研究者詳細 - 古澤　健司

論文 - 古澤　健司

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Ability of dynamic chest radiography to identify left ventricular systolic dysfunction in heart failure 査読有り

Hiraiwa, H; Nagai, S; Ito, R; Kondo, K; Kazama, S; Kondo, T; Adachi, S; Furusawa, K; Tanaka, A; Morimoto, R; Okumura, T; Murohara, T

INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 41 巻 ( 3 ) 頁： 507 - 521 2025年1月

記述言語：英語出版者・発行元：International Journal of Cardiovascular Imaging

Dynamic chest radiography (DCR) can estimate haemodynamic parameters in heart failure (HF). However, no studies have evaluated its ability to determine cardiac systolic function in HF. This experimental study investigates the correlation between left ventricular (LV) ejection fraction (LVEF) and DCR image parameters in HF. Ninety-one patients with acute HF (median age, 58 years; males, 75%) (cardiologist diagnosis using the Framingham criteria) underwent DCR and transthoracic echocardiography after treatment for the uncompensated phase of HF. The LV apex pixel value (PV) change was measured by DCR. Correlations between the PV change and LVEF, as well as sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of DCR, were evaluated. LVEF and LV apex PV change were correlated in all patients (R = 0.428, P < 0.001) and in patients with LVEF < 50% (n = 38; R = 0.355, P = 0.029), < 40% (n = 31; R = 0.343, P = 0.059), and < 30% (n = 23; R = 0.321, P = 0.135). There was no significant correlation for patients with LVEF ≥ 50% (n = 53; R = − 0.004, P = 0.980). The LV apex PV change rate cutoff values for identifying LVEF < 50%, < 40%, and < 30% were 9.3% (AUC: 0.761, sensitivity: 0.698, specificity: 0.789, P < 0.001), 5.5% (AUC: 0.765, sensitivity: 0.883, specificity: 0.645, P < 0.001), and 5.5% (AUC: 0.767, sensitivity: 0.838, specificity: 0.696, P < 0.001), respectively. DCR may be useful to identify LV systolic dysfunction based on LVEF in acute HF.

DOI： 10.1007/s10554-025-03332-x

The Incidence and Influencing Factors of In-hospital Frailty Progression following Transcatheter Aortic Valve Implantation. 査読有り Open Access

Miyazaki T, Tanaka A, Tokuda Y, Shirai Y, Mizutani K, Furusawa K, Akita S, Ozeki T, Kobayashi K, Ishii H, Mutsuga M, Murohara T

Internal medicine (Tokyo, Japan) 63 巻 ( 24 ) 頁： 3283 - 3289 2024年12月

記述言語：英語出版者・発行元：Internal Medicine

Objective Patients undergoing transcatheter aortic valve implantation (TAVI) are generally older and frailty is therefore an important clinical issue. The baseline degree of frailty is associated with the prognosis in patients undergoing TAVI; however, the incidence of in-hospital frailty progression and its influencing factors have not yet been elucidated. Methods This observational, single-center study retrospectively evaluated 281 patients who underwent TAVI. The degree of frailty at baseline and discharge was evaluated using the Clinical Frailty Scale (CFS). In-hospital frailty progression was defined as an increase of at least one level in the CFS score at discharge from baseline, and predictors of frailty progression were assessed. Results The median baseline CFS score was 4.0 (interquartile range: 3.0-4.0). In-hospital frailty progression was observed in 49 patients (17.4%). No significant differences were observed in age, sex, comorbidities, or surgical risk scores between patients with and without frailty progression. Patients with frailty progression experienced stroke more frequently during hospitalization than those without (12.2% vs. 1.3%, p=0.001). A multivariable logistic analysis showed that in-hospital stroke was a significant predictor of frailty progression (odds ratio, 10.7; 95% confidence interval: 2.34-49.2, p=0.002). Patients with frailty progression had a longer hospital stay than those without frailty progression [7.0 (4.0-17.0) vs. 4.0 (4.0-8.0) days, p=0.001]. Conclusion In-hospital frailty progression was not uncommon in patients undergoing TAVI. Stroke incidence was a significant influencing factor in frailty progression, whereas baseline comorbidities and surgical risks were not.

DOI： 10.2169/internalmedicine.3146-23

Refractory atrial tachycardia after transcatheter closure of an atrial septal defect, successfully treated by catheter ablation with transseptal approach via the side of the device. 査読有り Open Access

Hiramatsu K, Tanaka A, Furusawa K, Inden Y, Murohara T

Journal of cardiology cases 29 巻 ( 6 ) 頁： 258 - 260 2024年6月

記述言語：英語出版者・発行元：Journal of Cardiology Cases

Atrial tachyarrhythmias occurring after transcatheter atrial septal defect closure are not uncommon; however, those related to device stimulation are rare. Herein, a case involving a 24-year-old female, who developed drug-refractory atrial tachycardia during the early postoperative period, is reported. The results of electroanatomical mapping could eventually be obtained from both atria. They revealed a focal pattern, and the earliest site was located on the left atrial side of the superior atrial septum, between the left and right atrial discs of the device. An ablation catheter was inserted through the side of the device into the left atrial septum, and cauterization successfully achieved recovery of the sinus rhythm without device dislodgement. Learning objective: Atrial tachyarrhythmia related to mechanical stimulation with an atrial septal defect closure device in the early perioperative period is a rare complication. Catheter ablation with transseptal approach through the side of the device might be an option, although careful attention should be paid to the risk for device dislodgement.

DOI： 10.1016/j.jccase.2024.02.007

先天性無フィブリノゲン血症患者の多発動脈血栓の評価にSuperb microvascular imaging（SMI）を活用した1例査読有り

服部真代, 西堀正洋, 石津洋二, 荒木芳生, 泉孝嗣, 松原宏紀, 佐藤浩司, 加藤千秋, 古澤健司, 鈴木伸明, 松下正

超音波検査技術 49 巻 ( 2 ) 頁： 131 - 137 2024年4月

記述言語：日本語出版者・発行元：一般社団法人日本超音波検査学会

<p>症例は50代，女性．先天性無フィブリノゲン血症にて通院，加療されていた．202X年10月，C型慢性肝炎の既往に対する腹部超音波検査において腹部大動脈の右腎動脈分岐部付近に偶発的に11×6 mmの血管壁と等輝度の構造物を認め，腹部大動脈の壁在血栓が疑われた．その後施行した胸腹部造影CTにおいても腹部大動脈の壁在血栓が疑われたが，治療適応はなく経過観察となった．同年11月，塞栓源不明の脳梗塞を発症し，MRIにおいて右中大脳動脈領域に散在性梗塞巣，右頸動脈洞に軽度狭窄を認め，入院加療となった．入院中に行った頸動脈超音波検査では，右頸動脈洞に4 mmの低輝度プラークを認めたが，血液検査では高脂血症，糖尿病などの動脈硬化因子は認めず，12誘導心電図検査ならびに経胸壁心臓超音波検査においても異常所見は認めなかった．脳梗塞の原因は頸動脈低輝度プラークに起因することが疑われたため，フィブリノゲン製剤の定期補充とともに，アスピリンによる抗血栓療法が開始され，翌年の超音波検査で腹部大動脈壁在血栓の縮小，右頸動脈洞のプラークにおいても縮小を認めた．右頸動脈洞の低輝度プラークは，治療開始から2週間後に明らかに退縮を認めた臨床経過から，先天性無フィブリノゲン血症が要因で生じた血栓であると推測された．今回の症例では，Superb microvascular imaging（SMI）の活用により従来法であるBモードやカラードプラ法では得られなかった動脈血栓の性状ならびにプラーク内出血を評価したことが，適切な診断や治療効果判定に繋がった．</p>

DOI： 10.11272/jss.404

Preliminary efficacy and safety analysis of tafamidis in post-liver transplant patients with hereditary transthyretin cardiac amyloidosis

Okumura, T; Furusawa, K; Ito, R; Hiraiwa, H; Murohara, T

ARCHIVES OF MEDICAL RESEARCH 56 巻 ( 1 ) 頁： 103083 2024年1月

記述言語：英語出版者・発行元：Archives of Medical Research

Hereditary transthyretin cardiac amyloidosis (ATTRv-CA) after liver transplantation remains challenging to treat due to residual amyloid deposits in extrahepatic organs, including the heart. Tafamidis, a transthyretin tetramer stabilizer, has shown promise in the treatment of ATTRv-CA; however, its efficacy and safety after liver transplantation are uncertain. In this preliminary retrospective review, we assessed the efficacy and safety of tafamidis (80 mg) in three ATTRv-CA cases after liver transplantation. Following one year of treatment, all patients experienced improvement in dyspnea, New York Heart Association functional class, brain natriuretic peptide levels, and cardiac troponin T levels. No significant changes in echocardiographic parameters were observed. Notably, no cardiovascular or drug-related adverse events occurred during treatment. Our findings suggest that tafamidis may benefit post-liver transplant patients with ATTRv-CA and warrant further investigation through randomized controlled trials with larger cohorts. This study highlights a potential therapeutic avenue for the management of cardiovascular involvement in this challenging patient population.

DOI： 10.1016/j.arcmed.2024.103083

Impact of proteinuria on long-term prognosis in patients with coronary artery disease

Funakubo, H; Tanaka, A; Tobe, A; Kunieda, T; Kubota, Y; Yoshioka, N; Otsuka, S; Kudo, N; Shirai, Y; Furusawa, K; Ishii, H; Murohara, T

JOURNAL OF CARDIOVASCULAR MEDICINE 24 巻 ( 12 ) 頁： 900 - 905 2023年12月

記述言語：英語出版者・発行元：Journal of Cardiovascular Medicine

BackgroundThis study aimed to investigate the association between proteinuria and long-term prognosis in patients with coronary artery disease.MethodsThis was a single-center observational study. A total of 1351 patients were identified who underwent percutaneous coronary intervention, and whose urine data were available. Patients were divided into two groups according to the presence (n = 245) or absence (n = 1106) of proteinuria. All-cause and cardiovascular deaths were primarily evaluated.ResultsThe prevalence rates of hypertension and diabetes were significantly higher, and the baseline estimated glomerular filtration rate (eGFR) was lower in patients with proteinuria than in those without proteinuria. During the median follow-up of 4.1 years (interquartile range, 1.7-6.8 years), the occurrences of all-cause and cardiovascular deaths were significantly higher in patients with proteinuria. Multivariable Cox regression analysis indicated that the presence of proteinuria was a significant predictor of cardiovascular death as well as age, BMI, reduced eGFR, and left ventricular ejection fraction. When stratified into four groups based on eGFR category (eGFR <60 or ≥60 ml/min/1.73 m2) and absence or presence of proteinuria, the incidence rates of all-cause and cardiovascular deaths were highest in patients with proteinuria and eGFR less than 60 ml/min/1.73 m2. Furthermore, the incidence rates of all-cause and cardiovascular deaths were significantly higher in patients with proteinuria among both diabetic and nondiabetic patients.ConclusionProteinuria is associated with the long-term prognosis, and all-cause and cardiovascular deaths in patients with coronary artery disease, regardless of eGFR and the presence or absence of diabetes mellitus.

DOI： 10.2459/JCM.0000000000001573

Role of Common Antihypertensives in the Growth of Abdominal Aortic Aneurysm at the Presurgical Stage

Mitsui, T; Bando, YK; Hirakawa, A; Furusawa, K; Morimoto, R; Taguchi, E; Kimura, A; Kamiya, H; Nishikimi, N; Komori, K; Nishigami, K; Murohara, T

CIRCULATION REPORTS 5 巻 ( 11 ) 頁： 405 - 414 2023年11月

Transcatheter Aortic Valve Replacement for Bicuspid Aortic Stenosis With a Severely Calcified Raphe Using An Under-Sized SAPIEN 3 Valve: Sizing by the Circle Method and Deployment by the Pressure-Regulated Method Open Access

Tobe, A; Tanaka, A; Tokuda, Y; Shirai, Y; Miyazaki, T; Yuhara, S; Akita, S; Furusawa, K; Ishii, H; Mutsuga, M; Murohara, T

CARDIOVASCULAR REVASCULARIZATION MEDICINE 53 巻頁： S149 - S152 2023年8月

記述言語：英語出版者・発行元：Cardiovascular Revascularization Medicine

Transcatheter aortic valve replacement (TAVR) for bicuspid aortic valve stenosis is challenging, and the absence of established methods for sizing the bicuspid aortic valve (BAV) complicates TAVR. We report a case of successful TAVR for bicuspid aortic stenosis with a severely calcified raphe. We used an undersized SAPIEN 3 valve, with three safety measures based on assessment of structural characteristics, sizing by the circle method, and deployment of the valve by the pressure-regulated method.

DOI： 10.1016/j.carrev.2022.08.025

Clinical implications of the cardio-ankle vascular index before and after transcatheter aortic valve implantation

Miki, Y; Tanaka, A; Tokuda, Y; Tobe, A; Shirai, Y; Yuhara, S; Akita, S; Furusawa, K; Ishii, H; Mutsuga, M; Murohara, T

JOURNAL OF CARDIOVASCULAR MEDICINE 24 巻 ( 5 ) 頁： 302 - 307 2023年5月

記述言語：英語出版者・発行元：Journal of Cardiovascular Medicine

BackgroundArterial stiffness indices are used to assess the material properties of the arterial wall and are associated with cardiovascular events. Aortic stenosis (AS) is commonly caused by degenerative calcification and can be associated with increased arterial stiffness. However, the clinical implications of arterial stiffness indices in AS patients before and after treatment are unknown.MethodsThis single-center observational study enrolled 150 consecutive patients who underwent transcatheter aortic valve implantation (TAVI) for severe AS. The cardio-ankle vascular index (CAVI) was measured before and after TAVI. The patients were divided into two groups according to the CAVI values before and after TAVI: high CAVI group and low CAVI group. Patient and echocardiographic data and clinical outcomes, including cardiac death and hospitalization for heart failure (HF), were compared.ResultsThe pre- and postprocedural CAVI was 7.90 (6.75-9.30) and 9.65 (8.90-10.65), respectively. In the analyses with preprocedural CAVI, preprocedural echocardiographic aortic valve peak flow velocity was significantly lower in the high CAVI group. No significant differences between the two groups were observed in the occurrence of cardiac death or hospitalization for HF. In the analyses with postprocedural CAVI, B-type natriuretic peptide levels and E/e′ ratio after TAVI were significantly higher in the high CAVI group. The composite of cardiac death and hospitalization occurrence for HF was significantly higher in the high CAVI group.ConclusionCAVI before TAVI is mainly affected by the AS severity, while CAVI after TAVI is associated with left ventricular diastolic dysfunction and late cardiac events, which may reflect arterial stiffness.

DOI： 10.2459/JCM.0000000000001456

The potential of dynamic (99m)Tc-sestamibi cadmium zinc telluride-single-photon emission computed tomography camera assessing myocardial flow reserve in patients with heart failure with preserved ejection fraction. Open Access

Yoshida S, Unno K, Nanasato M, Niimi T, Inukai K, Morisaki H, Hattori T, Hirose M, Hayashi T, Uchida N, Simoda M, Oishi H, Ando M, Hirayama K, Takenaka M, Maeda M, Yoshida R, Ogura Y, Suzuki H, Furusawa K, Morimoto R, Kato K, Isobe S, Yoshida Y, Murohara T

European heart journal open 3 巻 ( 2 ) 頁： oead028 2023年3月

記述言語：英語出版者・発行元：European Heart Journal Open

Aims: Coronary microvascular dysfunction (CMD) is related to the pathophysiology, mortality, and morbidity of heart failure with preserved ejection fraction (HFpEF). A novel single-photon emission computed tomography (SPECT) camera with cadmium zinc telluride (CZT) detectors allows for the quantification of absolute myocardial blood flow and myocardial flow reserve (MFR) in patients with coronary artery disease. However, the potential of CZT-SPECT assessing for CMD has never been evaluated in patients with HFpEF. Methods and results: The clinical records of 127 consecutive patients who underwent dynamic CZT-SPECT were retrospectively reviewed. Rest and stress scanning were started simultaneously with 3 and 9MBq/kg of 99mTc-sestamibi administration, respectively. Dynamic CZT-SPECT imaging data were analysed using a net-retention model with commercially available software. Transthoracic echocardiography was performed in all patients. The MFR value was significantly lower in the HFpEF group (mean ± SEM = 2.00 ± 0.097) than that in the non-HFpEF group (mean ± SEM = 2.74 ± 0.14, P = 0.0004). A receiver operating characteristic analysis indicated that if a cut-off value of 2.525 was applied, MFR could efficiently distinguish HFpEF from non-HFpEF. Heart failure with preserved ejection fraction had a consistently low MFR, regardless of the diastolic dysfunction score. Heart failure with preserved ejection fraction patients with MFR values lower than 2.075 had a significantly higher incidence of heart failure exacerbation. Conclusion: Myocardial flow reserve assessed by CZT-SPECT was significantly reduced in patients with HFpEF. A lower MFR was associated with a higher hospitalization rate in these patients. Myocardial flow reserve assessed by CZT-SPECT has the potential to predict future adverse events and stratify the severity of disease in patients with HFpEF.

DOI： 10.1093/ehjopen/oead028

Impact of Albuminuria on the Prognosis After Transcatheter Aortic Valve Implantation

Tobe, A; Tanaka, A; Tokuda, Y; Shirai, Y; Miyazaki, T; Yuhara, S; Akita, S; Furusawa, K; Ishii, H; Mutsuga, M; Murohara, T

AMERICAN JOURNAL OF CARDIOLOGY 186 巻頁： 156 - 162 2023年1月

記述言語：英語出版者・発行元：American Journal of Cardiology

The impact of preoperative albuminuria on the prognosis after transcatheter aortic valve implantation (TAVI) has not been studied. A total of 228 patients who underwent TAVI for severe aortic stenosis (AS) and for whom preoperative urinary data was available were retrospectively investigated. Patients were divided into two groups according to the urinary albumin-to-creatinine ratio (ACR): high (ACR≥ 30 mg/g) and low (ACR<30 mg/g). The urinary total protein-to-creatinine ratio (PCR) and dipstick proteinuria were also evaluated. The primary outcome was the composite outcome of all-cause death and readmission for heart failure. In total, 117 patients had a high ACR and 111 patients had a low ACR. During the median follow-up period of 467 days, patients with a high ACR had a higher incidence of the primary outcome than those with a low ACR (p<0.001). Patients with a high PCR or positive dipstick proteinuria were also at a higher risk for the primary outcome (p<0.001 and p=0.008, respectively). Multivariable Cox proportional hazards analysis showed a high ACR was independently associated with a primary outcome (hazard ratio, 4.98; 95% confidence interval, 1.84–13.49; p=0.002). In conclusion, preoperative albuminuria is an independent predictor of cardiac events in patients with severe AS undergoing TAVI.

DOI： 10.1016/j.amjcard.2022.09.020

Heterogeneous Carotid Plaque Predicts Cardiovascular Events after Percutaneous Coronary Intervention Open Access

Tobe, A; Tanaka, A; Furusawa, K; Shirai, Y; Funakubo, H; Otsuka, S; Kubota, Y; Kunieda, T; Yoshioka, N; Sato, S; Kudo, N; Ishii, H; Murohara, T

JOURNAL OF ATHEROSCLEROSIS AND THROMBOSIS 30 巻 ( 9 ) 頁： 1187 - 1197 2023年

記述言語：英語出版者・発行元：Journal of Atherosclerosis and Thrombosis

Aim: The relationship between carotid artery ultrasound findings and clinical outcomes in patients who undergo percutaneous coronary intervention (PCI) has not been completely elucidated. Methods: This single-center retrospective study investigated 691 patients who underwent PCI and carotid ultrasound testing. Maximum carotid intima-media thickness (CIMT) was defined as the greatest CIMT at the maximally thick point among the common carotid artery, carotid bulb, and internal carotid artery. A carotid plaque was defined as vessel wall thickening with a CIMT ≥ 1.5 mm. The characteristics of carotid plaque (heterogeneity, calcification, or irregular/ulcerated surface) were evaluated visually. Patients were divided into those with and without heterogeneous carotid plaque (maximum CIMT ≥ 1.5 mm and heterogeneous texture). The endpoint was the incidence of a major adverse cardiovascular event (MACE) defined as a composite of cardiovascular (CV) death, myocardial infarction, and ischemic stroke. Results: Among 691 patients, 309 were categorized as having a heterogeneous plaque. Patients with heterogeneous plaques were at a higher risk of MACE than those without (p=0.002). A heterogeneous plaque was independently associated with MACE after adjusting for covariates (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.01–2.90; p=0.046). Calcified or irregular/ulcerated plaques were correlated with a higher incidence of MACE, but both were not independently associated with MACE (HR, 1.35; 95% CI, 0.69–2.64, p=0.38 and HR, 0.98; 95% CI, 0.57–1.69; p=0.95, respectively). Conclusion: The presence of a heterogeneous carotid plaque in patients who underwent PCI predicted future CV events. These patients may require more aggressive medical therapy and careful follow-up.

DOI： 10.5551/jat.63622

Impact of Handgrip Strength on Clinical Outcomes after Percutaneous Coronary Intervention Open Access

Tobe, A; Tanaka, A; Shirai, Y; Kubota, Y; Kunieda, T; Sato, S; Furusawa, K; Ishii, H; Murohara, T

JOURNAL OF ATHEROSCLEROSIS AND THROMBOSIS 30 巻 ( 9 ) 頁： 1115 - 1122 2023年

記述言語：英語出版者・発行元：Journal of Atherosclerosis and Thrombosis

Aim: The relationship between handgrip strength (HGS) and clinical outcomes after percutaneous coronary intervention (PCI) has not yet been thoroughly investigated. Methods: This was a single-center, observational study. A total of 469 patients who underwent PCI and whose periprocedural HGS was measured were included. Patients were divided into two groups: the low HGS group (men, ＜28 kg; women, ＜18 kg) and the high HGS group (men, ≥ 28 kg; women, ≥ 18 kg). The primary outcome was the composite endpoint of all-cause death, myocardial infarction (MI), and heart failure readmission. Results: There were 151 patients in the low HGS group and 318 patients in the high HGS group. The age of patients in the low HGS group was significantly higher (median [interquartile range]: 78 [71–82] vs. 70 [61–75] years, p＜0.001), while the body mass index and serum albumin level were significantly lower (body mass index: 22.5 [20.2–24.3] vs. 24.3 [22.3–26.6] kg/m2, p＜0.001; serum albumin: 3.6 [3.1–3.9] vs. 4.0 [3.7–4.3] g/dL, p＜ 0.001) than those in the high HGS group. During the median follow-up period of 778 days, the low HGS group had a higher incidence of composite endpoint than the high HGS group (p＜0.001). The low HGS group had a higher risk of all-cause, cardiac, and non-cardiac death (p＜0.001). Multivariable Cox proportional hazards analysis showed that low handgrip strength was an independent predictor for the composite endpoint (hazard ratio 1.80, 95% confidence interval 1.04–3.12, p=0.04). Conclusions: Low HGS was independently associated with adverse outcomes after PCI.

DOI： 10.5551/jat.63854

Impact of C-Reactive Protein on Long-Term Cardiac Events in Stable Coronary Artery Disease Patients with Chronic Kidney Disease Open Access

Tokuda, K; Tanaka, A; Tobe, A; Shirai, Y; Kurobe, M; Kubota, Y; Kunieda, T; Miyazaki, T; Mizutani, K; Furusawa, K; Ishii, H; Murohara, T

JOURNAL OF ATHEROSCLEROSIS AND THROMBOSIS 30 巻 ( 11 ) 頁： 1635 - 1643 2023年

記述言語：英語出版者・発行元：Journal of Atherosclerosis and Thrombosis

Aim: Chronic inflammation is associated with atherosclerosis development. Chronic kidney disease (CKD) is an independent risk factor for cardiovascular events and is associated with chronic inflammation. We aimed to investigate the influence of C-reactive protein (CRP), an important marker of inflammation, on the clinical outcomes of patients with CKD and stable coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). Methods: Among patients with stable CAD and CKD who underwent PCI, 516 patients whose CRP levels were available before the PCI procedure were identified. The patients were divided into two groups according to the CRP levels: those with CRP ≥ 2.0 mg/L (high-CRP group) and those with CRP ＜2.0 mg/L (low-CRP group). The primary endpoint of this study was the occurrence of major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, and unplanned revascularization. Results: Overall, the mean age of the patients was 72.5±9.7 years, and 20.7% were female. The median CRP level was 1.43 mg/L (0.6–4.9 mg/L). The median follow-up period was 3.6 years. The occurrence of MACE was significantly higher in the high-CRP group than in the low-CRP group (log-rank p＜0.001). Notably, the incidence rate of cardiac death was significantly higher in the high-CRP group (log-rank p＜0.001). According to the multivariable analysis, CRP level ≥ 2.0 mg/L was found to be a significant predictor of MACE (hazard ratio [HR]: 1.54, 95% confidence interval [CI]: 1.04–2.28, p=0.003), as well as estimated glomerular filtration rate (HR: 0.98, 95% CI: 0.97–0.99, p＜0.01). Conclusion: High-CRP levels adversely affect long-term cardiac events in patients with stable CAD and CKD.

DOI： 10.5551/jat.64047

寄生虫感染による孤立性壊死性結節の一例

服部真代, 伊藤隆徳, 山本健太, 水野史崇, 佐藤浩司, 松原宏紀, 石津洋二, 石川卓哉, 古澤健司, 服部昌志, 川嶋啓揮

超音波検査技術抄録集 48 巻 ( 0 ) 頁： S207 - S207 2023年

Albuminuria predicts worsening renal function after transcatheter aortic valve replacement Open Access

Tobe, A; Tanaka, A; Tokuda, Y; Fujii, T; Furusawa, K; Ishii, H; Usui, A; Murohara, T

JOURNAL OF CARDIOLOGY 79 巻 ( 5 ) 頁： 648 - 654 2022年11月

記述言語：英語出版者・発行元：Journal of Cardiology

Background: The impact of albuminuria on worsening renal function (WRF) and clinical outcomes after transcatheter aortic valve replacement (TAVR) is unknown. Methods: Overall, 142 patients who underwent TAVR for severe aortic stenosis were divided into two groups based on the preoperative urinary albumin-to-creatinine ratio (ACR): high (ACR ≥30 mg/g) and low (ACR <30 mg/g). The incidence of WRF (an absolute increase in serum creatinine level of ≥0.3 mg/dL or ≥1.5-fold from baseline or dialysis initiation) at 6 months after TAVR and the incidence of all-cause death and heart failure readmission during follow-up were investigated. Results: Half of the examined patients [n=71/142 (50.0%)] had a high ACR. Patients with a high ACR more frequently had WRF at 6 months than those with a low ACR (17.6% vs. 2.9%, p=0.004). Multivariate analysis showed a high ACR was independently associated with WRF (odds ratio, 7.76; 95% confidence interval, 1.62–37.30; p=0.01), whereas baseline estimated glomerular filtration rate <60 mL/min/1.73m² was not (odds ratio, 0.34; 95% confidence interval, 0.08–1.50; p=0.15). Patients with a high ACR had a higher risk of composite outcomes of all-cause death and heart failure readmission (p=0.002). Conclusions: Preoperative albuminuria (ACR ≥30 mg/g) was independently associated with WRF at 6 months after TAVR. Furthermore, patients with an ACR ≥30 mg/g had higher risks of all-cause death and heart failure readmission than those with an ACR <30 mg/g.

DOI： 10.1016/j.jjcc.2021.11.014

Albuminuria predicts worsening renal function at 1 month after transcatheter aortic valve implantation

Tobe, A; Tanaka, A; Tokuda, Y; Shirai, Y; Yamamoto, T; Tokoro, M; Furusawa, K; Ishii, H; Usui, A; Murohara, T

EUROPEAN HEART JOURNAL 43 巻頁： 1610 - 1610 2022年10月

Heterogeneous carotid plaque is associated with cardiovascular events after percutaneous coronary intervention

Tobe, A; Tanaka, A; Furusawa, K; Shirai, Y; Funakubo, H; Otsuka, S; Kubota, Y; Kunieda, T; Yoshioka, N; Sato, S; Kudo, N; Ishii, H; Murohara, T

EUROPEAN HEART JOURNAL 43 巻頁： 1140 - 1140 2022年10月

Albuminuria Predicts Short-Term Worsening Renal Function After Transcatheter Aortic Valve Replacement Open Access

Tobe, A; Tanaka, A; Tokuda, Y; Shirai, Y; Otsuka, S; Yamamoto, T; Tokoro, M; Furusawa, K; Ishii, H; Usui, A; Murohara, T

CARDIOVASCULAR REVASCULARIZATION MEDICINE 42 巻頁： 179 - 182 2022年9月

記述言語：英語出版者・発行元：Cardiovascular Revascularization Medicine

Albuminuria is a major risk factor of cardiovascular events, however, the impact of albuminuria on clinical outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) has not been fully investigated. This retrospective study included 206 patients who underwent TAVR for severe aortic stenosis. Patients were divided into two groups according to the preoperative urinary albumin-to-creatinine ratio (ACR): high (ACR ≥ 30 mg/g) and low (ACR < 30 mg/g). The incidence of 1-month worsening renal function (WRF), defined as a decrease in estimated glomerular filtration rate (eGFR) ≥10% from baseline after TAVR, was investigated. Patients with high ACR had acute kidney injury (8.5% vs. 1.0%, p = 0.01) and 1-month WRF (29.2% vs. 12.0%, p = 0.002) more frequently than those with low ACR. High ACR was independently associated with 1-month WRF (odds ratio, 3.72; 95% confidence interval, 1.72–8.08; p < 0.001). Albuminuria can be a useful predictor of deterioration of renal function at various time points after TAVR.

DOI： 10.1016/j.carrev.2022.03.014

Splenic size as an indicator of hemodynamics and prognosis in patients with heart failure

Hiraiwa, H; Okumura, T; Sawamura, A; Araki, T; Mizutani, T; Kazama, S; Kimura, Y; Shibata, N; Oishi, H; Kuwayama, T; Kondo, T; Furusawa, K; Morimoto, R; Murohara, T

HEART AND VESSELS 37 巻 ( 8 ) 頁： 1344 - 1355 2022年8月

記述言語：英語出版者・発行元：Heart and Vessels

The spleen is an important immune organ that releases erythrocytes and monocytes and destroys aged platelets. It also reserves 20–30% of the total blood volume, and its size decreases in hypovolemic shock. However, the clinical significance of splenic size in patients with heart failure (HF) remains unclear. We retrospectively analyzed the data of 206 patients with clinically stable HF gathered between January 2001 and August 2020 and recorded in a single-center registry. All patients underwent right heart catheterization and computed tomography (CT). Splenic size was measured using CT volumetry. The primary outcomes were composite cardiac events occurring for the first time during follow-up, namely, cardiac death and hospitalization for worsening HF. The median splenic volume and splenic volume index (SVI) were 118.0 mL and 68.9 mL/m2, respectively. SVI was positively correlated with cardiac output (r = 0.269, P < 0.001) and stroke volume (r = 0.228, P = 0.002), and negatively correlated with systemic vascular resistance (r = − 0.302, P < 0.001). Seventy cardiac events occurred, and the optimal receiver operating characteristic curve SVI cutoff value for predicting cardiac events was 68.9 mL/m2. The median blood adrenaline concentration was higher in the low-SVI group than the high-SVI group (0.039 ng/mL vs. 0.026 ng/mL, respectively; P = 0.004), and the low-SVI group experienced more cardiac events (log-rank test, P < 0.001). Multivariate Cox proportional hazards regression revealed that a low SVI was an independent predictor of cardiac events, even when adjusted for the validated HF risk score, blood–brain natriuretic peptide concentration, blood catecholamine concentrations, and hemodynamic parameters. Splenic size reflects hemodynamics, including systemic circulating blood volume status and sympathetic nerve activity, and is associated with HF prognosis.

DOI： 10.1007/s00380-022-02030-1

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