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Pleiotropic effects of Vitamin D (Vit D) on various cell types and causative association in the epidemiology of cardiovascular diseases is known for ages. Observational studies have successfully linked Vit D deficient states to critical illness and increased ICU morbidity and mortality. The role of preoperative Vit D deficiency on postoperative outcome in cardiac surgery patients is a new horizon for research. A prospective observational cohort study was planned to assess impact of pre-operative Vit D deficiency on post-operative cardiac outcomes in adult patients undergoing cardiac surgery, Vit D level was assessed in the preoperative period and divided into group I Vit D deficient (20ng/ml). Primary outcome was to study the occurrence of myocardial infarction, arrhythmia, low cardiac output syndrome (LCOS) and inotropic requirement. Secondary outcomes were duration of mechanical ventilation, ICU length of stay, hospital stay and mortality. Vit D deficiency was associated with increased incidence of arrhythmia (p=0.019), LCOS (0.003) and high inotropic requirements (p=0.001) with no relation to occurrence of MI (p=0.422) and mechanical support (p= 0.114) as compared to the sufficient group. Vit D deficiency was also associated with increased duration of mechanical ventilation (p=0.008), ICU (p=0.001) and hospital stay (p=0.00) as compared to other group. Vitamin D deficiency was associated with increased occurrence of arrhythmia, LCOS and high inotropic requirements. ICU morbidity in the form of increased duration of mechanical ventilation, ICU and hospital stay was increased in patients with Vit D deficiency.

No one in the world, particularly the economic community, could have predicted the manner in which the 2019 COVID pandemic erupted or shook the economies. Developing countries, particularly South Asian economies and the lower middle income (LMI) countries (India, Pakistan, Sri Lanka, Bangladesh, Bhutan, and Nepal), had also experienced similar turmoil. The COVID outbreak and trade-related risks were closely associated with exports, imports, international liquidity, and SDR exchange rates, posing time-varying risks. In this sphere, an analytical approach to generate meaningful trade-related time-varying volatility predictions with respect to India’s position is critical while considering the above-listed variables. The Markov-switching (endogenous switching) VAR model using the exponential moving average volatility model (EWMA) of the four macroeconomic variables was used. The author tried to use the EWMA volatility model to witness the impact of spillovers and shock persistence. The present study earmarked the behaviour of time-varying trade-related risks (for Regime 1, i.e., the Early COVID period versus Regime-2 during the COVID period) in terms of the top six economies (as per December 2021 data) when endogenous factors like international liquidity and exchange rate shocks are implemented.

We all are fully aware about the VUCA- volatility, uncertain, complex, and ambiguous world. This VUCA is a result of the cultural transformation due to the fusion of functional aspects of the virtual and physical world. We perceive the speed at which the digitally oriented marketing strategies are bombarded on the e-consumer. Hence, a question arises about the traditional conceptualization of cultural hybridization, which was considered as a pure, innovative, transformative, and organic process being, somewhat highly compromised while using digital resources to dynamically connect our consumers. These and many more concerns will be dealt by providing diversified views of the authors who have worked extensively in this direction. Right from views of the traditional sense of colonization and localisation perspective in cultural hybridisation to broader context of inclusion of media and communication studies, and the role of digital media in particular. This includes without saying the notion of globalization in shaping cultural hybridisation and its various facets.

The objective was to determine the feasibility and effectiveness of cardiac magnetic resonance (CMR) cine and strain imaging before and after cardiac resynchronization therapy (CRT) for assessment of response and the optimal resynchronization pacing strategy.CMR with cardiac implantable electronic devices can safely provide high-quality right ventricular/left ventricular (LV) ejection fraction (RVEF/LVEF) assessments and strain.CMR with cine imaging, displacement encoding with stimulated echoes for the circumferential uniformity ratio estimate with singular value decomposition (CURE-SVD) dyssynchrony parameter, and scar assessment was performed before and after CRT. Whereas the pre-CRT scan constituted a single "imaging set" with complete volumetric, strain, and scar imaging, multiple imaging sets with complete strain and volumetric data were obtained during the post-CRT scan for biventricular pacing (BIVP), LV pacing (LVP), and asynchronous atrial pacing modes by reprogramming the device outside the scanner between imaging sets.100 CMRs with a total of 162 imaging sets were performed in 50 patients (median age 70 years [IQR: 50-86 years]; 48% female). Reduction in LV end-diastolic volumes (P = 0.002) independent of CRT pacing were more prominent than corresponding reductions in right ventricular end-diastolic volumes (P = 0.16). A clear dependence of the optimal CRT pacing mode (BIVP vs LVP) on the PR interval (P = 0.0006) was demonstrated. The LVEF and RVEF improved more with BIVP than LVP with PR intervals ≥240 milliseconds (P = 0.025 and P = 0.002, respectively); the optimal mode (BIVP vs LVP) was variable with PR intervals 240 milliseconds. A lower pre-CRT displacement encoding with stimulated echoes (DENSE) CURE-SVD was associated with greater improvements in the post-CRT CURE-SVD (r = -0.69; P 0.001), LV end-systolic volume (r = -0.58; P 0.001), and LVEF (r = -0.52; P 0.001).CMR evaluation with assessment of multiple pacing modes during a single scan after CRT is feasible and provides useful information for patient care with respect to response and the optimal pacing strategy.

Background Transcatheter aortic valve replacement (TAVR) procedural success relies heavily on volumetric reconstruction imaging, particularly ECG-gated multi-detector row computed tomography. We postulated that single examination using fast low-angle shot (FLASH) dual source CT scanning (DS-CTA) could provide lower dose than ECG-gated CTA while maintaining the image quality. Methods In this single-centre cohort study, all patients who underwent ECG-gated and FLASH DS-CTA were evaluated. Volumetric reconstructions were performed for both ECG-gated and FLASH DS-CTA to obtain nonsagittal views of the structures. ECG-gated cardiac CT was obtained to evaluate the aortic annular size while FLASH DS-CTA was obtained to examine the aortic and iliac vasculature as part of TAVR imaging protocol. We evaluated measures of aortic annulus, coronaries and sinus of Valsalva using ECG-gated and FLASH DS-CTA scanning protocols. Image quality assessments were performed using aortic root region-of-interest signal-to-noise ratio. Results A total of 130 patients (mean age 81.5 ± 9.2 years, 46.2% female, and 99.2% white) underwent both ECG-gated CT and FLASH DS-CTA. There were excellent correlations between aortic annular area (R2 = 0.934) and aortic annular perimeter (R2 = 0.923) measured by the two protocols. Only 2 (1.5%) patients had >10% difference between aortic annular measurements by ECG-gated and FLASH DS-CTA, while none of the patients had a >10% difference between aortic annular perimeter measured by ECG-gated and FLASH DS-CT scans. There was no significant difference in signal-to-noise ratio between the two methods (mean difference 13.4; 95% CI −2.1–28.8, p = 0.09). There was significantly lower radiation dose for FLASH DS-CTA than ECG-gated CT scan (mean dose-length product difference 404.38; 95% CI 328.9–479.87, p Conclusion Overall, FLASH DS-CTA and ECG-gated CT scans provided comparable image quality and aortic annular dimensions for pre-TAVR evaluation. DS-CTA additionally provided the necessary angiographic imaging of the aorta and peripheral access vessels while still maintaining a lower radiation dose. We propose that a single non-ECG gated FLASH DS-CTA could be utilized to provide all the necessary pre-TAVR imaging information without a gated CT scan.

A 57-year-old male patient who is a known case of hypertension well controlled on ramipril presented with a history of shortness of breath and palpitation of 3 months duration. The symptoms were insidious in onset; however, it progressed rapidly over the period of 3 months, wherein at present the patient feels breathless in performing normal daily activities of living making him New York Heart Association class III patient. Palpitations are regular in nature and present throughout the time and are exacerbated on performing even light activities within his house. There was associated swelling of bilateral lower limbs that usually improved after a night's rest; however, it was not completely resolved. The individual did not give any history of chest pain, presyncope, syncope, or any other symptoms that pointed toward a cardiac condition.

COVID-19 Pandemic still affecting all countries. South Asian economies and that particularly India is no exception. Because of this “uncertainty shock”, India’s GDP has contracted by 3.1percent in the last quarter of 2020. The present empirical work covers broadly the “asymmetric spillover and related noisy shocks” surrounded with trade (export) volatility about LMI nations in “two phases” i.e. in terms of considering the During pandemic phase (DC) the period from April 2019 till June 2020 and Pre-pandemic phase (PC) from April 2013 till November 2020. A comparative trade volatility asymmetries analysis were applied using a nonlinear volatility function i.e. exponential weighted moving average (EWMA), and identification of noisy behaviour after the initial post-recovery for empirical evidence. The empirical findings discovered that there were “extended” non-smooth and noisy “shock propagation” post initial recovery across two phases by the use of VAR and VECM outcomes. Bangladesh and Pakistan were stronger “Noisy shock contributors” while Nepal and Sri Lanka were turned out to be the strongest “Noisy shock receivers”. This “noisy” behaviour implies “uncertainty” and chaos on the international trade front resulting in higherthan expected volatility in trade figures and in-built destabilized momentum in the impulses. The results also relate to the possible opportunities of intra-regional trade convergence as a policy imperative.

Cardiac resynchronization therapy (CRT) response is complex, and better approaches are required to predict survival and need for advanced therapies.The objective was to use machine learning to characterize multidimensional CRT response and its relationship with long-term survival.Associations of 39 baseline features (including cardiac magnetic resonance [CMR] findings and clinical parameters such as glomerular filtration rate [GFR]) with a multidimensional CRT response vector (consisting of post-CRT left ventricular end-systolic volume index [LVESVI] fractional change, post-CRT B-type natriuretic peptide, and change in peak VOAmong 200 patients (median age 67.4 years, 27.0% women) with CRT and CMR, associations with more than 1 response parameter were noted for the CMR CURE-SVD dyssynchrony parameter (associated with post-CRT brain natriuretic peptide [BNP] and LVESVI fractional change) and GFR (associated with peak VOMachine learning characterizes distinct CRT response clusters influenced by CMR features, kidney function, and other factors. These clusters have a strong and additive influence on long-term survival relative to baseline features.

The current empirical work used the robust portfolio mechanism using time-varying (aka conditional) skewness and kurtosis on an arbitrary nearly 50-days recurring window. The comparison of the Top GDP nations (mainly 6 of them according to December 2019 data) was conducted applying the recurring windows based time-varying higher moments on both at individual stock indexes as well as towards covid data. The underline objective was to ensure that the time varying patterns at covid-related “crashes'' vis-a-vis market crashes are managed through an appropriate time-varying portfolio moments specifically for recurring windows since covid pandemic was a kind of “rolling crisis” and its impact was found to be heterogeneous in terms of its intensity and effect on the global financial markets. In the end, the principal component analysis was used to further investigate the orthogonality in reference to the rolling window time varying moments across the six economies in consideration. JEL C180, G1, G 150

Peripheral artery disease (PAD) remains a major cause of morbidity and future cardiovascular events despite advancement in the surgical interventions and optimal medical therapy. The aim of our study is to evaluate the efficacy and safety of anticoagulation (AC) therapy for reducing cardiovascular and limb events in patients with PAD. PUBMED, Medline, and Cochrane Library were searched through 2020 for randomized clinical trials comparing major adverse cardiovascular events (MACE) and risk of major bleeding (MB), between AC and standard of care (SOC) therapy, among patients with PAD. Meta-analysis was performed using weighted pooled absolute risk difference (RD) with 95% confidence interval (CI) and fixed effects model for overall and sub-groups of full dose (FD) and low dose (LD) AC therapies. Amongst 17,684 patients from 7 different studies, the addition of AC to SOC therapy was associated with MACE reduction (RD -0.022, 95% CI -0.033 to -0.012, p0.001) and increased MB (RD 0.02, 95% CI 0.014 to 0.025, p0.001). For FD, MACE reduction was (RD -0.021, 95% CI -0.042 to 0.001, p = 0.061) and MB (RD 0.036, 95% CI 0.025 to 0.047, p0.001). For LD, MACE reduction was (RD -0.023, 95% CI -0.035 to -0.011, p0.001) and MB (RD 0.011, 95% CI 0.005 to 0.017, p0.001). In conclusion, addition of AC to the current SOC therapy can mitigate future MACE events in patients with PAD albeit at risk of increased bleeding. LD AC is associated with an efficacy/safety net benefit compared to FD AC therapy.

Aims Dermatologic evaluation for cardiac implantable electronic devices (CIEDs) has not been established. We sought to ascertain baseline wound scar features using quantifiable surgical tools and scar scales on post‐CIED patients. Methods A single‐center, prospective observational case‐control study was performed where 92 study subjects (40 healthy volunteers and 52 post‐CIED patients) completed the study. Durometer was used to quantify skin pliability before CIED placement, postprocedure, and 2 weeks postprocedure. Higher durometer readings signified reduced skin pliability. Durometer readings were compared to the patients’ contralateral pectoral skin and to a healthy volunteer's cohort skin within the prepectoral region. Patient wounds were observed and graded using the Patient Observer Scar Assessment Scale (POSAS) and Manchester Scar Scale (MSS). Results Baseline pectoral skin pliability readings were similar in healthy volunteers and CIED patient population. In comparison to preprocedural measurements, surgical site skin pliability decreased in postprocedural and 2 weeks follow‐up time points (P‐value .004 and 75 over time, P = .008). POSAS evaluations showed on average a thin painless hypopigmented scar with moderate stiffness. MSS scar evaluation showed a palpable scar with slight contour differences and color mismatch and appeared to be slightly better in the African American population. There was no difference in scar characteristics with preprocedural use of antiplatelet or anticoagulation or staple closure or gender. Conclusions Serial measurements could be of value for development of new strategies for cosmesis and improved wound healing., The skin pliability changes during early scar maturation following cardiac implantable electronic device implantation show a significant difference in the surgical and non‐surgical site at the 2 week follow‐up mark. Skin pliability was assessed with durometer readings (Shore Units) over the study duration.

Introduction Numerous case series have reported on the baseline characteristics and in-hospital mortality of patients with COVID-19, however, these studies included patients localized in a specific geographic region. The purpose of our study was to identify differences in the clinical characteristics and the in-hospital mortality of patients with a laboratory-confirmed diagnosis of COVID-19 internationally. Methods A comprehensive search of all published literature on adult patients with laboratory-confirmed diagnosis of COVID-19 that reported on the clinical characteristics and in-hospital mortality was performed. Groups were compared using a Chi-square test with Yates correction of continuity. A two-tailed p value of less than 0.05 was considered as statistically significant. Results After screening 516 studies across the globe, 43 studies from 12 countries were included in our final analysis. Patients with COVID-19 in America and Europe were older compared to their Asian counterparts. Europe had the highest percentage of male patients. American and European patients had a higher incidence of co-morbid conditions (p

Patients with multivalvular heart disease often presents a unique challenge with regard to the intraoperative decision-making in the form of choosing between a satisfactory valvular repair or a more definitive valve replacement. We describe a patient with multivalve involvement on antiretroviral therapy. Discussion presents a nuanced perspective on surgical decision-making in multi-valvular heart disease, wherein an effective communication between the surgeon and the echocardiographer is required for ensuring favorable postoperative outcomes.

This study sought to determine if combining the Seattle Heart Failure Model (SHFM-D) and cardiac magnetic resonance (CMR) provides complementary prognostic data for patients with cardiac resynchronization therapy (CRT) defibrillators.The SHFM-D is among the most widely used risk stratification models for overall survival in patients with heart failure and implantable cardioverter-defibrillators (ICDs), and CMR provides highly detailed information regarding cardiac structure and function.CMR Displacement Encoding with Stimulated Echoes (DENSE) strain imaging was used to generate the circumferential uniformity ratio estimate with singular value decomposition (CURE-SVD) circumferential strain dyssynchrony parameter, and the SHFM-D was determined from clinical parameters. Multivariable Cox proportional hazards regression was used to determine adjusted hazard ratios and time-dependent areas under the curve for the primary endpoint of death, heart transplantation, left ventricular assist device, or appropriate ICD therapies.The cohort consisted of 100 patients (65.5 [interquartile range 57.7 to 72.7] years; 29% female), of whom 47% had the primary clinical endpoint and 18% had appropriate ICD therapies during a median follow-up of 5.3 years. CURE-SVD and the SHFM-D were independently associated with the primary endpoint (SHFM-D: hazard ratio: 1.47/SD; 95% confidence interval: 1.06 to 2.03; p = 0.02) (CURE-SVD: hazard ratio: 1.54/SD; 95% confidence interval: 1.12 to 2.11; p = 0.009). Furthermore, a favorable prognostic group (Group A, with CURE-SVD 0.60 and SHFM-D 0.70) comprising approximately one-third of the patients had a very low rate of appropriate ICD therapies (1.5% per year) and a greater (90%) 4-year survival compared with Group B (CURE-SVD ≥0.60 or SHFM-D ≥0.70) patients (p = 0.02). CURE-SVD with DENSE had a stronger correlation with CRT response (r = -0.57; p 0.0001) than CURE-SVD with feature tracking (r = -0.28; p = 0.004).A combined approach to risk stratification using CMR DENSE strain imaging and a widely used clinical risk model, the SHFM-D, proved to be effective in this cohort of patients referred for CRT defibrillators. The combined use of CMR and clinical risk models represents a promising and novel paradigm to inform prognosis and device selection in the future.

An important complication of cardiac implantable electronic devices (CIED) implantation is the development of hematoma and device infection.We aimed to evaluate a novel mechanical compression device for hematoma prevention and cosmetic outcomes following CIED implantation.An open, prospective, randomized, single-center clinical trial was performed in patients undergoing CIED implantation. Patients were randomized to receive a novel mechanical compression device (PressRite, PR) or to receive the standard of care post device implantation. Skin pliability was measured with a calibrated durometer; the surgical site was evaluated using the Manchester Scar Scale (MSS) by a blinded plastic surgeon and the Patient and Observer Scar Scale (POSAS). Performance of PR was assessed through pressure measurements, standardized scar scales and tolerability.From the total of 114 patients evaluated for enrollment, 105 patients were eligible for analysis. Fifty-one patients were randomized to management group (PR) and 54 to the control group. No patients required early removal or experienced adverse effects from PR application. There were 11 hematomas (14.8% vs. 5.9% in the control and PR group respectively, p = NS). The control group had higher post procedure durometer readings in the surgical site when compared with the PR group (7.50 ± 3.45 vs. 5.37 ± 2.78; p = .01). There were lower MSS scores in the PR group after 2 weeks (p = .03).We have demonstrated the safety of PR application and removal. In addition, PR appears to improve postoperative skin pliability, which could facilitate wound healing.

The aim of this study was to determine the relationship between ischemia testing prior to ablation for sustained monomorphic ventricular tachycardia (VT) (SMVT) and post-ablation mortality and VT recurrence. As SMVT is generally caused by myocardial scar and not active ischemia, the utility of ischemia testing prior to SMVT ablation is unclear. Patients who underwent ablation for SMVT at 2 tertiary care centers between January 2016 and July 2018 were included in a retrospective study. A Kaplan-Meier survival analysis was performed, stratifying patients by pre-ablation ischemia testing for the endpoints of mortality and VT recurrence. A Cox multivariable regression analysis was performed to identify predictors of post-ablation VT recurrence. A total of 163 patients were included, with 46 (28%) patients undergoing ischemia testing prior to ablation. Only 5 of the 46 patients (11%) received revascularization pre-ablation. After a median follow-up period of 625 days (interquartile range, 292-982 days) following ablation, 97 of 163 patients (60%) had VT recurrence, and 32 patients (20%) had died. There was no difference in mortality or VT recurrence between patients who did or did not experience ischemia testing or revascularization. In the multivariable regression analysis, predictors of VT recurrence were the number of anti-arrhythmics failed, non-ischemic cardiomyopathy, sex, and cardiac magnetic resonance imaging pre-ablation. Neither ischemia testing nor revascularization was a significant predictor of VT recurrence in univariable or multivariable regression analysis. In conclusion, ischemia testing is frequently ordered prior to SMVT ablation but infrequently leads to revascularization and is not associated with post-ablation outcomes. The findings support adopting an individualized approach rather than performing routine ischemia testing.

Background ECG imaging (ECGI) with phase mapping has been used to identify rotational activity non-invasively that can be targeted during atrial fibrillation (AF) ablation. Acute termination of AF using this method has shown improved clinical outcomes. In this study we sought to evaluate whether patterns of rotational density are associated with acute procedural outcomes when using a step-wise ablation strategy. Methods 50 patients with persistent or long-standing persistent AF underwent non-invasive 3D mapping with CardioInsight™ prior to AF ablation. Composite maps of rotational activity were created and prioritized based on the density of rotations on a biatrial model. Stepwise ablation of pulmonary vein isolation (PVI) ± rotations ± linear lesions was done with AF termination as the procedural endpoint. Results Acute termination of AF was achieved in 34 patients (68%). Median number of rotations in the left atrium (LA), interatrial septum and right atrium (RA) were 22.2 (9.4 to 29.3), 12.0 (4.3 to 13.4), 25.0 (14.5 to 31.3), respectively. In patients with acute AF termination, a higher number of rotations in the LA was observed, 20.3 (10.0 to 37.1) compared to 10.6 (7.7 to 17.2) in the RA (p = 0.02). Additionally, high density of rotations in the posterior inferior right atrium (segment 2B on the biatrial model) was observed in patients without acute AF termination (p = 0.02). Conclusion Acute termination of persistent and long-standing persistent AF using rotational ablation guided by ECGI phase mapping can be achieved in a high percentage of both index and re-do cases. The distribution and pattern of these rotations may be associated with procedural outcomes and could potentially be used to stratify patients.

Objectives This updated meta-analysis evaluated outcomes with multi-vessel (MV-PCI) vs culprit lesion-only percutaneous coronary intervention (CL-PCI), in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Background There is considerable debate regarding the optimal revascularization strategy in patients with AMI and CS, particularly regarding management of non-culprit lesions. Methods Databases were searched for studies comparing MV-PCI and CL-PCI in patients with AMI and CS. The primary outcome of interest was short-term all-cause mortality. Secondary outcomes included long-term mortality, repeat revascularization and myocardial reinfarction. Safety outcomes were stroke, acute renal failure and major bleeding. Pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated using random-effects models. Results Our meta-analysis consisting of 14 studies (13 observational, 1 RCT) involving 8,552 patients showed that in comparison to CL-PCI, MV-PCI was associated with similar short-term mortality (OR 1.14; 95% CI 0.9-1.43), as well as similar long-term mortality (OR 0.94; 95% CI 0.68-1.28). There was no significant difference in the risk of myocardial reinfarction (OR 1.19; 95% CI 0.76-1.86), or repeat revascularization (OR 0.79; 95% CI 0.41-1.55) between the two groups. Compared to CL-PCI, MV-PCI was associated with a similar risk of bleeding (OR 1.13; 95% CI 0.91-1.40) and stroke (OR 1.28; 95% CI 0.84-1.96), but a higher risk of developing renal failure (OR 1.32; 95% CI 1.05-1.65). Conclusions Our meta-analysis suggests that there is a higher risk of renal failure with no additional benefit in efficacy outcomes with MV-PCI, compared to CL-PCI in patients with AMI and CS.

Acute pulmonary thromboembolism is associated with high mortality, similar to that of myocardial infarction and stroke. We studied the clinical presentation and management of pulmonary thromboembolism in the Indian population. An analysis of 140 patients who presented with acute pulmonary thromboembolism at a large volume center in India from June 2015 through December 2018 was performed. The mean age of our study population was 50 years with 59% being male. Comorbidities including deep vein thrombosis, diabetes mellitus, hypertension, and chronic obstructive pulmonary disease were present in 52.9%, 40%, 35.7% and 7.14% of patients, respectively. Out of 140 patients, 40 (28.6%) patients had massive pulmonary thromboembolism, 36 (25.7%) sub-massive pulmonary thromboembolism, and 64 (45.7%) had low-risk pulmonary thromboembolism. Overall, in-hospital mortality was 25.7%. Multivariate regression analysis found chronic kidney disease and pulmonary thromboembolism severity to be the only independent risk factors. Thrombolysis was performed in 62.5% of patients with a massive pulmonary thromboembolism and 63.9% of patients with a sub-massive pulmonary thromboembolism. In the massive pulmonary thromboembolism group, patients receiving thrombolytic therapy had lower mortality compared with patients who did not receive therapy ( p =0.022), whereas this difference was not observed in patients in the sub-massive pulmonary thromboembolism group. We conclude that patients with acute pulmonary thromboembolism in India presented more than a decade earlier than our western counterparts, and it was associated with poor clinical outcomes. Thrombolysis was associated with significantly reduced in-hospital mortality in patients with massive pulmonary thromboembolism.

Supplemental material, sj-pdf-1-pul-10.1177_2045894021992678 for Clinical profile and management of patients with acute pulmonary thromboembolism – a single centre, large observational study from India by Thoddi Ramamurthy Muralidharan, Sankaran Ramesh, Balakrishnan Vinod Kumar, Aditya V. Ruia, Mohan Kumar, Akshaya Gopalakrishnan, Gurpreet S. Johal, Amit Hooda, Rohit Malhotra, Reza Masoomi, Mahalakshmi Ramadoss, Vinodhini Subramanian, Maria J. Kalsingh, Panchanatham Manokar, Jebaraj Rathinasamy, Shanmugasundram Sadhanandham, Jayanthy V. Balasubramaniyan, Preetam Krishnamurthy, Jayanthy S. Murthy, Sadagopan Thanikachalam and Nagendra Boopathy Senguttuvan in Pulmonary Circulation

Intravascular imaging is an important tool in the arsenal of each interventional cardiologist. A multitude of imaging modalities are available to help understand coronary arterial and plaque morphology. While angiography provides a two-dimensional image of a three-dimensional structure, intravascular imaging enhances understanding by providing detailed cross-sectional images. The imaging modalities used often include intravascular ultrasound (IVUS) and Optical Coherence Tomography (OCT). Near-infrared spectroscopy (NIRS) is also available, although not widely used.

Introduction: Machine learning methods such as cluster analysis can identify commonality in patterns of short-term response measures after cardiac resynchronization therapy (CRT) to predict classes of patients with distinct long-term prognoses. Hypothesis: Distinct response clusters identified within 6 months of CRT implantation would provide independent prognostic value relative to known pre-CRT patient characteristics. Methods: Patients with heart failure (HF) undergoing CRT had assessments of left ventricular end-systolic volume fractional change (LVESV-FC), peak VO 2 , and B-type natriuretic peptide (BNP) based on cardiac magnetic resonance (CMR), echocardiography, exercise testing, and blood tests before and 6 months after CRT. Statistical methods included multivariate multiple linear regression, cluster analysis based on a mixture model, survival analysis, and receiver operating characteristic (ROC) analysis. Results: During a median of 5.0 years of follow-up after CRT, the cohort of 146 patients (age 66.0 ± 11.3 years, 34.9% female) had a death rate of 28.1%. A significant correlation was observed for BNP response and LVESV-FC (r=0.42, p>0.01), but not for the other response comparisons. Three clusters of patients (1: n=27; 2: n=82; 3: n=37) were identified. Kaplan-Meier analysis (Figure) demonstrated the best long-term survival in cluster 2, intermediate survival in cluster 3, and the worst survival in cluster 1 (p Conclusions: Response clusters based on 6-month parameters were strongly associated with long-term survival and improved prognostication compared with just pre-CRT predictors alone. This response clustering approach based on machine learning promises to be very useful for clinical risk stratification in heart failure after CRT.