Percutaneous aspiration of a right atrial thrombus with the AngioVac system

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Right atrium enlargement predicts clinically significant supraventricular arrhythmia in patients with pulmonary arterial hypertension

BACKGROUND

Right atrial (RA) enlargement is a common finding in patients with pulmonary arterial hypertension (PAH) and an important predictor of mortality, however its relation to the risk of atrial arrhythmias has not been assessed.

OBJECTIVES

To assess whether RA enlargement is associated with supraventricular arrhythmias (SVA) and whether it predicts new clinically significant SVA (csSVA).

METHODS

Patients with PAH were recruited between January 2010 and December 2014 and followed until January 2017. csSVA was diagnosed if it resulted in hospitalization. To assess predictors of new csSVA, only patients without a history of SVA at baseline were analyzed.

RESULTS

Among 97 patients, any SVA was observed in 45 (46.4%) and included permanent atrial fibrillation(AF, n = 8), paroxysmal AF (n = 10), permanent atrial flutter (AFl, n = 1), paroxysmal AFl (n = 2) or other types of supraventricular tachycardia (n = 24). Patients with SVA as compared to patients without SVA were characterized by older age, lower distance in a 6-minute test, higher NT-proBNP, higher RA area index (RAai), left atrial area index, mean right atrial pressure (mRAP) and were more commonly treated with β-blocker. Eighty five patients who were in sinus rhythm at baseline assessment and had no history of significant SVA were observed for 37 ± 19.9 months. During that time csSVA occurred in 15.3%. In univariate models, the occurrence of csSVA were predicted by age, right ventricular ejection fraction, right ventricular end diastolic index, RAai and mRAP, but in multivariate model only RAai remained significant predictor for csSVA (HR of 1.23, 95%CI: 1.11-1.36, p < 0.001). The optimal threshold for RA enlargement as discriminator of csSVA was 21.7 cm2/m2.

CONCLUSIONS

In PAH patients RA enlargement is associated with increased prevalence of SVA. RAai is an independent predictor of hospitalization due to csSVA.

Pulmonary artery pulse wave velocity in idiopathic pulmonary arterial hypertension

BACKGROUND

Idiopathic pulmonary artery (PA) hypertension (IPAH) is associated with severe PA remodelling. Although the resulting increase in pulse wave velocity (PWV) might be of major pathophysiological relevance, little is known about PA-PWV in IPAH. The aim of this study was to characterize PA-PWV and its predictors in patients with IPAH.

METHODS

We studied 26 consecutive patients with incident IPAH aged 55.0 (45.0-66.0) years (62% female) and 10 control subjects without pulmonary hypertension. PA-PWV was measured invasively; PA wall thickness and diameter were assessed using intravascular and transthoracic ultrasonography.

RESULTS

PA-PWV was higher in IPAH than in control subjects (10.0 [7.5-14.0] m/s vs 3.5 [1.9-4.0] m/s; P < 0.001) as was also PA diameter and PA wall thickness. In IPAH patients, in univariate analysis PA-PWV was greater in men than in women and in patients with body mass index (BMI) < 25 kg/m(2) than with BMI ≥ 25 kg/m(2) and correlated positively with symptomatic disease duration, mean PA pressure, pulmonary vascular resistance, creatinine level, and negatively with low-density lipoprotein (LDL) cholesterol and triglyceride level but not with PA diameter or PA wall thickness. In multiple regression analysis mean PA pressure, LDL cholesterol level and BMI < 25 kg/m(2) were the main predictors of PA-PWV in IPAH patients (R(2) = 77%; P < 0.001).

CONCLUSIONS

PA-PWV is increased in IPAH patients. High PA pressure, low LDL cholesterol level, and BMI < 25 kg/m(2) explain most of its variability in this group.

Changes in exercise capacity and cardiac performance in a series of patients with Eisenmenger's syndrome transitioned from selective to dual endothelin receptor antagonist

BACKGROUND

Differences in clinical effects between selective and dual endothelin (ET) receptor antagonists (ERA) in patients with pulmonary arterial hypertension (PAH) are currently unknown. We aimed to assess prospectively how transition from selective (sitaxsentan) to dual (bosentan) ERA affected exercise capacity and cardiocirculatory performance in patients with Eisenmenger's syndrome.

METHODS

A series of seven stable patients with Eisenmenger's syndrome aged 40.0 (30.0-56.0) years old treated with sitaxsentan were assessed before and three months after transition to bosentan. Six minute walk test and magnetic resonance to assess LV and RV mass, volume and ejection fraction, and pulmonary flow, and laboratory tests were performed.

RESULTS

We observed an increase in LV mass [96.5 (66.0-116.0) vs. 123.0 (93.0-146.0)g; p=0.03], LV ejection fraction [55.0 (44.0-63.0) vs. 65.0 (58.0-70.0)%; p=0.02)], and pulmonary flow [64 (53.0-71.0) vs. 69.0 (55.0-84.0)ml/beat; p=0.046]. This was accompanied by an increase of oxygen saturation, elongation of 6MWD [435.0 (378.0-482.3) vs. 474 (405.0-534.7); p=0.02], decrease of NTproBNP level and increase of ET-1 level.

CONCLUSIONS

Three month follow-up of stable patients with Eisenmenger's syndrome transitioned from sitaxsentan to bosentan revealed improvement of exercise capacity despite significant elevation of ET-1 level. Concurrent increase of LV ejection fraction and pulmonary flow might have contributed to these favourable effects.

Electrocardiogram for the diagnosis of right ventricular hypertrophy and dilation in idiopathic pulmonary arterial hypertension

BACKGROUND

Currently, there are no data on the association between right ventricular (RV) structure and ECG changes specific for idiopathic pulmonary arterial hypertension (IPAH). Therefore, we aimed to assess the accuracy of the recommended ECG criteria for predicting RV hypertrophy (RVH) and dilation in patients with IPAH.

METHODS AND RESULTS

Twelve-lead ECG and cardiovascular magnetic resonance imaging (CMR) were performed in 23 consecutive patients with IPAH aged 49.8±16.3 years. ECG criteria were referred to RV mass index and RV end-diastolic volume index as measured by CMR. Only the ECG voltage criteria based on R wave amplitude in lead V1, R wave amplitude in aVR, P wave amplitude in II and ventricular activation time in V1 were useful for differentiating between patients with and without RVH. A ventricular activation time in lead V1 of <0.01 s excluded RVH, whereas R in V1 >6 mm, R:S in V1 >1, R in aVR >4 mm, R:S in V5 to R:S in V1 <0.04 and P in II >2.5 mm confirmed the diagnosis. Only the ventricular activation time in V1 correlated with RV dilation and when >0.045s confirmed its diagnosis.

CONCLUSIONS

Only a few of the recommended ECG criteria proved to be useful in the diagnosis of RVH or RV dilation in patients with IPAH. Changes in the cut-off values improved their accuracy.

Repolarization parameters in patients with acute ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention with respect to predischarge ST-T pattern: a preliminary study

BACKGROUND

Negative T wave and lack of ST segment elevation in predischarge ECG in ST-segment elevation myocardial infraction (STEMI) patients are given as markers of good prognosis. Repolarization duration, especially its late part (TpeakTend - TpTe), likewise ST-T patterns, is related to local post-myocardial infarction myocardial attributes. We analyzed the differences in QT parameters in STEMI patients with negative or not-negative T wave pattern in predischarge ECG.

METHODS

The data from 83 STEMI patients (LVEF > 45%, first MI, one-vessel disease) who underwent successful percutaneous coronary intervention of infarct-related coronary artery (TIMI 3 flow) were collected. According to ST-T patterns in predischarge ECG, the cohort was divided into two groups: 38 patients with persistent ST elevation and/or non-negative T wave pattern (STT+), and 45 patients with negative T wave, without ST elevation (STT-). QT, QTpeak, and TpTe intervals were obtained from 5 consecutive beats of sinus rhythm 60-70 bpm between 6 a.m. and 8 a.m. from Holter recording, corrected to the heart rate (HR) with Bazett's formula.

RESULTS

The study groups did not differ in gender, age, or treatment. No true antiarrhythmics were given. Both QTc and TpTec were longer in STT+ patients: 459 +/- 26 ms vs. 440 +/- 25 ms, p = 0.01 and 108 +/- 10 ms vs. 96 +/- 11 ms, p = 0.000015, respectively. Prolongation of late repolarization was found both in anterior and inferior infarction.

CONCLUSIONS

STEMI patients who underwent successful percutaneous coronary intervention of infarct-related coronary arteries and demonstrated persistent ST elevation, without negative T wave at hospital discharge, had a longer repolarization duration, especially the late phase of it. Further studies are necessary to assess the prognostic value of this finding.

SCH23390, but not raclopride, decreases intake of intraorally infused 10% sucrose in adult rats

When 10% sucrose is infused intraorally on postnatal days (PN) 7, 14, and 21, raclopride, a D2 dopaminergic antagonist, does not affect intake at any age and SCH23390, a D1 antagonist, does not affect intake on PN 7 but a large dose decreases intake on PN 14 and 21. To determine if this differential effect of the antagonists on PN 14 and 21 remains after further postnatal development, we studied adult rats in this intraoral intake test. Female (n = 77) and male (n = 81) adult rats, approximately 43 or 96 days old, were deprived for 4 h before intraoral infusion of 10% sucrose. Each rat was tested once and this was its first experience with sucrose. SCH23390 (133 or 267 micrograms/kg), raclopride (357 or 714 micrograms/kg), or saline vehicle was given IP at -15 min. The larger dose of SCH23390 significantly decreased intake of rats that were approximately 43 and 96 days old, but neither dose of raclopride changed intake at either age. These results suggest that D1, but not D2, receptors are necessary components of the central neural network that processes the unconditioned gustatory stimulus of 10% sucrose into mouthing and swallowing movements that maintain ingestion in late preweanling and adult rats under these conditions.

Raclopride decreases sucrose intake of rat pups in independent ingestion tests

To investigate the role of dopaminergic activity at D2 receptors in the mediation of the positive reinforcing effect of sucrose on ingestion in preweanling rats, we tested the effects of the D2 antagonist, raclopride, on the intake of 10% sucrose of rats on postnatal days (PN) 7, 14, and 21. Intake was measured during independent ingestion tests in which pups licked sucrose from the floor of a beaker and during oral catheter tests in which sucrose was continuously infused through an anterior, sublingual, oral catheter. Rats were tested once to eliminate the possibility that repeated test experience would affect the response to raclopride. Pretreatment with raclopride resulted in decreased intake in independent ingestion (II) tests, but not in oral catheter (OC) tests on PN 7, 14, and 21. The inhibition of intake was not due to a generalized motor deficit because raclopride did not affect latency to eat, time-sampled activity scores, or latency to withdraw the hindlimb from a raised position. These results demonstrate that dopaminergic activity at D2 receptors is necessary for the positive reinforcing effect of sucrose that maintains ingestion in the II test but not in the OC test.

Trypsin inhibitor and maternal reunion increase plasma cholecystokinin in neonatal rats

Intragastric soybean trypsin inhibitor increased plasma CCK bioactivity by 87% in nondeprived, 9-12-day-old rat pups. Reunion with the dam for 1 h after overnight maternal deprivation also increased plasma CCK significantly. These results demonstrate that CCK can be released from the small intestine of rats as early as postnatal day 9.

Intravenous infusion of CCKA-receptor antagonist increases food intake in rats

To test the hypothesis that endogenous cholecystokinin (CCK) released from the small intestine by ingested food produces a satiating effect by acting at CCKA-receptors, we measured the effect of slow continuous intravenous infusions of three doses of MK-329, a potent and selective CCKA-antagonist, on food intake during 2.5-h tests in 13 Sprague-Dawley male rats after 1 h of food deprivation. MK-329 increased food intake significantly and the lowest dose tested (0.5 mg.kg-1.h-1) produced the most consistent effect on cumulative intake. Part of the increased food intake under these conditions was due to a decrease in the satiating effect of food ingested at the first meal on the postprandial intermeal interval. These results are consistent with, but do not prove, the hypothesis that the satiating effect of endogenous CCK released from the small intestine by ingested food is mediated by CCKA-receptors.

Potency of SCH 23390 for decreasing sucrose intake in rat pups depends on mode of ingestion

To investigate the role of dopaminergic mediation of the positive reinforcing effect of sucrose during development, we tested the effects of the D-1 antagonist, SCH 23390, on the intake of 10% sucrose in 7-, 14-, and 21-day-old rats during independent ingestion (pups lick sucrose from the floor of a beaker) or during continuous intraoral infusion of sucrose. SCH 23390 inhibited intake more in independent ingestion tests than in intraoral catheter tests. At 7 and 14 days this difference was qualitative--SCH 23390 was efficacious in independent ingestion tests, but not in intraoral catheter tests. At 21 days the difference was quantitative--SCH 23390 decreased intake in both tests, but was more potent in independent ingestion tests. SCH 23390 decreased intake during independent ingestion tests without changing latency to eat or time-sampled activity scores at 7 and 14 days, but not at 21 days; thus the inhibition of intake is not accounted for by a generalized motor deficit at 7 and 14 days. Possible explanations for the differential potency include density of reinforcement, pattern of central dopamine metabolism, and interference with the appetitive movements required to maintain contact with the sucrose in the independent ingestion test.

Type-A CCK receptors mediate the inhibition of food intake and activity by CCK-8 in 9- to 12-day-old rat pups

To determine the type of cholecystokinin (CCK) receptor that mediates the inhibitory effects of peripherally administered CCK-8 on food intake and activity in 9- to 12-day-old rat pups, we gave injections of a type-A CCK receptor antagonist, MK-329, or of the type-B CCK receptor antagonist, L-365,260, prior to CCK-8 (IP). MK-329 reversed the inhibitory effects of CCK-8, but L-365,260 did not. This demonstrates that the inhibitory effects of CCK-8 (IP) are mediated by type-A, but not type-B, CCK receptors in pups of this age.