John Jose

Assessment of right ventricular strain and strain rate in patients with severe mitral stenosis before and after balloon mitral valvuloplasty.

OBJECTIVE Right ventricular (RV) dysfunction in isolated severe mitral stenosis (MS) patients have prognostic significance. Study aim was to assess RV function in these subjects by strain and strain rate analysis, pre and post-balloon mitral valvuloplasty (BMV). METHODS Twenty five patients with isolated severe MS in sinus rhythm were assessed for RV function by two dimensional (2D) longitudinal strain & strain rate imaging before and after BMV and compared with that from twelve healthy age matched controls. RESULTS Patients with severe MS had significantly lower global RV systolic strain; segmental strain at basal, mid, apical septum and basal RV free wall; but similar strain at mid and apical RV free wall as compared to controls. The systolic strain rate was significantly lower only at mid septum. In addition, they had higher estimated pulmonary artery systolic pressure and RV myocardial performance index; lower tricuspid annular plane systolic excursion (TAPSE), peak systolic velocity at lateral tricuspid annulus, isovolumic acceleration and fractional area change (FAC). Global RV systolic strain as well as, segmental strain at basal, mid and apical septum showed a statistically significant rise after BMV. TAPSE and FAC also increased significantly post BMV. CONCLUSIONS RV systolic function is impaired in patients with severe MS and can be assessed by global and segmental RV strain before the appearance of clinical signs of systemic venous congestion. Impaired global and segmental RV strain values in these patients are primarily due to increased after load and improve after BMV with reduction in RV afterload.

Comparison of Bailout and Planned Rotational Atherectomy for Heavily Calcified Coronary Lesions: A Single-Center Experience

OBJECTIVES The aim of this study was to compare outcomes of bailout and planned rotational atherectomy (RA) in the treatment of calcified coronary lesions. BACKGROUND Current guidelines recommend RA as a bailout procedure for calcified or fibrotic lesions that cannot be adequately dilated before stenting. Nonetheless, planned RA is sometimes performed in certain challenging anatomies. METHODS Data of patients treated with RA between 2002 and 2014 at a single-center registry were retrospectively analyzed. The bailout RA group included patients where RA was employed after failure of balloon dilatation or stent delivery. Planned RA included patients where RA was employed electively without previous device failure. RESULTS The study comprised 204 patients (221 lesions) and 308 patients (338 lesions) treated with bailout or planned RA, respectively. Angiographic success was achieved in the majority of cases, but was lower in the bailout RA group (93.7% vs. 97.6%, P = 0.02). Coronary dissections occurred more frequently in the bailout RA group (8.6% vs. 4.4%, P = 0.04), mean contrast amount was higher (279 ± 135 mL vs. 202 ± 92 mL, P < 0.001), and fluoroscopy time and procedural duration were longer in that group (32 min [IQR 21-51] vs. 18 min [IQR 14-28], P < 0.001 and 111 ± 50 min vs. 76 ± 35 min, P < 0.001, respectively). In-hospital death and myocardial infarction were not significantly different between the groups (2.9% vs. 1.3%, P = 0.21 and 6.9% vs. 4.2%, P = 0.19). In-hospital major adverse cardiac events (MACE) were higher in the bailout RA group (10.3% vs. 5.5%, P = 0.04). The 2-year estimated rates of MACE (25.2% vs. 28.7%, log rank P = 0.52) and its components death, myocardial infarction, and target vessel revascularization were not significantly different between the groups. Equivalence of 2-year MACE rates was also seen in all examined subgroups. CONCLUSION Shortened procedural duration and reduction of coronary dissections were observed with planned RA for selected lesions. However, this strategy does not affect long-term clinical outcomes.

Management algorithms for acute ST elevation myocardial infarction in less industrialized world

AIIMS, New Delhi, India Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal 576104, Karnataka, India Department of Cardiology, AIIMS, New Delhi, India d PES-IMSR Superspeciality Hospital, Kuppam, District Chittoor, Andhra Pradesh, India e Interventional Cardiology & HOD Cardiology, The Mission Hospital, Durgapur, India f Sengupta Hospital and Research Institute, Nagpur, Maharashtra, India Clinical Research, Fortis Health Care, Fortis Escorts Heart Institute, Okhla Road, New Delhi 110025, India Apollo Speciality Hospitals, Vanagram, Chennai, India Medical College Vadodara, Vadodara, India Department of Cardiology, MGM New Bombay Hospital, New Mumbai 400702, India k Christian Medical College Hospital Vellore, Vellore 632004, India Dept of Medicine, Kishori Ram Hospital & Diabetes Care Centre, Kishori Ram Road, Basant Vihar, Bhatinda, India Moolchand Medicity, New Delhi, India Cardiology Department, LTMGH Sion, Mumbai, India CARE Hospitals, Hyderabad, India Dept of Cardiology, BHU, Varanasi, India

Relationship between peri-strut low intensity areas and vascular healing response after everolimus-eluting bioresorbable scaffold implantation: An optical coherence tomography study

BACKGROUND Peri-strut low intensity areas (PLIA) surrounding metallic coronary stent struts on optical coherence tomography (OCT) images have been histologically related to delayed healing and inflammation, and have been associated with neointimal proliferation. The relationship between PLIA and vascular healing response after bioresorbable scaffold (BRS) implantation remains unclear. METHODS This study includes 38 consecutive patients (50 scaffolds) evaluated using OCT 12 months after BRS implantation. Mean and percent neointimal area were quantified. A PLIA was defined as a peri-strut region with an homogenous lower intensity appearance than the surrounding tissue on OCT images without significant signal attenuation. Cross sections were scored as follows: score 0, no PLIA; score 1, <1 quadrant; score 2, ≥1 but <2 quadrants; score 3, ≥2 quadrants but <3 quadrants; and score 4, ≥3 quadrants. Scaffolds were divided into two groups (PLIA+ and PLIA-) based on the presence or absence of any PLIA in the scaffold segment. RESULTS The frequency of any PLIA within the scaffold segment was 70.0%. The median PLIA score per scaffold was 0.51 (interquartile range 0-1.07). Using both scaffold- and frame-level analysis, a significant positive correlation was observed between PLIA score and both mean and percent neointimal area. Mean and percent neointimal area were significantly higher in the PLIA+ group than in the PLIA- group (1.95±0.65mm2 vs. 1.51±0.27mm2, p<0.01 and 24.0±7.0% vs. 17.4±3.6%, p<0.01, respectively). CONCLUSION The presence and extent of PLIA on OCT imaging after BRS implantation appears to be significantly associated with neointimal formation.

Testosterone as a marker of coronary artery disease severity in middle aged males

Historically, higher levels of serum testosterone were presumed deleterious to the cardiovascular system. In the last two decades, studies have suggested that low testosterone levels are associated with increased prevalence of risk factors for cardiovascular disease (CVD), including dyslipidemia and diabetes. This is a cross sectional study. The aim of our study was to determine the relationship between serum testosterone levels and angiographic severity of coronary artery disease (CAD). Serum testosterone levels were also correlated with flow mediated dilation of brachial artery (BAFMD) – an indicator of endothelial function. Consecutive male patients, aged 40–60 years, admitted for coronary angiography (CAG) with symptoms suggestive of CAD, were included in the study. Out of the 92 patients included in the study, 32 patients had normal coronaries and 60 had CAD on coronary angiography. Severity of CAD was determined by Gensini coronary score. The group with CAD had significantly lower levels of total serum testosterone (363 ± 147.1 vs 532.09 ± 150.5 ng/dl, p < 0.001), free testosterone (7.1215 ± 3.012 vs 10.4419 ± 2.75 ng/dl, p < 0.001) and bioavailable testosterone (166.17 ± 64.810 vs 247.94 ± 62.504 ng/dl, p < 0.001) when compared to controls. Adjusting for the traditional risk factors for CAD, a multiple linear regression analysis showed that low testosterone was an independent predictor of severity of CAD (β = −0.007, p < 0.001). This study also showed that levels of total, free and bioavailable testosterone correlated positively with BAFMD %.

Bacteriological and molecular studies of group A streptococcal pharyngitis in a south Indian hospital.

the total diagnosed TB co-infection patients, 29 had active disease and were put on ATT. Nine patients had already been treated with ATT after being diagnosed with HIV infection. Patients with HBV were treated with 2NRTIs (Zidovudine + Lamivudine) + 1NNRTI (Efavirenz) and patients with syphilis were treated with Benzathine penicillin G, 2.4 MU IM in a single dose. The patients are on regular follow-up.

Transjugular Balloon Mitral Valvotomy in a Patient With Inferior Vena-Caval Interruption

Balloon mitral valvotomy (BMV) is an effective method of relieving severe rheumatic mitral valve stenosis in patients with suitable valve morphology. In the vast majority of patients, BMV can be successfully performed using femoral venous access; however, certain congenital or acquired anomalies of

Setting up a transcatheter aortic valve implantation program: Indian perspective.

Transcatheter aortic valve implantation (TAVI) has revolutionized the management of elderly patients with symptomatic severe aortic stenosis in the western world. It is a valuable alternative to surgical aortic valve replacement in patients, who are inoperable or at high surgical risk due to co-morbidities. The prevalence of aortic stenosis increases sharply with age after the sixth decade and is expected to have a significant impact on the geriatric health care system of India, given the rapid increase in life expectancy in recent years. Although a decade has passed since the first TAVI implantation, it is yet to penetrate most of the developing countries in a major way. This short review focuses on fundamentals of initiating a TAVI program based on the experience of a high volume TAVI center with a successful program in Germany.

Follicular thyroid carcinoma with tumour thrombus extending into superior vena cava and right atrium – A case report

Intra-cardiac extension of tumour thrombus of follicular carcinoma of thyroid is uncommon. We report a case of advanced thyroid carcinoma where tumour thrombus was well profiled with CT scan and transesophageal echo images and extension was noted from SVC into right atrium, with clinical features of superior vena cava syndrome. The clinical significance of the “ring sign” is discussed.

Radiation dose from percutaneous transluminal coronary angioplasty procedure performed using flat detector for different clinical angiographic projections

The radiation dose from complex cardiac procedures is of concern due to the lengthy fluoroscopic screening time and vessel complexities. This study intends to assess radiation dose based on angiographic projection and vessel complexities for clinical protocols used in the performance of percutaneous transluminal coronary angioplasty (PTCA). Dose-area product (DAP), reference air kerma (K a,r) and real-time monitoring of tube potentials and tube current for each angiographic projection and dose setting were evaluated for 66 patients who underwent PTCA using a flat detector system. The mean DAP and cumulative K a,r were 32.71 Gy cm2 (0.57 Gy), 51.24 Gy cm2 (0.9 Gy) and 102.03 Gy cm2 (1.77 Gy) for single-, double- and triple-vessel PTCA, respectively. Among commonly used angiographic projections, left anterior oblique 45°-caudal 35° reached 2 Gy in 55 min using a low-dose fluoroscopy setting and 21 min for a medium-dose setting. Use of a low-dose setting for fluoroscopic screening showed a radiation dose reduction of 39% compared with a medium-dose setting.