{"title":"India Cardiology Training Curriculum- A Critical Reappraisal: Is it the Time to Rethink?","authors":"Aditya Kapoor, Rishi Sethi, Rakesh Yadav","doi":"10.1016/j.ihj.2025.05.012","DOIUrl":"https://doi.org/10.1016/j.ihj.2025.05.012","url":null,"abstract":"<p><p>The challenges and rigors of the modern-day health care systems demand a critical reappraisal of our training paradigms in cardiology. Today, modern day DM and DNB Cardiology training needs to seamlessly amalgamate traditional teaching methodologies with the rapidly evolving technology based educational tools now available to us for personalized and adaptive learning. The contemporary cardiology curricula need to incorporate ALL components of clinical competency including cognitive, psychomotor and affective skills to enable the next generation of cardiologists to provide truly holistic care to their patients. In addition, a greater focus on impactful cardiology research with an intent to publish it while in training, is likely to encourage at least some of the young trainees to pursue careers in academia. Most importantly, the exit examination patterns need to be restructured. We need to decide whether we need cardiologists who simply follow textbooks and are trained in procedures -or we need those who have the ability to themselves write the next chapters in cardiology, have the precision of thought, the depth of empathy, and the courage to question.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A comprehensive review on myocardial infarction with non-obstructive coronary arteries (MINOCA): One size does not fit all.","authors":"Babu Ezhumalai, Ranjan Modi, Sundar Chidambaram","doi":"10.1016/j.ihj.2025.05.013","DOIUrl":"10.1016/j.ihj.2025.05.013","url":null,"abstract":"<p><p>Myocardial infarction with non-obstructive coronary arteries (MINOCA) is defined as clinical evidence of myocardial infarction (MI) without significant obstruction (<50 % stenosis) in coronary angiography, making it a clinically distinct and heterogeneous disorder. Unlike MI associated with obstructive coronary artery disease (MICAD), MINOCA is more common in younger women and often involves microvascular dysfunction or vasospastic conditions. Despite recent advancements in understanding MINOCA, its prognosis and predictors remain uncertain, necessitating further research into its pathogenesis. The diverse underlying causes of MINOCA mean that traditional treatment of the \"one-size-fits-all\" approach used for MICAD may not be appropriate, emphasizing the need for individualized treatment strategies based on accurate diagnosis. There is an urgent need to raise awareness among healthcare providers, implement standardized diagnostic protocols, and conduct targeted research to improve patient outcomes. Multi-centered studies and clinical trials are essential to establish evidence-based therapies and optimize management strategies for MINOCA, ensuring better long-term outcomes.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zina Otmani, Noura Abdrabou, Hazem Ayman Elsayed, Mazen Negmeldin Aly Yassin, Mohamed Abouzid, Mahmoud Diaa Hindawi, Ahmed K Awad
{"title":"The Effect of Mavacamten on Echocardiographic Parameters, Cardiac Function and Biomarkers in Hypertrophic Cardiomyopathy Patients, A Systematic Review and Meta-Analysis.","authors":"Zina Otmani, Noura Abdrabou, Hazem Ayman Elsayed, Mazen Negmeldin Aly Yassin, Mohamed Abouzid, Mahmoud Diaa Hindawi, Ahmed K Awad","doi":"10.1016/j.ihj.2025.05.011","DOIUrl":"https://doi.org/10.1016/j.ihj.2025.05.011","url":null,"abstract":"<p><strong>Background: </strong>Evaluate the effect of mavacamten on echocardiographic parameters and cardiac biomarkers in patients with hypertrophic cardiomyopathy (HCM).</p><p><strong>Methods: </strong>We searched PubMed, SCOPUS, Web of Science, and Cochrane Library until November 2023. Results were reported as mean difference (MD) and Risk Ratio (RR) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>Seven studies with 524 patients (456 with obstructive HCM and 59 with non-obstructive HCM) were included. Mavacamten significantly improved septal early diastolic mitral annular velocity (e') (MD 0.78, 95% CI [0.51 to 1.05]) and left ventricular mass index (LVMI). It reduced left ventricular outflow tract (LVOT) gradient, NT-proBNP (MD -557.14, 95% CI [-685.59 to -428.68]), and troponin levels. Improvements were also seen in left atrial volume index (MD -6.26, 95% CI [-8.88 to -3.63]) and E/e' ratios, particularly in obstructive HCM patients.</p><p><strong>Conclusion: </strong>Mavacamten enhances echocardiographic and cardiac biomarker outcomes in HCM patients on short-term follow-up. Limited data on non-obstructive HCM require cautious interpretation.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manish Kapoor, Arun Kumar Gunasekaran, Valerie Lyngdoh, Reuben Lamiaki Kynta, Pinak Pani Das
{"title":"Incidence and risk factors of pacemaker pocket infection - an observational study.","authors":"Manish Kapoor, Arun Kumar Gunasekaran, Valerie Lyngdoh, Reuben Lamiaki Kynta, Pinak Pani Das","doi":"10.1016/j.ihj.2025.05.009","DOIUrl":"10.1016/j.ihj.2025.05.009","url":null,"abstract":"<p><p>This retrospective, hospital-based observational study was aimed to examine the indications for PPM implantation, risk factors, demographics, and microbiological profiles of PPM infections (PPMI). The study included patients presenting with local inflammatory signs and excluded those under 18 years old. Of the 716 patients who underwent Cardiac Implantable Electronic Device (CIED) implantation, 37.7 % received single-chamber devices and 52.8 % received double-chamber devices. PPMI was identified in 15 patients (2.09 %), with infections more prevalent in devices implanted over 12 months prior. Diabetes (36.11 %) and hypertension (32.56 %) were the most common comorbidities. Culture-negative infections (53.33 %) predominated, followed by methicillin-resistant Staphylococcus aureus (MRSA) (33.33 %).</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ranajit Naik, Abhishek Prabhu, Mohan Gan, Richard Saldanha
{"title":"Early outcomes of aortic valve neocuspidization (the Ozaki procedure): Initial experience of a single centre.","authors":"Ranajit Naik, Abhishek Prabhu, Mohan Gan, Richard Saldanha","doi":"10.1016/j.ihj.2025.05.008","DOIUrl":"10.1016/j.ihj.2025.05.008","url":null,"abstract":"<p><strong>Introduction: </strong>Aortic valve neocuspidization (AVNeo) using fixed autologous pericardium, also known as the Ozaki technique, is an effective therapy for treating aortic valvulopathies. It serves as an alternative to complex aortic valve repair, offering better hemodynamics compared to biological or mechanical valve replacement, without the need for lifelong anticoagulation.</p><p><strong>Objectives: </strong>To evaluate the immediate and early outcomes of our initial experience with the AVNeo procedure in a spectrum of aortic valve diseases.</p><p><strong>Methods: </strong>In this retrospective cohort study, seventeen AVNeo procedures were performed between March 2023 and October 2023 at our center. All patients completed one year of follow-up. Outcomes were assessed by echocardiographic evaluation postoperatively and at one year, including complications and mortality.</p><p><strong>Results: </strong>Patient age ranged from 7 to 77 years (mean 35.2 ± 22.4 years), with 3 females among the 17 patients. Aortic valve morphology was bicuspid in 6 (35.3 %) and tricuspid in 11 (64.7 %) patients. Twelve patients had aortic stenosis as the primary pathology, and five had moderate to severe aortic regurgitation. In aortic stenosis patients, the preoperative mean peak gradient was 82.3 ± 20.3 mmHg, and mean gradient was 48.9 ± 18.5 mmHg. Postoperatively, mean peak gradient reduced to 9 ± 5.3 mmHg, and mean gradient to 16.7 ± 9.1 mmHg. Two patients required conversion to prosthetic valve replacement for progressive aortic regurgitation. There was no mortality at one year, though one patient developed severe aortic regurgitation.</p><p><strong>Conclusion: </strong>AVNeo is a feasible, reproducible procedure with favorable early outcomes, low pressure gradients, and mild regurgitation at one year. It is a cost-effective option, particularly in resource-limited settings like India.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Atit A Gawalkar, Ganesh Paramasivam, Krishna Prasad Akkineni, Mahek Vijayvergiya, Pragya Karki, Nirmal Ghati, R Padmakumar, Rajiv Narang, Rajesh Vijayvergiya
{"title":"Current status of cardiology fellow training based on COCATS-4 framework: A cross-sectional study from three tertiary care institutes across India.","authors":"Atit A Gawalkar, Ganesh Paramasivam, Krishna Prasad Akkineni, Mahek Vijayvergiya, Pragya Karki, Nirmal Ghati, R Padmakumar, Rajiv Narang, Rajesh Vijayvergiya","doi":"10.1016/j.ihj.2025.05.010","DOIUrl":"10.1016/j.ihj.2025.05.010","url":null,"abstract":"<p><strong>Background: </strong>The Core Cardiology Training Symposium (COCATS) guidelines, endorsed by the American College of Cardiology (ACC) emphasize competency-based training and establish milestones to be met during cardiology training. However, India lacks such guidelines for training cardiology fellows.</p><p><strong>Objectives: </strong>The study aimed to evaluate the self-declared competencies of cardiology fellows across multiple preselected domains as per the COCATS-4 recommendations.</p><p><strong>Methods: </strong>The study was conducted at three premier institutions across India between June 2022 and December 2024. A total of 52 cardiology fellows who had recently completed their 3-year core cardiology training course were included in the study. These candidates completed a questionnaire that included a checklist assessing different levels of competency in various preselected aspects of cardiovascular medicine. Candidates were also asked about their awareness of COCATS-4 standards and cardiology training in India.</p><p><strong>Results: </strong>While all trainees reported Level 1 competency in cardiac catheterization, heart failure, and adult congenital heart disease, a significantly lower percentage of trainees achieved Level 1 competency in nuclear medicine (1.9 %), cardiac MRI (3.8 %), and cardiac CT (17.3 %). At Level 2, cardiac catheterization (73.1 %) and echocardiography (63.5 %) had the highest self-declared competencies, whereas nuclear medicine (3.8 %), cardiac MRI (0 %), and cardiac CT (0 %) had the lowest. Only 23.1 % of trainees were aware of COCATS-4, and 82.7 % believed that standardized guidelines would improve cardiology training in India.</p><p><strong>Conclusions: </strong>The results emphasize the wide variability in self-reported competencies of cardiology trainees across India and highlight the deficiencies in certain core areas like cardiovascular imaging.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"DETERMINATION OF INDUCTION TIME IN ADULT PATIENTS WITH VALVULAR HEART DISEASE.","authors":"Tanya Mital, Suruchi Hasija, Sambhunath Das, Sandeep Chauhan, Maroof A Khan","doi":"10.1016/j.ihj.2025.05.007","DOIUrl":"https://doi.org/10.1016/j.ihj.2025.05.007","url":null,"abstract":"<p><strong>Objective: </strong>Intravenous anaesthetics induce loss of consciousness in one arm-brain circulation time. As the circulatory transit time in patients with mitral stenosis (MS) and aortic stenosis (AS) is increased, the delivery of anaesthetics to the brain may be prolonged and consequently the onset of hypnosis. This study aimed to compare the induction time in patients with and without valvular heart disease (VHD).</p><p><strong>Design: </strong>Prospective, single-center, open-label analytical study.</p><p><strong>Setting: </strong>It was conducted in adult patients undergoing elective cardiac surgery.</p><p><strong>Participants: </strong>The patients (n = 144) were segregated into three groups; Group 1 - Stenotic VHD (MS, AS), Group 2 - Regurgitant VHD (Mitral Regurgitation, Aortic Regurgitation), and Group 3 - Control (coronary artery disease).</p><p><strong>Method: </strong>General anaesthesia was induced with intravenous thiopental 4mg kg<sup>-1</sup> bolus over 20s. The time to induction was noted as loss of eyelash reflex. Bispectral Index (BIS) values were recorded over 2 minutes. Statistical analysis was performed using SPSS software version 25.0. A P value < 0.05 was considered significant.</p><p><strong>Main results: </strong>Patients in Group 1 (n = 48) had significantly prolonged induction time (99.6 ± 12.9s; P < 0.001) compared to the other two groups (n = 48 each) (68.5 ± 9.6s in Group 2 and 70.4 ± 11.8s in Group 3). Time required for BIS to fall below 60 was significantly longer in Group 1 (139.4 ± 24.6s; P < 0.001) compared to Group 2 (90.4 ± 6.3s) and Group 3 (92.1 ± 12s).</p><p><strong>Conclusion: </strong>The induction time was prolonged in patients with stenotic VHD compared to patients with regurgitant VHD or those without VHD.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Analysis of risk factors of low cardiac output syndrome after pericardiectomy for tuberculous constrictive pericarditis: A retrospective study.","authors":"Shuangshuang Yan, Jing Guo, Shuzhen Wang, Lijuan Zhang, Li Zhang, Qiuyu Xiao, Qian Li, Zhengkai Zhao, Lijian Cheng, Feng Xiong","doi":"10.1016/j.ihj.2025.05.006","DOIUrl":"10.1016/j.ihj.2025.05.006","url":null,"abstract":"<p><strong>Objective: </strong>Low cardiac output syndrome (LCOS) is the leading cause of death after cardiac surgery. Studies have shown that 24% of postoperative mortality in patients undergoing pericardiectomy is attributed to LCOS. It is necessary to explore the risk factors of LCOS after pericardiectomy in patients with tuberculous constrictive pericarditis (CP).</p><p><strong>Methods: </strong>Patients undergoing pericardiectomy for tuberculous CP were included in the study. The personal and clinical data of these patients with LCOS and without LCOS were collected and compared. Logistic regression analyses were conducted to identify the risk factors of postoperative LCOS. ROC curve analysis was used to check the accuracy of each risk factor to predict LCOS.</p><p><strong>Results: </strong>A total of 175 patients with tuberculous CP were included in this study, of which 35 cases developed LCOS postoperatively, resulting in an incidence rate of 20%. The independent predictors of LCOS were preoperative NYHA class III/IV, decreased left ventricular mass index (LVMI), and hypoalbuminemia in these patients (p < 0.05). When albumin (ALB) < 30.35 g/L, it had the highest diagnostic value in predicting postoperative LCOS, with sensitivity and specificity of 59.4% and 86.9%, respectively (p < 0.01).</p><p><strong>Conclusions: </strong>For patients with tuberculous CP, preoperative NYHA class III/IV, lower LVMI, and hypoalbuminemia are independent risk factors for LCOS following pericardiectomy. Clinically, these risk factors should be identified as early as possible, and early pericardiectomy should be performed when the patient's cardiac function remains well-preserved to avoid the occurrence of cardiac cachexia, myocardial atrophy and severe hepatic insufficiency.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Emerging role of angiotensin receptor neprilysin inhibitor in right ventricular systolic dysfunction with preserved left ventricular ejection fraction.","authors":"Ertan Yetkin","doi":"10.1016/j.ihj.2025.05.005","DOIUrl":"10.1016/j.ihj.2025.05.005","url":null,"abstract":"","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Outcomes of post myocardial infarction ventricular septal rupture: Experience from an Indian tertiary cardiac center.","authors":"Pramod Sagar, Raghuram Chikkala, Sridhara Suthan, Aayisha Nasser, Kothandam Sivakumar, Rajan Sethuratnam, Valikapthalil Mathew Kurian, Mullasari Sankardas Ajit","doi":"10.1016/j.ihj.2025.05.002","DOIUrl":"https://doi.org/10.1016/j.ihj.2025.05.002","url":null,"abstract":"<p><strong>Background: </strong>Post myocardial infarction ventricular septal rupture (MI-VSR) is a devastating complication after acute myocardial infarction (AMI); lacks uniform treatment recommendations and carries poor outcomes.</p><p><strong>Objectives: </strong>To evaluate the outcomes of post MI-VSR, stratify based on management strategy and determine the predictors of survival.</p><p><strong>Methods: </strong>All cases of VSR hospitalized in a tertiary referral cardiac care center over 11 years were retrospectively evaluated for various parameters and stratified based on the modality of treatment, either conservative, surgical or transcatheter closure.</p><p><strong>Results: </strong>Among a total of 131 cases of VSR with a median age of 65 years, hospitalized from January 2013 to December 2023, 47(35.9 %) had surgical closure, 25(19.1 %) had transcatheter closure and the rest were managed conservatively. 11(8.4 %) cases alone underwent primary percutaneous coronary intervention (PCI). Apex was the commonest (79.3 %) site. Older patients and patients in higher stages of shock at the time of VSR diagnosis were often managed conservatively. Two-thirds of surgical patients were in SHOCK stage A or B; three-fourths of transcatheter group were in stage C or D. Overall mortality was 71 % with 100 % in conservative, 68 % in transcatheter closure and 36.2 % in surgical group. Younger age, lower shock stage, VSR closure, and delayed closure were predictors of survival.</p><p><strong>Conclusions: </strong>Post MI VSR outcomes were poor, based on the hemodynamic status. Closure of VSR is essential for survival. Surgical closure had lower mortality than transcatheter closure possibly contributed by a selection bias.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}