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Peripartum cardiomyopathy (PPCM) is an idiopathic, non-ischemic systolic type of heart failure which can present anytime from the last month of pregnancy till the end of 5th month post-partum. The incidence of PPCM in the Indian population is 1:1340 with 60% of the cases occurring post-partum. PPCM has a mortality rate of 11.7% with unpredictable sequelae ranging from worsening heart failure, cardiogenic shock, development of arrythmias to complete recovery and recurrence in subsequent pregnancies. With an idiopathic aetiology with multiple theories, PPCM remains a diagnosis of exclusion, demanding a high index of suspicion and surveillance in pregnant women. The management involves a multidisciplinary approach involving the obstetrician, cardiologist and at times the anaesthesiologist and includes various drugs like beta- blockers, diuretics, digoxin, bromocriptine. In severe cases, maternal circulatory support may also be needed. We present three cases of PPCM diagnosed in the antepartum, intrapartum and immediate post-partum periods respectively. Out of 3 patients, one delivered vaginally and two underwent emergency caesarean sections. All of patients went home post-delivery with good outcomes and were doing well after 4 weeks of delivery.
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Background: Cardiovascular diseases are a leading cause of morbidity and mortality worldwide. The prevalence and risk factors of CVDs vary across different populations and regions. This study aimed to observe the cardiac profile among the adult population of Sreemangal, Bangladesh, to identify the prevalence and risk factors of CVDs in this population. Methods: This prospective observational study was conducted over a six-month period at a public health camp in Sreemangal, Bangladesh. A total of 137 adult participants were purposively selected. Data were collected through a structured questionnaire and physical examination, including measurements of blood pressure and laboratory analysis of blood samples. Results: The study found that 44.53% of participants had elevated blood pressure, and 21.90% had stage 1 hypertension. Interestingly, 36.50% of participants were unaware of their hypertension status. Furthermore, 26.28% of participants had a known history of diabetes, but blood glucose level analysis revealed an additional 14.85% of participants were prediabetic, and 6.93% were diabetic based on fasting blood glucose levels. A statistically significant association was found between increasing age and the stage of hypertension (p<0.001), and between fasting and normal blood glucose levels and the stage of hypertension (p<0.005 and p<0.05, respectively). Conclusions: The findings of this study underscore the need for targeted interventions to prevent and manage CVDs in the adult population of Sreemangal, Bangladesh. These interventions should include regular screening for CVD risk factors, health education to increase awareness of these risk factors, and strategies to promote healthy lifestyle behaviors.
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Left bundle branch block (LBBB) is generally associated with a poorer prognosis in comparison to normal intraventricular conduction. LBBB may be the first manifestation of a more diffuse myocardial disease.The typical surface ECG feature of LBBB is a prolongation of QRS above 0.11s in combination with a delay of the intrinsic deflection in leads V5 and V6 of more than 60 ms and no septal q waves in leads I, V5, and V6 due to the abnormal septal activation from right to left. LBBB may induce abnormalities in left ventricular performance due to abnormal asynchronous contraction patterns. Asynchronous electrical activation of the ventricles causes regional differences in workload which may lead to asymmetric hypertrophy and left ventricular dilatation, especially due to increased wall mass in late-activated regions, which may aggravate preexisting left ventricular pumping performance or even induce it.
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Objective:To explore the clinical characteristics and risk factors of abnormal urinary albumin/creatinine ratio(UACR) in obese population.Methods:Baseline data from 2011 to 2012 in Henan Sub-center of"Risk Evaluation of cAncers in Chinese diabeTic Individuals: A lONgitudinal(REACTION) study"were utilized and those of body mass index≥28 kg/m 2 were screened. The patients were divided into UACR normal group and UACR abnormal group(101 pairs) upon being matched on a 1∶1 basis by age and gender. Multivariate logistic regression analysis, receiver operating characteristic(ROC) curve, and restricted cubic spline(RCS)analysis were performed to explore the risk factors for abnormal UACR. Results:Compared with the normal UACR group, the UACR abnormal group had a higher number of alcohol consumers, a higher prevalence of hypertension, elevated systolic blood pressure, and triglyceride(all P<0.05). Multivariate logistic regression analysis showed that alcohol consumption( P=0.008), systolic blood pressure( P<0.001), triglyceride( P=0.049), and homeostasis model assessment for insulin resistance(HOMA-IR, P=0.033) were independent risk factors for abnormal UACR in obese people. The ROC curve analysis indicated that systolic blood pressure had the strongest diagnostic performance as a single factor(ROC curve area=0.801), and there was no significant difference in diagnostic performance compared to multiple factors combination. RCS analysis results showed that the probability of abnormal UACR increased monotonically with the increase of systolic blood pressure when the systolic blood pressure was between 130 and 158 mmHg(1 mmHg=0.133 kPa). When systolic blood pressure was not in the interval, the probability of abnormal UACR did not change significantly. The results of regression analysis of triglyceride subgroup showed that when triglyceride level was greater than or equal to 5.6 mmol/L, the risk of abnormal UACR level was significantly increased( P=0.029). Conclusion:Systolic blood pressure, triglyceride, HOMA-IR, and alcohol drinking history are independent risk factors for abnormal UACR in obese people. When systolic blood pressure is≥130 mmHg or triglyceride is≥5.6 mmol/L, the risk of abnormal UACR is significantly increased.
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Objective:Mendelian randomization (MR) was used to analyze the potential relationship between blood pressure and proliferative diabetic retinopathy (PDR).Methods:Two-sample MR analysis was performed using summary statistics from genome-wide association studies. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were selected as the exposure, PDR as the outcome. The instrumental variable of SBP and DBP came from the publicly available data of the the UK Medical Research Council Comprehensive Epidemiology Unit and Neale Laboratory; the outcome data (8 681 cases in the case group, 204 208 cases in the control group, European population) are from the FinnGen database. Inverse variance weighting (IVW) and weighted median (WM) were used to analyze the potential relationships between SBP, DBP and PDR.Results:MR analysis showed that IVW [SBP: odds ratio ( OR)=1.36, 95% confidence interval ( CI) 1.17-1.57, P= 4.22E-05; DBP: OR=1.29, 95% CI 1.11-1.51, P=8.6E-04], WM (SBP: OR=1.33, 95% CI 1.07-1.66, P=0.009; DBP: OR=1.28, 95% CI=1.03-1.59, P=0.002). The results showed that elevated SBP and DBP increased the risk of PDR. Conclusion:Blood pressure (SBP, DBP) change is positively correlated with the risk of PDR.
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First-phase ejection fraction （EF1） is the volume change rate of left ventricle （LV） from end-diastole to the time of peak aortic velocity. This article reviewed the research progress of EF1 in detecting early left ventricular systolic dysfunction （LVSD） of patients with aortic stenosis （AS）， stable coronary artery disease （SCAD）， Coronavirus Disease 2019 （COVID-19） and so on， analyzed the advantages and limitations of EF1 in clinical application， and envisioned the future development of EF1 as a novel predictor of early LVSD in clinical use.
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@#Objective To explore the predictive value of systolic pulmonary artery pressure (SPAP) on autonomic nerve excitation in patients with valvular disease, so as to provide reference for the formulation of clinical intervention plans. Methods The clinical data of patients with valvular disease who received surgical treatment in the General Hospital of Northern Theater Command from August 28, 2020 to February 3, 2021 were prospectively collected. According to the standard deviation of normal-to-normal R-R intervals (SDNN) of the heart rate variability (HRV) of the long-range dynamic electrocardiogram (ECG) 7 days before the operation, the patients were divided into three groups: a sympathetic dominant (SE) group (SDNN≤50 ms), a balance group (50 ms<SDNN<100 ms) and a parasympathetic dominant (PSE) group (SDNN≥100 ms). The correlation between the changes of echocardiographic indexes and autonomic nerve excitation among the groups and the predictive values were analyzed. Results A total of 186 patients were enrolled, including 108 males and 78 females aged 55.92±11.99 years. There were 26 patients in the SE group, 104 patients in the balance group, and 56 patients in the PSE group. The left anteroposterior diameter (LAD), left ventricular end diastolic inner diameter, ratio of peak E to peak A of mitral valve (Em/Am), left ventricular end diastolic volume, left ventricular end systolic volume and SPAP in the SE group were higher than those in the balance group (P<0.05), while peak A of tricuspid valve (At) and left ventricular ejection fraction (LVEF) were lower than those in the balance group (P<0.05). The LAD and Em/Am in the balance group were significantly higher than those in the PSE group (P<0.05). Multivariate analysis showed that patients in the SE group had lower At (right atrial systolic function declines), lower LVEF and higher SPAP than those in the balance group (P=0.04, 0.04 and 0.00). When HRV increased and parasympathetic nerve was excited in patients with valvular disease, Em/Am decreased (left atrial function and/or left ventricular diastolic function declined) with a normal LAD. Pearson analysis showed that there was a linear negative correlation between SPAP and SDNN, with a coefficient of −0.348, indicating that the higher SPAP, the lower HRV and the more excited sympathetic nerve. Receiver operating characteristic curve showed that when SPAP≥45.50 mm Hg (1 mm Hg=0.133 kPa), the sensitivity and specificity of sympathetic excitation in patients with valvular disease were 84.60% and 63.70%, respectively. Conclusion Parasympathetic excitation is an early manifestation of the disease, often accompanied by decreased left atrial function and/or left ventricular diastolic function. Sympathetic nerve excitation can be accompanied by the increase of SPAP and the decrease of left ventricular and right atrial systolic function. SPAP has a unique predictive value for the prediction of autonomic nerve excitation in patients with valvular disease.
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Objectives:To explore the influencing factors of inter-arm systolic blood pressure difference(sIAD)in young hypertensive population. Methods:A total of 12 895 young Kailuan employees aged≤40 years,who participated in the physical examination from 2010 to 2020,were enrolled in this study.All of them underwent blood pressure measurements of four limbs in supine position.Young hypertensive group(n=3 584)and young non-hypertensive group(n=3 584)were 1∶1 matched by sex and age(±1 year),and participants were further divided into sIAD＜10 mmHg(1 mmHg=0.133 kPa)and sIAD≥10 mmHg subgroups.A stepwise multivariate logistic regression model was established to analyze the determinants of sIAD≥10 mmHg. Results:The detection rate of sIAD≥10 mmHg was significantly higher in the young hypertensive group than in the young non-hypertensive group(31.72%vs.27.76%,P＜0.001).Stepwise multivariate logistic regression analysis showed that in young hypertensive population,ankle-brachial index(ABI)＜0.9,male,obesity,overweight,elevated low density lipoprotein cholesterol(LDL-C)level,and systolic blood pressure were positively associated with sIAD≥10 mmHg,while college education or above,physical exercise were negatively correlated with sIAD≥10 mmHg(all P＜0.05).In the young non-hypertensive population,ABI＜0.9,systolic blood pressure were positively correlated with sIAD≥10 mmHg,while age was negatively associated with sIAD≥10 mmHg(all P＜0.05). Conclusions:The detection rate of sIAD≥10 mmHg is higher in young hypertensive population than in young non-hypertensive population.Decreased ABI,male sex,obesity,overweight,increased LDL-C level,systolic blood pressure,college education and above,and physical exercise are the influencing factors of sIAD≥10 mmHg in young hypertensive population.
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@#Objective The tissue motion mitral annular displacement(TMAD)technique was used to evaluate left ventricular longitudinal systolic function in patients with hyperthyroidism,and its correlation with myocardial damage was analyzed.Methods Sixty-nine cases of hyperthyroidism diagnosed in Affiliated Hospital of Youjiang Medical University for Nationalities from July 2021 to November 2022 were selected as the study objects.According to whether the patients were combined with hyperthyroidism heart disease,they were divided into simple hyperthyroidism group(n=43)and thyrotoxic heart group(n=26).35 healthy people who underwent physical examination in our hospital during the same period were selected as normal control group.Three-dimensional echocardiography was used to obtain the left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV),left ventricular ejection fraction(LVEF)and TMAD parameters.The differences of above parameters among all groups were compared,and the correlations of TMAD parameters with creatine kinase isoenzymes(CK-MB)and high-sensitivity cardiac troponin T(hs-cTnT)were analyzed.Results The LVEDV,LVESV,LVEF,TMAD parameters,CK-MB and hs-cTnT of three groups were statistically significant(P<0.001),and LVEDV,LVESV,CK-MB and hs-cTnT of normal control group<simple hyperthyroidism group<thyrotoxic heart group,LVEF and TMAD parameters of normal control group>simple hyperthyroidism group>thyrotoxic heart group.All parameters of TMAD were positively correlated with LVEF(P<0.001),and some parameters of TMAD were negatively correlated with CK-MB(P<0.05).Conclusion TMAD technology can early evaluate left ventricular longitudinal systolic function in patients with hyperthyroidism,and is related to CK-MB and hs-cTnT.
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Abstract Background There are limited data about the effect of new P2Y12 inhibitors on left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI). Objectives We aimed to investigate the effect of ticagrelor on left ventricular function, compared to clopidogrel in patients with heart failure with mildly reduced ejection fraction (HFmrEF) after AMI. Methods In this cross-sectional, single-center study, we included 251 patients with LVEF between 40% and 50% after AMI before discharge. The patients were divided into 2 groups according to the use of ticagrelor (166 patients) and clopidogrel (85 patients). At the end of the 12-month period, LVEF changes were assessed by echocardiography. P < 0.05 was considered statistically significant. Results The mean LVEF before discharge was 46.5% ± 3.6%, and no difference was observed between the ticagrelor and clopidogrel groups (p = 0.20). At the end of the first year, the mean LVEF of the patients increased to 49.8% ± 7.6% in both groups. The use of ticagrelor (β ± SE = 2.05 ± 0.93; p = 0.029), low creatinine level (β ± SE = −10.44 ± 2.35; p < 0.001), low troponin level (β ± SE = −0.38 ± 0.14; p = 0.006), and low heart rate (β ± SE = −0.98 ± 0.33; p = 0.003) were found to be independent predictors of the increase in LVEF (β ± SE 2.05 ± 0.93; 95% confidence interval: 0.21 to 3.90; p = 0.029). Conclusion In our study, ticagrelor improved left ventricular function in 12 months follow-up compared to clopidogrel in patients with HFmrEF after AMI.
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Resumo Fundamento Embora tenha havido melhorias significativas no tratamento da insuficiência cardíaca (IC) nas últimas décadas, seu prognóstico permanece desfavorável. Embora existam muitos biomarcadores que podem ajudar a prever o prognóstico de pacientes com IC, há necessidade de biomarcadores mais simples, menos dispendiosos e mais facilmente disponíveis. Objetivo Avaliar o valor preditivo do valor pan-imune-inflamatório (PIV, do inglês pan-immune-inflammation value) em pacientes com IC agudamente descompensada. Métodos Analisamos 409 pacientes com IC com fração de ejeção reduzida internados por IC aguda descompensada. Os pacientes foram divididos em 3 grupos de acordo com os tercis de PIV: tercil 1 (PIV < 357,25), tercil 2 (PIV ≥ 357,25 e < 834,55) e tercil 3 (PIV ≥ 834,55). Foram considerados estatisticamente significativos valores de p < 0,05. Curvas de Kaplan-Meier e modelos de regressão de riscos proporcionais de Cox foram utilizados para avaliar a associação entre PIV e mortalidade por todas as causas. O desfecho primário foi mortalidade por todas as causas em 5 anos, e o desfecho secundário compreendeu a mortalidade por todas as causas intra-hospitalar em 30 dias, em 180 dias e em 1 ano Resultados Mostramos que valores mais elevados de PIV estavam associados a desfechos primários e secundários. A curva de Kaplan-Meier mostrou que pacientes com valores mais elevados de PIV apresentaram risco aumentado de mortalidade por todas as causas em curto e longo prazo (log-rank p < 0,001). Na análise multivariada, o PIV foi identificado como um preditor independente de mortalidade por todas as causas em longo prazo em pacientes com IC aguda descompensada, e observamos um aumento de 1,96 vezes no risco de um evento (razão de chances: 1,96; intervalo de confiança de 95%: 1,330 a 2,908; p = 0,001). Conclusões Nosso estudo mostrou que o novo biomarcador PIV pode ser usado como preditor de prognóstico em pacientes com IC aguda descompensada.
Abstract Background Although there have been significant improvements in the treatment of heart failure (HF) in recent decades, its prognosis remains poor. Although there are many biomarkers that can help predict the prognosis of patients with HF, there is a need for simpler, cheaper, and more easily available biomarkers. Objective To evaluate the predictive value of pan-immune-inflammation value (PIV) in patients with acute decompensated HF. Methods We analyzed 409 patients with HF with reduced ejection fraction who were hospitalized for acute decompensated HF. Patients were divided into 3 groups according to tertiles of PIV: tertile 1 (PIV < 357.25), tertile 2 (PIV ≥ 357.25 and < 834.55), and tertile 3 (PIV ≥ 834.55). P values < 0.05 were considered statistically significant. Kaplan-Meier curves and Cox proportional hazards regression models were used to evaluate the association between PIV and all-cause mortality. The primary outcome was 5-year all-cause mortality, and the secondary outcomes were in-hospital 30 days,, 180-day, and 1-year all-cause mortality. Results We showed that higher PIV value was associated with both primary and secondary outcomes. The Kaplan-Meier curve showed that patients with higher PIV values had an increased risk of short- and long-term all-cause mortality (log-rank p < 0.001). In the multivariate analysis, PIV was identified as an independent predictor of long-term all-cause mortality in patients with acute decompensated HF, and we observed a 1.96-fold increase in the hazard of an event (odds ratio: 1.96, 95% confidence interval: 1.330 to 2.908, p = 0.001). Conclusions Our study showed that the novel biomarker PIV can be used as a predictor of prognosis in patients with acute decompensated HF.
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Background: Aim and objectives were to compare the differences in blood pressure and pulse rate readings before and after extraction of a tooth. Methods: A total of 250 patients were selected for the study, out of which, 124 were males and 126 were females. All the patients were in an age group from 20 till beyond 73 years of age. Blood pressure and pulse rate readings were measured before the start of the procedure. Extraction procedure was performed and post extraction blood pressure and pulse rate values were recorded. Both the values were compared and evaluated. Results: There was an obvious increase in systolic blood pressure and pulse rate values after a tooth extraction. Conclusions: Blood pressure and pulse rate values showed changes before and after tooth extraction but were within normal limits.
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Introducción: la insuficiencia cardíaca es un síndrome clínico complejo con síntomas y signos que resultan de cualquier alteración estructural o funcional del llenado ventricular o la eyección de sangre. La prevalencia de insuficiencia cardiaca exhibe una variabilidad de 0,2% a 17,7% en naciones industrializadas Materiales y métodos: se realizó una revisión utilizando base de datos como: PubMed, Scopus, Embase, Cochrane Library, Scielo, incluyendo estudios de tipo observacionales, artículos de revisión, ensayos clínicos, y guías clínicas sobre el manejo de pacientes con insuficiencia cardiaca con fracción de eyección reducida. Resultados y conclusiones: la terapia en la insuficiencia cardíaca con fracción de eyección ventricular izquierda (FEVI) reducida busca contrarrestar los mecanismos deletéreos contrarreguladores. La disfunción sistólica del ventrículo izquierdo implica una FEVI ≤ 40%, mientras que la insuficiencia cardíaca se diagnostica por síntomas y signos de congestión, no solo por la FEVI. Los péptidos natriuréticos ayudan en el diagnóstico, pero niveles elevados pueden tener causas no cardíacas. La hipotensión arterial no contraindica el inicio del tratamiento farmacológico. La lesión renal aguda en estos pacientes indica un mal pronóstico, pero los diuréticos de asa de Henle pueden mejorar la función renal. Durante exacerbaciones agudas por insuficiencia cardiaca, no se deben suspender los medicamentos recomendados, ya que su continuidad reduce la mortalidad y las readmisiones. Terapias como la ivabradina, digoxina, hidralazina e isosorbida dinitrato no han demostrado beneficios en insuficiencia cardiaca y FEVI reducida. Sin embargo, vericiguat y omecamtiv mecarbil obtuvieron resultados significativos en reducción de muertes y hospitalizaciones por IC. Además, se recomienda el desfibrilador automático implantable para prevenir muerte cardíaca súbita. El uso de soporte mecánico circulatorio y el trasplante cardiaco debe ser considera en pacientes con IC avanzada que no responde adecuadamente al tratamiento farmacológico.
Introduction: Heart failure is a complex clinical syndrome with symptoms and signs resulting from any structural or functional alteration of ventricular filling or blood ejection. The prevalence of heart failure varies from 0.2% to 17.7% in industrialized nations. Materials and methods: A review was carried out using databases such as: PubMed, Scopus, Embase, Cochrane Library, Scielo, including observational studies, review articles, clinical trials, and clinical guidelines on the management of patients with heart failure with reduced ejection fraction. Results and conclusions: Therapy in heart failure with reduced left ventricular ejection fraction (LVEF) seeks to counteract deleterious counterregulatory mechanisms. Left ventricular systolic dysfunction implies an LVEF ≤ 40%, while heart failure is diagnosed by symptoms and signs of congestion, not LVEF alone. Natriuretic peptides aid in diagnosis, but elevated levels may have non-cardiac causes. Arterial hypotension does not contraindicate the start of pharmacological treatment. Acute kidney injury in these patients indicates a poor prognosis, but Henle loop diuretics may improve renal function. During acute exacerbations of heart failure, recommended medications should not be discontinued, because they reduce mortality and readmissions. Therapies such as ivabradine, digoxin, hydralazine, and isosorbide dinitrate have not demonstrated benefits in heart failure and reduced LVEF. However, vericiguat and omecamtiv mecarbil obtained significant results in reducing deaths and hospitalizations due to HF. Additionally, implantable cardioverter-defibrillator is recommended to prevent sudden cardiac death. The use of mechanical circulatory support and cardiac transplantation should be considered in patients with advanced HF that does not respond adequately to pharmacological treatment.
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Background: In this study, we compared ophthalmic artery Doppler indices between normotensive and hypertensive pregnant women in third trimester and then evaluated if the alterations in ophthalmic artery doppler indices were seen in all the types of hypertensions in pregnancy or confined to preclaampsia. Further we tried to see correlation of ophthalmic artery Doppler indices with perinatal outcomes in terms of fetal growth restriction (FGR), prematurity, neonatal intensive care unit admission (NICU) and maternal outcomes and tried to arrive at mean values of ophthalmic artery Doppler indices to predict adverse outcomes.Methods: 50 hypertensive and 50 normotensive pregnant women were recruited in third trimester. A thorough history about hypertension was taken, obstetric scan was done to know estimated fetal weight, and doppler of umbilical, middle cerebral artery, uterine arteries was done. Simultaneously maternal ophthalmic artery Doppler readings were taken, women were followed up after delivery and perinatal outcomes were recorded.Results: Comparison of mean values of ophthalmic artery doppler parameters in women with and without hypertension showed statistically significant differences with respect to the peak systolic velocity 2 (PSV2), PI (pulsatility index), RI (resistivity index) and peak ratio (PR) (PR=PSV2/PSV1). Significant difference was found only in PR value in preeclampsia group compared to other subgroups of hypertension. In the hypertension group complicated with FGR the mean peak ratio=0.8 whereas in the hypertension group requiring preterm delivery the mean peak ratio=0.78, and in the hypertension group requiring NICU admission the mean peak ratio=0.81. At ophthalmic artery PR cut off ?0.725, the sensitivity and specificity were 76% and 65% respectively to predict FGR.Conclusions: Pregnancy complicated by hypertension showed alterations in ophthalmic artery Doppler indices. Among the subgroups of hypertension, ophthalmic artery PR was the best index for discriminating preclampsia from other types and it was significantly higher in hypertensive pregnant women who had adverse perinatal outcomes. Ophthalmic artery PR has almost similar performance as uterine artery PI in indicating FGR in our study. It could also indicate maternal disease severity such as hypertensive crisis requiring ICU admission, the study number was small.
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Background: In this study, we compared ophthalmic artery Doppler indices between normotensive and hypertensive pregnant women in third trimester and then evaluated if the alterations in ophthalmic artery doppler indices were seen in all the types of hypertensions in pregnancy or confined to preclaampsia. Further we tried to see correlation of ophthalmic artery Doppler indices with perinatal outcomes in terms of fetal growth restriction (FGR), prematurity, neonatal intensive care unit admission (NICU) and maternal outcomes and tried to arrive at mean values of ophthalmic artery Doppler indices to predict adverse outcomes.Methods: 50 hypertensive and 50 normotensive pregnant women were recruited in third trimester. A thorough history about hypertension was taken, obstetric scan was done to know estimated fetal weight, and doppler of umbilical, middle cerebral artery, uterine arteries was done. Simultaneously maternal ophthalmic artery Doppler readings were taken, women were followed up after delivery and perinatal outcomes were recorded.Results: Comparison of mean values of ophthalmic artery doppler parameters in women with and without hypertension showed statistically significant differences with respect to the peak systolic velocity 2 (PSV2), PI (pulsatility index), RI (resistivity index) and peak ratio (PR) (PR=PSV2/PSV1). Significant difference was found only in PR value in preeclampsia group compared to other subgroups of hypertension. In the hypertension group complicated with FGR the mean peak ratio=0.8 whereas in the hypertension group requiring preterm delivery the mean peak ratio=0.78, and in the hypertension group requiring NICU admission the mean peak ratio=0.81. At ophthalmic artery PR cut off ?0.725, the sensitivity and specificity were 76% and 65% respectively to predict FGR.Conclusions: Pregnancy complicated by hypertension showed alterations in ophthalmic artery Doppler indices. Among the subgroups of hypertension, ophthalmic artery PR was the best index for discriminating preclampsia from other types and it was significantly higher in hypertensive pregnant women who had adverse perinatal outcomes. Ophthalmic artery PR has almost similar performance as uterine artery PI in indicating FGR in our study. It could also indicate maternal disease severity such as hypertensive crisis requiring ICU admission, the study number was small.
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Background: The data on clinical characteristics, treatment practices and out comes in patients with Nonischemic Systolic Heart Failure (NISHF) is limited. We report clinical characteristics, treatment and outcomes in patients with NISHF. Methods: 1004 patients with NISHF were prospectively enrolled and their demographics, clinical characteristics, and treatment were recorded systematically. Patients were followed annually for a median of 3 years (1 year to 8 years) for allcause death, major adverse cardiovascular events (MACE); composite of all-cause death, hospitalization of heart failure, and or for stroke. Results: Patients of NISHF were middle-aged (58.8±16.2 years) population with severely depressed left ventricular ejection fraction (29.3±7.02%) and 31.1% had symptoms of advanced Heart failure. Hypertension (43.6%), obesity and or overweight (28.0%), Diabetes (15.0%), and valvular heart disease (11.8%) were the common risk factors. The guideline directed medical treatment was prescribed in more than 80% of the study cohort. Incidence of all cause death and MACE was 7 (6.8, 8.8) per 100 person years and 11(10, 13) per 100 person years respectively. The cumulative incidence of deaths and MACE was 35% (30%, 40%) and 49% (44%, 53%) at 8 years of follow-up. Conclusions: Patients of NISHF were middle-aged population with severely depressed LV systolic function with significant incident morbidity and mortality. Early detection of risk factors and their risk management and enhancing the use of guideline directed treatment may improve the outcomes. Keywords: Non-ischemic systolic heart failure, risk factors, outcomes, guideline directed treatment
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The number of overweight and obese children in India was 19.3% (NFHS-5), which was a big jump from the previous number of 6.3% (NFHS-4). A school-based case-series design was conducted to assess the effect of yoga on biophysiological parameters among overweight and obese adolescents (11-13 years) at selected schools in Puducherry. The census method was used to screen 286 adolescents, aged 11 to 13, for height and weight. The study included 18 overweight boys and girls. Bio-physiological parameters were measured at baseline, three months, and six months after yoga practice. The results of the study showed that a significant difference was found after yoga practice. The mean difference in weight reduction was 4.0, the BMI was 1.7, the waist circumference was 4.6, the hip circumference was 6.2, the triceps skin fold thickness was 4.9, and the sub capsular skin fold thickness was 5.7. The mean difference in pulse reduction was 8.8, the systolic blood pressure was 11.0, and the diastolic pressure was 6.9. In terms of body composition, the decrease in fat (%) was 3.4, water (%) was 2.4, extracellular volume (ECW) (%) was 1.1, intracellular volume (ICW) (%) was 2.0, and the body fat mass index (BFMI) was 1.7. The study concluded that yoga is effective in managing obesity and building healthy citizens in future adolescents.
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Introduction: It has been suggested that isometric handgrip resistance exercise be used as the first line treatment for hypertension. This cross-sectional study sought to better understand the association between adult individual's systolic and diastolic blood pressures with hand grip strength. The present study is a cross-s Methods: ectional study done among 240 healthy participants aged 19-40 years. Clearance was obtained from Institutional Ethical Committee. Blood pressure was recorded following standard precautions. The average of the maximum handgrip strength from both hands were taken into consideration. General linear models were used to examine the association between handgrip strength and blood pressure. Data was analyzed by Independent t test and Pearson correlation test using software, SPSS version 26. Handgrip strength was significantly and positively associated Results: with systolic blood pressure (P<0.001), diastolic blood pressure (P<0.001) and body mass Index (P<0.05). There was an increase in systolic blood pressure, diastolic blood pressure and body mass index with increase in handgrip strength. High systolic and diastolic blood pressures w Conclusion: ere associated with increased handgrip strength in both men and women. This aids in controlling blood pressure and might have implications for early prevention
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Background: The data on incidence of recovered Left Ventricular Ejection Fraction (LVEF) and outcome in patients with non ischemic systolic heart failure is limited. We report the incidence, determinants and mortality in patients with recovered LVEF. Methods: The 369 patients with HFrEF with LVEF of less than 40% of non ischemic etiology with available follow up echocardiography study at one year were enrolled. The baseline data of clinical characteristics and treatment was recorded prospectively and were followed up annually for mean of 3.6 years (range 2 to 5 years) to record all cause death and LVEF measured echocardiographically. The recovered, partially recovered and no recovery of LVEF was defined based on increase in LVEF to 50% and more, 41% to 49% and to persistently depressed LVEF to 40% or lower respectively. Results: The LVEF recovered in 36.5%% of the cohort at 5 years. The rate of recovery of LVEF was slower in patients with no recovery of LVEF at one year compared to cohort with partially recovered LVEF (18% vs.53%) at five year. The Baseline LVEF was significantly associated with recovered LVEF, odd ratio (95% C.I.) 1.09(1.04, 1.14). The cumulative mortality at five years was significantly lower in cohort with recovered LVEF (18.1% vs. 57.1%). Conclusions: One third of the patients had recovered LVEF and was significantly associated with baseline LVEF and lower mortality rate.
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Introducción: La presencia de hipertensión arterial en población joven aumenta el riesgo de eventos cardiovasculares en la mediana edad y como consecuencia una morbimortalidad prematura. El propósito de este estudio es evaluar la progresión de los componentes de la presión arterial y la correlación con las medidas antropométricas y laboratoriales en estudiantes de la Universidad Nacional de Asunción- Paraguay. Materiales y métodos: Se realizó un estudio descriptivo correlacional, longitudinal, prospectivo, desde el año 2013 hasta el año 2017 evaluando al inicio 284 universitarios y 240 al final de las carreras. Se midieron variables sociodemográficas, antropométricas, presión arterial, determinaciones bioquímicas. La progresión de los componentes de la presión arterial, de las variables antropométricas y clínicas se calcularon mediante la prueba T de muestras relacionadas. La correlación de la presión arterial sistólica y presión arterial diastólica con las variables antropométricas y laboratoriales con la correlación de Pearson. Resultados: La progresión de los componentes de la presión arterial presentó una diferencia estadísticamente significativa en la presión arterial sistólica, presión arterial diastólica y presión de pulso. En relación con las características antropométricas y clínicas de los estudiantes se encontró una diferencia estadísticamente significativa entre la medición inicial y final en el peso, perímetro abdominal, glicemia, insulina, colesterol total, colesterol de alta densidad, colesterol de baja densidad, triglicéridos y proteína C reactiva. La correlación más importante encontrada entre las medidas antropométricas con la presión arterial sistólica y presión arterial diastólica fue la circunferencia abdominal. Conclusión: Se encontró aumento de la tendencia de la presión arterial y de otros factores de riesgo cardiovascular en universitarios.
Introduction: The presence of arterial hypertension in young population increases the risk of cardiovascular events in middle age and as a consequence premature morbimortality. The purpose of this study was to evaluate the progression of blood pressure components and the correlation with anthropometric and laboratory measurements in students of the National University of Asuncion, Paraguay. Materials and methods: A descriptive correlational, longitudinal, prospective, descriptive study was conducted from 2013 to 2017 evaluating at the beginning 284 undergraduates and 240 at the end of the careers. Sociodemographic variables, anthropometric variables, blood pressure, biochemical determinations were measured. The progression of blood pressure components, anthropometric and clinical variables were calculated using the related samples t-test. The correlation of systolic blood pressure and diastolic blood pressure with anthropometric and laboratory variables was correlated with Pearson's correlation. Results: The progression of blood pressure components presented a statistically significant difference in systolic blood pressure, diastolic blood pressure and pulse pressure. In relation to the anthropometric and clinical characteristics of the students, a statistically significant difference was found between the initial and final measurements in weight, abdominal perimeter, glycemia, insulin, total cholesterol, high-density cholesterol, low-density cholesterol, triglycerides, and C-reactive protein. The most important correlation found between anthropometric measurements with systolic blood pressure and diastolic blood pressure was abdominal circumference. Conclusion: An increase in the trend of blood pressure and other cardiovascular risk factors was found in university students.