Left Ventricular Noncompaction.

Circ J. 2012 Jun 5;

Authors: Paterick TE, Tajik AJ

Abstract
Diagnosing left ventricular noncompaction (LVNC) cardiomyopathy is a challenge for the medical community because the condition shares morphologic features of hypertrophic and dilated cardiomyopathies. The uncertainty surrounding the diagnosis of LVNC is related to the lack of a "perfect diagnostic tool," such as a reproducible genetic marker. The diagnosis requires expertise in the broad spectrum of overlapping cardiomyopathies. The demarcation between LVNC and normal phenotypic variations is often indistinct. Echocardiography, used in routine clinical practice to identify the typical morphologic features of LVNC, can be overly sensitive and lack specificity with the presently defined measurements and ratios used to diagnose LVNC. The available diagnostic criteria show a propensity toward overdiagnosing LVNC. The complex clinical sequelae of atrial and ventricular arrhythmias, heart failure, thromboembolic events and sudden death associated with LVNC make a valid and reproducible diagnosis critical. The trend to using a morphologic/pathophysiologic, instead of a solely morphologic, approach holds promise in the quest for an accurate, reliable diagnosis of LVNC. We must understand the distinction between morphological findings and morphological findings with pathophysiology. Our future understanding of LVNC depends on an integration of cardiac morphology, physiology, pathophysiology and evolving genetics.

PMID: 22664784 [PubMed - as supplied by publisher]

Randomized, Multicenter, Warfarin-Controlled Phase II Study of Edoxaban in Japanese Patients With Non-Valvular Atrial Fibrillation.

Circ J. 2012 May 18;

Authors: Yamashita T, Koretsune Y, Yasaka M, Inoue H, Kawai Y, Yamaguchi T, Uchiyama S, Matsumoto M, Ogawa S

Abstract
Background: Edoxaban is a once-daily (QD) oral, direct factor Xa inhibitor in clinical development for the prevention of stroke in patients with non-valvular atrial fibrillation (NVAF). The aim of this study was to evaluate the safety of edoxaban in Japanese patients with NVAF. Methods and Results: A total of 536 NVAF patients (CHADS2 ?1) were randomized to receive double-blinded edoxaban 30, 45, or 60mg QD or open-label warfarin (international normalized ratio [INR] 2.0-3.0 for age <70 years; 1.6-2.6 for age ?70 years) for 12 weeks. The primary endpoint was the incidence of all bleeding events (major, clinically relevant non-major, and minor bleeds). Patients underwent CT and/or MRI to assess asymptomatic intracranial hemorrhage (ICH). Secondary endpoints included thromboembolic events and pharmacodynamic indices. The mean incidence of all bleeding events for edoxaban 30, 45, and 60mg, and warfarin was 18.5%, 22.4%, 27.7%, and 20.0%, respectively. There were no statistically significant differences among the edoxaban groups and no significant differences from the warfarin group. There were no asymptomatic ICH events in any group. One episode of cerebral infarction was observed in the edoxaban 45-mg group. Subgroup analysis suggested low body weight (?60kg) was associated with higher bleeding risk. Conclusions: Edoxaban 30, 45, and 60mg QD in patients with NVAF was associated with a numerical increase in all bleeding across the dose range, but this was not statistically significant, nor was any dose compared with warfarin.

PMID: 22664798 [PubMed - as supplied by publisher]

Loop Diuretic Use at Discharge Is Associated With Adverse Outcomes in Hospitalized Patients With Heart Failure.

Circ J. 2012 May 26;

Authors: Hamaguchi S, Kinugawa S, Tsuchihashi-Makaya M, Goto D, Yamada S, Yokoshiki H, Takeshita A, Tsutsui H,

Abstract
Background: Loop diuretics are commonly used in patients with heart failure (HF) to remove retained fluid and improve symptoms. However, they may potentially worsen outcomes in HF. It remains unknown whether the use of loop diuretics is associated with adverse HF outcomes in routine clinical practice. We thus determined the effects of loop diuretic use at discharge on long-term mortality and rehospitalization among patients hospitalized with HF. Methods and Results: The Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD) prospectively studied the characteristics and treatments of a broad sample of patients hospitalized with worsening HF and followed for 2.1 years. Among a total of 2,549 HF patients, loop diuretics were used by 2,015 patients (79%), but not 534 patients (21%). The mean age was 70.7 years and 60% were male. Etiology was ischemic in 32% and mean left ventricular ejection fraction was 42%. After adjustment for covariates, discharge use of loop diuretics was associated with significant adverse risks of cardiac death (adjusted hazard ratio [HR] 2.348, 95% confidence interval [CI] 1.246-4.423, P=0.008) and rehospitalization (adjusted HR 1.427, 95% CI 1.040-1.959, P=0.027). Conclusions: Among patients hospitalized with worsening HF, loop diuretic use at discharge was associated with long-term adverse outcomes, which suggests that routine chronic use of loop diuretics may be harmful for patients with HF.

PMID: 22665070 [PubMed - as supplied by publisher]