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Prosthetic valve thrombosis (PVT) is a life-threatening emergency. Thrombolytic therapy is emerging as a potential substitute. The objective of this study was to assess the safety and efficacy of Tenecteplase (TNK) in comparison to streptokinase (STK) in patients with PVT. In this prospective study, patients with PVT who were not subjected to the surgery underwent thrombolysis with TNK (TNK arm) or STK (STK arm). Efficacy and safety of both treatment arms were judged from clinical, echocardiographic (ECHO), and Cinefluoroscopic parameters. Treatment outcomes and complications were compared between the two arms.Between December 2017 and December 2019, a total of 41 cases of PVT were enrolled to receive either TNK (n=23) or STK (n=18). After thrombolysis, complete recovery was significant in the TNK arm (82.6% [19/23] vs. 44.4% [8/18], respectively; p=0.007) irrespective of the valve position. This trend was observed in both mitral PVT (85.7% vs. 46.6%, respectively; p=0.03) and aortic PVT (77.8% vs. 33.3%, respectively; p=0.151). No failure was seen in the TNK arm but failure was observed in 1/3cases in the STK arm. No major bleeding was observed with either treatment. Minor bleeding and systemic embolization were non-significant (P=0.514). There were no deaths in the TNK arm but two patients (11%) from the STK arm died.To our knowledge, this is the largest published comparative evidence indicating superior efficacy and equal safety of tenecteplase compared to streptokinase for the treatment of prosthetic valve thrombosis irrespective of valve position and NYHA class.

Platelets have a major role in acute coronary syndrome and their activation is a hallmark of this. Troponin I, Troponin T and Creatine Kinase enzymes are not enough sensitive at an early stage of acute coronary syndrome. Platelet indices can be detected earlier, inexpensive, widely available and easily recordable in most clinical laboratories, thus could be a better marker in these patients. The primary objective of this study is to determine the correlation between platelet indices and spectrums of acute coronary syndrome or the number of vessels involved. This is a prospective observation study conducted in a tertiary care teaching hospital of eastern India over a period of six months where 125 patients were non-randomly selected with a diagnosis of acute coronary syndrome who underwent coronary angiogram and reports correlated with platelet parameters. A total of 100 patients were finally evaluated. Only platelet large cell ratio and platelet-crit were significantly higher in ST elevated myocardial infarction group compared to the unstable angina group. Across all the spectrums of acute coronary syndrome or extent of coronary artery disease there was a strong positive correlation within platelet distribution width, mean platelet volume and platelet large cell ratio, which was also very significant. Similarly total platelet count had a strong positive and very significant correlation with platelet-crit in the above groups. Increase platelet large cell ratio and platelet-crit seems to be independent risk factors for development of ST elevated myocardial infarct than unstable angina. Thus they could serve as simple but important early biomarkers for predicting development of ST elevated myocardial infarction compared to unstable angina in acute coronary syndrome patients.

Introduction: Coronary Artery Disease (CAD) is the leading cause of death worldwide. India has the highest burden of Acute Coronary Syndrome (ACS). Atherogenesis is a multifactorial process, abnormalities in lipoprotein metabolism especially elevated Low Density Lipoprotein Cholesterol (LDLc) remains one of most attributing key factor. Atherogenic Index of Plasma (AIP), can be calculated easily from the formula AIP=Log 10 Triglyceride (TG)/High Density Lipoprotein Cholesterol (HDLc). The AIP is inversely proportional to the diameter of LDLc particles, which indirectly reflects Small Dense LDLc levels. AIP has been proposed as a marker for Cardiovascular (CV) risk. Aim: The study aimed to assess the correlation between AIP and the Angiographic Profile by Gensini Score (GS) in ACS patients and also to evaluate the relationship between AIP and in-hospital mortality of ACS patients. Materials and Methods: This study was a hospital based cross- sectional study. This study was done from November 2019 to October 2020 in the Department of Cardiology, Sriram Chandra Bhanja Medical College, Odisha, India. A total of 240 patients of ACS were included in the study. AIP was calculated from the lipid profile of all the ACS patients. Coronary Angiography was done in all of these patients. Correlation of the AIP was done with the severity of CAD according to Gensini scoring system. Chi-square test was used to compare continuous variables p

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.

Context: The Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) scores in predicting coronary disease severity in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) have not been proved. Aims: We aimed to compare the GRACE score with TIMI risk score for prediction of the angiographic severity of coronary artery disease (CAD) in patients with NSTE-ACS. Settings and Design: This was an observational cross-sectional study. Subjects and Methods: Total 202 NSTE-ACS (NSTE myocardial infarction and unstable angina) patients were included. The GRACE and TIMI scores were estimated. Coronary angiogram was done and the Gensini score and vessel score were used to assess the severity of CAD. Statistical Analysis Used: SPSS software version 27.0 was used for statistical analysis. For comparison of two means, independent sample t-test/Mann–Whitney U-test was used, while for more than two means, one-way ANOVA/Kruskal–Wallis test was used. The receiver operating characteristic (ROC) curve was applied for the predictability of GRACE and TIMI scores for severity of disease. Results: A positive association between the Gensini score and vessel score was observed with both the GRACE (P = 0.001) and TIMI (P = 0.001) scores. The area under the ROC curve for the GRACE score was 0.765 (95% confidence interval [CI] = 0.676–0.854), significantly superior to the area under the ROC curve of the TIMI score (0.715; 95% CI = 0.618–0.812). Risk factors such as higher age, hypertension, smoking history, dyslipidemia, ECG changes such as ST deviation and T inversion, and Killip classification showed a statistically significant association with severity of disease. Conclusions: Both the GRACE and TIMI risk scores were a good predictor of angiographic severity of CAD in patients with NSTE-ACS, and the GRACE score was found to be superior to the TIMI risk score.

The COVID 19 global pandemic has engulfed humanity with a huge impact on health systems across the world. Many patients develop myocardial injury which can lead to significant cardiovascular complications including HF. This will require aggressive management strategies which are evolving. Guideline directed drug therapy including ACEI/ARB/ARNI is to be continued in patients with pre-existing HF. Long-term cardiovascular effects of COVID-19 are yet to be ascertained. Protection of health care personnel from contracting the disease should be given high priority.

Background: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The adverse impact of HF on the economic well-being has been narrated in various anecdotal reports from India, with affected individuals and their dependents pushed into the vicious cycle of poverty. There is limited research quantifying how HF impacts the economic well-being of households from low- and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The study will be initiated across 20 hospitals in India, which are part of the National heart Failure Registry (NHFR). The selected centres represent different regions in India, stratified based on the prevailing stages of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect data by using a validated and structured interview schedule. The study will have 80% power to detect an 8% difference in the proportion of households experiencing catastrophic health expenditures between two ETL groups. After considering a non-response rate of 5%, the target sample size is approximately 600 patients from each group and the total sample size is 1800 patients. Potential Impact: Our study will provide information on catastrophic health spending, distress financing and household expenditure in heart failure patients. Our findings will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Background and rationale: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The potential adverse impact of HF on the economic well-being of affected individuals and their families is narrated in various anecdotal reports. Further, HF is known to push the affected individuals and their dependents into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from the low and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The economic impact study in HF is initiated across 20 centres in India. The selected centres represent different regions in India stratified based on the prevailing stage of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months of follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect relevant data by using a validated and structured interview schedule. The study will have 80% power, after accounting for five percent non-response rate, to test eight percent difference in primary outcome (proportion of families under distress financing) between different ETLs. Impact: The results from the study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Background and rationale: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The potential adverse impact of HF on the economic well-being of affected individuals and their families is narrated in various anecdotal reports. Further, HF is known to push the affected individuals and their dependents into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from the low and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The economic impact study in HF is initiated across 20 centres in India. The selected centres represent different regions in India stratified based on the prevailing stage of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months of follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect relevant data by using a validated and structured interview schedule. The study will have 80% power, after accounting for five percent non-response rate, to test eight percent difference in primary outcome (proportion of families under distress financing) between different ETLs. Impact: The results from the study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Background and rationale: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The potential adverse impact of HF on the economic well-being of affected individuals and their families is narrated in various anecdotal reports. Further, HF is known to push the affected individuals and their dependents into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from the low and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The economic impact study in HF is initiated across 20 centres in India. The selected centres represent different regions in India stratified based on the prevailing stage of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months of follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect relevant data by using a validated and structured interview schedule. The study will have 80% power, after accounting for five percent non-response rate, to test eight percent difference in primary outcome (proportion of families under distress financing) between different ETLs. Impact: The results from the study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Background and rationale: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The potential adverse impact of HF on the economic well-being of affected individuals and their families is narrated in various anecdotal reports. Further, HF is known to push the affected individuals and their dependents into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from the low and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The economic impact study in HF is initiated across 20 centres in India. The selected centres represent different regions in India stratified based on the prevailing stage of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months of follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect relevant data by using a validated and structured interview schedule. The study will have 80% power, after accounting for five percent non-response rate, to test eight percent difference in primary outcome (proportion of families under distress financing) between different ETLs. Impact: The results from the study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Heart failure (HF), which is an emerging public health issue, adversely affects the already strained health system in India. Globally, HF unfavorably impacts the economic well-being of the affected individuals and their families, Further, HF is known to push the affected individuals and their dependents into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from low and middle-income countries. We describe the methods of a detailed economic impact assessment of HF in India. The economic impact study in HF is initiated across 20 centres in India. The selected centres represent different regions in India stratified based on the prevailing stage of epidemiological transition. We aim to collect data from 1800 patients who were admitted with acute decompensated HF and within 6-15 months of follow-up. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. The results from the study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Background and rationale: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The potential adverse impact of HF on the economic well-being of affected individuals and their families is narrated in various anecdotal reports. Further, HF is known to push the affected individuals and their dependents into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from the low and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The economic impact study in HF is initiated across 20 centres in India. The selected centres represent different regions in India stratified based on the prevailing stage of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months of follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect relevant data by using a validated and structured interview schedule. The study will have 80% power, after accounting for five percent non-response rate, to test eight percent difference in primary outcome (proportion of families under distress financing) between different ETLs. Impact: The results from the study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Background and rationale: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The potential adverse impact of HF on the economic well-being of affected individuals and their families is narrated in various anecdotal reports. Further, HF is known to push the affected individuals and their dependents into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from the low and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The economic impact study in HF is initiated across 20 centres in India. The selected centres represent different regions in India stratified based on the prevailing stage of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months of follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect relevant data by using a validated and structured interview schedule. The study will have 80% power, after accounting for five percent non-response rate, to test eight percent difference in primary outcome (proportion of families under distress financing) between different ETLs. Impact: The results from the study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Background and rationale: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The potential adverse impact of HF on the economic well-being of affected individuals and their families is narrated in various anecdotal reports. Further, HF is known to push the affected individuals and their dependents into poverty. However, there is limited research quantifying how HF impacts the economic well-being of households from the low and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The economic impact study in HF is initiated across 20 centres in India. The selected centres represent different regions in India stratified based on the prevailing stage of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months of follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect relevant data by using a validated and structured interview schedule. The study will have 80% power, after accounting for five percent non-response rate, to test eight percent difference in primary outcome (proportion of families under distress financing) between different ETLs. Impact: The results from the study will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.

Pregnancy with complete heart block is rare, its management is not streamlined and requires a multidisciplinary team approach involving the obstetrician, cardiologist, anaesthesiologist and neonatologist. High index of suspicion in a woman with slow heart rate and electrocardiographic examination will ensure the diagnosis of this condition. Such patient can be managed conservatively or may require temporary or permanent pacemaker implantation. We present a 26-year-old primigravida with complete heart block at term pregnancy. She was asymptomatic throughout her pregnancy with pulse rate between 50 and 60 beats per minute. Vaginal delivery was planned under continuous ECG monitoring. Isoprenaline drip and temporary pacemaker were kept stand-by. However, for obstetric reasons caesarean section was performed successfully under spinal anaesthesia without a pacemaker. Method of anaesthesia was planned to keep the haemodynamics stable and drugs causing bradycardia were avoided.

Background COVID-19 pandemic has affected around 20million patients worldwide and 2.0 million cases from India. The lockdown was employed to delay the pandemic. However, it had an unintentional impact on acute cardiovascular care, especially acute myocardial infarction (AMI). Observational studies have shown a decrease in hospital admissions for AMI in several developed countries during the pandemic period. We aimed to evaluate the impact of COVID-19 on the AMI admissions patterns across India. Methods In this multicentric, retrospective, cross-sectional study, we included all AMI cases admitted to participating hospitals during the study period 15th March to 15th June 2020 and compared them using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. Major objective of the study is to analyze the changes inthe number of hospital admissions for AMI in hospitals across India. In addition, we intend to evaluate the impact of COVID-19 on the weekly AMI admission rates, and other performance measures like rates of thrombolysis/primary percutaneous interventions (PCI), window period, door to balloon time, and door to needle time. Other objectives include evaluation of changes in the major complications and mortality rates of AMI and its predictors during COVID-19 pandemic. Conclusions This CSI-AMI study will provide scientific evidence about the impact of COVID-19 on AMI care in India. Based on this study, we may be able to suggest appropriate changes to the existing MI guidelines and to educate the public regarding emergency care for AMI during COVID-19 pandemic.

Proteinuria is a marker and predictor of cardiovascular morbidity and mortality. Blockade of angiotensin receptor might result in reduction in proteinuria. Olmesartan, an Angiotensin Receptor Blocker (ARB) which is approved for the treatment of hypertension is believed to produce antiproteinuric effects through different mechanisms. The objective of this review is to assess the cause, duration and degree of proteinuria and understand the current place of olmesartan in management of proteinuria associated with Cardiovascular Disease(CVD) and hypertension. We performed a comprehensive search of MEDLINE, PubMed and Google Scholar databases for articles related to Olmesartan and proteinuria (till June 2017). Angiotensin-II induces transforming growth factor-β upregulation and increase transcapillary pressure. AT-I receptor blocked by olmesartan result in reduction in proteinuria. Olmesartan significantly reduces Blood Pressure (BP) and delays the onset of Chronic Kidney Disease (CKD), it also delayed the risk of onset of microalbuminuria. Olmesartan have nephroprotective, antioxidant, antifibrotic activities and proteinuria reducing effects which can be beneficial in patients with hypertension. Olmesartanis believed to produce antiproteinuric effects through different mechanisms. It is indicated for treatment of hypertension to reduce the risk of fatal and non fatal CV events which may or may not be associated with proteinuria.

There is limited national-level data on the prevalence of hypertension among Indian adults; with few studies reporting prevalence according to the 2017 ACC/AHA criteria. This study was conducted to study the impact of a lowered cut-off on hypertension prevalence. A national-level survey was