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Sadanaga T, Hirota S. Association between sodium-to-potassium ratio in spot urine and hospitalization due to heart failure in high-risk Japanese patients. Int J Cardiol Heart Vasc 2024; 50:101334. [PMID: 38234681 PMCID: PMC10792732 DOI: 10.1016/j.ijcha.2023.101334] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/10/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024]
Abstract
Background In Japanese cardiovascular (CV) high-risk patients, the ESPRIT (Evaluation of Sodium Intake for the Prediction of Cardiovascular Events in Japanese High-risk Patients) study showed that high sodium excretion (≥4.0 g/day) was associated with a composite CV events of heart failure (HF) hospitalization, acute coronary syndrome, cerebrovascular events, and CV deaths. In this context, the sodium-to-creatinine (Na/Cr) ratio in spot urine was found to be significantly associated with HF hospitalizations. Since a stable potassium balance plays a particularly relevant role for CV patients, this post-hoc study was designed to investigate the extent to which consideration of the sodium-to-potassium (Na/K) ratio represents a better predictor of HF hospitalizations in the ESPRIT study population. Methods This is a post-hoc analysis of a previously reported ESPRIT study (n = 520, 60 HF hospitalizations). Results Receiver operating curve analysis yielded optimal Na/K ratio cut-off value of 2.9 for detecting HF hospitalization. Kaplan-Meier curve showed that high Na/K ratio in spot urine was associated with increased HF hospitalization (p < 0.001). Cox proportional hazards model analysis revealed that high Na/K ratio was associated with HF hospitalization with a hazard ratio of 2.97 (confidence interval: 1.67-5.61). An association between high Na/K ratio and HF hospitalization remained after adjustments for Na/Cr ratio in spot urine or the use of diuretics. Conclusion The Na/K ratio in spot urine is associated with HF hospitalization in high-risk Japanese patients.
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Manabe M, Fujino M, Kusuki H, Sadanaga T, Hata T, Bouda H, Miyata M, Yoshikawa T. Effect of Hypothermia on Myocardial Depolarization and Repolarization in Neonates with Hypoxic-Ischemic Encephalopathy Due to Asphyxia. Pediatr Cardiol 2022; 43:1792-1798. [PMID: 35670814 DOI: 10.1007/s00246-022-02916-x] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/15/2022] [Indexed: 11/24/2022]
Abstract
Therapeutic hypothermia (TH) is effective for neonatal hypoxic-ischemic encephalopathy (HIE). The combination of abnormal myocardial repolarization and fatal arrhythmia in patients with accidental hypothermia has prompted clinical validation of the proarrhythmic potential of TH. However, to our knowledge, there have been few clinical studies on myocardial depolarization and repolarization abnormalities caused by TH in neonates. Therefore, we investigated the effects of TH on neonatal myocardial depolarization and repolarization by capturing the waveform changes in electrocardiograms (ECGs) associated with body temperature (BT) before and after TH. We included three neonates with HIE diagnosed at birth who were treated with TH in our hospital. The heart rate, RR interval, P wave duration, PR interval, QRS duration, QT interval, corrected QT (QTc) interval by Fridericia's formula, J point-T end (JT) interval, corrected JT (JTc) interval by Fridericia's formula, T peak-T end (Tpe) interval, Tpe/QT, and QRS/QTc were calculated retrospectively using an ECG. The correlations of ECG parameters recorded concurrently with 33 samples in which BT measurements were confirmed were performed. BT and heart rate were positively correlated (R: 0.589, p = 0.0003). BT was negatively correlated with Tpe/QT (R: - 0.470, p = 0.0058), the QTc interval (R: - 0.680, p < 0.0001), and the corrected JT interval (R: - 0.697, p < 0.0001). TH does not affect atrial or ventricular depolarization but prolongs the ventricular repolarization process in a temperature-dependent manner.
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Affiliation(s)
- Masahiko Manabe
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Masayuki Fujino
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Hirofumi Kusuki
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | | | - Tadayoshi Hata
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan. .,Graduate School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan.
| | - Hiroko Bouda
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Masafumi Miyata
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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Sadanaga T, Hirota S. Sodium to creatinine ratio in spot urine is associated with heart failure hospitalization in Japanese high‑risk patients. Exp Ther Med 2022; 23:379. [PMID: 35495597 PMCID: PMC9019713 DOI: 10.3892/etm.2022.11306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/24/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Shinichi Hirota
- Department of Cardiology, Kumamoto City Ueki Hospital, Kumamoto 861‑0136, Japan
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Kusuki H, Mizutani Y, Tsuchiya Y, Nishio M, Oikawa S, Nagata R, Kiriyanagi Y, Horio K, Hosoi M, Matsuura H, Sadanaga T, Hata T. Myocardial repolarization time, J-point to T-peak and T-peak to T-end intervals, have different heart rate dependency and autonomic nerve interference in healthy prepubertal children. J Electrocardiol 2021; 67:119-123. [PMID: 34174541 DOI: 10.1016/j.jelectrocard.2021.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/10/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The JT interval of the myocardial repolarization time can be divided into Jpoint to T-peak interval (JTp) and T-peak to T-end interval (Tpe). It is well known that the JT interval is dependent on the heart rate, but little is known regarding heart rate dependence for JTp and Tpe. The aim of the present study was to clarify the heart rate dependence of JTp and Tpe and to elucidate the interference of autonomic nervous activity with these parameters. METHODS We evaluated 50 prepubertal children (mean age: 6.4 ± 0.5 years; male:female, 22:28) without heart disease. JTp, Tpe, and the preceding RR intervals were measured using 120 consecutive beats (lead CM5). First, the relationships between the RR interval and JTp and Tpe were evaluated by Pearson's correlation coefficient. Second, to evaluate autonomic interference with JTp and Tpe, the degree of coherence between RR interval variability and JTp or Tpe variability was calculated using spectral analysis. RESULTS Significant positive correlations were observed between the RR interval and JTp (y = 0.116x + 105.5; r = 0.594, p < 0.001) and between the RR interval and Tpe (y = 0.037x + 44.7; r = 0.432, p < 0.001). Tpe variability had a lower degree of coherence with RR interval variability (range: 0.039-0.5 Hz) than with JTp variability (0.401 [interquartile range, 0.352-0.460] vs. 0.593 [0.503-0.664], respectively; p < 0.001). CONCLUSIONS Tpe had lower heart rate dependence and a lower degree of autonomic nervous interference than did JTp.
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Affiliation(s)
- Hirofumi Kusuki
- Graduate school of Health Science, Fujita Health University, Toyoake, Japan.
| | - Yuri Mizutani
- Clinical Laboratory Division, Fujita Health University Hospital, Toyoake, Japan
| | - Yuka Tsuchiya
- Graduate school of Health Science, Fujita Health University, Toyoake, Japan
| | - Miki Nishio
- Graduate school of Health Science, Fujita Health University, Toyoake, Japan
| | - Shota Oikawa
- Clinical Laboratory Division, Fujita Health University Hospital, Toyoake, Japan
| | - Rina Nagata
- Clinical Laboratory Division, Fujita Health University Hospital, Toyoake, Japan
| | - Yumi Kiriyanagi
- Clinical Laboratory Division, Fujita Health University Hospital, Toyoake, Japan
| | - Kayo Horio
- Department of Physiology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Misa Hosoi
- Clinical Laboratory Division, Fujita Health University Hospital, Toyoake, Japan
| | - Hideaki Matsuura
- Graduate school of Health Science, Fujita Health University, Toyoake, Japan; Clinical Laboratory Division, Fujita Health University Hospital, Toyoake, Japan
| | | | - Tadayoshi Hata
- Graduate school of Health Science, Fujita Health University, Toyoake, Japan; Clinical Laboratory Division, Fujita Health University Hospital, Toyoake, Japan
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Sadanaga T, Hirota S, Mitamura H. Factors associated with heart failure hospitalization in patients with high sodium excretion: subanalysis of the ESPRIT, evaluation of sodium intake for the prediction of cardiovascular events in Japanese high-risk patients, cohort study. Heart Vessels 2020; 36:85-91. [PMID: 32720095 DOI: 10.1007/s00380-020-01673-2] [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] [Received: 05/06/2020] [Accepted: 07/17/2020] [Indexed: 11/28/2022]
Abstract
We have reported that high sodium excretion ≥ 4.0 g/day, assessed by repeated measurements of spot urine, is associated with composite cardiovascular (CV) events of heart failure (HF) hospitalization, acute coronary syndrome, cerebrovascular events, and documented CV deaths in Japanese high-risk patients with either stable and compensated congestive HF, high brain natriuretic peptide, coronary artery disease, cerebrovascular disease, chronic kidney disease, or atrial fibrillation. A total of 520 patients were enrolled. During the median follow-up period of 5.2 years, 105 (20%) experienced composite CV events, which were predominantly driven by 60 (12%) HF hospitalizations. The aim of the present study was to elucidate which subgroups of patients with high sodium excretion were associated with HF hospitalization. We divided the enrolled patients into three groups according to the amount of sodium excretion (< 3.0 g/day, 3.0-3.99 g/day (reference), and ≥ 4.0 g/day) based on a median of 14 measurements during follow-up. We assessed the hazard ratio for HF hospitalization according to age, bodyweight, and gender, using the Cox hazard model. In the total population, high sodium excretion ≥ 4.0 g/day was associated with HF hospitalization [hazard ratio (HR) 1.75, confidence interval (CI) 1.05-2.83] after adjustment for gender, age, and bodyweight, but was not associated with other CV events. In older patients (≥ 75 years old), high sodium excretion ≥ 4.0 g/day was associated with HF hospitalization after adjustment for gender and bodyweight (HR 3.25, CI 1.55-6.55), which was not observed in younger (< 75 years old) patients. In patients with lower bodyweight (< 60 kg), high sodium excretion ≥ 4.0 g/day was associated with HF hospitalization after adjustment for age and gender (HR 3.05, CI 1.34-6.61), which was not observed in heavier (≥ 60 kg) patients. High sodium excretion is associated with HF hospitalization in patients with older age and lower bodyweight in Japanese high-risk patients.
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Kusuki H, Tsuchiya Y, Mizutani Y, Nishio M, Oikawa S, Nagata R, Kiriyanagi Y, Horio K, Kojima A, Uchida H, Kojima N, Saito K, Sadanaga T, Hata T. QT Variability Index is Correlated with Autonomic Nerve Activity in Healthy Children. Pediatr Cardiol 2020; 41:1432-1437. [PMID: 32572546 PMCID: PMC7557489 DOI: 10.1007/s00246-020-02399-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022]
Abstract
The QT variability index (QTVI), which measures the instability of myocardial repolarization, is usually calculated from a single electrocardiogram (ECG) recording and can be easily applied in children. It is well known that frequency analysis of heart rate variability (HRV) can detect autonomic balance, but it is not clear whether QTVI is correlated with autonomic tone. Therefore, we evaluated the association between QTVI and HRV to elucidate whether QTVI is correlated with autonomic nerve activity. Apparently, healthy 320 children aged 0-7 years who visited Fujita Health University Hospital for heart checkup examinations were included. The RR and QT intervals of 60 continuous heart beats were measured, and the QTVI was calculated using the formula of Berger et al. Frequency analysis of HRV, including the QTVI analysis region, was conducted for 2 min and the ratio of low-frequency (LF) components to high-frequency (HF) components (LF/HF) and HF/(LF + HF) ratio was calculated as indicators of autonomic nerve activity. Then, the correlations between QTVI and these parameters were assessed. QTVI showed a significant positive correlation with LF/HF ratio (r = 0.45, p < 0.001) and negative correlation with HF/(LF + HF) ratio (r = -0.429, p < 0.001). These correlations remained after adjustment for sex and age. QTVI, which is calculated from non-invasive ECG and can detect abnormal myocardial repolarization, is significantly correlated with frequency analysis of HRV parameters. QTVI reflects autonomic nerve balance in children.
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Affiliation(s)
- Hirofumi Kusuki
- grid.256115.40000 0004 1761 798XGraduate School of Health Sciences, Fujita Health University, Toyoake, Aichi Japan
| | - Yuka Tsuchiya
- grid.256115.40000 0004 1761 798XGraduate School of Health Sciences, Fujita Health University, Toyoake, Aichi Japan
| | - Yuri Mizutani
- grid.256115.40000 0004 1761 798XGraduate School of Health Sciences, Fujita Health University, Toyoake, Aichi Japan
| | - Miki Nishio
- grid.256115.40000 0004 1761 798XGraduate School of Health Sciences, Fujita Health University, Toyoake, Aichi Japan
| | - Shota Oikawa
- grid.471500.70000 0004 0649 1576Laboratory of Clinical Medicine, Fujita Health University Hospital, Toyoake, Aichi Japan
| | - Rina Nagata
- grid.471500.70000 0004 0649 1576Laboratory of Clinical Medicine, Fujita Health University Hospital, Toyoake, Aichi Japan
| | - Yumi Kiriyanagi
- grid.471500.70000 0004 0649 1576Laboratory of Clinical Medicine, Fujita Health University Hospital, Toyoake, Aichi Japan
| | - Kayo Horio
- grid.256115.40000 0004 1761 798XDepartment of Physiology, School of Medicine, Fujita Health University, Toyoake, Aichi Japan
| | - Arisa Kojima
- grid.256115.40000 0004 1761 798XDepartment of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Aichi Japan
| | - Hidetoshi Uchida
- grid.256115.40000 0004 1761 798XDepartment of Pediatrics, School of Medicine, Fujita Health University, Toyoake, Aichi Japan
| | - Namiko Kojima
- Department of Pediatrics, Meijyo Hospital, Nagoya, Aichi Japan
| | - Kazuyoshi Saito
- Department of Pediatrics, Meijyo Hospital, Nagoya, Aichi Japan
| | | | - Tadayoshi Hata
- Graduate School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan.
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Mizutani Y, Kojima A, Takeuchi Y, Kusuki H, Sugimoto K, Osakabe K, Ichino N, Fujino M, Saito K, Miyata M, Sadanaga T, Hata T. Evaluation of perinatal autonomic development in infants using the QT/RR variability ratio. Fujita Med J 2020; 6:17-20. [PMID: 35111516 PMCID: PMC8766653 DOI: 10.20407/fmj.2019-006] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/17/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Development of the autonomic nervous system may play a role in myocardial repolarization lability in infants, but its relationship to repolarization abnormalities remains unclear. Thus, the aim of the present study was to evaluate the relationship between gestational age and ventricular repolarization lability using the variability ratio (VR). METHODS Infants who underwent electrocardiography at a 1-month check-up were included (n=209; 125 males). Gestational age and the following four VR parameters at 1 month of age were compared: VR-I, SDQT/SDRR; VR-II, SDQT/rMSSD; VR-III, SDQTc/SDRR; and VR-IV, SDQTc/rMSSD; where SD, QTc, and rMSSD are standard deviation, QT interval corrected using Fridericia's formula, and root mean square difference of successive RR intervals, respectively. Twenty-eight preterm infants born at <37 weeks of gestation and 181 full-term infants were included. RESULTS Significant correlations were observed between gestational age and VR-I, -III, and -IV (all p<0.05). All VR values were significantly higher in preterm infants compared with full-term infants (I: 0.54 vs 0.48, II: 1.15 vs 0.96, III: 0.88 vs 0.68, IV: 1.59 vs 1.39; median, all p<0.05). CONCLUSION VR assessed at 1 month after birth was impaired in preterm infants, suggesting immaturity of their cardiac autonomic nervous system and ventricular myocardial repolarization.
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Affiliation(s)
- Yuri Mizutani
- Graduate School of Health Sciences, Fujita Health University,
Toyoake, Aichi, Japan,Department of Joint Research Laboratory of Clinical Medicine, Fujita Health
University Hospital, Toyoake, Aichi, Japan
| | - Arisa Kojima
- Department of Pediatrics, Fujita Health University, School of
Medicine, Toyoake, Aichi, Japan
| | - Yuka Takeuchi
- Graduate School of Health Sciences, Fujita Health University,
Toyoake, Aichi, Japan
| | - Hirofumi Kusuki
- Graduate School of Health Sciences, Fujita Health University,
Toyoake, Aichi, Japan
| | - Keiko Sugimoto
- Graduate School of Health Sciences, Fujita Health University,
Toyoake, Aichi, Japan
| | - Keisuke Osakabe
- Graduate School of Health Sciences, Fujita Health University,
Toyoake, Aichi, Japan
| | - Naohiro Ichino
- Graduate School of Health Sciences, Fujita Health University,
Toyoake, Aichi, Japan
| | - Masayuki Fujino
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health
University Hospital, Toyoake, Aichi, Japan
| | - Kazuyoshi Saito
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health
University Hospital, Toyoake, Aichi, Japan
| | - Masafumi Miyata
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health
University Hospital, Toyoake, Aichi, Japan
| | | | - Tadayoshi Hata
- Graduate School of Health Sciences, Fujita Health University,
Toyoake, Aichi, Japan,Department of Joint Research Laboratory of Clinical Medicine, Fujita Health
University Hospital, Toyoake, Aichi, Japan,Department of Pediatrics, Fujita Health University, School of
Medicine, Toyoake, Aichi, Japan
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Sadanaga T. Are serial measurements of plasma concentrations of natriuretic peptide useful in real-world practice in patients with heart failure? Int J Cardiol 2018; 269:220-221. [DOI: 10.1016/j.ijcard.2018.07.123] [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] [Received: 07/16/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
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Sadanaga T. Can we “ScREEN” response to cardiac resynchronization therapy by a simple score? Int J Cardiol 2018; 260:105-106. [DOI: 10.1016/j.ijcard.2018.02.100] [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] [Received: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 11/25/2022]
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Sadanaga T, Ando K, Hirota S, Mitamura H, Tsuchihashi T, Kohsaka S, Fukuda K, Ogawa S. B-type natriuretic peptide levels are decreased by reducing dietary salt intake in patients with compensated heart failure with preserved ejection fraction. Intern Med J 2014; 43:663-7. [PMID: 23279137 DOI: 10.1111/imj.12063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 12/05/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dietary salt restriction is believed to be a mainstay in the management of patients with heart failure. However, the effect of salt intake on heart failure has not been well evaluated in outpatient medical practice. AIMS The aim of the present study was to assess the hypothesis that B-type natriuretic peptide (BNP) level, as an objective marker of heart failure, is associated with salt intake in patients with heart failure. METHODS One hundred and thirteen consecutive patients with mild compensated heart failure (77 ± 10 years old, 51 female) were included. We estimated dietary salt intake by the concentration of sodium and creatinine in spot urine. We measured BNP at the time of urine sampling and assessed the relationship between the % changes in BNP levels (%ΔBNP) and the changes in the estimated daily salt excretion (ΔNaCl) during the follow-up period. RESULTS The baseline median BNP level was 150 (interquartile range: 83-263) pg/mL and the estimated daily salt excretion was 162 ± 45 mmol/day. There was a positive correlation between %ΔBNP and ΔNaCl (r = 0.61, P < 0.01). Multiple regression analysis revealed that %ΔBNP was associated with ΔNaCl (P < 0.01), but not with changes in systolic blood pressure and bodyweight. CONCLUSIONS Changes in BNP levels were associated with changes in the estimated daily salt excretion in outpatients with compensated heart failure. Salt restriction may be beneficial for the management of patients with heart failure.
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Affiliation(s)
- T Sadanaga
- Division of Cardiology, Ueki Hospital, Kumamoto, Japan.
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Hirota S, Sadanaga T, Mitamura H, Fukuda K. Long-term compliance with salt restriction assessed using the spot urine method in Japanese cardiology outpatients. Hypertens Res 2013; 36:1096-9. [DOI: 10.1038/hr.2013.138] [Citation(s) in RCA: 7] [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: 03/28/2013] [Revised: 04/25/2013] [Accepted: 04/30/2013] [Indexed: 11/09/2022]
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Sadanaga T, Mitamura H. Soluble fibrin monomer complex levels during oral anticoagulant therapy do not predict subsequent thromboembolic events in patients with permanent atrial fibrillation. Int J Cardiol 2013; 168:578-80. [DOI: 10.1016/j.ijcard.2013.01.259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 01/18/2013] [Indexed: 11/15/2022]
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Hirota S, Sadanaga T, Mitamura H, Fukuda K. Erratum: Spot urine-guided salt reduction is effective in Japanese cardiology outpatients. Hypertens Res 2012. [DOI: 10.1038/hr.2012.118] [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: 11/09/2022]
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Hirota S, Sadanaga T, Mitamura H, Fukuda K. Spot urine-guided salt reduction is effective in Japanese cardiology outpatients. Hypertens Res 2012; 35:1069-71. [DOI: 10.1038/hr.2012.98] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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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Sadanaga T, Mitamura H, Fukuda K, Ogawa S. D-dimer levels positively correlate with B-type natriuretic peptide levels in patients with atrial fibrillation. Int J Cardiol 2012; 158:110-1. [PMID: 22572631 DOI: 10.1016/j.ijcard.2012.04.079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 03/06/2012] [Accepted: 04/08/2012] [Indexed: 10/28/2022]
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Sadanaga T, Sadanaga M, Ogawa S. Evidence That D-Dimer Levels Predict Subsequent Thromboembolic and Cardiovascular Events in Patients with Atrial Fibrillation during Oral Anticoagulant Therapy. J Arrhythm 2011. [DOI: 10.4020/jhrs.27.jpac_2] [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: 11/11/2022] Open
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Sadanaga T, Hirota S, Mitamura H. Dietary Salt Intake Contributes to the Variation of B-Type Natriuretic Peptide Levels in Patients with Chronic Atrial Fibrillation. J Arrhythm 2011. [DOI: 10.4020/jhrs.27.op22_1] [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: 11/11/2022] Open
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Sadanaga T, Sadanaga M, Ogawa S. Evidence That D-Dimer Levels Predict Subsequent Thromboembolic and Cardiovascular Events in Patients With Atrial Fibrillation During Oral Anticoagulant Therapy. J Am Coll Cardiol 2010; 55:2225-31. [DOI: 10.1016/j.jacc.2009.12.049] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 11/30/2009] [Accepted: 12/07/2009] [Indexed: 10/19/2022]
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Sadanaga T, Kohsaka S, Ogawa S. D-Dimer Levels in Combination with Clinical Risk Factors Can Effectively Predict Subsequent Thromboembolic Events in Patients with Atrial Fibrillation during Oral Anticoagulant Therapy. Cardiology 2010; 117:31-6. [DOI: 10.1159/000319626] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Accepted: 07/19/2010] [Indexed: 11/19/2022]
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Emi Y, Orita H, Yamamoto M, Sadanaga T, Kusumoto T, Takahashi I, Kakeji Y, Maehara Y. 6536 Feasibility of adjuvant S-1 plus docetaxel against stage II-III gastric cancer following R0 resection in gastrectomy. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71258-3] [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: 10/20/2022] Open
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Sakamoto T, Sadanaga T, Okazaki T. Sequential use of aminophylline and theophylline for the treatment of atropine-resistant bradycardia after spinal cord injury: a case report. J Cardiol 2007; 49:91-6. [PMID: 17354583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
A 66-year-old Japanese man was brought to our emergency department after he was accidentally compressed into a lateral groove. Physical examination revealed pinprick sensory level of T4 and motor level of C7. On the 4th hospital day, electrocardiography suddenly showed sinus bradycardia of 33 beats/min. Bolus injection of 0.5 mg of atropine sulphate was not effective. Bolus injection of aminophylline was administered followed by continuous infusion. His heart rate increased and remained stable at 60 to 70 beats/min. Therapy was switched from aminophylline to oral theophylline and continued for about 5 weeks, with no recurrence of bradycardia. Use of xanthine derivatives is thought to be an effective, safe and simple treatment for spinal cord injury-induced bradycardia.
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Affiliation(s)
- Tomohiro Sakamoto
- Division of Cardiology, Cardiovascular Center, Saiseikai Kumamoto Hospital, Kumamoto.
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Sadanaga T, Araki S, Tanaka Y, Ogawa H. Spontaneous Polymorphic Ventricular Tachycardia after Administration of Pilsicainide in a Patient Resuscitated from Ventricular Fibrillation. Pacing Clin Electrophysiol 2006; 29:1016-8. [PMID: 16981928 DOI: 10.1111/j.1540-8159.2006.00479.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/29/2022]
Abstract
We performed a pilsicainide challenge test in a 38-year-old man who was resuscitated from ventricular fibrillation without apparent baseline electrocardiogram (ECG) abnormality. His father had a history of ventricular fibrillation and his brother had multiple episodes of syncope. Pilsicainide (1 mg/kg) induced short coupled ventricular premature beats followed by repetitive polymorphic ventricular tachycardia without apparent J wave and ST elevation, and excessive changes in QRS duration and QT interval. An implantable cardioverter defibrillator was implanted.
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Affiliation(s)
- Tsuneaki Sadanaga
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
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Abstract
AIMS The aim of the present study is to elucidate the optimal lead to be selected for the evaluation of drug-induced QT prolongation. METHODS AND RESULTS We assessed the validity of each electrocardiography (ECG) lead for the evaluation of QT intervals in 688 patients receiving psychotropic drugs. Abnormal QTc prolongation was observed in 96 (14%) patients using the longest ECG lead. Prevalence of QTc prolongation was larger when using leads I, III, aVR, aVL, aVF, V1, and V6 (> 18%), and smaller when using lead V2 (10%). In the remaining 4 ECG leads, the overall accuracy to predict QTc prolongation was higher when using lead V3 (94%) compared with lead II (89%) or lead V5 (90%). Sensitivity to predict QTc prolongation was higher when using lead V4 (81%) compared with lead II (66%) or lead V2 (63%). CONCLUSION When a single lead was used for the evaluation of QT prolongation, the results were not always similar to those using the lead which demonstrated the longest QT interval, and if only one lead is to be chosen, lead V3 or V4 should be selected.
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Affiliation(s)
- Tsuneaki Sadanaga
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Abstract
QT prolongation induced by antipsychotics has been reported to be a determinant for the development of torsade de pointes and sudden death. However, the effect of lithium on QT interval has not been fully clarified. The aim of the present study was to elucidate the relationship between serum lithium concentration and QT interval in patients treated with lithium. We examined serum lithium concentrations and electrocardiographic features in 39 inpatients with bipolar affective disorder or schizophrenia. The longest QT interval in the 12 electrocardiographic leads was measured using GE Marquette QT guard System Software, and Bazett formula was used for heart rate correction. The longest QTc was positively correlated with lithium concentration ( r = 0.46, P = .003). Multiple regression analysis revealed that sex (female, P = .037), lower serum K + concentration ( P = .029), and especially, higher serum lithium concentration ( P = .009) were determinants for the prolongation of the QTc.
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Affiliation(s)
- Kohsuke Mamiya
- Department of Clinical Researh, Hizen psychiatric Center, Saga, 842-0192 Japan.
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Sadanaga T, Sadanaga F, Yao H, Fujishima M. Abnormal QT prolongation and psychotropic drug therapy in psychiatric patients: Significance of bradycardia-dependent QT prolongation. J Electrocardiol 2004; 37:267-73. [PMID: 15484154 DOI: 10.1016/j.jelectrocard.2004.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Because many psychotropic drugs have electrophysiological properties similar to antiarrhythmic drugs, they might lengthen QT interval and cause torsades de pointes. Electrocardiograms were obtained in 688 psychiatric patients receiving psychotropic drugs. A QTc interval >460 ms was observed in 96 (14%) patients. To elucidate the heart rate dependence of QT prolongation, we measured QT intervals and the preceding R-R intervals at various heart rates by 24-hour Holter electrocardiogram in 97 patients. We estimated the QT intervals at the heart rates of 80 beats/min and 50 beats/min by the regression curve. A QT interval at the heart rate of 80 beats/min exceeded 400 ms in 14 (15%) patients and that at the heart rate of 50 beats/min exceeded 480 ms in additional 12 (12%) patients. Therefore, additional attention is needed for bradycardia-dependent QT prolongation even when the QT interval was not prolonged at usual heart rates.
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Affiliation(s)
- Tsuneaki Sadanaga
- Department of Medicine and Clinical Science, Graduate School fo Medical Sciences, Kyushu University, Japan.
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Sadanaga T, Sadanaga F, Yao H, Fujishima M. Heart rate dependent modification of the QTc cut-off values can improve accurate evaluation of QT prolongation. Am J Cardiol 2004; 93:772-5. [PMID: 15019891 DOI: 10.1016/j.amjcard.2003.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 08/04/2003] [Revised: 12/02/2003] [Accepted: 12/02/2003] [Indexed: 10/26/2022]
Abstract
Significant amounts of over- and underestimation to detect QT prolongation were observed using Bazett's formula or Fridericia's formula for heart rate correction with any fixed QTc cut-off value. Heart rate dependent modification of the QTc cut-off values can improve accurate evaluation of QT prolongation.
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Affiliation(s)
- Tsuneaki Sadanaga
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Higashi-Ku, Fukuoka, Japan.
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Sadanaga T, Ohya Y, Ohtsubo T, Goto K, Fujii K, Abe I. Decreased 4-aminopyridine sensitive K+ currents in endothelial cells from hypertensive rats. Hypertens Res 2002; 25:589-96. [PMID: 12358146 DOI: 10.1291/hypres.25.589] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endothelial cell function is altered in hypertension. The present study was performed to evaluate the alterations in K+ channels in endothelial cells from hypertensive rats. Currents and membrane potentials were recorded in endothelial cells freshly dissociated from the aorta of stroke-prone spontaneously hypertensive rats (SHR-SP) and Wistar-Kyoto rats (WKY). Ca2+-dependent K+ channel blockers, charybdotoxin and apamin, a voltage-dependent K+ channel blocker, 4-aminopyridine, and a non-selective K+ channel blocker, tetrabutylammonium, were used to characterize K+ currents. Depolarizing command steps evoked delayed K+ outward currents in cells from both strains. The current density of 4-aminopyridine sensitive K+ currents was significantly smaller in SHR-SP than in WKY (1.5 +/- 0.4 vs. 4.9 +/- 0.6 pA/pF, at 36 mV, n = 13, p < 0.01), whereas that of other K+ current components did not differ between strains. The resting membrane potential of cells was significantly less negative in SHR-SP than in WKY (-25.0 +/- 1.7, n = 54 vs. -33.5 +/- 1.4 mV, n = 50, p < 0.01). Depolarization by 4-aminopyridine, but not that by charybdotoxin+apamin, abolished the difference in membrane potentials between SHR-SP and WKY (n=7-10 in each strain). Immunostaining of endothelial cells by anti-Kv1.5 antibody was decreased in SHR-SP compared to WKY. In summary, the 4-aminopyridine sensitive K+ currents in aortic endothelial cells were decreased in SHR-SP, which could contribute to the membrane depolarization. Decreased expression of Kv1.5 in SHR-SP might be associated with this alteration.
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Affiliation(s)
- Tsuneaki Sadanaga
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Sadanaga T, Sadanaga F, Yao H. Abnormal QT prolongation and psychotropic drug therapy in psychiatric patients: significance of bradycardia-dependent QT prolongation. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)80344-8] [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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Ohya Y, Ohtsubo T, Tsuchihashi T, Eto K, Sadanaga T, Nagao T, Abe I, Fujishima M. Altered diurnal variation of blood pressure in elderly subjects with decreased activity of daily living and impaired cognitive function. Hypertens Res 2001; 24:655-61. [PMID: 11768724 DOI: 10.1291/hypres.24.655] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Activity of daily living (ADL) and cognitive are indices of physical and psychological activity in elderly subjects. The present study was performed to clarify the relationship among ADL, cognitive function, and ambulatory blood pressure (ABP) in the elderly. Study subjects were 77 females and 22 males (aged 60 to 101 years) with various levels of ADL and cognition, who were in nursing homes or geriatric hospitals. ABP was recorded every 30 min for 24 h by a noninvasive device. Mini-mental state examination (MMSE) and Barthel index measurement were used to evaluate cognitive function and ADL, respectively. Both the MMSE and Barthel index values showed a significant positive correlation with daytime ABP but not with nighttime ABP. The dip in nighttime BP correlated negatively with age, and positively with MMSE and Barthel index. In the multiple regression analysis, age and Barthel index values remained significant determinants of the dip in nighttime BP. Presence of stroke and MMSE became significant when the Barthel index values were removed from the analyses. When subjects were classified by tertiles of MMSE or Barthel index, subjects in the lowest MMSE group and those in the lowest Barthel index group had both lower daytime ABP and smaller nighttime BP dip than those of the other groups. A low BP level during the daytime was associated with altered diurnal variation of BP in elderly subjects with greater age, impaired cognitive function, and/or decreased ADL. ADL had a greater influence on diurnal BP variation than did cognitive function.
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Affiliation(s)
- Y Ohya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Oguni T, Korogi Y, Yasunaga T, Sadanaga T, Uozumi H, Kawanaka K, Sumi S, Takahashi M. Superselective embolisation for intractable idiopathic epistaxis. Br J Radiol 2000; 73:1148-53. [PMID: 11144790 DOI: 10.1259/bjr.73.875.11144790] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
37 patients with intractable idiopathic epistaxis were treated with superselective embolisation between 1995 and 1999. A total of 40 embolisations was performed, including three procedures for recurrence. The embolic material was gelatin sponge in 27 procedures, microcoils in 9 and both gelatin sponge and microcoils in 4. Immediate cessation of nasal bleeding was obtained in all patients after embolisation. Recurrent epistaxis occurred in 2 (5.4%) of the 37 patients within 7 days after initial embolisation, giving a short-term success rate of 94.6%. The long-term follow-up ranged from 1-51 months (mean 21.6 months). Late re-bleeding occurred in two patients, giving a long-term success rate of 94.6%. Two patients underwent re-embolisation; it was necessary to embolise the ipsilateral facial artery and/or the contralateral internal maxillary as well as the ipsilateral maxillary artery. Although the overall complication rate was 45.0%, no major complications occurred. Superselective embolisation with gelatin sponge is an effective and safe treatment technique for intractable idiopathic epistaxis.
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Affiliation(s)
- T Oguni
- Department of Radiology, Kumamoto National Hospital, 1-5 Ninomaru Kumamoto, 860-0008, Japan
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Abstract
Repetitive monomorphic ventricular tachycardia with a morphology of inferior axis and left bundle branch block pattern in patients without structural heart disease commonly originates from the right ventricular outflow tract. We report the case of a 22-year-old man with an incessant, monomorphic ventricular tachycardia with a similar morphology originating from the left coronary cusp, which was confirmed by perfect pace mapping, local ventricular activation preceding the onset of QRS by 25 mse, and eliminated by a single delivery of low-energy (11 W) radiofrequency currents.
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Affiliation(s)
- T Sadanaga
- Department of Cardiology, Tokyo Dental College Ichikawa General Hospital, Ichikawa City, Chiba, Japan
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Okada Y, Ogawa S, Sadanaga T, Mitamura H. Assessment of reverse use-dependent blocking actions of class III antiarrhythmic drugs by 24-hour Holter electrocardiography. J Am Coll Cardiol 1996; 27:84-9. [PMID: 8522715 DOI: 10.1016/0735-1097(95)00424-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [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: 01/31/2023]
Abstract
OBJECTIVES This clinical study was designed to compare rate-dependent effects of class III agents on QT prolongation. BACKGROUND Clinical data that compare the electrophysiologic differences among class III agents with different selectivity for potassium channels are still lacking. METHODS QT intervals were measured over a wide range of preceding RR intervals during sinus rhythm by 24-h Holter electrocardiography before and after oral administration of four class III agents: E4031, dofetilide, MS551 and d-sotalol. Rate-dependent changes in the QT interval were assessed by the slope of the linear regression line estimating the QT-square root of RR relation. RESULTS All agents significantly increased the mean slope: E4031 increased the mean [+/- SD] value from 0.32 +/- 0.05 to 0.42 +/- 0.13 (p < 0.01), dofetilide from 0.32 +/- 0.03 to 0.50 +/- 0.12 (p < 0.03), MS551 from 0.35 +/- 0.06 to 0.45 +/- 0.10 (p < 0.02) and d-sotalol from 0.31 +/- 0.05 to 0.33 +/- 0.04 (p < 0.05). However, in those patients given either E4031, dofetilide or MS551, the degree of QT prolongation was smaller at shorter square root of RR intervals and was better preserved at shorter square root of RR intervals by d-sotalol, with a smaller increase in slope (p < 0.02 vs. dofetilide and MS551). CONCLUSIONS On ambulatory electrocardiography, reverse use dependence in QT prolongation was least prominent with d-sotalol among the four study drugs. In the range of physiologic heart rates, class III agents could manifest different profiles of rate dependence in their QT-prolonging effect.
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Affiliation(s)
- Y Okada
- Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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Tsutsumi N, Mitamura H, Okada Y, Yoshimoto T, Sadanaga T, Furuno I, Ogawa S. Rate-dependent anisotropic conduction property in the epicardial border zone of canine myocardial infarcts and its modification by moricizine. Cardiovasc Drugs Ther 1995; 9:715-22. [PMID: 8573555 DOI: 10.1007/bf00878555] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 01/31/2023]
Abstract
We evaluated anisotropic conduction properties, different conduction velocities depending on fiber orientation, in normal and infarcted myocardium and the effects of moricizine on anisotropic conduction. Various cycle lengths of stimulation were applied to 15 mongrel dogs, and epicardial mapping was performed using a 96-channel mapping electrode. Moricizine was then administered to seven dogs and the same procedure was performed. Conduction velocities were calculated from these maps. Programmed electrical stimulations were performed before and after moricizine administration to induce ventricular arrhythmias. Before moricizine administration, a rate-dependent decrease in longitudinal conduction velocity was observed in the infarcted zone. Moricizine suppressed longitudinal conduction in the normal zone significantly at 300 msec pacing, but not at slower rates. Moricizine at a dose of 4 mg/kg, on the other hand, suppressed longitudinal conduction in the infarcted zone significantly at all pacing cycle lengths. The effect of moricizine on transverse conduction was inconsistent. In three dogs, sustained ventricular tachycardia (VT) was induced either before or after moricizine administration. The mean cycle length of sustained VT was prolonged from 202 msec to 291 msec after 4 mg/kg of moricizine. Thus, the changes in cycle length of ventricular tachycardia observed were most likely the result of slowing of conduction velocity, especially in the longitudinal direction, in the infarcted myocardium. We conclude that the electrophysiologic nature of the subacute ischemic model was modified by moricizine, leading to depression of the conduction velocity of longitudinal conduction and the inducibility of ventricular arrhythmias.
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Affiliation(s)
- N Tsutsumi
- Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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Abstract
OBJECTIVES The aim of this study was to elucidate whether the electrophysiologic properties of pilsicainide, a novel class IC drug with slow kinetic properties, could be altered in the presence of acute myocardial ischemia. BACKGROUND An increase in the rate of sudden death in patients taking flecainide and encainide has been reported by the Cardiac Arrhythmia Suppression Trial (CAST), implying a proarrhythmic effect that may be due to the interaction between ischemia and class IC antiarrhythmic drugs. METHODS Thirty-five patients and 16 age-matched control patients performed a treadmill exercise test and were assigned to four study groups: group A = 16 control patients; group B = 15 patients with ischemic ST segment depression; group C = 11 patients receiving pilsicainide without ST segment depression; and group D = 9 patients receiving pilsicainide with ischemic ST segment depression. The QRS duration was measured at rest and at heart rates of 80, 100 and 120 beats/min. RESULTS There were no changes in the QRS duration as heart rates increased to 120 beats/min in the control patients. Ischemia, however, independently caused a significant increase in QRS duration at a heart rate of 120 beats/min. Pilsicainide produced a rate-dependent prolongation of the QRS duration in patients without ST segment depression as the heart rate increased to 100 beats/min. The combination of ischemia and pilsicainide led to a much greater rate-dependent prolongation of the QRS duration. CONCLUSIONS Combination of a class IC drug and acute ischemia could lead to additive rate-dependent ventricular conduction slowing. This may be one plausible mechanism for the induction of proarrhythmias noted in the CAST study.
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Affiliation(s)
- T Sadanaga
- Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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Saeki K, Ogawa S, Sadanaga T, Yoh S, Furuno I, Nakamura Y. Sympathetic denervation of the epicardial border zone in the genesis of dispersion of refractoriness and arrhythmogenesis in a 7-day-old canine myocardial infarction model. Coron Artery Dis 1993; 4:775-82. [PMID: 8287211 DOI: 10.1097/00019501-199309000-00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 01/29/2023]
Abstract
BACKGROUND The purpose of this study was to clarify whether sympathetic denervation occurs in the infarcted heart and contributes to the dispersion of the effective refractory period (ERP) and arrhythmogenesis. METHODS ERP was measured at 47 epicardial sites in 13 dogs with 7-day-old infarctions after proximal ligation of the left anterior descending artery. To delineate the sympathetic innervation, the effects of ansae subclaviae stimulation (ASS), norepinephrine infusion, and prazosin infusion on ERP were tested. RESULTS The per cent change in ERP (delta ERP) induced by ASS was significantly lower at test sites where the surviving epicardial myocardial thickness (Th) was 2 mm or less than at those with a Th of more than 2 mm and the normal zone. Eleven out of 179 sites (6.1%) overlying the infarct showed no ERP change after ASS. ASS paradoxically prolonged ERP at 29 sites (16.2%). In contrast, norepinephrine infusion produced a greater delta ERP in the infarct zone than in the normal zone. Prazosin shortened ERP at sites where ASS prolonged it, but had no effect at sites where ASS shortened ERP. ASS increased both the degree of ERP dispersion and inducibility of ventricular tachycardias or ventricular fibrillation (VT/VF), whereas norepinephrine increased VT/VF inducibility despite a reduction in ERP dispersion. CONCLUSIONS We conclude that heterogeneous sympathetic denervation contributed to a prolongation and dispersion of ERP in the surviving epicardium overlying the infarct. Furthermore, a supersensitive response to norepinephrine with resultant ERP shortening and a paradoxical ERP prolongation during ASS caused by alpha-receptor mechanisms that may be related to increased electrical instability were observed.
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Affiliation(s)
- K Saeki
- Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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Sadanaga T, Ogawa S, Okada Y, Tsutsumi N, Iwanaga S, Yoshikawa T, Akaishi M, Handa S. Clinical evaluation of the use-dependent QRS prolongation and the reverse use-dependent QT prolongation of class I and class III antiarrhythmic agents and their value in predicting efficacy. Am Heart J 1993; 126:114-21. [PMID: 8391748 DOI: 10.1016/s0002-8703(07)80017-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [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] [Indexed: 01/30/2023]
Abstract
We measured the QRS duration during a treadmill exercise test and the QT interval using a 24-hour Holter electrocardiogram at various heart rates to identify use-dependent QRS prolongation and reverse use-dependent QT prolongation of class I and III antiarrhythmic drugs. Use-dependent QRS prolongation was detected in 61%, 53%, and 64% of patients receiving disopyramide, mexiletine, and pilsicainide, respectively. Reverse use-dependent QT prolongation was found in 40% and 70% of patients receiving disopyramide and E4031. Drugs suppressed > or = 75% of the total premature ventricular contractions in all patients who had both use-dependent QRS prolongation and reverse use-dependent QT prolongation, in 79% of patients with use-dependent QRS prolongation alone, in 70% with reverse use-dependent QT prolongation alone, and in 11% with neither use-dependent QRS prolongation nor reverse use-dependent QT prolongation. Use-dependent QRS prolongation and reverse use-dependent QT prolongation were identified noninvasively and were useful in evaluating antiarrhythmic efficacy.
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Affiliation(s)
- T Sadanaga
- Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
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Sadanaga T, Ogawa S, Okada Y, Handa S. [Clinical significance of the use-dependent sodium channel block and reverse use-dependent potassium channel block of class I and class III antiarrhythmic agents and their values to predict drug efficacy]. Jpn Circ J 1993; 56 Suppl 5:1474-6. [PMID: 1337923 DOI: 10.1253/jcj.56.supplementv_1474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- T Sadanaga
- Department of Medicine, Keio University, School of Medicine
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Ogawa S, Furuno I, Satoh Y, Yoh S, Saeki K, Sadanaga T, Katoh H, Nakamura Y. Quantitative indices of dispersion of refractoriness for identification of propensity to re-entrant ventricular tachycardia in a canine model of myocardial infarction. Cardiovasc Res 1991; 25:378-83. [PMID: 1855242 DOI: 10.1093/cvr/25.5.378] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [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: 12/29/2022] Open
Abstract
STUDY OBJECTIVE To identify propensity to re-entry in a canine model of 7 day old myocardial infarction, the sensitivity and specificity of five indices of dispersion of refractoriness (ERP) were investigated. DESIGN With an epicardial patch electrode containing 47 electrodes, ERP was measured by S1-S2 method at each site overlying the infarct. ERP range, maximum adjacent dispersion, difference between mean ERPS of the infarct and normal zones, standard deviation (sigma) of the mean ERP, and sigma/mean ERP X 100 were calculated. EXPERIMENTAL MATERIAL 42 dogs were divided into three groups; 20 dogs with epicardial functional block on induction of sustained ventricular tachycardia or fibrillation, 10 dogs with inducible ventricular tachycardia or fibrillation but without epicardial functional block, and 12 control dogs without ventricular tachycardia, fibrillation or block. MEASUREMENTS AND MAIN RESULTS All five indices were significantly greater in the 20 dogs with ventricular tachycardia or fibrillation than in control dogs. A receiver operating characteristic curve analysis of the five indices showed that sigma was the most sensitive and specific index for discriminating these 20 dogs. The sensitivity and specificity of a sigma value greater than 14 ms (the mean value plus two SD of the control dogs) were 70% and 100%, respectively.
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Affiliation(s)
- S Ogawa
- Department of Medicine, Keio University, School of Medicine, Tokyo, Japan
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Yoh S, Ogawa S, Satoh Y, Furuno I, Saeki K, Sadanaga T, Nakamura Y. Electrophysiological and anatomical substrates for late potential recorded by signal averaging in seven-day-old myocardial infarction in dogs. Pacing Clin Electrophysiol 1990; 13:469-79. [PMID: 1692130 DOI: 10.1111/j.1540-8159.1990.tb02061.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [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: 12/28/2022]
Abstract
A filtered QRS (fQRS) was recorded by signal averaging in 7-day-old myocardial infarction (MI) in dogs to detect late potential (LP). The criteria for the LP included a duration of fQRS (D) greater than or equal to 60 msec and a voltage in the last 15 msec (V15) less than or equal to 10 microV. These parameters were determined from the control data from 15 dogs without infarction (D: 45 to 60 msec and V15: 12.0 to 83.6 microV). On the seventh day of infarction, the D had increased from 53.5 +/- 4.7 to 62.2 +/- 9.6 msec (P less than 0.05) and the V15 decreased from 38.6 +/- 19.5 to 18.4 +/- 16.0 microV (P less than 0.01). Of 23 dogs, 14 met the LP criteria (group A) and 9 did not (group B). Sustained ventricular tachycardia (SVT) was induced in 12 group A dogs and in none of the group B dogs. The delayed epicardial activation (DEA) was recorded after the end of QRS at 5.1 +/- 4.7 sites in group A dogs and 1.3 +/- 1.8 sites in group B dogs (P less than 0.05). The maximum value of epicardial activation time was more prolonged in group A than in group B (70.0 +/- 28.3 vs 44.4 +/- 9.8 msec, P less than 0.01). The area of MI was more extensive in dogs with DEA than those without (24.9 +/- 5.8% vs 10.3 +/- 9.0% of the total left ventricular weight, P less than 0.01). In 72 of 90 sites with DEA, the thickness of the surviving epicardial muscle was less than or equal to 1 mm. The sensitivity and specificity of the criteria for LP in detecting DEA were 71.4% and 55.6%, and 100% and 81.8% for predicting inducibility of SVT. It was thus concluded that LP, reflected the DEA, was identified from infarct areas of slow conduction within a reentry circuit of SVT.
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Affiliation(s)
- S Yoh
- Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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Sadanaga T, Hikida K, Tameto K, Matsushima Y, Ohkura Y. Determination of nifedipine in plasma by high-performance liquid chromatography. Chem Pharm Bull (Tokyo) 1982; 30:3807-9. [PMID: 7160022 DOI: 10.1248/cpb.30.3807] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Sadanaga T, Hikida K, Tameto K, Sugimoto K, Nakanishi M, Matsushima Y, Ohkura Y. Determination of osalmid in plasma by high-performance liquid chromatography. J Chromatogr 1981; 223:243-6. [PMID: 7251772 DOI: 10.1016/s0378-4347(00)80094-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Sadanaga T, Hikida K, Tameto K, Nakanishi M, Matsushima Y, Ohkura Y. Determination of sulthiame in plasma by high-performance liquid chromatography. Chem Pharm Bull (Tokyo) 1981; 29:872-4. [PMID: 6113899 DOI: 10.1248/cpb.29.872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Sadanaga T, Hikida K, Tameto K, Nakanishi M, Matsushima Y, Ohkura Y. Determination of carpipramine in plasma by high-performance liquid chromatography. J Chromatogr 1980; 183:246-9. [PMID: 7400284 DOI: 10.1016/s0378-4347(00)81701-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Kido S, Mimura G, Jinnai T, Sadanaga T, Ono K. [Proceedings: Changes in the glomerular basal membrane in alloxan diabetic in genetically predisposed rats]. Nihon Naibunpi Gakkai Zasshi 1974; 50:209. [PMID: 4476349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Sadanaga T, Miyao S, Mimura G. [Metabolic intermediates in patients with diabetes mellitus--pyruvates, alpha-ketoglutarates and lactates]. Rinsho Byori 1972; 20:10-5. [PMID: 5063726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Mimura G, Sadanaga T. [Secondary diabetes with special reference to the factors involved in thiazide induced diabetes]. Saishin Igaku 1966; 21:2296-302. [PMID: 5343088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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