Ryota Iwatsuka

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.

Three-dimensional echocardiography could distinguish a ventricular septal defect adjacent to asymptomatic ruptured sinus of Valsalva aneurysm

Sinus of Valsalva aneurysm (SVA) arises frequently in the right coronary sinus, and ventricular septal defect (VSD) is a prevalent coexistent cardiac abnormality. A 38-year-old asymptomatic male diagnosed with VSD on cardiac catheterization in his childhood, was referred to our hospital for the change in intensity of his cardiac murmur pointed out by his family physician. A grade V continuous murmur was auscultated with a thrill loudest at the forth left sternal border. Although, transthoracic and transesophageal echocardiography and cardiac catheterization have showed the ruptured right coronary sinus aneurysm, it was difficult to demonstrate coexistence of a doubly committed subarterial VSD. Three-dimensional echocardiography could provide clear images for diagnosis of the VSD closely adjacent to the ruptured SVA. The defect was confirmed at surgery.

Inferior Vena Cava Thrombus due to Left Inferior Vena Cava and Ulcerative Colitis

A 29-year-old man with diarrhea and abdominal pain for 2 weeks presented with new-onset left back pain. Contrast-enhanced computed tomography (CT) showed a left inferior vena cava (IVC) crossing over the aorta, and thrombus in the IVC and left renal vein. Colonoscopy and biopsy for assessment of diarrhea and abdominal pain provided a diagnosis of ulcerative colitis. Stasis of blood flow due to left IVC crossing over the aorta, and hypercoagulability due to ulcerative colitis influenced thrombus formation.

Histological examination of the right atrial appendage after failed catheter ablation for focal atrial tachycardia complicated by cardiogenic shock in a post-partum patient

A 26‐year‐old woman in her first pregnancy presented with persistent atrial tachycardia (AT). AT was resistant to medications, cardioversions, and the first attempt of catheter ablation. Two months after delivery she developed severe systolic dysfunction and circulatory collapse. Emergent catheter ablation was performed with the support of percutaneous cardiopulmonary bypass and intraaortic balloon pump. The AT originated in the apex of the right atrial appendage (RAA). Repeated attempts at ablation were unsuccessful, prompting surgical RAA resection, which terminated the tachycardia and improved the cardiac function. Histological examination of resected RAA provided insights into mechanism of resistance to catheter ablation.

Suppression of Ventricular Tachycardia Associated with Cardiac Sarcoidosis by Steroid Therapy

In patients with cardiac sarcoidosis, ventricular tachycardia (VT) is observed in some cases. However, effective therapies for the VT are still unknown.