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Abstract
The prognosis after out-of-hospital cardiac arrest (OHCA) has improved in the past few decades because of advances in interventions used outside and in hospital. About half of patients who have OHCA with initial ventricular tachycardia or ventricular fibrillation and who are admitted to hospital in coma after return of spontaneous circulation will survive to discharge with a reasonable neurological status. In this Series paper we discuss in-hospital management of patients with post-cardiac-arrest syndrome. In most patients, the most important in-hospital interventions other than routine intensive care are continuous active treatment (in non-comatose and comatose patients and including circulatory support in selected patients), cooling of core temperature to 32-36°C by targeted temperature management for at least 24 h, immediate coronary angiography with or without percutaneous coronary intervention, and delay of final prognosis until at least 72 h after OHCA. Prognosis should be based on clinical observations and multimodal testing, with focus on no residual sedation.
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Isogai T, Yoshikawa T, Ueda T, Yamaguchi T, Imori Y, Maekawa Y, Sakata K, Murakami T, Mochizuki H, Arao K, Kimura A, Nagao K, Yamamoto T, Takayama M. Apical Takotsubo syndrome versus anterior acute myocardial infarction: findings from the Tokyo Cardiovascular Care Unit network registry. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018. [DOI: 10.1177/2048872618762638] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Although the typical apical form of Takotsubo syndrome and anterior acute myocardial infarction have similar electrocardiographic and echocardiographic presentations, data on the clinical differences between the two disorders are limited. Methods: Using the Tokyo Cardiovascular Care Unit network registry, we identified patients hospitalised with apical Takotsubo syndrome ( n=540; 2010–2014) or anterior acute myocardial infarction ( n=2,806; 2013–2014) and created 522 age and sex-matched pairs (mean age 74.1 years; women 78.5%). We compared the clinical characteristics and inhospital outcomes between the two groups. Results: On admission, patients with apical Takotsubo syndrome showed a lower body mass index, less frequent chest pain/tightness, lower systolic blood pressure, higher heart rate, lower creatine kinase, higher C-reactive protein and brain natriuretic peptide, and less frequent ST-elevation than patients with anterior acute myocardial infarction. Patients with apical Takotsubo syndrome received catecholamine (12.8% vs. 24.5%, P<0.001) and intra-aortic balloon pumping (5.9% vs. 15.1%, P<0.001) less frequently. Despite similar all-cause mortality (5.4% vs. 7.9%, P=0.134), patients with apical Takotsubo syndrome showed lower cardiac mortality (2.1% vs. 6.7%, P<0.001; risk difference −4.6% (95% confidence interval −7.1% to −2.1%)) but higher non-cardiac mortality (3.3% vs. 1.1%, P=0.033; 2.1% (0.3%–3.9%)). In subgroup comparisons, patients with physically triggered Takotsubo syndrome had higher non-cardiac mortality (7.0%) than those with non-physically triggered Takotsubo syndrome (1.2%, P=0.001) or anterior acute myocardial infarction (1.1%, P<0.001). Conclusions: This study found that cardiac and non-cardiac mortality risks differed significantly between apical Takotsubo syndrome and anterior acute myocardial infarction. Our findings underscore the importance of differentiating between the two disorders for appropriate management.
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Shiraishi Y, Kohsaka S, Abe T, Harada K, Miyazaki T, Miyamoto T, Iida K, Tanimoto S, Yagawa M, Takei M, Nagatomo Y, Hosoda T, Yamamoto T, Nagao K, Takayama M. Impact of Triggering Events on Outcomes of Acute Heart Failure. Am J Med 2018; 131:156-164.e2. [PMID: 28941748 DOI: 10.1016/j.amjmed.2017.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/26/2017] [Accepted: 09/04/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The onset of acute heart failure is known to be associated with increased physical activity and other specific behaviors that can trigger hemodynamic deterioration. This analysis aimed to describe the distribution of triggers in patients hospitalized for acute heart failure, and investigate their effects on in-hospital outcomes. METHODS Consecutive patients hospitalized for acute heart failure between 2010 and 2014 were registered in a multicenter data registration system (72 institutions within Tokyo, Japan). Baseline demographics and in-hospital mortality were extracted from 17,473 patients. Patients with a trigger were grouped based on their triggering event: those with onset during (a) physical activity; (b) sleeping; (c) eating or watching television; (d) bathing or excretion (use of restrooms); and (e) engaging in other activities. These patients were compared with patients without identifiable triggers. Multiple imputation was used for missing data. RESULTS Patients were predominantly men (57.1%), with a mean age of 76.0 ± 13.0 years; a triggering event was present in 49.1%. No significant difference in baseline characteristics was noted between groups except for younger age, higher blood pressure, and prevalence of signs of congestion in the trigger-positive group. In-hospital mortality rate was 7.9%. Presence of triggers was positively associated with a reduced risk of in-hospital mortality (adjusted odds ratio 0.79; 95% confidence interval, 0.70-0.90; P = .0003). In a delta-adjusted pattern mixture model, the effect of a triggering event on in-hospital mortality remained consistently significant. CONCLUSION Triggering events for acute heart failure can provide additional information for risk prediction. Efforts to identify the triggers should be made to classify patients according to risk group.
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Nagao K, Okawa M, Iwai H, Tai T, Tanaka N, Kobayashi H, Nakajima K. 151 Use of Autologous Dermal Tissue Preserves Sexual Function after Pelvic Organ Prolapse Surgery. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2017.11.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kinoshita-Ise M, Ouchi T, Izumi E, Kawaguchi O, Nagao K, Amagai M, Funakoshi T. Combination of low-dose total skin electron beam therapy and subsequent localized skin electron beam therapy as a therapeutic option for advanced-stage mycosis fungoides. Clin Exp Dermatol 2017; 43:437-440. [PMID: 29266332 DOI: 10.1111/ced.13347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 11/28/2022]
Abstract
Electron beam therapy (EBT) is an established treatment for mycosis fungoides (MF), but evidence for the use of EBT in advanced cutaneous conditions is limited, and optimal scheduling of the regimen for such conditions remains unclear. We report the case of a 44-year-old woman diagnosed with MF with widespread cutaneous lesions, including multiple huge tumours in the craniofacial area. Low-dose total skin (TS)EBT and subsequent localized skin (LS)EBT achieved striking improvements in eruptions. Oral etretinate was also administered during therapy. Our experience implies that combined TSEBT and LSEBT may be worth attempting when a patient presents with both widespread lesions and prominent tumours, even when the tumours are extremely large.
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Komiyama K, Nakamura M, Tanabe K, Niikura H, Fujimoto H, Oikawa K, Daida H, Yamamoto T, Nagao K, Takayama M. In-hospital mortality analysis of Japanese patients with acute coronary syndrome using the Tokyo CCU Network database: Applicability of the GRACE risk score. J Cardiol 2017; 71:251-258. [PMID: 29102289 DOI: 10.1016/j.jjcc.2017.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/23/2017] [Accepted: 09/12/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The GRACE risk score was developed to predict in-hospital mortality for acute coronary syndrome (ACS) using multinational registries, but did not include Japanese data. Therefore, GRACE risk scores are not extensively used in Japan. The present study aimed to evaluate the relationship between the GRACE risk score and in-hospital mortality among Japanese patients with ACS using the Tokyo CCU (cardiovascular care unit) Network Database. METHODS AND RESULTS A total of 9460 patients with ACS hospitalized at 67 Tokyo CCUs between January 2011 and December 2013 were retrospectively reviewed and GRACE risk scores were calculated. Patients in the Tokyo CCU Network database had more severe conditions compared to those of the original GRACE study. There was a strong correlation between the GRACE risk score and in-hospital mortality for patients with ST-segment elevation myocardial infarction (STEMI) or non ST-segment elevation myocardial infarction (NSTEMI) (r=0.99, p<0.001); however, the correlation was not significant for patients with unstable angina (r=0.35, p=0.126). For STEMI+NSTEMI patients, the discrimination ability of the GRACE risk score was excellent, with a c statistic of 0.87 (95% confidence interval, 0.86-0.89). CONCLUSIONS The GRACE risk score is a good predictor of in-hospital mortality for Japanese patients with STEMI or NSTEMI, and can help clinicians stratify patients by risk for optimal patient triage and early treatment management.
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Hayashida K, Tagami T, Fukuda T, Suzuki M, Yonemoto N, Kondo Y, Ogasawara T, Sakurai A, Tahara Y, Nagao K, Yaguchi A, Morimura N. Mechanical Cardiopulmonary Resuscitation and Hospital Survival Among Adult Patients With Nontraumatic Out-of-Hospital Cardiac Arrest Attending the Emergency Department: A Prospective, Multicenter, Observational Study in Japan (SOS-KANTO [Survey of Survivors after Out-of-Hospital Cardiac Arrest in Kanto Area] 2012 Study). J Am Heart Assoc 2017; 6:JAHA.117.007420. [PMID: 29089341 PMCID: PMC5721797 DOI: 10.1161/jaha.117.007420] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Mechanical cardiopulmonary resuscitation (mCPR) for patients with out‐of‐hospital cardiac arrest attending the emergency department has become more widespread in Japan. The objective of this study is to determine the association between the mCPR in the emergency department and clinical outcomes. Methods and Results In a prospective, multicenter, observational study, adult patients with out‐of‐hospital cardiac arrest with sustained circulatory arrest on hospital arrival were identified. The primary outcome was survival to hospital discharge. The secondary outcomes included a return of spontaneous circulation and successful hospital admission. Multivariate analyses adjusted for potential confounders and within‐institution clustering effects using a generalized estimation equation were used to analyze the association of the mCPR with outcomes. Between January 1, 2012 and March 31, 2013, 6537 patients with out‐of‐hospital cardiac arrest were eligible; this included 5619 patients (86.0%) in the manual CPR group and 918 patients (14.0%) in the mCPR group. Of those patients, 28.1% (1801/6419) showed return of spontaneous circulation in the emergency department, 20.4% (1175/5754) had hospital admission, 2.6% (168/6504) survived to hospital discharge, and 1.2% (75/6419) showed a favorable neurological outcome at 1 month after admission. Multivariate analyses revealed that mCPR was associated with a decreased likelihood of survival to hospital discharge (adjusted odds ratio, 0.40; 95% confidence interval, 0.20–0.78; P=0.005), return of spontaneous circulation (adjusted odds ratio, 0.71; 95% confidence interval, 0.53–0.94; P=0.018), and hospital admission (adjusted odds ratio, 0.57; 95% confidence interval, 0.40–0.80; P=0.001). Conclusions After accounting for potential confounders, the mCPR in the emergency department was associated with decreased likelihoods of good clinical outcomes after adult nontraumatic out‐of‐hospital cardiac arrest. Further studies are needed to clarify circumstances in which mCPR may benefit these patients.
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Inokuchi S, Masui Y, Miura K, Tsutsumi H, Takuma K, Atsushi I, Nakano M, Tanaka H, Ikegami K, Arai T, Yaguchi A, Kitamura N, Oda S, Kobayashi K, Suda T, Ono K, Morimura N, Furuya R, Koido Y, Iwase F, Nagao K, Kanesaka S, Okada Y, Unemoto K, Sadahiro T, Iyanaga M, Muraoka A, Hayashi M, Ishimatsu S, Miyake Y, Yokokawa H, Koyama Y, Tsuchiya A, Kashiyama T, Hayashi M, Oshima K, Kiyota K, Hamabe Y, Yokota H, Hori S, Inaba S, Sakamoto T, Harada N, Kimura A, Kanai M, Otomo Y, Sugita M, Kinoshita K, Sakurai T, Kitano M, Matsuda K, Tanaka K, Yoshihara K, Yoh K, Suzuki J, Toyoda H, Mashiko K, Shimizu N, Muguruma T, Shimada T, Kobe Y, Shoko T, Nakanishi K, Shiga T, Yamamoto T, Sekine K, Izuka S. A New Rule for Terminating Resuscitation of Out-of-Hospital Cardiac Arrest Patients in Japan: A Prospective Study. J Emerg Med 2017; 53:345-352. [DOI: 10.1016/j.jemermed.2017.05.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 05/05/2017] [Accepted: 05/30/2017] [Indexed: 11/24/2022]
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Komiyama K, Tanabe K, Fujimoto H, Oikawa K, Daida H, Nakamura M, Yamamoto T, Nagao K, Takayama M. P2747Validation of clinical scoring system for predicting in-hospital mortality in non ST-segment elevation myocardial infarction; Comparison with the GRACE risk score. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kawakami S, Tahara Y, Noguchi T, Yasuda S, Kojima S, Yonemoto N, Saku K, Nonogi H, Nagao K. P2762Time to first administration of epinephrine after defibrillation and outcome in out-of-hospital cardiac arrest patients with shockable rhythm: a nationwide prospective registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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111
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Kiyotaka S, Kanazawa T, Kajitani K, Kobayashi T, Tamura A, Yukawa H, Kobayashi Y, Takahashi N, Nagao K, Nakagawa E, Ito H, Hayashi F, Inada T, Makita T, Tanaka M. P4275Incidence and predictors of radial artery stenosis after percutaneous coronary intervention using the transradial approach. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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112
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Ito H, Hayashi F, Nagao K, Takahashi N, Kobayashi Y, Kanazawa T, Yukawa H, Shimamura K, Tamura N, Kobayashi T, Kajitani K, Nakagawa E, Makita T, Inada T, Tanaka M. P4363Coronary flow reserve predicts improvement in left ventricular diastolic function after treatment in patients with impaired glucose tolerance. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Doebel T, Voisin B, Kelly M, Kobayashi T, Sohn S, Kelley M, Nagao K. 628 Heterogeneity and cytokine-dependency of macrophages in skin layers. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kobayashi T, Truong A, Shih H, Doebel T, Voisin B, Woodring T, Sohn S, Kennedy E, Jo J, Moro K, Leonard W, Kong H, Nagao K. 604 Spatial heterogeneity and functional diversity of innate lymphoid cells in the skin. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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115
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Yamagami J, Nakamura Y, Nagao K, Funakoshi T, Takahashi H, Tanikawa A, Hachiya T, Yamamoto T, Ishida-Yamamoto A, Tanaka T, Nishigori C, Ishii N, Hashimoto T, Amagai M. 053 Autoantibodies in vancomycin-induced linear IgA bullous dermatosis target type VII collagen in the presence of vancomycin. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kashiura M, Hamabe Y, Akashi A, Sakurai A, Tahara Y, Yonemoto N, Nagao K, Yaguchi A, Morimura N. Association between cardiopulmonary resuscitation duration and one-month neurological outcomes for out-of-hospital cardiac arrest: a prospective cohort study. BMC Anesthesiol 2017; 17:59. [PMID: 28431508 PMCID: PMC5401557 DOI: 10.1186/s12871-017-0351-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 04/13/2017] [Indexed: 02/06/2023] Open
Abstract
Background The duration of cardiopulmonary resuscitation (CPR) is an important factor associated with the outcomes for an out-of-hospital cardiac arrest. However, the appropriate CPR duration remains unclear considering pre- and in-hospital settings. The present study aimed to evaluate the relationship between the CPR duration (including both the pre- and in-hospital duration) and neurologically favorable outcomes 1-month after cardiac arrest. Methods Data were utilized from a prospective multi-center cohort study of out-of-hospital cardiac arrest patients transported to 67 emergency hospitals between January 2012 and March 2013 in the Kanto area of Japan. A total of 3,353 patients with out-of-hospital cardiac arrest (age ≥18 years) who underwent CPR by emergency medical service personnel and achieved the return of spontaneous circulation in a pre- or in-hospital setting were analyzed. The primary outcome was a 1-month favorable neurological outcome. Logistic regression analysis was performed to estimate the influence of cardiopulmonary resuscitation duration. The CPR duration that achieved a cumulative proportion >99% of cases with a 1-month neurologically favorable outcome was determined. Results Of the 3,353 eligible cases, pre-hospital return of spontaneous circulation was obtained in 1,692 cases (50.5%). A total of 279 (8.3%) cases had a 1-month neurologically favorable outcome. The CPR duration was significantly and inversely associated with 1-month neurologically favorable outcomes with adjustment for pre- and in-hospital confounders (adjusted odds ratio: 0.911, per minute, 95% CI: 0.892–0.929, p < 0.001). After 30 min of CPR, the probability of a 1-month neurologically favorable outcome decreased from 8.3 to 0.7%. At 45 min of CPR, the cumulative proportion for a 1-month neurologically favorable outcome reached >99%. Conclusions The CPR duration was independently and inversely associated with 1-month neurologically favorable outcomes after out-of-hospital cardiac arrest. The CPR duration required to achieve return of spontaneous circulation in >99% of out-of-hospital cardiac arrest patients with a 1-month favorable neurological outcome was 45 min, considering both pre- and in-hospital settings.
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Inaba O, Satoh Y, Isobe M, Yamamoto T, Nagao K, Takayama M. Factors and values at admission that predict a fulminant course of acute myocarditis: data from Tokyo CCU network database. Heart Vessels 2017; 32:952-959. [PMID: 28255801 DOI: 10.1007/s00380-017-0960-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 02/10/2017] [Indexed: 12/30/2022]
Abstract
Prognosis of acute myocarditis is generally benign, but fulminant cases exist which require advanced life support devices, such as percutaneous cardio-pulmonary support (PCPS) and ventricular assist devices (VAD), and lead to fatal outcomes. The purpose of this study was to identify predictors and their values at admission which might foreshadow a fulminant course of myocarditis. Data from 138 patients (mean age 42.0 years, 79 males) with a diagnosis of acute myocarditis in the Tokyo CCU Network database from 2007 to 2009 were analyzed retrospectively. Patients were divided into fulminant (in-hospital death, or PCPS or VAD requirement, N = 42) and non-fulminant groups (N = 96). Clinical data at admission were compared between them. Overall in-hospital mortality was 14.5%. On multivariate analysis, low systolic blood pressure (BPsys, odds ratio (OR)/mmHg 0.97; 95% confidence interval (CI) 0.93-1.00, p = 0.032) and electrocardiographic QRS complex prolongation (OR/10 ms 1.28; 95% CI 1.10-1.59, p = 0.0034) at admission were independent factors associated with a fulminant course. By receiver operator characteristic curve analysis, the area under the curve predicting a fulminant course was 0.769 for low BPsys and 0.821 for prolongation of QRS duration. The optimal cut-off value was 101 mmHg for BPsys (sensitivity 79.5%, specificity 68.0%), and 120 ms for QRS duration (sensitivity 72.2%, specificity 88.0%). Systolic hypotension and prolonged QRS on admission are predictors of a fulminant course of myocarditis.
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Onitsuka K, Mohri M, Ueki Y, Suwa S, Takahashi H, Hokama Y, Tanaka N, Kadokami T, Matoba T, Fukuhara R, Yagi T, Tachibana E, Yonemoto N, Nagao K. CLINICAL CHARACTERISTICS AND IN-HOSPITAL MORTALITY OF VERY ELDERLY PATIENTS WITH CARDIOVASCULAR SHOCK IN JAPAN: THE RESULTS FROM JAPANESE CIRCULATION SOCIETY SHOCK REGISTRY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33682-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ashida T, Tani S, Nagao K, Yagi T, Matsumoto N, Hirayama A. Usefulness of synthesized 18-lead electrocardiography in the diagnosis of ST-elevation myocardial infarction: A pilot study. Am J Emerg Med 2017; 35:448-457. [PMID: 27931763 DOI: 10.1016/j.ajem.2016.11.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/20/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022] Open
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Kimura Y, Kato T, Nagao K, Izumi T, Haruna T, Ueyama K. Outcomes and Radiographic Findings of Isolated Spontaneous Superior Mesenteric Artery Dissection. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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121
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Hagiwara S, Oshima K, Aoki M, Miyazaki D, Sakurai A, Tahara Y, Nagao K, Yonemoto N, Yaguchi A, Morimura N. Does the number of emergency medical technicians affect the neurological outcome of patients with out-of-hospital cardiac arrest? Am J Emerg Med 2017; 35:391-396. [DOI: 10.1016/j.ajem.2016.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022] Open
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Sonoda T, Ogita M, Matoba T, Mohri M, Tanaka N, Hokama Y, Fukutomi M, Hashiba K, Fukuhara R, Ueki Y, Matsuura H, Suwa S, Tachibana E, Yonemoto N, Nagao K. ASSOCIATION BETWEEN PRESENTATION TIME AND SHORT-TERM MORTALITY IN PATIENTS WITH CARDIOGENIC SHOCK COMPLICATING ACUTE CORONARY SYNDROME: FROM JCS SHOCK REGISTRY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Takahashi M, Ando J, Shimada K, Nishizaki Y, Tani S, Ogawa T, Yamamoto M, Nagao K, Hirayama A, Yoshimura M, Daida H, Nagai R, Komuro I. The ratio of serum n-3 to n-6 polyunsaturated fatty acids is associated with diabetes mellitus in patients with prior myocardial infarction: a multicenter cross-sectional study. BMC Cardiovasc Disord 2017; 17:41. [PMID: 28125968 PMCID: PMC5270364 DOI: 10.1186/s12872-017-0479-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 01/20/2017] [Indexed: 12/16/2022] Open
Abstract
Background In prior myocardial infarction (PMI) patients, diabetes mellitus (DM), dyslipidemia, and hypertension increase the risk of secondary cardiovascular events. Although a decreased ratio of serum eicosapentaenoic acid (EPA) to arachidonic acid (AA; EPA/AA) has been shown to significantly correlate with the onset of acute coronary syndrome, the associations between polyunsaturated fatty acid (PUFA) levels and coronary risk factors in PMI patients have not been evaluated thoroughly. This study aimed to assess the associations between PUFAs levels and the risk factors in PMI patients. Methods We enrolled 1733 patients with known PUFA levels who were treated in five divisions of cardiology in a metropolitan area of Japan, including 303 patients with PMI. EPA/AA and docosahexaenoic acid (DHA) to AA level ratio (DHA/AA) in patients with and without PMI were analyzed according to presence of coronary risk factors. Results Diabetes patients with PMI had significantly lower EPA/AA and DHA/AA than diabetes patients without PMI (EPA/AA: P <0.01; DHA/AA: P =0.003), with no such differences in dyslipidemia and hypertension patients. In DM patients with high high-sensitivity C-reactive protein (hs-CRP) levels (>0.1 mg/dL), EPA/AA was low in individuals who also had PMI, whereas DHA/AA was not (EPA/AA, with PMI: 0.43 ± 0.24; without PMI: 0.53 ± 0.30, P < 0.05). Moreover, patients on statins had significantly lower DHA/AA ratios, whereas the EPA/AA ratio did not depend on statin use. Multiple regression analysis revealed that statin use in DM patients was associated with low DHA/AA but not EPA/AA. Conclusion PMI patients with DM have low EPA/AA and DHA/AA. EPA/AA and DHA/AA are differently related to hs-CRP level in DM patients with PMI. Statin use can potentially affect DHA/AA but not EPA/AA, and therefore EPA/AA ratio is a better marker of assessment for cardiovascular events. Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0479-4) contains supplementary material, which is available to authorized users.
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Tai T, Nagao K, Ottomo T, Tamura K, Saigo R, Kobayashi H, Tanaka N, Nakajima K. 001 The Potential of Aromataze Inhibiter Therapy for Androgen Decline in the Aging Male. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yamaguchi T, Yoshikawa T, Isogai T, Miyamoto T, Maekawa Y, Ueda T, Sakata K, Murakami T, Yamamoto T, Nagao K, Takayama M. Predictive Value of QRS Duration at Admission for In-Hospital Clinical Outcome of Takotsubo Cardiomyopathy. Circ J 2017; 81:62-68. [DOI: 10.1253/circj.cj-16-0912] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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