Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 22
Filter
1.
Int Heart J ; 52(4): 224-8, 2011.
Article in English | MEDLINE | ID: mdl-21828948

ABSTRACT

Heart failure after acute myocardial infarction (AMI) is an important factor in determining clinical outcome. We examined whether the plasma homocysteine level was a predictor of heart failure in patients with AMI. A series of 96 patients without renal failure who were admitted to our hospital because of AMI between January 2003 and December 2005 were assigned to two groups; a group with a high homocysteine level (group H: n = 48) and a group with a low homocysteine level (group L: n = 48) based on a median homocysteine level. Congestive heart failure was defined as Killip Class II or higher at the time of admission or the development of congestive heart failure after hospitalization. The mean brain natriuretic peptide (BNP) level at the time of admission in group H was higher than that of group L (175.3 pg/mL versus 89.9 pg/mL; P = 0.068). The incidence of heart failure in group H was significantly higher than that in group L (43.7% versus 12.5%; P < 0.001, log-rank test; hazard ratio: 2.92). Multivariate Cox regression analysis indicated that a high plasma homocysteine level of 10.8 µmol/L or higher was a risk factor for the development of heart failure (HR: 7.175, P < 0.01). The plasma homocysteine level in patients with AMI may be related to the development of heart failure.


Subject(s)
Heart Failure/blood , Homocysteine/blood , Myocardial Infarction/complications , Biomarkers/blood , Chromatography, High Pressure Liquid , Disease Progression , Electrocardiography , Female , Follow-Up Studies , Heart Failure/epidemiology , Heart Failure/etiology , Humans , Incidence , Male , Middle Aged , Myocardial Infarction/blood , Myocardial Infarction/physiopathology , Natriuretic Peptide, Brain/blood , Prognosis , Proportional Hazards Models , Retrospective Studies
2.
Circ J ; 72(7): 1054-8, 2008 Jul.
Article in English | MEDLINE | ID: mdl-18577811

ABSTRACT

BACKGROUND: Sirolimus-eluting stents (SES) reduce restenosis and revascularization rates, compared with bare-metal stents (BMS), in elective percutaneous coronary intervention (PCI). This study investigated the safety and efficacy of SES for emergency PCI in acute coronary syndrome (ACS) patients. METHODS AND RESULTS: The 154 consecutive patients (SES: n=77, BMS: n=77) admitted to hospital with ACS were enrolled in this study. Procedural success (%DS <50%, Thrombolysis In Myocardial Infarction grade 3), major adverse cardiac events (MACE) at 30 days and 8 months, and the incidence of stent thrombosis were evaluated. There was no difference between the groups regarding procedural success. Patients treated with SES had smaller stent diameter (SES 3.04 mm vs BMS 3.24 mm; p=0.01) and longer stent length (25.7 mm vs 21.2 mm; p=0.01). At 30 days, there was no difference between the groups in the incidence of cardiovascular events. At 8 months, patients treated with the SES had a lower rate of repeat PCI (5.6% vs 18.6%; p=0.04) and MACE (9.7% vs 27.1%; p=0.01). Stent thrombosis was no different between groups (1.4% vs 2.9%). CONCLUSION: In emergency PCI for ACS patients, SES implantation significantly reduced cardiovascular events, compared with BMS, by decreasing the incidence of repeat PCI. The safety profile of SES is equal to that of BMS.


Subject(s)
Acute Coronary Syndrome/therapy , Angioplasty, Balloon, Coronary , Drug-Eluting Stents , Immunosuppressive Agents/administration & dosage , Sirolimus/administration & dosage , Acute Coronary Syndrome/mortality , Aged , Angioplasty, Balloon, Coronary/statistics & numerical data , Disease-Free Survival , Drug-Eluting Stents/adverse effects , Drug-Eluting Stents/statistics & numerical data , Emergency Medical Services , Female , Humans , Immunosuppressive Agents/adverse effects , Japan/epidemiology , Kaplan-Meier Estimate , Male , Middle Aged , Recurrence , Retrospective Studies , Sirolimus/adverse effects , Treatment Outcome
4.
Circ J ; 71(3): 370-6, 2007 Mar.
Article in English | MEDLINE | ID: mdl-17322638

ABSTRACT

BACKGROUND: Two randomized studies have shown a neurological benefit of therapeutic hypothermia in comatose survivors after out-of-hospital cardiac arrest, but there are no studies of the cardiac neurohormone of B-type natriuretic peptide (BNP) in patients treated with hypothermia. METHODS AND RESULTS: A prospective study was conducted of 109 comatose patients who were treated with mild hypothermia after out-of-hospital sudden cardiac arrest due to cardiac causes and whose BNP level was measured on arrival at the emergency room. The primary endpoint was a favorable neurological outcome at the time of hospital discharge. A total of 45 of the 109 patients had a favorable neurological outcome. The unadjusted rate of a favorable neurological outcome decreased in a stepwise fashion among patients in increasing quartiles of BNP level (p<0.001) and this association remained significant in subgroups of patients. The BNP cutoff value of 80 pg/ml for a favorable neurological outcome had an accuracy of 87.2%. In the multiple logistic-regression analysis, a BNP level of 80 pg/ml or less was an independent predictor of favorable neurological outcome. CONCLUSIONS: The measurement of BNP was found to provide valuable information regarding the neurological outcome of comatose survivors treated with mild hypothermia after out-of-hospital cardiac arrest due to cardiac causes.


Subject(s)
Coma/therapy , Heart Arrest/therapy , Hypothermia, Induced , Natriuretic Peptide, Brain/blood , Predictive Value of Tests , Resuscitation , Aged , Coma/complications , Coma/etiology , Female , Heart Arrest/complications , Heart Arrest/diagnosis , Heart Arrest/etiology , Heart Diseases/complications , Humans , Male , Middle Aged , Nervous System Diseases/diagnosis , Nervous System Diseases/etiology , Prospective Studies , Survivors , Treatment Outcome
5.
Circ J ; 71(2): 180-5, 2007 Feb.
Article in English | MEDLINE | ID: mdl-17251663

ABSTRACT

BACKGROUND: Progress in reperfusion therapy for acute myocardial infarction (AMI) has greatly reduced acute phase mortality, but few data exist regarding the time trends in left ventricular (LV) remodeling in hospital survivors of AMI. METHODS AND RESULTS: The study enrolled 813 patients with AMI who had received reperfusion therapy and survived to hospital discharge. The patients were divided into chronological groups: first treatment received between 1989 and 1992, n=196; 1993 and 1995, n=193; 1996 and 1998, n=211; and 1999 and 2002, n=213. A comparison was made of LV ejection fraction (LVEF) and LV end-diastolic volume index (LVEDVI) at 6 months after symptom onset. Along with the temporal improvements reperfusion therapy, LVEF and LVEDVI improved over time (55+/-14, 58+/-13, 59+/-13, 61+/-13%, p<0.001; 98+/-30, 94+/-27, 90+/-31, 76+/-27 ml/m2, p<0.0001). Multiregression analysis revealed that shortening of the door-to-Thrombolysis In Myocardial Infarction (TIMI)-3 time (time interval from arrival at the emergency room until patients achieved TIMI-3 flow) and achieving substantial TIMI-3 flow were independent predictors for LV remodeling. CONCLUSION: Although this was a retrospective analysis, the results demonstrated that the change in reperfusion therapy aiming at complete reperfusion at an earlier stage after AMI onset has contributed to improving post-MI remodeling.


Subject(s)
Myocardial Infarction/physiopathology , Myocardial Infarction/therapy , Myocardial Reperfusion/methods , Ventricular Function, Left/physiology , Ventricular Remodeling/physiology , Acute Disease , Aged , Disease-Free Survival , Female , Humans , Male , Middle Aged , Myocardial Infarction/diagnosis , Prognosis , Prospective Studies , Regression Analysis , Retrospective Studies , Stroke Volume/physiology , Thrombosis/diagnosis , Thrombosis/physiopathology , Thrombosis/therapy
6.
Heart Vessels ; 21(4): 236-41, 2006 Jul.
Article in English | MEDLINE | ID: mdl-16865299

ABSTRACT

The increasing elderly population will influence the treatment policies adopted in cases of acute myocardial infarction. Considering reperfusion therapy in elderly patients with acute myocardial infarction, we compared three strategies, as follows: primary percutaneous coronary intervention (primary PCI: n = 26), facilitated PCI with half the standard dose of mutant tissue-type plasminogen activator (t-PA) (half + PCI: n = 24), and facilitated PCI with a standard dose of mutant t-PA (standard + PCI: n = 15) between patients 75 and 80 years of age. The rate of acquisition of thrombolysis in myocardial infarction (TIMI-3) flow on initial coronary arteriography was significantly lower in the primary PCI group than in the other two groups (7.7% in the primary PCI group vs 60% in the half + PCI and 66.7% in the standard + PCI group). The incidence of hemorrhagic complications including blood transfusion was not significantly different between primary PCI and facilitated PCI. Considering reperfusion therapy in elderly patients with acute myocardial infarction, we concluded that facilitated PCI may be effective in elderly patients aged 75-80 years.


Subject(s)
Angioplasty, Balloon, Coronary , Myocardial Infarction/surgery , Myocardial Reperfusion/methods , Aged , Aged, 80 and over , Combined Modality Therapy , Female , Humans , Male , Myocardial Infarction/drug therapy , Thrombolytic Therapy , Tissue Plasminogen Activator/therapeutic use
7.
Int Heart J ; 47(1): 29-35, 2006 Jan.
Article in English | MEDLINE | ID: mdl-16479038

ABSTRACT

The outcome for facilitated percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is known to be more favorable in cases in which TIMI-3 flow is obtained before PCI. We investigated factors that affect the acquisition of TIMI-3 flow before PCI. Facilitated PCI was performed on 178 patients divided into two groups, a group in which TIMI-3 flow was acquired before conducting PCI and another in which it was not, and their background factors and short-term outcomes were investigated. The hemoglobin concentrations, white blood cell (WBC) counts, and HbA1c values were significantly lower in the group in which TIMI-3 flow was acquired before PCI and significantly more had a history of past smoking. According to the results of logistic analysis, WBC count (odds ratio [OR], 0.865, P = 0.0077), hemoglobin concentration (OR, 0.77, P = 0.0257), and smoking history (OR, 0.266, P = 0.0021) were independent factors that predicted acquisition of TIMI-3 flow. The WBC count and hemoglobin value on arrival at the emergency room and history of smoking were shown to be independent factors for acquisition of TIMI-3 flow before PCI in facilitated PCI.


Subject(s)
Angioplasty, Balloon, Coronary , Coronary Circulation/drug effects , Fibrinolytic Agents/therapeutic use , Myocardial Infarction/therapy , Aged , Aged, 80 and over , Female , Glycated Hemoglobin/analysis , Hemoglobins/analysis , Humans , Leukocyte Count , Male , Middle Aged , Predictive Value of Tests , Smoking
8.
Int Heart J ; 47(1): 131-7, 2006 Jan.
Article in English | MEDLINE | ID: mdl-16479048

ABSTRACT

The case of a 30-year-old man with myocardial infarction localized in the interventricular septum is described. Coronary angiography performed on day 28 after the onset of symptoms revealed ectasia in the right and left coronary arteries, but no overt stenotic or occlusive lesions were present. Spasm was induced in the first septal branch of the left anterior descending artery by an acetylcholine provocation test, and single photon emission computed tomography myocardial perfusion imaging showed a reduced thallium-201 uptake localized in the interventricular septum.


Subject(s)
Coronary Artery Disease/diagnosis , Myocardial Infarction/diagnosis , Adult , Coronary Angiography , Coronary Artery Disease/complications , Coronary Vasospasm/complications , Dilatation, Pathologic , Electrocardiography , Heart Conduction System , Humans , Male , Myocardial Infarction/etiology , Tomography, Emission-Computed, Single-Photon , Ventricular Septum
9.
Circ J ; 69(11): 1401-4, 2005 Nov.
Article in English | MEDLINE | ID: mdl-16247218

ABSTRACT

BACKGROUND: The role of arginine vasopressin (AVP) in the heart has yet to be determined. The present study was designed to examine whether AVP is regulated in the human heart. METHODS AND RESULTS: The subjects were 93 patients who underwent coronary angiography and left ventriculography. Blood samples were collected at the aortic root (AO) and the coronary sinus (CS) to measure the plasma levels of AVP. The patients who showed increases in AVP levels at the CS and AO were assigned to the increased AVP group and those who showed no change or a decrease were assigned to the non-increased AVP group. Cardiac function was compared between these 2 groups. There was a significant difference (p<0.0234) in left ventricular end-diastolic volume index between the increased AVP group (125.5 +/-53.4 ml/m2) and the non-increased AVP group (102.2+/-30.6 ml/m2). There was also a significant difference (p<0.0137) in left ventricular stroke volume index between the increased AVP group (66.6+/-23.2 ml/m2) and the non-increased AVP group (54.4+/-18.6 ml/m2). CONCLUSION: These results suggest that both the production of AVP and synthesis with its receptors may be enhanced at regional sites of the human heart in the volume load.


Subject(s)
Arginine Vasopressin/blood , Myocardial Infarction/blood , Myocardium/metabolism , Stroke Volume , Aged , Coronary Angiography/methods , Female , Humans , Male , Middle Aged , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/drug therapy
10.
Am J Cardiol ; 96(8): 1089-94, 2005 Oct 15.
Article in English | MEDLINE | ID: mdl-16214443

ABSTRACT

We hypothesized that a reduction in atherogenic malondialdehyde-modified low-density lipoprotein (MDA-LDL) levels, which may antagonize the action of atheroprotective high-density lipoprotein cholesterol, leads to coronary plaque regression. This study investigated the effects of pravastatin on the serum levels of MDA-LDL and coronary atherosclerosis. In a 6-month prospective study, 75 patients with stable coronary artery disease were randomly assigned to a pravastatin-treatment group (n = 52) or a control group (n = 23). Volumetric analyses were performed in matched coronary artery segments by 3-dimensional intravascular ultrasound. Pravastatin therapy for 6 months resulted in a decrease in coronary plaque volume (14.4%, p <0.0001) and a corresponding reduction in serum MDA-LDL levels (12.7%, p = 0.0001). In the pravastatin treatment group, the percentage of change in plaque volume correlated with changes in the MDA-LDL and high-density lipoprotein cholesterol levels (r = 0.52 and -0.55, respectively, p <0.0001) but not with the changes in any other lipid levels. Multivariate regression analysis revealed that a reduced MDA-LDL level is an independent predictor of plaque regression, as was an increase in high-density lipoprotein cholesterol. In conclusion, these results suggest that the reduction in the MDA-LDL levels induced by pravastatin may serve as a novel marker of coronary atherosclerosis regression.


Subject(s)
Anticholesteremic Agents/therapeutic use , Coronary Disease/drug therapy , Lipoproteins, LDL/blood , Malondialdehyde/analogs & derivatives , Pravastatin/therapeutic use , Cholesterol/blood , Coronary Disease/blood , Coronary Disease/diagnostic imaging , Diabetes Mellitus , Female , Humans , Hypertension/complications , Male , Malondialdehyde/blood , Middle Aged , Risk Factors , Smoking/adverse effects , Ultrasonography
11.
Heart Vessels ; 20(3): 123-5, 2005 May.
Article in English | MEDLINE | ID: mdl-15912310

ABSTRACT

A transient left ventricular apical ballooning (so-called "ampulla" or "Takotsubo-shaped" cardiomyopathy) with type I CD36 deficiency is described in a 71-year-old woman. The patient was referred because of chest pain and worsening of dyspnea. Electrocardiogram showed T-wave inversions on the precordal leads, and acute coronary syndrome was suspected. Left ventricular apical ballooning was observed by echocardiogram and left ventriculography, and coronary arteriography did not reveal any significant stenosis. Left ventricular motion normalized at the follow-up period and there were no increases in specific markers for myocardial damage, such as myocardial band fraction of creatine kinase and troponin T, through out the admission. 123I-metaiodobengylguanidine myocardial single photon emission computed tomography (SPECT) revealed decreased accumulation areas at the apex, while 201Tl SPECT showed normal accumulation. An abnormal metabolism of cardiac free fatty acid was suggested by lack of accumulation of 123I beta-methyliodophenyl pentadecanoic acid (BMIPP) SPECT. No CD36 expression in either platelets or monocytes/macrophages was shown using flow cytometer analysis and type I CD36 deficiency was diagnosed. DNA sequencing showed that the patient had compound heterozygosity of the CD36 gene (a nucleotide change in C478T and an adenine insertion at nucleotide 1159 in exon 10). Although CD36 deficiency is thought to be involved with many cardiovascular disease and metabolic abnormalities, Takotsubo-shaped cardiomyopathy with CD36 deficiency had not been reported. Further studies of Takotsubo-shaped cardiomyopathy and CD36 deficiency may reveal an association between this cardiomyopathy and specific genetic profiles.


Subject(s)
CD36 Antigens/genetics , Cardiomyopathies/diagnosis , Aged , Cardiomyopathies/genetics , Echocardiography , Fatty Acids , Female , Humans , Iodine Radioisotopes , Iodobenzenes , Tomography, Emission-Computed, Single-Photon
12.
Diabetes Res Clin Pract ; 68(2): 104-10, 2005 May.
Article in English | MEDLINE | ID: mdl-15860237

ABSTRACT

BACKGROUND: Pioglitazone is an insulin-sensitizing agent that has been reported to have anti-arteriosclerotic effects. OBJECTIVE: To investigate the anti-arteriosclerotic effects of pioglitazone in patients with diabetes mellitus using pulse wave velocity (PWV) as an index of efficacy. METHODS: Twenty-seven patients with type 2 diabetes mellitus were randomly assigned to two groups, and pioglitazone (n=13) or glibenclamide (n=14) was administered for 6 months. The TG, TC, LDL-C, and HDL-C, FPG, HbA1c, IRI levels, HOMA-IR, and ba-PWV data were examined before and after administration of each agent. RESULTS: FPG and HbA1c were significantly improved in both the groups after treatment, but IRI, HOMA-IR and were improved only in the PIO group. The percent change of ba-PWV from the baseline after treatment in the PIO group improved significantly than that in the GC group (-6.3 +/- 5.6% versus 0.8 +/- 5.7%). CONCLUSIONS: The findings in this study suggested that pioglitazone has anti-arteriosclerotic effects. We concluded that drugs for the treatment of diabetes mellitus should be selected taking into consideration such endpoints as blood sugar control, and also the risk of complications such as cardiovascular events in the future.


Subject(s)
Arteriosclerosis/etiology , Glyburide/therapeutic use , Thiazolidinediones/therapeutic use , Arteriosclerosis/diagnosis , Arteriosclerosis/drug therapy , Blood Glucose/drug effects , Cholesterol, LDL/blood , Cholesterol, LDL/drug effects , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/physiopathology , Drug Administration Schedule , Fasting/blood , Female , Glyburide/administration & dosage , Glyburide/blood , Humans , Insulin Resistance/physiology , Male , Middle Aged , Pioglitazone , Pulse/methods , Risk Factors , Thiazolidinediones/administration & dosage , Thiazolidinediones/blood , Time Factors , Triglycerides/blood
14.
Int Heart J ; 46(6): 1007-14, 2005 Nov.
Article in English | MEDLINE | ID: mdl-16394596

ABSTRACT

While the usefulness of measuring the plasma levels of brain natriuretic peptide (BNP) in cases with worsening heart failure and severe heart failure has already been established, the benefits of evaluation of this parameter in asymptomatic stable patients with left ventricular dysfunction is still under debate. Left ventricular function was evaluated in 141 ambulatory outpatients with a previous history of myocardial infarction not associated with symptoms of heart failure for at least one year. The plasma BNP level was also determined in these patients for comparative study. No correlation between the plasma level of BNP and EF was noted in the normal-EF group, while a negative correlation between the two parameters was observed in the low-EF group (Y = 0.439 - 0.000266X) (R2 = 0.244, P < 0.0001). The sensitivity was 91.5%, specificity 56.3%, positive predictive accuracy value 61.9%, and negative predictive accuracy value 83.8% for a plasma BNP cut-off level of 89.0 pg/mL. The results suggested that it might be meaningful to measure the plasma BNP level, especially in asymptomatic patients with a previous history of myocardial infarction having a low-EF.


Subject(s)
Heart Failure/etiology , Myocardial Infarction/physiopathology , Natriuretic Peptide, Brain/blood , Stroke Volume , Ventricular Function, Left/physiology , Biomarkers/blood , Cross-Sectional Studies , Female , Heart Failure/diagnosis , Humans , Male , Middle Aged , Myocardial Infarction/blood , Outpatients
16.
Circ J ; 68(12): 1117-22, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15564693

ABSTRACT

BACKGROUND: The purpose of the present study was to evaluate the efficacy and safety of facilitated percutaneous coronary intervention (PCI) in comparing young and elderly patients with acute myocardial infarction. METHODS AND RESULTS: The present study enrolled 168 initial myocardial infarction patients within 12 h of the symptom onset between 40 and 80 years of age who were indicated on the fibrinolysis and subsequent transluminal (FAST-3) trial. The patients were divided into 4 groups according to their age, peak creatine kinase (CK), peak CK-MB and peak troponin T (Tn-T) levels, and cardiac function were compared between the 4 groups. There were no differences between the 4 groups in terms of the time from arrival at the emergency room (ER) to the achievement of TIMI-3 patency. There were also no significant differences between the 4 groups in terms of the peak CK, peak CK-MB or peak Tn-T levels. Furthermore, there were no significant differences between the 4 groups in terms of the mortality rate or the incidence of hemorrhagic complications at 30 days. CONCLUSIONS: Facilitated PCI is considered to have an important potential role in the treatment of myocardial infarction in Japan, in which the age of the population is steadily increasing.


Subject(s)
Aging , Angioplasty, Balloon, Coronary , Myocardial Infarction/therapy , Thrombolytic Therapy , Adult , Age Factors , Aged , Aged, 80 and over , Coronary Angiography , Female , Hemorrhage/epidemiology , Hemorrhage/etiology , Humans , Incidence , Male , Middle Aged , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/drug therapy , Myocardial Infarction/mortality , Thrombolytic Therapy/adverse effects , Time Factors , Treatment Outcome
17.
Circ J ; 68(9): 853-9, 2004 Sep.
Article in English | MEDLINE | ID: mdl-15329508

ABSTRACT

BACKGROUND: Calcium channel blockers (CCBs) may have a positive influence on the long-term prognosis of Japanese patients with ischemic heart disease. METHODS AND RESULTS: The effect of nifedipine-retard (NR) (n=202) compared with that of non-CCB treatment (n=92) on the secondary prevention of myocardial infarction (MI) was retrospectively investigated in patients who had survived acute MI between 1987 and 1996. The primary endpoint was the occurrence of cardiac death or non-fatal MI. The median follow-up was 6.3+/-2.4 years. The incidence of cardiac events was 8.9% in the NR group and 14.1% in the non-CCBs group (p=0.14, odds ratio (OR): 0.584, 95% confidence interval (CI): 0.286-1,193). However, subanalysis revealed that NR significantly reduced the incidence of cardiac events in patients aged less than 55 years (4.2 vs 18.2%, p=0.016, OR: 0.180, 95%CI: 0.045-0.721) and those who did not smoke (8.6 vs 16.4%, p=0.048, OR: 0.462, 95%CI: 0.203-0.999). CONCLUSION: Although this was a retrospective analysis, it showed that NR did not cause an increase in the incidence of cardiac events in post-MI patients; it even prevented cardiac events, especially in those who were less than 55 years of age and in non-smokers, suggesting the potential usefulness of CCBs in the secondary prevention of MI in Japan.


Subject(s)
Calcium Channel Blockers/therapeutic use , Coronary Thrombosis/drug therapy , Fibrinolytic Agents/therapeutic use , Myocardial Infarction/prevention & control , Aged , Female , Follow-Up Studies , Heart Diseases/epidemiology , Heart Diseases/prevention & control , Humans , Incidence , Japan , Male , Middle Aged , Myocardial Reperfusion , Nifedipine/therapeutic use , Retrospective Studies , Risk Factors , Smoking , Time Factors
18.
Circ J ; 68(7): 628-33, 2004 Jul.
Article in English | MEDLINE | ID: mdl-15226626

ABSTRACT

BACKGROUND: Recently it has become clear that inflammatory changes play a part in the development of atherosclerosis, including coronary artery disease, and Chlamydia pneumoniae (C. pneumoniae) is thought to be a proinflammatory factor. The plasma concentration of high-sensitive C-reactive protein (hs-CRP) is a potential predictor of outcome in atherosclerotic diseases. Recent interest has focused on secretory group IIA phospholipase A(2) (sPLA (2)) in regard to the progression of atherosclerotic disease. METHODS AND RESULTS: The concentrations of sPLA(2), hs-CRP, and the titers of C. pneumoniae IgG and IgA antibodies were measured in blood samples. The study groups were an acute coronary syndrome (ACS) group, old myocardial infarction/angina pectoris (OMI/AP) group, and a control group. The concentrations of sPLA(2) and hs-CRP in the ACS group and the OMI/AP group were higher than in the control group. The titers of C. pneumoniae IgG and IgA were higher in the ACS group than in the control group. The sPLA(2) concentration was higher in those who were positive to C. pneumoniae IgG/IgA than in those who were negative. CONCLUSION: Increased concentrations of sPLA(2) reflect participation in the progression of coronary artery disease. The sPLA(2) concentration was higher in patients positive for C. pneumoniae than in those negative for C. pneumoniae, so C. pneumoniae infection poses a greater risk for ACS in those individuals than in those who are free of such infection.


Subject(s)
C-Reactive Protein/metabolism , Chlamydia Infections/diagnosis , Chlamydia/isolation & purification , Coronary Disease/diagnosis , Phospholipases A/blood , Acute Disease , Angina Pectoris/blood , Biomarkers/blood , Chlamydia Infections/blood , Coronary Disease/blood , Female , Humans , Male , Middle Aged , Reference Values , Statistics, Nonparametric
19.
Circ J ; 68(4): 280-5, 2004 Apr.
Article in English | MEDLINE | ID: mdl-15056821

ABSTRACT

BACKGROUND: The purpose of this study was to use the findings of a fibrinolysis and subsequent transluminal trial (FAST-3) to evaluate the association between the target time for obtaining a thrombolysis in myocardial infarction (TIMI)-3 flow after arrival at the emergency room with acute myocardial infarction (AMI) and the degree of myocardial salvage. METHODS AND RESULTS: The FAST-3 trial was administered to 100 patients suffering from AMI. Ranges in the door-to-TIMI-3 flow time (D-T3-time: TIMI-3 flow after arrival at the emergency room) according to quartile were as follows: 30-54 min (quartile 1), 55-77 min (quartile 2), 78-120 min (quartile 3) and 121-330 min (quartile 4). Peak creatine kinase (CK), peak CK-MB, and peak troponin-T values increased in a stepwise fashion across the increasing quartiles of D-T3-time. The left ventricular end diastolic volume index at 30 days after the start of treatment showed low values for quartile 1. In multiple logistic regression analyses for independent predictors of myocardial damage, the adjusted odds ratios for myocardial damage (peak CK>3,000 U/L) in quartiles 3 and 4 of the D-T3-time were 4.0 (95% CI: 1.0-16.1) and 7.0 (95% confidence interval (CI): 1.4-36.0), respectively. CONCLUSIONS: These findings suggest that physicians should monitor the D-T3-time for at least 55 min.


Subject(s)
Emergency Service, Hospital/statistics & numerical data , Fibrinolysis , Fibrinolytic Agents/therapeutic use , Myocardial Infarction/pathology , Thrombolytic Therapy/statistics & numerical data , Aged , Anticoagulants/therapeutic use , Aspirin/administration & dosage , Aspirin/therapeutic use , Biomarkers , Coronary Circulation , Creatine Kinase/blood , Creatine Kinase, MB Form , Drug Therapy, Combination , Electrocardiography , Female , Fibrinolytic Agents/administration & dosage , Heparin/administration & dosage , Heparin/therapeutic use , Hospitals, University/statistics & numerical data , Humans , Isoenzymes/blood , Japan/epidemiology , Male , Middle Aged , Myocardial Infarction/blood , Myocardial Infarction/drug therapy , Myocardial Infarction/epidemiology , Myocardial Reperfusion/methods , Patient Admission/statistics & numerical data , Plasminogen Activators/administration & dosage , Plasminogen Activators/therapeutic use , Prospective Studies , Recombinant Proteins/administration & dosage , Recombinant Proteins/therapeutic use , Risk Factors , Stroke Volume , Time Factors , Tissue Plasminogen Activator/administration & dosage , Tissue Plasminogen Activator/therapeutic use , Treatment Outcome , Troponin T/blood , Urokinase-Type Plasminogen Activator/administration & dosage , Urokinase-Type Plasminogen Activator/therapeutic use
20.
J Cardiol ; 42(5): 201-6, 2003 Nov.
Article in English | MEDLINE | ID: mdl-14658408

ABSTRACT

OBJECTIVES: Inflammation is important in the development of atherosclerosis. Matrix metalloproteinases (MMPs) and interferon-gamma which participate in collagen degradation are pathological factors in plaque vulnerability as an important mechanism underlying acute coronary syndrome. This study investigated whether inflammation is related to the onset of acute coronary syndrome. METHODS: This study included 56 patients with acute coronary syndrome (ACS group), 104 patients with chronic coronary artery disease (S group), and 38 control subjects with no evidence of ischemic heart disease (C group). High-sensitivity C-reactive protein (hs-CRP), MMP-9, and interferon-gamma were measured in peripheral blood samples. Soluble adhesion molecules (VCAM-1, ICAM-1) were also measured as inflammatory markers. RESULTS: The hs-CRP level was significantly higher in the ACS group (44.5 mg/l) than in the S group (2.1 mg/l) and the C group (0.6 mg/l) (p < 0.0001). The MMP-9 level was also significantly higher in the ACS group (333.8 ng/ml) than in the S group (110.8 ng/ml) and the C group (72.0 ng/ml) (p < 0.0001). The VCAM-1 level was significantly higher in the ACS group (506.5 ng/ml) than in the C group (448.8 ng/ml) (p < 0.05). The ICAM-1 level and the interferon-gamma level did not differ between the groups. There was a significant positive correlation between the level of hs-CRP and the level of the collagen degradation product MMP-9 (r = 0.52) in all subjects. CONCLUSIONS: These results suggest that plaque destabilized by MMP-9 produced in response to inflammation participates in the mechanism of acute coronary syndrome.


Subject(s)
C-Reactive Protein/analysis , Coronary Artery Disease/blood , Intercellular Adhesion Molecule-1/blood , Matrix Metalloproteinase 9/blood , Vascular Cell Adhesion Molecule-1/blood , Aged , Coronary Artery Disease/etiology , Coronary Disease/blood , Female , Humans , Inflammation , Interferon-gamma/blood , Male , Middle Aged
SELECTION OF CITATIONS
SEARCH DETAIL
...