Basic Concepts and Clinical Outcomes of Drug-Eluting Balloons for Treatment of Coronary Artery Disease: An Overview.

The technology of percutaneous coronary intervention for atherosclerotic coronary artery disease has evolved considerably since its inception. Though Drug-Eluting Stent (DES) reduces the rate of restenosis, long-term safety outcomes and persistent restenosis in complex lesion subset remain area of concern. Recently, Drug-Eluting Balloon (DEB) represents a novel treatment strategy for atherosclerotic coronary artery disease. DEB demonstrated its added value in preclinical studies. Inspired by these results, several clinical trials particularly in complex lesion subsets have been started to explore the value of this novel treatment strategy in a broader range of lesions. This review would summarise material compositions and different characteristics and clinical outcomes of currently available DEB.

A Post-Marketing Surveillance Study to Evaluate Performance of the EXIMO™ Blood Glucose Monitoring System.

INTRODUCTION: The performance of Blood Glucose Monitoring System (BGMS) is critical as the information provided by the system guide the patient or health care professional in making treatment decisions. However, besides evaluating accuracy of the BGMS in laboratory setting, it is equally important that the intended users (healthcare professionals and patients) should be able to achieve blood glucose measurements with similar level of high accuracy. AIM: To assess the performance of EXIMO™ (Meril Diagnostics Pvt. Ltd., Vapi, Gujarat, India) BGMS as per International Organization for Standardization (ISO) 15197:2013 section 8 user performance criteria. MATERIALS AND METHODS: This was a non-randomized and post-marketing study conducted at a tertiary care centre of India. A total of 1005 patients with diabetes themselves performed fingertip blood glucose measurement using EXIMO™ BGMS. Immediately after capillary blood glucose measurement using the blood glucose monitoring system, venous blood sample from each patient was obtained by a trained technician which was assessed by reference laboratory method- Cobas Integra 400 plus (Roche Instrument Centre, Rotkreuz, Switzerland). All the blood glucose measurements assessed by EXIMO™ were compared with laboratory results. Performance of the system was assessed as per ISO 15197:2013 criteria using Bland-Altman plot, Parkes-Consensus Error Grid (CEG) and Surveillance Error Grid analyses (SEG). RESULTS: A total of 1005 patients participated in the study. Average age of the patients was 44.93±14.65 years. Evaluation of capillary fingertip blood glucose measurements demonstrated that 95.82% measurements fulfilled ISO 15197:2013 section 8 user performance criteria. All the results lie within clinically non-critical zones; Zone A (99.47%; n=1000) and Zone B (0.53%; n=05) of the CEG analysis. As per SEG analysis, majority of the results fell within "no-risk" zone (risk score 0 to 0.5; 90.42%). CONCLUSION: The result of the study confirmed that intended users are able to obtain accurate glucose measurements when operating EXIMO™ BGMS, given only the instructions and training materials routinely provided with the system, in clinical practice.

A rare malady with a rarer complication.

Isolated ventricular noncompaction (IVNC) is an unclassified cardiomyopathy characterized by prominent intraventricular trabeculations separated by deep intertrabecular recesses. Although microvascular dysfunction is known, myocardial infarction is rare and usually seen as a consequence of coincidental coronary artery disease. We report the case of a 19-year-old male patient who presented to us with symptoms and signs of heart failure. Echocardiography revealed IVNC with severe left ventricular dysfunction. He was put on medical treatment including oral anticoagulants. Six months later, he came to our emergency department with anterior wall STEMI. Coronary angiogram revealed thrombotic occlusion of distal LAD, which resolved completely with tirofiban and heparin. Coronary thromboembolism due to blood stasis in the left ventricular cavity has not been previously documented in IVNC.

The age-specific clinical and anatomical profile of mitral stenosis.

INTRODUCTION: This cross-sectional study on the age-specific clinical and anatomical characteristics of mitral stenosis was conducted at the Department of Cardiology at Kottayam Medical College, South India. METHODS: The clinical profile, laboratory details and transthoracic echocardiographical features of 203 consecutive patients with mitral stenosis were studied. Wilkins score was used to assess the valve morphology and the feasibility of balloon mitral valvotomy (BMV)/closed mitral valvotomy (CMV). Patients were grouped according to age, into Group I (younger than 40 years; 68 cases), Group II (40-65 years; 78 cases) and Group III (older than 65 years; 57 cases) for analysis. RESULTS: The mean age of the patients was 53 years. History of rheumatic fever was less common in Group III (37 percent in Group I vs. 20 percent in Group III, p-value is equal to 0.05). Acute pulmonary oedema occurred commonly in Group III (six percent in Group I vs. 36 percent in Group III, p-value is less than 0.001). Incidence of ischaemic strokes increased with increasing age (three percent in Group I vs. 12 percent in Group II, p-value is equal to 0.05; 12 percent in Group II vs. 25 percent in Group III, p-value is equal to 0.05; and three percent in Group I vs. 25 percent in Group III, p-value is less than 0.001). Prevalence of atrial fibrillation (AF) increased progressively with increasing age (nine percent in Group I vs. 30 percent in Group II, p-value is less than 0.001; 30 percent in Group II vs. 64 percent in Group III, p-value equal to 0.003). Clinical features of pulmonary hypertension was highest among Group I (66 percent in Group I vs. 42 percent and 43 percent in Groups II and III, respectively, p-value is equal to 0.01). The mean duration of exertional dyspnoea, history of paroxysmal nocturnal dyspnoea, mean NYHA class, mean left atrial sizes, mean mitral valve areas and mean mitral valve gradients did not vary significantly among the three groups. Mitral valve scores were prohibitive for BMV/CMV in significant numbers of older patients (seven percent in Group I vs. 38 percent in Group II vs. 80 percent in Group III; p-value is less than 0.001). CONCLUSION: When compared to the trends in developed countries, the mean age at presentation of mitral stenosis is similar, but the degree of valve deformity is higher. Incidence of pulmonary oedema, AF and stroke increases with advancing age in mitral stenosis.

Microalbuminuria in patients with essential hypertension and its relationship to target organ damage: an Indian experience.

Persistent microalbuminuria (MA) is the earliest indicator of chronic kidney disease (CKD) in patients with diabetes mellitus and hypertension. Patients with MA have high risk for target organ damage (TOD) resulting in stroke, retinopathy and adverse cardiovascular events. Though the prevalence of hypertension is high in India, the relationship between MA and TOD in hypertension is not well studied. To address this issue, this study was conducted at the Kottayam Medical College, Kerala, South India, between May 2005 and October 2006. The principal aim was to find out the prevalence of MA and its relationship to TOD in patients with essential hypertension. A total of 150 hypertensives without diabetes mellitus and/or other conditions causing MA were studied. Urine albumin-creatinine ratio (ACR) was assessed and MA was defined as albumin excretion between 30-300 mg/day. The relationship of MA with the duration, severity and previous treatment of hypertension, body mass index (BMI), lipid profile and TOD's like left ventricular hypertrophy (LVH), hypertensive retinopathy and stroke was assessed by univariate analysis. Forty patients (26.67%) were found to have MA of whom 24 were males and 16 were females. MA was significantly higher in those with longer duration and greater severity of hypertension (p < 0.001 in each). Older age (p < 0.001), adverse lipid profile (p < 0.01) and higher BMI (p < 0.04) were the other identifiable risk factors for MA. Gender and history of smoking did not pose higher risk for MA. Stroke (OR=3.8), echocardiography-proven LVH (OR=9.42) and hypertensive retinopathy (OR=9.7) were significantly higher in those with MA. In conclusion, the prevalence of MA in essential hypertension is high and patients with MA have high odds for developing TOD like stroke, LVH and hypertensive retinopathy. Early screening of hypertensives for MA and prompt treatment of positive cases might reduce the burden of CKD and cardiovascular disease in the community.