Journal of cardiology
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Journal of cardiology · Oct 2013
ReviewIncreasing specificity of high-sensitivity troponin: new approaches and perspectives in the diagnosis of acute coronary syndromes.
In the past years, new generations of assays to detect cardiac troponin (cTn), called sensitive or high sensitivity troponin (hs-Tn), have been introduced. Progressive improvement in the analytical sensitivity of cTn assays has led to a more rapid diagnosis of acute myocardial infarction (AMI) and improved risk stratification in patients with non ST-elevation acute coronary syndromes (NSTE-ACS) but, at the same time, has introduced the problem of a lower diagnostic specificity. ⋯ The reduced specificity of hs-Tn versus the previous generation cTn assays may, therefore, lead to an increased number of inappropriate hospitalizations, i.e. patients with high cTn due to no-ACS conditions, and requires a more careful evaluation, not only on the clinical side, but also on the information that hs-Tn assessment may provide. Several approaches to increase this specificity have been used, but the most promising appear to be the "delta approach", which tries to quantify the relative or absolute change in cTn concentration, and the "age approach", which highlights the need for a different cutoff with a better diagnostic efficiency in the elderly population, often affected by other conditions, different from ACS, that can cause an increased level of cTn.
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Journal of cardiology · Sep 2013
Initial experience using Excimer laser for the extraction of chronically implanted pacemaker and implantable cardioverter defibrillator leads in Japanese patients.
Given the exponential growth in cardiac device implantations, the need for less invasive lead extraction is increasing. The Excimer laser was approved for lead removal in Japan in 2010. The present study reports the initial experience using this novel technique to extract chronically implanted pacemaker and implantable cardioverter defibrillator (ICD) leads from Japanese patients. ⋯ Laser sheaths appear to provide a feasible and effective means of extracting chronically implanted pacemaker and ICD leads in Japanese patients.
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Journal of cardiology · Aug 2013
Correlation between inflammation state and successful medical cardioversion using bepridil for refractory atrial fibrillation.
It has been reported that inflammation is associated with long-term maintenance of sinus rhythm after electrical cardioversion for non-valvular atrial fibrillation (AF). However, the relation between high-sensitive C-reactive protein (hs-CRP) and the recurrence of AF after medical cardioversion is unknown. On the other hand, bepridil is very effective in restoring sinus rhythm for patients with refractory AF. ⋯ Bepridil is effective in restoring sinus rhythm for refractory AF patients. Inflammation, in addition to left atrial dimension, may be associated with successful cardioversion using bepridil.
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Journal of cardiology · Aug 2013
Clinical characteristics and long-term clinical outcomes of Japanese heart failure patients with preserved versus reduced left ventricular ejection fraction: a prospective cohort of Shinken Database 2004-2011.
Clinical data on the mortality and morbidity of unselected Japanese patients with heart failure (HF) are limited. In this study, we aimed to determine the clinical characteristics, long-term outcomes, and prognostic factors of Japanese HF patients with preserved or reduced left ventricular ejection fraction (LVEF). ⋯ This prospective cohort study identified the clinical characteristics, long-term outcomes, and prognostic factors of Japanese HF patients with reduced and preserved ejection fractions in a real-world clinical setting.
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Journal of cardiology · Aug 2013
Bleeding events and activated partial thromboplastin time with dabigatran in clinical practice.
Dabigatran has demonstrated promising results for the prevention of strokes in patients with non-valvular atrial fibrillation (NVAF). However, there have been episodes of major bleeding, especially in elderly patients or those with renal dysfunction. The purpose of this study was to retrospectively examine the relationship between the bleeding events and activated partial thromboplastin time (APTT) values under dabigatran usage in the everyday clinical practice. Moreover, we investigated which factors would contribute to the APTT values. ⋯ The APTT values became prolonged under dabigatran usage and exhibited a remarkable diversity. Although major bleeding did not occur unless APTT was prolonged excessively, minor bleeding arose irrespective of the APTT values even within the range of the APTT values not exceeding 80s.