Entity

Time filter

Source Type

Ueki, Japan

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.


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.


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.


Yamasaki T.,Office of Nutrition | Sadanaga T.,Ueki Hospital | Sadanaga T.,Keio University | Hirota S.,Ueki Hospital
Experimental and Therapeutic Medicine | Year: 2015

The purpose of the present study was to assess the effects of single-session dietary counseling on salt restriction in Japanese cardiology outpatients as assessed using spot urine measurements. A total of 72 patients (73±11 years old, including 30 females) who visited a cardiology outpatient clinic and had a salt intake of >8 g/day were included in this study. The patients received dietary counseling for salt restriction by expert dieticians at the time of enrollment. The daily dietary salt intake was estimated using the spot urine test at baseline prior to dietary counseling, at 3-9 weeks (next office visit), and at 24-52 weeks during follow-up evaluations. The baseline level of estimated salt excretion was 11.3±1.5 g/day, which was reduced to 9.6±2.3 g/day (P<0.01) at 3-9 weeks, but increased again at 24-52 weeks to 10.4±2.1 g/day, which was less than the baseline value (P=0.034 vs. 3-9 weeks; P=0.025 vs. baseline). The numbers of patients who achieved salt excretion levels of <6.0 and <8.0 g/day at 3-9 weeks were 4 (5.6%) and 19 (26%) patients, respectively, and were further reduced to no patients (0%; P=0.043 vs. 3-9 weeks) and 9 (13%; P=0.035 vs. 3-9 weeks) patients at 24-52 weeks of follow-up evaluation, respectively. In conclusion, the efficacy of dietary counseling by expert dieticians in restricting the salt intake of patients who consumed large amounts of salt was modest and temporary. Multiple nutritional- and behavioral-oriented approaches should be considered to achieve further reductions in salt intake. © 2015, Spandidos Publications. All rights reserved.

Discover hidden collaborations