Ankle-Brachial Index as a Prognostic Indicator in Patients with Atrial Fibrillation -A Subanalysis of the IMPACT-ABI Study

Article信州医学雑誌 67(3): 197-204(2019)journal articl

Prognostic Impact of Cardio-renal-anemia Syndrome in Patients at Risk for Heart Failure from the IMPACT-ABI study

Article信州医学雑誌 68(3): 139-147(2020)journal articl

Initial Experience of Percutaneous Extraction of Infected Cardiac Implantable Electric Devices Using Excimer Laser

Article信州医学雑誌 63(2):103-108 (2015)journal articl

The Traditional Japanese Medicine (Kampo) Boiogito has a Dual Benefit in Cardiorenal Syndrome: A Pilot Observational Study

Article信州医学雑誌 62(2):89-97(2014)journal articl

Importance of Fatty Acid Compositions in Patients with Peripheral Arterial Disease

Objective: Importance of fatty acid components and imbalances has emerged in coronary heart disease. In this study, we analyzed fatty acids and ankle-brachial index (ABI) in a Japanese cohort. Methods: Peripheral arterial disease (PAD) was diagnosed in 101 patients by ABI <= 0.90 and/or by angiography. Traditional cardiovascular risk factors and components of serum fatty acids were examined in all patients (mean age 73.2 +/- 0.9 years; 81 males), and compared with those in 373 age- and sex-matched control subjects with no evidence of PAD. Results: The presence of PAD (mean ABI: 0.71 +/- 0.02) was independently associated with low levels of gamma-linolenic acid (GLA) (OR: 0.90; 95% CI: 0.85-0.96; P = 0.002), eicosapentaenoic acid: arachidonic acid (EPA: AA) ratio (OR: 0.38; 95% CI: 0.17-0.86; P = 0.021), and estimated glomerular filtration rate (OR: 0.97; 95% CI: 0.96-0.98; P<0.0001), and with a high hemoglobin A1c level (OR: 1.34; 95% CI: 1.06-1.69; P = 0.013). Individuals with lower levels of GLA (<= 7.95 mu g/mL) and a lower EPA: AA ratio (<= 0.55) had the lowest ABI (0.96 +/- 0.02, N = 90), while the highest ABI (1.12 +/- 0.01, N = 78) was observed in individuals with higher values of both GLA and EPA: AA ratio (P<0.0001). Conclusion: A low level of GLA and a low EPA: AA ratio are independently associated with the presence of PAD. Specific fatty acid abnormalities and imbalances could lead to new strategies for risk stratification and prevention in PAD patients.ArticlePLOS ONE. 9(9):e107003 (2014)journal articl

Association between Inter-atrial Septum Motion and Persistent Atrial Fibrillation Recurrence after Catheter Ablation

Article信州医学雑誌 69(4) : 189-201(2021)departmental bulletin pape

Left ventricular deformation and torsion assessed by speckle-tracking echocardiography in patients with mutated transthyretin-associated cardiac amyloidosis and the effect of diflunisal on myocardial function

AbstractBackgroundMutated transthyretin-associated (ATTRm) amyloidosis with heart failure is associated with decreased longitudinal left ventricular (LV) myocardial contraction, as measured by strain Doppler echocardiography. We sought to clarify whether speckle-tracking echocardiography (STE) would provide useful information in patients with ATTRm cardiac amyloidosis.MethodsOne hundred twenty-three consecutive patients with ATTRm amyloidosis were divided into 3 groups. Group 1 had no evidence of cardiac involvement (n=47), group 2 had heart involvement but no congestive heart failure (CHF) and/or serum brain natriuretic peptide (BNP) levels <100pg/mL (n=35), and group 3 had heart involvement and CHF and/or serum BNP levels ≥100pg/mL (n=41). All patients underwent standard 2-dimensional (2D), Doppler echo, and STE.ResultsBy standard 2D and Doppler echo, differences in parameters were only apparent between group 3 and groups 1 and 2. Global circumferential strains by STE at each LV level and LV torsion were different between group 1 and groups 2 and 3, but not between group 2 and group 3. In contrast, global longitudinal LV strain showed significant intergroup differences (−17.3±2.3%, −13.3±2.3%, −9.9±3.3% for groups 1 to 3, respectively, P<0.0001). Radial strain also showed significant intergroup differences for each basal LV segment. Among 41 patients who could have been followed up after 1year, 34 patients with diflunisal treatment had shown improvement in apical rotation and torsion without deterioration in multidirectional strains.ConclusionATTRm cardiac amyloidosis is characterized by progressive impairment in longitudinal and basal LV radial function when global circumferential shortening and torsion remain unchanged

High concentrations of omega-3 fatty acids are associated with the development of atrial fibrillation in the Japanese population

The favorable effect of fish oils rich in n-3 polyunsaturated fatty acids (PUFAs) on the development of atrial fibrillation (AF) is controversial. The relationship between the serum concentrations of n-3 PUFAs and the incidence of AF is unclear; therefore, in the present study, we aimed to elucidate this relationship. We evaluated the serum concentrations of n-3 PUFAs in 110 patients with AF, 46 patients with ischemic heart disease (IHD) and no AF, and 36 healthy volunteers. Thirty-six patients had a history of IHD (IHD-AF group) and 74 did not (L-AF group). The eicosapentaenoic acid (EPA) levels in the L-AF group were higher than those in the IHD-AF and control groups (117 +/- A 64, 76 +/- A 30, and 68 +/- A 23 mu g/ml, respectively); the docosahexaenoic acid (DHA) levels showed the same pattern (170 +/- A 50, 127 +/- A 27, and 126 +/- A 35 mu g/ml, respectively). In both the L-AF and IHD-AF groups, the EPA levels in patients with persistent and permanent AF were higher than those in patients with paroxysmal AF (L-AF 131 +/- A 74 vs. 105 +/- A 51 mu g/ml; IHD-AF 82 +/- A 28 vs 70 +/- A 33 mu g/ml). Multivariate analysis showed that cases of AF were associated with higher levels of EPA but not DHA. In this Japanese population study, the EPA and DHA levels in patients with L-AF were higher than those in normal subjects. In particular, the EPA level was associated with the incidence of AF. These findings suggest that an excess of EPA might be a precipitating factor of AF.ArticleHEART AND VESSELS. 28(4):497-504 (2013)journal articl

Polypharmacy and Clinical Outcomes in Hospitalized Patients With Acute Decompensated Heart Failure

BACKGROUND: Polypharmacy is a common problem among patients with acute decompensated heart failure (ADHF) who often have multiple comorbidities. OBJECTIVE: The aim of this study was to define the number of medications at hospital discharge and whether it is associated with clinical outcomes at 1 year. METHODS: We evaluated the number of medications in 2578 patients with ADHF who were ambulatory at hospital discharge in the Kyoto Congestive Heart Failure Registry and compared 1-year outcomes in 4 groups categorized by quartiles of the number of medications (quartile 1, ≤ 5; quartile 2, 6-8; quartile 3, 9-11; and quartile 4, ≥ 12). RESULTS: At hospital discharge, the median number of medications was 8 (interquartile range, 6-11) with 81.5% and 27.8% taking more than 5 and more than 10 medications, respectively. The cumulative 1-year incidence of a composite of death or rehospitalization (primary outcome measure) increased incrementally with an increasing number of medications (quartile 1, 30.8%; quartile 2, 31.6%; quartile 3, 39.7%; quartile 4, 50.3%; P < .0001). After adjusting for confounders, the excess risks of quartile 4 relative to those of quartile 1 remained significant (P = .01). CONCLUSIONS: In the contemporary cohort of patients with ADHF in Japan, polypharmacy at hospital discharge was common, and excessive polypharmacy was associated with a higher risk of mortality and rehospitalizations within a 1-year period. Collaborative disease management programs that include a careful review of medication lists and an appropriate deprescribing protocol should be implemented for these patients

Impact of Ambulation Status in Patients with End-stage Renal Disease on Hemodialysis due to Diabetic Nephropathy : The PREDICT Study

Article信州医学雑誌 68(3): 131-138(2020)journal articl