Abstract Background Oral infection contributes to atherosclerosis and coronary heart disease. We hypothesized that dental caries may be associated with out-of-hospital cardiac arrests (OHCA) of ...cardiac origin, but not non-cardiac origin. Methods and results We compared the age-adjusted incidence of OHCA (785,591 cases of OHCA: 55.4% of cardiac origin and 44.6% of non-cardiac origin) to the age-adjusted prevalence of dental caries between 2005 and 2011 in the 47 prefectures of Japan. In both the total population and males over 65 years, the number of cases of dental caries was significantly associated with the number of OHCA of total and cardiac origin from 2005 to 2011, but not those of non-cardiac origin. In the total population, the age-adjusted prevalence of dental caries was not significantly associated with the age-adjusted incidence of OHCA (total OHCA: r correlation coefficient = 0.22, p = 0.14; OHCA of cardiac origin: r = 0.25, p = 0.09; OHCA of non-cardiac origin: r = −0.002, p = 0.99). Among male patients over 65 years, the age-adjusted prevalence of dental caries was significantly associated with OHCA of total and cardiac origin, but not non-cardiac origin (total OHCA: r = 0.47, p < 0.001; OHCA of cardiac origin: r = 0.37, p = 0.01; OHCA of non-cardiac origin: r = 0.28, p = 0.054). Conclusions While oral hygiene is important in all age groups, it may be particularly associated with OHCAs of cardiac origin in males over 65 years.
Abstract Background It is not clear whether it is reasonable to use particular drugs for glycemic control in preference to other hypoglycemic agents in terms of the clinical outcome of percutaneous ...coronary intervention (PCI) in patients with diabetes mellitus (DM). Methods and results Among 2148 patients (2568 lesions) in the FU-Registry, DM patients who underwent PCI ( n = 758; 922 lesions) were investigated to clarify the effects of various drugs for glycemic control on the clinical outcome major adverse cardiac events (MACEs): death, myocardial infarction (MI), and target lesion revascularization (TLR) over approximately 300 days of follow-up (UMIN000005679). The MACEs(+) group ( n = 165) had a higher usage of insulin ( p < 0.001) and a lower usage of biguanides (BG, p < 0.05) and dipeptidyl peptidase-IV inhibitors ( p < 0.05) at PCI, compared to the MACEs(−) group ( n = 593). A multivariate logistic regression analysis showed that low-density lipoprotein cholesterol, insulin use, atherosclerosis obliterans, and lesion reference might be significantly associated with MACEs, while BG use was negatively correlated with MACEs ( p = 0.04). The cumulative frequency of MACEs in the insulin-treated group was significantly higher ( p < 0.05) than that in the non-insulin group, and the strongest association between insulin with MACEs was seen in the hemoglobin (Hb) A1c 6.5–7.5% group. There tended to be a negative correlation between the use of insulin and MACEs, with risk ratios of <1, for the HbA1c >8.5% groups. Conclusions Among different hypoglycemic agents, treatment with insulin was associated with poor mid-term clinical outcomes in DM patients who underwent PCI, while BG use was negatively correlated with MACEs. It may be reasonable for patients with HbA1c >8.5% to avoid hyperglycemia and glucotoxicity, even through the use of insulin.
Abstract There is some evidence in prospective randomized clinical trials that the administration of adrenaline (AD) before admission for the treatment of out-of-hospital cardiac arrest did not ...improve survival to hospital discharge. The aim of this study was to evaluate our real-world experience regarding the efficacy of intravenous AD in out-of-hospital cardiac arrest at our university hospital. In this retrospective study, we enrolled and divided 644 patients into AD (AD administration before arrival at the hospital) and non-AD (no AD administration before arrival at the hospital) groups. The patient characteristics including age, sex, percentage of cardiac cause, location of cardiac arrest, and witnessed arrest were similar between the AD and non-AD groups. There were no significant differences between the AD and non-AD groups with regard to return of spontaneous circulation, survival to hospital admission, survival to hospital discharge, or good neurologic recovery at hospital discharge in all patients. In addition, we excluded the data of patients with extrinsic cause. We analyzed whether intravenous AD before arrival in patients with intrinsic cause was effective. The outcomes in the AD group were similar to those in the non-AD group. In conclusion, our study indicated that AD administration before arrival at the hospital for the treatment of out-of-hospital cardiac arrest did not improve the clinical outcome.
Abstract Objective We investigated the associations between serum levels of glycated albumin (GA) or hemoglobin A1c (HbA1c) and the presence of coronary artery disease (CAD) in patients who underwent ...coronary computed tomography angiography (CTA). Methods and results The study consisted of 244 consecutive patients who underwent CTA and in whom we could measure the levels of both GA and HbA1c. Any narrowing of the normal contrast-enhanced lumen to >50% that could be identified in multiplanar reconstructions or cross-sectional images by CTA was defined as significant stenosis in CAD. We divided the patients into two groups: CAD group ( n = 72) and non-CAD group ( n = 172), as assessed by CTA. The CAD group showed significantly higher GA and HbA1c than the non-CAD group. GA and HbA1c showed a positive correlation ( r = 0.551, p < 0.0001). A multivariate logistic regression analysis was performed to examine the associations between the presence of CAD and age, gender, body mass index, and coronary risk factors (hypertension, dyslipidemia, and smoking), in addition to GA and HbA1c. Age odds ratio (OR): 1.04, p = 0.02, gender (OR: 2.84 p = 0.01), hypertension (OR: 3.20, p = 0.01), and GA (OR: 1.16, p = 0.03) were identified as significant independent variables that predicted the presence of CAD. In particular, GA (OR: 1.30, p = 0.02) was the only predictor of the presence of CAD in the diabetes mellitus group by a multivariate logistic regression analysis. We defined the cut-off value of GA for the prediction of CAD in patients with diabetes as 17.9% (sensitivity 0.639, specificity 0.639) by a receiver-operating characteristic curve analysis. Conclusion GA may be superior to HbA1c as a marker for evaluating the presence of CAD.
Abstract Background It is well known that percutaneous coronary intervention (PCI) in hemodialysis (HD) patients is associated with higher rates of in-stent restenosis and major adverse ...cardiovascular events (MACE) compared to that in non-HD patients, even if the target value in cholesterol management is achieved. Methods To evaluate the factors that are associated with MACE in HD patients, we selected 142 HD patients (164 lesions) without acute coronary syndrome (ACS) from 2148 patients (2568 lesions) who underwent PCI in our database of the FU-Registry UMIN000005679, Fukuoka University Hospital EC/IRB:10-1-08(09-105), and compared 52 patients (53 lesions) with MACE MACE(+) to 90 patients (111 lesions) without MACE MACE(−). Results Total cholesterol (TC: 150 ± 30 mg/dL vs 166 ± 39 mg/dL, p < 0.05) and high-density lipoprotein cholesterol (HDL-C: 40.1 ± 14.7 mg/dL vs 47.8 ± 13.5 mg/dL, p < 0.01) levels were significantly lower in the MACE(+) group at follow-up. No significant differences were observed in other parameters, including triglyceride, low-density lipoprotein cholesterol (LDL-C; LDL-C/HDL-C ratio, and % changes in HDL-C, non-HDL-C, LDL-C), and hemoglobin A1c (US National Glycohemoglobin Standardization Program) between before and after PCI. TC, LDL-C, and non-HDL-C at the time of PCI and TC, and HDL-C at the 9-month follow-up were negatively correlated with MACE, while body mass index (BMI) odds ratio (OR): 0.81; 95% confidence interval (CI): 0.68–0.95), prior coronary artery bypass graft (CABG) (OR: 3.89; 95%CI: 1.29–12.6), and insulin use (OR: 3.17; 95%CI: 1.23–8.55) were strongly correlated with MACE in a multivariate analysis. Conclusion BMI, CABG, and insulin use, but not LDL-C, are independent predictors of MACE in HD patients, suggesting that the application of lipid management for non-HD patients to HD patients at the time of PCI may not necessarily be beneficial for medium-term clinical outcomes.
Abstract Objective Aortic valve calcification (AVC) reflects the state of aortic valve sclerosis (AVS), which is a precursor to aortic valve stenosis (AS). Therefore, we investigated the presence of ...AVC in patients who underwent coronary computed tomography angiography (CTA), which is an effective tool for evaluating early-stage AVC, and examined the association between plasma levels of pentraxin 3 (PTX3) and AVC. Methods and results The subjects consisted of 162 consecutive patients who underwent CTA and in whom we could measure plasma levels of PTX3. We divided the patients into an AVC group ( n = 42) and a non-AVC group ( n = 120), as assessed by CT. Furthermore, we divided the patients without AS, assessed by echocardiography, into non-AS AVC ( n = 23) and non-AS non-AVC groups ( n = 60). We analyzed the predictors of the presence of AVC in all patients by a logistic regression analysis. AVC was independently associated with PTX3, in addition to age, chronic kidney disease, and coronary artery calcification. We also examined the predictors of the presence of AVC in patients without AS. PTX3, in addition to age, was an independent predictor of the presence of AVC in patients without AS. Finally, we found that adding PTX3 to the model containing age improves the specificity and, therefore, positive predictive value for AVC. Conclusions PTX3, in addition to age, was shown to be an independent predictor of AVC in patients without AS. The combination of age and PTX3 may be a better approach to the evaluation of AVC than either of these alone.
Abstract Background Coronary risk factors for the onset of acute coronary syndrome (ACS), including polyunsaturated fatty acids (PUFAs), in younger adult patients may be different from those in older ...patients. Methods and results We enrolled 578 patients who underwent coronary angiography at Fukuoka Saiseikai Hospital, and divided them into a younger adult group (YG) (<50 years, n = 47) and a middle-aged older group (OG) (≥50 years, n = 531). In a multivariate analysis, lower levels of high-density lipoprotein cholesterol and the ratio of eicosapentaenoic acid (EPA) to arachidonic acid (AA) (EPA/AA), and less aspirin, oral hypoglycemic agent, and calcium channel blocker (CCB) use were independent risk factors for ACS in all patients. In YG, lower levels of EPA/AA and less angiotensin II receptor blocker/angiotensin-converting enzyme inhibitor use were the independent risk factors. In OG, smoking, lower levels of EPA/AA, less aspirin and CCB use were the risk factors. While lower levels of EPA/AA was the only risk factor for ACS that was common to all patients, YG and OG, docosahexaenoic acid/AA was not associated with ACS in YG and OG. Conclusions Lower level of EPA/AA is a common critical risk factor for ACS in middle-aged older patients as well as younger adult patients. Some of the risk factors for the onset of ACS in younger patients were different from those in older patients.
Summary Background We evaluated the conduction properties of the posterior left atrium (LA) using a non-contact mapping (NCM) system as well as the significance of linear ablation at the roof of the ...posterior LA (LA roof) and inferior region of the posterior LA (LA bottom). Methods and results In 133 patients with atrial fibrillation (AF) (83 paroxysmal type, 50 persistent/long-lasting persistent type), we performed complete isolation of the posterior LA including pulmonary veins (Box isolation) using NCM. Isochronal activation maps were analyzed during sinus rhythm (SR), during pacing from the proximal coronary sinus (CS), and during pacing within the posterior LA before and after ablation. In sinus rhythm, horizontal conduction along the LA roof line, but not into the posterior LA wall, was observed in 59% of the patients. During paroxysmal CS pacing, horizontal conduction along the LA bottom line was observed in 69% of the patients. Posterior wall pacing conducted vertically over the LA roof and bottom lines in 98% and 83% of the patients, respectively. During AF, rotor wave conduction into the posterior LA through the LA roof and bottom lines was observed in 85% of the patients. Heterogeneous conduction directions in the posterior LA at the LA roof and bottom lines were observed in 60% of the patients. Conclusions Heterogeneous conduction was observed at the roof and inferior region of the posterior LA in most of these AF patients. The conduction properties of the posterior LA are affected by the direction of the wavefronts, and this may play an important role in the initiation and maintenance of AF. The complete isolation of the posterior LA may prevent AF.
Abstract A 31-year-old female with an 18-year history of systemic lupus erythematosus (SLE) complained of epigastralgia and consulted the emergency outpatient department at our hospital. Her physical ...examination revealed tenderness at the scrobiculus cordis, which was a non-specific symptom of coronary heart disease (CHD). We ultimately gave a diagnosis of acute myocardial infarction based on coronary angiography and performed percutaneous coronary intervention. Although pre-interventional intravascular ultrasound demonstrated distinct atherosclerotic lesions in the coronary arteries, there were no atherosclerotic lesions in other systemic arteries. Although CHD in young SLE patients is a significant cause of morbidity and premature death, it tends to be misdiagnosed because their symptoms may be non-specific. In addition, this case highlights the fact that even SLE patients with no systemic atherosclerosis are at risk for the development of CHD. < Learning objective: Coronary heart disease (CHD) in young systemic lupus erythematosus (SLE) patients is a significant cause of morbidity and premature death, but it tends to be misdiagnosed because their symptoms may be non-specific. Moreover, SLE patients are at risk for the development of CHD.>
Abstract A 44-year-old woman had a 15-year history of asthma and had recently been treated for sinusitis and unidentified limb eruption. She had presented at a nearby clinic with inspiratory chest ...pain one week before hospitalization, and was diagnosed as having eosinophilic pneumonia based on peripheral blood eosinophilia and ground glass opacities in the right lung field, without pericardial effusion, as detected by chest computed tomography. She additionally presented with a feeling of chest tightness, and extensive pericardial effusion appeared within a week. She developed heart failure on admission, and we performed pericardiocentesis. We gave a clinical diagnosis of acute probable myopericarditis as the cause of pericardial effusion based on pleuritic chest pain, pericardial effusion, and elevation of cardiac enzymes, as well as eosinophilic granulomatosis with polyangiitis (EGPA) based on eosinophilia, her history of sinusitis, asthma, and migratory pulmonary opacities. We initiated oral prednisone 25 mg daily and pericardial effusion disappeared. In patients with EGPA, cardiac involvement is more serious than the involvement of other organs, and is associated with a poor prognosis. In this report we describe a rare case of EGPA complicated with progressive pericardial effusion and discuss the importance of the early diagnosis and treatment of EGPA. < Learning objective: Eosinophilic granulomatosis with polyangiitis (EGPA), or Churg Strauss syndrome, is a multisystem disorder. It is important for patients with EGPA complicated with cardiac involvement to be diagnosed and treated early because cardiac involvement may lead to a fatal outcome.>
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