The advance of cryopreservation techniques has dramatically increased the durability of human allograft valves, resulting in the wide-spread use of allograft valves in many western countries except Japan. The superiority of the allograft valve to other prosthetic valves has become apparent in some specific situations such as active endocarditis, small aortic root and hemorrhagic conditions. In this manuscript, we described the setting-up of the cryopreservation laboratory, quality control and the clinical use of allograft valves in our institute. The authors believe that surgeons should have an option of utilizing allograft valves in selected patients in Japan.
Background: Randomized trials have shown that coronary revascularization benefits patients with acute coronary syndrome (ACS). Furthermore, recent studies reported that revascularization could improve the outcome even in high-risk patients. We investigated the prognostic impact of revascularization and the factors that abandon the invasive strategy in patients with ACS complicated with cardiogenic shock. Methods and results: The Japanese Circulation Society Cardiovascular Shock registry (JCS-Shock registry) was a prospective, observational, multi-center, cohort study. Between May, 2012 and June, 2014, a total of 980 patients with cardiovascular shock were enrolled from 82 centers in Japan. We assessed the prognostic impact of coronary revascularization in ACS patients in JCS-Shock registry. The primary endpoint was all cause mortality at 30 days after administration. Among 495 subjects with ACS (ST-segment elevation acute myocardial infarction (STEMI) 408, Non-ST-segment elevation ACS (NSTEACS) 87), emergent coronary angiography was carried out in 448 (90.9%) subjects and any revascularization (percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)) was performed in 411 (83.0%) subjects. Thirty-day mortality in subjects treated with PCI and/or CABG (Revasc group) was 29.8% and neither PCI nor CABG (Non-Revasc group) was 51.2% (n=84, 17.0%) (P=0.0015 by Chi-square test), suggesting a beneficial effect of revascularization. Baseline characteristics of subgroups in Revasc or Non-Revasc were significantly different in age (71.0 vs. 76.5, P<0.0037), female gender (23.2% vs. 40.5%, P=0.0016), previous PCI (66.7% vs. 39.1%, P<0.0276), STEACS (86.8% vs. 60.7%, P<0.0001). Conclusions: In the JCS Shock registry that observed contemporary emergency cardiovascular care in Japan, 30-day mortality of ACS complicated with cardiogenic shock was lower in patients underwent coronary revascularization compared with patients without any revascularization. Revascularization was less performed in elderly, female, patients without previous PCI and NSTEACS patients, associated with unfavorable outcomes. We may reconsider the therapeutic strategy to benefit patients by coronary revascularization.
Objective: The SPRINT (Systolic Blood Pressure Intervention Trial) recently demonstrated that strict blood pressure (BP) control resulted in a lower cardiovascular disease (CVD) risk compared to standard BP control, however, this association was not observed regarding the incidence of stroke. Previous studies revealed that the contribution of BP as a risk factor was higher for stroke incidence than for any other CVD, especially in Asian populations. It is thus not clear whether the results of the SPRINT can be generalized to all Asian populations. Design and Method: The Japan Morning Surge Home Blood Pressure (J-HOP) Study recruited 4,310 Japanese patients with at least one CVD risk between 2005 and 2012. The home BP values of the patients were measured during a 2-week baseline period and followed for an average of 4 years. Here we compared the patients’ background and CVD event rate between the J-HOP study and the SPRINT, and we examined the association between home BP levels and stroke incidence in the J-HOP population. Results: The Framingham 10-year CVD risk score was 20.1% and 19.6% in the SPRINT and the J-HOP study, respectively. The stroke event rate was 0.41%/year and 0.38%/year in the SPRINT and the J-HOP study, respectively. When defining morning systolic BP <135 mmHg as the reference stratum, the J-HOP study revealed that the hazard ratios and 95% confidence intervals of stroke risk for the patients with morning home systolic BP values of 135–144 mmHg, 145–155 mmHg, and 3155 mmHg were 2.91 (1.42–5.95), 4.02 (1.92–8.43), and 7.32 (3.69–14.51), respectively. This association was not found in evening home SBP. Conclusions: Although there was no significant difference in stroke incidence between strict and standard BP control groups in the SPRINT, the J-HOP study demonstrated that strict BP control using home BP measurement would be important for stroke prevention in Asian populations.
Background: Several guidelines recommend that home blood pressure (BP) be measured in both the morning and evening, but few studies of the clinical significance of home BP in the morning versus the...
We examined whether the level of highsensitivity C-reactive protein (hsCRP), a marker of low-grade inflammation, predicted the response of clinic and ambulatory blood pressure (BP) to antihypertensive treatment. A randomized, open-label, multicenter trial was performed in 88 hypertensive patients (mean age = 63.4 years) allocated to receive losartan 50 mg or amlodipine 5 mg for 4 weeks, and each treatment was changed to losartan 50 mg/hydrochlorothiazide (HCTZ) 12.5 mg in combination or amlodipine 10 mg for a further 4 weeks. Clinic and ambulatory BP were measured before and after 8 weeks of treatment, and hsCRP was measured at baseline. The patients were divided into groups with hsCRP levels above and below the median (0.47 mg/L) for the study population. In the total population, 24-hour systolic BP (SBP) (P = 0.03) and daytime SBP (P = 0.01) were significantly higher in the above-median hsCRP group after 8 weeks of treatment. In multivariable regression analysis, baseline hsCRP was a significant determinant of the percentage change in daytime SBP (β = 0.29; P = 0.02) in the total population. In the losartan/HCTZ treatment group, changes in 24-hour SBP, daytime SBP, and diastolic BP were significantly smaller in the above-median hsCRP group than the below-median hsCRP group, whereas the amlodipine group did not show these differences. Baseline low-grade inflammation in patients with hypertension was associated with a poor ambulatory BP response, especially with losartan/HCTZ treatment. Initial measurement of hsCRP could be useful for selection of an appropriate antihypertensive drug. Trial Number UMIN000002438
Background:The high mortality of acute myocardial infarction (AMI) with cardiogenic shock (i.e., Killip class IV AMI) remains a challenge in emergency cardiovascular care. This study aimed to examine institutional factors, including the number of JCS board-certified members, that are independently associated with the prognosis of Killip class IV AMI patients.
