Impact of COVID-19 on heart failure hospitalization and outcome in India - A cardiological society of India study (CSI-HF in COVID 19 times study - "The COVID C-HF study").

OBJECTIVES: The presentation and outcomes of acute decompensated heart failure (ADHF) during COVID times (June 2020 to Dec 2020) were compared with the historical control during the same period in 2019. METHODS: Data of 4806 consecutive patients of acute HF admitted in 22 centres in the country were collected during this period. The admission patterns, aetiology, outcomes, prescription of guideline-directed medical therapy (GDMT) and interventions were analysed in this retrospective study. RESULTS: Admissions for acute heart failure during the pandemic period in 2020 decreased by 20% compared to the corresponding six-month period in 2019, with numbers dropping from 2675 to 2131. However, no difference in the epidemiology was seen. The mean age of presentation in 2019 was 61.75 (±13.7) years, and 59.97 (±14.6) years in 2020. There was a significant decrease in the mean age of presentation (p = 0.001). Also. the proportion of male patients decreased significantly from 68.67% to 65.84% (p = 0.037). The in-hospital mortality for acute heart failure did not differ significantly between 2019 and 2020 (4.19% and 4.,97%) respectively (p = 0.19). The proportion of patients with HFrEF did not change in 2020 compared to 2019 (76.82% vs 75.74%, respectively). The average duration of hospital stay was 6.5 days. CONCLUSION: The outcomes of ADHF patients admitted during the Covid pandemic did not differ significantly. The length of hospital stay remained the same. The study highlighted the sub-optimal use of GDMT, though slightly improving over the last few years.

Cardiac tamponade due to primary hypothyroidism: acute management and approach to prevent recurrence-a case report.

BACKGROUND: Hypothyroidism is a common endocrine disorder resulting from deficiency of thyroid hormone, with iodine deficiency remains the foremost cause. It is more common in women with increasing incidence in the elderly. The manifestations of hypothyroidism results from the hypometabolism in the body at cellular level and affects all organs. Although there can be an incidental diagnosis of the disorder, the presentation with cardiac signs and symptoms is rare. We report a case of primary hypothyroidism with dysmorphic features manifesting as massive pericardial effusion with cardiac tamponade at presentation. CASE SUMMARY: A female aged 20 years presented with lethargy, constipation, and dyspnoea of 6 months duration. On examination, she was short-statured and had dysmorphic features with hypotension, raised jugular venous pressure (JVP), muffled heart sounds, and thyroid stimulating hormone >100 uIU/mL. Chest X-ray showed cardiomegaly and 2DEcho confirmed cardiac tamponade for which emergency pericardiocentesis was done. DISCUSSION: Cardiovascular manifestations in hypothyroidism are dyspnoea and decreased exercise tolerance. Bradycardia, diastolic hypertension, cardiomegaly, and non-pitting or pitting peripheral oedema may be seen on physical examination. Mild pericardial effusion is common and generally asymptomatic. Massive pericardial effusion being manifested at presentation primarily as a sign of hypothyroidism is rare. A few cases have been mentioned in the literature in India and western population. Rarely, hypothyroidism presents with massive pericardial effusion resulting in cardiac tamponade as in our case.

Association of CDKN2BAS gene polymorphism with periodontitis and Coronary Artery Disease from South Indian population.

BACKGROUND: Periodontal disease (PD), a chronic inflammatory disorder mediated by progressive destruction of the oral cavity is one of the key factors for many systemic disorders including Coronary Artery Disease (CAD). The upregulation of CDKN2BAS, a long noncoding RNA gene expression in gingival epithelial cells and gingival fibroblasts of periodontitis shows a strong correlation between the severity of atherosclerosis and PD. Considering the crucial role of CDKN2BAS gene polymorphisms (rs496892 G > A and rs7865618 A > G) and its expression the present study sought to identify the possible association with the disease predisposition in South Indian population. METHODS: For the present case-control study a total of 200 subjects that include 100 PD-CAD patients and 100 controls were recruited with prior consent. Genomic DNA and RNA were extracted and utilized for genotyping via ARMS-PCR and PCR-RFLP, and expression using RT-PCR respectively. RESULTS: The results showed a significant association of both the polymorphisms with that of the disease predisposition. The wild type genotypes (GG: OR-0.37; p-0.001; & AA: OR-0.29; p-0.005) conferred protection against the disease, whereas, the heterozygotes (GA: OR-2.45; p-0.004 & AG: OR-3.41; p-0.0001) conferred risk towards the disease, suggesting the involvement of the variant allele in disease causation. These results were further confirmed by haplotype analysis among A-G block (two variant alleles at both loci) with 2.5 fold risk (OR = 2.49, 95% CI = 1.16-5.36, p = 0.02) and G-G block (single risk allele at rs7865618 locus) with 3-fold risk (OR-3.0; p-0.01) towards the disease, suggesting the dominant involvement of rs7865618 in the disease causation. Though the expression of the CDKN2BAS gene is more in patients than controls, the variant genotypes among patients were evaluated to be down-regulated than the other genotypes. CONCLUSION: The present study concludes that the two selected polymorphisms have significant involvement individually and in interaction with each other in the disease predisposition. The expression studies also suggest that the selected polymorphisms in the 9p21.3 locus affect the CDKN2BAS gene expression. However, the results obtained in the present study should be confirmed with large samples in other ethnic cohorts.

"Correlation of red blood cell distribution width with the severity of coronary artery disease-A single center study".

OBJECTIVE: Coronary Artery Disease (CAD) is the leading cause of morbidity and mortality all around the world. We evaluated the correlation of Red blood cell Distribution Width (RDW) with the severity of lesion on coronary angiography as assessed by Modified Gensini score (MGS) in CAD patients. METHODS: A total of 576 consecutive patients admitted in Department of Cardiology over a period of one year, who underwent coronary angiography after diagnosis of CAD or presence of angina like chest pain and/or positive treadmill test were enrolled in the study (August 2014-May 2015). Patients were divided into two groups, with CAD (Group A) and without CAD (Group B). The RDW Cofficience of variance (RDW CV) and RDW standard deviatiton (RDW SD) of each patient, and their correlation with severity of CAD was assessed. RESULTS: Of the total 576 patients enrolled, 438 were in Group A and 138 were in Group B. The mean age of presentation in Group A and Group B was (53.64±10.36 vs 49.4±9.73)years (p<0.0001). The Male and Female ratio overall was 2.42:1. Patients in Group A had significantly elevated RDW CV and RDW SD levels compared with those in Group B [(14.59±1.04)% vs (13.6±0.68)%, p<0.0001], [(45.78±4.76) vs (40.77±3.01), p<0.0001 respectively]. A significant positive correlation between RDW CV, RDW SD and MGS was noted (r=0.33, p<0.0001) (r=0.43, p<0.0001) respectively. On multivariate logistic regression analysis, RDW was demonstrated to be an independent predictor for angiographic CAD (OR=4.17, 95% CI 3.05-5.69, p<0.0001). On receiver operating characteristic curve (ROC) analysis, an RDW value of 14.3% was identified as an effective cut off point in diagnosing CAD with a sensitivity of 58.9% and specificity of 84.8%. CONCLUSIONS: RDW is an independent predictor of CAD and severity of coronary stenosis, suggesting that it can be a readily available marker for prediction and severity of CAD.