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The tissue-specific circulating markers of thyroid hormone action on cardiac function have not been established. Although the relationship between thyroid function and plasma brain natriuretic peptide (BNP) levels has been evaluated in patients with thyroid disorders, the relationship between these parameters in the general population has not been yet studied. We conducted retrospective cohort study by health examination with concurrent measurements of TSH, free T4, body mass index, systolic blood pressure, hemoglobin, and estimated glomerular filtration rate from participants who visited the Department of Health Checkup, Enshu Hospital between July 2008 and March 2017. After participants with abnormal electrocardiogram and/or any history of cardiac disease were excluded, 2,807 individuals were subjected. Multivariate analyses demonstrated that, when compared to euthyroidism (n = 2,629), the increase in BNP levels was significant in overt thyrotoxicosis (n = 21) but not in subclinical thyrotoxicosis (n = 53) or subclinical hypothyroidism (n = 97). Interestingly, the standardized partial regression coefficient was the smallest for thyroid function category (overt thyrotoxicosis compared to euthyroidisim; β = 0.048, p = 0.006) among the independent variables including age, body mass index, systolic blood pressure, and hemoglobin. In longitudinal comparison, we identified 986 participants who had sequential data on the measurements and were stable as euthyroidism and subclinical hypothyroidism. Their annual percent change in BNP demonstrated no significant differences. In conclusion, a direct stimulatory effect of thyroid hormone on the secretion (or production) of BNP was confirmed even in a large number of health examination participants.

Background: Circulating levels of thyroid hormone (TH) and TSH may not always reflect TH activity in specific peripheral tissues. Although the heart is one of the major target organs for TH, the tissue-specific circulating markers of TH activity have not been characterized. Therefore, we investigated the independent effects of TH status on plasma brain natriuretic peptide (BNP) concentrations in a large number of health check-up participants. Methods: We retrospectively analyzed data from participants who visited our hospital for health check-ups between July 2008 and March 2017. Among 20,403 participants, 12,409 revisited periodically. Participants were included in the cross-sectional study population if measurements of their concurrent TSH, free T4, body mass index, systolic blood pressure, hemoglobin, and estimated glomerular filtration rate were available at the initial visit. Longitudinal analysis was performed if the concurrent results for the participants were consecutively available. Exclusion criteria were abnormal electrocardiogram and/or a history of cardiac disease. Results: In the cross-sectional study (n = 2,807), multivariate analyses demonstrated a significant elevation in BNP (logarithmically converted) in overt thyrotoxicosis (OT; n = 21) compared with euthyroidism (n = 2,629), but not in subclinical thyrotoxicosis (SCT; n = 53), subclinical hypothyroidism (SCH; n = 97), or overt hypothyroidism (OH; n = 7). However, the standardized partial regression coefficient for thyroid function category against BNP was the lowest (β = 0.048, p = 0.006) among several other independent variables. After participants with OT or OH were excluded because of the small group size, the longitudinal study (n = 990) demonstrated no significant differences in the annualized rate of change in BNP among SCT (n = 4), SCH (n = 963), and euthyroidism (n = 23). Conclusions: The direct stimulatory effects of TH on BNP were only confirmed for OT. Our study suggests that plasma BNP concentrations are not sufficiently sensitive to evaluate TH activity in the heart. Physicians should consider multiple independent contributing factors other than thyroid dysfunction when interpreting BNP data in patients with thyroid disorders.

Purulent pericarditis is a life-threatening disorder, even in the modern antibiotic era. Although diabetes mellitus is known to be associated with an increased risk of multiple types of infections, purulent pericarditis is extremely rare. We herein report an unusual case of pericarditis caused by Salmonella enterica subspecies arizona that was not associated with any evident underlying immunosuppressive disorder apart from uncontrolled type 2 diabetes mellitus. Because a pet snake was suspected as being the source of infection in the present case, patient education and a detailed review of exposure history could play an important role in treating patients with diabetes mellitus.

Rationale: Behcet Disease (BD) is a chronic inflammatory vasculitis with thrombogenicity and multisystem involvement. Deep vein thrombosis (DVT) in the lower extremities is the most frequent manifestation of vascular involvement in BD. The causes of thrombosis vary widely and include congenital predisposition and acquired factors, but of all the thrombosis, the cause is rarely BD. Furthermore, there are few reports of treatment for thrombosis in BD. Patient concerns: We herein describe the case of an Asian male patient aged 40 years, admitted to our hospital for left leg pain, edema, and swelling. Diagnoses: We confirmed the DVT and pulmonary artery thrombosis (PAT) by contrast computed tomography angiogram. At the same time, the patient developed oral ulcerations and skin lesions consistent with BD. Interventions: The patient was initially treated with anticoagulants. However, because the improvement of DVT was inadequate, we added colchicine in anticipation of anti-inflammatory effects. After that, anticoagulation was discontinued, and only colchicine was continuously prescribed. Outcomes: We observed an almost complete resolution of DVT and PAT with no recurrence of thrombosis for 6 months after discharge. Lessons: This case shows us that we should consider BD as a differential diagnosis of DVT and that colchicine therapy is effective for inflammation-induced thrombosis in BD.

Antihypertensive treatment has beneficial effects in the elderly. Surveying the situation of blood pressure in the elderly is quite important for planning strategies to manage elderly hypertensives. The aim of the present study was to investigate changes in blood pressure in the elderly over the past 15 years. As part of a physical check-up program between 2001 and 2015, 29,363 elderly participants (≥65 years of age) attended and were enrolled in the present study. The characteristics of the participants in each year were analyzed cross-sectionally and the results were compared over the 15 years. Changes in blood pressure, hypertension prevalence, and treatment rates, and the rate of reaching target blood pressure in the elderly were investigated. The prevalence of hypertension during the study period increased with increasing participant age. However, both the treatment rate and the rate of reaching target blood pressure in treated subjects improved. The blood pressure of treated hypertensive elderly subjects decreased from 146.1/83.0 to 130.6/75.4 mm Hg, and the reduction was most evident after revision of Japanese Society of Hypertension guidelines regarding target blood pressure in elderly hypertensives. Blood pressure in the entire cohort of elderly subjects decreased from 133.8/78.4 mm Hg in 2001 to 127.9/74.6 mm Hg in 2015. Blood pressure in elderly subjects had decreased over the 15-year study period primarily due to reductions in blood pressure in elderly hypertensive patients on medication. Guidelines for the treatment of hypertension have had a beneficial effect on the management of hypertension in the elderly.

Purulent pericarditis is a life-threatening disorder, even in the modern antibiotic era. Although diabetes mellitus is known to be associated with an increased risk of multiple types of infections, purulent pericarditis is extremely rare. We herein report an unusual case of pericarditis caused by Salmonella enterica subspecies arizona that was not associated with any evident underlying immunosuppressive disorder apart from uncontrolled type 2 diabetes mellitus. Because a pet snake was suspected as being the source of infection in the present case, patient education and a detailed review of exposure history could play an important role in treating patients with diabetes mellitus.

Background The prognostic implications of late gadolinium enhancement (LGE) have been evaluated in ischemic and non-ischemic cardiomyopathies. The present study analyzed LGE distribution in patients with end-stage hypertrophic cardiomyopathy (ES-HCM) and with dilated cardiomyopathy (DCM), and tried to identify high risk patients in DCM. Methods Eleven patients with ES-HCM and 72 with DCM underwent cine- and LGE-cardiac magnetic resonance and ultrasound cardiography. The patient outcome was analyzed retrospectively for 5 years of follow-up. Results LGE distributed mainly in the inter-ventricular septum, but spread more diffusely into other left ventricular segments in patients with ES-HCM and in a certain part of patients with DCM. Thus, patients with DCM can be divided into three groups according to LGE distribution; no LGE (n = 24), localized LGE (localized at septum, n = 36), and extensive LGE (spread into other segments, n = 12). Reverse remodeling occurred after treatment in patients with no LGE and with localized LGE, but did not in patients with extensive LGE and with ES-HCM. The event-free survival rate for composite outcome (cardiac death, hospitalization for decompensated heart failure or ventricular arrhythmias) was lowest in patients with extensive LGE (92%, 74% and 42% in no LGE, localized LGE, and extensive LGE, p = 0.02 vs. no LGE), and was comparable to that in patients with ES-HCM (42%). Conclusions In DCM, patients with extensive LGE showed no functional recovery and the lowest event-free survival rate that were comparable to patients with ES-HCM. The analysis of LGE distribution may be valuable to predict reverse remodeling and to identify high-risk patients.

Rationale:Inferior vena cava (IVC) thrombosis is an under-recognized entity that is associated with a mortality rate approaching twice that of lower extremity deep venous thrombosis (DVT). Thrombolytic therapy not only results in greater lysis, but also results in higher complication rates t

Background: Transient ischemic dilatation (TID) and post-stress dysfunction of the left ventricle (LV) are important markers of severe coronary artery disease (CAD). To clarify the effects of stressor type on TID and post-stress LV dysfunction, changes in LV measurements were compared between patients with exercise- or vasodilator-induced stress. Methods and Results: The 689 patients referred for technetium-99m tetrofosmin myocardial perfusion imaging were included. Patients were stressed with either a vasodilator (n=236) or exercise (n=453). LV measurements were obtained with ECG-gated SPECT. LV end-diastolic and end-systolic volume indexes (LVEDVI, LVESVI) increased and LV ejection fraction (LVEF) decreased after stress in the vasodilator-stress group. Vasodilator-stress and the summed difference score (SDS) were independent variables that decreased LVEF after stress. Even in patients without reversible defects, vasodilator-stress impaired LV function. There were no differences in the stress-to-rest ratios of LVEDVI (rEDV) and LVESVI (rESV) among patients with normal myocardial perfusion, fixed defects and reversible defects in the vasodilator-stress group, whereas in the exercise-stress group, rESV was significantly higher in the patients with reversible defects than in those without reversible defects. Within the vasodilator-stress group, neither rEDV nor rESV correlated with the SDS. Conclusions: Vasodilator-stress by itself decreases LVEF after stress. TID should be carefully interpreted when vasodilator-stress is used to detect severe CAD. (Circ J 2010; 74: 2666-2673)