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1.
Cureus ; 16(2): e53927, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38465102

RESUMO

A rare form of large vessel vasculitis, Takayasu arteritis (TA) typically affects the aorta and its primary branches and rarely involves the coronary arteries. We present a case study of a female patient who had refractory hypertension and coronary artery disease for which she underwent percutaneous transluminal angioplasty. Subsequently, she was diagnosed with Takayasu arteritis. We wish to underscore the significance of timely identification and intervention as pivotal factors in improving patient outcomes and optimizing the effectiveness of therapeutic strategies in managing TA.

2.
Egypt Heart J ; 70(4): 375-378, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30591758

RESUMO

INTRODUCTION: Dual antiplatelet treatment is recommended by current clinical practice guidelines for patients undergoing PCI. The PLATO trial showed superiority of ticagrelor to clopidogrel in reducing the rate of death from vascular causes, myocardial infarction and stroke without increase in the rate of overall major bleeding in ACS patients. However, real world evidence in Indian patients is limited. The objective of this study is to compare safety profile of ticagrelor with clopidogrel in real world settings. METHODOLOGY: In this single centered retrospective observational study, a total of 1208 serial patient records undergoing PCI (ACS and stable angina patients as well) treated with Ticagrelor or Clopidogrel were collected and analyzed to look into in hospital outcomes. We excluded the patient's data that were incomplete. RESULTS: In total of 1208 patients, 604 patients received ticagrelor and similarly 604 patient received clopidogrel. No significant differences in the rates of major life threatening bleeding and any major bleeding were observed between ticagrelor and clopidogrel group (0.2% (n = 1) vs. 0.7% (n = 4), p = 0.18 and 2.8% (n = 17) vs. 3% (n = 18), p = 0.86 respectively). There was increase in minor bleeding rate with ticagrelor compared to clopidogrel (21.4% & 13.6%, p = 0.00). CONCLUSION: In the real world settings, patients undergoing PCI treated with ticagrelor showed similar safety profile compared to clopidogrel but with increase in minor bleeding rate. The observed results were in alignment with PLATO clinical trial.

3.
Indian Heart J ; 68(6): 803-808, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27931551

RESUMO

OBJECTIVES: To study the role of metabolic modulator (trimetazidine: TMZ) in dilated cardiomyopathy (DCM). Optimizing altered substrate metabolism in heart failure (HF) with metabolic modulators allows more efficacious energy production from glucose than from free fatty acids. METHODS: 100 patients of DCM (47.7 years, NYHA class 2.17, LVEF 27.3%) were randomized to TMZ (20mg tid, n=50) vs conventional therapy (n=50). Functional status, BNP and various echocardiographic parameters were assessed at 3-6 months. RESULTS: At 3 months, TMZ group had significantly improved NYHA class (2.25 vs 1.85), 6min walk test (349.7 vs 402m), LVD-36 score (25.5 vs 21) and BNP (744.7 vs 248.3pg/ml), all p 0.001. Significant improvement was also seen in LV end-systolic (LVESV, 87.1±27.5 vs 78.5±24.9ml/m2, p 0.001), LV end-diastolic volumes (LVEDV, 117.6±29.3 vs 110.9±27.4ml/m2, p 0.001), LVEF (27 vs 30.9%, p 0.001) and LV wall stress (90.2±18.9 vs 71.1±13.2dyn/cm2, p 0.0001). The % change in LVESV, LVEDV, LVEF and LV wall stress was -9.5%, -5.4%, +8.4% and -21.8%. Other echo parameters also improved after 3 months of TMZ (E/A ratio 1.9 vs 1.2, p=0.001, E/A VTI 2.7 vs 1.6, p=0.001, myocardial performance index, MPI 0.8 vs 0.7, p=0.0001), Tissue Doppler parameters (E/E' septal (19.7 vs 12.5, p=0.001) and E/E' lateral (13.3 vs 9.4, p=0.0001)). Patients in control group had no change in NYHA class, LVD-36 scores, LV volumes or LVEF at 3 months although BNP and LV wall stress reduced to a slight extent. Patients on TMZ had further improvement in NYHA class, walk test, BNP levels and echocardiographic parameters at 6 months. CONCLUSIONS: Metabolic modulators (TMZ) may help in improving LV function in DCM. In this study, benefit was noted by 3 months with further improvement at 6 months.


Assuntos
Cardiomiopatia Dilatada/tratamento farmacológico , Metabolismo Energético/efeitos dos fármacos , Ventrículos do Coração/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Trimetazidina/administração & dosagem , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/metabolismo , Relação Dose-Resposta a Droga , Ecocardiografia , Teste de Esforço , Feminino , Seguimentos , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Vasodilatadores/administração & dosagem
4.
Indian Heart J ; 68(1): 36-42, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26896264

RESUMO

BACKGROUND: Although trials have shown efficacy of unprotected left main percutaneous coronary intervention (uLMPCI), data from Indian subcontinent are lacking. Hence, we planned this observational analysis of single-center uLMPCI data. OBJECTIVES: To study long-term outcome after uLMPCI and identify predictors of adverse outcome. METHODS: Case details of 62 consecutive patients of uLMPCI between 2006 and 2013 were retrieved from a computerized database wherein detailed records were maintained. RESULTS: Mean follow-up duration was 669.8±404.2 days. Procedural success rate was 98.4%. Primary endpoint was composite of major adverse cardiovascular and cerebrovascular events (MACCE), which included cardiac death (CD), cerebrovascular accident (CVA), myocardial infarction (MI), and need for repeat intervention (RI) at three years. MACCE occurred in 13 (20.9%) patients. Cardiac death (CD), (including possible stent thrombosis), RI, and CVA occurred in 6 (9.7%), 5 (8%), and 2 (3.2%) patients, respectively. Overall three-year MACCE-free survival rate was 76.7%. Event-free survival rate was similar among patients who underwent uLMPCI alone and patients who underwent uLMPCI along with additional one-vessel PCI [(88.9% vs 81.8%), p=0.492], while survival rate was lower in patients who underwent uLMPCI along with PCI of additional two or more vessels (40%, p=0.036). Patients with syntax score ≤32 had higher event-free survival rate than those with syntax score >32 [(87.1% vs 33.3%), p=0.001]. Syntax score >32 was the only independent predictor of adverse outcome. CONCLUSION: uLMPCI is safe and effective alternative to CABG for LM alone and LM plus single-vessel disease with syntax score ≤32.


Assuntos
Doença da Artéria Coronariana/cirurgia , Vasos Coronários/cirurgia , Stents Farmacológicos , Previsões , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/mortalidade , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Índia/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Fatores de Risco , Taxa de Sobrevida/tendências , Resultado do Tratamento
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