Bhanu Duggal

Background: Stability of the atherosclerotic plaque in coronary artery disease (CAD) is determined by features such as total plaque burden and necrotic core volume. Since invasive procedures are required to evaluate plaque stability, we tested whether the peripheral blood mononuclear cell (PBMC) microRNA (miR) signature could correlate with measures of plaque stability and thus serve as a non-invasive biomarker. Method: Patients from two distinct geographical locations in India were recruited to the study (Site 1: CAD=19, non-CAD=5; Site 2: CAD=12, non-CAD=7) and underwent invasive intravascular ultrasound with virtual histology to assess plaque burden and necrotic core volume. RNA from PBMCs of these patients was subjected to unbiased sequencing. Differential miR expression evaluated by DESeq2 and assessed for co-relationship with plaque stability. miR target gene prediction was performed using multiple databases, and Enrichr was used for enrichment analysis. Results: Unbiased RNA sequencing identified miR-664a-3p to be significantly downregulated in CAD patients from both sites (Site 1: log2FC=-1.02, p=0.0033 & Site 2: log2FC=-1.04, p=0.0007). miR-664a-3p expression was inversely correlated with plaque burden and necrotic core volume. Receiver operating characteristic (ROC) analysis of miR-664a-3p showed significant discriminative performance in the CAD cohort, with AUC values of 0.842 (Site 1) and 0.881 (Site 2). miR664a-3p target prediction and pathway enrichment analysis revealed selective enrichment of inflammatory signaling pathways, such as IL-17 and TNF, suggesting an association between PBMC pro-inflammatory response and plaque vulnerability. Conclusion: miR-664a-3p is downregulated in CAD patients and inversely correlates with measures of plaque stability, with potential as a biomarker for identifying patients at risk of CAD progression and plaque instability. Keywords: Coronary artery disease, peripheral blood mononuclear cells (PBMCs), microRNA, atherosclerotic plaque, necrotic core, plaque burden, biomarkers.

Rheumatic heart disease (RHD) remains a major cause of maternal morbidity in low- and middle-income countries, particularly among women of childbearing age. Severe mitral stenosis in pregnancy can lead to acute decompensated heart failure, especially in the third trimester. Timely intervention is essential but challenging in late presenters. We describe a series of three pregnant women presenting at term with severe rheumatic mitral stenosis complicated by heart failure. All underwent emergency lower segment cesarean section (LSCS) followed by balloon mitral valvotomy (BMV) in the same operative setting. Transesophageal echocardiography (TEE) was used for transseptal puncture to reduce radiation exposure, and abdominal lead shielding was applied. The radiation dose was limited to 249 mGy. Two patients had favorable maternal and fetal outcomes, while one patient succumbed due to septic shock despite successful valvotomy. Simultaneous LSCS and BMV is a feasible and potentially life-saving strategy in women presenting late in pregnancy with severe mitral stenosis and heart failure. A multidisciplinary approach with individualized hemodynamic and fetal considerations is critical. We propose that this time-sensitive strategy may improve outcomes in resource-limited settings.

Background: Left bundle branch block (LBBB) is an indication for cardiac resynchronization therapy (CRT) in patients with severe left ventricular (LV) systolic dysfunction. Accurate estimation of LV ejection fraction (LVEF) by echocardiography is often challenging in LBBB, leading to uncertainty regarding CRT eligibility. Alternative imaging modalities, such as contrast echocardiography (CE) and single‐photon emission computed tomography (SPECT) may provide more reliable LVEF in these cases. Aim: This study aimed to compare LVEF estimation by unenhanced trans‐thoracic echocardiography (UE‐TTE), CE, and SPECT in patients with LBBB and significant discrepancy (≥5%) between prior UE‐TTE reports. Methods: Sixty patients with LBBB referred for SPECT between May 2022 and May 2023 underwent LVEF assessment with UE‐TTE, CE, and SPECT. Correlation and absolute differences in LVEF estimate across modalities were analyzed. Results: LVEF on CE correlated strongly with SPECT ( r = 0.976, r ² = 0.952) outperforming UE‐TTE ( r = 0.824, r ² = 0.679). Among patients with LVEF ≤ 35% by UE‐TTE, 13 of 34 had LVEF ≥ 40% on SPECT, compared to only one of 21 by CE. An absolute LVEF difference ≥10% was observed in 40% (SPECT vs. UE‐TTE) and 0.5% (SPECT vs. CE). Conclusion: In patients with LBBB and discordant LVEF values on UE‐TTE, secondary evaluation with CE or SPECT improves accuracy of LVEF assessment, potentially optimizing CRT eligibility and clinical decision making.

The widespread use of plastics and improper disposal have resulted in the ubiquity of microplastics in the environment, from uninhabited polar regions to terrestrial ecosystems. This ubiquity poses significant health concerns for our environment and health. Various in vitro, in vivo, and ex vivo studies have indicated microplastic toxicity in humans' respiratory, digestive, neurological, reproductive, and developmental health. Recent studies have pointed out that these microplastics also have cardiovascular toxicity. Cardiovascular diseases (CVDs) are the number one killer in the world, with over 20 million annual deaths worldwide. Hence, microplastics, as a potential risk factor for CVDs, can result in a significant increase in mortality and morbidity because almost everyone is currently exposed to microplastics. This perspective article explores the toxic effects of microplastics on cardiovascular human health. It focuses on various studies that have found microplastics from human arteries/cardiac tissues and their potential role in atherosclerosis and subsequent increases in myocardial infarction, stroke, and mortality. Studies reported the presence of various microplastics, such as polyethylene, polyvinyl chloride, polyamide, and polystyrene, in cardiac tissues and arteries (coronary, aorta, cerebral, and carotid). Studies have suggested a potential negative correlation between microplastics and cardiovascular health, with the presence or increased concentration of microplastics linked to greater severity of health issues. Still, a causal relationship is yet to be established. Future studies, such as cohorts, should focus on deciphering and establishing whether microplastics are a potential cardiovascular risk factor.

Long‐term electrocardiogram (ECG) monitoring is crucial for detecting and diagnosing cardiovascular diseases (CVDs). Monitoring cardiac health and activities using efficient, noninvasive, and cost‐effective techniques such as ECG can be vital for the early detection of different CVDs. Wet electrode‐based traditional ECG techniques come with unavoidable limitations of the altered quality of ECG signals caused by gel volatilization and unwanted noise followed by dermatitis. The limitation related to the wet electrodes for long‐term ECG monitoring in static and dynamic postures reminds us of the urgency of a suitable substitute. Dry electrodes promise long‐term ECG monitoring with the potential for significant noise reduction. This review discusses traditional and alternative techniques to record ECG in terms of meeting the efficient detection of CVDs by conducting a detailed analysis of different types of dry electrodes along with materials (substrate, support, matrix, and conductive part) used for fabrication, followed by the number of human subjects they have been used for validation. The degradation of these electrodes has also been discussed briefly. This review finds a need for more validation on a sufficient number of subjects and the issue of cost and noise hindering the commercialization of these dry electrodes.

During the COVID-19 pandemic, hospitals were challenged to provide both COVID-19 and non-COVID treatment. A survey questionnaire was designed and distributed via email to hospitals empanelled under the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana(AB-PMJAY), the world’s largest National Health Insurance Scheme. Telephonic follow-ups were used to ensure participation in places with inadequate internet. We applied support vector regression to quantify the hospital variables that affected the use vs. non-use of hospital services (Model-1), and factors impacting COVID-19 revenue and staffing levels (Model-2).We quantified the statistical significance of important input variables using Fisher’s exact test. The survey, conducted early in the pandemic, included 461 hospitals across 20 states and union territories. Only 55.5% of hospitals were delivering emergency care, 26.7% were doing elective surgery and 36.7% providing obstetric services. Hospitals with adequate supplies of PPE, including N95 masks, and separate facilities designated for COVID-19 patients were more likely to continue providing emergency surgeries and services effectively. Data analysis revealed that large hospitals (> 250 beds) with adequate PPE and dedicated COVID-19 facilities continued both emergency and elective surgeries. Public hospitals were key in pandemic management, large private hospital systems were more likely to conduct non-COVID-19 surgeries, with not-for-profit hospitals performing slightly better. Public and large private not-for-profit hospitals faced fewer staff shortages and revenue declines. In contrast, smaller hospitals (< 50 beds) experienced significant staff attrition due to anxiety, stress and revenue losses. They requested government support for PPE supplies, staff training, testing kits, and special allowances for healthcare workers. The inclusion of COVID-19 coverage under AB-PMJAY improved access to healthcare for critical cases. Maintaining non-COVID-19 care during the pandemic indicates healthcare system resiliency. A state-wide data-driven system for ventilators, beds, and funding support for smaller hospitals, would improve patient care access and collaboration.