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  • Ovid Technologies (Wolters Kluwer Health)  (4)
  • Ogawa, Hisao  (4)
  • 1
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    Online Resource
    Peripheral Endothelial Function and Cardiovascular Events in High‐Risk Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Journal of the American Heart Association Vol. 2, No. 6 ( 2013-11-18)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 2, No. 6 ( 2013-11-18)
    Abstract: Endothelial dysfunction is a key component of vascular vulnerability. Reactive hyperemia index ( RHI ), as assessed by the peripheral arterial tonometry, can noninvasively evaluate endothelial function. This study was designed to determine the additional prognostic value of endothelial function to the Synergy Between PCI With Taxus and Cardiac Surgery Score ( SYNTAX sc) and the Framingham Risk Score ( FRS ) in predicting cardiovascular events in high‐risk patients. Methods and Results We undertook a two‐center prospective study in 528 stable patients at high‐risk for cardiovascular events from the years 2006–2011. The RHI was measured before coronary angiography and coronary complexity was assessed by SYNTAX sc. After optimal therapies including coronary revascularization, there was follow‐up with patients until August 2012. Cardiovascular events consist of cardiovascular death, myocardial infarction, unstable angina, ischemic stroke, coronary revascularization, heart failure‐induced hospitalization, aortic disease, and peripheral arterial disease. During 1468 person‐years of follow‐up, 105 patients developed cardiovascular events. Multivariate Cox proportional hazards analysis identified B‐type natriuretic peptide ( BNP ), SYNTAX sc, and RHI as independent cardiovascular event predictors (hazard ratio [95% confidence interval]: natural logarithm of BNP per 0.1: 1.019 [1.002 to 1.037]; P =0.023, SYNTAX sc per tertile: 2.426 [1.825 to 3.225]; P 〈 0.0001, RHI per 0.1: 0.761 [0.673 to 0.859]; P 〈 0.0001). When RHI was added to the FRS , BNP , and SYNTAX sc, net reclassification index was significantly improved (27.5%; P 〈 0.0001), with a significant increase in the C‐statistic (from 0.728 [0.679 to 0.778] to 0.766 [0.726 to 0.806] ; P =0.031). Conclusions Advanced endothelial dysfunction significantly correlated with near future cardiovascular events in high‐risk patients. This physiological vascular measurement improved risk discrimination when added to the FRS , BNP , and SYNTAX sc. Clinical Trial Registration URL : clinicaltrials.gov ( http://www.clinicaltrials.gov ). Unique identifier: NCT 00737945.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.113.000426
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
    detail.hit.zdb_id: 2653953-6
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  • 2
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    Online Resource
    Impaired Peripheral Endothelial Function Assessed by Digital Reactive Hyperemia Peripheral Arterial Tonometry and Risk of In‐Stent Restenosis
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Journal of the American Heart Association Vol. 5, No. 6 ( 2016-06-13)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 5, No. 6 ( 2016-06-13)
    Abstract: Drug‐eluting stents are replacing bare‐metal stents, but in‐stent restenosis ( ISR ) remains a problem. Reactive hyperemia index ( RHI ) assessed by peripheral arterial tonometry evaluates endothelial function noninvasively. We prospectively assessed the prognostic value of RHI in predicting ISR after percutaneous coronary intervention. Methods and Results RHI was measured before percutaneous coronary intervention and at follow‐up (F/U) angiography (F/U RHI ; 6 and 9 months post bare‐metal stents– and drug‐eluting stents– percutaneous coronary intervention, respectively) in 249 consecutive patients. At F/U, ISR (stenosis 〉 50% of diameter) was seen in 68 patients (27.3%). F/U natural logarithm ( RHI ) was significantly lower in patients with ISR than in those without (0.52±0.23 versus 0.65±0.27, P 〈 0.01); no between‐group difference in initial natural logarithm ( RHI ) (0.60±0.26 versus 0.62±0.25, P =0.56) was seen. By multivariate logistic regression analysis, even after adjusting for other significant parameters in univariate analysis, F/U natural logarithm ( RHI ) independently predicted ISR (odds ratio: 0.13; 95% CI : 0.04–0.48; P =0.002). In receiver operating‐characteristic analysis, F/U RHI was the strongest predictor of ISR (area under the curve: 0.67; 95% CI : 0.60–0.75; P 〈 0.01; RHI 〈 1.73 had 67.6% sensitivity, 64.1% specificity); area under the curve significantly improved from 0.62 to 0.70 when RHI was added to traditional ISR risk factors ( P =0.02). Net reclassification index was significant after addition of RHI (26.5%, P =0.002). Conclusions Impaired RHI at F/U angiography independently correlated with ISR , adding incremental prognostic value to the ISR ‐risk stratification following percutaneous coronary intervention. Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 02131935.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.116.003202
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 3
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    Online Resource
    Clinical Features and Prognosis of Patients With Coronary Spasm–Induced Non–ST‐Segment Elevation Acute Coronary Syndrome
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Journal of the American Heart Association Vol. 3, No. 3 ( 2014-05-22)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 3, No. 3 ( 2014-05-22)
    Abstract: The prevalence, clinical features, and long‐term outcome of patients with non– ST ‐segment elevation acute coronary syndrome ( NSTE ACS ) associated with coronary spasm are not fully investigated. Methods and Results This observational multicenter study enrolled 1601 consecutive patients with suspected NSTE ‐ ACS who underwent cardiac catheterization between January 2001 and December 2010. A culprit lesion was found in 1152 (72%) patients. In patients without a culprit lesion, the acetylcholine provocation test was performed in 221 patients and was positive in 175 patients. In the other patients, coronary spasm was verified in 145 patients during spontaneous attack. Spasm‐induced NSTE ‐ ACS was diagnosed in 320 (20%) patients. Multivariable analysis identified age 〈 70 years (odds ratio [ OR ] 2.19, 95% CI 1.58 to 3.04), estimated glomerular filtration rate 〉 60 mL/min per 1.73 m 2 ( OR 1.72, 95% CI 1.16 to 2.56), and lack of hypertension ( OR 2.55, 95% CI 1.90 to 3.41), dyslipidemia ( OR 2.76, 95% CI 2.05 to 3.73), diabetes mellitus ( OR 2.49, 95% CI 1.78 to 3.48), previous myocardial infarction ( OR 5.37, 95% CI 2.89 to 10.0), and elevated cardiac biomarkers ( OR 2.84, 95% CI 2.11 to 3.83) as significant correlates of spasm‐induced NSTE ‐ ACS ( P 〈 0.01 for all variables). Transient ST ‐segment elevation during spontaneous attack (variant angina) was observed in 119 patients with spasm‐induced NSTE ‐ ACS . Variant angina was more common in nondyslipidemic men among patients with spasm‐induced NSTE ‐ ACS . Conclusions The study showed frequent involvement of coronary spasm in the pathogenesis of NSTE ‐ ACS . Variant angina was observed in one third of patients with spasm‐induced NSTE ‐ ACS . Coronary spasm should be considered even in patients with less coronary risk factors and nonobstructive coronary arteries.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.114.000795
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 4
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    Online Resource
    Abstract 11845: Impaired Peripheral Endothelial Function Assessed by Digital Reactive Hyperemia Peripheral Arterial Tonometry and Risk of In-Stent Restenosis
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Circulation Vol. 130, No. suppl_2 ( 2014-11-25)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 130, No. suppl_2 ( 2014-11-25)
    Abstract: Introduction: Drug-eluting stents (DESs) are replacing bare-metal stents (BMSs), but in-stent restenosis (ISR) remains a problem. Impaired endothelial function is a key event in the atherosclerosis process and a predictor of future cardiovascular events. Reactive hyperemia index (RHI) assessed by peripheral arterial tonometry (PAT) evaluates endothelial function noninvasively. Hypothesis: We prospectively assessed the prognostic value of RHI in predicting ISR after percutaneous coronary intervention (PCI). Methods: RHI was measured using Endo-PAT 2000 before PCI (initial RHI) and at follow-up angiography (F/U RHI) in 249 consecutive patients who had successful PCI. F/U angiography was performed at six and nine months after PCI with BMS and DES, respectively. ISR was defined as percent diameter stenosis 〉 50% at F/U angiography assessed by quantitative coronary angiography. Results: At F/U, ISR was seen in 68 patients (27.3%). F/U ln(RHI) was significantly lower in patients with ISR than in those without (0.52 ± 0.23 vs. 0.65 ± 0.27, p 〈 0.01); no between-group difference in initial ln(RHI) was seen (0.60 ± 0.26 vs. 0.62 ± 0.25, p = 0.56). By multivariate logistic regression analysis, even after adjusting for other significant parameters in univariate analysis (BMS use, total stent length, HDL-Cholesterol, HbA1c, calcium antagonist use, and post-PCI minimum lumen diameter), F/U ln(RHI) independently predicted ISR (odds ratio: 0.13; 95% confidence interval [CI]: 0.04-0.48; p = 0.002). In receiver operating-characteristic analysis, F/U RHI was the strongest predictor of ISR (area under the curve [AUC] : 0.67; 95% CI: 0.60-0.75; p 〈 0.01; RHI 〈 1.73 had 67.6% sensitivity, 64.1% specificity); AUC significantly improved from 0.62 to 0.70 when RHI was added to traditional ISR risk factors (diabetes mellitus, total stent length, minimum stent diameter) (p = 0.02). Net reclassification index was significant after addition of RHI (26.5%, p = 0.002). Conclusions: To our knowledge, this is the first study indicating that impaired RHI at F/U angiography independently predicts occurrence of ISR. The simple and noninvasive assessment of endothelial function by RH-PAT adds incremental prognostic value to ISR-risk stratification following PCI.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.130.suppl_2.11845
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1466401-X
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