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Biomedical subjects

Hiroshi Kasanuki

Publications and source records attributed to Hiroshi Kasanuki.

At least 19 recordsLinked to original sources
PubMed2006

Impact of obstructive sleep apnea on clinical and angiographic outcomes following percutaneous coronary intervention in patients with acute coronary syndrome.

There has been growing evidence associating obstructive sleep apnea (OSA) with cardiovascular pathogenesis. We hypothesized that OSA may affect outcomes after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). We performed a sleep study in 89 consecutive patients with ACS who were successfully treated with PCI. Patients with an apnea hypopnea index > or =10/hour were considered to have OSA. Co-morbidity of OSA with ACS was found in 51 patients (57%). There were no differences in baseline demographics between patients with and without OSA, except for significantly higher high-sensitivity C-reactive protein levels (0.59 +/- 0.75 vs 0.29 +/- 0.20 mg/dl, p = 0.019) in patients with OSA. Patients were followed for a mean period of 227 days. The incidence of major adverse cardiac events (cardiac death, reinfarction, and target vessel revascularization) was significantly higher in patients with OSA (23.5% vs 5.3%, p = 0.022). By multivariate analysis, the presence of OSA was an independent predictor for major adverse cardiac events (hazard ratio 11.61, 95% confidence interval 2.17 to 62.24, p = 0.004). In addition, quantitative coronary angiography at 6-month follow-up depicted significantly greater late loss (1.28 +/- 0.84 vs 0.69 +/- 0.81 mm, p = 0.003) and a higher binary restenosis rate (36.5% vs 15.4%, p = 0.026) in patients with OSA compared with those without OSA. In conclusion, the present study showed a high prevalence of OSA among patients with ACS. Moreover, OSA appeared to be an independent predictor for clinical and angiographic outcomes after PCI.

Aged↗
PubMed2006

Single administration of cerivastatin, an HMG-CoA reductase inhibitor, improves the coronary flow velocity reserve: a transthoracic Doppler echocardiography study.

HMG-CoA reductase inhibitors (statins) have been shown to improve the endothelial function by lowering lipids. Recent studies also suggest a direct impact of statins on the vascular wall. We assessed the rapid effect of cerivastatin on the coronary flow velocity reserve (CFVR) using transthoracic Doppler echocardiography (TTDE). The coronary flow velocity from the distal left anterior descending artery was measured in 16 healthy subjects (all male, age 24-38 years) using a 5-MHz transducer, on the day before, just before, and 3 h after administering 0.3 mg of cerivastatin. Hyperemia was achieved by the intravenous administration of adenosine, and the CFVR was calculated as the radio of the mean diastolic hyperemic coronary flow velocity to the basal flow velocity. The serum lipid profile and high-sensitivity C-reactive protein (hsCRP) were measured. The CFVR following the single administration of cerivastatin increased from 2.93+/-0.58 to 3.91+/-0.86, P=0.003, and was significantly higher than the CFVR measured at the same time on the previous day (3.91+/-0.86 vs 3.37+/-0.48, P=0.009). Neither the serum lipid profile nor hsCRP exhibited a remarkable change after cerivastatin administration. We concluded that a single-dose administration of cerivastatin, an HMG-CoA reductase inhibitor, improves the coronary flow velocity reserve without modifying the serum lipid profile.

Adult↗
PubMed2006

Mild and short recurrence of type II amiodarone-induced thyrotoxicosis in three patients receiving amiodarone continuously for more than 10 years.

Although there are two types of amiodarone-induced thyrotoxicosis (AIT), only type II AIT has been seen at our institution in Japan so far. There have been few case reports of AIT recurrence, probably because of the fact that amiodarone is immediately discontinued once AIT has developed. Our own policy is not to discontinue amiodarone in all AIT patients, unless severe adverse effects such as pulmonary fibrosis develop. Among more than 50 patients with type II AIT we have encountered, three with arrhythmogenic right ventricular cardiomyopathy showed AIT recurrence. In these patients, the first episode of AIT developed 3, 4, and 2 years after the start of amiodarone administration, and recurrence was observed 5, 6, and 8 years after the first episode, respectively. The AIT resolved spontaneously in all cases while the patients continued to take amiodarone. In comparison with the first AIT episode, the second was milder and resolved within a shorter period. These three cases suggest that recurrence of type II AIT may not be rare in iodine-sufficient areas, and that it is relatively mild and may resolve spontaneously. Furthermore, at least in Japan, it may be possible for patients with recurrent type II AIT to continue taking amiodarone.

Aged↗
PubMed2006

Significance of 8-hydroxy-2'-deoxyguanosine levels in patients with idiopathic dilated cardiomyopathy.

BACKGROUND: Although oxidative stress mediated by reactive oxygen species plays an important role in the pathogenesis of heart failure (HF), good clinical markers for reactive oxygen species in patients with HF have not been established. 8-Hydroxy-2'-deoxyguanosine (8-OHdG) is formed from deoxyguanosine in DNA by hydroxyl free radicals and might serve as a sensitive biomarker of intracellular oxidative stress in vivo. Thioredoxin (TRX) is known to be induced in cells as a radical scavenger against oxidative stress. The aim of this study is to evaluate the clinical significance of the serum 8-OHdG and TRX of patients with chronic HF with idiopathic dilated cardiomyopathy (DCM). METHODS AND RESULTS: We estimated serum 8-OHdG and TRX levels using enzyme-linked immunosorbent assay in 32 patients with DCM and investigated the impact of these markers to the clinical characteristics of these patients. Serum levels of 8-OHdG, but not TRX were significantly correlated with New York Heart Association functional class, left atrial diameters, left ventricular end-diastolic diameters, left ventricular end-systolic diameters, and plasma levels of brain natriuretic peptide. CONCLUSION: These data suggest oxidative DNA damage is increased in patients with DCM according to the severity of HF. Serum levels of 8-OHdG may represent clinically useful markers of left ventricular remodeling.

8-Hydroxy-2'-Deoxyguanosine↗
PubMed2006

Video-assisted thoracoscopy to treat atrial tachycardia arising from left atrial appendage.

A 17-year-old male with tachycardia-induced cardiomyopathy presented with persistent, drug-resistant atrial tachycardia (AT). An electrophysiological study suggested focal abnormal automaticity, and localized the AT origin to the left atrial appendage. Radiofrequency catheter ablation at the site of the earliest endocardial activation during AT failed. A minimally invasive, video-assisted thoracoscopic (VAT) atrial appendectomy terminated the AT and restored left ventricular contractility. The patient remained free of AT and normal left ventricular function was maintained over a 24-month follow-up period. To our knowledge, we are the first to use VAT atrial appendectomy to treat focal AT.

Adolescent↗
PubMed2006

Non-invasive assessment of coronary arterial tone using trans-thoracic Doppler echocardiography.

BACKGROUND: As coronary flow velocity (CFV) is inversely related to the luminal size that exists for the myocardial bed, the elevated arterial tone can be assessed as the higher flow velocity in the epicardial artery. We examined the usefulness of transthoracic Doppler echocardiography (TTDE) for the assessment of coronary arterial tone. METHODS AND RESULTS: A total of 32 patients underwent TTDE and angiography. The luminal diameter (LD) in the left anterior descending artery (LAD) was measured by using quantitative coronary angiography before and after nitroglycerin (NTG) administration. The ratio of post NTG LD to the control (LD(NTG/Pre)) was assessed as a standard parameter of coronary arterial tone. We also measured CFV and CFV reserve (CFVR) at the LAD by TTDE. We evaluated the change of CFV (CFV(NTG/Pre)) and CFVR (CFVR(NTG/Pre)) following NTG administration. The LD increased from 1.98+/-0.46 to 2.51+/-0.34 mm (p<0.001), while the CFV decreased from 23.9+/-10.0 to 16.3+/-5.6 cm/s (p<0.03), and the CFVR increased from 2.39+/-0.65 to 3.56+/-1.12 (p<0.001). There were significant correlations between CFV(NTG/Pre) and LD(NTG/Pre) (p<0.0001, R2 = 0.532), and between the CFVR(NTG/Pre) and LD(NTG/Pre) (p<0.0001, R2 = 0.715). CONCLUSION: TTDE can assess the coronary arterial tone by measuring the responses of CFV and CFVR to NTG administration.

Adult↗
PubMed2006

[Follow-up study of diastolic paradoxical flow in the left ventricle with apical hypertrophic cardiomyopathy].

OBJECTIVES: Left ventricular apical asynergy and cardiovascular complications were evaluated in patients with apical hypertrophic cardiomyopathy, in whom apical diastolic paradoxical flow toward the base could be detected by Doppler color flow echocardiography. METHODS: Twenty-nine patients with apical hypertrophic cardiomyopathy were followed up with echocardiographic examinations for at least 5 years. They were divided into three groups: those who persistently exhibited paradoxical flow (Group A, n = 13), those in whom paradoxical flow developed during the follow-up period (Group B, n = 8), and those in whom paradoxical flow was not detected during the follow-up period (Group C, n = 8). Peak flow velocity and duration of paradoxical flow, the presence or absence of apical asynergy, and cardiovascular complications were evaluated. RESULTS: The mean follow-up period was 7.3 +/- 1.4 years. In Groups A and B, the apical wall motion deteriorated over time, whereas there was no asynergy change in Group C. Further, peak flow velocity and duration of paradoxical flow increased throughout the follow-up period in Groups A and B, and were correlated with the severity of apical asynergy. Ventricular tachycardia and cerebrovascular complications also occurred more often in patients with paradoxical flow. CONCLUSIONS: The presence of paradoxical flow was related to the severity of apical asynergy and cardiovascular complications, and may be an important marker for evaluating the clinical course of patients with apical hypertrophic cardiomyopathy.

Aged↗
PubMed2006

[Trend and contributing factors of in-hospital deaths in patients with infective endocarditis over the last twenty years].

OBJECTIVES: To evaluate the changes in the clinical background to infective endocarditis and identify the contributing factors to in-hospital deaths over the last 20 years. METHODS: Seventy-five patients (mean age 48.2 +/- 24.0 years) with infective endocarditis treated between January 1984 and December 2003 at our hospital were evaluated retrospectively. The patients were divided into two groups (first decade, n = 26 and second decade, n = 49). RESULTS: The infection route was unknown in 65% of the patients, but the oral route was the most common known route (16.0%). Congenital heart disease (24.0%)was the most common background disease, followed by valvular heart disease (22.7%), and post prosthetic valve replacement (22.7%). The mitral valve was most frequently infected(56.0%), followed by the aortic valve (34.7%). Multi-valve infection was present in 13.3% of the patients. Although the frequency of streptococcal endocarditis reduced, that of staphylococcal endocarditis increased in the second decade. The overall in-hospital mortality was 26.7%, but slightly improved in the second decade (34.6% vs 22.4%, p = 0.26). The overall in-hospital mortality was similar between the surgically treated group and the non-surgically treated group (25.0% vs 27.3%, NS). In the surgically treated group, in-hospital mortality was lower in the second decade than the first decade, but higher in the group treated for active infective endocarditis. Multivariate analysis found age > or = 51 years, renal insufficiency, neurological abnormality, and culture negative as predictors of in-hospital mortality. CONCLUSIONS: Rapid and appropriate primary medical treatment are important in the active phase of infective endocarditis. Age > or = 51 years was the strongest predictor of in-hospital infective endocarditis death.

Adolescent↗
PubMed2006

[Prognostic value of C-reactive protein and troponin T level in patients with unstable angina pectoris].

OBJECTIVES: The prognosis of unstable angina pectoris may be more accurately predicted by the combination of C-reactive protein (CRP), which is a known inflammation marker, and troponin T (TnT), which is used for risk assessment for the prognosis of acute coronary syndrome. The present study investigated the correlations between pathophysiology and prognosis of severe unstable angina pectoris and CRP and TnT levels. METHODS: The correlation between CRP at admission and the prognosis was studied in 367 patients with severe unstable angina pectoris (Braunwald type II and III) who were admitted to our hospital between January 1998 and December 2000. The in-hospital and long-term prognosis was investigated in TnT-positive patients. In-hospital cardiac events were defined as death, myocardial infarction, heart failure and angina attacks during hospitalization. Long-term cardiac events were defined as death, myocardial infarction, heart failure and recurrence of angina. RESULTS: The incidence of in-hospital cardiac events in all patients was 30.2%. The CRP levels were higher in patients with cardiac events (0.97 +/- 2.67 vs 0.53 +/- 1.29 mg/d/, p = 0.057), but there was no significant difference between the two groups. The incidence of long-term cardiac events was 26.8%. The mean CRP level was significantly higher in patients with cardiac events than in patients without cardiac events (1.17 +/- 1.86 vs 0.43 +/- 1.14 mg/dl, p = 0.098). In TnT-positive patients (TnT > 0.1 ng/ml, 23% of all patients), the incidence of in-hospital cardiac events was 47.6% (p < 0.0001), significantly higher than that in all patients. TnT-positive patients with CRP levels of 0.5 mg/dl or higher (8% of all patients) had a markedly higher incidence of in-hospital cardiac events of 56.7% (p = 0.001) and long-term cardiac events of 46.7% (p = 0.01). CONCLUSIONS: CRP levels were useful in prediction of the long-term prognosis. TnT levels were useful in prediction of in-hospital prognosis. The present study suggested the possibility that the combined use of these biological markers could predict the prognosis of patients with unstable angina at early stage and more accurately.

Angina, Unstable↗
PubMed2006

[Cardiac resynchronization therapy].

Despite recent advances in pharmacologic treatment for heart failure, the prognosis of patients with chronic heart failure remains poor. One third of patients with chronic heart failure have intraventricular conduction delay. The ventricular mechanical dyssynchrony based on intraventricular conduction delay worsen ventricular systolic dysfunction. Cardiac resynchronization therapy(CRT) through biventricular pacing significantly improves symptoms, exercise tolerance, hemodynamics, hospitalization for heart failure and mortality. However, it is estimated that 30 % of patients do not respond to CRT. A direct assessment of mechanical dyssynchrony with echocardiography seems more important than QRS duration in selecting appropriate patients for CRT.

Cardiac Pacing, Artificial↗
PubMed2006

[Long-term outcome and tolerability of carvedilol therapy in Japanese patients with chronic heart failure].

OBJECTIVES: Randomized controlled clinical studies in western countries have shown that the beta-blockers improve the survival of patients with chronic heart failure and are highly tolerable. The tolerability of beta-blocker therapy and the long-term prognosis for patients with chronic heart failure receiving beta-blockers remain unclear in Japan. In the present study, carvedilol was employed for the treatment of mild to severe chronic heart failure and the long-term prognosis of the patients was monitored to evaluate the tolerability and chronic efficacy of beta-blocker therapy in Japanese patients. METHODS: Three hundred and twenty-seven patients with chronic heart failure [Classes II to IV according to the New York Heart Association (NYHA) classification] were studied. Carvedilol was started at a dose of 1.25 to 5 mg/day and then increased to the final target dose of 20 mg/day, depending on its tolerability in each patient. The patients were monitored with respect to their NYHA classification, daily mean heart rate (evaluated by Holter electrocardiography), changes of the plasma brain natriuretic peptide level, and prognosis. They were followed up for a mean period of 4.4 +/- 1.8 years. RESULTS: Carvedilol was not tolerated by 21 of the 327 patients (6.4%), and was discontinued during the follow-up period in 38 patients (11.6%). The mean maintenance dose for the remaining 268 patients (82.0%), in whom treatment could be continued over the long term, was 14.1 +/- 7.5 mg. The NYHA classification and plasma brain natriuretic peptide level were significantly improved, and the daily mean heart rate was also significantly reduced in the 268 patients. Significant improvement was also observed in patients with severe heart failure (classes III or IV of the NYHA classification). The five-year survival rate of patients continuously treated with carvedilol was 83%, and their outcome was significantly better than that of those who could not tolerate the drug (49%; p < 0.001) or those who discontinued treatment prematurely (68%; p < 0.001). The treated group also had a significantly lower cardiac death rate than the intolerant group or discontinued group. CONCLUSIONS: Carvedilol was well tolerated by Japanese patients with chronic heart failure. Treatment with low-dose carvedilol may improve the symptoms and prognosis of patients with mild to severe chronic heart failure over the long term.

Adrenergic beta-Antagonists↗
PubMed2006

[Clinical impact of nephropathy induced by contrast medium in patients with acute myocardial infarction undergoing emergent coronary angiography].

OBJECTIVES: The incidence of contrast-induced nephropathy (CIN) after coronary angiography and the prognostic value in patients with acute myocardial infarction remains to be determined. This study investigated the frequency, predictors of CIN, and the prognostic significance of CIN in acute myocardial infarction patients undergoing emergent coronary angiography. METHODS: This study included 132 consecutive acute myocardial infarction patients undergoing emergent coronary angiography within 24 hr after the onset between January 1999 and June 2001. The serum creatinine concentration was measured on admission and at 48 hr after contrast medium exposure. CIN was defined as an increase in serum creatinine from the baseline > or = 0.5 mg/dl or > or = 25% at 48 hr after emergent coronary angiography. The patient characteristics, and in-hospital and long-term mortality were compared between the CIN and non-CIN groups. RESULTS: CIN occurred in 15 patients (11.4%) after emergent coronary angiography. The predictor of CIN development was preexisting renal impairment (serum creatinine concentration > or = 1.2 mg/dl on presentation; 21.9% vs 8.0%, odds ratio 3.22, 95% confidence interval 1.07-9.74, p = 0.04). In-hospital mortality was significantly higher in the CIN group than in the non-CIN group (13.3% vs 1.7%; odds ratio 8.85, 95% confidence interval 1.15-68.2, p = 0.01). The long-term mortality (mean follow-up period of 40 months) was also higher in the CIN group (26.7% vs 8.6%; hazard ratio 3.91, 95% confidence interval 1.21-12.5, p = 0.02). CONCLUSIONS: CIN was an independent predictor of both in-hospital and long-term mortality in acute myocardial infarction patients undergoing emergent coronary angiography. Preexisting renal insufficiency was associated with subsequent CIN.

Aged↗
PubMed2006

Excessive intrastent plaque volume is the major cause of restenosis after intracoronary bare metal stent implantation: a 3-dimensional intravascular ultrasound and quantitative coronary angiography based study.

Vascular response after percutaneous coronary intervention (PCI) may differ in different ethnic group. Here we show the impact of peri-stent and intra-stent remodeling on coronary stenotic lesions in a group of Japanese patients. Those lesions were evaluated before, after and during follow up, with 3 dimensional intravascular ultrasound (IVUS) (3-D IVUS) and quantitative coronary angiography (QCA) 30 patients with pre, post and follow up IVUS were enrolled. Quantitative data are presented as the mean +/- SD, and categorical data as frequencies. Binary variables were compared with Mann Whitney's U test. There were 7 cases with restenosis (RS) and 23 cases with no-restenosis (NR). In QCA based evaluation, minimum lumen diameter (1.2 +/- 0.4 mm vs. 2.4 +/- 0.6 mm, p < 0.001) and % diameter stenosis (59.1+/- 16.1 vs. 23.3 +/- 16.1, p < 0.001) were significantly reduced in RS at follow up. Acute gain was similar among both groups (RS; 2.1 +/- 0.6 mm vs. NS; 2.2 +/- 0.7 mm, p = 0.5), however, late loss was significantly increased in RS (2.1 +/- 0.8 vs. 0.8 +/- 0.5, p < 0.001). At 3-D IVUS based follow up, lumen volume index was significantly reduced in RS (3.6 +/- 0.8 mm3/mm vs. 6.9 +/- 0.8 mm3/mm, p < 0.01). There was higher intrastent plaque volume index in RS in comparison to NR (5.4 +/- 1.4 mm3/mm vs. 3.1+/- 1.1 mm3/mm, p < 0.05). Linear regression analysis showed a tendency for a significant inverse correlation between the percentage of delta peristent volume index and the percentage of delta intrastent volume index (R2 = 0.12, p = 0.054). The intrastent plaque growth is the major player in causing restenosis.

Angioplasty, Balloon, Coronary↗
PubMed2006

Hyper-echoic plaque with high attenuation in intravascular ultrasound may predict slow flow during percutaneous coronary intervention.

One patient with acute inferior wall myocardial infarction underwent percutaneous coronary intervention following intravenous thrombolysis. Intravascular ultrasound (IVUS) before stenting revealed huge plaque burden with high attenuation underneath the hyper-echoic eccentric plaque surface. Stent deployment resulted in slow flow, which was managed with intra-aortic balloon counter-pulsation. His another lession in the mid left anterior descending artery showing eccentric hypo-echoic plaque with neither hyper-echoic surface nor high attenuation was successfully stented without causing slow flow.

Angioplasty, Balloon, Coronary↗
PubMed2005

Heparin regulates transcription of endothelin-1 gene in endothelial cells.

Heparin, which is widely used as an anticoagulant, has been shown to have antiatherosclerotic and antihypertensive effects in animals and humans. These effects are mediated by the inhibition of endothelin-1 (ET-1) production in endothelial cells. To clarify the mechanism of this inhibition, we investigated the effect of heparin on transcriptional regulation of the ET-1 gene in bovine aortic endothelial cells (BAEC) cultured in fetal calf serum. ET-1 mRNA expression was significantly suppressed by heparin in a dose-dependent manner. Promoter analysis revealed that the minimum ET-1 promoter containing only the GATA and AP-1 sequences as positive cis-acting sites in the ET-1 promoter is sufficient for this suppression. Gel mobility shift assays using oligonucleotides encoding the ET-1 AP-1 and ET-1 GATA sites confirmed that both AP-1 and GATA binding activities in BAEC nuclear extract were markedly inhibited by heparin. Western blot analyses indicated that heparin completely blocked extracellular signal-regulated kinase (ERK) activation, and inhibiting ERK activity resulted in loss of heparin-dependent inhibition of the ET-1 gene. These data indicate that the ET-1 mRNA level is negatively regulated by heparin at the transcription level, through modification of AP-1 and GATA protein binding activities, which direct the ET-1 promoter in BAEC. This effect may be mediated, at least in part, through inhibition of ERK activity.

Animals↗
PubMed2005

Pulmonary hypertension during epileptic seizure with evidence of increased angiotensin II in pulmonary artery.

We experienced a 78-year-old man in whom transient pulmonary hypertension was documented during epileptic seizure. A Swan-Ganz catheter demonstrated that pulmonary arterial pressure rose immediately after the initiation of the seizure, which was followed by systemic hypertension. The plasma level of angiotensin II increased in pulmonary circulation during the seizures; however, catecholamines did not change from the baseline. The patient responded well to treatment with an antiepileptic drug and losartan potassium.

Aged↗
PubMed2005

Improvement of arterial stiffness by the antioxidant and anti-inflammatory effects of short-term statin therapy in patients with hypercholesterolemia.

The preventive effect of statins on coronary events is not only associated with the cholesterol-lowering effect of these drugs, but also various direct effects on the vascular wall, which include improvement of endothelial function, antioxidant activity, and anti-inflammatory activity. We investigated whether short-term statin therapy could improve arterial stiffness and assessed its mechanism of action in patients with hypercholesterolemia. We assessed arterial stiffness in 10 patients (mean age: 62.9 +/- 9.0 years) with hypercholesterolemia (total cholesterol > or =220 mg/dl). The patients were treated with cerivastatin (0.15 mg/day) for 4 weeks. Before and after 4 weeks of treatment, we determined arterial stiffness from brachial-ankle pulse wave velocity and the ankle-brachial blood pressure index (ABI) using a FORM apparatus (Colin, Komaki, Japan). We also measured the blood levels of high-sensitivity C-reactive protein (hsCRP) and malondialdehyde low-density lipoprotein (MDA-LDL) as markers of inflammation and oxidation, respectively. After statin therapy, both the right and left abPWV were significantly decreased from 1544.6 +/- 157.1 to 1349.0 +/- 223.9 cm/s and from 1592.1 +/- 164.8 to 1424.8 +/- 245.2 cm/s, respectively (P < 0.05). However, the ABI was unchanged after 4 weeks of cerivastatin therapy. MDA-LDL decreased significantly (from 161.2 +/- 42.4 to 119.4 +/- 33.5 U/l, P < 0.05) and hsCRP also decreased. Total cholesterol and LDL-cholesterol decreased, while triglycerides and high-density lipoprotein-cholesterol were unchanged. Blood pressure was not significantly altered from the baseline value by statin therapy. These results suggest that the preventive effect of statins on coronary events is partly associated with the various actions of these drugs on the vascular wall, and that statins are not only cholesterol-lowering agents but also antiatherosclerotic agents.

Administration, Oral↗