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1.
J Vasc Surg ; 2024 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-39029811

RESUMO

OBJECTIVE: To validate the Japanese below-the-knee (J-BTK) chronic total occlusion (CTO) score for the prediction of successful guidewire crossing (S-GC) in angiographic evaluation. METHODS: A prospective, multicenter, nonrandomized study examined 751 consecutive BTK CTOs in 497 patients treated with endovascular therapy in 16 Japanese medical centers from April 2021 to March 2022. The cohort was classified into 2 groups: an S-GC group and a failed guidewire crossing group. RESULTS: The J-BTK CTO score, which assigned one point to "Blunt type at the proximal entry point," one point to "Calcification at the proximal entry point," one point to "Reference vessel diameter <2.0 mm," one point to "CTO length ≥200 mm," and two points to "No outflow of the target vessel," was used to categorize BTK CTOs into 4 grades with varying probabilities of S-GC: grade A (J-BTK CTO score of 0 and 1), grade B (score of 2 and 3), grade C (score of 4 and 5), and grade D (score of 6). Rates of S-GC in each grade (grades A, B, C, and D) were 97.5%, 89.1%, 62.5%, and 27.3%, respectively. The area under the receiver-operating characteristic curve for S-GC was 0.8304. Although the previous J-BTK CTO study enrolled only de novo lesions, both de novo and restenotic lesions were evaluated in this study. De novo lesions have a lower chance of S-GC (odds ratio: 0.24, 95% confidence interval: 0.09-0.67) in the multivariate analysis, and the area under the receiver-operating characteristic curve of the modified J-BTK CTO score, which additionally assigned two points to "De novo lesion," was 0.846. The modified J-BTK CTO score showed an appropriate calibration (Hosmer-Lemeshow P = .957). CONCLUSIONS: The J-BTK CTO score and the modified J-BTK CTO score predict the probability of an S-GC of BTK CTOs and stratify the difficulty of endovascular therapy for BTK CTOs in angiographic evaluation.

2.
Eur J Vasc Endovasc Surg ; 63(6): 852-863, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35659488

RESUMO

OBJECTIVE: This study sought to: determine anatomically evaluated predictors of the technical failure of inframalleolar angioplasty (IMA), develop a predictive model for unsuccessful IMA, and investigate the effect of IMA on clinical outcomes in patients with chronic limb threatening ischaemia (CLTI). METHODS: This single centre retrospective observational study enrolled 159 patients with CLTI who underwent IMA for de novo occluded lesions between November 2017 and May 2021. These patients were divided into two groups: the Failed IMA group (n = 62) and the Successful IMA group (n = 97). RESULTS: In multivariable analysis, no target vessel outflow (OR 39.8, 95% CI 10.7 - 148, p < .001), medial artery calcification (MAC) grade (OR 4.91, 95% CI 1.40 - 17.3, p = .010), and occluded pedal arch (OR 5.2, 95% CI 1.2 - 22.7, p = .030) were identified as independent predictors of IMA technical failure. The risk prediction model had an area under the receiver operating characteristic curve (AUC) of 0.93; after bootstrapping adjustment for optimism, this value represented a corrected AUC of 0.95. The patients in the Successful IMA group had a significantly higher proportion of wound healing at 12 months than those in the Failed IMA group (log rank p = .030). IMA technical failure was associated with a significant change in the proportion of wound healing (HR 0.59, 95% CI 0.37- 0.94, p = .030). CONCLUSION: No target vessel outflow, MAC grade, and occluded pedal arch were independent predictors of IMA technical failure. Additionally, successful IMA was associated with better wound healing outcomes at 12 months. Furthermore, a model incorporating these three predictors precisely predicted IMA technical failure.


Assuntos
Salvamento de Membro , Doença Arterial Periférica , Amputação Cirúrgica , Angioplastia/efeitos adversos , Isquemia Crônica Crítica de Membro , Humanos , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Salvamento de Membro/efeitos adversos , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/etiologia , Doença Arterial Periférica/terapia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
4.
J Vasc Surg ; 74(2): 506-513.e2, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33607205

RESUMO

OBJECTIVE: To develop a scoring system that can adequately predict a successful guidewire crossing (S-GC) of below-the-knee (BTK) chronic total occlusions (CTOs) in angiographic evaluation. METHODS: A retrospective, multicenter, nonrandomized study examined 448 consecutive BTK CTOs in 299 patients treated with endovascular therapy in seven Japanese medical centers from April 2012 to April 2020. The cohort was classified into two groups: an S-GC group and a failed guidewire crossing group. RESULTS: The final logistic regression model created by a backward stepwise multivariate logistic regression model included five variables: "No outflow of the target vessel," "CTO length ≥200 mm," "Reference vessel diameter <2.0 mm," "Calcification at the proximal entry point," and "Blunt type at entry point." Optimisms were adjusted using 1000 bootstrap samples with replacement and candidate's risk score models developed according to optimism-adjusted correlation coefficients of risk factors. Choosing the best model as the Japanese-BTK (J-BTK) CTO score by comparing the optimism-adjusted area under receiver-operating characteristic curves it was decided to assign one point to "Blunt type at the proximal entry point," one point to "Calcification at the proximal entry point," one point to "Reference vessel diameter <2.0 mm," one point to "CTO length ≥200 mm," and two points to "No outflow of the target vessel." This rule was then used to categorize BTK CTOs into four grades with varying probabilities of S-GC: grade A (J-BTK CTO score of 0 and 1), grade B (score of 2 and 3), grade C (score of 4 and 5), and grade D (score of 6). Rates of S-GC in each grade (grades A, B, C, and D) were 97.3%, 76.8%, 19.3%, and 0%, respectively. Lesions categorized as grade C or D have a lower chance of S-GC. Internal validation was performed using the Hosmer-Lemeshow test (P = .99). CONCLUSIONS: The J-BTK CTO score predicts the probability of an S-GC of BTK CTOs and stratifies the difficulty of endovascular therapy for BTK CTOs in angiographic evaluation.


Assuntos
Técnicas de Apoio para a Decisão , Procedimentos Endovasculares , Doença Arterial Periférica/terapia , Idoso , Idoso de 80 Anos ou mais , Angiografia , Doença Crônica , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
5.
J Vasc Interv Radiol ; 29(8): 1174-1179, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29887182

RESUMO

PURPOSE: To evaluate the efficacy and safety of thrombectomy using myocardial biopsy forceps for the treatment of acute limb ischemia (ALI). MATERIALS AND METHODS: A retrospective review of 11 ALI patients (12 affected limbs, 18 affected vessels) who underwent thrombectomy using biopsy forceps between November 2011 and April 2016 was performed. Of the 12 affected limbs, 2 limbs had stent thrombosis, 1 limb had thrombotic occlusion at a de novo stenosis site, and 9 limbs had embolic ALI. Biopsy forceps were used for angiographically limited arterial flow that persisted after the use of an aspiration catheter and conventional balloon angioplasty. The general technique for use of the biopsy forceps included advancement in parallel to a guidewire to the thrombus site, grasping of the thrombus with the forceps, and confirmation of grasping the thrombus with injection of a contrast medium prior to thrombus extraction. RESULTS: Partial or total retrieval of the thrombus was angiographically confirmed in 12 of the 18 affected vessels, with restoration of normal blood flow in 11 vessels. Unsuccessful results in the remaining 6 affected vessels appeared to be due to friction at the aortoiliac bifurcation caused by the contralateral approach, small vessel size, or curvature of the anterior tibial artery. None of the 18 treated vessels had any complications such as dissection or perforation of the target vessel wall and distal emboli. None of the surviving patients required major or minor amputation. CONCLUSIONS: Thrombectomy using biopsy forceps is a feasible technique for removal of an arterial thrombus in patients with ALI.


Assuntos
Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Instrumentos Cirúrgicos , Trombectomia/instrumentação , Trombose/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Radiografia Intervencionista , Estudos Retrospectivos , Trombectomia/efeitos adversos , Trombose/diagnóstico por imagem , Trombose/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular
7.
Cardiovasc Interv Ther ; 33(1): 77-83, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27873169

RESUMO

The Crosser catheter is a unique device that facilitates antegrade intraluminal recanalization by high-frequency vibration energy and cavitation. We used this device not only as a chronic total occlusion (CTO) crossing device, but also as a flossing device in stenotic lesions and we also evaluated the efficacy of this device when used with both the "Crosser preceding" and the "Guidewire preceding" in CTOs. Complications related to this device were investigated, too. We retrospectively analyzed a total of 90 consecutive patients with peripheral artery disease in the femoropopliteal artery and below-the-knee artery (BTA). Primary technical success was defined as the successful delivery of this device into the distal true lumen. Secondary technical success was defined as successful revascularization. The safety endpoints were events of angiographic complications, including the occurrence of detachment of the metal tip from the shaft, slow flow, dissections, and perforations. Overall primary technical success rate was 93.3% and the secondary technical success rate was 96.7%. Detachment and slow flow occurred 14.4 and 4.4%, respectively, with no occurrences of either dissection or perforation. A predictor of detachment was Proposed Peripheral Arterial Calcium Scoring System (PACSS) grade 4 (OR 14.6; CI 1.26-168.5; P = 0.032). The Crosser catheter is useful not only as a CTO crossing device used with both the "Crosser preceding" and the "Guidewire preceding", but also as a flossing device in stenotic lesions. But we have to pay attention to complications related to the Crosser.


Assuntos
Artéria Femoral , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/terapia , Artéria Poplítea , Artérias da Tíbia , Terapia por Ultrassom/instrumentação , Idoso , Idoso de 80 Anos ou mais , Angiografia , Calcinose/diagnóstico por imagem , Calcinose/terapia , Cateterismo , Catéteres , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/terapia , Procedimentos Endovasculares , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Artéria Poplítea/diagnóstico por imagem , Estudos Retrospectivos , Artérias da Tíbia/diagnóstico por imagem , Resultado do Tratamento , Terapia por Ultrassom/métodos , Ondas Ultrassônicas , Ultrassonografia de Intervenção
8.
Circ Cardiovasc Interv ; 6(1): 68-76, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23362307

RESUMO

BACKGROUND: Recent technical advances have made endovascular treatment (EVT) an alternative first-line treatment for critical limb ischemia. METHODS AND RESULTS: A prospective multicenter study was conducted to evaluate the clinical outcomes of 314 Japanese critical limb ischemia patients (mean age, 73±10 years) with infrainguinal arterial lesions who underwent EVT. Patients were enrolled from December 2009 to July 2011 and were followed-up for 12 months. The primary end point was amputation-free survival (AFS) at 12 months. Secondary end points were anatomic, clinical, and hemodynamic measures, including 12-month freedom from major adverse limb events. The 12-month AFS rate was 74%, with body mass index <18.5 (hazard ratio [HR], 2.22; P=0.008), heart failure (HR, 1.73; P=0.04), and wound infection (HR, 1.89; P=0.03) associated with a poor prognosis for AFS. The 12-month major adverse limb event-free rate was 88%, with hemodialysis (HR, 1.98; P=0.005), heart failure (HR, 1.69; P=0.02), and Rutherford classification 6 (HR, 2.25; P=0.002) associated with a poor prognosis for major adverse limb events. The median time for wound healing was 97 days, with body mass index <18.5 (HR, 0.54; P=0.03) and wound infection (HR, 0.60; P=0.04) being significant risk factors for unhealed wounds after EVT. At 12 months, 34% had undergone reintervention (bypass surgery, 2.6%; repeat EVT, 31.7%), and 73% were major adverse event-free. CONCLUSIONS: The high reintervention rate notwithstanding, EVT was an effective treatment for Japanese critical limb ischemia patients with infrainguinal disease, with satisfactory AFS and major adverse limb event-free rates. The results of this study will be helpful for the future evaluation of critical limb ischemia therapy. CLINICAL TRIAL REGISTRATION: URL: http://www.umin.ac.jp/ctr. Unique identifier: UMIN000002830.


Assuntos
Artérias/cirurgia , Procedimentos Endovasculares/métodos , Extremidades/irrigação sanguínea , Extremidades/cirurgia , Isquemia/cirurgia , Doença Arterial Periférica/cirurgia , Idoso , Artérias/patologia , Extremidades/patologia , Feminino , Seguimentos , Humanos , Canal Inguinal/patologia , Japão , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema de Registros , Resultado do Tratamento , Cicatrização
9.
Nihon Rinsho ; 69(2): 318-21, 2011 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-21387683

RESUMO

Peripheral arterial disease (PAD) becomes a significant health problem in Japan, mostly because the rapid increase of aging and diabetic population. Intermittent claudication, rest pain, intractable foot ulcer and gangrene are the manifestations of PAD patients. Diagnosis of PAD is obtained by ankle brachial index. Several imaging modalities, such as duplex echo, multi-detector CT, are quite useful tools not only for the diagnosis but also for the planning of endovascular therapy. In this chapter, basic diagnosis, different treatment modalities in patients with PAD are described.


Assuntos
Arteriosclerose Obliterante/terapia , Procedimentos Endovasculares , Arteriosclerose Obliterante/diagnóstico , Diagnóstico por Imagem , Procedimentos Endovasculares/métodos , Humanos , Inibidores da Agregação Plaquetária/uso terapêutico , Stents , Procedimentos Cirúrgicos Vasculares
10.
J Cardiol ; 50(3): 167-74, 2007 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-17941192

RESUMO

BACKGROUND: Epidemiological studies have investigated the prevalence of acute myocardial infarction (AMI) in towns, medium cities and counties in Japan. The prevalence of AMI in a large city such as Sapporo has never been reported because of the difficulty of monitoring all patients with AMI. The population of middle-aged and senior residents has increased dramatically in Japan, and the impact of aging population on the prevalence of AMI is unknown. OBJECTIVES: This study determined the prevalence of AMI in Sapporo in 2003, and investigated the relationship between the population of older citizens and the prevalence of AMI within individual regions of Sapporo. METHODS: A questionnaire designed to focus on AMI was sent to every hospital in Sapporo offering services in internal medicine, cardiology, cardiovascular surgery, or surgery. Clinical and epidemiological data was requested on all patients presenting with AMI in 2003, including: municipal ward of patient's address, age, sex, whether hospitalization occurred via ambulance or through the out-patient clinic, whether the patient was transferred to another hospital for further treatment, whether the patient died, or was discharged alive. RESULTS: Responses were received from 114 of 140 hospitals (81.4%), including all 32 hospitals performing cineangiography. As 799 patients were reported with AMI in 2003, the prevalence of AMI of Sapporo in 2003 was 42.9/100,000 residents. Forty-six patients was excluded because the absence of data on the questionnaire. Data was available for analysis in 753 AMI patients (537 males and 216 females, range 30-101 years, mean age 67.9 years). The prevalence of AMI was 60.8/100,000 in males and 22.1/100,000 in females (p < 0.05). Ninety-four deaths (57 males and 37 females) were attributed to AMI (range 48-99 years, mean age 75.2 years), for an overall mortality rate of 12.5%. AMI was a less frequent cause of death in the female population than the male population (male 6.5/100,000 and female 3.8/100,000, p < 0.05), but AMI was more frequently fatal in women (10.6% in males vs 17.1% in females, p < 0.05). Both AMI and fatality were more common with increasing age. Sapporo has 10 municipal wards. The prevalence of AMI in 3 wards was significantly higher than in the other municipal wards, these differences were more prominent when the prevalence of AMI was corrected for the population distribution of patients > or = 50 years old (p < 0.05). Significant correlations between the number of citizens and number of patients with AMI were observed in every age cohort divided into 10 years old > or = 50 years old, and the slopes of those regression lines increased with age cohort. Admission was via the outpatient clinic for 364 patients and 341 patients arrived by ambulance. The fatality rate did not differ between the two routes for admission. CONCLUSIONS: AMI was more frequent in men than women in Sapporo, but AMI was more frequently fatal in females. Prevalence and fatality rate of AMI increased with age, and prevalence of AMI was determined by the number of senior citizens in certain wards.


Assuntos
Demografia , Infarto do Miocárdio/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Prevalência , Inquéritos e Questionários
11.
Int Heart J ; 48(3): 359-67, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17592200

RESUMO

Mechanical stress by pressure overload due to hypertension or valvular heart disease such as aortic valve stenosis induces cardiac hypertrophy. It has been well established that the mechanical stretch of cardiac myocytes in vitro induces hypertrophic responses such as the expression of immediate early response genes including c-fos. However, it remains uncertain whether the mechanical forces due to pure atmospheric pressure can induce similar responses in cardiac myocytes. We thus cultured rat neonatal cardiac myocytes in an atmospheric pressure chamber apparatus and determined the effects of pure pressure stress on c-fos gene expression. Pressures greater than 80 mmHg enhanced c-fos mRNA after 30 minutes. These results suggest that pure atmospheric pressure overload can also induce early hypertrophic responses in cardiac myocytes.


Assuntos
Cardiomegalia/genética , Regulação da Expressão Gênica no Desenvolvimento , Miócitos Cardíacos/metabolismo , Proteínas Proto-Oncogênicas c-fos/genética , RNA Mensageiro/genética , Animais , Animais Recém-Nascidos , Cardiomegalia/metabolismo , Cardiomegalia/patologia , Células Cultivadas , Modelos Animais de Doenças , Miócitos Cardíacos/patologia , Proteínas Proto-Oncogênicas c-fos/biossíntese , RNA Mensageiro/biossíntese , Ratos , Ratos Wistar , Reação em Cadeia da Polimerase Via Transcriptase Reversa
12.
Int Heart J ; 47(5): 795-801, 2006 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17106150

RESUMO

A 37 year-old female who had suffered from arteritis for 20 years underwent a Bentall operation. Since severe stenosis was observed in her left main coronary artery (LMCA) the following year, a minimally invasive direct coronary artery bypass (MIDCAB) operation was performed. Unfortunately, she again complained of angina about 6 months after the second surgery and coronary angiography (CAG) revealed that her left internal thoracic artery graft was totally occluded. Although a 4.0 x 15 mm S670 stent was placed in her LMCA, the LMCA re-stented every 3 months and she underwent reintervention 8 times. We placed 2 sirolimus-eluting stents for treating the LMCA using the culottes stenting technique. CAG 6 months after the index procedure showed no stenosis at her LMCA. Sirolimus-eluting stents were effective for treating stenosis resulting from arteritis as well as that caused by atherosclerosis.


Assuntos
Reestenose Coronária/terapia , Vasos Coronários , Sirolimo/administração & dosagem , Stents , Arterite de Takayasu/complicações , Adulto , Angiografia Coronária , Ponte de Artéria Coronária , Doença das Coronárias/cirurgia , Feminino , Humanos , Arterite de Takayasu/patologia
13.
Biochem Biophys Res Commun ; 338(3): 1661-7, 2005 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-16259944

RESUMO

Immature vascular smooth muscle cells (VSMCs) proliferate responding to extrinsic mitogens and accumulate in neointima after arterial injuries. Cell proliferation is positively regulated by cyclin/cyclin-dependent kinase (CDK) complex and negatively controlled by CDK inhibitors; CKIs such as p27(kip1) and p57(kip2). In this study, embryonic rat thoracic aorta VSMCs; A10 were G0/G1 arrested by serum starvation, re-stimulated with serum, and harvested every four hours. Both CKIs co-expressed in quiescent VSMCs and rapidly diminished by stimulation. Protein level of p27(kip1) was regulated by both transcription and post-transcription, but that of p57(kip2) was mainly by post-transcription. Supplemental overexpression of p57(kip2) inhibited the activations of G1 cyclin/CDKs and subsequent hyperphosphorylations of all three retinoblastoma pocket proteins as well as G1/S transition of cell cycle. Our findings suggest that the downregulations of not only p27(kip1), but also p57(kip2) responding to mitogenic stimulation, play key roles in the cell cycle progression of VSMCs.


Assuntos
Ciclo Celular/fisiologia , Inibidor de Quinase Dependente de Ciclina p57/metabolismo , Regulação para Baixo , Músculo Liso Vascular/citologia , Músculo Liso Vascular/metabolismo , Animais , Células Cultivadas , Ciclina G , Ciclina G1 , Inibidor de Quinase Dependente de Ciclina p57/genética , Ciclinas/metabolismo , Regulação Enzimológica da Expressão Gênica , Ligação Proteica , RNA Mensageiro/genética , Ratos , Soro
14.
Circ J ; 69(8): 987-90, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16041172

RESUMO

BACKGROUND: Enhanced expression of G protein-coupled receptor kinase (GRK) has been reported in failing hearts and in the present study the stability of enhanced GRK mRNA expression, and the correlation between the expression level of GRK mRNA in peripheral lymphocytes and in the heart were both evaluated. METHODS AND RESULTS: Isoproterenol was injected into rats for 2 weeks, and then GRK5 mRNA was assessed by quantitative reverse transcriptase-palymerase chain reaction. An enhanced expression of cardiac GRK5 mRNA was observed even after 4 weeks of recovery. The isoproterenol-induced increased expression of GRK2 and GRK5 mRNA was equally observed in the heart and lymphocytes, and there was a close correlation between the heart and lymphocytes in the level of expression of each GRK mRNA. CONCLUSIONS: The GRK mRNA level is maintained at a high level for a long period without continuous beta-adrenergic receptor stimulation. The level in circulating lymphocytes could be used as a surrogate marker to estimate the level of cardiac GRK expression and, presumably, the beta-adrenergic receptor function of cardiomyocytes.


Assuntos
Agonistas Adrenérgicos beta/administração & dosagem , Proteínas Quinases Dependentes de AMP Cíclico/biossíntese , Regulação da Expressão Gênica/efeitos dos fármacos , Isoproterenol/administração & dosagem , Linfócitos/metabolismo , Miocárdio/metabolismo , Proteínas Serina-Treonina Quinases/biossíntese , Animais , Proteínas Quinases Dependentes de AMP Cíclico/genética , Quinase 5 de Receptor Acoplado a Proteína G , Masculino , Miócitos Cardíacos/metabolismo , Proteínas Serina-Treonina Quinases/genética , RNA Mensageiro/biossíntese , RNA Mensageiro/genética , Ratos , Receptores Adrenérgicos beta/metabolismo , Quinases de Receptores Adrenérgicos beta
15.
Heart Vessels ; 20(2): 72-6, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15772782

RESUMO

Coronary vasomotor response to acetylcholine infusion was studied in a 69-year-old currently smoking man with enhanced insulin response to oral glucose load. Coronary angiogram showed no significant stenoses. Immediately after 20 microg acetylcholine infusion in the right coronary artery, angiographic no-flow, ischemic electrocardiographic changes, and anginal pain developed in the absence of epicardial coronary obstruction. While intracoronary infusion of isosorbide dinitrate was only partially effective, intracoronary infusion of nicorandil, an agent known to improve coronary microcirculation, completely resolved these changes. This is the first case reported so far suggesting that enhanced insulin response may be associated with acetylcholine-induced microvascular vasoconstriction. Microvascular vasoconstriction must be considered when a patient with insulin resistance presents with chest pain.


Assuntos
Acetilcolina , Angina Pectoris/etiologia , Circulação Coronária , Vasoespasmo Coronário/fisiopatologia , Hiperinsulinismo/fisiopatologia , Resistência à Insulina , Microcirculação , Vasoconstrição , Acetilcolina/administração & dosagem , Idoso , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/tratamento farmacológico , Angina Pectoris/fisiopatologia , Angiografia Coronária , Circulação Coronária/efeitos dos fármacos , Vasoespasmo Coronário/complicações , Vasoespasmo Coronário/diagnóstico por imagem , Vasoespasmo Coronário/tratamento farmacológico , Eletrocardiografia , Humanos , Hiperinsulinismo/complicações , Infusões Intra-Arteriais , Dinitrato de Isossorbida/administração & dosagem , Masculino , Microcirculação/efeitos dos fármacos , Nicorandil/administração & dosagem , Resultado do Tratamento , Vasoconstrição/efeitos dos fármacos , Vasodilatadores/administração & dosagem
17.
J Cardiol ; 41(1): 1-6, 2003 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-12564107

RESUMO

OBJECTIVES: Sixteen national surveys of Kawasaki disease in Japan from 1970 to 2000 have identified a total of 169,117 patients with Kawasaki disease. Based on that figure, 8,460 residents of Hokkaido probably have a history of Kawasaki disease. It is also estimated that almost 270 Hokkaido residents would have Kawasaki disease-related coronary artery disease. We underwent follow-up studies of Hokkaido residents > or = 15 years with Kawasaki disease. METHODS: We mailed a questionnaire to the departments of internal medicine, cardiology or cardiovascular surgery inquiring about the health status of patients with Kawasaki disease at 451 hospitals with 20 or more beds in Hokkaido. RESULTS: We obtained replies from 185 hospitals (41.0%). Only 11 hospitals(5.9%) reported experience of patients with Kawasaki disease(with or without coronary artery disease) at hospital follow-up. Detailed patient histories for 60 patients from 7 hospitals were obtained: Twenty patients had Kawasaki disease complicated with coronary artery disease, whereas 40 patients had a history of Kawasaki disease and no present coronary artery disease. Thirty-seven patients without coronary artery disease were followed up at one hospital. The 60 patients were aged from 15 to 36 years. Thirty-nine patients(65%) were in the 15 to 20 year age bracket. Coronary aneurysms were recognized in 25 patients(24 males and 1 female) with Kawasaki disease(41.7%) at the onset of the disease. Twenty patients had an aneurysm(s) in the left main trunk and/or the left anterior descending artery, and 13 patients in the right coronary artery. There was a history of myocardial infarction in four patients (6.7%) and nine patients(15.0%) still suffered from angina pectoris. Aortocoronary bypass surgery was performed in one patient, whereas two patients required percutaneous coronary intervention. CONCLUSIONS: Our study suggests that the majority of Hokkaido residents with Kawasaki disease(with or without coronary artery disease) are not being followed up at area hospitals. The characteristics of patients who were followed up included age < or = 20 years, male sex and the presence of severe coronary artery disease other than circumflex involvement.


Assuntos
Síndrome de Linfonodos Mucocutâneos/epidemiologia , Adolescente , Adulto , Doença das Coronárias/complicações , Doença das Coronárias/terapia , Métodos Epidemiológicos , Feminino , Seguimentos , Humanos , Japão/epidemiologia , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações
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