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   Table of Contents - Current issue
October-December 2022
Volume 11 | Issue 4
Page Nos. 91-114

Online since Monday, December 12, 2022

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Lifetime predicted risk of atherosclerotic cardiovascular disease among an urban cohort: A cross-sectional study p. 91
Nikita Maheshbhai Savani, Rajendra B Chauhan, Rajesh K Chudasama
Introduction: Although atherosclerotic cardiovascular disease (ASCVD) results have significantly improved in recent years, ASCVD continues to be the world's leading cause of morbidity and mortality. Therefore, in the present study, lifetime risk of ASCVD was calculated in an urban cohort. White-collar employees have higher risk of developing cardiovascular disease events because of their work profile. Aim and Objectives: To calculate lifetime predicted risk of ASCVD among study cohort and to explore factors contributing to the disparities of cardiovascular risks. Materials and Methods: This was community-based cross-sectional study. The baseline data were collected during the period 2016–2019 from Rajkot city, and their lifetime predicted risk of ASCVD was calculated using ASCVD risk calculator. Crude and adjusted prevalence ratio was calculated. Results: The study revealed that 69.25% and 6.37% of participants had low and intermediate lifetime predicted risk of ASCVD, respectively, while the remaining 16.12% and 8.25% had borderline and high risk, respectively. Conclusion: This study indicates that increased lifetime predicted risk of ASCVD was associated with increasing age, male, stress, elevated blood pressure, high level of body mass index, and central obesity among participants.
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The short outcomes and in-hospital complications in patients with STEMI revascularized with primary PCI: A prospective registry from India p. 96
Ambukeshwar Singh, Varun Narain, Jayesh Sharma, Gaurav Chaudhary, Pravesh Vishwakarma, Sharad Yadav, Sudhanshu Dwivedi
Context: Primary percutaneous coronary intervention (PCI) is the most effective reperfusion therapy with low complication rate in comparison to thrombolysis. Aims: We aimed to study the short-term outcomes of primary PCI at a large tertiary care center in India. Settings and Design: A prospective cohort of patients with ST-elevation myocardial infarction (STEMI) who underwent primary PCI was enrolled between December 2015 and November 2016. Subjects and Methods: The demographic profile, risk factors, clinical characteristics, inhospital complications, and outcomes at 30 days were assessed. The primary outcome was a composite of death, reinfarction, and repeat revascularization. Acute left ventricular failure (LVF), complete heart block (CHB) or bradyarrhythmia, ventricular tachycardia (VT) or ventricular fibrillation, stroke, and major thrombolysis in myocardial infarction bleeding were the inhospital complications that were considered the secondary outcomes. Results: A total of 237 STEMI patients with primary PCI were enrolled, accounting for 7.5% of all PCI procedures performed during this period. The mean age was 55.4 ± 11.9 years, and 86.5% were male. The mean window period was 5.1 ± 3.18 h, and the mean door-to-balloon time was 58.4 ± 11.5 min. Prior to PCI, the most often administered antiplatelets were clopidogrel in 54.4% of patients and prasugrel in 55.6%. The aspiration thrombectomy was done in 70.8% of patients. Predilatation with balloon was required in 41.8% of patients. Drug-eluting stents were implanted in 98.3% of patients. The primary outcome was found in 3.3% of patients (deaths – 2.9% and reinfarction – 0.4%) and the secondary outcomes were observed in 13%. The common inhospital complication was CHB or bradyarrhythmia in 5.0% followed by acute LVF in 4.6% and then VT in 2.1%. Conclusions: The primary outcome rate is as good as reported in developed Western countries in contemporary treatment practices of STEMI. CHB and acute LVF were the major inhospital complications among patients of STEMI treated with primary PCI.
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What is the Prevalence of Pulmonary Hypertension in Thalassemic Patients in Guilan? A Retrospective Analytic Study p. 102
Seyyed Aboozar Fakhr-Moosavi, Arsalan Salari, Yasaman Borghei, Tolou Hasandokht, Afrooz Haghdoost, Seyed Mehdi Mousavi, Sajad Ramezani
Introduction: Pulmonary hypertension (PH) is quite common among patients with thalassemia, and it can lead to cardiac failure and even death in those patients. Methods: This current cross-sectional study was conducted with 155 patients with β-thalassemia major and thalassemia intermedia referring to Razi Hospital Rasht, Iran in a recent year. All patients underwent echocardiography and the data (including age, sex, thalassemia type, splenectomy history, deferoxamine usage, hydroxyurea usage, hemoglobin, and ferritin level) were collected by a researcher-made checklist. Data analysis was performed using SPSS software. Results: The prevalence of PH was 13.7% in this study. There was a correlation between sex, thalassemia type, deferoxamine usage, and ferritin level with a prevalence of PH. However, there was not a significant relationship between splenectomy history, hydroxyurea usage, and hemoglobin level with PH prevalence (P = 0.187, P = 0.035, and P = 0.178, respectively). Conclusions: The findings of the study represented that the proposed variables can cause and exacerbate cardiac complications and may have a correlation with the disease's side effects. By conducting more studies and designing a more promising interventional study with a higher sample size, using the results of this study and similar studies, a step could be taken to identify patients susceptible to exacerbation of cardiac complications earlier. By treating them, we may be able to increase their chance of survival in the long run.
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Practical use of dual-lumen catheter-facilitated reverse wire technique for nonhighly angulated side branch p. 107
Issei Ota, Tetsuya Nomura, Kenshi Ono, Yu Sakaue, Keisuke Shoji, Naotoshi Wada, Natsuya Keira, Tetsuya Tatsumi
Dual-lumen catheter (DLC)-facilitated reverse wire technique is considered a method of last resort for inserting a guidewire into a markedly angulated side branch. Moreover, this technique can be practically applied to other types of anatomical variations around the bifurcation. Case 1 was that of a 53-year-old man with a tight stenosis of the proximal left anterior descending artery at the diagonal bifurcation with angiographically apparent coronary dissection. We successfully achieved guidewire insertion into the targeted branch using the DLC-facilitated reverse wire technique. Case 2 involved a 78-year-old man with total occlusion of the mid-portion of the right coronary artery. The guidewire reentry point in the atrioventricular branch was slightly distant from the true distal end of the occlusion. We successfully used the DLC-facilitated reverse wire technique to pass a second guidewire to the posterodescending artery. Case 3 was that of an 80-year-old man whose coronary artery had an aneurysm with severe stenoses at both entry and exit of the aneurysm. We adopted the DLC-facilitated reverse wire technique and easily advanced the guidewire by matching the guidewire advancing path with the direction of the sequential conduit constituted by the coronary aneurysm and stenosis. The timing of decision-making to try the DLC-facilitated reverse wire technique is important. The lesion for which reverse wiring is suitable is usually difficult to be treated with conventional guidewire crossing. We have to promptly judge the validity of applying this technique based on the angiographic findings of targeted lesions and take immediate action to implement this procedure to reduce the procedural time and irradiation dose.
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A rare case of williams–Beuren syndrome with presence of fibrocalcific supravalvular aortic stenosis and supravalvular pulmonary stenosis: Genetic disorder that bites the gene and bites the heart p. 111
Debasish Das, Anindya Banerjee, Abhinav Kumar, Shashikant Singh, Tutan Das, Manaranjan Dixit
We report an extremely rare case of Williams–Beuren (WB) syndrome in a 10-year-old boy with supravalvular aortic stenosis (SVAS) secondary to a large fibrocalcific eccentric shelf in the ascending aorta with fibrocalcific severe supravalvular pulmonary stenosis, which has not yet been described in the literature. Although the presence of peripheral pulmonary stenosis is well described in Williams syndrome (WS), our case is the unique and first to demonstrate fibrocalcific severe supravalvular pulmonary stenosis in WS without the presence of peripheral pulmonary artery stenosis. Although regarded as a strong genetic insult with 27 gene deletions (almost like biting the gene), it has also bitten the heart in this index child and left a large chunk of supravalvular fibrocalcific mass in the ascending aorta causing SVAS.
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