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European Heart Journal 03/2013; · 10.48 Impact Factor
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ABSTRACT: Contrast media affects renal function, especially in the patients with advanced chronic kidney disease (CKD). The aim of this study was to investigate the characteristics of contrast induced exacerbation of renal dysfunction in the patients with advanced CKD (estimated glomerular filtration rate <30 ml/min/1.73 m(2)). We enrolled 102 advanced CKD patients who underwent cardiac catheterization. Delta creatinine (post-catheterization creatinine minus pre-catheterization creatinine) were calculated. The patients were divided into three groups according to delta creatinine. The highest tertile of the delta creatinine was defined as the exacerbation group. Multivariate logistic regression analyses were performed to find the characteristics of the exacerbation group. Anemia (odds ratio (OR): 15.53, 95 % Confidence Interval (95 %CI): 1.81-133.27, p = 0.01) and proteinuria (OR: 5.91, 95 %CI: 1.64-21.28, p < 0.01) were significant characteristics of the exacerbation group after adjusting confounding factors. In conclusion, anemia and proteinuria were associated with contrast induced exacerbation of renal dysfunction in the advanced CKD patients.
Cardiovascular intervention and therapeutics. 11/2012;
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ABSTRACT: Left ventricular apical aneurysm (LVAA) is a serious complication of acute anterior myocardial infarction (MI). The purpose of our study was to investigate the clinical features of LVAA in the primary PCI era. A total of 161 acute anterior MI patients who had primary PCI and had an echocardiogram on chronic phase were included. The development of LVAA was reviewed on chronic phase. Univariate and multivariate logistic regression analyses were performed to identify the predictors of LVAA. Primary stenting was performed in 160 patients (99.4 %). Procedural success was obtained in all patients with a final TIMI flow grade 3 obtained in 142 patients (88.2 %). LVAA developed in the chronic phase in 29 patients (18.0 %). Multivariate logistic regression analysis revealed that peak CK (500 mU/ml increase; OR 1.24, 95 % CI 1.09-1.41, p = 0.001), heart rate at discharge (5/min increase; OR 1.39, 95 % CI 1.03-1.87, p = 0.03), final TIMI flow grade ≤2 (vs. TIMI 3; OR 6.95, 95 % CI 1.70-28.36, p = 0.01) and final myocardial brush grade (MBG) ≤2 (vs. MBG 3; OR 4.33, 95 % CI 1.06-17.66, p = 0.04) were significantly associated with the development of LVAA. The initial TIMI flow grade or the grade of collateral flow was not associated with LVAA. In conclusion, peak CK, heart rate, and final TIMI flow grade or final MBG ≤2 were significantly associated with the development of LVAA. Achieving a TIMI flow grade 3 by primary PCI may be important for preventing LVAA.
Heart and Vessels 10/2012; · 2.05 Impact Factor
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Harue Sasai,
Kenichi Sakakura,
Koichi Yuri,
Hiroshi Wada,
Kenshiro Arao,
Hiroshi Funayama, Yoshitaka Sugawara,
Atsushi Yamaguchi,
Hideo Adachi,
Shin-Ichi Momomura,
Junya Ako
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ABSTRACT: Fractional flow reserve (FFR) is considered as the gold standard for physiological assessment of coronary artery stenosis. However, it may be difficult to interpret FFR for the stenosis of the donor artery of chronic total occlusion (CTO), because revascularization of CTO may improve FFR of the donor artery. We present a case of 32-year-old male who had a CTO in right coronary artery (RCA), 90 % stenoses in left circumflex artery (LCx) and a mild stenosis in the middle segment of left anterior descending artery (LAD). FFR for the mild stenosis in LAD showed significant value (0.72). However LAD was the donor artery to CTO of RCA, revascularization to RCA was expected to improve FFR for LAD. As the patient had chronic granulocytic leukemia and the difficulty in continuing dual antiplatelet therapy, we selected coronary artery bypass grafting (CABG) to RCA and LCx, and we decided not to perform anastomosis to LAD. Although each graft was patent and collateral flow from LAD to RCA disappeared after CABG, FFR for LAD was still 0.72. Careful consideration should be given when interpreting FFR for the donor artery to a CTO lesion. When CABG is selected, it may be a practical approach to revascularize not only CTO but also FFR positive mild stenosis simultaneously, even though it appears angiographically mild stenosis.
Cardiovascular intervention and therapeutics. 10/2012;
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ABSTRACT: Background: Various factors associated with worsening heart failure (HF) events have been investigated in HF subjects. The purpose of this study was to identify the predictive factor(s) for worsening HF events after cardiac resynchronization therapy (CRT) among baseline parameters, as well as baseline factors associated with responsiveness or non-responsiveness to CRT. Methods and Results: Seventy-seven HF patients with an indication for CRT were enrolled. Baseline parameters of blood chemistry, electrocardiogram, echocardiogram and cardiac catheterization before device implantation were measured, and subsequent clinical HF events after CRT were investigated. During the follow-up period (median 601 days), 22 of 77 (29%) recipients had HF events (unscheduled HF hospitalization: 16; use of left ventricular assist system: 1; heart transplantation: 1; cardiac death: 4). In the multivariate Cox proportional hazards model, low serum sodium concentration was associated with the occurrence of HF events after CRT (hazard ratio 0.82, 95% confidence interval 0.68-0.99, P=0.034). At baseline, serum sodium concentration negatively correlated with pulmonary capillary wedge pressure (r=-0.71, P<0.001) and with plasma arginine vasopressin level (r=-0.68, P=0.008). Conclusions: Hyponatremia is an independent predictor for worsening HF events after CRT implantation, which may be partly explained by elevated level of plasma arginine vasopressin.
Circulation Journal 09/2012; · 3.77 Impact Factor
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ABSTRACT: Temporary vena cava filters have been used for protection from potentially fatal pulmonary embolism. However, recent reports suggested that they may be associated with serious adverse complications including filter-related thrombosis. The purpose of this study was to examine the clinical complications of temporary vena cava filter placement.
We enrolled 40 consecutive patients from January 2006 to December 2010 who underwent percutaneous temporary vena cava filter insertion in Saitama Medical Center, Jichi Medical University.
Major filter complications related to temporary vena cava filters were filter thrombosis in 4 patients (10.2%), filter dislocation in 4 (10.2%), and catheter-related infection in 3 (7.7%). Massive pulmonary embolism and cardiogenic shock was observed in one case (2.5%) at the time of retraction.
Temporary filter placement was associated with a high incidence of device-related complications. The benefit of temporary filter placement should be judiciously weighed against the risk of complications.
Journal of Cardiology 06/2012; 60(4):306-9. · 1.28 Impact Factor
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ABSTRACT: Peri-stent contrast staining (PSS) is an abnormal angiographic finding following drug-eluting stent implantation which suggests the presence of a space outside the stent struts. PSS has been reported to be associated with very late stent thrombosis (VLST). The aims of this study were to compare the occurrence rate of late acquired PSS between sirolimus-eluting stent (SES) and everolimus-eluting stent (EES) implantation, and to identify clinical characteristics as-sociated with PSS. The percutaneous coronary intervention (PCI) database of our hospital was queried to identify pa-tients meeting the following criteria: (i) patients who received SES or EES in de novo coronary artery lesions; and (ii) patients who had angiographic follow-up between 3 and 15 months after stent implantation. There were 221 patients with 249 lesions treated with SES, and 173 patients with 212 lesions treated with EES. The occurrence of PSS was eval-uated and compared between SES and EES implantation on a patient and lesion basis. The occurrence rate of late ac-quired PSS with EES was lower than that with SES. (On a patient basis; 1.2% versus 4.5%, P = 0.045, on a lesion basis; 0.9% versus 4.0%, P = 0.043). Among the clinical characteristics, chronic total occlusion (CTO) lesions were associated with PSS. The occurrence of late acquired PSS in EES was lower than that in SES. In conclusion, the occurrence rate of late acquired PSS with EES was lower than that with SES, however, it remains to be determined whether this difference translates to the difference in the rate of VLST. (Int Heart J 2012; 53: 165-169)
International Heart Journal 05/2012; 53(3):165-169. · 1.16 Impact Factor
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ABSTRACT: Peri-stent contrast staining (PSS) is an abnormal angiographic finding following drug-eluting stent implantation which suggests the presence of a space outside the stent struts. PSS has been reported to be associated with very late stent thrombosis (VLST). The aims of this study were to compare the occurrence rate of late acquired PSS between sirolimus-eluting stent (SES) and everolimus-eluting stent (EES) implantation, and to identify clinical characteristics as-sociated with PSS. The percutaneous coronary intervention (PCI) database of our hospital was queried to identify pa-tients meeting the following criteria: (i) patients who received SES or EES in de novo coronary artery lesions; and (ii) patients who had angiographic follow-up between 3 and 15 months after stent implantation. There were 221 patients with 249 lesions treated with SES, and 173 patients with 212 lesions treated with EES. The occurrence of PSS was eval-uated and compared between SES and EES implantation on a patient and lesion basis. The occurrence rate of late ac-quired PSS with EES was lower than that with SES. (On a patient basis; 1.2% versus 4.5%, P = 0.045, on a lesion basis; 0.9% versus 4.0%, P = 0.043). Among the clinical characteristics, chronic total occlusion (CTO) lesions were associated with PSS. The occurrence of late acquired PSS in EES was lower than that in SES. In conclusion, the occurrence rate of late acquired PSS with EES was lower than that with SES, however, it remains to be determined whether this difference translates to the difference in the rate of VLST. (Int Heart J 2012; 53: 165-169)
Circulation 03/2012; · 14.74 Impact Factor
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ABSTRACT: Little has been known about clinical features and prognosis of very old patients with heart failure with preserved ejection fraction (HFPEF). The aim of this study was to compare clinical features and clinical outcomes between HFPEF and heart failure with reduced ejection fraction (HFREF) in patients older than 80 years.
We enrolled a total of 113 patients over 80 years old, who were admitted for heart failure between 2006 and 2009. We retrospectively analyzed the clinical features including laboratory data and echocardiography parameters.
In 53 patients (49%) left ventricular ejection fraction was preserved. The clinical characteristics and treatment between HFPEF and HFREF showed that anemia was one of the risk factors for HFPEF, and the long-term outcomes of HFPEF in this population were not different from that of HFREF.
These results suggest that anemia is one of the important risk factors for HFPEF in the very elderly.
Journal of Cardiology 03/2012; 59(2):215-9. · 1.28 Impact Factor
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01/2012; 5(1):112-3. · 1.07 Impact Factor
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ABSTRACT: Rotational atherectomy (RA) can facilitate smooth stent delivery and stent expansion through lesion modification for a calcified coronary lesion. Several studies reported that sirolimus-eluting stent (SES) implantation following RA showed a lower rate of revascularization compared with bare-metal stents (BMS). However, there are limited data that compared the clinical outcomes between SES and paclitaxel-eluting stents (PES) after RA. We compared the long-term clinical outcomes of SES and PES following RA. Two hundred and thirty-three consecutive patients (SES n = 179, PES n = 54) who were treated with SES or PES following RA between 10<sup>th</sup> September 2004 and 13<sup>th</sup> April 2010 were investigated. Follow-up data for clinical outcomes were obtained in 91.4% of all subjects. The median follow-up period was 630 days (interquartile range, 300 to 1170 days) in the SES group, and 625 days (interquartile range, 285 to 900 days) in the PES group. Clinical outcomes including target lesion revascularization (TLR) (SES 4.9% versus PES 9.8%, P = 0.31), target vessel revascularization (TVR) (SES 6.8% versus PES 11.8%, P = 0.25), and major adverse cardiac events (MACE) (SES 14.8% versus PES 13.7%, P = 0.8) were not statistically different between the groups. The unadjusted cumulative event rates estimated by the Kaplan-Meier method and the log-rank test showed no significant differences between the two groups for time to event for TLR, cardiovascular death, all-cause death, or MACE. In conclusion, there was no significant difference in the long-term clinical outcomes between SES and PES following RA.
International Heart Journal 01/2012; 53(3):149-53. · 1.16 Impact Factor
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ABSTRACT: Drug-eluting stents (DES) have proven to be effective for reducing the rate of restenosis, whereas stent thrombosis (ST) after DES implantation has raised safety concerns. Everolimus-eluting stents (EES) are a new generation of DES that have demonstrated safety and efficacy compared with first-generation DES. However, the use of EES in patients presenting with acute coronary syndrome (ACS) has not been adequately investigated. We compared the clinical outcomes between the ACS and non-ACS groups treated with EES. A total of 335 consecutive patients who received EES implantation between January 2010 and January 2011 were investigated (ACS; n = 172, non-ACS; n = 163). Clinical outcome data were obtained for 94.3% of the patients. Follow-up angiography was performed in 58.5% of all patients. The median follow-up period was 8 months in both groups. Clinical outcomes were not statistically different between the groups. The rate of target lesion revascularization (TLR) was 2.5% in the ACS group and 3.8% in the non-ACS group (P = 0.37). MACE occurred in 8.2% of the ACS group and 10.2% of the non-ACS group (P = 0.54). A definite ST was identified in one patient in each group (P = 0.75). The unadjusted cumulative event rates estimated by the Kaplan-Meier method and the log-rank test showed no significant difference between the groups for TLR, target vessel revascularization (TVR), all-cause death, or MACE. In conclusion, EES was safe and efficacious for patients presenting with ACS, as well as for those with non-ACS during a mid-term follow-up period.
International Heart Journal 01/2012; 53(4):215-20. · 1.16 Impact Factor
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ABSTRACT: Peri-stent contrast staining (PSS) is an abnormal angiographic finding following drug-eluting stent implantation which suggests the presence of a space outside the stent struts. PSS has been reported to be associated with very late stent thrombosis (VLST). The aims of this study were to compare the occurrence rate of late acquired PSS between sirolimus-eluting stent (SES) and everolimus-eluting stent (EES) implantation, and to identify clinical characteristics associated with PSS. The percutaneous coronary intervention (PCI) database of our hospital was queried to identify patients meeting the following criteria: (i) patients who received SES or EES in de novo coronary artery lesions; and (ii) patients who had angiographic follow-up between 3 and 15 months after stent implantation. There were 221 patients with 249 lesions treated with SES, and 173 patients with 212 lesions treated with EES. The occurrence of PSS was evaluated and compared between SES and EES implantation on a patient and lesion basis. The occurrence rate of late acquired PSS with EES was lower than that with SES. (On a patient basis; 1.2% versus 4.5%, P = 0.045, on a lesion basis; 0.9% versus 4.0%, P = 0.043). Among the clinical characteristics, chronic total occlusion (CTO) lesions were associated with PSS. The occurrence of late acquired PSS in EES was lower than that in SES. In conclusion, the occurrence rate of late acquired PSS with EES was lower than that with SES, however, it remains to be determined whether this difference translates to the difference in the rate of VLST.
International Heart Journal 01/2012; 53(3):165-9. · 1.16 Impact Factor
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ABSTRACT: Transradial percutaneous coronary intervention (PCI), which is less invasive than transfemoral PCI, may facilitate early rehabilitation of patients with acute myocardial infarction (AMI). The aim of our study was to investigate whether transradial PCI is associated with a shorter coronary care unit (CCU) stay in very elderly AMI patients (≥ 80 years old). We enrolled 116 AMI patients aged ≥ 80 years. There were 39 patients in the transradial group and 77 patients in the non-transradial group. The length of CCU stay, the length of hospital stay, in-hospital mortality, the day of the monitored sitting and standing test, and the occurrence of delirium were compared between the two groups. The duration of CCU stay in the transradial and non-transradial groups was 3.6 ± 1.5 days and 5.0 ± 3.2 days, respectively (P = 0.001). The duration of hospital stay in the transradial and non-transradial groups was 13.3 ± 7.4 days and 19.2 ± 11.1 days, respectively (P = 0.001). In-hospital mortality was not different between the two groups (7.7% versus 2.6%, P = 0.20). The day of the monitored standing test in the transradial and non-transradial groups was 3.2 ± 0.7 and 4.6 ± 2.3, respectively (P < 0.0001). Multivariate logistic regression analysis identified a transradial approach as an independent predictor of short (≤ 3 days) CCU stay (OR: 3.01, 95%CI: 1.16-7.83, P = 0.02). In conclusion, transradial PCI was associated with a shorter CCU stay in AMI patients ≥ 80 years old. Furthermore, transradial PCI facilitated early rehabilitation in this high risk population.
International Heart Journal 01/2012; 53(2):79-84. · 1.16 Impact Factor
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ABSTRACT: Fulminant myocarditis is a rapidly progressive, life-threatening disease with severe impairment of systolic left ventricle function in the acute phase. However, the long-term prognosis of patients who survive the acute phase with percutaneous extracorporeal cardiopulmonary support (PCPS) is not established. The purpose of this study was to elucidate the long-term follow-up on chronic cardiac function and long-term outcome. Twenty consecutive patients with fulminant myocarditis in the acute phase supported by PCPS were enrolled between January 1995 and March 2010. Echocardiography was performed at least three times; acute phase (within 3 days from onset), predischarge (days 3-30), and chronic phase (>6 months, 2.67 ± 2.19 years, mean ± SD). The clinical events were queried by their medical record and questionnaires. Eight patients (40%) died in the acute phase. The time course of ejection fraction (%) by echocardiography was 22.7 ± 9.8, 53.1 ± 7.2, and 57.2 ± 9.6 in acute, predischarge, and chronic phase, respectively. Diastolic dimension (mm) was 46.8 ± 7.4, 51.3 ± 2.9, and 50.4 ± 1.8, and systolic dimension (mm) was 41.4 ± 7.7, 36.8 ± 4.0, and 35.2 ± 3.3 in acute, predischarge, and chronic phase, respectively. There was no recurrence or admission related to heart failure during the follow-up period. The cardiac function of patients with fulminant myocarditis recovers rapidly during their stay in hospital. The cardiac function of predischarge patients remains unchanged in the chronic phase. The long-term survival of fulminant myocarditis appears favorable in the chronic phase.
Heart and Vessels 12/2011; · 2.05 Impact Factor
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ABSTRACT: Hemodialysis (HD) is an important risk factor for progression of aortic valve stenosis (AS). However, there are varying degrees of disease progression among patients with AS on HD. The aim of this study was to find determinants of rapid progression of AS in patients on HD.
We enrolled 30 patients with AS on HD with a mean follow-up period of 4 years. The peak pressure gradient (PPG) between the initial echocardiography and the last echocardiography at least 3 months interval (ΔPPG) was adopted as the indicator of AS progression. We divided the patients into two groups according to ΔPPG per year [rapid progression (ΔPPG>4.5 mmHg/year), slow progression (ΔPPG<4.5 mmHg/year)] and compared the clinical characteristics between the two groups.
Overall mean ΔPPG was 4.5 mmHg/year. Systolic blood pressure (SBP), serum calcium, and calcium-phosphate product were significantly higher in rapid progression group compared with slow progression group (p<0.05).
High systolic blood pressure, serum calcium, and calcium-phosphate product were associated with rapid progression of AS in patients on chronic HD.
Journal of Cardiology 11/2011; 59(1):78-83. · 1.28 Impact Factor
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Circulation 10/2011; 124(14):e369-70. · 14.74 Impact Factor
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ABSTRACT: Ventricular septal perforation (VSP) is a serious complication associated with acute myocardial infarction (MI). The purpose of this study was to investigate the determinants of in-hospital death in patients with postinfarction VSP. Between January 1990 and April 2010, we identified 37 patients from our hospital records. Univariate analysis and multivariate logistic regression analysis were performed to find the determinants of in-hospital death. In-hospital mortality was 35% (13/37 patients). History of hypertension (P = 0.03), percutaneous coronary intervention (P = 0.04), and preoperative percutaneous cardiopulmonary support (P = 0.04) were associated with in-hospital death, whereas history of hyperlipidemia was associated with in-hospital survival. The interval from MI to VSP in survivors was significantly longer than that in nonsurvivors (P < 0.01). In multivariate logistic regression analysis, a shorter interval from MI to VSP (odds ratio 0.57, 95% confidence interval 0.34-0.95, P = 0.03) was found to be an independent predictor of in-hospital death. In conclusion, in-hospital mortality was high in patients with postinfarction VSP. A shorter interval from MI to VSP was a significant independent predictor of in-hospital death.
Heart and Vessels 08/2011; 27(5):475-9. · 2.05 Impact Factor
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ABSTRACT: Acute renal insufficiency after percutaneous coronary artery intervention (PCI) is a strong predictor of adverse events. However, the effect of chronic renal impairment on the long-term outcomes after PCI has not been well established. The aim of this study was to evaluate the incidence of deteriorated renal function during the chronic phase after PCI and its impact on clinical outcomes. We enrolled 282 consecutive patients who underwent PCI and had serum creatinine measured during the chronic phase (at least 3 months after PCI). We divided the study population into two groups: an advanced group that had an increase in stage of chronic kidney disease during the chronic phase, and a preserved group that included the remainder of the study population. There were 43 patients in the advanced group. We evaluated the incidence of major adverse cardiac events (MACE) that included all-cause death, nonfatal myocardial infarction, and rehospitalization with heart failure or angina pectoris. The rate of rehospitalization for heart failure and angina pectoris was significantly higher in the advanced group than in the preserved group (19.0% vs 6.8%, P < 0.01). In multivariate Cox regression analysis, the advanced group was associated with MACE (hazard ratio 3.50, 95% confidence interval 1.49-8.22, P < 0.01). Deterioration of renal function during long-term follow-up after percutaneous coronary intervention was associated with adverse cardiac events.
Heart and Vessels 08/2011; 27(5):460-7. · 2.05 Impact Factor
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ABSTRACT: Clinical importance of hyponatremia in ST-elevation acute myocardial infarction (STEMI) in the era of primary intervention has not been fully understood. The aim of this study was to investigate the impact of hyponatremia on outcomes in patients with STEMI and secondarily to investigate the contribution of arginine vasopressin (AVP) to hyponatremia in STEMI.
Hyponatremia was defined as a sodium concentration <136 mmol/L at 72h after hospitalization. First, the short-term (in-hospital mortality or congestive heart failure (CHF)) and long-term prognosis (cardiac death, re-admission for CHF) in STEMI patients was conducted. Second, the relationship between serum sodium level and plasma AVP was investigated. In hyponatremic patients the incidence of in-hospital heart failure was significantly greater (P=0.0018), long-term cardiac death was a higher trend (17.2% vs. 6.3%, P=0.19) and re-admission due to CHF was significantly more frequent (20.7% vs. 4.5%, P=0.0024). Plasma AVP level was higher in the hyponatremia group (4.5 vs. 2.7 pg/ml, P=0.003), and it had a negative correlation with serum sodium level (r=-0.28, P=0.02).
Hyponatremia was frequently found in the early phase of STEMI, and associated with heart failure in both short- and long-term outcomes. Non-osmotic secretion of AVP could be involved in hyponatremia in STEMI patients.
Circulation Journal 05/2011; 75(8):1927-33. · 3.77 Impact Factor
