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   Table of Contents - Current issue
April-June 2020
Volume 10 | Issue 2
Page Nos. 43-99

Online since Friday, September 25, 2020

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Cardiovascular abnormalities in people living with HIV/AIDS p. 43
Shailesh Singh, Katyayni Singh
HIV/ AIDS affects the heart late in the course of the disease. Many of these complications arise not because of the disease but because of the treatment of the disease itself. The various complications which may be seen include left ventricular systolic dysfunction, accelerated atherosclerosis, leading to coronary artery disease, and stroke, infective endocarditis, and pulmonary hypertension.
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Heart failure with reduced ejection fraction in people living with human immunodeficiency virus/acquired immunodeficiency syndrome p. 50
Shailesh Singh, Katyayni Singh
Heart failure is one of those complications of HIV/ AIDS, whose epidemiology has changed grossly after the widespread use of HAART. HIV DCM is multifactorial is the origin. The systolic heart failure can be having an ischemic etiology, or it may be non- ischemic in origin. HIV/ AIDS is no longer considered a contraindication for cardiac transplantation.
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Twenty-four-hour blood pressure management in India: A position statement by Indian College of cardiology p. 56
PB Jayagopal, BC Srinivas, TR Raghu, NN Khanna, KH Srinivas, SC Manchanda, Shantanu Guha, Saumitra Ray, Joy M Thomas, Sameer Srivastava, Devanu Ghosh Roy, Sadanand R Shetty, I Sathyamoorthy, KS Ravindranath, Girish B Navasundi, RR Mantri, Peeyush Jain, Amal Kumar Khan
Blood pressure (BP), even in healthy normotensive individuals, is dynamic, varies with a circadian periodicity, and is influenced by physiological and environmental factors. Abnormal 24-h BP patterns have been observed in many patients with hypertension (HTN), which may be overlooked if evaluations are based only on office BP measurements. Out of office BP measurements, such as Ambulatory Blood Pressure Monitoring and Home Blood Pressure Monitoring (ABPM and HBPM) is important for optimal BP management and are better predictors of adverse outcomes. However, HTN diagnosis and management are often based on relatively few clinic BP measurements, and there are no recommendations to guide clinicians managing patients with abnormal 24-h BP patterns in India. Thus, the present consensus statement aims to provide uniform evidence-based recommendations for the diagnosis and management of abnormal 24-h BP patterns. Strategies for screening for HTN based on the current prevalence trends in India have been suggested. Further, recommendations on the appropriate use of ABPM and HBPM in diagnosis and management of HTN are provided.
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Rationale, methodology, and design of Indian College of Cardiology National Heart Failure Registry p. 75
PB Jayagopal, CN Manjunath, TR Raghu, Jabir Abdullakutty, PR Vaidyanathan, Johny Joseph, Veena Nanjappa, L Sridhar
Aims: Heart Failure (HF) is a growing epidemic globally and a challenging situation particularly for a country like India. There is paucity of data in the Indian context and the Indian College of Cardiology National Heart Failure Registry (ICCNHFR) would be the first of its kind in understanding the aetiology, demographics and treatment pattern in the country. The rationale and design of the study is described. Methods and Results: This is a prospective observational registry study of Acute Decompensated Heart Failure (ADHF) across various hospitals in India. This would include data of consecutive adult patients admitted with acute heart failure in the hospitals. This study is from Sep 2019 to Sep 2021 and is expected to enroll about 10000 patients. The primary data would be to analyse the demographics, aetiology, comorbid conditions, inhospital mortality, 30 day and one year mortality and rehospitalisation. The secondary aim would be understand the diagnostic patterns and therapeutic options offered for these patients.Conclusion: The present registry is designed to analyse the national data on ADHF. This would identify gaps in HF care and therapy. This would help in improving quality of heart failure care in the country and better resource utilization. This will help in the reduction of mortality and morbidity rate related to HF
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An economic model to assess the value of triclosan-coated sutures in reducing the risk of surgical-site infection in coronary artery bypass graft in India p. 79
Nilesh Mahajan, Reshmi Pillai, Hitesh Chopra, Ajay Grover, Ashish Kohli
Background: The incidence of surgical site infections (SSIs) is higher in India compared to the rest of the world. In patients undergoing coronary artery bypass graft (CABG), the risk is even higher. SSI following CABG is associated with an additional length of stay (LOS) resulting in additional costs, thus causing a significant economic burden on patients and society. We aimed to determine the additional costs and LOS due to SSIs after CABG and to evaluate the efficacy of triclosan-coated sutures (TCS) in reducing the SSI rate. Methodology: A systematic literature search of available evidence for both epidemiologic and economic data related to the incidence of SSI (from 1998 to 2018) and efficacy of TCS (from 2000 to 2018) respectively, were gathered. We compared 100 surgeries from private and public hospitals for CABG and calculated cost-effectiveness of TCS in comparison to conventional nonantimicrobial-coated sutures (NCS) using a decision-tree cost model. Results: Three studies were analyzed out of 109 citations for the analysis of SSI incidence and for the efficacy of TCS versus NCS, five studies were included. We performed a one-way sensitivity analysis to calculate the impact of efficacy (%) and SSI incidences (%) and cost of NCS and TCS on cost savings depicted by Tornado charts. Sensitivity analysis on the comparison of TCS with NCS, a base cost saving of CABG for a private hospital was INR 14,476 and public hospital INR 4145. Conclusion: The use of TCS reduced SSI incidence and cost savings for CABG surgeries in both public and private sectors in India.
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A single-center study of the profile of spontaneous coronary artery dissection in acute coronary syndrome patients p. 85
Harsha Basappa, Sachin T Rao, KS Sadananda, Srinidhi Hegde, CN Manjunath
Background: Spontaneous coronary artery dissection (SCAD) is rarely encountered as a primary cause of acute coronary syndrome (ACS). There is a paucity of studies involving SCAD, especially in the Indian population. Aims: We aim to study the clinical and angiographic characteristics and in-hospital outcomes of ACS patients whose angiogram incidentally shows SCAD as the cause of ACS and the management strategies opted. Methods: This is a prospective and retrospective observational study. All coronary angiograms of patients with ACS, either ST-segment elevation myocardial infarction (STEMI) or unstable angina non-STEMI, underwent within 72 h of admission, were analyzed and those patients with Saw classification Type I SCAD were included in the study. Clinical and angiographic characteristics, in-hospital outcomes, and management strategies of patients with SCAD were recorded. Results: Of the total 70 cases with SCAD included in the study, 66 (94.28%) were male. Smoking was the most common risk factor seen in 22 (31.4%) cases. STEMI was the most common presentation seen in 44 (62.8%) subjects. Single-vessel involvement was seen in 67 (95.7%) patients. Significant stenosis, i. e., >70% luminal narrowing was seen in 40 (57.1%) patients. Root cause analysis (RCA) is the most common artery to be involved with 35 (50%) cases. Majority of the cases, i.e., 60 (85.7%) cases had thrombolysis in myocardial infarction 3 flow. The majority was managed conservatively. Percutaneous transluminal coronary angioplasty (PTCA) was done successfully in 18.5% of patients. Conclusion: Indian subjects, as observed in this study, differ significantly in their profile compared to the Western population. Indian subjects are predominantly middle-aged males with a significant proportion having traditional risk factors, and they tolerate thrombolysis better, success rates of PTCA are much higher, RCA is the most commonly involved artery as opposed to left anterior descending in Western population and more than half of the patients have atherosclerotic disease involving other arteries.
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Intervention on anomalous left anterior descending artery originating from right coronary sinus p. 89
Sandeep Bijapur, BS Arun, CN Manjunath, Prabhavathi Bhat
Coronary arteries anomalies are rare. We report a case of anterior wall myocardial infarction with anomalous left anterior descending artery (LAD) and left circumflex artery (LCX), with LAD originating from right coronary sinus and LCX from right coronary artery. We did successful percutaneous coronary intervention with stenting to LAD using Amplatzer AR1-catheter.
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Multivessel percutaneous coronary intervention in midterm anastomotic failure of all grafts post CABG: An unpredictable enigma? p. 92
Raghuram Palaparti, Gopala Krishna Koduru, Sudarshan Palaparthi, PS S. Chowdary, Purnachandra Rao Kondru, Somasekhar Ghanta
Coronary bypass graft failure can be divided into three temporal categories: Early (0–30 days), midterm (30 days to 1 year), or late (after 1 year). Early to midterm graft failure is still a significant problem in the clinical practice and often under reported. Here, we report a case of midterm failure of all grafts post CABG. A 56-year-old male presented to us with unstable angina and found to have triple vessel disease. He underwent CABG with left internal mammary artery (LIMA) to left anterior descending, venous grafts to diagonal and obtuse marginal. As ostial right coronary artery disease was moderate, it was not grafted. Three months later, he presented with acute coronary syndrome, acute heart failure, and moderate left ventricular (LV) dysfunction. Coronary and graft angiogram revealed critical anastomotic lesions of LIMA and both the venous grafts. Rapid progression of native vessel disease was also observed. He underwent successful multivessel percutaneous coronary intervention (PCI) with improvement in LV function. Midterm saphenous venous graft failure is mainly caused by neointimal hyperplasia leading to occlusive stenosis. Midterm failure of coronary artery bypass grafts is not a uniformly predictable response and has been the focus of extensive clinical research. Various mechanical strategies involving improvement of surgical techniques and various pharmacological strategies have been studied but did not address the problem adequately. PCI is the preferred strategy in these high-risk patients as it is less invasive and gives excellent results. Graft surveillance, early recognition of the problem and aggressive management has shown to improve the graft patency rates and decrease recurrent cardiovascular events in these patients.
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Percutaneous coronary intervention of the large right coronary artery using a renal stent – An off-label device for an on-label indication p. 97
Pankaj Jariwala, Marri Ajay Reddy
Percutaneous coronary intervention of large ectatic coronary arteries is always challenging for the interventional cardiologist. Large coronary arteries, also called as “dilated coronaropathy,” have heterogeneous etiology that angiographically manifests as localized or diffuse ectasia. The large caliber of the coronary artery poses many challenges such as the choice of type of the stent whether to use coronary versus noncoronary stent or drug-eluting versus bare-metal stent. Furthermore, the size of the stent and complete expansion after its deployment can be addressed using intracoronary imaging techniques such as intravascular ultrasound and optical coherence tomography in the setting of coronary artery ectasia. Different types of peripheral vascular or nonvascular stents were used for the percutaneous treatment of large native coronary arteries or saphenous vein graft lesions. We report a case, where a renal stent for a large coronary artery was used successfully to treat the clinical situation. Furthermore, we have discussed the various options of the percutaneous therapy available in the setting of large coronary arteries as described in the literature.
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