Publications by authors named "Jagat Narula"
The burden of cardiovascular disease has declined in high-income countries in the past 3 decades but is growing in low- and middle-income countries due to epidemiological, demographic, and socioeconomic shifts. A range of cost-effective policies and interventions are available for advancing cardiovascular health (CVH) through primordial, primary, and secondary prevention. We showcase multifaceted challenges that stifle the global progress of CVH including shortcomings in financial protection, health systems, primary health care, national health policies, service coverage, and surveillance.
View Article and Find Full Text PDFHigh-Risk Lesion-Level Physiology and Morphology: A Marriage With Unhappy Ending….
JACC Cardiovasc Imaging
January 2025
Aims: Quantitative rest-stress myocardial perfusion in millilitres per minute per gram among multiple 2D and 3D positron emission tomography-computed tomography (PET-CT) scanners is essential for personalized cardiac management and clinical trials. Accordingly, this study reports the accuracy and precision of quantitative rest-stress millilitres per minute per gram and coronary flow capacity among 2D and two different digital 3D silicon photomultiplier (SiPM) PET-CT scanners for quantifying the severity of coronary pathophysiology for clinical trials or guiding interventions vs. medical treatment.
View Article and Find Full Text PDFIn heart failure, sympathetic overdrive is evidenced by norepinephrine spillover, receptor level changes, etc. Beta-blockers continue to be the cornerstone of treatment in patients with chronic heart failure due to their ability to counteract sympathetic overdrive. Extensive clinical research has demonstrated that long-term beta-blocker treatment with metoprolol succinate, carvedilol, or bisoprolol enhances left ventricular function and reverses left ventricular remodeling, decreases hospitalization risk, and increases survival.
View Article and Find Full Text PDFCoronary artery calcium (CAC) scans contain valuable information beyond the Agatston Score which is currently reported for predicting coronary heart disease (CHD) only. We examined whether new artificial intelligence (AI) applied to CAC scans can predict non-CHD events, including heart failure, atrial fibrillation, and stroke. We applied AI-enabled automated cardiac chambers volumetry and calcified plaque characterization to CAC scans (AI-CAC) of 5830 asymptomatic individuals (52.
View Article and Find Full Text PDFArticle Synopsis
- The study investigated the left atrial septal pouch (LASP), a variant found in about one-third of hearts due to incomplete fusion of two septal structures, the septum primum (SP) and septum secundum (SS).
- Out of 864 heart scans analyzed, 242 patients (31.4%) were found to have LASP, while 181 (23.5%) had a patent foramen ovale (PFO) and 339 (44.0%) had a completely fused septum (CFS).
- Significant differences were noted in the lengths of the SS and overlapping SP among different groups, with LASP hearts showing longer measurements, but similar atr
Background: Robust and accurate prediction of cardiovascular disease (CVD) risk facilitates early intervention to benefit patients. The intricate relationship between mental health disorders and CVD is widely recognized. However, existing models often overlook psychological factors, relying on a limited set of clinical and lifestyle parameters, or being developed on restricted population subsets.
View Article and Find Full Text PDFArticle Synopsis
- * Current guidelines recommend early combination therapy using four drug classes, especially ARNI, which significantly reduces morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF).
- * A national consensus by Indian cardiology experts emphasizes that ARNI should be initiated early in HFrEF patients, including those hospitalized, and can also benefit patients with preserved and mildly reduced ejection fractions.
Advanced imaging of cardiac Paraganglioma: A systematic review.
Int J Cardiol Heart Vasc
August 2024
Background And Aims: Cardiac ParaGangliomas (PGLs) are rare extra-adrenal tumours that arise from chromaffin cells of the sympathetic ganglia. PGL are often diagnosed incidentally, with no symptoms or symptoms related to cardiovascular dysfunction.
Methods: Cardiac Computed Tomography (CCT) and Cardiac Magnetic Resonance (CMR) can detect the correct morphology and position of the lesion and provide proper tissue characterization.
Background: Clinical outcomes of patients presenting with STEMI are significantly improved by reducing time from vessel occlusion to coronary blood flow restoration. In an effort to improve outcomes, we developed a secure mobile application, STEMIcathAID, and designed a pilot project implementing the app into the workflow for STEMI patients transfer. The aim of the study is to assess the impact of the app on key metrics for STEMI transfer before (historic) and after app launch.
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- The study investigates whether the uptake of F-FDG and F-NaF can predict the expansion of abdominal aortic aneurysms in a rat model, highlighting a correlation between imaging uptake and pathological markers.
- The research involved 74 male rats and monitored changes in aortic size and imaging metrics over a period of 8 weeks, with effects from different medications assessed.
- Results indicated that F-FDG and F-NaF uptake varied over time, with specific drugs influencing these changes, and showed that F-NaF uptake at 1 week was the strongest predictor of final aortic size, suggesting potential for these imaging techniques in monitoring aneurysm progression.
Article Synopsis
- - The study evaluated how various cardiometabolic risk factors, such as metabolic syndrome and individual factors like high fasting glucose and low HDL cholesterol, impact the progression of coronary plaque and the likelihood of major cardiovascular events in patients with stable coronary artery disease.
- - In a cohort of 1,200 patients followed over several years, 28% experienced rapid coronary plaque progression, identified primarily through increased atheroma volume, which indicates worsening arterial health.
- - The findings suggest that a combination of risk factors, particularly high blood sugar and blood pressure, significantly forecast both plaque progression and serious cardiovascular incidents, highlighting the importance of monitoring these factors in at-risk patients.
Article Synopsis
- 3D intracardiac echocardiography (ICE) is becoming a valuable alternative to transesophageal echocardiography for guiding heart procedures, particularly in structural heart interventions.
- The expert position statement outlines standardized practices for using 3D-ICE, detailing necessary imaging fundamentals, views, and workflows for various procedures like transeptal puncture and device closures.
- Additionally, the paper addresses current challenges, potential future developments, and training needs to ensure that operators are proficient with 3D-ICE, aiming to enhance its safety and effectiveness in clinical settings.
Background: Coronary artery calcium (CAC) scans contain valuable information beyond the Agatston Score which is currently reported for predicting coronary heart disease (CHD) only. We examined whether new artificial intelligence (AI) algorithms applied to CAC scans may provide significant improvement in prediction of all cardiovascular disease (CVD) events in addition to CHD, including heart failure, atrial fibrillation, stroke, resuscitated cardiac arrest, and all CVD-related deaths.
Methods: We applied AI-enabled automated cardiac chambers volumetry and automated calcified plaque characterization to CAC scans (AI-CAC) of 5830 individuals (52.
Article Synopsis
- - Preeclampsia is a major pregnancy complication that significantly increases the risk of cardiovascular disease (CVD) for both mothers and infants, especially among Black women.
- - Early preeclampsia, occurring before 34 weeks of gestation, leads to systemic vascular issues that can cause lasting heart damage and pose long-term risks for heart failure (HF).
- - It’s important for women who experienced early or severe preeclampsia to receive careful monitoring after pregnancy to manage chronic hypertension and decrease the risks of CVD and HF.
Calcific aortic valve disease (CAVD) is a widely prevalent heart disorder in need of pharmacological interventions. Calcified areas in aortic valves often contain amyloid fibrils that promote calcification in vitro. This opinion paper suggests that amyloid contributes to CAVD development; amyloid-assisted nucleation can accelerate hydroxyapatite deposition onto collagen matrix.
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- A study was conducted to improve the prediction of which coronary artery lesions could lead to acute coronary syndrome (ACS) by integrating artificial intelligence (AI) with traditional methods.
- The research focused on patients who had undergone coronary CT angiography (CTA) before experiencing an ACS event, analyzing both culprit (problematic) and nonculprit lesions.
- The new model incorporating AI features showed significantly better predictability for identifying high-risk lesions compared to standard methods, suggesting that AI can enhance cardiac risk assessment.
Background: Diet is a key modifiable risk factor of coronary artery disease (CAD). However, the causal effects of specific dietary traits on CAD risk remain unclear. With the expansion of dietary data in population biobanks, Mendelian randomization (MR) could help enable the efficient estimation of causality in diet-disease associations.
View Article and Find Full Text PDFCurrent Place of SGLT2i in the Management of Heart Failure: An Expert Opinion from India.
J Assoc Physicians India
January 2024
Article Synopsis
- * Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are new medications that not only help control blood sugar in T2DM but also provide significant cardiovascular benefits for HF patients.
- * Evidence shows that SGLT2i can enhance heart function and improve outcomes in HF whether patients have diabetes or not, making them valuable for a wide range of HF patients, especially in India.
Article Synopsis
- South Korea's economic growth over the past two decades has affected the clinical profile of patients with rheumatic mitral stenosis (MS), leading to older patients with more severe conditions and comorbidities like hypertension and atrial fibrillation.
- Analysis of data from 2,337 patients showed that while the rate of mitral interventions increased, the overall clinical outcomes worsened, indicating a need for improved treatment strategies.
- Despite stable stroke incidence due to better anticoagulation therapy, the findings emphasize the challenges faced as the healthcare landscape transitions with the country’s development.
Aims: Coronary computed tomography angiography provides non-invasive assessment of coronary stenosis severity and flow impairment. Automated artificial intelligence (AI) analysis may assist in precise quantification and characterization of coronary atherosclerosis, enabling patient-specific risk determination and management strategies. This multicentre international study compared an automated deep learning-based method for segmenting coronary atherosclerosis in coronary computed tomography angiography (CCTA) against the reference standard of intravascular ultrasound (IVUS).
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- - The study investigates how high-intensity coronary plaques (HIPs) detected through T1-weighted MRI relate to fractional flow reserve (FFR) measurements in patients with chronic coronary syndrome.
- - Researchers analyzed data from 281 vessels and found that a higher plaque-to-myocardial signal intensity ratio (PMR) in stenotic lesions correlated with lower FFR values, indicating greater myocardial ischemia risk.
- - The presence of HIPs was identified as a significant independent predictor of low FFR, underscoring the impact of plaque characteristics on myocardial ischemia severity, even when accounting for other plaque features.
Article Synopsis
- In patients with complex coronary artery disease, selecting a revascularization strategy using coronary computed tomography angiography (CCTA) shows high agreement with invasive coronary angiography (ICA) results.
- The study involved planning coronary artery bypass grafting (CABG) based on CCTA alone, achieving a high feasibility rate of 99.1% and strong agreement between the CCTA team and actual treatment decisions.
- Follow-up results indicated a 92.6% graft patency rate after 30 days, with low rates of major adverse cardiac events (7.2%) and major bleeding (2.7%), supporting the safety of this approach.
Article Synopsis
- The Lipid Association of India updated its cardiovascular risk assessment algorithm to address the unique challenges of atherosclerotic cardiovascular disease (ASCVD) in Indians, focusing on early intervention.
- A series of expert meetings were held to review current evidence and refine treatment guidelines, emphasizing the need for aggressive preventive measures due to the young age of onset for ASCVD in the Indian population.
- The updated recommendations aim to enhance LDL-C-lowering therapy and improve risk management strategies for individuals at high risk of ASCVD, ultimately striving to reduce its prevalence in India and beyond.