|Year : 2019 | Volume
| Issue : 3 | Page : 115-116
Editor's Page July 2019
Ravi R Kasliwal MD, DM, FIMSA, MNAMS, FASE
Editor-in-Chief, Journal of Clinical and Preventive Cardiology, Gurgaon, Haryana, India
|Date of Web Publication||31-Jul-2019|
Dr. Ravi R Kasliwal
Chairman, Clinical and Preventive Cardiology, Medanta - The Medicity, Sector 38, Gurgaon, Haryana - 122 001
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kasliwal RR. Editor's Page July 2019. J Clin Prev Cardiol 2019;8:115-6
Aboard an Aeroflot flight from Moscow and St. Petersburg to Delhi NCR, I could not help thinking that the temperature here was 17°–20°, but in a few hours, back home, the temperature would be almost 45°. A few hours in the plane and a tremendous change! However, the sheer beauty of the Cathedrals of St Petersburg lingered in my mind.
While reviewing the first article “Ultrasonographic assessment of subclinical atherosclerosis in smokers aged <40 years,” I could not help wondering that despite smoking being one of the most known risk factors for coronary artery disease, cerebrovascular disease, peripheral vascular disease, and cancers, the deadly habit is still rampant. One person dies every 4.5 s from tobacco-related diseases, and almost 100 million deaths occurred in the 20th century from tobacco! If no action is taken, this number could rise to one billion people in the 21st century.
This article highlights the fact that smoking initiates and accelerates subclinical atherosclerosis and that noninvasive ultrasonographic techniques help detect it at an early stage – although a small study, but one that sends a strong message.
The area of atherosclerosis imaging has been very close to my heart. Over the past two decades, our group has extensively studied the role of atherosclerosis imaging in cardiovascular risk stratification in Indian subjects,,,,,,,, and has also defined normal reference values of carotid intima-media thickness for Indians. The concept of atherosclerosis imaging is based on a very sound principle that instead of looking at cardiovascular risk factors and guessing the probability of developing cardiovascular disease, it would be more meaningful to detect the disease directly, using tools that can detect it at a very early stage when institution of appropriate remedial measures can halt, or even reverse, the progression of the disease. Coronary calcium score has emerged as the most useful modality for this purpose; however, in expert hands, carotid ultrasound is also quite useful and clinically relevant. The above study by Singh et al. reiterates the same.
Continuing on the theme of vascular disease, peripheral artery disease is an important disease state and often overlooked. A single author study from Nigeria on “Skin manifestations of peripheral artery disease: Prevalence and diagnostic utility” highlights the importance of ankle-brachial index over skin manifestations in the diagnosis of peripheral artery disease.
Diagnosis of coronary artery disease has always posed problems in women, with false-positive exercise electrocardiographic stress test (the so-called treadmill test) being quite common. The present study “Two-dimensional speckle tracking echocardiography as a predictor of significant coronary artery stenosis in female patients with effort angina who are treadmill test positive: An angiographic correlation” proposes the use of global longitudinal stain (GLS) in the prediction of severity of coronary artery disease in women. The patient population is robust, and the optimum GLS cutoff is 17.5%. The study could be a trend setter.
Automated implantable cardioverter defibrillators (AICDs) are an integral part of treatment of patients with heart failure with reduced ejection fraction. These patients are at high risk of having sudden cardiac death and AICDs are the most effective way to protect against this risk. However, AICDs are an expensive mode of therapy and may sometimes impact quality of life as well. Unfortunately, there is only a limited data available regarding the impact of AICDs on clinical outcomes in heart failure patients in India. The study from the Post Graduate Institute of Medical Education and Research, Chandigarh informs us on this very issue. A worth read.
The case report from the Post Graduate Institute of Medical Education and Research, Chandigarh, “A case report of Mycobacterium abscessus infective endocarditis in rheumatic heart disease,” again reiterates the importance of a good microbiology laboratory and the need to do cultures for rare organisms from time to time in difficult cases.
Finally, the write-up on recent important trials delves into a commonly encountered clinical conundrum – how to optimally evaluate patients with stable chest pain with low-to-intermediate probability of coronary artery disease. An insightful read!
| References|| |
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Kasliwal RR, Bansal M, Mehrotra R, Trehan N. Relationship of arterial stiffness with hypertension and its management in a North-Indian population free of cardiovascular disease. J Clin Prev Cardiol 2012;1:1-8.
Kasliwal RR, Bansal M, Mehrotra R, Ahlawat K, Trehan N. Comparative diagnostic accuracy of different measures of preclinical atherosclerosis for detection of atherosclerotic coronary artery disease. J Clin Prev Cardiol 2014;3:36-42.
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Kasliwal RR, Bansal M, Desai N, Kotak B, Raza A, Vasnawala H, et al.
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Bansal M, Agarwala R, Kasliwal RR. Imaging atherosclerosis for cardiovascular risk prediction- in search of the Holy Grail! Indian Heart J 2018;70:587-92.