Objectives: Atherogenic index of plasma (AIP), calculated as log10 (triglycerides/High Density Lipoproteincholesterol), offers a low-cost index of atherogenic dyslipidemia, whereas left ventricular diastolic dysfunction (LVDD) marks the earliest subclinical stage of diabetic cardiomyopathy and falls disproportionately on women. Here, we quantify how AIP relates to LVDD among women living with type 2 diabetes mellitus (T2DM) and diabetic retinopathy (DR). Materials and Methods: We assessed 125 women with T2DM and fundoscopically confirmed DR in a hospital-based, cross-sectional observational design. AIP was calculated from a fasting lipid profile. LVDD was diagnosed by transthoracic echocardiography with tissue Doppler imaging, graded per the 2016 The American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) recommendations. The independent association of AIP with LVDD and its optimal discriminative cut-off were quantified using multivariable logistic regression together with receiver operating characteristic (ROC) curve analysis.sssssse Results: Fifty of 125 women (40.0%) had LVDD, and AIP was significantly higher in this group than in the remainder (0.70 ± 0.13 vs. 0.51 ± 0.17, p < 0.001). AIP correlated positively with the average E/e′ ratio (r = 0.29, p = 0.001). After multivariable adjustment for age, body mass index, glycated hemoglobin (HbA1c), duration of T2DM, systolic blood pressure, and DR severity, the association between AIP and LVDD persisted (adjusted odds ratio 2.34 per 0.1-unit increase, 95% CI 1.35–4.05, p = 0.002). ROC analysis identified an exploratory AIP cut-off of 0.65 for distinguishing women with LVDD (area under the curve 0.81, 95% CI 0.73–0.89; sensitivity 68%; specificity 83%). AIP did not differ significantly between non-proliferative and proliferative DR (0.57 ± 0.17 vs. 0.61 ± 0.19, p = 0.253). Conclusion: Among women with T2DM and established DR, subclinical LVDD tracked independently with AIP. AIP may be a potentially useful marker of LVDD, but the exploratory cut-off of 0.65 requires prospective external validation before any clinical application.
Objectives: Hypertension (HTN) is a prevalent cardiovascular disorder known to adversely affect microvascular function, leading to impaired vasodilation, altered blood flow regulation, and progression of vascular as well as cognitive disorders. These subtle microvascular alterations often remain undetected, particularly in women, who may present with different vascular responses compared to men. Functional near-infrared spectroscopy (fNIRS) is a non-invasive neuroimaging technique that measures changes in oxygenated (HbO 2 ) and deoxygenated hemoglobin (HbR), thereby providing insight into both cerebral and peripheral hemodynamic responses. The present study aimed to evaluate the utility of fNIRS in detecting microvascular dysfunction among hypertensive women. Materials and Methods: A cross-sectional comparative study was conducted following institutional ethical approval. Twenty women diagnosed with primary HTN and twenty normotensive age-matched normotensives were recruited. fNIRS recordings of HbO 2 and HbR concentrations were obtained at rest, during a 10-min mild-to-moderate exercise protocol, and in the recovery period. Data were analyzed using independent Student’s t -tests for pairwise baseline comparisons. To account for repeated measures across time points (rest, activity, post-activity), longitudinal linear mixed-effects models were conducted with Group, Time, and Group × Time interaction terms as fixed effects and subject identity as a random intercept (alpha = 0.05). Results: Hypertensive participants (mean age 44.2 ± 8.52 years) demonstrated significantly higher mean arterial pressure (116.75 ± 4.92; p < 0.005) compared with normotensives. Baseline (0.26 ± 0.12 vs. 0.57 ± 0.41) and activity-phase (0.91 ± 0.26 vs. 1.89 ± 1.31) HbO 2 values were significantly lower in hypertensive women ( p < 0.005). Post-exercise HbO 2 levels were also lower but did not reach statistical significance. Similarly, baseline (0.23 ± 0.25 vs. 0.73 ± 0.51), activity (0.64 ± 0.06 vs. 1.15 ± 1.33), and post-activity (0.30 ± 0.15 vs. 0.62 ± 0.44) HbR levels were significantly reduced ( p < 0.005). Conclusion: In this short cross-sectional study, fNIRS showed preliminary sensitivity in detecting changed cerebral hemodynamic profiles in hypertensive women under physical stress. While these preliminary data indicate that fNIRS may be useful as an exploratory research tool for detecting neurovascular changes, bigger prospective longitudinal trials are required to determine its true clinical utility and predictive significance.
Objectives: Early prenatal detection of congenital heart disease (CHD) using fetal echocardiography (FE) facilitates comprehensive prenatal evaluation, multidisciplinary perinatal planning, and timely postnatal management, improving outcomes. This study assessed FE for detecting major and complex CHD and identified cases that would have been missed using a risk-based referral strategy. Materials and Methods: A hospital-based prospective observational study was undertaken at a tertiary care teaching institution from June 2023 to January 2024. A total of 120 pregnant women between 15 and 35 weeks of gestation underwent FE irrespective of maternal or fetal risk factors. All live-born neonates underwent postnatal transthoracic echocardiography, which served as the reference standard for diagnostic accuracy. Results: FE detected complex CHD in 11 of the 120 fetuses (9.2%). Of these, nine pregnancies underwent medical termination, whereas two continued to delivery. Postnatal echocardiography was performed in 111 live-born neonates and identified CHD in 22 (19.8%), predominantly minor acyanotic lesions. Compared with the routine screening group, the high-risk group demonstrated a significantly higher detection rate of complex CHD (25.0% vs. 4.3%, p = 0.001). However, routine screening identified four additional cases of complex CHD that would have been missed by high-risk referral alone. FE demonstrated good diagnostic performance for detecting complex CHD, although small ventricular septal defects were not detected prenatally. The number screened to detect one additional case of complex CHD was 23. Conclusion: FE enabled prenatal detection of complex CHD, including additional cases among pregnancies undergoing routine screening without recognized risk factors. These findings support its potential role in prenatal CHD detection.
An aortoventricular tunnel is a congenital structural defect characterized by an anomalous extracardiac channel that bypasses the normal valvular apparatus and connects the ascending aorta – at a level above the sinotubular junction – directly to a ventricular cavity. While communication with the left ventricle is the predominant form, the right ventricle (RV) may also serve as the terminal chamber, producing a hemodynamically distinct and clinically challenging variant. This RV form is a recognized – though uncommon – cause of high-output cardiac failure in pediatric patients. We present the diagnostic workup and successful transcatheter closure in a 12-year-old girl with an aorta-to-RV tunnel, demonstrating that percutaneous intervention using the Konar MFO (multifunctional occluder) device is a feasible and effective minimally invasive treatment strategy for this rare malformation.
Managing complex arrhythmias requires careful antiarrhythmic selection. We describe the clinical course of a 54-year-old woman with Wolff–Parkinson–White (WPW) syndrome who developed ventricular tachycardia (VT) and ventricular fibrillation (VF) while receiving treatment for incessant supraventricular tachycardia (SVT). She presented with palpitations, chest discomfort, and progressive dyspnea. Electrocardiography demonstrated a narrow-complex tachycardia at approximately 180 beats/min. Electrical cardioversion transiently restored sinus rhythm and exposed a WPW pattern; however, recurrent SVT persisted despite repeated cardioversion and escalating antiarrhythmic therapy. During treatment with escalating antiarrhythmic drug therapy, the patient developed torsades de pointes, followed by episodes of VT and VF, leading to seizures and loss of consciousness that required cardiopulmonary resuscitation and direct current shocks. Electrophysiological mapping identified a right posterolateral accessory pathway, which was successfully ablated, resulting in stable sinus rhythm. This case highlights potential pro-arrhythmic consequences of anti-arrhythmic drug treatment and highlights the importance of prompt catheter ablation, particularly where healthcare resources are limited.
