Wednesday, November 11, 2009
Sunday, November 8, 2009
高血圧はアルツファイマーを引き起こす
Hypertension and evidence of arterial disease and a pro-inflammatory status in middle age contribute to the development of Alzheimer’s disease, say researchers. 4 November 2009Their study showed people aged around 50 years with a parental history of AD had higher systolic and diastolic blood pressures (BPs), lower ankle brachial indices, and greater production of pro-inflammatory cytokines than those with no family history of the disease. Late-onset AD is a complex but heritable polygenic disorder for which the identification of specific genetic risk markers has proved difficult through genome association studies. Using a proven family design study, Eric van Exel (VU University Medical Center, Amsterdam, The Netherlands) and team sought to identify and quantify early risk factors that contribute to AD. They recruited 206 offspring (mean age 49 years) of 92 families with a parental history of late-onset AD, and 200 offspring (mean age 52 years) of 97 families without such parental history, and compared various factors known to be associated with an increased risk for AD between the groups. “In such a family design, the offspring under study are enriched for risk factors of AD but do not yet have the disease,” the researchers explain in the Archives of General Psychiatry. “Differences between offspring dependent on their ancestry therefore lend an argument for causality.” Results showed that more offspring with parental history of AD carried the apolipoprotein E gene (APOE) ε4 variant, a known genetic risk factor for AD, than did those without a parental history of the disease (47% vs 21%, p<0.001). p="0.006)">139 mmHg or diastolic BP >89 mmHg; 40% vs 29%, p=0.02). Brachial ankle indices were on average lower in offspring with a parental history of AD (1.27 vs 1.31, p=0.005), reflecting a higher atherosclerotic burden, but lipid, glucose, and homocysteine levels did not differ significantly between groups. The researchers also found that individuals with a parental history of AD had a greater production capacity for pro-inflammatory cytokines than those without such history, with significantly higher levels of interleukin (IL)-1β, IL-1β to IL-1ra ratio, tumor necrosis factor α, IL-6, and interferon γ. Further analysis showed these associations remained true after adjusting for caregiver stress, education level, and lifestyle factors, use of anti-inflammatory drugs, and APOE ε4 allele frequency, and that they did not differ between APOE ε4 carriers and noncarriers.
血管造影剤が腎臓病と糖尿病を悪化させる
Clin Res Cardiol Contrast medium induced nephropathy in patients undergoing percutaneous coronary intervention for acute coronary syndrome: differences in STEMI and NSTEMI
Ingo Wickenbrock . Christian Perings . Petra Maagh . Received: 24 March 2009 / Accepted: 30 July 2009 Abstract The aim of this study was to assess the incidence, clinical predictors, and outcome of patients developing contrast medium induced nephropathy (CIN) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Background CIN is associated with significant higher morbidity and mortality after coronary intervention. Recently it was shown, that patients undergoing percutaneous coronary intervention for acute myocardial infarction have a significant higher risk of developing CIN. NonST-elevating myocardial infarction (NSTEMI) patients (pts) might be at an even higher risk developing CIN than patients with ST-elevating myocardial infarction (STEMI), because of presenting older and more often with diabetes. Methods In 392 consecutive ACS patients developing myocardial infarction and therefore undergoing emergent coronary angiography between October 2004 and March
Department of Cardiology and Pneumology, St. Marien Hospital Lu¨nen, Academic Teaching Hospital of the University of Mu¨nster, Lu¨nen, Germany Department of Cardiology and Angiology, Ruhr University of Bochum, Bochum, Germany Department of Nephrology, University of Du¨sseldorf, Du¨sseldorf, Germany Department of Cardiology, Pneumology, Nephrology and Intensive Care Medicine, Klinikum Lu¨nen, St. Marien Hospital Lu¨nen, Altstadtstr. 23, Lu¨nen 44534, Germany e-mail: wickenbrock.ingo@smh-online.de we measured serum creatinine concentration (Cr) at baseline and each day of the following 3 days. Contrast medium induced nephropathy was defined as an increase in Cr [ 0.5 mg/dl. ACS was defined according to the guidelines of the German Society of Cardiology. Results Overall, 392 pts were included: 203 (51.8%) with STEMI and 189 (48.2%) with NSTEMI. Patients with STEMI developed more often a cardiogenic shock (18 vs. 6%; P \ 0.001) whereas patients with NSTEMI were older (67 vs. 61 years; P \ 0.001) and presenting with a higher co-morbidity. Forty-five (11.5%) pts developed CIN; 22 (10.8%) in the STEMI group and 23(12.2%) in the NSTEMI group (P = 0.75). Patients developing CIN presented a more complicated clinical course and a significantly longer hospital stay (14 vs. 10 days; P \ 0.001). The mortality rate was also significantly higher (16 vs. 6%; P \0.05). Conclusion This prospective study showed no differences in the incidence of developing CIN in patients undergoing PCI for STEMI or NSTEMI, but the predisposing factors, however, differed significantly. Although STEMI patients needed significantly more contrast medium for revascularisation, they did not develop CIN more often. CIN was associated with higher in-hospital complication rate and mortality. Thus, better preventive strategies according to the different predisposing factors leading to CIN are needed to reduce morbidity and mortality, especially in high risk patients.
Ingo Wickenbrock . Christian Perings . Petra Maagh . Received: 24 March 2009 / Accepted: 30 July 2009 Abstract The aim of this study was to assess the incidence, clinical predictors, and outcome of patients developing contrast medium induced nephropathy (CIN) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). Background CIN is associated with significant higher morbidity and mortality after coronary intervention. Recently it was shown, that patients undergoing percutaneous coronary intervention for acute myocardial infarction have a significant higher risk of developing CIN. NonST-elevating myocardial infarction (NSTEMI) patients (pts) might be at an even higher risk developing CIN than patients with ST-elevating myocardial infarction (STEMI), because of presenting older and more often with diabetes. Methods In 392 consecutive ACS patients developing myocardial infarction and therefore undergoing emergent coronary angiography between October 2004 and March
Department of Cardiology and Pneumology, St. Marien Hospital Lu¨nen, Academic Teaching Hospital of the University of Mu¨nster, Lu¨nen, Germany Department of Cardiology and Angiology, Ruhr University of Bochum, Bochum, Germany Department of Nephrology, University of Du¨sseldorf, Du¨sseldorf, Germany Department of Cardiology, Pneumology, Nephrology and Intensive Care Medicine, Klinikum Lu¨nen, St. Marien Hospital Lu¨nen, Altstadtstr. 23, Lu¨nen 44534, Germany e-mail: wickenbrock.ingo@smh-online.de we measured serum creatinine concentration (Cr) at baseline and each day of the following 3 days. Contrast medium induced nephropathy was defined as an increase in Cr [ 0.5 mg/dl. ACS was defined according to the guidelines of the German Society of Cardiology. Results Overall, 392 pts were included: 203 (51.8%) with STEMI and 189 (48.2%) with NSTEMI. Patients with STEMI developed more often a cardiogenic shock (18 vs. 6%; P \ 0.001) whereas patients with NSTEMI were older (67 vs. 61 years; P \ 0.001) and presenting with a higher co-morbidity. Forty-five (11.5%) pts developed CIN; 22 (10.8%) in the STEMI group and 23(12.2%) in the NSTEMI group (P = 0.75). Patients developing CIN presented a more complicated clinical course and a significantly longer hospital stay (14 vs. 10 days; P \ 0.001). The mortality rate was also significantly higher (16 vs. 6%; P \0.05). Conclusion This prospective study showed no differences in the incidence of developing CIN in patients undergoing PCI for STEMI or NSTEMI, but the predisposing factors, however, differed significantly. Although STEMI patients needed significantly more contrast medium for revascularisation, they did not develop CIN more often. CIN was associated with higher in-hospital complication rate and mortality. Thus, better preventive strategies according to the different predisposing factors leading to CIN are needed to reduce morbidity and mortality, especially in high risk patients.
Friday, November 6, 2009
川崎病 それは小児の病気
Twenty-Five-Year Outcome of Pediatric Coronary Artery Bypass Surgery for Kawasaki Disease
Journal: Circulation
Authors: Soichiro Kitamura, Etsuko Tsuda, Junjiro Kobayashi, Hiroyuki Nakajima, Yoshiro Yoshikawa, Toshikatsu Yagihara, Akiko Kada
Background The long-term outcome of pediatric coronary artery bypass for patients with severe inflammatory coronary sequelae secondary to Kawasaki disease is unknown.
Methods and Results One hundred fourteen children and adolescents ranging in age from 1 to 19 (median, 10) years at operation were followed up for as long as 25 years with a median of 19 years. The number of distal anastomoses was
ｱ 0.8 per patient, and the internal thoracic artery was used in all but 3, most frequently for left anterior descending artery lesions. Saphenous vein grafts were used in 24 patients, mostly for non-left anterior descending artery lesions. Patients underwent multiple angiograms to evaluate their coronary and graft status There was no operative or hospital mortality. Both 20- and 25-year survival rates were 95% (95% confidenc interval [CI], 88 to 98). Five deaths occurred, all cardiac in origin. Cardiac event-free rates at 20 and 25 yea were 67% and 60% (95% CI, 46 to 72), respectively. Percutaneous coronary intervention and reoperation w the most common events. Overall, the 20-year graft patency rate was 87% (95% CI, 78 to 93) for internal thoracic artery grafts (n=154) and 44% (95% CI, 26 to 61) for saphenous vein grafts (n=30) (P<0.001), and the rate for non-left anterior descending artery lesions was also significantly better for arterial grafts (87% [95% CI, 73 to 94]; n=59) than for saphenous vein grafts (42% [95% CI, 23 to 60]; n=27) (P=0.002). Eighty eight patients (77%) remain on medications, but all 109 survivors are presently symptom free in their daily activities.
Conclusions Although the 25-year survival was excellent after pediatric coronary bypass for Kawasaki disease, the event free rate declined progressively. This reality mandated continued follow-up. Reinterventions successfully managed most cardiac events. An internal thoracic artery graft was the most favorable for children.
Journal: Circulation
Authors: Soichiro Kitamura, Etsuko Tsuda, Junjiro Kobayashi, Hiroyuki Nakajima, Yoshiro Yoshikawa, Toshikatsu Yagihara, Akiko Kada
Background The long-term outcome of pediatric coronary artery bypass for patients with severe inflammatory coronary sequelae secondary to Kawasaki disease is unknown.
Methods and Results One hundred fourteen children and adolescents ranging in age from 1 to 19 (median, 10) years at operation were followed up for as long as 25 years with a median of 19 years. The number of distal anastomoses was
ｱ 0.8 per patient, and the internal thoracic artery was used in all but 3, most frequently for left anterior descending artery lesions. Saphenous vein grafts were used in 24 patients, mostly for non-left anterior descending artery lesions. Patients underwent multiple angiograms to evaluate their coronary and graft status There was no operative or hospital mortality. Both 20- and 25-year survival rates were 95% (95% confidenc interval [CI], 88 to 98). Five deaths occurred, all cardiac in origin. Cardiac event-free rates at 20 and 25 yea were 67% and 60% (95% CI, 46 to 72), respectively. Percutaneous coronary intervention and reoperation w the most common events. Overall, the 20-year graft patency rate was 87% (95% CI, 78 to 93) for internal thoracic artery grafts (n=154) and 44% (95% CI, 26 to 61) for saphenous vein grafts (n=30) (P<0.001), and the rate for non-left anterior descending artery lesions was also significantly better for arterial grafts (87% [95% CI, 73 to 94]; n=59) than for saphenous vein grafts (42% [95% CI, 23 to 60]; n=27) (P=0.002). Eighty eight patients (77%) remain on medications, but all 109 survivors are presently symptom free in their daily activities.
Conclusions Although the 25-year survival was excellent after pediatric coronary bypass for Kawasaki disease, the event free rate declined progressively. This reality mandated continued follow-up. Reinterventions successfully managed most cardiac events. An internal thoracic artery graft was the most favorable for children.
Tuesday, November 3, 2009
６分間リハビリが心臓病治療に有効と発表
British Cardiovascular Society
Original articles
Preoperative 6 Minute Walk Test Adds Prognostic Information to Euroscore in Patients Undergoing Aortic Valve Replacement
Diego Perez de Arenaza 1, John Pepper 2, Belinda Lees 2, Fernando Rubinstein 1, Fiona Nugara 2, Michael Roughton 2, Marek Jasinski 3, Oscar Bazzino 1 and Marcus Flather 2*
1 Hospital Italiano of Buenos Aires, Argentina2 Royal Brompton Hospital, United Kingdom3 Department Of Cardiac Surgery, Medical University Of Silesia, Poland
Abstract
Aims: We investigated the additive prognostic value of the 6MWT to Euroscore in patients with severe aortic stenosis undergoing aortic valve replacement (AVR).
Methods and results: 208 patients with severe AS underwent six minute walk test (6MWT) prior to aortic valve replacement (AVR), as part of a randomized trial (ASSERT) comparing stented and stentless aortic valves.
Clinical follow-up was available for 200 patients up to 12 months. The rate of death, myocardial infarction (MI) or stroke (time to first event) was 13% (n=14) in patients walking <300 m compared to 4% (n=4) in those who walked 300 m (p= 0.017). When rate of death, MI or stroke by Euroscore risk was stratified by 6 minute walking distance, the 6MWT added prognostic information. In a Cox regression analysis 6MWT distance was the only variable retained as an independent predictor of the composite outcome of death, MI or stroke at 12 months (HR 0.28 95% CI 0.09-0.85, p=0.025).
Conclusions: The 6MWT is safe and feasible to carry out in patients with severe aortic stenosis prior to AVR, and provides potentially important functional and prognostic information to clinical assessment and the Euroscore risk score
Original articles
Preoperative 6 Minute Walk Test Adds Prognostic Information to Euroscore in Patients Undergoing Aortic Valve Replacement
Diego Perez de Arenaza 1, John Pepper 2, Belinda Lees 2, Fernando Rubinstein 1, Fiona Nugara 2, Michael Roughton 2, Marek Jasinski 3, Oscar Bazzino 1 and Marcus Flather 2*
1 Hospital Italiano of Buenos Aires, Argentina2 Royal Brompton Hospital, United Kingdom3 Department Of Cardiac Surgery, Medical University Of Silesia, Poland
Abstract
Aims: We investigated the additive prognostic value of the 6MWT to Euroscore in patients with severe aortic stenosis undergoing aortic valve replacement (AVR).
Methods and results: 208 patients with severe AS underwent six minute walk test (6MWT) prior to aortic valve replacement (AVR), as part of a randomized trial (ASSERT) comparing stented and stentless aortic valves.
Clinical follow-up was available for 200 patients up to 12 months. The rate of death, myocardial infarction (MI) or stroke (time to first event) was 13% (n=14) in patients walking <300 m compared to 4% (n=4) in those who walked 300 m (p= 0.017). When rate of death, MI or stroke by Euroscore risk was stratified by 6 minute walking distance, the 6MWT added prognostic information. In a Cox regression analysis 6MWT distance was the only variable retained as an independent predictor of the composite outcome of death, MI or stroke at 12 months (HR 0.28 95% CI 0.09-0.85, p=0.025).
Conclusions: The 6MWT is safe and feasible to carry out in patients with severe aortic stenosis prior to AVR, and provides potentially important functional and prognostic information to clinical assessment and the Euroscore risk score
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