Poets say your Eyes are the Windows to your Soul; now Science has just caught up:
Research on the eyes as windows to potential cardiovascular disease risk and dysfunctional coronary artery flow in prediabetics.
Eyes Provide Early Clues to CV Risk
Greek researchers presented three studies showing how retinal circulation could potentially distinguish patients who are at a low short-term, but high lifetime risk, of cardiovascular (CV) adverse events from those who are at a low short-term and low lifetime risk.
One study, involving 229 stage I-II never treated essential hypertensive patients with a median age of 62, found a significant correlation between deterioration of the retinal vascular category (stages 0 to 4) and impaired ejection fraction. There also was an increase in interventricular septum end-diastolic thickness and left atrial anteroposterior diameter.
A second study, which looked at 268 consecutive newly diagnosed, untreated, essential hypertensives with no history of diabetes or CV disease and a median age of 60, found a parallel escalation between retinal vascular alterations and arterial stiffness, measured by pulse pressure.
The third study, examining 202 consecutive patients with newly diagnosed hypertension without CV disease and a median age of 60, found a significant correlation with the stage of retinal vascular damage and metabolic syndrome.
Lead author of all three studies Vasiliki Katsi, MD, from Hippokration General Hospital in Athens, said in a statement that fundoscopy, the method of measuring retinal vasculature, is currently too subjective and would benefit from automated software.
Compression Rare with This Stent
A review of 2,936 Promus Element stents implanted during a 22-month period found a 1.44% per patient longitudinal stent compression rate, Michael Gick, MD, from the Heart Centre Bad Krozingen in Germany, and colleagues reported.
The mean age of patients was 67 and the rate of stent compression per lesion was 0.70% and per all stents was 0.68%.
The only significant predictors of stent compression were stents placed in the ostial segments (OR 8.33, 95% CI 3.30 to 21.28), number of stents implanted (OR 1.57, 95% CI 1.01 to 2.45), and the presence of a bifurcation(OR 3.57, 95% CI 1.36 to 9.35).
They concluded that longitudinal stent compression with the third-generation Element stent is rare.
Consensus Paper Focuses on CRT in HF.
The increased use of cardiac resynchronization therapy (CRT) in heart failure -- more than 200,000 devices implanted worldwide last year -- has led to an expert consensus statement on the practical management of these patients.
"Our goal was to establish a consensus statement on how to manage CRT patients before, during, and after the implantation procedure," said lead author Jean-Claude Daubert, MD, of the University of Rennes, France, in a statement. Daubert said that solid clinical evidence was lacking for all aspects of managment.
The document, developed by an international team from North America and Europe and released at the ESC meeting, is divided into six sections:
- Pre-implant evaluation
- CRT implantation
- Predischarge evaluation and device programming
- CRT follow-up
- Response to CRT management of the nonresponder
- Special considerations
In the pre-implant evaluation section, for example, the focus is on potential temporary contraindications to the intervention, and how to manage medications, particularly anticoagulants and antibiotics, just before and during the implantation procedure. Daubert said there was no consensus before on these particular aspects.
The statement has been published in EP Europace and HeartRhythm (2012;9:1524–1576), and can be downloaded at the European Heart Rhythm Association website.
Guidelines Come from Industry-Sponsored Studies
Industry-sponsored studies make up the bulk of class I recommendations in the 2011 ESC Guidelines for Acute Coronary Syndrome (ACS) without ST Elevation, researchers found.
This same group of researchers, led by Payal Kohli, MD, of the University of California in San Francisco, had previously found similar results for the guidelines pertaining to the management of patients with unstable angina/non-STEMI developed by the American Heart Association/American College of Cardiology.
For the current study, of the 85 citations used to support class I recommendations, they found 84% of them were funded by non-government or industry sources.
They noted that recommendations for pharmacological therapy had a higher percentage of industry support than other areas including secondary prevention, special populations, and diagnosis and intervention.
They concluded that industry-sponsored studies have a positive impact on clinical guidelines "in identifying many new strategies and treatments for ACS."
Diabetics Have Slow Coronary Blood Flow
Coronary blood flow is slow in prediabetic and diabetic patients with normal coronary arteries when compared to nondiabetics, a retrospective study found.
Researchers reviewed the angiograms of 759 patients with normal coronary arteries (left anterior descending artery, left circumflex, and right coronary artery) for TIMI frame counting.
They found significant differences in frame counts between nondiabetics, prediabetics, and diabetics in each artery, reported Ugur Arslan, MD, from Samsun Education and Research Hospital in Turkey, and colleagues.
In a second post hoc analysis, they found that prediabetics and diabetics had similar TIMI frame counts for all three coronary arteries, but both of these groups had significantly higher TIMI frame counts than nondiabetics.
"We have revealed for the first time that patients with prediabetes have slow coronary flow measured by TIMI frame count just like diabetic patients when compared to nondiabetics," they concluded.
They suggested that this abnormality "may show the endothelial dysfunction in the coronary arteries which develops in the prediabetic phase before overt diabetes mellitus arises."
From the American Heart Association:
Science News: ESC Congress 2012