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Background In contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity. Methods and results CLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure. Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportional hazards model, diabetes was associated with increased risks for the primary outcome (cardiovascular death, myocardial infarction, or stroke) with an adjusted hazard ratio of 1.28 (95% confidence interval 1.18, 1.39) and for all secondary outcomes (all-cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, and coronary revascularization). Differences on outcomes according to geography and ethnicity were modest. Conclusion In patients with chronic coronary syndromes, diabetes is independently associated with mortality and cardiovascular events, including heart failure, which is not accounted by demographics, prior medical history, left ventricular ejection fraction, or use of secondary prevention medication. This is observed across multiple geographic regions and ethnicities, despite marked disparities in the prevalence of diabetes. ClinicalTrials identifier ISRCTN43070564

INTRODUCTION: The anemia leads to a worse prognosis in patients with heart failure(HF). There are few data on the impact of anemia on mortality in patients with acute heart failiure(AHF), and the studies available are mainly retrospective and include hospitalized patients. OBJECTIVE. Evaluate the role of anemia in 30-days and one-year mortality in patients with AHF attended in hospital emergency departments(HEDs). METHODS. Multicenter, observational study of prospective cohorts of patients with AHF. Study variables: anemia(hemoglobin<12g/dL in women and <13g/dL in men), 30-days-mortality and at one year, risk factors, comorbidity, functional impairment, basal functional grade for dyspnea, chronic and acute treatment, clinical and analytical data of the episode and patient destination. Statistical analysis: bivariate analysis and survival analyses using Cox regression. RESULTS. A total of 13,454 patients were included, 7662(56.9%) of whom had anemia. Those with anemia were older, had more comorbidity, a worse functional status and New York Heart Association class, greater renal function impairment and more hyponatremia. The mortality was higher in patients with anemia at 30-days and one-year: 7.5% vs. 10.7%(p<0.001) and 21.2% vs. 31.4%(p<0.001), respectively. The crude and adjusted hazard ratios of anemia for 30-days-mortality were: 1.46(confidence interval[CI]

Funding Acknowledgements Type of funding sources: None. Introduction Inflammation may play an important role in the development of atrial fibrillation (AF). Some studies have suggested that cancer through inflammatory mediators may promote the development of AF (1-2). Our hypothesis was that patients with a first episode of AF might be at increased risk of developing cancer. We set out to study the incidence of cancer in the 2 years following a first episode of AF and to investigate the differences between patients (pts) who develop malignancies and those who do not. Methods Clinical and analytical data were collected from pts presenting with an episode of AF, diagnosed electrocardiographically, to the Emergency Department of our hospital in Spain between 2010-2015 (n=2013). After selecting pts with a first episode and excluding pts with a history of AF or cancer and those with an identified precipitating factor, a sample of 712 pts was obtained (mean age 74.3±14.7; 61.9% female). The minimum follow-up was 2 years, registering cancer occurrence and type, total mortality, emergency department attendance and hospitalization for cardiovascular causes, AF recurrences as well as bleeding and embolic events. We compared data from those who developed cancer during the 2 years after AF debut with those who did not, as well as with the incidence and types of cancer in the general population in Spain (SP) in 2012 (3). Results Of the 712 patients, 35 patients (4.91%) were diagnosed with cancer during the 2-year follow-up (annual incidence: 2.45% (sample) vs 0.46% (SP); p&lt;0.01). The annual incidence in our &lt;65 years old sample was 0.28% vs 0.18% in SP; p&lt;0.05. In the &gt;65 years old group, annual incidence was 2.17% (sample) vs 0.28% (SP); p&lt;0.01. There were also differences between cancer types, with non-solid neoplasms being more frequent in our sample (34.28%), followed by colorectal and breast (14.28% both) (Figure 1). In multivariate analysis comparing patients with and without cancer in our sample, occurrence of cancer was only associated with non-typical symptoms (absence of palpitations) : 33.38% vs 14.28%; p&lt;0.05, and lower creatinine levels in patients developing cancer. Multiple correspondence analysis (MCA) also found no variables associated with cancer development (Figure 2). The mortality rate was higher in the group that developed cancer (54.28% vs 36.02%, p&lt;0.05), with no significant differences in the remaining events. Conclusions There is a relatively high incidence of cancer in patients with a first episode of AF (annual incidence of 2.45% after AF debut is 6.1 times the risk in the general population), in particular in the group of age &gt; 65 years old. No relevant clinical or analytical variable was able to predict the patient who will develop cancer. Further studies and exploration of new variables are needed to better assess the association between AF and cancer occurrence.

The sistodiastolic dysfunction of the heart measured through global ejection of the left ventricle as systolic parameter and the ventricular rapid filling plus the time of ventricular total filling as parameters of function diastólica are informational facts of complementary examinations of high sensibility and specificity for this type of study. It was established a relationship between the fraction of left ventricular ejection global and segment, measured for ventriculografía radioisotópica of balance, with the disorders electrocardiográficos in chronic chagásic patients. It is possible to conclude that while major alteration exists in the fraction of ventricular ejection, major abnormal variations exist in the electrocardiography of the chronical chagasic patients. Those who presented complete block of right branch show the possible existence of association in the deterioration of the fraction of ejection apicoseptal, aspect that would allow to conclude that the complete blockade of right branch can be a variable predisposed. The statistical analysis of the fraction of ejection apical that was found shows that the decrease of this region has a statistical force with the electrocardiografic deterioration complete blockade of right branch more front left hemibloqueo, This scientific evidence is confirmed across the statistical and epidemiological evidence which indicators allow to observe a major prevalency in 66 % and a major association of 1.51 times of complete Blockade of Right Branch more front left hemibloqueo in relation to other segments.

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We report a case of sarcoidosis with an unusual presentation, initially manifesting as bilateral pulmonary embolism and then as a cardiac form of the disease with an ominous clinical event consisting of sustained ventricular tachycardia. The diagnosis was established by clinical and magnetic resonance criteria despite normal conventional echocardiographic study. Detailed functional assessment provided by tracking techniques (speckle tracking echocardiography and cardiac magnetic resonance tissue tracking) enabled the detection of regional deformation abnormalities, indicating prominent circumferential strain and epicardial layer alterations, partly matching the structural changes depicted by distribution of delayed enhancement. We find this case notable for various issues it raises concerning diagnosis and management of cardiac sarcoidosis. These are mainly related to recent developments in imaging modalities that enable non-invasive identification of structural and functional abnormalities in this condition early, before overt deterioration in left ventricular ejection fraction. Information from different imaging modalities and tools provide information that could potentially assist preclinical diagnosis, with possible prognostic implications.