Background and objectives: Cardiac failure is directly affected by left ventricular (LV) dysfunction, and particularly LV systolic dysfunction is strongly associated with survival in ESRD patients. The aim of this study was to determine the prognostic value of reduced LV ejection fraction (LVEF) measured at the time of initiation of hemodialysis (HD) in incident HD patients.Design, setting, participants, & measurements: 1254 consecutive ESRD patients who electively started HD therapy were screened by echocardiography within 1 month after its inception. They were divided into five groups according to LVEF levels with a decrease of 0.1 each and were followed up for up to 7 years. Survival was examined with the Kaplan-Meier method and compared using the log-rank test.Results: Among the 1254 patients, LVEF levels >0. Conclusions: Reduced LVEF on starting HD therapy could stratify risk of cardiovascular and all-cause mortality in ESRD patients. Screening by echocardiography at start of HD therapy might be recommended to predict prognosis in patients with ESRD.

Background-Circulating endothelial progenitor cells (EPCs) are known to be involved in vasculogenesis and mobilized after acute myocardial infarction (AMI). To test the hypothesis that the angiogenic function of EPCs affects post-myocardial infarction (MI) myocardial salvage, we evaluated the number and potential differentiation of EPCs and compared these data with clinical parameters 6 months after MI. Methods and Results-Consecutive 51 patients (age, 61Ϯ8 years, meanϮSD) with primary AMI who were successfully treated with stenting were enrolled. EPC identified as CD45 low , CD34 ϩ , CD133 ϩ , and VEGFR2 ϩ was quantified by a flow cytometry. The potential of EPCs to differentiate into endothelial cells (EPC differentiation) was also confirmed by the upregulation of CD31 and VEGFR2 after 7 days of culture. According to the proportion of EPC fraction, patients were divided into 2 groups (cut-off valueϭmedian). Although no difference was seen in myocardial damage shown by mean peak CK leakage and mean area at risk between the differentiated group (nϭ26) and nondifferentiated group (nϭ25), the number of attached cell was greater in differentiated group than in the nondifferentiated group (Pϭ0.023). Left ventricular function and ischemic damaged area were assessed by scintigraphic images of 123 I-BMIPP in the acute phase and 99m Tc-tetrofosmin in the chronic phase. We found that a greater increase in myocardial salvage (Pϭ0.0091), decrease in end-systolic volume (Pϭ0.012), and recovery of ejection fraction (Pϭ0.011) occurred in the group with differentiated EPCs than in the nondifferentiated group. Conclusions-In patients with primary AMI, the capability of EPCs to differentiate influences the functional improvement and infarct size reduction, indicating that manipulation of EPCs could be a novel therapeutic target to salvage ischemic damage.

on behalf of J-MINUET InvestigatorsBackground: According to troponin-based criteria of myocardial infarction (MI), patients without elevation of creatine kinase (CK), formerly classified as unstable angina (UA), are now diagnosed as non-ST-elevation MI (NSTEMI), but little is known about their outcomes.

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