Upendra Kaul, Rishi Sethi, Sanjeeb Roy, P K Goel, Nagendra Singh Chouhan, Rajesh Vijayvergiya, Manish Narang, Priyadarshini, D K Baruah, Rony Mathew
{"title":"Morphological characterization of coronary plaques in young indian patients with acute coronary syndrome: A multicentric study.","authors":"Upendra Kaul, Rishi Sethi, Sanjeeb Roy, P K Goel, Nagendra Singh Chouhan, Rajesh Vijayvergiya, Manish Narang, Priyadarshini, D K Baruah, Rony Mathew","doi":"10.1016/j.ihj.2024.11.001","DOIUrl":"10.1016/j.ihj.2024.11.001","url":null,"abstract":"<p><strong>Objectives: </strong>The prevalence of atherosclerosis and acute coronary syndrome (ACS) is increasing in young Indians (18-50 years of age). However, the characteristics of atherosclerotic plaques in such individuals are poorly understood, presenting distinct challenges for the management of ACS. This study aims to analyze plaque characteristics in young Indian patients with ACS who underwent percutaneous coronary intervention (PCI) using optical coherence tomography (OCT) imaging.</p><p><strong>Methods: </strong>This was a prospective, multicentric, non-interventional study on patients aged 18-50 years presenting with ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction, or unstable angina, and were scheduled to undergo OCT-guided PCI. Major adverse cardiac events (MACE) were assessed post-procedure and at the 6-month and 12-month follow-ups.</p><p><strong>Results: </strong>The study included 100 ACS patients (mean age = 43.6 ± 5.2 years), with 51% presenting with STEMI. Pre-PCI OCT assessment showed that fibrous plaques (75%) were most common followed by plaques containing macrophages (27%), microchannels (20%), and calcified nodules (14%). In addition, plaque rupture, plaque erosion, and lipid-rich plaques, along with red, white, and mixed thrombi, were observed in 31%, 25%, 24%, 21%, 14%, and 17% (total thrombus occurrence = 52%) of the patients, respectively. At 12 months, the MACE (coronary artery bypass graft) rate was 1%.</p><p><strong>Conclusions: </strong>Young Indian patients with ACS displayed a range of plaque morphologies identified through pre-PCI OCT. Among these, fibrous plaques were the most prominent type, followed by plaques containing macrophages. Additionally, plaque rupture, plaque erosion, and lipid-rich plaques were also observed in this population.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583118","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":"Safety and efficacy of protamine after transcatheter aortic valve replacement.","authors":"Lakshmi Durga Kumaraguruparan, Asuwin Anandaram, Kamalakkannan G Sambandam, Yogapriya Chidambaram, Bharath Raj Kidambi, Gautam Ganesan Karthikeyan, Madhesh Kasi, Rizwan Suliankatchi Abdulkader, Sankaran Ramesh, Vadivelu Ramalingam, Ravindran Rajendran, Nagendra Boopathy Senguttuvan","doi":"10.1016/j.ihj.2024.09.001","DOIUrl":"10.1016/j.ihj.2024.09.001","url":null,"abstract":"<p><p>Transfemoral Trans-catheter Aortic Valve Replacement (TF-TAVR) is a safe alternative to surgical aortic valve replacement (SAVR). Protamine is used to reverse heparin and reduce post-TAVR bleeding, but concerns about risks like valve thrombosis and stroke remain. This systematic review and meta-analysis, following PRISMA guidelines, found no statistically significant difference in major bleeding complications between the protamine and control groups [(3.0 % vs. 14.4 %); RR: 0.56; P = 0.16]. No differences were noted in life-threatening bleeding, blood transfusions, 30-day mortality, or stroke. Protamine appears safe post-TAVR without increasing stroke risk, but its effectiveness in reducing bleeding needs further investigation through a multicentric randomized study.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345935","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}
Indian heart journalPub Date : 2024-09-01Epub Date: 2024-10-09DOI: 10.1016/j.ihj.2024.10.006
Rajesh Kumar, Naveed Ullah Khan, Ayaz Mir, Khalid Naseeb, Gulzar Ali, Arti Ashok, Mukesh Kumar, Abiha Urooj, Uroosa Safdar, Aisha Hussain, Muhammad Ishaq, Tahir Saghir, Jawaid Akbar Sial, Abdul Hakeem, Musa Karim
{"title":"Do collaterals to infarct bed in STE-ACS patients undergoing emergent percutaneous coronary revascularization matter? An assessment of a prospective pool for in-hospital course.","authors":"Rajesh Kumar, Naveed Ullah Khan, Ayaz Mir, Khalid Naseeb, Gulzar Ali, Arti Ashok, Mukesh Kumar, Abiha Urooj, Uroosa Safdar, Aisha Hussain, Muhammad Ishaq, Tahir Saghir, Jawaid Akbar Sial, Abdul Hakeem, Musa Karim","doi":"10.1016/j.ihj.2024.10.006","DOIUrl":"10.1016/j.ihj.2024.10.006","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist on the role of coronary collaterals circulation (CCC) in patients with ST-elevation acute coronary syndrome (STE-ACS). This study aimed to assess CCC and the in-hospital course of patients with CCC undergoing primary percutaneous coronary intervention (pPCI).</p><p><strong>Methods: </strong>The study included consecutive STE-ACS patients undergoing pPCI. Good CCC was defined as Rentrop collateral score (RCS) of 2-3. Patients with good and poor CCC were compared regarding clinical characteristics, angiographic patterns, and hospital course.</p><p><strong>Results: </strong>In the sample of 4683 patients, mean age was 55.6 ± 11 years, and 78.8 % were male. Good CCC was observed in 499 (10.7 %) patients. The rate of intra-procedure slow-flow/no-reflow (SF/NR) was 29.9 % vs. 20.5 % (p < 0.001), and the rate of composite adverse clinical outcomes (CACO) was 21.2 % vs. 19 % (p = 0.225) for patients with good and poor CCC, respectively. Multivariable analysis identified left ventricular end-diastolic pressure (LVEDP), multi-vessel disease (MVD), and thrombus grade ≥4 as independent predictors of good CCC, with adjusted odds ratios of 0.98 [0.97-0.99], 1.69 [1.35-2.10], and 3.45 [2.64-4.52], respectively. In propensity-matched cohorts, the intra-procedure SF/NR rate was 29.9 % vs. 26.9 % (p = 0.292), and the rate of CACO was 21.2 % vs. 23.4 % (p = 0.403) for patients with good and poor CCC, respectively.</p><p><strong>Conclusion: </strong>Angiographic evidence of good CCC in STE-ACS patients was limited. Good CCC was associated with a higher prevalence of MVD, high thrombus burden, and low pre-procedure LVEDP, resulting in a higher incidence of intra-procedure SF/NR. However, the CACO did not differ significantly between patients with good and poor CCC.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400147","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}
Indian heart journalPub Date : 2024-09-01Epub Date: 2024-10-11DOI: 10.1016/j.ihj.2024.10.005
Maitri M Patel, Sumantkumar G Patel, Jigar K Patel, Dhruvkumar M Patel, Poojan J Prajapati, Harsh D Patel, Jayesh S Prajapati, Lalitkumar B Patel, Mukundkumar V Patel
{"title":"A groundbreaking electrocardiographic observation: \"Isoelectric horizontal ST-segment with sharp ST-T angle\" a novel sign for acute coronary syndrome.","authors":"Maitri M Patel, Sumantkumar G Patel, Jigar K Patel, Dhruvkumar M Patel, Poojan J Prajapati, Harsh D Patel, Jayesh S Prajapati, Lalitkumar B Patel, Mukundkumar V Patel","doi":"10.1016/j.ihj.2024.10.005","DOIUrl":"10.1016/j.ihj.2024.10.005","url":null,"abstract":"<p><p>Consecutive suspected acute coronary syndrome (ACS) cases were categorized into three groups: Group-1 (ST-depression), Group-2 (T-inversion), and Group-3 (remaining cases). Group-3 was subclassified into isoelectric horizontal ST-segment with sharp ST-T-angle (IHST) positive and IHST negative groups. They underwent serial high-sensitive Troponin-I testing. ACS incidence was 77.96 %, with 33.02 %, 15.96 %, and (15.04 %, 35.96 %) of patients in Groups 1, 2, and 3 (IHST positive, IHST negative), respectively. The presence of IHST exhibited higher sensitivity than T-inversion and greater specificity than ST-depression in detecting ACS. The presence of IHST sign additionally detected 15.04 % of ACS. The presence of IHST was significant among group-3 (p = 0.008) as well as the overall ACS cases (p = 0.048).</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464240","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}
Indian heart journalPub Date : 2024-09-01Epub Date: 2024-08-30DOI: 10.1016/j.ihj.2024.07.009
Anil Kumar Boddu, Bijulal S, Krishnamoorthy Km, Ajit Kumar Vk
{"title":"Long-term outcomes of percutaneous coronary intervention in patients with prior coronary artery bypass graft - A retrospective experience.","authors":"Anil Kumar Boddu, Bijulal S, Krishnamoorthy Km, Ajit Kumar Vk","doi":"10.1016/j.ihj.2024.07.009","DOIUrl":"10.1016/j.ihj.2024.07.009","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the long-term clinical outcomes of percutaneous coronary intervention (PCI) in patients who had previously undergone coronary artery bypass grafting (CABG).</p><p><strong>Method: </strong>A total of 219 patients who had a history of CABG and underwent PCI at tertiary care centre were retrospectively enrolled in this study. Clinical endpoints such as major adverse cardiac events (MACE; cardiac death, non-fatal myocardial infarction [MI], and target vessel revascularization), any death, cardiac death, MI, target vessel revascularization (TVR), and target lesion revascularisation (TLR) were reported at long-term follow-up.</p><p><strong>Results: </strong>About 66.6 % patients were treated on the native vessel, and 24.2 % on grafts vessel. In all, 360 stents [83.3 % drug-eluting stent (DES) and 16.6 % bare metal stent (BMS)] were implanted. Diabetes mellitus (p = 0.03), LVEF<55 % for PCI (p = 0.04), stent type [BMS (p < 0.001) and DES (p < 0.001)] and chronic kidney disease [(CKD) p < 0.01] were appeared to be the significant predictors of mortality. Age at CABG>50 years (p = 0.04), stent type [BMS (p = 0.03) and DES (p < 0.01)] and CKD (p < 0.01) as independent predictors for MACE. Higher event rate was reported in graft-vessel PCI group as compared to native-vessel PCI group: ISR (p < 0.01), TLR (p = 0.01), mortality (p = 0.04), MACE (p < 0.01) and MI (p = 0.05). Mortality (p < 0.001), MACE (p < 0.001) and MI (p < 0.001) were significantly lower in DES vs. BMS groups.</p><p><strong>Conclusion: </strong>Native-vessel PCI was associated with better clinical outcomes than graft-vessel PCI that also with the use of DES as the first choice in patients with a history of CABG.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107006","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":"Drug abuse and ACS in the very young (less than 30 years): Demographic, clinical and angiographic profile.","authors":"Shibba Takkar Chhabra, Gurleen Kaur, Samir Kapoor, Aastha Kapila, Gagandeep Kaur, Prannav Jain, Pankaj Kumar, Namita Bansal, Mamta Bansal, Anshuman Gupta, Akash Batta, Gautam Singal, Abhishek Goyal, Rohit Tandon, Naved Aslam, Bishav Mohan, Gurpreet Singh Wander","doi":"10.1016/j.ihj.2024.10.003","DOIUrl":"10.1016/j.ihj.2024.10.003","url":null,"abstract":"<p><strong>Aim: </strong>To identify incidence, type of drug abuse study clinical and angiographic profile in very young population presenting with acute coronary syndrome (ACS).</p><p><strong>Materials and methods: </strong>All consecutive patients less than 30 years with ACS included and segregated into Group 1 and 2 (with and without drug abuse respectively) RESULT: n = 153; n = 17 in group 1 of whom 35.29 % consumed opium, 17.64 % energy drinks, 17.64 % whey protein supplements, 17.64 % inhaled marijuana, 5.88 % heroin and spasmoproxyvon and 23.52 % multi-substance abusers. STEMI, Single vessel disease and urban domicile were predominant. Rising trends of drug abuse were identified in prospective (28.20 %) versus retrospective (5.30 %) timeframe (p = 0.011).</p><p><strong>Conclusion: </strong>Rising trends of drug abuse, a potentially modifiable risk factor of ACS in the young are alarming. Strict regulations are needed to curb this menace.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464241","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}
Indian heart journalPub Date : 2024-09-01Epub Date: 2024-10-09DOI: 10.1016/j.ihj.2024.10.002
Deep Dutta, Kunal Mahajan, Lokesh Verma, Gunjan Gupta, Meha Sharma
{"title":"Gender differences in the management and outcomes of acute coronary syndrome in indians: A systematic review and meta-analysis.","authors":"Deep Dutta, Kunal Mahajan, Lokesh Verma, Gunjan Gupta, Meha Sharma","doi":"10.1016/j.ihj.2024.10.002","DOIUrl":"10.1016/j.ihj.2024.10.002","url":null,"abstract":"<p><strong>Background: </strong>Gender differences in acute coronary syndrome (ACS) outcomes have been noted in global data, which however did not analyse Indian data. No prior systematic review and meta-analysis (SRM) has addressed this important aspect of gender bias in Indian women with ACS. Hence this SRM aimed to address this knowledge gap.</p><p><strong>Methods: </strong>Electronic databases were searched for studies in ACS comparing cardiovascular disease presentation, treatment received and outcomes in women and men from India. Primary outcomes were to evaluate gender-differences in 30-day death and major adverse cardiovascular events (MACE). Secondary outcomes were to evaluate gender-differences in presentation, management and mortality. The SRM is registered with PROSPERO (CRD42023477286).</p><p><strong>Results: </strong>From initially screened 3753 articles, data from 9 studies (61,185 patients) were analysed. Women with ACS had higher prevalence of diabetes [Odds ratio (OR) 1.65(95%CI:1.33-2.04); p < 0.001; I<sup>2</sup> = 95 %] and hypertension [OR2.06(95%CI:1.88-2.25); p < 0.001; I<sup>2</sup> = 42 %]. Smoking was significantly lower in women [OR 0.05(95%CI:0.03-0.07); p < 0.001; I<sup>2</sup> = 87 %]. Non-ST elevation myocardial infarction (NSTEMI) was significantly higher in women [OR 1.92(95%CI:1.66-2.21); p < 0.001; I<sup>2</sup> = 0 %]. Diagnostic angiography [OR 0.64(95%CI:0.56-0.74); p < 0.001; I<sup>2</sup> = 46 %] and percutaneous coronary interventions [OR0.71(95%CI:0.55-0.92); p = 0.01; I<sup>2</sup> = 92 %] were significantly lower in women. Women had significantly higher 30-day mortality [Hazard ratio (HR)2.26(95%CI:2.01-2.55); p < 0.001; I<sup>2</sup> = 6 %], 1-year mortality [HR2.41(95%CI:1.89-3.07); p < 0.001; I<sup>2</sup> = 53 %], in-hospital death [HR1.88(95%CI:1.19-2.96); p = 0.007; I<sup>2</sup> = 92 %], stroke [HR 1.84 (95%CI:1.34-2.52); p < 0.001; I<sup>2</sup> = 0 %] and MACE outcomes [OR 2.05 (95%CI:1.78-2.35); p < 0.001]. Use of aspirin, clopidogrel, beta-blockers and nitrates were significantly lower in women.</p><p><strong>Conclusion: </strong>Our study highlights worse outcomes in Indian women with ACS. Higher burden of diabetes and hypertension, decreased used of PCI and lesser aggressive pharmacotherapy may be some of the contributing factors.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400148","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}
Indian heart journalPub Date : 2024-09-01Epub Date: 2024-09-28DOI: 10.1016/j.ihj.2024.09.002
Sai Satish, Vijayakumar Subban, Yerramareddy Vijayachandra, Abraham Oomman, Ganapathy Arumugam, Hemalatha Senthil, Hema Kethavath, Kamala Devi Pulindram, Saibal Kar, Susheel Kodali, Krishnaswamy Chandrasekaran
{"title":"Outcomes of mitral transcatheter edge to edge repair with MitraClip™ - An Indian single center experience.","authors":"Sai Satish, Vijayakumar Subban, Yerramareddy Vijayachandra, Abraham Oomman, Ganapathy Arumugam, Hemalatha Senthil, Hema Kethavath, Kamala Devi Pulindram, Saibal Kar, Susheel Kodali, Krishnaswamy Chandrasekaran","doi":"10.1016/j.ihj.2024.09.002","DOIUrl":"10.1016/j.ihj.2024.09.002","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the outcomes of transcatheter edge-to-edge repair (TEER) with MitraClip™ (Abbott Vascular) in symptomatic high surgical risk Indian patients with significant mitral regurgitation (MR).</p><p><strong>Methods: </strong>Patients with moderately severe or severe primary or secondary MR and deemed high surgical risk were treated with MitraClip™. The data were collected retrospectively from medical records. The primary outcome was technical success, and secondary outcomes were ≤2+ MR reduction and improvement in functional capacity at 30 days.</p><p><strong>Results: </strong>Between November 2018 and August 2023, 64 patients were treated with MitraClip<sup>TM</sup>. The mean age was 70.0 ± 12.1 years and 64 % were males. The mean EuroScore II and STS score predicted mortality for mitral valve repair were 5.8 ± 4.5 % and 4.0 ± 3.8 % respectively. MR etiology was primary in 56.3 %, secondary in 40.6 % and mixed in 3.1 %. The device was implanted successfully in all but one patient with technical success rate of 98.4 %. The average number of clips per patient was 1.5 ± 0.6 and 42.2 % patients received more than one clip. The mean mitral valve gradient was 3.5 ± 1.6 mmHg. The MR severity of ≤2+ was achieved in 91.8 % of the subjects and similar proportion were in New York Heart Association Functional Class I or II at 30 days.</p><p><strong>Conclusion: </strong>In high-risk Indian patients with symptomatic significant MR, TEER with MitraClip™ was achieved with a high technical success rate. It was associated with significant reduction in MR severity and improvement in functional capacity in >90 % of the subjects.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345934","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}
Indian heart journalPub Date : 2024-09-01Epub Date: 2024-10-10DOI: 10.1016/j.ihj.2024.10.001
Parag Barwad, Navjyot Kaur, Bhupendra K Sihag, Sanjeev H Naganur
{"title":"Long-term outcome of variety of techniques used to stabilize left ventricular lead in difficult coronary sinus anatomy- A single centre experience.","authors":"Parag Barwad, Navjyot Kaur, Bhupendra K Sihag, Sanjeev H Naganur","doi":"10.1016/j.ihj.2024.10.001","DOIUrl":"10.1016/j.ihj.2024.10.001","url":null,"abstract":"<p><strong>Introduction: </strong>Difficult coronary sinus (CS) anatomy may lead to difficulty in optimal left ventricular (LV) lead placement and lead displacements leading to nonresponse to cardiac resynchronization therapy (CRT).</p><p><strong>Methods: </strong>In this retrospective study, we studied the CRT parameters of devices implanted by single operator during the time period from January 2014 till December 2021, where different off-label techniques were used to place/stabilize LV lead. The technique used to stabilize LV lead, CRT parameters at baseline and follow up were noted for each patient.</p><p><strong>Results: </strong>Out of 133 CRTs implanted during the study period, 23 patients (17.29 %) required off-label techniques. Stylet and guidewire retaining techniques were used in 11/23 (47.82 %) and 7/23 (30.43 %) patients respectively. In two patients, LV lead was jailed using coronary stent to prevent displacement. Two patients had CS stenosis and required balloon dilation while one patient had tortuous posterolateral vein which was straightened using a coronary stent. There was technical failure of 6/23 LV leads (26.08 %) with loss of capture, at a median follow up of 44 months (Range: 06-114 months). Out of these 6 patients, stylet and guidewire retaining techniques were used in 4 and 2 patients respectively.</p><p><strong>Conclusion: </strong>Despite having acceptable parameters at implantation, these techniques particularly stylet and guidewire retention, may lead to non-capture of LV lead on long term follow ups. Better LV leads like active fixation leads and conduction system pacing (His Bundle/left bundle branch pacing) should be preferred in difficult CS anatomy.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406377","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":"Use of strain imaging to detect subtle myocardial involvement in post COVID-19 patients: An Indian perspective.","authors":"Deepak Tomar, Aditya Kapoor, Zia Hashim, Kamlesh Raut, Arpita Katheria, Harshit Khare, Ankit Sahu, Roopali Khanna, Sudeep Kumar, Naveen Garg, Satyendra Tewari","doi":"10.1016/j.ihj.2024.09.003","DOIUrl":"10.1016/j.ihj.2024.09.003","url":null,"abstract":"<p><strong>Background: </strong>The study assessed Global longitudinal strain imaging (GLS) to detect subtle myocardial dysfunction among patients clinically recovered from COVID-19.</p><p><strong>Methods: </strong>All patients (n = 101 76 % males, mean age 55.45 ± 11.14 years), and controls (n = 30), underwent clinical assessment and echocardiography, including GLS assessment.</p><p><strong>Results: </strong>The prevalence of diabetes mellitus, hypertension and dyslipidemia was comparable amongst patients and controls. The average GLS was significantly lesser in post COVID patients (-16.21 ± 1.96 vs -18.49 ± 1.64 respectively, p = 0.004) and significantly higher proportion of post COVID patients had GLS > -18 % (43 % vs 22.58 % respectively, p = 0.001) as compared to controls. The RV free wall longitudinal strain (RVFLS) was also lower in the patient group (22.35 ± 4.69 vs 24.19 ± 4.11, p = 0.004) and 21.7 % post COVID-19 patients had pathological RV FWLS (> -20 %) vs controls (6.6 %). Average GLS was significantly lesser in severe post COVID patients (viz -14.25 ± 1.92 vs -16.63 ± 1.61 vs -17.63 ± 1.91, p < 0.0001, respectively among severe, moderate and mild COVID-19 patients. On performing regression analysis, severity of COVID-19 (OR 7.762) was a significant predictor of impaired GLS.</p><p><strong>Conclusion: </strong>Despite normal global LVEF, post COVID-19 recovered patients had significantly lower LV GLS and RV FWLS with severe COVID-19 infection, regardless of having a clinical recovery. This study reiterates the importance of speckle tracking echocardiography as an important imaging modality for detection of subclinical myocardial dysfunction in the post COVID-19 recovered patients.</p>","PeriodicalId":13384,"journal":{"name":"Indian heart journal","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371740","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}