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   Table of Contents - Current issue
April-June 2018
Volume 6 | Issue 2
Page Nos. 37-71

Online since Tuesday, June 19, 2018

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Preface to second issue of Heart India 2018 p. 37
Alok Kumar Singh
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Appraising risk of development of cardiovascular disease in patients with type 2 diabetes mellitus p. 39
Shadan Modaresahmadi, Shobha Rani R Hiremath, T Vithya, Shankar Prasad, Amy Bobbins, Sunitha Srinivas
Background: Research shows a strong relationship between type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD). Most commonly, diabetic participants experience increased morbidity and mortality due to CVD complications. This study aims to determine the proportion of CVD prevalence and to evaluate the risk factors for developing CVD among T2DM participants and to evaluate the CVD risk factor for the next 10 years using Joint British Societies recommendations on the the Prevention of Cardiovascular Disease (JBS3) scale. Materials and Methods: In this hospital-based observational study, data including serum creatinine, blood urea, high-density lipoprotein (HDL), low-density lipoprotein (LDL), very LDL, echocardiography, and ECHO readings were collected from a random sample of 106 participants, both diabetic and nondiabetic. The risk of developing CVD in participants with DM in the next 10 years was evaluated using the JBS3 risk calculator through analysis of collected data. Results: Among 106 participants, there were 72 participants with DM, and the majority of these participants had comorbidities, including hypertension and other CVDs. According to the data collected from DM participants, it was observed that 77.77% had elevated serum creatinine value, 27.77% had elevated blood urea level, 61.11% had abnormal HDL value, 65.27% had elevated LDL value, and 26.38% had elevated VLDL value. Total triglycerides level was also observed to be high in 54.16% of the DM participants. Moreover, the results indicated that CVD was present in 77.78% of type 2 diabetic patients, which was comparatively higher than in nondiabetic participants of whom 32.35% had CVD. Conclusion: Based on the data collected and results obtained from the JBS3 risk calculator, it was found that the participants with DM were at higher risk of developing CVD.
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Burden of congenital heart diseases in a tertiary cardiac care institute in Western India: Need for a national registry p. 45
Pooja M Vyas, Nilesh K Oswal, Iva V Patel
Objective: Congenital heart disease (CHD) is very common disease, and it is the major cause of childhood mortality and morbidity. Not much of Indian data are available particularly from the western part of the country. There are needs to further explicate the spectrum and epidemiology of the CHD. Materials and Methods: This retrospective study collected data of the paediatric patients received in our institute from January 2016 to June 2017. All simple and complex congenital anomalies diagnosed on echocardiography were included in our study. Results: Of total 22,275 cases, CHDs were diagnosed in 9728 cases with a male-to-female ratio of 1:0.6. Most CHDs (62.77%) were diagnosed between 1 month and 6 years of age. Incidence of cyanotic CHD was 27.14% and acyanotic CHDs was 72.86% with a ratio of cyanotic-to-acyanotic CHD being 1:2.7. Ventricular septal defect (26.24%) was the most common acyanotic CHD found followed by 2089 patients of atrial septal defect. Tetralogy of Fallot (13.57%) was the most common cyanotic CHD found followed by double-outlet right ventricle in 276 patients (2.84%). Conclusions: Ours is the largest Indian study till date in this spectrum which yielded new data on the epidemiology, incidence, and prevalence of CHD. Majority of the patients with CHD had acyanotic CHD with most common anomaly being ventricular septal defect. Tetralogy of Fallot was the most common cyanotic defect. This study will increase awareness in the people with a family history of CHD and health-care providers and will assist in early diagnosis.
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Frequency of increased carotid intima media thickness and its relation with vascular complication in newly diagnosed patients of type 2 diabetes: A Hospital-based study p. 51
Gagan Preet Singh Taneja, Rajesh Kumar Bhawani, Surender Thakur, Rajeev Merwaha
Objective: To study the frequency of increased carotid intima-media thickness (CIMT) and its relation with vascular complications in patients of newly diagnosed type 2 diabetes mellitus. Methodology: All consecutive newly diagnosed type 2 diabetics were enrolled and evaluated for the CIMT by B mode ultrasonography and presence of vascular complications. Results: 105 newly diagnosed patients of type 2 diabetes with a mean age of 56.55 ± 7.43 years were enrolled in the study. Mean age of patients with increased CIMT in the study was 56.45 ± 8.10 while mean age of patients with normal CIMT was 53.10 ± 9.66 years (P = 0.75) among them 53 were male and 52 were females. Conclusion: Type 2 diabetes mellitus can present with or without symptoms and with chronic vascular complications at the time of diagnosis, measurement of CIMT by B Mode ultrasonography is an important noninvasive, cost-effective tools for the diagnosis of subclinical/overt atherosclerosis.
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Evaluation of prosthetic valve dysfunction by three-dimensional echocardiography p. 54
Subhash Chaudhari, Jayesh Prajapati, Naman Shastri, Iva Patel, Sharad Jain, Sibasis Sahoo, Vijay Gupta
Background: Three-dimensional (3D) echocardiography (echo) and transesophageal echo images enable visualization of valvular anatomy from unique orientations with improved spatial relationships not previously seen with two-dimensional (2D) echo. Materials and Methods: Patients who fulfilled the criteria had undergone detailed evaluation of prosthetic valve dysfunction. Prosthetic valve dysfunction patients with stable hemodynamic were included and 3D echo findings were compared with 2D echo. Results: A total of 10 males and 25 females were evaluated in the study. Two females and one male had bioprosthetic, three males and two females had tilting disc valve, while 21 females and six males had bileaflet mechanical valve. 3D echo had shown abnormal motion of leaflets in seven male and 21 female patients compared to 2D echo. Abnormal valvular calcification was demonstrated in a total of 23 patients on 3D echo. Valve sewing-ring integrity and motion were found abnormal in two male and two female patients in 3D echo. Prosthetic valve dehiscence and thrombus were better seen in five and 15 patients, respectively, on 3D echo. On 3D echo, pannus was better seen in one male and two females. 3D echo defined exact site and size of vegetation better than 2D echo in two female patients. Conclusions: Real-time 3D imaging allows clinically useful visualization of prosthetic valve components such as leaflets, rings, and struts of all prosthetic valves, irrespective of position. “En face” view of the valve has proven useful in the assessment of prosthetic valve endocarditis, paravalvular regurgitation, and prosthesis dysfunction. 3D echo imaging plays an important role in device closure.
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Six months outcome in patients undergoing percutaneous coronary intervention for true bifurcation lesions without side branch stenting p. 61
Rahul Subhashrao Chalwade, Ajay Sharma, Neeraj Pandit
Context: Bifurcation lesions is one of the most challenging lesions in interventional cardiology. The optimal management is still a debate. Provisional stenting is preferred approach at present, yet with higher major adverse cardiovascular events (MACE) than other lesions. Aims: The aim of this study is to evaluate outcome in patients with true coronary bifurcation lesion undergoing percutaneous coronary intervention with stenting of the main vessel without side branch (SB) intervention. Design: This was prospective observational study. Subjects and Methods: The study was conducted in patients with stable angina or unstable angina or non ST elevation MI (NSTEMI) attributable to a de novo true coronary bifurcation lesion involving the main vessel and SB. The main vessel diameter has to be ≥≥2.5 mm and the SB has to be ≥≥2.25 mm by visual estimate. Statistical Analysis: Statistical analysis was performed using statistical software package SPSS v22.0. Results: Fifty-three consecutive patients of true bifurcation lesions were studied. They underwent main vessel stenting and were followed up for 6 months. Mean age of 54.9 ± 8.4 was studied, 66% were male, 45.3% were single-vessel disease, left anterior descending (LAD)-diagonal was the most common (43.4%) target bifurcation lesion, most common medina class was 1,1,1 (43.4%). On 6 months follow-up, total MACE events were 12 (22.6%), most were contributed by Target lesion revascularization (TLR) 11 (20.75%). The MACE were significantly associated with diabetes and the extend of coronary artery disease.. Conclusions: Simple stenting strategy in true bifurcation lesions is associated with high MACE events. Further studies dedicated to true coronary bifurcation lesions are required to look for best strategy for these lesions.
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Evaluation of short-term outcomes of impaired creatinine clearance in patients with acute coronary syndromes: A prospective cohort study at tertiary care center p. 66
Akshyaya Pradhan, Nirdesh Jain, Pravesh Vishwakarma, Rishi Sethi, Varun Shankar Narain, Sudhanshu Kumar Dwivedi, RK Saran, Sharad Chandra Yadav, Aniket Puri, Jyoti Bajpai
Background: Chronic kidney disease is commonly seen in patients presenting with acute coronary syndrome (ACS), and it has been shown to have poor outcomes. We evaluated the prevalence of impaired creatinine clearance and its impact on short-term clinical outcomes in patients admitted with ACS without prior documented chronic renal disease. Materials and Methods: The present study was an observational, prospective cohort study conducted at a tertiary care center in North India. In patients admitted with a diagnosis of ACS, glomerular filtration rate was estimated (eGFR) by the Modification of Diet in Renal Disease Study Equation. Patients with eGFR <90 mL/min were taken as study group and those with values >90 mL/min comprised control group. The study group was further categorized into three subgroups on the basis of eGFR (<30 mL/min; 30–59 mL/min; 60–89 ml/min). The primary outcomes compared between study and control group were major adverse cardiac event (MACE) (composite of death, reinfarction, congestive heart failure, cardiogenic shock, and arrhythmia). The secondary outcome measures were individual components of primary outcome. Results: Among the 200 enrolled patients with ACS, the prevalence of impaired creatinine clearance was 29.5%. The study cohort had higher rates of MACE (28.8 vs. 9.2%, P ≤≤ 0.0001), in-hospital mortality (13.6 vs. 3.5%, P = 0.009), and overall mortality (15.3 vs. 5.1%, P = 0.014) as compared to control group. However, the 30-day mortality was not significantly different. The MACE in the study subgroups was higher in eGFR 30–60 mL/min (odds ratio [OR] 3.97) subgroup followed by eGFR <30 mL/min (OR 3.04) and eGFR 60–90 mL/min (OR 1.38). Using eGFR <90 mL/min as cutoff (as compared to serum creatinine [SCr] >1.5 mg/dl) enhances the ability to predict death by 33% and MACE events by 143%. The OR for predicting death with various cutoff of eGFR was as follows: eGFR <30 ml/min – 3.61, eGFR: 30–60 ml/min – 4.2 and eGFR: 60–90 ml/min – 0.5. Conclusion: Almost one-third of the patients presenting with ACS have impaired creatinine clearance. Patients with impaired creatinine clearance have worse outcome in hospital vis-a-vis their contemporary groups with normal eGFR. eGFR is a better risk assessment parameter than SCr for predicting MACE and overall mortality in ACS patients.
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