Dysglycemia, in this survey defined as impaired glucose tolerance (IGT) or type 2 diabetes, is common in patients with coronary artery disease (CAD) and associated with an unfavorable prognosis. This European survey investigated dysglycemia screening and risk factor management of patients with CAD in relation to standards of European guidelines for cardiovascular subjects. RESEARCH DESIGN AND METHODS The European Society of Cardiology's European Observational Research Programme (ESC EORP) European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V (2016-2017) included 8,261 CAD patients, aged 18-80 years, from 27 countries. If the glycemic state was unknown, patients underwent an oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin A 1c. Lifestyle, risk factors, and pharmacological management were investigated. RESULTS A total of 2,452 patients (29.7%) had known diabetes. OGTT was performed in 4,440 patients with unknown glycemic state, of whom 41.1% were dysglycemic. Without the OGTT, 30% of patients with type 2 diabetes and 70% of those with IGT would not have been detected. The presence of dysglycemia almost doubled from that selfreported to the true proportion after screening. Only approximately one-third of all coronary patients had completely normal glucose metabolism. Of patients with known diabetes, 31% had been advised to attend a diabetes clinic, and only 24% attended. Only 58% of dysglycemic patients were prescribed all cardioprotective drugs, and use of sodium-glucose cotransporter 2 inhibitors (3%) or glucagon-like peptide 1 receptor agonists (1%) was small. CONCLUSIONS Urgent action is required for both screening and management of patients with CAD and dysglycemia, in the expectation of a substantial reduction in risk of further cardiovascular events and in complications of diabetes, as well as longer life expectancy.

IMPORTANCE Thyroid hormones play a key role in modulating myocardial contractility. Subclinical hypothyroidism in patients with acute myocardial infarction is associated with poor prognosis.OBJECTIVE To evaluate the effect of levothyroxine treatment on left ventricular function in patients with acute myocardial infarction and subclinical hypothyroidism. DESIGN, SETTING, AND PARTICIPANTSA double-blind, randomized clinical trial conducted in 6 hospitals in the United Kingdom. Patients with acute myocardial infarction including ST-segment elevation and non-ST-segment elevation were recruited between February 2015 and December 2016, with the last participant being followed up in December 2017.INTERVENTIONS Levothyroxine treatment (n = 46) commencing at 25 μg titrated to aim for serum thyrotropin levels between 0.4 and 2.5 mU/L or identical placebo (n = 49), both provided in capsule form, once daily for 52 weeks. MAIN OUTCOMES AND MEASURESThe primary outcome measure was left ventricular ejection fraction at 52 weeks, assessed by magnetic resonance imaging, adjusted for age, sex, type of acute myocardial infarction, affected coronary artery territory, and baseline left ventricular ejection fraction. Secondary measures were left ventricular volumes, infarct size (assessed in a subgroup [n = 60]), adverse events, and patient-reported outcome measures of health status, health-related quality of life, and depression. RESULTS Among the 95 participants randomized, the mean (SD) age was 63.5 (9.5) years, 72 (76.6%) were men, and 65 (69.1%) had ST-segment elevation myocardial infarction. The median serum thyrotropin level was 5.7 mU/L (interquartile range, 4.8-7.3 mU/L) and the mean (SD) free thyroxine level was 1.14 (0.16) ng/dL. The primary outcome measurements at 52 weeks were available in 85 patients (89.5%). The mean left ventricular ejection fraction at baseline and at 52 weeks was 51.3% and 53.8%, respectively, in the levothyroxine group compared with 54.0% and 56.1%, respectively, in the placebo group (adjusted difference in groups, 0.76% [95% CI, −0.93% to 2.46%]; P = .37). None of the 6 secondary outcomes showed a significant difference between the levothyroxine and placebo treatment groups. There were 15 (33.3%) and 18 (36.7%) cardiovascular adverse events in the levothyroxine and placebo groups, respectively. CONCLUSIONS AND RELEVANCEIn this preliminary study involving patients with subclinical hypothyroidism and acute myocardial infarction, treatment with levothyroxine, compared with placebo, did not significantly improve left ventricular ejection fraction after 52 weeks. These findings do not support treatment of subclinical hypothyroidism in patients with acute myocardial infarction.

Summary This document provides practical guidance for the management of people with cardiac implantable electronic devices who are undergoing surgical intervention. Increasing numbers of people have cardiac device implants including pacemakers, implantable defibrillators and cardiac resynchronisation devices. During surgical procedures, exposure to electromagnetic interference may lead to inappropriate device function including withholding of pacing function or shock therapies. The guideline summarises key aspects of pre‐operative assessment protocols to ensure that all people have their device clearly identified and have had appropriate device follow‐up pre‐operatively. It outlines general measures which can minimise the risk of potentially problematic electromagnetic interference in the surgical environment. It also includes detailed guidance according to the type of device, whether individuals are dependent on the pacing function of the device and the nature of the procedure they are undergoing. People identified as being at significant risk of harmful procedure‐related inappropriate device function may require temporary alteration to the device programming. This may be carried out by a trained cardiac physiologist using a device programmer or, in some cases, can be achieved by clinical magnet application. Guidance on the safe use of magnets and emergency situations is included. Common diagnostic procedures and dental interventions are covered. The guidance aims to provide specific and pragmatic advice which can be applied to provide safe and streamlined care for people with cardiac implantable devices.

E ndothelial progenitor cells (EPCs) are circulating bone marrow-derived mononuclear cells that have the potential to promote postnatal neovascularization and endothelial repair. 1 Reduced numbers of EPCs have been demonstrated in patients with coronary artery disease (CAD) and those with cardiac risk factors including smoking, hyperlipidemia, hypertension, diabetes mellitus, and increasing age. 2 EPCs are mobilized in the peripheral blood of patients after acute coronary syndromes, 2 percutaneous coronary intervention, 3,4 and vascular trauma/surgery, 5,6 suggesting that the numbers of circulating EPCs may be a useful biomarker of cardiovascular risk and that endogenous vascular repair may be an important modulator of the clinical course of CAD. 7,8 Present data suggest that CD133 ϩ KDR ϩ cells in the bone marrow mature to CD133 ϩ CD34 ϩ KDR ϩ cells with subsequent loss of CD133 and CD34 reflecting transformation into a differentiated mature endothelial cell. 9,10 It is also known that the hematopoietic system has a circadian rhythm and numbers of circulating blood cells show diurnal variations. 11 However, there have been no published studies to date that investigate this property in EPCs.We recruited 15 healthy male Caucasian adult volunteers aged between 23 and 45 (average age 30.5 years) who were free from cardiovascular disease or known cardiac risk factors, and were nonsmokers. Volunteers were also requested to refrain from caffeine during the study. We obtained an EDTA peripheral blood sample at 8 AM, 3 PM, and 10 PM on the same day from each individual. 100 L of peripheral blood was added to Trucount tubes (BD biosciences) containing fluorescent beads to permit calculation of absolute numbers of EPCs. A FACScalibur was used to record the presence of cells expressing the surface marker combinations that are commonly used to define EPCs: CD34, CD133, and kinase domain receptor (KDR). CD45 expression was used as an additional gating criterion for CD34 ϩ cells. Fluorescent antibodies, anti-CD45-fluorescein isothiocyanate (FITC), anti-CD34-PercP-cy5.5 (BD biosciences), anti-VEGR-2-PE (R&D Systems), and anti-CD133-activated protein C (APC) (Miltenyi Biotec), or fluorescent antibody isotype controls were added to 3 replicate blood samples at the 3 time points for each individual. After red blood cell lysis (Pharmlyse, BD biosciences), 60 000 cells in the lymphocyte region (defined on a forward and side scatter plot) were recorded using CellQuest software. EPC counts were normally distributed and differences in EPC numbers across the 3 time points were assessed using 2-way analysis of variance (ANOVA), with individual assigned as a blocking factor. Paired t tests were then performed on data that showed significant differences (PϽ0.05) in the ANOVA and were used to compare EPC numbers between time points. A 2-sided probability value of Ͻ0.05 was used to define statistical significance. All volunteers gave informed consent for the study and procedures were approved by the regional ethics committee.The mean cell c...

The specific localised vascular injury induced by PCI did not lead to early mobilisation of EPCs. However, the fall in EPCs 6 hours after PCI was significant and its relation to early post-PCI complications such as stent thrombosis requires further exploration.