Prevalence and Risk Factors of Heart Failure with Preserved Ejection Fraction in Middle-Aged Maintenance Haemodialysis Patients on a Twice-Weekly Schedule: Experience from a Single Indian Centre.

Background. Data on the prevalence of cardiac failure with preserved ejection in the haemodialysis population, which impacts treatment strategy, mortality, and morbidity, are scarce. Aims and Objectives. Estimate the prevalence of heart failure with preserved ejection fraction (HFpEF) in haemodialysis patients Classify cardiac failure and ascertain the risk factors influencing HFpEF in haemodialysis patients. Methods. All consenting individuals on haemodialysis over 18 years of age were included. Lung ultrasound was performed as per the LUST study protocol, and the labs were documented. Echocardiographic parameters were measured using two-dimensional (2D ECHO). Results. A total of 102 patients consented to participate in the study, which included 63 males (61.8%) and 39 females (38.2%). The mean patient age was 53 ± 13.1 years. The dialysis vintage of the participants was 38.92 ± 6.947 months. 47 (46.1%) patients had diabetes and 88 (80.4%) had hypertension. ECG findings included sinus rhythm (51/102, 50%), sinus tachycardia (22/102, 21.6%), ST-T wave abnormalities (18/102, 17.6%), and atrial fibrillation (11/102, 10.8%). Heart failure with preserved ejection fraction (HFpEF) was present in 44/102 (43.14%), heart failure with mid-range EF in 14/102 (13.72%), and heart failure with reduced EF in 13/102 (12.7%) patients. The ejection fraction was positively associated with haemoglobin (r = 0.23; p = 0.044), and calcium levels (r = 0.25; p =0 .03). E/lateral e' ratio was positively correlated with NT pro-BNP (r = 0.63; p < 0.001), systolic blood pressure (r = 0.44; p = 0.003) and age (r = 0.353; p = 0.003) and negatively correlated with transferrin saturation (r = -0.353; p = 0.027) and diastolic blood pressure (r = -0.31; p = 0.040). Binary logistic regression analysis revealed that the odds of diastolic dysfunction increased by 2.3 times with each unit increase of creatinine, and diabetics have 7.66 times higher risk for diastolic dysfunction. Binary logistic regression involving ejection fraction (EF) and all laboratory and clinical parameters revealed odds of HFpEF increased by 1.93 times with each unit increase in age, odds of HFpEF increases by 1.53 times with each unit increase in phosphorous and odds of HFpEF increased by 1.1 times with a unit increase of systolic blood pressure. Conclusion. HFpEF is the predominant form of heart failure in haemodialysis patients. Haemoglobin and calcium were positively associated with ejection fraction. Advancing age, elevated creatinine and diabetes mellitus levels are independent predictors of diastolic dysfunction in haemodialysis patients.

Never fail to surveil! Transcatheter closure of recurrent atrial septal defect secondary to patch degradation in a young boy.

We report a case of a 16-year-old boy with symptomatic recurrent atrial septal defect due to patch degradation of an autologous pericardial patch, done 10 years back. He successfully underwent transcatheter closure of the recurrent defect after meticulous assessment of patch rims for stability.

No Room for Excess Room: Cobra Head Deformity of Both Discs of an Amplatzer Atrial Septal Occluder Device.

To our knowledge, this is the first case in the literature citing cobra head deformity of both atrial discs. A large delivery sheath with excess room possibly led to deformity in our case. This case highlights the importance of following manufacturer- recommended sheath sizes for optimal device implantation.

"The Great Masquerader": An Interesting Case Series of Pulmonary Thromboembolism.

Venous thromboembolism (VTE) encompasses pulmonary embolism (PE) and deep vein thrombosis (DVT). The clinical manifestations of pulmonary embolism are highly variable and non-specific. We report five cases of pulmonary embolism, each with a unique clinical profile and degree of severity. The clinical, electrocardiographic, and radiologic findings of each patient are described in this case series along with the appropriate therapy based on hemodynamic stability. It is crucial to distinguish between hemodynamically stable and unstable pulmonary embolism and treatment should be started right away to reduce morbidity and mortality secondary to obstructive shock.

Challenging Case of Balloon Mitral Valvuloplasty: Coronary Balloon to the Rescue.

Owing to the demonstrated safety and cost-effectiveness, balloon mitral valvuloplasty is frequently performed using reused hardware. However, chances of hardware malfunction are higher in such settings, making it pertinent for operators to be adept at recognition and management of such complications. This case illustrates that when the rent is small, a coronary balloon may be used to tackle the inflation failure.