Kumamoto-shi, Japan
Kumamoto-shi, Japan

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Sadanaga T.,Ueki Hospital | Kohsaka S.,Keio University | Mitamura H.,Saiseikai Central Hospital | Ogawa S.,International University of Health and Welfare
Heart and Vessels | Year: 2011

The aim of the present study was to assess whether elevated B-type natriuretic peptide (BNP) levels, as an objective marker of heart failure, is a predictor of subsequent thromboembolic events in patients with atrial fibrillation (AF) during oral anticoagulant therapy. This was a post hoc analysis of a single-center, prospective, observational study. Consecutive patients with AF (261 patients, 74 ± 9 years old, 153 paroxysmal AF) treated with warfarin were included for the analysis. BNP level at baseline examination was measured to assess the relationship of this parameter with subsequent thromboembolic events. BNP levels at the time of entry were 161 ± 188 (5-1,500, median 105) pg/ml. During an average follow-up time of 762 ± 220 (median 742) days, nine (1.8%/year) thromboembolic events occurred. Receiver operating characteristic curve showed that an optimal cut-off value for BNP to predict thromboembolic events was 218 pg/ml. There were six thromboembolic events observed among patients with a baseline BNP levels ≥200 pg/ml (n = 73) as compared to three such events in those with baseline BNP levels <200 pg/ml (n = 188). Kaplan-Meier curves for BNP level showed that elevated BNP level (≥200 pg/ml) was significantly associated with thromboembolic events (p < 0.01). Cox-proportional hazard analysis also revealed that a high BNP level (≥200 pg/ml) was a significant predictor of subsequent thromboembolic events (hazard ratio 5.32, p = 0.018). Elevated BNP levels (≥200 pg/ml) could be a useful marker of subsequent thromboembolic events in patients with AF during oral anticoagulant therapy. However, the number of patients and events in this study was small and drawing a definite conclusion was not possible with this small sample size. Therefore, further larger-scale, multicenter studies are needed to confirm these findings. © Springer 2010.


Sadanaga T.,Ueki Hospital | Sadanaga T.,Keio University | Ando K.,University of Tokyo | Hirota S.,Ueki Hospital | And 5 more authors.
Internal Medicine Journal | Year: 2013

Background: Dietary salt restriction is believed to be a mainstay in the management of patients with heart failure. However, the effect of salt intake on heart failure has not been well evaluated in outpatient medical practice. Aims: The aim of the present study was to assess the hypothesis that B-type natriuretic peptide (BNP) level, as an objective marker of heart failure, is associated with salt intake in patients with heart failure. Methods: One hundred and thirteen consecutive patients with mild compensated heart failure (77 ± 10 years old, 51 female) were included. We estimated dietary salt intake by the concentration of sodium and creatinine in spot urine. We measured BNP at the time of urine sampling and assessed the relationship between the % changes in BNP levels (%ΔBNP) and the changes in the estimated daily salt excretion (ΔNaCl) during the follow-up period. Results: The baseline median BNP level was 150 (interquartile range: 83-263) pg/mL and the estimated daily salt excretion was 162 ± 45mmol/day. There was a positive correlation between %ΔBNP and ΔNaCl (r = 0.61, P < 0.01). Multiple regression analysis revealed that %ΔBNP was associated with ΔNaCl (P < 0.01), but not with changes in systolic blood pressure and bodyweight. Conclusions: Changes in BNP levels were associated with changes in the estimated daily salt excretion in outpatients with compensated heart failure. Salt restriction may be beneficial for the management of patients with heart failure. © 2012 Royal Australasian College of Physicians.


Hirota S.,Ueki Hospital | Sadanaga T.,Ueki Hospital | Sadanaga T.,Keio University | Mitamura H.,Saiseikai Central Hospital | Fukuda K.,Keio University
Hypertension Research | Year: 2012

Dietary salt restriction is recommended for the prevention of cardiovascular disease in patients with hypertension and heart failure as well as in the general population. However, salt reduction is very difficult without knowing the daily salt intake of individual patients. A total of 524 subjects (72±10 year old, 246 female) who visited an outpatient cardiology clinic were included in this study. Daily dietary salt intake was estimated based on the sodium and creatinine concentrations of spot urine at the time of enrollment and during follow-up for 8-26 weeks. The attending physicians explained the individual data to the patients and encouraged them to reduce their salt intake through simple counseling. The baseline estimated salt excretion was 9.6±2.7 (range: 3.5-22.1) g per day, which decreased to 8.7±2.3 (3.7-18.0) g per day during follow-up. The systolic blood pressure decreased from 127.0±15.4 (range: 80-170) to 125.6±14.5 (80-172) mm Hg (P0.026), and the diastolic blood pressure decreased from 73.4±11.0 (range: 40-106) to 71.5±10.8 (50-102) mm Hg (P0.001). In conclusion, the estimation of salt intake by spot urine was a useful method for motivating patients to reduce their salt intake; however, achieving salt reduction to the level recommended by the guideline could be a challenge. © 2012 The Japanese Society of Hypertension All rights reserved.


Sadanaga T.,Ueki Hospital | Mitamura H.,Saiseikai Central Hospital | Kohsaka S.,Keio University | Ogawa S.,International University of Health and Welfare
Heart and Vessels | Year: 2012

B-type natriuretic peptide level is increased in patients with atrial fibrillation. The aim of the present study was to present the distribution of steady-state B-type natriuretic peptide levels of various clinical backgrounds and to elucidate the usefulness of measuring them in patients with atrial fibrillation. B-type natriuretic peptide was measured in stable conditions in patients with atrialfibrillation (74±10 y/o, n = 473). The average B-type natriuretic peptide level was 161±202 (median 101) pg/ml. Multiple regression analysis showed that age, left ventricular ejection fraction, left atrial diameter, structural heart disease, chronic atrial fibrillation, and heart failure symptoms were independently associated with elevated B-type natriuretic peptide levels. However, in chronic atrial fibrillation patients without structural heart disease, B-type natriuretic peptide levels did not differ between those with and without heart failure symptoms. Notably, B-type natriuretic peptide levels were high (≤150 pg/ml) in 41% of asymptomatic chronic atrial fibrillation without structural heart disease. Steady-state B-type natriuretic peptide levels of various clinical backgrounds were presented. Contributions of BNP elevation by clinical variables were somewhat different in different population. B-type natriuretic peptide was elevated in substantial percentage of asymptomatic chronic atrial fibrillation even without structural heart disease. © 2011 Springer.


Sadanaga T.,Ueki Hospital | Kohsaka S.,Keio University | Ogawa S.,International University of Health and Welfare
Cardiology | Year: 2010

Objectives: Atrial fibrillation (AF) is associated with hemostatic abnormality and increased risk of thromboembolic events. The aim of the present study was to evaluate whether elevated D-dimer levels in combination with clinical risk factors can adequately predict subsequent thromboembolic events in patients with AF. Method: This was a post hoc analysis of the single-center, prospective observational study. Consecutive patients with nonvalvular AF (245 patients, 74 ± 9 years) treated with warfarin were included. D-dimer levels were measured in combination with clinical risk factors to assess the relationship of this parameter with subsequent thromboembolic events. Results:D-dimer levels were elevated (≥0.5 μg/ml) in 55 (22%) patients. During an average follow-up time of 756 ± 223 days, 9 (1.8%/year) thromboembolic events occurred. Cox proportional hazard analysis showed that elevated D-dimer levels (hazard ratio, HR, 14.3, p < 0.01) as well as high CHADS2 score (≥3; HR 9.43, p < 0.01) was associated with thromboembolic events. C-statistic improved to 0.848 from 0.781 when D-dimer level was added to the predictor model based on CHADS2 score. Elevated D-dimer levels also predicted thromboembolic events in the subgroup of patients with high CHADS2 score (n = 76, HR 12.1, p = 0.021). Conclusion: CHADS2 scores and D-dimer level can be a useful marker of subsequent thromboembolic events in patients with AF during oral anticoagulant therapy and combination of these can effectively predict thromboembolic events. Copyright © 2010 S. Karger AG, Basel.


Hirota S.,Ueki Hospital | Sadanaga T.,Ueki Hospital | Sadanaga T.,Keio University | Mitamura H.,Tachikawa Hospital | Fukuda K.,Keio University
Hypertension Research | Year: 2013

The purpose of this study was to evaluate long-term compliance with salt restriction in Japanese cardiology outpatients assessed by spot urine measurements. A total of 466 patients (72±10 years old, 216 females) who visited a cardiology outpatient clinic and were followed for at least 1 year were included in this study. Daily dietary salt intake was estimated based on the sodium and creatinine concentrations determined by spot urine at the time of enrollment, during an 8-26 week follow-up and at a long-term follow-up (>1 year). The average follow-up duration was 2.2±0.6 (1.0-3.4) years after enrollment, and spot urines were collected 5.2±2.8 times after 1 year. The baseline estimated salt excretion was 9.6±2.7 g per day, which was reduced to 8.7±2.3 g per day (P<0.01) at 8-26 weeks and remained unchanged at the long-term follow-up (8.9±2.0 g per day, P=0.36 vs. 8-26 weeks, P<0.01 vs. baseline). The percent of patients who achieved an average salt excretion<6.0 g per day was unchanged from baseline (6.9% vs. 7.7%, P=0.61). Among several variables (gender, age, body weight, salt excretion at enrollment) that might affect the incidence of salt excretion <6.0 g per day, salt excretion at baseline was the only determinant of successful salt restriction (P<0.01). In conclusion, compliance with salt restriction, assessed using a spot urine method, was maintained over the long term; however, achieving salt reduction to the level recommended by the guidelines remains a challenge. © 2013 The Japanese Society of Hypertension All rights reserved.


Shimoda S.,Kumamoto University | Iwashita S.,Kumamoto University | Ichimori S.,Ueki Hospital | Matsuo Y.,Saiseikai Kumamoto Hospital | And 11 more authors.
Endocrine Journal | Year: 2013

To assess the efficacy and safety of adding sitagliptin, an oral dipeptidyl peptidase-4 inhibitor, in subjects with type 2 diabetes inadequately controlled with multiple daily insulin injections therapy (MDI). HbA1c, 1,5-anhydroglucitol (1,5-AG), body mass index (BMI), insulin doses, six-point self-measured plasma glucose (SMPG) profiles were assessed before, after 12 weeks, and after 24 weeks of MDI with 50 mg/day of sitagliptin in 40 subjects with type 2 diabetes. Safety endpoints included hypoglycemia and any adverse events. HbA1c significantly decreased during the first 12 weeks (-0.64 ± 0.60 %), and was sustained over 24 weeks (-0.69 ± 0.85 %). 1,5-AG increased significantly from 7.5 ± 4.5 μg/mL at baseline to 9.6 ± 5.5 μg/mL after 24 weeks. The bolus insulin dose at 12 weeks was decreased, and the mean plasma glucose, the SD of daily glucose, M-value, and the mean amplitude of glycemic excursions (MAGE) also decreased significantly as compared with baseline values. BMI and frequency of hypoglycemia were not changed significantly. Univariate linear regression analyses revealed that % change in HbA1c was significantly associated with BMI, and % changes in the indexes of glycemic instability (SD of daily glucose and MAGE) were significantly associated with age. In conclusion, adding sitagliptin to MDI significantly improved glycemic control and decreased the daily glucose fluctuation in subjects with type 2 diabetes inadequately controlled with MDI, without weight gain or an increase in the incidence of hypoglycemia. This trial was registered with UMIN (no. UMIN000010157). © The Japan Endocrine Society.


Sadanaga T.,Ueki Hospital | Sadanaga T.,Keio University | Mitamura H.,Saiseikai Central Hospital
Journal of Arrhythmia | Year: 2013

The D-dimer and B-type natriuretic peptide (BNP) levels in relation to CHADS2 and CHA2DS2-VASc scores in 59 patients with atrial fibrillation who were not receiving anticoagulant therapy were analyzed. Among 19 patients with CHADS2 scores of 0-1, 3 of the 7 patients with elevated BNP levels also had elevated D-dimer levels. Among 8 patients with CHA2DS2-VASc scores of 1, 2 of the 3 patients with elevated BNP levels also had elevated D-dimer levels. Therefore, D-dimer levels can be elevated in low-risk patients when BNP levels are high, and anticoagulation therapy should be considered for these patients. © 2013 Japanese Heart Rhythm Society. Published by Elsevier B.V. All rights reserved.


PubMed | Ueki Hospital
Type: Journal Article | Journal: Hypertension research : official journal of the Japanese Society of Hypertension | Year: 2012

Dietary salt restriction is recommended for the prevention of cardiovascular disease in patients with hypertension and heart failure as well as in the general population. However, salt reduction is very difficult without knowing the daily salt intake of individual patients. A total of 524 subjects (72 10 year old, 246 female) who visited an outpatient cardiology clinic were included in this study. Daily dietary salt intake was estimated based on the sodium and creatinine concentrations of spot urine at the time of enrollment and during follow-up for 8-26 weeks. The attending physicians explained the individual data to the patients and encouraged them to reduce their salt intake through simple counseling. The baseline estimated salt excretion was 9.6 2.7 (range: 3.5-22.1) g per day, which decreased to 8.7 2.3 (3.7-18.0) g per day during follow-up. The systolic blood pressure decreased from 127.0 15.4 (range: 80-170) to 125.6 14.5 (80-172) mm Hg (P=0.026), and the diastolic blood pressure decreased from 73.4 11.0 (range: 40-106) to 71.5 10.8 (50-102) mm Hg (P<0.001). In conclusion, the estimation of salt intake by spot urine was a useful method for motivating patients to reduce their salt intake; however, achieving salt reduction to the level recommended by the guideline could be a challenge.


PubMed | Ueki Hospital
Type: Journal Article | Journal: Hypertension research : official journal of the Japanese Society of Hypertension | Year: 2013

The purpose of this study was to evaluate long-term compliance with salt restriction in Japanese cardiology outpatients assessed by spot urine measurements. A total of 466 patients (72 10 years old, 216 females) who visited a cardiology outpatient clinic and were followed for at least 1 year were included in this study. Daily dietary salt intake was estimated based on the sodium and creatinine concentrations determined by spot urine at the time of enrollment, during an 8-26 week follow-up and at a long-term follow-up (>1 year). The average follow-up duration was 2.2 0.6 (1.0-3.4) years after enrollment, and spot urines were collected 5.2 2.8 times after 1 year. The baseline estimated salt excretion was 9.6 2.7 g per day, which was reduced to 8.7 2.3 g per day (P<0.01) at 8-26 weeks and remained unchanged at the long-term follow-up (8.9 2.0 g per day, P = 0.36 vs. 8-26 weeks, P < 0.01 vs. baseline). The percent of patients who achieved an average salt excretion<6.0 g per day was unchanged from baseline (6.9% vs. 7.7%, P = 0.61). Among several variables (gender, age, body weight, salt excretion at enrollment) that might affect the incidence of salt excretion <6.0 g per day, salt excretion at baseline was the only determinant of successful salt restriction (P<0.01). In conclusion, compliance with salt restriction, assessed using a spot urine method, was maintained over the long term; however, achieving salt reduction to the level recommended by the guidelines remains a challenge.

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