Rationale and Design of the Double-Blind, Randomized, Placebo-Controlled Multicenter Trial on Efficacy of Early Initiation of Eplerenone Treatment in Patients with Acute Heart Failure (EARLIER).

BACKGROUND AND AIMS: Aldosterone is one of the major factors to cause organ damage during an acute phase of heart failure (HF), and many reports have demonstrated that patients with acute decompensated HF (ADHF) have high blood aldosterone concentrations, and the high aldosterone concentrations predict poor prognosis in patients with HF. These findings suggest that eplerenone, an antagonist of aldosterone receptors may provide a new concept and strategy for the treatment of ADHF, protecting the heart and other organs during chronic phases, depending on the restoration of hemodynamic abnormalities. METHODS: EARLIER is an event-driven clinical trial with an estimated enrolment of 300 patients hospitalized with ADHF with reduced left ventricular ejection fraction. ADHF includes ischemic or non-ischemic HF, and patients can be enrolled within 72 h after the visit to the hospital. We randomize the patients taking standard therapies for ADHF to the eplerenone and placebo groups. Eplerenone, either 25 or 50 mg, is administered for 6 months in the eplerenone group, and the corresponding placebo is administered in the placebo group on top of the standard care. We set the primary endpoint as the incidence of the composite endpoint (cardiac death or first re-hospitalization due to cardiac disease) 6 months after the enrollment, and also check the quality of life, i.e., exercise capacity and safety features of eplerenone. CONCLUSION AND PERSPECTIVES: EARLIER is a clinical trial of eplerenone targeting ADHF and also the first multicenter investigator-initiated phase III trial in the cardiovascular field in Japan, funded by the Japanese government.

Modified Cut-Off Value of the Urine Protein-To-Creatinine Ratio Is Helpful for Identifying Patients at High Risk for Chronic Kidney Disease: Validation of the Revised Japanese Guideline.

Chronic kidney disease (CKD) is a global public health issue, and strategies for its early detection and intervention are imperative. The latest Japanese CKD guideline recommends that patients without diabetes should be classified using the urine protein-to-creatinine ratio (PCR) instead of the urine albumin-to-creatinine ratio (ACR); however, no validation studies are available. This study aimed to validate the PCR-based CKD risk classification compared with the ACR-based classification and to explore more accurate classification methods. We analyzed two previously reported datasets that included diabetic and/or cardiovascular patients who were classified into early CKD stages. In total, 860 patients (131 diabetic patients and 729 cardiovascular patients, including 193 diabetic patients) were enrolled. We assessed the CKD risk classification of each patient according to the estimated glomerular filtration rate and the ACR-based or PCR-based classification. The use of the cut-off value recommended in the current guideline (PCR 0.15 g/g creatinine) resulted in risk misclassification rates of 26.0% and 16.6% for the two datasets. The misclassification was primarily caused by underestimation. Moderate to substantial agreement between each classification was achieved: Cohen's kappa, 0.56 (95% confidence interval, 0.45-0.69) and 0.72 (0.67-0.76) in each dataset, respectively. To improve the accuracy, we tested various candidate PCR cut-off values, showing that a PCR cut-off value of 0.08-0.10 g/g creatinine resulted in improvement in the misclassification rates and kappa values. Modification of the PCR cut-off value would improve its efficacy to identify high-risk populations who will benefit from early intervention.

Appropriateness of coronary interventions in Japan by the US and Japanese standards.

BACKGROUND: Appropriateness use criteria (AUC) are widely used to assess quality of care. American professional organizations and Japanese experts have both developed original AUC for percutaneous coronary intervention (PCI). However, rating discrepancies have not been investigated. METHODS: Patients registered in the Japanese multicenter PCI registry were analyzed. We assessed the appropriateness of PCI based on both the US and Japanese criteria and compared the ratings. A logistic regression analysis was performed to identify clinical predictors of inappropriate ratings under both standards. RESULTS: From a total of 4,950 nonacute, consecutive PCIs, 1,982 and 2,077 procedures could be successfully rated using the US and Japanese criteria, respectively. The major difference between the 2 criteria was the rating of "asymptomatic, low- or intermediate-risk patients, no lesion in the proximal left anterior descending coronary artery (PLAD)"; this scenario was deemed appropriate in the Japanese but not in the US criteria. As a consequence, the rate of inappropriate PCI using the Japanese criteria (5.2%) was substantially lower when compared with the rating using the US criteria (15%). Common clinical variables associated with "inappropriate" PCI were male, multivessel diseases, and lesions in the non-PLAD. Suboptimal antianginal medication was also a significant predictor of inappropriate PCI under the US but not under the Japanese criteria. CONCLUSIONS: Significant and clinically relevant rating discrepancies were observed between the US and Japanese criteria-based assessments, owing largely to the ratings of asymptomatic, non-PLAD-related, low- or intermediate-risk cases.

Benign prostatic hyperplasia. Clinical treatment can complicate cataract surgery.

PURPOSE: To investigate the effects of alpha-1 adrenergic receptor antagonists for the treatment of benign prostatic hyperplasia (BPH) regarding potential risks of complications in the setting of cataract surgery. AIM: To address recommendations, optimal control therapy, voiding symptoms and safety within the setting of cataract surgery. MATERIALS AND METHODS: A comprehensive literature review was performed using MEDLINE with MeSH terms and keywords "benign prostatic hyperplasia", "intraoperative floppy iris syndrome", "adrenergic alpha-antagonist" and "cataract surgery". In addition, reference lists from identified publications were reviewed to identify reports and studies of interest from 2001 to 2009. RESULTS: The first report of intraoperative floppy iris syndrome (IFIS) was observed during cataract surgery in patients taking systemic alpha-1 AR antagonists in 2005. It has been most commonly seen related to use of tamsulosin. Changes of medication and washout periods of up to 2 weeks have been attempted to reduce the risk of complications in the setting of cataract surgery. CONCLUSION: Patients under clinical treatment for BPH should be informed about potential risks of this drug class so that it can be discuss with their healthcare providers, in particular urologist and ophthalmologist, prior to cataract surgery.

Capsular bag refilling using a new accommodating intraocular lens.

PURPOSE: To describe a capsular bag refilling procedure using an accommodating intraocular lens (IOL). SETTING: Jinshikai Medical Foundation Nishi Eye Hospital, Osaka, Japan. METHODS: A disk-shaped anterior foldable silicone accommodating IOL that serves as an optical device and as a mechanical device to prevent leakage of the injected silicone polymers was developed. The IOL optic is 6.0 mm and the overall diameter, 9.0 mm. After a 3.5 to 4.0 mm continuous curvilinear capsulorhexis (PCCC) is created, phacoemulsification and aspiration are performed in the usual manner. Then, a posteriorly placed accommodating IOL with sharp edges is implanted in the capsular bag to prevent posterior capsule opacification (PCO) and leakage of the injected silicone polymer. A PCCC is an option at this point. Then, an anterior accommodating IOL is piggybacked over the existing IOL and silicone polymers are injected between the 2 IOLs. RESULTS: Experiments in numerous pig cadaver eyes and in 10 rabbit eyes showed minimal to no silicone leakage. In cases in which a PCCC was not created, 2 eyes had no PCO and 3 showed slight to moderate PCO. None of the 5 eyes with a PCCC had no PCO 5 to 8 weeks after surgery within the PCCC. CONCLUSION: The procedure in rabbit eyes overcame 2 problems of lens-refilling techniques: leakage of the injectable silicone polymer and capsule opacification.

Diagnostic evaluation of optical coherence tomography angiography and fundus autofluorescence in bilateral diffuse uveal melanocytic proliferation.

PURPOSE: To demonstrate the utility of optical coherence tomography angiography (OCTA) in visualizing the choroidal vasculature in bilateral diffuse uveal melanocytic proliferation (BDUMP), so as to elucidate pathophysiology and also aid in diagnosis. Additionally, to recommend autofluorescence (AF) over traditional angiography for purposes of noninvasive diagnosis. OBSERVATIONS: Three BDUMP cases are examined using AF, and two are examined using OCTA. Additionally, the cases vary in etiology and include a case with iris cysts, which we believe to have only been recorded once before in scientific literature, steroids were successfully used to treat two cases and anti-tumor drugs were used to treat the third case. OCTA revealed altered choroidal vasculature in the two cases tested, and AF was successfully used to diagnose all three cases regardless of etiology. CONCLUSIONS AND IMPORTANCE: We believe the OCTA findings are potentially elucidative regarding the pathophysiology at the choroidal layer, where BDUMP lesions primarily exist. Given the limited number of recorded BDUMP cases and relatively unknown pathophysiology, OCTA may prove to be invaluable in visualizing disease progression. Also we were able to use AF to diagnose all three cases ranging from extremely rare iris cysts to a more conventional presentation, indicating its utility regardless of etiology.

Comparing capsular bag performance of a hydrophilic and a hydrophobic intraocular lens: A randomised two-centre study.

PURPOSE:: To evaluate the capsular bag performance and posterior capsule opacification development of two intraocular lenses differing in material and design. METHODS:: This study included patients who were scheduled for cataract surgery and compared a hydrophilic intraocular lens (Super flex® intraocular lens; Rayner Surgical, Worthing, UK) with a hydrophobic intraocular lens (AcrySof® SA60AT; Alcon, Fort Worth, TX, USA). Follow-ups were performed 1 month and 2 years after cataract surgery, including a slit lamp examination and retroillumination images. RESULTS:: In total, 80 eyes of 80 patients were recruited. At the 1-month follow-up, 6 of 39 cases had a gap between the posterior lens capsule and intraocular lens (1 case in the hydrophilic intraocular lens group and 5 cases in the hydrophobic intraocular lens group; p = 0.348). Objective and subjective posterior capsule opacification scoring showed no statistically significant difference between both groups (p = 0.123). CONCLUSION:: Both intraocular lens showed a good capsular bag performance and a relatively low posterior capsule opacification development within the first 2 years after surgery.

Corneal radii and anterior chamber depth measurements using the IOLmaster versus the Pentacam.

PURPOSE: Corneal radii (R1, R2) and anterior chamber depth are important parameters for biometry and refractive surgery. This study aimed to investigate whether the IOLMaster, a biometric device, and the Pentacam, a rotating Scheimpflug camera, provide comparable results. METHODS: In this prospective study, corneal radii and anterior chamber depth were analyzed in 82 eyes of 41 phakic patients (median age 72 years) using the IOLMaster and Pentacam. Normal distribution was confirmed using the Kolmogorov-Smirnov test. A paired t test was used for statistical analysis. RESULTS: No statistically significant difference was noted for R2 using the Pentacam versus the IOLMaster (P = .40). There was a small statistical difference of 0.03 mm (P < .01) for R1 (corresponding to 0.08 diopters [D]). The IOLMaster measured a mean R1 of 7.87 mm and R2 of 7.67 mm. The Pentacam measured mean R1 of 7.90 mm and R2 of 7.69 mm. For anterior chamber depth values, a small statistically significant difference of 0.05 mm (P < .001) was found (corresponding to 0.01 D). Mean anterior chamber depth measured from the epithelium was 3.20 mm for the IOLMaster and 3.25 mm for the Pentacam. The Bland-Altman plot showed no distorting trends for either variable. CONCLUSIONS: Keratometry and anterior chamber depth were comparable for the two devices. If the axial length is known, the Pentacam can be used as a biometric device.

Contact inhibition of migrating lens epithelial cells at the capsular bend created by a sharp-edged intraocular lens after cataract surgery.

PURPOSE: To investigate whether the lens epithelial cells (LECs) at the capsular bend created by a sharp-edged intraocular lens (IOL) are in the G(0) phase of the cell cycle. SETTING: Nishi Eye Hospital, Osaka, Japan. METHOD: A CeeOn Edge silicone IOL (AMO) with sharp edges was implanted in 1 eye and a PhacoFlex II silicone IOL (AMO) with rounded edges in the contralateral eye after standard cataract surgery in 6 rabbits. Immunohistochemical staining for the Ki-67 antibody was performed 1 day, 3, 4, and 7 weeks after surgery. RESULTS: In eyes with the sharp-edged IOL, LECs with thin, elongated nuclei accumulated at, but did not extend beyond, the capsular bend and stained negative for the Ki-67 antibody, indicating that they were in the G(0) phase of the cell cycle. In contrast, in the eye with the round-edged IOL, continuous migration of a predominantly monolayer of LECs over the IOL and onto the posterior capsule occurred. These cells were Ki-67 positive, indicating that they were proliferating. CONCLUSIONS: Lens epithelial cells at the capsular bend of sharp-edged IOLs were in the G(0) phase of the cell cycle, indicating that they were contact inhibited. These findings support the theory the sharp posterior optic edge of the IOL inhibits LEC migration, reducing formation of posterior capsule opacification. Whether these LECs can reactivate when the capsular bend is eliminated by later formation of a Soemmerring's ring requires further studies.

Influence of 360-degree enhanced optic edge design of a hydrophilic acrylic intraocular lens on posterior capsule opacification.

PURPOSE: To compare the rate of posterior capsule opacification (PCO) with the single-piece hydrophilic acrylic foldable Rayner Centerflex 570H intraocular lens (IOL), which has a sharp optic edge design excluding the optic-haptic junction, and the Rayner C-flex 570C IOL, which has an improved 360-degree sharp edge. SETTING: Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. METHODS: As part of a multicenter U.S. Food and Drug Administration (FDA) study, 42 patients who had implantation of a C-flex IOL in 1 eye after uneventful phacoemulsification were enrolled. Six and 12 months postoperatively, PCO was evaluated by retroillumination photographs using Evaluation of Posterior Capsule Opacification (EPCO) 2000 image-analysis software. The data were then compared with those in a matched group of patients with a Centerflex IOL who participated in a previous FDA study. RESULTS: The mean age of the patients with the C-flex IOL was 71.5 years +/- 8.2 (SD) There was a statistically significant difference in EPCO scores between the C-flex group and Centerflex group. Six months after surgery, the mean EPCO value (total IOL optic) was 0.07 +/- 0.17 in the C-flex group (n = 37) and 0.20 +/- 0.20 in the Centerflex group (n = 36) (P<.01, Wilcoxon test). By 12 months, the mean had increased to 0.16 +/- 0.20 in the C-flex group (n = 37) and 0.35 +/- 0.22 in the Centerflex group (n = 31) (P<.01, Wilcoxon test). CONCLUSIONS: The C-flex IOLs showed good functional results and significantly lower PCO formation than the earlier model Centerflex IOL. The enhanced edge of the C-flex IOL seemed to improve PCO prevention clinically.

[Evaluation of cardiac dysfunction after herceptin treatment in patients with metastatic breast cancer by echocardiography].

Herceptin (Trastuzumab) is a humanized recombinant monoclonal antibody that binds the extracellular domain of the human epidermal growth factor receptor 2 (HER2) and is used in the treatment of patients with HER2 overexpressing metastatic breast cancer. Treatment with Herceptin is generally well tolerated. At times, however, it exerts cardiac toxicity especially when used in combination with anthracyclines. We evaluated cardiac function before and after Herceptin treatment in nine patients with metastatic breast cancer by echocardiography, measuring ejection fraction (EF) and deceleration time (DcT). EF was significantly reduced after treatment(P<0.05). Although the present study failed to show significant changes in DcT, definite diastolic disturbance of the left ventricle did occur in a couple of patients. We conclude that cardiac dysfunction may be a common side effect of Herceptin even in early stages of treatment and that echocardiography will be a useful means of monitoring cardiac function in these patients.

Prediction of the true IOL position.

PURPOSE: To develop algorithms for preoperative estimation of the true postoperative intraocular lens (IOL) position to be used for IOL power calculation. SETTING: Moorfields Eye Hospital NHS Foundation Trust, London, UK. METHODS: Fifty patients were implanted randomly with a 3-piece IOL model in one eye and a 1-piece model in the other eye. Preoperatively, the IOLMaster was used to determine axial length, anterior chamber depth and mean corneal radius. Lens thickness and corneal width were measured with the ACMaster. Postoperative IOL position was measured with the ACMaster. Partial least squares (PLS) regression analysis of IOL position in terms of preoperative parameters was performed with a commercially available software package. RESULTS: The PLS regression analysis showed that age, refraction, corneal width, lens thickness and corneal radius are not significant predictors of postoperative position of the anterior IOL surface, while axial length and in particular anterior chamber depth are. Regression relationships in terms of the above-mentioned predictors were determined for the two models implanted. Surprisingly, it turned out that the position of the posterior IOL surface could be described by a single regression relationship valid for both models. The residual SD for prediction of IOL position was about 0.17 mm for all relationships. CONCLUSIONS: Accurate relationships to determine the true postoperative IOL position were obtained. In addition to axial length and corneal radius, which are required for the IOL power calculation as such, they require measurement of preoperative anterior chamber depth only.

Hyperuricemia is an independent competing risk factor for atrial fibrillation.

BACKGROUNDS: The relationship between serum uric acid (SUA) and atrial fibrillation (AF) remains unclear because many parameters and diseases influence AF. This study was conducted to clarify the role of hyperuricemia as an independent competing risk factor for AF in an apparently healthy general population. METHODS: We retrospectively analyzed the medical records of 90,143 Japanese subjects who underwent annual regular health check-up in St. Luke's International Hospital, Tokyo, between January 2004 and June 2010. Of those subjects, 291 (0.32%) were identified as having AF by 12 leads electrocardiography. First, we analyzed 90,117 subjects to clarify the independent competing risk factors for AF and obtained odds ratios (ORs) by logistic regression analysis. Second, we excluded 40,825 subjects with hypertension, diabetes mellitus, dyslipidemia, chronic kidney disease, and current medication for hyperuricemia and/or gout, and we analyzed 49,292 subjects. RESULTS: First, AF groups were significantly higher SUA level (OR: 1.35; 95% confidence interval (CI), 1.22-1.50) than non-AF group. OR of hyperuricemia (>7.0mg/dL of SUA) for AF was 2.75 (95% CI, 2.10-3.60). Second, after multiple adjustments, higher SUA level (OR: 1.53; 95% CI, 1.21-1.92) was a significantly independent competing risk factor for AF, as well as older age, male sex, higher body mass index, lower FEV1/FVC, and higher hemoglobin. OR of hyperuricemia for AF was 3.19 (95% CI, 1.81-5.62). CONCLUSIONS: Hyperuricemia is an independent competing risk factor for AF. Further prospective intervention studies are needed to prove whether lowering SUA level might be important for preventing AF or not.

Paradoxical high augmentation index in females with diabetes mellitus.

The relationship between diabetes mellitus (DM) and augmentation index (AIx) remains unclear. We conducted an observational cross-sectional study. Subjects were patients who underwent coronary angiography. We examined the relationship between high AIx and several factors. The total number of diabetic patients was 144, and median AIx was 0.256. In diabetic patients, the significant relationship between female gender and high AIx (median cut-off value, ≥0.256) was found by the multivariate logistic analysis (adjusted odds ratio = 2.888; 95% confidence interval: 1.032-8.081). The significant relationship between female gender and high AIx was found in patients with DM.

Serum alkaline phosphatase as a predictor of worsening renal function in patients with acute decompensated heart failure.

BACKGROUND: Venous congestion has come into focus as an important hemodynamic factor for worsening renal function (WRF) in patients with acute decompensated heart failure (ADHF). Serum alkaline phosphatase (ALP) was reported as a biological marker of liver congestion in ADHF. The purpose of this study was to determine whether ALP is a predictor of WRF in patients with ADHF. METHODS: We enrolled consecutive patients admitted to a single cardiovascular center with ADHF, and defined WRF as an increase in creatinine of >0.3 mg/dl during hospitalization and chronic kidney disease (CKD) as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2). The patients were classified into tertiles by ALP level (<203, 203-278, and >278 IU/L). RESULTS: A total of 972 patients (mean age, 76±13 years; 54% male) were retrospectively analyzed. WRF was identified in 132 patients (13.6%). In multivariate logistic regression analysis, baseline CKD [odds ratio (OR) 2.46, 95% confidence interval (CI) 1.48-4.08, p<0.001], serum albumin (OR 0.52, 95% CI 0.35-0.77, p=0.001), and diabetes (OR 2.07, 95% CI 1.37-3.12, p<0.001) were associated with WRF. Compared with the lowest tertile (ALP <203 IU/L), an adjusted OR of WRF was 1.69 (95% CI 1.02-2.79, p=0.04) in the middle tertile (ALP, 203-278 IU/L) and 1.95 (95% CI 1.20-3.21, p=0.008) in the highest tertile (ALP >278 IU/L). CONCLUSION: Serum ALP is an independent predictor of WRF in the clinical course of ADHF.

Epidemiological evaluation of YAG capsulotomy incidence for posterior capsule opacification in various intraocular lenses in Japanese eyes.

BACKGROUND AND OBJECTIVE: We investigated the yttrium aluminum garnet (YAG) capsulotomy rates in various intraocular lenses (IOLs). STUDY DESIGN/PATIENTS AND METHODS: We retrospectively analyzed 23,440 eyes implanted with either MA60BM, MA60AC, VA-60BB, CeeOnEdge, Clariflex, Technis Z9002, SI-40NB, or UV26T IOLs. We calculated the YAG capsulotomy rates at 1, 3, 5, and 10 years post lens implantation. RESULTS: YAG capsulotomy rates at 3 years postimplantation for the eight groups of IOLs were, respectively, 3.7%, 3.9%, 23.7%, 3.4%, 4.5%, 4.7%, 10.4%, and 21.0%. YAG capsulotomy rates at 10 years postimplantation for the MA60BM and SI-40NB IOLs were, respectively, 9.1% and 15% (P<0.05). The average YAG rates for all sharp-edged and round-edged IOLs at 5 years postimplantation were, respectively, 5.2%±0.7% and 25.6%±9.0% (P<0.05). CONCLUSION: In all studied IOLs, posterior capsule opacification prevention seemed to be associated with the posterior optic sharp-edge design. Round-edged silicone IOLs may also retard posterior capsule opacification formation, though not as much as sharp-edged IOLs. As the follow-up period progressed, round-edged silicone IOLs showed significantly higher YAG rates than sharp-edged IOLs.

Capsular bag performance of a hydrophobic acrylic 1-piece intraocular lens.

PURPOSE: To compare parameters after 1-piece and 3-piece intraocular lens (IOL) implantation. SETTING: Moorfields West End Clinic, London, United Kingdom, and Hanusch Hospital, Vienna, Austria. DESIGN: Prospective randomized controlled trial. METHODS: Each eye of patients having bilateral surgery for age-related cataract was randomized to have implantation of a 1-piece IOL (Tecnis ZCB00) or a 3-piece IOL (Tecnis ZA9003). Changes in visual acuity, refraction, and anterior chamber depth (ACD) were evaluated during a 2-year follow-up. Intraocular lens tilt and decentration were evaluated using a Purkinje meter. Regeneratory posterior capsule opacification (PCO) was analyzed using retroillumination photographs in Automated Quantification of After-Cataract image-analysis software. RESULTS: This study comprised 100 eyes of 50 patients. No statistically significant differences were found in IOL tilt or decentration between groups (P≥.06). Minimal but statistically significant changes were observed in the vertical tilt component 12 months postoperatively in the 3-piece IOL group (P<.01). The tilt and decentration components did not correlate with changes in sphere or the regeneratory PCO score (r = 0.38, P≥.06). The ACD decreased significantly between 1 day and 1 month postoperatively in both groups (P<.01), with no significant changes afterward (P≥.22). The anterior chamber was significantly deeper in the 1-piece group at all follow-up visits (P<.01). CONCLUSIONS: Both the 1-piece IOL and the 3-piece IOL showed excellent positional stability in the capsular bag, resulting in good clinical outcomes. Regeneratory PCO levels were low and comparable between the IOLs. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Impact of the augmentation time ratio on direct measurement of central aortic pressure in the presence of coronary artery disease.

The augmentation index measured by using the central artery pressure is associated with an increased risk of coronary artery disease (CAD). However, no study has examined the role of the time duration of the central artery pressure on CAD. Therefore, we evaluated the relationship between the central blood pressure time duration and the presence of CAD. All patients without a history of revascularization or prior myocardial infarction who underwent an elective coronary angiography at one of the two hospitals from January to September 2013 were analyzed. CAD was defined as a significant stenosis in one of the main coronary branches. The augmentation time ratio was defined as the ratio of the reflection to peak systolic time T2T1 duration divided by the peak systolic time to aortic notch T3T2 duration. We analyzed the relationship between the central pressure waveform (not only augmentation pressure) and the presence of CAD. A total of 146 (57.3%) out of 255 patients had a significant CAD. T2T1 duration was longer in the CAD group than the no CAD group, and the T3T2 duration was shorter in the CAD group than the no CAD group. The augmentation time ratio (T2T1/T3T2) was significantly larger in the CAD group than in the no CAD group. The augmentation index and augmentation pressure were lower in the no CAD group, but this difference was not statistically significant. The augmentation time ratio was an independent factor related to no CAD, especially in patients with a high augmentation index (odds ratio, 2.17; 95% confidence interval, 1.02-4.63). The augmentation time ratio was an independent factor related to the presence of CAD.