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  • ISSN: 2333-6676
    Volume 4, Issue 3
    Case Report
    Reiffel James A*
    This is a case of paroxysmal atrial fibrillation in which changes in the patient’s age, concomitant medical conditions, and drug interactions result in sequential decisions over time to change treatments (both anti-arrhythmic and anticoagulant) and to deal with both potential and real adverse consequences of therapy. It illustrates the need for continued vigilance and thought-making when following each single patient as well as the need for inter-physician communication.
    Research Article
    Matthew F Yuyun*, Ian Loke, William B Nicolson, Louise Clayton and Iain B Squire
    Background: Recent guidelines advise early review of patients with exacerbation of chronic stable or suspected de novo heart failure by heart failure specialists. Although many hospitals across the United Kingdom are providing rapid access heart failure clinic (RAHFC) services, the impact on patient outcomes is uncertain.
    Aim: To determine the impact of a RAHFC on subsequent hospital admissions for heart failure and bed occupancy.
    Methods: Patients were seen in a secondary care cardiology RAHFC within three days of referral by their primary care physician. Leicestershire has three National Health Service (NHS) clinical commissioning groups (CCGs). Patients from one of these access the RAHFC and constituted the intervention group (Group 1). Patients from the other two CCGs do not access this service and constituted the comparator group (Group 2).
    Results: Three hundred and twelve patients attended the clinic, in 265 (84.9%) of whom the diagnosis of heart failure was confirmed. During follow-up (median 11.2 months), 67 (21.5%) died or were admitted for heart failure. Independent predictors of combined death and heart failure admission were age, male-gender, orthopnoea, and smoking. Heart failure admission rates were lower at 3.72/1000 population in Group 1 compared to 4.07/1000 in Group 2 (relative risk 0.91, 95% confidence interval 0.86-0.98, p = 0.007). Bed occupancy days in Group 1 were 47.44/1000 population for 11.2 months and 52.35/1000 in Group 2 (RR 0.91, 95% CI 0.89-0.92, P < 0.001).
    Conclusion: A rapid access heart failure clinic is feasible, clinically effective, and might have possible cost-reduction implications.
    Josep L. Melero-Ferrer*, Sandra Dolz-Gimeno, Ignacio J. Sánchez-Lázaro, Mónica Cebrián-Pinar, Vicenta Martinez-Sales, Virtudes Vila Liante, Begoña Laiz-Marro, Luis Martínez-Dolz and Luis Almenar Bonet
    Background: Pulmonary hypertension (PH) associates with high morbidity and mortality, being its main cause left heart diseases. Attending to its hemodynamic profile it can be divided in postcapillary or precapillary PH. The aim of this study was to search for new potentially useful biomarkers in this disease.
    Methods: Patients who underwent a right heart catheterization were recruited and a blood sample from pulmonary trunk was obtained. Samples were divided in three groups of eight individuals, according to their hemodynamic profile (no PH, postcapillary PH, precapillary PH) and then mixed to obtain three pooled samples. The microarray Human L-series 1.000 from Ray Biotech was then performed.
    Results: A thousand proteins were analysed. Among them, 67 showed significant expression differences. Seventeen proteins had a significant progressive increase (more that 1.5-fold) between two consecutive groups. These proteins were angiopoietin-like 4(ANGPTL4), transient receptor potential cation channel subfamily C6 (TRCP6),transient receptor potential cation channel subfamily M7 (TRPM7)and apelin receptor (APJ); myocardial-related ones such as glycogen phosphorylase iso enzyme BB (GPBB), cathepsin B and osteocrin-musclin; ubiquitin; matrix metalloprotease 7 (MMP7); transcription factors as Kruppel-like factor 4 (KLF4),LIN41, RIP1 and TRAILR2; and immunity proteins as LIF, thymic stromal lymphopoietin (TSLP), LIMPII and interleukin 17B receptor.
    Conclusions: Seventeen proteins, which correlate with the severity of PH due to left heart disease, have been identified. Further quantitative studies are needed to identify their potential use as biomarkers.
    Naoko Unami* and Shiro Katayama
    Background: Warfarin has a narrow therapeutic window, interacts with some foods, and requires routine monitoring. Direct oral anticoagulants (DOACs) are able to resolve some of the drawbacks of warfarin. Recently, it has been reported that the incidence of major bleeding in patients with atrial fibrillation who are receiving apixaban is similar to that in patients receiving warfarin. We therefore sought indices formeasuring/monitoringthe anticoagulant activity of apixaban.
    Methods: Twenty-three patients (70.0±8.6years;17 males, 6 females) with non-valvular atrial fibrillation, for whom warfarin was replaced with 10mg/day apixaban, were enrolled in the studyfrom February 1, 2013 to July 31, 2014. We examined the relationship between prothrombin time of warfarin (PTw) and PT of apixaban (PTa) by using paired t-test. We also used multiple regression analysis to predict PTa from PTw and other factors (age, body surface area, serum creatinine, and creatinine clearance).
    Results: PTw was significantly shorter than PTa (PTw, 19.0±3.2s versus PTa, 15.5±1.5s; P< 0.0001), and PTa was significantly prolonged compared with the normal PT range of 10s to 12s (P = 0.01). This finding suggested that PT is sensitive in the prediction of apixaban-associated Xa activity, and PTa could be predicted using PTw as follows: predicted PTa = 10.515 + 0.263×PTw (P = 0.056).
    Conclusions: When warfarin was replaced with 10mg/day apixaban, PTa could be predicted using PTw without any routine monitoring to evaluate anticoagulant activity.
    Mini Review
    Jessica Olivaes and Melissa Markoski*
    The genome editing is a tool continuously exploited in the search for repairing mutations that cause diseases. Recently, the CRISPR/Cas9 system, a defense mechanism found in bacteria, has been receiving special attention due to the ease of replacing erroneous bases to DNA sequence through specific nucleases. CRISPR/Cas9 technology is cheap, specially compared to gene therapy, and has been studied as a possibility in curing genetic disorders, acting only in mutant alleles, in several murine models. Recently, the FDA approved the use of a genomic editing tool, similar to the CRISPR/Cas9 system, for production of factor IX in patients with severe hemophilia B, a monogenic disorder. However, most cardiovascular diseases are multi factorial, specially coronary artery disease, and are caused by mutations not only in genes, but also in regulatory proteins key to the functions of these genes. Here, we reviewed the applications of CRISPR/Cas9 methodology in the cardiovascular area and speculate its possible application to atherosclerosis, highlighting features and potential risks.
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