Jumping across the gap - a series of atrial extrastimuli.

The "gap phenomenon" is an interesting phenomenon in electrophysiology arising from the differences in refractory periods at two or more levels of the atrioventricular (AV) conduction system. We present a patient with dual AV nodal physiology in whom the AH jump mediates the gap phenomenon. We also briefly discuss the other mechanisms of gap phenomenon that have been described in this setting.

Carotid intima-media thickness predicted the presence but not the severity or complexity of coronary artery disease in a South Asian population.

BACKGROUND: Carotid intima-media thickness (CIMT) is considered a marker of atherosclerosis, but the data is lacking from the South Asian population. We aimed to study the relation of CIMT with the presence and severity of coronary artery disease (CAD) in this population. METHODS: This was a prospective, single-center study of consecutive patients undergoing elective coronary angiography. Participants with >50% luminal stenosis in any major coronary artery were included in the CAD group and those with normal coronaries in the non-CAD group. Multivariate linear regression analysis was done to determine independent predictors of CAD. Pearson's correlation coefficients assessed correlations between CIMT and Syntax and Gensini score. RESULTS: The mean CIMT was significantly much higher in the CAD group when compared to the non-CAD group (0.83±0.16 vs 0.61±0.14mm, p<0.001). On multivariable linear regression analysis only diabetes (ß=0.208 and p=0.024), waist-hip ratio (ß=0.178 and p=0.043), current smoker (ß=0.293 and p=<0.001) and CIMT (ß=0.217 and p=0.031) were independent predictors of CAD. The mean Gensini score in the CAD group was 48.59±34.25 and the mean Syntax score was 19.45±10.24. No significant relation was found between CIMT and Gensini score (r=0.009 and p=0.89), and Syntax score (r=-0.087 and p=0.171). CONCLUSION: Mean CIMT is an independent predictor of CAD along with diabetes, waist-hip ratio, and smoking. However, CIMT was not related to the severity and complexity of the CAD as assessed by the Gensini score and Syntax score, respectively.

Relation of systolic and diastolic epicardial adipose tissue thickness with presence and severity of coronary artery disease (The EAT CAD study).

BACKGROUND: Recent studies have shown EAT to be an indicator of cardiovascular risk and atherosclerotic plaque development. However, such data is sparse from Indian sub-continent. The present study evaluated the relationship of EAT as determined by echocardiography to the presence and severity of coronary artery disease (CAD). MATERIALS AND METHODS: This was a cross-sectional observational study constituting 500 patients including 250 with angiographically normal coronary arteries (non-CAD group), and 250 patients with significant CAD on coronary angiogram (CAD group). CAD severity was assessed by Gensini and SYNTAX scores. RESULTS: The mean systolic and diastolic EAT thickness in the CAD group (5.7 ± 1.5 mm and 4.3 ± 1.1 mm) were significantly higher than the non-CAD group (4.2 ± 1.2 mm and 3.2 ± 1.2 mm), both P < 0.001. EAT thickness showed a significant positive correlation with waist circumference, LDL-C levels, Gensini score, and SYNTAX score. On multivariate logistic regression analysis, both systolic and diastolic EAT thickness were found to be independent predictor of CAD in addition traditional risk factors. Receiver operating characteristics (ROC) analysis showed that systolic EAT thickness of 5 mm and diastolic EAT thickness of 4 mm had similar sensitivity (85% vs 83%, respectively) and specificity (70% vs 72%, respectively) to detect presence of CAD. CONCLUSION: Systolic and diastolic EAT thicknesses are increased in CAD patients and related to both presence and severity of CAD. EAT, being modifiable, may be an attractive target for future interventions to reduce CV risk and has potential to monitor the response to life-style modification and therapy. However, larger and prospective studies required to validate these findings.

Real World Experience of a Biodegradable Polymer Sirolimus-Eluting Stent (Yukon Choice PC Elite) in Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Angioplasty: A Multicentric Observational Study (The Elite India Study).

BACKGROUND: The durable polymer drug-eluting stents (DPDES) reduce the risk of repeated target vessel revascularisation (TLR) compared with BMS, but are associated with increased risk of late adverse events. In broadly inclusive populations, the biodegradable-polymer drug-eluting stents (BPDES) have favourable results compared with DPDES in the long term. However, its use in primary angioplasty has not been adequately studied, and data of real-world clinical experience is lacking. AIM: Aim of this study was to assess the safety and efficacy of Yukon Choice PC Elite sirolimus-eluting stent (a novel BPDES) in STEMI patients undergoing primary angioplasty. METHODS: We have presented here one-year clinical follow-up data of the Yukon Choice PC Elite sirolimus-eluting stent in patients undergoing primary angioplasty. A total of 636 patients were enrolled in this single arm, prospective observational study from five centres. RESULTS: This multicentric observational study showed excellent safety and efficacy profile of the novel device at one year follow up. The device-oriented composite endpoint (DOCE) of cardiac death, target-vessel reinfarction, and target-lesion revascularisation (TLR) was 2.7%, and the patient-oriented composite endpoint (POCE) of all-cause death, any myocardial infarction, and any revascularisation was 4.2% at one year. Definite or probable stent thrombosis rate was 0.6%, and no events were recorded beyond 6 months of follow up. CONCLUSIONS: In patients with STEMI undergoing primary angioplasty, the use of Yukon Choice PC Elite (biodegradable polymer sirolimus-eluting stent) has excellent results at one year. It, therefore, represents an attractive alternative to second generation DES in this high-risk population.

Carotid intima-media thickness predicted the presence but not the severity or complexity of coronary artery disease in a South Asian population / El grosor de íntima media carotídeo predijo la presencia aunque no la gravedad ni complejidad de la enfermedad de las arterias coronarias en la población del sur de Asia

Background: Carotid intima-media thickness (CIMT) is considered a marker of atherosclerosis, but the data is lacking from the South Asian population. We aimed to study the relation of CIMT with the presence and severity of coronary artery disease (CAD) in this population. Methods: This was a prospective, single-center study of consecutive patients undergoing elective coronary angiography. Participants with >50% luminal stenosis in any major coronary artery were included in the CAD group and those with normal coronaries in the non-CAD group. Multivariate linear regression analysis was done to determine independent predictors of CAD. Pearson's correlation coefficients assessed correlations between CIMT and Syntax and Gensini score. Results: The mean CIMT was significantly much higher in the CAD group when compared to the non-CAD group (0.83±0.16 vs 0.61±0.14mm, p<0.001). On multivariable linear regression analysis only diabetes (β=0.208 and p=0.024), waist–hip ratio (β=0.178 and p=0.043), current smoker (β=0.293 and p=<0.001) and CIMT (β=0.217 and p=0.031) were independent predictors of CAD. The mean Gensini score in the CAD group was 48.59±34.25 and the mean Syntax score was 19.45±10.24. No significant relation was found between CIMT and Gensini score (r=0.009 and p=0.89), and Syntax score (r=−0.087 and p=0.171). Conclusion: Mean CIMT is an independent predictor of CAD along with diabetes, waist–hip ratio, and smoking. However, CIMT was not related to the severity and complexity of the CAD as assessed by the Gensini score and Syntax score, respectively. (AU)

Antecedentes: El grosor de íntima media carotídeo (GIM) está considerado un marcador de la aterosclerosis, aunque se carece de datos relativos a la población del sur de Asia. Nuestro objetivo fue estudiar la relación de GIM con la presencia y gravedad de la enfermedad de las arterias coronarias (EAC) en esta población. Métodos: Estudio prospectivo y unicéntrico de pacientes consecutivos sometidos a angiografía coronaria electiva. Se incluyó en el grupo EAC a los participantes con >50% estenosis luminal en cualquier arteria coronaria mayor, y en el grupo no EAC a los participantes con arterias coronarias normales. Se realizó un análisis de regresión lineal multivariante para determinar los factores predictivos independientes de EAC. Los coeficientes de correlación de Pearson evaluaron las correlaciones entre GIM y las puntuaciones de Gensini y Syntax. Resultados: El GIM medio fue significativamente mayor en el grupo EAC en comparación con el grupo no EAC (0,83±0,16 vs. 0,61±0,14mm, p<0,001). En el análisis de regresión lineal multivariante solo la diabetes (β=0,208 y p=0,024), el índice cintura-cadera (β=0,178 y p=0,043), y el tabaquismo actual (β=0,293 y p=<0,001) y GIM (β=0,217 y p=0,031) fueron factores predictivos independientes de EAC. La puntuación Gensini media en el grupo EAC fue de 48,59±34,25, y la puntuación Syntax media fue de 19,45±10,24. No se encontró relación significativa entre GIM y la puntuación de Gensini (r=0,009 y p=0,89) y la puntuación Syntax (r=−0,087 y p=0,171). Conclusión: El GIM medio es un factor predictivo independiente de EAC, junto con la diabetes, el índice cintura-cadera y el tabaquismo. Sin embargo, GIM no guardó relación con la gravedad y complejidad de EAC, según la evaluación de las puntuaciones de Gensini y Syntax, respectivamente. (AU)