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Introduction: Cardiovascular diseases are a major cause of death among patients with Diabetic Kidney Disease (DKD). Left Ventricular Hypertrophy (LVH) is a threatening prognostic sign and an independent risk factor for cardiovascular mortality and morbidity. A number of epidemiological studies have proven that LVH is common in patients with DKD. Aim: To estimate the Serum Uric Acid (SUA) levels in DKD patients and its association with LVH and estimated Glomerular Filtration Rate (eGFR). Materials and Methods: The current study was a cross-sectional study conducted at KR Hospital, Mysuru, a teritary care hospital, in Mysuru, Karnataka, India, during the period from 1st January 2020 to 31st December 2020. which included 53 patients with DKD. The demographic data, relevant investigations like Renal Function Test (RFT), SUA levels, complete haemogram, Fasting Blood Sugar (FBS), Postprandial Blood Sugar (PPBS), glycosylated haemoglobin, Liver Function Tests (LFT), urine routine, Urine Albumin Creatinine Ratio (UACR), electrocardiogram, 2D echo were done. The results were tabulated, and the patients were classified into those with high and low SUA levels. They were also evaluated for the presence of additional risk factors like hypertension and Ischaemic Heart Disease (IHD). Data obtained was analysed statistically using Statistical Packages of Social Sciences (SPSS) version 21.0 software. Mean, Standard Deviation (SD), Chi-square test, and Fischer's-exact tests were used where appropriate, with a p-value <0.05 considered statistically significant. Patients were classified into two groups, one with SUA more than 6.5 and the other with less than 6.5, as normouricaemia and hyperuricaemia, respectively. Results: The majority of the cases were in the age group of 51-60 years, accounting for 43.4%. Out of 53 patients, males constituted 60.4% and females 30.6%, with a male-to-female ratio of 1.52:1. Total 33 patients (62.3%) were hypertensive, 32 patients (60.4%) had LVH, and 15 patients (28.3%) had IHD. Among 38 patients with SUA levels >6.5 mg/dL, the mean UACR value was higher (1807.9 mg/gm), the mean eGFR value was 32.4 mL/min/1.73 m2, and the mean Left Ventricular Mass index (LVMI) was 117.1 g/m2, which was statistically significant. Conclusion: In patients with DKD, higher SUA levels were associated with significantly higher values of UACR, lower eGFR values, higher LVMI values, and an increased risk for LVH, hypertension, and IHD. However, there was no significant association between higher uric acid levels and HbA1c. [ABSTRACT FROM AUTHOR]

Introduction: One of the most challenging aspects of systemic sclerosis is the potential involvement of the cardiopulmonary system, which can lead to significant morbidity and mortality if not detected and managed promptly. Aim: To assess the clinical characteristics and prevalence of specific cardiopulmonary involvement and to investigate its association with disease duration in patients with systemic sclerosis from South India. Materials and Methods: This cross-sectional, observational study was conducted at the Department of General Medicine, Government Medical College, Thrissur, India, between January 1, 2020, and December 31, 2020. Forty patients with systemic sclerosis were included according to the European Alliance of Associations for Rheumatology (EULAR) and the American College of Rheumatology classification criteria. Skin thickening was evaluated using the modified Rodnan Skin Score (mRSS). Investigations such as chest X-ray, echocardiogram, and antibody profiling were conducted to evaluate cardiopulmonary involvement. The data were analysed using Statistical Package for Social Sciences (SPSS) version 23.0, and the Chi-square test was used to compare qualitative variables between groups. Results: Sixteen patients (40%) had an mRSS score between 11 and 20, followed by 14 patients (35%) with mRSS scores between 21 and 30. The prevalence of Interstitial Lung Disease (ILD) was 50%. The echocardiogram findings showed mitral regurgitation and moderate Pulmonary Arterial Hypertension (PAH) in 30% (n=12) and 25% (n=10) of patients, respectively. High-Resolution Computed Tomography (HRCT) and pulmonary function tests were normal in 10 patients (25%). The duration of the disease was three to eight years in 14 patients and eight to 12 years in 12 patients. Both ILD and PAH were significantly associated with the duration of the disease (p<0.05). Anti-scleroderma-70 and anti-centromere were the most common antibodies present in patients with ILD and PAH, respectively. Conclusion: The study indicated a high prevalence of PAH and ILD in patients with systemic sclerosis. Moreover, both ILD and PAH were significantly associated with the duration of the underlying disease, with longer disease duration being associated with a higher likelihood of these conditions. [ABSTRACT FROM AUTHOR]

Introduction: Coronary heart disease (CAD) is the leading cause of morbidity and mortality worldwide, with India being the top cause. The Asian subcontinent accounts for 20% of the world's population, but 60% of the cardiovascular disease burden is due to genetic predisposition and environmental factors. Arterial stiffness increases with aging, accelerated by cardiovascular risk factors like hypertension and diabetes. Endothelial dysfunction in coronary arteries affects arterial stiffness and potentially reversible in atherogenesis. Pressure wave velocity (PWV) is a useful index for assessing endothelial status and large artery stiffness. Large artery stiffening can increase systolic blood pressure, left ventricular afterload, and left ventricular hypertrophy, potentially limiting coronary perfusion. Material and Methods: A prospective cross-sectional study was conducted at Sri Jayadeva Institute of Cardiovascular Sciences and Research Centre in Bangalore, India, from 1/6/2018 to 31/01/2019. Thirty patients with triple vessel disease and 30 age-matched controls underwent angiography at the institute. Echocardiography and Doppler evaluation assessed heart carotid pulse wave velocity and transit time. The study included patients with triple vessel disease and normal epicardial coronary arteries. The study excluded patients over 70 years old, having a heart rate above 100, having severe LV dysfunction below 30%, having chronic kidney disease, or having coronary artery stenosis. Demographic details, family history, medical history, clinical presentation, diagnostic tests, and blood tests were collected from patients. The study used descriptive and inferential statistical analysis, with continuous measurements presented as Mean ± SD and categorical measurements as Number (%). Results: The study involved 30 cases and 30 controls, with the majority of patients aged 50-70 years and controls aged 40-60 years. The gender distribution was predominantly males. Diagnosis distribution was similar between the two groups, with patients with EA, UA, or TMT positive being more likely to undergo angiography. BMI (kg/m2) distribution was similar between the two groups, with the majority of patients still overweight or obese but having normal BMIs. Pulse transit time (PTT) was significantly lower in the triple vessel disease case group compared to the control group with normal coronary angiography. Pulse wave velocity (PWV) increased in the case group compared to the control group. In contrast to the control group, 66% of the patients in the case group showed some kind of LV dysfunction due to more patients with myocardial infarction. Pulse wave velocity was significantly lower in the case group, with 20% and 63% shorter. LMCA distribution was also similar between the two groups, with patients with LMCA having lower pulse transit time (20%) and (63% shorter) compared to the control group. The study highlights the importance of assessing patients' angiography and LMCA distribution in determining the appropriate treatment for patients with LV dysfunction. Conclusion: Aortic PWV predicts future cardiovascular risk by accounting for known risk variables. It could be a valuable biomarker for intermediate risk, but randomized controlled studies are needed to prove its therapeutic utility before implementation. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular diseases (CVDs) are the most prevalent cause of death and disability worldwide; more people die annually from CVDs than from any other cause. An estimated 17.7 million people died from CVDs in 2015, representing 31% of all global deaths. This transition is characterized by rapid urbanization and its accompanying adverse lifestyle changes (e.g., drug and alcohol addictions, unhealthy diet, physical inactivity and increasing psychosocial ailments) and by increasing longevity. India is experiencing an alarming increase in heart disease, which seems to be linked to changes in lifestyle and diet, rapid urbanization, and possibly an underlying genetic component. Objectives and Aims: To evaluate application of Doppler echocardiography in determining left ventricular diastolic dysfunction in primary hypertension. Proportions of hypertensive patients having left ventricular diastolic dysfunction. Materials and Methods: This study was carried out in the Department of General Medicine at Swami Dayan and Hospital, Delhi. This is the Cross sectional Observational Study. Study of diastolic function in hypertensives in tertiary care centre was observed. The study observed that 44% had abnormal diastolic function in hypertensive patients. Taking this value as reference, the minimum required sample size with 10% margin of error and 5% level of significance is 95 patients. So total sample size taken was 100. Observations and Results: Sample size was of 100 cases, the variable Age (Years) was not normally distributed (p = <0.001). The Age ranged from 26-67 years. The mean Age was 49.64 years (11.45). The median Age was 50 years (15.50). Maximum patients were between age of 50-59 years (comprises 30%) followed by age group 40-49 year (comprises 26%).Only 10.0% of the patients had age less than 30 Years. Diastolic Dysfunction was present in 56 patients out of 100 (56%). Majority of patients (42%) had mild diastolic dysfunction and only 4% had severe diastolic dysfunction. Conclusion: The prevalence of diastolic dysfunction is high among the population of patients with hypertension as reported in this study. There is a linear increase in the prevalence of DD with the increase in age. There is no difference in the prevalence of DD among males and females. LV diastolic dysfunction is significantly correlated with presence of high blood pressure, LVH and high BMI. The higher prevalence of left ventricular diastolic dysfunction and left ventricular hypertrophy among hypertensives in our study support the need for improved attainment of blood pressure goals in these patients. Every effort needs to be put in for early detection of LVDD as it has important diagnostic, prognostic and therapeutic implications. [ABSTRACT FROM AUTHOR]

Introduction: Anemia is a very common disease worldwide with even more prevalence in developing countries like India. Prevalence of anemia among women of reproductive age (% of women ages 15-49) in India was 51.40% as of 2016, compared to 9% prevalence in developed countries. It is also the second most common cause of maternal mortality in India. Anemia leads to hyperdynamic state of heart at rest leading to impaired oxygen supply to myocardium. This ultimately leads to supply-demand myocardial mismatch causing myocardial ischemia or infarction. Long standing hyperdynamic state due to anemia may lead to cardiac dilatation and hypertrophy as well. These changes in heart cause cardiac disturbances. Electrocardiography is used to detect ischemic heart diseases, hypertensive heart diseases and asymptomatic arrhythmias. The abnormalities may be proportional to the severity of anemia or show no correlation to hemoglobin levels. The studies which show the effect of iron deficiency anaemia on ECG changes in females are few in India. Hence in the present study we decided to study the electrocardiographic changes in female anemic population. Materials and methods: It is the cross section observation study of 100 female patients of age group between 19-49 years those who were admitted with Hb less than 12 gm/dl. We excluded the patients with pregnancy, diabetes, hypertension, fever, renal disease, liver disease, COPD, cardiac disease and who not giving consent. Results: In the present Cross sectional observational study ECG changes in female anemic patents was studied. In the present study, anemia prevalence was higher in age group 20-40. Studies have shown reduced triglyceride levels in patients with anaemia. In the present study, 31 patients out of the 100 had shown cardiomegaly in chest X-ray. In the present study 45% of the patients presented with sinus tachycardia in ECG. Left axis deviation and left ventricular hypertrophy are seen 30% of the patients in the present study. Lower the hemoglobin values higher is the frequency of left axis deviation In the present study there were no changes in the P wave and QRS complexes. In the present study, 26% of the patients had ST segment depression and 18% of the patients had inverted T wave in the ECG. Conclusion: Anemia is more prevalent in India. Anemia has major effect on heart due to hyperdynamic state. ECG is the basic tool to identify various cardiac diseases. The studies which show the effect of iron deficiency anaemia on ECG changes in females are few in India. Hence in the present study we decided to study the ECG changes in female anemic population. [ABSTRACT FROM AUTHOR]

Introduction: Ischaemic Heart Disease (IHD) is one of the most common co-morbidity among Indian population, so is Diabetes Mellitus (DM). IHD is associated not only with systolic, but also with Diastolic Dysfunction (DDFx) of Left Ventricle (LV). However, there is scarcity of data correlating the severity of Coronary Artery Disease (CAD) with LV DDFx. Aim: To assess the severity of CAD in diabetic stable IHD patients with normal LV systolic function (LV Ejection fraction ≥50%) and it's association with degree of DDFx. Materials and Methods: A prospective cross-sectional study was conducted over a period of one year, in a tertiary care hospital of Odisha, India among diabetic stable IHD patients. Grades of DDFx were assessed among the study population, using Transthoracic Echocardiography (TTE). Subsequently, severity of CAD was assessed, using invasive Coronary Angiography (CAG) using The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) score. Next, grades of DDFx were correlated with severity of IHD. Results: Among a total of 93 diabetic stable IHD patients with normal LV ejection fraction, 76.3% were males and the mean age was 60.7±8.9 years. Majority presented with chronic stable angina (59, 63.4%). Hypertension (50, 53.7%), followed by dyslipidaemia (36, 38.7%) and renal dysfunction (19, 20.4%) were the most common co-morbidities. Majority of patients had grade I (39.8%), followed by grade II (17.2%), and grade III (9.7%) DDFx. On invasive CAG, 39.8% had a SYNTAX score of ≤ 22, 36.6% had a score of 23-32, and 23.6% had a score of ≥33. Grades of DDFx were found to be significantly higher among the patients with greater SYNTAX score. Conclusion: Among diabetic stable IHD patients, greater the severity of CAD on CAG, higher were the grades of DDFx. [ABSTRACT FROM AUTHOR]

• We report 20 LOPD patients from India. • The common c.−32–13T>G (IVS1) Caucasian mutation is absent. • Increased severity of disease phenotype with earlier age at disease onset. • Significant cardiac involvement than previously reported in Caucasian population. • GAA variant spectrum and novel variants. We evaluated the clinical histories, motor and pulmonary functions, cardiac phenotypes and GAA genotypes of an Indian cohort of twenty patients with late onset Pompe disease (LOPD) in this multi-centre study. A mean age at onset of symptoms and diagnosis of 9.9 ± 9.7 years and 15.8 ± 12.1 years respectively was identified. All patients had lower extremity limb-girdle muscle weakness. Seven required ventilatory support and seven used mobility assists. Of the four who used both assists, two received ventilatory support prior to wheelchair use. Cardiac involvement was seen in eight patients with various combinations of left ventricular hypertrophy, tricuspid regurgitation, cardiomyopathy, dilated ventricles with biventricular dysfunction and aortic regurgitation. Amongst 20 biochemically diagnosed patients (low residual GAA enzyme activity) GAA genotypes of 19 patients identified homozygous variants in eight and compound heterozygous in 11: 27 missense, 3 nonsense, 2 initiator codon, 3 splice site and one deletion. Nine variants in 7 patients were novel. The leaky Caucasian, splice site LOPD variant, c.−32−13T>G mutation was absent. This first study from India provides an insight into a more severe LOPD phenotype with earlier disease onset at 9.9 years compared to 33.3 years in Caucasian patients, and cardiac involvement more than previously reported. The need for improvement in awareness and diagnosis of LOPD in India is highlighted. [ABSTRACT FROM AUTHOR]

Background: In a developing country like India where mobile phone usage is increasing at an exponential rate, tele monitoring techniques could be used to reduce cardiac related morbidity and mortality. The current study was undertaken to evaluate the acceptance and feasibility of handheld tele-ECG for screening general population for cardiac related abnormalities. Methods: The study was conducted among walk-in patients and their attenders of an urban health training centre attached a tertiary care teaching hospital for a period of 6 months in 2019. Results: Among the 410 respondents, majority were of age group 30-39yrs (54%) and females (62%). Left ventricular hypertrophy (15.4%) was the commonest abnormality. Majority (97.5%) were very satisfied with the hand held Tele-ECG instrument. Conclusion: Telecardiology has a potential to revolutionize the healthcare system particularly in resource poor rural and urban slum settings in bridging the gap between primary and secondary care. [ABSTRACT FROM AUTHOR]

HTN after renal transplantation is associated with cardiovascular morbidity. ABPM allows diagnosis of masked HTN and isolated nocturnal HTN. Longitudinal ABPM data in children post‐transplant are limited. ABPM was performed in children post‐transplant and repeated in 6‐12 months. BP indices were used to determine the prevalence of masked HTN, masked uncontrolled HTN (masked HTN in patients on antihypertensive medications), and isolated nocturnal HTN. Linear regression determined the association between LVMI and ABPM indices. Thirty children underwent a baseline ABPM. Ambulatory HTN was present in 25 (83%). Masked HTN was present in 18 (60%) and isolated nocturnal HTN in 13 (43%). Nocturnal ambulatory BP was higher than corresponding daytime BPs (P <.001 for systolic and diastolic) and 25 (83%) had a blunted nocturnal dip. Prednisone dose predicted nocturnal DBP index and DBP load (r2 =.40, P =.024 and r2 =.178, P =.02). ABPM was repeated in 18 patients within 11 (±3) months. BP indices decreased with time, but nocturnal BPs remained higher than daytime (P <.001 for SBP and DBP). Blunted nocturnal dip did not improve. LVH was present in 12 (57%). LVMI was directly related to the nocturnal SBP index (r2 =.377, P =.003) and nocturnal DBP index (r2 =.493, P <.001). We found no association between LVMI and daytime BP indices. The prevalence of masked HTN, isolated nocturnal HTN, and blunted nocturnal dip was high in children with kidney transplants. Nocturnal BP predicted LVMI. Ambulatory BP improved on longitudinal follow‐up, but the pattern of isolated nocturnal HTN persisted. [ABSTRACT FROM AUTHOR]

Background: Cardiorenal complications (CRCs) associated with T2D are a major cause of morbidity and mortality. There is a paucity of data regarding the burden of undiagnosed silent CRCs among individuals with T2D in India. Aim: To present country-specific analyses from the 'Take CaRe of Me' program, a subset of the iCaReMe global, cloud-based registry (NCT03549754), evaluating the prevalence and clinical manifestations of CRCs among individuals with T2D from the primary care setting in India. Methods: Cross-sectional data of adults with T2D and no history of CRCs at index visits were collected from December 2020 through December 2021. Here we present descriptive analyses of baseline cardiorenal characteristics. Presence of cardiovascular (CV) risk was analyzed as per ESC 2019 guidelines and renal risk as per KDIGO guidelines. Continuous variables were summarized as mean ± SD and categorical variables as frequency (%). Results: A total of 3284 individuals (mean ± SD age: 54.8 ± 11.92 years, BMI: 26.7 ± 4.7 kg/m2; 46.6% females) were enrolled. Mean HbA1c was 8.1 ± 1.97% (62.7% with HbA1c ≥7%) with a mean T2D duration of 9.1 ± 7.21 years; 61.5% of individuals had a T2D duration ≥5 years. Hypertension was reported in one-third (34.3%). Overall, 1091 (33.2%) individuals had moderate-to-severe renal risk (per urine albumin creatinine ratio). Of the 1280 (39.0%) individuals with high and very high CV risk, 251 (19.6%) had echocardiographic data, of whom, 70 (27.9%) had abnormal echocardiogram (12.0% left ventricular hypertrophy, 8.4% left atrial enlargement, 4.4% valvular disease, 2.4% diastolic dysfunction, and 0.8% pulmonary hypertension). Clinical heart failure was detected in 18 (0.5%) individuals overall [Table]. Conclusion: The results show silent CRCs to be prevalent in more than one-third of individuals with T2D. Such a high burden of unrecognized CRCs highlights the unmet need for early diagnosis, risk factor management, and the use of cardioreno protective anti-hyperglycemic drugs for individuals with long-standing T2D in India. [ABSTRACT FROM AUTHOR]

Hypertension is common in children with chronic kidney disease (CKD) and is a major determinant of CKD progression. Ambulatory blood pressure monitoring (ABPM) has been proposed to be better in detecting hypertension as compared to casual blood pressure (CBP). This study aims to study the usefulness of ABPM in detecting masked hypertension, evaluating the adequacy of blood pressure (BP) control and predicting left ventricular hypertrophy (LVH) amongst children with CKD. A prospective cross-sectional study of 46 children with stage 3-5 CKD was conducted at the Pediatric Nephrology department of a tertiary hospital in South India. All children underwent CBP, ABPM and an echocardiography. Results were categorized as normal BP; confirmed hypertension; masked hypertension and white coat hypertension. Out of 46 children studied, 11 were undergoing dialysis. While 39.1 % children had stage 3 and 4 CKD each, 21.7% had stage 5 CKD. Masked hypertension was detected in 19.6% and 21.7% had confirmed hypertension. Thirty-four (73.9%) children were already receiving antihypertensive medication. In these, CBP was elevated in 23.5% and ABP in 47%. Among children with hypertension as defined by ABPM, LVH was detected in 32.2%. We found that higher the number of abnormal ABPM indices (assessed by BP Index, nocturnal dipping and BP Load) higher the likelihood of LVH (P = 0.046). ABPM is better in detecting hypertension and monitoring adequacy of treatment in children with CKD. The high prevalence of masked hypertension and its association with LVH supports early echocardiography and ambulatory BP monitoring to evaluate cardiovascular risks in this population. [ABSTRACT FROM AUTHOR]

Background: Electrocardiogram (ECG) is a cost effective tool to evaluate left ventricular hypertrophy (LVH). However, its reliability is often questionable when compared to the gold standard - echocardiography.The validation of ECG as a tool to diagnose LVH would benefit centres that lack access to echocardiography. Aim: (1) To assess the efficacy of ECG criteria to screen for left ventricular hypertrophy in comparison to echocardiography. (2) To determine whether ECG can be used as a screening tool for LVH in rural primary health centres Materials and Methods: Fifty hypertensive patients admitted to a tertiary level hospital fulfilling the inclusion and the exclusion criteria, were evaluated for LVH using ECG and echocardiography. Romhilt-Estes and Sokolow-Lyon criteria were applied to all subjects and their efficiency in detecting LVH was measured using Kappa statistics in comparison to echocardiography. Results: Among the 50 patients, 23 had LVH by echocardiography. In comparison to echocardiography, Romhilt-Estes and Sokolow- Lyon criteria were specific for LVH (96.3%, 88.9% respectively), but were poorly sensitive (43.5%, 43.5%). Combining both the criteria, raised the sensitivity to 60.9% and specificity to 85.2%. Kappa statistical analysis showed moderate to fair agreement of the Romhilt-Estes criteria with echocardiography. Both criteria had high positive predictive values (90.9%, 76.9%). Conclusion: Both Romhilt-Estes and Sokolow-Lyon ECG criteria are poor screening tools due to low sensitivity. But during routine screening of hypertensive patients with ECG alone, if any patient is positive by Romhilt-Estes criteria or both criteria, it would certainly warrant echocardiographic evaluation. As echocardiography cannot be recommended to screen every patient with hypertension in developing countries, initial evaluation using ECG can certainly help in selecting those who require echocardiography. [ABSTRACT FROM AUTHOR]