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   2019| April-June  | Volume 7 | Issue 2  
    Online since June 28, 2019

 
 
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ORIGINAL ARTICLES
Prevalence and predictors of hypertension among adults of urban Lucknow, India: A community-based study
Syed Esam Mahmood, Ausaf Ahmad, Saurabh Kashyap
April-June 2019, 7(2):43-48
DOI:10.4103/heartindia.heartindia_6_19  
Background and Objective: Hypertension is an important public health problem in both economically developing and developed countries. In India, recent community surveys have reported that the prevalence of hypertension has risen among urban and rural inhabitants. This study was conducted to find out the prevalence of hypertension and to identify the risk factors among adults residing in urban areas of Lucknow. Materials and Methods: The cross-sectional field study involved a survey of 300 respondents, aged 18 years and above using the stratified random sampling and probability proportionate to size technique. A study tool which contained risk factor questionnaire and physical measurements of height, weight, and blood pressure were used to collect the data. Data analysis was performed using the SPSS version 16. The Chi-squared test and logistic regression analysis were used to analyze the data. Results: The prevalence of hypertension was 14.67% among urban adults. Hypertension was significantly higher among individuals aged >40 years and those who consumed tobacco products. A higher proportion of the hypertensives belonged to the illiterate category. There was a significant difference in hypertension prevalence in different education classes. Respondents living in overcrowded houses had higher odds of having hypertension than those not experiencing overcrowding. Conclusion: Age, education, and overcrowding were independent risk factors of hypertension. Prevention measures targeting the modifiable risk factors associated with hypertension should be taken.
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Coronary risk prediction by the correlation of total cholesterol/high-density lipoprotein, triglyceride/high-density lipoprotein, low-density lipoprotein/high-density lipoprotein ratios, non-high-density lipoprotein, apolipoprotein-B, and high-sensitivity C-reactive protein with low-density lipoprotein in Indian patients under statin therapy
AK Badrinath, K Nagarajan, P Anand, S Suresh Babu, S Asmathulla, M Mohammad Inaamul Hassan
April-June 2019, 7(2):63-67
DOI:10.4103/heartindia.heartindia_2_19  
Background: Patients are treated with statins for the control of cholesterol; but statins control only low-density lipoprotein (LDL) and not non-high-density lipoprotein (non-HDL). Also, LDL is not a good coronary risk predictor. That creates the necessity to find a better biomarker for future coronary risk prediction. Hence, biomarkers under this territory such as total cholesterol (TC)/HDL, LDL/HDL, triglyceride (TG)/HDL ratios, non-HDL, apolipoprotein-B (apo-B), and high-sensitivity C-reactive protein (hs-CRP) were to be assessed and correlated with LDL to find the better biomarker in Indian patients. Objective: The objective was to study non-HDL, apo-B, TC/HDL, TG/HDL, LDL/HDL ratios, and hs-CRP in patients under statin therapy; and to correlate them with their LDL; to predict the risk of future coronary events; and to identify which biomarker among them is better at detecting the same. Materials and Methods: This is a cross-sectional observational study performed by systematic random sampling among 87 patients under statin therapy, and the levels of LDL, TC/HDL, LDL/HDL, TG/HDL ratios, non-HDL, apo-B, and hs-CRP were measured in such patients, and their correlation with optimized and unoptimized LDL groups were done. Continuous data were represented as mean and standard deviation, andP value was calculated using independent t-test or z-test. Results: Non-HDL, TC/HDL, and LDL/HDL ratios were found to be statistically significant – all three parameters withP < 0.0001 in predicting the coronary artery disease attacks in the future. Conclusion: Even though all patients in our study were under statin therapy, they are still under the risk of developing coronary events. This can be solved by targeting the control of non-HDL or TC/HDL or LDL/HDL ratios, as they are found be better biomarkers for future coronary risk prediction.
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EDITORIAL
Preface to the second issue of Heart India 2019
Alok Kumar Singh
April-June 2019, 7(2):41-42
DOI:10.4103/heartindia.heartindia_27_19  
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ORIGINAL ARTICLES
Role of B-type natriuretic peptide level in predicting future cardiac events in patients presenting with dyspnea (a hospital-based study)
Saswata Saha, Lalit Prashant Meena, Jaya Chakravarty, Madhukar Rai
April-June 2019, 7(2):49-54
DOI:10.4103/heartindia.heartindia_17_19  
Introduction: Acute dyspnea is one of the most common reasons for admission to emergency rooms. Differentiation of heart failure (HF) from other causes of shortness of breath is often difficult but compulsory. Natriuretic peptides are present in higher concentration in patients with HF and have a potential diagnostic role. The decline in B type natriuretic peptide (BNP) levels subsequent to the treatment of acute HF could predict the future risk of HF and/or cardiac event. Materials and Methods: This was an in-hospital longitudinal study conducted on adult patients presenting with acute dyspnea to the Department of General Medicine in our institution from January 1, 2016, to December 31, 2016. Eligible patients were followed up over a period of the next 6 months from their day of the first visit. Patients presenting with acute dyspnea were selected. Patients were evaluated using predetermined pro forma including history, physical examination, blood investigations, electrocardiography, chest X-ray, BNP analysis, and two-dimensional echo. BNP levels of the patients with BNP >500 pg/ml at the time of admission were again measured at the time of discharge, and these patients were followed up for 6 months for any endpoint. Results: This study of 100 participants gives insight about common etiologies among the patients presenting with acute dyspnea in which HF is a competing diagnosis. In the study, a BNP cutoff of 413 pg/ml determines cardiogenic dyspnea. Out of 60 patients with BNP >500 pg/ml at admission, 22 patients had at least 1 endpoint by the end of 6 months. Cutoff for determination of an endpoint for BNP at admission and BNP at discharge was 1298 and 367.5 pg/ml, respectively. Conclusion: The study showed that BNP at admission and BNP at discharge determines prognosis in patients presenting with dyspnea. The study shows BNP as a better predictor of prognosis than ejection fraction or past history of any cardiac event.
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Critical analysis of all pregnancies with heart disease, misses and near misses over 1-year period along with expert group so as to optimize outcome and improve patient care – Need-based analysis
Shuchi Agrawal, Avinash Agrawal, Monika Bhandari, Suhail Sarwar Siddiqui, Sciddharth Koonwar
April-June 2019, 7(2):55-62
DOI:10.4103/heartindia.heartindia_15_19  
Introduction: Cardiac disorders complicate approximately 1%–3% of pregnancies and present a real challenge to treating healthcare providers.Maternal mortality may be as high as 7% when New York Heart Association (NYHA) Classes III and IV patients are combined. In contrast, Classes I and II combined yield a mortality of 0.5%. Similarly, fetal mortality maybe as high as 30% in Class III and IV patients, in contrast to 2% for Classes I and II. Managing pregnant patients with complex cardiac disease mandates participation from a multidisciplinary team early in the pregnancy. Audit of misses and near misses helps to determine causes of maternal mortality and morbidity and identify gaps in care. Aims and Objectives: To assess burden of maternal cardiac disease and its influence on maternal and fetal outcome. To assess gaps in multidisciplinary care and to analyze causes associated with increased morbidity and mortality. Methods: A retrospective analysis of all pregnant patients with heart disease admitted to department of obstetrics and gynecology at tertiary care center from January 2017 to January 2018. Results: Of 9563 deliveries, there were 108 cases of pregnancy with heart disease (1.12%). Majority of patients in study cohort belonged to low socioeconomic status and had rural background. 36 patients (33.33%) were primi-gravida; majority presented for antenatal care in the third trimester. 82 (75.92%) in functional Class (NYHA) I – II, predominant cardiac lesion was rheumatic valvular disease diagnosed in 101 patients (93.5%); 60 patients (58.82%) had vaginal delivery, 63 (64%) were delivered before 37 weeks and 6 patients had medical termination of pregnancy. 10 patients (9.2%) developed cardiac failure and 8 (7.4%) had atrial fibrillation. There were 4 maternal death and 8 near misses. Conclusion: The present study highlights need of training of physicians and obstetrician working at peripheral centres for early diagnosis, timely referral and strengthening pre-pregnancy counselling.
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Role of thiamine supplementation in the treatment of patients with heart failure: A double-blind randomized controlled trial
Shamim Iqbal, Aamir Rashid, Irfan Bhat, Jahangir Rashid, Imran Hafeez, Ajaz Lone, Khurshid Iqbal, Iqbal Dar
April-June 2019, 7(2):68-73
DOI:10.4103/heartindia.heartindia_7_19  
Introduction: The role of thiamine supplementation in heart failure (HF) patients has shown conflicting results and has not been adequately studied. Aims and Objectives: The aim and objective were to determine whether thiamine supplementation will provide clinical, biochemical, and echocardiographic benefit in congestive HF patients. Materials and Methods: In this single-center, double-blind, prospective randomized controlled trial, HF patients with varied etiology were included. Patients were randomly allocated to 1 week of inpatient double-blind intravenous therapy with either placebo or thiamine. Parameters studied included clinical, Echo left ventricular ejection fraction (LVEF), and thiamine pyrophosphate effect (TPPE) levels before/after treatment. After completion of 1-week treatment, all patients were given oral thiamine and evaluated at the outpatient clinic after 6 weeks. Results: A total of fifty patients were studied. There was no difference at baseline in mean age (61.4 ± 7.1 vs. 62.4 ± 8.0 years), sex (males 52% vs. 56%), etiology (idiopathic dilated cardiomyopathy 68% vs. 60%, ischemic heart disease 20% vs. 24%), clinical parameters, TPPE levels (16.4 ± 5.2 vs. 16.2 ± 6.5%), and LVEF (28.1% ± 6.7% vs. 28.3% ± 6.6%) in thiamine as compared to placebo group. After 1 week of treatment, there was significant improvement in systolic blood pressure (119.2 ± 18.3 vs. 106.1 ± 18.9 mmHgP < 0.001), diastolic blood pressure (77.4 ± 8.3 vs. 68.2 ± 9.7 mm HgP < 0.001), heart rate (67.0 ± 8.4 vs. 81.9 ± 10.7P < 0.001), weight (66.2 ± 9.5 vs. 71.2 ± 8.2 kgP < 0.001), 3rd-day urine output (1286.0 ± 505.7 ml vs. 750.0 ± 237.2 ml [P < 0.001]), New York Heart Association class (1.6 ± 0.5 vs. 2.1 ± 0.4P < 0.001), LVEF percentage change (7.0 ± 5.2 vs. 0.7% ± 4.7%P < 0.001), and TPPE levels (6.8% ± 1.5% vs. 16.0% ± 6.7%P < 0.001) in thiamine compared with placebo group. Conclusions: Thiamine supplementation significantly improved clinical and echocardiographic parameters. Thiamine supplementation is cost-effective, is benign, and is easily available with significant clinical benefits.
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CASE REPORTS
Coronary steal phenomenon in post CABG patients
Raman Chawla, Wasim Ahmad, Rajen Maniar, Vivek Sharm
April-June 2019, 7(2):85-86
DOI:10.4103/heartindia.heartindia_14_19  
Encountering a coronary subclavian steal syndrome phenomenon is a rare opportunity. We came across three such cases. Article describes unique cases of two elderly males and one female who underwent CABG few years ago and presented with recurrent chest pain symptoms.
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ORIGINAL ARTICLES
Congenital heart disease in neonates: Their clinical profile, diagnosis, and their immediate outcome
Amber Bashir Mir, Muzzafer Jan, Iram Ali, Kaiser Ahmed, Sitaraman Radhakrishnan
April-June 2019, 7(2):80-84
DOI:10.4103/heartindia.heartindia_3_19  
Background: Congenital heart disease (CHD) occurs in approximately 0.6%–0.8% of live births. Early recognition of CHD is important for appropriate management and decision-making regarding referral. The purpose of this study was to document the common presenting symptoms and signs in the neonates with CHD, definitive diagnosis, and their outcome. Materials and Methods: The study was conducted prospectively in Neonatal Intensive Care Unit, G.B Pant Children Hospital, Department of Pediatrics and Neonatology, GMC Srinagar, from January 2016 to January 2018. Echocardiography screening of all neonates suspected of having CHD was done. Details of all neonates having CHD diagnosed by echocardiography were noted in the prescribed pro forma and their incidence, clinical profile, and outcome were studied. Results: Totally 529 cases of CHD diagnosed by echocardiography in the neonatal period were studied, out of which 280 were male and 259 were female (male:female = 1.12:1). 382 (72.2%) had acyanotic CHD and 147 (27.7%) had cyanotic CHD (CCHD). Among the acyanotic CHD, the most common CHD was ventricular septal defects (n = 170, 32.1%), and among cyanotic group, d-transposition of great arteries was most common (n = 41, 7.75%). Majority of CCHDs were diagnosed in 1st week of life (n = 50, 34.01%) and most of the neonates with acyanotic CHD were diagnosed in the 4th week of life (n = 207, 39.1%). The most common presenting problem of neonates was fast breathing 230 (43.4%) followed by feeding difficulty 110 (20.77%), cyanosis 91 (17.2%), shock manifested as decreased urine output (n = 43, 8.1%), 43 neonates (8.1%) had cyanosis along with fast breathing, and 32 neonates (6.04%) presented with murmur only. Sixty neonates (40.8%) with CCHD expired within the neonatal period. Conclusion: Neonates with CHD have a unique presentation and they carry a poor outcome unless diagnosed early and managed appropriately. Infants presenting with multiple anomalies should be screened for any underlying structural heart disease. High index of suspicion is very important as many neonates with CHD are asymptomatic initially.
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Determinants of coronary collateral formation in patients with acute ST-elevation myocardial infarction and total occlusion of infarct-related artery
Sharad Chandra, Sharath Sanganagoudar, Gaurav K Chaudhary, Sudhanshu Kumar Dwivedi, Varun Shankar Narain, Rishi Sethi, Akshaya Pradhan, Pravesh Vishwakarma, Akhil Sharma, Monika Bhandari
April-June 2019, 7(2):74-79
DOI:10.4103/heartindia.heartindia_12_19  
Background: The presence or absence of collateral circulation to the infarct-related artery territory significantly impacts the infarct size and resulting left ventricular function and hence the prognosis. However, the determinants of collateral formation have been poorly understood. Materials and Methods: The present single-center observational study examined 200 patients with acute ST-elevation myocardial infarction (STEMI), irrespective of the status of thrombolysis, undergoing coronary angiogram within 48 h showing complete occlusion of infarct-related coronary artery. Results: High-grade collaterals (Rentrop Grade 2 and 3) were seen in 17% of patients (n = 34). High-grade coronary collaterals were more often seen in patients belonging to the age group of 46–70 years compared to elderly individuals >70 years of age (38.2% vs. 2.9%,P < 0.009). The occurrence of collaterals to culprit coronary artery either left anterior descending artery or right coronary artery was similar. There was a lower prevalence of high-grade collaterals to infarct-related artery territory in smokers versus nonsmokers (5.9% vs. 43.4%,P < 0.001). The prevalence of collaterals in patients with diabetes was lower compared to nondiabetics (11.8% vs. 47.6%,P < 0.001). There was a significantly higher prevalence and recruitment of collaterals in patients with a history of angina before they developed acute coronary syndrome (88.2% vs. 16.9%,P < 0.001). There was no significant association between hypertensive status and the prevalence of coronary collateral circulation. Conclusions: The finding of high-grade coronary collaterals was seen more in patients who had angina prior to STEMI. High-grade collaterals were significantly more in middle-aged individuals compared to the elderly. Diabetes mellitus and smoking status were negative predictors of high-grade collaterals.
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CASE REPORTS
Rare case of bacterial endocarditis associated with ostium secundum atrial septal defect
Rahul Singla, Nagesh Waghmare, Vikas Mishra, Anil Kumar, NO Bansal
April-June 2019, 7(2):87-89
DOI:10.4103/heartindia.heartindia_4_19  
Aortic valve disease and ventricular septal defects are common lesions to be associated with Infective Endocarditis. However atrial septal defect is rarely associated with infective endocarditis, due to shunting taking place between low pressure difference chambers. Though rare there are few case reports of Infective endocarditis in atrial septal defects. We report a case of atrial septal defect with infective endocarditis having vegetation over the warfarin ridge near left atrial appendage. Mitral regurgitation was caused due LV geometrical changes secondary to Ostium secundum ASD producing a turbulent jet that was hitting warfarin ridge of left atrium which may have lead to injury and development of vegetation.
  230 32 -
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