Insulin Resistance Predicts Severity of Coronary Atherosclerotic Disease in Non-Diabetic Patients

Background: Insulin resistance (IR) in patients with type 2 diabetes mellitus (T2DM) represents a predictor of coronary artery disease (CAD). However, how IR is able to impact the severity of coronary atherosclerosis in non-diabetic patients is unknown. Objectives. We investigated the relation between the IR and the extent and severity of coronary atherosclerosis in non-diabetic patients referred to coronary angiography (CA) Methods: Consecutive patients undergoing to CA for acute coronary syndromes or stable angina were analyzed. The IR was assessed by mean of the homeostasis model assessment of insulin resistance (HOMA-IR) whereas the SYNTAX score (SS) was used as index of the severity of coronary atherosclerosis Results: Overall, 126 patients were included, with a median SS of 12 (IQR 5.25–20.5). Patients were divided in four groups according to the distribution in quartiles of SS (SS1-2-3-4). A significant correlation between HOMA-IR and SS was observed, especially in women. A progressive increase of HOMA-IR was observed in parallel with the increasing severity (from SS1 to SS4) and extension (1-2-3-vessel disease) of coronary atherosclerosis. Multivariable analysis showed that the HOMA-IR was the strongest independent predictor of severe (SS4) and extensive (three-vessel disease) coronary atherosclerosis. Conclusion: Insulin resistance goes hand in hand with the extension and severity of coronary atherosclerosis in non-diabetic patients. The HOMA index is an independent predictor of three-vessel disease at CA. The HOMA index could be useful for risk stratification of CAD even in absence of T2D

Corneal thickness evaluation in healthy eyes: Comparison between two different Scheimpflug devices.

PurposeTo evaluate the correlation between corneal thickness (CT) measurements obtained with two Scheimpflug devices, Pentacam HR and Precisio, and to elaborate, if necessary, a regression formula which could make these results comparable.DesignRetrospective, Comparative, Observational study.SettingDepartment of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana" University of Salerno, Italy.MethodsOne hundred twenty four healthy eyes of 124 volunteers (65 males; range: 20-32 years; mean age of 24.8 ± 1.7) were included in this study. CT was measured using Pentacam HR and Precisio in three different points: the pupil center (PC), the corneal apex (CA) and the thinnest point (TP).ResultsCT obtained with both devices at the PC, at the CA and at the TP showed a good correlation (r = 0.97, r = 0.97, r = 0.97, respectively), but Pentacam HR measurements were significantly thicker than those provided by Precisio (p ConclusionsThe findings provided by this study highlight that Precisio measures thinner corneas compared to Pentacam HR. The identified regression formulas could be utilized to make interchangeable the results obtained with these two devices

Extracardiac Inappropriate Shocks in Subcutaneous Implantable Cardioverter Defibrillator: Management in Emergency Department

Background: The subcutaneous implantable cardioverter defibrillator (S-ICD) is an established treatment for the prevention of sudden cardiac death. In the S-ICD studies, inappropriate shocks (IAS) rate were reported to renge between 5% to 25% and to be mainly due to cardiac and noncardiac oversensing. Objective: This review highlights data on IAS complications of the S-ICD and is aimed to help in identifying the causes of extracardiac oversensing to facilitate safe and effective emergency management and to reduce the incidence of adverse outcomes. Methods: Literature between January 2010 and March 2020 on IAS and S-ICD was identified by database search. We included studies assessing IAS rates due to extracardiac oversensing. We identified 12 eligible articles including meta-analysis and 28 selected case reports. Results: The total population included 2654 reported patients. Of these, 84 patients received extracardiac IAS. The malfunction of S-ICD due to extracardiac oversensing was related, in particular, to myopotentials (34%) and electromagnetic interferences (29%). The meta-analysis demonstrates an overall high prevalence of extracardiac IAS of 22% (95% CI 8% - 50%); the prevalence was 6% (95% CI 3% - 12%) in patients without the SP (SMART-Pass) filter and 46% (95% CI 12% - 84%) in patients with the SP filter (P=0.047). Conclusion: Our findings show the high prevalence of extracardiac IAS in patients with S-ICD and demonstrated that the SP is unable to prevent the IAS due to extracardiac reasons. It is important in the Emergency Department for the appropriate management of IAS to identify the various causes

Appropriate ICD Interventions for Ventricular Arrhythmias Are Predicted by Higher Syntax Scores I and II in Patients with Ischemic Heart Disease

The occurrence of ventricular arrhythmias (VAs) in ischemic heart disease (IHD) patients is related to the presence and extent of fibrotic/scar tissue. As coronary atherosclerosis is the underlying cause of myocardial ischemia and fibrosis, in IHD patients implanted with an implantable cardioverter defibrillator (ICD) we investigated the relation between the VA burden and the complexity of coronary atherosclerotic lesions