Widespread Down-Regulation of Cardiac Mitochondrial and Sarcomeric Genes in Patients With Sepsis.

OBJECTIVES: The mechanism(s) for septic cardiomyopathy in humans is not known. To address this, we measured messenger RNA alterations in hearts from patients who died from systemic sepsis, in comparison to changed messenger RNA expression in nonfailing and failing human hearts. DESIGN: Identification of genes with altered abundance in septic cardiomyopathy, ischemic heart disease, or dilated cardiomyopathy, in comparison to nonfailing hearts. SETTING: ICUs at Barnes-Jewish Hospital, St. Louis, MO. PATIENTS: Twenty sepsis patients, 11 ischemic heart disease, nine dilated cardiomyopathy, and 11 nonfailing donors. INTERVENTIONS: None other than those performed as part of patient care. MEASUREMENTS AND MAIN RESULTS: Messenger RNA expression levels for 198 mitochondrially localized energy production components, including Krebs cycle and electron transport genes, decreased by 43% ± 5% (mean ± SD). Messenger RNAs for nine genes responsible for sarcomere contraction and excitation-contraction coupling decreased by 43% ± 4% in septic hearts. Surprisingly, the alterations in messenger RNA levels in septic cardiomyopathy were both distinct from and more profound than changes in messenger RNA levels in the hearts of patients with end-stage heart failure. CONCLUSIONS: The expression profile of messenger RNAs in the heart of septic patients reveals striking decreases in expression levels of messenger RNAs that encode proteins involved in cardiac energy production and cardiac contractility and is distinct from that observed in patients with heart failure. Although speculative, the global nature of the decreases in messenger RNA expression for genes involved in cardiac energy production and contractility suggests that these changes may represent a short-term adaptive response of the heart in response to acute change in cardiovascular homeostasis.

Right ventricular septal pacing in patients with right bundle branch block.

BACKGROUND: Cardiac resynchronization therapy (CRT) has been shown to improve left ventricular (LV) function and exercise performance in patients with left bundle branch block. Patients with right bundle branch block (RBBB) do not have a similar positive response to standard CRT. We hypothesized that single site pacing of the right ventricular septum (RVS) near the proximal right bundle could restore more normal activation of the LV in RBBB patients. METHODS: 78 consecutive patients (56 M, 22 F) with baseline RBBB underwent pacemaker or ICD implantation. Leads were placed in the right atrium and RVS. RESULTS: Baseline QRS duration was 120-220 ms (mean QRSd = 147 ms). At the optimal AV delay, the fused QRSd was 56-160 ms (mean QRSd = 112 ms). The mean decrease in QRSd was 34 ± 20.4 ms (p<0.001). CONCLUSION: RVS pacing in patients with RBBB resulted in a marked decrease in QRS duration and often normalized the ECG.

Percutaneous Suture - Closure Device Used for Iatrogenic Carotid Artery Injury Management: Case Report and Review of Literature.

Accidental carotid artery injury is an uncommon but serious central venous catheter insertion complication. Hemostasis might not be readily achieved by manual compression; therefore, surgery or endovascular treatment remains the mainstay for accidental carotid artery injury. However, not all patients are suitable candidates for surgery.Vascular closure devices are widely used in femoral arteries to achieve hemostasis and early ambulation. The use of vascular closure devices is occasionally reported in other vascular beds. Here we present a case of an iatrogenic left common carotid artery injury treated by vascular closure device, which is of help in the future management of this complication.

Planned Robotic Chronic Total Occlusion Percutaneous Coronary Intervention: Feasibility Report.

BACKGROUND: Complex robotic percutaneous coronary intervention (R-PCI) is technically possible and leads to clinically comparable outcomes compared with the manual approach. However, there are limited data on the feasibility of chronic total occlusion (CTO) revascularization via the R-PCI approach. METHODS: Ten consecutive patients undergoing R-PCI for a coronary CTO at a single tertiary academic center were analyzed. The PRECISION, PRECISION GRX, and PROGRESS CTO registries were utilized for data collection with regard to procedural/clinical details and results. RESULTS: Technical success, defined as successful CTO revascularization with full or partial robotic support, occurred in 7 of 10 patients. There were no periprocedural major adverse cardiac events. Average J-CTO score was 2; all procedures were performed from an antegrade approach. The time from robotic wire manipulation to completion of procedure regardless of method averaged 55.1 minutes; average fluoroscopy time was 29.9 minutes. CONCLUSIONS: CTO revascularization via a robotic approach is feasible. Technical success may be best predicted by those patients with low J-CTO scores and lesions amenable to antegrade wire escalation technique. Given the potential benefits to both operators and patients, further research is warranted.

Use of the Ocelot catheter in iliac chronic total occlusion intervention.

PURPOSE: The optical-coherence tomography guided Ocelot catheter has previously been shown to be a safe and effective tool for crossing peripheral chronic total occlusions. However, the existing literature focuses mostly on the superficial femoral artery, without prior evidence of use within the suprainguinal vasculature. CASE SERIES: We present the first known cases of the Ocelot catheter for revascularization of chronic total occlusions in the iliac vasculature. In the first case a retrograde approach is used for intervention of the right common iliac artery, while in the second case an antegrade approach is used for revascularization of the left external iliac artery. CONCLUSIONS: In this case report we first demonstrate as proof of feasibility the use of the Ocelot catheter in suprainguinal artery chronic total occlusions.