हृदय रोग एवं निदान

Introduction: Subclinical atherosclerosis, which can be identified by elevated coronary artery calcium (CAC) or arterial stiffness as measured by the cardio-ankle vascular index (CAVI), has been linked to major adverse cardiovascular events (MACEs). Nevertheless, there are few comparable data from these two assessments of the same population.

Methods: Patients with stable coronary artery disease (CAD) who were asymptomatic or symptomatic and underwent coronary computed tomography and coronary angiography (CAVI) were enrolled and followed until December 2019 for the occurrence of MACEs (cardiovascular [CV] death, nonfatal myocardial infarction [MI], and nonfatal stroke). A cause-specific hazard model was used to look at how the CAC score related to CAVI and long-term MACEs.

Results: All in all, 8687 patients participated. The CAC scores were 0–99, 100–399, and 400 in 49.7%, 31.9%, 12.3%, and 6.1% of them, respectively. Arterial stiffness (CAVI 9.0) was linked to the severity of CAC in 23.8 percent, 36.3%, 44.5 percent, and 56.2 percent of cases, respectively. 8.0% of patients, on average 9.9, experienced MACEs. 2.4 years of follow-up (interquartile range: 7.4% to 8.6%) of the subjects. After adjusting for covariables, it was discovered that CAC scores of 100–399 and CAVI scores of 9.0 independently predicted the occurrence of MACEs, with hazard ratios (95% CI) of 1.70 (1.13–1.98), 1.87 (1.33–2.63), and 1.27 (1.06–1.52), respectively. Additional risk factors included aspirin and statin therapy, diabetes mellitus (DM), chronic kidney disease (CKD), and hypertension.

Conclusion: Patients with stable CAD who are asymptomatic or symptomatic are more likely to experience MACEs in the long run if their CAC or CAVI scores are below 9.0. These two non-invasive tests can be utilized to screen for CV events and direct treatment to prevent future ones.

Chronic heart failure (CHF), which frequently affects a large portion of the global population, frequently progresses to a life-threatening condition, and has a high mortality rate, is another significant global public health issue. The most recent developments in the treatment of CHF patients whose left ventricular ejection fraction (LVEF) is less than 40% interest us. In recent years, cardiac disease etiology has been linked to BNP. Since sacubitril and aspirin, an angiotensin receptor neprilysin inhibitor, were part of a complex medical treatment plan for CHF patients, we decided to investigate their effects. In addition, we looked into the treatments, particularly cardiac resynchronization therapy, that were used to treat these patients with the device. Last but not least, we compared the outcomes of cardiac resynchronization therapy to those of a sophisticated medical treatment plan that included sacubitril and valsartan, both of which are angiotensin receptor neprilysin inhibitors.