Indian heart journal最新文献

Patients with CKD are at increased risk for cardiovascular events. Clinical studies suggest statins reduce all-cause mortality and cardiovascular events in patients with CKD. Lipid lowering therapy with statin with or without ezetemibe is recommended for most of the patients in patients with eGFR <60 mL/min and also in those who have an increased urinary albumin-to-creatinine ratio (≥3 mg/mmol) for at least 3 months. Evidence suggests that it should not be started for hemodialysis patients without evidence of ASCVD. Patients who were already taking statins or statin/ezetimibe combination at the time of dialysis should consider continuing these medications, especially if they have ASCVD. Fibrates should not be used in conjunction with statins in patients with CKD, and ezetimibe monotherapy is also not recommended. The role of PCSK9 inhibitors is evolving suggests that it is effective in lowering LDL cholesterol without affecting the renal outcomes.

Objective

The primary objective of the study was to investigate the correlation between high-sensitivity troponin I (hsTropI) levels during hospitalization and the prognostic outcome in patients with non-acute coronary syndrome (non-ACS) acute heart failure, over a follow-up period of one year. The secondary objective was to assess and characterize acute heart failure during index hospitalization.

Methods

High sensitivity troponin I value was noted both at the time of admission and discharge. The correlation of admission hsTropI along with other parameters and risk factors with in-hospital mortality was studied. Patients of index hospitalization after discharge were followed up for one year and the composite endpoint of cardiovascular death or re-hospitalization for heart failure was noted. The correlation between admission and discharge hsTropI values with the composite endpoint was then analyzed.

Results

Out of 350 patients, 38 (10.8 %) patients died during index hospitalization while 142 patients (46 %) developed composite outcomes during follow-up. Age, previous history of heart failure, atrial fibrillation, low left ventricular ejection fraction, systolic blood pressure, and high values of hsTropI above 99th percentiles were independent in-hospital mortality predictors. The value of hsTropI at the time of admission was not associated with poor composite outcome during follow-up. However, patients who showed an increasing trend of hsTropI value at the time of discharge were found to have a significant increase in the composite outcome.

Conclusion

High-sensitivity troponin I is a valuable biomarker that can predict in-hospital mortality and long-term follow-up outcomes in patients with acute heart failure. It plays a crucial role in developing improved strategies for heart failure surveillance and management in the community.

Lipid disorders are common in several endocrine conditions. Diabetes mellitus, hypothyroidism and Cushing's syndrome are the common endocrine disorders with dyslipidemia. Dyslipidemia has a significant impact on endocrine and metabolic health and the risk of atherosclerotic cardiovascular disease. In most cases of dyslipidemia, the suspicion of endocrine diseases must be based on clinical symptoms and signs. Optimal management of the dyslipidemia requires treatment of the underlying endocrine condition. Lipid lowering therapy is a useful adjunct or a requirement in many cases. The Indian guidelines provide a pragmatic and practical approach to the management of lipid disorders in endocrine disease, as well as endocrine vigilance with lipid therapy.

Background

Left atrial (LA) volume indexing for body surface area (BSA) is the common practice. Since LA volume index is of cardiovascular pathophysiologic significance, it is suggested that indexing for other body size parameters be explored to evaluate a more appropriate alternative method. The aims of this study were to find normal and the best cutoff values for LA volume indexed for multiple body size parameters in normal Indian subjects.

Methods

Data from the multicentric prospective INDEA study conducted through 2018 to 2020 was reviewed and subjects without known cardiac disease and completely normal echocardiograms that had the left atrial volume (LAV) measured by biplane Simpson's method were included. LAV was indexed by BSA (ml/m²), by height (LAV/m), by height raised to exponent 1.72 (mL/m ^1.72 and 2.7 (ml/m^2.7), by body weight, by ideal body weight (IBW), by ideal body surface area (IBSA) and by height squared (ml/h²).

Results

A total of 1046 healthy volunteers (382 female, 38%), mean age 38 ± 10.4 years (range 30–48 years) and body mass index 23.6 kg/m² (22–25 kg/m²) were analyzed. Mean and normal values were: LAV/BSA 18.7 + 3.15 ml/m² (range 15–21 ml/m²), LAV/ht 26.0 ± 4.5 ml/m, (range 17–35 ml/m), LAV/ht² 16 ± 2.8 ml/m² (range 10.4–21.6 ml/m²) and LAV/ht^2.7 8.71 ± 2.2 ml/m^2.7 (range 6.98–13.58 ml/m^2.7). Using ROC curve analysis, LAV/h ^1.72 had the highest AUC and the best predictive value to identify LA enlargement but not very different from LAV/BSA. Ideal BSA and ideal body weight as a denominator did not provide any incremental value.

Conclusion

Normal values for LAV indexed for height, weight, body surface area by three different methods of height as an allometric parameter are described in normal Indian individuals. We reinforce that LA volume indexation for BSA is an acceptable and robust method in non-obese Indian subjects. Indexing for height ^1.72 is probably slightly superior method to evaluate LAV.

Background

Despite significant progress in primary prevention, rates of myocardial infarction (MI) in South Asian population is alarmingly high.

Objectives

We sought to compare risk factor profiles and outcomes between individuals with ST-Segment Elevation Myocardial Infarction (STEMI) in young (<50 years) and old (≥50 years) age groups.

Methods

North India STEMI Registry (NORIN-STEMI) is a prospective observational registry of patients hospitalised with STEMI. We conducted a study of young patients (<50 years) regarding their risk factors for coronary artery disease (CAD), in-hospital and 30-day mortality and compared with their older counterpart.

Results

Among 5335 patients enrolled, 1752 (32.8%) were young and were 19 years younger than the older cohort. Major risk factors in young patients were physical inactivity (75.1%) and alcohol intake (67.8%). Higher prevalence of tobacco use (66.6% vs 52.4%), but lower prevalence of diabetes (16% vs 26.3%) and hypertension (18.5% vs 29.9%) were seen in young STEMI. Young patients were less likely to die both in-hospital (5.9% vs 10.0%) and at 30-days (11.1% vs 16.2%). Left ventricular ejection fraction (LVEF) < 30% at admission [OR: 8.00, 95% confidence interval (CI): 4.60–13.90, P < 0.001 in-hospital, OR: 3.92, 95% CI: 2.69–5.73 at 30-days] and female sex were strongest predictors of mortality.

Conclusions

Young STEMI patients constituted one-third of total cohort. Most of them were tobacco consumers with lesser prevalence of diabetes and hypertension. They were less likely to die both in-hospital and at 30 days because of earlier presentation to a health care facility and hence a relatively preserved LVEF.

Background

The data on prognostic values of SYNTAX score II in patients undergoing percutaneous coronary intervention is limited. We report predictive utility of SYNTAX score II in relation to in hospital and 1 year mortality of the patients undergoing percutaneous coronary intervention.

Methods

This was a cohort study of patients who underwent percutaneous coronary intervention (PCI) at a single centre from January 2018 to December 2019. In hospital and 12-month events and mortality was analysed among 1000 patients. The patients were divided into 3 groups based on tertiles of Syntax II score (<22, 22–27.7 and >27.7).

Result

The total mortality at 12 months was 60 (6%). Major adverse cardiac events (MACE) occurred in 87 (9%). The patients who died had higher SYNTAX score II score compared to those alive at 12 months 34 (38, 24) vs 24 (28.1, 20.9) P < 0.01. The same trend was seen in patients who had major adverse cardiac events (MACE) 28 (34, 24) vs 24 (28.6, 21) P < 0.01 Among the 3 groups of SYNTAX score II, in hospital mortality, all-cause mortality, cardiovascular death, myocardial infarction, unstable angina, revascularization and major adverse cardiac events (MACE) were higher in the third tertile (>27.7) compared the lower tertiles.

Conclusion

The patients who had higher SYNTAX score II had more in hospital and 12 month mortality and major adverse cardiac events (MACE). SYNTAX II score is a better predictor of in-hospital, and 12 month cardiovascular and all cause mortality.

Lowering of cholesterol containing atherogenic particles through lipid lowering therapies is of outmost important in both in the elderly age group and younger age group in reducing the cardiovascular risk. This chapter summarizes the current existing knowledge regarding the factors which affects the key decision-making process in patients with older age, and also in special circumstance where the direct evidence of benefit for cholesterol lowering is lacking. Effort has been made to briefly summarize the recommendations to the patient and his/her family based on risk stratification of atherosclerotic versus non-atherosclerotic cardiovascular disease, comorbidity burden, quality of life, survival prognosis, lifestyle/socioeconomic status and presence of frailty. Here in this chapter, we have collated and presented the available robust clinical trial evidence which is very much necessary for the assessment of risk versus benefit for hypolipidemic drugs in the elderly age group.

While plethora of pharmacological interventions has evolved including statins, ezetimibe, bempedoic acid, PCSK9 inhibitors, Inclisiran etc., but it is essential to establish lipid-lowering therapy goals based on the stroke subtype and the presence of comorbidities. Here in this section we have reviewed the collated clinical evidences for optimal drug regimen recommendation for elderly stroke patients for both primary and secondary prevention.

Cardiovascular disease complicates 1–4% of pregnancies. Women with heart disease going through pregnancy are on the increase. While global maternal deaths during pregnancy are decreasing, India remains a significant contributor to maternal deaths in the world. Cardiovascular disease during pregnancy is the leading cause of maternal mortality in developed nations, and this trend is expected soon in India, with the ongoing obstetric transition.

Research in developed nations indicates that a high proportion of maternal mortality related to heart disease is preventable. However, India lacks indigenous data, risk stratification tools, management guidelines, and a well-defined cardio-obstetric team concept for pregnant women with heart disease.

There is a pressing need to establish national registries, develop risk stratification tools, develop and disseminate management guidelines, and create dedicated cardio-obstetric programs. This article provides a comprehensive overview of this requirement and offers solutions to bridge the existing gaps in India's maternal healthcare landscape.

Evidence from the existing literature suggests that exercise has positive effects for prevention and treatment of cardiovascular diseases by reducing risk factors such as elevated blood lipids. Based on clinical and observational clinical trials, it is well established that increased physical activity and regular exercise has a favourable impact on blood lipids and lipoprotein profiles. Exercise training significantly decreases blood triglycerides concentration and increases high density lipoprotein cholesterol levels. Though the Indian data depicting the effect of exercise on lipids is scarce, exercise directly improves “atherogenic dyslipidaemia” which is frequently present among Indians i.e. HDL-C is increased, TG is reduced and LDL-C particle size is improved. While drug therapy is key to the treatment of dyslipidaemia, lifestyle alterations such as exercise should continue to be actively promoted and encouraged by clinicians. Exercise is a low cost, non pharmacological therapeutic lifestyle change that is of value to lipid metabolism and cardiovascular fitness.