The long-term outcome of asymptomatic patients with severe AS was dismal when managed conservatively in this real-world analysis and might be substantially improved by an initial AVR strategy. (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis Registry; UMIN000012140).

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Cachexia is associated with a high risk of death in heart failure (HF) patients [1,2]. Right ventricular dysfunction (RVD) reportedly often coexists with cachexia and is associated with accelerated weight loss, abnormal body composition, and a worsened prognosis in advanced HF [3]. Multiple mechanisms are thought to be involved in the development of cardiac cachexia. In particular, this condition is related to hemodynamics of HF including pulmonary hypertension [4] as well as increased neurohumoral and cytokine responses [5,6], impaired gastrointestinal function [7], and an increased metabolic rate [8].However, only a few studies have investigated pulmonary arterial hypertension (PAH) and nutritional status [9]. In the present study, we sought to examine the relationships among nutritional status, markers of congestion, and echocardiographic parameters in patients with stable PAH. Findings from the present study would provide insights on the mechanism underlying the effect of PAH alone on nutritional status.We enrolled 8 patients with stable (N6 months) pulmonary hypertension from our out-patient clinic prospectively, and written informed consent was obtained. The study conformed to the ethical guidelines of the 1975 Declaration of Helsinki and was approved by the ethical committee of Kyoto University Hospital. Patients underwent the scored Patient-Generated Subjective Global Assessment (PG-SGA) for nutritional status, blood tests, and comprehensive echocardiography. After morning fasting, patients underwent blood testing for complete blood counts, chemistry, zinc, pre-albumin, transferrin, retinol-binding proteins, and brain natriuretic peptide (BNP) levels. Glomerular filtration rate (GFR) was estimated with the CKD-EPI Creatinine Equation.Spearman's rank correlation tests were conducted to assess relationships between nonparametric variables, and multiple regression analyses were performed to exclude multicollinearity. Data were analyzed with JMP 12 software (SAS Institute, Inc., Cary, NC).Patient characteristics are summarized in Table 1. The estimated systolic pulmonary artery pressure (ePAP) and BNP levels were 82.7 ± 15.7 (mean ± SD) mm Hg and 176 ± 146 ng/L, respectively. LV diastolic diameter (LVDd) was negatively correlated with ePAP (rs = − 0.76, p = 0.04), which implied a dilated RV and compressed LV. Body mass index (BMI) was positively correlated with white blood cell count (WBC, rs = 0.84, p = 0.03) and fasting insulin levels (rs = − 0.57, p = 0.03) and negatively correlated with aspartate aminotransferase concentration (AST, rs = −0.47, p = 0.02), serum sodium concentration (rs = − 0.60, p = 0.03), and inferior vena cava (IVC) diameter (rs = −0.76, p = 0.04). Blood urea nitrogen, a marker of protein catabolism, was positively correlated with SGA scores (rs = 0.81, p b 0.01) and BNP (rs = 0.68, p = 0.04) and negatively correlated with LV diameter (rs = − 0.87, p b 0.01). Serum pre-albumin -a rapid-turnover hepatic protein -was positively correlated with ePAP (rs = 0.70, p = 0.01) and negatively cor...

Whether patients with severe aortic stenosis (AS) die because of AS-related causes is an important issue for the management of these patients. We used data from CURRENT AS registry, a Japanese multicenter registry, to assess the causes of death in severe AS patients and to identify the factors associated with non-cardiac mortality. We enrolled 3815 consecutive patients with a median follow-up of 1176 days; the 1449 overall deaths comprised 802 (55.3%) from cardiac and 647 (44.7%) from non-cardiac causes. Heart failure (HF) (25.7%) and sudden death (13.0%) caused the most cardiac deaths, whereas infection (13.0%) and malignancy (11.1%) were the main non-cardiac causes. According to treatment strategies, infection was the most common cause of non-cardiac death, followed by malignancy, in both the initial aortic valve replacement (AVR) cohort (N = 1197), and the conservative management cohort (N = 2618). Both non-cardiac factors (age, male, body mass index <22, diabetes, prior history of stroke, dialysis, anemia, and malignancy) and cardiac factors (atrial fibrillation, ejection fraction <68%, and the initial AVR strategy) were associated with non-cardiac death. These findings highlight the importance of close monitoring of non-cardiac comorbidities, as well as HF and sudden death, to improve the mortality rate of severe AS patients.