Low-density lipoprotein cholesterol lowering by adding ezetimibe to statin is associated with improvement of postprandial hyperlipidemia in diabetic patients with coronary artery disease

Objective and methods: We investigated the hypothesis that serum low-density lipoprotein cholesterol (LDL-C) reduction by ezetimibe is associated with the improvement in postprandial hyperlipidemia by performing an oral fat loading test before and 24 weeks after ezetimibe treatment in diabetic (n = 29) and non-diabetic (n = 30) male patients with coronary artery disease (CAD). Results: Serum LDL-C levels were significantly reduced by ezetimibe in both groups (diabetic, from 120.3 ± 39.4 to 79.5 ± 23.2 mg/dL, p < 0.001; non-diabetic, from 98.2 ± 41.7 to 76.7 ± 29.2 mg/dL, p < 0.001), and the mean reduction in serum LDL-C was greater in diabetic than non-diabetic patients (−32.0 vs. −19.0%, p = 0.004). The area under the curve (AUC) for triglyceride (TG) and remnant-like particle cholesterol (RLP-C) decreased significantly in both groups. When compared with the reduction before and after treatment in AUC of TG (∆AUC0–6 h TG) and RLP-C (∆AUC0–6 h RLP-C), they were significantly greater in diabetic than non-diabetic patients (∆AUC0–6h TG, −28.9 vs. −12.2%, p = 0.028; ∆AUC0–6h RLP-C, −27.8 vs. −12.3%, p = 0.007). In diabetic patients, ∆AUC0–6 h TG and ∆AUC0–6 h RLP-C in the highest tertile of serum LDL-C reduction were significantly greater than those in the lowest tertile (∆AUC0-6h TG, −34.1 vs. −20.9%, p = 0.012; ∆AUC0-6h RLP-C, −34.5 vs. −15.1%, p = 0.024). Conclusions: These findings suggest that serum LDL-C reduction by ezetimibe might be associated with the improvement of postprandial hyperlipidemia in diabetic patients with CAD

Sudden failure of ventricular pacing and recovery in a patient with cardiac sarcoidosis

A 76-year-old woman with sarcoidosis who had an implantable pacemaker for complete atrioventricular block was admitted with syncope. Electrocardiogram revealed ventricular pacing failure, and a marked rise in the ventricular pacing threshold. 18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) indicated increased uptake of FDG in the ventricular septum. Three days after steroid therapy, the ventricular pacing threshold reverted to normal, and FDG-PET showed decreased FDG uptake in the ventricular septum. In this case report, we demonstrate that a sudden deterioration in the ventricular pacing threshold due to worsening cardiac sarcoidosis can be reversed with early steroid therapy

Inhaled nitric oxide testing in predicting prognosis in pulmonary hypertension due to left‐sided heart diseases

Abstract Aims The pathophysiology of pulmonary hypertension (PH) due to left‐sided heart disease (Group 2 PH) is distinct from that of other groups of PH, yet there are still no approved therapies that selectively target pulmonary circulation. The increase in pulmonary capillary pressure due to left‐sided heart disease is a trigger event for physical and biological alterations of the pulmonary circulation, including the nitric oxide (NO)–soluble guanylate cyclase–cyclic guanosine monophosphate axis. This study investigated inhaled NO vasoreactivity tests for patients with Group 2 PH and hypothesized that these changes may have a prognostic impact. Methods and results This was a single‐centre, retrospective study with a median follow‐up of 365 days. From January 2011 to December 2015, we studied 69 patients with Group 2 PH [age, 61.5 ± 13.0 (standard deviation) years; male:female, 49:20; left ventricular ejection fraction, 50.1 ± 20.4%; mean pulmonary arterial pressure, ≥25 mmHg; and pulmonary arterial wedge pressure (PAWP), >15 mmHg]. No adverse events were observed after NO inhalation. Thirty‐four patients with Group 2 PH showed increased PAWP (ΔPAWP: 3.26 ± 2.22 mmHg), while the remaining 35 patients did not (ΔPAWP: −2.11 ± 2.29 mmHg). Multivariate analysis revealed that increased PAWP was the only significant predictor of all‐cause death or hospitalization for heart failure (HF) after 1 year (hazard ratio 4.35; 95% confidence interval, 1.27–14.83; P = 0.019). The acute response of PAWP to NO differed between HF with preserved and reduced ejection fractions. Conclusions Patients with Group 2 PH were tolerant of the inhaled NO test. NO‐induced PAWP is a novel prognostic indicator

Prognostic value of end-of-induction PET response after first-line immunochemotherapy for follicular lymphoma (GALLIUM): secondary analysis of a randomised, phase 3 trial

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