研究者詳細 - 古澤　健司

Flexion limitation of the Impella 5.0 when implanted using the femoral approach in patients with small stature

Hiraiwa, H; Kimura, Y; Morimoto, R; Ito, R; Araki, T; Mizutani, T; Kazama, S; Oishi, H; Kuwayama, T; Kondo, T; Furusawa, K; Okumura, T; Mutsuga, M; Usui, A; Murohara, T

JOURNAL OF ARTIFICIAL ORGANS 25 巻 ( 2 ) 頁： 182 - 183 2022年6月

Right Ventricular Dyssynchrony Casts New Light on the Risk Stratification and Prediction of Prognosis in Patients With Pulmonary Hypertension Open Access

Adachi, S; Nakano, Y; Furusawa, K

CIRCULATION JOURNAL 86 巻 ( 6 ) 頁： 945 - 946 2022年6月

Relationship between spleen size and exercise tolerance in advanced heart failure patients with a left ventricular assist device Open Access

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; Adachi, T; Yamada, S; Mutsuga, M; Usui, A; Murohara, T

BMC RESEARCH NOTES 15 巻 ( 1 ) 頁： 40 2022年2月

記述言語：英語出版者・発行元：BMC Research Notes

Objective: Spleen volume increases in patients with advanced heart failure (HF) after left ventricular assist device (LVAD) implantation. However, the relationship between spleen volume and exercise tolerance (peak oxygen consumption [VO2]) in these patients remains unknown. In this exploratory study, we enrolled 27 patients with HF using a LVAD (median age: 46 years). Patients underwent blood testing, echocardiography, right heart catheterization, computed tomography (CT), and cardiopulmonary exercise testing. Spleen size was measured using CT volumetry, and the correlations/causal relationships of factors affecting peak VO2 were identified using structural equation modeling. Results: The median spleen volume was 190.0 mL, and peak VO2 was 13.2 mL/kg/min. The factors affecting peak VO2 were peak heart rate (HR; β = 0.402, P =.015), pulmonary capillary wedge pressure (PCWP; β = − 0.698, P =.014), right ventricular stroke work index (β = 0.533, P =.001), blood hemoglobin concentration (β = 0.359, P =.007), and spleen volume (β = 0.215, P =.041). Spleen volume correlated with peak HR, PCWP, and hemoglobin concentration, reflecting sympathetic activity, cardiac preload, and oxygen-carrying capacity, respectively, and was thus related to peak VO2. These results suggest an association between spleen volume and exercise tolerance in advanced HF.

DOI： 10.1186/s13104-022-05939-y

Clinical Significance of the Left Atrial Appendage Orifice Area Open Access

Miki, Y; Uchida, Y; Tanaka, A; Tobe, A; Sakakibara, K; Kataoka, T; Niwa, K; Furusawa, K; Ichimiya, H; Watanabe, J; Kanashiro, M; Ishii, H; Ichimiya, S; Murohara, T

INTERNAL MEDICINE 61 巻 ( 12 ) 頁： 1801 - 1807 2022年

記述言語：英語出版者・発行元：Internal Medicine

Objective The left atrial appendage (LAA) is one of the major sources of cardiac thrombus formation. Three-dimensional transesophageal echocardiography (TEE) made it possible to perform a detailed evaluation of the LAA morphologies. This study aimed to evaluate the clinical implications of the LAA orifice area. Methods A total of 149 patients who underwent TEE without significant valvular disease were studied. The LAA orifice area was measured using three-dimensional TEE. The patients were divided into two groups according to the LAA orifice area (large LAA orifice group, !median value, and small LAA orifice group). The clinical characteristics and echocardiographic findings were evaluated. Results The median LAA orifice area among all patients was 4.09 cm2 (interquartile range 2.92-5.40). The large LAA orifice group were older (67.2±10.4 vs. 62.4±15.3 years, p=0.02), more often had hypertension (66.7% vs. 44.6%, p=0.007), and atrial fibrillation (70.7% vs. 39.2%, p<0.001) than the small LAA orifice group. Regarding the TEE findings, the LAA flow velocity was significantly lower (33.7±20.0 vs. 50.2±24.3, p<0.001) and spontaneous echo contrast was more often observed (21.3% vs. 8.1%, p=0.02) in the large LAA orifice group. Multivariate models demonstrated that atrial fibrillation was an independent predictor of the LAA orifice area. In the analysis of atrial fibrillation duration, the LAA orifice area tended to be larger as patients had a longer duration of atrial fibrillation. Conclusion Our findings indicated that a larger LAA orifice area was associated with the presence of atrial fibrillation and high thromboembolic risk based on TEE findings. A continuation of the atrial fibrillation rhythm might lead to the gradual expansion of the LAA orifice.

DOI： 10.2169/internalmedicine.8301-21

肺血栓塞栓症を発症した浮遊血栓の検討

笹木優賢, 弘津真由子, 金沙玲, 三井由姫乃, 新島萌, 古澤健司

超音波検査技術抄録集 47 巻 ( 0 ) 頁： S134 - S134 2022年

大学病院における下肢静脈超音波検査の臨床的特徴

新島萌, 笹木優賢, 弘津真由子, 三井由姫乃, 金沙玲, 古澤健司

超音波検査技術抄録集 47 巻 ( 0 ) 頁： S134 - S134 2022年

冠静脈洞開口部に欠損孔を有する冠静脈洞型心房中隔欠損症の一例

佐藤夏巳, 古澤健司, 大熊相子, 諸岡貴子, 菊地はつみ, 住田佳陽, 三井由姫乃, 金沙玲, 弘津真由子, 加藤智美, 鈴木伊都子, 笹木優賢

超音波検査技術抄録集 47 巻 ( 0 ) 頁： S179 - S179 2022年

先天性フィブリノゲン異常症患者に合併した多発動脈血栓の一例

服部真代, 笹木優賢, 鈴木伸明, 石津洋二, 荒木芳生, 岩﨑純子, 新島萌, 山本健太, 伊藤隆徳, 川嶋啓揮, 古澤健司, 松下正

超音波検査技術抄録集 47 巻 ( 0 ) 頁： S137 - S137 2022年

Incidental findings on computed tomography for preoperative assessment before transcatheter aortic valve implantation in Japanese patients

Tobe, A; Tanaka, A; Tokuda, Y; Miki, Y; Furusawa, K; Akita, S; Fujii, T; Tsutsumi, Y; Ishii, H; Iwano, S; Naganawa, S; Usui, A; Murohara, T

HEART AND VESSELS 36 巻 ( 12 ) 頁： 1911 - 1922 2021年12月

記述言語：英語出版者・発行元：Heart and Vessels

Extra-cardiovascular incidental findings (IFs) on preoperative computed tomography (CT) are frequently observed in transcatheter aortic valve implantation (TAVI) candidates. However, the backgrounds of TAVI candidates and comorbidities differ based on the race and/or country, and data on IFs in a specific population are not always applicable to another. The aim of this study was to assess the prevalence, type, and clinical impact of IFs in Japanese TAVI candidates. This was a retrospective, single-center, observational study. CT reports of 257 TAVI candidates were reviewed, and IFs were classified as (a) insignificant: findings that did not require further investigation, treatment, or follow-up; (b) intermediate: findings that needed to be followed up or were considered for further investigation but did not affect the planning of TAVI; and (c) significant: findings that required further investigation immediately or affected the planning of TAVI. At least one IF was found in 254 patients (98.8%). Insignificant, intermediate, and significant IFs were found in 253 (98.4%), 153 (59.5%), and 34 (13.2%) patients, respectively. Newly indicated significant IFs were found in 19 patients (7.4%). In 2 patients (0.8%), TAVI was canceled because of significant IFs. In patients who consequently underwent TAVI, the presence of significant IFs was not associated with the duration from CT performance to TAVI [28 (19–40) days vs. 27 (19–43) days, p = 0.74] and all-cause mortality during the median follow-up period of 413 (223–805) days (p = 0.44). Almost all Japanese TAVI candidates had at least one IF, and the prevalence of significant IFs was not negligible. Although the presence of significant IFs was not associated with mid-term mortality, appropriate management of IFs was considered important.

DOI： 10.1007/s00380-021-01875-2

Clinical outcomes following percutaneous coronary intervention for bifurcation lesions: kissing balloon inflation vs. sequential dilation

Hitora, Y; Teraoka, T; Tanaka, A; Uemura, Y; Tobe, A; Sakakibara, K; Miki, Y; Kataoka, T; Niwa, K; Tashiro, H; Furusawa, K; Takemoto, K; Watarai, M; Kimura, A; Ishii, H; Murohara, T

CARDIOVASCULAR INTERVENTION AND THERAPEUTICS 36 巻 ( 4 ) 頁： 436 - 443 2021年10月

記述言語：英語出版者・発行元：Cardiovascular Intervention and Therapeutics

Percutaneous coronary intervention for bifurcation lesions remains challenging, with there being several debatable issues, including the requirement for kissing balloon inflation (KBI). The objective of this study was to assess the clinical outcomes following single crossover stent implantation with KBI or sequential dilation alone. Data were examined for 255 non-left main bifurcation lesions (246 patients) treated with single crossover stent implantation, followed by side branch (SB) strut dilation with KBI (n = 74 lesions) or sequential dilation (n = 181 lesions) in three hospitals. Target lesion revascularization (TLR) was the primary endpoint. There was no significant difference in the pre-procedural reference diameter of both the main vessel (MV) and SB between the KBI and sequential dilation groups. However, MV post-dilation balloon size was smaller with lower pressure and post-procedural minimal lumen diameter was significantly smaller in the KBI group. During the median follow-up period of approximately 3 years, TLR incidence was significantly higher in the KBI group than in the sequential dilation group; in particular, the TLR rate at the distal MV was higher in the former. For bifurcation lesions treated with single crossover stent implantation, the TLR rate was higher after KBI than after sequential dilation; this was mainly due to higher revascularization in the distal MV. For bifurcation lesions treated with KBI, MV post-dilation balloon diameter tended to be smaller with lower pressure, which might lead to poorer stent expansion and a higher TLR rate.

DOI： 10.1007/s12928-020-00728-5

Regression of electrocardiographic left ventricular hypertrophy after transcatheter aortic valve replacement for aortic stenosis

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

EUROPEAN HEART JOURNAL 42 巻頁： 1625 - 1625 2021年10月

Incidental findings on computed tomography for preoperative assessment before transcatheter aortic valve implantation in japanese patients

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

EUROPEAN HEART JOURNAL 42 巻頁： 1626 - 1626 2021年10月

Clinical significance of spleen size in patients with heart failure

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

EUROPEAN HEART JOURNAL 42 巻頁： 756 - 756 2021年10月

Clinical impact of visually assessed right ventricular dysfunction in patients with septic shock Open Access

Hiraiwa, H; Kasugai, D; Ozaki, M; Goto, Y; Jingushi, N; Higashi, M; Nishida, K; Kondo, T; Furusawa, K; Morimoto, R; Okumura, T; Matsuda, N; Matsui, S; Murohara, T

SCIENTIFIC REPORTS 11 巻 ( 1 ) 頁： 18823 2021年9月

記述言語：英語出版者・発行元：Scientific Reports

We retrospectively analyzed data from the Medical Information Mart for Intensive Care-III critical care database to determine whether visually-assessed right ventricular (RV) dysfunction was associated with clinical outcomes in septic shock patients. Associations between visually-assessed RV dysfunction by echocardiography and in-hospital mortality, lethal arrhythmia, and hemodynamic indicators to determine the prognostic value of RV dysfunction in patients with septic shock were analyzed. Propensity score analysis showed RV dysfunction was associated with increased risk of in-hospital death in patients with septic shock (adjusted odds ratio [OR] 2.15; 95% confidence interval [CI] 1.99–2.32; P < 0.001). In multivariate logistic regression analysis, RV dysfunction was associated with in-hospital death (OR 2.19; 95% CI 1.91–2.53; P < 0.001), lethal arrhythmia (OR 2.19; 95% CI 1.34–3.57; P < 0.001), and tendency for increased blood lactate levels (OR 1.31; 95% CI 1.14–1.50; P < 0.001) independent of left ventricular (LV) dysfunction. RV dysfunction was associated with lower cardiac output, pulmonary artery pressure index, and RV stroke work index. In patients with septic shock, visually-assessed RV dysfunction was associated with in-hospital mortality, lethal arrhythmia, and circulatory insufficiency independent of LV dysfunction. Visual assessment of RV dysfunction using echocardiography might help to identify the short-term prognosis of patients with septic shock by reflecting hemodynamic status.

DOI： 10.1038/s41598-021-98397-8

Improvement in the nutritional status after transcatheter aortic valve implantation Open Access

Tobe, A; Tanaka, A; Tokuda, Y; Akita, S; Miki, Y; Furusawa, K; Ishii, H; Usui, A; Murohara, T

JOURNAL OF CARDIOLOGY 78 巻 ( 3 ) 頁： 250 - 254 2021年9月

記述言語：英語出版者・発行元：Journal of Cardiology

Background: A poor nutritional status of patients before transcatheter aortic valve implantation (TAVI) has been reported to be associated with poor clinical outcomes. However, changes in the nutritional status following TAVI have not been fully elucidated. Methods: In this single-center retrospective observational study, 129 patients whose nutritional status at baseline and 6 months after TAVI were available were investigated. The prognostic nutritional index (PNI) and geriatric nutritional risk index (GNRI) were used to assess the nutritional status of the patients at baseline and at 6 months. We further assessed changes in the nutritional status of patients in the subgroups stratified according to the baseline levels as low and high. Results: The PNI and GNRI values at 6 months were significantly better than at baseline [PNI, baseline: 44.5 (41.0–48.0), 6 months: 46.0 (41.9–48.3), p = 0.02; GNRI, baseline: 95.3 (89.0–100.3), 6 months: 97.8 (91.5–101.4), p = 0.006]. Both PNI and GNRI values at 6 months were significantly better in the patients with a low baseline nutritional status, while no significant change was observed in those with high baseline levels [PNI, low; baseline: 36.8 (36.1–39.4), 6 months: 40.8 (39.0–43.4), p = 0.002, high; baseline: 47.0 (43.0–49.5), 6 months: 46.5 (43.5–50.5), p = 0.44 and GNRI, low; baseline: 86.4 (81.7–88.7), 6 months: 88.6 (83.4–95.3), p = 0.001, high; baseline: 99.8 (95.3–102.8), 6 months: 100.7 (96.8–103.4), p = 0.34]. Conclusion: Nutritional status of patients might improve during the chronic phase after TAVI, especially in those with poor baseline levels.

DOI： 10.1016/j.jjcc.2021.04.006

Prognostic impact of immune-related adverse events on patients with and without cardiovascular disease: a retrospective review Open Access

Prognostic value of resting cardiac power index depends on mean arterial pressure in dilated cardiomyopathy Open Access

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

ESC HEART FAILURE 8 巻 ( 4 ) 頁： 3206 - 3213 2021年8月

記述言語：英語出版者・発行元：ESC Heart Failure

Aims: In recent decades, haemodynamic parameters have been estimated for risk stratification and determining treatment strategies for patients with non-ischaemic dilated cardiomyopathy (DCM). In various invasive procedures, the cardiac pumping capability is defined as cardiac power output (CPO), which is calculated by multiplying cardiac output by the mean arterial pressure. Lower CPO values in advanced heart failure predict adverse outcomes. However, few studies discuss the prognostic value of CPO in mild-to-moderate phase patients. This study aimed to determine the value of the cardiac power index (CPI) obtained from the resting CPO for predicting the prognosis of patients with New York Heart Association Functional Class II or III DCM. Methods and results: From March 2000 to January 2020, a total of 623 cardiomyopathy patients were evaluated for haemodynamic parameters. Patients with secondary cardiomyopathy, ischaemic cardiomyopathy, valvular heart disease, and Class IV cardiomyopathy were excluded. A total of 176 DCM patients fulfilled the criteria for inclusion. Patients were 51.7 ± 12.5 years old (mean ± standard deviation) with a mean left ventricular ejection fraction of 32.1 ± 9.2%. The patients were divided into two groups by their median CPI (CPI < 0.52, low-CPI; CPI ≥ 0.52, high-CPI). No significant differences were found in the left ventricular end-diastolic diameter, left ventricular ejection fraction, or pulmonary arterial wedge pressure between the groups. The probability of cardiac event-free survival was significantly lower for low-CPI than for high-CPI groups by Kaplan–Meier analysis (P = 0.012), even with no significant difference between the high and low cardiac index groups (P = 0.069). Furthermore, Cox proportional hazards regression analysis revealed that, in addition to the CPI, the systolic and mean arterial pressure involved in CPI calculation were independent predictors of cardiac events. Indeed, among these factors, mean arterial pressure had the strongest prognostic ability. Conclusions: Although CPI is effective for stratifying DCM and predicting cardiac events in patients with Class II/III DCM, this prognostic value depends on mean arterial pressure.

DOI： 10.1002/ehf2.13446

Kazama, S; Morimoto, R; Kimura, Y; Shibata, N; Ozaki, R; Araki, T; Mizutani, T; Oishi, H; Arao, Y; Kuwayama, T; Hiraiwa, H; Kondo, T; Furusawa, K; Shimokata, T; Okumura, T; Bando, YK; Ando, Y; Murohara, T

CARDIO-ONCOLOGY 7 巻 ( 1 ) 頁： 26 2021年7月

記述言語：英語出版者・発行元：Cardio-Oncology

Background: The emergence of immune checkpoint inhibitors (ICIs) has brought about a paradigm shift in cancer treatment as the use of these drugs has become more frequent and for a longer duration. As a result of T-cell-mediated inflammation at the programmed cell death-1, programmed death-ligand-1, and cytotoxic T-lymphocyte antigen-4 pathways, immune-related adverse events (irAEs) occur in various organs and can cause a rare but potentially induced cardiotoxicity. Although irAEs are associated with the efficacy of ICI therapy and better prognosis, there is limited information about the correlation between irAEs and cardiotoxicity and whether the benefits of irAEs apply to patients with underlying cardiovascular disease. This study aimed to investigate the association of irAEs and treatment efficacy in patients undergoing ICI therapy with and without a cardiovascular history. Methods: We performed a retrospective review of the medical records of 409 consecutive patients who received ICI therapy from September 2014 to October 2019. Results: Median patient age was 69 years (29.6% were female). The median follow-up period was 278 days. In total, 69 (16.9%) patients had a history of any cardiovascular disease and 14 (3.4%) patients experienced cardiovascular irAEs after ICI administration. The rate of cardiovascular irAEs was higher in patients with prior non-cardiovascular irAEs than without. The prognosis of patients with irAEs (+) was significantly better than that of the patients without irAEs (P < 0.001); additionally, this tendency did not depend on the presence or absence of a cardiovascular history. Furthermore, the Cox proportional hazards analysis revealed that irAEs were an independent predictor of mortality. Conclusions: Although cardiovascular irAEs may be related to prior non-cardiovascular irAEs under ICI therapy, the occurrence of irAEs had a better prognostic impact and this tendency was not affected by cardiovascular history.

DOI： 10.1186/s40959-021-00112-z

Worsening renal function after transcatheter aortic valve replacement and surgical aortic valve replacement

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

HEART AND VESSELS 36 巻 ( 7 ) 頁： 1080 - 1087 2021年7月

記述言語：英語出版者・発行元：Heart and Vessels

Several prior reports have investigated worsening renal function around transcatheter aortic valve replacement (TAVR) procedures. However, in clinical practice, it seems more important to evaluate changes associated with TAVR-related procedures, including preoperative enhanced computed tomography (CT), as well as the TAVR procedure itself, as CT assessment is considered essential for safe TAVR. This study evaluated worsening renal function during the TAVR perioperative period, from the preoperative enhanced CT to 1 month after TAVR, and then compared the incidence with that in patients undergoing surgical aortic valve replacement (SAVR). This retrospective single-center study investigated 123 TAVR patients and 130 SAVR patients. We evaluated baseline renal function before enhanced CT in TAVR patients and before operation in SAVR patients, and again at 1 month post-operatively. We defined worsening renal function at 1 month according to three definitions: (1) an increase in serum creatinine ≥ 0.3 mg/dL or ≥ 1.5-fold from baseline or initiation of dialysis, (2) a decline in eGFR at 1 month ≥ 20% from baseline or initiation of dialysis, (3) a decline in eGFR at 1 month ≥ 30% from baseline or initiation of dialysis. TAVR patients were significantly older and had higher surgical risk scores than SAVR patients. In TAVR patients, serum creatinine levels were 1.00 ± 0.32 mg/dL at baseline and 1.01 ± 0.40 mg/dL at 1 month post-operatively (p = 0.58), while in SAVR patients, these levels were 0.99 ± 0.51 mg/dL and 0.98 ± 0.49 mg/dL, respectively (p = 0.59). In TAVR patients, 7 (5.7%), 14 (11.4%), and 3 (2.4%) patients experienced worsening renal function according to the three definitions, respectively, but there were no significant differences from those in SAVR patients, for any definition. Worsening renal function after TAVR was uncommon, and the incidence rate was comparable to that in SAVR patients, even though TAVR patients had worse baseline characteristics.

DOI： 10.1007/s00380-021-01778-2