Mie Seya

Tolvaptan reduces the risk of worsening renal function in patients with acute decompensated heart failure in high-risk population

BACKGROUND Although tolvaptan is a recently approved drug for heart failure and causes aquaresis without affecting renal function, its clinical efficacy for patients with acute decompensated heart failure (ADHF) is yet to be elucidated. METHODS AND RESULTS We conducted a prospective observational study in patients with ADHF and high risk for worsening renal function (WRF). Risk stratification for WRF was done by scoring system. Of 174 patients, 114 patients were included as high-risk population for WRF. Incidence of WRF, urine output within 24h and 48 h, and changes in brain natriuretic peptide (BNP) were recorded in 44 patients treated with tolvaptan plus conventional therapy, and 70 patients with only conventional therapy. Urine output at 24h and 48 h after admission were both significantly higher in the tolvaptan group (p=0.001 and <0.001, respectively), and changes in BNP were not significantly different (p=0.351). However, the incidence of WRF was significantly lower in the tolvaptan group compared to the conventional group (22.7% vs 41.4%, p=0.045). Logistic regression analysis showed that treatment with tolvaptan was an independent factor for reducing WRF (hazard ratio 0.28, 95% confidence interval; 0.10-0.84; p=0.023). CONCLUSION In patients with ADHF with high risk of WRF, treatment with tolvaptan could prevent WRF compared to conventional therapy.

Prognostic implications of chronic kidney disease and anemia after percutaneous coronary intervention in acute myocardial infarction patients

Anemia is a common complication of chronic kidney disease (CKD), and a few studies suggest that both CKD and anemia have a marked impact on the prognosis of patients with cardiovascular disease. We retrospectively analyzed the prevalence of CKD and anemia in 312 patients with acute myocardial infarction (AMI). The patients were divided into four groups according to the presence of CKD and anemia. Chronic kidney disease was defined as estimated glomerular filtration rate <60 ml/min/1.73 m2, and anemia was defined according to the World Health Organization definition. Of 312 AMI patients, 166 (53.2%) had CKD and 87 (27.8%) had anemia. A powerful relationship was observed between both CKD and anemia and major adverse cardiac and cerebrovascular events (MACCE) or death by any cause. After adjustment for comorbidities, the hazard ratio (HR) for MACCE was significantly higher in the anemia-only group (HR 5.42, 95% confidence interval (CI) 1.38–21.27, P = 0.015), the CKD-only group (HR 6.4, 95% CI 2.09–19.58, P = 0.001), and the CKD and anemia group (HR 11.61, 95% CI 3.65–36.89, P < 0.001). With respect to death by any cause, the HR was significantly higher in the CKD-only group (HR 2.68, 95% CI 1.02–7.02, P = 0.045) and the CKD and anemia group (HR 4.40, 95% CI 1.56–12.43, P = 0.005). One-half of the patients with AMI had CKD as well. Furthermore, when anemia coexisted with CKD, these conditions had a multiplicative amplification effect on the risk of MACCE and death by any cause in patients with AMI.

A Case of Atrial Lead Dislodgement after Surgery for Lung Cancer

Case is a 77 years-old female. She started having episodes of palpitations followed by pre-syncope from 3 months ago. Holter ECG was performed which revealed runs of paroxysmal atrial fibrillation followed by sinus pause up to 4.3 seconds, which was consistent with the symptoms. With the diagnosis of bradycardia-tachycardia syndrome, DDD pacemaker implantation was performed. Tined leads were implanted to right atrial appendage and right ventricular apex without any complications. Shortly after the pacemaker implantation, patient was found to have left lung cancer. Left upper lobe resection and broad partial left lower lobe resection was performed 3 months after the pacemaker implantation. Two days after the surgery, monitor ECG revealed atrial lead sensing and pacing failure, and atrial lead dislodgement was observed on chest rentogenography. The left lung resection caused the mediastinum to shift leftward, resulting in advancement of the leads which lead to the dislodgement. Atrial lead repositioning was performed which only needed a short pull of the lead. We report a case of atrial lead dislodgement after surgery for lung cancer due to the shift of the mediastinum.