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

Large interventricular membranous septal aneurysm renders the anatomy unsuitable for transcatheter aortic valve replacement

Shirai, Y; Tanaka, A; Tokuda, Y; Tobe, A; Furusawa, K; Usui, A; Murohara, T

JOURNAL OF CARDIAC SURGERY 37 巻 ( 7 ) 頁： 2103 - 2104 2022年7月

記述言語：英語出版者・発行元：Journal of Cardiac Surgery

An interventricular membranous septal aneurysm, though rare, can coexist with aortic valve stenosis. In this report, we present an unsuitable anatomy for transcatheter aortic valve replacement (TAVR) due to large interventricular membranous septal aneurysm. This case suggests that the feasibility of TAVR would depend on the location and size of the aneurysm and its relationship with the aortic root.

DOI： 10.1111/jocs.16504

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 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

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

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

Regression of Electrocardiographic Left Ventricular Hypertrophy After Transcatheter Aortic Valve Implantation for Aortic Stenosis Open Access

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

CIRCULATION JOURNAL 85 巻 ( 7 ) 頁： 1093 - 1098 2021年7月

記述言語：英語出版者・発行元：Circulation Journal

Background: The changes in electrocardiographic left ventricular hypertrophy (ECG-LVH) after transcatheter aortic valve implantation (TAVI) are not fully elucidated. Methods and Results: The study group included 64 patients who underwent TAVI for aortic stenosis. Their 12-lead ECGs before and at 2 days and 1, 6 and 12 months after TAVI were analyzed, and ECG-LVH was evaluated using various definitions. Values and prevalence of each ECG-LVH parameter significantly decreased between 1 and 6 months after TAVI. Values of ECG-LVH parameters decreased especially in patients with ECG-LVH at baseline. Conclusions: Regression of ECG-LVH was observed between 1 and 6 months after TAVI.

DOI： 10.1253/circj.CJ-21-0354

Association between splenic volume and pulsatility index in patients with left ventricular assist devices

Hiraiwa, H; Okumura, T; Sawamura, A; Kondo, T; Kazama, S; Kimura, Y; Shibata, N; Arao, Y; Oishi, H; Kato, H; Kuwayama, T; Yamaguchi, S; Furusawa, K; Morimoto, R; Fujimoto, K; Mutsuga, M; Usui, A; Murohara, T

INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS 44 巻 ( 4 ) 頁： 282 - 287 2021年4月

記述言語：英語出版者・発行元：International Journal of Artificial Organs

The spleen serves as a blood volume reservoir for systemic volume regulation in heart failure (HF) patients. Changes are seen in spleen size in advanced HF patients after left ventricular assist device (LVAD) implantation. The pulsatility index (PI) is an indicator of native heart contractility with hemodynamic changes in patients using LVAD. We hypothesized that the splenic volume was associated with the PI, reflecting the hemodynamics in advanced HF patients with LVADs. Herein, we investigated the relationship between splenic volume and PI in these patients. Forty-four patients with advanced HF underwent implantation of HeartMate II® (Abbott, Chicago, IL, USA) as a bridge to heart transplantation at the Nagoya University Hospital between October 2013 and June 2019. The data of 27 patients (21 men, median age 46 years) were analyzed retrospectively. All patients underwent blood tests, echocardiography, right heart catheterization, and computed tomography (CT). Spleen size was measured via CT volumetry; the splenic volume (median: 190 mL) correlated with right arterial pressure (r = 0.431, p = 0.025) and pulmonary capillary wedge pressure (r = 0.384, p = 0.048). On multivariate linear regression analysis, the heart rate (β = −0.452, p = 0.003), pump power (β = −0.325, p = 0.023), and splenic volume (β = 0.299, p = 0.038) were independent determinants of PI. The splenic volume was associated with PI, reflecting the cardiac preload in advanced HF patients with LVADs. Thus, spleen measurement using CT may help estimate the systemic volume status and understand the hemodynamic conditions in LVAD patients.

DOI： 10.1177/0391398820957019

Relationship between epicardial adipose tissue volume and coronary artery spasm

Kataoka, T; Harada, K; Tanaka, A; Onishi, T; Matsunaga, S; Funakubo, H; Harada, K; Nagao, T; Shinoda, N; Marui, N; Niwa, K; Tashiro, H; Hitora, Y; Furusawa, K; Ishii, H; Amano, T; Murohara, T

INTERNATIONAL JOURNAL OF CARDIOLOGY 324 巻頁： 8 - 12 2021年2月

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

Background: Epicardial adipose tissue (EAT) is considered to play a critical role in vascular endothelial function. Coronary artery spasm has been postulated to be a causal factor in vascular endothelial abnormalities and atherosclerosis. This study aimed to investigate the relationship between coronary artery spasm and EAT volume, total abdominal adipose tissue (AAT) area, and abdominal visceral adipose tissue (AVAT) area. Method: Among patients undergoing coronary computed tomography (CT) to evaluate coronary artery disease, we identified 110 patients who did not have significant coronary artery stenosis and underwent a coronary spasm provocation test with cardiac catheterization. They were divided into two groups according to the results of the spasm provocation test: spasm-positive and spasm-negative. EAT volume, total AAT area, and AVAT area were evaluated using CT images. Results: Seventy-seven patients were included in the spasm-positive group and 33 patients in the spasm-negative group. There were no significant differences in baseline clinical characteristics between the two groups, except for the prevalence of current smoking (48% vs. 27%, p = 0.04). EAT volume was significantly higher in the spasm-positive group (108 ± 38 mL vs. 87 ± 34 mL, p = 0.007), while no significant difference was seen in total AAT area (280 ± 113 cm2 vs. 254 ± 128 cm2, p = 0.32) or AVAT area (112 ± 54 cm2 vs. 98 ± 55 cm2, p = 0.27). Multivariate logistic analysis indicated that EAT volume (per 10 cm3) (odds ratio, 1.198; 95% confidence interval, 1.035–1.388; p = 0.016) was a significant predictor of coronary artery spasm. Conclusion: Our results suggest that EAT has a strong association with coronary artery spasm, while AAT may not.

DOI： 10.1016/j.ijcard.2020.09.074

A case of reexpansion pulmonary edema and acute pulmonary thromboembolism associated with diffuse large B-cell lymphoma treated with venovenous extracorporeal membrane oxygenation. Open Access

Kazama S, Hiraiwa H, Kimura Y, Ozaki R, Shibata N, Arao Y, Oishi H, Kato H, Kuwayama T, Yamaguchi S, Kondo T, Furusawa K, Morimoto R, Okumura T, Bando YK, Sato T, Shimada K, Kiyoi H, Nakamura G, Yasuda Y, Kasugai D, Ogawa H, Higashi M, Yamamoto T, Jingushi N, Ozaki M, Numaguchi A, Goto Y, Matsuda N, Murohara T

Journal of cardiology cases 23 巻 ( 1 ) 頁： 53 - 56 2021年1月

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

A 37-year-old man diagnosed with diffuse large B-cell lymphoma two weeks previously, visited our emergency department with sudden dyspnea. He had a severe respiratory failure with saturated percutaneous oxygen at 80% (room air). Chest radiography showed a large amount of left pleural effusion. After 1000 mL of the effusion was urgently drained, reexpansion pulmonary edema (RPE) occurred. Despite ventilator management, oxygenation did not improve and venovenous extracorporeal membrane oxygenation (VV-ECMO) was initiated in the intensive care unit. The next day, contrast-enhanced computed tomography showed a massive thrombus in the right pulmonary artery, at this point the presence of pulmonary thromboembolism (PTE) was revealed. Fortunately, the patient's condition gradually improved with anticoagulant therapy and VV-ECMO support. VV-ECMO was successfully discontinued on day 4, and chemotherapy was initiated on day 8. We speculated the following mechanism in this case: blood flow to the right lung significantly reduced due to acute massive PTE, and blood flow to the left lung correspondingly increased, which could have caused RPE in the left lung. Therefore, our observations suggest that drainage of pleural effusion when contralateral blood flow is impaired due to acute PTE may increase the risk of RPE. <Learning objective: This is a case of reexpansion pulmonary edema (RPE) in the left lung following acute pulmonary thromboembolism (PTE) in the right lung associated with malignant lymphoma, managed by venovenous extracorporeal membrane oxygenation. Contralateral pleural drainage could increase the risk of RPE because contralateral pulmonary blood flow is assumed to increase when PTE obstructs blood flow. Pleural drainage should be performed carefully in patients with malignant tumors because PTE may be hidden.>

DOI： 10.1016/j.jccase.2020.08.013

Perioperative D-dimer levels after transcatheter aortic valve replacement: Comparison of patients with and without anticoagulant therapy Open Access

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

CARDIOLOGY JOURNAL 28 巻 ( 1 ) 頁： 170 - 172 2021年1月

High-output Heart Failure Caused by a Tumor-related Arteriovenous Fistula: A Case Report and Literature Review Open Access

Tobe, A; Tanaka, A; Yoshida, S; Kondo, T; Morimoto, R; Furusawa, K; Okumura, T; Bando, YK; Ishii, H; Murohara, T

INTERNAL MEDICINE 60 巻 ( 18 ) 頁： 2979 - 2984 2021年

記述言語：英語出版者・発行元：Internal Medicine

High-output heart failure caused by a tumor-related arteriovenous fistula in adults is a rare clinical condition. We herein report a case of high-output heart failure caused by an arteriovenous fistula associated with renal cell carcinoma and a literature review of 29 published cases to date. Renal cell carcinoma seems to be the most common underlying tumor. For the diagnosis, right heart catheterization and enhanced computed tomography (CT) are considered useful. The removal of the underlying tumor and arteriovenous fistula is the best treatment for heart failure.

DOI： 10.2169/internalmedicine.6962-20

The Influence of Eicosapentaenoic Acid to Arachidonic Acid Ratio on Long-term Cardiovascular Events Following Percutaneous Coronary Intervention Open Access

Niwa, K; Tanaka, A; Funakubo, H; Otsuka, S; Yoshioka, N; Kudo, N; Tobe, A; Sakakibara, K; Miki, Y; Kataoka, T; Furusawa, K; Ishii, H; Murohara, T

INTERNAL MEDICINE 60 巻 ( 24 ) 頁： 3865 - 3871 2021年

記述言語：英語出版者・発行元：Internal Medicine

Objective The relationship between cardiovascular disease and the serum polyunsaturated fatty acid parameters has been reported. The aim of the present study was to investigate the association between the eicosapentaenoic acid and arachidonic acid (EPA/AA) ratio and long-term cardiovascular events in patients with coronary artery disease. Methods We identified a total of 831 patients who underwent percutaneous coronary intervention and whose EPA/AA ratio was available. The patients were divided into two groups according to their serum EPA/ AA ratio (median, 0.29; interquartile range 0.19-0.47): those in the lower quartile of EPA/AA ratios (Low EPA/AA group; n=231) and all other subjects (High EPA/AA group; n=600). The primary endpoints included a composite of cardiovascular death, myocardial infarction, and ischemic stroke. Results Patients in the Low EPA/AA group were significantly younger (66.0±12.6 years vs. 69.9±9.3 years, p<0.001), current smokers (33.3% vs. 22.7%, p=0.002), and had a history of myocardial infarction (20.3% vs. 12.3%, p=0.003). During the follow-up (median, 1,206 days; interquartile range, 654-1,910 days), the occurrence of the primary endpoint was significantly higher in the Low EPA/AA group than in the High EPA/ AA group. Of note, the rate of cardiovascular death was significantly higher in the Low EPA/AA group, and the rates of myocardial infarction and stroke tended to be higher. Conclusion A low EPA/AA ratio was associated with long-term adverse cardiovascular events in Japanese patients with coronary artery disease.

DOI： 10.2169/internalmedicine.7336-21

Serial Images of Aortic Plaque Rupture During Transfemoral Transcatheter Aortic Valve Replacement Open Access

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

JACC-CARDIOVASCULAR INTERVENTIONS 13 巻 ( 22 ) 頁： E203 - E204 2020年11月

Efficacy of right ventricular dysfunction estimated by pulmonary artery pulsatility index in stable phased dilated cardiomyopathy

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

EUROPEAN HEART JOURNAL 41 巻頁： 902 - 902 2020年11月

Associations between spleen volume and exercise capacity in advanced heart failure patients with left ventricular assist device

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

EUROPEAN HEART JOURNAL 41 巻頁： 1094 - 1094 2020年11月

The prognostic impact of right ventricular dysfunction in patients with septic cardiomyopathy

Hiraiwa, H; Kasugai, D; Okumura, T; Kazama, S; Kimura, Y; Shibata, N; Arao, Y; Oishi, H; Kato, H; Kuwayama, T; Yamaguchi, S; Kondo, T; Furusawa, K; Morimoto, R; Murohara, T

EUROPEAN HEART JOURNAL 41 巻頁： 1836 - 1836 2020年11月

Cholesterol Crystal Embolization After Transcatheter Aortic Valve Replacement.

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

Circulation reports 2 巻 ( 11 ) 頁： 701 - 702 2020年10月

Efficacy of Pulmonary Artery Pulsatility Index as a Measure of Right Ventricular Dysfunction in Stable Phase of Dilated Cardiomyopathy Open Access

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

CIRCULATION JOURNAL 84 巻 ( 9 ) 頁： 1536 - + 2020年9月

記述言語：英語出版者・発行元：Circulation Journal

Background: Right ventricular dysfunction (RVD) in the setting of left ventricular (LV) myocardial damage is a major cause of morbidity and mortality, and the pulmonary artery pulsatility index (PAPi) is a novel hemodynamic index shown to predict RVD in advanced heart failure. However, it is unknown whether PAPi can predict the long-term prognosis of dilated cardiomyopathy (DCM) even in the mild to moderate phase. This study aimed to assess the ability of PAPi to stratify DCM patients without severe symptoms. Methods and Results: Between April 2000 and March 2018, a total of 162 DCM patients with stable symptoms were evaluated, including PAPi, and followed up for a median of 4.91 years. The mean age was 50.9±12.6 years and the mean LV ejection fraction (EF) was 30.5±8.3%. When divided into 2 groups based on median value of PAPi (low, L-PAPi [<3.06] and high, H-PAPi [≥3.06]), even though there were no differences in B-type natriuretic peptide or pulmonary vascular resistance, the probability of cardiac event survival was significantly higher in the L-PAP than in the H-PAP group by Kaplan-Meier analysis (P=0.018). Furthermore, Cox’s proportional hazard regression analysis revealed that PAPi was an independent predictor of cardiac events (hazard ratio: 0.782, P=0.010). Conclusions: Even in patients identified with DCM in the mild to moderate phase, PAPi may help stratify DCM and predict cardiac events.

DOI： 10.1253/circj.CJ-20-0279

Fulminant myocarditis with myositis of ocular and respiratory muscles

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

NAGOYA JOURNAL OF MEDICAL SCIENCE 82 巻 ( 3 ) 頁： 585 - 593 2020年8月

記述言語：英語出版者・発行元：Nagoya Journal of Medical Science

A 46-year-old Japanese woman visited a nearby hospital because of diplopia after flu-like symptoms. One month later, she presented with blepharoptosis and external ophthalmoplegia. Laboratory tests showed a high creatine kinase concentration (3146 U/L). She underwent intravenous immunoglobulin therapy; however, her symptoms did not improve, prompting transfer to our institute. On admission, transthoracic echocardiography revealed 30% of left ventricular ejection fraction and edema of the left ventricular wall. Coronary angiography showed no significant coronary stenosis. An endomyocardial biopsy resulted in a diagnosis of acute myocarditis. On the following day, she needed a temporary pacemaker because she had complete atrioventricular block and intra-aortic balloon pump because of cardiogenic shock. Intravenous immunoglobulin therapy was again administered and her cardiac function gradually recovered. She was successfully weaned off her temporary pacemaker and intra-aortic balloon pump on Day 5 after improvement in her complete atrioventricular block. Steroid therapy administered from Day 9 was effective in reducing her creatine kinase concentrations. However, contrast-enhanced magnetic resonance imaging revealed inflammation of the scalene, semispinalis cervicis, sternocleidomastoid, and intercostal muscles. On Day 25, her cardiac function had recovered to a left ventricular ejection fraction of 59%. Finally, she was successfully discharged on Day 45 after undergoing rehabilitation.

DOI： 10.18999/nagjms.82.3.585

Reduced exercise capacity and clinical outcomes following acute myocardial infarction

Tashiro, H; Tanaka, A; Ishii, H; Motomura, N; Arai, K; Adachi, T; Okajima, T; Iwakawa, N; Kojima, H; Mitsuda, T; Hirayama, K; Hitora, Y; Hayashi, M; Furusawa, K; Yoshida, R; Imai, H; Ogawa, Y; Kawaguchi, K; Murohara, T

HEART AND VESSELS 35 巻 ( 8 ) 頁： 1044 - 1050 2020年8月

記述言語：英語出版者・発行元：Heart and Vessels

Reduced exercise capacity is known to be an important predictor of poor prognosis and disability in patients with cardiovascular diseases and chronic heart failure, and even members of the general population. However, data about exercise capacity assessed by cardiopulmonary exercise testing (CPX) in acute myocardial infarction (AMI) patients who underwent primary percutaneous coronary intervention (PCI) is scarce. Among 594 consecutive AMI patients who underwent primary PCI, we examined 136 patients (85.3% men, 64.9 ± 11.9 years) who underwent CPX during hospitalization for AMI. CPX was usually performed 5 days after the onset of AMI. Reduced exercise capacity was defined as peak VO2 ≤ 12. Clinical outcomes including all-cause death, myocardial infarction, and hospitalization due to heart failure were followed. Among 136 patients, reduced exercise capacity (peak VO2 ≤ 12) was seen in 38 patients (28%). Patients with reduced exercise capacity were older, more likely to have hypertension, and had lower renal function. In echocardiography, patients with reduced exercise capacity had higher E/e’ and larger left atrial dimension. Multivariate logistic analysis showed that E/e’ (OR 1.19, 95% CI 1.09–1.31, p < 0.001) was an independent predictor of reduced exercise capacity (peak VO2 ≤ 12). Median follow-up term was 12 months (IQR 9–22). The occurrence of composite endpoints of all-cause death, myocardial infarction, and hospitalization due to heart failure was significantly higher in patients with peak VO2 ≤ 12 than those with peak VO2 > 12 (p < 0.001). Reduced exercise capacity following primary PCI in AMI patients is associated with diastolic dysfunction and may lead to poorer clinical outcomes.

DOI： 10.1007/s00380-020-01576-2

Prognostic impact of recanalizing chronic total occlusion in non-infarct related arteries on long-term clinical outcomes in acute myocardial infarction patients undergoing primary percutaneous coronary intervention

Yoshida, R; Ishii, H; Morishima, I; Tanaka, A; Takagi, K; Yoshioka, N; Kataoka, T; Tashiro, H; Hitora, Y; Niwa, K; Furusawa, K; Morita, Y; Tsuboi, H; Murohara, T

CARDIOVASCULAR INTERVENTION AND THERAPEUTICS 35 巻 ( 3 ) 頁： 259 - 268 2020年7月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Cardiovascular Intervention and Therapeutics

Although chronic total occlusion (CTO) in non-infarct-related arteries (non-IRAs) negatively affects long-term mortality in patients with acute myocardial infarction (AMI) who are undergoing primary percutaneous coronary intervention (PCI), the prognostic impact of successful CTO-PCI has not been completely addressed. Among 1855 consecutive patients with AMI who underwent primary PCI, those who were treated for CTO with either PCI or medical therapy were included. We evaluated the association between recanalization of CTO and long-term cardiac mortality. Of the 172 included patients, 88 underwent CTO-PCI, and the procedures were successful in 65 patients. Thus, the successfully recanalized CTO (SR-CTO) group included 65 patients; and the no recanalized CTO (NR-CTO) group, 107 patients. During the follow-up, 72 patients died, and of whom 56 (77.8%) died because of cardiac causes. The cumulative 10-year, 30-day, and 30-day to 10-year incidences of cardiac mortality were lower in the SR-CTO group than in the NR-CTO group (19.0% vs. 51.9% p = 0.004; 4.6% vs. 14.0%, p = 0.05; 15.0% vs. 44.1%, p = 0.003, respectively). After adjusting for confounding factors, the benefits of SR-CTO for the 10-year cardiac mortality remained significant compared with those of NR-CTO (hazard ratio 0.37; 95% confidence interval 0.17–0.75; p = 0.004). In conclusion, patients with SR-CTO in non-IRAs after AMI was associated with reduced long-term cardiac mortality compared with those with NR-CTO.

DOI： 10.1007/s12928-019-00615-8

Spleen size improvement in advanced heart failure patients using a left ventricular assist device

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

ARTIFICIAL ORGANS 44 巻 ( 7 ) 頁： 700 - 708 2020年7月

記述言語：英語出版者・発行元：Artificial Organs

The spleen has been recognized as an important organ that holds a reserve of 20% to 30% of the total blood volume. Spleen contraction and splenic volume reduction occur in patients with hypovolemic shock. However, the change in the spleen volume and the association between spleen size and hemodynamic parameters remain unclear in patients with advanced heart failure (HF) who need left ventricular assist device (LVAD) support. This study was performed to investigate the change in spleen size and the relationship between spleen size and hemodynamic parameters before and after LVAD implantation in patients with advanced HF. We enrolled 20 patients with advanced HF on LVAD support. All patients underwent right heart catheterization and computed tomography before and after LVAD implantation. The spleen size was measured by computed tomography volumetry. We excluded patients with a mean right atrial pressure (RAP) of <5 mm Hg because of the possibility of hypovolemia and those with a cardiac index of >2.2 L/min/m2 before LVAD implantation. The splenic volume significantly increased from 160.6 ± 46.9 mL before LVAD implantation to 224.6 ± 73.5 mL after LVAD implantation (P <.001). Before LVAD implantation, there was a significant negative correlation between spleen volume and systemic vascular resistance (SVR). After LVAD implantation, however, there were significant correlations between spleen volume and the cardiac index, RAP, and pulmonary capillary wedge pressure despite the absence of a significant correlation between spleen volume and SVR. Furthermore, one patient developed reworsening HF because of LVAD failure due to pump thrombosis. In this case, the splenic volume was 212 mL before LVAD implantation and increased to 418 mL after LVAD implantation, although it decreased to 227 mL after LVAD failure. The spleen size may change depending on hemodynamics in patients with advanced HF with LVAD support, reflecting sympathetic nerve activity and the systemic volume status.

DOI： 10.1111/aor.13658

Ablation effect of additional low-speed rotational atherectomy following high-speed rotational atherectomy: Low-speed RA following high-speed RA. Open Access

Yoshida R, Ishii H, Morishima I, Tanaka A, Tsuda T, Takagi K, Morita Y, Kataoka T, Niwa K, Furusawa K, Yoshioka N, Tsuboi H, Murohara T

AsiaIntervention 6 巻 ( 1 ) 頁： 52 - 55 2020年7月

Lipid-rich large plaques in a non-culprit left main coronary artery and long-term clinical outcomes

Tashiro, H; Tanaka, A; Ishii, H; Sakakibara, K; Tobe, A; Kataoka, T; Miki, Y; Hitora, Y; Niwa, K; Furusawa, K; Murohara, T

INTERNATIONAL JOURNAL OF CARDIOLOGY 305 巻頁： 5 - 10 2020年4月

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

Background: An integrated backscatter (IB) intravascular ultrasound (IVUS) provides an information about tissue components and vulnerability of coronary plaques. The presence of vulnerable plaque in non-culprit lesion is associated with future clinical events. The purpose of this study was to assess the association between the characteristics of non-culprit left main coronary artery (LMCA) plaques evaluated by IB-IVUS and long-term clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). Methods: Among the patients who underwent non-LMCA PCI, we studied 366 patients with adequate LMCA IVUS images. Conventional and IB-IVUS analyses of the LMCA segment were performed. Lipid-rich large plaque was defined as the presence of both a lager plaque volume and a higher percentage of the lipid component than the obtained median values. Major adverse cardiovascular events (MACE) included cardiac death, myocardial infarction, and unplanned revascularization. Results: The mean age of the patients was 68.5 ± 10.2 years, 79.8% were men. Median follow-up period was 6.0 years (IQR: 4.2–8.1 years). The incidence of MACE was significantly higher in patients with lipid-rich large plaques (P = .006). The incidence rates of cardiac death, myocardial infarction, and unplanned revascularization were significantly higher in patients with lipid-rich large plaques (P = .02, 0.004, and 0.02, respectively). Multivariate Cox regression analysis showed that the presence of a lipid-rich large plaque was significantly associated with MACE (HR: 1.74; 95%CI: 1.17–2.58; P = .006). Conclusion: The presence of lipid-rich large plaques in a non-culprit LMCA can be associated with the long-term MACE in patients who have undergone PCI.

DOI： 10.1016/j.ijcard.2020.01.072

Pathological changes of the myocardium in reworsening of anthracycline-induced cardiomyopathy after explant of a left ventricular assist device

Hiraiwa, H; Okumura, T; Shimizu, S; Arao, Y; Oishi, H; Kato, H; Kuwayama, T; Yamaguchi, S; Haga, T; Yokoi, T; Kondo, T; Sugiura, Y; Kano, N; Watanabe, N; Fukaya, K; Furusawa, K; Sawamura, A; Morimoto, R; Fujimoto, K; Mutsuga, M; Usui, A; Murohara, T

NAGOYA JOURNAL OF MEDICAL SCIENCE 82 巻 ( 1 ) 頁： 129 - 134 2020年2月

記述言語：英語出版者・発行元：Nagoya Journal of Medical Science

We herein report the long-term changes in cardiac function and pathological findings after successful explantation of a left ventricular assist device in a 42-year-old patient with anthracycline-induced cardiomyopathy with reworsening heart failure. Endomyocardial biopsy samples revealed that the cardiomyocyte diameter decreased and collagen volume fraction increased just after left ventricular assist device explantation. The collagen volume fraction decreased after 6 months, despite preserved systolic function. At 5 years after left ventricular assist device explantation, the systolic function markedly decreased and cardiomyocyte diameter increased. Pathological changes of the myocardium may enable the identification of cardiac dysfunction prior to echocardiographic changes in patients with reworsening heart failure after left ventricular assist device explantation.

DOI： 10.18999/nagjms.82.1.129

Impact of Diabetes Mellitus on the Aortic Wall Changes as Atherosclerosis Progresses: Aortic Dilatation and Calcification Open Access

Iwakawa, N; Tanaka, A; Ishii, H; Kataoka, T; Niwa, K; Hitora, Y; Tashiro, H; Mitsuda, T; Kojima, H; Hirayama, K; Furusawa, K; Yoshida, R; Suzuki, S; Murohara, T

JOURNAL OF ATHEROSCLEROSIS AND THROMBOSIS 27 巻 ( 6 ) 頁： 509 - 515 2020年

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

Aim: An inverse association between diabetes mellitus (DM) and aortic dilatation has recently been reported. However, little is known about the association between DM and the progression of aortic dilatation/calcification as atherosclerosis progresses. Methods: We identified 216 patients who had undergone percutaneous coronary intervention (PCI) and abdominal computed tomography (CT) during the PCI and follow-up phases. The patients were classified into two groups: those with DM (DM+ group; n=107) and those without DM (DM− group; n=109). The infrarenal aortic diameter and aortic calcification index (ACI) were measured, and annual changes were calculated using measurement results obtained during the PCI and follow-up phases. Results: Infrarenal aortic diameters were significantly shorter in the DM+ group than in the DM-group during the PCI phase, and no significant ACI differences were observed between the DM+ and DM− groups. The median duration between the PCI and follow-up phase CT was 3.0 years. The growth rate of the infrarenal aor-tic dilatation from the PCI phase in the DM+ group was similar to that in the DM− group. Annual ACI changes were significantly larger in the DM+ group than in the DM− group. Multivariate logistic regression analysis indi-cated that the prevalence of DM was an independent predictor of rapid aortic calcification progression (odds ratio: 2.51; 95% confidence interval: 1.23–5.14; p =0.01). Conclusion: Our findings suggest that DM negatively affects aortic dilatation during an earlier phase of atherosclerosis progression and positively affects the progression of aortic calcification in a later phase.

DOI： 10.5551/jat.50930

Impact of adjunctive use of guide extension catheter on midterm outcome of drug-coated balloon angioplasty

Yoshida, R; Ishii, H; Morishima, I; Tanaka, A; Takagi, K; Iwakawa, N; Tashiro, H; Kojima, H; Mitsuda, T; Hirayama, K; Hitora, Y; Furusawa, K; Murohara, T

EUROINTERVENTION 15 巻 ( 8 ) 頁： 688 - 691 2019年10月

Reduced exercise capacity and clinical outcomes following acute myocardial infarction

Tashiro, H; Tanaka, A; Ishii, H; Motomura, N; Arai, K; Adachi, T; Okajima, T; Hitora, Y; Hayashi, M; Furusawa, K; Imai, H; Ogawa, Y; Kawaguchi, K; Murohara, T

EUROPEAN HEART JOURNAL 40 巻頁： 2813 - 2813 2019年10月

Splenic volume changes as a hemodynamic parameter in advanced heart failure with left ventricular assist device

Hiraiwa, H; Okumura, T; Sawamura, A; Kondo, T; Arao, Y; Oishi, H; Kato, H; Kuwayama, T; Yamaguchi, S; Haga, T; Yokoi, T; Fukaya, K; Furusawa, K; Morimoto, R; Murohara, T

EUROPEAN HEART JOURNAL 40 巻頁： 3303 - 3303 2019年10月

Early versus delayed invasive strategy in patients with non-ST-elevation acute coronary syndrome and concomitant congestive heart failure Open Access

Yoshida, R; Ishii, H; Morishima, I; Tanaka, A; Morita, Y; Takagi, K; Yoshioka, N; Hirayama, K; Iwakawa, N; Tashiro, H; Kojima, H; Mitsuda, T; Hitora, Y; Furusawa, K; Tsuboi, H; Murohara, T

JOURNAL OF CARDIOLOGY 74 巻 ( 3-4 ) 頁： 320 - 327 2019年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiology

Background: Although there are guidelines that recommend an early invasive strategy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and concomitant congestive heart failure (CHF), optimal timing of the invasive strategy remains controversial. Methods: Among 2045 patients who were admitted owing to NSTE-ACS or CHF, 300 presented with NSTE-ACS and concomitant CHF. Of the 300 patients, we enrolled 160 patients for whom coronary angiography (CAG) during their hospital stay was planned at the time of admission; 64 of these patients were classified into the early invasive group (<24 h) and 96 were classified to the delayed invasive group (≥24 h). We evaluated the primary outcome which was defined as a composite of cardiac mortality, life-threatening arrhythmia, and non-fatal myocardial infarction (MI). Results: The median time between presentation and CAG was 2 h in the early invasive group and 240 h in the delayed group. During follow-up, the primary outcome was significantly lower in the early invasive group [hazard ratio (HR), 0.52; 95% confidence interval (CI), 0.30–0.87; p = 0.01]. After the adjustment of confounding factors, the primary outcome was significantly less frequent (HR, 0.44; 95% CI, 0.23–0.78; p = 0.004) in the early invasive group compared to the delayed invasive group. Conclusions: The early invasive strategy was associated with a lower risk of the composite primary outcome in the long-term follow-up of patients with NSTE-ACS and concomitant CHF.

DOI： 10.1016/j.jjcc.2019.03.006

Impact of Postdischarge Bleeding on Long-Term Mortality in Percutaneous Coronary Intervention Patients Taking Oral Anticoagulants

Yoshida, R; Ishii, H; Morishima, I; Tanaka, A; Morita, Y; Takagi, K; Yoshioka, N; Hirayama, K; Iwakawa, N; Tashiro, H; Kojima, H; Mitsuda, T; Hitora, Y; Furusawa, K; Tsuboi, H; Murohara, T

JOURNAL OF CARDIOVASCULAR PHARMACOLOGY 74 巻 ( 3 ) 頁： 210 - 217 2019年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiovascular Pharmacology

Although postdischarge bleeding (PDB) is known to negatively affect long-term outcome in patients undergoing percutaneous coronary intervention (PCI) with antiplatelet therapy (APT), the prognostic importance of PDB in patients who require both oral anticoagulants (OACs) and APT has not been fully elucidated. Among 3718 consecutive patients who underwent PCI, 302 patients were treated with both OACs and APT. We evaluated the association between PDB and 3-year all-cause mortality, as estimated by a time-updated Cox proportional hazard regression model. We performed nearest-neighbor matching on the propensity score to adjust the differences in baseline characteristics. Among 302 patients treated with OACs and APT, PDB was observed in 98 patients at a median time of 239 days. Patients experienced PDB had significantly higher incidence of 3-year all-cause mortality in the overall cohort and 94 propensity-score-matched pairs (hazard ratio 6.21, 95% confidence interval 3.29-11.72, P < 0.0001; and hazard ratio 6.13, 95% confidence interval 2.68-14.02, P < 0.0001, respectively). The risk of subsequent mortality was the highest within 180 days after PDB (58.3% within 180 days and 75.0% within 1 year). In conclusion, PDB was significantly associated with long-term mortality in patients taking both OACs and APT after PCI.

DOI： 10.1097/FJC.0000000000000702

Left Ventricular Relaxation Half-Time as a Predictor of Cardiac Events in Idiopathic Dilated Cardiomyopathy and Hypertrophic Cardiomyopathy With Left Ventricular Systolic and/or Diastolic Dysfunction

Yokoi, T; Morimoto, R; Oishi, H; Kato, H; Arao, Y; Yamaguchi, S; Kuwayama, T; Haga, T; Hiraiwa, H; Kondo, T; Furusawa, K; Fukaya, K; Sawamura, A; Okumura, T; Hirashiki, A; Murohara, T

AMERICAN JOURNAL OF CARDIOLOGY 124 巻 ( 3 ) 頁： 435 - 441 2019年8月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：American Journal of Cardiology

Purpose: Diastolic dysfunction preceding systolic dysfunction is considered an important interaction in cardiomyopathy with poor prognosis. The aim of this study was to compare left ventricular (LV) isovolumic relaxation with the other parameters as a potential prognostic marker for patients with idiopathic dilated cardiomyopathy (IDC) and hypertrophic cardiomyopathy (HC). Methods: A total of 145 patients with IDC and 116 with HC were evaluated for hemodynamic parameters; LV pressure was directly measured by a micromanometer catheter, and relaxation half-time (T1/2) was used to determine LV isovolumic relaxation. The median follow-up period was 4.7 years. Results: The mean ages of the patients with IDC and HC were 52.0 ± 12.0 and 57.1 ± 12.4 years, respectively. Each patient group was further divided into 2 groups based on the median value of T1/2: (1) <41.0 ms (D-L group) and ≥41.0 ms (D-H group) (2) <38.5 ms (H-L group) and ≥38.5 ms (H-H group). Kaplan-Meier analysis showed a significantly higher probability of cardiac events in the D-H group than in the D-L group (p = 0.001) and in the H-H group than in the H-L group (p = 0.028). Further, Cox proportional hazard regression analysis revealed that T1/2 was an independent predictor of cardiac events for patients with IDC (hazard ratio 1.109; p = 0.007) and HC (hazard ratio 1.062; p = 0.041). In conclusion, regardless of the type of cardiomyopathy, T1/2 as a measure of LV isovolumic relaxation function was found to be associated with the occurrence of cardiac events.

DOI： 10.1016/j.amjcard.2019.05.005

Performance of HAS-BLED, ORBIT, PRECISE-DAPT, and PARIS risk score for predicting long-term bleeding events in patients taking an oral anticoagulant undergoing percutaneous coronary intervention Open Access

Yoshida, R; Ishii, H; Morishima, I; Tanaka, A; Morita, Y; Takagi, K; Yoshioka, N; Hirayama, K; Iwakawa, N; Tashiro, H; Kojima, H; Mitsuda, T; Hitora, Y; Furusawa, K; Tsuboi, H; Murohara, T

JOURNAL OF CARDIOLOGY 73 巻 ( 6 ) 頁： 479 - 487 2019年6月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiology

Background: No standardized tool exists for weighting bleeding risk before selecting an antithrombotic regimen in patients undergoing percutaneous coronary intervention (PCI) who require both oral anticoagulant (OAC) and antiplatelet agents. Methods: We performed PCI in 3718 consecutive patients between April 2011 and March 2017, 302 of whom were treated with both OAC and antiplatelet agents. We retrospectively evaluated the predictive performance of four major bleeding risk scores (HAS-BLED, ORBIT, PRECISE-DAPT, and PARIS score). Patients were followed for up to 3 years for bleeding events, defined as a composite of major and minor bleeding according to the Thrombolysis in Myocardial Infarction (TIMI) criteria and the Bleeding Academic Research Consortium (BARC) criteria. Results: TIMI significant bleedings (major, minor, and requiring medical attention) were seen in 90 patients (29.8%); whereas the BARC class ≥3 bleedings were seen in 53 patients (17.5%). Regarding TIMI significant bleedings, HAS-BLED, ORBIT, and PRECISE-DAPT scores equally categorized high-risk patients, but the PARIS score could not [high-risk versus non-high-risk: hazard ratio (HR), 1.74; 95% confidence interval (CI), 1.15–2.64; p = 0.01; HR, 1.63; 95% CI, 1.08–2.48; p = 0.02; HR, 1.62; 95% CI, 1.06–2.51; p = 0.03; HR, 1.05; 95% CI, 0.70–1.63; p = 0.79, respectively); regarding BARC class ≥3 bleeding, all four scores could stratify high-risk patients (high-risk versus non-high-risk: HR, 2.23; 95% CI, 1.30–3.88; p = 0.004; HR, 2.25; 95% CI, 1.31–3.96; p = 0.003; HR, 3.87; 95% CI, 2.06–7.91; p < 0.0001; HR, 1.85; 95% CI, 1.04–3.47; p = 0.04, respectively). Conclusions: In patients taking an OAC undergoing PCI, HAS-BLED, ORBIT, and PRECISE-DAPT scores predicted TIMI significant bleeding events better than the PARIS score; whereas all four scores could predict BARC class ≥3 bleeding events.

DOI： 10.1016/j.jjcc.2018.10.013

Impact of Nutritional and Inflammation Status on Long-Term Bleeding in Patients Undergoing Percutaneous Coronary Intervention with an Oral Anticoagulant Open Access

Yoshida, R; Ishii, H; Morishima, I; Tanaka, A; Morita, Y; Takagi, K; Yoshioka, N; Hirayama, K; Iwakawa, N; Tashiro, H; Kojima, H; Mitsuda, T; Hitora, Y; Furusawa, K; Tsuboi, H; Murohara, T

JOURNAL OF ATHEROSCLEROSIS AND THROMBOSIS 26 巻 ( 8 ) 頁： 728 - 737 2019年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Atherosclerosis and Thrombosis

Aim: Patients undergoing percutaneous coronary intervention (PCI) who require both oral anticoagulant (OAC) and antiplatelet therapy (APT) are exposed to a serious risk of bleeding. The aim of this study was to clarify the relationship among nutritional and inflammation status and long-term bleeding in patients requiring both OACs and APT after PCI. Methods: We performed PCI in 3,718 consecutive patients between April 2011 and March 2017, 302 of whom were treated with both OACs and APT. Patients were followed for up to 3 years for bleeding events, defined as the Bleeding Academic Research Consortium (BARC) class ≥ 3 bleeding. We retrospectively evaluated the ability of the Geriatric Nutritional Risk Index (GNRI) and high-sensitivity C-reactive protein (hs-CRP) to detect bleeding events. Results: During a median follow-up of 1,080 days, bleeding events were observed in 53 (17.5%) patients. Bleeding events were associated with a low GNRI (≤ 98) (hazard ratio [HR], 3.16; 95% confidence interval [CI], 1.84 – 5.45; p＜0.0001) and hs-CRP level ≥ 2.5 mg/L (HR, 2.75; 95% CI, 1.61 – 4.78; p=0.0003). A low GNRI＋ high hs-CRP showed a 5.12-fold increase in the incidence of BARC class ≥ 3 bleeding (95% CI, 2.68 – 9.91; p＜ 0.0001) compared with a normal GNRI＋low hs-CRP. The addition of the GNRI and hs-CRP to the PRECISE-DAPT score improved C-statistics from 0.67 to 0.71 and enhanced the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI, 0.36, p＜0.0001; IDI, 0.066, p＜0.0001). Conclusions: The GNRI and hs-CRP were novel predictors of the long-term bleeding risk in patients requiring both OACs and APT after PCI.

DOI： 10.5551/jat.47654

Assessment of abdominal aortic calcification by computed tomography for prediction of latent left ventricular stiffness and future cardiovascular risk in pre-dialysis patients with chronic kidney disease: A single center cross-sectional study Open Access

Furusawa, K; Takeshita, K; Suzuki, S; Tatami, Y; Morimoto, R; Okumura, T; Yasuda, Y; Murohara, T

INTERNATIONAL JOURNAL OF MEDICAL SCIENCES 16 巻 ( 7 ) 頁： 939 - 948 2019年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：International Journal of Medical Sciences

Introduction: There is general interest in finding clinical markers for left ventricular diastolic dysfunction (LVDD), a major cause of cardiorenal syndrome leading to heart failure in chronic kidney disease (CKD) patients. The aim was to assess the utility of computed tomography (CT)-based abdominal aortic calcification (AAC) for the prediction of LVDD and prognosis of asymptomatic pre-dialysis CKD patients. Materials and methods: We prospectively evaluated 218 pre-dialysis CKD patients [median estimated glomerular filtration rate (eGFR); 40.9 mL/min/1.73m2]. Non-contrast CT scan and echocardiography were performed to determine the aortic calcification index (ACI) as a semi-quantitative measure of AAC. Results: The median ACI was 11.4. AAC and LVDD were diagnosed in 193 patients (89%) and 75 patients (34%), respectively. Using receiver operating characteristic curve analysis for the estimation of LVDD, ACI of 20 showed optimal sensitivity (52.0%) and specificity (62.8 %) (AUC = 0.664, p <.001). High ACI group included more patients with LVDD-related factors, such as old age, hypertension, diabetes, and more severe CKD. LVDD was significantly more common in patients with high ACI group [39 (50%) and 36 (26%), respectively, p<0.001]. Multivariate analysis showed that ACI correlated significantly with E/A (β=-0.993, p=0.003), E/e' (β=0.077, p<0.001), and cardio-ankle vascular index (β=0.209, p=0.001). Correspondingly, E/e' correlated with logBNP and log(ACI+1), and increased proportionately and significantly with the quartiles of ACI values. Cox proportional hazard models showed that ACI was an independent predictor of CV outcome (hazard ratio 1.03, 95% confidence interval 1.00-1.06, p=0.029). Conclusion: The results would suggest the usefulness of AAC assessment by CT to predict latent LVDD and future CV risk in asymptomatic pre-dialysis CKD patients.

DOI： 10.7150/ijms.32629

頸動脈超音波検査が契機となり診断された硬膜動静脈瘻の1例

笹木優賢, 松原宏紀, 金沙玲, 弘津有沙, 古澤健司

超音波検査技術抄録集 44 巻 ( 0 ) 頁： S189 - S189 2019年

The Selvester QRS score as a predictor of cardiac events in nonischemic dilated cardiomyopathy (vol 71, pg 284, 2018) Open Access

Hiraiwa, H; Okumura, T; Sawamura, A; Sugiura, Y; Kondo, T; Watanabe, N; Aoki, S; Ichii, T; Kitagawa, K; Kano, N; Fukaya, K; Furusawa, K; Morimoto, R; Takeshita, K; Bando, YK; Murohara, T

JOURNAL OF CARDIOLOGY 72 巻 ( 1-2 ) 頁： 178 - 178 2018年7月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiology

There is an error in the section of methods of statistical analysis. Correctly, the covariates with p < 0.01 in univariate analysis were retested for multivariate analysis. In addition, Table 3 is incorrect. Please see the corrected Table 3 here.

DOI： 10.1016/j.jjcc.2018.02.001

The Selvester QRS score as a predictor of cardiac events in nonischemic dilated cardiomyopathy Open Access

Hiraiwa, H; Okumura, T; Sawamura, A; Sugiura, Y; Kondo, T; Watanabe, N; Aoki, S; Ichii, T; Kitagawa, K; Kano, N; Fukaya, K; Furusawa, K; Morimoto, R; Takeshita, K; Bando, YK; Murohara, T

JOURNAL OF CARDIOLOGY 71 巻 ( 3-4 ) 頁： 284 - 290 2018年3月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiology

Background: Myocardial fibrosis is associated with poor prognosis in nonischemic dilated cardiomyopathy (NIDCM) patients. The Selvester QRS score on 12-lead electrocardiogram is associated with both the amount of myocardial scar and poor prognosis in myocardial infarction patients. However, its use in NIDCM patients is limited. We investigated the prognostic value of the QRS score and its association with collagen volume fraction (CVF) in NIDCM patients. Methods: We enrolled 91 consecutive NIDCM patients (66 men, 53 ± 13 years) without permanent pacemakers or cardiac resynchronization therapy devices. The Selvester QRS score was calculated by two expert cardiologists at NIDCM diagnosis. All patients were followed up over 4.5 ± 3.2 years. Cardiac events were defined as a composite of cardiac death, hospitalization for worsening heart failure, and lethal arrhythmia. We also evaluated CVF using endomyocardial biopsy samples. Results: At baseline, the left ventricular ejection fraction was 32 ± 9%, plasma brain natriuretic peptide level was 80 [43–237] pg/mL, and mean Selvester QRS score was 4.1 points. Twenty cardiac events were observed (cardiac death, n = 1; hospitalization for worsening heart failure, n = 16; lethal arrhythmia, n = 3). Cox proportional hazard regression analysis revealed that the Selvester QRS score was an independent determinant of cardiac events (hazard ratio, 1.32; 95% confidence interval, 1.05–1.67; p = 0.02). The best cut-off value was determined as 3 points, with 85% sensitivity and 47% specificity (area under the curve, 0.688, p = 0.011). In Kaplan–Meier survival analysis, the QRS score ≥3 group had more cardiac events than the QRS score <3 group (log-rank, p = 0.007). Further, there was a significant positive correlation of Selvester QRS score with CVF (r = 0.46, p < 0.001). Conclusions: The Selvester QRS score can predict future cardiac events in NIDCM, reflecting myocardial fibrosis assessed by CVF.

DOI： 10.1016/j.jjcc.2017.09.002

Sokolow-Lyon voltage is suitable for monitoring improvement in cardiac function and prognosis of patients with idiopathic dilated cardiomyopathy Open Access

Fukaya, K; Takeshita, K; Okumura, T; Hiraiwa, H; Aoki, S; Ichii, T; Sugiura, Y; Kitagawa, K; Kondo, T; Watanabe, N; Kano, N; Furusawa, K; Sawamura, A; Morimoto, R; Bando, Y; Murohara, T

ANNALS OF NONINVASIVE ELECTROCARDIOLOGY 22 巻 ( 5 ) 2017年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Annals of Noninvasive Electrocardiology

Background: The clinical significance of electrocardiogram in the assessment of patients with idiopathic dilated cardiomyopathy (IDCM) is currently unknown. The aim of this study was to determine the feasibility of recording serial changes in Sokolow–Lyon voltage (∆%QRS-voltage) in one year to estimate left ventricular reverse remodeling (LVRR) and predict a prognosis of IDCM patients under tailored medical therapy. Methods: Sixty-eight consecutive patients with mild symptoms (52.1 ± 13 years old; 69% men; NYHA I/II/III/IV; 33/29/6/0) underwent electrocardiography and echocardiography at baseline and 12 month follow-up (follow-up period: 3.9 years). Results: LVRR was observed in 30 patients (44.1%). The ∆%QRS-voltage was significantly lower in the LVRR group (LVRR; −26.9%, non-LVRR: −9.2%, p <.001). Univariate analysis showed that ∆%QRS-voltage correlated with ∆%LV end-diastolic diameter (r =.634, p <.001), and with ∆%LV ejection fraction and ∆%LV mass index (r = −.412, p <.001; r =.429, p <.001 respectively). Using receiver operating characteristic curve analysis for the estimation of LVRR, ∆%QRS of −14.7% showed optimal sensitivity (63.2%) and specificity (83.3%) (AUC = 0.775, p <.001). The composite endpoints of cardiac death (n = 0), hospitalization for advanced heart failure (n = 11) and fatal arrhythmia (n = 2) were observed in 13 patients during the follow-up period. Kaplan–Meier analysis showed significantly higher event-free rate in patients of the low ∆%QRS-voltage group (<−14.7%) (83%) than those of the high group (66%, p =.022). Conclusions: The present study showed that decrease in Sokolow–Lyon voltage is associated with improvement in cardiac function and favorable prognosis in IDCM patients on medical therapy, suggesting that this index is a feasible marker for response to treatment of IDCM.

DOI： 10.1111/anec.12431

Myocardial contractile reserve predicts left ventricular reverse remodeling and cardiac events in dilated cardiomyopathy Open Access

Morimoto, R; Okumura, T; Hirashiki, A; Ishii, H; Ichii, T; Aoki, S; Furusawa, K; Hiraiwa, H; Kondo, T; Watanabe, N; Kano, N; Fukaya, K; Sawamura, A; Takeshita, K; Bando, YK; Murohara, T

JOURNAL OF CARDIOLOGY 70 巻 ( 3-4 ) 頁： 303 - 309 2017年9月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiology

Background Catecholamine sensitivity estimated using a dobutamine stress test (DST) is recognized as a measure of the beta-adrenergic myocardial contractile reserve, which is involved with left ventricular reverse remodeling (LV-RR). We investigated whether the prognostic ability of the DST for LV-RR could predict cardiac events. Methods There was a total of 192 enrolled patients with dilated cardiomyopathy (DCM). DCM was defined as a LV ejection fraction (LV-EF) ≤45% and LV end-diastolic dimension (LVDd) ≥55 mm. One hundred patients were subjected to micromanometer-based measurement of the maximal first derivative of LV pressure (LVdP/dtmax), an index of LV contractility, at baseline and following the infusion of dobutamine (10 μg/kg/min) via a pigtail catheter. Percentage changes in LVdP/dtmax from the baseline to peak values under dobutamine stress (ΔLVdP/dtmax) were also calculated. After excluding 17 patients who received cardiac resynchronization therapy within 3 months of undergoing DST (n = 15) and who did not receive follow-up echocardiography (n = 2), 83 patients were enrolled (52.5 ± 12.3 years). Results During the follow-up period (4.7 ± 2.6 years), LV-RR was recognized in 49 of 83 patients (59.0%). A multivariate logistic regression analysis revealed that ΔLVdP/dtmax (hazard ratio: 1.024, p = 0.007) and the symptom duration (hazard ratio: 0.977, p = 0.003) were independent predictors of LV-RR. A receiver operating characteristic curve analysis revealed a ΔLVdP/dtmax cut-off value of 75.1% for LV-RR and a significantly lower cardiac event rate in the ΔLVdP/dtmax ≥ 75.1% group (p = 0.045). Conclusions ΔLVdP/dtmax estimated using DST was a useful predictor of LV-RR and cardiac events in patients with DCM.

DOI： 10.1016/j.jjcc.2017.02.005

The Selvester QRS score as a predictor of cardiac events in nonischemic dilated cardiomyopathy

Hiraiwa, H; Okumura, T; Sawamura, A; Sugiura, Y; Kondo, T; Watanabe, N; Aoki, S; Ichii, T; Kano, N; Fukaya, K; Furusawa, K; Morimoto, R; Takeshita, K; Bando, Y; Murohara, T

EUROPEAN HEART JOURNAL 38 巻頁： 143 - 144 2017年8月

Cholesterol metabolism as a prognostic marker in patients with mildly symptomatic nonischemic dilated cardiomyopathy Open Access

Sawamura, A; Okumura, T; Hiraiwa, H; Aoki, S; Kondo, T; Ichii, T; Furusawa, K; Watanabe, N; Kano, N; Fukaya, K; Morimoto, R; Bando, YK; Murohara, T

JOURNAL OF CARDIOLOGY 69 巻 ( 5-6 ) 頁： 888 - 894 2017年5月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Cardiology

Background Little is known about whether the alteration of cholesterol metabolism reflects abdominal organ impairments due to heart failure. Therefore, we investigated the prognostic value of cholesterol metabolism by evaluating serum campesterol and lathosterol levels in patients with early-stage nonischemic dilated cardiomyopathy (NIDCM). Methods We enrolled 64 patients with NIDCM (median age 57.5 years, 31% female) with New York Heart Association functional class I/II. Serum campesterol and lathosterol levels were measured in all patients. The patients were then divided into four subsets based on the median non-cholesterol sterol levels (campesterol 3.6 μg/mL, lathosterol 1.4 μg/mL): reference (R-subset), high-campesterol/high-lathosterol; absorption-reduced (A-subset), low-campesterol/high-lathosterol; synthesis-reduced (S-subset), high-campesterol/low-lathosterol; double-reduced (D-subset), low-campesterol/low-lathosterol. Endpoint was a composite of cardiac events, including cardiac-related death, hospitalization for worsening heart failure, and lethal arrhythmia. Results Median brain natriuretic peptide (BNP) level was 114 pg/mL. Mean left ventricular ejection fraction was 31.4%. D-subset had the lowest total cholesterol level and cardiac index and the highest BNP level and pulmonary capillary wedge pressure. D-subset also had the highest cardiac event rate during the mean 3.8 years of follow-up (log-rank p = 0.001). Multivariate regression analysis showed that D-subset was an independent determinant of cardiac events. The receiver operating characteristic curve analysis revealed that total cholesterol <153 mg/dL was a best cut-off value for discrimination of the D-subset. Conclusions The combined reduction of campesterol and lathosterol that indicated intestinal cholesterol absorption and liver synthesis predicts future cardiac events in patients with mildly symptomatic NIDCM.

DOI： 10.1016/j.jjcc.2016.08.012

Long-Term Pathological Follow-Up of Myocardium in a Carrier of Duchenne Muscular Dystrophy With Dilated Cardiomyopathy

Kondo, T; Okumura, T; Takefuji, M; Hiraiwa, H; Sugiura, Y; Watanabe, N; Aoki, S; Ichii, T; Kitagawa, K; Kano, N; Fukaya, K; Furusawa, K; Sawamura, A; Morimoto, R; Bando, YK; Takemura, G; Murohara, T

CIRCULATION-HEART FAILURE 10 巻 ( 3 ) 頁： e003826 2017年3月

Impact of Renal Functional/Morphological Dynamics on the Calcification of Coronary and Abdominal Arteries in Patients with Chronic Kidney Disease Open Access

Ichii, T; Morimoto, R; Okumura, T; Ishii, H; Tatami, Y; Yamamoto, D; Aoki, S; Hiraiwa, H; Furusawa, K; Kondo, T; Watanabe, N; Kano, N; Fukaya, K; Sawamura, A; Suzuki, S; Yasuda, Y; Murohara, T

JOURNAL OF ATHEROSCLEROSIS AND THROMBOSIS 24 巻 ( 11 ) 頁： 1092 - 1104 2017年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Atherosclerosis and Thrombosis

Aim: Fast-progressing vascular calcification (VC) is accompanied by renal atrophy and functional deterioration along with atherosclerosis in patients with chronic kidney disease (CKD). However, the relationship between VC progression and renal functional and/or morphological changes remains unclear. Methods: We included 70 asymptomatic patients with CKD without hemodialysis in our study. To identify temporal variations, the coronary artery calcification score (CACS), abdominal aortic calcification index (ACI), and renal parenchymal volume index (RPVI) were determined via spiral computed tomography scans taken during the study. We investigated significant factors related to annualized variations of CACS (ΔCACS/y) and ACI (ΔACI/y). Results: During the follow-up period (4.6 years), median values of CACS [in Agatston units (AU)] and ACI increased from 40.2 to 113.3 AU (p=0.053) and from 13.2 to 21.7% (p=0.036), respectively. Multivariate analysis revealed that CACS at baseline (p＜0.001) and diabetes mellitus (DM) status (p=0.037) for ΔCACS/y and ACI at baseline (p=0.017) and hypertension (HT) status (p= 0.046) for ΔACI/y were significant independent predictors. Furthermore, annualized RPVI variation was significantly related to both ΔCACS/y and ΔACI/y (R=－0.565, p＜0.001, and R=－0.289, p=0.015, respectively). On the other hand, independent contributions of the estimated glomerular filtration rate (eGFR) and annualized eGFR variation to VC progression were not confirmed. Conclusion: The degree of VC at baseline, DM, HT, and changes in renal volume, but not eGFR, had a strong impact on VC progression in patients with CKD.

DOI： 10.5551/jat.39271

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