Preface to the second issue of Heart India 2025

In this “Heart India” issue, we publish one review article, ten original research articles, and five case reports. Acute coronary syndrome (ACS) is a significant contributor to morbidity and mortality across the globe, including India. Effective management of ACS involves pharmacological therapies, percutaneous coronary intervention (PCI) or coronary artery bypass graft, and lifestyle modifications to enhance recovery and prevent recurrence. Posthospital discharge care in ACS patients is crucial for the prevention of recurrent cardiac events. For effective secondary prevention measures in post-ACS patients, such as regular monitoring, medication, and lifestyle changes, are of paramount importance. In the first review article, Kerkar et al.[1] have emphasized the importance of post-ACS home-based care for preventing recurrent cardiac events, enhancing recovery, and improving the quality of life. Valvular heart disease (VHD) often presents with subclinical left ventricular (LV) dysfunction that may not be detected by traditional echocardiographic parameters such as LV ejection fraction (LVEF). In the first original research article, Malani et al.[2] have studied the utility of global longitudinal strain (GLS) as an early marker of subclinical LV dysfunction in patients with VHD. This study supports GLS as a valuable tool in the early diagnosis and management of subclinical cardiac dysfunction in VHD. Trimetazidine (TMZ), a metabolic modulator with cardioprotective and renal protective properties, may reduce myocardial ischemia and contrast-induced nephropathy (CIN) in patients undergoing PCI. In the second original research article, Jain et al.[3] have studied the role of TMZ in preventing myocardial injury and CIN in patients undergoing PCIs. The findings of this study support the role of TMZ’s potential adjunctive therapy in patients undergoing PCI, although large randomized studies are needed to confirm these findings. Del Nido (DN) and St. Thomas (ST) are both cardioplegia solutions used in valvular heart surgery for myocardial protection. In the third original research article, Patel et al.[4] have done a comparative analysis of trends of echocardiographic parameters in double valve replacement cases involving the use of Del Nido’s and Saint Thomas’ cardioplegia for myocardial protection. Despite having different cardioplegic solutions used, postoperative dysfunction of both the LV and right ventricular is inevitable. The authors of this study concluded that both solutions can be used with equal efficacy and safety in terms of dysfunction caused. In the fourth original research article, Khurshid et al.[5] have also reported their finding of a comparative analysis of Del Nido versus St. Thomas Cardioplegia in an adult undergoing cardiac surgery. The authors of this study have concluded that both DN and ST cardioplegia provided comparable myocardial protection and clinical outcomes. However, DN was associated with a significantly higher postoperative LVEF, indicating potential advantages in myocardial preservation. Unlike LVEF, speckle-tracking echocardiography (STE) can identify earlier, subclinical systolic dysfunction. Early STE detection may allow early interventions to prevent heart failure (HF) progression. In the fifth original research article, Goyal et al.[6] have studied the subclinical LV dysfunction by GLS imaging in diabetic and prediabetic patients and its correlation with high-sensitivity C-reactive protein (hs-CRP) and glycosylated hemoglobin. GLS imaging revealed subclinical LV systolic dysfunction in 46.7% of subjects despite normal LVEF. This dysfunction was more prevalent in prediabetics (53.6%) compared to diabetics. The correlation between GLS and hs-CRP and glycated hemoglobin was not statistically significant in this study. Two-dimensional (2D) echocardiographic imaging is one of the basic tools of investigation during any successful cardiology management. It provides a comprehensive landscape of information, from direct visualization to hemodynamic parameters of the heart. Over the past 30 years, there has been significant scientific growth that has occurred, especially in the field of computer technology (both in hardware and software). In the sixth original research article, Reddy et al.[7] compared 156 2D echo subjects with the “BEST Test” – A method to convert 2D to three-dimensional (3D) slices during the offline process using the specific steps. From this pool, researchers had randomly selected 28 subjects for a sub-study linear measurement analysis. The authors of this study concluded that “BEST” Test from Blender 3D Software can be used as an offline imaging tool for 2D echo because it qualifies the features of an ideal tool. Drug-eluting stent implantation has been associated with delayed arterial healing and can rarely lead to the development of coronary artery pseudoaneurysm. In the seventh original research article, Parikh et al.[8] have reported their collective experience of the management and long-term outcomes of poststenting coronary pseudoaneurysm. ACS refers to a range of clinical indications, characterized by acute ischemia-related conditions extending from unstable angina to myocardial infarction with (ST-elevation myocardial infarction [STEMI]) or without ST-elevation (non-STEMI [NSTEMI]). In the eighth original research article, Deb et al.[9] have done a comparative analysis of risk factors and coronary angiographic severity in patients of NSTEMI with and without electrocardiogram abnormalities. There is a lack of reference values for the resistive index (RI) of cerebral arteries in preterm infants for our local population. There is a lack of data on the impact of patent ductus arteriosus (PDA) on the RI of cerebral arteries in preterm infants from India. In the ninth original research article, Rafiq et al.[10] studied the RI values in the cerebral arteries of preterm infants born throughout the neonatal intensive care unit stay and compared the RI in those with hemodynamically significant PDA (HSPDA), with those with hemodynamically insignificant or no PDA (HIS/non-PDA). RI was lower in cases without PDA or HIS PDA than in those with HSPDA. This difference was statistically significant in all intracerebral arteries. Intraventricular hemorrhage was more common and more severe in those with HSPDA. Transradial access (TRA) has become the preferred method of vascular access for coronary interventions globally because of its demonstrated reduction in vascular complications and mortality rates among patients with STEMI. In the tenth original research article, Chirde et al.[11] have conducted a comparative safety study of the mother-and-child technique using the same size radial sheath and guide for transradial PCI, and they have concluded that the method of using the mother-and-child technique compared with a 6F group decreased overall adverse events, indicating improved safety for TRA. Mixed connective tissue disorder is a systemic autoimmune disorder that can affect any organ system, including the cardiovascular system. In the first case report, Mr Jain[12] reports an uncommon manifestation of mixed connective tissue disorder presenting as dilated cardiomyopathy. Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic heart condition defined by the replacement of cardiac muscle cells with fibro-fatty tissue. In the second case report, Dhadve et al.[13] report a rare case of ARVC mimicking myocarditis. Chronic total occlusions (CTOs) represent one of the most intricate and technically demanding challenges in interventional cardiology. In the third case report, Mr Swaroop[14] reports an application of advanced CTO-PCI techniques in managing complex ISR and explained how he successfully managed the case. HF in infants is a critical, life-threatening event with a wide range of etiologies. In the fourth case report, Rashid et al.[15] report an unusual cause of infantile congestive HF due to infantile hemangiomatosis. Primary cardiac tumors are a relatively uncommon clinical entity. In the fifth case report, Kotasthan et al.[16] identified a rare case of undifferentiated pleomorphic cardiac sarcoma mimicking a left atrium myxoma.