Platelet dysfunction has been implicated as a central contributor to the increased risk of coronary artery disease in patients with DM, and it is not surprising that the anti-platelet agent, clopidogrel, has been shown to have efficacy in both short and long term outcomes in patients with acute coronary syndrome and those undergoing percutaneous coronary intervention. However, accumulating data suggest a clinically relevant sub-optimal clopidogrel response in some patients with DM. The exact mechanism of these observations is not yet fully understood, but appears to be related to reduced concentrations of circulating clopidogrel active metabolite, with less variability in pharmacodynamic and clinical
response suggested Selleck SB203580 by the evaluation of newer P2Y(12) antagonists, such as prasugrel SNX-5422 ic50 and ticagrelor. More research is needed to better
understand both the pharmacology and clinical consequences of these observations.”
“We present a case of a 76-year-old woman on a permanent pacing device, with early abrasion of silicone endocardial lead insulations complicated by lead-dependent infective endocarditis 13 months after placement of an implantable pulse generator. The leads were removed using transvenous technique with direct traction, and with no additional tools. In the previous report, a set of additional tools was used, and therefore intraoperative endocardial lead abrasions or mechanical damage of leads could have not been excluded. The present case undoubtedly proves that the friction of leads against each other may result in abrasions of insulation of the intracardiac section of the lead. (PACE 2012; 35:e156e158)”
“Purrpose: To evaluate myocardial microvascular disease in patients with type 2 diabetes mellitus (DM) using myocardial contrast echocardiography (MCE) and to report on its diagnostic accuracy using single
photon emission tomography (SPECT) as reference test.
Methods: We prospectively enrolled 79 patients (25 DM; 66 +/- 11 years) who underwent simultaneous SPECT and MCE with contrast agent during adenosine stress. MCE and SPECT were visually analyzed using 17 segments. Quantitative MCE parameters were derived from replenishment curves. Microbubble velocity (beta min(-1)), absolute myocardial blood Selleck VX-680 flow (MBF ml/min/g), and reserve values were calculated. Diagnostic accuracy and area under curve (AUC) was reported.
Results: Patients with DM had higher BMI vs non DM (33 +/- 7 vs 28 +/- 5kg/m(2) P=0.007), with more prior myocardial infarction (40 vs 15% P=.01). Visual MCE was abnormal in 40 (51%) patients (60% in DM vs 46% in non DM P=0.04). SPECT was abnormal in 38 (48%) patients [ 60% in DM vs 42% non DM, P=0.01]. Reserve parameters were lower in DM vs. non DM patients: (beta 1.77 +/- 1.12 vs 2.20 +/- 1.4, P<0.001 and MBF 2.86 +/- 2.62 vs. 3.67 +/- 2.84, P<0.001).