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Tomohiro Nakayama,
Michiyoshi Minato,
Makio Nakagawa,
Masayoshi Soma,
Hideko Tobe,
Noriko Aoi,
Kotoko Kosuge,
Mikano Sato,
Yukio Ozawa, Katsuo Kanmatsuse,
Shinichiro Kokubun
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ABSTRACT: Missense mutations in the calcium-sensing receptor (CaSR) gene have previously been identified in patients with familial hypocalciuric hypercalcemia (FHH) and neonatal severe hyperparathyroidism.
We identified a newborn with hypercalcemia in our hospital by mass screening. The family members were studied, and we found
a novel CaSR missense mutation with polymerase chain reaction single-strand conformational polymorphism analysis. The mother, grandmother,
and aunt of the baby all had FHH. A heterozygous missense mutation in exon 6 that substitutes a glutamic acid for the glycine
at codon 557 (Gly557 Glu), which corresponds to the extracellular domain of CaSR, was identified and shown to cosegregate with the disease. Identification of the mutation responsible for the FHH phenotype
in this family may facilitate rapid testing of individuals at risk for FHH.
Endocrine 04/2012; 15(3):277-282. · 1.42 Impact Factor
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Shigemasa Tani,
Ikuyoshi Watanabe,
Takeo Anazawa,
Hirofumi Kawamata,
Eizo Tachibana,
Takeshi Fuji,
Michiaki Matsumoto,
Motoyuki Onikura,
Yuichi Sato,
Ken Nagao, Katsuo Kanmatsuse,
Toshio Kushiro,
Atsushi Hirayama
[show abstract]
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ABSTRACT: We experienced a case of vasospastic angina showing resolution of vasospasm in the acetylcholine provocation test corresponding to regression of coronary atherosclerotic plaque following treatment with a combination of benidipine and pravastatin.
International journal of cardiology 04/2008; 125(1):e1-3. · 7.08 Impact Factor
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Fumio Saito,
Shinobu Imai,
Nobuyuki Tanaka,
Hideyuki Tanaka,
Kazutaka Suzuki,
Hidehito Takase,
Hiroshi Aoyama,
Kagari Matsudaira,
Tomonori Ebuchi,
Yasuyuki Akamine,
Naoyuki Takahashi,
Keiichi Sugino, Katsuo Kanmatsuse,
Hiroshi Yagi,
Toshio Kushiro
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ABSTRACT: Basic autonomic nervous function was evaluated in patients with neurocardiogenic syncope (NCS). Atropine, isoproterenol, propranolol, phenylephrine, and phentolamine were administered successively, and parasympathetic nerve activity and beta- (and alpha-) activity, sensitivity, and secretion of the sympathetic nerve were determined in patients with NCS and control subjects. In patients with NCS, beta- and alpha- sensitivity were higher and beta-activity and beta- and alpha-secretion lower than in control subjects. In patients with NCS, the increased basic beta-sensitivity may contribute to induce strong cardiac contractions and augment ventricular mechanoreceptor response, and a compensatory state against diminished neuronal sympathetic activity is suggested by the increased alpha-sensitivity.
Clinical and Experimental Hypertension 05/2007; 29(3):165-73. · 1.07 Impact Factor
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ABSTRACT: Two randomized studies have shown a neurological benefit of therapeutic hypothermia in comatose survivors after out-of-hospital cardiac arrest, but there are no studies of the cardiac neurohormone of B-type natriuretic peptide (BNP) in patients treated with hypothermia.
A prospective study was conducted of 109 comatose patients who were treated with mild hypothermia after out-of-hospital sudden cardiac arrest due to cardiac causes and whose BNP level was measured on arrival at the emergency room. The primary endpoint was a favorable neurological outcome at the time of hospital discharge. A total of 45 of the 109 patients had a favorable neurological outcome. The unadjusted rate of a favorable neurological outcome decreased in a stepwise fashion among patients in increasing quartiles of BNP level (p<0.001) and this association remained significant in subgroups of patients. The BNP cutoff value of 80 pg/ml for a favorable neurological outcome had an accuracy of 87.2%. In the multiple logistic-regression analysis, a BNP level of 80 pg/ml or less was an independent predictor of favorable neurological outcome.
The measurement of BNP was found to provide valuable information regarding the neurological outcome of comatose survivors treated with mild hypothermia after out-of-hospital cardiac arrest due to cardiac causes.
Circulation Journal 03/2007; 71(3):370-6. · 3.77 Impact Factor
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Shigemasa Tani,
Ken Nagao,
Ikuyoshi Watanabe,
Kimio Kikushima,
Kazuhiro Watanabe,
Takeo Anazawa,
Hirofumi Kawamata,
Eizo Tachibana,
Michiaki Matsumoto,
Takamichi Kumabe, Katsuo Kanmatsuse,
Toshio Kushiro
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ABSTRACT: Progress in reperfusion therapy for acute myocardial infarction (AMI) has greatly reduced acute phase mortality, but few data exist regarding the time trends in left ventricular (LV) remodeling in hospital survivors of AMI.
The study enrolled 813 patients with AMI who had received reperfusion therapy and survived to hospital discharge. The patients were divided into chronological groups: first treatment received between 1989 and 1992, n=196; 1993 and 1995, n=193; 1996 and 1998, n=211; and 1999 and 2002, n=213. A comparison was made of LV ejection fraction (LVEF) and LV end-diastolic volume index (LVEDVI) at 6 months after symptom onset. Along with the temporal improvements reperfusion therapy, LVEF and LVEDVI improved over time (55+/-14, 58+/-13, 59+/-13, 61+/-13%, p<0.001; 98+/-30, 94+/-27, 90+/-31, 76+/-27 ml/m2, p<0.0001). Multiregression analysis revealed that shortening of the door-to-Thrombolysis In Myocardial Infarction (TIMI)-3 time (time interval from arrival at the emergency room until patients achieved TIMI-3 flow) and achieving substantial TIMI-3 flow were independent predictors for LV remodeling.
Although this was a retrospective analysis, the results demonstrated that the change in reperfusion therapy aiming at complete reperfusion at an earlier stage after AMI onset has contributed to improving post-MI remodeling.
Circulation Journal 03/2007; 71(2):180-5. · 3.77 Impact Factor
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Toshihide Suzuki,
Yuichi Sato,
Shinichiro Niizuma,
Toshio Kushiro,
Shigemasa Tani,
Kazutoshi Ishikawa,
Nagao Kajiwara, Katsuo Kanmatsuse,
Hironori Ikeda,
Motoichirou Takahashi,
Shunichi Kojima
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ABSTRACT: We have recognized marked effectiveness for intermittent claudication with low-density lipoprotein (LDL) apheresis in two cases of arteriosclerosis obliterans (ASO). The Case 1 was a 73-year-old man with intermittent claudication of both lower extremities (Fontaine class II), digital subtraction angiography (DSA) revealed complete obstruction of the left common iliac artery, formation of a collateral to the peripheral portion of the left common iliac artery, and diffuse stenosis of the peripheral portion of the right common iliac artery. Ten sessions of LDL apheresis (LDL-A) improved the walking distance from 100 m before to 600 m after LDL-A treatment. The Case 2 was a 61-year-old man with intermittent claudication of the left lower extremity (walking distance: 200 m) began at 59 years. DSA revealed diffuse stenosis of the peripheral portion of the left popliteal artery. Ten sessions of LDL-A improved the walking distance from 200 m before to 800 m after LDL-A. At one month after the end of LDL-A treatment, DSA revealed formation of collateral to the peripheral portion of the left popliteal artery. Our findings suggest that LDL-A combined with drug treatment is safe and useful for the treatment of ASO, especially walking distance improved with short term treatment.
Journal of Clinical Apheresis 02/2007; 22(5):287-91. · 1.93 Impact Factor
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Fumio Saito,
Hirotaka Fujita,
Atsuhiko Takahashi,
Izumi Ichiyama,
Shinsuke Harasawa,
Kouji Oiwa,
Naoyuki Takahashi,
Yuji Otsuka,
Takashi Uchiyama, Katsuo Kanmatsuse,
Toshio Kushiro
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ABSTRACT: In hypertensive patients with chronic renal disease, angiotensin receptor blockers (ARBs) are among the first-line drugs, and calcium channel blockers (CCBs) are recommended as a second line. We examined the effects of two therapeutic strategies using ARBs and benidipine, a CCB, on blood pressure (BP), urinary albumin excretion (UAE), and cost-effectiveness in hypertensive patients with albuminuria. Patients whose BP was 140/90 mmHg or higher despite treatment with low- or medium-dose ARBs were assigned randomly to two groups. In Group A (n=14), the ARB dose was maximized and then benidipine was added until BP targets were reached (<130/85 mmHg). In Group B (n=18), benidipine was administered first and then the ARB dose was increased until BP targets were reached. The BP targets were achieved by ARB alone in 36% of Group A patients and by the addition of benidipine in 83% of Group B patients. Finally, BP decreased in each group, reaching the targets in 93% of Group A patients and 94% of Group B patients after a 4-month therapeutic period. UAE was decreased in both groups after a 4-month therapeutic period compared to the allocation period (-33+/-6% in Group A, -31+/-6% in Group B; p<0.001, respectively). The monthly drug cost was higher (11,426+/-880 vs. 8,955+/-410 yen, p=0.012) and the cost-effectiveness of antihypertensive treatment was lower (p=0.003) in Group A than in Group B. We conclude that the addition of benidipine to low- or medium-dose ARB is, in light of the renal protection and the cost-effectiveness of this approach, a useful therapeutic strategy for controlling BP in hypertensive patients with albuminuria.
Hypertension Research 01/2007; 30(1):39-47. · 2.58 Impact Factor
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Fumio Saito,
Hirotaka Fujita,
Atsuhiko Takahashi,
Izumi Ichiyama,
Shinsuke Harasawa,
Kouji Oiwa,
Naoyuki Takahashi,
Yuji Otsuka,
Takashi Uchiyama, Katsuo Kanmatsuse,
Toshio Kushiro
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[hide abstract]
ABSTRACT: In hypertensive patients with chronic renal disease, angiotensin receptor blockers (ARBs) are among the first-line drugs, and calcium channel blockers (CCBs) are recommended as a second line. We examined the effects of two therapeutic strategies using ARBs and benidipine, a CCB, on blood pressure (BP), urinary albumin excretion (UAE), and cost-effectiveness in hypertensive patients with albuminuria. Patients whose BP was 140/90 mmHg or higher despite treatment with low- or medium-dose ARBs were assigned randomly to two groups. In Group A (n=14), the ARB dose was maximized and then benidipine was added until BP targets were reached (<130/85 mmHg). In Group B (n=18), benidipine was administered first and then the ARB dose was increased until BP targets were reached. The BP targets were achieved by ARB alone in 36% of Group A patients and by the addition of benidipine in 83% of Group B patients. Finally, BP decreased in each group, reaching the targets in 93% of Group A patients and 94% of Group B patients after a 4-month therapeutic period. UAE was decreased in both groups after a 4-month therapeutic period compared to the allocation period (-336% in Group A, -316% in Group B; p<0.001, respectively). The monthly drug cost was higher (11,426880 vs. 8,955410 yen, p=0.012) and the cost-effectiveness of antihypertensive treatment was lower (p=0.003) in Group A than in Group B. We conclude that the addition of benidipine to low- or medium-dose ARB is, in light of the renal protection and the cost-effectiveness of this approach, a useful therapeutic strategy for controlling BP in hypertensive patients with albuminuria.Keywords: angiotensin receptor blocker, benidipine, blood pressure, urinary albumin excretion, renal protection
Hypertension Research 12/2006; 30(1):39-47. · 2.58 Impact Factor
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Annals of the New York Academy of Sciences 12/2006; 748(1):494 - 497. · 3.15 Impact Factor
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ABSTRACT: The increasing elderly population will influence the treatment policies adopted in cases of acute myocardial infarction. Considering reperfusion therapy in elderly patients with acute myocardial infarction, we compared three strategies, as follows: primary percutaneous coronary intervention (primary PCI: n = 26), facilitated PCI with half the standard dose of mutant tissue-type plasminogen activator (t-PA) (half + PCI: n = 24), and facilitated PCI with a standard dose of mutant t-PA (standard + PCI: n = 15) between patients 75 and 80 years of age. The rate of acquisition of thrombolysis in myocardial infarction (TIMI-3) flow on initial coronary arteriography was significantly lower in the primary PCI group than in the other two groups (7.7% in the primary PCI group vs 60% in the half + PCI and 66.7% in the standard + PCI group). The incidence of hemorrhagic complications including blood transfusion was not significantly different between primary PCI and facilitated PCI. Considering reperfusion therapy in elderly patients with acute myocardial infarction, we concluded that facilitated PCI may be effective in elderly patients aged 75-80 years.
Heart and Vessels 08/2006; 21(4):236-41. · 2.05 Impact Factor
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ABSTRACT: The proportion of cardiac etiology is more than 50% of the patients of out-of-hospital cardiac arrest and the cause of cardiac etiology is acute coronary syndromes (ACS) in about 70%. Although the mortality rate of acute myocardial infarction with ST elevation was about 7% in the cardiac reperfusion era, there is a high mortality rate in the patients with ACS who developed out-of-hospital cardiac arrest. We summarized the emergency medical service system in Japan and its problems. Achieving the optimal survival rate for out-of-hospital cardiac arrest due to ACS is the challenge now and in the future.
Nippon rinsho. Japanese journal of clinical medicine 05/2006; 64(4):771-8.
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ABSTRACT: The outcome for facilitated percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is known to be more favorable in cases in which TIMI-3 flow is obtained before PCI. We investigated factors that affect the acquisition of TIMI-3 flow before PCI. Facilitated PCI was performed on 178 patients divided into two groups, a group in which TIMI-3 flow was acquired before conducting PCI and another in which it was not, and their background factors and short-term outcomes were investigated. The hemoglobin concentrations, white blood cell (WBC) counts, and HbA1c values were significantly lower in the group in which TIMI-3 flow was acquired before PCI and significantly more had a history of past smoking. According to the results of logistic analysis, WBC count (odds ratio [OR], 0.865, P = 0.0077), hemoglobin concentration (OR, 0.77, P = 0.0257), and smoking history (OR, 0.266, P = 0.0021) were independent factors that predicted acquisition of TIMI-3 flow. The WBC count and hemoglobin value on arrival at the emergency room and history of smoking were shown to be independent factors for acquisition of TIMI-3 flow before PCI in facilitated PCI.
International Heart Journal 02/2006; 47(1):29-35. · 1.16 Impact Factor
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Shigemasa Tani,
Ikuyoshi Watanabe,
Ken Nagao,
Takeo Anazawa,
Hirofumi Kawamata,
Eizo Tachibana,
Kana Nomoto,
Takamichi Kumabe,
Naoya Matsumoto,
Yuichi Sato, Katsuo Kanmatsuse,
Toshio Kushiro
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ABSTRACT: The case of a 30-year-old man with myocardial infarction localized in the interventricular septum is described. Coronary angiography performed on day 28 after the onset of symptoms revealed ectasia in the right and left coronary arteries, but no overt stenotic or occlusive lesions were present. Spasm was induced in the first septal branch of the left anterior descending artery by an acetylcholine provocation test, and single photon emission computed tomography myocardial perfusion imaging showed a reduced thallium-201 uptake localized in the interventricular septum.
International Heart Journal 02/2006; 47(1):131-7. · 1.16 Impact Factor
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Yasuo Okumura,
Ichiro Watanabe,
Toshiko Nakai,
Hidezou Sugimura,
Kenichi Hashimoto,
Riko Masaki,
Kimie Ohkubo,
Yasuhiro Takagi,
Atsushi Shindo,
Yukio Ozawa,
Satoshi Saito, Katsuo Kanmatsuse
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ABSTRACT: The purpose of this study was to determine whether the extent of atrial electrical remodeling affects the recurrence of atrial fibrillation (AF) after cardioversion of persistent AF (PAF).
Internal atrial cardioversion was performed in 47 patients with PAF. The right atrial monophasic action potential duration (RA-MAPD) at pacing cycle lengths (PCLs) of 800-300 ms and P wave signal-averaged electrocardiogram were recorded after cardioversion. Bepridil (150-200 mg/day) and carvedilol (10 mg/day) were administered to all patients after cardioversion. Of the 47 patients, 20 had recurrent AF within 3 months. No relation was observed between age, left atrial dimension, left ventricular ejection fraction, and AF recurrence. The AF duration was significantly longer (p<0.05) and RA-MAPD at PCLs of 800 to 300 ms were significantly shorter (p<0.05) in patients with AF recurrence than in those without recurrence. The mean slope of the RA-MAPD for PCLs between 600 and 300 ms did not differ between the patients with and without AF recurrence. The filtered P-wave duration (FPD) was significantly longer in the patients with AF recurrence than in those without (p<0.05). Multivariate analysis also showed that the RA-MAPD at a PCL of 300 ms and FPD were predictors of AF recurrence (RAMAPD: p=0.038; FPD: p=0.052).
These results suggest that electrical remodeling related to the repolarization and depolarization may be the main contributors to early AF recurrence after cardioversion under the administration of bepridil and carvedilol.
Circulation Journal 12/2005; 69(12):1514-20. · 3.77 Impact Factor
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ABSTRACT: The role of arginine vasopressin (AVP) in the heart has yet to be determined. The present study was designed to examine whether AVP is regulated in the human heart.
The subjects were 93 patients who underwent coronary angiography and left ventriculography. Blood samples were collected at the aortic root (AO) and the coronary sinus (CS) to measure the plasma levels of AVP. The patients who showed increases in AVP levels at the CS and AO were assigned to the increased AVP group and those who showed no change or a decrease were assigned to the non-increased AVP group. Cardiac function was compared between these 2 groups. There was a significant difference (p<0.0234) in left ventricular end-diastolic volume index between the increased AVP group (125.5 +/-53.4 ml/m2) and the non-increased AVP group (102.2+/-30.6 ml/m2). There was also a significant difference (p<0.0137) in left ventricular stroke volume index between the increased AVP group (66.6+/-23.2 ml/m2) and the non-increased AVP group (54.4+/-18.6 ml/m2).
These results suggest that both the production of AVP and synthesis with its receptors may be enhanced at regional sites of the human heart in the volume load.
Circulation Journal 12/2005; 69(11):1401-4. · 3.77 Impact Factor
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ABSTRACT: While the usefulness of measuring the plasma levels of brain natriuretic peptide (BNP) in cases with worsening heart failure and severe heart failure has already been established, the benefits of evaluation of this parameter in asymptomatic stable patients with left ventricular dysfunction is still under debate. Left ventricular function was evaluated in 141 ambulatory outpatients with a previous history of myocardial infarction not associated with symptoms of heart failure for at least one year. The plasma BNP level was also determined in these patients for comparative study. No correlation between the plasma level of BNP and EF was noted in the normal-EF group, while a negative correlation between the two parameters was observed in the low-EF group (Y = 0.439 - 0.000266X) (R2 = 0.244, P < 0.0001). The sensitivity was 91.5%, specificity 56.3%, positive predictive accuracy value 61.9%, and negative predictive accuracy value 83.8% for a plasma BNP cut-off level of 89.0 pg/mL. The results suggested that it might be meaningful to measure the plasma BNP level, especially in asymptomatic patients with a previous history of myocardial infarction having a low-EF.
International Heart Journal 11/2005; 46(6):1007-14. · 1.16 Impact Factor
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ABSTRACT: We hypothesized that a reduction in atherogenic malondialdehyde-modified low-density lipoprotein (MDA-LDL) levels, which may antagonize the action of atheroprotective high-density lipoprotein cholesterol, leads to coronary plaque regression. This study investigated the effects of pravastatin on the serum levels of MDA-LDL and coronary atherosclerosis. In a 6-month prospective study, 75 patients with stable coronary artery disease were randomly assigned to a pravastatin-treatment group (n = 52) or a control group (n = 23). Volumetric analyses were performed in matched coronary artery segments by 3-dimensional intravascular ultrasound. Pravastatin therapy for 6 months resulted in a decrease in coronary plaque volume (14.4%, p <0.0001) and a corresponding reduction in serum MDA-LDL levels (12.7%, p = 0.0001). In the pravastatin treatment group, the percentage of change in plaque volume correlated with changes in the MDA-LDL and high-density lipoprotein cholesterol levels (r = 0.52 and -0.55, respectively, p <0.0001) but not with the changes in any other lipid levels. Multivariate regression analysis revealed that a reduced MDA-LDL level is an independent predictor of plaque regression, as was an increase in high-density lipoprotein cholesterol. In conclusion, these results suggest that the reduction in the MDA-LDL levels induced by pravastatin may serve as a novel marker of coronary atherosclerosis regression.
The American Journal of Cardiology 11/2005; 96(8):1089-94. · 3.37 Impact Factor
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ABSTRACT: Pioglitazone is an insulin-sensitizing agent that has been reported to have anti-arteriosclerotic effects.
To investigate the anti-arteriosclerotic effects of pioglitazone in patients with diabetes mellitus using pulse wave velocity (PWV) as an index of efficacy.
Twenty-seven patients with type 2 diabetes mellitus were randomly assigned to two groups, and pioglitazone (n=13) or glibenclamide (n=14) was administered for 6 months. The TG, TC, LDL-C, and HDL-C, FPG, HbA1c, IRI levels, HOMA-IR, and ba-PWV data were examined before and after administration of each agent.
FPG and HbA1c were significantly improved in both the groups after treatment, but IRI, HOMA-IR and were improved only in the PIO group. The percent change of ba-PWV from the baseline after treatment in the PIO group improved significantly than that in the GC group (-6.3 +/- 5.6% versus 0.8 +/- 5.7%).
The findings in this study suggested that pioglitazone has anti-arteriosclerotic effects. We concluded that drugs for the treatment of diabetes mellitus should be selected taking into consideration such endpoints as blood sugar control, and also the risk of complications such as cardiovascular events in the future.
Diabetes Research and Clinical Practice 06/2005; 68(2):104-10. · 2.75 Impact Factor
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Toshio Kushiro,
Fumio Saito,
Junji Kusama,
Hiroshi Takahashi,
Takako Imazeki,
Shigemasa Tani,
Satoru Kikuchi,
Shinobu Imai,
Kagari Matsudaira,
Ikuyoshi Watanabe,
Tohru Hino,
Yuichi Sato,
Tomohiro Nakayama,
Ken Nagao, Katsuo Kanmatsuse
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ABSTRACT: A transient left ventricular apical ballooning (so-called "ampulla" or "Takotsubo-shaped" cardiomyopathy) with type I CD36 deficiency is described in a 71-year-old woman. The patient was referred because of chest pain and worsening of dyspnea. Electrocardiogram showed T-wave inversions on the precordal leads, and acute coronary syndrome was suspected. Left ventricular apical ballooning was observed by echocardiogram and left ventriculography, and coronary arteriography did not reveal any significant stenosis. Left ventricular motion normalized at the follow-up period and there were no increases in specific markers for myocardial damage, such as myocardial band fraction of creatine kinase and troponin T, through out the admission. 123I-metaiodobengylguanidine myocardial single photon emission computed tomography (SPECT) revealed decreased accumulation areas at the apex, while 201Tl SPECT showed normal accumulation. An abnormal metabolism of cardiac free fatty acid was suggested by lack of accumulation of 123I beta-methyliodophenyl pentadecanoic acid (BMIPP) SPECT. No CD36 expression in either platelets or monocytes/macrophages was shown using flow cytometer analysis and type I CD36 deficiency was diagnosed. DNA sequencing showed that the patient had compound heterozygosity of the CD36 gene (a nucleotide change in C478T and an adenine insertion at nucleotide 1159 in exon 10). Although CD36 deficiency is thought to be involved with many cardiovascular disease and metabolic abnormalities, Takotsubo-shaped cardiomyopathy with CD36 deficiency had not been reported. Further studies of Takotsubo-shaped cardiomyopathy and CD36 deficiency may reveal an association between this cardiomyopathy and specific genetic profiles.
Heart and Vessels 06/2005; 20(3):123-5. · 2.05 Impact Factor
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Shigemasa Tani,
Ikuyoshi Watanabe,
Takahiro Kida,
Kazutoshi Ishikawa,
Kiyoshi Iida,
Michiaki Matsumoto,
Kana Nomoto,
Tetsu Kawamata,
Satoru Kikuchi,
Toshio Kushiro,
Ken Nagao, Katsuo Kanmatsuse
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ABSTRACT: It is unusual for coronary vasospasm to develop following angioplasty of a coronary vascular lesion that is located elsewhere. We experienced a rare case of shock with vasospasm of the right coronary artery in a patient following balloon angioplasty performed for stent restenosis of the left anterior descending artery.
Heart and Vessels 04/2005; 20(2):82-4. · 2.05 Impact Factor
