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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 12  |  Issue : 3  |  Page : 106-110

Impact of Ayurveda-based ischemia reversal program on reduction of resting myocardial ischemia studied with speckle-tracking global longitudinal strain imaging


1 Madhavbaug Cardiac Care Clinics and Hospitals, Thane, Maharashtra, India
2 Intensive Care Unit, ICU Head of Madhavbaug Khopoli Cardiac Hospital, Thane, Maharashtra, India
3 Department of Research and Development, Madhavbaug Cardiac Clinics and Hospitals, Thane, Maharashtra, India
4 Consultant Echocardiology, Madhavbaug Khopoli Cardiac Hospital, Thane, Maharashtra, India
5 Head of Operations, Madhavbaug Khopoli Cardiac Hospital, Thane, Maharashtra, India
6 Administration, Madhavbaug Khopoli Cardiac Hospital, Thane, Maharashtra, India
7 Head, In-Patient Department Madhavbaug Khopoli Cardiac Hospital, Thane, Maharashtra, India

Date of Submission23-Jun-2021
Date of Decision01-Dec-2021
Date of Acceptance07-Dec-2021
Date of Web Publication14-Sep-2022

Correspondence Address:
Dr. Rahul Mandole
201B Madhavbaug, Bhoomi Velocity, Wagle Estate, Thane, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jicc.jicc_38_21

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  Abstract 


Background: Cardiovascular disease, commonly seen on a rise globally, is especially prevalent in the developing countries, whose numerous causes are improper diet and lifestyle. Ayurveda, the ancient medical practice, offers antidotes to major diseases. Its detoxification process, Panchakarma, boosts immunity, reduces stress, eliminates toxins from the body, etc., This study was conducted to establish the role of Ayurveda-based ischemia reversal program (IRP) in minimizing ischemic heart disease (IHD). Materials and Methods: A retrospective clinical study was conducted in cardiac hospital on patients, having a clinical evidence of IHD. During the 7-day study period, patients received, 14 IRP Panchakarma sessions comprising, Snehana, Svedana, and Gokshur Haridra Amalki Basti. In addition, the patients were given a calorie-controlled diet. The primary endpoint was change in the global longitudinal strain score as compared to baseline and secondary endpoint was reduced dependency on modern medicine with respect to weight, body mass index (BMI), left ventricular (LV) ejection fraction (EF), 6-min walk test, noninvasive cardiac output, and end diastolic volume. Results: Fifty-nine patients were involved in the study, belonging to 61.02 ± 11.47 years of age, with 74.58% being males. The primary endpoint, decreased from −10.26 ± 4.02, on day 1, to −10.99 ± 3.94, on day 7. Appreciable decrease was also observed for the abdominal girth, body weight, BMI, and dependency on modern medicines. Conclusion: This study revealed that IRP notably reduces heart disease, by influencing various parameters studied in this investigation. An increased EF, decreased LV mass, an improved 6-min walk test, decreased heart rate, normal systolic and diastolic blood pressures, and other parameters indicate an improvement in the existing disease of the heart.

Keywords: Global longitudinal strain, ischemia reversal program, ischemic heart disease, Panchakarma


How to cite this article:
Sane R, Manohar P, Mandole R, Amin G, Ghadigaonkar P, Patil D, Dongre S, Jadhav R, PrafullYanshwantrao. Impact of Ayurveda-based ischemia reversal program on reduction of resting myocardial ischemia studied with speckle-tracking global longitudinal strain imaging. J Indian coll cardiol 2022;12:106-10

How to cite this URL:
Sane R, Manohar P, Mandole R, Amin G, Ghadigaonkar P, Patil D, Dongre S, Jadhav R, PrafullYanshwantrao. Impact of Ayurveda-based ischemia reversal program on reduction of resting myocardial ischemia studied with speckle-tracking global longitudinal strain imaging. J Indian coll cardiol [serial online] 2022 [cited 2022 Oct 1];12:106-10. Available from: https://www.joicc.org/text.asp?2022/12/3/106/356063




  Introduction Top


Cardiovascular diseases (CVDs) mainly cause deaths globally.[1] Ischemia, the reduced blood supply to heart, is a common CVD. Global longitudinal strain (GLS), assessed by two-dimensional speckle-tracking echocardiography, has emerged as a new method for assessing left ventricular (LV) function to identify heart patients.[2] In India, the factors such as less awareness about diseases and low diagnosis rates have disabled the optimal use of these resources. Exploring new therapies is thus mandatory.[3] Ayurveda, uses Panchakarma (five therapies of body detoxification) in various disorders such as obesity, heart diseases, etc.[4],[5] Panchakarma along with a calorie-controlled diet may reduce ischemia. The present study is aimed at proving efficacy of the combination therapy in reducing and eliminating heart disease studied using GLS.[6]


  Materials and Methods Top


Study design and patient population

A retrospective clinical observational study was conducted to study the primary objective of improving myocardial blood flow and improving myocardial ischemia. The study was conducted in the cardiac care clinic and hospital for 7 days. Patients with known ischemic heart disease (IHD) condition were enrolled in the study for a period of 7 days. IHD was diagnosed based on latest cardiac angiography reports. Patients were recruited after obtaining written informed consent from them. The study was conducted as per the ethical principles mentioned in the Declaration of Helsinki, good clinical practices, and applicable regulatory requirements.

Study procedure

Increased LV mass and LV hypertrophy are the important independent predictors of cardiovascular morbidity including heart failure. LV systolic function evaluation by echocardiography has been a pivotal measure in clinical cardiology but has many limitations.[7] LV GLS assessed with two-dimensional speckle-tracking echocardiography is a marker of LV systolic function. The incremental prognostic value of LV GLS over conventional echocardiographic parameters of LV systolic function such as LV ejection fraction (EF) has been demonstrated in patients with various CVDs (IHD, valvular heart disease, and heart failure).[8] It has been shown that LV GLS is a more sensitive marker of LV systolic dysfunction than LV EF. Patients with LV hypertrophy and preserved LV EF may show impaired LV GLS in the various clinical scenarios indicating that LV GLS better reflects the true damage of the LV myocardium compared with LV EF.[9] Patients with a known history of IHD were screened with GLS two-dimensional (2D) echo to identify GLS score at baseline. GLS 2D echo was performed using Vivid T9 system (Ge Healthcare), R3 version equipped with automated functional imaging software. The system and technician/observer/reporting cardiologist were same throughout the study to control intervendor/observer/instrument errors/bias. Patients with a GLS score of >16 were included in the study, who were willing to undergo the said treatment at the cardiac care clinic and hospital for a duration of 7 days. The exclusion criteria for this study were as follows:

  • GLS score of <16 at baseline
  • Unstable angina
  • Acute illness, if any.


On day 1, the anthropometric parameters and GLS score were determined at baseline. However, few investigations were carried out at baseline only. After this, ischemia reversal program (IRP) in combination with the calorie-controlled diet was given to the patients. A total of 14 IRP kit sessions, each session given twice a day for a period of 7 days, were conducted for the patients. The IRP program comprises of the following steps in detail.

The Panchakarma Therapy Kit

It Includes

Centripetal oleation or Snehana

A massage with the Til oil having fragrance of Lavender is given to the patients for about 20 min.

Thermal vasodilation or Svedana

A Dashmool Bharadswedan was given in which, steam arousing from a group of ten herbs (Dasmoola) was passed steadily to the patients for about 20 min.

Per rectal drug administration Gokshur Haridra Amalki Basti

In this procedure, a kadha, 100 ml in volume, comprising of the Ayurvedic herbs, Gokshur 60%, Haridra 20%, and Amalki 20%, was administered per rectally to the patients for a duration of 10 min.

At the end of the 7th day treatment, the patients were analyzed for their following parameters, GLS, EF, 6-min walk test (6MWT), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), systemic vascular resistance (SVR), and compared with the baseline.

Statistical analysis

Data were entered in MS Excel 2010 and analyzed. The primary endpoint was change in GLS score, after 7 days, and secondary endpoints included, EF, 6MWT, HR, SBP, DBP, SVR, as compared to the baseline. Paired t-test and ANOVA single-factor tests were used for GLS, whereas ANOVA single-factor tests were used for the secondary endpoint parameters. All the results were reported as mean ± standard deviation.


  Results Top


In the study period, a total of 59 patients were enrolled, after initial GLS screening. All of them continued to receive the IRP in combination with the calorie-controlled diet for a duration of 7 days. There were no reports of any serious adverse events during the tenure of this study. Out of the 59 enrolled patients, 15 were females, constituting 25.42% of the total population falling in the age group of 61.02 ± 11.47 years, and 44 were males, constituting 74.58% of the total population, falling in the age group of 59.6 ± 13.98 years. The baseline values for the comorbid conditions are mentioned in [Table 1].
Table 1: Baseline values of comorbid conditions on day 1

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IHD, also called as coronary heart disease, comprises of heart problems that mainly involve narrowing of the coronary heart arteries that supply blood to the heart muscles. It is often associated with other diseases such as hypertension, diabetes, obesity, dyslipidemia, congestive heart failure, cardiomyopathy, and so on. Thus, the heart patients are kept on various medications. In this study, the accompanying medications taken by patients included beta-blockers, ARNI, ACE inhibitor, sulfonylurea, Bigunide, Dpp 4 inhibitor, CCB, PPI, aspirin (NSAID), nitrate, diuretic, and antiplatelet. Nevertheless, there was a significant reduction on the medicine dependency at the end of the 7th day. This is shown in [Table 2].
Table 2: Dependency on allopathic medicines at baseline and day 7

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The primary endpoint of this study, GLS score showed a reduction from −10.26 ± 4.02 to −10.99 ± 3.94 at day 7. The secondary endpoints in this study and their considerable changes are shown in [Table 3] along with the primary endpoint changes. As captured in the transthoracic echocardiogram, GLS score of -7.4 on day 1 reduced to -10.3 on day 6. This is elaborated by the improvement in the LV strain, in the inferio-septal segments, also indicating a decrease in the global hypoperfusion. [Figure 1] shows improved LV strain in inferio-septal segments as compared with earlier scan [Figure 2].
Figure 1: Representative global longitudinal strain report on day 6

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Figure 2: Representative global longitudinal strain report on day 1

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Table 3: Comparison of clinical parameters at baseline and at day 7

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A few parameters were measured only at baseline. [Table 4] depicts this data.
Table 4: Other clinical parameters at baseline (n=59)

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  Discussion Top


GLS assessed using automated speckle-tracking echocardiography is an emerging tool for the detection and quantification of slight disturbances in LV systolic function. GLS reflects the longitudinal contraction of the myocardium and its accuracy has been validated against tagged magnetic resonance imaging. In the general population and patients with heart failure, GLS was shown to be a superior predictor of cardiac events and all-cause mortality compared to EF. More recently, GLS was found to be a robust prognostic marker following myocardial infarction and cardiac surgery and in patients with cardiomyopathy.[10] IHD or myocardial ischemia can result from increased myocardial oxygen demand and decreased myocardial perfusion and oxygen delivery. In most patients with stable angina, physical effort or emotion, a resultant increase in HR, blood pressure or contractile state, or any such combination, increases myocardial oxygen demand without an adequate increase in oxygen delivery through tightly stenosed coronary arteries. As a result, myocardial ischemia develops.[11] Imbalance in the oxidant/antioxidant mechanisms leads to oxidative stress and uncontrolled vascular injury. Reactive oxygen species (ROS) negatively affect myocardial calcium handling, cause arrhythmias, and contribute to cardiac remodeling by inducing hypertrophic signaling, apoptosis, and necrosis. Aging, traditional cardiovascular risk factors (arterial hypertension, dyslipidemia, diabetes mellitus, and smoking), genetic predisposition, and environmental factors increase ROS generation and decrease endothelial nitric oxide (NO) production, which is responsible for the contraction of smooth muscles of the heart.[12] Hypoperfusion at resting can be identified with the help of GLS. While reduced effort tolerance duet to IHD can be assessed with exercise. We observed positive significant change in both the parameters. According to Ayurveda, the human body when healthy is in a state of balanced vatta, pitta, kapha, the three “doshas.” However, improper diet and living habits unbalance these doshas resulting in ama which is a sticky accumulation that blocks circulating channels, thereby preventing tissues from nourishment and leading to various disorders.[5] Traditional and conventional medical treatments are somewhere falling short of completely curing this disease condition. Moreover, the side effects associated with allopathic drugs are posing concerns throughout the medical fraternity. Hence, it is imperative to turn to alternative treatments to fight and curb heart disease.[6] Ayurveda teaches us and empowers us with a healthy diet and a way of living life, (Ahara-Vihara, dincharya, and Ritucharya) and codes of conduct (Achara Rasayana) that are potent in the prevention of heart diseases. Ayurveda has been used to treat various heart conditions and related diseases such as hypertension, diabetes, obesity, hyperlipidemia previously, and the Ayurvedic approach of modifying the diet, lifestyle, and conducting the body has proven to be beneficial in minimizing heart and related disorders.[13] As per Ayurveda, “Ahar” is primary cause of all metabolic disorders; hence, we provided a low carbohydrate and easily digestible diet to correct metabolism. Raised afterload is one of the causes of high demand of myocardial oxygen, with panchkarma procedures such as centripetal oleation and thermal vasodilation, it helped to reduced afterload and that we have observed as reduction in the SVR. Snehana or oleation that is massage loosens the body toxins, and the oils applied to the skin in this aid in the process. Svedana, application of steam, liquifies toxins and pushes them toward the gastrointestinal tract. Besides this, it ameliorates the sodium and fluid retention thus reducing the preload and myocardial oxygen demand in IHD patients.[6] Basti which involves the administration of the concoction of gokshur, haridra, and amalki has its own set of benefits. Gokshur can reduce can reduce smooth muscles contraction probably by NO synthesis. Haridra is a potent anti-inflammatory herb which can significantly reduce inflammation along with it can improve diabetes-induced endothelial dysfunction through superoxide reduction. Amalki acts as antioxidant that helps to available best environment for endothelial regeneration that ultimately helps in NO synthesis and improvement in elasticity. In our study, the primary endpoint was change in GLS score. We observed reduction in GLS with statistical significance. GLS predicts myocardial perfusion; hence, betterment in GLS within 7 days is indicative of effective treatment. GLS change is small but consistent. This points out that the 7-day treatment of IRP with lifestyle and diet modification as per Ayurveda is effective in curing IHD. Furthermore, the changes in other anthropometric parameters, such as, high EF near to fifty, increase in 6MWT, decrease in HR, optimal SBP and DBP, and decreased SVR, all indicate a positive outcome of the therapy, since these parameters are vital to maintaining an effective, healthy life. The major line of treatment for heart disease includes the lipid-lowering, antihypertensive, and platelet-inhibitor agents. Most of the times, these medications are costly and add to the existing list of high end expenses in the life of patients. Furthermore, the overall safety and efficacy of these drugs remains a concern.[1] In our study, at the end of the 7th day, the dependency on modern medicine was found to be lowered considerably as shown in [Table 2]. An important factor to reflect in this study is the time period. A short study period of 7 days and a small patient size may not be sufficient to establish fully the role of therapy. Further investigations with a larger population for a longer duration will suffice in completely establishing the therapy as effective and alternative to the conventional therapies.


  Conclusion Top


This study revealed that a 7 day treatment, with a low carbohydrate diet and IRP caused improvement in the GLS score and significant improvement in EF, 6MWT, HR, SBP, DBP, SVR, all of which are imperative in keeping the body healthy. Thus, this line of treatment may be considered as a powerful replacement of existing therapies.

Acknowledgment

The authors would like to thank Ms Harshita Gupta and Ms Pallavi Mohe from Madhavbaug Research and Development Department for their contribution toward data collection and analysis. The authors also thank Ms. Saili Dixit for writing assistance and Ms. Poonam Pawar for additional editorial support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Hensen LC, Goossens K, Delgado V, Rotmans JI, Jukema JW, Bax JJ. Prognostic implications of left ventricular global longitudinal strain in predialysis and dialysis patients. Am J Cardiol 2017;120:500-4.  Back to cited text no. 9
    
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Krishnasamy R, Isbel NM, Hawley CM, Pascoe EM, Burrage M, Leano R, et al. Left ventricular Global Longitudinal Strain (GLS) is a superior predictor of all-cause and cardiovascular mortality when compared to ejection fraction in advanced chronic kidney disease. PLoS One 2015;10:e0127044.  Back to cited text no. 10
    
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Kibel A, Lukinac AM, Dambic V, Juric I, Selthofer-Relatic K. Oxidative stress in Ischemic Heart Disease. Oxid Med Cell Longev 2020;2020: 6627144.  Back to cited text no. 12
    
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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