ABSTRACT Coronary artery disease (CAD) in young adults is increasingly reported, often in association with nontraditional risk factors. Posttransplant erythrocytosis (PTE) is an uncommon complication following renal transplantation and is associated with increased blood viscosity and a heightened risk of thromboembolic events. A 38-year-old male with long-standing hypertension and chronic kidney disease underwent renal transplantation 4 years earlier. He developed PTE posttransplant, requiring repeated phlebotomies. He presented with acute-onset typical angina of 5–6 h duration. Electrocardiography revealed an extensive anterior wall ST-segment elevation myocardial infarction (MI). Laboratory evaluation showed elevated hemoglobin (17.5 g/dL) and hematocrit (51.4%). Coronary angiography demonstrated a critical thrombotic 90% stenosis in the proximal left anterior descending artery with impaired distal flow. Emergency primary percutaneous coronary intervention was successfully performed, restoring thrombolysis in MI Grade III flow. The patient had an uneventful recovery and was discharged on guideline-directed medical therapy with multidisciplinary follow-up. PTE typically occurs within months to years after kidney transplantation and results from multifactorial mechanisms including persistent erythropoietin activity, activation of the renin–angiotensin–aldosterone system, and other erythropoietic stimulators. Although its incidence is declining, PTE remains an underrecognized cause of arterial thrombosis and premature CAD in young renal transplant recipients. PTE should be considered a potential modifiable cardiovascular risk factor in young patients after renal transplantation. Regular hematological monitoring and timely intervention may help prevent serious thrombotic complications, including MI.

ABSTRACT Cardiac hydatid cysts are a rare cause of cystic cardiac masses, most frequently encountered in cattle and sheep rearing areas. They may have varied clinical presentations. Transthoracic echocardiography demonstrating the cystic cardiac mass is the initial investigation of choice for cardiac hydatid cyst. Cardiac computed tomography and cardiac magnetic resonance imaging, along with serologic tests and histopathological examination of the excised specimen, help in confirming the diagnosis. Surgical resection is the treatment of choice. We present a case of cardiac hydatid cyst in an 18-year-old male, a farmer by occupation, who presented to us with complaints of exertional breathlessness and palpitations for 2 years.

ABSTRACT Introduction: Data on prevalence and risk determinants of raised high-sensitivity C-reactive protein (hs-CRP) levels in patients with stable coronary artery disease (CAD) are limited. We report the prevalence and risk determinants of raised hs-CRP levels in patients with stable CAD on secondary preventive treatment. Materials and Methods: A tertiary care hospital-based cross-sectional study was carried out in consecutive patients ( n = 353) with established CAD aged 18 years and above, who were under follow-up in the department of cardiology outdoor clinic. Assuming a prevalence of 40%, the required sample size was 344 to predict the prevalence of elevated hs-CRP levels. Demographic data, cardiovascular (CV) risk factors, health risk behavior, clinical characteristics, and drug history were recorded systematically. hs-CRP levels were measured using human enzyme-linked immunosorbent assay kits. The data were analyzed using STATA version 13 statistical software. Results: Raised hs-CRP levels were found in 146 (41.4%) patients (95% confidence interval [CI]: 36.3–46.6). Independent determinants of raised hs-CRP level were body mass index (odds ratio: 1.11; 95% CI: 1.03–1.19), uncontrolled non-high-density lipoprotein cholesterol (HDL-C) 100 mg/dl (odds ratio: 4.52; 95% CI: 1.33–15.4), and male gender (odds ratio: 2.51; 95% CI: 1.21–5.18), respectively. Overweight/obesity, elevated non-HDL-C, and male gender together accounted for nearly 50% of the population-attributable risk for elevated hs-CRP levels in patients with stable CAD. Conclusion: These findings underscore the need for comprehensive CV risk assessment in stable CAD patients, beyond traditional lipid target achievement. Targeted interventions addressing modifiable factors such as weight management and non-HDL-C control may help reduce residual inflammatory risk.

Introduction: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide and dyslipidemia is the major risk factor for CVD. Aim: The aim of the study was to assess the real-world treatment patterns associated with the use of rosuvastatin + ezetimibe combination therapy for lipid management. Methods: This retrospective multicentric, noncomparative, nonrandomized, observational real-world study was conducted at multiple healthcare centers in India. Patients aged ≥18 years (either sex), with uncontrolled dyslipidemia, familial hypercholesteremia, and mixed dyslipidemias, with persistently elevated levels of low-density lipoprotein cholesterol (LDL-C) despite receiving statin therapy were included. Fasting blood LDL-C was monitored in high, very high, and extreme-risk patients. Results: A total of 1465 patients were enrolled with a mean age of 60.87 years and men predominance (67.49%). Median (range) duration of hypercholesteremia of patients was 4.00 (0.40–19.50) years. The majority of patients were on moderate-intensity statin therapy (54.68%), followed by high-intensity statin (27.37%) and low-intensity statin (17.95%). The majority of patients taking moderate-intensity statins (47.38%) had LDL-C levels between 151 and 200 mg/dL, compared to those taking low (36.50%). Combination rosuvastatin + ezetimibe therapy showed a significant reduction in mean LDL-C levels of patients using low, moderate, and high-intensity statins with a mean difference of 100.63 mg/dL, 94.24 mg/dL, and 92.00 mg/dL ( P < 0.001 each) as well as a significant reduction in LDL-C levels, total cholesterol levels, and triglycerides levels ( P < 0.001 each). Conclusion: Rosuvastatin and ezetimibe therapy was an effective and well-tolerated lipid-lowering agent, offering higher efficacy, especially in the reduction of LDL-C levels.

Background: Hypertension (HTN) is the primary modifiable risk factor for chronic coronary syndrome (CCS), which significantly contributes to morbidity and mortality. This study aimed to gather expert consensus from Indian cardiologists on managing HTN in patients with CCS, to optimize therapy and improve patient care. Methods: A consensus is based on Indian cardiologists’ inputs collected via an online survey. The questionnaire covered diagnostic practices, clinical patterns, and real-world treatment regimens for managing hypertensive CCS patients. Survey responses were analyzed and discussed during round table meetings. Further expert opinions were graded from Level A (strong consensus) to Level D (no consensus). Recommendations were formulated based on collective expert opinions. Results: The consensus highlights the clinical strategies for managing patients with CCS and associated comorbid conditions. The key diagnostic tools, such as ambulatory blood pressure monitoring and Holter electrocardiogram, are strongly recommended for comprehensive evaluation. Pharmacological management should prioritize the use of angiotensin II receptor blockers and beta-blockers combinations, particularly telmisartan–metoprolol fixed-dose combination (FDC) in the management of hypertensive CCS patients with type 2 diabetes mellitus or dyslipidemia. Conclusions: Indian cardiologists emphasized the importance of using, telmisartan–metoprolol FDC as a preferred drug regimen owing to their cost-effectiveness, improved efficacy, and enhanced adherence. These consensus recommendations aim to enhance therapeutic outcomes and guide future clinical practice in Indian context.

ABSTRACT Background: Premature coronary artery disease (CAD), defined as onset at or before 45 years of age, has a disproportionately higher prevalence among South Asians compared to Western populations, with Indian individuals particularly affected. Traditional lipid metrics primarily quantify low-density lipoprotein cholesterol (LDL-C) but often fail to reflect qualitative changes, such as LDL oxidation, which may contribute to residual cardiovascular risk. Objective: This study aimed to assess the concordance among three LDL-C estimation methods (Friedewald, Martin–Hopkins, and NIH Equation-2) and their relationship with oxidized LDL (ox-LDL) levels in young Indian adults with premature CAD. Methods: This case–control study enrolled 150 participants, including 100 patients with CAD and 50 age-matched controls. Standard lipid parameters were measured, and LDL-C levels were calculated using Friedewald, Martin–Hopkins, and NIH Equation 2 methods while ox-LDL levels were quantified using sandwich enzyme-linked immunosorbent assay. Intergroup differences were evaluated using Mann–Whitney U-test. Associations among LDL-C estimates, conventional lipid fractions, and ox-LDL were examined using Spearman’s rho correlation analysis. Results: LDL-C estimation by all three methods demonstrated strong concordance. However, ox-LDL showed no significant correlation with any of the LDL-C estimation methods. This indicates that ox-LDL “quality” reflects a distinct atherogenic dimension independent of LDL-C “quantity.” Conclusions: Although LDL-C equations provide reliable estimates of LDL cholesterol levels, they do not capture oxidative modifications that contribute to residual cardiovascular risk. Integrating ox-LDL assessment into routine screening may strengthen early detection and enable targeted prevention, addressing the escalating public health burden of premature CAD among young Indians.

ABSTRACT Background: Valvular heart disease (VHD) often presents with subclinical left ventricular (LV) dysfunction that may not be detected by traditional echocardiographic parameters. This study explores the utility of global longitudinal strain (GLS) as an early marker of LV dysfunction in patients with VHD. Material and Methods: A descriptive and cross-sectional study was conducted at Dr. D. Y. Patil Medical College, Pune, from July 2022 to July 2024, involving 100 patients diagnosed with VHD and scheduled for two-dimensional (2D) echocardiography. Clinical data, including demographic characteristics, medical history, and symptoms, were recorded. Participants underwent echocardiographic evaluation using 2D and speckle-tracking echocardiography to assess GLS, LV volumes, ejection fraction, and other myocardial deformation parameters using Vivid™ E95 Ultra Edition ECHO machine. The analysis was done by the single operator to avoid operated-related bias and discrepancy. Statistical analysis was performed using the IBM software SPSS version 26.0. Results: The majority of participants with GLS ≤17 were aged >60 years and had severe symptoms, including chest pain, dizziness, and NYHA class IV dyspnea. GLS ≤17 was strongly associated with higher NT-proBNP levels, larger left atrial (LA) size, and significant valvular abnormalities, particularly aortic stenosis, aortic regurgitation, and mitral regurgitation. Notably, GLS ≤17 showed poor correlation with mitral stenosis (MS). Lower GLS values correlated with worse echocardiographic findings, reflecting myocardial dysfunction and structural changes. Conclusion: GLS serves as a sensitive marker for the early detection of subclinical LV dysfunction in VHD, particularly in conditions involving regurgitation or stenosis. The association of GLS ≤17 with elevated NT-proBNP levels and increased LA size underscores its potential in identifying early myocardial stress. However, its limited applicability in MS highlights the need for further research in specific valvular pathologies. This study supports GLS as a valuable tool in the early diagnosis and management of subclinical cardiac dysfunction in VHD.

ABSTRACT Introduction: Advanced echocardiography should be accurate, versatile, comprehensive, and cost-effective that can be incorporated into daily clinical care. Methods: We randomly selected 156 two-dimensional (2D) echo subjects for “BEST Test” – To convert 2D to three-dimensional (3D) slice during offline process using specific steps. From this pool, we had 28 randomly selected subjects for substudy linear measurement analysis. Each had three sets of values by direct measurement, before and after 3D slice. Between the methods, correlation analysis and Bland–Altman scatter plot analysis was done. Results: Out of 154, 147 were male (95.5%) with a mean age of 48.7 years (16–85 years). Following specific steps, all 2D Echo clips were converted into realistically rendered realtime “3D Slice” data, depends on quality of 2D echo images. From correlation analysis, most measurement methods show a positive correlation. Maximum with left atrium measurements between Methods 2 and 3 (r 2= +0.66) and least with right atrium measurements between Methods 1 and 2 (r 2= −0.17). Bland–Altman analysis reports the least mean of −14.5 (95% confidence interval [CI]: −11.5–−17.5) for left ventricular internal diameter at end-diastole and maximum mean of −1.1 (95%CI: +0.3–−2.4) for posterior wall diameter measurements with Methods 1 and 3. The range of agreement varies. Conclusion: “BEST” Test from Blender 3D Software can be used as an offline imaging tool for 2D echo because it qualifies the features of an ideal tool. The complete process can be customizable and reproducible at zero cost. Statistical significance and relationship were noted and established.

ABSTRACT Background: The diagnosis of acute coronary syndrome (ACS) is fundamental for the early detection and distinction of chest pain from alternative causes, as it is a common and life-threatening reason for Emergency Medicine Department (EMD) admission. The history, electrocardiogram, age, risk factors, and initial troponin (HEART) score which was recently diagnosed is intended for early risk stratification of patients presenting with chest pain in EMD, and categories them into low, intermediate, or high-risk of experiencing major adverse cardiac events (MACEs) within 6-weeks, serves as an indicator of ACS. To evaluate the effectiveness of HEART scores in patients presenting with chest pain in the EMD and to stratify them using HEART score. Methodology: This 6-month prospective study was done in 239 patients presented in EMD with chest pain in Government Medical College Hospital, South India. After obtaining Institutional Review Board approval and informed consent, patients were categorized based on HEART score. The patients were followed for 6 weeks through telephone to identify MACEs after discharge. Analysis was done using the SPSS (Ver. 24) software. Results: Among 239 patients, 52.7%, 35.1%, and 12.1% of patients were stratified as low, moderate, and high risk, respectively, using HEART score. Of which low-risk and high-risk category, 1.6% and 89.7% developed MACE at 6 weeks, where 46 patients had acute myocardial infarction, 42 patients underwent invasive procedure, and five patients died. Moderate HEART score risk patients had 34.5% of MACE which suggests admission and further evaluation to prevent cardiac complication. Conclusion: Our study suggests that if HEART score is adopted for risk stratifying patients who are presenting with chest pain to ED half of the patients can be very well discharged from ED based on the clinical evaluation and prevent the further complications in high-risk patients.