Sanjeev Kathuria

Institute of Post Graduate Medical Education and Research

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Jamal Yusuf

Institute of Post Graduate Medical Education and Research

Saibal Mukhopadhyay

Institute of Post Graduate Medical Education and Research

Vimal Mehta

Govind Ballabh Pant Hospital

Vishal Batra

Institute of Post Graduate Medical Education and Research

Mohit Gupta

Institute of Post Graduate Medical Education and Research

Ankit Bansal

Institute of Post Graduate Medical Education and Research

Vijay Trehan

Govind Ballabh Pant Hospital

Narendra Kumar Chauhan

Govind Ballabh Pant Hospital

Ankur Gautam

Institute of Post Graduate Medical Education and Research

Ghazi Muheeb

Institute of Post Graduate Medical Education and Research

Cooperative Institutions

Govind Ballabh Pant Hospital

Institute of Post Graduate Medical Education and Research

Maulana Azad Medical College

All India Institute of Medical Sciences

Indraprastha Institute of Information Technology Delhi

University of Delhi

Icahn School of Medicine at Mount Sinai

BLK Super Speciality Hospital

University of North Carolina at Chapel Hill

Institute of Medical Sciences

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End-of-life care in advanced heart failure during cardiology training in India

Heart India (2021)

Muzaffar Ali Deepak Padmanabhan Bharatraj Banavalikar R Raja Anunay Gupta

Background: The incidence of heart failure (HF) is likely to increase in future in India. As a result, India's health-care system has to care for an increased number of patients with advanced HF (AHF) in future. The objectives of this survey were as follows: (a) to assess cardiology trainees' approach toward treating HF patients and end-of-life (EOL) care, and (b) to review cardiology training curricula and HF management guidelines regarding the approach to EOL care issues in AHF. Methods: We surveyed cardiology fellows undergoing training. The survey questions aimed to assess cardiology fellows' approach in treating patients with different severities of HF and at EOL. We reviewed the cardiology training curricula of various Indian institutions and HF management guidelines from Indian professional bodies. Results: Ninety-nine fellows took part in the survey. 93%–100% reported that they were likely to prescribe recommended drug therapy and Cardiac resynchronization therapy-D implantation to all the patients. The number of likely responses for various EOL interventions was consistently lower when fellows had to rate interventions for themselves as patients. Sixty-four percent of fellows were unfamiliar or uncertain about the idea of hospice care. Eighty-four percent of fellows reported that their training was inadequate, or they were uncertain about the adequacy of their training regarding EOL care issues. None of the training curricula has mentioned “EOL care,” “palliative care,” or “hospice care,” and none of the HF management guidelines discussed such topics. Conclusion: There is an urgent need for sensitizing and training Indian cardiology fellows regarding different aspects of AHF and EOL care.

10.4103/heartindia.heartindia_66_21

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A Young boy with palpitations: Electrocardiogram evidence avoids the need for an Electrophysiology Study

IHJ Cardiovascular Reports (2024)

Sanjeev Kathuria Rahul Nijhawan Ankit Bansal Vimal Mehta

Palpitations

Cardiac Electrophysiology

Electrophysiology study

10.1016/j.ihjcvr.2024.11.001

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ASSESSMENT OF COAGULATION FACTORS IN PATIENTS WITH SEVERE RHEUMATIC MITRAL STENOSIS IN SINUS RHYTHM WITH LEFT ATRIAL APPENDAGE INACTIVITY

CJC Open (2024)

Saibal Mukhopadhyay Narendra Kumar Chauhan Ghazi Muheeb Jamal Yusuf Vimal Mehta

BackgroundPatients with severe mitral stenosis (MS) in normal sinus rhythm (NSR), presenting with left atrial appendage (LAA) inactivity and associated left atrial spontaneous echo contrast (LASEC), are prone to left atrial (LA) or LAA thrombus formation. But unlike atrial fibrillation (AF), oral anticoagulants (OAC) are not commonly prescribed for this patient subset. This study aimed to compare the levels of procoagulants and fibrinogen in both local (LA) and systemic contexts between patients with severe MS in NSR and healthy controls.MethodsThe study involved 35 patients with severe MS in NSR with LAA inactivity and LASEC eligible for balloon mitral valvuloplasty and 35 controls. All patients underwent transthoracic and trans-esophageal echocardiography to assess MS severity, LAA activity, and LASEC grade, with blood samples analysed for procoagulant levels.ResultsResults showed comparable baseline characteristics between groups, with most patients in NYHA II or III functional classes and varying LASEC grades. Patients exhibited significantly higher levels of prothrombin fragment 1+2 {patient vs control, 9017(6228.0-10963.5)pg/mL vs 1790(842.3-2712)pg/mL, p<0.0001)}, thrombin-antithrombin III {patient vs control, 39(5.45-74.85)ng/ml vs 2.80(1.6-6.5)ng/mL, p<0.0001}, plasminogen activator inhibitor-1 {patients vs controls, 26.09±8.18ng/mL vs 8.05±3.53ng/mL, p<0.0001)}, and fibrinogen (3.48±0.89g/L vs 3.01±0.53g/L, p=0.029) in the LA of patients compared to controls. Systemic procoagulant levels were also elevated in patients, but D-dimer levels were similar between the two groups.ConclusionThe findings suggest a hypercoagulable state in patients similar to those with AF. The study advocates for consideration of OAC in these patients until LA and LAA function improve to mitigate thrombus formation.

10.1016/j.cjco.2024.07.004

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Transcatheter embolization of a giant pancreatic pseudoaneurysm: A tale of two bleeds and one thrombus!

Indian Heart Journal (2012)

Gagan Jain Sanjeev Kathuria Arima Nigam Vijay Trehan

Erosion of a peripancreatic artery into the pseudocyst as a result of enzymatic digestion of vessel wall gives rise to a pancreatic pseudoaneurysm (PSA), which is a rare complication seen in patients with chronic pancreatitis.(1) Angiographic embolization as a treatment method for acute hemorrhage from pancreatic PSA has become increasingly popular. Here we report a unique case with bleeding from a giant pancreatic PSA where the single PSA had blood supply originating from the branches of both the celiac artery and superior mesenteric artery.

Pseudoaneurysm

10.1016/j.ihj.2012.12.015

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Accuracy of 64-slice CT coronary angiography: our initial experience.

Indian Heart Journal (2009)

Ashutosh Prakash Kulbir Ahlawat U Kaul Sanjay Tyagi Bharat Aggarwal

Gold standard (test)

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A Network Meta-Analysis Comparing Osteoporotic Fracture among Different Direct Oral Anticoagulants and Vitamin K Antagonists in Patients with Atrial Fibrillation

Journal of Bone Metabolism (2021)

Dibbendhu Khanra Anindya Mukherjee Saurabh Deshpande Hassan Khan Sanjeev Kathuria

Background There are limited studies comparing the risk of osteoporosis and fractures between different direct oral anticoagulants (DOACs) and vitamin K antagonists (VKA) in non-valvular atrial fibrillation (AF). Using a network meta-analysis (NMA), we compared osteoporotic fractures among 5 different treatment arms, viz. dabigatran, rivaroxaban, apixaban, edoxaban, and VKA. Methods Ten studies, including 5 randomized control trials and 5 population-based studies, with a total of 321,844 patients (148,751 and 173,093 in the VKA and DOAC group, respectively) with a median follow-up of 2 years, were included. A Bayesian random-effects NMA model comparing fractures among the treatment arms was performed using MetInsight V3. Sensitivity analysis excluded studies with the highest residual deviances from the NMA model. Results The mean age of the patients was 70 years. The meta-analysis favored DOACs over VKA with significantly lower osteoporotic fracture (odds ratio [OR], 0.77; 95% credible interval [CrI], 0.70-0.86). The NMA demonstrated that fractures were significantly lower with apixaban compared with dabigatran (OR, 0.64; 95% CrI, 0.44-0.95); however, fractures were statistically similar between apixaban and rivaroxaban (OR, 0.84; 95% CrI, 0.58-1.24) and dabigatran and rivaroxaban (OR, 1.32; 95% CrI, 0.90-1.87). Based on the Bayesian model of NMA, the probability of osteoporotic fracture was highest with VKA and lowest with apixaban, followed by rivaroxaban, edoxaban, and dabigatran. Conclusions The decision to prescribe anticoagulants in elderly patients with AF should be made not only based on thrombotic and bleeding risks but also on the risk of osteoporotic fracture; these factors should be considered and incorporated in contemporary cardiology practice. Key words: Atrial fibrillation · Factor Xa inhibitors · Network meta-analysis · Osteoporotic fractures · Vitamin K

Apixaban

Edoxaban

10.11005/jbm.2021.28.2.139

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Left Atrial Function by Two-Dimensional Speckle Tracking Echocardiography in Patients with Severe Rheumatic Mitral Stenosis and Pulmonary Hypertension

Authorea (Authorea) (2021)

Vimal Mehta Dhanjibhai Chaudhari Pratishtha Mehra Sudhanshu Mahajan Jamal Yusuf

Aim: The aim of this study was to assess the left atrial (LA) function in severe rheumatic mitral stenosis (MS) patients using two-dimensional speckle tracking echocardiography (STE) and its correlation with clinical symptoms and echocardiography parameters. Methods: A total of 120 subjects (80 patients with isolated severe MS [mitral valve area (MVA) ≤1.5 cm2] in sinus rhythm and 40 healthy controls) underwent comprehensive echocardiography including STE for assessment of LA strain [reservoir strain (LASr), conduit strain (LAScd) and contractile strain (LASct)]. Results: The mean MVA in cases was 0.93 ± 0.21 cm2. The mean values of LASr (14.73 ± 8.59%), LAScd (-7.61 ± 4.47%) and LASct (-7.16 ± 5.15%) among cases were significantly less (p< 0.001) when compared to controls where the values were 44.11 ± 10.44%, -32.45 ± 7.63%, -11.85 ± 6.77% respectively. Thus the compensatory LA contractile function was also compromised. The New York Heart Association (NYHA) class III, II and I dyspnea was present in 37 (46.25%), 38 (47.5%) and 5 (6.25%) subjects respectively. All the three LA strain parameters showed a trend towards decline with increase in severity of MS, increase in LA size, increase in mean and peak diastolic transmitral gradients and with higher NYHA functional class. Conclusion: Left atrial dysfunction is common in severe rheumatic MS as suggested by severely reduced LA reservoir, conduit and contractile strain. Early and timely intervention in these patients irrespective of NYHA functional class is advocated as it may likely improve the LA function and avoid clinical deterioration.

Speckle tracking echocardiography

10.22541/au.162075990.09345656/v1

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Rhythm Control of Persistent Atrial Fibrillation in Systolic Heart Failure: A Bayesian Network Meta-Analysis of Randomized Controlled Trials

International Journal of Heart Failure (2021)

Dibbendhu Khanra Saurabh Deshpande Anindya Mukherjee Siddhartha Mohan Hassan Khan

Persistent atrial fibrillation (PeAF) with heart failure (HF) arguably constitutes the sickest subset of atrial fibrillation (AF) patients.A systematic search was made in PubMed, Embase, and Scopus databases. Network meta-analysis (NMA) of PeAF patients with systolic HF comparing all-cause mortality, change in HF-related quality of life (QoL) and hospitalization due to heart failure (HHF) were performed among catheter ablation (CA) of AF, rate-controlling drugs (RCDs), anti-arrhythmic drugs (AADs), and atrio-ventricular nodal ablation (AVNA) using Bayesian random effect model.Ablation strategies resulted significantly lower mortality than medical therapies (odds ratio [OR], 0.51; 95% confidence interval [CI], 0.35 to 0.76). CA of AF was associated with lower trend of mortality (OR, 0.78; 95% credible interval [CrI], 0.08 to 7.63) in comparison to AVNA in the Bayesian NMA. Rhythm control strategies resulted significantly higher improvement of QoL than rate control strategies (mean difference [MD], -12.78; 95% CI, -21.26 to -4.31). Bayesian NMA showed that CA of AF was better than AAD (MD, -7.98; 95% CrI, -27.68 to 8.27), however ranked AVNA to be lowest. Ablation strategies provided significantly lower HHF than medical therapies (OR, 0.42; 95% CI, 0.30 to 0.58). Bayesian NMA showed that CA of AF performed not only better than AAD (OR, 0.33; 95% CrI, 0.09 to 1.3) to reduce HHF, but also than AVNA (OR, 0.20; 95% CrI, 0.00 to 4.76). Of note, RCD ranked lowest with regard to mortality and HHF.CA of AF remains the best strategy even for the sickest group of PeAF patients with systolic HF in regards to all-cause mortality, HF-related QoL and HHF.

10.36628/ijhf.2021.0008

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Railroad Pattern of Atrial Intervals in a Dual-chamber Pacemaker Patient—What Is the Mechanism and How to Manage?

Journal of Innovations in Cardiac Rhythm Management (2022)

Debabrata Bera Anunay Gupta Sanjeev Kathuria

A 55-year-old woman with a dual-chamber pacemaker presented with brief episodes of rapid palpitation. The device recorded several stored atrial high-rate and ventricular high-rate episodes. The atrial intervals showed an interesting railroad track pattern during a non-sustained episode of ventricular tachycardia. We discussed the differential diagnosis of railroad track patterns on the atrial channel. In our case, it was related to far-field R-wave oversensing.

Ventricular rate

Atrial tachycardia

P wave

10.19102/icrm.2022.130406

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Design and rationale of an intelligent algorithm to detect BuRnoUt in HeaLthcare workers in COVID era using ECG and artificiaL intelligence: The BRUCEE-LI study

Indian Heart Journal (2020)

Mohit Gupta Ankit Bansal Prattay Guha Sarkar M.P. Girish Manish K. Jha

There is no large contemporary data from India to see the prevalence of burnout in HCWs in covid era. Burnout and mental stress is associated with electrocardiographic changes detectable by artificial intelligence (AI). The present study aims to estimate the prevalence of burnout in HCWs in COVID-19 era using Mini Z-scale and to develop predictive AI model to detect burnout in HCWs in COVID-19 era. This is an observational and cross-sectional study to evaluate the presence of burnout in HCWs in academic tertiary care centres of North India in the COVID-19 era. At least 900 participants will be enrolled in this study from four leading premier government-funded/public-private centres of North India. Each study centre will be asked to recruit HCWs by approaching them through various listed ways for participation in the study. Interested participants after initial screening and meeting the eligibility criteria, will be asked to fill the questionnaire (having demographic and work related with Mini Z questionnaire) to assess burnout. The healthcare workers will include physicians at all levels of training, nursing staff and paramedical staff who are involved directly or indirectly in COVID-19 care. The analysis of the raw electrocardiogram (ECG) data and development of algorithm using convolutional neural networks (CNN) will be done by experts. In Summary, we propose that ECG data generated from the people with burnout can be utilized to develop AI-enabled model to predict the presence of stress and burnout in HCWs in COVID-19 era.

10.1016/j.ihj.2020.11.145

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