Fumiki Yoshihara

National Cerebral and Cardiovascular Center, Ōsaka, Ōsaka, Japan

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Publications (103)350.38 Total impact

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    ABSTRACT: Since acute kidney injury (AKI) is not always related to mortality in patients with acute decompensated heart failure (ADHF), the aim of this study was to focus on onset time of AKI and its clinical importance. A total of 371 ADHF patients were included. The impact of AKI (≥0.3 mg/dl or 1.5-fold increase in serum creatinine level within 48 h) with early onset (≤4 days from admission) or late onset (≥5 days from admission) was assessed. AKI occurred in 99 patients, who were divided into two groups according to the median onset time of AKI: 50 with early onset of AKI and 49 with late onset of AKI. The maximum increase in serum creatinine level from admission was greater in patients with late onset of AKI than in patients with early onset of AKI (p = 0.012). Patients with late onset of AKI had a higher 12-month mortality rate than that in patients with early onset of AKI (log-rank test, p = 0.014). Late onset of AKI was an independent predictor of mortality (hazard ratio: 3.39, 95 % confidence interval: 1.84-6.18, p < 0.001). Late onset of AKI was associated with high blood urea nitrogen level at admission and intravenous administration of dobutamine. In conclusion, late onset of AKI related to high blood urea nitrogen level and intravenous administration of dobutamine, but not early onset of AKI, is linked to high mortality rate. Onset time of AKI may be useful for risk stratification of mortality in ADHF patients developing AKI.
    Heart and Vessels 08/2014; · 2.13 Impact Factor
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    ABSTRACT: The infusion of chronic angiotensin II (Ang II) has been shown to promote renal interstitial fibrosis. To evaluate the pathophysiological significance of the natriuretic peptide-GC-A system, we infused Ang II (1.0 mg/kg/day) in GC-A-deficient mice (GC-A-KO).
    Clinical and Experimental Nephrology 05/2014; · 1.25 Impact Factor
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    ABSTRACT: Abstract Blood pressure (BP) control in hypertensives has improved in recent years; however, it remains insufficient. We investigated the trend of BP control status in hypertensive patients with antihypertensive medication and salt intake. Two hundred and eight treated hypertensive patients were prospectively followed between 2007 and 2012. During this period, average clinic BP significantly decreased from 137 ± 12/80 ± 9 to 133 ± 11/76 ± 8 mmHg, and the achievement rate of BP control defined as <140/90 mmHg increased from 58% to 71% (p < 0.01). Morning home BP also significantly decreased from 132 ± 8/80 ± 8 to 130 ± 8/76 ± 7 mmHg, and the percentage of patients with sustained hypertension (CBP ≥140/90 mmHg and HBP ≥135/85 mmHg) decreased from 27% to 16% (p < 0.05). The number of antihypertensive drugs increased significantly from 2.1 ± 1.2 to 2.3 ± 1.1 (p < 0.01), while no differences were observed in urinary salt excretion (9.0 ± 2.4 g/day in 2007, 9.0 ± 2.6 g/day in 2012). Office and home BP decreased and the rate of BP control increased in treated hypertensive patients in the past 5 years. Intensive pharmacological therapy, but not a reduction in salt intake appears to have contributed to improved BP control.
    Clinical and Experimental Hypertension 01/2014; 36(2):103-7. · 1.28 Impact Factor
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    ABSTRACT: Carotid artery intima-media thickness (IMT) has emerged as a predictor of cardiovascular events. Home blood pressure (BP) is more closely associated with cardiovascular prognosis than clinic BP. The aim of this study was to compare the progression of carotid IMT with respect to strict and mild control of morning home systolic BP (SBP) and amlodipine- and losartan-based antihypertensive therapy in hypertensive patients. Subjects included 80 hypertensive outpatients who participated in the Hypertension Control Based on Home Systolic Pressure (HOSP) pilot study. After a 1-month drug-free period, the patients were randomly assigned to either the strict control group (target SBP <130 mm Hg) or the mild control group (130-139 mm Hg) and to either the amlodipine group or the losartan group. Additional antihypertensive drugs were added if target BP was not achieved with monotherapy. Morning SBP achieved target levels during 5 years in the strict control group and in the mild control group, while it was comparable between amlodipine and losartan groups. In all patients, mean and maximum carotid IMT increased significantly. Changes in carotid IMT did not differ between strict and mild control groups. Changes in mean carotid IMT in amlodipine group were smaller than those in losartan group at year 1, but were not different between the two groups at year 5. In conclusion, carotid IMT increased over time in hypertensive patients in spite of the strict control of home BP. Amlodipine may slow the progression of IMT more than losartan, although a difference was not obvious after 5 years.
    Clinical and Experimental Hypertension 03/2013; · 1.28 Impact Factor
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    ABSTRACT: It has been suggested that fibrates, lipid-lowering agents with a peroxisome proliferator-activated receptor-α agonistic property, lower blood pressure (BP) in some experimental models of hypertension. However, the effect of fibrates on BP in humans has been inconsistent, and there are few studies using home or ambulatory BP monitoring. We investigated the effects of bezafibrate on office, home and ambulatory BP in hypertensive patients with dyslipidemia. Thirty-two essential hypertensive patients with dyslipidemia (6 men and 26 women, mean age 65±8 years old) were assigned to a control period and a bezafibrate period (200 mg twice daily) for 8 weeks each in a randomized crossover manner. Bezafibrate significantly reduced serum triglyceride, total and low-density lipoprotein-cholesterol, blood glucose, plasma insulin, the homeostasis model assessment ratio and increased high-density lipoprotein-cholesterol. Compared with the control period, changes in office, home and 24-h BP with bezafibrate were -0.7±2.1/-1.6±1.2 mm Hg, +0.9±1.0/-0.5±0.6 and +0.8±1.4/-0.6±0.9 mm Hg, respectively. None of these differences in BP was significant. In conclusion, bezafibrate improved lipid metabolism and insulin sensitivity but did not affect office, home or ambulatory BP in hypertensive patients with dyslipidemia. Fibrates do not appear to lower BP in patients with essential hypertension.Journal of Human Hypertension advance online publication, 20 December 2012; doi:10.1038/jhh.2012.64.
    Journal of human hypertension 12/2012; · 2.80 Impact Factor
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    ABSTRACT: Background The renal resistive index (RI) measured using Doppler ultrasonography has been used as a diagnostic tool in the daily work-up of kidney diseases. A better understanding of its relationship with preclinical organ damage may help in determining overall cardiovascular risk in hypertensive patients.Methods We evaluated the association between RI and the presence and degree of target organ damage (TOD) in 288 (130 male) essential hypertensive patients. RI, carotid intima-media thickness (IMT), and left ventricular (LV) mass index were assessed by ultrasound scan. Albuminuria was measured as the albumin-to-creatinine ratio (ACR) in three consecutive first morning urine samples.ResultsIn univariate analysis, patients with TOD showed significantly higher RI as compared with those without TOD (presence vs. absence of carotid wall thickening, LV hypertrophy, and albuminuria, P < 0.01, respectively). The severity of each TOD increased progressively from the lower to the upper RI tertile. Multiple logistic regression analysis found that each standard deviation increase in RI gave a 47% higher odds of having LV hypertrophy, and a 70% higher odds of having albuminuria (P < 0.05, respectively). The occurrence of at least two signs of TOD also significantly increased in parallel with elevation of RI (odds ratio (OR): 1.89 for 1 s.d. increase, P < 0.01).Conclusions These results suggest that increased RI may be a marker of subclinical TOD in patients with essential hypertension.American Journal of Hypertension 2012; doi:10.1038/ajh.2012.113.
    American Journal of Hypertension 08/2012; · 3.67 Impact Factor
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    ABSTRACT: Increased renal restive index (RI) measured using Doppler ultrasonography has been shown to correlate with the degree of renal impairment in hypertensive patients. We investigated the prognostic role of RI in cardiovascular and renal outcomes. A total of 426 essential hypertensive subjects (mean age, 63 years; 50% female) with no previous cardiovascular disease were included in this study. Renal segmental arterial RI was measured by duplex Doppler ultrasonography. During follow-up (mean, 3.1 years), 57 participants developed the primary composite end points including cardiovascular and renal outcomes. In multivariate Cox regression analysis, RI was an independent predictor of worse outcome in total subjects (hazard ratio, 1.71 for 1 SD increase), as well as in patients with estimated glomerular filtration rate (eGFR) <60 mL/min per 1.73 m(2) (hazard ratio, 2.11 for 1 SD increase; P<0.01, respectively). When divided into 4 groups based on the respective sex-specific median levels of RI in the eGFR ≥60 and eGFR <60 mL/min per 1.73 m(2) groups, the group with eGFR <60 and high RI (male ≥0.73, female ≥0.72) had a significantly poorer event-free survival rate (χ(2)=126.4; P<0.01), and the adjusted hazard ratio by multivariate Cox regression analysis was 9.58 (95% CI, 3.26-32.89; P<0.01). In conclusion, impairment of renal hemodynamics evaluated by increased RI is associated with an increased risk of primary composite end points, and the combination of high RI and low eGFR is a powerful predictor of these diseases in essential hypertension. In hypertensive patients with chronic kidney disease, RI evaluation may complement predictors of cardiovascular and renal outcomes.
    Hypertension 07/2012; 60(3):770-7. · 6.87 Impact Factor
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    ABSTRACT: Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease (CVD). We previously reported renal parenchymal damage in autopsy subjects with stroke or abdominal aortic aneurysm. The aim of this study is to evaluate the relationship between renal histology and clinical characteristics of patients with myocardial infarction (MI). A total of 699 subjects were autopsied at the National Cerebral and Cardiovascular Center Hospital. We retrospectively evaluated all autopsy cases with MI (n = 123). Estimated glomerular filtration rate (eGFR) was calculated using the Japanese formula. Subjects were classified into four groups: 25 subjects with eGFR ≥ 60 mL/min/1.73 m(2) and no proteinuria (no CKD), 10 subjects with eGFR ≥ 60 and proteinuria (CKD1/2), 65 subjects with 60 > eGFR ≥ 30 (CKD3), and 23 subjects with eGFR < 30 (CKD4/5). Renal parenchymal damage was evaluated using a semi-quantitative histological score (score 0-3) for glomerulosclerosis, interstitial fibrosis, tubular atrophy, arteriolar hyalinosis, and arteriosclerosis of medium-sized artery (maximum score = 15). The mean histological score was significantly higher in patients with CKD3 and CKD4/5 and was associated with age, hypertension, diabetes, kidney function, proteinuria, and other CVD. In patients with MI, renal parenchymal damage and deteriorating kidney function are closely associated.
    Renal Failure 08/2011; 33(9):847-52. · 0.94 Impact Factor
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    ABSTRACT: Inflammation is associated with the development of atherosclerotic vascular lesions and some inflammatory parameters are used as cardiovascular (CV) risk markers. The present study was designed to assess the predictive power of interleukin (IL)-6 for future CV events. In 121 Japanese patients with multiple CV risk factors and/or disease, serum concentrations of IL-6 and high sensitive C-reactive protein (hs-CRP) were measured. During follow-up periods (mean, 2.9 years) after the baseline assessment, 50 patients newly experienced CV events such as stroke/transient ischemic attack (n=10), heart failure hospitalization (n=6), acute coronary syndrome (n=7), and revascularization for coronary artery disease (n=15) and peripheral arterial disease (n=12). The serum level of IL-6, but not hs-CRP, was significantly higher in patients who had CV events than in event-free subjects (3.9±2.6 and 3.0±2.2 pg/mL, P=0.04). When the patients were divided into three groups by tertiles of basal levels of IL-6 (<1.85, 1.85-3.77, and ≥3.77 pg/mL), cumulative event-free rates by the Kaplan-Meier method were decreased according to the increase in basal IL-6 levels (65%, 50%, and 19% in the lowest, middle, and highest tertiles of IL-6, respectively; log-rank test, P=0.002). By univariate Cox regression analysis, previous CV disease, creatinine clearance, and serum IL-6 levels were significantly associated with CV events during follow-up. Among these possible predictors, the highest tertile of IL-6 was only an independent determinant for the morbidity in the multivariate analysis (hazard ratio 2.80 vs. lowest tertile, P=0.006). These findings indicate that IL-6 is a powerful independent predictor of future CV events in high-risk Japanese patients, suggesting its predictive value is superior to that of hs-CRP.
    Cytokine 03/2011; 53(3):342-6. · 2.52 Impact Factor
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    ABSTRACT: Regulator of G-protein signaling 2 (RGS2) is a key molecule in signal pathways of vasoactive peptides, such as angiotensin II and endothelin 1, and is believed to have an important role in the pathophysiology of atherosclerosis. We have previously reported that common polymorphisms of RGS2 are associated with hypertension in Japanese. In this study, we studied whether the three previously identified common polymorphisms of RGS2 (-638A>G, 1026T>A and 1891-1892delTC) could be implicated in carotid atherosclerosis in Japanese patients with hypertension (459 men and 382 woman) and in a Japanese general population (814 men and 956 woman). We assessed two criteria for carotid atherosclerosis: maximal intima-media thickness (M-IMT) and mean-IMT. When subjects with atherosclerotic lesions were defined as having mean-IMT≥1.0 mm, multivariate logistic regression analysis performed after adjusting for confounding factors showed a significant association of the three common polymorphisms, -638A>G (AA versus AG+GG: odds ratio (OR), 1.55; 95% confidence interval (CI), 1.105-2.185; P=0.0113 only for the general population), 1026T>A (TT versus TA+AA: OR, 1.42; 95% CI, 1.027-1.972; P=0.034 for hypertensive subjects and OR, 1.56; 95% CI, 1.129-2.151; P=0.0071 for the general population), and 1891-1892delTC (II versus ID+DD: OR, 1.44; 95% CI, 1.043-2.008; P=0.028 for hypertensive subjects, OR, 1.32; 95% CI 1.002-1.742; P=0.048 for the total general population and OR 1.59; 95% CI 1.155-2.207; P=0.0047 for the general population), with carotid atherosclerosis. When atherosclerosis was defined as M-IMT 1.0 mm, the values of M-IMT were also significantly different between the three genotypes in the three common polymorphisms. Taken together, these data suggest that genetic polymorphisms in RGS2 are associated with intima-media thickening of carotid artery in humans.
    Hypertension Research 03/2011; 34(6):740-6. · 2.79 Impact Factor
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    ABSTRACT: Atherosclerosis is a major cause of mortality and morbidity among hemodialysis patients, but whether it is more severe in hemodialysis patients than in cardiovascular disease patients without chronic kidney disease is unclear. We examined 46 autopsy patients who had undergone hemodialysis, and age and sex-matched 46 patients with cardiovascular disease and an eGFR of >60 mL/min/1.73 m(2). There was no difference in the prevalence of diabetes or hypertension between the groups. We divided the aorta into four segments: A, ascending artery to arch; B, descending artery to diaphragm; C, suprarenal; and D, infrarenal. We used the classification of the American Heart Association to evaluate atherosclerosis progression. Distribution was scored by the extent to which each segment was damaged: 0, none; 1, less than 1/3; 2, more than 1/3 to less than 2/3; 3, more than 2/3. Histological examination revealed that the progression score (P < 0.05) and distribution score (P<0.005) were more severe in the hemodialysis group, especially in segment A. Regression analysis showed that atherosclerosis of segment A was related to age, gender, dyslipidemia, smoking, hemodialysis therapy, and hemodialysis duration. In hemodialysis patients, atherosclerotic changes in the aorta were more severe than in cardiovascular disease patients with an eGFR of >60 mL/min/1.73 m(2). Aortic atherosclerosis was aggravated by traditional and chronic kidney disease-related risk factors.
    Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 02/2011; 15(1):51-7. · 1.53 Impact Factor
  • International Journal of Cardiology - INT J CARDIOL. 01/2011; 152.
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    ABSTRACT: Chronic kidney disease (CKD) has recently been recognized to be a powerful predictor of cardiovascular morbidity and mortality. Atrial fibrillation (AF), which is a common arrhythmia in hypertensives, is associated with increased risks of cardiovascular events and death. However, the association between CKD and the onset of AF has not been fully elucidated. The present study assessed the hypothesis that CKD may influence the onset of AF in hypertensives. A total of 1118 hypertensive patients (mean age, 63 years) without previous paroxysmal AF, heart failure, myocardial infarction, or valvular disease were enrolled. CKD was defined as decreased glomerular filtration rate (<60 ml/min per 1.73 m) and/or the presence of proteinuria (>or=1+). During follow-up periods (mean, 4.5 years), 57 cases of new-onset AF were found (1.1% per year). Kaplan-Meier curves revealed that the cumulative AF event-free rate was decreased in the CKD group (log-rank test P < 0.001). By univariate Cox regression analysis, age, smoking, left atrial dimension, left ventricular mass index, and the presence of CKD were significantly associated with the occurrence of AF. Among these possible predictors, CKD (hazard ratio 2.18, P = 0.009) was an independent determinant for the onset of AF in multivariate analysis. Advanced stages of CKD (stages 4 and 5) were strongly related to the increased occurrence of AF. The present study demonstrated that the complication of CKD, especially progressed renal dysfunction, was a powerful predictor of new-onset AF in hypertensive patients, independently of left ventricular hypertrophy and left atrial dilatation.
    Journal of Hypertension 08/2010; 28(8):1738-44. · 4.22 Impact Factor
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    ABSTRACT: We examined blood pressure (BP) and medication over 5 years in 80 hypertensive patients who participated in the Hypertension Control Based on home systolic pressure (HOSP) study that compares effects of strict and mild control of morning home systolic blood pressure (SBP) as well as amlodipine- and losartan-based regimens. Average morning home SBP after 5 years was 126 mmHg in the strict control group and 135 mmHg in the mild control group. The strict control group and the losartan group required more combination therapy than the other groups. These results show that long-term strict control of morning BP is feasible. Amlodipine appears to be more effective in controlling morning BP than losartan when the medication is administered alone in the morning.
    Clinical and Experimental Hypertension 07/2010; 32(4):239-43. · 1.28 Impact Factor
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    ABSTRACT: Recent epidemiologic analyses have demonstrated a link between the metabolic syndrome (MetS) and chronic kidney disease (CKD). We examined the association between MetS, CKD, and left ventricular hypertrophy (LVH), and prospectively investigated the predictive value of the combination of MetS and CKD for cardiovascular disease (CVD) in essential hypertension. A total of 1,160 essential hypertensive patients (mean age 63 years, 53% male) underwent clinical evaluation, laboratory testing, and Doppler echocardiography, and were monitored for a mean follow-up of 4.8 years. At baseline, total subjects were divided into four groups according to the presence/absence of MetS and/or CKD, and, compared to the group without MetS and CKD (MetS-/CKD-); those with MetS and CKD (MetS+/CKD+) had a multivariate-adjusted odds ratio of 2.40 (95% confidence interval (CI) 1.66-3.48) for LVH. During the follow-up period, 172 subjects developed CVD. Multiple Cox regression analysis including LV mass index (LVMI) showed that the presence of MetS as well as that of CKD were each independent predictors of CVD (hazard ratio 1.90 for MetS, 1.82 for CKD). We then divided the total subjects into four groups, and found that, compared to the MetS-/CKD- group, multivariate-adjusted HR for the MetS+/CKD+ group was 3.58 (95% CI 2.14-5.95). Our findings suggest that, in essential hypertension, the combination of MetS and CKD is a strong risk for LVH as well as a strong and independent predictor of subsequent CVD. These findings highlight the clinical importance of the concomitance of MetS and CKD in essential hypertension.
    American Journal of Hypertension 03/2010; 23(3):290-8. · 3.67 Impact Factor
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    ABSTRACT: A close linkage between chronic kidney disease (CKD) and cardiovascular disease (CVD) has been demonstrated. Coronary artery calcification (CAC) is considered to be the causal link connecting them. The aim of the study is to determine the relationship between level of kidney function and the prevalence of CAC. Autopsy subjects known to have coronary artery disease and a wide range of kidney function were studied. Patients without CKD were classified into five groups depending on estimated GFR (eGFR) and proteinuria: eGFR > or =60 ml/min/1.73 m(2) without proteinuria; CKD1/2: eGFR > or =60 ml/min/1.73 m(2) with proteinuria; CKD3: 60 ml/min/1.73 m(2) >eGFR > or =30 ml/min/1.73 m(2); CKD4/5: eGFR <30 ml/min/1.73 m(2); and CKD5D: on hemodialysis. Intimal and medial calcification of the coronary arteries was evaluated. Risk factors for CVD and uremia were identified as relevant to CAC using logistic regression analysis. Intimal calcification of plaques was present in all groups, but was most frequent and severe in the CKD5D group and less so in the CKD4/5 and CKD3 groups. Risk factors included luminal stenosis, age, smoking, diabetes, calcium-phosphorus product, inflammation, and kidney function. Medial calcification was seen in a small number of CKD4/5 and CKD5D groups. Risk factors were use of calcium-containing phosphate binders, hemodialysis treatment, and duration. It was concluded that CAC was present in the intimal plaque of both nonrenal and renal patients. Renal function and traditional risks were linked to initimal calcification. Medial calcification occurred only in CKD patients.
    Clinical Journal of the American Society of Nephrology 10/2009; 4(12):1892-900. · 5.07 Impact Factor
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    ABSTRACT: Stimulation of insulin-like growth factor (IGF)-1 receptor by IGF-1 and insulin strongly induces cardiomyocyte hypertrophy. In this study, we assessed the hypothesis that genetic variations of the IGF-1 receptor may be linked to the diversity of left ventricular (LV) structure in hypertensive patients. Genotypes in 12 single nucleotide polymorphisms (SNPs) of the IGF-1 receptor gene identified by direct sequencing were determined in 795 Japanese patients with essential hypertension. In echocardiographic examinations, LV mass index (LVMI) and relative wall thickness (RWT) were measured. Among 12 SNPs, promoter -328C>T and intron-13 275124A>C polymorphisms were significantly associated with LV hypertrophy (LVMI> or =125 g m(-2)) and concentric change (RWT> or =0.44), respectively. In allele frequencies, the C allele of -328C>T was related to LV hypertrophy, and the A allele of 275124A>C was related to LV concentric change. In fact, LVMI and prevalence of LV hypertrophy increased in CC genotype of -328C>T. RWT and prevalence of LV concentric change increased in AA genotype of 275124A>C. A multiple logistic regression analysis revealed that the presence of CC genotype of -328C>T or AA genotype of 275124A>C was an independent determinant for LV hypertrophy or concentric change, respectively. Furthermore, the combination of CC of -328C>T and AA of 275124A>C genotypes was significantly associated with abnormal LV geometry, especially concentric hypertrophy. Our findings show that two SNPs of the IGF-1 receptor gene are related to LV hypertrophy in patients with essential hypertension, suggesting that the genetic variation of the IGF-1 receptor may be involved in the diversity of LV structure in hypertensives.
    Journal of human hypertension 09/2009; 24(5):320-6. · 2.80 Impact Factor
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    ABSTRACT: Pulmonary arterial hypertension (PAH) is a life-threatening disease characterized by progressive PAH and right ventricular failure. Despite recent advances in therapeutic approaches using prostanoids, endothelin antagonists, and so on, PAH remains a challenging condition. To develop a novel therapeutic approach, we have established a nonviral gene delivery system of poly(ethylene glycol) (PEG)-based block catiomers, which form a polyplex nanomicelle with a nanoscaled core-shell structure in the presence of DNA. The polyplex nanomicelle from PEG-b-poly{N-[N-(2-aminoethyl)-2-aminoethyl]aspartamide} (PEG-b-P[Asp(DET)]), having ethylenediamine units at the side chain, showed ~100-fold increase in luciferase transgene expression activity in mouse lung via intratracheal administration with a minimal toxicity compared with the polyplex from linear poly(ethylenimine) (LPEI). The transfection activity was highest on day 3 after administration and remained detectable until day 14. PEG-b-P[Asp(DET)] polyplex nanomicelles were formulated with a therapeutic plasmid bearing the human adrenomedullin (AM) gene and intratracheally administered to rats with monocrotaline-induced pulmonary hypertension. The right ventricular pressure significantly decreased 3 days after administration as confirmed by a notable increase of pulmonary human AM mRNA levels. Intratracheal administration of PEG-b-P[Asp-(DET)] polyplex nanomicelles showed remarkable therapeutic efficacy with PAH animal models without compromising biocompatibility.
    Molecular Therapy 04/2009; 17(7):1180-6. · 7.04 Impact Factor
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    ABSTRACT: It was reported previously that 30 min administration of adrenomedullin (AM) improves hemodynamics in chronic stable heart failure patients. The present study was designed to examine whether long-term AM + human atrial natriuretic peptide (hANP) administration can be used as a therapeutic drug in patients with acute decompensated heart failure (ADHF) in clinical setting. Seven acute heart failure patients (74 +/- 5 years) with dyspnea and pulmonary congestion were studied. AM (0.02 microg x kg(-1) x min(-1)) + hANP (0.05 microg x kg(-1) x min(-1)) was infused for 12 h and then hANP (0.05 microg x kg(-1) x min(-1)) was infused for 12 h. Hemodynamic, renal, hormonal and oxidative stress responses were evaluated. AM + hANP significantly reduced mean arterial pressure, pulmonary arterial pressure and systemic and pulmonary vascular resistance without changing heart rate, and increased cardiac output for most time-points compared with those at baseline. In addition, AM + hANP reduced aldosterone, brain natriuretic peptide and free-radical metabolites compared with those at baseline (all P<0.05). AM + hANP increased urine volume and U(Na)V compared with baseline data. In this small, pilot trial, AM + hANP therapy had beneficial hemodynamic and hormonal effects in ADHF. Intravenous infusion of AM with hANP could be used as a therapeutic drug in ADHF. These data are preliminary and require confirmation in a larger clinical study.
    Circulation Journal 04/2009; 73(5):892-8. · 3.58 Impact Factor
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    ABSTRACT: Chronic kidney disease is a major risk factor for patients with cardiovascular diseases (CVD). The aim of this study is to evaluate the relationship between clinical characteristics and renal histology in patients with abdominal aortic aneurysm (AAA). We studied 79 cases with AAA autopsied at the National Cardiovascular Center. They were classified into two groups: 14 subjects with renal artery stenosis (RAS) (group A) and 65 subjects without RAS (group B). Proteinuria, elevated serum creatinine and decreased estimated glomerular filtration rate had been recorded. We evaluated renal parenchymal damage using a semiquantitative histological score (score 0-3; normal to severe) for glomerulosclerosis, interstitial fibrosis, tubular atrophy, and arteriolar hyalinosis (maximal score = 12). Total histological score was 8.2 +/- 2.4 and significantly higher in the stenosed kidneys of group A than in the non-stenosed kidneys of group B (8.9 +/- 2.6 vs. 8.0 +/- 2.3). The histological score had a significant association with RAS, smoking, kidney function, proteinuria, kidney weight and the presence of other CVD. We demonstrated that renal parenchymal damage and deteriorated kidney function are closely associated in the patients with AAA. Treatment of these patients in view of protection of the kidney is thus relevant.
    Kidney and Blood Pressure Research 02/2009; 32(1):11-6. · 1.60 Impact Factor

Publication Stats

2k Citations
350.38 Total Impact Points

Institutions

  • 1998–2012
    • National Cerebral and Cardiovascular Center
      • Department of Cardiovascular Medicine
      Ōsaka, Ōsaka, Japan
    • Jichi Medical University
      • Division of Cardiology
      Totigi, Tochigi, Japan
  • 2002–2009
    • Dokkyo Medical University
      • Department of Hypertension and Cardiorenal Medicine
      Tochigi, Tochigi-ken, Japan