[Show abstract][Hide abstract] ABSTRACT: Background:
Endothelial function is a prognostic predictor in patients undergoing percutaneous coronary intervention (PCI). However, in an era with widespread use of drug-eluting stents, the clinical relevance of endothelial dysfunction on restenosis in patients undergoing PCI has not been fully evaluated.
This study included 80 patients with stable angina pectoris. Flow-mediated dilation (FMD) of the brachial artery was examined 1 week after PCI. Patients were retrospectively followed-up for an average of 21 months after PCI. The primary endpoints included cardiac death, nonfatal myocardial infarction, stroke, coronary revascularization, and critical limb ischemia.
A drug-eluting stent was used in 58 patients and a cardiovascular event was recorded in 34 patients during follow-up. The incidence of all cardiovascular diseases was significantly greater in the low FMD (median FMD <4.2 %) than the high FMD (median FMD ≥4.2 %) group (60 % vs. 25 %, p <0.01). Furthermore, the incidence of coronary revascularization was significantly higher in the low than the high FMD group (p = 0.02), while the incidence of in-stent restenosis did not differ between the two groups. Cox regression analysis showed that low FMD was an independent predictor of cardiovascular events (hazard ratio: 2.77, 95 % confidence interval: 1.23 to 6.19, p = 0.01).
Impaired brachial artery FMD independently predicts long-term cardiovascular events after PCI in the era of drug-eluting stents.
[Show abstract][Hide abstract] ABSTRACT: Ambulatory measurement of intrathoracic impedance (ITI) with an implanted device may detect increases in pulmonary fluid retention early, but the clinical utility of this method is not well established. The goal of this study was to test whether conventional ITI-derived parameters can diagnose fluid retention that may cause early stage heart failure (HF).Methods and Results:HF patients implanted with high-energy devices with OptiVol (Medtronic) monitoring were enrolled in this study. Patients were monitored remotely. At both baseline and OptiVol alert, patients were assessed on standard examinations, including analysis of serum brain natriuretic peptide (BNP). From April 2010 to August 2011, 195 patients from 12 institutes were enrolled. There were 154 primary OptiVol alert events. BNP level at the alerts was not significantly different from that at baseline. Given that ITI was inversely correlated with log BNP, we added a criterion specifying that the OptiVol alert is triggered only when ITI decreases by ≥4% from baseline. This change improved the diagnostic potential of increase in BNP at OptiVol alert (sensitivity, 75%; specificity, 88%).
BNP increase could not be identified based on OptiVol alert. Decrease in ITI ≥4% compared with baseline, in addition to the alert, however, may be a useful marker for the likelihood of HF (Clinical trial info: UMIN000003351).
[Show abstract][Hide abstract] ABSTRACT: Background:
Residual risk of cardiovascular disease from increased small dense low-density lipoprotein (sdLDL)-cholesterol levels and low n-3 polyunsaturated fatty acid (PUFA) levels is a considerable therapeutic issue. The purpose of this study was to evaluate the effect of ezetimibe as an add-on to statins and supplemental eicosapentaenoic acid (EPA) on sdLDL cholesterol and absorption of EPA in patients with coronary artery disease.
The study population consisted of ten male patients who were concurrently receiving statins and EPA 1,800 mg/day. Serum lipids and PUFAs, including EPA and arachidonic acid, were measured in blood samples collected before ezetimibe (baseline), 4 weeks after starting 10-mg/day ezetimibe, and 4 weeks after discontinuing ezetimibe.
Ezetimibe significantly decreased sdLDL-cholesterol levels after 4 weeks of treatment (baseline 35 ± 13 mg/dl; treatment 27 ± 9 mg/dl), but the levels returned to baseline after discontinuation of ezetimibe (37 ± 13 mg/dl). The concentration of EPA did not significantly change during the study.
Ezetimibe shows great promise as an add-on therapy to statins to reduce sdLDL-cholesterol-related residual risk of cardiovascular disease without affecting absorption of supplemental EPA in patients with coronary artery disease.
American Journal of Cardiovascular Drugs 06/2014; 14(5). DOI:10.1007/s40256-014-0082-3 · 2.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Excess visceral adipose tissue (VAT) is closely associated with the presence of coronary artery plaques that are vulnerable to rupture. Patients with diabetes mellitus (DM) have more VAT than patients without DM, but the extent to which VAT contributes to the characteristics of coronary plaques before and after the development of DM is not fully understood.
We retrospectively evaluated 456 patients (60% male, age 64 +/- 16 years) who were suspected to have cardiovascular disease and underwent 64-slice computed tomography angiography (CTA). Seventy-one (16%) patients had vulnerable plaques (CT density < 50 Hounsfield Units, positive remodeling index > 1.05, and adjacent spotty areas of calcification).
Patients were divided into tertiles according to the VAT area. There were stepwise increases in noncalcified and vulnerable plaques with increasing tertiles of VAT area in patients without DM, but not in patients with DM. Multivariate analysis showed that a larger VAT area was significantly associated with a higher risk of vulnerable plaque in patients without DM (odds ratio 3.17, 95% confidence interval 1.08-9.31, p = 0.04), but not in patients with DM.
The VAT area is associated with the characteristics of coronary plaques on CTA in patients without DM, but not in patients with DM. VAT may be a significant cardiometabolic risk factor that is associated with plaque vulnerability before the development of DM. CTA findings may help to improve risk stratification in such patients.
[Show abstract][Hide abstract] ABSTRACT: Background: A major cause of heart failure (HF) related hospitalizations is fluid accumulation. Recent studies have suggested that intrathoracic impedance (ITI) may be a useful parameter to track daily changes in pulmonary fluid status. OptiVol alert (OA), which is a fluid status algorithm calculated from ITI, can detect impending fluid accumulation at an early stage. However, the sensitivity and specificity of OA for deteriorated HF have not been sufficient for it to be a clinically useful parameter. Therefore, we sought to examine the difference of various parameters between OA and baseline.
Objectives: The purpose of study 1 was to examine how various parameters changed in OA compared to baseline. And the purpose of study 2 was to evaluate what parameters could predict increased log BNP.
Methods: This study was a prospective multicenter study. Patients who suffered from structural heart disease and who had been implanted with a high energy device with an OptiVol feature were included in this study. The patients underwent various examinations at enrolment and following an OA. In study 1, primary endpoint was to examine how log BNP changed between OA and baseline. Secondary endpoint was to examine how other parameters changed between OA and baseline. We defined low ITI as equal or less than 96% of ITI at baseline.
Results: From 2010 to 2011, 200 patients in 12 institutes were enrolled in the present study. Mean age was 65.3 years, mean ejection fraction was 44.2% and mean log BNP was 2.2 ng/ml. We had 376 OA events and 289 periodical follow-up events. In primary endpoint of study 1, there was no significant difference in log BNP between OA and baseline. However, the change rate of ITI was negatively correlated with the change rate of log BNP (r = -0.35, p < 0.01). In 115 OA events with low ITI, log BNP was significantly higher than that at baseline (2.33 vs 2.19, p < 0.01). In secondary endpoint of study 1, there was no significant difference in body weight, cardio-thoracic ratio in chest X ray, end diastolic volume, end systolic volume and tricuspid regurgitation pressure gradient between OA and baseline. In study 2, we searched what parameters could predict increased log BNP by 0.4 compared to that at baseline. To predict increased log BNP by 0.4, the area under ROC curve for OA events with low ITI was significantly larger than that for only OA events (0.78 vs 0.62, p < 0.01).
Conclusions: There was no significant difference in log BNP between OA and baseline. However, OA events with low ITI can predict increased BNP, but only OA events.
[Show abstract][Hide abstract] ABSTRACT: Despite the use of statin therapy and achieving the target for low-density lipoprotein cholesterol, a substantial number of coronary events are not prevented, and residual risk factors remain unsettled. Recently, ezetimibe has been shown to reduce not only low-density lipoprotein cholesterol but also triglyceride (TG) levels. The aim of this study was to investigate the associations of residual risk factors, mainly hypertriglyceridemia, with endothelial function during statin therapy in patients with coronary heart disease and examine the effect of ezetimibe add-on therapy. A total of 109 consecutive patients with coronary heart disease during statin therapy were enrolled. Lipid profile was measured and endothelial function was assessed by flow-mediated dilation (FMD) of the brachial artery in a fasting state. Next, 32 patients with high TG levels (≥150 mg/dl) were prospectively assigned to the ezetimibe add-on group or the no-ezetimibe group, and endothelial function was assessed after 3 months. Multivariate linear regression analysis demonstrated that serum TG and high-density lipoprotein cholesterol levels were independent determinants of percentage FMD (β = -0.210 and 0.208, respectively, p <0.05). In patients with high TG levels, ezetimibe add-on therapy significantly improved percentage FMD (from 3.3 ± 1.1% to 4.0 ± 1.1%, p <0.005), whereas no significant change was observed in the no-ezetimibe group. Moreover, the improvement in percentage FMD was significantly associated with reduction in serum TG levels (β = -0.387, p <0.05) independent of the change in serum low-density lipoprotein cholesterol levels. In conclusion, hypertriglyceridemia is independently associated with endothelial dysfunction in patients with coronary heart disease during statin therapy. Ezetimibe add-on therapy improves endothelial function in these high-risk populations.
The American journal of cardiology 05/2011; 108(3):333-9. DOI:10.1016/j.amjcard.2011.03.049 · 3.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recent studies suggest that intrathoracic impedance may be a useful parameter to track daily changes in the pulmonary fluid status. OptiVol indexTM, which was fluid status algorism calculated from intrathoracic impedance, may detect impending fluid accumulation. However, intrathoracic impedance was likely to change in various situations, such as pneumonia, pneumothrax or hemodialysis. We experienced the patient in whom intrathoracic impedance changed along with menstrual cycle. A case was 35-year-old female implanted cardiac resynchronization therapy with defibrillator (CRTD). She was followed in out patient clinic and remote monitoring system. We received OptiVol alertTM once a month and often asked her to come to the hospital to examine if she developed to heart failure. However, she has never developed to heart failure, pneumonia or other diseases. After several OptiVol alertsTM, she noticed that the OptiVol alertTM was appeared just before menses. And intrathoracic impedance was going down 2 weeks before her menses. We could repeatedly observe that OptiVol alertTM was appeared during Premenstrual Syndrome (PMS), which was reported to cause fluid retention. In some report, volume dysregulation is caused by PMS, but is not demonstrated directly. Then, this is the first report that fluid retention in PMS was directly estimated by changing of intrathoracic impedance and OptiVol indexTM.
Journal of Arrhythmia 01/2011; 27(Supplement):PJ3_030. DOI:10.4020/jhrs.27.PJ3_030
[Show abstract][Hide abstract] ABSTRACT: Introduction: Heart failure is one of the most common causes for hospitalizations. OptiVol alert, which was fluid status algorism calculated from intrathoracic impedance, may detect impending fluid accumulation. Then, we tried to examine the relationship of OptiVol alert or intrathoracic impedance with various parameters. Methods: The patients who were implanted high energy device with OptiVol feature were included in this study. The patients were evaluated various examinations at enrolment and following an OptiVol alert. We examined how various parameters were different between baseline and OptiVol alert, and the relationships among the factors included in OptiVol alert and intrathoracic impedance were evaluated by factor analysis. Results: From April in 2010, 191 patients were eligible for the present study. In all patients, there was no significant difference in all parameters between OptiVol alert and baseline. However, in the patients with ejection fraction less than 35%, BNP value was likely to increase in OptiVol alert compared with that in baseline, but not significantly. In factor analysis, there was no parameter correlated with OptiVol alert. However, intrathoracic impedance was negatively correlated with BNP value. Conclusions: Intrathoracic impedance, but OptiVol alert, seems to represent fluid retention.
Journal of Arrhythmia 01/2011; 27(Supplement):PJ2_053. DOI:10.4020/jhrs.27.PJ2_053