Elevated levels of arterial lactate on admission were related to worse in-hospital mortality in patients with ADHF either with or without ACS, suggesting that the presence of high lactate in patients who enter the ICU with ADHF could help stratify the initial risk of early mortality.

No abstract

We describe the case of a 59-year-old Japanese man who had an acute pulmonary embolism in addition to acute myocardial infarction after a laparoscopic cholecystectomy. The posterior descending coronary artery was totally occluded. and direct percutaneous transluminal balloon angioplasty was performed. The pulmonary embolism was diagnosed by lung perfusion scanning and was treated with anticoagulant therapy. A patent foramen ovale and right-to-left atrial shunting of blood were detected by contrast transesophageal echocardiography. Paradoxical embolism is a rare complication of pulmonary embolism and may have been responsible for the acute myocardial infarction in our patient.

he combination of angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) has been reported to offer more complete blockade of the effect of angiotensin II than treatment with ACEI alone, while retaining the benefits of bradykinin potentiation obtained from ACEI treatment. 1,2 In the clinical setting, the combination of ACEI and ARB is more beneficial in preventing left ventricular remodeling and decreasing the plasma concentrations of aldosterone and brain natriuretic peptide (BNP) than either ACEI or ARB alone. 3,4 In addition, the combination therapy has recently been proved to improve prognosis to a greater extent than the monotherapy. 4,5 However, the doses of ACEI and ARB in large-scale trials performed in the USA and Europe have been 3-4-fold higher than the standard doses prescribed in Japan. The aim of this study was to Circulation Journal Vol.68, April 2004 investigate the effects of the combination of ACEI and ARB at the standard doses prescribed in Japan on left ventricular remodeling and neurohumoral factors in patients with chronic heart failure. Methods Study DesignThis is a multicenter, randomized, open-labeled trial to compare the clinical effects of ACEI or ARB monotherapy and their combination for 6 months. All the patients treated in the 26 institutes gave their written informed consent to participate in the trial, which was approved by the institutional review board of the National Cardiovascular Center, Osaka, Japan. EligibilityMen and women, 18 years old or older, with stable chronic heart failure for at least 3 months before the screening were eligible to participate in this study. In addition, they had to have documented left ventricular (LV) systolic dysfunction with an LV ejection fraction (EF) equal to or less than 45%, determined by echocardiography or LV venCirc J 2004; 68: 361 -366 (Received November 13, 2003; revised manuscript received January 20, 2004; accepted January 27, 2004) The institutes particpating in the study are listed in Appendix 1. Background The present multicenter study investigated whether the combination of angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II receptor blocker (ARB) is more beneficial for preventing left ventricular remodeling and suppressing neurohumoral factors than either ACEI or ARB alone. Methods and ResultsOne hundred and six patients with mild-to-moderate congestive heart failure treated in 26 Japanese institutes were randomly assigned to the combination therapy or monotherapy. Changes in physical activity (New York Heart Association functional classes, Specific Activity Scale (SAS)), concentrations of neurohumoral factors (plasma renin activity, angiotensin II, aldosterone, and brain natriuretic peptide (BNP)), and cardiac function for 6 months were compared between the 2 groups. It was found that the combination therapy, which was administered at doses standard in Japan, increased the SAS score (4.5±1.5 to 4.9±1.5, p<0.05) and decreased the plasma BNP concentration (183±163 to 135±1...

Some studies have suggested that radial access (RA) for percutaneous coronary intervention (PCI) reduces vascular complications and bleeding compared to femoral access (FA). The purpose of this study was to investigate the routine use of hemostatic devices and bleeding complications among RA, brachial access (BA), and FA. Between January 2015 and December 2015, 298 patients treated for PCI with RA were compared with 158 patients using BA and 206 patients using FA. The radial sheath was routinely removed with ADAPTY, the brachial sheath with BLEED SAFE, and the femoral sheath with Perclose ProGlide. In-hospital bleeding complications were investigated. Cardiogenic shock was most frequent in patients in the femoral group (RA 1.3%, BA 2.5%, FA 9.2%, p < 0.0001). The rate of major bleeding was highest in the femoral group (RA 1.0%, BA 2.5%, FA 5.3%, p = 0.01). Blood transfusion rates were highest in the femoral group (RA 0.7%, BA 1.3%, FA 4.4%, p = 0.01). Retroperitoneal bleeding was observed in 1.9% of patients in the femoral group. Patients in the brachial group had large hematomas (RA 0.7%, BA 4.4%, FA 1.5%, p = 0.01). Pseudoaneurysm formation needing intervention occurred most frequently in the brachial group (RA 0%, BA 1.3%, FA 0%, p = 0.04). In conclusion, compared to the brachial and femoral approaches, the radial approach appears to be the safest technique to avoid local vascular bleeding complications. The brachial approach has the highest risk of large hematoma and pseudoaneurysm formation among the three groups.