Publications by authors named "Sudhanshu Dwivedi"

Background: Permanent pacemaker implantation has the potential to impact left ventricular (LV) function and hence quality of life (QoL) in the long term.

Aim: To assess the effect of single- and dual-chamber pacing on LV function and QoL.

Methods: This study included 56 patients who underwent permanent pacing: Dual pacing, dual sensing, dual responsive and rate responsive (DDDR) for the initial 3 months and ventricular pacing, ventricular sensing, inhibited response and rate responsive (VVIR) for the next 3 months, and DDDR mode for the last 3 months.

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  • The study focused on non-ischemic symptomatic reversible bradyarrhythmia, a condition that can be often misunderstood in clinical settings, aiming to determine how often it recurs and the predictors for needing permanent cardiac pacing.
  • It included 124 adults monitored for up to 24 months after conservative treatment, finding that 21.8% required permanent pacing due to recurrence, with common causes being certain medications and high potassium levels.
  • Key predictors for needing pacing included advanced atrioventricular block and bifascicular block observed during the patient's initial hospitalization, highlighting the need for closer monitoring and potential intervention.
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Aims: Underlying mechanisms responsible for acute coronary syndrome (ACS) in young patients compared with older counterparts are yet to be explored with optical coherence tomography (OCT). This study aims to explore underlying mechanisms of ACS in ≤35- (very young) and >35-year-old (older counterparts) ACS patients using OCT.

Methods And Results: This was a prospective, single-centre, investigational study.

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Objectives We investigated the reproducibility of fractional flow reserve (FFR) of significant stenoses (≥70% narrowing) in the non-infarct related artery (NIRA) during the pharmaco-invasive percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) within 24 hours of thrombolysis and at a follow up of 2-3 weeks. Background STEMI with multivessel disease has worse outcomes. The benefits of FFR-directed PCI of NIRA at the time of primary PCI are yet controversial.

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  • * A total of 34 patients were examined, with results revealing two main types of neointimal hyperplasia: homogenous and non-homogenous, with a significant number of diabetics in the homogenous group.
  • * Key findings highlighted the presence of neoatherosclerosis and stent underexpansion, and the only significant association found was between diabetes and homogenous neointimal hyperplasia.
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Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80-90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms.

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Background: Anatomic complete revascularization (ACR) and functional complete revascularization (FCR) have been associated with reduced death and myocardial infarction (MI) in some prior studies. The impact of complete revascularization (CR) in patients undergoing an invasive (INV) compared with a conservative (CON) management strategy has not been reported.

Objectives: Among patients with chronic coronary disease without prior coronary artery bypass grafting randomized to INV vs CON management in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial, we examined the following: 1) the outcomes of ACR and FCR compared with incomplete revascularization; and 2) the potential impact of achieving CR in all INV patients compared with CON management.

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Left main coronary artery chronic total occlusion is an unusual finding discovered on coronary angiography. Historically, coronary artery bypass graft has been the preferred treatment. However, recent studies have revealed the role of left main percutaneous coronary intervention in selected patients.

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  • ST-elevation myocardial infarction (STEMI) is a serious heart condition that requires quick treatment to restore blood flow, and if timely primary intervention isn't possible, a pharmacoinvasive strategy (thrombolysis followed by PCI) can be implemented.
  • This study analyzed the effectiveness of delayed pharmacoinvasive therapy (PCI performed 24-72 hours after thrombolysis) compared to routine therapy (PCI within 3-24 hours) in patients with STEMI.
  • Results showed no significant differences in major adverse cardiac events or complications between the two treatment groups within 30 days after the procedure, despite the longer wait for PCI in the delayed group.
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The present study sought to assess the clinical outcomes of the Mozec™ Non-compliant (NC) Rx PTCA balloon dilatation catheter (BDC) (Meril Life Sciences Pvt. Ltd., Vapi, India) for dilatation of coronary lesions.

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Background: Several lines of evidence have supported small dense low-density lipoproteins (sd-LDL) as a marker of cardiovascular disease. The present study assessed the relationship between lipid profile and sd-LDL levels with demographic, clinical, angiographic, and therapeutic variables in acute coronary syndrome (ACS) patients. Methods: This was a single-centre, prospective, cross-sectional study conducted from September 2014 to September 2015.

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Introduction: Levels of lipoprotein (LP) (a) are useful marker for risk stratification of cardiovascular disease. This genetic biomarker is suggestive of patient predisposition to acute coronary event. The present study was to study correlation of LP(a) levels and plaque morphology in very young patients (<35 years) with acute coronary syndrome (ACS).

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Background: Ischemia with nonobstructive coronary arteries (INOCA) is common clinically, particularly among women, but its prevalence among patients with at least moderate ischemia and the relationship between ischemia severity and non-obstructive atherosclerosis severity are unknown.

Objectives: The authors investigated predictors of INOCA in enrolled, nonrandomized participants in ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), sex differences, and the relationship between ischemia and atherosclerosis in patients with INOCA.

Methods: Core laboratories independently reviewed screening noninvasive stress test results (nuclear imaging, echocardiography, magnetic resonance imaging or nonimaging exercise tolerance testing), and coronary computed tomography angiography (CCTA), blinded to results of the screening test.

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  • Coronary sinus (CS) imaging is important for mapping heart conditions and is currently done using retrograde venogram, especially during cardiac resynchronization therapy (CRT).
  • This study evaluated the anatomy of the CS during the levophase of coronary angiography in 164 patients to help improve left ventricular lead placement during CRT.
  • Results showed that while the visibility of coronary veins was generally good, there was a variety in the size and shape of the CS ostium and variations in the take-off angles of coronary veins, which could impact LV lead implantation strategies.
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  • A study was conducted to evaluate the safety and effectiveness of a heparin rota-flush (OHRF) solution compared to an alternative rota-flush (ARF) solution during rotational atherectomy (RA) procedures.
  • Out of 48 patients, 25 received the OHRF solution and 23 received the ARF solution, with both groups achieving procedural success without significant differences in related cardiovascular adverse events.
  • The findings suggest that OHRF is a simpler option for rotablation, with potential to reduce certain side effects like hypotension and bradycardia.
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Background: Prevalence of abdominal aortic aneurysm (AAA) has ethnic differences, and coronary artery disease (CAD) shares several risk factors with AAA. Sparse Indian data are available on this. We evaluated the prevalence of AAA during transthoracic echocardiography (TTE) and risk factors of AAA in patients with CAD.

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Objective: The concept of managing patients on the basis of culprit lesion characteristics is emerging. Atherosclerotic plaques are reported to be rare in young patients presenting with acute coronary syndrome (ACS). We aimed to assess culprit lesion characteristics in very young patients presenting with ACS by optical coherence tomography (OCT).

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Background: Forearm hematomas are not uncommon after transradial coronary interventions. The present study describes the incidence and predictors of forearm hematoma formation after transradial coronary interventions.

Methods: This was a prospective study in 1754 patients undergoing angiography/angioplasty through transradial access.

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Background: The ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) postulated that patients with stable coronary artery disease (CAD) and moderate or severe ischemia would benefit from revascularization. We investigated the relationship between severity of CAD and ischemia and trial outcomes, overall and by management strategy.

Methods: In total, 5179 patients with moderate or severe ischemia were randomized to an initial invasive or conservative management strategy.

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Background: Determining the infarct-related artery in STEMI during a coronary angiogram can be challenging due to the affliction of multiple vessels. Isolated STEMI involving only EKG leads I and aVL is infrequent. Localization of infarct-related artery based on EKG findings has not been previously done in this subset.

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Background: Many patients with dilated cardiomyopathy (DCMP), presenting with only dyspnea, have hidden ischemic etiology. In low-income countries, logistic and financial restraints lead to reduced identification of this ischemic burden. We aimed to assess the role of coronary angiography in patients with cardiomyopathy presenting predominantly dyspnea.

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Objective: The purpose of this study was to determine the time to reversal of complete AV block (CAVB) in ST-segment elevation myocardial infarction (STEMI) with various modalities of treatment and to examine the factors associated with early reversal of CAVB.

Methods: We prospectively assessed the STEMI patients complicated by CAVB. The mean time to reversal of CAVB was analyzed and compared according to the treatment received.

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Background: Thrombolytic therapy has evolved as an alternative to surgery for prosthetic valve thrombosis (PVT). Therefore, this retrospective, single-center study aimed to evaluate the clinical profile of PVT and the role of thrombolytic therapy in patients with PVT.

Methods: Data from a total of 16 consecutive patients with PVT enrolled between January 2017 and January 2018 at a tertiary care center in India were retrospectively evaluated.

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