Language：English   Publisher：(一社)日本循環器学会  

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AIMS: As part of the Toon Health Study, which is an ongoing population-based cohort study, we aimed to develop a prediction model for N-terminal pro-brain natriuretic peptide (NT-proBNP) in a general Japanese population. We sought to explore the influence of various demographic and clinical factors on NT-proBNP levels and assess the model's performance. In addition, our objectives included internal validation and investigation of the diagnostic potential of the observed-to-predicted NT-proBNP ratio (OPR) at baseline for predicting the risk of heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: In this prospective cohort study, participants were recruited from Toon City, Japan, as part of the larger Toon Health Study, focusing on cardiovascular risk factors. We measured the NT-proBNP levels and used linear regression with penalization (ridge regression) to develop the model. The model incorporated 10 prespecified predictors (age, gender, body mass index, diastolic blood pressure, heart rate, haemoglobin, albumin, total cholesterol, haemoglobin A1c, and estimated glomerular filtration rate) and underwent assessment using R2 and root mean squared error (RMSE). Internal validation was conducted through bootstrapping. In a post hoc analysis, we explored the OPR's diagnostic potential using 5 year follow-up data (n = 636) to predict the elevation of NT-proBNP > 125 pg/mL at the 5 year follow-up as the risk of HFpEF. A total of 2505 participants (age: 60.4 ± 12.9 years, men: 35%) were enrolled in this study. There was a linear relationship between the observed and predicted values of NT-proBNP in which the logarithm of observed NT-proBNP was <6, which corresponds to 403 pg/mL in NT-proBNP. The prediction model demonstrated satisfactory performance (R2 : 0.291, RMSE: 0.688), with age identified as a dominant predictor. The stability of the model was underscored by the internal validation. The OPR at baseline predicted NT-proBNP > 125 pg/mL at the 5 year follow-up with an area under the curve of 0.793. CONCLUSIONS: This study introduces the first prediction model for NT-proBNP in a general Japanese population. Although the model has acceptable performance, ongoing refinement is essential. Our transparent approach to model development, alongside a web-based interactive tool, lays the groundwork for further improvements and external validation. The OPR holds potential for predicting the future risk of HFpEF. This research contributes to understanding the nuanced influence of patient backgrounds on levels of NT-proBNP in asymptomatic individuals within the context of a broader population-based cohort study.

DOI： 10.1002/ehf2.14691

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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BACKGROUND: Although remote monitoring (RM) after pacemaker implantation is common, its cost-effectiveness has not been fully investigated. Therefore, we assessed the cost-effectiveness of RM compared with conventional follow-up (CFU) in Japanese patients with pacemakers. METHODS: A Markov model was constructed to analyze costs and quality-adjusted life years after pacemaker implantation. The target population was Japanese patients implanted with a dual-chamber pacemaker for bradycardia. Transition probabilities (e.g. atrial fibrillation, stroke, and device trouble) were obtained from literature and expert sources. Additionally, stroke risk was determined according to anticoagulation and CHADS2 scores. We used a 10-year horizon with sensitivity analyses for significant variables. RESULTS: Compared to CFU, RM was more effective; however, it was also more expensive. When the range of the Japanese willingness-to-pay threshold was considered to be \5,000,000, RM was at least cost-neutral relative to the CFU in all elderly patients with pacemakers for bradycardia. The cost-effectiveness of RM relative to CFU could be higher for patients with high CHADS2 scores, especially in patients with a CHADS2 score ≥ 3. Scenario analyses changing the interval between visits to an in-office evaluation in the CFU also demonstrated the same conclusions. In particular, when the interval between office visits was 1 year for the CFU, the RM could be more cost-effective. CONCLUSIONS: This study demonstrated that RM can be a cost-effective option for Japanese patients, especially those with high CHADS2 scores and long-term intervals between office visits.

DOI： 10.1016/j.jjcc.2023.06.003

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DOI： 10.1016/j.cjco.2023.02.008

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本循環器学会  

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AIMS: Currently, virtual reality (VR) constitutes a vital aspect of digital health, necessitating an overview of study trends. We classified type A studies as those in which health care providers utilized VR devices and type B studies as those in which patients employed the devices. This study aimed to analyse the characteristics of each type of studies using natural language processing (NLP) methods. METHODS AND RESULTS: Literature related to VR in cardiovascular research was searched in PubMed between 2010 and 2022. The characteristics of studies were analysed based on their classification as type A or type B. Abstracts of the studies were used as corpus for text mining. A binary logistic regression model was trained to automatically categorize the abstracts into the two study types. Classification performance was evaluated by accuracy, precision, recall, F-1 score, and c-statistics of the receiver operator curve (ROC) analysis. In total, 171 articles met the inclusion criteria, where 120 (70.2%) were type A studies and 51 (29.8%) were type B studies. Type A studies had a higher proportion of case reports than type B studies (18.3% vs. 3.9%, P = 0.01). As for abstract classification, the binary logistic regression model yielded 88% accuracy and an area under the ROC of 0.98. The words 'training', '3d', and 'simulation' were the most powerful determinants of type A studies, while the words 'patients', 'anxiety', and 'rehabilitation' were more indicative for type B studies. CONCLUSIONS: NLP methods revealed the characteristics of the two types of VR-related research in cardiology.

DOI： 10.1093/ehjdh/ztad008

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DOI： 10.1161/CIRCIMAGING.122.014895

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Language：Japanese   Publisher：(一社)日本脈管学会  

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BACKGROUND: Although premature atrial contractions (PACs) just after catheter ablation (CA) for atrial fibrillation (AF) are common, their clinical significance is uncertain. This study aimed to evaluate whether the PAC burden after an initial CA for AF was associated with late recurrence. METHODS: We enrolled 346 patients with AF (median age, 65 years; 30% female; 57% with paroxysmal AF) who underwent an initial radiofrequency CA and a 24-h Holter monitoring the day after the procedure. PAC was defined as supraventricular complexes occurring ≥30% earlier than expected compared with a previous RR interval, and the number of PAC/24 h during post-procedural Holter monitoring was analyzed. RESULTS: AF recurred in 106 patients (31%) during a median follow-up of 19 months. These patients had significantly more PAC/24 h than those without (median [interquartile range], 891 [316-4,351] beats vs. 409 [162-1,303] beats; P<0.01). The number of PACs was independently associated with AF recurrence after adjustment for clinical parameters and left atrial (LA) enlargement. Receiver operating characteristic curve analysis revealed that 1,431 PAC/24 h was the optimal cut-off value for predicting AF recurrence. ???Adding the PAC/24 h to the prediction model with LA diameter appeared to correctly reclassify patients who were thought to be at high risk for AF recurrence into the low-risk group and vice versa. CONCLUSIONS: The number of PACs was an independent risk factor for AF recurrence. A 24-h Holter recording the day after an initial CA is a simple and beneficial tool for the risk stratification of AF recurrence. This article is protected by copyright. All rights reserved.

DOI： 10.1111/pace.14648

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Language：Japanese   Publisher：(一社)日本人工臓器学会  

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Pulmonary artery intimal sarcomas (PAIS) are often misdiagnosed as pulmonary embolisms (PE) as their clinical findings and imaging findings are similar. However, given the clinical outcome of both diseases is different in its prognosis, accurate and rapid diagnosis is mandatory. This is a case report of a histologically-proven PAIS which was initially treated as a PE. The color-coded iodine map using dual-energy computed tomography (dual-energy CT iodine map) well reflected the distribution of the tumor consistent with 18fluoro-2-deoxyglucose-uptake region using positron emission tomography/CT. This case demonstrates the potential of using dual-energy CT iodine map to differentiate PAIS from PE. Learning objective: Use of a dual-energy computed tomography iodine map to visualize a pulmonary artery intimal sarcoma may provide useful diagnostic information.

DOI： 10.1016/j.jccase.2022.03.011

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BACKGROUND: Diagnostic guidelines for isolated cardiac sarcoidosis (iCS) were first proposed in 2016, but there are few reports on the imaging and prognosis of iCS. This study aimed to evaluate the use of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging in predicting iCS prognosis. METHODS AND RESULTS: We retrospectively reviewed the clinical and imaging data of 306 consecutive patients with suspected CS who underwent FDG PET/CT with a dedicated preparation protocol and included 82 patients (55 with systemic sarcoidosis including cardiac involvement [sCS], 27 with iCS) in the study. We compared the FDG PET/CT findings between the two groups. We examined the relationship between the CS type and the rate of adverse cardiac events. The iCS group had a significantly lower target-to-background ratio than the sCS group (P = 0.0010). The event-free survival rate was significantly lower in the iCS group than the sCS group (log-rank test, P < 0.0001). iCS was identified as an independent prognostic factor for adverse events (hazard ratio 3.82, P = 0.0059). CONCLUSION: iCS was an independent prognostic factor for adverse cardiac events in patients with CS. The clinical diagnosis of iCS based on FDG PET/CT and new guidelines may be important.

DOI： 10.1007/s12350-022-03034-0

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Language：Japanese   Publisher：(NPO)日本小児循環器学会  

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Language：Japanese   Publisher：(NPO)日本医工学治療学会  

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Language：Japanese   Publisher：(NPO)日本医工学治療学会  

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DOI： 10.1253/circj.CJ-21-1001

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The left and right atria serve as buffer chambers to control the flow of venous blood for ventricular filling. If an atrium is absent, blood does not flow effectively into the ventricle, leading to venous blood retention and low cardiac output. The importance of atrial function has become increasingly recognized, because left atrial (LA) function contributes to cardiac performance, and loss of LA function is associated with heart failure. LA volume change has been used for LA function assessment in experimental and clinical studies. In conjunction with LA pressure, the LA pressure-volume relationship provides a better understanding of LA mechanics. LA strain measurement by speckle tracking echocardiography was introduced to evaluate three components of LA function as a (booster) pump, reservoir and conduit. Furthermore, increasing evidence supports the theory that LA reservoir strain has prognostic utility in various cardiac diseases. In this review, we summarize LA contribution to maintain cardiac performance by evaluating LA function with echocardiography according to our experiences and previous reports. Furthermore, we discuss LA dysfunction in challenging cardiac diseases of cardiac amyloidosis and adult congenital heart disease.

DOI： 10.3390/jcdd9030068

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Language：Japanese   Publisher：日本成人先天性心疾患学会  

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Language：Japanese   Publisher：日本成人先天性心疾患学会  

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DOI： 10.1093/ehjcr/ytab414

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DOI： 10.1253/circj.CJ-21-0366

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Inc.  

Transthyretin (TTR) cardiac amyloidosis is a systemic disease caused by amyloid deposits in several systemic organs. The thickening of the yellow ligament because of amyloid deposits results in spinal canal stenosis. This study reports a case of mutant-type TTR cardiac amyloidosis in a patient with recurrent spinal canal stenosis. To our knowledge, this is the first study to report pathologic amyloid involvement in both spinal and cardiac tissues of a patient with hereditary TTR amyloidosis. It is important to be aware of underlying amyloidosis as a cause of spinal canal stenosis, especially regarding refractory diseases in older adults.

DOI： 10.1016/j.cjca.2021.02.004

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Language：Japanese   Publisher：(一社)日本人工臓器学会  

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DOI： 10.1093/ehjci/jeab102

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AIMS: Cardiac amyloidosis (CA) is an infiltrative myocardial disease that occasionally mimics hypertrophic cardiomyopathy (HCM). The aim of this study is to investigate the discriminatory ability of visual assessment of left atrial (LA) function between CA and HCM on echocardiography. METHODS AND RESULTS: In total, 93 patients with cardiac magnetic resonance imaging (CMR)-confirmed HCM and 34 with cardiac biopsy-confirmed CA were retrospectively assessed. LA dilatation was assessed via echocardiography in an apical four-chamber view. Visual assessment was performed to identify LA dilatation grade (preserved = 1, abnormal = 2, and restricted = 3) based on the extent of outward expansion in the LA reservoir phase. Regarding the reproducibility of visually assessing LA dilatation grade, the kappa values between intra- and inter-observer measurements were 0.82 and 0.70, respectively. Of 127 participants, 57 (45%), 42 (33%), and 28 (22%) presented with LA dilatation Grades 1, 2, and 3, respectively. All 57 patients with preserved LA dilatation (Grade 1) had HCM, and 20 of 28 patients (71%) with restricted LA dilatation (Grade 3) presented with CA. Patients with CA had a higher LA dilatation grade than those with HCM (P < 0.01). LA emptying fraction and reservoir strain were also quantitatively evaluated. The area under the curves of LA dilatation grade (0.88) and LA emptying fraction (0.88) for differentiation of these two diseases were higher than that of LA reservoir strain (0.73) (P < 0.01, respectively). During follow-up, nine patients with HCM and 16 with CA experienced cardiac event (cardiac death or hospitalization due to heart failure). In Kaplan-Meier analysis including both groups of HCM and CA, the incidence of cardiac events was higher in patients with restricted LA dilatation than in those with preserved or abnormal LA dilatation (log-rank test, P < 0.01). CONCLUSIONS: Restricted LA dilatation is an indicator for the diagnosis of CA. Further, visual assessment of abnormal LA motion may facilitate diagnosis in patients with CA and high-risk patients with HCM.

DOI： 10.1002/ehf2.13442

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Language：English   Publisher：(一社)日本循環器学会  

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DOI： 10.1161/CIRCHEARTFAILURE.120.007571

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Language：English   Publisher：(一社)日本心血管インターベンション治療学会  

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The Impella (Abiomed, Danvers, MA, USA) is a novel percutaneous heart pump device for left ventricular (LV) assistance; however, LV thrombus is a notable contraindication for this device. Contrast computed tomography assessment is useful for detecting LV thrombus and preventing thromboembolism in patients recommended for Impella use. <Learning objective: The Impella (Abiomed, Danvers, MA, USA) is a heart pump device which aspirates blood from a left ventricular (LV) cavity and ejects it into an ascending aorta. Therefore, LV thrombus should be explored before the Impella insertion to prevent systemic embolism. Generally, echocardiography is the first choice to detect LV thrombus. Given limited diagnostic sensitivity for detecting LV thrombus in echocardiography, contrast computed tomography might be a useful strategy for the patient targeting Impella insertion.>.

DOI： 10.1016/j.jccase.2020.07.016

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Language：Japanese   Publisher：(一社)日本人工臓器学会  

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Language：Japanese   Publisher：(一社)日本老年医学会  

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Language：Japanese   Publisher：(一社)日本人工臓器学会  

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Language：Japanese   Publisher：(一社)日本人工臓器学会  

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Background: Sarcoidosis is a systemic inflammatory disorder and can often affect any other organs beyond the heart. Whole-body 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is used to detect not only cardiac but also extra-cardiac involvement of sarcoidosis. However, the features and clinical impact of extra-cardiac lesions have not yet been fully elucidated. Therefore, this study aimed to clarify these using FDG-PET. Methods and results: We enrolled 120 consecutive patients with abnormal findings clinically suggesting cardiac sarcoidosis who underwent whole-body FDG-PET. In this study, a patient with suspected cardiac sarcoidosis was defined as one having both clinically suspected findings and FDG-PET positive cardiac uptake. Subsequently, a total of 36 patients with suspected cardiac sarcoidosis were found and analyzed. Extra-cardiac involvement was detected in 35 lesions of 14 patients (39% per patient). In particular, the extra-cardiac lesions were widely distributed throughout the body, and mediastinal/hilar lymph node involvement was most commonly observed. In most of the patients (93% per patient, 13/14), the extra-cardiac lesions were localized in the regions that were considered more accessible with less risk of complication compared with endomyocardial biopsy (EMB). Based on the FDG-PET findings, 8 patients underwent extra-cardiac biopsy without complication, and its diagnostic sensitivity for histological sarcoidosis was high (75%, 6/8). Moreover, FDG-PET-guided extra-cardiac biopsy could confirm histological sarcoidosis in 4 lesions that EMB failed to prove. Conclusions: Extra-cardiac involvement in patients with suspected cardiac sarcoidosis was relatively high. FDG-PET-guided extra-cardiac biopsy may be safe and useful for the imaging based diagnosis of cardiac sarcoidosis.

DOI： 10.1016/j.ijcha.2020.100587

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AIMS: Traditional criteria for heart transplantation by cardiopulmonary exercise testing (CPX) include peak oxygen uptake (VO2 ) < 14 mL/kg/min. Reaching a sufficient exercise load is challenging for patients with refractory heart failure (HF) because of their exercise intolerance. Recently, a substantial impact of right ventricular (RV) dysfunction was highlighted on urgent heart transplantation and mortality. This study aims to investigate the impact of RV contractile reserve, assessed by low-load exercise stress echocardiography (ESE), on exercise intolerance defined as peak VO2  < 14 mL/kg/min, in patients with HF. METHODS AND RESULTS: We prospectively examined 67 consecutive patients hospitalized for HF who underwent ESE and CPX under a stabilized HF condition. Although low-load ESE was defined as 25 W load exercise, an increment in RV systolic (s') velocity was regarded as the preservation of RV contractile reserve. All patients completed low-load ESE. During low-load ESE, the variation in RV s' velocity significantly correlated with peak VO2 (r = 0.787, P < 0.001). The change in RV s' velocity during low-load ESE accurately identified patients with peak VO2  < 14 mL/kg/min (area under the curve, 0.95; sensitivity, 92%; specificity, 85%). The intraclass correlation coefficient for intra-observer and inter-observer agreement for the change in RV s' velocity was 0.96 (95% confidence interval, 0.88-0.99, P < 0.001) and 0.86 (95% confidence interval, 0.64-0.95, P < 0.001), respectively. The RV-to-pulmonary circulation (PC) coupling, which was assessed by the slope of the relationship between RV s' velocity and pulmonary artery systolic pressure at rest and low-load exercise, was worse in the low-peak VO2 group (<14 mL/kg/min) than the preserved-peak VO2 group (≥14 mL/kg/min). CONCLUSIONS: The change in RV s' velocity during low-load ESE could estimate the exercise capacity in HF patients. The assessments of RV contractile reserve and RV-to-PC coupling could be clinically beneficial to distinguish high-risk HF patients.

DOI： 10.1002/ehf2.12968

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Background: For relief of cold symptoms, methylephedrine is considered to be safer than ephedrine, particularly when used at the predetermined dose. It is often present in various over-the-counter (OTC) drugs for cold, including paediatric cough syrups. Case summary: A 52-year-old man presented with worsening dyspnoea and anorexia for 2 weeks. He was a night shift worker and had been habitually taking large doses of methylephedrine-containing paediatric cough syrup for 20 years for sleep averting. On admission, his chest X-ray revealed pulmonary congestion and electrocardiogram showed sinus tachycardia with left-axis deviation. Echocardiography revealed diffuse hypokinesis with a reduced ejection fraction (EF) of 25%. The B-type natriuretic peptide level was elevated to 1092 ng/L. Even after treatment with low-dose dobutamine and furosemide in intensive care unit, right-heart catheterization demonstrated a 'wet and cold' profile. Coronary angiography revealed normal coronary arteries. Pathological examination by endomyocardial biopsy revealed cardiomyocyte hypertrophy with moderate interstitial and replacement fibrosis. In addition, cardiac magnetic resonance imaging revealed diffuse hypokinesis with mid-wall late gadolinium enhancement, which suggested fibrosis. Discontinuation of the cough syrup and optimal medical treatment with an angiotensin-converting enzyme inhibitor and a β blocker resulted in improvement in the heart failure symptoms to New York Class Association Class II. The EF also improved to 50% at 4 months after discharge. Discussion: Methylephedrine is considered to have adrenergic effects; it has milder side effects on the cardiovascular system than ephedrine. However, the long-lasting excessive intake of methylephedrine, even through OTC paediatric cough syrups, has the potential to cause heart failure.

DOI： 10.1093/ehjcr/ytaa095

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DOI： 10.1093/ehjci/jez131

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DOI： 10.1253/circj.CJ-18-1039

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Language：English   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：(一社)日本成人先天性心疾患学会  

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Language：English   Publisher：(一社)日本成人先天性心疾患学会  

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Calcification of bioprosthetic valves (BVs) implanted in aortic position can result in gradual deterioration and necessitate aortic valve replacement. The molecular mechanism of calcium deposition on BV leaflets has been investigated, but remains to be fully elucidated. The present study aimed to identify explanted bioprosthetic valve (eBV)-specific proteins using a proteomics approach and to unveil their biochemical and histological involvements in calcium deposition on BV leaflets. Calcification, fibrosis, and glycosylation of the valves were histologically assessed using Von Kossa, Masson's Trichrome and Alcian Blue staining, as well as immunostaining. Protein expression in the explanted biological valves was analysed using proteomics and western blotting. In a histological evaluation, αSMA-positive myofibroblasts were not observed in eBV, whereas severe fibrosis occurred around calcified areas. SDS-PAGE revealed three major bands with considerably increased intensity in BV leaflets that were identified as plasminogen and fibrinogen gamma chain (100 kDa), and fibrinogen beta chain (50 and 37 kDa) by mass analysis. Immunohistochemistry showed that fibrinogen β-chain was distributed throughout the valve tissue. On the contrary, plasminogen was strongly stained in CD68-positive macrophages, as evidenced by immunofluorescence. The results suggest that two important blood coagulation-related proteins, plasminogen and fibrinogen, might affect the progression of BV degeneration.

DOI： 10.1242/bio.034009

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PURPOSE: Hypertrophic cardiomyopathy (HCM) impairs left ventricular (LV) diastolic function leading to left atrial (LA) dilatation. Because Doppler echocardiography cannot accurately assess LV diastolic function in hearts with heterogeneous hypertrophy, assessment of LA function might be useful for risk stratification of patients with HCM. This study aimed to elucidate the impact of LA function on outcome in patients with patients. METHODS: Seventy-six patients with HCM who underwent echocardiographic and cardiac magnetic resonance imaging were retrospectively enrolled. Twenty-six control subjects were also included. Using speckle tracking echocardiography, LA function was divided into active and passive strain indices based on the timing of the second positive peak of LA strain rate that occurred during LV systole. RESULTS: Left atrial strain indices of active and passive function were significantly impaired concomitantly with increased LA volume index in HCM patients compared with controls. During follow-up (2.6 ± 1.7 years), 14 patients with HCM developed cardiac events (heart failure hospitalization or atrial fibrillation). The association of LA active strain with cardiac events was independent of and incremental to clinical and echocardiographic parameters (age, gender, E/e', LV global longitudinal strain, and LA volume index) in sequential models. Cardiac events were more frequent in HCM patients with LA active strain <20.3% than with active strain ≥20.3% (P = .01). CONCLUSION: Loss of LA active function was associated with increased cardiac events in patients with HCM.

DOI： 10.1111/echo.13886

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DOI： 10.1253/circj.CJ-18-0047

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© 2018, International Heart Journal Association. All rights reserved. The cardiac phenotype of laminopathies is characterized by cardiac conduction disorders (CCDs) and dilated cardiomyopathy (DCM). Although laminopathies have been considered monogenic, they exhibit a remarkable degree of clinical variability. This case series aimed to detect the causal mutation and to investigate the causes of clinical variability in a Japanese family with inherited CCD and DCM. Of the five family members investigated, four had either CCD/DCM or CCD alone, while one subject had no cardiovascular disease and acted as a normal control. We performed targeted resequencing of 174 inherited cardiovascular disease-associated genes in this family and pathological mutations were confirmed using Sanger sequencing. The degree of clinical severity and variability were also evaluated using long-term medical records. We discovered a novel heterozygous truncating lamin A/C (LMNA) mutation (c.774delG) in all four subjects with CCD. Because this mutation was predicted to cause a frameshift mutation and premature termination (p.Gln258HisfsTer222) in LMNA, we believe that this LMNA mutation was the causal mutation in this family with CCD and laminopathies. In addition, gender-specific intra-familiar clinical variability was observed in this Japanese family where affected males exhibited an earlier onset of CCD and more severe DCM compared to affected females. Using targeted resequencing, we discovered a novel truncating LMNA mutation associated with CCD and DCM in this family characterized by gender differences in clinical severity in LMNA carriers. Our results suggest that in patients with laminopathy, clinical severity may be the result of multiple factors.

DOI： 10.1536/ihj.17-377

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BACKGROUND: Fractional flow reserve (FFR) is widely used for the assessment of myocardial ischemia. Intravascular ultrasound (IVUS) is an intracoronary imaging method that provides information about lumen and vessel morphology. Previous studies on the expanded use of IVUS to identify functional ischemia have noted an association between anatomy and physiology, but IVUS-derived minimum lumen area (MLA) has a weak-moderate correlation with myocardial ischemia compared with FFR. We developed a method to calculate FFR using IVUS-derived anatomical information for the assessment of myocardial ischemia. The aims of this study were to investigate the relationship between wire-based FFR and IVUS-derived FFR (IVUS-FFR) and to compare the usefulness of IVUS-FFR and IVUS-derived MLA for functional assessment.Methods and Results:We retrospectively analyzed 50 lesions in 48 patients with coronary stenosis who underwent IVUS and FFR simultaneously. IVUS-FFR was calculated using our original algorithm and fluid dynamics. Mean percent diameter stenosis determined on quantitative coronary angiography and on FFR was 56.4±10.7 and 0.69±0.08, respectively. IVUS-FFR had a stronger linear correlation with FFR (R=0.78, P<0.001; root mean square error, 0.057 FFR units) than with IVUS-derived MLA (R=0.43, P=0.002). CONCLUSIONS: IVUS-FFR may be a more valuable method to identify myocardial ischemia, compared with IVUS-derived MLA.

DOI： 10.1253/circj.CJ-17-1042

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Language：English   Publisher：Japanese Circulation Society  

DOI： 10.1253/circj.CJ-18-0199

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC  

Fractional flow reserve (FFR) is widely used for the assessment of myocardial ischemia. Optical coherence tomography (OCT) provides accurate visualization of coronary artery morphology. The aim of this study was to investigate the relation between FFR and OCT-derived FFR. We retrospectively analyzed 31 lesions (25 left anterior descending arteries, 2 left circumflex arteries, and 4 right coronary arteries) in 31 patients with moderate-to severe coronary stenosis, who underwent OCT and FFR measurements simultaneously. OCT-derived FFR was calculated by the original algorithm, which was calculated using the following equation based on fluid dynamics: Delta P = FV + SV2, where V is the flow velocity, F is the coefficient of pressure loss because of viscous friction (Poiseuille resistance), and S is the coefficient of local pressure loss because of abrupt enhancement (flow separation). Mean values of % diameter stenosis by quantitative coronary angiography and FFR were 55.2 +/- 14.0% and 0.70 +/- 0.14, respectively. OCT-derived FFR showed a stronger linear correlation with FFR measurements (r = 0.89, p &lt;0.001; root mean square error = 0.062 FFR units) than quantitative coronary angiography % diameter stenosis (r = 0.65, p &lt;0.001), OCT measurements of minimum lumen area (r = 0.68, p &lt;0.001), and % area stenosis (r = 0.70, p &lt;0.001). OCT-derived FFR has the potential to become an alternative method for the assessment of functional myocardial ischemia, and may elucidate the relation between coronary morphology and FFR. (C) 2017 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.amjcard.2017.07.083

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Paradoxical low-flow, low-gradient aortic stenosis (LFLG AS) is recognized as a subtype of aortic stenosis. A small left ventricular (LV) cavity with marked LV concentric remodeling leads to a reduced stroke volume in this condition. The case is reported of a paradoxical LFLG AS patient who was undergoing treatment for pulmonary hypertension (PH) and interstitial pneumonia associated with scleroderma. Echocardiography demonstrated enlargement of the right ventricle and a diminished LV cavity. Moreover, the aortic valve opening was restricted despite a preserved LV ejection fraction (61%). The patient's aortic valve area (obtained with the continuity equation) was 0.57 cm2 (indexed AVA was 0.39 cm2/m2), and the mean gradient was 16 mmHg. Multi-detector computed tomography findings confirmed that the aortic valve calcification was not severe. The main mechanism responsible for LFLG AS was considered to be a reduced LV cavity secondary to PH, rather than a sclerotic aortic valve. Thus, a decision was taken to treat the patient with additional medical management prior to performing any invasive procedures. It should be borne in mind that PH can lead to paradoxical LFLG AS, and that appropriate treatment should be contemplated depending on the underlying mechanisms. Video 1: Transthoracic echocardiography in the parasternal long-axis view showing right ventricular dilatation and a diminished left ventricular cavity. Video 2: Transthoracic echocardiography in the shortaxis view showing enlargement of the right ventricle and septal flattening due to pulmonary hypertension. Video 3: Transesophageal echocardiography clearly demonstrates an insufficient valve opening.

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DOI： 10.1253/circj.CJ-16-0945

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DOI： 10.1093/eurheartj/ehx125

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Objective The underlying mechanisms of stent thrombosis are not completely understood.
Methods We experienced 12 definite stent thrombosis cases (1 early, 1 late, and 10 very late) at our hospital from July 2011 to April 2016 and evaluated the possible causes of stent thrombosis by intravascular ultrasound (IVUS).
Results Five different potential morphological causes of stent thrombosis (neoatherosclerosis, stent malapposition, stent fracture, edge dissection, and stent underexpansion) were detected by IVUS in 10 cases (83.3%); in 1 of the remaining 2 cases, the discontinuation of antithrombotic drugs resulted in early stent thrombosis without abnormal IVUS findings. Of the 12 stent thrombosis cases, 4 occurred at a bare-metal stent (average time from stent implantation, 106 months); in all 12, significant neointimal hyperplasia was observed on IVUS, and 2 had plaque ruptures at an in-stent or proximal reference. Malapposed stent struts were observed in three very-late stent thromboses, and all of these underwent sirolimus-eluting stent implantation. Stent thrombosis due to mechanical (stent fracture) or procedure-related complications (edge dissection and stent underexpansion) was observed in three cases.
Conclusion In patients with stent thrombosis, heterogeneous findings were observed in IVUS. This IVUS case series illustrates the possible mechanisms of stent thrombosis.

DOI： 10.2169/internalmedicine.56.7093

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DOI： 10.1016/j.jccase.2016.08.003

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DOI： 10.1016/j.ijcard.2016.08.248

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC  

Fractional flow reserve (FFR) is widely used for the assessment of myocardial ischemia. However, it has the disadvantage of cost and invasive complication risks. We investigated the usefulness of quantitative coronary angiography derived translesional pressure (QCA-TP) for predicting functional myocardial ischemia, using FFR as the gold standard. We retrospectively analyzed 152 coronary narrowings (98 left anterior descending arteries, 28 left circumflex arteries, and 26 right) in 132 patients with mild-severe coronary stenosis who underwent coronary angiography and FFR measurements simultaneously. QCA-TP was calculated using software implemented in the QCA software. Coronary morphology was calculated using both densitometry and lumen edges. Functional myocardial ischemia was defined as an FFR of 0.8 or less. The mean values of diameter stenosis by QCA and FFR were 48.9% +/- 14.9 and 0.76 +/- 0.14, respectively. QCA-TP was significantly correlated with FFR (r = 0.76, p &lt;0.01). The cut-off values of QCA-TP for predicting functional myocardial ischemia based on FFR were 72.8 mm Hg for the left, anterior descending arteries (accuracy, 86.7%; area under the curve [AUC], 0.93), 60.5 mm Hg for the left circumflex arteries (accuracy, 89.3%; AUC, 0.88), and 64.4 mm Hg for the right (accuracy, 88.5%; AUC, 0.94). Therefore, our data suggest that QCA-TP can predict myocardial ischemia with high diagnostic accuracy. (C) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.amjcard.2016.07.026

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Intraprocedural stent thrombosis (IPST) is a rare complication of percutaneous coronary intervention that leads to poor outcomes; however, the factors contributing to IPST remain largely unknown. Accordingly, we used intravascular ultrasound (IVUS) to examine the lesion characteristics in patients with IPST. We retrospectively analyzed 1,504 consecutive stent-implanted lesions in 1,324 patients (326 with ST-segment elevation myocardial infarction [STEMI], 403 patients with non ST-segment elevation acute coronary syndrome [NSTE-ACS], and 595 patients with stable angina). Of these, IPST occurred in 5 patients during percutaneous coronary intervention (0.4% per patient; 3 with STEMI, 2 with NSTE-ACS). The IVUS characteristics of plaques that developed IPST were compared with those of controls without the evidence of IPST (non-IPST; n = 15) who were matched by age, gender, lesion location, and clinical presentation (STEMI, NSTE-ACS, or stable angina). All 5 lesions that led to IPST had ruptured plaques with positive remodeling and attenuation. Plaque rupture was also observed in 40% of the non-IPST group. Multiple plaque ruptures in the culprit lesion were more common in the IPST group (80% vs 7%; p &lt;0.01). The maximum cavity area was larger in the IPST group than in the non-IPST group having plaque rupture (4.6 mm(2) [inter quartile range, 4.3 to 6.5] vs 2.4 mm(2) [1.8 to 2.9]; p &lt;0.01). In conclusion, we found using IVUS that multiple plaque ruptures with larger cavities more often evolved into IPST. (c) 2016 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.amjcard.2015.12.026

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DOI： 10.1093/eurheartj/ehv659

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DOI： 10.1093/ehjci/jev317

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DOI： 10.2169/internalmedicine.55.6484

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Background: Postoperative delirium is a common and serious condition in the clinical setting that has been linked to increased mortality and worse outcomes. Some patients after pacemaker operations may suffer from delirium
however, this condition has not been clarified. The aim of this study was to investigate the prevalence and predictors of delirium after pacemaker operations such as initial permanent pacemaker implantation or pacemaker generator replacement. Methods: We retrospectively evaluated 192 consecutive patients who underwent pacemaker operations. According to the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) criteria, patients were divided into two groups: patients with delirium and patients without delirium after pacemaker operation. The two groups were compared in terms of patient characteristics, clinical settings, and environmental factors. Results: Forty patients (20.8%) suffered from delirium after pacemaker operations and were significantly older than patients without delirium (85.3 ± 6.4. years vs. 80.8 ± 8.4. years, p = 0.0014). Temporary pacing before permanent pacemaker implantation (30% vs. 11%, p = 0.0019) and intensive care unit admission (28% vs. 12%, p = 0.014) were more common in patients with delirium. Moreover, patients with delirium had more frequent heart failure than patients without delirium (78% vs. 41%, p. &lt
. 0.0001). Multiple regression models showed heart failure as an independent predictor of delirium after pacemaker implantation. Conclusions: Delirium after pacemaker operations was not uncommon and heart failure was a strong independent predictor of such a condition.

DOI： 10.1016/j.ijcme.2015.07.003

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This study investigated the relationship between the degree of atherosclerotic changes in the descending thoracic aorta (TA) and the coronary artery using angioscopy. Twenty-five consecutive patients undergoing angioscopy of the TA and coronary angiography were enrolled in this study. Participants were divided into three groups according to the angioscopic grading of the TA: white plaque group (W-group), yellow plaque group (Y-group) and intensive yellow, ruptured plaque with ulceration and/or thrombus group (RP-group). The maximum plaque grade, plaque score, number of yellow plaques, frequency of yellow-plaque grades by coronary angioscopy, and SYNTAX score by coronary angiography were evaluated. Brachial-artery pulse wave velocity and high-sensitivity C-reactive protein level tended to be higher in the RP-group than in the other groups, although the differences were not statistically significant. The SYNTAX score was significantly higher in the RP-group than in the W-group (W-group 4.0 +/- A 3.6 vs. RP-group 17.5 +/- A 10.0, P = 0.045). In addition, the angioscopic maximum plaque grade, plaque score, and number of yellow plaques in the RP-group were significantly higher than in the W-group (maximum plaque grade W-group 0.8 +/- A 0.4 vs. RP-group 1.8 +/- A 0.8, P = 0.026; plaque score W-group 1.0 +/- A 1.2 vs. RP-group 4.0 +/- A 1.4, P = 0.014; and number of yellow plaques W-group 1.0 +/- A 1.2 vs. RP-group 2.5 +/- A 0.5, P = 0.023). The yellow-plaque grade in the coronary artery was correlated significantly with the plaque grading of TA (P = 0.043). Our study suggests that the angioscopic progression of aortic atherosclerosis is closely associated with vulnerability to and the extent of coronary stenosis, indicating that vulnerability toward atherosclerotic plaque development occurs simultaneously in the coronary tree and systemic arteries.

DOI： 10.1007/s10554-015-0669-z

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DOI： 10.1093/eurheartj/ehu497

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The aim of this study was to investigate the effect of sex on the correlation between arterial stiffness and left ventricular (LV) diastolic function in a healthy population without significant atherosclerosis.
Subjects (n 446) who had simultaneous echocardiography and arterial stiffness recordings were enrolled. From these subjects, 95 men and 72 age-matched women without atherosclerotic risk factors (hypertension, dyslipidemia, and diabetes mellitus) were included in the analysis. We measured brachialankle pulse wave velocity (baPWV) and carotid augmentation index (AIx) as arterial stiffness parameters.
Peak early diastolic mitral annular velocity (e) was significantly correlated with baPWV (men: r 0.428, P &lt; 0.001; women: r 0.515, P &lt; 0.001) and carotid AIx (men: r 0.295, P 0.004; women: r 0.558, P &lt; 0.001). The ratio of early diastolic mitral flow velocity to e (E/e) was significantly correlated with both arterial stiffness parameters in women but not men. Multivariable regression analysis revealed carotid AIx ( 0.257; P 0.02) was a significant independent predictor of e in women but not men.
These results suggest that the correlation between AIx and LV diastolic function is stronger in women than men in a healthy population.

DOI： 10.1093/ajh/hpt115

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The diagnosis of lesions with severe calcium or in-stent stenosis using coronary computed tomography angiography (CCTA) is still difficult. The aim of the present study was to evaluate the accuracy of transthoracic Doppler echocardiography (TTDE) in patients with suspected angina pectoris, who had a proximal left coronary artery (LCA) site that could not be evaluated by CCTA. Fifty-eight patients were evaluated. The proximal LCA was defined as the left main coronary artery and proximal left anterior descending coronary artery. All patients underwent TTDE and had coronary angiography performed as a reference method. We measured the proximal left coronary flow velocity (CFV) by both color and pulse Doppler methods. Proximal coronary flow was detected in 45 (78%) of 58 patients. CFVs measured by both methods were significantly greater in the group with severe stenosis (percent diameter stenosis &gt;70%) than in the groups with moderate stenosis (percent diameter stenosis 40% to 70%) or without stenosis (color Doppler: 148 +/- 42 cm/s, 89 +/- 40 cm/s, and 41 +/- 22 cm/s, respectively, p &lt;0.05; pulse Doppler: 143 +/- 61 cm/s, 82 +/- 33 cm/s, and 39 +/- 17 cm/s, respectively, p &lt;0.05). Receiver operating characteristic curve analysis showed that the optimal CFV cut-off values obtained by color and pulse Doppler to diagnose severe stenosis were 92 cm/s (sensitivity, 100%; specificity, 90%) and 81 cm/s (sensitivity, 100%; specificity, 85%), respectively. In conclusion, TTDE could diagnose proximal LCA stenosis with good accuracy in patients who could not be evaluated by CCTA. (c) 2013 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.amjcard.2013.05.023

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DOI： 10.1016/j.jacc.2012.08.1037

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Adaptive servo ventilation (ASV) is reported to be effective for the treatment of heart failure. We treated a patient with idiopathic dilated cardiomyopathy using ASV and assessed the effects on hemodynamics, coronary flow, and flow reserve before and after ASV therapy. This case suggests that ASV might decrease myocardial oxygen demand, which was represented by the decreased resting coronary flow velocity (the improvement of coronary flow velocity reserve) on ASV.

DOI： 10.1016/j.cjca.2012.02.016

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Aims Several studies have demonstrated that type 2 diabetes mellitus (T2DM) is associated with accelerated atherosclerosis, which results in an increased risk of coronary vascular events. However, serial changes in plaque characteristics have not been reported in vivo. We evaluated the progression of coronary atherosclerosis in patients with T2DM using an integrated backscatter intravascular ultrasound (IB-IVUS) examination.
Methods and results Forty-two T2DM and 48 non-diabetic patients who underwent percutaneous coronary intervention were enrolled in the study. Non-culprit 20-mm length coronary lesions with mild-to-moderate stenosis were measured using a 40-MHz (motorized pullback of 0.5 mm/s) IVUS catheter. IVUS examinations were performed on one target lesion in each patient. Six months later, a follow-up IVUS examination was repeated in the same coronary segment imaged at the baseline examination. T2DM patients demonstrated a greater total plaque volume (TPV; 139 +/- 53 vs. 114 +/- 45 mm(3), P = 0.02) and total lipid volume (TLV; 67 +/- 26 vs. 55 +/- 30 mm(3), P = 0.039) at the baseline examination. The progression of TPV (8.6 +/- 15.4 vs. -2.2 +/- 16.0%, P &lt; 0.01) and TLV (10.8 +/- 28.8 vs. -2.5 +/- 20.0%, P &lt; 0.05) from the baseline was observed in T2DM patients, but not in non-diabetic patients. The increase in TLV was blunted in T2DM patients who achieved HbA1c levels of &lt;6.5%.
Conclusion Accelerated plaque progression with an increase in the lipid-rich component of non-culprit plaques was observed in T2DM, despite the use of standard medical treatment. Better glycaemic control ameliorated the worsening of plaque characteristics in T2DM.

DOI： 10.1093/ehjci/jes033

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Aims Late gadolinium enhancement (LGE) on contrast-enhanced magnetic resonance imaging (MRI) in hypertrophic cardiomyopathy (HCM) has been reported to be associated with myocardial fibrosis and cardiac events. In patients with HCM, two-dimensional (2D) strain can identify subclinical global systolic dysfunction despite normal left ventricular (LV) chamber function. Therefore, this study tested the hypothesis that global 2D strain could detect subtle myocardial fibrosis and serve as a novel prognostic parameter in HCM patients.
Methods and results Echocardiography and MRI were performed in 48 consecutive patients with HCM and normal chamber function. We measured global longitudinal strain (GLS) in apical two-chamber, four-chamber, and long-axis views using speckle-tracking analysis. The extent of LGE (%LGE = LGE volume/total LV volume) and LV mass index were calculated by MRI using Simpson's rule and custom software. All patients were followed up for major cardiac events. Global longitudinal strain in patients with LGE was significantly lower than that without LGE (-11.8 +/- 2.8 vs. -15.0 +/- 1.7%, P &lt; 0.001). Multivariate analysis showed that GLS was an independent predictor of %LGE (standard coefficient = 0.627, P &lt; 0.001). During a mean follow-up period of 42 +/- 12 months, five patients had cardiac events. When the patients were stratified based on the median level of GLS (-12.9%), all events were observed in the worse GLS group (P = 0.018).
Conclusion These results suggest that global 2D strain might provide useful information on myocardial fibrosis and cardiac events in HCM patients with normal chamber function.

DOI： 10.1093/ejechocard/jer318

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Slow/no-reflow phenomenon during emergent percutaneous coronary intervention in patients with ST-elevation myocardial infarction (STEMI) results in a poor prognosis. A high thrombus burden was an independent predictor of angiographic slow/no-reflow phenomenon. We experienced a case of a STEMI patient with massive intracoronary thrombus. In our case, a massive red thrombus was aspirated easily by adjunctive pulse infusion thrombolysis (PIT) after failed aspiration. Adjunctive pulse infusion thrombolysis after failed aspiration might be a useful strategy to prevent the slow/no-reflow phenomenon in STEMI patients with massive intracoronary thrombus.

DOI： 10.1016/j.cjca.2011.07.005

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DOI： 10.1016/j.ijcard.2010.10.100

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Coronary steal&apos; is frequently observed in the recipient artery supplied from collaterals. Coronary steal during stress may have an adverse effect on myocardial function even in a &apos;well-collateralized&apos; territory. We experienced one case with functional occlusion in which the coronary steal phenomenon was demonstrated non-invasively using transthoracic Doppler echocardiography. The non-invasive assessment of coronary flow measurement might allow us to obtain useful information for understanding the pathophysiology of coronary steal.

DOI： 10.1093/ejechocard/jer100

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Myocardial bridging (MB) is a congenital anomaly characterized by systolic compression of the tunnelled arterial segment. MB may cause myocardial ischaemia due to abnormal coronary blood flow. We report a case of MB in which transthoracic Doppler echocardiography was used to evaluate the long-term effect of beta-blocker therapy on abnormal coronary blood flow. In this case, beta-blocker therapy with bisoprolol (5.0 mg/day) for 1 month eliminated the patient&apos;s symptoms and normalized coronary blood flow through the tunnelled arterial segment.

DOI： 10.1093/ejechocard/jeq159

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Background: The post-cardiac arrest syndrome includes a decline in myocardial microcirculation function. Inhibition of the platelet IIb/IIIa glycoprotein receptor has improved myocardial microvascular function post-percutaneous coronary intervention. Therefore, we evaluated such inhibition with eptifibatide for its effect on myocardial microcirculation function post-cardiac arrest and resuscitation.
Methods: Four groups of swine were studied in a prospective, randomized, blinded, placebo-controlled protocol including; eptifibatide administered during CPR (Group 1, n = 5), after resuscitation (Group 2, n = 4), during and after resuscitation (Group 3,1 5), or placebo (Group 4, n = 10). CPR was initiated following 12 min of untreated VF. Those successfully resuscitated were studied during a 4-h post-resuscitation period. Coronary flow reserve, a measure of microcirculation function (in the absence of coronary obstruction), as well as parameters of left ventricular systolic and diastolic function, were measured pre-arrest and serially post-resuscitation.
Results: Coronary flow reserve was preserved during the post-resuscitation period, indicating normal microcirculatory function in the eptifibatide-treated animals, but not in the placebo-treated group. However. LV function declined equally in both groups during the first 4 h after cardiac arrest.
Conclusion: Inhibition of platelet IIb/IIIa glycoprotein receptors with eptifibatide post-resuscitation prevented myocardial microcirculation dysfunction. Left ventricular dysfunction post-resuscitation was not improved with eptifibatide, and perhaps transiently worse at 30 min post-resuscitation. Post-cardiac arrest ventricular dysfunction may require a multi-modality treatment strategy for successful prevention or amelioration. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.resuscitation.2010.09.005

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DOI： 10.1016/j.hrthm.2010.08.006

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We experienced a case with atherosclerotic renal artery (RA) stenosis mimicking fibromuscular dysplasia (FMD). In this case, renal angiography, which is considered the 'gold standard' for diagnosing FMD, demonstrated a typical 'string-of-beads' sign. However, integrated backscatter intravascular ultrasound (IB-IVUS) showed severe atherosclerotic stenosis of the RA with a large amount of lipid pool. Therefore, we decided to perform adjunctive stent implantation which is considered optimal treatment of atherosclerotic RA stenosis. Our case suggests that IVUS evaluation might be useful for an accurate diagnosis and to help develop a treatment strategy for revascularisation. © 2011 European Society for Vascular Surgery.

DOI： 10.1016/j.ejvsextra.2011.06.011

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Mitral annular calcification (MAC) is a common finding especially among the elderly. Caseous calcification of the mitral annulus (CCMA) is a rare variant of MAC, which may be mistaken for an intracardiac tumor or abscess. The clinical significance of CCMA and its potential as a source for cerebral embolism is not known.A 76-year-old woman with an acute ischemic stroke was found to have CCMA on echocardiography apparent as a round mass with a central echolucent area and an echo-dense smooth border, in the periannular position of the mitral valve. She subsequently suffered a second embolic stroke. The central cavity of the CCMA seemed to communicate with the left atrium on echocardiography, suggesting the causal relationship between the second brain attack and the CCMA. She was anticoagulated and has not suffered any further strokes.Previous case reports have suggested that CCMA is a benign condition. This detailed report suggests that CCMA may be a potential source of embolic stroke. © 2010 Japanese College of Cardiology.

DOI： 10.1016/j.jccase.2010.05.012

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Thermal therapy for heart failure is recognized to improve clinical symptoms. We describe our experience with appendicular thermal therapy applied to a patient fitted with an extracorporeal left ventricular assist device (LVAD) who was wait-listed for a heart transplant. A 21-year-old mate with end-stage heart failure due to dilated cardiomyopathy was fitted with a LVAD. His general condition stabilized after LVAD placement and the status of his heart failure has remained at NYHA class II for the past 13 months. However, his cardiac function did not sufficiently recover to discontinue LVAD support. We conducted appendicular thermal therapy using a steam foot bath and heated gloves for 2 weeks. Immediately after thermal therapy, his average sublingual temperature increased from 36.3 to 37.0 degrees C and the grade of mitral regurgitation, as well as LV ejection fraction and endothelial function improved. Furthermore, Levels of oxidative and anti-oxidative stress markers decreased and increased, respectively, after 2 weeks of therapy. No complications developed. We conclude that appendicular thermal therapy was safe in this patient waiting for a heart transplant and who had an extracorporeal LVAD, and that the procedure might be beneficial for others with end-stage heart failure. (C) 2008 Japanese College of Cardiology. Published by Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.jjcc.2008.07.020

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【背景】植込みデバイス治療の安全性向上のためには、心臓解剖の習熟と手術手技の修練が不可欠である。本邦でも、手術手技習得を目的としたカダバートレーニング(死体を使った手術研修)が始まっており、今回デバイス植込み手技習得のためのカダバートレーニングを施行したため、報告する。【方法】Thiel固定液で固定された献体を対象とした。解剖室に放射線管理区域を設定し、X線透視を使用できる環境を整えた。実際のデバイス植込みと同様に鎖骨下静脈から心房・心室リードを留置し、その後解剖を行った。【結果】実臨床と同様に鎖骨下静脈からのリード留置が可能であった。しかしながら、非拍動下では心耳の同定が難しく、右心耳へのリード留置は困難であった。リード留置後の解剖では、解剖学的に組織が薄い部位を確認することができた。また、透視では心尖部と思われたリードは実際には心尖部近傍中隔に留置されており、透視上と解剖上の留置部位が異なっていた。真の解剖学的心尖部は、透視のみでは把握困難と考えられた。【結語】カダバートレーニングは心臓の構造を理解し、手技の安全性を向上させるうえで有用であると考えられた。(著者抄録)

DOI： 10.5105/jse.37.12

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS  

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J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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J-GLOBAL

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J-GLOBAL

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：OXFORD UNIV PRESS  

Web of Science

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：OXFORD UNIV PRESS  

Web of Science

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Language：Japanese   Publisher：(公財)日本心臓財団  

症例は64歳、女性。2005年に完全房室ブロックのため、DDDペースメーカー植え込み術を施行された。2008年に左前脛骨部の皮膚生検からサルコイドーシスと確定診断された。2009年4月より労作時呼吸困難が出現し、徐々に増悪した。2010年1月には軽労作でも呼吸困難が出現するようになったため、精査目的で当院に紹介された。心エコー図検査で左室拡大、び漫性の壁運動低下(特に心室中隔基部と後壁の菲薄化)、Gaシンチグラフィや18F-FDG-PETで心臓への集積を認め心サルコイドーシスと診断した。心エコー図検査で右室心尖部ペーシングによる左室同期不全も認めたため、心臓再同期療法およびステロイド療法を開始した。また、終夜睡眠検査で中枢性優位の睡眠時無呼吸症候群の合併を認めたため、陽圧換気療法(adaptive servo-ventilation;ASV)も開始した。治療後、左室駆出率は22.5%から29.7%に、拡張末期左室容積も148mLから104mLに軽度改善したが、reverse remodelingは認めず心機能改善効果は軽度であった。心筋障害や左室remodelingの高度な症例での治療には一定の効果が認められたが限定的であった。このため、心不全早期からの治療介入が重要と考えられたため、文献的考察を加えて報告する。(著者抄録)

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：OXFORD UNIV PRESS  

Web of Science

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Language：Japanese   Publisher：(公社)日本超音波医学会  

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Language：Japanese   Publisher：(公社)日本超音波医学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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An 83-year-old male was diagnosed with acute inferior myocardial infarction and underwent emergency percutaneous coronary intervention (PCI). During primary PCI for the right coronary artery, we experienced coronary perforation induced by the hydrophilic guidewire. We successfully controled the bleeding from the perforated site by embolization with the patient&#039;s own subcutaneous fat tissue taken from the puncture site. Coronary perforation induced by hydrophilic guidewire occurs not only while trying to cross the culprit lesion but also all throughout the wire manipulation process. For prevention and early detection of wire-induced perforation, it is important to watch for the tip of the guidewire during all procedural processes. In case of coronary perforation, prompt management based on angiographic classification and therapeutic algorithm is required to prevent of cardiac tamponade. Embolization by fat tissue is a more rapid and simple method than other embolic procedures.

Scopus

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：OXFORD UNIV PRESS  

Web of Science

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Language：Japanese   Publisher：(一社)日本老年医学会  

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Language：Japanese   Publisher：日本心血管インターベンション学会  

83歳男。労作時、安静時の前胸部痛を主訴とした。脳梗塞の既往がある。胸部X線、心電図、血液検査各所見より、急性下壁心筋梗塞と診断した。右鼠径アプローチにて緊急冠動脈造影を行って責任部位を検索し、経皮的冠動脈インターベンション(PCI)を行った。術中、親水性ガイドワイヤーによる冠動脈穿孔をきたしたため、患者自身の脂肪組織にて塞栓して止血した。タンポナーデ合併は認めなかった。患者自身の皮下組織を用いる方法は、迅速な止血を要する冠動脈穿孔に対して有用性が高いと考えられた。

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

DOI： 10.1253/circj.71.880

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：Japanese   Publisher：社団法人日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(公財)日本心臓財団  

症例は76歳,男性.60歳ころより気管支喘息と診断され近医でテオフィリンなどの内服治療中であった.2005年1月某日から息苦しさが増悪し,夜間の呼吸困難,不眠が出現したため症状出現の3日後に当科を受診した.来院時の胸部X線写真で両側の胸水を認め,うっ血性心不全と診断し同日入院した.両肺野で聴取される湿性ラ音に加えLevine III/VIの収縮期雑音を聴取し,心電図では洞性頻脈とII,III,aVFのQSパターンとV1〜5で深いS波とR波の減高を認めた.また,心エコー図検査では閉塞性肥大型心筋症(HOCM)の所見であった.テオフィリンによる頻拍が心不全の誘因と考え投与を中止し,気管支喘息に対してはロイコトリエン受容体拮抗薬と吸入抗コリン薬を投与した.心不全に対してはシベンゾリンと少量の利尿薬の使用で約1週間後に胸水は消失し,症状も軽快した.シベンゾリン静注による効果を検討する目的でシベンゾリンの内服を3日間中止した後の心エコー図検査で72mmHgの左室内圧較差(LVPG)が確認された.シベンゾリン静注によりLVPGは20mmHgに軽減した.シベンゾリンの内服を継続し,自覚症状も消失したことから2月某日に退院した.今回われわれは気管支喘息や心不全のためにβ遮断薬の投与が不適当であるHOCM患者に対し,シベンゾリンの投与で症状,検査所見とも著明に改善した1例を経験したので報告する(著者抄録)

DOI： 10.11281/shinzo1969.38.8_813

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Language：Japanese   Publisher：(一社)日本老年医学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(公財)日本心臓財団  

症例は68歳,男性.高血圧と糖尿病で近医に通院治療中であった.2004年8月4日に全身倦怠感を主訴に当科外来を受診した.外来時のトレッドミル負荷心電図でII・III・aVFのST低下を認めたため,ATPタリウム心筋シンチグラフィを施行した.下壁の取り込み低下と後期像で同部位の再分布現象を認めたため,9月9日に心臓カテーテル検査を施行した.冠動脈造影では右冠動脈seg.1の慢性完全閉塞を認めた.ワイヤーをIntermediateからShinobi,Conquestに変更しExelsiorのバックアップ下でワイヤーを通過させた.Sprinter(1.5×15mm)で拡張後,血管内視鏡による観察を行った.病変部はワイヤーによる内膜損傷や小さなフラップが観察された.Seg.1〜2にDriver(4.0×30mm),seg.2〜3にPenta(3.5×28mm)を留置し終了した.PCI後の内視鏡ではフラップやプラークをステントが押さえつけている所見が観察された.今回われわれは慢性完全閉塞の病変部を内視鏡で観察し得た1例を経験したので報告する(著者抄録)

DOI： 10.11281/shinzo1969.38.4_346

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本循環器学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：Japanese   Publisher：(一社)日本心臓病学会  

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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Language：English   Publisher：Japanese Circulation Society  

CiNii Books

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