Ōzu, Japan
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Funada J.-I.,NHO Ehime National Hospital | Takata Y.,Ehime University | Hashida H.,NHO Ehime National Hospital | Matsumoto Y.,Saijo Central Hospital | And 5 more authors.
Atherosclerosis | Year: 2010

Objective: Postprandial hyperlipidemia and insulin resistance play roles in the development of atherosclerosis in metabolic syndrome (MetS); however, the clinical significance of postprandial hemodynamic variables in this condition is still in question. The aim of this study was to investigate hemodynamic and metabolic indicators related to MetS after a mixed meal (Calorie mate, 500. kcal). Methods: Of 107 participants undergoing this investigation, 24 fulfilled ATPIII criteria for MetS. The remaining 83 subjects were controls. Both the augmentation index (AI) and late systolic blood pressure in the radial artery (rSBP2) as an index of central blood pressure were monitored using HEM-9000AI (Omron Healthcare, Kyoto, Japan) until 240. min after meal intake. Results: Both AI and rSBP2 showed significant decreases after meal intake in both groups. Changes in postprandial AI showed a similar trend in the groups. rSBP2 reduction 60. min after meal ingestion was also comparable, -7.5 ± 2.3. mmHg in MetS; -7.8 ± 0.9. mmHg in control; however, delta rSBP2-120, the degree of rSBP2 reduction 120. min after meal ingestion comparing the fasting level, showed a significant difference between 2 groups, -0.5 ± 2.0. mmHg in MetS; -5.3 ± 0.9. mmHg in control, P<0.02. Stepwise regression analysis revealed low-density-lipoprotein cholesterol (β=0.333, P=0.001), high-density-lipoprotein cholesterol (β=-0.209, P<0.05) and systolic blood pressure (β=-0.377, P<0.001) as independent variables for determining delta rSBP2-120. Conclusion: Subjects with MetS exhibit signs of blunted rSBP2 (=central blood pressure) regulation after food intake. Dysfunctional postprandial hemodynamic regulation is another feature of MetS that may contribute to the progression of cardiovascular disease. © 2009 Elsevier Ireland Ltd.


Aono J.,Kitaishikai Hospital | Aono J.,University of Kentucky | Ikeda S.,Uwajima City Hospital | Katsumata Y.,University of Kentucky | And 6 more authors.
International Journal of Cardiovascular Imaging | Year: 2015

This study investigated the relationship between the degree of atherosclerotic changes in the descending thoracic aorta (TA) and the coronary artery using angioscopy. Twenty-five consecutive patients undergoing angioscopy of the TA and coronary angiography were enrolled in this study. Participants were divided into three groups according to the angioscopic grading of the TA: white plaque group (W-group), yellow plaque group (Y-group) and intensive yellow, ruptured plaque with ulceration and/or thrombus group (RP-group). The maximum plaque grade, plaque score, number of yellow plaques, frequency of yellow-plaque grades by coronary angioscopy, and SYNTAX score by coronary angiography were evaluated. Brachial-artery pulse wave velocity and high-sensitivity C-reactive protein level tended to be higher in the RP-group than in the other groups, although the differences were not statistically significant. The SYNTAX score was significantly higher in the RP-group than in the W-group (W-group 4.0 ± 3.6 vs. RP-group 17.5 ± 10.0, P = 0.045). In addition, the angioscopic maximum plaque grade, plaque score, and number of yellow plaques in the RP-group were significantly higher than in the W-group (maximum plaque grade W-group 0.8 ± 0.4 vs. RP-group 1.8 ± 0.8, P = 0.026; plaque score W-group 1.0 ± 1.2 vs. RP-group 4.0 ± 1.4, P = 0.014; and number of yellow plaques W-group 1.0 ± 1.2 vs. RP-group 2.5 ± 0.5, P = 0.023). The yellow-plaque grade in the coronary artery was correlated significantly with the plaque grading of TA (P = 0.043). Our study suggests that the angioscopic progression of aortic atherosclerosis is closely associated with vulnerability to and the extent of coronary stenosis, indicating that vulnerability toward atherosclerotic plaque development occurs simultaneously in the coronary tree and systemic arteries. © 2015, The Author(s).


Saito M.,Kitaishikai Hospital | Okayama H.,Ehime Prefectural Central Hospital | Yoshii T.,Kitaishikai Hospital | Higashi H.,Kitaishikai Hospital | And 10 more authors.
European Heart Journal Cardiovascular Imaging | Year: 2012

Aims: Late gadolinium enhancement (LGE) on contrast-enhanced magnetic resonance imaging (MRI) in hypertrophic cardiomyopathy (HCM) has been reported to be associated with myocardial fibrosis and cardiac events. In patients with HCM, two-dimensional (2D) strain can identify subclinical global systolic dysfunction despite normal left ventricular (LV) chamber function. Therefore, this study tested the hypothesis that global 2D strain could detect subtle myocardial fibrosis and serve as a novel prognostic parameter in HCM patients. Methods and results: Echocardiography and MRI were performed in 48 consecutive patients with HCM and normal chamber function. We measured global longitudinal strain (GLS) in apical two-chamber, four-chamber, and long-axis views using speckle-tracking analysis. The extent of LGE (%LGE = LGE volume/total LV volume) and LV mass index were calculated by MRI using Simpson's rule and custom software. All patientswere followed up for major cardiac events. Global longitudinal strain in patients with LGE was significantly lower than that without LGE (-11.8±2.8 vs. -15.0±1.7%, P < 0.001). Multivariate analysis showed that GLS was an independent predictor of %LGE (standard coefficient = 0.627, P < 0.001). During a mean follow-up period of 42±12 months, five patients had cardiac events. When the patients were stratified based on the median level of GLS (-12.9%), all events were observed in the worse GLS group (P = 0.018). Conclusion: These results suggest that global 2D strain might provide useful information on myocardial fibrosis and cardiac events in HCM patients with normal chamber function. © The Author 2012.


PubMed | Kitaishikai Hospital, Ehime University and Uwajima City Hospital
Type: Journal Article | Journal: Open heart | Year: 2016

Readmission is a common and serious problem associated with heart failure (HF). Unfortunately, conventional risk models have limited predictive value for predicting readmission. The recipients of long-term care insurance (LTCI) are frail and have mental and physical impairments. We hypothesised that adjustment of the conventional risk score with an LTCI certificate enables a more accurate appreciation of readmission for HF.We investigated 452 patients with HF who were followed up for 1year to determine all-cause readmission. We obtained their clinical and socioeconomic data, including LTCI. The three clinical risk scores used in our evaluation were Keenan (2008), Krumholz (2000) and Charlson (1994). We used net reclassification improvement (NRI) to assess the incremental benefit.Patients with LTCI were significantly older, and had a higher prevalence of cerebrovascular disease and dementia than those without LTCI. One-year all-cause readmission (n=193, 43%) was significantly associated with all risk scores, receiving LTCI and the category of LTCI. Receiving LTCI was associated with readmission independent of all risk scores (HR, 1.59 to 1.63; all p<0.01). Adding LTCI to all risk scores led to a significantly improved reclassification, which was observed in the subgroup of patients with HF with preserved ejection fraction (50%) but not in the subgroup with reduced ejection fraction (<50%).Possession of an LTCI certificate was independently associated with 1-year all-cause readmission after adjusting for validated clinical risk scores in patients with HF. Adding LTCI status significantly improved the model performance for readmission risk, particularly in patients with HF and preserved ejection fraction.


PubMed | Kitaishikai Hospital and Uwajima City Hospital
Type: Journal Article | Journal: The American journal of cardiology | Year: 2016

Intraprocedural stent thrombosis (IPST) is a rare complication of percutaneous coronary intervention that leads to poor outcomes; however, the factors contributing to IPST remain largely unknown. Accordingly, we used intravascular ultrasound (IVUS) to examine the lesion characteristics in patients with IPST. We retrospectively analyzed 1,504 consecutive stent-implanted lesions in 1,324 patients (326 with ST-segment elevation myocardial infarction [STEMI], 403 patients with non-ST-segment elevation acute coronary syndrome [NSTE-ACS], and 595 patients with stable angina). Of these, IPST occurred in 5 patients during percutaneous coronary intervention (0.4% per patient; 3 with STEMI, 2 with NSTE-ACS). The IVUS characteristics of plaques that developed IPST were compared with those of controls without the evidence of IPST (non-IPST; n= 15) who were matched by age, gender, lesion location, and clinical presentation (STEMI, NSTE-ACS, or stable angina). All 5 lesions that led to IPST had ruptured plaques with positive remodeling and attenuation. Plaque rupture was also observed in 40% of the non-IPST group. Multiple plaque ruptures in the culprit lesion were more common in the IPST group (80% vs 7%; p <0.01). The maximum cavity area was larger in the IPST group than in the non-IPST group having plaque rupture (4.6mm(2) [interquartile range, 4.3 to 6.5] vs 2.4mm(2) [1.8 to 2.9]; p <0.01). In conclusion, we found using IVUS that multiple plaque ruptures with larger cavities more often evolved into IPST.


Inoue K.,Ehime University | Okayama H.,Ehime University | Nishimura K.,Ehime University | Ogimoto A.,Ehime University | And 7 more authors.
Journal of the American Society of Echocardiography | Year: 2010

Objective: The study objective was to compare the left ventricular (LV) dyssynchrony and torsional behavior between right ventricular apical (RVA) and right ventricular septal (RVS) pacing. Methods: Forty-six patients with symptomatic sick sinus syndrome and preserved LV function were assigned to 2 groups: RVA (n = 23) and RVS (n = 23). Echocardiographic study including two-dimensional speckle tracking imaging was performed in the AAI and DDD modes. Results: Mean QRS width during DDD mode was significantly longer with RVA pacing than with RVS pacing. Dyssynchrony, torsion, and untwisting rate during DDD mode were significantly worse with RVA than with RVS pacing. In patients with RVA pacing, there was an increase in longitudinal dyssynchrony from AAI to DDD mode that significantly correlated with the deterioration of untwisting rate. Conclusion: In bradyarrhythmic patients with preserved LV function, RVS pacing resulted in a reduced LV dyssynchrony and better torsional behavior than RVA pacing. © 2010 American Society of Echocardiography.


Higashi H.,Kitaishikai Hospital | Inaba S.,Kitaishikai Hospital | Saito M.,Kitaishikai Hospital | Yamaoka M.,Kitaishikai Hospital | And 5 more authors.
IJC Metabolic and Endocrine | Year: 2015

Background: Postoperative delirium is a common and serious condition in the clinical setting that has been linked to increased mortality and worse outcomes. Some patients after pacemaker operations may suffer from delirium; however, this condition has not been clarified. The aim of this study was to investigate the prevalence and predictors of delirium after pacemaker operations such as initial permanent pacemaker implantation or pacemaker generator replacement. Methods: We retrospectively evaluated 192 consecutive patients who underwent pacemaker operations. According to the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) criteria, patients were divided into two groups: patients with delirium and patients without delirium after pacemaker operation. The two groups were compared in terms of patient characteristics, clinical settings, and environmental factors. Results: Forty patients (20.8%) suffered from delirium after pacemaker operations and were significantly older than patients without delirium (85.3 ± 6.4. years vs. 80.8 ± 8.4. years, p = 0.0014). Temporary pacing before permanent pacemaker implantation (30% vs. 11%, p = 0.0019) and intensive care unit admission (28% vs. 12%, p = 0.014) were more common in patients with delirium. Moreover, patients with delirium had more frequent heart failure than patients without delirium (78% vs. 41%, p. <. 0.0001). Multiple regression models showed heart failure as an independent predictor of delirium after pacemaker implantation. Conclusions: Delirium after pacemaker operations was not uncommon and heart failure was a strong independent predictor of such a condition. © 2015 The Authors.


Saito M.,Kitaishikai Hospital | Okayama H.,Ehime Prefectural Central Hospital | Inoue K.,Ehime University | Yoshii T.,Kitaishikai Hospital | And 5 more authors.
Hypertension Research | Year: 2012

Recently, the development of two-dimensional speckle-tracking (2DST) technology has allowed the direct measurement of the elastic parameters of the carotid arterial wall. The aims of this study were to determine the feasibility of measuring peak circumferential strain (CS) of the carotid arterial wall using 2DST and to compare this value with conventional arterial stiffness parameters in subjects with and without hypertension. The study included 90 healthy subjects and 40 age-and sex-matched patients with hypertension. The short-axis view of the right common carotid artery was recorded. The CS in the posterior region of the carotid artery was calculated by 2DST using special software and corrected by the following equation: circ ln (systolic blood pressure/diastolic blood pressure)/CS. We simultaneously measured the stiffness index β (β) at the same location and the brachial-ankle pulse wave velocity (baPWV). Sixty randomly selected healthy subjects were used to assess the inter/intra-observer variability of circ and Β. In healthy subjects, circ was significantly correlated with Β, age and baPWV. These correlations were slightly better than the corresponding correlations of Β with age and baPWV. The hypertensive patients had a significantly larger circ than the healthy subjects (0.112±0.074 vs. 0.066±0.029/%, P<0.001). The inter/intra-observer variability for circ was significantly lower than that for Β. Our data suggest that the measurement of carotid circ using 2DST is feasible and has better reproducibility than conventional carotid arterial stiffness. © 2012 The Japanese Society of Hypertension All rights reserved.


PubMed | Kitaishikai Hospital and Ehime University
Type: | Journal: Hypertension research : official journal of the Japanese Society of Hypertension | Year: 2016

We investigated the independent and incremental role of worsening arterial stiffness in new-onset heart failure (HF) in patients with preclinical HF. We retrospectively studied 456 consecutive asymptomatic patients with HF risk factors (hypertension, obesity, type 2 diabetes mellitus, atrial fibrillation and ischemic heart disease) who underwent paired applanation tonometry examinations (median interval of 2.4 years) during 2006-2011. Brachial ankle pulse wave velocity (baPWV) was measured as a surrogate marker of arterial stiffness. Patients were followed up for admission for new-onset HF over a median duration of 4.9 years after the second examination. HF was observed in 30 patients (7%). The change in baPWV (baPWV) was significantly associated with hospitalization for new-onset HF, independent of and incremental to comorbidities, renal dysfunction, left ventricular (LV) dysfunction and baPWV at baseline. Even in patients with an LV ejection fraction of 40%, baPWV was significantly associated with hospitalization for new-onset HF after similar adjustments. When the patients were divided into groups based on this cutoff value of 15% baPWV and the generally accepted external cutoff value of 1750cms


PubMed | Kitaishikai Hospital
Type: Comparative Study | Journal: The international journal of cardiovascular imaging | Year: 2015

This study investigated the relationship between the degree of atherosclerotic changes in the descending thoracic aorta (TA) and the coronary artery using angioscopy. Twenty-five consecutive patients undergoing angioscopy of the TA and coronary angiography were enrolled in this study. Participants were divided into three groups according to the angioscopic grading of the TA: white plaque group (W-group), yellow plaque group (Y-group) and intensive yellow, ruptured plaque with ulceration and/or thrombus group (RP-group). The maximum plaque grade, plaque score, number of yellow plaques, frequency of yellow-plaque grades by coronary angioscopy, and SYNTAX score by coronary angiography were evaluated. Brachial-artery pulse wave velocity and high-sensitivity C-reactive protein level tended to be higher in the RP-group than in the other groups, although the differences were not statistically significant. The SYNTAX score was significantly higher in the RP-group than in the W-group (W-group 4.0 3.6 vs. RP-group 17.5 10.0, P = 0.045). In addition, the angioscopic maximum plaque grade, plaque score, and number of yellow plaques in the RP-group were significantly higher than in the W-group (maximum plaque grade W-group 0.8 0.4 vs. RP-group 1.8 0.8, P = 0.026; plaque score W-group 1.0 1.2 vs. RP-group 4.0 1.4, P = 0.014; and number of yellow plaques W-group 1.0 1.2 vs. RP-group 2.5 0.5, P = 0.023). The yellow-plaque grade in the coronary artery was correlated significantly with the plaque grading of TA (P = 0.043). Our study suggests that the angioscopic progression of aortic atherosclerosis is closely associated with vulnerability to and the extent of coronary stenosis, indicating that vulnerability toward atherosclerotic plaque development occurs simultaneously in the coronary tree and systemic arteries.

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