RESUMEN
Patients with type 2 diabetes mellitus are frequently hospitalized for heart failure. The ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e'), measured by echocardiography, is a simple and convenient indicator of diastolic dysfunction. Various large clinical trials have reported that sodium glucose transporter-2 inhibitor therapy reduced cardiovascular events and hospitalizations in heart failure patients. We examined the effect of tofogliflozin on various physiological and cardiac function. A retrospective analysis was performed on elderly patients aged 65 years or older with type 2 diabetes mellitus attending Himi Municipal Hospital who were taking oral tofogliflozin 20 mg/day. Measurement of physiological and hormonal variables, blood sampling, and echocardiographic evaluations at 0, 1, 3, and 6 months were performed on those with ejection fraction (EF) of 40% or greater at the time of treatment. Statistical analysis was performed using t-tests and mixed-effects models, with brain natriuretic peptide less than or not less than 100 pg/mL, estimated glomerular filtration rate (eGFR) less than or not less than 50 mL/min/1.73 m2, and diuretics administered or not. Hypoglycemic effects were observed at 0, 1, 3, and 6 months. At each time point, EF was retained and E/e' was significantly reduced. On the other hand, most physiological parameters and laboratory results showed no clinical abnormalities. Mixed-effects models showed time-dependent reduction of E/e' in high/low brain natriuretic peptide, high/low eGFR, with or without diuretics between baseline and at 6 months. The interaction with time was significant in high/low eGFR. Tofogliflozin was shown to improve E/e', a measure of diastolic function, while maintaining EF, with hypoglycemic effects and no clinical side effects.
Asunto(s)
Compuestos de Bencidrilo , Diabetes Mellitus Tipo 2 , Glucósidos , Insuficiencia Cardíaca , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Volumen Sistólico , Humanos , Estudios Retrospectivos , Anciano , Masculino , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/fisiopatología , Compuestos de Bencidrilo/administración & dosificación , Compuestos de Bencidrilo/uso terapéutico , Compuestos de Bencidrilo/farmacología , Femenino , Glucósidos/administración & dosificación , Glucósidos/uso terapéutico , Glucósidos/farmacología , Volumen Sistólico/efectos de los fármacos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/fisiopatología , Inhibidores del Cotransportador de Sodio-Glucosa 2/administración & dosificación , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/farmacología , Anciano de 80 o más Años , Ecocardiografía , Tasa de Filtración Glomerular/efectos de los fármacosRESUMEN
AIM: Whether serum concentration of procalcitonin (PCT), brain natriuretic peptide (BNP) and albumin (Alb) have an association with the outcome of hospitalized older patients is unclear. We investigated clinical outcomes and any predictive factors in hospitalized Japanese older patients with a risk of infection. METHODS: In the retrospective study, 820 Japanese patients were followed up for 30 days or until death. During the observation period, 656 patients survived and 164 patients died. The predictive factors of death were analyzed according to demographic and clinical variables. RESULTS: The survival rate was decreased as the serum PCT increased from <0.5 to ≥10 ng/mL, as was also the case with BNP from <300 to ≥300 pg./mL, whereas low Alb (<2.5 g/dL) showed a lower survival rate than high Alb (≥2.5 g/dL; P < 0.01). Using the Cox regression model, the multivariable-adjusted hazard ratios (95% confidence interval) were as follows: PCT 0.5-2 versus <0.5 ng/mL: 1.61(1.04-2.49), PCT 2-10 versus <0.5 ng/mL: 1.91(1.15-3.16), PCT ≥10 versus <0.5 ng/mL: 2.90(1.84-4.59), high BNP 1.26 (0.89-1.76) and low Alb 0.68 (0.52-0.87). The mortality rate increased as the number of scores (PCT + BNP + Alb) increased. CONCLUSIONS: Concentration-dependent high PCT, high BNP and low Alb were positive risk factors associated with poor prognosis in hospitalized older patients with a risk of infection. Geriatr Gerontol Int 2024; 24: 571-576.
Asunto(s)
Biomarcadores , Péptido Natriurético Encefálico , Polipéptido alfa Relacionado con Calcitonina , Albúmina Sérica , Humanos , Masculino , Femenino , Biomarcadores/sangre , Anciano , Japón/epidemiología , Péptido Natriurético Encefálico/sangre , Pronóstico , Estudios Retrospectivos , Polipéptido alfa Relacionado con Calcitonina/sangre , Anciano de 80 o más Años , Albúmina Sérica/análisis , Hospitalización , Medición de Riesgo/métodos , Valor Predictivo de las Pruebas , Factores de Riesgo , Tasa de Supervivencia/tendencias , Infecciones/sangre , Infecciones/mortalidad , Pueblos del Este de AsiaRESUMEN
The sodium glucose transporter 2 (SGLT2) inhibitor tofogliflozin is a glucose-lowering drug that causes the excretion of surplus glucose by inhibiting SGLT2. Because of tofogliflozin's osmotic diuresis mechanism, patients' serum electrolytes, body fluid levels, and cardiac function must be monitored. We retrospectively analyzed the cases of 64 elderly Japanese patients with type 2 diabetes mellitus (T2DM) who received tofogliflozin for 3 months. Their HbA1c, serum electrolytes (sodium, potassium, chloride), hematocrit, brain natriuretic peptide (cardiac volume load marker) and renin and aldosterone (RAA; an index of regulatory hormones involved in body fluid retention) were continuously monitored during the investigation period. Renal function and cardiac function (by echocardiography) were assessed throughout the period. HbA1c significantly decreased (ß1=-0.341, p<0.0001, linear regression analysis [LRA]). Most of the hormonal, electrolyte, and physiological parameters were maintained throughout the study period. In these circumstances, E/e' tended to decrease (ß1=-0.382, p=0.13, LRA). Compared to the baseline, E/e' was significantly decreased at 1 and 3 months (p<0.01, p<0.05). In the higher E/e' group (E/e'≥10, n=34), E/e' decreased significantly (ß1=-0.63, p<0.05, LRA). ΔE/e' was correlated with body-weight change during treatment (r=0.64, p<0.01). The 3-month tofogliflozin treatment improved glycemic control and diastolic function represented by E/e' in T2DM patients, without affecting serum electrolytes, renal function, or RAA. No negative impacts on the patients were observed. Three-month tofogliflozin treatment lowered glucose and improved cardiac diastolic function.
Asunto(s)
Diabetes Mellitus Tipo 2 , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Humanos , Anciano , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hemoglobina Glucada , Glucemia , Transportador 2 de Sodio-Glucosa/uso terapéutico , Estudios Retrospectivos , Pueblos del Este de Asia , Inhibidores del Cotransportador de Sodio-Glucosa 2/farmacología , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Electrólitos/uso terapéuticoRESUMEN
BACKGROUND: Hospitalized elderly patients are often at risk of life-threatening infectious diseases such as pneumonia and urinary tract infection, thus diagnostic tools for bacterial infections are demanded. We developed a new predictive tool consolidating modified CURB-65, procalcitonin (PCT) and albumin (Alb). METHOD: This is a retrospective study. Modified CURB-65 (mCURB-65) score, PCT, Alb, and various cardiovascular/respiratory/renal functions were measured. Survival analyses were conducted to assess 30-days mortality of elderly patients using mCURB-65 score, PCT and Alb. The consolidated scores were compared with the number of patients died. RESULTS: There were 445 elderly patients included. Kaplan-Meier survival curves showed significant differences between the high and low groups of mCURB-65, PCT and Alb (log-rank test, Pâ <â .001). Cox proportional regression showed that the hazard ratios (95% confidence intervals) for high mCURB-65, high Alb, and high PCT were all significant, 1.95 (1.24-3.05), 0.50 (0.32-0.77), and 2.09 (1.32-3.31), respectively. The consolidated scores showed tendency of increase with proportion of the number of patients died. CONCLUSIONS: The consolidated score consisted of mCURB-65, PCT and Alb can be a useful tool to predict short-term mortality of the hospitalized elderly patients with infectious disease.
Asunto(s)
Enfermedades Transmisibles , Polipéptido alfa Relacionado con Calcitonina , Humanos , Anciano , Estudios Retrospectivos , Biomarcadores , AlbúminasRESUMEN
ABSTRACT: Adrenocorticotropic hormone (ACTH) and cortisol reportedly play a role in glycemic control in patients with type 2 diabetes mellitus (T2DM); however, the underlying mechanism remains controversial. We retrospectively investigated the effect of tofogliflozin on serum ACTH and cortisol levels in elderly patients with T2DM.Patients received 20âmg tofogliflozin daily for 3 months. Serum ACTH and cortisol levels were measured at baseline, as well as after 1 month and 3 months of tofogliflozin therapy.Serum ACTH levels were significantly reduced 3âmonths after tofogliflozin treatment (Pâ<â.01). Additionally, serum cortisol levels were reduced 3âmonths after tofogliflozin treatment, demonstrating borderline significance (Pâ=â.05). The higher body mass index (BMI; ≥25âkg/m2) group showed higher ACTH and cortisol levels than the lower BMI (<25âkg/m2) group, with borderline significance (Pâ=â.05). Renin levels were significantly increased 1âmonth after treatment (Pâ<â.05), maintaining serum aldosterone levels in parallel with the extracellular fluid.Our findings suggested that tofogliflozin decreased both serum ACTH and cortisol levels, with higher levels observed in the high BMI group. Tofogliflozin increased serum renin levels while maintaining serum aldosterone and extracellular fluid levels. Collectively, tofogliflozin could affect the hypothalamic-pituitary-adrenal pathway in patients with T2DM, especially in the low BMI group.
Asunto(s)
Aldosterona , Diabetes Mellitus Tipo 2 , Hormona Adrenocorticotrópica , Anciano , Compuestos de Bencidrilo , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Glucósidos , Humanos , Hidrocortisona , Renina , Estudios RetrospectivosRESUMEN
BACKGROUND: The introduction of biological agents, such as infliximab, which act against tumor necrosis factor-α was a major advance for the treatment of an increasing number of chronic diseases. Tumor necrosis factor-α antagonists represent a major therapeutic advance for the management of chronic inflammatory diseases, such as psoriasis. Previous studies have reported that the use of tumor necrosis factor-α antagonists increased the risk of opportunistic infections and reactivation of latent bacterial infections. Cardiac involvement, such as infective endocarditis, is very rare in the literature. CASE PRESENTATION: A 77-year-old Asian man with a 10-year history of psoriatic erythroderma was referred due to high fever and general malaise. He was treated with Predonine (prednisolone) and infliximab. After treatment, cardiac echography showed mitral valve vegetation and brain magnetic resonance imaging indicated multiple fresh infarctions. He died from large brain infarction in October 2013. An autopsy showed fresh thrombosis in his left middle cerebral artery, mitral valve vegetations, and septic micro-embolisms in multiple organs. CONCLUSIONS: Lethal bacterial endocarditis was revealed after administration of tumor necrosis factor-α inhibitor, infliximab, for the treatment of psoriatic erythroderma. An autopsy showed vegetation in his mitral valve and brain infarction with fresh purulent embolism in his left middle cerebral artery and septic micro-embolisms.
Asunto(s)
Infarto Encefálico/patología , Dermatitis Exfoliativa/tratamiento farmacológico , Fármacos Dermatológicos/administración & dosificación , Endocarditis/tratamiento farmacológico , Infliximab/administración & dosificación , Prednisolona/administración & dosificación , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Anciano , Infarto Encefálico/microbiología , Dermatitis Exfoliativa/complicaciones , Fármacos Dermatológicos/efectos adversos , Endocarditis/complicaciones , Resultado Fatal , Humanos , Infliximab/efectos adversos , Masculino , Prednisolona/efectos adversosRESUMEN
Vacuum-assisted closure (VAC) therapy is increasingly applied for patients with wound dehiscence or mediastinitis caused by surgical site infection (SSI) after open-heart surgery. We have used wall suction for such cases in the past. But this method was an obstacle for improvement of the quality of life (QOL) of the patient. Since the S-B Vac is portable, this equipment may allow wound healing without decreasing QOL. Here, we report a case in which VAC therapy was performed using the S-B Vac.
Asunto(s)
Terapia de Presión Negativa para Heridas/instrumentación , Infección de la Herida Quirúrgica/terapia , Humanos , Masculino , Persona de Mediana Edad , Terapia de Presión Negativa para Heridas/métodos , Calidad de VidaRESUMEN
Mitral valve replacement in the presence of severe annular calcification and an infectious lesion may be complicated by atrioventricular rupture, left circumflex coronary artery injury, and recurrence of infective endocarditis. Confronted with these circumstances, we have developed a technique of annular reconstruction for mitral valve replacement. The prosthetic valve is made by enlarging the circumference of the sewing ring with a Dacron collar. The collar can be sutured to the left atrial wall above the mitral annulus. This technique has been employed in five patients: three had extensive annular calcification, and two had acute valve endocarditis with destruction of mitral annulus. In all cases, the circumferential or partial annular reconstruction permitted secure implantation of the prosthetic valve. The one postoperative death was related to hemodialysis due to chronic renal failure. There were no other fatalities during the postoperative course, and the valves functioned normally. Our results suggest that this technique can be performed in high operative risk patients when mitral valve replacement is impossible using conventional techniques.