Background/Aim: Progressive cardiovascular calcification in dialysis patients with end-stage renal disease (ESRD) is a serious complication; however, the precise mechanism remains uncertain. We tested whether metabolic calcium abnormalities and hypoparathyroidism might have a correlation with cardiovascular complications in ESRD patients. Methods: A series of 48 ESRD patients with cardiovascular diseases and/or congestive heart failure, aged 36–82 (61 ± 12) years, 23 male and 25 female, were enrolled in this study. Serum total calcium (Ca, mmol/l), inorganic phosphate (mmol/l), and intact parathyroid hormone (iPTH, pg/ml) levels were determined in all cases. Results: Organic heart disease was confirmed in 28 patients (58.3%), including 15 with coronary artery disease: 8 with aortic aneurysm, 8 with stenotic valvular heart disease, 9 with excessive mitral annular calcification, 3 with dialysis cardiomyopathy, and 7 with obstructive arterial disease. Serum iPTH measurement revealed hypoparathyroidism (iPTH <60) in 20 of 48 (41.7%) and hyperthyroidism (iPTH ≧200) in 13 of 48 (27.1%) subjects. The 20 patients with low iPTH had a higher prevalence of valvular heart disease, a higher total Ca level corrected for serum albumin (2.70 ± 0.30 in low iPTH vs. 2.47 ± 0.30 in normal iPTH, 2.35 ± 0.20 in high iPTH, p = 0.003) and a higher tendency of vitamin D₃ analog use (65% in low iPTH vs. 33% in normal iPTH and 46% in high iPTH, p = 0.078). Moreover, corrected serum Ca exhibited a negative logarithmic correlation with serum iPTH: corrected Ca = –0.284× log (iPTH) + 3.021 (r = 0.637, p = 0.0001). Multiple logistic regression analysis revealed diabetes and hypoparathyroidism (iPTH <60) as risk factors for cardiovascular complications in ESRD. Conclusion: These results suggest that hypercalcemia and hypoparathyroidism in conjunction with vitamin D₃ use might play an important role in cardiovascular complications of chronic dialysis patients.

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A noninvasive method for the diagnosis of cardiac calcinosis, a life-threatening complication in hemodialysis patients with end-stage renal disease (ESRD), has not, as yet, been firmly established. We tested whether whole body scanning with 99m-technetium methylene diphosphonate (MDP) might visualize cardiac calcinosis. In 19 consecutive chronic hemodialysis ESRD patients (13 males and 6 females, aged 40–81, mean 63 ± 8 years) with cardiovascular disease [mitral annular calcinosis and/or calcified aortic valve (n = 4), hemodialysis cardiomyopathy (n = 1), coronary artery disease (n = 9) and peripheral artery atherosclerotic disease (n = 6)], MDP uptake in the heart was compared to that in 7 non-ESRD controls with hyperparathyroidism due to adenoma. Cardiac and lung field MDP uptake was confirmed in only 3 (16%) and 5 (26%) of the 19 ESRD subjects, respectively, but was absent in controls. Positive cardiac uptake was related to cardiac calcified complications (mobile intracardiac calcinosis, myocardial calcinosis and mitral annular calcification) and the duration of hemodialysis (p = 0.015). While it was statistically insignificant, subjects showing MDP uptake were elder and had higher serum Ca or Ca × P product and lower intact parathyroid hormone levels. These results suggest that cardiac calcinosis in ESRD patients can be detected noninvasively by myocardial scintigraphy with 99m-technetium MDP.

Aim:The number of elderly patients with heart failure is increasing in Japan owing to the increase in the aging population. In the field of emergency medicine, the treatment and management of elderly patients with heart failure are key issues. We aimed to clarify the clinical characteristics and outcomes of these patients. Methods:We enrolled 72 consecutive patients (age, 76.5 ± 12.5 years) with heart failure who were admitted to our hospital between January 1 and December 31, 2010. The characteristics and outcomes of super-elderly patients aged >85 years (n = 21) were compared with those of patients aged ≤85 years (n = 51). Results:The overall prevalence of chronic atrial fibrillation was high (43.1%). Underlying diseases, left ventricular function, renal function, in-hospital mortality, hospital stay period, and major complications were similar between the two groups. The super-elderly group had a significantly higher mortality rate and lower event-free survival rate after discharge (log-rank test, P = 0.0018 and P = 0.0032, respectively). The incidence of readmission for heart failure recurrence was 55.0% in the super-elderly group and 25.0% in the younger group.Conclusion: There were no significant differences in the background characteristics and in-hospital treatment between super-elderly heart failure patients and younger patients. High mortality and cardiovascular event rates after discharge were observed in the super-elderly group.

The natural history of uncomplicated mitral valve prolapse (MVP) is not clearly understood. To determine the site-related differences in regression and progression of MVP, 112 patients with idiopathic MVP were enrolled in this echocardiographic follow-up study. Cardiovascular complications, including dysarrhythmias (n = 3, 2.7%), overt congestive heart failure (n = 4, 3.6%), progression of mitral regurgitation over one grade (n = 28, 25.0%), newly confirmed chordal rupture (n = 1, 0.9%), and surgical repair (n = 2, 1.8%), were observed in these patients during a follow-up period of 1–13 years (mean, 4.0 ± 2.8 years). Multivariate analysis and Kaplan-Meier analysis revealed that posterior leaflet prolapse and significant mitral regurgitation (grade ≥2) were considerable risks for cardiovascular complications. Regression of MVP was seen in 17 (18.7%) of the anterior prolapse patients; however, new prolapse was observed in 40 (35.7%) patients, mainly in posterior prolapse patients. These results suggest that site-related differences exist in uncomplicated MVP prognosis and that MVP in the posterior leaflet has a poor outcome compared to that in the anterior leaflet.