Preface to the third issue of Heart India 2025

In this “Heart India” issue, we are publishing one review article, ten original research articles, and two case reports. Cardiovascular diseases (CVDs), including ischemic heart disease, stroke, and heart failure (HF), account for nearly 18 million deaths worldwide. In the first review article of this issue, Manoria has discussed the role of air pollution in the causation of CVDs and emphasized the fact that air pollution, especially ambient fine particulate matter 2.5, is now the fourth leading global risk factor for mortality, with over 6.7 million deaths attributed to it in 2019, of which a substantial proportion were cardiovascular in nature.[1] Coronary artery disease (CAD) is a major cause of global mortality. Diabetes impacts cardiac function even in the absence of hypertension or CAD. The carotid arteries are a primary site for atherosclerosis, and carotid intima–media thickness (CIMT) measurement through ultrasonography aids in early detection. In the first original research article, Jamwal et al. have studied the association of CIMT with CAD severity using SYNTAX and GENSINI scores in patients undergoing elective coronary angiography.[2] Patients with significant CAD had higher mean right CIMT (0.80 ± 0.16 mm) and left CIMT than controls (P < 0.001). CIMT was significantly associated with CAD severity (P = 0.001), but correlations with SYNTAX and GENSINI scores were inconsistent. Patients with CIMT >0.9 mm had higher SYNTAX scores, indicating complex CAD. Hypertension is one of the important cardiovascular risk factors, which, if left untreated, leads to left ventricular hypertrophy. In the second original research article, Karthik et al. have studied the clinical correlation of serum N-terminal pro-brain natriuretic peptide (NT-pro BNP) levels in hypertensive patients with left ventricular hypertrophy.[3] Authors of this study have concluded that systemic hypertensive patients’ serum NTpro BNP level increases proportionately with their left ventricular mass as determined by a transthoracic echocardiogram. As a result, it can be regarded as a prognostic biomarker for imminent cardiac failure, which will aid in a more accurate assessment of cardiovascular risk in hypertensive individuals. Triple-vessel disease (TVD), a severe form of CAD, has a significant risk of morbidity and mortality. In the third original research article, Bharath et al. have studied the clinical profile and risk factors in CAD patients with TVD.[4] Multiple comorbidities, particularly smoking, dyslipidemia, and LV dysfunction, are associated with a higher complexity of CAD. Effective management of these factors may reduce disease progression and complications. Left main coronary artery disease is a potentially fatal condition that may be managed effectively if recognized early. In the fourth original research article, Bhatnagar et al. have studied risk factors and clinical profile of significant left main CAD in a high-volume tertiary care hospital.[5] The authors of this study have concluded that left main disease appears to be related to increasing age. Hypertension is the most common risk factor in this patient population. Among male smokers, obstructive left main disease prevalence is higher. The left anterior descending artery is most frequently involved. Atrial fibrillation (AF) is a common cardiac arrhythmia that significantly contributes to morbidity and mortality worldwide. In the fifth original research article, Harikrishnan et al. have done the retrospective analysis of AF risk in patients with premature ventricular contraction (PVC) burden.[6] The authors of this study have concluded that high-PVC burden is strongly associated with increased risk predictors of AF. Regular monitoring and timely intervention are essential for patients with high-PVC burden to prevent AF onset. Further research is needed to explore effective strategies for reducing PVC burden and mitigating AF risk. Diabetes mellitus (DM) is associated with increased cardiovascular death in acute coronary syndrome (ACS). In the sixth original research article, Elsaughier et al. have studied the prevalence and clinical significance of uncontrolled DM in patients presenting with ACS.[7] The authors of this study have concluded that the prevalence of uncontrolled diabetes was higher among patients presented with ACS, and the rate of severe CAD lesions was significantly higher among the uncontrolled DM group compared with the controlled DM group, and most of the lesions were proximal. Intermediate coronary artery lesions (ICLs) are difficult to assess using angiography alone. In the seventh original research article, Sharma et al. have studied the correlation between frequency-domain optical coherence tomography (FD-OCT) parameters and fractional flow reserve (FFR) in angiographically intermediate coronary lesions in a prospective observational study.[8] FD-OCT-derived minimum lumen area and percentage area stenosis strongly correlate with FFR and can serve as reliable anatomical indicators of lesion significance. Morphological features further enhance risk assessment, supporting the combined use of OCT and FFR for evaluating ICLs. Pulmonary thromboembolism is a life-threatening condition with varying clinical presentations and prognostic implications based on the anatomical location of the embolus, if not timely treated. In the eighth original research article, Kotasthane et al. have conducted a comparative analysis of central and peripheral pulmonary embolism (PE), examining clinical profiles, imaging findings, and outcomes in a tertiary care center.[9] The authors of the present study concluded that peripheral PE, traditionally considered less severe, was found to be associated with significant symptoms, DVT, and elevated cardiac biomarkers. Clinical vigilance, early use of CT pulmonary angiography (CTPA), and individualized risk stratification are critical for the diagnosis of both central and peripheral PE. HF is an emerging epidemic, and its prevalence is increasing over the period of time because of better cardiovascular care and treatment modalities for most CVDs. In the ninth original research article, Naaz et al. have assessed the effectiveness of the thirst intervention package on thirst intensity and thirst distress among patients of HF with fluid restriction at a tertiary care center.[10] The authors of this study concluded that the thirst intervention package was beneficial in reducing thirst intensity and thirst distress in HF. The evaluation of presyncope or syncope always poses a challenge in clinical practice. In the tenth original research article, Parachikkottil et al. have done the study of head-up tilt evaluation of syncope and presyncope in patients with and without structural heart disease.[11] The prevalence of vasovagal syncope (VVS) among the study population was 68%. Patients with hypertrophic cardiomyopathy and electrocardiogram (ECG) changes, such as sinus bradycardia and Brugada pattern, have a higher likelihood of developing VVS. Accurate diagnosis of VVS, particularly in structural heart disease patients, may help avoid inadvertent device therapy. Spontaneous microbubbles in the heart are more frequently observed in patients with mechanical mitral prostheses, in contrast to those with tissue valve prostheses. In the first case report, Saha et al. reported a case of illuminating spontaneous microbubbles in prosthetic heart valves with echocardiography and literature review.[12] ST elevation is most commonly associated with ST-elevated myocardial infarction, but there are various other conditions which can cause ST elevation, such as pericarditis, takotsubo cardiomyopathy, J-wave syndromes such as Brugada and early repolarization syndrome, left bundle branch blocks, left ventricular hypertrophy, and electrolyte imbalance such as hyperkalemia and hypercalcemia. In the second case report, Sridevi et al. reported a case of Picklehaube sign – A sinister ECG presentation, in a case of multiple myeloma with electrolyte imbalance.[13]