Publications by authors named "Narula J"

Context: Ischemic heart disease (IHD) due to coronary atherosclerosis constitutes the leading cause of morbidity and mortality worldwide. This review was undertaken to document the historical basis for our contemporary understanding of atherosclerosis-based disease and to provide a rationale for continued support for autopsy-based research to make further progress in reducing the morbidity and mortality from atherosclerosis-related disease.

Objectives: To analyze the contributions of the autopsy-initiated pathological studies to complement and validate other lines of investigation in determining the pathology and pathogenesis of the leading worldwide cause of morbidity and mortality, namely, atherosclerosis and its major complications of coronary atherosclerosis, ischemic heart disease, coronary thrombosis, acute myocardial infarction, and sudden cardiac death.

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Context: Ischemic heart disease (IHD) due to coronary atherosclerosis constitutes the leading cause of morbidity and mortality worldwide. This review was undertaken to retrospectively analyze the lines of research that generated the evidence for our contemporary understanding of atherosclerosis-based coronary artery disease and to provide a rationale for continued support for autopsy-based research in order to make further progress in reduction of the morbidity and mortaility from IHD.

Objectives: To analyze the contributions of the autopsy to complement and validate other lines of investigation in determining the complex interactions between coronary artery alterations linked to the major manifestations of coronary atherosclerosis, namely, coronary thrombosis, acute myocardial infarction, and sudden cardiac death.

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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.

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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.

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The Radiology Research Alliance (RRA) of the Association of Academic Radiology (AAR) creates task forces to study emerging trends shaping the future of radiology. This article highlights the findings of the AAR-RRA Task Force on Balancing High Clinical Volumes and non-relative value unit (Non-RVU)-Generating Activities. The Task Force's mission was to evaluate and emphasize the value of non-RVU-generating activities that academic radiologists perform.

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In 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.

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Cardiopulmonary resuscitation (CPR) is a critical intervention for cardiac arrest but can result in significant internal injuries due to the force of chest compressions. Among these, subcapsular hepatic hematoma is a rare and serious complication. Here we present a 55-year-old male with a history of alcohol abuse presented with a severe ischemic stroke and subsequently required CPR due to pulseless ventricular tachycardia.

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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) 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.

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Article 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
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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.

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  • * 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.
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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.

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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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Sexual reproduction relies on meiosis, a specialized cell division program that produces haploid gametes. Oocytes of most organisms lack centrosomes, and therefore chromosome segregation is mediated by acentrosomal spindles. Here, we explore the role of Polo-like kinase 1 (PLK-1) in oocytes, revealing mechanisms that ensure the fidelity of this unique form of cell division.

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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.
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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.
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  • 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.
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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.

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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.
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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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Article Synopsis
  • 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.
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