- 著者
- Norihiro Okada Naohiko Takahashi Kunio Yufu Yukichi Murozono Osamu Wakisaka Tetsuji Shinohara Futoshi Anan Mikiko Nakagawa Masahide Hara Tetsunori Saikawa Hironobu Yoshimatsu
- 出版者
- The Japanese Circulation Society
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- vol.74, no.7, pp.1379-1383, 2010 (Released:2010-06-25)
- 参考文献数
- 29
- 被引用文献数
- 24 35
Background: Cardiovascular autonomic neuropathy is a major complication in patients with diabetes mellitus (DM). However, the relationship between cardiovascular autonomic neuropathy and the incidence of cardiovascular events has been poorly investigated in type 2 DM. The present study aimed to assess the long-term cardiovascular predictive value of baroreflex sensitivity (BRS) in Japanese patients with type 2 DM without structural heart disease. Methods and Results: BRS was evaluated using the phenylephrine method in 210 patients with type 2 DM who did not have structural heart disease or other severe complications. BRS was considered depressed if <6 ms/mmHg. Accurate follow-up information for 3-10 years (mean 4.7 years) was obtained in 184 patients (90 females, 94 males; mean age 58±12 years). The initial onset of a major adverse cardiovascular event (MACE) was investigated. During follow-up, 19 patients presented with a MACE (4 cardiovascular deaths, 3 nonfatal myocardial infarctions, 4 coronary revascularizations, 5 strokes, 2 congestive heart failures). Cox proportional hazards regression analysis revealed that depressed BRS was independently associated with the incidence of MACE (hazard ratio 1.93, 95% confidence interval 1.09-3.82, P=0.0236). Conclusions: Depressed BRS at baseline has long-term cardiovascular predictive value in Japanese patients with type 2 DM without structural heart disease. (Circ J 2010; 74: 1379 - 1383)
- 著者
- Satoshi Ogawa Takeshi Yamashita Tsutomu Yamazaki Yoshifusa Aizawa Hirotsugu Atarashi Hiroshi Inoue Tohru Ohe Hiroshi Ohtsu Ken Okumura Takao Katoh Shiro Kamakura Koichiro Kumagai Yoshihisa Kurachi Itsuo Kodama Yukihiro Koretsune Tetsunori Saikawa Masayuki Sakurai Kaoru Sugi Toshifumi Tabuchi Haruaki Nakaya Toshio Nakayama Makoto Hirai Masahiko Fukatani Hideo Mitamura for the J-RHYTHM Investigators
- 出版者
- The Japanese Circulation Society
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- vol.73, no.2, pp.242-248, 2009 (Released:2009-01-23)
- 参考文献数
- 31
- 被引用文献数
- 85 161
Background Although previous clinical trials demonstrated the non-inferiority of a rate control to rhythm control strategy for management of atrial fibrillation (AF), the optimal treatment strategy for paroxysmal AF (PAF) remains unclear. Methods and Results A randomized, multicenter comparison of rate control vs rhythm control in Japanese patients with PAF (the Japanese Rhythm Management Trial for Atrial Fibrillation (J-RHYTHM) study) was conducted. The primary endpoint was a composite of total mortality, symptomatic cerebral infarction, systemic embolism, major bleeding, hospitalization for heart failure, or physical/psychological disability requiring alteration of treatment strategy. In the study, 823 patients with PAF were followed for a mean period of 578 days. The primary endpoint occurred in 64 patients (15.3%) assigned to rhythm control and in 89 patients (22.0%) to rate control (P=0.0128). No significant differences between the treatment strategies were observed in the incidences of death, stroke, bleeding and heart failure. Meanwhile, significantly fewer patients requested changes of assigned treatment strategy in the rhythm control vs the rate control group, which was accompanied by improvement in AF-specific quality of life scores. Conclusion The J-RHYTHM study showed that rhythm control was associated with fewer primary endpoints than rate control. However, mortality and cardiovascular morbidity were not affected by the treatment strategy (umin-CTR No. C000000106). (Circ J 2009; 73: 242 - 248)
- 著者
- Hiroshi Inoue Ken Okumura Hirotsugu Atarashi Takeshi Yamashita Hideki Origasa Naoko Kumagai Masayuki Sakurai Yuichiro Kawamura Isao Kubota Kazuo Matsumoto Yoshiaki Kaneko Satoshi Ogawa Yoshifusa Aizawa Masaomi Chinushi Itsuo Kodama Eiichi Watanabe Yukihiro Koretsune Yuji Okuyama Akihiko Shimizu Osamu Igawa Shigenobu Bando Masahiko Fukatani Tetsunori Saikawa Akiko Chishaki on behalf of the J-RHYTHM Registry Investigators
- 出版者
- 日本循環器学会
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- pp.CJ-13-0290, (Released:2013-05-25)
- 参考文献数
- 24
- 被引用文献数
- 52 110
Background: Target anticoagulation levels for warfarin in Japanese patients with non-valvular atrial fibrillation (NVAF) are unclear. Methods and Results: Of 7,527 patients with NVAF, 1,002 did not receive warfarin (non-warfarin group), and the remaining patients receiving warfarin were divided into 5 groups based on their baseline international normalized ratio (INR) of prothrombin time (≤1.59, 1.6–1.99, 2.0–2.59, 2.6–2.99, and ≥3.0). Patients were followed-up prospectively for 2 years. Primary endpoints were thromboembolic events (cerebral infarction, transient ischemic attack, and systemic embolism), and major hemorrhage requiring hospital admission. During the follow-up period, thromboembolic events occurred in 3.0% of non-warfarin group, but at lower frequencies in the warfarin groups (2.0, 1.3, 1.5, 0.6, and 1.8%/2 years for INR values of ≤1.59, 1.6–1.99, 2.0–2.59, 2.6–2.99, and ≥3.0, respectively; P=0.0059). Major hemorrhage occurred more frequently in warfarin groups (1.5, 1.8, 2.4, 3.3, and 4.1% for INR values ≤1.59, 1.6–1.99, 2.0–2.59, 2.6–2.99, and ≥3.0, respectively; P=0.0041) than in non-warfarin group (0.8%/2 years). These trends were maintained when the analyses were confined to patients aged ≥70 years. Conclusions: An INR of 1.6–2.6 is safe and effective at preventing thromboembolic events in patients with NVAF, particularly patients aged ≥70 years. An INR of 2.6–2.99 is also effective, but associated with a slightly increased risk in major hemorrhage. (UMIN Clinical Trials Registry UMIN000001569)