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   Table of Contents - Current issue
April-June 2022
Volume 11 | Issue 2
Page Nos. 29-62

Online since Friday, June 24, 2022

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Editor's page April 2022 p. 29
Ravi R Kasliwal
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Impact of COVID-19 pandemic induced lockdown on management of myocardial infarction: An Indian survey report from the experiences by 1083 cardiologists p. 30
Chandrashekar K Ponde, Dharmendra Jain, Manjula Suresh, Sengottuvelu Gunasekaran, Sundeep Mishra, Thomas Alexander, Tiny Nair
Background: COVID-19 has induced a change in the management of myocardial infarction (MI). Methods: We developed a customized technological virtual response system for mapping exercise, during August 14–28, 2020, to understand the management of MI. Prior telephonic consent was obtained, and the weblink of the questionnaire was provided on individual WhatsApp. Anonymized data were statistically analyzed by GraphPad software version 8.4.3. Results: The mean year of experience in active clinical practice was 12 years (standard deviation 10, 95% confidence interval 12–13). There were 41% (n = 445) participants who reported reduction by 25%–29% of MI patients, reporting to hospital, followed by 27.8% (n = 302) participants, reporting that <25% patients with MI approached the hospital. Sixty percent reported as the most important reason for a decrease in cases of MI patient's fear of contracting COVID-19 (n = 648), followed by limited transportation by 20.49% (n = 222) participants. There were health-care-driven reasons for a decrease in MI primary percutaneous coronary intervention activations. These included cardiologist's reluctance to do primary percutaneous cardiovascular interventions (PCI) due to COVID-19 and patients presenting late beyond the optimal window for PCI/thrombolysis by 34.71% (n = 376) and 31% (n = 341) of participants, respectively. There were 68.5% (n = 742) of respondents that were of opinion that the time component of MI care that has increased most was time between symptom onset to first medical contact, followed by time between medical contact to catheterization laboratory arrival, as opined by 20% (n = 217) of the participants. It was reported that patients undergoing no reperfusion due to delayed treatment were increased to less than 25%, as reported by 43.4% (n = 471), respondents. This was followed by 32.5% (n = 352), respondents reporting that there was 26%–50% increase in the number of patients undergoing no reperfusion due to delayed treatment. Immediate thrombolysis was preferred by 28% (n = 304) of participants from the teaching institutions. There were 75.1% (n = 814) of the participants, that tested patients for COVID-19 before shifting to the catheterization laboratory. Conclusion: This is one of the largest perception mapping exercises, limited with the absence of actual patient data, which is a cohesive reflection in line with global evidence for a remarkable decrease in cases and interventions for the management of MI. The lessons from the experiences entail that there is a need to encourage patients with symptoms suspected of MI to promptly contact emergency services to enable timely diagnosis and enable reperfusion therapy. Impact on the MI management appears to be substantial, which calls for action for change in infrastructure and policy framework to improvise MI care.
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Effectiveness of a home-based cardiovascular disease prevention program during the COVID-19 pandemic p. 37
Priya Chockalingam, Vaishnav Natarajan, Tharani Sekar, Rajaram Anantharaman, Meeranghani Mohamed Yusuf, Sengottuvelu Gunasekaran, Pradeep G Nayar, V Chockalingam
Purpose: Home-based cardiovascular disease (CVD) primary prevention (HBPP) and cardiac rehabilitation (HBCR) programs which occupied a small proportion of the overall Preventive Cardiology work in the past have become mainstream during the COVID-19 pandemic. This study aims to analyze the effectiveness of a home-based CVD prevention program implemented during the pandemic in India. Methods: A retrospective study was conducted on prepandemic and pandemic enrollees. Health behavior, CVD risk factors, physical and mental component score (PCS, MCS) from SF-12 questionnaire, body mass index (BMI), 6-min walk distance (6MWD), and clinical and biochemical parameters were assessed. A multidisciplinary team consisting of Physician, Physiotherapist, Dietician, and Counseling Psychologist provided the program using telehealth platforms. Results: Of the 66 subjects (55 ± 13 years, 73% male), 17 (26%) enrolled prepandemic and 49 (74%) enrolled during pandemic, 28 (42%) were HBPP, and 38 (58%) were HBCR participants. Majority of the subjects (n = 51, 77%) with significantly more HBCR than HBPP participants harbored 4 or more risk factors (P = 0.04). In the 60 (91%) program completers, BMI, 6MWD, PCS, and MCS had improved significantly. Systolic blood pressure, diastolic blood pressure, left ventricular ejection fraction, glycosylated hemoglobin, total cholesterol, and low-density lipoproteins had improved significantly in affected subjects. Completely home-based participants (n = 44, 67%) who never had any in-person contact with the team during the program also showed significant improvement. No adverse events were reported. Conclusions: Comprehensive home-based CVD prevention programs are effective in improving anthropometric, clinical, biochemical, and psychosocial parameters, are a safe alternative to conventional programs, and could potentially become the standard-of-care in the postpandemic era.
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Diagnostic accuracy of coronary artery calcium score for excluding obstructive coronary artery disease p. 44
Manish Bansal, Deepak Sharma, Ravi R Kasliwal
Background: Studies in western populations have shown that zero coronary artery calcium score (CACS) is associated with a very low prevalence of obstructive coronary artery disease (CAD), even in patients presenting with chest pain. However, no data are available about the relationship between CACS and coronary artery plaques among Indian subjects. Methods: A total of 380 subjects undergoing comprehensive health check, including computed tomography coronary angiography (CTCA), at a tertiary care center in North India were included. The distribution of CACS was correlated with the coronary plaque burden and with the clinical and laboratory investigation findings. Results: The mean age of the subjects was 52.8 ± 10.0 years, and 71.8% were men. The median CACS value in the study population was 0 (interquartile range 0–4.3). Two-third of all the subjects had zero CACS and 91 (23.9%) had CACS between 1 and 99. Nonobstructive and obstructive (>50% stenosis) plaques were found in 106 (27.9%) and 24 (6.3%) subjects, respectively. Only 5.9% of the subjects with zero CACS had any coronary plaque and only 1.2% had obstructive plaques, yielding zero CACS 98.8% negative predictive value for excluding obstructive disease. Conclusion: This study shows that similar to the western populations, in Indian subjects also, zero CACS is associated with a very low prevalence of obstructive CAD and has excellent negative predictive value for ruling it out. Further large studies in diverse patient subgroups, including those with stable or unstable chest pain, are required to validate these findings.
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Evaluation of clinical and biochemical parameters of trinidadian patients with coronary artery disease for predicting the revascularization strategy p. 50
Tamika Kachada Monplaisir, B Shivananda Nayak, Geetha Bhaktha, Ronan Ali, Surapaneni Krishna Mohan, Jenifer Mallavarapu Ambrose
Background: In recent times, optimal revascularization approaches have been used for treating multi-vessel obstructive coronary artery disease (CAD) patients. Based on the disease severity, making the decision to perform a suitable revascularization intervention in the patients is of paramount importance. Aim: This study aimed to evaluate the biochemical parameters of patients with suspected CAD in Trinidad and assess their clinical significance for predicting revascularization strategy. Materials and Methods: One hundred and twenty-four patients referred for angiography were recruited for the study. Biochemical parameters such as fasting blood sugar (FBS), lipid profile, cardiac enzymes, creatinine, uric acid, N-terminal probrain natriuretic peptide (NT-proBNP), soluble ST2, interleukin 6, and hemoglobin A1C (HbA1c) were explored. Similarly, we examined clinical parameters such as age, the presence of chronic conditions, and ethnicity. Results: With respect to revascularization strategies, FBS, NT-proBNP, HbA1c, and soluble ST2 correlated moderately with coronary artery bypass grafting (CABG) by Point-Biserial correlations: FBS-r = 0.196, P = 0.029, NT-proBNP-r = 0.208, P = 0.020, soluble ST2-r = 0.178, P = 0.048, and HbA1c-r = 0.282, P = 0.001. The presence of Type 2 diabetes (T2D) at baseline and ethnicity also formed statistically significant associations with CABG-ethnicity (χ2 (1) =7.267, P = 0.007) and T2D at baseline (χ2 (1) =12.858, P < 0.001). Conclusion: Ethnicity and presence of T2D were also significantly associated with both CAD severity and revascularization decision-making and should be taken into consideration for further study. Further investigation of these parameters might prove to be useful to predict the revascularization strategy required for treating CAD patients.
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Moderator band calcification masquerading infrahisian conduction system disease p. 56
Debasish Das, Tutan Das, Subhas Pramanik, Anindya Bannerjee, Abhinav Kumar
Relationship between moderator band (MB) calcification and infrahisian conduction system disease has not been described in the world literature so far. We report a case of a 74-year old male presenting with recurrent cardiogenic syncope 6 times is the last 2 months.He had echocardiographic evidence of dense moderator band calcification.Electrophysiology study revealed a His-Ventricular(HV) interval of 100 msec suggestive of significant infrahisian conduction system disease.He was put on a dual chamber pacemaker and he had no further episode of syncope during the follow up. Our description is unique and the first in the world literature that dense MB calcification in echocardiography may be an indirect clue to the presence of severe infrahisian conduction system disease.
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Left atrial myxoma in a patient with hypertrophic obstructive cardiomyopathy p. 60
Jayaprasad Narayanapillai, Suresh Madhavan
Hypertrophic cardiomyopathy and left atrial myxoma are important cardiac causes of syncope. We present an extremely rare combination of these two diseases in a middle-aged man with syncope. Transthoracic echocardiographic images show the typical features of both conditions. There were no features of progressive cardiomyopathic lentiginosis (LEOPARD syndrome) which is known to be associated with both the conditions.
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