Ebsencoble5025
We studied awareness, treatment and control of hypertension and factors associated with hypertension prevalence in Barmer district, Rajasthan. A cross-sectional study was conducted among 300 adults aged ≥ 30 years. Data were collected using a modified World Health Organization STEPs tool. Bivariate and multivariate analyses were done to find the factors associated with hypertension prevalence. Hypertension and pre-hypertension prevalence were 22.0% and 50.7% respectively. A quarter (27%) was aware, 25% were on treatment and 9% achieved adequate control of hypertension. Hypertension prevalence was significantly higher among men, older adults, overweight adults and those reported higher income compared to their counterparts.
Accurate estimation of fluid status is paramount in patients with heart failure. We hypothesized that bedside ultrasound assessment of the internal jugular vein (IJV) and subclavian vein (SCV) could reliably estimate right atrial pressure (RAP).
Prospectively enrolled patients were positioned supine. IJV was imaged at the apex of the right sternocleidomastoid muscle and SCV was imaged at the lateral third of the right clavicle. Using M-mode on a portable ultrasound machine, the maximum (D
) and minimum (D
) anteroposterior diameters were noted during normal breathing. Respiratory variation in diameter (RVD) was calculated as [(D
- D
)/D
] and expressed as percent. Collapsibility was assessed with sniff maneuver. Patients then underwent right heart catheterization and their findings were correlated with above.
Total of 72 patients were enrolled with mean age 61 years, mean BSA 1.9m
, and left ventricular ejection fraction 45±20%. Elevated RAP≥ 10mmHg was associated with dilated IJV D
(1.0 vs. 0.7cm, p=0.001), less RVD with resting respiration (14% vs. 40% for IJV, p=0.001 and 24% vs. 45% for SCV, p=0.001), and reduced likelihood of total collapsibility with sniff (16% vs. 66% patients for IJV, p=0.001 and 25% vs. 57% patients for SCV, p=0.01). For RAP ≥10mmHg, lack of IJV complete collapsibility with sniff had a sensitivity of 84% while IJV D
> 1cm and RVD <50% had a specificity of 80%.
The IJV and SCV diameters and their respiratory variation are reliable in estimating RA pressure.
The IJV and SCV diameters and their respiratory variation are reliable in estimating RA pressure.The prognostic value of atrial thrombi (AT) among elective patients with atrial fibrillation (AF) referred for a rhythm control strategy is unclear. In this study, clinical variables were correlated with the presence of AT and long term survival among 205 patients submitted to transesophageal echocardiography before elective AF cardioversion or ablation. Atrial thrombi were present in 7.8% of cases and were significantly associated with reduced survival. Obesity was the only independent clinical predictor of AT [OR 4.27 (1.15-15.79), p = 0.03]. In patients with AF, AT appear to be associated with adverse outcomes, possibly indicating more advanced atrial cardiomyopathy.The benefits of CRT in select subsets of systolic heart failure patients with LBBB are proven. We prospectively evaluated conventional and newer echocardiographic parameters of left ventricular dyssynchrony in 35 patients who underwent CRT and were followed up after 6 months. Of the 33 surviving patients, 21 were echocardiographic responders and 24 were clinical responders. The parameters in clinical responders and non-responders were compared. The anatomic M Mode parameters of delays improved, while the radial strain and the mitral valve velocity time integral (MVVTI) did not show any significant change after CRT.Radiation exposure during electrophysiology procedures has been a point of discussion. We measured the ionising radiation dosage during ablation procedures for supraventricular tachycardia. This was compared with coronary angiographies performed via the radial route to put it in perspective. We found that the radiation dosage during the ablation procedure was far lower, less than forty percent of that during coronary angiography (Air Kerma 249.1 mGy ± 266.95 mGy v/s 671.9 mGy ± 328.6 mGy; p less then 0.001).Links between periodontitis and atherosclerosis can be predicted based on inflammatory mechanisms initiated by bacteria associated with periodontal lesions, which then influence the initiation or propagation of the atherosclerotic lesion. This study aimed to detect the presence of three periodontal pathogens, in atheromatous plaques of patients with coronary artery disease. Subgingival and atherosclerotic plaque samples were obtained from 80 patients scheduled for CABG or angioplasty. A nested PCR was done for the detection of the pathogens in the plaque samples. Porphyromonas gingivalis, Tanarella forsythia, and Treponema denticola were detected in 10%, 12.5%, and 1.3% of the atherosclerotic plaque samples respectively. It was also observed that patients whose atherosclerotic plaques tested positive for one or more of the pathogens had chronic periodontitis.Increasing evidence suggests that apelin and ghrelin may participate in atherogenesis. We sought to investigate whether the serum levels of apelin and ghrelin are significantly different in patients with coronary artery disease (CAD) compared to patients with nonsignificant coronary stenosis and determine the correlation between these adipokines and the severity of coronary stenosis. The study population included 31 stable CAD patients, 38 unstable CAD patients, and 39 non-CAD subjects. PK11007 supplier Serum levels of apelin and ghrelin, fasting blood glucose, lipid parameters, hs-CRP and hematological indices were determined in all groups using routine standard laboratory procedures. Serum apelin levels were significantly lower in patient with unstable CAD (0.354 ± 0.063 ng/mL) compared to stable CAD patients (0.401 ± 0.045 ng/mL, p = 0.003) and non-CAD subjects (0.415 ± 0.055 ng/mL, p less then 0.001). In addition, serum apelin levels were inversely correlated with the severity of coronary stenosis in CAD patients (p less then 0.05). However, there was no significant difference in ghrelin levels among the 3 groups. This data may suggest that the presence of unstable CAD may be associated with lower serum apelin which may indicate the potential role of this peptide in the progression and destabilization of coronary plaques.The goal of this study is to portray an initial experience with the efficacy, safety, and, acceptance of ARNI in ambulatory cardiology practices in India. The research is a retrospective review of single-centre data who began therapy with ARNI in HFrEF between 2019 and 2020. The analysis included data for 454 symptomatic patients, aged 57 ± 20.8 years in NYHA class II-III. During follow-up, patients experienced significant improvement in HF symptoms determined by using Kansas City Cardiomyopathy Questionnaire (KCCQ) and a considerable reduction in NT-proBNP levels. ARNI is associated with substantial clinical benefit in an outpatient setting in HFrEF.
Sacubitril/Valsartan (ARNI) has now class 1 recommendation for treatment of heart failure with reduced ejection fraction (HFrEF). It has been shown to reduce cardiovascular morbidity & mortality in Heart failure with reduced ejection fraction (HFrEF) and significant improvement in all echocardiographic parameters besides TEI index. Tei index is a marker of inflammation, myocardial cell metabolism and its contractile function has not been evaluated as a distinctive entity so we took up this study to evaluate the effects of ARNI on the LV functions using two dimensional (2D)ECHO parameters in Indian population and to assess TEI index for myocardial function.
256 patients with class II, III or IV HF and EF<40% were enrolled. 171(66.8%) were males and 85(33.2%) were females. Patients were evaluated at baseline, 6 and 12 months for LVEF, LV mass &,LVMPI. Drug was discontinued in 2 patients due to angioedema, in 5 patients due to acute kidney injury and in 2 patients due to hypotension. LV mass measurement done by linear echocardiographic method and Flow Doppler method used for TEI index calculation.
Baseline parameters in 247 patients were mean EF=26.33±6.28%, mean LV mass=270.84±68.94gm, mean Tei Index=0.852±0.22. ARNI use was associated with an average gradual increase in EF, from a mean baseline of 26.33±6.28% to 33.88±7.73%(p=0.000001) after 1 year of treatment. There was a significant progressive reduction of 57.97g/m2 in mean LV mass index after 1 year of treatment (p=0.000001).TEI index showed significant reduction from baseline mean 0.85±0.22 to 0.70±0.12(p=0.000001)after 1 year of treatment.
Use of ARNI as additive adjunct to standard care of treatment resulted in significant progressive decline in LV mass and increase in TEI index.
Use of ARNI as additive adjunct to standard care of treatment resulted in significant progressive decline in LV mass and increase in TEI index.
Potts shunt has been suggested as an effective palliative therapy for patients with pulmonary artery hypertension (PAH) not associated with congenital heart disease.
This is a prospective single-center study performed to assess outcomes of Potts shunt in patients with PAH who are in functional class III or IV.
52 patients in functional class III/IV with pulmonary arterial hypertension without significant intra or extracardiac shunt on maximal medical therapy were evaluated and counseled for undergoing Potts shunt/patent ductus arteriosus (PDA) stenting. 16/52 patients (13 females) consented for the procedure; 14 patients underwent surgical creation of Potts, and 2 underwent transcatheter stenting of PDA, which physiologically acted like a Potts shunt. Standard medical therapy was continued in patients who did not consent for the procedure. 12/16 patients survived the procedure. Patients who did not survive the procedure were older, with severe right ventricular systolic dysfunction, and functional class intra or extracardiac shunts. It can be done safely with an acceptable success rate. Patient selection, preoperative stabilization, and meticulous postoperative management are essential. It should be performed at the earliest sign of clinical, echocardiographic, or laboratory deterioation for optimal outcomes. Long-term follow-up is required to see a sustained improvement in functional class and the need for a lung transplant in the future.
In patients with ACS, risk assessment at hospital discharge has not received much consideration in prior risk scoring systems. Hence, there is a need for a reliable and simple tool to identify patients with high mortality risk at discharge form the hospital.
In a 1-year observational, prospective study, 1012 patients admitted with ACS were followed up for 6 months after discharge. From 26 potential variables, a new risk score to predict 6-month mortality was developed.
A multi-variant Cox regression analysis with forward stepwise variable selection was performed and 10 highly significant independent predictors of 6-month mortality were identified. These include previous history of ACS, higher Killip class at admission, NYHA class at discharge, recurrent ischemia during hospital stay, heart failure, requiring ionotropic supports, requiring hemodialysis, presence of arrhythmia, left ventricular dysfunction detected on echocardiography and elevated admission blood glucose levels. Points were given to each variable and a total score was calculated.
