Explore the vast range of titles available.

BACKGROUND: Aspirin is indicated in the emergency management of acute coronary syndrome. However, oral aspirin has erratic bioavailability compared to i.v. formulation. OBJECTIVE: The objective of this study was to evaluate the comparative efficacy and safety of intravenous (IV) and oral aspirin in acute coronary syndrome. STUDY DESIGN: This was a systematic review and meta-analysis. RESULTS: Two randomized controlled trials were included. Compared to oral aspirin, lower platelet aggregability was seen with IV aspirin at 5 min and 20 min. Lower thromboxane B2 and lower platelet CD-62p levels were noted in the IV group; however, no significant difference was observed in terms of \"composite cardiovascular death, stroke, and myocardial infarction (MI) at 4-6 weeks,\" \"any cause mortality,\" \"cardiovascular mortality,\" \"occurrence of stroke,\" and \"occurrence of MI/reinfarction.\" However, no difference was noted in terms of the occurrence of serious adverse events. CONCLUSION: IV aspirin showed some advantages in terms of platelet aggregability biomarkers at 20 min and 1 week with comparable safety to oral aspirin. No difference was seen in terms of clinical outcomes (at 24 h, 7, and 30 days) and the occurrence of serious adverse events.

Bioreceptor functionalized metallic nano-colloids have been identified as effective nanobioprobes to realize the detection of an analyte based on a common phenomenon of salt-induced aggregation. In marked contrast to this, we describe a nano-sandwich assay integrating the novel match-pair of aptamer and peptide functionalized gold nanoparticles. The site-directed biomolecular interaction of high affinity aptamer and peptide bioreceptors directed towards distinct sites of cardiac biomarker troponin I; this was found to form a nano-sandwich assay in a peculiar manner. The gold nanoconjugates interact with specific and distant regions of troponin I to result in collision of probes upon target identification. In the presence of TnI, both nanobioprobes bind at their respective sites forming a nano-sandwich pair providing a visual color change from red to blue. Thus, the presence of target TnI itself causes instant agglomeration in just a single-step without addition of any external aggregator. The assay imparts 100% specificity and 90% sensitivity in a dynamic concentration range of 0.1–500 ng/mL troponin I with detection limit as low as 0.084 ng/mL. The applicability of the assay has been validated in clinical samples of acute myocardial infarction patients thus establishing a promising point-of-care detection of TnI. Graphical abstract

Severe pulmonary artery hypertension (PAH) is a disorder with limited treatment options. Recently, several newer drugs have recently been introduced to treat PAH. Sildenafil is one which has shown promise in several uncontrolled studies, but controlled trials have been few. In this randomized placebo-controlled study, we evaluated the efficacy of oral sildenafil in idiopathic PAH and PAH caused by Eisenmenger syndrome. This was a randomized, double-blind, placebo-controlled crossover study. Twenty patients, 10 of each of idiopathic PAH and Eisenmenger syndrome, were randomized to receive placebo or sildenafil in a double-blind manner for 6 weeks and, after a washout period of 2 weeks, were crossed over. The primary end point of efficacy was the improvement in distance covered in 6-minute walk test. Secondary end points were reduction in pulmonary artery pressure as measured by Doppler echocardiography after 6 weeks of treatment, improvement in clinical condition, New York Heart Association (NYHA) class, and exercise duration and metabolic equivalents (Mets) achieved on modified Bruce exercise protocol. There was significant improvement in primary and secondary end points. The primary end point of distance covered in 6-minute walk test improved from 262 ± 99 to 358.9 ± 96.5 m ( P < .0001) after treatment with sildenafil. Pulmonary artery pressure, the secondary end point, improved from the baseline of 98.8 ± 20.5 to 78.3 ± 15.3 mm Hg ( P < .0001), NYHA class improved from 2.65 ± 0.59 to 1.55 ± 0.51 ( P < .0001), exercise duration from 6.4 ± 3.1 to 10.2 ± 2.05 minutes ( P < .0001), and Mets achieved from 3.32 ± 1.57 to 6.04 ± 1.87 ( P < .0001) after treatment with sildenafil. There was no significant fall in blood pressure with placebo and sildenafil, and no serious side effects of drug were observed in the study. Sildenafil significantly improved the symptomatic status, exercise capacity, NYHA class, and hemodynamic parameters of patients with severe PAH and can be safely used as a primary or adjunctive treatment of the same.

Coarctation of aorta (CoA) is one of the common congenital heart diseases. The two approaches for intervention in CoA include surgical and transcatheter (TC). Out of the two TC interventions available, stenting has been proved better than balloon angioplasty. We have two types of stents; the conventional ones - balloon expandable and the covered stent grafts. The elective covered stent implantation in all CoA has not offered any advantage. However, there are peculiar situations, apart from acute aortic complications, when they should be considered the first choice. We describe our experience of three cases of coarctation stenting, in which covered stenting should have been the preferred choice. A 32-year-old female with Turner's syndrome and severe CoA developed dissection after balloon angioplasty which was successfully managed with a covered stent. A 27-year-old female with near atresia of aorta was managed with balloon expandable stent which remained underexpanded despite post dilatation. A 17-year-old girl with severe CoA and patent ductus arteriosus (PDA) was managed with balloon angioplasty for the CoA and Amplatzer Duct Occluder I for the PDA. However, she developed re-coarctation in 6 months which was managed with a covered stent. Not all CoA requires the covered stents, but there are certain \"high risk\" CoA which require covered stent as first choice.

While Multisite stimulation in Cardiomyopathy (MUSTIC-SR), Multicenter In Sync Randomized Clinical Evaluation (MIRACLE), and CONTAK CD trials showed a significant improvement in NYHA functional class and peak oxygen consumption (pVO2) in selected patients of HFrEF (NYHA classes III and IV) with CRT, the subsequent two trials, Cardiac Resynchronization in Heart Failure Trial (CARE HF) and Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (CHAMPION) trials, provided evidence for a reduction in mortality and HF hospitalizations in same functional class of patients with HFrEF [6]. [...]the CRT has shown maximum and most consistent benefit only in a subset of patients with HFrEF and has a non-response rate of 30% even in this highly selected subgroup. Summary of major randomized controlled trials on angiotensin receptor neprilysin inhibitor Trial Intervention Comparator Inclusion criteria Primary endpoints Outcomes PARADIFM-HF (2014) (n = 8399) F/up 27 months Sacubitril/vvalsartan Enalapril -LVRF ≤ 35 -NYHA classes II–IV -Elevated NP Composite of CVD or HF hospitalization Primary endpoint HR = 0.80 (0.73–0.87) P = 0.0000002 CVD HR = 0.80 (0.71–0.89) P = 0.00004 All-cause mortality HR = 0.84 (0.76–0.93) P < 0.0001 Symptomatic hypotension (14% vs 9.2%; P < 0.001) TITRATION (2016) (n = 498) F/up 12 weeks Condensed regimen (full dose of ARNI by 3 weeks) Comparator regimen (full dose of ARNI by 6 weeks) LVEF ≤ 35% NYHA classes II–IV Adverse events (hypotension, renal dysfunction, hyperkalemia, angioedema) No significant difference PIONEER-HF (2019) (n = 881) F/up 8 weeks Sacubitril/valsartan Enalapril LVEF ≤ 40% Elevated NP Hospitalized for ADHF Time-averaged change of NT-proBNP Primary endpoint HR 0.71 (0.63–0.81), P < 0.05 HF rehospitalization 8.0 % vs. 13.8%, P < 0.05 PARAMOUNT (2012) (n = 301) F/up 12 weeks Sacubitril/valsartan Valsartan LVEF ≥45% NYHA classes II–III Elevated NP Change in NT-pro BNP from baseline Significant change in favor of ARNI: Ratio 0.77 (0.64–0.92) PARAGON-HF (2019) (n = 4822) F/up 35 months Sacubitril/valsartan Valsartan LVEF ≥ 45% NYHA classes II–III Elevated NP Composite of HF hospitalizations and CVDs Non-significant Relative risk 0.87 (0.75–1.01) EVALUATE-HF (2019) (n = 464) F/up 12 weeks Sacubitril/valsartan Enalapril LVEF ≤40% NYHA classes I–III History of hypertension Aortic characteristic impedance (Zc) Non-significant difference in two groups PRIME (2019) (n = 118) F/up 12 months Sacubitril/valsartan Valsartan LVEF 25–50% NYHA classes I–III Chronic functional MR (EROA >  0.1 cm2 despite optimal medical therapy) Change in EROA Significant decrease in EROA (∇ 0.04cm2), regurgitant volume (∇ 7.3 ml), LVEDVI (∇ 7.01 ml) PROVE-HF (2019) (n = 794) F/up 12 months Sacubitril/valsartan ACEi/ARB LVEF ≤ 40% NYHA II–IV Correlation between change in NT-pro BNP and remodeling (LVEF, LVEDVi, LVESVi, LAVi, E/E/e' at 12 months Significant correlations observed between the change in NT-proBNP concentration and all cardiac remodeling parameters ACEi Angiotensin-converting enzyme inhibitor, ADHF Acute decompensated heart failure, ARB Angiotensin receptor blocker, ARNI Angiotensin receptor neprolysin inhibitor, CV Cardiovascular, CVD Cardiovascular death, E/e' Ratio of early mitral diastolic filling velocity/early diastolic mitral annular velocity, EROA Effective regurgitant orifice area, EVALUATE-HF Effect of Sacubitril-Valsartan Versus Enalapril on Aortic Stiffness in Patients with Heart Failure and Reduced Ejection Fraction, F/up Follow-up, HF Heart failure, HR Hazard ratio, LAVi Left atrial volume index, LVEDVi LV end-diastolic volume index, LVEF Left ventricular ejection fraction, LVESVi LV end-systolic volume index, MR Mitral regurgitation, NP Natriuretic peptide, NT-proBNP N-terminal-pro B-type NP, NYHA New York Heart Association, PARADIGM-HF Prospective comparison of Angiotensin Receptor-Neprilysin Inhibitor (ARNI) with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure, PARAGON-HF Prospective Comparison of ARNI with ARB Global Outcomes in HF With Preserved Ejection Fraction, PARAMOUNT Prospective comparison of ARNI with ARB on Management Of heart failure with preserved ejection fraction, PIONEER-HF Comparison of Sacubitril-Valsartan versus Enalapril on Effect on NT-proBNP in Patients Stabilized from an Acute Heart Failure Episode, PRIME Pharmacological Reduction of Functional, Ischemic Mitral Regurgitation, PROVE-HF Prospective Study of Biomarkers, Symptom Improvement and Ventricular Remodeling During Entresto Therapy for Heart Failure, RFT Renal function test, ∇ Change CRT and ARNI: cardiac remodeling CRT is considered one of the most powerful cardiac remodeling agents, second only to beta blockers [4].

There has been tremendous progress in treatment of heart disease in children. Device therapy is increasingly being used in acyanotic congenital heart disease, while surgical results have improved significantly to give smile to many cyanotic heart disease children and their parents. This article makes an attempt to increase awareness of general pediatricians about common congenital heart diseases.

Early recognition and timely management of cyanotic congenital heart disease (CCHD) is necessary for good outcome. CCHD is an umbrella term encompassing many diseases with variable pathophysiology, which determines clinical presentation of CCHD. Conditions like total anomalous pulmonary venous connection (TAPVC) and transposition of great arteries (TGA) usually present in neonatal period. Tetralogy of Fallot (TOF) and related conditions present with squatting, cyanotic spells and silent chest with no evidence of congestive heart failure, whereas transposition physiology presents with congestive heart failure with cyanosis.

Pediatricians often find it difficult to make specific diagnosis of arrhythmia based on ECG. This article is an effort to make the pediatricians understand common arrhythmias. Diagnosing arrhythmias is important as some arrhythmias, if not diagnosed or suspected, can lead to heart failure. With proper diagnosis, some of them can be cured with therapeutic ablation. Adenosine is not only a therapeutic drug but in many circumstances, it gives definite diagnosis also.

The speckle noise is inherent to transthoracic echocardiographic images. A standard noise-free reference echocardiographic image does not exist. The evaluation of filters based on the traditional parameters such as peak signal-to-noise ratio, mean square error, and structural similarity index may not reflect the true filter performance on echocardiographic images. Therefore, the performance of despeckling can be evaluated using blind assessment metrics like the speckle suppression index, speckle suppression and mean preservation index (SMPI), and beta metric. The need for noise-free reference image is overcome using these three parameters. This paper presents a comprehensive analysis and evaluation of eleven types of despeckling filters for echocardiographic images in terms of blind and traditional performance parameters along with clinical validation. The noise is effectively suppressed using the logarithmic neighborhood shrinkage (NeighShrink) embedded with Stein’s unbiased risk estimation (SURE). The SMPI is three times more effective compared to the wavelet based generalized likelihood estimation approach. The quantitative evaluation and clinical validation reveal that the filters such as the nonlocal mean, posterior sampling based Bayesian estimation, hybrid median, and probabilistic patch based filters are acceptable whereas median, anisotropic diffusion, fuzzy, and Ripplet nonlinear approximation filters have limited applications for echocardiographic images.