The purpose of this study was to evaluate the effect of decalcification and existence of stent at the aortic annulus on mitral annular motion after surgery. Patients receiving Inspiris (Edwards, CA, USA, n = 117), Intuity (Edwards, n = 36), Perceval (Corcym, London, UK, n = 36), Evolut (Medtronics, MN, USA, n = 81) and Sapien 3 (Edwards, n = 250) were included in the study. Mitral annular motion was evaluated by E’, using tissue doppler imaging. After surgery, a significant increase in E’ was observed in patients receiving Inspiris (Before: 4.2 ± 1.21 cm/s vs. Discharge: 5.0 ± 1.23 cm/s, p < 0.001). Mid-term echocardiogram performed at 11.8 ± 2.2 months after the surgery, showed a significant increase in E’ in patients receiving Inspiris (Before: 4.2 ± 1.21 cm/s vs. Mid-term: 5.2 ± 1.20 cm/s, p < 0.001) and Perceval (Before: 3.9 ± 1.34 cm/s vs. Mid-term: 4.5 ± 1.24 cm/s, p = 0.008). Univariable analysis showed a higher increase in E’ in patients with decalcified annulus compared to those without decalcified annulus (Decalcification: 0.15 ± 1.321 cm/s vs. No Decalcification: 0.66 ± 1.420 cm/s, p < 0.001). Multivariable analysis showed that balloon-expandable stent (β = − 0.6960, p < 0.001) and self-expanding stent (r = − 0.3592, p = 0.042) were independent limiting factors for an increase in E’ at discharge. However, balloon-expandable stent (β = − 0.8382, p < 0.001), and not self-expanding stent (β = − 0.3682, p = 0.089), was a remaining independent factor associated with E’ at mid-term follow-up. Decalcification was associated with improvement in E’ after surgery. Balloon-expandable stent was an independent limiting factor for improvement in E’ up to 1 year after the surgery, while self-expanding stent was not a significant factor after 1 year.

OBJECTIVE:The purpose of this study was to evaluate the changes in mitral annular motion after surgery in patients with aortic stenosis.METHODS:Patients receiving Edwards (Edwards) valves were included in the study. Echocardiographic findings were compared among the three treatments postoperatively, at discharge, and at 1 year after the surgery. Mitral annular motion was evaluated by e prime, using tissue doppler imaging.RESULTS:There were 111 patients receiving Inspiris, 30 patients receiving Intuity and 241 patients receiving Sapien 3. The patients receiving Sapien 3 were significantly older, (Inspiris: 71 ± 6.7 years vs. Intuity: 75 ± 5.2 years vs. Sapien 3: 84 ± 5.1 years, p < .001), and prevalence of hemodialysis were significantly higher in patients receiving Intuity (Inspiris: 11.7% vs. Intuity: 46.7% vs. Sapien 3: 0.0%, p < .001). There was a significant improvement in mean pressure gradient in all groups (Inspiris: 55 ± 21.2-13 ± 5.2 mmHg, p < .001; Intuity: 48 ± 17.6-12 ± 4.9 mmHg, p < .001, Sapien 3: 55 ± 16.6-14 ± 5.2 mmHg, p < .001). Decalcification was associated with increase in e prime after surgery (no decalcification: 0.10 ± 1.280 cm/s vs. decalcification: 0.68 ± 1.405 cm/s, p < .001) Further, existence of stent was associated with less increase in e prime after surgery (no stent: 0.83 ± 1.210 cm/s vs. stent: 0.10 ± 1.356; p < .001). Multivariate analysis showed that existence of stent but not decalcification of the aortic valve was independently associated with changes in e prime after surgery (β: -.4679, 95% confidence interval: -0.93389 to -0.00200, p = .049).CONCLUSIONS:Although improvement in pressure gradient was achieved in all treatments, existence of stent inhibited mitral annular motion after surgery.

Background Stent edge dissection (SED) is a well-known predictor of worse clinical outcomes. However, impact of SED after current-generation drug-eluting stent (DES) implantation remains unknown since there was no study using only current-generation DES to assess impact of SED. This study aimed to investigate a relationship between SED detected by optical coherence tomography (OCT) and clinical outcomes after current-generation DES implantation. Methods This study enrolled 175 patients receiving OCT after current-generation DES implantation. The SED group was compared with the non-SED group in terms of the primary study endpoints which was the cumulative incidence of major adverse cardiac event (MACE) composed of cardiac death, target vessel myocardial infarction (TV-MI), and clinically-driven target lesion revascularization (CD-TLR). Results Of 175 patients, SED detected by OCT was observed in 32 patients, while 143 patients did not show SED. In the crude population, the SED group showed a significantly higher incidence of CD-TLR, definite stent thrombosis, TV-MI and cardiac death relative to the non-SED group. After adjustment by an inverse probability weighted methods, the SED group showed a significantly higher incidence of MACE compared with the non-SED group (hazard ratio 3.43, 95% confidence interval 1.09-10.81, p = 0.035). Fibrocalcific or lipidic plaques, greater lumen eccentricity, and stent-oversizing were the predictors of SED. Conclusions SED detected by OCT after the current-generation DES implantation led to unfavorable outcomes. Aggressive post-dilatation around the stent edge might worse clinical outcomes due to SED, although achievement of optimal stent expansion is strongly encouraged to improve clinical outcomes.

The immune response after transcatheter aortic valve implantation (TAVI) in comparison to that after surgical aortic valve replacement (SAVR) remains to be fully elucidated. In a 2-part study, we assessed laboratory data obtained before, immediately after, and 24 and 48 hours after SAVR (128 patients; age ≥80 [mean 82] years) or transfemoral TAVI (102 patients; age ≥80 [mean 86] years) performed for aortic stenosis. In-hospital mortalities were similar (3% vs 0%), but leukocyte counts and aspartate aminotransferase and creatine kinas concentrations were decreased immediately and 24 hours after surgery (all, p <0.001). We performed cytokine profiling in a SAVR group (11 patients; mean age, 77 years) and transfemoral TAVI group (12 patients; mean age, 84 years). By measuring normalized concentrations of 71 cytokines at 3 time points, we found a significant difference (defined as fold change >1.7 and p <0.05 [by Mann-Whitney U-test]) in 23 cytokines. The differentially expressed cytokines fell into 3 hierarchical clusters: cluster A (high increase after SAVR and suppressed increase after TAVI only immediately after surgery [CCL2, CCL4, and 2 others]), cluster B (high increase after SAVR and suppressed increase after TAVI at 2 time points [IL-1Ra, IL-6, IL-8, IL-10, and 5 others]), and cluster C (various patterns [TRAIL, CCL11, and 8 others]). Gene enrichment analysis identified multiple pathways associated with the inflammatory responses in SAVR and altered responses in TAVI, including cellular responses to tumor necrosis factor (p = 0.0035) and interleukin-1 (p = 0.0062). In conclusion, a robust inflammatory response follows SAVR, and a comparatively attenuated response follows TAVI.

Background: A low eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio is known to be associated with cardiovascular events. However, the relationship between the EPA/AA ratio and coronary plaque vulnerability assessed by optical coherence tomography (OCT) has not been examined thoroughly. This study examined the relationship between the EPA/AA ratio and coronary plaque vulnerability assessed by OCT in patients with acute coronary syndrome (ACS).Methods: We evaluated 59 ACS patients who had undergone percutaneous coronary intervention using OCT. We divided them into 2 groups according to OCT findings-those with and without thin-cap fibroatheroma (TCFA)-and compared the EPA/AA ratio between the groups.Results: We identified 32 and 27 patients with and without TCFA, respectively. The EPA/AA ratio was significantly lower in patients with TCFA than in those without TCFA [0.35, interquartile range (0.21-0.44) vs. 0.54, interquartile range (0.42-0.70); p < 0.001]. In multivariate logistic regression analysis, the EPA/AA ratio was an independent predictor of TCFA (odds ratio, 0.09; 95% confidence interval, 0.007-0.99; p = 0.049). The EPA/AA ratio and fibrous cap thickness showed a significant positive correlation (Spearman rho = 0.46; p < 0.001). Furthermore, receiver operating characteristic curve analysis showed that an EPA/AA ratio < 0.46 could predict TCFA (81.3%, sensitivity; 74.1%, specificity).Conclusions: A low serum EPA/AA ratio is significantly associated with coronary plaque vulnerability assessed by OCT in ACS patients. (C) 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Percutaneous extracorporeal life support (ECLA) is effective for the patients with cardiogenic shock or fatal arrhythmia due to fulminant myocarditis. The purpose of this study was to elucidate the prognostic factor in patients with fulminant myocarditis supported by ECLA. Twenty-two consecutive patients with fulminant myocarditis supported by ECLA between 1999 and 2013 were enrolled. Survival to discharge was 59% (13 patients), and in-hospital mortality was 41% (9 patients). The age in Survivor group was significantly lower than that in Non-Survivor group (36.5 ± 4.1 vs. 60.2 ± 5.0 years, p=0.001). Although ECLA support duration was similar between two groups (181 ± 22 vs. 177 ± 31 hrs), the rate of complication related to ECLA was significantly lower in Survivor group (15.3 vs. 66.6 %, p=0.02). In comparison of laboratory data during ECLA support, serum direct-bilirubin at day 7 was significantly lower in Survivor group (2.2 ± 0.5 vs. 9.8 ± 4.5 mg/dl, p=0.009). Fulminant myocarditis still carries high mortality rates in spite of ECLA support. High age and complication related to ECLA are associated with poor prognosis. Serum direct-bilirubin during clinical course might be helpful to determine the treatment strategy.

Re-hospitalization in patient with acute decompensated heart failure (ADHF) is well-known as a clinically important problem in terms of prognosis of heart failure. However, there are few reports about determinants of re-hospitalization of ADHF. We investigated 252 patients with ADHF admitted to our institute in 2012, and analyzed re-hospitalization event within 1 year and the factors concerning with re-hospitalization of unexpected cardiovascular event. The total rate of re-hospitalization is 39.3%. There were significant some differences between re-hospitalization group and non-re-hospitalization group (Table). The determinant of re-admission was CTR of chest X -ray on admission in multivariate analysis. Further study is warranted including parameters of social background, medical compliance, or self-control in determinants of re-hospitalization in patients of ADHF.Tabled 1Re-admissionSingle admissionPTotal No.61153Hospital stay23.9 ± 19.622.2 ± 17.80.38Age71.5 ± 13.668.5 ± 15.00.43Male42 (68.9%)102 (66.7%)0.87Hypertension32 (52.5%)91 (59.5%)0.36Diabetes mellitus24 (39.3%)58 (37.9%)0.88Dyslipidemia24 (39.3%)51 (33.3%)0.43on HD1 (1.6%)5 (3.3%)1Cerebral vascular disease14 (23.0%)20 (13.1%)0.097COPD0 (0%)4 (2.6%)0.58OMI20 (32.8%)32 (20.9%)0.078Atrial fibrillation29 (47.55)51 (33.3%)0.062HR (bpm)90.7 ± 27.585.8 ± 27.40.19SBP (mmHg)116.3 ± 28.4127.8 ± 30.80.002BMI22.7 ± 4.123.8 ± 5.00.24Hb (g/dL)12.1 ± 2.212.7± 2.20.076Cr (mg/dL)1.2 ± 0.61.3 ± 1.00.325Na (mEq/l)136.9 ±4 .9136.8 ± 14.90.045BNP (pg/dl)981.9 ± 1075.7866.5 ± 916.30.24UA (mg/dl)7.7 + 2.97.3± 2.20.328Dd (mm)62.0 ± 15.662.1 ± 27.40.585Ds (mm)49.9 ± 17.748.0 ± 16.20.542EF (%)41.0 ± 17.943.5 ± 18.20.448TR pressure gradient (mmHg)33.6 ± 15.128.8 ± 14.20.019LA (mm)53.2 ± 11.649.5 ± 10.30.09Cardio-thoracic ratio (%)63.1 ± 7.858.2 ± 7.10.006 Open table in a new tab