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Okabe T, Yakushiji T, Igawa W, Ono M, Kido T, Ebara S, Yamashita K, Yamamoto MH, Saito S, Hoshimoto K, Amemiya K, Isomura N, Araki H, Ochiai M. The Efficacy of Tolvaptan in Congestive Heart Failure Patients with and Without Hypoalbuminemia: A Pilot Study. Cardiovasc Ther 2016; 33:275-81. [PMID: 26122275 DOI: 10.1111/1755-5922.12142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Heart failure (HF) with hypoalbuminemia is associated with poor response to conventional therapy. We investigated whether tolvaptan, a potent aquaretic agent, might be of benefit in HF patients with hypoalbuminemia. METHODS We prospectively enrolled 40 patients hospitalized for HF. Patients received conventional therapy including loop diuretics. We subsequently added tolvaptan in the range of 3.75-15 mg daily and it was discontinued after improvement of HF symptoms. We compared clinical and laboratory data in HF patients with and without hypoalbuminemia (defined as serum albumin <3.0 g/dL). RESULTS Tolvaptan was administered in 18 HF patients with hypoalbuminemia (Group A) and 22 HF patients without hypoalbuminemia (Group B). The mean serum albumin was 2.63 ± 0.27 and 3.46 ± 0.25 g/dL, respectively. The average urine output on tolvaptan increased significantly in both groups (1644.4 ± 797.6-3011.6 ± 1453.8 mL/day, P = 0.004; 1459 ± 612.7-2112.2 ± 724.5 mL/day, P = 0.008; respectively). In addition, we observed higher urine output on therapy in Group A than in Group B (P = 0.015). There was a moderate negative correlation between serum albumin and average urine output on tolvaptan (r = -0.42, P = 0.007). CONCLUSIONS The addition of tolvaptan to low dose loop diuretics might be an effective strategy for treatment of HF patients with hypoalbuminemia.
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Affiliation(s)
- Toshitaka Okabe
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
| | - Tadayuki Yakushiji
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
| | - Wataru Igawa
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
| | - Morio Ono
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
| | - Takehiko Kido
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
| | - Seitaro Ebara
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
| | - Kennosuke Yamashita
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
| | - Myong Hwa Yamamoto
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
| | - Shigeo Saito
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
| | - Koichi Hoshimoto
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
| | - Kisaki Amemiya
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
| | - Naoei Isomura
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
| | - Hiroshi Araki
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
| | - Masahiko Ochiai
- Division of Cardiology and Cardiac Catheterization Laboratories, Showa University Northern Yokohama Hospital, Tsuzuki, Yokohama, Japan
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Weinhandl ED, Peng Y, Gilbertson DT, Bradbury BD, Collins AJ. Hemoglobin variability and mortality: confounding by disease severity. Am J Kidney Dis 2011; 57:255-65. [PMID: 20801571 DOI: 10.1053/j.ajkd.2010.06.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 06/07/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Substantial variability in hemoglobin levels has been associated with increased mortality risk in hemodialysis patients. Variability also has been associated with concurrent comorbid conditions and hospitalization. Adequate adjustment for confounding by disease severity is needed to estimate the association of hemoglobin level variability with mortality risk. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Medicare hemodialysis patients in 3 groups: prevalent on July 1, 2006 (n = 133,246), prevalent on July 1, 1996 (n = 78,602), and incident between January 1, 2005, and June 30, 2006 (n = 24,999). PREDICTOR Hemoglobin level variability estimated using the residual deviation around the linear trend in hemoglobin levels during a 6-month entry period. OUTCOME Time to death. MEASUREMENTS We fit Cox models of 1-year mortality with and without adjustment for disease severity (comorbid conditions, hospitalization days, and months with hemoglobin level <10 g/dL), measured concurrently with hemoglobin level variability. RESULTS Disease severity was associated positively with hemoglobin level variability in all groups. Before adjustment for disease severity, HRs for hemoglobin level variability were 1.27 (95% CI, 1.24-1.31) per 1 g/dL for patients prevalent in 2006, 1.32 (95% CI, 1.27-1.38) for patients prevalent in 1996, and 1.08 (95% CI, 1.03-1.13) for patients incident in 2005-2006. After adjustment, HRs for hemoglobin level variability were 1.02 (95% CI, 0.99-1.05), 1.07 (95% CI, 1.03-1.12), and 1.01 (95% CI, 0.95-1.06), respectively. LIMITATIONS We did not adjust for time-varying confounding of hemoglobin level; an inclusion requirement introduces potential selection bias; our findings may not apply to incident hemodialysis patients younger than 65 years; assessment of comorbid conditions from claims is subject to misclassification, with possible residual confounding attributable to comorbid conditions; this observational study cannot prove causality. CONCLUSIONS After adjustment for concurrent disease severity, evidence supporting an association between hemoglobin level variability and mortality risk was weak and inconsistent. The clinical utility of hemoglobin level variability may be limited.
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Patanè S, Marte F, Sturiale M. Prostate-specific antigen kallikrein complexes and acute myocardial infarction. Int J Cardiol 2009; 145:227-228. [PMID: 19615765 DOI: 10.1016/j.ijcard.2009.06.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 06/26/2009] [Indexed: 10/20/2022]
Abstract
Recently, attention has focused on prostate-specific antigen kallikrein and the cardiovascular system. The finding of diminished PSA during acute myocardial infarction and the correlation of variation of PSA with coronary lesions and occurrence of major adverse cardiac events have opened a possible new intriguing scenario. As with many stories in biology, the tale of PSA can be more complex than was first appreciated. In the bloodstream, the proteolytic activity of PSA is inhibited by the formation of irreversible complexes with serum protease inhibitors and other acute-phase proteins. We noticed that the formation of irreversible PSA complexes (reflected by the increased bound PSA) has significant correlation with high-sensitivity C-reactive protein (hsCRP) and that seems to play a crucial role in the adverse event prevention.
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Affiliation(s)
- Salvatore Patanè
- Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G(Me) AUSL5 Messina, Italy. patane-@libero.it
| | - Filippo Marte
- Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G(Me) AUSL5 Messina, Italy
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Response of high-sensitivity C-reactive protein to percutaneous coronary intervention in patients with acute coronary syndrome. Heart Vessels 2009; 24:175-80. [DOI: 10.1007/s00380-008-1110-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 08/28/2008] [Indexed: 11/26/2022]
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Brunetti ND, Pellegrino PL, Correale M, De Gennaro L, Cuculo A, Di Biase M. Acute phase proteins and systolic dysfunction in subjects with acute myocardial infarction. J Thromb Thrombolysis 2007; 26:196-202. [PMID: 18038115 DOI: 10.1007/s11239-007-0088-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 08/06/2007] [Indexed: 08/30/2023]
Abstract
AIM To investigate correlations between plasmatic concentrations of acute phase proteins (APPs) and left ventricular systolic function during the early phase of acute myocardial infarction. METHODS Plasmatic concentrations of alpha-1-anti-trypsin (A1AT), alpha 1 glyco-protein (A1GP), haptoglobin (HG), caeruloplasmin (CP) and C-reactive protein (CRP) were evaluated in 123 patients with ST elevation acute myocardial infarction (STEMI) within 12 h after onset of chest pain. Systolic function was assessed with bi-dimensional echography and incidence of in-hospital adverse events was compared to APPs levels. RESULTS A1AT, A1GP, HG and CP showed a statistically significant correlation with admission CRP concentrations (P < 0.001). Left ventricular ejection fraction inversely correlated with plasmatic concentrations of A1GP, A1AT, CP and HG. Incidence of acute heart failure correlated with values of APPs and, in a stepwise analysis, CP values were the most significant markers of acute heart failure. CONCLUSIONS Systolic dysfunction in STEMI patients seems to be associated with an inflammatory response featured by a rise in plasmatic concentration of APPs; increase in APPs concentrations seems to own a short-term prognostic relevance.
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Süer Gökmen S, Kazezoğlu C, Sunar B, Ozçelik F, Güngör O, Yorulmaz F, Gülen S. Relationship between serum sialic acids, sialic acid-rich inflammation-sensitive proteins and cell damage in patients with acute myocardial infarction. Clin Chem Lab Med 2006; 44:199-206. [PMID: 16475908 DOI: 10.1515/cclm.2006.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractThe role of sialic acid (SA) in the pathogenesis of atherosclerosis and as a predictor of cardiovascular events has attracted much attention in recent years. However, most studies investigating the role of total and lipid-bound sialic acids (TSA and LSA) in the pathogenesis of atherosclerosis lack information on the reason for the elevated SA concentrations in coronary heart disease and myocardial infarction. Since the inflammation-sensitive proteins are glycoproteins with SA residues, an increase in their levels due to some type of acute-phase reaction or inflammation could be responsible for the elevated TSA levels in acute myocardial infarction (AMI). Elevated serum SA levels might also be due to either shedding or secretion of free SA from the cell or cell membrane surface if neuraminidase levels are increased, or to the release of cellular SA-containing glycolipids and/or glycoproteins into plasma from myocardial cells after AMI. The aim of the present study was to investigate both the possible role of SA-rich inflammation-sensitive proteins and the cell damage due to elevated serum TSA levels in AMI. A possible role of serum LSA as an indicator of the shedding or secretion of SA from the cell or cell membrane surface in AMI was also evaluated. The study included 38 subjects with AMI and 32 healthy volunteers. Serum TSA and LSA were determined using the methods of Warren and Katopodis, respectively. The concentrations of serum SA-rich inflammation-sensitive proteins, namely α
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Affiliation(s)
- Selma Süer Gökmen
- Department of Biochemistry, Trakya University, School of Medicine, Edirne, Turkey.
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Brunetti ND, Troccoli R, Correale M, Pellegrino PL, Di Biase M. C-reactive protein in patients with acute coronary syndrome: correlation with diagnosis, myocardial damage, ejection fraction and angiographic findings. Int J Cardiol 2005; 109:248-56. [PMID: 16055214 DOI: 10.1016/j.ijcard.2005.06.021] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2005] [Revised: 06/12/2005] [Accepted: 06/18/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND C-reactive protein (CRP) plasmatic levels increase in patients with acute coronary syndromes (ACS). Correlations between CRP levels, myocardial functional damage and cardiomyocyte lysis remain to be defined. METHODS 192 consecutive patients with acute coronary syndromes (64.97 +/- 11.08 mean age, 71.35% male gender) were included in the study; 138 patients (71.87%) were discharged with an acute myocardial infarction (AMI) diagnosis (28 with non Q-wave AMI) and 54 with an unstable angina (UA) diagnosis (28.13%). In all patients CRP, CK, LDH, CK-MB and troponin I plasmatic concentrations were evaluated every 6 h for 48 h and every 24 h for the following 2 days from the onset of symptoms. Ejection fraction was estimated by bidimensional echocardiography and extension of myocardial lysis by cardiac enzymes plasmatic release. 92 patients (67 with AMI, 25 with UA) underwent coronary-angiography. Incidence of adverse cardiac events was recorded in a 6 months follow up. RESULTS Mean CRP levels in Q-wave MI showed a statistically significant increase in the different blood samples with baseline. Mean CRP levels of the three groups were not statistically different at baseline and after 6, 12, and 18 h. Q-wave AMI CRP levels showed a statistically significant difference as against non Q-wave AMI at 36 (p < 0.05), 48 (p < 0.05) and 72 h (p < 0.05) and UA at 24 (p < 0.01), 30 (p < 0.01), 48 (p < 0.0001), 72 (p = 0.0001) and 96 h (p = 0.0003); non Q-wave AMI CPR levels showed a statistically significant difference as against UA at 48 h (p < 0.01). CRP peak mean levels were significantly different when comparing Q-wave AMI patients with UA patients (8.21 +/- 7.85 vs. 2.75 +/- 3.33 mg/dl, p < 0.001). In patients with Q-wave AMI there was a correlation between CRP peak concentrations and CK (r = 0.264, p = 0.008) and LDH (r = 0.32, p = 0.001), while correlation with CK-MB peak concentrations was not statistically significant (r = 0.196, p = 0.051). In the same patient group, there was also a correlation between CRP plasmatic concentrations and troponin I plasmatic concentrations from the 30th to 96th h after the onset of symptoms (r = 0.38-0.53, p < 0.05). No correlation was found between CRP levels and ejection fraction and angio-coronarography findings (number of stenotic vessels, culprit lesions, ruptured plaques). Peak CRP levels were associated in a 6 months follow up with an increased incidence of major adverse cardiac events (MACEs) in patients with Q-wave AMI (HR 1.1649, 95% C.I. 1.0197-1.3307, p < 0.05). CONCLUSIONS CRP plasmatic concentrations showed a different release curve in patients with Q-wave AMI in comparison with patients with non Q-wave AMI and with patients with UA. CRP peak concentrations did not correlate with ejection fraction and angiographic findings, but correlate with incidence of MACE. The increase in CRP levels during Q-wave MI seems to be linked to the extension of myocardial damage rather than pre-existing inflammation.
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Posthouwer D, Voorbij HAM, Grobbee DE, Numans ME, van der Bom JG. Influenza and pneumococcal vaccination as a model to assess C-reactive protein response to mild inflammation. Vaccine 2005; 23:362-5. [PMID: 15530681 DOI: 10.1016/j.vaccine.2004.05.035] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2004] [Revised: 04/13/2004] [Accepted: 05/27/2004] [Indexed: 11/23/2022]
Abstract
This study was set up to examine whether an influenza vaccine or an influenza vaccine in combination with pneumococcal vaccine can be used as a model to study responses to mild stimulation of the inflammatory system. In this study, 19 subjects received the influenza vaccine, 20 subjects the combination of influenza and pneumococcal vaccine. CRP and prothrombin fragment 1 and 2 (F1+2) were measured at baseline, and two times after vaccination. Influenza vaccination increased CRP by 0.20 mg/L, and influenza in combination with pneumococcal vaccine increased CRP by 0.60 mg/L. F1+2 increased 0.15 nmol/L after the combined vaccination; an increase in response to the influenza vaccination was not statistically significant. Our findings show that the influenza vaccine alone as well as the combination of the influenza and pneumococcal vaccine increases CRP-levels with a peak 2 days after vaccination.
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Affiliation(s)
- D Posthouwer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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Bodí V, Núñez J, Sanchis J, Llàcer A, Fácila L, Chorro FJ. Why does C-reactive protein increase in non-ST elevation acute coronary syndromes? Int J Cardiol 2003; 92:129-35. [PMID: 14659843 DOI: 10.1016/s0167-5273(03)00056-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION C-reactive protein is an important prognostic indicator for early risk stratification in patients with an acute coronary syndrome. The mechanisms underlying the elevation of C-reactive protein in these patients have not been fully understood. We studied the factors related to the increase of this acute-phase reactant. METHODS AND RESULTS Within a single-centre registry, 419 consecutive patients admitted for a non-ST elevation acute coronary syndrome were studied. Serum high sensitivity C-reactive protein was measured late (median 3 days) after admission. Clinical, electrocardiographic, biochemical and angiographic variables were recorded. In the multivariate analysis, an increased C-reactive protein (n=162) was related to high levels of troponin I (OR 2.5 (1.6-4) P<0.001) and to a Killip class>1 at presentation (OR 2.9 (1.6-5.4) P<0.001). The coronary angiographic characteristics were not related to C-reactive protein. Finally, in 52 patients with no previous heart disease in whom regional dysfunction was quantified by left ventriculography the presence of a significant (>6 chords) regional dysfunction was significantly related to C-reactive protein (OR 5.1 (1.7-15.3) P=0.006) CONCLUSION Our results indicate that in acute coronary syndromes elevated levels of C-reactive protein late after admission are mainly related to clinical, biochemical and angiographic evidences of myocardial damage. The prognostic utility of this parameter could be in part explained by its relationship with a major regional dysfunction.
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Affiliation(s)
- Vicent Bodí
- Servei de Cardiología, Hospital Clínic i Universitari, Universitat de València, Avda Blasco Ibáñez 17, 46010 València, Spain.
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Mathews ST, Deutsch DD, Iyer G, Hora N, Pati B, Marsh J, Grunberger G. Plasma alpha2-HS glycoprotein concentrations in patients with acute myocardial infarction quantified by a modified ELISA. Clin Chim Acta 2002; 319:27-34. [PMID: 11922920 DOI: 10.1016/s0009-8981(02)00013-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Human alpha2-HS glycoprotein (alpha2-HSG) is synthesized and secreted by the liver into circulation. Plasma concentrations of alpha2-HSG decrease significantly following infection, inflammation and malignancy. Since increased plasma concentrations of C-reactive protein are observed in patients with acute myocardial infarction (AMI), we hypothesized that plasma concentrations of alpha2-HSG would decrease during the initial phase of AMI and begin to increase in the recovery phase. METHODS Twenty patients diagnosed with AMI were recruited for the study. A sensitive and specific ELISA was developed to assay alpha2-HSG concentrations in plasma. RESULTS In AMI patients, plasma alpha2-HSG concentrations were decreased (281.3+/-25.8 mg/l, ranging from 132 to 489 mg/l on admission) compared to healthy individuals (312.3+/-9.9 mg/l, ranging from 210 to 450 mg/l) (P= 0.142). Interestingly, 40% of AMI patients demonstrated alpha2-HSG concentrations below 200 mg/l compared to none in the healthy control group. During the recovery period, alpha2-HSG concentrations begin to increase, with a mean+/-SEM of 290.1+/-22.1 mg/l. Regression analysis comparing plasma alpha2-HSG concentrations on admission to concentrations on discharge showed a significant positive correlation in matched-pair patient samples (P<0.01, r=0.45). CONCLUSIONS We conclude that, in contrast to C-reactive protein, alpha2-HSG functions as a negative acute phase protein in AMI patients. Plasma alpha2-HSG concentrations start to decrease within a few hours after the onset of AMI and return to near normal concentrations during the recovery period (5-7 days after AMI).
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Affiliation(s)
- Suresh T Mathews
- Division of Endocrinology, Wayne State University, School of Medicine, Detroit, MI 48201, USA
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