Characterization of a stepwise approach in cavotricuspid isthmus ablation for typical atrial flutter: A randomized study comparing three catheters.

INTRODUCTION: Our aim was to characterize a stepwise approach in cavotricuspid isthmus ablation for typical atrial flutter in a prospective, noncrossover randomized study. METHODS: One hundred and fifty patients referred for cavotricuspid isthmus (CTI)-dependent atrial flutter ablation were randomized to undergo an ablation with an 8-mm-tip catheter (group 1), a 3.5-mm open irrigation-tip catheter (group 2), and a 3.5-mm open irrigation porous-tip catheter (group 3). A stepwise approach was performed, changing the ablation site from medial to septal aspects of the CTI, in case it was not effective without crossover between catheters. RESULTS: CTI block was achieved in all the patients using only one catheter. There was a 68% efficacy in group 1, 40% in group 2, and 28% in group 3 to achieve CTI block within 10 minutes (P  =  0.001) and 96%, 70%, and 70% in groups 1, 2, and 3, respectively, within 20 minutes (P  =  0.002) of radiofrequency ablation. The 8-mm catheter was also faster in fluoroscopy time and CTI block time. There were no differences in efficiency in the both irrigated catheters. There were no significant differences in complications among three catheters. CONCLUSIONS: With this stepwise approach, it is possible to achieve CTI block in all cases, using a single catheter without crossover, with good times of procedure and with a low complication rate. The 8-mm solid catheter is faster than the other irrigated-tip catheters. The 3.5-mm open irrigation porous-tip catheter is as effective and safe as the conventional irrigated-tip catheter.

Sodium-Glucose Cotransporter-2 Inhibitors at Discharge from Cardiology Hospitalization Department: Decoding A New Clinical Scenario.

Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) are new glucose-lowering drugs (GLDs) with demonstrated cardiovascular benefits in patients with heart disease and type-2 diabetes mellitus (T2DM). However, their safety and efficacy when prescribed at hospital discharge are unexplored. This prospective, observational, longitudinal cohort study included 104 consecutive T2DM patients discharged from the cardiology department between April 2018 and February 2019. Patients were classified based on SGLT-2 inhibitor prescription and adjusted by propensity-score matching. The safety outcomes included discontinuation of GLDs; worsening renal function; and renal, hepatic, or metabolic hospitalization. The efficacy outcomes were death from any cause, cardiovascular death, cardiovascular readmission, and combined clinical outcome (cardiovascular death or readmission). The results showed that, the incidence rates of safety outcomes were similar in the SGLT-2 inhibitor or non-SGLT-2 inhibitor groups. Regarding efficacy, the SGLT-2 inhibitors group resulted in a lower rate of combined clinical outcomes (18% vs. 42%; hazard ratio (HR), 0.35; p = 0.02), any cause death (0% vs. 24%; HR, 0.79; p = 0.001) and cardiovascular death (0% vs. 17%; HR, 0.83; p = 0.005). No significant differences were found in cardiovascular readmissions. SGLT-2 inhibitor prescription at hospital discharge in patients with heart disease and T2DM was safe, well tolerated, and associated with a reduction in all-cause and cardiovascular deaths.

Infective endocarditis and caseous calcification of the mitral annulus: the odd couple.

Caseous calcification of the mitral annulus is an infrequent echocardiographic finding. The differential diagnosis includes other entities like tumors, abscess or thrombus. Both cardiac CT and cardiac MRI may be useful for its definitive diagnosis.

Real incidence of diabetes mellitus in a coronary disease population.

The high prevalence of unknown diabetes mellitus (DM) in patients with coronary disease and that the oral glucose tolerance test (OGTT) is the best diagnostic method in this context are well known. However, data about the incidence of DM in this population have not been well described. In the present study, we sought to determine the actual incidence of new-onset DM in patients with coronary disease using the OGTT. Our secondary objective was to validate a predictive model. We studied a series of 338 patients with coronary disease without known DM using the OGTT. After the OGTT, the patients were reclassified as normoglycemic, prediabetic, and unknown DM, according to the American Diabetes Association 2010 criteria. After 3 years of follow-up, the patients without DM were again reassessed using the OGTT. We then built a predictive model using the multivariate logistic regression method and validated it using the leave-one-out method. The final sample was 191 patients. The mean follow-up was 3.13 years. The overall incidence of DM was 43.6 cases/1,000 person-years (95% confidence interval [CI] 26.8 to 60.4). The incidence was significantly different between the initially normoglycemic patients (11.5%, 95% CI 2.3% to 31.8%) and the prediabetic patients (70.5%, 95% CI 42.7% to 98.3%; p <0.001). A risk model that included the glucose level 2 hours after challenge, glycosylated hemoglobin and triglyceride levels, and presence of noncoronary vascular disease showed good predictive capacity for incident DM (area under the curve 0.882, 95% CI 0.819 to 0.946; p <0.0001). In conclusion, the real incidence of new DM is very high in the coronary population, especially in those with prediabetes. It is necessary to use the OGTT for diagnosis, but we can optimize its indication using a risk model.

Enfermedad difusa no revascularizable de los tres vasos coronarios: pronóstico a largo plazo / Diffuse coronary artery disease not amenable to revascularization: long-term prognosis

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Infective endocarditis and caseous calcification of the mitral annulus: The odd couple / La endocarditis infecciosa y la calcificación caseosa del anillo mitral: la extraña pareja

Caseous calcification of the mitral annulus is an infrequent echocardiographic finding. The differential diagnosis includes other entities like tumors, abscess or thrombus. Both cardiac CT and cardiac MRI may be useful for its definitive diagnosis.

La calcificación caseosa del anillo mitral es un hallazgo ecocardiográfico poco frecuente. Debe hacerse el diagnóstico diferencial con otras entidades tales como tumores, abscesos o trombos. Para su diagnóstico definitivo además del ecocardiograma tanto el TC cardiaco como la Cardio RM pueden ser de utilidad.