Echocardiographic Assessment of Atrial Function: From Basic Mechanics to Specific Cardiac Diseases

The left and right atria serve as buffer chambers to control the flow of venous blood for ventricular filling. If an atrium is absent, blood does not flow effectively into the ventricle, leading to venous blood retention and low cardiac output. The importance of atrial function has become increasingly recognized, because left atrial (LA) function contributes to cardiac performance, and loss of LA function is associated with heart failure. LA volume change has been used for LA function assessment in experimental and clinical studies. In conjunction with LA pressure, the LA pressure–volume relationship provides a better understanding of LA mechanics. LA strain measurement by speckle tracking echocardiography was introduced to evaluate three components of LA function as a (booster) pump, reservoir and conduit. Furthermore, increasing evidence supports the theory that LA reservoir strain has prognostic utility in various cardiac diseases. In this review, we summarize LA contribution to maintain cardiac performance by evaluating LA function with echocardiography according to our experiences and previous reports. Furthermore, we discuss LA dysfunction in challenging cardiac diseases of cardiac amyloidosis and adult congenital heart disease

Post-resuscitation myocardial microcirculatory dysfunction is ameliorated with eptifibatide

The post-cardiac arrest syndrome includes a decline in myocardial microcirculation function. Inhibition of the platelet IIb/IIIa glycoprotein receptor has improved myocardial microvascular function post-percutaneous coronary intervention. Therefore, we evaluated such inhibition with eptifibatide for its effect on myocardial microcirculation function post-cardiac arrest and resuscitation

Inner nuclear membrane protein Lem2 augments heterochromatin formation in response to nutritional conditions

Inner nuclear membrane proteins interact with chromosomes in the nucleus and are important for chromosome activity. Lem2 and Man1 are conserved members of the LEM-domain nuclear membrane protein family. Mutations of LEM-domain proteins are associated with laminopathy, but their cellular functions remain unclear. Here, we report that Lem2 maintains genome stability in the fission yeast Schizosaccharomyces pombe. S.pombe cells disrupted for the lem2(+) gene (lem2) showed slow growth and increased rate of the minichromosome loss. These phenotypes were prominent in the rich culture medium, but not in the minimum medium. Centromeric heterochromatin formation was augmented upon transfer to the rich medium in wild-type cells. This augmentation of heterochromatin formation was impaired in lem2 cells. Notably, lem2 cells occasionally exhibited spontaneous duplication of genome sequences flanked by the long-terminal repeats of retrotransposons. The resulting duplication of the lnp1(+) gene, which encodes an endoplasmic reticulum membrane protein, suppressed lem2 phenotypes, whereas the lem2 lnp1 double mutant showed a severe growth defect. A combination of mutations in Lem2 and Bqt4, which encodes a nuclear membrane protein that anchors telomeres to the nuclear membrane, caused synthetic lethality. These genetic interactions imply that Lem2 cooperates with the nuclear membrane protein network to regulate genome stability

Heart failure as a strong independent predictor of delirium after pacemaker operations

Background: Postoperative delirium is a common and serious condition in the clinical setting that has been linked to increased mortality and worse outcomes. Some patients after pacemaker operations may suffer from delirium; however, this condition has not been clarified. The aim of this study was to investigate the prevalence and predictors of delirium after pacemaker operations such as initial permanent pacemaker implantation or pacemaker generator replacement. Methods: We retrospectively evaluated 192 consecutive patients who underwent pacemaker operations. According to the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) criteria, patients were divided into two groups: patients with delirium and patients without delirium after pacemaker operation. The two groups were compared in terms of patient characteristics, clinical settings, and environmental factors. Results: Forty patients (20.8%) suffered from delirium after pacemaker operations and were significantly older than patients without delirium (85.3 ± 6.4 years vs. 80.8 ± 8.4 years, p = 0.0014). Temporary pacing before permanent pacemaker implantation (30% vs. 11%, p = 0.0019) and intensive care unit admission (28% vs. 12%, p = 0.014) were more common in patients with delirium. Moreover, patients with delirium had more frequent heart failure than patients without delirium (78% vs. 41%, p < 0.0001). Multiple regression models showed heart failure as an independent predictor of delirium after pacemaker implantation. Conclusions: Delirium after pacemaker operations was not uncommon and heart failure was a strong independent predictor of such a condition

Senile diabetes mellitus complicated with celiac arterial obliteration and heaptocellular carinoma : A case report

We report a 75-year-old female with diabetes mellitus complicated with celiac arterial obliteration and hepatocellular cercinoma (HCC). She had been treated with diet therapy by her family doctor for essential hypertension and diabetes mellitus and was referred to our hospital because a space occupying lesion (SOL) was detected in the liver by abdominal CT examination. The SOL was confirmed as hepatocellular carcinoma by ultrasonography and magnetic resoance imaging. Celiac angiography revealed complete obliteration of the celiac artery probably due to diabetic macroangiopathy. Sine the deterioration of the liver function was not conspicuous, it was suggested that the development of HCC was affected by diabetes mellitus