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1. Coronary Perforation A Nightmare in Cath Lab

Author: Ashok Kumar Thakur, Puneet Aggarwal, Rajeev Bharadwaj, Bhagya Narayan Pandit, and Ranjit Kumar Nath
Subjects: ellis classification, guidewire, percutaneous coronary intervention, Medicine
Abstract: Percutaneous Coronary Intervention (PCI) is now the standard of care in patients with coronary artery disease. With advances in modern technology, the success of PCI has relatively increased, and so is its complication, specifically in complex coronary intervention. Coronary perforation is one of the most dreadful and life-threatening complications of PCI. The most vital step in the management of coronary perforation is its identification and quick action. Multiple methods for management are now recommended in the literature, but the mainstay of treatment is still prevention. This review discusses the incidence, risk factors, prevention, identification, and management of Coronary Artery Perforation (CAP).
Published: 2021
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2. Epidemiological, demographic, laboratory, clinical management, and outcome data of symptomatic bradyarrhythmia in COVID-19 patients

Author: Abhinav Shrivastava, Bhagya Narayan Pandit, Ashok Kumar Thakur, Ranjit Kumar Nath, and Puneet Aggarwal
Subjects: COVID-19, Bradiarritmias, Marcapasos, Medicine, Surgery, RD1-811
Abstract: Background: Cardiovascular manifestations are an important cause of mortality and morbidity in COVID-19 infections. Conduction system abnormality in the form of symptomatic bradyarrhythmia is underreported in the literature. Aim: To evaluate epidemiological, demographic, laboratory, clinical management, and outcome data of symptomatic bradyarrhythmia in COVID-19 patients. Methods: This was a retrospective, observational study including all the adult patients (>18 years) who were diagnosed with COVID-19 infection and had complete heart block (CHB) or symptomatic high-grade Atrio-Ventricular (AV) block requiring a temporary pacemaker insertion (TPI). Epidemiological, demographic, laboratory, clinical management, and outcome data were extracted from all the enrolled patients and studied for the primary clinical composite endpoint of all-cause death. Results: The study population included 15 patients, including 14 patients with CHB and 1 patient with 2:1 AV block. Syncope was the most common presentation. The clinical endpoint in the form of death was seen in 5 patients (33.3%), 3 patients reverted to sinus rhythm, and 7 patients required permanent pacemaker implantation. The markers of inflammation were raised in all patients; however trend toward more inflammation was seen in patients reaching the primary clinical endpoint. 3 out of 7 patients with narrow QRS rhythm reverted to normal sinus rhythm, while all 8 patients with broad complex QRS either died or required a permanent pacemaker insertion. Conclusion: Symptomatic bradyarrhythmia is associated with a high inflammatory state, and high mortality in COVID-19 infection and a transient conduction block in patients with narrow QRS rhythm may suggest local subclinical myocardial inflammation. Resumen: Antecedentes: Las manifestaciones cardiovasculares son una causa importante de mortalidad y morbilidad en las infecciones por COVID-19. La anomalía del sistema de conducción en forma de bradiarritmia sintomática no se informa en la literatura. Objetivo: Evaluar datos epidemiológicos, demográficos, de laboratorio, de manejo clínico y de resultado de la bradiarritmia sintomática en pacientes con COVID-19. Métodos: Este fue un estudio observacional retrospectivo que incluyó a todos los pacientes adultos (> 18 años) que fueron diagnosticados con infección por COVID-19 y tenían bloqueo cardíaco completo (HBC) o bloqueo auriculoventricular (AV) de alto grado sintomático que requería una inserción de marcapasos (TPI). Los datos epidemiológicos, demográficos, de laboratorio, de manejo clínico y de resultado se extrajeron de todos los pacientes inscritos y se estudiaron para el criterio de valoración clínico primario compuesto de muerte por cualquier causa. Resultados: La población del estudio incluyó a 15 pacientes, 14 de los cuales tenían HBC y uno tenía bloqueo AV 2:1. El síncope fue la presentación más común. El criterio de valoración clínico en forma de muerte se observó en 5 pacientes (33,3%), 3 pacientes revirtieron al ritmo sinusal y 7 pacientes requirieron implantación de marcapasos permanente. Los marcadores de inflamación se elevaron en todos los pacientes; sin embargo, se observó una tendencia hacia una mayor inflamación en los pacientes que alcanzaron el criterio de valoración clínico primario. Tres de cada 7 pacientes con QRS estrecho revirtieron al ritmo sinusal normal, mientras que los 8 pacientes con QRS de complejo ancho murieron o requirieron la inserción de un marcapasos permanente. Conclusión: La bradiarritmia sintomática se asocia con un estado inflamatorio alto y una alta mortalidad en la infección por COVID-19, y un bloqueo transitorio de la conducción en pacientes con ritmo QRS estrecho puede sugerir una inflamación miocárdica subclínica local.
Published: 2021
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3. Cardiovascular outcomes of antidiabetic drugs

Author: Ranjit Kumar Nath, Neeraj Pandit, Ajay Raj, B.N Pandit, Vinod Kumar, Rajeev Bhardwaj, Ajay Pratap Singh, and Ashok Thakur
Subjects: antidiabetic drugs, cardiovascular outcomes, dpp 4 inhibitors, sglt2 inhibitors, glp-1 receptor agonist, Medicine
Abstract: Type 2 Diabetes Mellitus (T2DM) is associated with a high risk of atherosclerotic cardiovascular disease (ASCVD). Intensive blood glucose reduction with antidiabetic drugs significantly reduce microvascular complications but there is no strong evidence of reduction in cardiovascular (CV) events. In 2008, the US Food and Drug Administration (FDA) issued guidance to demonstrate cardiovascular safety of newer antidiabetic drugs in addition to reduction in blood glucose level. After which a number of CVOTs were conducted involving newer antidiabetic drugs. The newer drugs (e.g. GLP-1 RAs, SGLT2 inhibitors and DPP 4 inhibitors) might have potential effects on body weight, lipid parameters and blood pressure, as well as endothelial dysfunctions, inflammatory markers and oxidative stress. The current review summarizes the results of the main trials focused on the cardiovascular outcomes of traditional as well as newer antidiabetic drugs.
Published: 2021
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4. Percutaneous management of Stuck Rotational Atherectomy Burr: Experience at a tertiary care centre

Author: Ajay Raj, Ranjit Kumar Nath, Ashok Kumar Thakur, Ajay Pratap Singh, Neeraj Pandit, and Sripad Vasant Khairnar
Subjects: rotational atherectomy, stuck burr, entrapment, rotablator, Medicine
Abstract: Background: The incidence of stuck rotational atherectomy (RA) burr is extremely low, and its description has been sporadic in the literature about the systemic management of this complication. Aims and Objective: The current study was designed to present the experience of our center and propose an algorithm for the retrieval of stuck RA burr. Materials and Methods: We retrospectively evaluated cases of RA between August 2018 to August 2020 at our center. An entrapped RA burr was defined as an inability to move the burr backward without any additional maneuvers during or after the rotablation of a coronary lesion. Angiographic and procedural details were reviewed in the identified cases of entrapped rotablator burr, details of maneuvers used to retract the burr was documented. We further analyzed the literature using PubMed search using the keywords “entrapment of rotablator burr”, “stuck rotablator” and “rotablation complications”. All the articles with entrapped rotablation burr were identified and scrutinized for the techniques used for percutaneous retrieval. Results: Out of the total 5780 Percutaneous coronary intervention (PCI) procedures, RA was performed in 75 patients and RA burr entrapment was confirmed in two cases. Both the cases were seen in patients with angulated and heavily calcified lesions. The cases were managed percutaneously by endovascular maneuvers. A total of 8 techniques were identified by analysis of available literature for burr retrieval with surgery being the favored one. Using the experience of our center and available literature we propose a simplified working algorithm towards systematic management of this complication. Conclusion: RA burr entrapment is rare, but a life-threatening complication, and the operator should be prepared with strategies for successful retrieval of stuck burr. Percutaneous retraction maneuvers should be used as the first-line management for retrieval of stuck burr followed by surgical referral. Using the proposed algorithm this rare complication can be managed systematically and effectively.
Published: 2021
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5. Correlation between Cardiac Biomarkers and Right Ventricular Dysfunction in Acute Inferior Wall Myocardial Infarction with and without Right Ventricular Myocardial Infarction

Author: Rajeev Bharadwaj, Ranjit Kumar Nath, Ashok Thakur, Bhagya Narayan Pandit, and Dheerendra Kuber
Subjects: brain natriuretic peptide, doppler echocardiography, right ventricular involvement, tricuspid annular plane systolic excursion, troponin i, Medicine
Abstract: Introduction: Right Ventricular Myocardial Infarction (RVMI) along with inferior wall left ventricular (LV) dysfunction or Inferior Wall Myocardial Infarction (IWMI) is found in 30-50% of the cases. Isolated Right Ventricular (RV) dysfunction or infarction is rare except in iatrogenic (interventional) procedures. RVMI is being more commonly diagnosed retrospectively in the era of primary angioplasty, when these patients post-procedure fail to improve satisfactorily as compared to isolated IWMI patients. Clues to identify early RV involvement in acute IWMI patients will help in better management and less morbidity in this group of patients. Aim: The study was undertaken to search for any correlation between cardiac biomarkers {Troponin I (Trop I), Creatinine Kinase-MB (CK-MB), Brain Natriuretic Peptide (BNP)} and RV involvement using echocardiographic parameters in inferior Acute Myocardial Infarction (AMI), with and without associated RVMI, in patients who underwent primary Percutaneous Coronary Intervention (PCI). Materials and Methods: This was a cross-sectional study, conducted from September, 2018 to August, 2019, in the Cardiology Department of ABVIMS and Dr. Ram Manohar Hospital. A total of 294 patients, presenting with acute IWMI, were included in the study. Samples for Trop-I, CK-MB and BNP were taken immediately after admission. One hundred and thirty two patients had an associated RVMI. Two-dimensional Echocardiography was done within the first 12 hours of admission. Electrocardiography (ECG) and Echocardiography (EEG) assessments were used to determine RV involvement. Comparison was done first between patients with and without RV involvement, followed by comparison among groups for quantitative parameters, especially biomarkers, for finding correlation between biomarker levels and echocardiographic parameters (both RV and LV functions). Results: Patients presenting with IWMI with an associated RVMI had increased LV E/E’ ratio. Also, as predicted, they had a low Tricuspid Annulus Plane Systolic Excursion (TAPSE) and a low RV fractional area change, as well, due to stunning of right ventricle in the acute phase. In the group with higher BNP levels (≥400 pg/mL), the ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/E’) was increased; on the other hand LV ejection fraction and TAPSE were decreased. There was negative correlation between RSm (RV systolic wave), TAPSE and BNP levels. BNP, Trop I and CKMB levels showed a positive correlation with E/E’ at higher levels. Hypotension was more in patients presenting with RVMI, but it did not reach statistical significance. The mortality was 4.5% in the inferior Myocardial Infarction (MI) with RV involvement group versus 1.8% in isolated inferior MI group (during hospital stay). Conclusion: In acute Inferior wall MI, higher levels of BNP, CKMB, Trop I, alone or in combination, might be used for prediction of RV involvement. BNP levels ≥400 pg/mL, Trop I levels ≥1.1 ng/ mL, and CK-MB levels ≥4.5 ng/mL, along with hypotension and higher E/E’ ratio were observed in such cases and were associated with RV dysfunction and increased mortality.
Published: 2020
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6. Idiopathic isolated annular dilatation causing congenital mitral regurgitation

Author: Lalitaditya Malik, Anubhav Gupta, Ranjit Kumar Nath, Vijay Grover, and Vijay Kumar Gupta
Subjects: Annular dilatation, congenital mitral regurgitation, isolated annular dilatation, Medicine, Pediatrics, RJ1-570, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Isolated annular dilatation is an extremely uncommon cause of congenital mitral regurgitation. We report a case of a 5-year-old child with idiopathic isolated annular dilatation causing severe congenital mitral regurgitation.
Published: 2012
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7. Initial Invasive or Conservative Strategy for Stable Coronary Disease

Author: Maron D. J., Hochman J. S., Reynolds H. R., Bangalore S., O'Brien S. M., Boden W. E., Chaitman B. R., Senior R., Lopez-Sendon J., Alexander K. P., Lopes R. D., Shaw L. J., Berger J. S., Newman J. D., Sidhu M. S., Goodman S. G., Ruzyllo W., Gosselin G., Maggioni A. P., White H. D., Bhargava B., Min J. K., John Mancini G. B., Berman D. S., Picard M. H., Kwong R. Y., Ali Z. A., Mark D. B., Spertus J. A., Krishnan M. N., Elghamaz A., Moorthy N., Hueb W. A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T. D., Szwed H., Doerr R., Keltai M., Selvanayagam J. B., Gabriel Steg P., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N. O., Harrell F. E., Rockhold F. W., Broderick S., Bruce Ferguson T., Williams D. O., Harrington R. A., Stone G. W., Rosenberg Y, ISCHEMIA Research Group: Joseph Ricci, A Tello Montoliu, A I Robero Aniorte, Abbey Mulder, Abhay A Laddu, Abhinav Goyal, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Abraham Oomman, Adam J Jaskowiak, Adam Kolodziej, Adam Witkowski, Adnan Hameed, Adriana Anesini, Afshan Hussain, Agne Juceviciene, Agne Urboniene, Agnes Jakal, Agnieszka Szramowska, Ahmad Khairuddin, Ahmed Abdel-Latif, Ahmed Adel, Ahmed Aljzeeri, Ahmed Kamal, Ahmed Talaat, Aimee Mann, Aira Contreras, Ajit Kumar, V K Kumar, Akemi Furukawa, Akshay Bagai, Akvile Smigelskaite, Alain Furber, Alain Rheault, Alaine Melanie Loehr, Alan Rosen, Albert Varga, Albertina Qelaj, Alberto Barioli, Aldo Russo, Alec Moorman, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alena Kuleshova, Alessandro Sionis, Alexander A Sirker, Alexander M Chernyavskiy, Alexandra Craft, Alexandra Vazquez, Alexandre Ciappina Hueb, Alexandre S Colafranseschi, Alexandre Schaan de Quadros, Alexandre Tognon, Ali Alghamdi, Alice Manica Muller, Aline Nogueira Rabaça, Aline Peixoto Deiro, Alison Hallam, Allegra Stone, Allison Schley, Almudena Castro, Alvaro Rabelo Ales, Amanda Germann, Amanda O'Malley, Amar Uxa, Amarachi Ojajuni, Amarino C Oliveira Jr, Amber B Hull, Ambuj Roy, Amer Zarka, Amir Janmohamed, Ammani Brown, Ammy Malinay, Amparo Martinez Monzonis, Amy J Richards, Amy Iskandrian, Amy Ollinger, Ana D Djordjevic-Dikic, Ana Fernández Martínez, Ana Gomes Almeida, Ana Paula Batista, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anam Siddiqui, Anastasia M Kuzmina-Krutetskaya, Andras Vertes, Andre S Sousa, Andre Gabriel, André Schmidt, Andrea M Lundeen, Andrea Bartykowszki, Andrea Lorimer, Andrea Mortara, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew G Howarth, Andrew J Moriarty, Andrew Docherty, Andrew Starovoytov, Andrew Zurick, Andrzej Łabyk, Andrzej Swiatkowski, Andy Lam, Anelise Kawakami, Angela Hoye, Angela Kim, Angelique Smit, Angelo Nobre, Anil V Shah, Anja Ljubez, Anjali Anand, Ankush Sachdeva, Ann Greenberg, Ann Luyten, Ann Ostrander, Anna Di Donato, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Proietti, Anna Teresinska, Anne Marie Webb, Anne Cartwright, Anne Heath, Anne Mackin, Anong Amaritakomol, Anong Chaiyasri, Anoop Chauhan, Anoop Mathew, Anthony Gemignani, Anto Luigi Andres, Antonia Vega, Antonietta Hansen, Antonino Ginel Iglesias, Antonio Carlos Carvalho, Antonio Di Chiara, Antonio Serra Peñaranda, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anupama Rao, Aquiles Valdespino-Estrada, Araceli Boan, Areef Ishani, Ariel Diaz, Arijit Ghosh, Arintaya Prommintikul, Arline Roberts, Arnold H Seto, Arnold P Good, Arshed Quyyumi, Arthur J Labovitz, Arthur Kerner, Arturo S Campos-Santaolalla, Arunima Misra, Ashok Mukherjee, Ashok Seth, Ashraf Seedhom, Asim N Cheema, Asker Ahmed, Atul Mathur, Atul Verma, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Baljeet Kaur, Bandula Guruge, Barbara Brzezińska, Barbara Nardi, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Belen Cid Alvarez, Benjamin J Spooner, Benjamin J W Chow, Benjamin Cheong, Benoy N Shah, Bernard de Bruyne, Bernardas Valecka, Bernhard Jäger, Beth A Archer, Beth Abramson, Beth Jorgenson, Bethany Harvey, Betsy O'Neal, Bev Atkinson, Bev Bozek, Bevin Lang, Bijulal Sasidharan, Bin Yang, Bin Zhang, Binoy Mannekkattukudy Kurian, Bjoern Goebel, Bob Hu, Bogdan A Popescu, Bogdan Crnokrak, Bolin Zhu, Bonnie J Kirby, Brandi D Zimbelman, Brandy Starks, Branko D Beleslin, Brenda Hart, Brian P Shapiro, Brian McCandless, Brianna Wisniewski, Brigham R Smith, Brooks Mirrer, Bruce McManus, Bruce Rutkin, Bruna Edilena Paulino, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Cameron Hague, Camila Thais de Ormundo, Candace Gopaul, Candice P Edillo, Carísi A Polanczyk, Carita Krannila, Carla Vicente, Carl-Éric Gagné, Carlo Briguori, Carlos Peña Gil, Carlos Alvarez, Carly Ohmart, Carmen C Beladan, Carmen Ginghina, Carol M Kartje, Caroline Alsweiler, Caroline Brown, Caroline Callison, Caroline Pinheiro, Caroline Rodgers, Caroline Spindler, Carolyn Corbett, Carrie Drum, Casey Riedberger, Catherine Bone, Catherine Fleming, Catherine Gordon, Catherine Jahrsdorfer, Catherine Lemay, Catherine Weick, Cathrine Patten, Cecilia Goletto, Cezary Kepka, Chandini Suvarna, Chang Xu, Chantale Mercure, Charle A Viljoen, Charlene Wiyarand, Charles Jia-Yin Hou, Charles Y Lui, Charles Cannan, Charles Cornet, Charlotte Pirro, Chataroon Rimsukcharoenchai, Chen Wang, Cheng-Ting Tsai, Chen-Yen Chien, Cheryl A Allardyce, Chester M Hedgepeth, Chetan Patel, Chiara Attanasio, Chih-Hsuan Yen, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Beck, Chris Buller, Christel Vassaliere, Christian Hamm, Christiano Caldeira, Christie Ballantyne, Christina Björklund, Christine R Hinton, Christine Bergeron, Christine Masson, Christine Roraff, Christine Shelley, Christophe Laure, Christophe Thuaire, Christopher Kinsey, Christopher McFarren, Christopher Spizzieri, Christopher Travill, Chun-Chieh Liu, Chung-Lieh Hung, Chunguang Li, Chun-Ho Yun, Chunli Xia, Ciarra Heard, Cidney Schultz, Clare Venn-Edmonds, Claudia P Hochberg, Claudia Wegmayr, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Claudio T Mesquita, Clemens T Kadalie, Colin Berry, Constance Philander, Corine Thobois, Costantino Costantini, Courtney Page, Craig Atkinson, Craig Barr, Craig Paterson, Cristina Bare, Cynthia Baumann, Cynthia Burman, Dalisa Espinosa, Damien Collison, Dan Deleanu, Dan Elian, Dan Gao, Dana Oliver, Daniel P Vezina, Daniel O'Rourke, Daniele Komar, Danielle Schade, Darrel P Francis, Dastan Malaev, David A Bull, David E Winchester, David P Faxon, David Booth, David Cohen, David DeMets, David Foo, David Schlichting, David Taggart, David Waters, David Wohns, Davis Vo, Dawid Teodorczyk, Dawn Shelstad, Dawn Turnbull, Dayuan Li, Dean Kereiakes, Deborah O'Neill, Deborah Yip, Debra K Johnson, Debra Dees, Deepak L Bhatt, Deepika Gopal, Deepti Kumar, Deirdre Mattina, Deirdre Murphy, Delano R Small, Delsa K Rose, Dengke Jiang, Denis Carl Phaneuf, Denise Braganza, Denise Fine, Derek Cyr, Desiree Tobin, Diana Cukali, Diana Parra, Diane Camara, Diane Minshall Liu, Diego Adrián Vences, Diego Franca de Cunha, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Dorit Grahl, Dragana Stanojevic, Duarte Cacela, Dwayne S G Conway, E Pinar Bermudez, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Edoardo Verna, Eduardo Hernandez-Rangel, Edward D Nicol, Edward O McFalls, Edward T Martin, Edyta Kaczmarska, Ekaterina I Lubinskaya, Elena A Demchenko, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise L Hannemann, Elise van Dongen, Elissa Restelli Piloto, Eliza Kaplan, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizabeth Congdon, Elizabeth Ferguson, Elizaveta V Zbyshevskaya, Ellen Magedanz, Ellie Fridell, Ellis W Lader, Elvin Kedhi, Emanuela Racca, Emilie Tachot, Emily DeRosa, Encarnación Alonso-Álvarez, Eric Nicollet, Eric Peterson, Erick Alexánderson Rosas, Erick Donato Morales, Erin Orvis, Ermina Moga, Estelle Montpetit, Estevao Figueiredo, Eugene Passamani, Eugenia Nikolsky, Eunice Yeoh, Evgeniy I Kretov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, F Marin Ortuño, Fabio R Farias, Fabio Fimiani, Fabrizio Rolfo, Fa-Chang Yu, Fadi Hage, Fadi Matar, Fahim Haider Jafary, Fang Feng, Fang Liu, Fatima Ranjbaran, Fatima Rodriguez, Fausto J Pinto, Fauzia Rashid, Federica Ramani, Fei Wang, Fernanda Igansi, Filipa Silva, Filippo Ottani, Fiona Haines, Firas Al Solaiman, Flávia Egydio, Flavio Lyra, Florian Egger, Fran Farquharson, Frances Laube, Francesc Carreras Costa, Francesca de Micco, Francesca Bianchini, Francesca Pezzetta, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francis Burt, Francisca Patuleia Figueiras, Francisco Fernandez-Aviles, Francois Pierre Mongeon, Frans Van de Werf, Franziska Guenther, Fraser N Witherow, Fred Mohr, Frederico Dall'Orto, Fumiyuki Otsuka, G De La Morena, G Karthikeyan, Gabor Dekany, Gabor Kerecsen, Gabriel Galeote, Gabriel Grossmann, Gabriel Vorobiof, Gabriela Sanchez de Souza, Gabriela Guzman, Gabriela Zeballos, Gabriele Gabrielli, Gabriele Jakl-Kotauschek, Gail A Shammas, Gail Brandt, Gang Chen, Gary E Lane, Gary J Luckasen, Gautam Sharma, Gelmina Mikolaitiene, Gennie Yee, Georg Nickenig, George E Revtyak, George J Juang, Gerald Fletcher, Gerald Leonard, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Geza Fontos, Ghada Mikhail, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Giles Roditi, Gilles Barone-Rochette, Girish Mishra, Giuseppe Tarantini, Glenda Wong, Glenn S Hamroff, Glenn Rayos, Gong Cheng, Gonzalo Barge-Caballero, Goran Davidović, Goran Stankovic, Gordana Stevanovic, Grace Jingyan Wang, Grace M Young, Graceanne Wayser, Graciela Scaro, Graham S Hillis, Graham Wong, Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, J David Knight, Jacek Kusmierek, Jackie M White, Jackie Chow, Jacob Udell, Jacqueline E Tamis-Holland, Jacqueline Fannon, Jacquelyn A Quin, Jacquelyn Do, Jaekyeong Heo, Jakub Maksym, James E Davies, James H O'Keefe Jr, James J Jang, James Cha, James Harrison, James Hirsch, James Stafford, James Tatoulis, Jamie Rankin, Jan Henzel, Jan Orga, Jana Tancredi, Janaina Oliveira, Jane Burton, Jane Eckstein, Jane Marucci, Janet P Knight, Janet Blount, Janet Halliday, Janetta Kourzenkova, Janitha Raj, Jan-Malte Sinning, Jaqueline Pozzibon, Jaroslaw Drozdz, Jaroslaw Karwowski, Jason D Glover, Jason Loh Kwok, Jason T Call, Jason Linefsky, Jassira Gomes, Jati Anumpa, Javier J Garcia, Javier Courtis, Jay Meisner, K Jayakumar, Jayne Scales, Jean E Denaro, Jean Michel Juliard, Jean Ho, Jeanette K Stansborough, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeet Thambyrajah, Jeff Leimberger, Jeffery A Breall, Jeffrey A Kohn, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Blume, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima Euathrongchit, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Kai Eggers, Kamalakar Surineni, Kanae Hirase, T R Kapilamoorthy, Karen Calfas, Karen Gratrix, Karen Hallett, Karen Hultberg, Karen Nugent, Karen Petrosyan, Karen Swan, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karsten Lenk, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Kate Pointon, Kate Robb, Katherine Martin, Kathleen Claes, Kathryn Carruthers, Kathy E Siegel, Katia Drouin, Katie Fowler-Lehman, Kavita Rawat, Kay Rowe, Keiichi Fukuda, Keith A A Fox, Ken Mahaffey, Kendra Unterbrink, Kenneth Giedd, Kerrie Van Loo, Kerry Lee, Kerstin Bonin, Kevin R Bainey, Kevin T Harley, Kevin Anstrom, Kevin Chan, Kevin Croce, Kevin Landolfo, Kevin Marzo, Keyur Patel, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khaled Ziada, Khaula Baloch, Khrystyna Kushniriuk, Kian-Keong Poh, Kim F Ireland, Kim Holland, Kimberly Ann Byrne, Kimberly E Halverson, Kimberly Elmore, Kimberly Miller-Cox, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kotiboinna Preethi, Kozhaya Sokhon, Krissada Meemuk, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristina Wippler, Kristine Arges, Kristine Teoh, Krystal Etherington, Krystyna Łoboz-Grudzień, Krzysztof W Reczuch, Krzysztof Bury, Krzysztof Drzymalski, Krzysztof Kukuła, Kuo-Tzu Sung, Kurt Huber, Ladda Douangvila, Lance Sullenberger, Larissa Miranda Trama, Laszlone Matics, Laura Drew, Laura Flint, Laura Keinaite, Laura Sarti, Laurel Kolakaluri, Lawrence M Phillips, Lawrence Friedman, Lawrence Phillips, Lazar Velicki, Leah Howell, Leandro C Maranan, Leanne Cox, Ledjalem Daba, Lei Zhang, Lekshmi Dharmarajan, Leo Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Leszek Sokalski, Li Hai Yan, Li Li, Lia Nijmeijer, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilia Schiavi, Lilian Mazza Barbosa, Lillian L Khor, Lina Felix-Stern, Linda L Hall, Linda M Hollenweger, Linda Arcand, Linda Davidson-Ray, Linda Schwarz, Lindsey N Sikora, Lingping Chi, Lino Patricio, Liping Zhang, Lisa Chaytor, Lisa Hatch, Lisa McCloy, Lisa Wong, Liselotte Persson, Lixin Jiang, Liz Low, Ljiljana Pupic, Loïc Bière, Lorenzo Monti, Lori Christensen, Lori Pritchard, Loriane Black, Lori-Ann Desimone, Lori-Ann Larmand, Lorraine McGregor, Louise Morby, Louise Thomson, Luc Harvey, Luciana de Pádua Baptista, Lucilla Garcia, Ludivine Eliahou, Ludmila Helmer, Luis F Smidt, Luis Bernanrdes, Luis Guzman, Luiz A Carvalho, Luyang Xiong, Lynette L Teo, Lynn M Neeson, Lynne Winstanley, M Barbara Srichai-Parsia, M Quintana Giner, M Sowjanya Reddy, M Valdés Chávarri, M Grazia Rossi, Maarten Simoons, Maayan Konigstein, Maciej Lesiak, Maciej Olsowka, Mafalda Selas, Magalie Corfias, Magdalena Madero Rovalo, Magdalena Łanocha, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdalena Rantinella, Magdy Abdelhamid, Magnolia Jimenez, Mahboob Alam, Mahevamma Mylarappa, Mahfouz El Shahawy, Mahmoud Mohamed, Mahmud Al-Bustami, Majo X Joseph, Malgorzata Frach, Małgorzta Celińska-Spodar, Malte Helm, Manas Chacko, Mandy Murphy, Manitha Vinod, Manjula Rani, Manu Dhawan, Manuela Mombelli, Marcel Weber, Marcello Galvani, Marcelo Jamus Rodrigues, Marcia F Dubin, Marcia F Werner Bayer, Marcin Szkopiak, Marco Antonio Monsalve, Marco Bizzaro Santos, Marco Magnoni, Marco Marini, Marco Sicuro, Marco Zenati, Marcos Valério Coimbra Resende, Marek Roik, Margalit Bentzvi, Margaret Gilsenan, Margaret Iraola, Margot C 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Jr, Matthew Budoff, Matthew Jezior, Matthew Luckie, Matthias Friedrich, Mauren P Haeffner, Maximilian Tscharre, Max-Paul Winter, Mayana Almeida, Mayil S Krishnam, Mayuri Patel, Meenakshi Mishra, Megan Manocchia, Meghana Kakade, Melanie J Munro, Melissa D Chaplin, Melissa LeFevre, Mervyn Andiapen, Michael A Gibson, Michael B Rubens, Michael C Turner, Michael D Shapiro, Michael W Lee, Michael Berlowitz, Michael Davidson, Michael Mack, Michael McDaniel, Michael Mumma, Michal Wlodarczyk, Michel G Khouri, Michel S Slama, Michele Rawlins, Michelle M Bonner, Michelle M Seib, Michelle Chang, Michelle Crowder, Michelle Dixon, Michelle Mayon, Michelle McEvoy, Michelle Yee, Miguel M Fernandes, Miguel Nobre Menezes, Miguel Souto Bayarri, Miguel Barrero, Mikhail T Torosoff, Milan R Dobric, Milan Dobric, Milica Nikola Dekleva, Milind Avdhoot Gadkari, Millie Gomez, Min Tun Kyaw, Miriam Brooks, Miroslav Stevo Martinovic, Mitchel B Lustre, Mohammad Tariq Vakani, Mohammad El-Hajjar, Mohammed Al-Amoodi, 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Riezebos, Robert M Donnino, Robert Bojar, Robert Chilton, Robert Guyton, Robert Henderson, Robert Kornberg, Robert Leber, Robert Mao, Robert Stenberg, Roberta P Santos, Roberto René Favaloro, Roberto Amati, Rodolfo G S D Lima, Rodrigo J Cerci, Rogerio Tumelero, Rohit Tandon, Roma Tewari, Romalisa Miranda-Peats, Ron Wald, Ronald A Mastouri, Ronald G Morford, Ronald G Schwartz, Ronald P Pedalino, Rongrong Hu, Ronnell A Hansen, Ronny A Cohen, Rory Hachamovitch, Rosa Homem, Rosa Sandonato, Rosane Laimer, Rosann Gans, Roxanne Yost, Roy Mathew, Rubén Baleón-Espinosa, Ruben Ramos, Rubine Gevorgyan, Rui Ferreira, Rui Jing, Ruth Pérez-Fernández, S K Dwivedi, S Ramakrishnan, Saadat Khan, Sabahat Bokhari, Sabu Thomas, Sadath Lubna, Sajeeda Parveen Khan, Sajeev Chakanalil Govindan, Saket Girotra, Saleem Kassam, Sallie Canada, Salvador Cruz-Flores, Samaa Mohamed, Samantha Ly, Sameh El Kaffas, Samia Massalha, Sampoornima Setty, Samuel Nwosu, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandra M 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Hachamovitch, Rosa Homem, Rosa Sandonato, Rosane Laimer, Rosann Gans, Roxanne Yost, Roy Mathew, Rubén Baleón-Espinosa, Ruben Ramos, Rubine Gevorgyan, Rui Ferreira, Rui Jing, Ruth Pérez-Fernández, S K Dwivedi, S Ramakrishnan, Saadat Khan, Sabahat Bokhari, Sabu Thomas, Sadath Lubna, Sajeeda Parveen Khan, Sajeev Chakanalil Govindan, Saket Girotra, Saleem Kassam, Sallie Canada, Salvador Cruz-Flores, Samaa Mohamed, Samantha Ly, Sameh El Kaffas, Samia Massalha, Sampoornima Setty, Samuel Nwosu, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandra M Rivest, Sandra S Zier, Sandra Ahoud, Sandy Carr, Sanjay Ganapathi, Sanjay Shetty, Sanjeev Sharma, Santa Jimenez, Santhosh Satheesh, Santiago A Garcia, Sara Fernandez, Sara Karlsson, Sara Salkind, Sara Temiyasathit, Sarah Medina Rodriguez, Sarah Beaudry, Sarah Hadjih, Sarah Williams, Sarah Zahrani, Sarju Ralhan, Sasa Hinic, Sasko Kedev, Satinder Singh, Satoshi Yasuda, Satvic Cholenahally Manjunath, Sau Lee, Scott M Kaczkowski, Scott Kinlay, Sean W Hayes, Sebastian Sobczak, Senait Asier, Sergey A Sayganov, Seth I Sokol, Shaheen Pandie, Shaiful Azmi Yahaya, Shamir Mehta, Shao-Ping Nie, Sharad Chandra, Sharder Islam, Sharon Tai, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Sherron C Crook, Shigeyuki Nishimura, Shintaro Nakano, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shobana Ganesan, Shruti Pandey, Shuyang Zhang, Shweta Hande, Siddharth Gadage, Sik-Yin V Tan, Silvia Zottis Poletti, Silvia Riera, Silvia Valbuena, Simon Walsh, Simona Maspoli, Simone Savaris, Si-Ting Feng, So Yang Cho, Solomon Yakubov, Songlin Zhu, Songtao Wang, Sonia Guerrero, Sonika Gupta, Sonja Salinger Martinovic, Sonya Brons, Sorin Brener, Sothinathan Gurunathan, Souheil Saba, Soundarya Nayak, Sowjanya Reddy, Srinivasa Potluri, Sriram Sudarshan, Srun Kuanprasert, Stacie Van Oosterhout, Stamatios Lerakis, Stanley E Cobos, Stefan C Bertog, Stefan M Simović, Stefan Weikl, Stefano Di Marco, Stefano Provasoli, Stephanie A Tirado, Stephanie C Boer, Stephanie M Lane, Stephanie Ferket, Stephanie Kelly, Stephanie Wasmiller, Stephen H McKellar, Stephen P Hoole, Stephen Fremes, Stephen Preston, Steve Leung, Steven A Fein, Steven J Lindsay, Steven P Sedlis, Steven Giovannone, Steven Michael, Steven Weitz, Stijn van Vugt, Subhash Banerjee, Sudhir Naik, Suellen Hosino, Sukie Desire, Sukit Yamwong, Suku T Thambar, Sulagna Mookherjee, Suman Singh, Sundeep Mishra, Sunil Kumar Verma, Supap Kulthawong, Supatchara Khwakhong, Surendra Naik, Suresh Babu, Surin Woragidpoonpol, Suryaprakash Narayanappa, Susan Derbyshire, Susan Gent, Susan Mathus, Susan Milbrandt, Susan Moore, Susan Regan, Susan Stinson, Susan Webber, Susana Silva, Susanna Stevens, Susanne Gruensfelder, Suthara Aramcharoen, Suvarna Kolhe, Suzana Tavares, Suzanne Arnold, Suzanne Welsh, Svetlana Apostolovic, Swapna Kunhunny, Ta-Chuan Hung, Taissa Zappernick, Tali Sharir, Talita Silva, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarun K Mittal, Tatiana Trifonova, Tauane Bello Duarte, Tauqir Huk, Téodora Dutoiu, Terrance Chua, Terry Weyand, Thabitha Charles, Theodoros Kofidis, Theresa McCreary, Thierry Lefevre, Thippeekaa Arumairajah, Thitipong Tepsuwan, Thomas J Mulhearn, Thomas M Meyer, Thomas P Rocco, Thomas R Downes, Thomas Crain, Thomas Haldis, Thomas Mathew, Thomas Redick, Thounaojam Indira Devi, Thuraia Nageh, Tia Cauthren, Tiago Silva, Tiffany Little, Tijana Andric, Tina Harding, Titus Lau, Tiziana Formisano, Tiziano Moccetti, Tomasz Ciurus, Tomasz Mazurek, Tomasz Tarchalski, Toshiyuki Nagai, Tri Tran, Tricia Youn, Trish Tucker, Trudie Milner, Tuhina Bose, Tushar Kotecha, Udo Sechtem, Uma S Valeti, Umberto Cucchini, Umesh Badami, Upendra Kaul, V K Bahl, V S Narain, Valentina Casali, Valeria Godoy, Valerie Robesyn, Vamshi P Priya, Vandana Yadav, Vera McKinney, Veronica De Lenges, Veronica Tinnirello, Vicente Miro, Victor Navarro, Victoria Gumerova, Victoria Hernandez, Vidya Seeratan, Vijay Kumar, Vikentiy Y Kozulin, Viktoria Bulkley, Vilmar Veiga Jr, Vincent Setang, C P Vineeth, Virginai Pubull Nuñez, Virginia Fernández-Figares, Vitor Gomes, Viviana Gabriel, Viviane Dos Santos, Viviane Almeida, Vlad A Iliescu, Vladan Mudrenovic, Vladimir Dzavik, Vojislav L Giga, Walter Enrique Mogrovejo, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Warangkana Mekara, Wassim Nona, Wayne Old, Wayne Pennachi, Weerachai Nawarawong, Wei Chen, Wei Su, Weibing Xing, Wei-Ren Lan, Wenda Crawford, Wendy L Stewart, Wendy Drewes, Wenhua Lin, William B Abernethy, William D Salerno, William F Fearon, William Vergoni, William Weintraub, Winnie C Sia, Wlodzimierz J Musial, Xacobe Flores-Ríos, Xavier Garcia-Moll Marimon, Xi Su, Xiang Ma, Xiangqiong Gu, Xiao Wang, Xiaomei Li, Xiaowei Yao, Xin Fu, Xin Su, Xin Zeng, Xinchun Yang, Xiuhong Li, Xuehua Fang, Xutong Wang, Yaming Geng, Yan Yan, Yanek Pépin-Dubois, Yanfu Wang, Yang Wang, Yanmeng Tian, Yaping Huang, Yechen Han, Yesenia Zambrano, Yi-Hsuan Yang, Ying Tung Sia, Yining Yang, Yitong Ma, Yolayfi Peralta, Yongjian Wu, Yu Kunwu, Yu Zhao, Yudong Peng, Yueh-Hung Lin, Yulan Zhao, Yumei Dong, Yunhai Zhao, Yutthaphan Wannasopha, Yvonne Taul, Zakir Sahul, Zalina Kudzoeva, Zbigniew Kalarus, Zeljko Z Markovic, Zhen Huang, Zheng Ji, Zhenyu Liu, Zhou Yue, Zhulin Zhang, Zhuxi Li, Zile Singh Meharwal, Ziliang Bai, Zixiang Yu, Zohra Huda, Zoltan Davidovits
Subjects: Male, Cardiac Catheterization, Computed Tomography Angiography, medicine.medical_treatment, Myocardial Ischemia, Coronary Disease, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, ISCHEMIA Research Group, law.invention, Angina, Coronary artery disease, 0302 clinical medicine, Randomized controlled trial, law, Cardiovascular Disease, Myocardial Revascularization, 030212 general & internal medicine, Coronary Artery Bypass, 11 Medical and Health Sciences, Cardiac catheterization, General Medicine, Middle Aged, humanities, Cardiovascular Diseases, Cardiology, Female, Human, medicine.medical_specialty, Ischemia, Article, 03 medical and health sciences, Geriatric cardiology, Percutaneous Coronary Intervention, General & Internal Medicine, Internal medicine, medicine, Humans, Angina, Unstable, Aged, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Bayes Theorem, medicine.disease, Heart failure, Quality of Life, business
Abstract: BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).
Published: 2020

8. An unusual intracoronary honeycomb pattern in a patient with coronary artery disease with dextrocardia

Author: Ajay Pratap Singh, Ajay Raj, Kaushal Chaudhary, and Ranjit Kumar Nath
Subjects: Honeycomb, Dextrocardia, medicine.medical_specialty, genetic structures, medicine.diagnostic_test, business.industry, Honeycomb (geometry), Case Report, Diagnostic dilemma, medicine.disease, eye diseases, Coronary artery disease, OCT, Optical coherence tomography, Honeycomb Pattern, medicine, sense organs, Radiology, Thrombus, Cardiology and Cardiovascular Medicine, Artery dissection, business
Abstract: This case highlights the diagnostic dilemma and emphasis the role of Optical Coherence Tomography (OCT) to differentiate between spontaneous coronary artery dissection and recanalized thrombus with multiple channels in a patient with dextrocardia.
Published: 2021

9. Largest giant left atrium in rheumatic heart disease

Author: Jaskaran Singh Gujral, Siva Subramaniyan, Ranjit Kumar Nath, Bhagya Narayan Pandit, and Puneet Aggarwal
Subjects: medicine.medical_specialty, medicine.diagnostic_test, Heart disease, business.industry, Incidence (epidemiology), Left atrium, Case Report, Magnetic resonance imaging, 030204 cardiovascular system & hematology, medicine.disease, Giant left atrium, Dysphagia, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Cardiothoracic ratio, Internal medicine, Mitral valve, cardiovascular system, medicine, Cardiology, 030212 general & internal medicine, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: In the current era of echocardiography, early diagnosis and treatment of rheumatic heart disease make giant left atrium a rare condition, with a reported incidence of 0.3%, and following mainly with rheumatic mitral valve disease. We report a 50-year-old female, a known case of rheumatic heart disease who presented with breathlessness and dysphagia, and the cardiothoracic ratio on chest roentgenogram was 0.95. Echocardiography was suggestive of giant left atrium with a size of 19.4 x 18.3 cm, while magnetic resonance imaging revealed a size of 22.3 x 19.2 x 20.1 cm making it the largest left atrium to be reported in the literature.
Published: 2021

10. Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic

Author: Tom Devasia, Katyal Virender Kumar, Mrinal Kanti Das, Sreekanth Yerram, Narendranath Khanna, Nitish Naik, Geevar Zachariah, Swaminathan Nagarajan, Amal Kumar Khan, Neil Bardoloi, Pushkraj Gadkari, Gurpreet Singh Wander, Debabrata Roy, Kewal C. Goswami, Anshul Gupta, Bishav Mohan, Lekha Pathak, Cibu Mathew, Nitin Modi, Dipak Ranjan Das, Krishna Kishore Goyal, Bivin Wilson, Satyanarayan Routray, Venugopal Krishnan Nair, Shashi Bhushan Gupta, Chakkalakkal Prabhakaran Karunadas, Biswajit Majumder, Satyendra Tiwari, Sivabalan Maduramuthu, Rakesh Gupta, P.P. Mohanan, Kalaivani Mani, J. Ezhilan, Rahul Patil, K.R. Subramanyam, Santanu Guha, Saumitra Ray, Dinesh Choudhary, Rathinavel Sivakumar, Rituparna Baruah, Bishwa Bhushan Bharti, Santhosh Krishnappa, Manish Bansal, Rambhatla Suryanarayana Murty, Uday Jadhav, Prafulla Kerker, Siddiqui Kkh, Bateshwar Prasad Singh, Pradeep K. Hasija, Cholenahally Nanjappa Manjunath, Seemala Saikrishna Reddy, Karthik Tummala, Ashok Goyal, Natesh Bangalore Hanumanthappa, Sudeep Kumar, Ramakrishnan Sivasubramanian, Shashi Shekhar Chatterjee, Varun Shankar Narain, Diapk Sarma, Vitull K. Gupta, Sharad Chandra, Harsh Wardhan, Jayagopal Pathiyil Balagopalan, Rakesh Yadav, Girish Meennahalli Palleda, Vijay Kumar Garg, Pradip Kumar Deb, Sanjay Tyagi, C. B. Meena, Amit Malviya, Rishi Sethi, Ranjit Kumar Nath, Dorairaj Prabhakaran, Rabindra Nath Chakraborthy, A. Jabir, Pranab Jyoti Bhattacharyya, Manoranjan Mandal, Satish Kumar, Kumar Kenchappa, and Mohit Gupta
Subjects: Male, medicine.medical_treatment, Myocardial Infarction, 030204 cardiovascular system & hematology, Logistic regression, Ventricular Function, Left, 0302 clinical medicine, Pandemic, 030212 general & internal medicine, Myocardial infarction, Non-ST Elevated Myocardial Infarction, Mortality rate, Middle Aged, Low-and middle-income country, Acute myocardial infarction (AMI), Patient volume, Non ST elevation Myocardial infarction (NSTEMI) and outcome, Female, Original Article, Acute coronary syndrome, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), RD1-811, India, COVID-19 pandemic, 03 medical and health sciences, LMIC, Percutaneous Coronary Intervention, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, Pandemics, Management practices, Aged, business.industry, COVID-19, Percutaneous coronary intervention, Stroke Volume, medicine.disease, Cross-Sectional Studies, RC666-701, Communicable Disease Control, Time course, Emergency medicine, ST Elevation Myocardial Infarction, Surgery, business, ST elevation Myocardial infarction (STEMI), Demography
Abstract: Background: Admissions for acute myocardial infarction (MI) have declined significantly during the COVID-19 pandemic. The changes in the presentation, management, and outcomes of MI during the pandemic period are not well recognized, and data from low- and middle-income countries are limited. Methods: In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with MI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We sought to determine the changes in the number of admissions, management practices, and outcomes. Findings: We included 41,832 consecutive adults with MI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India with the North zone reporting greater decline (-44·8%) than the South zone (-27·7%). The weekly average decrease in MI admissions in 2020 which peaked around the mid- study period, correlated negatively with the number of COVID cases (r = -0·48; r 2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r 2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume, and teaching programs. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. However, the in-hospital mortality rates did not differ. Interpretation: The magnitude of reduction in MI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing MI admissions during the pandemic. Funding Statement: The study is funded by cardiological society of India. Declaration of Interests: Nothing to declare for all the authors. Ethics Approval Statement: Individual participating centres either obtained an ethical approval from respective Institutional ethics committees or a no objection certificate from the administration.
Published: 2021

11. Coronary Perforation A Nightmare in Cath Lab

Author: Rajeev Bharadwaj, Bhagya Narayan Pandit, Ashok Kumar Thakur, Puneet Aggarwal, and Ranjit Kumar Nath
Subjects: medicine.medical_specialty, Cath lab, business.industry, General surgery, Clinical Biochemistry, Perforation (oil well), percutaneous coronary intervention, guidewire, General Medicine, ellis classification, Nightmare, Medicine, medicine.symptom, business
Abstract: Percutaneous Coronary Intervention (PCI) is now the standard of care in patients with coronary artery disease. With advances in modern technology, the success of PCI has relatively increased, and so is its complication, specifically in complex coronary intervention. Coronary perforation is one of the most dreadful and life-threatening complications of PCI. The most vital step in the management of coronary perforation is its identification and quick action. Multiple methods for management are now recommended in the literature, but the mainstay of treatment is still prevention. This review discusses the incidence, risk factors, prevention, identification, and management of Coronary Artery Perforation (CAP).
Published: 2021

12. Marshall to the rescue in cardiac resynchronization therapy: Left ventricular lead placement in coronary sinus ostial atresia

Author: Dheerendra Kuber, Ranjit Kumar Nath, Vatsal Kayal, and Ajay Pratap Singh
Subjects: medicine.medical_specialty, Ventricular lead, medicine.medical_treatment, Cardiac resynchronization therapy, Coronary sinus, Physiology (medical), Internal medicine, medicine, Diseases of the circulatory (Cardiovascular) system, Congenital anomaly, cardiovascular diseases, Vein, business.industry, Left ventricular lead placement, medicine.disease, medicine.anatomical_structure, Atresia, RC666-701, Cardiology, cardiovascular system, Right atrium, Cardiology and Cardiovascular Medicine, business, Coronary sinus ostium
Abstract: This case highlights the importance of proper identification of congenital anomalies of the coronary sinus for the successful placement of left ventricular lead during cardiac resynchronization therapy device implantation. We discuss an alternate route for left ventricular lead placement via the vein of Marshall when the coronary sinus ostium in the right atrium was atretic and was facing difficulty initially in detecting the anomaly.
Published: 2022

13. Epidemiological, demographic, laboratory, clinical management, and outcome data of symptomatic bradyarrhythmia in COVID-19 patients

Author: Ranjit Kumar Nath, Bhagya Narayan Pandit, Puneet Aggarwal, Ashok Kumar Thakur, and Abhinav Shrivastava
Subjects: medicine.medical_specialty, RD1-811, Heart block, 030204 cardiovascular system & hematology, Article, 03 medical and health sciences, QRS complex, 0302 clinical medicine, Internal medicine, Epidemiology, medicine, Clinical endpoint, Sinus rhythm, Marcapasos, Subclinical infection, business.industry, COVID-19, medicine.disease, Bradyarrhythmia, Pacemaker, Bradiarritmias, Medicine, Population study, Surgery, Electrical conduction system of the heart, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract: Background: Cardiovascular manifestations are an important cause of mortality and morbidity in COVID-19 infections. Conduction system abnormality in the form of symptomatic bradyarrhythmia is underreported in the literature. Aim: To evaluate epidemiological, demographic, laboratory, clinical management, and outcome data of symptomatic bradyarrhythmia in COVID-19 patients. Methods: This was a retrospective, observational study including all the adult patients (>18 years) who were diagnosed with COVID-19 infection and had complete heart block (CHB) or symptomatic high-grade Atrio-Ventricular (AV) block requiring a temporary pacemaker insertion (TPI). Epidemiological, demographic, laboratory, clinical management, and outcome data were extracted from all the enrolled patients and studied for the primary clinical composite endpoint of all-cause death. Results: The study population included 15 patients, including 14 patients with CHB and 1 patient with 2:1 AV block. Syncope was the most common presentation. The clinical endpoint in the form of death was seen in 5 patients (33.3%), 3 patients reverted to sinus rhythm, and 7 patients required permanent pacemaker implantation. The markers of inflammation were raised in all patients; however trend toward more inflammation was seen in patients reaching the primary clinical endpoint. 3 out of 7 patients with narrow QRS rhythm reverted to normal sinus rhythm, while all 8 patients with broad complex QRS either died or required a permanent pacemaker insertion. Conclusion: Symptomatic bradyarrhythmia is associated with a high inflammatory state, and high mortality in COVID-19 infection and a transient conduction block in patients with narrow QRS rhythm may suggest local subclinical myocardial inflammation. Resumen: Antecedentes: Las manifestaciones cardiovasculares son una causa importante de mortalidad y morbilidad en las infecciones por COVID-19. La anomalía del sistema de conducción en forma de bradiarritmia sintomática no se informa en la literatura. Objetivo: Evaluar datos epidemiológicos, demográficos, de laboratorio, de manejo clínico y de resultado de la bradiarritmia sintomática en pacientes con COVID-19. Métodos: Este fue un estudio observacional retrospectivo que incluyó a todos los pacientes adultos (> 18 años) que fueron diagnosticados con infección por COVID-19 y tenían bloqueo cardíaco completo (HBC) o bloqueo auriculoventricular (AV) de alto grado sintomático que requería una inserción de marcapasos (TPI). Los datos epidemiológicos, demográficos, de laboratorio, de manejo clínico y de resultado se extrajeron de todos los pacientes inscritos y se estudiaron para el criterio de valoración clínico primario compuesto de muerte por cualquier causa. Resultados: La población del estudio incluyó a 15 pacientes, 14 de los cuales tenían HBC y uno tenía bloqueo AV 2:1. El síncope fue la presentación más común. El criterio de valoración clínico en forma de muerte se observó en 5 pacientes (33,3%), 3 pacientes revirtieron al ritmo sinusal y 7 pacientes requirieron implantación de marcapasos permanente. Los marcadores de inflamación se elevaron en todos los pacientes; sin embargo, se observó una tendencia hacia una mayor inflamación en los pacientes que alcanzaron el criterio de valoración clínico primario. Tres de cada 7 pacientes con QRS estrecho revirtieron al ritmo sinusal normal, mientras que los 8 pacientes con QRS de complejo ancho murieron o requirieron la inserción de un marcapasos permanente. Conclusión: La bradiarritmia sintomática se asocia con un estado inflamatorio alto y una alta mortalidad en la infección por COVID-19, y un bloqueo transitorio de la conducción en pacientes con ritmo QRS estrecho puede sugerir una inflamación miocárdica subclínica local.
Published: 2021

14. Six months clinical outcome comparison between quadripolar and bipolar left ventricular leads in cardiac resynchronization therapy: A prospective, non-randomized, single-centre observational study

Author: Rajeev Bharadwaj, Ranjit Kumar Nath, Ajay Pratap Singh, Neeraj Pandit, Ashok Kumar Thakur, Puneet Aggarwal, Ajay Raj, and Vinod Kumar
Subjects: medicine.medical_specialty, medicine.medical_treatment, Cardiac resynchronization therapy, Heart failure, Quadripolar lead, 030204 cardiovascular system & hematology, 03 medical and health sciences, QRS complex, 0302 clinical medicine, Physiology (medical), Internal medicine, medicine, Diseases of the circulatory (Cardiovascular) system, 030212 general & internal medicine, Lead (electronics), Bipolar lead, Ejection fraction, business.industry, Incidence (epidemiology), medicine.disease, medicine.anatomical_structure, Ventricle, RC666-701, Cardiology, Original Article, Cardiology and Cardiovascular Medicine, Complication, business
Abstract: Background and objectives Quadripolar left ventricular (LV) leads in cardiac resynchronization therapy (CRT) offer multi-vector pacing with different pacing configurations and hence enabling LV pacing at most suitable site with better lead stability. We aim to compare the outcomes between quadripolar and bipolar LV lead in patients receiving CRT. Methods In this prospective, non-randomized, single-center observational study, we enrolled 93 patients receiving CRT with bipolar (BiP) (n = 31) and quadripolar (Quad) (n = 62) LV lead between August 2016 to August 2019. Patients were followed for six months, and outcomes were compared with respect to CRT response (defined as ≥5% absolute increase in left ventricle ejection fraction), electrocardiographic, echocardiographic parameters, NYHA functional class improvement, and incidence of LV lead-related complication. Results At the end of six months follow up, CRT with quadripolar lead was associated with better response rate as compared to bipolar pacing (85.48% vs 64.51%; p = 0.03), lesser heart failure (HF) hospitalization events (1.5 vs 2; p = 0.04) and better improvement in HF symptoms (patients with ≥1 NYHA improvement 87.09% vs 67.74%; p = 0.04). There were fewer deaths per 100 patient-year (6.45 vs 9.37; p = 0.04) and more narrowing of QRS duration (Δ12.56 ± 3.11 ms vs Δ7.29 ± 1.87 ms; p = 0.04) with quadripolar lead use. Lead related complications were significantly more with the use of bipolar lead (74.19% vs 41.94%; p = 0.02). Conclusions Our prospective, non-randomized, single-center observational study reveals that patients receiving CRT with quadripolar leads have a better response to therapy, lesser heart failure hospitalizations, lower all-cause mortality, and fewer lead-related complications, proving its superiority over the bipolar lead.
Published: 2021

15. Comparison of original and modified Q risk 2 risk score with Framingham risk score - An Indian perspective

Author: Puneet Aggarwal, Ranjit Kumar Nath, Santosh Kumar Sinha, Dibbendhu Khanra, Kranthi Kumar Reddy, Jaskaran Singh Gujral, and Anindya Mukherjee
Subjects: medicine.medical_specialty, RD1-811, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Epidemiology, medicine, Prevalence, Humans, Diseases of the circulatory (Cardiovascular) system, 030212 general & internal medicine, Family history, Framingham Risk Score, Primary prevention, business.industry, Q risk 2, medicine.disease, Cardiovascular disease, Obesity, Smokeless tobacco, Cardiovascular Diseases, RC666-701, Observational study, Original Article, Framingham risk score, Surgery, Cardiology and Cardiovascular Medicine, Risk assessment, business, Body mass index
Abstract: Objective No study among Indian population has proposed modification of existing cardiovascular disease (CVD) risk scores or novel risk scores as risk estimation using conventional risk calculators can’t be generalized because of epidemiological differences. Material and methods A single center observational study was performed at a tertiary care center among participants having no evidence of CVD. Prevalence of various cardiac risk factors were analysed and 10-year risk was estimated using Framingham risk score (FRS), Q risk 2 score calculator (QRISK2) and Modified Q risk 2 (mQRISK2) which included smokeless tobacco consumption. QRISK2 and mQRISK2 were compared with FRS and participant’s eligibility for statin therapy as primary preventive measure was assessed. Results Total of 4045 participants were enrolled from August 2016 to July 2019. 3520(87%) had no history of smoking in their lifetime while smokeless tobacco consumption was seen in 1153(28.5%), diabetes in 422(10.4%), hypertension in 1096(27.1%), obesity in 2035(50.3%), and family history of CVD in 353(8.7%) participants. High risk participants were found to be 826(20.4%), 627(15.5%), and 509(12.6%) by using FRS, mQRISK2 and QRISK2, whereas those eligible for statin therapy were maximum by mQRISK2 among 1323(32.7%) participants compared to QRISK2 (n = 1191; 29.4%) and FRS (n = 826; 20.4%) model. Krippendorff’s alpha for mQRISK2 was in better agreement with body mass index (BMI) and lipid FRS CVD scoring system as compared to QRISK2 risk model. Conclusion CVD risk stratification based on smokeless tobacco use is first of its kind from this part of world and should be part of CV risk assessment.
Published: 2021

16. Cardiovascular outcomes of antidiabetic drugs

Author: Bhagya Narayan Pandit, Rajeev Bhardwaj, Neeraj Pandit, Ajay Raj, Ajay Pratap Singh, Ashok Kumar Thakur, Vinod Kumar, and Ranjit Kumar Nath
Subjects: Cardiovascular safety, business.industry, DPP-4 Inhibitors, lcsh:R, lcsh:Medicine, Type 2 Diabetes Mellitus, antidiabetic drugs, glp-1 receptor agonist, Pharmacology, medicine.disease, medicine.disease_cause, cardiovascular outcomes, Food and drug administration, Blood pressure, Diabetes mellitus, dpp 4 inhibitors, Medicine, sglt2 inhibitors, General Agricultural and Biological Sciences, business, Cardiovascular outcomes, Oxidative stress
Abstract: Type 2 Diabetes Mellitus (T2DM) is associated with a high risk of atherosclerotic cardiovascular disease (ASCVD). Intensive blood glucose reduction with antidiabetic drugs significantly reduce microvascular complications but there is no strong evidence of reduction in cardiovascular (CV) events. In 2008, the US Food and Drug Administration (FDA) issued guidance to demonstrate cardiovascular safety of newer antidiabetic drugs in addition to reduction in blood glucose level. After which a number of CVOTs were conducted involving newer antidiabetic drugs. The newer drugs (e.g. GLP-1 RAs, SGLT2 inhibitors and DPP 4 inhibitors) might have potential effects on body weight, lipid parameters and blood pressure, as well as endothelial dysfunctions, inflammatory markers and oxidative stress. The current review summarizes the results of the main trials focused on the cardiovascular outcomes of traditional as well as newer antidiabetic drugs.
Published: 2021

17. Percutaneous management of Stuck Rotational Atherectomy Burr: Experience at a tertiary care centre

Author: Sripad Vasant Khairnar, Ajay Raj, Ajay Pratap Singh, Neeraj Pandit, Ashok Kumar Thakur, and Ranjit Kumar Nath
Subjects: medicine.medical_specialty, Percutaneous, business.industry, medicine.medical_treatment, lcsh:R, Percutaneous coronary intervention, rotablator, lcsh:Medicine, Rotational atherectomy, Tertiary care, Surgery, entrapment, stuck burr, Conventional PCI, Medicine, In patient, General Agricultural and Biological Sciences, business, rotational atherectomy
Abstract: Background: The incidence of stuck rotational atherectomy (RA) burr is extremely low, and its description has been sporadic in the literature about the systemic management of this complication. Aims and Objective: The current study was designed to present the experience of our center and propose an algorithm for the retrieval of stuck RA burr. Materials and Methods: We retrospectively evaluated cases of RA between August 2018 to August 2020 at our center. An entrapped RA burr was defined as an inability to move the burr backward without any additional maneuvers during or after the rotablation of a coronary lesion. Angiographic and procedural details were reviewed in the identified cases of entrapped rotablator burr, details of maneuvers used to retract the burr was documented. We further analyzed the literature using PubMed search using the keywords “entrapment of rotablator burr”, “stuck rotablator” and “rotablation complications”. All the articles with entrapped rotablation burr were identified and scrutinized for the techniques used for percutaneous retrieval. Results: Out of the total 5780 Percutaneous coronary intervention (PCI) procedures, RA was performed in 75 patients and RA burr entrapment was confirmed in two cases. Both the cases were seen in patients with angulated and heavily calcified lesions. The cases were managed percutaneously by endovascular maneuvers. A total of 8 techniques were identified by analysis of available literature for burr retrieval with surgery being the favored one. Using the experience of our center and available literature we propose a simplified working algorithm towards systematic management of this complication. Conclusion: RA burr entrapment is rare, but a life-threatening complication, and the operator should be prepared with strategies for successful retrieval of stuck burr. Percutaneous retraction maneuvers should be used as the first-line management for retrieval of stuck burr followed by surgical referral. Using the proposed algorithm this rare complication can be managed systematically and effectively.
Published: 2021

18. Prevalence of abnormal upper limb arterial anatomy and its correlation with access failure during transradial coronary angiography

Author: Sulabh Chandraker, Ranjit Kumar Nath, Kakasaheb H. Bhosale, Balram Yadav, and Sripad Vasant Khairnar
Subjects: Adult, Male, Coronary angiography, medicine.medical_specialty, RD1-811, Coronary Artery Disease, 030204 cardiovascular system & hematology, Upper Extremity, Ulnar Artery, Young Adult, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, Internal medicine, Catheterization, Peripheral, Prevalence, medicine, Diseases of the circulatory (Cardiovascular) system, Humans, Prospective Studies, 030212 general & internal medicine, Angioplasty, Balloon, Coronary, Radial artery, Aged, Aged, 80 and over, Transradial, Arterial anatomy, business.industry, Middle Aged, Arterial tree, Access failure, Catheter, medicine.anatomical_structure, RC666-701, Radial Artery, Cardiology, Upper limb, Surgery, Original Article, Female, Abnormality, Cardiology and Cardiovascular Medicine, business, Abnormal upper limb arterial anatomy
Abstract: Objective The study aimed at to find out prevalence of abnormal upper limb arterial anatomy and its correlation with access failure during transradial coronary angiography. Method This was a prospective observational study of 1512 patients who had undergone transradial coronary angiography (CAG). Angiographic assessment of upper limb arterial tree was performed when the angiographic guidewire or the diagnostic catheter followed an abnormal path or got stuck in its course. Results About 5.29% patients (80/1512) were noted to have abnormal upper limb arterial anatomy. The most common abnormality detected were radio-ulnar loop in 22 (1.46%) patients, tortuous upper limb arteries 19 (1.25%) and abnormal high origin of radial artery 10 (0.66%) patients. Access failure was encountered in 4.4% (67/1512) of total patients and 64.17% (43/67) access failure was due to abnormal upper limb arterial anatomy. Conclusion Abnormal upper limb arterial anatomy was the most common cause of access failure in transradial coronary angiography in this study.
Published: 2021

19. Large intracoronary thrombus and its management during primary PCI

Author: Ranjit Kumar Nath, Vinod Kumar, Tarun Kumar, and Ajay Sharma
Subjects: MBG, myocardial blush grade, MACE, major adverse cardiac events, medicine.medical_treatment, IRA, infarct related artery, Review Article, LTB, large thrombus burden, 030204 cardiovascular system & hematology, GPI, Gp IIb/IIIa inhibitor, Coronary Angiography, SVG, saphenous venous graft, 0302 clinical medicine, Thrombolytic Therapy, 030212 general & internal medicine, Embolization, Embolic protection device, Primary PCI, Thrombectomy, DAPT, dual antiplatelet therapy, Disease Management, surgical procedures, operative, Treatment Outcome, Cardiology, cardiovascular system, MI, myocardial infarction, Cardiology and Cardiovascular Medicine, IV, intravenous, medicine.medical_specialty, Standard of care, Intracoronary thrombus, RD1-811, Thrombus aspiration, Distal embolization, TIMI, thrombolysis in myocardial infarction, TLR, target lesion revascularisation, Large thrombus burden, 03 medical and health sciences, STEMI, ST elevation myocardial infarction, Percutaneous Coronary Intervention, Internal medicine, medicine, Diseases of the circulatory (Cardiovascular) system, Humans, In patient, cardiovascular diseases, UFH, unfractionated heparin, IC, Intracoronary, PCI, percutaneous coronary intervention, business.industry, Coronary Thrombosis, EPD, Embolic protection devices, Management strategy, Thrombus burden, RC666-701, Conventional PCI, TG, thrombus grade, Surgery, ACS, acute coronary syndrome, business, BMS, bare metal stent
Abstract: Large intracoronary thrombus has been reported in significant number of patients with STEMI. Primary PCI is the current standard of care in patients of STEMI. Despite the availability of dual antiplatelets, GP IIb/IIIa inhibitor and effective anticoagulation regimens, large intracoronary thrombus remains one of the biggest challenge to interventional cardiologists during primary PCI. Large intracoronary thrombus may lead to distal embolization, no/slow reflow or embolization into a non-culprit vessel and is associated with adverse cardiovascular outcome. There is no ideal management strategy. We hereby discuss the current available methods/strategies to deal with large thrombus burden encountered during primary PCI, in the current manuscript.
Published: 2020

20. Transpedal Approach in Failed Antegrade Attempt of Lower Limb Peripheral Arterial Disease—A Review with Different Treatment Strategies

Author: Siva Subramaniyan, Neeraj Pandit, Deepankar Vatsa, and Ranjit Kumar Nath
Subjects: medicine.medical_specialty, business.industry, Arterial disease, medicine.medical_treatment, Femoral artery, Critical limb ischemia, Lower limb, Surgery, Review article, Peripheral, Lesion, Amputation, medicine.artery, medicine, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: Transpedal access is an evolving technique primarily used in patients after failed femoral antegrade approach to revascularize complex tibiopedal lesions. In patients who are at high risk for surgery the transpedal access may be the only option in failed antegrade femoral access to avoid amputation of the limbs. In recent years transpedal access is used routinely to revascularize supra-popliteal lesions due to more success and less complications over femoral artery approach. Retrograde approach parse will not give success in all cases and importantly success depends on techniques used. There are different techniques that need to be used depending on lesion characteristics, comorbidities, and hardware available to improve success with less complications. This review provides different strategies for successful treatment of iliac and femoral artery lesions by transpedal approach after failed antegrade femoral attempt.
Published: 2020

21. A Nest Within the Heart: A Rare Cause of Embolic Phenomenon

Author: Ranjit Kumar Nath and Abhinav Shrivastava
Subjects: medicine.medical_specialty, Heart Diseases, Computed Tomography Angiography, Magnetic Resonance Imaging, Cine, Fatal Outcome, Rare Diseases, Nest, Internal medicine, Mitral valve, medicine, Humans, Radiology, Nuclear Medicine and imaging, Atrial Appendage, Stroke, business.industry, Cysts, Middle Aged, medicine.disease, medicine.anatomical_structure, Embolism, Splenic infarction, Cardiology, Mitral Valve, Female, Cardiology and Cardiovascular Medicine, business, Pulmonary Embolism, Echocardiography, Transesophageal
Published: 2021

22. Outcomes in the ISCHEMIA Trial Based on Coronary Artery Disease and Ischemia Severity

Author: Judith S. Hochman, Matyas Keltai, Claes Held, Sripal Bangalore, Sean M. O'Brien, Bernard R. Chaitman, Raymond Y. Kwong, Courtney Page, P. Smanio, Zhen Huang, James K. Min, David J. Maron, Leslee J. Shaw, Daniel B. Mark, Jonathan D. Newman, Michael H. Picard, Daniel S. Berman, Ranjit Kumar Nath, Sudhanshu Kumar Dwivedi, Gregg W. Stone, John A. Spertus, Harmony R. Reynolds, and Peter Stone
Subjects: Male, medicine.medical_specialty, Myocardial revascularization, business.industry, medicine.medical_treatment, Ischemia, Percutaneous coronary intervention, Coronary Artery Disease, medicine.disease, Article, Coronary artery disease, Geriatric cardiology, Treatment Outcome, Physiology (medical), Heart failure, Internal medicine, Cardiology, medicine, Humans, Female, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business
Abstract: Background: The ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) postulated that patients with stable coronary artery disease (CAD) and moderate or severe ischemia would benefit from revascularization. We investigated the relationship between severity of CAD and ischemia and trial outcomes, overall and by management strategy. Methods: In total, 5179 patients with moderate or severe ischemia were randomized to an initial invasive or conservative management strategy. Blinded, core laboratory–interpreted coronary computed tomographic angiography was used to assess anatomic eligibility for randomization. Extent and severity of CAD were classified with the modified Duke Prognostic Index (n=2475, 48%). Ischemia severity was interpreted by independent core laboratories (nuclear, echocardiography, magnetic resonance imaging, exercise tolerance testing, n=5105, 99%). We compared 4-year event rates across subgroups defined by severity of ischemia and CAD. The primary end point for this analysis was all-cause mortality. Secondary end points were myocardial infarction (MI), cardiovascular death or MI, and the trial primary end point (cardiovascular death, MI, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest). Results: Relative to mild/no ischemia, neither moderate ischemia nor severe ischemia was associated with increased mortality (moderate ischemia hazard ratio [HR], 0.89 [95% CI, 0.61–1.30]; severe ischemia HR, 0.83 [95% CI, 0.57–1.21]; P =0.33). Nonfatal MI rates increased with worsening ischemia severity (HR for moderate ischemia, 1.20 [95% CI, 0.86–1.69] versus mild/no ischemia; HR for severe ischemia, 1.37 [95% CI, 0.98–1.91]; P =0.04 for trend, P =NS after adjustment for CAD). Increasing CAD severity was associated with death (HR, 2.72 [95% CI, 1.06–6.98]) and MI (HR, 3.78 [95% CI, 1.63–8.78]) for the most versus least severe CAD subgroup. Ischemia severity did not identify a subgroup with treatment benefit on mortality, MI, the trial primary end point, or cardiovascular death or MI. In the most severe CAD subgroup (n=659), the 4-year rate of cardiovascular death or MI was lower in the invasive strategy group (difference, 6.3% [95% CI, 0.2%–12.4%]), but 4-year all-cause mortality was similar. Conclusions: Ischemia severity was not associated with increased risk after adjustment for CAD severity. More severe CAD was associated with increased risk. Invasive management did not lower all-cause mortality at 4 years in any ischemia or CAD subgroup. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01471522.
Published: 2021

23. Looking Deep Into the Palpitation – Pheochromocytoma Presenting as Sinus Node Dysfunction

Author: Ranjit Kumar Nath, Abhinav Shrivastava, and Puneet Aggarwal
Subjects: medicine.medical_specialty, medicine.diagnostic_test, business.industry, Cardiology, General Engineering, Secondary hypertension, bradyarrythmia, Metanephrines, medicine.disease, nodal escape, Pheochromocytoma, junctional rhythm, medicine.anatomical_structure, adrenal pheochromocytoma, Positron emission tomography, Internal Medicine, secondary hypertension, medicine, Outpatient clinic, Radiology, Headaches, medicine.symptom, business, Junctional rhythm, Sinus (anatomy)
Abstract: A 23-year-old male came to the outpatient department with a history of intermittent palpitations and headaches for the past six to eight months. He was diagnosed with hypertension and had a junctional rhythm on an electrocardiogram (ECG). On further workup for his hypertension, he was found to have elevated levels of serum metanephrines and computed tomography (CT) and positron emission tomography (PET) scan revealed pheochromocytoma. He was subsequently operated upon and his arrhythmia subsided after surgery. We discuss our approach to this scenario, which leads us to a rather rare cause of sinus node dysfunction.
Published: 2021

24. Impact of COVID-19 on Thrombus Burden and Outcome in Acute Myocardial Infarction

Author: Santosh Kumar Sinha, Bhagya Narayan Pandit, Puneet Aggarwal, Dheerendra Kuber, Ranjit Kumar Nath, and Abhinav Shrivastava
Subjects: medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, Cardiology, coronary thrombus, acute myocardial infarction, Infectious Disease, Chest pain, st-elevation myocardial infarction (stemi), Internal medicine, Epidemiology, medicine, cardiovascular diseases, Myocardial infarction, business.industry, percutaneous coronary intervention, General Engineering, Percutaneous coronary intervention, medicine.disease, covid-19, Thrombus burden, Population study, Observational study, medicine.symptom, business
Abstract: Background Cardiovascular manifestations are one of the most common complications in coronavirus disease 2019 (COVID-19) infection and are associated with increased mortality. However, the impact of COVID-19 infection on thrombus burden and the outcome of acute myocardial infarction (AMI) has not been studied. Methods This was a retrospective, observational study that included all adult patients (>18 years) diagnosed with AMI with or without COVID-19 infection. Epidemiological, laboratory, clinical, interventional, and outcome data were extracted and the impact of COVID-19 on thrombus burden and the primary clinical composite endpoint of all-cause death during hospital admission or 30 days after discharge was studied. Results The study population included 336 patients, including 56 patients with COVID and AMI and 280 patients with AMI without COVID-19 infection. Chest pain was the most common symptom (84.8%) while one or more co-morbidity was present in 117 (34.8%) patients. Forty-eight patients in the AMI with COVID group had ST-segment elevation myocardial infarction (STEMI) while 256 patients in the AMI without COVID group had STEMI, eight patients in the AMI with COVID group had non-ST-segment elevation myocardial infarction (NSTEMI), and 24 in the AMI without COVID group had NSTEMI. Patients with COVID-19 co-infection had a higher thrombus burden as compared to the patients without COVID-19 AMI group (p-value 0.008). The primary outcome in the form of all-cause mortality was seen in 13 (3.9%) patients, which was also more in the AMI with COVID group. Conclusion COVID-19 in AMI is a state of high thrombus burden associated with higher mortality, especially in patients with chronic co-morbidities.
Published: 2021

25. Aortic Dissection With Complete Occlusion of Left Main Coronary Artery Presenting as Acute ST-Segment Elevation Myocardial Infarction

Author: Ajay Pratap Singh, Vatsal Kayal, and Ranjit Kumar Nath
Subjects: medicine.medical_specialty, Cardiology, Asymptomatic, Sudden cardiac death, Internal medicine, medicine, Myocardial infarction, aortic dissection, Aortic dissection, left main stem occlusion, business.industry, General Engineering, Blood flow, medicine.disease, stemi, myocardial infarction, medicine.anatomical_structure, Cardiac/Thoracic/Vascular Surgery, Emergency Medicine, coronary angiography, medicine.symptom, Presentation (obstetrics), business, Artery, Retrograde extension
Abstract: Acute Aortic Dissection (AAD) is a life-threatening condition, which presents with a wide variety of symptoms ranging from being asymptomatic to sudden cardiac death. A retrograde extension of AAD can lead to partial or complete occlusion of coronary vessels, leading to an exceedingly rare presentation in the form of acute Myocardial Infarction (MI). A prognosis of AAD depends on prompt diagnosis and urgent surgical intervention to re-establish coronary blood flow. Here, we report a case of AAD, presenting as acute anterolateral wall MI, due to total occlusion of the left main coronary artery.
Published: 2021

26. Occluded superior vena cava and failed epicardial pacing: An unorthodox solution

Author: Ranjit Kumar Nath and Satyam Rajvanshi
Subjects: medicine.medical_specialty, business.industry, Superior vena cava, Internal medicine, Epicardial pacing, medicine, Cardiology, business
Published: 2020

27. Rheumatic valve disease in a 2-year-old child: A rare case report

Author: Rajeev Bharadwaj and Ranjit Kumar Nath
Subjects: Pediatrics, medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, Heart disease, business.industry, Mitral obstruction, Disease, medicine.disease, juvenile, pediatric, lcsh:RC666-701, Rare case, Medicine, Rheumatic fever, rheumatic, Presentation (obstetrics), business, Valve disease, mitral stenosis
Abstract: Rheumatic fever (RF) and rheumatic heart disease (RHD) are major health hazards in developing countries. Affection with RF-RHD in preschool years is uncommon, but prognostically worse as management is technically difficult. We report a rare early presentation of rheumatic valve disease in a 2-year-old child. This is probably the youngest case of rheumatic mitral obstruction documented in literature till date. It highlights that RF-RHD is still a very prevalent disease in India yet is underdiagnosed and underreported.
Published: 2020

28. Acute effect of primary PCI on diastolic dysfunction recovery in anterior wall STEMI – A non-invasive evaluation by echocardiography

Author: Siva Subramaniyan, Ajay Raj, Ranjit Kumar Nath, Neeraj Pandit, Deepankar Vatsa, and Athar Kamal
Subjects: medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_treatment, Anterior wall, Diastole, 030204 cardiovascular system & hematology, Chest pain, Percutaneous Intervention, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, 030212 general & internal medicine, business.industry, Isovolumic relaxation time, Primary percutaneous coronary intervention, Percutaneous coronary intervention, ST elevation myocardial infarction, medicine.anatomical_structure, Coronary occlusion, lcsh:RC666-701, Conventional PCI, Cardiology, Deceleration time, Diastolic dysfunction, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Artery
Abstract: Background: It is well established fact that acute coronary occlusion leads to diastolic dysfunction, followed by systolic dysfunction when myonecrosis occur. It is also proven that primary percutaneous coronary intervention (PPCI) is an excellent therapy for ST elevation myocardial infarction (STEMI) to improve outcomes. However there is a paucity of information on efficacy of PPCI in improving diastolic function. Evaluation of the role of PPCI in improving diastolic dysfunction is required. Methods: 61 patients with first anterior wall STEMI who underwent PPCI to left anterior descending artery were included. Echocardiographic evaluation was performed within 24 h of PPCI and then on day 15, 3 months and 6 months after PPCI. We evaluated the prevalence of diastolic dysfunction after PPCI and its recovery during 6 months along with effect of duration of chest pain on diastolic function. Results: 54.1% of patients had diastolic dysfunction after PPCI whereas it was only 21.3% after 6 months (p value
Published: 2018

29. Hematinic deficiency in patients with heart failure with reduced ejection fraction (HFrEF)

Author: Ranjit Kumar Nath, Santosh Kumar Sinha, Puneet Aggarwal, Dibbendhu Khanra, Mahmoodullah Razi, and Abhinav Shrivastava
Subjects: Adult, Male, medicine.medical_specialty, Anemia, Gastroenterology, Ventricular Dysfunction, Left, Folic Acid, Internal medicine, medicine, Humans, Vitamin B12, Hematinic, Prospective Studies, Aged, Heart Failure, Framingham Risk Score, Ejection fraction, Anemia, Iron-Deficiency, business.industry, Dilated cardiomyopathy, Stroke Volume, Vitamin B 12 Deficiency, Middle Aged, medicine.disease, Vitamin B 12, Iron-deficiency anemia, Heart failure, Hematinics, Female, Cardiology and Cardiovascular Medicine, business
Abstract: Hematinic deficiency irrespective of anemia is not uncommon in patients with heart failure. We studied the prevalence, distribution, and etiology of anemia in patients with heart failure with reduced ejection fraction (HFrEF) and compared it with non-anemic patients.Congestive heart failure (CHF) was diagnosed by modified Framingham criteria and ejection fraction (EF)40%. Iron deficiency (ID) anemia was defined as serum ferritin level100 ng/ml (absolute) or 100-300 ng/ml with transferrin saturation20% (functional). Vitamin B12 and folate deficiency were defined as200pg/ml and4ng/ml respectively.688 patients with HFrEF were studied with an overall mean age of 57.2±13.8 years, and males outnumbering females (62.3% vs. 37.7%). Coronary artery disease (44.2%), dilated cardiomyopathy (46.8%), and valvular heart disease (6.7%) were major causes of CHF.Anemia was found in 63.9% of patients. Vit B12 deficiency, and folate deficiency were found in 107 (15.55%), and 54 (7.85%) subjects, respectively. Absolute ID was detected in 186 (42.27%) patients with anemia and 84 (33.87%) patients without anemia, while functional ID was present in 80 (18.18%) patients with anemia and 29 (11.69%) patients without anemia. Vitamin B12 deficiency was noted in 70 (15.9%) patients with anemia and 37 (14.9%) patients without anemia, while folate deficiency was noted in 31 (7.04%) patients with anemia and 23 (9.2%) patients without anemia. Hematinic deficiency among the study population was distributed equally among patients irrespective of EF, NYHA class, socioeconomic class diet pattern.The study shows that hematinic deficiency was seen even in non-anemic patients irrespective of diet pattern. Supplementation could be a strong strategy to improve outcomes in these patients of heart failure irrespective of anemia and should be evaluated in prospective studies.
Published: 2021

30. Comparing the Modified Frailty Index with conventional scores for prediction of cardiac resynchronization therapy response in patients with heart failure

Author: Bhagya Narayan Pandit, Puneet Aggarwal, Ajay Raj, Ajay Pratap Singh, Neeraj Pandit, and Ranjit Kumar Nath
Subjects: medicine.medical_specialty, Cardiac resynchronization therapy, Ejection fraction, Frailty, business.industry, medicine.medical_treatment, Frailty Index, Renal function, Atrial fibrillation, Heart failure, medicine.disease, QRS complex, Risk score model, Internal medicine, medicine, Cardiology, cardiovascular system, Observational study, Original Article, cardiovascular diseases, business, circulatory and respiratory physiology
Abstract: Objective: The aim of the study was to compare, Modified Frailty Index (mFI), EAARN (LVEF
Published: 2021

31. Predictors of no-reflow phenomenon following percutaneous coronary intervention for ST-segment elevation myocardial infarction

Author: L. Rekwal, Puneet Aggarwal, A.P. Singh, Santosh Kumar Sinha, Ranjit Kumar Nath, and Dibbendhu Khanra
Subjects: Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Blood Pressure, 030204 cardiovascular system & hematology, Coronary Angiography, Lesion, 03 medical and health sciences, Ventricular Dysfunction, Left, 0302 clinical medicine, Percutaneous Coronary Intervention, Predictive Value of Tests, Risk Factors, Internal medicine, medicine, ST segment, Humans, cardiovascular diseases, Myocardial infarction, Prospective Studies, Aged, medicine.diagnostic_test, business.industry, Troponin I, Age Factors, Percutaneous coronary intervention, Stroke Volume, Thrombosis, Middle Aged, medicine.disease, surgical procedures, operative, Logistic Models, Case-Control Studies, Conventional PCI, Angiography, No reflow phenomenon, cardiovascular system, Cardiology, No-Reflow Phenomenon, ST Elevation Myocardial Infarction, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Perfusion
Abstract: No reflow during percutaneous coronary intervention (PCI) is a complex issue with serious outcomes. Multiple studies have studied predictors of no-reflow during primary PCI, but data on patients with the late presentation is sparse, which constitutes the majority of patients in peripheral centers. This study aimed to determine predictors of no-reflow during PCI in patients with ST-segment elevation myocardial infarction (STEMI) in 7 days.It was a single-center prospective case-control study performed at a tertiary care center and included 958 patients with STEMI who underwent PCI within 7 days of symptom onset. Baseline and angiographic data of patients undergoing PCI were recorded and patients divided into reflow and no-reflow group.Of 958 who underwent PCI, 182 (18.9%) showed no-reflow by myocardial blush grade (MBG)2. No-reflow group had a higher mean age (66.46±10.71 vs. 61.36±9.94 years), lower systolic blood pressure (SBP) on admission (100.61±26.66 vs. 112.23±24.35, P0.0001), a higher level of peak Troponin I level (9.37±2.81 vs. 7.66±3.11ng/dL, P0.0001), low left ventricular ejection fraction (36.71±3.89 vs. 39.58±4.28% respectively P0.0001). Among angiographic data and procedural features, multivariable logistic regression analysis identified that advanced age, reperfusion time6hours, SBP100mmHg on admission, functional status of Killip class for heart failure≥3, lower EF (≤35%), low initial myocardial blush grade (≤1) before PCI, long target lesion length, larger reference diameter of vessel (3.5mm) and high thrombus burden on angiography were found to be independent predictors of no-reflow (P0.05).No-reflow phenomenon after PCI for STEMI is complex and multifactorial and can be identified by simple clinical, angiographic, and procedural features. Preprocedural characters of the lesion and early perfusion decides the fate of the outcome.
Published: 2020

32. Rate of Rehospitalization in 60 Days of Discharge and It's Determinants in Patients with Heart Failure with Reduced Ejection Fraction in a Tertiary Care Centre in India

Author: Ranjit Kumar Nath, Neeraj Pandit, Balram Yadav, Sulabh Chandrakar, Kakasaheb H. Bhosale, Shripad Khairnar, and Puneet Agarwal
Subjects: medicine.medical_specialty, Ejection fraction, Anemia, business.industry, Internal medicine, Heart failure, medicine, Cardiology, In patient, medicine.disease, business, Tertiary care
Abstract: Identifying the patients with acute heart failure (HF) at high risk for rehospitalization after hospital discharge will enable proper optimization of treatment. This study is aimed to evaluate the rehospitalization rate at 60 days of discharge and their predictors in patients of chronic heart failure with reduced ejection fraction (HFrEF).This prospective observational study enrolled patients with left ventricle ejection fraction (LVEF)40%, who were admitted because of acute decompensation. Patients were followed for 60 days to analyze rehospitalization rate and its predictors.Of 103 HFrEF patients (74% male; mean age 55.8 years) enrolled, 7 patients died during index admission and 3 patients lost to follow up. The 60-day rehospitalization rate was 37% (34/93). We studied 23 clinical and 9 biochemical predictors of rehospitalization. Out of 34 events of rehospitalization, 79.41% (n=28) was due to cardiac cause followed by respiratory 5.8% (n=2), renal 5.8% (n=2) and others 5.8% (n=2). Among all the parameters, on logistic regression analysis having longer length of index hospital stay (7 days) (52.8% vs. 28.8%; odds ratio [OR], 1.79; confidence interval [CI], 1.2-7.25; p=0.040) and chronic kidney disease (CKD) (26.5% vs. 8.5%; OR, 3.06; CI, 1.1-57.04; p=0.050) independently increased the risk of rehospitalization at 60 days of discharge. Further higher haemoglobin level (11.3 vs. 9.9 gm/dL; OR, 0.71; CI, 0.48-0.97; p=0.050) and higher LVEF at index admission (30.4% vs. 26.5%; OR, 0.87; CI, 0.75-0.99; p=0.049) were associated with decreased the risk of rehospitalization.Our study reveals that patients with HFrEF have significantly higher rehospitalization rate (37%) and in-hospital mortality rates (6.78%) of any chronic cardiac disease conditions. Correction of low hemoglobin and special care in those who are having very low LVEF, CKD and longer length of stay, including tailored therapy and frequent visits may play an important role in preventing future rehospitalization in these patients.
Published: 2020

33. To determine the prevalence of dyslipidemia and lipoprotein abnormalities among siblings of young acute myocardial infarction patients

Author: Awadhesh Kumar Sharma, Neeraj P, and Ranjit Kumar Nath
Subjects: medicine.medical_specialty, Acute coronary syndrome, Waist, biology, business.industry, Lipoprotein(a), medicine.disease, Internal medicine, Diabetes mellitus, medicine, biology.protein, Myocardial infarction, medicine.symptom, business, Dyslipidemia, Abdominal obesity, Lipoprotein
Abstract: Introduction: Despite all available theoretical assumptions, there is no study defining the prevalence of lipid and lipoprotein abnormalities among siblings of young acute myocardial infarction (MI) patients. This is the first such study. Methods: This was a case-control study. A total 110 siblings of young acute MI patients (Group A) and 50 healthy young controls (Group B) were studied for a duration of 2 years. Clinical profiles included age, sex, smoking, hypertension, diabetes mellitus, abdominal obesity and dyslipidemia for both cases and controls.The primary objective was to study the prevalence of dyslipidemia and lipoprotein abnormalities. The secondary objective was to study the prevalence of conventional risk factors among siblings of young (
Published: 2020

34. Baseline hemoglobin and creatinine clearance as independent risk factors for 30-day event rate in patients of acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Author: Neeraj Pandit, Ranjit Kumar Nath, Richa Agrawal, and Ajay Raj
Subjects: Acute coronary syndrome, medicine.medical_specialty, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_treatment, Renal function, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, 030212 general & internal medicine, Myocardial infarction, cardiovascular diseases, Adverse effect, business.industry, Incidence (epidemiology), percutaneous coronary intervention, Percutaneous coronary intervention, hemoglobin, medicine.disease, surgical procedures, operative, ST-elevation myocardial infarction, lcsh:RC666-701, Heart failure, Conventional PCI, Cardiology, Creatinine clearence, business
Abstract: Background: Primary percutaneous coronary intervention (PCI) is the most effective therapy for managing acute ST-segment elevation myocardial infarction (STEMI). Studies have shown baseline low hemoglobin (Hb) and reduced creatinine clearance (CrCl) as risk factors for adverse outcomes in patients with heart failure, in patients undergoing PCI, and in acute coronary syndrome. However, their similar role in patients of acute STEMI undergoing primary PCI is not known. Objective: The main objective is to study whether baseline Hb and CrCl are the independent risk factors for the 30 days event rate in patients of acute STEMI undergoing primary PCI. Methods: We prospectively studied 500 patients of acute STEMI undergoing primary PCI. Hb and CrCl were measured at baseline and then at 15th and 30th day after the event. Patients were divided into four groups based on whether they have normal or abnormal baseline Hb and CrCl. Patients were followed for 30-day postdischarge for incidence of major adverse events in the form of death, reinfarction, reintervention, and hemodynamically unstable ventricular tachyarrhythmias. We assessed correlation between baseline Hb, CrC, l and 30-day event rate among four groups using Chi-square test. Results: On comparison among groups, compared to Group 1, Group 2, 3, and 4 had significantly higher adverse events ([6.48% vs. 19.44%] [P = 0.021]), ([6.48% vs. 30%] [P = 0.0003]), ([6.48% vs. 51.66%] [P ≤ 0.0001]), respectively, at 30 days after primary PCI. Conclusion: In patients of acute STEMI undergoing primary PCI, both baseline impaired CrCl and low Hb behaved independently as risk factors for increased 30-day event rates.
Published: 2018

35. Left main coronary artery compression in patients of atrial septal defect with dilated pulmonary artery

Author: Jaskaran Singh Gujral, Bhagya Narayan Pandit, Ajay Pratap Singh, Ranjit Kumar Nath, Puneet Aggarwal, Abhinav Shrivastava, Santosh Kumar Sinha, and Munish Guleria
Subjects: medicine.medical_specialty, Percutaneous, Ejection fraction, business.industry, medicine.medical_treatment, Hemodynamics, Retrospective cohort study, Compression (physics), medicine.anatomical_structure, Internal medicine, medicine.artery, Pediatrics, Perinatology and Child Health, Pulmonary artery, Cardiology, Medicine, Cardiology and Cardiovascular Medicine, business, Cardiac catheterization, Artery
Abstract: Background External compression of left main coronary artery (LMCA) by dilated pulmonary artery is a rare and less known phenomenon. Objective To find incidence and associated angiographic findings of LMCA compression by a dilated pulmonary artery in adult patients with an Atrial septal defect (ASD). Methods It was a retrospective observational study done in 55 patients with ASD and age more than 35 years. All patients underwent coronary angiogram along with cardiac catheterization to look for hemodynamic parameters and status of the epicardial coronary artery. Patients with significant LMCA compression underwent computed tomography and intravascular imaging to confirm significant compression and rule out atherosclerotic stenosis. Patients with and without LMCA compression were compared to find any causation, and patients with LMCA compression were followed up after the final consensus of management. Results As compared to patients without LMCA compression, significant LMCA compression was found in 4 (7.27%) of patients and associated with reduced ejection fraction (46.3 ± 10.3% vs 60 ± 2.0%; p-value 0.001), increased pulmonary artery diameter (55 ± 14.5 mm vs 24.9 ± 4.7 mm; p-value Conclusions LMCA compression is rarely seen in patients with an atrial septal defect and is associated with a reduced ejection fraction, increased pulmonary artery diameter, increased pulmonary artery/aortic diameter ratio, and raised mPAP. Treatment modalities like medical management, percutaneous intervention by stenting, and surgical correction play an important role in management.
Published: 2021

36. Monomorphic ventricular tachycardia in a young female: look out for the zebras

Author: Abhinav Shrivastava, Ranjit Kumar Nath, and Jaskaran Singh Gujral
Subjects: Tachycardia, medicine.medical_specialty, 030204 cardiovascular system & hematology, Electrocardiography, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Humans, 030212 general & internal medicine, Young female, Brugada syndrome, Pregnancy, medicine.diagnostic_test, Monomorphic Ventricular Tachycardia, biology, business.industry, Syncope (genus), General Medicine, medicine.disease, biology.organism_classification, Tachycardia, Ventricular, Cardiology, Gestation, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract: A 22-year-old pregnant patient (32 weeks of gestation) presented to casualty with a history of syncope resulting in a fall. On examination, she was having tachycardia with hypotension. Electrocardi...
Published: 2020

37. Risk factors, clinical presentation, angiographic profile and 30-day outcomes of young patients (aged ≤35 Years) with ST-elevation myocardial infarction

Author: Lokesh Kumar Sharma, Ajay Sharma, Neeraj Pandit, Tarun Kumar, Bhagya Narayan Pandit, Ranjit Kumar Nath, Ajay Raj, and Vinod Kumar
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, General Medicine, Thrombolysis, Disease, medicine.disease, Obesity, Coronary artery disease, Internal medicine, Diabetes mellitus, medicine, cardiovascular diseases, Myocardial infarction, Risk factor, Family history, business
Abstract: Background: Acute ST-elevation myocardial infarction (STEMI) is the most devastating form of coronary artery disease (CAD). The aim of the present study was to assess the risk factors, clinical presentation, angiographic profile and 30-day outcomes of young patients (aged ≤35 years) with STEMI. Materials and Methods: Between 1 March, 2019 and 29 February, 2020, a total of 75 young patients aged ≤35 years old, with acute STEMI were included in the study. All patients underwent coronary angiography and were evaluated for clinical presentation, risk factors for CAD, management and in hospital and 30-day outcome. Results: The mean age of patients was 31 ± 4.5 years and 96% were male. The most common cardiovascular risk factor was smoking (66.7%), followed by dyslipidaemia (61%), family history of CAD (40%) and obesity (33.3%). Diabetes mellitus (9.3%) and hypertension (14.7%) were less common. Novel risk factors such as high-sensitivity C-reactive protein, lipoprotein (a) and hyperhomocysteinaemia were having significant association to young myocardial infarction (MI). The most common location of MI was the anterior wall (68%). Significant CAD was found in 86.7% of patients. Most patients had single vessel disease (68%) with left anterior descending being the most common vessel involved (53.3%). There was no mortality during hospitalisation or 30-day period. Conclusion: Acute MI in young (≤35 years) almost exclusively occurs in male and smoking is the most common cardiovascular risk factor. Young patients have less extensive coronary involvement and favourable outcomes.
Published: 2021

38. Veno-venous loop through coronary sinus for LV lead placement during cardiac resynchronization therapy

Author: Neeraj Pandit, C. Parvatagouda, Ajay Raj, and Ranjit Kumar Nath
Subjects: Adult, Male, medicine.medical_specialty, Vena Cava, Superior, RD1-811, medicine.medical_treatment, Middle Cardiac Vein, Cardiomyopathy, Cardiac resynchronization therapy, Case Report, 030204 cardiovascular system & hematology, Cardiac Resynchronization Therapy, Electrocardiography, 03 medical and health sciences, 0302 clinical medicine, Superior vena cava, Internal medicine, Diseases of the circulatory (Cardiovascular) system, Humans, Medicine, Veno-venous loop, cardiovascular diseases, Thoracotomy, Coronary sinus, Snare, business.industry, Anastomosis, Surgical, Coronary Sinus, LV lead, medicine.disease, Coronary Vessels, Electrodes, Implanted, Surgery, 030228 respiratory system, RC666-701, Heart failure, Tachycardia, Ventricular, cardiovascular system, Cardiology, Implant, Cardiology and Cardiovascular Medicine, business
Abstract: Left ventricular lead placement in the appropriate branch of coronary sinus is the key to successful cardiac resynchronization therapy (CRT) and this step is technically challenging. We describe a case of non-ischemic cardiomyopathy with heart failure, taken up for cardiac resynchronization therapy with defibrillator (CRT-D) implantation. The quadripolar left ventricular lead was impossible to advance into the target lateral branch of the coronary sinus. We made a veno-venous loop, advancing the coronary guidewire through the middle cardiac vein to coronary sinus and then to superior vena cava. The guidewire then snared through the same left subclavian vein and exteriorized. Over this loop, the left ventricular lead of the CRT-D device was implanted successfully. This novel approach can be used to successfully implant the LV lead in difficult to implant situations, obviating the need for thoracotomy or other methods of LV lead implantation.
Published: 2016

39. A case of sinus venosus atrial septal defect misdiagnosed as primary pulmonary hypertension

Author: Ranjit Kumar Nath, Neeraj Pandit, and Awadhesh Kr Sharma
Subjects: Adult, Male, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Partial anomalous pulmonary venous return, 030204 cardiovascular system & hematology, Chest pain, Heart Septal Defects, Atrial, Sinus venosus atrial septal defect, Pulmonary heart disease, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine.artery, medicine, Humans, Familial Primary Pulmonary Hypertension, cardiovascular diseases, 030212 general & internal medicine, Diagnostic Errors, Medicine(all), Transoesophageal echocardiography, Lung, Electromyography, business.industry, medicine.disease, Pulmonary hypertension, Electrocardiogram, Radiography, medicine.anatomical_structure, Echocardiography, Pulmonary Veins, lcsh:RC666-701, Pulmonary artery, cardiovascular system, Cardiology, Radiology, medicine.symptom, Tricuspid valve regurgitation, Cardiology and Cardiovascular Medicine, Right axis deviation, business
Abstract: We present a case of sinus venosus atrial septal defect in a patient who was previously diagnosed as having primary pulmonary hypertension in a tertiary care center. Our findings are based on 2-dimensional trans-thoracic echocardiography, chest X–ray and surface electrocardiogram. A 26-year-old man, previously diagnosed as a case of primary pulmonary hypertension, presented to the emergency department (ED) with chest pain and breathlessness on exertion. Cardiac biomarkers were within their normal ranges. Surface electrocardiogram showed right atrial and ventricular overload with right axis deviation. Chest imaging noted enlarged central pulmonary vascularity with bilateral plethoric lung fields.Trans-thoracic echocardiography showed a dilated right atria and ventricle with severe tricuspid regurgitation and severe pulmonary artery hypertension with an intact atrial septum. Surprisingly, the transoesophageal echocardiogram revealed the presence of a sinus venous superior vena cava-type atrial septal defect with the right pulmonary vein draining into the right atria.In this full-text version, we present a more detailed discussion of sinus-venous atrial septal defect associated with partial anomalous pulmonary venous return that was wrongly diagnosed as a case of primary pulmonary hypertension in a tertiary care center.
Published: 2016
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40. Asymptomatic late embolization of Amplatzer septal occluder device

Author: Ranjit Kumar Nath and Neeraj Pandit
Subjects: Cardiac Catheterization, medicine.medical_specialty, RD1-811, Septal Occluder Device, medicine.medical_treatment, Embolism, Late embolization, Foramen secundum, Case Report, 030204 cardiovascular system & hematology, Asymptomatic, Heart Septal Defects, Atrial, Atrial septal defects, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Amplatzer Septal Occluder Device, Humans, Diseases of the circulatory (Cardiovascular) system, Medicine, cardiovascular diseases, 030212 general & internal medicine, Embolization, Device Removal, Ostium secundum atrial septal defect, business.industry, Amplatzer Septal Occluder, Amplatzer septal occluder, Middle Aged, Prosthesis Failure, Surgery, RC666-701, Asymptomatic Diseases, cardiovascular system, Female, Radiology, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Echocardiography, Transesophageal, Follow-Up Studies
Abstract: Atrial septal defects of Ostium Secundum type with suitable anatomy and margins are commonly closed with septal occluder devices. With the increasing number of catheterization laboratories and increasing availability of different devices, the device closure procedure is very commonly performed in different institutes. Embolization of the septal occluder is one of the most dreaded complications of this procedure, which usually occurs in the early hours or days after the procedure. We report a case of silent embolization of the Amplatzer septal occluder, detected seven months after its use to close an Ostium Secundum atrial septal defect, which was detected during pre-anaesthetic evaluation and echocardiography for non-cardiac surgery. The patient denied having any symptom in-between. The device was retrieved and the defect was closed surgically.
Published: 2017

41. Embolized Guidewire into Central Aorta: A Nightmare in the Pediatric Intensive Care Unit

Author: Richa Agrawal, Ranjit Kumar Nath, Manoj Sarowa, and Neeraj Pandit
Subjects: Pediatric intensive care unit, Central line, Aorta, medicine.medical_specialty, Percutaneous, Critically ill, business.industry, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Nightmare, Surgery, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, Pediatrics, Perinatology and Child Health, medicine, cardiovascular system, 030212 general & internal medicine, medicine.symptom, business, Subclavian artery, Bioptome
Abstract: A 4-month-old preterm, critically ill infant weighing 3.8 kg was admitted to our pediatric intensive care unit with congestive cardiac failure due to a large ventricular septal defect and its sequelae. During an attempt to insert a central line into the right subclavian vein at bedside, the guidewire inadvertently entered the subclavian artery and embolized distally. After multiple failed retrieval attempts, including surgical femoral cut-down to retrieve the wire, it was removed finally by fluoroscopic-guided percutaneous catheterization with the help of a cardiac bioptome and a gooseneck snare utilizing a novel maneuver.
Published: 2018

42. Successful balloon dilatation of both orifices in a case of double-orifice mitral valve with severe rheumatic stenosis

Author: Dheeraj Kumar Soni and DM Ranjit Kumar Nath Md
Subjects: Mitral regurgitation, medicine.medical_specialty, business.industry, General Medicine, Parasternal heave, Balloon, medicine.disease, Stenosis, medicine.anatomical_structure, Mitral valve stenosis, Mitral valve, Internal medicine, Cardiology, Medicine, Radiology, Nuclear Medicine and imaging, Radiology, Cardiology and Cardiovascular Medicine, business, Double orifice mitral valve, Body orifice
Abstract: A 24-year-old female patient presented to us with progressive dyspnea on exertion for last three year. She was not a known case of rheumatic heart disease. Her physical examination showed regular pulse and her blood pressure was 100/76 mm Hg. Cardiac palpation showed grade 3 parasternal heave and auscultation revelled an accentuated first heart sound, loud P2 and mid-diastolic long rumbling murmur at apex and pansystolic murmur of tricuspid regurgitation at lower left sterna border. Chest X-ray showed evidence of grade 3 pulmonary venous congestion. Transthoracic and transesophageal two-dimensional echocardiography revealed a double-orifice mitral valve of complete bridge type at the leaflet level. Both orifice sizes were unequal, with the anterolateral orifice being smaller than its counterpart. There was moderate subvalvular fusion and both commisures were fused. Color doppler examination showed two separate mitral diastolic flows with mean gradients of 22 mm and 20 mm of Hg, respectively. There was no mitral regurgitation and no left atrial or appendage clot was seen by transesophageal echocardiography. Transseptal puncture was done by the modified fluoroscopic method. Posteromedial orifice was crossed with a 24 mm Inoue balloon and dilated using the stepwise dilation technique. Anterolateral orifice was not crossed by Inuoe balloon after multiple attempts. A TYSHAK (NuMAD Canada Inc.) balloon (16 × 40mm) was taken over the wire and inflated successfully across the anterolateral orifice with the help of transthoracic echocardiography guidance. Mean gradient become 9 and 8 mm across the medial and lateral orifice. Patient was discharged in stable condition after two day. © 2015 Wiley Periodicals, Inc.
Published: 2015

43. Retrograde non trans-septal balloon mitral valvotomy in mitral stenosis with interrupted inferior vena cava, left superior vena cava, and hugely dilated coronary sinus

Author: Ranjit Kumar Nath and Dheeraj Kumar Soni
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, General Medicine, medicine.disease, Balloon, Surgery, Stenosis, medicine.anatomical_structure, Mitral valve stenosis, Tricuspid Valve Insufficiency, Ventricle, Internal medicine, cardiovascular system, medicine, Cardiology, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Persistent left superior vena cava, Cardiology and Cardiovascular Medicine, business, Coronary sinus, Cardiac catheterization
Abstract: A 22-year-old woman with severe mitral stenosis was referred to us for further evaluation and management. She was found to have severe mitral stenosis, severe tricuspid regurgitation with dilated right atrium and right ventricle with persistent left superior vena cava and hugely dilated coronary sinus. Valve was suitable for balloon mitral valvotomy. Cardiac catheterization showed interrupted inferior vena cava with azygos continuation to right atrium and large left superior vena cava draining to coronary sinus which was very much dilated. Right trans-jugular approach was tried for balloon mitral valvotomy, but was unsuccessful due to a very large right atrium and coronary sinus. Retrograde non trans-septal approach was used and balloon valvotomy was done successfully using a 24 mm × 40 mm TYSHAK balloon without any major complication. Reduction in the transmitral pressure gradient on cardiac catheterization data and transthoracic echocardiography confirmed successful procedure. Balloon mitral valvotomy can be done successfully in patients with the above unusual cardiac anatomy with no major procedural complications.
Published: 2015

44. An unconventional valvuloplasty: severe pulmonary stenosis with 'candy cane' inferior vena cava

Author: Satyam Rajvanshi, Ranjit Kumar Nath, Ankit Gupta, and Neeraj Pandit
Subjects: Balloon Valvuloplasty, medicine.medical_specialty, viruses, Femoral vein, Vena Cava, Inferior, Balloon, Inferior vena cava, Article, 03 medical and health sciences, 0302 clinical medicine, Medicine, Humans, 030212 general & internal medicine, cardiovascular diseases, Child, Interrupted inferior vena cava, Interventional cardiology, business.industry, General Medicine, medicine.disease, Surgery, Valvular pulmonary stenosis, Pulmonary Valve Stenosis, Stenosis, medicine.vein, cardiovascular system, Female, Radiology, Jugular Veins, business
Abstract: Femoral vein is the usual approach to balloon pulmonary valvuloplasty (BPV). However, alternative access may be mandated in some peculiar situations. We hereby report a 10-year-old patient with symptomatic severe valvular pulmonary stenosis with interrupted inferior vena cava which was successfully treated with transjugular BPV. Technical considerations for this approach as well as other possible options for such patients are discussed.
Published: 2017

45. Successful Management of a Rare Case of Ruptured Ovarian Artery Aneurysm by Coil Embolization

Author: Ranjit Kumar Nath, Neeraj Pandit, and Pawan Kumar Ola
Subjects: medicine.medical_specialty, Abdominal pain, business.industry, Exploratory laparotomy, Wound dehiscence, medicine.medical_treatment, Obstetrics and Gynecology, Case Report, Ovarian artery, medicine.disease, Surgery, Pseudoaneurysm, medicine.anatomical_structure, Hematoma, Aneurysm, medicine.artery, medicine, Abdomen, Radiology, medicine.symptom, business
Abstract: A 35 year-old female presented to casualty after 3 days of giving birth to a healthy baby via normal vaginal delivery (third child). She had complained of left-sided abdominal pain without any vomiting, dysuria or altered bowel habits. On examination, she was distressed and anemic. Her hemoglobin level was 6.8 gm%. Her pulse rate was 110/min and blood pressure was 110/70 mmHg along with signs of peritonitis. Her coagulation profile was within normal limits. Ultrasonography of abdomen revealed left retroperitoneal hematoma with a possibility of psoas abscess. Contrast enhanced computed tomography (CT) scan of abdomen showed left psoas and left renal paracolic compartment hematoma with a possibility of ovarian aneurysm. For further confirmation, CT Angiography was performed which showed left ovarian artery pseudoaneurysm (1.46 9 1.38 cms) at L4 vertebral level with large left retroperitoneal hematoma (Fig. 1). She was taken for exploratory laparotomy with adnexectomy but she continued to have peritoneal bleeding and symptoms. Her hospital course was complicated with wound dehiscence. Ola P. K. (&), Senior Resident Nath R. K., Professor Pandit N., Professor & Head Department of Cardiology, PGIMER & Dr Ram Manohar Lohia Hospital, New Delhi 110001, India e-mail: drpawan25@gmail.com Pawan Kumar Ola He is a post graduate in General Medicine from RNT Medical College, Udaipur, Rajasthan in 2008. Presently, he is doing DM Cardiology (final year) from RML Hospital, New Delhi. His field of interest is intervention cardiology. The Journal of Obstetrics and Gynecology of India (November–December 2015) 65(6):423–425
Published: 2014

46. Correlation of corrected QT interval with quantitative cardiac troponin-I levels and its prognostic role in Non-ST-elevation myocardial infarction

Author: Neeraj Pandit, Manoj Kumar, Ankit Gupta, Ranjit Kumar Nath, and Satyam Rajvanshi
Subjects: Adult, Male, medicine.medical_specialty, Prognostic variable, Population, 030204 cardiovascular system & hematology, QT interval, Cohort Studies, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, Heart Rate, Internal medicine, Troponin I, Medicine, Humans, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Prospective Studies, education, Prospective cohort study, Non-ST Elevated Myocardial Infarction, Aged, Aged, 80 and over, education.field_of_study, business.industry, Middle Aged, medicine.disease, Prognosis, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, TIMI, Mace, Biomarkers, Follow-Up Studies
Abstract: Background Non-ST-elevation Myocardial Infarction (NSTEMI) subgroup of ACS has wide variability in patient prognosis. Risk stratification in NSTE-ACS is essential for deciding about early management. Corrected QT interval estimation is one tool which has utility in bedside risk stratification. Whether it differentiates NSTEMI patients into different risk groups is the contention of this study. Objective To assess (1) correlation between maximum corrected QT interval (QTc) and cardiac Troponin I (cTnI) levels; (2) if prolonged corrected QT interval is an independent predictor of higher MACE in NSTEMI patients. Methods We prospectively studied 301 NSTEMI patients. cTnI level and QTc were measured at 0, 12, 24 and 48h post-admission. Patients were followed for 30days post-discharge for incidence of major adverse cardiac events (MACE) defined as composite of cardiac death, non-fatal MI and urgent revascularization. We assessed correlation between cTnI level and maximum QTc value. Regression analysis was performed to identify independent predictors of MACE. Results We found a strong positive linear correlation between maximum QTc interval and cTnI level with a correlation coefficient of 0.637 ( p 468ms predicted poor prognosis in form of MACE with 72% sensitivity and 61% specificity. Multivariate analysis revealed that after adjusting for different prognostic variables, TIMI score>2 and QTc>468ms, were the only independent predictors of MACE. Conclusion QTc-max interval has a strong positive linear correlation with cTnI level. Prolonged QTc has utility as an independent high risk predictor in NSTEMI population.
Published: 2016

47. Massive right atrial myxoma presenting as congestive heart failure: an unusual presentation of a rare tumour

Author: Bhagya Narayan Pandit, Richa Agrawal, Ajay Sharma, and Ranjit Kumar Nath
Subjects: Male, Tachycardia, medicine.medical_specialty, animal diseases, Usually asymptomatic, 030204 cardiovascular system & hematology, Diagnosis, Differential, Heart Neoplasms, Electrocardiography, 03 medical and health sciences, Rare Diseases, 0302 clinical medicine, Internal medicine, medicine, Humans, Heart Atria, cardiovascular diseases, neoplasms, Heart Failure, Unusual Presentation of More Common Disease/Injury, medicine.diagnostic_test, business.industry, virus diseases, Myxoma, General Medicine, Middle Aged, medicine.disease, Dyspnea, Treatment Outcome, Heart failure, cardiovascular system, Cardiology, Right Atrial Myxoma, Differential diagnosis, medicine.symptom, Presentation (obstetrics), business, 030217 neurology & neurosurgery
Abstract: Cardiac myxomas are the most common type of primary cardiac tumour. The most common location of cardiac myxoma is left atrium. Right atrial myxomas are very rare and usually asymptomatic or sometimes present with dyspnoea. Right atrial myxoma presenting as a right-sided heart failure is very rare. We report a very rare case of a 52-year-old man of right atrial myxoma presented unsually as right-sided heart failure.
Published: 2018

48. A Study of Clinical, Microbiological, and Echocardiographic Profile of Patients of Infective Endocarditis

Author: Soumik Ghosh, Adesh Kumar Gadpayle, Ratnakar Sahoo, Ranjit Kumar Nath, and Nandini Duggal
Subjects: medicine.medical_specialty, Article Subject, Heart disease, business.industry, Atrial fibrillation, medicine.disease, Pallor, Surgery, Bacteremia, Internal medicine, Infective endocarditis, Epidemiology, medicine, Endocarditis, Risk factor, medicine.symptom, business, Research Article
Abstract: Infective endocarditis, a great masquerader, is a clinical entity which may present with a myriad of manifestations. Its changing epidemiological profile has been studied in the previous decades in both the developed and the developing nations. In this study, we strived to uphold the evolving clinical profile and its outcome from a government tertiary care hospital in Northern India. It was a descriptive, cross-sectional, observational study conducted over two years’ period involving 44 patients diagnosed with definite infective endocarditis, according to modified Dukes’ criteria. Demographic, clinical, microbiological, and echocardiographic data were analysed. Mean age of patients was 31 years. Rheumatic heart disease with regurgitant lesions was the commonest risk factor. Dyspnea and fever were the predominant symptom, and pallor and heart failure the commonest sign. Cultures were positive in 52% with Staphylococcus, the major isolate. Transesophageal echocardiography fared better than transthoracic one to define the vegetations. Mortality is reported in 4.5%. Prolonged duration of fever, pallor, hematuria, proteinuria, rheumatoid factor positivity, and large vegetations proved to be poor prognostic variables. Culture positive endocarditis, with persistent bacteremia, had higher incidence of acute renal failure. Right sided endocarditis was frequent in congenital lesions or IV drug user, whereas left sided endocarditis mostly presented with atrial fibrillation.
Published: 2014

49. Successful percutaneous management of Lutembacher syndrome

Author: Harsh Wardhan, Neeraj Pandit, Ajay Sharma, Ranjit Kumar Nath, and Sandeep Goel
Subjects: medicine.medical_specialty, Cardiac Catheterization, Percutaneous, RD1-811, Adolescent, Septal Occluder Device, medicine.medical_treatment, Foramen secundum, Case Report, Lutembacher Syndrome, PTMC, medicine, Fluoroscopy, Diseases of the circulatory (Cardiovascular) system, Humans, Cardiac Surgical Procedures, Cardiac catheterization, Mitral stenosis, medicine.diagnostic_test, business.industry, Surgery, Surgery, Computer-Assisted, Ostium secundum, Echocardiography, RC666-701, Female, Radiology, Cardiology and Cardiovascular Medicine, business
Abstract: Background: The surgical management of Lutembacher syndrome is straight forward but percutaneous management, though technically demanding, is always desirable. Methods: A 17 year old unmarried female presented with severe Mitral stenosis and a 19 mm almost circular Ostium secundum ASD with moderate pulmonary artery hypertension and dilated right sided chambers. She was managed in a staged manner. Percutaneous trans mitral commissurotomy (PTMC) was done first, using a 26 mm Inoue balloon catheter set, and after 48 h, ASD was closed with a 20 mm Cocoon Septal Occluder. Results: The mitral valve area increased after PTMC from 0.8 cm2 to 2.1 cm2 and QP/QS decreased from 4.9 to 2. ASD was successfully closed under echocardiographic and fluoroscopic guidance. Conclusion: Percutaneous management of the Lutembacher syndrome (PTMC and ASD device closure) is an effective and low risk procedure and avoids considerable morbidity and mental trauma for the patients.
Published: 2014

50. Cardiac Troponin I Level in STEMI and Clinical Correlation with Left Ventricular Dysfunction in Indian Population

Author: Lokesh Kumar Sharma, A.K Varshney, Ranjit Kumar Nath, Brijesh Kumar Yadaw, Rajnish Singh, and Neera Sharma
Subjects: medicine.medical_specialty, animal structures, Ejection fraction, biology, business.industry, Cardiac arrhythmia, macromolecular substances, musculoskeletal system, medicine.disease, Clinical correlation, Troponin, Internal medicine, Ventricular fibrillation, Troponin I, cardiovascular system, medicine, biology.protein, Cardiology, Biomarker (medicine), cardiovascular diseases, Myocardial infarction, business
Abstract: Objective: To determine the relationship of serum troponin I after first acute myocardial infarction with left ventricular ejection fraction as assessed by echocardiography. Methods: A total of 40 patients of acute myocardial infarction were included in the study. Troponin I concentration was measured by ELISA method and echocardiographic ejection fraction was calculated by modified Simpson’s rule. Echocardiographic ejection fraction was compared with serum troponin I concentration. Patients with previous myocardial infarction were excluded. Result: There was strong negative correlation between troponin I concentration and left ventricular ejection fraction, i.e., with an increasing troponin level, there was a fall in ejection fraction. The Pearson’s correlation coefficient was –0.69, which was statistically significant (p 50%, though small in number were having cTnI levels at 24 hrs ≤ 8 ng/ml. Patients with ejection fraction 50% may be due to peak value of biomarker achieved at 24-36 hrs after myocardial injury as most of troponin I are attached to myofibrils. Conclusion: Serum troponin I concentration has a strong negative correlation with left ventricular ejection fraction after first acute myocardial infarction, and hence can be used to assess the LVEF in patients with first myocardial infarction. An observation was made that a cut off level of cTnI ≤ 8 ng/ml was associated with normal left ventricular systolic function.
Published: 2013

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