Increased Ca2+ sensitivity of myofibrillar tension in ischaemic vs dilated cardiomyopathy

P>1. There is evidence that different aetiologies of heart failure, especially ischaemic vs dilated cardiomyopathy (ICM and DCM, respectively), may influence the prognosis of patients with this disease. Patients with ICM have a worse prognosis than those with DCM; the mechanisms underlying this difference have not yet been clarified. The aim of the present study was to investigate whether there are changes in myofibrillar function depending on the aetiology of human heart failure. 2. Ca2+-dependent tension (DT) and actomyosin ATPase acitivity (MYO) in Triton X-skinned fibre preparations of the left ventricular myocardium from patients with heart failure due to ICM (n = 5) and DCM (n = 5) were measured. Tension-dependent ATP consumption was calculated by the ratio of DT and MYO ('tension cost'). Non-failing myocardium (NF) from donor hearts, which could not be transplanted because of technical reasons, was evaluated as a control. 3. Although DT was reduced, the myofibrillar Ca2+ sensitivity of DT and MYO, as well as tension cost, were increased in preparations from ICM and DCM myocardium compared with NF. The Ca2+ sensitivity of DT and MYO was significantly increased in ICM compared with DCM preparations, resulting in more economic cross-bridge cycling in ICM than in DCM. 4. In conclusion, ICM is associated with an increased Ca2+ sensitivity of myofibrillar tension and ATPase activity accompanied by decreased tension cost compared with DCM. Thus, the worse prognosis associated with ICM does not seem to be due to differences in myofibrillar function

Transapical Valve Implantation After David Operation and Stenting of the Descending Aorta

This case report illustrates our experience with transapical minimally invasive aortic valve implantation in a patient with an extended aneurysm of the thoracoab-dominal aorta, who had previously undergone a replacement of the ascending aorta with concomitant aortic valve reconstruction (David procedure). Endovascular stent grafting of the descending aorta was also performed. The implantation of a 23-mm SAPIEN valve (Edwards Lifesciences, Irvine, CA) did not interfere with the existing 26-mm aortic Hemashield prosthesis (Boston Scientific, Natick, MA) or the previously implanted endograft in the descending aortic position. No paravalvular leakage with aortic valve regurgitation, prosthesis instability, or coronary malperfusion was seen after valve implementation. (Ann Thorac Surg 2010;90:2035-7) (C) 2010 by The Society of Thoracic Surgeon

Acute on/off effects and chronic blood pressure reduction after long-term baroreflex activation therapy in resistant hypertension

Background: Baroreflex activation therapy (BAT) by electrical stimulation of baroreceptors at the carotid sinus is a promising therapeutic approach to reduce elevated blood pressure (BP). To assess the efficacy of long-term BAT, we investigated acute BP alterations after device deactivation and reactivation (on/off effects) in patients on chronic BAT, as well as chronic BP reductions. Method: Resistant hypertension patients (n = 17) were enrolled in an open-label, single-arm evaluation of unilateral BAT after exclusion of secondary hypertension. Initial eligibility criteria were SBP >= 140 mmHg, despite stable medical therapy with at least three antihypertensive drugs including at least one diuretic. For on/off testing, several office cuff BP measurements were performed: at rest with activated device, 4-6 min after deactivation, and 4-6 min after reactivation. Results: Before BAT, mean office cuff BP was 179 +/- 25 over 98 +/- 18 mmHg. At the time of on/off testing (15.1 +/- 8.7 months after initial activation and before deactivation), BP was reduced to 147 +/- 29 over 84 +/- 20 mmHg. On deactivation, SBP increased to 158 +/- 38 mmHg (P = 0.004) and DBP to 89 +/- 23 mmHg (P = 0.04). After reactivation, SBP decreased to 144 +/- 34 mmHg (P = 0.002 vs. deactivation) and DBP to 83 +/- 23 mmHg (P = 0.009). There was no correlation between duration of chronic BAT and systolic or diastolic acute on/off response. Conclusion: Unilateral BAT reduces BP in patients with resistant hypertension in the long term. There is a significant on/off effect on BP, supporting the efficacy of BAT. The acute on/off response to BAT does not depend on treatment duration. Thus, no evidence of tolerance over time to chronic BAT was found

Baroreflex activation therapy in patients with pre-existing implantable cardioverter-defibrillator: compatible, complementary therapies

The Neo (TM) System (CVRx) is an implantable device, CE certified for the treatment of resistant hypertension and investigationally used to treat systolic heart failure by electrical stimulation of the carotid baroreceptors. It is unknown whether interaction might exist between the Neo System and implantable cardioverter-defibrillators (ICDs). Compatibility of the Neo device was tested in seven consecutive patients with pre-existing ICDs. Intra- and post-operative testing was completed with ICD and Neo settings programmed to provoke interaction. Intracardiac electrograms were printed to determine interaction with the ICD. Interaction testing during implantation and follow-up showed that there was no device-device interaction. No interaction was observed at maximum atrial and ventricular sensitivity settings and maximum Neo output settings. Combined therapy with the Neo device and at least in this study reported that transvenous ICD systems can be performed safely

Prediction of survival on the waiting list for heart transplantation and of posttransplant nonadherence-Results of a prospective longitudinal study

Background Only a few previous studies have focused on the interaction between pretransplant psychological variables, survival on the waiting list, and adherence to therapy after heart transplantation (HTx). Methods This work combined two studies: Study 1 monitored survival of patients on a HTx waiting list (n = 50) and study 2 examined barriers to adherence after HTx (subgroup of n = 20). All patients were evaluated immediately after listing for HTx (T0). Those in study 2 were also evaluated immediately after HTx (T1) and after 6 months (T2). Psychosocial functioning was measured by the Transplant Evaluation Rating Scale (TERS), and depression and anxiety by Patient Health Questionnaire and Hospital Anxiety and Depression Scale. Barriers to immunosuppressive adherence post-HTx were measured by the Medication Experience Scale for Immunosuppressants (MESI). Results According to the TERS classification of Rothenhausler et al, patients were divided into three groups in study 1. Compared with inconspicuous patients (n = 23) and risk patients (n = 21), high-risk patients (n = 6) demonstrated a higher mortality (log-rank test of trend, P = 0.002). In study 2, there was a strong correlation between the TERS (T0) and the MESI (T2) (r = 0.84, P = 0.001). Conclusions The TERS may serve as a predictor of survival on the waiting list. There is need for further longitudinal data with larger sample sizes