Coronary disease – ABC CARDIOL

IJCS

Review Article

Management of Chronic Coronary Syndromes in Resource-Constrained Settings in India: An Expert Opinion With a Proposed Algorithm

Vijay Shah et al. Saumitra Ray Devanu Ghosh Roy Samir Kubba … Sarita Rao Jabir Abdullakutty K. P. Suresh Kumar

Abstract

Cardiovascular diseases (CVDs) are associated with considerable morbidity and mortality across the world. The global financial burden caused by CVD emphasizes the importance of preventive strategies and appropriate management. Chronic coronary syndrome (CCS) is a new term recently introduced for stable coronary artery disease (CAD), which is associated with the highest cause-specific mortality in the Indian population. CCS adversely affects the quality of life (QoL) due to anxiety, fatigue, and prolonged disease course. Risk factor modification, adaptation to lifestyle changes, and pharmacotherapy are the optimal treatment options for CCS. Despite the guidelines proposed by numerous groups and societies, such as the European Society of Cardiology (ESC), the American College of Cardiology/American Heart Association (ACC/AHA), and the Taiwan Society of Cardiology, managing CCS in resource-limited situations remains challenging. Lack of awareness about CCS among patients and healthcare professionals (HCPs), limited resources, accessibility and affordability of lifesaving therapies, poor transport facilities for patients, and asymmetrical distribution are among the challenges identified. In India, the scenario of CCS is no different in rural areas and among urban poor populations due to resource constraints. The current expert opinion review based on 48 experts in the field of cardiology from eastern, western, northern, southern, and pan-India regions highlights the management of CCS in resource-constrained settings with a focus on diagnostic modalities, risk stratification, referral pathways, and medical management. Based on expert opinions and a thorough literature search, an algorithm for the management of patients with CCS in resource-constrained settings in India is also proposed.

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IJCS

Original Article

Home-based Virtual Reality Exercise Program During the Maintenance Stage of Cardiac Rehabilitation: A Randomized Controlled Trial

Ágata Vieira et al. Cristina Melo Andreia Noites Jorge Machado Joaquim Mendes

Abstract

Background:

Home-based virtual reality technology may become an alternative to cardiac rehabilitation.

Objectives:

To evaluate the effects of a specific, home-based exercise program, performed either through a virtual reality (Kinect) or a conventional format (booklet) in the maintenance stage of cardiac rehabilitation for six months on functional muscle strength of the lower limbs, physical activity and exercise tolerance.

Methodology:

This is a randomized clinical trial (ClinicalTrials.gov — NCT02753829) with individuals with coronary artery disease from a hospital in Porto, Portugal, randomly allocated to an experimental group “1” (EG1; n = 11), submitted to a virtual reality exercise program (Kinect); an experimental group “2” (EG2; n = 11), submitted to an exercise program described in a booklet (conventional format); or a control group (CG) (n=11), submitted to routine care. Parameters of functional muscle strength of the lower limbs (sit-to-stand test), physical activity (accelerometer) and exercise tolerance (stress test) were assessed and compared between the groups. Descriptive and inferential statistics were applied, with 95% with a significance level of 0.05.

Results:

Significant improvements in functional muscle strength of the lower limbs were observed in EG1 compared to EG2, at three months (19.5 ± 7.7 versus 11.9 ± 4.7, p = 0.042), and at six months (23.0 ± 7.7 versus 14.6 ± 4.6, p = 0.027) of intervention.

Conclusions:

The program did not demonstrate superior results, in relation to the control group and among the different formats, in physical activity and effort tolerance. In relation to the functional muscle strength of the lower limbs, the virtual reality format showed significantly better results when compared to the conventional format only.

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IJCS

Original Article

Impact of the COVID-19 Outbreak on Coronary Artery Bypass Grafting in Brazil

Felipy de Almeida Machado et al. Rui M. S. Almeida

Abstract

Background

The COVID-19 pandemic has disrupted the routine of emergency centers around the world, including in Brazil, where the crisis has affected the volume of major cardiac surgeries such as coronary artery bypass grafting.

Objective

To analyze the impact of the COVID-19 pandemic on the number of surgical procedures for coronary artery bypass grafting in Brazil.

Methods

An ecological, cross-sectional, quantitative, and descriptive study was conducted. Data for the period from July 2018 to June 2019 and from July 2020 to June 2021 were collected from SIHSUS using DATASUS/Tabwin.

Results

A global reduction of 26.58% was observed in the analyzed population, with on-pump coronary artery bypass grafting decreasing by 28.10%, and off-pump coronary artery bypass grafting reduced by only 10.31%.

Conclusion

During the pandemic, there was a 26.58% reduction in the number of surgical procedures for myocardial revascularization in Brazil.

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IJCS

Review Article

Coronary Artery Disease in Women: Getting to Know Gender Related Disparities

Ana Gilabert-Garcia et al. Cristina Cristina Villarreal Guerrero Rodrigo Dagio-Cuéllar Jorge Luis Bermudez-Gonzalez … Arantza Marie Perez-Partida Joaquin Berarducci Javier Ivan Armenta-Moreno Jose Luna-Alvarez-Amezquita Juan Ignacio Straface Nilda Espinola-Zavaleta Erick Alexanderson

Abstract

Coronary artery disease (CAD) and ischemic heart disease (IHD) are often indistinctly used terms. Both combined have generated, over the past years, concerns about sex disparities in their presentation. From an epidemiological perspective, females have several disadvantages regarding the prevention, diagnosis, and treatment of CAD. Most of the general cardiovascular risk factors affect women more frequently, or with a higher morbidity and mortality association. Besides, atypical manifestations of the disease and uncommon forms of CAD represent a diagnostic challenge for clinicians. Even if current treatments for CAD have no apparent sex bias, women representation in clinical trials and treatment patterns analyzed in clinical practice refuse this statement. Several disparities are caused by inevitable sex-particularities, but many of them are more social, cultural, and dogmatic beliefs that have to be addressed and overhaul.

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IJCS

Review Article

Inflammation in Cardiovascular Disease: From Basic Concepts to Clinical Application

David D. Waters

Abstract

Although low-density lipoprotein cholesterol is central to the development and progression of atherosclerosis, the role of inflammation in the atherosclerotic process is becoming better understood and appreciated. Chronic inflammatory conditions such as rheumatoid arthritis, lupus, psoriasis, HIV infection, and inflammatory bowel disease have all been shown to be associated with an increased blood levels of inflammatory biomarkers and increased risk of cardiovascular events. Evidence from observational studies suggests that anti-inflammatory therapy decreases this risk in these conditions. Clinical trials of anti-inflammatory drugs in patients with coronary disease have yielded mixed results. Drugs that have failed in recent trials include the P38 MAP kinase inhibitor losmapimod, the phospholipase A2 inhibitors darapladib and varespladib, and methotrexate. Canakinumab, an interleukin-1β inhibitor, reduced cardiovascular events in patients with coronary disease in the Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS). Canakinumab increased the rate of fatal infections in CANTOS and is very expensive; it is thus unlikely to be widely used for risk reduction in cardiology. On the other hand, colchicine is a safe and inexpensive anti-inflammatory drug. In the Colchicine Cardiovascular Outcomes Trial (COLCOT), where patients within 30 days of a myocardial infarction were randomized to low-dose colchicine or placebo and followed for a median of almost 2 years, colchicine treatment was associated with a 23% reduction (p=0.02) in cardiovascular events. Newer studies with anti-inflammatory drugs have the potential to improve outcomes of patients with atherosclerosis, just as low-density lipoprotein cholesterol-lowering drugs have done over the past two decades.

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ABC

Original Article

Study of Coronary Flow Reserve with Intravenous Use of Microbubbles (Contrast Echocardiography) and Adenosine: Protocol for Clinical Application in Patients Suspected of Having Coronary Heart Disease

Fernando Morcerf et al. Alvaro Moraes Marcia Carrinho Hans J. F. Dohmann

OBJECTIVE: To test the feasibility, safety and accuracy of the adenosine protocol in the study of myocardial perfusion with microbubbles contrast echocardiography. METHODS: 81 pts (64 male, 60+11 years) were submitted to contrast echocardiography with PESDA (sonicated solution of albumin 20%-1ml, dextrose 5%-12ml and deca-fluorobutane gas-8ml) to study the myocardial perfusion at rest and after bolus injection of adenosine (6 to 18mg) and to coronary angiography within 1 month each other. For each patient 3 left ventricle perfusion beds were considered (total of 243 territories). 208 territories were analyzed and 35 territories were excluded. PESDA was continuously infused (1-2ml/min), titrated for best myocardial contrast. Triggered (1:1) second harmonic imaging was used. RESULTS: Coronary angiography showed 70 flow limiting (> 75%) lesions and 138 no flow limiting lesions. At rest an obvious myocardium contrast enhancement was seen in at least 1 segment of a territory in all patients. After adenosine injection an unquestionable further increase in myocardial contrast was observed in 136 territories (99%) related to no flow limiting lesions, lasting < 10 s, and a myocardial perfusion defect was detected in 68 territories (97%) related to flow limiting lesions. It was observed only 4 false results. There were no serious complications. CONCLUSION: Myocardial perfusion study with PESDA and adenosine protocol is a practical, safe and accurate method to analyze the coronary flow reserve.

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