Yukichi Tokita

Utility of rapid D-dimer measurement for screening of acute cardiovascular disease in the emergency setting

BACKGROUND Rapid and accurate methods for screening are necessary for the diagnosis of acute cardiovascular diseases (ACVD), including acute coronary syndrome (ACS), pulmonary thromboembolism, and acute aortic dissection. In this study, the utility of rapid D-dimer measurement for the screening of ACVD was evaluated. METHODS AND RESULTS Consecutive 279 emergent patients in whom ACVD was suspected or not ruled out were enrolled. The median D-dimer concentration of ACVD group (1.10 μg/ml) was significantly higher than that in the non-ACVD group (0.69 μg/ml, p<0.05). Sensitivity, specificity, positive predictive value, and negative predictive value of D-dimer (with cut-off level of 0.75 μg/ml) for the discrimination of ACVD from non-ACVD was 75%, 55%, 38%, and 85%, respectively. In ACVD group, the level of D-dimer in the large vessel disease subgroup was significantly higher than that in the ACS subgroup (6.99 μg/ml and 0.89 μg/ml, respectively; p<0.05). The well-balanced cut-off point for discriminating the two subgroups was D-dimer level of 5.0 μg/ml. D-dimer (with cut-off level of 0.75 μg/ml) showed significantly higher positive test rate for the detection of ACS in very early phase (within 2 h from the onset) compared with troponin T (p<0.05). CONCLUSIONS Rapid measurement of D-dimer is useful for the screening of ACVD in the emergency setting.

Usefulness of N-Terminal Pro-Brain Natriuretic Peptide Levels to Predict Success of Weaning from Intra-Aortic Balloon Pumping

There is currently no reliable method of predicting the success of weaning from intra-aortic balloon pumping (IABP). The aim of this study was to investigate the ability of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level to predict the success of weaning from IABP. Consecutive patients scheduled for weaning from IABP were prospectively enrolled. NT-proBNP levels were measured at baseline (before the start of weaning) and cessation (just before cessation of IABP). Changes in NT-proBNP level between baseline and cessation were analyzed in 2 groups of patients: those who were successfully weaned and those who were not successfully weaned for any reason, including a decision to discontinue weaning, worsening of pulmonary edema after cessation of IABP, or unstable hemodynamics after cessation of IABP. A total of 30 patients were enrolled (mean age 66 ± 12 years, 16 men, 16 with acute myocardial infarctions, and 14 with acute exacerbation of chronic heart failure). Median (interquartile range) baseline NT-proBNP levels were not significantly different between the successful and unsuccessful weaning groups (4,200 [1,400 to 8,752] pg/ml vs (5,620 [2,035 to 13,950] pg/ml, p = 0.30). In the unsuccessful weaning group, the median NT-proBNP level was significantly higher at cessation (9,995 [2,920 to 15,100] pg/ml) than at baseline (p = 0.008). All patients with decreases in NT-proBNP level between baseline and cessation were successfully weaned from IABP. In conclusion, these results show that NT-proBNP levels were useful for predicting the success of weaning from IABP. If the NT-proBNP level increases during weaning from IABP, more intense management should be considered.

Inhaled nitric oxide therapy for secondary pulmonary hypertension with hypertrophic obstructive cardiomyopathy and severe kyphoscoliosis

Inhaled nitric oxide therapy for secondary pulmonary hypertension with hypertrophic obstructive cardiomyopathy and severe kyphoscoliosis☆ YusukeHosokawa ⁎, Takeshi Yamamoto , Yuto Yabuno , KeisukeHara , Toshiyuki Aokage , KeikoNakazato , Hiroomi Suzuki , Manabu Suzuki , Akira Ueno , Ryo Munakata , Yukichi Tokita , Eisei Yamamoto , Koichi Akutsu , Hitoshi Takano , Naoki Sato , Morimasa Takayama , Keiji Tanaka , Kyoichi Mizuno b

Prognostic Value of Myocardial Perfusion SPECT After Intravenous Bolus Administration of Nicorandil in Patients with Acute Ischemic Heart Failure.

Nicorandil, a hybrid adenosine triphosphate (ATP)–sensitive potassium channel opener and nitrate, is commonly used for the management of acute ischemic heart failure (AIHF). The aims of this study were to predict the effect of nicorandil by calculating myocardium-to-background ratio increasing rate (MBR-IR) using nicorandil stress myocardial perfusion SPECT and to evaluate the prognostic value of MBR-IR in patients with AIHF. Methods: Twenty-two patients (age, 70 ± 12 y) admitted to the coronary care unit with AIHF underwent nicorandil-stress and rest myocardial perfusion SPECT. Using these images, MBR-IR was calculated by dividing stress MBR by rest MBR (MBR = peak value of left ventricular myocardial segments/mean value of upper mediastinum). In order to evaluate the clinical importance of MBR-IR derived from the nicorandil-stress test, all patients were divided into 2 groups, based on the value of MBR-IR. All patients were observed over 5 y from the onset of AIHF for the occurrence of major adverse cardiac events (MACE). Results: Both high– and low–MBR-IR groups contained 11 participants. Median MBR-IR was 1.55 (1.34–1.61) in the high–MBR-IR group and 1.08 (1.02–1.10) in the low–MBR-IR group. The proportion of patients who experienced MACE was significantly higher in the low–MBR-IR group than in the high–MBR-IR group (91% vs. 18%, P < 0.001). Conclusion: This study demonstrated that the MBR-IR calculated using nicorandil-stress myocardial perfusion SPECT may have a high prognostic value for MACE in patients with AIHF.

Surgical Thrombectomy for Right Heart Thrombus with Acute Aortic Dissection

An 81-year-old female complaining of severe back pain was admitted to hospital and diagnosed with acute type A aortic dissection with a thrombosed false lumen. Aggressive antihypertensive therapy was selected. On day 8, computed tomography showed pulmonary artery thrombus, and transthoracic echocardiography showed a 76×70 mm worm-like floating right heart thrombus. Thrombolytic therapy is reported to be the optimal treatment for patients with pulmonary embolism and floating right heart thrombus, but is contraindicated in acute aortic dissection. The patient underwent surgical thrombectomy, which revealed thrombus entrapped in the Chiari network. An inferior vena cava filter was placed. The patient recovered uneventfully and was discharged home after initiation of warfarin therapy.