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
Online first papers have undergone full scientific review and copyediting, but have not been typeset or proofread. To cite this article, use the DOIs number provided. Mandatory typesetting and proofreading will commence with regular print and online publication of the online first papers of the SMJ.
Background Visit-to-visit heart rate variability (VVV-HR) has been associated with adverse cardiovascular outcomes. We aimed to determine the predictive value of VVV-HR for adverse clinical outcomes in patients with nonvalvular atrial fibrillation (AF). Methods We used data from a prospective multicenter AF registry of 27 hospitals in Thailand during 2014 to 2017. After the baseline visit, patients were followed up every 6 months until 3 years. VVV-HR was calculated from the standard deviation of heart rate data from baseline visit and every follow-up visit. VVV-HR was categorized into four groups according to the quartiles. Clinical outcomes were all-cause death, ischemic stroke/systemic embolism (SE), and heart failure. Cox proportional hazard models were used for multivariable analysis. Results There were a total of 3,174 patients (mean age: 67.7 years; 41.8% female). The incidence rates of all-cause death, ischemic stroke/SE, and heart failure were 3.10 (2.74–3.49), 1.42 (1.18–1.69), and 2.09 (1.80–2.42) per 100 person-years respectively. The average heart rate was 77.8 ± 11.0 bpm and the average of standard deviation of heart rate was 11.0 ± 5.9 bpm. VVV-HR Q4 was an independent predictor of all-cause death, ischemic stroke/SE, and heart failure with adjusted hazard ratios of 1.45 (95% confidence interval: 1.07–1.98), 2.02 (1.24–3.29), and 2.63 (1.75–3.96), respectively. VVV-HR still remained a significant predictor of clinical outcomes when analyzed based on coefficient of variation and variability independent of mean. Conclusion VVV-HR is an independent predictor for adverse clinical outcomes in patients with AF. A J-curve appearance was demonstrated for the effect of VVV-HR on all-cause death.
Introduction: Identification of critical isthmus sites for post-infarction ventricular tachycardia (VT) ablation can be challenging. Unexcitable scar during pacing can identify one of the borders of the re-entry circuit. This area however is not thought to be critical to the circuit. Because of current-to-load mismatch, higher power might be required in order to obtain capture of individual surviving muscle bundles within scar tissue. The purpose of this study was to evaluate the value of high output capture of scar tissue in patients with post-infarction VT. Methods: In a consecutive series of 18 patients (15 men, age 62 ± 9, EF 0.28 ± 0.15) with post-infarction VT, mapping was performed using an electroanatomic mapping system. A voltage map was obtained during sinus rhythm and bipolar pace-mapping was performed in areas with low voltage (< 1.5 mV) with an output of 10 mA at a pulse width (PW) of 2 ms. High output capture was defined when capture at these settings failed but capture could be achieved with increased output. If there was no capture at the initial settings, output was increased to 20 mA at a PW of 2 ms, eventually the PW was increased up to 10 ms as required to achieve capture. A critical isthmus was defined as a site with a matching pace-map, and/or matching stimulus-QRS to electrogram-QRS intervals in the presence of concealed entrainment, and/or mechanical termination of VT and failure to induce VT after radiofrequency ablation. Results: Focal areas with high output capture could be observed in 10/18 (56%) patients. In 9/10 patients in whom high output capture was present (mean output: 20 mA; mean pulse width: 7.4 ms), this area was critical for the re-entry circuit of 10 VTs (cycle length 444 ± 72 ms). A total of 77 VTs (cycle length 390 ± 115 ms) was induced in these patients. Forty-three isthmus sites could be identified and effectively ablated for 56 of the VTs. During a follow-up of 4.9 ± 5.3 months 2 patients had VTs that were not targeted during the ablation. Conclusions: High output pacing is helpful in identifying critical areas of post-infarction VT that otherwise might be missed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.