93 results on '"Rajiv Ananthakrishna"'
Search Results
2. 'Incidence, clinical and angiographic characteristics, management and outcomes of coronary artery perforation at a high volume cardiac care center during percutaneous coronary intervention'
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Chetana Krishnegowda, Beeresha Puttegowda, Santhosh Krishnappa, Rajiv Ananthakrishna, Nagesh C. Mahadevappa, Sadananda K. Siddegowda, Raghu T. Ramegowda, and Cholenahally N. Manjunath
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Cardiac tamponade ,Coronary artery perforation ,Covered stent ,Percutaneous coronary interventions ,Pericardiocentesis ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Aims: To study the incidence, clinical and angiographic characteristics, management and outcomes of coronary artery perforation (CAP) during percutaneous coronary intervention (PCI) at a high volume center in South-east Asia. Methods: Data from patients who had CAP during PCI from January 2016 to December 2019 at our center were collected. Clinical features, angiographic and procedural characteristics, their management and outcomes were analyzed retrospectively. Results: A total of 40,696 patients underwent PCI during the study period and the incidence of CAP was 0.13% (n = 51). Mean age was 60.0 ± 10.8 years and 69% were males. CAP cases involved complex type B2/C lesions in 73%, calcified lesions in 58%, and chronic total occlusions in 25%. Majority of patients presented as acute coronary syndrome (65%) and STEMI was the most frequent indication for PCI (33%). Most of the CAPs were Ellis type II (33%) and III (55%). CAP most frequently occurred during post dilation (n = 20) and wire manipulation (n = 17). Majority were treated by prolonged balloon inflation (53%) and covered stents (33%). Pericardiocentesis was required in 19 patients to alleviate tamponade. In one patient coil embolisation was done and two patients required bail-out emergency cardiac surgery. Periprocedural myocardial infarction occurred in 6% and in-hospital mortality was 10%. All-cause mortality accrued to 14% at 30 days and 16% at 6 months. Conclusion: Although incidence of CAP in contemporary interventional practice remains low, the morbidity and mortality are considerable. Early recognition and management strategies tailored to the severity of perforation play a key role in achieving better outcomes.
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- 2020
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3. Cardiac Amyloidosis
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Rajiv Ananthakrishna, MBBS, DM, Rachael Lloyd, MBBS (Hons), Bryone J. Kuss, MBBS, PhD, and Joseph B. Selvanayagam, MBBS (Hons), DPhil
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amyloidosis ,biopsy ,cardiac magnetic resonance ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Cardiac amyloidosis is a progressive disorder and is sometimes difficult to diagnose even when suspected in the appropriate clinical setting. We present an interesting case of rapidly progressive light-chain cardiac amyloidosis and highlights the importance of close monitoring even when the initial biopsy and imaging findings are not pathognomonic for amyloidosis. (Level of Difficulty: Beginner.)
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- 2020
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4. Spontaneous coronary artery dissection: A retrospective analysis of 19,676 coronary angiograms
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Dinesha Basavanna, Chollenahally Nanjappa Manjunath, Arunkumar Panneerselvam, Rajiv Ananthakrishna, Mohan Honnayanayak, and Prabhavathi Bhat
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Coronary angiogram ,coronary artery disease ,left coronary artery ,spontaneous dissection ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Aim: Spontaneous coronary artery dissection (SCAD) is a rare cause of angina, myocardial infarction (MI), and sudden cardiac death (SCD) and may frequently manifest as acute coronary syndrome (ACS). The diagnosis of SCAD relies on angiographic visualization of a radiolucent intimal flap. Therapeutic options include medical therapy, percutaneous coronary interventions, and bypass surgery. The aim of this study is to analyze the clinical profile, inhospital outcomes, management, and follow-up of patients with angiographic SCAD. Methods: About 19,676 diagnostic coronary angiograms (CAGs) were reviewed retrospectively during a 2-year period; 64 patients had SCAD and were included in the study. Complete medical histories before and during the event as well as treatment regimens were obtained from patients' hospital files. Results: A total of 64 cases of SCAD were considered for the study within an age range of 25–70 years. Fifty-eight patients presented with ACS, two patients presented with unstable angina, one patient presented with rheumatic mitral stenosis in atrial fibrillation, one patient presented with non-ST-elevation myocardial infarction, one patient with dilated cardiomyopathy with left ventricular dysfunction, and one patient with effort. Out of 64 patients, four patients died and the average hospital stay is 3–5 days. Conclusion: SCAD occurs in 0.32% of patients undergoing CAG for evaluation of coronary artery disease. Majority of SCAD occurs in men. The left coronary artery is most commonly affected. The inhospital outcomes are good. Most of the patients with SCAD have good prognosis following optimal medical therapy.
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- 2017
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5. Balloon valvotomy for rheumatic valvar stenosis in a patient with complex congenital heart disease
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Rajiv Ananthakrishna, Dattatreya PV Rao, Nagaraja Moorthy, and Manjunath C Nanjappa
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Medicine ,Pediatrics ,RJ1-570 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2016
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6. Chronic postrheumatic fever arthropathy
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Nagaraja Moorthy and Rajiv Ananthakrishna
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Immunologic diseases. Allergy ,RC581-607 - Published
- 2019
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7. Coronary artery disease in patients undergoing cardiac surgery for non-coronary lesions in a tertiary care centre
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Cholenahally Nanjappa Manjunath, Ashish Agarwal, Prabhavathi Bhat, Khandenahally Shankarappa Ravindranath, Rajiv Ananthakrishna, R. Ravindran, and Neena Agarwal
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Coronary artery disease ,Prevalence ,Preoperative coronary angiogram ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: The objective of the present study was to determine the prevalence of coronary artery disease (CAD) in patients undergoing surgery for various valvular as well as non-valvular cardiac pathologies. Methods: Patients with various valvular and non-valvular pathologies were selected. All patients with age ≥40 years and an indication for open heart surgery underwent pre-operative coronary angiogram and were included in the study. Results: The mean age was 51.5 ± 9.02 years. 178 (59.3%) patients were males and 122 (40.7%) patients were females. Out of 300 patients, 270 (90%) patients had valvular heart disease (VHD) and 30 (10%) patients had non-valvular heart disease. Rheumatic heart disease (RHD), mitral valve prolapse (MVP), degenerative aortic valve disease (DAVD) and bicuspid aortic valve (BAV) was present in 161 (53.7%), 17 (5.7%), 60 (20%) and 32 (10.7%) patients respectively. Overall, 26 (8.7%) patients were found to have significant CAD. CAD was significantly more common in patients with VHD as compared to patients with other etiologies (1 patient, 3.3%, p 60 years, male sex, typical angina, HT, dyslipidemia and smoking were significantly greater as compared to those with normal coronaries. Conclusion: The overall prevalence of CAD among patients undergoing non-coronary cardiac surgery is 8.7%. Coronary artery disease is relatively uncommon in patients with rheumatic VHD (4.9%), while its prevalence is highest in DAVD (23.4%).
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- 2014
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8. Dystrophic myocardial calcification
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Rajiv Ananthakrishna and Nagaraja Moorthy
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Calcification ,Myocardium ,Myocardial infarction ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Myocardial calcification is rare and occurs in previous myocardial infarction, endomyocardial fibrosis, and infections such as tuberculosis, chronic renal failure, or hyperparathyroidism. We present an interesting case of massive myocardial calcification of the left ventricle following prior extensive myocardial infarction, presenting as progressive heart failure.
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- 2016
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9. An adult with central cyanosis and differential pulmonary vascularity
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Rajiv Ananthakrishna, Nagaraja Moorthy, Dattatreya PV Rao, and Manjunath C Nanjappa
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Anomalous origin ,congenital heart disease ,pulmonary vascularity ,pulmonary artery ,Medicine ,Pediatrics ,RJ1-570 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A 22-year-old male patient presented with progressive effort intolerance of 2-years duration. Clinical findings and investigations were suggestive of Tetralogy of Fallot (TOF). In addition, there was a conspicuous difference in the pulmonary vascularity with oligemia on the left side and relative hypervascularity on the right side. The right pulmonary artery was arising from the proximal ascending aorta and the main pulmonary artery was continuing as the left pulmonary artery. The anomalous origin of a branch pulmonary artery from the aorta (AOPA) is a rare cardiac anomaly. We report this condition in association with TOF, highlighting the differential pulmonary vascularity.
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- 2015
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10. Infective Endocarditis: A Rare Organism in an Uncommon Setting
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Rajiv Ananthakrishna, Ravindranath K. Shankarappa, Naveena Jagadeesan, Ravi S. Math, Satish Karur, and Manjunath C. Nanjappa
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Infectious and parasitic diseases ,RC109-216 - Abstract
Facklamia hominis is a rare causative organism of infective endocarditis (IE). Only few cases of infection due to F. hominis have been reported in the literature. We describe a case of IE due to Gram-positive, alpha-haemolytic, catalase-negative coccus F. hominis in an adult patient with rheumatic mitral stenosis. Isolated mitral stenosis is an uncommon valve lesion predisposing to IE. The following paper is being presented to emphasize the possibility of IE due to F. hominis, and laboratories need to be alert of the potential significance in appropriate clinical setting.
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- 2012
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11. Xanthoma tuberosum in homozygous familial hypercholesterolemia
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Nagaraja Moorthy, Rajiv Ananthakrishna, Prabhavathi Bhat, and Manjunath C Nanjappa
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Coronary artery disease ,hypercholesterolemia ,xanthoma tuberosum ,Medicine ,Pediatrics ,RJ1-570 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Familial homozygous hypercholesterolemia is one of the high risk factors that can result in premature coronary arterial disease leading to severe morbidity and premature death in children and young adults. We describe a rare example of extensive xanthoma tuberosum in a case of familial homozygous hypercholesterolemia.
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- 2014
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12. Pulsatile neck mass: A rare cause
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Dattatreya P.V. Rao, Rajiv Ananthakrishna, and Manjunath C Nanjappa
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Cervical aortic arch ,pulsatile neck mass ,vascular anomaly ,Medicine ,Pediatrics ,RJ1-570 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A 20-year-old female presented with a pulsatile neck mass. On evaluation, she was found to have right cervical aortic arch, which is a rare anomaly. We highlight the conventional and Computed tomography angiography features of this vascular anomaly.
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- 2013
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13. Myocardial Oxygenation in Hibernating Myocardium
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Rajiv Ananthakrishna, Karthigesh Sree Raman, Ranjit Shah, Richard J. Woodman, Angela Walls, Craig Bradbrook, Suchi Grover, and Joseph B. Selvanayagam
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2022
14. Regression of Left Ventricular Hypertrophy in a Case of Adult Hypertrophic Cardiomyopathy: Importance of Clinical Context at Initial Diagnosis
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Zach, Liang, Rajiv, Ananthakrishna, and Joseph B, Selvanayagam
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Adult ,Pulmonary and Respiratory Medicine ,Echocardiography ,Humans ,Hypertrophy, Left Ventricular ,Cardiomyopathy, Hypertrophic ,Cardiology and Cardiovascular Medicine - Published
- 2022
15. Left ventricular ischemia in pre-capillary pulmonary hypertension: a cardiovascular magnetic resonance study
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Rajiv Ananthakrishna, David S. Celermajer, Jennifer G Walker, Carmine G. De Pasquale, Angela Walls, Ranjit Shah, Susanna Proudman, Karthigesh Sree Raman, Richard J. Woodman, Joseph B. Selvanayagam, P. Steele, and Michael B. Stokes
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Ischemia ,Vasodilation ,Magnetic resonance imaging ,030204 cardiovascular system & hematology ,medicine.disease ,Pulmonary hypertension ,030218 nuclear medicine & medical imaging ,Coronary arteries ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Internal medicine ,Right heart ,Cardiology ,Magnetic resonance study ,Medicine ,Original Article ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Prognosis in pulmonary arterial hypertension (PAH) is largely dependent on right ventricular (RV) function. However, recent studies have suggested the presence of left ventricular (LV) dysfunction in PAH patients. The potential role of LV ischemia, as a contributor to progressive LV dysfunction, has not been systematically studied in PAH. We aim to assess the presence and extent of LV myocardial ischemia in patients with known PH and without obstructive coronary artery disease (CAD), using oxygen-sensitive (OS) cardiovascular magnetic resonance (CMR) and stress/rest CMR T1 mapping. Methods We prospectively recruited 28 patients with right heart catheter-proven PH and no significant CAD, 8 patients with known CAD and 11 normal age-matched controls (NC). OS-CMR images were acquired using a T2* sequence and T1 maps were acquired using Shortened Modified Look-Locker Inversion recovery (ShMOLLI) at rest and adenosine-induced stress vasodilatation; ΔOS-CMR signal intensity (SI) index (stress/rest SI) and ΔT1 reactivity (stress-rest/rest T1 mapping) were calculated. Results Global LV ΔOS SI index was significantly lower in PH patients compared with controls (11.1%±6.7% vs. 20.5%±10.5%, P=0.016), as was ΔT1 reactivity (5.2%±4.5% vs. 8.0%±2.9%, P=0.047). The ischemic segments of CAD patients had comparable ΔOS SI (10.3%±6.4% vs. 11.1%±6.7%, P=0.773) to PH patients, but lower ΔT1 reactivity (1.1%±4.2% vs. 5.2%±4.5%, P=0.036). Conclusions Decreased OS-CMR SI and T1 reactivity signify the presence of impaired myocardial oxygenation and vasodilatory response in PH patients. Given their unobstructed epicardial coronary arteries, this is likely secondary to coronary microvascular dysfunction (CMD).
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- 2020
16. Cardiac Amyloidosis
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Rachael Lloyd, Rajiv Ananthakrishna, Bryone J. Kuss, and Joseph B. Selvanayagam
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0301 basic medicine ,medicine.medical_specialty ,Case Report ,030105 genetics & heredity ,cardiac magnetic resonance ,ATTR, transthyretin ,03 medical and health sciences ,0302 clinical medicine ,Clinical Case ,Progressive disorder ,CMR, cardiac magnetic resonance ,Biopsy ,medicine ,Cardiac biopsy ,Diseases of the circulatory (Cardiovascular) system ,biopsy ,CA, cardiac amyloidosis ,amyloidosis ,medicine.diagnostic_test ,NT-proBNP, N-terminal pro-B-type natriuretic peptide ,business.industry ,Amyloidosis ,ECV, extracellular volume ,medicine.disease ,MGUS, monoclonal gammopathy of unknown significance ,Cardiac amyloidosis ,AL, light-chain ,RC666-701 ,Radiology ,Cardiology and Cardiovascular Medicine ,Cardiac magnetic resonance ,business ,030217 neurology & neurosurgery - Abstract
Cardiac amyloidosis is a progressive disorder and is sometimes difficult to diagnose even when suspected in the appropriate clinical setting. We present an interesting case of rapidly progressive light-chain cardiac amyloidosis and highlights the importance of close monitoring even when the initial biopsy and imaging findings are not pathognomonic for amyloidosis. (Level of Difficulty: Beginner.), Graphical abstract, Cardiac amyloidosis is a progressive disorder and is sometimes difficult to diagnose even when suspected in the appropriate clinical setting. This…
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- 2020
17. Utility of cardiovascular magnetic resonance in patients with stable troponin elevation
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Rajiv Ananthakrishna, Benita P Rajvi, Diana E Hancock, Feruza Kholmurodova, Richard J Woodman, Sanjana Patil, Matthew Horsfall, Derek P Chew, Noor Darinah Mohd Daril, and Joseph B Selvanayagam
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Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Aims Cardiovascular magnetic resonance (CMR) imaging has a potential role in the evaluation of symptomatic patients with stable troponin elevation; however, its utility remains unexplored. We sought to determine the incremental diagnostic value of CMR in this unique cohort and assess the long-term clinical outcomes. Methods and results Two hundred twenty-five consecutive patients presenting with cardiac chest pain/dyspnoea, stable troponin elevation, and undergoing CMR assessment were identified retrospectively from registry database. The study cohort was prospectively followed for major adverse cardiac events (MACEs) (defined as composite of all-cause mortality and cardiovascular readmissions). The primary outcome measure was the diagnostic utility of CMR, i.e. percentage of patients for whom CMR identified the cause of stable troponin elevation. Secondary outcome measures included the incremental value of CMR and occurrence of MACE. CMR was able to identify the cause for stable troponin elevation in 160 (71%) patients. A normal CMR was identified in 17% and an inconclusive CMR in 12% of the patients. CMR changed the referral diagnosis in 59 (26%) patients. Utilizing a baseline prediction model (pre-CMR referral diagnosis), the net reclassification index was 0.11 and integrated discriminatory improvement index measured 0.33 following CMR. Over a median follow-up of 4.3 years (interquartile range 2.8–6.3), 72 (32%) patients experienced MACE. Conclusion CMR identified a cause for stable troponin elevation in 7 of 10 cases, and a new diagnosis was evident in 1 of 4 cases. CMR improved the net reclassification of patients with stable troponin elevation.
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- 2021
18. Myocardial Oxygenation in Hibernating Myocardium: Insights From Oxygenation-Sensitive Cardiovascular Magnetic Resonance Imaging
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Rajiv, Ananthakrishna, Karthigesh, Sree Raman, Ranjit, Shah, Richard J, Woodman, Angela, Walls, Craig, Bradbrook, Suchi, Grover, and Joseph B, Selvanayagam
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Myocardial Stunning ,Predictive Value of Tests ,Myocardium ,Humans ,Heart ,Cardiomyopathies ,Magnetic Resonance Imaging - Published
- 2021
19. Long-term clinical outcomes in patients with a working diagnosis of myocardial infarction with non-obstructed coronary arteries (MINOCA) assessed by cardiovascular magnetic resonance imaging
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Rajiv Ananthakrishna, Suchi Grover, Cameron Bridgman, Sanjana Patil, Joseph B. Selvanayagam, Benita Rajvi, Betty Raman, Zach Liang, and John L. Moran
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medicine.medical_specialty ,Myocarditis ,Cardiomyopathy ,Myocardial Infarction ,Magnetic Resonance Imaging, Cine ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Clinical endpoint ,Humans ,cardiovascular diseases ,Myocardial infarction ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,medicine.disease ,Prognosis ,Coronary Vessels ,Magnetic Resonance Imaging ,Coronary arteries ,medicine.anatomical_structure ,Cohort ,cardiovascular system ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
Myocardial infarction with non-obstructed coronary arteries (MINOCA) is a distinct entity among patients presenting with troponin-positive acute chest pain. We have previously reported on the incremental diagnostic capability of cardiovascular magnetic resonance (CMR) in this cohort. There is paucity of evidence on the long-term (5 years) clinical outcomes of these patients as graded by their acute CMR diagnosis.A total of 229 patients with a working diagnosis of MINOCA who underwent CMR assessment during the acute admission (2010-2017) were prospectively studied. The primary endpoint was major adverse cardiac events (MACE) defined as a composite of all-cause mortality and cardiovascular readmissions, identified from hospital and primary care records. CMR performed at a median of 6 days (IQR 2, 8) from presentation provided a diagnosis in 85% of the patients (38% myocarditis, 28% acute myocardial infarction and 19% Takotsubo cardiomyopathy). Over a median follow-up of 7.1 years (IQR 3.7, 8.2), 56 (24%) patients experienced a MACE. We found a strong association between CMR diagnosis and MACE (log rank 30.47, p 0.001). In multivariate analysis, age (hazard ratio = 1.07; 95% confidence interval = 1.05, 1.10; p 0.001) and CMR diagnosis of acute myocardial infarction (hazard ratio = 8.87; 95% confidence interval = 2.58, 30.4; p = 0.001) were independent predictors of MACE.In a large cohort of patients with a working diagnosis of MINOCA, one in four suffer a MACE during long-term clinical follow-up. CMR diagnosis of acute myocardial infarction and age were significant predictors of MACE even in the absence of significant coronary artery obstruction.
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- 2021
20. Randomized controlled trial of perhexiline on regression of left ventricular hypertrophy in patients with symptomatic hypertrophic cardiomyopathy (RESOLVE-HCM trial)
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Richard J. Woodman, Arduino A. Mangoni, Benedetta C. Sallustio, Joseph B. Selvanayagam, Giulia Binda, John D. Horowitz, Rajiv Ananthakrishna, Christopher Semsarian, Jonathon Foote, and Sau L Lee
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Adult ,Male ,medicine.medical_specialty ,Perhexiline ,Phases of clinical research ,macromolecular substances ,030204 cardiovascular system & hematology ,Placebo ,Left ventricular hypertrophy ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Double-Blind Method ,law ,Internal medicine ,Clinical endpoint ,Medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Prospective Studies ,business.industry ,Hypertrophic cardiomyopathy ,Cardiovascular Agents ,Cardiomyopathy, Hypertrophic ,medicine.disease ,Magnetic Resonance Imaging ,Echocardiography ,Heart failure ,cardiovascular system ,Cardiology ,Female ,Hypertrophy, Left Ventricular ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background The presence and extent of left ventricular hypertrophy (LVH) is a major determinant of symptoms in patients with hypertrophic cardiomyopathy (HCM). There is increasing evidence to suggest that myocardial energetic impairment represents a central mechanism leading to LVH in HCM. There is currently a significant unmet need for disease-modifying therapy that regresses LVH in HCM patients. Perhexiline, a potent carnitine palmitoyl transferase-1 (CPT-1) inhibitor, improves myocardial energetics in HCM, and has the potential to reduce LVH in HCM. Objective The primary objective is to evaluate the effects of perhexiline treatment on the extent of LVH, in symptomatic HCM patients with at least moderate LVH. Methods/Design RESOLVE-HCM is a prospective, multicenter double-blind placebo-controlled randomized trial enrolling symptomatic HCM patients with at least moderate LVH. Sixty patients will be randomized to receive either perhexiline or matching placebo. The primary endpoint is change in LVH, assessed utilizing cardiovascular magnetic resonance (CMR) imaging, after 12-months treatment with perhexiline. Summary RESOLVE-HCM will provide novel information on the utility of perhexiline in regression of LVH in symptomatic HCM patients. A positive result would lead to the design of a Phase 3 clinical trial addressing long-term effects of perhexiline on risk of heart failure and mortality in HCM patients.
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- 2020
21. Long-term clinical outcomes of troponin-positive chest pain and unobstructed coronary arteries assessed by cardiovascular magnetic resonance imaging
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Rajiv Ananthakrishna, Richard J. Woodman, Cameron Bridgman, Joseph B. Selvanayagam, and Suchi Grover
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medicine.medical_specialty ,medicine.diagnostic_test ,biology ,business.industry ,Magnetic resonance imaging ,Chest pain ,Troponin ,Term (time) ,Coronary arteries ,medicine.anatomical_structure ,Internal medicine ,medicine ,Cardiology ,biology.protein ,cardiovascular diseases ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background and introduction Troponin-positive chest pain with unobstructed coronary arteries is a distinct entity with different pathophysiological causes. We have previously reported on the incremental diagnostic capability of cardiovascular magnetic resonance (CMR) in this cohort. However, there is paucity of literature on the long-term clinical outcomes of these patients assessed with CMR. Objectives Using the unique cohort of patients previously studied, we sought to assess the long-term clinical outcomes in patients with troponin-positive chest pain and unobstructed coronary arteries, as graded by their acute CMR presentation. Methods A total of 122 consecutive patients with troponin-positive chest pain and unobstructed coronary arteries undergoing CMR assessment during the acute admission (2010–2014) were studied. The primary endpoint was major adverse cardiac event (MACE), defined as a composite of all-cause mortality and cardiovascular readmissions (heart failure, acute myocardial infarction [AMI], atrial or ventricular arrhythmia and stroke). Patients were grouped into 4 categories based on their initial CMR findings: AMI, acute myocarditis, Takotsubo cardiomyopathy and normal CMR. Results The mean age of the study cohort was 55.6±16.5 years and 56.5% were women. CMR (performed at a median of 6 days from presentation) provided a diagnosis in 87% of the patients (38% myocarditis, 28% Takotsubo cardiomyopathy and 21% AMI). Patients with a diagnosis of AMI were prescribed guideline recommended medical therapy. Over a median follow-up of 2524 days (6.9 years), 32 (26.2%) patients experienced a MACE. The all-cause mortality was 2.5%. The most common indication for cardiovascular readmissions in this cohort was heart failure (12.3%) and AMI (9%). In multivariate analysis, a CMR diagnosis of AMI (hazard ratio = 2.6; 95% confidence interval = 1.2, 5.7; p=0.019) and peak troponin (hazard ratio = 1.0003; 95% confidence interval = 1.00003, 1.0006; p=0.028) were significantly associated with MACE after adjusting for age and gender. In addition, CMR diagnosis of AMI was significantly associated with a lower event-free survival rate compared with a diagnosis of non-AMI (adjusted hazard ratio = 2.57, p=0.019) (Figure). Conclusions The long-term prognosis of patients with troponin-positive chest pain and unobstructed coronary arteries is not benign. CMR diagnosis of AMI is a significant predictor of MACE even in the absence of significant coronary artery obstruction and despite guideline recommended post AMI therapy. Figure 1 Funding Acknowledgement Type of funding source: None
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- 2020
22. Timing of cardiovascular magnetic resonance in clinical trials evaluating cardioprotective therapies to reduce infarct size
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Cheerag Shirodaria, Rajiv Ananthakrishna, Keith M. Channon, and Joseph B. Selvanayagam
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medicine.medical_specialty ,Magnetic Resonance Spectroscopy ,medicine.diagnostic_test ,business.industry ,Myocardium ,Magnetic resonance imaging ,Infarct size ,Magnetic Resonance Imaging ,Clinical trial ,Percutaneous Coronary Intervention ,Treatment Outcome ,Internal medicine ,medicine ,Cardiology ,Humans ,ST Elevation Myocardial Infarction ,Cardiology and Cardiovascular Medicine ,business - Abstract
Although the short- and long-term clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) has improved substantially over the last 2 decades the risk of future cardiovascular events, in particular heart failure, remains high [ 1 ]. The most important determinant of long-term clinical outcomes after STEMI is infarct size (IS). In a recent meta-analysis, IS measured within 1 month after primary percutaneous intervention (pPCI) was strongly associated with all-cause mortality and hospitalization for heart failure within 1 year [ 2 ]. There are currently no established therapies to reduce IS, with the exception of timely reperfusion by pPCI. Furthermore, ischemia-reperfusion injury (IRI) remains a major clinical problem in patients with STEMI, leading to greater IS, ventricular arrhythmias and heart failure, despite early reperfusion by pPCI. There are no effective therapies to prevent or limit IRI, which is caused by multiple pathways activated by rapid tissue reoxygenation and the generation of reactive oxygen species. Contemporary research focus is on new therapeutic interventions to reduce IRI and subsequent IS, with the ultimate aim of improving event-free survival in STEMI patients.
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- 2020
23. Down the Memory Lane of Tamponade During Balloon Mitral Valvotomy
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Sourabh, Agstam, Arunkumar, Panneerselvam, Satvic C, Manjunath, and Rajiv, Ananthakrishna
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Humans ,Mitral Valve Stenosis ,Punctures ,Pericardial Effusion ,Catheterization - Published
- 2020
24. Incidence and predictors of target lesion failure in a multiethnic Asian population receiving the SYNERGY coronary stent: A prospective all-comers registry
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Ronald Chi-Hang Lee, Adrian F. Low, Liu Li, Huay-Cheem Tan, Edgar Tay, Joshua Ping Yun Loh, Rajiv Ananthakrishna, Koo Chan, Mark Y. Chan, Poay Huan Loh, Siew Pang Chan, and William Kristanto
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Male ,Target lesion ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Ethnic group ,Myocardial Infarction ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Prosthesis Design ,Lesion ,03 medical and health sciences ,Coronary artery bypass surgery ,0302 clinical medicine ,Asian People ,Risk Factors ,Internal medicine ,Absorbable Implants ,Coronary stent ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Everolimus ,Prospective Studies ,Registries ,Treatment Failure ,030212 general & internal medicine ,Myocardial infarction ,Angioplasty, Balloon, Coronary ,Aged ,Singapore ,business.industry ,Incidence ,Incidence (epidemiology) ,Percutaneous coronary intervention ,Stent ,Cardiovascular Agents ,Drug-Eluting Stents ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Asian population ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives To evaluate the target lesion failure (TLF) rate of the SYNERGY stent in all-comers, multiethnic Asian population. Background Currently, most drug eluting stents deliver anti-proliferative drugs from a durable polymer which is associated with a risk of late stent thrombosis. The novel everolimus-eluting, platinum chromium SYNERGY stent is coated with a bioabsorbable abluminal polymer that resolves within 4 months. Methods This was a prospective, single center registry of consecutive patients treated with the SYNERGY stent between December 2012 and April 2015. The primary outcome was the incidence of TLF, defined as the combination of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization (TLR) at 1 year. Results A total of 807 patients received the SYNERGY stent during the study period. One-year clinical outcome data was available for 765 patients (94.8%) and were considered for statistical analysis. The mean age was 60.7 ± 10.8 years, and 83.4% were males. Patients with acute myocardial infarction consisted of 50.3% (ST-segment elevation myocardial infarction: 23.0%, Non-ST-segment elevation myocardial infarction: 27.3%) of the study population. The treated lesions were complex (ACC/AHA type B2/C: 72.7%). The primary end point of TLF at 1 year was 5.8%. Rates of cardiac mortality, target vessel myocardial infarction, and TLR were 4.2, 1.0, and 1.3%, respectively, at 1 year. Predictors of the incidence and time to early TLF were female gender, Malay ethnicity, diabetes mellitus, acute myocardial infarction at presentation, a prior history of coronary artery bypass surgery and the presence of lesion calcification. The incidence of definite stent thrombosis was 0.4% at 1 year. Conclusions In this registry, the use of the SYNERGY stent was associated with low rates of TLF at 1 year.
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- 2018
25. Intracardiac mass in chronic myeloid leukemia
- Author
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Ashita Barthur, Rajiv Ananthakrishna, Srinivas B. Chikkaswamy, and Chetana Krishnegowda
- Subjects
Pathology ,medicine.medical_specialty ,Myeloid ,medicine.medical_treatment ,Aggressive disease ,030204 cardiovascular system & hematology ,Intracardiac injection ,03 medical and health sciences ,0302 clinical medicine ,Cardiac magnetic resonance imaging ,hemic and lymphatic diseases ,Medicine ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,030212 general & internal medicine ,Embolization ,neoplasms ,Intracardiac thrombus ,medicine.diagnostic_test ,business.industry ,Myeloid leukemia ,Peripheral ,medicine.anatomical_structure ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business - Abstract
Chronic myeloid leukaemia (CML) is a neoplastic disorder of myeloid cell lines and is a less aggressive disease compared to acute myeloid leukemia (AML). Although cardiovascular complications are not uncommon, intracardiac thrombosis in CML is rarely reported. Herein, we report a case of CML presenting with an intracardiac thrombus attached to the posterior mitral leaflet, and subsequently resulting in peripheral embolization.
- Published
- 2019
26. Spontaneous coronary artery dissection: A retrospective analysis of 19,676 coronary angiograms
- Author
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Arunkumar Panneerselvam, Dinesha Basavanna, Mohan Honnayanayak, C.N. Manjunath, Rajiv Ananthakrishna, and Prabhavathi Bhat
- Subjects
medicine.medical_specialty ,Acute coronary syndrome ,lcsh:Diseases of the circulatory (Cardiovascular) system ,business.industry ,Unstable angina ,Coronary angiogram ,spontaneous dissection ,left coronary artery ,Atrial fibrillation ,medicine.disease ,Sudden cardiac death ,Coronary artery disease ,Angina ,Left coronary artery ,lcsh:RC666-701 ,Internal medicine ,medicine.artery ,Cardiology ,Medicine ,Myocardial infarction ,business ,coronary artery disease - Abstract
Aim: Spontaneous coronary artery dissection (SCAD) is a rare cause of angina, myocardial infarction (MI), and sudden cardiac death (SCD) and may frequently manifest as acute coronary syndrome (ACS). The diagnosis of SCAD relies on angiographic visualization of a radiolucent intimal flap. Therapeutic options include medical therapy, percutaneous coronary interventions, and bypass surgery. The aim of this study is to analyze the clinical profile, inhospital outcomes, management, and follow-up of patients with angiographic SCAD. Methods: About 19,676 diagnostic coronary angiograms (CAGs) were reviewed retrospectively during a 2-year period; 64 patients had SCAD and were included in the study. Complete medical histories before and during the event as well as treatment regimens were obtained from patients' hospital files. Results: A total of 64 cases of SCAD were considered for the study within an age range of 25–70 years. Fifty-eight patients presented with ACS, two patients presented with unstable angina, one patient presented with rheumatic mitral stenosis in atrial fibrillation, one patient presented with non-ST-elevation myocardial infarction, one patient with dilated cardiomyopathy with left ventricular dysfunction, and one patient with effort. Out of 64 patients, four patients died and the average hospital stay is 3–5 days. Conclusion: SCAD occurs in 0.32% of patients undergoing CAG for evaluation of coronary artery disease. Majority of SCAD occurs in men. The left coronary artery is most commonly affected. The inhospital outcomes are good. Most of the patients with SCAD have good prognosis following optimal medical therapy.
- Published
- 2017
27. Prosthetic mitral valve thrombosis, malfunction, and paroxysmal mitral regurgitation
- Author
-
Rajiv Ananthakrishna, Nagaraja Moorthy, Dattatreya P.V. Rao, Manjunath C. Nanjappa, and Satvic C. Manjunath
- Subjects
Adult ,Reoperation ,medicine.medical_specialty ,medicine.medical_treatment ,Physical examination ,030204 cardiovascular system & hematology ,Prosthesis ,03 medical and health sciences ,0302 clinical medicine ,Mechanical Mitral Valve ,PROSTHETIC MITRAL VALVE ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Prosthetic Valve Thrombosis ,Mitral regurgitation ,medicine.diagnostic_test ,business.industry ,Coronary Thrombosis ,Mitral Valve Insufficiency ,medicine.disease ,Thrombosis ,Prosthesis Failure ,Echocardiography ,Heart Valve Prosthesis ,Heart failure ,cardiovascular system ,Cardiology ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Intermittent dysfunction of mechanical mitral valve prosthesis is an uncommon condition. It carries serious clinical implications if unrecognized. Here, we present a case of a 28-year-old female with a history of rheumatic multivalvular disease, for which she had undergone double valve replacement and tricuspid annuloplasty. Six months later, she presented with heart failure. Clinical examination revealed intermittent loss of closing clicks followed by a pansystolic murmur at the apex, suggestive of mitral prosthetic valve dysfunction. We highlight the echocardiographic findings of paroxysmal mitral valvular regurgitation secondary to prosthetic valve malfunction secondary to prosthetic valve thrombosis.
- Published
- 2018
28. Hemopericardium Following Transseptal Puncture During Balloon Mitral Valvotomy: Management Strategies and Outcomes
- Author
-
Arunkumar, Panneerselvam, Rajiv, Ananthakrishna, Budanur Chikkaswamy, Srinivas, Srinivasa K, Hemanna Setty, Satvic C, Manjunath, Dinesha, Basavanna, and Manjunath C, Nanjappa
- Subjects
Adult ,Balloon Valvuloplasty ,Male ,Reoperation ,Emergency Medical Services ,Incidence ,Punctures ,Pericardial Effusion ,Outcome and Process Assessment, Health Care ,Heart Septum ,Humans ,Mitral Valve ,Mitral Valve Stenosis ,Female ,Prospective Studies ,Intraoperative Complications - Abstract
Hemopericardium is a major complication of balloon mitral valvotomy (BMV). Only a few studies are available to address this issue following transseptal access. In addition, the management strategy regarding completion of BMV is uncertain.We sought to determine the incidence of hemopericardium complicating transseptal puncture during BMV. In addition, the management strategy adopted and outcomes are highlighted.This prospective study included 29 consecutive patients who developed hemopericardium following transseptal access during BMV.Out of 1424 patients who underwent BMV, hemopericardium developed in 29 patients following transseptal access (2.0%). The mean age of the study cohort was 36.9 ± 13.7 years and 82.8% were women. A second transseptal puncture was done and BMV was completed in 26 patients (89.6%). An acceptable hemodynamic result was obtained in 22 patients (84.6%). Six patients (20.7%) underwent emergency surgery for hemopericardium. The sites of perforation were inferior vena cava-right atrial junction in 4 cases, left atrial posterior wall in 1 case, and left atrial appendage in 1 case. In addition to repair of the perforation, a total of 2 patients underwent mitral valve replacement and 1 patient underwent open mitral commissurotomy. The in-hospital mortality rate was 6.9%.The incidence of hemopericardium complicating transseptal access during BMV was 2.0%, and was associated with a mortality rate of 6.9%. BMV can be safely performed in the same sitting with a second transseptal puncture, in patients with a favorable valve morphology. Surgical intervention can be reserved for a subset of patients with persistent pericardial collection.
- Published
- 2019
29. Observational study of left ventricular global longitudinal strain in ST-segment elevation myocardial infarction patients with extended pharmaco-invasive strategy: A six months follow-up study
- Author
-
Rajiv Ananthakrishna, Prabhavathi Bhat, Satvic C. Manjunath, Sumangala B. Veervhadraiah, Cholenahally Nanjappa Manjunath, Vikram Patil, Sridhar Lakshmana Sastry, Lachikrathman Devegowda, and Balaraju Doddaiah
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Internal medicine ,Fibrinolysis ,medicine ,ST segment ,Humans ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,Prospective Studies ,Prospective cohort study ,Ejection fraction ,business.industry ,Percutaneous coronary intervention ,medicine.disease ,Conventional PCI ,Cohort ,Cardiology ,ST Elevation Myocardial Infarction ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
AIMS AND OBJECTIVES To evaluate left ventricular (LV) function by assessment of LV global longitudinal strain (GLS) in ST-segment elevation myocardial infarction (STEMI) patients who underwent delayed fibrinolysis and coronary intervention (extended pharmaco-invasive strategy), since LV function is one of the determinants of both immediate and long-term outcomes. METHODS Prospective study of consecutive STEMI patients who underwent extended pharmaco-invasive strategy. The LV function was estimated using LV GLS at baseline and at 6 months. RESULTS The study included eighty-seven STEMI patients who received delayed pharmaco-invasive therapy and coronary intervention. The primary aim of the study was to evaluate a change in LV function by assessment of GLS at 6 months as compared to baseline. Prior to PCI, LV ejection fraction was 48.08 ± 6.23% and GLS was -11.11 ± 2.99%. Procedural success was achieved in all patients. LV ejection fraction after 6 months of follow-up increased to 53.12 ± 5.61% and the GLS improved to -13.03 ± 3.06% In comparison to baseline, there was a significant improvement in both LV ejection fraction and GLS at 6 months of follow-up (P
- Published
- 2019
30. Diagnosis of Löffler Endocarditis Secondary to Chronic Eosinophilic Leukaemia With FIP1L1-PDGFRA Rearrangement
- Author
-
Cameron Bridgman, C. De Pasquale, Rajiv Ananthakrishna, K. Snaith, and M. Gieve
- Subjects
Pulmonary and Respiratory Medicine ,Fip1l1 pdgfra ,Pathology ,medicine.medical_specialty ,business.industry ,medicine ,Endocarditis ,Chronic eosinophilic leukaemia ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Published
- 2021
31. Surgical Ventricular Restoration for Post infarction Left Ventricular Aneurysm
- Author
-
JR Vijay Kumar, Seetharama P.S. Bhat, Rahul Patil, H.S. Natraj Setty, C.N. Manjunath, and Rajiv Ananthakrishna
- Subjects
medicine.medical_specialty ,Left Ventricular Aneurysm ,medicine.anatomical_structure ,Post infarction ,Ventricle ,business.industry ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,Electrocardiography in myocardial infarction ,cardiovascular diseases ,business - Abstract
Surgical ventricular restoration is a procedure designed to restore or remodel the left ventricle.
- Published
- 2017
32. 374 Long-term Clinical Outcomes of Troponin-positive Chest Pain and Unobstructed Coronary Arteries Assessed by Cardiovascular Magnetic Resonance Imaging
- Author
-
Richard J. Woodman, Suchi Grover, Cameron Bridgman, Rajiv Ananthakrishna, and Joseph B. Selvanayagam
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.diagnostic_test ,biology ,business.industry ,Magnetic resonance imaging ,Chest pain ,Troponin ,Term (time) ,Coronary arteries ,medicine.anatomical_structure ,Internal medicine ,Cardiology ,biology.protein ,Medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
33. Giant syphilitic aortic pseudoaneurysm with extrinsic compression of the left atrium, right pulmonary artery, and oesophagus
- Author
-
Nagaraja Moorthy, Budanur Chikkaswamy Srinivas, Sandeep Shankar, Babu Reddy, and Rajiv Ananthakrishna
- Subjects
medicine.medical_specialty ,Left atrium ,Pulmonary Artery ,Esophageal Diseases ,Aortography ,Severity of Illness Index ,Extrinsic compression ,Pseudoaneurysm ,Imaging, Three-Dimensional ,Internal medicine ,medicine.artery ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Heart Atria ,Syphilis ,Esophagus ,Aorta ,Aortic pseudoaneurysm ,Aged ,business.industry ,General Medicine ,medicine.disease ,Right pulmonary artery ,medicine.anatomical_structure ,Dyspnea ,Pulmonary artery ,Cardiology ,Female ,Radiography, Thoracic ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Aneurysm, False - Published
- 2018
34. Treatment of Very Small De Novo Coronary Artery Disease With 2.0 mm Drug-Coated Balloons Showed 1-Year Clinical Outcome Comparable With 2.0 mm Drug-Eluting Stents
- Author
-
Hui Wen, Sim, Rajiv, Ananthakrishna, Siew Pang, Chan, Adrian F, Low, Chi-Hang, Lee, Mark Y, Chan, Edgar L, Tay, Poay Huan, Loh, Koo Hui, Chan, Huay Cheem, Tan, and Joshua P, Loh
- Subjects
Male ,Singapore ,Drug-Eluting Stents ,Coronary Artery Disease ,Kaplan-Meier Estimate ,Organ Size ,Middle Aged ,Coronary Angiography ,Prosthesis Design ,Coronary Vessels ,Percutaneous Coronary Intervention ,Postoperative Complications ,Outcome Assessment, Health Care ,Humans ,Female ,Aged - Abstract
To evaluate the 1-year clinical outcomes of patients treated with 2.0 mm drug-coated balloon (DCB) vs 2.0 mm drug-eluting stent (DES) implantation in small-caliber vessel de novo coronary artery disease (CAD).All patients treated with 2.0 mm DCB or 2.0 mm DES for very small vessel de novo CAD from July 2014 to June 2016 were included in this study. The primary endpoint was the occurrence of target-lesion failure (TLF) and time to TLF, defined as a combination of cardiac mortality, target-vessel myocardial infarction, and target-lesion revascularization (TLR).A total of 87 patients (96 lesions) were implanted with 2.0 mm DCBs and 200 patients (223 lesions) were implanted with 2.0 mm DESs during the study period. Mean reference vessel diameter was similar between the DCB and DES groups (1.88 ± 0.38 mm vs 1.95 ± 0.21 mm, respectively; P=.11). The 1-year TLF rates were 7.0% in the DCB group and 8.2% in the DES group (P=.73). TLF was driven by TLR in both groups. Bailout stenting was performed in 7 patients (8 lesions) who received a DCB. Stent thrombosis was seen in 4 patients (2.0%) who underwent DES implantation. There was no vessel thrombosis noted in the DCB group. Cardiogenic shock was identified as a direct and significant predictor for both the occurrence of TLF and time to TLF.In this first report, treatment of very small vessel CAD with 2.0 mm DCB vs 2.0 mm DES was associated with similar 1-year TLF rates.
- Published
- 2018
35. Chronic postrheumatic fever arthropathy
- Author
-
Rajiv Ananthakrishna and Nagaraja Moorthy
- Subjects
lcsh:Immunologic diseases. Allergy ,medicine.medical_specialty ,business.industry ,Arthropathy ,medicine ,lcsh:RC581-607 ,Images in Rheumatology ,medicine.disease ,business ,Dermatology - Published
- 2019
36. Bioresorbable Vascular Scaffolds in Routine Clinical Practice
- Author
-
Huay-Cheem Tan and Rajiv Ananthakrishna
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,030204 cardiovascular system & hematology ,medicine.disease ,Absorbable Implants ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Tissue scaffolds ,Good clinical practice ,medicine ,Clinical safety ,Routine clinical practice ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Bioresorbable vascular scaffold - Abstract
The practice of cardiovascular medicine is rapidly evolving, with an increasing number of new pharmaceutical agents and medical devices being evaluated for clinical safety and efficacy. Recommendations for good clinical practice are on the basis of the results derived from quality studies. Data from
- Published
- 2016
37. Refractory vasospastic angina
- Author
-
Manjunath Cholenahally Nanjappa and Rajiv Ananthakrishna
- Subjects
medicine.medical_specialty ,Framingham Risk Score ,business.industry ,medicine.disease ,Sudden death ,Angina ,Coronary artery disease ,medicine.anatomical_structure ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,ST segment ,cardiovascular diseases ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,Nicorandil ,business ,medicine.drug ,Artery - Abstract
Vasospastic angina, a form of angina pectoris due to coronary artery spasm responds to nitrates and calcium antagonists in majority of the cases. Rarely, they are unresponsive to conventional treatment, and recurrent ischemia can lead to ventricular arrhythmias, myocardial infarction and sudden death. We report a patient with multi-vessel coronary artery spasm and recurrent ST segment elevation in anterior leads, which was successfully managed with intravenous administration of nicorandil. Key words: Coronary spasm, Coronary artery disease, Vasospastic angina, Nicorandil, Imaging.
- Published
- 2015
38. Percutaneous Balloon Dilation of Discrete Subaortic Stenosis: A Futile Exercise
- Author
-
Nagaraja, Moorthy, Rajiv, Ananthakrishna, Dattatreya P V, Rao, Satvic C, Manjunath, and Manjunath C, Nanjappa
- Subjects
Adult ,Male ,Cardiac Catheterization ,Angiography ,Discrete Subaortic Stenosis ,Humans ,Dilatation - Abstract
Discrete subaortic stenosis (DSS) is a progressive obstruction of left ventricular outflow tract (LVOT) resulting in the development of aortic regurgitation in its natural course. Hence, early intervention is recommended. Percutaneous balloon dilation of DSS has been reported and can substantially reduce LVOT pressure gradient. The response to balloon dilation of DSS is transient and may complicate with chordal or papillary muscle rupture. Hence, balloon dilation of DSS should be discouraged.
- Published
- 2017
39. Double jeopardy in acute ST-segment elevation myocardial infarction
- Author
-
Huay-Cheem Tan, Liang Ping Zhao, Rajiv Ananthakrishna, and Li-Jun Wang
- Subjects
Coronary angiography ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Acute ST segment elevation myocardial infarction ,Treatment outcome ,MEDLINE ,Percutaneous coronary intervention ,Electrocardiography in myocardial infarction ,General Medicine ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Cardiology ,cardiovascular diseases ,030212 general & internal medicine ,business ,Double jeopardy ,Electrocardiography ,Letter to the Editor - Published
- 2017
40. Right Aortic Arch With Left-Sided Arteria Lusoria: A Challenge for Radial Interventionalists
- Author
-
Nagaraja, Moorthy, Rajiv, Ananthakrishna, Dattatreya P V, Rao, Madhav, Hegde, and Manjunath C, Nanjappa
- Subjects
Male ,Cardiac Catheterization ,Incidental Findings ,Computed Tomography Angiography ,Cardiovascular Abnormalities ,Subclavian Artery ,Aorta, Thoracic ,Drug-Eluting Stents ,Coronary Artery Disease ,Coronary Angiography ,Aortography ,Percutaneous Coronary Intervention ,Esophageal Stenosis ,Humans ,Aged - Published
- 2017
41. Percutaneous stenting of interrupted aortic arch to treat compressive myelopathy
- Author
-
Manjunath C. Nanjappa, Nagaraja Moorthy, and Rajiv Ananthakrishna
- Subjects
Intracerebral hemorrhage ,medicine.medical_specialty ,Aorta ,Percutaneous ,Adult male ,business.industry ,Interrupted aortic arch ,Neurology department ,food and beverages ,General Medicine ,medicine.disease ,Surgery ,Compressive myelopathy ,medicine.artery ,medicine ,heterocyclic compounds ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,Abscess ,business - Abstract
Neurological complications of coarctation of aorta include spontaneous SAH, intracerebral hemorrhage, and cerebral abscess. Interrupted aortic arch (IAA) present as compressive myelopathy is not known. We describe an adult male presenting to neurology department with progressive paraparesis and was detected to have IAA with intraspinal collaterals causing compressive myelopathy. He was successfully treated with percutaneous stenting of IAA with dramatic improvement in paraparesis. © 2014 Wiley Periodicals, Inc.
- Published
- 2014
42. Coronary artery disease in patients undergoing cardiac surgery for non-coronary lesions in a tertiary care centre
- Author
-
Rajiv Ananthakrishna, R. Ravindran, Neena Agarwal, Ashish Agarwal, Prabhavathi Bhat, Cholenahally Nanjappa Manjunath, and K.S. Ravindranath
- Subjects
Adult ,Male ,medicine.medical_specialty ,Heart disease ,RD1-811 ,Heart Valve Diseases ,India ,Comorbidity ,Coronary Angiography ,Preoperative care ,Risk Assessment ,Coronary artery disease ,Cohort Studies ,Tertiary Care Centers ,Bicuspid aortic valve ,Age Distribution ,Internal medicine ,Preoperative Care ,medicine ,Prevalence ,Mitral valve prolapse ,Humans ,Diseases of the circulatory (Cardiovascular) system ,cardiovascular diseases ,Cardiac Surgical Procedures ,Sex Distribution ,Retrospective Studies ,Incidental Findings ,Chi-Square Distribution ,business.industry ,valvular heart disease ,Rheumatic Heart Disease ,Middle Aged ,medicine.disease ,Echocardiography, Doppler ,Cardiac surgery ,Preoperative coronary angiogram ,Treatment Outcome ,RC666-701 ,Cardiology ,cardiovascular system ,Female ,Original Article ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background: The objective of the present study was to determine the prevalence of coronary artery disease (CAD) in patients undergoing surgery for various valvular as well as non-valvular cardiac pathologies. Methods: Patients with various valvular and non-valvular pathologies were selected. All patients with age ≥40 years and an indication for open heart surgery underwent pre-operative coronary angiogram and were included in the study. Results: The mean age was 51.5 ± 9.02 years. 178 (59.3%) patients were males and 122 (40.7%) patients were females. Out of 300 patients, 270 (90%) patients had valvular heart disease (VHD) and 30 (10%) patients had non-valvular heart disease. Rheumatic heart disease (RHD), mitral valve prolapse (MVP), degenerative aortic valve disease (DAVD) and bicuspid aortic valve (BAV) was present in 161 (53.7%), 17 (5.7%), 60 (20%) and 32 (10.7%) patients respectively. Overall, 26 (8.7%) patients were found to have significant CAD. CAD was significantly more common in patients with VHD as compared to patients with other etiologies (1 patient, 3.3%, p 60 years, male sex, typical angina, HT, dyslipidemia and smoking were significantly greater as compared to those with normal coronaries. Conclusion: The overall prevalence of CAD among patients undergoing non-coronary cardiac surgery is 8.7%. Coronary artery disease is relatively uncommon in patients with rheumatic VHD (4.9%), while its prevalence is highest in DAVD (23.4%).
- Published
- 2014
43. A review of bioresorbable scaffolds: hype or hope?
- Author
-
Huay-Cheem Tan and Rajiv Ananthakrishna
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Biocompatible Materials ,Coronary Artery Disease ,Review Article ,030204 cardiovascular system & hematology ,Prosthesis Design ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Absorbable Implants ,Medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Inflammation ,Tissue Scaffolds ,business.industry ,Percutaneous coronary intervention ,Drug-Eluting Stents ,Thrombosis ,General Medicine ,Treatment Outcome ,Metals ,Stents ,business ,Bioresorbable scaffold ,Platelet Aggregation Inhibitors - Abstract
In the field of percutaneous coronary intervention, the evolution of coronary metal stents has been well established for the past three decades, but research on bioresorbable scaffolds has only gained momentum in the recent past. Although second-generation drug-eluting metal stents are the gold standard for the treatment of obstructive coronary artery disease, a few drawbacks exist. The development of bioresorbable scaffolds is an attempt to overcome the limitations of metal stents. This review highlights the rationale for the bioresorbable scaffold, its properties and potential applications. It also focuses on the current evidence and concerns regarding the application of the bioresorbable scaffold in day-to-day practice.
- Published
- 2016
44. Myocardial Oxygenation in Hibernating Myocardium: Insights from Oxygen-Sensitive (OS) Cardiac Magnetic Resonance Imaging (CMR)
- Author
-
Rajiv Ananthakrishna, Ajay Sinhal, Joseph B. Selvanayagam, Richard J. Woodman, Craig Bradbrook, K. Sree Raman, and Suchi Grover
- Subjects
Pulmonary and Respiratory Medicine ,Hibernating myocardium ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Myocardial oxygenation ,chemistry.chemical_element ,Oxygen ,chemistry ,Cardiac magnetic resonance imaging ,Internal medicine ,Cardiology ,Medicine ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
45. Balloon valvotomy for rheumatic valvar stenosis in a patient with complex congenital heart disease
- Author
-
Nagaraja Moorthy, Dattatreya P.V. Rao, Manjunath C. Nanjappa, and Rajiv Ananthakrishna
- Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,business.industry ,lcsh:R ,lcsh:RJ1-570 ,lcsh:Medicine ,lcsh:Pediatrics ,medicine.disease ,Stenosis ,Balloon valvotomy ,lcsh:RC666-701 ,Internal medicine ,Pediatrics, Perinatology and Child Health ,Cardiology ,Medicine ,Complex congenital heart disease ,Cardiology and Cardiovascular Medicine ,business ,Letters to Editor - Published
- 2016
46. Acute Dyspnea
- Author
-
K. H. Srinivasa, Rajiv Ananthakrishna, and Kapil Rangan
- Subjects
business.industry ,Anesthesia ,Medicine ,business ,Acute dyspnea - Published
- 2016
47. Cardiogenic Infarction in Acute Myocardial Infarction
- Author
-
Budanur Chikkaswamy Srinivas and Rajiv Ananthakrishna
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,Cardiology ,Medicine ,Electrocardiography in myocardial infarction ,Infarction ,Myocardial infarction ,business ,medicine.disease - Published
- 2016
48. Endothelial Function and Carotid Intimal Medial Thickness in Asymptomatic Subjects With and Without Cardiovascular Risk Factors
- Author
-
Ravindranath K. Shankarappa, Manjunath C. Nanjappa, Dhanalakshmi Chandrasekaran, Rajiv Ananthakrishna, and Kapil Rangan
- Subjects
medicine.medical_specialty ,business.industry ,medicine.disease ,Asymptomatic ,Carotid intimal medial thickness ,Blood pressure ,Risk factors ,Internal medicine ,medicine.artery ,Diabetes mellitus ,Cardiology ,cardiovascular system ,Medicine ,Outpatient clinic ,Original Article ,cardiovascular diseases ,Endothelial dysfunction ,Brachial artery ,Metabolic syndrome ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Background: The study was performed to assess endothelial function and carotid intimal-medial thickness (IMT) in asymptomatic patients, with and without risk factors for cardiovascular disease. Methods: A cross sectional survey of asymptomatic patients, aged 21 - 60 years, with and without risk factors for cardiovascular disease was recruited from the outpatient department of Cardiology. Endothelial function was evaluated by flow mediated dilatation (FMD) of the brachial artery and carotid IMT was determined using a high resolution B mode ultrasonography system. Results: A total of 104 patients were included in the study. The mean carotid IMT was 0.67 ± 0.05 mm in the group without risk factors and 0.78 ± 0.12 mm in the group with risk factors (P value < 0.05). Endothelial dysfunction (ED) and increased carotid IMT were more significant in the group with risk factors (P value < 0.001). Age, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, blood pressure, body mass index and HbA1c had a significant correlation with both IMT and FMD response. A higher proportion of subjects with diabetes mellitus (87%), metabolic syndrome (86%) and family history of premature coronary artery disease (78%) had ED. In subjects with normal coronary angiogram, 71% had abnormal FMD response and 36% had increased carotid IMT. Conclusion: In asymptomatic subjects, risk factors for cardiovascular disease are significantly associated with objective evidence of ED and increased carotid IMT. FMD response and carotid IMT values are likely to yield additional information beyond traditional risk factors for classifying patients in regard to the likelihood of cardiovascular event. Therapeutic measures with the aim of improving endothelial function and reducing carotid IMT may reduce the burden of cardiovascular disease. Cardiol Res. 2012;3(4):180-186 doi: https://doi.org/10.4021/cr194w
- Published
- 2012
49. Acute severe mitral regurgitation following balloon mitral valvotomy: Echocardiographic features, operative findings, and outcome in 50 surgical cases
- Author
-
Arunkumar Panneerselvam, Ravindranath K. Shankarappa, Rajiv Ananthakrishna, Srinivasa K Hemanna Setty, Manjunath C. Nanjappa, Venugopal Ram Rao, Giridhar Kamalapurkar, Seetharama P.S. Bhat, and Prabhavathi Bhat
- Subjects
medicine.medical_specialty ,Mitral regurgitation ,Orthopnea ,business.industry ,medicine.medical_treatment ,Mitral valve replacement ,General Medicine ,Surgery ,medicine.anatomical_structure ,Internal medicine ,Predictive value of tests ,Mitral valve ,Severity of illness ,cardiovascular system ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Prospective cohort study ,business ,Mitral valve calcification - Abstract
Objective To analyze the echocardiographic and operative findings with respect to mitral valve anatomy in individuals undergoing emergency surgery for acute severe mitral regurgitation (MR) following balloon mitral valvotomy (BMV). In addition, the clinical profile and outcomes are highlighted. Background Acute severe MR is a major complication of BMV. There are only a few reports which have studied the echocardiographic and operative findings in this setting. In addition, optimal timing of surgery is uncertain. Methods Prospective study of 50 consecutive patients undergoing emergency mitral valve replacement (MVR) for acute severe MR following BMV. Results In 3855 patients who underwent BMV, acute severe MR developed in 50 cases (1.3%) and was referred for emergency MVR. Hypotension (72%), hypoxia (64%), orthopnea (14%), and pulmonary edema (12%) were the clinical manifestations. Severe MR was secondary to anterior mitral leaflet tear in 36 cases (72%), paracommisural tear with annular involvement in seven cases (14%), posterior mitral leaflet tear in five cases (10%) and chordal tear in two cases (4%). The correlation between two-dimensional transthoracic echocardiography (2D-TTE) and operative finding for mitral valve calcification was found to be strong (r = 0.862), in contrast to submitral fusion, where it was found to be moderate (r = 0.536). In-hospital mortality was 12%. Mortality was higher in patients whose time to surgery was ≥24 hr when compared to those who underwent MVR within 24 hr (P < 0.001). Conclusions Hypotension and hypoxia are the predominant manifestations of acute severe MR following BMV. Anterior mitral leaflet tear is the most common etiology for severe MR. 2D-TTE underestimated the severity of submitral disease. Early MVR (
- Published
- 2012
50. TCTAP C-203 Post Bentall's Periconduit Aneurysm, Severe Paraconduit Leak, Aorta to Periconduit Fistula Periconduit to RA Fistula- a Challenging Successful Multiple Device Closures: Clinical-imaging-autopsy Correlation
- Author
-
C.N. Manjunath, Nagaraja Moorthy, P.V. Dattatreya, Rajiv Ananthakrishna, and S.R. Kalpana
- Subjects
Leak ,medicine.medical_specialty ,Aorta ,business.industry ,Fistula ,Autopsy ,medicine.disease ,Surgery ,Aneurysm ,medicine.artery ,Medicine ,Clinical imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Multiple device - Published
- 2017
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