Use of an Intrapericardial Continuous Flow Ventricular Assist Device in a 4-Year-Old Child Weighing 12 Kilograms

Ventricular assist devices are implanted in patients with intractable heart failure as a bridge to cardiac transplantation to support the circulatory system mechanically. We present a report of a continuous flow ventricular assist device successfully placed as a bridge to transplantation in the intrapericardium of a petite-sized child with a BSA of 0.56 m2. Not only is the use of an intrapericardial, continuous-flow, centrifugal pump feasible for destination therapy, but also for low-weight pediatric patients with end-stage heart failure as a bridge to transplantation when there is chronic shortage of donor organs for heart transplantation. Consequently, the HeartWare system has been implanted in smaller patients with acceptable results, and this patient may be the youngest ever reported.

Assessment of 25-Hydroxyvitamin D Levels in Patients with Resistant Hypertension

OBJECTIVE

To investigate the possible correlation between serum 25-hydroxyvitamin D levels and resistant hypertension (RH).

SUBJECTS AND METHODS

Patients who had undergone ambulatory blood pressure measurements (ABPM) during outpatient controls were enrolled. Fifty subjects with RH, 50 with controlled hypertension (CHT) and 50 normotensive subjects (NT) were included in the study. RH was defined as 'suboptimal blood pressure control despite using 3 antihypertensive agents including a diuretic or need for 4 or more drugs to control blood pressure'. The 25-hydroxyvitamin D and parathormone levels were compared between the groups. Pearson's correlation coefficient test was applied to assess the correlation between 25-hydroxyvitamin D levels and office blood pressure (BP) and ABPM. Logistic regression analysis was used to determine the independent correlates of RH.

RESULTS

The 25-hydroxyvitamin D level was significantly lower in the RH group (17.02 ± 5.4 ng/ml) compared to the CHT (24.9 ± 4.8 ng/ml) and NT groups (28.0 ± 5.7 ng/ml, p < 0.001). In univariate correlation analysis, 25-hydroxyvitamin D levels had a significant negative correlation with office systolic BP (r = -0.329, p < 0.001), office diastolic BP (r = -0.395, p < 0.001), systolic ambulatory BP (r = -0.844, p = 0.004), and diastolic ambulatory BP (r = -0.567, p = 0.005). ROC analysis revealed that 25-hydroxyvitamin D levels <21.50 ng/ml predicted the presence of RH with a sensitivity of 78% and a specificity of 79% (AUC = 0.89, 95% CI 0.83-0.94). In the multivariate logistic regression analysis, 25-hydroxyvitamin D level was independently correlated with the presence of RH (β 0.660, 95% CI 0.572-0.760, p < 0.001).

CONCLUSION

There was an independent correlation between lower 25-hydroxyvitamin D levels and presence of RH.

Increased Transforming Growth Factor-β Levels Associated With Cardiac Adverse Events in Hypertrophic Cardiomyopathy

BACKGROUND

Hypertrophic cardiomyopathy (HCM) is a common genetic heart disease characterized by ventricular hypertrophy, myocardial fibrosis, and impaired ventricular relaxation. The exact mechanisms by which fibrosis is caused remain unknown.

HYPOTHESIS

Circulating TGF-β is related to poor prognosis in HCM.

METHODS

We compared TGF-β levels of 49 HCM patients with those of 40 non-HCM patients. We followed the patients with HCM for 18 months and divided them into 2 groups: low TGF-β (≤ 4877 pg/mL) and high TGF-β (> 4877 pg/mL). We compared the 2 groups in terms of brain natriuretic peptide (BNP), echocardiographic parameters, and clinical outcomes including myocardial infarction, arrhythmias, implantable cardioverter-defibrillator implantation, hospitalization, New York Heart Association (NYHA) class, acute heart failure, and mortality.

RESULTS

The HCM patients had higher TGF-β levels than those in the control group (P = 0.005). In the follow-up, those in the high TGF-β group had higher BNP levels, larger left-atrial size, thicker interventricular septum, NYHA class, more hospitalizations, and a greater number of clinical adverse events (P < 0.001, P = 0.01, P < 0.001, P = 0.002, P < 0.001 and P = 0.003, respectively). TGF-β level of > 4877 pg/mL can predict adverse events with a specificity of 75% and a sensitivity of 72% (P = 0.014). In multivariate regression analysis, TGF-β, BNP, and interventricular septum thickness were significantly associated with adverse events (P = 0.028, P = 0.030, and P = 0.034, respectively).

CONCLUSIONS

The TGF-β level is higher in HCM patients and associated with a poor prognosis in HCM.