Feasibility and outcome of community-based screening for cardiovascular disease risk factors in a remote rural area of South India: The Chunampet rural-Cardiovascular health assessment and management program.

BACKGROUND: As committed by India in Global Action Plan, Sustainable Development Goals and National Health Policy 2017, India has the responsibility to provide accessible, affordable noncommunicable disease care to the people. Our study aimed to find out the burden of cardiovascular risk factors among hypertension and diabetic patients, through a community-based screening, in a remote rural area of South India. METHODS: A special program named "Chunampet Rural-Cardiovascular Health Assessment and Management Program" (CR-CHAMP) was launched in August and September 2017 in a Rural Health Training Center (RHTC), functioning under a private medical college in South India. In this program, participants with hypertension (HT) and diabetes (DM) were line listed from 10 remote villages, and then history, initial biochemical, hormonal, and hematological screenings were done to assess the cardiovascular diseases (CVDs) risk factors among these patients, following which special consultation was offered in RHTC. RESULTS: Out of 415 eligible patients with HT and DM, 389 were approached; among them, 328 were willing to participate and were screened initially; among them, 235 were attended special consultation. Higher CVD risk was found in 21%. Prevalence of chronic kidney disease was 14%, deranged lipid profile was more than 50%, metabolic syndrome was 49%, anemia was 68%, abnormal waist-hip ratio was 56%, abdominal obesity was 59%, and overweight and obesity using body mass index (BMI) was 59%. Females' participation was more in our community-based screening procedure (66%) than male participation (34%). CONCLUSION: CR-CHAMP demonstrated feasibility and value of implementing a screening program for high-risk individuals with HT and DM for CVD risk through existing primary care in a remote rural area of South India. This will help the National Program and policymakers to plan for interventions in the remote rural area in future.

A Novel Tram Stent Method in the Treatment of Coronary Bifurcation Lesions - Finite Element Study.

A novel stent was designed for the treatment of coronary bifurcation lesion, and it was investigated for its performance by finite element analysis. This study was performed in search of a novel method of treatment of bifurcation lesion with provisional stenting. A bifurcation model was created with the proximal vessel of 3.2 mm diameter, and the distal vessel after the side branch (2.3 mm) was 2.7 mm. A novel stent was designed with connection links that had a profile of a tram. Laser cutting and shape setting of the stent was performed, and thereafter it was crimped and deployed over a balloon. The contact pressure, stresses on the arterial wall, stresses on the stent, the maximal principal log strain of the main artery and the side-branch were studied. The study was performed in Abaqus, Simulia. The stresses on the main branch and the distal branch were minimally increased after deployment of this novel stent. The side branch was preserved, and the stresses on the side branch were lesser; and at the confluence of bifurcation on either side of the side branch origin the von-Mises stress was marginally increased. The stresses and strain at the bifurcation were significantly lesser than the stresses and strain of the currently existing techniques used in the treatment of bifurcation lesions though the study was primarily focused only on the utility of the new technology. There is a potential for a novel Tram-stent method in the treatment of coronary bifurcation lesions.

Finite element modeling of a novel self-expanding endovascular stent method in treatment of aortic aneurysms.

A novel large self-expanding endovascular stent was designed with strut thickness of 70 µm × 70 µm width. The method was developed and investigated to identify a novel simpler technique in aortic aneurysm therapy. Stage 1 analysis was performed after deploying it in a virtual aneurysm model of 6 cm wide × 6 cm long fusiform hyper-elastic anisotropic design. At cell width of 9 mm, there was no buckling or migration of the stent at 180 Hg. Radial force of the stents was estimated after parametric variations. In stage 2 analysis, a prototype 300 µm × 150 µm stent with a cell width of 9 mm was chosen, and it was evaluated similarly after embedding in the aortic wall, and also with a tissue overgrowth of 1 mm over the stent. The 300/150 µm stent reduced the peak wall stress by 70% in the aneurysm and 50% reduction in compliance after embedding. Stage 3 analysis was performed to study the efficacy of stents with struts (thickness/width) 70/70, 180/100 and 300/150 µm after embedding and tissue overgrowth. The adjacent wall stresses were very minimal in stents with 180/100 and 70/70 µm struts after embedding. There is potential for a novel stent method in aortic aneurysm therapy.

Ejection fraction at the first attack of myocardial infarction and postinfarction survival in South Indian population.

Ischemic heart disease is estimated to be the most important cause of mortality by the end of 2020 world wide despite sufficient improvement in health care. It has several modifiable and few non modifiable prognostic variables. Therefore, we analyzed the data of all patients admitted for the first time for acute myocardial infarction (MI) and evaluated the long term modifiable prognostic variables retrospectively. We did not find any difference in the age, blood pressure, hematological and several biochemical parameters between patients who survived and those who expired in 4 years of follow up. Our study revealed that in the expired group patients, the mean admission heart rate, ejection fraction, serum urea and creatinine levels were higher and bicarbonate level was lower compared to survived group patients at the first attack of MI. Also, despite the less incidence of myocardial infarction in females, the percentage of cardiac death was higher in female MI patients. We suggest from our retrospective analysis that MI patients with higher heart rate, altered renal function and metabolic acidosis should be rigorously followed up and special counseling should be provided to old age female patients for better prognosis and survival.

Myocardial infarction in prediabetic patients: role of blood pressure dyshomeostasis.

Male gender and fasting sugar level at pre diabetic range are two of the recognized risk factors associated with coronary artery disease. Recently it was found that although males are at increased incidence of myocardial infarction (MI), the severity of disease is same for both genders among pre-diabetic myocardial infarction cases. In this study, we have retrospectively analyzed various biochemical and physiological parameters and cardiac markers of patients admitted for the first instance of myocardial infarction. We found an evidence of impairment in blood pressure homeostasis in female patients which could be one of the factors responsible for the equal degree of severity in myocardial infarction among females compared to males, despite lower incidence of MI in them.

Left ventricular lateral annulus and left atrial free-wall velocity time integral indicate thromboembolism in patients with rheumatic atrial fibrillation.

BACKGROUND: Low wall motion and stasis increase the likelihood of clot formation. We hypothesized that tissue Doppler indices of left atrial (LA) motion are reduced in the presence of LA thrombi and may be predictive for clot formation in patients with atrial fibrillation (AF). METHODS: We did an observational study for 3 years in 118 patients with rheumatic mitral valve disease in chronic AF who had not received anticoagulation, with (Group 1, n = 36) and without (Group 2, n = 82) thromboembolism. Pulsed tissue Doppler systolic velocities and velocity time integrals (VTIs) were measured in all four chambers. A mean LA VTI was calculated. LA strain during ventricular systole was calculated using VTI and distance between two LA locations. RESULTS: Logistic regression analysis showed that, after adjusting for age, gender, diabetes, hypertension, LA size, and left ventricular (LV) ejection fraction, mean LA VTI [Odds ratio (OR) 0.69, 95%CI (0.56-0.86, P = 0.03)] and lateral mitral annulus VTI [OR 0.15 (0.04-0.56, P = 0.03)] were associated with clot formation. The addition of these two parameters to the conventional risk factors increased the ability to predict thromboembolism (Nagelkerke R² = 0.32-0.50, P = 0.01; area under the curve 0.83 by receiver operating characteristic analysis, P = 0.01). LA strain also had potential to indicate clot formation (0.9 ± 13.8 vs. -8.2 ± 15.1%, group 1 vs. 2, respectively, P = 0.01). CONCLUSION: Patients with chronic AF and thromboembolism have reduced LA and LV motion independently of LA size and LV ejection fraction. Tissue Doppler parameters may have potential to predict clot formation in these patients.

Myocardial infarction in nondiabetic and prediabetic population: a retrospective analysis.

Diabetes mellitus (DM) is one of the important risk factors for cardiac diseases. Type 2 DM is the commonest form of diabetes, which is characterized by insulin resistance. Insulin resistance can be preceded by long term abnormality in glucose homeostasis which is called pre-diabetes. Recently, pre-diabetes has been suggested to have an increased risk of cardiovascular disease. Considering that India has been declared as a diabetic capital of the world it deemed pertinent to assess the exact load of pre diabetics and non diabetics landing in myocardial infarction. We analyzed retrospectively the data of all patients admitted for the first time for acute myocardial infarction (MI) and evaluated the load of non diabetics, pre diabetics and diabetics among them. We found difference in the severity of diseases and degree of biochemical alterations among the three groups suggesting that abnormal glucose homeostasis has no role on the severity of MI. No previous studies have investigated the difference in male and female MI patients with respect to their glucose metabolism and its impact on the severity of the disease. Our study reveals that males even with normal glucose level are at increased risk to develop MI. Males on the other hand have increased risk for MI when compared to females with normal glucose homeostasis.