Aims The aim of this study was to investigate whether ethnicity influences the associations between trimethylamine N-oxide (TMAO) levels and heart failure (HF) outcomes. Methods and results Trimethylamine N-oxide levels were measured in two cohorts with acute HF at two sites. The UK Leicester cohort consisted mainly of Caucasian (n = 842, 77%) and South Asian (n = 129, 12%) patients, whereas patients in the Japanese cohort (n = 116, 11%) were all Japanese. The primary endpoint was the measurement of all-cause mortality and/or HF rehospitalization within 1 year post-admission. Association of TMAO levels with outcome was compared in the entire population and between ethnic groups after adjustment for clinical parameters. TMAO levels were significantly higher in Japanese patients [median (interquartile range): 9.9 μM (5.2-22.8)] than in Caucasian [5.9 μM (3.6-10.8)] and South Asian [4.5 μM (3.1-8.4)] (P < 0.001) patients. There were no differences in the rate of mortality and/or HF rehospitalization between the ethnic groups (P = 0.096). Overall, higher TMAO levels showed associations with mortality and/or rehospitalization after adjustment for confounders (P = 0.002). Despite no differences between ethnicity and association with mortality/HF after adjustment (P = 0.311), only in Caucasian patients were TMAO levels able to stratify for a mortality/HF event (P < 0.001). Conclusions Differences were observed in the association of mortality and/or rehospitalization based on circulating TMAO levels. Elevated TMAO levels in Caucasian patients showed increased association with adverse outcomes, but not in non-Caucasian patients.

The appropriate indication for, management of and limitations to extracorporeal life support (ECLS) and the timing of a switch to a ventricular assist device (VAD) remain controversial issues in patients with acute myocardial infarction (AMI) complicated with cardiogenic shock or cardiopulmonary arrest. To evaluate and discuss these issues, we studied patients with AMI treated with ECLS and compared deceased and discharged patients. Thirty-eight patients with AMI who needed ECLS [35 men (92.1 %), aged 59.9 ± 13.5 years] were enrolled in this study. Of these 38 patients, 34 subsequently underwent percutaneous coronary intervention (PCI), and four subsequently received coronary artery bypass grafting (CABG). Fourteen patients (36.8 %) were discharged from the hospital. The outcome was not favorable for those patients with deteriorating low output syndrome (LOS) and the development of leg ischemia, hemolysis and multiple organ failure during ECLS. Levels of creatine kinase, creatine kinase-MB (CK-MB), lactate dehydrogenase, serum creatinine (Cr) and amylase after the patient had been put on ECLS and fluctuation of the cardiac index, blood pressure, arterial blood gas analysis and CK-MB and Cr levels during ECLS were indicators to switch from the ECLS to VAD. In the case of patients with no complication associated with ECLS, 4.6-5.6 days after initiation of ECLS was assumed to be the threshold to decide whether to switch from ECLS to VAD. Patients with AMI who suddenly developed refractory pulseless ventricular tachycardia or ventricular fibrillation without deteriorating LOS and who underwent successful PCI or CABG, and who prevented the complications associated with ECLS, showed a high probability of recovering with ECLS.

Major adverse cardiovascular events (MACEs), such as stroke and myocardial infarction (MI), are the most common cause of death worldwide (the second leading cause in Japan), and their prevention is critical in healthcare. 1-3 Hypertension, hyperlipidemia, and diabetes mellitus are known risk factors for MACEs, and a number of pharmaceutical agents have been developed to control the risk

sex in heart failure populations, the results are conflicting. 13, 14 This may explain why data were unable to discriminate between BNP and NT-proBNP in heterogeneous heart failure populations, yielding inconsistent results.The aim of this study was therefore to investigate differences between BNP and NT-proBNP with regard to cardiovascular events and extend the search for this difference to sex, in a large clinical population with cardiovascular risk factors. Methods SubjectsWe used baseline data from the Japan Morning SurgeHome Blood Pressure (J-HOP) Study. The protocol of the J-HOP study has been published (Supplementary File 1). 15 Briefly, the J-HOP study is a prospective observational study (University Hospital Medical Information Network Clinical Trials Registry, UMIN000000894) evaluating the use of home blood pressure (BP) measurements to predict S erum levels of natriuretic peptide hormones, in particular brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP), are useful biomarkers for ruling out heart failure, 1-3 as well as strong prognostic markers for cardiovascular events in not only heart failure and hypertensive populations but also the general population. 4-6 BNP, in contrast to NT-proBNP, is biologically active when released into the circulation. 7, 8 In some studies comparing the utility of BNP and NT-proBNP for heart failure screening and prognostic value for cardiovascular events, no practical difference was observed. 3,9 The value of those studies, however, was limited by their evaluation of selected patients. One study involved a small sample of patients with suspected heart failure, 3 and another study was performed in a stable and symptomatic heart failure population. 9 In addition, both BNP and NT-proBNP are higher in women than in men. Background: Brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are prognostic biomarkers. Although these 2 peptides differ with regard to biological characteristics, there are few reports on the differences between BNP and NT-proBNP with regard to cardiovascular events or according to sex.

Appropriate patient selection for PCPS in cases of O-CPA is likely to give a similar survival rate as for I-CPA. Patient selection and reversibility of the underlying disease and clinical state after starting PCPS affect the prognosis. Aggressive diagnosis and therapy for the underlying disease and prevention of complications associated with PCPS are essential factors in successful discharge of patients. Patients with an unknown etiology are not expected to fully recover, despite PCPS.