International heart journal
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The modified Blalock-Taussig shunt (mBTS) is one of the most important palliative procedures in congenital heart surgery. However, in neonates and small infants, operative mortality and morbidity due to excessive pulmonary blood flow or shunt failure remains high. In this study, a small shunt graft (3.0-mm diameter) was estimated to determine the optimal shunt graft size of BTS as an initial palliation for ultimate biventricular circulation. ⋯ There were no differences in body weight at intracardiac repair (ICR) between the groups. During the interstage to ICR, body weight gain was significantly greater in group S than in group L (P = 0.008). The small shunt graft (3.0-mm diameter) in BTS was safe, provided adequate pulmonary blood flow, and led to significant weight gain between mBTS and ICR for ultimate biventricular circulation in neonates and small infants with low body weight.
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Review Comparative Study
CABG versus PCI in the treatment of diabetic patients affected by coronary artery disease.
Surgical coronary revascularization and percutaneous coronary intervention were demonstrated to be effective treatments for coronary artery disease. However, the optimal revascularization strategy remains unclear in certain patient subsets. ⋯ The purpose of this study was to review the available literature based on randomized trials and observational studies in order to allow clinicians to make evidence-based decisions when treating diabetic patients with multivessel coronary disease. The current evidence suggests that CABG should remain the standard of care for this patient population.
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Several studies have demonstrated that tolvaptan (TLV) can improve hyponatremia in advanced heart failure (HF) patients with rare chance of hypernatremia. However, changes in serum sodium concentrations (S-Na) in patients with or without hyponatremia during TLV treatment have not been analyzed. Ninety-seven in-hospital patients with decompensated HF who had received TLV at 3.75-15 mg/day for 1 week were enrolled. ⋯ In contrast, in normonatremic responders (n = 43), S-Na remained unchanged (136.6 ± 3.1 versus 137.4 ± 2.9 mEq/L, NS) along with increased U-NaEx(24) (2201 ± 1644 versus 4198 ± 3550 mg/day, P < 0.05). TLV increased S-Na only in hyponatremic responders by way of pure aquaresis, but increased U-NaEx(24) only in normonatremic responders, which explains the scarcity of hypernatremia. Epithelial Na-channels in the distal nephrons, whose repression by TLV increases urinary sodium excretion, may be attenuated by reduced ATP-supply in worse hemodynamics under hyponatremia.
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It remains unclear if the CHADS2 score or CHA2DS2-VASc score is more useful for the risk stratification of ischemic stroke/systemic thromboembolism in Japanese patients with non-valvular paroxysmal atrial fibrillation (NVPAF). We retrospectively investigated the incidence of ischemic stroke on the basis of CHADS2 and CHA2DS2-VASc scores in 332 NVPAF patients (224 men, mean age, 65 ± 13 years) who were not administered anticoagulation therapy before publication of the 2008 JCS guideline (mean follow-up period, 53 ± 35 months). Annual rates of ischemic stroke/ systemic thromboembolism underlying antiarrhythmic drug therapy were 0.2%/year for the 0-point group; 0.9%/year for the 1-point group; 2.8%/year for the 2-point group; 9.4 %/year for the 3-point group; and 10.9%/year for the ≥ 4-point group on the basis of the CHADS2 scores, and 0%/year for the 0-point group; 0.6%/year for the 1-point group; 1.0%/ year for the 2-point group; 2.0 %/year for the 3-point group; 5.5%/year for the 4-point group; 9.1%/year for the 5-point group; and 13.7%/year for the ≥ 6-point group on the basis of the CHA2DS2-VASc scores. ⋯ In multivariate logistic regression analysis, the CHADS2 (odds ratio [OR]:4.74, 95% confidence interval [CI]:2.80-8.00, P < 0.001) and CHA2DS2-VASc scores (OR: 4.15, 95% CI:2.57-6.71, P < 0.001) were significant independent predictors for ischemic stroke/systemic thromboembolism. Area under the receiver-operator characteristic curves for predicting ischemic stroke/systemic thromboembolism were 0.89 in the CHA2DS2-VASc scores (P < 0.001) and 0.87 in the CHADS2 scores (P < 0.001). In Japanese patients with NVPAF, both the CHADS2 and CHA2DS2-VASc scores are useful parameters for the risk stratification of ischemic stroke/systemic thromboembolism.
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Meta Analysis Comparative Study
Diuretics and ultrafiltration in acute heart failure syndrome.
The use of diuretics and ultrafiltration in acute heart failure syndrome (AHFS) has been investigated in a number of randomized controlled trials (RCTs). However, the benefits have been variable. We therefore performed a meta-analysis to examine the overall effect of all-cause mortality, rehospitalization, renal function, dyspnea relief, and adverse events in patients with AHFS. ⋯ However, there was significantly more weight loss (WMD, 1.333 kg; 95% CI, 0.186 to 2.479; P = 0.023; I² = 57.7%) and net fluid removal (WMD, 1459.432 mL; 95% CI, 275.911 to 2642.953; P = 0.016; I² = 25.2%) in the ultrafiltration-therapy group. There was no significant difference in the risk of adverse events between the two groups. Compared with diuretic therapy, ultrafiltration produces greater weight loss and net fluid removal in a safe and effective manner.