Corrigendum: Malnutrition and Frailty Are Critical Determinants of 6-Month Outcome in Hospitalized Elderly Patients With Heart Failure Harboring Surgically Untreated Functional Mitral Regurgitation.

[This corrects the article DOI: 10.3389/fcvm.2021.764528.].

Malnutrition and Frailty Are Critical Determinants of 6-Month Outcome in Hospitalized Elderly Patients With Heart Failure Harboring Surgically Untreated Functional Mitral Regurgitation.

Background: Hospitalized patients with acute decompensated heart failure (ADHF) frequently exhibit aggravating mitral regurgitation (MR). Those patients do not always undergo surgical mitral valve repair, but particularly in the elderly, they are often treated by conservative medical therapy. This study was aimed to investigate factors affecting 6-month outcomes in hospitalized patients with heart failure (HF) harboring surgically untreated MR. Methods: We screened the presence of MR in hospitalized patients with HF between September 2017 and May 2020 in the Yamaguchi Prefectural Grand Medical (YPGM) center. At the time of discharge of these patients, individuals with surgically unoperated MR, including primary and secondary origin, were consequently recruited to this single-center prospective cohort study. The patients with severe MR who undergo surgical mitral valve treatment were not included in this study. The primary endpoint was all-cause readmission or all-cause death and the secondary endpoint was HF-related endpoint at 6 months after discharge. The Cox proportional hazard regression analyses were employed to assess the predictors for the composite endpoint. Results: Overall, 489 patients with ADHF were admitted to the YPGM center. Of those, 146 patients (30% of total patients with HF) (median age 83.5 years, 69 men) were identified as harboring grade II MR or greater. Consequently, all the recruited patients were diagnosed as functional MR. During a median follow-up of 186.0 days, a total of 55 patients (38%) reached the primary or secondary endpoints (HF death and readmission in 31 patients, other in 24 patients). As a result of multivariate analysis, geriatric nutritional risk index [hazard ratio (HR) = 0.932; 95% CI = 0.887-0.979, p = 0.005], age (HR = 1.058; 95% CI = 1.006-1.112, p = 0.027), and left ventricular ejection fraction (HR = 0.971; 95% CI = 0.945-0.997, p = 0.030) were independent predictors of all-cause death or all-cause admission. Body mass index (HR = 0.793; 95% CI = 0.614-0.890, p = 0.001) and ischemic heart disease etiology (HR = 2.732; 95% CI = 1.056-7.067, p = 0.038) were also independent predictors of the HF-related endpoints. Conclusion: Malnutrition and underweight were substantial predictors of adverse outcomes in elderly patients with HF harboring surgically untreated moderate-to-severe functional MR.

Epicardial flow in the right ventricular wall on echocardiography: A sign of chronic total occlusion of left anterior descending artery.

Transthoracic coronary Doppler echocardiography (TCDE) can be useful for the detection of chronic total occlusion (CTO) of the proximal left anterior descending coronary artery (LAD) noninvasively, by detecting retrograde flow through the distal LAD or its septal branch. This intriguing case report details the detection of abnormal blood flow in the right ventricular free wall by TCDE. This detection of abnormal flow may be useful to predict CTO of the LAD, even in the absence of retrograde flow in the LAD and its septal branch.

Serotonin potentiates high-glucose-induced endothelial injury: the role of serotonin and 5-HT(2A) receptors in promoting thrombosis in diabetes.

To clarify the involvement of 5-hydroxytryptamine (5-HT) in promotion of thrombogenesis in diabetes, we examined the inhibitory effect of sarpogrelate, a 5-HT(2A) receptor antagonist, on thrombus formation in diabetic rats. In streptozotocin-induced diabetic rats, polyethylene tube-induced thrombus formation was enhanced compared with that in normal rats. The thrombogenesis was inhibited by sarpogrelate; cilostazol, a PDE3 inhibitor; and aspirin, a COX inhibitor, by 75.8%, 42.3%, and 34.3%, respectively. The inhibition by sarpogrelate was more pronounced in diabetic rats than normal ones. High glucose and 5-HT increased the expression of vascular cell adhesion molecule-1 (VCAM-1) in human umbilical vein endothelial cells (HUVECs) and combination of both high glucose and 5-HT further potentiated the effect. Sarpogrelate but not aspirin inhibited the increase in VCAM-1 expression induced by high glucose and 5-HT. These findings suggest that 5-HT mediates the enhanced thrombogenesis in diabetes and suggests that a 5-HT(2A) receptor antagonist may have novel therapeutic potential for the treatment of diabetic complications.

[Influence of epidural lidocaine injection on vecuronium-induced neuromuscular blockade].

BACKGROUND: We investigated vecuronium-induced neuromuscular blockade in patients with continuous epidural lidocaine injection and those without epidural lidocaine. METHODS: Lower thoracic epidural injection of lidocaine was commenced at a rate of 2-3 mg x kg(-1) x h(-1) following its bolus injection (1.5-2 mg x kg(-1)) only in epidural group. Neuromuscular function was monitored by acceleromyographic train-of-four (TOF) responses of the adductor pollicis muscle to ulnar nerve stimulation after induction of general anesthesia. RESULTS: Neuromuscular block was obtained by vecuronium 0.1 mg x kg(-1) as an intubating dose and was maintained 5-10% of baseline first twitch (T 1) of TOF responses by continuous vecuronium administration. The maximum depression of T 1 response and onset time obtained by vecuronium 0.1 mg x kg(-1) were not different between the groups, but mean clinical duration from administration of the first dose to T 1 recovery to 5% of baseline was significantly prolonged in group with epidural lidocaine (49.5 min), compared to that without lidocaine (32.3 min). Furthermore, maintenance dose of vecuronium obtained in the group with epidural lidocaine (0.034 mg x kg(-1) x h(-1)) was significantly smaller than that in the group without lidocaine (0.060 mg x kg(-1) x h(-1)). CONCLUSIONS: Based on our results, we conclude that lidocaine injected continuously into the epidural space potentiates vecuronium-induced neuromuscular block.