New research is constantly impacting the way cardiovascular disease (CVD) is treated and managed. This article summarises three such studies that have changed diagnostic and treatment angles for CVDs.

Heart failure

A recent review published in the Indian Heart Journal has claimed that Metformin (MET)¹ is safe to use in heart failure (HF) patients with diabetes, is believed to reduce mortality by 14-35% in diabetic patients.

A few recent studies claim that, in patients with a glomerular filtration rate of >30ml/min, administration of MET (<2g/day) was actually associated with no risk of acidosis.

This contradicts previous claims that MET should not be considered in treating heart failure patients with diabetes, due to the potential risk of lactic acidosis because several studies in the past had reported increased mortality and worsening heart failure with the use of MET.

MET reduces Left Ventricular (LV) volumes, wall stress, perivascular fibrosis, and cardiac lipid accumulation resulting in attenuation of LV remodelling. But, the reported cardioprotective effects of metformin may not be universal to all forms of HF and may require AMPK (AMP-activated protein kinase) activation or ATP depletion.

White-coat heart rate

A recent, observational, pilot study conducted on 57 consecutive ambulatory patients at a hospital in France has found that the Resting Heart Rate (HR) measured by the physician during consultation does not reflect the true resting HR. Also, a significant correlation between average home DBP and average home HR was noted.

This could also be explained as the ‘white-coat effect’, a well-known phenomenon in blood pressure.

Researchers assessed the differences between resting HR measured during a consultation and self-measured HR at home. HR, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at different times during the study.

Through this paper, the researchers have stressed that physicians should take into consideration these differences before and during patient assessment.

Criss-Cross Heart

Researchers who recently studied the diagnosis of Criss-Cross Heart (CCH) among Indian paediatric patients have found that superior-inferior ventricular relations can co-exist with CCH, but not necessarily in all cases of CCH.

Also, early diagnosis of CCH is required as it is a rare congenital anomaly. The age range for diagnosis is 1 month to 8 years. The retrospective, observational study conducted over a 3-year period in a tertiary care centre in South India analysed transthoracic echocardiographic features for the diagnosis of criss-cross heart (CCH)³ among Indian patients. The complex and distorted cardiac anatomy seen in CCH makes accurate diagnosis difficult.

Out of the 10,500 paediatric echocardiographic studies, only 5 emerged positive for diagnosis of CCH, with crossed ventricular inflow streams present in all cases, cyanosis present in all but one, and superior-inferior ventricular relationship present in 3 cases.

References:

1. Kinsara AJ, Ismail YM. Metformin in heart failure patients. Indian Heart Journal. 2018; 70: 175–176
2. Lequeux B, Uzan C, Rehman MB. Does resting heart rate measured by the physician reflect the patient’s true resting heart rate? White-coat heart rate. Indian Heart Journal. 2018; 70: 93-98
3. Manuel D, Ghosh G, Joseph G, et al. Criss-cross heart: Transthoracic echocardiographic features. Indian Heart Journal. 2018; 70: 71–74