Background:Although anticoagulation is the key treatment to prevent stroke in patients with atrial fibrillation (AF), including elderly patients, anticoagulation is sometimes withheld for elderly ...people because of concerns about frailty. However, it remains unknown whether frailty increases bleeding events.Methods and Results:A total of 120 consecutive non-valvular AF patients admitted with symptoms of AF or congestive heart failure were included in this study. Frailty was assessed using the Cardiovascular Health Study (CHS) frailty index. We performed a retrospective analysis of the risk factors associated with major bleeding events. After a median follow-up of 518 days, major bleeding events occurred in 17 (14.2%) patients. Patients with major bleeding events had a higher CHS frailty index (P=0.015). The cutoff value for high-risk CHS frailty index was 2 (area under the ROC curve: 0.68 95% confidence interval (CI): 0.57–0.78). The event-free rates at 2 years were 97.6% (95% CI: 83.9–99.7) in patients with a CHS frailty index <2 and 59.6% (95% CI: 27.9–81.0) for those with a CHS frailty index ≥2 (P<0.001).Conclusions:Frailty is associated with increased bleeding events related to anticoagulant therapy in patients previously hospitalized with AF. Greater care should be taken with patients with a CHS frailty index ≥2.
Purpose
Several clinical studies have demonstrated that angiotensin-converting enzyme inhibitors, but not angiotensin II receptor blockers (ARBs), reduce the risk of non-fatal myocardial infarction ...and cardiovascular mortality. We found that ARBs inhibited the activity of various cytochrome enzymes in arachidonic acid metabolism, resulting in decreased
in vitro
production of epoxyeicosatrienoic acids (EETs), which exhibit vasodilation and anti-inflammatory effects, and their subsequent metabolites, dihydroxyeicosatrienoic acids (DHETs). The present study examined the effects of ARBs on serum levels of EETs and DHETs in patients admitted to a cardiovascular center.
Methods
A total of 223 patients were enrolled, of which 107 were exposed to ARBs in this study. ARB-free individuals were defined as the control group (
n
= 116). Serum levels of EETs and DHETs were measured by liquid chromatography–tandem mass spectrometry. Multiple linear regression analyses were carried out to identify covariates for total serum levels of EETs and DHETs.
Results
A significant negative association was observed between ARB use and serum EET and DHET levels (
p
= 0.034), whereas a significant positive association was observed between the estimated glomerular filtration rate (eGFR) and serum EET and DHET levels (
p
= 0.007). The median serum total EET and DHET level in the ARB group tended to become lower than that in the control group, although the difference was not significant.
Conclusion
ARB use and eGFR were significantly associated with total serum levels of EETs and DHETs. Our results suggest that ARBs could affect the concentration of EETs
in vivo
.
This study aimed to compare lower limb events associated with preplanned and finally selected treatment strategies-the validity and usefulness of the physician-chosen strategy were verified.We ...examined the data of 1003 patients in the registry of multicenter endovascular treatment for superficial femoral and popliteal artery disease study and prospectively enrolled patients who underwent endovascular treatment (EVT) of the femoropopliteal (FP) artery between February 2017 and June 2018 from 67 Japanese institutes. The outcome measures were major adverse limb events (MALE) and target vessel revascularization.The EVT strategies were classified into balloon angioplasty-alone (37.3%), primary stenting (26.7%), and provisional stenting (36.0%) groups. In the initial strategy analysis for the balloon angioplasty-alone, primary stenting, and provisional stenting groups, two-year rates of freedom from MALE (95% confidence interval) were 0.680 (0.620-0.732), 0.754 (0.688-0.808), and 0.798 (0.746-0.840), respectively. Additionally, the rate of MALE was significantly higher among patients in the balloon angioplasty-alone group than among those in the primary or provisional stenting groups in the initial strategy analysis (P = 0.007). Changes in treatment strategy were more frequent in the primary stenting group than in the other groups. Furthermore, the rate of MALE did not significantly differ among the three groups in the final strategy analysis (P = 0.56).Limb outcomes for the final applied strategy did not differ among the three strategies. Additionally, the physician's selection bias was mostly appropriate in the EVT of the FP artery.
Postmortem computed tomography (PMCT) has been recently reported to be useful for detecting causes of death in the emergency department. In this study, the incidence and causes of death of type A ...acute aortic dissection (AAD) were investigated in patients who experienced out-of-hospital cardiopulmonary arrest (OHCPA) using PMCT. PMCT or enhanced computed tomography was performed in 311 of 528 consecutive patients experiencing OHCPA. A total of 23 (7%) of 311 patients were diagnosed with type A AAD based on clinical courses and CT findings. Eighteen consecutive patients who did not experience OHCPA were diagnosed with type A AAD during the same period. Pre-hospital death was observed in 21 (51%) of 41 patients with type A AAD. Bloody pericardial effusion was observed more frequently in patients who experienced OHCPA with type A AAD than in those who did not experience OHCPA with type A AAD (91% vs 28%, respectively; p <0.05). In conclusion, the incidence of type A AAD was common (7%) in patients who experienced OHCPA, with a high rate of pre-hospital death. Aortic rupture to the intrapericardial space was considered the major cause of death in patients who experienced OHCPA with type A AAD.
Infective endocarditis (IE) is caused by bacterial vegetation in valves, but it can also occur in implanted mechanical devices. We report a rare case of IE occurring at the site of percutaneous ...atrial septal closure devices in a patient in her 50s that had been placed for residual defects on a closure patch in her childhood for an atrial septal defect (ASD). She also had a medical history of distal pancreatectomy for insulinoma in her 40s and had insulin-dependent diabetes mellitus, which means she had been immunocompromised.
She visited our hospital with complaints of fever and lumbar pain. A computed tomography scan revealed liver abscess. In blood, urine, and drainage specimens submitted for culture testing, extended spectrum beta-lactamase-producing Escherichia coli was cultured in all specimens. Echocardiography showed vegetation at the atrial septal closure devices. In accordance with IE therapy, removal of the atrial septal patch and closure device was performed after antibiotic treatment for 6 weeks.
Because the atrial septal patch was calcified and the two devices implanted on the patch were not well covered by neointima, bacteria could easily form vegetation. Percutaneous residual ASD closure on an atrial patch, especially for immunocompromised hosts, should be carefully considered.
In general, neointima forms and coats a closure device several years after its insertion. However, as in the present case, the closed atrial septal patch may be severely calcified and the neointima may not be sufficiently formed on the closure device, and infective endocarditis may occur at the site of implantation. In some cases, the indication for closure device implantation after atrial septal patch closure should be carefully considered.
Abstract Background The prevalence of severe sclerotic aortic stenosis (ScAS) in those at least ≧80 years old has been increasing in Japan; however, the prognosis of these Japanese patients without ...surgical treatment has not been reported. Methods and results Ninety consecutive patients with medically treated severe ScAS were prospectively studied. To assess further event-free survival rate (EFSR) from either cardiac (heart failure or cardiac death) events or noncardiac deaths, they were divided into three groups based on aortic valve area (AVA) at the initial diagnosis (group A: AVA ≦ 0.6 cm2 , group B: 0.6 cm2 < AVA ≦ 0.8 cm2 , and group C: 0.8 cm2 < AVA ≦ 1.0 cm2 ). In comparison, 73 consecutive patients ≧80 years old with moderate ScAS (group M: 1.0 cm2 < AVA ≦ 1.5 cm2 ) were also enrolled. The EFSR in group A was significantly lower than that in the other groups ( p < 0.05) while no difference was seen among the other groups although the EFSR from cardiac events in group B was lower than the moderate group ( p < 0.05). Multivariate analysis showed that the cardiac risk factors were AVA ≦0.6 cm2 and left ventricular ejection fraction (EF) ≦55%. Conclusions Since patients with AVA ≦0.6 cm2 have a significantly worse prognosis, more symptoms, and higher prevalence of cardiac events, early aortic valve replacement should be considered in this group. Furthermore, patients having AVA ranging from 0.6 to 0.8 cm2 have a worse prognosis in cardiac events compared to group M. In addition, EF ≦55% is another significant factor for cardiac events.
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