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Yoichiro Otaki,
Tetsu Watanabe,
Tetsuro Shishido,
Hiroki Takahashi,
Akira Funayama,
Taro Narumi,
Shinpei Kadowaki,
Hiromasa Hasegawa,
Shintaro Honda,
Shunsuke Netsu,
Mitsunori Ishino,
Takanori Arimoto, Takehiko Miyashita,
Takuya Miyamoto,
Tsuneo Konta,
Isao Kubota
[show abstract]
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ABSTRACT: BACKGROUND: -Renal dysfunction was reported to be closely associated with clinical outcomes in patients with chronic heart failure (CHF). Renal tubulointerstitial damage has been shown to be an important factor in the development of renal dysfunction as well as glomerular damage. However, it remains to be determined the impact of renal tubular damage on clinical outcomes in patients with CHF. METHODS AND RESULTS: -Urinary β2-microglobulin-creatinine ratio (UBCR) was measured in 315 patients with CHF. Renal tubular damage was defined as a UBCR ≥ 300 μg/g, as previously reported. Patients were prospectively followed for a median period of 1097 days. There were 91 cardiac events, including 16 cardiac deaths and 75 re-hospitalizations for worsening heart failure. Log10 UBCR was increased with worsening New York Heart Association (NYHA) functional class. Multivariate analysis revealed that renal tubular damage was an independent predictor of cardiac events. Kaplan-Meier analysis demonstrated that the rate of cardiac events was higher in patients with renal tubular damage compared to those without it. Patients were divided into 4 groups according to the presence of chronic kidney disease and renal tubular damage. The Cox proportional hazard analysis revealed that comorbidity of chronic kidney disease and renal tubular damage was associated with the highest risk for cardiac events compared to other groups. CONCLUSIONS: -Renal tubular damage was related to the severity of heart failure and was associated with poor outcomes in patients with CHF. Renal tubular damage could add clinical information to chronic kidney disease in patients with CHF.
Circulation Heart Failure 05/2013; · 6.29 Impact Factor
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Yoichiro Otaki,
Tetsu Watanabe,
Hiroki Takahashi,
Hiromasa Hasegawa,
Shintaro Honda,
Akira Funayama,
Shunsuke Netsu,
Mitsunori Ishino,
Takanori Arimoto,
Tetsuro Shishido, Takehiko Miyashita,
Takuya Miyamoto,
Tsuneo Konta,
Isao Kubota
[show abstract]
[hide abstract]
ABSTRACT: Renal dysfunction is reported to be associated with poor outcomes in patients with chronic heart failure (CHF). A recent study showed that acidic urine is related to chronic kidney disease, which is a risk factor for the development of CHF. However, it remains to be determined whether acidic urine is associated with poor outcomes in patients with CHF. We measured urine pH using dipsticks in 537 patients with CHF. Acidic urine was defined as urine pH ≤5.5. Patients were prospectively followed during a median follow-up period of 556 days. There were 145 cardiac events. Prevalence of acidic urine was increased with advancing stage of chronic kidney disease. Patients with acidic urine had a more severe New York Heart Association functional class compared with those with normal urine. In the multivariate Cox proportional hazard analysis, acidic urine was independently associated with poor outcomes in patients with CHF after adjustment of confounding factors. A Kaplan-Meier analysis demonstrated that the rate of cardiac events was higher in patients with acidic urine than in those with normal urine. The presence of acidic urine can reliably identify patients at high risk of future cardiac events in patients with CHF.
Heart and Vessels 12/2012; · 2.05 Impact Factor
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Akira Funayama,
Tetsuro Shishido, Takehiko Miyashita,
Shunsuke Netsu,
Yoichiro Otaki,
Takanori Arimoto,
Hiroki Takahashi,
Takuya Miyamoto,
Tetsu Watanabe,
Tsuneo Konta,
Isao Kubota
[show abstract]
[hide abstract]
ABSTRACT: Background: Urinary β2 microglobulin (U-β2MG) is a more sensitive and accurate marker of tubulointerstitial damage. The etiology of glomerular damage is related to the occurrence of major adverse cardiovascular events (MACE) in patients with myocardial infarction (MI); however, the prognostic importance of tubulointerstitial damage in patients with ST-segment elevation MI (STEMI) has not been established. The aim of this study was to elucidate whether renal tubulointerstitial damage is associated with the occurrence of MACE in patients after STEMI undergoing percutaneous coronary intervention. Methods and Results: The degree of renal tubulointerstitial damage was evaluated by measuring the U-β2MG level in 89 consecutive STEMI patients. There were 22 MACEs during the follow-up period. Patients with MACE had higher U-β2MG levels than those without MACE, and the U-β2MG level was an independent predictor for MACE. A Kaplan-Meier analysis revealed that the group with higher U-β2MG levels corrected for urinary creatinine was associated with a greater risk for MACE. Conclusions: An elevated U-β2MG level was associated with the occurrence of MACE in STEMI patients who underwent PCI. Renal tubulointerstitial damage is therefore considered to be associated with the occurrence of MACE.
Circulation Journal 10/2012; · 3.77 Impact Factor
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ABSTRACT: BACKGROUND: The relationship between ongoing myocardial damage and heart failure with preserved left ventricular systolic function (HF-PEF) is still unclear. To investigate this relationship, we measured the cardiac-specific cytosolic marker, heart-type fatty acid binding protein (H-FABP), and a myofibrillar component (troponin T), and analyzed clinical outcomes. METHODS AND RESULTS: Consecutive heart failure patients (n=151) with echocardiographic left ventricular ejection fraction >50% were prospectively enrolled. The cut-off values for myocardial membrane injury (H-FABP >4.3ng/mL) and myofibrillar injury (troponin T >0.01ng/mL) were defined using receiver operating characteristic curves. Myocardial membrane injury was observed more frequently than myofibrillar injury (41% vs. 26% of patients, p<0.05). Patients were followed up for a median of 694days, with the end-points being cardiovascular death or re-hospitalization. By multivariate analysis, the serum H-FABP level was an independent predictor of cardiovascular events (hazard ratio 1.165 per 1ng/mL increase, 95% confidence interval 1.034-1.314, p=0.012). CONCLUSIONS: Latent myocardial injury was frequently observed in patients with HF-PEF. The circulating H-FABP level was an independent predictor of subsequent cardiovascular events.
Journal of Cardiology 07/2012; · 1.28 Impact Factor
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Hyuma Daidoji,
Takanori Arimoto,
Joji Nitobe,
Harutoshi Tamura,
Daisuke Kutsuzawa,
Daisuke Ishigaki,
Mitsunori Ishino,
Hiroki Takahashi,
Tetsuro Shishido, Takehiko Miyashita,
Takuya Miyamoto,
Tetsu Watanabe,
Isao Kubota
[show abstract]
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ABSTRACT: The association between ongoing myocardial damage and outcomes in patients who have received an implantable cardioverter-defibrillator (ICD) is unclear.
Consecutive patients with cardiomyopathy, who had received an ICD (n = 107, mean age 65 ± 11 years), were prospectively enrolled. Myocardial membrane injury (heart-type fatty acid binding protein [H-FABP] >4.3 ng/mL) and myofibrillar injury (troponin T >0.01 ng/mL) were defined using receiver operating characteristic curves. Patients were followed for a median of 33.6 months, to an end point of appropriate ICD shock or cardiac death. Myocardial membrane injury (45%) and myofibrillar injury (41%) were equally prevalent among patients with cardiomyopathy who had received ICDs. Appropriate ICD shocks or cardiac death occurred in 31% and 15% of patients, respectively. Multivariate Cox regression analysis showed that serum H-FABP levels >4.3 ng/mL, but not troponin T levels, were a significant independent prognostic factor for cardiac events (hazard ratio 5.502, 95% confidence interval 1.705-17.75, P = .004). Subgroup analysis revealed that measuring H-FABP levels was valuable for anticipating event-free survival among patients with ICDs who were receiving amiodarone. High H-FABP levels also predicted subsequent outcomes in patients who had received ICDs for primary or secondary prevention.
Evaluating myocardial damage using H-FABP may be a promising tool for predicting outcomes in patients with cardiomyopathy who have received ICDs.
Journal of cardiac failure 07/2012; 18(7):556-63. · 3.25 Impact Factor
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Harutoshi Tamura,
Tetsu Watanabe,
Satoshi Nishiyama,
Shintaro Sasaki,
Masahiro Wanezaki,
Takanori Arimoto,
Hiroki Takahashi,
Tetsuro Shishido, Takehiko Miyashita,
Takuya Miyamoto,
Osamu Hirono,
Takamasa Kayama,
Isao Kubota
[show abstract]
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ABSTRACT: It is well known that left atrial appendage (LAA) dysfunction plays an important role in the occurrence of cardioembolic stroke. The atrium is the main source of brain natriuretic peptide (BNP) in patients with atrial fibrillation (AF). We hypothesized that the plasma BNP level would be a sensitive predictor of LAA dysfunction in patients with acute ischemic stroke.
Transesophageal echocardiography was performed and plasma BNP levels were measured in 223 patients (145 males, age 69 ± 14 years), within 7 days after the onset of acute ischemic stroke. None of the patients had a history of congestive heart failure. LAA thrombus was detected in 23 of 77 (30%) patients with AF. Plasma BNP levels were markedly higher in patients with cardioembolic stroke compared to those without (144 pg/ml vs. 35 pg/ml, p<0.05). Plasma BNP levels were significantly correlated with LAA emptying flow velocity regardless of sinus rhythm (R=-0.352) or AF (R=-0.436). Furthermore, among patients with cardioembolic stroke, plasma BNP levels were markedly higher in patients with cardiogenic stroke, as diagnosed by transesophageal echocardiography, than in those with cryptogenic stroke (193 pg/ml vs. 14 pg/ml, p<0.05). Multivariate logistic regression analysis showed that a BNP concentration >90 pg/ml was an independent predictor of cardiogenic stroke (odds ratio 41.39, 95% confidence interval 1.28-138; p=0.0358).
Elevated plasma BNP concentrations may be a reliable surrogate marker for the prediction of LAA dysfunction and cardiogenic stroke in patients with acute ischemic stroke.
Journal of Cardiology 04/2012; 60(2):126-32. · 1.28 Impact Factor
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Harutoshi Tamura,
Tetsu Watanabe,
Satoshi Nishiyama,
Shintaro Sasaki,
Masahiro Wanezaki,
Takanori Arimoto,
Hiroki Takahashi,
Tetsuro Shishido, Takehiko Miyashita,
Takuya Miyamoto,
Isao Kubota
[show abstract]
[hide abstract]
ABSTRACT: It is important to evaluate left atrial appendage (LAA) dysfunction for primary and secondary prevention of stroke in patients with atrial fibrillation (AF). LAA dysfunction can reportedly be evaluated by LAA wall velocity (LAWV) measured by transthoracic echocardiographic (TTE) imaging. The aim of this study was to examine whether TTE-LAWV can predict long-term cerebrovascular events in patients with ischemic stroke with AF.
TTE imaging and transesophageal echocardiographic imaging were performed <7 days after onset in 179 consecutive patients with stroke with AF. TTE-LAWV was measured using Doppler tissue imaging at the LAA tip from the parasternal short-axis view on TTE imaging, as previously reported. All patients were followed up prospectively.
Cerebrovascular events were defined as cerebrovascular death and/or recurrent ischemic stroke requiring hospitalization. There were 32 cerebrovascular events during a median follow-up period of 397 days. TTE-LAWV was significantly lower in patients with cerebrovascular events than in patients without (8.3 ± 2.8 vs 11.3 ± 4.0 cm/sec, P < .01). Cox multivariate hazard analysis showed that low TTE-LAWV (<8.7 cm/sec) was an independent predictor of cerebrovascular events (hazard ratio, 3.460; P < .05). Kaplan-Meier analysis showed that cerebrovascular event rates were significantly higher in patients with low TTE-LAWV (<8.7 cm/sec) compared with those with high TTE-LAWV (34% vs 7%, P < .01).
Impaired LAA function was associated with long-term cerebrovascular events in patients with stroke with AF. TTE-LAWV may be a feasible parameter for risk stratification in patients with AF.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 02/2012; 25(5):576-83. · 2.98 Impact Factor
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Daisuke Kutsuzawa,
Takanori Arimoto,
Tetsuro Shishido,
Shintaro Sasaki,
Tadateru Iwayama,
Daisuke Ishigaki,
Hiroki Takahashi, Takehiko Miyashita,
Takuya Miyamoto,
Joji Nitobe,
Tetsu Watanabe,
Isao Kubota
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ABSTRACT: A patient with cardiac sarcoidosis showed low R-wave amplitude in the entire right ventricle (RV). To troubleshoot this, a left ventricular (LV) lead was implanted in the coronary vein. The pace/sense terminal of the defibrillation lead was connected to LV:IS-1 of the defibrillator. Conversely, the LV lead was connected to RV:IS-1. Induced ventricular fibrillation was successfully terminated without any undersensing.
Europace 01/2012; 14(8):1217-9. · 1.98 Impact Factor
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Taro Narumi,
Tetsuro Shishido,
Nobuyuki Kiribayashi,
Shinpei Kadowaki,
Satoshi Nishiyama,
Hiroki Takahashi,
Takanori Arimoto, Takehiko Miyashita,
Takuya Miyamoto,
Tetsu Watanabe,
Yoko Shibata,
Tsuneo Konta,
Yoshiyuki Ueno,
Takeo Kato,
Takamasa Kayama,
Isao Kubota
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ABSTRACT: Background. Insulin resistance (IR) is part of the metabolic syndrome (Mets) that develops after lifestyle changes and obesity. Although the association between Mets and myocardial injury is well known, the effect of IR on myocardial damage remains unclear. Methods and Results. We studied 2200 normal subjects who participated in a community-based health check in the town of Takahata in northern Japan. The presence of IR was assessed by homeostasis model assessment ratio, and the serum level of heart-type fatty acid binding protein (H-FABP) was measured as a maker of silent and ongoing myocardial damage. H-FABP levels were significantly higher in subjects with IR and Mets than in those without metabolic disorder regardless of gender. Multivariate logistic analysis showed that the presence of IR was independently associated with latent myocardial damage (odds ratio: 1.574, 95% confidence interval 1.1-2.3) similar to the presence of Mets. Conclusions. In a screening of healthy subjects, IR and Mets were similarly related to higher H-FABP levels, suggesting that there may be an asymptomatic population in the early stages of metabolic disorder that is exposed to myocardial damage and might be susceptible to silent heart failure.
Experimental Diabetes Research 01/2012; 2012:815098. · 1.20 Impact Factor
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Harutoshi Tamura,
Tetsu Watanabe,
Satoshi Nishiyama,
Shintaro Sasaki,
Takanori Arimoto,
Hiroki Takahashi,
Tetsuro Shishido, Takehiko Miyashita,
Takuya Miyamoto,
Joji Nitobe,
Osamu Hirono,
Isao Kubota
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ABSTRACT: Left atrial volume index (LAVI) is known to reflect the duration and severity of increased left atrial pressure caused by left ventricular (LV) diastolic dysfunction. However, the prognostic value of LAVI in patients with heart failure (HF) has not been fully investigated.
Transthoracic echocardiography was performed in 146 consecutive patients (78 men, 68 women; mean age 72 ± 12 y) who were hospitalized for HF. There were 45 cardiac events (32%) during a median follow-up period of 448 days. There were no significant differences in LV end-diastolic dimensions or ejection fraction between patients who did or did not have cardiac events. However, LAVI was markedly higher in patients with, than those without, cardiac events (56 ± 26 vs 44 ± 22 mL/m(2); P < .01). Kaplan-Meier analysis showed that there was a stepwise increase in risk of cardiac events with each increment of LAVI category, and LAVI >53.3 mL/m(2) correlated with the highest risk of cardiac events (log-rank test; P < .01). Multivariate Cox proportional hazard analysis showed that high LAVI was an independent predictor for cardiac events (hazard ratio 1.427; 95% confidence interval 1.024-1.934; P < .05).
LAVI may be useful for stratification of risk in patients with HF.
Journal of cardiac failure 03/2011; 17(3):210-6. · 3.25 Impact Factor
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Takanori Arimoto,
Tetsu Watanabe,
Joji Nitobe,
Tadateru Iwayama,
Daisuke Kutsuzawa,
Takuya Miyamoto, Takehiko Miyashita,
Tetsuro Shishido,
Hiroki Takahashi,
Naoki Nozaki,
Akio Fukui,
Isao Kubota
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ABSTRACT: The aim of this study was to compare the long-term procedural outcomes, the stability of atrioventricular conduction, and the new onset of atrial fibrillation (AF), after ablation of atrioventricular nodal reentrant tachycardia (AVNRT).
Consecutive patients with AVNRT (n=109), who underwent slow-pathway ablation, were divided into two groups based on the median age of the studied patients: the younger group aged <55 years and the older group aged ≥55 years. During a mean follow-up period of 60.6 months, the rate of change in the PR interval from before ablation to follow-up was significantly greater in older patients compared with younger patients. However, there was no delayed-onset high-degree AV block during follow-up in either group. No patients in the younger group suffered from persistent AF, whereas persistent AF occurred in 5/54 (9.3%) older patients. Multivariate Cox analysis revealed that atrial vulnerability, with induction of AF during the electrophysiological study, was the only predictor of the development of AF (Hazard ratio: 13.9, 95% confidence interval: 1.62-119.2, p<0.01).
Slow-pathway ablation of AVNRT is a reliable strategy even in older patients. However, physicians should consider regular long-term follow-up of older patients with atrial vulnerability, in order to assess the subsequent development of AF.
Internal Medicine 01/2011; 50(16):1649-55. · 0.94 Impact Factor
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ABSTRACT: Hypokalemia accentuates the electrocardiographic (ECG) pattern of Brugada syndrome. We report two patients with Brugada syndrome and hypokalemia-induced lethal events. Despite concealing the typical ECG pattern with normalization of serum potassium levels, late potentials were persistently detected by signal-averaged ECG, even at the 18-month follow-up. An implantable cardioverter defibrillator was inserted to prevent sudden cardiac death.
Annals of Noninvasive Electrocardiology 01/2011; 16(1):104-6. · 1.10 Impact Factor
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Satoshi Suzuki,
Tetsuro Shishido,
Mitsunori Ishino,
Shigehiko Katoh,
Toshiki Sasaki,
Satoshi Nishiyama, Takehiko Miyashita,
Takuya Miyamoto,
Joji Nitobe,
Tetsu Watanabe,
Yasuchika Takeishi,
Isao Kubota
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ABSTRACT: DNA in the nucleus is one of the major targets of reactive oxygen species (ROS), and oxidative DNA damage has been implicated in the pathogenesis of chronic heart failure. 8-Hydroxy-2'-deoxyguanosine (8-OHdG) is produced from deoxyguanosine in DNA by ROS. The purpose of this present study was to examine the clinical significance of serum 8-OHdG levels in patients with heart failure.
We measured serum 8-OHdG levels in 230 patients with chronic heart failure and 42 control subjects without heart failure by sandwich enzyme-linked immunosorbent assay. Patients were prospectively followed during a median follow-up period of 472 days with the end points of cardiac death or progressive heart failure requiring re-hospitalization.
Serum 8-OHdG concentrations were higher in patients with heart failure than in control subjects (P < 0·001) and increased with advancing New York Heart Association (NYHA) functional class (P < 0·001). Normal upper limit of 8-OHdG level was determined as mean ± 2SD value from 42 control subjects (0·40 ng mL(-1)). Abnormally high serum 8-OHdG levels (> 0·40 ng mL(-1)) were observed in 21·2%, 43·1%, 42·6% and 69·4% through NYHA I to IV (P < 0·001). A total of 66 cardiac events occurred during a follow-up period, and Kaplan-Meier survival curves demonstrated that cardiac event rate was markedly higher in patients with high 8-OHdG levels than in those with normal 8-OHdG levels (62·4% vs. 29·6%, P = 0·0007).
Serum 8-OHdG levels provide important prognostic information for the risk stratification of patients with heart failure.
European Journal of Clinical Investigation 01/2011; 41(7):759-66. · 3.02 Impact Factor
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ABSTRACT: The presence of metabolic syndrome (Mets) increases the risk for cardiovascular disease. There is a significant correlation between the levels of urinary albumin to creatinine ratio (UACR) and high-sensitive C-reactive peptide (hs-CRP), and accumulation of each Mets component. Increasing evidence has shown the importance of blockade of renin-angiotensin-systems (RAS) for reducing urinary albumin excretion and hs-CRP levels in Mets patients. However, the impact of RAS blockade on these effects in hypertensive (HT) Mets patients without diabetes mellitus (DM) has not been evaluated. We prospectively measured the levels of UACR and hs-CRP in 153 HT patients with and without Mets. Body weight; waist circumference; presence of dyslipidemia and DM, and levels of HOMA-R, UACR, and hs-CRP were significantly higher in HT patients with Mets than in those without Mets. After we treated these Mets patients with valsartan for 6 months, blood pressure (BP), UACR, and hs-CRP were decreased, whereas body weight, HOMR-R, and the lipid profile were not changed. In HT Mets patients without DM, 6 months after valsartan administration, levels of UACR and hs-CRP were also significantly decreased by 37.8% (-9.0-56.5%, p < 0.05) and 23.6% (-28.7-73.4%, p < 0.05), respectively. However, the percentage change of UACR and hs-CRP was not correlated with the reduction in BP. Valsartan administration lowered increased levels of chronic inflammation in both HT Mets patients with DM and in those without DM. These results indicate that the anti-inflammatory properties of valsartan might also have beneficial effects in Mets patients without DM.
Clinical and Experimental Hypertension 01/2011; 33(2):117-23. · 1.07 Impact Factor
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Shigehiko Katoh,
Tetsuro Shishido,
Daisuke Kutsuzawa,
Takanori Arimoto,
Shunsuke Netsu,
Akira Funayama,
Mitsunori Ishino,
Takeshi Niizeki,
Satoshi Nishiyama,
Hiroki Takahashi, Takehiko Miyashita,
Takuya Miyamoto,
Joji Nitobe,
Tetsu Watanabe,
Isao Kubota
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ABSTRACT: Iodine-123-metaiodobenzylguanidine ((123)I-MIBG) has been used to assess the function of the cardiac sympathetic nervous system in patients with chronic heart failure (HF). The usefulness of (123)I-MIBG imaging for evaluating patients with heart failure with preserved ejection fraction (HFPEF) has not been established.
We performed (123)I-MIBG scintigraphy and echocardiography and measured the plasma brain natriuretic peptide (BNP) levels of 117 consecutive HF patients (64 men, mean age 66 ± 14 years) with a left ventricular ejection fraction (LVEF) of ≥50% who were admitted to our hospital. Patients were divided into 2 groups according to the New York Heart Association (NYHA) functional class.
The (123)I-MIBG delayed heart-to-mediastinum (H/M) ratio was significantly lower, and the washout rate (WR) was higher in patients with HFPEF with advanced NYHA functional class (NYHA functional class I and II vs. III: 1.90 ± 0.34 vs. 1.49 ± 0.32, p < 0.0001; 25.9 ± 13.4 vs. 46.9 ± 16.3%, p < 0.0001, respectively). On the other hand, the (123)I-MIBG WR was not correlated with LVEF and had a weak correlation with plasma BNP levels (R = 0.207, p = 0.0346). Moreover, patients with a high (123)I-MIBG WR showed a poor clinical outcome (p = 0.0033).
(123)I-MIBG imaging provides independent prognostic information in patients with HFPEF.
Annals of Nuclear Medicine 11/2010; 24(9):679-86. · 1.50 Impact Factor
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Satoshi Nishiyama,
Tetsu Watanabe,
Takanori Arimoto,
Hiroki Takahashi,
Tetsuro Shishido, Takehiko Miyashita,
Takuya Miyamoto,
Joji Nitobe,
Yoko Shibata,
Tsuneo Konta,
Sumio Kawata,
Takeo Kato,
Akira Fukao,
Isao Kubota
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ABSTRACT: Recently, there has been an increase in the prevalence of coronary risk factors, such as diabetes and dyslipidemia, in Japan; however, it is unclear whether this has resulted in an increased incidence of acute myocardial infarction (AMI). We investigated the relationship between risk factors changes and AMI incidence in a Japanese population.
Trends in AMI incidence (per 100,000 person-years) were examined using data from the Yamagata AMI Registry from 1993 to 2007. We included 6,222 patients with a first-ever AMI (4175 men). The prevalence of coronary risk factors was investigated in three age groups of AMI patients (<65, 65-74, and ≥75 years) for the periods 1993-1997, 1998-2002, and 2003-2007. Coronary risk factors were further compared between recently registered AMI patients and 2,400 age-matched controls.
The age-adjusted incidence of AMI increased significantly in men, but not in women. Younger men particularly showed a significant increase in the incidence of AMI. The prevalence of hypertension and diabetes increased in both genders; however, the prevalence of treatment for risk factors was significantly lower in men than women. Younger men showed significant increases in obesity and hypertriglyceridemia. Consequently, risk factors associated with the metabolic syndrome had accumulated among younger men. We revealed that hypertension, diabetes, hypercholesterolemia and current smoking were independent risk factors for AMI.
The incidence rate for AMI increased significantly in men, especially younger men. Preventive care for risk factors associated with metabolic syndrome, in addition to conventional risk factors, may be required in younger men.
Journal of atherosclerosis and thrombosis 09/2010; 17(9):989-98. · 2.69 Impact Factor
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Tatsuro Kitahara,
Tetsuro Shishido,
Satoshi Suzuki,
Shigehiko Katoh,
Toshiki Sasaki,
Mitsunori Ishino,
Joji Nitobe,
Takuya Miyamoto, Takehiko Miyashita,
Tetsu Watanabe,
Yasuchika Takeishi,
Isao Kubota
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ABSTRACT: Midkine, a heparin-binding growth factor, has various functions such as migration of inflammatory cell and anti-apoptotic effect. Invasion of inflammatory cell and cardiomyocyte apoptosis are involved in development and progression of heart failure (HF). However, the relationship between midkine and HF has not been previously examined. Therefore, we examined clinical significance of serum midkine levels to determine the prognosis of HF patients.
Serum levels of midkine were measured at admission in 216 consecutive patients hospitalized for HF and 60 control subjects. Patients were prospectively followed during a mean follow-up period of 653 +/- 375 days with the end points of cardiac death and progressive HF requiring rehospitalization. Serum concentrations of midkine were significantly higher in patients with HF than in controls. Patients with cardiac events had significantly higher concentrations of midkine than those without cardiac events. Kaplan-Meier analysis revealed that cardiac event rates increased markedly as midkine levels rose. Furthermore in the multivariate analysis, after adjustment for age, gender ,and complications, midkine was the independent predictor of cardiac events.
Serum midkine levels are increased in HF patients, and midkine is a novel marker for risk stratifying HF patients.
Journal of cardiac failure 04/2010; 16(4):308-13. · 3.25 Impact Factor
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Harutoshi Tamura,
Tetsu Watanabe,
Osamu Hirono,
Satoshi Nishiyama,
Shintaro Sasaki,
Tetsuro Shishido, Takehiko Miyashita,
Takuya Miyamoto,
Joji Nitobe,
Takamasa Kayama,
Isao Kubota
[show abstract]
[hide abstract]
ABSTRACT: Atrial fibrillation is associated with ischemic stroke because of thrombi that form within the left atrial appendage (LAA). The aim of this study was to develop a new parameter for LAA function that is easily performed using transthoracic echocardiography (TTE).
TTE and transesophageal echocardiography were performed in 106 patients with stroke. LAA wall motion velocity (TTE-LAWV) was measured using Doppler tissue imaging at the LAA tip.
TTE-LAWV was significantly lower in patients with atrial fibrillation and LAA thrombus than in those with atrial fibrillation and no LAA thrombus and in sinus rhythm (7.5 +/- 1.9 vs 10.0 +/- 3.4 and 13.8 +/- 5.7 cm/s, respectively, P < .05). TTE-LAWV was significantly correlated with LAA emptying flow velocity (R = 0.462, P < .05). The multivariate logistic regression analysis showed that TTE-LAWV < 8.7 cm/s was an independent predictor of LAA thrombus formation (odds ratio, 9.473; 95% confidence interval, 1.172-76.55; P < .05).
TTE-LAWV can noninvasively evaluate LAA dysfunction and assist in the detection of LAA thrombus.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 03/2010; 23(5):545-552.e1. · 2.98 Impact Factor
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Takeshi Niizeki,
Yasuchika Takeishi,
Tetsu Watanabe,
Joji Nitobe, Takehiko Miyashita,
Takuya Miyamoto,
Tatsuro Kitahara,
Satoshi Suzuki,
Toshiki Sasaki,
Olga Bilim,
Mitsunori Ishino,
Isao Kubota
[show abstract]
[hide abstract]
ABSTRACT: Heat shock protein (HSP) 60 is induced by a variety of stressors, including oxidative stress and inflammation, and it plays a protective role against stress-induced cardiomyocyte injury. Recently, it has been reported that HSP 60 exists in the circulation. Chronic heart failure (CHF) is characterized by systemic abnormalities, and the myocardium is exposed to various stressors. However, the clinical significance of serum HSP 60 has not been examined in CHF. Therefore, the purpose of this study was to examine whether HSP 60 is correlated with the severity of CHF and whether HSP 60 can predict clinical outcomes in patients with CHF. Serum HSP 60 levels were measured in 112 patients with CHF and 62 control subjects. Serum HSP 60 levels were higher in patients with CHF than in control subjects and increased with advancing New York Heart Association functional class. There were 37 cardiac events during a mean follow-up period of 569 +/- 476 days (range 17 to 1,986). Serum HSP 60 levels were higher in patients with cardiac events than in event-free patients. Patients were divided into 4 groups on the basis of HSP 60 level. Cox proportional-hazards regression analysis and Kaplan-Meier analysis revealed that the fourth quartile was associated with the greatest risk for cardiac events. In conclusion, serum HSP 60 level was related to the severity of CHF and associated with a high risk for adverse cardiac events in patients CHF.
The American Journal of Cardiology 10/2008; 102(5):606-10. · 3.37 Impact Factor
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Mitsunori Ishino,
Yasuchika Takeishi,
Takeshi Niizeki,
Tetsu Watanabe,
Joji Nitobe,
Takuya Miyamoto, Takehiko Miyashita,
Tatsuro Kitahara,
Satoshi Suzuki,
Toshiki Sasaki,
Olga Bilim,
Isao Kubota
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ABSTRACT: B-type natriuretic peptide (BNP), heart-type fatty acid-binding protein (H-FABP), and pentraxin 3 (PTX3) each predict adverse cardiac events in chronic heart failure (CHF) patients. For prognostic evaluation from different aspects, the utility of combined measurement of the 3 biomarkers in patients with CHF was examined in the present study.
Levels of BNP (associated with left ventricular dysfunction, positive if >200 pg/ml), H-FABP (marker of myocardial damage, positive if >4.1 ng/ml), and PTX3 (marker of inflammation, positive if >4.0 ng/ml) were measured in 164 consecutive CHF patients, and patients were prospectively followed with endpoints of cardiac death or rehospitalization. When patients were categorized on the basis of the number of elevated biomarkers, patients with 1, 2, and 3 elevated biomarkers had a 5.4-fold (not significant), 11.2-old (p<0.05), and 34.6-fold increase (p<0.01), respectively, in the risk of adverse cardiac events compared with those without elevated biomarkers. Kaplan-Meier analysis revealed that patients with 3 elevated biomarkers had a significantly higher cardiac event rate than patients with a lower number of elevated biomarkers.
The combination of these 3 biomarkers could reliably risk-stratify CHF patients for prediction of cardiac events.
Circulation Journal 10/2008; 72(11):1800-5. · 3.77 Impact Factor
