Usefulness of Plasma Branched-Chain Amino Acid Analysis in Predicting Outcomes of Patients with Nonischemic Dilated Cardiomyopathy.
- 作者列表："Kimura Y","Okumura T","Kazama S","Shibata N","Oishi H","Arao Y","Kuwayama T","Kato H","Yamaguchi S","Hiraiwa H","Kondo T","Morimoto R","Murohara T
:The metabolism of branched-chain amino acids (BCAAs) is reported to change in heart failure (HF) and correlate with cardiac function. However, the effect of BCAAs on HF remains controversial. We investigate the prognostic value of the plasma BCAA level in nonischemic dilated cardiomyopathy (NIDCM).This study enrolled 39 NIDCM patients, who underwent plasma amino acid (AA) analysis. The ratio of BCAAs to total AAs was calculated. All patients were divided into two groups at the median of BCAA/total AA ratio; high BCAA/total AA group (≥ 0.15, n = 20) and low BCAA/total AA group (< 0.15, n = 19). A cardiac event was defined as a composite of cardiac death, hospitalization for worsening HF, and lethal arrhythmia.The mean age was 51.1 ± 12.3 years and left ventricular ejection fraction (LVEF) was 32.7 ± 10.1%. In the low BCAA/total AA group, the body mass index and the total cholesterol level were lower than in the high BCAA/total AA group. The BCAA/total AA ratio was positively correlated with LVEF (r = 0.35, P = 0.031) and negatively correlated with brain natriuretic peptide (r = -0.37, P = 0.020). The low BCAA/total AA group had a lower cardiac event-free rate (5-year: 100% versus 73%; P = 0.019). In univariate analysis, angiotensin converting enzyme inhibitor or angiotensin II receptor blocker (hazard ratio: 0.045, P = 0.0014), hemoglobin (hazard ratio: 0.49 per 1 g/dL, P = 0.0022), and BCAA/total AA ratio < 0.15 (hazard ratio: not available, P = 0.0066) were major predictors for cardiac events.The BCAA/total AA ratio might be a useful predictor for future cardiac events in patients with NIDCM.
: 据报道，支链氨基酸 (BCAAs) 的代谢在心力衰竭 (HF) 中发生变化，并与心脏功能相关。然而，BCAAs对HF的影响仍然存在争议。我们研究了血浆BCAA水平对非缺血性扩张型心肌病 (NIDCM) 的预后价值。本研究纳入了39例NIDCM患者，他们接受了血浆氨基酸 (AA) 分析。计算BCAAs与总AAs的比率。所有患者按中位BCAA/总AA比值分为两组; 高BCAA/总AA组 (≥ 0.15，n = 20) 和低BCAA/总AA组 (< 0.15，n = 19)。心脏事件被定义为心脏性死亡、因心力衰竭恶化而住院和致死性心律失常的复合事件。平均年龄为51.1 ± 12.3岁，左心室射血分数 (LVEF) 为32.7 ± 10.1%。在低BCAA/总AA组中，体重指数和总胆固醇水平低于高BCAA/总AA组。BCAA/总AA比值与LVEF呈正相关 (r = 0.35，P = 0.031)，与脑钠肽呈负相关 (r = -0.37，P = 0.020)。低BCAA/总AA组无心脏事件率较低 (5年: 100% 对73%; P = 0.019)。在单变量分析中，血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂 (风险比: 0.045，P = 0.0014) 、血红蛋白 (风险比: 0.49每1g/dL，P = 0.0022) 和BCAA/总AA比值 <0.15 (风险比: 不可用，P = 0.0066)BCAA/总AA比值可能是NIDCM患者未来心脏事件的有用预测因子。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.