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Manish Bansal

Bio: Manish Bansal is an academic researcher from Medanta. The author has contributed to research in topics: Business & Internal medicine. The author has an hindex of 24, co-authored 110 publications receiving 2700 citations. Previous affiliations of Manish Bansal include All India Institute of Medical Sciences & Apollo Hospital, Indraprastha.


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Manish Bansal1
TL;DR: It has been consistently shown that the presence of pre-existing CV disease and/or development of acute cardiac injury are associated with significantly worse outcome in patients with coronavirus disease 2019.
Abstract: Background and aims Many patients with coronavirus disease 2019 (COVID-19) have underlying cardiovascular (CV) disease or develop acute cardiac injury during the course of the illness. Adequate understanding of the interplay between COVID-19 and CV disease is required for optimum management of these patients. Methods A literature search was done using PubMed and Google search engines to prepare a narrative review on this topic. Results Respiratory illness is the dominant clinical manifestation of COVID-19; CV involvement occurs much less commonly. Acute cardiac injury, defined as significant elevation of cardiac troponins, is the most commonly reported cardiac abnormality in COVID-19. It occurs in approximately 8–12% of all patients. Direct myocardial injury due to viral involvement of cardiomyocytes and the effect of systemic inflammation appear to be the most common mechanisms responsible for cardiac injury. The information about other CV manifestations in COVID-19 is very limited at present. Nonetheless, it has been consistently shown that the presence of pre-existing CV disease and/or development of acute cardiac injury are associated with significantly worse outcome in these patients. Conclusions Most of the current reports on COVID-19 have only briefly described CV manifestations in these patients. Given the enormous burden posed by this illness and the significant adverse prognostic impact of cardiac involvement, further research is required to understand the incidence, mechanisms, clinical presentation and outcomes of various CV manifestations in COVID-19 patients.

644 citations

01 Jan 2011
TL;DR: In this paper, a 2-h accelerated diagnostic protocol (ADP) was proposed to identify patients presenting with chest pain who have a low short-term risk of a major adverse cardiac event.
Abstract: Background: Patients with chest pain contribute substantially to emergency department attendances, lengthy hospital stay, and inpatient admissions. A reliable, reproducible, and fast process to identify patients presenting with chest pain who have a low short-term risk of a major adverse cardiac event is needed to facilitate early discharge. We aimed to prospectively validate the safety of a predefined 2-h accelerated diagnostic protocol (ADP) to assess patients presenting to the emergency department with chest pain symptoms suggestive of acute coronary syndrome. Methods: This observational study was undertaken in 14 emergency departments in nine countries in the Asia-Pacific region, in patients aged 18 years and older with at least 5 min of chest pain. The ADP included use of a structured pre-test probability scoring method (Thrombolysis in Myocardial Infarction [TIMI] score), electrocardiograph, and point-of-care biomarker panel of troponin, creatine kinase MB, and myoglobin. The primary endpoint was major adverse cardiac events within 30 days after initial presentation (including initial hospital attendance). This trial is registered with the Australia-New Zealand Clinical Trials Registry, number ACTRN12609000283279. Findings: 3582 consecutive patients were recruited and completed 30-day follow-up. 421 (11•8%) patients had a major adverse cardiac event. The ADP classified 352 (9•8%) patients as low risk and potentially suitable for early discharge. A major adverse cardiac event occurred in three (0•9%) of these patients, giving the ADP a sensitivity of 99•3% (95% CI 97•9–99•8), a negative predictive value of 99•1% (97•3–99•8), and a specificity of 11•0% (10•0–12•2). Interpretation: This novel ADP identifies patients at very low risk of a short-term major adverse cardiac event who might be suitable for early discharge. Such an approach could be used to decrease the overall observation periods and admissions for chest pain. The components needed for the implementation of this strategy are widely available. The ADP has the potential to affect health-service delivery worldwide.

232 citations

Journal ArticleDOI
Manish Bansal1
TL;DR: The present trial showed that a combination of enalapril and carvedilol might prevent cardiotoxicity in patients undergoing chemotherapy for hematological malignancies.
Abstract: Background: Cardiotoxicity is an important and a common complication of cancer chemotherapeutic drugs. It may not only be associated with significant morbidity and mortality but also often becomes a limiting factor in adequate anti-cancer treatment. Several pharmacological agents are being evaluated for their efficacy in preventing cardiotoxicity of the cancer drugs. Material and methods: Ninety patients with hematological malignancies undergoing chemotherapy and/or autologous hematopoietic stem cell transplantation (HSCT) were recruited in this study and were randomized to receive a combination of enalapril and cardvedilol (intervention arm) or no intervention (control arm). Comprehensive echocardiography and cardiac magnetic resonance imaging (MRI) were performed at baseline and at 6 months after randomization. The primary efficacy endpoint was the absolute change from baseline in left ventricular ejection fraction (LVEF). Results: The mean age of the study subjects was 50 ± 13 years. By the end of the 6 months, there was a significant fall in LVEF in controls (3.28% absolute reduction from baseline) but no change was seen in the intervention group. As a result, at 6 months, LVEF was significantly lower in the control group in comparison to the intervention group (an absolute difference of 3.1% by echocardiography and 3.4% by cardiac MRI, p = 0.035 and 0.09, respectively). The beneficial effect was seen almost exclusively in patients receiving chemotherapy alone (absolute difference in LVEF of 6.38% at 6 months, p = 0.025) and not in those undergoing HSCT (absolute difference of 1.01%, p = 0.56). In addition, compared to controls, patients in the intervention group had a lower incidence of the combined event of death or heart failure (6.7% vs. 22%, p = 0.036) and of death, heart failure, or a final LVEF <45% (6.7% vs. 24.4%, p = 0.02). Conclusions: The present trial showed that a combination of enalapril and carvedilol might prevent cardiotoxicity in patients undergoing chemotherapy for hematological malignancies.

176 citations

Journal ArticleDOI
TL;DR: Two-dimensional strain measured with AFI has significantly better accuracy than VVI and Circumferential strain with A FI has the best discriminative ability for the detection of regional myocardial dysfunction.
Abstract: Background Different 2-dimensional speckle-based strain techniques have been developed to overcome the problem of angle dependency with Doppler-based strain. However, their relative accuracy has not been assessed. The aim of this study was to determine the feasibility and accuracy of 2 such techniques (velocity vector imaging [VVI] and automated function imaging [AFI]), using tagged harmonic phase (HARP) magnetic resonance imaging (MRI) as a reference standard. Methods Thirty patients with known or suspected ischemic heart disease underwent measurement of peak systolic longitudinal, radial, and circumferential Lagrangian strain with all 3 techniques using a 16-segment model. The extent of scar tissue in each segment was determined using contrast-enhanced MRI. Results The measurement of myocardial strain in all 3 directions was highly feasible with both VVI and AFI. Longitudinal strain was underestimated by both VVI (−11 ± 8%; P P P P Conclusions Two-dimensional strain measured with AFI has significantly better accuracy than VVI. Circumferential strain with AFI has the best discriminative ability for the detection of regional myocardial dysfunction.

172 citations


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TL;DR: The current guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation are based on the findings of the ESC Task Force on 12 March 2015.
Abstract: ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation : The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).

6,866 citations

01 Jan 2020
TL;DR: Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
Abstract: Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

4,408 citations

Journal ArticleDOI
TL;DR: This paper presents a Randomized Assessment of Acute Coronary Syndrome Treatment of Intracoronary Stenting With Antithrombotic Regimen and Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction.
Abstract: ABOARD : Angioplasty to Blunt the Rise of Troponin in Acute Coronary Syndromes Randomized for an Immediate or Delayed Intervention ACC : American College of Cardiology ACE : angiotensin-converting enzyme ACS : acute coronary syndromes ACT : activated clotting time ACUITY : Acute Catheterization and Urgent Intervention Triage strategY AF : atrial fibrillation AHA : American Heart Association APPRAISE : Apixaban for Prevention of Acute Ischemic Events aPTT : activated partial thromboplastin time ARB : angiotensin receptor blocker ARC : Academic Research Consortium ATLAS : Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Aspirin With or Without Thienopyridine Therapy in Subjects with Acute Coronary Syndrome BARI-2D : Bypass Angioplasty Revascularization Investigation 2 Diabetes BMS : bare-metal stent BNP : brain natriuretic peptide CABG : coronary bypass graft CAD : coronary artery disease CI : confidence interval CK : creatinine kinase CKD : chronic kidney disease CK-MB : creatinine kinase myocardial band COX : cyclo-oxygenase CMR : cardiac magnetic resonance COMMIT : Clopidogrel and Metoprolol in Myocardial Infarction Trial CPG : Committee for Practice Guidelines CrCl : creatinine clearance CRP : C-reactive protein CRUSADE : Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines CT : computed tomography CURE : Clopidogrel in Unstable Angina to Prevent Recurrent Events CURRENT : Clopidogrel Optimal Loading Dose Usage to Reduce Recurrent Events CYP : cytochrome P450 DAPT : dual (oral) antiplatelet therapy DAVIT : Danish Study Group on Verapamil in Myocardial Infarction Trial DES : drug-eluting stent DTI : direct thrombin inhibitor DIGAMI : Diabetes, Insulin Glucose Infusion in Acute Myocardial Infarction EARLY-ACS : Early Glycoprotein IIb/IIIa Inhibition in Non-ST-Segment Elevation Acute Coronary Syndrome ECG : electrocardiogram eGFR : estimated glomerular filtration rate ELISA : Early or Late Intervention in unStable Angina ESC : European Society of Cardiology Factor Xa : activated factor X FFR : fractional flow reserve FRISC : Fragmin during Instability in Coronary Artery Disease GP IIb/IIIa : glycoprotein IIb/IIIa GRACE : Global Registry of Acute Coronary Events HINT : Holland Interuniversity Nifedipine/Metoprolol Trial HIT : heparin-induced thrombocytopenia HORIZONS : Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction HR : hazard ratio hsCRP : high-sensitivity C-reactive protein ICTUS : Invasive vs. Conservative Treatment in Unstable coronary Syndromes INR : international normalized ratio INTERACT : Integrilin and Enoxaparin Randomized Assessment of Acute Coronary Syndrome Treatment ISAR-COOL : Intracoronary Stenting With Antithrombotic Regimen Cooling Off ISAR-REACT : Intracoronary stenting and Antithrombotic Regimen- Rapid Early Action for Coronary Treatment i.v. : intravenous LDL-C : low-density lipoprotein cholesterol LMWH : low molecular weight heparin LV : left ventricular LVEF : left ventricular ejection fraction MB : myocardial band MDRD : Modification of Diet in Renal Disease MERLIN : Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndromes MI : myocardial infarction MINAP : Myocardial Infarction National Audit Project MRI : magnetic resonance imaging NNT : numbers needed to treat NSAID : non-steroidal anti-inflammatory drug NSTE-ACS : non-ST-elevation acute coronary syndromes NSTEMI : non-ST-elevation myocardial infarction NT-proBNP : N-terminal prohormone brain natriuretic peptide OASIS : Organization to Assess Strategies for Ischaemic Syndromes OPTIMA : Optimal Timing of PCI in Unstable Angina OR : odds ratio PCI : percutaneous coronary intervention PENTUA : Pentasaccharide in Unstable Angina PLATO : PLATelet inhibition and patient Outcomes PURSUIT : Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy RCT : randomized controlled trial RE-DEEM : Randomized Dabigatran Etexilate Dose Finding Study In Patients With Acute Coronary Syndromes (ACS) Post Index Event With Additional Risk Factors For Cardiovascular Complications Also Receiving Aspirin And Clopidogrel REPLACE-2 : Randomized Evaluation of PCI Linking Angiomax to reduced Clinical Events RIKS-HIA : Register of Information and Knowledge about Swedish Heart Intensive care Admissions RITA : Research Group in Instability in Coronary Artery Disease trial RR : relative risk RRR : relative risk reduction STE-ACS : ST-elevation acute coronary syndrome STEMI : ST-elevation myocardial infarction SYNERGY : Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors trial SYNTAX : SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery TACTICS : Treat angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy TARGET : Do Tirofiban and ReoPro Give Similar Efficacy Outcomes Trial TIMACS : Timing of Intervention in Patients with Acute Coronary Syndromes TIMI : Thrombolysis In Myocardial Infarction TRITON : TRial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet InhibitioN with Prasugrel–Thrombolysis In Myocardial Infarction UFH : unfractionated heparin VKA : vitamin K antagonist VTE : venous thrombo-embolism Guidelines summarize and evaluate all available evidence, at the time of the writing process, on a particular issue with the aim of assisting physicians in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes but are complements for textbooks and cover the European Society of Cardiology (ESC) Core Curriculum topics. Guidelines and recommendations should help the physicians to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible physician(s). A great number of Guidelines have been issued in recent years by the ESC as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC website (http://www.escardio.org/guidelines-surveys/esc-guidelines/about/Pages/rules-writing.aspx). ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated. Members of this Task Force were selected by the ESC to represent professionals involved with the medical care of patients with this pathology. Selected experts in the field undertook a comprehensive review of the published evidence for diagnosis, management, and/or prevention of a given condition according to ESC Committee for Practice Guidelines (CPG) policy. A critical evaluation of diagnostic and therapeutic procedures was performed including assessment of the risk–benefit ratio. Estimates of expected health outcomes for larger populations were included, where data exist. The level of evidence and the strength of recommendation of particular treatment options were weighed and graded according to pre-defined scales, as outlined in Tables 1 and 2 . …

3,841 citations