International heart journal
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Multicenter Study Comparative Study
Incidence and mortality of acute myocardial infarction. A population-based study including patients with out-of-hospital cardiac arrest.
The in-hospital mortality rate of acute myocardial infarction (AMI) is improving. In Japan, little information exists concerning the incidence and mortality of AMI. Therefore, our population-based analysis examined the incidence and mortality rate in AMI cases in individuals that lived in the Matsumoto region in 2002. ⋯ The population-based mortality rate of AMI was 34% to 42%. The mortality rate of AMI remains high, and most deaths occur outside of the hospital. Prehospital care may lower the mortality rate of AMI.
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Randomized Controlled Trial
Role of preoperative atorvastatin administration in protection against postoperative atrial fibrillation following conventional coronary artery bypass grafting.
Atrial fibrillation (AF) is one of the most common postoperative arrhythmias in patients who undergo coronary artery bypass grafting (CABG). The aim of this study was to evaluate the effect of preoperative atorvastatin on postoperative atrial fibrillation following coronary artery bypass grafting with cardiopulmonary bypass (CCABG). One hundred consecutive patients undergoing elective CCABG, without history of AF or previous statin treatment, were enrolled and randomly assigned to a statin group (atorvastatin 20 mg/d, n = 49) or a control group (placebo, n = 51) starting 7 days preoperatively. ⋯ Kaplan-Meier curves confirmed a significantly better postoperative atrial fibrillation-free survival in the statin group (χ(2) = 7.466, P = 0.006). Logistic regression analysis showed preoperative atorvastatin treatment was an independent factor associated with a significant reduction in postoperative AF (OR = 0.235, P = 0.007), whereas high postoperative CRP levels were associated with increased risk (OR = 2.421, P = 0.015). Preoperative atorvastatin administration may inhibit inflammatory reactions to prevent atrial fibrillation following coronary artery bypass grafting with cardiopulmonary bypass.
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Comparative Study
Adaptive servo ventilation improves cardiac dysfunction and prognosis in chronic heart failure patients with Cheyne-Stokes respiration.
Cheyne-Stokes respiration (CSR) is often observed in patients with chronic heart failure (CHF). Although adaptive servo ventilation (ASV) is effective for CSR, it remains unclear whether ASV improves the cardiac function and prognosis of patients with CHF and CSR. Sixty patients with CHF and CSR (mean left ventricular ejection fraction 38.7%, mean apnea hypopnea index 36.8 times/hour, mean central apnea index 19.1 times/hour) were enrolled in this study. ⋯ In contrast, none of these parameters changed in the Non-ASV group. Importantly, Kaplan-Meier analysis clearly demonstrated that the event-free rate was significantly higher in the ASV group than in the Non-ASV group. Adaptive servo ventilation improves cardiac function and prognosis in patients with chronic heart failure and Cheyne-Stokes respiration.
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Randomized Controlled Trial
Effect of ischemic postconditioning in correction of tetralogy of Fallot.
Inappropriate myocardial protection is considered one of the main causes of mortality and morbidity in the correction of tetralogy of Fallot (TOF). Results of previous reports about the effects of ischemic postconditioning on myocardial protection in animals and humans are very encouraging. This randomized and controlled trial aimed to assess the effect of ischemic postconditioning on protection against myocardial ischemia reperfusion injury in TOF patients receiving cardioplegia. ⋯ As a result, ischemic postconditioning reduced postoperative peak release by 45% for cTnI compared with the control group (0.43 ± 0.18 ng/mL versus 0.78 ± 0.15 ng/mL, P < 0.0001). Ischemic postconditioned patients had a lower peak inotropic score during the first postoperative 24 hours (5.6 ± 2.2 µg/kg/minute versus 8.6 ± 3.6 µg/kg/minute, P < 0.0001), extubation time (21.5 ± 7.3 hours versus 30.2 ± 12.4 hours, P = 0.0002) and length of ICU stay (43.4 ± 12.6 hours versus 56.3 ± 17.8 hours, P = 0.0003), while they had a higher cardiac output on the first postoperative day (1.41 ± 0.26 L/minute versus 1.28 ± 0.25 L/minute, P = 0.0255) as compared to the control group. In conclusion, ischemic postconditioning may to some extent provide myocardial protection in children undergoing correction of tetralogy of Fallot.
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Nemaline myopathy is a representative form of congenital myopathy, and is characterized by nemaline bodies in muscle fibers. Here we report a 47-year-old man with congenital nemaline myopathy complicated with dilated cardiomyopathy-related heart failure, and restrictive respiratory failure. ⋯ The patient responded to the combination of conventional therapy for heart failure including β-blocker and noninvasive continuous positive-pressure ventilation for respiratory failure. His general condition has been stable during a 10-month follow up period.