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BACKGROUND: ST-elevation myocardial infarction (STEMI) refers to a clinical syndrome that features symptoms of myocardial ischemia with consequent ST-elevation on electrocardiography and an associated rise in cardiac biomarkers. Rapid restoration of brisk flow in the coronary vasculature is critical in reducing mortality and morbidity. In patients with STEMI who could not receive primary percutaneous coronary intervention (PCI) on time, pharmacoinvasive strategy (thrombolysis followed by timely PCI within 3-24 h of its initiation) is an effective option. AIM: To analyze the role of delayed pharmacoinvasive strategy in the window period of 24-72 h after thrombolysis. METHODS: This was a physician-initiated, single-center prospective registry between January 2017 and July 2017 which enrolled 337 acute STEMI patients with partially occluded coronary arteries. Patients received routine pharmacoinvasive therapy (PCI within 3-24 h of thrombolysis) in one group and delayed pharmacoinvasive therapy (PCI within 24-72 h of thrombolysis) in another group. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) within 30 d of the procedure. The secondary endpoints included major bleeding as defined by Bleeding Academic Research Consortium classification, angina, and dyspnea within 30 d. RESULTS: The mean age in the two groups was comparable (55.1 ± 10.1 years vs 54.2 ± 10.5 years, P = 0.426). Diabetes was present among 20.2% and 22.1% of patients in the routine and delayed groups, respectively. Smoking rate was 54.6% and 55.8% in the routine and delayed groups, respectively. Thrombolysis was initiated within 6 h of onset of symptoms in both groups (P = 0.125). The mean time from thrombolysis to PCI in the routine and delayed groups was 16.9 ± 5.3 h and 44.1 ± 14.7 h, respectively. No significant difference was found for the occurrence of measured clinical outcomes in the two groups within 30 d (8.7% vs 12.9%, P = 0.152). Univariate analysis of demographic characteristics and risk factors for patients who reported MACCE in the two groups did not demonstrate any significant correlation. Secondary endpoints such as angina, dyspnea, and major bleeding were non-significantly different between the two groups. CONCLUSION: Delayed PCI pharmacoinvasive strategy in a critical diseased but not completely occluded artery beyond 24 h in patients who have been timely thrombolyzed seems a reasonable strategy.
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Background: Several lines of evidence have supported small dense low-density lipoproteins (sd-LDL) as a marker of cardiovascular disease. The present study assessed the relationship between lipid profile and sd-LDL levels with demographic, clinical, angiographic, and therapeutic variables in acute coronary syndrome (ACS) patients. Methods: This was a single-centre, prospective, cross-sectional study conducted from September 2014 to September 2015. Patients with a diagnosis of ACS were included in this study. High-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were determined by direct homogenous assay and sd-LDL levels were calculated using an earlier described equation by Srisawadi et al. Results: A total of 200 patients with a diagnosis of ACS were studied. Males constituted 78% of the population cohort and almost 45% of participants were aged <45 years. Patients aged ≤45 years displayed higher mean sd-LDL levels of 30.40 ± 14.18 mg/dL versus patients aged >45 years with mean sd-LDL levels of 28.01 ± 11.58 mg/dL, but the difference was not statistically significant (p = 0.19). Females also displayed higher mean sd-LDL levels, but the difference also failed to achieve statistical significance (30.95 ± 13.44 mg/dL and 28.54 ± 12.64, respectively; p = 0.185). Diabetics had higher mean sd-LDL levels (33.64 ± 13.01 mg/dL and 28.07 ± 12.60 mg/dL; p = 0.273) whilst smokers had lower mean levels (27.21 ± 12.12 mg/dL and 30.51 ± 13.21 mg/dL, respectively; p = 0.071). However, the ratio of sd-LDL/lb-LDL (large buoyant LDL) was significantly higher in diabetics (0.48 vs. 0.39; p = 0.023). In the angiography cohort (n = 88), single-vessel disease was the most predominant overall while among patients aged >45 years, triple-vessel disease was significantly higher (p = 0.005). Similarly, the sd-LDL levels were 33.12 ± 11.13 mg/dL, 27.68 ± 9.80 mg/dL, and 31.65 ± 15.26 mg/dL among patients with single, double, and triple-vessel disease and did not differ significantly (p = 0.262). Prior statin users had significantly lower mean sd-LDL levels of 24.79 ± 12.23 mg/dL compared to statin-naïve patients with a mean sd-LDL of 30.01 ± 12.79 mg/dL (p = 0.027). Non-HDL levels were also significantly lower in prior statin users (112.83 mg/dL vs. 128.9 mg/dL; p = 0.017). Conclusion: In this cohort of ACS patients, age, sex, diabetes, smoking, and the angiographic severity of coronary artery disease had no significant impact on sd-LDL levels, while prior statin usage led to significantly lower sd-LDL levels. Diabetic patients, however, did have significantly higher sd-LDL/lb-LDL ratios.
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Abstract Introduction: A high incidence of cardiovascular disease (CVD) events and premature mortality is observed in patients with chronic kidney disease (CKD). Thus, new biomarkers that may help predict the development of CVD in early stages of CKD are being investigated along with other traditional risk factors. Objective: To investigate cathepsin S as an early biomarker for CVD in patients with CKD. Methods: A total of 64 patients with CKD were included and classified into 2 groups: CKD patients with established CVD and CKD patients with non-established CVD. All patients were submitted to routine investigations including complete blood count, random blood sugar, glycated hemoglobin (HbA1c), serum electrolytes, urea, creatinine, total protein, total albumin, calcium total, phosphorous, uric acid, vitamin D, parathormone, lipid profile, liver function test, measurement of serum cathepsin S (Cat S), and 2D Echo of the heart. Results: The level of serum Cat S was increased in CKD patients with CVD (p <0.05) as well as in later stages of CKD (p <0.05). CVD was also more common in patients in early stage CKD. In early stages CKD, Cat S and CVD were positively correlated. Conclusion: These findings suggest that serum Cat S might be useful as an early biomarker for CVD in CKD patients.
Resumo Introdução: Uma alta incidência de eventos de doença cardiovascular (DCV) e mortalidade prematura é observada em pacientes com doença renal crônica (DRC). Assim, novos biomarcadores que podem ajudar a prever o desenvolvimento de DCV nos estágios iniciais da DRC estão sendo investigados juntamente com outros fatores de risco tradicionais. Objetivo: Investigar a catepsina S como um biomarcador precoce para DCV em pacientes com DRC. Métodos: Um total de 64 pacientes com DRC foram incluídos e classificados em 2 grupos: pacientes com DRC com DCV estabelecida e pacientes com DRC com DCV não estabelecida. Todos os pacientes foram submetidos a investigações de rotina incluindo hemograma completo, glicemia aleatória, hemoglobina glicada (HbA1C), eletrólitos séricos, ureia, creatinina, proteína total, albumina total, cálcio total, fósforo, ácido úrico, vitamina D, paratormônio, perfil lipídico, teste de função hepática, medição da catepsina S sérica (Cat S), e Eco 2D do coração. Resultados: O nível de Cat S sérica esteve aumentado em pacientes com DRC com DCV (p <0,05), bem como em estágios posteriores da DRC (p <0,05). A DCV também foi mais comum em pacientes com DRC em estágio inicial. Em estágios iniciais da DRC, a Cat S e a DCV foram positivamente correlacionadas. Conclusão: Estes achados sugerem que a Cat S sérica pode ser útil como um biomarcador precoce para DCV em pacientes com DRC.
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INTRODUCTION: Pericardial effusion (PE) is a life-threatening condition. However, there are very few Indian studies which determined etiological distribution. The current retrospective observational study was carried out to assess etiological factors responsible for PE in a tertiary care centre in India. METHODS: The study enrolled consecutive 55 patients with the diagnosis of moderate to large PE as established by echocardiography between January 2018 and December 2018. The echocardiography guided percutaneous pericardiocentesis was performed by the standard procedure. RESULTS: Amongst the enrolled PE patients in the study, 30 (54.55%) were males and 25 (45.45%) were females, with the average age of 43.00 ± 15.54 years. In clinical assessment, tamponade was found in 52 (94.54%) patients. Tuberculosis was the most common etiology for PE (n=35, 63.64%) followed by hypothyroidism (n = 6, 10.9%), and malignancies (n = 4, 7.27%). Among 12.72% patients, the PE was of recurrent type. Additionally, no death or any complication was encountered during pericardiocentesis. CONCLUSION: Pericardial disease and effusion is a major cause of morbidity in India. Despite developments in the healthcare facilities, tuberculosis was the most common etiology for PE. Additionally, the raised number of hypothyroid and malignant PE cases demonstrates the changing etiological trends, similar to western countries.
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Derrame Pericárdico , Adulto , Demografia , Ecocardiografia/efeitos adversos , Ecocardiografia/métodos , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/epidemiologia , Derrame Pericárdico/etiologia , Pericardiocentese/efeitos adversos , Pericardiocentese/métodosRESUMO
Bicuspid aortic valve (BAV) is the most common valvular congenital anomaly and is apparent in nearly 50% of candidates for AV replacement. While transcatheter aortic valve implantation (TAVI) is a recommended treatment for patients with symptomatic severe aortic stenosis (AS) at all surgical risk levels, experience with TAVI in severe bicuspid AS is limited. TAVI in BAV is still a challenge due to its association with multiple and complex anatomical considerations. A retrospective study has been conducted to investigate TAVI's procedural and 30-day outcomes using the Myval transcatheter heart valve (THV) (Meril Life Sciences Pvt. Ltd. Vapi, Gujarat, India) in patients with severe bicuspid AS. Data were collected on 68 patients with severe bicuspid AS who underwent TAVI with the Myval THV. Baseline characteristics, procedural, 30-day echocardiographic and clinical outcomes were collected. The mean age and STS PROM score were 72.6 ± 9.4 and 3.54 ± 2.1. Procedures were performed via the transfemoral route in 98.5%. Major vascular complications (1.5%) and life-threatening bleeding (1.5%) occurred infrequently. No patient had coronary obstruction, second valve implantation or conversion to surgery. On 30-day echocardiography, the mean transvalvular gradient and effective orifice area were 9.8 ± 4.5 mmHg and 1.8 ± 0.4 cm2, respectively. None/trace aortic regurgitation occurred in 76.5%, mild AR in 20.5% and moderate AR in 3%. The permanent pacemaker implantation rate was 8.5% and 30-day all-cause death occurred in 3.0% of cases. TAVI with the Myval THV in selected BAV anatomy is associated with favorable short-term hemodynamic and clinical outcomes.
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BACKGROUND: The prevalence of hypertension in the young adult population is rising in India. Increased arterial stiffness due to RAAS activation and increased sympathetic overactivity due to stress have been implicated as primary factors for the same. This study was aimed to understand the Indian clinician's perspective on approach to management of hypertension in young adults. METHODS: A cross sectional observational survey using a structured questionnaire was conducted online with 2287clinicians (cardiologists, diabetologists, consultant physicians and family physicians). RESULTS: The prevalence of hypertension was 10-30% as per opinion of 64.8% clinicians. The top three risk factors for hypertension in young were perceived to be smoking, mental stress and obesity. Around 57.4% respondents opined that both increased heart rate and systolic blood pressure were markers of sympathetic overactivity. More than 60% respondents across specialities preferred ARBs to treat hypertension in young adults. Amongst the ARBs, telmisartan was the preferred ARB by >80% respondents. Metoprolol was the preferred beta blocker by almost 64% respondents. The objective of selection of beta-blocker by majority of clinicians due to sympathetic overactivity. Telmisartan and Metoprolol single pill combination achieved the BP goal in 40-60% of patients as reported by 41.3% of the physicians. The combination therapy was well tolerated in young hypertensive patients. CONCLUSIONS: Initiation of an early and appropriate antihypertensive treatment in young population may lower the burden of cardiovascular disease in this population. ARBs and beta -blockers were the preferred class of anti-hypertensive drugs in the cohort of young hypertensive patients .
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Antagonistas de Receptores de Angiotensina , Hipertensão , Antagonistas de Receptores de Angiotensina/farmacologia , Inibidores da Enzima Conversora de Angiotensina , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Estudos Transversais , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Índia/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Prevalence of abdominal aortic aneurysm (AAA) has ethnic differences, and coronary artery disease (CAD) shares several risk factors with AAA. Sparse Indian data are available on this. We evaluated the prevalence of AAA during transthoracic echocardiography (TTE) and risk factors of AAA in patients with CAD. METHODS: This was a prospective observational study carried out in the cardiology department at a tertiary care center from January 1, 2017 to November 30, 2017. All patients with CAD/acute coronary syndrome (ACS) were included in the study, and patients with AAA due to other etiology were excluded. Screening for an AAA was performed directly using an echocardiographic 3.5-MHz cardiac probe. RESULTS: A total of 526 patients were screened; and AAA was present in 25 (4.8%) of CAD patients. Smoking, hypertension and hyperlipidemia were predominant risk factors for AAA in our study, but were not statistically significant because same risk factors were also prevalent in the comparison group. Diabetes, peripheral vascular disease and family history were statistically significant risk factors for AAA in our study. The mean size of AAA was 34 mm. CONCLUSIONS: Presence of AAA is significantly higher among CAD patients. CAD shares several risk factors with AAA. Therefore, opportunistic examination of the abdominal aorta during routine TTE could be an effective way of screening. Diabetes mellitus, peripheral artery disease and family history were the significant associated risk factors of AAA in CAD patients.
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Liver abscess requiring drainage is conventionally managed by interventional radiology-guided percutaneous drainage (PCD). Radiologically inaccessible abscesses are managed with laparoscopic or open surgery, which carries high rates of morbidity and mortality. EUS-guided transluminal liver abscess drainage is minimally invasive and can be an alternative approach for caudate lobe, segment 4, and left lateral segment abscesses. We report on three consecutive patients with radiologically inaccessible left lobe liver abscess involving the caudate lobe, segment 4, and lateral segment in whom EUS-guided transluminal drainage using a modified technique was successful.
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BACKGROUND: Percutaneous mitral balloon valvotomy (PBMV) is an alternative to surgery for patients with severe mitral valve (MV) stenosis. However, the safety and feasibility of same-day discharge (SDD) in patients undergoing elective PBMV for severe MV stenosis is yet to be investigated. This study aimed to assess safety and feasibility of SDD in patients undergoing elective PBMV because of severe MV stenosis in a tertiary-care hospital in India. METHODS: From January 2018 to November 2018, patients with a diagnosis of severe MV stenosis were treated with PBMV at our institution. Among these patients, those suitable for SDD were prospectively included in this registry. Vascular access was achieved in forearm arteries and femoral veins. Clinical, echocardiographic and hemodynamic features were collected before and after PBMV. The primary outcome was 30-day mortality. The secondary outcome was incidence of in-hospital complications. Other outcomes of interest were arterial spasm and forearm haematoma. RESULTS: A total of 98 patients scheduled for SDD after elective PBMV were included in the registry. Mean MV area increased from 0.8 ± 0.1 to 1.6 ± 0.2 cm2 (p < .001). Severe MV regurgitation after PBMV occurred in 3 patients, and 1 patient developed pericardial tamponade. Severe arterial spasm occurred in 2 patients. None of the included patients developed a clinically relevant haematoma of forearm. A total of 94 (96%) were discharged on the same day. No patient died up to 30-day follow-up. CONCLUSION: PBMV from the venous access site can reduce the hospital stay of patients to less than a day with less local site complications.
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Cateterismo Cardíaco , Estenose da Valva Mitral , Alta do Paciente , Estudos de Viabilidade , Humanos , Índia , Estenose da Valva Mitral/diagnóstico , Estenose da Valva Mitral/cirurgia , Estudos Prospectivos , Sistema de Registros , Resultado do TratamentoRESUMO
BACKGROUND: Many patients with dilated cardiomyopathy (DCMP), presenting with only dyspnea, have hidden ischemic etiology. In low-income countries, logistic and financial restraints lead to reduced identification of this ischemic burden. We aimed to assess the role of coronary angiography in patients with cardiomyopathy presenting predominantly dyspnea. METHODS: This was a single-center, prospective, observational study conducted at a tertiary-care center in North India over the period of one year. The study population consisted of patients with dyspnea (NYHA II and III) and left ventricular dysfunction [i.e., left ventricular ejection fraction (< 40%)] without a prior documented coronary artery disease (CAD). All patients underwent invasive coronary angiography to detect underlying occult CAD. RESULTS: A total of 209 patients with global left ventricular hypokinesia (LVEF) were enrolled. Almost half of the study population belonged to the 51-60-year-old group. Diabetes mellitus and smoking were most prevalent risk factors observed in 93 (44.5%) and 92 (44.1%) patients, respectively. Abnormal coronaries were detected in 75 (35.9%) patients; 44 (58.7%) and 29 (38.7%) patients had significant and insignificant CAD, respectively. Single-, double-, and triple-vessel disease was observed in 18 (40.9%), 14 (31.8%), and 12 (27.3%) patients, respectively. The mean age (54.08 ± 6.02 years), LVEF (39.83 ± 3.27%), SYNTAX score (17.14 ± 2.21), and left ventricular internal dimensions (4.93 ± 0.44 cm) were all statistically insignificant. CONCLUSION: Patients with DCMP presenting predominantly with dyspnea and having silent underlying significant CAD may benefit from revascularization if CAD is detected by angiography on time.
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BACKGROUND: Thrombolytic therapy has evolved as an alternative to surgery for prosthetic valve thrombosis (PVT). Therefore, this retrospective, single-center study aimed to evaluate the clinical profile of PVT and the role of thrombolytic therapy in patients with PVT. METHODS: Data from a total of 16 consecutive patients with PVT enrolled between January 2017 and January 2018 at a tertiary care center in India were retrospectively evaluated. PVT was diagnosed based on clinical presentation, transthoracic echocardiography, and fluoroscopy. All patients received 0.25 MU intravenous (IV) bolus streptokinase over 30 min, followed by a 0.1 MU/h IV infusion for a maximum of 72 h. Transthoracic echocardiography and fluoroscopy were repeated after completion of thrombolysis session. The clinical endpoints were death and hemodynamic success within 24 h of thrombolytic therapy or during the hospital stay, and major complications, including stroke or major bleeding (intracranial bleed or bleeding requiring transfusion or surgical treatment) during the hospital stay and within 3 months of thrombolytic therapy. RESULTS: The median age of the patients was 40 ± 11.60 years and about 62.5% (n = 10) were females. The median time between the valve placement and presentation for PVT was 3 years (range: 1 - 4 years). The peak gradient across the thrombotic mitral and aortic valve was 43.79 ± 18.47 and 93.5 ± 33.11 mmHg, respectively. At 3 days post-thrombolysis, peak gradient across both mitral valve (15.91 ± 7.56; mean gradient: 8.45 ± 4.01) and aortic valve (23.50 ± 6.45; mean gradient: 13.60 ± 3.83) decreased significantly (P ≤ 0.05). The thrombolytic therapy was successful in 13 (81.25%) patients. While, two (12.50%) patients died, none developed stroke or myocardial infarction during the study period. CONCLUSIONS: The present study with short-term follow-up demonstrated the acceptable clinical efficacy of thrombolytic therapy. However, larger trials with a greater number of patients and longer follow-up are warranted to establish the safety and effectiveness of thrombolytic therapy in patients with PVT.
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BACKGROUND: Chemotherapy-induced cardiotoxicity constitutes subclinical myocardial dysfunction, arrhythmias, pericarditis, coronary vasospasm, and significant symptomatic heart failure. Anthracyclines pose higher risk for long-term cardiac dysfunction, with increased incidences of morbidity and mortality. Hence, early detection of chemotherapy-induced cardiac dysfunction may prompt an earlier treatment modification. AIM: To evaluate global, longitudinal, radial, and circumferential strain changes in adult patients undergoing anthracycline chemotherapy along with the usefulness of three-dimensional (3D) echocardiography as the new modality over two-dimensional (2D) echocardiography. METHODS: This was a single centre, prospective, observational study that included asymptomatic patients free from any cardiac signs and symptoms attributable to heart failure, who underwent potentially cardiotoxic chemotherapy for malignancy from December 2017 to November 2018 at a tertiary care centre in India. Baseline demographics were recorded, and 2D and 3D echocardiography was performed at baseline and after completion of four cycles of chemotherapy. RESULTS: All the 55 patients received a cumulative dose of doxorubicin of less than 550 mg/m2. Follow-up period from the beginning of doxorubicin therapy was 108 ± 14 days. 9 patients were excluded from the study due to poor 3D images, so data analysis was done only for 46 patients. In 2D echocardiography, only global longitudinal strain (GLS) was observed to be significantly reduced (Δ18.33%; P < 0.001). 2D ejection fraction (EF) did not show significant change (Δ0.67%; P = 0.176), while by 3D echo, EF reduced significantly (Δ3.55%; P < 0.001). 3D global longitudinal (Δ29.19%; P < 0.001), circumferential (Δ30.65%; P < 0.001), area (Δ21.61%; P < 0.001), and radial (Δ29.66%; P < 0.001) strains were observed to be significantly reduced at follow-up. CONCLUSION: Myocardial dysfunction induced by cardiotoxic chemotherapy can be detected earlier by using 2D GLS, 3D volumetric analysis, and 3D strain analysis by calculating global, longitudinal, radial, and circumferential strain changes. 3D echocardiographic assessment seems to be more accurate in picking out small changes in left ventricular functions, but at the cost of slightly poor image quality as compared to the 2D echocardiography. These newer techniques could potentially improve the ability for early detection of subclinical abnormalities of LV function in patients undergoing cardiotoxic chemotherapy and thus early initiation of treatment could be possible.
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Doxorrubicina/efeitos adversos , Ecocardiografia Tridimensional , Ecocardiografia , Volume Sistólico/efeitos dos fármacos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adolescente , Adulto , Idoso , Antibióticos Antineoplásicos/efeitos adversos , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Disfunção Ventricular Esquerda/induzido quimicamente , Adulto JovemRESUMO
OBJECTIVE: We sought to investigate the incidence and predictors of 30-day mortality associated with ventricular septal rupture (VSR) complicating acute myocardial infarction (AMI) in a cohort of patients admitted to a single centre in India. METHODS: From October 2013 to February 2016, a total of 6560 patients with a diagnosis of AMI were admitted to our institution. Among these patients, those with a diagnosis of VSR were retrospectively included in this registry. Clinical and echocardiographic features were collected in all cases. The primary outcome was 30-day mortality. A Cox proportional hazard regression analysis explored the predictors of 30-day mortality. RESULTS: During the observation period, a total of 51 consecutive patients (mean age 63.8 years (9.1); 51.0% male, 41.2% were patients with diabetes) with a diagnosis of VSR complicating AMI were included. On echocardiography, left ventricular ejection fraction was 42.5% (6.5), and the most frequent location of VSR was apical (78.4%). Overall, 27.4% of the patients received reperfusive therapy (pharmacological, 23.5%; mechanical, 3.9%) and 19.6% of the patients underwent surgical repair. The mean time to surgery was 7.7 days (2.4). At 30-day follow-up, death occurred in 80.4% of patients. Advanced age (HR 1.07, 95% CI (1.02 to 1.13), p=0.004), previous cerebrovascular accident (HR 52.2, 95% CI (3.98 to 685.06), p=0.003) and surgical repair (HR 0.05, 95% CI (0.01 to 0.26), p<0.001) were effect modifiers of the 30-day risk of death. CONCLUSIONS: In this retrospective cohort of patients with AMI, the occurrence of VSR was not rare and carried a considerable risk of 30-day mortality. Advanced age, previous cerebrovascular accident and surgical repair influenced the risk for 30-day mortality.
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BACKGROUND: Tumor necrosis factor-alpha (TNF-α) are considered as a pro inflammatory and interleukin-10 (IL-10) anti inflammatory have been shown to predict the risk of incident of coronary artery disease (CAD). The polymorphism at promoter of TNF-α and IL-10 has been shown to increase transcriptional activity of the gene and play a important role in patho physiology of CAD. Aim of present study is to examine the impact of the TNF-α and IL-10 variant allele on various markers of the CAD and to study its relation with circulating TNF-α and IL-10 levels. METHODS: The -308 G/A & -238 G/A of TNF-α and -1082 G/A & -819 C/T of IL-10 gene polymorphism has been studied in 301 diagnosed CAD subjects (Age 51.50⯱â¯9.28; BMI 25.30⯱â¯3.58) and 305 healthy controls (Age 51.57⯱â¯9.50; BMI 24.06⯱â¯7.26). These polymorphism of TNF-α and IL-10 were detected by real time PCR by using Taqman SNP genotyping assay. Furthermore serum TNF-alpha and IL-10 levels were also measured by ELISA. RESULTS: Allelic and genotypic frequencies did not deviate from Hardy-Weinberg equilibrium in the controls (pâ¯>â¯0.05). On allele contrast, significant association with susceptibility to CAD was detected with polymorphisms in TNF-α -308 G/A, that variant genotype GAâ¯+â¯AA (dominant model) (pâ¯=â¯0.030: ORâ¯=â¯1.61: 95% CIâ¯=â¯1.06-2.44) and variant allele (A) (pâ¯=â¯0.006: ORâ¯=â¯1.71: 95% CIâ¯=â¯1.17-2.51) of TNF-α 308 G/A gene was significant highly observed in the cases as compared to control group. Furthermore, variant genotype CTâ¯+â¯TT (dominant model) (pâ¯=â¯0.004: ORâ¯=â¯1.62: 95% CIâ¯=â¯1.17-2.24) and variant allele (T) (pâ¯<â¯0.001: ORâ¯=â¯1.49: 95% CIâ¯=â¯1.17-1.89) of IL-10 -819 C/T gene was significant highly observed in the cases as compared to control group. CONCLUSION: Our results suggest that the TNF-α G-308A polymorphism independently associated with DBP, cholesterol, triglyceride, LDL, TNF-α and IL-10 levels which may be leads to the development of coronary artery disease of North Indians.
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Povo Asiático/genética , Doença da Artéria Coronariana/genética , Predisposição Genética para Doença/genética , Interleucina-10/genética , Polimorfismo de Nucleotídeo Único/genética , Regiões Promotoras Genéticas/genética , Alelos , Biomarcadores , Estudos de Casos e Controles , Feminino , Frequência do Gene/genética , Genótipo , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Fator de Necrose Tumoral alfa/genéticaRESUMO
BACKGROUND/AIM: Cytokines are responsible for the modulation of immunological and inflammatory processes and play a significant role in the pathogenesis of coronary artery disease (CAD). Tumor necrosis factor-alpha (TNF-α) are considered as a pro inflammatory and interleukin-10 (IL-10) anti inflammatory have been shown to predict the risk of incident of CAD. Aim of present study is to examine the impact of the TNF-α and Il-10 levels on various components of the CAD. METHODS: Total 580 subjects were recruited in the present study out of which 290 diagnosed CAD subjects (Age 51.61±9.26; BMI 25.27±3.58) and 290 healthy controls (Age 51.72±9.48; BMI 24.02±7.42). Serum TNF-alpha and IL-10 levels were measured by ELISA. RESULTS: Data of present study revealed that CAD patients had higher frequency (p=0.001) of smoking (38.28%), Alcohol (21.03%), Diabetes (53.45%) and hypertension (48.28%) as compare to controls. Moreover, we have observed highly significant (p<0.05) difference in PR, BMI, DBP, DBP, Glucose, TC, TG, VLDL, LDL, TNF-α and TNF-α/IL-10. However, HDL and IL-10 were found lower in CAD. CONCLUSION: The findings of present study suggest that the TNF-α/IL-10 ratio may play a vital role in the development of CAD of North Indian population.
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Biomarcadores/sangue , Doença da Artéria Coronariana/sangue , Interleucina-10/sangue , Fator de Necrose Tumoral alfa/sangue , Adulto , Idoso , Estudos de Casos e Controles , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de RiscoAssuntos
Aorta/anormalidades , Ecocardiografia Doppler , Aneurisma Cardíaco/diagnóstico por imagem , Ventrículos do Coração/anormalidades , Tomografia Computadorizada Multidetectores , Adulto , Aorta/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Aortografia , Bradicardia/etiologia , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Cardiomiopatias/diagnóstico por imagem , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/patologia , Bloqueio Cardíaco/etiologia , Septos Cardíacos/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Síndrome de Marfan/patologia , Marca-Passo Artificial , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/etiologia , Síncope/etiologia , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/etiologiaRESUMO
A 12-year-old boy presented to our outpatient department with progressive dyspnoea and palpitations of 6-month duration. Cardiovascular system examination revealed a short ejection systolic murmur at the left lateral heart border. Chest X-ray showed gross cardiomegaly. Two-dimensional ECHO revealed massive aneurysmal right atrial (RA) enlargement, low-pressure tricuspid regurgitation and dysplastic tricuspid valve with compression of the left atrium (LA) and left ventricle (LV). Cardiac CT showed grossly enlarged RA compressing the LA, LV, right pulmonary artery and right upper lobe pulmonary vein. Initially, the patient refused surgery. On follow-up, a thrombus was seen in the giant RA and the patient agreed to and underwent successful surgery. Absence of pericardium was specifically excluded on cardiac MRI and on surgery. Resected atrial tissue showed wall thinning and focal fibrosis establishing idiopathic dilation of the RA. The patient is on regular follow-up.
Assuntos
Cardiomegalia/diagnóstico , Átrios do Coração/patologia , Trombose/etiologia , Cardiomegalia/complicações , Cardiomegalia/cirurgia , Criança , Ecocardiografia , Aneurisma Cardíaco/complicações , Átrios do Coração/cirurgia , Sopros Cardíacos/diagnóstico , Sopros Cardíacos/etiologia , Ventrículos do Coração/patologia , Humanos , Masculino , Trombose/cirurgia , Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/diagnóstico por imagemRESUMO
Peripartum cardiomyopathy is a cardiac condition characterized by development of heart failure during the last month of pregnancy or during the first five months of post partum period without any other identifiable cause of heart failure. The hypercoagulable state in the pregnancy along with left ventricular (LV) systolic dysfunction predisposes the patient to thromboembolic complications like intraventricular thrombi. We report a case of a 30-year-old female with peripartum cardiomyopathy along with a highly mobile mass in the LV cavity on two dimensional echocardiography. Three dimensional transthoracic echocardiography clearly showed the pedicle of the mass attached to the interventricular septum along with internal echolucent areas within the mass. Due to denial of the patient to undergo surgery, she was started on oral anticoagulation, with complete dissolution of the mass within one month.
RESUMO
Aorto-atrial fistulas are rare, but important complications resulting from aortic valve infective endocarditis, aortic valve surgery, or aortic dissection. We hereby report a case of a 20-year male, referred to us with infective endocarditis of the native aortic valve with severe aortic regurgitation and symptoms of heart failure. Detailed evaluation with two-dimensional and three-dimensional transthoracic echocardiography revealed aorto-left atrial fistula secondary to the involvement of the mitral-aortic intervalvular fibrosa (MAIVF) region. The patient underwent successful removal of the vegetations, closure of the defect along with aortic valve replacement, and mitral valve repair.
Assuntos
Valva Aórtica/diagnóstico por imagem , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Cardiopatias/complicações , Cardiopatias/diagnóstico por imagem , Fístula Vascular/complicações , Fístula Vascular/diagnóstico por imagem , Adulto , Ecocardiografia Tridimensional , Fístula/complicações , Fístula/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Insuficiência Cardíaca/complicações , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Adulto JovemRESUMO
OBJECTIVES: Coronary artery aneurysm is a rare condition with a reported incidence of 0.14-4.9% in patients undergoing coronary angiography and 0.3-5.3% in patients after percutaneous transluminal coronary angioplasty (PTCA). Optimum surgical therapy for this entity is difficult to standardize. We present here a series of 4 cases with the aim of establishing an optimal surgical therapy for this rare entity. METHODS: Four cases of coronary artery aneurysm were admitted in the Department of Cardiology and Department of Cardiothoracic and Vascular Surgery, King George's Medical University, Lucknow, from April 2010 to April 2012. All patients underwent a surgical procedure that involved ligation and plication of the aneurysm with coronary artery bypass grafting. RESULTS: Out of the four coronary artery aneurysm patients, 1 was atherosclerotic and the remaining 3 patients developed coronary artery aneurysm after PTCA with a drug eluting stent to the left anterior descending artery. After surgery, all patients recovered uneventfully without any recurrence of symptoms in the follow-up. CONCLUSIONS: Coronary artery aneurysm is a rare entity and is being seen more frequently with the increasing use of stents during PTCA. Proximal ligation and plication of the aneurysm with coronary artery bypass grafting in the present series provided good results. With this case series, we seek to establish an optimal surgical therapy for this rare entity.