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Anthracycline chemotherapy-related cardiac dysfunction is believed to be refractory to conventional pharmacological therapy and is associated with a poor prognosis. Increased heart rate (HR) is a known marker of cardiovascular outcomes for various categories of heart failure (HF). However, little interest has been expressed regarding increased HR after anthracycline chemotherapy. Aim of this study was to investigate the effect of increased HR soon after completion of anthracycline chemotherapy on subsequent left ventricular (LV) ejection fraction (LVEF) in cancer patients. We studied 172 patients with breast cancer and malignant lymphoma with preserved LVEF (≥ 50 %) and sinus rhythm treated with anthracyclines. Electrocardiography was performed before and soon after completion of anthracycline chemotherapy (2.3 months), and echocardiography before and late after completion of anthracycline chemotherapy (10.5 months). HR significantly increased from 74.2 ± 14.2 bpm to 75.9 ± 13.2 bpm (P = 0.05) soon after completion of anthracycline chemotherapy, while LVEF subsequently significantly decreased from 65.3 ± 5.5 % to 62.4 ± 6.1 % (P < 0.01) late after completion of anthracycline chemotherapy. Patients whose HR increased ≥10 bpm subsequently showed a significantly greater decrease in LVEF than those whose HR increased <10 bpm [−4.9 % (−32.7 % - 10.8 %) vs. -2.2 % (−21.2 % - 12.9 %), p = 0.04]. Multivariable logistic regression analysis showed that an increase in HR soon after completion of anthracycline chemotherapy was independently associated with a subsequent decrease in LVEF (odds ratio: 1.022, 95 % confidential interval; 1.008–1.037, P = 0.002). Our findings may have a novel effect on the management of cancer patients scheduled for anthracycline chemotherapy. [Display omitted] • Heart rate (HR) increased soon after completion of anthracycline chemotherapy. • Left ventricular ejection fraction (LVEF) subsequently decreased late after completion of anthracycline chemotherapy. • Patients whose HR increased ≥10 bpm showed a greater decrease in LVEF. • Increased HR after anthracycline was associated with subsequent decrease in LVEF. [ABSTRACT FROM AUTHOR]

• A total 21 quality indicators of palliative care were settled. • Symptom palliation and supporting decision-making process are two major domains. • Outcome measure could only be evaluated by bereaved family survey. Although recent attention to palliative care for patients with cardiovascular diseases has been increasing, there are no specific recommendations on detailed palliative care practices. We proceed on a discussion of the appropriateness and applicability of potential quality indicators for acute cardiovascular diseases according to our previous systematic review. We created a multidisciplinary panel of 20 team members and 7 external validation clinicians composed of clinical cardiologists, a nutritionist, a physiotherapist, a clinical psychologist, a critical and emergent care specialist, a catheterization specialist, a primary care specialist, a palliative care specialist, and nurses. After crafting potential indicators, we performed a Delphi rating, ranging from "1 = minimum" to "9 = maximum". The criterion for the adoption of candidate indicators was set at a total mean score of seven or more. Finally, we subcategorized these indicators into several domains by using exploratory factor analysis. Sixteen of the panel members (80%) were men (age, 49.5 ± 13.7 years old). Among the initial 32 indicators, consensus was initially reached on total 23 indicators (71.8%), which were then summarized into 21 measures by selecting relatively feasible time variations. The major domains were "symptom palliation" and "supporting the decision-making process". Factor analysis could not find optimal model. Narratively-developed seven sub-categories included "presence of palliative care team", "patient-family relationship", "multidisciplinary team approach", "policy of approaching patients", "symptom screening and management", "presence of ethical review board", "collecting and providing information for decision-maker", and "determination of treatment strategy and the sharing of the care team's decision". In this study we developed 21 quality indicators, which were categorized into 2 major domains and 7 sub-categories. These indicators might be useful for many healthcare providers in the initiation and enhancement of palliative care practices for acute cardiovascular diseases in Japan. [ABSTRACT FROM AUTHOR]

• The adult patients with congenital heart disease (ACHD) treated in a minimal essential regional (MER)-ACHD center were better than others. • Half of ACHD admissions were simple cases such as atrial septal defect. • About half of the patients with ACHD were not treated in tertiary ACHD or MER-ACHD center. The emerging burden and need of hospital admission due to adult congenital heart disease (ACHD) will need many facilities with expertise in ACHD. Regional specialized ACHD centers are carrying this increasing patient burden. Although these centers are considered to perform better management than other institutes, their impact on outcome has not been fully evaluated. We used the Japanese Registry of All cardiac and vascular Diseases (JROAD) and the JROAD Diagnosis Procedure Combination (DPC)/Per Diem Payment System dataset and certification data. We only analyzed adult (≥15 years old) patients with ACHD, defined by the International Classification of Diseases, Tenth Revision , diagnosis codes, between April 1, 2013, and March 31, 2014. We defined a "minimal essential regional ACHD (MER-ACHD) center" as an education institute accredited by adult and pediatric cardiology societies. The primary outcome is 30-day mortality. We investigated the impact of MER-ACHD centers on 30-day mortality by using generalized estimating equations. Of the 538 hospitals registered at JROAD that agreed to participate in the DPC discharge database study, 65 (12.1%) were MER-ACHD centers. Of 4818 patients (46.8% male; age, 50.1 ± 21.4 years), 45.5% were admitted to a MER-ACHD center. Nearly half (48.1%) of the admissions were cases of atrial septal defect, followed by ventricular septal defect, tetralogy of Fallot, and congenital insufficiency of the aortic valve or bicuspid aortic valve. Multivariate analysis revealed a negative impact of emergency admission [1.051 (1.042–1.061)] and a positive impact of MER-ACHD centers [0.986 (0.973–0.999)] on 30-day mortality after adjustment of disease severity. We noted the impact of MER-ACHD centers on 30-day mortality. Further investigation is needed to establish appropriate regional ACHD center criteria to deliver appropriate ACHD management. [ABSTRACT FROM AUTHOR]

• Skeletal muscle mass index was lower in adults with congenital heart disease (CHD), suggesting sarcopenia. • Calorie, protein, and fat intake in adults with CHD was higher than controls. • Resistance training and amino acid intake increased skeletal muscle in adults with CHD. • Resistance training and amino acid intake also improved edema index, and N-terminal prohormone of brain natriuretic peptide levels. • Appropriate nutritional education and resistance training guidelines should be provided. This study aimed (1) to assess the nutritional status and dietary intake, (2) compare the body composition and nutritional intake between sarcopenia and non-sarcopenia, and (3) evaluate the effects of resistance training and amino acid intake in adults with congenital heart disease (CHD). Study 1 In total, 172 adults with CHD were prospectively enrolled. The Food Frequency Questionnaire was used, and body composition analysis was conducted. Study 2 : Thirty of 172 adult patients with CHD were divided into two groups: amino acid intake plus resistance training (group A) and amino acid intake only (group B) for 2 months. Study 1: Skeletal muscle mass index was lower in adults with CHD compared to healthy Japanese. Calorie, protein, and fat intake in adults with CHD was higher than those in the National Nutritive Intake Investigation; however, the difference in carbohydrate or salt intake was non-significant. Study 2 : In adults with CHD in group A, body fat percentage, edema index, and N-terminal prohormone of brain natriuretic peptide improved, and body weight, skeletal muscle mass index, and basic metabolism increased after the intervention. There was no improvement after intervention for group B. According to this study, adults with CHD have higher calorie, protein, and fat intake than those in a national survey despite decreased skeletal muscle mass. Amino acid intake plus resistance training positively improved body fat percentage, skeletal muscle mass, and edema in adults with CHD. Appropriate nutritional education and resistance training guidelines should be provided. [ABSTRACT FROM AUTHOR]

A 75-year-old male presented with palpitation on exertion. He suffered from frequent tachycardia attacks. His 12-leads electrocardiogram showed irregular cycle lengths (400–550 ms) of tachycardia with occasional 2:1 atrioventricular conduction (thus AV reentry was excluded). He had a complex anatomy of persistent left superior vena cava (PLSVC)/ enlarged coronary sinus (CS). The activation map in a 3-dimensional CARTO system (Biosense-Webster, USA) was merged with the multi-detector computed tomography image and revealed that the tachycardia spread centrifugally from the junction between the PLSVC and enlarged CS. However, delivery of radio frequency (RF) energy to the earliest atrial activation site did not affect the tachycardia. Finally, the tachycardia was diagnosed as a fast/ slow type atrioventricular nodal reentrant tachycardia (AVNRT) because the tachycardia was cured only after the anterograde/retrograde AV conduction was disturbed by the application of RF energy to the posteroseptal perimitral area, possibly due to the injury to the AV node. [Copyright &y& Elsevier]