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STATISTICAL PAGES
Chi-square test and its application in hypothesis testing
Rakesh Rana, Richa Singhal
January-April 2015, 1(1):69-71
DOI:10.4103/2395-5414.157577  
In medical research, there are studies which often collect data on categorical variables that can be summarized as a series of counts. These counts are commonly arranged in a tabular format known as a contingency table. The chi-square test statistic can be used to evaluate whether there is an association between the rows and columns in a contingency table. More specifically, this statistic can be used to determine whether there is any difference between the study groups in the proportions of the risk factor of interest. Chi-square test and the logic of hypothesis testing were developed by Karl Pearson. This article describes in detail what is a chi-square test, on which type of data it is used, the assumptions associated with its application, how to manually calculate it and how to make use of an online calculator for calculating the Chi-square statistics and its associated P-value.
  15 53,236 3,631
ORIGINAL ARTICLES
Heart failure in India: The INDUS (INDia Ukieri Study) study
Vivek Chaturvedi, Neeraj Parakh, Sandeep Seth, Balram Bhargava, S Ramakrishnan, Ambuj Roy, Anita Saxena, Namit Gupta, Puneet Misra, Sanjay Kumar Rai, K Anand, Chandrakant S Pandav, Rakesh Sharma, Sanjay Prasad
January-April 2016, 2(1):28-35
DOI:10.4103/2395-5414.182988  
Introduction: There are few data on heart failure (HF) burden and none available on the community prevalence of HF in India. We conducted a study aimed at determining the HF prevalence in a rural community as well as tertiary hospital care setting in North India. We also reviewed the existing literature regarding the estimated and projected prevalence of HF in India. Methodology: All adults (>20 years) with chronic breathlessness in six villages under a primary health care center in Northern India were identified and evaluated with standardized questionnaire and physical examination by trained health care workers. HF was diagnosed by standardized criteria and a transthoracic echocardiogram was performed in all subjects. In the hospital study, 500 consecutive patients presenting to our tertiary referral hospital were evaluated for the diagnosis of HF. For the systematic review, all published studies addressing HF or the burden of risk factors in India were identified. Projections for the absolute HF burden were made using local data and global studies of HF incidence, morbidity, and mortality. Results: Among the surveyed rural adult population of 10,163 patients, chronic breathlessness was present in 128 (1.3%). HF was present in 9% (n = 12), of which 67% (n = 8) had preserved left ventricular (LV) systolic function and 33% (n = 4) had LV systolic dysfunction. Therefore, the prevalence of HF in this general community was 1.2/1000. All patients with HF and preserved ejection fraction had poorly controlled hypertension. In the hospital study, of 500 consecutive patients, 20.4% had HF. Rheumatic heart disease (52%) was the most common cause followed by ischemic heart disease (17%). The mean age of presentation was 39 ± 16 years. The prevalence of HF in the outpatient department patients was 22.5% below 30 years and 14.9% above 50 years, reflecting the young population of HF. For the estimates concerning HF burden in India, projections were made using both age-specific extrapolations from developing countries and data regarding development of HF in the presence of risk factors. The estimated prevalence of HF is about 1% of the total population or about 8–10 million individuals. The estimated mortality attributable to HF is about 0.1–0.16 million individuals per year. Conclusions: While our hospital data are consistent with the HF burden and etiology expected in a government tertiary hospital setting, our community-based study is the first of its kind reported from India. The community study demonstrates a surprisingly low prevalence of symptomatic HF in the surveyed villages. This could be partially explained by the rural farming-based community setting but is also likely due to under-reporting of symptoms. Our review of the projected national estimates suggests an alarming burden of HF in India despite a younger population than the developed nations. A significant proportion of this burden may be preventable with better screening and early and adequate treatment of the risk factors.
  14 12,789 1,571
CURRICULUM IN CARDIOLOGY - STATISTICAL PAGES
Decoding the Bland–Altman plot: Basic review
Aakshi Kalra
January-April 2017, 3(1):36-38
DOI:10.4103/jpcs.jpcs_11_17  
The Bland–Altman plot is a method for comparing two measurements of the same variable. The concept is that X-axis is the mean of your two measurements, and the Y-axis is the difference between the two measurements. The chart can then highlight anomalies, for example, if one method always gives too high a result, then all points are above or below the zero line. It can also reveal that one method overestimates high values and underestimates low values. If the points on the Bland–Altman plot are scattered all over the place, above and below zero, then it suggests that there is no consistent bias of one approach versus the other. It is, therefore, a good first step for two measurement techniques of a variable.
  9 18,206 2,179
Number needed to treat
Amitabh Biswas
May-August 2017, 3(2):106-108
DOI:10.4103/jpcs.jpcs_31_17  
The Number Needed To Treat (NNT) is a measure used in epidemiology to convey the effectiveness of an intervention. It is the average number of patients who need to be treated to prevent one bad outcome. It is the reverse of the Absolute Risk Reduction. The lower the NNT, the more effective the intervention. In this article we discuss the concept and limitations of this measure.
  5 2,207 319
ORIGINAL ARTICLES
Epidemiology of acute decompensated heart failure in India : The AFAR study (Acute failure registry study)
Sandeep Seth, Suraj Khanal, Sivasubramanian Ramakrishnan, Namit Gupta, Vinay K Bahl
January-April 2015, 1(1):35-38
DOI:10.4103/2395-5414.157563  
Objectives: There is a paucity of data on acute decompensated heart failure (ADHF) in Indian patients. We herein report the in-hospital and 6-month outcome of Indian patients admitted with ADHF. Methods: We prospectively enrolled consecutive patients with ADHF due to systolic dysfunction in the acute failure registry and followed them up for at least 6 months. We analyzed the data on death and hospitalization of the first 90 patients on death and hospitalization over 6-months. Results: A total of 90 patients were enrolled with a mean age of 53.5 ± 17. 7 years and the majority were male (63%). The mean left ventricular ejection fraction was 29.2± 11.9%. The in hospital mortality was 30.8%. Postdischarge 6-month major adverse event (re-hospitalization/mortality combined) and mortality rates were 39.5% and 26.3%, respectively. Conclusions: These data from a single referral center provide insights into the current status of acute HF care in India. We report a higher in-hospital and follow-up mortality rates in ADHF patients who present at younger ages than reported in Western literature.
  5 3,807 488
REVIEW ARTICLES
Implications of 2017 hypertension guidelines for Indian patients
Rajiv Narang, S Srikant
January-April 2018, 4(1):3-5
DOI:10.4103/jpcs.jpcs_19_18  
The new US blood pressure guideline lowers the definition of high blood pressure to 130/80 mm Hg.The new guideline adopts a key component of the 2013 cholesterol guideline and incorporates overall cardiovascular risk. The AAFP has decided to not endorse the recent hypertension guideline because it gave undue importance to the SPRINT trial and cardiovascular risk which was not validated and would lead to overtreatment. The guidelines are discussed in this article.
  5 9,732 1,252
ORIGINAL ARTICLES
Acute coronary syndrome in young - A tertiary care centre experience with reference to coronary angiogram
Tammiraju Iragavarapu, T Radhakrishna, K Jagadish Babu, R Sanghamitra
January-April 2019, 5(1):18-25
DOI:10.4103/jpcs.jpcs_74_18  
Background: Acute coronary syndrome (ACS) is a potentially life-threatening condition which is more common in elderly people, and young are relatively protected. Currently, the protective effect on young from coronary artery disease (CAD) is taken away by several risk factors. The aim of this study is to determine the conventional risk factors and angiographic correlation of CAD in young age (<40 years) to that of elderly age (>40 years). Materials and Methods: This study was a hospital-based retrospective cross-sectional analytical study involving 1151 patients of ACS admitted in the cardiac ICU from May 2016 to May 2018. Among these patients, coronary risk factors such as smoking, diabetes, hypertension, dyslipidemia, and family history were studied. Patients were divided into two groups, Group A: <40 years and Group B: >40 years. Patients were evaluated angiographically. The significance of each risk factor between the groups was calculated by employing the Chi-square test and P < 0.05 was taken as statistically significant. Results: A total of 1151 cases were included in the study, of which 120 cases were <40 years of age. The prevalence of CAD in young in our study is 10.42% with male preponderance. P value is statistically significant (P < 0.05) among younger individuals for smoking, dyslipidemia, obesity, family history. Of 120 cases with critical CAD, single-vessel disease (SVD), predominantly the left anterior descending artery, was the most prevalent. SVD and recanalized coronaries were statistically significant among younger group whereas triple-vessel disease (TVD) is statistically significant among the elderly. Thrombus burden is more in young when compared to the elderly. Conclusion: Although ACS is a less common entity in young adults aged 40 years or less, recent epidemiological trend is progressing and it constitutes an important challenge both for a patient and for a treating physician. Young patients with CAD are mainly males, and SVD is more common. Emphasis should be given on diagnosis and management of risk factors in this vulnerable group to prevent mortality and morbidity.
  4 2,877 458
An Observational study of prehospital and hospital delay in reperfusion for acute myocardial infarction at a University Hospital in India
Rahul Choudhary, Shashi Mohan Sharma, Vimla Kumar, Dinesh Kumar Gautam
September-December 2016, 2(3):163-168
DOI:10.4103/2395-5414.201378  
Objective: Cardiovascular disease is the leading cause of death among Indian adults, and approximately 50% of deaths usually occur during the 1st hour after symptom onset before arriving at the hospital. A study was planned to evaluate the prehospital and hospital delay in patients with acute myocardial infarction (AMI). Methods: This was a prospective observational study of 390 patients with AMI admitted to the Department of Cardiology between March 2014 and August 2015. Detailed patient demographics, socioeconomic status, and prehospital and hospital delay were reviewed. Results: The mean age of presentation for male and female was 57 ± 12.91 and 61.5 ± 12.83 years, respectively. The mean prehospital delay, time to act after chest pain, and travel time were 9.08 ± 6.3, 7.16 ± 6.1, and 1.84 ± 0.8 h, respectively, and only three (9.7%) patients reached the hospital within 2 h after symptom onset. Out of 300 patients who received reperfusion therapy, thrombolysis was done in 276 (92%) patients while primary percutaneous coronary intervention was performed in only 24 (8%) patients. Mean door-to-needle (D-N) time and door-to-device time for those who received reperfusion therapy were 27.8 ± 4.3 and 78.95 ± 9.5 min, respectively. A multivariate logistic regression analysis revealed that the prehospital delay was significantly associated with older age, female sex, rural background, diabetes, having atypical pain, and lack of knowledge regarding the seriousness of chest pain. Conclusion: Approximately 79% of total prehospital delay was due to patient-related factors; old age, female sex, rural background, diabetes, atypical angina, and lack of knowledge being the significant attributes. D-N time and door-to-device time were within the limits of those recommended by current guidelines.
  4 2,920 328
REVIEW ARTICLES
Heart failure guidelines for India: Update 2017
Sandeep Seth, S Ramakrishnan, Neeraj Parekh, G Karthikeyan, Sandeep Singh, Gautam Sharma
September-December 2017, 3(3):133-138
DOI:10.4103/jpcs.jpcs_1_18  
Heart failure (HF) is a major health problem in India with a postadmission mortality of 20%–30%. Medication adherence ranges from 25% to 50%, and the tolerance of guideline-based medication is low for Indian patients. We took out guidelines on HF in 2015, and this update covers the changes which have occurred in HF management in the past 2 years. As a number of new drugs such as angiotensin receptor-neprilysin inhibitor and ivabradine have been approved for use in India, devices such as implantable cardioverter-defibrillators and cardiac resynchronization therapy are becoming more accessible and more left ventricular assist devices and transplants are being done in India, there is need for clear guidelines for the use of each which are practical for India.
  4 6,989 1,254
STATISTICAL PAGES
Commonly used t-tests in medical research
RM Pandey
May-August 2015, 1(2):185-188
DOI:10.4103/2395-5414.166321  
Student's t-test is a method of testing hypotheses about the mean of a small sample drawn from a normally distributed population when the population standard deviation is unknown. In 1908 William Sealy Gosset, an Englishman publishing under the pseudonym Student, developed the t-test. This article discusses the types of T test and shows a simple way of doing a T test.
  4 18,356 1,397
CURRICULUM IN CARDIOLOGY - HISTORY OF MEDICINE
The story of heart transplantation: From cape town to cape comorin
Aakshi Kalra, Sandeep Seth, Milind Padmaker Hote, Balram Airan
May-August 2016, 2(2):120-125
DOI:10.4103/2395-5414.191525  
Norman Shumway is widely regarded as the father of heart transplantation although the world's first adult human heart transplant was performed by Christiaan Barnard, on December 3, 1967, at the Groote Schuur Hospital in Cape Town, South Africa. Adrian Kantrowitz performed the world's first pediatric heart transplant on December 6, 1967 and Norman Shumway performed the first adult heart transplant in the United States on January 6, 1968, at the Stanford University Hospital. In India, PK Sen attempted the first heart transplant in humans soon after Christaan Barnaard but the first and subsequent patients died. The first successful heart transplant in India was by Dr. P Venugopal in 1994 at AIIMS, New Delhi. This was followed soon after by Dr. KM Cherian who also did the first pediatric and first heart lung transplant in India.
  3 3,393 285
MISCELLANEOUS - HISTORY
Development of mechanical heart valves - an inspiring tale
P Rajashekar
September-December 2015, 1(3):289-293
DOI:10.4103/2395-5414.177309  
The historical evolution of the prosthetic heart valves from the first attempts with the Hufnagel's valve in the treatment of the aortic insufficiency to the Starr-Edwards' ball valve and later the tilting disc valves (Bjork-Shiley etc.,) and finally the bileaflet valves (St. Jude) are discussed. The Indian contribution with Chitra valve is also described.
  3 9,029 1,224
ORIGINAL ARTICLES
Heart transplant in India: Lessons learned
Balram Airan, Sarvesh Pal Singh, Sandeep Seth, Milind Padmakar Hote, Manoj Kumar Sahu, Palleti Rajashekar, Velayoudham Devagourou, Sambhunath Das, Neeraj Parakh, Ruma Ray, Sudheer Arava
May-August 2017, 3(2):94-99
DOI:10.4103/jpcs.jpcs_25_17  
Introduction: Heart Transplant in India started in 1994. We were initially doing 1-2 per year but the numbers have picked up since 2014 and we have done 25 in the past 3 years. We describe our experience of the last 4 years in this paper. Results: Initially, we experienced a relatively higher rate of rejections, fungal infections and graft failure. As we changed protocols, stopped using induction therapy except in high risk, maintained higher levels of immune suppression and tapered steroids faster in the first year, the complications reduced. All patients who had rejections and all the later transplants were maintained on a regime of tacrolimus, mycophenolate mofetil and steroids along with six months of valgancyclovir, voriconazole and co-trimoxazole. Steroids were tapered by six months to 0.1 mg/kg per day in all patients. Conclusions: In our recent patients, infection was the most common adverse event followed by rejection and PGD. In the latter half of our experience, we found that the complications reduced, suggesting that experience leads to less complications.
  3 6,153 394
Epidemiology of cardiomyopathy - A clinical and genetic study of hypertrophic cardiomyopathy: The EPOCH-H study
Amitabh Biswas, Soumi Das, Mitali Kapoor, Sandeep Seth, Balram Bhargava, Vadlamudi Raghavendra Rao
May-August 2015, 1(2):143-149
DOI:10.4103/2395-5414.166323  
Background: Hypertrophic cardiomyopathy (HCM) is a genetic disorder with the prevalence of 1 in 500 globally. HCM is clinically characterized by thickening of the wall of the heart, predominantly left ventricle (LV), and interventricular septum (IVS). Our study aims to report the demographical, clinical and genetic profile of Indian HCM patients. Methods: HCM patients were recruited on the basis of WHO criteria. The clinical phenotypes were analyzed using electrocardiography, two-dimensional electrocardiography, and hotspot region of the MYH7 gene was sequenced for all patients as well as for controls. Results: There were 59 patients with a clinical diagnosis of HCM with a preponderance of disease in males with a ratio (men, women) of 5.5:1. Average age of onset of the disease was late 30 s (39.2 ± 14.5) with familial HCM accounting for 18% (n = 9) for total HCM families (n = 50). Nonobstructive kind of HCM was more prevalent as compared to obstructive HCM (66.1% vs. 33.9%). Average posterior wall LV thickness of the HCM patients was 16 ± 4.8 mm and IVS thickness was 21 ± 8.3 mm with familial patients having greater wall thickness as compared to sporadic patients. Sequencing of hotspot region of MYH7 identified three mutations in three different patients. Two mutations were found to be segregating in familial cases. Conclusion: HCM is more prevalent in males with a predominance of hypertrophic nonobstructive cardiomyopathy form. Eighteen percent of cases were familial and showed an early onset of the disease and worse prognosis as compared to sporadic cases. Hotspot sequencing of MYH7 only explains 6% of its genetic basis. More of the candidate genes need to be screened through advanced techniques like next generation sequencing to identify the causal genes which could make us understand the mechanistic pathways.
  3 4,711 459
Role of human cardiac biopsy derived conditioned media in modulating bone marrow derived mesenchymal stem cells toward cardiomyocyte-like cells
Anupama Kakkar, Sujata Mohanty, Balram Bhargava, Balram Airan
May-August 2015, 1(2):150-155
DOI:10.4103/2395-5414.166327  
Background: Mesenchymal stem cells (MSCs) are multipotent and can be easily cultured and expanded. Therefore, these are considered to be an attractive therapeutic tool for cardiac repair. These have been found to have tremendous potential to transdifferentiate to cardiac lineage both in vitro and in vivo. A number of chemicals and growth factors have been explored for the same. However, the effect of the paracrine factors released by cardiac tissue has not been studied much. Materials and Methods: In the present study, we have examined the differentiation capacity of conditioned media (CM) derived from human cardiac tissue on human bone marrow-derived MSCs (BM-MSCs). BM-MSCs after characterization were induced by culture supernatant collected from human cardiac tissue (21 days). Parallel cultures treated with 5-azacytidine (AZA) (30 days), were taken as controls. Results: MSCs treated with CM formed “muscle island” like structure and were found to be positive for cardiac-specific markers - myosin light chain-2v and cardiac troponin I proteins. However, uninduced BM-MSCs did not show positivity for any of these markers and maintained fibroblastic morphology. Conclusion: These findings demonstrate that cardiac CM is capable of effective induction of morphological and molecular changes in MSCs toward cardiac features. However, differentiation efficiency is less than that of 5-AZA and the mode of action and the components of CM are still to be known.
  3 2,337 234
REVIEW ARTICLES
Epigenetic role of micrornas in diabetic cardiomyopathy
Satish K Raut, Akhilesh Kumar, Madhu Khullar
May-August 2016, 2(2):79-85
DOI:10.4103/2395-5414.191519  
Cardiovascular complications in diabetic individuals account for significant morbidity and mortality. Clinical and epidemiological studies have also shown significantly increased incidence and prevalence of cardiovascular complications in diabetes. Heart failure (HF) in diabetes in the absence of known cardiac complications such as myocardial infarction and coronary artery disease further supports the existence of diabetic cardiomyopathy (DbCM). Myocyte hypertrophy and myocardial fibrosis are the established pathological features of the DbCM and are associated with differential expression of genes involved in cardiac hypertrophy and fibrosis. Recent studies show the role of tiny noncoding regulatory RNAs, known as microRNAs (miRs), in the transcriptional and post-transcriptional regulation of gene expression. A large number of miRs have been identified that regulate diverse aspects of cardiac development and function and also play key role in regulating various signaling pathways involved in the pathogenesis of HF. The present review provides an overview of the role of miRs in diabetes-associated heart disease.
  3 2,110 241
STATE OF THE ART
Evolution, evidence and effect of secondary prophylaxis against rheumatic fever
Rosemary Wyber, Jonathan Carapetis
January-April 2015, 1(1):9-14
DOI:10.4103/2395-5414.157554  
The association between group A streptococcal infection and rheumatic fever (RF) was established in the early 20 th century. At the time, RF and subsequent rheumatic heart disease (RHD) were an untreatable scourge of young people in developed and developing countries. Resultingly, research efforts to understand, treat and prevent the disease were widepread. The development of antibiotics in the 1930s offered therapeutic promise, although antibotic treatment of acute RF had little impact. Improved understanding of the post-infectious nature of RF prompted attempts to use antibiotics prophylactically. Regular doses of sulphonamide antibiotics following RF appeared to reduce disease progression to RHD. Development of penicillin and later, benzathine penicillin G, was a further thereputic advance in the 1950s. No new prophylactic options against RF have emerged in the intervening 60 years, and delivery of regularly scheduled BPG injections remains a world wide challenge.
  3 3,922 524
CURRICULUM IN CARDIOLOGY - STATISTICS
Correlation analysis in biological studies
Suniti Yadav
May-August 2018, 4(2):116-121
DOI:10.4103/jpcs.jpcs_31_18  
Correlation is a statistical procedure to test the relationship between quantitative variables and categorical variables. In other words, it describes the degree of relation between two variables. It is one of the most commonly used statistical techniques. The present article is based on selected statistical textbook, review of the literature, and our own research experience study.
  2 12,577 558
LESSONS FROM HISTORY
History of pediatric cardiology in India
Anita Saxena
May-August 2015, 1(2):203-205
DOI:10.4103/2395-5414.166318  
In India, the discipline of cardiology started in the late 1950s and at that time pediatric cardiology was practiced as a part of cardiology specialty. This article traces the history of pediatric cardiology in India. Dr. S. Padmawati and Dr. Kamala Vytilingam underwent training in pediatric cardiology at international centers in the early 1950s and early 1960s. Dr. N. Gopinath successfully closed a ventricular septal defect using a pump oxygenator at Christian Medical College, Vellore. Open heart surgery program kicked off in the 1960s with the tireless efforts of many other surgeons. Dr. Rajendra Tandon, trained for 2 years at Boston Children Hospital under Dr. Alexander Nadas, joined the Department of Cardiology at the All India Institute of Medical Sciences, New Delhi in 1963. This and many other stories are described.
  2 2,999 371
ORIGINAL ARTICLES
A study to evaluate the effectiveness of an indigenous exercise protocol in patients with heart failure to improve their quality of life: (Exercise in congestive heart failure study [E - CHF study])
Urvashi , Kamlesh K Sharma, Vishwa Prakash Gupta, Sandeep Seth
January-April 2015, 1(1):39-44
DOI:10.4103/2395-5414.157565  
Background: Congestive heart failure (CHF) is characterized by an intolerance to activities of daily living, office environment and shortness of breath in any level of extraneous activity depending on their level of heart failure (HF). This significantly contributes to reduced participation and poor quality of life (QoL) among these patients. Methods: The study was conducted from June 2014 to December 2014 in Cardio-Neuro-Centre, OPD, AIIMS, New Delhi on 40 medically stable CHF outpatients (mean age 46.3±11.4 years) in NYHA class -I & II with 3 month follow-up. IEP (Indigenous Exercise Protocol) training, consisting of one supervised session at baseline visit followed by home-based practice and telephonic encouragement and monitoring of the group was given. Outcome measures were QoL, physiological parameters (6 minute walk test - distance, VO2 max and double product) and frequency of hospitalization. Results: The results showed significant difference between QoL (P < 0.02) as measured by KCCQ, mean walking distance on the 6 minute walk test (P < 0.01) and VO2 max (P < 0.01) at entry and after 12 weeks within the experimental group, but compared to the control group, no significant difference was found between the two groups. Two hospitalizations and one death were reported in the control group, whereas none was reported in the experimental group. Conclusion: IEP was effective in achieving adequate exercise tolerance in experimental group. It showed no deleterious effect and is safe to practice at home, but more evidence is needed to consider using IEP when caring for stable heart failure patient.
  2 2,440 317
Indications, timing and techniques of radical pericardiectomy via modified left anterolateral thoracotomy (ukc's modification) and total pericardiectomy via median sternotomy (holman and willett) without cardiopulmonary bypass
Ujjwal Kumar Chowdhury, Rajeev Narang, Poonam Malhotra, Minati Choudhury, Arindam Choudhury, Sarvesh Pal Singh
January-April 2016, 2(1):17-27
DOI:10.4103/2395-5414.182999  
Background: Patients with constrictive pericarditis can be treated by pericardiectomy by either left anterolateral thoracotomy or median sternotomy. The terms “radical,” “total,” “extensive,” “complete,” “subtotal,” “adequate,” “near-total,” and partial pericardiectomy have been used often without much clarity. We describe our experience with a radical pericardiectomy technique via modified left anterolateral thoracotomy and compare the same to total pericardiectomy via median sternotomy. Methods: In this study, 67 (54.9%) patients underwent radical pericardiectomy via modified left anterolateral thoracotomy (Group I), and 55 (45.1%) patients underwent total pericardiectomy via median sternotomy (Group II). Results: The operative mortalities were 2.9% and 7.2% for the radical and total pericardiectomy groups, respectively. The time taken for normalization to Class I/II in Groups I and II was 30 ± 11 and 36 ± 14 days, respectively (P = 0.009). Surgical techniques did not affect the outcome of atrial fibrillation (P = 0. 77). Reoperation was not required for any patient. The radical pericardiectomy was also associated with less postoperative low cardiac output state as compared to patients undergoing total pericardiectomy (P < 0.001). There was no difference in mean duration of hospitalization; however, the radical pericardiectomy group achieved the New York Heart Association I and II Status quicker than the total pericardiectomy group (P = 0. 009). Conclusions: We conclude that using several technical modifications of pericardial excision, it is possible to achieve radical pericardiectomy via modified left anterolateral thoracotomy, particularly removing the constricting pericardium over the anterolateral, diaphragmatic surfaces of left ventricle and the anterior and diaphragmatic surfaces of the right ventricle until the right atrioventricular groove without using cardiopulmonary bypass in the great majority of patients undergoing pericardiectomy for chronic constrictive pericarditis. Although the surgical approach for pericardiectomy is based on surgeon's preference, left anterolateral thoracotomy is the preferred and noncontroversial approach in the setting of purulent pericarditis and effusive constrictive pericarditis to prevent sternal infection. We recommend median sternotomy approach with or without cardiopulmonary bypass, in the setting of calcific pericardial patches, pericardial masses, reoperations, and calcific pericardial “cocoon” and for those with predominant right-sided and annular involvement.
  2 4,885 469
Polytetrafluoroethylene patch versus autologous pericardial patch for right ventricular outflow tract reconstruction
Sachin Talwar, Murugan Sathiya Selvam, Palleti Rajasekhar, Sivasubramanian Ramakrishnan, Shiv Kumar Choudhary, Balram Airan
September-December 2016, 2(3):175-180
DOI:10.4103/2395-5414.201372  
Objective: Reconstruction of right ventricular outflow tract (RVOT) during repair of Tetralogy of Fallot (TOF) often requires placement of a transannular patch (TAP). The purpose of the present study was to compare the outcomes following reconstruction of RVOT using polytetrafluoroethylene (PTFE) patch versus autologous glutaraldehyde-fixed pericardial patch. Materials and Methods: Fifty-three consecutive patients undergoing TAP repair for TOF in a single institute were randomized into two groups: Group I (pericardial patch), Group II (PTFE patch) and their postoperative outcomes in terms of postoperative rhythm, duration of mechanical ventilation, mediastinal and pleural drainage, stay in the Intensive Care Unit (ICU) and hospital, were assessed. The preoperative and postoperative gradients across the RVOT, pulmonary insufficiency, systolic right ventricular function were assessed echocardiographically by an independent cardiology team. Results: There was one death; there were no differences between the two groups regarding the postoperative duration of mechanical ventilation, ICU, and hospital stay. The requirement of inotropes was less in the PTFE patch group compared to the pericardial patch group (12.80 ± 8.04 vs. 17.30 ± 7.21, median 10 vs. 20, P = 0.025). The re-exploration rate in the PTFE group was higher than the other group (6 vs. 1). There was no difference in the RV systolic function between the two groups as assessed by echocardiogram before discharge. Conclusion: RVOT reconstruction during TOF repair can safely be performed using a PTFE patch with results similar to an autologous patch of glutaraldehyde-treated pericardium. Its results in the mid and long term need further evaluation.
  2 2,183 215
Prevalence of thiamine deficiency in heart failure patients on long-term diuretic therapy
Shrenik Doshi, T Velpandian, Sandeep Seth, SK Maulik, Balram Bhargava, Vinay K Bahl
January-April 2015, 1(1):25-29
DOI:10.4103/2395-5414.157561  
Background: Loop diuretics are an integral part of heart failure management. It has been shown that loop diuretics cause thiamine deficiency (TD) by increasing its urinary loss. The aim of this study was to determine the prevalence of TD in heart failure patients on long-term oral loop diuretics. Methods: Heart failure patients (cases) on oral loop diuretics (furosemide ≥40 mg/day or torsemide ≥20 mg/day), irrespective of the cause of heart failure, were compared to non-heart failure patients (controls) not on loop diuretics in a 1:1 ratio. Whole blood free thiamine level was determined by liquid chromatography-tandem mass spectrometry method. Results: A total of 100 subjects were enrolled in a 1:1 ratio (50 cases and 50 controls). 67% of the total study population had TD, (defined as whole blood free thiamine level <0.7 ng/ml). There was no difference in mean thiamine level between cases and controls. On comparing patients with TD in both groups, patients on diuretics had significantly lower thiamine level compared to the patients, not on diuretics (P < 0.0001). Conclusions: There was no difference in the thiamine level when patients on loop diuretics were compared to controls. However, very low thiamine levels (<0.1 ng/ml) was significantly more common in patients on loop diuretics.
  2 3,666 330
REVIEW ARTICLES
Insights into the human gut microbiome and cardiovascular diseases
Soumalya Sarkar, Bhabatosh Das, Sanjay K Banerjee
January-April 2018, 4(1):10-14
DOI:10.4103/jpcs.jpcs_18_18  
The microbiome comprises all of the genetic materials within a microbiota. This can also be referred to as the metagenome of the microbiota. Dysbiosis, a change in the composition of the gut microbiota, has been associated with pathology, including cardiovascular diseases (CVDs). The recently discovered contribution of gut microbiota-derived molecules in the development of heart disease and its risk factors has significantly increased attention toward the connection between our gut and heart. The gut microbiome is virtually an endocrine organ, capable of contributing to and reacting to circulating signaling molecules within the host. Gut microbiota-host interactions occur through many pathways, including trimethylamine-N-oxide and short-chain fatty acids. These molecules and others have been linked to chronic kidney disease, atherosclerosis, and hypertension. Dysbiosis has been implicated in CVD as well as many aspects of obesity, hypertension, chronic kidney disease, and diabetes.
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Burden of atrial fibrillation in India
Vijay Bohra, Gautam Sharma, Rajnish Juneja
September-December 2015, 1(3):230-232
DOI:10.4103/2395-5414.177228  
Atrial fibrillation (AF) is becoming a major public health burden worldwide, and its prevalence is set to increase owing to the increase in the elderly population. Despite the availability of good epidemiological data on the prevalence of AF in the Western countries, the corresponding data are limited from our country. In this article, we have tried to assimilate all the data available. A national registry on AF does provide some insight into the causes and effects. It is necessary to have a precise knowledge of the national burden for formulating national evidence-based policy and guidelines.
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* Source: CrossRef