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.

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Introduction Myotonic dystrophy type 1 (DM 1), also known as Steinert's disease (SD), is the most common muscular dystrophy in adults. It is characterized by multisystemic involvement and the cardiac affectation is the second leading cause of death after the respiratory one. Purpose The objective of our work was to study the cardiac involvement by transthoracic echocardiography (TTE) including systolic function, diastolic function and myocardial deformation with global longitudinal strain (GLS) by speckle tracking and trough biomarkers of myocardial damage with high-sensitive cardiac troponin T (hs-cTnT) and NT-proBNP. Methods 24 patients affected by SD were included. The TTE machine used has software to perform GLS with reference values: −20±2%. The normal values of hs-cTnT and NT-proBNP of our central laboratory are: <14 ng/L and 0–250 pg/ml, respectively. Results The mean age of patients was 52,08±12,14 years and the average age of diagnosis was 31,42 years. There was no gender predilection (12 women, 12 men). In the TTE 55% of patients had a GLS <−18% with a global average of −17,72±4,02%. The 50% of patients with LVEF >50% had a GLS <−18% and the 27,77% had a GLS between −18 and −20%. The diastolic dysfunction assessed by pulsed wave doppler and tissue doppler imaging was present in 26.82%. The 95,83% of the patients had levels of hs-cTnT≥14 ng/L with median of 34,93 ng/L (minimum 3,96 and maximum 429), however only 30,4% of these had values of NT-proBNP above 250 pg/ml with a median of 71,83 pg/ml (minimum 9,37 and maximum 8771). Conclusions According to our experience GLS and hs-cTnT could be markers of early myocardial damage in patients with SD. We therefore need to develop protocols for the follow-up including these markers in the usual cardiac assessment.

Both arterial and venous thromboembolic events are common in patients hospitalized in intensive care units with severe COVID-19. These patients often have laboratory findings consistent with a hypercoagulable state, suggesting widespread thrombosis and fibrinolysis, as well as elevated levels of D-dimer, von Willebrand factor (VWF), and factor VIII. There is increasing evidence that these thromboembolic events are associated with worse outcomes. We present the case of a 61-year-old man admitted for bilateral pneumonia due to COVID-19 infection, who developed during his hospitalization; Bilateral pulmonary thromboembolism, an acute myocardial infarction due to multiple coronary thrombosis, an intracavitary thrombus and thrombus in the ascending aorta. The patient was treated with systemic fibrinolysis and full doses of anticoagulation for pulmonary embolism, an emergency primary percutaneous coronary intervention (PCI) was performed with the implant of a drug eluting stent (DES) in the left anterior descending artery (LAD). Triple therapy with aspirin, clopidogrel and heparin was maintained until discharge. After the patient discharge, aspirin was stopped and treatment with clopidogrel and dabigatran was maintained for three months. In a subsequent outpatient control, the thrombi of the left ventricle and the ascending aorta resolved.

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