Clinical utility of the "balloon lever technique" in the right inferior pulmonary vein cryoballoon ablation.

Background: The acute success rate of pulmonary vein isolation (PVI) with cryoballoon (CB) is reported to be lower in the right inferior pulmonary vein (RIPV). This study aimed to investigate the utility of the "balloon lever technique (BLT)" for RIPV CB ablation. Methods: We retrospectively studied consecutive patients who underwent CB-PVI for atrial fibrillation between February 21, 2020 and June 3, 2022. RIPV cryoablation was performed according to a specific protocol. The patients underwent RIPV cryoablation using the conventional method. If the method was found ineffective, BLT cryoablation was performed. The acute success rate of RIPV CB ablation was examined. We also investigated the RIPV isolation rate and procedural parameters during conventional and BLT cryoablation. Results: Ninety-three patients were included in the analysis. RIPV isolation was achieved in 89.2% (83/93) of the patients using conventional method and subsequent BLT cryoablation. Meanwhile, 68 patients underwent BLT cryoablation because the conventional method was ineffective. RIPV was isolated with BLT in 85.3% (58/68) of patients. Additionally, BLT was found to be superior to conventional cryoablation in terms of nadir balloon temperature, freezing time, and thawing time to a specific temperature in patients who underwent both conventional and BLT cryoablations. Conclusions: BLT is useful in RIPV cryoablation when the conventional method is ineffective. BLT cryoablation may be helpful, mainly because of the BLT-mediated contact of the balloon with the bottom of the RIPV, which leads to optimal RIPV occlusion.

Dual additive of lithium titanate and sulfurized pyrolyzed polyacrylonitrile in sulfur cathode for high rate performance in lithium-sulfur battery.

Lithium-Sulfur (Li-S) batteries have attracted much attention as next-generation batteries due to their high theoretical energy density. However, lithium polysulfide generated during the discharge loses intimate electrical contact with the carbon matrix due to its high solubility in the electrolyte, causing a high charge transfer resistance and slow redox kinetics for the discharge reactions, resulting in a low rate capability. A cathode additive having a strong chemical adsorbing site toward the polysulfide can effectively inhibit their dissolution. We now report a dual additive of lithium titanium oxide (LTO) and sulfurized polyacrylonitrile (SPAN). LTO provides a rapid charge transfer and a fast Li+ ion transfer in the cathode. On the other hand, SPAN helps to enhance the polysulfide adsorption capability. This dual additive system synergistically supplies the cathode with a strong polysulfide adsorption capability and fast redox kinetics. As a result, the dual additive exhibits high discharge capacities of 1430 mA h g-1 at 0.1C and 1200 mA h g-1 at 0.5C at the high-sulfur-loading cathode of 5.0 mg cm-2. Our findings demonstrated the manufacturing of the cathode with a strong polysulfide adsorption capability and a fast redox reaction which could then effectively improve the rate performance of the Li-S batteries.

A successful treatment of ganglionated plexi ablation for vagally mediated nocturnal atrioventricular block.

Patients suffering from sleep-related bradyarrhythmias are often underdiagnosed, due to the presence of asymptomatic cases. Although the consequence of increased nocturnal parasympathetic nerve activities and decreased sympathetic nerve activity during sleep are associated with nocturnal bradyarrhythmias, the detailed mechanisms are still unknown. It is well known that ganglionated plexi (GP) ablation is an effective therapeutic approach to modify autonomic nerve functions. Here, we report a case of successful treatment for the vagally mediated long ventricular pauses during sleep using autonomic modulation through GP ablation. Learning objective: Sleep-related bradyarrhythmias unrelated to sleep apnea or hypopnea are rare sleep disorders. Treatment of this disorder has not been established. High-frequency stimulation guided ganglionated plexi ablation could be an effective therapeutic approach to achieve long-term vagal attenuation to prevent vagally induced nocturnal bradyarrhythmias.

Ectopic discharge originating from the ostium of the inferior vena cava that is likely to cause atrial fibrillation.

It has been established that the initiation of paroxysmal atrial fibrillation (AF) is frequently associated with ectopic beats inside the thoracic veins, including the pulmonary veins, superior vena cava, coronary sinus, and/or vein of Marshall. However, similar arrhythmogenic ectopic discharge or premature atrial contractions (PACs) originating from the inferior vena cava (IVC) have been rarely described. We present the case of a 51-year-old man with paroxysmal AF undergoing electrophysiological study. Twelve-lead electrocardiography demonstrated PACs with negative P waves in the inferior leads. Ectopic beats originating from the ostium of the IVC, which were likely to initiate AF, were observed. Furthermore, the origin of the PAC was visualized using an electroanatomical local activation timing (LAT) map and located close to the fibrotic tissue of the vasculature. Radiofrequency catheter ablation was performed at the earliest activation site, and ectopic beats were not observed after the procedure. This is the first report to demonstrate a LAT contact map of ectopic discharge arising from the IVC. If PACs with negative P waves in the inferior leads are found in a patient with AF, the IVC should be investigated for possible focal ectopic discharges. Learning objective: Non-pulmonary vein foci play a significant role in the pathogenesis of atrial fibrillation (AF). However, inferior vena cava (IVC) triggers that initiate AF have rarely been described. Premature atrial contractions with negative P waves in the inferior leads may be associated with ectopic discharges originating from the IVC, which contribute to the initiation of AF.

Association of device-measured physical activity with peak oxygen consumption measured by cardiopulmonary exercise testing in patients with cardiac implantable electronic devices.

PURPOSE: Cardiac implantable electronic devices (CIEDs) offer diagnostic information such as device-measured physical activity (PA). Peak oxygen consumption (VO2) measured by cardiopulmonary exercise testing (CPET) is the most objective variable showing exercise capacity. The purpose of this study was to investigate the relationship between these 2 variables. METHODS: We retrospectively studied consecutive patients with CIEDs undergoing CPET between April 1, 2018, and January 31, 2021. These patients were divided into 2 groups: patients with peak VO2 ≤ 14 ml/kg/min (low peak VO2 group) and those showing peak VO2 > 14 ml/kg/min (high peak VO2 group). The peak device-measured PA was compared between the 2 groups. The relationship between the peak device-measured PA and peak VO2 was also investigated. RESULTS: There were 50 and 51 patients in the low and high peak VO2 groups, respectively. The peak device-measured PA, which was expressed in units of hours/day, was significantly lower in the low peak VO2 group than in the high peak VO2 group (3.06, interquartile range [2.43-4.00] vs. 5.50, interquartile range [4.04-6.70] p < 0.01). The peak device-measured PA and peak VO2 showed a significant positive correlation (Spearman's ρ = 0.53; p < 0.01). Furthermore, receiver operating characteristic curve analysis showed that a peak device-measured PA > 3.87 h/day could predict high peak VO2 (80.4%, sensitivity; 72.0%, specificity). In multivariate linear regression analysis, peak device-measured PA was an independent predictor of peak VO2 (regression coefficient, 0.61; 95% confidence interval, 0.33-0.89; p < 0.01). CONCLUSIONS: Peak device-measured PA was significantly associated with peak VO2.

Clinical utility of CorVue intrathoracic impedance alert with device-measured physical activity in predicting heart failure events.

Cardiac implantable electronic devices (CIEDs) offer heart failure (HF) diagnostic information, including intrathoracic impedance (ITI) or physical activity (PA). However, few studies have evaluated the utility of these parameters measured by CIEDs with CorVue algorithm. The purpose of this study was to investigate the relationship between ITI alerts triggered by the CorVue algorithm and HF development. We also examined the association between device-measured PA and ITI alerts associated with HF development. We retrospectively studied consecutive patients with CIEDs equipped with CorVue algorithm, which were implanted between June 1, 2011 and August 31, 2019. These patients were divided into two groups: patients with decreased ITI followed by the ITI alerts (ITI alert group) and those without the alerts (non-ITI alert group). There were 35 and 14 patients in the ITI and non-ITI alert groups, respectively. A total of 96 ITI alerts were observed. ITI alerts associated with HF development were observed in 21% (20/96); whereas, ITI alerts not associated with HF development were observed in 79% (76/96). Accurate device-measured PA was confirmed in 76 ITI alerts, which consisted of 30 alerts with lower PA and 46 alerts without lower PA. ITI alerts associated with HF development were observed in 30% (9/30) of the alerts with lower PA, whereas observed only in 6.5% (3/46) of the alerts without lower PA. In conclusion, the CorVue ITI alerts indicated a high false-positive rate. However, device-measured PA may be useful to determine whether ITI alerts are associated with HF development or not, which was attributed to the high negative predictive value.

Technology Applications of Capnography Waveform Analytics for Evaluation of Heart Failure Severity.

This study aimed to elucidate the influential parameter, acquired from the analyses of nasal capnography waveforms, for the elevated plasma brain natriuretic peptide (BNP) levels in patients (n = 34) with heart failure (HF). The capnography waveforms were analyzed to evaluate changes in end-tidal CO2 (ETCO2) values and expiratory and inspiratory durations. The relationship between these parameters, estimated from capnography analyses and plasma BNP, was then evaluated. Mean ETCO2 values and BNP levels showed a strong negative correlation (R2 = 0.6355, p < 0.0001) in HF patients with chronic kidney disease (CKD) (R2 = 0.6355, p < 0.0001). The ETCO2 value was the most influential parameter that indicated elevated BNP levels in HF patients with CKD (ß = - 0.577; p = 0.031). The mean ETCO2 level could be a potentially influential parameter reflecting elevated BNP levels in HF patients, especially in HF patients with CKD. Respiratory parameters, acquired from detailed nasal capnography analyses, might be reasonable for evaluating the severity of HF. Graphical abstract.

Laryngeal mask versus facemask in the respiratory management during catheter ablation.

BACKGROUND: The purpose of this study is to investigate if a laryngeal mask could improve respiratory condition during radiofrequency catheter ablation (RFCA). METHODS: Twenty-four consecutive patients who underwent RFCA for atrial fibrillation were divided into two groups (Facemask group; n = 10, Laryngeal mask group; n = 14). All patients were completely sedated under intravenous anesthesia and fitted with artificial respirators during the RFCA. The capnography waveforms and their differential coefficients were analyzed to evaluate the changes of end-tidal CO2 (ETCO2) values, respiratory intervals, expiratory durations, and inspiratory durations. RESULTS: During the RFCA, ETCO2 values of the laryngeal mask group were higher than those of the facemask group (36.0 vs. 29.2 mmHg, p = 0.005). The respiratory interval was significantly longer in the laryngeal mask group than those in the facemask group (4.28 s vs.5.25 s, p < 0.001). In both expiratory and inspiratory phases, the mean of the maximum and minimum values of CO2 was significantly higher when using a laryngeal mask than when using a facemask. The inspiratory-expiratory ratio of the laryngeal mask group was significantly larger than that of the facemask group (1.59 vs. 1.27, p < 0.001). The total procedure duration, fluoroscopic duration and the ablation energy were significantly lower in the laryngeal mask group than in the facemask group. The ETCO2 value is the most influential parameter on the fluoroscopic duration during the RFCA procedure (ß = - 0.477, p = 0.029). CONCLUSIONS: The use of a laryngeal mask could stabilize respiration during intravenous anesthesia, which could improve the efficiency of RFCA.

Increased respiratory disturbance index measured using an advanced device algorithm is associated with heart failure development.

Previous studies suggested that sleep-disordered breathing was associated with cardiovascular diseases such as heart failure (HF). Recently, algorithms of cardiac implantable electronic devices (CIEDs) have been developed to detect advanced sleep apnea (SA); the Apnea Scan (AP Scan) being an example. The purpose of this study was to investigate the association between respiratory disturbance index (RDI) measured using the AP Scan algorithm and HF development. We retrospectively studied consecutive patients with CIEDs equipped with the AP Scan algorithm which were implanted between December 1, 2011 and March 31, 2019. These patients were divided into 2 groups according to the trends of RDI: patients with a continually high RDI > 30 (severe SA group) and those without a continually high RDI (non-severe SA group). There were 16 and 46 patients in the severe and non-severe SA groups, respectively. Increased left ventricular end-diastolic and end-systolic dimensions were observed in the severe SA group. Regarding cardiovascular events, HF was observed in 8 patients (50.0%) in the severe SA group and 1 patient (2.2%) in the non-severe SA group; thus, there was a significantly higher proportion of patients with HF in the severe SA group. In conclusion, continually high RDI was associated with HF development in patients with CIEDs equipped with the AP Scan algorithm. Therefore, an elevated RDI may be a risk factor for the development of HF in patients with CIEDs.

Copy number variation analysis in 83 children with early-onset developmental and epileptic encephalopathy after targeted resequencing of a 109-epilepsy gene panel.

Early-onset developmental and epileptic encephalopathy (DEE) is a group of devastating disorders that appear during the neonatal and infantile periods. Despite great progress in the discovery of genes leading to early-onset DEE, many cases with unexplained etiology remain. Furthermore, to date, the association of copy number variations (CNVs) with early-onset DEE has seldom been addressed. Here, we investigated the contribution of CNVs to epilepsy in a cohort of Japanese children with a variety of early-onset DEEs. Single nucleotide polymorphism (SNP) array analysis was performed for 83 cases that were previously negative for pathogenic single nucleotide variants (SNVs) in 109 genes known or suspected to cause epileptic seizures. Rare CNVs were detected in a total of 12 cases (14.4%), of which three cases (3.6%) involved clearly pathogenic CNVs and nine cases (10.8%) were CNVs of uncertain significance. The three pathogenic CNVs included two de novo heterozygous deletions involving known epileptic encephalopathy genes, such as GABRG2 and PCDH19, and one maternally inherited duplication encompassing MECP2. Our findings indicate rare CNVs are also relevant for the diagnosis of early-onset DEEs, highlighting the importance of not relying only on the investigation of SNVs/small indels at the risk of missing large deletions and duplications.

Long-Term Stable Lithium Metal Anode in Highly Concentrated Sulfolane-Based Electrolytes with Ultrafine Porous Polyimide Separator.

Highly concentrated solutions composed of lithium bis(fluorosulfonyl)imide (LiFSI) and sulfolane (SL) are promising liquid electrolytes for lithium metal batteries because of their high anodic stability, low flammability, and high compatibility with lithium metal anodes. However, it is still challenging to obtain the stable lithium metal anodes in the concentrated electrolytes due to their poor wettability to the conventional polyolefin separators. Here, we report that the highly concentrated 1:2.5 LiFSI/SL electrolyte coupled with a three-dimensionally ordered macroporous polyimide (3DOM PI) separator enables the stable lithium plating/stripping cycling with an average Coulombic efficiency of ca. 98% for over 400 cycles at 1.0 mA cm-2. The 3DOM PI separator shows good electrolyte wettability and large electrolyte uptake due to its high porosity and polar constituent of the imide structure, allowing superior cycling performance in the highly concentrated solution, compared with the polyolefin separators. Electrochemical and spectroscopic analyses reveal that the superior cycling stability in the concentrated electrolyte is attributed to the formation of highly stable and Li+ ion conductive solid electrolyte interphase (SEI) layer derived from FSI- anions, which reduces the side reactions of SL with lithium metal, prevents the growth of lithium dendrites, and suppresses the increase in cell impedance over long-term cycling. Our findings demonstrate that polar and porous separators could effectively improve the affinity to the concentrated electrolytes and allow the formation of the anion-derived SEI layer by increasing the salt concentration of the electrolytes, achieving the long-term stable lithium metal anode.

An application of pacemaker respiratory monitoring system for the prediction of heart failure.

Sleep-disordered breathing (SDB) is one of the most common complications among heart failure (HF) patients. Changes of respiratory patterns during the various stages in patients with HF have not been fully investigated. In this case, the algorism using thoracic impedance sensor and minute ventilation (sleep apnea monitoring [SAM] algorithm) with implanted pacemaker (REPLY 200 SR or DR, Sorin CRM SAS, Clamart, France) was used to monitor respiration. Impedance data from the implanted pacemaker can be converted into respiratory data, which can be used to calculate the respiratory disturbance index (RDI) per unit of time. Using this algorithm, we observed a sudden appearance of abnormal breathing at the onset of HF, followed by gradual improvement of respiratory patterns during the recovery stage. The results from respiratory monitoring using the SAM algorithm were strongly correlated with those from the positive airway pressure device. This case report could imply that proper utilization of this sensor could facilitate the early detection and therapeutic control of HF.

Continuous Positive Airway Pressure Therapy Improves Heterogeneity of R-R intervals in a Patient with Obstructive Sleep Apnea Syndrome.

Obstructive sleep apnea (OSA) is associated with the occurrence of various kinds of bradyarrhythmia and tachyarrhythmia. The activation of the autonomic nerve system is an important causative factor of the pathogenesis of the arrhythmia in OSA patients. Previous studies have shown that the R-R interval is an effective parameter for evaluating autonomic nerve activities. However, whether or not OSA can induce variations in the R-R interval and whether or not continuous positive airway pressure (CPAP) therapy can improve these variations in OSA patients are unclear. The present study explored whether or not CPAP therapy could improve the regularity of the R-R interval.

Efficacy of biolimus A9-eluting stent for treatment of right coronary ostial lesion with intravascular ultrasound guidance: a multi-center registry.

The aim of this study was to assess the efficacy of a biolimus A9-eluting stent in patients with a right coronary artery (RCA) ostial lesion. Ostial lesions of the RCA have been a limitation of percutaneous coronary intervention even in the drug-eluting stent (DES) era. However, clinical outcomes after the deployment of a second generation DES to an RCA ostial lesion with intravascular ultrasound (IVUS) guidance have not been fully elucidated. From September 2011 to March 2013, 74 patients were enrolled in 17 centers from Japan. RCA ostial lesion was defined as de novo significant stenotic lesion located within 15 mm from ostium. IVUS was used for all cases to confirm the location of ostium and evaluate stent coverage of ostium. Patients with hemodialysis were excluded. The primary endpoint is a major adverse cardiac event (MACE) at 1 year. Forty two percent of patients had multi-vessel disease. Angiographically severe calcification was observed in 26% of the lesions. The mean stent diameter was 3.3 ± 0.3 mm (3.5 mm, 72%, 3.0 mm, 25%, and 2.75 and 2.5 mm, 3%), stent length was 17.5 ± 5.8 mm, and dilatation pressure of stenting was 15.6 ± 4.1 atm. RCA ostium was covered by stent in all lesions in IVUS findings. Post dilatation was performed for 64% of lesions (balloon size 3.7 ± 0.6 mm). MACE rate at 1 year was 5.4% (target lesion revascularization 5.4%, myocardial infarction 1.2%, and no cardiac death). The biolimus A9-eluting stent for RCA ostial lesions with IVUS guidance showed favorable results at 1-year follow-up.

Two-year clinical outcome in patients with small coronary artery disease treated with everolimus- versus paclitaxel-eluting stenting.

BACKGROUND: Percutaneous coronary interventions involving small coronary vessels represent a true challenge because of the increased risk of restenosis and adverse outcomes. We evaluated the 2-year clinical outcomes between single everolimus-eluting stents (EES) and paclitaxel-eluting stents (PES) in small coronary artery disease. METHODS: From the data of SACRA (SmAll CoronaRy Artery treated by TAXUS Liberté) and PLUM (PROMUS/Xience V Everolimus-ELUting Coronary Stent for sMall coronary artery disease) registries, 245 patients with 258 lesions and 264 patients with 279 lesions, respectively, were enrolled in this study. RESULTS: The 2-year clinical driven target lesion revascularization (4.5% vs. 10.6%, p=0.01) and target vessel revascularization (8.0% vs. 13.9%, p=0.03) rates were significantly lower in the EES group compared with the PES group. Major adverse cardiac events in the EES group tended to be lower than those in the PES group (8.7% vs. 14.3%, p=0.05). On the other hand, all new lesions for remote target vessel revascularization were observed at the proximal site of target lesions in both groups and those rates were not different between the two groups (3.4% vs. 3.3%, p>0.99). CONCLUSION: EES showed better clinical results at 2-year follow-up compared with PES in small coronary artery diseases, however, new lesions at the proximal remote site of the target lesion remain problematic.

Effect of abscisic acid on symbiotic nitrogen fixation activity in the root nodules of Lotus japonicus.

The phytohormone abscisic acid (ABA) is known to be a negative regulator of legume root nodule formation. By screening Lotus japonicus seedlings for survival on an agar medium containing 70 µM ABA, we obtained mutants that not only showed increased root nodule number, but also enhanced nitrogen fixation. The mutant was designated enf1 (enhanced nitrogen fixation 1) and was confirmed to be monogenic and incompletely dominant. In long-term growth experiments with M. loti, although some yield parameters were the same for both enf1 and wild-type plants, both the dry weight and N content of 100 seeds and entire enf1 plants were significantly larger compared than those traits in wild-type seeds and plants. The augmentation of the weight and N content of the enf1 plants most likely reflects the increased N supplied by the additional enf1 nodules and the concomitant increase in N fixation activity. We determined that the endogenous ABA concentration and the sensitivity to ABA of enf1 were lower than that of wild-type seedlings. When wild-type plants were treated with abamine, a specific inhibitor of 9-cis-epoxycarotenoid dioxygenase (NCED), which results in reduced ABA content, the N fixation activity of abamine-treated plants was elevated to the same levels as enf1. We also determined that production of nitric oxide (NO) in enf1 nodules was decreased. We conclude that endogenous ABA concentration not only regulates nodulation, but also nitrogen fixation activity by decreasing NO production in nodules.

Efficacy of continuous positive airway pressure on arrhythmias in obstructive sleep apnea patients.

The purpose of this study was to determine the relationship between obstructive sleep apnea (OSA) and cardiovascular disorders in a large Japanese population, and to assess the efficacy of continuous positive airway pressure (CPAP) in the treatment of OSA-associated arrhythmias. The study population comprised 1394 Japanese subjects (1086 men and 308 women) who were divided into four groups on the basis of polysomnography (PSG) analysis as follows: the no sleep apnea (N-SA) group (n = 44, apnea-hypopnea index [AHI] < 5), the mild OSA (Mi-OSA) group (n = 197, 5 < AHI < 15), the moderate OSA (Mo) group (n = 368, 15 < AHI < 30), and severe OSA (SOSA) group (n = 785, AHI < 30). The following baseline characteristics were significantly associated with OSA: age (P < 0.001), gender (P < 0.001), body mass index (P < 0.001), hypertension (P < 0.001), diabetes (P = 0.009), and hyperlipidemia (P = 0.013). In the OSA group, PSG revealed the predominance of paroxysmal atrial fibrillation (PAF) (P = 0.051), premature atrial complex short run (P < 0.005), premature ventricular complex (PVC, P = 0.004), sinus bradycardia (P = 0.036), and sinus pause (arrest >2 s, P < 0.001) during the PSG recording. A total of 316 patients from the group underwent CPAP titration and were then re-evaluated. Continuous positive airway pressure therapy significantly reduced the occurrences of PAF (P < 0.001), PVC (P = 0.016), sinus bradycardia (P = 0.001), and sinus pause (P = 0.004). The results of this study demonstrate a significant relationship between OSA and several cardiac disorders, and also demonstrate the efficacy of CPAP in preventing OSA-associated arrhythmias in a large population of Japanese patients.

Enhanced nodulation and nitrogen fixation in the abscisic acid low-sensitive mutant enhanced nitrogen fixation1 of Lotus japonicus.

The phytohormone abscisic acid (ABA) is known to be a negative regulator of legume root nodule formation. By screening Lotus japonicus seedlings for survival on an agar medium containing 70 microM ABA, we obtained mutants that not only showed increased root nodule number but also enhanced nitrogen fixation. The mutant was designated enhanced nitrogen fixation1 (enf1) and was confirmed to be monogenic and incompletely dominant. The low sensitivity to ABA phenotype was thought to result from either a decrease in the concentration of the plant's endogenous ABA or from a disruption in ABA signaling. We determined that the endogenous ABA concentration of enf1 was lower than that of wild-type seedlings, and furthermore, when wild-type plants were treated with abamine, a specific inhibitor of 9-cis-epoxycarotenoid dioxygenase, which results in reduced ABA content, the nitrogen fixation activity of abamine-treated plants was elevated to the same levels as enf1. We also determined that production of nitric oxide in enf1 nodules was decreased. We conclude that endogenous ABA concentration not only regulates nodulation but also nitrogen fixation activity by decreasing nitric oxide production in nodules.

Valve repair improves central sleep apnea in heart failure patients with valvular heart diseases.

BACKGROUND: Recent studies suggest that treatment of heart failure (HF) could improve cardiac function and sleep apnea syndrome (SAS), but it is unknown how cardiac surgery may affect SAS in HF patients. Relationships between HF with valvular heart diseases and 2 types of SAS (obstructive sleep apnea (OSA) and central sleep apnea (CSA)) were examined. The effects of valve repair surgery on OSA and CSA was also investigated. METHODS AND RESULTS: Polysomnography, echocardiography and right cardiac catheterization were used to study 150 severe HF patients with mitral valvular and/or aortic valvular diseases. Significant associations between SAS and age, gender, body mass index, or hypertension were observed. The value of the CSA-apnea index (AI) was significantly correlated with pulmonary capillary wedge pressure (PCWP) and mean pulmonary artery pressure (PAP). These associations were not identified for OSA-AI. Valve repair surgery was used to treat 74 patients with severe SAS. The treatment led to a significant improvement in PCWP and mean PAP, and CSA-AI, but not in OSA-AI. CONCLUSIONS: These findings suggest close associations between CSA and cardiac function in HF patients with valvular heart diseases. Furthermore, improvement of cardiac function with valvular surgery reduces the severity of CSA in HF patients with valvular heart diseases.