Journal of Clinical and Preventive Cardiology最新文献

{"title":"Baseline High-Sensitive-Cardiac Troponin I as a Predictor of Fatality in Stable Chronic Heart Failure Patients in Nigeria","authors":"O. Areo, S. Atiba, P. Olowoyo, O. Busari","doi":"10.4103/JCPC.JCPC_33_19","DOIUrl":"https://doi.org/10.4103/JCPC.JCPC_33_19","url":null,"abstract":"Background: The prognostic value of high-sensitive-cardiac troponin I (hs-cTnI), a biomarker for heart failure (HF), has been well studied in developed countries. However, its significance in patients with chronic HF (CHF) in Nigeria and Africa at large remains unknown. Methods: This was a hospital-based prospective study. Sixty-four consecutive consenting patients with clinical and echocardiographic evaluation for HF attending cardiology clinic were recruited. They all had resting 12-lead electrocardiogram done. Blood sample for serum hs-cTnI assay (enzyme-linked immunosorbent assay), electrolytes, urea, and creatinine was obtained at recruitment and at 6 months. The participants were followed up monthly for 6 months from baseline to determine the case fatality rate and hospitalization rate. Results: At the end of 6 months, four patients were lost to follow-up. Eight participants died of HF-related cause and had statistically significantly higher mean recruitment serum hs-cTnI levels than the survivors (0.35 ± 0.05 ng/ml vs. 0.23 ± 0.02 ng/ml),P ≤ 0.001. Baseline hs-cTnI ≥0.25 ng/ml was found to be an independent significant prognostic predictor of HF fatality on Cox regression analysis. Conclusions: This study demonstrated that hs-cTnI was predictive of HF fatality in a cohort of patients with CHF in Nigeria. Thus, it may be used to risk stratify patients as a guide to identify those likely to benefit from more aggressive management.","PeriodicalId":31371,"journal":{"name":"Journal of Clinical and Preventive Cardiology","volume":"9 1","pages":"8 - 12"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42012263","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":"Percutaneous intervention in thrombotically occluded grafted renal artery","authors":"V. Magarkar, D. Borgaonkar, Pravir Lathi, Suhas S. Bavikar","doi":"10.4103/JCPC.JCPC_41_19","DOIUrl":"https://doi.org/10.4103/JCPC.JCPC_41_19","url":null,"abstract":"Early kidney loss due to thrombosis of the renal artery is a rare yet a dreaded vascular complication. Arterial thrombosis can be averted only if arterial inflow is regarded as the cause of poor graft function and intervention is undertaken immediately. We report our experience of percutaneous intervention in a case of renal arterial thrombosis following renal allograft transplant.","PeriodicalId":31371,"journal":{"name":"Journal of Clinical and Preventive Cardiology","volume":"9 1","pages":"31 - 33"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45519536","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":"Prevalence and major cardiac causes of cardio-embolic stroke and in-hospital mortality in Eastern Nepal","authors":"Rajesh Nepal, M. Choudhary, Sahadev Dhungana, Sushant Katwal, S. Khanal, Madhav Bista, A. Monib, D. Kafle","doi":"10.4103/JCPC.JCPC_57_19","DOIUrl":"https://doi.org/10.4103/JCPC.JCPC_57_19","url":null,"abstract":"Background: Cardioembolism accounts for 15%–30% of all ischemic strokes. The study aims to assess conventional and major cardiac causes of cardio-embolic stroke, its prevalence, lesions associated with the side of weakness, and in-hospital mortality. Materials and Methods: Patients with cardio-embolic stroke over 18 months were included in the study. Groups were compared using Chi-square test and Student's t-test. Results: In 384 patients with ischemic stroke, 168 (44%) had a cardio-embolic stroke. Among these 168 cardio-embolic patients, 56% were male and 44% female with a mean age of 69 ± 1 year. Dyslipidemia (72%), hypertension (69%), smoking (34%), and diabetes (33%) were the most prevalent conventional cardiovascular risk factors in these patients. Atrial fibrillation (AF) (71%) was the most common specific cardiac cause for cardio-embolic stroke. Hypertension was present in more than 76%, while dyslipidemia in 66% of patients with AF. Seventeen patients (10%) had in-hospital mortality, while nine (5%) left the hospital against medical advice. The in-hospital mortality rates were not different in AF patients as compared to those with sinus rhythm (59% vs. 41%,P = 0.225). However, patients with left ventricular ejection fraction ≤50% had a higher rate of mortality when compared to patients with normal ejection fraction (P < 0.001). Patients with AF had a higher incidence of left-sided weakness when compared to sinus rhythm (P = 0.049). Conclusion: Hypertension and dyslipidemia were the most prevalent conventional risk factors, while AF was the most common cardiac cause of cardio-embolic stroke. Reduced left ventricular ejection fraction less than 50% was significant predictor of in-hospital mortality in cardio-embolic stroke patients.","PeriodicalId":31371,"journal":{"name":"Journal of Clinical and Preventive Cardiology","volume":"9 1","pages":"19 - 24"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47538091","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":"Total cardiovascular risk assessment of women in delta state, Nigeria, using the world health Organization/International Society of Hypertension risk prediction chart","authors":"E. Umuerri, I. Obiebi","doi":"10.4103/JCPC.JCPC_50_19","DOIUrl":"https://doi.org/10.4103/JCPC.JCPC_50_19","url":null,"abstract":"Background: Globally, women are not exempt from the menace of cardiovascular diseases. Methods: This cross-sectional study assessed the 10-year cardiovascular risk (CVR) for stroke or myocardial infarction of women aged ≥18 years attending opportunistic medical screening programs in two suburban communities in Delta State, Nigeria. Consenting women were consecutively recruited for the study, and the study instrument was the World Health Organization/International Society of Hypertension prediction chart for Africa (AFR D) without blood cholesterol. Total CVR was graded as low (<10), moderate (10–< 20), and high (≥20). Results: Data from 456 women were analyzed; 50.9% were aged >40 years, 9.9% had never married, and 39.9% had a secondary level of education. The mean body mass index (29 vs. 27 kg/m2), systolic blood pressure (140 vs. 121 mmHg), diastolic blood pressure (87 vs. 77 mmHg), and blood glucose (104 vs. 92 mg/dl) were significantly higher among women aged ≥40 years. Smoking, hyperglycemia, and hypertension were noted in 0.0%, 7.0%, and 34.4% of the women, respectively. The 10-year risk of stroke or myocardial infarction was low in 87.7%, moderate in 7.2%, and high in 5.0% of the women. All the respondents with high CVR were aged ≥40 years. Among respondents aged <40 years, 98.2% had low CVR. Significant associations were observed between CVR and age (P < 0.001), marital status (P = 0.047), and level of education (P < 0.001). Conclusion: This study shows that 12.2% of the women have a moderate-to-high 10-year risk of stroke or myocardial infarction. Increasing age and lower educational levels were significantly associated with a high CVR. Educating women indeed have far-reaching benefits on their cardiovascular health.","PeriodicalId":31371,"journal":{"name":"Journal of Clinical and Preventive Cardiology","volume":"9 1","pages":"2 - 7"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48890128","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":"Recent trials in heart failure","authors":"Mayank Gupta, R. Mehrotra","doi":"10.4103/JCPC.JCPC_8_20","DOIUrl":"https://doi.org/10.4103/JCPC.JCPC_8_20","url":null,"abstract":"The benefits observed among diabetic patients were expected, given the strong signal of lower hospitalization for HF observed in the cardiovascular outcome trials with dapagliflozin (DECLARE–TIMI 58), canagliflozin (CANVAS 2017 and CREDANCE 2019), and empagliflozin (EMPA‐REG 2015). However, the magnitude of the benefit was similar to other foundational HF therapies (RAAS inhibitors, beta-blocker, and cardiac resynchronization therapy). This was quite unexpected and will result in a change in current practice approaches.","PeriodicalId":31371,"journal":{"name":"Journal of Clinical and Preventive Cardiology","volume":"9 1","pages":"34 - 36"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47126651","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":"Two T waves following one QRS complex – Unusual treadmill test tracings due to printer malfunction","authors":"S. Mittal","doi":"10.4103/jcpc.jcpc_39_19","DOIUrl":"https://doi.org/10.4103/jcpc.jcpc_39_19","url":null,"abstract":"We observed two T waves following one QRS complex during treadmill stress testing of three patients evaluated on the same machine. Careful analysis revealed that this happened due to transient stopping of the printer of the machine.","PeriodicalId":31371,"journal":{"name":"Journal of Clinical and Preventive Cardiology","volume":"8 1","pages":"183 - 185"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45273173","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":"Impact of comorbidities in heart failure – prevalence, effect on functional status, and outcome in indian population: A single-center experience","authors":"S. Mehrotra, Tejinder Sharma, A. Bahl","doi":"10.4103/JCPC.JCPC_27_19","DOIUrl":"https://doi.org/10.4103/JCPC.JCPC_27_19","url":null,"abstract":"Background: We sought to estimate the prevalence of comorbidities in heart failure (HF) patients and their impact on functional status and clinical outcomes in Indian population. Patients and Methods: This prospective study was carried out at a tertiary care institute in North India. Patients were followed up prospectively for readmission and mortality for a median of 18 months. Results: A total of 113 HF patients were included in the study – 59 being HF with preserved ejection fraction (HFpEF) and 54 being HF with reduced ejection fraction (HFrEF). Patients with HFpEF were older (P = 0.03) with an equal proportion of males and females. Patients with HFpEF were less intensively treated with HF medications, particularly, spironolactone and other diuretics (P = 0.001). A total of 17 comorbidities were identified, and patients with HFpEF exhibited a higher burden of total and noncardiac comorbidities. After 18 months of follow-up, the all-cause readmissions and all-cause mortality were higher (P = 0.01) in patients with HFrEF as compared to HFpEF. The high New York Heart Association (NYHA) class, low ejection fraction, and high proBNP were associated with an increased risk of all-cause mortality. The mean Geriatric Nutritional Risk Index (GNRI) was significantly low in the HFrEF group (96.4 ± 10.8 vs. 102.3 ± 12.9, P = 0.009). Quality of life was poor in patients with HFrEF as compared with the HFpEF group, and 36-item Short-Form Health Survey score decreased proportionately with a decrease in EF. Multivariate analysis showed EF, GNRI, albumin (mg/dl), urea (mg/dl), sodium, and all-cause mortality to be associated with HF-related readmissions. Furthermore, NYHA class, urea (mg/dl), all-cause readmission, and HF-related readmission were seen to be associated with HF-related mortality. Conclusion: Despite differential prevalence, comorbidities exert substantial impact on the functional status in HFrEF as well as HFpEF patients. An individualized treatment approach based on comorbidities could provide a way forward, especially in low-resource countries.","PeriodicalId":31371,"journal":{"name":"Journal of Clinical and Preventive Cardiology","volume":"8 1","pages":"166 - 172"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45897970","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 study of cardiac dysfunction in human immunodeficiency virus-infected patients and its correlation with cd4 count","authors":"V. Tuteja, C. Nawal, C. Meena, Aradhana Singh, R. Chejara, Rajbeer Singh, P. Bansal","doi":"10.4103/JCPC.JCPC_20_19","DOIUrl":"https://doi.org/10.4103/JCPC.JCPC_20_19","url":null,"abstract":"Introduction: Human immunodeficiency virus (HIV) is an infectious disease, leading to rapid failure of the immune system. Since the introduction of combination antiretroviral therapy (ART), it has led to a substantial decrease in the incidence of AIDS-related conditions and all-cause mortality over time. However, clinical chronic nonAIDS conditions including cardiovascular disease are on a rise with the prolonged life expectancy of HIV-infected patients. Study Design: The study design involves hospital-based observational comparative analysis.Materials and Methods: A total of 200 individuals, including 100 infected with HIV and 100 controls, were taken after ruling out the various exclusion factors. Cases were further scrutinized on the basis of CD4 count and duration of highly active ART. Every patient underwent a battery of tests, and also various echocardiography parameters were recorded and analyzed carefully. Results: Male:female ratio in cases and controls was 3.3:1. Cases were divided according to CD4 count, as patients having CD4 <200/200–350/>350. The mean CD4 count was 108.47 ± 36.51/277.85 ± 46.73/576.63 ± 195, respectively. Forty-one percent of individuals had abnormal electrocardiography findings, pulmonary hypertension (PH) was found in 10% of patients, and also three patients (30%) had a moderate grade of PH. Twenty-seven percent had minimal pericardial effusion. Among cases, the mean ejection fraction observed was 54.68% ± 6.82% which was significantly lower than controls (60.72% ± 1.47%). Left ventricular diastolic dysfunction was seen in 46% of cases as compared to 3% controls. Conclusions: This study indicates that cardiovascular abnormalities are more common in HIV-infected patients than the normal population. Even asymptomatic patients had abnormal echocardiographic findings. Echocardiography is a useful noninvasive technique for the early recognition of cardiac dysfunction in such patients.","PeriodicalId":31371,"journal":{"name":"Journal of Clinical and Preventive Cardiology","volume":"8 1","pages":"156 - 160"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41891929","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":"Wellysis S-PAtch Cardio versus Conventional Holter Ambulatory Electrocardiographic Monitoring (The PACER Trial): Preliminary Results","authors":"S. Upadhyayula, R. Kasliwal","doi":"10.4103/JCPC.JCPC_43_19","DOIUrl":"https://doi.org/10.4103/JCPC.JCPC_43_19","url":null,"abstract":"Aims and Objectives: The Wellysis S-PAtch Cardio versus Conventional Holter Ambulatory Electrocardiographic Monitoring (PACER) trial consists of multiple arms. First arm is a prospective, interventional, nonrandomized, single group assignment, diagnostic substudy with intention to treat. This head-to-head trial aims to compare the diagnostic yield, or ability to detect arrhythmias – especially paroxysmal atrial fibrillation (PAF) – of the conventional Ambulatory Holter monitoring device with the Wellysis S-Patch Cardio, a novel, low-profile device consisting of a single positive bipolar lead corresponding to the standard limb lead II (n = 10). Second arm is a validation substudy of the Wellysis S-Patch Cardio device in terms of overall performance (n = 86). Background: It is widely recognized that technology can improve the health of populations in countries around the world. Smartphone technology is at the forefront of innovation in low-, middle-, and high-income countries. The smartphone technology has already improved the doctor–patient interaction, reducing costs and improving care for patients. Methodology: In the comparator arm, patients who satisfied the eligibility criteria as well as referred for ambulatory ECG monitoring were consented and enrolled prospectively to have the Holter monitor and the Wellysis S-Patch Cardio device placed simultaneously (n = 10) for 24–48 h and the incidence of clinically significant arrhythmias were compared. A feedback questionnaire was given to patients/paramedics and clinicians after completion of the study. The overall performance (patient, paramedic and clinician feedback and questionnaire derived subjective composite index of comfort, usability, interference with daily activities, adverse events, adaptability, robustness, repeatability, durability, clinical analysis, clarity of recorded signals, efficiency, accuracy, and cost-effectiveness) of Wellysis S-Patch Cardio device was compared with multi lead Holter Monitor in this head to head trial (n = 10). In the validation arm patients who satisfied the eligibility were consented and enrolled prospectively to have the Wellysis S-Patch Cardio device placed (n = 86) for 24–48 h and the incidence of clinically significant arrhythmias noted. Results: Preliminary results from the comparator arm (n = 10), Mc Nemars analysis, revealed odds ratio 1.000, 95% confidence interval 0.072–13.796, χ2 = 0.250, DF = 1, P < 0.6171; supporting the null hypothesis-Wellysis S-Patch Cardio is comparable to Holter in terms of Overall Performance (comfort, usability, interference with daily activities, adverse events, adaptability, robustness, repeatability, durability, clinical analysis, clarity of recorded signals, efficiency, accuracy, and cost-effectiveness). Conclusion: Multi lead ambulatory Holter monitoring remains the gold standard for arrhythmia detection. However, Wellysis S-Patch Cardio device has a definite complementary role in the detection of PAF in cryptogenic ","PeriodicalId":31371,"journal":{"name":"Journal of Clinical and Preventive Cardiology","volume":"8 1","pages":"173 - 182"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43608894","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":"Can Shorter Fluoroscopic Time Obviates the Need of Routine Heparin Use in Coronary Angiography via Femoral Route? A Prospective Study","authors":"O. Anil, N. Chaudhary, A. Sayami, Saheb K Jayswal, N. Maharjan, B. Manandhar, P. Koirala, Ujit Karmacharya","doi":"10.4103/JCPC.JCPC_28_19","DOIUrl":"https://doi.org/10.4103/JCPC.JCPC_28_19","url":null,"abstract":"Background: The use of heparin in coronary angiography (CAG) through radial route is a well-known practice. However, the prophylactic use of heparin following the femoral arterial sheath insertion is still controversial, so we aimed to assess the safety of CAG without the use of heparin through femoral approach by minimizing fluoroscopy time. Methods: All patients undergoing diagnostic CAG through femoral approach were enrolled in our study. Heparin was not given after femoral sheath insertion contrary to the usual practice. Depending on the fluoroscopy time, patients were divided into three groups: (a) group with fluoroscopy time <2 min, (b) group with fluoroscopy time 2–5 min, and (c) group with fluoroscopy time 5–10 min. The study patients were prospectively assessed for any thrombus formation or embolic event. Femoral puncture site and other complications were also studied simultaneously. Patients with primary/elective angioplasty and longer fluoroscopy time (>10 min) were excluded from the study as well as those who received heparin. Results: Altogether, 1550 patients were enrolled in the study over a period of 3 years. The mean age of the study population was 57.0 ± 12.5 years; 71% of the patients were male. Fluoroscopy time was <2 min in 63% of the patients, 2–5 min in 33% of the patients, and 4% of the patients had fluoroscopy time of 5–10 min. No thromboembolic clinical events were recorded in the entire population during the study. Femoral sheath thrombus was seen in only 2.9% of the patients, and all of these cases had a fluoroscopy time of 𕟷 min. Conclusion: CAG can be safely performed through femoral route without the use of heparin and without any associated thromboembolic complications if fluoroscopy time is <10 min.","PeriodicalId":31371,"journal":{"name":"Journal of Clinical and Preventive Cardiology","volume":"8 1","pages":"161 - 165"},"PeriodicalIF":0.0,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44223508","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}