IntroductionIn general, the most common initial symptom of aortic stenosis is decreased exercise tolerance. Over time, exertional dyspnea may progress to decompensated heart failure. However, the ...impact of preprocedural decompensated heart failure (DHF) on clinical outcomes in patients with severe aortic stenosis after transcatheter aortic valve replacement (TAVR) remains unclear.HypothesisWe assessed the hypothesis that preprocedural DHF might predict future adverse cardiovascular events in patients undergoing TAVR.MethodsWe performed TAVR in 73 consecutive patients with symptomatic severe aortic stenosis between December 2015 and April 2019. DHF was defined as unplanned hospitalization to necessitate the treatment with intravenous diuretics and/or cardiac stimulants.ResultsBecause of DHF, 29 patients (39.7%) admitted to hospital before TAVR. During the follow-up, 10 (34.5%) patients in DHF group and 2 (4.5%) in non DHF group experienced major adverse cardiovascular events defined as a composite of death from any cause, cardiac related rehospitalization. On Kaplan-Meier analysis, the proportion of adverse event-free survival was significantly lower in DHF group (log-rank P = 0.02, Figure). After adjustment for confounding factors, preprocedural DHF remained an independent significant predictor of major adverse cardiovascular events on multivariate Cox proportional hazard analysis hazard ratio 5.53 (95% confidence interval1.08 to 28.2, P = 0.04).ConclusionsPreprocedural DHF is an independent predictor of major adverse cardiovascular events in patients undergoing TAVR. Therefore, we should perform TAVR for patients with symptomatic severe aortic stenosis before development of DHF.
IntroductionAlthough the clinical outcomes of transcatheter aortic valve replacement (TAVR) have significantly improved, some patients still have a poor prognosis due to their intrinsic clinical ...risks. Therefore, it is important to identify patients at risk for mortality after TAVR. Both nutritional status and muscle strength reflect the degree of frailty and these disorders increase risk of mortality in elderly population.HypothesisWe assessed the hypokinesis that the combination of malnutrition and muscle weakness (MW) might predict future adverse cardiovascular events in patients undergoing TAVR.MethodsWe performed TAVR in 72 consecutive patients with symptomatic severe aortic stenosis between December 2015 and March 2019. Nutritional deficiency (ND) and MW were defined as geriatric nutritional index <92, and grip strength <26.0kg in men and <18.0kg in women, respectively. Nutritional status and muscle strength were classified into four groupsND+/MW+ (n=24), ND+/MW- (n=4), ND-/MW+ (n=31), and ND-/MW- (n=13).ResultsDuring the follow-up, 8 (33.3%) patients in ND+/MW+ group, 1 (25.0%) in ND+/MW- group, and 4 (12.9%) in ND-/MW+ group experienced major adverse cardiovascular events defined as a composite of death from any cause, cardiac related rehospitalization, and stroke. On Kaplan-Meier analysis, the proportion of adverse event-free survival was significantly lower in ND+/MW+ group (log-rank P = 0.03, Figure). After adjustment for confounding factors, the combination of ND and MW remained an independent significant predictor of major adverse cardiovascular events on multivariate Cox proportional hazard analysis hazard ratio 11.97 (95% confidence interval1.81 to 78.9, P = 0.01).ConclusionsThe combination of malnutrition and MW was significantly associated with clinical outcomes in patients undergoing TAVR. Therefore, assessment of nutritional status and muscle strength is crucial in clinical practice.
Summary Restenosis of saphenous vein grafts (SVG) after bare-metal stent (BMS) implantation remains a clinical problem. Recently, intravascular optical coherence tomography (OCT) has been proposed as ...a high resolution intravascular imaging modality, and is able to distinguish several components of intracoronary structures. In vivo images of in-stent restenosis (ISR) lesions in an SVG using OCT have not been reported. In this case report, we present the characteristics of in vivo OCT images from an ISR lesion of an SVG after BMS implantation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
IntroductionRecently, sarcopenia is proposed a new prognostic factor for cardiovascular disease. However, the prognostic impact of skeletal muscle mass on clinical outcomes in patients with severe ...aortic stenosis after transcatheter aortic valve replacement (TAVR) remains unclear.HypothesisWe assessed the hypothesis that skeletal muscle mass might predict future adverse cardiovascular events in patients undergoing TAVR.MethodsWe performed TAVR in 51 consecutive patients with symptomatic severe aortic stenosis between December 2015 and March 2018. We used bilateral psoas muscles as an indicator of skeletal muscle mass. Psoas muscle volumes were measured from the origin of psoas at the level of the lumbar vertebrae to its insertion in the lesser trochanter on three-dimensional computed tomography datasets using a semi-automated analysis program. Psoas muscle mass index (PMI) was calculated as psoas muscle volume/height (cm/m).ResultsAccording to the median value of PMIs, the enrolled patients were divided into two groups low PMI (< 66.1 cm/m) (n=25) or high PMI (≥ 66.1 cm/m) (n=26). During the follow-up, 8 (32.0%) patients in low PMI group and 2 (7.7%) in high PMI group experienced major adverse cardiovascular events defined as a composite of death from any cause, cardiac related rehospitalization, and cerebral infarction. On Kaplan-Meier analysis, the proportion of adverse event-free survival was significantly lower in low PMI group (log-rank P = 0.018, Figure). After adjustment for confounding factors, low PMI remained an independent significant predictor of major adverse cardiovascular events on multivariate Cox proportional hazard analysis hazard ratio 6.90 (95% confidence interval1.36 to 35.1, P = 0.019).ConclusionsLow skeletal muscle mass is an independent predictor of major adverse cardiovascular events in patients with severe aortic stenosis undergoing TAVR. Therefore, assessment of PMI is crucial in clinical practice.
We report here the case of a 92-year-old woman with atrial fibrillation bradycardia in which leadless pacemaker implantation was performed with a difficult delivery of the catheter sheath due to an ...extremely large right atrium. Using a snare technique with correction of the direction of the force on the catheter toward the right ventricle (RV) can result in successful delivery of the pacemaker catheter and stable placement of the pacemaker system in the RV septum. This specific snare technique has the potential to facilitate leadless pacemaker implantation safely in a severely dilated chamber of the heart, making this technique effective to use in clinical practice.
A study was made of a method for increasing the durability of concrete structures by reinforcing concrete with short fibers to prevent the falling of covering concrete due to corrosion and expansion ...of reinforcing bars. Fiber-reinforced concrete is required to (1) prevent concrete from falling, (2) have little influence on concrete composition and construction and (3) be economical. Steel fibers, which are generally used, and four types of organic fibers were examined. As a result of the study, it was found that the number of fibers added to concrete had a greater influence on the prevention of concrete falling than the strength of the fiber and that adding more than 300, 000 fibers per cubic meter could prevent covering concrete from falling.
Auxin‐binding protein (ABP1) is a putative receptor for auxin in the plasma membrane. We isolated a full‐length cDNA encoding ABP1 from radish by screening a cDNA library with its partial cDNA ...fragment generated by the reverse transcriptase‐polymerase chain reaction (RT‐PCR) method. Radish abpl mRNA was highly expressed in cotyledons, hooks and hypocotyls, and less so in roots of radish seedlings. The deduced amino acid sequence of radish abpl consisted of conserved auxin‐binding motifs, a signal peptide and ER‐retention signal, and contained two potentially N‐linked glycosylation signals. To analyze the biochemical properties of the radish abpl product, this cDNA was expressed in insect cells by the baculovirus vector system. The result of tunicamycin‐treatment showed that the signal peptide was cleaved and that the radish abpl product was glycosylated at both target sites in insect cells.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
The cDNA fragments of auxin-binding protein (ABP1) were isolated by degenerated-primer mediated reverse transcription-polymerase chain reaction (RT-PCR) from dicotyledonous plant species, i.e. cress, ...mung bean, pea, radish and soybean, and monocotyledonous species, i.e. oat and rice. Cloned
abp 1 cDNA fragments were sequenced and compared with known
abp 1 clones from
A. thaliana, maize, strawberry and tobacco at the amino acid level. In all plant species studied, the amino acid sequences of newly isolated
abp 1 clones were highly conserved at two regions (region A: Thr-Pro-Ile-His-Arg-His-Ser-Cys-Glu-Glu-Ile/Val-Phe-Ile/Thr/Val-Val-Leu/Pro/Val-Lys-Gly-Xaa-Gly-Thr-LeuAy; region B: His-Glu-Asp-Leu-Gln-Phe/Val-Leu-Asp/Val-Ile/Val-Ile-Ser-Arg-Pro-Pro), which were previously reported to be important for auxin-binding. On the other hand, some putative residues of amino acids in the region between regions A and B could be found to be specific in dicot and monocot species, respectively. Southern-blot analysis indicated a small
abp 1 gene family in all species studied. Northern-blot analysis indicated that the size of
abp 1 mRNA transcripts in all species studied was conserved at approximately 850bp. The phyloge-netic tree of ABP1 was analyzed by the UPGMA method.
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IJS, IMTLJ, KILJ, KISLJ, NUK, SBCE, SBJE, UL, UM, UPUK
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