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Background Hepatitis C increases the mortality and morbidity of patients after heart transplant. Direct-acting antivirals (DAAs) are the primary drugs for hepatitis C treatment. However, such drugs are expensive and frequently unaffordable for patients. In DAA treatment, the assessment of drug interaction is crucial. Methods We investigated a retrospective case series study from January 2017 to December 2019. Sustained virologic response 12 (SVR12) was used to assess the effectiveness of DAA treatment. Data on patients’ demographic information, timing of hepatitis C virus (HCV) infection (before or after heart transplant), HCV genotypes and viral loads, DAAs used (branded drugs or generic drugs), and drug interaction assessments were collected. Results Fifteen heart transplant patients received hepatitis C treatments during the study period, 11 of whom were infected because their donors had hepatitis C. After DAA treatment, HCV was undetectable in all patients, and 93.3% of them achieved SVR12. Nine patients used the generic sofosbuvir/velpatasvir, and 88.9% of them achieved SVR12. A total of 256 drugs were used with DAAs; 51 records of drug interactions were noted, 3 of which were contraindications, and the remaining records were potential interactions. Patients who used sofosbuvir or elbasvir/grazoprevir experienced fewer drug interactions. Conclusions DAA treatment is effective for hepatitis C treatment in patients after heart transplant. Patients who cannot afford branded drugs because of their prices can use generic drugs as an alternative. Drug interactions must be surveyed during DAA treatment.

Background Systemic lupus erythematosus (SLE) is associated with a higher risk of cardiovascular disease. However, it is not clear whether or not SLE is associated with poor outcomes after acute myocardial infarction (AMI). Methods and results Using the Taiwan National Health Insurance Database, we identified the SLE group as patients with AMI who have a concurrent discharge diagnosis of SLE. We also selected an age-, sex-, hospital level-, and admission calendar year-matched non-SLE group at a ratio of 1:3 from the total non-SLE group. One hundred fifty-one patients with SLE, 113,791 patients without SLE, and 453 matched patients without SLE were admitted with a diagnosis of AMI. Patients with SLE were significantly younger, predominantly female, and more likely to have chronic kidney disease than those without SLE. The in-hospital mortality rates were 12.6%, 9.0%, and 4.2% in the SLE, total non-SLE, and matched non-SLE groups, respectively. The in-hospital mortality was significantly higher in the SLE group than in the total non-SLE group (OR = 1.98; 95% CI = 1.2–3.26) and the matched non-SLE group (mortality OR = 2.20; 95% CI = 1.06–4.58). In addition, the SLE group was associated with a borderline significant risk of prolonged hospitalization when compared with the non-SLE group. Conclusion SLE is associated with a higher risk of in-hospital mortality and a borderline significantly higher risk of prolonged hospitalization after AMI.

The identification of prognostic markers for colorectal cancer (CRC) has important clinical implications. However, the association between meningioma 1 (MN1) expression and clinical outcomes of CRC has not been fully investigated. The aim of this study was to investigate the expression of MN1 in the clinical context of CRC. We first used immunohistochemistry (IHC) staining to examine and compare MN1 expression between multiple human cancer tissues and normal tissues. Initial screening revealed that the expression of MN1 proteins was significantly higher in tumor tissues of the breast, colon, and liver than in normal tissues. In further testing conducted on 59 paired CRC samples, we observed that the expression of MN1 in CRC tissue samples was significantly higher than in adjacent normal tissues. Moreover, high MN1 expression was not significantly associated with clinicopathological characteristics. Kaplan-Meier survival analysis revealed that high expression of MN1 mRNA or MN1 protein was significantly associated with poor CRC prognosis. Furthermore, univariate Cox analysis revealed that a high MN1 score was significantly associated with prognostic factors. Multivariate Cox analysis further indicated that gender, histologic grade, tumor-node-metastasis (TNM) stage, and a high MN1 score were independent factors of overall CRC survival rates. Finally, MN1 and PCNA protein levels were positively correlated, which suggests that MN1 may be involved in the cell proliferation process during CRC formation. Our results, which confirm those of other studies, indicate that (1) high levels of MN1 expression contribute to poor CRC prognosis and (2) MN1 can serve as a novel potential biomarker in predicting the prognosis of CRC patients.

Background/Purpose Sustained ventricular tachycardia and ventricular fibrillation (VT/VF) are rare complications after coronary surgery. Off-pump coronary artery bypass (OPCAB) was developed to decrease postoperative complications. No studies to date have specifically addressed VT/VF after OPCAB. We sought to assess the incidence, risk factors, and outcome of VT/VF after OPCAB. Methods The study included a retrospective review of 1010 patients undergoing OPCAB between 2000 and 2012. Data were compared between the VT/VF patients and control patients who were the first cases of OPCAB in each month during the study period and did not have VT/VF. Results Twenty-three patients (2.3%) developed VT/VF after OPCAB. The hospital mortality rate was 17.4%. In univariate analysis, the risk factors for VT/VF were old age, rapid heart rate, prolonged corrected QT interval, severe congestive heart failure, poor left ventricular ejection fraction, large left ventricular end-diastolic diameter, chronic kidney disease, preoperative dialysis, low blood hemoglobin level, preoperative intubation, recent myocardial infarction, high European System for Cardiac Operative Risk Evaluation, urgent/emergent operation, use of intra-aortic balloon pump, conversion to on-pump beating heart, postoperative dialysis, and no use of beta-blockers after operation. Multivariate analysis identified preoperative corrected QT interval > 426 milliseconds [odds ratio (OR) = 4.501; 95% confidence interval (CI) = 1.153–17.570] and estimated glomerular filtration rate 2 (OR = 4.876; 95% CI = 1.112–21.374) as independent risk factors. Conclusion Postoperative VT/VF was rare after OPCAB but was associated with high mortality. Prolonged corrected QT interval and chronic kidney disease were independent risk factors. Recognition of these risk factors, proper prevention, and early intervention may improve survival.

Summary We present a case of congestive heart failure with pulmonary artery hypertension caused by a left-to-right shunt. Physical examination on admission revealed hypertension, arrhythmia, a diastolic murmur over the bilateral sternal borders, and a pitting edema over both lower legs. Imaging studies revealed a large coronary artery fistula (CAF). After ligation of the fistula, the patient recovered adequately and was discharged. Although cases of CAF have been reported and clinical presentations such as congestive heart failure are not rare, CAFs require particular attention, because they typically exhibit a varied clinical course. We present this case to share our experience regarding myocardial protection and help practitioners prevent misdiagnosis or delayed treatment for such cases.

Background/Purpose End-stage renal disease (ESRD) is an important complication arising after heart transplantation. At least 3–10% of recipients reach ESRD within 10 years after transplant. The incidence of ESRD in Chinese recipients has not been reported. Here we sought to assess the incidence, prognosis, and risk factors for ESRD in Chinese recipients. Methods We conducted a retrospective analysis of 248 heart recipients who survived >1 year from 1998 through 2007. ESRD was defined as the requirement of maintenance dialysis. Results Renal dysfunction was present in 20 patients (8%) prior to transplant. With a follow-up duration of 5.8 ± 3.9 years, 30 patients developed ESRD. The cumulative incidence of ESRD after heart transplantation was 2.1% ± 0.9%, 6.5% ± 1.8%, 16.8% ± 3.3%, and 36.5% ± 9.5% at 2, 5, 10, and 15 years after transplant, respectively. Median onset of ESRD was 6.9 years after transplant. Actuarial survival after dialysis was 74.8% ± 8.3%, 66.6% ± 9.2%, and 43.6% ± 12.6% at 1, 2, and 5 years, respectively. Independent risk factors for ESRD included pretransplant serum creatinine (hazard ratio, 1.84; p = 0.001), presence of diabetes prior to transplant (hazard ratio, 2.51; p = 0.017), and old age at transplant (hazard ratio, 1.05; p = 0.008). Conclusion There was a high incidence of ESRD in Chinese heart recipients. Patients with ESRD had poor prognosis after dialysis.

Patient Initials or Identifier Number B076473 ### Relevant Clinical History and Physical Exam 86-year-old man complained of chest distress and dyspnea with sub ordinary activity for one year. He was a case of severe aortic stenosis with heart failure functional class III for one year and CAD

Background Sudden cardiac death (SCD) occurs commonly after heart transplantation (HTX). The utilization of surface electrocardiography (ECG) to assess post-HTX SCD has not been investigated thoroughly. This study aimed to investigate the specific changes in surface ECG in HTX patients with SCD. Methods A total of 227 HTX patients (age 48±14y/o, mean donor age 34±14y/o, 173males) were followed up regularly at the outpatient clinic. Twelve-lead ECG's were recorded during 1–2 monthly visits. Serial ECG parameters and relevant clinical data were collected and analyzed. Results During the follow-up period of 96±51months, SCD occurred in 28 (12.3%) patients. The baseline ECG parameters were comparable between patients with and without SCD. Important ECG trends of rising rest heart rates and prolongation of corrected QT (QTc) and JT (JTc) intervals were observed prior to development of SCD. After adjustment for other clinical variables, the independent predictors for SCD were older donor age (p=0.014, OR 1.05, 95% CI 1.01–1.09), faster heart rate (p=0.006, OR 1.06, 95% CI 1.02–1.1) and longer JTc interval (p=0.015, OR 1.03, 95% CI 1.01–1.06). SCD occurred in 71.4% patients presenting with all three risk predictors. Conclusions Besides older donor age, important ECG signs, including prolongation of the JTc interval and increased heart rate during post HTX follow up, could predict SCD.

Accumulation of oxygen free radicals is an important mediator of post-ischemia/reperfusion cardiac dysfunction. However, oxidative injury has not been well characterized in human cardiac tissues. In the present study, we superfused hydrogen peroxide (H(2)O(2)) into the diseased human ventricle in order to assess the effects of oxygen free radicals on the electromechanical parameters and the intracellular pH (pH(i)), and to test the ability of certain potential cardioprotective agents, including scavengers of hydrogen peroxide (dibenzamidostilbene disulfonic acid; DBDS), the.OH free radical (N-(mercaptopropionyl)-glycine; N-MPG), and the HOCl free radical (L-methionine), to protect against oxidative injury. Disease human ventricular tissues were obtained from patients undergoing heart transplantation. Electrophysiological experiments were performed using a traditional micropipette, while the pH(i) was measured by microspectrofluorimetry. We found that (a) H(2)O(2) (30 microM-3 mM) induced a significant dose-dependent intracellular acidosis, (b) H(2)O(2) (30 microM-3 mM) had a notable dose-dependent biphasic effect on the contractile force (an increase, followed by a decrease), while moderate concentrations of H(2)O(2) also inhibited the generation of action potential and increased the diastolic resting force significantly, and (c) N-MPG caused significant block of both the intracellular acidosis and the electromechanical inhibition induced by 3 mM H(2)O(2), whereas L-methionine and DBDS did not. Our data suggest that the toxic effects of H(2)O(2) are caused mainly through the generation of.OH, which is attributed to the intracellular acidosis seen in the diseased human ventricle.

Quantitative two-dimensional echocardiography was evaluated in 39 open-chest dogs placed on cardiopulmonary bypass. The correlation coefficient of left ventricular end-diastolic volume against postmortem pressure-volume curves was r = 0.89 to 0.93 (347 measurements in 15 dogs, 0 to 24 mm Hg). Ejection fraction was validated against roller pump flow and echo left ventricular end-diastolic volume (r = 0.83, n = 13). Left ventricular mass in vivo was compared with postmortem left ventricular mass (r = 0.81 in 21 early studies, r = 0.91 in 10 later studies with updated equipment) and was found to increase with ischemic injury as well as cardiopulmonary bypass with hemodilution. Left ventricular mass increased (p less than 0.001) from 119 +/- 5 (standard error of the mean) to 138 +/- 6 gm (n = 23) after 2 1/2 hours on cardiopulmonary bypass and moderate hemodilution. With the addition of ischemic arrest, left ventricular mass increased from 119 +/- 7 to 148 +/- 11 gm (p less than 0.01, n = 8), and myocardial water content increased by 2.0% +/- 0.4%, which accounted for at least 65% of the observed mass change. Mean left ventricular wall thickness increased from 13.8 to 15.5 mm (p = 0.02) after ischemia. Ventricular shape became more spherical with increasing left ventricular end-diastolic pressure. We conclude that two-dimensional echocardiography can be reliably used for accurate, serial measurements in physiological studies. The demonstrated variability in left ventricular mass is important, yet frequently ignored. Recognizing left ventricular mass changes may facilitate the detection of myocardial injury reflected as edema.

A young woman with shortness of breath was diagnosed preoperatively as having a coronary artery aneurysm. The aneurysm originated from the right coronary artery and was extraordinarily large. The aneurysm was excised successfully under extracorporeal circulation.