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Role of MDCT in Assessment of Long-term Graft Patency in Female Patients MDCT在评估女性患者长期移植物通畅中的作用
Pub Date : 2022-12-17 DOI: 10.25259/mm_ijcdw_475
Amin Dhanush Jayananda, S. Patnaik, A. Rao, S. Rammurti
The aim of the study was to analyze the utility of CT-coronary angiogram (CT-CAG) in assessment of long-term graft patency compared to conventional invasive coronary angiography (ICA) and highlight any gender-specific issues in female post-coronary artery bypass surgery (CABG) patients.The medical records and images of 30 patients including four female patients who had CABG in the past and underwent both conventional and CT-CAGs were analyzed retrospectively.We studied 30 patients who had CABG in whom both CT-CAG and conventional coronary angiograms were performed. CT-CAG was able to evaluate the grafts better than ICA and was useful even in those which could not be assessed due to technical failure by ICA. There were only four female patients in this series. In first patient, the arterial graft (left internal mammary artery [LIMA]) was patent but distal run off was absent in LAD in CT-CAG images and was reported as poor in conventional coronary angiogram. The second patient had CABG 10 years back. The arterial graft (LIMA) to LAD was patent and there was total block in SVG graft to RCA at proximal anastomotic site. The third patient with hypertension and diabetes also had CABG 10 years back. Both LIMA to LAD and SVG to PDA were patent in her. In last case who had CABG 7 years, two of the three SVG grafts were blocked which were well-demonstrated on CT CAG, including one SVG missed on conventional CAG.CT-CAG is a non-invasive and less cumbersome alternative to conventional CAG for the assessment of grafts long after CABG even in women. The data generated by CT-CAG in post-CABG are as good as the invasive CAG and it has distinct advantage of greater acceptability.
本研究的目的是分析ct冠状动脉造影(CT-CAG)与传统有创冠状动脉造影(ICA)相比在评估移植物长期通畅方面的作用,并强调女性冠状动脉搭桥手术(CABG)后患者的任何性别特异性问题。回顾性分析30例既往行冠脉搭桥并行常规及ct - cag的患者的病历及影像资料,其中4例为女性。我们研究了30例CABG患者,他们同时进行了CT-CAG和常规冠状动脉造影。CT-CAG能够比ICA更好地评估移植物,即使在那些由于ICA技术故障而无法评估的移植物中也是有用的。在这个系列中只有四位女性患者。在第一例患者中,动脉移植物(左内乳动脉[LIMA])通畅,但在CT-CAG图像中LAD中没有远端跑流,并且在常规冠状动脉造影中表现不佳。第二个病人10年前做了冠脉搭桥。动脉移植物(LIMA)到LAD通畅,SVG移植物到RCA近端吻合处有完全阻滞。第三位高血压和糖尿病患者也在10年前做了冠脉搭桥。LIMA到LAD和SVG到PDA都是她的专利。最后一例冠脉搭桥7年的患者,3个SVG移植物中有2个在CT CAG上被阻断,其中1个在常规CAG上缺失。CT-CAG是一种非侵入性和更简单的替代传统的CAG评估移植后很长一段时间,甚至在妇女。CT-CAG在cabg后产生的数据与有创CAG一样好,具有明显的可接受性优势。
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引用次数: 0
A Study of Fertility and Pregnancy Outcomes in Women after Surgery for Valvular Heart Disease 瓣膜性心脏病术后妇女生育能力和妊娠结局的研究
Pub Date : 2022-12-17 DOI: 10.25259/mm_ijcdw_459
A. Malempati, S. Palanki, N. Dixit
Chronic Rheumatic Heart Disease (CRHD)is a common condition in India. CRHD accounts for a majority of heart valve surgery, including those in the younger age group. These young women almost traditionally get married in a country like India, and the social pressure to bear children is tremendous. Anticoagulation and the postoperative state of the patient itself can be a risk factor for maternal and fetal outcomes. There is very little data available for the same in India.In this study, 100 cases were studied retrospectively to study the fertility patterns after valvular heart surgery including fetal outcomes. This study was conducted at Nizam’s Institute of Medical Sciences, Hyderabad in which pregnancy, anticoagulation, maternal and fetal outcomes were studied.A total of 63 patients conceived after surgery (pregnancy rate = 63%/ failure rate =37%) (p=0.001). Fetal loss occurred in 6 of the pregnancies, due to spontaneous abortion (n=3) and medical abortion (n=3). Parity, associated conditions and age did not affect the outcome. During pregnancy, 28 patients switched to UF heparin, 31 stayed on warfarin, 4 did not take any anticoagulation. Fetal loss was observed in 3 patients on Warfarin during pregnancy and 3 on UF heparin. Maternal loss was observed in 4 patients out of which 2 were on Warfarin, 1 on unfractionated UF heparin and 1 did not take any anticoagulation during pregnancy. In comparison, warfarin and UF heparin had similar fetal outcomes.The study recorded good outcomes irrespective of type of prosthesis and anticoagulation.
慢性风湿性心脏病(CRHD)是印度的一种常见疾病。CRHD占心脏瓣膜手术的大多数,包括年轻年龄组的手术。在印度这样的国家,这些年轻女性几乎是传统上结婚的,生育孩子的社会压力是巨大的。抗凝和术后患者本身的状态可能是产妇和胎儿结局的危险因素。在印度,这方面的数据很少。在本研究中,我们回顾性研究了100例心脏瓣膜手术后的生育模式,包括胎儿结局。这项研究是在海得拉巴的尼扎姆医学科学研究所进行的,研究了妊娠、抗凝血、母婴结局。术后妊娠63例(妊娠率63%/失败率37%)(p=0.001)。由于自然流产(n=3)和药物流产(n=3), 6例妊娠发生胎儿丢失。胎次、相关条件和年龄对结果没有影响。在怀孕期间,28例患者改用UF肝素,31例继续使用华法林,4例未使用任何抗凝剂。妊娠期使用华法林3例,使用UF肝素3例。妊娠期产妇丢失4例,其中2例使用华法林,1例使用未分离UF肝素,1例未使用任何抗凝药物。相比之下,华法林和UF肝素有相似的胎儿结局。该研究记录了良好的结果,无论假体和抗凝类型如何。
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引用次数: 0
Cardio-obstetrics in India: The Mission, the Scope and the Road Ahead 印度的心脏产科:使命、范围和未来的道路
Pub Date : 2022-12-17 DOI: 10.25259/ijcdw_12_2022
S. Chhabra
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引用次数: 0
Venous Intervention 静脉介入
Pub Date : 2022-12-17 DOI: 10.25259/ijcdw_13_2022
R. Bhardwaj, A. Bhambhani, Sivaji Patibandla, M. Mirza, Gaurav Aggrawal
Any overview of the treatment of venous disease should begin with a brief examination of its history. From the first rudimentary attempt at venous thrombectomy in the early 1920s to the evolution of percutaneous and mechanical thrombectomy and endovascular stents in the 21st century. It is the aim of this review to provide a comprehensive summary of the state of the art of venous disease treatment at the turn of the new century.
对静脉疾病治疗的任何概述都应该从对其历史的简要检查开始。从20世纪20年代早期静脉取栓的初步尝试,到21世纪经皮机械取栓和血管内支架的发展。这篇综述的目的是提供一个全面的总结在新世纪之交静脉疾病治疗的艺术状态。
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引用次数: 0
Current Status of the Bioresorbable Scaffolds in Coronary Interventions 生物可吸收支架在冠状动脉介入治疗中的现状
Pub Date : 2022-12-17 DOI: 10.25259/ijcdw_11_2022
A. Patnaik, J. Maddury
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引用次数: 0
NT-proBNP as a Predictive Biomarker for Contrast-Induced Nephropathy in ACS Patients Undergoing Coronary Angiogram – An Observational Study NT-proBNP作为ACS患者冠脉造影造影剂肾病的预测性生物标志物——一项观察性研究
Pub Date : 2022-10-17 DOI: 10.25259/mm_ijcdw_429
R. K. Reddy, J. Maddury
1. To assess the value of baseline NTproBNP at admission and to determine the levels of serum creatinine at 48 hours and 72 hours after procedure for evidence of contrast-induced nephropathy (CIN) for patients undergoing CAG. 2. To evaluate the relationship between the values of NTproBNP and evidence of CIN.This is an observational study performed between June 2021-November 2021 at Nizams Institute of Medical Sciences in 75 patients diagnosed with ACS. we assessed the role of nt pro bnp as a predictive biomarker for diagnosis of contrast induced nephropathy in patients of ACS undergoing coronary angiography. Serum creatinine is repeated at 48 h post procedure and compared to baseline.Spearman’s correlation test was used to assess the correlation between NT-proBNP values and ejection fraction on the 2D echo. The rho value (-0.69) was suggestive of a strong negative correlation. P value & lt; 0.001 making it statistically significant. Simple linear regression analysis was used to predict the NT-proBNP levels by ejection fraction percentage among study patients, it showed that, for every 1% decrease in ejection fraction, the NT-proBNP levels will significantly increase by 102.90 pg/mL at P and lt; 0.001. Wilcoxon Signed Rank test was used to compare the baseline serum creatinine values with 48/72 h serum creatinine values after undergoing angiography with contrast, incidence of acute kidney injury (AKI) as shown by the resulting P value was and lt; 0.001, thus statistically significant. The ROC curve analysis to establish the association between NT-proBNP as a marker for incidence of AKI (CIN) shows shows that, NT-proBNP cut off and gt;1670 pg/mL has a sensitivity of 81.82% and specifity of 98.44% and is statistically significant with P value and lt; 0.001.It was observed that NT-proBNP >1670 pg/mL prior to the procedure, was significantly associated with the risk of development of contrast induced nephropathy. Measurement of serum NT-proBNP pre procedure aids in identifying at risk population for developing CIN.
1. 评估入院时基线NTproBNP的价值,并测定术后48小时和72小时血清肌酐水平,作为CAG患者造影剂肾病(CIN)的证据。2. 评价NTproBNP值与CIN证据之间的关系。这是一项观察性研究,于2021年6月至2021年11月在Nizams医学科学研究所对75名被诊断为ACS的患者进行了研究。我们评估了nt pro bnp作为ACS患者冠脉造影造影剂肾病诊断的预测性生物标志物的作用。术后48小时再次测定血清肌酐,并与基线比较。采用Spearman相关检验评估NT-proBNP值与2D回波射血分数的相关性。rho值(-0.69)提示有很强的负相关。P值& lt;0.001,具有统计学意义。采用简单线性回归分析预测研究患者射血分数百分比的NT-proBNP水平,结果表明,在P和lt下,射血分数每降低1%,NT-proBNP水平将显著升高102.90 pg/mL;0.001. 采用Wilcoxon sign Rank检验比较血管造影后基线血清肌酐值与48/72 h血清肌酐值,对比得出急性肾损伤(AKI)发生率P值为、lt;0.001,因此具有统计学意义。建立NT-proBNP作为AKI (CIN)发生率标志物的ROC曲线分析显示,NT-proBNP cut off与gt;1670 pg/mL的敏感性为81.82%,特异性为98.44%,P值和lt均有统计学意义;0.001.观察到术前NT-proBNP >1670 pg/mL与造影剂肾病的发生风险显著相关。术前测定血清NT-proBNP有助于识别发生CIN的高危人群。
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引用次数: 0
Drug-induced Macro-T-Wave Alternans with QTc Prolongation 药物诱导的大t波随QTc延长而变化
Pub Date : 2022-10-17 DOI: 10.25259/mm_ijcdw_470
Sridevi Chigullapali, Ravindra Jain, R. Patil
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引用次数: 1
Gender Specific Coronary Artery Diameters in CT Coronary Angiogram: A Comparative Study in Female and Male Population CT冠状动脉造影中不同性别冠状动脉直径的比较研究
Pub Date : 2022-10-17 DOI: 10.25259/mm_ijcdw_438
Bairy Thejasree, S. Patnaik, J. Maddury
Women show significant in-hospital morbidity and mortality with greater extent of symptoms, poorer post-revascularization outcome with increased restenosis and repeat revascularization after angioplasty, than men. Smaller sized coronary arteries in females can be attributable for this differential outcome, which is also similar in case of Indians, compared to Caucasians. Our aim is to assess the gender-specific difference in coronary arteries using noninvasive Multidetector Computed-Tomography Coronary-Angiogram(CT-CAG) and comparing the same with other racial database.With Ethics committee approval, present retrospective comparative study conducted in 128CT-CAG scans in 18-45years aged 100 women and 89 men with no atherosclerotic burden excluding pathological coronaries and high calcium score>100. Diameter measurements of proximal (≤10mm) segments of right coronary artery(RCA), left main coronary artery(LMCA), left anterior descending(LAD) and circumflex(LCx) arteries were taken, averaged and compared using 2-sample z-test. Considering the obtained mean diameters of total sample as South-Indian dataset which is then compared with Caucasians dataset taken from previous study.Women showed smaller coronary artery diameters compared to men in all the arteries, with greater gender-specific age-adjusted difference in LMCA, followed by LAD, RCA and least in LCX. South-Indians showed statistically significant smaller diameters of all the coronary arteries compared to Caucasians.Gender-specific difference among the coronary arteries does exist, with females having smaller dimensions; South-Indians also show smaller diameters. This warrants a clinician for gender-specific approaches during the interventions because of technical difficulties.
与男性相比,女性表现出显著的住院发病率和死亡率,症状程度更大,血管重建后的结果更差,血管成形术后再狭窄和重复血管重建增加。女性较小的冠状动脉可以归因于这种不同的结果,与高加索人相比,印度人的情况也类似。我们的目的是利用无创多探测器计算机断层扫描冠状动脉造影(CT-CAG)评估冠状动脉的性别差异,并将其与其他种族数据库进行比较。经伦理委员会批准,本研究采用128CT-CAG扫描对18-45岁无动脉粥样硬化负担的100名女性和89名男性进行回顾性比较,不包括病理性冠状动脉和高钙评分>100。测量右冠状动脉(RCA)、左冠状动脉主干(LMCA)、左前降支(LAD)和旋支(LCx)近端(≤10mm)段内径,取其平均值,采用2样本z检验进行比较。将获得的总样本平均直径作为南印度数据集,然后与先前研究的高加索数据集进行比较。与男性相比,女性所有动脉的冠状动脉直径都更小,LMCA的性别年龄差异更大,其次是LAD, RCA, LCX最小。与高加索人相比,南印度人的所有冠状动脉直径都比高加索人小。冠状动脉确实存在性别差异,女性冠状动脉尺寸较小;南印度群岛的直径也较小。由于技术上的困难,这需要临床医生在干预期间采取针对性别的方法。
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引用次数: 0
Effect of Dapagliflozin on Left Ventricular Diastolic Function in Diabetics - A Prospective Interventional Study 达格列净对糖尿病患者左室舒张功能的影响——一项前瞻性介入研究
Pub Date : 2022-10-17 DOI: 10.25259/mm_ijcdw_439
Srikiran Jakkula, J. Maddury, Srikanth Nakka, Achukatla Kumar
In patients with established heart failure, the SGLT2 inhibitor dapagliflozin found to alleviate the risk of worsening heart failure or cardiovascular mortality regardless of the presence of Diabetes Mellitus. To evaluate the effect of Dapagliflozin on Left Ventricular Diastolic function in Patients with Type 2 Diabetes Mellitus, to study the baseline Diastolic function in patients with type 2 diabetes mellitus and to study the Diastolic function at rest and after exercise in patients with type 2 diabetes mellitus 24 weeks after taking Dapagliflozin.It is a Prospective interventional Pilot study with study population consisting of T2DM who are 18 years and older with HbA1C between 7.0% to 10% and LV diastolic dysfunction of at least grade 1 on resting echocardiography. Baseline diastolic function was measured. Dapagliflozin 10 mg once daily was given to all patients for 24 weeks and then left ventricular diastolic function was measured by e’, E/A ratio, E/e’ at 24 weeks from baseline as assessed by Stress Echocardiography.Diastolic Dysfunction grading between Baseline and post 24 weeks treatment with dapagliflozin, using Marginal Homogeneity Test showed p value <0.001 which is highly significant. Comparision of e’ at rest for baseline and post 24 weeks of treatment with dapagliflozin showed statistical significance. The e’ after exercise for baseline and post 24 weeks of treatment showed p value of <0.01. Comparision of E/e’ at rest and after exercise for baseline and post 24 weeks showed statistical significance.The diastolic function has been significantly improved after 24 weeks of using dapagliflozin. The diastolic function parameters between age and sex groups at baseline and post 24 weeks of treatment with dapagliflozin does not correlate.
在心力衰竭患者中,无论是否存在糖尿病,SGLT2抑制剂达格列净均可减轻心力衰竭恶化或心血管死亡的风险。评价达格列净对2型糖尿病患者左心室舒张功能的影响,研究2型糖尿病患者的基线舒张功能,研究2型糖尿病患者服用达格列净24周后静息和运动后的舒张功能。这是一项前瞻性干预性研究,研究人群为18岁及以上的T2DM患者,HbA1C在7.0% - 10%之间,静息超声心动图显示左室舒张功能障碍至少为1级。测量基线舒张功能。所有患者给予达格列净10 mg,每日1次,持续24周,然后通过应激超声心动图评估24周时的e′、e /A比、e /e′来测量左心室舒张功能。经边际齐性检验,达格列净治疗24周后与基线舒张功能障碍分级p值<0.001,具有高度显著性。达格列净治疗24周后与基线时的e ' at比较有统计学意义。运动后与治疗24周后比较p值均<0.01。基线与24周后静息与运动后E/ E比较,差异有统计学意义。使用达格列净24周后,舒张功能明显改善。基线时和24周后,年龄和性别组之间的舒张功能参数没有相关性。
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引用次数: 0
Heart Failure in Women 女性心力衰竭
Pub Date : 2022-10-17 DOI: 10.25259/mm_ijcdw_482
J. Maddury
Heart failure (HF) in women is one of the leading causes in women after coronary artery diseases. There are gender differences at every aspect of HF. These females usually present in older age with significant comorbidities. Even though there are few risk factors common to males and females for the development of HF, diabetes and hypertension are considered more stronger association for the development of HF in females than in males. There are certain sex-specific factors such as abnormal pregnancies and breast cancer therapies in addition to genetic predisposition for the development of cardiomyopathies, especially postpartum cardiomyopathy in female. Usually, females have HF with preserved ejection fraction when compared to men who more frequently have HF due to reduced ejection fraction. Even in the left ventricular remodeling to injury is different in both sexes. The main aim of this review is to bring the sex differences in HF and to stress the need of separate guidelines for females with HF for better outcome.
女性心力衰竭(HF)是冠状动脉疾病后女性发病的主要原因之一。心衰的各个方面都存在性别差异。这些女性通常出现在老年,并伴有明显的合并症。尽管男性和女性发生HF的共同危险因素很少,但糖尿病和高血压被认为与女性发生HF的关联比男性更强。心肌病,尤其是女性产后心肌病的发生,除遗传易感性外,还有某些性别特异性因素,如异常妊娠、乳腺癌治疗等。通常情况下,女性心衰与保留射血分数相比,男性更常见的心衰是由于射血分数降低。甚至在左心室重构损伤中,两性也是不同的。本综述的主要目的是揭示心衰的性别差异,并强调为女性心衰患者制定单独指南的必要性,以获得更好的治疗效果。
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引用次数: 1
期刊
Indian journal of cardiovascular disease in women WINCARS
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