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1.
Adv Exp Med Biol ; 1232: 323-329, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893427

RESUMO

Recent guidelines on cardiopulmonary resuscitation (CPR) have stressed the necessity to improve the quality of CPR. Our previous studies demonstrated the usefulness of monitoring cerebral blood oxygenation (CBO) during CPR by near-infrared spectroscopy (NIRS). The present study evaluates whether the NIRO-CCR1, a new NIRS device, is as useful in the clinical setting as the NIRO-200NX. We monitored CBO in 20 patients with cardiac arrest by NIRS. On the arrival of patients at the emergency department, the attending physician immediately assessed whether the patient was eligible for this study after conventional advanced life support and, if eligible, measured CBO in the frontal lobe by NIRS. We found that in all patients, the cerebral blood flow waveform was in synchrony with the chest compressions. Moreover, the tissue oxygenation index increased following cardiopulmonary bypass (CPB) in patients undergoing CPB, including one patient in whom CBO was monitored using the NIRO-CCR1. In addition, although the NIRO-CCR1 could display the pulse rate (Tempo) in real time, Tempo was not always detected, despite detection of the cerebral blood flow waveform. This suggested that chest compressions may not have been effective, indicating that the NIRO-CCR1 also seems useful to assess the quality of CPR. This study suggests that the NIRO-CCR1 can measure CBO during CPR in patients with cardiac arrest as effectively as the NIRO-200NX; in addition, the new NIRO-CCR1 may be even more useful, especially in prehospital fields (e.g. in an ambulance), since it is easy to carry.


Assuntos
Reanimação Cardiopulmonar , Circulação Cerebrovascular , Parada Cardíaca , Monitorização Fisiológica , Oximetria , Espectroscopia de Luz Próxima ao Infravermelho , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/normas , Oximetria/instrumentação , Oximetria/normas , Projetos Piloto , Espectroscopia de Luz Próxima ao Infravermelho/instrumentação , Espectroscopia de Luz Próxima ao Infravermelho/normas
2.
Adv Exp Med Biol ; 1232: 331-337, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893428

RESUMO

Obesity, a risk factor of coronary artery disease, is known to cause peripheral microcirculatory disturbances. This study evaluated the relationship between the degree of obesity and peripheral microcirculatory disturbances, using peripheral near infrared spectroscopy (NIRS) with a vascular occlusion test (VOT). We compared correlations between the NIRS parameter changes induced by VOT and body mass index (BMI) in patients with and without statin therapy. A NIRS probe was set on the right thenar eminence, brachial artery blood flow was blocked for 3 min, and then released. Although total hemoglobin (ΔcHb), deoxyhemoglobin (ΔHHb) and tissue oxygenation index (ΔTOI) were not correlated with BMI, a significant negative correlation was found between oxyhemoglobin (ΔO2Hb) and BMI in the overall study population (r = -0.255, p-value 0.02). In addition, a significant negative correlation was found between ΔO2Hb and BMI in patients without statin therapy (r = -0.353, p-value 0.02) but not in patients with statin therapy (r = -0.181, p-value 0.27). These findings suggest that ΔO2Hb may be a useful indicator to assess peripheral microcirculation.


Assuntos
Índice de Massa Corporal , Doença da Artéria Coronariana , Espectroscopia de Luz Próxima ao Infravermelho , Idoso , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Microcirculação/fisiologia , Oxigênio , Consumo de Oxigênio , Oxiemoglobinas/metabolismo , Fatores de Risco , Espectroscopia de Luz Próxima ao Infravermelho/normas
3.
Adv Exp Med Biol ; 1232: 355-360, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893431

RESUMO

Epicardial adipose tissue (EAT) is associated with visceral fat and various cardiac disorders, such as atrial fibrillation and adverse cardiovascular events. Therefore, it is important to develop a simple and non-invasive inspection method to assess EAT, to prevent unfavorable cardiac events. This study assessed correlations between near-infrared spectroscopy (NIRS) changes induced by a vascular occlusion test (VOT) and EAT volume measured by cardiac computed tomography (CCT) in patients with suspected coronary artery disease. We also assessed correlations between body mass index (BMI) and EAT volume in the same population. In addition, these correlations were compared in patients treated with statin therapy and in those without statin therapy. A NIRS probe was set on the right thenar eminence, and brachial artery blood flow was blocked for 3 min before being released. A negative correlation was found between oxyhemoglobin (ΔO2Hb) and EAT volume in the overall study population (r = -0.236, p = 0.03). Interestingly, although a strong correlation was observed in patients without statin therapy (r = -0.488, p < 0.001), this correlation was not observed in patients with statin therapy (r = 0.157, p = 0.34). These findings suggest that NIRS measurements with VOT may be a useful method to identify patients with high EAT volume and high cardiovascular risks.


Assuntos
Doença da Artéria Coronariana , Espectroscopia de Luz Próxima ao Infravermelho , Tecido Adiposo/metabolismo , Idoso , Índice de Massa Corporal , Angiografia por Tomografia Computadorizada , Doença da Artéria Coronariana/diagnóstico , Feminino , Humanos , Masculino , Oxiemoglobinas/metabolismo , Fatores de Risco
4.
Intensive Care Med Exp ; 7(1): 62, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31792731

RESUMO

BACKGROUND: High-quality cardiopulmonary resuscitation (HQ-CPR) is of paramount importance to improve neurological outcomes of cardiac arrest (CA). The purpose of this study was to evaluate chest compression methods by combining two theories: cardiac and thoracic pumps. METHODS: Male Sprague-Dawley rats were used. Three types of chest compression methods were studied. The 1-side method was performed vertically with 2 fingers over the sternum. The 2-side method was performed horizontally with 2 fingers, bilaterally squeezing the chest wall. The 3-side method combined the 1-side and the 2-side methods. Rats underwent 10 min of asphyxial CA. We examined ROSC rates, the left ventricular functions, several arterial pressures, intrathoracic pressure, and brain tissue oxygen. RESULTS: The 3-side group achieved 100% return of spontaneous circulation (ROSC) from asphyxial CA, while the 1-side group and 2-side group achieved 80% and 60% ROSC, respectively. Three-side chest compression significantly shortened the time for ROSC among the groups (1-side, 105 ± 36.0; 2-side, 141 ± 21.7; 3-side, 57.8 ± 12.3 s, respectively, P < 0.05). Three-side significantly increased the intrathoracic pressure (esophagus, 7.6 ± 1.9, 7.3 ± 2.8, vs. 12.7 ± 2.2; mmHg, P < 0.01), the cardiac stroke volume (the ratio of the baseline 1.2 ± 0.6, 1.3 ± 0.1, vs. 2.1 ± 0.6, P < 0.05), and the common carotid arterial pressure (subtracted by femoral arterial pressure 4.0 ± 2.5, 0.3 ± 1.6, vs. 8.4 ± 2.6; mmHg, P < 0.01). Three-side significantly increased the brain tissue oxygen (the ratio of baseline 1.4±0.1, 1.3±0.2, vs. 1.6 ± 0.04, P < 0.05). CONCLUSIONS: These results suggest that increased intrathoracic pressure by 3-side CPR improves the cardiac output, which may in turn help brain oxygenation during CPR.

5.
Am J Emerg Med ; 2019 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-31843334

RESUMO

OBJECTIVE: A 12-lead electrocardiogram (ECG) is the standard of care for chest pain patients. However, 12-lead ECGs have difficulty detecting ischemia of the right ventricle or posterior wall of the heart. New technology exists to mathematically synthesize these leads from a 12-lead ECG; however, this technology has not been evaluated in the emergency department (ED). We assessed the level of agreement between synthesized 18-lead ECGs and actual 18-lead ECGs in identifying ST elevations, ST depressions, and T wave inversions in ED patients. METHODS: Actual 12- and 18-lead ECGs were acquired and synthesized 18-lead ECGs were produced based on waveforms from 12-lead ECGs. A blinded cardiologist interpreted the actual and synthesized 18-lead ECGs to identify the presence of abnormalities. Using actual 18-lead ECGs as the reference, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa of synthesized 18-lead ECGs in identifying abnormalities were determined. RESULTS: Data from 295 patients were analyzed. There was 100% agreement between synthesized 18-lead ECGs and actual 18-lead ECGs in identifying ST elevations and ST depressions (sensitivity, specificity, PPV, and NPV of 100%, and kappa of 1.00). Synthesized 18-lead ECGs had 95% sensitivity, 80% specificity, 97% PPV, and 70% NPV in identifying T wave inversions, when compared with actual 18-lead ECGs (kappa: 0.70). CONCLUSION: Synthesized 18-lead ECGs demonstrated 100% agreement with actual 18-lead ECGs in the identification of ST elevations and ST depressions and good agreement in the identification of T wave inversions in a sample of patients ED patients with complaints suspicious of cardiac origin.

6.
J Cardiol ; 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31543378

RESUMO

BACKGROUND: Combined statin plus eicosapentaenoic acid (EPA) therapy might be a potentially effective treatment option to prevent coronary artery disease (CAD). The serum EPA/arachidonic acid (AA) ratio has been identified as a potential new risk marker for CAD. Few data exist whether administration of EPA could affect high-density lipoprotein (HDL) particle size. We hypothesized that the addition of EPA to ongoing statin therapy may result in altered HDL heterogeneity. METHODS: We conducted this 6-month, single-center, prospective, randomized open-label clinical trial to investigate the effect of the additional administration of EPA on the HDL heterogeneity (HDL2, HDL3, and HDL2/HDL3 ratio) in stable CAD patients receiving treatment with statins. We assigned stable CAD patients already receiving statin therapy to the EPA group (1800mg/day: n=50) or the control group (n=50). RESULTS: A significant decrease in the serum HDL3 level (-4.7% vs. -0.5%, p=0.037), but not of the serum HDL2 level, and a significant increase in the HDL2/HDL3 ratio (5.5% vs. -5.1%, p=0.032) were observed in the EPA group as compared to the control group. Multiple regression analysis with adjustments for coronary risk factors identified the achieved EPA/ AA ratio as an independent and significant predictor of an increase of the HDL2/HDL3 ratio (ß=0.295, p=0.001). Furthermore, the change in the serum cholesterol ester transfer protein mass was positively correlated with the change in the EPA/AA ratio in the EPA group (r=0.286, p=0.044), but not in the control group (r=0.121, p=0.401). CONCLUSION: Administration of EPA might decrease the serum HDL3 level, resulting in an increase in the HDL2/HDL3 ratio. Furthermore, increased EPA/AA ratio by the addition of EPA to ongoing statin therapy might be an indicator of an increase in the HDL2/HDL3 ratio, thereby regulating HDL particle size. CLINICAL TRIAL REGISTRATION: UMIN (http://www.umin.ac.jp/) Study ID: UMIN000010452.

7.
BMJ Case Rep ; 12(8)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31383682

RESUMO

Coronary artery aneurysm (CAA) is a rare cause of myocardial infarction. However, only a few studies have investigated this aspect. An 84-year-old woman with a history of hypertension presented with nausea. showed ST elevation in the inferior leads, and coronary angiography revealed two giant CAAs in the right coronary artery. Percutaneous coronary intervention was difficult because of risk of CAA rupture. Thus, these aneurysms were further evaluated using multimodality cardiac imaging to determine the treatment. MRI using late gadolinium enhancement revealed structural features of the aneurysms and the viability of the myocardium. Only antithrombotic medication was administered on the basis of the results of the multimodality cardiac imaging. Here, we report a rare case of a patient diagnosed with ST elevation myocardial infarction caused by thrombosis in giant CAAs using multimodality cardiac imaging, particularly MRI.


Assuntos
Aneurisma Coronário/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Imagem Multimodal/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Idoso de 80 Anos ou mais , Meios de Contraste , Aneurisma Coronário/complicações , Doença da Artéria Coronariana/complicações , Feminino , Gadolínio , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia
8.
Cancers (Basel) ; 11(4)2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30979045

RESUMO

Increased detection of plasma lysophosphatidic acid (LPA) has been proposed as a potential diagnostic biomarker in ovarian cancer, but inconsistency exists in these reports. It has been shown that LPA can undergo an artificial increase during sample processing and analysis, which has not been accounted for in ovarian cancer research. The aim of this study is to provide a potential explanation about how the artificial increase in LPA may have interfered with previous LPA analysis in ovarian cancer research. Using an established LC-MS method, we measured LPA and other lysophospholipid levels in plasma obtained from three cohorts of patients: non-cancer controls, patients with benign ovarian tumors, and those with ovarian cancer. We did not find the LPA level to be higher in cancer samples. To understand this inconsistency, we observed that LPA content changed more significantly than other lysophospholipids as a function of plasma storage time while frozen. Additionally, only LPA was found to be adversely impacted by incubation time depending on the Ethylenediaminetetraacetic acid (EDTA) concentration used during blood drawing. We also show that the inhibition of autotaxin effectively prevented artificial LPA generation during incubation at room temperature. Our data suggests that the artificial changes in LPA content may contribute to the discrepancies reported in literature. Any future studies planning to measure plasma LPA should carefully design the study protocol to consider these confounding factors.

9.
Circ J ; 83(6): 1247-1253, 2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-30944275

RESUMO

BACKGROUND: Consciousness disturbance is one of the major clinical signs associated with shock state, but its prognostic value has not been previously evaluated in cardiovascular shock patients. We aimed to evaluate the prognostic value of neurological status for 30-day mortality in cardiovascular shock patients without out-of-hospital cardiac arrest (OHCA). Methods and Results: Patients with out-of-hospital onset cardiovascular shock were recruited from the Japanese Circulation Society Shock Registry. Neurological status upon hospital arrival was evaluated using the Japan Coma Scale (JCS). Patients were divided into 4 groups according to the JCS: alert, JCS 0; awake, JCS 1-3 (not fully alert but awake without any stimuli); arousable, JCS 10-30 (arousable with stimulation); and coma JCS 100-300 (unarousable). The primary endpoint was 30-day all-cause death. In total, 700 cardiovascular shock patients without OHCA were assessed. The coma group was associated with a higher incidence of 30-day all-cause death compared with other groups (alert, 15.3%; awake, 24.4%; arousable, 36.8%; coma, 48.5%, P<0.001). Similar trends were observed in etiologically divergent subgroups (acute coronary syndrome, non-ischemic arrhythmia, and aortic disease). On multivariate Cox regression analysis, arousable (hazard ratio [HR], 1.82; 95% CI: 1.16-2.85, P=0.009) and coma (HR, 2.72; 95% CI: 1.76-4.22, P<0.001) (reference: alert) independently predicted 30-day mortality. CONCLUSIONS: Neurological status upon hospital arrival was useful to predict 30-day mortality in cardiovascular shock patients without OHCA.

10.
Heart Vessels ; 33(5): 470-480, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29159568

RESUMO

Decreased high-density lipoprotein (HDL) particle size, cholesterol poor, apolipoprotein A-I-rich HDL particles leading to smaller HDL particle size, may be associated with an anti-atherosclerotic effect. The data are sparse regarding the relationship between n-3 polyunsaturated fatty acids [n-3 PUFAs: eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA)] and HDL particle size. This study was designed as a hospital-based cross-sectional study to investigate the relationship between the serum levels of n-3 PUFAs and the HDL-cholesterol/apolipoprotein A-1 ratio, as estimated by the HDL particle size, in patients with the presence of one or more risk factors for atherosclerotic cardiovascular disease (ASCVD). Six hundred and forty sequential patients were enrolled in this study. The serum levels of EPA and DHA showed a strong correlation (r = 0.736, p < 0.0001). However, in a multivariate regression analysis after adjustment for ASCVD risk factors, increased serum DHA (ß = - 0.745, p = 0.021), but not serum EPA (ß = - 0.414, p = 0.139) or EPA + DHA (ß = 0.330, p = 0.557) level, was identified as an independent indicator of decreased HDL particle size. In 476 patients followed up for at least 6 months, the absolute change (Δ) in the HDL-cholesterol/apolipoprotein A-1 ratio decreased significantly as the quartile of the Δ DHA level increased (p = 0.014), whereas no significant difference in the Δ HDL-cholesterol/apolipoprotein A-1 ratio was noted with the increase in the quartile of the Δ EPA level. Moreover, a multivariate regression analysis identified increased DHA level and decreased estimated low-density lipoprotein (LDL) particle size measured relative to the mobility value of LDL with polyacrylamide gel electrophoresis (i.e., relative LDL migration: LDL-Rm value), as independent predictors of decreased HDL-cholesterol/apolipoprotein A-1 ratio (ß = - 0.171, p = 0.0003 and ß = - 0.142, p = 0.002). The results suggest that increased serum DHA level, but not EPA level, might be associated with decreased HDL-cholesterol/apolipoprotein A-1 ratio, an indicator of estimated HDL particle size. Further studies are needed to investigate the useful clinical indices and outcomes of these patients. Clinical Trial Registration Information UMIN ( http://www.umin.ac.jp/ ), Study ID: UMIN000010603.


Assuntos
Aterosclerose/dietoterapia , HDL-Colesterol/sangue , Ácidos Graxos Ômega-3/farmacocinética , Peixes , Animais , Aterosclerose/sangue , Aterosclerose/epidemiologia , Biomarcadores/sangue , Estudos Transversais , Feminino , Humanos , Incidência , Japão/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco
11.
Cardiovasc Diabetol ; 16(1): 123, 2017 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-28969633

RESUMO

BACKGROUND: The low-density lipoprotein cholesterol/apolipoprotein B (LDL-C/apoB) ratio has conventionally been used as an index of the LDL-particle size. Smaller LDL-particle size is associated with triglyceride (TG) metabolism disorders, often leading to atherogenesis. We investigated the association between the LDL-C/apoB ratio and TG metabolism in coronary artery disease (CAD) patients with diabetes mellitus (DM). METHODS: In the cross-sectional study, the LDL-C/apoB ratio, which provides an estimate of the LDL-particle size, was calculated in 684 consecutive patients with one additional risk factor. The patients were classified into 4 groups based on the presence or absence of CAD and DM, as follows: CAD (-) DM (-) group, n = 416; CAD (-) DM (+) group, n = 118; CAD (+) DM (-) group, n = 90; CAD (+) DM (+) group, n = 60. RESULTS: A multi-logistic regression analysis after adjustments for coronary risk factors revealed that the CAD (+) DM (+) condition was an independent predictor of the smallest LDL-C/apoB ratio among the four groups. Furthermore, multivariate regression analyses identified elevated TG-rich lipoprotein (TRL)-related markers (TG, very-LDL fraction, remnant-like particle cholesterol, apolipoprotein C-II, and apolipoprotein C-III) as being independently predictive of a smaller LDL-particle size in both the overall subject population and a subset of patients with a serum LDL-C level < 100 mg/dL. In the 445 patients followed up for at least 6 months, multi-logistic regression analyses identified increased levels of TRL-related markers as being independently predictive of a decreased LDL-C/apoB ratio, which is indicative of smaller LDL-particle size. CONCLUSIONS: The association between disorders of TG metabolism and LDL heterogeneity may account for the risk of CAD in patients with DM. Combined evaluation of TRL-related markers and the LDL-C/apoB ratio may be of increasing importance in the risk stratification of CAD patients with DM. Further studies are needed to investigate the useful clinical indices and outcomes of these patients. Clinical Trial Registration UMIN (http://www.umin.ac.jp/) Study ID: UMIN000028029 retrospectively registered 1 July 2017.


Assuntos
Apolipoproteínas B/sangue , LDL-Colesterol/sangue , Doença da Artéria Coronariana/sangue , Diabetes Mellitus Tipo 2/sangue , Triglicerídeos/sangue , Idoso , Biomarcadores/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Feminino , Humanos , Lipoproteínas/sangue , Masculino , Pessoa de Meia-Idade
12.
Coron Artery Dis ; 28(7): 577-587, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28692480

RESUMO

BACKGROUND: We hypothesized that an increase in plasminogen activator inhibitor 1 (PAI-1) might reduce low-density lipoprotein (LDL) particle size in conjunction with triglyceride (TG) metabolism disorder, resulting in an increased risk of atherosclerotic cardiovascular disease (ASCVD). METHODS: This study was carried out as a hospital-based cross-sectional study in 537 consecutive outpatients (mean age: 64 years; men: 71%) with one or more risk factors for ASCVD from April 2014 to October 2014 at the Cardiovascular Center of Nihon University Surugadai Hospital. The estimated LDL-particle size was measured as relative LDL migration using polyacrylamide gel electrophoresis with the LipoPhor system.The plasma PAI-1 level, including the tissue PA/PAI-1 complex and the active and latent forms of PAI-1, was determined using a latex photometric immunoassay method. RESULTS: A multivariate regression analysis after adjustments for ASCVD risk factors showed that an elevated PAI-1 level was an independent predictor of smaller-sized LDL-particle in both the overall patients population (ß=0.209, P<0.0001) and a subset of patients with a serum low-density lipoprotein cholesterol (LDL-C) level lower than 100 mg/dl (ß=0.276, P<0.0001). Furthermore, an increased BMI and TG-rich lipoprotein related markers [TG, remnant-like particle cholesterol, apolipoprotein (apo) B, apo C-II, and apo C-III] were found to be independent variables associated with an increased PAI-1 level in multivariate regression models. A statistical analysis of data from nondiabetic patients with well-controlled serum LDL-C levels yielded similar findings. Furthermore, in the 310 patients followed up for at least 6 months, a multiple-logistic regression analysis after adjustments for ASCVD risk factors identified the percent changes of the plasma PAI-1 level in the third tertile compared with those in the first tertile as being independently predictive of decreased LDL-particle size [odds ratio (95% confidence interval): 2.11 (1.12/3.40), P=0.02]. CONCLUSION: The plasma PAI-1 levels may be determined by the degree of obesity and TG metabolic disorders. These factors were also shown to be correlated with a decreased LDL-particle size, increasing the risk of ASCVD, even in nondiabetic patients with well-controlled serum LDL-C levels.


Assuntos
Aterosclerose/sangue , Hipertrigliceridemia/sangue , Lipoproteínas LDL/sangue , Inibidor 1 de Ativador de Plasminogênio/sangue , Triglicerídeos/sangue , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/diagnóstico , Aterosclerose/etiologia , Biomarcadores/sangue , Índice de Massa Corporal , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Hipertrigliceridemia/complicações , Hipertrigliceridemia/diagnóstico , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Obesidade/sangue , Obesidade/complicações , Obesidade/diagnóstico , Razão de Chances , Tamanho da Partícula , Projetos Piloto , Fatores de Risco , Regulação para Cima
13.
Am J Cardiovasc Drugs ; 17(5): 409-420, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28634822

RESUMO

BACKGROUND: We investigated the relationship between the eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio and non-high-density lipoprotein cholesterol (non-HDL-C) level, a major residual risk of coronary artery disease (CAD), in statin-treated CAD patients following EPA therapy. METHODS: We conducted a 6-month, prospective, randomized clinical trial to investigate the effect of the additional administration of EPA on the EPA/AA ratio and the serum non-HDL-C level in stable CAD patients receiving statin treatment. We assigned CAD patients already receiving statin therapy to an EPA group (1800 mg/day; n = 50) or a control group (n = 50). RESULTS: A significant reduction in the serum non-HDL-C level was observed in the EPA group, compared with the control group (-9.7 vs. -1.2%, p = 0.01). A multiple-regression analysis with adjustments for coronary risk factors revealed that achieved EPA/AA ratio was more reliable as an independent and significant predictor of a reduction in the non-HDL-C level at a 6-month follow-up examination (ß = -0.324, p = 0.033) than the absolute change in the EPA/AA ratio. Interestingly, significant negative correlations were found between the baseline levels and the absolute change values of both non-HDL-C and triglyceride-rich lipoproteins, both markers of residual risk of CAD, indicating that patients with a higher baseline residual risk achieved a greater reduction. CONCLUSION: The present results suggest that the achieved EPA/AA ratio, but not the absolute change in EPA/AA ratio, following EPA therapy might be a useful marker for the risk stratification of CAD among statin-treated patients with a high non-HDL-C level. CLINICAL TRIAL REGISTRATION: UMIN ( http://www.umin.ac.jp/ ) Study ID: UMIN000010452.


Assuntos
Ácido Araquidônico/uso terapêutico , Doença da Artéria Coronariana/tratamento farmacológico , Ácido Eicosapentaenoico/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Idoso , Biomarcadores/sangue , HDL-Colesterol/sangue , Doença da Artéria Coronariana/sangue , Feminino , Humanos , Lipoproteínas/sangue , Masculino , Estudos Prospectivos , Triglicerídeos/sangue
14.
Am J Cardiovasc Drugs ; 17(1): 49-59, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27778191

RESUMO

BACKGROUND: We hypothesized that the additional administration of eicosapentaenoic acid (EPA) in patients with stable coronary artery disease (CAD) receiving statin has the potential to lower the serum pentraxin 3 (PTX3) level, an indicator of plaque stabilization. METHODS: We randomly assigned CAD patients already receiving statin therapy to an EPA group (1800 mg/day, n = 53) or control group (n = 53). RESULTS: No significant difference was found in the change in the plasma PTX3 level between the groups. However, in a subgroup analysis, a significant percentage reduction in the plasma PTX3 level was observed in patients receiving strong statin compared with the patients receiving moderate statin in the EPA group (-5.6 vs. 14.7 %, p = 0.0082), while no such difference in the percentage change in the plasma PTX3 level was noted between the two same statin subgroups in the control group. A multiple logistic regression analysis identified the addition of EPA to ongoing strong statin treatment as an independent predictor of PTX3 level reduction. Furthermore, even in patients with relatively well-controlled serum lipid levels, pretreatment with EPA added to ongoing statin therapy reduced serum non-high-density lipoprotein cholesterol and triglyceride-rich lipoproteins as residual risk factors. CONCLUSION: Through this study design, the results could not support the hypothesis that adding EPA in patients with stable CAD receiving varying degrees of statin treatment reduces the plasma PTX3 level comprehensively. However, addition of EPA to ongoing strong statin treatment, but not ongoing moderate statin treatment, may reduce the plasma PTX3 level, possibly leading to coronary plaque stabilization. CLINICAL TRIAL REGISTRATION INFORMATION: UMIN ( http://www.umin.ac.jp/ ), Study ID: UMIN000010452.


Assuntos
Proteína C-Reativa/metabolismo , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/tratamento farmacológico , Ácido Eicosapentaenoico/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Componente Amiloide P Sérico/metabolismo , Idoso , Biomarcadores/sangue , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
15.
Am J Emerg Med ; 35(3): 448-457, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27931763

RESUMO

OBJECTIVE: This was a pilot retrospective case-series study performed to investigate whether synthesized 18-lead electrocardiogram (ECG) could improve the accuracy of infarction site diagnosis in patients presenting with ST-elevation myocardial infarction (STEMI). METHOD: Of 103 consecutive patients with acute coronary syndrome who underwent emergency coronary angiography between October 1, 2014 and December 10, 2015, 33 patients fulfilling the diagnostic criteria for STEMI were enrolled in this study. RESULTS: Comparison by the infarct-related coronary artery revealed that ST elevation in the 6 synthesized leads (any of syn-V3R-V5R and syn-V7-V9 leads), in addition to ST elevation in the standard 12-lead ECG, was lower in patients in whom the left anterior descending coronary artery (LAD) was the infarct-related coronary artery LAD vs. right coronary artery (RCA) vs. left circumflex coronary artery (LCX): 3/11 [27.3%] vs. 4/6 [66.7%] vs. 11/16 [68.6%], p=0.007). The above data indicate that the synthesized 18-lead ECG was useful for diagnosing STEMI in 18 of the 33 patients (54.5%). Furthermore, in 17 of the 18 patients (94.4%), the area of myocardium supplied by the infarct-related coronary artery was consistent with the site of infarction estimated from the ST elevation profile in the 6 synthesized leads. CONCLUSION: The diagnosis of STEMI by synthesized 18-lead ECG is useful to identify the site of infarction in patients with infarction of the right ventricular wall (supplied by the RCA) or posterior wall of the left ventricle (supplied by the LCX), which often fail to be diagnosed by the standard 12-lead ECG.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Angiografia Coronária/métodos , Eletrocardiografia/métodos , Infarto do Miocárdio/diagnóstico , Idoso , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Guias de Prática Clínica como Assunto , Estudos Retrospectivos
16.
Adv Exp Med Biol ; 876: 151-157, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26782207

RESUMO

Return of spontaneous circulation (ROSC) during chest compression is generally detected by arterial pulse palpation and end-tidal CO2 monitoring; however, it is necessary to stop chest compression during pulse palpation, and to perform endotracheal intubation for monitoring end-tidal CO2. In the present study, we evaluated whether near-infrared spectroscopy (NIRS) allows the detection of ROSC during chest compression without interruption. We monitored cerebral blood oxygenation in 19 patients with cardiac arrest using NIRS (NIRO-200NX, Hamamatsu Photonics, Japan). On arrival at the emergency room, the attending physicians immediately assessed whether a patient was eligible for this study after conventional advanced life support (ALS) and employed NIRS to measure cerebral blood oxygenation (CBO) in the bilateral frontal lobe in patients. We found cerebral blood flow waveforms in synchrony with chest compressions in all patients. In addition, we observed abrupt increases of oxy-hemoglobin concentration and tissue oxygen index (TOI), which were associated with ROSC detected by pulse palpation. The present findings indicate that NIRS can be used to assess the quality of chest compression in patients with cardiac arrest as demonstrated by the detection of synchronous waveforms during cardiopulmonary resuscitation (CPR). NIRS appears to be applicable for detection of ROSC without interruption of chest compression and without endotracheal intubation.


Assuntos
Encéfalo/metabolismo , Parada Cardíaca/fisiopatologia , Oxigênio/metabolismo , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Adulto , Idoso , Reanimação Cardiopulmonar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
17.
Emerg Med J ; 31(8): 654-8, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23704758

RESUMO

OBJECTIVE: Near-infrared spectroscopy (NIRS)-derived variables during a vascular occlusion test (VOT) have recently been used to evaluate peripheral circulatory insufficiency in patients with sepsis. We investigated the relationship between NIRS-derived variables and the lactate concentration during sepsis. METHODS: This was a prospective observational study. Forty-one patients with sepsis were divided into two groups according to their blood lactate concentration: a high lactate group (≥2.0 mmol/l; n=15) and a normal lactate group (<2.0 mmol/l; n=26). NIRS was used to evaluate the tissue oxygen index (TOI) at the thenar eminence before and after a VOT. VOT was performed by sphygmomanometer cuff inflation around upper arm for 3 min. The TOI value before VOT was defined as the TOI baseline, the TOI value immediately after VOT was defined as the minimum TOI and the TOI value after releasing the muscle from the VOT was defined as the TOI after VOT. The ΔTOI was defined as the difference between the TOI after VOT and minimum TOI. RESULTS: NIRS-derived variables had significant differences between the normal lactate group and the high lactate group with respect to the TOI baseline (median: 65% vs 55%, p=0.01), TOI after VOT (median: 65% vs 46%, p<0.001) and ΔTOI (median: 19% vs 6%, p<0.001). The lactate concentration was significantly correlated with the TOI after VOT (R=0.594, p<0.001), TOI baseline (R=0.513, p<0.001), ΔTOI (R=0.488, p=0.001) and minimum TOI (R=0.377, p=0.02). CONCLUSIONS: We revealed a significant correlation between NIRS-derived variables and the lactate concentration during sepsis.


Assuntos
Mãos/irrigação sanguínea , Hiperlactatemia/fisiopatologia , Microcirculação/fisiologia , Sepse/fisiopatologia , Espectroscopia de Luz Próxima ao Infravermelho , Adulto , Idoso , Feminino , Humanos , Lactatos/sangue , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/irrigação sanguínea , Consumo de Oxigênio/fisiologia , Estudos Prospectivos
18.
Adv Exp Med Biol ; 789: 121-128, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23852485

RESUMO

BACKGROUND: The 2010 CPR Guidelines recommend that extracorporeal cardiopulmonary resuscitation (ECPR) using an emergency cardiopulmonary bypass (CPB) should be considered for patients with cardiac arrest. However, it is not yet clear whether this therapy can improve cerebral circulation and oxygenation in these patients. To clarify this issue, we evaluated changes of cerebral blood oxygenation (CBO) during ECPR using near-infrared spectroscopy (NIRS). METHODS: We employed NIRS to measure CBO in the bilateral frontal lobe in patients transported to the emergency room (ER) after out-of-hospital cardiac arrest between November 2009 and June 2011. RESULTS: Fifteen patients met the above criteria. The tissue oxygenation index (TOI) on arrival at the ER was 36.5 %. This increased to 67.8 % during ECPR (P < 0.001). The one patient whose TOI subsequently decreased had a favorable neurological outcome. CONCLUSION: Increase of TOI during ECPR might reflect an improvement in cerebral blood flow, while decrease of TOI after ECPR might reflect oxygen utilization by the brain tissue as a result of neuronal cell survival. NIRS may be useful for monitoring cerebral hemodynamics and oxygen metabolism during CPR.


Assuntos
Reanimação Cardiopulmonar , Circulação Cerebrovascular/fisiologia , Cérebro/irrigação sanguínea , Cérebro/metabolismo , Hipotermia/metabolismo , Oxigênio/metabolismo , Reanimação Cardiopulmonar/métodos , Feminino , Hemodinâmica , Humanos , Hipotermia/sangue , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/metabolismo , Oxigênio/sangue , Consumo de Oxigênio/fisiologia , Espectroscopia de Luz Próxima ao Infravermelho/métodos
19.
Circ J ; 76(4): 891-9, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22313800

RESUMO

BACKGROUND: Although studies have shown there is a correlation between increased blood ammonia level and hepatic encephalopathy, little information is available for patients with out-of-hospital cardiac arrest. METHODS AND RESULTS: We did a prospective study of 357 adult patients with out-of-hospital cardiac arrest whose venous blood ammonia levels were measured on arrival at the emergency room. The primary endpoint was favorable of neurological outcome to hospital discharge. Of the 357 patients, 25 (7%) had a favorable neurological outcome. The venous ammonia levels were lower in the favorable neurological outcome group than in the unfavorable neurological outcome group (median, 50 µg/dl vs. 210 µg/dl, P<0.0001). The adjusted odds ratio of ammonia levels for favorable neurological outcome was 0.98 (95% confidence interval, 0.96-0.99; P<0.0001). The ammonia cutoff value of 93.0 µg/dl for the identification of favorable neurological outcome had the highest combined sensitivity and specificity, and higher ammonia levels were associated with more accurate negative predictive values (for ammonia levels of 192.5 µg/dl, the negative predictive value was 100%). Hyperammonemia was significantly related to patient variables that had a poor outcome (R=0.439, P<0.001). In addition, there was a significant correlation between venous ammonia level and arterial pH on emergency room arrival (R=0.633, P<0.0001). CONCLUSIONS: The measurement of ammonia was found to provide valuable information regarding neurological outcome to hospital discharge in adult patients with out-of-hospital cardiac arrest.


Assuntos
Amônia/sangue , Encefalopatia Hepática/etiologia , Hiperamonemia/diagnóstico , Parada Cardíaca Extra-Hospitalar/diagnóstico , Idoso , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Intervalos de Confiança , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Feminino , Encefalopatia Hepática/sangue , Humanos , Hiperamonemia/sangue , Hiperamonemia/etiologia , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Parada Cardíaca Extra-Hospitalar/sangue , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/terapia , Alta do Paciente , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Transporte de Pacientes , Resultado do Tratamento
20.
Circ J ; 74(1): 77-85, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19942784

RESUMO

BACKGROUND: Therapeutic hypothermia for comatose survivors of out-of-hospital cardiac arrest has demonstrated neurological benefits. Although early cooling during cardiac arrest enhances efficacy in animal studies, few clinical studies are available. METHODS AND RESULTS: The 171 patients who failed to respond to conventional cardiopulmonary resuscitation were studied prospectively. Patients underwent emergency cardiopulmonary bypass (CPB) plus intra-aortic balloon pumping, with subsequent percutaneous coronary intervention (PCI) if needed. Mild hypothermia (34 degrees C for 3 days) was induced during cardiac arrest or after return of spontaneous circulation. Of the 171 patients, 21 (12.3%) had a favorable neurological outcome at hospital discharge. An unadjusted rate of favorable outcome decreased in a stepwise fashion for increasing quartiles of collapse-to-34 degrees C interval (P=0.016). An adjusted odds ratio for favorable outcome after collapse-to-CPB interval was 0.89 (95% confidence interval (CI) 0.82-0.97) and after CPB-to-34 degrees C interval, 0.99 (95%CI 0.98-0.99) when collapse-to-34 degrees C interval was divided into 2 components. Favorable neurological accuracy of a collapse-to-CPB interval at a cutoff of 55.5 min and CPB-to-34 degrees C interval at a cutoff of 21.5 min was 85.4% and 89.5%, respectively. CONCLUSIONS: Early attainment of a core temperature had neurological benefits for patients with out-of-hospital cardiac arrest who underwent CPB and PCI. (Circ J 2010; 74: 77 - 85).


Assuntos
Angioplastia Coronária com Balão , Ponte Cardiopulmonar , Parada Cardíaca/terapia , Hipotermia Induzida , Doenças do Sistema Nervoso/prevenção & controle , Pacientes Ambulatoriais , Idoso , Temperatura Corporal/fisiologia , Reanimação Cardiopulmonar , Circulação Extracorpórea , Feminino , Parada Cardíaca/complicações , Parada Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Razão de Chances , Estudos Prospectivos , Curva ROC , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
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