Kaoruko Sengoku

Non-Ischemic Heart Failure With Reduced Ejection Fraction Is Associated With Altered Intestinal Microbiota

BACKGROUND Research suggests that heart failure with reduced ejection fraction (HFrEF) is a state of systemic inflammation that may be triggered by microbial products passing into the bloodstream through a compromised intestinal barrier. However, whether the intestinal microbiota exhibits dysbiosis in HFrEF patients is largely unknown.Methods and Results:Twenty eight non-ischemic HFrEF patients and 19 healthy controls were assessed by 16S rRNA analysis of bacterial DNA extracted from stool samples. After processing of sequencing data, bacteria were taxonomically classified, diversity indices were used to examine microbial ecology, and relative abundances of common core genera were compared between groups. Furthermore, we predicted gene carriage for bacterial metabolic pathways and inferred microbial interaction networks on multiple taxonomic levels.Bacterial communities of both groups were dominated by the Firmicutes and Bacteroidetes phyla. The most abundant genus in both groups wasBacteroides. Although α diversity did not differ between groups, ordination by β diversity metrics revealed a separation of the groups across components of variation.StreptococcusandVeillonellawere enriched in the common core microbiota of patients, whileSMB53was depleted. Gene families in amino acid, carbohydrate, vitamin, and xenobiotic metabolism showed significant differences between groups. Interaction networks revealed a higher degree of correlations between bacteria in patients. CONCLUSIONS Non-ischemic HFrEF patients exhibited multidimensional differences in intestinal microbial communities compared with healthy subjects.

Ratio of pulmonary artery diameter to ascending aortic diameter and severity of heart failure

BACKGROUND Treatment decisions in dilated cardiomyopathy (DCM) patients with severe heart failure (HF) and short clinical history are challenging because of the difficulty of determining HF stage or prognosis in the acute HF phase. We hypothesized that persistent decreased systemic or increased pulmonary arterial pressure, including in the sub-clinical phase, might affect the main pulmonary artery diameter (PAD), ascending aortic diameter (AoD), and their ratio (PAD/AoD). This study assessed AoD, PAD, and PAD/AoD by non-contrast computed tomography scans in DCM patients in the acute phase of HF and examined the association of these parameters with their clinical course. METHODS Of 261 screened individuals, we studied 110 consecutive hospitalized patients with DCM suspected of being in advanced stage of HF and 45 age-matched controls, assessing clinical data and later events (cardiac death or left ventricular assist device implantation). RESULTS Compared with controls, DCM patients had smaller AoD (26.6 ± 4.4 vs 30.6 ± 2.7 mm) and larger PAD (27.7 ± 3.5 vs 25.4 ± 2.8 mm) and PAD/AoD (1.05 ± 0.14 vs 0.83 ± 0.08; all p < 0.01). DCM patients with high PAD/AoD (median, > 1.05) had more frequent past HF hospitalizations, lower blood pressure, stroke volume, and ejection fraction, higher brain natriuretic peptide levels, smaller AoD, and similar PAD compared with patients with a low PAD/AoD. A higher PAD/AoD was associated with poorer outcomes even after adjusting for age, blood pressure, ejection fraction, or number of hospitalizations. CONCLUSION Assessment of AoD and PAD may have important clinical implications in determining whether DCM patients are in an advanced stage of HF with a poorer prognosis.

The role of echocardiography in transcatheter aortic valve implantation

Transcatheter aortic valve implantation (TAVI) is an effective and less invasive treatment for the increasing population of individuals with severe aortic stenosis (AS). Echocardiography is crucial in the assessment of AS patients from pre- to post-procedure. Transthoracic echocardiography (TTE) may be used to assess patient suitability for TAVI, as well as evaluate the severity of AS, the aortic valve complex, aortic valve morphology, mitral regurgitation (MR), and left ventricular function. Transesophageal echocardiography (TEE) is usually used as an intra-procedural monitoring tool to provide feedback during the procedure, to assess prosthetic valve function, and to detect complications rapidly before and after balloon aortic valvuloplasty (BAV) or transcatheter heart valve (THV) deployment. In this review, the role of echocardiography in the pre-, intra-, and post-TAVI procedure periods is described in detail.

MODERATE TO SEVERE ACUTE KIDNEY INJURY DURING HEART FAILURE TREATMENT PROVIDES THE ADDITIONAL LONG-TERM PROGNOSTIC INFORMATION TO MALNUTRITION IN PATIENTS ADMITTED WITH ACUTE DECOMPENSATED HEART FAILURE

Malnutrition is associated with the increased mortality risk in patients (pts) with heart failure. Acute kidney injury (AKI) during heart failure treatment is also associated with poor outcome in pts admitted with acute decompensated heart failure (ADHF). However, there is no information available

EVEN STANDARD DOSE OF FUROSEMIDE IS ASSOCIATED WITH THE PROGRESSION OF CARDIORENAL SYNDROME IN PATIENTS WITH CHRONIC HEART FAILURE VIA CARDIAC SYMPATHETIC NERVE ACTIVATION

High dose of loop diuretics has been associated with poor outcome in heart failure patients. However, it remains to be uncertain whether even standard dose of diuretics would be related to worsening renal function and cardiac events in chronic heart failure (CHF) patients, from a viewpoint of

CARDIAC I-123 METAIODOBENZYLGUANIDINE IMAGING COULD IDENTIFY PATIENTS WITH CHRONIC HEART FAILURE AND LVEF<35% AT LOW RISK FOR SUDDEN CARDIAC DEATH FOR FIVE YEARS

Patients (pts) with chronic heart failure (CHF) at risk of sudden cardiac death (SCD) are often treated with implantable cardiac defibrillator (ICD), but current criteria for device use, based largely on LVEF, leads many pts receiving ICDs that never deliver therapy. It is of clinical significance

PERSISTENCE OF HYPONATREMIA IMPLIES LONG-TERM POOR OUTCOMES IN PATIENTS WITH CHRONIC HEART FAILURE

Hyponatremia is a common electrolyte abnormality in patients with chronic heart failure (CHF). It was reported that hyponatremia is associated with increased mortality in CHF patients. However, the prognostic significance of persistent hyponatremia remains to be unclear in CHF patients. We sought to

SPIRONOLACTONE IMPROVES POOR OUTCOME IN PATIENTS WITH NYHA CLASS I OR II CHRONIC HEART FAILURE AND ELEVATED CARDIAC SYMPATHETIC NERVE ACTIVITY

Background: Mineralocorticoid antagonist has been shown to decrease the morbidity and mortality in patients with systolic chronic heart failure (CHF) and mild symptoms. Since cardiac sympathetic nerve activity (CSNA) is reported to be associated with poor outcome in patients with CHF, we tried to elucidate the relation between the eficacy of spironolactone and CSNA in CHF patients with NYHA class I or II.

EFFECT OF THE CONCOMITANT USE OF SPIRONOLACTONE AND LOOP DIURETICS ON THE CLINICAL OUTCOME IN PATIENTS WITH NYHA CLASS 1 OR 2 CHRONIC HEART FAILURE

Aldosterone receptor antagonists (ARA) classified as potassium sparing diuretics is administered concomitantly with loop diuretics for the management of patients with chronic heart failure (CHF) in usual clinical setting. Recently, ARA has been shown to decrease the morbidity and mortality in