Impact of postconditioning with lactate-enriched blood on in-hospital outcomes of patients with ST-segment elevation myocardial infarction.

BACKGROUND: Reperfusion injury offsets the beneficial effects of reperfusion therapy for ST-segment elevation myocardial infarction (STEMI). In our previous reports, postconditioning with lactate-enriched blood (PCLeB) induced excellent microcirculation recovery and less inflammation in STEMI patients. This study aimed to determine the in-hospital outcomes of STEMI patients treated using PCLeB. METHODS: Fifty-five consecutive STEMI patients were treated using PCLeB (Age 66.6±13.8years, 76.4% men) within 12h of symptom onset. In our modified postconditioning protocol, the duration of each brief reperfusion was prolonged from 10s to 60s in a stepwise manner. Lactated Ringer's solution (20-30mL) was injected directly into the culprit coronary artery at the end of each brief reperfusion and the balloon was quickly inflated at the lesion site, whereby lactate could be trapped inside the ischemic myocardium. Each brief ischemic period lasted 60s. After 7cycles of balloon inflation and deflation, full reperfusion was performed. Thereafter, stenting was performed and percutaneous coronary intervention (PCI) was completed. RESULTS: The mean corrected thrombolysis in myocardial infarction frame count was 20.1±10.1 after PCI completion. The mean peak serum creatine kinase and creatine kinase-MB levels were 2751±2227IU/L and 276±181IU/L respectively. None of the study patients died during their hospital stay or required continuation of oral diuretic or inotropic therapy for heart failure on discharge. CONCLUSIONS: PCLeB led to zero in-hospital mortality and no overt heart failure on discharge in 55 consecutive STEMI patients undergoing reperfusion therapy.

A case of echocardiographic evaluation of ruptured pseudoaneurysm of the mitral-aortic intervalvular fibrosa by infective endocarditis.

This report describes an unusual case of ruptured pseudoaneurysm (PSA) of mitral-aortic intervalvular fibrosa (MAIVF) caused by infective endocarditis. The PSA ruptured into the left sinus of Valsalva in addition to the left atrium, resulting in complicated shunting among the aorta, left ventricle and left atrium, leading to refractory heart failure. The transesophageal echocardiography provided the precise information concerning the anatomical detail of the PSA, which is crucial for the surgical repair. This is the first report describing a patient with PSA of MAIVF with two rupture sites.

Brain natriuretic peptide response is heterogeneous during beta-blocker therapy for congestive heart failure.

BACKGROUND: Plasma brain natriuretic peptide (BNP) levels are useful marker to guide medical treatment in patients with congestive heart failure (CHF). We tested the hypothesis that the plasma BNP concentration would be a useful marker of beta-blocker therapy for CHF. METHODS AND RESULTS: Eighty-four patients with New York Heart Association class II-IV CHF and a left ventricular ejection fraction (LVEF) <40% were treated with beta-blockers, including metoprolol and carvedilol, for at least 16 weeks. End-diastolic and end-systolic dimensions decreased, and radionuclide LVEF increased 4 weeks after introduction of beta-blockers (early phase). LV end-diastolic and end-systolic dimensions both decreased, and LVEF increased 16 to 48 weeks after the therapy (late phase). However, the BNP concentration did not change during the observation period. Overall LV function improved in all 4 subgroups divided according to the baseline BNP levels. CONCLUSIONS: Plasma BNP concentration is not a sensitive marker of successful beta-blocker therapy for CHF.

Beta-blockers are effective in congestive heart failure patients with atrial fibrillation.

BACKGROUND: It is controversial whether or not beta-blockers are effective in patients with congestive heart failure (CHF) who are complicated by persistent atrial fibrillation (AF). METHODS: We attempted to determine the potential differences in the efficacy between atrial fibrillation and sinus rhythm in 70 CHF patients with NYHA class II-IV and radionuclide ejection fraction (LVEF) <40% who received metoprolol or carvedilol over 16 weeks. RESULTS: Left ventricular end-diastolic dimension was decreased in AF group (n=24) 4 weeks (early) and 16 to 48 weeks (late) after introduction of beta-blockers (P<.05, P<.001), but not in the sinus rhythm (NSR) group (n=46). End-systolic dimension was decreased in both the AF group (P<.01, P<.0001) and the NSR group (P<.01, P<.0001). LVEF was increased in both the AF group (P<.0005, P<.0001) and the NSR group (P<.0001, P<.0001) early and late after the therapy. Increase in LVEF by the therapy tended to be higher in the AF group than in the NSR group (P=.056). Plasma brain natriuretic peptide level did not change significantly throughout the observation period, although the level tended to be lowered in the AF group late after introduction of beta-blockers (P=.093). CONCLUSIONS: Because beta-blockers are effective in both NSR and AF patients with CHF, such a mode of therapy should be recommended in patients with AF.