SEVERITY OF MITRAL REGURGITATION AND ITS ASSOCIATION WITH LEFT VENTRICULAR DYSFUNCTION AND BRAIN-NATRIURETIC PEPTIDE LEVELS IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

Acute decompensated heart failure (ADHF) is greatly influenced by levels of brain-natriuretic peptides (BNP) and thereby may have strong correlation with severity of mitral regurgitation (MR) and left ventricular ejection fraction (LVEF). The available data on its association is limited which sought us to investigate correlations between type of ADHF, BNP levels and severity of MR. A single-center, cross-sectional, observational study was conducted at Sri Ramachandra Institute of Higher Education and Research, Chennai, India. Adults aged >18 years, either gender, diagnosed as ADHF requiring hospital admission within 24 hours were incorporated into the research.Between June 2019 to June 2020, we included 79 patients of ADHF. The mean age was 64.9±11 years and 60.8% were males. The mean LVEF was 40.2±10.2%. The severity of MR was severe, moderate, and mild in 3.8%, 21.5% and 74.7% of patients, respectively. The proportion of patients with moderate to severe MR was significantly higher in ADHF patients with reduced EF compared to mid-range or preserved EF. The median levels of BNP significantly increased from 520.0 pg/ml in mild MR to 1020.0 pg/ml in moderate and 1410.0 pg/ml in severe MR. In patients with ADHF, MR is a common finding. The severity of MR is associated with greater reduction in ejection fraction. Determination of MR severity is essential in all ADHF cases. Further, stratification of patients using BNP levels may help in identifying those at higher risk of adverse outcomes in ADHF.

Improved Diagnosis through Diastolic Hyperemia-Free Ratio (DFR) over Fractional Flow Reserve (FFR) in Intermediate Coronary Lesions

OBJECTIVES

To compare the fractional flow reserve (FFR) and diastolic hyperemia-free ratio (DFR) measurements in a population with intermediate coronary artery stenosis and improve the diagnosis.

BACKGROUND

Visual assessment of coronary artery stenosis severity, particularly in intermediate lesions, is prone to errors in decision-making. FFR provides a reliable assessment of functional severity in these cases but requires hyperemia induction by adenosine, which has side effects and increased cost. DFR is a novel hyperemia-independent index, which could be used as an alternative to adenosine-based hyperemia induction.

METHODS AND RESULTS

Between September 2019 to March 2020, 25 patients with 38 intermediate coronary stenotic lesions were included in the study. All patients underwent assessment of whole cycle Pd/Pa (ratio of distal coronary pressure to proximal aortic pressure), DFR and FFR. Mean whole cycle Pd/Pa, DFR and FFR were 0.93±0.06, 0.88±0.09, and 0.85±0.08, respectively. A significant positive correlation between DFR and FFR [r = 0.74; p<0.001] was observed. Receiver operating characteristic analysis showed an area under the curve of 0.90. DFR-only strategy with a treatment cut-off of ≤0.89 showed a diagnostic agreement with the FFR-only strategy in 74% of lesions, with a sensitivity of 54%, specificity of 82%, a positive predictive value of 60%, and a negative predictive value of 79%.

CONCLUSIONS

Real-time DFR measurements show a clinically reliable correlation with FFR. Hence, using DFR is likely to avoid adenosine administration as well as reduce the cost and procedural time. Further studies with a larger sample size would be ideal to evaluate specific cut-off values and endpoints.

Demographic analysis and clinical outcomes of COVID-19 and myocardial infarction from a tertiary care centre in south India

Funding Acknowledgements

Type of funding sources: None.

Back ground – COVID-19  is reported in India from March 2020. It is known to cause  myocarditis , arrythmias and heart failure. COVID-19 infection has been proposed to be associated with myocardial infarction.

PURPOSE

–We intent to study outcomes of acute coronary syndrome associated with  COVID-19 patients .

METHODS

– This is a  single center case-control study done in an University hospital in south India ,  from May 2020 to October 2020 . Data of patients who came with acute coronary syndrome (ACS) with COVID- 19 were collected retrospectively from the hospital database. The clinical outcomes of the these patients were compared with the patients who were admitted in the hospital for ACS without  COVID -19  in the same period.

RESULITS – 508  patients were admitted between May 2020 to October 2020  with ACS and out of which  58 patients were positive for COVID-19 and 450 patients were COVID-19 negative.  In COVID positive group, most of the patients were above 50 years  with 17 % of them being female sex.  60 %  were having diabetes and 44.8 % had hypertension . 55%  of them had STEMI with the rest being  NSTE- ACS . 43.1 %  patients were thrombolysed . 25% patients underwent revascularization either with  PCI / CABG . 10.3% died in the COVID - 19 positive group ,  at the same time there were only  2.2 % deaths in the control group . Most the patients were asymptomatic COVID-19 at presentation . Among the symptomatic COVID-19  patients the onset of myocardial infarction after COVID-19 ranged from 9 – 90 days .

CONCLUSION

– Acute coronary syndrome in COVID-19 patients  can present as late  as 3 months after index infection,  and these patients had higher mortality compared with those who did not have COVID -19 .

ACEI-induced cough: A review of current evidence and its practical implications for optimal CV risk reduction

Cough is one of the common adverse effects in patients receiving angiotensin-converting enzyme inhibitors (ACEIs). This review presents the current evidence on incidence and mechanisms of cough associated with ACEIs use, and proposes a practical approach for managing the same for optimal cardiovascular (CV) risk reduction. The incidence of dry cough in patients receiving ACEIs vary among individual ACEIs, and is the lowest with perindopril. Cough is thought to originate from multiple mechanisms, bradykinin theory is the most commonly appealed hypothesis. The strategies for optimal management could be temporarily discontinuation of ACEI upon a reported incidence of cough and reintroduction after its remission. However, studies have reported disappearance of cough despite continuing treatment. Another important approach could be adding calcium channel blockers to ACEIs. Switching to alternative drugs such as angiotensin receptor blockers should be suggested in case intolerable symptoms recur and after exclusion of all other possible causes of cough.

A Study of salt and fat Consumption pattern in Regional Indian diet among hypertensive and dyslipidemic PaTients - SCRIPT study

BACKGROUND

Cardiovascular diseases are leading cause of mortality and morbidity. There is an increasing prevalence of hypertension and dyslipidemia due to globalization and adoption of westernized dietary habits in India. These transitions are manifest in dietary patterns and health outcomes.

OBJECTIVE

To study the dietary salt and fat intake among patients diagnosed with hypertension and dyslipidemia in India.

METHODS

SCRIPT study was a pilot exploratory, cross-sectional, observational, descriptive, multi-center study. It was conducted across hospitals and clinics in five metro cities of India, represented into four regional zones. In each region (North, n = 113; East, n = 98; West, n = 83; South, n = 152), patients diagnosed with hypertension and dyslipidemia were enrolled in the study. Socio-demographic and treatment details were recorded. Participants were interviewed by a dietician and their dietary intake was assessed by a three-day recall of food item questionnaire/ food diary.

RESULTS

Overall the mean total daily salt consumption was 10.9 grams. Region-wise, the mean daily salt consumption in North, East, West and South were 14.13, 9.81, 10.12 and 9.38 grams respectively. The daily salt consumption in the North was significantly higher than other regions (P=0.012). The daily consumption of saturated fats (total saturated fat, ghee and butter) in the North was higher and statistically significantly in comparison to West, South and East (P <0.05). Overall, fats contributed to 24.1%, proteins contributed to 12.7% and carbohydrate contributed to 63.2% of total energy per day. The percentage of fat and protein contributing to total energy per day was within the acceptable range.

CONCLUSIONS

Our study documented higher dietary salt intake than that recommended in India. There is an urgent need to address the issue of high salt and saturated fat consumption. Nutritional strategies for reducing salt intake, saturated fat and balancing energy nutrients should be urgently applied in Indian hypertensive and dyslipidemia patients.