Toshinobu Saito

Riser Blood Pressure Pattern Is Associated With Mild Cognitive Impairment in Heart Failure Patients

BACKGROUNDnThe riser pattern, an abnormal blood pressure (BP) rhythm in which sleep BP exceeds awake BP, is a predictor of future stroke events. Although the riser pattern is caused by autonomic dysfunction, its significance in heart failure (HF) patients is not established. HF patients often suffered from cognitive impairment (CI), but the relationship between riser pattern and CI is not clearly understood. We tested the hypothesis that the riser pattern is associated with mild CI, a form of brain damage that could develop to dementia.nnnMETHODSnWe performed Mini-Mental State Examination (MMSE), ambulatory BP monitoring (ABPM), echocardiography, and blood tests in 444 HF patients just before leaving hospitals. Mild CI, a measure of cognitive function, was defined as the score <26.nnnRESULTSnThe mean age of the patients was 68±13 years; 61.5% were male; 22.5% were riser pattern. The MMSE score was significantly lower in the Riser group than in the Non-dipper and Dipper group (23±4 vs. 25±5, 26±4, respectively, P < 0.01). In multivariable logistic regression analysis, a riser pattern was significantly associated with mild CI (odds ratio 2.38, 95% confidence intervals 1.29-4.42, P < 0.01) after adjusting for significant covariates.nnnCONCLUSIONSnThe riser pattern was associated with mild CI in HF patients. An abnormal circadian BP rhythm in HF patients is clinically significant as a potential indicator of subclinical brain damage.

Riser Pattern Is a Novel Predictor of Adverse Events in Heart Failure Patients With Preserved Ejection Fraction

BACKGROUNDnThe cardiovascular prognosis of heart failure with preserved ejection fraction (HFpEF) has been shown to be similar to that of heart failure with reduced ejection fraction (HFrEF). It is unknown which factors predict cardiovascular outcome in HFpEF. We tested the hypothesis that the abnormal pattern of circadian blood pressure (BP) rhythm known as the riser BP pattern is associated with adverse outcomes in HFpEF.Methodsu2004andu2004Results:We performed a prospective, observational cohort study of hospitalized HF patients who underwent ambulatory BP monitoring (ABPM). Five hundred and sixteen hospitalized HF patients (age, 69±13xa0years; male, n=321 [62%]; female, n=195 [38%]) were followed up for a median 20.9xa0months. The composite outcome consisting of all-cause mortality and cardiovascular events was observed in 220 patients. On Kaplan-Meier analysis, the riser BP pattern subgroup had a significantly higher incidence of the composite outcome than the other subgroups of HFpEF patients (HR, 3.01; 95% CI: 1.54-6.08, P<0.01), but not the HFrEF patients.nnnCONCLUSIONSnThe riser BP pattern was found to be a novel predictor of cardiovascular outcome in HFpEF patients.

Riser Pattern: Another Determinant of Heart Failure With Preserved Ejection Fraction

Paradoxical increase in blood pressure (BP) during sleep, exceeding those of awake BP, is called the “riser” BP pattern, and known as an abnormal circadian BP rhythm, has been reported to be associated with adverse cardiovascular prognoses. However, the significance of ambulatory BP in heart failure patients with preserved ejection fraction (HFpEF) has never been reported. Here, we tested our hypothesis that abnormal circadian BP rhythm is associated with HFpEF. The authors enrolled 508 patients with hospitalized HF (age 68±13 years; 315 men, 193 women). There were 232 cases of HFpEF and 276 cases of heart failure with reduced ejection fraction (HFrEF). The riser BP pattern was significantly more frequent in the HFpEF (28.9%) group compared with the HFrEF group (19.9%). In a multivariable logistic regression analysis, the riser BP pattern was associated with HFpEF (odds ratio, 1.73; 95% confidence interval, 1.02–2.91; P=.041) independent of the other covariates. In conclusion, the riser BP pattern was associated with HFpEF.

High-sensitivity troponin T is a prognostic marker for patients with aortic stenosis after valve replacement surgery

BACKGROUNDnAortic stenosis (AS) is recognized as a cause of sudden cardiac death. Recently, the measurement of high-sensitivity troponin T (hs-TnT) has become possible. Several studies have clarified that hs-TnT is a marker to indicate mortality of cardiovascular diseases.nnnOBJECTIVESnTo examine whether hs-TnT can be used as a prognostic marker to predict the operative outcome of AS.nnnMETHODSnWe enrolled 60 patients with AS (mean age=68.7 ± 9.6 years, male/female=30/30). Cardiac catheterization and echocardiography were performed to evaluate the severity of AS. Aortic valve replacement surgery was performed in all patients. We defined major adverse cardiac events (MACE) as composite events of heart failure, fatal arrhythmia, and all causes of death.nnnRESULTSnWe followed up the patients for 922 ± 800 days. Mean left ventricular ejection fraction was 60.0 ± 1.8%. Mean aortic valve area was 0.61 ± 0.03 cm(2). MACE occurred in 11 patients (18%), including 5 sudden cardiac deaths. We divided the patients into three groups based on the percentile of the plasma levels of hs-TnT. Kaplan-Meier curve revealed a statistically significant difference in MACE rate among the groups (log-rank test, χ(2)=13.0, p=0.002). We conducted a Cox proportional hazard analysis with a model including age, sex, estimated glomerular filtration rate, and hs-TnT tertile as explanatory variables to predict MACE. We found that hs-TnT tertile to be a significant factor to predict MACE (hazard ratio: 3.71, p=0.03).nnnCONCLUSIONSnhs-TnT can be a prognostic marker for patients with AS after valve replacement surgery.

Relationship between Fibroblast Growth Factor 21 and Extent of Left Ventricular Remodeling after Acute Myocardial Infarction

Background: Fibroblast growth factor 21 (FGF21) is a novel myokine released from skeletal muscle. Recent studies have showed that FGF21-transgenic mice had low plasma levels of insulin-like growth factor-1, a potent tissue survival factor, in ischemic myocardium following acute myocardial infarction (AMI). nObjective: To examine a role of FGF21 in subsequent complication after AMI. nMethods: Patients experiencing their first AMI (n=71, mean age 62.4±10.1 years old) was employed. Successful coronary reperfusion was accomplished within 12 hours in all patients. Plasma FGF21 levels were measured on admission, and 7 days and 6 months after onset. Left ventricular (LV) remodeling was assessed by left ventriculography on the day of admission and 6 months after AMI. nResults: Levels of FGF21 in plasma peaked on admission and had declined by 6 months (admission: 611±40, day 7: 246±23, 6 months: 316±24 pg/ml, P<0.001). The FGF21 levels were correlated with plasma lactate levels on admission (r=+0.26, P=0.03). The LV end-diastolic volume index (LVEDVI) significantly increased 6 months after AMI (admission: 79.5±2.4, 6 months: 84.5±2.9 ml/m 2 , P=0.004). The FGF 21 levels on admission were positively correlated with the changes in LVEDVI (r=+0.23, P=0.04). The multivariate regression analysis showed that the plasma FGF21 levels on admission was a significant explanatory variable for the changes in LVEDVI (β=+0.232, P=0.041). nConclusions: These results suggest that a novel myokine, FGF21, reflects circulatory insufficiency and could be a marker for late-stage LV remodeling after AMI.

An α-glucosidase inhibitor could reduce T-wave alternans in type 2 diabetes patients

BACKGROUNDnWe tested the hypothesis that an alpha-glucosidase inhibitor (α-GI), miglitol, is effective in protecting the cardiovascular system in type 2 diabetes mellitus (T2DM).nnnMETHODSnWe studied 19 hospitalized heart disease patients with T2DM in whom we performed continuous glucose monitoring, Holter electrocardiogram, and ambulatory blood pressure (BP) monitoring simultaneously for 48h. The α-GI miglitol was administered for half of the study period by a cross-over fashion. T-wave alternans (TWA), a marker of future fatal arrhythmic events, was also analyzed by Holter ECG.nnnRESULTSnOf the 19 patients, the measures of glucose variability were significantly lower during miglitol therapy than in control period. BP variability was similar with/without miglitol. However, TWA was significantly lower during the miglitol period compared to control period (63±4.8 vs. 75.8±5.1μV, p=0.032).nnnCONCLUSIONnAn α-GI, miglitol, can reduce TWA by reducing the fluctuation of glucose in heart disease patients with T2DM.