Circulating sLR11 levels predict severity of pulmonary hypertension due to left heart disease.

BACKGROUND: Heart failure is a severe condition often involving pulmonary hypertension (PH). Soluble low-density lipoprotein receptor with 11 ligand-binding repeats (sLR11) has been associated with pulmonary artery hypertension. We examined whether sLR11 correlates with PH in left heart disease and can be used as a predictive marker. METHOD: We retrospectively analyzed patients with severe mitral regurgitation who underwent right heart catheterization before surgery for valve replacement or valvuloplasty from November 2005 to October 2012 at Juntendo University. We measured sLR11 levels before right heart catheterization and analyzed correlations with pulmonary hemodynamics. We compared prognoses between a group with normal sLR11 (≤9.4 ng/ml) and a group with high sLR11 (>9.4 ng/ml). Follow-up was continued for 5 years, with end points of hospitalization due to HF and death due to cardiovascular disease. RESULTS: Among 34 patients who met the inclusion criteria, sLR11 correlated with mean pulmonary artery pressure (r = 0.54, p<0.001), transpulmonary pressure gradient (r = 0.42, p = 0.012), pulmonary vascular resistance (r = 0.36, p<0.05), and log brain natriuretic peptide (BNP). However, logBNP did not correlate with pulmonary vascular resistance (p = 0.6). Levels of sLR11 were significantly higher in the 10 patients with PH (14.4±4.3 ng/ml) than in patients without PH (9.9±3.9 ng/ml; p = 0.002). At 5 years, the event rate was higher in the high-sLR11 group than in the normal-sLR11 group. The high-sLR11 group showed 5 hospitalizations due to HF (25.0%) and 2 deaths (10.0%), whereas the normal-sLR11 group showed no hospitalizations or deaths. Analyses using receiver operating characteristic curves showed a higher area under the concentration-time curve (AUC) for sLR11 level (AUC = 0.85; 95% confidence interval (CI) = 0.72-0.98) than for BNP (AUC = 0.80, 95%CI = 0.62-0.99) in the diagnosis of PH in left heart disease. CONCLUSIONS: Concentration of sLR11 is associated with severity of PH and offers a strong predictor of severe mitral regurgitation in patients after surgery.

[Chronic myeloid leukemia complicated by pulmonary hypertension during dasatinib therapy: a single-center retrospective study].

Pulmonary artery hypertension (PAH) has been reported to be a severe adverse event associated with dasatinib therapy. Among the 76 chronic myeloid patients who were treated with dasatinib at our hospital, six patients showed high estimated pulmonary arterial systolic pressure, as observed by echocardiography. PAH was confirmed using right heart catheterization in three (3.9%) patients with increased mean pulmonary artery pressure (mPAP). In one patient, although mPAP was higher than the normal range, it did not fulfill the criteria of pulmonary hypertension. After the discontinuation of dasatinib, BNP and dyspnea were improved in five patients. Therefore, it should be noted that dasatinib can cause PAH at higher rates than those reported previously, and if PAH is confirmed or suspected during dasatinib therapy, then dasatinib should be immediately discontinued.

Upper-extremity Deep Vein Thrombosis Complicating Apheresis in a Healthy Donor.

Venous thrombus was recognized in the upper extremity of a 53-year-old man after blood donation. The patient presented with a 15-day history of swelling in the left upper-extremity that started 6 hours after apheresis. Contrast-enhanced computed tomography revealed clots in the deep veins of the left arm and the peripheral pulmonary artery. Blood donation had proceeded smoothly, and the patient had no thrombotic predisposition, except for a smoking habit. The thrombus resolved following anticoagulant therapy, and the patient' s clinical course was uncomplicated. Despite a thorough investigation, the cause of this thrombus remains unknown.

Prognostic impact of chronic kidney disease on 10-year clinical outcomes among patients with acute coronary syndrome.

BACKGROUND: Chronic kidney disease (CKD) is closely associated with a higher risk of cardiovascular disease. However, whether patients with acute coronary syndrome (ACS) and CKD are at increased risk for long-term mortality after coronary revascularization remains unknown. METHODS AND RESULTS: Data from consecutive patients with ACS who had undergone coronary revascularization, including percutaneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) were analyzed. The estimated glomerular filtration rate (eGFR) was calculated using the current Japanese equation and CKD was defined as eGFR < 60 mL/min/1.73 m(2). Among 375 enrolled patients with ACS, 75 (20.0%) had CKD. During a follow-up period of 10.0 ± 3.4 years, the total number of deaths was 80 (21.3%), of which 36 (9.6%) were due to cardiovascular causes. Kaplan-Meier analysis showed that the presence of CKD was associated with a significant increase in mortality from all causes (log-rank test, p<0.001) and cardiovascular mortality (p<0.001). Cox proportional-hazard analysis revealed that CKD increased the risk of mortality with a hazard ratio of 2.31 (95% confidence interval (CI): 1.25-4.29, p=0.008) and of cardiovascular death with a hazard ratio of 3.76 (95% CI: 1.60-8.80, p=0.002) in patients with ACS. CONCLUSIONS: CKD is a powerful determinant of long-term all-cause and cardiovascular mortality after ACS.