SEVERITY OF MITRAL REGURGITATION AND ITS ASSOCIATION WITH LEFT VENTRICULAR DYSFUNCTION AND BRAIN-NATRIURETIC PEPTIDE LEVELS IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE.

Acute decompensated heart failure (ADHF) is greatly influenced by levels of brain-natriuretic peptides (BNP) and thereby may have strong correlation with severity of mitral regurgitation (MR) and left ventricular ejection fraction (LVEF). The available data on its association is limited which sought us to investigate correlations between type of ADHF, BNP levels and severity of MR. A single-center, cross-sectional, observational study was conducted at Sri Ramachandra Institute of Higher Education and Research, Chennai, India. Adults aged >18 years, either gender, diagnosed as ADHF requiring hospital admission within 24 hours were incorporated into the research.Between June 2019 to June 2020, we included 79 patients of ADHF. The mean age was 64.9±11 years and 60.8% were males. The mean LVEF was 40.2±10.2%. The severity of MR was severe, moderate, and mild in 3.8%, 21.5% and 74.7% of patients, respectively. The proportion of patients with moderate to severe MR was significantly higher in ADHF patients with reduced EF compared to mid-range or preserved EF. The median levels of BNP significantly increased from 520.0 pg/ml in mild MR to 1020.0 pg/ml in moderate and 1410.0 pg/ml in severe MR. In patients with ADHF, MR is a common finding. The severity of MR is associated with greater reduction in ejection fraction. Determination of MR severity is essential in all ADHF cases. Further, stratification of patients using BNP levels may help in identifying those at higher risk of adverse outcomes in ADHF.

A Study of salt and fat Consumption pattern in Regional Indian diet among hypertensive and dyslipidemic PaTients - SCRIPT study.

BACKGROUND: Cardiovascular diseases are leading cause of mortality and morbidity. There is an increasing prevalence of hypertension and dyslipidemia due to globalization and adoption of westernized dietary habits in India. These transitions are manifest in dietary patterns and health outcomes. OBJECTIVE: To study the dietary salt and fat intake among patients diagnosed with hypertension and dyslipidemia in India. METHODS: SCRIPT study was a pilot exploratory, cross-sectional, observational, descriptive, multi-center study. It was conducted across hospitals and clinics in five metro cities of India, represented into four regional zones. In each region (North, n = 113; East, n = 98; West, n = 83; South, n = 152), patients diagnosed with hypertension and dyslipidemia were enrolled in the study. Socio-demographic and treatment details were recorded. Participants were interviewed by a dietician and their dietary intake was assessed by a three-day recall of food item questionnaire/ food diary. RESULTS: Overall the mean total daily salt consumption was 10.9 grams. Region-wise, the mean daily salt consumption in North, East, West and South were 14.13, 9.81, 10.12 and 9.38 grams respectively. The daily salt consumption in the North was significantly higher than other regions (P=0.012). The daily consumption of saturated fats (total saturated fat, ghee and butter) in the North was higher and statistically significantly in comparison to West, South and East (P <0.05). Overall, fats contributed to 24.1%, proteins contributed to 12.7% and carbohydrate contributed to 63.2% of total energy per day. The percentage of fat and protein contributing to total energy per day was within the acceptable range. CONCLUSIONS: Our study documented higher dietary salt intake than that recommended in India. There is an urgent need to address the issue of high salt and saturated fat consumption. Nutritional strategies for reducing salt intake, saturated fat and balancing energy nutrients should be urgently applied in Indian hypertensive and dyslipidemia patients.

ACEI-induced cough: A review of current evidence and its practical implications for optimal CV risk reduction.

Cough is one of the common adverse effects in patients receiving angiotensin-converting enzyme inhibitors (ACEIs). This review presents the current evidence on incidence and mechanisms of cough associated with ACEIs use, and proposes a practical approach for managing the same for optimal cardiovascular (CV) risk reduction. The incidence of dry cough in patients receiving ACEIs vary among individual ACEIs, and is the lowest with perindopril. Cough is thought to originate from multiple mechanisms, bradykinin theory is the most commonly appealed hypothesis. The strategies for optimal management could be temporarily discontinuation of ACEI upon a reported incidence of cough and reintroduction after its remission. However, studies have reported disappearance of cough despite continuing treatment. Another important approach could be adding calcium channel blockers to ACEIs. Switching to alternative drugs such as angiotensin receptor blockers should be suggested in case intolerable symptoms recur and after exclusion of all other possible causes of cough.