Indian Heart Journal
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Item Nuclear imaging studies in patients with an indeterminate diagnosis of infective endocarditis: A retrospective analysis of a case series(Elsevier, 2025-04) Pinheiro, ´Isis da Capela; Santiago, Alysson Selton; Silva, Vitor Deriquehem de Araújo; Oliveira, Lucas Ferreira de; Alves, Rebeca Maria Gomes Guimar˜aes; Bucar, Ana Gl´oria; Filho, Jo˜ao Mansu; Salis, Lúcia Helena Alvares; Silva, Nelson Albuquerque de Souza e; Ferreira, Roberto MunizObjectives: To determine the role of nuclear imaging (NI) in evaluating inconclusive cases with suspicion of infective endocarditis (IE). Methods: Consecutive patients with an indeterminate diagnosis of IE who underwent labelled leucocyte scin- tigraphy (LS) or 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) between 2018 and 2021 at 2 reference hospitals in Rio de Janeiro were retrospectively analysed. Subsequent confirmed or rejected diagnoses of IE were evaluated, in addition to clinical and imaging data. Kappa coefficient was used to compared the diagnostic agreement between echocardiographic and NI findings, with a p-value <0.05 considered statistically significant. Results: A total of 85 NI scans (28 FDG-PET/CT, 57 LS) from 76 patients were evaluated, of whom 48 (63.2 %) underwent only LS, 19 (25 %) only FDG-PET/CT, and 9 (11.8 %) both studies. Average age was 63.8 years (SD ± 18.5) and 51.3 % were women. Prosthetic valves were present in 15.8 % of cases, and intracardiac devices in 10.5 %. Among the 76 patients, 18 (23.7 %) had NI findings suggestive of IE. A total of 28 patients (36.8 %) were ultimately diagnosed with IE, 28.6 % of whom had confirmed infections by NI scans. Echocardiographic results had a low level of agreement with NI findings in those diagnosed with IE (kappa = 0.44). Conclusions: Nuclear imaging contributed to the diagnosis of IE in approximately 30 % of subsequently confirmed cases, which were initially classified as inconclusive by echocardiography. The low level of agreement between these methods underscores their complementary role in the diagnosis of IE, particularly in indeterminate cases.Item The diastolic duration as a percentage of the cardiac cycle in healthy adults: A pilot study(Elsevier, 2025-04) Bachani, Neeta; Vijay, Soorampally; Vyas, Aniruddha; Jadwani, Jaipal; Panicker, Gopikrishna; Lokhandwala, YashBackground: A widely accepted concept in cardiovascular physiology states that diastole constitutes 62.5 % of the cardiac cycle during a typical 0.8-s cycle at 75 beats per minute. However, this has not been confirmed by using modern technology in healthy individuals. Objective: This study aimed to accurately measure diastolic duration as a fraction of the cardiac cycle using echocardiography in healthy adults with structurally normal hearts. Methods: In this prospective study, 200 healthy adults aged over 18 years, with heart rates between 50 and 100 beats per minute, normal ECGs, and structurally normal hearts, were included. Using a modified apical 5-cham- ber view and pulse wave Doppler at the aortic and mitral valves, researchers measured the RR interval (total cardiac cycle), diastolic duration (from aortic valve closure to mitral valve closure), and systolic duration. Three measurements were taken for each parameter, and the mean was used for analysis. Results: Participants had a mean age of 47.7 years (range 19–79), with an equal gender distribution. The mean RR interval was 799 ± 97 ms. The left ventricular (LV) diastolic duration was 469 ± 76 ms, and the LV systolic duration was 330 ± 42 ms. The ratio of diastolic duration to the total cardiac cycle was 0.58 ± 0.04, slightly higher in males (0.59 ± 0.04) compared to females (0.57 ± 0.04). Conclusion: This study challenges the longstanding teaching that diastole accounts for two-thirds of the cardiac cycle. Instead, diastole represents 58 % of the cycle, highlighting the need to reconsider its role in cardiovascular physiology and clinical applications.Item Early experience with the “modified jailed balloon technique” for side branch protection in bifurcation lesions(Elsevier, 2025-04) Somendra, Somyata; Gupta, Himanshu; Sharma, Yash PaulObjective: M-JBT is a novel approach to the "keep-it-open strategy" for bifurcation lesions where SB anatomy is unsuitable for stenting. We intend to provide insight into a contemporary way through our experience of the M- JBT. Methods: A semi-compliant balloon sized appropriately for the SB diameter is inflated simultaneously with the MB stent balloon during stent deployment, followed by POT of the MB stent and then recrossing the SB. Results: We performed the “M-JBT” in 25 cases of bifurcation lesions between September 2023–24, with absolute procedural success in preventing SB occlusion during MB stenting in all 25 lesions. SB occlusion after MB stent POT was seen in one case. Conclusion: This is the first report of clinical experience with the MJBT from the Indian subcontinent. MJBT proves to be a safe and effective approach to the protection of a clinically important SB during MB stenting across it.Item Comparison of hybrid coronary revascularization versus conventional Coronary Artery Bypass surgery in patients with multi-vessel coronary artery disease in a real-world setting: In-hospital outcomes and medium-term follow-up: COHOS study(Elsevier, 2025-04) Kaliyamoorthy, Dhamodaran; Yusuf, Meeranghani Mohamed; Ramalingam, Vadivelu; Kasha, Abhishek; Kathiresan, Manickam; Abdulkader, Rizwan Suliankatchi; Kathiresan, Jeyashree; Kumar, Aishwarya Mahesh; Grace, Elsa; Choudhury, AnirbanObjectives: The aim of this observational study was to evaluate the in-hospital and medium-term outcomes of hybrid coronary revascularization (HCR) in the real-world setting compared to conventional coronary artery bypass grafting (CABG). Methods: All patients with multi-vessel coronary artery disease (MV-CAD) who underwent conventional CABG and HCR in our institution between January 2018 to January 2021 were evaluated in terms of length of intensive care unit (ICU), in-hospital stay, repeat revascularization rates, bleeding, stroke, and in-hospital mortality. Clinical outcomes (mortality and major adverse cardiac and cerebrovascular events [MACCE]) were assessed at average follow up of 3.6 years. Results: Pre-procedural characteristics were balanced between the groups after propensity score matching. There was no significant difference in MACCE [Odds ratio: 0.57; 95 % CI: 0.05 to 1.52; p = 0.66], in-hospital mortality [n = 2 (1.9 %) vs n = 0; p = 0.80], post procedure stroke [n = 2 (1.9 %) vs n = 2 (3.7 %); p = 0.86], post- procedural myocardial infarction requiring repeat revascularization [n = 2 (1.9 %) versus n = 1 (1.9 %); p = 1] during the in-hospital stay of the patients in the CABG vs HCR groups respectively. HCR was associated with significantly lower requirement for blood transfusions, bleeding risk, in-hospital stay, and intensive care unit stay. Analysis of the outcomes after 3.6 years revealed no significant difference in MACCE [Odds ratio: 1.40; 95 % CI: 0.46 to 4.30; p = 0.55], and post discharge mortality [n = 0 vs n = 0; p = 1]. Both groups had similar rates of post-procedural myocardial infarction requiring repeat revascularization [n = 0 vs n = 4 (7.4 %); p = 0.278], and rate of re-intervention [n = 0 vs n = 3 (5.6 %); p = 0.41]. Conclusion: HCR may be considered as a safe and feasible alternative to conventional CABG in selected in- dividuals with MV-CAD.Item Study of fluoroscopic landmarks in IVUS guided zero contrast PCI - A single centre experience(Elsevier, 2025-04) Khanolkar, Uday B.; Banotra, Pankaj; Mahala, Bijay Kumar; Hegde, Nitin Kumar; Jino, Blessvin; Shetty, Devi Prasad; Sangoi, Parin ChandrakantIntroduction: Contrast induced nephropathy is third most common cause of renal insufficiency following percu- taneous coronary angioplasty (PCI) and patients with preexisting renal dysfunction are even at a higher risk for poor outcomes. With the advent of intravascular imaging, safety and efficacy of angioplasty can be improved significantly in these patients. Material and methods: This observational prospective study included 72 consecutive patients with CKD(eGFR ?45 ml/min/m2) and established CAD who underwent absolute zero contrast PCI at a single tertiary center.PCI was planned in patients with significant stenosis and indications for revascularization.All Procedures were performed under dry fluoroscopy and IVUS guidance without use of any contrast.Informed consent, clinical, procedural and follow-up data was collected and analysed. Results: Total 72 patients (90 vessels) with median age of 63 years and eGFR (34.1 ml/min/1.73 m2) underwent zero contrast PCI. Procedure was performed by Femoral (45.6 %)and radial (54.4%) route. Total 11 patients (15.3%) underwent left main stenting. Fluoroscopic landmarks such as side-branch wiring (71.1%),floating wire in aorta (22.2 %), calcifications (21.1%), bony landmarks such as ribs or vertebrae (45.5%) and Sternal wires/ clips (6.6%) were used in addition to IVUS to enable more accurate placement of stent.Technical and procedural success were achieved in 91.1% and 97.2% of patients.One patient died in hospital due to non-cardiac cause and one patient required hemodialysis.Post procedure at 48 hrs, there was no deterioration of renal function.On 3 months followup, there was no significant major adverse cardiovascular events (MACE). Conclusion: Our study shows that with the help of fluoroscopy landmarks and intravascular imaging, zero contrast PCI can be performed safely with good clinical outcomes in patients at risk of nephropathy.Item Adherence to pharmacotherapy for secondary prevention of coronary heart disease: A registry-based prospective study(Elsevier, 2025-04) Bana, Aradhai; Sharma, Krishna Kumar; Guptha, Soneil; Gupta, RajeevBackground and objective: There is limited data on secondary prevention medications following acute coronary syndrome (ACS) in India. We performed a registry-based study to evaluate adherence to recommended medi- cations following ACS hospitalisation. Methods: Consecutive patients admitted with ACS were recruited. Data on demographics, baseline characteristics, in-hospital interventions, and prescribed secondary prevention therapies (antiplatelets, statins, beta-blockers, angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and calcium channel blockers (CCB) at discharge were recorded. 6-months follow-up was conducted to evaluate adherence using validated tools. Results: 716 patients were recruited; the mean age was 60.4 ± 11 years, percutaneous coronary angioplasty (PCI) was performed in 714 (99.7 %) and bypass surgery in none. At hospital discharge, the cardioprotective medi- cations were: aspirin 97.3 %, dual antiplatelets 99.7 %, statins 99.7 %, beta-blockers 74.2 %, ACEI/ARB 38.8 % and CCB 10.9 %. Follow-up data were available for 554 patients; 15 (2.1 %) died and 147 (20.5 %) were lost to follow-up. Medication status and change at 6 months was aspirin 83.9 % ( 15.9 %); dual antiplatelets 70.2 % ( 29.5 %), statins 70.0 % ( 29.8 %), beta-blockers 50.4 % ( 32.1 %), ACEI/ARB 22.4 % ( 42.3 %) and CCB ( 36.7 %) (p < 0.05). Use of high-intensity statins declined from 92.0 % to 45.7 % ( 50.3 %). At follow-up, good adherence (>80 %) was 42.7 %, low adherence 24.4 % and non-adherence 10.2 %. Patients with government- sponsored insurance had better adherence than privately insured and self-paying. Conclusions: Following acute coronary syndrome and PCI, the adherence to prescribed pharmacotherapy is sub- optimal at 6 months with a decline in various medications of 16–42 %. Strategies to increase adherence to secondary prevention therapies are required.Item A contemporary review of the head-up tilt test: Utility and limitations(Elsevier, 2025-06) Udyavar, Ameya; Shenthar, Jayaprakash; Naik, Ajay Madhukar; Khanra, Dibbendhu; Ramalingam, Vadivelu; Singhal, Rahul; Choudhary, Dinesh; Gupta, Prabha Nini; Rao, B Hygriv; Mehrotra, Saurabh; Arora, Vanita; Kathuria, Sanjeev; Suri, Pawan; Benditt, David; Sutton, RichardThe Head-Up Tilt Test (HUTT) has been widely used for the past four decades as part of the overall assessment of the potential causes of collapse in patients with recurring transient loss of consciousness (TLOC) of unknown cause. The ability of a positive HUTT often to reproduce patient symptoms and illustrate to the patient that the physician is confident of the diagnosis have been major advances in clinical TLOC management. Tilt testing has been particularly important in understanding and diagnosing vasovagal syncope (VVS) and orthostatic hypotension. Despite HUTT having great clinical utility, different HUTT protocols and drug provocations result in different test yields. Limited HUTT reproducibility has led some researchers to criticize HUTT utility. As in most medical tests, limitations are part of the test. Herein, we provide a contemporary review of HUTT’s utility in diagnosing and managing various TLOC disorders with intent to clarify its role in clinical practice.Item Percutaneous device closure for Paravalvular leak- A single centre experience(Elsevier, 2025-06) Khanolkar, Uday B.; Buch, Meemansa Kashyap; Govind, Satish C.; Raut, Barendra Kumar; Raghuraman, Bagirath; Kumawat, Kapil; Mahala, Bijay Kumar; Shenoi, Arjun; Shetty, Devi PrasadThe incidence of paravalvular leak (PVL) following surgical valve replacement is 5–17%. Our main aim is to determine the safety and efficacy of percutaneous device closure for significant PVLs.Transcatheter device closure was done for 45 PVLs in 42 patients. PVLs were closed percutaneously in mitral position in 23 cases, in aortic position in 20 cases, and combined mitral and aortic leaks in 2 cases. We achieved a technical success rate of 93.33 % and procedural success rate of 91.11%. Transcatheter PVL closure is a safe and effective procedure for symptomatic PVLs.Item Implementation of a hub and spoke STEMI Goa project – Initial results, gains and challenges(Elsevier, 2025-04) Naik, Guruprasad; Prabhudesai, Amar; Malali, Venkatesh; Parab, Michelle Viegas; Quadros, Joel; Vaidya, Pankajam; D’Mello, Edward; Arsekar, Swapnil; Valaulikar, RadhaObjectives: To study the impact of a ‘hub and spoke’ STEMI management programme on delivery of thrombolysis in the state of Goa. Methods: A prospective observational study was conducted to assess the ‘hub and spoke’ model STEMI pro- gramme in the state of Goa. Data was collected using predesigned proformas filled at Primary Health Centres or District Hospitals which served as the spokes. Primary programme efficacy outcomes studied were the proportion of eligible patients of STEMI receiving thrombolysis and the time to thrombolysis. Secondary outcome assessed was in-hospital mortality. Results: A total of 2050 number of patients were diagnosed with STEMI between November 2019 and March 2022, of which complete data was available for 1325 patients. After ruling out contraindications, delayed pre- sentations or refusal for treatment, 74.3 % of STEMI patients received thrombolysis. The median window period was 130.83 min with an interquartile range (IQR) of 159.63 min. The median time from presentation to recording ECG was 7.9 (IQR = 11.63) minutes and presentation to cloud diagnosis was 11.78 (IQR = 12.96) minutes. The median time from presentation to administering thrombolysis (Door to Needle time) was 18.48 (IQR = 28.85) minutes. Only 0.22 % patients received inappropriate thrombolysis and the in-hospital mortality was 9.4 %. Conclusion: A STEMI programme utilizing the existing manpower and primary health care setup improved ‘secondary’ level of care to patients by providing thrombolysis to a high percentage of patients in quick time. This may serve as a model to improve the outreach of reperfusion therapy in a resource challenged country like India.Item Safety and one-year follow-up analysis of percutaneous ASD closure at a tertiary care hospital(Elsevier, 2025-06) Thota, Naga Raghunandan; Kosaraju, Kamalakar; Rudrapogu, John Satish; Nevali, Krishna Prasad; Kondaveeti, Thirupathi RaoAim: This study was designed to evaluate the safety and effectiveness of the Cocoon Septal Occluder device (Vascular Innovations Co. Nonthaburi, Thailand) for transcatheter closure of isolated secundum type atrial septal defect (ASD) in Indian patients. Methods: This was a single-center, retrospective, observational study which included patients who underwent transcatheter closure of isolated secundum ASD using the Cocoon Septal Occluder between April 2014 and May 2023. Follow-up assessments up to one-year were conducted through review of hospital medical records, clinic visits, or via telephonic communication with primary care physicians. Results: A total of 400 patients were included in the study, consisting of 28 paediatric (aged ?15 years, 8.14 ± 4.41 years) and 372 adult patients (40.83 ± 13.23 years). The mean defect diameter and device size were 16.75 ± 5.85 mm and 20.43 ± 6.24 mm for paediatric patients, and 21.62 ± 6.87 mm and 24.94 ± 7.28 mm for adult patients, respectively. The device was successfully implanted in all paediatric patients, achieving 100 % closure of the defect with no complications, which persisted through one-year follow-up. In the adult cohort, complete ASD closure was achieved in 99.2 % of patients, with two cases of device embolization and one case of device withdrawal. At one-year follow-up, adult patients experienced 0.3 % late device embolization, 0.8 % pericardial effusion/cardiac tamponade, 0.5 % atrioventricular block, and 0.5 % atrial flutter/fibrillation. No cases of endocarditis, haemolysis, nickel allergy, stroke/transient ischemic attack, or migraine were reported in either paediatric or adult patients. Conclusion: The results demonstrate that Cocoon Septal Occluder is safe and effective in closing isolated secundum ASD during one-year follow-up.Item Genetic testing of cardiomyopathies: Position statement of the Cardiological Society of India(Elsevier, 2025-06) Bahl, Ajay; Seth, Sandeep; Dhandapany, Perundurai S.; Mittal, Anupam; Chockalingam, Priya; Ahamed, Hisham; Subramanian, Muthiah; Nampoothiri, Sheela; Namboodiri, Narayanan; Das, Soumi; Vaidya, Vanya; Anantharaman, Rajaram; Khullar, Madhu; Rani, Deepa Selvi; Thangaraj, Kumarasamy; Naik, Nitish; Sivasubbu, Sridhar; Roy, Debabrata; Bang, Vijay Harikisan; Banerjee, Partha Sarathi; Rath, Pratap Chandra; Sinha, Dhurjati Prasad; Yadav, Rakesh; Dastidar, Dipankar GhoshItem Fate of mitral regurgitation after transcatheter closure of patent ductus arteriosus: single centre study(Elsevier, 2025-06) Kartha, Gayathri Bhuvaneswaran; Varghese, Shruti Irene; Krupa, Jesu; Alex, Anoop George; George, Oommen K.; Thomson, Viji SamuelA hemodynamically significant patent ductus arteriosus (PDA) may be associated with mitral regurgitation (MR). Available treatment strategies are - surgical PDA ligation ± mitral valve surgery and initial transcatheter PDA closure (PDA-DC) with treatment of MR subsequently, if necessary. We aimed to describe the fate of MR after PDA-DC in patients with PDA and significant MR. On retrospective review of electronic health records between 2013 and 2023, 14 eligible patients were identified. Amongst them, PDA-DC resulted in symptomatic improvement in all. A reduction in the severity of MR was noted in 12 patients (85.7 %)Item Cardiac evaluation in patients awaiting kidney transplant-position statement of the Cardiological Society of India and Indian Society of Nephrology(Elsevier, 2025-06) Bahl, Ajay; Prasad, Narayan; Sinha, Dhurjati Prasad; Ganguly, Kajal; Roy, Sandipta; Roy, Debabrata; Rakshit, Sumit; Kumar, Dilip; Das, Saurav; Bhasin, Dinkar; Raju, Sree Bhushan; Trivedi, Mayuri; Rathi, Manish; Gulati, Sanjeev; Agstam, Sourabh; Bhargava, Vinant; Bhalla, Anil Kumar; Bansal, Shyam Bihari; Varughese, Santosh; Patel, Manas Ranjan; Yadav, Rakesh; Naik, Nitish; Bang, Vijay Harikisan; Dastidar, Dipankar Ghosh; Banerjee, Partha SarathiCardiovascular diseases are a major cause of death after kidney transplantation. This statement addresses pre- operative cardiac decision-making and management with the aim of assessing and reducing the risk of the kidney transplant surgery. Important issues from a clinician’s perspective include the basic cardiovascular workup of these patients, coronary evaluation and management of coronary artery disease, valvular heart disease and left ventricular systolic dysfunction. Recovery left ventricular function after kidney transplant is discussed. In addition, the use of cardiovascular drugs in patients with special emphasis on antiplatelets and anticoagulants in patients planned for kidney transplant is also discussed.Item A study of intracoronary thrombolytic agents in high thrombus burden lesions during primary PCI(Elsevier, 2025-06) Sarma, Venkata RS. Subrahmanya; Gopalakrishna, K.; Rao, K. Purnachandra; Somasekahr, G.; Chowdary, P.S.S.; Raghuram, P.; Dasarath, B.; Reddy, Manohar; Ramkishore; Veeramachineni, Raji; Sasidhar, Y.; Prasad, M.Objectives: High thrombus burden during Primary Percutaneous Coronary Intervention begets poor outcomes; there are several lacunas in the management of those patients.- The purpose of this study is to analyse the long- term outcomes of patients undergoing primary percutaneous coronary intervention with high thrombus burden, treated with intracoronary thrombolysis as an adjunctive therapy. Methods: In this prospective observational study, 108 consecutive primary percutaneous coronary intervention patients with high thrombus burden were stratified into two groups basing on whether they received intra- coronary thrombolytic agent before stent implantation. The primary outcome is Net Adverse Clinical Events. Secondary outcomes include Major Adverse Cardiac Events, and all other individual components of the Net Adverse Clinical Events when analysed separately. Results: The primary outcome events occurred in 21 patients (26 %) in the Primary stent group (n = 80), whereas it occurred in 2 patients (6 %) in the primary intra-coronary thrombolysis group (n = 28), this study shows that there is no difference in primary endpoints in both groups (26 % Vs 7 %, p-value – .042, Hazard ratio - 2.56; 95 % CI - .76–8.57), however Kaplan–Meier event-free survival curves show that both the curves are well separated apart even at the end of the one year of follow – up. Conclusion: There is no difference in the primary outcome events in both groups, however there was a consistent increase in events in the primary stent group over the one-year follow-up period. These findings suggest the need for a larger randomized clinical trial to confirm and further elucidate these results.Item Incidence and determinants of left ventricular ejection fraction (LVEF) recovery in heart failure with reduced ejection fraction (HFrEF) of non-ischemic aetiology; a hospital-based prospective longitudinal registry study(Elsevier, 2025-06) Kumar, Sanjeev; Negi, Prakash Chand; Asotra, Sanjeev; Kumar, Jitender; Merwah, Rajeev; Sharma, Rajesh; Kumar, Ritesh; Bhardwaj, Vinay; Thakur, Preetam SinghBackground: Heart failure with reduced ejection fraction (HFrEF) can show recovery in some patients, especially with non-ischemic causes, leading to better outcomes. Recovery varies due to factors like aetiology and severity of myocardial injury. This study examines the incidence and predictors of left ventricular ejection fraction (LVEF) recovery in non-ischemic HFrEF patients. Methods: This was a prospective observational study conducted at a tertiary care hospital, involving 500 patients with non-ischemic HFrEF (baseline LVEF <40 %). Patients were followed for a duration of 8 years (2011–2023) with periodic clinical assessments and annual echocardiographic evaluations. Data on comorbidities, baseline cardiac function, medication adherence, and clinical events were collected. The incidence rate of LVEF recovery was determined, and Kaplan–Meier survival analysis was used to identify recovery trends over time. Predictors of recovery were evaluated using Cox proportional hazards models. Results: Cumulative incidence of LVEF recovery was 27.4 % (95 % CI: 23.7–31.5) at 8 years, with an incidence rate of 4.5 per 100 person-years. Higher baseline LVEF (?30 %) strongly predicted recovery (HR: 2.17, p < 0.001), while dilated LV (LVEDD ?60 mm, HR: 0.6, p = 0.02) and diabetes (HR: 0.36, p = 0.01) were associated with lower recovery. Education (?Class 5) was linked to better recovery (HR: 1.45, p = 0.04). Beta-blockers showed a potential but nonsignificant benefit. Conclusion: Nearly one-fourth (27.4 %) of patients achieved LVEF recovery over 8 years, with higher baseline LVEF and education associated with better outcomes, while adverse cardiac remodeling and diabetes were linked to lower recovery.Item Acute changes in left atrial appendage function with premature ventricular complexes(Elsevier, 2025-06) Sukumaran, Suresh Kumar; Bhargav, Anish; Balaguru, Sridhar; Anantharaj, Avinash; Satheesh, Santhosh; Selvaraj, Raja J.Objectives: Left atrial appendage (LAA) dysfunction is a risk factor for stroke. Evidence shows that frequent premature ventricular complexes (PVCs) are associated with embolic stroke. Whether left atrial dysfunction is the bridging link between frequent premature ventricular complexes and stroke is unknown. Materials and methods: Patients with a structurally normal heart undergoing elective electrophysiology study were included. Transoesophageal echo was used to measure LAA flow velocities. To simulate PVCs in bigeminal rhythm, single paced beats were delivered from the right ventricle with a coupling interval of QT + 10 % RR interval after each sinus beat. LAA flow doppler velocities were acquired at baseline, after 5 min of pacing and again 5 min after cessation of pacing. Results: Ten patients were included in the study. Late diastolic emptying velocity decreased significantly after 5 min of PVCs (55.68 ± 16.33 cm/s, p = 0.01) compared to baseline (68.01 ± 10.34 cm/s). This almost returned to baseline after a rest period of 5 min (63.13 ± 16.16 cm/s, p = 0.277). The left atrial appendage filling velocity exhibited a statistically non-significant trend toward a decrease after 5 min of PVCs (45.70 ± 10.85 cm/s, p = 0.129), compared to the baseline value of 51.31 ± 14.11 cm/s. Conclusions: Premature ventricular complexes in bigeminal pattern for 5 min resulted in an acute decrease in the late diastolic emptying velocity. This is a possible mechanism for the increased risk of strokes in patients with frequent PVCs.Item Analysis of risk factors of low cardiac output syndrome after pericardiectomy for tuberculous constrictive pericarditis: A retrospective study(Elsevier, 2025-06) Yan, Shuangshuang; Guo, Jing; Wang, Shuzhen; Zhang, Lijuan; Zhang, Li; Xiao, Qiuyu; Li, Qian; Zhao, Zhengkai; Cheng, Lijian; Xiong, FengObjective: Low cardiac output syndrome (LCOS) is the leading cause of death after cardiac surgery. Studies have shown that 24% of postoperative mortality in patients undergoing pericardiectomy is attributed to LCOS. It is necessary to explore the risk factors of LCOS after pericardiectomy in patients with tuberculous constrictive pericarditis (CP). Methods: Patients undergoing pericardiectomy for tuberculous CP were included in the study. The personal and clinical data of these patients with LCOS and without LCOS were collected and compared. Logistic regression analyses were conducted to identify the risk factors of postoperative LCOS. ROC curve analysis was used to check the accuracy of each risk factor to predict LCOS. Results: A total of 175 patients with tuberculous CP were included in this study, of which 35 cases developed LCOS postoperatively, resulting in an incidence rate of 20%. The independent predictors of LCOS were preop- erative NYHA class III/IV, decreased left ventricular mass index (LVMI), and hypoalbuminemia in these patients (p < 0.05). When albumin (ALB) < 30.35 g/L, it had the highest diagnostic value in predicting postoperative LCOS, with sensitivity and specificity of 59.4% and 86.9%, respectively (p < 0.01). Conclusions: For patients with tuberculous CP, preoperative NYHA class III/IV, lower LVMI, and hypo- albuminemia are independent risk factors for LCOS following pericardiectomy. Clinically, these risk factors should be identified as early as possible, and early pericardiectomy should be performed when the patient’s cardiac function remains well-preserved to avoid the occurrence of cardiac cachexia, myocardial atrophy and severe hepatic insufficiency.Item Short-term outcomes of rotational atherectomy in patients with reduced left ventricular ejection fraction: A retrospective review from a tertiary referral centre(Elsevier, 2025-06) Kanabar, Kewal; Vyas, Pooja; Patel, Krutika; Behra, GouravObjective: Rotational atherectomy (RA), a commonly used technique for the percutaneous intervention of calcific coronary lesions, produces micro-debris which cause downstream microvascular obstruction, slow flow, and myocardial stunning leading to adverse outcomes in patients with left ventricular (LV) systolic dysfunction. Hence, the presence of LV dysfunction was considered a relative contraindication for RA. We aimed to assess the safety of RA in patients with LV dysfunction. Method: This is a retrospective review of all consecutive patients who underwent RA at our tertiary referral centre over a 6-year period (2018–2023). All medical records, procedural details, and in-hospital outcomes were recorded. The primary outcome of the study was in-hospital mortality. Results: 504 patients who underwent RA during the study duration were divided into two groups: Group 1 (n = 209) with left ventricular ejection fraction (LVEF) ?35 % (mean 29.14 ± 4.95 %) and group 2 (n = 295) with moderately reduced or preserved LVEF >35 % (mean 47.86 ± 6.68 %). There was no significant difference in the baseline demographic characteristics, risk factors, angiographic profile, stent length, contrast volume, and procedure time between the two groups. The in-hospital mortality was not different between the two groups (2.3 % vs 0.7 % p = 0.63). LVEF was not found to be an independent predictor of mortality in patients undergoing RA. Conclusion: The in-hospital mortality of patients undergoing PCI with RA was not affected by the presence of LV dysfunction. Additional studies with a longer follow-up duration and a larger sample or a meta-analysis incor- porating our study are needed to confirm these results.Item A cross-sectional study on the incidence of prosthetic valve thrombosis and its outcome treated with fibrinolysis in a tertiary care hospital(Elsevier, 2025-04) Murugesan, Dhiviya; Sundaram, Balasubramanian; Gurusamy, Nagasundar; Ramamurthy, Hemanath; Mohideen, Nisamudeen KajaAims: To find the incidence, risk factors of Prosthetic Valve Thrombosis (PVT)To study the efficacy, outcome and complications of fibrinolysis in PVT. Methods: Data from 44 consecutive patients admitted with PVT treated with fibrinolytics were assessed, outcomes recorded. Only medically managed PVT were included in this study and Surgical management were not included due to inadequate resources. Results: Out of 44 patients, 28 were female and 16 were male with mean age of 36.5 41 had underwent MVR, 3 had underwent DVR. 42 (92.4 %) had thrombus at mitral valve 2 (4.5 %) were at aortic valve. Visible clot was present in 7 (15.9 %) and absent in 37 (84 %) patients. 7 (15.9 %) had recurrent episode of PVT. At the time of thrombolysis, no patient had major bleeding manifestation. During follow up after thrombolysis, 37 (84 %) were alive and 7 (16 %) expired. The incidence of primary end point i.e successful thrombolysis (as defined as complete response without complications) was seen in 61.3 % patients. The secondary end point i.e. Therapeutic failure/death is recorded in 15.9 % study subjects. Among the vulnerable population, therapeutic Failure/death is seen with 57.1 % sub-therapeutic anticoagulant consumers and 42.8 % patients with poor drug compliance. Conclusion: In conclusion this study sheds light on the complexities and challenges associated with prosthetic valve thrombosis in pregnant patients, patients with sub therapeutic anticoagulation or poor drug consumers. This study underscores the importance of close monitoring, optimal anticoagulation, patient education. This study highlights that fibrinolysis unless contraindicated can be considered as effective especially in developing countries or in centres with limited resources, where multiple factors such as surgical availability, financial cost, high operative mortality are to be weighed before treatment.Item Leveraging ECG images for predicting ejection fraction using machine learning algorithms(Elsevier, 2025-06) Swamy, Abhyuday Kumara; Rajagopal, Vivek; Krishnan, Deepak; Ghorai, Paramita Auddya; Choukhande, Anagha; Palani, Santhosh Rathnam; Padmanabhan, Deepak; Rupert, Emmanuel; Shetty, Devi Prasad; Narayan, PradeepIntroduction: The capability to accurately predict the ejection fraction (EF) from an electrocardiogram (ECG) holds significant and valuable clinical implications. Various algorithms based on ECG images are currently being evaluated, with most methods requiring raw signal data from ECG devices. In this study, our objective was to train and validate a neural network on a readily available ECG trace image graph to determine the presence or absence of left ventricular dysfunction (LVD). Methods: 12-lead ECG trace images paired with their echocardiogram reports performed on the same day were selected. A DenseNet121 model, using ECG images as input, was trained to identify EF <50 %. and then externally validated. Results: 1,19,281 ECG-echocardiogram pairs were used for model development. The model demonstrated com- parable performance in both the internal test data and external validation data. The area under receiver oper- ating characteristic and precision–recall curves were 0.92 and 0.78, respectively, for the internal test data and 0.88 and 0.74, respectively, for the external validation data. The model accurately identified more than 85 % of cases with EF <50 % in both datasets. Conclusions: Actual images of ECGs with simple pre-processing and model architecture can be used as a reliable tool to screen for LVD. The use of images expands the reach of these algorithms to geographies with resource and technological limitations.