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Harikrishnan S, Bahl A, Roy A, Mishra A, Prajapati J, Manjunath C, Sethi R, Guha S, Satheesh S, Dhaliwal R, Sarma M, Ganapathy S, Jeemon P, Joseph S, Narayanan S, G R, Varghese AC, Damodara R, Joseph J, Davidson D, Thomas JK, George T, Mattummal S, Naik N, Singh S, Sharma G, Seth S, Palleda G, Gupta MD, Kumar P, Kumar N, Susheel M, Vohra MV, Negi PC, Asotra S, Mahajan K, Sharma R, D B, Raj S, Katageri A, Nanjappa V, Shetty R, Katheria R, Rai M, Musthafa M M, DKS S, Selvaraj R, M V, RJ V, Rajasekhar D, V V, Naik KS, Gnanaraj JP, Hussain F, N S, Menon S, TR H, G S, S B, SR V, Alex AG, G S, Yerram S, Bhyravavajhala S, Maddury J, Oruganti SS, Mehrotra S, Dahiya N, Sharma V, Sood A, Mohan B, Tandon R, Singh CN, Monga I, Kashyap JR, Reddy S, Kumar M, Guleria D, Sharma A, Singhal R, Joshi H, Iby M, Roy B, Thakkar P, Choudhary D, Agarwal DK, Swamy A, IC M, Bohora S, Pradhan A, Vishwakarma P, Kapoor A, Kumar S, Jain D, Pande U, Tripathi S, Verma B, Ghosh S, Prajapati R, Vemuri KS, Kaushley A, Chaturvedi S, Jha N, Kumar S, Agrawal AK, Kumar N, Chowdhary S, Shrivastava S, Yadav B, Gupta R, Singh R, Singh G, Bagchi PC, Kumari T, Agrawal MK, Mondal M, Mandal SC, Mitra KK, Routray S, Das DR, Mishra TK, Malviya A, Laitthma A, Dorjee R, Kalita HC, Chaliha MS, Dutta DJ, Tramboo NA, Rashid A, Singh Rao R, Chaturvedi H, Naik GD, Nevrekar R. Clinical profile and 90 day outcomes of 10 851 heart failure patients across India: National Heart Failure Registry. ESC Heart Fail 2022; 9:3898-3908. [PMID: 36214477 PMCID: PMC9773752 DOI: 10.1002/ehf2.14096] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Limited data on the uptake of guideline-directed medical therapies (GDMTs) and the mortality of acute decompensated HF (ADHF) patients are available from India. The National Heart Failure Registry (NHFR) aimed to assess clinical presentation, practice patterns, and the mortality of ADHF patients in India. METHODS AND RESULTS The NHFR is a facility-based, multi-centre clinical registry of consecutive ADHF patients with prospective follow-up. Fifty three tertiary care hospitals in 21 states in India participated in the NHFR. All consecutive ADHF patients who satisfied the European Society of Cardiology criteria were enrolled in the registry. All-cause mortality at 90 days was the main outcome measure. In total, 10 851 consecutive patients were recruited (mean age: 59.9 years, 31% women). Ischaemic heart disease was the predominant aetiology for HF (72%), followed by dilated cardiomyopathy (18%). Isolated right HF was noted in 62 (0.6%) participants. In eligible HF patients, 47.5% received GDMT. The 90 day mortality was 14.2% (14.9% and 13.9% in women and men, respectively) with a re-admission rate of 8.4%. An inverse relationship between educational class based on years of education and 90 day mortality (high mortality in the lowest educational class) was observed in the study population. Patients with HF with reduced ejection fraction and HF with mildly reduced ejection fraction who did not receive GDMT experienced higher mortality (log-rank P < 0.001) than those who received GDMT. Baseline educational class, body mass index, New York Heart Association functional class, ejection fraction, dependent oedema, serum creatinine, QRS > 120 ms, atrial fibrillation, mitral regurgitation, haemoglobin levels, serum sodium, and GDMT independently predicted 90 day mortality. CONCLUSION One of seven ADHF patients in the NHFR died during the first 90 days of follow-up. One of two patients received GDMT. Adherence to GDMT improved survival in HF patients with reduced and mildly reduced ejection fractions. Our findings call for innovative quality improvement initiatives to improve the uptake of GDMT among HF patients in India.
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Affiliation(s)
| | - Ajay Bahl
- CardiologyPostgraduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
| | - Ambuj Roy
- CardiologyAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
| | - Animesh Mishra
- CardiologyNorth Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS)ShillongIndia
| | - Jayesh Prajapati
- CardiologyUN Mehta Institute of Cardiology and Research Centre (UNMICRC)AhmedabadIndia
| | - C.N. Manjunath
- CardiologySri Jayadeva Institute of Cardiovascular Sciences and Research (SJICR)BangaloreIndia
| | - Rishi Sethi
- CardiologyKing George's Medical University (KGMU)LucknowIndia
| | - Santanu Guha
- CardiologyMedical College Hospital (MCH)KolkataIndia
| | - Santhosh Satheesh
- CardiologyJawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)PondicherryIndia
| | - R.S. Dhaliwal
- Division of Non‐Communicable DiseasesIndian Council of Medical Research (ICMR)New DelhiIndia
| | - Meenakshi Sarma
- Division of Non‐Communicable DiseasesIndian Council of Medical Research (ICMR)New DelhiIndia
| | - Sanjay Ganapathy
- CardiologySree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST)TrivandrumIndia
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science StudiesSree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST)Trivandrum695011KeralaIndia
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Naresh B, Kuchi C, Rajasekhar D, Reddy PS. Solvothermal synthesis of MnCo2O4 microspheres for high-performance electrochemical supercapacitors. Colloids Surf A Physicochem Eng Asp 2022. [DOI: 10.1016/j.colsurfa.2022.128443] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sriram K, Vanajakshamma V, Rajasekhar D. Echocardiographic assessment of right ventricular function in inferior wallmyocardial infarction and angiographic correlation with right coronary artery disease. Indian Heart J 2021. [DOI: 10.1016/j.ihj.2021.11.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Harikrishnan S, Ganapathi S, Reethu S, Bahl A, Katageri A, Mishra A, Alex AG, Roy B, Mohan B, Joshi H, Abdullakutty J, Paul J, Rai M, Manjunath C, Negi PC, Rajasekhar D, Sethi R, Routray S, Shanmugasundaram R, Padhi SS, Reddy P SS, Jeemon P. Assessment of the impact of heart failure on household economic well-being: a protocol. Wellcome Open Res 2021; 6:167. [PMID: 34632090 DOI: 10.12688/wellcomeopenres.16709.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The adverse impact of HF on the economic well-being has been narrated in various anecdotal reports from India, with affected individuals and their dependents pushed into the vicious cycle of poverty. There is limited research quantifying how HF impacts the economic well-being of households from low- and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The study will be initiated across 20 hospitals in India, which are part of the National heart Failure Registry (NHFR). The selected centres represent different regions in India, stratified based on the prevailing stages of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect data by using a validated and structured interview schedule. The study will have 80% power to detect an 8% difference in the proportion of households experiencing catastrophic health expenditures between two ETL groups. After considering a non-response rate of 5%, the target sample size is approximately 600 patients from each group and the total sample size is 1800 patients. Potential Impact: Our study will provide information on catastrophic health spending, distress financing and household expenditure in heart failure patients. Our findings will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.
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Affiliation(s)
- Sivadasanpillai Harikrishnan
- ICMR Centre for Advanced Research and Excellence In Heart Failure (CARE-HF), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Sanjay Ganapathi
- ICMR Centre for Advanced Research and Excellence In Heart Failure (CARE-HF), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Salim Reethu
- ICMR Centre for Advanced Research and Excellence In Heart Failure (CARE-HF), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Ajay Bahl
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anand Katageri
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Kalaburagi, India
| | - Animesh Mishra
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | | | | | - Bishav Mohan
- Dayanand Medical College Hospital, Ludhiana, India
| | - Hasit Joshi
- Apollo Hospitals International Ltd, Gandhinagar, India
| | | | | | | | | | | | | | - Rishi Sethi
- King George's Medical University, Lucknow, India
| | | | | | | | | | - Panniyammakal Jeemon
- ICMR Centre for Advanced Research and Excellence In Heart Failure (CARE-HF), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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Harikrishnan S, Ganapathi S, Reethu S, Bahl A, Katageri A, Mishra A, Alex AG, Roy B, Mohan B, Joshi H, Abdullakutty J, Paul J, Rai M, Manjunath C, Negi PC, Rajasekhar D, Sethi R, Routray S, Shanmugasundaram R, Padhi SS, Reddy P SS, Jeemon P. Assessment of the impact of heart failure on household economic well-being: a protocol. Wellcome Open Res 2021; 6:167. [PMID: 34632090 PMCID: PMC8491152 DOI: 10.12688/wellcomeopenres.16709.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Heart failure (HF), which is an emerging public health issue, adversely affects the strained health system in India. The adverse impact of HF on the economic well-being has been narrated in various anecdotal reports from India, with affected individuals and their dependents pushed into the vicious cycle of poverty. There is limited research quantifying how HF impacts the economic well-being of households from low- and middle-income countries. Methods: We describe the methods of a detailed economic impact assessment of HF at the household level in India. The study will be initiated across 20 hospitals in India, which are part of the National heart Failure Registry (NHFR). The selected centres represent different regions in India, stratified based on the prevailing stages of epidemiological transition levels (ETLs). We will collect data from 1800 patients with acute decompensated HF and within 6-15 months follow-up from the time of initial admission. The data that we intend to collect will consist of a) household healthcare expenditure including out-of-pocket expenditure, b) financing mechanisms used by households and (c) the impoverishing effects of health expenditures including distress financing and catastrophic health expenditure. Trained staff at each centre will collect data by using a validated and structured interview schedule. The study will have 80% power to detect an 8% difference in the proportion of households experiencing catastrophic health expenditures between two ETL groups. After considering a non-response rate of 5%, the target sample size is approximately 600 patients from each group and the total sample size is 1800 patients. Potential Impact: Our study will provide information on catastrophic health spending, distress financing and household expenditure in heart failure patients. Our findings will help policy makers in understanding the micro-economic impact of HF in India and aid in allocation of appropriate resources for prevention and control of HF.
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Affiliation(s)
- Sivadasanpillai Harikrishnan
- ICMR Centre for Advanced Research and Excellence In Heart Failure (CARE-HF), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Sanjay Ganapathi
- ICMR Centre for Advanced Research and Excellence In Heart Failure (CARE-HF), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Salim Reethu
- ICMR Centre for Advanced Research and Excellence In Heart Failure (CARE-HF), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Ajay Bahl
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anand Katageri
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Kalaburagi, India
| | - Animesh Mishra
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | | | | | - Bishav Mohan
- Dayanand Medical College Hospital, Ludhiana, India
| | - Hasit Joshi
- Apollo Hospitals International Ltd, Gandhinagar, India
| | | | | | | | | | | | | | - Rishi Sethi
- King George's Medical University, Lucknow, India
| | | | | | | | | | - Panniyammakal Jeemon
- ICMR Centre for Advanced Research and Excellence In Heart Failure (CARE-HF), Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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G. Kale P, Bimineni C, Lakshmi AY, Rajasekhar D, Madhusudan M. Association of computed tomography pulmonary angiography findings with clinical outcome in patients with acute pulmonary embolism. J NTR Univ Health Sci 2021. [DOI: 10.4103/jdrntruhs.jdrntruhs_197_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ram Pavan Kumar G, Rajasekhar D, Vanajakshamma V, Ravindra Dev V, Kiran B, Venkata Harish P. Assessment of right ventricular strain and strain rate before and after percutaneous atrial septal defect closure. Indian Heart J 2020. [DOI: 10.1016/j.ihj.2020.11.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Chandrasekhar Reddy P, Rajasekhar D, Bhargavi D, Vanajakshamma V, Sumanth P, Raghuram B, Sriram K. Assessment of left ventricular function by myocardial strain imaging in cancer patients before and after chemotherapy. Indian Heart J 2020. [DOI: 10.1016/j.ihj.2020.11.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ramasamy SM, Saravanavel J, Palanivel K, Kumanan CJ, Rajasekhar D. Detection of Submerged Harbour Using GEBCO and Mbes MBES, in the Offshore Region of Ancient Port City Poompuhar, South India. CURR SCI INDIA 2020. [DOI: 10.18520/cs/v119/i3/526-534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Rajasekhar D, Deepak Sankar PS, Rao AK, Narendrakumar D, Ramasundaram K. Reliability Assessment and System Performance Improvement of ORV <i>Sagar Nidhi</i> Propulsion System. CURR SCI INDIA 2020. [DOI: 10.18520/cs/v118/i11/1782-1785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Manda P, Srinivasa Rao PVLN, Bitla AR, Vinapamula KS, Jeyaseelan L, Rajasekhar D, Vishnubhotla S. Study of contrast-induced oxidative stress in nondiabetic patients undergoing coronary angiography. Saudi J Kidney Dis Transpl 2019; 30:45-52. [PMID: 30804266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Administration of iodinated contrast media is associated with serious complications such as acute kidney injury (AKI). Oxidative stress is implicated as a major mechanism underlying the production of contrast-induced AKI (CI-AKI). There are very few human studies on oxidative stress occurring after contrast administration. Twenty-seven patients scheduled for coronary angiography were recruited. An average of 22.2 mL low-osmolal nonionic contrast was administered. Plasma conjugated dienes (CD), lipid hydroperoxides (LOOH), malondialdehyde (MDA), protein carbonyl (PC), protein thiols (PTs), ferric reducing ability of plasma (FRAP), erythrocyte super oxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and glutathione reductase were estimated before, 30 min, 2 and 4 h after contrast administration. CD, LOOH, MDA, and PC increased (P <0.001), whereas PTs, FRAP, SOD, CAT (P <0.001), and GPx (P = 0.013) decreased in the first 4 h. Estimated glomerular filtration rate (eGFR) showed inverse association with MDA and positive association with GPx. The study provides evidence for oxidative stress following contrast administration even in the absence of predisposing factors. Association of eGFR with MDA and GPx indicate kidney as the source of oxidative stress. Hence, antioxidant therapy before contrast administration helps to prevent the development of oxidative stress, thereby reducing the risk of CI-AKI.
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Affiliation(s)
- Prasanth Manda
- Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - P V L N Srinivasa Rao
- Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Aparna R Bitla
- Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Kiranmayi S Vinapamula
- Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - L Jeyaseelan
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - D Rajasekhar
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Sivakumar Vishnubhotla
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Srinivasa Rao PVLN, Manda P, Bitla A, Vinapamula K, Jeyaseelan L, Rajasekhar D, Vishnubhotla S. Study of contrast-induced oxidative stress in nondiabetic patients undergoing coronary angiography. Saudi J Kidney Dis Transpl 2019. [DOI: 10.4103/1319-2442.252932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Satyanarayana V, Battula S, Rajasekhar D, Simha Reddy AK, Satri V. Clinical presentation and outcome in patients presenting with acute coronary syndrome – A prospective study. ACTA ACUST UNITED AC 2019. [DOI: 10.4103/jcsr.jcsr_50_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Doddipalli SR, Rajasekhar D, Vanajakshamma V, Sreedhar Naik K. Determinants of total ischemic time in primary percutaneous coronary interventions: A prospective analysis. Indian Heart J 2018; 70 Suppl 3:S275-S279. [PMID: 30595273 PMCID: PMC6309146 DOI: 10.1016/j.ihj.2018.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/23/2018] [Accepted: 05/05/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To assess the factors contributing to longer total ischemic times in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). METHODS Three hundred forty-six patients who underwent PPCI from July 2016 to June 2017 were studied. From time for the patient to recognize the symptoms, time was divided into 11 stages, any reason for delay was observed. RESULTS Mean window period was 6.7 ± 9.8 hours. Mean time to recognize the symptoms, reach first medical contact and prehospital management were 150.2 ± 140.5 min, 58.5 ± 57.0 min and 36.3 ± 38.0 min, respectively. Mean time for the patients brought in ambulance was 82.4 ± 59.8 min whereas for those transported in other vehicles was 130.4 ± 59.7 min (p = < 0.0001). Mean door to electrocardiogram (ECG) time, decision for PPCI, consent time and STEMI team activation time were 6.2 ± 3.1 min, 8.3 ± 4.5 min, 12.6 ± 16.2 min and 10.7 ± 8.2 min, respectively. Mean time for financial process and mean sheath to balloon time were 9.1 ± 6.9 min and 21.8 ± 11.7 min, respectively. Door to balloon time (DTB) was <90 min in 81% of the patients, mean DTB was 72.0 ± 33.0 min. Mean DTB for cases performed during night was 72.6 ± 32.9 min, whereas for those performed during day was 60.3 ± 30.2 min (p < 0.05). Total 30 day mortality was 2.9%. Mortality among DTB <90 min was 1.4%, mortality among DTB > 90 min was 9% (p < 0.05). CONCLUSIONS The main contributor for longer total ischemic time was the time taken for the patient to recognize the symptoms. DTB of <90 min can be achieved with effective hospital strategies.
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Affiliation(s)
| | - D Rajasekhar
- Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India.
| | - V Vanajakshamma
- Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India.
| | - K Sreedhar Naik
- Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India.
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Chanda N, Rajasekhar D, Vanajakshamma V, Kalyan M, Babu TS. Real time trans thoracic three dimensional echocardiography score (RT-TT3DE SCORE) in predicting the immediate outcomes of percutaneous transvenous mitral commissurotomy. Indian Heart J 2017. [DOI: 10.1016/j.ihj.2017.09.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Sreenivasa Reddy D, Rajasekhar D, Vanajakshamma V, Vijayalakshmi Devi B, Obul Reddy G, Sreedhar Naik K, Praveen Kumar Reddy S. Computed tomographic coronary angiography as a tool in diagnosis of coronary artery disease in patients with negative exercise stress test. Indian Heart J 2017. [DOI: 10.1016/j.ihj.2017.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Sreenivasa Reddy D, Rajasekhar D, Vanajakshamma V, Madhavi R, Kiran Kumar K, Sreedhar Naik K, Sowjenya G. Determinants of total ischemic time in primary percutaneous coronary interventions: A retrospective analysis. Indian Heart J 2017. [DOI: 10.1016/j.ihj.2017.09.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Vinodkumar N, Rajasekhar D, Vanajakshamma V, Madhavi R, Sowjenya G, Sreedhar NK, Narasimhareddy N. A comparative study of clinical profile and outcomes of patients with ischemic and non-ischemic complete heart block. Indian Heart J 2017. [DOI: 10.1016/j.ihj.2017.09.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Vinodkumar N, Rajasekhar D, Vanajakshamma V, Obul Reddy G, Sowjenya G, Sreedhar Naik K, Narasimhareddy N. Clinical risk scores correlation with angiographic extent of coronary artery disease and their 6 month outcomes in patients with non ST-elevation myocardial infarction. Indian Heart J 2017. [DOI: 10.1016/j.ihj.2017.09.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Vasudeva Chetty P, Rajasekhar D, Vanajakshamma V, Ranganayakulu KP, Kranthi Chaithanya D. Aortic velocity propagation: A novel echocardiographic method in predicting atherosclerotic coronary artery disease burden. J Saudi Heart Assoc 2017; 29:176-184. [PMID: 28652671 PMCID: PMC5475356 DOI: 10.1016/j.jsha.2016.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/02/2016] [Accepted: 10/13/2016] [Indexed: 11/26/2022] Open
Abstract
Background The major burden of cardiovascular disease mortality around the globe is due to atherosclerosis and its complications. Hence its early detection and management with easily accessible and noninvasive methods are valuable. Aortic velocity propagation (AVP) through color M-mode of the proximal descending aorta determines aortic stiffness, reflecting atherosclerosis. The aim of this study was to find the utility of AVP in predicting coronary artery disease (CAD) burden assessed through SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score and compared with carotid intima-media thickness (CIMT), which is an established surrogate marker of atherosclerosis. Methods In this cross-sectional comparative study, we measured AVP by color M-mode and CIMT by using Philips QLAB-IMT software in 100 patients, who underwent conventional coronary angiogram (CAG) between May 2013 and November 2014. Coronary artery disease is considered significant if >50% diameter stenosis is present in any epicardial coronary artery and insignificant if otherwise. Results Initially, to know the normal range we measured AVP and CIMT in 50 patients without any major risk factors for CAD but CAG was not done. Aortic velocity propagation ranged from 46 cm/s to 76 cm/s (mean = 58.62 ± 6.46 cm/s), CIMT ranged from 0.50 mm to 0.64 mm (mean = 0.55 ± 0.03 mm). Among 100 patients who underwent CAG we found 69% had significant CAD, 13% had insignificant CAD, and 18% had normal coronaries. Those with significant CAD had significantly lower AVP (41.65 ± 4.94 cm/s) [F (2,97) = 44.05, p < 0.0001] and significantly higher CIMT (0.86 ± 0.11 mm) [F (2,97) =35.78, p < 0.0001]. AVP had significant strong negative correlation with CIMT (r = −0.836, p < 0.0001, n = 100) and SYNTAX score (r = –0.803, p < 0.0001, n = 69), while CIMT was positively correlated with SYNTAX score significantly (r = 0.828, p < 0.0001, n = 69). Conclusions AVP and CIMT can predict CAD burden in a robust way. AVP may emerge as an exquisite bedside tool to predict atherosclerotic burden and guide in implementing preventive therapy for cardiovascular disease.
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Affiliation(s)
- Pakala Vasudeva Chetty
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, IndiaaIndia
| | - Durgaprasad Rajasekhar
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, IndiaaIndia
| | - Velam Vanajakshamma
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, IndiaaIndia
| | | | - Dommara Kranthi Chaithanya
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, IndiaaIndia
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Latha VLA, Suchitra MM, Bitla ARR, Srinivasa Rao PVLN, Rajasekhar D. Oxidant and antioxidant status in patients undergoing percutaneous coronary interventions. Asian J Med Sci 2017. [DOI: 10.3126/ajms.v8i2.16208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Coronary artery disease (CAD) is the major disease leading to cause mortality and morbidity. The imbalance between the generation of reactive oxygen species (ROS) and the intrinsic antioxidant defense system leading to the oxidative stress, has been implicated in the pathogenesis of the cardiovascular disease. The formed free radicals and subsequent lipid peroxidation may be responsible for myocardial damage in patients undergoing percutaneous coronary interventions. Therefore, the understanding of the pathophysiological role of ROS generated during or after coronary interventions is essential to improve the success rate of these procedures.Aims and Objective: The aim of this study was to evaluate the time course changes of oxidant and antioxidant status, in patients undergoing percutaneous coronary interventions (PCI).Materials and Methods: The study included 120 consecutive patients (117 males, 3 females; mean age 58.4 years) who underwent elective PCI. Coronary angiography and coronary angioplasty were performed according to the standard protocols. Blood samples were taken just before (0hrs) and at 4 hrs and 24 hrs after coronary interventions to determine the oxidative status i.e. plasma malondialdehyde (MDA) and for antioxidative status, erythrocyte glutathione peroxidase (GPx), erythrocyte glutathione (GSH) and plasma ferric reducing ability of plasma (FRAP).Results: There was significant increase in MDA levels (1.87±0.34, 1.90±0.46, p=0.000), at 4hrs and 24hrs after coronary interventions when compared to baseline levels. After coronary interventions, the GPx activity (12.96±8.37, 12.3±7.76, p=0.000) and FRAP levels (0.73±0.21, 0.70±0.23, p=0.001 respectively) were found to be increased significantly at 4hrs and 24hrs. However, the glutathione levels (2.40±0.57, 2.47±0.53, p=0.040) were decreased at 4hrs and 24hrs after coronary interventions.Conclusion: Our study demonstrates that presence of oxidative stress in coronary interventions. The increase in antioxidants in the present study may be due to paradoxical increase in oxidant levels in patients undergoing coronary interventions.Asian Journal of Medical Sciences Vol.8(2) 2017 29-33
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Ashalatha VL, Bitla AR, Kumar VS, Rajasekhar D, Suchitra MM, Lakshmi AY, Rao PVLNS. Biomarker response to contrast administration in diabetic and nondiabetic patients following coronary angiography. Indian J Nephrol 2017; 27:20-27. [PMID: 28182042 PMCID: PMC5255986 DOI: 10.4103/0971-4065.179335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C represent early renal injury markers for contrast-induced nephropathy (CIN). Baseline parameters such as type and quantity of contrast, patient preparation, renal function status, and diabetes mellitus (DM) are known to affect the response of the kidney to contrast-induced injury. This study was taken up to know the biomarker response to contrast administration in 58 diabetic and 59 nondiabetic male patients with same baseline parameters and baseline serum creatinine <1.2 mg/dl undergoing coronary angiography and their role in predicting the development of CIN. Serum creatinine, serum cystatin C, and urinary-NGAL (u-NGAL) were analyzed at baseline (0 h), 4 h, and 24 h after the administration of contrast medium. CIN was defined as a 25% increase in serum creatinine concentration from the baseline value or an absolute increase of at least 0.5 mg/dl within 48 h after the administration of contrast media. Serum creatinine rose 24 h after contrast administration in the diabetic group compared to 48 h in the nondiabetic group. Serum cystatin C levels rose 24 h after contrast administration in both the groups. The earliest marker to rise in both the groups was u-NGAL at 4 h. Diabetic patients had significantly higher u-NGAL (P = 0.005), and serum creatinine levels (P = 0.008) 4 h, and 24 h after contrast administration, respectively. Serum creatinine and u-NGAL/creatinine at 4 h were found to be the best predictors of CIN in the DM and non-DM patients, respectively. Biomarker response to contrast administration is different in diabetic and nondiabetic patients following contrast administration. Diabetic patients exhibit early and greater degree of renal impairment compared to the nondiabetic patients irrespective of the outcome. We propose the use of serum creatinine in patients with DM and u-NGAL/creatinine in non-DM patients to identify CIN as early as 4 h after contrast administration.
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Affiliation(s)
- V L Ashalatha
- Department of Biochemistry, S.V. Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - A R Bitla
- Department of Biochemistry, S.V. Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - V S Kumar
- Department of Nephrology, S.V. Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - D Rajasekhar
- Department of Cardiology, S.V. Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - M M Suchitra
- Department of Biochemistry, S.V. Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - A Y Lakshmi
- Department of Radiology, S.V. Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - P V L N S Rao
- Department of Biochemistry, S.V. Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Vamsidhar A, Rajasekhar D, Vanajakshamma V, Lakshmi AY, Latheef K, Siva Sankara C, Obul Reddy G. Comparison of PESI, echocardiogram, CTPA, and NT-proBNP as risk stratification tools in patients with acute pulmonary embolism. Indian Heart J 2016; 69:68-74. [PMID: 28228310 PMCID: PMC5319130 DOI: 10.1016/j.ihj.2016.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/29/2016] [Accepted: 07/16/2016] [Indexed: 11/28/2022] Open
Abstract
Objective The aim of this study is to prospectively assess the diagnostic accuracy of pulmonary embolism severity index, echocardiogram, computed tomography pulmonary angiogram (CTPA), and N-terminal pro b-type natriuretic peptide (NT-proBNP) for predicting adverse events in acute pulmonary embolism patients. Methods Thirty consecutive acute pulmonary embolism patients were included in this study. Combined adverse events consisted of in-hospital death or use of escalation of care including cardiopulmonary resuscitation, mechanical ventilation, vasopressor therapy, or secondary thrombolysis during hospital stay. Results The outcomes were met in 30% of patients. Qanadli index (a measure of clot burden on CTPA) and NT-proBNP were significantly higher in patients with adverse events than those without (p = 0.005 and p = 0.009, respectively). PESI had moderate positive correlation with right ventricular dysfunction (RVD) (r = 0.449, p = 0.013) but there was no significant difference in PESI between patients with and without adverse events (p = 0.7). Receiver operating characteristic analysis indicated that Qanadli index was the best predictor of adverse events with area under the curve (AUC) of 0.807 (95% CI: 0.651–0.963) with a negative predictive value (NPV) of 100% and positive predictive value (PPV) of 47.4% at cut-off value of 19. Right ventricle to left ventricle ratio on CTPA was found to predict RVD with AUC of 0.94 (95% CI: 0.842–1.000), NPV (77.8%), and PPV (95.2%) at cut-off value at 1.15. Conclusion Qanadli index is more accurate predictor of adverse events than pulmonary embolism severity index, NT-proBNP, and RVD on echocardiogram and CTPA.
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Affiliation(s)
- A Vamsidhar
- Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India
| | - D Rajasekhar
- Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India.
| | - V Vanajakshamma
- Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India
| | - A Y Lakshmi
- Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India
| | - K Latheef
- Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India
| | - C Siva Sankara
- Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India
| | - G Obul Reddy
- Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India
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Rajasekhar D, Vanajakshamma V, Ranganayakulu KP. Percutaneous Closure of an Iatrogenic Aorta to Right Ventricle Fistula Acquired Following Intracardiac Repair. Acta Cardiol Sin 2016; 32:371-4. [PMID: 27274181 PMCID: PMC4884768 DOI: 10.6515/acs20150701a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Iatrogenic aortocardiac fistulae have been described rarely following intracardiac repair. This 28 year-old-male presented to our facility with dyspnea going on 20 days after closure of ventricular septal defect (VSD) and resection of subaortic membrane. A communication was noticed between the aorta and the right ventricle (RV) upon transthoracic echocardiography. Cardiac catheterisation revealed a significant shunt and an aortogram revealed a 6 mm communication between aorta and right ventricle. Percutaneous closure of this defect was attempted under local anaesthesia through right femoral access. An alpha arteriovenous loop was formed despite repeated attempts, hence a retrograde approach for device delivery was considered. An 8 mm Amplatzer muscular VSD occluder device was deployed across the defect achieving a complete closure through an 8F delivery sheath. To the best of our knowledge this is the first report of an iatrogenic aorta to RV fistula occurring in a patient following an intracardiac repair which has been successfully treated percutaneously.
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Renuka IV, Premalatha P, Rayapa Reddy T, Rajasekhar D. Clear Cell Carcinoma of Salivary Gland with Intracranial Extension Through Jugular Foramen. Indian J Otolaryngol Head Neck Surg 2015; 67:422-4. [PMID: 26693463 DOI: 10.1007/s12070-015-0844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022] Open
Abstract
Clear cell carcinoma not otherwise specified type affecting the parotid gland is rare and extension of this tumor through the jugular foramen presenting as an intracranial space occupying lesion is extremely uncommon. We report a case of clear cell carcinoma of the parotid gland presenting as a left cerebellopontine angle tumor.
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Affiliation(s)
- I V Renuka
- Department of Pathology, NRI Medical College, Mangalagiri, 522503 Andhra Pradesh India
| | - P Premalatha
- Department of Pathology, NRI Medical College, Mangalagiri, 522503 Andhra Pradesh India
| | - T Rayapa Reddy
- Department of Pathology, NRI Medical College, Mangalagiri, 522503 Andhra Pradesh India
| | - D Rajasekhar
- Department of Pathology, NRI Medical College, Mangalagiri, 522503 Andhra Pradesh India
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Namratha K, Byrappa K, Byrappa S, Venkateswarlu P, Rajasekhar D, Deepthi BK. Hydrothermal fabrication of selectively doped organic assisted advanced ZnO nanomaterial for solar driven photocatalysis. J Environ Sci (China) 2015; 34:248-255. [PMID: 26257367 DOI: 10.1016/j.jes.2015.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/02/2015] [Indexed: 06/04/2023]
Abstract
Hydrothermal fabrication of selectively doped (Ag(+)+Pd(3+)) advanced ZnO nanomaterial has been carried out under mild pressure temperature conditions (autogeneous; 150°C). Gluconic acid has been used as a surface modifier to effectively control the particle size and morphology of these ZnO nanoparticles. The experimental parameters were tuned to achieve optimum conditions for the synthesis of selectively doped ZnO nanomaterials with an experimental duration of 4 hr. These selectively doped ZnO nanoparticles were characterized using powder X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), UV-Vis spectroscopy and scanning electron microscopy (SEM). The solar driven photocatalytic studies have been carried out for organic dyes, i.e., Procion MX-5B dye, Cibacron Brilliant Yellow dye, Indigo Carmine dye, separately and all three mixed, by using gluconic acid modified selectively doped advanced ZnO nanomaterial. The influence of catalyst, its concentration and initial dye concentration resulted in the photocatalytic efficiency of 89% under daylight.
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Affiliation(s)
- K Namratha
- Center for Material Science and Technology, Vijnan Bhavan, Manasagangotri, P. B. No 21, University of Mysore, Mysore 570006, India
| | - K Byrappa
- Center for Material Science and Technology, Vijnan Bhavan, Manasagangotri, P. B. No 21, University of Mysore, Mysore 570006, India.
| | - S Byrappa
- Department of Materials Science and Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - P Venkateswarlu
- Department of Chemistry, Sri Venkateswara University, Tirupati 517 502, India
| | - D Rajasekhar
- Department of Chemistry, Sri Venkateswara University, Tirupati 517 502, India
| | - B K Deepthi
- Center for Material Science and Technology, Vijnan Bhavan, Manasagangotri, P. B. No 21, University of Mysore, Mysore 570006, India
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Rajasekhar D, Vanajakshamma V, Vidyasagar A, Ranganayakulu KP, Babu MB, Sivasankara C, Kothari S, Thakkar A. Evaluation of prolonged safety and efficacy of biodegradable polymer coated sirolimus-eluting coronary stent system: 1-year outcomes of the INDOLIMUS Registry. Cardiovasc Diagn Ther 2015; 5:249-53. [PMID: 26331108 PMCID: PMC4536476 DOI: 10.3978/j.issn.2223-3652.2015.04.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 03/18/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND The main aim is to evaluate prolonged safety and efficacy of the Indolimus (Sahajanand Medical Technologies Pvt. Ltd.) sirolimus-eluting coronary stent system. METHODS It was a single center, non randomized, retrospective registry. Out of total 530 patients involved in the INDOLIMUS Registry, follow-up of 523 patients were obtained at 1-year The primary end-point of this was major adverse cardiac events, which is a composite of cardiac death, target lesion revascularization, target vessel revascularization, myocardial infarction and stent thrombosis, at 1-year follow-up. RESULTS Cardiac death, target lesion revascularization and myocardial infarction at 1-year were reported in 19 (3.6%), 2 (0.4%), and 2 (0.4%) patients respectively, while stent thrombosis was reported in 1 (0.2%) patient. The resultant major adverse cardiac events at 1-year were reported to be 24 (4.5%). CONCLUSIONS The lower incidence of MACE in uncontrolled and more complex cohorts at 1-year follow-up clearly depicts the prolonged safety and efficacy of the Indolimus sirolimus-eluting stent (SES) system.
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Devi BV, Lakshmi BS, Supraja C, Vanajakshmma V, Ram R, Rajasekhar D, Lakshmi AY, Sivakumar V. Hemorrhage from lumbar artery following percutaneous renal biopsy. Indian J Nephrol 2015. [PMID: 26199475 PMCID: PMC4495478 DOI: 10.4103/0971-4065.158174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We present a 58-year-old lady who underwent ultrasound-guided renal biopsy for suspected acute glomerulonephritis. Within minutes, the radiologist noticed an echogenic band around left kidney and in the muscular planes. Computerized tomography revealed focal active contrast extravasation from arcuate or interlobular artery in lower pole of left kidney and lumbar artery at third lumbar vertebra. The bleeding vessel was occluded with gelfoam.
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Affiliation(s)
- B Vijayalakshmi Devi
- Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - B Sangeetha Lakshmi
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - C Supraja
- Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - V Vanajakshmma
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - R Ram
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - D Rajasekhar
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - A Y Lakshmi
- Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - V Sivakumar
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Siva Sankara C, Rajasekhar D, Vanajakshamma V, Praveen Kumar BS, Vamsidhar A. Prognostic significance of NT-proBNP, 3D LA volume and LV dyssynchrony in patients with acute STEMI undergoing primary percutaneous intervention. Indian Heart J 2015; 67:318-27. [PMID: 26304563 DOI: 10.1016/j.ihj.2015.04.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 04/14/2015] [Accepted: 04/25/2015] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES The aim of the present study was to assess the short term prognostic significance of N-terminal pro BNP (NT-proBNP), 3D left atrial volume (LAV) and left ventricular (LV) dyssynchrony in patients of acute ST-elevation myocardial infarction (STEMI) who underwent primary Percutaneous intervention (PCI). BACKGROUND NT-proBNP, LV dyssynchrony and LAV in patients with acute coronary syndrome have been associated with PCI outcomes and predict the short and long-term prognosis. METHODS This study consisted of 142 patients with a first STEMI who underwent primary PCI. Baseline echocardiographic data was collected at admission and at 6 months follow up. Left ventricular dyssynchrony was measured by tissue Doppler imaging and LAV by real time 3D-echocardiography, plasma NT-proBNP levels were estimated between 72 and 96 h of admission. RESULTS During study period 3 patients expired and 4 developed congestive heart failure (CHF). Baseline NT-proBNP and LV dyssynchrony correlated with LV size and LV ejection fraction (LVEF) at baseline and during follow up. Patients with higher NT-proBNP levels and higher LV dyssynchrony showed significant increase in LV size with decrease in LVEF during follow-up. Baseline Left atrial volume index (LAVI) showed significant correlation with LV size but no association with LVEF at baseline and during follow-up. CONCLUSIONS Higher levels of NT-proBNP and higher LV dyssynchrony can predict patients with increase in LV size, worsening of LV systolic and diastolic function during follow-up. Patients with higher NT-proBNP levels at baseline developed CHF during follow-up.
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Affiliation(s)
- C Siva Sankara
- Senior Resident, Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India
| | - D Rajasekhar
- Professor & Head, Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India.
| | - V Vanajakshamma
- Professor, Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India
| | - B S Praveen Kumar
- Assistant Professor, Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India
| | - A Vamsidhar
- Senior Resident, Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India
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Praveen Kumar BS, Rajasekhar D, Vanajakshamma V. Study of clinical, radiological and echocardiographic features and correlation of Qanadli CT index with RV dysfunction and outcomes in pulmonary embolism. Indian Heart J 2014; 66:629-34. [PMID: 25634397 DOI: 10.1016/j.ihj.2014.10.405] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 10/09/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There are no Indian studies correlating the CT pulmonary embolism index (Qanadli) with right ventricular function and outcome. In the present study we aimed to study the clinical manifestations of patients presenting with acute pulmonary thromboembolism and correlate the radiographic features with echocardiographic features and outcome. METHODS Thirty five patients presenting with symptomatic acute pulmonary thromboembolism in between 2011 and 2013 were studied for clinical, radiological and echocardiographic features and outcome (in-hospital & 1 month follow up). RESULTS The mean duration of presentation after onset of symptoms was 5.7 ± 3.7 days. Right ventricular dysfunction was observed in 11 (31.4%) patients. Out of 35 patients in whom CT pulmonary angiogram performed, 14 patients had Qanadli PE index >60% of whom 11 (78.6%) patients had right ventricular dysfunction. None had right ventricular dysfunction when PE index was <60% (p < 0.001). There was significant correlation between pulmonary vascular obstruction index and right ventricular dysfunction (p < 0.0001). Nine (25.7%) patients were thrombolysed with Streptokinase. Total mortality including in-hospital and 1 month follow up was 11.4% (4 patients). The mortality in patients with PE index >60% was 21.4% and was nil with <60% (p = 0.02). The mortality in patients with right ventricular dysfunction was 27.2% and was nil without right ventricular dysfunction (p = 0.0075). CONCLUSION A PE index which was shown to be a strong independent predictor of right ventricular dysfunction in PE, correlating linearly with different variables associated with higher morbidity and mortality, enabling accurate risk stratification and selection of patients for more aggressive treatment.
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Affiliation(s)
- B S Praveen Kumar
- Assistant Professor, Department of Cardiology, SVIMS, Tirupati, A.P., India
| | - D Rajasekhar
- Professor and Head, Department of Cardiology, Sri Venkateswara Institute of Medical Sciences & University (SVIMS), Tirupati 517507, A.P., India.
| | - V Vanajakshamma
- Professor, Department of Cardiology, SVIMS, Tirupati, A.P., India
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Naresh K, Rajasekhar D, Vanajakshamma V, Sarath D. Predictive value of D-dimer levels and tissue Doppler mitral annular systolic velocity for detection of left atrial appendage thrombus in patients with mitral stenosis. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Vasudeva Chetty P, Rajasekhar D, Vanajakshamma V, Sarath Babu D, Ranganayakulu K. Comparative study of aortic velocity propagation by colour M-Mode with carotid intima media thickness as a non-invasive marker of atherosclerosis. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Vasudeva Chetty P, Rajasekhar D, Vanajakshamma V, Praveen kumar B, Ranganayakulu K. Study on appropriateness of Percutaneous Coronary Interventions [PCI] done in a high volume tertiary care centre. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Buchi Babu M, Rajasekhar D, Vanajakshamma, Sarath Babu D, Ravikanth A. Study of the relationship between metabolic syndrome score and angiographic severity of coronary artery disease according to the presence of diabetes. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Vamsidhar A, Rajasekhar D, Lakshmi A, Vanajakshamma V, Praveen Kumar B, Boochi Babu M. Incremental prognostic value of NT-pro BNP levels in acute pulmonary thromboembolism. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Siva sankara C, Rajasekhar D, Vanajakshamma V, Praveen Kumar B, Vamshidhar. Prognostic significance of NT-pro BNP, 3D LA volume and LV dyssynchrony in patients with acute STEMI undergoing primary PCI. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Boochi Babu M, Rajasekhar D, Vanajakshamma V, Yogesh K. Successful ablation of a concealed accessory pathway mediated tachycardia in a patient with Lutembacher syndrome. Minerva Cardioangiol 2014; 62:433-436. [PMID: 25295495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- M Boochi Babu
- Department of Cardiology, SVIMS, Tirupati, Andhra Pradesh, India -
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Vamsidhar A, Rajasekhar D, Vanajakshamma V, Babu DS, Rao KS, Vinod B. Multiple ruptures of left sinus of Valsalva aneurysm into main pulmonary artery. Asian Cardiovasc Thorac Ann 2014; 23:1096-9. [PMID: 24939914 DOI: 10.1177/0218492314540290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sinus of Valsalva aneurysm is a rare congenital glitch. We report an extremely rare case of left sinus of Valsalva aneurysm compressing and rupturing into the main pulmonary artery with 2 communications. The 34-year-old man also had severe aortic regurgitation and severe tricuspid regurgitation. He underwent successful polytetrafluoroethylene patch repair and aortic valve replacement. The rarity of this case highlights the need for a precise preoperative diagnosis, the roles of transthoracic echocardiography, transesophageal echocardiography, and 3-dimensional echocardiography, and the importance of prompt surgical management.
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Affiliation(s)
- Akkulagari Vamsidhar
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Durgaprasad Rajasekhar
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Velam Vanajakshamma
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | | | - Kanchumarthi Sudhakar Rao
- Department of Cardiothoracic and Vascular Surgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Bhan Vinod
- Department of Cardiothoracic and Vascular Surgery, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
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Rajasekhar D, Vanajakshamma V, Shashank C, Srinivasakumar ML, Sivasankara C. The real world experience of the biodegradable polymer-coated sirolimus-eluting coronary stent system: Results From an "All-Comers" Clinical Experience. Catheter Cardiovasc Interv 2013; 88:E93-8. [PMID: 24307634 DOI: 10.1002/ccd.25246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/31/2013] [Accepted: 10/10/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVES This INDOLIMUS Registry sought to evaluate the safety and efficacy of the biodegradable polymer coated Indolimus(®) sirolimus-eluting coronary stent for the treatment of coronary artery disease across a wide range of patients treated in routine clinical practice, including those with high-risk characteristics and complex lesions. BACKGROUND First-generation drug-eluting stents utilize nonbiodegradable polymeric coatings, whose persistent presence in the arterial wall may negatively affect long-term outcomes. It has been hypothesized that persistent presence of polymer may compromise the safety of drug-eluting stents, and that therefore biodegradable polymer coatings might reduce late adverse events in an unselected patient population. METHODS All 530 consecutive unselected patients (415 males and 115 females) included who underwent percutaneous coronary intervention at the Sri Venkateswara Institute of Medical Sciences, Tirupati, India between August 2012 and March 2013, with an in-hospital, at 30-days and at 6-months follow-up. Retrospective analysis of those data had been done. RESULTS A total of 617 lesions were treated in 530 enrolled patients (mean age 54.9 ± 10.8 years) with average stent length of 18.8 ± 6.0 mm. An average of 1.18 stents was implanted per patient. The patients' characteristics are noted as having 169 (31.9%) patients of diabetics and 215 (40.6%) hypertension. Smoking, alcoholism and tobacco chewing were found in 273 (51.5%), 130 (24.5%) and 17 (3.2%), respectively. The indications for intervention were unstable angina in 77 (14.5%) and previous myocardial infarction in 56 (10.6%) of the patients. Lesions were of type B2 in 264 (42.7%) and type C in 127 (20.6%). Stent delivery was successful in all cases and in-hospital, 30-days and 6-months follow-up of all 530 patients was obtained. The incidence of any major adverse cardiac events at in-hospital, at 30-days and at 6-months were 5 (0.94%), 8 (1.52%), and 18 (3.40%), respectively. Long term follow-up of this registry is ongoing to confirm safety and efficacy profiles. CONCLUSIONS The relatively low event rate that was observed in INDOLIMUS Registry indicates that the biodegradable polymer coated Indolimus(®) sirolimus-eluting coronary stent can achieve excellent clinical performances in a large group of patients. © 2013 Wiley Periodicals, Inc.
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Affiliation(s)
- D Rajasekhar
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, 517507, India.
| | - V Vanajakshamma
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, 517507, India
| | - C Shashank
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, 517507, India
| | - M L Srinivasakumar
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, 517507, India
| | - C Sivasankara
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, 517507, India
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Varalakshmi M, Srinivasulu D, Rajasekhar D, Raju CN, Sreevani S. CeCl3·7H2O Catalyzed, Microwave-Assisted High-Yield Synthesis of α-Aminophosphonates and their Biological Studies. PHOSPHORUS SULFUR 2013. [DOI: 10.1080/10426507.2013.798785] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rajasekhar D, Rao DS, Srinivasulu D, Raju CN, Balaji M. Microwave Assisted Synthesis of Biologically Active α-Aminophosphonates Catalyzed by Nano-BF3·SiO2 under Solvent-Free Conditions. PHOSPHORUS SULFUR 2013. [DOI: 10.1080/10426507.2012.723656] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- D. Rajasekhar
- a Department of Chemistry , Sri Venkateswara University , Tirupati , Andhra Pradesh , India
| | - D. Subba Rao
- a Department of Chemistry , Sri Venkateswara University , Tirupati , Andhra Pradesh , India
| | - D. Srinivasulu
- a Department of Chemistry , Sri Venkateswara University , Tirupati , Andhra Pradesh , India
| | - C. Naga Raju
- a Department of Chemistry , Sri Venkateswara University , Tirupati , Andhra Pradesh , India
| | - M. Balaji
- b Department of Biochemistry , Sri Venkateswara University , Tirupati , Andhra Pradesh , India
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Shashanka C, Rajasekhar D, Vanajakshamma V, Kumar MLS. Three-dimensional echocardiographic assessment before and after percutaneous transvenous mitral commissurotomy in patients with rheumatic mitral stenosis. J Heart Valve Dis 2013; 22:543-549. [PMID: 24224418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Real-time three-dimensional transthoracic echocardiography (RT3DE) is a relatively recent imaging technique that provides excellent image quality of the mitral valve. It has been suggested that this new echocardiographic modality, which allows a precise cross-section of the mitral orifice at the tips of the leaflets with correct plane orientation, may provide a more accurate assessment of rheumatic mitral stenosis (MS) than two-dimensional echocardiography (2DE), before and after percutaneous transvenous mitral commissurotomy (PTMC). METHODS A total of 50 patients with symptomatic mitral stenosis who underwent PTMC was evaluated prospectively. Patients in all age groups, with evidence of severe MS admitted to the authors' institution, in whom PTMC was feasible were included. RESULTS A good valve opening was observed in 45 patients (90%). The mitral valve area (MVA) assessed before PTMC with 3DE (3D-MVA) correlated well with that assessed with 2DE (2D-MVA) (0.85 +/- 0.12 cm2 versus 0.86 +/- 0.13 cm2, p < 0.001); the mean difference between methods was small (0.01 +/- 0.11 cm2) and correlation excellent (r = 0.64, p < 0.001). After PTMC, values of 3D-MVA did not differ from, and correlated well with, values of 2D-MVA (1.79 +/- 0.20 cm2 versus 1.74 +/- 0.18 cm2, p = 0.006); the mean difference between methods was small (0.05 +/- 0.02 cm2) and correlation excellent (r = 0.76, p = 0.0001). Before PTMC, Bland-Altman analysis showed a good agreement between methods (mean difference -0.01 +/- 0.11 cm2, lower limit -0.24, upper limit 0.22). After PTMC, Bland-Altman analysis showed a good agreement between methods (mean difference -0.05 +/- 0.13 cm2, lower limit -0.3, upper limit 0.2). Evaluation of the commissural opening after PTMC, using RT3DE, showed that excellent commissural evaluation was possible in all patients. Compared with RT3DE, an underestimation of the degree of commissural fusion using 2DE was observed in 32%, with a weak agreement between methods. CONCLUSION RT3DE provided accurate measurements of MVA, similar to 2D planimetry. RT3DE also improved the description of valvular anatomy and provided a unique assessment of the extent of commissural splitting.
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Affiliation(s)
- Chunduri Shashanka
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India.
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Rao UV, Vanajakshamma V, Rajasekhar D, Lakshmi AY, Reddy RN. Magnetic resonance angiography vs. angiography in tetralogy of Fallot. Asian Cardiovasc Thorac Ann 2013; 21:418-25. [PMID: 24570523 DOI: 10.1177/0218492312457360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM : To determine whether gadolinium-enhanced three-dimensional magnetic resonance angiography can provide a noninvasive alternative to diagnostic catheterization for evaluation of pulmonary artery anatomy in tetralogy of Fallot. PATIENTS AND METHODS Thirty-five consecutive patients with tetralogy of Fallot, who attended the cardiology outpatient department between January 2008 and December 2009, were included in the study. There were 21 males and 14 females, with a mean age of 9 ± 4.15 years (range, 3-21 years). Thirty-two patients had tetralogy of Fallot with varying severities of valvular and infundibular stenosis. Three patients had tetralogy of Fallot with pulmonary atresia. All patients underwent both cardiac catheterization with X-ray angiography and 3-dimensional magnetic resonance angiography within one month. RESULTS Measurements of right and left pulmonary arteries and aortopulmonary collaterals were equal by both methods. There was a good correlation between magnetic resonance angiography and catheterization measurements of branch pulmonary arteries. CONCLUSION Gadolinium-enhanced three-dimensional magnetic resonance angiography can be used as a reliable noninvasive alternative to X-ray cineangiography for delineation of pulmonary arterial anatomy in sick infants and young children, obviating the need for catheterization.
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Priyadarshini V, Pradhan D, Munikumar M, Swargam S, Umamaheswari A, Rajasekhar D. Genome-based approaches to develop epitope-driven subunit vaccines against pathogens of infective endocarditis. J Biomol Struct Dyn 2013; 32:876-89. [PMID: 24404767 DOI: 10.1080/07391102.2013.795871] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Infective endocarditis (IE) has emerged as a public health problem due to changes in the etiologic spectrum and due to involvement of resistant bacterial strains with increased virulence. Developing potent vaccine is an important strategy to tackle IE. Complete genome sequences of eight selected pathogens of IE paved the way to design common T-cell driven subunit vaccines. Comparative genomics and subtractive genomic analysis were applied to identify adinosine tri phosphate (ATP)-binding cassette (ABC) transporter ATP-binding protein from Streptococcus mitis (reference organism) as common vaccine target. Reverse vaccinology technique was implemented using computational tools such as ProPred, SYFPEITHI, and Immune epitope database. Twenty-one T-cell epitopes were predicted from ABC transporter ATP-binding protein. Multiple sequence alignment of ABC transporter ATP-binding protein from eight selected IE pathogens was performed to identify six conserved T-cell epitopes. The six selected T-cell epitopes were further evaluated at structure level for HLA-DRB binding through homology modeling and molecular docking analysis using Maestro v9.2. The proposed six T-cell epitopes showed better binding affinity with the selected HLA-DRB alleles. Subsequently, the docking complexes of T-cell epitope and HLA-DRBs were ranked based on XP Gscore. The T-cell epitope (208-LNYITPDVV-216)-HLA-DRB1(∗)0101 (1T5 W) complex having the best XP Gscore (-13.25 kcal/mol) was assessed for conformational stability and interaction stability through molecular dynamic simulation for 10 ns using Desmond v3.2. The simulation results revealed that the HLA-DRB-epitope complex was stable throughout the simulation time. Thus, the epitope would be ideal candidate for T-cell driven subunit vaccine design against infective endocarditis.
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Affiliation(s)
- Vani Priyadarshini
- a SVIMS Bioinformatics Centre, SVIMS University , Tirupati , Andhra Pradesh , 517507 , India
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Sarath Babu D, Ranganayakulu KP, Rajasekhar D, Vanajakshamma V, Pramod Kumar T. Assessment of mitral valve commissural morphology by transoesophageal echocardiography predicts outcome after balloon mitral valvotomy. Indian Heart J 2013; 65:269-75. [PMID: 23809380 DOI: 10.1016/j.ihj.2013.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Revised: 03/10/2013] [Accepted: 04/03/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Balloon mitral valvotomy (BMV) is a safe and an effective treatment in patients with symptomatic rheumatic mitral stenosis. This study was conducted to validate the importance of assessing the morphology of mitral valve commissures by transoesophageal echocardiography and thereby predicting the outcome after balloon mitral valvotomy [BMV]. MATERIALS AND METHODS Study consisted of 100 patients with symptomatic mitral stenosis undergoing BMV. The Commissural Morphology and Wilkins score were assessed by transoesophageal echocardiography. Both the commissures (anterolateral and posteromedial) were scored individually according to whether non-calcified fusion was absent (0), partial (1), or extensive (2) and calcification (score 0) and combined giving an overall commissural score of 0-4. Outcome of BMV was correlated with commissural score and Wilkins score. RESULTS The commissural score and outcome after BMV correlated significantly. 66 of 70 patients (94%) with a commissural score of 3-4 obtained a good outcome compared with only six (20%) patients of 30 with a commissural score of 0-2 (positive and negative predictive accuracy 94% and 80%, respectively, p < 0.001). Increase in 2DMVA post BMV was more in patients with higher commissural score (score of 3-4). Wilkins score <8 usually predicts a good outcome but even in patients with Wilkins score >8 a commissural score >2 predicts a 50% chance of a good result. CONCLUSIONS A higher commissural score predicts a good outcome after BMV hence it can be concluded that along with Wilkins score, commissural morphology and score should be assessed with TOE in patients undergoing BMV.
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Affiliation(s)
- D Sarath Babu
- Senior Resident, Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati 517507, Andhra Pradesh, India.
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Himabindu G, Rajasekhar D, Latheef K, Sarma PVGK, Vanajakshamma V, Chaudhury A, Bitla AR. Factor V Leiden mutation is not a predisposing factor for acute coronary syndromes. Indian Heart J 2012; 64:570-5. [PMID: 23253409 DOI: 10.1016/j.ihj.2012.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 05/20/2012] [Accepted: 07/17/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prevalence of Coronary artery disease (CAD) in India has increased considerably over the past few years and could become the number one killer disease if interventions are not done. Factor V Leiden (FVL) mutation and FII G20210A polymorphism are two recently described genetic factors with a propensity towards venous thrombosis. This warrants the investigations for thrombophilia in myocardial infarction patients in India. METHODS The study cohort consisted of 51 patients aged below 50 years presenting with acute coronary syndromes. In both patient group and normal individuals the major risk factors Protein C deficiency, Protein S deficiency, anticardiolipin antibodies, Fibrinogen and Lipoprotein [a] were studied. Factor V Leiden (FVL) G1691A mutation in both control and patient group was looked by using Polymerase chain reaction (PCR) followed by sequencing of the PCR products. RESULTS Our results indicated significantly higher levels of anticardiolipin antibodies and fibrinogen in the patients and absence of FVL (G1691A) mutation in our study cohort. One of the patients (H5) showed insertion of an extra A nucleotide in exon 10 of the Factor V gene resulting in frame shift mutation in this patient. CONCLUSION The results of present study showed absence of FVL mutation in our population. However, there is a need to confirm the above findings on patients from different populations from different parts of the country. The insertion of an extra A in exon 10 in the patient needs to be ascertained to confirm that it is one of its kinds or is prevalent in the population.
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Affiliation(s)
- G Himabindu
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences & University, Andhra Pradesh, India
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Rajasekhar D, Saibaba KSS, Srinivasa Rao PVLN, Latheef SAA, Subramanyam G. Lipoprotein (A): Better assessor of coronary heart disease risk in south Indian population. Indian J Clin Biochem 2012; 19:53-9. [PMID: 23105457 DOI: 10.1007/bf02894258] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In an attempt to search for risk factors which can explain the increasing prevalence of coronary heart disease (CHD) in Indian population, we conducted a case-control study to assess the association of Lipoprotein (a)(Lp(a)) with CHD. One hundred and fifty one consecutive patients with clinical and angiographic evidence of CHD and forty-nine healthy controls were drawn for the study. Triglycerides, very low density cholesterol (VLDL-C), total cholesterol (total-C)/high density cholesterol (HDL-C) ratio, low density cholesterol (LDL-C)/HDL cholesterol ratio and Lp(a) were found to be higher in patients than controls. In female sex and in those with family history of CHD, higher total and LDL cholesterol levels were observed to be associated with higher Lp(a) levels. Lp(a) levels were also found to be higher in triple vessel disease than other vessel disease patients. Significant difference in Lp(a) levels were observed between normal coronaries vs. single and triple vessel disease(P<0.05) and also between single vs. double and triple vessel disease (P<0.01).Lp(a) levels correlated positively with vessel severity(P<0.005). Lp(a) levels >25 mg/dl were associated with coronary heart disease (Odds ratio 1.98 P<0.05 95% CI 0.007-1.18). Our findings suggest a cut-off level of 25mg/dl for determination of risk of CHD. Studies from different areas involving larger sample size are needed to confirm the findings of the present study.
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Affiliation(s)
- D Rajasekhar
- Department of Cardiology, Sri Venkatesware Institute of Medical Sciences, 517507 Tirupati, India
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Ganeswara Reddy V, Rajasekhar D, Vanajakshamma V. Effect of percutaneous mitral balloon valvuloplasty on left atrial appendage function: transesophageal echo study. Indian Heart J 2012; 64:462-8. [PMID: 23102383 DOI: 10.1016/j.ihj.2012.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 06/20/2012] [Accepted: 07/17/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To compare left atrial appendage (LAA) function by Doppler and Doppler tissue imaging (DTI) before and after percutaneous balloon mitral valvuloplasty (PBMV). MATERIALS AND METHODS Fifty-nine patients with symptomatic rheumatic mitral stenosis who underwent PBMV were included in this study. LAA function was measured before and after PBMV. To study LAA function, LAA late emptying (LAALE) velocity, LAA late filling (LAALF) velocity, and LAA area change percentage (LAAAC %) were measured. In the DTI study, tissue Doppler velocities of the LAA, including peak early diastolic (E(LAA)), peak late diastolic (A(LAA)), and peak systolic (S(LAA)), were measured. RESULTS There was significant increase in LAALE velocity, LAALF velocity, E(LAA), A(LAA), S(LAA) waves measured by Doppler and DTI after PBMV compared with baseline (p < 0.001) but there was no significant change in LAAAC% (p = not significant). Spontaneous echo contrast was present in 10 of the 59 patients before the procedure. It completely disappeared (6 patients) or decreased (4 patients) after PBMV. CONCLUSIONS Our results suggest that PBMV improves LAA function and, thereby, may have a favorable influence on future thromboembolic complications.
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Affiliation(s)
- V Ganeswara Reddy
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Andhra Pradesh, India.
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Naidu OA, Rajasekhar D, Latheef SAA. Assessment of endothelial function by brachial artery flow mediated dilatation in microvascular disease. Cardiovasc Ultrasound 2011; 9:40. [PMID: 22151947 PMCID: PMC3250931 DOI: 10.1186/1476-7120-9-40] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 12/09/2011] [Indexed: 11/15/2022] Open
Abstract
Background Cardiac syndrome X is an important therapeutic and diagnostic challenge to physician. Study of Csx patients may help to understand the pathophysiology of coronary microcirculation and to gain an insight on the management of these group patients. Methods We measured the flow mediated dilation of the brachial artery both endothelium dependent and independent vasodilatation by high resolution ultrasound in 30 cardiac syndrome X patients and matched with 30 healthy control subjects. Results Significantly decreased flow mediated dilatation was observed in patients when compared to control (9.42 ± 7.20 vs 21.11 ± 9.16 p < 0.01) but no significant difference was observed between groups in response to nitroglycerin (25.39 ± 6.82 vs 28.87 ± 8.69). Receiver operator characteristic analysis showed that value of < 11.11 had sensitivity of 80%, specificity 86.67%, positive predictive value 76.66%, negative predictive value 83.33%. In total, 46% of subjects had endothelial dysfunction and of them, CSX subjects had higher prevalence (76% vs 16% p < 0.01) than control subjects. Higher mean values of body mass index, systolic blood pressure and diastolic blood pressure was observed in subjects with FMD < 11.11 than > 11.11(p < 0.01). In logistic regression analysis, FMD was significantly associated with systolic blood pressure (Odds ratio 1.122 95% CI 1.053-1.196 p < 0.01) and body mass index (Odds 1.248 95%CI 0.995-1.56 p < 0.05). Conclusions The study suggests impairment of endothelial function in cardiac syndrome X patients. Increased Systolic blood pressure and body mass index may increase the risk of impairment of endothelial function in this group of patients.
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Affiliation(s)
- Otikunta Adikesava Naidu
- Department of Cardiology, Osmania General Hospital and Osmania Medical College, Hyderabad, Andhra Pradesh, India.
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