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Nihon Naika Gakkai Zasshi 02/2012; 101(2):424-42.
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Takahiro Ohara, Kazuhiko Hashimura,
Masanori Asakura,
Akiko Ogai,
Makoto Amaki,
Takuya Hasegawa,
Hideaki Kanzaki,
Mina Sonoda,
Hitoshi Nishizawa,
Tohru Funahashi,
Masafumi Kitakaze
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ABSTRACT: Elevated levels of total plasma adiponectin (APN) and high molecular weight (HMW)-APN have been observed in chronic heart failure (HF) and are associated with poor prognosis, however, the response of APN levels in acute HF is not known. The purpose of this study was to clarify the dynamic changes of the plasma total APN, HMW-APN levels, and the ratio of HMW-APN to total APN (HMWR) in acute HF.
From February 2006 to January 2007, 20 patients with acute HF (non-ischemic and non-valvular origin, 17 men, aged 63±11 years) were enrolled, and blood was sampled before the onset of the treatment and at discharge. Ten patients admitted for the treatment of supraventricular arrhythmia (8 men, aged 45±13 years) were included as controls.
The medians and interquartile ranges of the plasma total APN, HMW-APN levels, and HMWR at admission were 20.8 (14.5-38.9) μg/mL, 12.4 (7.7-23.3) μg/mL, and 0.60 (0.50-0.69), respectively. The total APN and HMW-APN values were significantly higher than the values of the control. The plasma total APN, HMW-APN, and HMWR values at discharge decreased to 19.4 (7.2-27.3)μg/mL, 10.5 (3.2-12.8) μg/mL, and 0.52 (0.46-0.57), respectively. An exploratory survival analysis showed that the higher HMWR values at admission and the larger decrease in HMWR were associated with a better prognosis after discharge.
Plasma total APN and HMW-APN values are elevated at the admission for acute HF. Plasma total APN, HMW-APN, and HMWR values decrease following treatment. Higher HMWR at admission and its larger decrease may be the signs of favorable treatment responsiveness in acute HF.
Journal of Cardiology 08/2011; 58(2):181-90. · 1.28 Impact Factor
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ABSTRACT: Cerebrovascular accident (CVA) is a major adverse event following left ventricular assist device (LVAD) surgery. This study investigates pre- and post-operative factors associated with CVA in this population.
A total of 118 consecutive patients who underwent LVAD surgery at our institution between April 1994 and April 2009 were retrospectively reviewed. Clinical characteristics, hemodynamic data, and laboratory indexes associated with CVA after LVAD surgery were analyzed. In total, 57 (48.3%) patients developed CVA 133.5 ± 184.7 days after surgery. The combination of baseline heart disease, type of LVAD surgery, mean right atrial pressure (mRA), serum total bilirubin and total protein concentration, and right ventricular end-diastolic dimension (RVEDd) was associated with CVA at any time after LVAD surgery, with a discriminant probability of 718%. With regard to CVA development later than 3 months after surgery, the combination of mRA and RVEDd before surgery [odds ratio (OR), 1.24, 1.20; 95% confidential interval (CI), 1.07-1.42, 1.06-1.34; P = 0.004, P = 0.006, respectively], positive blood culture, and C-reactive protein after surgery (OR, 7.66, 2.19; 95%CI, 1.50-39.0, 1.47-3.25; P = 0.015, P < 0.0001, respectively) was associated with CVA with a discriminant probability of 85.9%.
Patients' general condition including malnutrition, in addition to device selection, contributed to overall CVA development after surgery. In the chronic phase after surgery, pre-LVAD right heart failure and post-LVAD systemic infection were highly associated with CVA development.
Circulation Journal 03/2011; 75(5):1138-46. · 3.77 Impact Factor
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Shuji Hashimoto,
Tomoko S Kato,
Kazuo Komamura,
Akihisa Hanatani,
Kazuo Niwaya,
Toshihiro Funatsu,
Junjiro Kobayashi,
Yoshiyuki Sumita,
Norio Tanaka, Kazuhiko Hashimura,
Masanori Asakura,
Hideaki Kanzaki,
Masafumi Kitakaze
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ABSTRACT: Evaluating donor heart as accurately as possible upon the organ procurement would help lead careful post-transplant heart management. Our institution (National Cerebral and Cardiovascular Center, Osaka, Japan) has sent a transplant cardiologist upon the organ procurement for evaluating a donor heart ever since our first case of heart transplantation.
Thirteen consecutive bedside echocardiograms obtained from donors upon the organ procurement and post-transplant echocardiograms obtained from their recipients were retrospectively reviewed. The impact of donor echocardiograms on their recipients' post-transplant time course was analyzed and both the donor echocardiographic parameters and their recipients' parameters within 1 week after the heart transplant were compared.
Both the left ventricular end-diastolic diameter and the ventricular wall thickness of donors correlated well with those parameters of their corresponding recipients (r(2)=0.740, p<0.0001, r(2)=0.704, p<0.0001, respectively). The information on coronary flow of the donor heart with risk factors for ischemic heart disease was useful for judging the availability for heart transplantation. The information on the pre-existing localized wall motion abnormality of donor hearts was useful for ruling out a possibility of rejection and other causes of wall motion abnormality after transplantation. The mean time required for bedside echocardiography for the donor heart was only 3.7 min. None of the recipients either developed primary graft failure or required treatment for cellular rejection.
Detailed observation of donor hearts by bedside echocardiograms upon the organ procurement is of clinical benefit.
Journal of Cardiology 01/2011; 57(2):215-22. · 1.28 Impact Factor
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Takahiro Sato,
Tomoko S Kato,
Kazuo Kamamura,
Shuji Hashimoto,
Toshiaki Shishido,
Akiko Mano,
Noboru Oda,
Ayako Takahashi,
Hatsue Ishibashi-Ueda,
Takeshi Nakatani,
Masanori Asakura,
Hideaki Kanzaki, Kazuhiko Hashimura,
Masafumi Kitakaze
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ABSTRACT: Reduced left ventricular torsion (LV-tor) has been reported to be associated with acute rejection in heart transplant (HTx) recipients. We investigated the utility of LV-tor analysis derived from 2-dimensional speckle-tracking echocardiography (2D-STE) for detecting allograft rejection.
A total of 301 endomyocardial biopsies (EMBs), right heart catheterizations and echocardiograms were performed in 32 HTx recipients. Echocardiography was done within 3 hours from EMB or simultaneously with the procedures. The LV-tor was defined as the difference between apical and basal end-systolic rotations. The LV-tor values with and without cellular rejection were compared. In addition, we investigated whether the change in LV-tor values predicts the change in rejection grade in each patient. The baseline LV-tor value in each patient was defined as a mean value of the first 3 LV-tor measurements obtained when the patient was free from rejection.
According to the conventional International Society for Heart and Lung Transplantation criteria, 274 biopsies showed a rejection Grade of 0, 1a or 1b (Group AR(-)), whereas 27 biopsies were Grade 2 or higher (Group AR(+)). LV-tor decreased more in Group AR(+) than in Group AR(-) (9.3 ± 0.7 vs 12.2 ± 0.2 degrees, p < 0.0001). In the LV-tor measurement for each patient, the 25% reduction in LV-tor value from baseline predicted Grade 2 or higher rejection with a predictive accuracy of 92.9%.
LV-tor derived from 2D-STE could be of clinical value for non-invasive monitoring of acute rejection in HTx recipients.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 12/2010; 30(5):536-43. · 3.54 Impact Factor
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Mika Mori,
Hideaki Kanzaki,
Makoto Amaki,
Takahiro Ohara,
Takuya Hasegawa,
Hiroyuki Takahama, Kazuhiko Hashimura,
Tetsuo Konno,
Kenshi Hayashi,
Masakazu Yamagishi,
Masafumi Kitakaze
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ABSTRACT: Atrial fibrillation is commonly associated with impaired reservoir and booster functions of the left atrium (LA). Recent advances in two-dimensional speckle tracking technique (2DST) enabled automatic analysis of the time-LA volume curve representing these functions. Our objective was to evaluate LA function in patients with or without paroxysmal atrial fibrillation (PAF) using 2DST.
We studied 111 patients (68 men, age 62 ± 16 years) with (n = 53) or without (n = 58) PAF. After constructing time-LA volume curves from the apical four and two chamber views (iE33, Philips with QLAB 6.0, Philips Medical Systems, Bothell, WA, USA), maximal LA volume (LAVmax), preatrial contraction LA volume (LAVpreA), and minimum LA volume (LAVmin) were obtained. Then, LA reservoir volume (ARV=LAVmax-LAVmin) and active emptying volume (AEV=LAVpreA-LAVmin) were calculated to determine ARV/LAVmax as reservoir function and AEV/LAVpreA as booster pump function.
PAF was associated with greater LAVmax than that in controls (80 ± 21 ml versus 65 ± 16 ml, p < 0.001) and with reduced reservoir and booster functions (ARV/LAVmax 46 ± 9% versus 52 ± 7%; AEV/LAVpreA 29 ± 10% versus 36 ± 6%, p < 0.001). Multivariate logistic analysis demonstrated that ARV/LAVmax and AEV/LAVpreA were closely associated with the existence of PAF.
These results demonstrate that the present 2DST enables determining LA reservoir and booster functions, providing insights into the diagnosis of PAF.
Journal of Cardiology 10/2010; 57(1):89-94. · 1.28 Impact Factor
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Ayako Takahashi,
Tomoko S. Kato,
Noboru Oda,
Kazuo Komamura,
Hideaki Kanzaki,
Masaki Asakura, Kazuhiko Hashimura,
Kazuo Niwaya,
Toshiaki Funatsu,
Takeshi Nakatani,
Junjiro Kobayashi,
Soichiro Kitamura,
Toshiaki Shishido,
Shigeki Miyata,
Jun C. Takahashi,
Koji Iihara,
Masafumi Kitakaze
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ABSTRACT: Background
Intracerebral hemorrhage (ICH) is one of the most serious complications in patients supported by a left ventricular assist device (LVAD). We evaluate the efficacy of prothrombin complex concentrate (PCC) for rapid reversal of warfarin-induced anticoagulation in this population.
Methods
A total of 38 consecutive ICH events in patients supported by an LVAD between 1996 and 2007 were retrospectively reviewed. Fourteen ICH events were treated with fresh frozen plasma (FFP) (Group FFP) and 24 ICH events were treated with PCC (Group PCC). The efficacy and outcome of PCC administration versus FFP were evaluated.
Results
The proportion of patients surviving after an ICH event was significantly smaller in Group FFP than Group PCC (35.7% vs. 75.0%, p < 0.05). None of the patients in Group FFP were able to undergo heart transplantation, whereas 21.4% patients in Group PCC successfully underwent heart transplantation.
Conclusion
Patients on LVAD are in need for intensified anticoagulation and are at high risk of ICH; therefore, adequate use of PCC in the event of ICH could be of importance for survival and allow subsequent heart transplantation.
nternational Journal of Gerontology. 09/2010; 4(3):143-147.
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Taro Sasaoka,
Tomoko S Kato,
Kazuo Komamura,
Ayako Takahashi,
Ikutaro Nakajima,
Noboru Oda,
Akihisa Hanatani,
Akiko Mano,
Masanori Asakura, Kazuhiko Hashimura,
Kazuo Niwaya,
Toshihiro Funatsu,
Junjiro Kobayashi,
Soichiro Kitamura,
Toshiaki Shishido,
Kyoichi Wada,
Shigeki Miyata,
Takeshi Nakatani,
Mitsuaki Isobe,
Masafumi Kitakaze
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ABSTRACT: The majority of heart transplant (HTx) candidates require left ventricular assist device (LVAD) support for more than 2 years before transplantation in Japan. However, the only currently available device is the extracorporeal pulsatile LVAD. The long-term management of extracorporeal LVAD support has improved remarkably over the years. To determine which post-operative management factors are related to the long-term survival of patients on such LVAD, we retrospectively compared the incidence of complications and their management strategies between the initial and recent eras of LVAD use, classified by the year of LVAD surgery.
Sixty-nine consecutive patients supported by extracorporeal pulsatile LVAD as a bridge to HTx between 1994 and 2007 were reviewed retrospectively. The patients were assigned according to the time of LVAD surgery to either group A (n=30; between 1994 and 2000) or group B (n=39; between 2001 and 2007).
Patients in group B survived significantly longer on LVAD support than those in group A (674.6 vs. 369.3 days; p<0.001). The 1- and 2-year survival rates were significantly higher in group B than that in group A (82% vs. 48%, p<0.0001; 68% vs. 23%, p<0.0001, respectively). The proportion of deaths due to cerebrovascular accidents was lower (17% vs. 50%, p<0.001) in group B compared with group A. The incidences of systemic infection were similar in both groups, but the proportions of patients alive and achieving transplant surgery after systemic infection were higher in group B than those in group A (55% vs. 14%, p<0.01; 14% vs. 36%, p<0.05, respectively).
The long-term survival of patients even on "first-generation" extracorporeal LVAD has improved significantly in the recent era. Careful management of cerebrovascular accidents and systemic infection will play important roles in the long-term LVAD management.
Journal of Cardiology 09/2010; 56(2):220-8. · 1.28 Impact Factor
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Takahiro Sato,
Hideaki Kanzaki,
Yoshio Ishida,
Makoto Amaki,
Takahiro Ohara,
Takuya Hasegawa, Kazuhiko Hashimura,
Satoshi Nakatani,
Naoaki Yamada,
Yoshihiko Ikeda,
Hatsue Ueda-Ishibashi,
Masafumi Kitakaze
Circulation Journal 09/2010; 74(11):2477-8. · 3.77 Impact Factor
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Tomoko S Kato,
Kazuo Komamura,
Yusuke Sata,
Hatsue Ishibashi-Ueda,
Yoshihiko Ikeda,
Taka-aki Matsuyama,
Hideo Izawa,
Mitsuhiro Yokota,
Toshiaki Shishido,
Takeshi Nakatani,
Soichiro Kitamura,
Masaki Asakura, Kazuhiko Hashimura,
Masafumi Kitakaze
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ABSTRACT: The aim of the present study was to investigate the relationship between rejections and gene expression of Ca(2+)-handling proteins in heart transplant recipients. Thirty-seven heart transplant recipients underwent routine endomyocardial biopsy. Levels of sarcoplasmic reticulum Ca(2+)-ATPase (SERCA2) and ryanodine receptor-2 mRNAs in endomyocardial tissue were quantified by a real-time quantitative reverse transcription polymerase chain reaction (RT-PCR) method. Rejections were diagnosed according to the conventional International Society for Heart and Lung Transplantation criteria. Patients were classified as follows; group AR(+) (n = 9) with rejection grade of 2 or higher versus group AR(-) (n = 28) with rejection grade of 0, 1a or 1b at the time of biopsy, and group Rec-AR(+) (n = 6) with a history of more than 4 episodes of treatment required rejection versus group Rec-AR(-) (n = 31) without history of recurrent rejection. The mRNA levels of the SERCA2/GAPDH ratio and ryanodine receptor-2/GAPDH ratio were not different between group AR(+) and group AR(-); however, they were reduced in group Rec-AR(+) more than in group Rec-AR(-) (0.83 +/- 0.07 versus 0.90 +/- 0.07, P = 0.034, 0.74 +/- 0.06 versus 0.84 +/- 0.10, P = 0.027, respectively). A single episode of on-going rejection would not affect myocardial Ca(2+)-handling proteins; however, cumulative rejection episodes might alter the gene expression of myocardial Ca(2+)-handling proteins in heart transplant recipients.
International Heart Journal 07/2010; 51(4):259-63. · 1.16 Impact Factor
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Noboru Oda,
Tomoko S Kato,
Kazuo Komamura,
Akihisa Hanatani,
Akiko Mano, Kazuhiko Hashimura,
Masanori Asakura,
Kazuo Niwaya,
Toshihiro Funatsu,
Junjiro Kobayashi,
Kyoichi Wada,
Shuji Hashimoto,
Hatsue Ishibashi-Ueda,
Yukiko Nakano,
Yasuki Kihara,
Masafumi Kitakaze
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ABSTRACT: The number of heart transplant (HTx) surgeries in Japan is expected to increase under the Revised Organ Transplant Law. To date, among 69 HTx surgeries performed in Japan, 27 operations (39.1%) were performed at our institution, the National Cardiovascular Center (NCVC), located in Osaka. We have reviewed the outcomes of HTx conducted at NCVC during a 10 year period (May 1999 to January 2009). Among 27 heart transplant recipients at NCVC, the clinical charts of 26 recipients whose post-HTx period exceeded 1 year were retrospectively reviewed and compared to data from the International Society for Heart and Lung Transplantation (ISHLT) Registry. The survival rate of our recipients was 96.2% at 10.8 years, which was excellent even compared to the ISHLT Registry. The immunosuppressive regimen at NCVC was equivalent to that of the ISHLT Registry, except for more frequent use of Muromonab-CD3 (26.9% versus 3.3%, P < 0.0001) and an initial CSA-based regimen (65.3% versus 34.4%, P < 0.001). The drug we use for induction therapy has been recently changed from Muromonab-CD3 to Basiliximab. The incidences of post-HTx hypertension, diabetes, hyperlipidemia, and renal insufficiency were significantly less in patients at NCVC compared to those in the ISHLT Registry, however, the incidence of transplant coronary artery disease (TxCAD) was almost identical. Clinical review of post-HTx outcome at NCVC can provide useful information for Japanese transplant cardiologists who will engage in HTx management.
International Heart Journal 07/2010; 51(4):264-71. · 1.16 Impact Factor
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ABSTRACT: Non-invasive diagnosis of rejection is a major objective in the management of heart transplant recipients. The ability of strain rate (SR) imaging on echocardiograms to detect rejection in heart transplant recipients was investigated.
A total of 396 endomyocardial biopsies, right-heart catheterisation and echocardiograms were performed in 35 heart transplant recipients. Mean values of systolic strain (epsilon(sys)), peak systolic SR (SR(sys)), and peak early diastolic SR (SR(dia)) obtained from eight left ventricular segments were calculated.
According to the conventional International Society for Heart and Lung Transplantation criteria, 351 biopsies showed a rejection grade (acute rejection, AR) of 0 or 1a (group AR(-)) whereas 45 biopsies showed a grade of 1b or higher (group AR(+)). The epsilon(sys), SR(sys) and SR(dia) were significantly different between group AR(+) and group AR(-) (-20.7+/-8.0 vs -32.6+/-6.3%, p<0.0001, 2.5+/-1.8 vs 3.6+/-1.1/s, p<0.0001, and -1.9+/-1.6 vs -3.5+/-1.3/s, p<0.001, respectively). Multivariate analysis identified epsilon(sys) (p<0.0001) as a strong predictor for group AR(+), and epsilon(sys) cut-off value of -27.4% was associated with a predictive accuracy of 82.3%. The combination of epsilon(sys) and SR(dia) discriminated group AR(+) from group AR(-) with a predictive accuracy of 84.8%. The pulmonary artery wedge pressure was higher in group AR(+) than that in group AR(-) (7.4+/-3.0 vs 9.4+/-4.4 mm Hg, p<0.05).
SR imaging is of potential clinical value for monitoring acute rejection in heart transplant recipients.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2010; 37(5):1104-10. · 2.40 Impact Factor
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ABSTRACT: Identifying patients at high risk for the occurrence of atrial fibrillation is one means by which subsequent thromboembolic complications may be prevented. Left atrial enlargement is associated with progression of atrial remodeling, which is a substrate for atrial fibrillation, but impaired atrial pump function is also another aspect of the remodeling. Our objective was to differentiate patients with a history of paroxysmal atrial fibrillation using echocardiography. We studied 280 hypertensive patients (age: 66+/-7 years; left ventricular ejection fraction: 65+/-8%), including 140 consecutive patients with paroxysmal atrial fibrillation and 140 age- and sex-matched control subjects. Left atrial volume was measured using the modified Simpson method at both left ventricular end systole and preatrial contraction and was indexed to body surface area. Peak late-diastolic mitral annular velocity was measured during atrial contraction using pulsed tissue Doppler imaging as an atrial pump function. Left atrial volume index measured at left ventricular end systole had a 74% diagnostic accuracy and a 71% positive predictive value for identifying patients with paroxysmal atrial fibrillation; these values for the ratio of left atrial volume index at left ventricular end systole to the peak late-diastolic mitral annular velocity were 82% and 81%, respectively, and those for the ratio of left atrial volume index at preatrial contraction to the peak late-diastolic mitral annular velocity were 86% and 90%, respectively. In conclusion, left atrial size combined with atrial pump function enabled a more accurate diagnosis of a history of paroxysmal atrial fibrillation than conventional parameters.
Hypertension 04/2010; 55(5):1150-6. · 6.21 Impact Factor
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ABSTRACT: A 19-year-old man was admitted for severe traumatic tricuspid regurgitation (TR) 4 months after a traffic accident. Transthoracic echocardiography revealed severe TR, with an abnormal chordal structure. Three-dimensional echocardiography showed widely lacerated right ventricular endocardium involving many subvalvular components. In this case of traumatic TR, three-dimensional echocardiography was useful not only for its diagnosis but also in providing important information for surgical decision making.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 02/2010; 23(8):903.e1-3. · 2.98 Impact Factor
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ABSTRACT: Understanding the clinical characteristics of transthyretin familial amyloid polyneuropathy (TTR-FAP) is critical for early diagnosis and timely referral for liver transplantation. Here, we describe a 52-year-old man who had slight paresthesia for four years and whose final diagnosis of TTR-cardiac amyloidosis caused by sporadic FAP was delayed despite annual electrocardiography. Curative liver transplantation was postponed because of progressive cardiac involvement. This experience highlights the difficulties associated with diagnosing TTR-FAP, especially when it is sporadic, and underscores the importance of slight changes in ECG that could indicate FAP.
Internal Medicine 01/2010; 49(2):139-44. · 0.94 Impact Factor
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ABSTRACT: Congenital diseases causing an obstruction of the right ventricular outflow are difficult to precisely diagnose, especially in elderly patients. Here, we describe a 76-year-old woman who presented to our hospital with shortness of breath on exertion and was finally diagnosed as infundibular pulmonary stenosis by multiple modalities. Surgery was successfully performed and the symptom was relieved. This case underscored the usefulness of multiple modalities for the precise assessment of the right ventricular outflow obstruction and the effectiveness of surgery even in elderly patients with infundibular pulmonary stenosis.
Internal Medicine 01/2010; 49(6):563-7. · 0.94 Impact Factor
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ABSTRACT: Reversible posterior leukoencephalopathy syndrome (RPLS) is one of the important adverse events following organ transplantation, associated with calcineurin inhibitors (CNIs). We describe a case of 54-year-old woman, who was diagnosed with RPLS within weeks after transplantation. Considering the risk of causing fatal rejection by discontinuation of CNIs, the immunosuppressive regimen of the patient was switched from a cyclosporine A-based regimen to a tacrolimus-based regimen. The patient recovered rapidly from RPLS following the switch to tacrolimus. This case demonstrated that not only discontinuation but also a substitution of CNIs would be a valid treatment option for RPLS in transplant recipients.
Internal Medicine 01/2010; 49(11):1013-6. · 0.94 Impact Factor
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Kazuhiro Nakao,
Teruo Noguchi,
Jiyoong Kim,
Kazuto Fukushima,
Keisuke Kiso,
Takahiro Ohara,
Hideaki Kanzaki, Kazuhiko Hashimura,
Naoaki Yamada,
Yoshio Ishida,
Masahumi Kitakaze
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ABSTRACT: Constrictive pericarditis occurs following pericardial fibrosis and often leads to refractory right side heart failure. Surgical relief is often required for correction of hemodynamic abnormalities. Two recent reports described a transient form of constrictive pericarditis that resolved without surgical intervention. In this case, we present representative images of transient constrictive pericarditis detected by late gadolinium enhancement of cardiac magnetic resonance, 67Ga scintigraphy, and 18FDG positron emission tomography before and after corticosteroid therapy. This is the first demonstration of the utility of imaging modalities in the diagnosis of transient constrictive pericarditis, and we document radiologic changes in pericardial inflammation after medical therapy.
International journal of cardiology 06/2009; 137(3):e70-2. · 7.08 Impact Factor
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Haruhiko Higashi,
Kazuo Komamura,
Noboru Oda,
Tomoko S Kato,
Masanobu Yanase,
Akiko Mano,
Shuji Hashimoto,
Kyoichi Wada,
Toshiaki Shishido, Kazuhiko Hashimura,
Masafumi Kitakaze,
Soichiro Kitamura,
Takeshi Nakatani
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ABSTRACT: Thermal therapy for heart failure is recognized to improve clinical symptoms. We describe our experience with appendicular thermal therapy applied to a patient fitted with an extracorporeal left ventricular assist device (LVAD) who was wait-listed for a heart transplant. A 21-year-old male with end-stage heart failure due to dilated cardiomyopathy was fitted with a LVAD. His general condition stabilized after LVAD placement and the status of his heart failure has remained at NYHA class II for the past 13 months. However, his cardiac function did not sufficiently recover to discontinue LVAD support. We conducted appendicular thermal therapy using a steam foot bath and heated gloves for 2 weeks. Immediately after thermal therapy, his average sublingual temperature increased from 36.3 to 37.0 degrees C and the grade of mitral regurgitation, as well as LV ejection fraction and endothelial function improved. Furthermore, levels of oxidative and anti-oxidative stress markers decreased and increased, respectively, after 2 weeks of therapy. No complications developed. We conclude that appendicular thermal therapy was safe in this patient waiting for a heart transplant and who had an extracorporeal LVAD, and that the procedure might be beneficial for others with end-stage heart failure.
Journal of Cardiology 05/2009; 53(2):301-5. · 1.28 Impact Factor
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ABSTRACT: In a 57-year-old woman who was referred as refractory diastolic heart failure, dobutamine stress echocardiography facilitated the diagnosis of acute worsening of mitral regurgitation accompanied with latent left ventricular outflow tract obstruction as a cause of recurrent flash pulmonary edema. Echocardiography revealed the presence of sigmoid septum and concentric left ventricular hypertrophy, being consistent with hypertensive heart disease. Dobutamine induced systolic anterior motion of the mitral valve (SAM) with massive mitral regurgitation, resulting in sudden hypotension with dyspnea. The class Ia antiarrhythmic drug, cibenzoline, reduced the SAM during a dobutamine stress test, followed by no recurrence of flash pulmonary edema.
Internal Medicine 02/2009; 48(2):95-9. · 0.94 Impact Factor
