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Abnormal liver function test results are often observed in acute decompensated heart failure (ADHF). However, the prognostic value of bilirubin fractionation has not been elucidated. The prognostic value of direct bilirubin (DB), in comparison with total bilirubin (TB), was examined in 556 consecutive patients with ADHF. Patients with elevated DB showed mostly similar patient characteristics including signs of elevated right-sided pressure (frequent hepatomegaly, jugular venous distention, dilated inferior vena cava, and elevated gamma-glutamyltransferase) and decreased cardiac output (cold extremities, decreased pulse pressure, and lower blood pressure) and other parameters of heart failure (HF) severity (increased plasma renin activity, decreased sodium, total cholesterol, and ejection fraction) to elevated TB; however, only patients with elevated DB showed a significant difference in the frequency of HF history and alkaline phosphatase value. Kaplan-Meier analysis showed that patients with elevated DB had a significantly higher rate of the composite end point of all-cause mortality or HF readmission (p = 0.021) compared with those with normal DB, whereas patients with elevated TB did not show a statistically significant difference compared with those with normal TB (NS). A multivariate Cox hazards model showed that DB was an independent predictor of adverse events (adjusted hazard ratio 1.052, 95% confidence interval 1.001 to 1.099, p = 0.034), whereas TB was not (adjusted hazard ratio 1.017, 95% confidence interval 0.985 to 1.046, p = 0.27). Adding DB to existing prognostic variables resulted in higher C-statistics than adding TB (C-statistics: 0.670 to 0.675, 0.670 to 0.674, respectively). In conclusion, elevated DB in ADHF was an independent prognostic predictor that was superior to TB. DB may be useful for further risk stratification in ADHF.

A 31‐year‐old female with 10 years indwelled Hickman catheter for idiopathic pulmonary hypertension presented infectious findings. We decided to remove it but simple traction did not work. Although it was an off labeled use, we could remove it using a laser sheath and snare technique without any complication.

BACKGROUND: Elevation of serum erythropoietin (EPO) level is frequently observed in heart failure (HF) patients, and higher serum EPO level has been reported to be associated with worse clinical outcome in chronic HF. However, serum EPO level was highly influenced by the presence of anemia and its prognostic significance in acute HF (AHF) patients without anemia remains unknown. METHODS: We examined 320 consecutive AHF patients who admitted to our institution between January 2013 and January 2014 from prospective registry. Patients who had anemia defined as a hemoglobin concentration < 13g/dl (males) and RESULTS: Adverse events were occurred in 10 patients (11 %). Higher EPO group had significantly higher incidence of adverse events compared with lower EPO group (19.6% vs 10.9%, P CONCLUSIONS: Higher serum EPO level might be a predictor for worse short-term clinical outcome in AHF patients without anemia.