心血管疾病与诊断

Brucellosis is a rare zoonotic infection with an annual incidence of 100 to 200 cases in the United States. Infective endocarditis secondary to brucellosis involving native or prosthetic valves is contemplated to be an extremely rare entity, accounting for less than 2% of the total cases but amounting to 80% of mortality in brucellosis. As Brucella can present with non-specific sign and symptoms, clinicians need to have a higher degree of suspicion of Brucella endocarditis in culture-negative endocarditis patients particularly those who have a history of exposure to farm animals. Timely diagnosis with appropriate management using antibiotics can prevent valvular damage and restore the valve's structural integrity. In this case report, we present a case of culture-negative, serology proven Brucella endocarditis of native mitral valve, with an initial presentation of stroke that was successfully treated with combination antibiotic therapy.
 

Background: 2D PISA method has some technical limitations, mainly the geometric assumptions of PISA shape required to calculate effective regurgitant orifice area (EROA). Real-time three-dimensional (3D) color Doppler imaging allows measurement of PISA without geometric assumptions. The aim of this study was to validate this method in patients with chronic mitral regurgitation (MR).

Methods: 25 patients were included, ten (40%) with rheumatic MR, ten (40%) with functional MR, three (12%) with flail MV, one (4%) with MV prolapse and one (4%) with degenerative MR. EROA, regurgitant volume and regurgitant fraction were assessed using transthoracic 2D and 3D PISA methods. The quantitative Doppler EROA method and trans-thoracic VCW were used as reference methods.

Results: Both EROA and regurgitant volume assessed using the 3D PISA method had better correlations with the reference methods than conventional 2D PISA. A consistent significant underestimation of EROA and regurgitant volume using 2D PISA was observed. On the basis of the quantitative Doppler EROA method 14 patients had severe MR (EROA ≥ 0.4 cm²). Of these 14 patients, 78.5% (11 of 14) were underestimated as having non severe MR (EROA <0.4 cm²) by the 2D PISA method. In contrast, the 3D PISA method had 92.9% (13 of 14) agreement with The quantitative Doppler EROA method 14 patients had severe MR in classifying severe MR. Good intra-observer and interobserver agreement for 3D PISA measurements was observed, with intraclass correlation coefficients of 0.96 and 0.92, respectively.

Conclusion: Measurement of PISA without geometric assumptions using single-beat, real-time 3D color Doppler echocardiography is feasible in the clinical setting. MR quantification using this methodology is more accurate than the conventional 2D PISA method.

Introduction: It is known that diet plays a major role in metabolic disorders and CAD is no exception to it. Atheroma is developed due to oxidative stress and inflammation. This single case study was aimed to observe the effect of low calorie, high antioxidant diet on plaque volume.

Methods: Post-enrollment the patient underwent a CT-angiogram to measure plaque volume of the four major arteries. Thereafter for the next two months, the patient has advised a reverse diet kit, a scientifically designed diet box contains pre-portion ready to cook food products that fulfil daily requirements of breakfast, lunch, dinner, soup, and early morning diet. After two months the patient again underwent CT-angiogram.

Results: The results of the CT-angiogram show reduction in non-calcified plaque volume (baseline vs. post-diet: 48.9% vs. 38.4%). Also, there was a reduction in weight and blood pressure.

Objective: There is a scarcity of literature that documents the results of evidence-based traditional/complementary medicine. Aim of this study was to analyze survival benefit in patients that were treated with ayurvedic therapy called Sampurna Hridaya Shuddhikaran (SHS). Secondary endpoints were to observe a change in demographics and VO2peak.

Methods: This retrospective study analyzed data of CAD patients who received and completed 12-week SHS. Patients whose data was available before and after intervention were enrolled in the study. These patients were then approached via a telephonic call at 36 months to know their survival status and other demographic and clinical parameters.

Results: CAD patients (N=154, males: 127(82)) with a mean age of 63.19 ± 9.91 and LVEF: 50.79 ± 12.57 were enrolled in the study. Peak oxygen uptake (VO2peak) which is an independent predictor of survival benefit was documented to be increased post 12-weeks SHS treatment. At 36 months the all-cause mortality was reported to be 13%. Increase in age, gender (male/female), previous MI history was found to be associated with the mortality rate.

Conclusion: Enhanced survival percentage was observed at 36 months as compared to the documented clinical trials. Therefore, Ayurvedic interventions need to be a strong candidate for better management of CAD and survival benefits.

Introduction: Treatment of atherosclerosis and ischemic heart disease is a yet unresolved mystery. Reversal of atherosclerosis is studied by intra vascular ultrasound. Effect of atherosclerosis regression on myocardial perfusion is studied by SPECT myocardial perfusion (SPECT-MPI). Ayurvedic therapy in the form “ ischemia reversal programme” (IRP) was studied with SPECT-MPI to see its effect on myocardial perfusion.

Methods: The present open label study involved fourteen IHD patients who underwent IPR (21 IRP sittings) in Madhavbaug clinics, Maharashtra. The inclusion criteria was patients (aged between 40-70 years) with BMI >20 kg/m² and positive for stress test induced ischemia. However, patients with recent myocardial infarction/known hypo or hyper thyroidism/chornic kidney disorder were excluded. SPECT-MPI was performed at enrolment and after 21 IRP sittings. Additionally, VO₂ peak and time of ischemia after stress test were recorded.

Results: SPECT_MPI results showed significant difference in Summed Stress Score [SSS] (baseline vs. post 21 IRP sittings, 13.5+10.3 vs. 10.7+10.1; p=0.01) as well as Summed Difference Score [SDS] (baseline vs. post 21 IRP sittings, 8.9+6.2vs. 6.2+6.3; p=0.03) in IHD patients. Similarly an increase in VO₂ peak levels (baseline vs. post 21 IRP sittings, 12.8+5.7, vs. 19.4+7.8 and 23.6+6.0, post 25-30 IRP sittings) and time of ischemia in seconds (baseline vs. post 21 IRP sittings, 370.7+201.1 vs. 597.8+201.9 and 702.0+ 138.0, 30 days follow up) was recorded. Significant improvement post IRP (30.2+3.6, baseline vs. 32.7+3.5, post IRP sittings) was observed according to SAQ scores. However, ejection fraction score was not significantly changed post IRP vs. baseline.

Conclusion and Interpretation: Statistically significant improvement in myocardial perfusion after IRP in IHD patients is observed, depicting positive role of IRP in IHD management.