In-hospital outcomes and usage of embolic protection devices in percutaneous coronary intervention for coronary artery bypass grafts: Insights from a Japanese nationwide registry.

OBJECTIVES: We evaluated the in-hospital outcomes of percutaneous coronary intervention (PCI) for bypass graft vessels (GV-PCI) compared with those of PCI for native vessels (NV-PCI) using data from the Japanese nationwide coronary intervention registry. METHODS: We included PCI patients (N = 748,229) registered between January 2016 and December 2018 from 1,123 centers. We divided patients into three groups: GV-PCI (n = 2,745); NV-PCI with a prior coronary artery bypass graft (pCABG) (n = 23,932); and NV-PCI without pCABG (n = 721,552). RESULTS: GV-PCI implementation was low, and most cases of PCI in pCABG patients were performed in native vessels (89.7%) in contemporary Japanese practice. The risk profile of patients with pCABG was higher than that of those without pCABG. Consequently, GV-PCI patients had a significantly higher in-hospital mortality than NV-PCI patients without pCABG after adjusting for covariates (odds ratio [OR] 2.36, 95% confidence interval [CI] 1.66-3.36, p < .001). Of note, embolic protection devices (EPDs) were used in 18% (n = 383) of PCIs for saphenous vein grafts (SVG-PCI) with a significant variation in its use among institutions (number of PCI: hospitals that had never used an EPD vs. EPD used one or more times = 240 vs. 345, p < .001). The EPDs used in the SVG-PCI group had a significantly lower prevalence of the slow-flow phenomenon after adjusting for covariates (OR 0.45, 95% CI 0.21-0.91, p = .04). CONCLUSION: GV-PCI is associated with an increased risk of in-hospital mortality. EDP use in SVG-PCI was associated with a low rate of the slow-flow phenomenon. The usage of EPDs during SVG-PCI is low, with a significant variation among institutions.

[Hip Fracture Repair with Concomitant Transcatheter Aortic Valve Implantation;Report of a Case].

The incidences of hip fracture and aortic valve stenosis are increasing in the aging population. Operative repair for hip fracture contributes to excellent clinical results. Transcatheter aortic valve implantation, which does not require cardiopulmonary bypass, represents a new era for the treatment of aortic valve stenosis. We herein describe a patient with both hip fracture and severe aortic valve stenosis. A 93-year-old woman underwent transcatheter aortic valve implantation for the valve stenosis immediately followed by open repair surgery for the fracture. She fully recovered without heart failure during the postoperative rehabilitation period. The performance of concomitant surgeries for hip fracture and aortic valve stenosis might increase in the future.

The incidence of slow flow after rotational atherectomy of calcified coronary arteries: A randomized study of low speed versus high speed.

OBJECTIVES: The purpose of this randomized trial was to compare the incidence of slow flow between low-speed and high-speed rotational atherectomy (RA) of calcified coronary lesions. BACKGROUND: Preclinical studies suggest that slow flow is less frequently observed with low-speed than high-speed RA because of less platelet aggregation with low-speed RA. METHODS: This was a prospective, randomized, single center study. A total of 100 patients with calcified coronary lesions were enrolled and randomly assigned in a 1:1 ratio to low-speed (140,000 rpm) or high-speed (190,000 rpm) RA. The primary endpoint was the occurrence of slow flow following RA. Slow flow was defined as slow or absent distal runoff (Thrombolysis in Myocardial Infarction [TIMI] flow grade ≤ 2). RESULTS: The incidence of slow flow in the low-speed group (24%) was the same as that in the high-speed group (24%) (P = 1.00; odds ratio, 1.00; 95% confidence interval, 0.40-2.50). The frequencies of TIMI 3, TIMI 2, TIMI 1, and TIMI 0 flow grades were similar between the low-speed (TIMI 3, 76%; TIMI 2, 14%; TIMI 1, 8%; TIMI 0, 2%) and high-speed (TIMI 3, 76%; TIMI 2, 14%; TIMI 1, 10%; TIMI 0, 0%) groups (P = 0.77 for trend). The incidence of periprocedural myocardial infarction was the same between the low-speed (6%) and high-speed (6%) groups (P = 1.00). CONCLUSIONS: This randomized trial did not show a reduction in the incidence of slow flow following low-speed RA as compared with high-speed RA (UMIN ID: UMIN000015702). © 2016 Wiley Periodicals, Inc.

Incidence and Determinants of Complications in Rotational Atherectomy: Insights From the National Clinical Data (J-PCI Registry).

BACKGROUND: The usage of rotational atherectomy (RA) is growing in the current percutaneous coronary intervention (PCI) because of the expansion of PCI indication to more complex lesions. However, the complications after RA have been linked to procedure-related morbidity and mortality. The purpose of this study was to investigate the incidence and determinants of complications in RA using a large nationwide registration system in Japan (J-PCI). METHODS AND RESULTS: The primary composite outcome of this study was defined as the occurrence of in-hospital death, cardiac tamponade, and emergent surgery after RA. A total of 13 335 RA cases (3.2% of registered PCI cases) were analyzed. The composite outcome was observed in 175 cases (1.31%) and included 80 in-hospital deaths (0.60%), 86 tamponades (0.64%), and 24 emergent surgeries (0.18%). The clinical variables associated with occurrence of the composite outcome were age (odds ratio [OR] 1.03 per unit increment, 95% confidence interval [CI] 1.02-1.05), impaired kidney function (OR 1.59, 95% CI 1.15-2.19), previous myocardial infarction (OR 1.69, 95% CI 1.21-2.35), emergent PCI (OR 4.02, 95% CI 1.66-8.27), and triple-vessel disease (versus single-vessel disease: OR 2.17, 95% CI 1.43-3.28). Notably, institutional volume of RA cases was inversely associated with the composite outcomes (high- versus low-volume institution: OR 0.56, 95% CI 0.36-0.89). CONCLUSIONS: The reported incidence of important procedure-related complication rate was 1.3%, with each component ranging between 0.2% and 0.6% in J-PCI. Its determinants were both patient related (age, impaired kidney function, and previous myocardial infarction) and procedure related (emergent procedures, number of diseased vessels, and institutional volume of RA).

Determinants of Left Ventricular Systolic Function Improvement Following Coronary Artery Revascularization in Heart Failure Patients With Reduced Ejection Fraction (HFrEF).

Revascularization therapy such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) should be considered for heart failure with reduced ejection fraction (HFrEF). However, revascularization therapy does not always improve left ventricular ejection fraction (LVEF). The purpose of this study was to investigate the determinants of LVEF improvement following revascularization in HFrEF patients. From 2,229 consecutive decompensated heart failure patients, a total of 47 HFrEF patients who underwent revascularization were included in the analysis. Improvement of LVEF was defined as [(LVEF during chronic phase) - (LVEF during acute phase)] ≥ 10%. Univariate and multivariate logistic regression analyses were applied to investigate the determinants of LVEF improvement. The prevalence of revascularization by PCIs including chronic total occlusion (CTO) was significantly greater in the improved EF group (45.0%) as compared to the non-improved EF group (11.1%) (P = 0.02). Multivariate logistic regression analysis revealed that revascularization by PCIs including CTO was the significant determinant of the LVEF improvement after adjusting for confounding factors (OR 5.43, 95% CI 1.06-27.74, P = 0.04). Optimal medical therapy (angiotensin-converting enzyme (ACE) inhibitor and/or angiotensin II receptor blocker (ARB) and beta-blockers) was less frequently prescribed in patients with CABG (50.0% for ACE inhibitor and/or ARB and 41.7% for beta-blocker) than in patients without CABG (94.3% for both) (P < 0.01 and P < 0.001, respectively). In conclusion, revascularization by PCIs including CTO was the significant determinant of LVEF improvement in HFrEF patients. Our results underscore the importance of optimal medical therapy even if patients receive complete revascularization such as CABG.

Predictors of prolonged fluoroscopy time in diagnostic coronary angiography.

BACKGROUND: Prolonged fluoroscopy time during coronary angiography is a major concern for interventional cardiologists as well as for patients. It is unknown which factors affect the prolonged fluoroscopy time. METHODS: A total of 458 patients who underwent diagnostic coronary angiography were included. The patients who had the highest decile of fluoroscopy time were assigned to the prolonged fluoroscopy group (fluoroscopy time ≥15.7min), while the other patients were assigned to the non-prolonged fluoroscopy group (fluoroscopy time <15.7min). We performed univariate and multivariate logistic regression analysis to identify the predictors of prolonged fluoroscopy time. RESULTS: Mean fluoroscopy time in 458 patients was 8.5±5.8min. Median and ranges of fluoroscopy time were 19.0 [15.7-47.0]min in the prolonged fluoroscopy group and 6.0 [2.0-15.3]min in the non-prolonged fluoroscopy group, respectively. The multivariate logistic regression analysis showed that significant predictors of prolonged fluoroscopy time were prior surgery of ascending aorta replacement [odds ratios (OR) 11.46, 95% confidence intervals (CI) 1.53-85.74, p=0.02] and the prevalence of moderate to severe aortic regurgitation (OR 2.83, 95% CI 1.20-6.66, p=0.02). CONCLUSIONS: The prior surgery of ascending aorta replacement and moderate to severe aortic regurgitation were significant predictors of the prolonged fluoroscopy time.

Ruptured saphenous vein graft pseudoaneurysm successfully treated with covered stents.

Saphenous vein graft (SVG) pseudoaneurysms are rare complications following coronary bypass graft surgery. A 46-year-old man presented with streptococcal infectious endocarditis and needed sequential operations for aortic root reconstruction. Shortly after the surgeries, a composite SVG on the right coronary artery developed a ruptured pseudoaneurysm, which was successfully treated using covered stents.

Clinical features of myocardial infarction in young Japanese patients.

Clinical features and outcomes of acute myocardial infarction (AMI) in the young have been poorly investigated. The aim of this study was to investigate the clinical features and hospital outcomes of AMI in young Japanese. We conducted a case-control study. A total of 53 consecutive AMI patients whose age was ≤ 45 years old were assigned to the young group and 106 AMI patients whose age was > 45 years old were assigned to the non-young group. We compared the clinical features and hospital outcomes between the two groups. Compared with the non-young group, the young group was associated with male sex, hyperlipidemia, current smoking, being overweight, single vessel disease, and Killip class I on admission. There were no differences in the length of hospital stay or major adverse cardiac events between the groups. However, mortality and ventricular rupture were slightly lower in the young. In conclusion, young AMI patients had clinical characteristics different to those of the non-young patients. Compared to non-young patients, modifiable risk factors such as smoking, hyperlipidemia, and being overweight were associated with young AMI patients.

Fractional flow reserve for a mild stenosis on the donor artery to chronic total occlusion.

Fractional flow reserve (FFR) is considered as the gold standard for physiological assessment of coronary artery stenosis. However, it may be difficult to interpret FFR for the stenosis of the donor artery of chronic total occlusion (CTO), because revascularization of CTO may improve FFR of the donor artery. We present a case of 32-year-old male who had a CTO in right coronary artery (RCA), 90% stenoses in left circumflex artery (LCx) and a mild stenosis in the middle segment of left anterior descending artery (LAD). FFR for the mild stenosis in LAD showed significant value (0.72). However LAD was the donor artery to CTO of RCA, revascularization to RCA was expected to improve FFR for LAD. As the patient had chronic granulocytic leukemia and the difficulty in continuing dual antiplatelet therapy, we selected coronary artery bypass grafting (CABG) to RCA and LCx, and we decided not to perform anastomosis to LAD. Although each graft was patent and collateral flow from LAD to RCA disappeared after CABG, FFR for LAD was still 0.72. Careful consideration should be given when interpreting FFR for the donor artery to a CTO lesion. When CABG is selected, it may be a practical approach to revascularize not only CTO but also FFR positive mild stenosis simultaneously, even though it appears angiographically mild stenosis.

Beta-blocker use is not associated with slow flow during rotational atherectomy.

OBJECTIVES: The purpose of this study was to investigate the association between beta-blocker use and slow flow during rotational atherectomy (RA). BACKGROUND: RA is often performed as part of percutaneous coronary interventions for the treatment of calcified lesions; however, the procedure can be complicated by slow flow. Previous reports suggested that the use of beta-blockers was associated with slow flow during RA. METHODS: A total of 186 patients who received RA were included, and 87 patients were on beta-blockers. The occurrence of slow flow was compared between the beta-blocker group (n = 87) and the non-beta-blocker group (n = 99). Multivariate logistic regression analysis was performed to investigate whether the use of beta-blockers was associated with slow flow. RESULTS: The occurrence of slow flow was not different between the beta-blocker group (29.9%) and the non-beta-blocker group (24.2%; P=.39). The use of beta-blockers was not significantly associated with slow flow (odds ratio, 0.75; 95% confidence interval, 0.34-1.68; P=.49) after controlling for all potential confounding factors. CONCLUSIONS: There was no definitive association between slow flow and the use of beta-blockers during RA. There is no need to discontinue beta-blockers in patients receiving RA.

Comparison of long-term clinical outcomes between sirolimus-eluting stents and paclitaxel-eluting stents following rotational atherectomy.

Rotational atherectomy (RA) can facilitate smooth stent delivery and stent expansion through lesion modification for a calcified coronary lesion. Several studies reported that sirolimus-eluting stent (SES) implantation following RA showed a lower rate of revascularization compared with bare-metal stents (BMS). However, there are limited data that compared the clinical outcomes between SES and paclitaxel-eluting stents (PES) after RA. We compared the long-term clinical outcomes of SES and PES following RA. Two hundred and thirty-three consecutive patients (SES n = 179, PES n = 54) who were treated with SES or PES following RA between 10th September 2004 and 13th April 2010 were investigated. Follow-up data for clinical outcomes were obtained in 91.4% of all subjects. The median follow-up period was 630 days (interquartile range, 300 to 1170 days) in the SES group, and 625 days (interquartile range, 285 to 900 days) in the PES group. Clinical outcomes including target lesion revascularization (TLR) (SES 4.9% versus PES 9.8%, P = 0.31), target vessel revascularization (TVR) (SES 6.8% versus PES 11.8%, P = 0.25), and major adverse cardiac events (MACE) (SES 14.8% versus PES 13.7%, P = 0.8) were not statistically different between the groups. The unadjusted cumulative event rates estimated by the Kaplan-Meier method and the log-rank test showed no significant differences between the two groups for time to event for TLR, cardiovascular death, all-cause death, or MACE. In conclusion, there was no significant difference in the long-term clinical outcomes between SES and PES following RA.

Association of CD40 ligand levels in the culprit coronary arteries with subsequent prognosis of acute myocardial infarction.

OBJECTIVE: CD40 ligand (CD40L) plays a crucial role in atherogenesis and plaque destabilization. The purpose of this study was to clarify the association of CD40L levels in the culprit coronary arteries (CA) with the subsequent cardiovascular events in patients with acute myocardial infarction (AMI). METHODS: We enrolled 68 patients with AMI whose CA were treated using thrombectomy devices. Blood samples were collected from the peripheral veins (PV), the ascending aortae (AO) and CA. RESULTS: CD40L levels in the CA were significantly greater than those in the PV and AO. Statistical analyses revealed that CD40L levels in CA correlated positively with the corrected TIMI frame counts and maximal serum creatine kinase-MB in throughout clinical course, and inversely with myocardial blush grade and left ventricular ejection fraction 6 months after AMI. In logistic regression analyses, the group with high CD40L levels in CA was associated with an 8.58-fold increase in the odds of a cardiovascular event rate compared with the group with low CD40L levels. CONCLUSIONS: In patients with AMI, enhanced CD40L levels in CA might affect myocardial perfusion, myocardial damage, and subsequent cardiovascular events, and could be a predictive marker for the prognosis of AMI.

Clinical features of early recurrent myocardial infarction.

Recurrence of myocardial infarction, especially when occurring early after the prior one, carries a significant morbidity and mortality rate. The aim of this study was to investigate the characteristics of patients who experienced recurrence under secondary prevention therapy. Case record review identified myocardial infarction patients who had a history of previous myocardial infarction within 5 years. Hospital chart records, initial laboratory data, medications, and type of infarction were reviewed. Patients were divided into two groups according to the interval of recurrence: an early group (recurrence within 1 year), and a late group (recurrence after more than 1 year). A total of 89 patients were included in the analysis; 40 patients in the early group, and 49 patients in the late group. Mean age in the early group and late groups was 67.3 +/- 11.9 and 59.4 +/- 8.9, respectively (P = 0.001). Mean body mass index in the early and late groups was 22.1 +/- 3.6 and 25.0 +/- 3.3, respectively (P < 0.001). There were fewer current smokers in the early group (7.5% vs 44.9%, P < 0.001) and more stent thrombosis (17.5% vs 2%, P = 0.02), as compared with the late group. The in-hospital mortality rate tended to be higher in the early group (7.5% vs 0%, P = 0.09). Multiple logistic regression revealed that smoking status (odds ratio [OR] 0.09, 95% confidence interval [CI] 0.02-0.49, P = 0.005), HDL cholesterol level (5 mg/dl increase: OR 1.34, 95% CI 1.04-1.74, P = 0.03), and stent thrombosis (OR 35.59, 95% CI 2.13-595.49, P = 0.01) had significant associations with early recurrence. Early recurrence of myocardial infarction was associated with stent thrombosis, a higher HDL cholesterol level, and a lower frequency of smoking. Early recurrence had a trend toward higher mortality than late recurrence.

Plaque characteristics of the coronary segment proximal to the culprit lesion in stable and unstable patients.

BACKGROUND: Identifying vulnerable plaque is important for preventing an acute coronary event. The present study examined the relationship between the clinical presentation of coronary artery disease and the plaque characteristics of nonculprit segment assessed by virtual histology intravascular ultrasound (VH-IVUS). METHOD: We performed VH-IVUS analysis on nonculprit segments with < 50% diameter stenosis in 91 patients (48 acute coronary syndrome [ACS] patients, 43 stable angina [SA] patients). RESULTS: ACS patients showed significantly higher ratio of dense calcium (7.9% +/- 1.0% versus 5.0% +/- 0.9%, p = 0.03) and necrotic core plaque (13.7% +/- 1.1% versus 8.6% +/- 1.1%, p = 0.001) compared with SA patients. VH-IVUS-derived thin-cap fibroatheroma (VH-TCFA) was more frequently observed in ACS patients compared with SA patients (64.6% versus 35.7%, p = 0.006). Among ACS patients, plasma high sensitivity C-reactive protein (hs-CRP) levels were significantly higher in patients with VH-TCFA than in patients without VH-TCFA (7.9 +/- 2.6 mg/l versus 1.6 +/- 0.3 mg/l, p = 0.004). CONCLUSION: ACS patients presented higher prevalence of VH-TCFA in nonculprit segment. Presence of VH-TCFA was associated with an increased level of plasma hs-CRP in ACS patients.

Elevation of plasma placental growth factor in the patients with ischemic cardiomyopathy.

BACKGROUND: Placental growth factor (PlGF), which is a member of the vascular endothelial growth factor family, stimulates angiogenesis and collateral growth in ischemic tissues. In addition, PlGF has been known to be a useful biomarker of vascular inflammation. This study was undertaken to examine whether plasma PlGF levels were increased in patients with congestive heart failure (CHF). METHODS: Ninety-eight patients with systolic heart failure (ejection fraction <40%) and twenty control subjects were enrolled. The patients were divided into four subgroups according to the criteria of NYHA functional class. Plasma PlGF, tumor necrosis factor (TNF)-alpha, brain natriuretic peptide (BNP), norepinephrine, high-sensitive C-reactive protein (hs-CRP) were determined. RESULTS: In analysis of all the subjects, there was no significant difference in plasma PlGF levels among the subgroups of NYHA classes and the controls. In the ischemic cardiomyopathy (ICM) patients, however, plasma PlGF levels were significantly increased according to the severity of NYHA class; control: 8.9+/-0.5; NYHA I: 9.4+/-1.1, NYHA II: 9.7+/-1.9, NYHA III: 14.6+/-1.2, NYHA IV: 17.9+/-1.9 pg/ml (p=0.0006). Plasma PlGF levels correlated positively with BNP (r=0.53, p=0.0003) and hs-CRP (r=0.23, p=0.02) in the ICM patients, whereas there was not any correlation between plasma PlGF levels and other variable values in the non-ICM patients. CONCLUSIONS: In the ICM patients, plasma PlGF levels are increased according to the severity of heart failure. These results may indicate that augmented release of PlGF is involved in the pathogenesis of cardiomyopathy derived from chronic myocardial ischemia.

Pathophysiological role of aquaporin-2 in impaired water excretion.

In a state of chronic arginine vasopressin (AVP)-induced antidiuresis, the antidiuretic efficacy has been attenuated: a phenomenon known as "AVP escape". We compared the experimental SIADH rats with 1-deamino-8-D-AVP (dDAVP)-excess rats. The SIADH rats, but not the dDAVP-excess rats, showed a marked attenuation of urinary concentrating ability. This is closely associated with diminished up-regulation of aquaporin-2 (AQP-2) mRNA and protein expression. The following in vitro study clarified tonicity-response elements in the 5'-flanking region of AQP-2 gene. There are at least more than two hypertonicity-response elements, and a hypotonicity-response element resided at tonicity-response enhancer (TonE) (-570 to -560bp) in the AQP-2 gene. Hypotonicity directly reduced the cAMP-induced AQP-2 promoter activity by mediating JNK kinase. Reduction in transcriptional regulation of AQP-2 under hypotonic state may support the in vivo finding of AVP escape phenomenon in chronic AVP-induced antidiuresis.

Determinants of in-hospital death and rupture in patients with a Stanford B aortic dissection.

BACKGROUND: In Stanford B acute aortic dissection (AAD), medical treatment is the choice of therapy in the acute phase, however, a portion of patients experience complications caused by serious clinical outcomes including aortic rupture and abdominal visceral ischemia. The objective of this study was to determine the predictors of in-hospital events in an Asian cohort of Stanford type B AAD. METHODS AND RESULTS: Hospital records were queried to identify patients that met following criteria: (1) AAD presenting within 14 days of symptom onset; and (2) computed tomography (CT) confirmation of a dissected descending aorta not involving the ascending aorta. An in-hospital event was defined as death, rupture/impending rupture, or organ malperfusion. Patient characteristics, inflammatory markers, and CT findings were obtained from clinical case records and retrospectively analyzed. Two hundred and twenty patients with Stanford B AAD were identified. In-hospital events occurred in 15 patients (there were 8 deaths, and 5 patients need to undergo emergent surgery because of impending rupture or rupture, and 4 patients experienced organ malperfusion). In univariate logistic regression analysis, the non-thrombosed type (odds ratio (OR) 3.88, 95% confidence interval (CI) 1.20-12.61, p=0.02) and maximum aortic diameter measured by an initial CT (each having a 5 mm increment: OR 1.61, 95% CI 1.20-2.15, p=0.001) were significant predictors of in-hospital events. In multiple logistic regression analysis, the only significant predictor was maximum aortic diameter measured by an initial CT (each having a 5 mm increment: OR 1.41, 95% CI 1.04-1.92, p=0.03). CONCLUSION: The results identified a large maximum aortic diameter as the independent predictor of in-hospital events in Stanford type B AAD. The non-thrombosed type might also help differentiate high-risk patients.

Association of hyperadiponectinemia with severity of ventricular dysfunction in congestive heart failure.

BACKGROUND: Adiponectin, which is a collagen-like plasma protein produced by adipose tissue, has anti-atherogenic and anti-inflammatory effects. Plasma adiponectin levels in patients with congestive heart failure (CHF) were determined, as well as relationships between the plasma levels of adiponectin and other hormones. METHODS AND RESULTS: The study group comprised 90 patients with CHF and 20 control subjects, who were divided into 4 subgroups according to New York Heart Association (NYHA) functional class. Plasma levels of adiponectin, tumor necrosis factor (TNF)-alpha and brain natriuretic peptide (BNP) and cardiac hemodynamics were determined. Plasma adiponectin levels were significantly increased according to the severity of NYHA class in the patients with CHF; control: 6.2+/-1.0; NYHA I: 8.5+/-1.9, NYHA II: 12.0+/-2.2, NYHA III: 13.0+/-2.7, NYHA IV: 14.9+/-2.7 microg/ml (p=0.0008). Similarly, plasma BNP levels were significantly increased in accordance with the NYHA class. Plasma adiponectin levels correlated positively with BNP (r=0.40, p=0.0002) and TNF-alpha (r=0.49, p=0.0001), and correlated negatively with cardiac index (r=-0.27, p=0.05). In 24 of 46 patients in the NYHA III and IV subgroups, according to the prompt improvement in cardiac function, levels of both plasma adiponectin and BNP were significantly reduced (p<0.0001). CONCLUSION: Plasma adiponectin levels increased according to the severity of CHF and, moreover, they correlated with the plasma levels of BNP and TNF-alpha. These results indicate that augmented release of adiponectin is involved in the pathogenesis of CHF and further study is needed to elucidate its exact role.