High Plasma Docosahexaenoic Acid Associated to Better Prognoses of Patients with Acute Decompensated Heart Failure with Preserved Ejection Fraction

The clinical relevance of polyunsaturated fatty acids (PUFAs) in heart failure remains unclear. The aim of this study was to investigate the association between PUFA levels and the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). This retrospective study included 140 hospitalized patients with acute decompensated HFpEF (median age 84.0 years, 42.9% men). The patients' nutritional status was assessed, using the geriatric nutritional risk index (GNRI), and their plasma levels of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), arachidonic acid (AA), and dihomo-gamma-linolenic acid (DGLA) were measured before discharge. The primary outcome was all-cause mortality. During a median follow-up of 23.3 months, the primary outcome occurred in 37 patients (26.4%). A Kaplan-Meier analysis showed that lower DHA and DGLA levels, but not EPA or AA levels, were significantly associated with an increase in all-cause death (log-rank; p < 0.001 and p = 0.040, respectively). A multivariate Cox regression analysis also revealed that DHA levels were significantly associated with the incidence of all-cause death (HR: 0.16, 95% CI: 0.06-0.44, p = 0.001), independent of the GNRI. Our results suggest that low plasma DHA levels may be a useful predictor of all-cause mortality and potential therapeutic target in patients with acute decompensated HFpEF

Effect of heart rate and myocardial contractile force on coronary resistance.

The effect of the heart rate and myocardial contractile force on the extravascular resistance to blood flow of the left anterior descending coronary artery (LAD) was evaluated in 15 mongrel dogs anesthetized with sodium pentobarbital. The LAD was maximally dilated by intracoronary infusion of adenosine, which precluded the influence of vasomotor tone. Increases in the heart rate and myocardial contractile force decreased coronary blood flow in the absence of a change in coronary perfusion pressure. The changes in mean coronary resistance showed a significant linear relationship to changes in developed tension. The changes in coronary resistance caused by varying the heart rate and contractile force were so small that a normal coronary vascular tree could easily compensate for the increase in resistance. However, it is supposed that with critical stenosis of the vascular tree even a small increase in resistance might cause deleterious effects on coronary blood flow.</p

Heterogeneous oxygen uptake of the left ventricle

Left ventricular contraction progresses from the apex to the base, and because the base has a large internal diameter than the apex, the workload of the left ventricular wall is greater at the base. However, many studies have revealed that the level of regional myocardial blood flow is the same in all areas of the left ventricle. This fact strongly suggests that oxygen metabolic levels differ along the long axis of the left ventricle. To clarify the differences in local oxygen metabolism of the left ventricle, regional myocardial oxygen uptake of the left ventricle was examined in the anesthetized open chest dog. Small polyethylene catheters were inserted into the veins of the lateral, the antero-basal, the mid-anterior and the apical wall of the left ventricle. Venous blood samples were collected anaerobically, and blood gases and oxygen saturation were analyzed as aortic blood. The regional myocardial oxygen uptake of the left ventricle was not homogeneous. It was higher at the base and lower at the apex indicating that the differences in the workload and oxygen demand of the left ventricular wall were met by different levels of oxygen extraction. With left atrial pacing, a small increase in myocardial oxygen demand was compensated for by increased myocardial blood flow without changes in regional oxygen extraction. In contrast, continuous intravenous infusion of isoproterenol increased both myocardial flow and regional oxygen extraction in the middle and apical wall, while the extraction of the lateral wall did not change. Differences in the extraction between each area became smaller with isoproterenol infusion, but the gradient of myocardial oxygen uptake still existed. These findings suggest that the basal area of the left ventricle has a smaller reserved capacity of oxygen extraction

A case of periarteritis nodosa with advanced A-V block and ventricular tachycardia

A case of periarteritis nodosa with advanced A-V block and ventricular tachycardia is reported. The patient was a 62-year-old man who was admitted to Ibara City Hospital because of leg pain and fever. Laboratory examinations and microscopic examination of biopsy sections of the soleus muscle revealed that he had periarteritis nodosa. His electro cardiogram (ECG) and chest X-ray films on admission were normal. Treatment with prednisolone resulted in relief of his complaints, and improved laboratory data. One year later the parient complained of fainting attacks, and an ECG indicated non-sustained ventricular tachycardia. Two months later, a I° A-V block with LBBB appeared, which progressed to complete A-V block within a month. Good results were achieved with ventricular pacing (VVI) in this patient

Impact of Chronic Kidney Disease on Left Main Coronary Artery Disease and Prognosis in Japanese Patients

Background: Renal insufficiency plays a critical role in the pathogenesis of ischemic heart disease. The aim of the present study was to investigate the prevalence of renal dysfunction and its impact on prognosis in patients with left main coronary artery disease (LMCAD) and stable angina pectoris. Methods and Results: A total of 626 consecutive patients with significant coronary artery stenosis were enrolled. Renal insufficiency was graded using estimated glomerular filtration rate (eGFR) before coronary angiography. Chronic kidney disease (CKD) was defined as eGFR = 60 ml.min(-1).1.73 m(-2) (P=0.03). The hazard ratio for a cardiovascular event was 9.54 (95% CI: 3.15-28.89, P= 60 ml.min(-1).1.73 m(-2). Conclusions: Renal insufficiency is a risk factor for LMCAD and predicts poor prognosis in Japanese patients