive utility of Residual SYNTAX Score in relation to in hospital and 1 year mortality of the patients undergoing percutaneous coronary intervention (PCI).
{"title":"Prognostic value of residual SYNTAX score in patients with coronary artery disease undergoing percutaneous coronary intervention-cohort study","authors":"","doi":"10.1016/j.ihj.2024.06.006","DOIUrl":"10.1016/j.ihj.2024.06.006","url":null,"abstract":"<div><p>Residual Syntax Score (RSS) is derived from Syntax Score to quantify the burden of residual coronary artery disease after percutaneous coronary intervention (PCI). As data is limited, we report predictive utility of Residual SYNTAX Score in relation to in hospital and 1 year mortality of the patients undergoing percutaneous coronary intervention (PCI).</p></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0019483224000798/pdfft?md5=03d5cc0a5062dd9db955fd16215b672a&pid=1-s2.0-S0019483224000798-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141317058","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}
Pub Date : 2024-03-01DOI: 10.1016/j.ihj.2023.12.001
Kavita Singh , Dorairaj Prabhakaran
This review article describes the pathophysiological mechanisms linking Apolipoprotein B (Apo-B) and atherosclerosis, summarizes the existing evidence on Apo B as a predictor of atherosclerotic cardiovascular disease and recommendations of (inter)national treatment guidelines regarding Apo B in dyslipidemia management. A single Apo B molecule is present in every particle of very low-density lipoprotein, intermediate density lipoprotein, low density lipoprotein, and lipoprotein(a). This unique single Apo B per particle ratio makes plasma Apo B concentration a direct measure of the number of circulating atherogenic lipoproteins. This review of global evidence on Apo B as a biomarker for atherosclerosis confirms that Apo B is a single atherogenic lipid marker present in all lipids sub-fractions except HDL-C, and thus, Apo B integrates and extends the information from triglycerides and cholesterol, which could simplify and improve care for atherosclerotic cardiovascular disease.
这篇综述文章描述了载脂蛋白 B(Apo-B)与动脉粥样硬化之间的病理生理机制,总结了载脂蛋白 B 作为动脉粥样硬化性心血管疾病预测因子的现有证据,以及各国(间)治疗指南对血脂异常管理中载脂蛋白 B 的建议。极低密度脂蛋白、中密度脂蛋白、低密度脂蛋白和脂蛋白(a)的每一个颗粒中都有一个载脂蛋白 B 分子。这种独特的每颗粒单一载脂蛋白 B 比率使血浆载脂蛋白 B 浓度成为循环中致动脉粥样硬化脂蛋白数量的直接测量指标。这份关于载脂蛋白 B 作为动脉粥样硬化生物标志物的全球证据综述证实,载脂蛋白 B 是一种单一的致动脉粥样硬化脂质标志物,存在于除高密度脂蛋白胆固醇以外的所有脂质亚组分中,因此,载脂蛋白 B 整合并扩展了甘油三酯和胆固醇的信息,可简化并改善动脉粥样硬化性心血管疾病的治疗。
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Peripheral arterial disease (PAD) affects 12 % of adult population and is increasing globally and in India. Peripheral arterial disease when associated with atherosclerosis in two or more other arterial beds such as coronary artery disease (CAD), mesenteric/renal artery and cerebrovascular disease (CVD), is known as polyvascular disease. The Reduction of Atherothrombosis for Continued Health (REACH) registry reported that 1 out of 6 patients had multi-vascular bed involvement. Progression of PAD to critical limb ischaemia (CLI) is seen in 1 % of affected patients per year, but patients who progress to CLI may have a 10- to 15-fold increased risk of cardiovascular death.
The 2019 ECS/EAS guidelines for the management of dyslipidaemias have suggested that for primary or secondary prevention in very high risk, patients should follow a therapeutic regimen that achieves >50 % LDL-C reduction from baseline and an LDL-C goal of <55 mg/dl. High Intensity Statin is mainstay of treatment but optimal management is inadequate. Statin treatment reduces all-cause mortality by 39 %, CV death by 41 %, CV outcomes by 34 %, ischaemic stroke by 28 %, acute limb ischaemia by 30 % and amputations by 35 %. Ezetimibe when added to statins in IMPROVE-IT trial, showed significant reduction of MACE. PCSK9 inhibitor (FOURIER TRIAL) showed reduction in primary end point in PAD vs Non PAD patients (3.5 % vs 1.6 %).
There is a critical need for an Indian multi-disciplinary task force for research on the direct impact of lipid-lowering agents on limb salvage rates and major limb-related events in PAD patients.
{"title":"Dyslipidemia and peripheral arterial disease","authors":"Ajay Yadav , Vivek Sawant , Varinder Singh Bedi , Kanupriya Yadav","doi":"10.1016/j.ihj.2024.01.010","DOIUrl":"10.1016/j.ihj.2024.01.010","url":null,"abstract":"<div><p>Peripheral arterial disease (PAD) affects 12 % of adult population and is increasing globally and in India. Peripheral arterial disease when associated with atherosclerosis in two or more other arterial beds such as coronary artery disease (CAD), mesenteric/renal artery and cerebrovascular disease (CVD), is known as polyvascular disease. The Reduction of Atherothrombosis for Continued Health (REACH) registry reported that 1 out of 6 patients had multi-vascular bed involvement. Progression of PAD to critical limb ischaemia (CLI) is seen in 1 % of affected patients per year, but patients who progress to CLI may have a 10- to 15-fold increased risk of cardiovascular death.</p><p>The 2019 ECS/EAS guidelines for the management of dyslipidaemias have suggested that for primary or secondary prevention in very high risk, patients should follow a therapeutic regimen that achieves >50 % LDL-C reduction from baseline and an LDL-C goal of <55 mg/dl. High Intensity Statin is mainstay of treatment but optimal management is inadequate. Statin treatment reduces all-cause mortality by 39 %, CV death by 41 %, CV outcomes by 34 %, ischaemic stroke by 28 %, acute limb ischaemia by 30 % and amputations by 35 %. Ezetimibe when added to statins in IMPROVE-IT trial, showed significant reduction of MACE. PCSK9 inhibitor (FOURIER TRIAL) showed reduction in primary end point in PAD vs Non PAD patients (3.5 % vs 1.6 %).</p><p>There is a critical need for an Indian multi-disciplinary task force for research on the direct impact of lipid-lowering agents on limb salvage rates and major limb-related events in PAD patients.</p></div>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0019483224000105/pdfft?md5=90d83a5367a65af68b7f54906ee2788e&pid=1-s2.0-S0019483224000105-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139472341","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}