Cardiovascular

Checklists, artificial intelligence, and much more! Sandeep Seth, Shyamal K Goswami Journal of the Practice of Cardiovascular Sciences 2019 5(1):1-1

Checklists – The road to a safer healthcare in heart failure patients Bharat Raj Kidambi, Sandeep Seth Journal of the Practice of Cardiovascular Sciences 2019 5(1):2-11 Health care today is complex and mistakes can occur due to multiple reasons from lack of knowledge to simply lack of attention to detail. Checklists are a way to prevent mistakes and implement common standards of care but there are difficulties in implementing checklists. In this article we are showing a series of checklists which we have successfully used in the management of heart failure in a tertiary care hospital in India. The checklists start from the time the patient is admitted (the Intensive care Check list) to the time of discharge. The patient's visit to the out patient department is also covered by multiple education cards and checklists (Heart Failure Checklist, HRIDAY CARD). There are also standard prognostic tools (Seattle heart failure score and many others) which are used to prognosticate patients which do not respond to drug therapy. The I-NEED-HELP tool is explained to choose patients who might benefit from an cardiac assist device or a heart transplant.

Machine learning and medical research data analysis Rajiv Narang, Jaya Deva, Sada Nand Dwivedi Journal of the Practice of Cardiovascular Sciences 2019 5(1):12-13

Cardiology update - The first quarter Satyavir Yadav, Faraz Ahmed Farooqui, Swati Singh Journal of the Practice of Cardiovascular Sciences 2019 5(1):14-17 The first round of this year covers a lot about dual-antiplatelet therapy duration after stent placement, coronary angiography after a cardiac arrest, transcatheter aortic valve replacement indications in low-risk patients, sodium–glucose cotransporter 2 inhibitor results, angiotensin receptor neprilysin inhibitor in acute heart failure, and many other trials.

Acute coronary syndrome in young - A tertiary care centre experience with reference to coronary angiogram Tammiraju Iragavarapu, T Radhakrishna, K Jagadish Babu, R Sanghamitra Journal of the Practice of Cardiovascular Sciences 2019 5(1):18-25 Background: Acute coronary syndrome (ACS) is a potentially life-threatening condition which is more common in elderly people, and young are relatively protected. Currently, the protective effect on young from coronary artery disease (CAD) is taken away by several risk factors. The aim of this study is to determine the conventional risk factors and angiographic correlation of CAD in young age (<40 years) to that of elderly age (>40 years). Materials and Methods: This study was a hospital-based retrospective cross-sectional analytical study involving 1151 patients of ACS admitted in the cardiac ICU from May 2016 to May 2018. Among these patients, coronary risk factors such as smoking, diabetes, hypertension, dyslipidemia, and family history were studied. Patients were divided into two groups, Group A: <40 years and Group B: >40 years. Patients were evaluated angiographically. The significance of each risk factor between the groups was calculated by employing the Chi-square test and P < 0.05 was taken as statistically significant. Results: A total of 1151 cases were included in the study, of which 120 cases were <40 years of age. The prevalence of CAD in young in our study is 10.42% with male preponderance. P value is statistically significant (P < 0.05) among younger individuals for smoking, dyslipidemia, obesity, family history. Of 120 cases with critical CAD, single-vessel disease (SVD), predominantly the left anterior descending artery, was the most prevalent. SVD and recanalized coronaries were statistically significant among younger group whereas triple-vessel disease (TVD) is statistically significant among the elderly. Thrombus burden is more in young when compared to the elderly. Conclusion: Although ACS is a less common entity in young adults aged 40 years or less, recent epidemiological trend is progressing and it constitutes an important challenge both for a patient and for a treating physician. Young patients with CAD are mainly males, and SVD is more common. Emphasis should be given on diagnosis and management of risk factors in this vulnerable group to prevent mortality and morbidity.

Is there an association of intracardiac mass with high urate level? AIM-HUL study Kamal Sharma, Dhammdeep Humane, Jevin Jhamaria, Sharad Jain, Krutika Patel, Sachin Patil, Sanjeev Bhatia, Jasraj Panwar Journal of the Practice of Cardiovascular Sciences 2019 5(1):26-29 Context: Hyperuricemia is associated with idiopathic left atrium/left ventricular clot, and its association with other intracardiac tumors is not clear. Aim: The study aimed to establish if there is an association of intracardiac mass with high urate level. Settings and Design: This prospective study included 440 individuals, of which 330 were consecutive all comers with intracardiac mass detected on echocardiography from June 2016 to December 2017, who were compared with 110 randomly selected healthy controls undergoing echocardiography during the same without intracardiac mass in a ratio of 3:1. Materials and Methods: Imaging modalities such as transesophageal echocardiography, cardiac computerized tomography, and/or cardiac magnetic resonance imaging were done to analyze the intracardiac mass. Both the groups were analyzed for serum uric acid (SUA) levels at the time of detection of intracardiac mass. Statistical Analysis Used: Univariate analysis was done for continuous variables using Student's t-test, whereas the Chi-square test was used for the categorical data. Logistic regression analysis was performed with the presence of a mass with SUA as the dependent variable. Results: Among a total of 440 patients, 330 were cases and 110 were controls with the mean age of 47.52 ± 16.02 years (18–77 years) versus 45.23 ± 14.10 (18–73 years) years with male:female ratio of nearly 3:2 in both the groups. Mean SUA in cases was significantly higher than controls (7.60 ± 0.93 vs. 4.52 ± 1.20 mg%) (P < 0.001 with 7.6 [95% confidence interval (CI): 7.5–7.7] and 4.52 [95% CI: 4.3–4.74]) with linear logistic regression coefficient of 0.64. There was no significant difference in SUA levels among different types of intracardiac mass (P = 0.31). Conclusion: Hyperuricemia is associated with all comers of intracardiac mass with a regression coefficient of 0.64 irrespective of the nature of mass.

Obstructive coronary artery disease in women presenting with ischemic chest pain: Prevalence and risk determinants Kunal Mahajan, Arvind Kandoria, Rajeev Bhardwaj, Meenakshi Kandoria Journal of the Practice of Cardiovascular Sciences 2019 5(1):30-34 Background: Women present more commonly with atypical angina, false-positive exercise test, and normal/nonobstructive coronary angiogram. It thus becomes essential to identify the predictors of obstructive coronary artery disease (CAD) in women to avoid unnecessary invasive angiograms. Methods: We prospectively recorded the data of consecutive 578 women who underwent coronary angiography in our institute for typical/atypical chest pain suspected to be secondary to CAD. Results: Normal coronaries/nonobstructive CAD were seen in 273 (47.2%) patients, whereas 305 (52.8%) patients were found to have obstructive CAD (P < 0.0001). On multivariate logistic regression analysis, the presence of typical angina, age >55 years, smoking, diabetes mellitus, hypertension, low-density lipoprotein cholesterol >150 mg/dl, and high-density lipoprotein cholesterol <40 mg/dl were found to be independent predictors of obstructive CAD. Conclusion: These risk predictors can help in the reliable assessment of pretest likelihood of obstructive CAD in women, thereby avoiding many unnecessary invasive coronary angiograms. Further larger studies are warranted to validate these results and propose accurate prediction models for the diagnosis of obstructive CAD in women.

Tumor necrosis factor-alpha gene polymorphisms and complex disorders: A study among mendelian population with East Asian Ancestry Salam Kabita, Priyanka Rani Garg, Masan Kambo Newmei, Kallur Nava Saraswathy, Huidrom Suraj Singh Journal of the Practice of Cardiovascular Sciences 2019 5(1):35-43 Background and Objectives: Tumor necrosis factor-alpha (TNF-α)-238G/A and -308G/A single-nucleotide polymorphisms (SNPs) in the promoter region of the gene have been implicated in numerous diseases. The present study aims to investigate the frequency of two TNF-α polymorphisms among Mendelian population of India and to assess their association with various cardiovascular risk variables and outcomes (hypertension [HTN], metabolic syndrome [MetS], and type 2 diabetes mellitus). Materials and Methods: A total of 1142 unrelated individuals aged 35–75 years belonging to Meitei community of Manipur were included in the study. Height, weight, waist and hip circumferences, blood pressures (systolic and diastolic), and lipid profile were measured. Polymerase chain reaction was done using standard protocols. Further, HTN, MetS, diabetic, and healthy individuals were identified, and a nested case–control study design was formulated. Results: The mutant allele frequency was found to be similar (4%) for both the polymorphisms among the Meiteis of Manipur. No mutant homozygote of TNF-α-308G/A polymorphism was observed. No significant risk of the two polymorphisms was found with any of the disease groups in nested case–control analysis. However, TNF-α-308G/A polymorphism, but not TNF-α-238G/A polymorphism, was found to be associated with total cholesterol (TC), triglyceride (TG), and very-low-density lipoprotein (VLDL) in overall population only with TG and VLDL among the HTN cases. Conclusion: The association of TNF-α-308A allele with metabolic risk factors such as TC, TG, and VLDL suggests that though it may not increase the development of any of the diseases considered in the present study, it could possibly enhance the risk of human metabolic disorder. The absence of mutant homozygote among cases is suggestive of lethality of TNF-α-308A allele in double dose coupled with other environmental factors or in the presence of haplotype pairing with TNF-α-238A allele.

Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia M Aseem Basha Journal of the Practice of Cardiovascular Sciences 2019 5(1):44-47

Eisenmenger's syndrome: Management and workup for heart–lung transplant Jay Relan, Sakshi Sachdeva, Neeraj Awasthy, Sivasubramanian Ramakrishnan Journal of the Practice of Cardiovascular Sciences 2019 5(1):48-52 Heart–lung transplant remains the final option for patients with congenital heart disease (CHD) and irreversible pulmonary vascular obstructive disease (PVOD) when the patients are symptomatic despite optimal medical management. This panel discussion, held during cardiovascular disease convergence 2018, takes us through the journey of an 18-year-old patient suffering from a complex cyanotic CHD with irreversible PVOD and severe ventricular dysfunction. Pertinent management issues concerning pharmacotherapy and supportive care are discussed. Finally, workup and listing criteria for heart–lung transplant are discussed. The patient still awaits heart–lung transplant.

Alexandros Sfakianakis
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