Biomedical subjects

Katsusuke Yano

Publications and source records attributed to Katsusuke Yano.

At least 37 records · Page 2Linked to original sources

PubMed2006

[Clinical manifestations and outcome of acute myocardial infarction in young adults treated with primary coronary angioplasty].

OBJECTIVES: This study investigated the differences in presentation, complications, and outcome of young patients with acute myocardial infarction compared to other patients. METHODS: Our series of 379 consecutive patients with acute myocardial infarction, who were admitted within 12 hr of onset and successfully reperfused by primary percutaneous coronary intervention, included 28 (7.4%) young patients (< 50 years). RESULTS: There were significantly more male patients, current smokers, and hyperlipidemia in the young group than in the other patients (p < 0.01). The levels of acute phase brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) were significantly lower (BNP: 128 +/- 103 vs 379 +/- 470 pg/ml, p = 0.009, ANP: 17 +/- 11 vs 66 +/- 81 pg/ml, p = 0.004) and peak creatine kinase value was significantly higher (3,824 +/- 3,459 vs 2,413 +/- 2,023 IU/l, p = 0.009) in the young group than in the other patients. The increase (chronic phase-acute phase) of left ventricular ejection fraction was significantly better in the young group (8 +/- 9% vs 4 +/- 10%, p < 0.05). There were significantly fewer patients with ventricular arrhythmia in the young group than in the other patients (10.7% vs 33.0%, p = 0.04). The cardiac mortality rate in the first 6 months was only 3.6% in the young group. CONCLUSIONS: Young patients with acute myocardial infarction, in spite of higher peak creatine kinase value, seemed to have excellent prognosis, with lower BNP and good recovery of left ventricular ejection fraction.

Adult↗

PubMed2006

[Clinical manifestations and acute myocardial infarction in women treated with primary coronary angioplasty].

OBJECTIVES: The differences in presentation, complications, and outcome of acute myocardial infarction treated with primary coronary angioplasty were compared in male and female patients. METHODS: Consecutive patients with acute myocardial infarction who were admitted within 12 hr of onset underwent primary percutaneous coronary intervention, including 120 female (31%) and 264 male (69%) patients. RESULTS: There were significantly more patients with diabetes mellitus (42% vs 31%, p = 0.03), and hyperlipidemia(56% vs 38%, p = 0.001), and fewer patients with current smoking (10% vs 60%, p < 0.0001) in the female group than in the male group (p < 0.01). The female group was significantly older (75 +/- 11 vs 67 +/- 12 years, p < 0.0001). The value of acute phase brain natriuretic peptide was significantly higher (483 +/- 543 vs 306 +/- 404 pg/ml, p = 0.001), and peak creatine kinase value was significantly lower (1,743 +/- 1,732 vs 2,855 +/- 2,997 IU/l, p = 0.0003) in the female group than in the male group. Both Killip's classification on admission (p = 0.04) and Thrombolysis in Myocardial Infarction grade soon after mechanical reperfusion therapy (p = 0.03) were significantly worse in the female group. There were significantly more patients with heart failure in the female group (40% vs 27%, p = 0.04). The cardiac mortality rates during 6 months was significantly higher in the female group (11% vs 5%, p = 0.02). However, multivariate analysis showed that female sex was not an independent predictor of cardiac death. CONCLUSIONS: Female patients with acute myocardial infarction seemed to have a poor prognosis, in spite of lower peak creatine kinase value and higher brain natriuretic peptide value. The reasons for poorer outcomes in women were considered to be patient background, such as higher age and diabetes mellitus, and condition of heart failure on admission.

Age Factors↗

PubMed2006

["Smoker's paradox" in patients with acute myocardial infarction receiving primary coronary intervention].

OBJECTIVES: Smokers with acute myocardial infarction have lower mortality rates than non-smokers despite increased risk for coronary artery disease. This study assessed the effects of smoking on complications and outcomes after acute myocardial infarction, and investigated the relationship between the clinical factors and the paradoxical effects of smoking in patients receiving primary coronary intervention. METHODS: Subjects were 367 consecutive patients with acute myocardial infarction who were admitted within 24 hr of onset and underwent successful coronary intervention, 165 (45%) of whom were smokers. RESULTS: The smoking group contained significantly more male patients, and the smoking group was significantly younger than the non-smoking group (p < 0.0001). The value of acute phase brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) were significantly lower (BNP: 250 +/- 366 vs 448 +/- 513pg/ml, p = 0.0002; ANP: 48 +/- 77 vs 74 +/- 82pg/ml, p = 0.005) in the smoking group. Peak creatine kinase time from onset was significantly earlier (12.9 +/- 9.3 vs 16.1 +/- 10.0 hr, p = 0.049) in the smoking group. Left ventricular ejection fraction in the chronic phase was significantly better in the smoking group (58 +/- 13% vs 52 +/- 14%, p = 0.03). The early ST-segment resolution rate was higher in the smoking group (81% vs 67%, p = 0.003), and there were significantly fewer patients with heart failure in the smoking group than in the non-smoking group (28% vs 41%, p = 0.01). The cardiac mortality rate during 6 months was significantly lower in the smoking group (3% vs 9%, p = 0.01). The beneficial effects of smoking on the prognosis were related with the differences in sex and age of the study group. CONCLUSIONS: The reason why smokers with acute myocardial infarction have lower mortality rates than non-smokers, the "smoker's paradox", may be related to less damage to the microvascular function after primary coronary intervention, with lower BNP and better left ventricular ejection fraction.

Aged↗

PubMed2005

Influence of advancing age on fractionated right atrial endocardial electrograms.

The influence of advancing age on atrial endocardial electrograms recorded during sinus rhythm in humans who do not have atrial fibrillation has not been assessed thus far. The prevalence of atrial arrhythmias has been reported to increase with advancing age. Right atrial endocardial catheter mapping during sinus rhythm was performed in 106 patients who had normal sinus node function and no paroxysmal atrial fibrillation to evaluate the influence of advancing age on atrial endocardial electrograms. The bipolar electrograms were recorded at 12 sites in the right atrium, and an abnormal atrial electrographic result was defined as lasting > or =100 ms and/or showing > or =8 fragmented deflections. A total of 1,272 right atrial endocardial electrograms was assessed and quantitatively measured. The mean number of abnormal atrial electrograms per patient (0.61 vs 0.14, p <0.02) and the incidence of abnormal atrial electrograms (11% vs 30%, p <0.02) were significantly greater in patients who were >60 years of age than in younger patients. The longest duration (r = 0.24, p <0.02) and the maximal number of fragmented deflections (r = 0.28, p <0.005) of atrial electrograms among the 12 right atrial sites showed a slight positive correlation with age. The process of aging modifies the electrophysiologic properties of the atrial muscle. There is a progressive increment in the extension of altered atrial muscle with advancing age in humans who do not have atrial fibrillation. Patients who are >60 years of age have significantly greater abnormalities on atrial endocardial electrograms than do younger patients.

Adolescent↗

PubMed2005

D-dimer level influences thromboembolic events in patients with atrial fibrillation.

BACKGROUND: Elevated coagulative molecular markers could reflect the prothrombotic state in the cardiovascular system of patients with non-valvular atrial fibrillation (NVAF). A prospective, cooperative study was conducted to determine whether levels of coagulative markers alone or in combination with clinical risk factors could predict subsequent thromboembolic events in patients with NVAF. METHODS: Coagulative markers of prothrombin fragment 1+2, D-dimer, platelet factor 4, and beta-thromboglobulin were determined at the enrollment in the prospective study. RESULTS: Of 509 patients with NVAF (mean age, 66.6 +/- 10.3 years), 263 patients were treated with warfarin (mean international normalized ratio, 1.86), and 163 patients, with antiplatelet drugs. During an average follow-up period of 2.0 years, 31 thromboembolic events occurred. Event-free survival was significantly better in patients with D-dimer level < 150 ng/ml than in those with D-dimer level>or==150 ng/ml. Other coagulative markers, however, did not predict thromboembolic events. Age (>or==75 years), cardiomyopathies, and prior stroke or transient ischemic attack were independent, clinical risk factors for thromboembolism. Thromboembolic risk in patients without the clinical risk factors was quite low (0.7%/year) when D-dimer was < 150 ng/ml, but not low (3.8%/year) when D-dimer was >or==150 ng/ml. It was >5%/year in patients with the risk factors regardless of D-dimer levels. This was also true when analyses were confined to patients treated with warfarin. CONCLUSIONS: D-dimer level in combination with clinical risk factors could effectively predict subsequent thromboembolic events in patients with NVAF even when treated with warfarin.

Aged↗

PubMed2005

Functional analysis of titin/connectin N2-B mutations found in cardiomyopathy.

Hypertrophic cardiomyopathy and dilated cardiomyopathy are two major clinical phenotypes of "idiopathic" cardiomyopathy. Recent molecular genetic analyses have now revealed that "idiopathic" cardiomyopathy is caused by mutations in genes for sarcomere components. We have recently reported several mutations in titin/connectin gene found in patients with hypertrophic cardiomyopathy or dilated cardiomyopathy. A hypertrophic cardiomyopathy-associated titin/connectin mutation (Arg740Leu) was found to increase the binding to actinin, while other dilated cardiomyopathy-associated titin/connectin mutations (Ala743Val and Val54Met) decreased the binding to actinin and Tcap/telethonin, respectively. We also reported several other mutations in the N2-B region of titin/connectin found in hypertrophic cardiomyopathy and dilated cardiomyopathy. Since the N2-B region expresses only in the heart, it was speculated that functional alterations due to the mutations cause cardiomyopathies. In this study, we investigated the functional changes caused by the N2-B region mutations by using yeast-two-hybrid assays. It was revealed that a hypertrophic cardiomyopathy-associated mutation (Ser3799Tyr) increased the binding to FHL2 protein, whereas a dilated cardiomyopathy-associated mutation (Gln4053ter) decreased the binding. In addition, another TTN mutation (Arg25618Gln) at the is2 region was found in familial DCM. Because FHL2 protein is known to tether metabolic enzymes to N2-B and is2 regions of titin/connectin, these observations suggest that altered recruitment of metabolic enzymes to the sarcomere may play a role in the pathogenesis of cardiomyopathies.

Aged↗

PubMed2005

QRST isointegral departure mapping after exercise in patients with congenital long QT syndrome.

Congenital long QT syndrome (LQTS) is known to be a critical syndrome associated with a bizarre T wave, prolonged QT interval, and ventricular arrhythmias and is followed by syncope and/or sudden death. Body surface mapping, especially QRST isointegral departure mapping, was used after exercise to assess exercise-induced repolarization changes in patients with this syndrome. This study included 12 patients with the Romano-Ward syndrome (LQTS group, 9 women, 30 +/- 19 years) and 19 healthy adults (control group, 5 women, 24 +/- 5 years). In the LQTS group, there was a significant increase in the number of local extrema and abnormal points after exercise in the departure maps. In the LQTS group, QRST isointegral departure mapping presented more marked abnormalities of repolarization after an exercise stress test. In mild cases that revealed abnormalities only after the exercise stress, such testing may be helpful for LQTS diagnosis.

Adolescent↗

PubMed2005

The influence of beta-adrenergic agonists and antagonists on T-wave alternans in patients with and without ventricular tachyarrhythmia.

BACKGROUND: T-wave alternans (TWA) is an important noninvasive measurement of ventricular tachyarrhythmia (VT) and is known to be influenced by the sympathetic nervous system. We examined the correlation between TWA measurement and the sympathetic nervous system in patients with and without VT. METHODS AND RESULTS: Thirty-five patients (28 men, 7 women; mean age, 59 +/- 15 years) with tachyarrhythmia were assigned to two groups: VT group (n = 15) and supraventricular tachyarrhythmia (SVT) group (n = 20). Alternans voltage in lead vector magnitude (eVM) was measured during atrial pacing (90, 110 beats/min (bpm)). After eVM was measured at baseline, propranolol was administered, and eVM was measured again. In a subset of 18 patients (10 with VT and 8 with SVT), isoproterenol was administered prior to propranolol infusion. After propranolol infusion, eVM of both the VT and the SVT groups decreased significantly compared to baseline. The changes in absolute value of eVM at 110 bpm after propranolol infusion were greater in the VT group than in the SVT group (-1.3 +/- 0.8 microV vs -0.5 +/- 0.8 microV, P < 0.05). The eVM values of both the VT and the SVT groups increased after administration of isoproterenol compared to the baseline value. The changes in absolute value and percentile of eVM after isoproterenol infusion were smaller in the VT group than in the SVT group (2.0 +/- 1.8 microV vs 3.9 +/- 3.5 microV, P < 0.05; 21 +/- 18% vs 48 +/- 36%, P < 0.05). CONCLUSIONS: The sympathetic nervous system has an influence over microvolt-level TWA. Administration of a beta-adrenergic antagonist caused a significant decrease in TWA, particularly in the VT group. This may partially explain the mechanism by which adrenergic antagonists inhibit VTs.

Adrenergic beta-Agonists↗

PubMed2005

Prognostic value of serum amyloid A protein in patients with acute myocardial infarction.

BACKGROUND: The relationship between plasma levels of serum amyloid A protein (SAA) concentrations and clinical course (including mortality) was investigated in patients with acute myocardial infarction (AMI). METHODS AND RESULTS: The study enrolled 280 consecutive AMI patients who were admitted within 10 h of onset and were successfully reperfused by primary percutaneous coronary intervention. Plasma SAA concentrations were evaluated at 24 h after onset. The threshold of the upper quintile (325 mug/dl) was used to divide patients into 2 groups: either a high SAA (H group: > or =325 mug/dl; n=56) or low SAA (L group: <325 microg/dl; n=224). (I) Left ventricular (LV) ejection fraction in the chronic phase was significantly less in the H group than in the L group (52+/-14% vs 57+/-13%, p=0.03). (II) There were significantly more major complications in the H group than in the L group (cardiac rupture: p=0.0007, cardiogenic shock: p<0.0001; subacute thrombosis: p=0.0007; cardiac death: p=0.0003). (III) Multivariate analysis identified SAA as an independent predictor of 6-month mortality in AMI patients (risk ratio: 5.8, 95%confidence interval: 1.3-27.7, p=0.03). CONCLUSIONS: In the setting of AMI, plasma SAA concentrations may be closely related to LV systolic dysfunction and poor patient outcomes, including mortality.

Acute Disease↗

PubMed2005

Valsartan decreases type I collagen synthesis in patients with hypertrophic cardiomyopathy.

BACKGROUND: Fibrosis, as well as myocyte hypertrophy, is the major determinant of prognosis in hypertrophic cardiomyopathy (HCM). Valsartan, an angiotensin II type 1 receptor blocker, may improve myocardial fibrosis in patients with HCM. METHODS AND RESULTS: Twenty-three patients with HCM were randomly divided into 2 groups: 11 patients had valsartan added to conventional treatment (V group) and 12 patients received the conventional therapy (C group). Plasma concentrations of brain natriuretic peptide (BNP), troponin T (TnT), aldosterone (ALDO), procollagen type I (PIP) and procollagen type III aminoterminal peptide (PIIINP) were measured before and 12 months after this study. Left ventricular wall thickness (LVWT) and ejection fraction (LVEF) were measured by echocardiography. PIP was decreased in the V group (123.2+/-63.1 ng/ml to 102.8+/-37.6, p<0.05), but unchanged in C group (110+/-40.5 ng/ml to 119.9+/-47.4, p=0.22). ALDO concentration was unchanged in the V group (88.5+/-26.2 pg/ml to 91.2+/-26.8, p=0.27), and increased in C group (92.6+/-36.6 ng/ml to 116.0+/-33.3, p<0.05). BNP, PIIINP, and TnT were unchanged by the treatment. There was no significant difference between the 2 groups in either LVWT or LVEF. CONCLUSION: Valsartan suppresses the synthesis of type I collagen in patients with HCM and this was associated with suppression of the increase in ALDO.

Adult↗

PubMed2005

Clinical significance of acute-phase endothelin-1 in acute myocardial infarction patients treated with direct coronary angioplasty.

BACKGROUND: The aim of the present study was to investigate the relationship between plasma concentrations of endothelin (ET)-1 and clinical outcome (including mortality) and left ventricular (LV) systolic function in acute myocardial infarction (AMI). METHODS AND RESULTS: The study group comprised 110 consecutive first-AMI patients who were successfully reperfused by primary coronary intervention. Plasma ET-1 concentrations were evaluated 24 h from onset and the patients were divided into 2 groups according to the median value, either a high group (H group: > or = 2.90 pg/ml plasma ET-1; n = 55) or low group (L group: < 2.90 pg/ml plasma ET-1; n = 55). Major complications and LV systolic function were monitored in the 2 groups. Both highly sensitive C-reactive protein (hs-CRP) and brain natriuretic peptide (BNP) showed a significant positive correlation with ET-1 (BNP: r = 048, p < 0.0001, hs-CRP: r = 0.43, p < 0.001). Chronic stage left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume index (LVEDVI) were significantly poorer in the H group (LVEF: 51+/-15% vs 60+/-13%, p = 0.003, LVEDVI: 74+/-19 ml/m2 vs 66+/-14 ml/m2, p < 0.05). There were significantly more major complications in the H group than in the L group (cardiogenic shock: 18% vs 5%, p = 0.04; cardiac death: 13% vs 0%, p < 0.01). CONCLUSIONS: In the setting of AMI, plasma ET-1 concentrations may be closely related to LV systolic dysfunction and poor patient outcome, including mortality.

Aged↗

PubMed2005

Predictors of mortality in patients with acute myocardial infarction and cardiogenic shock.

BACKGROUND: Although cardiogenic shock (CS) is the leading cause of death for acute myocardial infarction (AMI) patients, reliable predictive factors in the acute stage, such as cardiovascular peptides, have not yet been identified. METHODS AND RESULTS: In 42 consecutive AMI patients with CS on admission, successfully treated by primary percutaneous coronary intervention (PCI) within 12 h of onset, related factors including brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), renin, aldosterone, catecholamines, and adrenomedullin, were investigated 24 h from onset, as well as the 1-year mortality rates. During the 12-month follow-up period, 15 patients died from cardiovascular causes (group D). There were no significant differences in patient characteristics, angiographic findings, and left ventricular systolic function between group D subjects and the survivors (group S: n=27). Multivariate analysis identified high levels of adrenomedullin as an independent predictor of 1-year mortality (risk ratio: 6.42, 95% confidence interval, 1.49-43.31, p<0.05). CONCLUSIONS: The acute-phase plasma concentration of adrenomedullin may be a reliable predictor of mortality in patients with AMI complicated by CS and successfully treated by direct PCI, as may be BNP concentration, peak-creatine kinase value, and ventricular fibrillation.

Angioplasty, Balloon↗

PubMed2005

Histopathological findings of the no-reflow phenomenon following coronary intervention for acute coronary syndrome.

Although no-reflow phenomenon may occur in patients that experience reperfusion after ischemia, there have been no reports describing the postmortem findings in these patients. We describe the findings of an autopsy in a 56-year-old man who experienced acute coronary syndrome with no-reflow phenomenon after coronary intervention. Macroscopic study demonstrated myocardial infarction with diffuse hemorrhage, and microscopic analysis revealed vascular damage and microembolization in the no-reflow area. In conclusion, coronary microembolization and damage to the small coronary artery may contribute to the pathogenesis of no-reflow phenomenon following coronary intervention in humans.

Angioplasty, Balloon, Coronary↗

PubMed2005

Clinical outcomes and left ventricular function in diabetic patients with acute myocardial infarction treated by primary coronary angioplasty.

The objective of the present study was to compare left ventricular (LV) function and clinical outcomes in diabetics versus nondiabetics with acute myocardial infarction (AMI) treated by primary coronary angioplasty. A total of 327 consecutive AMI subjects were reperfused by primary coronary angioplasty within 12 hours from onset. Diabetes mellitus (DM) was present in 104 of the 327 patients. LV function was serially determined by left ventriculograms taken in the acute and chronic phases (6 months after onset). (I) The early ST-segment resolution rate was lower in DM patients compared with non-DM patients (59% versus 83%, P < 0.0001). (II) During a 6-month follow-up, the percentages of target vessel revascularization (TVR), coronary aorta bypass grafting (CABG), and cardiac death were higher in the DM patients compared with the non-DM patients (TVR: 29% versus 19%; P < 0.05, CABG: 10% versus 5% ; P < 0.05, cardiac death: 12% versus 4%; P = 0.01). (III) The differences in left ventricular ejection fraction (LVEF) between two stages (delta-LVEF) were significantly lower in the DM patients than the non-DM patients (1 +/- 9% versus 7 +/- 10%, P < 0.0001). (IV) Multivariate analysis identified DM as an independent predictor of cardiac death (Odds ratio 5.5, 95% CI, 1.3-23.7, P < 0.05) and as a sole independent predictor of LVEF deterioration (Odds ratio 5.8, 95% CI, 2.8-11.8, P < 0.001). In patients with AMI treated using primary coronary angioplasty, DM is closely related to left-ventricular systolic dysfunction and a poor patient outcome, including mortality.

Adult↗

PubMed2005

Histopathological changes of biopsied myocardium in Shoshin beriberi.

Cardiovascular beriberi is caused by thiamine deficiency and usually arises for one of two reasons: alcoholism or diet. Shoshin beriberi is a fulminant form of cardiac beriberi. We investigated the histopathological features of biopsied myocardial tissue samples from two patients with Shoshin beriberi (one patient with nonalcoholic beriberi and another patient with alcoholic beriberi). Interstitial fibrosis and a variation in size of the myocardial fibers were the main findings in the sample from these patients after thiamine treatment. These findings are persistent histopathological features in the myocardium of patients with Shoshin beriberi after thiamine treatment.

Beriberi↗

PubMed2005

Prognostic significance of time-delay to peak creatine kinase after direct percutaneous coronary intervention in acute myocardial infarction patients.

The aim of the present study was to investigate the prognostic significance of time-delay to peak creatine kinase (CK) after successful direct percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Our 240 consecutive first AMI attack subjects admitted within 5 hours from onset were successfully reperfused by direct PCI therapy. Subjects were divided into two groups according to the upper quartile value of peak-CK time from onset, the early peak-CK group (peak-CK time < or = 16 hours from onset, n = 180) and the late peak-CK group (peak-CK time > 16 hours, n = 60). (I) The early ST-segment resolution rate was lower in the late peak-CK group compared with the early peak-CK group (P < 0.05), and there were significantly fewer patients with preinfarction angina pectoris in the late peak-CK group than in the early peak-CK group (P < 0.01). (II) LVEF in the chronic stage was significantly lower in the late peak-CK group than in the early peak-CK group (49 +/- 13% versus 57 +/- 13%, P < 0.001). (III) There were significantly more patients with major complications in the late peak-CK group than in the early peak-CK group (required CABG: 10% versus 3%, P < 0.05; cardiac death: 18% versus 3%, P = 0.0001). (IV) Multivariate analysis identified late peak-CK as an independent predictor of cardiac death (Odds ratio 7.91, 95% C.I. 1.40-44.11, P < 0.05). In patients with AMI, the time-delay to peak-CK after successful direct PCI may be closely related to left-ventricular systolic dysfunction and poor patient outcome, including mortality.

Adult↗

PubMed2005

ST-segment elevation of electrocardiogram in a patient with Shoshin beriberi.

We report a case of a 58-year-old man with Shoshin beriberi who demonstrated ST-segment elevation and myocardial damage without coronary artery stenosis. The patient subsequently recovered with thiamine treatment. We conclude that it is important to consider Shoshin beriberi as part of the differential diagnosis in patients with shock and ST-segment elevation.

Beriberi↗

PubMed2005

Thrombosed Stanford type A dissection of the aorta in an elderly patient following a fall.

Physical or mental exertion is an important antecedent to dissection. A fall is one of the causes of hip fracture in the elderly population. We report the case of a 78-year-old woman who was diagnosed to have a thrombosed aortic dissection after a fall. We wish to emphasize with this case report that aortic dissection should be considered in the differential diagnosis of patients who complain of chest discomfort after a tumbling over.

Accidental Falls↗