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1.
Ann Noninvasive Electrocardiol ; 28(6): e13089, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37724719

RESUMO

BACKGROUND: The prevalence of Holter-based late potentials (H-LPs) in cases of fatal cardiac events has increased. Although the noise level of H-LP is higher than that of conventional real-time late potential (LP) recording, a procedure to reduce the noise severity in H-LP by increasing the averaging beats has not been investigated. METHODS: We enrolled 104 patients with post-myocardial infarction (MI) and 86 control participants. Among the patients, 30 reported sustained ventricular tachycardia (VT), and the remaining 74 had unrecorded VT. H-LPs were measured twice in all groups to evaluate the efficacy of increasing the averaging beats for H-LPs. Thereafter, the average of LP was calculated at 250 (default setting), 300, 400, 500, 600, 700, and 800 beats. RESULTS: Across all three groups (MI-VT group, MI non-VT group, and control group), the noise levels significantly decreased in consonance with the increase in averaging beats. In the MI-VT group, the H-LP positive rate considerably increased with the increase in the averaging beats from 250 to 800 both at night and daytime. In the MI-VT group, the LP parameters significantly deteriorated, which led to a positive judgment corresponding to the increment of the averaged night and day beats. The H-LP positive rates were unchanged in the MI non-VT and control groups, while the LP parameters remained consistent, despite the increased averaging beats in the MI non-VT and control groups. CONCLUSION: Increasing the calculated averaging beats in H-LPs can improve the sensitivity of predicting fatal cardiac events in patients with MI.


Assuntos
Infarto do Miocárdio , Taquicardia Ventricular , Humanos , Eletrocardiografia/métodos , Lipopolissacarídeos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/diagnóstico , Taquicardia Ventricular/diagnóstico
2.
Medicina (Kaunas) ; 59(8)2023 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-37629750

RESUMO

Background and Objectives: Holter-based late potentials (LPs) are useful for predicting lethal arrhythmias in organic cardiac diseases. Although Holter-based LPs exhibit diurnal variation, no studies have evaluated the optimal timing of LP measurement over 24 h for predicting lethal arrhythmia that leads to sudden cardiac death. Thus, this study aimed to validate the most effective timing for Holter-based LP testing and to explore factors influencing the diurnal variability in LP parameters. Materials and Methods: We retrospectively analyzed 126 patients with post-myocardial infarction (MI) status and 60 control participants who underwent high-resolution Holter electrocardiography. Among the 126 post-MI patients, 23 developed sustained ventricular tachycardia (VT) (the MI-VT group), while 103 did not (the MI-non-VT group) during the observation period. Holter-based LPs were measured at 0:00, 4:00, 8:00, 12:00, 16:00, and 20:00, and heart rate variability analysis was simultaneously performed to investigate factors influencing the diurnal variability in LP parameters. Results: Holter-based LP parameters showed diurnal variation with significant deterioration at night and improvement during the day. Assessment at the time with the longest duration of low-amplitude signals < 40 µV in the filtered QRS complex terminus (LAS40) gave the highest receiver operating characteristics curve (area under the curve, 0.659) and the highest odds ratio (3.75; 95% confidence interval, 1.45-9.71; p = 0.006) for predicting VT. In the multiple regression analysis, heart rate and noise were significant factors affecting the LP parameters in the MI-VT and control groups. In the non-VT group, the LP parameters were significantly influenced by noise and parasympathetic heart rate variability parameters, such as logpNN50. Conclusions: For Holter-based LP measurements, the test accuracy was higher when the LP was measured at the time of the highest or worst value of LAS40. Changes in autonomic nervous system activity, including heart rate, were factors influencing diurnal variability. Increased parasympathetic activity or bradycardia may exacerbate Holter-based LP parameters.


Assuntos
Cardiopatias , Infarto do Miocárdio , Humanos , Lipopolissacarídeos , Estudos Retrospectivos , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Infarto do Miocárdio/complicações
3.
Ann Noninvasive Electrocardiol ; 27(2): e12923, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34873791

RESUMO

BACKGROUND: Noninvasive electrocardiographic markers (NIEMs) are promising arrhythmic risk stratification tools for assessing the risk of sudden cardiac death. However, little is known about their utility in patients with chronic kidney disease (CKD) and organic heart disease. This study aimed to determine whether NIEMs can predict cardiac events in patients with CKD and structural heart disease (CKD-SHD). METHODS: We prospectively analyzed 183 CKD-SHD patients (median age, 69 years [interquartile range, 61-77 years]) who underwent 24-h ambulatory electrocardiographic monitoring and assessed the worst values for ambulatory-based late potentials (w-LPs), heart rate turbulence, and nonsustained ventricular tachycardia (NSVT). The primary endpoint was the occurrence of documented lethal ventricular tachyarrhythmias (ventricular fibrillation or sustained ventricular tachycardia) or cardiac death. The secondary endpoint was admission for cardiovascular causes. RESULTS: Thirteen patients reached the primary endpoint during a follow-up period of 24 ± 11 months. Cox univariate regression analysis showed that existence of w-LPs (hazard ratio [HR] = 6.04, 95% confidence interval [CI]: 1.4-22.3, p = .007) and NSVT [HR = 8.72, 95% CI: 2.8-26.5: p < .001] was significantly associated with the primary endpoint. Kaplan-Meier analysis demonstrated that the combination of w-LPs and NSVT resulted in a lower event-free survival rate than did other NIEMs (p < .0001). No NIEM was useful in predicting the secondary endpoint, although the left ventricular mass index was correlated with the secondary endpoint. CONCLUSION: The combination of w-LPs and NSVT was a significant risk factor for lethal ventricular tachyarrhythmias and cardiac death in CKD-SHD patients.


Assuntos
Insuficiência Renal Crônica , Taquicardia Ventricular , Idoso , Morte Súbita Cardíaca/etiologia , Eletrocardiografia/efeitos adversos , Eletrocardiografia Ambulatorial/métodos , Feminino , Humanos , Japão/epidemiologia , Lipopolissacarídeos , Masculino , Estudos Prospectivos , Insuficiência Renal Crônica/complicações , Medição de Risco , Fatores de Risco , Taquicardia Ventricular/complicações , Taquicardia Ventricular/diagnóstico , Fibrilação Ventricular/complicações
4.
Acta Med Okayama ; 76(6): 705-713, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36549773

RESUMO

The sodium glucose transporter 2 (SGLT2) inhibitor tofogliflozin is a glucose-lowering drug that causes the excretion of surplus glucose by inhibiting SGLT2. Because of tofogliflozin's osmotic diuresis mechanism, patients' serum electrolytes, body fluid levels, and cardiac function must be monitored. We retrospectively analyzed the cases of 64 elderly Japanese patients with type 2 diabetes mellitus (T2DM) who received tofogliflozin for 3 months. Their HbA1c, serum electrolytes (sodium, potassium, chloride), hematocrit, brain natriuretic peptide (cardiac volume load marker) and renin and aldosterone (RAA; an index of regulatory hormones involved in body fluid retention) were continuously monitored during the investigation period. Renal function and cardiac function (by echocardiography) were assessed throughout the period. HbA1c significantly decreased (ß1=-0.341, p<0.0001, linear regression analysis [LRA]). Most of the hormonal, electrolyte, and physiological parameters were maintained throughout the study period. In these circumstances, E/e' tended to decrease (ß1=-0.382, p=0.13, LRA). Compared to the baseline, E/e' was significantly decreased at 1 and 3 months (p<0.01, p<0.05). In the higher E/e' group (E/e'≥10, n=34), E/e' decreased significantly (ß1=-0.63, p<0.05, LRA). ΔE/e' was correlated with body-weight change during treatment (r=0.64, p<0.01). The 3-month tofogliflozin treatment improved glycemic control and diastolic function represented by E/e' in T2DM patients, without affecting serum electrolytes, renal function, or RAA. No negative impacts on the patients were observed. Three-month tofogliflozin treatment lowered glucose and improved cardiac diastolic function.


Assuntos
Diabetes Mellitus Tipo 2 , Inibidores do Transportador 2 de Sódio-Glicose , Humanos , Idoso , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hemoglobinas Glicadas , Glicemia , Transportador 2 de Glucose-Sódio/uso terapêutico , Estudos Retrospectivos , População do Leste Asiático , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Eletrólitos/uso terapêutico
5.
Ann Noninvasive Electrocardiol ; 26(1): e12803, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32969113

RESUMO

BACKGROUND: Noninvasive electrocardiographic (ECG) markers are promising arrhythmic risk stratification tools for identifying sudden cardiac death. However, little is known about the usefulness of noninvasive ECG markers derived from ambulatory ECGs (AECG) in patients with previous myocardial infarction (pMI). We aimed to determine whether the ECG markers derived from AECG can predict serious cardiac events in patients with pMI. METHODS: We prospectively analyzed 104 patients with pMI (88 males, age 66 ± 11 years), evaluating late potentials (LPs), heart rate turbulence, and nonsustained ventricular tachycardia (NSVT) derived from AECG. The primary endpoint was the documentation of ventricular fibrillation or sustained ventricular tachycardia. RESULTS: Eleven patients reached the primary endpoint during a follow-up period of 25 ± 9.5 months. Of the 104 patients enrolled in this study, LP positive in worst values (w-LPs) and NSVT were observed in 25 patients, respectively. In the arrhythmic event group, the worst LP values and/or NSVT were found in eight patients (7.6%). The positive predictive and negative predictive values of the combined assessment with w-LPs and NSVT were 56% and 94%, respectively, for predicting ventricular lethal arrhythmia. Kaplan-Meier analysis demonstrated that the combination of w-LPs and NSVT had a poorer event-free period than negative LPs (p < .0001). In the multivariate analysis, the combined assessment of w-LPs and NSVT was a significant predictor of arrhythmic events (hazard ratio = 14.1, 95% confidence intervals: 3.4-58.9, p < .0001). CONCLUSION: Combined evaluation of w-LPs and NSVT was a powerful risk stratification strategy for predicting arrhythmia that can lead to sudden cardiac death in patients with pMI.


Assuntos
Morte Súbita Cardíaca/epidemiologia , Eletrocardiografia Ambulatorial/métodos , Infarto do Miocárdio/epidemiologia , Taquicardia Ventricular/complicações , Taquicardia Ventricular/diagnóstico , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/epidemiologia , Idoso , Estudos de Coortes , Comorbidade , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco
6.
Ann Noninvasive Electrocardiol ; 24(3): e12620, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30403436

RESUMO

BACKGROUND: T-wave alternans (TWA) is a risk stratification predictor for sudden cardiac death. However, little is known about the diurnal variation of TWA. Whether TWA are affected by heart rate (HR) or cardiac autonomic nervous activity in the subjects without significant structural heart disease in daily life is not fully understood. Thus, this study was aimed to clarify these issues. METHODS: Frequency domain (FD)-TWA analysis was conducted in 47 subjects without significant structural heart disease using 24-hr ambulatory electrocardiogram (AECG). Measurement of heart rate variability (HRV) was performed in order to evaluate the autonomic activity of the heart. The maximum FD-TWA value in each period was measured four times per day (A, 00:00-6:00 hr; B, 06:00-12:00 hr; C, 12:00-18:00 hr; D, 18:00-24:00 hr). Correlations between FD-TWA and either HR or HRV parameters (LF/HF, LFnu, HFnu, SDNN, CVNN, pNN50) were analyzed in each period (A-D). RESULTS: There was diurnal variation of FD-TWA (median, inter-quartile range [IQR]: A, 8.2 [6.5, 10.6] µV; B, 10.1 [8.4, 15.0] µV; C, 17.6 [12.3, 25.0] µV: D, 11.9 [9.1, 19.9] µV; p < 0.0001). Maximum FD-TWA had positive correlations with HR and LF/HF (HR, r = 0.496, p < 0.0001; LF/HF, r = 0.414, p = 0.004), while FD-TWA had a negative correlation with HFnu (r = -0.291, p = 0.048). On multiple linear regression analysis, HR had an independent effect on log FD-TWA amplitude (ß = 0.461, p = 0.001). CONCLUSIONS: FD-TWA has marked diurnal variation in the daily life of the subjects without significant structural heart disease. This variation could be more strongly affected by HR than the HRV indices.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Morte Súbita Cardíaca/prevenção & controle , Ecocardiografia Doppler/métodos , Eletrocardiografia Ambulatorial/métodos , Eletrocardiografia/métodos , Estudos de Coortes , Feminino , Voluntários Saudáveis , Frequência Cardíaca/fisiologia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos
7.
J Electrocardiol ; 51(6): 1145-1152, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30497747

RESUMO

BACKGROUND: A novel signal-averaged electrocardiogram (SAECG) device and a novel ambulatory SAECG device are clinically available, but reference values have not been established. This study aimed to validate the novel SAECG and the novel ambulatory-based SAECG devices by comparison with the conventional SAECG device. METHODS AND RESULTS: High-resolution SAECGs were recorded consecutively in 83 healthy volunteers using the 3 devices. A novel ambulatory SAECG device was used as real-time recording within 15 min for validation study (15 min ambulatory-based SAECG). We examined the concordance of positive results (at least 2/3 abnormal SAECG parameters) and negative results (0 or 1/3 abnormal parameters), as well as the correlations between SAECG parameters (filtered QRS duration [fQRS]); duration of low-amplitude signals < 40 µV in the terminal filtered QRS complex [LAS40]; root mean square voltage of the terminal 40 ms of the filtered QRS complex [RMS40]). Qualitative analysis showed excellent concordance among the novel SAECG, the 15 min ambulatory-based SAECG, and the conventional SAECG methods (novel SAECG vs. conventional SAECG = 94%; 15 min ambulatory-based SAECG vs. conventional SAECG = 91.6%; p = 0.755), while quantitative analysis indicated strong correlations between the novel SAECG and the conventional SAECG values for fQRS, LAS40, and LnRMS40 (r = 0.838-0.805, p < 0.0001, respectively). Strong correlations were also seen between 15 min ambulatory-based SAECG and conventional SAECG values for fQRS, LAS40, and RMS40 (r = 0.943-0.888, p < 0.0001, respectively). However, Bland-Altman quantitative analysis showed better agreement in fQRS and LnRMS40 measured by the 15 min ambulatory-based SAECG and the conventional SAECG than those by the novel SAECG and the conventional SAECG (fQRS, Lin's rho_c = 0.923 vs. 0757; RMS40, Lin's rho_c = 0.932 vs. 0.818, respectively). CONCLUSION: In healthy subjects, the parameters of either the novel SAECG or the 15 min ambulatory-based SAECG and those of the conventional SAECG were strongly correlated. Relatively good agreements were observed among 3 SAECGs, especially better between the 15 min ambulatory-based SAECG and the conventional SAECG probably due to similar measurement system of 2 methods.


Assuntos
Eletrocardiografia Ambulatorial/instrumentação , Eletrocardiografia/métodos , Adulto , Desenho de Equipamento , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Processamento de Sinais Assistido por Computador
9.
Clin Exp Hypertens ; 38(2): 194-202, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26794149

RESUMO

Many of the elderly Kazakhs have been found to exhibit non-dipping blood pressure variations (BPV). Such variations are seen in both normotensive and hypertensive Kazakhs. The purpose of this study was (1) to determine whether middle-aged Kazakhs also include large numbers of non-dippers, (2) to compare the characteristics of non-dipping and dipping, and (3) to clarify the mechanisms responsible for non-dipping type BPV by examining the autonomic nervous activity and physical activity. We performed ambulatory blood pressure (BP) monitoring. The subjects were divided into two groups (dipping and non-dipping type). We monitored the subjects' physical activity with accelerometry and assessed their autonomic nerve activity by performing a frequency domain analysis of their heart rate variability (HRV). The power spectral density (PSD) of the HRV was calculated using fast Fourier transformation. We analyzed the systolic blood pressure (SBP) variations with the maximum entropy method (MEM). The dippers and non-dippers accounted for 48% and 52% of the subjects, respectively. MEM analysis revealed that the SBP variations of the non-dippers exhibited a 24 hour periodicity with a very weak PSD as well as an ultradian periodicity. The non-dippers exhibited higher low-frequency/high-frequency (LF/HF) ratio and lower HF/(LF + HF) ratios than the dippers, particularly during the nighttime. In addition, the non-dippers performed less physical activity than the dippers. These differences in cardiac autonomic function and physical activity might contribute to the generation of a weak circadian rhythm in SBP, and thus, ultimately lead to the non-dipping SBP variations observed in non-dipper Kazakhs.


Assuntos
Pressão Sanguínea/fisiologia , Ritmo Circadiano/fisiologia , Atividade Motora/fisiologia , Sistema Nervoso Simpático/fisiopatologia , Acelerometria , Adulto , Povo Asiático , Sistema Nervoso Autônomo , Monitorização Ambulatorial da Pressão Arterial , Estudos de Casos e Controles , Estudos Transversais , Eletrocardiografia Ambulatorial , Feminino , Frequência Cardíaca , Humanos , Hipertensão/etnologia , Hipertensão/fisiopatologia , Cazaquistão , Masculino , População Branca
10.
Int Heart J ; 57(1): 53-60, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26742700

RESUMO

Although calcium channel blockers (CCB) are expected to improve the augmentation index (AI) in CKD patients, the potential effect of benidipine on AI has been poorly studied.The present study aimed to compare the effect of benidipine and amlodipine in the treatment of CKD patients as measured through AI and urinary albumin excretion (UAE). Eligible patients with CKD were randomized to either the benidipine group or amlodipine group. Changes in UAE and AI were compared with target blood pressure level set at < 130/80 mmHg. A total of 108 patients were enrolled; 88 patients who were followed up were included in the analysis. Although no significant change in renal function was noted in either group, there was a significant improvement in AI only in the benidipine group (85.7 ± 13.3% to 81.4 ± 15.2%; P = 0.021) A subgroup analysis of 64 patients who achieved SBP < 140 mmHg at the end of follow-up (31 on amlodipine and 33 on benidipine) was carried out. Significant improvement in AI was noted only in the benidipine group (84.5 ± 13.6% to 79.5 ± 15.2%; P = 0.0138). In another subgroup of patients with UAE ≥ 300 mg/g Cr, a significant improvement in UAE in the benidipine group was found compared with the amlodipine group (-25 ± 46, 51 ± 60%, P = 0.031, respectively).These results suggest that benidipine might reduce significantly AI and might have potentially greater improvements in UAE than amlodipine in advanced CKD patients receiving RAS inhibitors.


Assuntos
Albuminúria/tratamento farmacológico , Pressão Sanguínea/efeitos dos fármacos , Di-Hidropiridinas/administração & dosagem , Hipertensão/tratamento farmacológico , Insuficiência Renal Crônica/urina , Idoso , Albuminúria/urina , Bloqueadores dos Canais de Cálcio/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Hipertensão/etiologia , Hipertensão/urina , Masculino , Estudos Prospectivos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico
11.
Kansenshogaku Zasshi ; 88(6): 849-54, 2014 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-25764807

RESUMO

We report herein on a rare case of deep-soft tissue infection due to invasive pneumococcal disease (IPD). A 77-year-old woman was admitted to our hospital with progressive pain in the right upper arm and the distal leg associated with swelling. We diagnosed the condition as multiple instances of cellulitis that were initially treated with ceftriaxone and clindamycin. Penicillin-susceptible Streptococcus pneumoniae (PSSP) was isolated from blood cultures on admission. Although inflammatory marker levels improved following susceptive antibiotic therapy (ampicillin), multiple abscesses, septic arthritis and osteomyelitis were detected with image testing. The antibiotic was then changed to meropenem and arthroscopic surgery was performed for the right shoulder; the patient's clinical symptoms improved. Since pneumococcal infection including skin and soft tissue infection (SSTI) often causes blood stream invasion or metastatic suppurative complications, metastatic lesions or multiple abscesses should be taken care of.


Assuntos
Infecções Pneumocócicas , Dermatopatias/microbiologia , Infecções dos Tecidos Moles/microbiologia , Idoso , Celulite (Flegmão)/microbiologia , Feminino , Humanos , Imunocompetência , Infecções Pneumocócicas/microbiologia
12.
J Arrhythm ; 40(1): 17-25, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38333400

RESUMO

Computer diagnosis of electrocardiograms is widely used to provide useful information in clinical practice and medical checkups. However, it is common for users to be confused by the inappropriate diagnosis. We illustrate some examples of inappropriate automatic diagnoses and discuss the actual situation of inappropriate automatic processing and its problems.

13.
Medicine (Baltimore) ; 103(32): e38948, 2024 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-39121281

RESUMO

Patients with type 2 diabetes mellitus are frequently hospitalized for heart failure. The ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e'), measured by echocardiography, is a simple and convenient indicator of diastolic dysfunction. Various large clinical trials have reported that sodium glucose transporter-2 inhibitor therapy reduced cardiovascular events and hospitalizations in heart failure patients. We examined the effect of tofogliflozin on various physiological and cardiac function. A retrospective analysis was performed on elderly patients aged 65 years or older with type 2 diabetes mellitus attending Himi Municipal Hospital who were taking oral tofogliflozin 20 mg/day. Measurement of physiological and hormonal variables, blood sampling, and echocardiographic evaluations at 0, 1, 3, and 6 months were performed on those with ejection fraction (EF) of 40% or greater at the time of treatment. Statistical analysis was performed using t-tests and mixed-effects models, with brain natriuretic peptide less than or not less than 100 pg/mL, estimated glomerular filtration rate (eGFR) less than or not less than 50 mL/min/1.73 m2, and diuretics administered or not. Hypoglycemic effects were observed at 0, 1, 3, and 6 months. At each time point, EF was retained and E/e' was significantly reduced. On the other hand, most physiological parameters and laboratory results showed no clinical abnormalities. Mixed-effects models showed time-dependent reduction of E/e' in high/low brain natriuretic peptide, high/low eGFR, with or without diuretics between baseline and at 6 months. The interaction with time was significant in high/low eGFR. Tofogliflozin was shown to improve E/e', a measure of diastolic function, while maintaining EF, with hypoglycemic effects and no clinical side effects.


Assuntos
Compostos Benzidrílicos , Diabetes Mellitus Tipo 2 , Glucosídeos , Insuficiência Cardíaca , Inibidores do Transportador 2 de Sódio-Glicose , Volume Sistólico , Humanos , Estudos Retrospectivos , Idoso , Masculino , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/fisiopatologia , Compostos Benzidrílicos/administração & dosagem , Compostos Benzidrílicos/uso terapêutico , Compostos Benzidrílicos/farmacologia , Feminino , Glucosídeos/administração & dosagem , Glucosídeos/uso terapêutico , Glucosídeos/farmacologia , Volume Sistólico/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/fisiopatologia , Inibidores do Transportador 2 de Sódio-Glicose/administração & dosagem , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia , Idoso de 80 Anos ou mais , Ecocardiografia , Taxa de Filtração Glomerular/efeitos dos fármacos
14.
Geriatr Gerontol Int ; 24(6): 571-576, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38690756

RESUMO

AIM: Whether serum concentration of procalcitonin (PCT), brain natriuretic peptide (BNP) and albumin (Alb) have an association with the outcome of hospitalized older patients is unclear. We investigated clinical outcomes and any predictive factors in hospitalized Japanese older patients with a risk of infection. METHODS: In the retrospective study, 820 Japanese patients were followed up for 30 days or until death. During the observation period, 656 patients survived and 164 patients died. The predictive factors of death were analyzed according to demographic and clinical variables. RESULTS: The survival rate was decreased as the serum PCT increased from <0.5 to ≥10 ng/mL, as was also the case with BNP from <300 to ≥300 pg./mL, whereas low Alb (<2.5 g/dL) showed a lower survival rate than high Alb (≥2.5 g/dL; P < 0.01). Using the Cox regression model, the multivariable-adjusted hazard ratios (95% confidence interval) were as follows: PCT 0.5-2 versus <0.5 ng/mL: 1.61(1.04-2.49), PCT 2-10 versus <0.5 ng/mL: 1.91(1.15-3.16), PCT ≥10 versus <0.5 ng/mL: 2.90(1.84-4.59), high BNP 1.26 (0.89-1.76) and low Alb 0.68 (0.52-0.87). The mortality rate increased as the number of scores (PCT + BNP + Alb) increased. CONCLUSIONS: Concentration-dependent high PCT, high BNP and low Alb were positive risk factors associated with poor prognosis in hospitalized older patients with a risk of infection. Geriatr Gerontol Int 2024; 24: 571-576.


Assuntos
Biomarcadores , Peptídeo Natriurético Encefálico , Pró-Calcitonina , Albumina Sérica , Humanos , Masculino , Feminino , Biomarcadores/sangue , Idoso , Japão/epidemiologia , Peptídeo Natriurético Encefálico/sangue , Prognóstico , Estudos Retrospectivos , Pró-Calcitonina/sangue , Idoso de 80 Anos ou mais , Albumina Sérica/análise , Hospitalização , Medição de Risco/métodos , Valor Preditivo dos Testes , Fatores de Risco , Taxa de Sobrevida/tendências , Infecções/sangue , Infecções/mortalidade , População do Leste Asiático
16.
Heart Vessels ; 28(2): 208-14, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22370591

RESUMO

A relationship may exist between plasma atrial natriuretic peptide (P-ANP) and heart rate variability (HRV), which reflects the activity of the autonomic nervous system. We performed a survey in human subjects to examine the relationship between P-ANP and HRV parameters. Three ethnic groups (Han, Uygur, and Kazakh) provided blood and urine samples and underwent 24-h ambulatory blood pressure monitoring and 24-h ECG recording (24-h Holter ECG). There was a positive correlation between P-ANP and HF, as well as a negative correlation between P-ANP and the LF/HF ratio, in all subjects from the 3 ethnic groups. There was no association of BP with any of the blood, urinary, and HRV parameters. Our results suggested the possibility of a relationship between P-ANP and HRV, which reflects autonomic activity. These findings are consistent with the previous report of a close relationship between ANP and cardiac parasympathetic and/or sympathetic activity.


Assuntos
Fator Natriurético Atrial/sangue , Sistema Nervoso Autônomo/fisiologia , Ritmo Circadiano , Frequência Cardíaca , Coração/inervação , Idoso , Povo Asiático , Biomarcadores/sangue , Monitorização Ambulatorial da Pressão Arterial , China/epidemiologia , Eletrocardiografia Ambulatorial , Feminino , Humanos , Modelos Lineares , Masculino , Análise Multivariada , Fatores de Tempo
17.
J Vasc Surg Venous Lymphat Disord ; 11(1): 31-38, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-35934305

RESUMO

OBJECTIVE: The primary aim of this observational study was to measure the Revised Venous Clinical Severity Score (rVCSS) in patients treated for varicose veins (VVs) owing to saphenous vein reflux. Treatment was by endovenous thermal ablation (ETA) alone or by ETA and ambulatory phlebectomy (AP). A secondary aim was to determine whether participant characteristics and treatment methods affect rVCSS and how the score changes over time. METHODS: We enrolled 44 men with 55 treated legs and 79 women with 105 treated legs (bilateral cases, 23.1%). Patients were treated and evaluated from April 2016 to September 2020. All legs were treated by ETA, and participants were divided into three groups depending on AP treatment: E0 group (40 legs), no AP; EP1 group (101 legs), AP performed only at one site above or below the knee; and EP2 group (19 legs), AP performed both above and below the knee. The rVCSS was measured in the treated legs up to five times: preoperatively and on postoperative days (POD) 1, 7, 90, and 180. RESULTS: The mean age was 67.5 ± 11.24 years (range, 32-87 years). No significant differences in medical history or demographics or lifestyle were found between the groups. The mean preoperative rVCSS also was not different between groups (E0, 4.4 ± 0.3 points; EP1, 4.6 ± 0.2 points; and EP2, 5.4 ± 0.4 points; P = .14). Factors associated with less improvement in the rVCSS were a high body mass index (P = .046) and the occurrence of endovenous heat-induced thrombosis (P = .001), and factors associated with more improvement in the rVCSS were hypertension (P = .026), hyperuricemia (P = .022), and wearing compression stockings (P = .013). The rVCSS decreased strongly at POD1 and then gradually decreased until POD180. It was not significantly different between EP1 and EP2, but it improved significantly earlier in these two groups than in the E0 group. The rVCSS at POD180 was as follows: E0, 1.633 ± 0.233 points; EP1, 1.003 ± 0.148 points; and EP2, 0.982 ± 0.322 points. CONCLUSIONS: Factors associated with less improvement in the rVCSS are a high body mass index and the occurrence of endovenous heat-induced thrombosis. Hypertension, hyperuricemia, and wearing compression stockings are associated with greater improvements in the rVCSS. Patients treated with ETA and AP tend to improve earlier than patients treated by ETA alone, but all patients improve to nearly the same level within 6 months.


Assuntos
Hipertensão , Hiperuricemia , Trombose , Varizes , Insuficiência Venosa , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Hiperuricemia/complicações , Varizes/diagnóstico por imagem , Varizes/cirurgia , Veia Safena/diagnóstico por imagem , Veia Safena/cirurgia , Hipertensão/complicações , Resultado do Tratamento , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/cirurgia , Insuficiência Venosa/complicações
18.
Ann Transl Med ; 11(6): 254, 2023 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-37082669

RESUMO

Background: Pneumonia in elderly patients who require nursing care is becoming more and more common among the aging populations of developed countries, and treatment is an important topic worldwide. A simpler prognostic indicator would be expected to improve the treatment of pneumonia. This single-center, prospective cohort study aimed to compare the usefulness of B-type natriuretic peptide (BNP), procalcitonin (PCT), and the A-DROP score, which have been reported to correlate with pneumonia prognoses, such as aspiration pneumonia (AP). Methods: We included patients who were admitted to the Kanazawa Medical University Himi Municipal Hospital with a diagnosis of either nursing- and healthcare-associated pneumonia (NHCAP) or AP between January 1, 2012 and July 31, 2019. We collected demographic, clinical, and laboratory characteristics and outcome data from electronic medical records, and calculated A-DROP scores. The primary outcome was 30-day mortality. We evaluated correlations with the primary outcome using the chi-square test, Fisher exact test, t-test, Cox-regression analysis, and receiver operating characteristic curve analysis. Results: Of the 1,215 patients with pneumonia, 297 were eligible for the study, of whom 37 (12%) died whin 30 days. After univariate analysis, we performed Cox proportional-hazards analysis for BNP, PCT, A-DROP score, albumin, C-reactive protein, and disseminated intravascular coagulation, which were significantly correlated with the primary outcome in univariate analysis. As a result, only BNP showed a significant correlation (P=0.008, 95% CI: 1.30-6.06). No significant correlation was obtained in PCT (P=0.529) and A-DROP score (P=0.107). Furthermore, we generated receiver operating characteristic curve to estimate the prognostic cut-off values of BNP for the primary outcome of NHCAP and AP. The optimal cut-off value of BNP for predicting death was 179.3 pg/mL (sensitivity 62.2%, specificity 76.2%, negative likelihood ratio 0.50%, positive likelihood ratio 2.61%). And, BNP yielded the highest area under the curve (0.72) in comparison with PCT (0.67) and A-DROP score (0.69). Conclusions: BNP may be a more clinically useful prognostic factor for NHCAP and AP than PCT or A-DROP score, and should be considered as a routine test at the beginning of these treatments.

19.
JMA J ; 6(4): 365-370, 2023 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-37941699

RESUMO

People devoid of COVID-19 may exhibit mental health problems, such as anxiety disorders, depression, panic attack, insomnia, emotional disorder, and suicidal actions. Healthcare workers (HCWs) may also exhibit these problems. Physicians should be careful an "at-risk" population. Physicians revealed higher levels of resilience than the popular workers. Humans with stronger resilience have lower feeling of anxiety and depression. We investigated the risk to physicians from an infected environment to infected patients during the pandemic. The social and psychological support of all HCWs, particularly physicians, is significant in the fight against this pandemic. Physicians working with patients with COVID-19 should set enough time to relax, sleep, and spend time with family. Resilience in physicians facing COVID-19 can induce post-traumatic growth in the future.

20.
Front Cardiovasc Med ; 10: 1099157, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36950291

RESUMO

Background: The advent of novel monitoring technologies has dramatically increased the use of ambulatory electrocardiography (AECG) devices. However, few studies have conducted detailed large-scale investigations on the incidence of arrhythmias over 24 h, especially ectopy, in healthy individuals over a wide age range. Objectives: This study aimed to investigate the incidence of arrhythmias detected using AECG and associated factors, in healthy individuals, over a wide age range. Methods: In this cross-sectional study, we performed AECG on 365 healthy volunteers (median [interquartile range]: 48 [36, 67], 20-89 years, 165 men) under free-running conditions for 24 h. Ultrasonic echocardiography and heart rate variability analysis were performed to explore the factors associated with the incidence of arrhythmias. Results: The 97.5th percentile of single ventricular ectopy (VE) was 149/day, 254/day, and 1,682/day in the 20-39-, 40-59- and 60-89-year age groups, respectively; that of single supraventricular ectopy (SVE) was 131/day, 232/day, and 1,063/day, respectively. Multivariate analysis revealed that aging was the only independent significant factor influencing the frequency of VE (ß = 0.207, P = 0.001). Age (ß = 0.642, P < 0.001), body mass index (BMI) (ß = -0.112, P = 0.009), and the root mean square of successive differences in RR intervals (ß = 0.097, P = 0.035) were factors significantly associated with SVE frequency. Conclusions: Age-specific reference intervals of VE and SVE in a large population of healthy participants over a wide age range were generated. VE and SVE increased with age; SVE was influenced by BMI and the aging-induced decrease in parasympathetic tone activity.

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