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  • Ovid Technologies (Wolters Kluwer Health)  (51)
  • 1
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    Impact of Previous Stroke on Clinical Outcome in Elderly Patients With Nonvalvular Atrial Fibrillation: ANAFIE Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. 8 ( 2022-08), p. 2549-2558
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. 8 ( 2022-08), p. 2549-2558
    Abstract: We determined the long-term event incidence among elderly patients with nonvalvular atrial fibrillation in terms of history of stroke/transient ischemic attack (TIA) and oral anticoagulation. Methods: Patients aged ≥75 years with documented nonvalvular atrial fibrillation enrolled in the prospective, multicenter, observational All Nippon Atrial Fibrillation in the Elderly Registry between October 2016 and January 2018 were divided into 2 groups according to history of stroke/TIA. The primary end point was the occurrence of stroke/systemic embolism within 2 years, and secondary end points were major bleeding and all-cause death within 2 years. Cox models were used to determine whether there was a difference in the hazard of each end point in patients with/without history of stroke/TIA, and in ischemic stroke/TIA survivors taking direct oral anticoagulants versus those taking warfarin. Results: Of 32 275 evaluable patients (13 793 women [42.7%]; median age, 81.0 years), 7304 (22.6%) had a history of stroke/TIA. The patients with previous stroke/TIA were more likely to be male and older and had higher hazard rates of stroke/systemic embolism (adjusted hazard ratio, 2.25 [95% CI, 1.97–2.58] ), major bleeding (1.25, 1.05–1.49), and all-cause death (1.13, 1.02–1.24) than the other groups. Of 6446 patients with prior ischemic stroke/TIA, 4393 (68.2%) were taking direct oral anticoagulants and 1668 (25.9%) were taking warfarin at enrollment. The risk of stroke/systemic embolism was comparable between these 2 groups (adjusted hazard ratio, 0.90 [95% CI, 0.71–1.14]), while the risk of major bleeding (0.67, 0.48–0.94), intracranial hemorrhage (0.57, 0.39–0.85), and cardiovascular death (0.71, 0.51–0.99) was lower among those taking direct oral anticoagulants. Conclusions: Patients aged ≥75 years with nonvalvular atrial fibrillation and previous stroke/TIA more commonly had subsequent ischemic and hemorrhagic events than those without previous stroke/TIA. Among patients with previous ischemic stroke/TIA, the risk of hemorrhagic events was lower in patients taking direct oral anticoagulants compared with warfarin. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique Identifier: UMIN000024006.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.121.038285
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1467823-8
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  • 2
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    Abstract 255: Half of Patients With Acute Myocardial Infarction Died Before Receiving the Advances in Coronary Intervention: The Yamagata Acute Myocardial Infarction Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation: Cardiovascular Quality and Outcomes Vol. 8, No. suppl_2 ( 2015-05)
    Details
    In: Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. suppl_2 ( 2015-05)
    Abstract: Background: Recent advances in cardiac critical care have improved the outcome in patient with AMI; however, there are patients who could not receive acute medical care due to death before arrival to hospital. Objective: To describe the characteristics of the persons who died of AMI before arrival to hospital in regional registry for AMI in Japan. Methods: The Yamagata AMI registry established as a hospital-based registration of AMI (according to the MONICA criteria) in 1993 with cooperation from every hospitals in Yamagata prefecture (located in northern part of Japan, total population were 1,168,924 in 2010). Since 2009, all death certificates in Yamagata prefecture have been collected to monitor and investigate the characteristics of AMI in this area. Cases diagnosed as I-21 (stands for AMI on 10th revision of International Classification of Disease) were registered. In the current study, we used the registration data from January 2010 to November 2012. Cases from death certificate and cases died in emergency room were defined as “death outside the hospital”, and the rest cases were defined as “case arrived alive”. Multiple regression analysis was performed to describe the features of out-of-hospital death. Age, gender, onset season and year were used as independent variables in the analysis. Result: A total of 3663 cases were registered, and crude incident rate of AMI was 1.001 per 1000 persons. The proportion of “death outside the hospital” was 52.4% (1920 of 3663) and 36.0% (501 of 1392) in total subjects and subjects aged 〈 75 years, respectively. In multiple logistic regression analysis, odds ratio and 95% confidence interval for “death outside the hospital” of age (10 years increased), female (vs. male), winter (vs. summer) were 1.38 (1.27-1.49), 1.38 (1.15-1.64) and 1.58 (1.24-1.96), respectively. These associations were preserved when confined to the patients aged 〈 75 years. Discussion: Compared to previous report from UK in the middle of 1990’s, fatality outside hospital seemed to be unchanged (36.0% in this analysis vs. 32.7% (1151 of 3523) in subjects aged ≤75 years). Cases derived from death certificate could overestimate this rate in our analysis; however, this is after we exclude suspicious cases such as I-46 (cardiac arrest and cardiac sudden death) or I-50.9 (heart failure, unspecified) in this registration. It is also consistent to see that delay from onset to arrival to hospital was more frequently seen in women as reported previously. We furthermore found that the risk of out-of-hospital death increased in winter season, and this might be affected to the accessibility because of the amount of snow in this study area. Conclusion: Approximately half of the AMI patients could not reach to hospital for acute medical care. Opportunities to reduce cardiovascular mortality are still lying outside of hospital in this era and this might be of the point of intervention to improve the care.
    Type of Medium: Online Resource
    ISSN: 1941-7713 , 1941-7705
    URL: Article
    DOI: 10.1161/circoutcomes.8.suppl_2.255
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2453882-6
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  • 3
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    Home Blood Pressure Can Predict the Risk for Stroke/Bleeding Events in Elderly Patients With Nonvalvular Atrial Fibrillation From the ANAFIE Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Hypertension Vol. 79, No. 12 ( 2022-12), p. 2696-2705
    Details
    In: Hypertension, Ovid Technologies (Wolters Kluwer Health), Vol. 79, No. 12 ( 2022-12), p. 2696-2705
    Abstract: Blood pressure (BP) fluctuates significantly in patients with atrial fibrillation (AF); office BP measurements seem insufficient to assess AF patient risk accurately. We hypothesized that home BP could better predict the risk of stroke/systemic embolic events (SEE) and major bleeding in patients with AF than office BP. Methods: In this prespecified subcohort study of the ANAFIE (All Nippon AF in the Elderly) Registry, we evaluated the impact of home BP on the risk of stroke/SEE, major bleeding, intracranial hemorrhage, all-cause death, and net cardiovascular outcome (a composite of stroke/SEE and major bleeding). At enrollment, home BP was measured twice in the morning and evening for 7 days. Results: In total, 4933 elderly patients (aged ≥75 years) with nonvalvular AF participated. Incidences of net cardiovascular outcome, stroke/SEE, major bleeding, and intracranial hemorrhage increased significantly with increasing home systolic BP (H-SBP). Compared with H-SBP 〈 125 mm Hg, ≥145 mm Hg was associated with increased risk of these events. The association between H-SBP and the events was observed only in patients with ≥20 H-SBP measurements. Conclusions: In elderly patients with nonvalvular AF, high H-SBP (≥145 mm Hg) was a significant predictor of stroke/SEE, major bleeding, and intracranial hemorrhage risk. Strict BP control guided by the increasing number of home BP measurements may provide an accurate clinical outcome risk assessment. Registration: URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000024006
    Type of Medium: Online Resource
    ISSN: 0194-911X , 1524-4563
    URL: Article
    DOI: 10.1161/HYPERTENSIONAHA.122.19810
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2094210-2
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  • 4
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    Abstract 3240: High Speed Rotational Coronary Venous Angiography Improves Delineation of Coronary Venous Anatomy during Cardiac Resynchronization Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2007
    In:  Circulation Vol. 116, No. suppl_16 ( 2007-10-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 116, No. suppl_16 ( 2007-10-16)
    Abstract: Background: The implantation of the left ventricular lead for biventricular devices can be challenging due to anatomic variation in the branching pattern of the coronary sinus (CS). Standard coronary venous (CV) angiography (SCVA) provides a static, fixed projection of the CV tree. Typically multiple contrast injections are obtained to gain a better understanding of vessels overlap and foreshortening. But, even in this situation, the site of side branch takeoff, its angulation and course cannot be reliably predicted - particularly in the presence of complex branching patterns. High-speed rotational CV angiography (RCVA) permits a dynamic, multi angle visualization of the CV anatomy. Objective: To compare RCVA with SCVA during cardiac resynchronization therapy. Methods: Digitally acquired RCVA from 10 patients were analyzed. RCVA uses a rapid isocentric rotation over a 180° arc, RAO 54° to LAO 54° in 4 sec, acquiring 121 frames /angiogram with a single injection of 20 ml of contrast (Infinix, Toshiba). The CV anatomy assessed by RCVA was compared with 2 static perpendicular views: RAO 45° and LAO 45°. Results: Three-dimensional models of the venous tree were reconstructed (Figure ), and the rotational images were analyzed using a full range of gantry angles, providing the operator with considerably more information about the CV anatomy than SCVA images. Conclusion: RCVA provides a better understanding of the CV anatomy and the special relationship of its branches. The SCVA view which optimally displayed the appropriate CS branch for left ventricular lead implantation was often different from the conventional RAO and LAO views.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.116.suppl_16.II_728-c
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2007
    detail.hit.zdb_id: 1466401-X
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  • 5
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    MP33-16 CLINICAL EFFICACY OF A β3-ADRENOCEPTOR AGONIST AND AN ANTIMUSCARINIC AGENT IN FEMALE PATIENTS WITH OVERACTIVE BLADDER: A RANDOMIZED CROSSOVER STUDY (AN INTERIM REPORT)
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Journal of Urology Vol. 191, No. 4S ( 2014-04)
    Details
    In: Journal of Urology, Ovid Technologies (Wolters Kluwer Health), Vol. 191, No. 4S ( 2014-04)
    Type of Medium: Online Resource
    ISSN: 0022-5347 , 1527-3792
    URL: Article
    DOI: 10.1016/j.juro.2014.02.967
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 6
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    Distal Protection Improved Reperfusion and Reduced Left Ventricular Dysfunction in Patients With Acute Myocardial Infarction Who Had Angioscopically Defined Ruptured Plaque
    Ovid Technologies (Wolters Kluwer Health) ; 2005
    In:  Circulation Vol. 112, No. 7 ( 2005-08-16), p. 1001-1007
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 112, No. 7 ( 2005-08-16), p. 1001-1007
    Abstract: Background— Distal protection, in the Saphenous Vein Graft Angioplasty Free of Emboli (SAFER) trial, is demonstrated to prevent distal embolism in the percutaneous coronary intervention of saphenous vein graft. However, in the Enhanced Myocardial Efficacy and Recovery by Aspiration of Liberated Debris (EMERALD) trial, it was not effective in the percutaneous coronary intervention of native coronary arteries in patients with acute myocardial infarction (AMI). We hypothesized that its effectiveness would be determined by lesion characteristics. Therefore, we classified the type of culprit lesion by angioscopy and examined its influence on the effectiveness of distal protection, comparing patients with AMI treated with and without distal protection. Methods and Results— Consecutive patients with AMI treated without distal protection (n=110) from July 2000 to July 2002 and those treated with distal protection (n=81) from July 2002 to July 2004 were included. Patients in each group were subdivided according to whether or not they had angioscopically defined ruptured plaque at culprit lesion. Among those groups, incidence of no-reflow phenomenon, ST-segment resolution, myocardial blush grade, and left ventricular ejection fraction at 6 months were compared. Aspirated samples by distal protection were semiquantitatively and histologically analyzed and compared between patients with and without ruptured plaque. No-reflow phenomenon was most frequently ( P 〈 0.05) observed in patients with ruptured plaque treated without distal protection. ST-segment resolution (68±15% versus 40±21%, P 〈 0.001), myocardial blush grade (2.6±0.5 versus 1.8±0.3, P 〈 0.001), and left ventricular ejection fraction (47.2±6.7% versus 41.0±9.7%, P 〈 0.01) were improved by distal protection among patients with ruptured plaque but not among patients without ruptured plaque. Aspirated samples 〉 1 mm were detected more frequently (97.3% versus 78.5%, P 〈 0.05) in patients with ruptured plaque than those without ruptured plaque. Histologically, aspirated samples contained plaque debris (95.3% versus 31.1%, P 〈 0.05) more frequently in patients with ruptured plaque than in those without ruptured plaque. Conclusions— Distal protection reduced microcirculation damage and left ventricular dysfunction in patients with AMI who had angioscopically defined ruptured plaque. Distal embolization of plaque debris was detected more frequently in patients with ruptured plaque. These results suggest that microcirculation damage and left ventricular dysfunction are increased mainly by distal embolization of plaque debris rather than of thrombus.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/CIRCULATIONAHA.104.532820
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2005
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  • 7
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    Endoscope-aided cataract surgery in corneal opacity associated with aniridia
    Ovid Technologies (Wolters Kluwer Health) ; 2005
    In:  Journal of Cataract and Refractive Surgery Vol. 31, No. 7 ( 2005-07), p. 1455-1456
    Details
    In: Journal of Cataract and Refractive Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 31, No. 7 ( 2005-07), p. 1455-1456
    Type of Medium: Online Resource
    ISSN: 0886-3350
    URL: Article
    DOI: 10.1016/j.jcrs.2005.05.015
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2005
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  • 8
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    Is Vagal Response During Left Atrial Ganglionated Plexi Stimulation a Normal Phenomenon? : Comparison Between Patients With and Without Atrial Fibrillation
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Circulation: Arrhythmia and Electrophysiology Vol. 12, No. 10 ( 2019-10)
    Details
    In: Circulation: Arrhythmia and Electrophysiology, Ovid Technologies (Wolters Kluwer Health), Vol. 12, No. 10 ( 2019-10)
    Abstract: Ganglionated plexi (GPs) play an important role in both the initiation and maintenance of atrial fibrillation (AF). GPs can be located by using continuous high-frequency stimulation (HFS) to elicit a vagal response, but whether the vagal response phenomenon is common to patients without AF is unknown. Methods: HFS of the left atrial GPs was performed in 42 patients (aged 58.0±10.2 years) undergoing ablation for AF and 21 patients (aged 53.2±12.8 years) undergoing ablation for a left-sided accessory pathway. The HFS (20 Hz, 25 mA, 10-ms pulse duration) was applied for 5 seconds at 3 sites within the presumed anatomic area of each of the 5 major left atrial GPs (for a total of 15 sites per patient). We defined vagal response to HFS as prolongation of the R-R interval by 〉 50% in comparison to the mean pre-HFS R-R interval averaged over 10 beats and active-GP areas as areas in which a vagal response was elicited. Results: Overall, more active-GP areas were found in the AF group patients than in the non-AF group patients, and at all 5 major GPs, the maximum R-R interval during HFS was significantly prolonged in the AF patients. After multivariate adjustment, association was established between the total number of vagal response sites and the presence of AF. Conclusions: The significant increase in vagal responses elicited in patients with AF compared with responses in non-AF patients suggests that vagal responses to HFS reflect abnormally increased GP activity specific to AF substrates.
    Type of Medium: Online Resource
    ISSN: 1941-3149 , 1941-3084
    URL: Article
    DOI: 10.1161/CIRCEP.118.007281
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2425487-3
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  • 9
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    Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Subsequent Risk of Emergency Department Visits and Hospitalizations for Atrial Fibrillation
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Circulation: Arrhythmia and Electrophysiology Vol. 11, No. 9 ( 2018-09)
    Details
    In: Circulation: Arrhythmia and Electrophysiology, Ovid Technologies (Wolters Kluwer Health), Vol. 11, No. 9 ( 2018-09)
    Abstract: Although emerging evidence has suggested the relationship of chronic obstructive pulmonary disease with atrial fibrillation (AF), little is known about whether acute exacerbation of chronic obstructive pulmonary disease (AECOPD) increases the risk of repeated AF-related healthcare utilization. Methods This is a self-controlled case series study using the population-based emergency department (ED) and inpatient databases of 5 US states from 2007 through 2012. Among patients with existing AF, we identified patients with an AECOPD hospitalization and at least 1 ED visit or hospitalization for AF during the observation period. We constructed conditional Poisson regression models to compare the rate of AF-related ED visits or hospitalizations during sequential 90-day periods after the AECOPD hospitalization, with pre-AECOPD days 1 to 90 as the reference. Results We analyzed 944 patients who were hospitalized for AECOPD and had an ED visit or hospitalization for AF during a 450-day period. The median age was 77 years, and 41% were men. Compared with the reference period, the rate of AF-related ED visits or hospitalizations significantly increased in the post-AECOPD days 1 to 90 (7.3 versus 14.1 per 100 person-months; rate ratio, 1.93; 95% CI, 1.63–2.29; P 〈 0.001). Then, the rate decreased to the reference level in the post-AECOPD days 91 to 180 (7.5 per 100 person-months; rate ratio, 1.03; 95% CI, 0.85–1.25; P =0.77) and remained at the reference level during post-AECOPD days 181 to 270 (rate ratio, 0.84; 95% CI, 0.68–1.03; P =0.09) and days 271 to 360 (rate ratio, 0.90; 95% CI, 0.73–1.10; P =0.29). These temporal associations persisted with stratification by age, sex, and season. Conclusions Among patients with existing AF, AECOPD was associated with a higher risk of AF-related ED visit or hospitalization in the first 90-day post-AECOPD period.
    Type of Medium: Online Resource
    ISSN: 1941-3149 , 1941-3084
    URL: Article
    DOI: 10.1161/CIRCEP.118.006322
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 10
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    Development of Human‐Like Advanced Coronary Plaques in Low‐Density Lipoprotein Receptor Knockout Pigs and Justification for Statin Treatment Before Formation of Atherosclerotic Plaques
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Journal of the American Heart Association Vol. 5, No. 4 ( 2016-04-03)
    Details
    In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 5, No. 4 ( 2016-04-03)
    Abstract: Although clinical trials have proved that statin can be used prophylactically against cardiovascular events, the direct effects of statin on plaque development are not well understood. We generated low‐density lipoprotein receptor knockout ( LDLR −/− ) pigs to study the effects of early statin administration on development of atherosclerotic plaques, especially advanced plaques. Methods and Results LDLR −/− pigs were generated by targeted deletion of exon 4 of the LDLR gene. Given a standard chow diet, LDLR −/− pigs showed atherosclerotic lesions starting at 6 months of age. When 3‐month‐old LDLR −/− pigs were fed a high‐cholesterol, high‐fat ( HCHF ) diet for 4 months ( HCHF group), human‐like advanced coronary plaques developed. We also fed 3‐month‐old LDLR −/− pigs an HCHF diet with pitavastatin for 4 months (Statin Prophylaxis Group). Although serum cholesterol concentrations did not differ significantly between the 2 groups, intravascular ultrasound revealed 52% reduced plaque volume in statin‐treated pigs. Pathological examination revealed most lesions (87%) in the statin prophylaxis group were early‐stage lesions, versus 45% in the HCHF diet group ( P 〈 0.01). Thin‐cap fibroatheroma characterized 40% of the plaques in the HCHF diet group versus 8% in the statin prophylaxis group ( P 〈 0.01), intraplaque hemorrhage characterized 11% versus 1% ( P 〈 0.01), and calcification characterized 22% versus 1% ( P 〈 0.01). Conclusions Results of our large animal experiment support statin prophylaxis before the occurrence of atherosclerosis. Early statin treatment appears to retard development of coronary artery atherosclerosis and ensure lesion stability. In addition, the LDLR −/− pigs we developed represent a large animal model of human‐like advanced coronary plaque suitable for translational research.
    Type of Medium: Online Resource
    ISSN: 2047-9980
    URL: Article
    DOI: 10.1161/JAHA.115.002779
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 2653953-6
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