- 著者
- Shunsuke Tamaki Yoshihiro Sato Takahisa Yamada Takashi Morita Yoshio Furukawa Yusuke Iwasaki Masato Kawasaki Atsushi Kikuchi Takumi Kondo Tatsuhisa Ozaki Masahiro Seo Iyo Ikeda Eiji Fukuhara Makoto Abe Jun Nakamura Masatake Fukunami
- 出版者
- 日本循環器学会
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- pp.CJ-16-1122, (Released:2017-02-16)
- 参考文献数
- 39
- 被引用文献数
- 34
Background:Although the mainstay of treatment for acute decompensated heart failure (ADHF) is decongestion by diuretic therapy, it is often associated with worsening renal function (WRF). The effect of tolvaptan, a selective V2 receptor antagonist, on WRF in ADHF patients with preserved left ventricular ejection fraction (LVEF) is unknown.Methods and Results:We enrolled 50 consecutive ADHF patients whose LVEF on admission was ≥45%. Patients were randomly assigned to either tolvaptan add-on (n=26) or conventional diuretic therapy (n=24). The primary endpoint was the incidence of WRF, defined as an increase in serum creatinine (Cr) ≥0.3 mg/dL or 50% above baseline within 48 h of randomization. There was no significant difference between the 2 groups in the change in body weight or the total urine volume during 48 h. However, the change in Cr (∆Cr) at 24 and 48 h after randomization and the incidence of WRF (12% vs. 42%, P=0.0236) were significantly lower, and the fractional excretion of urea (FEUN) at 24 and 48 h after randomization was significantly higher in the tolvaptan group. There was an inverse correlation between ∆Cr and FEUN at 48 h after randomization.Conclusions:Tolvaptan can alleviate congestion with a significantly lower risk of WRF in ADHF patients with preserved LVEF, presumably through maintenance of renal perfusion.
- 著者
- Taro Takeuchi Shumpei Kosugi Yasunori Ueda Kuniyasu Ikeoka Haruya Yamane Kohtaro Takayasu Takuya Ohashi Takashi Fukushima Kohei Horiuchi Takashi Iehara Mai Sakamoto Kazuho Ukai Shinya Minami Yuuki Mizumori Naoya Muraoka Masayuki Nakamura Tatsuhisa Ozaki Tsuyoshi Mishima Haruhiko Abe Koichi Inoue Yasushi Matsumura
- 出版者
- The Japanese Circulation Society
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- pp.CJ-22-0838, (Released:2023-04-12)
- 参考文献数
- 35
- 被引用文献数
- 1
Background: It remains controversial whether a cancer history increases the risk of cardiovascular (CV) events among patients with myocardial infarction (MI) who undergo revascularization.Methods and Results: Patients who were confirmed as type 1 acute MI (AMI) by coronary angiography were retrospectively analyzed. Patients who died in hospital or those not undergoing revascularization were excluded. Patients with a cancer history were compared with those without it. A cancer history was examined in the in-hospital cancer registry. The primary outcome was a composite of cardiac death, recurrent type 1 MI, post-discharge coronary revascularization, heart failure hospitalization, and stroke. Among 551 AMI patients, 55 had a cancer history (cancer group) and 496 did not (non-cancer group). Cox proportional hazards model revealed that the risk of composite endpoint was significantly higher in the cancer group than in the non-cancer group (adjusted hazard ratio [HR]: 1.78; 95% confidence interval [CI]: 1.13–2.82). Among the cancer group, patients who were diagnosed as AMI within 6 months after the cancer diagnosis had a higher risk of the composite endpoint than those who were diagnosed as AMI 6 months or later after the cancer diagnosis (adjusted HR: 5.43; 95% CI: 1.55–19.07).Conclusions: A cancer history increased the risk of CV events after discharge among AMI patients after revascularization.