Relation of risk factors with response to carvedilol in heart failure with preserved ejection fraction - a report from the Japanese Diastolic Heart Failure Study (J-DHF).

BACKGROUND: The Japanese Diastolic Heart Failure Study (J-DHF) has suggested beneficial effects of the standard-dose prescription of carvedilol in heart failure with preserved ejection fraction (HFPEF). However, it is unclear whether any risk factors modulate the effects of the standard-dose carvedilol. METHODS AND RESULTS: Data from 245 patients with HFPEF in J-DHF were evaluated. Decreased body mass index, diabetes mellitus, and left atrial (LA) dilatation were independent risk factors for both of the primary outcomes (cardiovascular death and unplanned hospitalization for heart failure) and another major composite outcome (cardiovascular death and unplanned hospitalization for any cardiovascular causes) in multivariable analysis. In patients with LA diameter≥the median value (43.2mm), standard-dose carvedilol was associated with unadjusted hazard ratio (HR) 0.263 [95% confidence interval (CI): 0.080-0.859] and covariate adjusted 0.264 (0.080-0.876) for the primary outcome. In those with LA diameter<43.2mm, unadjusted and adjusted HRs were 1.123 (0.501-2.514) and 1.067 (0.472-2.412). A p-value for interaction was 0.046 (unadjusted) and 0.058 (adjusted). The similar effects of LA diameter were observed regarding another major composite outcome. The other risk factors in univariate or multivariable analyses did not influence the response to the standard-dose carvedilol. CONCLUSIONS: The standard-dose carvedilol may exert greater reduction of the incidence of clinical outcomes in the patients with HFPEF and advanced rather than mild diastolic dysfunction.

Brugada-type electrocardiogram in a patient with hypothyroidism.

We encountered a case of hypothyroidism showing Brugada-type electrocardiogram (ECG). A 52-year-old man was referred to our hospital in August 2009. Past medical history showed that liver dysfunction and face edema of unknown origin had been pointed out 1 year earlier. He was diagnosed with primary hypothyroidism at this admission. ECG exhibited first-degree atrio-ventricular block (0.24 s) and showed Brugada-type ST-segment elevation ≥2 mm followed by a negative T wave (coved type) in the V1, V2 leads. On genetic analysis, the patient demonstrated three common variants in the SCN5A gene, L1988R (c.5963 T>G), H558R (c.1673 A>G), and R1193Q (c.3578 G>A). Brugada-type ECG disappeared when the thyroid function normalized. We hypothesize that Brugada-type ECG in hypothyroidism is modified not only by a direct effect of thyroid hormone, but also due to SCN5A variants. Some SCN5A gene polymorphisms or mutations will induce changes on ECG when ion channels are affected by hypothyroidism.

Tricuspid valve stenosis related to subvalvular adhesion of pacemaker lead: a case report.

Endocardial pacemaker leads may cause tricuspid valve regurgitation, but only four cases of tricuspid stenosis without endocarditis have been reported. A 77-year-old woman had received three endocardial leads when aged 44, 57, and 72 years. One lead pushed up the septal leaflet of the tricuspid valve from below the valve, then adhered to the leaflet, and was positioned against the ventricular septum. Tricuspid valve stenosis and moderate regurgitation were separately detected by transthoracic echocardiography. The tricuspid valve orifice area was 0.93 cm2 at cardiac catheterization. An excessive loop of a ventricular lead, especially a subvalvular loop, can cause opening limitation of the tricuspid valve, and the entangling of the lead in the subvalvular structures can easily induce reactive fibrosis and adhesions.

An autopsy case of isolated eosinophilic coronary periarteritis: a limited form of Churg-Strauss syndrome or a new entity?

A 52-year-old man without a history of asthma or allergic diseases died of ventricular fibrillation early in the morning. His autopsy revealed no significant findings, except for a mild mural-thickening localized at the proximal region of the right coronary artery. Microscopic examination showed periarteritis with infiltration of numerous eosinophils in the adventitia. No significant vasculitis was found in any other organs. Based on the findings this seems to be the second reported case of isolated eosinophilic coronary periarteritis.