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Hasegawa S, Nakano T, Mukai Y, Matsukuma Y, Yotsueda R, Tsuchimoto A, Fujisaki K, Tsuruya K, Tsutsui H, Kitazono T. High low-density lipoprotein cholesterol as an independent risk factor for coronary restenosis in hemodialysis patients undergoing percutaneous coronary interventions. Ther Apher Dial 2020; 25:296-303. [PMID: 32643821 DOI: 10.1111/1744-9987.13558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/29/2020] [Accepted: 07/07/2020] [Indexed: 12/01/2022]
Abstract
HD patients have been reported to have a higher risk of restenosis after percutaneous coronary intervention (PCI). The aim of this study was to investigate the risk factors of coronary restenosis in HD patients. We enrolled 54 HD patients (mean age: 66.5 ± 10.1 years; 72.2% men; mean HD duration: 3.7 years), who received PCI and follow-up coronary angiography. Of the patients, 22 (40.7%) had restenosis within 3 to 12 months of PCI. Univariate logistic analysis showed low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio, LDL-C, non-HDL-C, and history of major adverse cardiovascular events were significantly associated with coronary restenosis (OR]: 1.89, 1.27, 1.22, and 5.79, respectively). Multivariate analysis showed that LDL-C was significantly associated with coronary restenosis (OR: 1.43). These data suggest that LDL-C is an independent risk factor for coronary restenosis in HD patients undergoing PCI, and strict lipid management may be required.
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Affiliation(s)
- Shoko Hasegawa
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasushi Mukai
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yuta Matsukuma
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryusuke Yotsueda
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akihiro Tsuchimoto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiichiro Fujisaki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Lin FJ, Zhang X, Huang LS, Zhou X, Ji G, Luo R, Jiang GR, Lu W. De novo Cardiac Valve Calcification after Hemodialysis in End-Stage Renal Disease Patients Predicts Future Cardiovascular Events: A Longitudinal Cohort Study. Cardiorenal Med 2019; 9:229-239. [PMID: 30995648 DOI: 10.1159/000494701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/18/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiac valve calcification (CVC) in maintenance hemodialysis patients is associated with adverse cardiovascular outcomes. However, whether de novo CVC in incident hemodialysis patients predicts future cardiovascular events is unknown. METHODS This study included 174 patients newly receiving hemodialysis without CVC as reflected by echocardiography between January 2005 and December 2014. De novo CVC was determined with echocardiography once every 6 months until December 2016. RESULTS The median follow-up was 66 months (range, 19-141). De novo CVC developed in 80 out of 174 (45.98%) subjects: 58 developed aortic valve calcification (AVC) alone, 42 developed mitral valve calcification (MVC) alone, and 20 developed both AVC and MVC. The median time from baseline to de novo CVC was 46 months (range, 3-120) for AVC and 50 months (range, 13-127) for MVC. Patients who developed CVC had a higher major adverse cardiovascular events (MACE) rate than those who did not (AVC: 30/58 [51.72%] vs. 23/116 [19.83%]; MVC: 25/42 [59.52%] vs. 28/132 [21.21%]). Multivariate time-dependent Cox regression showed an association between MACE with both de novo AVC and MVC (AVC: hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.55-6.63; MVC: HR 5.95, 95% CI 2.90-12.20). CONCLUSIONS De novo CVC is an independent risk factor for MACE in hemodialysis patients, and regular CVC screening among hemodialysis patients without preexisting CVC may be helpful to identify patients at increased risk of adverse cardiovascular outcomes.
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Affiliation(s)
- Fu-Jun Lin
- Renal Division, Department of Internal Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi Zhang
- Clinical Research Unit, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu-Sheng Huang
- Renal Division, Department of Internal Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Zhou
- Clinical Research Unit, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gang Ji
- Renal Division, Department of Internal Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Luo
- Clinical Research Unit, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Geng-Ru Jiang
- Renal Division, Department of Internal Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Lu
- Renal Division, Department of Internal Medicine, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China,
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Shibata Y, Ishii H, Suzuki S, Tanaka A, Tatami Y, Harata S, Ota T, Shimbo Y, Takayama Y, Kunimura A, Hirayama K, Harada K, Osugi N, Murohara T. Predictive Value of Aortic Valve Calcification for Periprocedural Myocardial Injury in Patients Undergoing Percutaneous Coronary Intervention. J Atheroscler Thromb 2017; 24:487-494. [PMID: 27733732 PMCID: PMC5429164 DOI: 10.5551/jat.36582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/21/2016] [Indexed: 12/19/2022] Open
Abstract
AIMS Previous studies have shown that aortic valve calcification (AVC) was associated with cardiovascular events and mortality. On the other hand, periprocedural myocardial injury (PMI) in percutaneous coronary intervention (PCI) is a well-known predictor of subsequent mortality and poor clinical outcomes. The purpose of the study was to assess the hypothesis that the presence of AVC could predict PMI in PCI. METHODS This study included 370 patients treated with PCI for stable angina pectoris. AVC was defined as bright echoes >1 mm on one or more cusps of the aortic valve on ultrasound cardiography (UCG). PMI was defined as an increase in high-sensitivity troponin T level of >5 times the upper normal limit (>0.070 ng/ml) at 24 hours after PCI. RESULTS AVC was detected in 45.9% of the patients (n=170). The incidence of PMI was significantly higher in the patients with AVC than in those without AVC (43.5% vs 21.0%, p<0.001). The presence of AVC independently predicted PMI after adjusting for other significant variables (odds ratio 2.26, 95% confidence interval 1.37-3.74, p=0.002). Other predictors were male sex, age, estimated glomerular filtration rate, and total stent length. Furthermore to predict PMI, adding AVC to the established risk factors significantly improved the area under the receiver operating characteristic curves, from 0.68 to 0.72, of the PMI prediction model (p=0.025). CONCLUSION The presence of AVC detected in UCG could predict the incidence of PMI.
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Affiliation(s)
- Yohei Shibata
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yosuke Tatami
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shingo Harata
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoyuki Ota
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusaku Shimbo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yohei Takayama
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ayako Kunimura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenshi Hirayama
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Harada
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naohiro Osugi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Yousry M, Rickenlund A, Petrini J, Jenner J, Liska J, Eriksson P, Franco-Cereceda A, Eriksson MJ, Caidahl K. Aortic valve type and calcification as assessed by transthoracic and transoesophageal echocardiography. Clin Physiol Funct Imaging 2014; 35:306-13. [PMID: 24889906 DOI: 10.1111/cpf.12166] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/28/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Aortic valve calcification (AVC) may predict poor outcome. Bicuspid aortic valve (BAV) leads to several haemodynamic changes accelerating the progress of aortic valve (AV) disease. AIMS To compare the diagnostic accuracy of transoesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) in the assessment of aortic valve phenotype and degree of AVC, with intra-operative evaluation as a reference. METHODS We examined 169 patients (median age 65 years, 51 women) without significant coronary artery disease undergoing AV and/or aortic root surgery. TTE was performed within a week prior to surgery and TEE at the time of surgery. RESULTS Compared with surgical AVC assessment, visual evaluation using a 5-grade scoring system and real-time images showed a higher correlation (TTE r = 0·83 and TEE r = 0·82) than visual (TTE r = 0·64 and TEE 0·63) or grey scale mean (GSMn) (TTE r = 0·63 and TEE r = 0·52) assessment of end-diastolic still frames. AVC assessment using real-time images showed high intraclass correlation coefficients (TTE 0·94 and TEE 0·93). With regard to BAV, TEE was superior to TTE with a higher interobserver agreement, sensitivity and specificity (0·86, 92% and 94% versus 0·57, 77% and 82%, respectively). CONCLUSION Semi-quantitative AVC assessment of real-time cine loops from both TEE and TTE correlated well with intra-operative evaluation of AVC. Applying a predefined scoring system for AVC evaluation assures a high interobserver correlation. TEE was superior to TTE for evaluation of valve phenotype and should be considered when a diagnosis of BAV is clinically important.
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Affiliation(s)
- Mohamed Yousry
- Departments of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Anette Rickenlund
- Departments of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Johan Petrini
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Jenner
- Departments of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jan Liska
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Thoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Per Eriksson
- Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Thoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Maria J Eriksson
- Departments of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Kenneth Caidahl
- Departments of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Sardi GL, Loh JP, Torguson R, Laynez-Carnicero A, Kitabata H, Xue Z, Satler LF, Pichard AD, Waksman R. Drug-eluting stents in patients on chronic hemodialysis: paclitaxel-eluting stents vs. limus-eluting stents. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:86-91. [PMID: 24684759 DOI: 10.1016/j.carrev.2014.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 01/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients requiring chronic hemodialysis (HD) are at high risk for restenosis after percutaneous coronary intervention (PCI) with bare metal stents. Outcome data on drug-eluting stent (DES) implantation in HD patients are limited and suggest superiority of paclitaxel-eluting stents (PES) over limus-eluting stents (LES). METHODS In total, 218 consecutive patients were prospectively enrolled. A comparison of post-PCI outcomes up to 2 years was carried out between patients receiving PES (n=62) and LES (n=156; SES n=112, EES n=44). The primary end point was 2-year major adverse cardiac events [MACE; death, Q-wave myocardial infarction and target lesion revascularization (TLR)]. RESULTS Baseline characteristics were comparable. The overall prevalence of diabetes mellitus was 71%. On clinical follow-up to 2 years, MACE rates were similar [PES 32/51 (62.7%) vs. LES 77/132 (58.3%), p=0.59]; however, clinically-driven revascularization occurred more than twice as frequently in LES patients: TLR [PES 4/36 (11.1%) vs. LES 24/93 (25.8%), p=0.07] and target vessel revascularization [5/37 (13.5%) vs. 33/96 (34.4%), p=0.02]. Given that overall mortality was nominally higher for PES patients [31/50 (62.0%) vs. 61/127 (48.0%), p=0.09], a competing outcome analysis was implemented for TLR against mortality, which demonstrated that the trend for increased TLR with LES was no longer apparent (p=0.282). On multivariable adjustment, only diabetes mellitus was independently associated with TLR (use of PES was not). CONCLUSIONS Patients on chronic HD experience high rates of clinically driven TLR despite DES implantation. Use of PES does not demonstrate a significant advantage over LES in this population.
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Affiliation(s)
- Gabriel L Sardi
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Joshua P Loh
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Rebecca Torguson
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | | | - Hironori Kitabata
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Zhenyi Xue
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Lowell F Satler
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Augusto D Pichard
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.
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Rattazzi M, Bertacco E, Del Vecchio A, Puato M, Faggin E, Pauletto P. Aortic valve calcification in chronic kidney disease. Nephrol Dial Transplant 2013; 28:2968-76. [PMID: 24097800 DOI: 10.1093/ndt/gft310] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Several clinical studies reported an increased prevalence and accelerated progression of aortic valve calcification among patients with end-stage renal disease when compared with subjects with normal kidney function. Recently, mechanisms of calcific valve degeneration have been further elucidated and many of the pathways involved could be amplified in patients with decreased renal function. In particular, calcium-phosphate balance, MGP metabolism, OPG/RANK/RANKL triad, fetuin-A mineral complexes and FGF-23/Klotho axis have been shown to be impaired among patients with advanced chronic kidney disease and could play a role during vascular/valve calcification. The scope of the present review is to summarize the clinical data and the pathophysiological mechanisms potentially involved in the link between renal function decline and the progression of aortic valve disease.
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7
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Takahashi H, Ishii H, Aoyama T, Kamoi D, Kasuga H, Ito Y, Yasuda K, Tanaka M, Yoshikawa D, Maruyama S, Matsuo S, Murohara T, Yuzawa Y. Association of Cardiac Valvular Calcifications and C-Reactive Protein With Cardiovascular Mortality in Incident Hemodialysis Patients: A Japanese Cohort Study. Am J Kidney Dis 2013; 61:254-61. [DOI: 10.1053/j.ajkd.2012.09.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 09/18/2012] [Indexed: 11/11/2022]
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8
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Sakakibara T, Ishii H, Toriyama T, Aoyama T, Takahashi H, Kamoi D, Kawamura Y, Kawashima K, Yoneda K, Amano T, Tanaka M, Yoshikawa D, Hayashi M, Matsubara T, Murohara T. Sirolimus-Eluting Stent vs. Everolimus-Eluting Stent for Coronary Intervention in Patients on Chronic Hemodialysis. Circ J 2012; 76:351-5. [DOI: 10.1253/circj.cj-11-0814] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takashi Sakakibara
- Cardiovascular Center, Nagoya Kyoritsu Hospital
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | - Toru Aoyama
- Cardiovascular Center, Nagoya Kyoritsu Hospital
| | | | | | | | | | | | - Tetsuya Amano
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Miho Tanaka
- Cardiovascular Center, Nagoya Kyoritsu Hospital
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Daiji Yoshikawa
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Mutsuharu Hayashi
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Tatsuaki Matsubara
- Department of Internal Medicine, School of Dentistry Aichi-Gakuin University
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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9
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Kamoi D, Ishii H, Takahashi H, Aoyama T, Toriyama T, Tanaka M, Kawamura Y, Kawashima K, Yoshikawa D, Amano T, Uetani T, Matsubara T, Murohara T. Sirolimus- vs. paclitaxel-eluting stent to coronary intervention in dialysis patients. Int J Cardiol 2011; 165:533-6. [PMID: 22000423 DOI: 10.1016/j.ijcard.2011.09.078] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 06/07/2011] [Accepted: 09/17/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Patients on maintenance hemodialysis (HD) are at high risk for restenosis after percutaneous coronary intervention (PCI) even if treated with a sirolimus-eluting stent (SES). The aim of this study was to compare the effects of SES and paclitaxel-eluting stent (PES) in preventing restenosis in HD patients with coronary artery disease. METHODS A total of 100 consecutive patients on HD who underwent PCI were enrolled into the study. They were randomly assigned to receive either SES or PES. We compared follow-up angiographic outcomes between the SES and PES groups at 8-month follow-up. RESULTS The angiographical restenosis rate, defined as % diameter stenosis>50% at 8-month follow-up, was 19.7% in the SES group and 20.0% in the PES group (p=0.97). Late loss was also similar between the two groups (0.49±0.70 mm vs. 0.48±0.91 mm, P=0.94). There were no significant differences in the rates of all-cause death, non-fatal myocardial infarction, or TLR due to stent restenosis-induced ischemia between the two groups (2.0% vs. 4.0%, p=0.56, 2.0% vs. 4.0%, p=0.56, and 16.0% vs. 12.0%, p=0.57, respectively). CONCLUSIONS There was no significant difference in angiographical outcome at 8-month follow-up between HD patients treated with SES and PES. Even if treated with DES including SES and PES, patients on HD are at high risk of restenosis after PCI.
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Affiliation(s)
- Daisuke Kamoi
- Department of Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Japan
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10
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Ishii H, Kumada Y, Toriyama T, Aoyama T, Takahashi H, Murohara T. Prognostic values of C-reactive protein levels on clinical outcome after endovascular therapy in hemodialysis patients with peripheral artery disease. J Vasc Surg 2010; 52:854-9. [PMID: 20638228 DOI: 10.1016/j.jvs.2010.05.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 05/12/2010] [Accepted: 05/12/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE Endovascular therapy (EVT) has been widely performed for peripheral artery disease. However, the high restenosis rate after EVT remains a major problem in patients on hemodialysis. Recent studies suggest that C-reactive protein (CRP) reflects vascular wall inflammation and can predict adverse events. We evaluated the possible prognostic values of CRP on outcomes in hemodialysis patients undergoing EVT. METHODS A total of 234 hemodialysis patients undergoing EVT for peripheral artery disease were enrolled and followed-up for up to 5 years. They were divided into tertiles according to serum CRP levels (lowest tertile, < 1.4 mg/L; middle tertile, 1.4-6.0 mg/L; highest tertile, ≥ 6.0 mg/L). We analyzed the incidence of any reintervention or above-ankle amputation of the limb index (RAO) and any-cause death. RESULTS Kaplan-Meier analysis showed that the event-free rate from the composite end point of RAO and any-cause death for 5 years was 60.2% in the lowest tertile, 50.0% in the middle tertile, and 25.1% in the highest tertile (P < .0001). The survival rate from any-cause death for 5 years was 81.5% in the lowest tertile, 65.2% in the middle tertile, and 59.3% in the highest tertile (P = .0078). Even after adjusting for other risk factors at baseline, preprocedural CRP levels were a significant predictive factor for RAO and any-cause death after EVT in a multivariable Cox analysis. CONCLUSIONS Elevated preprocedural serum CRP levels were associated with RAO and any-cause death after EVT in hemodialysis patients with peripheral artery disease.
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Affiliation(s)
- Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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11
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Ikee R, Honda K, Ishioka K, Oka M, Maesato K, Moriya H, Hidaka S, Ohtake T, Kobayashi S. Differences in associated factors between aortic and mitral valve calcification in hemodialysis. Hypertens Res 2010; 33:622-6. [PMID: 20379193 DOI: 10.1038/hr.2010.44] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Increased prevalence of aortic and mitral valve calcification has been reported in patients on hemodialysis, but it remains unknown whether aortic and mitral valve calcification arise from similar pathogenesis. We detected heart valve calcification using two-dimensional echocardiography, and we related valve calcification to various clinical parameters in patients treated with hemodialysis three times a week for more than 1 year. In 112 patients (77 men and 35 women, age 67+/-10 years, duration on hemodialysis 95+/-67 months), aortic and mitral valve calcification were observed in 84 (75.0%) and 58 (51.7%) patients, respectively. Aortic valve calcification was associated with increased age, higher serum calcium, lower serum albumin, lower total cholesterol and higher high-sensitivity C-reactive protein. Multivariate analysis showed that increased age and higher serum calcium were independently associated with aortic valve calcification. Conversely, mitral valve calcification was associated with increased age, higher high-sensitivity C-reactive protein and higher serum beta(2)-microglobulin, but not with higher serum calcium. In multivariate analysis, increased age and higher serum beta(2)-microglobulin were independently associated with mitral valve calcification. Serum beta(2)-microglobulin was associated with longer duration on hemodialysis, malnutrition inflammation (lower serum albumin and higher high-sensitivity C-reactive protein) and dyslipidemia. Considering the results in previous studies showing that the distribution of beta(2)-microglobulin amyloid deposition was consistent with that of tissue calcification in patients on hemodialysis, beta(2)-microglobulin may have pathogenic roles in valve calcification.
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Affiliation(s)
- Ryota Ikee
- Department of Nephrology and Kidney and Dialysis Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
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Ishii H, Kumada Y, Toriyama T, Aoyama T, Takahashi H, Tanaka M, Kamoi D, Kawamura Y, Yamada S, Hayashi M, Yasuda Y, Yuzawa Y, Maruyama S, Matsuo S, Matsubara T, Murohara T. Effects of oral cilostazol 100 mg BID on long-term patency after percutaneous transluminal angioplasty in patients with femoropopliteal disease undergoing hemodialysis: A retrospective chart review in Japanese patients. Clin Ther 2010; 32:24-33. [DOI: 10.1016/j.clinthera.2010.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2009] [Indexed: 10/19/2022]
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13
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Sherman RA. Briefly Noted. Semin Dial 2009. [DOI: 10.1111/j.1525-139x.2009.00631.x] [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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