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Takatsuki S, Shimokawahara H, Shimizu Y, Kawai R, Matsuura H, Matsubara H. Clinical differences between children and adults with idiopathic and heritable pulmonary arterial hypertension. Cardiol Young 2023; 33:1909-1912. [PMID: 36330840 DOI: 10.1017/s1047951122003432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although previous studies have demonstrated that paediatric pulmonary arterial hypertension remains distinct from that in adults, there are limited studies evaluating a direct comparison between children and adults. The aim of this head-to-head comparison study was to compare the gender, haemodynamic parameters, and prognosis between paediatric and adult pulmonary arterial hypertension. METHODS AND RESULTS We retrospectively assessed the clinical differences in 40 childhood-onset (under 20 years old) patients and 40 adult-onset patients with idiopathic and heritable pulmonary arterial hypertension who were followed up at two centres. There was no female predominance among patients with childhood-onset pulmonary arterial hypertension (child female: 42.5%, adult female: 80%). The percent of New York Heart Association functional class IV in adult-onset pulmonary arterial hypertension tended to be higher than those in childhood-onset pulmonary arterial hypertension (22.5 and 10%, respectively), although children had worse haemodynamic parameters at diagnosis (mean pulmonary artery pressure (children versus adults); median 65 mmHg versus 49 mmHg, p < 0.001). There was no significant difference in the event-free survival rate between the two groups (95% vs. 85%) during the follow-up period (median, 96 months; range, 1-120 months). CONCLUSIONS Although paediatric pulmonary arterial hypertension patients had worse haemodynamic parameters at diagnosis than adults, children survived as long as adults with appropriate therapeutic strategies.
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Affiliation(s)
- Shinichi Takatsuki
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
| | - Hiroto Shimokawahara
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yurika Shimizu
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
| | - Reiko Kawai
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
| | - Hiroyuki Matsuura
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
| | - Hiromi Matsubara
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Okayama, Japan
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Hashimoto K, Miyama H, Seki Y, Ibe S, Yamashita T, Fujisawa T, Katsumata Y, Kimura T, Fukuda K, Takatsuki S. Advantage of POLARx over ARCTIC FRONT ADVANCE PRO during pulmonary vein isolation for paroxysmal atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The electrical pulmonary vein (PV) isolation has been established as a curative therapy for paroxysmal atrial fibrillation (AF). Arctic Front™cryoballoon has been used worldwide for AF cryoablation. Recently, a new cryoballoon, POLARxTM CRYOABLATION system have been introduced, of which material of the balloon is softer and the N2O gas flow rate is higher.
Purpose
The aim was to investigate the procedural parameter and efficacy of POLARx comparing with Arctic Front.
Methods
This retrospective single center study included 101 consecutive patients who underwent paroxysmal AF ablation using cryoballoon at Keio University hospital from April 2021 to March 2022. The procedural data including the cryoballoon temperature and the number and duration of cryoablation were compared between POLARx (POLARx group) and ARCTIC FRONT ADVANCE PRO (AFA group). After the cryoablation, we added the radiofrequency application in order to maximize the isolated area when the voltage was remained inside PV (Figure 1). The necessities of the additional radiofrequency applications were also compared.
Results
In the present study, 64 patients in AFA group and 37 patients in POLARx group were analyzed. POLARx group included younger population and less females (62.8±9.9 vs 67.5±9.4 year of age, P=0.02; 13.5 vs 32.8%, P=0.04). There was no significant difference in comorbidities and examination data such as left atrium diameter or brain natriuretic peptide level. The minimal cryoballoon temperatures reached in POLARx group were lower than AFA group (−59.3±6.2 vs −47.7±7.5°C, P<0.01). No difference was found in the total number and duration of cryoablation and the time to isolate PV (6.1±2.1 vs 5.9±1.6, P=0.69; 790.2±256.1 vs 776.1±235.0 sec, P=0.69; 41.8±21.3 vs 47.1±29.6 sec, P=0.44, respectively). With regard to individual PVs, the total number and duration were tended to be larger at right superior PV in POLARx group (1.9±1.1 vs 1.4±0.7, P=0.01; 231.8±123.8 vs 193.2±83.0 sec, P=0.07), while there was no significant difference at the other PVs. The rate of successful PV isolation by a single cryo-application was not different between AFA and POLARx group (54.3 vs 61.4%, P=0.17). The additional radiofrequency applications were more frequent in AFA group (14.8 vs. 4.9%, P=0.003). There was a significant difference at right inferior PV (32.8 vs 8.1%, P=0.01), while not at left superior PV, left inferior PV and right superior PV (9.4 vs 2.9%, P=0.42; 9.4 vs 5.7%, P=0.71; 7.8 vs 2.7%, P=0.41). Phrenic nerve injury was occurred 1 case in both group and esophageal ulcer was occurred in 1 case in AFA group. No other complication including cardiac tamponade was occurred.
Conclusion
The total number and duration of cryoablation were not significantly different between AFA and POLARx group, except for right superior PV. There was an advantage in largely isolating right inferior PV in POLARx group comparing with AFA group.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Hashimoto
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - H Miyama
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - Y Seki
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - S Ibe
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - T Yamashita
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - T Fujisawa
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - Y Katsumata
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - T Kimura
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - K Fukuda
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
| | - S Takatsuki
- Keio University School of Medicine, Department of Cardiology , Tokyo , Japan
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Miyamoto K, Inai K, Kobayashi T, Maeda J, Takatsuki S, Nakayama T, Furutani Y, Yamagishi H, Nakanishi T. Outcomes of idiopathic pulmonary arterial hypertension in Japanese children: a retrospective cohort study. Heart Vessels 2021; 36:1392-1399. [PMID: 33738606 DOI: 10.1007/s00380-021-01806-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/09/2021] [Indexed: 11/25/2022]
Abstract
Recently, targeted therapy has been developed for idiopathic pulmonary arterial hypertension (IPAH). Studies evaluating the prognosis of IPAH have been conducted in adults. However, there is no nationwide survey of pediatric patients with IPAH regarding the long-term prognosis in Japan. Therefore, we investigated the clinical outcomes of Japanese pediatric patients with IPAH and risk factors for a poor prognosis. This multi-center, retrospective cohort study included pediatric patients with IPAH under the age of 15 years, who were gleaned from the nationwide network of Japanese Society of Pediatric Cardiology and Cardiac Surgery (JSPCCS). The questionnaire was sent to members of JSPCCS in 2015. Patients who were diagnosed with IPAH from 1994 to 2014 were included. The primary endpoint was death or lung transplantation. Ninety-five patients were finally enrolled. Both the mean age at diagnosis and the mean follow-up duration were 7 years. Ninety-five percent of patients had received targeted therapy for IPAH during follow-up. The overall 1, 3, 5, and 10-year event free rate, estimated using Kaplan-Meier survival estimate, was 96, 91, 83, and 74%, respectively. The prognosis was significantly poorer in patients with increased right ventricular systolic pressure (RVp), mean pulmonary artery pressure (mPAP) (≥ 52 mmHg), cardiothoracic ratio (≥ 55%), and levels of B-type natriuretic peptide (BNP) during follow-up (≥ 300 pg/mL) than in those without these parameters. In conclusion, in Japanese children with IPAH, the event-free rate for death or lung transplantation was found to be good. Greater RVp, mPAP, BNP levels during follow-up, and cardiothoracic ratio may be predictive indicators for a poor prognosis.
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Affiliation(s)
- Kenji Miyamoto
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
- Department of Pediatrics, School of Medicine, Dokkyo Medical University, Shimotoga, Tochigi, 321-0293, Japan
| | - Kei Inai
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tohru Kobayashi
- Department of Strategy and Management, Clinical Research Center, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Jun Maeda
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center, Musashidai 2-8-29,, Fuchu-shi, Tokyo, 183-8561, Japan.
- Department of Pediatrics, Keio Medical University, Shinjuku-ku, Tokyo, Japan.
| | - Shinichi Takatsuki
- Department of Pediatrics, Toho University Omori Medical Center, Ota-ku, Tokyo, Japan
| | - Tomotaka Nakayama
- Department of Pediatrics, Kouchi Medical School, Nankoku City, Kochi, Japan
| | - Yoshiyuki Furutani
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Hiroyuki Yamagishi
- Department of Pediatrics, Keio Medical University, Shinjuku-ku, Tokyo, Japan
| | - Toshio Nakanishi
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
- Department of Pediatrics, School of Medicine, International University of Health and Welfare, Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-8520, Japan.
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Takatsuki S, Furutani Y, Inai K, Kobayashi T, Inuzuka R, Uyeda T, Kamisago M, Muneuchi J, Kaneko M, Misaki Y, Ono H, Kato H, Shimada E, Shinohara T, Waki K, Suda K, Hayabuchi Y, Ohki H, Ishizaki R, Maeda J, Yamagishi H. Pregnancy and Delivery in Patients With Repaired Congenital Heart Disease - A Retrospective Japanese Multicenter Study. Circ J 2020; 84:2270-2274. [PMID: 33055459 DOI: 10.1253/circj.cj-19-1150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although advances in cardiac surgery have led to an increased number of survivors with congenital heart disease (CHD), epidemiological data regarding the pregnancies and deliveries of patients with repaired CHD are scarce.Methods and Results:In this study, we retrospectively reviewed the clinical outcomes of pregnancies and deliveries of women with repaired CHD. Overall, 131 women with repaired CHD were enrolled and there were 269 gestations. All patients were classified as New York Heart Association (NYHA) Class I or II. The prevalence of cesarean sections was higher in patients with (CyCHD) than without (AcyCHD) a past history of cyanosis (51% vs. 19%, respectively; P<0.01). There were 228 offspring from 269 gestations and the most prevalent neonatal complication was premature birth (10%), which was more frequent in the CyCHD than AcyCHD group (15.7% vs. 5.6%, respectively; P<0.01). Five maternal cardiac complications during delivery were observed only in the CyCHD group (8%); these were classified as NYHA Class II and none was fatal. CONCLUSIONS Delivery was successful in most women with repaired CHD who were classified as NYHA Class I or II, although some with CyCHD and NYHA Class II required more attention. Cesarean sections were more common in the CyCHD than AcyCHD group, and CyCHD may be a potential risk for preterm deliveries.
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Affiliation(s)
| | - Yoshiyuki Furutani
- Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University
| | - Kei Inai
- Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University
| | - Tohru Kobayashi
- Department of Development Strategy, Center for Clinical Research and Development, National Center for Child Health and Development
| | - Ryo Inuzuka
- Department of Pediatrics, The University of Tokyo Hospital
| | - Tomomi Uyeda
- Department of Pediatric Cardiology, Sakakibara Heart Institute
| | | | - Jun Muneuchi
- Department of Pediatric Cardiology, Japan Health Care Community Organization Kyushu Hospital
| | - Masahide Kaneko
- Department of Pediatric Cardiology, National Center for Child Health and Development
| | - Yasushi Misaki
- Department of Pediatric Cardiology, National Center for Child Health and Development
| | - Hiroshi Ono
- Department of Pediatric Cardiology, National Center for Child Health and Development
| | - Hitoshi Kato
- Department of Pediatric Cardiology, National Center for Child Health and Development
| | - Eriko Shimada
- Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University
| | - Tokuko Shinohara
- Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women's Medical University
| | - Kenji Waki
- Department of Pediatrics, Kurashiki Central Hospital
| | - Kenji Suda
- Department of Pediatrics, Kurume University Hospital
| | | | - Hirotaka Ohki
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | - Reina Ishizaki
- Department of Pediatrics, Keio University School of Medicine
| | - Jun Maeda
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center.,Department of Pediatrics, Keio University School of Medicine
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Miyama H, Takatsuki S, Hashimoto K, Yamashita T, Fujisawa T, Katsumata Y, Kimura T, Fukuda K. Change of the pulmonary vein anatomy after cryoballoon ablation reflecting left atrial reverse remodeling. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cryoballoon ablation (CBA) is a widely used procedure for atrial fibrillation (AF). However, the anatomical change of pulmonary veins (PVs) and the risk factors of PV stenosis is less clear. We aimed to decipher the prevalence and the predictive factors for PV stenosis after CBA.
Methods
We analyzed the data of 320 PVs from 80 patients who underwent CBA for AF (age: 62±10 years, 59 males, 75 paroxysmal AF). All patients underwent pre- and post-procedural cardiac computed tomography (mean 6.7±3.3 months after ablation). We defined the PV stenosis when the cross sectional area of PV was less than 50% compared with that of PV before the CBA.
Results
The average cross sectional PV area decreased significantly after CBA (pre- vs. post-CBA; 2.4±1.0cm2 vs. 2.3±1.1cm2, P<0.001), whereas the volume of left atrium (LA) also decreased significantly (pre- vs. post-CBA; 75.0±23.2cm3 vs. 70.7±21.9cm3, P<0.001). There was a weak but significant correlation between the reduction rate of PV area and that of LA volume (Pearson's correlation coefficient 0.411, p<0.001). Only 6 PV stenosis were revealed, in which area reduction of more than 75% and 50–75% were observed in 2 PVs and 4 PVs, respectively. The incidence of PV stenosis was greater in female (male vs. female; 0.8% vs. 4.8%, P=0.043) and tend to be frequent in left PVs (left PVs vs. right PVs; 3.1% vs. 0.6%: P=0.107). Moreover, patients who developed PV stenosis tended to have lower weight and shorter height (PV stenosis group vs. non-PV stenosis group; 58.2±12.4kg vs. 67.7±13.0kg: P=0.078, 161.2±9.1cm vs. 167.2±8.8cm: P=0.094). There were no significant differences in the number of freezing, minimum temperature and total freezing time between PV stenosis group and non-PV stenosis group.
Conclusions
The ostial PV area decreased significantly but little after CBA, possibly due to LA reverse remodeling. The PV stenosis was more common in women and tend to be frequent in left PVs, lower weight, and shorter height patients, though severe stenosis after CBA was not observed in this study.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- H Miyama
- Keio University School of Medicine, Tokyo, Japan
| | - S Takatsuki
- Keio University School of Medicine, Tokyo, Japan
| | - K Hashimoto
- Keio University School of Medicine, Tokyo, Japan
| | - T Yamashita
- Keio University School of Medicine, Tokyo, Japan
| | - T Fujisawa
- Keio University School of Medicine, Tokyo, Japan
| | - Y Katsumata
- Keio University School of Medicine, Tokyo, Japan
| | - T Kimura
- Keio University School of Medicine, Tokyo, Japan
| | - K Fukuda
- Keio University School of Medicine, Tokyo, Japan
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6
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Nakashima Y, Sakai Y, Mizuno Y, Furuno K, Hirono K, Takatsuki S, Suzuki H, Onouchi Y, Kobayashi T, Tanabe K, Hamase K, Miyamoto T, Aoyagi R, Arita M, Yamamura K, Tanaka T, Nishio H, Takada H, Ohga S, Hara T. Lipidomics links oxidized phosphatidylcholines and coronary arteritis in Kawasaki disease. Cardiovasc Res 2019; 117:96-108. [PMID: 31782770 DOI: 10.1093/cvr/cvz305] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/13/2019] [Accepted: 11/26/2019] [Indexed: 12/14/2022] Open
Abstract
AIMS Coronary arteritis is a life-threatening complication that may arise in the acute stage of Kawasaki disease (KD), the leading cause of systemic vasculitis in childhood. Various microorganisms and molecular pathogens have been reported to cause KD. However, little is known about the key molecules that contribute to the development of coronary arteritis in KD. METHODS AND RESULTS To identify causative molecules for coronary arteritis in KD, we prospectively recruited 105 patients with KD and 65 disease controls in four different parts of Japan from 2015 to 2018. During this period, we conducted lipidomics analyses of their sera using liquid chromatography-mass spectrometry (LC-MS). The comprehensive LC-MS system detected a total of 27 776 molecules harbouring the unique retention time and m/z values. In the first cohort of 57 KD patients, we found that a fraction of these molecules showed enrichment patterns that varied with the sampling region and season. Among them, 28 molecules were recurrently identified in KD patients but not in controls. The second and third cohorts of 48 more patients with KD revealed that these molecules were correlated with inflammatory markers (leucocyte counts and C-reactive proteins) in the acute stage. Notably, two of these molecules (m/z values: 822.55 and 834.59) were significantly associated with the development of coronary arteritis in the acute stage of KD. Their fragmentation patterns in the tandem MS/MS analysis were consistent with those of oxidized phosphatidylcholines (PCs). Further LC-MS/MS analysis supported the concept that reactive oxygen species caused the non-selective oxidization of PCs in KD patients. In addition, the concentrations of LOX-1 ligand containing apolipoprotein B in the plasma of KD patients were significantly higher than in controls. CONCLUSION These data suggest that inflammatory signals activated by oxidized phospholipids are involved in the pathogenesis of coronary arteritis in KD. Because the present study recruited only Japanese patients, further examinations are required to determine whether oxidized PCs might be useful biomarkers for the development of coronary arteritis in broad populations of KD.
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Affiliation(s)
- Yasutaka Nakashima
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yumi Mizuno
- Kawasaki Disease Center, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka 813-0017, Japan
| | - Kenji Furuno
- Kawasaki Disease Center, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka 813-0017, Japan
| | - Keiichi Hirono
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama 930-194, Japan
| | - Shinichi Takatsuki
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo 143-8540, Japan
| | - Hiroyuki Suzuki
- Department of Pediatrics, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Yoshihiro Onouchi
- Department of Public Health, Chiba University Graduate School of Medicine, Chiba 260-0856, Japan
| | - Tohru Kobayashi
- Department of Management and Strategy, Clinical Research Center, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Kazuhiro Tanabe
- Medical Solution Promotion Department, LSI Medience Corporation, Tokyo 101-8517, Japan
| | - Kenji Hamase
- Department of Drug Discovery and Evolution, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Tomofumi Miyamoto
- Department of Pharmaceutical Health Care and Sciences, Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Ryohei Aoyagi
- Laboratory for Metabolomics, RIKEN Center for Integrative Medical Sciences (IMS), Tsurumi, Yokohama, Kanagawa 230-0045, Japan.,Division of Physiological Chemistry and Metabolism, Graduate School of Pharmaceutical Sciences, Keio University, Minato-ku, Tokyo 105-0011, Japan
| | - Makoto Arita
- Laboratory for Metabolomics, RIKEN Center for Integrative Medical Sciences (IMS), Tsurumi, Yokohama, Kanagawa 230-0045, Japan.,Division of Physiological Chemistry and Metabolism, Graduate School of Pharmaceutical Sciences, Keio University, Minato-ku, Tokyo 105-0011, Japan
| | - Kenichiro Yamamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tamami Tanaka
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hisanori Nishio
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hidetoshi Takada
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Toshiro Hara
- Kawasaki Disease Center, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha, Higashi-ku, Fukuoka 813-0017, Japan
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7
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Masuda T, Hamasaki Y, Kubota M, Hashimoto J, Takahashi Y, Muramatsu M, Takatsuki S, Matsuura H, Sakai K, Shishido S. Changes in cardiac function after renal transplantation in children: Significance of pre-transplantation left ventricular hypertrophy. Pediatr Transplant 2019; 23:e13558. [PMID: 31407865 DOI: 10.1111/petr.13558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 01/26/2023]
Abstract
LVH is a significant risk factor for the development of cardiovascular morbidity. However, few studies have evaluated the changes in cardiac function that occur in pediatric patients with ESRD undergoing RTx. Therefore, we assessed the changes in parameters associated with LVH in children within the first year after RTx. We retrospectively evaluated patients aged < 18 years who underwent initial RTx from April 2014 to December 2016. The patients were divided into 2 groups according to the presence of LVH before RTx. Clinical, biochemical, and echocardiographic parameters including the LVMI before and 1 year after RTx were evaluated in both groups. Twenty-six patients were included in this study. Seven of the 26 patients had LVH before RTx. Among the echocardiographic parameters, the LVMI was significantly improved 1 year after RTx in the initial LVH group (57.79 ± 11.86 vs 42.20 ± 6.03 g/cm2.7 , P = .018), while no change was observed in the initial non-LVH group (32.66 ± 7.52 vs 35.17 ± 12.86 g/cm2.7 , P = .376). Improvement of the ejection fraction was also observed only in the initial LVH group (66.5% ± 5.3% vs 72.2% ± 5.2%, P = .042). Children who had LVH before RTx showed significant improvements in the LVMI and ejection fraction even within 1 year after RTx. To minimize aggravation of cardiac function, early RTx should be considered for patients with LVH.
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Affiliation(s)
- Toshiki Masuda
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Yuko Hamasaki
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Mai Kubota
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Junya Hashimoto
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Yusuke Takahashi
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Masaki Muramatsu
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Shinichi Takatsuki
- Department of Pediatrics, Toho University Faculty of Medicine, Tokyo, Japan
| | - Hiroyuki Matsuura
- Department of Pediatrics, Toho University Faculty of Medicine, Tokyo, Japan
| | - Ken Sakai
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Seiichiro Shishido
- Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
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8
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Hamada H, Suzuki H, Onouchi Y, Ebata R, Terai M, Fuse S, Okajima Y, Kurotobi S, Hirai K, Soga T, Ishiguchi Y, Okuma Y, Takada N, Yanai M, Sato J, Nakayashiro M, Ayusawa M, Yamamoto E, Nomura Y, Hashimura Y, Ouchi K, Masuda H, Takatsuki S, Hirono K, Ariga T. 307. EFFICACY OF PRIMARY TREATMENT WITH IMMUNOGLOBULIN PLUS CYCLOSPORINE FOR PREVENTION OF CORONARY ARTERY ABNORMALITIES IN KAWASAKI DISEASE PATIENTS PREDICTED TO BE AT INCREASED RISK OF IVIG NON- RESPONSE (KAICA STUDY): A CONTROLLED, PHASE 3, RANDOMISED, OPEN-LABEL, BLINDED-ENDPOINTS TRIAL. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez063.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | - Ryota Ebata
- Chiba University Graduate School of Med Chiba, Japan
| | | | | | | | | | | | - Takashi Soga
- Showa University Northern Yokohama Hospital Yokohama, Japan
| | | | - Yoshiaki Okuma
- National Center for Global Health and Medicine Shinjuku, Japan
| | | | | | - Junichi Sato
- Funabashi Municipal Medical Center Funabashi, Japan
| | - Mami Nakayashiro
- Okinawa Pref Nambu & Children’s Medical Center Shimajiri-gun, Japan
| | | | | | | | | | | | - Hiroshi Masuda
- National Center for Child Health and Development Setagaya, Japan
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Hamada H, Suzuki H, Onouchi Y, Ebata R, Terai M, Fuse S, Okajima Y, Kurotobi S, Hirai K, Soga T, Ishiguchi Y, Okuma Y, Takada N, Yanai M, Sato J, Nakayashiro M, Ayusawa M, Yamamoto E, Nomura Y, Hashimura Y, Ouchi K, Masuda H, Takatsuki S, Hirono K, Ariga T, Higaki T, Otsuki A, Terauchi M, Aoyagi R, Sato T, Fujii Y, Fujiwara T, Hanaoka H, Hata A. Efficacy of primary treatment with immunoglobulin plus ciclosporin for prevention of coronary artery abnormalities in patients with Kawasaki disease predicted to be at increased risk of non-response to intravenous immunoglobulin (KAICA): a randomised controlled, open-label, blinded-endpoints, phase 3 trial. Lancet 2019; 393:1128-1137. [PMID: 30853151 DOI: 10.1016/s0140-6736(18)32003-8] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Genetic studies have indicated possible involvement of the upregulated calcium-nuclear factor of activated T cells pathway in the pathogenesis of Kawasaki disease. We aimed to assess safety and efficacy of ciclosporin, an immunosuppressant targeting this pathway, for protection of patients with Kawasaki disease against coronary artery abnormalities. METHODS We did a randomised, open-label, blinded endpoints trial involving 22 hospitals in Japan between May 29, 2014, and Dec 27, 2016. Eligible patients predicted to be at higher risk for intravenous immunoglobulin (IVIG) resistance were randomly assigned to IVIG plus ciclosporin (5 mg/kg per day for 5 days; study treatment) or IVIG (conventional treatment) groups, stratified by risk score, age, and sex. The primary endpoint was incidence of coronary artery abnormalities using Japanese criteria during the 12-week trial, assessed in participants who received at least one dose of study drug and who visited the study institution at least once during treatment. This trial is registered to Center for Clinical Trials, Japan Medical Association, number JMA-IIA00174. FINDINGS We enrolled 175 participants. One patient withdrew consent after enrolment and was excluded and one patient (in the study treatment group) was excluded from analysis because of lost echocardiography data. Incidence of coronary artery abnormalities was lower in the study treatment group than in the conventional treatment group (12 [14%] of 86 patients vs 27 [31%] of 87 patients; risk ratio 0·46; 95% CI 0·25-0·86; p=0·010). No difference was found in the incidence of adverse events between the groups (9% vs 7%; p=0·78). INTERPRETATION Combined primary therapy with IVIG and ciclosporin was safe and effective for favourable coronary artery outcomes in Kawasaki disease patients who were predicted to be unresponsive to IVIG. FUNDING Japan Agency for Medical Research and Development (grant CCT-B-2503).
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Affiliation(s)
- Hiromichi Hamada
- Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Pediatrics, Yachiyo Medical Center, Tokyo Women's Medical University, Chiba, Japan
| | - Hiroyuki Suzuki
- Department of Pediatrics, Wakayama Medical University of Medicine, Wakayama, Japan
| | | | - Ryota Ebata
- Department of Pediatrics, Chiba University, Chiba, Japan
| | - Masaru Terai
- Department of Pediatrics, Yachiyo Medical Center, Tokyo Women's Medical University, Chiba, Japan
| | - Shigeto Fuse
- Department of Pediatrics, NTT Sapporo Medical Center, Sapporo, Japan
| | | | | | - Katsuki Hirai
- Department of Pediatrics, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Takashi Soga
- Department of Pediatrics, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yukiko Ishiguchi
- Department of Pediatric Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yoshiaki Okuma
- Department of Pediatrics, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobuyuki Takada
- Department of Pediatrics, Kimitsu Chuo Hospital, Chiba, Japan
| | - Masaaki Yanai
- Department of Pediatrics, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Junichi Sato
- Department of Pediatrics, Funabashi Municipal Medical Center, Funabashi, Japan
| | - Mami Nakayashiro
- Department of Pediatric Cardiology, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan
| | - Mamoru Ayusawa
- Department of Pediatrics, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Eiichi Yamamoto
- Department of Pediatrics, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Yuichi Nomura
- Department of Pediatrics, Kagoshima City Hospital, Kagoshima, Japan
| | - Yuya Hashimura
- Department of Pediatrics, Takatsuki General Hospital, Osaka, Japan
| | - Kazunobu Ouchi
- Department of Pediatrics, Kawasaki Medical School Hospital, Okayama, Japan
| | - Hiroshi Masuda
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | | | - Keiichi Hirono
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Tadashi Ariga
- Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan
| | - Takashi Higaki
- Department of Regional Pediatrics and Perinatology, Graduate School of Medicine, Ehime University, Ehime, Japan
| | - Akio Otsuki
- Department of Pediatrics, Komatsu Municipal Hospital, Ishikawa, Japan
| | - Moe Terauchi
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Reiko Aoyagi
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Takatoshi Sato
- Department of Pediatrics, Funabashi Municipal Medical Center, Funabashi, Japan; Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Yasuhisa Fujii
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Tadami Fujiwara
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Hideki Hanaoka
- Clinical Research Centre, Chiba University Hospital, Chiba, Japan
| | - Akira Hata
- Department of Public Health, Chiba University, Chiba, Japan.
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Nakajima K, Kimura T, Fujisawa T, Katsumata Y, Nishiyama T, Aizawa Y, Mano Y, Kageyama T, Mitamura H, Fukuda K, Kohsaka S, Takatsuki S. P6600Improvement in quality of life in patients that underwent catheter ablation for persistent atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Nakajima
- Keio University School of Medicine, cardiology, Tokyo, Japan
| | - T Kimura
- Keio University School of Medicine, cardiology, Tokyo, Japan
| | - T Fujisawa
- Keio University School of Medicine, cardiology, Tokyo, Japan
| | - Y Katsumata
- Keio University School of Medicine, cardiology, Tokyo, Japan
| | - T Nishiyama
- Keio University School of Medicine, cardiology, Tokyo, Japan
| | - Y Aizawa
- Keio University School of Medicine, cardiology, Tokyo, Japan
| | - Y Mano
- Tokyo Dental College Ichikawa General Hospita, Cardiology, Ichikawa, Japan
| | - T Kageyama
- Tachikawa Hospital, Cardiology, Tachikawa, Japan
| | - H Mitamura
- Tachikawa Hospital, Cardiology, Tachikawa, Japan
| | - K Fukuda
- Keio University School of Medicine, cardiology, Tokyo, Japan
| | - S Kohsaka
- Keio University School of Medicine, cardiology, Tokyo, Japan
| | - S Takatsuki
- Keio University School of Medicine, cardiology, Tokyo, Japan
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11
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Miura M, Kobayashi T, Kaneko T, Ayusawa M, Fukazawa R, Fukushima N, Fuse S, Hamaoka K, Hirono K, Kato T, Mitani Y, Sato S, Shimoyama S, Shiono J, Suda K, Suzuki H, Maeda J, Waki K, Kato H, Saji T, Yamagishi H, Ozeki A, Tomotsune M, Yoshida M, Akazawa Y, Aso K, Doi S, Fukasawa Y, Furuno K, Hayabuchi Y, Hayashi M, Honda T, Horita N, Ikeda K, Ishii M, Iwashima S, Kamada M, Kaneko M, Katyama H, Kawamura Y, Kitagawa A, Komori A, Kuraishi K, Masuda H, Matsuda S, Matsuzaki S, Mii S, Miyamoto T, Moritou Y, Motoki N, Nagumo K, Nakamura T, Nishihara E, Nomura Y, Ogata S, Ohashi H, Okumura K, Omori D, Sano T, Suganuma E, Takahashi T, Takatsuki S, Takeda A, Terai M, Toyono M, Watanabe K, Watanabe M, Yamamoto M, Yamamura K. Association of Severity of Coronary Artery Aneurysms in Patients With Kawasaki Disease and Risk of Later Coronary Events. JAMA Pediatr 2018; 172:e180030. [PMID: 29507955 PMCID: PMC5875323 DOI: 10.1001/jamapediatrics.2018.0030] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Few studies with sufficient statistical power have shown the association of the z score of the coronary arterial internal diameter with coronary events (CE) in patients with Kawasaki disease (KD) with coronary artery aneurysms (CAA). OBJECTIVE To clarify the association of the z score with time-dependent CE occurrence in patients with KD with CAA. DESIGN, SETTING, AND PARTICIPANTS This multicenter, collaborative retrospective cohort study of 44 participating institutions included 1006 patients with KD younger than 19 years who received a coronary angiography between 1992 and 2011. MAIN OUTCOMES AND MEASURES The time-dependent occurrence of CE, including thrombosis, stenosis, obstruction, acute ischemic events, and coronary interventions, was analyzed for small (z score, <5), medium (z score, ≥5 to <10; actual internal diameter, <8 mm), and large (z score, ≥10 or ≥8 mm) CAA by the Kaplan-Meier method. The Cox proportional hazard regression model was used to identify risk factors for CE after adjusting for age, sex, size, morphology, number of CAA, resistance to initial intravenous immunoglobulin (IVIG) therapy, and antithrombotic medications. RESULTS Of 1006 patients, 714 (71%) were male, 341 (34%) received a diagnosis before age 1 year, 501 (50%) received a diagnosis between age 1 and 5 years, and 157 (16%) received a diagnosis at age 5 years or older. The 10-year event-free survival rate for CE was 100%, 94%, and 52% in men (P < .001) and 100%, 100%, and 75% in women (P < .001) for small, medium, and large CAA, respectively. The CE-free rate was 100%, 96%, and 79% in patients who were not resistant to IVIG therapy (P < .001) and 100%, 96%, and 51% in patients who were resistant to IVIG therapy (P < .001), respectively. Cox regression analysis revealed that large CAA (hazard ratio, 8.9; 95% CI, 5.1-15.4), male sex (hazard ratio, 2.8; 95% CI, 1.7-4.8), and resistance to IVIG therapy (hazard ratio, 2.2; 95% CI, 1.4-3.6) were significantly associated with CE. CONCLUSIONS AND RELEVANCE Classification using the internal diameter z score is useful for assessing the severity of CAA in relation to the time-dependent occurrence of CE and associated factors in patients with KD. Careful management of CE is necessary for all patients with KD with CAA, especially men and IVIG-resistant patients with a large CAA.
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Affiliation(s)
- Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan,Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Tohru Kobayashi
- Division of Clinical Research Planning, Department of Development Strategy, Center for Clinical Research and Development, National Center for Child Health and Development, Tokyo, Japan
| | - Tetsuji Kaneko
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Mamoru Ayusawa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Ryuji Fukazawa
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Naoya Fukushima
- Department of Cardiology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
| | - Shigeto Fuse
- Department of Pediatrics, NTT Sapporo Medical Center, Hokkaido, Japan
| | - Kenji Hamaoka
- Department of Pediatric Cardiology and Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Hirono
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Taichi Kato
- Division of Clinical Research Planning, Department of Development Strategy, Center for Department of Pediatrics, Nagoya University Hospital, Aichi, Japan
| | - Yoshihide Mitani
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| | - Seiichi Sato
- Department of Pediatrics, Niigata City General Hospital, Niigata, Japan
| | - Shinya Shimoyama
- Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Junko Shiono
- Department of Pediatric Cardiology, Ibaraki Children's Hospital, Ibaraki, Japan
| | - Kenji Suda
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroshi Suzuki
- Department of Pediatrics, Niigata University, Niigata, Japan
| | - Jun Maeda
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Waki
- Department of Pediatrics, Kurashiki Central Hospital, Okayama, Japan
| | | | - Hitoshi Kato
- Division of Clinical Research Planning, Department of Development Strategy, Center for Clinical Research and Development, National Center for Child Health and Development, Tokyo, Japan
| | - Tsutomu Saji
- Department of Pediatrics, Toho University Medical Center Omori Hospital, Tokyo, Japan
| | - Hiroyuki Yamagishi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Aya Ozeki
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Masako Tomotsune
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Makiko Yoshida
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yohei Akazawa
- Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan
| | - Kentaro Aso
- Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shouzaburoh Doi
- Department of Pediatrics, Perinatal and Maternal Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshi Fukasawa
- Division of Clinical Research Planning, Department of Development Strategy, Center for Department of Pediatrics, Nagoya University Hospital, Aichi, Japan
| | - Kenji Furuno
- Department of General Pediatrics & Interdisciplinary Medicine, Fukuoka Children's Hospital, Fukuoka, Japan
| | | | - Miyuki Hayashi
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Takafumi Honda
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Norihisa Horita
- Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Kazuyuki Ikeda
- Department of Pediatric Cardiology and Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Ishii
- Department of Pediatrics, Kitasato University, Kanagawa, Japan
| | - Satoru Iwashima
- Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Masahiro Kamada
- Department of Pediatrics, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Masahide Kaneko
- Division of Clinical Research Planning, Department of Development Strategy, Center for Clinical Research and Development, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroshi Katyama
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Yoichi Kawamura
- Department of Pediatrics, National Defense Medical College, Saitama, Japan
| | - Atushi Kitagawa
- Department of Pediatrics, Kitasato University, Kanagawa, Japan
| | - Akiko Komori
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Kenji Kuraishi
- Department of Pediatric Cardiology and Neonatology, Ogaki Municipal Hospital, Gifu, Japan
| | - Hiroshi Masuda
- Division of Clinical Research Planning, Department of Development Strategy, Center for Clinical Research and Development, National Center for Child Health and Development, Tokyo, Japan
| | - Shinichi Matsuda
- Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan
| | - Satoshi Matsuzaki
- Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan
| | - Sayaka Mii
- Department of Pediatrics, Japanese Red Cross Nagoya Daiichi Hospital, Aichi, Japan
| | - Tomoyuki Miyamoto
- Department of Pediatrics, Yokosuka General Hospital Uwamachi, Kanagawa, Japan
| | - Yuji Moritou
- Department of Pediatrics, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Noriko Motoki
- Department of Pediatrics, Shinshu University School of Medicine, Nagano, Japan
| | - Kiyoshi Nagumo
- Department of Pediatrics, Teine Keijinkai Hospital, Hokkaido, Japan
| | | | - Eiki Nishihara
- Department of Pediatric Cardiology and Neonatology, Ogaki Municipal Hospital, Gifu, Japan
| | - Yuichi Nomura
- Department of Pediatrics, Kagoshima University, Kagoshima, Japan
| | - Shohei Ogata
- Department of Pediatrics, Kitasato University, Kanagawa, Japan
| | - Hiroyuki Ohashi
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| | - Kenichi Okumura
- Department of Pediatrics, Osaka Medical College, Osaka, Japan
| | - Daisuke Omori
- Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Tetsuya Sano
- Department of Pediatrics, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Eisuke Suganuma
- Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan
| | - Tsutomu Takahashi
- Department of Pediatrics, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Shinichi Takatsuki
- Department of Pediatrics, Toho University Medical Center Omori Hospital, Tokyo, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Hokkaido, Japan
| | - Masaru Terai
- Department of Pediatrics, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | | | | | - Makoto Watanabe
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
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12
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Masuda H, Kobayashi T, Hachiya A, Nakashima Y, Shimizu H, Nozawa T, Ogihara Y, Ito S, Takatsuki S, Katsumata N, Suzuki Y, Takenaka S, Hirono K, Kobayashi T, Suzuki H, Suganuma E, Takahashi K, Saji T. Infliximab for the Treatment of Refractory Kawasaki Disease: A Nationwide Survey in Japan. J Pediatr 2018; 195:115-120.e3. [PMID: 29224935 DOI: 10.1016/j.jpeds.2017.10.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/10/2017] [Accepted: 10/12/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of infliximab (IFX) for the treatment of patients with Kawasaki disease (KD). STUDY DESIGN This was a nationwide survey of 274 Japanese institutions exploring how IFX was used to treat patients with KD. The patients' sex, age, treatment course, pre- and post-IFX therapy blood test results, coronary artery lesions (CALs), and adverse events (AEs) were evaluated. RESULTS We analyzed 434 patients with KD who received IFX between March 2005 and November 2014. The median age at onset was 33 months (range 1-138), and 66 patients (15.2%) were under 1 year old. In all cases, IFX was administered as additional treatment. The median days of illness at the initiation of IFX was 9 days. In 275 patients (63.4%), IFX was administered as third-line treatment, and in 106 patients (24.4%), IFX was administered as fourth-line treatment. Single dose IFX 5 mg/kg was administered to 412 patients (94.9%). After IFX, 363 patients (83.6%) became afebrile within 2 days, and the white blood cell count, percentage of neutrophils, and serum C-reactive protein levels significantly decreased (P < .001), although 119 patients (27.4%) received additional treatment. Before IFX, 132 patients (30.4%) had already developed CALs. In patients without CALs before IFX, 31 patients (10.3%) newly developed CAL after IFX, whereas 32 patients (24.2%) with CAL before IFX showed increased CAL severity. Eighty AEs were observed in 69 patients (15.9%); however, serious AEs were few and reversible. CONCLUSIONS IFX might be an effective and tolerable treatment for refractory KD.
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Affiliation(s)
- Hiroshi Masuda
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan; Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Tohru Kobayashi
- Division of Clinical Research Planning, Department of Development Strategy, Center for Clinical Research and Development, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.
| | - Akira Hachiya
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yasutaka Nakashima
- Department of Pediatrics, Graduate School of Medical Sciences, Kyusyu University, Fukuoka, Fukuoka, Japan
| | - Hiroyuki Shimizu
- Children's Medical Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Tomo Nozawa
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Yoshihito Ogihara
- Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan; Division of Pediatric Nephrology and Rheumatology, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Shinichi Takatsuki
- Department of Pediatrics, Toho University, Medical Center Omori Hospital, Ota-ku, Tokyo, Japan
| | - Nobuyuki Katsumata
- Department of Pediatrics, Faculty of Medicine University of Yamanashi, Chuo, Yamanashi, Japan
| | - Yasuo Suzuki
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Satoshi Takenaka
- Department of Pediatrics, Japan Community Healthcare Organization (JCHO), Kyusyu Hospital, Kitakyushu, Fukuoka, Japan
| | - Keiichi Hirono
- Department of Pediatrics, Graduate School of Medicine, University of Toyama, Toyama, Toyama, Japan
| | - Tomio Kobayashi
- Division of Cardiology, Gunma Children's Medical Center, Shibukawa, Gunma, Japan
| | - Hiroshi Suzuki
- Department of Pediatrics, Yamagata University School of Medicine, Yamagata, Yamagata, Japan
| | - Eisuke Suganuma
- Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Saitama, Japan
| | - Kei Takahashi
- Department of Pathology, Toho University Ohashi Medical Center, Shibuya-ku, Tokyo, Japan
| | - Tsutomu Saji
- Advanced and Integrated Cardiovascular Research Course in the Young and Adolescence, Ota-ku, Toho University, Tokyo, Japan
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- Japan Society of Kawasaki Disease, Tokyo, Japan
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13
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Ikehara S, Takatsuki S, Nakayama T, Naoi K, Matsuura H, Saji T. Clinical Impact of Main Pulmonary Artery Dilatation on Outcome in Pediatric Idiopathic and Heritable Pulmonary Arterial Hypertension. Circ J 2018; 82:541-545. [PMID: 28904266 DOI: 10.1253/circj.cj-17-0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Few studies have investigated the clinical impact of pulmonary artery (PA) dilatation on outcomes in pediatric pulmonary arterial hypertension (PAH).Methods and Results:This study investigated the clinical outcomes of idiopathic or heritable PAH in 66 children aged <18 years at diagnosis. Main PA/thorax (MPA/T) ratio was measured on chest radiography in PAH patients. Patients were divided into 2 groups based on MPA/T ratio, and compared with a control group of 166 age- and gender-matched healthy children. Group A had higher MPA/T ratio than normal, and group B had normal MPA/T ratio. Composite outcomes included cardiac death, lung transplantation, and hospitalization due to heart failure. Group A consisted of 27 patients and group B, 39 patients. At diagnosis, group A had significantly higher brain natriuretic peptide (BNP), cardiothoracic ratio, PA pressure, and pulmonary vascular resistance index compared with group B. The number of patients with New York Heart Association (NYHA) functional class III and IV was significantly higher in group A than in group B. Cumulative event-free survival rate was significantly lower in group A. CONCLUSIONS MPA dilatation correlated with BNP, NYHA functional class, and hemodynamics with regard to disease severity, and may be a potential prognostic factor in pediatric idiopathic and heritable PAH.
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Affiliation(s)
- Satoshi Ikehara
- Department of Pediatrics, Toho University Omori Medical Center
| | | | | | - Kazuyuki Naoi
- Department of Pediatrics, Toho University Omori Medical Center
| | | | - Tsutomu Saji
- Department of Pediatrics, Toho University Omori Medical Center
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14
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Takatsuki S, Ogata S, Ishii M, Yokozawa M, Ono M, Fujiwara M, Ida H, Motomura H, Moriuchi H, Taketazu M, Kawamura Y, Kawano T, Izumi T, Shiono J, Tsuchiya S, Tsuchiya K, Goushi T, Ichida F, Saji T. Low risk of treatment resistance in Down syndrome with Kawasaki disease. Pediatr Int 2017; 59:1236-1239. [PMID: 28960680 DOI: 10.1111/ped.13429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 07/24/2017] [Accepted: 09/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND A Japanese nationwide survey has reported that Down syndrome (DS) is a less-frequently occurring comorbidity in Kawasaki disease (KD). Although altered immune responses are frequently observed in DS, no studies have focused on the treatment response and risk for coronary artery abnormalities (CAA) in DS patients with KD. The aim of this study was therefore to evaluate the clinical manifestations, treatment response and prevalence of CAA in DS with KD. METHODS We retrospectively reviewed the medical records of DS patients with KD from 2005 through 2012. The survey questionnaires were sent to facilities nationwide, and clinical data regarding KD in DS were collected. A control group consisted of non-DS patients with KD who were managed at Toho University. RESULTS Of the 94 233 children diagnosed with acute KD from 2005 to 2012, 16 children with acute KD also had DS (0.017%). The DS-KD patients were significantly older than the non-DS patients (median, 8 years vs 1 year, P < 0.05, respectively). Half of the DS patients had incomplete KD. Although 50% of the DS children were at high risk of immunoglobulin resistance, all children responded to initial treatment and none had CAA. CONCLUSIONS All DS-KD patients responded to initial i.v. immunoglobulin (IVIG) or aspirin despite having a high risk of IVIG resistance, and none of the DS patients had CAA. This suggests that the risk of treatment resistance and development of CAA may be not higher in DS patients with acute KD.
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Affiliation(s)
- Shinichi Takatsuki
- Department of Pediatrics, Toho University Omori Medical Center, ota, Tokyo, Japan
| | - Shohei Ogata
- Department of Pediatrics, Tokyo Teishin University Hospital, Chiyoda, Tokyo, Japan
| | - Masahiro Ishii
- Department of Pediatrics, Tokyo Teishin University Hospital, Chiyoda, Tokyo, Japan
| | - Masato Yokozawa
- Department of Pediatrics, Jikei University Hospital, Minato, Tokyo, Japan
| | - Masae Ono
- Department of Pediatrics, Japan Red Cross Medical Center, Shibuya, Tokyo, Japan
| | - Masako Fujiwara
- Department of Pediatrics, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Hiroyuki Ida
- Department of Pediatrics, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Hideki Motomura
- Department of Pediatrics, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Hiroyuki Moriuchi
- Department of Pediatrics, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Mio Taketazu
- Department of Pediatrics, Asahikawa-Koisei General Hospital, Asahikawa, Hokkaido, Japan
| | - Yoichi Kawamura
- Department of Pediatrics, Nagasaki Medical Center, Omura, Nagasaki, Japan
| | - Tatsuya Kawano
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Japan
| | - Tatsuro Izumi
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Japan
| | - Junko Shiono
- Department of Pediatrics, Soka Municipal Hospital, Soka, Saitama, Japan
| | - Shiro Tsuchiya
- Department of Pediatrics, Oita University Hospital, Yuhu, Japan
| | - Keiji Tsuchiya
- Department of Pediatrics, Nakatsu Municipal Hospital, Nakatsu, Oita
| | - Terufumi Goushi
- Department of Pediatric Cardiology, Ibaraki Children's Hospital, Mito, Ibaraki, Japan
| | - Fukiko Ichida
- Department of Pediatrics, Toyama University Hospital, Toyama, Toyama, Japan
| | - Tsutomu Saji
- Department of Pediatrics, Toho University Omori Medical Center, ota, Tokyo, Japan
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15
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Nishiyama N, Takatsuki S, Fujisawa T, Nakajima K, Kashimura S, Kunitomi A, Katsumata Y, Nishiyama T, Kimura T, Fukumoto K, Aizawa Y, Fukuda K. P1400Inadvertently achieved bidirectional conduction block of the lateral mitral isthmus by cryoballoon applications applied at the left atrial appendage and left superior pulmonary vein - CASE REPORT. Europace 2017. [DOI: 10.1093/ehjci/eux158.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Affiliation(s)
- Shinichi Takatsuki
- Department of Pediatrics Toho University Omori Medical Center Tokyo, Japan
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17
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Nishiyama T, Katsumata Y, Inagawa K, Kimura T, Nishiyama N, Fukumoto K, Tanimoto Y, Aizawa Y, Tanimoto K, Fukuda K, Takatsuki S. Visualization of the left atrial appendage by phased-array intracardiac echocardiography from the pulmonary artery in patients with atrial fibrillation. Europace 2015; 17:546-51. [DOI: 10.1093/europace/euu383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 12/07/2014] [Indexed: 12/21/2022] Open
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18
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Saji T, Takatsuki S, Kobayashi T. [Anti TNF-α (infliximab) treatment for intravenous immunoglobulin (IVIG) resistance patients with acute Kawasaki disease the effects of anticytokine therapy]. Nihon Rinsho 2014; 72:1641-1649. [PMID: 25518416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Among the patients with acute Kawasaki disease treated with intravenous immunoglobulin (IVIG), 10-20 % demonstrate resistance or incomplete effects. Cardiac complication such as the coronary arterial aneurysm is frequent in these patients. For patients with IVIG-resistance, we have surveyed the efficacy and safety of anti-cytokine therapy with use of infliximab (Remicade), chimera type anti TNF-α agent, for children. After May, 2005, Remicade has been used in >500 pediatric patients in whom IVIG and intravenous methylprednisolone pulse therapy did not show significant effects. The efficacy and safety of Remicade on patients with IVIG-resistant Kawasaki disease has been observed but 10~20 % of patients was Remicade-resistant. Re-treatment with IVIG or steroids was also effective. The efficacy of Remicade for reducing the fever duration, CRP, WBC counts was promising, but reduction of the incidence of coronary aneurysm was not confirmed. Randomized clinical trial will be needed.
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19
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Takahashi M, Ito A, Kimura T, Takatsuki S, Fukuda K, Arai T. Myocardial necrosis depth prediction during extracellular photosensitization reaction of talaporfin sodium by defined index using fluorescence measurement. Lasers Med Sci 2013; 29:1173-81. [DOI: 10.1007/s10103-013-1504-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Affiliation(s)
- M Takahashi
- School of Fundamental Science and Technology, Graduate School of Science and Technology, Keio University, 3-14-1, Hiyoshi, Kohoku-ku, Yokohama City, Kanagawa, 223-8522, Japan,
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20
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Wagner BD, Takatsuki S, Accurso FJ, Ivy DD. Evaluation of circulating proteins and hemodynamics towards predicting mortality in children with pulmonary arterial hypertension. PLoS One 2013; 8:e80235. [PMID: 24278261 PMCID: PMC3835871 DOI: 10.1371/journal.pone.0080235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 10/01/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although many predictors have been evaluated, a set of strong independent prognostic mortality indicators has not been established in children with pediatric pulmonary arterial hypertension (PAH). The aim of this study was to identify a combination of clinical and molecular predictors of survival in PAH. METHODS This single-center, retrospective cohort study was performed from children with PAH between 2001 and 2008 at Children's Hospital Colorado. Blood samples from 83 patients (median age of 8.3 years-old) were obtained. We retrospectively analyzed 46 variables, which included 27 circulating proteins, 7 demographic variables and 12 hemodynamic and echocardiographic variables for establishing the best predictors of mortality. A data mining approach was utilized to evaluate predictor variables and to uncover complex data structures while performing variable selection in high dimensional problems. RESULTS Thirteen children (16%) died during follow-up (median; 3.1 years) and survival rates from time of sample collection at 1 year, 3 years and 5 years were 95%, 85% and 79%, respectively. A subset of potentially informative predictors were identified, the top four are listed here in order of importance: Tissue inhibitors of metalloproteinases-1 (TIMP-1), apolipoprotein-AI, RV/LV diastolic dimension ratio and age at diagnosis. In univariate analysis, TIMP-1 and apolipoprotein-AI had significant association with survival time (hazard ratio [95% confidence interval]: 1.25 [1.03, 1.51] and 0.70 [0.54-0.90], respectively). Patients grouped by TIMP-1 and apolipoprotein-AI values had significantly different survival risks (p<0.01). CONCLUSION Important predictors of mortality were identified from a large number of circulating proteins and clinical markers in this cohort. If confirmed in other populations, measurement of a subset of these predictors could aid in management of pediatric PAH by identifying patients at risk for death. These findings also further support a role for the clinical utility of measuring circulating proteins.
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Affiliation(s)
- Brandie D. Wagner
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, United States of America
- * E-mail:
| | - Shinichi Takatsuki
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
| | - Frank J. Accurso
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
| | - David Dunbar Ivy
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States of America
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21
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Abstract
Pulmonary arterial hypertension (PAH) in the pediatric population is associated with a variety of underlying diseases and causes, significantly morbidity and mortality. In the majority of patients, PAH in children is idiopathic or associated with congenital heart disease (CHD), with pulmonary hypertension (PH) associated with connective tissue disease, a rare cause in children. Classification of pediatric PH has generally followed the WHO classification, but recognition of the importance of fetal origins of PH and developmental abnormalities have led to the formation of a new pediatric-specific classification. Incidence data from the Netherlands has revealed an annual incidence and point prevalence of 0.7 and 4.4 for idiopathic PAH and 2.2 and 15.6 for associated pulmonary arterial hypertension-CHD cases per million children. Although the treatment with new selective pulmonary vasodilators offers hemodynamic and functional improvement in pediatric populations, the treatments in children largely depend on results from evidence-based adult studies and experience of clinicians treating children. A recent randomized clinical trial of sildenafil and its long-term extension has led to disparate recommendations in the United States and Europe.
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Affiliation(s)
- Shinichi Takatsuki
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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22
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Kimura T, Takatsuki S, Miyoshi S, Fukumoto K, Ito A, Takahashi M, Ogawa E, Motohashi S, Arai T, Fukuda K. Non-thermal photodynamic therapy: a radical and reliable approach to cardiac catheter ablation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.1909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Sakazaki H, Niwa K, Nakazawa M, Saji T, Nakanishi T, Takamuro M, Ueno M, Kato H, Takatsuki S, Matsushima M, Kojima N, Ichida F, Kogaki S, Kido S, Arakaki Y, Waki K, Akagi T, Joo K, Muneuchi J, Suda K, Lee HJ, Shintaku H. Clinical features of adult patients with Eisenmenger's syndrome in Japan and Korea. Int J Cardiol 2013; 167:205-9. [PMID: 22227251 DOI: 10.1016/j.ijcard.2011.12.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 12/17/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND There are few articles on mortality and morbidity of adult patients with Eisenmenger's syndrome (ES) in the current era when disease targeting therapy (DTT) has been available. METHODS AND RESULTS 198 patients (a median age 35 years, 64% female) with ES who visited the 16 participating institutes in Japan and Korea from 1998 to 2009 were enrolled. Clinical data during adulthood were collected from each institutional chart and analyzed centrally. During a median follow-up of 8 years, 30 patients died including 14 sudden deaths. 89 patients took oral medication of DTT and clinical improvement was observed in 54 of them. However, survival rate in patients taking DTT was not different from those without (87% vs 84%, p=0.55). When the clinical data in between first and last clinic visits were compared in 85 patients, the patients with NYHA >/=III increased from 24% to 48% (p<0.001), SpO2 decreased from 89% to 85% (p=0.008) and hematocrit increased from 51.4% to 52.9% (p=0.04). Non-survivors had poorer NYHA function class, lower body weight (BW), lower body mass index (BMI), and higher serum level of Cr at the first visits than survivors. CONCLUSIONS Long term survival and clinical status of adult patients with ES remains unsatisfactory even in the current era of DTT. Poor NYHA functional class, low BW, low BMI and high serum level of Cr were related to mortality. DTT therapy improved clinical status in many patients with Eisenmenger's syndrome, but no significant impact on survival could be shown.
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Affiliation(s)
- Hisanori Sakazaki
- Department of Pediatric Cardiology, Hyogo Prefectural Amagasaki Hospital, Japan.
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24
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Ogata S, Tremoulet AH, Sato Y, Ueda K, Shimizu C, Sun X, Jain S, Silverstein L, Baker AL, Tanaka N, Ogihara Y, Ikehara S, Takatsuki S, Sakamoto N, Kobayashi T, Fuse S, Matsubara T, Ishii M, Saji T, Newburger JW, Burns JC. Coronary artery outcomes among children with Kawasaki disease in the United States and Japan. Int J Cardiol 2013; 168:3825-8. [PMID: 23849968 DOI: 10.1016/j.ijcard.2013.06.027] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 05/10/2013] [Accepted: 06/20/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE It has been claimed that the aneurysm rate for Kawasaki disease (KD) patients in Japan is lower than in the U.S. However it has been difficult to compare coronary artery (CA) outcomes between the two countries because of different definitions for CA abnormalities. Therefore, we compared CA internal diameters between Japanese and U.S. KD patients using standard definitions and methods. STUDY DESIGN We retrospectively reviewed CA outcomes in 1082 KD patients from 2 centers in the U.S. and 3 centers in Japan and compared Z-max scores (maximum internal diameter for the left anterior descending or right coronary artery expressed as standard deviation units from the mean (Z-score) normalized for body surface area) obtained within 12 weeks after onset and calculated using two different regression equations from Canada (Dallaire) and Japan (Fuse). We defined a Z-max of < 2.5 as normal and a Z-max of ≥ 10 as giant aneurysm. RESULT The median Z-max for the U.S. and Japanese subjects was 1.9 and 2.3 SD units, respectively (p < 0.001). There was no significant difference in rates of patients with Z-max ≥ 5.0 between the countries. In a multivariable model adjusting for age, sex, and treatment response, being Japanese was still associated with a higher Z-max score. CONCLUSION Previously reported differences in aneurysm rates between Japan and the U.S. likely resulted from use of different definitions and nomenclature. Adoption of Z-scores as a standard for reporting CA internal diameters will allow meaningful comparisons among different countries and will facilitate international, collaborative clinical trials.
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Affiliation(s)
- Shohei Ogata
- Department of Pediatrics, Rady Children's Hospital, University of California San Diego, School of Medicine, La Jolla, CA, United States
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Abstract
Acute pulmonary vasodilator testing (AVT) is essential to determining the initial therapy for children with pulmonary arterial hypertension (PAH). This study aimed to report the initial experience with inhaled treprostinil used for AVT in children with PAH and to evaluate the hemodynamic change after inhaled treprostinil compared with inhaled nitric oxide. This prospective cohort study was designed for 13 children who underwent AVT with inhaled treprostinil or oxygen plus inhaled nitric oxide (iNO) during catheterization. Inhaled treprostinil was delivered during cardiac catheterization by adapting the Optineb ultrasonic nebulizer via either a flow-inflating bag or the manual mode of the anesthesia system. The median age of the patients was 10 years (range 4-17 years). The etiologies of PAH included idiopathic PAH and associated PAH. All the patients tolerated inhaled treprostinil without marked clinical worsening and received six or nine breaths (36 or 54 μg) of treprostinil. The median of the total treprostinil doses was 1.53 μg/kg (range 0.71-2.89 μg/kg). Inhaled treprostinil was administrated via an endotracheal tube (n = 8), anesthesia mask (n = 3), or laryngeal mask airway (n = 2). Inhaled nitric oxide (iNO) and inhaled treprostinil significantly decreased the mean pulmonary artery pressure and the pulmonary vascular resistance index compared with baseline. Three adverse events were reported after inhaled treprostinil, including cough and mild to moderate hypotension with higher doses. All adverse events resolved without any intervention. This study report is the first to describe the use of inhaled treprostinil for AVT in children with PAH. In this small pediatric cohort, inhaled treprostinil was effectively delivered and well tolerated and may be useful for AVT.
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Affiliation(s)
- Shinichi Takatsuki
- Pediatric Cardiology, Children’s Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B100, Aurora, CO 80045, USA
| | - Donna K. Parker
- Respiratory Care, Children’s Hospital Colorado, Aurora, CO, USA
| | - Aimee K. Doran
- United Therapeutics Corporation, Research Triangle Park, NC, USA
| | - Robert H. Friesen
- Pediatric Anesthesia, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - D. Dunbar Ivy
- Pediatric Cardiology, Children’s Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B100, Aurora, CO 80045, USA
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26
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Aizawa Y, Takatsuki S, Inagawa K, Katsumata Y, Nishiyama T, Kimura T, Nishiyama N, Sato Y, Fukumoto K, Tanimoto Y, Tanimoto K, Fukuda K. Narrow QRS tachycardia. Mechanism behind changes in conduction. Herz 2013; 39:276-8. [PMID: 23483224 DOI: 10.1007/s00059-013-3784-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/15/2013] [Accepted: 02/17/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Y Aizawa
- Division of Cardiology, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku-ku, Tokyo, Japan,
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27
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Takatsuki S, Rosenzweig EB, Zuckerman W, Brady D, Calderbank M, Ivy DD. Clinical safety, pharmacokinetics, and efficacy of ambrisentan therapy in children with pulmonary arterial hypertension. Pediatr Pulmonol 2013; 48:27-34. [PMID: 22511577 PMCID: PMC3412194 DOI: 10.1002/ppul.22555] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 01/19/2012] [Indexed: 02/06/2023]
Abstract
Recent trials in adult PAH revealed the efficacy of ambrisentan. However, in children with PAH, the clinical safety and pharmacokinetics of ambrisentan has not been well studied. Our aim was to investigate the clinical safety, pharmacokinetics, tolerability, and efficacy of endothelin receptor antagonist therapy with ambrisentan in children with pulmonary arterial hypertension (PAH). This retrospective cohort study provides clinical data from pediatric patients with PAH receiving ambrisentan as add-on therapy or transition from bosentan. Safety included evaluation of adverse events including aminotransferase abnormalities. The clinical impact was evaluated by improvement from baseline in clinical variables. A total of 38 pediatric patients with PAH received ambrisentan. Fifteen of 38 patients were switched from bosentan to ambrisentan. The remaining 23 children were treated with ambrisentan as an add-on therapy due to disease progression. In both transition and add-on cases, mean pulmonary artery pressure significantly improved (transition; 55 ± 18 vs. 45 ± 20 mmHg, n = 13, P = 0.04, add-on; 52 ± 17 vs. 45 ± 19 mmHg, n = 13, P = 0.03) during the follow-up. World Health Organization functional class improved in 31% of patients, but one patient required an atrial septostomy due to disease progression during the follow-up period (median, range; 20, 4-44 months). Five patients (13%) discontinued ambrisentan due to severe headache, lack of clinical efficacy, or near syncope. Ten patients (26%) had side effects associated with ambrisentan treatment, including nasal congestion, headache, and flushing. However, no patients had aminotransferase abnormalities and there were no deaths after initiation of ambrisentan during follow-up. Pharmacokinetics were evaluated in sixteen children treated with ambrisentan from 2.5 mg to 10.0 mg; the mean peak plasma concentration was 738 ± 452 ng/ml, mean time to peak plasma concentration was 3.2 ± 2.1 hours, and mean area under the curve plasma concentration was 6657 ± 4246 ng·hour/ml. In conclusion, initial experience with ambrisentan in children suggests that treatment is safe with similar pharmacokinetics to those in adults and may improve PAH in some children.
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Affiliation(s)
- Shinichi Takatsuki
- Pediatric Cardiology, University of Colorado School of Medicine, Children's Hospital, Aurora, CO 80045, USA.
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28
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Badagliacca R, Reali M, Vizza C, Poscia R, Pezzuto B, Gambardella C, Papa S, Mezzapesa M, Nocioni M, Fedele F, Freed B, Bhave N, Tsang W, Gomberg-Maitland M, Mor-Avi V, Patel A, Lang RM, Liel-Cohen N, Yaacobi M, Guterman H, Jurzak P, Ternacle J, Gallet R, Bensaid A, Kloeckner M, Monin JL, Gueret P, Dubois-Rande JL, Lim P, Otsuka T, Suzuki M, Yoshikawa H, Hashimoto G, Ishikawa Y, Osaki T, Masai H, Ono T, Yamamoto M, Sugi K, Satendra M, Sargento L, Sousa C, Arsenio A, Lousada N, Palma Reis R, Wang S, Lam Y, Liu M, Fang F, Shang Q, Luo X, Wang J, Sun J, Sanderson J, Yu C, De Marchi S, Hopp E, Urheim S, Hervold A, Murbrach K, Massey R, Remme E, Hol P, Aakhus S, Bouzas Mosquera A, Peteiro J, Broullon F, Garcia NA, Rodriguez Garrido J, Martinez Ruiz D, Yanez Wonenburger J, Bouzas Zubeldia B, Fabregas Casal R, Castro Beiras A, Le Tourneau T, Sportouch C, Foucher C, Delasalle B, Rosso J, Neuder Y, Trochu J, Roncalli J, Lemarchand P, Manrique A, Sharif D, Sharif-Rasslan A, Shahla C, Khalil A, Rosenschein U, Monti L, Tramarin M, Calcagnino M, Lisignoli V, Nardi B, Balzarini L, Khalatbari A, Mills J, Chenzbraun A, Theron A, Morera P, Resseguier N, Thuny F, Riberi A, Giorgi R, Collart F, Habib G, Avierinos J, Liu D, Hu K, Niemann M, Herrmann S, Gaudron P, Voelker W, Ertl G, Bijnens B, Weidemann F, Lenders GD, Bosmans JM, Van Herck PL, Rodrigus IE, Claeys MJ, Vrints CJ, Paelinck BP, Veronesi F, Fusini L, Tamborini G, Gripari P, Maffessanti F, Mirea O, Alamanni F, Pepi M, Caiani E, Frikha Z, Zairi I, Saib W, Fennira S, Ben Moussa F, Kammoun S, Mrabet K, Ben Yaala A, Said L, Ghannouchi M, Carlomagno G, Ascione L, Sordelli C, Iengo R, Severino S, D'andrea A, Calabro' R, Caso P, Mizia M, Mizia-Stec K, Sikora-Puz A, Gieszczyk-Strozik K, Chmiel A, Haberka M, Hudziak D, Jasinski M, Gasior Z, Wos S, Biaggi P, Felix C, Gruner C, Hohlfeld S, Herzog B, Gaemperli O, Gruenenfelder J, Corti R, Tanner F, Bettex D, Kovalova S, Necas J, Dominguez Rodriguez F, Monivas V, Mingo S, Garcia-Lunar I, Garcia-Pavia P, Gonzalez-Mirelis J, Zegri I, Cavero M, Jeon HK, Lee D, Youn H, Shin H, Yoon J, Chung H, Choi E, Kim J, Min P, Lee B, Yoon Y, Hong B, Kwon H, Rim S, Petronilli V, Cimino S, De Luca L, Cicogna F, Arcari L, Francone M, Iacoboni C, Agati L, Halmai L, Atkinson P, Kardos A, Bogle R, Meimoun P, Flahaut G, Charles V, Villain Y, Clerc J, Germain A, Elmkies F, Zemir H, Luycx-Bore A, Kim K, Song J, Jeong H, Yoon H, Ahn Y, Jeong M, Cho J, Park J, Kang J, Tolba OA, El-Shanshory MR, El-Shitany NAEA, El-Hawary ES, Elkilany GN, Tolba OA, El-Shanshory MR, El-Shitany AEA, El-Hawary EES, Nagib Elkilany GE, Costanzo L, Buccheri S, Monte IP, Curatolo G, Crapanzano P, Di Pino L, Rodolico M, Blundo A, Leggio S, Tamburino C, Rees E, Hocking R, Dunstan F, Lewis M, Tunstall K, Rees DA, Halcox JP, Fraser AG, Rodrigues A, Guimaraes L, Guimaraes J, Monaco C, Cordovil A, Lira E, Vieira M, Fischer C, Nomura C, Morhy S, Bruno R, Cogo A, Sharma R, Bartesaghi M, Pomidori L, Basnyat B, Taddei S, Picano E, Sicari R, Pratali L, Satendra M, Sargento L, Sousa C, Lousada N, Palma Reis R, Zakhama L, Sioua S, Naffati S, Marouen A, Boussabah E, Kadour R, Thameur M, Benyoussef S, Vanoli D, Wiklund U, Henein M, Naslund U, Lindqvist P, Palinsky M, Petrovicova J, Pirscova M, Korpi K, Blafield H, Suomi H, Linden P, Valtonen M, Jarvinen V, Laine M, Loimaala A, Kaldararova M, Kantorova A, Vrsanska V, Tittel P, Hraska V, Masura J, Simkova I, Attenhofer Jost C, Zimmermann C, Greutmann M, Dave H, Valsangiacomo Buechel E, Pretre R, Mueller C, Seifert B, Kretschmar O, Weber R, Carro A, Teixido G, Rodriguez-Palomares J, Gutierrez L, Maldonado G, Paucca E, Gonzalez-Alujas T, Evangelista A, Al Akhfash A, Al Mesned D, Maan Hasson D, Al Harbi B M, Cruz C, Pinho T, Lebreiro A, Silva Cardoso J, Julia Maciel M, Kalimanovska-Ostric D, Nastasovic T, Deljanin-Ilic M, Milakovic B, Dostanic M, Stosic M, Lam YY, Fang F, Yu C, Bobbo M, Leonelli V, Piazza R, Leiballi E, Pecoraro R, Cinello M, Mimo R, Cervesato E, Nicolosi GL, Cruz C, Pinho T, Lebreiro A, Silva Cardoso J, Julia Maciel M, Moral Torres S, Evangelista A, Gonzalez-Alujas M, Rodriguez-Palomares J, Teixido G, Gutierrez L, Cuellar H, Carro A, Maldonado G, Garcia-Dorado D, Kocabay G, Dal Bianco L, Muraru D, Peluso D, Segafredo B, Iliceto S, Badano L, Schiano Lomoriello V, Santoro A, Esposito R, Ippolito R, De Palma D, Schiattarella P, Muscariello R, Galderisi M, Teixido Tura G, Redheuil A, Rodriguez-Palomares J, Gutierrez L, Sanchez V, Forteza A, Lima J, Garcia-Dorado D, Evangelista A, Moral Torres S, Evangelista A, Gonzalez-Alujas M, Rodriguez-Palomares J, Teixido G, Gutierrez L, Cuellar H, Carro A, Maldonado G, Garcia-Dorado D, Mihalcea D, Florescu M, Suran B, Enescu O, Mincu R, Patrascu N, Serbanoiu I, Margulescu A, Vinereanu D, Teixido Tura G, Rodriguez-Palomares J, Gutierrez L, Gonzalez-Alujas T, Carro A, Thomas M, Garcia-Dorado D, Evangelista A, Tosello F, Milan A, Magnino C, Leone D, Chiarlo M, Bruno G, Losano I, Burrello J, Fulcheri C, Veglio F, Styczynski G, Szmigielski CA, Kaczynska A, Kuch-Wocial A, Jansen R, Kracht P, Kluin J, Tietge W, Cramer M, Chamuleau S, Zito C, Tripepi S, Cusma-Piccione M, Di Bella G, Mohammed M, Oreto L, Manganaro R, D'angelo M, Pizzino F, Carerj S, Arapi S, Tsounis D, Matzraki V, Kaplanis I, Perpinia A, Varoudi M, Mpitsios G, Lazaros G, Karavidas A, Pyrgakis V, Mornos C, Ionac A, Cozma D, Mornos A, Dragulescu D, Petrescu L, Pescariu S, Lupinek P, Sramko M, Kubanek M, Kautznerova D, Tintera J, Lanska V, Kadrabulatova S, Pavlukova E, Tarasov D, Karpov R, Sveric K, Forkmann M, Richter U, Wunderlich C, Strasser R, Grapsa J, Dawson D, Zimbarra Cabrita I, Punjabi P, Nihoyannopoulos P, Kovacs A, Apor A, Nagy A, Vago H, Toth A, Becker D, Merkely B, Ranjbar S, Karvandi M, Hassantash S, Yoshikawa H, Suzuki M, Kusunose Y, Hashimoto G, Otsuka T, Nakamura M, Sugi K, De Knegt M, Biering-Sorensen T, Sogaard P, Sivertsen J, Jensen J, Mogelvang R, Montserrat S, Gabrielli L, Borras R, Bijnens B, Castella M, Berruezo A, Mont L, Brugada J, Sitges M, Tarr A, Stoebe S, Pfeiffer D, Hagendorff A, Ternacle J, Jurzak P, Gallet R, Champagne S, Teiger E, Monin JL, Gueret P, Dubois-Rande JL, Lim P, Monney P, Jeanrenaud X, Monivas Palomero V, Mingo Santos S, Garcia Lunar I, Beltran Correas P, Gonzalez Lopez E, Sanchez Garcia M, Gonzalez Mirelis J, Cavero Gibanel M, Gomez Bueno M, Segovia Cubero J, Haarman M, Van Den Bosch A, Domburg R, Mcghie J, Roos-Hesselink J, Geleijnse M, Yanikoglu A, Altekin E, Kucuk M, Karakas S, Ozel D, Yilmaz H, Demir I, Tsuruta H, Iwanaga S, Sato T, Miyoshi S, Nishiyama N, Aizawa Y, Tanimoto K, Murata M, Takatsuki S, Fukuda K, Carrilho-Ferreira P, Cortez-Dias N, Silva D, Jorge C, Goncalves S, Santos I, Sargento L, Marques P, Carpinteiro L, Sousa J, Schubert U, Kockova R, Tintera J, Kautznerova D, Cerna D, Sedlacek K, Kryze L, Sikula V, Segetova M, Kautzner J, Iwaki T, Dores H, Goncalves P, Sousa P, Carvalho M, Marques H, Machado F, Gaspar A, Aleixo A, Carmo M, Roquette J, Lagopati N, Sotiropoulos M, Baka I, Ploussi A, Lyra Georgosopoulou M, Miglioranza M, Gargani L, Sant'anna R, Rover M, Mantovani A, Kalil R, Sicari R, Picano E, Leiria T, Minarik T, Taborsky M, Fedorco M, Novak P, Ledakowicz-Polak A, Polak L, Zielinska M, Zhong L, Chin C, Lau Y, Sim L, Chua T, Tan B, Tan R. Poster session: Dobutamine stress echo. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Takatsuki S, Nakayama T, Jone PN, Wagner BD, Naoi K, Ivy DD, Saji T. Tissue Doppler imaging predicts adverse outcome in children with idiopathic pulmonary arterial hypertension. J Pediatr 2012; 161:1126-31. [PMID: 22748515 PMCID: PMC3508005 DOI: 10.1016/j.jpeds.2012.05.050] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 04/24/2012] [Accepted: 05/22/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the clinical utility of tissue Doppler imaging (TDI) in assessment of disease severity and prognostic value in children with idiopathic pulmonary arterial hypertension (PAH). STUDY DESIGN A prospective study was performed to evaluate TDI velocities (systolic myocardial velocity, early diastolic myocardial relaxation velocity [Em], late diastolic myocardial velocity associated with atrial contraction), brain natriuretic peptide, New York Heart Association (NYHA) functional class, and hemodynamics in 51 children (mean age; 11.6 years) with idiopathic PAH. Fifty-one healthy children with comparable demographics served as controls. RESULTS Em, Em/late diastolic myocardial velocity associated with atrial contraction ratio, and systolic myocardial velocity at mitral annulus, septum, and tricuspid annulus in PAH were significantly reduced compared with controls. Tricuspid Em had significant inverse correlations with plasma brain natriuretic peptide levels (r = -0.60, P < .001), right ventricular end-diastolic pressure (r = -0.79, P < .001), and mean pulmonary arterial pressure (r = -0.67, P < .001). Statistically significant differences were observed in tricuspid Em between NYHA functional class II vs combined III and IV (mean and SD; 11.9 ± 4.2 cm/s vs 8.2 ± 3.6 cm/s, respectively, P = .002). Cumulative event-free survival rate was significantly lower when tricuspid Em was ≤8 cm/s (log-rank test, P < .001) CONCLUSIONS Tricuspid Em velocity correlated with NYHA functional class as disease severity and may serve as a useful prognostic marker in children with idiopathic PAH. The present study is the initial report to evaluate TDI velocities against midterm outcome variables in a relatively large pediatric PAH population.
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Affiliation(s)
- Shinichi Takatsuki
- Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, CO, USA
,Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
| | - Tomotaka Nakayama
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
| | - Pei-Ni Jone
- Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, CO, USA
| | - Brandie D Wagner
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Denver
| | - Kazuyuki Naoi
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
| | - David D Ivy
- Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, CO, USA
| | - Tsutomu Saji
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
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Krishnan U, Takatsuki S, Ivy DD, Kerstein J, Calderbank M, Coleman E, Rosenzweig EB. Effectiveness and safety of inhaled treprostinil for the treatment of pulmonary arterial hypertension in children. Am J Cardiol 2012; 110:1704-9. [PMID: 22917554 DOI: 10.1016/j.amjcard.2012.07.037] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/12/2012] [Accepted: 07/12/2012] [Indexed: 12/22/2022]
Abstract
The introduction of prostanoid therapy has revolutionized the treatment of pulmonary arterial hypertension (PAH). However, continuous intravenous prostacyclin infusion poses significant risks and challenges, particularly in children. Inhaled treprostinil has been shown to be safe and efficacious in adults. This study describes the safety and efficacy of inhaled treprostinil in children with PAH. A retrospective analysis of 29 children treated with inhaled treprostinil for ≥6 weeks was performed. Effects of inhaled treprostinil on exercise capacity, functional class, and echocardiographic and hemodynamic data were evaluated. Adverse events were documented. Patients received 3 to 9 breaths (6 μg/breath) of inhaled treprostinil 4 times/day. All were receiving background PAH therapy; 12 had previously received parenteral prostanoid. Inhaled treprostinil was discontinued in 4 patients because of symptoms including cough and bronchospasm (n = 3) and progression of PAH (n = 1). Mild side effects including cough (n = 9) and sore throat (n = 6) did not require discontinuation of therapy. World Health Organization functional class improved in 19 and was unchanged in 10; exercise capacity significantly improved with the 6-minute walk distance, improving on follow-up from 455.7 ± 71.5 to 498 ± 70 m (p = 0.01) and peak oxygen consumption increasing from 25.5 ± 10.2 to 27.4 ± 10 (p = 0.04). In conclusion, inhaled treprostinil was associated with improvement in exercise capacity and World Health Organization functional class when added to background targeted PAH therapy in children and had an acceptable safety profile. Based on these early data, further study of inhaled treprostinil appears warranted in pediatric patients with PAH.
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Kobayashi T, Saji T, Otani T, Takeuchi K, Nakamura T, Arakawa H, Kato T, Hara T, Hamaoka K, Ogawa S, Miura M, Nomura Y, Fuse S, Ichida F, Seki M, Fukazawa R, Ogawa C, Furuno K, Tokunaga H, Takatsuki S, Hara S, Morikawa A. Efficacy of immunoglobulin plus prednisolone for prevention of coronary artery abnormalities in severe Kawasaki disease (RAISE study): a randomised, open-label, blinded-endpoints trial. Lancet 2012; 379:1613-20. [PMID: 22405251 DOI: 10.1016/s0140-6736(11)61930-2] [Citation(s) in RCA: 417] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Evidence indicates that corticosteroid therapy might be beneficial for the primary treatment of severe Kawasaki disease. We assessed whether addition of prednisolone to intravenous immunoglobulin with aspirin would reduce the incidence of coronary artery abnormalities in patients with severe Kawasaki disease. METHODS We did a multicentre, prospective, randomised, open-label, blinded-endpoints trial at 74 hospitals in Japan between Sept 29, 2008, and Dec 2, 2010. Patients with severe Kawasaki disease were randomly assigned by a minimisation method to receive either intravenous immunoglobulin (2 g/kg for 24 h and aspirin 30 mg/kg per day) or intravenous immunoglobulin plus prednisolone (the same intravenous immunoglobulin regimen as the intravenous immunoglobulin group plus prednisolone 2 mg/kg per day given over 15 days after concentrations of C-reactive protein normalised). Patients and treating physicians were unmasked to group allocation. The primary endpoint was incidence of coronary artery abnormalities during the study period. Analysis was by intention to treat. This trial is registered with the University Hospital Medical Information Network clinical trials registry, number UMIN000000940. FINDINGS We randomly assigned 125 patients to the intravenous immunoglobulin plus prednisolone group and 123 to the intravenous immunoglobulin group. Incidence of coronary artery abnormalities was significantly lower in the intravenous immunoglobulin plus prednisolone group than in the intravenous immunoglobulin group during the study period (four patients [3%] vs 28 patients [23%]; risk difference 0·20, 95% CI 0·12-0·28, p<0·0001). Serious adverse events were similar between both groups: two patients had high total cholesterol and one neutropenia in the intravenous immunoglobulin plus prednisolone group, and one had high total cholesterol and another non-occlusive thrombus in the intravenous immunoglobulin group. INTERPRETATION Addition of prednisolone to the standard regimen of intravenous immunoglobulin improves coronary artery outcomes in patients with severe Kawasaki disease in Japan. Further study of intensified primary treatment for this disease in a mixed ethnic population is warranted. FUNDING Japanese Ministry of Health, Labour and Welfare.
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Affiliation(s)
- Tohru Kobayashi
- Department of Pediatrics, Gunma University Graduate School of Medicine, Gunma, Japan.
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Onouchi Y, Ozaki K, Burns JC, Shimizu C, Terai M, Hamada H, Honda T, Suzuki H, Suenaga T, Takeuchi T, Yoshikawa N, Suzuki Y, Yasukawa K, Ebata R, Higashi K, Saji T, Kemmotsu Y, Takatsuki S, Ouchi K, Kishi F, Yoshikawa T, Nagai T, Hamamoto K, Sato Y, Honda A, Kobayashi H, Sato J, Shibuta S, Miyawaki M, Oishi K, Yamaga H, Aoyagi N, Iwahashi S, Miyashita R, Murata Y, Sasago K, Takahashi A, Kamatani N, Kubo M, Tsunoda T, Hata A, Nakamura Y, Tanaka T. A genome-wide association study identifies three new risk loci for Kawasaki disease. Nat Genet 2012; 44:517-21. [PMID: 22446962 DOI: 10.1038/ng.2220] [Citation(s) in RCA: 234] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 02/24/2012] [Indexed: 12/18/2022]
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Takatsuki S, Wagner BD, Ivy DD. B-type natriuretic peptide and amino-terminal pro-B-type natriuretic peptide in pediatric patients with pulmonary arterial hypertension. CONGENIT HEART DIS 2012; 7:259-67. [PMID: 22325151 DOI: 10.1111/j.1747-0803.2011.00620.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES B-type natriuretic peptide (BNP) and the amino-terminal fragment (NTproBNP) correlate with clinical variables, but have not been simultaneously studied in a large number of pediatric patients with pulmonary arterial hypertension (PAH). The purpose of our investigation was to compare BNP and NTproBNP with clinical indicators of disease in a pediatric PAH population for which biomarkers are much needed. DESIGN We retrospectively compared BNP and NTproBNP levels with exercise capacity, echocardiographic data, and hemodynamics in PAH patients under 21 years old. Two hundred sixty-three blood samples from 88 pediatric PAH patients were obtained, with BNP and NTproBNP drawn at the same time. RESULTS There was a correlation between BNP and NTproBNP with mean pulmonary arterial pressure/mean systemic arterial pressure ratio (r= 0.40, P < .01; r= 0.45, P < .01; respectively), mean right atrial pressure (r= 0.48, P < .01; r= 0.48, P < .01), and tricuspid regurgitant velocity (r= 0.36, P < .01; r= 0.41, P < .01). BNP and NTproBNP are associated with 6-minute walk distance, mean pulmonary arterial pressure, mean pulmonary arterial pressure/mean systemic arterial pressure ratio, mean right atrial pressure, pulmonary vascular resistance index, and tricuspid regurgitant velocity when investigated longitudinally. On the average, a 1-unit increase in log BNP or NTproBNP was associated with 4.5 units × m(2) or 3.4 units × m(2) increase in pulmonary vascular resistance index, respectively. There was a strong correlation between log BNP and log NTproBNP measurements (r= 0.87, P < .01). CONCLUSION In pediatric PAH, BNP and NTProBNP are strongly correlated and predict changes in clinical variables and hemodynamics. In a cross-sectional analysis, NTproBNP correlated with echocardiographic and exercise data better than BNP; NTproBNP showed less within patient variability over time; therefore, NTproBNP can add additional information toward predicting these clinical measurements.
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Affiliation(s)
- Shinichi Takatsuki
- Department of Pediatrics, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, CO 80045, USA.
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Yeager ME, Nguyen CM, Belchenko DD, Colvin KL, Takatsuki S, Ivy DD, Stenmark KR. Circulating myeloid-derived suppressor cells are increased and activated in pulmonary hypertension. Chest 2011; 141:944-952. [PMID: 21940769 DOI: 10.1378/chest.11-0205] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Myeloid-derived suppressor cells (MDSCs) are increased in inflammatory and autoimmune disorders and orchestrate immune cell responses therein. Pulmonary hypertension (PH) is associated with inflammation, autoimmunity, and lung vascular remodeling. Immature myeloid cells are found in the lungs of humans and animals with PH, and we hypothesized that they would be increased in the blood of patients with PH compared with control subjects. METHODS Twenty-six children with PH and 10 undergoing cardiac catheterization for arrhythmia ablation were studied. Five milliliters of fresh blood were analyzed using flow cytometry. Results were confirmed using magnetic bead sorting and immunofluorescence, while quantitative polymerase chain reaction and intracellular urea concentration assays were used as measures of MDSC arginase-1 activation. RESULTS Flow cytometry demonstrated enrichment of circulating MDSCs among patients with PH (n = 26; mean, 0.271 × 10(6) cells/mL ± 0.17; 1.86% of CD45(+) population ± 1.51) compared with control subjects (n = 10; mean, 0.176 × 10(6) cells/mL ± 0.05; 0.57% of CD45(+) population ± 0.29; P < .05). Higher numbers of circulating MDSCs correlated to increasing mean pulmonary artery pressure (r = 0.510, P < .05). Among patients with PH, female patients had a twofold increase in MDSCs compared with male patients. Immunofluorescence analysis confirmed the results of flow cytometry. Quantitative reverse transcription polymerase chain reaction assay results for arginase-1 and measurement of intracellular urea concentration revealed increased activity of MDSCs from patients with PH compared with control subjects. CONCLUSIONS Circulating activated MDSCs are significantly increased in children with PH compared with control subjects. Further investigation of these cells is warranted, and we speculate that they might play significant immunomodulatory roles in the disease pathogenesis of PH.
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Affiliation(s)
- Michael E Yeager
- Department of Pediatrics, Division of Pulmonary and Critical Care Medicine, University of Colorado, Denver, Aurora, Colorado.
| | - Cecilia M Nguyen
- Department of Pediatrics, Division of Pulmonary and Critical Care Medicine, University of Colorado, Denver, Aurora, Colorado
| | - Dmitry D Belchenko
- Department of Pediatrics, Division of Pulmonary and Critical Care Medicine, University of Colorado, Denver, Aurora, Colorado
| | - Kelley L Colvin
- Department of Pediatrics, Pulmonary Hypertension Program and Pediatric Heart Lung Center, Children's Hospital, University of Colorado, Denver, Aurora, Colorado
| | - Shinichi Takatsuki
- Department of Pediatrics, Omori Medical Center, Toho University, Tokyo, Japan
| | - D Dunbar Ivy
- Department of Pediatrics, Pulmonary Hypertension Program and Pediatric Heart Lung Center, Children's Hospital, University of Colorado, Denver, Aurora, Colorado
| | - Kurt R Stenmark
- Department of Pediatrics, Division of Pulmonary and Critical Care Medicine, University of Colorado, Denver, Aurora, Colorado; Gates Center for Regenerative Medicine and Stem Cell Biology, University of Colorado, Denver, Aurora, Colorado
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Takatsuki S, Soep JB, Calderbank M, Ivy DD. Connective tissue disease presenting with signs and symptoms of pulmonary hypertension in children. Pediatr Cardiol 2011; 32:828-33. [PMID: 21448619 PMCID: PMC3142789 DOI: 10.1007/s00246-011-9950-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 02/24/2011] [Indexed: 11/30/2022]
Abstract
Our case series describes three children who were initially diagnosed as having severe pulmonary arterial hypertension (PAH) and subsequently found to be positive for specific autoantibodies suggestive of an underlying autoimmune process. The signs and symptoms of PAH are subtle and may be part of the initial presentation of childhood connective tissue disease (CTD). Evaluation for connective tissue disease in the newly diagnosed pulmonary hypertension (PH) patient is important because early diagnosis of PH as well as CTD is crucial in the successful management of these complex patients. Ongoing monitoring for CTD in patients with severe PAH is warranted.
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Affiliation(s)
- Shinichi Takatsuki
- Department of Pediatrics, The Children's Hospital, University of Colorado Denver School of Medicine, 3123 East 16th Avenue, B100, Aurora, CO 80045, USA.
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Yeager ME, Nguyen CM, Belchenko DD, Colvin KL, Takatsuki S, Ivy DD, Stenmark KR. Circulating fibrocytes are increased in children and young adults with pulmonary hypertension. Eur Respir J 2011; 39:104-11. [PMID: 21700605 DOI: 10.1183/09031936.00072311] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Chronic inflammation is an important component of the fibroproliferative changes that characterise pulmonary hypertensive vasculopathy. Fibrocytes contribute to tissue remodelling in settings of chronic inflammation, including animal models of pulmonary hypertension (PH). We sought to determine whether circulating fibrocytes were increased in children and young adults with PH. 26 individuals with PH and 10 with normal cardiac anatomy were studied. Fresh blood was analysed by flow cytometry for fibrocytes expressing CD45 and procollagen. Fibrocyte numbers were correlated to clinical and haemodynamic parameters, and circulating CC chemokine ligand (CCL)2 and CXC chemokine ligand (CXCL)12 levels. We found an enrichment of circulating fibrocytes among those with PH. No differences in fibrocytes were observed among those with idiopathic versus secondary PH. Higher fibrocytes correlated to increasing mean pulmonary artery pressure and age, but not to length or type of treatment. Immunofluorescence analysis confirmed flow sorting specificity. Differences in plasma levels of CCL2 or CXCL12, which could mobilise fibrocytes from the bone marrow, were not found. We conclude that circulating fibrocytes are significantly increased in individuals with PH compared with controls. We speculate that these cells might play important roles in vascular remodelling in children and young adults with pulmonary hypertension.
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Affiliation(s)
- M E Yeager
- Dept of Paediatrics, Division of Pulmonary and Critical Care Medicine, University of Colorado Denver, Aurora, CO 80045, USA.
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Andersson T, Magnusson A, Bryngelsson IL, Frobert O, Henriksson KM, Edvardsson N, Poci D, Polovina M, Potpara T, Licina M, Mujovic N, Kocijancic A, Simic D, Ostojic MC, Providencia RA, Botelho A, Trigo J, Nascimento J, Quintal N, Mota P, Leitao-Marques AM, Bosch RF, Kirch W, Rosin L, Willich SN, Pittrow D, Bonnemeier H, Valenza MC, Martin L, Munoz Casaubon T, Valenza G, Botella M, Serrano M, Valenza B, Cabrera I, Anderson K, Benzaquen BS, Koziolova N, Nikonova J, Shilova Y, Scherr D, Narayan S, Wright M, Krummen D, Jadidi A, Jais P, Haissaguerre M, Hocini M, Hunter R, Liu Y, Lu Y, Wang W, Schilling RJ, Bernstein S, Wong B, Rooke R, Vasquez C, Shah R, Rosenberg S, Chinitz L, Morley G, Bashir Choudhary M, Holmqvist F, Carlson J, Nilsson HJ, Platonov PG, Jadidi AS, Cochet H, Miyazaki S, Shah AJ, Scherr D, Marrouche N, Haissaguerre M, Jais P, Calvo N, Nadal M, Andreu D, Tamborero D, Diaz FE, Berruezo A, Brugada J, Mont L, Fichtner S, Hessling G, Estner HL, Jilek C, Reents T, Ammar S, Wu J, Deisenhofer I, Nakanishi H, Kashiwase K, Hirata A, Wada M, Ueda Y, Skoda J, Neuzil P, Popelova J, Petru J, Sediva L, Lavergne T, Le Heuzey JY, Mousseaux E, Hersi A, Alhabib K, Alfaleh H, Sulaiman K, Almahmeed W, Alsuwidi J, Amin H, Reddy VY, Almotarreb A, Pang HWK, Redfearn DP, Simpson CS, Michael K, Pereira EJ, Munt PW, Fitzpatrick MF, Baranchuk A, Revishvili AS, Uldry L, Simonyan G, Dzhordzhikiya T, Sopov O, Kalinin V, Locati ET, Vecchi AM, Cattafi G, Sachero A, Lunati M, Sayah S, Forclaz A, Alizadeh A, Nazari N, Hekmat M, Moradi M, Zeighami M, Ghanji H, Suzuki K, Takagi M, Maeda K, Tatsumi H, Virag N, Gomes C, Meireles A, Anjo D, Roque C, Vieira P, Lagarto V, Reis H, Torres S, Toth A, Vago H, Hocini M, Takacs P, Edes E, Marki A, Balazs GY, Huttl K, Merkely B, Lainis F, Buckley MM, Johns EJ, Seifer CM, Vesin JM, Daba L, Liebrecht K, Pietrucha AZ, Borowiec A, Mroczek-Czernecka D, Bzukala I, Wnuk M, Piwowarska W, Nessler J, Toquero Ramos J, Jais P, Perez Pereira E, Mitroi C, Castro 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Alkmim-Teixeira R, Peixoto GL, Costa R, Pedersen SS, Versteeg H, Nielsen JC, Mortensen PT, Johansen JB, Kwasniewski W, Filipecki A, Urbanczyk-Swic D, Orszulak W, Trusz - Gluza M, Jimenez-Candil J, Hernandez J, Morinigo J, Ledesma C, Martin-Luengo C, Vogtmann T, Gomer M, Stiller S, Kuehlkamp V, Zach G, Loescher S, Kespohl S, Baumann G, Snell JD, Korsun N, Rooke R, Snell JR, Morley B, Bharmi R, Nabutovsky Y, Mollerus M, Naslund L, Meyer A, Lipinski M, Libey B, Dornfeld K, Jimenez-Candil J, Hernandez J, Martin A, Gallego M, Morinigo J, Ledesma C, Martin-Luengo C, De Bie MK, Van Rees JB, Borleffs CJ, Thijssen J, Jukema JW, Schalij MJ, Van Erven L, Van Der Velde ET, Witteman TA, Foeken H, Van Erven L, Schalij MJ, Szili-Torok T, Akca F, Caliskan K, Ten Cate F, Jordaens L, Michels M, Cozma DC, Petrescu L, Mornos C, Dragulescu SI, Groeneweg JA, Velthuis BK, Cox MGPJ, Loh P, Dooijes D, Cramer MJ, De Bakker JMT, Hauer RNW, Park SD, Shin SH, Woo SI, Kwan J, Park KS, Kim DH, Kwan J, Iorio A, Vitali Serdoz L, Brun F, Daleffe E, Zecchin M, Dal Ferro M, Santangelo S, Sinagra GF, Ouali S, Hammemi R, Hammas S, Kacem S, Gribaa R, Neffeti E, Remedi F, Boughzela E, Korantzopoulos P, Letsas K, Christogiannis Z, Kalantzi K, Ntorkos A, Goudevenos J, Foley PWX, Yung L, Barnes E, Munetsugu Y, Tanno K, Kikuchi M, Ito H, Miyoshi F, Kawamura M, Kobayashi Y, Pecini R, Marott JM, Jensen GB, Theilade J, Mine T, Kodani T, Masuyama T, Mozos IM, Serban C, Costea C, Susan L, Barthel P, Mueller A, Malik M, Schmidt G, Schmidt G, Barthel P, Mueller A, Malik M, Karakurt O, Kilic H, Munevver Sari DR, Mroczek-Czernecka D, Pietrucha AZ, Borowiec A, Wnuk M, Bzukala I, Kruszelnicka O, Konduracka E, Nessler J, Kikuchi Y, Meireles A, Gomes C, Anjo D, Roque C, Pinheiro Vieira A, Lagarto V, Hipolito Reis A, Torres S, Nof E, Miller L, Kuperstein R, Eldar M, Glikson M, Luria D, Vedrenne G, Bruguiere E, Redheuil A. Poster Session 2. Europace 2011. [DOI: 10.1093/europace/eur222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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M, Steffel J, Jetzer S, Bayrak F, Chierchia GB, Jenni R, Duru F, Brugada P, Bakos Z, Medvedev M MM, Jonas Carlsson JC, Fredrik Holmqvist FH, Pyotr Platonov PP, Nurbaev T, Pirnazarov M, Nikishin A, Aagaard P, Sahlen A, Bergfeldt L, Braunschweig F, Simeonidou E, Kastellanos S, Varounis C, Michalakeas C, Koniari C, Nikolopoulou A, Anastasiou-Nana M, Furukawa Y, Yamada T, Morita T, Tanaka K, Iwasaki Y, Kawasaki M, Kuramoto Y, Fukunami M, Blanche C, Tran N, Rigamonti F, Zimmermann M, Okisheva E, Tsaregorodtsev D, Sulimov V, Novikova D, Popkova T, Udachkina E, Korsakova Y, Volkov A, Novikov A, Alexandrova E, Nasonov E, Arsenos P, Gatzoulis K, Manis G, Dilaveris P, Gialernios T, Kartsagoulis E, Asimakopoulos S, Stefanadis C, Marocolo M, Barbosa Neto O, Carvalho AC, Marques Neto SR, Mota GR, Barbosa PRB, Fernandez-Fernandez A, Manzano Fernandez S, Pastor-Perez FJ, Barquero-Perez O, Goya-Esteban R, Salar M, Rojo-Alvarez JL, Garcia-Alberola A, Takigawa M, Kawamura M, Aiba T, Kamakura S, Sakaguchi T, Itoh H, Horie M, Shimizu W, Miyazaki A, Sakaguchi H, Yamamoto T, Igarashi T, Negishi J, Toyota N, Ohuchi H, Yamada O, Arsenos P, Gatzoulis K, Manis G, Dilaveris P, Gialernios T, Papavasileiou M, Asimakopoulos S, Stefanadis C, Cabrera Bueno F, Molina Mora MJ, Alzueta Rodriguez J, Barrera Cordero A, De Teresa Galvan E, Revishvili AS, Dzhordzhikiya T, Sopov O, Simonyan G, Lyadzhina O, Fetisova E, Kalinin V, Balt JC, Steggerda RC, Boersma LVA, Wijffels MCEF, Wever EFD, Ten Berg JM, Ricci RP, Morichelli L, D'onofrio A, Zanotto G, Vaccari D, Calo' L. Poster Session 1. Europace 2011. [DOI: 10.1093/europace/eur220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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M, Goya M, Hiroshima K, Ohe M, Hayashi K, Iwabuchi M, Nosaka H, Nobuyoshi M, Doiny D, Perez-Silva A, Castrejon Castrejon S, Estrada A, Ortega M, Lopez-Sendon JL, Merino JL, Garcia Fernandez FJ, Gallardo R, Pachon M, Almendral J, Gonzalez Torrecilla E, Martin J, Yahya D, Al-Mogheer B, Gouda S, Eweis E, El Ramly M, Abdelwahab A, Kassenberg W, Wittkampf FHM, Hof IE, Heijden JH, Neven KGEJ, Meine M, Hauer RNW, Loh P, Baratto F, Bignami E, Pappalardo F, Maccabelli G, Nicolotti D, Zangrillo A, Della Bella P, Hayashi K, Goya M, Hiroshima K, Nagashima M, An Y, Fukunaga M, Okreglicki A, Russouw C, Tilz R, Yoshiga Y, Mathew S, Fuernkranz A, Rillig A, Wissner E, Kuck KH, Ouyang F, De Sisti A, Tonet J, Gueffaf F, Amara W, Touil F, Aouate P, Hidden-Lucet F, Doiny D, Castrejon Castrejon S, Estrada A, Ortega M, Perez-Silva A, Lopez-Sendon JL, Merino JL, Makimoto H, Satomi K, Yamada Y, Okamura H, Noda T, Shimizu W, Aihara N, Kamakura S, Estrada A, Perez Silva A, Doiny D, Castrejon S, Gonzalez Vasserot M, Merino JL, Tilz R, Senges J, Brachmann J, Andresen D, Hoffmann E, Schumacher B, Willems S, Kuck KH, Reents T, Deisenhofer I, Ammar S, Springer B, Fichtner S, Jilek C, Kolb C, Hessling G, Akca F, Bauernfeind T, De Groot NMS, Schwagten B, Witsenburg M, Jordaens L, Szili-Torok T, Hata Y, Nakagami R, Watanabe T, Sato A, Watanabe H, Kabutoya T, Mituhashi T, Theuns DAMJ, Smith T, Pedersen SS, Dabiri-Abkenari L, Jordaens L, Prull MW, Unverricht S, Bittlinsky A, Wirdemann H, Sasko B, Wirdeier S, Trappe HJ, Zorio Grima E, Rueda J, Medina P, Jaijo T, Sevilla T, Osca J, Arnau MA, Salvador A, Starrenburg AH, Kraaier K, Pedersen SS, Scholten MF, Van Der Palen J, De Haan S, Commandeur J, De Boer K, Beek AM, Van Rossum AC, Allaart CP, Berne P, Porres JM, Fernandez-Lozano I, Arnaiz JA, Mont L, Berruezo A, Brugada R, Brugada J, Man S, Maan AC, Thijssen J, Van Der Wall EE, Schalij MJ, Burattini L, Burattini R, Swenne CA, Bonny A, Hidden-Lucet F, Ditah I, Larrazet F, Frank R, Fontaine G, Van Den Broek KC, Pedersen SS, Theuns DAMJ, Jordaens L, Van Der Voort PH, Alings M, Denollet J, Shimane A, Okajima K, Kanda G, Yokoi K, Yamada S, Taniguchi Y, Hayashi T, Kajiya T, Santos MC, Wright J, Betts J, Denman R, Dominguez-Perez L, Arias Palomares MA, Toquero J, Jimenez-Candil J, Olague J, Diaz-Infante E, Tercedor L, Valverde I, Miracle Blanco AL, Datino Romaniega T, Arenal Maiz A, Atienza Fernandez F, Gonzalez Torrecilla E, Eidelman G, Hernandez Hernandez J, Fernandez Aviles F, Napp A, Joosten S, Stunder D, Zink M, Marx N, Schauerte P, Silny J, Trucco ME, Arce M, Palazzolo J, Femenia F, Glad JM, Szymkiewicz SJ, Glad JM, Szymkiewicz SJ, Fernandez-Armenta J, Camara O, Mont LL, Andreu D, Diaz E, Silva E, Frangi A, Berruezo A, Brembilla-Perrot B, Laporte F, Jimenez-Candil J, Martin A, Gallego M, Morinigo J, Ledesma C, Martin-Luengo C, Hadid C, Almendral J, Ortiz M, Quesada A, Wolpert C, Cobo E, Navarro X, Arribas F, Miki Y, Naitoh S, Kumagai K, Goto K, Kaseno K, Oshima S, Taniguchi K, Rivera S, Scazzuso F, Albina G, Klein A, Laino R, Sammartino V, Giniger A, Fukumoto K, Takatsuki S, Kimura T, Nishiyama N, Aizawa Y, Sato T, Miyoshi S, Fukuda K, Muggenthaler M, Raju H, Papadakis M, Chandra N, Bastiaenen R, Behr ER, Sharma S, Samniah N, Radezishvsky Y, Omari H, Rosenschein U, Perez Riera AR, Ferreira M, Hopman WM, Mcintyre WF, Baranchuk AR, Wongcharoen W, Keanprasit K, Phrommintikul A, Chaiwarith R, Yagishita A, Hachiya H, Nakamura T, Tanaka Y, Higuchi K, Kawabata M, Hirao K, Isobe M, Havranek S, Simek J, Wichterle D, Stoickov V, Ilic S, Deljanin Ilic M, Aagaard P, Sahlen A, Bergfeldt L, Braunschweig F, Sousa A, Lebreiro A, Sousa C, Oliveira S, Correia AS, Rangel I, Freitas J, Maciel MJ, Asensio Lafuente E, Aguilera AAC, Corral MACC, Mendoza KLMC, Nava PEND, Rendon ALRC, Villegas LVC, Castillo LCM, Schaerf R, Develle R, Brembilla-Perrot B, Oliver C, Zinzius PY, Providencia RA, Botelho A, Trigo J, Nascimento J, Quintal N, Mota P, Leitao-Marques AM, Borbola J, Abraham P, Foldesi CS, Kardos A, Miranda R, Almeida S, Santos MB, Cavaco D, Quaresma R, Morgado FB, Adragao P, Fatemi M, Didier R, Le Gal G, Etienne Y, Jobic Y, Gilard M, Boschat J, Mansourati J, Zubaid M, Rashed W, Alsheikh-Ali A, Almahmeed W, Shehab A, Sulaiman K, Asaad N, Amin H, Boersma LVA, Swaans M, Post M, Rensing B, Jarverud K, Broome M, Noren K, Svensson T, Hjelm S, Hollmark M, Bjorling A, Providencia RA, Botelho A, Trigo J, Nascimento J, Quintal N, Mota P, Leitao-Marques AM, Maeda K, Takagi M, Suzuki K, Tatsumi H, Yoshiyama M, Simeonidou E, Michalakeas C, Kastellanos S, Varounis C, Nikolopoulou A, Koniari C, Anastasiou-Nana M, Furukawa T, Maggi R, Bertolone C, Fontana D, Brignole M, Pietrucha AZ, Wnuk M, Bzukala I, Mroczek-Czernecka D, Konduracka E, Kruszelnicka O. Poster Session 4. Europace 2011. [DOI: 10.1093/europace/eur231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ito A, Kajihara T, Suenari T, Takahashi M, Kimura T, Fukumoto K, Takatsuki S, Miyoshi S, Arai T. Non-thermal cardiac ablation with photosensitization reaction in right atrial isthmus of porcine heart. Photodiagnosis Photodyn Ther 2011. [DOI: 10.1016/j.pdpdt.2011.03.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Onouchi Y, Ozaki K, Buns JC, Shimizu C, Hamada H, Honda T, Terai M, Honda A, Takeuchi T, Shibuta S, Suenaga T, Suzuki H, Higashi K, Yasukawa K, Suzuki Y, Sasago K, Kemmotsu Y, Takatsuki S, Saji T, Yoshikawa T, Nagai T, Hamamoto K, Kishi F, Ouchi K, Sato Y, Newburger JW, Baker AL, Shulman ST, Rowley AH, Yashiro M, Nakamura Y, Wakui K, Fukushima Y, Fujino A, Tsunoda T, Kawasaki T, Hata A, Nakamura Y, Tanaka T. Common variants in CASP3 confer susceptibility to Kawasaki disease. Hum Mol Genet 2010; 19:2898-906. [PMID: 20423928 DOI: 10.1093/hmg/ddq176] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Kawasaki disease (KD; OMIM 611775) is an acute vasculitis syndrome which predominantly affects small- and medium-sized arteries of infants and children. Epidemiological data suggest that host genetics underlie the disease pathogenesis. Here we report that multiple variants in the caspase-3 gene (CASP3) that are in linkage disequilibrium confer susceptibility to KD in both Japanese and US subjects of European ancestry. We found that a G to A substitution of one commonly associated SNP located in the 5' untranslated region of CASP3 (rs72689236; P = 4.2 x 10(-8) in the Japanese and P = 3.7 x 10(-3) in the European Americans) abolished binding of nuclear factor of activated T cells to the DNA sequence surrounding the SNP. Our findings suggest that altered CASP3 expression in immune effecter cells influences susceptibility to KD.
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Affiliation(s)
- Yoshihiro Onouchi
- Laboratory for Cardiovascular diseases, Center for Genomic Medicine RIKEN, Yokohama 230-0045, Japan.
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Takatsuki S, Nakamura R, Haga Y, Mitsui K, Hashimoto T, Shimojima K, Saji T, Yamamoto T. Severe pulmonary emphysema in a girl with interstitial deletion of 2q24.2q24.3 includingITGB6. Am J Med Genet A 2010; 152A:1020-5. [DOI: 10.1002/ajmg.a.33362] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sakazaki H, Niwa K, Nakazawa M, Saji T, Nakanishi T, Takamuro M, Ueno M, Katou H, Takatsuki S, Matsushima S, Kojima N, Ichida F, Kogaki S, Kido S, Aragaki Y, Waki K, Akagi T, Jo K, Souuchi A, Suda K. CLINICAL STUDY ON MORTALITY AND MORBIDITY OF PATIENTS WITH EISENMENGER SYNDROME -JAPANESE MULTICENTER STUDY. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)60401-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ozaki M, Kaji K, Matsuda N, Ochiai K, Asada M, Ohba T, Hosoi E, Tado H, Koizumi T, Suwa G, Takatsuki S. The relationship between food habits, molar wear and life expectancy in wild sika deer populations. J Zool (1987) 2010. [DOI: 10.1111/j.1469-7998.2009.00653.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Satoh M, Aso K, Nakayama T, Naoi K, Ikehara S, Uchino Y, Shimada H, Takatsuki S, Matsuura H, Saji T. Autoimmune thyroid disease in children and adolescents with idiopathic pulmonary arterial hypertension. Circ J 2009; 74:371-4. [PMID: 20009390 DOI: 10.1253/circj.cj-09-0369] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Previous studies have reported a high prevalence of autoimmune thyroid disease (AITD) in adult patients with pulmonary arterial hypertension (PAH). The aim of this retrospective study was to determine the prevalence of AITD in children and adolescents with idiopathic PAH (IPAH). METHODS AND RESULTS The study group included 16 patients who had been diagnosed as having idiopathic PAH when they were younger than 15 years old; all were younger than 20 years of age. Thyroid function and antithyroid antibody levels were examined regularly at 6-12-month intervals and when there were clinical signs of thyroid dysfunction. In total, 7 patients (44%) had AITD; 2 patients developed Graves' disease, 2 developed silent thyroiditis, and 3 had antithyroid antibodies with euthyroidism. The duration after PAH onset and the prostacyclin (PGI(2)) treatment period were significantly longer in patients with AITD (7.6+/-2.1 and 7.4+/-2.3 years, respectively) than in patients without AITD (5.0+/-1.1 and 4.8+/-1.2 years, respectively; P<0.01 and P<0.05). CONCLUSIONS The prevalence of AITD is high in children and adolescents with IPAH, so evaluation of thyroid function is important to prevent deterioration of right heart failure.
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Affiliation(s)
- Mari Satoh
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan.
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Affiliation(s)
| | - Yuka Ito
- Pediatrics, Toho University Omori Medical Center
| | | | | | | | | | - Tsutomu Saji
- Pediatrics, Toho University Omori Medical Center
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Ozaki M, Suwa G, Kaji K, Ohba T, Hosoi E, Koizumi T, Takatsuki S. Correlations between feeding type and mandibular morphology in the sika deer. J Zool (1987) 2007. [DOI: 10.1111/j.1469-7998.2006.00264.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Takeuchi D, Saji T, Takatsuki S, Fujiwara M. Abnormal Tissue Doppler Images are Associated With Elevated Plasma Brain Natriuretic Peptide and Increased Oxidative Stress in Acute Kawasaki Disease. Circ J 2007; 71:357-62. [PMID: 17322635 DOI: 10.1253/circj.71.357] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aims of this study were to evaluate myocardial mechanics using pulsed tissue Doppler imaging (TDI), and to determine the relationship between abnormal myocardial performance and plasma brain natriuretic peptide (BNP) levels and oxidative stress in acute Kawasaki disease (KD). METHODS AND RESULTS Consecutive TDI parameters, including peak systolic velocity (Sw) and early (Ew) and late diastolic excursion of the mitral annuli were obtained in 42 patients with KD (mean age: 2.4+/-0.4 years) in weeks 1, 2, and 3, and during convalescence. Plasma BNP level and urinary 8-isoprostane were also examined during the acute phase. These data were then compared with TDI profiles from 62 healthy children, plasma BNP levels in 38 controls with other febrile illnesses, and urinary 8-isoprostane levels in 13 healthy children. Ew in week 1 was significantly lower than in controls, subsequently normalizing in the convalescent stage. Plasma BNP level in acute KD patients was significantly higher (65+/-9 pg/ml) than in controls (13+/-2 pg/ml). Urinary 8-isoprostane level in acute KD patients was significantly higher as compared with control (596 +/-37 vs 379+/-26 pg/ml Cr, p<0.05). There was a significant negative correlation between week 1 Sw and plasma BNP level (r=-0.55, p=0.0001). Change in Sw velocity in the BNP >/=51 group was significantly greater than in the BNP <51 group. There was a significant negative correlation between week 1 Sw and urinary 8-isoprostane level (r=-0.48, p=0.001). CONCLUSIONS Latent abnormal tissue Doppler profiles, possibly reflecting long-axis systolic and diastolic dysfunction have been noted in KD patients. Abnormal myocardial mechanics may contribute to the increased plasma BNP level and enhanced oxidative stress may contribute to cardiac dysfunction in KD.
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Affiliation(s)
- Daiji Takeuchi
- Department of Pediatric Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
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Nakayama T, Shimada H, Takatsuki S, Hoshida H, Ishikita T, Matsuura H, Saji T. Efficacy and Limitations of Continuous Intravenous Epoprostenol Therapy for Idiopathic Pulmonary Arterial Hypertension in Japanese Children. Circ J 2007; 71:1785-90. [DOI: 10.1253/circj.71.1785] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tomotaka Nakayama
- The First Department of Pediatrics, Toho University School of Medicine
| | - Hiromitsu Shimada
- The First Department of Pediatrics, Toho University School of Medicine
| | | | - Hiroshi Hoshida
- The First Department of Pediatrics, Toho University School of Medicine
| | - Takashi Ishikita
- The First Department of Pediatrics, Toho University School of Medicine
| | - Hiroyuki Matsuura
- The First Department of Pediatrics, Toho University School of Medicine
| | - Tsutomu Saji
- The First Department of Pediatrics, Toho University School of Medicine
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