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   Table of Contents - Current issue
April-June 2022
Volume 12 | Issue 2
Page Nos. 43-81

Online since Saturday, May 21, 2022

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Left ventricular global longitudinal strain by speckle tracking echocardiography as a noninvasive predictor in evaluation of myocardial infarction p. 43
KP Kumar, Joel Quadros Piedade, Venkatesh Malali, Srinidhi Hegde
Background: Coronary artery disease (CAD) has assumed epidemic proportions in the world. Accurate risk stratification and early invasive management when indicated can reduce morbidity and mortality substantially. The study aims to correlate left ventricular (LV) function assessed by global longitudinal strain (GLS) with the extent of CAD in patients with myocardial infarction (MI). Methods: The study was conducted in a tertiary care hospital in Southern India. A total of 105 patients admitted with a diagnosis of non ST-elevation MI were included. All patients had a detailed echocardiogram with the evaluation of LV GLS by two-dimensional speckle tracking echocardiography and ejection fraction by Simpson's method. Coronary angiogram was also done in all patients to study the coronary anatomy and the relation between CAD and LV GLS. Results: The mean age of study population was 53.9 years. Echocardiographic study revealed mean LV ejection fraction (LVEF) was 48.16 + 12.27. The mean LVEF in patients with single-vessel disease was 50.11 + 11.62; with two-vessel disease, it was 51.81 + 10.34, and in patients with triple-vessel disease, it was 41.5 + 11.8. The mean GLS in the abovementioned groups was − 15.6 + 3.33, −13.5 + 3.2, and − 11.02 + 4.14, respectively. The follow-up of patients also showed a considerably lower GLS in patients who suffered higher morbidity and mortality. Conclusion: LV GLS is a good noninvasive predictor of the burden of CAD on the angiogram and also a predictor of future cardiovascular events and mortality.
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Understanding the status of the Egyptian coronary lesions: Lesion location and vulnerability p. 49
Ibtesam Ibrahim El-Dosouky, Baher Nabil Nashy, Hala Gouda Abomandour
Background: High-probability zones of coronary thrombosis may exist along the coronary tree. We aimed to determine the nature and distribution of significant coronary lesions among our patients. Methods: This study included 529 patients, for whom coronary angiography was done for suspected or proved coronary artery disease (CAD), they were divided into three groups according to the distribution of the coronary lesions: left anterior descending (LAD) group (n = 305) with significant LAD lesion, left circumflex (LCx) group (n = 148) with significant LCx lesion and right coronary artery (RCA) group (n = 181) with significant RCA lesion. Results: One hundred and sixty-nine (31.9%) had nonsignificant lesion, 166 (31.4%) had single-vessel disease, with significantly higher incidence of significant LAD lesion 305 (57.5%) which were proximal 52.4%, LAD lesions were more prone to be the culprit vessel 47.5%, LCx was the least vessel with significant lesion 148 (27.9%), and the least to be prone as a culprit 21.1%. Proximal culprit LAD 63.5% and RCA 55.6% had significantly higher incidence, mid culprit LC× 53.9% had significantly higher incidence. ST-elevation acute coronary syndrome (STE-ACS) was significantly more prevalent in culprit LAD 76.7%. Non-STE-ACS was significantly more prevalent in culprit LC× 56.5% and RCA 55.6%. Conclusion: LAD tends to carry more than one culprit lesion, more to be proximal. Risk factors responsible for instability and sheer stress (uncontrolled diabetes mellitus, uncontrolled hypertension, heavy smoking) were more prevalent between patients with LCx as a culprit followed by RCA in Egyptian; this may throw the light on the need for aggressive control of these risk factors to reduce vulnerability in these patients.
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QT-dispersion and major adverse cardiovascular events prediction after percutaneous coronary intervention in patients with Type 2 diabetes mellitus p. 55
Shaimaa Wageeh, Ibtesam EL-Dosouky, Arafa M ELShabrawy, Rasha E H Omar, Shimaa G Zein
Objectives: The objective of this study investigated the relation between QT-dispersion (QTd) and both number of coronary artery disease and major adverse cardiovascular events (MACEs) among patients with type 2 diabetes after elective percutaneous coronary intervention (PCI). Methods: One hundred ischemic heart disease patients undergoing elective coronary angioplasty were included; 49 patients with diabetes (group I) and 51 patients without diabetes mellitus (group II). Based on the QTd parameter after PCI, both groups were subdivided into tertiles. Angiographic, electrocardiographic parameters, and MACE were compared. Results: Both QTd after PCI and delta QTd were correlated to the number of diseased coronary arteries and MACE in patients with diabetes compared to patients without diabetes. QTd was longer in patients with diabetes developing MACE than those without MACE (r = −0.31, P = 0.04). Conclusion: QTd after PCI and delta QTd are the independent predictors of MACE in patients with type 2 diabetes.
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Left ventricular global longitudinal strain in patients with chronic kidney disease with and without renal replacement therapy: A cross-sectional study p. 60
Ramesh Sankaran, S Ramalakshmi, Manish Babbu Uppupetai Ganeshbabbu, Matcha Jayakumar, Muralidharan Thoddi Ramamurthy, Vinod Kumar Balakrishnan, Nagendra Boopathy Senguttuvan
Background: Cardiovascular disease is the leading cause of mortality among patients with chronic kidney disease (CKD). Hemodialysis treatment is associated with an increased risk of developing left ventricular (LV) dysfunction. LV global longitudinal strain (GLS) has emerged as a sensitive parameter in evaluating LV function in patients with CKD. We aimed to assess cardiac function using two-dimensional (2D) echocardiogram, 2D speckle-tracking echocardiogram (2DSTE), and traditional ejection fraction (EF) in patients undergoing hemodialysis. Methods: A cross-sectional study was conducted for 3 months in patients with CKD at a tertiary care center in Southern India. Patients were subjected to conventional 2DSTE and evaluated for LV ejection fraction (LVEF), GLS, pulmonary systolic blood pressure, and the degree of tricuspid regurgitation. Results: Among 100 patients with CKD, 54.3% underwent hemodialysis, and 26.7% on drug therapy had impaired LV GLS. The LVEF was normal in 61.4% of patients undergoing hemodialysis and 86.7% of patients on drug therapy. Proportion of patients undergoing hemodialysis were significantly high with moderate-to-severe pulmonary hypertension (21.4%), moderate-to-severe tricuspid regurgitation (21.4%), and mild-to-moderate EF (37.1%) compared to respective patients on drug therapy. Pulmonary hypertension and abnormal EF are significantly associated with lesser GLS in patients undergoing hemodialysis. Conclusions: This study indicated that patients undergoing hemodialysis are at higher risk for impaired LV GLS. The GLS by 2DSTE can act as an early diagnostic tool for this high-risk patient group. Thus, regular cardiac screening is required for early detection, and treatment in patients undergoing hemodialysis with risk of LV dysfunction.
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Elevated thyroid-stimulating hormone is a risk factor in coronary artery bypass grafting p. 66
Ankit Thukral, Ankush Singh Kotwal, Rajan Prasad Gupta, Amit Rastogi, Shantanu Pande, Surendra Kumar Agarwal, Satyendra Tewari
Introduction: Asymptomatic hypothyroidism is endemic in most regions of our country. We planned a study to observe the effect of thyroid-stimulating hormone (TSH) in otherwise asymptomatic for hypothyroidism patients, on outcome after coronary artery bypass grafting (CABG). Materials and Methods: This is a retrospective cohort study conducted between January 2017 and December 2019. A total of 449 patients undergoing CABG were included in the study. Patients with redo operations, combined procedures, and emergency operations were excluded from the study. The groups were formed on the level of TSH (normal, subclinical elevation, and clinical elevation) as follows: TSH normal (Group 1, n = 309), TSH subclinical elevation (Group 2, n = 122), and TSH clinical elevation (Group 3, n = 12). One-way ANOVA was used to analyze the groups. Results: There was an increase in the use of inotrope, appearance of atrial fibrillation, and use of intra-aortic balloon pump in Group 3 when compared to that in Groups 1 and 2, P = 0.0001. Higher mortality was observed in group 3 (25%) when compared to group 1 (2.91%) and group 2 (2.45%). There was no difference in the level of free T4, between groups. T3 was similar in TSH normal, TSH subclinical elevation, and clinical elevation group. TSH level of >10 mIU/l predicted mortality with a sensitivity of 91.7% and a specificity of 99.8% in predicting mortality. Conclusion: About 2.67% of the patients undergoing CABG had asymptomatic but clinical elevation of TSH, and it is associated with higher mortality.
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Gerbode defect – Percutaneous closure of three cases and a brief review of literature p. 71
Mahua Roy, Debasree Gangopadhyay, Siddhartha Saha, Sushil Sukla, Pooja Sinha
Gerbode defect is very rare cardiac abnormality accounting for <1% of cardiac defects. Historically treated by open heart surgery, many authors have now popularized the concept of percutaneous closure of such defects by various devices. We report three such cases and provide a brief review of the literature.
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Difficulties with optical coherence tomography in assessment of an in-stent restenosis lesion p. 76
R S. Venkata Subrahmanya Sarma, Gopalakrishna Koduru, Purnachandra Rao Koduru, Somasekahr Ghanta, Sarada Srinivas Chowdary Parvathaneni, Raghuram Palaparti, Dasarath Boppana, V Swarajyam, Y Srinivas, Y Sasidhar, M Prasad
In-stent restenosis (ISR) is a critical drawback of coronary stents, although initially described as benign, guidelines both support the use of intravascular imaging in the diagnosis and treatment of stent failure (Class IIa); however, our case highlights the limitation of optical coherence tomography in the assessment of the ISR (stent failure), it also highlights the association of self-limited severe acute respiratory syndrome coronavirus-2 illness and an acute coronary syndrome ISR presentation.
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Post-COVID-19 sequela: Massive tubercular pericardial effusion in immunocompromised patient p. 79
G Anand Kumar, Lakhan Parajiya, SP Avinash Pandi, Vishalkumar Amrutbhai Patel
Long-term sequelae following COVID-19 infection are not well established. Hence, COVID-19 sequelae are been studied extensively as cases are being followed up to reduce avoidable prolonged morbidity and mortality in the country. COVID-19 and currently available drugs for treatment are both reasons for a change in immune status of patients leading to reactivation or increase the chance of infection of common diseases like tuberculosis (TB), particularly in India. A case of post-COVID-19 disease (2 months back) presented with breathlessness and chest pain. On history, workup, and evaluation, the case was diagnosed with massive tubercular pericardial effusion suggesting reactivation of latent TB in a post-COVID-19 disease. Due to COVID-19 disease itself and possible immunomodulatory drugs used for treatment, reactivation of latent TB has to be considered in post-COIVD-19 disease with nonspecific presentation and unexplained prolonged clinical course of the disease. This case highlights the need of further follow-up of COVID-19 patients to understand the effects of disease on the immune system and the possibilities of opportunistic infections, especially after this second wave of COVID-19.
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