[Early Postoperative Hemodynamics of Mitral Valvuloplasty Using Colvin-Galloway Future Band].

The Colvin-Galloway( CG) Future annuloplasty band is a new semirigid partial band, which was introduced in 2012 in Japan. A total of 60 consecutive patients who underwent mitral valve repair with the CG Future Band were assessed by echocardiography in terms of residual mitral regurgitation and diastolic mitral function postoperatively. Intraoperative 3-dimensional echocardiography beautifully demonstrated the physiological change of the aortic curtain during the cardiac cycle. 30 mm was used in 18 patients, 32 mm in 17, 28 mm in 15, 34 mm in 5, 36 mm in 2, and 26 mm in 2. There were 2 patients with mild residual mitral regurgitation and 58 patients with less than mild. The mean gradient of diastolic mitral pressure gradient was 2.8±1.3 mmHg. Early results of mitral valve repair with a CG Future Band were acceptable in terms of residual mitral regurgitation and diastolic mitral function after repair.

Cardiac tamponade as an independent condition affecting the relationship between the plasma B-type natriuretic peptide levels and cardiac function.

Plasma B-type natriuretic peptide (BNP) is finely regulated by the cardiac function and several extracardiac factors. Therefore, the relationship between the plasma BNP levels and the severity of heart failure sometimes seems inconsistent. The purpose of the present study was to investigate the plasma BNP levels in patients with cardiac tamponade and their changes after pericardial drainage. This study included 14 patients with cardiac tamponade who underwent pericardiocentesis. The cardiac tamponade was due to malignant diseases in 13 patients and uremia in 1 patient. The plasma BNP levels were measured before and 24-48 h after drainage. Although the patients reported severe symptoms of heart failure, their plasma BNP levels were only 71.2 ± 11.1 pg/ml before drainage. After appropriate drainage, the plasma BNP levels increased to 186.0 ± 22.5 pg/ml, which was significantly higher than that before drainage (P = 0.0002). In patients with cardiac tamponade, the plasma BNP levels were low, probably because of impaired ventricular stretching, and the levels significantly increased in response to the primary condition after drainage. This study demonstrates an additional condition that affects the relationship between the plasma BNP levels and cardiac function. If inconsistency is seen in the relationship between the plasma BNP levels and clinical signs of heart failure, the presence of cardiac tamponade should therefore be considered.

The clinical value of the apex beat as a marker of left atrial enlargement.

BACKGROUND: The palpation of the apex beat, one of the most fundamental physical examinations, provides a clue to left ventricular (LV) dilatation and hypertrophy; however, its relation to left atrial (LA) volume has rarely been investigated. METHODS: The clinical value of the apex beat, especially in relation to LA volume was studied in 138 consecutive patients. Patients were examined in the supine position for a palpable apex beat. When an apex beat was felt, the apex beat distance, defined as the distance from the mid-clavicular line to the lateral border of the apex beat, was measured. The LA and LV geometry were assessed using echocardiography. RESULTS: Of the 138 patients, an apex beat was palpable in 52 (38%) patients and the apex distance of these 52 patients ranged from -2 to 8 cm. The parameters of LV dilatation or hypertrophy were significant according to univariate but not to multivariate analysis. Only LA volume index was significant both for the palpability of the apex beat (p=0.0042) and the apex distance (p=0.0017) by multivariate analysis. The best cut-off point for the apex distance was -1 cm for LA enlargement (sensitivity 61%, specificity 92%, p<0.0001). CONCLUSIONS: The LA volume is the most significant factor for the palpability and leftward deviation of the apex beat. Palpation of the apex beat is a crucial diagnostic tool for the detection of not only LV dilatation or hypertrophy but also of LA enlargement.

Impact of alcohol intake on the relationships of uric acid with blood pressure and cardiac hypertrophy in essential hypertension.

BACKGROUND: Hyperuricemia, which is frequently associated with hypertension, can be caused by alcohol intake. To date, limited data have shown the link between alcohol intake and hyperuricemic hypertension. METHODS: We retrospectively examined the influence of alcohol intake on the relationship between the uric acid level and blood pressure or cardio-metabolic parameters in 171 untreated non-failing hypertensive patients (mean 59.3±10.7 years). Cross-sectional analysis was separately performed in regular alcohol drinkers (more than 25g/day ethanol, n=74, 82.4% men) and non-drinkers (n=97, 33.0% men). RESULTS: Diastolic blood pressure was significantly higher in drinkers than in non-drinkers (101.6±11.5mmHg vs. 96.8±8.2mmHg, p<0.01). Estimated glomerular filtration rate (80.4±14.7mL/min/1.73m2 vs. 80.0±17.8mL/min/1.73m2) and body mass index (BMI, 24.7±4.4kg/m2 vs. 24.8±4.2kg/m2) were similar in the two groups. In the drinker group, the uric acid level (mean 6.3±1.7mg/dL) was positively correlated with both systolic and diastolic blood pressures (r=0.270/p=0.020 and r=0.354/p=0.0020, respectively), and with the markers of cardiac hypertrophy, including electrocardiographic voltage (V1S+V5R, r=0.244/p=0.042) and echocardiographic left ventricular mass index (r=0.270/p=0.026). These correlations were also observed in the male drinker sub-group. In the non-drinkers, the uric acid level (mean 5.0±1.4mg/dL) was positively correlated with BMI (r=0.369/p=0.0002) but not with blood pressure or the markers of cardiac hypertrophy. CONCLUSIONS: The results suggest that the role of uric acid in blood pressure might differ between hypertensive drinkers and non-drinkers. In regular alcohol drinkers, there was a positive association of uric acid level with blood pressure and the severity of cardiac hypertrophy. In non-regular drinkers, an increased uric acid level is likely to be closely associated with increased BMI.