-
Hidehiro Kaneko,
Junji Yajima,
Yuji Oikawa,
Shingo Tanaka,
Daisuke Fukamachi,
Shinya Suzuki,
Koichi Sagara,
Takayuki Otsuka,
Shunsuke Matsuno,
Ryuichi Funada,
Hiroto Kano, Tokuhisa Uejima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: Japan has become an aging society, resulting in an increased prevalence of coronary artery disease. However, clinical outcomes of elderly Japanese patients after percutaneous coronary intervention (PCI) remain unclear. Of the 15,227 patients in the Shinken Database, a single-hospital-based cohort of new patients, 1,214 patients who underwent PCI, was evaluated to determine the differences in clinical outcomes between the elderly (≥75 years) (n = 260) and the non-elderly (<75 years) (n = 954) patients. A major adverse cardiac event (MACE) was defined as a composite end point, including all-cause death, myocardial infarction (MI), and target lesion revascularization. Male gender and obesity were less common, and the estimated glomerular filtration rate (eGFR) was significantly lower in the elderly than in the non-elderly. Left ventricular ejection fraction (LVEF) was comparable between these groups. Left main trunk disease and multivessel disease were more common in the elderly than in the non-elderly group. Occurrence of MACE was frequent, and the incidences of all-cause death, cardiac death, and the admission rate for heart failure were significantly higher in the elderly patients. Multivariate analysis showed that prior MI, low eGFR, and poor LVEF were independent predictors for all-cause death in the elderly patients. Elderly patients had worse clinical outcomes than the non-elderly patients. Low eGFR and LVEF were independent predictors of all-cause death after PCI, suggesting that left ventricular dysfunction and renal dysfunction might synergistically contribute to the adverse clinical outcomes of the elderly patients undergoing PCI.
Heart and Vessels 04/2013; · 2.05 Impact Factor
-
Shinya Suzuki,
Koichi Sagara,
Takayuki Otsuka,
Hiroto Kano,
Shunsuke Matsuno,
Hideaki Takai, Tokuhisa Uejima,
Yuji Oikawa,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Junji Yajima,
Hiroaki Tanabe,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: Frequent supraventricular extrasystoles (SVEs) are associated with the subsequent first-time appearance of atrial fibrillation (AF) and ischemic stroke. The aim of this study was to investigate the combined role of SVEs and an AF-related risk score for ischemic stroke, the CHADS2 score, on the occurrence of new AF in patients in sinus rhythm. The Shinken Database 2004-2010 lists 3,263 patients who underwent 24-hour Holter monitoring. A total of 2,589 patients were analyzed, after excluding 674 patients previously diagnosed with AF. Frequent SVEs were defined as ≥102 beats/day (the top quartile) and the presence of a clinical background for a CHADS2 score ≥2 points as a high CHADS2 score. During the mean follow-up period of 571.4 ± 606.4 days, new AF occurred in 38 patients (9.4 per 1,000 patient-years). The incidence of new AF was 2.7 and 37.7 per 1,000 patient-years for patients with nonfrequent SVEs (<102 beats/day) and low CHADS2 scores and those with frequent SVEs and high CHADS2 scores, respectively. Multivariate Cox regression analysis showed that the hazard ratio for frequent SVEs and a high CHADS2 score compared with nonfrequent SVEs and a low CHADS2 score was 9.49 (95% confidence interval 3.20 to 28.15, p <0.001), even after adjustment for gender, age, medications, and echocardiographic parameters. In conclusion, frequent SVEs and a high CHADS2 score independently and synergistically predict the first-time appearance of AF in patients in sinus rhythm, indicating an approximately 10-fold higher risk. Patients meeting these criteria should have more aggressive early intervention for preventing AF.
The American journal of cardiology 03/2013; · 3.58 Impact Factor
-
Hidehiro Kaneko,
Junji Yajima,
Yuji Oikawa,
Shingo Tanaka,
Daisuke Fukamachi,
Shinya Suzuki,
Koichi Sagara,
Takayuki Otsuka,
Shunsuke Matsuno,
Ryuichi Funada,
Hiroto Kano, Tokuhisa Uejima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: Statins reduce cardiovascular morbidity and mortality from coronary artery disease (CAD). However, the effects of statin therapy in patients with CAD and chronic kidney disease (CKD) remain unclear. Within a single hospital-based cohort in the Shinken Database 2004-2010 comprising all patients (n = 15,227) who visited the Cardiovascular Institute, we followed patients with CKD and CAD after percutaneous coronary intervention (PCI). A major adverse cardiovascular and cerebrovascular event (MACCE) was defined by composite end points, including death, myocardial infarction, cerebral infarction, cerebral hemorrhage, and target lesion revascularization. A total of 391 patients were included in this study (median follow-up time 905 ± 679 days). Of these, 209 patients used statins. Patients with statin therapy were younger than those without. Obesity and dyslipidemia were more common, and the glomerular filtration rate (GFR) was significantly higher, in patients undergoing statin treatment. MACCE and cardiac death tended to be less common, and all-cause death was significantly less common, in patients taking statins. Multivariate analysis showed that low estimated GFR, poor left ventricular ejection fraction, and the absence of statin therapy were independent predictors for all-cause death of CKD patients after PCI. Statin therapy was associated with reduced all-cause mortality in patients with CKD and CAD after PCI.
Heart and Vessels 02/2013; · 2.05 Impact Factor
-
Shinya Suzuki,
Koichi Sagara,
Takayuki Otsuka,
Hiroto Kanou,
Shunsuke Matsuno, Tokuhisa Uejima,
Yuji Oikawa,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Junji Yajima,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Several reports have identified that decline in renal function and presence of proteinuria are closely associated with incidence of atrial fibrillation (AF). However, it is still unclear whether these kidney-related markers are associated with the progression of AF from paroxysmal to persistent form. METHODS AND RESULTS: Among the new patients who visited the Cardiovascular Institute Hospital between 2004 and 2010 (Shinken Database 2004-2010, n=15,227), both estimated glomerular filtration rate (eGFR) and proteinuria were measured in 1074 AF patients (paroxysmal/persistent 579/495, respectively), who were divided into tertiles of eGFR (the borderlines were 60.07 and 73.67ml[min(-1)]1.73[m(-2)], respectively), and then further divided into the two categories with/without proteinuria. The average value of eGFR was lower (63.1ml[min(-1)]1.73[m(-2)] vs. 68.8ml[min(-1)]1.73[m(-2)], p<0.001) and the detection rate of proteinuria was higher (13.7% vs. 8.5%, p=0.006) in patients with persistent AF than in those with paroxysmal AF, respectively. In the multivariate analysis without parameters of echocardiography [left ventricular ejection fraction (LVEF) and left atrial dimension (LAD)], both eGFR and proteinuria were independently associated with persistent AF, but the association was abolished when the model included LAD and LVEF. CONCLUSIONS: In the present analysis with cross-sectional design, both eGFR and proteinuria were apparently linked to the persistent form of AF, but their role in the pathogenesis does not seem to exceed the atrial stretch and remodeling, represented by LAD and LVEF.
Journal of Cardiology 10/2012; · 1.28 Impact Factor
-
Shinya Suzuki,
Koichi Sagara,
Takayuki Otsuka,
Shunsuke Matsuno,
Ryuichi Funada, Tokuhisa Uejima,
Yuji Oikawa,
Junji Yajima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: Risk stratification for heart failure (HF) in patients with atrial fibrillation (AF) has not been well established. The aim of this study was to identify the predictors of HF events in patients with AF, consequently developing a new risk-scoring system that stratifies the risk for HF events. In this prospective, single hospital-based cohort, all patients who presented from July 2004 to March 2010 were registered (Shinken Database 2004-2009). Follow-up was maintained by being linked to the medical records or by sending study documents of prognosis. Of the 13,228 patients in the Shinken Database 2004-2009, 1,942 patients with AF were identified. Of the patients with AF, HF events (hospitalization or death from HF) occurred in 147 patients (7.6%) during a mean follow-up period of 776 ± 623 days. After identifying the parameters that were independently associated with the incidence of HF events (coexistence of organic heart diseases, anemia [hemoglobin level <11 g/dl], renal dysfunction [estimated glomerular filtration rate <60 ml/min/m(2)], diabetes mellitus, and the use of diuretics), a new scoring system was developed, the H(2)ARDD score (heart diseases = 2 points, anemia = 1 point, renal dysfunction = 1 point, diabetes = 1 point, and diuretic use = 1 point; range 0 to 6 points). This scoring system discriminated the low- and high-risk populations well (incidence in patients scoring 0 and 6 points of 0.2% and 40.8% per patient-year, respectively) and showed high predictive ability (area under the curve 0.840, 95% confidence interval 0.803 to 0.876). In conclusion, the new H(2)ARDD score may help identify the population of patients with AF at high risk for HF events.
The American journal of cardiology 05/2012; 110(5):678-82. · 3.58 Impact Factor
-
Hidehiro Kaneko,
Akira Koike,
Keitaro Senoo,
Shingo Tanaka,
Shinya Suzuki,
Osamu Nagayama,
Koichi Sagara,
Takayuki Otsuka,
Shunsuke Matsuno,
Ryuichi Funada, Tokuhisa Uejima,
Yuji Oikawa,
Junji Yajima,
Kazuyuki Nagashima,
Hajime Kirigaya,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: The presence of heart failure (HF) with preserved ejection fraction (HFPEF) is increasingly recognized. However, prognostic factors for HFPEF remain unclear.
The data were derived from Shinken Database 2004-2010, a prospective cohort study (n=15,227). We examined 301 consecutive HFPEF patients (New York Heart Association Class II or greater) and tracked them for an average 3.5 years. Cardiopulmonary exercise testing (CPX), blood exams, and ultrasound cardiogram (UCG) were performed at the first medical examination. Acute decompensated HF (ADHF) admission was observed in 19 patients (6.3%). CPX showed that the anaerobic threshold was lower (7.3±4.8mL/min/kg vs. 9.7±4.3mL/min/kg, p=0.02) and slope of the increase in ventilation to the increase in CO(2) output (VE-VCO(2) slope) was higher (40.6±8.5 vs. 34.6±7.9, p<0.01) in patients with ADHF admission than those without. Serum brain natriuretic peptide (BNP) tended to be higher and left atrial (LA) dimension was significantly greater (47.0±15.8mm vs. 41.0±9.9mm, p=0.01) in patients with ADHF admission than those without. Multivariate analysis showed that higher VE-VCO(2) slope and greater LA dimension were independent determinants of ADHF admission.
An aggravated CPX parameter and LA dilatation were associated with ADHF admission in patients with symptomatic HFPEF, suggesting the prognostic role of cardiopulmonary dysfunction during exercise and LA remodeling in the pathogenesis of decompensated HF development in HFPEF.
Journal of Cardiology 03/2012; 59(3):359-65. · 1.28 Impact Factor
-
Shinya Suzuki,
Takayuki Otsuka,
Koichi Sagara,
Shunsuke Matsuno,
Ryuichi Funada, Tokuhisa Uejima,
Yuji Oikawa,
Junji Yajima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUNd: The distribution of activated partial thromboplastin time (APTT) in nonvalvular atrial fibrillation (NVAF) patients under dabigatran therapy remains to be clarified. METHODS AND RESULTS: The study population was 196 NVAF patients who were treated with dabigatran in 2011 (126 with 220 mg/day). The APTT values showed a wide distribution among the patients, especially in those with a reduced dose, who seemed to show a high value even in patients without contraindications. CONCLUSIONS: We found a wide distribution of APTT in NVAF patients under dabigatran treatment. High APTT might help screen for bleeding risks among patients under dabigatran, but requires future investigation.
Circulation Journal 02/2012; 76(3):755-7. · 3.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Left ventricular outflow tract obstruction (LVOTO) is commonly observed in patients with hypertrophic cardiomyopathy (HCM) or left ventricular hypertrophy (LVH). While some patients develop LVOTO at rest, it can also be provoked by physical exertion, and hence termed latent LVOTO (L-LVOTO). Recent reports demonstrated that L-LVOTO develops not only in LVH patients, but also in patients without LVH (non-LVH). However, the prevalence and clinical prognosis of non-LVH patients with L-LVOTO are not yet elucidated. In this study, we retrospectively investigated the echocardiographic features of patients with malignancy who underwent dobutamine stress echocardiography (DSE) to evaluate preoperative cardiac risk. One hundred ninety-nine patients were found not to have LVH or coronary artery disease. Among them, 106 patients exhibited L-LVOTO after DSE. We next compared the baseline echocardiographic features of L-LVOTO (+) patients with those of L-LVOTO (-) patients, and identified the left ventricular outflow tract (LVOT) ratio (systolic LVOT diameter/diastolic LVOT diameter) as a significant predictor of L-LVOTO. An LVOT ratio ≤ 0.83 was the best cutoff value to detect the presence of L-LVOTO, with a sensitivity of 81.1% and specificity of 80.6%. Overall, L-LVOTO was found to develop in almost half of non-LVH patients with malignancy. In addition, the baseline LVOT ratio was strongly related to the presence of L-LVOTO in non-LVH patients. Therefore, patients with dynamic LVOT narrowing may benefit from DSE to detect the presence of L-LVOTO.
International Heart Journal 01/2012; 53(4):230-3. · 1.16 Impact Factor
-
Keitaro Senoo,
Shinya Suzuki,
Koichi Sagara,
Takayuki Otsuka,
Shunsuke Matsuno,
Ryuichi Funada, Tokuhisa Uejima,
Yuji Oikawa,
Junji Yajima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: The characteristics and prognosis of patients with first-detected atrial fibrillation (AF) in Japan remain unclear.
First-detected AF patients without structural heart disease (n=289) were reviewed with regard to 2 symptom classifications (CCS-SAF and EHRA). In both classifications, asymptomatic patients comprised ≈40% of the patients, and patients in the most symptomatic class (≈6%) had peculiar characteristics and poor prognosis. In other symptomatic classes, symptoms affected the treatment strategy without a significant difference in the patients' backgrounds and prognosis.
This is the first report to describe the distribution, characteristics and outcomes of first-detected AF patients according to symptom classifications.
Circulation Journal 01/2012; 76(4):1020-3. · 3.77 Impact Factor
-
Shinya Suzuki,
Koichi Sagara,
Takayuki Otsuka,
Shunsuke Matsuno,
Ryuichi Funada, Tokuhisa Uejima,
Yuji Oikawa,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Junji Yajima,
Hitoshi Sawada,
Tadanori Aizawa,
Takeshi Yamashita
[show abstract]
[hide abstract]
ABSTRACT: Although various kinds of cardiovascular risk factors have been reported to be associated with atrial fibrillation (AF), the relationship between serum uric acid level and AF has not been fully examined.
Data were collected from a single hospital-based cohort in the Shinken Database 2004-2008 (n=11,123), and consisted of serum uric acid level for 7,155 patients. The association between serum uric acid level and AF prevalence was evaluated on logistic regression. Uric acid significantly increased the crude AF prevalence in both men and women (both, P<0.001). The odds ratio (OR) and 95% confidence interval (95%CI) in the highest tertile compared with the lowest one were 3.368 (2.478-4.578) and 1.408 (1.169-1.695) in women and men, respectively. Uric acid was also significantly associated with other various cardiovascular risk factors for AF. Even after the multivariate model was adjusted using these variables, the effect of uric acid on AF was independent in women (OR, 1.888; 95%CI: 1.278-2.790), but not in men.
Reflecting the composite of various cardiovascular risk factors, serum uric acid level was apparently associated with AF prevalence. The independent association in women might imply some sex-specific mechanisms. The results should be confirmed in prospective studies.
Circulation Journal 12/2011; 76(3):607-11. · 3.77 Impact Factor
-
Shinya Suzuki,
Takeshi Yamashita,
Takayuki Otsuka,
Koichi Sagara, Tokuhisa Uejima,
Yuji Oikawa,
Junji Yajima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Ken Ogasawara,
Hitoshi Sawada,
Tadanori Aizawa
[show abstract]
[hide abstract]
ABSTRACT: In Japan, the recent status of the mortality of atrial fibrillation (AF) patients is still unclear.
We used a single-hospital based cohort database in an urban city (Tokyo) in Japan, including all the new visitors from 2004 to 2009 (n=13,228). The non-adjusted death rates of AF patients for all-cause, stroke, and cardiovascular death were 1091, 97, and 727 per 100,000 patient-years, and the age-adjusted ones were 317 (95% CI, 316-318), 16 (95% CI, 16-16), and 238 (95% CI, 237-239), respectively. The age-adjusted relative risk of AF on all-cause mortality was 1.7 in the particular population.
The present study provides the most recent data about the characteristics and the mortality of AF patients in Tokyo, thus serving as the basic information for finding problems to solve regarding Japanese AF patients.
Journal of Cardiology 08/2011; 58(2):116-23. · 1.28 Impact Factor
-
Michinari Nakamura,
Takeshi Yamashita,
Junji Yajima,
Yuji Oikawa,
Ken Ogasawara,
Koichi Sagara,
Akira Koike,
Hajime Kirigaya,
Kazuyuki Nagashima,
Takayuki Otsuka, Tokuhisa Uejima,
Ryuichi Funada,
Shunsuke Matsuno,
Shinya Suzuki,
Hitoshi Sawada,
Tadanori Aizawa
[show abstract]
[hide abstract]
ABSTRACT: The effect of early statin initiation on secondary prevention remains uncertain in unselected Japanese populations with coronary artery disease (CAD).
We investigated the mortality and morbidity in CAD patients according to presence or absence of statins within 3 months after the diagnosis of CAD in the Shinken Database cohort study. The primary endpoint was all-cause mortality.
Data were available on 789 Japanese patients with CAD (male 78.8%). Among those, 351 patients (44.5%) received a statin. The mean (SD) baseline low-density lipoprotein (LDL)-cholesterol levels were 113.6 (35.7) mg/dL in the statin group and 113.6 (26.4) mg/dL in the non-statin group (p=0.992). Unadjusted 2-year survival in patients with or without statins was 98.4% and 92.1%, respectively (p<0.001). Among a prespecified subgroup of patients undergoing percutaneous coronary intervention (PCI) (n=238 with statins and n=183 without statins), a consistent effect of statins on 2-year survival was observed (98.5% and 90.9%, respectively, p<0.001). However, there was no significant difference in 2-year target lesion revascularization-free survival (77.9% in statins versus 73.7% in non-statins, respectively, p=0.298). The age- and gender-adjusted survival in the PCI subgroup was significantly higher in the statin group [hazard ratio (HR) 0.29, 95% confidence interval (CI) 0.095-0.913] compared to non-statin. Multivariate analysis showed statins significantly reduced mortality (HR 0.27, 95%CI 0.078-0.944), but not revascularization (HR 0.91, 95%CI 0.589-1.406).
This study suggested that statin therapy initiated early after the diagnosis of CAD can decrease the risk of fatal events in Japanese CAD patients.
Journal of Cardiology 12/2010; 57(2):172-80. · 1.28 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Isolated non-compaction of ventricular myocardium (INVM) is characterized by persistent embryonic myocardial morphology without other cardiac anomalies. Congestive heart failure, critical arrhythmias, and systemic thromboemboli are known as major manifestations during childhood. Recently it was reported that there are some patients who seem apparently healthy in adult INVM. Clinical characteristics including that for electrocardiograms (ECG) of adult INVM, however, are unknown for Japanese subjects.
From 24,082 patients who underwent echocardiography between June 2000 and June 2007, 187 patients (0.78%, 41.3+/-16.8 years, 122 male) were identified as having INVM according to the criteria proposed by Oechslin et al. Although fatal ventricular arrythmias and thromboembolic events occurred in 2 patients and in 1 patient, respectively, the rest had no severe cardiac complications. Normal ECG findings were found only in 24.6% of the patients. Most of the ECG abnormalities, however, were non-specific: ST-T changes in 35.2% and bundle branch block in 14.9%. Notably, Brugada-like ECG was frequently seen in the present Japanese INVM patients (3.2%). The incidence of these ECG findings was not dependent upon the extent of non-compaction.
The prevalence and ECG findings of adult Japanese INVM patients in a hospital-based clinical practice have been identified.
Circulation Journal 07/2010; 74(7):1431-5. · 3.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A new mathematical method for estimating velocity vectors from color Doppler datasets is proposed to image blood flow dynamics; this method has been called echodynamography or vector flow mapping (VFM). In this method, the concept of stream function is exploited to expand a 2-D distribution of radial velocities in polar coordinates, observed with color Doppler, to a 2-D distribution of velocity vectors. This study was designed to validate VFM using 3-D numerical flow models. Velocity fields were reconstructed from the virtual color Doppler datasets derived from the models. VFM captured the gross features of flow structures and produced comparable images of the distribution of vorticity, which correlated significantly with the original field (for velocity magnitudes, standard error of estimate = 0.003 to 0.007 m/s; for vorticity, standard error of estimate = 0.35 to 2.01/s). VFM may be sensitive for depicting flow structures derived from color Doppler velocities with reasonable accuracy.
Ultrasound in medicine & biology 04/2010; 36(5):772-88. · 2.02 Impact Factor
-
Ayumi Goda,
Takeshi Yamashita,
Shinya Suzuki,
Takayuki Ohtsuka, Tokuhisa Uejima,
Yuji Oikawa,
Junji Yajima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Koichi Sagara,
Ken Ogasawara,
Mitsuaki Isobe,
Hitoshi Sawada,
Tadanori Aizawa
[show abstract]
[hide abstract]
ABSTRACT: Several hospital-based investigations have reported that a high proportion of patients with heart failure (HF) have preserved left ventricular ejection fraction (LVEF). The purpose of this study was to determine the prevalence, prognosis, and predictors for mortality of Japanese HF patients with preserved versus reduced LVEF in a prospective cohort fashion.
Our hospital-based database including inpatients and also outpatients was used for analysis. Out of 4255 new patients, 597 patients (male/female 414/183, age 65.1+/-12.9 years) were diagnosed as having symptomatic HF at the initial visit. Among 589 HF patients undergoing echocardiography, 398 (67.6%) showed a preserved LVEF (>50%) and 191 (32.4%) had a reduced LVEF (< or =50%). Patients with preserved LVEF were older (p=0.004) and more likely to be female (p=0.002). During follow-up of an average 539 days, 34 cardiovascular deaths occurred, and patients with preserved LVEF showed a better prognosis than those with reduced LVEF (3.2% vs. 7.4% per year, p=0.0097). Multivariate Cox hazards analysis identified LVEF as an independent predictor in all HF patients. Also, separated group analysis showed that presence of chronic kidney disease was independently associated with poor prognosis irrespective of HF types.
This prospective cohort study identified prevalence and prognosis of HF in Japanese in- and outpatients, where patients with preserved LVEF showed a better prognosis than those with reduced LVEF.
Journal of Cardiology 01/2010; 55(1):108-16. · 1.28 Impact Factor
-
Michinari Nakamura,
Takeshi Yamashita,
Junji Yajima,
Yuji Oikawa,
Ken Ogasawara,
Koichi Sagara,
Hajime Kirigaya,
Akira Koike,
Kazuyuki Nagashima,
Takayuki Ohtsuka, Tokuhisa Uejima,
Shinya Suzuki,
Hitoshi Sawada,
Tadanori Aizawa
[show abstract]
[hide abstract]
ABSTRACT: Mortality and morbidity after acute coronary syndrome (ACS) in Japan appear to be different from those in Western countries due to different social healthcare systems, races, geographical locations, and interventional procedures, although data are limited in Japan.
With a hospital-based cohort study comprising all the new patients who had visited our hospital between 2004 and 2007 (n=6562), we identified all-cause mortality, the composite endpoint of cardiac death, non-fatal myocardial infarction (MI), or target vessel revascularization and the predictors.
Of the total, 293 patients were included with a discharge diagnosis of ACS (median follow-up of 24.5 months). Non-ST elevation-ACS (NSTE-ACS) (unstable angina and non-ST elevation MI) and ST elevation MI (STEMI) were observed in 165 (56.3%) and 128 (43.7%) patients, respectively. Percutaneous coronary intervention or coronary artery bypass graft surgery was performed in 72.7% and 14.5% of NSTE-ACS patients, respectively and in 82.8% and 10.2% of STEMI patients. The use of aspirin, ticlopidine, and beta-blockers for NSTE-ACS patients were 93.3%, 66.9%, and 38.0%, respectively, with corresponding rates of 96.0%, 75.4%, and 57.1% for STEMI patients. All-cause mortality rates in NSTE-ACS and STEMI were 1.8% and 5.5% at 30 days, respectively, and 6.3% and 12.9% at 2 years, with corresponding rates of 3.7% and 8.7% at 30 days, respectively, and 23.4% and 35.6% at 2 years for the composite endpoint. Multivariate analysis showed that predictors for mortality were older age (hazard ratio [HR] 1.13, 95% confidence interval [CI] 1.018-1.244) and estimated glomerular filtration rate value (HR 0.96, 95% CI 0.929-0.988) in NSTE-ACS, and older age (HR 1.10, 95% CI 1.011-1.119) and congestive heart failure on admission (HR 20.0, 95% CI 2.439-164.4) in STEMI.
The present study identified long-term mortality, morbidity, and predictors of adverse events for Japanese patients with ACS.
Journal of Cardiology 01/2010; 55(1):69-76. · 1.28 Impact Factor
-
Shinya Suzuki,
Takeshi Yamashita,
Takayuki Ohtsuka,
Koichi Sagara, Tokuhisa Uejima,
Yuji Oikawa,
Junji Yajima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Ken Ogasawara,
Hitoshi Sawada,
Tsutomu Yamazaki,
Tadanori Aizawa
[show abstract]
[hide abstract]
ABSTRACT: Although recent studies have suggested that height and body mass index (BMI) independently affect the prevalence of atrial fibrillation (AF), their combined effects have not been fully examined in Japanese patients.
Patients without organic cardiac diseases, hypertension and diabetes mellitus were screened from a prospective, single hospital-based cohort of the Shinken Database 2004-2007 (n=4,719). Both height and BMI significantly increased the crude rate of AF prevalence and the effects were significant even after adjustment by age, sex and left atrial dimension. The relative risks (RRs) for AF in the height and BMI categories were 2.07 (95% confidence interval [CI] 1.70-2.52) and 1.78 (95%CI 1.46-2.17), respectively, in the highest tertile compared with the lowest tertile. The RRs in the highest combined tertile was high to 2.98 (95%CI 2.07-4.28) compared with the lowest combined tertile, an unignorable figure for AF prevalence in the future.
Height and BMI synergistically affected the prevalence of AF in Japanese patients. With respect to the recent increase in body size of the Japanese population, the present study predicts that there will be more occurrences of AF than previously predicted. (Circ J 2010; 74: 66 - 70).
Circulation Journal 10/2009; 74(1):66-70. · 3.77 Impact Factor
-
Ayumi Goda,
Takeshi Yamashita,
Shinya Suzuki,
Takayuki Ohtsuka, Tokuhisa Uejima,
Yuji Oikawa,
Junji Yajima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Koichi Sagara,
Ken Ogasawara,
Mitsuaki Isobe,
Hitoshi Sawada,
Tadanori Aizawa
[show abstract]
[hide abstract]
ABSTRACT: Prognosis of patients with heart failure (HF) remains unclear in Japan and should be determined in a prospective fashion. A prospective cohort of The Shinken Database comprised details on all of the new patients, including both inpatients and outpatients, who visited The Cardiovascular Institute Hospital in 2004-2005. HF patients were defined as those with symptomatic HF coexisting with structural heart diseases. Among 4,255 patients who visited our hospital, 597 patients (male/female 414/183, age 65.1 +/- 12.9 years, LVEF 56.2 +/- 18.0%) were diagnosed as presenting symptomatic HF. Ischemic heart disease was present in 305 (51.1%), valvular heart disease in 212 (35.5%), dilated cardiomyopathy in 59 (9.9%), hypertrophic cardiomyopathy in 24 (4.0%), hypertensive heart disease in 14 (2.3%), and others in 67 (11.2%). Hypertension, atrial fibrillation, and diabetes were observed in 35.3%, 27.4%, and 23.7%, respectively. During the mean follow-up period of 539 +/- 257 days, 40 deaths (5.0% per year) occurred, including 34 cardiovascular deaths (4.5% per year, NYHA class II: 1.0%, III: 11.3%, IV: 36.6% per year, respectively). The present study showed that the prognosis of Japanese patients with HF among moderate to severe severity was found to be similar to that of Western countries. Multiple Cox hazard analysis identified the presence of chronic kidney disease and NYHA class as independent predictors for cardiovascular death. This prospective cohort study identified the prevalence, prognosis, and risk factors in HF patients to provide a basis for therapeutic management in Japan.
International Heart Journal 09/2009; 50(5):609-25. · 1.16 Impact Factor
-
Shinya Suzuki,
Takeshi Yamashita,
Takayuki Otsuka,
Koichi Sagara, Tokuhisa Uejima,
Yuji Oikawa,
Junji Yajima,
Akira Koike,
Kazuyuki Nagashima,
Hajime Kirigaya,
Ken Ogasawara,
Hitoshi Sawada,
Tsutomu Yamazaki,
Tadanori Aizawa
[show abstract]
[hide abstract]
ABSTRACT: Many large-scale randomized control trials (RCTs) have been performed regarding treatment strategy in atrial fibrillation (AF) in Western countries and also in Japan. However, limited data are available concerning real-world relationships between the treatment strategy and prognosis of AF patients. Out of a prospective cohort of The Shinken Database 2004 (n = 2 412), 286 AF patients (male 205, 64.1 +/- 12.3 years, paroxysmal form 165) were retrospectively investigated. The percentage of AF patients under the rhythm control strategy was evaluated using the Kaplan-Meier method, which showed the cumulative proportion of rhythm control strategy was approximately 30% at the 90th day after the initial visit and 40.0% at 1 year. The average time to the first rhythm control strategy was 68.3 +/- 106.7 days. Those under rhythm control strategy were associated with fewer coexisting organic cardiac diseases, a younger age, and smaller left atrial dimension. Consequently, they showed very good prognosis (cumulative incidence rate of cardiovascular events at 1 year was 0.0%). Careful induction of rhythm control strategy, which was adopted in approximately 40% of the patients in the real world, was associated with fewer comorbidities and therefore might lead to better prognosis, although this does not mean the direct effects of rhythm control strategy.
Heart and Vessels 08/2009; 24(4):287-93. · 2.05 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Vascular Ehlers-Danlos syndrome is an inherited connective-tissue disorder causing arterial and gastrointestinal fragility and spontaneous rupture of the large arteries, uterus, or bowel. Among arterial dissections and ruptures, spontaneous coronary artery dissection is extremely rare in this disorder. The specific therapeutic strategy for this disorder and its complications has not yet been established. In this report, we describe a 33-year-old woman with all three coronary artery spontaneous dissections, resulting in cardiogenic shock and therapy-resistant ventricular fibrillation. We could successfully complete revascularization of all three coronary arteries and terminate the life-threatening arrhythmia. Biochemical findings finally revealed a point mutation in the COL3A1 gene, consistent with a diagnosis of vascular Ehlers-Danlos syndrome. To the best of our knowledge, this is the first case of vascular Ehlers-Danlos syndrome causing all three coronary artery spontaneous dissections. Our case also suggests that, from vascular fragility even if it is spontaneous coronary dissection, physicians always consider connective-tissue disorders as a differential diagnosis at an early stage even though that would be a first complication, and percutaneous coronary intervention with stenting using intravascular ultrasound could be a strategic option for even repeated and fatal spontaneous coronary artery dissections in vascular Ehlers-Danlos syndrome.
Journal of Cardiology 07/2009; 53(3):458-62. · 1.28 Impact Factor
