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Senguttuvan NB, Reddy PMK, Shankar P, Abdulkader RS, Yallanki HP, Kumar A, Majmundar M, Ramalingam V, Rajendran R, Bhoopalan K, Kaliyamoorthy D, T. R. M, Kalra A, Jayaraj R, Ramakrishnan S, Daggubati R, Thanikachalam S, Seth A, Bahl VK. Trans-radial approach versus trans-femoral approach in patients with acute coronary syndrome undergoing percutaneous coronary intervention: An updated meta-analysis of randomized controlled trials. PLoS One 2022; 17:e0266709. [PMID: 35483028 PMCID: PMC9050011 DOI: 10.1371/journal.pone.0266709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/25/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Trans-radial approach (TRA) is recommended over trans-femoral approach (TFA) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). We intended to study the effect of access on all-cause mortality. Methods and results We searched PubMed and EMBASE for randomized studies on patients with ACS undergoing PCI. The primary outcome was all-cause mortality at 30-days. The secondary outcomes included in-hospital mortality, major adverse cardiac or cerebrovascular event (MACE) as defined by the study, net adverse clinical event (NACE), non-fatal myocardial infarction, non-fatal stroke, stent thrombosis, study-defined major bleeding, and minor bleeding, vascular complications, hematoma, pseudoaneurysm, non-access site bleeding, need for transfusion, access site cross-over, contrast volume, procedure duration, and hospital stay duration. We studied 20,122 ACS patients, including 10,037 and 10,085 patients undergoing trans-radial and trans-femoral approaches, respectively. We found mortality benefit in patients with ACS for the trans-radial approach [(1.7% vs. 2.3%; RR: 0.75; 95% CI: 0.62–0.91; P = 0.004; I2 = 0%). Out of 10,465 patients with STEMI, 5,189 patients had TRA and 5,276 had TFA procedures. A similar benefit was observed in patients with STEMI alone [(2.3% vs. 3.3%; RR: 0.71; 95% CI: 0.56–0.90; P = 0.004; I2 = 0%). We observed reduced MACE, NACE, major bleeding, vascular complications, and pseudoaneurysms. No difference in re-infarction, stroke, and serious bleeding requiring blood transfusions were noted. We noticed a small decrease in contrast volume(ml) {mean difference (95% CI): −4.6 [−8.5 to −0.7]}, small but significantly increase in procedural time {mean difference (95% CI) 1.2 [0.1 to 2.3]}and fluoroscopy time {mean difference (95% CI) 0.8 [0.3 to1.4] min} in the trans-radial group. Conclusion TRA has significantly reduced 30-day all-cause mortality among patients undergoing PCI for ACS. TRA should be the preferred vascular access in patients with ACS.
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Affiliation(s)
- Nagendra Boopathy Senguttuvan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
- Adjunct Faculty, Department of Engineering and design, Indian Institute of Technology-Madras, Chennai, India
- * E-mail:
| | - Pothireddy M. K. Reddy
- Department of Medicine, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
| | - PunatiHari Shankar
- Department of Medicine, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
| | | | - Hanumath Prasad Yallanki
- Department of Medicine, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
| | - Ashish Kumar
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, Ohio
| | - Monil Majmundar
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, Ohio
- Department of Internal Medicine, New York Medical College, Metropolitan Hospital, New York, New York, United States of America
| | - Vadivelu Ramalingam
- Department of Cardiology, Velammal Medical College and Hospital, Madurai, India
| | | | | | | | - Muralidharan T. R.
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
| | - Ankur Kalra
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, Ohio
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Ramesh Daggubati
- Department of Cardiovascular Medicine, WVU Heart and Vascular Institute, Morgantown, India
| | - Sadagopan Thanikachalam
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
| | - Ashok Seth
- Department of Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Vinay Kumar Bahl
- Department of Cardiovascular Medicine, WVU Heart and Vascular Institute, Morgantown, India
- Department of Cardiology, Max- Super-speciality Hospitals, New Delhi, India
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2
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Kerkar PG, Naik N, Alexander T, Bahl VK, Chakraborty RN, Chatterjee SS, Chopra HK, Dani SI, Deb PK, Goswami KC, Guha S, Gupta R, Gupta V, Hasija PK, Jayagopal PB, Justin Paul G, Kahali D, Katyal VK, Khanna NN, Mandal M, Mishra SS, Mohanan PP, Mullasari A, Mehta S, Pancholia AK, Ray S, Roy D, Shanmugasundarm S, Sharma S, Singh BP, Tewari S, Tyagi SK, Venugopal KN, Wander GS, Yadav R, Das MK. Cardiological Society of India: Document on acute MI care during COVID-19. Indian Heart J 2020; 72:70-74. [PMID: 32534693 PMCID: PMC7201231 DOI: 10.1016/j.ihj.2020.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022] Open
Abstract
The unprecedented and rapidly spreading Coronavirus Disease-19 (COVID-19) pandemic has challenged public health care systems globally. Based on worldwide experience, India has initiated a nationwide lockdown to prevent the exponential surge of cases. During COVID-19, management of cardiovascular emergencies like acute Myocardial Infarction (MI) may be compromised. Cardiological Society of India (CSI) has ventured in this moment of crisis to evolve a consensus document for care of acute MI. However, this care should be individualized, based on local expertise and governmental advisories.
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Affiliation(s)
- P G Kerkar
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - N Naik
- All India Institute of Medical Sciences, New Delhi, India
| | - T Alexander
- Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - V K Bahl
- All India Institute of Medical Sciences, New Delhi, India
| | - R N Chakraborty
- Medica Group of Superspeciality Hospitals, Kolkata, West Bengal, India
| | - S S Chatterjee
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | | | - S I Dani
- Apollo Hospital, Ahmedabad, Gujarat, India
| | - P K Deb
- Daffodil Hospital, Kolkata, West Bengal, India
| | - K C Goswami
- All India Institute of Medical Sciences, New Delhi, India
| | - S Guha
- Calcutta Medical College Hospital, Kolkata, West Bengal, India
| | - R Gupta
- JROP Healthcare, New Delhi, India
| | - V Gupta
- Kishori Ram Hospital & Diabetes Care Centre, India
| | - P K Hasija
- Armed Forces Medical College, Pune, Maharashtra, India
| | | | | | - D Kahali
- BM Birla Heart Research Center, Kolkata, West Bengal, India
| | - V K Katyal
- Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - N N Khanna
- Indraprastha Apollo Hospital, New Delhi, India
| | - M Mandal
- NRS Medical College and Hospital, Kolkata, West Bengal, India
| | - S S Mishra
- Hi-Tech Medical College and Hospital, Bhubaneshwar, Odisha, India
| | - P P Mohanan
- Westfort Hi-Tech Hospital, Thrissur, Kerala, India
| | - A Mullasari
- Madras Medical Mission Hospital, Chennai, Tamil Nadu, India
| | - S Mehta
- University of Miami, Florida, USA
| | | | - S Ray
- Vivekanand Institute of Medical Sciences, Kolkata, West Bengal, India
| | - D Roy
- Rabindranath Tagore International Institute of Medical Sciences, Kolkata, West Bengal, India
| | | | | | - B P Singh
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - S Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | - K N Venugopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - G S Wander
- Dayanand Medical College, Ludhiana, Punjab, India
| | - R Yadav
- All India Institute of Medical Sciences, New Delhi, India
| | - M K Das
- C K Birla Group of Hospitals (BMB and CMRI), Kolkata, West Bengal, India.
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3
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Bansal R, Parakh N, Gupta A, Juneja R, Naik N, Yadav R, Sharma G, Roy A, Verma SK, Bahl VK. Incidence and predictors of pacemaker-induced cardiomyopathy with comparison between apical and non-apical right ventricular pacing sites. J Interv Card Electrophysiol 2019; 56:63-70. [PMID: 31363943 DOI: 10.1007/s10840-019-00602-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/22/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Asynchronous activation of left ventricle (LV) due to chronic right ventricular (RV) pacing has been known to predispose to LV dysfunction. The predictors of LV dysfunction remain to be prospectively studied. This study was designed to follow up patients with RV pacing to look for development of pacing-induced cardiomyopathy (PiCMP), identify its predictors and draw comparison between apical vs non-apical RV pacing sites. METHODS Three hundred sixty-three patients undergoing dual-chamber and single-chamber ventricular implants were enrolled and followed up. Baseline clinical parameters; paced QRS duration and axis; RV lead position by fluoroscopy; LV ejection fraction (LVEF) by Simpson's method on transthoracic echocardiography (TTE); intraventricular dyssynchrony (septal-posterior wall contraction delay) and interventricular dyssynchrony (aortopulmonary ejection delay) on TTE were recorded. The patients were followed up at 6-12 monthly interval with estimation of LVEF and pacemaker interrogation at each visit. Pacemaker-induced cardiomyopathy (PiCMP) was defined as a fall in ejection fraction of 10% as compared to the baseline LVEF. Patients developing PiCMP were compared to other patients to identify predictors. RESULTS The mean age of study population was 59.8 years, 68.3% being males. Fifty-one percent and 49% patients underwent VVIR and DDDR pacemaker implantation, respectively. After attrition, 254 patients were analysed. PiCMP developed in 35 patients (13.8%) over a mean follow-up of 14.5 months. After multivariate analysis, burden of ventricular pacing > 60% [HR 4.26, p = 0.004] and interventricular dyssynchrony (aortopulmonary ejection delay > 40 msec) [HR 3.15, p = 0.002] were identified as predictors for PiCMP in patients undergoing chronic RV pacing. There was no effect of RV pacing site (apical vs non-apical) on incidence of PiCMP [HR 1.44, p = 0.353). CONCLUSIONS Incidence of PiCMP with RV pacing was found to be 13.8% over a mean follow-up of 14.5 months. Burden of right ventricular pacing and interventricular dyssynchrony were identified as the most important predictors for the development of PiCMP. Non-apical RV pacing site did not offer any benefit in terms of incidence of PiCMP over apical lead position.
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Affiliation(s)
- Raghav Bansal
- Department of Cardiology, All India Institute of Medical Sciences, 7th Floor, Cardiothoracic Sciences Centre, New Delhi, 110029, India
| | - Neeraj Parakh
- Department of Cardiology, All India Institute of Medical Sciences, 7th Floor, Cardiothoracic Sciences Centre, New Delhi, 110029, India.
| | - Anunay Gupta
- Department of Cardiology, All India Institute of Medical Sciences, 7th Floor, Cardiothoracic Sciences Centre, New Delhi, 110029, India
| | - Rajnish Juneja
- Department of Cardiology, All India Institute of Medical Sciences, 7th Floor, Cardiothoracic Sciences Centre, New Delhi, 110029, India
| | - Nitish Naik
- Department of Cardiology, All India Institute of Medical Sciences, 7th Floor, Cardiothoracic Sciences Centre, New Delhi, 110029, India
| | - Rakesh Yadav
- Department of Cardiology, All India Institute of Medical Sciences, 7th Floor, Cardiothoracic Sciences Centre, New Delhi, 110029, India
| | - Gautam Sharma
- Department of Cardiology, All India Institute of Medical Sciences, 7th Floor, Cardiothoracic Sciences Centre, New Delhi, 110029, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, 7th Floor, Cardiothoracic Sciences Centre, New Delhi, 110029, India
| | - Sunil Kumar Verma
- Department of Cardiology, All India Institute of Medical Sciences, 7th Floor, Cardiothoracic Sciences Centre, New Delhi, 110029, India
| | - Vinay Kumar Bahl
- Department of Cardiology, All India Institute of Medical Sciences, 7th Floor, Cardiothoracic Sciences Centre, New Delhi, 110029, India
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4
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Guha S, Harikrishnan S, Ray S, Sethi R, Ramakrishnan S, Banerjee S, Bahl VK, Goswami KC, Banerjee AK, Shanmugasundaram S, Kerkar PG, Seth S, Yadav R, Kapoor A, Mahajan AU, Mohanan PP, Mishra S, Deb PK, Narasimhan C, Pancholia AK, Sinha A, Pradhan A, Alagesan R, Roy A, Vora A, Saxena A, Dasbiswas A, Srinivas BC, Chattopadhyay BP, Singh BP, Balachandar J, Balakrishnan KR, Pinto B, Manjunath CN, Lanjewar CP, Jain D, Sarma D, Paul GJ, Zachariah GA, Chopra HK, Vijayalakshmi IB, Tharakan JA, Dalal JJ, Sawhney JPS, Saha J, Christopher J, Talwar KK, Chandra KS, Venugopal K, Ganguly K, Hiremath MS, Hot M, Das MK, Bardolui N, Deshpande NV, Yadava OP, Bhardwaj P, Vishwakarma P, Rajput RK, Gupta R, Somasundaram S, Routray SN, Iyengar SS, Sanjay G, Tewari S, Sengottuvelu G, Kumar S, Mookerjee S, Nair T, Mishra T, Samal UC, Kaul U, Chopra VK, Narain VS, Raj V, Lokhandwala Y. Corrigendum to "Cardiological Society of India position statement on management of heart failure in India" [Indian Heart J 70 (S1) (2018) S1-S72]. Indian Heart J 2018; 70:952-953. [PMID: 30580876 PMCID: PMC6306345 DOI: 10.1016/j.ihj.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Santanu Guha
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | - S Harikrishnan
- Chief Coordinator, CSI HF Position Statement; Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India.
| | - Saumitra Ray
- Convenor, CSI Guidelines Committee; Vivekananda Institute of Medical Sciences, Kolkata, India
| | - Rishi Sethi
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow, India
| | - S Ramakrishnan
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Suvro Banerjee
- Joint Convenor, CSI Guidelines Committee; Apollo Hospitals, Kolkata, India
| | - V K Bahl
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - K C Goswami
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Amal Kumar Banerjee
- Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal, India
| | - S Shanmugasundaram
- Department of Cardiology, Tamil Nadu Medical University, Billroth Hospital, Chennai, Tamil Nadu, India
| | | | - Sandeep Seth
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Yadav
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, Uttar Pradesh, India
| | - Ajaykumar U Mahajan
- Department of Cardiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - P P Mohanan
- Department of Cardiology, Westfort Hi Tech Hospital, Thrissur, Kerala, India
| | - Sundeep Mishra
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - P K Deb
- Daffodil Hospitals, Kolkata, West Bengal, India
| | - C Narasimhan
- Department of Cardiology & Chief of Electro Physiology Department, Care Hospitals, Hyderabad, Telangana, India
| | - A K Pancholia
- Clinical & Preventive Cardiology, Arihant Hospital & Research Centre, Indore, Madhya Pradesh, India
| | | | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - R Alagesan
- The Tamil Nadu Dr.M.G.R. Medical University, Tamil Nadu, India
| | - Ambuj Roy
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Amit Vora
- Arrhythmia Associates, Mumbai, Maharashtra, India
| | - Anita Saxena
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - B P Singh
- Department of Cardiology, IGIMS, Patna, Bihar, India
| | | | - K R Balakrishnan
- Cardiac Sciences, Fortis Malar Hospital, Adyar, Chennai, Tamil Nadu, India
| | - Brian Pinto
- Holy Family Hospitals, Mumbai, Maharashtra, India
| | - C N Manjunath
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | | | - Dharmendra Jain
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Dipak Sarma
- Cardiology & Critical Care, Jorhat Christian Medical Centre Hospital, Jorhat, Assam, India
| | - G Justin Paul
- Department of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
| | | | | | - I B Vijayalakshmi
- Bengaluru Medical College and Research Institute, Bengaluru, Karnataka, India
| | - J A Tharakan
- Department of Cardiology, P.K. Das Institute of Medical Sciences, Vaniamkulam, Palakkad, Kerala, India
| | - J J Dalal
- Kokilaben Hospital, Mumbai, Maharashtra, India
| | - J P S Sawhney
- Department of Cardiology, Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
| | - Jayanta Saha
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | | | - K K Talwar
- Max Healthcare, Max Super Speciality Hospital, Saket, New Delhi, India
| | - K Sarat Chandra
- Indo-US Super Speciality Hospital & Virinchi Hospital, Hyderabad, Telangana, India
| | - K Venugopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - Kajal Ganguly
- Department of Cardiology, N.R.S. Medical College, Kolkata, West Bengal, India
| | | | - Milind Hot
- Department of CTVS, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mrinal Kanti Das
- B.M. Birla Heart Research Centre & CMRI, Kolkata, West Bengal, India
| | - Neil Bardolui
- Department of Cardiology, Excelcare Hospitals, Guwahati, Assam, India
| | - Niteen V Deshpande
- Cardiac Cath Lab, Spandan Heart Institute and Research Center, Nagpur, Maharashtra, India
| | - O P Yadava
- National Heart Institute, New Delhi, India
| | - Prashant Bhardwaj
- Department of Cardiology, Military Hospital (Cardio Thoracic Centre), Pune, Maharashtra, India
| | - Pravesh Vishwakarma
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow, India
| | | | - Rakesh Gupta
- JROP Institute of Echocardiography, New Delhi, India
| | | | - S N Routray
- Department of Cardiology, SCB Medical College, Cuttack, Odisha, India
| | - S S Iyengar
- Manipal Hospitals, Bangalore, Karnataka, India
| | - G Sanjay
- Chief Coordinator, CSI HF Position Statement; Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - Satyendra Tewari
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, Uttar Pradesh, India
| | | | - Soumitra Kumar
- Convenor, CSI Guidelines Committee; Vivekananda Institute of Medical Sciences, Kolkata, India
| | - Soura Mookerjee
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | - Tiny Nair
- Department of Cardiology, P.R.S. Hospital, Trivandrum, Kerala, India
| | - Trinath Mishra
- Department of Cardiology, M.K.C.G. Medical College, Behrampur, Odisha, India
| | | | - U Kaul
- Batra Heart Center & Batra Hospital and Medical Research Center, New Delhi, India
| | - V K Chopra
- Heart Failure Programme, Department of Cardiology, Medanta Medicity, Gurugram, Haryana, India
| | - V S Narain
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow, India
| | - Vimal Raj
- Narayana Hrudayalaya Hospital, Bangalore, Karnataka, India
| | - Yash Lokhandwala
- Mumbai & Visiting Faculty, Sion Hospital, Mumbai, Maharashtra, India
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5
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Deepti S, Roy A, Patel CD, Tandon N, Naik N, Singh S, Sharma G, Bahl VK. Assessment of asymptomatic ischemic heart disease using stress myocardial perfusion imaging in patients with type 2 diabetes mellitus. Indian Heart J 2018; 70 Suppl 3:S157-S160. [PMID: 30595249 PMCID: PMC6310734 DOI: 10.1016/j.ihj.2018.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/15/2018] [Accepted: 08/30/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is the leading cause of death in patients with type 2 diabetes mellitus (T2DM) and may be asymptomatic. OBJECTIVE The objective of this study was to assess the prevalence of asymptomatic myocardial ischemia in patients with T2DM using stress myocardial perfusion imaging. METHODS We evaluated 97 consecutive patients with T2DM without clinical evidence of CAD presenting to Cardiology and Endocrinology clinics using Tc-99m MIBI gated single-photon emission-computed tomography (SPECT) myocardial perfusion imaging for the presence of asymptomatic CAD. RESULTS Abnormal myocardial perfusion was observed in 10 patients (10.3%). Of these, one half of patients had reversible myocardial perfusion defects suggestive of inducible myocardial ischemia. The other half had fixed perfusion defects suggestive of previous silent myocardial infarctions. Small and moderate reversible perfusion defects were observed in 3 and 2 patients, respectively. The fixed perfusion defects observed in 5 patients were medium sized. The presence of asymptomatic ischemia was significantly associated with age and smoking but not with other traditional cardiac risk factors. CONCLUSION Ten percent of patients with T2DM with no clinical evidence of CAD were found to have evidence of asymptomatic ischemia or infarction.
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Affiliation(s)
- Siddharthan Deepti
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Chetan D Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Nitish Naik
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Singh
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Gautam Sharma
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Kumar Bahl
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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6
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Guha S, Harikrishnan S, Ray S, Sethi R, Ramakrishnan S, Banerjee S, Bahl VK, Goswami KC, Banerjee AK, Shanmugasundaram S, Kerkar PG, Seth S, Yadav R, Kapoor A, Mahajan AU, Mohanan PP, Mishra S, Deb PK, Narasimhan C, Pancholia AK, Sinha A, Pradhan A, Alagesan R, Roy A, Vora A, Saxena A, Dasbiswas A, Srinivas BC, Chattopadhyay BP, Singh BP, Balachandar J, Balakrishnan KR, Pinto B, Manjunath CN, Lanjewar CP, Jain D, Sarma D, Paul GJ, Zachariah GA, Chopra HK, Vijayalakshmi IB, Tharakan JA, Dalal JJ, Sawhney JPS, Saha J, Christopher J, Talwar KK, Chandra KS, Venugopal K, Ganguly K, Hiremath MS, Hot M, Das MK, Bardolui N, Deshpande NV, Yadava OP, Bhardwaj P, Vishwakarma P, Rajput RK, Gupta R, Somasundaram S, Routray SN, Iyengar SS, Sanjay G, Tewari S, G S, Kumar S, Mookerjee S, Nair T, Mishra T, Samal UC, Kaul U, Chopra VK, Narain VS, Raj V, Lokhandwala Y. CSI position statement on management of heart failure in India. Indian Heart J 2018; 70 Suppl 1:S1-S72. [PMID: 30122238 PMCID: PMC6097178 DOI: 10.1016/j.ihj.2018.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Santanu Guha
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | - S Harikrishnan
- Chief Coordinator, CSI HF Position Statement; Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India.
| | - Saumitra Ray
- Convenor, CSI Guidelines Committee; Vivekananda Institute of Medical Sciences, Kolkata
| | - Rishi Sethi
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow
| | - S Ramakrishnan
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Suvro Banerjee
- Joint Convenor, CSI Guidelines Committee; Apollo Hospitals, Kolkata
| | - V K Bahl
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - K C Goswami
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Amal Kumar Banerjee
- Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal, India
| | - S Shanmugasundaram
- Department of Cardiology, Tamil Nadu Medical University, Billroth Hospital, Chennai, Tamil Nadu, India
| | | | - Sandeep Seth
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Yadav
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, Uttar Pradesh, India
| | - Ajaykumar U Mahajan
- Department of Cardiology, LokmanyaTilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - P P Mohanan
- Department of Cardiology, Westfort Hi Tech Hospital, Thrissur, Kerala, India
| | - Sundeep Mishra
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - P K Deb
- Daffodil Hospitals, Kolkata, West Bengal, India
| | - C Narasimhan
- Department of Cardiology & Chief of Electro Physiology Department, Care Hospitals, Hyderabad, Telangana, India
| | - A K Pancholia
- Clinical & Preventive Cardiology, Arihant Hospital & Research Centre, Indore, Madhya Pradesh, India
| | | | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - R Alagesan
- The Tamil Nadu Dr.M.G.R. Medical University, Tamil Nadu, India
| | - Ambuj Roy
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | - Amit Vora
- Arrhythmia Associates, Mumbai, Maharashtra, India
| | - Anita Saxena
- Joint Coordinator, CSI HF Position Statement; All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - B P Singh
- Department of Cardiology, IGIMS, Patna, Bihar, India
| | | | - K R Balakrishnan
- Cardiac Sciences, Fortis Malar Hospital, Adyar, Chennai, Tamil Nadu, India
| | - Brian Pinto
- Holy Family Hospitals, Mumbai, Maharashtra, India
| | - C N Manjunath
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | | | - Dharmendra Jain
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Dipak Sarma
- Cardiology & Critical Care, Jorhat Christian Medical Centre Hospital, Jorhat, Assam, India
| | - G Justin Paul
- Department of Cardiology, Madras Medical College, Chennai, Tamil Nadu, India
| | | | | | - I B Vijayalakshmi
- Bengaluru Medical College and Research Institute, Bengaluru, Karnataka, India
| | - J A Tharakan
- Department of Cardiology, P.K. Das Institute of Medical Sciences, Vaniamkulam, Palakkad, Kerala, India
| | - J J Dalal
- Kokilaben Hospital, Mumbai, Maharshtra, India
| | - J P S Sawhney
- Department of Cardiology, Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
| | - Jayanta Saha
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | | | - K K Talwar
- Max Healthcare, Max Super Speciality Hospital, Saket, New Delhi, India
| | - K Sarat Chandra
- Indo-US Super Speciality Hospital & Virinchi Hospital, Hyderabad, Telangana, India
| | - K Venugopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - Kajal Ganguly
- Department of Cardiology, N.R.S. Medical College, Kolkata, West Bengal, India
| | | | - Milind Hot
- Department of CTVS, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mrinal Kanti Das
- B.M. Birla Heart Research Centre & CMRI, Kolkata, West Bengal, India
| | - Neil Bardolui
- Department of Cardiology, Excelcare Hospitals, Guwahati, Assam, India
| | - Niteen V Deshpande
- Cardiac Cath Lab, Spandan Heart Institute and Research Center, Nagpur, Maharashtra, India
| | - O P Yadava
- National Heart Institute, New Delhi, India
| | - Prashant Bhardwaj
- Department of Cardiology, Military Hospital (Cardio Thoracic Centre), Pune, Maharashtra, India
| | - Pravesh Vishwakarma
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow
| | | | - Rakesh Gupta
- JROP Institute of Echocardiography, New Delhi, India
| | | | - S N Routray
- Department of Cardiology, SCB Medical College, Cuttack, Odisha, India
| | - S S Iyengar
- Manipal Hospitals, Bangalore, Karnataka, India
| | - G Sanjay
- Chief Coordinator, CSI HF Position Statement; Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - Satyendra Tewari
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, Uttar Pradesh, India
| | | | - Soumitra Kumar
- Convenor, CSI Guidelines Committee; Vivekananda Institute of Medical Sciences, Kolkata
| | - Soura Mookerjee
- Chairman, CSI Guidelines Committee; Medical College Kolkata, India
| | - Tiny Nair
- Department of Cardiology, P.R.S. Hospital, Trivandrum, Kerala, India
| | - Trinath Mishra
- Department of Cardiology, M.K.C.G. Medical College, Behrampur, Odisha, India
| | | | - U Kaul
- Batra Heart Center & Batra Hospital and Medical Research Center, New Delhi, India
| | - V K Chopra
- Heart Failure Programme, Department of Cardiology, Medanta Medicity, Gurugram, Haryana, India
| | - V S Narain
- Joint Coordinator, CSI HF Position Statement; KG Medical University, Lucknow
| | - Vimal Raj
- Narayana Hrudayalaya Hospital, Bangalore, Karnataka, India
| | - Yash Lokhandwala
- Mumbai & Visiting Faculty, Sion Hospital, Mumbai, Maharashtra, India
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Gupta A, Verma SK, Sharma R, Parakh N, Ramakrishnan S, Roy A, Singh S, Sharma G, Karthikeyan G, Naik N, Yadav R, Mishra S, Seth S, Narang R, Goswami KC, Bhargava B, Bahl VK. Clinical and angiographic profiles and six months outcomes of smokers with acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary angioplasty. Indian Heart J 2018; 70:680-684. [PMID: 30392506 PMCID: PMC6205248 DOI: 10.1016/j.ihj.2018.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 01/15/2018] [Accepted: 02/28/2018] [Indexed: 12/05/2022] Open
Abstract
Background Outcomes of primary percutaneous coronary intervention (PCI) for acute STEMI (ST-segment elevation myocardial infarction) in smokers are expected to be better than non-smokers as for patients of acute STEMI with or without fibrinolytic therapy. Objectives This comparative study was designed to evaluate the outcomes of primary PCI in patients with acute STEMI in smokers and non-smokers. Clinical and angiographic profile of the two groups was also compared. Methods Over duration of two year, a total of 150 consecutive patients of acute STEMI eligible for primary PCI were enrolled and constituted the two groups [Smokers (n = 90), Non-smokers (n = 60)] of the study population. There was no difference in procedure in two groups. Results In the present study of acute STEMI, current smokers were about a decade younger than non-smokers (p value = 0.0002), majority were male (98.9% vs 56.6%) were male with a higher prevalence of hypertension and diabetes mellitus (61.67% vs 32.28% and 46.67% vs 14.44%, p = 0.001) respectively. Smokers tended to have higher thrombus burden (p = 0.06) but less multi vessel disease (p = 0.028). Thirty day and six month mortality was non-significantly higher in smokers 4.66% vs 1.33% (p = 0.261) and 5.33% vs 2.66% (p = NS) respectively. Rate of quitting smoking among smokers was 80.90% at 6 months. Conclusion The study documents that smokers with acute STEMI have similar outcomes as compared to non smokers with higher thrombus burden and lesser non culprit artery involvement. Smokers present at much younger age emphasizing the role of smoking cessation for prevention of myocardial infarction.
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Affiliation(s)
- A Gupta
- Senior Resident, Department of cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S K Verma
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - R Sharma
- Senior Resident, Department of cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - N Parakh
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S Ramakrishnan
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - A Roy
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S Singh
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - G Sharma
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - G Karthikeyan
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - N Naik
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - R Yadav
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S Mishra
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - S Seth
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - R Narang
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - K C Goswami
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - B Bhargava
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - V K Bahl
- 7th Floor, Department of Cardiology, CTC, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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8
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Mishra S, Mohan JC, Nair T, Chopra VK, Harikrishnan S, Guha S, Ramakrishnan S, Ray S, Sethi R, Samal UC, Sarat Chandra K, Hiremath MS, Banerjee AK, Kumar S, Das MK, Deb PK, Bahl VK. Management protocols for chronic heart failure in India. Indian Heart J 2018; 70:105-127. [PMID: 29455764 PMCID: PMC5903070 DOI: 10.1016/j.ihj.2017.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Heart failure is a common clinical syndrome and a global health priority. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. Heart failure not only increases the risk of mortality, morbidity and worsens the patient's quality of life, but also puts a huge burden on the overall healthcare system. The management of heart failure has evolved over the years with the advent of new drugs and devices. This document has been developed with an objective to provide standard management guidance and simple heart failure algorithms to aid Indian clinicians in their daily practice. It would also inform the clinicians on the latest evidence in heart failure and provide guidance to recognize and diagnose chronic heart failure early and optimize management.
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Affiliation(s)
- S Mishra
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - J C Mohan
- Department of Cardiology, Fortis Hospital, Shalimar Bagh, New Delhi, 110088, India
| | - Tiny Nair
- Department of Cardiology, PRS Hospital, Thiruvananthapuram, 695002, India
| | - V K Chopra
- Department of Clinical and Preventive Cardiology, Medanta - The Medicity, Gurugram, Haryana, 122001, India
| | - S Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 695011, India
| | - S Guha
- Department of Cardiology, Medical College, Kolkata, 700073, India
| | - S Ramakrishnan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - S Ray
- Department of Cardiology, Vivekananda Institute of Medical Sciences, Kolkata, 70026, India
| | - R Sethi
- Department of Cardiology, King George's Medical University, Ludhiana, Uttar Pradesh, 226003, India
| | - U C Samal
- Heart Failure Subspecialty, Cardiological Society of India, Kolkata, India
| | - K Sarat Chandra
- Department of Cardiology, Institute of Post Graduate Medical Education & Research and Memorial Hospital, Kolkata, 700020, India
| | - M S Hiremath
- Department of Cardiology, Ruby Hall Clinic, Pune, 411001, India
| | - A K Banerjee
- Department of Cardiology, Institute of Post Graduate Medical Education & Research and Memorial Hospital, Kolkata, 700020, India
| | - S Kumar
- Cardiological Society of India, Kolkata, India
| | - M K Das
- Cardiological Society of India, Kolkata, India
| | - P K Deb
- Cardiological Society of India, Kolkata, India
| | - V K Bahl
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India
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Seth A, Chandra P, Bahl VK, Nanjappa MC, Chandra Rath P, Kalarickal MS, Wander GS, Mishra A, Mahajan AU, Mahajan AU, Velaparambil Kumaran AK, Koshy AG, Goel PK, Ganeshwala G, Kumar V, Kaul U, Kumar V. CRT-700.01 Favourable Outcomes for Systemic Pharmacokinetic Study of Sirolimus-Eluting BioResorbable Vascular Scaffold System in Treating de novo Native Coronary Artery Lesion: A Sub Study of MeRes-1 Trial. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2016.12.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Varghese MJ, Sharma G, Shukla G, Seth S, Mishra S, Gupta A, Bahl VK. Longitudinal ventricular systolic dysfunction in patients with very severe obstructive sleep apnea: A case control study using speckle tracking imaging. Indian Heart J 2016. [PMID: 28648418 PMCID: PMC5485386 DOI: 10.1016/j.ihj.2016.12.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective Obstructive sleep apnea (OSA) is a prevalent condition that is increasingly recognized to be associated with cardiovascular disease. We aimed to investigate the subclinical systolic ventricular dysfunction of patients with OSA using novel speckle tracking echocardiographic (STE) techniques. Methods This study included 31 patients of polysomnography proven very severe OSA [Apnea Hypopnea Index(AHI) >40] and an equal number of matched population with no OSA as controls. All the study participants underwent a detailed conventional and tissue Doppler strain echocardiogram in addition to STE. Results There was no significant difference in conventional ventricular systolic function parameters including left ventricular (LV) ejection fraction, and myocardial performance index of left ventricle. Diastolic function was significantly reduced in patients with OSA as compared to controls. There was no difference in global circumferential strain or time to its peak between the two groups. However global longitudinal LV strain (GLS) was significantly reduced in patients with OSA (p < 0.01). Similarly time to peak longitudinal strain was prolonged in the OSA group as compared to controls. Segmental analysis revealed that the longitudinal strain abnormalities were more pronounced in the apical and mid segments of LV. AHI remained the only significant predictor of GLS in these patients. Conclusion Very severe OSA is associated with significant diastolic dysfunction as well as early systolic abnormalities as evidenced by abnormal global longitudinal strain. Sleep apnea severity as measured by AHI was the only significant predictor of abnormal longitudinal strain in these patients.
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Affiliation(s)
| | - Gautam Sharma
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Garima Shukla
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Seth
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sundeep Mishra
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anupama Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Kumar Bahl
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Sharma G, Shetkar S, Bhasin A, Ramakrishnan L, Juneja R, Naik N, Roy A, Ramakrishnan S, Bhargava B, Bahl VK. High sensitive C-reactive protein and interleukin 6 in atrial fibrillation with rheumatic mitral stenosis from Indian cohort. Indian Heart J 2016; 69:505-511. [PMID: 28822519 PMCID: PMC5560862 DOI: 10.1016/j.ihj.2016.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 11/26/2016] [Accepted: 12/12/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction Presence of chronic low grade inflammation has often been implicated in the etiology of atrial fibrillation (AF). Whether pre-existing inflammatory state promotes AF or initiation of AF activates inflammation is a dilemma among clinicians. This study investigates the role of high sensitive C reactive protein (hs-CRP) and interleukin 6 (IL-6) in AF with rheumatic mitral stenosis (Rh-MS) as markers of chronic inflammation. Methods This case control cohort included sixty five (n = 65) Rh-MS patients having other valve lesions as trivial to mild. Out of them twenty nine (n = 29; group C) had baseline AF and rest were normal sinus rhythm (NSR). A 24 h holter recording was done in NSR patients to diagnose paroxysmal AF/tachyarrhythmia forming group B (n = 12) and not having any tachyarrhythmia were designated as NSR; group A (n = 24). Results hs-CRP and IL6 showed statistically significant increase in group C (permanent AF) compared to group A (95% CI: 4.2–0.9, p = 0.007; 95% CI: 1.2–0.89; p = 0.05 respectively), while it was non significant between group A and group B (p > 0.05). A weak positive correlation was observed with hs-CRP and left atrial volume index (LAVi) (r = 0.45, p = 0.06) in AF group as compared to NSR group. 68.2% of patients in AF group (27/41) had moderate to severe spontaneous echo contrast (SEC) as compared to 37.5% (10/24) in NSR group. Conclusion Increased hs-CRP and IL-6 levels in the paroxysmal and permanent AF group may favour the hypothesis that low grade chronic inflammation could be the cause of atrial fibrillation than a consequence.
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Affiliation(s)
- Gautam Sharma
- Department of Cardiology, Room No 12, 8th floor, All India Institute of Medical Sciences, New Delhi, India.
| | - Sudhir Shetkar
- Department of Cardiology, Apollo Group of Hospitals, Nashik, India.
| | - Ashu Bhasin
- Department of Neurology, All India Institute of Medical Sciences, Room No 708, New Delhi, India.
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, Room No 61 Ground Floor, New Delhi, India.
| | - Rajnish Juneja
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Nitish Naik
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | | | - Balram Bhargava
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Vinay Kumar Bahl
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
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12
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Mishra S, Ray S, Dalal JJ, Sawhney JPS, Ramakrishnan S, Nair T, Iyengar SS, Bahl VK. Management standards for stable coronary artery disease in India. Indian Heart J 2016; 68 Suppl 3:S31-S49. [PMID: 28038722 PMCID: PMC5198886 DOI: 10.1016/j.ihj.2016.11.320] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Coronary artery disease (CAD) is one of the important causes of cardiovascular morbidity and mortality globally, giving rise to more than 7 million deaths annually. An increasing burden of CAD in India is a major cause of concern with angina being the leading manifestation. Stable coronary artery disease (SCAD) is characterised by episodes of transient central chest pain (angina pectoris), often triggered by exercise, emotion or other forms of stress, generally triggered by a reversible mismatch between myocardial oxygen demand and supply resulting in myocardial ischemia or hypoxia. A stabilised, frequently asymptomatic phase following an acute coronary syndrome (ACS) is also classified as SCAD. This definition of SCAD also encompasses vasospastic and microvascular angina under the common umbrella.
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Affiliation(s)
- Sundeep Mishra
- Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
| | | | | | - J P S Sawhney
- Department of Cardiology, Sir Ganga Ram Hospital, New Delhi, India
| | - S Ramakrishnan
- Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | | | | | - V K Bahl
- Department of Cardiology, AIIMS, New Delhi, India
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13
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Dubey G, Verma SK, Bahl VK. Primary percutaneous coronary intervention for acute ST elevation myocardial infarction: Outcomes and determinants of outcomes: A tertiary care center study from North India. Indian Heart J 2016. [PMID: 28648416 PMCID: PMC5485382 DOI: 10.1016/j.ihj.2016.11.322] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Primary percutaneous coronary intervention (PCI) is the current standard of care for acute ST elevation myocardial infarction (STEMI). Most of the data on primary PCI in acute STEMI is from western countries. We studied the outcomes of primary PCI for acute STEMI at a tertiary care center in North India. Methods Consecutive patients undergoing primary PCI for STEMI were prospectively studied during the period from February 2103 to May 2015. The outcomes assessed were all cause in hospital mortality, factors associated with mortality, major adverse cardiac and cerebrovascular event rate (composite of all cause in hospital mortality, non-fatal re infarction and stroke) and procedural complications. Results 371 patients underwent primary PCI during the study period. The mean age was 54 years and 82.7% were males. The mean total ischemia time and door to balloon times were 6.8 h and 51 min respectively. 96.4% patients underwent successful primary PCI. The total in hospital mortality was 12.9%. Mortality with cardiogenic shock at presentation was 66.7% while non-shock mortality was 2.6%. In hospital MACCE rate was 13.5%. Factors significantly associated with mortality were KILLIP class (OR: 8.4), door to balloon time (OR 1.02), final TIMI flow (OR 0.44) and severe LV dysfunction (OR 22.0). Procedure related adverse events were rare and there was no non-CABG associated major TIMI bleeding. Conclusion Primary PCI for acute STEMI is feasible in our setup and associated with high success rate, low mortality in non-shock patients and low complication rates.
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Affiliation(s)
- Gajendra Dubey
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Sunil Kumar Verma
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Kumar Bahl
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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14
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Sharma G, Anantha Krishnan R, Bohra V, Ramakrishnan S, Naik N, Seth S, Juneja R, Kalaivani M, Bahl VK. Evaluation of early direct current cardioversion for maintenance of sinus rhythm in rheumatic atrial fibrillation following successful balloon mitral valvotomy. Indian Heart J 2016; 68:486-92. [PMID: 27543470 PMCID: PMC4990730 DOI: 10.1016/j.ihj.2015.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 11/12/2015] [Indexed: 11/25/2022] Open
Abstract
Background Patients with rheumatic mitral stenosis (MS) and atrial fibrillation (AF) are at risk for thromboembolism and restoration of sinus rhythm (SR) may be the preferred strategy. Percutaneous balloon mitral valvotomy (PBMV) improves hemodynamics, but may not be enough to restore SR. Methods Prospective randomized study aimed at evaluating efficacy of early direct current cardioversion (DCCV) following successful PBMV in patients with long-standing AF. Group 1 (n = 20) had patients of rheumatic MS with AF who underwent successful PBMV. Group 2 (n = 15) patients were DC cardioverted and administered oral Amiodarone for 6 weeks. Primary endpoint was maintenance of SR after 6 months. Secondary endpoints were functional capacity, number of embolic episodes, adverse drug effects, and all-cause mortality. Results In Group 2, all patients underwent successful cardioversion. At a mean follow-up of 7.6 months, 95% in Group 1 were in AF. In Group 2, 87% patients were in SR and 13% had reverted to AF. Difference in rate of SR was 0.82 (95% CI 0.2, 1.01) (p = 0.001), with relative risk of 7.1 (1.95, 25.9, 95% CI, p = 0.001) for patients to be in AF who underwent only successful PBMV, i.e. Group 1. There was significant improvement in quality of life (SF36) score in Group 2 (p = 0.001), with no deaths, stroke, or adverse drug effects in either group. Conclusion In patients with rheumatic MS and AF, early DCCV and a short-duration oral Amiodarone, following successful PBMV, may be a reasonable strategy to attain long-term SR.
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Affiliation(s)
- Gautam Sharma
- Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - R Anantha Krishnan
- Senior Resident, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Vijay Bohra
- Senior Resident, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sivasubramanian Ramakrishnan
- Additional Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Nitish Naik
- Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sandeep Seth
- Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rajnish Juneja
- Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - M Kalaivani
- Scientist-II, Department of Biostatistics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Vinay Kumar Bahl
- Professor & Head, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
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15
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Parakh N, Mehrotra S, Seth S, Ramakrishnan S, Kothari SS, Bhargava B, Bahl VK. NT pro B type natriuretic peptide levels in constrictive pericarditis and restrictive cardiomyopathy. Indian Heart J 2015; 67:40-4. [PMID: 25820049 DOI: 10.1016/j.ihj.2015.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/05/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The differentiation of constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM) may be clinically difficult and may require multiple investigations. Even though brain natriuretic peptide (BNP) is shown to be higher in patients with RCM as compared to CP, the clinical utility is not fully established especially in Indian patients known to have advanced CP and myocardial involvement. METHODS AND RESULTS We measured NT-pro-BNP levels in 49 patients suspected of having either CP or RCM, diagnosed on the basis of echocardiography, computed tomography, magnetic resonance imaging, endomyocardial biopsy and cardiac catheterization data as needed. Twenty nine patients (Mean age - 26 yrs, 24 males) had CP and 20 patients (Mean age - 39 yrs, 14 males) had RCM. The median plasma NT-pro-BNP levels were significantly higher in RCM as compared to CP [1775 (208-7500) pg/ml vs 124 (68-718) pg/ml, respectively; p = 0.001]. A cut off value of 459 pg/ml had sensitivity, specificity and overall accuracy of 90%, 86% and 88% respectively, for differentiating CP from RCM. CONCLUSIONS The NT-pro-BNP levels are significantly elevated in RCM as compared to CP.
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Affiliation(s)
- Neeraj Parakh
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Mehrotra
- Division of Cardiology, Medanta the Medicity, Gurgaon, India
| | - Sandeep Seth
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - S Ramakrishnan
- Additional Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Shyam S Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Balram Bhargava
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - V K Bahl
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Vemparala K, Roy A, Bahl VK, Prabhakaran D, Nath N, Sinha S, Nandi P, Pandey RM, Reddy KS, Manhapra A, Lakshmy R. Early accelerated senescence of circulating endothelial progenitor cells in premature coronary artery disease patients in a developing country - a case control study. BMC Cardiovasc Disord 2013; 13:104. [PMID: 24245738 PMCID: PMC3871012 DOI: 10.1186/1471-2261-13-104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 11/09/2013] [Indexed: 12/04/2022] Open
Abstract
Background The decreased number and senescence of circulating endothelial progenitor cells (EPCs) are considered markers of vascular senescence associated with aging, atherosclerosis, and coronary artery disease (CAD) in elderly. In this study, we explore the role of vascular senescence in premature CAD (PCAD) in a developing country by comparing the numerical status and senescence of circulating EPCs in PCAD patients to controls. Methods EPCs were measured by flow cytometry in 57 patients with angiographically documented CAD, and 57 controls without evidence of CAD, recruited from random patients ≤ 50 years of age at All India Institute of Medical Sciences. EPC senescence as determined by telomere length (EPC-TL) and telomerase activity (EPC-TA) was studied by real time polymerase chain reaction (q PCR) and PCR– ELISA respectively. Result The number of EPCs (0.18% Vs. 0.039% of total WBCs, p < 0.0001), and EPC-TL (3.83 Vs. 5.10 kb/genome, p = 0.009) were markedly lower in PCAD patients compared to controls. These differences persisted after adjustment for age, sex, BMI, smoking and medications. EPC-TA was reduced in PCAD patients, but was statistically significant only after adjustment for confounding factors (1.81 Vs. 2.20 IU/cell, unadjusted p = 0.057, adjusted p = 0.044). Conclusions We observed an association between increased vascular cell senescence with PCAD in a sample of young patients from India. This suggests that early accelerated vascular cell senescence may play an important mechanistic role in CAD epidemic in developing countries like India where PCAD burden is markedly higher compared to developed countries.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ramakrishnan Lakshmy
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India.
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Sharma D, Vatsa M, Lakshmy R, Narang R, Bahl VK, Gupta SK. Study of cardiovascular risk factors among tertiary hospital employees and their families. Indian Heart J 2012; 64:356-63. [PMID: 22929817 PMCID: PMC3861102 DOI: 10.1016/j.ihj.2012.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 06/15/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The aim of the present study was to estimate the prevalence of cardiovascular risk factors among administrative employees working at a tertiary hospital (All India Institute of Medical Sciences, New Delhi) and their families. METHODS AND RESULTS A cross-sectional survey was conducted among a total of 453 individuals aged 30 years and above. The mean age of the study group was 43.3 ± 9.5 years. There was a high prevalence of major cardiovascular risk factors - current smoking 58 (12.8%), tobacco consumption 26 (5.7%), family history of coronary artery disease 79 (17.4%), diabetes mellitus 25 (5.8%), hypertension 94 (20.7%), hypercholesterolemia 110 (25.7%), hypertriglyceridemia 148 (34.5%), physical inactivity 180 (39.7%), body mass index ≥23 kg/m(2) 350 (77.3%), central obesity 201 (80.1%) of males and 163 (80.7%) of females, inadequate fruit and vegetable consumption 387 (85.4%), heavy drinking 12 (2.6%), and stress 58 (12.7%). CONCLUSION This indicates an urgent need to initiate a comprehensive health promotion and cardiovascular disease prevention programme at workplace and community level.
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Affiliation(s)
- Divya Sharma
- All India Institute of Medical Sciences, New Delhi, India.
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Abstract
Neurocardiogenic syncope (NCS) is a common clinical entity. Most of these patients are managed medically by internists and general practitioners. Though NCS is frequently a benign disease, a malignant form of this disorder with episodes of prolonged cardioinhibition culminating in asystole is described. Here, we describe a 52-year-old woman who had such a life threatening malignant form of arrhythmia during a routine colonoscopy and review the literature of similar cases.
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Affiliation(s)
- Gautam Sharma
- Department of Cardiology, Cardiothoracic Center, All India Institute of Medical Sciences, India.
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Sharma D, Vatsa M, Lakshmy R, Narang R, Bahl VK, Gupta SK. Study of cardiovascular risk factors among tertiary hospital employees and their families. Indian Heart J 2011; 63:418-424. [PMID: 23550419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Cardiovascular diseases have become the leading cause of mortality and morbidity in most countries of the world. The aim of the present study was to estimate the prevalence of cardiovascular risk factors among administrative employees working at a tertiary hospital (All India Institute of Medical Sciences, New Delhi) and their families. METHODS AND RESULTS A cross-sectional survey was conducted among a total of 453 individuals aged 30 years and above (N1 = 453 for the questionnaire, anthropometric and clinical parameters; N2 = 429 for biochemical investigations). Evaluation for cardiovascular risk factors, anthropometric measurements, blood pressure, fasting blood glucose and serum lipids were performed using standard definitions. The mean age of the study group was 43.3 +/- 9.5 years. There was a high prevalence of major cardiovascular risk factors--current smoking in 58 (12.8%), tobacco consumption in 26 (5.7%), family history of coronary artery disease 79 (17.4%), diabetes mellitus in 25 (5.8%), hypertension in 94 (20.7%), hyperlipidemia--hypercholesterolemia in 110 (25.7%) & hypertriglyceridemia in 148 (34.5%), physical inactivity in 180 (39.7%), body mass index e" 23 kg/m2 in 350 (77.3%), central obesity i.e. waist circumference > 90 cm for males and > 80 cm for females -in 201 (80.1%) of males and 163 (80.7%) of females, inadequate fruit and vegetable consumption in 387 (85.4%), heavy drinking in 12 (2.6%), and stress in 58 (12.7%). CONCLUSION The study demonstrated an overall high prevalence of cardiovascular risk factors even amongst employees at a tertiary hospital and their families. This indicates an urgent need to initiate a comprehensive health promotion and cardiovascular disease prevention programme at workplace and community level.
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Affiliation(s)
- Divya Sharma
- All India Institute of Medical Sciences, New Delhi, India.
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Mishra S, Bahl VK. Current concepts in management of acute ST-segment elevation myocardial infarction. J Indian Med Assoc 2009; 107:680-684. [PMID: 20469741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Math RS, Mishra S, Kumar KS, Bahl VK. Clinical validation of a low-cost telemedicine equipment remote medical diagnostics kit at a tertiary care hospital. J Assoc Physicians India 2008; 56:769-776. [PMID: 19263702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND The Remote Medical Diagnostics kit is an indigenous and low-cost technology that can measure and transmit via the internet 6 clinical parameters viz. Blood pressure (BP), pulse, temperature, oxygen saturation, 12-lead Electrocardiogram (ECG) and heart/breath sounds. Prior to commercial use, it needs clinical validation. METHODS Fifty three patients (including 1 acute myocardial infarction) were evaluated for the above parameters using accepted standard methods and the Remote Medical Diagnostics kit. RESULTS The intraclass correlation coefficient (ICC) for systolic BP (SBP), diastolic BP (DBP), saturation pulse, manual pulse and temperature was 0.927, 0.904, 0.989, 0.99 and 0.912 indicating a high degree of agreement between the two methods. For oxygen saturation, the ICC was 0.763 indicating a moderately high agreement. For heart sounds, the kappa coefficient (kappa) for inter-rater reliability was 0.48 (observed agreement of 96.1%). For breath sounds, the 'kappa' value was 0.48 indicating moderate agreement. For the breath sounds, the 'kappa' value was 0.38, indicating fair agreement (the observed agreement of 94.2%). For the ECG, the observed agreement was 94.4% by visual assessment. CONCLUSION At the bedside, the Remote Medical Diagnostics kit was clinically validated for the above 6 parameters.
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Affiliation(s)
- R S Math
- Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
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22
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Singh S, Bahl VK. The encouraging 'COURAGE'. Indian J Med Res 2008; 127:423-425. [PMID: 18653902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Affiliation(s)
- Rhys P Beynon
- Department of Cardiology, Wythenshawe Hospital, Manchester M23 9LT
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Bahl VK, Narang R. Current opinions on usage and regulation of drug-eluting stents in India: results of a nation-wide survey of Indian cardiologists. Indian Heart J 2005; 57:355-9. [PMID: 16350687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Affiliation(s)
- V K Bahl
- Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi.
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Kothari SS, Ramakrishnan S, Bahl VK. Infective endocarditis--an Indian perspective. Indian Heart J 2005; 57:289-94. [PMID: 16350673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
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Singh S, Gopal AK, Bahl VK. Glycoprotein IIb/IIIa receptor antagonists: are we ignoring the evidence. Indian Heart J 2005; 57:201-9. [PMID: 16196176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
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27
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Anandaraja S, Kothari SS, Bahl VK. Management of valvular heart disease during pregnancy. Indian Heart J 2005; 57:101-8. [PMID: 16013348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
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28
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Mozersky RP, Girdhar R, Palushock S, Patel N, Nolan S, Bahl VK. Malignant nonfunctioning pheochromocytoma occurring in a mixed multiple endocrine neoplasia syndrome. Endocr Pract 2005; 3:236-9. [PMID: 15251797 DOI: 10.4158/ep.3.4.236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present the first documented case of malignant nonfunctioning pheochromocytoma occurring in a mixed multiple endocrine neoplasia (MEN) syndrome. METHODS We describe the personal and family history of a 34-year-old man with headaches, increased serum prolactin levels, and hyperparathyroidism and review the details of his clinical course and treatment. RESULTS After diagnosis of a prolactinoma, bromocriptine therapy was implemented but eventually discontinued by the patient when severe headaches recurred. A transsphenoidal resection of a prolactinoma was performed; the patient continued to have abnormally high serum prolactin levels. Subsequent left lower flank pain prompted an exploratory laparotomy, and a left nephroad-renalectomy was performed. Pathologic examination disclosed a 1-cm tumor, consistent with malignant pheochromocytoma. Electron microscopy demonstrated neurosecretory granules. A hypercoagulable state complicated the course postoperatively. Despite chemotherapy, extensive metastatic disease ensued, and the patient died. CONCLUSION Although pheochromocytomas are usually associated with MEN type IIA and type IIB, this patient had a malignant pheochromocytoma, without the usual clinical and biochemical manifestations, in the setting of MEN type I.
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Affiliation(s)
- R P Mozersky
- Division of Endocrinology, Shadyside Hospital, and the University of Pittsburgh, Department of Medicine, Pittsburgh, Pennsylvania, USA
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Ramakrishnan S, Kothari SS, Bahl VK. Heart failure--definition and diagnosis. Indian Heart J 2005; 57:13-20. [PMID: 15852889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
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30
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Singh S, Kothari SS, Bahl VK. Coronary slow flow phenomenon: an angiographic curiosity. Indian Heart J 2004; 56:613-7. [PMID: 15751515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
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Abstract
OBJECTIVE To report a new association between polyglandular autoimmune syndrome and multiple endocrine neoplasia. METHODS We present a detailed case report and discuss the various types of polyglandular failure and multiple endocrine neoplasia. RESULTS A 56-year-old woman with a past history of primary hypothyroidism and impaired glucose tolerance was admitted to the hospital for removal of renal staghorn calculi. In addition to the presence of mucocutaneous candidiasis, vitiligo, and macroglossia, the patient was found to have truncal obesity, a "buffalo hump," and supraclavicular fat pads. Subsequent workup confirmed the presence of Cushing's disease and primary hyperparathyroidism. CONCLUSION A hitherto unreported association between polyglandular autoimmune syndrome type II and multiple endocrine neoplasia type I is documented in our current patient.
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Affiliation(s)
- V K Bahl
- Shadyside Hospital, Pittsburgh, Pennsylvania 15232, USA
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Anandaraja S, Kothari SS, Bahl VK. Oral anticoagulation therapy for prosthetic valves. Indian Heart J 2004; 56:281-5. [PMID: 15586734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
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Kothari SS, Ramakrishnan S, Bahl VK. Cardiac amyloidosis--an update. Indian Heart J 2004; 56:197-203. [PMID: 15584560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
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Singh S, Bahl VK. Prehospital thrombolysis: a reappraisal. Indian Heart J 2004; 56:93-8. [PMID: 15377129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
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Narang R, Sakhare M, Bahl VK. Contrast-induced nephropathy. Indian Heart J 2004; 56:13-20. [PMID: 15129784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
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Singh S, Bahl VK. Plaque passivation: role of statins in acute coronary syndromes. Indian Heart J 2003; 55:605-10. [PMID: 14989509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
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Abstract
The relative noninvasive nature, easy accessibility, convenience and accuracy of helical CT in the rapid evaluation of not only the aorta and its branches, but the entire thorax/abdomen, makes it the best suited imaging modality for use in evaluation of aortic aneurysms and dissection. Excellent vascular opacification, the advantage of reconstructing overlapping scans without respiratory misregistration, multiplanar reconstruction and 3D rendering of the vessels highlight the benefits of helical CT. Helical CT evaluation combines the advantages of conventional CT, giving true information about the exact transverse and longitudinal extent of the aneurysm, the vessel wall, luminal thrombus and structures around the aorta, and those of aortography in the form 3D volumetric information display. The purpose of this essay is to present a spectrum of aortic aneurysms and dissection to highlight the role of helical CT in their evaluation.
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Affiliation(s)
- Umesh Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110 029, India
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Kothari SS, Roy A, Bahl VK. Chronic constrictive pericarditis: pending issues. Indian Heart J 2003; 55:305-9. [PMID: 14686660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
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Singh S, Kothari SS, Bahl VK. Aspirin resistance: myth or reality? Indian Heart J 2003; 55:217-22. [PMID: 14560929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
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40
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Ramakrishnan S, Kothari SS, Bahl VK. Stem cells and myocardial regeneration. Indian Heart J 2003; 55:119-24. [PMID: 12921327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
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41
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Ramakrishnan S, Kothari SS, Bahl VK. Hypertensive heart failure. Indian Heart J 2003; 55:21-6. [PMID: 12760583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
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42
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Sharma G, Kothari SS, Bahl VK. Thrombolytic therapy for acute pulmonary embolism. Indian Heart J 2002; 54:667-71. [PMID: 12674177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
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43
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Nalk N, Bahl VK. Acute rheumatic fever: whither steroids? Indian Heart J 2002; 54:363-7. [PMID: 12462662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Kothari SS, Bahl VK. Primary pulmonary hypertension--an update. Indian Heart J 2002; 54:255-60. [PMID: 12216919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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45
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Bahl VK, Seth S. Takayasu's arteritis revisited. Indian Heart J 2002; 54:147-51. [PMID: 12086376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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46
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Arora P, Naik N, Bahl VK, Mishra S, Yadav R, Sharma S, Manchanda SC. Coronary angiography using 4 French catheters with power injection: a randomized comparison with 6 French catheters. Indian Heart J 2002; 54:184-8. [PMID: 12086383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Coronary angiography using 4 F catheters may reduce access-site complications and enable early ambulation, although earlier studies suggested that the quality of images may be an issue of concern. METHODS AND RESULTS To ascertain the quality of angiographic images and safety of early ambulation, 500 patients were randomized to coronary angiography with either 4 F or 6 F catheters. Procedural characteristics, angiographic quality scores and results of ambulation were analyzed in the two groups. Patients in the 4 F group were mobilized at 2 hours post-procedure while those in the 6 F group were ambulated at 6 hours. There was no procedure-related complication in either group. The procedure was successfully completed in 250 of 252 patients randomized to the 4 F group. In two patients in the 4 F group, sheaths were upgraded to 6 F to complete the procedure, as difficulty was encountered in hooking the coronary ostium with a 4 F Judkin's catheter. Coronary angiographic quality scores in these two groups were comparable. Angiographic scores for the 4 F and 6 F groups for the left coronary artery averaged 4.45+/-0.5 and 4.58+/-0.3 (p>0.1), respectively. The right coronary artery scores averaged 4.30+/-0.4 and 4.35+/-0.2 (p>0.1) in the 4 F and 6 F groups. Angiographic scores for the left ventricular angiogram averaged 4.22+/-0.1 and 4.44+/-0.3 (p>0.1) in the 4 F and 6 F groups, respectively. None of the angiograms were assigned a score of <3.0 (not diagnostic). The total contrast volume consumed in the two groups was also equivalent. There were no groin-related complications in the 4 F group although these patients were ambulated 2 hours after the procedure. CONCLUSIONS Coronary angiography performed with a 4 F catheter is a safe and reliable procedure. The quality of image obtained with a 4 F catheter is equivalent to that obtained with a 6 F catheter. Early ambulation at 2 hours is feasible without compromising safety.
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Affiliation(s)
- Parneesh Arora
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi
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Bahl VK, Sengupta PP, Sathpathy G, Sharma A, Narang R, Sharma S, Manchanda SC. Chlamydia pneumoniae infection and nonspecific aortoarteritis: search for a link with a nonatherosclerotic inflammatory arterial disease. Indian Heart J 2002; 54:46-9. [PMID: 11999087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The association between Chlamydia pneumoniae infection and atherosclerosis has gained recognition. However, the nature of this association is controversial. The infective link may not be specific for atherosclerosis and may also exist in other nonatherosclerotic arterial diseases. We investigated patients with nonspecific aortoarteritis for serological evidence of prior Chlamydia pneumoniae infection. METHODS AND RESULTS Fifty patients each of nonspecific aortoarteritis and coronary artery disease with angiographic evidence of significant (>70%) coronary artery lesions were tested for the presence of IgG antibodies against Chlamydia pneumoniae by micro-immunofluorescence assay and compared with 50 age- and sex-matched normal healthy controls. The number of patients with nonspecific aortoarteritis who tested positive for Chlamydia pneumoniae antibodies (IgG) was not significantly different from controls (8 v. 7, p=ns). The mean titer amongst positive subjects in the two groups was also similar (1:40+/-40 v. 1:50+/-25; p=ns). Patients with coronary artery disease were significantly older than patients with nonspecific aortoarteritis and controls (53.2+/-5.8 v. 21.2+/-9.9 years and 24.5+/-5.2 years, p<0.01 for both) and showed a higher seroprevalence of prior Chlamydia pneumoniae infection (18 v. 8 and 7, p < 0.05 for both). The mean IgG titers of patients with coronary artery disease who tested positive were also significantly higher than the other two groups (1:98+/-34 v. 1:40+/-40, p<0.001 and 1:98+/-34 v. 1:50+/-25, p<0.01, respectively). CONCLUSIONS In patients with nonspecific aortoarteritis, the seroprevalence of prior Chlamydia pneumnoniae infection is not more than that in healthy individuals of the same age group, but is significantly lesser than that in patients with coronary artery disease. Thus Chlamydia pneumoniae infection may not be associated with all forms of chronic inflammatory arterial lesions.
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Affiliation(s)
- V K Bahl
- Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi.
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Bahl VK, Naik N. Hormone replacement therapy and coronary artery disease: buried alive? Indian Heart J 2002; 54:23-30. [PMID: 11999084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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Bahl VK, Prabhakaran D, Karthikeyan G. Coronary artery disease in Indians. Indian Heart J 2001; 53:707-13. [PMID: 11838923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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Ramamurthy S, Bahl VK, Manchanda SC. Successful inoue balloon valvotomy in a difficult case of mitral stenosis using multiple modifications of technique: alternative method for loop formation of the Inoue balloon catheter. J Invasive Cardiol 2001; 13:755-7. [PMID: 11689721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Transseptal puncture was accomplished with difficulty at an unfavorable site in a case of severe mitral stenosis with distorted atrial and septal anatomy. Septal balloon entrapment could not be avoided during attempts to cross the mitral valve using the standard technique. This problem was circumvented by resorting to the loop method and the left ventricle was entered first with a guidewire, which then supported the balloon catheter. Successful mitral valve dilatation could thus be performed. A simple alternative method that was used to form the Inoue balloon catheter into a loop is also described.
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Affiliation(s)
- S Ramamurthy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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