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Balloon pulmonary valvuloplasty: A systematic review 球囊肺动脉瓣成形术:系统综述。
IF 1.5 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2023.12.007
P. Syamasundar Rao

There is conclusive evidence for relief of pulmonary valve obstruction immediately after balloon pulmonary valvuloplasty (BPV) and at follow-up. Development of infundibular obstruction is seen in more severe PS cases and in older subjects. Reappearance of PS was observed in approximately 10 % of patients following BPV. The reasons for recurrence were found to be balloon/annulus ratio less than 1.2 and immediate post-BPV pulmonary valve peak gradients greater than 30 mmHg. Recurrent stenosis is successfully addressed by repeating BPV with lager balloons than used initially. Long-term results revealed continue relief of obstruction, but with development of pulmonary insufficiency, some patients requiring replacement of the pulmonary valve. It was concluded that BPV is the treatment of choice in the management valvar PS and that balloon/annuls ratio used for BPV should be lowered to 1.2 to 1.25. It was also suggested that strategies should be developed to prevent/reduce pulmonary insufficiency at long-term follow-up.

有确凿证据表明,球囊肺动脉瓣成形术(BPV)术后和随访期间,肺动脉瓣阻塞立即得到缓解。较严重的 PS 病例和年龄较大的受试者会出现肺底梗阻。约有 10% 的患者在 BPV 术后再次出现 PS。发现复发的原因是球囊/瓣环比小于 1.2,以及 BPV 术后肺动脉瓣峰值梯度大于 30 mmHg。通过使用比最初使用的更大的球囊重复进行 BPV,可以成功解决复发性狭窄问题。长期结果显示,阻塞继续得到缓解,但肺不张有所发展,一些患者需要更换肺动脉瓣。结论是 BPV 是治疗瓣膜 PS 的首选方法,BPV 使用的球囊/annuls 比率应降至 1.2 至 1.25。还有人建议,在长期随访中应制定预防/减少肺不张的策略。
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引用次数: 0
The potential influence of GSTT1 null genetic polymorphism on coronary artery disease: A pilot study in a South Indian cohort GSTT1 空基因多态性对冠心病的潜在影响:一项在南印度队列中进行的试点研究。
IF 1.5 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2024.03.002
Pranesh Rajamuthiah , Sabari Krishnan B B , Sharon Benita Antony , Teena Koshy

Background

Indians are known to have the highest rates of coronary artery disease (CAD), with the conventional risk factors failing to explain the increased risk. Possible candidate genes to study both the environmental and genetic risk associated with CAD is the glutathione S-transferase (GST) family, as it is involved in detoxification.

Methods

This case–control assessed the association between GSTM1 and GSTT1 polymorphisms in Indian patients with CAD. Fifty patients with CAD and 50 healthy volunteers were genotyped for the two polymorphisms by polymerase chain reaction. The genotype frequencies between the groups were compared, where a p-value of less than 0.05 was considered as statistically significant.

Results

There was a significant inverse association between GSTT1 null polymorphism and CAD susceptibility.

背景:众所周知,印度人罹患冠状动脉疾病(CAD)的比例最高,而传统的风险因素无法解释这种风险的增加。研究与 CAD 相关的环境和遗传风险的可能候选基因是谷胱甘肽 S-转移酶(GST)家族,因为它参与解毒:该病例对照评估了印度 CAD 患者中 GSTM1 和 GSTT1 多态性之间的关联。通过聚合酶链反应对 50 名 CAD 患者和 50 名健康志愿者进行了这两种多态性的基因分型。比较两组之间的基因型频率,P 值小于 0.05 即为具有统计学意义:结果:GSTT1 空多态性与 CAD 易感性之间存在明显的反相关性。
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引用次数: 0
Cardiovascular diseases and the heart–gut cross talk 心血管疾病与心脏-肠道交叉对话
IF 1.5 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2023.12.003
Snehali Majumder , Rohan Kiritkumar Makwana , Varun Shetty , Suparna Mukherjee , Pradeep Narayan

The purpose of this narrative review is to provide a comprehensive overview of current research on heart-gut cross talk and its implications for cardiovascular disease. To uncover relevant preclinical and clinical research examining heart-gut cross talk, a thorough literature search was undertaken utilising electronic databases. The chosen publications were critically examined, and major findings were synthesised to offer a thorough perspective on the subject. We want to synthesise the most recent study findings, explain the underlying mechanisms, and provide potential treatment techniques. By exploring bidirectional connection between the heart and the gut, we shed light on novel future options for the prevention and treatment of cardiovascular diseases. The heart-gut cross talk is an exciting field of study with implications for cardiovascular disease. Understanding the complex connection between the heart and the gastrointestinal tract may lead to the development of novel therapeutic targets and therapies for the prevention and management of cardiovascular diseases. Future research should concentrate on identifying the specific processes driving this crosstalk as well as assessing the efficacy of therapies targeting the gut microbiota and the gut–brain axis in improving cardiovascular outcomes.

这篇叙述性综述旨在全面概述当前有关心脏-肠道交叉对话及其对心血管疾病影响的研究。为了揭示检查心脏-肠道交叉对话的相关临床前和临床研究,我们利用电子数据库进行了全面的文献检索。我们对所选出版物进行了严格审查,并对主要研究结果进行了综合,以提供有关该主题的全面观点。我们希望综合最新的研究结果,解释其基本机制,并提供潜在的治疗技术。通过探索心脏与肠道之间的双向联系,我们为预防和治疗心血管疾病提供了新的未来选择。心脏-肠道交叉对话是一个令人兴奋的研究领域,对心血管疾病具有重要影响。了解心脏和胃肠道之间的复杂联系可能有助于开发预防和治疗心血管疾病的新型治疗靶点和疗法。未来的研究应集中于确定驱动这种串扰的特定过程,以及评估针对肠道微生物群和肠道-大脑轴的疗法在改善心血管预后方面的疗效。
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引用次数: 0
CSI clinical practice guidelines for dyslipidemia management: Executive summary CSI 血脂异常管理临床实践指南:执行摘要。
IF 1.5 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2023.11.271
Jitendra PS. Sawhney , Sivasubramanian Ramakrishnan , Kushal Madan , Saumitra Ray , P Balagopalan Jayagopal , Dorairaj Prabhakaran , Tiny Nair , Geevar Zachariah , Peeyush Jain , Jamshed Dalal , Sitaraman Radhakrishnan , Arun Chopra , Sanjay Kalra , Ashwani Mehta , Arvind K. Pancholia , Nitin K. Kabra , Dhiman Kahali , Tapan Ghose , Satyavir Yadav , Prafulla Kerkar , Rajeev Gupta

Dyslipidemias are the most important coronary artery disease (CAD) risk factor. Proper management of dyslipidemia is crucial to control the epidemic of premature CAD in India. Cardiological Society of India strived to develop consensus-based guidelines for better lipid management for CAD prevention and treatment. The executive summary provides a bird's eye-view of the ‘CSI: Clinical Practice Guidelines for Dyslipidemia Management’ published in this issue of the Indian Heart Journal. The summary is focused on the busy clinician and encourages evidence-based management of patients and high-risk individuals. The summary has serialized various aspects of lipid management including epidemiology and categorization of CAD risk. The focus is on management of specific dyslipidemias relevant to India-raised low density lipoprotein (LDL) cholesterol, non-high density lipoprotein cholesterol (non-HDL-C), apolipoproteins, triglycerides and lipoprotein(a). Drug therapies for lipid lowering (statins, non-statin drugs and other pharmaceutical agents) and lifestyle management (dietary interventions, physical activity and yoga) are summarized. Management of dyslipidemias in oft-neglected patient phenotypes-the elderly, young and children, and patients with comorbidities-stroke, peripheral arterial disease, kidney failure, posttransplant, HIV (Human immunodeficiency virus), Covid-19 and familial hypercholesterolemia is also presented. This consensus statement is based on major international guidelines (mainly European) and expert opinion of lipid management leaders from India with focus on the dictum: earlier the better, lower the better, longer the better and together the better. These consensus guidelines cannot replace the individual clinician judgement who remains the sole arbiter in management of the patient.

血脂异常是冠状动脉疾病(CAD)最重要的危险因素。适当的血脂异常管理是控制早发性冠心病在印度流行的关键。印度心脏病学会努力制定基于共识的指南,以更好地预防和治疗冠心病的脂质管理。执行摘要提供了“CSI:血脂异常管理临床实践指南”的鸟瞰图,发表在本期《印度心脏杂志》上。摘要的重点是忙碌的临床医生,并鼓励循证管理的病人和高危个体。摘要对脂质管理的各个方面进行了序列化,包括流行病学和冠心病风险分类。重点是管理与印度饲养的低密度脂蛋白(LDL)胆固醇、非高密度脂蛋白胆固醇(non-HDL-C)、载脂蛋白、甘油三酯和脂蛋白(a)相关的特异性血脂异常。本文总结了降低血脂的药物治疗(他汀类药物、非他汀类药物和其他药物)和生活方式管理(饮食干预、体育活动和瑜伽)。血脂异常的管理经常被忽视的患者表型-老年人,年轻人和儿童,以及合并症-中风,外周动脉疾病,肾衰竭,移植后,HIV(人类免疫缺陷病毒),Covid-19和家族性高胆固醇血症的患者也被提出。这一共识声明是基于主要的国际指南(主要是欧洲)和来自印度的脂质管理领导者的专家意见,重点是格言:越早越好,越低越好,越长越好,一起越好。这些共识指南不能取代个人临床医生的判断,谁仍然是唯一的仲裁者在病人的管理。
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引用次数: 0
Indian dyslipidaemia guidelines: Need of the hour 印度血脂异常指南:当务之急。
IF 1.5 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2024.01.008
Jitendra Pal Singh Sawhney, Rajeev Gupta
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引用次数: 0
Management of dyslipidemia in special groups 特殊群体的血脂异常管理。
IF 1.5 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2024.01.018
Jayagopal P B , Prafulla G. Kerkar

Dyslipidemia management in situations like pregnancy, in diseases like rheumatoid arthritis, human immunodeficiency virus (HIV) disease, chronic liver disease, and in the elderly are challenging scenarios. Pregnancy is a contraindication for many drugs. The interaction of various drugs used in HIV infection and rheumatoid arthritis makes it even more difficult to treat with conventional and approved drugs for dyslipidemia. Elderly and chronic renal failure patients often do not tolerate the drugs very well and the data of dyslipidemia management is very different. Lastly, COVID-19 is a unique scenario where clear information is yet to be provided. In this manuscript, the current understanding and available data on the treatment of dyslipidemia in these special situations are discussed.

在妊娠、类风湿性关节炎、人类免疫缺陷病毒(HIV)疾病、慢性肝病等疾病以及老年人等情况下,血脂异常的治疗都具有挑战性。妊娠是许多药物的禁忌症。艾滋病毒感染和类风湿性关节炎所用的各种药物之间的相互作用,使血脂异常的常规和批准药物的治疗变得更加困难。老年患者和慢性肾功能衰竭患者对药物的耐受性往往不佳,血脂异常的治疗数据也大相径庭。最后,COVID-19 是一种尚未提供明确信息的特殊情况。本手稿将讨论目前对这些特殊情况下血脂异常治疗的理解和现有数据。
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引用次数: 0
Trends in epidemiology of dyslipidemias in India 印度血脂异常流行病学趋势。
IF 1.5 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2023.11.266
Sonali Sharma , Kiran Gaur , Rajeev Gupta

Dyslipidemias are the most important coronary artery disease (CAD) risk factor. High total cholesterol and its principal subtypes: low-density lipoprotein (LDL) cholesterol and non-high-density lipoprotein (NHDL) cholesterol are the most important. Epidemiological and Mendelian randomization studies have confirmed role of raised triglycerides and lipoprotein(a). INTERHEART study reported a significant association of raised ApoB/ApoA1, total-, LDL-, and NHDL-cholesterol in South Asians. Prospective Urban Rural Epidemiology (PURE) study identified raised NHDL cholesterol as the most important risk factor. Regional and multisite epidemiological studies in India have reported increasing population levels of total-, LDL-, and NHDL cholesterol and triglycerides. India Heart Watch reported higher prevalence of total and LDL cholesterol in northern and western Indian cities. ICMR-INDIAB study reported regional variations in hypercholesterolemia (≥200 mg/dl) from 4.6 % to 50.3 %, with greater prevalence in northern states, Kerala, Goa, and West Bengal. Non-Communicable Disease Risk Factor Collaboration and Global Burden of Diseases Studies have reported increasing LDL- and NHDL-cholesterol in India. Studies among emigrant Indians in UK and USA have reported higher triglycerides in compared to Caucasians. Identification of regional variations and trends in dyslipidemias need more nationwide surveys. Prospective studies are needed to assess quantum of risk with CAD incidence.

血脂异常是最重要的冠状动脉疾病(CAD)风险因素。高总胆固醇及其主要亚型:低密度脂蛋白(LDL)胆固醇和非高密度脂蛋白(NHDL)胆固醇是最重要的因素。流行病学和孟德尔随机研究证实了甘油三酯和脂蛋白(a)升高的作用。INTERHEART 研究报告称,南亚人的载脂蛋白 B/载脂蛋白 A1、总胆固醇、低密度脂蛋白和非高密度脂蛋白胆固醇升高有显著关联。前瞻性城市农村流行病学(PURE)研究发现,NHDL 胆固醇升高是最重要的风险因素。印度的地区性和多地点流行病学研究报告显示,总胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇和甘油三酯的人群水平不断上升。印度心脏观察报告称,印度北部和西部城市的总胆固醇和低密度脂蛋白胆固醇患病率较高。ICMR-INDIAB 研究报告显示,高胆固醇血症(≥200 mg/dl)的地区差异从 4.6 % 到 50.3 % 不等,北部各邦、喀拉拉邦、果阿邦和西孟加拉邦的发病率更高。非传染性疾病危险因素合作组织和全球疾病负担研究报告称,印度的低密度脂蛋白胆固醇和非高密度脂蛋白胆固醇不断增加。对英国和美国移民印度人的研究报告显示,他们的甘油三酯高于白种人。要确定血脂异常的地区差异和趋势,需要进行更多的全国性调查。需要进行前瞻性研究,以评估与 CAD 发病率相关的风险量子。
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引用次数: 0
Role of PCSK9 inhibitors in the management of dyslipidaemia PCSK9 抑制剂在治疗血脂异常中的作用。
IF 1.5 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2023.12.011
Tiny Nair

Proprotein convertase subtilisin kexin9 (PCSK9) inhibitors are novel agents that lower LDL cholesterol and reduce cardio-vascular event rate. Being expensive, these agents are reserved for those with high risk or very high risk of CV events and with suboptimal response to statins and ezetimibe, with or without bempedoic acid or those intolerant to statins.

Proprotein convertase subtilisin kexin9(PCSK9)抑制剂是一种新型药物,可降低低密度脂蛋白胆固醇并减少心血管事件发生率。由于价格昂贵,这些药物只适用于心血管事件高风险或极高风险患者,以及对他汀类药物和依折麦布(含或不含贝美多酸)反应不佳的患者或对他汀类药物不耐受的患者。
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引用次数: 0
Management of triglycerides, non-high density lipoprotein cholesterol and high density lipoprotein cholesterol 管理甘油三酯,非高密度脂蛋白胆固醇和高密度脂蛋白胆固醇。
IF 1.5 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2023.11.004
Geevar Zachariah

Dyslipidaemia characterised by elevated total cholesterol/LDL-C, triglyceride or both or decreased HDL-C is an important risk factor for the development of ASCVD. Atherogenic dyslipidaemia characterised by high TG, low HDL-C and elevated small dense LDL (sdLDL) is more prevalent in Asian Indians. Normal level of TG is generally considered as <150 mg/dl. Hypertriglyceridemia is closely associated with obesity, metabolic syndrome and diabetes mellitus. Goals of management of hypertriglyceridemia are to lower the risk of atherosclerotic cardiovascular events and reduce the risk of pancreatitis. Lifestyle modification is important. In severe hypertriglyceridemia, TG lowering pharmacotherapy is important to prevent pancreatitis. In mild to moderate hypertriglyceridemia, pharmacotherapy is employed only if associated with ASCVD or high risk factors and not controlled with lifestyle modifications and statins.

Non-High Density Lipoprotein Cholesterol which estimates the cholesterol content of the atherogenic apoB containing lipoproteins, measured as total cholesterol minus HDL-C is equivalent to LDL-C in ASCVD risk assessment and superior to it in those with mild to moderate hypertriglyceridemia. Some international guidelines, have included measurement of non-HDL-C as primary therapeutic target for patients with ASCVD.

Low HDL cholesterol is common in Indians. Despite evidence of inverse relationship between HDL-C and cardiovascular events, HDL-C as a causative factor for development of atherosclerosis is unproven. Therapeutic strategies directed at increasing HDL-C levels have not been shown to have cardiovascular benefits and hence HDL-C is currently not a target for drug-based treatment

以总胆固醇/LDL-C、甘油三酯或两者均升高或HDL-C降低为特征的血脂异常是ASCVD发生的重要危险因素。以高TG、低HDL-C和高小密度低密度脂蛋白(sdLDL)为特征的动脉粥样硬化性血脂异常在亚洲印度人中更为普遍。一般认为TG的正常水平为
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引用次数: 0
Implantable cardioverter defibrillators for primary prevention in cardiomyopathies 用于心肌病一级预防的植入式心律转复除颤器。
IF 1.5 Q3 Medicine Pub Date : 2024-03-01 DOI: 10.1016/j.ihj.2024.03.005
Vineetha Kanneganti , Ajay Bahl , Manoj Kumar Rohit , Saurabh Mehrotra

Background

Implantable cardioverter defibrillators (ICD) are often used as primary prevention strategy for sudden cardiac death (SCD) in young individuals. This study analyzed appropriate therapies, complications and inappropriate shocks in the real-world Indian population.

Methods

All patients in the cardiomyopathy cohort under follow up who had ICD implanted as a primary prevention strategy were studied. The objective was to assess the incidence of appropriate ICD therapies, inappropriate therapies and complications. ICD was interrogated and stored electrograms analyzed. Underlying arrhythmia or conditions resulting in appropriate or inappropriate ICD therapy were studied. Correlation and regression studies was done to assess for the predictors of appropriate therapy.

Results

Fifty patients were followed up for a mean follow-up duration of 4.4 ± 3.1 years with total follow up of 220.2 patient years. Appropriate ICD therapy was delivered in 16 out of 50 (32%) patients, with 65 appropriate therapies (median 2 per patient, range: 0–20). Inappropriate therapy delivered in 7 of the 50 (14%) patients, with 44 inappropriate therapies (median 5 per patient, range: 0–20). Complications occurred in 8 of the 50 (16%) patients. Overall, the rate of appropriate therapy was 29.5 per 100 patient years, that of inappropriate therapy was 19.9 per 100 patient years and the rate of complications was 3.6 per 100 patient years.

Conclusions

When implanted for primary prevention in patients with cardiomyopathies over a mean period of 4.4 ± 3.1 years, appropriate ICD therapy was delivered in 32% patients. However, inappropriate therapy (14% patients) and complications (16% patients) were also common.

背景:植入式心律转复除颤器(ICD)通常被用作年轻人心脏性猝死(SCD)的一级预防策略。本研究分析了现实世界中印度人群的适当疗法、并发症和不当电击:方法:研究随访的心肌病队列中所有植入 ICD 作为一级预防策略的患者。目的是评估 ICD 适当疗法、不适当疗法和并发症的发生率。对 ICD 进行询问并分析存储的电图。研究了导致适当或不适当 ICD 治疗的潜在心律失常或病症。进行了相关性和回归研究,以评估适当治疗的预测因素:对 50 名患者进行了随访,平均随访时间为 4.4 ± 3.1 年,总随访时间为 220.2 年。50 名患者中有 16 人(32%)接受了适当的 ICD 治疗,其中 65 人接受了适当的治疗(中位数为每名患者 2 次,范围:0-20)。在 50 位患者中,有 7 位(14%)接受了不适当的治疗,其中 44 位接受了不适当的治疗(每位患者的中位数为 5,范围:0-20)。50 名患者中有 8 名(16%)出现并发症。总体而言,适当治疗率为每 100 个患者年 29.5 例,不适当治疗率为每 100 个患者年 19.9 例,并发症发生率为每 100 个患者年 3.6 例:结论:在平均 4.4 ± 3.1 年的时间内,为心肌病患者植入 ICD 进行一级预防时,32% 的患者接受了适当的 ICD 治疗。然而,治疗不当(14% 的患者)和并发症(16% 的患者)也很常见。
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引用次数: 0
期刊
Indian heart journal
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