Aims: The aim was to study the clinical profile, risk factors prevalence, angiographic distribution, and severity of coronary artery stenosis in acute coronary syndrome (ACS) patients of South Indian population. Materials and Methods: A total of 1562 patients of ACS were analyzed for various risk factors, angiographic pattern and severity of coronary heart disease, complications and in hospital mortality at Sri Jayadeva Institute of Cardiovascular Research and Sciences, Bengaluru, Karnataka, India. Results: Mean age of presentation was 54.71 ± 19.90 years. Majority were male 1242 (79.5%) and rest were females. Most patients had ST elevation myocardial infarction (STEMI) 995 (63.7%) followed by unstable angina (UA) 390 (25%) and non-STEMI (NSTEMI) 177 (11.3%). Risk factors; smoking was present in 770 (49.3%), hypertension in 628 (40.2%), diabetes in 578 (37%), and obesity in (29.64%) patients. Angiography was done in 1443 (92.38%) patients. left anterior descending was most commonly involved, left main (LM) coronary artery was least common with near similar frequency of right coronary artery and left circumflex involvement among all three groups of ACS patients. Single-vessel disease was present in 168 (45.28%) UA, 94 (56.29%) NSTEMI and 468 (51.71%) STEMI patients. Double-vessel disease was present in 67 (18.08%) UA, 25 (14.97%) NSTEMI and 172 (19.01%) STEMI patients. Triple vessel disease was present in 28 (7.55%) UA, 16 (9.58%) NSTEMI, 72 (7.95%) STEMI patients. LM disease was present in 12 (3.23%) UA, 2 (1.19%) NSTEMI and 9 (0.99%) STEMI patients. Complications; ventricular septal rupture occurred in 3 (0.2%), free wall rupture in 2 (0.1%), cardiogenic shock in 45 (2.9%), severe mitral regurgitation in 3 (0.2%), complete heart block in 11 (0.7%) patients. Total 124 (7.9%) patients died in hospital after 2.1 ± 1.85 days of admission. Conclusion: STEMI was most common presentation. ACS occurred a decade earlier in comparison to Western population. Smoking was most prevalent risk factor. Diabetic patients had more of multivessel disease. Complications and in hospital mortality was higher in females and elderly population.

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Background: Congenital heart disease (CHD) is one of the major causes of mortality and morbidity in the pediatric population of both the developing and developed countries. Variability in incidence and prevalence of CHD from various countries of Indian subcontinent and rest of the world could be because of genetic, cultural, and environmental factors. Objective: To find the prevalence and pattern of CHD in a tertiary care hospital in Kashmir (J&K). Materials and Methods: A retrospective analysis of case-records data of 767,921 patients (0-18 years) over 3 years and 10 months period was conducted to ascertain the prevalence and spectrum of CHDs. Results: A total of 877 patients out of 767,921, were found having CHDs measuring a prevalence of 1.12/1000. About 777 (88.5%) were the acyanotics, and 100 (11.5%) were cyanotic heart patients. Among the acyanotic heart diseases ventricular septal defect was the most frequent lesion seen in 241 (31.2%), followed by patent ductus arteriosus in 184 (24.3%) children. Among the cyanotic heart diseases tetralogy of Fallot was the most frequent cyanotic heart disease seen in 48 (48.0%) patients. Conclusion: Prevalence of 1.12/1000 among the hospital attending patients could be an underestimation of the actual disease burden in our community, and heightened awareness among the treating physicians about the cardiac diseases could actually reduce the mortality and morbidity associated with these ailments.

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Objective : The objective of this study was to analyses the major risk factors for coronary artery disease (CAD) for patients with ischemic heart disease in Kerala. Design : A cross-sectional study among patients with established CAD admitted in the Department of Cardiology during the month of June-Dec 2012. Setting : Study was carried out in a tertiary cardiac center in Kerala. Participants: A total of 496 patients who were admitted in the Cardiology department between June 2012 and December 2012 with acute coronary syndrome or coronary angiographic or Electrocardiography evidence of ischemic heart disease. Risk factors studied were the conventional risk factors for coronary artery disease - hypertension, diabetes mellitus, dyslipidemia, body mass index (BMI), smoking, and family history of coronary artery disease. Data are collected from the patients, old medical records, Clinical Examination and Laboratory results of the patients were analyzed for the study. Results: From the study, it was seen that in Keralites-irrespective of gender, diabetes or impaired glucose tolerance (79%) and dyslipidemia (71%) are the major risk factor for Coronary artery disease. Hypertension (39%) and cigarette smoking (24%) were not seen to be a major risk factors for coronary artery disease as only a minority of the study population had hypertension or gives a history of cigarette smoking. 57% of the study population had a family history of coronary artery disease. Among the studied population, 55% of females are with increased BMI, whereas only 16% of males with CAD were with BMI above 30. Conclusion: Among South Indian population irrespective of gender, diabetes mellitus and dyslipidemia are the major Risk factor for Coronary artery disease. So early detection of diabetes mellitus and dyslipidemia and proper treatment of both, before developing the end organ damage, play a vital role for the prevention of coronary artery disease.

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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 artery disease (CAD) is a huge global burden and is a leading cause of morbidity and mortality across the world. We have done this review to elucidate the pathogenesis of herpesviruses in causing CAD and to study an association between herpesviruses (cytomegalovirus [CMV] and herpes simplex virus [HSV-1 and -2]) and CAD. CMV can cause atherosclerosis directly through the activity of its gene products on endothelial cells, monocytes/macrophages, and smooth muscle cells and indirectly through production of pro-inflammatory cytokines at far off place. HSV infection causes atherosclerosis mainly by causing increased prothrombotic activity on endothelial cells, accumulation of cholesterol esters and triacylglycerols in vascular smooth muscle cells, and upregulating expression of Lectin like oxidized Low density lipoprotein receptor-1 (LOX-1) receptor on macrophages. The association between CMV and CAD is related to its seroprevalence with a positive association in developing countries (higher seroprevalence) and no significant association in developed countries (lower seroprevalence). However, the association between HSV infection and atherosclerosis is not related to its seroprevalence.

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Rasopathy syndromes are a class of phenotypically similar, but genetically distinct multiple anomaly syndromes caused by germ line mutations in genes that encode protein components of the Ras/mitogen activated protein kinase (MAPK) pathway. Noonan syndrome, cardiofaciocutaneous syndrome and Costello syndrome are part of this group of developmental syndromes and have similar cardiac abnormalities. A 19-year-old male presented with complaints of exertional breathlessness class I for 6 months. Clinical examination revealed characteristic facial features, skeletal abnormalities, growth and neurocognitive problems reported in patients with Noonan syndrome. There was evidence of severe pulmonary hypertension. Trans-thoracic echocardiography revealed right atrial and right ventricular enlargement, severe pulmonary hypertension, no intra cardiac shunt, prolapse of anterior mitral leaflet with mild mitral regurgitation. CT pulmonary angiogram revealed bilateral branch pulmonary artery stenosis. A final diagnosis of Noonan syndrome was made.

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Background: Various studies have shown that people of Indian origin have an increased risk of ischemic heart disease (IHD) compared with most other ethnic groups. This increased risk has been attributed to multiple risk factors related to lifestyle. Patients and Methods: A total of 100 cases and 100 age and sex-matched controls were taken into this prospective case-control study from Intensive Coronary Care Unit. Prevalence of the following risk factors for myocardial infarction: Age, sex, diet, smoking, alcohol consumption, history of hypertension, history of diabetes mellitus, and lipid profile were studied. Patient data were extracted from the medical records department and by interview. Results: The most important predictor of acute myocardial infarction (AMI) was high low-density lipoprotein (adjusted odds ratio [OR]: 4.124, confidence interval [CI]: 1.44-11.73, P = 0.008) history of hypertension and of overt diabetes mellitus were also independent risk factors (OR: 2, CI: 1.4-3 and OR: 2.29, CI: 1.5-3.5), respectively. Low high-density lipoprotein was found to have no significant association with AMI. Heavy drinkers were found to have a high-risk (OR: 68), while moderate drinkers were found to have protection (OR: 1). Conclusion: Smoking and heavy drinking cessation, treatment of hypertension and reduction in blood glucose, correction of abnormal lipid profile either through use of statins or by dietary modification may be important in preventing IHD in Asian Indians.

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Context: An association between cardiac autonomic neuropathy and QT interval prolongation was demonstrated in many studies and it may predispose to sudden death in diabetes mellitus. Aims: To find out the prevalence of cardiac autonomic neuropathy and its relation to QTc interval and QTc dispersion in type 2 diabetes. Settings and Design: Observational study. Materials and Methods: Fifty patients with type 2 diabetes mellitus of more than 5-years duration and 30 age- and sex-matched controls without any history of diabetes were selected. A battery of five autonomic function tests was done in all cases. Heart rate, QTc values, and QTc dispersion were measured and compared among patients with and without autonomic neuropathy and controls. Statistical analysis used: Students t test/Chi-square test. Results: Among the 50 patients in the study population, 21 (42%) had severe autonomic neuropathy and 12 (24%) had early autonomic neuropathy. Mean heart rate was significantly more in patients with autonomic neuropathy than those without neuropathy. Diabetics with autonomic neuropathy had significantly higher QTc mean and QTc max values compared to diabetics without autonomic neuropathy and controls. QTc dispersion was significantly more among patients with autonomic neuropathy compared to those without autonomic neuropathy and controls. Conclusions: Diabetic autonomic neuropathy is associated with increase in resting heart rate and prolongation of QTc intervals. QTc max was correlating with severity of autonomic neuropathy. QTc dispersion is significantly high in diabetes mellitus with autonomic neuropathy.

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Background: Noncommunicable diseases are increasing and constitute a serious concern, accounting for 52% of the deaths and 38% of the disease burden in the World Health Organization (WHO) South-East Asia Region. Eighty percent of total deaths due to noncommunicable diseases occur in the low-income countries. Lifestyle changes are resulting in an increased risk of cardiovascular diseases (CVD). Surveillance of CVD risk factors is a key to reduce the burden of CVD. WHO–International Society of Hypertension (ISH) 10-year risk prediction charts have been developed for the screening of CVD risk factors in different regions. The National Programme for Prevention and Control of Diabetes, Cardiovascular Diseases and Stroke (NPDCS) has also recommended the utilization of these charts for routine screening. The present study has used the WHO-ISH CVD risk prediction chart to assess the feasibility of utilization of this chart as a predicting tool of a CVD event. Materials and Methods: A cross-sectional survey was conducted among supporting staff of JSS Hospital, Mysuru, Karnataka, India to assess the CVD risk factors and risk factor profiling, and the prediction of 10-year risk for CVD was done using a WHO-ISH risk prediction chart. Results: A total of 900 supporting staff were screened for CVD risks. Out of them, 30 (3.3%) had hypertension, 20 (2.2%) had diabetes mellitus, 18 (1.99%) consumed tobacco. The proportion of newly detected diabetes cases was 8 (0.9%) and of prediabetics was 32 (3.7%). The proportion of newly detected prehypertensives were 292 (39.08%), and 27 (3.61%) were hypertensives. Out of 175 individuals aged above 40 years, the WHO-ISH risk prediction chart predicted that 1.7% of them had >10% risk of CVD event within 10 years. Conclusion: Hidden, asymptomatic individual of diabetes, and hypertension were identified; the WHO-ISH 10 year risk prediction chart was easier for assessing the CVD risk factors and risk grouping, and could also be used to show them the extent of risk and predicting their 10-year risk of stroke or myocardial infarction (MI).

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Objective: Congenital coronary artery anomalies (CCAs) are rare, clinically benign, and majority are diagnosed incidentally during coronary angiography or an autopsy. Identification of CCA is important for management by cardiologists or cardiac surgeons, and also few cases of CCA are potentially serious which may cause sudden cardiac death. We performed a retrospective, single-center study to evaluate the clinical profile, incidence, pattern, and atherosclerotic involvement of CCA in patients undergoing coronary angiography. Methods: Coronary angiographies performed in adult patients during the study period of 2 years were screened for CCA. These patients were retrospectively analyzed in terms of clinical characteristics and angiographic profiles. Results: Of 4481 angiograms screened, 86 patients were found to have CCA with the incidence of 1.91%. Nearly 76.7% were male and 23.3% were female, with a mean age of 53.02 ± 10 years. Anomalies of origin and course were most common (94.18%) followed by anomalies of termination (5.81%), with right coronary artery (RCA) being the most common artery. Anomalous origin of RCA from the left sinus of Valsalva and separate origin of left anterior descending artery and left circumflex artery were both found to be the most common types. The incidence of atherosclerosis in anomalous vessels was 52.32%. Conclusions: CCAs were diagnosed incidentally during coronary angiography and had male predominance with conventional risk factors. The incidence of CCA was slightly higher than that of the previous angiographic studies, but the pattern of anomalies was similar with majority being benign. Anomalous vessels did not predispose to atherosclerotic involvement as compared to normal vessels in the same patients.

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Objective: To discuss the management in a subset of patients with severe mitral valve disease having calcified, nonpliable valves not suitable for percutaneous balloon mitral valvuloplasty during pregnancy, presenting with Stage III–IV of the clinical classification of New York Heart Association. Methods: Patients with nonpliable valves presenting with heart failure in pregnancy at advanced gestation were planned for simultaneous cesarean section followed by mitral valve replacement. Results: All patients underwent successful surgery with good maternal and neonatal outcome. Conclusion: Patients with severe mitral valvular disease in failure in pregnancy, who are at high risk of mortality in pregnancy or during and following delivery, benefit from combined surgery.

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The mural endocarditis is a rare cause of intracardiac masses, which is difficult to diagnose and usually requires surgery to prevent embolization and intracardiac complications. We herein present an unusual case of right ventricular mural endocarditis in a patient with rheumatic heart disease, in which presence of multiple mural vegetations was visualized on two-dimensional transthoracic echocardiography and better delineated with three-dimensional echocardiography. There was complete resolution of vegetations with antibiotic therapy.

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The extra-articular manifestations of Rheumatoid Arthritis (RA) have drawn as much interest as the disease itself and thus leading to it being labeled as a chronic inflammatory joint disease with a multisystem involvement. Of the various known extra-articular manifestations, one of the rare complications is the conduction abnormalities of the heart that is seen in the active disease. Here, we are reporting a case of a female patient with RA, who to begin with had conduction defects secondary to RA which later progressed to a complete heart block, as its sequelae.

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Cardiac mass is always challenging, specially in the right side of the heart that should raise suspicion of a malignancy. A 15-year-old poor growth and poor weight gain girl with dyspnea was examined in the emergency room. Transthoracic echocardiography revealed a large homogeneous mass in the RV apex which disappeared one week after intravenous heparin therapy. A trial of anticoagulation should be considered when the differential diagnosis is difficult and thrombus is a possibility.

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A 32-year-old lady attended the outpatient door with the complaint of new-onset paroxysmal palpitation for the last 1 month. Her past medical history was not significant. There was no past history of cardiac illness. Her initial 12-lead electrocardiogram (ECG) was within normal limits. While examining the patient, she developed atrial fibrillation (AF) followed by right ventricular outflow tract ventricular tachycardia (RVOT VT). It resolved spontaneously in 2-3 min. AF and RVOT VT are two common arrhythmias having separate mechanisms of onset. Rarely, they can coexist in the same patient. Though uncommon, one tachycardia can act as a trigger for the other. This is known as “tachycardia induced tachycardia or dual tachycardia.”

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Coronary artery anomalies are rare, but still rarer is anomalous branching pattern of the left coronary artery (LCA) alone, without any congenital anomalies. We report the case of a 50-year-old man who presented with dyspnea on exertion New York Heart Association (NYHA) class II, had a positive stress test, and his coronaryangiogram revealed the left main coronary artery (LMCA) dividing into four branches. This type of branching pattern is quite rare. He had type I dual left anterior descending (LAD) artery in addition to a fairly large ramus intermedius (RI) and a nondominant left circumflex (LCx) arising from the LCA. Awareness and recognition of dual LAD is of importance to surgeons and interventionalists alike in planning the revascularization strategy.

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Aortopulmonary window (APW) is an extremely rare cardiac malformation accounting for 0.2-0.6% of all congenital heart defects. In an acyanotic patient with clinical evidence of patent ductus arteriosus with large left to right shunts and systolic rather than continuous murmur one should keep in mind the possibility of APW. If not treated early in childhood or adolescence, they tend to develop pulmonary hypertension, which can be fatal in almost all cases. Few surviving adult patients have symptoms associated with severe pulmonary hypertension, making these cases inoperable. We document an unusual case presenting in the second decade.

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Background: India has a high burden of cardiovascular diseases (CVDs). High-risk interventions can be initiated only when individuals at high-risk have been identified. Objectives: The objective was to estimate the prevalence and the sociodemographic pattern of cardiovascular risk factors and to predict the 10 years risk of fatal and nonfatal major cardiovascular events in a rural population in Tamil Nadu. Materials and Methods: A cross-sectional study was conducted among 30 villages of a rural block in Tamil Nadu from March 2012 to February 2013 in the age group of 40-79 years attending our fixed mobile clinics using structured interview schedule and subsequently, the World Health Organization/International Society of Hypertension (WHO/ISH) risk charts were used to predict the 10 years absolute risk of fatal or nonfatal cardiovascular event. Results: A total of 482 individuals were studied of which 68.3% were women and 31.7% were men. Prevalence of overweight, diabetes, and systolic hypertension was found to be 60%, 22.8%, and 34.6%, respectively. A majority (79.9%) of the study population had 10 years cardiovascular risk of <10% while only 2.5% had a risk of more than 40%. As the age advances, the proportion of participants with high-risk also increased and this trend was statistically significant (P = 0.001). Conclusion: Less than 10% of the population had a high-risk of CVD based on WHO/ISH risk score. These charts help identify the high-risk groups in the population in resource-scarce setting and thus an appropriate action can be taken.

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Background: Electrocardiography (ECG) is a simple, noninvasive, and relatively cheap investigative tool used for cardiac evaluation. However, there are limited electrocardiographic studies of Nigerian children. Adult studies of ECG have shown significant differences between Black and Caucasian populations. These differences may also be seen in children, hence, the need to develop local reference values. Materials and Methods: This was a cross-sectional study and multistage random sampling method was applied to select 650 subjects. The ECG machine was a portable heated stylus direct writing AT-2 Swiss made electrocardiograph (Schiller AG Cardiovit CH6341). Results: There were 350 males (53.3%) and 300 females (46.7 %), with a male:female ratio of 1.2:1. The mean heart rate decreased with increasing age. R-wave amplitudes were higher in the left precordial leads, in keeping with left ventricular dominance. Mean values were higher in boys than girls in the three age-groups in most of the precordial and limb leads. In V ₄ R, V ₂ , and V ₃ highest mean R wave voltages of 0.5 ± 0.1, 1.4 ± 0.3, and 1.4 ± 0.2 mV, respectively, were recorded in the 5-7-year-old. While in V ₅ and V ₆ , the mean R waves were higher in the 12-15-year-old age group (3.7± 0.5 and 2.5±0.4 mV, respectively). The S-waves showed progressive decrease in its amplitude on the left precordial leads with increasing age. Conclusion: The mean values in heart rate, QRS duration, PR interval, and P-wave amplitude showed higher amplitudes in boys. Similarly higher amplitudes of R-waves in boys were recorded in precordial leads V ₂ , V ₃ , V ₅ , and V ₆ in the three age groups.

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Objective: This study compares the quality of mitral valve (MV) replacement performed through a submammary right thoracotomy incision with nerve sparing opening and closure to the standard midline sternotomy procedure. Materials and Methods: Hundred young female patients underwent MV replacement with 50 patients in the thoracotomy group and the remaining 50 patients in the median sternotomy group between August 2013 and April 2014 with follow-up till August 2015. Demographics, procedures, operative techniques, and postoperative morbidity and mortality, along with follow-up, were recorded in both the patients and compared. Results: In our study, postoperative pain and postoperative drainage were significantly lower in the thoracotomy variant with 60% of the cases draining only 100-200 mL. Morbidity is quite less in the thoracotomy variant with 60% of the cases able to stand up without support postoperatively 12 h after extubation while the number is only 20% in the sternotomy variant and that too with sternal support. Most of the thoracotomy cases were discharged from the hospital within 1 week. On follow-up, there were only two cases, i.e., 4% of the total cases presenting with hypertrophied scar, which is significantly lower than 20% of the sternotomy cases where three cases developed into keloid while in the sternotomy cases, 10 (20%) cases reported with wound discharge and infection. Conclusions: This procedure provides the same quality of treatment through a less traumatic and better cosmetic incision, resulting in less hospital stay and a lower overall cost.

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The current study attempts to address an issue which is the need to obtain a preoperative electrocardiography (ECG) in all patients prior to non-cardiac surgery. Significance in patients without symptoms is uncertain. Aims: To study the incidence of ECG abnormalities in preoperative patients posted for elective non-cardiac surgery. 2. To study the co-relation of risk factors with ECG abnormalities. Materials and Methods: All hospitalized clinically stable patients advised ECG for preanesthetic assessment prior to elective non-cardiac surgery were included as subjects. Co-relation of risk factors with ECG abnormalities were studied. Statistical analysis used: Statistical Package for the Social Sciences (SPSS) software (chi-square test) Results: One hundred and twenty-eight males and 65 females were enrolled for study. Preoperative ECG was normal in 116 (60.10%) and abnormal in 77 (39.90%) patients. Abnormal ECG was more common in those with hypertension, diabetes, cardiovascular disease, and smoking. No adverse postoperative event was observed in any of the patient. Conclusions: ECG being a simple non-invasive tool should be considered for all patients undergoing elective procedures and should be mandatory for those with risk factors.

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Background: Chronic obstructive pulmonary disease (COPD) and pulmonary arterial hypertension (PAH) are common and underdiagnosed medical conditions in India. Prevalence of these chronic diseases is high both in rural and urban areas. However, the exact prevalence of PAH in Indian COPD patients is unclear. Comorbid conditions like PAH have a great impact on the outcome of COPD in the form of severity, exacerbations, morbidity, and mortality. Right heart catheterization remains the gold standard test for diagnosis of PAH, but it is invasive and practically not feasible. Aims and objectives: The present study objective was to screen COPD patients for PAH using two-dimensional transthoracic Doppler echocardiography (ECHO) in Tertiary Care Hospital. Results: A total of 2040 patients with a confirmed diagnosis of COPD were enrolled in the study. Among these patients, 1509 were males (73.9%), 531 were females (23.06%), and 1428 were known or ex-smokers (70%). None of the females were smokers, but there was a history of biomass fuel exposure for >10 years. As per global initiative for chronic obstructive lung disease criteria, mild, moderate, severe, and very severe COPD was noted in 525,629,511, and 375 patients, respectively. When they were screened using ECHO, prevalence of PAH was 41.96% as 856 subjects had PAH. Prevalence of PAH among mild, moderate, severe, and very severe COPD was 23.8%, 34.81%, 48.53%, and 70.4%, respectively. There was a linear relationship between PAH and severity of COPD. Conclusion: PAH is very common in COPD patients in India. As the severity of COPD increased, the frequency and degree of PAH also increased. ECHO is an excellent tool for detection of PAH in COPD patients. All patients with severe to very severe COPD should be routinely screened by ECHO for PAH and with mild to moderate COPD, who have dyspnea out of proportion to their clinical condition should also be screened for PAH.

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Introduction: Thalassemia is the most common genetic disorder worldwide. Regular transfusion therapy, while improving patient quality of life, creates a state of iron overload. Once reticuloendothelial stores saturate, iron deposition increases in parenchymal tissues such as endocrine glands, hepatocytes, and myocardium. Cardiac iron deposition produces arrhythmias, systolic and diastolic dysfunction, and congestive heart failure in the second or third life decade. Aims and Objective: The present study was planned to find the prevalence of thalassemia cardiomyopathy and to study the spectrum of cardiac disease in thalassemia patients. Methods: All consecutive patients of thalassemia more than 12-year-old were included in this study. Screening included medical history assessment, focusing on cardiovascular symptomatology, transfusion and chelation history, physical examination, and transthoracic resting echocardiography. Clinical parameters included age, sex, address, height weight, body mass index (BMI), systolic blood pressure (BP), diastolic BP, mean hemoglobin, and mean serum ferritin. Results: A total of 56 patients of thalassemia were included in the study. Fifty-one patients were of thalassemia major and 5 patients were of thalassemia intermedia. Mean age of patients included in our study was 15.9 ± 4.6 years. Mean duration of thalassemia in our patients was 12.9 ± 3.05 years. Mean hemoglobin of the patients included in our study was 8.7 ± 1.1 g%. The level of mean serum ferritin in our patients was 666.69 ± 325.46 ng/ml. In our study, we had 8 (14.2%) patients out of 56 having systolic dysfunction. Furthermore, our patients with left ventricular systolic dysfunction had younger mean age as compared to those patients who had a normal left ventricular function. We also found a higher ferritin value in patients with left ventricular dysfunction as compared to patients with normal left ventricular dysfunction studies. Conclusion: In our study, we found out that patients with left ventricular dysfunction had a younger age of onset of disease, higher ferritin levels, lower blood pressure, and paradoxically higher BMI as compared to patients with normal left ventricular dysfunction.

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Coronary angiography underestimates or overestimates lesion severity, but still remains the cornerstone in the decision making for revascularization for an overwhelming majority of interventional cardiologists. Guidelines recommend and endorse non invasive functional evaluation ought to precede revascularization. In real world practice, this is adopted in less than 50% of patients who go on to have some form of revascularization. Fractional flow reserve (FFR) is the ratio of maximal blood flow in a stenotic coronary relative to maximal flow in the same vessel, were it normal. Being independent of changes in heart rate, BP or prior infarction; and take into account the contribution of collateral blood flow. It is a majorly specific index with a reasonably high sensitivity (88%), specificity (100%), positive predictive value (100%), and overall accuracy (93%). Whilst FFR provides objective determination of ischemia and helps select appropriate candidates for revascularization (for both CABG and PCI) in to cath lab itself before intervention, whereas intravascular ultrasound/optical coherence tomography guidance in PCI can secure the procedure by optimizing stent expansion. Functional angioplasty simply is incorporating both intravascular ultrasound and FFR into our daily Intervention practices.

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