Impact of renal insufficiency on long-term clinical outcome in patients with heart failure treated by cardiac resynchronization therapy

AbstractBackgroundRenal insufficiency is recognized as a predictor of mortality and adverse outcome in heart failure (HF) patients. However, the long-term clinical outcome of cardiac resynchronization therapy (CRT) in Japanese HF patients with renal insufficiency remains uncertain.MethodsWe evaluated 67 consecutive patients who underwent CRT at our hospital. The patients were divided into two groups according to a baseline estimated glomerular filtration rate (e-GFR) cut-off value of 50ml/min, which is defined as the time at which patients should be referred to a nephrologist, by the Japanese Society of Nephrology. Follow-up echocardiographic findings and renal function were examined at 3–6 months after CRT. Then, we compared long-term clinical outcomes between the two groups, and analyzed the effect of CRT on renal function, echocardiographic parameters and cardiac survival.ResultsDuring a mean follow-up period of 30.3 months, patients with advanced renal insufficiency (e-GFR<50ml/min) had significant higher all-cause mortality (log-rank p=0.033) and higher cardiac mortality combined with HF hospitalization (log-rank p=0.017) than patients with e-GFR≥50ml/min. Multivariate analysis revealed that advanced renal insufficiency was an independent predictor of cardiac mortality combined with HF hospitalization (odds ratio=3.01, p=0.008). Subgroup analysis in the baseline advanced renal insufficiency group revealed that patients with preserved renal function by CRT (<10% reduction in e-GFR) had a higher rate of decrease of left ventricular end-systolic diameter (−14.0% vs. −0.8%, p=0.023) and lower cardiac mortality combined with HF hospitalization (log-rank p=0.029) compared with patients with deterioration of renal function (≥10% reduction in e-GFR).ConclusionsThe present study suggests that advanced renal insufficiency is quite useful for the prediction of worsening clinical outcomes in HF patients treated by CRT. Preservation of renal function by CRT brings about better cardiac survival through prevention of adverse cardiac events, even in HF patients with advanced renal insufficiency

Changes of Sympathetic Activity in Patient with Chronic Atrial Fibrillation and Severe Congestive Heart Failure Treated with Biventricular Pacing

The patient was a 64-year-old man with chronic atrial fibrillation with bradycardia. Left ventricular ejection fraction was 34%. He was treated with biventricular pacing. Heart failure improved from NYHA class III to II. Sympathetic nerve activity (SNA. was recorded during 6 minutes of biventricular (BV), right ventricular apical (RVA. and left ventricular (LV. pacing. SNA was significantly lower during biventricular pacing (49.5 ± 4.0/min. compared with RVA (58.8 ±6:9/min, p = 0.016. and LV (63.3 ± 4.3/min, p = 0.002. pacing. BV pacing improves hemodynamics and decreases SNA compared with RVA or LV pacing

Rationale and Design of the Orencia Atherosclerosis and Rheumatoid Arthritis Study (ORACLE Arthritis Study): Implications of Biologics against Rheumatoid Arthritis and the Vascular Complications, Subclinical Atherosclerosis

To explore the biological and immunological basis of human rheumatoid arthritis and human atherosclerosis, we planned and reported a detailed design and rationale for Orencia Atherosclerosis and Rheumatoid Arthritis Study (ORACLE Arthritis Study) using highly sensitive, high-throughput, human autoantibody measurement methods with cell-free protein synthesis technologies. Our previous study revealed that subjects with atherosclerosis had various autoantibodies in their sera, and the titers of anti-Th2 cytokine antibodies were correlated with the severity of atherosclerosis. Because rheumatoid arthritis is a representative autoimmune disease, we hypothesized that both rheumatoid arthritis and atherosclerosis are commonly developed by autoantibody-mediated autoimmune processes, leading to incessant inflammatory changes in both articular joint tissues and vessel walls. We planned a detailed examination involving carotid artery ultrasonography, measurements of adhesion molecules, such as ICAM-1 (intercellular adhesion molecule 1) and VCAM-1 (vascular cell adhesion molecule 1) for the evaluation of atherosclerosis progression, and high-throughput, high-sensitivity, autoantibody analyses using cell-free technologies, with detailed examinations of the disease activity of rheumatoid arthritis. Analyses of correlations and associations between biological markers and degrees of carotid atherosclerosis over time under consistent conditions may enable us to understand the biological and humoral immunity background of human atherosclerosis and autoimmune diseases

Effects of dietary n-3/n-6 fatty acid content on post-operative adhesions in myocardial infarction mice

Summary: Background and aim: Adhesions after thoracic surgery led to more difficult sternal re-entry and surgical dissection, blunted visibility of mediastinal tissues, potential injury to cardiovascular structures, an increased risk of surgical bleeding, and more time-consuming procedures.Recent molecular and cell biology studies have shown that n-3 unsaturated fatty acids exert pleiotropic effects on vascular endothelial cells, inflammatory cells, and platelets, suppress lesion formation and plaque instability, prevent recurrence of vascular events and cardiac death in patients with ischemic heart disease. Since around 2010′, attention has been focused on the n-3 fatty acids and DHA of edible “seaweed oil” extracted from algae. However, no previous studies have reported how dietary containing marine algae oil and nutritional oral taking habits affect post-operative adhesions.The purpose of this study was to investigate the effects of diets with different n-3/n-6 fatty acid content on adhesions in thoracic cavity. Methods: Four-week-old mice were randomly divided into three groups and housed in separate cages. The groups of animals were continuously provided with three different diets for 1 month (the Control group (n=4), DHA-containing “marine algae oil” diet; the DHA group (n=4), the HF group (n=5)). MI model mice were induced by a trained animal surgical expert. After operation, evaluated items were 1) body weight, 2) echocardiography for cardiac function, and 3) adhesions. Evaluations of 1) and 2) were performed before MI preparation, 1 day, and 7 days after MI, and assessment of 3) was evaluated the adhesion at 7 days after MI. Results: The results were 1) there were no significant differences in body weight among the three groups, 2) cardiac function in the HF group tended to deteriorate, and on post-operative day 7, the DHA group tended to deteriorate less than the Control group and 3) adhesions tended to be worse in the HF group and mild in the DHA group. Conclusion: Adhesions tended to be the worst in the HF group and mild in the DHA group. The results in this study indicated that the type of diet affects adhesion levels following MI