Relationship between CHADS2 score and efficacy of antiarrhythmic drug therapy in patients with paroxysmal atrial fibrillation.

BACKGROUND: The Cardiac failure, Hypertension, Age, Diabetes, Stroke [Doubled] (CHADS(2)) score is a useful scheme for risk stratification of thromboembolism patients, but there is little information about its usefulness for the evaluation of antiarrhythmic drug (AAD) therapy. METHODS AND RESULTS: This study included 459 paroxysmal atrial fibrillation (AF) patients (309 men, mean age 66 ± 12 years, mean follow-up 50 ± 35 months) and prophylactic efficacy was analyzed on the basis of CHADS(2) score. (1) Survival rates free from AF recurrence at 1, 6, 12 and 24 months were, respectively, 89%, 74%, 63% and 47% in score-0 group (n=152); 92%, 68%, 59% and 48% in score-1 group (n=158); 86%, 64%, 56% and 46% in score-2 group (n=84); 81%, 65%, 51% and 35% in score-3 group (n=43); and 68%, 50%, 36% and 18% in ≥ score-4 group (n=22) (P<0.05; score-0, score-1 or score-2 vs. ≥ score-4 group). (2) Survival rates free from progression to chronic AF at 12, 36, 60 and 90 months were, respectively, 95%, 93%, 91% and 89% in score-0 group; 97%, 91%, 89% and 88% in score-1 group; 96%, 93%, 88% and 83% in score-2 group; 91%, 74%, 67% and 60% in score-3 group; and 91%, 82%, 68% and 55% in ≥ score-4 group (P<0.01; score-0, score-1 or score-2 vs. ≥ score-4 group). (3) In multivariate logistic regression analysis adjusted for potentially confounding variables, CHADS(2) score was associated with AF recurrence (odds ratio [OR] 1.45, 95% confidence interval [CI] 1.16-1.81, P<0.001), and progression to chronic AF during AAD therapy (OR 1.64, 95% CI 1.04-2.69, P<0.001). CONCLUSIONS: When using a rhythm control strategy, the CHADS(2) score is a useful scheme for predicting the outcome of AAD treatment of patients with paroxysmal AF.

Tsunami lung.

We encountered three cases of lung disorders caused by drowning in the recent large tsunami that struck following the Great East Japan Earthquake. All three were females, and two of them were old elderly. All segments of both lungs were involved in all the three patients, necessitating ICU admission and endotracheal intubation and mechanical ventilation. All three died within 3 weeks. In at least two cases, misswallowing of oil was suspected from the features noted at the time of the detection. Sputum culture for bacteria yielded isolation of Stenotrophomonas maltophilia, Legionella pneumophila, Burkholderia cepacia, and Pseudomonas aeruginosa. The cause of tsunami lung may be a combination of chemical induced pneumonia and bacterial pneumonia.

Percutaneous repair of systemic atrioventricular valve regurgitation with the MitraClip-NT system in congenitally corrected transposition of great arteries.

In a patient with congenitally corrected transposition of the great arteries, dilatation of the atrioventricular valve annulus related to worsening of systemic ventricular function, which worsened systemic atrioventricular valve (SAVV) functional regurgitation. In this article, we report a case of successful transcatheter treatment with MitraClip (Abbott Vascular, Santa Clara, CA, USA) in a 68-year-old female patient with congenitally corrected transposition of the great arteries and severe SAVV failure using imaging modalities. The patient had been hospitalized four times within 8 months, receiving optimal medical therapy for severe SAVV regurgitation and systemic ventricular failure. In this patient, the risk associated with surgery was considered extremely high owing to severe heart failure and liver cirrhosis. We positioned two clips appropriately, side by side, in between the anterior and septal leaflets, guided by computed tomography and three-dimensional echocardiography. The procedure resulted in optimal post-procedural reduction of regurgitation without stenosis, with a good clinical outcome noted at 2-year follow-up. Learning objective: Since surgery for adult congenital heart disease is linked to high risk, we seek less invasive treatment for such patients. In patients with congenital heart disease and severe valve regurgitation, the use of MitraClip (Abbott Vascular, Santa Clara, CA, USA) could be a feasible option for select cases.

Reliability of respiratory-triggered two-dimensional cine k-adaptive-t-autocalibrating reconstruction for Cartesian sampling for the assessment of biventricular volume and function in patients with repaired tetralogy of Fallot.

OBJECTIVE: To compare left ventricular (LV) and right ventricular (RV) volume, function, and image quality of a respiratory-triggered two-dimensional (2D)-cine k-adaptive-t-autocalibrating reconstruction for Cartesian sampling (2D kat-ARC) with those of the standard reference, namely, breath-hold 2D balanced steady-state free precession (2D SSFP), in patients with repaired tetralogy of Fallot (TOF). METHODS: 30 patients (14 males, mean age 32.2 ± 13.9 years) underwent cardiac magnetic resonance, and 2D kat-ARC and 2D SSFP images were acquired on short-axis view. Biventricular end-diastolic volume (EDV) and end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), and LV mass (LVM) were analysed. RESULTS: The 2D kat-ARC had significantly shorter scan time (35.2 ± 9.1 s vs 80.4 ± 16.7 s; p < 0.0001). Despite an analysis of image quality showed significant impairment using 2D kat-ARC compared to 2D SSFP cine (p < 0.0001), the two sequences demonstrated no significant difference in terms of biventricular EDV, LVESV, LVSV, LVEF, and LVM. However, the RVESV was overestimated for 2D kat-ARC compared with that for 2D SSFP (73.8 ± 43.2 ml vs 70.3 ± 44.5 ml, p = 0.0002) and the RVSV and RVEF were underestimated (RVSV = 46.2±20.5 ml vs 49.4 ± 20.4 ml, p = 0.0024; RVEF = 40.2±12.7% vs. 43.5±14.0%, p = 0.0002). CONCLUSION: Respiratory-triggered 2D kat-ARC cine is a reliable technique that could be used in the evaluation of LV volumes and function. ADVANCES IN KNOWLEDGE: 2D cine kat-ARC is a reliable technique for the assessment LV volume and function in patients with repaired TOF.

A case of suspected portal-pulmonary hypertension due to hepatitis C virus infection.

A 44-year-old woman with chronic hepatitis C virus (HCV) infection was referred by a primary care doctor and admitted to our hospital because of worsening dyspnea on exertion and right atrial and ventricular enlargement. The patient was diagnosed with pulmonary arterial hypertension (PAH) associated with portal hypertension induced by chronic HCV infection. This diagnosis was based on a cardiological examination and findings related to liver cirrhosis with portal hypertension. After the prescription of anti-PAH medicine and a slight improvement in her respiratory symptoms, 12-week direct-acting antiviral (DAA) treatment for HCV was started. Serum HCV RNA levels rapidly decreased and HCV elimination was confirmed 24 weeks after completing DAA treatment. Before confirmation of a sustained virological response at 24 weeks after completing DAA treatment, a remarkable improvement in her cardiac markers was found in a right heart catheter study. This study was performed 6 weeks after the end of DAA administration. Therefore, we considered that HCV infection was involved in the development of PAH and that elimination of HCV by interferon-free treatment was important for this patient.

Relationship between CHA(2)DS(2)-VASc scores and ischemic stroke/cardiovascular events in Japanese patients with paroxysmal atrial fibrillation not receiving anticoagulant therapy.

BACKGROUND AND METHODS: The CHA(2)DS(2)-VASc score has been newly proposed for stratifying patients with nonvalvular atrial fibrillation (AF) according to the risk of ischemic stroke in the 2010 European Society of Cardiology guideline. However, there is little information about its usefulness for predicting long-term prognosis of cardiovascular events in Japanese patients with paroxysmal AF. This study retrospectively included 332 paroxysmal AF patients (224 men, mean age 65±13 years, mean follow-up period 53±35 months) without receiving anticoagulant therapy between June 1995 and August 2008 who were categorized into risk stratification on the basis of CHA(2)DS(2)-VASc score. RESULTS: The distribution of CHA(2)DS(2)-VASc scores was 0, 1, 2, 3, 4, 5, 6, and 7 points in 76 (23%), 60 (18%), 69 (21%), 69 (21%), 28 (8%), 23 (7%), 6 (2%), and 1 (0.3%) patients, respectively. The annual rates of symptomatic ischemic stroke were 0%, 0.60%, 0.95%, 1.96%, 5.45%, 9.06%, and 13.7% when the CHA(2)DS(2)-VASc score was 0, 1, 2, 3, 4, 5, and ≥6 points, respectively (p<0.001) and those of cardiovascular events including hospitalization for thromboembolism, heart failure and cardiovascular death were 0%, 1.43%, 1.50%, 2.52%, 10.14%, 12.85%, and 17.13% when the CHA(2)DS(2)-VASc score was 0, 1, 2, 3, 4, 5 and ≥6 points, respectively (p<0.001). Higher CHA(2)DS(2)-VASc scores were associated with greater annual rates of ischemic stroke and cardiovascular events. In a multivariate logistic regression analysis adjusted for the potentially confounding variables, the CHA(2)DS(2)-VASc score was associated with symptomatic ischemic stroke (odds ratio 7.051, 95% confidence interval 3.76-13.22, p<0.001) and cardiovascular events (odds ratio 3.448, 95% confidence interval 2.33-5.11, p<0.001). CONCLUSION: In Japanese patients with paroxysmal AF, the CHA(2)DS(2)-VASc score is a useful scheme for risk stratification of ischemic stroke and cardiovascular events.

Cyclic compression loaded on cartilage explants enhances the production of reactive oxygen species.

OBJECTIVE: Although mechanical forces are an essential factor in the regulation of cartilage metabolism, the precise mechanisms involved have not yet been determined. We previously demonstrated that mechanical forces on chondrocytes inhibited proteoglycan (PG) synthesis. We also demonstrated the induction of reactive oxygen species (ROS) is loaded on the chondrocytes. Our purpose was to determine the ROS induction with mechanical compression and its involvement in PG synthesis of cartilage slices. METHODS: Bovine articular cartilage slices were subjected to cyclic compression loading. Synthesis of PG and ROS was measured using Na2[35S]-SO4 and a chemiluminescent probe, respectively. The induction of nitrotyrosine was determined using immunohistochemistry. RESULTS: The synthesis of PG was significantly inhibited with 2.0 MPa of compression stress; 1 h of compression was sufficient to inhibit PG synthesis. The ROS inhibitor ebselen reversed the compression-inhibited synthesis of PG. Compression on the cartilage induced synthesis of ROS and the expression of nitrotyrosine. CONCLUSION: Mechanical compression at 2.0 MPa inhibited PG synthesis by cartilage explants. ROS were involved in this action.