GLICEMIC VARIABILITY EVALUATED BY CONTINUOUS GLUCOSE MONITORING SYSTEM I-PRO™ AND RENAL FUNCTION DETERIORATION AFTER PERCUTANEOUS CORONARY INTERVENTION: PRELIMINARY RESULTS OF A PROSPECTIVE STUDY

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Glycemic Variability Assessed by Continuous Glucose Monitoring and Short-Term Outcome in Diabetic Patients Undergoing Percutaneous Coronary Intervention: An Observational Pilot Study

Poor glycemic control is associated with unfavorable outcome in patients undergoing percutaneous coronary intervention (PCI), irrespective of diabetes mellitus. However a complete assessment of glycemic status may not be fully described by glycated hemoglobin or fasting blood glucose levels, whereas daily glycemic fluctuations may influence cardiovascular risk and have even more deleterious effects than sustained hyperglycemia. Thus, this paper investigated the effectiveness of a continuous glucose monitoring (CGM), registering the mean level of glycemic values but also the extent of glucose excursions during coronary revascularization, in detecting periprocedural outcome such as renal or myocardial damage, assessed by serum creatinine, neutrophil gelatinase-associated lipocalin (NGAL), and troponin I levels. High glycemic variability (GV) has been associated with worse postprocedural creatinine and NGAL variations. Moreover, GV, and predominantly hypoglycemic variations, has been observed to increase in patients with periprocedural myocardial infarction. Thus, our study investigated the usefulness of CGM in the setting of PCI where an optimal glycemic control should be achieved in order to prevent complications and improve outcome

PLATELET INDICES ARE NOT ASSOCIATED WITH OCCURRENCE OF PERIPROCEDURAL MYOCARDIAL INFARCTION IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY ANGIOPLASTY

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Prevalence of Rheumatic Heart Disease in North Madagascar: An echocardiographic screening in young and adult populations

BackgroundRheumatic Heart Disease (RHD) prevalence in Madagascar is poorly known. Echocardiographic screening detects a higher prevalence of RHD than clinical examination.AimsWe aimed to describe RHD prevalence in children and adults in North Madagascar using the most updated World Heart Federation (WHF) criteria for RHD echocardiographic diagnosis.Methods Children aged 5–19 years (Group One) and adults aged more than 20 years (Group Two) underwent a four-steps visit: clinical questionnaire, physical examination, laboratory test - oropharyngeal swab for Group One and Anti-streptolysin O (ASO) titre for Group Two - and echocardiogram using a portable machine..Results Among 859 people (522 in Group One, 337 in Group Two) RHD prevalence was 2.1 per cent. Group Two had a higher risk of having RHD than Group One (OR 4.39, CI 1.39–13.9, p=0.004), while clinical findings were more frequent in Group One (children had a higher risk of heart murmur (O.R. 3.85 C.I. 1.08–13.72; p=0.029)). RHD prevalence was 1.34 per cent in children. Those positive to oropharyngeal swab had a higher risk of RHD (OR 14.5, CI 3.04–69.44, p=0.0024); children with history of fever and sore-throat had a higher risk of positive oropharyngeal swab (OR 15.97, CI 3.14–81.19, p=0.002). RHD prevalence was 3.3 per cent in adults. None of those had history of fever and throat-pain, positive ASO titre and cardiac murmur simultaneously. ConclusionThis is the first study describing prevalence of RHD in Madagascar. Our results, although preliminary, are important to enhance prevention programs in this country

Statin pretreatment and risk of in-hospital atrial fibrillation among patients undergoing cardiac surgery: a collaborative meta-analysis of 11 randomized controlled trials

Aims Statin pretreatment in patients undergoing cardiac surgery is understood to prevent postoperative atrial fibrillation (AF). However, this is based on observational and limited randomized trial evidence, resulting in uncertainty about any genuine anti-arrhythmic benefits of these agents in this setting.We therefore aimed to quantify precisely the association between statin pretreatment and postoperative AF among patients undergoing cardiac surgery. Methods and results A detailed search of MEDLINE and PubMed databases (1st January 1996 to 31st July 2012)was conducted, followed by a review of the reference lists of published studies and correspondence with trial investigators to obtain individual– participant data for meta-analysis. Evidence was combined across prospective, randomized clinical trials that compared the risk of postoperative AF among individuals randomized to statin pretreatment or placebo/control medication before elective cardiac surgery. Postoperative AF was defined as episodes of AF lasting ≥5 min. Overall, 1105 participants from 11 trials were included; of them, 552 received statin therapy preoperatively. Postoperative AF occurred in 19% of these participants when compared with 36% of those not treated with statins (odds ratio 0.41, 95% confidence interval 0.31–0.54, P , 0.00001, using a random-effects model). Atrial fibrillation prevention by statin pretreatmentwas consistent across different subgroups. Conclusion Short-term statin pretreatment may reduce the risk of postoperative AF among patients undergoing cardiac surgery

Glycaemic Control in Patients Undergoing Percutaneous Coronary Intervention: What Is the Role for the Novel Antidiabetic Agents? A Comprehensive Review of Basic Science and Clinical Data

Coronary artery disease (CAD) remains one of the most important causes of morbidity and mortality worldwide, and revascularization through percutaneous coronary interventions (PCI) significantly improves survival. In this setting, poor glycaemic control, regardless of diabetes, has been associated with increased incidence of peri-procedural and long-term complications and worse prognosis. Novel antidiabetic agents have represented a paradigm shift in managing patients with diabetes and cardiovascular diseases. However, limited data are reported so far in patients undergoing coronary stenting. This review intends to provide an overview of the biological mechanisms underlying hyperglycaemia-induced vascular damage and the contrasting actions of new antidiabetic drugs. We summarize existing evidence on the effects of these drugs in the setting of PCI, addressing pre-clinical and clinical studies and drug-drug interactions with antiplatelet agents, thus highlighting new opportunities for optimal long-term management of these patients

Vascular approaches and its potential implications in transcatheter aortic valve implantation

Transcatheter aortic valve implantation (TAVI) has become in the last years a primary therapeutic tool in order to treat percutaneously severe aortic stenosis in frail patients with multiple comorbidity and a high surgical risk. In almost all cases, the complexity of patients who are candidates for TAVI is also reflected in challenging access sites. This vascular issue addresses the invasive play of constantly evolving devices and resulting complications have a considerable impact on patient morbidity and mortality. For this reason, the study and the choice of the different access site require the attention and experience of the operators to reach the most reliable and feasible vascular approach for a real procedural success

Who is the next for aortic valve implantation? Present and future indications

Aortic valve stenosis (AS) represents the most prevalent valvular defect worldwide. It is a progressive disease with a long latency interval and a poor prognosis after symptoms present. According to current European Society of Cardiology guidelines, transcatheter aortic valve implantation (TAVI) is recommended in all patients with severe symptomatic AS and a predicted survival longer than one year, who are not suitable for surgical valve replacement. Despite these recommendations, several studies over the past few years suggest extending these indications towards lower risk AS populations. Otherwise, current available operative risk scores such as Society of Thoracic Surgeons score and EuroSCORE, may offer an incomplete risk assessment; in this setting, the Heart Team plays a crucial role in defining the most appropriate therapeutic strategy in patients with AS. In this review, we aim to discuss the current and future indications for TAVI, analyzing available literature according to patients’ profile risk (high/mid/low risk) and other specific conditions (valve-in-valve, bicuspid valve and pure aortic regurgitation)