Effect of biventricular pacing therapy in patients with dilated cardiomyopathy with severe congestive heart failure.

OBJECTIVES: Biventricular pacing (BVP) therapy has recently emerged as an effective treatment for patients with moderate to severe congestive heart failure (CHF) and ventricular asynchrony all over the world. However, this therapy is not yet available in Japan. We evaluated the effects of BVP in patients with severe CHF due to dilated cardiomyopathy (DCM). SUBJECTS: Four patients with medically refractory severe CHF due to DCM in New York Heart Association functional class III or IV heart failure underwent BVP therapy. We combined the implantation of the left ventricular (LV) epicardial lead via small thoracotomy following right atrial and ventricular intravenous leads under general anesthesia. We evaluated to determine whether improvements of ventricular function, ventricular size, mitral regurgitation, functional status, frequency of hospitalization, and quality of life were associated with BVP therapy. RESULTS: BVP improved LV systolic function, decreased LV size and mitral regurgitation, and shortened prolonged QRS interval. The patients' symptoms, exercise tolerance, frequency of hospitalization, and quality of life were also dramatically improved by BVP. Furthermore, combination of BVP and oral administration of amiodarone significantly prevented recurrence of ventricular tachycardia and paroxysmal atrial fibrillation, and maintained sinus rhythm for a long period. CONCLUSIONS: In view of these findings, BVP therapy may contribute to the development of new therapeutic method for patients with severe CHF due to DCM.

MRSA tricuspid valve infective endocarditis with multiple embolic lung abscesses treated by combination therapy of vancomycin, rifampicin, and sulfamethoxazole/trimethoprim.

A 26-year-old pregnant woman who was an intravenous drug user (IDU) was admitted to our hospital for the treatment of tricuspid valve infective endocarditis (IE) and lung abscesses due to methicillin-resistant Staphylococcus aureus (MRSA). We started to treat her with vancomycin (VCM) alone and then in combination with rifampicin (RFP), but her condition did not improve. Then we added sulfamethoxazole/trimethoprim (SMZ/TMP) to VCM and RFP. After that, she improved rapidly. In Japan, there are very few reports about tricuspid valve IE caused by MRSA in IDUs. This case suggests that the combination of VCM, RFP, and SMZ/TMP may be effective for the treatment of severe MRSA infections.

Mitral annulus displacement measured by tissue-tracking method with Doppler-tissue images is a useful marker of the severity of heart failure.

OBJECTIVES: This study investigated whether the measurement of mitral annulus displacement by the tissue-tracking method with Doppler-tissue images can provide more accurate information on the severity of heart failure compared to conventional methods, such as left ventricular ejection fraction (LVEF). BACKGROUND: Impaired left ventricular function is an important predictor of poor prognosis. Although LVEF has been used to assess left ventricular function, such indicators do not necessarily correlate well to clinical variables such as New York Heart Association (NYHA) functional class or plasma brain natriuretic peptide (BNP) concentration. METHODS: In 90 subjects with or without various heart diseases, mitral annulus displacement was measured by the tissue-tracking method with Doppler-tissue images and the correlations evaluated with NYHA functional class, plasma BNP concentration, left ventricular mass index and Tei index. RESULTS: Mitral annulus displacement by the tissue-tracking method with Doppler-tissue images was well correlated with NYHA functional class and plasma BNP concentration. LVEF was also correlated with these clinical variables, but significantly more weakly. Furthermore, mitral annulus displacement by the tissue-tracking method with Doppler-tissue images was correlated with left ventricular mass index and Tei index, which indicate left ventricular systolic and diastolic function. CONCLUSIONS: The present study suggests that mitral annulus displacement measured by our technique is a useful and reliable method for assessing the severity of heart failure.