International heart journal
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We describe a case of a 41-year-old woman with acute exacerbation of chronic thromboembolic pulmonary hypertension (CTEPH) complicated by rapidly progressive respiratory failure and right heart failure with cardiogenic shock. A computed tomography (CT) showed thrombi in the right main pulmonary artery and bilateral peripheral pulmonary arteries, and echocardiography showed right ventricular dilatation and tricuspid regurgitation, with an estimated pressure gradient of 80 mmHg. The patient was initially diagnosed with acute pulmonary thromboembolism, and thrombolytic therapy was administered. ⋯ Five days after BPA, the patient was removed from VA-ECMO and on the 57th day of hospitalization, she was weaned off the ventilator. The patient was discharged after 139 days of hospitalization. Rescue BPA represents a useful intervention for improving PH and weaning off VA-ECMO in a patient with acute exacerbation of CTEPH.
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Review Comparative Study
CABG versus PCI in the treatment of diabetic patients affected by coronary artery disease.
Surgical coronary revascularization and percutaneous coronary intervention were demonstrated to be effective treatments for coronary artery disease. However, the optimal revascularization strategy remains unclear in certain patient subsets. ⋯ The purpose of this study was to review the available literature based on randomized trials and observational studies in order to allow clinicians to make evidence-based decisions when treating diabetic patients with multivessel coronary disease. The current evidence suggests that CABG should remain the standard of care for this patient population.
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Several studies have demonstrated that tolvaptan (TLV) can improve hyponatremia in advanced heart failure (HF) patients with rare chance of hypernatremia. However, changes in serum sodium concentrations (S-Na) in patients with or without hyponatremia during TLV treatment have not been analyzed. Ninety-seven in-hospital patients with decompensated HF who had received TLV at 3.75-15 mg/day for 1 week were enrolled. ⋯ In contrast, in normonatremic responders (n = 43), S-Na remained unchanged (136.6 ± 3.1 versus 137.4 ± 2.9 mEq/L, NS) along with increased U-NaEx(24) (2201 ± 1644 versus 4198 ± 3550 mg/day, P < 0.05). TLV increased S-Na only in hyponatremic responders by way of pure aquaresis, but increased U-NaEx(24) only in normonatremic responders, which explains the scarcity of hypernatremia. Epithelial Na-channels in the distal nephrons, whose repression by TLV increases urinary sodium excretion, may be attenuated by reduced ATP-supply in worse hemodynamics under hyponatremia.
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It remains unclear if the CHADS2 score or CHA2DS2-VASc score is more useful for the risk stratification of ischemic stroke/systemic thromboembolism in Japanese patients with non-valvular paroxysmal atrial fibrillation (NVPAF). We retrospectively investigated the incidence of ischemic stroke on the basis of CHADS2 and CHA2DS2-VASc scores in 332 NVPAF patients (224 men, mean age, 65 ± 13 years) who were not administered anticoagulation therapy before publication of the 2008 JCS guideline (mean follow-up period, 53 ± 35 months). Annual rates of ischemic stroke/ systemic thromboembolism underlying antiarrhythmic drug therapy were 0.2%/year for the 0-point group; 0.9%/year for the 1-point group; 2.8%/year for the 2-point group; 9.4 %/year for the 3-point group; and 10.9%/year for the ≥ 4-point group on the basis of the CHADS2 scores, and 0%/year for the 0-point group; 0.6%/year for the 1-point group; 1.0%/ year for the 2-point group; 2.0 %/year for the 3-point group; 5.5%/year for the 4-point group; 9.1%/year for the 5-point group; and 13.7%/year for the ≥ 6-point group on the basis of the CHA2DS2-VASc scores. ⋯ In multivariate logistic regression analysis, the CHADS2 (odds ratio [OR]:4.74, 95% confidence interval [CI]:2.80-8.00, P < 0.001) and CHA2DS2-VASc scores (OR: 4.15, 95% CI:2.57-6.71, P < 0.001) were significant independent predictors for ischemic stroke/systemic thromboembolism. Area under the receiver-operator characteristic curves for predicting ischemic stroke/systemic thromboembolism were 0.89 in the CHA2DS2-VASc scores (P < 0.001) and 0.87 in the CHADS2 scores (P < 0.001). In Japanese patients with NVPAF, both the CHADS2 and CHA2DS2-VASc scores are useful parameters for the risk stratification of ischemic stroke/systemic thromboembolism.
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Comparative Study
Can we obtain a noninvasive and continuous estimation of cardiac output? Comparison between three noninvasive methods.
Cardiac output (CO) is often desirable for assessing the hemodynamic condition of a patient, especially in critically ill cardiac patients. Various noninvasive methods are available for this purpose. Inert gas rebreathing (IGR) and 2D-Doppler echocardiography methods have been validated. ⋯ The intraclass correlation coefficient was poor whatever the methods. However, esCCO had a satisfactory reproducibility and accuracy compared rather well with the other 2. This method could be suitable for patient screening and monitoring.