Browsing by Author "Aditya Kapoor"

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A study of clinical presentation and delays in management of acute myocardial infarction in community
(Elsevier B.V., 2012) Pravin K. Goel; Saurabh Kumar Srivastava; Fauzia Ashfaq; P.R. Gupta; P.C. Saxena; Rajeev Agarwal; Sudeep Kumar; Naveen Garg; Satyendra Tewari; Aditya Kapoor
To assess the medico social demographics of acute myocardial infarction (AMI) in our community we studied 609 patients presenting between January 2008 to December 2008 with a detailed questionnaire in four centres of UP. Medical attention was sought late (> 6 hours) in 316 (51. 6%), thrombolysis was obtained in 45. 2% (275) and presentation was atypical in 16. 3% (99). 36. 2% (221) had pre-monitory symptoms of which 68% (150) ignored the same while of 32% (71) who did seek medical attention 47. 9% (37) were brushed away as non-cardiac in origin. 20. 3% (46/226) of hy- pertension, 23. 2% (43/185) of diabetes and 83. 4% (91/109) of hyperlipidaemia was diagnosed post event. We conclude that at least half of patients with AMI do not get definitive therapy, at least one in 10 patients do not have the classical symptoms, reasonable proportion are unaware of their risk factors, and a good majority have pre-monitory symptoms which get overlooked. © 2012, Cardiological Society of India. All rights reserved.
Consensus Statement from India on the Renal Benefits of ARNi, SGLT-2i, and Bisoprolol in Chronic Kidney Disease
(Journal of Association of Physicians of India, 2024) H.K. Chopra; Dinesh Khullar; Tiny Nair; G.S. Wander; C.K. Ponde; Saumitra Ray; Navin C. Nanda; Ravi R. Kasliwal; D.S. Rana; Ashok Kirpalani; J.P.S. Sawhney; Praveen Chandra; Yatin Mehta; Viveka Kumar; S. Tewari; A.K. Pancholia; Vijay Kher; Sandeep Bansal; Sanjay Mittal; Praful Kerkar; P.K. Sahoo; Ramesh Hotchandani; Sunil Prakash; Nagendra Chauhan; Vishal Rastogi; A. Jabir; S. Shanmugasundaram; Mangesh Tiwaskar; Ajay Sinha; Vittul Gupta; S.S. Mishra; S.N. Routray; A.K. Omar; Onkar C. Swami; Aparna Jaswal; Shamsad Alam; Rajeev Passey; Rajeeve Rajput; Justin Paul; Aditya Kapoor; D. Prabhakar; Subhash Chandra; Poonam Malhotra; Vivudh Pratap Singh; Manish Bansal; Priyank Shah; Sanjay Jain; Mohan Bhargava; I.B. Vijayalakshmi; Kiron Varghaese; Dharmender Jain; Anupam Goel; Namrata Gaur; Rohit Tandon; Asha Moorthy; Sheeba George; V.K. Katyal; R.R. Mantri; Rahul Mehrotra; Dilip Bhalla; Vinod Mittal; Sarita Rao; Manish Jagia; Harmeet Singh; Surabhi Awasthi; Ameet Sattur; Rekha Mishra; Anand Pandey; Rajeev Chawla; Shalini Jaggi; Blessy Sehgal; Alok Sehgal; Naresh Goel; Ripen Gupta; Samir Kubba; Abhinav Chhabra; Saurabh Bagga; N.R. Shastry
Chronic kidney disease (CKD) is a major contributor to morbidity and mortality in India. CKD often coexists with heart failure (HF), diabetes, and hypertension. All these comorbidities are risk factors for renal impairment. HF and CKD are pathophysiologically intertwined, and the deterioration of one can worsen the prognosis of the other. There is a need for safe renal pharmacological therapies that target both CKD and HF and are also useful in hypertension and diabetes. Neurohormonal activation achieved through the activation of the sympathetic nervous system (SNS), the renin–angiotensin–aldosterone system (RAAS), and the natriuretic peptide system (NPS) is fundamental in the pathogenesis and progression of CKD and HF. Angiotensin receptor neprilysin inhibitor (ARNi), sodium-glucose cotransporter 2 inhibitors (SGLT-2i), and selective β1-blocker (B1B) bisoprolol suppress this neurohormonal activation. They also have many other cardiorenal benefits across a wide range of CKD patients with or without concomitant HF, diabetes, or hypertension. This consensus statement from India explores the place of ARNi, SGLT-2i, and bisoprolol in the management of CKD patients with or without HF and other comorbidities. ©The Author(s). 2024.
Corrigendum to “Cardiological Society of India position statement on management of heart failure in India” (Indian Heart Journal (2018) 70(S1) (S1–S72), (S0019483218303006) (10.1016/j.ihj.2018.05.003))
(Elsevier B.V., 2018) Santanu Guha; S. Harikrishnan; Saumitra Ray; Rishi Sethi; S. Ramakrishnan; Suvro Banerjee; V.K. Bahl; K.C. Goswami; Amal Kumar Banerjee; S. Shanmugasundaram; P.G. Kerkar; Sandeep Seth; Rakesh Yadav; Aditya Kapoor; Ajaykumar U. Mahajan; P.P. Mohanan; Sundeep Mishra; P.K. Deb; C. Narasimhan; A.K. Pancholia; Ajay Sinha; Akshyaya Pradhan; R. Alagesan; Ambuj Roy; Amit Vora; Anita Saxena; Arup Dasbiswas; B.C. Srinivas; B.P. Chattopadhyay; B.P. Singh; J. Balachandar; K.R. Balakrishnan; Brian Pinto; C.N. Manjunath; Charan P. Lanjewar; Dharmendra Jain; Dipak Sarma; G. Justin Paul; Geevar A. Zachariah; H.K. Chopra; I.B. Vijayalakshmi; J.A. Tharakan; J.J. Dalal; J.P.S. Sawhney; Jayanta Saha; Johann Christopher; K.K. Talwar; K. Sarat Chandra; K. Venugopal; Kajal Ganguly; M.S. Hiremath; Milind Hot; Mrinal Kanti Das; Neil Bardolui; Niteen V. Deshpande; O.P. Yadava; Prashant Bhardwaj; Pravesh Vishwakarma; Rajeeve Kumar Rajput; Rakesh Gupta; S. Somasundaram; S.N. Routray; S.S. Iyengar; G. Sanjay; Satyendra Tewari; G. Sengottuvelu; Soumitra Kumar; Soura Mookerjee; Tiny Nair; Trinath Mishra; U.C. Samal; U. Kaul; V.K. Chopra; V.S. Narain; Vimal Raj; Yash Lokhandwala
In the article titled ‘Cardiological Society of India Position Statement on Management of Heart Failure in India’ below is the list of corrections to be included. The authors would like to apologise for any inconvenience caused. Fig. 14 ECG of a patient with RVEMF and atrial fibrillation, qR in V1 and R/S ratio in lead V2 more than V1. Fig. 15 ECG of a patient with LVEMF showing LVH with strain pattern. Fig. 16. Fluoroscopy showing the presence of LV apical calcium. Fig. 17. LV angiogram in a patient with LVEMF showing the obliteration of the LV apex, transverse diameter more than the longitudinal diameter and no MR (primary diastolic HF). Fig. 18. RV angiogram in a patient with RVEMF showing obliteration of the RV apex and body, RVOF dilatation and significant TR. Fig. 19. Echocardiogram, apical 4-chamber view, showing the presence of calcium at the LV apex. Fig. 20. Perfusion MRI, 4-chamber view in diastole showing fibrosis and obliteration of RV apex (white arrow) [RV – right ventricle, RA – Right atrium, LA – left atrium]. In the text – Page S 48 Column 2 Section 3.10.3 Figs. 13 and 14 – Corrected as Figs. 14 and 15. Figs. 16–18 – Corrected as Figs. 16–19. Fig 19 – Corrected as Fig 20 References: The references are changed as given below (Page S 66). 240. K Balakrishnan, Ratnagiri R, S. Rao, M. Tungaturu Limiting the Number of Endomyocardial Biopsies does not impact one year survival after Heart Transplant. J heart Lung Transplant. Supplement. April 2016 Volume 35; Issue 4, Supplement: S210. 241. Stehlik J, Starling RC, Movsesian MA, et al. Utility of long-term surveillance endomyocardial biopsy: a multi-institutional analysis. J Heart Lung Transplant. 2006; 25:1402–1409. To be added at the end of references (Can be given as reference in the heading 2.8). Status of Cardiac Transplantation in India.(583) 583. Dr KR Balakrishnan, R Ravi Kumar; - “Status of Cardiac Transplantation in India” Pages 599–606 in Chapter 44 of CSI TEXT BOOK OF CARDIOLOGY. (Ed) PK Deb 2018 Jaypee Brothers, New Delhi. © 2018 Cardiological Society of India
CSI position statement on management of heart failure in India
(Elsevier B.V., 2018) Santanu Guha; S. Harikrishnan; Saumitra Ray; Rishi Sethi; S. Ramakrishnan; Suvro Banerjee; V.K. Bahl; K.C. Goswami; Amal Kumar Banerjee; S. Shanmugasundaram; P.G. Kerkar; Sandeep Seth; Rakesh Yadav; Aditya Kapoor; Ajaykumar U. Mahajan; P.P. Mohanan; Sundeep Mishra; P.K. Deb; C. Narasimhan; A.K. Pancholia; Ajay Sinha; Akshyaya Pradhan; R. Alagesan; Ambuj Roy; Amit Vora; Anita Saxena; Arup Dasbiswas; B.C. Srinivas; B.P. Chattopadhyay; B.P. Singh; J. Balachandar; K.R. Balakrishnan; Brian Pinto; C.N. Manjunath; Charan P. Lanjewar; Dharmendra Jain; Dipak Sarma; G. Justin Paul; Geevar A. Zachariah; H.K. Chopra; I.B. Vijayalakshmi; J.A. Tharakan; J.J. Dalal; J.P.S. Sawhney; Jayanta Saha; Johann Christopher; K.K. Talwar; K. Sarat Chandra; K. Venugopal; Kajal Ganguly; M.S. Hiremath; Milind Hot; Mrinal Kanti Das; Neil Bardolui; Niteen V. Deshpande; O.P. Yadava; Prashant Bhardwaj; Pravesh Vishwakarma; Rajeeve Kumar Rajput; Rakesh Gupta; S. Somasundaram; S.N. Routray; S.S. Iyengar; G. Sanjay; Satyendra Tewari; G. Sengottuvelu; Soumitra Kumar; Soura Mookerjee; Tiny Nair; Trinath Mishra; U.C. Samal; U. Kaul; V.K. Chopra; V.S. Narain; Vimal Raj; Yash Lokhandwala
[No abstract available]
Current Place of SGLT2i in the Management of Heart Failure: An Expert Opinion from India
(Journal of Association of Physicians of India, 2024) H.K. Chopra; Tiny Nair; G.S. Wander; C.K. Ponde; Saumitra Ray; Dinesh Khullar; Navin C. Nanda; Jagat Narula; Ravi R. Kasliwal; D.S. Rana; Ashok Kirpalani; J.P.S. Sawhney; Praveen Chandra; Yatin Mehta; Viveka Kumar; S. Tewari; A.K. Pancholia; Vijay Kher; Sandeep Bansal; Sanjay Mittal; Praful Kerkar; P.K. Sahoo; Ramesh Hotchandani; Sunil Prakash; Nagendra Chauhan; Vishal Rastogi; A. Jabir; S. Shanmugasundaram; Mangesh Tiwaskar; Ajay Sinha; Vittul Gupta; S.S. Mishra; S.N. Routray; A.K. Omar; Onkar C. Swami; Aparna Jaswal; Shamsad Alam; Rajeev Passey; Rajeeve Rajput; Justin Paul; Aditya Kapoor; D. Prabhakar; Subhash Chandra; Poonam Malhotra; Vivudh Pratap Singh; Manish Bansal; Priyank Shah; Sanjay Jain; Mohan Bhargava; I.B. Vijayalakshmi; Kiron Varghaese; Dharmender Jain; Anupam Goel; Kiran Mehmood; Namrata Gaur; Rohit Tandon; Asha Moorthy; Sheeba George; V.K. Katyal; R.R. Mantri; Rahul Mehrotra; Dilip Bhalla; Vinod Mittal; Sarita Rao; Manish Jagia; Harmeet Singh; Surabhi Awasthi; Ameet Sattur; Rekha Mishra; Anand Pandey; Rajeev Chawla; Shalini Jaggi; Blessy Sehgal; Alok Sehgal; Naresh Goel; Ripen Gupta; Samir Kubba; Abhinav Chhabra; Saurabh Bagga; N.R. Shastry
Heart failure (HF) is a global health concern that is prevalent in India as well. HF is reported at a younger age in Indian patients with comorbidity of type 2 diabetes (T2DM) in approximately 50% of patients. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), originally approved for T2DM, are new guideline-recommended and approved treatment strategies for HF. Extensive evidence highlights that SGLT2i exhibits profound cardiovascular (CV) benefits beyond glycemic control. SGLT2i, in conjunction with other guideline-directed medical therapies (GMDT), has additive effects in improving heart function and reducing adverse HF outcomes. The benefits of SGLT2i are across a spectrum of patients, with and without diabetes, suggesting their potential place in broader HF populations irrespective of ejection fraction (EF). This consensus builds on the updated evidence of the efficacy and safety of SGLT2i in HF and recommends its place in therapy with a focus on Indian patients with HF. ©The Author(s). 2024.
Factors associated with unexplained sudden deaths among adults aged 18-45 years in India – A multicentric matched case–control study
(Wolters Kluwer Medknow Publications, 2023) Manickam Ponnaiah; Tarun Bhatnagar; Rizwan Suliankachi Abdulkader; Rajalakshmi Elumalai; Janani Surya; Kathiresan Jeyashree; Muthusamy Santhosh Kumar; Ranjithkumar Govindaraju; Jeromie Wesley Vivian Thangaraj; Hari Krishan Aggarwal; Suresh Balan; Tridip Dutta Baruah; Ayan Basu; Yogita Bavaskar; Ajeet Singh Bhadoria; Ashish Bhalla; Pankaj Bhardwaj; Rachana Bhat; Jaya Chakravarty; Gina Maryann Chandy; Bal Kishan Gupta; Rakesh Kakkar; Ali Hasan Faiz Karnam; Sushila Kataria; Janakkumar Khambholja; Dewesh Kumar; Nithin Kumar; Monaliza Lyngdoh; M. Selva Meena; Kedar Mehta; M.P. Sheethal; Subhasis Mukherjee; Anuj Mundra; Arun Murugan; Seetharaman Narayanan; Balamurugan Nathan; Jutika Ojah; Pushpa Patil; Sunita Pawar; A. Charles Pon Ruban; R. Vadivelu; Rishabh Kumar Rana; S. Nagendra Boopathy; S. Priya; Saroj Kumar Sahoo; Arti Shah; Mohammad Shameem; Karthikeyan Shanmugam; Sachin K. Shivnitwar; Abhishek Singhai; Saurabh Srivastava; Sudheera Sulgante; Arunansu Talukdar; Alka Verma; Rajaat Vohra; Rabbanie Tariq Wani; Bhargavi Bathula; Gayathri Kumari; Divya Saravana Kumar; Aishwariya Narasimhan; N.C. Krupa; Thirumaran Senguttuvan; Parvathi Surendran; Dharsikaa Tamilmani; Alka Turuk; Gunjan Kumar; Aparna Murkherjee; Rakesh Aggarwal; Manoj Vasant Murhekar; Anjan Jyoti Talukdhar; Raj Prathim Das; Pranab Jyoti Bhattacharyya; Pankaj Jyoti Barman; Partha Pratim Das; P.V.M. Lakshmi; Naveen Panday; Ashok Kumar Pannu; Debaprasad Dhibar; Pankaj Kumar Kanauje; Satyajit Singh; Sabah Siddiqui; Nitin Bhajandas Borkar; Mayur Adalja; Sandip Shah Varsha Godbole; Rikin Raj; Nehal Shah; Nilay Suthar; Hemang Purohit; Bhargav Patel; Rutika Pathkjee; Niraj Pandit; Siddharth Shah; Bhavesh Patel; Anuja Agrawal; Deepak Jain; Manish Bansal; Vikas Deswal; Pooja Sharma; Farhana Siraj; Aamir Rashid; Anjum Bashir Fazili; Pradip Kumar Bhattacharya; Hirendra Birua; Manoj Kumar Prasad; Shashi Bhushan Singh; Umendra Kumar Ojha; Ravi Ranjan Jha; L.M. Manuja; S.K. Raghavendra; Vijay Hugar; R. Radha; Pallavi Kesari; Sunil Tapse; Ambrish Avate; Prasanna Kumar; Bhaskaran Unnikrishnan; T. Rekha; A. Basavaprabhu; Mithun Rao; Prithvishree Ravindra; Chythra R. Rao; Jayaraj Mymbilly Balakrishnan; Vikram Palimar; S. Ashwini; Bhavana Hiremath; Rajnikanth Malapur; Ankur Joshi; Manoj Nagar; Atul S. Keche; Arjun Lal Kakrani; Shubhangi Kanitkar; Srikanth Tripathy; Savita Mahajan; Akshada Shinde; Sunil Patil; Vijay Gaikwad; Ganesh Lokhande; Astha Ganeriwal; Ramesh Wasnik; Ashwini Kalantri; Dhiraj Bhandari; Preetam Salunkhe; Abhishek Raut; Star Pala; K.G. Lynrah; Nari Lyngdoh; Rajani Thabah; Manish Kapoor; Sadananda Barik; Chitta Ranjan Mohanty; Sonu Hangma Subba; Satyabrata Guru; Manu Ayyan; Sitanshu Sekhar Kar; Nanda Kishore Maroju; Naveen Kumar; Roselin Mohandas; Charulatha Tamilselvan; Saranya Rajaram; Ankita Kankaria; Moonis Mirza; Preeti Singh Dhoat; Jaspreet Shergill; Manoj Kumar Gupta; Akhil Dhanesh Goel; Amit Kumar Rohila; Durga Shankar Meena; Archana Paliwal; Niti Gahlot; Nikita Sharma; Harkesh Kumar; Dinesh Choudhary; Shyam Lal Meena; Dinesh Bhambhu; Jigyasa Gupta; G. Priya; Sonia Samuel; S. Bagyalakshmi; Sathish Kumar T; Aazmi Mohamed; G. Rathna Kumar; A. Rajesh; V. Rajendran; M. Soorya; P.N. Sridevi; A. Karthika; K. Santha Sheela Kumari; K. Sathish Kumar; Pavithra Gnanavel; Dasarathan Ramesh; Aravind Gunasekaran; R. Kaverikannan; Madhumitha Manohar; P. Sofia; R. Abishek; Jeevithan Shanmugam; Mohan Kumar; Aparnavi Periyasamy; Dhilipan Kumar; G. Selvarani; Thirukumaran Ramasamy; N. Suresh; Kannan Muthuraman Alagappan; Mathavasami Vijayageetha; Sudha Ramalingam; Petchiappan Velammal; Yamini Subramani; Lakshmi Marappa; Viswanathan Pandurangan; T.R. Muralidharan; M. Rajkumar; Senthil Murugan Ramasamy; Bodhare Trupti; Bharath Rajh; Duvuru Amareswar Reddy; Rashmi Upadhyay; Anurag Srivastava; Rakesh Gupta; Ranjan Bhattnagar; Manaswi Chaubey; Soumik Ghosh; Nilesh Kumar; Mohammad Azharuddin; Nafees A. Khan; Mohammad Aslam; Asad Mahmood; R.K. Singh; Priyank Yadav; Aditya Kapoor; Om Prakash Sanjeev; Shyam Sundar; Prasan Kumar Panda; Mukesh Bairwa; Mahendera Singh Gehlot; Pooja Bhadoria; Arup Chakravorty; Sarmistha Chakravorty; Arindam Ray; Aparup Dhua; Amitava Pal; Priyanka Ghosh; Yogiraj Roy; Sinjita Dutta; Subhro Samujjal Basu
Background & objectives: In view of anecdotal reports of sudden unexplained deaths in India’s apparently healthy young adults, linking to coronavirus disease 2019 (COVID-19) infection or vaccination, we determined the factors associated with such deaths in individuals aged 18-45 years through a multicentric matched case–control study. Methods: This study was conducted through participation of 47 tertiary care hospitals across India. Cases were apparently healthy individuals aged 18-45 years without any known co-morbidity, who suddenly (<24 h of hospitalization or seen apparently healthy 24 h before death) died of unexplained causes during 1st October 2021-31st March 2023. Four controls were included per case matched for age, gender and neighborhood. We interviewed/perused records to collect data on COVID-19 vaccination/infection and post-COVID-19 conditions, family history of sudden death, smoking, recreational drug use, alcohol frequency and binge drinking and vigorous-intensity physical activity two days before death/interviews. We developed regression models considering COVID-19 vaccination ≤42 days before outcome, any vaccine received anytime and vaccine doses to compute an adjusted matched odds ratio (aOR) with 95 per cent confidence interval (CI). Results: Seven hundred twenty nine cases and 2916 controls were included in the analysis. Receipt of at least one dose of COVID-19 vaccine lowered the odds [aOR (95% CI)] for unexplained sudden death [0.58 (0.37, 0.92)], whereas past COVID-19 hospitalization [3.8 (1.36, 10.61)], family history of sudden death [2.53 (1.52, 4.21)], binge drinking 48 h before death/interview [5.29 (2.57, 10.89)], use of recreational drug/substance [2.92 (1.1, 7.71)] and performing vigorous-intensity physical activity 48 h before death/interview [3.7 (1.36, 10.05)] were positively associated. Two doses lowered the odds of unexplained sudden death [0.51 (0.28, 0.91)], whereas single dose did not. Interpretation & conclusions: COVID-19 vaccination did not increase the risk of unexplained sudden death among young adults in India. Past COVID-19 hospitalization, family history of sudden death and certain lifestyle behaviors increased the likelihood of unexplained sudden death. © 2023 Indian Journal of Medical Research, published by Wolters Kluwer - Medknow for Director-General, Indian Council of Medical Research.
Indian Consensus on the Role and Position of Angiotensin Receptor-neprilysin Inhibitors in the Management of Heart Failure
(Journal of Association of Physicians of India, 2024) Hriday Kumar Chopra; Chandrashekhar Ponde; Gurpreet Singh Wander; Tiny Nair; Saumitra Ray; Dinesh Khullar; Navin C. Nanda; Jagat Narula; Ravi R. Kasliwal; Devinder Singh Rana; Ashok Kirpalani; Jitendrapal Singh Sawhney; Praveen Chandra; Yatin Mehta; Viveka Kumar; Satyendra Tiwari; Arvind K. Pancholia; Vijay Kher; Sandeep Bansal; Sanjay Mittal; Praful Kerkar; Prasant Kumar Sahoo; Ramesh Hotchandani; Sunil Prakash; Nagendra Chauhan; Vishal Rastogi; Jabir Abdullakutty; S. Shanmugasundaram; Mangesh Tiwaskar; Ajay Sinha; Vittul Gupta; Shishu Shankar Mishra; Satya Narayan Routray; Ashok Kumar Omar; Onkar C. Swami; Aparna Jaswal; Shamsad Alam; Rajeev Passey; Rajeeve Rajput; Justin Paul; Aditya Kapoor; Prabhakar Dorairaj; Subhash Chandra; Poonam Malhotra; Vivudh Pratap Singh; Manish Bansal; Sanjay Jain; Priyank Shah; Mohan Bhargava; Ishwarappa Balekundri Vijayalakshmi; Kiron Varghaese; Dharmender Jain; Anupam Goel; Kiran Mahmood; Namrata Gaur; Rohit Tandon; Asha Moorthy; Sheeba George; V.K. Katyal; R.R. Mantri; Rahul Mehrotra; Dilip Bhalla; Vinod Mittal; Sarita Rao; Manish Jagia; Harmeet Singh; Surabhi Awasthi; Ameet Sattur; Rekha Mishra; Anand Pandey; Rajeev Chawla; Shalini Jaggi; Blessy Sehgal; Alok Sehgal; Naresh Goel; Ripen Gupta; Samir Kubba; Abhinav Chhabra; Saurabh Bagga; Rajnikant N. Shastry
The incidence of heart failure (HF) in India is estimated to be 0.5–1.7 cases per 1,000 people per year, and approximately 4,92,000–1.8 million new cases are detected every year. Despite the high rate of mortality associated with HF, most patients do not receive maximal guideline-directed medical therapy (GDMT). Current guidelines advocate early multidrug combination therapy with four classes of drugs, namely, beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), angiotensin receptor-neprilysin inhibitors (ARNIs), and sodium-glucose transport protein 2 inhibitors (SGLT-2is), particularly in patients with heart failure with reduced ejection fraction (HFrEF). ARNIs reduce cardiac morbidity and mortality in patients with HFrEF. However, recent data indicated that only 4.8% of patients with HFrEF receive ARNI in India. Hence, at a national consensus on HF meeting, cardiology experts from India formulated a national consensus on the use of ARNI in HF based on current evidence and guidelines. The consensus states that ARNI should be used early in HF, particularly in de novo patients with HFrEF, and those with acute decompensated heart failure (ADHF), irrespective of the presence of low systolic blood pressure (SBP) or diabetes. Moreover, those with HFrEF on renin–angiotensin–aldosterone system (RAAS) inhibitors should be switched to ARNI to reduce the risk of repeated hospitalization for HF, worsening HF, and cardiac death, and to improve the quality of life (QoL). Starting ARNI during the first hospitalization is preferable, and it is safe and effective across all doses. ARNIs can also be used for secondary benefits in patients with preserved ejection fraction [heart failure with preserved ejection fraction (HFpEF)] and HF with mildly reduced EF [heart failure with mildly reduced ejection fraction (HFmrEF)]. ©The Author(s). 2024Open Access.
Patterns and determinants of dyslipidaemia in 'Young' versus 'Not so Young' patients of coronary artery disease: A multicentric, randomised observational study in northern India
(Elsevier B.V., 2012) Nakul Sinha; Sudeep Kumar; Himanshu Rai; Neha Singh; Aditya Kapoor; Satyendra Tewari; R.K. Saran; V.S. Narain; R.P.S. Bharadwaj; R.K. Bansal; P.C. Saxena; P.R. Sinha; P.R. Gupta; Mukul Mishra; Praveen Jain; C.M. Pandey; Uttam Singh; S.S. Agarwal
Aims: The aims of the study were to ascertain difference in lipid levels of 'Young' onset of coronary artery disease (CAD) (≤ 45 years) vs. 'Not so Young' onset of CAD (≥ 55 years) among north Indians and also to investigate determinants of 'dyslipidaemia' in CAD patients. Methods: This was a prospective, multicentric, randomised, observational study carried in eight cen- tres of UP, India. All blood investigations were performed employing a central laboratory. Results: Out of a total 435 patients studied, 218 were in the 'young group' (YG) and 235 were in the 'Not so Young Group' (NSYG). Dyslipidaemia was more common in YG as evident by significantly higher levels of total cholesterol, triglycerides, low- and very low-density lipoprotein cholesterol as compared to NSYG. Diabetes, hypertension, urban lifestyle, and family history of CAD were found to be important determinants of dyslipidaemia in YG. Conclusion: We conclude that lipid levels among north Indians are significantly higher in younger patients with CAD when compared with elderly. © 2012, Cardiological Society of India. All rights reserved.
Rest or 30-Min Walk as Exercise Intervention (RESTOREX) in Myasthenia Gravis: A Randomized Controlled Trial
(S. Karger AG, 2021) Usha K. Misra; Jayantee Kalita; Varun K. Singh; Aditya Kapoor; Abhilasha Tripathi; Prabhakar Mishra
Introduction: There is a lack of evidence about the usefulness of exercise or rest in myasthenia gravis (MG). This study is aimed to evaluate the efficacy and safety of exercise or rest in MG. Methods: In a single-center open-labeled randomized controlled trial, the patients with mild to moderate MG were randomized to 30-min walk or rest in addition to the standard treatment. The primary endpoint was 50% improvement in the MG Quality of Life (MG-QOL15), and secondary endpoints were change in the Myasthenic Muscle Score (MMS), MG Activities of Daily Living (MGADL), grip strength, dose of acetylcholine esterase inhibitor and prednisone, 6-min walk test (6MWT), decrement in trapezius on the low-rate repetitive nerve stimulation test, and adverse events. The outcomes were defined at 3 months, by >50% improvement in these outcome parameters. Results: Forty patients with MG were randomized to the exercise or rest arm. The 2 arms were matched for demographic and clinical parameters. The patients in the exercise arm had significantly better QOL evidenced by MG-QOL15 (p = 0.02). The secondary endpoints, distance covered in 6MWT (p = 0.007), were also better in the exercise arm without any adverse event. Conclusion: Regular exercise for 30 min in mild and moderate MG improves quality of life and walking distance compared to rest and is safe. Clinical Trial Registration: The clinical trial registration number is CTRI/2019/11/021869. © 2021 S. Karger AG, Basel. Copyright: All rights reserved.
Role of Bisoprolol in Heart Failure Management: A Consensus Statement from India
(Journal of Association of Physicians of India, 2023) H.K. Chopra; Tiny Nair; G.S. Wander; C.K. Ponde; Saumitra Ray; Dinesh Khullar; Navin C. Nanda; Ravi R. Kasliwal; D.S. Rana; Ashok Kirpalani; J.P.S. Sawhney; Praveen Chandra; Yatin Mehta; Viveka Kumar; S. Tewari; A.K. Pancholia; Vijay Kher; Sandeep Bansal; Sanjay Mittal; Praful Kerkar; P.K. Sahoo; Ramesh Hotchandani; Sunil Prakash; Nagendra Chauhan; Vishal Rastogi; A. Jabir; S. Shanmugasundaram; Mangesh Tiwaskar; Ajay Sinha; Vittul Gupta; S.S. Mishra; S.N. Routray; A.K. Omar; Onkar C. Swami; Aparna Jaswal; Shamsad Alam; Rajeev Passey; Rajeeve Rajput; Justin Paul; Aditya Kapoor; D. Prabhakar; Subhash Chandra; Poonam Malhotra; Vivudh Pratap Singh; Manish Bansal; Priyank Shah; Sanjay Jain; Mohan Bhargava; I.B. Vijayalakshmi; Kiron Varghaese; Dharmender Jain; Anupam Goel; Namrata Gaur; Rohit Tandon; Asha Moorthy; Sheeba George; V.K. Katyal; R.R. Mantri; Rahul Mehrotra; Dilip Bhalla; Vinod Mittal; Sarita Rao; Manish Jagia; Harmeet Singh; Surabhi Awasthi; Ameet Sattur; Rekha Mishra; Anand Pandey; Rajeev Chawla; Shalini Jaggi; Blessy Sehgal; Alok Sehgal; Naresh Goel; Ripen Gupta; Samir Kubba; Abhinav Chhabra; Saurabh Bagga; N.R. Shastry
In India, heart failure (HF) is an important health concern affecting younger age groups than the western population. A limited number of Indian patients receive guideline-directed medical therapy (GDMT). Selective β-1 blockers (BB) are one of the GDMTs in HF and play an important role by decreasing the sympathetic overdrive. The BB reduces heart rate (HR) reverse the adverse cardiac (both ventricular and atrial), vascular, and renovascular remodeling seen in HF. Bisoprolol, a β-1 blocker, has several advantages and can be used across a wide spectrum of HF presentations and in patients with HF and comorbid conditions such as coronary artery disease (CAD), atrial fibrillation (AF), post-myocardial infarction (MI), uncontrolled diabetes, uncontrolled hypertension, and renal impairment. Despite its advantages, bisoprolol is not optimally utilized for managing HF in India. This consensus builds on updated evidence on the efficacy and safety of bisoprolol in HF and recommends its place in therapy with a focus on Indian patients with HF. © The Author(s).
The Power and Promise of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure Management: National Consensus Statement
(Journal of Association of Physicians of India, 2023) H.K. Chopra; G.S. Wander; C.K. Ponde; Navin C. Nanda; Dinesh Khullar; K. Venugopal; Saumitra Ray; Tiny Nair; D.S. Rana; Vijay Kher; J.P.S. Sawhney; R.R. Kasliwa; A. Jabir; Rabin Chakraborty; Praveen Chandra; Sandeep Bansal; Viveka Kumar; A.K. Pancholia; Aditya Kapoor; Sunil Prakash; Anil Saxena; Vishal Rastogi; Vinod Sharma; Y.K. Arora; Arup Dasbiswas; Mohan Bhargava; Aparna Jaswal; K. Bhargava; Mona Bhatia; A.K. Omar; N.N. Khanna; Rajiv Passey; Dilip Bhalla; I.B. Vijayalakshmi; A.K. Bhalla; Asha Moorthy; H.S. Isser; S.S. Mishra; S.N. Routray; Vivek Tandon; Ajay Sinha; Manish Bansal; Praveen Jain; Ramesh Hotchandani; Dharmendra Jain; V.K. Katyal; Sanjiv Gulati; Rohit Tandon; Shalini Jaggi; Blessy Sehgal; Vitull Gupta; Rahul Mehrotra; N.C. Krishnamani; S.N. Pathak; M.S. Yadav; Rajeev Chawla; Jyotirmoy Pal; Nandini Chatterjee; Shambo S. Samajdar; N.R. Shastry
Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril–Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril–Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril–Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril–Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40–50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk. © 2023 Journal of Association of Physicians of India. All rights reserved.
The Promise of Cilnidipine in Hypertension with Comorbidities: National Consensus Statement
(Journal of Association of Physicians of India, 2024) Hirday Kumar Chopra; Gurpreet S. Wander; Chandrashekhar K. Ponde; Navin C. Nanda; Dinesh Khullar; K. Venugopal; Saumitra Ray; Tiny Nair; D.S. Rana; Vijay Kher; J.P.S. Sawhney; R.R. Kasliwal; Jabir Abdullakutty; Rabin Chakraborty; Praveen Chandra; Sandeep Bansal; Viveka Kumar; Arvind K. Pancholia; Aditya Kapoor; Sunil Prakash; Anil Saxena; Vishal Rastogi; Vinod Sharma; Y.K. Arora; Arup Dasbiswas; Mohan Bhargava; Aparna Jaswal; Kartikeya Bhargava; Mona Bhatia; Ashok K. Omar; Narendra Nath Khanna; Rajiv Passey; Dilip Bhalla; I.B. Vijayalakshmi; Anil Kumar Bhalla; Asha Moorthy; Harmohander S. Isser; S.S. Mishra; Satyanarayan Routray; Vivek Tandon; Ajay Sinha; Manish Bansal; Praveen Jain; Ramesh Hotchandani; Dharmendra Jain; V.K. Katyal; Sanjiv Gulati; Rohit Tandon; Shalini Jaggi; Blessy Sehgal; Vitull Gupta; Rahul Mehrotra; N.C. Krishnamani; S.N. Pathak; M.S. Yadav; Rajeev Chawla; N.R. Shastry; Nandini Chatterjee; Shambo Samrat Samajdar; Jyotirmoy Pal; Mangesh Tiwaskar
The rapidly increasing burden of hypertension is responsible for premature deaths from cardiovascular disease (CVD), renal disease, and stroke, with a tremendous public health and financial burden. Hypertension detection, treatment, and control vary worldwide; it is still low, particularly in low- and middle-income countries (LMICs). High blood pressure (BP) and CVD risk have a strong, linear, and independent association. They contribute to alarming numbers of all-cause and CVD deaths. A major culprit for increased hypertension is sympathetic activity, and further complications of hypertension are heart failure, ischemic heart disease (IHD), stroke, and renal failure. Now, antihypertensive interventions have emerged as a global public health priority to reduce BP-related morbidity and mortality. Calcium channel blockers (CCB) are highly effective vasodilators. and the most common drugs used for managing hypertension and CVD. Cilnidipine, with both L- and N-type calcium channel blocking activity, is a promising 4th generation CCB. It causes vasodilation via L-type calcium channel blockade and inhibits the sympathetic nervous system (SNS) via N-type calcium channel blockade. Cilnidipine, which acts as a dual L/N-type CCB, is linked to a reduced occurrence of pedal edema compared to amlodipine, which solely blocks L-type calcium channels. The antihypertensive properties of cilnidipine are very substantial, with low BP variability and long-acting properties. It is beneficial for hypertensive patients to deal with morning hypertension and for patients with abnormal nocturnal BP due to exaggerated sympathetic nerve activation. Besides its BP-lowering effect, it also exhibits organ protection via sympathetic nerve inhibition and renin–angiotensin–aldosterone system inhibition; it controls heart rate and proteinuria. Reno-protective, neuroprotective, and cardioprotective effects of cilnidipine have been well-documented and demonstrated. © 2024 Journal of Association of Physicians of India. All rights reserved.