Browsing by Author "Ray, Saumitra"
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Item Adaptation of 2016 European Society of Cardiology/European Atherosclerosis Society guideline for lipid management to Indian patients – A consensus document(Cardiological Society of India, 2018-09) Ray, Saumitra; Sawhney, J.P.S.; Das, M.K.; Deb, Jyoti; Jain, Peeyush; Natarajan, Sivakadaksham; Sinha, K.K.In the year 2016, European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines provided recommendations on dyslipidemia management. The recommendation from these guidelines are restricted to European subcontinent. To adapt the updated recommendations for Indian subset of dyslipidemia, a panel of experts in management of dyslipidemia provided their expert opinions. This document provides expert consensus on adapting 2016 ESC dyslipidemia guidelines recommendations in Indian setting. The document also discussed India-specific relevant literature to support the consensus opinions provided in management of dyslipidemia.Item Angiotensin Receptor-Neprilysin Inhibitor Therapy and Cardiac Remodeling in Heart Failure: Consensus Statement from India(Association of Physicians of India, 2023-04) Chopra, H K; Wander, G S; Nair, Tiny; Ponde, C K; Nanda, Navin C; Narula, Jagat; Ray, Saumitra; Venugopal, K; Iyengar, S S; Kasliwal, R R; Chandra, Praveen; Prakash, Sunil; Bansal, Sandeep; Rana, D S; Kerkar, Prafulla; Dasbiswas, Arup; Sawhney, JPS; Shanmungasundram, S; Kumar, Viveka; Vijayalakshmi, I B; Pancholia, A K; Sharma, Vinod; Kapoor, Aditya; Swami, Onkar C; Isser, H S; Rastogi, Vishal; Arora, Y K; Omar, Ashok K; Sathe, Sunil; Rajput, Rajeeve; Prabhakar, D; Paul, G Justin; Jagia, Priya; Malhotra, Poonam; Suryaprakash, G; Mittal, Vinod; Jagia, Manish; Jabir, A; Mishra, S, S; Routray, S N; Sinha, Ajay Kumar; Bhargava, Mohan; Mahmood Kiran; Lal, Shreya; Dabhade, Dhammdeep; Bhatia, Mona; Kalra, Pramila; Katyal, V K; Tandon, Rohit; Grover, Rahul; Chhabra, Abhinav; Shastry, N RAdverse cardiac remodeling refers to progressive structural and functional modifications in the heart because of increased wall stress in the myocardium, loss of viable myocardium, and neurohormonal stimulation. The guideline-directed medical therapy for Heart failure (HF) includes Angiotensin receptor-neprilysin inhibitor (ARNI) (sacubitril/valsartan), ?-blockers, sodium-glucose co-transporter 2 (SGLT2) inhibitors, and mineralocorticoid receptor antagonists (MRA). ARNI is under-prescribed in India despite its attractive safety and efficacy profile. Therefore, the consensus discusses objectives and topics related to ARNI in the management of cardiac remodeling, and experts shared their views on the early timely intervention of effective dosage of ARNI to improve the diagnosis and enhance mortality and morbidity benefits in cardiac reverse remodeling (CRR).Item Contrast-induced nephropathy.(2008-03-17) Ray, Saumitra; Dutta, AnjanlalContrast-induced nephropathy (CIN) is a fairly common yet under-recognized clinical condition in the interventional cardiological practice. A 25% or more than 0.5 mg/dl rise of serum creatinine is generally accepted as defining CIN. The most important risk factors for CIN are pre-existing renal disease, volume of contrast media, nature of contrast media, and diabetes mellitus. Among the various postulated pathophysiological mechanisms for the precipitation of CIN, intra-renal vasoconstriction, and oxidative tubular injury are the best documented. Effective strategies to prevent CIN include adequate peri-procedural hydration with normal saline, use of N-acetylcysteine, keeping the volume of contrast media as low as feasible, and avoiding high-osmolal ionic contrast media. However, more efficient and cost-effective strategies are being developed and the search for the ideal contrast media is still on.Item CSI clinical practice guidelines for dyslipidemia management: Executive summary(Elsevier, 2024-03) Sawhney, Jitendra PS.; Ramakrishnan, Sivasubramanian; Madan, Kushal; Ray, Saumitra; Jayagopal, P Balagopalan; Prabhakaran, Dorairaj; Nair, Tiny; Zachariah, Geevar; Jain, Peeyush; Dalal, Jamshed; Radhakrishnan, Sitaraman; Chopra, Arun; Kalra, Sanjay; Mehta, Ashwani; Pancholia, Arvind K.; Kabra, Nitin K.; Kahali, Dhiman; Ghose, Tapan; Yadav, Satyavir; Kerkar, Prafulla; Yadav, Ajay; Roy, Debabrata; Das, Mrinal Kanti; Bang, Vijay H.; Rath, Pratap Chandra; Sinha, Dhurjati Prasad; Banerjee, P.S.; Yadav, Rakesh; Gupta, RajeevDyslipidemias are the most important coronary artery disease (CAD) risk factor. Proper management of dyslipidemia is crucial to control the epidemic of premature CAD in India. Cardiological Society of India strived to develop consensus-based guidelines for better lipid management for CAD prevention and treatment. The executive summary provides a bird's eye-view of the CSI: Clinical Practice Guidelines for Dyslipidemia Management published in this issue of the Indian Heart Journal. The summary is focused onthe busy clinician and encourages evidence-based management of patients and high-risk individuals. The summary has serialized various aspects of lipid management including epidemiology and categorization of CAD risk. The focus is on management of specific dyslipidemias relevant to India-raised low density lipoprotein (LDL) cholesterol, non-high density lipoprotein cholesterol (non-HDL-C), apolipoproteins, triglycerides and lipoprotein(a). Drug therapies for lipid lowering (statins, non-statin drugs and other pharmaceutical agents) and lifestyle management (dietary interventions, physical activity and yoga) are summarized. Management of dyslipidemias in oft-neglected patient phenotypes-the elderly, young and children, and patients with comorbidities-stroke, peripheral arterial disease, kidney failure, posttrans- plant, HIV (Human immunodeficiency virus), Covid-19 and familial hypercholesterolemia is also pre- sented. This consensus statement is based on major international guidelines (mainly European) and expert opinion of lipid management leaders from India with focus on the dictum: earlier the better, lower the better, longer the better and together the better. These consensus guidelines cannot replace the indi- vidual clinician judgement who remains the sole arbiter in management of the patient.Item Experts’ Consensus on Use of Long-Acting Nitroglycerine in the Management of Angina and Chronic Coronary Syndrome in India(Association of Physicians of India, 2022-03) JC, Mohan; Chopra, Arun; JS, Hiremath; Mahajan, Ajay; Nair, Tiny; Ray, Saumitra; TR, Muralitharan; Pandey, Ajay; Srivastava, Sameer; Kumar, Y Shiva; Navasundi, Girish; Das, Deepak Rajan; Abhyankar, Mahesh V; Revankar, Santosh; Mate, PradipAim: To address the existing gaps in knowledge about long-acting nitroglycerine (LA-NTG) and provide recommendations to address these issues. Methodology: Approved LA-NTG questionnaire that included 17 questions related to the role of LA-NTG in the management of angina and chronic coronary syndrome (CCS) was shared with 150 expert cardiologists from different regions from India. Results of these survey questionnaires were further discussed in 12 regional level meetings. The opinions and suggestions from all the meetings were compiled and analyzed. Further, recommendations were made with the help of attending national cardiology experts and a consensus statement was derived. Results: This is the first consensus on LA-NTG, summarizing the clinical evidence from India and suggesting recommendations based on these data. The experts recommended early use of LA-NTG as a first-line antianginal therapy in combination with beta-blocker since it improves exercise tolerance in patients with CCS. A strong consensus was observed for using LA-NTG in patients with co-morbid hypertension, diabetes, chronic kidney disease and post-percutaneous coronary intervention angina. As a part of cardiac rehabilitation, LA-NTG allows patients with angina to exercise to a greater functional capacity. Conclusions: A national consensus was observed for several aspects of LA-NTG in the management of angina and CCS. The clinical experience of the experts confirmed an extremely satisfied patient perception about the efficacy of LA-NTG.Item Indian Perspective on De-escalation from Dual Antiplatelet Therapy to Single Antiplatelet Therapy Study: A Knowledge, Attitude, and Practice Study among Indian Interventional Cardiologists(Journal of Indian Medical Association, 2024-04) Mohan, Jagdish Chander; Singhal, Amar; Oomman, Abraham; Ray, Saumitra; Shah, V T; Nath, Baishali; Bachani, DeepakBackground: Coronary artery disease (CAD) management is one of the most significant facets of interventional cardiology. Evidence from several clinical trials has redefined the drug management of CAD, including optimizing the duration of antiplatelet treatment regimens in the management of CAD, which is an intricate clinical issue. The available evidence indicates that East Asians have a higher bleeding risk. However, the Indian phenotype differs from that of East Asians, making this data confounding when applied to clinical decision-making among Indian patients. There is a need for a close understanding of Indian interventional cardiologists’ perceptions of complex decision-making pertaining to antiplatelet agents among Indian CAD patients in real-world clinical settings. Aim: This Indian Perspective on De-escalation from Dual Antiplatelet Therapy to Single Antiplatelet Therapy (INDEPTH) study aims to assess the perspective of Indian interventional cardiologists regarding de-escalating from dual antiplatelet therapy (DAPT) to single antiplatelet therapy (SAPT), approach to decision-making, barriers, and related challenges in CAD management. Methods: A cross-sectional knowledge, attitude, and practice (KAP) study survey was carried out among Indian interventional cardiologists practicing across different regions of India. A total of 209 responses were received. Descriptive statistics was used to summarize all the parameters. IBM Statistical Package for the Social Sciences (SPSS) statistics was used for biostatistical analysis. Results: The study indicated that >90% of CAD patients received DAPT therapy immediately after percutaneous coronary intervention (PCI) (86.1%, p < 0.001). About 115 (55%) of the respondents reported using calculator-based scoring for evaluating bleeding risk in patients on DAPT therapy for the management of acute coronary syndrome (ACS) with post-PCI (p = 0.167). Regarding the usual duration of DAPT therapy post-ACS, nearly half of the respondents, 94 (45%), said that 6–12 months is the usual duration for DAPT therapy in post-ACS patients, followed by > 12 months 94 (45%) of the respondents; 17 (8.1%) of the respondents reported it is 3–6 months, and lastly up to 3 months as per four (1.9%) of the respondents (p < 0.001). A total of 128 (61%) of the respondents strongly believe that balancing bleeding with ischemic risk influenced the choice of antiplatelet agent when treating established CAD. As per interventional cardiologists surveyed, the perfect de-escalation time frame for Indian CAD patients with high bleeding risk (HBR) is up to 3 months (35.9%, p < 0.001), 6–12 months for medium bleeding risk (48.8%, p < 0.001), and >12 months for low bleeding risk (65.6%, p < 0.001). Regarding SAPT therapy, almost one-third of the respondents, 65 (31.1%), reported that they prescribed antiplatelet therapy other than aspirin in 20–40% of their SAPT-eligible patients. Furthermore, 69 (33%) of the respondents said that they preferred to prescribe clopidogrel in 50–75% of SAPT-eligible patients. While 64 (30.5%) prescribed in 25–50%, 53 (25.4%) prescribed in <25% and 23 (11%) of the respondents prescribed the drug in >75% of the SAPT-eligible patients. (p < 0.001). “Atorvastatin + clopidogrel” is the most preferred combination of SAPT primarily for the management of CAD among the majority of interventional cardiologists [33%, 95% confidence interval (CI): 1.97–2.24, p < 0.001]. The study respondents also indicated a need for Indian-specific guidelines on de-escalating from DAPT to SAPT in CAD management. Conclusion: The INDEPTH study indicated that the majority of CAD patients received DAPT immediately after PCI. The perfect de-escalation time frame for Indian CAD patients with “highbleeding” risk is up to 3 and 6–12 months for “medium-bleeding” risk and >12 months for “lowbleeding” risk. One-third of respondents used clopidogrel as an antiplatelet agent in 50–75% of SAPT-eligible patients. Atorvastatin + clopidogrel is predominantly the most preferred combination of statin + SAPT for the management of CAD. Although the current international guidelines cover the Indian perspective to some extent, there is a need for Indian-specific guidelines on de-escalating from DAPT to SAPT.Item Navigating Choices: A Questionnaire-based Study on Usage of Antiplatelet Therapies in Management of Acute Coronary Syndrome in India(IJCP Group, 2024-05) Kerkar, Prafulla; Prajapati, Jayesh; Sahoo, PK; Rastogi, Pankaj; Banerjee, Sunip; Ray, Saumitra; Desai, Bhupen; Sathe, Sunil; Christopher, Johann; Murthy, Narayana; Shah, Chetan; Mayabhate, Mayur; Dali, JessicaBackground: Percutaneous coronary intervention (PCI) is a common invasive cardiac procedure used to treat acute coronary syndrome (ACS). The main objective of anticoagulant therapy in PCI is to minimize the risk of plaque rupture and decrease the formation of blood clots. Understanding clinicians' prescription patterns is crucial for optimizing treatment strategies for patients with ACS who have undergone PCI. Methods: It was a cross-sectional, questionnaire-based, noninterventional study which included questionnaire responses from 136 cardiologists, regarding usage of antiplatelets in ACS management. Results: Ticagrelor and aspirin dual antiplatelet therapy (DAPT) is favored by 54% cardiologists in managing ACS patients who have undergone PCI, regardless of the presence or absence of type 2 diabetes mellitus (T2DM). Further, 78% of the participants preferred long-term DAPT over short-term and medium-term alternatives. Forty percent respondents preferred a 1-month triple antithrombotic therapy (TAT) for PCI patients with atrial fibrillation. Additionally, the study emphasized the importance of considering factors like age, bleeding history, hemoglobin, and creatinine clearance in determining the optimal antithrombotic strategy. Conclusion: This study contributes valuable insights into the real-world practices of health care practitioners, paving the way for more informed and personalized ACS management strategies in Indian patients.Item The Power and Promise of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure Management: National Consensus Statement(Association of Physicians of India, 2023-02) Chopra, H K; Wander, G S; Ponde, C K; Nanda, Navin C; Khullar, Dinesh; Venugopal, K; Ray, Saumitra; Nair, Tiny; Rana, D S; Kher, Vijay; Sawhney, J P S; Kasliwa, R R; Jabir, A; Chakraborty, Rabin; Chandra, Praveen; Bansal, Sandeep; Kumar, Viveka; Pancholia, A K; Kapoor, Aditya; Prakash, Sunil; Saxena, Anil; Rastogi, Vishal; Sharma, Vinod; Arora, Y K; Dasbiswas, Arup; Bhargava, Mohan; Jaswal, Aparna; Bhargava, K; Bhatia, Mona; Omar, A K; Khanna, N N; Passey, Rajiv; Bhalla, Dilip; Vijayalakshmi, I B; Bhalla, A K; Moorthy, Asha; Isser, H S; Mishra, S S; Routray, S N; Tandon, Vivek; Sinha, Ajay; Bansal, Manish; Jain, Praveen; Hotchandani, Ramesh; Jain, Dharmendra; Katyal, V K; Gulati, Sanjiv; Tandon, Rohit; Jaggi, Shalini; Sehgal, Blessy; Gupta, Vitull; Mehrotra, Rahul; Krishnamani, N C; Pathak, S N; Yadav, M S; Chawla, Rajeev; Pal, Jyotirmoy; Chatterjee, Nandini; Samajdar, Shambo, S; Shastry, N R.Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril–Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril–Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril–Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril–Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40–50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk.Item Role of Iron Therapy in Heart Failure: A Consensus Statement from India(Association of Physicians of India, 2023-03) Chopra, H K; Wander, G S; Nair, Tiny; Ponde, C K; Nanda, Navin C; Narula, Jagat; Ray, Saumitra; Venugopal, K; Iyengar, S S; Kasliwal, R R; Chandra, Praveen; , Prakash, Sunil; Bansal, Sandeep; Rana, D S; Kerkar, Prafulla; Dasbiswas, Arup; Sawhney, JPS; Shanmungasundram, S; Kumar, Viveka; Vijayalakshmi, I B; Pancholia, A K; Sharma, Vinod; Kapoor, Aditya; Swami, Onkar C; Isser, , S; Rastogi, Vishal; Arora, Y K; Omar, Ashok K; Sathe, Sunil; Rajput, Rajeeve; Prabhakar, D; Paul, G J; Priya, Jagia; Poonam, Malhotra; G, Suryaprakash; Vinod, Mittal; Manish, Jagia; A, Jabir; S, S Mishra; S, N Routray; Ajay, K Sinha; Mohan, Bhargava; Kiran, Mahmood; Bhatia, Mona; Kalra, Pramila; Katyal, V K; Tandon, Rohit; Grover, Rahul; Chhabra, Abhinav; Shastry, N RIron deficiency (ID) with or without anemia is frequently observed in patients with heart failure (HF). Uncorrected ID is associated with higher hospitalization and mortality in patients with acute HF (AHF) and chronic HF (CHF). Hence, in addition to chronic renal insufficiency, anemia, and diabetes, ID appears as a novel comorbidity and a treatment target of CHF. Intravenous (IV) ferric carboxymaltose (FCM) reduces the hospitalization risk due to HF worsening and improves functional capacity and quality of life (QOL) in HF patients. The current consensus document provides criteria, an expert opinion on the diagnosis of ID in HF, patient profiles for IV FCM, and correct administration and monitoring of such patients.Item Role of statins in the management of dyslipidaemia(Elsevier, 2024-03) Ray, SaumitraBlood cholesterol has firmly been established as a crucial risk factor for the development of atherosclerotic cardiovascular disease (ASCVD) by elegant epidemiological studies. Naturally, means to reduce blood cholesterol level took the centerstage of research in this field. After initial lukewarm results with nicotinic acid, fibrates and some other agents, statins emerged as the most effective class of medicine to reduce blood cholesterol; in particular, the most atherogenic low density lipoprotein cholesterol (LDL-C). Also, they are very safe and well tolerated. As ASCVD comes in various stages, statins have also been tried in different settings, e.g., primary prevention, secondary prevention, as part of coronary intervention strategy, familial hypercholesterolemia, etc. Almost in all clinical scenarios, statins proved themselves to impart clinical benefit. Though side effects of statins are outweighed by their benefits, nonetheless clinicians should detect the side effects early to avoid major problems.