Heart Failure in Patients with Arrhythmogenic Cardiomyopathy

Arrhythmogenic cardiomyopathy (ACM) is a rare inherited cardiomyopathy characterized as fibro-fatty replacement, and a common cause for sudden cardiac death in young athletes. Development of heart failure (HF) has been an under-recognized complication of ACM for a long time. The current clinical management guidelines for HF in ACM progression have nowadays been updated. Thus, a comprehensive review for this great achievement in our understanding of HF in ACM is necessary. In this review, we aim to describe the research progress on epidemiology, clinical characteristics, risk stratification and therapeutics of HF in ACM

Risk factors and in-hospital mortality in Chinese patients undergoing coronary artery bypass grafting: Analysis of a large multi-institutional Chinese database

ObjectiveThis study was undertaken to delineate outcomes and to assess risk factors for in-hospital mortality among Chinese patients undergoing coronary artery bypass grafting.MethodsFrom 2007 to 2008, a total of 9838 consecutive adult patients undergoing coronary artery bypass grafting were enrolled in the Chinese Coronary Artery Bypass Grafting Registry, which included 43 centers from 17 province-level regions in China. This registry collected information on 67 preoperative factors and 30 operative factors believed to influence in-hospital mortality. The relationship between risk factors and in-hospital mortality was evaluated by univariate and logistic regression analyses.ResultsOverall in-hospital mortality was 2.5%. Eleven risk factors were found to be significant predictors for outcome: age (continuous), body mass index (continuous), left ventricular ejection fraction (continuous), preoperative New York Heart Association functional class III or IV, chronic renal failure, extracardiac arteriopathy, chronic obstructive pulmonary disease, preoperative atrial fibrillation or flutter (within 2 weeks), preoperative critical state, other than elective surgery, and combined valve procedure. Calibration with the Hosmer-Lemeshow test was satisfactory (P = .35), and the discrimination power was good (area under the receiver operating characteristic curve, 0.81; 95% confidence interval, 0.79–0.84).ConclusionsThe risk profiles and in-hospital mortality of Chinese patients undergoing coronary artery bypass grafting were determined from data in the most up-to-date multi-institutional database. Eleven variables were demonstrated to be independent risk factors for in-hospital death after coronary artery bypass grafting

Risk factors and in-hospital mortality in Chinese patients undergoing coronary artery bypass grafting: Analysis of a large multi-institutional Chinese database

ObjectiveThis study was undertaken to delineate outcomes and to assess risk factors for in-hospital mortality among Chinese patients undergoing coronary artery bypass grafting.MethodsFrom 2007 to 2008, a total of 9838 consecutive adult patients undergoing coronary artery bypass grafting were enrolled in the Chinese Coronary Artery Bypass Grafting Registry, which included 43 centers from 17 province-level regions in China. This registry collected information on 67 preoperative factors and 30 operative factors believed to influence in-hospital mortality. The relationship between risk factors and in-hospital mortality was evaluated by univariate and logistic regression analyses.ResultsOverall in-hospital mortality was 2.5%. Eleven risk factors were found to be significant predictors for outcome: age (continuous), body mass index (continuous), left ventricular ejection fraction (continuous), preoperative New York Heart Association functional class III or IV, chronic renal failure, extracardiac arteriopathy, chronic obstructive pulmonary disease, preoperative atrial fibrillation or flutter (within 2 weeks), preoperative critical state, other than elective surgery, and combined valve procedure. Calibration with the Hosmer-Lemeshow test was satisfactory (P = .35), and the discrimination power was good (area under the receiver operating characteristic curve, 0.81; 95% confidence interval, 0.79–0.84).ConclusionsThe risk profiles and in-hospital mortality of Chinese patients undergoing coronary artery bypass grafting were determined from data in the most up-to-date multi-institutional database. Eleven variables were demonstrated to be independent risk factors for in-hospital death after coronary artery bypass grafting

Apical conicity ratio: A new index on left ventricular apical geometry after myocardial infarction

ObjectiveOur objective was to introduce a new index to evaluate left ventricular aneurysm by quantitative analysis of left ventricular apical geometry.MethodsA total of 116 selected subjects underwent magnetic resonance imaging, 28 healthy volunteers, 29 patients with dilated cardiomyopathy, and 59 patients with ischemic heart disease (26 with left ventricular aneurysm; 33 with no aneurysm). The apical conicity ratio was calculated as the ratio of left ventricular apical area over apical triangle.ResultsDiastolic apical conicity ratio of patients with left ventricular aneurysm was 1.62 ± 0.20 and systolic apical conicity ratio was 1.78 ± 0.43. After left ventricular reconstruction, the diastolic apical conicity ratio decreased to 1.47 ± 0.23 and the systolic ratio to 1.51 ± 0.21, which came close to the normal level, whereas other global indices remained. In patients with dilated cardiomyopathy, sphericity index and eccentricity index increased significantly without changes in the apical conicity ratio. Among patients with ischemic heart disease, the apical conicity ratio of the group with left ventricular aneurysm was significantly higher than that of the group without an aneurysm when the other indices between the 2 groups showed no statistically difference. Receiver operating characteristic curves showed only apical conicity ratio had high power of discriminating left ventricular aneurysm from no aneurysm.ConclusionsThe new index, apical conicity ratio, can be used to quantify the regional left ventricular deformation, especially in patients with left ventricular aneurysm resulting from myocardial infarction

Epicardial transplantation of atrial appendage micrograft patch salvages myocardium after infarction

Iskeeminen sydänsairaus, toiselta nimeltään sepelvaltimotauti, on suomalainen kansansairaus, joka useista hoitomuodoistaan huolimatta on edelleen maailmanlaajuisesti yleisin yksittäinen kuolinsyy. Sepelvaltimoiden ohitusleikkaus on revaskularisoiva sepelvaltimotaudin kirurginen hoitomuoto, josta on kertynyt jo vuosikymmenien vankka kokemus. Ohitusleikkauksen vaikuttavuutta on pyritty tehostamaan sen yhteydessä annosteltavien soluhoitojen tai kudosteknologian avulla rakennettujen siirteiden avulla . Valitettavasti nämä nk. adjuvanttihoidot ovat kustannuksiltaan ja toteutukseltaan niin raskaita, että niiden kliininen toteutettavuus ja vaikuttavuus ovat jääneet odotetusta. Tutkimuksessa arvioimme sydänlihaksen akuutin hapenpuutteen, eli sydäninfarktin, kokeellisessa mallissa sydämien vauriopinnalle asetettujen pienien eteiskorvakudospalojen toiminnallista, kudosopillista sekä mekanistista vaikuttavuutta. Pienet eteiskorvakekudospalat kerättiin saman hiirilinjan hiiristä, pilkottiin mekaanisesti ja siirrettiin sydämen pinnalle vauriopintaa vasten. Ultraäänitutkimusseurannan perusteella kudospalat tehostivat toiminnallista paranemista alkuvaiheen ensivaurion jälkeen kontrolliryhmiin (lumeoperoitu, pelkkä sydäninfarkti sekä infarkti ja pelkkä paikkamateriaali) nähden. Sydänkudoksen histologiset värjäystutkimukset paljastivat vähentyneen kollageeniarpipitoisuuden, lisääntyneen sydänlihassolujen troponiinipitoisuuden sekä kokonaisuutena ilmeisen sydänlihaksen säilymisen. Anatomisesti kohdennetut proteomiikka-analyysit paljastivat kudospalahoitoon assosioituvien useiden kudosparanemisen kannalta keskeisien biologisten prosessien aktivoitumisia juuri sydämen vaurioalueella vielä viikkojakin vaurion jälkeen. Näitä prosesseja olivat mm. lisääntynyt uudisverisuonitus, sydänlihassolujen jakaantuminen sekä vähentynyt ohjelmoitunut solukuolema. Sydämen pinnalle sydäninfarktin aikana kirurgista paikkamateraalia hyödyntäen asetetut eteiskorvakekudospalat suojaavat sydänlihasta iskeemiseltä vauriolta. Hoitomuodon tulokset ja selkeä toteutusprotokolla tukevat sen kliinistä soveltuvuutta ohitusleikkauksen adjuvanttihoidoksi

Epicardial transplantation of atrial appendage micrograft patch salvages myocardium after infarction

Iskeeminen sydänsairaus, toiselta nimeltään sepelvaltimotauti, on suomalainen kansansairaus, joka useista hoitomuodoistaan huolimatta on edelleen maailmanlaajuisesti yleisin yksittäinen kuolinsyy. Sepelvaltimoiden ohitusleikkaus on revaskularisoiva sepelvaltimotaudin kirurginen hoitomuoto, josta on kertynyt jo vuosikymmenien vankka kokemus. Ohitusleikkauksen vaikuttavuutta on pyritty tehostamaan sen yhteydessä annosteltavien soluhoitojen tai kudosteknologian avulla rakennettujen siirteiden avulla . Valitettavasti nämä nk. adjuvanttihoidot ovat kustannuksiltaan ja toteutukseltaan niin raskaita, että niiden kliininen toteutettavuus ja vaikuttavuus ovat jääneet odotetusta. Tutkimuksessa arvioimme sydänlihaksen akuutin hapenpuutteen, eli sydäninfarktin, kokeellisessa mallissa sydämien vauriopinnalle asetettujen pienien eteiskorvakudospalojen toiminnallista, kudosopillista sekä mekanistista vaikuttavuutta. Pienet eteiskorvakekudospalat kerättiin saman hiirilinjan hiiristä, pilkottiin mekaanisesti ja siirrettiin sydämen pinnalle vauriopintaa vasten. Ultraäänitutkimusseurannan perusteella kudospalat tehostivat toiminnallista paranemista alkuvaiheen ensivaurion jälkeen kontrolliryhmiin (lumeoperoitu, pelkkä sydäninfarkti sekä infarkti ja pelkkä paikkamateriaali) nähden. Sydänkudoksen histologiset värjäystutkimukset paljastivat vähentyneen kollageeniarpipitoisuuden, lisääntyneen sydänlihassolujen troponiinipitoisuuden sekä kokonaisuutena ilmeisen sydänlihaksen säilymisen. Anatomisesti kohdennetut proteomiikka-analyysit paljastivat kudospalahoitoon assosioituvien useiden kudosparanemisen kannalta keskeisien biologisten prosessien aktivoitumisia juuri sydämen vaurioalueella vielä viikkojakin vaurion jälkeen. Näitä prosesseja olivat mm. lisääntynyt uudisverisuonitus, sydänlihassolujen jakaantuminen sekä vähentynyt ohjelmoitunut solukuolema. Sydämen pinnalle sydäninfarktin aikana kirurgista paikkamateraalia hyödyntäen asetetut eteiskorvakekudospalat suojaavat sydänlihasta iskeemiseltä vauriolta. Hoitomuodon tulokset ja selkeä toteutusprotokolla tukevat sen kliinistä soveltuvuutta ohitusleikkauksen adjuvanttihoidoksi

In Vitro Effects of Pirfenidone on Cardiac Fibroblasts: Proliferation, Myofibroblast Differentiation, Migration and Cytokine Secretion

Cardiac fibroblasts (CFs) are the primary cell type responsible for cardiac fibrosis during pathological myocardial remodeling. Several studies have illustrated that pirfenidone (5-methyl-1-phenyl-2-[1H]-pyridone) attenuates cardiac fibrosis in different animal models. However, the effects of pirfenidone on cardiac fibroblast behavior have not been examined. In this study, we investigated whether pirfenidone directly modulates cardiac fibroblast behavior that is important in myocardial remodeling such as proliferation, myofibroblast differentiation, migration and cytokine secretion. Fibroblasts were isolated from neonatal rat hearts and bioassays were performed to determine the effects of pirfenidone on fibroblast function. We demonstrated that treatment of CFs with pirfenidone resulted in decreased proliferation, and attenuated fibroblast α-smooth muscle actin expression and collagen contractility. Boyden chamber assay illustrated that pirfenidone inhibited fibroblast migration ability, probably by decreasing the ratio of matrix metalloproteinase-9 to tissue inhibitor of metalloproteinase-1. Furthermore, pirfenidone attenuated the synthesis and secretion of transforming growth factor-β1 but elevated that of interleukin-10. These direct and pleiotropic effects of pirfenidone on cardiac fibroblasts point to its potential use in the treatment of adverse myocardial remodeling

Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting.

BACKGROUND: We previously reported that there was no significant difference at 30 days or at 1 year in the rate of the composite outcome of death, stroke, myocardial infarction, or renal failure between patients who underwent coronary-artery bypass grafting (CABG) performed with a beating-heart technique (off-pump) and those who underwent CABG performed with cardiopulmonary bypass (on-pump). We now report the results at 5 years (the end of the trial). METHODS: A total of 4752 patients (from 19 countries) who had coronary artery disease were randomly assigned to undergo off-pump or on-pump CABG. For this report, we analyzed a composite outcome of death, stroke, myocardial infarction, renal failure, or repeat coronary revascularization (either CABG or percutaneous coronary intervention). The mean follow-up period was 4.8 years. RESULTS: There were no significant differences between the off-pump group and the on-pump group in the rate of the composite outcome (23.1% and 23.6%, respectively; hazard ratio with off-pump CABG, 0.98; 95% confidence interval [CI], 0.87 to 1.10; P=0.72) or in the rates of the components of the outcome, including repeat coronary revascularization, which was performed in 2.8% of the patients in the off-pump group and in 2.3% of the patients in the on-pump group (hazard ratio, 1.21; 95% CI, 0.85 to 1.73; P=0.29). The secondary outcome for the overall period of the trial - the mean cost in U.S. dollars per patient - also did not differ significantly between the off-pump group and the on-pump group ($15,107 and$14,992, respectively; between-group difference, $115; 95$697 to $927). There were no significant between-group differences in quality-of-life measures. CONCLUSIONS: In our trial, the rate of the composite outcome of death, stroke, myocardial infarction, renal failure, or repeat revascularization at 5 years of follow-up was similar among patients who underwent off-pump CABG and those who underwent on-pump CABG. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294 .)