Taishi Okuno

Hemodynamic correlates of nutritional indexes in heart failure

BACKGROUND Malnutrition in heart failure (HF) is related to altered intestinal function, which could be due to hemodynamic changes. We investigated the usefulness of novel nutritional indexes in relation to hemodynamic parameters. METHODS We retrospectively analyzed 139 HF patients with reduced ejection fraction who underwent right heart catheterization. We investigated correlations between right side pressures and nutritional indexes, which include controlling nutritional (CONUT) score and geriatric nutritional risk index (GNRI). Receiver operating characteristic (ROC) curves were generated to investigate the prognostic accuracy of CONUT score and GNRI for a composite of death or HF hospitalization in 12 months. Logistic regression analysis was performed to investigate whether hemodynamic correlates were associated with malnutrition, which was defined based on CONUT sore or GNRI. RESULTS Higher right side pressures were positively correlated with worse nutritional status according to CONUT score, but were negatively correlated with worse nutritional status according to GNRI. Area under ROC curve for the composite endpoint was 0.746 in CONUT score and 0.576 in GNRI. The composite endpoint occurred in 40% of CONUT score≥3 and in 11% of CONUT score<3 (p<0.001). These relationships were also investigated with GNRI (40% of GNRI<95 vs. 17% of GNRI≥95, p=0.002). In multivariate analysis, higher right atrial pressure was significantly associated with higher CONUT score, while no hemodynamic parameter was related to GNRI. CONCLUSIONS CONUT score was associated with right side congestion, while no association between GNRI and right side congestion was noted. CONUT score had better predictive value than GNRI.

Mismatch between right- and left-sided filling pressures in heart failure patients with preserved ejection fraction

BACKGROUND Mismatch between right- and left-sided filling pressures is poorly understood in heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS We retrospectively analyzed 170 patients with HFpEF (EF≥40%) who underwent right heart catheterization. Low match (right atrial pressure [RAP] < 10 mm Hg and pulmonary capillary wedge pressure [PCWP] < 22 mm Hg) was 76%, high match (RAP ≥ 10 mm Hg and PCWP ≥ 22 mm Hg) was 6.5%, high-R mismatch (RAP ≥ 10 mm Hg and PCWP < 22 mm Hg) was 12%, and high-L mismatch (RAP < 10 mm Hg and PCWP ≥ 22 mm Hg) was 5.9%. Elevated PCWP was a significant predictor of the composite endpoint of death or HF hospitalization within 12months (hazard ratio 5.40, 95% confidence interval 2.17-12.5, p<0.001). Elevated RAP was not significantly associated with worse outcomes. Pulmonary artery systolic pressure (PASP) and diastolic pressure (PADP) showed strong correlations with PCWP (PASP, r=0.738, p<0.001; PADP, r=0.834, p<0.001; RAP, r=0.638, p<0.001, respectively). CONCLUSIONS Discordance exists between right- and left-sided filling pressures in HFpEF. Physicians may utilize pulmonary artery pressure to evaluate left-sided filling pressure, which is a significant predictor of prognosis.

Simultaneous transcatheter aortic valve implantation and endovascular aneurysm repair in a patient with very severe aortic stenosis with abdominal aortic aneurysm

The safety of non-cardiac surgery is uncertain for asymptomatic patients with very severe aortic stenosis (AS). Herein, we describe a case involving an elderly and frail patient with asymptomatic, very severe AS. The patient was considered a high-risk candidate for aortic valve replacement (AVR); thus, transcatheter aortic valve implantation (TAVI) was planned. On perioperative examination, an abdominal aortic aneurysm (AAA) was observed, which required endovascular aneurysm repair (EVAR). To reduce the risks involved with sequential procedures, TAVI and EVAR were performed simultaneously. In patients with severe AS who are high-risk candidates for AVR, TAVI can be considered as an alternative therapy before non-cardiac surgery. In addition, the combined TAVI and EVAR procedure can reduce the risks associated with the perioperative period. <Learning objective: For patients with severe aortic stenosis who are high-risk candidates for aortic valve replacement (e.g. elderly patients with comorbidities), transcatheter aortic valve implantation (TAVI) can be considered as an alternative therapy before non-cardiac surgery. In addition, combining TAVI and endovascular aneurysm repair can reduce the perioperative risks compared with those for sequential procedures. However, additional research is needed.>.

Transcatheter aortic valve implantation in a patient with severe aortic valve stenosis, colon cancer, and obstructive ileus: A case report

An 82-year-old woman with symptomatic severe aortic stenosis (AS) developed an obstructive ileus caused by colon cancer. Colectomy was considered a high-risk surgery due to both the severe AS and obstructive ileus. Therefore, we planned placement of a colonic stent for the obstructive ileus. After stenting, we performed transcatheter aortic valve implantation (TAVI) instead of surgical aortic valve replacement (SAVR), because of the risk of bleeding during extracorporeal circulation and the perioperative risk of AVR (Society of Thoracic Surgery predicted risk of mortality: 7.4%). Successful colonic stenting and TAVI allowed a safer colectomy. The period from TAVI to colectomy was 12 days. TAVI could be useful for symptomatic severe AS in high-risk patients prior to non-cardiac surgery, especially for malignant tumors. <Learning objective: In patients with symptomatic severe aortic stenosis, aortic valve replacement is recommended prior to non-cardiac surgery. However, in patients with a malignancy, the complications due to the tumor and the risk of extracorporeal circulation remain a challenge in surgical aortic valve replacement. In such cases, transcatheter aortic valve implantation may be a useful option to reduce the incidence of complications and the time to surgery for the malignancy.>.

Efficacy of Pericardial Drainage in Annular Rupture and Periaortic Hematoma After Transcatheter Aortic Valve Replacement

Received January 30, 2018; revised manuscript received May 1, 2018; accepted May 17, 2018; released online June 22, 2018 Time for primary review: 21 days Division of Cardiology (T.T., K.Y., T.O., K.S., K.T.), Division of Cardiovascular Surgery (A.O., S.M.), Division of Anesthesia (M.Y.), Mitsui Memorial Hospital, Tokyo, Japan Mailing address: Kazuyuki Yahagi, MD, Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo 101-8643, Japan. E-mail: yyahakazu@gmail.com ISSN-1346-9843 All rights are reserved to the Japanese Circulation Society. For permissions, please e-mail: cj@j-circ.or.jp Efficacy of Pericardial Drainage in Annular Rupture and Periaortic Hematoma After Transcatheter Aortic Valve Replacement

ELEVATED RIGHT SIDED HEART PRESSURE IS ASSOCIATED WITH MALNUTRITION IN HEART FAILURE PATIENTS WITH REDUCED EJECTION FRACTION

Background: In heart failure (HF) patients, malnutrition was investigated to be related to altered intestinal function, which could be caused by bowel edema and hypoperfusion. However, relationships between malnutrition and hemodynamic parameters have not been fully elucidated. Methods: We

IMPACT OF LESION CORONARY CALCIUM SCORE ON OUTCOMES FOLLOWING EVEROLIMUS-ELUTING STENT IMPLANTATION

Previous studies have reported that calcified lesions have worse outcomes following percutaneous coronary intervention, but the evaluation of coronary calcium was often qualitative and not quantitative. Computed tomography enabled us to quantitatively analyze coronary calcium. We sought to elucidate