The present findings suggest that circulating levels of miRNAs are differentially expressed in patients with HF of different aetiologies. The presence of a transcoronary concentration gradient suggests a selective release of miRNAs by the failing heart into the coronary circulation. The presence of aetiology-specific transcoronary concentration gradients in HF patients might provide important information to better understand their role in HF, and suggests they could be useful biomarkers to distinguish HF of different aetiologies.

Background: Insulin resistance (IR) in patients with type 2 diabetes mellitus (T2DM) represents a predictor of coronary artery disease (CAD). However, how IR is able to impact the severity of coronary atherosclerosis in non-diabetic patients is unknown. Objectives. We investigated the relation between the IR and the extent and severity of coronary atherosclerosis in non-diabetic patients referred to coronary angiography (CA) Methods: Consecutive patients undergoing to CA for acute coronary syndromes or stable angina were analyzed. The IR was assessed by mean of the homeostasis model assessment of insulin resistance (HOMA-IR) whereas the SYNTAX score (SS) was used as index of the severity of coronary atherosclerosis Results: Overall, 126 patients were included, with a median SS of 12 (IQR 5.25–20.5). Patients were divided in four groups according to the distribution in quartiles of SS (SS1-2-3-4). A significant correlation between HOMA-IR and SS was observed, especially in women. A progressive increase of HOMA-IR was observed in parallel with the increasing severity (from SS1 to SS4) and extension (1-2-3-vessel disease) of coronary atherosclerosis. Multivariable analysis showed that the HOMA-IR was the strongest independent predictor of severe (SS4) and extensive (three-vessel disease) coronary atherosclerosis. Conclusion: Insulin resistance goes hand in hand with the extension and severity of coronary atherosclerosis in non-diabetic patients. The HOMA index is an independent predictor of three-vessel disease at CA. The HOMA index could be useful for risk stratification of CAD even in absence of T2DM.

The registration accuracy of skin-and bone-implanted fiducials using a frameless stereotactic system were analyzed prospectively.Twenty-eight patients underwent resection of intra-axial neoplasms after both skin-and bone-implantable fiducial markers were placed. Both sets offiducials were independently co-registered to a magnetic resonance imaging data set acquired preoperatively using the ISG Viewing WandTm. Root mean square errors were recorded as an objective measure of registration accuracy ofthe two types offiducials.Root mean square errors of bone-implanted fiducials registration were lower than those of skin fiducials; however, this difference was not statistically significant (p = 0.206).The registration accuracy ofskin-and bone-implanted fiducials appears to be similar. Still, bone-implanted fiducials may be advantageous compared to skin fiducials when re-registration ofthe patient-image space is desired intraoperatively such as during major drift in the patient's position or after surgical repositioning. KEYWORDS: Fiducial markers, frameless stereotaxis, registration accuracyComputer-guided frameless stereotactic that need to be matched precisely to the patient in systems are used routinely for intraoperative neu-the surgical position using a digitizer. This prorosurgical navigation. Their use hinges on pre-cess, during which the patient's preoperatively acoperatively acquired magnetic resonance imaging quired images (image space) are matched to the (MRI) and computed tomography (CT) studies patient in the surgical position (physical space), is Skull Base, volume 12, number 3

Arterial hypertension is a leading risk factor for developing atrial fibrillation. CHA 2 DS 2 -VASc score can help to decide if patients with atrial fibrillation need anticoagulation. Whether CHA 2 DS 2 -VASc may predicts incident atrial fibrillation and how it interacts with left atrial dilatation is unknown. We tested this hypothesis in a large registry of treated hypertensive patients. From 12154 hypertensive patients we excluded those with prevalent atrial fibrillation (n 51), without follow-up (n 3496), or carotid ultrasound (n 1891), and low ejection fraction (i.e. <50%, n 119). A CHA 2 DS 2 -VASc score ≥3 was compared with CHA 2 DS 2 -VASc score ≤2. Incident symptomatic or occasionally detected atrial fibrillation was the end-point of the present analysis. At baseline, 956 (15%) patients exhibited high CHA 2 DS 2 -VASc; they were older, most likely to be women, obese and diabetic, with lower glomerular filtration rate, and higher prevalence of left ventricular hypertrophy, left-atrial dilatation and carotid plaque (all p < 0.005). Prevalent Stroke/TIA was found only in the subgroup with high CHA 2 DS 2 -VASc. During follow-up (median = 54 months) atrial fibrillation was identified in 121 patients, 2.57-fold more often in patients with high CHA 2 DS 2 -VASc (95% Cl 1.71–4.86 p < 0.0001). In multivariable Cox analysis, CHA 2 DS 2 -VASc increased incidence of atrial fibrillation by 3-fold, independently of significant effect of left-atrial dilatation (both p < 0.0001) and other markers of organ damage. Incident AF is more than doubled in hypertensive patients with CHA 2 DS 2 -VASc ≥3. Coexisting CHA 2 DS 2 -VASc score >3 and LA dilatation identify high risk subjects potentially needing more aggressive management to prevent AF and associated cerebrovascular ischemic events.

Aim Remote monitoring (RM) of implantable cardiac devices has enabled continuous surveillance of atrial high rate episodes (AHREs) with well‐recognized clinical benefits. We aimed to add evidence on the role of the RM as compared to conventional follow‐up by investigating the interval from AHRE onset to physician’s evaluation and reaction time in actionable episodes. Methods and Results A total of 97 dual‐chamber pacemaker recipients were followed with RM (RM‐ON group; N = 64) or conventional in‐office visits (RM‐OFF group; N = 33) for 18 months. In‐office visits were scheduled at 1, 6, 12, and 18 months in the RM‐OFF group and at 1 and 18 months in the RM‐ON group. The overall AHRE rate was 1.98 per patient‐year (95% confidence interval [CI], 1.76–2.20) with no difference between the two groups (RM‐ON vs. RM‐OFF weighted‐HR, 0.88; CI, 0.36–2.13; p = .78). In the RM‐ON group, 100% AHREs evaluated within 11 days from onset, and within 202 days in the RM‐OFF group, with a median evaluation delay 79 days shorter in the RM‐ON group versus the RM‐OFF group (p < .0001). Therapy adjustment in actionable AHREs occurred 77 days earlier in the RM‐ON group versus the control group (p < .001). In the RM‐ON group, there were 50% less in‐office visits as compared to the RM‐OFF group (p < .001). Conclusions In our pacemaker population with no history of atrial fibrillation, RM allowed significant reduction of AHRE evaluation delay and prompted treatment of actionable episodes as compared to biannual in‐office visit schedule.