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Remdesivir and Favipiravir for COVID-19: An update
Suman Omana Soman, AV Raveendran
July-December 2020, 2(2):51-54
COVID-19 pandemic due to SARS-CoV-2 infection has already resulted in more than 6 lakhs death worldwide. Various drugs like hydroxychloroquine, lopinavir/ritonavir, dexamethasone, ivermectin etc are examples of drugs currently used to treat COVID-19 with varying results. Remdesivir is a broad spectrum anti-viral agent, which is active against Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-1, Ebola virus etc. Favipiravir had been widely used for treating influenza pandemics in Japan in 2014 .Studies showed that it was effective for treating many RNA viruses like arenavirus, bunyavirus, flavivirus, and filoviruses causing hemorrhagic fever and Ebola virus. Remdesivir and favipiravir are anti-viral agents tried in patients with COVID-19 with varying results. Currently Remdesivir is recommended in hospitalized patients with COVID-19 requiring supplemental oxygen and favipiravir in patients with mild to moderate disease. In this article we are reviewing the pharmacological features and clinical use of Remdesivir and favipiravir in COVID-19.
  11,743 415 1
Multicentric, randomized, double-blind, comparative study in STEMI patients to establish clinical biosimilarity of biosimilar tenecteplase with reference product
Prasad Apsangikar, Sunil Chaudhry, Manoj Naik, Shashank Deoghare, Jamila Joseph
January-December 2019, 1(1):8-14
Objectives: Tenecteplase (TNK) is an established third-generation class 1A thrombolytic. The objective of the present study was to establish clinical biosimilarity of TNK biosimilar in a comparative phase III study with the reference product in the patients of ST elevation myocardial infarction (STEMI). Materials and Methods: In the double-blind, randomized, comparative clinical study 105 individuals were enrolled (70 in biosimilar TNK arm and 35 in the reference arm). Primary endpoint was thrombolysis in myocardial infarction (TIMI) 3-flow rate of the infarct-related artery at 90 min and all-cause mortality rate at 30 days' post dosing. Secondary endpoints considered were 50% resolution of elevated ST segment at 90 min, re-infarction till day 30, change in the left ventricular ejection fraction at day 30, events of ventricular tachyarrhythmias till day 30, and comparative pharmacokinetics. Immunogenicity was assessed along with the evaluation of safety at day 30. Results: TIMI grade 3-flow rate was achieved in 29 (43.28%) individuals in biosimilar arm and 14 (41.18%) individuals in the reference arm. The difference between the groups was statistically not significant (P = 0.8396). Four (5.71%) all-cause mortality were reported in biosimilar TNK arm compared to 2 (5.71%) in reference arm (all-cause mortality rate at 30 days' post dosing) and the difference between the two arms was statistically not significant (P = −1.00). Conclusion: Biosimilar TNK demonstrated biosimilar equivalence with the reference product in terms of the efficacy and safety analysis in this Phase III study and may be considered as a suitable alternative to reference TNK in patients with STEMI.
  3,681 340 -
Impact of digoxin on all-cause mortality and re-hospitalizations in acute heart failure patients
Mohammed Al-Jarallah, Rajesh Rajan, Ibrahim Al-Zakwani, Raja Dashti, Bassam Bulbanat, Mustafa Ridha, Kadhim Sulaiman, Alawi A Alsheikh-Ali, Prashanth Panduranga, Khalid F AlHabib, Jassim Al Suwaidi, Wael Al-Mahmeed, Hussam AlFaleh, Abdelfatah Elasfar, Ahmed Al-Motarreb, Nooshin Bazargani, Nidal Asaad, Haitham Amin
January-June 2020, 2(1):29-35
Background and Objectives: The use of digoxin in acute heart failure (AHF) is not without controversy. The aim of this study was to examine the impact of digoxin therapy on all-cause mortality and re-hospitalizations for heart failure (HF) at 3 months and 12 months in AHF patients in the Arabian Gulf stratified by left ventricular ejection fraction (EF). Methods: Data were analyzed from 4577 consecutive patients admitted to 47 hospitals in seven Middle Eastern countries with AHF from February to November, 2012. Analyses were performed using univariate and multivariate statistical techniques. Results: The overall mean age of the cohort was 59 ± 15 years, and 63% (n = 2887) were males. At hospital discharge, digoxin was prescribed to 25% (n = 1156) of the patients. Nearly 59% (n = 2683) of the patients had HF with reduced EF (HFr EF) (<40%), 21% (n = 962) had HF with mid-range EF (HFmr EF) (40%–49%), and 20% (n = 932) had HF with preserved EF (HFp EF) (≥50%). The most prominent comorbidities included hypertension (61%; n = 2783), coronary artery disease (60%; n = 2762), and diabetes mellitus (49%; n = 2258). Multivariate logistic regression analysis demonstrated that digoxin use was associated with lower cumulative all-cause mortality at 3-month (adjusted odds ratio [aOR]: 0.57; 95% confidence interval [CI]: 0.41–0.79; P = 0.001) and at 12-month (aOR: 0.74; 95% CI: 0.58–0.96; P = 0.021) follow-up post hospital discharge in patients with HFr EF. There was, however, no survival advantage conferred by digoxin use in those with HFmr EF or HFp EF, at either the 3-month or 12-month follow-up (all P > 0.05). Digoxin use was also not associated with any benefits regarding re-hospitalization for HF at either 3 months or at 12 months in any type of HF (all P > 0.05). Conclusions: Digoxin was associated with lower cumulative all-cause mortality at both 3-month and 12-month follow-ups in AHF patients with reduced EF in the Arabian Gulf. However, digoxin use did not offer any survival advantages in those with HFmr EF and HFp EF after either 3 months or 12 months. Digoxin use was also not associated with any benefits toward re-hospitalizations for HF at a 3-month or 12-month follow-up in AHF patients.
  3,217 303 -
COVID vaccines; the search continues!!!
G Vijayaraghavan
July-December 2020, 2(2):49-50
  3,021 254 -
The yoga–meditation heart connection: A pilot study looking to improve women's heart health
Sasha De Jesus, Emily Schultz, Rachel M Bond
January-December 2019, 1(1):24-29
Background: Stress, anxiety, and depression are nontraditional risk factors for cardiovascular disease (CVD) that are more common in women. For nearly four decades, we have seen a steady decline in the number of deaths in women related to heart disease, especially in those >65 years old. However, recent data suggests there has been a stagnation among women <55 years. With this, it is imperative that we continue to increase awareness, understand, and research the unique pathophysiology of women's CVD, and increase recognition of the prevalence of nontraditional risk factors that are more common in women such as stress, anxiety and depression. Aims and Objectives: Although there is limited understanding of the mechanism behind its benefit, measures such as yoga and meditation may decrease morbidity in patients with CVD. With this in mind, we hypothesize that regular, supervised sessions of chair yoga and meditation can be a complementary measure to decrease the level of anxiety, stress and depression in female patients with or at risk for CVD, as well as increase their likelihood to pursue lifestyle modifications. Methods: Participants of a weekly complimentary chair yoga/meditation workshop supervised by a trained cardiac yoga therapist performed a survey on day 1 and on week 24. A total of 16 and 10 female participants with or at risk for CVD completed the initial and follow-up survey, respectively, which included validated screening tools for depression, anxiety, and stress. Results: The Patient Health Questionnaire-9 from the initial to the follow-up survey showed an increase in the mean score (2.25 vs. 3.2). Despite this, the severity remained as minimal depression. The mean Generalized Anxiety Disorder-7 went from 7 to 4.9 (decreased from mild to no clinical anxiety). Finally, the perceived stress score demonstrated a reduction from 18.25 to 15.2, both remaining as moderate perceived stress. Participants also endorsed a trend toward healthier eating habits, and 37.5% of participants endorsed a 3–9 lbs weight loss. Conclusion: Given the low harm and cost of these measures, they can be done as adjuvants to our standard of care to increase the patient's overall well being by improving the psychological aspect of their lives, which in turn could reflect on their physical health.
  2,804 239 -
Perm-Cath catheter-related atrial thrombus – Case series and management recommendations
Prashanth Panduranga, Kumail Al-Lawatiya, Issa Al-Salmi, Baher Hanna
January-June 2020, 2(1):42-46
Catheter-related atrial thrombus (CRAT) is frequent, with no clear guidelines available with regard to diagnosis and management. Here, we report five patients with Perm Cath related AT. We conclude and recommend that Perm Cath, when not needed or used needs to be removed as soon as possible. A majority of CRAT are detected incidentally. They commonly occur at inferior vena cava and right atrial junction and a transoesophageal echocardiogram is needed in most patients to clearly define the thrombus and see additional hidden thrombi. Differentiating CRAT versus vegetation is difficult and one needs to treat both if blood cultures are positive. Commonly these thrombi do not embolize and are fixed to atrial walls, but silent pulmonary embolism needs to be considered. All patients initially should be treated with intravenous or subcutaneous anticoagulation. Patients with “High Risk” features such as, “multiple thrombi > 2,” “mobile thrombi,” “extending or embolizing thrombi to pulmonary artery,” “infected thrombi,” and “failed anticoagulation” must be considered for thrombolysis followed by surgery if required.
  2,686 223 -
Gender difference of blood pressure variables on ambulatory blood pressure monitoring following percutaneous transluminal coronary angioplasty and 1-year outcomes
Maddury Jyotsna, D Malleswara Rao, Gopikrishna Kenchi, Sudhakar Kanumuri, Shravan Kumar Ch, Rama Kishore Yalampati, C Bharat Kumar Goud, Suresh Yerra, Indrani Garre
January-December 2019, 1(1):2-7
Background and Aim: Lack of fall in nocturnal blood pressure (BP) is an independent predictor of poor prognosis. This study determined the prognostic value of BP variables by 24-h ambulatory BP monitoring (ABPM) and associated gender differences after percutaneous transluminal coronary angioplasty (PTCA). Methods: A total of 58 patients underwent PTCA who were subjected to 24-h ABPM and followed for 1-year. Results: All demographic and clinical parameters (female: 10; mean age: 59.4 years), including ABP parameters, were comparable between genders, except smoking and alcoholism. Among nondippers (n = 33), 8 (24.2%) were females, 25 (75.8%) males, 30 (90.9%) diabetes mellitus (DM), 32 (97.0%) hypertension, and had mean diastolic BP (DBP): 86.15 ± 6.31 mmHg, pulse pressure (PP): 55.85 ± 10.09 mmHg, and pulse-wave velocity (PWV): 6.21 ± 01.87 m/s. Most females were nondippers (8 [24.2%]). Nondippers were older in age (P < 0.02) with higher PP (P < 0.001), DBP, and mean BP (MBP). Ejection fraction, presence of coronary artery disease (CAD) or DM, and PWV were comparable between both groups. At 1-year follow-up, one out of two symptomatic patients died, and the other developed chronic stable angina. The major adverse cardiac event rate was 1.7% (1/58). Each left ventricular dysfunction was deteriorated, and contrast-induced nephropathy was seen in three patients. Conclusion: Immediately after PTCA, females were more nondippers than males. Overall, nondippers had higher DBP, MBP, and PP. Nocturnal dipping was not influenced by the presence of DM or CAD. At 1-year follow-up, combined clinical and laboratory events were comparable.
  2,575 283 -
Considerations for the use of statin therapy in Coronavirus Disease 2019 Era
Priyanka Thakur, Kunal Mahajan, Prakash Chand Negi, Neeraj Ganju, Sanjeev Asotra, Arvind Kandoria
July-December 2020, 2(2):55-59
Background: Patients with cardiovascular disease (CVD) are at an increased risk of developing severe disease and mortality associated with coronavirus disease 2019 (COVID-19). Statins form the cornerstone of therapy for primary and secondary prevention of CVD. Objective: This review aims at exploring the possible advantages and the risks associated with the use of statins in patients with COVID-19. Methods: We searched the PubMed and Google Scholar databases until June 5, 2020, and reviewed the available literature on this topic. Results: Statins have been shown to improve outcomes in acute respiratory distress syndrome, which is one of the major causes of death in COVID-19. Statins exert many pleiotropic effects (anti-inflammatory, immunomodulatory effect, nitric oxide release, and effects on coagulation cascade), which would theoretically appear beneficial in COVID-19. Statins also increase angiotensin-converting enzyme 2 levels in animal models and can potentially reduce lung injury related to viral infections. Besides, the cardioprotective effects of statins can be beneficial in cardiovascular complications (e.g., acute myocardial infarction) of COVID-19. Nonetheless, there are concerns regarding the adverse effects associated with the use of statins in the setting of COVID-19, which can be simply avoided by dose modification and clinical monitoring. Conclusions: Statins appear to be beneficial in COVID-19 and may improve the outcome, but future-focused studies are needed before recommending their de novo use in COVID-19.
  2,579 266 1
Association of social support and myocardial infarction: A case-control study
MT Manoj, KA Joseph, Govindan Vijayaraghavan, A Joseph
January-December 2019, 1(1):15-19
Background: Social support plays an important role in the promotion and maintenance of our health. Lack of social support leads to various health issues including heart diseases, especially myocardial infarction (MI). Studies investigating the association between lack of social support and MI are very limited among our population. Therefore, the current study was carried out for determining the effect of social support on the incidence of MI. Materials and Methods: We using convenient sampling method recruited a total of 150 each case (with MI) and controls (without MI) who were matched for age and gender during September 2016 and August 2017 into the study from a tertiary care hospital in Kerala. The design we employed for this study was a case–control study design. Results: Among the cases, 35.3% reported low levels of social support as against 21.3% among controls. Multivariate logistic regression analysis after adjusting for the confounders indicated that low level of social support is positively and statistically significantly associated with MI (odds ratio 2.541; 95% confidence interval: 1.121–5.761, P = 0.026). Conclusion: Low social support is associated with the incidence of MI.
  2,544 261 1
Mortality and morbidity associated with type 2 myocardial infarction: A single-center study
Hoang H Truong, Maiskov V Victor, Meray A Imad, Zhanna D Kobalava, Usha T Parvathy, Ibrahim Al-Zakwani
July-December 2020, 2(2):70-79
Background: The incidence of Type 1 (T1) and Type 2 (T2) myocardial infarction (MI) varies according to the definition used. In clinical practice, approximately one third of T2MI underwent coronary angiography. It may be difficult to accurately diagnose this entity based only on clinical evidence of imbalance between oxygen supply and demand without angiographic data. Objective: The objective of this study was to assess the correlation between angiographic and clinical definitions of Type-2 versus Type-1 myocardial infarction (T2MI vs. T1MI) and prognosis. Methods: A total of 450 consecutive patients with a diagnosis of acute MI were prospectively recruited and underwent coronary angiography <24 h after the onset of symptoms. The mean follow-up was 1.9 years. Results: Atherothrombotic events were found in 275 (61.1%) patients, whereas clinical triggers were identified in 244 (54.2%) cases. T2MI was diagnosed in 175 (28.9%) patients. Rates of in-hospital (7.4% vs. 10.6%; P = 0.268) and long-term (16.6% vs. 17.1%; P = 0.886) mortality were comparable between T2MI and T1MI patients. Those with T2MI had a higher cardiac rehospitalization rate during follow-up (33.3% vs. 19.5%; P = 0.030). Reduced left ventricular ejection fraction (LVEF) was associated with increased long-term mortality (odds ratio 5.2; 95% confidence interval: 1.1–23.5; P = 0.030). GRACE score had a comparable predictive power for in-hospital mortality in both T1 and T2MI subtypes, but was poor in predicting all-cause long-term mortality in patients with T2MI (area under the receiver operating curve 0.663 vs. 0.847; P = 0.009). Conclusions: There was a discrepancy between angiographic and clinical definitions of MI types in a substantial proportion of our patient population. Reduced LVEF was a strong predictor for worse outcomes in T2MI patients. The GRACE score predicted in-hospital mortality well, but not long-term mortality in patients with T2MI.
  2,502 281 -
Genetic markers in hypertensive hypertrophic cardiomyopathy
Suman Omana Soman, G Vijayaraghavan, Ramesh Natarajan, CC Karta, Radhakrishnan R Nair, Heera R Pillai
January-December 2019, 1(1):20-23
Background: The concept of hypertrophic cardiomyopathy came from observations on patients with systemic hypertension (HTN) where few patients developed inappropriate hypertrophy and even outflow tract obstruction. Over a period of time, research workers found that it is hereditary disorder and has no relationship with systemic HTN. However, many workers have observed that some patients with HTN have massive left ventricular hypertrophy disproportionate to the severity or duration of HTN. Materials and Methods: By using echocardiography, we identified inappropriate left ventricular hypertrophy in long-standing hypertensive patients. Markers of genetic abnormality were tested in those patients to find whether they differ from the usual hypertensive population. Results: We identified 29 hypertensive patients with severe concentric left ventricular hypertrophy (wall thickness, ≥1.6 cm). All patients were considered to have essential HTN. From these patients, we collected blood samples for detailed genetic study. Twenty-nine adult patients with age between 20 and 50 years of either sex with HTN on medications for 5 years or more were selected. Genotyping was done by sequencing. Genetic mutations were detected in 3 (11%) of 27 patients. myosin-binding protein of chromosome were detected in two patients, and mycophenolic acid xanthine hypoxanthine of igg was detected in one patient. Conclusion: In our study, we found that these genes are involved in hypertensive hypertrophic cardiomyopathy also. This suggests that patients with inappropriate left ventricular hypertrophy have a genetic involvement and all the family members should be screened.
  2,395 297 -
Pulmonary dysfunction: A predictor of postoperative outcome in severe mitral stenosis
Usha T Parvathy, Rajesh Rajan, AG Faybushevich, Kobalava D Zhanna
July-December 2020, 2(2):60-69
Background: Pulmonary function (PF) derangements in mitral stenosis (MS) can have an impact on the postmitral valve-replacement (MVR) period, which is not well studied. Objectives: The objectives were (1) to study the impact of the preoperative PF derangements intrinsic to MS on the early postoperative outcome and (2) to assess the prognostic relevance of spirometric tests as to the postoperative complications and morbidity. Methods: Prospective observational study: The spirometric pulmonary function tests (PFTs) performed in 25 patients with isolated MS (nonrandomized sampling) and arterial blood gas (ABG) were correlated to postoperative (post-MVR) variables: duration of ventilation, intensive care unit (ICU) stay, hospital stay, ABG, pulmonary complications, and outcome. Data were analyzed and compared under types, grades, and risk-based groups using nonparametric (Spearman's correlation, Kruskal–Wallis, and Mann–Whitney) tests. Results: The significant correlations were forced vital capacity (FVC)%, forced expiratory volume in 1 s (FEV1), FEV1%, peak expiratory flow rate (PEFR), and oxygen status to ventilation duration (P < 0.05); FEV1, PEFR, forced expiratory flow (FEF)-50, and oxygenation with ICU duration (P < 0.05); FVC, PEFR, and FEF-50 with hospital stay (P < 0.05); FVC, FEV1, and oxygenation to postoperative oxygen status (P = 0.02); FVC and FEV1 to pulmonary complications (P < 0.05); and FVC, PEFR, and FEF-50 with ventilation modification (P < 0.05). The morbidity and respiratory events showed a higher incidence with the mixed and severe categories (though not significant) and also with high-risk group in terms of postoperative pulmonary complications (P = 0.044) and prolonged ventilation. Mild trend toward hypercarbia needed ventilation optimization. Conclusions: PFT derangements in MS play an impact on the postoperative course to varying degrees. The advanced (severe and mixed) derangements and the high-risk group associate with greater morbidity and complications, calling for precautionary care, but on the whole do not contraindicate surgery. Spirometric evaluation can to a certain extent predict the postoperative morbidity risk.
  2,369 232 -
Microbiological and clinical characteristics of sternal wound infections following cardiac surgery in a teaching hospital in Kuwait: A 5-year retrospective study
Deepthi Nair, Mustafa Firoz Singapurwala, Khalifa Al-Benwan
January-December 2019, 1(1):30-36
Background: Sternal wound infections (SWI) following cardiac surgery are health-care-associated infections which have to be prevented as the morbidity and mortality attributed to SWI are high. Objective: The aim is to study incidence, microbial etiology, risk factors, and outcome of SWI that followed cardiac surgery in our hospital. Methods: A retrospective, single-center study involving 833 patients who underwent cardiac surgery from January 2012 to December 2016 was conducted in Al-Amiri hospital in collaboration with the Cardiac Coronary Care Unit, Sabah Al Ahmed Cardiac Centre, Kuwait. Microbiological data were retrieved from laboratory computers, and clinical details from patient files. Age, sex, microbial etiology, risk factors, and outcome were analyzed. A statistical study was done using the SPSS statistical package. Results: The incidence of SWI was 2.1%. Predominant microorganisms isolated were Staphylococcus epidermidis (27.7%) and Pseudomonas aeruginosa (27.7%). The most common risk factor was diabetes mellitus, 88.9% cases. About 50% cases were obese and 72.2% cases had a hospital stay for more than 10 days, with the median length of stay being 13.50 days. 30-day mortality outcome was zero. Conclusion: SWI lead to bacteremia, sepsis and extended hospital stay placing the patient at risk of further hospital acquired infections, and increased cost. Preoperative blood sugar control and weight reduction are important. Infection control measures such as nasal screen for Staphylococcus aureus and rectal screen for multidrug-resistant Gram-negative bacilli have to be considered. Based on the most common organisms isolated, ceftazidime with vancomycin could be a better option for surgical antibiotic prophylaxis in our center.
  2,340 218 1
Comparison of demographics and outcomes of acute heart failure patients with reduced, mid-range, and preserved ejection fraction
Mohammed Al-Jarallah, Rajesh Rajan, Hussein Heshmat, Ibrahim Al-Zakwani, Raja Dashti, Bassam Bulbanat, Mustafa Ridha, Kadhim Sulaiman, Alawi A Alsheikh-Ali, Prashanth Panduranga, Khalid F AlHabib, Jassim Al Suwaidi, Wael Al-Mahmeed, Hussam AlFaleh, Abdelfatah Elasfar, Ahmed Al-Motarreb, Nooshin Bazargani, Nidal Asaad, Haitham Amin
July-December 2020, 2(2):86-94
Background: Heart failure (HF) burden in the developing world is not well quantified. Objectives: The objective is to evaluate the demographics and outcomes of acute HF patients with reduced ejection fraction (EF) (<40%) (HFr EF), HF with midrange EF (40%–49%) (HFmr EF) and HF with preserved EF (≥50%) (HFp EF) in the Arabian Gulf. Methods: Gulf CARE registry analyzed 4577 HF patients admitted to 47 hospitals in seven Middle Eastern countries (Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates, Bahrain, and Yemen.) Analyses were performed using multivariate statistical techniques. Results: The overall median age was 60 (50–70) years and 63% (n = 2887) were male. The most prominent comorbidities included hypertension (61%; n = 2783), coronary artery disease (60%; n = 2762), and diabetes mellitus (49%; n = 2258). A total of 59% (n = 2683) of the patients had HFr EF, 21% (n = 962) had HFmr EF and 20% (n = 932) had HFp EF. Compared to those with HFr EF, patients with HFmr EF and HFp EF were more likely to be associated with hypertension (57% vs. 67% vs. 64%; P < 0.001), diabetes mellitus (47% vs. 57% vs. 51%; P = 0.002), and higher systolic blood pressure (133 vs. 143 vs. 143 mmHg; P < 0.001). Multiple logistic regressions demonstrated that there were no significant differences among the groups with regards to the 3-month (overall adjusted P value; P = 0.188) and 12-month (P = 0.220) cumulative all-cause mortality. The results also indicated that there were no significant differences among the groups with regards to the 3-month (P = 0.117) and 12-month (P = 0.244) re-hospitalization rates for HF. Conclusions: No significant differences among the groups with regards to 3-month and 12-month all-cause mortality and re-hospitalization rates for HF were observed between the groups in the Arabian Gulf.
  2,339 181 -
Chloroquine/hydroxychloroquine in the treatment and prophylaxis of COVID-19 disease
Deepthi Nair
January-June 2020, 2(1):5-7
COVID-19 is a zoonotic viral infection caused by severe acute respiratory syndrome coronavirus-2. Although the management of COVID-19 infection is mainly supportive, the arena of infective therapy now also includes drugs such as chloroquine and its substitute, hydroxychloroquine, which are believed to have antiviral properties in addition to their antimalarial and immunomodulating effects. The objective of this review article is to focus on the antiviral effect of chloroquine/hydroxychloroquine in the treatment and prophylaxis of COVID-19 disease.
  2,181 242 -
Antiplatelet drug resistance in Indians
Sadath A Pareed, G Vijayaraghavan, CC Kartha, MT Manoj
January-June 2020, 2(1):36-41
Background and Objectives: Resistance to the antiplatelet drugs aspirin and clopidogrel is well recognized, and its prevalence has been reported from many countries. There is, however, a paucity of reports on the prevalence of resistance to these drugs in Indian patients. This information is important as resistance to one or both of these drugs may play a role in-stent thrombosis and post angioplasty complications while using drug-eluting stents. The present study was conducted in 200 consecutive patients with myocardial infarction (MI) who underwent elective percutaneous coronary intervention in a single center and who gave consent for the study. The objective of the study was to determine the prevalence of aspirin and clopidogrel resistance in Indian patients who were administrated either of the drugs after PCI, using the VerifyNow P2Y12 assay. Methods: All patients were evaluated on day 7 after the procedure, and blood was collected in the laboratory and immediately analyzed. Platelete resistance to aspirin and clopidogrel was determined by verifying now RPFT point of the care system. Asprin resistance was measured as Aspirin Reaction Unit (ARU); >550 ARU was considered as aspirin resistance. Clopidogrel resistance was considered when Platelet Reaction Unit (PRU) was >213. Results: Among the 200 patients with MI, 87% were males and 13% were female. Their age group varied from 35 to 83 years. Among the study participants, 22% were resistant to an aspirin dose of 150 mg orally and the remaining 78% had normal platelet aggregation. About 68% were sensitive to clopidogrel, and 32% were resistant. About 58% of females were resistant to aspirin as against 29% of male patients, and 38% of females were resistant to clopidogrel as against 18% of male patients. Further, aspirin and clopidogrel were not associated with age and diabetes mellitus (P ≥ 0.05). Conclusions: The prevalence of aspirin and clopidogrel resistance in India is similar to those reported from the United States of America and Europe. The resistance pattern was also found to be similar.
  2,111 259 1
Uncommon cause of wide complex tachycardia - Anterior fascicular ventricular tachycardia
Ramadan Fouad Arafa, Hussein Heshmat, Rajesh Rajan, Peter A Brady
January-December 2019, 1(1):37-38
A 24-year-old female presented to the emergency room with sudden-onset palpitations and shortness of breath for 4 h. We report a rare cause of anterior fascicular ventricular tachycardia.
  2,074 257 -
Does clinical cardiology need a journal?
Govindan Vijayaraghavan
January-December 2019, 1(1):1-1
  2,012 270 -
Limitations in using angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in the management of heart failure due to comorbidities: An Indian scenario
Suman Omana Soman, G Vijayaraghavan, AR Muneer, AM Mujeeb, AS Ankudinov, AN Kalyagin
January-June 2020, 2(1):24-28
Background and Objectives: The essential drugs used in heart failure are angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers. Many trials had shown that these are the group of drugs with maximum benefits for the patients with heart failure. However, most of the patients were not receiving these drugs due to the negative impact of the comorbidities. Our study aims at identifying the limitations in giving ACE/angiotensin receptor blockers (ARBs) in chronic heart failure patients in our population. Methods: This is a prospective observational study conducted in a tertiary care center, over a period of 2 years from 2012. We selected 310 consecutive patients with the New York Heart Association (NYHA) Class 3 or 4 with various etiologies of heart failure. The patients with new-onset myocardial infarction, acute inflammatory conditions, septicemia, and end-stage renal disease with glomerular filtration rate (GFR) <30 were excluded from the study. Results: In our study population of 310 patients with various etiologies of heart failure, only 60.3% (187) of the patients received ACE/ARBs, in which 34.5% (107) received ACE inhibitors and 16.4% (n-51) received ARB s. Hence, we noticed that 39.7% (n-123) of the patients with heart failure could not receive these drugs due to renal failure (10.3%), hyperkalemia (13.5%), and hypotension (15.8%). Conclusion: We noticed that many of the patients (39.7%) with heart failure did not receive these drugs due to comorbidities. We found that many patients had moderate renal failure with a significant reduction in GFR. Hypotension may be due to reduced ejection fraction because of the patient selection of Class NYHA 3 or 4. Hypotension may reduce the GFR and hence the progressive rise of serum creatinine. Careful patient selection and detailed evaluation alone can improve the number of subjects to whom the above drugs can be given.
  2,046 200 -
COVID-19 and Cardiovascular diseases
Govindan Vijayaraghavan
January-June 2020, 2(1):1-2
  1,944 288 -
Computed tomography as an alternative to transesophageal echocardiography: A review of the literature in light of COVID-19
Michael J Accavitti, Sorin Danciu
January-June 2020, 2(1):8-12
During the outbreak of coronavirus disease 2019 (COVID-19) in the spring of 2020, the CDC recommended health-care providers limit performing aerosol-producing procedures when possible. Transesophageal echocardiography (TEE) is a procedure used frequently for both procedural and nonprocedural cardiac imaging. The performance of a TEE requires not only for physicians and staff to be physically close to the mouths of potentially infected patients, but also involves aerosol generating activities such as airway suctioning. In addition, intubation with TEE probe can cause coughing. Cardiac computed tomography (CT) is an imaging modality that does not increase COVID-19 exposure risk to cardiology staff and physicians. In this article, we review the most common indications for TEE and discuss the data supporting the viability of using cardiac CT as an alternative to TEE.
  1,954 227 -
A variant of type IV dual left anterior descending coronary artery
Prashanth Panduranga, Rajkumar Gangappa Nadakinamani
January-December 2019, 1(1):39-40
In type IV dual left anterior descending (LAD) coronary artery, one short LAD artery originates from the left main coronary artery and the second long LAD takes origin from the right coronary sinus or right coronary artery (RCA) with an independent distal anterior interventricular sulcus course. Here, we describe a patient with a variant of Type IV dual LAD wherein the first LAD originated from the left main coronary artery but was long (instead of a usual short one) and the second LAD did not have an independent distal anterior interventricular sulcus course. It originated from proximal RCA coursing with a retro-aortic loop and continuing at mid-segment of the first LAD without independent course.
  1,899 204 -
Atherosclerosis and oncology: Shared mechanisms, shared treatment principles
Sorin C Danciu, Enrique Padilla Campos
January-June 2020, 2(1):3-4
Atherosclerosis and cancer are two chronic, progressive entities with major global disease burden that shares several mechanistic features. Despite these similarities, treatment strategies for malignancy and atherosclerosis differ significantly from each other. We propose that cardiovascular therapies can be optimized with the implementation of established cancer treatment principles.
  1,838 230 -
Chronic coronary syndrome: A review of the literature
Salman Hussain, Maraam AlRashed, Rajesh Rajan, Mohammed Al-Jarallah, Peter A Brady, Biji Soman, Raja Dashti
January-June 2021, 3(1):3-7
Chronic coronary syndrome (CCS) is a newly proposed entity by the European Society of Cardiology that replaces stable coronary artery disease (CAD), which is defined as a progressive process of plaque accumulation in coronary circulation with associated functional changes. CCS has replaced stable CAD to raise awareness that despite the clinically silent nature of the disease, there are progressive pathological changes occurring in the coronary arteries. This has allowed clinicians to review the current various diagnostic modalities, methods of risk stratifying patients based on different models and the various management options available, including lifestyle modifications, pharmacological therapies, and revascularization. With the emergence of this new entity, great emphasis has been placed on the consolidation of our comprehension of the dynamic character of the disease and the preventative actions that aim to reduce the cardiovascular disease burden.
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Chloroquine for coronavirus disease 2019 (COVID-19)?
Suman Omana Soman, Muneer Abdul Rahaman
January-June 2020, 2(1):47-48
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