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   Table of Contents - Current issue
Coverpage
January-December 2019
Volume 1 | Issue 1
Page Nos. 1-40

Online since Friday, December 13, 2019

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EDITORIAL  

Does clinical cardiology need a journal? p. 1
Govindan Vijayaraghavan
DOI:10.4103/ACCJ.ACCJ_10_19  
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ORIGINAL ARTICLES Top

Gender difference of blood pressure variables on ambulatory blood pressure monitoring following percutaneous transluminal coronary angioplasty and 1-year outcomes p. 2
Maddury Jyotsna, D Malleswara Rao, Gopikrishna Kenchi, Sudhakar Kanumuri, Shravan Kumar Ch, Rama Kishore Yalampati, C Bharat Kumar Goud, Suresh Yerra, Indrani Garre
DOI:10.4103/ACCJ.ACCJ_6_19  
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.
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Multicentric, randomized, double-blind, comparative study in STEMI patients to establish clinical biosimilarity of biosimilar tenecteplase with reference product p. 8
Prasad Apsangikar, Sunil Chaudhry, Manoj Naik, Shashank Deoghare, Jamila Joseph
DOI:10.4103/ACCJ.ACCJ_6_18  
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.
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Association of social support and myocardial infarction: A case-control study p. 15
MT Manoj, KA Joseph, Govindan Vijayaraghavan, A Joseph
DOI:10.4103/ACCJ.ACCJ_8_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.
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Genetic markers in hypertensive hypertrophic cardiomyopathy p. 20
Suman Omana Soman, G Vijayaraghavan, Ramesh Natarajan, CC Karta, Radhakrishnan R Nair, Heera R Pillai
DOI:10.4103/ACCJ.ACCJ_9_19  
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.
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The yoga–meditation heart connection: A pilot study looking to improve women's heart health p. 24
Sasha De Jesus, Emily Schultz, Rachel M Bond
DOI:10.4103/ACCJ.ACCJ_5_18  
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.
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Microbiological and clinical characteristics of sternal wound infections following cardiac surgery in a teaching hospital in Kuwait: A 5-year retrospective study p. 30
Deepthi Nair, Mustafa Firoz Singapurwala, Khalifa Al-Benwan
DOI:10.4103/ACCJ.ACCJ_3_19  
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.
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CASE REPORTS Top

Uncommon cause of wide complex tachycardia - Anterior fascicular ventricular tachycardia p. 37
Ramadan Fouad Arafa, Hussein Heshmat, Rajesh Rajan, Peter A Brady
DOI:10.4103/ACCJ.ACCJ_7_18  
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.
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A variant of type IV dual left anterior descending coronary artery p. 39
Prashanth Panduranga, Rajkumar Gangappa Nadakinamani
DOI:10.4103/ACCJ.ACCJ_3_18  
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.
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