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In India and the Southeast Asian population, hypertension and type 2 diabetes mellitus (T2DM) are the leading lifestyle-related diseases, responsible for a majority burden of morbidity and mortality. Multiple population-spanning studies have revealed the staggering prevalence of both diseases in India, and the prevalence of both will only increase further due to factors such as an aging population, rapid urbanization, increased obesity, and sedentary lifestyles. More than 50 percent of hypertensive patients in India are also diagnosed with T2DM, and a detailed management protocol for the same is required, especially when a major portion of the disease is managed at the primary care level. The Association of Physicians of India (API) guidelines for the management of hypertension in patients with T2DM have been formulated based on consultation with leading physicians, cardiologists, diabetologists, and endocrinologists of India and Southeast Asia, keeping in mind the challenges faced by the patients in these countries and the appropriate management protocols that will be beneficial. While standard office-based blood pressure (BP) measurement forms the cornerstone of hypertension diagnosis and demands a uniform methodology to be followed, home blood pressure monitoring (HBPM) is recommended for long-term follow-up with validated devices. Ambulatory blood pressure monitoring (ABPM) offers comprehensive insights crucial for cardiovascular (CV) risk stratification. The complications of diabetic hypertension can span from increased CV risk, heart failure (HF), and renal dysfunction, and nonpharmacological and pharmacological management should be aimed toward not only control of the BP values but also protecting the end organs. While nonpharmacological measures include a focus on nutrition and diet, they also focus on approaches to weight loss, including a novel section covering the benefits of yoga. The guideline also focuses on a novel section of factors influencing CV risk, especially in the Indian population. For the pharmacological management, the guidelines address each of the categories of antihypertensive drugs, emphasizing the significance of combination therapies in the management of diabetic hypertension. In line with leading global guidelines for the management of hypertension in T2DM, for diabetic patients who often struggle with BP management and carry a high CV risk, the recommended dual combination antihypertensive therapy is particularly crucial and should be considered as first-line management therapy. While angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) play a highly beneficial role in the management of diabetic hypertension, a combination of ACEi or ARB with dihydropyridine calcium channel blockers (DHP-CCBs) is recommended to reduce the risk of complications and enhance patient adherence. To achieve the target of effective BP control and end-organ protection, it is beneficial and recommended to include newer CCBs (e.g., cilnidipine) in the management protocol in combination with ACEi/ARBs. Combination therapy including ARBs and DHP-CCBs should be preferred over ß-blockers and thiazides. Among the CCBs, cilnidipine, a novel molecule, is a more effective and safer option for diabetic hypertensive patients in India. ß-blockers should be used if there is a history of myocardial infarction (MI), HF, coronary artery disease (CAD), or stable angina along with the initial hypertensive regimen. The guideline also focuses on the novel reno- and cardioprotective molecules such as finerenone and sodium-glucose cotransporter 2 inhibitors (SGLT2i) and their benefits in the management of diabetic hypertension.
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Antihipertensivos , Diabetes Mellitus Tipo 2 , Hipertensión , Humanos , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Hipertensión/terapia , India/epidemiología , Antihipertensivos/uso terapéutico , Monitoreo Ambulatorio de la Presión Arterial/métodosRESUMEN
The management of edema requires a systematic approach to screening, diagnosis, and treatment, with an essential initial assessment to differentiate between generalized and localized edema. The Association of Physicians of India (API) aimed to develop the first Indian Edema Consensus (Edema India), offering tailored recommendations for screening, diagnosing, and managing edema based on the insights from the expert panel. The panel suggested when evaluating edema symptoms, important factors to consider include the patient's current illness, medical history, risk factors, family history, and medications. Key diagnostic investigations for edema include complete blood count, cardiovascular imaging and markers, deep vein thrombosis (DVT) assessment, along with renal, hepatic, and thyroid function tests. Edema management involves a combination of pharmacologic and nonpharmacologic interventions, including limb elevation, physiotherapy, compression therapy, fluid removal, diuretics (loop diuretics: first-line therapy), and a sodium-restricted diet. The panel believed that educating patients could foster a preventive mindset, helping to prevent the worsening of edema.
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Edema , Humanos , Edema/terapia , Edema/diagnóstico , Edema/etiología , IndiaRESUMEN
Background and Aims: N95 mask being an essential element of personal protective equipment to be worn by health-care workers (HCWs) may lead to adverse effects and physiological stress as HCWs have to wear it for prolonged hours. Therefore, we planned to conduct a study in our intensive care unit staff to look for the effects of N95 masks on their health as well as to plan recommendations to ease them. Material and Methods: We conducted this study on our intensive care unit nursing staff and HCWs. We noted their oxygen saturation and heart rate at baseline as well as after 1 h, 2 h, 3 h, and 6 h of duty along with their subjective sensations. Institutional ethical clearance for the same was taken. Collected data were entered in MS Excel database and analyzed using SPSS version 20.0. Fisher's Z test was applied for comparing proportion and analysis of variance for comparing two means. Results: One hundred and nine HCWs participated in this, out of which 93 (85.3%) were females and 16 (14.7%) were males. Eighty-four (77.1%) participants were below 40 years. Twenty-three participants (21.1%) were overweight and 37 (33.9%) were obese. There was no significant drop in saturation and rise in heart rate during these hours. Conclusions: On comparing subjective sensations of HCWs, our study found that feeling of uneasiness was found more in less than 40 years age group as compared to more than 40 years. N95 masks were found to have no impact on cardiovascular system and do not lead to hypoxia while working routinely even for prolonged hours.
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OBJECTIVE: Recent studies have shown that lower serum chloride is associated with diuretic resistance and increased mortality in heart failure. Impact of lower admission chloride on duration of stay in acute decompensated heart failure (ADHF) has not been studied previously. METHODS: In this retrospective analysis, we studied the effect of admission serum chloride on the duration of hospital stay in patients admitted with ADHF. A total of 167 patients were studied. Serum chloride levels were divided into tertiles - <96 meq/L (tertile 1), 96-101 meq/L (tertile 2), and >101 meq/L (tertile 3) based on the distribution of serum chloride levels in our patients. RESULTS: The median lengths of hospital stay in tertiles 1, 2, and 3 were 8(Interquartile range :6 -11), 7 (Interquartile range :5 -10.50), and 6 days(Interquartile range :4.25 - 8), respectively (p = 0.011). Admission serum chloride levels were inversely associated with duration of stay (R2 linear = 0.074, p = 0.001). On multiple linear regression analysis, serum chloride remained independent predictor of increased hospital stay (p=0.003) while association with serum sodium was not significant (p=0.07). 1 unit increase in chloride level was associated with 1.3% (p=0.003) decrease in hospital stay (95% CI: 2.2% to 0.5%). CONCLUSION: This retrospective analysis suggests that admission serum chloride levels are independently and inversely associated with increased duration of stay. This is independent of admission sodium levels. Thus serum chloride, rather than sodium, is an important poor prognostic marker in heart failure patients.
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Insuficiencia Cardíaca/tratamiento farmacológico , Hospitalización , Enfermedad Aguda , Biomarcadores , Diuréticos , Humanos , Tiempo de Internación , Pronóstico , Estudios RetrospectivosRESUMEN
BACKGROUND: Asians are predisposed to a lean heart failure (HF) phenotype. Data on the 'obesity paradox', reported in Western populations, are scarce in Asia and have only utilised the traditional classification of body mass index (BMI). We aimed to investigate the association between obesity (defined by BMI and abdominal measures) and HF outcomes in Asia. METHODS AND FINDINGS: Utilising the Asian Sudden Cardiac Death in Heart Failure (ASIAN-HF) registry (11 Asian regions including Taiwan, Hong Kong, China, India, Malaysia, Thailand, Singapore, Indonesia, Philippines, Japan, and Korea; 46 centres with enrolment between 1 October 2012 and 6 October 2016), we prospectively examined 5,964 patients with symptomatic HF (mean age 61.3 ± 13.3 years, 26% women, mean BMI 25.3 ± 5.3 kg/m2, 16% with HF with preserved ejection fraction [HFpEF; ejection fraction ≥ 50%]), among whom 2,051 also had waist-to-height ratio (WHtR) measurements (mean age 60.8 ± 12.9 years, 24% women, mean BMI 25.0 ± 5.2 kg/m2, 7% HFpEF). Patients were categorised by BMI quartiles or WHtR quartiles or 4 combined groups of BMI (low, <24.5 kg/m2 [lean], or high, ≥24.5 kg/m2 [obese]) and WHtR (low, <0.55 [thin], or high, ≥0.55 [fat]). Cox proportional hazards models were used to examine a 1-year composite outcome (HF hospitalisation or mortality). Across BMI quartiles, higher BMI was associated with lower risk of the composite outcome (ptrend < 0.001). Contrastingly, higher WHtR was associated with higher risk of the composite outcome. Individuals in the lean-fat group, with low BMI and high WHtR (13.9%), were more likely to be women (35.4%) and to be from low-income countries (47.7%) (predominantly in South/Southeast Asia), and had higher prevalence of diabetes (46%), worse quality of life scores (63.3 ± 24.2), and a higher rate of the composite outcome (51/232; 22%), compared to the other groups (p < 0.05 for all). Following multivariable adjustment, the lean-fat group had higher adjusted risk of the composite outcome (hazard ratio 1.93, 95% CI 1.17-3.18, p = 0.01), compared to the obese-thin group, with high BMI and low WHtR. Results were consistent across both HF subtypes (HFpEF and HF with reduced ejection fraction [HFrEF]; pinteraction = 0.355). Selection bias and residual confounding are potential limitations of such multinational observational registries. CONCLUSIONS: In this cohort of Asian patients with HF, the 'obesity paradox' is observed only when defined using BMI, with WHtR showing the opposite association with the composite outcome. Lean-fat patients, with high WHtR and low BMI, have the worst outcomes. A direct correlation between high WHtR and the composite outcome is apparent in both HFpEF and HFrEF. TRIAL REGISTRATION: Asian Sudden Cardiac Death in HF (ASIAN-HF) Registry ClinicalTrials.gov Identifier: NCT01633398.
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Insuficiencia Cardíaca/epidemiología , Obesidad/epidemiología , Adiposidad , Anciano , Asia/epidemiología , Índice de Masa Corporal , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Obesidad/fisiopatología , Estudios Prospectivos , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Volumen Sistólico , Función Ventricular , Relación Cintura-CaderaRESUMEN
Torsades de pointes with prolonged QTc interval is a form of ventricular tachycardia. Many predisposing factors have been identified and hypocalcemia is among the rare ones. Our case illustrates that though rare, hypocalcemia might manifest as torsades de pointes with prolongation of QTc interval. Early diagnosis and management of dyselectrolytemia can prevent these patients from catastrophic torsades de pointes.
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Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Rotura de la Aorta/diagnóstico por imagen , Dolor de Espalda/etiología , Anciano , Aneurisma de la Aorta Abdominal/complicaciones , Enfermedades de la Aorta/complicaciones , Enfermedades de la Aorta/diagnóstico por imagen , Rotura de la Aorta/complicaciones , Aortografía , Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Servicio de Urgencia en Hospital , Resultado Fatal , Humanos , Hipotensión/etiología , Masculino , Taquicardia/etiología , Vena Cava Inferior/anomalías , Vena Cava Inferior/diagnóstico por imagenAsunto(s)
Electrocardiografía , Síndrome de QT Prolongado/diagnóstico por imagen , Torsades de Pointes/diagnóstico por imagen , Antagonistas Adrenérgicos beta/uso terapéutico , Desfibriladores Implantables , Diagnóstico Diferencial , Femenino , Humanos , Síndrome de QT Prolongado/terapia , Persona de Mediana Edad , Torsades de Pointes/terapiaRESUMEN
BACKGROUND: Aluminum phosphide (AlP) poisoning carries a high rate of mortality despite intensive care management, primarily because of refractory myocardial depression, resistant hypotension, and severe metabolic acidosis as well as acute respiratory distress syndrome. Extracorporeal membrane oxygenation (ECMO) is a modified "heart-lung" machine to provide temporary cardiorespiratory support. We studied the novel use of ECMO in the management of a subset of patients with AlP poisoning. CASE REPORT: In this case series, seven patients with AlP poisoning suffering from severe metabolic acidosis and refractory cardiogenic shock with a reduced left ventricular ejection fraction (<35%) received ECMO treatment. The acidosis and hemodynamic status improved within 6-12 h and 12-24 h, respectively, in five patients. Two patients did not survive because of a long delay in presentation after ingestion. The majority of the patients developed dysrhythmias, ECMO cannulation site bleeding, and thrombocytopenia. Two patients required surgical exploration of the femoral artery. At 9 months of follow-up, all five surviving patients were doing well, with the near normalization of ventricular function. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We have found that timely intervention with ECMO in patients with AlP poisoning-induced severe metabolic acidosis and refractory cardiogenic shock may lead to a significant improvement in overall survival. Therefore, ECMO might be considered as a bridge therapy for patients with intractable cardiorespiratory failure caused by AlP poisoning who are not responding to conventional treatment. ECMO, however, also is associated with significant complication rates, which must be incorporated into the risk-benefit analysis while considering treatment options.
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Compuestos de Aluminio/envenenamiento , Oxigenación por Membrana Extracorpórea , Fosfinas/envenenamiento , Choque Cardiogénico/terapia , Disfunción Ventricular Izquierda/terapia , Acidosis/inducido químicamente , Adolescente , Adulto , Arritmias Cardíacas/etiología , Oxigenación por Membrana Extracorpórea/efectos adversos , Resultado Fatal , Femenino , Hemorragia/etiología , Humanos , Masculino , Persona de Mediana Edad , Choque Cardiogénico/inducido químicamente , Choque Cardiogénico/fisiopatología , Volumen Sistólico , Trombocitopenia/etiología , Disfunción Ventricular Izquierda/inducido químicamente , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
OBJECTIVES: To determine the plasma and erythrocyte zinc levels in women with preeclampsia and eclampsia after 28 weeks of gestation and compare with normal pregnancy and to correlate with the foetal outcome. MATERIAL AND METHODS: 150 antenatal women were divided into Study group A (75 women with preeclampsia or eclampsia); Control group B (75 women with normal pregnancy). Plasma and erythrocyte zinc levels were estimated in both the groups and correlated with the foetal outcome. RESULTS: The plasma zinc levels were significantly low (p < 0.01) in women with severe pre-eclampsia (9.28 +/- 1.63 micromol/l) and eclampsia (9.28 +/- 2.61 micromol/l) as compared to controls (10.63 +/- 1.82 micromol/l). The difference in the erythrocyte zinc levels was not statistically significant in the two groups. There were 4 (5.33%) stillbirths and 8 (10.66%) neonatal deaths in the study group as compared to 2 (2.6%) neonatal deaths in the control group. There was no statistically significant difference in the plasma and erythrocyte zinc levels in infants weighing less than 2500 gm in both the groups.The maternal mortality rate was 1.33% and the overall perinatal mortality rate in the study group was 17.3% as compared to 2.6% in the control group. CONCLUSIONS: Plasma zinc levels were significantly lowered in severe preeclampsia and eclampsia while the erythrocyte zinc levels did not show any significant change. There was no correlation between plasma or erythrocyte zinc levels and intrauterine growth restriction in pre-eclampsia.
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Preeclampsia/sangre , Zinc/sangre , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Embarazo , Resultado del EmbarazoRESUMEN
Aim: The index study aimed to investigate the clinical impact of initial high-sensitivity C-reactive protein (hs-CRP) on outcomes in nonvalvular atrial fibrillation (AF). Methods: Single-center, prospective, observational study recruiting all recently diagnosed treatment-naive AF patients. Hs-CRP was measured at baseline and patients were followed for 24 months. Results: A total of 126 patients with a mean age of 66.2 (±12.0) years were enrolled. The composite outcome of major adverse cardiac or cerebrovascular events (MACCE) occurred in 19 (17.7%) at 24 months. Raised initial hs-CRP emerged as an independent predictor of MACCE on regression analysis (OR: 1.569, 95% CI: 1.289-1.912; p < 0.001). Conclusion: Raised hs-CRP was an independent predictor of MACCE at 24 months. It allows for early identification of high-risk patients.
Atrial fibrillation (AF) is the most common cause of irregular heartbeat in adults. It has a significant association with clot formation in the heart and acute vessel closure throughout the vascular system particularly of the brain causing stroke. Stroke has a significant impact on quality of life and also is associated with an increased likelihood of death. Inflammation has been linked to the development and progression of AF. In this study, we evaluated the role of a simple inflammatory blood parameter high sensitivity C-reactive protein (hs-CRP) with adverse outcomes in 126 AF patients at our center over a period of 2 years. We concluded that hs-CRP was an independent predictor of worse cardiovascular outcomes in AF patients and can help in the earlier identification of high-risk patients, for whom appropriate measures can be taken to prevent adverse events.
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Fibrilación Atrial , Biomarcadores , Proteína C-Reactiva , Humanos , Fibrilación Atrial/complicaciones , Fibrilación Atrial/sangre , Proteína C-Reactiva/metabolismo , Proteína C-Reactiva/análisis , Femenino , Masculino , Anciano , Estudios Prospectivos , Biomarcadores/sangre , Pronóstico , Factores de Riesgo , Persona de Mediana Edad , Estudios de Seguimiento , Medición de Riesgo/métodosRESUMEN
OBJECTIVE: In 2016, the Lipid Association of India (LAI) developed a cardiovascular risk assessment algorithm and defined low-density lipoprotein cholesterol (LDL-C) goals for prevention of atherosclerotic cardiovascular disease (ASCVD) in Indians. The recent refinements in the role of various risk factors and subclinical atherosclerosis in prediction of ASCVD risk necessitated updating the risk algorithm and treatment goals. METHODS: The LAI core committee held twenty-one meetings and webinars from June 2022 to July 2023 with experts across India and critically reviewed the latest evidence regarding the strategies for ASCVD risk prediction and the benefits and modalities for intensive lipid lowering. Based on the expert consensus and extensive review of published data, consensus statement IV was commissioned. RESULTS: The young age of onset and a more aggressive nature of ASCVD in Indians necessitates emphasis on lifetime ASCVD risk instead of the conventional 10-year risk. It also demands early institution of aggressive preventive measures to protect the young population prior to development of ASCVD events. Wide availability and low cost of statins in India enable implementation of effective LDL-C-lowering therapy in individuals at high risk of ASCVD. Subjects with any evidence of subclinical atherosclerosis are likely to benefit the most from early aggressive interventions. CONCLUSIONS: This document presents the updated risk stratification and treatment algorithm and describes the rationale for each modification. The intent of these updated recommendations is to modernize management of dyslipidemia in Indian patients with the goal of reducing the epidemic of ASCVD among Indians in Asia and worldwide.
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Enfermedades Cardiovasculares , Consenso , Humanos , India/epidemiología , Medición de Riesgo , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/epidemiología , Lípidos/sangre , Aterosclerosis/prevención & control , Aterosclerosis/tratamiento farmacológico , Factores de Riesgo , LDL-Colesterol/sangre , Factores de Riesgo de Enfermedad CardiacaRESUMEN
BACKGROUND: Awareness of hypertension and blood pressure (BP) control rates are still low in India. Home blood pressure monitoring (HBPM) is recognized as a valuable tool to diagnose and support hypertension treatment including the prevention of cardiovascular diseases(CVD) and target organ damage. We explored the prevailing knowledge and current recommendation of HBPM in daily practice by physicians in India. MATERIALS AND METHODS: As part of Asia HBPM Survey 2020, a cross-sectional survey was conducted among healthcare providers from India between June 2020 to June 2021. The questionnaire consisted of 37 questions and sub-questions related to HBPM awareness and recommendations to patients. RESULTS: A total of 832 physicians participated in the survey. Almost 83% were male, whereas age, specialty and workplace were well distributed. 31.3% of physicians instruct their patients to measure their BP before taking antihypertensive drugs, while around 30% of physicians gave no instructions. The reference value of hypertension diagnosis amongst the physicians was substantially low based on clinic BP (34.4%) and home BP (15.1%). Among physicians who manage hypertensive patients, nearly 88% recommend HBPM to their patients, however, only 34.9% of their patients own HBPM device and 30.4% of the patients measure their own BP at home. CONCLUSION: The survey reveals that HBPM instructions to the patients are either lacking or not well aligned with the local hypertension guidelines which may have led to the low HBPM use among patients. Clear and practical educational material and sessions are needed to improve the understanding of HBPM amongst physicians.
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Hipertensión , Médicos , Humanos , Masculino , Femenino , Presión Sanguínea/fisiología , Estudios Transversales , Monitoreo Ambulatorio de la Presión Arterial/métodos , Cooperación del Paciente , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Asia , India/epidemiología , Encuestas y CuestionariosRESUMEN
Background: With over 18.6 million deaths annually, cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. One such complication of CVDs that can result in stroke is atrial fibrillation (Afib). As part of global outreach and awareness, World Heart Day and Atrial Fibrillation Awareness Month are celebrated annually on 29 September and the month of September, respectively. Both of these events are important cardiovascular awareness initiatives to assist public education and develop awareness strategies, and they have received considerable support from leading international organizations. Objective: We studied the global digital impact of these campaigns via Google Trends and Twitter. Methods: We evaluated the overall number of tweets, impressions, popularity and top keywords/hashtags, and interest by region to determine the digital impact using various analytical tools. Hashtag network analysis was done using ForceAtlas2 model. Beyond social media, Google Trends web search analysis was carried out for both awareness campaigns to examine 'interest by region' over the past five years by analyzing relative search volume. Results: #WorldHeartDay and #UseHeart (dedicated social media hashtags for World Heart Day by the World Heart Federation) alone amassed over 1.005 billion and 41.89 million impressions as compared with the 1.62 million and 4.42 million impressions of #AfibMonth and #AfibAwarenessMonth, respectively. On Google Trends web search analysis, the impact of Afib awareness month was limited to the USA, but World Heart Day had a comparatively global reach with limited digital involvement in the African continent. Conclusions: World Heart Day and Afib awareness month present a compelling case study of vast digital impact and the effectiveness of targeted campaigning using specific themes and keywords. Though the efforts of the backing organizations are commended, planning and collaboration are needed to further widen the reach of Afib awareness month.
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Fibrilación Atrial , Medios de Comunicación Sociales , Humanos , Fibrilación Atrial/epidemiologíaRESUMEN
Emerging data highlights the heightened risk of atherosclerotic cardiovascular diseases (ASCVD) in patients with chronic inflammatory disorders, particularly those afflicted with inflammatory bowel disease (IBD). This review delves into the epidemiological connections between IBD and ASCVD, elucidating potential underlying mechanisms. Furthermore, it discusses the impact of current IBD treatments on cardiovascular risk. Additionally, the cardiovascular adverse effects of novel small molecule drugs used in moderate-to-severe IBD are investigated, drawing parallels with observations in patients with rheumatoid arthritis. This article aims to comprehensively evaluate the existing evidence supporting these associations. To achieve this, we conducted a meticulous search of PubMed, spanning from inception to August 2023, using a carefully selected set of keywords. The search encompassed topics related to IBD, such as Crohn's disease and ulcerative colitis, as well as ASCVD, including coronary artery disease, cardiovascular disease, atrial fibrillation, heart failure, conduction abnormalities, heart blocks, and premature coronary artery disease. This review encompasses various types of literature, including retrospective and prospective cohort studies, clinical trials, meta-analyses, and relevant guidelines, with the objective of providing a comprehensive overview of this critical intersection of inflammatory bowel disease and cardiovascular health.
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Multisystem inflammatory syndrome in children (MIS-C) can cause significant morbidity and mortality in children. This study was conducted to assess the pattern and outcome of cardiac abnormalities in MIS-C. This retrospective study was conducted in children with MIS-C between 1 month and 18 years. We enrolled 53 children with a mean age of 7.78 ± 4.62 years. Overall, 35.8% of children with MIS-C had cardiac manifestations in the form of coronary artery abnormalities (CAAs) or left ventricular (LV) dysfunction. Younger age (P 0.009) and high C-reactive protein at admission (P = 0.001) were significant predictors of cardiac involvement. CAAs were seen in 11.3% of children. On follow-up, 67% and 83% of children showed regression of CAA at 1 and 6 months, respectively. 24.5% of patients had presented with LV dysfunction. LV ejection fraction improved significantly at 1 month (P = 0.002) and 6 months (P = 0.001). Cardiac outcomes in MIS-C were favorable with timely identification and treatment.
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Background: Diabetes mellitus (DM), chronic kidney disease (CKD), and heart failure (HF) are pathophysiologically linked and increasing in prevalence in Asian populations, but little is known about the interplay of DM and CKD on outcomes in HF. Objectives: This study sought to investigate outcomes in patients with heart failure with preserved ejection fraction (HFpEF) vs heart failure with reduced ejection fraction (HFrEF) in relation to the presence of DM and CKD. Methods: Using the multinational ASIAN-HF registry, we investigated associations between DM only, CKD only, and DM+CKD with: 1) composite of 1-year mortality or HF hospitalization; and 2) Kansas City Cardiomyopathy Questionnaire scores, according to HF subtype. Results: In 5,239 patients with HF (74.6% HFrEF, 25.4% HFpEF; mean age 63 years; 29.1% female), 1,107 (21.1%) had DM only, 1,087 (20.7%) had CKD only, and 1,400 (26.7%) had DM+CKD. Compared with patients without DM nor CKD, DM+CKD was associated with 1-year all-cause mortality or HF hospitalization in HFrEF (adjusted HR: 2.07; 95% CI: 1.68-2.55) and HFpEF (HR: 2.37; 95% CI: 1.40-4.02). In HFrEF, DM only and CKD only were associated with 1-year all-cause mortality or HF hospitalization (both HRs: 1.43; 95% CI: 1.14-1.80), while in HFpEF, CKD only (HR: 2.54; 95% CI: 1.46-4.41) but not DM only (HR: 1.01; 95% CI: 0.52-1.95) was associated with increased risk (interaction P < 0.01). Adjusted Kansas City Cardiomyopathy Questionnaire scores were lower in patients with DM+CKD (HFrEF: mean 60.50, SEM 0.77, HFpEF: mean 70.10, SEM 1.06; P < 0.001) than with no DM or CKD (HFrEF: mean 66.00, SEM 0.65; and HFpEF: mean 75.80, SEM 0.99). Conclusions: Combined DM and CKD adversely effected outcomes independently of HF subtype, with CKD a consistent predictor of worse outcomes. Strategies to prevent and treat DM and CKD in HF are urgently required.