High BMI was associated with better clinical outcomes in Japanese CHF patients.

BackgroundAlthough 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.MethodsThe 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.ResultsSerum 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.ConclusionsWe 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.

The risk factors were significantly different between initially diagnosed ACS and SAP. Smoking was a more important risk factor of initially diagnosed ACS. Smoking cessation might have a preventive effect on subsequent cardiac events. Also, we found that treatment with a calcium-channel blocker would help prevent ACS in Japanese patients.

The low plasma BNP levels in true obesity patients with acute heart failure are of concern, because plasma BNP cannot increase in such patients.

atients with congestive heart failure (CHF) are frequently re-hospitalized, worsening their quality of life, and re-hospitalization for CHF is also associated with increased mortality rates. 1,2 Therefore, re-hospitalization for CHF should be avoided. Renal insufficiency increases the risk of CHF, [3][4][5] but most studies that have investigated the role of renal function in CHF have included only subjects with no known CHF or mild-to-moderate CHF and excluded patients with severe renal dysfunction. Patients hospitalized for CHF have more severe disease and impaired renal function, but little is known about the relation between renal dysfunction and re-hospitalization because of CHF. Thus, the aim of the present study was to investigate whether renal dysfunction is associated with rehospitalization for CHF after successful discharge. MethodsThe study protocol was approved by the Ethics Committee of The Jikei University School of ).Patients with CHF who had been admitted from January 2003 through December 2004 and followed up after discharge at the outpatient clinic were reviewed. CHF was diagnosed by 2 or more cardiologists on the basis of the Framingham criteria. Patients were excluded if they had CHF complicated by acute myocardial infarction, were undergoing or starting dialysis during the follow-up period, or had undergone cardiac surgery during the follow-up period. With these selection criteria, 109 patients were enrolled. The duration of follow-up was 6-1,466 days (mean, 496 days; median, 348 days). The estimated glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease equation 6 coefficient modified for Japanese patients: estimated GFR = 0.741×175× Cr -1.154 × age -0.203 (ml · min -1 · 1.73 m -2 ). For women, the estimated GFR was multiplied by a correction factor of 0.742.The 109 patients were divided into 2 groups: decreased renal function (estimated GFR on admission <45 ml·min -1 · 1.73 m -2 ; 42 patients) and preserved renal function (estimated GFR on admission ≥45 ml·min -1 ·1.73 m -2 ; 67 patients). The 2 groups were compared on the basis of age, sex, New York Heart Association (NYHA) class on admission, prescribed anti-CHF drugs at discharge, and the rates of coronary artery disease, valvular heart disease, cardiomyopathy, atrial fibrillation, hypertension, diabetes mellitus (DM), dyslipidemia, anemia, systolic dysfunction, previous hospitalization for CHF, and worsening renal function during hospitalization. Cardiomyopathy was defined according to heart catheterization or previous diagnosis. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or previous history. DM was defined as fasting plasma glucose concentration ≥126 mg/dl, Background Patients with congestive heart failure (CHF) are often re-hospitalized, worsening both their quality of life and prognosis. Although renal dysfunction reportedly increases the risk of CHF, the association between renal dysfunction and re-hospitalization for CHF remains unclear...

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.

Lung oxygenation impairment often occurs in patients with type B acute aortic dissection (AAD), necessitating mechanical ventilation. Patients receiving mechanical ventilation are at risk of complications, so a low-oxygen condition requiring mechanical ventilation should be avoided. We explored the predictors of oxygenation impairment. We enrolled 46 patients with type B AAD who had been medically treated and underwent computed tomography. Blood was sampled to measure markers of inflammation, such as the C-reactive protein (CRP) levels and white blood cell count. The arterial partial pressure of oxygen/fraction of inspired oxygen ratio (PaO/FiO) was calculated to quantify the severity of respiratory failure. Spearman's rank correlation analysis revealed that the minimum PaO/FiO ratio was significantly correlated with gender, age, and current smoker, and the peak CRP, body temperature, and D-dimer values. A multivariate regression analysis revealed that younger age, male sex, and the peak CRP level were significant predictors of the minimum PaO/FiO ratio (P = 0.01, 0.035 and 0.005, respectively). A covariance structure analysis showed that a younger age and the peak CRP level were significant predictors of oxygenation impairment in type B AAD. Oxygenation impairment in type B AAD is correlated with younger age and a higher peak CRP level. This will enable the identification of patients whose respiratory condition is susceptible to worsening and help prevent mechanical ventilation, leading to the provision of appropriate therapy.

HF and diabetes tend to worsen with each other; however, the appearance of an association between them was likely blunted due to the considerable effect of NP in counteracting insulin resistance, even during the metabolically harmful condition of HF.