Correspondence Address:
Dr. Alok Kumar Singh
Department of Cardiology, Opal Hospital, Varanasi, Uttar Pradesh
India

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In this issue of “Heart India,” we are publishing one review article, five original research articles, and one case report. A Shepherd's Crook right coronary artery is characterized by a tortuous and high course, usually just after its origin from the aorta. In the first review article, Das et al. have described Shepherd's Crook right coronary artery anomaly and all technical difficulties in detail, which may arise during the interventional management of coronary artery disease in this anomaly. In the first original research article, Hiremath et al. have reported the real-world experience of clinical management with antiplatelet and lipid-lowering therapy in post-acute coronary syndrome (ACS) patients in Indian setting. Dual antiplatelet therapy and statin were the standard of care in majority of ACS patients. Triple fixed-dose combination therapy of aspirin, clopidogrel, and rosuvastatin was the most preferred choice of physicians, for optimal management post-ACS patient in Indian setting as per this study.

In high-risk pulmonary embolism (PE), systemic thrombolysis (ST) is associated with a significant reduction in mortality and recurrent PE but is associated with high bleeding risk.[1] Tated et al. in the second original research article have reported that catheter-directed thrombolysis (CDT) is noninferior to ST with respect to primary outcomes of mortality and success rate of thrombolysis. CDT had lower occurrence of bleeding episodes. CDT can be considered a viable alternative to ST in patients with high bleeding risk. The systemic inflammatory response after cardiopulmonary bypass (CPB) results in capillary leak syndrome that remains a major cause of morbidity and mortality in children.[2] This process can lead to fluid overload, impede pulmonary gas exchange, and delay separation from mechanical ventilation. In the third original research article, Singh et al. have studied the effects of hemofiltration during CPB in children undergoing intracardiac repair for tetralogy of Fallot and have concluded that there was a significant reduction in the postoperative blood loss and extubation time in the hemofiltration group. There was no significant reduction in cytokines. No significant difference was observed in requirement of inotropic agents, hemodynamic status, and intensive care unit stay between the two groups.

Heart failure with preserved ejection fraction (HFpEF), formerly termed diastolic heart failure (ejection fraction >50%), worsens with aging and is more frequent in older hypertensive women. In the fourth original research article, Jariwala et al. have studied the safety and effectiveness of angiotensin receptor-neprilysin inhibitors (ARNIs) in Indian patients with HFpEF – “ARNI” study. Symptomatic clinical improvement was observed, with a substantial decrease in NYHA functional class. A considerable decrease in NYHA class resulted in symptomatic clinical improvement, as well as the rales and peripheral edema had also resolved. The NT-pro-BNP levels were considerably lowered. The echocardiographic parameters for diastolic function (E/A, E/E' ratios) improved. In individuals with HFpEF, ARNI resulted in significant clinical benefits in this study.

The risk of developing coronary artery disease (CAD) and duration of diabetes have shown positive correlation in various studies. In the fifth original research article, Singh et al. have evaluated the association between glycated hemoglobin (HbA1c) levels and severity of CAD in nondiabetic patients. Authors of this study have concluded that HbA1c level has a prognostic value for predicting the severity of CAD among nondiabetic patients and can act as a useful marker in risk stratification of nondiabetic patients presenting with ACS and indicated for angiographic evaluation. In the last article, Kumar et al. reported an interesting case of right coronary artery intervention through right radial access in a patient with aberrant right subclavian artery and anomalous origin of the right coronary artery.

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