br Method br Results br Discussion The present
Discussion The present evaluation of ΔFCL in chronic AF patients over a long-term observation order shk revealed a few interesting findings. First, at the end of the 6-year observation period, the mean FCL had prolonged from 154±20ms to 187±37ms in patients with ARB therapy (p=0.005), but remained unchanged (150±12ms vs. 149±10ms, NS) in patients without ARB therapy. To the best of our knowledge, this is the first study on the change in FCL data over a long-term observation period, during which the patients received the same medical therapy. Furthermore, the prescription of ARB was the only parameter that differed significantly between the patients with and without FCL prolongation. Differences in the clinical background of the patients, such as age or comorbidity, did not contribute to FCL prolongation in this study, but this lack of influence may be attributable to the small study population and therefore warrants further reevaluation in a larger study population.
Acknowledgments This study was supported by a grant for scientific research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (No. 11838015), and a grant to the Research Committee for Epidemiology and Etiology of Idiopathic Cardiomyopathy from the Ministry of Health and Welfare of Japan.
Background Along with the aging of the population, the prevalence of atrial fibrillation (AF) has been rapidly increasing . AF has been gaining much attention as one of the major causes of cerebral infarction , which highlights the importance of the establishment of antithrombotic treatment for AF patients. Thus far, guidelines for antithrombotic treatment have been published from Europe, the United States , Canada , and Japan (JPN) . The European Society of Cardiology has recently published updated guidelines , including data on the verification of the effectiveness of direct thrombin and factor Xa inhibitors. However, no such guidelines have been established for the Asia-Pacific region, and optimal antithrombotic treatment for AF patients from this region has not yet been defined.
Methods The physicians surveyed the examined 300 patients with cardiovascular disease per month on an average, and of these, 37 (12%) had NVAF (Fig. 1). There were no significant differences among countries (5/76 patients or 6.5% in IND to 42/249 patients or 16.9% in Australia: AUS). Physicians in these countries were asked questions pertaining to the following points:
Discussion Under these circumstances, various oral anticoagulants are being developed, and a large-scale comparative trial with warfarin for AF patients is currently underway. The direct thrombin inhibitor, dabigatran, in particular, has attracted much attention because the RE-LY trial provided evidence that it lowers the risk of stroke/systemic embolisms without increasing the risk of hemorrhage, unlike warfarin [8,9]. Dabigatran has already been approved in the United States and Canada, as well as in 6 countries in the Asia-Pacific region. It is slated for approval in several other countries. The approval of new oral anticoagulants is expected to drastically change the antithrombotic treatment strategy for AF.
Conflict of interest
Acknowledgment This survey was conducted with the generous support of the members of the APHRS. Moreover, we greatly appreciate the financial support extended by Pfizer Inc.; Bristol-Myers Squibb Company; Nippon Boehringer Ingelheim Co., Ltd.; DaiIchi Sankyo Co., Ltd.; Eisai Co., Ltd.; and Bayer Yakuhin, Ltd. which made this survey possible.
Case report A 67-year-old man was first hospitalized with heart failure and diagnosed with dilated cardiomyopathy 14 years ago. Thereafter, he was managed as an outpatient at our hospital. The patient developed paroxysmal atrial fibrillation (AF) in February 2000. This AF had converted to persistent AF in June 2003. Subsequently, he presented with intermittent left bundle-branch block (LBBB) in February 2008, and at that time, his brain natriuretic peptide (BNP) level was 130pg/ml. In January 2010, the condition was persistent, and the patient presented with shortness of breath due to complete LBBB along with a gradual increase in BNP level. He was then admitted to our hospital with worsening heart failure in June 2010, qualifying as a New York Heart Association functional class III patient. At admission, the patient had leg edema and dyspnea. His blood pressure and heart rate were 131/93mmHg and 110bpm, respectively. His laboratory data was as follows: hemoglobin level of 8.7g/ml, consistently over a period of 5 years, indicating anemia and creatine level of 1.2mg/dl and a BNP level of 385pg/ml, indicative of mild renal insufficiency. His 12-lead electrocardiogram showed AF with rapid ventricular rates and a QRS complex duration of 154ms. Echocardiography revealed a low ejection fraction (EF) of 26%; LV end-diastolic diameter (LVDd), 75mm; LV end-systolic diameter (LVDs), 66mm; and LV dyssynchrony. The cardiothoracic ratio (CTR) was 67%, and plural effusion was observed on a chest radiograph at admission. After his condition stabilized with optimal medications, he complained of exertional dyspnea. Therefore, we performed cardiopulmonary exercise testing, which revealed a low anaerobic threshold (AT) oxygen consumption level of 11.0mlkg−1min−1.