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Introduction In 2017, the American College of Cardiology/American Heart Association revised guidelines for diagnosis and management of hypertension in adults. The regional impact of the updated guidelines on the prevalence of hypertension in India is unknown. Methods Data from nationally representative Indian households were analyzed to estimate the regional prevalence of hypertension according to the old and the new guidelines in men (age 18-54 years) and women (age 18-49 years). The old guidelines defined hypertension as a systolic blood pressure of ≥140 mmHg or diastolic blood pressure of ≥90 mmHg or treatment. The new guidelines define hypertension as a systolic blood pressure of ≥130 mmHg or diastolic blood pressure of ≥80 mmHg or treatment. We calculated the increase in the prevalence of hypertension among the states and union territories of India (hereafter "states"). Results Among 679,712 participants (85.6% women), the median age was 31 years (interquartile range 24, 40) and was comparable among men and women (33 vs. 31 years, respectively). The overall weighted prevalence according to old and new guidelines was 18.5% (95% CI 18.2, 18.7) and 43.0% (95% CI 42.8, 43.3), respectively. There was a significant increase in hypertension prevalence, both among men and women, and across all regions. The northeast region of the country had the highest prevalence. Conclusion The overall prevalence of hypertension significantly increases with the new compared to the old guidelines, however, the regional heterogeneity of prevalence of hypertension is maintained.

Aims Immunomodulation in heart failure (HF) has been studied in several randomized controlled trials (RCTs) with variable effects on cardiac structure, function, and outcomes. We sought to determine the effect of immunomodulation on left ventricular ejection fraction (LVEF), LV end‐diastolic dimension (LVEDD), and all‐cause mortality in patients with HF with reduced ejection fraction (HFrEF) through meta‐analyses and trial sequential analyses (TSAs) of RCTs. Methods and results PubMed, Embase®, Cochrane CENTRAL, and http://ClinicalTrials.gov were systematically reviewed to identify RCTs that studied the effects of immunomodulation in patients with HFrEF. The primary endpoint in this analysis was change in LVEF. Secondary outcomes were changes in LVEDD and all‐cause mortality. TSA was used to quantify the statistical reliability of data in the cumulative meta‐analyses. Nineteen RCTs with 1341 HFrEF subjects were eligible for analyses. The aetiology of HF, specific immunomodulation strategy, and treatment duration were variable across trials. Immunomodulation led to a greater improvement in LVEF [mean difference: +5.7% 95% confidence interval (CI): 3.0–8.5%, P < 0.001] and reduction in LVEDD (mean difference: −3.7 mm, 95% CI: −7.0 to −0.4 mm, P = 0.028) than no immunomodulation in meta‐analyses and TSAs. We observed a non‐significant decrease in all‐cause mortality among those on immumomodulation (risk ratio: 0.7, 95% CI: 0.4–1.3, P = 0.234), but the Z‐curve for cumulative treatment effect of immunomodulation in the TSA did not cross the boundary of futility. Conclusions Immunomodulation led to improved cardiac structure and function in patients with HFrEF. While these benefits did not translate into a significant improvement in mortality, our analysis suggests that larger studies of targeted immunomodulation are needed to understand the true benefits.

Visual Abstract, Highlights • Extensive LA fibrosis is related to an increase in LA size and decrease in total LA EF. This supports the contention that the LA is not merely a bystander of MR but rather is actively involved in the pathophysiology of MR. • Chymase is plentiful in the human heart, especially in the LA, and correlates with extracellular matrix accumulation in primary MR. • Because of the unreliability of the LV ejection fraction in primary MR, future studies may consider LA size and total LA EF for timing of surgical intervention of asymptomatic moderate to severe MR., Summary Increasing left atrial (LA) size predicts outcomes in patients with isolated mitral regurgitation (MR). Chymase is plentiful in the human heart and affects extracellular matrix remodeling. Chymase activation correlates to LA fibrosis, LA enlargement, and a decreased total LA emptying fraction in addition to having a potential intracellular role in mediating myofibrillar breakdown in LA myocytes. Because of the unreliability of the left ventricular ejection fraction in predicting outcomes in MR, LA size and the total LA emptying fraction may be more suitable indicators for timing of surgical intervention.

Background: Myocardial blood flow (MBF) can be quantified using dynamic PET studies. These studies also inherently contain tomographic images of early bolus displacement, which can provide cardiopulmonary transit times (CPTT) as measure of cardiopulmonary physiology. The aim of this study was to assess the incremental prognostic value of CPTT in heart transplant (OHT) recipients. Methods: 94 patients (age 56 ± 16 years, 78% male) undergoing dynamic 13N-ammonia stress/rest studies were included, of which 68 underwent right-heart catherization. A recently validated cardiac allograft vasculopathy (CAV) score based on PET measures of regional perfusion, peak MBF and left-ventricular (LV) ejection fraction (LVEF) was used to identify patients with no, mild or moderate-severe CAV. Time-activity curves of the LV and right ventricular (RV) cavities were obtained and used to calculate the difference between the LV and RV bolus midpoint times, which represents the CPTT and is expressed in heartbeats. Patients were followed for a median of 2.5 years for the occurrence of major adverse cardiac events (MACE), including cardiovascular death, hospitalization for heart failure or acute coronary syndrome, or re-transplantation. Results: CPTT was significantly correlated with cardiac filling pressures (r =.434, P =.0002 and r =.439, P =.0002 for right atrial and pulmonary wedge pressure), cardiac output (r = − .315, P =.01) and LVEF (r = − .513, P

Aims Hypertension is a well-established heart failure (HF) risk factor, especially in the context of adverse left ventricular (LV) remodelling. We aimed to use myocardial flow reserve (MFR) and global longitudinal strain (GLS), markers of subclinical microvascular and myocardial dysfunction, to refine hypertensive HF risk assessment. Methods and results Consecutive patients undergoing symptom-prompted stress cardiac positron emission tomography (PET)-computed tomography and transthoracic echocardiogram within 90 days without reduced left ventricular ejection fraction ( Conclusion We have demonstrated important associations between coronary microvascular dysfunction and myocardial mechanics that refine disease characterization and HF risk assessment of patients with hypertension based on subclinical target organ injury.

In this post-hoc analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, we evaluated the prognostic role of anemia in adverse cardiovascular (CV) outcomes in heart failure with a preserved ejection fraction (HFpEF). We defined anemia as hemoglobin of 0.05) as compared to those without anemia. Among CV causes, patients with anemia had a higher risk of sudden cardiac death (SCD)/ACA and presumed CV death (HR 1.67 and 1.83, respectively, p0.05). Among non-CV causes, patients with anemia had a higher risk of death due to malignancy (HR 2.61, p

Background: Eighty percent of premature mortality from cardiovascular disease occurs in low- and middle-income countries. Hypertension, diabetes, and smoking are the top risk factors causing this disease burden. Objectives: The study aimed to test the hypothesis that utilizing community health workers (CHWs) to manage hypertension, diabetes and smoking in an integrated manner would lead to improved control of these conditions. Methods: This was a 2-year cluster (n = 12) randomized controlled trial of 3,556 adults (35 to 70 years of age) in a single town in India, who were screened at home for hypertension, diabetes, and smoking. Of these adults, 1,242 (35%) had at least 1 risk factor (hypertension = 650, diabetes = 317, smoking = 500) and were enrolled in the study. The intervention group had behavioral change communication through regular home visits from community health workers. The control group received usual care in the community. The primary outcomes were changes in systolic blood pressure, fasting blood glucose, and average number of cigarettes/bidis smoked daily among individuals with respective risk factors. Results: The mean ± SD change in systolic blood pressure at 2 years was –12.2 ± 19.5 mm Hg in the intervention group as compared with –6.4 ± 26.1 mm Hg in the control group, resulting in an adjusted difference of –8.9 mm Hg (95% confidence interval [CI]: –3.5 to –14.4 mm Hg; p = 0.001). The change in fasting blood glucose was –43.0 ± 83.5 mg/dl in the intervention group and –16.3 ± 77.2 mg/dl in the control group, leading to an adjusted difference of –21.3 mg/dl (95% CI: 18.4 to –61 mg/dl; p = 0.29). The change in mean number of cigarettes/bidis smoked was nonsignificant at +0.2 cigarettes/bidis (95% CI: 5.6 to –5.2 cigarettes/bidis; p = 0.93). Conclusions: A population-based strategy of integrated risk factor management through community health workers led to improved systolic blood pressure in hypertension, an inconclusive effect on fasting blood glucose in diabetes, and no demonstrable effect on smoking. (Study of a Community-Based Approach to Control Cardiovascular Risk Factors in India [SEHAT]; NCT02115711). Highlights Previous studies have used community health workers (CHWs) to target single cardiovascular risk factors. We conducted a randomized controlled trial to test an integrated approach to hypertension, diabetes, and smoking through CHWs. We found that CHWs have a significant effect on hypertension, an inconclusive effect on diabetes, and no effect on smoking. Low- and middle-income countries such as India should consider home-based care for cardiovascular risk factors through CHWs.

Objectives: This study sought to assess the effects of neurohormonal therapies in preventing cardiotoxicity in patients receiving chemotherapy. Background: Various cardioprotective approaches have been evaluated to prevent chemotherapy-related cardiotoxicity; however, their overall utility remains uncertain. Methods: This meta-analysis included randomized clinical trials of adult patients that underwent chemotherapy and neurohormonal therapies (β-blockers, mineralocorticoid receptor antagonists, or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers) versus placebo with follow-up ≥4 weeks. The primary outcome was change in left ventricular ejection fraction (LVEF) from baseline to the end of the trial. Other outcomes of interest were measures of LV size, strain, and diastolic function. Pooled estimates for each outcome were reported as standardized mean difference and weighted mean difference between the neurohormonal therapy and placebo groups using random effects models. Results: We included 17 trials, collectively enrolling 1,984 participants. In pooled analysis, neurohormonal therapy (vs. placebo) was associated with significantly higher LVEF on follow-up (standardized mean difference: +1.04 [95% confidence interval (CI): 0.57 to 1.50]) but with significant heterogeneity in the pooled estimate (I2 = 96%). Compared with placebo-treated patients, those randomized to neurohormonal therapies experienced a 3.96% (95% CI: 2.90 to 5.02) less decline in LVEF estimated by weighted mean difference, but with significant heterogeneity (I2 = 98%). There was a trend toward lower adverse clinical events with neurohormonal therapy (vs. placebo) that did not meet statistical significance (risk ratio: 0.80 [95% CI: 0.53 to 1.20]; I2 = 71%). Conclusions: Neurohormonal therapies are associated with higher LVEF in follow-up among cancer patients receiving chemotherapy, although absolute changes in LVEF are small and may be within inter-test variability. Furthermore, significant heterogeneity is observed in the treatment effects across studies highlighting the need for larger trials of cardioprotective strategies.

Targeted temperature management (TTM) with therapeutic hypothermia is an integral component of postarrest care for survivors. However, recent randomized controlled trials (RCTs) have failed to demonstrate the benefit of TTM on clinical outcomes. We sought to determine if the pooled data from available RCTs support the use of prehospital and/or in-hospital TTM after cardiac arrest.A comprehensive search of SCOPUS, Elsevier's abstract and citation database of peer-reviewed literature, from 1966 to November 2016 was performed using predefined criteria. Therapeutic hypothermia was defined as any strategy that aimed to cool post-cardiac arrest survivors to a temperature ≤34°C. Normothermia was temperature of ≥36°C. We compared mortality and neurologic outcomes in patients by categorizing the studies into 2 groups: (1) hypothermia versus normothermia and (2) prehospital hypothermia versus in-hospital hypothermia using standard meta-analytic methods. A random effects modeling was utilized to estimate comparative risk ratios (RR) and 95% confidence intervals (CIs).The hypothermia and normothermia strategies were compared in 5 RCTs with 1389 patients, whereas prehospital hypothermia and in-hospital hypothermia were compared in 6 RCTs with 3393 patients. We observed no difference in mortality (RR, 0.88; 95% CI, 0.73-1.05) or neurologic outcomes (RR, 1.26; 95% CI, 0.92-1.72) between the hypothermia and normothermia strategies. Similarly, no difference was observed in mortality (RR, 1.00; 95% CI, 0.97-1.03) or neurologic outcome (RR, 0.96; 95% CI, 0.85-1.08) between the prehospital hypothermia versus in-hospital hypothermia strategies.Our results suggest that TTM with therapeutic hypothermia may not improve mortality or neurologic outcomes in postarrest survivors. Using therapeutic hypothermia as a standard of care strategy of postarrest care in survivors may need to be reevaluated.

The burden of cardiovascular events among patients hospitalized with severe sepsis and the association of these events with in-hospital mortality is not well known. We examined the incidence of cardiovascular events and their association with in-hospital mortality among patients with severe sepsis. Patients with severe sepsis from the New York State Inpatient Database from 2012 through 2014 were identified using a validated International Classification of Diseases 9th Revision, Clinical Modification code 995.92. The primary outcome was the incidence of cardiovascular events during the hospitalizations, defined as a composite of ischemic, acute heart failure, or arrhythmic events and the secondary outcome was in-hospital mortality. Multivariable logistic regression models were used to compare the risk of in-hospital mortality among severe sepsis patients with and without cardiovascular events. A total of 117,418 patients (mean age, 70.8 years; 50.4% males, 59.5% whites) with severe sepsis occurred during the study period 2012 to 2014. New-onset (incident) cardiovascular event occurred in 13.1%, ischemic events in 4.5%, acute heart failure events in 2.3%, and arrhythmic events in 8.0% of patients, respectively. An estimated 32.9% of patients with severe sepsis died during their hospitalization. Severe sepsis patients with new-onset cardiovascular events were associated with 30% higher odds for in-hospital mortality (odds ratio: 1.30; 95% CI: 1.23 to 1.37, p0.001) as compared with patients without cardiovascular events in multivariable adjusted model. In conclusion, among patients with severe sepsis, incident cardiovascular events occur frequently. Further research is required to improve recognition and treatment of new-onset cardiovascular events in patients with severe sepsis.

BACKGROUND: Although myocardial scar is a known substrate for ventricular arrhythmias, the association of myocardial ischemia with ventricular arrhythmias in stable patients with left ventricular dysfunction is less clear. OBJECTIVES: To investigate the association of myocardial scar and ischemia with major arrhythmic events (MAEs) in patients with left ventricular ejection fraction (LVEF) ≤35%. METHODS: A total of 439 consecutive patients (median age 70 years, 78% male, 55% with implantable cardioverter defibrillator [ICD]) referred for stress/rest positron emission tomography (PET) and resting LVEF ≤35% were included. Primary outcome was time-to-first MAE defined as sudden cardiac death, resuscitated sudden cardiac death, or appropriate ICD shocks for ventricular tachyarrhythmias ascertained by blinded adjudication of hospital records, Social Security Administration’s Death Masterfile, National Death Index, and ICD vendor databases. RESULTS: Ninety-one MAEs including 20 sudden cardiac deaths occurred in 75 (17%) patients over a median follow-up of 3.2 years. Transmural myocardial scar was strongly associated with MAEs beyond age, sex, cardiovascular risk factors, beta-blocker therapy, and resting LVEF (adjusted hazard ratio [95% confidence interval] per 10% increase in scar: 1.48[1.22-1.80], p

Patients with metabolic syndrome (MetS) and diabetes mellitus (DM) are at increased risk for coronary artery disease (CAD) and heart failure [(1)][1]. Impaired coronary flow reserve (CFR), the ratio of stress to rest myocardial blood flow, is a marker of coronary microvascular dysfunction (CMD) in

Regadenoson is a selective A

Aims The optimal revascularization strategy for left main coronary artery disease (LMD) remains controversial, especially with two recent randomized controlled trials showing conflicting results. We sought to address this controversy with our analysis. Methods and results Comprehensive literature search was performed. We compared percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for LMD revascularization using standard meta-analytic techniques. A 21% higher risk of long-term major adverse cardiac and cerebrovascular event [MACCE; composite of death, myocardial infarction (MI), stroke, and repeat revascularization] was observed in patients undergoing PCI in comparison with CABG [risk ratio (RR) 1.21, 95% confidence interval (CI) 1.05–1.40]. This risk was driven by higher rate of repeat revascularization in those undergoing PCI (RR 1.61, 95% CI 1.34–1.95). On the contrary, MACCE rates at 30 days were lower in PCI when compared with CABG (RR 0.55, 95% CI 0.39–0.76), which was driven by lower rates of stroke in the PCI arm (RR 0.41, 95% CI 0.17–0.98). At 1 year, lower stroke rates (RR 0.21, 95% CI 0.08–0.59) in the PCI arm were balanced by higher repeat revascularization rates in those undergoing PCI (RR 1.78, 95% CI 1.33–2.37), resulting in a clinical equipoise in MACCE rates between the two revascularization strategies. There was no difference in death or MI between PCI when compared with CABG at any time point. Conclusion Outcomes of CABG vs. PCI for LMD revascularization vary over time. Therefore, individualized decisions need to be made for LMD revascularization using the heart team approach.

The use of implantable cardioverter-defibrillators (ICDs) has been a major advancement in patients with ischemic cardiomyopathy with reduced ejection fraction 1100 patients with NICM on optimal medical therapy (OMT) and cardiac resynchronization therapy (CRT) to ICD versus no ICD for primary prevention of sudden cardiac death, revealed no difference in all-cause mortality between the 2 groups at 5-year follow-up.4 Although the primary results of DANISH were neutral, the ICD group showed reduction in incidence of sudden cardiac death by half, and there was an interaction …

OBJECTIVE: Internet has become an easy source for healthcare information. In recent years, websites like YouTube have become increasingly popular as a source of information. It is necessary to keep in check the information disseminated from these open-access sites to prevent the spread of false information. This study analyzed how information related to the superbug New Delhi Metallo-β-lactamase 1 (NDM1) was portrayed in video clips available on YouTube. METHODS: YouTube (www.youtube.com) was searched on June 22, 2011, using the search terms keywords NDM1, New Delhi beta-metallolactamase, NDM, New Delhi superbug, New Delhi metallolactamase to identify clips related to NDM-1. Videos were classified as useful, misleading and news update. Data analyses were conducted for the duration of videos, number of viewers, and positive and negative rating. RESULTS: A total of 47 videos were included in this analysis. Twenty-nine videos were classified as news update, 9 videos as useful, and 9 videos as misleading videos. There was no statistically significant difference in the 3 groups regarding duration of videos, number of viewers, and positive and negative rating. CONCLUSIONS: The results demonstrate that there is a wide variety of information on YouTube regarding NDM-1. The viewers are exposed to the useful videos as much as to misleading videos. As a result, public health professionals should be more vigilant in recognizing videos containing misleading information and physicians should counsel and educate patients against inappropriate use of online videos for medical purposes. RESUMO OBJETIVO: A Internet tornou-se uma fonte de fácil acesso para informações relativas à saúde. Nos últimos anos, sites como o YouTube tornaram-se cada vez mais populares como fonte de informação. No entanto, é necessário manter sob controle as informações divulgadas a partir destes sites de livre acesso para evitar a propagação de informações falsas. Este estudo analisou o modo pelo qual a informação relacionada com a superbactéria New Delhi metalo-β-lactamase 1 foi retratada em vídeos disponíveis no YouTube. MÉTODOS: YouTube (www.youtube.com) foi pesquisada em 22 de junho de 2012, utilizando os termos de busca palavras-chave NDM1, Nova Deli beta-metallolactamase, NDM, Nova Deli superbactéria, Nova Deli metallolactamase para identificar clipes relacionados a NDM-1. Vídeos foram classificados como úteis, enganosos e de atualização de notícias. A análise dos dados foi realizada por meio da avaliação de duração dos vídeos, do número de espectadores, e de um avaliação positiva ou negativa. RESULTADOS: Um total de 47 vídeos foram incluídos nesta análise. Vinte e nove foram classificados como atualização de notícias, nove como úteis, e nove como vídeos enganadores. Não houve diferença estatisticamente significativa nos três grupos em relação à duração dos vídeos, o número de espectadores, e avaliação positiva e negativa. CONCLUSÕES: Os resultados demonstram que existe uma grande variedade de informações sobre o YouTube sobre NDM-1. Os espectadores são expostos a vídeos úteis, tanto quanto a vídeos enganadores. Como resultado, os profissionais de saúde pública devem ser mais vigilantes em reconhecer vídeos com informação enganosa e os médicos devem aconselhar e educar os pacientes contra o uso inadequado de vídeos on-line para fins médicos.

Radiation scatter (RS) in the catheterization laboratory is a function of beam angulation, among other factors. RS is an important determinant of total radiation dose, although has undergone limited clinical study. To model radiation dosimetry during diagnostic catheterization (DC) and percutaneous