Vivek Mutha
University of Melbourne
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Publication
Featured researches published by Vivek Mutha.
World Journal of Cardiology | 2014
Muhammad Asrar ul Haq; Chiew Wong; Vivek Mutha; Nagesh S. Anavekar; Kwang Lim; David L. Hare
Heart failure with preserved ejection fraction (HFPEF) is common and represents a major challenge in cardiovascular medicine. Most of the current treatment of HFPEF is based on morbidity benefits and symptom reduction. Various pharmacological interventions available for heart failure with reduced ejection fraction have not been supported by clinical studies for HFPEF. Addressing the specific aetiology and aggressive risk factor modification remain the mainstay in the treatment of HFPEF. We present a brief overview of the currently recommended therapeutic options with available evidence.
Cardiovascular Ultrasound | 2014
Muhammad Asrar ul Haq; Vivek Mutha; Tina Lin; Konstantinos Profitis; Z. Tuer; Kwang Lim; David L. Hare; Chiew Wong
Aims2D speckle tracking echocardiography allows for assessment of left ventricular (LV) torsional deformation as a composite function of the radial, longitudinal and circumferential fibres. We test the hypothesis that post-exercise LV torsional dynamics are more sensitive markers for myocardial dysfunction than resting measures, and better predictors for exercise capacity compared to post-exercise LV diastolic filling pressure (E/e’).MethodsWe studied 88 patients referred for stress echocardiogram. Treadmill exercise was performed using Bruce protocol, and echo images were acquired using GE Vivid 7. LV rotational dynamics were analysed by speckle tracking method using the GE ECHOPAC software. Tertiles were defined according to exercise capacity measured by the achieved metabolic equivalents (METS) adjusted for age and gender. Comparison was made between LV torsional dynamics and E/e’ to correlate with METS to predict exercise capacity.ResultsMean age of the study population was 58 years, 48% females. Patients with systolic dysfunction or evidence of ischaemia were excluded from the analysis. No significant correlation was found between METS and LV torsion measures at rest. There was statistically significant correlation between METS and post-exercise LV torsion (r=0.34, p=0.001), twist velocity increase (r=0.27, p=0.01), and incremental change in torsion (r=0.22, p<0.05). In addition, a correlation was also shown between post-exercise E/e’ and METS (r=-0.33, p=0.002).ConclusionPost-exercise LV torsional dynamics correlate with exercise capacity and may be a useful tool for assessing LV myocardial function in subjects with normal LVEF.
Heart Asia | 2013
Muhammad Asrar ul Haq; Jamie Layland; Vivek Mutha
Ischaemic heart disease (IHD) remains one of the leading causes of death. Atherosclerosis has been intensely researched given the IHD prevalence and the financial impacts on healthcare systems. More recently, in vivo characterisation of coronary atherosclerotic plaque and tissue responses following stent implantation in a coronary artery has been made possible by a novel technology called optical coherence tomography (OCT). OCT is a light-based, invasive, intracoronary imaging modality long applied to the field of ophthalmology and now in clinical use worldwide. It gives a unique view of within the coronary artery using near-infrared light with a resolution of 15 microns, 10 times higher than other invasive coronary imaging techniques like intravascular ultrasound. The technology is being adopted to comprehensively detect features that make plaques ‘vulnerable’ (eg, large lipid pool, thin, fibrous-cap atheroma), whether stents are implanted optimally within the artery, and visualise the small layers of tissue that form over stent metal surfaces over time, which in turn may provide surrogate markers for long-term stent safety and help guide the optimal duration of dual antiplatelet therapy, a topic of big discussion at the current point of time.
Open Heart | 2014
Vivek Mutha; Muhammad Asrar ul Haq; William J. van Gaal
Background Intravenous adenosine is used to minimise the coronary micro-resistance to achieve maximal hyperaemia along with nitrates for optimal fractional flow reserve (FFR) measurements. We hypothesise that caffeine, being a competitive inhibitor of adenosine, would influence adenosine-mediated FFR readings. Methods Consecutive patients undergoing angiogram and FFR measurements were enrolled after abstaining from caffeine for 24 h. Patients with any contraindications to intravenous adenosine or caffeine were excluded. FFR measurements were taken using nitrates and adenosine pre and post 4 mg/kg intravenous caffeine administration and results were compared. Results 10 patients were analysed (80% men, age 59.9±9.4, weight 87.5±15.6). Baseline caffeine levels were undetectable in all patients and increased significantly postintravenous caffeine administration (16.4±5.5 μg/mL). Baseline preadenosine FFR values were similar before and after caffeine administration (0.91±0.06 vs 0.91±0.07; p=0.41). Postadenosine FFR readings were 0.79±0.07, which increased non-significantly to 0.82±0.11 postcaffeine (p=0.15). Two significant FFR readings (≤0.8) changed to non-significant after caffeine administration (0.77–0.93 and 0.8–0.91). Conclusions Caffeine may affect FFR results in some patients. Larger studies are warranted to clarify the extent and magnitude of caffeine/adenosine interaction particularly due to ubiquitous nature of caffeine and increasing importance of FFR in clinical practice.
Heart Lung and Circulation | 2014
Muhammad Asrar ul Haq; Paul D. Williams; Vivek Mutha; A. Wilson
The transradial approach for coronary angiography was first described in 1989. With the advent of modern equipment and improved technology it has recently gained significant interest amongst interventional cardiologists. As compared to femoral access, the radial approach has the major advantages of lower access site complication rates, cost-effectiveness, and shorter hospital stays. Further clinical benefits of lower morbidity and cardiac mortality in patients with ST-elevation myocardial infarction have been shown recently. Rare vascular complications may include radial artery spasm, dissection, occlusion, perforation or compartment syndrome. Here, we present two unusual cases of an entrapped catheter in the radial artery and their outcomes.
Open heart | 2014
Muhammad Asrar ul Haq; Nima Rudd; Mueed Mian; Anastasia Vlachadis Castles; Tamara Mogilevski; Vivek Mutha; William J. van Gaal
Introduction The best strategy in patients with prior coronary artery bypass graft surgery (CABG) who present with non-ST elevation myocardial infarction (NSTEMI) remains less well defined. We compare the characteristics, therapeutic interventions and outcomes of patients with prior CABG presenting with NSTEMI. Methods All patients who presented to our hospital during 2007–2012 with available electronic records were analysed retrospectively. Outcomes were compared between patients who underwent coronary angiography or percutaneous coronary intervention (PCI) versus those who were treated medically. Results A total of 117 patients were analysed. Of that, 79 patients were managed medically while 38 underwent early angiography, of which only 11 (9.5%) received PCI. Patients treated medically (did not undergo angiography) were older (74±10 vs70±8; p=0.05). ECG changes were the only independent predictor for early angiography (OR 0.4, 95% CI 0.15 to 0.99; p=0.05) while recurrent chest pain (OR 0.2, 95% CI 0.05 to 0.97; p=0.05) predicted PCI on multivariate analysis. The PCI group had higher Global Registry of Acute Cardiac Events (GRACE) score (176±29 vs 150±31; p=0.01). No significant difference was found in readmission rates, morbidity (unstable angina pectoris, NSTEMI, ST elevation myocardial infarction (STEMI), or combination) or mortality at 12 months between the groups who underwent angiography, PCI, or treated medically on univariate and multivariate analysis. Conclusions The opportunity to intervene in prior CABG patients presenting with NSTEMI is often low. Initial medical management may be a reasonable option in carefully selected patients particularly in the absence of ongoing symptoms, ECG changes or very high GRACE scores. Further studies are required to evaluate the safety of non-invasive strategies in managing this population.
World Journal of Cardiology | 2017
Wei Liang Sim; Vivek Mutha; Muhammad Asrar Ul-Haq; Victoria Sasongko; William Van-Gaal
AIM To investigate the characteristics and outcomes of octogenarians who presented with ST-elevation myocardial infarction (STEMI) compared to non-octogenarians and to investigate the outcomes of octogenarians that received primary percutaneous coronary intervention (PCI) compared to those managed conservatively. METHODS We performed a single center retrospective case controlled study. All octogenarians who presented with STEMI to a tertiary referring hospital between 2007 and 2012 were included. The subsequent non-octogenarian patient who presented with a STEMI following the octogenarian patient was assigned to the control group in a 1:1 manner. The outcomes measured were peri-procedural cardiac arrest, death on table, cerebrovascular accidents (CVA), in-hospital and 30-d mortality. RESULTS A total of 146 patients were analyzed. The octogenarian group had a higher percentage of females, higher overall comorbidities, higher Charlson Comorbidity Index score, worse renal function and were more likely to require residential care and home help. The octogenarian group were also less likely to have PCI attempted and had a longer symptom onset to PCI time. Mortality rate was high amongst octogenarians who presented with STEMI. However, those managed conservatively had a higher in-hospital and 30-d mortality rate CONCLUSION Octogenarians who presented with STEMI that were managed conservatively had a higher mortality rate compared to those who had primary PCI. Therefore, we propose that revascularization may be beneficial to patients in this age group.
BMC Cardiovascular Disorders | 2015
Cheng Yee Goh; Muhammad Asrar ul Haq; Vivek Mutha; William J. van Gaal
BackgroundHypertrophic cardiomyopathy (HCM) is a myocardial disorder characterised by left ventricular hypertrophy (LVH) in the absence of another cardiac or systemic disease capable of producing the magnitude of LVH evident. HCM causes variable symptoms and is one of the leading causes of sudden cardiac death (SCD) in young adults. While various phenotypic features of HCM among monozygotic twin pairs are not uncommonly reported, occurrence of synchronous cardiac arrest among them is not known from literature.Case presentationWe present a case of monozygotic twins with HCM who both had a cardiac arrest post physical exertion in 63rd year of their lives.ConclusionThis case highlights potential genetics predisposition of cardiac arrest in patients with HCM despite having different phenotypic expression. SCD may be the only manifestation of patients with HCM. Decision of implantable cardioverter-defibrillator (ICD) placement for primary prevention of SCD should be based on the recommended guidelines, clinical judgment and patient’s preference.
European Journal of Echocardiography | 2014
Vivek Mutha; Muhammad Asrar ul Haq
A 67-year-old male presented with non-ST segment elevation myocardial infarction accompanied by inferior electrocardiogram (ECG) changes. Coronary angiography demonstrated a dominant right coronary artery (RCA) with two discrete regions of angiographic haziness, suggesting possible plaque ulceration and the presence of thrombus ( Panel A ). Prior studies have demonstrated non-culprit plaque rupture in acute myocardial infarction patients; however, …
Case Reports | 2014
Muhammad Asrar ul Haq; Vivek Mutha; Ahmed Al-Kaisey; William J. van Gaal
Platypnoea orthodeoxia is a rare clinical syndrome characterised by dyspnoea and deoxygenation exhibited in upright position with improvement in supine posture. Previously described aetiologies include cardiac (pericardial effusion or constrictive pericarditis), pulmonary (pneumonectomy, emphysema or amiodarone toxicity), abdominal (cirrhosis or ileus) or vascular (abdominal aortic aneurysm) causes. We report an unusual case of platypnoea orthodeoxia associated with patent foramen ovale and partial hepatic resection.