Rheumatic Heart Disease among Patients with Valvular Heart Disease Admitted to the In-patient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction: Valvular heart disease continues to cause significant morbidity and mortality around the world, with rheumatic heart disease accounting for the bulk of cases in developing nations. The aim of this study is to find out the prevalence of rheumatic heart disease among patients with valvular heart disease admitted to the in-patient department of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted from December, 2018 to December, 2020 at a tertiary care centre after receiving ethical approval from the Institutional Review [Reference number: 395 (6-11) e2 077/078]. Patients of age ≥18 years presenting with valvular manifestations of any disease diagnosed by transthoracic echocardiography were included and patients other than Nepalese nationals were excluded. Convenience sampling was done and a sample size of 327 was taken. Data were collected, entered and analyzed using the Statistical Package for the Social Sciences version 22.0. Point estimate at a 95% Confidence Interval was calculated along with frequency and percentages for binary data. Results: Among 327 patients, the prevalence of rheumatic heart disease was found to be 237 (72.47%) (67.63-77.31 at 95% Confidence Interval). Conclusions: The prevalence of rheumatic heart disease was similar to the other similar studies conducted in similar settings.</jats:p

CT-IGFBP-4 as a Predictive Novel Biomarker of Ischemic Cardiovascular Events and Mortality: A Systematic Review

Background and objective. Numerous novel biomarkers have been proposed for the early diagnosis of cardiovascular diseases. Measurement of the carboxyl-terminal (CT) fragment of IGFBP-4, the CT-IGFBP-4, has shown promising efficacy in cardiac risk assessment in various studies. We performed a systematic review of studies that accessed the utility and predictability of CT-IGFBP-4 in different ischemic cardiovascular events. Methods. The electronic databases PubMed, medRxiv, ScienceDirect, and Google Scholar were searched for relevant literature from inception to the 10th of December, 2021. Thus, retrieved literature was screened by title and abstract, followed by full-text screening based on the eligibility criteria. The risk of bias was accessed using the quality in prognostic studies (QUIPSs) tool. The data on cardiovascular outcomes about CT-IGFBP-4 levels were studied and the results were synthesized. Results. Five studies with a total of 1,417 participants were included in our study. The studies reported a low risk of bias. The mean age of the participants was 66.14 and more than 65% were males. Elevated CT-IGFBP-4 levels were associated with poor cardiovascular outcomes and increased mortality in severely ill patients. In contrast, there were no significant findings in the case of stable patients. Sandwich ELISA using lithium-heparin plasma provided a better detection limit of 0.15 ng/ml, low cross-reactivity (<2%), and generated linear results between 12 and 500 ng/ml. Conclusion. CT-IGFBP-4 is an efficient biomarker for the prediction of MACE and mortality in patients with severe ischemic cardiovascular events

A study on coronary bifurcation lesions and procedural outcome at Manmohan cardiothoracic vascular and transplant center, Kathmandu, Nepal

Background and Aims: Coronary bifurcation lesions are associated with high atherosclerotic plaque burden due to turbulent blood flow and high shear stress. There are various strategies for bifurcation stenting however, they are often prone to major cardiac events during percutaneous coronary intervention. The aim of this study was to assess the clinical profile and procedural outcome of patients with coronary bifurcation lesions.&#x0D; Methods: This retrospective study was carried out at Manmohan Cardiothoracic Vascular and Transplant center, Kathmandu, Nepal. Two hundred and eight patients were enrolled in this study who had coronary bifurcation lesions seen on invasive coronary angiography from August 2017 to October 2021. The procedural complications were assessed.&#x0D; Results: The mean age of patients with coronary bifurcation lesions was 61.48±11.19 years. Out of total 208 patients, 77% were males. True bifurcation lesion was seen in 65.4% of patients. Left anterior descending artery with diagonal was the most common bifurcation lesion (67.3%). The provisional stenting was done in 80.8% of patients and rest underwent 2-stent strategy. The complications mainly observed during the provisional stenting were plaque shift and side branch dissection.&#x0D; Conclusion: The provisional stenting is the most preferred and suitable technique for most bifurcation lesions if technically feasible.</jats:p

Immediate and Short-Term Variations in the Echocardiographic Cardiac Hemodynamic Parameters after the Transcatheter Atrial Septal Defect Device Closure and its Procedural Success.

Background and Aims:Transcatheter closure of the secundum atrial septal defect (ASD) has become an accepted alternative to surgical repair. We aimed to analyze and compare the changes in cardiac hemodynamics with transthoracic echocardiography (TTE) before, within 48 hours, and after 3 months of ASD closure.&#x0D; Methods: This was a prospective, single-centered study of 43 patients who underwent ASD device closure in the Manmohan Cardiothoracic Vascular and Transplant Center during June 2020 to June 2021 with Amplatzer Septal Occluder under transesophageal and fluoroscopic guidance. The patients were evaluated with TTE before, at 48 hours, and 3 months after the procedure.&#x0D; Results: At 48 hours and 3 months of device closure, the right atrial major dimension, the maximum blood flow velocity at the pulmonary valve orifice, mean flow velocity, velocity time integral, and E peak and A peak blood flow velocity at the tricuspid valve orifice were significantly reduced (P &lt; 0.001). At 3 months, the dimensions and ejection fraction of the left ventricle showed significant increment (P &lt; 0.001).   Likewise, the right atrial minor dimension and area, right ventricular basal, mid, and longitudinal dimensions, tricuspid annular plane systolic excursion, right ventricular Tei Index, and fractional area change were significantly reduced (P &lt; 0.001). The main pulmonary artery diameter, pulmonary artery systolic and mean pressure, and the pulmonary vascular resistance and index were significantly reduced (p &lt;0.001). The procedural success rate was 97.6%.&#x0D; Conclusion: Echocardiographic evaluation demonstrated that cardiac hemodynamics and loading conditions improved significantly at 3 months after percutaneous closure of ASD. The transcatheter closure of ASD was safe with good short-term outcomes.</jats:p

sj-pdf-1-imr-10.1177_03000605231187806 - Supplemental material for Risk factors, lab parameters, angiographic characteristics and outcomes of coronary artery disease in young South Asian patients: a systematic review

Supplemental material, sj-pdf-1-imr-10.1177_03000605231187806 for Risk factors, lab parameters, angiographic characteristics and outcomes of coronary artery disease in young South Asian patients: a systematic review by Anushka Agrawal, Pratik Lamichhane, Mason Eghbali, Roshni Xavier, Daniel Elkin Cook, Reem Maged Elsherbiny, Loveleen Kaur Jhajj and Rajaram Khanal in Journal of International Medical Research</p

Cardiac Implications of COVID-19 in Deceased and Recovered Patients: A Systematic Review

Background. Patients infected with coronavirus disease 2019 (COVID-19) present with various clinical presentations with majority of them developing pulmonary complications. This study focuses on cardiac implications of COVID-19 which are less discussed and thus will help to address cardiac implications of COVID-19. Methods. PubMed, PubMed Central, and Google Scholar were screened for articles which mentioned cardiac implications of COVID-19. NHLBI Study Quality Assessment Tools for the observational cohort and cross-sectional studies was used for assessing the risk of bias of our studies. Results. All 14 studies selected were good and had score of ≥9 by NHLBI Study Quality Assessment Tools. Cardiac complications of COVID-19 are common. They are associated with significant mortality. Also, people infected with COVID-19 with premorbid conditions such as cardiovascular diseases and diabetes mellitus have poor prognosis as compared to those without premorbid conditions. Cardiac biomarkers such as highly sensitive troponin I, creatinine, and creatinine kinase-MB on admission are good prognostic markers. Conclusions. Cardiac complications such as heart failure, myocardial injury, and arrhythmias are common among patients infected with COVID-19. Elevated cardiac markers and patients with cardiac complications require utmost care and continuous cardiac monitoring

Cardiac Implications of COVID-19 in Deceased and Recovered Patients: A Systematic Review

Background. Patients infected with coronavirus disease 2019 (COVID-19) present with various clinical presentations with majority of them developing pulmonary complications. This study focuses on cardiac implications of COVID-19 which are less discussed and thus will help to address cardiac implications of COVID-19. Methods. PubMed, PubMed Central, and Google Scholar were screened for articles which mentioned cardiac implications of COVID-19. NHLBI Study Quality Assessment Tools for the observational cohort and cross-sectional studies was used for assessing the risk of bias of our studies. Results. All 14 studies selected were good and had score of ≥9 by NHLBI Study Quality Assessment Tools. Cardiac complications of COVID-19 are common. They are associated with significant mortality. Also, people infected with COVID-19 with premorbid conditions such as cardiovascular diseases and diabetes mellitus have poor prognosis as compared to those without premorbid conditions. Cardiac biomarkers such as highly sensitive troponin I, creatinine, and creatinine kinase-MB on admission are good prognostic markers. Conclusions. Cardiac complications such as heart failure, myocardial injury, and arrhythmias are common among patients infected with COVID-19. Elevated cardiac markers and patients with cardiac complications require utmost care and continuous cardiac monitoring.</jats:p