Influence of Obstructive Sleep Apnea on Diastolic Heart Failure

Heart failure is frequently complicated by obstructive sleep apnea, which raises blood pressure and arrhythmiaand worsens prognosis. However, the incidence and influence of obstructive sleep apnea in patientswith diastolic heart failure is unknown. We hypothesized that patients with diastolic heart failurecomplicated by obstructive sleep apnea may have a worse outcome compared to those without obstructivesleep apnea. The study included 49 patients with an ejection fraction ≥ 50 %, of whom 34 had diastolic heartfailure and 15 did not have diastolic heart failure. The patients were examined in a sleep study and byechocardiography. Brain natriuretic peptide (BNP) levels were determined at admission and 1, 6 and 12months thereafter. The prevalence of obstructive sleep apnea in patients with diastolic heart failure( 18/34,53 %) was significantly higher than that in those without diastolic heart failure (3/15, 20 %)(p=0.032).BNP levels were high at admission in patients with diastolic heart failure, but then decreased gradually inthose without obstructive sleep apnea. However, BNP in patients with diastolic heart failure and obstructivesleep apnea remained high and was significantly elevated compared to the level in patients without obstructivesleep apnea at 6 and 12 months after admission. Patients with diastolic heart failure and obstructivesleep apnea showed prolongation of elevated BNP, indicating that complication of diastolic heart failure byobstructive sleep apnea may aggravate cardiac function

Transcatheter aortic valve-in-surgical aortic valve for a patient with repeated healed endocarditis: a case report

Abstract Background Transcatheter valve replacement is contraindicated in patients with active infective endocarditis. However, few reports suggest that it could be beneficial for high-risk surgical patients with healed infective endocarditis. Here, we report a case of a surgical transcatheter aortic valve in a patient with healed repeated prosthetic valve endocarditis using a stentless valve. Case presentation A 79-year-old female who underwent the Bentall procedure using a stentless valve and coronary artery bypass grafting for annuloaortic ectasia 22 years ago was hospitalized for stage II bioprosthetic valve failure. The patient had a history of prosthetic valve endocarditis three times: the first and second prosthetic valve endocarditis occurred 15 years ago, and the third prosthetic valve endocarditis occurred 3 years ago. The causative organisms were Campylobacter fetus and Enterococcus faecalis. With appropriate antibiotic therapy, the lesion was localized and healed completely without valve destruction; however, the patient developed rapid aortic regurgitation. Based on a review of the patient’s history of prosthetic valve endocarditis, the absence of signs of infection, and clinical findings of transesophageal echocardiography and computed tomography, a diagnosis of structural valve deterioration with healed infective endocarditis was made. Subsequently, a transcatheter aortic valve in a surgical aortic valve using a balloon-expandable type was performed, because the patient had a high surgical risk of 12.7%. The patient’s postoperative course was uneventful. At the 1-year follow-up, there were no signs of infection or valve abnormalities. Conclusions Transcatheter valve replacement can be a treatment option for high-risk surgical patients with healed limited lesions in infective endocarditis

Characteristics of regional cerebral oxygen saturation levels in patients with out-of-hospital cardiac arrest with or without return of spontaneous circulation: A prospective observational multicentre study.

[Aim] Our study aimed at filling the fundamental knowledge gap on the characteristics of regional brain oxygen saturation (rSO2) levels in out-of-hospital cardiac arrest (OHCA) patients with or without return of spontaneous circulation (ROSC) upon arrival at the hospital for estimating the quality of cardiopulmonary resuscitation and neurological prognostication in these patients. [Methods] We enrolled 1921 OHCA patients from the Japan – Prediction of Neurological Outcomes in Patients Post-cardiac Arrest Registry and measured their rSO2 immediately upon arrival at the hospital by near-infrared spectroscopy using two independent forehead probes (right and left). We also assessed the percentage of patients with a good neurological outcome (defined as cerebral performance categories 1 or 2) 90 days post cardiac arrest. [Results] After 90 days, 79 (4%) patients had good neurological outcomes and a median lower rSO2 level of 15% (15–20%). Compared to patients without ROSC upon arrival at the hospital, those with ROSC had significantly higher rSO2 levels (56% [39–65%] vs. 15% [15–17%], respectively; P < 0.01), and significantly correlated right- and left-sided regional brain oxygen saturation levels (R = 0.94 vs. 0.66, respectively). In both groups, the percentage of patients with a good 90-day neurological outcome increased significantly in proportion to their rSO2 levels upon arrival at the hospital (P < 0.01). [Conclusion] Our data indicate that measuring rSO2 levels might be effective for both monitoring the quality of resuscitation and neurological prognostication in patients with OHCA