Takao Kato

Impact of Predischarge Nocturnal Pulse Oximetry (Sleep-Disordered Breathing) on Postdischarge Clinical Outcomes in Hospitalized Patients With Left Ventricular Systolic Dysfunction After Acute Decompensated Heart Failure

Stratifying patients at a high risk for readmission and mortality before their discharge after acute decompensated heart failure (ADHF) is important. Although sleep-disordered breathing (SDB) is prevalent in patients with chronic heart failure, only few studies have investigated the impact of SDB on hospitalized patients with left ventricular (LV) systolic dysfunction after ADHF. Thus, we assessed the prevalence of SDB using nocturnal pulse oximetry and the relation between SDB and clinical events in this patient group. One hundred consecutive patients with LV systolic dysfunction who were hospitalized for ADHF were enrolled in the study. Predischarge nocturnal oximetry was performed to determine if they had SDB (defined as an oxygen desaturation index of ≥5 events/hour with ≥4% decrease in saturation level). Data on death and readmission for ADHF were collected. Forty-one patients had SDB. Complete outcome data were collected in the mean follow-up period of 14.2 months during which 33 events occurred. On multivariate Cox proportional hazards regression analysis, the presence of SDB was a significant independent predictor of postdischarge readmission and mortality (hazard ratio 2.93, p = 0.006). In conclusion, SDB, as determined by predischarge nocturnal oximetry, is prevalent and is an independent predictor of the combined end point of readmission and mortality in hospitalized patients with LV systolic dysfunction after ADHF.

Association between elevated blood glucose level on admission and long-term mortality in patients with acute decompensated heart failure

BACKGROUNDnThe effect of elevated blood glucose (BG) levels on the long-term prognosis of acute decompensated heart failure (ADHF) patients has not been well defined. The purpose of this study is to evaluate the long-term prognosis of ADHF with elevated BG.nnnMETHODSnA cohort of patients consecutively admitted to the cardiac intensive care unit from 2007 to 2011 was studied. Among these, 495 patients who met the criteria were divided into 4 groups based on their BG level and diabetes mellitus (DM) status. The risks for all-cause mortality in each group were assessed using the multivariate Cox proportional hazards model.nnnRESULTSnAt a median follow-up of 1.8 years, 148 patients had died. There were 168 patients without either BG elevation or DM, 67 without BG elevation but with DM, 105 with BG elevation but not DM, and 155 with both BG elevation and DM. In a multivariate model, those with BG elevation, regardless of DM status, showed a greater risk of increased mortality when compared with patients without either BG elevation or DM [hazard ratio (HR), 1.79; p=0.042 for BG elevation without DM and HR, 1.73; p=0.048 for BG elevation with DM].nnnCONCLUSIONnElevated BG levels, irrespective of the DM status, at the time of admission in patients with ADHF, appear to be a prognostic marker for ADHF.

Positive airway pressure therapy for heart failure

Heart failure (HF) is a life-threatening disease and is a growing public health concern. Despite recent advances in pharmacological management for HF, the morbidity and mortality from HF remain high. Therefore, non-pharmacological approaches for HF are being developed. However, most non-pharmacological approaches are invasive, have limited indication and are considered only for advanced HF. Accordingly, the development of less invasive, non-pharmacological approaches that improve outcomes for patients with HF is important. One such approach may include positive airway pressure (PAP) therapy. In this review, the role of PAP therapy applied through mask interfaces in the wide spectrum of HF care is discussed.

Low 1,5-anhydroglucitol levels are associated with long-term cardiac mortality in acute coronary syndrome patients with hemoglobin A1c levels less than 7.0%

BackgroundDiabetes mellitus is considered an important risk factor for cardiovascular diseases. High hemoglobin A1c (HbA1c) levels, which indicate poor glycemic control, have been associated with occurrence of cardiovascular diseases. There are few parameters which can predict cardiovascular risk in patients with well-controlled diabetes. Low 1,5-anhydroglucitol (1,5-AG) levels are considered a clinical marker of postprandial hyperglycemia. We hypothesized that low 1,5-AG levels could predict long-term mortality in acute coronary syndrome (ACS) patients with relatively low HbA1c levels.MethodsThe present study followed a retrospective observational study design. We enrolled 388 consecutive patients with ACS admitted to the cardiac intensive care unit at the Juntendo University Hospital from January 2011 to December 2013. Levels of 1,5-AG were measured immediately before emergency coronary angiography. Patients with early stent thrombosis, no significant coronary artery stenosis, malignancy, liver cirrhosis, a history of gastrectomy, current steroid treatment, moderately to severely reduced kidney function (estimated glomerular filtration rate <xa045xa0ml/min/1.73xa0m2; chronic kidney disease stage 3B, 4, and 5), HbA1c levels ≥xa07.0%, and those who received sodium glucose co-transporter 2 inhibitor therapy were excluded.ResultsDuring the 46.9-month mean follow-up period, nine patients (4.5%) died of cardiovascular disease. The 1,5-AG level was significantly lower in the cardiac death group compared with that in the survivor group (12.3xa0±xa05.3 vs. 19.2xa0±xa07.7xa0µg/ml, pxa0<xa00.01). Kaplan–Meier survival analysis showed that low 1,5-AG levels were associated with cardiac mortality (pxa0=xa00.02). Multivariable Cox regression analysis showed that 1,5-AG levels were an independent predictor of cardiac mortality (hazard ratio 0.76; 95% confidence interval 0.41–0.98; pxa0=xa00.03).ConclusionLow 1,5-AG levels, which indicate postprandial hyperglycemia, predict long-term cardiac mortality even in ACS patients with HbA1c levelsxa0<xa07.0%.

ASSOCIATION BETWEEN PERIODIC LEG MOVEMENTS DURING SLEEP AND CLINICAL OUTCOMES IN HOSPITALIZED PATIENTS WITH SYSTOLIC HEART FAILURE FOLLOWING ACUTE DECOMPENSATION

Periodic leg movement during sleep (PLM) is a disorder characterized by regularly recurring movements of the legs during sleep. Although PLM disorder (PLMD) is common and a predictor of mortality in patients with chronic heart failure, prevalence and clinical significance of PLMD in hospitalized

Relationship between blood urea nitrogen-to-creatinine ratio at hospital admission and long-term mortality in patients with acute decompensated heart failure

Although elevated blood urea nitrogen (BUN)-to-creatinine (BUN/Cr) ratio at hospital admission has been reported to be associated with poor short-term prognosis, its association to long-term mortality in patients with acute decompensated heart failure (ADHF) remains to be elucidated. Moreover, an additive prognostic value to preexisting renal markers including creatinine and BUN has not been well described. A cohort of 557 consecutive ADHF patients admitted to the cardiac intensive care unit was studied. All cohorts were divided into high and low BUN/Cr ratios according to the median value of BUN/Cr ratio at admission. Association between admission BUN/Cr ratio and long-term all-cause mortality was assessed. There were 145 deaths (27%) observed during the follow-up period of 1.9xa0years in median. Patients with high BUN/Cr ratio showed with higher mortality compared to low BUN/Cr ratio (log-rank: Pxa0=xa00.006). In the multivariable analysis, patients with high BUN/Cr ratio at admission were associated with high mortality independently from other covariates including BUN and creatinine (HR 1.81, 95% CI 1.16–2.80, Pxa0=xa00.009). In patients with ADHF, there is a relationship between admission BUN-to-creatinine ratio and long-term mortality.

Influence of sleep-disordered breathing assessed by pulse oximetry on long-term clinical outcomes in patients who underwent percutaneous coronary intervention

BackgroundSleep-disordered breathing (SDB) has been recognized as an important risk factor for coronary artery disease (CAD). However, SDB was not fully examined, because sleep studies are limited. Nocturnal pulse oximetry has been suggested to be a useful tool for evaluating SDB. Therefore, the aim of this study was to investigate the influence of SDB assessed by nocturnal pulse oximetry on clinical outcomes in patients who underwent percutaneous coronary intervention (PCI).MethodsWe conducted a prospective, multicenter, observational cohort study, wherein SDB was assessed by finger pulse oximetry in patients who underwent PCI from January 2014 to December 2016. SDB was defined as 4% oxygen desaturation index of 5 and higher. The primary endpoint was major adverse cardiac or cerebrovascular event (MACCE), defined as a composite of all-cause mortality, acute coronary syndrome, and/or stroke.ResultsOf 539 patients, 296 (54.9%) had SDB. MACCE occurred in 32 patients (5.8%) during a median follow-up of 1.9xa0years. The cumulative incidence of MACCE was significantly higher in patients with SDB (Pu2009=u20090.0134). In the stepwise multivariable Cox proportional model, the presence of SDB was a significant predictor of MACCE (hazard ratio 2.26; 95% confidence interval 1.05–5.4, Pu2009=u20090.036).ConclusionsSDB determined by nocturnal pulse oximetry was associated with worse clinical outcomes in patients who underwent PCI. Screening for SDB with nocturnal pulse oximetry was considered to be important for risk stratification in patients with CAD.

Prevalence and Clinical Correlates of Sleep-Disordered Breathing in Patients Hospitalized With Acute Decompensated Heart Failure

BACKGROUNDnLimited data are available regarding the presence of sleep-disordered breathing (SDB) assessed using polysomnography in patients hospitalized with left ventricular (LV) systolic dysfunction after acute decompensated heart failure (ADHF). We investigated the prevalence and clinical correlates of SDB in patients hospitalized with ADHF and LV systolic dysfunction.nnnMETHODSnProspectively collected data from 105 consecutive patients with an LV ejection fraction < 50% who were hospitalized with ADHF from May 2012 to July 2014 were retrospectively assessed. Polysomnography was performed during the initial hospitalization after the initial improvement in ADHF acute signs and symptoms. The apnea-hypopnea index (AHI), including obstructive or central AHI, was computed as a severity of obstructive or central sleep apnea. Echocardiography and blood sampling for various parameters, such as B-type natriuretic peptide level, were performed systematically.nnnRESULTSnThe proportions of patients with an AHI ≥ 5 events per hour and those with an AHI ≥ 15 events per hour were 93% and 69%, respectively, and central sleep apnea was predominant (66% and 44%, respectively). In the multivariate analysis, only body mass index (BMI) was independently correlated with AHI, whereas age, BMI, and E/e level were independently correlated with obstructive AHI. In addition, use of loop diuretics and E/e level were independently correlated with central AHI.nnnCONCLUSIONSnSDB determined using polysomnography was common in hospitalized patients with ADHF and LV systolic dysfunction. Age, BMI, and E/e levels were significantly correlated with obstructive sleep apnea severity, whereas E/e levels and use of loop diuretics were significantly correlated with central sleep apnea severity.

Decreased circulating dihomo-gamma-linolenic acid levels are associated with total mortality in patients with acute cardiovascular disease and acute decompensated heart failure

BackgroundPolyunsaturated fatty acids (PUFAs) have important roles in the pathogenesis of cardiovascular diseases. However, the clinical significance of omega-6 PUFAs in acute cardiovascular disease remains unknown.MethodsWe enrolled 417 consecutive patients with acute cardiovascular disease admitted to the cardiac intensive care unit at Juntendo University Hospital between April 2012 and October 2013. We investigated the association between serum PUFA levels and long-term mortality. Blood samples were collected after an overnight fast, within 24xa0h of admission. We excluded patients who received eicosapentaenoic acid therapy and those with malignancy, end-stage kidney disease, chronic hepatic disease, and connective tissue disease.ResultsOverall, 306 patients (mean age: 66.4xa0±xa015.0xa0years) were analysed. During the follow-up period of 2.4xa0±xa01.2xa0years, 50 patients (16.3%) died. The dihomo-gamma-linolenic acid (DGLA) levels, arachidonic acid (AA) levels, and DGLA/AA ratio were significantly lower in the nonsurvivor group than in the survivor group (DGLA: 23.2xa0±xa09.8 vs. 31.5xa0±xa012.0xa0μg/ml, AA: 151.1xa0±xa041.6 vs. 173.3xa0±xa051.6xa0μg/ml, and DGLA/AA: 0.16xa0±xa00.05 vs. 0.19xa0±xa00.06, all pxa0<xa00.01). Kaplan–Meier curves showed that survival rates were significantly higher in the higher DGLA, AA, and DGLA/AA groups than in their lower counterparts (DGLA and AA; pxa0<xa00.01, DGLA/AA; pxa0=xa00.01), although omega-3 PUFAs were not associated with prognosis. Furthermore, in patients with acute decompensated heart failure (ADHF), survival rates were significantly higher in the higher DGLA, AA, and DGLA/AA groups than in their lower counterparts (DGLA and AA; pxa0<xa00.01, DGLA/AA; pxa0=xa00.04). However, among patients with acute coronary syndrome, none of the PUFA levels were associated with prognosis. Among patients with ADHF, after controlling for confounding variables, DGLA and DGLA/AA were associated with long-term mortality [DGLA: hazard ratio (HR), 0.94; 95% confidence interval (CI), 0.88–0.99; pxa0=xa00.01 and DGLA/AA: HR, 0.87; 95% CI, 0.77–0.97; pxa0<xa00.01], whereas AA was not associated with prognosis.ConclusionLow omega-6 PUFA levels, particularly DGLA, and a low DGLA/AA ratio predict long-term mortality in patients with acute cardiovascular disease and ADHF.Trial registrationUMIN-CTR; UMIN000007555.

Low circulating coenzyme Q10 during acute phase is associated with inflammation, malnutrition, and in-hospital mortality in patients admitted to the coronary care unit

Coenzyme Q10 (CoQ10) has a potential role in the prevention and treatment of heart failure through improved cellular bioenergetics. In addition, it has antioxidant, free radical scavenging, and vasodilatory effects that may be beneficial. Although critical illness in intensive care unit is associated with decreased circulating CoQ10 levels, the clinical significance of CoQ10 levels during acute phase in the patients of cardiovascular disease remains unclear. We enrolled 257 consecutive cardiovascular patients admitted to the coronary care unit (CCU). Serum CoQ10 levels were measured after an overnight fast within 24xa0h of admission. We examined the comparison of serum CoQ10 levels between survivors and in-hospital mortalities in patients with cardiovascular disease. Serum CoQ10 levels during the acute phase in patients admitted to the CCU had similar independent of the diagnosis. CoQ10 levels were significantly lower in patients with in-hospital mortalities than in survivors (0.43xa0±xa00.19 vs. 0.55xa0±xa00.35xa0mg/L, Pxa0=xa00.04). In patients admitted to the CCU, CoQ10 levels were negatively associated with age and C-reactive protein levels, and positively associated with body mass index, total cholesterol, and high-density lipoprotein cholesterol levels. Low CoQ10 levels correlated with low diastolic blood pressure. Multivariate logistic regression analysis demonstrated that low CoQ10 levels were an independent predictor of in-hospital mortality. Low serum CoQ10 levels during acute phase are significantly associated with cardiovascular risk and in-hospital mortality in patients admitted to the CCU.