A randomized controlled trial of eicosapentaenoic acid in patients with coronary heart disease on statins.

Background: There is a residual risk of coronary heart disease (CHD) despite intensive statin therapy for secondary prevention. The aim of this study was to investigate whether coronary plaque regression and stabilization are reinforced by the addition of eicosapentaenoic acid (EPA) to high-dose pitavastatin (PTV).

Methods: We enrolled 193 CHD patients who underwent percutaneous coronary intervention (PCI) in six hospitals.

Combination therapy of eicosapentaenoic acid and pitavastatin for coronary plaque regression evaluated by integrated backscatter intravascular ultrasonography (CHERRY study)-rationale and design.

Background And Purpose: Many clinical trials have shown that 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) can significantly reduce coronary artery disease in both primary and secondary prevention. A recent study showed that aggressive lipid-lowering therapy with strong statins could achieve coronary artery plaque regression, as evaluated with gray-scale intravascular ultrasound (IVUS). However, it is unknown whether coronary plaque regression and stabilization are reinforced when eicosapentaenoic acid (EPA) is used with a strong statin.

Serial evaluation of left ventricular contraction and relaxation in Takotsubo cardiomyopathy by 2D speckle tracking echocardiography.

A 78-year-old woman was referred to our hospital because of general fatigue. The electrocardiogram showed ST elevation in the I, II, aVL, and V2-V6 leads. Echocardiography showed left ventricular apical akinesis.

Elevated plasma brain natriuretic peptide levels predict left atrial appendage dysfunction in patients with acute ischemic stroke.

Background: It is well known that left atrial appendage (LAA) dysfunction plays an important role in the occurrence of cardioembolic stroke. The atrium is the main source of brain natriuretic peptide (BNP) in patients with atrial fibrillation (AF). We hypothesized that the plasma BNP level would be a sensitive predictor of LAA dysfunction in patients with acute ischemic stroke.

[Two cases of mixed infection following 2009 H1N1 influenza pneumonia].

Case 1 was a 73-year-old woman admitted to our hospital due to bilateral pneumonia with respiratory failure. Real-time reverse transcription polymerase chain reaction (RRT-PCR) analysis confirmed 2009 H1N1 influenza infection. Streptococcus pneumoniae was confirmed from sputum culture and a urine antigen test on admission.

Increased left atrial volume index predicts a poor prognosis in patients with heart failure.

Background: Left atrial volume index (LAVI) is known to reflect the duration and severity of increased left atrial pressure caused by left ventricular (LV) diastolic dysfunction. However, the prognostic value of LAVI in patients with heart failure (HF) has not been fully investigated.

Methods And Results: Transthoracic echocardiography was performed in 146 consecutive patients (78 men, 68 women; mean age 72 ± 12 y) who were hospitalized for HF.

Percutaneous transvenous stent implantation to external iliac vein stenosis in a patient with retroperitoneal fibrosis.

A 59-year-old man visited our hospital due to right leg edema and right leg pain. Computed tomography revealed that the circumferential enhancement of bilateral external iliac arteries by soft tissue that had similar density as the adjacent psoas muscle and that the right external iliac vein that was constricted by those tissues. The patient was diagnosed as retroperitoneal fibrosis.

Low wall velocity of left atrial appendage measured by trans-thoracic echocardiography predicts thrombus formation caused by atrial appendage dysfunction.

Background: Atrial fibrillation is associated with ischemic stroke because of thrombi that form within the left atrial appendage (LAA). The aim of this study was to develop a new parameter for LAA function that is easily performed using transthoracic echocardiography (TTE).

Methods: TTE and transesophageal echocardiography were performed in 106 patients with stroke.

Impact of aortic arch stiffness on recurrence of stroke in patients with acute ischemic stroke.

Background: Aortic arch plaques are associated with increased risk of stroke recurrence. The atherosclerotic process also affects aortic stiffness. The purpose of the present study was to evaluate aortic arch stiffness by transesophageal echocardiography (TEE) and its effect on recurrence of stroke.

Usefulness of intensity variation in the left atrial appendage with contrast echocardiography to predict ischemic stroke recurrence in patients with atrial fibrillation.

The left atrial appendage (LAA) is 1 of the common thromboembolic sources in patients with atrial fibrillation (AF) with stroke. The aim of this study was to examine the usefulness of LAA opacification seen on contrast echocardiography for predicting stroke recurrence in patients with AF. In 192 patients with stroke with AF who underwent transesophageal echocardiography within 7 days after the onset, intracardiac intensity variation at the orifice of the LAA just after intravenous infusion of Levovist (1,500 mg) was measured.

Persistently increased serum concentration of heart-type fatty acid-binding protein predicts adverse clinical outcomes in patients with chronic heart failure.

Background: Heart-type fatty acid-binding protein (H-FABP) is a small cytosolic protein that is released into the circulation when the myocardium is injured. This study examined whether serial measurement of the H-FABP level provides additional prognostic information.

Methods And Results: Serum H-FABP levels were measured in 113 consecutive chronic heart failure (CHF) patients at both admission and discharge.

Elevated serum fibrin-monomer levels are associated with high long-term cerebrovascular event rates in acute ischemic stroke patients.

Background: Serum fibrin-monomer (FM) is a precursor of stable fibrin, and is a sensitive marker of a systemic hypercoagulable state. It has been reported that, in patients with acute ischemic stroke, higher levels of serum FM reflect intracardiac thrombus formation.

Methods And Results: Serum coagulation and fibrinolytic activity were measured in 113 patients with acute ischemic stroke within 7 (6+/-1) days after onset.

Serum carboxy-terminal telopeptide of type I collagen (ICTP) predicts cardiac events in chronic heart failure patients with preserved left ventricular systolic function.

Background: Clinical markers to predict adverse outcome have not yet been established for patients with preserved left ventricular (LV) systolic function. The present study was designed to examine whether carboxy-terminal telopeptide of type I collagen (ICTP), a marker of collagen degradation, is useful for determining the prognosis of such patients.

Methods And Results: Serum levels of ICTP were measured at admission in 156 consecutive patients hospitalized for chronic heart failure (CHF).

High serum level of pentosidine, an advanced glycation end product (AGE), is a risk factor of patients with heart failure.

Background: Pentosidine, one of the advanced glycation end products (AGE), is generated by nonenzymatic glycation and oxidation of proteins. The receptor of AGE (RAGE) is expressed in a variety of tissue, and interaction of AGE with RAGE induces oxidative stress and activation of intracellular signaling, causing production of cytokines and mediators of inflammation. We investigated whether serum pentosidine is a risk factor for heart failure.

Heart-type fatty acid-binding protein is more sensitive than troponin T to detect the ongoing myocardial damage in chronic heart failure patients.

Background: Heart-type fatty acid-binding protein (H-FABP) is a small cytosolic protein and released into the circulation when the myocardium is injured. Previous studies have demonstrated that both H-FABP and troponin T (TnT) are detectable in venous blood samples in chronic heart failure (CHF) patients, suggesting the presence of ongoing myocardial damage (OMD). We hypothesized that a cytosolic marker (H-FABP) is more sensitive than a myofibrillar component (TnT) in the detection of OMD in CHF.

Serum resistin is associated with high risk in patients with congestive heart failure--a novel link between metabolic signals and heart failure.

Background: Resistin is derived from fat tissue in rodents, and serum levels are elevated in animal models of obesity and insulin resistance. Recent studies have reported that resistin is correlated with markers of inflammation and oxidative stress and is predictive of coronary atherosclerosis in humans. However, clinical significance of serum resistin has not been examined in heart failure.

Cardiac sympathetic denervation and ongoing myocardial damage for prognosis in early stages of heart failure.

Background: Iodine-123-metaiodobenzylguanidine ((123)I-MIBG) can assess cardiac sympathetic nervous function. Heart-type fatty acid binding protein (H-FABP) has been used as a marker of ongoing myocardial damage. The prognostic value of combination (123)I-MIBG imaging and H-FABP in heart failure is unknown.

Ratio of peak early to late diastolic filling velocity of the left ventricular inflow is associated with left atrial appendage thrombus formation in elderly patients with acute ischemic stroke and sinus rhythm.

Objectives: To investigate the useful parameters of transthoracic echocardiography (TTE) for the diagnosis of stroke subtypes in patients with acute cerebral infarction.

Methods: One hundred and one acute ischemic stroke patients met all of the following criteria; > or = 50 years of age, normal sinus rhythm on admission, and transesophageal echocardiography (TEE) within 7 days from the onset. The clinical significance of the TTE parameters on admission was examined for identifying intracardiac thrombus formation as follows: left atrial dimension, left ventricular end-diastolic dimension, percentage fractional shortening, left ventricular mass index, ratio of the transmitral inflow velocities (E/A), and deceleration time of the E wave.

Higher levels of serum fibrin-monomer reflect hypercoagulable state and thrombus formation in the left atrial appendage in patients with acute ischemic stroke.

Background: It is sometimes difficult to make a diagnosis of cardioembolic stroke in the stroke care unit, because of the splashing and vanishing of the intracardiac source of the emboli on transesophageal echocardiography. Serum fibrin-monomer (FM) is a new marker for coagulation activity that is useful for identifying older individuals at increased risk of ischemic stroke.

Methods And Results: Two hundred and four patients with acute ischemic stroke were examined for serum coagulation and fibrinolytic activity on admission, and underwent transesophageal echocardiography within 7 days of onset.

Hyperuricemia associated with high cardiac event rates in the elderly with chronic heart failure.

Objectives: Congestive heart failure (CHF) is the major cause of death and hospitalization in the elderly population. Simple markers that can be measured anywhere at low cost are necessary to identify patients at high risk. Recent studies have reported that hyperuricemia is a prognostic marker for CHF.

Ongoing myocardial damage relates to cardiac sympathetic nervous disintegrity in patients with heart failure.

Unlabelled: Iodine-123-metaiodobenzylguanidine (123I-MIBG) has been used to assess the integrity and function of the cardiac sympathetic nervous system in patients with heart failure. Heart-type fatty acid binding protein (H-FABP) is released into the circulation when the myocardium is injured, and H-FABP has been recently used as a novel marker for the diagnosis of ongoing myocardial damage.

Objective: The aim of the present study was to compare cardiac sympathetic nervous activity assessed by 123I-MIBG imaging with serum levels of H-FABP in patients with heart failure.

Cystatin C, a novel measure of renal function, is an independent predictor of cardiac events in patients with heart failure.

Background: Cystatin C, a novel endogenous marker of glomerular filtration rate, has been reported as more sensitive to detect renal insufficiency than creatinine. The purpose of the present study was to examine the clinical significance of serum cystatin C level in patients with mild to moderate heart failure.

Methods And Results: Serum levels of cystatin C were measured by an enzyme immunoassay in 140 patients with heart failure and 64 control subjects without heart failure.

Serum heart-type fatty acid binding protein predicts cardiac events in elderly patients with chronic heart failure.

Background And Objectives: Heart-type fatty acid binding protein (H-FABP) is released into the circulation from the damaged myocardium of patients with severe chronic heart failure. Chronic heart failure is the most frequent cause of death and disability in the elderly. However, there are no data for the prognostic value of H-FABP in the elderly population.

Combination of heart-type fatty acid binding protein and brain natriuretic peptide can reliably risk stratify patients hospitalized for chronic heart failure.

Background: The aim of the present study was to prospectively study whether a combination of markers for myocardial cell injury and left ventricular overload at admission can reliably risk stratify patients hospitalized for chronic heart failure (CHF).

Methods And Results: Serum concentrations of heart-type fatty acid binding protein (H-FABP) and plasma concentrations of brain natriuretic peptide (BNP) were measured at admission in 186 consecutive patients hospitalized for CHF. During a mean follow-up period of 534+/-350 days, there were 44 cardiac events, including 16 cardiac deaths and 28 readmissions for worsening heart failure.