International heart journal
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Recently, platelet-derived growth factor (PDGF) has been implicated in the abnormal proliferation and migration of pulmonary artery vascular smooth muscle cells. Imatinib meslylate, a PDGF receptor antagonist, has been reported to dramatically improve pulmonary arterial hypertension (PAH) in some human cases as well as animal models. Five patients with PAH (3 scleroderma-associated PAH and 2 idiopathic/familial PAH) taking no less than 2 PAH agents were treated with low-dose imatinib (100 mg/day) for 24 weeks. ⋯ Diffusion capacity of the lung for carbon monoxide significantly improved after 12 weeks of treatment (P < 0.01) and this improvement tended to be sustained for 24 weeks (P = 0.05). Renal dysfunction was observed in 3 patients during imatinib therapy. The upregulated PDGF-BB in patients with PAH could be suppressed by imatinib treatment, and also seemed to be one of the determinant factors for its efficacy.
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The mortality of heart failure patients with renal insufficiency is high, and these patients tend to develop diuretic resistance. Under these conditions, continuous hemodiafiltration (CHDF) is a possible alternative volume reduction therapy to diuretics. However, its efficacy and safety are not clear. ⋯ In-hospital mortality of the VH group and cardiogenic shock (CS) group were 10.0% and 54.5%, respectively. CHDF for acute decompensated heart failure (ADHF) is a safe, effective, and reliable volume reduction therapy for volume overloaded heart failure. Further investigation is required to assess the effectiveness of CHDF for cardiogenic shock.
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Controlled Clinical Trial
Evaluation of renal microcirculation by contrast-enhanced ultrasound with Sonazoid as a contrast agent.
Chronic kidney disease (CKD) is a major and serious risk factor for cardiovascular disease (CVD). Continuous hypoxia due to hypoperfusion in peritubular capillaries is one of the factors aggravating CKD, but evaluation of perfusion in this region is difficult using clinically available imaging methods. Since the second-generation ultrasound contrast agent Sonazoid has a stable shell, it enables visualization of the renal vasculature for a long period of time. ⋯ No side effects of the contrast agent were observed in any subjects. The attenuation of renal contrast enhancement observed in CKD patients appears to reflect disturbance of perfusion in peritubular capillaries. CEUS with Sonazoid is a useful and safe means of visualizing the renal microvasculature.
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It has previously been reported that cardiac troponin I (cTnI) is useful in predicting the postoperative course after cardiac surgery, and that elevated serum cTnI levels are associated with increased in-hospital mortality. However, these findings have been reported in heterogeneous groups of cardiac surgical procedures. In the current study, the usefulness of postoperative cTnI measurements for the prediction of patient outcomes in a specific group of cardiac surgical procedures was determined, with the analysis limited to patients undergoing mitral valve surgery. ⋯ Values of cTnI on POD 1 and POD 2 were significantly correlated with the length of ICU stay, whereas only the CK-MB level on POD 2 was significantly correlated with the length of ICU stay. In addition, the cTnI levels on POD 1 and POD 2 were significantly correlated with POHS, however, there was no relationship between postoperative CK-MB levels and POHS. Postoperative cTnI measurements are more useful than CK-MB measurements in predicting the postoperative course of a patient following mitral valve surgery.
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Although extracorporeal membrane oxygenation (ECMO) is widely used as temporary circulation support, there are no reports of direct parameters indicating cardiac recovery to determine the timing of weaning off. Twenty-five patients supported by ECMO due to hemodynamic deterioration were divided into 2 groups according to their outcome: weaned ECMO (W: n = 18) or not (NW: n = 7). In the W group, we examined the differences in parameters between the 2 time points, ECMO introduction, and the reduction in ECMO flow to 40% of the initial setting known as the conventional recovery point (C-point). ⋯ The E-point was defined as an initial increase in ETCO(2) of >or= 5 mmHg over the preceding 12 hours with a continued rise over the next 12 hours. E-points appeared as much as 95 +/- 60 hours earlier than C-points and also preceded weaning off of ECMO. ETCO(2) can be a useful continuous parameter for predicting the adequate timing of weaning off of ECMO for circulatory failure at the bedside.