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1.
Intern Med ; 61(5): 663-666, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-34433724

RESUMO

A lotus root-like appearance on blood vessels is a rare abnormality. The multiple channels within arteries may represent the recanalization or neovascularization of the thrombus. This abnormality is most frequently found in coronary arteries. A 39-year-old woman had a thrombus-like structure in the external iliac artery. We subsequently performed an endovascular treatment six months later due to intermittent claudication. A lotus root-like appearance was found on intravascular ultrasound. To our knowledge, this is the first study to report a case of lotus root-like appearance in lower-extremity arteries.


Assuntos
Artéria Ilíaca , Ultrassonografia de Intervenção , Adulto , Aorta Abdominal , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Stents , Ultrassonografia
2.
Medicine (Baltimore) ; 100(18): e25775, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950969

RESUMO

RATIONALE: The relationship between spontaneous coronary artery dissection (SCAD) and takotsubo syndrome (TTS) remains unclear. Coexistence of SCAD and TTS has been reported in the literature. However, the relationship between these two diseases has not yet been elucidated. PATIENT CONCERNS: A 36-year-old breastfeeding woman was brought to our hospital 52 days after cesarean section because of discomfort in her left arm and convulsions. DIAGNOSES: She was diagnosed of acute myocardial infarction (AMI). The convulsions were attributed to lethal arrhythmia. INTERVENTIONS: An immediate coronary angiography revealed that her left anterior descending artery (LAD) was Type 2a SCAD, but with no flow limitation. In addition, a 12-lead electrocardiogram (ECG) revealed improvement in ST-elevation. We chose the conservative treatment according to the patient's needs. OUTCOMES: Conservative treatment was unsuccessful. She developed another acute myocardial infarction requiring another percutaneous coronary intervention (PCI) during hospitalization. From the course of hospitalization, we suspected the coexistence of SCAD and TTS. LESSONS: When we treat patients with SCAD, we should consider the possibility of coexistence of TTS and confirm left ventricular wall motion. Patients with SCAD may require invasive treatment, hence, should be monitored for a while. An urgent strategy for managing patients with SCAD who require PCI should be established.


Assuntos
Tratamento Conservador , Anomalias dos Vasos Coronários/diagnóstico , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Doenças Vasculares/congênito , Adulto , Aleitamento Materno , Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/terapia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Ecocardiografia , Eletrocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Inibidores da Agregação Plaquetária/uso terapêutico , Recidiva , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Prevenção Secundária/métodos , Cardiomiopatia de Takotsubo/complicações , Resultado do Tratamento , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico , Doenças Vasculares/terapia
3.
Intern Med ; 60(2): 275-279, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-32921692

RESUMO

A 55-year-old man treated with polycythemia vera visited our hospital, complaining of left abdominal pain and dyspnea. He had received minocycline infusions three weeks earlier for mycoplasma pneumonia. Contrast-enhanced computed tomography revealed pulmonary embolism and splenic infarction. Ultrasonography of the vein in the forearm revealed a thrombus filling the distal brachial veins to the radial veins on both sides. His condition improved after anticoagulant therapy, and right and left shunts were detected on transesophageal echocardiography. This suggested that thrombus in the forearm may have been the source of the embolism.


Assuntos
Policitemia Vera , Embolia Pulmonar , Infarto do Baço , Trombose , Humanos , Masculino , Pessoa de Meia-Idade , Minociclina/efeitos adversos , Policitemia Vera/complicações , Policitemia Vera/tratamento farmacológico , Embolia Pulmonar/induzido quimicamente , Embolia Pulmonar/diagnóstico por imagem , Infarto do Baço/diagnóstico , Infarto do Baço/diagnóstico por imagem
4.
Hypertens Res ; 43(8): 781-790, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32152482

RESUMO

The usefulness of brachial-ankle pulse wave velocity (baPWV), an index of arterial stiffness, is not fully known for the management of treated hypertensive patients with a history of coronary artery disease (CAD) who have blood pressure less than 130/80 mmHg, a recommended blood pressure target in the updated major hypertension guidelines. We analyzed data for 447 treated hypertensive patients with CAD enrolled in FMD-J Study A for assessment of the predictive value of baPWV for future cardiovascular events. The primary outcome was a composite of coronary events, stroke, heart failure, and sudden death. During a median follow-up period of 47.6 months, the primary outcome occurred in 64 patients. Blood pressure less than 130/80 mmHg was significantly associated with a lower risk of the composite outcome independent of other cardiovascular risk factors in treated hypertensive patients with CAD (hazard ratio, 0.59; 95% confidence interval (CI), 0.35-0.99; P = 0.04). In treated hypertensive patients with CAD who had blood pressure less than 130/80 mmHg, baPWV above the cutoff value of 1731 cm/s, derived from receiver-operator characteristic curve analysis for the composite outcome was significantly associated with a higher risk of the composite outcome independent of conventional risk factors (hazard ratio, 2.83; 95% CI, 1.02-7.91; P = 0.04). baPWV was an independent predictor of cardiovascular events in treated hypertensive patients with CAD who had blood pressure less than 130/80 mmHg, for whom measurement of baPWV is recommended for cardiovascular risk assessment.


Assuntos
Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Hipertensão/fisiopatologia , Rigidez Vascular/fisiologia , Idoso , Índice Tornozelo-Braço , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Medição de Risco , Vasodilatação/fisiologia
5.
J Am Heart Assoc ; 7(14)2018 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-30005558

RESUMO

BACKGROUND: The usefulness of vascular function tests for management of patients with a history of coronary artery disease is not fully known. METHODS AND RESULTS: We measured flow-mediated vasodilation (FMD) and brachial-ankle pulse wave velocity (baPWV) in 462 patients with coronary artery disease for assessment of the predictive value of FMD and baPWV for future cardiovascular events in a prospective multicenter observational study. The first primary outcome was coronary events, and the second primary outcome was a composite of coronary events, stroke, heart failure, and sudden death. During a median follow-up period of 49.2 months, the first primary outcome occurred in 56 patients and the second primary outcome occurred in 66 patients. FMD above the cutoff value of 7.1%, derived from receiver-operator curve analyses for the first and second primary outcomes, was significantly associated with lower risk of the first (hazard ratio, 0.27; 95% confidence interval, 0.06-0.74; P=0.008) and second (hazard ratio, 0.32; 95% confidence interval, 0.09-0.79; P=0.01) primary outcomes. baPWV above the cutoff value of 1731 cm/s was significantly associated with higher risk of the first (hazard ratio, 1.86; 95% confidence interval, 1.01-3.44; P=0.04) and second (hazard ratio, 2.19; 95% confidence interval, 1.23-3.90; P=0.008) primary outcomes. Among 4 groups stratified according to the combination of cutoff values of FMD and baPWV, stepwise increases in the calculated risk ratio for the first and second primary outcomes were observed. CONCLUSIONS: In patients with coronary artery disease, both FMD and baPWV were significant predictors of cardiovascular events. The combination of FMD and baPWV provided further cardiovascular risk stratification. CLINICAL TRIAL REGISTRATION: URL: www.umin.ac.jp. Unique identifier: UMIN000012950.


Assuntos
Doença da Artéria Coronariana/fisiopatologia , Morte Súbita Cardíaca/epidemiologia , Insuficiência Cardíaca/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Rigidez Vascular/fisiologia , Idoso , Artéria Braquial/diagnóstico por imagem , Doenças Cardiovasculares , Doença da Artéria Coronariana/epidemiologia , Endotélio Vascular/fisiopatologia , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Análise de Onda de Pulso , Medição de Risco , Vasodilatação
6.
Atherosclerosis ; 268: 92-98, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29195110

RESUMO

BACKGROUND AND AIMS: Baseline brachial artery (BBA) diameter has been reported to be a potential confounding factor of flow-mediated vasodilation (FMD). The purpose of this study was to evaluate the relationships between BBA diameter and cardiovascular risk factors and compare the diagnostic accuracy of BBA diameter in subjects without cardiovascular risk factors and patients with cardiovascular disease (CVD) with that of FMD. METHODS: We measured BBA diameter and FMD in 5695 male subjects. In addition, we retrospectively investigated the incidence of cardiovascular events using another population sample consisting of 440 male subjects, to compare the accuracy of BBA diameter with that of FMD in predicting cardiovascular events. RESULTS: BBA diameter and FMD significantly correlated with age, body mass index, systolic blood pressure, diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol, and glucose as well as Framingham risk score. The prevalence of cardiovascular risk factors and CVD increased with the increase in BBA diameter and FMD. Area under the curve (AUC) value of the receiver operating characteristic (ROC) curve for BBA diameter to diagnose subjects without cardiovascular risk factors (0.59 vs. 0.62, p = 0.001) or patients with CVD (0.58 vs. 0.64, p < 0.001) was significantly lower than that for FMD. In the retrospective study, the AUC value of the ROC curve for BBA diameter to predict first major cardiovascular events was significantly lower than that of FMD (0.50 vs. 0.62, p = 0.03). CONCLUSIONS: In men, BBA diameter was inferior to FMD for assessment of cardiovascular risk.


Assuntos
Artéria Braquial/fisiopatologia , Doenças Cardiovasculares/epidemiologia , Vasodilatação , Adulto , Idoso , Artéria Braquial/diagnóstico por imagem , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/fisiopatologia , Estudos Transversais , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Ultrassonografia
7.
Intern Med ; 56(21): 2891-2894, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-28943564

RESUMO

The effect of non-vitamin K antagonist oral anticoagulants on left atrial appendage (LAA) thrombus has not been fully elucidated. There are a few reports showing resolution of LAA thrombus with apixaban. An 84-year-old woman was admitted to our hospital due to acute exacerbation of chronic heart failure and marked tachycardia with atrial fibrillation. She had permanent atrial fibrillation and was treated with warfarin; however, transthoracic echocardiography revealed a non-mobile thrombus in the LAA. Therefore, we switched warfarin to apixaban at a dose of 5 mg/day. After two weeks on that therapy, the thrombus in the LAA was successfully resolved.


Assuntos
Apêndice Atrial/patologia , Fibrinolíticos/uso terapêutico , Insuficiência Cardíaca/complicações , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Trombose/tratamento farmacológico , Idoso de 80 Anos ou mais , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Ecocardiografia , Ecocardiografia Transesofagiana , Feminino , Humanos , Varfarina/uso terapêutico
8.
Hypertension ; 70(4): 790-797, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28808069

RESUMO

Hypertension is associated with endothelial dysfunction. Blood pressure significantly correlates with endothelial function in antihypertensive drug-naive subjects. The purpose of this study was to determine whether treatment status affects the relationship between blood pressure and endothelial function. We measured flow-mediated vasodilation (FMD) in 2297 subjects, including 1822 antihypertensive drug-naive subjects and 475 treated hypertensive patients. FMD significantly decreased in relation to increase in systolic blood pressure (8.2±3.1% in subjects with systolic blood pressure of <120 mm Hg, 7.5±2.8% for 120-129 mm Hg, 7.1±2.8% for 130-139 mm Hg, and 6.7±2.6% for ≥140 mm Hg; P<0.001). Systolic blood pressure was independently associated with FMD in untreated subjects. In contrast, there was no significant relationship between systolic blood pressure and FMD in treated hypertensive patients (4.6±3.1% in treated hypertensives with systolic blood pressure of <120 mm Hg, 4.8±2.7% for 120-129 mm Hg, 4.9±2.8% for 130-139 mm Hg, and 4.5±2.3% for ≥140 mm Hg; P=0.77). Propensity score matching analysis revealed that the prevalence of endothelial dysfunction defined as FMD of less than the division point for the lowest tertile, and the middle tertile of FMD was significantly higher in treated hypertensive patients than in untreated subjects in all systolic blood pressure categories. Endothelial function assessed by FMD was impaired regardless of the level of blood pressure achieved by antihypertensive drug treatment in hypertensive patients.


Assuntos
Anti-Hipertensivos , Endotélio Vascular , Hipertensão , Vasodilatação/efeitos dos fármacos , Adulto , Idoso , Anti-Hipertensivos/farmacologia , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/fisiopatologia , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Japão/epidemiologia , Masculino , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Pessoa de Meia-Idade
9.
J Am Heart Assoc ; 5(12)2016 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-28003249

RESUMO

BACKGROUND: A new device for automatic measurement of flow-mediated vasodilation (FMD) using an oscillometric method has been developed to solve technical problems of conventional FMD measurement. This device measures enclosed zone FMD (ezFMD). The purpose of this study was to evaluate the prognostic value of endothelial function assessed by ezFMD for future cardiovascular events. METHODS AND RESULTS: We measured ezFMD in 272 participants who underwent health-screening examinations. First, we investigated cross-sectional associations between ezFMD and cardiovascular risk factors, and then we assessed the associations between ezFMD and first major cardiovascular events (death from cardiovascular causes, stroke, and coronary revascularization). Univariate regression analysis revealed that ezFMD was significantly correlated with age, triglycerides, glucose, smoking pack-years, estimated glomerular filtration rate, high-sensitivity C-reactive protein, and Framingham risk score. During a median follow-up period of 36.1 months (interquartile range 18.8-40.1 months), 12 participants died (6 from cardiovascular causes), 3 had stroke, 8 had coronary revascularization, and 10 were hospitalized for heart failure. There was no episode of acute coronary syndrome during the study period. Participants were divided into tertiles (low, intermediate, and high) based on ezFMD. Kaplan-Meier curves for first major cardiovascular events among the 3 groups were significantly different (P=0.004). After adjustment for cardiovascular risk factors, the low group was significantly associated with an increased risk of first major cardiovascular events compared with the high group (hazard ratio 6.47; 95% CI 1.09-125.55; P=0.038). CONCLUSIONS: These findings suggest that endothelial function assessed by ezFMD may be useful as a surrogate marker of future cardiovascular events. CLINICAL TRIAL REGISTRATION: URL: https://upload.umin.ac.jp. Unique identifier: UMIN000004902.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Artéria Braquial/fisiopatologia , Doenças Cardiovasculares/diagnóstico , Endotélio Vascular/fisiopatologia , Oscilometria/instrumentação , Vasodilatação/fisiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/fisiopatologia , Estudos Transversais , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos
10.
Ann Nucl Med ; 29(3): 256-67, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25472779

RESUMO

OBJECTIVE: Although several studies have shown the diagnostic and prognostic value of CT-based attenuation correction (AC) of single photon emission computed tomography (SPECT) images for diagnosing coronary artery disease (CAD), this issue remains a matter of debate. To clarify the characteristics of CT-AC SPECT images that might potentially improve diagnostic performance, we analyzed images acquired using adenosine-stress thallium-201 myocardial perfusion SPECT/CT equipped with IQ[Symbol: see text]SPECT (SPECT/CT-IQ[Symbol: see text]SPECT) from patients with angiographically proven normal coronary arteries after changing the CT attenuation correction (CT-AC) in a stepwise manner. METHODS: We enrolled 72 patients (Male 36, Female 36) with normal coronary arteries according to findings of invasive coronary angiography or CT-angiography within three months after a SPECT/CT study. Projection images were reconstructed at CT-AC values of (-), 40, 60, 80 and 100 % using a CT number conversion program according to our definition and analyzed using polar maps according to sex. RESULTS: CT attenuation corrected segments were located from the mid- and apical-inferior spread through the mid- and apical-septal regions and finally to the basal-anterior and basal- and mid-lateral regions in males, and from the mid-inferior region through the mid-septal and mid-anterior, and mid-lateral regions in females as the CT-AC values increased. Segments with maximal mean counts shifted from the apical-anterior to mid-anterolateral region under both stress and rest conditions in males, whereas such segments shifted from the apical-septal to the mid-anteroseptal region under both stress and rest conditions in females. CONCLUSIONS: We clarified which part of the myocardium and to which degree CT-AC affects it in adenosine-stress thallium-201 myocardial perfusion SPECT/CT-IQ[Symbol: see text]SPECT images by changing the CT-AC value stepwise. We also identified sex-specific shifts of segments with maximal mean counts that changed as CT-AC values increased.


Assuntos
Vasos Coronários/diagnóstico por imagem , Imagem de Perfusão do Miocárdio , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Adenosina/administração & dosagem , Idoso , Artefatos , Angiografia Coronária , Vasos Coronários/efeitos dos fármacos , Feminino , Humanos , Masculino , Imagem Multimodal/instrumentação , Imagem Multimodal/métodos , Imagem de Perfusão do Miocárdio/instrumentação , Imagem de Perfusão do Miocárdio/métodos , Imagens de Fantasmas , Compostos Radiofarmacêuticos , Descanso , Caracteres Sexuais , Processamento de Sinais Assistido por Computador , Software , Estresse Fisiológico , Radioisótopos de Tálio , Tomografia Computadorizada de Emissão de Fóton Único/instrumentação , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X/instrumentação , Tomografia Computadorizada por Raios X/métodos , Vasodilatadores/administração & dosagem
11.
World J Cardiol ; 6(7): 685-8, 2014 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-25068030

RESUMO

We present the case of a 65-year-old male with vasospastic angina (VSA) whose condition worsened during the perioperative period. He had been diagnosed with VSA 10 years prior. He was treated with two types of vasodilators and had not experienced any chest symptoms for 5 years. At this juncture, he underwent surgery for relapsed maxillary sublingual carcinoma. He had taken two vasodilators one day prior to surgery. Intravenous infusion of nitroglycerin (NTG) was initiated immediately before the surgery and continued the following day. Instead of stopping NTG, a dermal isosorbide dinitrate tape was applied on post-operative day 1. Two days later, a complete atrioventricular block with pulseless electrical activity appeared. After cardiopulmonary resuscitation, emergent coronary angiography showed severe coronary spasm in both the left and right coronary arteries. Intracoronary infusion of nitroglycerin and epinephrine with percutaneous cardiopulmonary support relieved the coronary spasm. During the perioperative period, several factors can trigger coronary vasospasm, including the discontinuation of vasodilators. Thus, surgeons, anesthetists, and cardiologists should watch for coronary vasospasm during this period and for worsening coronary spasm when discontinuing vasodilators in patients at risk for VSA.

12.
BMJ Open ; 3(11): e003659, 2013 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-24213096

RESUMO

OBJECTIVES: The purpose of this study was to determine the relationships between uric acid, endothelial function and cardiovascular risk factors and to investigate whether menopausal status was associated with the relationship between uric acid and endothelial function in women. DESIGN: Cross-sectional study. SETTING: 3 general hospitals in Japan. PARTICIPANTS: 749 Japanese women aged 30-74 years recruited from people who underwent health-screening examinations with agreement for measurement of vascular function. MEASURES: We measured serum concentrations of uric acid and flow-mediated vasodilation (FMD). Percentage of FMD (peak diameter-baseline diameter/baseline diameter) was used for analysis. Endothelial dysfunction was defined as FMD ≤4.90%, division point for the lowest tertile and the middle tertile of FMD. Menopause women were defined as participants without menstruation for over 1 year or participants with a history of hysterectomy or bilateral oophorectomy. RESULTS: Of the 749 participants, 368 (49.1%) were premenopausal women and 381 (50.9%) were postmenopausal women. Age, body mass index, systolic blood pressure, total cholesterol, triglycerides, glucose, estimated glomerular filtration rate and Framingham risk score were significantly correlated with serum uric acid level. FMD showed a gradual decrease in accordance with the serum uric acid level in the entire study population (<4 mg/dL, 6.85±3.65%; 4 to <5 mg/dL, 6.79±3.60%; 5 to <6 mg/dL, 6.24±3.58%; ≥6 mg/dL, 5.27±3.18%; p=0.01). Multivariate analysis revealed that uric acid was a significantly independent risk factor for endothelial dysfunction in postmenopausal women (OR 1.23, 95% CI 1.01 to 1.50), but not in premenopausal women. CONCLUSIONS: These findings suggest that uric acid can be used as a risk marker of endothelial dysfunction in a female population, and particularly as an independent risk factor in postmenopausal women but not in premenopausal women. REGISTRATION NUMBER OF THE STUDY: UMIN000003409.

13.
Heart ; 99(24): 1837-42, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24153417

RESUMO

OBJECTIVE: To determine the relationships between flow-mediated vasodilation (FMD) and cardiovascular risk factors, and to evaluate confounding factors for measurement of FMD in a large general population in Japan. METHODS: This was a cross-sectional study. A total of 5314 Japanese adults recruited from people who underwent health screening from 1 April 2010 to 31 August 2012 at 3 general hospitals in Japan. Patients' risk factors (age, Body Mass Index, blood pressure, cholesterol parameters, glucose level and HbA1c level) and prevalence of cardiovascular disease (coronary heart disease and cerebrovascular disease) were investigated. RESULTS: Univariate regression analysis revealed that FMD correlated with age (r=-0.27, p<0.001), Body Mass Index (r=-0.14, p<0.001), systolic blood pressure (r=-0.18, p<0.001), diastolic blood pressure (r=-0.13, p<0.001), total cholesterol (r=-0.07, p<0.001), triglycerides (r=-0.10, p<0.001), high-density lipoprotein cholesterol (r=0.06, p<0.001), low-density lipoprotein cholesterol (r=-0.04, p=0.01), glucose level (r=-0.14, p<0.001), HbA1c (r=-0.14, p<0.001), and baseline brachial artery diameter (r=-0.43, p<0.001) as well as Framingham Risk score (r=-0.29, p<0.001). Multivariate analysis revealed that age (t value=-9.17, p<0.001), sex (t value=9.29, p<0.001), Body Mass Index (t value=4.27, p<0.001), systolic blood pressure (t value=-2.86, p=0.004), diabetes mellitus (t value=-4.19, p<0.001), smoking (t value=-2.56, p=0.01), and baseline brachial artery diameter (t value=-29.4, p<0.001) were independent predictors of FMD. CONCLUSIONS: FMD may be a marker of the grade of atherosclerosis and may be used as a surrogate marker of cardiovascular outcomes. Age, sex, Body Mass Index, systolic blood pressure, diabetes mellitus, smoking and, particularly, baseline brachial artery diameter are potential confounding factors in the measurement of FMD.


Assuntos
Velocidade do Fluxo Sanguíneo , Artéria Braquial/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Medição de Risco/métodos , Vasodilatação/fisiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Estudos Transversais , Eletrocardiografia , Endotélio Vascular/fisiopatologia , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Adulto Jovem
14.
Atherosclerosis ; 229(2): 324-30, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23880183

RESUMO

BACKGROUND: It is clinically important to estimate the degree of endothelial dysfunction. Several methods have been used to assess endothelial function in humans. Recently, we developed a new noninvasive method for measurement of vascular response to reactive hyperemia in the brachial artery, named enclosed zone flow-mediated vasodilation (ezFMD). The purpose of this study was to determine the validity of ezFMD for assessment of endothelial function. METHODS AND RESULTS: We measured ezFMD by a new device using an oscillometric method and conventional FMD using ultrasonography in 306 subjects, including patients with hypertension, dyslipidemia, and diabetes mellitus (218 men and 88 women, 30 ± 16 yr). Univariate regression analysis revealed that ezFMD significantly correlated with age (r = -0.42, P < 0.0001), body mass index (r = -0.13, P = 0.028), systolic blood pressure (r = -0.15, P = 0.009), diastolic blood pressure (r = -0.14, P = 0.011), fasting glucose level (r = -0.27, P = 0.006), smoking (r = -0.21, P = 0.007) and baseline pulse wave amplitude (r = -0.51, P < 0.0001). ezFMD significantly correlated with conventional FMD (r = 0.34, P < 0.0001). Multiple regression analysis revealed that age (P = 0.002), body mass index (P = 0.013), systolic blood pressure (P = 0.009), smoking (P = 0.004) and baseline pulse wave amplitude (P < 0.001) were independent predictors of ezFMD. CONCLUSIONS: These findings suggest that measurement of ezFMD, a novel noninvasive and simple method, may be useful for determination of vascular diameter response to reactive hyperemia. Since ezFMD is automatically measured by a device with an oscillometric method, measurement of ezFMD is easier and less biased than that of conventional FMD.


Assuntos
Aterosclerose/diagnóstico , Aterosclerose/fisiopatologia , Endotélio Vascular/fisiologia , Oscilometria/métodos , Fluxo Sanguíneo Regional/fisiologia , Vasodilatação/fisiologia , Adolescente , Adulto , Pressão Sanguínea/fisiologia , Artéria Braquial/fisiologia , Diabetes Mellitus/fisiopatologia , Dislipidemias/fisiopatologia , Feminino , Humanos , Hiperemia/fisiopatologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Oscilometria/instrumentação , Adulto Jovem
15.
Arterioscler Thromb Vasc Biol ; 33(6): 1401-8, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23520168

RESUMO

OBJECTIVE: Nitroglycerine-induced vasodilation has been used as a control test for flow-mediated vasodilation (FMD) to differentiate endothelium-dependent from endothelium-independent response when evaluating endothelial function in humans. Recently, nitroglycerine-induced vasodilation has also been reported to be impaired in patients with atherosclerosis. The purpose of this study was to determine the relationships between nitroglycerine-induced vasodilation and cardiovascular risk factors. APPROACH AND RESULTS: We measured nitroglycerine-induced vasodilation and FMD in 436 subjects who underwent health examinations (mean age, 53 ± 19 years; age range, 19-86 years), including patients with cardiovascular diseases. There was a significant relationship between nitroglycerine-induced vasodilation and FMD (r=0.42; P<0.001). Univariate regression analysis revealed that nitroglycerine-induced vasodilation correlated with age (r=-0.34; P<0.001), systolic blood pressure (r=-0.32; P<0.001), diastolic blood pressure (r=-0.24; P<0.001), heart rate (r=-0.21; P<0.001), glucose (r=-0.23; P<0.001), and smoking pack-year (r=-0.12; P=0.01), as well as Framingham risk score (r=-0.30; P<0.001). Nitroglycerine-induced vasodilation was significantly smaller in patients with cardiovascular disease than in both subjects with and without cardiovascular risk factors (10.5 ± 5.6% versus 13.7 ± 5.4% and 15.3 ± 4.3%; P<0.001, respectively), whereas there was no significant difference in nitroglycerine-induced vasodilation between subjects with and without cardiovascular risk factors. Multivariate analysis revealed that male sex, body mass index, hypertension, diabetes mellitus, baseline brachial artery diameter, and FMD were independent predictors of nitroglycerine-induced vasodilation. CONCLUSIONS: These findings suggest that nitroglycerine-induced vasodilation may be a marker of the grade of atherosclerosis. FMD should be interpreted as an index of vascular function reflecting both endothelium-dependent vasodilation and endothelium-independent vasodilation in subjects with impaired nitroglycerine-induced vasodilation.


Assuntos
Aterosclerose/epidemiologia , Doenças Cardiovasculares/epidemiologia , Endotélio Vascular/efeitos dos fármacos , Nitroglicerina/farmacologia , Vasodilatação/efeitos dos fármacos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Angiografia/métodos , Aterosclerose/diagnóstico por imagem , Aterosclerose/patologia , Velocidade do Fluxo Sanguíneo , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/patologia , Estudos de Coortes , Endotélio Vascular/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Estudos Prospectivos , Valores de Referência , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Fatores Sexuais , Grau de Desobstrução Vascular/fisiologia , Adulto Jovem
16.
Circ J ; 77(4): 1073-80, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23220859

RESUMO

BACKGROUND: The purpose of this study was to evaluate the effect of anatomical variation of the brachial artery on flow-mediated vasodilation (FMD) in healthy subjects and patients with cardiovascular disease (CVD). METHODS AND RESULTS: There was no significant difference in the prevalence of double brachial artery between healthy subjects (6.1%) and patients with CVD (6.5%). In healthy subjects, FMD was larger in a single brachial artery than in large and small vessels of a double brachial artery (7.2±3.4% vs. 4.7±3.3% and 4.5±2.5%, P<0.01, respectively). In patients with CVD, there were no significant differences in FMD among a single brachial artery, large vessel of a double brachial artery and small vessel of a double brachial artery (3.3±1.4%, 3.1±2.3% and 3.6±2.1%). FMD in a single brachial artery was smaller in patients with CVD than in healthy subjects. There were no significant differences in FMD in the large vessel of a double brachial artery between the 2 groups or in the small vessel of a double brachial artery between the 2 groups. Nitroglycerine-induced vasodilation was similar in all arteries in healthy subjects and patients with CVD. CONCLUSIONS: When measuring FMD, the existence of a double brachial artery should be checked. FMD measured in a double brachial artery may be underestimated in healthy subjects.


Assuntos
Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/fisiopatologia , Vasodilatação , Adulto , Idoso , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nitroglicerina/administração & dosagem , Ultrassonografia , Vasodilatadores/administração & dosagem
17.
J Cardiol Cases ; 8(2): e72-e76, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30546747

RESUMO

A 51-year-old man recently diagnosed with preclinical Cushing's syndrome complained of chest oppression concomitant with back pain. Following contrast-enhanced computed tomography (CT) to rule out acute aortic dissection, he developed chest symptoms accompanied by elevation of blood pressure to 240/120 mmHg and ischemic electrocardiographic change. Urgent coronary angiography revealed a coronary artery aneurysm (15 mm × 6 mm) in the distal portion of the left anterior descending artery concomitant with coronary flow delay. Re-analysis of the blood sample taken at admission showed elevated plasma catecholamine concentrations, leading to a diagnosis of paroxysmal pheochromocytoma. An adrenal tumor was excised laparoscopically and histologically shown to be a pheochromocytoma. These findings show that coronary artery aneurysm may be a rare complication of pheochromocytoma, and indicate that monitoring of blood pressure or analysis of stored blood samples, if necessary, is essential to detect pheochromocytoma when using contrast medium or glucagon in patients known to have an adrenal incidentaloma. It should be noted that pre-treatment with an α-blocker is necessary when patients who are likely to have pheochromocytoma need to undergo contrast-enhanced CT. .

18.
Med Biol Eng Comput ; 50(12): 1239-47, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23054376

RESUMO

Measurement of flow-mediated dilatation (FMD) is the conventional non-invasive method for assessment of endothelial function; however, it requires an expensive ultrasound system and high levels of technical skill. Therefore, we developed a novel method for measurement of endothelial function, namely, measurement of ezFMD. ezFMD estimates the degree of vasodilatation from the oscillation signals transmitted to a sphygmomanometer cuff attached to the upper arm. The objective of this study was to validate the principle underlying the measurement of ezFMD, and to evaluate the repeatability of the ezFMD measurements. We observed the blood vessel behavior and oscillometric pattern in ten subjects. When the cuff was inflated to the level of the mean blood pressure, the oscillation amplitude increased with increasing degree of vasodilatation. In experiment to evaluate the repeatability of the ezFMD measurement, the average difference between the paired measurements was 3.7 %, the standard deviation was 11.5 %, and the average coefficient of variation value for the 11 paired measurements was 23.7 %. These results suggest the validity of the principle underlying the measurement of the ezFMD for the assessment of endothelial function. And, this study suggests that the repeatability of the ezFMD measurements is superior to that of the conventional measurement of FMD.


Assuntos
Técnicas de Diagnóstico Cardiovascular , Endotélio Vascular/fisiologia , Processamento de Sinais Assistido por Computador , Adulto , Algoritmos , Artéria Braquial/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Oscilometria , Reprodutibilidade dos Testes , Esfigmomanômetros , Vasodilatação
19.
Arterioscler Thromb Vasc Biol ; 32(9): 2295-303, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22796580

RESUMO

OBJECTIVE: Cardiovascular diseases are associated with impaired flow-mediated vasodilation (FMD) and increase in carotid intima-media thickness (IMT). Both FMD and IMT are independent predictors for cardiovascular outcomes. When measuring FMD and nitroglycerine-induced vasodilation in the brachial artery, IMT can also be simultaneously assessed in the same brachial artery. The purpose of this study was to determine the relationships between IMT of the brachial artery, vascular function, and cardiovascular risk factors. METHODS AND RESULTS: We measured brachial IMT, FMD, and nitroglycerine-induced vasodilation by ultrasound in 388 subjects who underwent health examination (mean age, 45±22 years; age range, 19-86), including patients with cardiovascular diseases. Univariate regression analysis revealed that brachial IMT significantly correlated with age (r=0.71; P<0.001), body mass index (r=0.27; P<0.001), systolic blood pressure (r=0.40; P<0.001), diastolic blood pressure (r=0.31; P<0.001), heart rate (r=0.15; P=0.002), glucose level (r=0.18; P=0.01), and smoking pack-years (r=0.42; P<0.001), as well as Framingham risk score, a cumulative cardiovascular risk index for heart attack (r=0.49; P<0.001). FMD and nitroglycerine-induced vasodilation were inversely associated with brachial IMT (r=-0.39, P<0.001; r=-0.32, P<0.001, respectively). In addition, there was a significant relationship between brachial IMT and carotid IMT (r=0.58; P<0.001). Multivariate analysis revealed that age, sex, hypertension, and brachial artery diameter were independent predictors of brachial IMT. CONCLUSIONS: These findings suggest that brachial IMT may be a marker of the grade of atherosclerosis and may be used as a marker of vascular function, providing additive information for stratifying subjects with cardiovascular risk factors.


Assuntos
Aterosclerose/diagnóstico , Artéria Braquial , Doenças Cardiovasculares/etiologia , Túnica Íntima , Túnica Média , Vasodilatação , Adulto , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/complicações , Aterosclerose/diagnóstico por imagem , Aterosclerose/fisiopatologia , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/efeitos dos fármacos , Artéria Braquial/fisiopatologia , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/fisiopatologia , Artéria Carótida Primitiva/diagnóstico por imagem , Espessura Intima-Media Carotídea , Distribuição de Qui-Quadrado , Feminino , Humanos , Hiperemia/diagnóstico por imagem , Hiperemia/fisiopatologia , Japão , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nitroglicerina/administração & dosagem , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Túnica Íntima/diagnóstico por imagem , Túnica Íntima/efeitos dos fármacos , Túnica Íntima/fisiopatologia , Túnica Média/diagnóstico por imagem , Túnica Média/efeitos dos fármacos , Túnica Média/fisiopatologia , Vasodilatação/efeitos dos fármacos , Vasodilatadores/administração & dosagem , Adulto Jovem
20.
Circulation ; 126(5): 598-603, 2012 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-22773454

RESUMO

BACKGROUND: Patients with Gilbert syndrome have mild unconjugated hyperbilirubinemia. It has been shown that bilirubin is an endogenous antioxidant. We evaluated the role of oxidative stress in endothelial function in patients with Gilbert syndrome under normal conditions without cardiovascular risk factors. METHODS AND RESULTS: A total of 108 young men with Gilbert syndrome without cardiovascular risk factors and 108 age-matched healthy men (normal controls) were enrolled in this study. Serum concentrations of bilirubin were higher in patients with Gilbert syndrome than in control subjects (29.2±11.6 versus 9.4±2.7 µmol/L; P<0.001). Serum concentrations of malondialdehyde-modified low-density lipoprotein and urinary excretion of 8-hydroxy-2'-deoxyguanosine (8-OHdG), as indices of oxidative stress, were lower in patients with Gilbert syndrome than in control subjects (61.8±24.5 versus 72.5±21.8 U/L, P=0.034; 7.8±2.4 versus 10.4±3.2 ng/mg creatinine, P=0.001, respectively). Flow-mediated vasodilation was greater in patients with Gilbert syndrome than in normal control subjects (7.2±2.2% versus 5.9±1.7%; P<0.001). Vascular responses to nitroglycerine were not significantly different between the 2 groups. Flow-mediated vasodilation correlated with serum concentration of bilirubin (r=0.44, P<0.001), malondialdehyde-modified low-density lipoprotein (r=-0.25, P=0.01), and urinary excretion of 8-OHdG (r=-0.27, P=0.004) in patients with Gilbert syndrome but not in control subjects. In addition, serum concentration of bilirubin correlated with malondialdehyde-modified low-density lipoprotein (r=-0.20, P=0.04) and 8-OHdG (r=-0.21, P=0.02) in patients with Gilbert syndrome but not in control subjects. CONCLUSIONS: Patients with Gilbert syndrome had low levels of oxidative stress associated with hyperbilirubinemia and enhancement of endothelium-dependent vasodilation. CLINICAL TRIAL REGISTRATION: URL: http://www.umin.ac.jp. Unique identifier: UMIN000003409.


Assuntos
Endotélio Vascular/fisiologia , Doença de Gilbert/sangue , Doença de Gilbert/fisiopatologia , Hiperbilirrubinemia/fisiopatologia , Estresse Oxidativo/fisiologia , 8-Hidroxi-2'-Desoxiguanosina , Adulto , Bilirrubina/sangue , Artéria Braquial/fisiologia , Estudos de Casos e Controles , Desoxiguanosina/análogos & derivados , Desoxiguanosina/urina , Humanos , Hiperbilirrubinemia/sangue , Lipoproteínas LDL/sangue , Masculino , Nitroglicerina/farmacologia , Fluxo Sanguíneo Regional/fisiologia , Vasodilatação/efeitos dos fármacos , Vasodilatação/fisiologia
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