Combination of Urinary Sodium/Creatinine Ratio and Plasma Brain Natriuretic Peptide Level Predicts Successful Tolvaptan Therapy in Patients with Heart Failure and Volume Overload

• Material Type: 博士論文
• Title: Combination of Urinary Sodium/Creatinine Ratio and Plasma Brain Natriuretic Peptide Level Predicts Successful Tolvaptan Therapy in Patients with Heart Failure and Volume Overload
• Author/Editor: Sato, Yuichi
• Author Heading: Sato, Yuichi
• Publication, Distribution, etc.: 三重大学
• Publication Date: 2016-03-25
• Publication Date (W3CDTF): 2016-03-25
• Degree grantor/type: 三重大学
• Date Granted: 2016-03-25
• Date Granted (W3CDTF): 2016-03-25
• Dissertation Number: 甲医学第1776号
• Degree Type: 博士(医学)
• Conferring No. (Dissertation): 甲医学第1776号
• Text Language Code: eng
• Alias of Author: サトウ, ユウイチ; 佐藤, 雄一
• Subject Heading: vasopressin V2-receptor antagonist; loop diuretics; diuresis; heart failure
• Target Audience: 一般
• Note (General): application/pdf; To evaluate short-term clinical and hemodynamic effects of tolvaptan therapy and to identify predictors of the therapeutic outcomes, we retrospectively recruited sixty consecutive hospitalized heart failure (HF) patients (70 ± 11 years) with volume overload. The subjects were divided into two groups on the basis of the changes in HF symptom scores and hemodynamic status assessed by right heart catheterization after tolvaptan therapy (median: 7 days). The majority of patients were successfully treated (Group 1). However, 22% of patients (Group 2) were unsuccessfully treated, in whom 1) HF symptom score worsened or 2) there was a stationary HF symptom score ≥6 points, and mean PCWP >18 mmHg and mean RAP >10 mmHg, after tolvaptan therapy. HF symptom scores, hemodynamic parameters and plasma brain natriuretic peptide (BNP) level improved in Group 1, but all of these parameters remained unchanged in Group 2. Lower urine sodium/creatinine ratio (UNa/UCr) and higher BNP level at baseline were independently associated with unsuccessful tolvaptan therapy, and UNa/UCr best predicts unsuccessful tolvaptan therapy with a cut-off value of 46.5 mEq/g-Cr (AUC 0.858, 95% CI: 0.743-0.974, sensitivity 81%, specificity 77%, p <0.01). Double-positive results of UNa/UCr <46.5 mEq/g-Cr and plasma BNP level >778 pg/ml predicted unsuccessful tolvaptan therapy with high diagnostic accuracy (sensitivity 54%, specificity 100%, positive predictive value 100%, negative predictive value 89% and accuracy 90%). In summary, short-term tolvaptan therapy ameliorated HF symptoms and provided hemodynamic improvement in the majority of patients, and UNa/UCr and BNP level strongly predicted the therapeutic outcomes.; 本文 / Department of Cardiology and Nephrology, Mie University Graduate School of Medicine; 36p; http://doi.org/10.1536/ihj.15-330
• DOI: info:doi/10.1536/ihj.15-330; https://doi.org/info:doi/10.1536/ihj.15-330
• Persistent ID (NDL): info:ndljp/pid/10402951; https://dl.ndl.go.jp/pid/10402951
• Collection: 障害者向け資料
• Collection (Materials For Handicapped People:1): テキストデータ
• Collection (particular): 国立国会図書館デジタルコレクション > デジタル化資料 > 博士論文; https://dl.ndl.go.jp/collections/A00014
• Acquisition Basis: 博士論文（自動収集）
• Date Accepted (W3CDTF): 2017-08-02T04:31:34+09:00
• Date Created (W3CDTF): 2017-07-04
• Format (IMT): application/pdf
• Access Restrictions: 国立国会図書館内限定公開
• Service for the Digitized Contents Transmission Service: 図書館・個人送信対象外
• Availability of remote photoduplication service: 可
• Related Material (URI): http://doi.org/10.1536/ihj.15-330
• Periodical Title (URI): http://hdl.handle.net/10076/00016981; https://mie-u.repo.nii.ac.jp/records/11325
• Data Provider (Database): 国立国会図書館 : 国立国会図書館デジタルコレクション; https://dl.ndl.go.jp

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