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   Table of Contents - Current issue
July-September 2021
Volume 7 | Issue 3
Page Nos. 63-109

Online since Saturday, September 25, 2021

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Does short-term dialysis significantly increase coronary artery disease burden in diabetic patients who undergo renal transplantation? p. 63
Umut Karabulut, Kudret Keskin
Background: Although preemptive renal transplantation decreases mortality associated with dialysis, coronary artery disease (CAD) remains the primary cause of mortality even after transplantation in patients with diabetes. We sought to determine whether short-term dialysis treatment significantly impacts CAD burden, revascularization strategy, and all-cause long-term mortality in diabetic renal transplant (RT) recipients without prior CAD. Subjects and Methods: Diabetic patients with end-stage renal disease and without prior CAD who were referred to coronary angiography before renal transplantation were retrospectively included. These patients were then divided into two groups as short-term dialyzed (nonpreemptive) and preemptive group. Angiographic findings, the severity of CAD, and long-term mortality were compared between the groups. Results: Overall, 164 included patients were included, of whom 125 (78%) were male, and the median age was 54 years (Q1–Q3 = 45–59). The mean duration of dialysis before RT was 1 year (range, 0.5–1.5 years) in the nonpreemptive group. The extent of CAD, revascularization rates, SYNTAX, and Gensini scores were similar between groups (all P > 0.05). During 4.8 years of follow-up, there were no significant differences in major adverse cardiovascular and cerebrovascular events ([hazard ratio (HR) = 0.88 (0.38–2.01), P = 0.76]) and all-cause mortality rates ([(HR) = 0.59 (0.20–1.71), P = 0.33]). Only age and hyperlipidemia were predictive of all-cause mortality (HR = 1.03 [1.001–1.07], P = 0.04 and HR = 2.75 [1.20–6.28], P = 0.01, respectively). Conclusion: Short-term dialysis does not seem to increase newly diagnosed CAD prevalence and burden in diabetic patients undergoing renal transplantation compared to patients who directly undergo renal transplantation. Moreover, long-term all-cause mortality rates did not differ between the two groups as well. Age and hyperlipidemia were independent predictors of all-cause mortality
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The predictive value of precise-dapt score for mortality in patients with acute decompansed heart failure p. 70
Mevlut Demir, Ahmet Korkmaz, Bekir Demirtas
Introduction: Acute decompensated heart failure (ADHF) is an emergency clinical syndrome defined as a sudden worsening of heart failure. PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti-Platelet Therapy (PRECISE-DAPT) score is a new scoring used in the management of duration of dual-antiplatelet therapy after coronary intervention. We presented the hypothesis that this scoring can be used as a predictor of mortality in heart failure. Objective: In this study, the correlation between mortality and PRECISE-DAPT score will be analyzed in patients diagnosed with ADHF. Materials and Methods: A total of 114 patients hospitalized with a diagnosis of ADHF were included in this study. The patients were divided into two groups: PRECISE-DAPT score ≥25 and PRECISE-DAPT score <25, and these groups were evaluated in terms of correlation with early (<6 months), late (>6 months) and overall mortality. Results: According to univariate analysis, it was found that PRECISE-DAPT score was significantly related with early (P < 0.001), late (P < 0.001), and overall (P < 0.001) mortality. Multivariate Cox regression analysis showed that PRECISE-DAPT was independently associated with late (hazard ratio: 6.6; 95% confidence interval [CI] 1.6–27.3; P = 0.009) and overall (hazard ratio: 11.3; 95% CI 3.2–40.9; P < 0.001) mortality. According to Kaplan–Meier curve, those with a score of ≥25 were shown to have significantly higher mortality. The predictive ability for the PRECISE-DAPT score threshold value of 25 was investigated in 3 mortality subgroups. Conclusion: The PRECISE-DAPT score may be a significant independent predictor of mortality in patients with ADHF. Limitations: This study is subject to the limitations inherent to a retrospective study and the sample size in our study is relatively small.
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Comparison of clinical and angiographic results in COVID-19–positive and –negative patients undergoing primary coronary intervention due to ST-elevation myocardial infarction p. 78
Zeynep Yapan Emren, Rahman Bilal Gediz, Fatih Levent, Sadik Volkan Emren, Oktay Senoz
Introduction: Although coronavirus disease-19 (COVID-19) primarily causes respiratory system infection, it may cause thrombosis in the cardiovascular system. In this regard, we aimed to compare cardiovascular outcomes between COVID-19–positive and –negative patients with ST-segment elevation myocardial infarction (STEMI). Methods: This was a retrospective study that consecutively included 96 COVID − and 36 COVID+ patients with STEMI. Clinical, laboratory, and angiographic characteristics were obtained from hospital records, and these variables were compared between groups. Results: COVID-19 patients with STEMI had higher Killip score (3–4) (78 vs. 30, P < 0.001) and mortality (42% vs. 21%, P = 0.017). Among COVID-19 patients with STEMI, 83% had lung infiltration. According to the angiographic findings, COVID-19 patients had a shorter door to balloon time (35 ± 20 vs. 49 ± 17, P = 0.013), glycoprotein IIb/IIIa antagonist use, and shorter door to balloon time. Conclusion: COVID-19 patients with STEMI had a higher rate of cardiogenic shock and mortality.
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Query in dealing progressive tricuspid regurgitation with mitral valve disease p. 83
Kinnaresh Baria, Jignesh Kothari, Ishan Gohil
Objective: The recommendation to repair progressive tricuspid regurgitation (TR) at the time of mitral valve (MV) surgery is questionable. We assessed the outcomes of tricuspid valve (TV) repair for progressive TR with MV surgery. Patients and Methods: We assigned 611 patients with progressive TR who had MV replacement with or without concomitant TV repair from January 2015 to December 2016. Results: There were no remarkable variation in early mortality or major morbidity rates according to the etiology of the MV disease. Median follow-up was 36 months. After adjustment for baseline characteristics using a propensity score adjustment model, there were no significant differences in the frequency of re-admission for congestive heart failure between the groups. Both groups had similar risk for other late complications affected by valve surgery such as stroke, significant hemorrhage related to anticoagulation, reoperation due to valvular heart lesions other than TV, or infective endocarditis. However, comparing the severity of TR at the last follow-up, patients with greater than progressive TR were significantly less common in the repair group of mitral regurgitation compared with those in the control group. Conclusions: The clinical benefit of simultaneous TV repair for progressive TR with MV surgery for rheumatic mitral regurgitation is certain. Concomitant TV repair cannot be routinely recommended in patients with rheumatic mitral stenosis at the time of MV repair or replacement.
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Effect of banana leaf bath on blood pressure, pulse rate, and its related variables in healthy individuals p. 88
M Fathima-Jebin, A Mooventhan, N Manavalan
Introduction: Sunbath (heliotherapy) is a popular treatment modality being used since ancient times in many parts of the world. Banana leaf bath (BLB), a type of sunbath, is commonly employed in the treatment of various diseases in India. This study was conducted to evaluate the effect of BLB on blood pressure (BP) in healthy individuals. Materials and Methods: A single group pretest and posttest study design was adopted. Twenty (9 males, 11 females) healthy individuals aged 23.80 ± 3.93 years were recruited. All the subjects underwent a 30-min session of BLB. Assessments such as systolic-BP (SBP), diastolic-BP (DBP), and pulse rate (PR) were measured using an automatic BP monitor before and after the intervention, while pulse pressure (PP), mean arterial pressure (MAP), rate pressure product (RPP), and double product (Do-P) were derived using standard formula. Statistical analysis was performed using Statistical Package for the Social Sciences version-16. Results: Results of this study showed a significant increase in SBP, PP, and MAP with a significant reduction in PR and no significant difference in DBP, RPP, and Do-P in the posttest assessment compared with baseline assessment. However, subgroups (male group and female group) analysis showed the presence of a significant increase in RPP in male participants unlike in female participants. Conclusion: Results of this study suggest that 30 min of BLB might increases SBP, PP, and MAP and reduces PR with and without affecting cardiac workload in males and females, respectively.
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Left atrial volume index to predict long-term recovery of the left ventricular ejection fraction in patients with heart failure and reduced ejection fraction p. 92
Ayano Yoshida, Atsushi Suzuki, Tsuyoshi Shiga, Sae Tanino, Chihiro Saito, Kotaro Arai, Tsuyoshi Suzuki, Kyomi Ashihara, Nobuhisa Hagiwara
Context: Left ventricular ejection fraction (LVEF) recovery is an important treatment goal for patients with heart failure (HF) and reduced EF (HFrEF); however, the applicability of the left atrial volume index (LAVI) in predicting long-term LVEF recovery in HFrEF remains unknown. Aim: We aimed to assess the predictive value of the LAVI in predicting long-term LVEF recovery in patients hospitalized with HFrEF. Settings and Design: This was a retrospective cohort study. Materials and Methods: We analyzed 70 decompensated patients with HF, hospitalized between 2013 and 2014, with an LVEF <40%. Patients were categorized into recovered (≥40% LVEF and ≥10% improvement in LVEF) and nonrecovered groups, according to an echocardiography-measured LVEF >3 years postdischarge. Predictive LAVI values used to predict long-term LVEF improvement were determined. Statistical Analysis: The survival rate was determined using Kaplan–Meier analysis. In receiver operating characteristic curve (ROC) analysis, the area under the curve (AUC) and optimal cutoff values were obtained from several echocardiographic parameters. Univariate and multivariate logistic regression analyses identified predictors of LVEF improvement. Results: Twenty-seven (39%) patients had recovered LVEFs. During a median follow-up period of 76 (60–80) months, the survival rate was significantly higher in the recovered group (log-rank test, P = 0.001). ROC analysis showed that LAVI's predictive performance in long-term LVEF improvement (AUC 0.78, 95% confidence interval [CI] 0.66–0.87) was optimal at a cutoff of 35 g/m2. LAVI <35 ml/m2 independently predicted LVEF improvement (odds ratio 6.02, 95% CI 1.26-28.81, p=0.025). Conclusions: LAVI is associated with predicting long-term LVEF improvement.
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Dual versus split right coronary artery: What is there in the name? p. 100
Surendra Kumar Naik, Raghav Bansal
Congenital coronary artery anomalies are rare which are generally detected incidentally during coronary angiograms. Double right coronary artery (RCA) is one such rare coronary anomaly, and various other terms are being used to describe it such as dual RCA or split RCA. However, no final consensus regarding definition of dual or split RCA has been made till now. We reported two different cases of double RCA and proposed to differentiate dual versus split RCA on the basis of their number of ostia from the right sinus of Valsalva. Various reports of increased atherosclerosis particularly in single ostial origin split RCA have been described recently. Their clinical implication lies in the fact that one should have background knowledge of such a rare coronary anomaly particularly during acute coronary syndromes with complete occlusion so that culprit artery could not be missed.
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Covered stent treatment of coronary aneurysm in an octogenarian p. 103
Kiran Siddavaram
Coronary artery aneurysms are rare cardiac entities that may remain clinically silent throughout life. However, failure to diagnose and treat these cardiac entities could prove fatal due to their tendency to rupture, thrombose, or embolize. Here, we present the case of an octogenarian who presented with 90% stenosis in the left descending coronary artery accompanied by a coronary artery aneurysm.
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A rare case of ulnar and popliteal artery thrombosis in antiphospholipid antibody syndrome p. 106
Ashish Kumar Nayak, Debasish Das
We report an extremely rare case of medium vessel thrombosis (ulnar and popliteal artery) in a 26-year-old female presenting with recurrent abortion and gangrenous right ring finger and pregangrenous toes of the left feet. Medium vessel thrombosis i.e. selective involvement of ulnar and popliteal vessels is an extremely rare phenomenon described in the literature of antiphospholipid antibody (APLA) syndrome. We conservatively managed the patient with antiplatelets and anticoagulants which substantially improved the ischemia of the finger and toes. Our case is a unique description of ulnar and popliteal artery thrombosis in APLA syndrome which has not been described in world literature so far.
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