scholarly journals P1355NEW SURGICAL TECHNIQUE TO CONTROL EXCESS VASCULAR ACCESS BLOOD FLOW

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
KIYOSHI IKEDA
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Cardiac Function ◽  
Vascular Access ◽  
Shortness Of Breath ◽  
Dialysis Patients ◽  
New Device ◽  
Surgical Method ◽  
Patients With Heart Failure ◽  
One Year

Abstract Background and Aims During dialysis, if blood flow rate increases above 1500ml/min. there is an increase in pulsation and a high possibility of heart failure. In the long run, it can cause valvular disease and arrhythmia. In EDTA 2015, we presented a method of blood flow suppression for dialysis patients who had heart failure caused by excessive blood flow. However, within one year, 30% of the cases had relapsed. To solve this problem, we were able to prevent the recurrence of excess blood flow through improvement measures with a new device. Report including theoretical mechanisms. During vascular access excessive shunt blood flow creates a heavy load on cardiac function. Performing blood flow control surgery on dialysis patients with heart failure symptoms improves said function. Depending on the surgical method, it may recur. For this reason, we devised a surgical method that theoretically considers recurrence suppression. Method Clinical symptoms before surgery were based on trial hemodialysis patients with significant arrhythmia and shortness of breath at the time of exertion (6 males 4 females) using EPTFE of 4mm in diameter and 4cm in length or more replaced veins extended from anastomosis. (As shown in Poiseuille's law, it is necessary to replace veins with a shunt of smaller diameter but longer length than the vein being replaced.) The point of insertion at the anastomosis portion of the artery is 4mm. In order to connect to the larger section of the vein to the other end, it is cut diagonally to make the connection secure. During the operation, blood flow was monitored using ultrasound. The central side of the tibia artery was also tied off in some cases to control blood flow. Results Blood flow was reduced to 787 ml/min immediately after surgery from 1970ml/min before surgery, 1007ml after 6 months, and 721 ml/min after one year. Symptoms of arrhythmia disappeared in two patients during surgery and in all cases shortness of breath during exertion disappeared the day after surgery. Cardiac index improved three months after surgery in three cases. In none of the cases did we observe the complete rekindling of blood flow after one year. The average blood flow was less than 63% of the rate before surgery. Conclusion Replacement of 4cm or more length sections of veins with a 4mm diameter graft was useful in improving cardiac function in dialysis patients with heart failure.

Catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O.M Aldaas ◽  
F Lupercio ◽  
C.L Malladi ◽  
P.S Mylavarapu ◽  
D Darden ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Systematic Review ◽  
Catheter Ablation ◽  
Ejection Fraction ◽  
Meta Analysis ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure ◽  
One Year

Abstract Background Catheter ablation improves clinical outcomes in symptomatic atrial fibrillation (AF) patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, the role of catheter ablation in HF patients with a preserved ejection fraction (HFpEF) is less clear. Purpose To determine the efficacy of catheter ablation of AF in patients with HFpEF relative to those with HFrEF. Methods We performed an extensive literature search and systematic review of studies that compared AF recurrence at one year after catheter ablation of AF in patients with HFpEF versus those with HFrEF. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method for dichotomous variables, where a RR<1.0 favors the HFpEF group. Results Four studies with a total of 563 patients were included, of which 312 had HFpEF and 251 had HFrEF. All patients included were undergoing first time catheter ablation of AF. Patients with HFpEF experienced similar recurrence of AF one year after ablation on or off antiarrhythmic drugs compared to those with HFrEF (RR 0.87; 95% CI 0.69–1.10, p=0.24), as shown in Figure 1. Recurrence of AF was assessed with electrocardiography, Holter monitoring, and/or event monitoring at scheduled follow-up visits and final follow-up. Conclusion Based on the results of this meta-analysis, catheter ablation of AF in patients with HFpEF appears as efficacious in maintaining sinus rhythm as in those with HFrEF. Funding Acknowledgement Type of funding source: None

scholarly journals Aspartate aminotransferase to alanine aminotransferase ratio is associated with frailty and mortality in older patients with heart failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Daichi Maeda ◽  
Nobuyuki Kagiyama ◽  
Kentaro Jujo ◽  
Kazuya Saito ◽  
Kentaro Kamiya ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Patients ◽  
Early Recognition ◽  
Walk Distance ◽  
Failure Data ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
One Year ◽  
Independent Marker

AbstractFrailty is a common comorbidity associated with adverse events in patients with heart failure, and early recognition is key to improving its management. We hypothesized that the AST to ALT ratio (AAR) could be a marker of frailty in patients with heart failure. Data from the FRAGILE-HF study were analyzed. A total of 1327 patients aged ≥ 65 years hospitalized with heart failure were categorized into three groups based on their AAR at discharge: low AAR (AAR < 1.16, n = 434); middle AAR (1.16 ≤ AAR < 1.70, n = 487); high AAR (AAR ≥ 1.70, n = 406). The primary endpoint was one-year mortality. The association between AAR and physical function was also assessed. High AAR was associated with lower short physical performance battery and shorter 6-min walk distance, and these associations were independent of age and sex. Logistic regression analysis revealed that high AAR was an independent marker of physical frailty after adjustment for age, sex and body mass index. During follow-up, all-cause death occurred in 161 patients. After adjusting for confounding factors, high AAR was associated with all-cause death (low AAR vs. high AAR, hazard ratio: 1.57, 95% confidence interval, 1.02–2.42; P = 0.040). In conclusion, AAR is a marker of frailty and prognostic for all-cause mortality in older patients with heart failure.

scholarly journals SELENIUM DEFICIENCY IN PATIENTS WITH HEART FAILURE ENHANCES THE OXIDATIVE STRESS AND AGGRAVATES THE IMPAIRMENT OF CARDIAC FUNCTION

2011 ◽  
Vol 57 (14) ◽  
pp. E353
Author(s):  
Yuji Hiraoka ◽  
Akihiro Nakayama ◽  
Yutaka Iida ◽  
Hiroyuki Yasui ◽  
Tadashi Matsumura ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Heart Failure ◽  
Cardiac Function ◽  
Selenium Deficiency ◽  
Patients With Heart Failure

Abstract 1785: Renal Artery Angioplasty Improves Diastolic Cardiac Function In Patients With heart failure Possessing Renal Artery Stenosis.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Eisei Yamamoto ◽  
Hitoshi Takano ◽  
Hiroyuki Tajima ◽  
Jun Tanabe ◽  
Hidekazu Kawanaka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Blood Flow ◽  
Cardiac Function ◽  
Renal Artery ◽  
Renal Blood Flow ◽  
Renal Artery Stenosis ◽  
Arterial Blood Pressure ◽  
Arterial Blood ◽  
Diastolic Cardiac Function

Background: Renal artery stenosis (RAS) often plays an important role not only in malignant hypertension but also in sudden development of heart failure (HF) so called ‘flash pulmonary edema’ or chronic HF refractory to medical treatment. One of the possible mechanisms whereby RAS affects these unique conditions of HF is suppression of LV compliance through the complex interaction between neurohormonal systems originating from the reduction of renal blood flow. Renal artery angioplasty is expected to be an effective treatment for restoring renal blood flow in patients with RAS. The aim of the present study was whether the angioplasty can improve the impaired neurohormonal systems and diastolic cardiac function in patients with RAS. Methods: A prospective analysis was performed in 18 HF patients with RAS (age: 72±6, 3 females, NYHA I/II/III: 5/9/4) who underwent renal artery angioplasty between 2005 and 2007. Four patients with significant bilateral RAS and 3 patients with unilateral RAS in the vessel supplying a functional solitary kidney were included. We monitored the changes of biochemical and neurohormonal markers and blood pressure. Cardiac function was evaluated by tissue Doppler echocardiogram before and 3 months after the procedure. Results: Technical success was achieved in all interventions. The results are shown in table . Systolic arterial blood pressure significantly decreased by renal angioplasty. B-type natriuretic peptide (BNP) was significantly reduced 3 months after the angioplasty, whereas the change of sCr or angiotensinII was not statistically significant. Myocardial early diastolic velocity (Em), a parameter of diastolic LV function, was significantly improved compared with that measured before the procedure. Conclusions: In patients with either overt or latent HF possessing RAS, renal artery angioplasty not only decreases arterial blood pressure but also improves diastolic cardiac function in parallel with the reduction of BNP level.

A plain language summary of the EXPLORER-HCM study: mavacamten for obstructive hypertrophic Cardiomyopathy

2021 ◽  
Author(s):  
Cynthia Burstein Waldman ◽  
Anjali Owens
Keyword(s):  
Heart Failure ◽  
Blood Flow ◽  
Hypertrophic Cardiomyopathy ◽  
Well Being ◽  
Daily Activities ◽  
Shortness Of Breath ◽  
Plain Language ◽  
Clinical Trial Registration ◽  
Obstructive Hypertrophic Cardiomyopathy ◽  
Active Substances

Mavacamten is an investigational therapy for the treatment of hypertrophic cardiomyopathy (HCM), a condition where the heart muscle wall thickens, becomes stiff, and makes it harder for the heart to pump blood. In obstructive HCM (sometimes referred to as oHCM or HOCM), the thickened muscle also blocks blood flow from the heart. The EXPLORER-HCM trial compared mavacamten to placebo (a pill with no medicine/active substances) in symptomatic people with obstructive HCM who had exercise limitations and suffered from shortness of breath, tiredness, palpitations, and chest pain. The study showed that mavacamten reduced the obstruction that restricts blood flow and improved people’s symptoms, well-being, and ability to participate in daily activities. Side effects, such as irregular heartbeat, palpitations, rapid heartbeat, and heart failure, were similar for people who received mavacamten or placebo. To read the full Plain Language Summary of this article, click on the View Article button above and download the PDF. Clinical Trial Registration: NCT03470545 ( ClinicalTrials.gov )

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