Abstract Background Loop diuretics used in the treatment of heart failure often induce renal impairment. This study was conducted in order to evaluate the renal protective effect of adding tolvaptan ...(TLV), compared to increasing the furosemide (FRM) dose, for the treatment of acute decompensated heart failure (ADHF) in a real-world elderly patient population. Methods This randomized controlled trial enrolled 52 consecutive hospitalized patients (age 83.4 ± 9.6 years) with ADHF. The patients were assigned alternately to either the TLV group (TLV plus conventional treatment, n = 26) or the FRM group (increasing the dose of FRM, n = 26). TLV was administered within 24 h from admission. Results The incidence of worsening renal function (WRF) within 7 days from admission was significantly lower in the TLV group (26.9% vs. 57.7%, p = 0.025). Furthermore, the rates of occurrence of persistent and late-onset (≥5 days from admission) WRF were significantly lower in the TLV group. Persistent and late-onset WRF were significantly associated with a higher incidence of cardiac death or readmission for worsening heart failure in the 90 days following discharge, compared to transient and early-onset WRF, respectively. Conclusions Early administration of TLV, compared to increased FRM dosage, reduces the incidence of WRF in real-world elderly ADHF patients. In addition, it reduces the occurrence of ‘worse’ WRF—persistent and late-onset WRF—which are associated with increased rates of cardiac death or readmission for worsening heart failure in the 90 days after discharge.
Abstract Background This study compared adenosine stress computed tomography myocardial perfusion (CTP) with single-photon emission computed tomography (SPECT) in the diagnosis of functionally ...significant coronary artery stenosis using fractional flow reserve (FFR) as reference standard. Methods We included a total of 93 coronary arteries from 31 patients in whom at least one vessel with ≥50% stenosis was detected with computed tomography coronary angiography. All patients underwent both SPECT and adenosine stress CTP, followed by invasive coronary angiography (ICA) and FFR. Diagnostic accuracy between CTP and SPECT was compared according to positive findings of either ≥99% stenosis on ICA or FFR ≤0.8. Results Among 78 vessels eligible for the quantitative analyses, significant coronary artery disease (CAD) was diagnosed in 22 vessels of 19 patients. Comparison of CTP vs. SPECT for sensitivity, specificity, positive predictive value (PPV), negative predictive value, and accuracy in detecting significant CAD were 59% vs. 18%, 96% vs. 93%, 87% vs. 50%, 86% vs. 74%, and 86% vs. 72%, respectively. Conclusions CTP demonstrated a significant diagnostic advantage over SPECT in the identification of significant CAD, especially in terms of sensitivity and PPV. Adenosine stress CTP is useful for the noninvasive diagnosis of functionally significant CAD.
Abstract Background Serum cystatin C (CysC), a novel marker of renal function, is associated with the components of metabolic syndrome in adults. Little is known about the utility of CysC and its ...association with cardiometabolic risks in young subjects. Methods and results In a cohort of 454 Japanese junior high school students, the distribution of serum CysC levels and associated variables were analyzed. CysC levels were significantly higher in boys than in girls (0.92 ± 0.10 mg/L vs. 0.77 ± 0.08 mg/L, p < 0.001). CysC was significantly correlated with serum creatinine ( r = 0.473, p < 0.001), and serum uric acid (SUA) ( r = 0.546, p < 0.001). Multivariable regression analysis revealed significant associations between CysC and SUA in all subjects ( β = 0.241, p < 0.001), and in boys and girls separately ( β = 0.264 and 0.240, respectively, both p < 0.001). Importantly, subjects with elevation of both serum CysC and SUA levels had the highest ratio of triglyceride to high-density lipoprotein cholesterol. Conclusions CysC had significant associations with both creatinine and SUA in Japanese junior high school students. The concomitant elevation of serum CysC and SUA levels was associated with subclinical lipid metabolism dysregulation, and suggested the presence of cardiometabolic risk accumulation.
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