No abstract

The low prevalence of PPM and mortality at 1 year in patients with PPM after TAVR in this Japanese cohort implies that PPM is not a risk factor for mid-term mortality in Asian patients who have undergone TAVR.

on behalf of the J-RHYTHM Registry Investigators* Background--To clarify the influence of hypertension and blood pressure (BP) control on thromboembolism and major hemorrhage in patients with nonvalvular atrial fibrillation, a post hoc analysis of the J-RHYTHM Registry was performed.

Recent evidence suggests that there is a close correlation between the physiological responses to muscle chemoreflex and the decrease in intracellular pH during ischaemia after handgrip. This study evaluated whether the relationship is linear or has an apparent threshold. We measured muscle cellular pH through phosphorous nuclear magnetic resonance spectroscopy (31P-NMR), mean arterial blood pressure (MAP) and heart rate (HR) during ischaemia after sustained handgrip exercise at 50% of maximum voluntary contraction (MVC). Contraction was sustained for 15, 30, 45 and 60 s, followed by 2 min of circulatory arrest, respectively. Muscular pH during the ischaemia decreased linearly with increasing contraction time, from the base-line level of 7.11 +/- 0.03 units (U) to 6.98 +/- 0.03, 6.90 +/- 0.04, 6.72 +/- 0.06 and 6.54 +/- 0.06 U after 15-, 30, 45-, and 60-s contractions, respectively. The MAP was 86 +/- 2 mmHg at rest and did not change during the ischaemia after 15- and 30-s contractions. However, it significantly increased to 95 +/- 2 and 107 +/- 2 mmHg, after 45- and 60-s contractions, respectively. These data indicate that the relationship between MAP and pH is not a single linear relationship, showing one breaking point around the pH of 6.90 units. It suggests that the muscle chemoreflex has a clear threshold around 6.90 units of muscle pH, and below this pH, MAP increased linearly with decreasing muscle cellular pH.

R ecently, the indication for transcatheter aortic valve replacement (TAVR) has been expanded not only to patients with degenerative aortic stenosis considered inoperable or of high surgical risk but also to those with intermediate surgical risk. [1][2][3] Thus, optimal patient risk stratification should be performed before the TAVR procedure. Frailty, which is not captured in the classical surgical risk model, is considered highly prevalent in elderly vulnerable patients and can be characterized by Background-Gait speed reflects an important factor of frailty and is associated with an increased risk of late mortality in patients with cardiac disease. This study sought to assess the prognostic value of gait speed in elderly patients who underwent transcatheter aortic valve replacement. Methods and Results-We investigated the 5-m or 15-feet gait speed (m/sec) in 1256 patients who underwent transcatheter aortic valve implantation using data from the OCEAN-TAVI Japanese multicenter registry (Optimized Catheter Valvular Intervention-Transcatheter Aortic Valve Implantation). Baseline characteristics, procedural outcomes, and all-cause mortality were compared among groups defined by differential gait speed classification: model 1, normal (>0.83 m/sec; n=563; 44.8%), slow (0.5-0.83 m/sec; n=429; 34.2%), slowest (<0.83 m/sec; n=205; 16.3%), unable to walk (n=48; 3.8%); and model 2, classification and regression tree survival model indicating the threshold of gait speed as 0.385 m/sec (>0.385 m/sec; n=1080 versus ≤0.385 m/sec; n=117). The cumulative 1-year mortality rate showed significant differences in the classical gait speed groups in model 1 (7.6%, 6.6%, 18.2%, and 40.7%, respectively; P<0.001) and survival classification and regression tree group in model 2 (7.7% versus 21.9%; P<0.001). The slowest walkers and those unable to walk demonstrated independent associations with increased midterm mortality after adjustment for several confounding factors (hazard ratio, 1.83, 4.28; 95% confidence interval, 1.03-3.26, 2.22-8.72; P=0.039, <0.001, respectively). Gait speed <0.385 m/sec determined by classification and regression tree also independently associated with worse prognosis (hazard ratio, 2.40; 95% confidence interval, 1.75-5.88; P=0.001). Conclusions-Gait speed using both traditional and specific classification is useful as a potential marker for predicting vulnerable patients associated with adverse clinical outcomes after transcatheter aortic valve replacement. (Circ Cardiovasc Interv. 2017;10:e005088.