Managing right-sided chronic heart failure (CHF) due to tricuspid regurgitation (TR) remains a clinical challenge. Tolvaptan (TLV), a vasopressin V2 receptor inhibitor, is effective in controlling ...decompensated HF. However, its effects on right-sided CHF caused by TR are unclear. We sought to clarify the effects of TLV in CHF patients complicated with TR. The cohort consisted of 33 CHF patients with moderate or severe TR and permanent atrial fibrillation, who required hospitalization for HF. We observed 19 patients treated with TLV plus conventional therapies (TLV group) and 14 patients with conventional therapies alone (conventional group). Clinical characteristics, echocardiographic parameters, and laboratory data were investigated. Baseline characteristics were similar between groups. In the TLV group, the severity of TR at admission was 73.7% moderate and 26.3% severe. In the conventional group, these percentages were 85.7% and 14.3%, respectively. During the follow-up, the severity of TR improved in the TLV group (trivial–mild: 52.6%; moderate: 36.8%; severe: 10.5%) (
p
< 0.01). However, it did not improve in the conventional group (trivial–mild: 21.4%; moderate: 50.0%; severe: 28.6%) (
p
= 0.08). The diameter of the tricuspid annulus (
p
< 0.01), basal (
p
= 0.02), and mid right ventricle (
p
= 0.04) was reduced at follow-up in the TLV group. Nevertheless, these parameters did not change in the conventional group. Serum creatinine levels were maintained (
p
= 0.74) in the TLV group, but deteriorated in the conventional group (
p
= 0.03). TLV reduced right ventricular dimensions and improved TR without deterioration of renal function. Thus, TLV may be a new drug for the treatment of CHF patients with TR.
Considering that transcatheter aortic valve replacement (TAVR) procedures have become less invasive, the duration for monitoring patient care after a successful TAVR can be reduced. Therefore, this ...study aimed to investigate the prognostic value of baseline echocardiographic parameters for non-delayed discharge in patients after TAVR. The study group included 154 consecutive patients (mean age: 84.4 ± 4.5 years; and 101 women) who underwent a TAVR. Comprehensive echocardiograms including both side indices of myocardial performance (IMP) and blood tests were obtained prior to the TAVR procedure. The median post-TAVR length of stay was 6 days while the mode and first quartile were both 4 days. Receiver operating characteristic curve analysis showed that the optimum cut-off value of the left-sided IMP in patients with a normal left ventricular ejection fraction (LVEF, ≥ 50%) (n = 124) for non-delayed discharge (≤ 4 days) was 0.34 with an area under the curve (AUC) value of 0.71563 and p value of < 0.0001, while the optimum cut-off value in patients with reduced LVEF (< 50%) (n = 30) was 0.47 with an AUC value of 0.77778 and p value of < 0.0120. An adjusted analysis indicated the negative left-sided IMP results as the only predictor for non-delayed discharge (p < 0.0001). Furthermore, the adjusted predictors for survival without early cardiovascular re-hospitalization within 6 months after TAVR were the positive left-sided IMP result, when the cut-off value of 0.52 was used, and the presence of elevated RAP of 8 to 15 mmHg. The early discharge policy should be carefully considered in high-risk populations, but the left-sided IMP may play a significant role in the pre-screening process.
This study aims to elucidate 1-year clinical outcomes using this technique for patients with stage 4 or 5 advanced chronic kidney disease (CKD). Research has proven that imaging-guided percutaneous ...coronary intervention (PCI) reduces contrast volume significantly; however, only short-term clinical benefits have been reported. Minimum-contrast (MINICON) studies are based on the registry design pattern to enroll PCI results in patients with advanced CKD stage 4 or 5 comorbid with coronary artery disease. We excluded cases of emergency PCI or maintenance dialysis from this study. In this study, we compared the intravascular ultrasound (IVUS)-guided MINICON PCI group (
n
= 98) with the angiography-guided standard PCI group (
n
= 86). Enrollment of the MINICON studies started in 2006. Before 2012, IVUS-guided MINICON PCI was performed only in 14% (stage 1), but it was 100% after 2012 (stage 2). The enrollment finished in 2016. The IVUS-guided MINICON PCI group exhibited a significantly reduced contrast volume (22 ± 20 vs. 130 ± 105 mL;
P
< 0.0001) and contrast-induced acute kidney injury (CI-AKI; 2% vs. 15%;
P
= 0.001). The PCI success rate was similarly high (100% vs. 99%;
P
= 0.35). At 1 year (follow-up rate, 100%), we observed less induction of renal replacement therapy (RRT; 2.7% vs. 13.6%;
P
= 0.01), but all-cause mortality or myocardial infarction was similar in both groups. The IVUS-guided MINICON PCI reduces CI-AKI significantly and induction of RRT at 1 year in patients with stage 4 or 5 advanced CKD.
Aims
Exogenous atrial natriuretic peptide (ANP) may be a logical treatment for heart failure (HF) patients with ANP deficiency. Lower ANP concentrations may result from HF with preserved ejection ...fraction (HFpEF), which also results in lower brain natriuretic peptide levels in HFpEF relative to HF with reduced ejection fraction (HFrEF), although clinical features regarding circulating ANP in HFpEF and HFrEF have not been fully investigated during acute HF. Here, we characterized the differential regulation of circulating ANP and the efficacy of exogenous ANP (carperitide) in patients with acute HF, especially HFpEF.
Methods and results
Serum ANP levels before treatment and the diuretic effect of 0.0125 μg/kg/min of carperitide alone for the first 6 h were prospectively evaluated in 113 patients with acute HF who were divided into two groups: HFpEF vs. HFrEF. We mainly analysed the impact of baseline ANP levels and the presence of HFpEF on the diuretic effect of exogenous ANP. There was an inverse relationship between ANP levels and the diuretic effect of exogenous ANP (r2 = 0.19, P < 0.001). Patients with HFpEF had lower ANP levels (P < 0.001) and a greater diuretic effect of exogenous ANP than patients HFrEF (P < 0.001). HFpEF was an independent predictor of greater diuretic effect of exogenous ANP (P = 0.003), as with a lower baseline ANP level (P = 0.004).
Conclusions
Patients with HFpEF might have an aspect of ANP deficiency and represent a promising therapeutic target for modulating circulating ANP.
Cardiac hemangiomas are extremely rare tumors, accounting for only 2.5 % of all cardiac tumors. Most of these develop in the ventricles, and obtaining a good field of view is, therefore, the key to ...successful operation. A 40-year-old female visited a local hospital due to palpitation. Transthoracic echocardiography revealed a spherical high-echo mass (13.5 × 10.7 mm in diameter) between the papillary muscles. She was referred to our hospital to undergo close examination. Cardiac contrast-enhanced magnetic resonance imaging was performed to differentiate between malignant and benign lesions. However, this did not provide any findings leading to a definite diagnosis. To make a diagnosis and prevent embolism, the mass was excised using a right minithoracotomy approach with thoracoscopic assistance. The post-operative pathological diagnosis was a cardiac capillary-cavernous hemangioma. A right minithoracotomy approach combined with thoracoscopy allowed accurate evaluation of the mass in the left ventricle beyond the mitral valve and its accurate excision.
IntroductionAcute myocardial infarcted (AMI) patient prognosis is strictly dependent on early diagnosis and the adoption of adequate interventions.HypothesisImmune cellsʼ blood level as a possible ...candidate to use distinct diagnostic biomarkers of AMI (H1) with/out the combination with clinical-laboratory findings are little known (H2).Materials &MethodsEighteen patients with the diagnosis of AMI were enrolled. Patients with a history of chronic inflammatory disease excluded. All patients underwent emergent percutaneous coronary intervention via the radial artery and guided by optical coherence tomography. Peripheral blood was drawn after obtaining informed consent from patients at days three and seven (MI-D3 & MI-D7) after onset AMI along with sixteen healthy volunteers as a control. The mononuclear cells isolated by density gradient centrifugation and evaluated with EPCs colony formation assay, and flow cytometry analysis (FCA).ResultsFCA revealed that total mononuclear live cells were significantly lower at MI-D3 and MI-D7 in myocardial infarcted patients compared with healthy controls (55.18±6.7 vs. 77.5±2, P>0.01; and 64.52±7.33 vs. 77.5±2, P>0.08, respectively). An area under the ROC curve (AUC) in MI-D3 was 0.95 (P>0.0007), that is, total CD34+cells/ml counts for MI-D3 vs. healthy controls whereas at MI-D7 the value of EPCs as a predictor was reduced AUC=0.71(P<0.16). In correlation analysis, coronary vessels lesions number inversely correlates vs. MI-D3 total EPCs number (r= -0.45) but not at MI-D7 (r= 0.39). Correlation test showed the tendency of a positive correlation between creatine kinase myocardial band to CD8+ cells at MI-D3 (r=0.58; P<0.054) but not at MI-D7. ROC curve analysis depicted a high accuracy AMI prediction rate of CD8+ cells at MI-D3 (AUC=0.94; P>0.0004) and MI-D7 (AUC=0.85; P>0.03). Notably, all T cells subsets negatively correlated with myeloid cell subsets such as M1 and M2 macrophages at MI-D7, indicating T cells loss in PB stream compensated by monocyte/macrophage.ConclusionOur data demonstrated that circulating EPCs number associates with cardiac vessel lesion, whereas CD8+ cells may serve as a high accuracy biomarker of AMI with a combination of classical clinical-laboratory findings.
Introduction & HypothesisDiabetes mellitus patients’(DMP) peripheral blood mononuclear cells (PBMNC) regenerative capacity level is impaired. An in vitro evaluation of PBMNC pre/post vasculogenic ...conditioning (VC) facilitates the assessment of immune cells regenerative potential (H1) and possible cell therapy for DMP with acute myocardial infarction (AMI) (H2).Materials & MethodsEighteen DMP with the diagnosis of AMI enrolled. Blood drawn in heparin-coated syringes from AMI patients (between day 3 to 7) along with sixteen healthy control. Isolated PBMNC regenerative capability evaluated pre and post VC (Fig 1) with EPCs colony formation assay/unit (EPC-CFA/U) and flow cytometry analysis.ResultsAn in vitro EPC-CFA revealed that DMP fresh PBMNC derived definitive EPC (DEPC) decreased compared to control. The differentiation rate of EPC, definitive vs. primitive in control groups composed equal (50%, PEPC vs. 50%, DEPC) while in DMP, PEPC prevails (70% vs. 30%). After VC, DEPC-CFU markedly increased while PEPC-CFU decreased, indicating EPC qualitatively and quantitatively improvement in DMP (Control, PBMNC vs. VC P>0.001; DMP, PBMNC vs. VC, P>0.01). DMP glycoalbumin and Hb1Ac inversely correlated with CD34+ cells (r= -0.48, P>0.03) while VC recovered CD34+ cells (r= 0.17, P<0.54). ROC curve analysis also confirmed that the CD34+ cell number is an independent risk classifier of cardiac vessel lesion (AUC=0.85, P>0.002). In contrast, VC preserved from the senescence by expansion and differentiation of CD34+ (AUC=0.54, P<0.7). Proinflammatory M1 type significantly increased in DMP compared to Control (P>0.03), while VC shifted the M1 type phenotype toward M2 type (P>0001).ConclusionOur EPC-CFA enables us to precisely assess impaired EPC function, while VC enhanced differentiation from PEPC toward DEPC. Furthermore, these methodologies facilitate the evaluation of RACs capacities such as EPC, M1/M2, and Treg cells in DMP with AMI for cell therapy.
Abstract only Introduction: Peripheral blood mononuclear cell (PBMC) regenerative capacity is impaired in pre/diabetes mellitus patients (DMPs). In vitro evaluation of PBMCs pre/post vasculogenic ...conditioning (VC) and integrative assessment of classical clinical risk factors using complex machine learning-based (ML) methods may help to distinguish patients' immune cell regenerative potential. Methods: Eighteen DMPs diagnosed with myocardial infarction and sixteen controls were enrolled. Isolated PBMC regenerative capability was evaluated pre/post-VC using endothelial progenitor cell colony formation assay/unit (EPC-CFA/U) and flow cytometry analysis. The following classification ML algorithms were used for data analysis: support vector machine (SVM), logistic regression (LR), random forest (RF), decision tree (DT), and adaptive boosting (AB). Results: An in vitro EPC-CFA assay revealed that DMPs showed decreased fresh PBMC-derived definitive EPCs (DEPCs) compared with controls. Decreased colony formation was observed in patients with a reduced number of circulating EPCs and they did not appropriately respond to VC according to ML findings. Furthermore, proinflammatory M1 macrophages significantly increased (P = 0.03) in the majority of DMPs (non-responders) compared to that in controls, whereas VC shifted the phenotype toward M2 along with CD4 + T and Treg cell expansion. Clinical, pre/post culture cell phenotype, and EPC-CFU data integration and comprehensive ML analyses distinguished “non-responder”-associated distinct biomarkers, clinical parameters, such as elevated proinflammatory cells and systemic inflammation, and elderly patients from those of responders. Notably, SVM prediction accuracy was 100%; both LR and RF were 86%; and those of AB and DT were 71% and 43%, respectively. Conclusions: Applying comprehensive ML methods, as well as integrative analysis of the findings of in vitro assays, such as EPC-CFA; such as EPCs, M1/M2 macrophages, and T cells pre/post-VC; and clinical-laboratory parameters, enabling us to precisely evaluate regeneration capacity of impaired PBMNC functions. Moreover, this cell culture methodology can be used before cell therapy to define optimal dose and cell ratio for transplantation.
Objectives
To evaluate the feasibility and efficacy of transcatheter aortic valve replacement (TAVR) in patients with small sinus of Valsalva (SOV).
Background
Patients with small SOV are considered ...unfavorable for TAVR since it carries risk of coronary obstruction after valve implantation. Therefore, these patients with small SOV were excluded from previous clinical trials.
Methods
Between February 2017 and February 2019, a total of 139 consecutive patients with severe aortic stenosis (AS) undergoing TAVR were prospectively enrolled in the Tokai Valve Registry. Patients with small SOV who were treated with smaller size of self‐expandable transcatheter heart valve (THV) than expected by perimeter‐based sizing were included in this study. Eleven patients (7.9%) were included.
Results
Mean age was 86.5 ± 3.8 years and median STS Score was 8.5% (interquartile range: 6.3–12.3%). Device success was accomplished in all patients and no coronary obstruction was observed. No moderate/severe paravalvular leakage, new onset conduction disturbance, and new permanent pacemaker implantation were noted. At 30‐day follow‐up, mean aortic valve gradient was 6.9 ± 1.7 mmHg and mean indexed aortic valve area was 0.95 ± 0.16 cm2/m2. Prosthetic valve performance was stable at 12‐month follow‐up. No severe prosthesis patient mismatch was documented at any time point. No in‐hospital, 30‐day, and 12‐month mortality were observed. The median follow‐up was 711 days (IQR: 547–803 days), and no patient was lost to follow‐up.
Conclusions
Our preliminary experience suggests favorable safety and efficacy of TAVR utilizing self‐expandable THV with intentional down‐sizing in patients with severe AS and small SOV in a mid‐term follow‐up.
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