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American Journal of Cardiology | 2011
Hiromichi Ueda; Takahisa Yamada; Masaharu Masuda; Yuji Okuyama; Takashi Morita; Yoshio Furukawa; Tanaka Koji; Yusuke Iwasaki; Takeshi Okada; Masato Kawasaki; Yuki Kuramoto; Takashi Naito; Tadao Fujimoto; Issei Komuro; Masatake Fukunami
We conducted a prospective study to determine whether a bolus injection of sodium bicarbonate before emergent coronary procedures in patients with chronic kidney disease (CKD) might prevent contrast-induced nephropathy (CIN). We enrolled 59 patients with CKD, defined by a serum creatinine concentration of >1.1 mg/dl or an estimated glomerular filtration rate of <60 ml/min, who were scheduled at admission to undergo an emergent coronary procedure. The patients were randomized to receive a bolus intravenous injection of 154 mEq/L of sodium bicarbonate (n = 30) or sodium chloride (n = 29) at the dose of 0.5 ml/kg, before contrast administration, followed by infusion of 154 mEq/L sodium bicarbonate at 1 ml/kg/hour for 6 hours in both groups. The primary end point was the occurrence of CIN, defined as an increase by > 25% or > 0.5 mg/dl of the serum creatinine level within 2 days after the procedure. In the sodium bicarbonate group, the serum creatinine concentration remained unchanged within 2 days of contrast administration (from 1.32 ± 0.46 to 1.38 ± 0.60 mg/dl, p = 0.33). In contrast, it had increased in the sodium chloride group (1.51 ± 0.59 to 1.91 ± 1.19 mg/dl, p = 0.006). The incidence of CIN was significantly lower in the sodium bicarbonate group than in the sodium chloride group (3.3% vs 27.6%, p = 0.01). In conclusion, rapid alkalization by bolus injection of sodium bicarbonate was effective for the prevention of CIN in patients with CKD undergoing emergent procedures.
Pacing and Clinical Electrophysiology | 2006
Yoshio Furukawa; Hiroki Shimizu; Kenji Hiromoto; Tetsuzou Kanemori; Tohru Masuyama; Mitsumasa Ohyanagi
Background: Recent studies have demonstrated that increased QT interval variability (QTV) is associated with a greater susceptibility to ventricular arrhythmias and that patients with prior myocardial infarction (MI) were prone to ventricular arrhythmias during the daytime. The goal of the present study was to investigate the circadian variation of the QTV and to determine whether β‐blocker therapy improves the temporal fluctuation of the ventricular repolarization in patients with MI.
American Journal of Cardiology | 2011
Yuki Kuramoto; Takahisa Yamada; Shunsuke Tamaki; Yuji Okuyama; Takashi Morita; Yoshio Furukawa; Koji Tanaka; Yusuke Iwasaki; Taku Yasui; Hiromichi Ueda; Takeshi Okada; Masato Kawasaki; Wayne C. Levy; Issei Komuro; Masatake Fukunami
The Seattle Heart Failure Model (SHFM) is a validated prediction model that estimates the mortality in patients with chronic heart failure (CHF) using commonly obtained information, including clinical data, laboratory test results, medication use, and device implantation. In addition, cardiac iodine-123 meta-iodobenzylguanidine (MIBG) imaging provides prognostic information for patients with CHF. However, the long-term predictive value of combining the SHFM and cardiac MIBG imaging in patients with CHF has not been elucidated. To prospectively investigate whether cardiac iodine-123 MIBG imaging provides additional prognostic value to the SHFM in patients with CHF, we studied 106 outpatients with CHF who had radionuclide left ventricular ejection fraction < 40% (30 ± 8%). The SHFM score was obtained at enrollment, and the cardiac MIBG washout rate (WR) was calculated from anterior chest images obtained at 20 and 200 minutes after isotope injection. During a mean follow-up of 6.8 ± 3.5 years (range 0 to 13), 32 of 106 patients died from cardiac causes. A multivariate Cox analysis revealed that the WR (p = 0.0002) and SHFM score (p = 0.0091) were independent predictors of cardiac death. Kaplan-Meier analysis showed that patients with an abnormal WR (> 27%) had a significantly greater risk of cardiac death than did those with a normal WR for both those with a SHFM score of ≥ 1 (relative risk 3.3, 95% confidence interval 1.2 to 9.7, p = 0.01) and a SHFM score of ≤ 0 (relative risk 3.4, 95% confidence interval 1.2 to 9.6, p = 0.004). In conclusion, the cardiac MIBG WR provided additional prognostic information to the SHFM score for patients with CHF.
Journal of Cardiovascular Electrophysiology | 2013
Yoshio Furukawa; Takahisa Yamada; Takashi Morita; Yusuke Iwasaki; Masato Kawasaki; Atsushi Kikuchi; Takashi Naito; Tadao Fujimoto; Kentaro Ozu; Takumi Kondo; Kaoruko Sengoku; Hironori Yamamoto; F.A.C.C. Tohru Masuyama M.D.; Masatake Fukunami
Identification of patients with chronic heart failure (CHF) at a risk for sudden cardiac death (SCD) is an important objective. Early repolarization pattern (ERP) is associated with ventricular fibrillation in patients without structural heart diseases. Moreover, ERP was reported to be associated with SCD in patients with old myocardial infarction in a case‐control study. However, little information is available on the prognostic significance of ERP in CHF patients. Thus, we aimed to investigate whether ERP is associated with SCD in CHF patients.
The American Journal of the Medical Sciences | 2012
Yuki Kuramoto; Yoshio Furukawa; Takahisa Yamada; Masatake Fukunami; Yuji Okuyama
A 37-year-old Japanese woman experienced aborted sudden cardiac death from ventricular fibrillation and was diagnosed with Andersen-Tawil syndrome by genetic analysis that revealed 2 mutations in the KCNJ2 gene. Although she received an implantation of implantable cardioverter defibrillator and beta-blocker therapy, the frequency of premature ventricular contraction and bidirectional ventricular tachycardia did not decrease. Her ventricular arrhythmias increased after a full stomach test and a neostigmine provocation test, and reduced after cibenzoline administration, which indicates the relation with vagal tone. Moreover, increasing the pacing rate significantly decreased them. These findings indicate that the arrhythmia was bradycardia-dependent in this case.
Circulation | 2017
Shunsuke Tamaki; Yoshihiro Sato; Takahisa Yamada; Takashi Morita; Yoshio Furukawa; Yusuke Iwasaki; Masato Kawasaki; Atsushi Kikuchi; Takumi Kondo; Tatsuhisa Ozaki; Masahiro Seo; Iyo Ikeda; Eiji Fukuhara; Makoto Abe; Jun Nakamura; Masatake Fukunami
BACKGROUND Although the mainstay of treatment for acute decompensated heart failure (ADHF) is decongestion by diuretic therapy, it is often associated with worsening renal function (WRF). The effect of tolvaptan, a selective V2 receptor antagonist, on WRF in ADHF patients with preserved left ventricular ejection fraction (LVEF) is unknown.Methods and Results:We enrolled 50 consecutive ADHF patients whose LVEF on admission was ≥45%. Patients were randomly assigned to either tolvaptan add-on (n=26) or conventional diuretic therapy (n=24). The primary endpoint was the incidence of WRF, defined as an increase in serum creatinine (Cr) ≥0.3 mg/dL or 50% above baseline within 48 h of randomization. There was no significant difference between the 2 groups in the change in body weight or the total urine volume during 48 h. However, the change in Cr (∆Cr) at 24 and 48 h after randomization and the incidence of WRF (12% vs. 42%, P=0.0236) were significantly lower, and the fractional excretion of urea (FEUN) at 24 and 48 h after randomization was significantly higher in the tolvaptan group. There was an inverse correlation between ∆Cr and FEUN at 48 h after randomization. CONCLUSIONS Tolvaptan can alleviate congestion with a significantly lower risk of WRF in ADHF patients with preserved LVEF, presumably through maintenance of renal perfusion.
Esc Heart Failure | 2015
Shunsuke Tamaki; Takahisa Yamada; Takashi Morita; Yoshio Furukawa; Yusuke Iwasaki; Masato Kawasaki; Atsushi Kikuchi; Takumi Kondo; Tsutomu Kawai; Satoshi Takahashi; Masashi Ishimi; Hideyuki Hakui; Tatsuhisa Ozaki; Yoshihiro Sato; Masahiro Seo; Yasushi Sakata; Masatake Fukunami
Right ventricular (RV) systolic dysfunction has been shown to be an independent predictor of clinical outcome in patients with chronic heart failure (CHF), and cardiac metaiodobenzylguanidine (MIBG) imaging also provides prognostic information. We aimed to evaluate the long‐term predictive value of combining RV systolic dysfunction and abnormal findings of cardiac MIBG imaging on outcome in CHF patients.
Circulation | 2018
Takumi Kondo; Takahisa Yamada; Shunsuke Tamaki; Takashi Morita; Yoshio Furukawa; Yusuke Iwasaki; Masato Kawasaki; Atsushi Kikuchi; Tatsuhisa Ozaki; Yoshihiro Sato; Masahiro Seo; Iyo Ikeda; Eiji Fukuhara; Makoto Abe; Jun Nakamura; Yasushi Sakata; Masatake Fukunami
BACKGROUND Although hyponatremia predicts morbidity and mortality in acute decompensated heart failure (ADHF), hypochloremia is also independently associated with poor prognosis in ADHF. Little is known, however, about the prognostic value of serial change in serum chloride during hospitalization in ADHF patients.Methods and Results:We prospectively studied 208 ADHF survivors after discharge and divided them into 4 groups according to serum chloride on admission and at discharge: (1) persistent hypochloremia group (n=12), hypochloremia both on admission and at discharge; (2) progressive hypochloremia group (n=42), development of hypochloremia after admission; (3) improved hypochloremia group (n=14), hypochloremia only on admission; and (4) no hypochloremia group, no hypochloremia during hospitalization (n=140). During a mean follow-up period of 1.86±0.76 years, 20 of 208 patients had heart failure death (HFD). In a model adjusted for hyponatremia, hypochloremia both on admission and at discharge was still significantly associated with HFD. Hyponatremia, however, was not significantly associated with HFD after adjustment for hypochloremia. Patients with persistent hypochloremia (HR, 9.13; 95% CI: 2.56-32.55) and with progressive hypochloremia (HR, 4.65; 95% CI: 1.61-13.4) had a significantly greater risk of HFD than those without hypochloremia during hospitalization. CONCLUSIONS Both persistent hypochloremia and progressive hypochloremia during hospitalization are associated with HFD in ADHF patients.
Pacing and Clinical Electrophysiology | 2017
Masato Kawasaki; Takahisa Yamada; Yuji Okuyama; Takashi Morita; Yoshio Furukawa; Shunsuke Tamaki; Yusuke Iwasaki; Atsushi Kikuchi; Yasushi Sakata; Masatake Fukunami
Eplerenone is reported to reduce the development of atrial fibrillation (AF). The aim of this study was to clarify the mechanism of eplerenone for AF prevention from the viewpoint of P wave morphology, which is reported to correlate with atrial fibrosis.
American Journal of Cardiology | 2017
Koichi Inoue; Shinichiro Suna; Katsuomi Iwakura; Takafumi Oka; Masaharu Masuda; Yoshio Furukawa; Yasuyuki Egami; Kazunori Kashiwase; Akio Hirata; Tetsuya Watanabe; Toshihiro Takeda; Hiroya Mizuno; Hitoshi Minamiguchi; Tetsuhisa Kitamura; Tomoharu Dohi; Daisaku Nakatani; Shungo Hikoso; Yuji Okuyama; Yasushi Sakata; Akito Nakagawa; Takayuki Kojima; Rie Nagai; Sugako Mitsuoka; Masaaki Uematsu; Mitsuru Wada; Masatake Fukunami; Takahisa Yamada; Yoshio Yasumura; Jun Tanouchi; Masami Nishino
Although we have occasionally experienced silent thrombi in the left atrium (LA), defined as thrombi free from embolic events, by screening transesophageal echocardiography (TEE) for atrial fibrillation (AF), few data are available on predictors and outcomes of silent LA thrombi in patients with AF. We retrospectively reviewed clinical records and identified 83 patients (2.6%) with silent LA thrombi, out of 4,214 TEE procedures in 3,139 patients with AF at 6 hospitals from January 2010 to December 2012. The median [interquartile range] CHA2DS2-VASc score was 3 [2, 5]. Most patients (n = 71, 86%) were taking oral anticoagulants before the TEE, and 59 patients (71%) had heart failure (HF). During follow-up periods of 905 [620, 1301] days, ischemic stroke and systemic embolism, and hemorrhagic stroke occurred only in 3 (3.6%) and 2 patients (2.4%), respectively. All-cause death developed in 14 patients (17%), and cardiac death was the primary cause of death (n = 9, 11%). Multivariate Cox regression analysis showed the composite end point of death, stroke, systemic embolism, and major bleeding was significantly associated with age (hazard ratio; 1.06, 95% confidence interval; 1.01 to 1.11, p = 0.019) and HF (3.18, 1.27 to 7.99, p = 0.014). In conclusion, the incidence of ischemic stroke after detecting silent LA thrombi was relatively low in patients with AF under oral anticoagulation. Advanced age and HF were predictors for worse outcomes in AF patients with silent LA thrombi.