Aims The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE). Methods and results Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated. Conclusion Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.

Dysglycemia, in this survey defined as impaired glucose tolerance (IGT) or type 2 diabetes, is common in patients with coronary artery disease (CAD) and associated with an unfavorable prognosis. This European survey investigated dysglycemia screening and risk factor management of patients with CAD in relation to standards of European guidelines for cardiovascular subjects. RESEARCH DESIGN AND METHODS The European Society of Cardiology's European Observational Research Programme (ESC EORP) European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V (2016-2017) included 8,261 CAD patients, aged 18-80 years, from 27 countries. If the glycemic state was unknown, patients underwent an oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin A 1c. Lifestyle, risk factors, and pharmacological management were investigated. RESULTS A total of 2,452 patients (29.7%) had known diabetes. OGTT was performed in 4,440 patients with unknown glycemic state, of whom 41.1% were dysglycemic. Without the OGTT, 30% of patients with type 2 diabetes and 70% of those with IGT would not have been detected. The presence of dysglycemia almost doubled from that selfreported to the true proportion after screening. Only approximately one-third of all coronary patients had completely normal glucose metabolism. Of patients with known diabetes, 31% had been advised to attend a diabetes clinic, and only 24% attended. Only 58% of dysglycemic patients were prescribed all cardioprotective drugs, and use of sodium-glucose cotransporter 2 inhibitors (3%) or glucagon-like peptide 1 receptor agonists (1%) was small. CONCLUSIONS Urgent action is required for both screening and management of patients with CAD and dysglycemia, in the expectation of a substantial reduction in risk of further cardiovascular events and in complications of diabetes, as well as longer life expectancy.

Objective The carotid bodies (CBs) are peripheral chemoreceptor organs classically described as being O2 sensors, which are increasingly emerging as core players in metabolic control. Herein we evaluated CB activity in prediabetes patients and determined its correlation with dysmetabolism clinical features. Design and methods Prediabetes patients were recruited at the Cardiology Service, Hospital Santa Marta, Centro Hospitalar Lisboa Central, EPE (CHLC-EPE). The study was approved by CHLC-EPE and NOVA Medical School Ethics Committee. Thirty-three prediabetic and 14 age-matched, non-prediabetic, volunteers had their peripheral chemosensitivity evaluated by the Dejours test. Serum biomarkers of metabolic disease, insulin sensitivity (HOMA-IR), blood pressure, carotid intima-media thickness (cIMT) and glucose tolerance were assessed. Results CB chemosensitivity was significantly increased in prediabetic group (P < 0.01). Fasting blood, glucose intolerance, fasting insulin and HOMA-IR were significantly higher in prediabetes patients. Insulin resistance correlated both with peripheral chemosensitivity, assessed by the Dejours test (P < 0.05) and with abdominal circumference (P < 0.01). HbA1c correlated with HOMA-IR (P < 0.05) and left cIMT (P < 0.05) in prediabetes patients. Conclusions We conclude that CB is overactive in prediabetes subjects and that peripheral chemosensitivity correlates with fasting insulin and insulin resistance representing a novel non-invasive functional biomarker to forecast early metabolic disease.

Abbreviations: AMI ¼ acute myocardial infarction; APC ¼ allophycocyanin; Asp ¼ aspartate; cTNT ¼ cardiac troponin; CAD ¼ coronary artery disease; CRP ¼ C-reactive protein; CK ¼ creatine kinase; eNOS ¼ endothelial nitric oxide synthase; ELISA ¼ enzyme-linked immunosorbent assay; FITC ¼ fluorescein isothiocyanate; FAU ¼ fluorescence arbitrary units; Glu ¼ glutamic acid; LME ¼ linear mixed effects model; MPs ¼ microparticles; NO ¼ nitric oxide; NT-proBNP ¼ N-terminal pro-brain natriuretic peptide; PCI ¼ percutaneous coronary intervention; PBS ¼ phosphate-buffered saline; PE ¼ Phycoerythrin; CD62P ¼ P-selectin; sCD40L ¼ soluble CD40 ligand; SA ¼ stable angina pectoris; VEGF ¼ vascular endothelial growth factor INTRODUCTION CD40L is a signaling molecule, 1-3 implicated in thrombosis and inflammatory response to vascular injury. [4][5][6] The relationship of CD40L with coronary artery disease (CAD) has been established, 2,7-9 as also its implication in endothelial dysfunction. [10][11][12][13][14] However, whether the soluble CD40 ligand (sCD40L) could also influence endothelial dysfunction after acute myocardial infarction (AMI) injury remains unclear.In vitro studies have shown that sCD40L inhibits angiogenesis and also growth factor-induced human umbilical vein endothelial cell migration, which is achieved by generation of free radicals and inhibition of nitric oxide (NO) production. 10 The authors hypothesized that the sCD40L could inhibit reendothelialization of an injured vessel, thereby affecting the restenosis. 10Research efforts have been directed toward the finding of biomarkers to assess endothelial function and its correlation with AMI. Genetic indicators, such as the polymorphisms of endothelial NO synthase (eNOS) gene, 15,16 may provide insight into endothelial cells function.Vascular endothelial growth factor (VEGF) is a wellknown promoter of angiogenesis and an endogenous regulator of endothelial integrity. [17][18][19] The prognostic information provided by VEGF independently of other markers likely points toward an important role for angiogenesis in regulating myocardial repair and reperfusion after AMI. 17,20 Current opinion suggests a differential role of CD40L (both soluble and membrane-bound forms, which includes microparticles in circulation) 21 at different stages of CAD, contrasting with the traditional view of an unvarying function of the CD40L-CD40-sCD40L system interactions in the disease. 6 In that perspective, no clear indication of the interplay of CD40L with endothelial and vascular function markers and their importance in the pathophysiology of the AMI has been obtained so far in human clinical studies. Therefore, the aim of this study was to evaluate the relationship of sCD40L with markers of platelet activation, endothelial and vascular function during an early recovery period after AMI. To achieve this goal, the time changes over 1 month of sCD40L levels were assessed in AMI patients and correlated with the CD40L expressed on platelets and microparticles, CD62P expression on platele...

We examined the longitudinal changes of VEGF levels after percutaneous coronary intervention for predicting major adverse cardiac events (MACE) in coronary artery disease (CAD) patients. VEGF was measured in 94 CAD patients' serum before revascularization, 1-month and 1-year after. Independently of clinical presentation, patients had lower VEGF concentration than a cohort of healthy subjects (median, IQ: 15.9, 9.0–264 pg/mL versus 419, 212–758 pg/mL; P < 0.001) at baseline. VEGF increased to 1-month (median, IQ: 276, 167–498 pg/mL; P < 0.001) and remained steady to 1-year (median, IQ: 320, 173–497 pg/mL; P < 0.001) approaching control levels. Drug eluting stent apposition and previous medication intake produced a less steep VEGF evolution after intervention (P < 0.05). Baseline VEGF concentration <40.8 pg/mL conveyed increased risk for MACE in a 5-year follow-up. Results reflect a positive role of VEGF in recovery and support its importance in CAD prognosis.