Toward a Universal Definition of Etiologies in Heart Failure: Categorizing Causes and Advancing Registry Science.

Heart failure (HF) is a well-described final common pathway for a broad range of diseases however substantial confusion exists regarding how to describe, study, and track these underlying etiologic conditions. We describe (1) the overlap in HF etiologies, comorbidities, and case definitions as currently used in HF registries led or managed by members of the global HF roundtable; (2) strategies to improve the quality of evidence on etiologies and modifiable risk factors of HF in registries; and (3) opportunities to use clinical HF registries as a platform for public health surveillance, implementation research, and randomized registry trials to reduce the global burden of noncommunicable diseases. Investment and collaboration among countries to improve the quality of evidence in global HF registries could contribute to achieving global health targets to reduce noncommunicable diseases and overall improvements in population health.

Predicting the Length of Stay of Cardiac Patients Based on Pre-Operative Variables-Bayesian Models vs. Machine Learning Models.

Length of stay (LoS) prediction is deemed important for a medical institution's operational and logistical efficiency. Sound estimates of a patient's stay increase clinical preparedness and reduce aberrations. Various statistical methods and techniques are used to quantify and predict the LoS of a patient based on pre-operative clinical features.

Predictors of Non-Obstructive Coronary Artery Disease in Patients Undergoing Elective Coronary Angiography.

Background: Appropriate patient selection for coronary angiography (CAG) is essential to minimize the unnecessary risk of morbidities and exposure to radiation and iodinated contrast. This becomes even more relevant in low-to-middle-income settings where most health expenditures are out-of-pocket due to lack of medical insurance. We determined predictors of non-obstructive coronaries (NOC) in patients undergoing elective CAG.

Management and outcome of post-myocardial infarction ventricular septal rupture-A Low-Middle-Income Country Experience.

Background: Ventricular septal rupture (VSR) is a rare complication after acute myocardial infarction (AMI) especially in the reperfusion era but its associated mortality has remained high. This case series evaluated in-hospital and intermediate-term mortality in VSR patients. Additionally, we also analyzed risk factors, clinical presentation, intervention, and predictors of in-hospital mortality in VSR patients.

Cases of acute coronary syndrome and presumed cardiac death prior to arrival at an urban tertiary care hospital in Pakistan during the COVID-19 pandemic.

Background: A reduction in overall acute coronary syndrome (ACS) cases, increases in the severity of ACS presentation, and increased rates of out-of-hospital cardiac arrest (OHCA) have been reported from multiple countries during the COVID-19 pandemic. The attributed factors include COVID-19 infection, fear of COVID-19 and resultant avoidance of health care facilities, and restrictions on mobility. Pakistan, a country with a high burden of cardiovascular disease (CVD) and challenges related to health care access, will be expected to demonstrate these same findings.

Randomized trial comparing radial hemostasis techniques; catechol conjugated chitosan pad (InnoSEAL) versus pneumatic compression band.

Objectives: Primary objectives: to compare radial artery occlusion rate (RAO) after cardiac catheterization between catecholamine-chitosan pad (InnoSEAL) and pneumatic compression device (PCD) and to compare difference in hemostasis time and radial monitoring termination time between two arms. Secondary objectives: to compare radial site bleeding and ease of use of two methods by cath-lab technicians.

Background: Hemostatic pads may be an effective alternative to PCD with lesser chance of access site complications with advantage of shortened compression time.

Combination of InnoSEAL plus TR band compared with TR band alone for radial artery outcomes in patients undergoing transradial coronary intervention (InnoSEAL-II): an open-label randomised controlled trial (protocol).

Introduction: About 2%-30% of cardiac catheterisation procedures get complicated by radial artery occlusion (RAO). Ensuring patent haemostasis appears to be an important factor in reducing RAO. Currently employed method is a radial compression device (RCD) such as transradial band (TRB) that take hours to achieve haemostasis and cause discomfort to the patients.

Major adverse cardiovascular events in patients undergoing percutaneous coronary intervention or coronary artery bypass graft with underlying chronic kidney disease.

Objective: To assess early and late outcome in severe chronic kidney disease patients undergoing revascularisation.

Methods: The retrospective ambi-directional cohort study was conducted at Tabba Heart Institute, Karachi, and comprised data from May, 2012, to July,2016, related to severe chronic kidney disease patients with creatinine clearance <30ml/min or end-stage renal disease on haemodialysis who had undergone coronary artery bypass graft / percutaneous coronary intervention. Early outcome was in-hospital major adverse cardiac event, like mortality, stroke and new haemodialysis.

Frequency, predictors and prognosis of worsening renal function in patients admitted with acute heart failure.

Objective: To calculate frequency of worsening renal failure (WRF) in patients with acute decompensated heart failure (ADHF), to evaluate predictors of WRF and to assess its effect on in-hospital and 12 month adverse outcomes.

Methods: A single center observational prospective study was conducted on consecutive patients admitted with ADHF from Sept 2016 - February 2017. Follow-up was done for 12 months post discharge.

Clinical characteristics and in-hospital outcome in percutaneous coronary interventions with ST elevation myocardial infarction patients developing acute kidney injury.

Objective: To find predictors, incidence and hospital mortality of acute kidney injury in ST elevation myocardial infarction patients undergoing percutaneous coronary interventions.

Methods: The retrospective cross-sectional study was conducted at Tabba Heart Institute Karachi, and comprised data from June 2013 to December 2017 of ST elevation myocardial infarction patients undergoing percutaneous coronary interventions during index admission. Acute kidney injury was defined as serum creatinine ≥0.

In-hospital management and intermediate term outcomes in stable patients with ST segment elevation myocardial infarction presenting between 12-48 hours of symptom onset versus 2-7 days after the onset of chest pain; a single center study.

Objective: To evaluate hospital management, revascularisation and intermediate-term major adverse cardiac events amongst ST elevation myocardial infarction patients and to compare them in early and late presentations. .

Methods: The retrospective study was conducted at Tabba Heart Institute, Karachi, and comprised data from July 2013 to December 2016.

Mortality and deciding factors for no revascularization in cardiogenic shock patients; a cross sectional study.

Objective: To assess the frequency of acute coronary syndrome patients with cardiogenic shock and not undergoing revascularisation, their in- hospital outcome and reasons underlying management decisions.

Methods: The retrospective cross-sectional study was conducted at Tabba Heart Institute, Karachi, and comprised data from July 2013 to December 2017 of acute coronary syndrome with hypotension and not having under gone revascularisation. Data was analyzed using Stata 12.

Management, hospital outcome and revascularization trends in non-ST elevation myocardial infarction with high GRACE risk score.

Objective: To assess clinical characteristics, management strategies and in-hospital outcome among high-risk patients of non-ST elevation myocardial infarction.

Methods: The retrospective cross-sectional study was conducted at Tabba Heart Institute, Karachi, and comprised data from July 2013 to December 2016 of adult non-ST elevation myocardial infarction patients who had first cardiac event having Global Registry of Acute Coronary Eventsrisk score>140. Subcategories were formed on the basis of score range 140-159, 160-189 and ?190.

Frequency and factors related to not receiving acute reperfusion therapy in patients with ST elevation myocardial infarction; a single specialty cardiac center.

Objective: To determine the frequency of no reperfusion therapy, its reasons, hospital management and intermediate-term outcome s of ST- elevation my ocardial in farction patients .

Methods: The retrospective ambi-directional observational study was conducted at Tabba Heart Institute, Karachi, and comprised record of ST-elevation myocardial infarction patients without immediate reperfusion therapy with symptom onset time of 12 hours who presented between January 2013 and December 2017. Prospective follow-up of all patients was performed till June 2018.

In-Hospital outcomes in acute coronary syndrome patients with concomitant severe chronic kidney disease undergoing percutaneous coronary intervention.

Objective: To determine in-hospital mortality and major adverse cardiac events (MACE) in acute coronary syndrome (AMI) patients with underlying severe chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI).

Methods: We conducted a retrospective cohort study from June'2013-December'2017 at Tabba Heart Institute, Karachi. Data was drawn from institutes' database modeled after US National Cardiovascular data CathPCI registry.

Prevalence of non-acute ischaemic cardiomyopathy in a Pakistani cohort.

Unlabelled: Heart failure with reduced left ventricular ejection fraction (HFrEF) is a frequently encountered clinical scenario. Coronary angiography (CAG) is usually performed to assess obstructive epicardial coronary artery disease (CAD) and the resultant ischaemia as causes of HFrEF.

Objectives: To determine the frequency of obstructive CAD (OCAD) in patients with HFrEF and its independent predictors and outcomes.

Primary percutaneous coronary intervention for ST elevation myocardial infarction complicated by cardiogenic shock.

Objective: To determine the outcomes of primary percutaneous coronary intervention for ST elevation myocardial infarction complicated by cardiogenic shock.

Methods: The retrospective study was conducted at the Tabba Heart Institute, a private-sector facility in Karachi. It reviewed the medical records of 56 consecutive patients between January 2009 and June 2011 with acute ST elevation myocardial infarction complicated by cardiogenic shock and subjected to primary percutaneous coronary intervention.

Transradial primary percutaneous coronary intervention - experience from a tertiary care cardiac centre.

Objective: To determine the outcomes of primary percutaneous coronary intervention via transradial approach in a tertiary care cardiac centre.

Methods: The study retrospectively reviewed the medical records of 160 consecutive patients who presented to Tabba Heart Institute, a private-sector facility in Karachi, between January 2009 and January 2011 with acute ST-elevation myocardial infarction and treated with primary percutaneous coronary intervention via transradial approach. The primary end-points were in-hospital mortality and procedural success.

Primary percutaneous coronary aspiration of thrombus from infarct related artery.

We are reporting the case of a 48-year-old man hypertensive, and smoker presenting with acute inferoposterior ST elevation myocardial infarction (STEMI) with right ventricular infarction. He underwent diagnostic angiogram which revealed total occlusion of mid right coronary artery (RCA) by thrombus. Multiple runs of aspiration were performed using Export Aspiration Catheter-6F and thrombus was aspirated from RCA.

Percutaneous balloon pericardiotomy in a patient with advanced case of malignant pericardial effusion and tamponade.

Surgical creation of a pericardial window has been a standard procedure for relieving symptoms of patients presenting with recurrent pericardial effusion. In this report we describe the application of Multitrack balloon catheter for creating a pericardial window in a patient who had recurrent pericardial effusion with tamponade as a result of advance malignant disease of breast.

Percutaneous balloon valvuloplasty of coexisting mitral and tricuspid stenosis: single-wire, double-balloon technique.

Background: Percutaneous transmitral commissurotomy (PTMC) was first described by Inoue as an alternative to surgical closed mitral commissurotomy for severe rheumatic mitral stenosis. Two techniques - single- and double-balloon methods and percutaneous metallic devices - have been described for mitral dilatation. The Multi-Track system, a single-wire, double-balloon device was introduced by Bonhoeffer for mitral valve dilatation.

Percutaneous coronary intervention for acute coronary syndrome in dextrocardia and situs inversus.

A 55-year-old male presented with Non-ST Elevated Myocardial Infarction (NSTEMI). He was a known case of dextrocardia. His standard ECG showed finding consistent with dextrocardia.

Evaluation of routine functional testing after percutaneous coronary intervention.

Following percutaneous coronary intervention, 348 patients were randomized to either routine or selective functional testing strategies. For the primary end point of maximal exercise endurance on a treadmill at 9 months, achievement was similar in the routine and selective groups. For the secondary end points measuring functional status and quality of life, scores were also similar.