Effects of hypertonic saline solution on body weight and serum creatinine in patients with acute decompensated heart failure.

AIM: To test the safety and effectiveness of hypertonic saline solution (HSS + F) as a strategy for weight loss and prevention of further deterioration of renal function. METHODS: Patients admitted with acute decompensated heart failure (ADHF) who received HSS + F were included in the study. After a period of a standard ADHF treatment, our patients received an intravenous infusion of furosemide (250 mg) combined with HSS (150 mL of 3% NaCl) twice a day for a mean duration of 2.3 d. Our primary outcomes were weight loss and a change in serum creatinine per day of treatment. The parameters of the period prior to treatment with HSS + F were compared with those of the period with HSS + F. RESULTS: A total of 47 patients were included. The mean creatinine on admission was 155 µmol/L ± 65 µmol/L, the ejection fraction was 40% ± 17%. The experimental treatment (HSS + F) resulted in greater weight loss per day of treatment than the standard treatment (-1.4 kg/d ± 1.4 kg/d vs -0.4 kg/d ± 1.0 kg/d, P = 0.0168). Importantly, the change in creatinine was not significantly different. CONCLUSION: This study supports the effectiveness of HSS + F on weight loss in patients with ADHF. The safety profile, particularly with regard to renal function, leads us to believe that HSS + F may be a valuable option for those patients presenting with ADHF who do not respond to conventional treatment with intravenous furosemide alone.

Feasibility of using a sheathless guiding catheter for left ventricular endomyocardial biopsy performed by transradial approach.

The role of endomyocardial biopsy (EMB) in the diagnosis and treatment of adults presenting a newly unexplained cardiomyopathy remains controversial and the clinical indication varies among different centers. Furthermore, the choice of the ventricular site for EMB is still under debate. The right ventricular EMB is commonly used due to safety features and left ventricle (LV) EMB has not yet gained acceptance because of concerns about possible complications. Of note, when LV-EMB is performed, the femoral artery is usually the access site. There is a large body of evidence supporting the safety and feasibility of transradial approach in a broad spectrum of patients and settings in the catheterization laboratory. Therefore, the aim of the present manuscript is to report the feasibility of performing a LV-EMB by the transradial approach using a sheathless guiding catheter as an ad hoc procedure.

Acute myocarditis triggering coronary spasm and mimicking acute myocardial infarction.

A 24-year-old healthy man consulted to our center because of typical on-and-off chest-pain and an electrocardiogram showing ST-segment elevation in inferior leads. An urgent coronary angiography showed angiographically normal coronary arteries. Cardiovascular magnetic resonance imaging confirmed acute myocarditis. Although acute myocarditis triggering coronary spasm is an uncommon association, it is important to recognize it, particularly for the management for those patients presenting with ST-segment elevation and suspect myocardial infarction and angiographically normal coronary arteries. The present report highlights the role of cardiovascular magnetic resonance imaging to identify acute myocarditis as the underlying cause.