bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Derived Central Aortic Pressure vs Cuff Peripheral Pressure
Authors: Krishna K. , Kiran M. , Garre Indrani 
Published: May 2018

AbstractBackground: Emerging evidence favours Central aortic pressure as a better correlate of cardiovascular events than peripheral BP recorded with sphygmomanometer. Noninvasive devices to calculate the derived central aortic pressures are available now. We want to see the difference of BP between derived central BP vs manual recorded BP and to see whether these BP values are consistent among different sexes and age groups.Materials and methods: In the present study 63 consecutive patients both male and female who attended the cardiology outpatient department were studied. In all these patients blood pressure was recorded both manually by sphygmomanometer and by Mobil-O-Graph® Pulse Wave Analyser (ARC Solver). The Mobil-O-Graph ® system works on the oscillometric recording of pulse waves at the brachial artery site. We recorded the BP in sitting posture. We compared the derived central, manual and device measured BP, cardiac output, and pulse wave velocity between both genders.Results: Among the study population (63 patients) 20 were females and 43 were males with mean age of 58.92±10.9 yrs. The mean systolic and diastolic manually recorded peripheral BP was 127.25 ± 19.89 and 79.25 ± 8.58 mm of Hg respectively, whereas the mean peripheral SBP and DBP recorded by the device was 129.40 ± 21.21 and 81.56 ± 12.83 mm of Hg respectively (comparable p=0.6, 0.2). The mean central aortic SBP & DBP recorded by the device was 117.37 ± 19.17 and 81.67 ± 13.04 mm of Hg with the mean pulse wave velocity of 8.392 ± 1.741 m/sec. There was a statistically significant difference in the central aortic SBP and manual SBP (p=0.005), whereas the difference in DBP was not statistically significant (p=0.2). There is no statistically significant difference in the central and peripheral SBP and DBP recorded by the device among males and females. The device derived parameters including cardiac output, pulse wave velocity also did not show significant difference in both sexes.Conclusion: Derived central aortic systolic pressure recorded by the device is lower than the manually recorded pressure whereas there was no difference in diastolic BP. There is no difference in these BP recordings between the genders.
Failure of Stent Delivery in Lima PCI
Authors: Janapati Rama , Sneha G , Garre Indrani 
Published: May 2018

AbstractBack Ground: The internal mammary artery was the most effective conduit for coronary artery bypass surgery and it was associated with significantly better long term patency, survival, and reintervention rates compared to other bypass conduits. The internal mammary artery (IMA) is not immune to atherosclerosis. IMA interventions constitute low percentage out of all coronary interventions. In addition to the tortuous course, the long length of IMA than native coronaries adds procedural difficulties to IMA PCI.Aim: To analyze the acute outcomes of Percutaneous intervention procedures to the internal mammary artery and to found any association with clinical and demographic parameters to the procedural success at a single tertiary care hospital from IndiaMaterials And Methods: This study was a retrospective analysis of post CABG patient who required and undergone the IMA intervention. We collected the clinical, demographic and procedural details of the IMA intervention. We defined as failure of the procedure when the stent could not be delivered to the lesion site through IMA.Results: Total 21 patients were included in this retrospective analysis. Mean age of the study population was 56.1± 9.98 years and 18 patients were male. Twelve (57.1%) patients presented with chronic stable angina and six (28.6%) had Left ventricular dysfunction (LVD) (mild LVD in 5 and one patient had severe LVD). Mean stent diameter was 2.75±0.442 mm and the mean stent length was 17.71 ±5.63 mm. Transient slow flow occurred in 5 patients, but the end result of PCI procedure was good in them. In 4 (19.1%) patients stent could not be delivered. No LIMA dissections were observed. On binary logistic regression, there was no significant difference between successful PCI to the failed PCI with respect to age (p=0.9, z=0.16, OR=0.99, 95%CI=0.83to1.17), male sex (p=0.7, Z=0.34, OR=1.68), type of presentation (p=0.7, Z=0.38, OR=1.60, 95%CI= 0.14 to 17.7), presence of Left ventricular dysfunction (p=0.7, z=0.38, OR=1.60, 95%CI= 0.14 to 16.97) and with pre-dilatation during PCI (p=0.9, z=-0.16, OR=0.99).Conclusion: PCI to the internal mammary artery was associated with 80.95% of success. Not able to deliver the stent to the target lesion was the major problem with LIMA PCI, in addition, to slow or no flow. The success or failure of PCI were not dependent on the age, sex, type of presentation or LV dysfunction.
Difference in the Mortality Between Weekend and Non-Weekend Coronary Artery Disease Admissions
Authors: Sandeep M. , Satish K. 
Published: May 2018

AbstractBackground: Acute coronary syndrome requires urgent diagnostic and therapeutic procedures, which may not be uniformly available throughout the week. So, we sought to examine the effects of admission on clinical outcomes in patients with wide spectrum coronary artery diseases.Methods: A retrospective analysis of ICCU Inpatient sample database of 17 months from 2015 to 2016 used to compare differences in in-hospital mortality between patients admitted on a non-weekday versus weekend for wide spectrum ACS which include STEMI, NSTEMI and unstable angina and patients with cardiogenic shock. Out of these 75% had higher TIMI risk score (5-7).Results: Total 2700 patients with ACS were included in the present study with wide spectrum coronary artery diseases. Out of that 20 % (n=541) were admitted in weekends and 79.9% (n=2159) were admitted in non-weekends. Total 804 females admitted on non-weekend had a mean age of 61.05±12 years and 162 females admitted on weekend had mean age 58.5±13.3 years (p value=0.025). Out of 2159 admitted on non-weekend, 1355 were males with mean age of 57.65±15.55 years and 379 were males admitted on weekend out of 541 patients with mean age of 56.85±13.1 years (p value =0.314). In-hospital mortality rate of these patients admitted on non-weekends was 9.4% (n=204) and those admitted on weekends was 5.9% (n=32) with statistically significant difference (95% CI; p= 0.003). The mortality rate of ACS without STEMI in non-weekend group was 8.6% (n=170) which was statistically significant (p = 0.006) with mortality of weekend group 5.3% (n=26).Conclusion: Our study shows that there is no added mortality in patients with coronary artery disease on weekend days compared with non-weekend days. As the patients admitted during non-weekend were elder and sicker than the weekend admissions (having the high risk score), the in-hospital mortality is higher on non-weekends. Efforts to improve health care system should ensure comparable outcomes for patients irrespective of time of hospital admission.
Discordance is the Key
Authors: Prasad K. , Kumar A. 
Published: May 2018

AbstractCongenitally corrected transposition of the great arteries (CCTGA) is a rare form of congenital heart disease characterised by atrioventricular as well as ventriculoarterial discordance. It is usually associated with a variety of severe intracardiac defects. Few patients with this abnormality survive past 50 years. A 54 Yr old male patient referred to our hospital for the management of post MI VSD. At the presentation Patient had mild central cyanosis, clubbing grade 2 and the vitals are stable. Cardiac examination revealed a 2/6 long ESM in a left parasternal area with pulsations in left 2nd and 3rd ICS. There is a lot of discrepancy in both clinical examination and workup. After detailed evaluation patient is diagnosed as having cyanotic congenital heart disease – L TGA + VSD with PS. Survival up to this age is very rare with this combination of associated defects in LTG. The patient is misdiagnosed as coronary artery disease with mechanical complication in another hospital. Unless there is suspicion and having knowledge about the asymptomatic presentation of congenital heart diseases up to this age group, patients will be misdiagnosed and treatment will be delayed.
Obstructive Coronary Artery Disease in Young Females
Authors: Jyotsna Maddury , Aditya Madhavapeddy , Lalitha Nemani 
Published: May 2018

AbstractBACKGROUND: To define myocardial infarction in “young”, many studies taken < 40 to 45 yrs. of age as cut off point. We have data in young males with obstructive coronary artery disease, but limited data in young females.OBJECTIVES: To see the disease pattern, risk factors, presentation, ventricular function and PCI efficiency of young females in comparison with young males with obstructive coronary artery disease who require PCI.MATERIAL AND METHODS We retrospectively analyzed the data of young patients (< 45 yrs. of age) who undergone PCI over past two years. We noted the clinical, investigative and treatment modalities of these patients.RESULTS: 200 young patients had undergone PCI for obstructive CAD with 42 females over two year period. Females had more frequently hypertension (69.1% vs. 43.7%) and Type 2 Diabetes (33.3% vs22.8%) which are statistically significant. Smoking was frequent in young males than young females. Males were presented as acute MI, whereas females with rest chest pain. Multi-vessel involvements, LV dysfunction, success of PCI and complication rates were similar in both groups. Females are more anemic (< 11 g/dl in females and < 13g/dl in males). Complexity of lesion (B2 or C type of lesions) is more in females which is statistically significant.CONCLUSION: Young females had more frequently hypertension, Diabetes, acute coronary syndrome without MI, mild anemia, complex lesions than young males, but with same success and complication rate of PCI.
Importance of Proximal Angle in Generation of Abnormal Plaque at Coronary Bifurcation Lesions
Authors: Deepti K. , Aditya M 
Published: May 2018

AbstractBACKGROUND: Changing of linear blood flow to turbulence at branching points predisposes to development of obstructive coronary lesions. We hypothesize that in addition to bifurcation angle (BA), proximal (PA) and third angle (TA) of branching site are important in generating more vertices of blood flow.METHODS: 65 normal and 36 significantly diseased LAD – D1, 72 normal and 27 significantly diseased LCX – OM, 73 normal and 16 significantly diseased RCA – PDA – PLV and 34 normal and 14 significantly diseased LMCA – LAD – LCX bifurcations were analyzed with QCA.RESULTS: In LAD – D1 normal vs. significantly diseased bifurcations BA and PA were 78.2±13.2 vs. 65.1±11.3 (p <0.000) and 122.7±13.8 vs. 131.6.36±12.5 (p <0.001) respectively. In LCX – OM normal vs. significantly diseased bifurcations BA and PA were 76.8±13.6 vs. 60.7±13.8 (p=0.000) and 125.1±13.5 vs. 137.8±12.8 (p <0.000) respectively. In RCA - PDA – PLV normal vs. significantly diseased bifurcations BA, PA and TA were 91.1±13.8 vs. 71.5±15.9 (p 0.004), 113.0±14.1 vs. 128.4±20.2 (p=0.000), 118.2±21.7 vs. 133.8±12.4 (p=0.007) respectively. In LMCA –LAD – LCX normal vs. significantly diseased bifurcations BA, PA and TA were 84.0±39.1 vs. 73.0±17.6 (p >0. 32), 123.2±26.3 vs. 115.3±30.4 (p > 0.38), 130.3±27.3 vs. 137.5±33.5 (p >0.45) respectively. There was a significant difference but no correlation between the angles in normal and diseased bifurcation segment. We derived logistic regression equations for predicting the disease in different coronary bifurcations.CONCLUSION: In LAD - D1, LCX – OM and RCA – PDA – PLV bifurcations lesser the BA, greater the PA, were more likely to develop significant lesion, which was not true in LMCA – LAD – LCX bifurcation.
Unusual Site Hemorrhagic Complications of Anticoagulantion
Authors: Kumar A. 
Published: May 2018

AbstractAnticoagulation has inherent quality to produce bleeding complications, more frequently in the elderly. Usual sites following anticoagulation is gastrointestinal, nasal, intracranial hemorrhage or petechial bleed. Here were reporting unusual sites of anticoagulation induced bleed. Rectus sheath hematoma is an unusual bleeding site, can mimic acute abdomen. Bleeding into intestinal wall can produce intussusception and presentation will be again as acute abdomen. Similarly, Sub lingual space is an unexpected site of bleeding and can present as upper airway obstruction or esophageal obstruction. Here we report one case of rectal sheath hematoma, 2 cases of sublingual hematoma and one case in the intestinal wall hematoma due to oral anticoagulation.
PBTV and PBMV in a Patient with CRHD
Authors: Pechetty Ramya 
Published: May 2018

Case DetailsA 26 year old gentleman who is a known case of chronic rheumatic heart disease, presented with exertional breathlessness of 1 year duration. He underwent percutaneous balloon mitral valvotomy in 2004 for severe mitral stenosis. ECG showed atrial fibrillation with controlled ventricular rates. 2D Echocardiography showed severe mitral restenosis (MVA=0.8 cm2; MVG =18/12, Panel A), Organic tricuspid valve disease with severe tricuspid stenosis (TVG=13/8, Panel B) with mild tricuspid regurgitation. Balloon mitral and tricuspid valvotomy was done sequentially in this patient with Acura 28 balloon, inflated to 28mm across mitral valve and 18mm across tricuspid valve with wire in LV and RV apex respectively (Panel C and D). There was significant drop in the trans-Valvular gradients (Panel E and F). Procedure was uneventful. The post procedure course was unremarkable and the patient is doing well at one year follow up.
Role of BMS in Des ERA
Authors: Kumar C Guru , Rao Phani kotewsar 
Published: May 2018

AbstractBACKGROUND: DES has gained significant importance in coronary interventions due to its superiority of decrease in target vessel revascularization when compared to BMS. In this DES era, we want to study the role of BMS as it is more economical.MATERIAL AND METHODS: We have analyzed acute coronary syndrome (ACS) and chronic stable angina patients who underwent BMS implantation between January 2011 to March 2011 under government health scheme of Andhra Pradesh.RESULTS: We retrospectively analyzed the cardiac events in 4181 BMS implanted patients. 1938 (46.4%) patients were followed for 365 days. More men than women with 40 to 69 years were there. ST elevation MI was the common presenting symptom in 1902patients (45.49%). 1881 patients (44.98%) were diabetic. Single vessel disease was more common 2522(60.32%), Multivessel disease was seen in 210 patients (5.02%). LAD being the common vessel involved followed by RCA. Primary PCI was done in 320 patients(7.65%).Out of 4181 patients, 9366 lesions were stented with BMS, stainless steel BMS was used in 4988(53.26%) and cobalt chromium BMS was used in 4378 (46.74%) patients.Out of 4181 patients, 1938 patients (46.4%) were followed up of 1yr, post PCI 686 (35.4%) patients had worsening angina, 226(11.66%) patients had worsening heart failure, 17 (0.88%) patients had repeat STEMI, 11(0.56%) patients had repeat NSTEMI, 16(0.82%) patients had subacute stent thrombosis, 27(1.39%) patients developed late stent thrombosis, 51 patients (2.63%) underwent repeat target vessel revascularization(TVR). 52 (2.68%) patients died due to cardiac cause with in one year of follow up.CONCLUSIONS: Our study show that even in present era of DES, BMS implantation is effective and associated with less mortality and less stent thrombosis and less chances of target vessel revascularization with the limitations (as it was telephonic follow up).
Is the Pleotropic Effect of Ranolazine is Due to its Antioxidant Action
Authors: Krishna Janapati , Kumar Vijay , Kumar Narendra , Indrani Garre 
Published: May 2018

AbstractBACKGROUND: Ranolazine is indicated as antianginal drug. We observed that it has other pleotropic effects also. So, we want to study the effect of Ranolazine in improvement of left ventricular (LV) function in obstructive coronary artery (CAD) diseased patients along with ACC/AHA guidelines of treatment. And to see the mode of improvement in LV function is due to its antioxidant effect.MATERIALS AND METHODS: We recruited CAD patient between the age group 18-80 yrs with LV dysfunction in whom ischemic component was treated. Cases received ranolazine 500 mg two times a day and controls without the drug. Both groups received standard drug therapy according to ACC/AHA guidelines of treatment CAD. For all these patients at basal and at 6 months of follow up, all baseline and demographic parameters, clinical features and symptomatology with blood chemistry parameters were collected. In addition Two Dimensional echocardiography (EF, MAV), Treadmill test (METs) and plasma oxidative stress levels (MDA) will be performed at 0 day (day of recruitment) and at 6 months. MDA concentration was tested by using the method described by Draper and Hadley based on TBA reactivity. Normal Range of MDA is 3.60 ± 0.90 Nano mole/ml.RESULTS: 100 cases and 40 controls were recruited for this study. Male: Female ratio was 3.4:1 in cases and in controls. The mean age of cases was 56.8 ± 9.6 yrs in cases and 55.1 ± 12 yrs in controls. There was no difference in demographic features and risk factor profile in between the cases and controls expect smoking ( high in cases). Even in echo EF was comparable but MAV is more in cases than controls (9.5 ±2.1 vs 8.8±1.8) which are also not statistically significant.There is statistically significant improvement of EF either by dimension (48.3 ± 9.6 vs 43.8±8.4 %, p= 0.008) or volume (p=0.018) method of estimation and peak mitral annular velocity in cases (9.8±1,8 vs 8.7± 1.8 cm/sec, p= 0.001) who received additional ranolazine therapy than controls.MDA at 6 months in cases was decreases to 3.4±0.8 nano mole/dl where as in controls increased to 3.9±0.7 nano mole/dl. Out of 100 cases we could able to get Treadmill test done only for 89 patients with modified Bruce protocol and there was a statistically significant improvement in the number of metabolic equivalents at 6 months in cases comparison to basal exercise capacity (6.8± 2.4 vs 8.2 ± 8.1 METS, p= 0.05).ConclusionsRanolazine can act as not only an anti anginal drug but also it was shown to have positive effects on improving LV function (improvement in EF and mitral annular velocities) and improving the exercise capacity (increased METs by TMT). These effects may be due to reduction in the oxidative stress (decreased MDA levels).
Congenital Aortic Stenosis in a Fetus: A Case Report and Review of Syndromic Associations
Authors: Aggarwal Shagun 
Published: May 2018

AbstractThis is report of post-mortem findings in a fetus with prenatally detected aortic stenosis. A diagnosis of non-syndromic aortic stenosis was made following evaluation. In view of carbimazole exposure in pregnancy, teratogenic effect was an etiological possibility. Literature was reviewed to look for etiological basis of congenital aortic stenosis with emphasis on syndromic associations.
Carotid or Coronary Intervention which is to be done First?
Authors: M. Ravikiran , Afshan Jabeen , Lalita Nemani 
Published: May 2018

AbstractIn carotid artery disease patients with concomitant significant coronary artery disease (CAD - especially left main diseases – LMCA), the risk of perioperative myocardial infarction and early and late death are increased. Conversely, in patients undergoing coronary artery bypass surgery (CABG), uncorrected severe carotid disease increases the risk of adverse neurologic events [1]. The optimal management of these co-existing conditions and the timing and sequence of correcting them remain controversial. Over the past 2 decades, staged carotid revascularisation followed by CABG, staged CABG followed by carotid revascularisation, or combined coronary and carotid revascularisation simultaneously in one operative setting have each been advocated. Our patient presented with both carotid and significant LMCA CAD, first we have done carotid intervention followed one week later by LMCA percutaneous coronary intervention (PCI).
Experience of LMCA Angioplasty from a Referral Center and in Hospital Outcomes
Authors: Subramanyam P. , Sireesha P. 
Published: May 2018

AbstractIntroduction and Objectives: CABG is the treatment of choice for severe left main coronary artery stenosis. The results of a number of multicenter trials have suggested angioplasty with stenting as a possible alternative treatment. Previous studies demonstrated procedural success of 90-100% and Mortality 0.8-2% So, want to see these parameters in Asian population though the LMCA registry of a referral center institute.Material and Methods: We have collected data from patient records who underwent LMCA angioplasty procedure (both unprotected or protected LMCA) performed at our institution between April 2003 to July 2015. Detailed in-hospital data including age, gender, coronary risk factors, procedural events were obtained and analyzed.Results: Angiographically documented success was obtained in 98% patients with zero mortality. In 134 patients the lesions were pre-dilated using a conventional balloon. In 19 patients direct stenting was done. The median diameter and length of the stent was 3.2542 mm and 13.790 mm, respectively. POBA was done in two cases, BMS were used in 27 cases, DES were used in 124 cases.Only LMCA stenting was done in 53 cases LMCA with other vessels stenting was done in 98 cases. FFR was used in 2 cases, Kissing balloon dilatation was used in 8 cases, ostial flaring was done in 5 cases. There was no mortality in the study but on table stent thrombosis was seen in one patient for which thrombuster was used, IABP was placed immediately and sent for CABG. For one case result was suboptimal.Conclusions: Present study demonstrated that stenting for significant LMCA disease is safe and feasible with very high procedural and clinical success rates and zero mortality. LMCA-left main coronary artery, POBA-plain old balloon angioplasty, PCI-Percutaneous coronary intervention, CABG-coronary artery bypass grafting, FFR-Fractional flow reserve, TIMI- thrombolysis in myocardial infarction, DES-drug eluting stent, BMS-bare metal stent, TLR-Target lesion revascularization.
Multiple Myeloma Presenting with Nstemi
Authors: kiran M. , Praveen A. 
Published: May 2018

AbstractMultiple myeloma, also known as plasma cell myeloma, is a cancer of plasma cells, a type of white blood cell normally responsible for producing antibodies. Multiple myeloma is associated with hyperviscosity of the blood depending on the properties of the para-protein. Here we are reporting a case of multiple myeloma presented with a cute coronary syndrome with Troponin T positive with regional wall motion abnormality but with normal coronaries.