Shinjo H.,Nagoya University |
Sato W.,Nagoya University |
Imai E.,Nagoya University |
Kosugi T.,Nagoya University |
And 4 more authors.
Clinical and Experimental Nephrology | Year: 2014
Background: The Kidney Disease: Improving Global Outcomes (KDIGO) group proposed to adopt the 48-h time window for the 0.3 mg/dL rise in serum creatinine (sCr) proposed by the Acute Kidney Injury Network (AKIN) group as a modification to the original risk, injury, failure, loss, and end-stage renal disease criteria, keeping the 7-day window for the 50 % increase in sCr from baseline. The present study evaluates the prevalence of acute kidney injury (AKI) and the accuracy of predicting mortality based on the KDIGO and AKIN criteria.Patients and methods: We retrospectively studied a cohort of 2579 patients admitted to the intensive care unit of Nagoya University Hospital between 2005 and 2009.Results: The total AKI prevalence was higher according to the KDIGO than to the AKIN criteria (38.4 versus 29.5 %). In-hospital mortality rates were higher among 238 patients classified as non-AKI by the AKIN but AKI by the KDIGO criteria than among those classified as non-AKI by both criteria (7.1 versus 2.7 %). Survival curves generated using KDIGO significantly differed among all stages, but not between AKIN stages I and II. Multivariate analysis showed that KDIGO criteria were better in a statistical model than the AKIN criteria according to the Akaike information criterion. Harrell’s C statistic was greater for the KDIGO than for the AKIN criteria.Conclusions: The KDIGO criteria have improved sensitivity without compromising specificity for AKI and might predict mortality at least as well as the AKIN criteria. © 2013, Japanese Society of Nephrology.
Aoki T.,Tohoku University |
Takahashi J.,Tohoku University |
Fukumoto Y.,Tohoku University |
Yasuda S.,National Cerebral and Cardiovascular Center Hospital |
And 12 more authors.
Circulation Journal | Year: 2013
Background: We reported an increased occurrence of cardiovascular diseases (CVDs) after the Great East Japan Earthquake by examining ambulance records, but it had to be confirmed by cardiologists. Methods and Results: We enrolled patients admitted to the cardiology department of the 10 hospitals in the disaster area from 4 weeks prior to 15 weeks after March 11 in the years 2008-2011 (n=14,078). The weekly occurrence of several CVDs, including heart failure (HF), pulmonary thromboembolism (PTE) and infectious endocarditis (IE), was sharply and significantly increased after the Earthquake. Conclusions: The Disaster caused significantly increases in the occurrence of HF, PTE and IE.
Rationale and design of a randomized clinical study to investigate the effect of ezetimibe, a cholesterol absorption inhibitor, on the regression of intracoronary plaque evaluated by non-obstructive angioscopy and ultrasound: The ZIPANGU study
Hiro T.,Nihon University |
Hirayama A.,Nihon University |
Ueda Y.,Osaka Police Hospital |
Komatsu S.,Amagasaki Central Hospital |
And 7 more authors.
Journal of Cardiology | Year: 2014
It is well recognized that low-density lipoprotein cholesterol (LDL-C)-lowering therapy is effective for primary and secondary prevention of cerebrovascular/cardiovascular disease. Ezetimibe, an inhibitor of the Niemann-Pick C1-Like 1 cholesterol transporter, is a relatively new drug for LDL-C-lowering therapy in addition to statins. However, comparison between an aggressive LDL-C-lowering therapy with a combination of statin and ezetimibe versus a standard LDL-C-lowering therapy with statin alone is still unclear in terms of their effects on stabilization and volume regression of coronary plaque. The ZIPANGU (Ezetimibe clinical investigation for the regression of intracoronary plaque evaluated by angioscopy and ultrasound) study is aimed at comparing these two types of therapy based on indices of plaque characteristics using non-obstructive coronary angioscopy and intravascular ultrasound. Methods: The study is a multi-center, prospective, randomized, open-label, blinded-endpoint trial. Through a centralized enrollment method, patients will be allocated to either monotherapy with atorvastatin alone or to combination therapy with atorvastatin (maximum: 20. mg/day) and ezetimibe (10. mg/day). The target LDL-C level will be <100. mg/dL for the monotherapy group and <70. mg/dL for the combination therapy group. At the baseline and the follow-up period of 9 months, non-obstructive coronary angioscopy and intravascular ultrasound will be performed to compare the changes in plaque color and volume between the two groups. Conclusions: The ZIPANGU study will clarify whether combination therapy with statins and ezetimibe is better for stabilizing coronary plaque as secondary prevention than monotherapy by statins alone. The study will give new insights into lipid-lowering guidelines in Japan. © 2014 Japanese College of Cardiology.
Kamouchi M.,Kyushu University |
Sakai H.,Data Management |
Sakai H.,Gunma University |
Sakai H.,Kyushu University |
And 4 more authors.
Journal of Stroke and Cerebrovascular Diseases | Year: 2013
Background: A free radical scavenger, edaravone, which has been used for the treatment of ischemic stroke, was reported to cause acute kidney injury (AKI) as a fatal adverse event. The aim of the present study was to clarify whether edaravone is associated with AKI in patients with acute ischemic stroke. Methods: From the Fukuoka Stroke Registry database, 5689 consecutive patients with acute ischemic stroke who were hospitalized within 24 hours of the onset of symptoms were included in this study. A logistic regression analysis for the Fukuoka Stroke Registry cohort was done to identify the predictors for AKI. A propensity score-matched nested case-control study was also performed to elucidate any association between AKI and edaravone. Results: Acute kidney injury occurred in 128 of 5689 patients (2.2%) with acute ischemic stroke. A multivariate analysis revealed that the stroke subtype, the basal serum creatinine level, and the presence of infectious complications on admission were each predictors of developing AKI. In contrast, a free radical scavenger, edaravone, reduced the risk of developing AKI (multivariate-adjusted odds ratio [OR].45, 95% confidence interval [CI].30-.67). Propensity score-matched case-control study confirmed that edaravone use was negatively associated with AKI (propensity score-adjusted OR.46, 95% CI.29-.74). Conclusions: Although AKI has a significant impact on the clinical outcome of hospital inpatients, edaravone has a protective effect against the development of AKI in patients with acute ischemic stroke. © 2013 Elsevier B.V. All rights reserved.
Fujita T.,National Cerebral and Cardiovascular Center Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012
Cerebral event is the 2nd leading cause of mortality and morbidity after cardiac surgery. Therefore, management of cerebrovascular disease is essential to improve the outcome. We reviewed the literatures and cases in our institute to present the current strategy for these patients. Firstly, for the patients in high risk of stroke, if patients undergo coronary artery bypass grafting (CABG), off-pump CABG (OPCAB) with aorta non-touch technique is recommended. We experienced no intraoperative stroke in our recent consecutive 1,000 cases. If patients require cardiopulmonary bypass, keeping blood pressure high during bypass may prevent local hypoperfusion in brain. Second, for the patients having carotid artery disease, the team approach with neurologists is essential to determine to precede either of cardiac surgery or carotid endoarterectomy. Because preceding carotid endoarterectomy gives the best result to prevent stroke, these patients had better have carotid endoarterectomy first, unless there is indication of urgent cardiac surgery. Third, for the patients with active endocarditis, early indication of surgery is recently recommended, unless patients have intracranial hemorrhage. Recent magnetic resonance imaging (MRI) examination revealed more than 60% of patients have stroke regardless of size, therefore, team approach with neurologists is important to decide the timing of the surgery. Team approach and correct selection of procedural technique are important to prevent cerebrovascular events during cardiac surgery.
Minamino T.,Osaka University |
Komuro I.,Osaka University |
Kitakaze M.,National Cerebral and Cardiovascular Center Hospital
Circulation Research | Year: 2010
Cardiovascular disease constitutes a major and increasing health burden in developed countries. Although treatments have progressed, the development of novel treatments for patients with cardiovascular diseases remains a major research goal. The endoplasmic reticulum (ER) is the cellular organelle in which protein folding, calcium homeostasis, and lipid biosynthesis occur. Stimuli such as oxidative stress, ischemic insult, disturbances in calcium homeostasis, and enhanced expression of normal and/or folding-defective proteins lead to the accumulation of unfolded proteins, a condition referred to as ER stress. ER stress triggers the unfolded protein response (UPR) to maintain ER homeostasis. The UPR involves a group of signal transduction pathways that ameliorate the accumulation of unfolded protein by increasing ER-resident chaperones, inhibiting protein translation and accelerating the degradation of unfolded proteins. The UPR is initially an adaptive response but, if unresolved, can lead to apoptotic cell death. Thus, the ER is now recognized as an important organelle in deciding cell life and death. There is compelling evidence that the adaptive and proapoptotic pathways of UPR play fundamental roles in the development and progression of cardiovascular diseases, including heart failure, ischemic heart diseases, and atherosclerosis. Thus, therapeutic interventions that target molecules of the UPR component and reduce ER stress will be promising strategies to treat cardiovascular diseases. In this review, we summarize the recent progress in understanding UPR signaling in cardiovascular disease and its related therapeutic potential. Future studies may clarify the most promising molecules to be investigated as targets for cardiovascular diseases. © 2010 American Heart Association. All rights reserved.
Nakatani T.,National Cerebral and Cardiovascular Center Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013
Since the organ transplantation law was passed, we performed 50 heart transplantation at National Cerebral and Cardiovascular Center. Of those, 2 patients have been doing well over 13 years and 10 years survival rate was 93.4%.During those years, we performed 139 applications of left ventricular assist systems( LVAS). Initially, extracorporeal LVASs had been used. Now, 2 implantable LVAS were approved by medical insurance as bridge to transplant in 2011. Now, our 1st option as bridge to transplantation(BTT) is implantable LVAS.
Murakami M.,National Cerebral and Cardiovascular Center Hospital
Rinsho byori. The Japanese journal of clinical pathology | Year: 2011
CK-MB is an important marker for the diagnosis of acute myocardial infarction (AMI). Since mitochondrial CK (MtCK) is universally present in the blood of healthy individuals, it is known to positively affect the measurement of CK-MB using the immunoinhibition method, causing false-positive results. We performed basic evaluation of ACCURAS AUTO CK-MB MtO, a new reagent containing anti-MtCK antibody that inhibits MtCK activity, and attempted to calculate a cut-off CK-MB level to diagnose AMI. The measurement was performed in samples submitted to the Clinical Laboratory of our center for the measurement of CK-MB. This method was confirmed to have satisfactory basic attributes concerning the reproducibility, linearity, lower detection limit, and effects of interfering substances. When 2886 samples were examined using this and conventional methods, the results of the two methods were correlated in some but not in others. In the samples that showed no correlation, MtCK was demonstrated by isozyme analysis using electrophoresis. The AUC calculated from the ROC curve in AMI patients was 0.912 with this method and 0.861 with the conventional method. The sensitivity and specificity of the new method were higher than those of the conventional method. The cut-off value determined by ROC analysis was 7.7 U/l using the new method and 13.6 U/l using the conventional method, causing an increase in false-positive results compared with the cut off value of 25 U/l widely used for the conventional method to date. However, the cut-off value for the new method that yielded a specificity comparable to 99.1%, which is the specificity of the conventional method using a cut-off value of 25 U/l, was 12 U/l. With a cut-off value of 12 U/l, the sensitivity was improved compared with that employing the conventional method, and both the sensitivity and specificity became comparable to those of the CK-MB mass method. This method is very useful for the accurate measurement of CK-MB activity.
Yamamoto H.,Advanced Technology Development Center |
Minematsu K.,National Cerebral and Cardiovascular Center Hospital
Clinical Neurology | Year: 2011
Success of a multicenter clinical trial relies on the good and stable support system including a number of experienced people and sufficient funds. In Japan, lack of the experienced and well-funded support system makes conducting of the multicenter clinical trials very difficult. In the US, substantial amount of governmental funds have been injected to develop the clinical trial infrastructure. The cooperative group system is a model of the US governmental-funded clinical trial support system, in which the researchers can plan and conduct the clinical trials effectively and reliably, cooperating with other clinical research professionals including biostatisticians. Although there are some active oncology cooperative groups in Japan, this system remains unfamiliar to the researchers in neurology. It should be more noticed and utilized widely.
PubMed | Kumamoto University and National Cerebral and Cardiovascular Center Hospital
Type: Journal Article | Journal: Journal of the American Heart Association | Year: 2014
There is little known about whether the clinical and pathological characteristics and incidence of cardiac rupture (CR) in patients with acute myocardial infarction (AMI) have changed over the years.The incidence and clinical characteristics of CR were investigated in patients with AMI, who were divided into 3 cohorts: 1977-1989, 1990-2000, and 2001-2011. Of a total of 5699 patients, 144 were diagnosed with CR and 45 survived. Over the years, the incidence of CR decreased (1977-1989, 3.3%; 1990-2000, 2.8%; 2001-2011, 1.7%; P=0.002) in association with the widespread adoption of reperfusion therapy. The mortality rate of CR decreased (1977-1989, 90%; 1990-2000, 56%; 2001-2011, 50%; P=0.002) in association with an increase in the rate of emergent surgery. In multivariable analysis, first myocardial infarction, anterior infarct, female sex, hypertension, and age >70 years were significant risk factors for CR, whereas impact of hypertension on CR was weaker from 2001 to 2011. Primary percutaneous coronary intervention (PPCI) was a significant protective factor against CR. In 64 autopsy cases with CR, myocardial hemorrhage occurred more frequently in those who underwent PPCI or fibrinolysis than those who did not receive reperfusion therapy (no reperfusion therapy, 18.0%; fibrinolysis, 71.4%; PPCI, 83.3%; P=0.001).With the development of medical treatment, the incidence and mortality rate of CR have decreased. However, first myocardial infarction, anterior infarct, female sex, and old age remain important risk factors for CR. Adjunctive cardioprotection against reperfusion-induced myocardial hemorrhage is emerging in the current PPCI era.