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Malnutrition in heart failure (HF) is related to altered intestinal function, which could be due to hemodynamic changes. We investigated the usefulness of novel nutritional indexes in relation to hemodynamic parameters.We retrospectively analyzed 139 HF patients with reduced ejection fraction who underwent right heart catheterization. We investigated correlations between right side pressures and nutritional indexes, which include controlling nutritional (CONUT) score and geriatric nutritional risk index (GNRI). Receiver operating characteristic (ROC) curves were generated to investigate the prognostic accuracy of CONUT score and GNRI for a composite of death or HF hospitalization in 12 months. Logistic regression analysis was performed to investigate whether hemodynamic correlates were associated with malnutrition, which was defined based on CONUT sore or GNRI.Higher right side pressures were positively correlated with worse nutritional status according to CONUT score, but were negatively correlated with worse nutritional status according to GNRI. Area under ROC curve for the composite endpoint was 0.746 in CONUT score and 0.576 in GNRI. The composite endpoint occurred in 40% of CONUT score≥3 and in 11% of CONUT score3 (p0.001). These relationships were also investigated with GNRI (40% of GNRI95 vs. 17% of GNRI≥95, p=0.002). In multivariate analysis, higher right atrial pressure was significantly associated with higher CONUT score, while no hemodynamic parameter was related to GNRI.CONUT score was associated with right side congestion, while no association between GNRI and right side congestion was noted. CONUT score had better predictive value than GNRI.

Background The endothelial progenitor cell (EPC) plays an important role in repairing vascular injury. Statins and angiotensin II receptor blockers increase the level of circulating EPCs. However, it is unknown whether the angiotensin II receptor blocker olmesartan synergistically acts with statins to increase the levels of circulating EPCs. Moreover, the association between the levels of circulating EPCs and endothelial dysfunction after implantation of drug-eluting stents (DESs) has not been evaluated. Methods Nine patients with stable coronary artery disease underwent percutaneous coronary intervention (PCI) and received DES implantation. All patients received olmesartan in addition to statin therapy after PCI. The dose of olmesartan was based on the physician's discretion as per the patients’ blood pressure. The levels of circulating EPCs were analyzed at baseline, post-PCI, and 1, 2, 3, and 8 months after PCI. Coronary angiography and the acetylcholine provocation test were performed on all patients at 8 months. Results Although the angiotensin II level significantly changed, the levels of circulating EPCs did not change during 8 months of olmesartan treatment (3.1 ± 0.6 cells/ml, 2.5 ± 0.8 cells/ml, 2.0 ± 0.6 cells/ml, 2.9 ± 0.9 cells/ml, 3.0 ± 0.4 cells/ml, 3.4 ± 0.8 cells/ml, p = 0.64). The patients were subsequently divided into two groups based on whether the level of circulating EPCs was less or greater than 4 cells/ml at 8 months. There were no significant differences in the mean vessel diameter of each segment (proximal, proximal edge, distal edge, and distal) after the acetylcholine provocation test between the two groups. Conclusions Low-to-moderate doses of olmesartan might not increase the level of circulating EPCs in patients receiving statin therapy. There might be no association between the levels of circulating EPCs and the degree of coronary vasospasm in the acetylcholine provocation test 8 months after DES implantation.