BACKGROUND:Thromboelastography (TEG) offers real-time evaluation of hemostatic function and holds promise for assessing thrombus burden during ST-segment elevation myocardial infarction (STEMI). This study aimed to validate the diagnostic utility of kaolin-activated TEG in correlating coagulation parameters with angiographic thrombus burden in acute STEMI patients. METHODS:Eighty-one consecutive STEMI patients (age 18-75 years) underwent TEG testing during emergency visit just prior to primay percutaneous coronary intervention (PPCI). Diagnostic validity for TEG indices (R-time, K-time, α-angle, MA, CI, TPI, Ly30) was assessed by sensitivity, specificity, predictive values, and odds ratios. RESULTS:R-time and K-time showed high specificity (96.4% and 85.7%, respectively) and positive predictive values (85.7% and 75%), supporting their use as specific indicators ("SPIN") for thrombus presence. However, sensitivity of all indices was low (R: 12.5%, K: 27.3%), limiting their utility as screening tools. The α-angle and MA displayed moderate specificity (71.4% and 57.7%), with positive predictive values of 60% and 63.3% respectively. The α-angle significantly correlated with higher thrombus grades (p = 0.01), indicating faster fibrin polymerization in more severe cases. Gains in diagnostic knowledge were highest for R-min (23%) and K-min (14%). CONCLUSION:Kaolin-activated TEG, particularly R-time and K-time, demonstrates high specificity but limited sensitivity for identifying high thrombus burden during STEMI. The α-angle remains clinically informative for clot kinetics. While TEG may complement existing assessments for targeted antithrombotic therapy, its greatest utility lies in confirming, rather than screening for, severe thrombus burden. Further prospective studies are warranted to refine its prognostic value (Graphical abstract).
Background Acute coronary syndrome (ACS) remains a leading cause of cardiovascular morbidity and mortality worldwide. High-throughput omics technologies offer opportunities for more comprehensive understanding of ACS pathophysiology. Methods A systematic review was conducted in accordance with PRISMA 2020 guidelines. Searches of PubMed/MEDLINE, Scopus, Web of Science and Embase (January 2015-April 2026) identified 8,731 records. Study quality and risk of bias were assessed for studies selected for detailed evidence synthesis using the Newcastle-Ottawa Scale, QUADAS-2 and AMSTAR-2. Results Systematic searching identified 866 primary studies and 47 systematic reviews. Detailed synthesis focused on the most robust and replicated biomarker candidates where ceramide risk scores, GDF-15, MPO and miR-208a emerged as particularly promising while multi-omics machine-learning models improved ACS classification. Conclusions Multi-omics approaches may enhance precision risk stratification in ACS although prospective validation and standardization remain essential.
Atrial functional mitral regurgitation (AFMR) may account for a substantial proportion of functional MR, although its prevalence varies by population and diagnostic definition. AFMR increases mortality risk regardless of left ventricular (LV) function. The mechanism involves mitral annular dilation and "atriogenic leaflet tethering." Key echocardiographic features include preserved left ventricular ejection fraction (LVEF; typically >50%), significant left atrial (LA) enlargement, mitral annular dilation, and minimal leaflet tethering. Medical therapy, including renin-angiotensin system inhibition/angiotensin receptor-neprilysin inhibition (ARNI) and sodium-glucose co-transporter 2 (SGLT2) inhibitors, may favorably influence LA remodeling and AFMR severity, although AFMR-specific evidence remains limited. In patients with concomitant atrial fibrillation/flutter, restoration of sinus rhythm with cardioversion or catheter ablation may improve LA function and reduce AFMR severity. Surgical mitral annuloplasty is an also an option for low-risk patients with concomitant procedures. Mitral transcatheter edge-to-edge repair (M-TEER) in AFMR has had outcomes comparable to ventricular functional MR (VFMR). Maintaining a low post-procedural mean pressure gradient (MPG < 5 mmHg) is crucial. Preliminary experience with transcatheter indirect mitral valve annuloplasty (Carillon device) has also shown feasibility. Mitral replacement platforms face challenges due to high risk of LV outflow tract obstruction and atrial migration.
OBJECTIVE:This study aimed to characterize differences in clinical presentation, metabolic parameters and cytokine profiles between STEMI and NSTE-ACS patients and identify potential biomarkers of disease severity and inflammation. METHODS:An exploratory study was conducted on 60 ACS patients (30 STEMI, 30 NSTE-ACS) experiencing their first episode. Clinical characteristics, routine laboratory parameters and multiplex cytokine analysis (GM-CSF, IFN-γ, IL-1β, IL-4, IL-6, IL-8, IL-9, IL-10, IL-12P70, IL-18, MCP-1, M-CSF, TNF-α) were compared. Normality was assessed using the Shapiro-Wilk test and statistical comparisons were made using t-tests or Mann-Whitney U tests for continuous variables and chi-square tests for categorical variables. Multivariable logistic regression and Benjamini-Hochberg false-discovery-rate (FDR) correction were applied. RESULTS:Chest pain was more frequent in STEMI (28/30 [93.3%] vs 15/30 [50.0%]; p = 0.0006) with higher prevalence of diabetes mellitus (24/30 [80.0%] vs 6/30 [20.0%]; p < 0.0001), worse lipid profile and increased inflammation (CRP 126.48 [44.63 - 169.75] mg/L vs 15.98 [3.75 - 39.49] mg/L; p = 0.0001). Cytokine analysis revealed significantly higher levels of IL-6, IL-8, IL-1β, IL-18, and M-CSF in STEMI after FDR correction (all FDR < 0.05). These differences persisted in non-diabetic sensitivity analysis and after multivariable adjustment for diabetes, HbA1c and CRP. The composite cytokine panel showed modest discriminatory capacity (AUC 0.69, 95% CI 0.55 - 0.83). CONCLUSIONS:STEMI is characterized by greater inflammation, dyslipidemia and diabetes burden compared to NSTE-ACS. These differences persist after sensitivity analysis, multivariable adjustment and FDR correction revealing distinct inflammatory profiles that support the hypothesis of subtype-specific immune activation and pathways.
BACKGROUND:TGA accounts for 5-7% of congenital heart disease, with a prevalence of 0.2 per 1000 live births. The Modified Leiden Convention provides a standardized nomenclature for describing coronary artery anatomy across imaging and surgical practice. A thorough understanding of coronary artery anatomy is essential for planning the arterial switch operation as it is the established treatment for infants with TGA. METHODS:Our study was a cross-sectional study which included 62 infants (<6 months) diagnosed with TGA or TGA-type DORV. Origin of the coronary artery anatomy was classified using the Modified Leiden Convention. Interpretation of findings were performed independently by experienced observers who were blinded to the findings of the other modality. CT angiography was considered the reference standard. Sensitivity, specificity, predictive values, diagnostic accuracy, and agreement (Cohen's kappa) were calculated. RESULTS:CT angiography identified usual coronary anatomy in 33 patients (53.2%) and variant patterns in 29 patients (46.8%) among the 62 infants. Echocardiography demonstrated a sensitivity of 84.8% and a specificity of 31.0% in diagnosing usual coronary artery anatomy. The positive predictive value for usual anatomy was 58.3%, and the negative predictive value was 64.3%. Echocardiography demonstrated a sensitivity of only 31.0% and a specificity of 84.8% in demonstrating variant anatomy. CONCLUSION:Echocardiography accurately identified the usual coronary artery pattern but had limited sensitivity for coronary variants. CT angiography is a valuable complementary tool when echocardiographic findings are inconclusive or complex anatomy is suspected before arterial switch surgery.
BACKGROUND:Peripartum cardiomyopathy(PPCM) is an uncommon but potentially life-threatening cause of heart failure occurring during late pregnancy or the early postpartum period. Data describing the clinical profile and long-term outcomes of hospitalized PPCM patients remain limited. OBJECTIVES:To describe the clinical presentation, disease severity, one-year clinical and echocardiographic outcomes of women with PPCM requiring hospitalisation, and to explore factors associated with left ventricular (LV) functional recovery. METHODS:A prospective observational study enrolled 47 consecutive women diagnosed with PPCM between June 2021 to June 2023 at a tertiary cardiac care hospital. The study assessed clinical characteristics, echocardiographic, electrocardiographic parameters, with the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores and maternal outcomes at presentation, 6 months and 1 year follow up, with LV recovery defined as LVEF ≥45%. RESULTS:The mean age was 29.3 ± 5.5 years. Most patients presented postpartum (83%) and with advanced heart failure; over 98% were in NYHA class III-IV, and 83% had severe LV systolic dysfunction at admission.Mean LVEF improved from 25.7 ± 6.3% at baseline to 31.8 ± 9.4% at 6 months and 38.8 ± 13.1% at 1 year (p=<0.0001).LV recovery (LVEF ≥45%) occurred in 13.3% of patients at 6 months and 42.2% at 1 year. TAPSE, NYHA class and KCCQ score were also improved significantly at 1 year (p=<0.0001). Exploratory analysis showed baseline TAPSE(OR 1.29,95% CI 1.03-1.61,p = 0.03)was independent predictor of LV recovery.Rehospitalisation occurred in 29.8% and overall, one-year mortality rate was 6.4%. CONCLUSIONS:Despite severe initial presentation, substantial improvement in ventricular function and clinical status occurs in many high risk PPCM patients with guideline-directed therapy and structured follow-up.
In this study, Mohan et al found that, of the 15,527 industrial workers in Ludhiana, North India, 22% had hypertension, of which 85% was undiagnosed and 11% had diabetes. Three methodological issues discussed in this commentary are worthy of consideration: firstly, the implications of the largely migrant male workforce for generalisability; secondly, the lack of a structured cardiovascular risk-scoring system to put individual risk factor prevalence into context; and, thirdly, the need to consider occupational exposures (such as noise, shift work and heat stress) as separate cardiovascular risk factors not included in the study's risk profile.
BACKGROUND:Amiodarone is an effective antiarrhythmic agent but causes thyroid dysfunction in 15-20% of patients, resulting in amiodarone-induced hypothyroidism (AIH) and thyrotoxicosis (AIT). METHODS:We performed a narrative review of randomized trials, prospective cohort studies, systematic reviews, and major guideline documents. PubMed and Embase were searched from January 2000 to December 2024 using terms related to amiodarone, thyroid dysfunction, thyrotoxicosis, and hypothyroidism. Priority was given to higher-quality evidence and contemporary society guidelines, including those from the ACC/AHA, ESC, ETA, and ATA. RESULTS:AIH is generally managed with levothyroxine without routine amiodarone discontinuation. AIT requires phenotypic differentiation and phenotype-directed therapy, with corticosteroids preferred for Type 2 AIT and antithyroid drugs for Type 1 AIT. Decisions regarding amiodarone continuation should be individualized according to thyroid and cardiac risk. CONCLUSIONS:Baseline screening, structured monitoring, and phenotype-directed management allow effective treatment of amiodarone-associated thyroid dysfunction while preserving arrhythmia control.
Ostial stent placement invariably results in a ‘miss’ or ‘overshoot’ compromising clinico-angiographic outcomes and is largely due to the inadequate localization of the true ostium in different angiographic views. We herein describe a novel “Two - wire technique” for ostial stenting which helps precise ostial stent placement.
BACKGROUND:Self-management of vitamin K antagonist (VKA) therapy may enhance the quality of anticoagulation compared with conventional monitoring; however, selection criteria in low-socioeconomic settings-and the role of education-remain unclear. This study aims to evaluate the effect of education level and socio-economic factors on the quality of anticoagulation control. METHODS:This single-center observational study included adult patients on VKA for ≥6 months; exclusions were age >70 years, prior life-threatening bleeding/thromboembolism, illiteracy without a co-resident caregiver, or refusal to join the study. Participants followed self-management (1-h training and a dose-INR algorithm with escalation rules) or standard clinic monitoring led by specialized nurses. Follow-up was conducted for 6 months. Primary endpoints were Roosendaal TTR and percentage of INR tests in range. RESULTS:A total of 589 participants were enrolled (self-management n = 295; standard n = 294); 6-month TTR was available for 524 patients (255 vs 269; respectively). Median [Q1-Q3] TTR was similar between groups (63% [41-85] vs 59% [44-79]; p = 0.55), as was the percentage of INR tests in range (57% [36-78] vs 57% [42-71]; p = 0.76). Using tests-in-range categories, self-management had higher rates of both adequate control (>70%) (36.6% vs 27.1%; p = 0.024) and poor control (<30%) (18.1% vs 10.8%; p = 0.018). Within the self-management group, Rosendaal TTR did not differ by education level (70.2%, 62.4%, 65.2%, and 58.3% for illiterate/primary/secondary/higher education; p = 0.66). CONCLUSION:Self-management of INR is feasible in low-socioeconomic settings and is not predicted by education level; rather, it requires structured training, demonstrated competency, and an effective health-support system.
OBJECTIVES:To determine the sensitivity and specificity of fetal echo (FE) and predictive risk factors for congenital heart disease (CHD) in high-risk pregnancies. METHODS:970 consecutive high-risk pregnancies referred for FE were studied. All patients were followed up with a neonatal echo. Risk factors in the mother were correlated with CHD in the fetus. The sensitivity and specificity of fetal echo for CHD were compared with the neonatal echo. RESULTS:1010 fetuses were evaluated. A follow-up of the fetal echo was obtained in 904 (89.5%) patients. Risk factors for referral for fetal echocardiography included maternal diabetes (n = 454, 45%), echogenic foci (n = 93, 9.2%), cardiac anomaly on ultrasound (n = 90, 8.9%), and IVF pregnancies (n = 52, 5.1%). 0.4% had arrhythmias. 89 patients had CHD. VSD was the commonest CHD (15 patients), followed by single ventricle (11) and TOF (10). GDM did not correlate with CHD. None of the IVF pregnancies had CHD. Only ultrasound showing cardiac anomaly correlated with CHD (p < 0.001), but 25% of cases were missed. Fetal echo had a very high sensitivity of 95.5% and specificity of 99.5% for detecting CHD, with slightly reduced sensitivity of 94.3% after 28 weeks. The commonly missed anomalies were small VSDs and anomalies of venous drainage. The fetal mortality with CHD was significantly higher at 38.6% versus 4.5% with no CHD. CONCLUSION:Fetal echo has a very high sensitivity of 95.5% and specificity of 99.5% in detecting CHD. There was a high incidence of CHD in high-risk pregnancies, 88/1000. The most common CHD was VSD. Small VSDs and anomalies of venous drainage were the most frequently missed anomalies. In this study, GDM did not correlate with CHD. Ultrasound showing cardiac anomaly was the only predictor of CHD; hence, in India, where there is a shortage of healthcare resources, training radiologists to include outflow tract views and performing fetal echo in all high-risk pregnancies would result in optimal utilization of resources.
BACKGROUND:Implantable cardioverter-defibrillators (ICDs) are effective in preventing sudden cardiac death; however, contemporary data regarding appropriate and inappropriate device therapy rates from India remains limited. OBJECTIVE:To evaluate rate of appropriate and inappropriate ICD therapies in a cohort of patients who underwent ICD or CRT-D implantation for either primary or secondary prevention at a tertiary care centre METHODS: We conducted a retrospective single-centre study of 190 patients who underwent ICD or CRT-D implantation between 2010 and 2024 for primary or secondary prevention. The primary outcome included appropriate and inappropriate ICD therapy rates assessed using Kaplan-Meier analysis RESULTS: The mean age of cohort was 53.1 ± 12.5 years. Secondary prevention accounted for 79% of implants. Over mean follow-up of 43.4 ± 39.6 months, appropriate ICD therapy occurred in 23.2% of patients, with median time to first therapy of 28.5 months. The cumulative incidence of appropriate therapy was 6% at 1 year and 22% at 3 years. Inappropriate therapy occurred in 8.9% of patients with cumulative incidence of 4% and 8% at 1 and 3 years respectively. The rates of appropriate and inappropriate therapies were not statistically different between primary and secondary prevention groups (p = 0.92 and 0.72 respectively) and between ischemic and non-ischemic subset (p = 0.56 and 0.32 respectively). CONCLUSION:In this contemporary Indian cohort, ICD therapies remain substantial despite advances in GDMT, with a persistent long-term risk of ventricular arrhythmias. These findings support continued guideline-based ICD use and highlight the need to improve ICD utilization, particularly for primary prevention.
Introduction: Postprandial glucose excursions can contribute to increased cardiovascular risk, microvascular complications, and glycaemic variability in type 2 diabetes mellitus (T2DM). Nutritional interventions play a major role. Whey protein, known for its insulinotropic and incretin-stimulating effects, could be an effective supplement. The objective of the study was to evaluate the acute effects of pre-breakfast whey protein supplementation on postprandial glucose, insulin, GLP-1, and C-peptide responses in patients with T2DM. Methods: This single-centre, prospective, within-subject comparative study included two test visits per participant: a water pre-load (control) and a whey protein pre-load (30 g in 250 mL water) given 30 min before breakfast. Uniform breakfast and lunch meals were provided, and blood samples were collected up to 2 h after lunch. Plasma glucose, insulin, GLP-1, and C-peptide were recorded, and the incremental area under the curve (iAUC) was calculated. Results: Ten patients with T2DM were studied (mean age 47.8 years, body mass index 29.2 kg/m², glycated haemoglobin 7.4%, disease duration 3.2 years). Compared with water, whey protein significantly reduced post-breakfast and post-lunch glucose excursions (glucose iAUC 48,329 vs. 54,743; P < 0.01) and increased insulin (13,377 vs. 9,492; P < 0.01), GLP-1 (18,803 vs. 12,814; P < 0.01), and C-peptide (1860 vs. 1535; P < 0.01) iAUCs. The effect persisted through the second meal. Conclusion: Pre-breakfast whey protein supplementation reduced postprandial glucose excursions and enhanced insulin and incretin responses in T2DM. It may serve as a practical and low-cost dietary approach to improve postprandial glycaemic control.
