Hidenori Yagi

Difference in risk factors between acute coronary syndrome and stable angina pectoris in the Japanese: smoking as a crucial risk factor of acute coronary syndrome.

BACKGROUND AND PURPOSE Metabolic syndrome and chronic kidney disease (CKD) have received attention as new risk factors for cardiovascular disease. This study evaluated differences in key risk factors between acute coronary syndrome (ACS) and stable angina pectoris (SAP) by using traditional coronary risk factors, metabolic syndrome, and CKD. METHODS Among 1890 consecutive patients admitted to our institution, we studied 140 patients with initially diagnosed ACS and 163 patients with initially diagnosed SAP and compared risk factors between the two groups. Next, the relationship between smoking status after the initial diagnosis of coronary artery disease (CAD) and the incidence of subsequent cardiac event was examined after discharge in 284 patients. RESULTS Adjusted multivariate analysis showed that only current smoking was an independent predictor of ACS (odds ratio, 2.20; 95% CI, 1.28-3.78; p=0.004) among all risk factors we examined. Treatment with a calcium-channel blocker had a preventive effect on ACS (odds ratio, 0.44; 95% CI, 0.26-0.75; p=0.003), but treatment with a beta-blocker did not. Patients who continued to smoke after CAD was diagnosed had a risk of cardiac events about 5 times that of smokers who quit (adjusted hazard ratio, 5.05; 95% CI, 1.33-19.20; p=0.02). CONCLUSIONS The risk factors were significantly different between initially diagnosed ACS and SAP. Smoking was a more important risk factor of initially diagnosed ACS. Smoking cessation might have a preventive effect on subsequent cardiac events. Also, we found that treatment with a calcium-channel blocker would help prevent ACS in Japanese patients.

Substrate Modification by Pulmonary Vein Isolation and Left Atrial Linear Ablation in Patients with Persistent Atrial Fibrillation: Its Impact on Complex‐Fractionated Atrial Electrograms

PV and Linear Ablation for CFAEs. Introduction: Linear ablations in the left atrium (LA), in addition to pulmonary vein (PV) isolation, have been demonstrated to be an effective ablation strategy in patients with persistent atrial fibrillation (PsAF). This study investigated the impact of LA linear ablation on the complex‐fractionated atrial electrograms (CFAEs) of PsAF patients.

Inhibitory effect of valsartan against progression of left ventricular dysfunction after myocardial infarction: T-VENTURE study.

BACKGROUND Angiotensin-converting enzyme inhibitors (ACEI) reduce the mortality in the chronic phase of myocardial infarction (MI), and similar effects of angiotensin receptor blockers (ARB) have been reported. However, these effects of ARB have not yet been established in Japanese patients. A multicenter randomized study was designed for the present study to examine the effect of valsartan as compared to that of ACEI against left ventricular dysfunction after MI. METHODS AND RESULTS Patients with acute MI were randomly allocated to either the valsartan group (n=120; mean age 63 +/-1.0) or the ACEI group (n=121; mean age 62.9 +/-1.0) and followed up until 6 months. Left ventriculography was performed during hospital admission and at 6 months. The blood pressure was similar in the 2 groups throughout the study. The incidences of cardiovascular events and target vessel revascularization were similar, although that of adverse events was significantly higher in the ACEI (12.4%) than in the valsartan group (3.3%; P<0.05). There were no differences in left ventricular ejection fraction and left ventricular end-diastolic volume index between the groups. CONCLUSIONS Valsartan exhibits similar efficacy effective to that of ACEI in preventing left ventricular dysfunction in Japanese patients with acute MI, and is, in addition, better tolerated than ACEI.

Current status of the use of inferior vena cava filters in cases of pulmonary embolism in CCUs: From the Tokyo CCU Network

OBJECTIVE To elucidate the current status of use of inferior vena cava filters (IVCFs) in cases of pulmonary embolism at institutions belonging to the Tokyo CCU Network. METHODS We conducted a retrospective investigation of 832 consecutive cases of pulmonary embolism reported on survey forms to the Tokyo CCU Network between 2005 and 2010. RESULTS Of 832 cases of pulmonary embolism, IVCFs were used in 338 (40.6%) and not used in 415 (49.9%). Their use was unclear in 79 (9.5%) cases. The use rate gradually increased each year from 2005 until 2008 but decreased from 2009 onward. Moreover, 68.9% of the IVCFs used in cases were non-permanent types. In terms of pulmonary embolism severity, the rate of use was 37.2% in non-massive cases, 49.4% in sub-massive cases, 46.9% in massive cases, and 31.9% in collapse cases. Thirty-day mortality in cases of collapse in which IVCFs were not used was extremely high at 75.8%, suggesting that in many cases, rapid deterioration may occur with insufficient time for IVCF insertion. The differences in IVCF usage rate among institutions were large in the range of 12.5-90% from 2005 to 2008, which slightly declined to the range of 25.0-72.2% from 2009 to 2010. CONCLUSIONS We elucidated the current IVCF use status in cases of pulmonary embolism at institutions belonging to the Tokyo CCU Network. Since the status of use differed among institutions, future studies of effective methods of use are required.

Transient increase in blood pressure after the Great East Japan Earthquake in patients with hypertension living around Tokyo

The Great East Japan Earthquake occurred at 2:46 p.m. on March 11, 2011. The focus of the earthquakemeasured 9.0 on the Richter scale and therefore demonstrated the greatest magnitude in the recorded history of Japan, and it affected a large area of ranging 500 km north and south from Iwate to Ibaragi, and about 200 km of east and west. In addition, the Dai-ichi nuclear power plant of Tokyo Electric Power in Fukushima Prefecture was damaged by the earthquake and the subsequent tsunami. The plant lost all power, and was unable to cool the nuclear reactor, thus resulting in a serious nuclear accident accompanied by the discharge of a lot of radioactive materials. Accumulating evidence demonstrates that blood pressure increases in hypertension patients after such a big earthquake. An acute elevation of bloodpressure has been reported after the Earthquake [1–5]. However, all previous reports studied only hypertension patients living in regions of “the active faults” of the earthquake. People experienced frequent aftershocks and the accident of powerplant not only in the region of the active faults of the earthquake but also in the surrounding areas following the Great East Japan Earthquake. The aftershocks and radiation may also have induced psychological and emotional stress that influenced the blood pressure even around Tokyo, which is approximately 200 kilometers away from the active faults. This studyexamined theblood pressure inpatients after theGreat East Japan Earthquake and compared those before and after the earthquake. Out of 306 patients who visited 1 of the 8 physicians in the outpatient clinic within 2 weeks after the Great East Japan Earthquake (at 0 week), we studied 110 patients (86males, age 68.0±11.9 years; 39 patients with ischemic heart disease, 73 with hypertension, 26 with diabetes mellitus and 18 with atrial fibrillation) who had regularly visited every 8 weeks before and continued to visit after the earthquake, and in whom medications had not been changed over the previous 2 years. The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the