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Development of pulmonary hypertension remains a major hurdle to corrective surgery in Down syndrome

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World Journal of Cardiology 2024年第1期16卷 1-4页

Down syndrome is the most common chromosomal abnormality encountered in clinical practice with 50%of them having associated congenital heart disease(CHD).Shunt lesions account for around 75%of all CHDs in Down *** syndrome patients,especially with large shunts are particularly predisposed to early development of severe pulmonary hypertension(PH)compared with shunt lesions in general *** necessitates timely surgical correction which remains the only viable option to prevent long term morbidity and ***,despite clear recommendations,there is wide gap between actual practice and fear of underlying PH which often leads to surgical refusals in Down syndrome even when the shunt is *** peculiarity is that Down syndrome patients can develop PH even after successful correction of *** is not uncommon to come across Down syndrome patients with uncorrected shunts in adulthood with irreversible PH at which stage intracardiac repair is contraindicated and the only option available is a combined heartlung ***,despite the guidelines laid by authorities,the rates of cardiac transplant in adult Down syndrome remain dismal largely attributable to the high prevalence of intellectual disability in *** index case presents a real-world scenario highlighting the impact of severe PH on treatment strategies and discrimination driven by the fear of worse outcomes in these patients.

关键词： Down syndrome Congenital heart disease Pulmonary hypertension Cardiac transplantation Pulmonary vascular resistance Surgical correction

Risk of permanent pacemaker implantation following transcatheter aortic valve replacement:Which factors are most relevant?

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World Journal of Cardiology 2024年第2期16卷 49-53页

Transcatheter aortic valve replacement(TAVR)has emerged as a formidable treatment option for severe symptomatic aortic stenosis ahead of surgical aortic valve *** encouraging results from large randomized controlled trials has resulted in an exponential rise in the use of TAVR even in the low-risk ***,this is not without *** for permanent pacemaker(PPM)post-TAVR remains the most frequent and clinically relevant ***,identifying risk factors which predispose an individual to develop high grade conduction block post-TAVR is *** demographic factors,electrocardiographic features,anatomic factors and procedural characteristics have all been linked to the development of advanced conduction block and need for PPM following *** these electrophysiological variables,most notably a prolonged QRS>120 ms regardless of the type of conduction block seems to be one of the strongest predictors on logistic regression *** index study by Nwaedozie et al highlights that patients requiring PPM post-TAVR had higher odds of having a baseline QRS>120 ms and were more likely to be having diabetes mellitus that those who did not require PPM.

关键词： Transcatheter aortic valve replacement Permanent pacemaker Diabetes mellitus QRS duration Electrophysiological variables

Ultrasound based estimate of central venous pressure:Are we any closer?

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World Journal of Cardiology 2024年第6期16卷 310-313页

作者： Atit A Gawalkar akash batta Department of Cardiology Fortis HospitalHimachal PradeshKangra 176001India Department of Cardiology Dayanand Medical College and HospitalPunjabLudhiana 141001India

Central venous pressure(CVP)serves as a direct approximation of right atrial pressure and is influenced by factors like total blood volume,venous compliance,cardiac output,and *** CVP falls within 8-12 mmHg but varies with volume status and venous *** and managing disturbances in CVP are vital in patients with circulatory shock or fluid *** CVP can lead to fluid accumulation in the interstitial space,impairing venous return and reducing cardiac *** pulmonary artery catheterization and central venous catheter obtained measurements are considered to be more accurate,they carry risk of complications and their usage has not shown clinical ***-based assessment of the internal jugular vein(IJV)offers real-time,non-invasive measurement of static and dynamic parameters for estimating *** parameters,including diameter and ratio,has demonstrated good correlation with *** significant advancements in non-invasive CVP measurement,a reliable tool is yet to be *** methods can offer reasonable guidance in assessing CVP,provided their limitations are acknowledged.

关键词： Central venous pressure Internal jugular vein Point of care ultrasound Shock Volume status Fluid balance

Transcatheter aortic valve replacement in low-risk young population:A double edge sword?

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World Journal of Cardiology 2024年第4期16卷 177-180页

作者： Sukhdeep Bhogal akash batta Department of Cardiology Sovah HealthMartinsvilleVA 24112United States Department of Cardiology Dayanand Medical College and HospitalLudhiana 141001India

Since the advent of transcatheter aortic valve replacement(TAVR)in 2002,it has now become the default interventional strategy for symptomatic patients presenting with severe aortic stenosis,particularly in intermediate to highsurgical risk *** 2019,the United States Food and Drug Administration approved TAVR in low-risk patients based on two randomized ***,these breakthrough trials excluded patients with certain unfavorable anatomies and odd *** currently there is no randomized study of TAVR in young patients,it may be preferred by the young population given the benefits of early discharge,shorter hospital stay,and expedite ***,it is important to ruminate various factors including lifetime expectancy,risk of pacemaker implantation,and the need for future valve or coronary interventions in young cohorts before considering TAVR in these ***,the data on long-term durability(>10 years)of TAVR is still unknown given most of the procedures were initially performed in the high or prohibitive surgical risk ***,this editorial aims to highlight the importance of considering an individualized approach in young patients with consideration of various factors including lifetime expectancy while choosing TAVR against surgical aortic valve replacement.

关键词： Transcatheter aortic valve replacement Surgical aortic valve replacement Pacemaker implantation Coronary re-access Structural deterioration

Left bundle branch pacing set to outshine biventricular pacing for cardiac resynchronization therapy?

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World Journal of Cardiology 2024年第4期16卷 186-190页

作者： akash batta Juniali Hatwal Department of Cardiology Dayanand Medical College and HospitalLudhiana 141001India Department of Internal Medicine Advanced Cardiac CentrePost Graduate Institute of Medical Education&ResearchChandigarh 160012India

The deleterious effects of long-term right ventricular pacing necessitated the search for alternative pacing sites which could prevent or alleviate pacinginduced *** recently,biventricular pacing(BiVP)was the only modality which could mitigate or prevent pacing induced ***,BiVP could resynchronize the baseline electromechanical dssynchrony in heart failure and improve ***,the high non-response rate of around 20%-30%remains a major *** non-response has been largely attributable to the direct non-physiological stimulation of the left ventricular myocardium bypassing the conduction *** overcome this limitation,the concept of conduction system pacing(CSP)came *** initial success of the first CSP via His bundle pacing(HBP),certain drawbacks including lead instability and dislodgements,steep learning curve and rapid battery depletion on many occasions prevented its widespread use for cardiac resynchronization therapy(CRT).Subsequently,CSP via left bundle branch-area pacing(LBBP)was developed in 2018,which over the last few years has shown efficacy comparable to BiVP-CRT in small observational ***,its safety has also been well established and is largely free of the pitfalls of the *** the recent metanalysis by Yasmin et al,comprising of 6 studies with 389 participants,LBBPCRT was superior to BiVP-CRT in terms of QRS duration,left ventricular ejection fraction,cardiac chamber dimensions,lead thresholds,and functional status amongst heart failure patients with left bundle branch ***,there are important limitations of the study including the small overall numbers,inclusion of only a single small randomized controlled trial(RCT)and a small follow-up ***,the entire study population analyzed was from China which makes generalizability a *** the concerns,the meta-analysis adds to the growing body of evidence demonstrating the efficacy of *** this st

关键词： Biventricular pacing Cardiac resynchronization therapy Conduction system pacing Left bundle branch-area pacing Left bundle branch block Electromechanical dssynchrony

Excess cardiovascular mortality in men with non-alcoholic fatty liver disease:A cause for concern!

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World Journal of Cardiology 2024年第7期16卷 380-384页

Non-alcoholic fatty liver disease(NAFLD)has emerged as the commonest cause of chronic liver disease worldwide in recent *** time,our understanding of NAFLD has evolved from an isolated liver condition to a systemic disease with significant manifestations beyond the *** them,cardiovascular diseases(CVDs)are the most important and clinically *** research supports a strong independent link between NALFD and CVD beyond the shared risk factors and *** sex hormones are well known to not only protect against CVD in pre-menopausal females,but also contribute to improved adipose tissue function and preventing its systemic *** research highlights the increased risk of major adverse cardiovascular-cerebral events(MACCE)amongst male with NAFLD compared to ***,racial variation was observed in MACCE outcomes in NAFLD,with excess mortality in the Native Americans and Asian Pacific Islanders compared to the other races.

关键词： Non-alcoholic fatty liver disease Cardiovascular diseases Male sex Major adverse cardiovascular-cerebral events Inflammation Endothelial dysfunction

Atrial fibrillation and coronary artery disease:An integrative review focusing on therapeutic implications of this relationship

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World Journal of Cardiology 2023年第5期15卷 229-243页

作者： akash batta Juniali Hatwal Akshey batta Samman Verma Yash Paul Sharma Department of Cardiology Dayanand Medical College and HospitalLudhiana 141001PunjabIndia Department of Internal Medicine Post Graduate Institute of Medical Education&ResearchChandigarh 160012India Department of Medicine and Surgery Sohana Multi Super Specialty HospitalMohali 160062PunjabIndia Department of Cardiology Post Graduate Institute of Medical Education&ResearchChandigarh 160012India

The incidence of both atrial fibrillation(AF)and coronary artery disease(CAD)increases with advancing *** share common risk factors and very often *** points to an intricate relationship between atrial tissue excitability and neuronal remodeling with ischemia at the microcirculatory *** this review,we delineated this complex relationship,identified a common theme between the two,and discussed how the knowledge of this relationship translates into a positive and meaningful impact in patient *** research indicates a high prevalence of CAD among AF patients undergoing coronary ***,the incidence of AF is much higher in those suffering from CAD compared to age-matched adults without CAD underlying this reciprocal *** adversely affects AF by promoting progression via re-entry and increasing excitability of atrial tissue as a result of ischemia and electrical *** in turn accelerates atherosclerosis via endothelial dysfunctional and inflammation and together with enhanced thrombogenicity and hypercoagulability contribute to micro and macrothrombi throughout cardiovascular *** a nutshell,the two form a vicious cycle wherein one disease promotes the *** AF recommendations focuses on rate/rhythm control and prevention of *** few studies have discussed the importance of unmasking coexistent CAD and how the treatment of underlying ischemia will impact the burden of AF in these *** and endothelial dysfunction remain central to both disease processes and form a handsome therapeutic target in the management of the two *** relationship between AF and CAD is complex and much more than mere *** two diseases share common risk factor and ***,it is impractical to treat them in ***,we share the implications of managing underlying ischemia and inflammation to positively impact and improve quality of life amon

关键词： Atrial fibrillation Coronary artery disease Antithrombotic therapy Ischemia Early rhythm control Endothelial dysfunction

Role of fibrinogen,albumin and fibrinogen to albumin ratio in determining angiographic severity and outcomes in acute coronary syndrome

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World Journal of Cardiology 2023年第1期15卷 13-22页

作者： Kunaal Makkar Yash Paul Sharma akash batta Juniali Hatwal Prashant Kumar Panda Department of Cardiology Post Graduate Institute of Medical Education and ResearchChandigarh 160012India Department of Cardiology Dayanand Medical College and HospitalLudhiana 141001PunjabIndia Department of Internal Medicine Post Graduate Institute of Medical Education and ResearchChandigarh 160012India

BACKGROUND Coronavirus disease 2019(COVID-19)pandemic unmasked the huge deficit in healthcare resources *** highlighted the need for efficient risk stratification in management of cardiovascular *** To study the applicability of the old,available and affordable nonconventional biomarkers:albumin and fibrinogen in their ability to predict angiographic severity and clinical outcomes in patients with acute coronary syndrome(ACS).METHODS In this prospective,observational study,166 consecutive patients with ACS were ***,albumin and their ratio were determined from *** with underlying chronic liver disease,active malignancy,autoimmune disease,active COVID-19 infection and undergoing thrombolysis were *** Mean age of the population was 60.5±1.5 years,74.1%being *** elevation myocardial infarction(STEMI)was most common presentation of ACS seen in 57%*** albumin ratio(FAR)≥19.2,had a sensitivity of 76.9%and specificity of 78.9%[area under the receiver operating characteristic curves(AUROC)=0.8,P=0.001]to predict≤thrombolysis in myocardial infarction(TIMI)1 flow in culprit artery in STEMI *** in non-STEMI patients,FAR≥18.85 predicted the same with 80%sensitivity and 63%specificity(AUROC=0.715,P=0.006).CONCLUSION Novel biomarkers,with their high cost,lack of availability and long turn over time are impractical for real-world ***≤TIMI 1 flow in the culprit artery has significant impact of management and *** study has shown that readily available biomarkers like fibrinogen and albumin can help identify these high-risk patients with good *** allows risk-stratification and individualization of treatment in ACS.

关键词： Acute coronary syndrome Albumin Fibrinogen Fibrinogen to albumin ratio Total occlusion of culprit artery

Cardiovascular implications of inflammatory bowel disease: An updated review

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World Journal of Cardiology 2023年第11期15卷 553-570页

作者： Arshia Bhardwaj Arshdeep Singh Vandana Midha Ajit Sood Gurpreet Singh Wander Bishav Mohan akash batta Department of Gastroenterology Dayanand Medical College and HospitalPunjabLudhiana 141001India Department of Internal Medicine Dayanand Medical College and HospitalPunjabLudhiana 141001India Department of Cardiology Dayanand Medical College and HospitalPunjabLudhiana 141001India

Emerging data highlights the heightened risk of atherosclerotic cardiovascular diseases(ASCVD)in patients with chronic inflammatory disorders,particularly those afflicted with inflammatory bowel disease(IBD).This review delves into the epidemiological connections between IBD and ASCVD,elucidating potential underlying ***,it discusses the impact of current IBD treatments on cardiovascular ***,the cardiovascular adverse effects of novel small molecule drugs used in moderate-to-severe IBD are investigated,drawing parallels with observations in patients with rheumatoid *** article aims to comprehensively evaluate the existing evidence supporting these *** achieve this,we conducted a meticulous search of PubMed,spanning from inception to August 2023,using a carefully selected set of *** search encompassed topics related to IBD,such as Crohn’s disease and ulcerative colitis,as well as ASCVD,including coronary artery disease,cardiovascular disease,atrial fibrillation,heart failure,conduction abnormalities,heart blocks,and premature coronary artery *** review encompasses various types of literature,including retrospective and prospective cohort studies,clinical trials,meta-analyses,and relevant guidelines,with the objective of providing a comprehensive overview of this critical intersection of inflammatory bowel disease and cardiovascular health.

关键词： Inflammatory bowel diseases Cardiovascular disorders Pericarditis myocarditis Thromboembolism Chronic inflammation Oxidative stress Endothelial dysfunction