Showing papers in "Journal of the Practice of Cardiovascular Sciences in 2019"
59 citations
TL;DR: In this paper, a review of the sampling techniques used in research including simple random sampling, systematic random sampling and stratified random sampling is presented, including quota sampling, self-selection sampling, convenience sampling, snowball sampling and purposive sampling.
Abstract: Sampling is one of the most important factors which determines the accuracy of a study. This article review the sampling techniques used in research including Probability sampling techniques, which include simple random sampling, systematic random sampling and stratified random sampling and Non-probability sampling, which include quota sampling, self-selection sampling, convenience sampling, snowball sampling and purposive sampling.
57 citations
TL;DR: Although ACS is a less common entity in young adults aged 40 years or less, recent epidemiological trend is progressing and it constitutes an important challenge both for a patient and for a treating physician.
Abstract: Background: Acute coronary syndrome (ACS) is a potentially life-threatening condition which is more common in elderly people, and young are relatively protected. Currently, the protective effect on young from coronary artery disease (CAD) is taken away by several risk factors. The aim of this study is to determine the conventional risk factors and angiographic correlation of CAD in young age ( 40 years). Materials and Methods: This study was a hospital-based retrospective cross-sectional analytical study involving 1151 patients of ACS admitted in the cardiac ICU from May 2016 to May 2018. Among these patients, coronary risk factors such as smoking, diabetes, hypertension, dyslipidemia, and family history were studied. Patients were divided into two groups, Group A: 40 years. Patients were evaluated angiographically. The significance of each risk factor between the groups was calculated by employing the Chi-square test and P
22 citations
TL;DR: The underlying steps and assumptions regarding use of the Bayes theorem and the analytical techniques that can be used to analyze and interpret medical data while treating any disease are sketched.
Abstract: In this work, we outlined the application of the Bayesian technique for integrating the results of multiple tests while treating any disease. We provided an overview of the fundamental concept of Bayesian analysis in making an inference about a phenomenon using a concordance between available information and prior knowledge. An attempt is being made to demonstrate the applicability using core aspects, viz., nature of probability, parameters, and inferential procedure used to draw inference about the population characteristic under both paradigms. Here, we tried to sketch the underlying steps and assumptions regarding use of the Bayes theorem and the analytical techniques that can be used to analyze and interpret medical data while treating any disease.
7 citations
2 citations
TL;DR: It is indicated that hyperuricemia is associated with severity of CAD, though it does not correlate with conventional risk factors such as diabetes, hypertension and elevated cholesterol levels.
Abstract: Background: There is paucity of studies on the prevalence of hyperuricemia in Indian patients with coronary artery disease (CAD). Population differences have been observed in both the prevalence and relationship of hyperuricemia with CAD risk factors in previous studies. Objectives: Our study objectives were to analyze the prevalence and determinants of hyperuricemia in south Indian patients with stable and angiographic evidence of CAD. Methods: Study subjects were 520 patients with stable CAD. Severity of CAD was assessed by estimating the Gensini score. Patients in heart failure, those who had a recent myocardial infarction (
2 citations
TL;DR: Vitamin D deficiency and insufficiency were common in patients with the acute coronary syndrome, and patients with diabetes and dyslipidemia were strongly associated with Vitamin D deficiency, but there was no correlation between Vitamin D deficiencies and ACS outcomes.
Abstract: Introduction: Epidemiologic studies have shown a strong association between Vitamin D deficiency and cardiovascular risk factors, myocardial infarction, and all-cause cardiovascular mortality. The purpose of this study was to determine the clinical implications of serum Vitamin D levels in an unselected cohort of acute coronary syndrome (ACS) patients at the time of hospital admission. Methods: This was a prospective observational study which enrolled a total of 310 patients from December 2015 to March 2018. The consecutive in-hospital patients with ACS diagnosed by the typical history of angina, electrocardiography changes, with or without cardiac enzymes were included in the study. The primary endpoint of the study was all-cause death during hospitalization. The secondary endpoint was the in-hospital incidence of major adverse cardiac events (MACEs). Results: The number of patients with diabetes and dyslipidemia was significantly higher in the Vitamin D-deficient group (46.7%, P = 0.04 and 45.4%, P =
2 citations
TL;DR: The trial suggests that prasugrel may be superior to ticagrelor in reducing the thrombotic outcomes and it could be that once daily dosing with pr asugrel and higher rate of drug discontinuation in the ticAGrelor group may be the mechanism.
Abstract: The Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment 5 trial randomized patients with acute coronary syndrome for whom invasive treatment was planned to ticagrelor versus prasugrel. At 1-year, prasugrel was associated with a 2.4% absolute reduction in the primary outcome. The trial suggests that prasugrel may be superior to ticagrelor in reducing the thrombotic outcomes. It could be that once daily dosing with prasugrel and higher rate of drug discontinuation in the ticagrelor group may be the mechanism.
1 citations
TL;DR: A series of checklists which are successfully used in the management of heart failure in a tertiary care hospital in India are shown.
Abstract: Health care today is complex and mistakes can occur due to multiple reasons from lack of knowledge to simply lack of attention to detail. Checklists are a way to prevent mistakes and implement common standards of care but there are difficulties in implementing checklists. In this article we are showing a series of checklists which we have successfully used in the management of heart failure in a tertiary care hospital in India. The checklists start from the time the patient is admitted (the Intensive care Check list) to the time of discharge. The patient's visit to the out patient department is also covered by multiple education cards and checklists (Heart Failure Checklist, HRIDAY CARD). There are also standard prognostic tools (Seattle heart failure score and many others) which are used to prognosticate patients which do not respond to drug therapy. The I-NEED-HELP tool is explained to choose patients who might benefit from an cardiac assist device or a heart transplant.
1 citations
TL;DR: The test procedure showed agreement with the standard protocol of cuff positioning, therefore, it could be used interchangeably and could beused interchangeably for BP measurement.
Abstract: Introduction: Elevated blood pressure (BP)/hypertension contributes significantly to global morbidity and mortality. It is a silent killer; therefore, earlier diagnosis is imperative. A simple instrument called sphygmomanometer measures BP. Getting an accurate and precise reading is essential for making the diagnosis. Our study sorts to determine if there is any significant change in BP readings when the bladder cuff is inverted during BP measurement. Materials and Methods: This was a cross-sectional study involving 540 individuals who were consecutively recruited from the outpatient clinics over a year period. BP was measured with a mercury sphygmomanometer in three postures of sitting, standing, and supine comparing the standard protocol (control) and our designed protocol of inverted cuff (test). Results: The mean systolic and diastolic BP for all the postures for both sexes were significantly corresponding for both test positions in majority of the age groups; all observed differences in means were
1 citations
TL;DR: Two autopsy cases are reported and histopathological changes in heart are highlighted which helped in diagnosing in correlation with other organ findings the final cause of death as leptospirosis, an important sporadic zoonotic disease.
Abstract: Leptospirosis is an important sporadic zoonotic disease. This disease is caused by the spirochete leptospira icterohemorrhagica. In India, leptospirosis has always remained a major health concern, particularly during monsoons. This disease mainly affects vital organs such as the lung, kidney, and heart. Acute respiratory distress syndrome and acute renal failure mainly contribute to the mortality in patients, but cardiac involvement leading to death still remains an underestimated critical clinical factor. We report here two autopsy cases and highlight histopathological changes in heart which helped us in diagnosing in correlation with other organ findings the final cause of death as leptospirosis.
TL;DR: A case of cardiac myxoma with glandular elements in a 34-year-old male, who presented with right-sided hemiparesis following a cardiovascular attack 2 months back, is reported.
Abstract: Cardiac myxoma with glandular elements is an unusual histologic variant of cardiac myxoma and constitutes 2%–5% of all cardiac myxomas. Here, we report a case of cardiac myxoma with glandular elements in a 34-year-old male, who presented with right-sided hemiparesis following a cardiovascular attack 2 months back. Echocardiography revealed a large right atrial mass measuring 3.5 cm × 3.5 cm × 2 cm. Under cardiopulmonary bypass, left atrial mass was excised. Histopathological and immunohistochemical examination of the mass confirmed the diagnosis of cardiac myxoma with glandular elements. It is important to recognize this variant to avoid misdiagnosis of metastatic adenocarcinoma due to its rarity as well as due to its unusual morphological features.
TL;DR: A case of Cor Triatriatum Sinister presenting with acute myocardial infarction and underwemt a successful coronary angioplasty is described.
Abstract: A case of Cor Triatriatum Sinister presenting with acute myocardial infarction is described. The patient underwemt a successful coronary angioplasty.
TL;DR: The prevalence of symptomatic and asymptomatic PAD was high among ART-naïve HIV-infected cases of relatively younger age group and HIV seropositivity was found to be significantly associated with the development of PAD.
Abstract: Background and Objectives: Human immunodeficiency virus (HIV)-induced endothelial dysfunction leads to premature atherosclerosis, which may manifest as peripheral arterial disease (PAD) of the lower limbs. Studies are not available on the prevalence of PAD among antiretroviral therapy (ART)-naive HIV-infected population. The objective was to explore the prevalence of PAD among HIV seropositive cases and to determine the relation of PAD with HIV infectivity and with CD4 count. Materials and Methods: This hospital-based case-control study included 100 newly diagnosed HIV seropositive ART naive cases (age 20–49 years) and 100 HIV seronegative frequency or group matched controls. Demographic, clinical and routine laboratory parameters, and ankle-brachial pressure index (ABI) were studied. PAD was diagnosed by Doppler study of lower limb arteries. Results: The prevalence of PAD was significantly more among HIV-infected cases (71%) in comparison to HIV-negative controls (P
TL;DR: This update includes some landmark trials which were published in the last 3 months, including rivaroxaban reduced thromboembolic events in heart failure with coronary artery disease, drug-coated balloons show superiority to bare metal stents in patients with high bleeding risk, and various studies are also published to improve cardiac resynchronization therapy pacemaker response.
Abstract: This update includes some landmark trials which were published in the last 3 months. Myocardial perfusion cardiovascular magnetic resonance imaging has shown some initial promise in trials, rivaroxaban reduced thromboembolic events in heart failure with coronary artery disease, drug-coated balloons show superiority to bare metal stents in patients with high bleeding risk, and various studies are also published to improve cardiac resynchronization therapy pacemaker response.
TL;DR: SanketLife effectively captured AF cases and demonstrated the feasibility of using such a device in any care setting being clinical or home monitoring, and concluded that the device can be used for regular monitoring by patients suffering from chronic AF.
Abstract: Background: Atrial Fibrillation (AF) is one of the most common types of arrhythmia across the world. Yet, many cases remain undiagnosed making it difficult to estimate the exact prevalence of AF. Aims: This observational study was done to understand the feasibility of a hand-held electrocardiography (ECG) device – SanketLife – in detecting AF cases. Materials and Methods: In the study, ECG data collected from the device for a period of 2 months were evaluated to detect AF cases. The device took 12-lead and single-lead ECG recordings in various health-care settings including self-monitoring done by patients at their homes and in diagnostic laboratories using the device for screening as well as hospitals using the device in their outpatient departments. The reports were saved in SanketLife Cloud and evaluated anonymously by a certified ECG expert and the findings were further confirmed by a cardiologist to evaluate AF or any other findings in the ECG. Results: SanketLife effectively captured AF cases and demonstrated the feasibility of using such a device in any care setting being clinical or home monitoring. Conclusion: The study concluded that the device can be used for regular monitoring by patients suffering from chronic AF. In health-care settings ranging from primary care to tertiary care, the device can be beneficial.
TL;DR: Side effects such as diarrhea, tremors, and headache were easily treated by clinical manipulation of drugs and three patients died of severe renal failure and sepsis.
Abstract: Introduction: Heart transplant in India was started in 1994. The Indian transplant program differs from the West. In this study, we report the heart transplant experience from Gleneagles Global, Chennai. Materials and Methods: There were 55 patients who underwent a heart transplant during this period. Patients were induced with basiliximab, and the maintenance therapy was with tacrolimus, mycophenolate, and steroids. Results: Fifty patients underwent a heart transplant between 2017 and 2018. The age ranged from 21 to 66 years, and there were 45 males and 10 females. All patients were Class III and IV. Induction for transplant was with basiliximab 10 mg–20 mg. In 54 patients, tacrolimus was used, and low-dose tacrolimus plus everolimus 0.25 mg twice a day was given in five patients. Mycophenolate mofetil was given to all patients. Steroids were given to all patients. In 38 patients, renal function normalized by day 5, and in 12 patients, the renal recovery was delayed to day 10. Two patients needed postoperative dialysis. Three patients died of severe renal failure and sepsis. Fifteen patients had new-onset diarrhea in the 1st year with four having CMV[CE2] [CE2] antigen positivity, one with Clostridium difficile, and seven patients with diarrhea resolving with termination of mycophenolate. Four had Escherichia coli or Salmonella diarrhea which responded to oral antibiotics. One patient developed herpes zoster and another developed hepatic mucormycosis. Twelve patients developed sustained tremors and ten had severe headaches needing tricyclic antidepressants. Ten patients had episodes of leukopenia, eight of which resolved after temporary stoppage of valganciclovir and reduced dose of mycophenolate and two patients needed Granulocyte-colony stimulating factor therapy. Conclusions: This report covers the experience of 2 years and 55 patients. Mild side effects were noted in 30 patients after heart transplant. Side effects such as diarrhea, tremors, and headache were easily treated by clinical manipulation of drugs. Overall, 14 patients had significant bacterial or fungal or viral infections. Three patients died of sepsis ( first 15 days after transplant in 2 patients and 3–6 months in another).
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TL;DR: The association of TNF-α-308A allele with metabolic risk factors such as TC, TG, and VLDL suggests that though it may not increase the development of any of the diseases considered in the present study, it could possibly enhance the risk of human metabolic disorder.
Abstract: Background and Objectives: Tumor necrosis factor-alpha (TNF-α)-238G/A and -308G/A single-nucleotide polymorphisms (SNPs) in the promoter region of the gene have been implicated in numerous diseases. The present study aims to investigate the frequency of two TNF-α polymorphisms among Mendelian population of India and to assess their association with various cardiovascular risk variables and outcomes (hypertension [HTN], metabolic syndrome [MetS], and type 2 diabetes mellitus). Materials and Methods: A total of 1142 unrelated individuals aged 35–75 years belonging to Meitei community of Manipur were included in the study. Height, weight, waist and hip circumferences, blood pressures (systolic and diastolic), and lipid profile were measured. Polymerase chain reaction was done using standard protocols. Further, HTN, MetS, diabetic, and healthy individuals were identified, and a nested case–control study design was formulated. Results: The mutant allele frequency was found to be similar (4%) for both the polymorphisms among the Meiteis of Manipur. No mutant homozygote of TNF-α-308G/A polymorphism was observed. No significant risk of the two polymorphisms was found with any of the disease groups in nested case–control analysis. However, TNF-α-308G/A polymorphism, but not TNF-α-238G/A polymorphism, was found to be associated with total cholesterol (TC), triglyceride (TG), and very-low-density lipoprotein (VLDL) in overall population only with TG and VLDL among the HTN cases. Conclusion: The association of TNF-α-308A allele with metabolic risk factors such as TC, TG, and VLDL suggests that though it may not increase the development of any of the diseases considered in the present study, it could possibly enhance the risk of human metabolic disorder. The absence of mutant homozygote among cases is suggestive of lethality of TNF-α-308A allele in double dose coupled with other environmental factors or in the presence of haplotype pairing with TNF-α-238A allele.
TL;DR: In pediatric heart failure, due to dilated cardiomyopathy,entricular-arterial coupling use as a prognostic tool has been first documented in this study, and cutoff values determining outcome, have been derived.
Abstract: Ventricular-arterial coupling, earlier used for research and experimental purposes, is being used currently for bedside patient evaluation and decision making. Its use in adults with heart failure has been proven. In pediatric heart failure, due to dilated cardiomyopathy, its use as a prognostic tool has been first documented in this study, and cutoff values determining outcome, have been derived.
TL;DR: Considering the vast information available on GPCRs and their importance in human health and diseases, the following review provides a broad outline on the mechanisms of their functional diversity.
Abstract: In metazoan organisms, communication of the constituent cells to its exterior is an essential component of tissue homeostasis and organ function. A plethora of growth factors, cytokines, hormones, regulatory small molecules, etc., interact with the cells surface receptors to initiate the signaling process that is transduced to the cell interior, regulating its functions. Over the years, thousands of such receptors have been identified and characterized. This number has substantially gone up in the postgenome era. Although the mechanisms of signal transduction by cell surface receptors is of immense interest for both clinicians and basic biologists, certain group of receptors have drawn equal attention of both the communities. One such group is the G protein-coupled receptors (GPCRs). Over the past half a century, this group of receptors has been extensively investigated, and a volume of information regarding their complexity as well as diversities has been revealed. Another interesting aspect of the GPCR study is their predominant roles in drug discovery and development. A substantial number of commonly used drugs are targeted toward the GPCR family, and several more are expected to be coming to the market in near future. Taking into consideration of the importance of these receptors, the following review summarizes certain fundamental aspects of its signaling mechanisms. Considering the vast information available on GPCRs and their importance in human health and diseases, following review provides a broad outline on the mechanisms of their functional diversity.
TL;DR: This clinical pattern is peculiarly contrasting from the usual presentation of a decompensated congestive cardiac failure, posing a diagnostic conundrum.
Abstract: Dear Editor, Platypnea–orthodeoxia represents an uncommon syndrome that can often be difficult to articulate, albeit carries plenty of information. It is characterized by positional dyspnea (platypnea) and hypoxemia (orthodeoxia) with pronounced symptomatology in the upright posture, and a tendency to resolve with recumbency. This clinical pattern is peculiarly contrasting from the usual presentation of a decompensated congestive cardiac failure, posing a diagnostic conundrum.
TL;DR: Forest plots as discussed by the authors are a graphical representation of a meta-analysis, also known as blobbogram, which allows users to view and analyze the resulting sample individual statistics from multiple similar studies all in one place, along with summary statistics at the bottom.
Abstract: When the data-based practice began to accumulate, forest plots were introduced to realize the collective power of the statistical data. It is a graphical representation of a meta-analysis, also known as blobbogram. It allows you to view and analyze the resulting sample individual statistics from multiple similar studies all in one place, along with summary statistics at the bottom. The plot includes the point value of the sample statistic as well as its confidence interval (usually taken as 95%).
TL;DR: An atypical case of a chronic painless type A AD in an elderly female, who is still surviving at 6 months follow-up without any surgical/catheter-based intervention is presented, emphasizing that chronictype A ADs have different natural history and could potentially be managed differently from the acute lesions.
Abstract: Stanford type A aortic dissection (AD) is a rapidly progressive disease associated with a very high mortality rate, especially in the absence of emergent surgical repair. However, very rarely, few cases remain undiagnosed in acute phase because of atypical or absent symptoms. We present such an atypical case of a chronic painless type A AD in an elderly female, who is still surviving at 6 months follow-up without any surgical/catheter-based intervention. This case emphasizes that chronic type A ADs have different natural history and could potentially be managed differently from the acute lesions.
TL;DR: A huge intercoronary fistula without any obstructive coronary artery disease is described and its clinical significance and future implications are unknown and subject of debate.
Abstract: Coronary artery fistulas are rare but fascinating anomalies. It is defined as an abnormal direct vascular connection from coronary artery to a cardiac chamber or major central blood vessel without an intervening capillary bed. Among all coronary fistulas, intercoronary fistula without obstructive coronary artery disease is extremely rare. Such huge intercoronary fistula without any obstructive coronary artery disease is not described previously in literature to best of our knowledge. Clinical significance and future implications of these anomalies is unknown and subject of debate.
TL;DR: A case was picked up early in a stage with active thrombosis and inflammation using magnetic resonance imaging and DOTANOC scans and treated leading to regression of inflammation and thrombus, advocating aggressive investigation of all cardiomyopathies to look for treatable causes.
Abstract: Endomyocardial fibrosis usually is an end-stage cardiomyopathy. We present a case which was picked up early in a stage with active thrombosis and inflammation using magnetic resonance imaging and DOTANOC scans and treated leading to regression of inflammation and thrombus. We advocate aggressive investigation of all cardiomyopathies to look for treatable causes.
TL;DR: These exploratory data demonstrate an increased procoagulant F-XII and fibrinolytic tPA content within intracoronary thrombi derived from patients on CVD prevention therapy compared with controls.
Abstract: Introduction: Aspirin and statin therapy are the basis of cardiovascular disease (CVD) prevention therapy. Recent data have suggested new additional preventive mechanisms: both aspirin and statin exhibit anti-inflammatory effects within intracoronary thrombi. As inflammation, aggregation, and thrombosis are closely intertwined, aspirin and subsequent statin therapy might influence the hemostatic content within intracoronary thrombi. Aim: The aim of the study is to explore the spectrum of CVD prevention therapy on intracoronary thrombus composition by analyzing main hemostasis components in patients with ST-segment elevation myocardial infarction (STEMI). Materials and Methods: We performed a cross-sectional histological pilot study with intracoronary thrombi derived from STEMI patients on CVD prevention therapy without usage of another anticoagulant agent other than aspirin. They were actively matched with intracoronary thrombi in a control group derived from STEMI patients not on any therapy – without a previous CVD history – based on thrombus age (fresh), sex, and age of the participant. Immunohistochemistry was performed with primary antibodies of factor XII (F-XII), tissue plasminogen activator (tPA), and factor VII (F-VII). Results: Four of the 13 thrombi derived from patients on CVD prevention therapy were not characterized as fresh and subsequently excluded. Moreover, one participant in the patient group had to be excluded post hoc. The thrombi in the patient group had a significantly more F-XII (27.7%) and tPA (10.1%) positive area versus the controls (17.5%; 4.5%), respectively. The F-VII-positive thrombus area was similar in both groups. Conclusion: These exploratory data demonstrate an increased procoagulant F-XII and fibrinolytic tPA content within intracoronary thrombi derived from patients on CVD prevention therapy compared with controls.
TL;DR: Some recent trials include CAPTURE study that showed benefits of carotid filter in stroke prevention, THEMIS study showed that in stable CAD patients ticagrelor plus aspirin had a lower incidence of ischemic cardiovascular events but a higher incidence of major bleeding than aspirin alone, AMBER study concluded that potassium binder patiromer enabled more patients to continue treatment with spironolactone with less hyperkalaemia.
Abstract: In continuation of previous updates this article contains some recent trials which includes CAPTURE study that showed benefits of carotid filter in stroke prevention,THEMIS study showed that in stable CAD patients ticagrelor plus aspirin had a lower incidence of ischemic cardiovascular events but a higher incidence of major bleeding than aspirin alone, AMBER study concluded that potassium binder patiromer enabled more patients to continue treatment with spironolactone with less hyperkalaemia.
TL;DR: The average satisfaction level of heart transplant recipients for the medical care they receive at AIIMS, New Delhi was 80%, and the aspects of “communication” and “time spent with the doctor” had maximum satisfaction levels at 84%.
Abstract: Background: India is a country of approximately 1.35 billion people. Heart transplant surgery is resource intensive requiring extensive efforts both on the part of the patient and the treating physician. This study was designed to assess the satisfaction level of heart transplant recipients seeking post transplant medical care at our hospital. Methods: Twenty heart transplant recipients who are in our follow up participated in this study anonymously. The quality of medical care was evaluated by using Long Form Patient Satisfaction Questionnaire III (RAND Healthcare, CA). Results: All the grouped items - general satisfaction (82.4%), technical competence (82.4%), interpersonal aspects (79.1%), communication (84%), financial aspects (76.7%), time spent with the doctor (84%) and access to care (77.3%) had similar satisfaction levels. The aspects of “communication” and “time spent with the doctor” had maximum satisfaction levels at 84%. Conclusion: The average satisfaction level of heart transplant recipients for the medical care they receive at AIIMS, New Delhi (as evaluated by the help of long form patient satisfaction questionnaire III) was 80%.
TL;DR: This is a bedside case discussion of a patient presenting with acute myocardial infarction, where the symptoms and signs, the choices at each stage, the electrocardiogram (ECG), the angiogram, and the therapeutic findings are discussed in detail.
Abstract: This is a bedside case discussion of a patient presenting with acute myocardial infarction. The symptoms and signs are discussed. The choices at each stage, the electrocardiogram (ECG), the angiogram, and the therapeutic findings are discussed in detail. The context with reference to India is also discussed. The differential diagnosis of the history of presentation is also discussed. ECG localization of myocardial infarction, management of acute coronary occlusion, and medical management of myocardial infarction are discussed.