Fumihiko Takahashi

A newly estimated glomerular filtration rate is independently associated with arterial stiffness in Japanese patients.

Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular disease, and thus is a major worldwide public health problem. Recently, an estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation for Japanese patients was proposed by the Japanese Society of Nephrology. However, the role of eGFR in the assessment of atherosclerosis is not well understood in Japanese patients. We analyzed the relationship between eGFR and severity of arterial stiffness using brachial-ankle pulse wave velocity (baPWV) in 647 adult Japanese patients. baPWV correlated significantly and positively with age, hypertension, diabetes, prior cardiovascular disease, blood pressure, pulse pressure and heart rate, and negatively with eGFR (r=−0.405, p<0.0001). A multiple regression analysis revealed that baPWV correlated independently with eGFR. Furthermore, there was a stepwise increase in baPWV, corresponding to advances in CKD through stages 1 to 5. When CKD stage 3 was divided at eGFR 45 mL/min/1.73 m2, the baPWV of stage 3b (eGFR 30 to 44) was significantly higher than that of stage 3a (eGFR 45 to 59) independent of traditional risk factors, suggesting that an eGFR of 45 mL/min/1.73 m2 may be a critical cut off value to predict arterial stiffness in CKD. In conclusion, the newly proposed eGFR is significantly associated with arterial stiffness, independent of traditional risk factors for cardiovascular disease.

A Case of a Short-Coupled Variant of Torsades De Pointes with Electrical Storm

TAKEUCHI, T., et al.: A Case of a Short‐Coupled Variant of Torsades De Pointes with Electrical Storm. This case report describes a short‐coupled variant of Torsades de Pointes with a characteristic ECG pattern consisting of a prominent J wave in leads V3–V6, in which an electrical storm was evoked with autonomic receptor stimulation and a blockade test. The patients frequent VF attacks were triggered by short‐coupled premature ventricular contractions with a right bundle branch block morphology and left‐axis deviation, and were suppressed by deep sedation followed by a combination therapy using verapamil and mexiletine. Interestingly, with the use of those drugs, the prominent J wave diminished. The mechanism underlying this syndrome is discussed. (PACE 2003; 26[Pt. I]:632–636)

Multiple and Recurrent Systemic Thrombotic Events Associated with Congenital Anomaly of Inferior Vena Cava

We describe a case of a 67-year-old woman with a history of cerebral infarction and pulmonary embolism that presented with chest pain. Subsequent evaluation resulted in a diagnosis of acute myocardial infarction and occult DVT, and imaging revealed a rare congenital absence of the infra-renal portion of the inferior vena cava, with lower extremity venous drainage diverted via an ascending lumbar vein. Associations between congenital absence of the inferior vena cava and thrombosis are discussed.

Renal Artery Stenosis Emerged After Angiotensin-Converting Enzyme Inhibitor Treatment for Myocardial Infarction A Case Report

A 76-year-old woman with acute myocardial infarction underwent percutaneous coronary angioplasty followed by treatment with an angiotensin-converting enzyme (ACE) inhibitor, lisinopril. Her renal function deteriorated after the administration of lisinopril, so it was changed to another ACE inhibitor, temocapril. Renography suggested a complication of severe right renal artery stenosis, and renal angiography revealed bilateral renal artery stenoses. Her renal hemodynamics were assessed by 99mTc-Mercaptoacetyltriglycine (99mTc-MAG3)-renography before and after withdrawal of temocapril. The authors concluded the patient had essential hypertension complicated by atherosclerotic renovascular disease. In the treatment of elderly patients with heart disease, hypertension, or both, with ACE inhibitor, the possibility of coexisting renal artery stenosis should be considered. Renography is recommended as a reliable tool for detecting renal artery stenosis.

Effects of long-term oral magnesium treatment on blood pressure and vascular reacitivity in Dahl salt-sensitive rats

BackgroundThis study was designed to investigate the effects of long-term oral magnesium treatment on blood pressure and vascular reactivity in Dahl salt-sensitive and Dahl salt-resistant rats.MethodsThe rats were fed a low-salt (0.3% sodium chloride [NaCl]) or a high-salt (8% NaCl) diet, with or without magnesium in the drinking water (aspartic acid magnesium, 15.4 g/L), for 4 weeks. Blood pressure, urinary electrolytes, and noradrenaline excretion were measured. Vascular reactivity to potassium chloride (KCl), 5-hydroxytryptamine, acetylcholine and sodium nitroprusside were studied using the rings of isolated superior mesenteric arteries.ResultsFour weeks of oral magnesium treatment significantly prevented blood pressure elevation in salt-loaded salt-sensitive rats, and decreased heart rate and urinary noradrenaline excretion. Alteration of vascular reactivity, hypercontractility to KCl or 5-hydroxytryptamine, and the decrease in endothelium-dependent relaxation to acetylcholine were observed in the superior mesenteric arteries of salt-loaded salt-sensitive rats, and magnesium treatment improved the hypercontractility to KCl.ConclusionsIn salt-sensitive rats fed the high-salt diet, 4 weeks of oral magnesium treatment prevented the blood pressure elevation, and improved hypercontractility to KCl, in isolated superior mesenteric arteries. These results suggest that an appropriate oral magnesium treatment may be effective in salt-loaded hypertensive salt-sensitive rats.