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1.
Echocardiography ; 31(9): 1113-21, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24460617

RESUMEN

BACKGROUND: Elevated aortic stiffness determined by transesophageal echocardiography (TEE), and presence of complicated aortic plaque provide prognostic information about cerebrovascular disease risk. Recently, pulse-wave tissue Doppler imaging (PW-TDI) has offered a new technique for assessing aortic wall stiffness. METHODS: The following aortic long-axis view TEE measurements were carried out in 103 consecutive acute ischemic stroke patients and 72 controls (stroke-free patients requiring TEE for conditions such as atrial fibrillation and valvular heart disease): (a) PW-TDI motion velocities measured as expansion peak velocity during systole (Vs) and contraction peak velocity during diastole (Vd); (b) aortic arch stiffness parameter ß (Aoß), defined as ß = ln (systolic blood pressure/diastolic blood pressure)/([Dmax - Dmin]/Dmin), where ln is the natural logarithm, Dmax is maximum aortic lumen diameter, and Dmin is minimum aortic lumen diameter. The PW-TDI of Vs and Vd was compared with conventional vessel parameters brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI, calculated from blood pressure and PWV). RESULTS: Comparing acute ischemic stroke patients versus controls, Vs and Vd were significantly decreased (3.3 ± 1.6 vs. 3.9 ± 2.0 cm/sec, P < 0.05; 1.7 ± 0.6 vs. 2.1 ± 0.8 cm/sec, P < 0.01, respectively), and Aoß and aortic arch intima-media thickness (AoIMT) were significantly increased (15.3 ± 12.5 vs. 11.6 ± 6.5, P < 0.05; 3.2 ± 2.5 vs. 2.4 ± 2.1 mm, P < 0.05; respectively). Furthermore, Vs and Vd were significantly negatively correlated with age, Aoß, AoIMT, CAVI, and baPWV in all cases. CONCLUSIONS: The use of aortic arch wall PW-TDI for Vs and Vd evaluation constitutes an easily and readily assessed parameter for evaluating aortic arch stiffness.


Asunto(s)
Aorta Torácica/diagnóstico por imagen , Ecocardiografía Doppler/métodos , Ecocardiografía Transesofágica/métodos , Accidente Cerebrovascular/diagnóstico por imagen , Rigidez Vascular/fisiología , Anciano , Isquemia Encefálica/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Medición de Riesgo/métodos
2.
J Stroke Cerebrovasc Dis ; 23(6): 1682-9, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24739590

RESUMEN

The effect of rosuvastatin was investigated on complicated aortic arch plaque (CAP) morphology and lipid profiles in acute cerebral embolism (CE) patients with normal low-density lipoprotein-cholesterol (LDL-c) levels. Transesophageal echocardiography (TEE) studies were performed in 56 consecutive CE patients with LDL-c less than 140 mg/dL who were not taking lipid-lowering agents at baseline. CAP observed by TEE was defined as the presence of greater than 4-mm diameter, ulcerated, or mobile aortic plaque. Patients were divided into those with CAP versus without CAP (group A, n=24, age 69±8 years) and without CAP (group B, n=32, age 62±10 years). Of the 24 group A patients, 18 received 5 mg/d of rosuvastatin for 6 months and had follow-up TEE studies. In Group A, the baseline values of high-density lipoprotein-cholesterol (HDL-c) and apolipoprotein A-1 (ApoA-1) were significantly lower than in Group B (44±15 versus 55±15 mg/dL, P=.0059; 103±19 versus 137±25 mg/dL, P=.0006, respectively) and age and serum high-sensitivity C-reactive protein concentration were significantly higher (69±8 vs. 62±10 years, P=.0080; 2.34±3.05 vs. 0.67±1.00 mg/dL, P=.0054, respectively). By multivariate logistic regression analysis, ApoA-1 was shown to be an independent predictor of CAP (odds ratio=.894, 95% confidence intervals .800-.996, P=.0483). In the 18 group A patients receiving rosuvastatin for 6 months, aortic arch plaque diameter and serum LDL-c were significantly decreased (5.8±2.2 to 5.1±2.1 mm, P=.0377; 110±23 to 81±23 mg/dL, P=.0008, respectively), whereas serum HDL-c and ApoA-1 concentrations were significantly increased (42±8 to 52±9 mg/dL, P=.0002; 109±22 to 135±15 mg/dL, P=.0002, respectively). Plaques were morphologically improved in 11 patients, unchanged in 6, and worsened in 1. These data suggest that rosuvastatin improves plaque morphology concomitant with improving lipid profiles in CE patients with normal LDL-c levels.


Asunto(s)
Aorta Torácica/efectos de los fármacos , Fluorobencenos/uso terapéutico , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Embolia Intracraneal/tratamiento farmacológico , Lipoproteínas LDL/sangre , Placa Aterosclerótica/tratamiento farmacológico , Pirimidinas/uso terapéutico , Sulfonamidas/uso terapéutico , Anciano , Aorta Torácica/patología , Femenino , Fluorobencenos/farmacología , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/farmacología , Embolia Intracraneal/sangre , Embolia Intracraneal/patología , Lípidos/sangre , Masculino , Persona de Mediana Edad , Placa Aterosclerótica/sangre , Placa Aterosclerótica/patología , Pirimidinas/farmacología , Rosuvastatina Cálcica , Sulfonamidas/farmacología , Resultado del Tratamiento
3.
Cureus ; 16(3): e56346, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38633944

RESUMEN

BACKGROUND: Drug-eluting stents (DES) are the major treatment option in percutaneous coronary intervention (PCI). Recently, drug-coated balloon (DCB) utilization has been increasing globally, leading to the expected new strategy of "stent-less PCI." This study aimed to evaluate the one-year outcome of DCB compared to DES. METHODS: Patients who underwent initial PCI for de novo lesions in our institution from January 2018 to December 2021 (n=337) were subjected to retrospective analysis. Among them, 75 patients were treated with DCB, while 262 patients were treated with DES. Target lesion failure (TLF) was evaluated during the follow-up period. RESULTS: The proportion of PCIs for ACS was significantly lower in the DCB group (DCB, n=23, 30.7% vs. DES, n=143, 54.6%; p=0.001). The median device diameter and length in the DES group were larger than those in the DCB group (DCB, 2.60 mm vs. DES, 2.98 mm; p<0.001; DCB, 19.1 mm vs. DES, 25.2 mm; p<0.001). There was no significant difference between the DCB and DES groups in lesion calcification. The proportion of ostial lesions was significantly higher in the DCB group (DCB, n=13, 17.3% vs. DES, n=21, 8.0%; p=0.018). The cumulative rate of TLF (DCB, n=5, 6.7% vs. DES, n=18, 6.9%; p=0.951) did not significantly differ between the DCB and DES groups. CONCLUSION: DCB may be as effective a strategy as DES in the patient who underwent initial PCI for a de novo lesion.

4.
Am J Case Rep ; 25: e944485, 2024 Jun 19.
Artículo en Inglés | MEDLINE | ID: mdl-38894511

RESUMEN

BACKGROUND Virtual reality (VR)-guided GC simulation for patients with anatomical anomalies using cardiac computed tomography (CT) has been recently reported. Rotational atherectomy (RA) for the left circumflex (LCX) ostium is challenging due to the tortuous anatomy, acute angulation, and variable vessel size compared to other lesions. The appropriate positioning and coaxiality of the guide catheter (GC) are key factors for safely performing RA. It would be beneficial if it could be simulated prior to percutaneous coronary intervention (PCI). CASE REPORT We treated a 55-year-old man with angina. We performed coronary angiography and detected an ostial calcified lesion of the LCX. We needed RA for this lesion, but PCI was very difficult and challenging. CT revealed right-sided aortic arch with stenosis of left subclavian artery from the Kommerell diverticulum at the distal part of the aortic arch. Therefore, the approach site for PCI was limited. We simulated the appropriate guide catheter and approach site for PCI by VR. PCI was successfully performed with RA, as in the VR simulation. CONCLUSIONS We successfully performed PCI for an ostial calcified lesion of the LCX in a patient with a right-sided aortic arch. Use of VR-guided GC simulation is a useful new option that can help visualize the anatomy and ensure safe procedures for complex lesions.


Asunto(s)
Intervención Coronaria Percutánea , Realidad Virtual , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/métodos , Angiografía Coronaria , Tomografía Computarizada por Rayos X , Aorta Torácica/anomalías , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía
5.
JACC Cardiovasc Interv ; 16(20): 2542-2551, 2023 10 23.
Artículo en Inglés | MEDLINE | ID: mdl-37879806

RESUMEN

BACKGROUND: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is still challenging due to complex lesion morphology. Success rates may vary among the 3 major coronary arteries, influenced by clinical and angiographic characteristics. OBJECTIVES: This study sought to evaluate the differences in the predictors of unsuccessful PCI in first-attempt CTO lesions of the 3 major coronary arteries compared with the J-CTO (Japanese CTO) score. METHODS: This study assessed 6,408 first-attempt CTO patients from the Japanese CTO-PCI expert registry between January 2014 and December 2021, randomly assigned to derivation and validation sets. Difficulty scores for each artery were determined by assigning points to predictive unsuccessful factors. RESULTS: The CTO lesions were distributed as follows: left anterior descending coronary artery: 2,245 (35%), left circumflex coronary artery: 1,131 (18%), and right coronary artery (RCA): 3,032 (47%). Regarding success rates, left circumflex coronary artery CTO had the lowest procedural success rate (90%) followed by RCA CTO (92%) and left anterior descending coronary artery CTO (94%). RCA CTO was significantly longer and more severely angulated, requiring more often the retrograde approach. A multivariate logistic analysis revealed that predictors of failed PCI were different in CTO lesions among the 3 major coronary arteries, respectively. Moreover, our difficulty score for RCA CTO was superior to the J-CTO score in predicting unsuccessful PCI. CONCLUSIONS: Clinical and angiographic differences might explain the discrepancies of success rates in CTO lesions among the 3 major coronary arteries. Our novel difficulty score was comparable to the J-CTO score in predicting unsuccessful CTO-PCI with a superior discriminatory capacity.


Asunto(s)
Oclusión Coronaria , Intervención Coronaria Percutánea , Humanos , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Resultado del Tratamiento , Intervención Coronaria Percutánea/efectos adversos , Angiografía Coronaria , Enfermedad Crónica , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/terapia , Sistema de Registros , Factores de Riesgo
6.
J Cardiol Cases ; 25(2): 91-94, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35079306

RESUMEN

BACKGROUND: Directional coronary atherectomy (DCA) was revived in Japan in 2014. DCA is a special procedure to remove the atherosclerotic plaque of coronary artery during percutaneous coronary intervention. We present the case of a 91-year-old woman with symptoms of angina. Coronary angiography revealed significant stenosis with a slit lesion of the proximal left anterior descending artery. Because she had a high risk of bleeding, we did not want to implant a stent to prevent bleeding events. Then, we performed optical coherence tomography (OCT) and intravascular ultrasound to evaluate the morphology of the slit lesion in more detail. OCT showed clearly that the direction of the flap was counterclockwise and the edge of the flap was located in the epicardium. Since we could understand the localization of plaque distribution fully by OCT examination, we successfully removed the flap by DCA based on information from OCT. After that, we performed balloon dilatation with a 3.0-mm drug-coated balloon and finished without implanting the stent successfully. Her symptoms completely disappeared and postoperative course was good. DCA supported with OCT might be one of the options in high bleeding risk patients, suggesting a potential stent-less therapeutic option. .

7.
Clin Med Insights Case Rep ; 15: 11795476221075497, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35295408

RESUMEN

Background: Directional coronary atherectomy (DCA) revived in Japan since 2014. DCA is a special device to remove the atherosclerotic plaque of coronary artery in percutaneous coronary intervention (PCI). However, DCA procedure is recommended to perform by 8Fr system, which is one of the limitations of DCA. Case Series: Since transradial approach is the main access route for PCI, we considered how to perform DCA by TRA. The external diameter of 8Fr guiding catheter (GC) and 6Fr sheath are 2.70 and 2.67 mm. Then, if 6Fr sheath can be inserted without any resistance, 8Fr GC is considered to be insertable. We performed 5 cases of DCA by the transradial 8Fr sheathless GC approach, all cases were successful without discomfort associated with insertion and removal of the 8Fr GC. Conclusion: DCA by the transradial 8Fr sheathless GC approach might be one of options to avoid bleeding complication and serve more comfortable treatment for the patients.

8.
Cardiovasc Interv Ther ; 37(1): 116-127, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33550529

RESUMEN

Recently, antegrade dissection re-entry (ADR) with re-entry device for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has evolved to become one of the pillar techniques of the hybrid algorithm. Although the success rate of the device is high, it could be improved. We sought to evaluate the current trends and issues associated with ADR in Japan and evaluate the potential of cardiac computed tomography angiography (CCTA) for ADR procedure. A total 48 patients with CTO suitable for ADR evaluated by baseline conventional angiography and CCTA were enrolled. Procedural success and technical success were evaluated as the primary and secondary observations. Furthermore, all puncture points were analyzed by CCTA. CT score at each punctured site depended on the location of plaque deposition (none; + 0, at isolated myocardial site; + 1, at epicardial site; + 2) and the presence of calcification (none; + 0, presence; + 1) was analyzed and calculated (score 0-3). Overall procedure success rate was 95.8%. Thirty-two cases were attempted with the ADR procedure and 25 cases of them were successful. The technical success rate was 78.1% and myocardial infarction or other major complications were not observed in any cases. CT score at 60 puncture sites in 32 cases were analyzed and the score at technical success points was significantly smaller compared to that at technical failure points (0.68 ± 1.09 vs 1.77 ± 1.09, p < 0.0001). CTO-PCI with Stingray device in Japan could achieve a high procedure success and technical success rate. Pre procedure cardiac CT evaluation might support ADR procedure for appropriate patient selection or puncture site selection.


Asunto(s)
Oclusión Coronaria , Intervención Coronaria Percutánea , Enfermedad Crónica , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Oclusión Coronaria/diagnóstico , Oclusión Coronaria/cirugía , Disección , Humanos , Japón , Sistema de Registros , Factores de Riesgo , Resultado del Tratamiento
9.
Circ J ; 75(10): 2333-42, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21778596

RESUMEN

BACKGROUND: Diacylglycerol kinase ζ (DGKζ) inhibited atrial tachyarrhythmias in a mouse model of heart failure (HF) in our study. However, whether DGKζ prevents the HF-induced ventricular tachyarrhythmia (VT) is unknown. METHODS AND RESULTS: Effects of DGKζ on VT using transgenic mice with transient cardiac expression of activated G protein α(q) (Gα(q)-TG; model of HF) were elucidated and double transgenic mice with cardiac-specific overexpression of both DGKζ and the activated Gα(q) (Gα(q)/DGKζ-TG) were used. Premature ventricular contraction (PVC) and/or VT were frequently observed in Gα(q)-TG mice but not in Gα(q)/DGKζ-TG and wild-type (WT) mice (P<0.01). Protein expressions of canonical transient receptor potential (TRPC) channels 3 and 6 increased in Gα(q)-TG hearts compared with WT and Gα(q)/DGKζ-TG hearts. SK&F96365, a TRPC channel blocker, decreased the number of PVC and prevented VT in anesthetized Gα(q)-TG mice (P<0.05). 1-oleoyl-2-acyl-sn-glycerol (OAG), a diacylglycerol analogue, increased the number of PVC in isolated Gα(q)-TG hearts compared with WT hearts and induced VT in Gα(q)-TG hearts (P<0.01). SK&F96365 decreased the number of PVC and prevented VT in isolated Gα(q)-TG hearts (P<0.01) even in the presence of OAG. Early afterdepolarization (EAD)-induced triggered activity was frequently observed in single Gα(q)-TG ventricular myocytes. Moreover, SK&F96365 prevented the EAD. CONCLUSIONS: These results demonstrated that DGKζ inhibited VT in a mouse model of HF and suggest that TRPC channels participate in VT induction in failing hearts.


Asunto(s)
Diacilglicerol Quinasa/fisiología , Insuficiencia Cardíaca/complicaciones , Taquicardia Ventricular/prevención & control , Animales , Diacilglicerol Quinasa/genética , Subunidades alfa de la Proteína de Unión al GTP Gq-G11/genética , Ratones , Ratones Transgénicos , Miocitos Cardíacos , Canales Catiónicos TRPC , Taquicardia Ventricular/etiología , Complejos Prematuros Ventriculares/etiología
10.
J Int Med Res ; 49(12): 3000605211062770, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34914568

RESUMEN

OBJECTIVE: Heart failure (HF) is a common and highly morbid cardiovascular disorder. Oxidative stress worsens HF, and uric acid (UA) is a useful oxidative stress marker. The novel anti-hyperuricemic drug febuxostat is a potent non-purine selective xanthine oxidase inhibitor. The present study examined the UA-lowering and prognostic effects of febuxostat in patients with HF compared with conventional allopurinol. METHODS: This multicenter, randomized trial included 263 patients with chronic HF who were randomly assigned to two groups and received allopurinol or febuxostat (UA >7.0 mg/dL). All patients were followed up for 3 years after enrollment. RESULTS: There were no significant differences in baseline clinical characteristics between the two groups. The UA level was significantly decreased after 3 years of drug administration compared with the baseline in both groups. Urine levels of the oxidative stress marker 8-hydroxy-2'-deoxyguanosine were lower in the febuxostat group than in the allopurinol group (11.0 ± 9.6 vs. 22.9 ± 15.9 ng/mL), and the rate of patients free from hospitalization due to worsening HF tended to be higher in the febuxostat group than in the allopurinol group (89.0% vs. 83.0%). CONCLUSIONS: Febuxostat is potentially more effective than allopurinol for treating patients with chronic HF and hyperuricemia.This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (https://www.umin.ac.jp/ctr/; ID: 000009817).


Asunto(s)
Insuficiencia Cardíaca , Hiperuricemia , Alopurinol/uso terapéutico , Febuxostat/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Hiperuricemia/tratamiento farmacológico , Ácido Úrico
11.
J Cardiol Cases ; 22(5): 212-215, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33133312

RESUMEN

Advances in microcatheters (MCs) enables the establishment of retrograde systems for the treatment of chronic total occlusion (CTO). However, there are still cases in which establishing a retrograde system is difficult because the guidewire or MC cannot pass through due to calcification, stenosis, or tortuosity. We present a case of a 56-year-old man with angina. Coronary angiography revealed a CTO of the right coronary artery (RCA). Although we started an antegrade approach at first, the guidewire went to subintimal lumen. We switched to a retrograde approach. Although the guidewire passed through posterolateral (PL) channel, the MC could not pass due to a stenosis at the junction of the main RCA trunk. Therefore, we negotiated the septal channel; however, it could only be guided in the peripheral direction. When the guidewire was more advanced in the peripheral direction, it crossed the guidewire that had previously passed through the PL channel. Then, when a balloon was delivered via the septal channel and trapped the guidewire from the PL channel, the MC was successfully delivered via the PL channel. After establishing the retrograde system, revascularization succeeded smoothly. In conclusion, this technique can be one option for the treatment of CTO patients. .

12.
Am J Case Rep ; 21: e923007, 2020 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-32305993

RESUMEN

BACKGROUND Three-dimensional (3D) printed models have been recently introduced for diagnosis and preprocedural planning for percutaneous interventions or surgery in cardiovascular disease. CASE REPORT We treated a 71-year-old woman with angina. Although we performed coronary angiography, we could not engage the catheters for the left coronary artery (LCA). Then, we withdrew the catheter and examined her anatomy using coronary computed tomographic angiography (CCTA). The CCTA revealed that the LCA originated from the noncoronary cusp (NCC). Because anomalous LCA originating from the NCC is a rare congenital anomaly, percutaneous coronary intervention was considered difficult. We decided to use a 3D-printed model, which enabled us to clearly see the anatomy and simulation before the actual procedure, which went smoothly according to the preprocedural planning using the 3D printed model. 3D printed modeling is feasible for use in reproducing coronary artery anatomy and enhancing understanding of coronary abnormalities. CONCLUSIONS Use of 3D-printed models is a useful new option that can help visualize the anatomy and perform preprocedural planning for complex cases.


Asunto(s)
Angina de Pecho/diagnóstico por imagen , Imagenología Tridimensional/métodos , Intervención Coronaria Percutánea/métodos , Anciano , Angina de Pecho/cirugía , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/cirugía , Stents Liberadores de Fármacos , Femenino , Humanos , Tomografía Computarizada por Rayos X
13.
Cardiovasc Res ; 80(1): 40-6, 2008 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-18558628

RESUMEN

AIMS: High-mobility group box 1 (HMGB1) is a nuclear DNA-binding protein and is released from necrotic cells, inducing inflammatory responses and promoting tissue repair and angiogenesis. To test the hypothesis that HMGB1 enhances angiogenesis and restores cardiac function after myocardial infarction (MI), we generated transgenic mice with cardiac-specific overexpression of HMGB1 (HMGB1-Tg) using alpha-myosin heavy chain promoter. METHODS AND RESULTS: The left anterior descending coronary artery was ligated in HMGB1-Tg and wild-type littermate (Wt) mice. After coronary artery ligation, HMGB1 was released into circulation from the necrotic cardiomyocytes of HMGB1-overexpressing hearts. The size of MI was smaller in HMGB1-Tg than in Wt mice. Echocardiography and cardiac catheterization demonstrated that cardiac remodelling and dysfunction after MI were prevented in HMGB1-Tg mice compared with Wt mice. Furthermore, the survival rate after MI of HMGB1-Tg mice was higher than that of Wt mice. Immunohistochemical staining revealed that capillary and arteriole formation after MI was enhanced in HMGB1-Tg mice. CONCLUSION: We report the first in vivo evidence that HMGB1 enhances angiogenesis, restores cardiac function, and improves survival after MI. These results may provide a novel therapeutic approach for left ventricular dysfunction after MI.


Asunto(s)
Vasos Coronarios/crecimiento & desarrollo , Proteína HMGB1/fisiología , Corazón/fisiología , Infarto del Miocardio , Neovascularización Fisiológica , Animales , Ligadura , Ratones , Ratones Transgénicos , Infarto del Miocardio/patología , Miocardio/patología , Cadenas Pesadas de Miosina/genética , Regiones Promotoras Genéticas , Miosinas Ventriculares/genética , Remodelación Ventricular
14.
Am J Cardiol ; 123(7): 1109-1113, 2019 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-30678833

RESUMEN

Mild cognitive impairment (MCI) impedes a patient's decision-making ability to support self-care and is associated with increased mortality in patients with chronic heart failure (CHF). Thus, screening for MCI is very important. The assessment of hippocampal atrophy using magnetic resonance imaging can effectively diagnose early MCI. The purpose of this study was to assess the prevalence and prognostic significance of hippocampal atrophy using magnetic resonance imaging in patient with CHF. Of the 491 patients with CHF included in the study, 170 demonstrated hippocampal atrophy. Patients with hippocampal atrophy were older, and showed a higher rate of renal dysfunction and cardiac events than patients without hippocampal atrophy. A total of 180 cardiac events occurred during the follow-up period. A Cox proportional hazards regression model and Kaplan-Meier analysis showed that hippocampal atrophy was significantly associated with cardiac events. In conclusion, hippocampal atrophy is a significant and independent predictor of poor prognosis in patients with CHF and can aid risk stratification of these patients.


Asunto(s)
Disfunción Cognitiva/diagnóstico , Insuficiencia Cardíaca/complicaciones , Hipocampo/patología , Imagen por Resonancia Magnética/métodos , Anciano , Anciano de 80 o más Años , Atrofia/diagnóstico , Disfunción Cognitiva/etiología , Disfunción Cognitiva/psicología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Pruebas Neuropsicológicas , Pronóstico , Estudios Prospectivos
15.
Am Heart J ; 155(1): 75-81, 2008 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-18082493

RESUMEN

BACKGROUND: Pentraxin 3 (PTX3) is a novel inflammatory marker produced by endothelial cells, smooth muscle cells, and macrophages. The purpose of the present study was to examine the clinical significance of plasma PTX3 levels in patients with heart failure. METHODS: We measured the plasma PTX3 levels in 196 patients with heart failure and 60 control subjects without heart failure by sandwich enzyme-linked immunosorbent assay. Patients were prospectively followed during a median follow-up period of 655 days with the end points of cardiac death or progressive heart failure requiring rehospitalization. RESULTS: Plasma PTX3 concentrations were higher in patients with heart failure than in control subjects (P < .0001) and increased as the severity of New York Heart Association functional class advanced (P < .0001). A total of 63 cardiac events occurred during a follow-up period, and cardiac event-free rate was markedly lower in patients with high PTX3 levels than in those with normal PTX3 levels (44.7% vs 89.2%, P < .0001). The multivariate Cox proportional hazard analysis demonstrated that the plasma PTX3 level, but not the high-sensitive C-reactive protein, was the independent predictor of cardiac events (hazard ratio 1.20, 95% CI 1.03-1.40, P = .0162). Patients were divided into 4 groups based on plasma PTX3 values from first to fourth quartile. The highest fourth quartile of plasma PTX3 levels was associated with the highest risk of cardiac events (9.23-fold compared with the first quartile). CONCLUSIONS: The plasma PTX3 level provides important prognostic information for the risk stratification of patients with heart failure.


Asunto(s)
Proteína C-Reactiva/análisis , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/mortalidad , Mediadores de Inflamación/sangre , Componente Amiloide P Sérico/análisis , Vasculitis/sangre , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Progresión de la Enfermedad , Femenino , Insuficiencia Cardíaca/sangre , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Probabilidad , Pronóstico , Modelos de Riesgos Proporcionales , Valores de Referencia , Medición de Riesgo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Análisis de Supervivencia
16.
Am J Cardiol ; 102(5): 606-10, 2008 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-18721521

RESUMEN

Heat shock protein (HSP) 60 is induced by a variety of stressors, including oxidative stress and inflammation, and it plays a protective role against stress-induced cardiomyocyte injury. Recently, it has been reported that HSP 60 exists in the circulation. Chronic heart failure (CHF) is characterized by systemic abnormalities, and the myocardium is exposed to various stressors. However, the clinical significance of serum HSP 60 has not been examined in CHF. Therefore, the purpose of this study was to examine whether HSP 60 is correlated with the severity of CHF and whether HSP 60 can predict clinical outcomes in patients with CHF. Serum HSP 60 levels were measured in 112 patients with CHF and 62 control subjects. Serum HSP 60 levels were higher in patients with CHF than in control subjects and increased with advancing New York Heart Association functional class. There were 37 cardiac events during a mean follow-up period of 569 +/- 476 days (range 17 to 1,986). Serum HSP 60 levels were higher in patients with cardiac events than in event-free patients. Patients were divided into 4 groups on the basis of HSP 60 level. Cox proportional-hazards regression analysis and Kaplan-Meier analysis revealed that the fourth quartile was associated with the greatest risk for cardiac events. In conclusion, serum HSP 60 level was related to the severity of CHF and associated with a high risk for adverse cardiac events in patients CHF.


Asunto(s)
Cardiomiopatía Dilatada/complicaciones , Chaperonina 60/sangre , Insuficiencia Cardíaca/sangre , Isquemia Miocárdica/complicaciones , Anciano , Biomarcadores/sangre , Cardiomiopatía Dilatada/sangre , Cardiomiopatía Dilatada/diagnóstico por imagen , Enfermedad Crónica , Progresión de la Enfermedad , Ecocardiografía , Ensayo de Inmunoadsorción Enzimática , Femenino , Estudios de Seguimiento , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/etiología , Humanos , Masculino , Isquemia Miocárdica/sangre , Isquemia Miocárdica/diagnóstico por imagen , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
17.
J Card Fail ; 14(2): 133-9, 2008 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-18325460

RESUMEN

BACKGROUND: We recently reported that serum levels of pentosidine, one of the well-defined advanced glycation end products (AGE), was an independent prognostic factor for heart failure. Receptor for AGEs (RAGE) is expressed in a variety of tissues, and RAGE has a C-truncated secretory isoform of the receptor protein, termed soluble RAGE. In the present study, we measured serum soluble RAGE levels in patients and examined whether serum soluble RAGE predicts prognosis in patients with heart failure. METHODS AND RESULTS: Serum soluble RAGE concentration was measured in 160 patients with heart failure by a competitive enzyme-linked immunosorbent assay. Patients were prospectively followed during a median follow-up period of 872 days with end points of cardiac death or rehospitalization. Serum soluble RAGE level increased with advancing New York Heart Association functional class. Serum soluble RAGE level was also higher in patients with cardiac events than in event free patients. From the receiver operating characteristic curve analysis, the cutoff value of serum soluble RAGE level was determined as 1220 pg/mL. Kaplan-Meier analysis clearly demonstrated that the high soluble RAGE group had a significantly higher incidence of cardiac events than occurred in the low serum soluble RAGE group (P = .0004). In the multivariate Cox proportional hazard analysis, soluble RAGE and serum pentosidine were independent risk factors for cardiac events (soluble RAGE: HR 1.90, 95% CI 1.16-3.09, P = .010; pentosidine: HR 1.59, 95% CI 1.11-2.29, P = .012). CONCLUSIONS: Serum soluble RAGE level is an independent prognostic factor for heart failure, and this novel marker may be useful for risk stratification of patients with heart failure.


Asunto(s)
Productos Finales de Glicación Avanzada/sangre , Insuficiencia Cardíaca/fisiopatología , Anciano , Biomarcadores , Progresión de la Enfermedad , Femenino , Productos Finales de Glicación Avanzada/farmacología , Indicadores de Salud , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/mortalidad , Humanos , Masculino , Pronóstico , Estudios Prospectivos , Curva ROC , Medición de Riesgo , Índice de Severidad de la Enfermedad , Volumen Sistólico , Ultrasonografía
18.
Cardiovasc Diabetol ; 7: 2, 2008 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-18241357

RESUMEN

BACKGROUND: Activation of the diacylglycerol (DAG)-protein kinase C (PKC) pathway has been implicated in the pathogenesis of a number of diabetic complications. Diacylglycerol kinase (DGK) converts DAG to phosphatidic acid and acts as an endogenous regulator of PKC activity. Akt/PKB is associated with a downstream insulin signaling, and PKCbeta attenuates insulin-stimulated Akt phosphorylation. METHODS AND RESULTS: We examined transgenic mice with cardiac-specific overexpression of DGKzeta (DGKzeta-TG) compared to wild type (WT) mice in streptozotocin-induced (STZ, 150 mg/kg) diabetic and nondiabetic conditions. After 8 weeks, decreases in heart weight and heart weight/body weight ratio in diabetic WT mice were inhibited in DGKzeta-TG mice. Echocardiography at 8 weeks after STZ-injection demonstrated that decreases in left ventricular end-diastolic diameter and fractional shortening observed in WT mice were attenuated in DGKzeta-TG mice. Thinning of the interventricular septum and the posterior wall in diabetic WT hearts were blocked in DGKzeta-TG mice. Reduction of transverse diameter of cardiomyocytes isolated from the left ventricle in diabetic WT mice was attenuated in DGKzeta-TG mice. Cardiac fibrosis was much less in diabetic DGKzeta-TG than in diabetic WT mice. Western blots showed translocation of PKCbeta and delta isoforms to membrane fraction and decreased Akt/PKB phosphorylation in diabetic WT mouse hearts. However in diabetic DGKzeta-TG mice, neither translocation of PKC nor changes Akt/PKB phosphorylation was observed. CONCLUSION: DGKzeta modulates intracellular signaling and improves the course of diabetic cardiomyopathy. These data may suggest that DGKzeta is a new therapeutic target to prevent or reverse diabetic cardiomyopathy.


Asunto(s)
Diabetes Mellitus Experimental/fisiopatología , Angiopatías Diabéticas/prevención & control , Diacilglicerol Quinasa/metabolismo , Corazón/fisiopatología , Animales , Atrofia , Peso Corporal , Diabetes Mellitus Experimental/enzimología , Diabetes Mellitus Experimental/patología , Angiopatías Diabéticas/diagnóstico por imagen , Angiopatías Diabéticas/patología , Diacilglicerol Quinasa/genética , Ecocardiografía , Corazón/anatomía & histología , Ratones , Ratones Transgénicos , Miocardio/enzimología , Tamaño de los Órganos , Estreptozocina , Disfunción Ventricular Izquierda/enzimología , Disfunción Ventricular Izquierda/patología
20.
Am J Case Rep ; 19: 941-945, 2018 Aug 11.
Artículo en Inglés | MEDLINE | ID: mdl-30097560

RESUMEN

BACKGROUND Recanalized thrombi are usually unrecognized in conventional coronary angiography. However, multiple channels have been observed in recanalized thrombotic lesions. Therefore, the wire apparently crosses the lesion in some difficult cases. We analyzed the cause of difficult wiring of a recanalized thrombotic lesion using optical coherence tomography (OCT). CASE REPORT An 87-year-old man with chest pain was admitted to our hospital. Coronary angiography showed significant stenosis of the proximal right coronary artery with irregular linear filling and haziness. Crossing of the wire for the lesion was very difficult but was achieved using a parallel wire technique. OCT clearly demonstrated multiple small channels which had ambiguous findings on angiography and intravascular ultrasound. These structures showed a honeycomb-like appearance suggests the recanalized thrombi. A drug-eluting stent was subsequently deployed to fully cover the entire lesion. CONCLUSIONS OCT is useful to evaluate the accurate tissue characteristics of a recanalized thrombotic lesion. Because recanalized thrombi have multiple small channels and since there are some cases in which a part of the channel only flows into a side branch, it is necessary to carefully monitor wiring at the time of percutaneous coronary intervention.


Asunto(s)
Angiografía Coronaria/métodos , Estenosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Tomografía de Coherencia Óptica , Anciano de 80 o más Años , Angiografía Coronaria/instrumentación , Estenosis Coronaria/terapia , Trombosis Coronaria/terapia , Vasos Coronarios/patología , Stents Liberadores de Fármacos , Humanos , Masculino , Intervención Coronaria Percutánea , Ultrasonografía Intervencional
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