Silent Myocardial Infarction Research Articles

Abstract 11198: Intra-Myocardial Dissecting Haematoma Presented as a Ventricular Tachycardia in a Patient With Remote Silent Myocardial Infarction

Intramyocardial dissecting haematoma (IMDH), a rare form of myocardial rupture, is recognised as a complication of acute myocardial infarction (MI) but can also occur as a result of a thoracic trauma or spontaneous rupture of intramural coronary vessels. Before the advent of advanced multi-modality cardiac imaging, IMDH was an autopsy diagnosis. In this report, we present a patient with recent onset of palpitation due to non-compromising ventricular tachycardia (VT). Post cardioversion ECG showed anterior-apical deep Q waves in keeping with prior silent MI. Transthoracic echocardiography showed severely reduced left ventricular ejection fraction due to extensive apical aneurysm and raised the possibility of protruding apical thrombus. Subsequent contrast echocardiography showed features compatible with extensive LV apical thrombus and raised the differential diagnosis of contained myocardial rupture and IMDH. During the two years follow-up guideline directed medical therapy for heart failure and antiarrhythmic medication stabilised patient at NYHA class I-II with no recurrence of VT. Multimodality imaging including cardiac CT and MRI confirmed the suspicion of IMDH. With this case we are highlighting the difficulties in the diagnosis and the controversies of the management of IMDH. Figure: A: ECG shows monomorphic VT. B: after chemical cardioversion, ECG shows sinus rhythm with old transmural extensive anterior MI. C: Transthoracic echocardiography, apical 4 chamber view shows aneurysmatic left ventricular apex with echo lucent space with mobile intraventricular membrane separating the true LV lumen and the dissecting hematoma (Asterix). D: Contrast enhanced echocardiography delineating the true LV cavity from the IMDH. E,F: Contrast enhanced CT showing the low attenuation hematoma located in the anterior LV apex. Note the calcification in the LV apical myocardium indication of prior transmural MI.

Quantitative myocardial blood flow as a prognostic marker for cardiovascular outcomes in patients with Type 2 Diabetes Mellitus: a multicentre study

Abstract Introduction: Patients with Type 2 Diabetes Mellitus (T2DM) are at increased risk of cardiovascular disease, including epicardial coronary heart disease, silent myocardial infarction (MI), and coronary microvascular dysfunction (CMD) [1]. All of these can be assessed and quantified using cardiac magnetic resonance (CMR), including most recently quantitative myocardial blood flow (MBF). We aimed to determine the prognostic relevance of MBF in patients with T2DM and test the hypothesis that impaired stress MBF and myocardial perfusion reserve (MPR) have independent prognostic value over standard clinical and imaging parameters. Methods A 4-centre study of patients with T2DM who underwent quantitative perfusion assessment using CMR. Diagnosis of T2DM was based on Hba1c >48mmol/l or a known diagnosis of T2DM. Image analysis was performed automatically using an artificial intelligence approach deriving global MBF and MPR [2]. Cox proportional hazard models adjusting for comorbidities and CMR parameters sought associations between stress MBF and MPR with death and major adverse cardiovascular events (MACE), including MI, non-fatal stroke, heart failure hospitalisation and death. Results A total of 630 patients with T2DM were included with a median follow-up of 722 days (interquartile range 493) days. There were 27 (4.3%) deaths and 76 MACE events in 62 (12.1%) patients. Patient data was represented into groups depending on threshold stress MBF values of 1.94ml/g/min and MPR thresholds of 1.96 using validated data from invasive coronary physiology [3]. Patient demographics and CMR data are seen in table 1. Kaplan-Meier curves are seen in figure 1. Stress MBF was associated with mortality and MACE after adjusting for age, LV ejection fraction and HbA1c. The stress MBF adjusted hazard ratios for all cause death and death and MACE were 0.35 (95% CI, 0.13–0.95, P=0.04) and 0.54 (95% CI, 0.30–0.96, P=0.04), respectively. MPR was not significantly associated with death and MACE after adjusting for age, LV ejection fraction and HbA1c; hazard ratio for all cause death and death and MACE was 0.83 (95% CI, 0.41–1.69, P=0.60) and 0.81 (95% CI, 0.53–1.23, p=0.32) respectively. Conclusion In patients with T2DM, reduced stress MBF measured automatically inline using artificial intelligence quantification of cardiovascular magnetic resonance perfusion mapping provides a strong, independent predictor of adverse cardiovascular outcome. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): 1. REC ID 14/EE/0007 (Barts Heart Centre funding). 2. For PREDICT (Leicester data) ethical approval was provided by the UK Health Research Authority Research Ethics Committee (reference 17/WM/0192). 3. MATCH Study, Leeds - British Heart Foundation - 17/YH/0300. 4. LEAN-DM, Leeds - British Heart Foundation - 18/YH/01685. CEED, Leeds: British Heart Foundation - REC reference - 18/YH/0190

Large vessel occlusions requiring repeated mechanical thrombectomy caused by silent myocardial infarction in a young adult

ObjectivesSilent myocardial ischemia, defined as objective evidence of myocardial ischemia without symptoms, is associated with ischemic stroke. Nevertheless, silent myocardial infarction is a rare cause of ischemic stroke, especially in young adults with no medical history. Materials and methodsHerein, we report a young adult patient with acute ischemic stroke treated with repeated mechanical thrombectomy for recurrent large vessel occlusions caused by left ventricular thrombus following a silent myocardial infarction. ResultsA 40-year-old man was transferred by ambulance to our hospital because of a generalized seizure. He was diagnosed with cerebral infarction and left middle cerebral artery occlusion. We performed intravenous thrombolysis and mechanical thrombectomy. Recanalization was achieved and his symptoms gradually improved. However, the day after treatment he developed bilateral cerebellar infarction and basilar artery occlusion. We performed a second mechanical thrombectomy and recanalization was achieved. Transthoracic echocardiography revealed a mobile left ventricular thrombus. Although he had no previous chest symptomatic episodes, cardiac examination confirmed myocardial infarction of unknown onset. He was diagnosed with acute ischemic stroke with large vessel occlusions caused by left ventricular thrombus following a silent myocardial infarction. Anticoagulation therapy reduced the amount of thrombus. At 1-year follow-up, he had not experienced any recurrences or symptoms. ConclusionsSilent myocardial infarction should be considered a cause of ischemic stroke in young adults, even without any vascular risk factors. Recurrent large vessel occlusion may occur in patients with left ventricular thrombus, and repeated mechanical thrombectomy should be considered for treatment.

Outcomes among heart transplant recipients following acute coronary syndrome: A nationwide population based study

BackgroundFor patients with refractory heart failure despite optimal medical therapy, orthotopic heart transplantation (OHT) remains the treatment of choice. Since transplanted hearts have variable cardiac denervation and acute coronary syndrome often presents as a silent myocardial infarction or with atypical symptoms, the true impact of ACS on outcomes within this population needs more study. The aim of this study is to evaluate in-hospital mortality in post-transplant patients with ACS. MethodsUtilizing data from the 2002–15 Nationwide Inpatient Sample database, patients with a primary diagnosis of acute coronary syndrome among those with prior heart transplantation were included. A risk adjusted regression analysis was performed to assess if ACS post-OHT had an independent impact on the risk of in-hospital mortality. A 2:1 propensity matching was used to match ACS patients with and without OHT, respectively to assess differences in mortality. ResultsA total of 3,224,073 patients with a primary diagnosis of acute coronary syndrome were included, of which 842 (0.03%) were heart-transplant recipients. The type of ACS: NSTEMI (76.0% vs 74.5%; p = 0.32) and STEMI (24.8% vs 26.7%; p = 0.21) between heart transplant and non-heart transplant patients was similar in both groups. Following ACS, patients with heart transplant were more likely to have accompanying shock of any etiology (15.6% vs 3.8%; p < 0.001) and cardiogenic shock (11.2% vs 2.6%; p < 0.001) compared to those with native hearts. OHT patients also had significantly higher in-hospital mortality (14.3% vs. 3.7%; p < 0.001) that remain significant following regression analysis (aOR 3.6, 95% CI 2.8–4.5; p < 0.001) irrespective of the presence of cardiogenic shock compared to native hearts. This relationship remained consistent following propensity matching where patients with OHT had significantly higher in-hospital mortality (13.5% vs. 7%; p < 0.001). ConclusionsACS following OHT was more likely to have accompanying cardiogenic shock. ACS in the setting of prior OHT remained a strong independent predictor of higher mortality as compared to native hearts.

Aneurysmal formation from silent myocardial infarction mimics increased 18F-FDG uptake pattern

Aneurysmal formation from silent myocardial infarction mimics increased 18F-FDG uptake pattern

Effects of Long-term Metformin and Lifestyle Interventions on Cardiovascular Events in the Diabetes Prevention Program and Its Outcome Study.

Lifestyle intervention and metformin have been shown to prevent diabetes; however, their efficacy in preventing cardiovascular disease associated with the development of diabetes is unclear. We examined whether these interventions reduced the incidence of major cardiovascular events over a 21-year median follow-up of participants in the DPP trial (Diabetes Prevention Program) and DPPOS (Diabetes Prevention Program Outcomes Study). During DPP, 3234 participants with impaired glucose tolerance were randomly assigned to metformin 850 mg twice daily, intensive lifestyle or placebo, and followed for 3 years. During the next 18-year average follow-up in DPPOS, all participants were offered a less intensive group lifestyle intervention, and unmasked metformin was continued in the metformin group. The primary outcome was the first occurrence of nonfatal myocardial infarction, stroke, or cardiovascular death adjudicated by standard criteria. An extended cardiovascular outcome included the primary outcome or hospitalization for heart failure or unstable angina, coronary or peripheral revascularization, coronary heart disease diagnosed by angiography, or silent myocardial infarction by ECG. ECGs and cardiovascular risk factors were measured annually. Neither metformin nor lifestyle intervention reduced the primary outcome: metformin versus placebo hazard ratio 1.03 (95% CI, 0.78-1.37; P = 0.81) and lifestyle versus placebo hazard ratio 1.14 (95% CI, 0.87-1.50; P = 0.34). Risk factor adjustment did not change these results. No effect of either intervention was seen on the extended cardiovascular outcome. Neither metformin nor lifestyle reduced major cardiovascular events in DPPOS over 21 years despite long-term prevention of diabetes. Provision of group lifestyle intervention to all, extensive out-of-study use of statin and antihypertensive agents, and reduction in the use of study metformin together with out-of-study metformin use over time may have diluted the effects of the interventions. URL: https://www. gov; Unique identifiers: DPP (NCT00004992) and DPPOS (NCT00038727).

Silent Myocardial Ischemia in Patients after Permanent Coronary Intervention

Frequency and timing of appearance of myocardial ischemia, including silent ischemia, were analyzed in published scientific sources. Silent myocardial ischemia is risk factor for stent restenosis after percutaneous coronary interventions. Patients with silent ischemia lack clinical symptoms while perfusion, metabolic and electrical activity of their myocardium may be compromised. These patients do not have warning clinical symptoms during physical exercise and do not stop inappropriate activity. Silent myocardial ischemia itself can indicate severity of atherosclerosis in coronary arteries. High probability of stent restenosis can be assessed by exercise tests prior to coronary angiography. These tests also allow to reveal clinically silent myocardial ischemia. Quarter of patients after coronary intervention develop silent myocardial ischemia. Silent myocardial infarction comprises 22-78 % of all infarctions after coronary interventions. Exercise tests based on single-photon emitting computed tomography can be used in diagnosing stent restenosis, silent ischemia and assessment of cardiovascular risk in patients after coronary interventions. Its results can be used as indications for repeated coronary interventions and for prognosis after revascularization. Exercise tests are recommended in two years after revascularization in absence of ischemic symptoms. Early tests are recommended in cases of high cardiovascular risk, suboptimal revascularization, stenting of arteries with small diameter or at bifurcation. Diagnosis of silent myocardial ischemia by single-photon emitting computed tomography in patients after coronary revascularization is significant for clinical practice.

Silent Myocardial Infarction in Hypereosinophilic Syndrome Overlapped with JAK2-Mediated Essential Thrombocytosis: A Case Report

A 61-year-old male with chronic cough, paraesthesia of the extremities, and sinusitis presented for acute worsening of symptoms despite initial treatment with antibiotics and prednisone. Emergency department evaluation revealed mild elevated troponin without ECG changes in absence of coronary symptoms, but markedly elevated eosinophil count and an abnormal chest CT. A nuclear stress test revealed basal and inferoseptal dyskinesis with fixed apical defect. Left heart catheterisation revealed multiple coronary stenosis requiring intervention. Further extensive work-up confirmed a diagnosis of hypereosinophilic syndrome complicated with respiratory, cardiac, gastroenterological, and neurological involvement. The patient was initially treated with a high dose of intravenous steroid and hydroxyurea. Flow cytometry revealed negative FIP1L1-PDGFRA gene rearrangement, but was positive for JAK2 V617F mutation and perinuclear antineutrophil cytoplasmic antibodies/cytoplasmic antineutrophil cytoplasmic antibodies, indicating possible overlap of eosinophilic granulomatosis with polyangiitis.

Ah-type Baroreceptor Neurons Expressing Estrogen Dependent mGluR7 Mediate Descending Inhibition of Cardiac Nociception

Silent myocardial infarction (MI) is critical for clinical practice with increasing risk for women and the cause remains a medical mystery. Upon the discovery of female-specific Ah-type baroreceptor neurons (BRNs), we hypothesize that glutamate mediates depressor response through afferent-specific expression of particular glutamate receptors (mGluRs) leading descending inhibition of cardiac nociception. In vivo, tail-flick reflex and electromyography were assessed to evaluate glutamate-mediated blood pressure regulation, peripheral and cardiac nociception. The results showed that glutamate decreased mean arterial pressure (MAP) and increased peripheral nociception. Interestingly, glutamate-mediated capsaicin-induced cardiac nociception was strongly reduced in female rats compared with males. Furthermore, Nodose (NG) microinjection of mGluR7 agonist significantly increased MAP in males and slightly decreased that in females. Even though mGluR8 direct activation intensified baroreceptor activation, the sensitivity was similar between sexes. In vitro, the expression profiles of mGluRs were investigated using Western blot and identified BRNs using single-cell qRT-PCR under ischemic conditions. Glutamate in serum, NG and nucleus tractus solitary (NTS) was raised significantly in the model rats of both sexes vs. sham-controls. Female-specific expression of mGluR7 in the baroreflex afferent pathway, especially higher expression in Ah-type BRNs, contributes significantly to cardiac analgesia, which may explain that the pathogenesis of silent MI occurs mainly in female patients. Therefore, higher expression of mGluR7 in female-specific subpopulation of Ah-type BRNs plays a critical role in cardiac analgesia and peripheral nociception.

Prognostic value of silent myocardial infarction in patients with chronic kidney disease after kidney transplantation

We have shown that silent myocardial infarction (SMI) on 12-lead ECG is associated with increased cardiovascular disease (CVD) risk in patients awaiting renal transplantation (RT). In this study, we evaluated the prevalence of SMI in patients undergoing RT and their prognostic value after RT. MI was determined by automated analysis of ECG. SMI was defined as ECG evidence of MI without a history of clinical MI (CMI). The primary outcome was a composite of CVD death, non-fatal MI and coronary revascularization after RT. Of the 1189 patients who underwent RT, a 12-lead ECG was available in >99%. Of the entire cohort 6% had a history of CMI while 7% had SMI by ECG. During a median follow-up of 4.6years, 147 (12%) experienced the primary outcome (8% CVD death, 4% MI, 4% coronary revascularization) and 12% died. Both SMI and CMI were associated with an increased risk of CVD events and all-cause deaths. In a multivariable adjusted Cox-regression model, both SMI (adjusted hazard ratio 2.03 [1.25-3.30], p=.004) and CMI (2.15 [1.24-3.74], p=.007) were independently associated with the primary outcome. SMI detected by ECG prior to RT is associated with increased risk of CVD events after RT.

Eversion Carotid Endarterectomy: Cardiac Troponin Assessment.

Myocardial infarction (MI) is an eversion carotid endarterectomy (eCEA) complication, but most events are unknown, and true incidence and correlation remain controversial. Routine cardiac troponin measurement is a commonly used method for assessing early identification and treatment of MI and stratifying high-risk patients. The aim of the present study is to evaluate the effect of troponin elevation levels following eCEA and to investigate a possible correlation between adverse cardiovascular events and the incidence of postoperative myocardial infarction following emergent vascular surgery. The study included 54 patients who underwent eCEA. High-sensitive troponin I (hsTnI) levels were routinely monitored pre- and postoperatively, with an upper reference range of 34.5 pg/mL for men and 15.6 pg/mL for women. Increases were correlated with demographic and clinical risk factors, as well as clinical or subclinical cardiovascular events. hsTnI was increased in percentage (13%) postoperatively, and non-ST segment elevation MI was diagnosed in eight patients. No patient had clinical symptoms of MI and only two of them presented with simultaneous electrocardiographic changes. Increased levels did not correlate with comorbidities or other surgical risk factors. hsTnI elevation may occur in patients after eCEA and mostly correlates with silent non-ST segment elevation MI that occurred in the early postoperative phase, indicating a possible value as a tool for cardiovascular event diagnosis during the patient's hospitalization.

Sudden Cardiac Death from Coronary Arteriosclerosis and Coronary Artery Aneurysm in Childhood: An Autopsy Case

Coronary artery disease in childhood is rare. However, coronary arteriosclerosis and coronary artery aneurysm may occur in childhood as congenital malformations, or as complications of vasculitis, other connective tissue disorders, and infections. Coronary arteriosclerosis and coronary artery aneurysm may manifest in varied ways, including silent ischemia, myocardial infarction and sudden cardiac death. In this report, we present a rare case of sudden death in 5-year-old child. Autopsy examination showed coronary arteriosclerosis and coronary artery aneurysm with myocardial fibrosis of the septal wall. Pathologic examination showed near total occlusion of the left anterior descending branch of the coronary artery and the aneurysm, with fibrosis and calcification of the right coronary artery.

Left Ventricular Diastolic Dysfunction and Silent Myocardial Ischemia amongst Asymptomatic Type 2 Diabetic Patients in Two Referral Hospitals in Cameroon

Background: Cardiovascular events, the leading cause of death among diabetic patients, are usually under-diagnosed due to subclinical presentation. Methods: We conducted a cross-sectional study from March-2019 to September-2020, in two reference hospitals in Yaoundé, Cameroon, to assess the prevalence of asymptomatic Left Ventricular Diastolic Dysfunction (LVDD) and Silent Myocardial Infarction (SMI) and potentially associated factors. Results: Out of 95 participants (mean age ± SD: 43 ± 7 years; M/F sex-ratio 1.6), 22 (23.1%; 95% CI: 15.8% - 32.6%) had LVDD and fewer (n = 13, 13.6%; 95% CI: 8.2% - 22.0%) had SMI, p = 0.86. Though not statistically significant, patients with ≥5 years diabetes duration, as well as patients with HbA1C ≥ 7.5% had two-fold increased risk of LVDD (p = 0.22 and p = 0.15 respectively). LVDD was significantly higher in patients with SMI (29% vs 6.3%, p Conclusion: The significant presence of asymptomatic cardiovascular manifestations in this population entails mandatory preventive screening, especially, in patients with long standing diabetes and poor glycemic control, to allow timely detection and management.

Ischemic Heart Disease Treatment

Ischemic heart disease IHD is a rapidly increasing common cause of death in the world. This disease is the insufficient status of oxygen within the cardiac muscles due to an imbalance between oxygen supply and demand, and a cardiac disease that occurs as a result of coronary artery stenosis. Ischemic heart disease diseases are the leading cause of death in both developed and developing countries ,among these IHD is the most prevalent manifestation and is associated with high mortality and morbidity. The clinical presentation of IHD include silent ischaemia, stable angina, unstable angina, myocardial infarction, heart failure and sudden death.

Early Myocardial Changes in Patients with Rheumatoid Arthritis without Known Cardiovascular Diseases-A Comprehensive Cardiac Magnetic Resonance Study.

Clinically silent cardiac disease is frequently observed in rheumatoid arthritis (RA), and cardiovascular complications are the leading cause of mortality in RA. We sought to evaluate the myocardium of young RA patients without known cardiac disease using cardiac magnetic resonance (CMR), including T1/T2 mapping sequences. Eighteen RA patients (median age 41 years, 83% females) mainly with low disease activity or in remission and without any known cardiovascular disease were prospectively included to undergo CMR. A control group consisted of 10 sex- and age-matched patients without RA or any known structural cardiovascular disease. Heart chambers size and left/right ventricular systolic function were similar in patients with RA and controls. Signs of myocardial oedema were present in up to 39% of RA patients, including T2 time above cut-off value in 7 patients (39%) in comparison to none of the controls (p = 0.003) and T2 signal intensity ratio above the cut-off value in 6 patients (33%) and in none of the controls (p = 0.06). Extracellular volume was similar in both groups signifying a lack of diffuse fibrosis in studied group of RA patients. There were also no signs of late gadolinium enhancement (LGE) in either group except for one patient with RA who was found to have prior silent myocardial infarction. No correlation was found between markers of disease severity and markers of oedema observed on CMR in patients with RA. Nevertheless, patients with increased T2 time (≥50 ms) were more likely to have X-ray erosions (p = 0.02) and a longer duration between symptom onset and diagnosis (p = 0.02). Finally, there were no significant arrhythmias on 24-h ECG Holter monitoring in RA patients. CMR features of myocardial oedema without signs of myocardial fibrosis were found in 39% of young RA patients without known heart disease or cardiac symptoms. Presence of myocardial oedema was associated with X-ray erosions and a longer duration between symptom onset and diagnosis. The clinical significance of the observed early myocardial changes accompanying RA requires additional studies.

Metabolomic Analysis of Coronary Heart Disease in an African American Cohort From the Jackson Heart Study

African American individuals have disproportionate rates of coronary heart disease (CHD) but lower levels of coronary artery calcium (CAC), a marker of subclinical CHD, than non-Hispanic White individuals. African American individuals may have distinct metabolite profiles associated with incident CHD risk compared with non-Hispanic White individuals, and examination of these differences could highlight important processes that differ between them. To identify novel biomarkers of incident CHD and CAC among African American individuals and to replicate incident CHD findings in a multiethnic cohort. This analysis targeted plasma metabolomic profiling of 2346 participants in the Jackson Heart Study (JHS), a prospective population-based cohort study that included 5306 African American participants who were examined at baseline (2000-2004) and 2 follow-up visits. Replication of CHD-associated metabolites was sought among 1588 multiethnic participants from the Women's Health Initiative (WHI), a prospective population-based multiethnic cohort study of 161 808 postmenopausal women who were examined at baseline (1991-1995) and ongoing follow-up visits. Regression analyses were performed for each metabolite to examine the associations with incident CHD and CAC scores. Data were collected from the WHI between 1994 and 2009 and from the JHS between 2000 and 2015. All data were analyzed from November 2020 to August 2021. Plasma metabolites. Incident CHD was defined as definite or probable myocardial infarction or definite fatal CHD in both the JHS and WHI cohorts. In the JHS cohort, silent myocardial infarction between examinations (as determined by electrocardiography) and coronary revascularization were included in the incident CHD analysis. Coronary artery calcium was measured using a 16-channel computed tomographic system and reported as an Agatston score. Among 2346 African American individuals in the JHS cohort, the mean (SD) age was 56 (13) years, and 1468 individuals (62.6%) were female. Among 1588 postmenopausal women in the WHI cohort, the mean (SD) age was 67 (7) years; 217 individuals (13.7%) self-identified as African American, 1219 (76.8%) as non-Hispanic White, and 152 (9.6%) as other races or ethnicities. In the fully adjusted model including 1876 individuals, 46 of 303 targeted metabolites were associated with incident CHD (false discovery rate q <0.100). Data for 32 of the 46 metabolites were available in the WHI cohort, and 13 incident CHD-associated metabolites from the JHS cohort were replicated in the WHI cohort. A total of 1439 participants from the JHS cohort with available CAC scores received metabolomic profiling. Nine metabolites were associated with CAC scores. Minimal overlap was found between the results from the incident CHD and CAC analyses, with only 3 metabolites shared between the 2 analyses. This cohort study identified metabolites that were associated with incident CHD among African American individuals, including 13 incident CHD-associated metabolites that were replicated in a multiethnic population and 9 novel metabolites that included N-acylamides, leucine, and lipid species. These findings may help to elucidate common and distinct metabolic processes that may be associated with CHD among individuals with different self-identified race.

Abstract 9305: Association of Silent Myocardial Infarction on Electrocardiogram and Coronary Artery Calcium: The Multi-Ethnic Study of Atherosclerosis

Introduction: Silent myocardial infarction (SMI) on electrocardiogram (ECG) is associated with atherosclerotic cardiovascular disease, but the relationship between SMI on ECG and coronary artery calcium (CAC) remains poorly understood. Hypothesis: SMI on ECG is predictive of elevated CAC. Methods: Eligible participants from the Multi-Ethnic Study of Atherosclerosis (MESA) had ECG and CAC scoring at study enrollment (2000-2002). SMI was defined as ECG evidence of myocardial infarction in the absence of a history of clinical cardiovascular disease. CAC was modeled both continuously and categorically. The cross-sectional relationships between SMI on ECG and CAC were assessed using logistic regression and linear regression. Results: Among 6,705 eligible participants, 178 (2.7%) had baseline SMI. Compared to participants without SMI, those with SMI had higher CAC (median [IQR]: 61.2 [0 - 261.7] vs. 0 [0 - 81.5]; p &lt; 0.0001). Participants with SMI were more likely to have non-zero CAC (74% vs. 49%) and were more likely to have CAC ≥ 100 (40% vs. 23%). In a multivariable-adjusted logistic model, SMI was associated with higher odds of non-zero CAC (odds ratio 2.17, 95% CI 1.48 - 3.20, p &lt; 0.0001) and 51% higher odds of CAC ≥ 100 (odds ratio 1.51, 95% CI 1.06 - 2.16, p = 0.02). Conclusions: An incidental finding of SMI on ECG may serve to identify patients who have a higher odds of significant CAC and may benefit from additional risk-stratification to further refine their cardiovascular risk. Further exploration of the utility of CAC assessment in this patient population is needed.

Потенциальная роль бенфотиамина в лечении диабетической автономной нейропатии сердца

Актуальность. Диабетическая нейропатия сердца — серьезное осложнение сахарного диабета, связанное с примерно пятикратным повышением риска сердечно-сосудистой смертности. Автономная нейропатия сердца проявляется широким спектром, начиная от тахикардии покоя и фиксированного сердцебиения до развития бессимптомного инфаркта миокарда. Значение диабетической автономной нейропатии сердца до конца не выяснено, также не существует единого алгоритма лечения. Цель: исследовать влияние бенфотиамина на состояние вариабельности ритма сердца, корригированный интервал QT, дисперсию QT и пространственный угол QRS-T у больных сахарным диабетом 2-го типа и автономной нейропатией. Материалы и методы. Тридцать два пациента с сахарным диабетом 2-го типа и функциональной стадией автономной нейропатии сердца были распределены в две группы лечения: контрольную (n = 15), получавшую стандартную сахароснижающую терапию, и группу 2 (n = 17) — бенфотиамин 300 мг/сут в дополнение к традиционной терапии в течение трех месяцев. Результаты. Установлено, что назначение бенфотиамина вызывало увеличение процента последовательных интервалов NN, разница между которыми превышает 50 мс, — pNN50 (Δ% = + 45,90 ± 7,91 %, р &lt; 0,05), высокочастотной компоненты вариабельности ритма сердца во время активного (Δ % = + 25,80 ± 5,58 %, p &lt; 0,05) и пассивного периодов суток (Δ% = +21,10 ± 4,17 %, р &lt; 0,05), способствовало уменьшению корригированного интервала QT (Δ% = –7,30 ± 1,36 %, p &lt; 0,01), дисперсии QT (Δ% = –27,7 ± 9,0 %, p &lt; 0,01) и пространственного угла QRS-T (Δ% = –24,4 ± 10,2 %, p &lt; 0,01). Выводы. Положительное влияние бенфотиамина свидетельствует о целесообразности его назначения пациентам с сахарным диабетом 2-го типа и функциональной стадией автономной нейропатии сердца.

A Study of Cardiac Autonomic Neuropathy among Type-II Diabetic Patients

Background: Though very common, CAN is a least understood complication of diabetes which is often under diagnosed. In diabetes mellitus patients, CAN leads to silent myocardial infarction and sudden death. So by identifying CAN early, which is asymptomatic will help to delay or arrest its progression.&#x0D; AIM: To find out the prevalence and the associated risk factors of Cardiac autonomic neuropathy (CAN) among type-II Diabetes Mellitus patients in a tertiary care hospital.&#x0D; Materials &amp; Methods: A total of 273 type-II diabetic participants were selected after taking into consideration of inclusion &amp; exclusion criteria. The prevalence of CAN was assessed by ewings and clarkesnon invasive cardiac autonomic neuropathy reflex tests. The association of risk factors with the presence of CAN was analysed by using Pearson’s chi square test. Data were analysed by using SPSS 16. The accepted level of significance was set below 0.05 (P&lt;0.05).&#x0D; Results: The prevalence of CAN among type-II diabetic patients in this study was found to be 34%. Prevalence of CAN increased in the participants with male gender, increased age, and increased BMI, increased duration of diabetes, poor glycaemic control,dyslipidimea, smokers and hypertension and it is statistically significant.&#x0D; Conclusion: In this study it is observed that the prevalence of CAN increased with old age, male gender, poor glycemic control, increased duration of diabetes, Dyslipidemia, higher BMI, Hypertension &amp; smoking. So risk factors associated with the CAN be detected and treated at an early stage to further reduce morbidity and mortality.

Spotlight on the August 3 Issue

#### Notable in Neurology This Week This issue features an article that evaluates the association between silent myocardial infarction and subsequent ischemic stroke, and a review that discusses the diagnosis, pathophysiology, and management of transient focal neurologic episodes related to cerebral amyloid angiopathy. A featured Special Article presents the 2020 update of the American Academy of Neurology's Parkinson disease quality …