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Koprululu Kucuk G, Guney AI, Sunbul M, Guctekin T, Koç G, Kirac D. Il-6 and UGT1A1 variations may related to furosemide resistance in heart failure patients. IUBMB Life 2023; 75:830-843. [PMID: 37260062 DOI: 10.1002/iub.2732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/07/2023] [Indexed: 06/02/2023]
Abstract
Furosemide is a diuretic and is used for the treatment of patients with heart failure (HF). It has been found that in some HF patients, the drug does not treat patients efficiently. This condition is named as furosemide resistance. In this study, it is aimed to investigate the relationship between UDP-glucuronosyltransferase 1 (UGT1A1) and interleukine-6 (IL-6) variations with furosemide resistance in HF patients. Sixty HF patients using furosemide (patient group) and 30 healthy individuals (control group) were enrolled in this study. Patients were divided into two subgroups as non-responders (furosemide resistant) group (n = 30) and the responders (non-resistant) group (n = 30) according to the presence of furosemide resistance (n = 30). Variations in the first exon of UGT1A1 and rs1800795 and rs1800796 variations in IL-6 were analyzed by direct sequencing and real-time polymerase chain reaction (RT-PCR), respectively. The effects of newly detected mutations on 3-D protein structure were analyzed by in silico analysis. At the end of the study, 11 variations were detected in UGT1A1, of which nine of them are novel and eight of them cause amino acid change. Also, rs1800795 and rs1800796 variations were detected in all the groups. When patient and control groups were compared with each other, rs1800796 mutation in IL-6 was found statistically high in the patient group (p = 0.027). When the three groups were compared with each other, similarly, rs1800796 mutation in IL-6 was found statistically high in the non-responders group (p = 0.043). When allele distributions were compared between the patient and control groups, the C allele of rs1800795 mutation in IL-6 was found statistically high in the patient group (p = 0.032). When allele distributions were compared between the three groups, 55T-insertion in UGT1A1 was found statistically high in the non-responders group (p = 0.017). According to in silico analysis results, two variations were found deleterious and six variations were detected as probably damaging to protein functions. Our study may contribute to the elucidation of pharmacogenetic features (drug response-gene relationship) and the development of individual-specific treatment strategies in HF patients using furosemide.
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Affiliation(s)
- G Koprululu Kucuk
- Faculty of Medicine, Department of Medical Biology, Yeditepe University, Istanbul, Turkey
- Department of Radiotherapy, Istanbul Sisli Vocational School, Istanbul, Turkey
| | - A I Guney
- Faculty of Medicine, Department of Medical Genetics, Marmara University, Istanbul, Turkey
| | - M Sunbul
- Faculty of Medicine, Department of Cardiology, Marmara University, Istanbul, Turkey
| | - T Guctekin
- Faculty of Medicine, Department of Cardiology, Marmara University, Istanbul, Turkey
| | - G Koç
- Faculty of Medicine, Department of Medical Biology, Istanbul Aydın University, Istanbul, Turkey
| | - D Kirac
- Faculty of Medicine, Department of Medical Biology, Yeditepe University, Istanbul, Turkey
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Shirasaki K, Minai K, Kawai M, Tanaka TD, Ogawa K, Inoue Y, Morimoto S, Nagoshi T, Ogawa T, Komukai K, Yoshimura M. Unique crosstalk between platelet and leukocyte counts during treatment for acute coronary syndrome: A retrospective observational study. Medicine (Baltimore) 2022; 101:e32439. [PMID: 36595999 PMCID: PMC9803419 DOI: 10.1097/md.0000000000032439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In the pathophysiology of acute coronary syndrome (ACS), platelet (PLT) and neutrophil (Neu) crosstalk may be important for activating coagulation and inflammation. It has been speculated that PLTs and Neu may affect each other's cell counts; however, few studies have investigated this hypothesis. In this study, we measured changes in blood cell counts in 245 patients with ACS during treatment and investigated the mutual effects of each blood cell type. Path diagrams were drawn using structural equation modeling, and temporal changes in the count of each blood cell type and the relevance of these changes were analyzed. Throughout the treatment period, the numbers of all blood cell types (red blood cells [RBCs], leukocytes, and PLTs) were associated with each other before and after treatment. A detailed examination of the different cell types revealed that the PLT count at admission had a significant positive effect on the leukocyte (especially Neu) count after treatment. Conversely, the leukocyte (especially Neu) count at admission had a significant positive effect on the PLT count after treatment. During ACS, PLTs and leukocytes, especially Neu, stimulate each other to increase their numbers. The formation of a PLT-leukocyte complex may increase coagulation activity and inflammation, which can lead to a further increase in the counts of both blood cell types.
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Affiliation(s)
- Keisuke Shirasaki
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kosuke Minai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
- * Correspondence: Kosuke Minai, Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishi-shimbashi, Minato-ku, Tokyo, Japan (e-mail: )
| | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshikazu D. Tanaka
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuo Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasunori Inoue
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Morimoto
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomohisa Nagoshi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takayuki Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kimiaki Komukai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Cancer and malnutrition were independently associated with a poor prognosis in patients with heart failure. J Cardiol 2021; 79:15-20. [PMID: 34865821 DOI: 10.1016/j.jjcc.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recent advances in treatment have improved the survival of cancer patients. Such survivors may go on to develop heart failure (HF) later in life. HF and cancer are wasting diseases, and malnutrition is associated with a poor prognosis in patients with HF or cancer. METHODS AND RESULTS Patients admitted to our hospital with HF from April 2012 to March 2020 were retrospectively reviewed. They were divided into 2 groups: cancer patients (N = 185) and patients without cancer (N = 930). Patients discharged alive and followed by our outpatient clinic were also examined (N = 857, median follow-up period: 794 days). RESULTS In cancer patients, the geriatric nutritional risk index and prognostic nutritional index were lower and the controlling nutritional status score was higher than in HF patients without cancer; nutrition was disturbed in HF patients with cancer. The in-hospital mortality rates of the two groups were not markedly different; however, cancer patients showed higher long-term mortality in comparison to HF patients without cancer. A multivariate analysis revealed that cancer and malnutrition were independently associated with all-cause death. CONCLUSIONS The long-term mortality of HF patients with cancer was higher than that of HF patients without cancer. Malnutrition was associated with long-term mortality, independently of the presence of cancer. Multidisciplinary treatment is needed when treating HF patients with cancer.
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Kubota T, Komukai K, Miyanaga S, Shirasaki K, Oki Y, Yoshida R, Fukushima K, Kamba T, Okuyama T, Maehara T, Yoshimura M. Out-of-Hospital Cardiac Arrest Does Not Affect Post-Discharge Survival in Patients With Acute Myocardial Infarction. Circ Rep 2021; 3:249-255. [PMID: 33842731 PMCID: PMC8024018 DOI: 10.1253/circrep.cr-21-0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background:
Acute myocardial infarction (AMI) patients complicated by out-of-hospital cardiac arrest (OHCA) show poor in-hospital outcomes. However, the post-discharge outcomes of survivors of OHCA have not been well studied. Methods and Results:
Data for patients admitted to The Jikei University Kashiwa Hospital with AMI between April 2012 and March 2020 were examined retrospectively. The Jikei University Kashiwa Hospital is a tertiary emergency medical facility, so the frequency of OHCA in this hospital is higher than in an ordinary AMI population. Of 803 patients, 92 (11.5%) were complicated by OHCA. Of the 92 OHCA patients, 37 died in hospital, compared with 45 of 711 non-OHCA patients who died in hospital (P<0.001). OHCA was more frequent in men than in women. The estimated glomerular filtration rate was lower in those with than without OHCA. Long-term mortality was evaluated in patients discharged alive and followed-up at an outpatient clinic (n=635; median follow-up period 607 days). The long-term post-discharge mortality was comparable between AMI patients with and without OHCA. Conclusions:
The post-discharge mortality of AMI patients with OHCA was comparable that of patients without OHCA.
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Affiliation(s)
- Takeyuki Kubota
- Division of Cardiology, The Jikei University Kashiwa Hospital Kashiwa Japan
| | - Kimiaki Komukai
- Division of Cardiology, The Jikei University Kashiwa Hospital Kashiwa Japan
| | - Satoru Miyanaga
- Division of Cardiology, The Jikei University Kashiwa Hospital Kashiwa Japan
| | - Keisuke Shirasaki
- Division of Cardiology, The Jikei University Kashiwa Hospital Kashiwa Japan
| | - Yoshitsugu Oki
- Division of Cardiology, The Jikei University Kashiwa Hospital Kashiwa Japan
| | - Ritsu Yoshida
- Division of Cardiology, The Jikei University Kashiwa Hospital Kashiwa Japan
| | - Keisuke Fukushima
- Division of Cardiology, The Jikei University Kashiwa Hospital Kashiwa Japan
| | - Takahito Kamba
- Division of Cardiology, The Jikei University Kashiwa Hospital Kashiwa Japan
| | - Toraaki Okuyama
- Division of Cardiology, The Jikei University Kashiwa Hospital Kashiwa Japan
| | - Tomoki Maehara
- Division of Cardiology, The Jikei University Kashiwa Hospital Kashiwa Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine Tokyo Japan
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Minai K, Kawai M, Ogawa K, Nagoshi T, Morimoto S, Inoue Y, Tanaka TD, Komukai K, Ogawa T, Yoshimura M. A Pilot Evaluation Study of Diffuse Coronary Arterial Contraction Causing Ischemia by Double Measurement of Left Ventriculography Before and After Intracoronary Administration of Nitrates. Circ Rep 2021; 3:241-248. [PMID: 33842730 PMCID: PMC8024012 DOI: 10.1253/circrep.cr-21-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background:
Abnormal diffuse coronary artery contraction is not easily diagnosed. In order to evaluate its true risk, we performed double left ventriculography (LVG) before and after intracoronary administration of isosorbide dinitrate (ISDN). We also investigated the relationship between changes in coronary lumen area and changes in left ventricular ejection fraction (LVEF) after ISDN. Methods and Results:
The study included 53 patients who underwent an acetylcholine (ACh) provocation test after coronary angiogram and LVG. The second LVG was performed after intracoronary ISDN administration. Coronary lumen area was measured by quantitative coronary arteriography (QCA). Simple and multiple regression analyses showed a significant correlation between changes in total QCA area before and after ISDN administration (pre-and post-total QCA area, respectively) and changes in LVEF. Using structural equation modeling, we observed a negative effect of pre-total QCA area and a positive effect of post-total QCA area on LVEF improvement. Importantly, LVEF improvement was similar between the ACh-positive and -negative groups on the coronary artery spasm test. Receiver operating characteristic curves indicated that the cut-off value at which changes in total QCA area affected changes in LVEF was 5%. Conclusions:
Performing double LVG tests before and after ISDN administration may detect myocardial ischemia caused by diffuse coronary artery contraction. The addition of this method to the conventional ACh provocation test may detect the presence of local and/or global myocardial ischemia.
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Affiliation(s)
- Kosuke Minai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine Tokyo Japan
| | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine Tokyo Japan
| | - Kazuo Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine Tokyo Japan
| | - Tomohisa Nagoshi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine Tokyo Japan
| | - Satoshi Morimoto
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine Tokyo Japan
| | - Yasunori Inoue
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine Tokyo Japan
| | - Toshikazu D Tanaka
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine Tokyo Japan
| | - Kimiaki Komukai
- Division of Cardiology, Department of Internal Medicine, Kashiwa Hospital, The Jikei University School of Medicine Kashiwa Japan
| | - Takayuki Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine Tokyo Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine Tokyo Japan
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6
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Shimoyama S, Ono T, Ebihara S. Geriatric nutritional risk index and 100‐m walk achievement predict discharge to home in elderly patients with heart failure. Geriatr Gerontol Int 2020; 20:1029-1035. [DOI: 10.1111/ggi.14014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/27/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Shota Shimoyama
- Department of Rehabilitation Medicine Toho University Graduate School of Medicine Ota‐ku Japan
- Department of Rehabilitation Medicine Toho University Ohashi Medical Center Tokyo Japan
| | - Tsuyoshi Ono
- Division of Cardiovascular Medicine Toho University Ohashi Medical Center Tokyo Japan
| | - Satoru Ebihara
- Department of Rehabilitation Medicine Toho University Graduate School of Medicine Ota‐ku Japan
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7
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Therapeutic hypothermia after cardiac arrest increases the plasma level of B-type natriuretic peptide. Sci Rep 2020; 10:15545. [PMID: 32968178 PMCID: PMC7511910 DOI: 10.1038/s41598-020-72703-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/03/2020] [Indexed: 12/15/2022] Open
Abstract
Natriuretic peptides (NPs) regulate blood pressure and fluid homeostasis and exert various effects on the cardiovascular system. Recently, the relationship between NPs and the energy metabolism has been reported, and using a cell culture experiment system, we previously showed that NP activated brown cells in a low temperature environment while also suppressing a decrease in the cell temperature. However, few reports have described the secretion of NPs in cold environments, and there have been almost no studies of B-type natriuretic peptide (BNP) in humans. We investigated how NPs respond to cold environments in 21 patients who underwent therapeutic hypothermia (TH) after cardiac arrest. The plasma BNP levels were significantly increased (more than fivefold) during TH (logarithmically from 1.98 ± 0.79 to 2.63 ± 0.59, P < 0.01). During TH, diastolic pulmonary artery pressure (PAP) significantly decreased, and there were no significant changes in the stroke volume index (SVI). This increase of BNP was not associated with any hemodynamic changes. In contrast to our findings for BNP, the change in A-type NP (ANP) was quite small. We detected a significant increase in the plasma BNP levels during TH, unrelated to hemodynamics. This elevation of BNP levels seems to be potential influenced by hypothermia.
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Yamamoto K, Tsuchihashi-Makaya M, Kinugasa Y, Iida Y, Kamiya K, Kihara Y, Kono Y, Sato Y, Suzuki N, Takeuchi H, Higo T, Miyazawa Y, Miyajima I, Yamashina A, Yoshita K, Washida K, Kuzuya M, Takahashi T, Nakaya Y, Hasebe N, Tsutsui H. Japanese Heart Failure Society 2018 Scientific Statement on Nutritional Assessment and Management in Heart Failure Patients. Circ J 2020; 84:1408-1444. [PMID: 32655089 DOI: 10.1253/circj.cj-20-0322] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | | | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Yuki Iida
- Department of Rehabilitation Medicine, Kainan Hospital
| | | | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences
| | - Yuji Kono
- Department of Rehabilitation, Fujita Health University Bantane Hospital
| | - Yukihito Sato
- Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki General Medical Center
| | - Norio Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital
| | - Harumi Takeuchi
- Department of Clinical Nutrition, Nagoya University Hospital
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Yasushi Miyazawa
- Department of Clinical Nutrition, Tokyo Medical University Hospital
| | - Isao Miyajima
- Department of Clinical Nutrition, Chikamori Hospital
| | | | - Katsushi Yoshita
- Department of Food and Human Health Science, Osaka City University Graduate School of Human Life Science
| | - Koichi Washida
- Faculty of Nursing, Kobe Women's University.,Department of Nursing, Hyogo Prefectural Amagasaki General Medical Center
| | - Masafumi Kuzuya
- Department of Community Healthcare & Geriatrics, Nagoya University Graduate School of Medicine
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University.,Department of Rehabilitation, Juntendo University Hospital
| | - Yutaka Nakaya
- Department of Internal Medicine, Touto Kasukabe Hospital
| | - Naoyuki Hasebe
- Division of Cardiology, Nephrology, Pulmonology and Neurology, Department of Internal Medicine, Asahikawa Medical University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
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9
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Matsuo H, Yoshimura Y, Fujita S, Maeno Y. Incidence of Dysphagia and Its Association With Functional Recovery and 1‐Year Mortality in Hospitalized Older Patients With Heart Failure: A Prospective Cohort Study. JPEN J Parenter Enteral Nutr 2020; 45:372-380. [DOI: 10.1002/jpen.1845] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/04/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Haruyo Matsuo
- Department of Nursing Kagoshima Medical Association Hospital Kagoshima Japan
| | - Yoshihiro Yoshimura
- Department of Rehabilitation Medicine Kumamoto Rehabilitation Hospital Kumamoto Japan
| | - Shoji Fujita
- Department of Cardiology Kagoshima Medical Association Hospital Kagoshima Japan
| | - Yuichi Maeno
- Department of Rehabilitation Kagoshima Medical Association Hospital Kagoshima Japan
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10
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Relationship between nutritional status and improved ADL in individuals with cervical spinal cord injury in a convalescent rehabilitation ward. Spinal Cord 2019; 57:501-508. [PMID: 30700852 DOI: 10.1038/s41393-019-0245-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 12/24/2018] [Accepted: 01/14/2019] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To investigate the relationship of nutritional status with improvement of activities of daily living in individuals with cervical spinal cord injury. SETTING A convalescent rehabilitation ward at the Toyama Prefectural Rehabilitation Hospital and Support Center for Children with Disabilities in Japan. METHODS This retrospective analysis investigated adults (age ≥20 years) with cervical spinal cord injury who were consecutively admitted to a convalescent rehabilitation ward between 2006 and 2015. Data of 154 patients were analyzed. Nutritional status was evaluated using the Subjective Global Assessment (SGA; 3 groups: well-nourished, suspected of being malnourished or moderately malnourished, severely malnourished) and body mass index (BMI; 3 groups: underweight, standard, and overweight and obese). The main outcome was functional independence measure (FIM) efficiency. Multiple regression analysis was performed to investigate the relationship of SGA and BMI to FIM efficiency. RESULTS FIM efficiency was significantly higher in the well-nourished group based on the SGA than in the two groups with malnutrition (P = .007: 0.32 vs. 0.26 vs. 0.10). Multivariate regression analysis revealed that FIM efficiency was similar in the underweight and standard group, but was significantly higher in the overweight and obese group (P = .006: 0.20 vs. 0.21 vs. 0.31). CONCLUSIONS SGA and BMI on admission may be independently associated with FIM efficiency in patients with cervical spinal cord injury.
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11
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Matsuo H, Yoshimura Y, Fujita S, Maeno Y. Risk of malnutrition is associated with poor physical function in patients undergoing cardiac rehabilitation following heart failure. Nutr Diet 2018; 76:82-88. [PMID: 30155947 DOI: 10.1111/1747-0080.12465] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 12/25/2022]
Abstract
AIM Patients who experience heart failure are prone to malnutrition. The aim of this study was to determine the association between risk of malnutrition and physical function in patients undergoing cardiac rehabilitation following heart failure. METHODS A cross-sectional study was performed in consecutive patients hospitalised for cardiac rehabilitation following heart failure. Risk of malnutrition was evaluated using the Mini Nutritional Assessment-Short Form (MNA-SF). Physical function was evaluated using the Barthel index (BI). Univariate and multivariate analyses were used to determine whether nutritional status was associated with BI in these patients. RESULTS The present study included 105 patients (mean age of 77.3 years, 56 men and 49 women) for analysis. The median (interquartile range) scores of the MNA-SF and BI were 11 (9-13) and 75 (45-90), respectively. Patients with high risk of malnutrition (MNA-SF score < 7) were significantly older, had a lower body mass index, exhibited lower muscle mass and strength, could walk shorter distances, and had lower BI scores (all P < 0.05). On multivariate analysis, the MNA-SF score was independently associated with BI (β = 0.409, P < 0.001) after adjusting for age, sex, muscle mass and strength, brain natriuretic peptide levels, ejection fraction of the left ventricle, and reason for admission. CONCLUSIONS Risk of malnutrition is associated with physical function in patients undergoing cardiac rehabilitation following heart failure. Early detection of malnutrition and commencement of nutritional support may improve functional recovery in these patients.
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Affiliation(s)
- Haruyo Matsuo
- Department of Nursing, Kagoshima Medical Association Hospital, Kagoshima, Japan
| | - Yoshihiro Yoshimura
- Department of Rehabilitation Medicine, Kumamoto Rehabilitation Hospital, Kumamoto, Japan
| | - Shoji Fujita
- Department of Cardiology, Kagoshima Medical Association Hospital, Kagoshima, Japan
| | - Yuichi Maeno
- Department of Rehabilitation, Kagoshima Medical Association Hospital, Kagoshima, Japan
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12
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Ito M, Wada H, Sakakura K, Ibe T, Ugata Y, Fujita H, Momomura SI. Clinical Characteristics and Mid-Term Outcomes of Non-Elderly Obese Patients with Acute Decompensated Heart Failure in Japan. Int Heart J 2018; 59:766-771. [PMID: 29794377 DOI: 10.1536/ihj.17-410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Obesity is a well-known risk factor for cardiovascular diseases including heart failure (HF). However, some literatures suggested better clinical outcomes in obese patients with HF. Since higher body mass index (BMI) levels of HF patients were significantly associated with younger age, the impact of obesity on clinical outcomes in non-elderly HF patients should be elucidated.Consecutive 155 non-elderly acute decompensated HF patients (< 60-year-old) who admitted to our institution between 2009 and 2013 were included. Those patients were divided into the two groups according to the BMI: the obesity group (BMI ≥ 25 kg/m2, n = 81) and the non-obesity group (BMI < 25 kg/m2, n = 74). The primary composite outcome of this study was defined as re-admission due to HF and all-cause death.The primary composite outcome was less frequently observed in the obesity group as compared with the non-obesity group (Hazard ratio [HR] 0.50, 95% confidence interval [CI] 0.26-0.95, P = 0.03). Re-admission due to HF was significantly less in the obesity group than in the non-obesity group (HR 0.44, 95% CI 0.23-0.86, P = 0.02), whereas all-cause death was not significantly different between the groups (P = 0.44).The mid-term outcomes in non-elderly HF patients with obesity were better as compared with non-elderly HF patients without obesity, which supports obesity paradox in this specific population.
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Affiliation(s)
- Miyuki Ito
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Tatsuro Ibe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yusuke Ugata
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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13
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Hong S, Lee JH, Kim KM, Lee JW, Youn YJ, Ahn MS, Ahn SG, Lee SH, Yoon J, Choe KH, Yoo BS. Is There a Sex-Related Difference in the Obesity Paradox in Systolic Heart Failure? Sex-Related Difference in the Obesity Paradox. Yonsei Med J 2018; 59:57-62. [PMID: 29214777 PMCID: PMC5725365 DOI: 10.3349/ymj.2018.59.1.57] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/11/2017] [Accepted: 09/09/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Obesity is often associated with better clinical outcomes in heart failure (HF). This so-called obesity paradox remains controversial. The aim of present study was to investigate the prognostic value of obesity in patients hospitalized for systolic HF. MATERIALS AND METHODS We performed a pooled analysis of data from two multicenter, observational HF studies. Patients hospitalized for systolic HF were eligible for the present study. We divided the subjects into two groups, a normal body mass index (BMI) group and a high BMI group. Study endpoints included all-cause mortality and any re-hospitalization within 1 year. RESULTS We enrolled 3145 patients (male, 1824; female, 1321). The high BMI group was significantly associated with lower 1-year mortality rate [odds ratio (OR), 0.543; 95% confidence interval (CI), 0.355-0.832] after adjusting for age, hypertension, diabetes, ischemic HF, previous myocardial infarction, serum creatinine level, anemia, and ejection fraction in men. After adjustment for clinical characteristics, high BMI was not significantly associated with 1-year mortality (OR, 0.739; 95% CI, 0.450-1.216) or 1-year re-hospitalization (OR, 0.958; 95% CI, 0.696-1.319) in women. CONCLUSION In pooled analysis of data from two Korean HF registries, the high BMI group was independently associated with lower 1-year mortality rate from systolic HF, especially in men.
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Affiliation(s)
- Soonchang Hong
- Department of Thoracic and Cardiovascular Surgery, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Ji Hyun Lee
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Kyung Min Kim
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Jun Won Lee
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Young Jin Youn
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Min Soo Ahn
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Sung Gyun Ahn
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Seung Hwan Lee
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Junghan Yoon
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Kyung Hoon Choe
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Byung Su Yoo
- Department of Cardiology, Wonju College of Medicine, Yonsei University, Wonju, Korea.
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Tanaka Y, Nagoshi T, Kawai M, Uno G, Ito S, Yoshii A, Kimura H, Inoue Y, Ogawa K, Tanaka TD, Minai K, Ogawa T, Yoshimura M. Close linkage between serum uric acid and cardiac dysfunction in patients with ischemic heart disease according to covariance structure analysis. Sci Rep 2017; 7:2519. [PMID: 28559584 PMCID: PMC5449391 DOI: 10.1038/s41598-017-02707-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/18/2017] [Indexed: 01/05/2023] Open
Abstract
High serum uric acid (UA) level has been assumed to be a risk factor for left ventricular (LV) dysfunction; however, the precise relationship between these conditions has not been fully examined because many confounding factors are associated with UA level. We herein examined the precise relationship by proposing structural equation models. The study population consisted of 1432 cases with ischemic heart disease who underwent cardiac catheterization. Multiple regression analyses and covariance structure analyses were performed to elucidate the cause-and-effect relationship between UA level and LV ejection fraction (LVEF). A path model exploring the factors contributing to LVEF showed that high UA was a significant cause of reduced LVEF (P = 0.004), independent of other significant factors. The degree of atherosclerosis, as estimated by the number of diseased coronary vessels, was significantly affected by high UA (P = 0.005); and the number of diseased coronary vessels subsequently led to reduced LVEF (P < 0.001). Another path model exploring the factors contributing to UA level showed that LVEF was a significant cause of high UA (P = 0.001), while other risk factors were also independent contributing factors. This study clearly demonstrated that there was a close link between high UA and LV dysfunction, which was represented by possible cause-and-effect relationship.
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Affiliation(s)
- Yoshiro Tanaka
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Tomohisa Nagoshi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Goki Uno
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Satoshi Ito
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Akira Yoshii
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Haruka Kimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yasunori Inoue
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kazuo Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Toshikazu D Tanaka
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kosuke Minai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takayuki Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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15
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Ito S, Nagoshi T, Minai K, Kashiwagi Y, Sekiyama H, Yoshii A, Kimura H, Inoue Y, Ogawa K, Tanaka TD, Ogawa T, Kawai M, Yoshimura M. Possible increase in insulin resistance and concealed glucose-coupled potassium-lowering mechanisms during acute coronary syndrome documented by covariance structure analysis. PLoS One 2017; 12:e0176435. [PMID: 28430816 PMCID: PMC5400267 DOI: 10.1371/journal.pone.0176435] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/10/2017] [Indexed: 12/16/2022] Open
Abstract
Objective Although glucose-insulin-potassium (GIK) therapy ought to be beneficial for ischemic heart disease in general, variable outcomes in many clinical trials of GIK in acute coronary syndrome (ACS) had a controversial impact. This study was designed to examine whether “insulin resistance” is involved in ACS and to clarify other potential intrinsic compensatory mechanisms for GIK tolerance through highly statistical procedure. Methods and results We compared the degree of insulin resistance during ACS attack and remission phase after treatment in individual patients (n = 104). During ACS, homeostasis model assessment of insulin resistance (HOMA-IR) values were significantly increased (P<0.001), while serum potassium levels were transiently decreased (degree of which was indicated by ΔK) (P<0.001). This finding provides a renewed paradox, as ΔK, a surrogate marker of intrinsic GIK cascade activation, probably reflects the validated glucose metabolism during ischemic attack. Indeed, multiple regression analysis revealed that plasma glucose level during ACS was positively correlated with ΔK (P = 0.026), whereas HOMA-IR had no impact on ΔK. This positive correlation between ΔK and glucose was confirmed by covariance structure analysis with a strong impact (β: 0.398, P = 0.015). Intriguingly, a higher incidence of myocardial infarction relative to unstable angina pectoris, as well as a longer hospitalization period were observed in patients with larger ΔK, indicating that ΔK also reflects disease severity of ACS. Conclusions Insulin resistance most likely increases during ACS; however, ΔK was positively correlated with plasma glucose level, which overwhelmed insulin resistance condition. The present study with covariance structure analysis suggests that there are potential endogenous glucose-coupled potassium lowering mechanisms, other than insulin, regulating glucose metabolism during ACS.
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Affiliation(s)
- Satoshi Ito
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Tomohisa Nagoshi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
- * E-mail:
| | - Kosuke Minai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Yusuke Kashiwagi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Hiroshi Sekiyama
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Akira Yoshii
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Haruka Kimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Yasunori Inoue
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Kazuo Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Toshikazu D. Tanaka
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Takayuki Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, JAPAN
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16
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Kroenke CH, Neugebauer R, Meyerhardt J, Prado CM, Weltzien E, Kwan ML, Xiao J, Caan BJ. Analysis of Body Mass Index and Mortality in Patients With Colorectal Cancer Using Causal Diagrams. JAMA Oncol 2017; 2:1137-45. [PMID: 27196302 DOI: 10.1001/jamaoncol.2016.0732] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Physicians and investigators have sought to determine the relationship between body mass index (BMI [calculated as weight in kilograms divided by height in meters squared]) and colorectal cancer (CRC) outcomes, but methodologic limitations including sampling selection bias, reverse causality, and collider bias have prevented the ability to draw definitive conclusions. OBJECTIVE To evaluate the association of BMI at the time of, and following, colorectal cancer (CRC) diagnosis with mortality in a complete population using causal diagrams. DESIGN, SETTING, AND PARTICIPANTS This retrospective observational study with prospectively collected data included a cohort of 3408 men and women, ages 18 to 80 years, from the Kaiser Permanente Northern California population, who were diagnosed with stage I to III CRC between 2006 and 2011 and who also had surgery. EXPOSURES Body mass index at diagnosis and 15 months following diagnosis. MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) for all-cause mortality and CRC-specific mortality compared with normal-weight patients, adjusted for sociodemographics, disease severity, treatment, and prediagnosis BMI. RESULTS This study investigated a cohort of 3408 men and women ages 18 to 80 years diagnosed with stage I to III CRC between 2006 and 2011 who also had surgery. At-diagnosis BMI was associated with all-cause mortality in a nonlinear fashion, with patients who were underweight (BMI <18.5; HR, 2.65; 95% CI, 1.63-4.31) and patients who were class II or III obese (BMI ≥35; HR, 1.33; 95% CI, 0.89-1.98) exhibiting elevated mortality risks, compared with patients who were low-normal weight (BMI 18.5 to <23). In contrast, patients who were high-normal weight (BMI 23 to <25; HR, 0.77; 95% CI, 0.56-1.06), low-overweight (BMI 25 to <28; HR, 0.75; 95% CI, 0.55-1.04), and high-overweight (BMI 28 to <30; HR, 0.52; 95% CI, 0.35-0.77) had lower mortality risks, and patients who were class I obese (BMI 30 to <35) showed no difference in risk. Spline analysis confirmed a U-shaped relationship in participants with lowest mortality at a BMI of 28. Associations with CRC-specific mortality were similar. Associations of postdiagnosis BMI and mortality were also similar, but patients who were class I obese had significantly lower all-cause and cancer-specific mortality risks. CONCLUSIONS AND RELEVANCE In this study, body mass index at the time of diagnosis and following diagnosis of CRC was associated with mortality risk. Though evidence shows that exercise in patients with cancer should be encouraged, findings suggest that recommendations for weight loss in the immediate postdiagnosis period among patients with CRC who are overweight may be unwarranted.
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Affiliation(s)
| | | | | | - Carla M Prado
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Erin Weltzien
- Division of Research, Kaiser Permanente Oakland, California
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Oakland, California
| | - Jingjie Xiao
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Bette J Caan
- Division of Research, Kaiser Permanente Oakland, California
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17
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Konishi M, Ishida J, Springer J, Anker SD, von Haehling S. Cachexia research in Japan: facts and numbers on prevalence, incidence and clinical impact. J Cachexia Sarcopenia Muscle 2016; 7:515-519. [PMID: 27239422 PMCID: PMC4864161 DOI: 10.1002/jcsm.12117] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 03/09/2016] [Indexed: 12/25/2022] Open
Abstract
Even though most clinical data on cachexia have been reported from Western countries, cachexia may be a growing problem in Asia as well, as the population in this area of the world is considerably larger. Considering the current definitions of obesity and sarcopenia in Japan, which are different from the ones in Western countries, the lack of a distinct cachexia definition in Japan is strinking. Only one epidemiological study has reported the prevalence of cachexia using weight loss as part of the definition in patients with stage III or IV non-small cell lung cancer. Although the reported prevalence of 45.6% is within the range of that in Western countries (28-57% in advanced cancer), we cannot compare the prevalence of cachexia in other types of cancer, heart failure, chronic obstructive pulmonary disease (COPD), and kidney disease (CKD) between Japan and Western countries. In patients with heart failure, one third of Japanese patients has a body mass index <20.3 kg/m2 whereas the prevalence of underweight is 13.6% in reports from Western countries. These results may suggest that there are more cachectic heart failure patients in Japan, or that using the same definition like Western countries leads to gross overestimation of the prevalence of cachexia in Japan. The rate of underweight patients in COPD has been reported as 31-41% in COPD and seems to be high in comparison to the prevalence of cachexia in Western countries (27-35%). The reported lowest quartile value of BMI (19.6 kg/m2) in CKD may match with the prevalence of cachexia in Western countries (30-60%). The number of clinical trials targeting cachexia is very limited in Japan so far.
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Affiliation(s)
- Masaaki Konishi
- Innovative Clinical Trials, Department of Cardiology and Pneumology University Medical Centre Göttingen Göttingen Germany
| | - Junichi Ishida
- Innovative Clinical Trials, Department of Cardiology and Pneumology University Medical Centre Göttingen Göttingen Germany
| | - Jochen Springer
- Innovative Clinical Trials, Department of Cardiology and Pneumology University Medical Centre Göttingen Göttingen Germany
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology University Medical Centre Göttingen Göttingen Germany
| | - Stephan von Haehling
- Innovative Clinical Trials, Department of Cardiology and Pneumology University Medical Centre Göttingen Göttingen Germany
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18
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Forbang NI, Allison MA, Ix JH, Criqui MH, Vaidya D, Yeboah J, Duprez DA, Jacobs DR. Associations of body composition measures and C2, a marker for small artery elasticity: The MESA. Obesity (Silver Spring) 2015; 23:2294-8. [PMID: 26373903 PMCID: PMC4633382 DOI: 10.1002/oby.21221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/15/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Lower C2, a continuous blood pressure waveform characteristic asserted to represent small artery elasticity, predicts future cardiovascular disease events. It is hypothesized that the paradoxical positive association between body mass index (BMI) and C2 may reflect muscle instead of excess fat. METHODS In a multi-ethnic, community-living cohort of 1,960 participants, computed tomography scans of the abdomen were used to measure visceral adipose tissue (VAT) and total abdominal muscle tissue (TAMT), and applanation tonometry of the radial arteries was used to assess C2. The period cross-sectional associations between BMI, TAMT, and VAT with C2 were ascertained. RESULTS The mean age was 62 ± 9 years and 51% were male. After adjustments for age, gender, ethnicity, pack years smoking cigarettes, diabetes, hypertension, and total and HDL cholesterol, higher BMI (standardized beta = 0.09, P-value < 0.01) and more TAMT (standardized beta = 0.12, P-value < 0.01) were significantly associated with higher C2. In contrast, more VAT (standardized beta = -0.09, P-value < 0.01) was associated with lower C2. CONCLUSIONS In multivariable analysis, VAT, in contrast to TAMT and BMI, was associated with less compliant small arteries. Visceral fat may be a better marker for detrimental excess body fat than BMI.
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Affiliation(s)
- Nketi I Forbang
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California, USA
- Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
| | - Joachim H Ix
- Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California, USA
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | | | - Joseph Yeboah
- Wake Forest University, Winston-Salem, North Carolina, USA
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Narumi T, Watanabe T, Kubota I. Simple measurement popularizes sarcopenia evaluation in patients with heart failure. Eur J Intern Med 2015; 26:e35. [PMID: 26111789 DOI: 10.1016/j.ejim.2015.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 06/04/2015] [Accepted: 06/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Taro Narumi
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Tetsu Watanabe
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
| | - Isao Kubota
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
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20
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Rayner JJ, Neubauer S, Rider OJ. The paradox of obesity cardiomyopathy and the potential for weight loss as a therapy. Obes Rev 2015; 16:679-90. [PMID: 26096833 DOI: 10.1111/obr.12292] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/08/2015] [Accepted: 04/23/2015] [Indexed: 12/18/2022]
Abstract
Obesity is an independent risk factor for developing heart failure and the combination of the two disease states will prove to be a significant health burden over the coming years. Obesity is likely to contribute to the development of heart failure through a variety of mechanisms, including structural and functional changes, lipotoxicity and steatosis and altered substrate selection. However, once heart failure has developed, it seems that obesity confers a beneficial influence on prognosis in what has been termed the 'obesity paradox'. This may be a statistical phenomenon, but it should be considered that there is truly a protective state in the physiology of obesity. There is little evidence regarding the impact of weight loss in obese heart failure and whether or not this is beneficial. There have been small studies regarding the cardiovascular effects of both dietary weight loss and bariatric surgery, but few in heart failure. This is an important and increasingly relevant clinical question which must be addressed.
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Affiliation(s)
- J J Rayner
- Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - S Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - O J Rider
- Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
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21
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Diabetes is a predictor of coronary artery stenosis in patients hospitalized with heart failure. Heart Vessels 2015; 31:671-6. [DOI: 10.1007/s00380-015-0669-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/20/2015] [Indexed: 01/03/2023]
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22
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Yoshimura M. Developing Improved Clinical Markers to Detect Heart Failure and Chronic Kidney Disease. Circ J 2015; 79:522-3. [DOI: 10.1253/circj.cj-15-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Michihiro Yoshimura
- Division of Cardiology, Department of Medicine, The Jikei University School of Medicine
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23
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Cai C, Hua W, Ding LG, Wang J, Chen KP, Yang XW, Liu ZM, Zhang S. Association of body mass index with cardiac reverse remodeling and long-term outcome in advanced heart failure patients with cardiac resynchronization therapy. Circ J 2014; 78:2899-907. [PMID: 25345991 DOI: 10.1253/circj.cj-14-0812] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of adiposity on response to cardiac resynchronization therapy (CRT) and long-term outcome in patients undergoing CRT has not been previously reported. This study assessed the impact of baseline body mass index (BMI) on cardiac reverse remodeling and prognosis following CRT. METHODS AND RESULTS: A total of 247 CRT patients were included and divided into 4 groups according to baseline BMI. During 6-month follow-up, overweight and obese patients (BMI, 24-28 kg/m(2), ≥28 kg/m(2), respectively) were inclined to have better clinical and echocardiographic improvements (P<0.05) as well as higher response rate (P<0.001) than underweight and normal weight patients (BMI, <18.5 kg/m(2), 18.5-24 kg/m(2), respectively). During long-term follow-up, overweight and obese patients had lower all-cause mortality (P=0.015) and combined endpoint of death or HF hospitalizations (P=0.001) than underweight and normal weight patients. Compared with normal weight patients, underweight patients had a 2.29-fold increase in risk of combined endpoint events whereas overweight and obese patients had a reduction in the risk of death (66% and 58%, respectively) and combined endpoint events (52% and 38%, respectively). CONCLUSIONS Patients with obesity and overweight derived more benefit from CRT. Higher BMI was independently associated with better clinical outcome in CRT patients.
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Affiliation(s)
- Chi Cai
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
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Ogah OS, Stewart S, Falase AO, Akinyemi JO, Adegbite GD, Alabi AA, Durodola A, Ajani AA, Sliwa K. Short-term outcomes after hospital discharge in patients admitted with heart failure in Abeokuta, Nigeria: data from the Abeokuta Heart Failure Registry. Cardiovasc J Afr 2014; 25:217-23. [PMID: 25210973 PMCID: PMC4241595 DOI: 10.5830/cvja-2014-040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 07/01/2014] [Indexed: 01/20/2023] Open
Abstract
Background Compared to other regions of the world, there is a paucity of data on the short-term outcome of acute heart failure (AHF) in Africa’s most populous country, Nigeria. We examined the six-month outcomes (including case fatalities) in 285 of 309 AHF subjects admitted with HF to a tertiary hospital in Abeokuta, Nigeria. Methods The study cohort of 285 subjects comprised 150 men (52.6%) and 135 women (47.4%) with a mean age of 56.3 ± 15.6 years and the majority in NYHA class III (75%). Results There were a number of differences according to the subject’s gender; men being older and more likely to present with hypertensive heart disease (with greater left ventricular mass) while also having greater systolic dysfunction. Mean length of stay was 10.5 ± 5.9 days. Mean follow up was 205 days, with 23 deaths and 20 lost to follow up. At 30 days, 4.2% (95% CI: 2.4–7.3%) had died and by 180 days this had increased to 7.5% (95% CI: 4.7–11.2%); with those subjects with pericardial disease demonstrating the highest initial mortality rate. Over the same period, 13.9% of the cohort was re-admitted at least once. Conclusions The characteristics of this AHF cohort in Nigeria were different from those reported in high-income countries. Cases were relatively younger and presented with non-ischaemic aetiological risk factors for HF, especially hypertensive heart disease. Moreover, mortality and re-admission rates were relatively lower, suggesting region-specific strategies are required to improve health outcomes.
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Affiliation(s)
- Okechukwu S Ogah
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria; Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Simon Stewart
- NHMRC Centre of Research Excellence to Reduce, Inequality in Heart Disease Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Ayodele O Falase
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Gali D Adegbite
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokuta, Nigeria
| | - Albert A Alabi
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokuta, Nigeria
| | - Amina Durodola
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Akinlolu A Ajani
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa and IIDMM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; NHMRC Centre of Research Excellence to Reduce, Inequality in Heart Disease Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
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25
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The increasing impact of a higher body mass index on the decrease in plasma B-type natriuretic peptide levels. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.ijcme.2014.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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Abstract
Obesity is a medical disease that is increasing significantly nowadays. Worldwide obesity prevalence doubled since 1980. Obese patients are at great risk for complications with physical and psychological burdens, thus affecting their quality of life. Obesity is well known to have higher risk for cardiovascular diseases, diabetes mellitus, musculoskeletal diseases and shorter life expectancy. In addition, obesity has a great impact on surgical diseases, and elective surgeries in comparison to general population. There is higher risk for wound infection, longer operative time, poorer outcome, and others. The higher the BMI (body mass index), the higher the risk for these complications. This literature review illustrates the prevalence of obesity as a diseases and complications of obesity in general as well as, in a surgical point of view, general surgery perioperative risks and complications among obese patients. It will review the evidence-based updates in these headlines.
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27
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Abstract
As the link between heart failure (HF) and diabetes mellitus (DM) becomes unignorable, so the need is further increasing for pathological comprehension: What is "diabetic cardiomyopathy (DMC)?" In response to current concern, the most updated guidelines stated by the ACCF/AHA and by the ESC/EASD take one step further, including the definition of DMC, although it is a matter yet to be completed. For more than 40 years, coronary artery disease and hypertension have been considered as the main causes of diabetes-related cardiac dysfunction. HF was originally considered as a result of reduced left ventricular ejection fraction (HF-REF); however, it has been recognized that HF symptoms are often observed in patients with preserved EF (HF-PEF). DMC includes HF with both reduced and preserved entities independent of coronary stenosis and hypertension. Cardiologists are thus facing a sort of chaos without clear guidelines for the "deadly intersection" of DM and HF. Today, the increasing interest and concern have caused DMC to be revisited and the first step in controlling the chaos around DMC is to organize and analyze all of the available evidence from preclinical and clinical studies. This review aims to illustrate the current concepts of DMC by shedding light on the new molecular mechanisms. (Circ J 2014; 78: 576-583).
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Affiliation(s)
- Yasuko K Bando
- Department of Cardiology, Nagoya University Graduate School of Medicine
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28
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Makita S, Nakamura M. Possible Clinical Aspects of a Linkage of Preceding Weight Loss and Heart Failure. Circ J 2014; 78:590-1. [DOI: 10.1253/circj.cj-14-0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shinji Makita
- Department of Internal Medicine, Division of Cardioangiology, Iwate Medical University
| | - Motoyuki Nakamura
- Department of Internal Medicine, Division of Cardioangiology, Iwate Medical University
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29
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Ito K, Kawai M, Nakane T, Narui R, Hioki M, Tanigawa SI, Yamashita S, Inada K, Matsuo S, Date T, Yamane T, Yoshimura M. Serial measurements associated with an amelioration of acute heart failure: an analysis of repeated quantification of plasma BNP levels. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 1:240-7. [PMID: 24062913 DOI: 10.1177/2048872612458580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 07/28/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND The magnitude of improvement of acute heart failure achieved during treatment varies greatly among patients. We examined changes in the plasma B-type natriuretic peptide (BNP) levels of patients with acute heart failure and attempted to elucidate the clinical factors associated with amelioration of acute heart failure. METHODS AND RESULTS The study population consisted of 208 consecutive patients admitted to our institution with acute heart failure. We measured plasma BNP levels before and after treatment of acute heart failure and evaluated these levels based on median age, body mass index (BMI), creatinine (Cr) level, and left ventricular ejection fraction (EF). Plasma BNP levels before treatment were equivalent between the younger and older age groups; however, plasma BNP levels after treatment were higher in the older age group (p<0.01). Plasma BNP levels before treatment were significantly high in the lower BMI group (p<0.05) and the higher Cr group (p<0.01). Similarly, plasma BNP levels after treatment were high in both the lower BMI and higher Cr groups (p<0.01 for both). In the low EF group, plasma BNP levels before treatment were significantly high (p<0.01), while plasma BNP levels after treatment were equivalent to those in the high EF group. A multiple linear regression analysis revealed that Cr was positively correlated and BMI and EF were negatively correlated with plasma BNP levels before treatment; however, the contributions of age, BMI, and Cr in reducing plasma BNP levels were more significant after treatment. CONCLUSIONS The contributions of clinical factors working against amelioration of heart failure vary before and after treatment. Regarding plasma BNP levels, older age, very low BMI, and the presence of renal dysfunction eventually act to prevent amelioration of acute heart failure. Systolic dysfunction does not act against amelioration of acute heart failure.
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Affiliation(s)
- Keiichi Ito
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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30
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Affiliation(s)
- Vojtech Hainer
- Institute of Endocrinology, Obesity Management Center, Prague, Czech Republic.
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31
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Narumi T, Arimoto T, Funayama A, Kadowaki S, Otaki Y, Nishiyama S, Takahashi H, Shishido T, Miyashita T, Miyamoto T, Watanabe T, Kubota I. Prognostic importance of objective nutritional indexes in patients with chronic heart failure. J Cardiol 2013; 62:307-13. [PMID: 23806549 DOI: 10.1016/j.jjcc.2013.05.007] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/23/2013] [Accepted: 05/08/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND Although malnutrition indicates an unfavorable prognosis in some clinical settings, the association between nutritional indexes and outcomes for patients with chronic heart failure (CHF) is unclear. METHODS AND RESULTS All the previously established objective nutritional indexes were evaluated. The controlling nutritional status score (CONUT), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) were determined for 388 consecutive patients with CHF (mean age 69.6±12.3 years). The prevalence of malnutrition in this cohort was 60-69%. Patients were followed prospectively, with the endpoints being death due to a cardiovascular event or re-hospitalization. There were 130 events, including 33 deaths and 97 re-hospitalizations, during a mean follow-up period of 28.4 months. Patients experiencing cardiovascular events showed impaired nutritional status, higher CONUT scores, lower PNI scores, and lower GNRI scores, compared with those who did not experience cardiovascular events. CONUT score [hazard ratio 40.9, 95% confidence interval (CI) 10.8-154.8], PNI score (hazard ratio 6.4, 95% CI 5.4-25.1), and GNRI score (hazard ratio 11.6, 95% CI 3.7-10.0) were independently associated with cardiovascular events. Kaplan-Meier analysis showed that there was a significantly higher incidence of cardiovascular events in patients who were malnourished than in those who were not. CONCLUSION Malnutrition was common in patients with CHF. Evaluation of nutritional status may provide additional prognostic information in patients with CHF.
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Affiliation(s)
- Taro Narumi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
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32
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Sekiyama H, Nagoshi T, Komukai K, Matsushima M, Katoh D, Ogawa K, Minai K, Ogawa T, Yoshimura M. Transient decrease in serum potassium level during ischemic attack of acute coronary syndrome: paradoxical contribution of plasma glucose level and glycohemoglobin. Cardiovasc Diabetol 2013; 12:4. [PMID: 23289667 PMCID: PMC3561250 DOI: 10.1186/1475-2840-12-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 12/30/2012] [Indexed: 11/26/2022] Open
Abstract
Background Although a decrease in serum potassium level has been suggested to be a fairly common observation in acute coronary syndrome (ACS), there have so far been no definitive reports directly demonstrating the transient potassium decrease (the potassium dip) during ischemic attack of ACS compared to stable phase in individual patients. To understand the pathophysiological significance of the potassium dip, we examined the changes in serum potassium level throughout ischemic attack and evaluated the clinical factors affecting it. Methods The degree of the potassium dip during ischemic attack (as indicated by ΔK, ΔK = K at discharge − K on admission) was examined in 311 consecutive patients with ACS who required urgent hospitalization in our institution. Results Serum potassium level during ischemic attack was significantly decreased compared to that during stable phase (P < 0.001). Multiple regression analysis revealed that plasma glucose level during attack was the sole factor which was positively correlated with ΔK (P < 0.01), while HbA1c level was negatively correlated (P < 0.05). The medication profiles and renal function had no impact on ΔK. A longer hospitalization period, higher incidence of myocardial infarction and higher peak creatine kinase level were observed in patients with a larger ΔK. Conclusions We have clearly demonstrated that there is a transient decrease in serum potassium level during ischemic attack of ACS compared to stable phase. The degree of the potassium dip was tightly correlated with glucose level, which overwhelmed the diabetic condition, and it also indicates the disease severity. The present study therefore promotes awareness of the significance of monitoring potassium level in parallel with glucose level in patients with ACS.
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Affiliation(s)
- Hiroshi Sekiyama
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Gleim S, Stitham J, Tang WH, Martin KA, Hwa J. An eicosanoid-centric view of atherothrombotic risk factors. Cell Mol Life Sci 2012; 69:3361-80. [PMID: 22491820 PMCID: PMC3691514 DOI: 10.1007/s00018-012-0982-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 03/22/2012] [Accepted: 03/26/2012] [Indexed: 02/06/2023]
Abstract
Cardiovascular disease is the foremost cause of morbidity and mortality in the Western world. Atherosclerosis followed by thrombosis (atherothrombosis) is the pathological process underlying most myocardial, cerebral, and peripheral vascular events. Atherothrombosis is a complex and heterogeneous inflammatory process that involves interactions between many cell types (including vascular smooth muscle cells, endothelial cells, macrophages, and platelets) and processes (including migration, proliferation, and activation). Despite a wealth of knowledge from many recent studies using knockout mouse and human genetic studies (GWAS and candidate approach) identifying genes and proteins directly involved in these processes, traditional cardiovascular risk factors (hyperlipidemia, hypertension, smoking, diabetes mellitus, sex, and age) remain the most useful predictor of disease. Eicosanoids (20 carbon polyunsaturated fatty acid derivatives of arachidonic acid and other essential fatty acids) are emerging as important regulators of cardiovascular disease processes. Drugs indirectly modulating these signals, including COX-1/COX-2 inhibitors, have proven to play major roles in the atherothrombotic process. However, the complexity of their roles and regulation by opposing eicosanoid signaling, have contributed to the lack of therapies directed at the eicosanoid receptors themselves. This is likely to change, as our understanding of the structure, signaling, and function of the eicosanoid receptors improves. Indeed, a major advance is emerging from the characterization of dysfunctional naturally occurring mutations of the eicosanoid receptors. In light of the proven and continuing importance of risk factors, we have elected to focus on the relationship between eicosanoids and cardiovascular risk factors.
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Affiliation(s)
- Scott Gleim
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06511
| | - Jeremiah Stitham
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06511
| | - Wai Ho Tang
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06511
| | - Kathleen A. Martin
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06511
| | - John Hwa
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06511
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Minai K, Komukai K, Arase S, Nagoshi T, Matsuo S, Ogawa K, Kayama Y, Inada K, Tanigawa SI, Takemoto T, Sekiyama H, Date T, Ogawa T, Taniguchi I, Yoshimura M. Cardiac tamponade as an independent condition affecting the relationship between the plasma B-type natriuretic peptide levels and cardiac function. Heart Vessels 2012; 28:510-3. [PMID: 22926410 DOI: 10.1007/s00380-012-0278-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 07/27/2012] [Indexed: 11/30/2022]
Abstract
Plasma B-type natriuretic peptide (BNP) is finely regulated by the cardiac function and several extracardiac factors. Therefore, the relationship between the plasma BNP levels and the severity of heart failure sometimes seems inconsistent. The purpose of the present study was to investigate the plasma BNP levels in patients with cardiac tamponade and their changes after pericardial drainage. This study included 14 patients with cardiac tamponade who underwent pericardiocentesis. The cardiac tamponade was due to malignant diseases in 13 patients and uremia in 1 patient. The plasma BNP levels were measured before and 24-48 h after drainage. Although the patients reported severe symptoms of heart failure, their plasma BNP levels were only 71.2 ± 11.1 pg/ml before drainage. After appropriate drainage, the plasma BNP levels increased to 186.0 ± 22.5 pg/ml, which was significantly higher than that before drainage (P = 0.0002). In patients with cardiac tamponade, the plasma BNP levels were low, probably because of impaired ventricular stretching, and the levels significantly increased in response to the primary condition after drainage. This study demonstrates an additional condition that affects the relationship between the plasma BNP levels and cardiac function. If inconsistency is seen in the relationship between the plasma BNP levels and clinical signs of heart failure, the presence of cardiac tamponade should therefore be considered.
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Affiliation(s)
- Kosuke Minai
- Division of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
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