Carriers of TXNIP genetic variants presented higher TXNIP expression, early signs of glucose homeostasis derangement and increased susceptibility to chronic metabolic conditions such as diabetes and hypertension. Our data suggest that genetic variation in the TXNIP gene may act as a "common ground" modulator of both traits: diabetes and hypertension.

BackgroundAlthough the release of cardiac biomarkers after percutaneous (PCI) or surgical revascularization (CABG) is common, its prognostic significance is not known. Questions remain about the mechanisms and degree of correlation between the release, the volume of myocardial tissue loss, and the long-term significance. Delayed-enhancement of cardiac magnetic resonance (CMR) consistently quantifies areas of irreversible myocardial injury. To investigate the quantitative relationship between irreversible injury and cardiac biomarkers, we will evaluate the extent of irreversible injury in patients undergoing PCI and CABG and relate it to postprocedural modifications in cardiac biomarkers and long-term prognosis.Methods/DesignThe study will include 150 patients with multivessel coronary artery disease (CAD) with left ventricle ejection fraction (LVEF) and a formal indication for CABG; 50 patients will undergo CABG with cardiopulmonary bypass (CPB); 50 patients with the same arterial and ventricular condition indicated for myocardial revascularization will undergo CABG without CPB; and another 50 patients with CAD and preserved ventricular function will undergo PCI using stents. All patients will undergo CMR before and after surgery or PCI. We will also evaluate the release of cardiac markers of necrosis immediately before and after each procedure. Primary outcome considered is overall death in a 5-year follow-up. Secondary outcomes are levels of CK-MB isoenzyme and I-Troponin in association with presence of myocardial fibrosis and systolic left ventricle dysfunction assessed by CMR.DiscussionThe MASS-V Trial aims to establish reliable values for parameters of enzyme markers of myocardial necrosis in the absence of manifest myocardial infarction after mechanical interventions. The establishments of these indices have diagnostic value and clinical prognosis and therefore require relevant and different therapeutic measures. In daily practice, the inappropriate use of these necrosis markers has led to misdiagnosis and therefore wrong treatment. The appearance of a more sensitive tool such as CMR provides an unprecedented diagnostic accuracy of myocardial damage when correlated with necrosis enzyme markers. We aim to correlate laboratory data with imaging, thereby establishing more refined data on the presence or absence of irreversible myocardial injury after the procedure, either percutaneous or surgical, and this, with or without the use of cardiopulmonary bypass.

Background and Aim of the Study This study analyzed the arrival of coronavirus disease 2019 (COVID‐19) in Brazil and its impact on coronary artery bypass grafting (CABG) surgery. Methods Patients undergoing isolated CABG in six hospitals in Brazil were divided into two periods: pre‐COVID‐19 (March–May 2019, N = 468) and COVID‐19 era (March–May 2020, N = 182). Perioperative data were included on a dedicated REDCap platform. Patients with clinical and tomographic criteria and/or PCR (+) for severe acute respiratory syndrome coronavirus 2 infection were considered COVID‐19 (+). Logistic regression analysis was performed to create a multiple predictive model for mortality after CABG in COVID‐19 era. Results Compared to 2019, in 2020, CABG surgeries had a 2.8‐fold increased mortality risk (95% confidence interval [CI]: 1–7.6, p = .041), patients who evolved with COVID‐19 had a 11‐fold increased mortality risk (95% CI: 2.2–54.9, p < .003), rates of morbidities and readmission to the intensive care unit. The surgical volume was decreased by 60%. The model to predict mortality after CABG in the COVID‐19 era was validated with good calibration (Hosmer–Lemeshow = 1.43) and discrimination (receiver operating characteristic = 0.78). Conclusion The COVID‐19 pandemic had an adverse impact on mortality, morbidity and volume of patients undergoing CABG.

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From July, 1981 to December, 1988, 2431 percutaneous transluminal coronary angioplasties were performed on 1901 patients at the Heart Institute of São Paulo University Medical School. Seventy-six patients (4.0 per cent) underwent emergency coronary artery bypass grafting for failed angioplasty. The incidence of failed angioplasty was significantly higher in the impending myocardial infarction group (11.5 per cent) than in the angina group (4.8 per cent) and the acute myocardial infarction group (1.3 per cent). The mean age of the seventy-six patients was 54.4 years, and 54 patients were male. The operative mortality was 15.8 per cent, being 9 males and 3 females. Patients who had had a left main trunk dissection during angioplasty and those who were hemodynamically unstable following the failed angioplasty or who had had a cardiac arrest necessitating a cardiac massage during transportation to the operating room, had a higher mortality than patients in whom the failure occurred in other sites and those who were hemodynamically stable. Perioperative myocardial infarction was documented in 50 per cent of the patients. Patients who had had a cardiac arrest during the procedure had a higher rate of perioperative myocardial infarction than those whose preoperative hemodynamic condition was stable.

Introduction Vasoplegic syndrome (VS) is one of the most common unexpected complications following cardiothoracic surgery, approaching a 25% mortality rate. No standardized methods for diagnosing VS are available. A biomarker is a valuable tool in all fields of medicine, especially in cardiovascular disease when the patient has to undergo invasive surgery as on-pump CABG. MicroRNAs (miRNAs) have been studied and employed as biomarkers for numerous diseases, however, there are no studies regarding their expression in VS. Purpose To discover a new predictor of VS by comparing the miRNA profiles from patients who evolved to VS versus those who did not evolve after following Coronary artery bypass graft surgery (CABG). Methods A nested case-control study had an exploratory nature and involved an initial cohort of 87 patients who underwent on-pump CABG in elective or urgency procedures,considering the low surgical risk (STS score &lt;2%). For this analysis, we compared 30 patients, divided into two groups: patients who evolved VS (VASO group, n=15) and who did not evolve VS (NONVASO group, n=15) after surgery. To perform the miRNA profiling, the target prediction, and identify the putative targets of the dysregulated miRNAs, the whole blood samples were collected after anesthetic induction and before incision in the chest (Figure 1A). Results We identified among the 754 screened miRNAs, eight differentially circulating miRNAs in the whole blood of VASO versus NONVASO groups (Figure 1B). Six miRNAs were increased (hsa-miR-548c-3p, hsa-miR-30d-5p, hsa-miR8 199b-5p, hsa-miR-183-3p, hsa-miR-571, hsa-miR-383-5p) and two were decreased (hsa-miR-1236-3p, hsa-miR-770-5p) and hsa-miR-1236-3p was not statistically significant (Figure 1C). The ROC curves for each single miRNAs yielded the top 2 highest AUC values of 0.8333 and 0.8178 for hsa-miR-770-5p and hsa-miR-30d-5p, respectively. The combination of these two miRNAs yielded an AUC value of 0.9615 with 84.6% sensitivity and 91.67% specificity in distinguishing patients from VASO from NONVASO groups showed a superior diagnostic power to that of a single miRNA (Figure 2). Computational analyses identified as the top enriched pathway the “Apelin Liver Signaling Pathway” with 14 out of 26 molecules within the pathway (53,8%) containing the higher number of targets of the dysregulated miRNAs. There was no statistical difference in preoperative, postoperative, EuroSCORE II, and variables comparing both groups. Conclusion(s) We showed that miRNA-770-5p and miRNA-30d-5p could be employed as potential biomarkers of VS, a new strategy to VS diagnosis since miRNAs expression could distinguish patients who could and could not evolve the disease. The capability of predicting VS with high accuracy would drastically change the clinical management and patient's referral to cardiac surgery by helping in decision-making once the clinical score risks proved to be unable to predict VS in low-risk patients. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Fundação de Amparo a Pesquisa de São Paulo - FAPESP

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