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Makino K, Hashimoto G, Ide S, Hayama H, Isekame Y, Otsuka T, Iijima R, Hara H, Moroi M, Suzuki M, Nakamura M. P1480 A case of triple left ventricular aneurysms diagnosed by CT and echocardiography. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
【Background】
Left ventricular aneurysms is complication of myocardial infarction (MI) that can lead to death or serious morbidity. False aneurysm is rare complications of myocardial infarction or iatrogenic perforation and represent a contained myocardial rupture. False aneurysm does not contain all the three layers of the myocardium and is frequently lined by pericardium and mural thrombus. Definitive diagnosis is achieved by echocardiography, computed tomography (CT), angiography, or magnetic resonance imaging. Coexistence of true and false aneurysms is rare.
【Case】 A 58 years old man with a history of hypertension and MI was referred to our hospital for aneurysmectomy. During the course of prior MI, he got fever and pericardial effusion.
CT revealed that three left ventricular aneurysms were present. Also, three aneurysms were connected by narrow ducts each other. Transthoracic echocardiography (TTE) revealed that three ventricular aneurysms were connected via acceleration blood flow which swirling in the spherical aneurysm. We determined that this triple ventricular aneurysms were at high risk for rupture, so we performed surgery.
The postoperative course was good and he was discharged without any complications.
【Discussion】
False aneurysms occur after hemorrhagic dissection into an area of transmural infarction and most commonly result in free intrapericardial rupture of the heart, cardiac tamponade, and death. Rarely, if the overlying pericardium becomes adherent to the epicardium along the surface of the infarct, it can contain the rupture.
We were able to evaluate the mechanism of development with triple left ventricular aneurysms using CT and TTE. We could know about spatial comprehension of triple aneurysms using CT. False aneurysms were restricted enlargement due to stiff pericardium because of complicating Dressler syndrome. We hypothesis that aneurysms were enlarging in the direction of the base of heart in the adhered pericardium space.
We were able to evaluate the thickness of aneurysms and blood flow condition using TTE. TTE revealed that the wall of aneurysm was fragile. Multimodality imaging like TTE or cardiac CT are useful diagnostic methods in this case.
Abstract P1480 Figure. Triple aneurysms
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Hashimoto G, Ide S, Hayama H, Makino K, Otsuka T, Suzuki M, Iijima R, Hara H, Moroi M, Nakamura M. 1638 A case of capturing changes in interatrial blood flow and anatomical structure during percutaneous PFO closure with platypnea orthodeoxia syndrome using intra-cardiac echocardiography. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Platypnea–orthodeoxia syndrome (POS) is an uncommon condition characterized by positional dyspnea and hypoxemia due to intracardiac right-to-left shunting through a patent foramen ovale (PFO). The most commonly associated conditions included pneumonectomy, ascending aortic dilation, and arch surgery, as previously reported. Percutaneous closure of PFO is useful treatment for POS.
Case
A 76 year old man used home oxygen therapy because of unexplained hypoxemia. A decrease in blood oxygen saturation was observed in sitting and standing positions. The patient was diagnosed as "POS" because a shunt blood flow with PFO and atrial septal aneurysm (ASA) and eustachian valve was observed at transesophageal echocardiography. He was admitted for the purpose of percutaneous PFO closure.
He was treated with intra-cardiac echocardiography (ICE) guidance under local anesthesia because of poor lung function.
PFO closure was performed successfully with 30mm AMPLATZER Cribriform. The ICE findings prior to PFO closure showed a right-to-left shunt blood flow through the PFO in the sitting position but almost disappeared after closure. Furthermore, it was observed that the aortic artery compression was stronger in the sitting position than in the supine position with right-to-left shunt blood flow. After PFO closure, hypoxia associated with postural change improved and patient’s symptom as shortness of breath also significantly improved.
Discussion
POS is a position-dependent condition of dyspnea and hypoxemia due to right-to-left shunting. It often remains unrecognized in clinical practice, possibly because of its complex underlying pathophysiology. It is considered that the cause of POS in this patient was multiple factors such as ASA, aortic displacement, and venous valve remnant. In addition, being able to observe the change of the atrium due to compression from the aortic artery using ICE during the operation was very significant to explain the mechanism of POS.
Abstract 1638 Figure. Intra-cardiac echocardiography
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Hashimoto G, Ide S, Hayama H, Makino K, Otsuka T, Suzuki M, Iijima R, Hara H, Moroi M, Nakamura M. P1713 A case of quadricuspid aortic valve complicated with infective endocarditis diagnosed by 3D transesophageal echocardiography. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Quadricuspid aortic valve (QAV) is a rare congenital heart disease with an estimated incidence of 0.008% to 1.46%. The functional status of QAV is predominantly a pure aortic regurgitation. The extensive use of echocardiography has allowed an early and accurate diagnosis of this malformation. In many cases, the transthoracic echocardiography (TTE) is suitable for the diagnosis but, transesophageal echocardiography (TEE), especially 3-dimensional (3D) TEE, is a tool for the accurate definition of the valve anatomy.
Clinical case
A 60-year-old female underwent a head CT for intermittent headaches for one month ago. She was admitted to neurosurgery in our hospital diagnosed of subarachnoid hemorrhage. Four mm aneurysm was found on the periphery of the right middle cerebral artery on CT examination, and a cerebral aneurysm coil embolization was performed with a catheter in emergency. The possibility of infectious cerebral aneurysm was pointed out, and we examined in cardiovascular internal medicine. TTE revealed moderate aortic regurgitation. The ventricular septum exhibits sigmoid septum. A mobile mass was found near the left ventricular outflow tract in the sigmoid septum. TEE revealed a hypoplasia cusp (accessory cusp) is found between non coronary cusp and right coronary cusp. Aortic valve leaflets have become thickened and regurgitation from the central part of the cusps. 3DTEE was able to more accurately visualize that only the accessory cusp was hypoplastic, and the size of the other three leaflets appears almost the same. Similarly, vegetation on the left ventricular outflow tract were clearly revealed by 3DTEE.
Based on the above, it was diagnosed that quadricuspid aortic valve complicated with infective endocarditis (IE) with aortic valve regurgitation. After treatment with antibiotics according to IE, surgical treatment was scheduled.
Discussion
QAV is a rare congenital heart disease, and TTE is an important imaging tool for accurate diagnosis. Furthermore, TEE, especially 3DTEE, was a more appropriate diagnostic method in QAV and IE.
Abstract P1713 Figure. 3DTEE
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Yamada M, Kimura Y, Ishiyama D, Otobe Y, Suzuki M, Koyama S, Kikuchi T, Kusumi H, Arai H. Letter to the Editor: Recovery of Physical Activity among Older Japanese Adults since the First Wave of the COVID-19 Pandemic. J Nutr Health Aging 2020; 24:1036-1037. [PMID: 33155634 PMCID: PMC7597429 DOI: 10.1007/s12603-020-1466-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022]
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105
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Suzuki M, Shimamoto K, Tatsumi F, Tsuji T, Satoya N, Y. inoue, Hagiwara N. Impact of continuous positive airway pressure or oral appliance on pulse wave velocity and carotid artery atherosclerosis for the patients with obstructive sleep apnea syndrome: a prospective observational study for five years. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1027] [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: 11/16/2022]
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106
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Suzuki M, Okamoto T, Akagi Y, Sekiguchi H, Matsui K, Satoya N, Inoue Y, Hagiwara N. Impact of oral myofunctional therapy to treat the patients with moderate to severe obstructive sleep apnea. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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107
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Takaesu Y, Utsumi T, Okajima I, Shimura A, Kotorii N, Kuriyama K, Yamashita H, Suzuki M, Watanabe N, Mishima K. Psychosocial intervention for discontinuing benzodiazepine hypnotics in patients with chronic insomnia: a systematic review and meta-analysis. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1036] [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: 10/25/2022]
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108
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Kimura H, Ishikawa T, Suzuki M. A novel, orally available orexin 2 receptor-selective agonist, tak-994, ameliorates narcolepsy-like symptoms in narcolepsy mouse models. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nanba K, Omata K, Gomez-Sanchez CE, Stratakis CA, Demidowich AP, Suzuki M, Thompson LDR, Cohen DL, Luther JM, Gellert L, Vaidya A, Barletta JA, Else T, Giordano TJ, Tomlins SA, Rainey WE. Genetic Characteristics of Aldosterone-Producing Adenomas in Blacks. Hypertension 2019; 73:885-892. [PMID: 30739536 DOI: 10.1161/hypertensionaha.118.12070] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Somatic mutations have been identified in aldosterone-producing adenomas (APAs) in genes that include KCNJ5, ATP1A1, ATP2B3, and CACNA1D. Based on independent studies, there appears to be racial differences in the prevalence of somatic KCNJ5 mutations, particularly between East Asians and Europeans. Despite the high cardiovascular disease mortality of blacks, there have been no studies focusing on somatic mutations in APAs in this population. In the present study, we investigated genetic characteristics of APAs in blacks using a CYP11B2 (aldosterone synthase) immunohistochemistry-guided next-generation sequencing approach. The adrenal glands with adrenocortical adenomas from 79 black patients with primary aldosteronism were studied. Seventy-three tumors from 69 adrenal glands were confirmed to be APAs by CYP11B2 immunohistochemistry. Sixty-five of 73 APAs (89%) had somatic mutations in aldosterone-driver genes. Somatic CACNA1D mutations were the most prevalent genetic alteration (42%), followed by KCNJ5 (34%), ATP1A1 (8%), and ATP2B3 mutations (4%). CACNA1D mutations were more often observed in APAs from males than those from females (55% versus 29%, P=0.033), whereas KCNJ5 mutations were more prevalent in APAs from females compared with those from males (57% versus 13%, P<0.001). No somatic mutations in aldosterone-driver genes were identified in tumors without CYP11B2 expression. In conclusion, 89% of APAs in blacks harbor aldosterone-driving mutations, and unlike Europeans and East Asians, the most frequently mutated aldosterone-driver gene was CACNA1D. Determination of racial differences in the prevalence of aldosterone-driver gene mutations may facilitate the development of personalized medicines for patients with primary aldosteronism.
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Le Mestre J, Duparc C, Reznik Y, Bonnet-Serrano F, Touraine P, Chabre O, Young J, Suzuki M, Sibony M, Gobet F, Stratakis CA, Raverot G, Bertherat J, Lefebvre H, Louiset E. Illicit Upregulation of Serotonin Signaling Pathway in Adrenals of Patients With High Plasma or Intra-Adrenal ACTH Levels. J Clin Endocrinol Metab 2019; 104:4967-4980. [PMID: 31074783 PMCID: PMC6937520 DOI: 10.1210/jc.2019-00425] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/06/2019] [Indexed: 12/21/2022]
Abstract
CONTEXT In the human adrenal, serotonin (5-HT), released by mast cells stimulates corticosteroid secretion through activation of type 4 serotonin receptors (5-HT4R). In primary pigmented nodular adrenocortical disease cells, activation of the cAMP/protein kinase A (PKA) pathway by PRKAR1A mutations triggers upregulation of the 5-HT synthesizing enzyme tryptophan hydroxylase (TPH) and the 5-HT4, 5-HT6, and 5-HT7 receptors. Because ACTH stimulates cortisol secretion through activation of PKA, adrenocortical tissues exposed to sustained stimulation by ACTH may harbor increased expression of TPH and 5-HT4/6/7 receptors. OBJECTIVE To investigate the effects of long-term ACTH stimulation on the serotonergic pathway in adrenals of patients with high plasma or intra-adrenal ACTH levels. METHODS Adrenal tissues were obtained from patients with Cushing disease, ectopic secretion of ACTH [paraneoplastic Cushing syndrome; (paraCS)], 21-hydroxylase deficiency (21-OHD), primary bilateral macronodular adrenal hyperplasia with intra-adrenal ACTH presence, or cortisol-producing adenomas. TPH and 5-HT4/6/7 receptor expression was investigated using RT-PCR and immunochemistry in comparison with normal adrenals. Primary cultured adrenocortical cells originating from a patient with paraCS were incubated with 5-HT and 5-HTR agonists/antagonists. RESULTS TPH and/or 5-HT4/6/7 receptors were overexpressed in the different types of tissues. In paraCS cultured cells, the cortisol response to 5-HT was exaggerated compared with normal adrenal cells and the stimulatory action of 5-HT was reduced by 5-HT4R antagonist. CONCLUSION Our results indicate that prolonged activation of the cAMP/PKA pathway by ACTH induces an aberrant serotonergic stimulatory loop in the adrenal cortex that likely participates in the pathogenesis of corticosteroid hypersecretion.
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Shimazaki T, Taniguchi T, Saludar NRD, Gustilo LM, Kato T, Furumoto A, Kato K, Saito N, Go WS, Tria ES, Salva EP, Dimaano EM, Parry C, Ariyoshi K, Villarama JB, Suzuki M. Bacterial co-infection and early mortality among pulmonary tuberculosis patients in Manila, The Philippines. Int J Tuberc Lung Dis 2019; 22:65-72. [PMID: 29297428 DOI: 10.5588/ijtld.17.0389] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of bacterial co-infection and its effect on early mortality among hospitalised human immunodeficiency virus (HIV) negative pulmonary tuberculosis (PTB) patients in Manila, the Philippines. DESIGN A prospective observational study was conducted at a national infectious disease hospital. HIV-negative PTB patients aged 13 years hospitalised from November to December 2011 and from December 2012 to May 2013 were enrolled. Sputum samples were tested for Mycobacterium tuberculosis and six respiratory bacterial pathogens using polymerase chain reaction (PCR). RESULTS Of 466 patients, 228 (48.9%) were TB-PCR-positive. Overall, bacterial pathogens in purulent sputum were detected in 135 (29.0%) patients: Haemophilus influenzae was the most common bacterium (21.2%), followed by Streptococcus pneumoniae (7.9%). The prevalence of bacterial co-infection did not differ between TB-PCR-positive and -negative patients. A total of 92 (19.7%) patients died within 2 weeks. Bacterial co-infection was significantly associated with an increased risk of 2-week mortality among TB-PCR-positive patients (adjusted risk ratio [aRR] 1.67, 95%CI 1.03-2.72). This association was also observed but did not reach statistical significance among TB-PCR-negative patients (aRR1.7, 95%CI 0.95-3.02). CONCLUSION Bacterial co-infection is common and contributes to an increased risk of early mortality among HIV-negative PTB patients.
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Manno T, Shimizu M, Ohomri M, Taomoto Y, Kaneda T, Yamakami Y, Iiya M, Shimada H, Isshiki A, Kimura S, Fujii H, Suzuki M, Hirao K. P4386Prognostic value of pressure-strain curve analysis by echocardiography for cardiac death in patients with congestive heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Pressure-strain curve analysis (PS-curve) is novel method of echocardiographic evaluation for left ventricular (LV) systolic myocardial work including the effect of blood pressure. However, the prognostic value of PS-curve for prospective cardiac death in patients with congestive heart failure (CHF).
Purpose
To elucidate the prognostic value of PS-curve analysis for cardiac death in patients with CHF.
Methods
We enrolled 63 consecutive sinus-rhythm patients with CHF admission who were evaluated by PS-curve analysis before discharge (76.0±13.3 years, 39 males). Endpoint was set as all cardiac death.
Results
Observation period was median 327 days [25%: 91, 75%: 656 days], and the longest period was 1004 days. Five patients died for cardiac causes. Multivariate Cox regression analysis (stepwise regression) revealed diastolic blood pressure (BP) and global constructive work (GCW) were independent predictors (Hazard ratio: 0.854, 0.996, P value: 0.016, 0.019, respectively). ROC curve analysis demonstrated GCW ≤601 had high diagnostic performance for cardiac death (specificity 0.891, sensitivity 0.800, area under ROC 0.824). Kaplan-Meyer curve analysis indicated the group with GCW ≤601 was worse cardiac prognosis (Logrank P<0.001).
Cox Hazard Regression Analysis Univariate Multivariate (stepwise regression) Hazard Ratio 95% CI P Hazard Ratio 95% CI P BP systole (mmHg) 0.915 0.85–0.99 0.026 BP diastole (mmHg) 0.915 0.84–0.99 0.043 0.854 0.75–0.97 0.016 LVDd (mm) 1.064 1.01–1.12 0.025 NA LVDs (mm) 1.066 1.01–1.12 0.016 LVEF (%) 0.963 0.91–1.02 0.221 LAD (mm) 1.197 1.06–1.36 0.005 GWE 0.937 0.88–0.99 0.041 GWI 0.998 0.99–0.99 0.041 NA GCW 0.998 0.99–0.99 0.037 0.996 0.99–0.99 0.019 GWW 0.996 0.98–1.01 0.502 Considering multicollinearity, we excluded GWI and LVDd (correlation coefficient: GWI and GCW = 0.979, LVDd and LVDs = 0.942).
Conclusion
Pressure-strain curve analysis had powerful predictive value for cardiac death in patients with CHF.
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Iguchi M, Suzuki M, Matsuda M, Ajiro Y, Shinozaki T, Sakagami S, Yonazawa K, Shimizu M, Funada J, Takenaka T, Wada M, Abe M, Akao M, Hasegawa K, Wada H. P1645Vascular endothelial growth factor-D and mortality in suspected or known coronary heart disease patients with a history of heart failure: a subanalysis of the ANOX study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Vascular endothelial growth factor-D (VEGF-D) is a secreted glycoprotein that can act as lymphangiogenic and angiogenic growth factors through binding to its specific receptors, VEGFR-3 (Flt-4) and VEGFR-2 (KDR/Flk-1). VEGF-D signaling via VEGFR-3 plays an important role in lipoprotein metabolisms which may contribute to coronary heart disease (CHD). Recent studies suggest that VEGF-D appears to be a biomarker of pulmonary congestion and heart failure in both dyspnea patients and the general population. However, the prognostic value of VEGF-D in suspected or known CHD patients with a history of heart failure is unknown.
Methods
Serum VEGF-D levels were measured in 253 suspected or known CHD patients with a history of heart failure undergoing elective coronary angiography, enrolled in the development of novel biomarkers related to angiogenesis or oxidative stress to predict cardiovascular events (ANOX) study, and followed up for 3 years. The primary outcome was all-cause death. The secondary outcomes were cardiovascular death, and major adverse cardiovascular events (MACE) defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke.
Results
During the follow-up, 54 patients died from any cause, 24 died from cardiovascular disease, and 35 developed MACE. After adjustment for established risk factors, VEGF-D levels were significantly associated with all-cause death (hazard ratio [HR] for 1-SD increase, 1.44; 95% confidence interval [CI], 1.18–1.75), cardiovascular death (HR, 1.73; 95% CI, 1.32–2.25), and MACE (HR, 1.49; 95% CI, 1.14–1.89). Even after incorporation of N-terminal pro-brain natriuretic peptide, contemporary sensitive cardiac troponin-I, and high-sensitivity C-reactive protein into a model with established risk factors, the addition of VEGF-D levels further improved the prediction of all-cause death (continuous net reclassification improvement [NRI], 0.471; 95% CI, 0.176–0.766; P=0.002; integrated discrimination improvement [IDI], 0.036; 95% CI, 0.008–0.064; P=0.011) and cardiovascular death (NRI, 0.722; 95% CI, 0.326–1.118; P<0.001; IDI, 0.063; 95% CI, 0.005–0.122; P=0.033), but not that of MACE (NRI, 0.453; 95% CI, 0.100–0.805; P=0.012; IDI, 0.028; 95% CI, −0.007–0.063; P=0.116).
Conclusions
In suspected or known CHD patients with a history of heart failure undergoing elective coronary angiography, elevated VEGF-D levels may predict all-cause and cardiovascular mortality independent of established risk factors and cardiovascular biomarkers.
Acknowledgement/Funding
The ANOX study is supported by a Grant-in-Aid for Clinical Research from the National Hospital Organization.
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Iiya M, Kimura S, Shimizu M, Fujii H, Suzuki M. P1704The impact of electrocardiographic changes upon resuscitation from out-of-hospital cardiac arrest on mortality. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The serial electrocardiographic changes in patients following out-of-hospital cardiac arrest (OHCA) are unclear.
Purpose
To evaluate serial electrocardiographic changes and to predict all-cause mortality in patients following OHCA.
Methods
We retrospectively studied 101 OHCA patients (70±16 years, 49 male) who achieved a return of spontaneous circulation (ROSC) and survived for ≥3hours. Twelve-lead electrocardiograms (ECGs) were evaluated twice in each patient: initial-ECG, after achieving ROSC; and 2nd-ECG, after receiving the initial evaluation in the emergency room. Patients were divided into two groups: S-group, those surviving for 28 days, and D-group, those dying within 28 days. Multivariate Cox regression analyses were performed to predict the 28-day survival following OHCA. A Kaplan-Meier curve analysis for the 28 day mortality stratified by the QRS morphology and rhythm of initial-ECG was performed.
Results
Among variables of initial-ECG, there were significant differences between the group-S and group-D (table). Multivariate analysis with a step-wise regression demonstrated that age, lactate, and QRS duration of the initial-ECG were significant predictors of all-cause mortality (Odds ratio (OR): 1.04, 1.21, 1.02, p: 0.002, 0.001, 0.001, respectively). Kaplan-Meier analysis revealed that a complete right bundle branch block (CRBBB) of initial-ECG and presence of atrial fibrillation were associated with an increased risk of all-cause mortality (Picture).
Serial change of ECG variables Initial-ECG 2nd-ECG Group S Group D p Group S Group D p Heart Rate [/min] 109±23 105±31 0.527 88±21 94±23 0.341 Af [N,%] 10 (25%) 27 (52%) 0.018* 3 (9%) 6 (26%) 0.134 QRS duration [ms] 111±18 139±33 0.001* 107±29 111±30 0.623 Morphology 0.001* 0.284 – Normal [N,%] 30 (75%) 10 (19%) 29 (81%) 14 (61%) – CRBBB [N,%] 5 (13%) 30 (57%) 5 (14%) 5 (22%) – CLBBB [N,%] 1 (2%) 0 0 1 (4%) – IVCD [N,%] 4 (10%) 13 (24%) 2 (6%) 3 (13%) Comparing variables between group S and group D stratified by initial ECG and delayed ECG. QRS morphology were examined, normal, complete right bundle branch block (CRBBB), complete left bundle branch block (CLBBB), and unspecific interventricular conduction delay (IVCD).
Study flow diagram, KM curve analysis
Conclusions
The QRS duration and morphology upon resuscitation were associated with an increased risk of all-cause mortality following OHCA.
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Unoki T, Suzuki M, Matsuda M, Ajiro Y, Shinozaki T, Sakagami S, Yonezawa K, Shimizu M, Funada J, Takenaka T, Wada K, Abe M, Akao M, Hasegawa K, Wada H. P3639Vascular endothelial growth factor-C and mortality in patients with suspected but no history of coronary heart disease: a subanalysis of the ANOX study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The lymphatic system has been suggested to play an important role in cholesterol metabolism and cardiovascular disease. Recently, we demonstrated that serum levels of vascular endothelial growth factor-C (VEGF-C), a central player of lymphangiogenesis, are inversely and independently associated with the risk of all-cause mortality in patients with suspected or known coronary heart disease (CHD). However, the prognostic value of VEGF-C in patients with suspected but no history of CHD is still unclear.
Methods
Serum VEGF-C levels were measured in 1,717 patients with suspected but no history of CHD undergoing elective coronary angiography, enrolled in the development of novel biomarkers related to angiogenesis or oxidative stress to predict cardiovascular events (ANOX) study, and followed up for 3 years. The primary outcome was all-cause death. The secondary outcomes were cardiovascular death, and major adverse cardiovascular events (MACE) defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke.
Results
During the follow-up, 161 patients died from any cause, 50 died from cardiovascular disease, and 104 developed MACE. After adjustment for established risk factors, VEGF-C levels were significantly and inversely associated with all-cause death (hazard ratio [HR] for 1-SD increase, 0.69; 95% confidence interval [CI], 0.58–0.83) and cardiovascular death (HR, 0.72; 95% CI, 0.52–0.998), but not with MACE (HR, 0.91; 95% CI, 0.74–1.13). Even after incorporation of N-terminal pro-brain natriuretic peptide, contemporary sensitive cardiac troponin-I, and high-sensitivity C-reactive protein into a model with established risk factors, the addition of VEGF-C levels further improved the prediction of all-cause death (continuous net reclassification improvement [NRI], 0.282; 95% CI, 0.121–0.443; P<0.001; integrated discrimination improvement [IDI], 0.009; 95% CI, 0.003–0.016; P=0.005), but not that of cardiovascular death (NRI, 0.178; 95% CI, r=−0.103–0.458; P=0.214; IDI, 0.004; 95% CI, r=−0.002–0.009; P=0.194) or MACE (NRI, 0.037; 95% CI, r=−0.162–0.235; P=0.717; IDI, 0.000; 95% CI, r=−0.0004–0.0005; P=0.872).
Conclusions
In patients with suspected but no history of CHD undergoing elective coronary angiography, a low VEGF-C value may predict all-cause mortality independent of established risk factors and cardiovascular biomarkers.
Acknowledgement/Funding
The ANOX study is supported by a Grant-in-Aid for Clinical Research from the National Hospital Organization
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Shimizu M, Iiya M, Hara K, Ohmori M, Taomoto Y, Kaneda T, Yamakami Y, Shimada H, Manno T, Isshiki A, Kimura S, Fujii H, Suzuki M, Nishizaki M. P5643Simple 12-leads electrocardiography can predict cardiac death in patients with complete left bundle branch block. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with complete left bundle branch block (CLBBB) generally fall in two categories: CLBBB with good prognosis and poor prognosis. However, a simple electrocardiography (ECG) was considered impossible to predict the two categories.
Purpose
To elucidate the possibility of 12-leads ECG for predicting cardiac prognosis in patients with CLBBB
Methods
To estimate myocardial damage and left ventricular function, the ECG was performed with semiconductor SPECT simultaneously. Among consecutive 5864 patients who underwent ECG gated SPECT, finally 103 sinus-rhythm patients were enrolled. The observed period of them was median 632 days, and primary endpoint was set as cardiac death.
Results
Eight patients fell into cardiac death. Cox univariate analysis showed ventricular activation time (VAT: duration from onset of Q wave to peak of R wave) in V1 lead, T wave amplitude in aVR (aVR T-amp), and multiple fragmented QRS (At least 2 fQRS in LV anterior/inferior/lateral wall), and left ventricular ejection fraction, standard deviation of phase analysis (Phase SD), and summed rest score were significant predictors. After optimization of all significant continuous predictors by ROC curve analysis, all the significant predictors were analyzed by multivariate Cox analysis (stepwise regression). VAT in V1 (Hazard ratio: 4.594, P=0.034), aVR T-amp ≥-85microV (HR: 11.11, P=0.029), and Phase SD≥48.7 (HR6.047, P=0.035) were independent predictors. Kaplan-Meyer curve analysis demonstrated VAT V1≥70 and aVR T amp≥-85 showed the worst prognosis (P=0.008).
Cox Regression after Optimization by ROC Univariate Multivariate (Stepwise regression) HR 95% CI P HR 95% CI P VAT I ≥70 6.861 1.759–26.76 0.006 4.594 1.126–18.75 0.034 T amp in aVR ≥−85 27.34 3.458–216.2 0.002 11.11 1.274–96.85 0.029 Multiple fQRS 3.836 1.081–13.61 0.037 LVEF ≤37% 7.250 1.874–28.04 0.004 SD ≥48.7 17.30 3.671–81.57 <0.001 6.047 1.133–32.28 0.035 SRS≥17 4.178 1.206–14.48 0.024 SD: standard deviation of histogram by phase analysis of SPECT; SRS: summed rest score by myocardial perfusion analysis of SPECT.
Conclusion
Simple 12-leads ECG could predict the prognosis of patients with CLBBB.
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Takemoto N, Miyabe J, Fukusumi T, Suzuki M, Inohara H. Clinical utility of metabolic tumor volume in papillary thyroid carcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz267.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Unoki T, Suzuki M, Matsuda M, Ajiro Y, Shinozaki T, Sakagami S, Yonezawa K, Shimizu M, Funada J, Takenaka T, Morita Y, Abe M, Akao M, Hasegawa K, Wada H. 5195Growth differentiation factor-15 and mortality in suspected or known coronary heart disease patients with diabetes: a subanalysis of the ANOX study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diabetes is a risk factor for coronary heart disease (CHD), but further risk stratification in patients with diabetes is necessary to improve the prediction and prevention of cardiovascular events and deaths. Growth differentiation factor-15 (GDF-15) is a stress-responsive cytokine, which plays an important role in the regulation of the inflammatory response, growth and cell differentiation. Elevated GDF-15 was found in various diseases including diabetes and stable CHD, and was reported to predict mortality and cardiovascular events in general or established CHD population. However, the prognostic value of GDF-15 in suspected or known CHD patients with diabetes is unknown.
Methods
Serum GDF-15 levels were measured in 1,087 suspected or known CHD patients with diabetes undergoing elective coronary angiography, enrolled in the development of novel biomarkers related to angiogenesis or oxidative stress to predict cardiovascular events (ANOX) study, and followed up for 3 years. The primary outcome was all-cause death. The secondary outcomes were cardiovascular death, and major adverse cardiovascular events (MACE) defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke.
Results
During the follow-up, 147 patients died from any cause, 47 died from cardiovascular disease, and 94 developed MACE. After adjustment for established risk factors, GDF-15 levels were significantly associated with all-cause death (hazard ratio [HR] for 1-SD increase, 1.66; 95% confidence interval [CI], 1.48–1.86), cardiovascular death (HR, 1.63; 95% CI, 1.34–1.99), and MACE (HR, 1.41; 95% CI, 1.20–1.65). Even after incorporation of N-terminal pro-brain natriuretic peptide, contemporary sensitive cardiac troponin-I, and high-sensitivity C-reactive protein into a model with established risk factors, the addition of GDF-15 levels further improved the prediction of all-cause death (continuous net reclassification improvement [NRI], 0.344; 95% CI, 0.172–0.517; P<0.001; integrated discrimination improvement [IDI], 0.049; 95% CI, 0.026–0.072; P<0.001), but not that of cardiovascular death (NRI, −0.013; 95% CI, −0.300–0.274; P=0.931; IDI, 0.023; 95% CI, 0.003–0.043; P=0.026) or MACE (NRI, 0.059; 95% CI, −0.151–0.268; P=0.583; IDI, 0.005; 95% CI, −0.004–0.015; P=0.244).
Conclusions
In suspected or known CHD patients with diabetes undergoing elective coronary angiography, elevated GDF-15 levels may predict all-cause mortality independent of established risk factors and cardiovascular biomarkers.
Acknowledgement/Funding
The ANOX study is supported by a Grant-in-Aid for Clinical Research from the National Hospital Organization.
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Wada H, Suzuki M, Matsuda M, Ajiro Y, Shinozaki T, Sakagami S, Yonezawa K, Shimizu M, Funada J, Takenaka T, Morita Y, Wada M, Abe M, Akao M, Hasegawa K. P5529Vascular endothelial growth factor-D and mortality in suspected or known coronary heart disease patients with diabetes: a subanalysis of the ANOX study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Diabetes is a risk factor for coronary heart disease (CHD), but further risk stratification in patients with diabetes is necessary to improve the prediction and prevention of cardiovascular events and deaths. Vascular endothelial growth factor-D (VEGF-D) is a secreted glycoprotein that can act as lymphangiogenic and angiogenic growth factors through binding to its specific receptors, VEGFR-3 (Flt-4) and VEGFR-2 (KDR/Flk-1). VEGF-D signaling via VEGFR-3 plays an important role in lipoprotein metabolisms which may contribute to CHD. VEGF-D signaling has been used as a therapeutic target of human diseases such as lymphangioleiomyomatosis and refractory angina. Furthermore, in clinical settings, the VEGF-D level is already established as a diagnostic biomarker for lymphangioleiomyomatosis. However, the prognostic value of VEGF-D in suspected or known CHD patients with diabetes is unknown.
Methods
Serum VEGF-D levels were measured in 1,087 suspected or known CHD patients with diabetes undergoing elective coronary angiography, enrolled in the development of novel biomarkers related to angiogenesis or oxidative stress to predict cardiovascular events (ANOX) study, and followed up for 3 years. The primary outcome was all-cause death. The secondary outcomes were cardiovascular death, and major adverse cardiovascular events (MACE) defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke.
Results
During the follow-up, 147 patients died from any cause, 47 died from cardiovascular disease, and 94 developed MACE. After adjustment for established risk factors, VEGF-D levels were significantly associated with all-cause death (hazard ratio [HR] for 1-SD increase, 1.34; 95% confidence interval [CI], 1.21–1.47), cardiovascular death (HR, 1.40; 95% CI, 1.18–1.62), and MACE (HR, 1.22; 95% CI, 1.07–1.40). Even after incorporation of N-terminal pro-brain natriuretic peptide, contemporary sensitive cardiac troponin-I, and high-sensitivity C-reactive protein into a model with established risk factors, the addition of VEGF-D levels further improved the prediction of all-cause death (continuous net reclassification improvement [NRI], 0.258; 95% CI, 0.088–0.429; P=0.003; integrated discrimination improvement [IDI], 0.013; 95% CI, 0.002–0.024; P=0.022), but not that of cardiovascular death (NRI, 0.046; 95% CI, −0.245–0.336; P=0.759; IDI, 0.013; 95% CI, −0.005–0.031; P=0.146) or MACE (NRI, 0.064; 95% CI, −0.146–0.274; P=0.552; IDI, 0.001; 95% CI, −0.002–0.004; P=0.557).
Conclusions
In suspected or known CHD patients with diabetes undergoing elective coronary angiography, elevated VEGF-D levels may predict all-cause mortality independent of established risk factors and cardiovascular biomarkers.
Acknowledgement/Funding
The ANOX study is supported by a Grant-in-Aid for Clinical Research from the National Hospital Organization
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Mori T, Matsushima R, Hinokuma H, Suzuki M. P2.05-11 3D CT Is Useful for Segmentectomy but Is Not Always True. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1610] [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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121
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Wada H, Suzuki M, Matsuda M, Ajiro Y, Shinozaki T, Sakagami S, Yonezawa K, Shimizu M, Funada J, Takenaka T, Morita Y, Wada M, Abe M, Akao M, Hasegawa K. P5526Vascular endothelial growth factor-D and mortality in suspected or known coronary heart disease patients with chronic kidney disease: a subanalysis of the ANOX study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Chronic kidney disease (CKD) is an independent risk factor for the development and progression of coronary heart disease (CHD). Vascular endothelial growth factor-D (VEGF-D) is a secreted glycoprotein that can act as lymphangiogenic and angiogenic growth factors through binding to its specific receptors, VEGFR-3 (Flt-4) and VEGFR-2 (KDR/Flk-1). VEGF-D signaling via VEGFR-3 plays an important role in lipoprotein metabolisms which may contribute to CHD. VEGF-D signaling has been used as a therapeutic target of human diseases such as lymphangioleiomyomatosis and refractory angina. Furthermore, in clinical settings, the VEGF-D level is already established as a diagnostic biomarker for lymphangioleiomyomatosis. However, the prognostic value of VEGF-D in suspected or known CHD patients with CKD is unknown.
Methods
Serum VEGF-D levels were measured in 999 suspected or known CHD patients with CKD undergoing elective coronary angiography, enrolled in the development of novel biomarkers related to angiogenesis or oxidative stress to predict cardiovascular events (ANOX) study, and followed up for 3 years. The primary outcome was all-cause death. The secondary outcomes were cardiovascular death, and major adverse cardiovascular events (MACE) defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke.
Results
During the follow-up, 154 patients died from any cause, 61 died from cardiovascular disease, and 96 developed MACE. After adjustment for established risk factors, VEGF-D levels were significantly associated with all-cause death (hazard ratio [HR] for 1-SD increase, 1.41; 95% confidence interval [CI], 1.27–1.56), cardiovascular death (HR, 1.48; 95% CI, 1.28–1.71), and MACE (HR, 1.34; 95% CI, 1.18–1.53). Even after incorporation of N-terminal pro-brain natriuretic peptide, contemporary sensitive cardiac troponin-I, and high-sensitivity C-reactive protein into a model with established risk factors, the addition of VEGF-D levels further improved the prediction of all-cause death (continuous net reclassification improvement [NRI], 0.272; 95% CI, 0.100–0.445; P=0.002; integrated discrimination improvement [IDI], 0.015; 95% CI, 0.003–0.027; P=0.013), but not that of cardiovascular death (NRI, 0.230; 95% CI, −0.029 to 0.488; P=0.082; IDI, 0.012; 95% CI, −0.007 to 0.031; P=0.207) or MACE (NRI, 0.102; 95% CI, −0.106 to 0.310; P=0.337; IDI, 0.005; 95% CI, −0.005 to 0.015; P=0.337).
Conclusions
In suspected or known CHD patients with CKD undergoing elective coronary angiography, elevated VEGF-D levels may predict all-cause mortality independent of established risk factors and cardiovascular biomarkers.
Acknowledgement/Funding
The ANOX study is supported by a Grant-in-Aid for Clinical Research from the National Hospital Organization
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Shoji S, Sawano M, Shiraishi Y, Ikemura N, Noma S, Suzuki M, Numasawa Y, Fukuda K, Kohsaka S. P6531Evidence-practice gap in the preprocedural risk assessment for contrast-induced acute kidney injury. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Contrast-induced acute kidney injury (CI-AKI) is one of the frequently encountered and costly complications after percutaneous coronary intervention (PCI). Clinical practice guidelines strongly recommend that PCI patients should universally undergo preprocedural assessment for the risk of CI-AKI, and the contrast volume (CV) should be minimized to an achievable level, particularly among the high AKI risk patients. However, data on the CV use based on the comprehensive preprocedural risk assessment is still lacking.
Purpose
Our study aimed to 1) assess the impact of CV increase with the incidence of AKI among high AKI risk patients, and 2) retrospectively evaluate the used CV based on the preprocedural comprehensive risk assessment for patients undergoing PCI within multicenter longitudinal registry.
Methods
Between 2009 and 2018, 22,373 patients underwent PCI in 14 participating facilities, and consecutive patient data was registered. AKI was defined as a >0.3mg/dl absolute or >1.5-fold relative increase in post-PCI creatinine or new initiation of dialysis, based on the Acute Kidney Injury Network criteria. The post-procedural creatinine was defined as the highest value within 30 days after the indexed procedure. Congruent with the National Cardiovascular Data Registry (NCDR) definition, if more than 1 post-procedural creatinine level was measured, the highest value was used for determining AKI. We divided the patients into four groups according to quartile of NCDR AKI risk scores.
Results
Mean age of the patients were 68.7±11.1 years, and 79.1% were male. Mean CV use was 161.4±74.8ml. The incidence of CI-AKI was 8.9%, and was particularly high among high AKI risk patients (21.1%); CV (per 1ml linear increase) was directly associated with the occurrence of AKI (OR: 1.002 per unit in CV; 95% CI: 1.001–1.003; P<0.001) in these patients. CV during PCI decreased with the progression of chronic kidney disease (CKD), but it did not alter by the overall NCDR AKI risk score (Figure). After multivariable adjustment, CV was predicted by stage of CKD (−13.68ml; 95% CI: −12.05 to −15.30ml; P<0.001), but not by the value of pre-procedure prediction score (NCDR AKI risk score, P=0.575).
CV according to CKD/NCDR AKI risk score
Conclusions
Higher CV was directly associated with the occurrence of AKI among higher AKI risk patients. However, CV use was largely influenced by the stage of renal disease, and not with overall patient risk presented by contemporary risk scores. Our results have identified an important evidence-practice gap and emphasizes the importance of total preprocedural assessment to minimize CV and prevent subsequent AKI.
Acknowledgement/Funding
KAKENHI (16KK0186, 16H05215, 25460630, 25460777), Bayer, Daiichi Sankyo, Bristol-Myers Squibb, Teikoku Seiyaku, Sumitomo Dainippon, AstraZeneka, Pfizer
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Iguchi M, Suzuki M, Matsuda M, Ajiro Y, Shinozaki T, Sakagami S, Yonezawa K, Shimizu M, Funada J, Takenaka T, Morita Y, Abe M, Akao M, Hasegawa K, Wada H. P3765Low vascular endothelial growth factor-C was a predictor for cardiovascular events in patients with atrial fibrillation and suspected or known coronary artery disease: a subanalysis of the ANOX study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Lymphatic system has been considered to play an important role in cardiovascular disease. We recently reported that vascular endothelial growth factor-C (VEGF-C), a central player in lymphangiogenesis, predicted all-cause mortality in patients with suspected or known coronary artery disease (CAD). However, relationship between VEGF-C and atrial fibrillation (AF) remains unclear.
Methods
The ANOX study is a multicenter, prospective cohort study of 2,418 patients with suspected CAD, to determine the predictive value of possible novel biomarkers related to angiogenesis or oxidative stress for major adverse cardiovascular events (MACE) among patients undergoing elective angiography. Blood samples were collected from the arterial catheter sheath at the beginning of coronary angiography. Serum levels of VEGF-C, as well as N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin-I (cTnI), and high-sensitivity C-reactive protein (hsCRP), were measured. The outcome was a MACE defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke.
Results
Of a total of 2,418 patients, 261 patients had AF at baseline. AF group were older, and had more chronic kidney disease, history of heart failure, and history of stroke, but less diabetes, dyslipidemia, and CAD. The median level of NT-proBNP, cTnI, and hsCRP were higher in AF group [AF vs non-AF: NT-proBNP, 1048 pg/ml vs 162 pg/ml (p<0.0001); cTnI, 0.0003 ng/ml, vs 0.0 ng/ml (p<0.0001); hsCRP, 1.43 ug/ml vs 0.88 ug/ml (p=0.0005)], whereas median level of VEGF-C was lower in AF group [3107 pg/ml vs 3590 pg/ml (p<0.0001)]. AF was associated with lower VEGF-C and higher hsCRP after adjustment for potential confounders. During the 3-year follow-up, 29 (11.1%) patients in AF group and 136 (6.3%) patients in non-AF group developed MACE (p=0.007). Incidence of stroke was higher in AF group (17 (6.5%) vs 52 (2.4%); p<0.0009), despite that the incidence of cardiovascular death and myocardial infarction were similar between the groups. We divided the entire cohort into two groups based on the lowest quartile of VEGF-C or highest quartile of other biomarkers, lowest quartile of VEGF-C (log rank p=0.0004), as well as highest quartile of cTnI (log rank p=0.0009), were significantly associated with MACE in AF group. After adjustment for established risk factors and these biomarkers, both lowest quartile of VEGF-C (HR, 2.73; 95% CI, 1.27–6.06) and highest quartile of cTnI (HR, 2.54; 95% CI, 1.08–6.09) were significantly associated with MACE in AF group.
Conclusions
AF was associated with lower level of VEGF-C, and low VEGF-C as well as high cTnI might serve as an independent predictor of MACE in patients with AF and suspected or known CAD.
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Nakano Y, Suzuki M, Waseda K, Niwa T, Ando H, Sakurai S, Shimoda M, Ohashi H, Takashima H, Amano T. P2688A novel risk factor of stent restenosis after drug-eluting stent implantation; Involvement of triglyceride deposit cardiomyovasculopathy, coronary atherosclerosis with triglyceride deposition. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Triglyceride deposit cardiomyovasculopathy (TGCV) is a novel disease concept characterized by the excessive accumulation of triglyceride in cardiomyocytes and vascular smooth muscle cells, leading to coronary artery disease (CAD), heart failure, and arrhythmia. However, it is rarely known whether TGCV contributes to the increased risk of vascular failure after drug eluting stent (DES) implantation.
Purpose
The aim of this study was to evaluate vascular failure after 2nd generation DES implantation in patients with TGCV.
Methods
Among 637 consecutive patients suspected of having CAD who underwent both coronary angiography and iodine-123-β-methyliodophenyl-pentadecanoic acid (BMIPP) scintigraphy between 2010 and 2018, we analyzed the data from 92 patients who met the inclusion criteria (shown in Table and Figure). Ninety-two patients were allocated to the presence (TGCV group, 11 patients) or absence (control group, 81 patients) of TGCV. All of 92 patients were implanted 2nd generation DES and underwent planned follow up coronary angiography. Control patients were diagnosed of diabetes mellitus. Binary restenosis (ISR), defined as angiographic luminal diameter ≥50% by quantitative coronary angiography, target lesion revascularization (TLR), In-stent late loss and restenosis morphology were assessed in 23 stents of TGCV group and 120 stents of control group.
Results
There were no significant differences in baseline characteristics between the two groups except for the prevalence of hypertension. In-stent late loss was greater in TGCV than in control (0.45 (−0.04 to 3.33) vs. 0.15 (−0.18 to 2.75), p=0.ehz748.10067), resulting in greater incidence of ISR and TLR in TGCV than in control (34.8% vs. 10.0%, p=0.0017; 21.7% vs. 6.7%, p=0.021, respectively). On multivariable logistic regression analysis, TGCV was found to be a significant and independent predictor for ISR after 2nd generation DES implantation. Regarding restenosis morphology, diffuse and occlusive pattern of ISR, were more frequently observed in TGCV than control (87.5% and 33.3%, Fisher's exact test p=0.028).
Table 1.The 4th edition diagnostic criteria for TGCV Items Clinical findings 2 points I) BMIPP scintigraphy Wash-Out Rare <10% II) Diffuse narrowng coronary arteries 1 point III) Jordans anomaly in peripheral blood smear IV) Diabetes Decision 4 points or more → Definite TGCV
Figure 1
Conclusion
Patients with TGCV showed the greater incidence of vascular failure even after 2nd generation DES implantation, contributing to the novel risk factor for coronary intervention even in the 2nd DES era.
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Fujino K, Motooka Y, Matsushima R, Ito T, Suzuki M, Yasufuku K. EP1.12-03 The Significance of INSM1 Expression in Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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