Relationship between patent foramen ovale anatomical features and residual shunt after patent foramen ovale closure.

Transcatheter closure of patent foramen ovale (PFO) is an effective strategy for preventing recurrence of paradoxical embolism. However, PFO closure is often associated with residual shunt, which is a risk of recurrent stroke. This study aimed to evaluate the relationship between the anatomical features of PFO and residual shunt. The degree of residual shunt and its relationship with the anatomical features of PFO were evaluated in 106 patients who underwent PFO closure at our institution between March 2011 and January 2022 and in whom contrast transthoracic echocardiography was performed 1 year later. The mean PFO tunnel length was 9.3 ± 3.6 mm and the mean PFO height was 3.2 ± 2.2 mm. Atrial septal aneurysm (ASA) was found in 37 patients. After PFO closure, residual shunt was observed in 28 patients (grade 1, n = 8; grade 2, n = 16; grade 3, n = 3; grade 4, n = 1). Univariate logistic analysis identified ASA to be associated with residual shunt (odds ratio 2.78, 95% confidence interval 1.14 to 6.79; p = 0.024). There was no association of residual shunt with the size of the PFO, the length of PFO tunnel, or the size of the device used for closure. Two of four patients with a large residual shunt of grade 3 or grade 4 were found to have device size mismatch. Residual shunt after PFO closure was observed in a quarter of patients and was related to the presence of ASA. A few patients had a large residual shunt due to the device size mismatch.

Efficacy of shear wave elasticity for predicting clinical outcomes in patients with significant tricuspid regurgitation.

This study aimed to evaluate the efficacy of shear wave (SW) elasticity for assessing clinical outcomes in patients with significant tricuspid regurgitation (TR). Significant TR develops right heart failure (HF) with organ congestion, resulting in adverse outcomes, but appropriate therapeutic strategies remain unclear. The assessment of the degree of hepatic congestion using SW elasticity may be effective for determining therapeutic strategies. We prospectively enrolled 77 patients with moderate or severe TR who underwent SW elastography. Patients were divided into three groups according to the value of SW elasticity: low group (SW elasticity < 6.4 kPa, n = 26), medium group (6.4 ≤ SW elasticity < 9.5 kPa, n = 26), and high group (SW elasticity ≥ 9.5 kPa, n = 25). The endpoint was cardiovascular death or hospitalization for HF. During the median follow-up period of 17 months (range 7-39 months), cardiovascular death or hospitalization for HF occurred in seven patients of high group, in three patients of medium group, and in no patients of low group. In high group, three patients died and seven patients were hospitalized for HF. In medium group, two patients died and one patient was hospitalized. Kaplan-Meier analysis showed that the event-free survival rate was worse in high group than in other groups (log-rank test, p = 0.02). High SW elasticity was independently related to cardiac events as well as right ventricular and left ventricular dysfunction. SW elasticity was a predictor of cardiac events in patients with significant TR by assessing hepatic congestion. SW elasticity can be valuable for determining therapeutic strategies for TR.

The Association of Postprandial Triglyceride Variability with Renal Dysfunction and Microalbuminuria in Patients with Type 2 Diabetic Mellitus: A Retrospective and Observational Study.

OBJECTIVE: We examined whether or not day-to-day variations in lipid profiles, especially triglyceride (TG) variability, were associated with the exacerbation of diabetic kidney disease. METHODS: We conducted a retrospective and observational study. First, 527 patients with type 2 diabetes mellitus (DM) who had had their estimated glomerular filtration rate (eGFR) checked every 6 months since 2012 for over 5 years were registered. Variability in postprandial TG was determined using the standard deviation (SD), SD adjusted (Adj-SD) for the number of measurements, and maximum minus minimum difference (MMD) during the first three years of follow-up. The endpoint was a ≥40% decline from baseline in the eGFR, initiation of dialysis or death. Next, 181 patients who had no micro- or macroalbuminuria in February 2013 were selected from among the 527 patients for an analysis. The endpoint was the incidence of microalbuminuria, initiation of dialysis, or death. RESULTS: Among the 527 participants, 110 reached a ≥40% decline from baseline in the eGFR or death. The renal survival was lower in the higher-SD, higher-Adj-SD, and higher-MMD groups than in the lower-SD, lower-Adj-SD, and lower-MMD groups, respectively (log-rank test p = 0.0073, 0.0059, and 0.0195, respectively). A lower SD, lower Adj-SD, and lower MMD were significantly associated with the renal survival in the adjusted model (hazard ratio, 1.62, 1.66, 1.59; 95% confidence intervals, 1.05-2.53, 1.08-2.58, 1.04-2.47, respectively). Next, among 181 participants, 108 developed microalbuminuria or death. The nonincidence of microalbuminuria was lower in the higher-SD, higher-Adj-SD, and higher-MMD groups than in the lower-SD, lower-Adj-SD, and lower-MMD groups, respectively (log-rank test p = 0.0241, 0.0352, and 0.0474, respectively). CONCLUSIONS: Postprandial TG variability is a novel risk factor for eGFR decline and the incidence of microalbuminuria in patients with type 2 DM.

Assessment of congestion and clinical outcomes in patients with chronic heart failure using shear wave elasticity.

AIMS: The relief of congestion is essential for the prevention of worsening heart failure (HF) resulting in hospitalizations. Assessment of the degree of organ congestion in the chronic phase of HF is important for determining therapeutic strategies. The aim of this study was to evaluate the efficacy of shear wave (SW) elasticity for assessing congestion and clinical outcomes in patients with chronic HF. METHODS AND RESULTS: We prospectively enrolled 345 consecutive patients with chronic HF who underwent SW elastography at outpatient clinic. Patients were divided into two groups according to the median value of SW elasticity: low group (SW elasticity <6.4 kPa, n = 176) and high group (SW elasticity ≥6.4 kPa, n = 169). The endpoint was cardiovascular death or hospitalization for HF. During the median follow-up period of 19 months (range: 7-36 months), cardiovascular death or hospitalization for HF occurred in 4 patients of low group and 27 patients of high group. In high group, 8 patients died, and 19 patients were hospitalized for HF. In low group, 3 patients died, and 1 patient was hospitalized. Kaplan-Meier analysis showed that the event-free survival rate was worse in high group than in low group (log-rank test, P = 0.004). After adjusting for variables, high SW elasticity was independently related to cardiac events. In multivariate regression analysis, SW elasticity was correlated with left atrial volume index, early diastolic mitral inflow velocity to mitral annular velocity ratio, and inferior vena cava diameter. CONCLUSIONS: The SW elasticity reflected haemodynamic congestion in patients with chronic HF, which was related to cardiac events.

Total vascular resistance, augmentation index, and augmentation pressure increase in patients with peripheral artery disease.

ABSTRACT: Peripheral arterial disease (PAD) is one of major vascular diseases which frequently coexists with coronary arterial disease and cerebrovascular disease. The patients with PAD have a poor prognosis when it progresses. A new blood pressure testing device enables to simultaneously measure brachial blood pressure (BP), central BP, and several vascular parameters, with easy and non-invasive, in a short time. Here, we aimed to evaluate these arterial stiffness parameters in patients with PAD.In this study, 243 consecutive patients who were suspected of having PAD and referred to our hospital from September 2016 to June 2019, were registered. Several parameters, such as brachial BP, central BP, aortic pulse wave velocity (aPWV), total vascular resistance (TVR), augmentation index (AI) and augmentation pressure (AP), were determined by Mobil-O-Graph. Ankle-brachial pressure index (ABI) was used to define PAD (ABI ≤ 0.9 as PAD). The relationship between PAD and central BP, aPWV, TVR, AI, or AP were investigated.One hundred sixty-two patients (67%) were categorized as the PAD group and 81 patients (33%) as the non-PAD group. In the PAD group, the systolic brachial BP and central systolic BP were significantly higher than those in the non-PAD group (138 ±â€Š24 mmHg vs 131 ±â€Š19 mmHg, P < .05, 125 ±â€Š22 mmHg vs 119 ±â€Š18 mmHg, P < .05, respectively). TVR, AI, and AP were significantly higher in the PAD group (1785 ±â€Š379 dyn s/cm5 vs 1661 ±â€Š317 dyn s/cm5, P < .05, 26.2 ±â€Š13.0% vs 22.2 ±â€Š13.3%, P < .05, 13.5 ±â€Š9.4 mmHg vs 10.7 ±â€Š7.2 mmHg, P < .05, respectively). No significant differences in diastolic BP, central diastolic BP, and aPWV were found between the groups. Multivariate logistic regression analysis revealed that PAD was significantly associated with TVR, AI, and AP (P < .05, respectively).TVR/AP/AI were significantly higher in the PAD group than in the non-PAD group.

The Protective Effect of Chlorogenic Acid on Vascular Senescence via the Nrf2/HO-1 Pathway.

The world faces the serious problem of aging. In this study, we aimed to investigate the effect of chlorogenic acid (CGA) on vascular senescence. C57/BL6 female mice that were 14 ± 3 months old were infused with either Angiotensin II (AngII) or saline subcutaneously for two weeks. These mice were administered CGA of 20 or 40 mg/kg/day, or saline via oral gavage. AngII infusion developed vascular senescence, which was confirmed by senescence associated-ß-galactosidase (SA-ß-gal) staining. CGA administration attenuated vascular senescence in a dose-dependent manner, in association with the increase of Sirtuin 1 (Sirt1) and endothelial nitric oxide synthase (eNOS), and with the decrease of p-Akt, PAI-1, p53, and p21. In an in vitro study, with or without pre-treatment of CGA, Human Umbilical Vein Endothelial Cells (HUVECs) were stimulated with H2O2 for an hour, then cultured in the absence or presence of 0.5-5.0 µM CGA for the indicated time. Endothelial cell senescence was induced by H2O2, which was attenuated by CGA treatment. Pre-treatment of CGA increased Nrf2 in HUVECs. After H2O2 treatment, translocation of Nrf2 into the nucleus and the subsequent increase of Heme Oxygenase-1 (HO-1) were observed earlier in CGA-treated cells. Furthermore, the HO-1 inhibitor canceled the beneficial effect of CGA on vascular senescence in mice. In conclusion, CGA exerts a beneficial effect on vascular senescence, which is at least partly dependent on the Nuclear factor erythroid 2-factor 2 (Nrf2)/HO-1 pathway.

Increase in prefrontal cortex blood flow during the computer version trail making test.

BACKGROUND/AIMS: Previous studies using near-infrared spectroscopy (NIRS) have reported increases in both oxygenated hemoglobin (oxyHb) and deoxygenated hemoglobin (deoxyHb) during the paper version Trail Making Test (TMT), a neuropsychological test for evaluating cognitive and executive functions. We measured oxyHb and deoxyHb in the prefrontal cortex during the computer version TMT. METHODS: Fifteen healthy students first performed TMT-A and then TMT-B; another 7 students first performed TMT-B and then TMT-A. The mean concentrations of Hb (10 s before TMT, during TMT and 30-40 s after TMT) were determined and analyzed by ANOVA. RESULTS: oxyHb increased while deoxyHb decreased during the TMT. There was a significant order effect on the change in deoxyHb, but not in oxyHb. oxyHb significantly increased in the bilateral prefrontal cortices both in TMT-A and TMT-B. The increase tended to be more prominent in TMT-B than in TMT-A. deoxyHb significantly decreased in the bilateral prefrontal cortices, both in TMT-A and TMT-B. CONCLUSION: The results suggest that blood flow increases in the prefrontal cortex during the performance of TMT, and that the bilateral prefrontal cortices are involved in the performance of the computer version TMT.