Insulin resistance and the severity of coronary artery disease based on obesity status in stable-angina patients: A cross-sectional analysis

The evaluation of coronary artery disease (CAD) concerning the metabolic status and body mass index (BMI) is poorlystudied. This study was designed to observe the relationship between insulin resistance (IR) and the severity of CADon the basis of the metabolic and phenotypic status in stable-angina patients. A cross-sectional study was conductedon 532 patients with stable angina and coronary angiogram was done to diagnose the CAD for all. Determination ofmetabolic obesity was done using the National Cholesterol Education Program-Adult Treatment Panel III criteria.Phenotypic obesity was defined as BMI ≥ 25 kg/m2. Homeostasis model assessment IR in correlation with the severityof CAD was measured using SYNTAX (TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for theTreatment of Narrowed Arteries) Score. The average age of the patients was 57.58 ± 10.40 years, and 69.4% weremales. Out of 532 subjects, 51.3% were hypertensive, 14.5% were smokers, 29.1% consumed alcohol, 49.3% weremetabolically obese, and 50% were phenotypically obese. Increase in IR increased the risk of severity of CAD inmetabolically obese subjects (OR = 2.51, p = 0.048). In the phenotypically obese group, the relationship between IRand the severity of CAD was not statistically significant (OR = −2.19, p = 0.08). The study concludes that the increasedIR increases the risk of severity of CAD in metabolically obese subjects.

Percutaneous intervention for symptomatic central vein stenosis in patients with upper limb arteriovenous dialysis access

Central venous stenosis is an important hindrance to long-term maintenance of arteriovenous access in the upper extremities in dialysis patients. Aim The present study was done to determine feasibility and clinical success of endovascular approach for the treatment of symptomatic central venous stenosis associated with significant ipsilateral limb edema in dialysis patients with vascular access in the upper limb. Methods A database of hemodialysis patients who underwent endovascular treatment for central venous stenosis from January 2014 to January 2017 at our institute was retrospectively reviewed. Follow-up was variable. Results The study included ten patients (6 men and 4 women) with a mean age of 45.2 years, who underwent thirteen interventions during a period of 3 years. The technical success rate for endovascular treatment was 100%. One patient underwent primary PTA (percutaneous transluminal angioplasty). Seven patients underwent primary PTA and stenting. Three patients underwent secondary PTA. One among these patients underwent secondary PTA twice along with fistuloplasty. One patient underwent secondary PTA with stenting. No immediate complications were encountered during the procedure. Our study shows a primary patency rate of 67% and 33% at 6 months and 12 months for PTA with stenting. Our study also shows secondary or assisted primary patency of 75% at 6 months of follow-up. Conclusions Endovascular therapy (PTA) with or without stenting for central venous stenosis is safe, with low rates of technical failure. Multiple additional interventions are the rule and long-term patency rate is not very good.

Cardiac Dysfunction in Patients with Sepsis, Severe Sepsis and Septic Shock.

Aims: Patients with severe sepsis and septic shock often exhibit significant cardiovascular dysfunction. We designed the study with an aim to determine the severity of cardiac dysfunction in the different group of sepsis patients. Study Design: Single-center, cross-sectional study Place and Duration of Study: The study was carried out at Department of Cardiology, Kasturba Medical College and Hospital, Manipal from June 2011 to December 2012. Methodology: A total of 74 patients who were diagnosed with sepsis were enrolled in the study. All patients were subjected to routine analysis, laboratory test and echocardiogrphic assessment. Results: The patients were divided into 3 groups: sepsis group (n = 11), severe sepsis group (n =37) and septic shock group (n = 26). The mitral E/A value is significantly higher in patients with septic shock than that of the patients with sepsis (P = 0.04). The indices of right ventricular dysfunction did not show any significant difference in the patients with septic shock and that of sepsis. Conclusion: Left ventricular dysfunction may be considered prevalent in sepsis as per the significant E/A values. However, the other echocardiographic parameter should also be considered. This may even infer that cardiac dysfunction may not correlate with the severity of sepsis.