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Kosuke Endo,
Yukiko Naito,
Xu Ji,
Michio Nakanishi,
Teruo Noguchi,
Yoichi Goto, Hiroshi Nonogi,
Xiao Ma,
Huachun Weng,
Go Hirokawa,
Takashi Asada,
Sachiro Kakinoki,
Tetsuji Yamaoka,
Yasue Fukushima,
Naoharu Iwai
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ABSTRACT: MicroRNAs (miRNAs) are endogenous small RNAs that are 18-23 nucleotides long. Recently, plasma miRNAs were reported to be sensitive and specific biomarkers of various pathological conditions. In the present study, we focused on miR-210, which is known to be induced by hypoxia and might therefore be an excellent biomarker for congestive heart failure. Plasma miR-210 levels and expression levels in mononuclear cells and skeletal muscles were elevated in Dahl salt-sensitive rats with heart failure. We also assessed miR-210 expression in patients with heart failure. The miR-210 expression levels in the mononuclear cells of patients with NYHA III and IV heart failure according to the New York Heart Association (NYHA) functional classification system were significantly higher than those with NYHA II heart failure and controls. Although no significant correlation was observed between plasma brain natriuretic peptide (BNP) and plasma miR-210 levels in patients with NYHA II heart failure, patients with an improved BNP profile at the subsequent hospital visit were classified in a subgroup of patients with low plasma miR-210 levels. Plasma miR-210 levels may reflect a mismatch between the pump function of the heart and oxygen demand in the peripheral tissues, and be a new biomarker for chronic heart failure in addition to plasma BNP concentrations.
Biological & Pharmaceutical Bulletin 01/2013; 36(1):48-54. · 1.66 Impact Factor
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Taku Iwami,
Tetsuhisa Kitamura,
Takashi Kawamura,
Hideo Mitamura,
Ken Nagao,
Morimasa Takayama,
Yoshihiko Seino,
Hideharu Tanaka, Hiroshi Nonogi,
Naohiro Yonemoto,
Takeshi Kimura
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ABSTRACT: BACKGROUND: It remains unclear which is more effective to increase survival after out-of-hospital cardiac arrest in those with public-access defibrillation, bystander-initiated chest compression-only cardiopulmonary resuscitation (CPR) or conventional CPR with rescue breathing. METHODS AND RESULTS: A nationwide, prospective, population-based observational study covering the whole population of Japan and involving consecutive out-of-hospital cardiac arrest patients with resuscitation attempts has been conducted since 2005. We enrolled all out-of-hospital cardiac arrests of presumed cardiac origin that were witnessed and received shocks with public-access automated external defibrillation (AEDs) by bystanders from January 1, 2005, to December 31, 2009. The main outcome measure was neurologically favorable 1-month survival. We compared outcomes by type of bystander-initiated CPR (chest compression-only CPR and conventional CPR with compressions and rescue breathing). Multivariable logistic regression was used to assess the relationship between the type of CPR and a better neurological outcome. During the 5 years, 1376 bystander-witnessed out-of-hospital cardiac arrests of cardiac origin in individuals who received CPR and shocks with public-access AEDs by bystanders were registered. Among them, 506 (36.8%) received chest compression-only CPR and 870 (63.2%) received conventional CPR. The chest compression-only CPR group (40.7%, 206 of 506) had a significantly higher rate of 1-month survival with favorable neurological outcome than the conventional CPR group (32.9%, 286 of 870; adjusted odds ratio, 1.33; 95% confidence interval, 1.03-1.70). CONCLUSIONS: Compression-only CPR is more effective than conventional CPR for patients in whom out-of-hospital cardiac arrest is witnessed and shocked with public-access defibrillation. Compression-only CPR is the most likely scenario in which lay rescuers can witness a sudden collapse and use public-access AEDs.
Circulation 12/2012; 126(24):2844-2851. · 14.74 Impact Factor
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ABSTRACT: BACKGROUND: Little is known about the nationwide trend in the survival of out-of-hospital cardiac arrest (OHCA) in Japan and the differences in incidence and survival by age group and origin of arrest. METHODS AND RESULTS: A nationwide, prospective, population-based observation covering the whole population of Japan and involving consecutive OHCA patients with resuscitation attempts has been conducted from January 2005 to December 2009. The main outcome measure was one-month survival with favorable neurological outcome. The nationwide trend in OHCA incidence and outcome by age and origin were assessed. Multiple logistic regression analysis for bystander-witnessed OHCA was used to adjust for factors that were potentially associated with favorable neurological outcome. During 5-years, 547,153 overall OHCAs and 169,360 bystander-witnessed OHCAs were enrolled. The annual incidence significantly increased among overall OHCAs and bystander-witnessed OHCAs. Neurologically favorable survival significantly increased from 1.6% (1676/102,737) in 2005 to 2.8% (3280/115,250) in 2009 (P<0.001), from 2.1% (638/30,556) to 4.3% (1558/36,361) (P<0.001), from 9.8% (437/4461) to 20.6% (1215/5906) (P<0.001) among overall OHCA, bystander-witnessed OHCA, and bystander-witnessed ventricular fibrillation OHCA, respectively. Public-access automated external defibrillator use, either bystander-initiated chest compression-only cardiopulmonary resuscitation (CPR) or conventional CPR, and earlier EMS response time were associated with a better neurological outcome. Favorable neurological outcome among adult OHCAs significantly improved, but the outcome among younger children and very elderly did not improve and was dismal irrespective of origin of OHCA. CONCLUSIONS: The nationwide improvements of favorable neurological outcome from OHCA were observed in Japan, and differed by age group and origin of OHCA.
Circulation 10/2012; · 14.74 Impact Factor
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Taketomo Soga,
Ken Nagao,
Hirotaka Sawano,
Hiroyuki Yokoyama,
Yoshio Tahara,
Mamoru Hase,
Takayuki Otani,
Shinichi Shirai,
Hiroshi Hazui,
Hideki Arimoto,
Kazunori Kashiwase,
Shunji Kasaoka,
Tomokazu Motomura,
Yasuhiro Kuroda,
Yuji Yasuga,
Naohiro Yonemoto, Hiroshi Nonogi
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ABSTRACT: Background: Although therapeutic hypothermia is an effective therapy for comatose adults experiencing out-of-hospital shockable cardiac arrest, there is insufficient evidence that is also applicable for those with out-of-hospital non-shockable cardiac arrest. Methods and Results: Of 452 comatose adults treated with therapeutic hypothermia after return of spontaneous circulation (ROSC) subsequent to an out-of-hospital cardiac arrest of cardiac etiology, 372 who had a bystander-witnessed cardiac arrest, target core temperature of 32-34°C and cooling duration of 12-72h were eligible for this study (75 cases of non-shockable cardiac arrest, 297 cases of shockable cardiac arrest). The median collapse-to-ROSC interval was significantly longer in the non-shockable group than in the shockable group (30min vs. 22min, P=0.008), resulting in a significantly lower frequency of 30-day favorable neurological outcome in the non-shockable group compared with the shockable group (32% vs. 66%, P<0.001). However, an analysis of data in quartiles assigned to varying lengths of collapse-to-ROSC interval revealed a similar frequency of 30-day favorable neurological outcome among both groups when the collapse-to-ROSC interval was ≤16min (90% non-shockable group vs. 92% shockable group; odds ratio 0.80, 95% confidence interval 0.09-7.24, P=0.84). Conclusions: Post-ROSC cooling is an effective treatment for patients with non-shockable cardiac arrest when the time interval from collapse to ROSC is short. (Circ J 2012; 76: 2579-2585).
Circulation Journal 07/2012; 76(11):2579-2585. · 3.77 Impact Factor
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ABSTRACT: CK-MB is an important marker for the diagnosis of acute myocardial infarction (AMI). Since mitochondrial CK (MtCK) is universally present in the blood of healthy individuals, it is known to positively affect the measurement of CK-MB using the immunoinhibition method, causing false-positive results. We performed basic evaluation of ACCURAS AUTO CK-MB MtO, a new reagent containing anti-MtCK antibody that inhibits MtCK activity, and attempted to calculate a cut-off CK-MB level to diagnose AMI. The measurement was performed in samples submitted to the Clinical Laboratory of our center for the measurement of CK-MB. This method was confirmed to have satisfactory basic attributes concerning the reproducibility, linearity, lower detection limit, and effects of interfering substances. When 2886 samples were examined using this and conventional methods, the results of the two methods were correlated in some but not in others. In the samples that showed no correlation, MtCK was demonstrated by isozyme analysis using electrophoresis. The AUC calculated from the ROC curve in AMI patients was 0.912 with this method and 0.861 with the conventional method. The sensitivity and specificity of the new method were higher than those of the conventional method. The cut-off value determined by ROC analysis was 7.7 U/l using the new method and 13.6 U/l using the conventional method, causing an increase in false-positive results compared with the cut off value of 25 U/l widely used for the conventional method to date. However, the cut-off value for the new method that yielded a specificity comparable to 99.1%, which is the specificity of the conventional method using a cut-off value of 25 U/l, was 12 U/l. With a cut-off value of 12 U/l, the sensitivity was improved compared with that employing the conventional method, and both the sensitivity and specificity became comparable to those of the CK-MB mass method. This method is very useful for the accurate measurement of CK-MB activity.
Rinsho byori. The Japanese journal of clinical pathology 07/2011; 59(7):649-55.
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ABSTRACT: Little is known about triggers of sudden cardiac arrest. This study aimed to analyze the association of the occurrence of out-of-hospital cardiac arrest (OHCA) with patient activities just before the arrest and ambient temperature as one of the major environmental factors.
This prospective, population-based cohort study enrolled all person aged 18 years or older with OHCA of presumed cardiac origin in Osaka Prefecture, Japan, from 2005 through 2007. Patient activities before arrest were divided into six categories: sleeping, bathing, working, exercising, non-specific activities, and unknown. Age-adjusted annual incidence rate of OHCA according to their prior activity and an hourly event rate in each activity by temperature were calculated.
Among 19,303 OHCAs, 10,723 were presumed to be of cardiac etiology. The event rate of OHCA was 6.22, 54.49, 1.15, and 10.11 per 10,000,000 population per hour for sleeping, bathing, working, and exercising, respectively. Among patients who suffered OHCA during bathing, the event rate of OHCA per 10,000,000 per hour increased with decreasing temperature from 18.27 (≥25.1°C) to 111.42 (≤5.0°C) (odds ratio [OR] for 1°C increase in temperature, 0.915; 95% confidence interval [CI], 0.907-0.923), while it was almost constant among those who were working (OR for 1°C increase, 0.994; 95% CI, 0.981-1.007) or exercising (OR for 1°C increase, 1.004; 95% CI, 0.971-1.038) before arrest.
Both activities before cardiac arrest and ambient temperature were associated with the occurrence of OHCA. Preventive measures against OHCA should be enveloped considering these behavioral and environmental factors.
Resuscitation 04/2011; 82(8):1008-12. · 3.60 Impact Factor
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Hiroyuki Yokoyama,
Ken Nagao,
Mamoru Hase,
Yoshio Tahara,
Hiroshi Hazui,
Hideki Arimoto,
Kazunori Kashiwase,
Hirotaka Sawano,
Yuji Yasuga,
Yasuhiro Kuroda,
Shunji Kasaoka,
Shinichi Shirai,
Naohiro Yonemoto, Hiroshi Nonogi
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ABSTRACT: Mild hypothermia is an effective therapy for patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest. However, evidence of the effectiveness of therapeutic hypothermia (TH) remains unclear.
A multicenter registry in Japan (J-PULSE-HYPO study registry) was conducted to investigate the effectiveness of TH for post-resuscitation neurological dysfunction developing after out-of-hospital cardiac arrest from 14 institutions, between January 2005 and December 2009. The committee entrusted each hospital with the timing of cooling, cooling methods, target temperature, duration, and rewarming. There were 452 patients (375 men) enrolled into the registry. The mean age was 58.6 ± 13.5 years. Initial electrocardiogram rhythm at the time of occurrence of the cardiac arrest showed 68.9% had ventricular fibrillation or pulseless ventricular tachycardia, 13.7% had pulseless electrical activity, and 9.1% had asystole. The median interval from the occurrence of cardiac arrest to ROSC was 26 min. The target core temperature during TH was 33.9 ± 0.4°C and the mean duration of cooling was 31.5 ± 13.9 h. Intra-aortic balloon pumping was used in 40.1% and percutaneous cardiopulmonary support in 22.6% of patients. At 30 days after cardiac arrest, the proportion of survival was 80.1% and the proportion of patients with favorable neurological functions, with a cerebral performance category score of 1 or 2, was 55.3%.
The J-PULSE-HYPO study registry showed a clinical aspect of TH.
Circulation Journal 04/2011; 75(5):1063-70. · 3.77 Impact Factor
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Hiroyuki Yokoyama,
Naohiro Yonemoto,
Kazuya Yonezawa,
Jun Fuse,
Naoki Shimizu,
Toshimasa Hayashi,
Teppei Tsuji,
Kei Yoshikawa,
Hiroya Wakamatsu,
Nozomu Otani,
Satoru Sakuragi,
Masahiko Fukusaki,
Hideki Tanaka, Hiroshi Nonogi
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ABSTRACT: In-hospital cardiopulmonary arrest (CPA) is an important issue, but data in Japan are limited.
To investigate in-hospital CPA, we conducted a prospective multicenter observational registry of in-hospital CPA and resuscitation in Japan (J-RCPR). During January 2008 to December 2009, patients were registered from 12 participating hospitals. All patients, visitors and employees within the facility campus who experience a cardiopulmonary resuscitation event defined as either a pulseless or a pulse with inadequate perfusion requiring chest compressions and/or defibrillation of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) were registered. Data were collected in 6 major categories of variables: facility data, patient demographic data, pre-event data, event data, outcome data, and quality improvement data. Data for 491 adults were analyzed. The prevalence of pulseless VT/VF as first documented rhythm was 28.1%, asystole was 29.5% and pulseless electrical activity was 41.1%. Immediate causes of event were arrhythmia 30.6%, acute respiratory insufficiency 26.7%, and hypotension 15.7%. Return of spontaneous circulation was 64.7%; the proportion of survival 24h after CPA was 49.8%, the proportion of survival to hospital discharge was 27.8% and proportion of favorable neurological outcome at 30 days was 21.4%.
This is the first report of the registry for in-hospital CPA in Japan and shows that the registry provides important observational data.
Circulation Journal 03/2011; 75(4):815-22. · 3.77 Impact Factor
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ABSTRACT: This study aimed to evaluate the association of cardiopulmonary resuscitation (CPR) training with bystander resuscitation performance and patient outcomes after out-of-hospital cardiac arrest (OHCA).
This was a prospective, population-based cohort study of all persons aged 18 years or older with OHCA of presumed intrinsic origin and their rescuers from January through December 2008 in Takatsuki, Osaka prefecture, Japan. Data on resuscitation of OHCA patients were obtained by emergency medical service (EMS) personnel in charge based on the Utstein style. Rescuers' characteristics including experience of CPR training were obtained by EMS personnel interview on the scene. The primary outcome was the attempt of bystander CPR.
Data were collected for 120 cases out of 170 OHCAs of intrinsic origin. Among the available cases, 60 (50.0%) had previous CPR training (trained rescuer group). The proportion of bystander CPR was significantly higher in the trained rescuer group than in the untrained rescuer group (75.0% and 43.3%; p = 0.001). Bystanders who had previous experience of CPR training were 3.40 times (95% confidence interval 1.31-8.85) more likely to perform CPR compared with those without previous CPR training. The number of patients with neurologically favorable one-month survival was too small to evaluate statistical difference between the groups (2 [3.3%] in the trained rescuer group versus 1 [1.7%] in the untrained rescuer group; p = 0.500).
People who had experienced CPR training had a greater tendency to perform bystander CPR than people without experience of CPR training. Further studies are needed to prove the effectiveness of CPR training on survival.
Resuscitation 02/2011; 82(5):523-8. · 3.60 Impact Factor
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ABSTRACT: The efficacy of out-patient cardiac rehabilitation (OPCR) in patients with a low prognostic risk after acute myocardial infarction (AMI) is unclear in the recent primary intervention era.
A total of 637 AMI patients who participated in in-hospital cardiac rehabilitation were divided into 2 groups; low prognostic risk group (n=219; age <65 years, successful reperfusion, Killip class I, peak serum creatine kinase <6,000U/L, and left ventricular ejection fraction ≥40%) and non-low prognostic risk group (n=418). The prevalence of coronary risk factors (CRF) was compared between the 2 groups. Then, in the low-risk group, the efficacy of OPCR was compared between active OPCR participants (n=52; ≥20 sessions/3 months) and non-active participants (n=60; <6 sessions/3 months). Compared with the non-low prognostic risk group, the low prognostic risk group had a significantly higher prevalence of current smokers (72% vs. 49%, P<0.05) and patients with multiple CRF (3 or more; 49% vs. 39%, P<0.05). Among the low- risk group, active OPCR participants showed a significantly greater improvement in exercise capacity (peak VO(2), P<0.05) and maintained a better CRF profile (total cholesterol, triglyceride and blood pressure, all P<0.05) than inactive participants at 3 months.
Low prognostic risk AMI patients have a higher prevalence of multiple CRF than non-low risk patients. Even in this low risk group, active participation in OPCR is associated with improved exercise capacity and better CRF profile.
Circulation Journal 02/2011; 75(2):315-21. · 3.77 Impact Factor
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ABSTRACT: MicroRNAs (miRNAs) are endogenous small RNAs that are 21-25 nucleotides in length. Recently, plasma miRNAs have been reported to be sensitive and specific biomarkers of various tissue injuries and pathological conditions. The goal of this study was to assess plasma miRNA profiles and to identify plasma miRNAs that are differentially expressed in patients with heart failure.
A total of 33 patients with ischemic heart diseases and 17 asymptomatic controls were recruited. In 10 patients with heart failure, miRNAs were assessed at both NYHA IV and III. miRNA array analyses were found to be not appropriate for plasma miRNA profiling. The plasma concentrations of well-characterized miRNAs (miR-126, 122 and 499) were assessed by a real-time reverse transcription-polymerase chain reaction using an artificial small RNA as an internal standard. Plasma concentrations of miR-126 were negatively correlated with age and logBNP. In 10 patients with heart failure, plasma concentrations of miR-126 were up-regulated with improvement of the NYHA class from IV to III.
The plasma concentration of miR-126 was negatively correlated with age and NYHA class, and could be a useful biomarker for heart failure.
Circulation Journal 02/2011; 75(2):336-40. · 3.77 Impact Factor
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ABSTRACT: Diabetes mellitus (DM) and impaired glucose tolerance (IGT) are risk factors for acute myocardial infarction (AMI). However, it is unknown whether hyperglycemic state is associated with increased major adverse cardiovascular events (MACE) after AMI. In this study, we evaluated the relationship between glucometabolic status and MACE in patients after AMI, and determined the critical level of 2 h post-load plasma glucose that may be used to predict MACE.
AMI patients (n = 422) were divided into 4 groups as follows: normal glucose tolerance (NGT) group, IGT group, newly diagnosed DM (NDM) group, and previously known DM (PDM) group. MACE of the 4 groups were compared for 2 years from AMI onset.
The NDM group had a significantly higher event rate than the IGT and NGT groups and had a similar event rate curve to PDM group. The logistic models analyses revealed that 2 h post-load plasma glucose values of ≥160 mg/dL was the only independent predictor of long-term MACE after AMI (p = 0.028, OR: 1.85, 95% CI: 1.07-3.21). The 2-year cardiac event rate of patients with a 2 h post-load hyperglycemia of ≥160 mg/dL was significantly higher than that of patients with 2 h post-load glucose of <160 mg/dL (32.2% vs. 19.8%, p < 0.05) and was similar to that of PDM group (37.4%, p = 0.513).
NDM increases the risk of MACE after AMI as does PDM. Particularly, post-AMI patients with a 2 h post-load hyperglycemia ≥160 mg/dL may need adjunctive therapy after AMI.
Cardiovascular Diabetology 11/2010; 9:75. · 3.35 Impact Factor
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ABSTRACT: Neovascularization such as formation of collateral vessels following total occlusion of native coronary artery is common in coronary artery disease. This is a case report of a very rare connection by newly formed conduit vessels between the left internal mammalian artery and the radial artery establishing bypass, which occurred after failure of bypass grafts.
Heart and Vessels 11/2010; 26(2):226-30. · 2.05 Impact Factor
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ABSTRACT: This study aimed to compare the time-dependent deterioration of chest compressions between chest compression-only cardiopulmonary resuscitation (CPR) and conventional CPR.
This study involved 106 and 107 participants randomly assigned to chest compression-only CPR training and conventional CPR training, respectively. Immediately after training, participants were asked to perform CPR for 2 min and the quality of their CPR skills were evaluated. The number of chest compressions in total and those with appropriate depth were counted every 20-s CPR period from the start of CPR. The primary outcome was the CPR quality index calculated as the proportion of chest compressions with appropriate depth among total chest compressions.
The total number of chest compressions remained stable over time both in the chest compression-only and the conventional CPR groups. The CPR quality index, however, decreased from 86.6+/-25.0 to 58.2+/-36.9 in the chest compression-only CPR group from 0-20 s through 61-80 s. The reduction was greater than in the conventional CPR group (85.9+/-25.5 to 74.3+/-34.0). The difference in the CPR quality index reached statistical significance (p=0.003) at 61-80 s period.
Chest compressions with appropriate depth decreased more rapidly during chest compression-only CPR than conventional CPR. We recommend that CPR providers change their roles every 1 min to maintain the quality of chest compressions during chest compression-only CPR. (UMIN-CTR C0000000321).
Resuscitation 09/2010; 81(9):1152-5. · 3.60 Impact Factor
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ABSTRACT: Nifekalant hydrochloride (NIF) is an intravenous class-III antiarrhythmic agent that purely blocks the K(+)-channel without inhibiting β-adrenergic receptors. The present study was designed to investigate the feasibility of NIF as a life-saving therapy for out-of-hospital ventricular fibrillation (VF).
The Japanese Population-based Utstein-style study with basic and advanced Life Support Education study was a multi-center registry study with 4 participating institutes located at the northern urban area of Osaka, Japan. Eligible patients were those treated with NIF because of out-of-hospital VF refractory to 3 or more precordial shocks and intravenous epinephrine. Between February 2006 and February 2007, 17 patients were enrolled for the study. The time from a call for emergency medical service to the first shock was 12(6-26)min. The time from the first shock to the NIF administration was 25.5(9-264)min and the usage dose of NIF was 25(15-210)mg. When excluding 3 patients in whom percutaneous extracorporeal membrane oxygenation was applied before NIF administration, the rate of return of spontaneous circulation was 86% and the rate of admission alive to the hospital was 79%. One patient developed torsade de pointes.
Intravenous administration of NIF seems to be feasible as a potential therapy for advanced cardiac life-support in patients with out-of-hospital VF, and therefore further study is warranted.
Circulation Journal 09/2010; 74(11):2308-13. · 3.77 Impact Factor
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Mitsuru Abe,
Takeshi Kimura,
Takeshi Morimoto,
Takuya Taniguchi,
Futoshi Yamanaka,
Kazuhiro Nakao,
Nobuhito Yagi,
Nobuaki Kokubu,
Yoichiro Kasahara,
Yu Kataoka, [......],
Ren Kawaguchi,
Manabu Setoguchi,
Tsukasa Inada,
Koichi Kishi,
Hiroki Sakamoto,
Nobuyuki Morioka,
Masao Imai,
Hiroki Shiomi, Hiroshi Nonogi,
Kazuaki Mitsudo
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ABSTRACT: Optimal treatment strategies for restenosis of sirolimus-eluting stents (SES) have not been adequately addressed yet.
During the 3-year follow-up of 12 824 patients enrolled in the j-Cypher registry, 1456 lesions in 1298 patients underwent target-lesion revascularization (TLR). Excluding 362 lesions undergoing TLR for stent thrombosis or TLR using treatment modalities other than SES or balloon angioplasty (BA), 1094 lesions with SES-associated restenosis in 990 patients treated with either SES (537 lesions) or BA (557 lesions) constituted the study population for the analysis of recurrent TLR and stent thrombosis after the first TLR. Excluding 24 patients with both SES- and BA-treated lesions, 966 patients constituted the analysis set for the mortality outcome. Cumulative incidence of recurrent TLR in the SES-treated restenosis lesions was significantly lower than that in the BA-treated restenosis lesions (23.8% versus 37.7% at 2 years after the first TLR; P<0.0001). Among 33 baseline variables evaluated, only hemodialysis was identified to be the independent risk factor for recurrent TLR by a multivariable logistic regression analysis. After adjusting for confounders, repeated SES implantation was associated with a strong treatment effect in preventing recurrent TLR over BA (odds ratio, 0.44; 95% confidence interval, 0.32 to 0.61; P<0.0001). The 2-year mortality and stent thrombosis rates between the SES- and the BA-treated groups were 10.4% versus 10.8% (P=0.4) and 0.6% versus 0.6%, respectively.
Repeated implantation of SES for SES-associated restenosis is more effective in preventing recurrent TLR than treatment with BA, without evidence of safety concerns.
Circulation 07/2010; 122(1):42-51. · 14.74 Impact Factor
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ABSTRACT: MicroRNAs (miRNAs) are endogenous small RNAs 21-25 nucleotides in length. Recently, we reported that miRNA 208 (miR-208) is produced exclusively in the rat myocardium and that plasma miR-208 is a biomarker of myocardial injury in rats. In the present study, we assessed the hypothesis that plasma concentrations of myocardial-specific miRNAs can be used to diagnose myocardial injury in humans.
We used array analysis of miRNA production in various human tissues to identify heart-specific miRNAs. We assessed the plasma concentrations of miR-499 in 14 individuals with acute coronary syndromes, 15 individuals with congestive heart failure, and 10 individuals without cardiovascular diseases. Plasma miR-499 concentrations were measured with a real-time reverse-transcription PCR method that used an artificial small RNA as an internal calibrator.
The miRNA array analysis of various human tissues indicated that miR-499 was produced almost exclusively in the heart. Plasma miR-499 concentrations were measurably increased in all individuals with acute myocardial infarction but were below the limit of detection for all individuals in the other patient groups.
The plasma concentration of miR-499 may be a useful biomarker of myocardial infarction in humans.
Clinical Chemistry 07/2010; 56(7):1183-5. · 7.91 Impact Factor
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ABSTRACT: Coronary vasospasm can be induced by allergic reactions with some chemical mediators, and the angina and myocardial infarction secondary to allergy-induced coronary vasospasm are referred to as "Kounis syndrome." Only two cases of Kounis syndrome following food ingestion have been reported. However, they had pre-existing atheromatous coronary artery disease, and no provocation test to induce coronary vasospasm was done. We describe here another probable case of allergic vasospasm after food intake. To the best of our knowledge, this is the first documented report of a patient with food-induced allergic vasospasm subsequent to the provocation test with ergometrine maleate.
Heart and Vessels 05/2010; 25(3):263-6. · 2.05 Impact Factor
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Tetsuhisa Kitamura,
Taku Iwami,
Graham Nichol,
Tatsuya Nishiuchi,
Yasuyuki Hayashi,
Chika Nishiyama,
Tomohiko Sakai,
Kentaro Kajino,
Atsushi Hiraide,
Hisashi Ikeuchi, Hiroshi Nonogi,
Takashi Kawamura
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ABSTRACT: The aim of this study was to determine relative risk (RR) of incidence and fatality of out-of-hospital cardiac arrest (OHCA) by gender and oestrogen status.
In a prospective, population-based observational study from 1998 through 2007, incidence and neurologically intact 1-month survival after OHCA were compared by gender after grouping: 0-12 years, 13-49 years, and > or =50 years according to menarche and menopause age. Among 26 940 cardiac arrests, there were 11 179 females and 15 701 males. Age-adjusted RR of females for OHCA incidence compared with males was 0.72 [95% confidence interval (CI), 0.58-0.91] in age 0-12 years, 0.39 (95% CI, 0.37-0.43) in age 13-49 years, and 0.54 (95% CI, 0.52-0.55) in age > or =50 years. Females aged 13-49 years had a significantly higher good neurological outcome than males [adjusted odds ratio (OR), 2.00 (95% CI 1.21-3.32)]. This sex difference was larger than that in the other age groups [adjusted OR, 0.82 (95% CI, 0.06-12.02) in age 0-12 years and 1.23 (95% CI, 0.98-1.54) in age > or =50 years].
Reproductive females had a lower incidence and a better outcome of OHCA than females of other ages and males, which might be explained by cardioprotective effects of endogenous oestrogen on OHCA.
European Heart Journal 03/2010; 31(11):1365-72. · 10.48 Impact Factor
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ABSTRACT: Although the existence of the young patients with aortic disease not fulfilling the diagnostic criteria for Marfan syndrome (MFS) has been known, the etiology of their disease has not yet been elucidated. The purpose of the present study was to elucidate the genetic and clinical features of the young patients with aortic disease not having MFS.
Eighty young adult patients with aortic disease were examined. They were divided into a definite MFS (n=51) and a non-definite MFS group (n=29) according to the Ghent nosology. Clinical and genetic characteristics were compared between the 2 groups. Among 29 non-definite MFS probands, 1 (3%) FBN1, 2 (7%) TGFBR1, and 3 (10%) TGFBR2 mutations were found, and 4 ACTA2 mutations were found in the 23 probands examined without FBN1, TGFBR1, or TGFBR2 mutations. In total, more than 10 out of 29 (34%) probands in the non-definite MFS group were associated with genetic mutations. Skeletal involvement was less frequent in the non-definite than in the definite MFS group (7% vs 82%, P<0.01).
In the probands with aortic diseases in young who cannot be diagnosed with MFS, mutations other than FBN1 mutations accounted for at least one-third of all causes of aortic disease.
Circulation Journal 03/2010; 74(5):990-7. · 3.77 Impact Factor
