No abstract

PCT can be a useful marker to exclude bacteremia and also to predict severe bacteremia, but renal function should be taken into account.

ypertrophic cardiomyopathy (HCM) is characterized by regional hypertrophy, especially asymmetrical ventricular septal hypertrophy, and left ventricular (LV) diastolic dysfunction. 1,2 The mechanisms responsible for the myocardial ischemia associated with HCM remain unclear, and it is difficult to differentiate nonobstructive HCM from hypertensive LV hypertrophy (H-LVH). We previously showed that longitudinal strain rate (SR) imaging is able to discriminate HCM from H-LVH. 3 Radial fiber thickening varies across the different layers of the myocardial wall and is more pronounced in the endomyocardium than in the epimyocardium. 4 The endomyocardium moves faster than the epimyocardium during myocardial contraction, reflecting the rate of increase in wall thickness (WT). The endomyocardium and mid-wall of the LV play important roles in ventricular function. [5][6][7] Measurement of strain and the SR derived from tissue Doppler imaging (TDI) allows quantitative assessment of regional myocardial wall motion, reflecting both systolic and diastolic LV function, 3,8,9 especially the endomyocardial region. 10 We have now investigated the utility of endomyocardial radial strain and SR derived from TDI for assessment of regional myocardial dysfunction in patients with HCM or H-LVH. Methods Study SubjectsWe studied 14 consecutive patients with nonfamilial HCM and 16 patients with H-LVH ( Table 1). The diagnosis of HCM was based on conventional echocardiographic demonstration of a nondilated and hypertrophic LV (maximum LVWT >13 mm) in the absence of other cardiac or systemic diseases that might lead to LVH; 11 it was confirmed by cardiac catheterization, angiography, and endomyocardial biopsy. The diagnosis of H-LVH was based on conventional echocardiographic demonstration of a hypertrophic LV (maximum LVWT >12 mm) in the absence of other cardiac or systemic diseases with the exception of long-term hypertension (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, or both). All patients were in normal sinus rhythm and had a normal LV ejection fraction , and the early diastolic SR at the posterior and septal segments of the LV short axis were calculated. Endomyocardial peak strain (ε) and the absolute value of peak early diastolic SR at the posterior segment were significantly smaller in patients with HCM than in those with H-LVH, whereas the thickness of the LV posterior wall did not differ between these 2 groups. Multivariate analysis of discrimination, including the ratio of interventricular septal thickness and posterior wall thickness (IVST/PWT), ε, and SR parameters, between HCM and H-LVH patients revealed that ε at the LV posterior segment was the highest discriminant parameter (discriminant coefficient: -14.6, P=0.012). The ε at the posterior segment significantly correlated with early diastolic mitral annular velocity. Conclusions: Endomyocardial radial strain imaging may prove informative for discriminating between HCM and H-LVH. (Circ J 2009; 73: 2294 -2299

Background:Continuous positive airway pressure (CPAP) therapy has been shown to be effective in alleviating the underlying obstruction as well as reducing patients’ excessive sleepiness and improving their functioning and health-related quality of life. However, residual excessive sleepiness is observed in some patients even though CPAP therapy eliminates sleep apnea and desaturation. Objectives:The aim of this study was to determine the prognostic effect of actigraphic sleep-wake rhythm evaluation in the management of patients with obstructive sleep apnea syndrome (OSAS) treated with CPAP. Methods: Eighteen patients with OSAS diagnosed by standard polysomnography (PSG; 48.1 ± 12.5 years) were enrolled in this study. The sleep-wake parameters were determined by actigraphy before and after 1 month of CPAP treatment, and results were compared with PSG data. In addition, data obtained before CPAP were compared with those measured after 1 month of CPAP treatment. Results:The total sleep time (TST) and sleep efficiency using PSG were significantly correlated with those using actigraphy. Bland-Altman plots of TST and sleep efficiency confirmed good agreement between PSG and actigraphy data. Sleep efficiency significantly improved following CPAP compared to baseline, and sleep fragmentation and sleep fragmentation >5 min determined by actigraphy were significantly lower during CPAP therapy than at baseline. Movement was significantly lower on CPAP therapy than at baseline. Conclusions:Actigraphy provides a valuable sleep-wake rhythm assessment in outpatients with OSAS where PSG is difficult to perform.

Daily consumption of garlic is known to lower the risk of hypertension and ischemic heart disease. In this study, we examined whether aged garlic extract (AGE) prevents hypertension and the progression of compensated left ventricular (LV) hypertrophy in Dahl salt-sensitive (DS) rats. DS rats were randomly divided into three groups: those fed an 8% NaCl diet until 18 weeks of age (8% NaCl group), those additionally treated with AGE (8% NaCl + AGE group), and control rats maintained on a diet containing 0.3% NaCl until 18 weeks of age (0.3% NaCl group). AGE was administered orally by gastric gavage once a day until 18 weeks of age. LV mass was significantly higher in the 8% NaCl + AGE group than in the 0.3% NaCl group at 18 weeks of age, but significantly lower in the 8% NaCl + AGE group than in the 8% NaCl group. No significant differences were observed in systolic blood pressure (SBP) between the 8% NaCl and 8% NaCl + AGE groups at 12 and 18 weeks of age. LV end-diastolic pressure and pressure half-time at 12 and 18 weeks of age were significantly lower in the 8% NaCl + AGE group compared with the 8% NaCl group. AGE significantly reduced LV interstitial fibrosis at 12 and 18 weeks of age. Chronic AGE intake attenuated LV diastolic dysfunction and fibrosis without significantly decreasing SBP in hypertensive DS rats.