Nishant Kalra

Climate Change, Climate Variability and Indian Agriculture: Impacts Vulnerability and Adaptation Strategies

Climate is changing naturally at its own pace, since the beginning of the evolution of earth, 4–5 billion years ago, but presently, it has gained momentum due to inadvertent anthropogenic disturbances. These changes may culminate in adverse impact on human health and the biosphere on which we depend. The multi-faceted interactions among the humans, microbes and the rest of the biosphere, have started reflecting an increase in the concentration of greenhouse gases (GHGs) i.e. CO2, CH4 and N2O, causing warming across the globe along with other cascading consequences in the form of shift in rainfall pattern, melting of ice, rise in sea level etc. The above multifarious interactions among atmospheric composition, climate change and human, plant and animal health need to be scrutinized and probable solutions to the undesirable changes may be sought.

Update on tetralogy of Fallot for the adult cardiologist including a brief historical and surgical perspective.

There has been a steady rise in the prevalence of severe congenital heart disease (CHD) in adults because of improved treatment and survival during childhood. This has resulted in a shift in CHD morbidity and mortality beyond 18 years of age. The healthcare community must be prepared to meet this new challenge. Adult cardiologists need to be aware of common CHD, such as tetralogy of Fallot (TOF), as they will encounter adults with this CHD in their practice. With routine monitoring, cardiac imaging, early intervention, and treatment as highlighted in this report, continued improvement in the long-term fitness and avoidance of late complications for adult TOF patient is anticipated.

Tricuspid regurgitation after orthotopic heart transplantation.

Background: Tricuspid regurgitation (TR) is a relatively common abnormality in normal adults as well as after orthotopic heart transplantation (OHT). A few studies have shown reduction in the incidence of TR after OHT by total bicaval surgical anastomosis technique. Other studies reported no significant difference in the rates of TR between the standard and bicaval techniques. Objective: Evaluate and compare the degree of TR after OHT by standard and bicaval anastomosis techniques. Method: Echocardiograms from the first 56 consecutive patients that had the total bicaval surgical technique performed were retrospectively reviewed and compared with the last 57 consecutive patients who had the standard biatrial technique performed. Patients with adequate two‐dimensional and Doppler echocardiograms were included. Results: No statistical difference was observed for each grade of TR at both early and late time points. No significant difference was observed between the TR velocities of both biatrial and bicaval anastomosis patients at different periods. Conclusion: There appears to be no difference between the TR severity and TR velocity at early and late time points regardless of anastomotic technique. (Echocardiography 2010;27:1‐4)

Left atrial appendage aneurysm-a rare anomaly with an atypical presentation.

Left atrial appendage aneurysm (LAAA) is a rare condition caused by congenital dysplasia of the atrial muscles. Patients usually present with atrial tachyarrhythmias as a result of ectopic foci of atrial rhythm generation or systemic thromboembolism. We report a case of a 38-year-old Native American female presenting with 1-month history of cough, in sinus rhythm, and found to have a large cyst-like structure next to the left ventricular lateral wall on transthoracic echocardiography. This structure was later confirmed as a LAAA on cardiac magnetic resonance imaging. Patient underwent aneurysmectomy without any complications.

Cardiac imaging in right ventricular cardiomyopathy/dysplasia—how does cardiac imaging assist in understanding the morphologic, functional, and electrical changes of the heart in this disease?

Arrhythmogenic right ventricular dysplasia/cardiomyopathy is a complex disease and a difficult diagnosis to make that requires a multifaceted approach. Genetic mutations in proteins that alter the cardiomyocyte gap junction formation, stabilization, and general function lead to electrical and structural disturbances. The electrocardiogram (ECG) remains an excellent barometer of severe disease, but there is a large variation in the electroanatomic relationship and the ECG is less sensitive for detection of concealed early disease. With added knowledge of the genotypic/phenotypic expressions of this disease, continued experience with and development of current imaging modalities, and greater use of quantitative, 3-dimensional interpretative techniques, it seems clear that imaging will continue to play a pivotal role in collaborating with the ECG findings for the screening, diagnostic, prognostic, and serial assessment of patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy.

Comparison of LVEF Obtained with Single-Plane RAO Ventriculography and Echocardiography in Patients with and without Obstructive Coronary Artery Disease

The left ventricular ejection fraction (LVEF) determined by invasive ventriculography (routine cardiac cath; LV‐gram) was compared with that determined by echocardiography in 100 patients scheduled for angiography (86% had LV‐gram and 2DE during same hospital admission). Seventy percent of patients had at least single‐vessel obstructive coronary artery disease, defined as more than 50% stenosis. By all estimates, the LVEF was higher in patients without coronary artery disease (CAD) compared to patients with CAD. There was an excellent correlation between the LVEF by cath and echo, but this correlation was noticeably less strong in patients with CAD, especially with involvement of the left circumflex artery. (ECHOCARDIOGRAPHY, Volume 26, July 2009)

Left Ventricular Endocardial and Epicardial Border Length Delineation with Perflutren Contrast during Transthoracic Echocardiography

Objective: Precise estimation of wall motion abnormalities during routine echocardiography rests on optimal endocardial border visualization. Endocardial “dropout” may result in the misinterpretation of regional wall motion. Left ventricular opacification (LVO) with intravenous contrast improves the visualization of the left ventricular endocardial border length (EnBL). The purpose of this study was to determine if contrast also improves the visualization of the epicardial border length (EpBL) in addition to the EnBL. Method: This is a single center retrospective observational study. From 200 consecutive patients referred to the Echocardiography Laboratory for the assessment and evaluation of coronary artery disease, 73 patients who received contrast were enrolled. All the images were standardized using offline software. The visualized segments of the epicardium and endocardium were measured in diastole and systole, without and with contrast‐enhancement and these segments were summed to provide the total visualized EnBL and EpBL. Results: Contrast enhanced imaging improved EnBL by 65% and 45% in end‐diastolic and end‐systolic views, respectively. Similarly, EpBL was improved by 61% and 57% in end‐diastolic and end‐systolic views, respectively (all P values <0.05). Conclusion: Contrast LVO improves the EnBL as previously reported. Additionally, based upon the blinded review of 1,752 regional myocardial wall segments, this study is the first to suggest that contrast also enhances the visualization of the EpBL. This finding has direct clinical implications as the improvement in both EnBL and EpBL with contrast may assist in evaluation of regional left ventricular wall thickening which is a critical parameter used to assess for myocardial ischemia. (Echocardiography 2011;28:761‐766)

Transient Severe Mitral Regurgitation after Mitral Valve Repair Is Associated with a Poor Clinical Outcome: A Small Case Series

Background: During mitral valve repair, patients with transesophageal echo‐detected immediate postoperative systolic anterior motion of the mitral valve (SAM) and mitral regurgitation (MR) are successfully medically managed. They have been shown to do well in a short‐term follow‐up. However, the long‐term outcome has not been investigated. The objective of this project was to investigate the long‐term outcome of these patients. Methods: This is an observational, retrospective study of 385 patients who underwent MVR. All cases of SAM and MR in this report were successfully medically managed with conservative therapy preventing the need for immediate surgical reintervention. Patients were divided into two groups based on the severity of MR. Group I had grade ≤ 2 + MR (

Is Renal Function-Based Contrast Dosing of Radiographic Contrast Media in Patients Undergoing Percutaneous Coronary Intervention Sufficient to Delineate Safe Limits of Contrast Dose?

The observational study by Gurm et al. ([1][1]) showed that the ratio of contrast volume to creatinine clearance (CV/CCC) is a simple tool that can help reduce the risk of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention. The most important preventive

Tricuspid annular plane systolic excursion (TAPSE) revisited using CMR

Summary This observational pilot project was performed as background to eventually create a rapid, automated and accurate assessment of RV systolic function in variable clinical subgroups. We propose new parameters that characterize the global systolic function of the right ventricle with a simple linear measurement. Background The tricuspid annular plane systolic excursion (TAPSE), which has been used for over a quarter century as a quick estimate of RV systolic function, was revisited using CMR. It shows good correlation with invasive hemodynamics. MRI is the current gold standard to assess the volumes and anatomy of the heart and we can measure TAPSE more precisely with cardiac MRI to accurately detect any current problems TAPSE measurements may suffer from.