Updated on 2021/11/12

写真a

 
HIRAIWA HIROAKI
 
Organization
Nagoya University Hospital Cardiology Assistant professor of hospital
Title
Assistant professor of hospital
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Degree 1

  1. 博士(医学) ( 2019.3   名古屋大学 ) 

Research Interests 4

  1. 心臓リハビリテーション

  2. 植込型左室補助人工心臓

  3. 体外式補助循環

  4. 重症心不全

Research Areas 1

  1. Life Science / Cardiology  / 臨床心不全

Research History 2

  1. Nagoya University   Department of Cardiology   Assistant professor of hospital

    2021.4

  2. Nagoya University   Department of Emergency and Critical Care Medicine   Assistant professor of hospital

    2019.4 - 2021.3

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    Country:Japan

Education 2

  1. Nagoya University   Graduate School of Medicine

    - 2019.3

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    Country: Japan

  2. Nagoya University   Graduate School of Medicine   Graduate School of Medicine

    - 2009.3

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    Country: Japan

Professional Memberships 10

  1. 日本移植学会

  2. 日本人工臓器学会

  3. 日本集中治療学会

  4. 日本心血管インターベンション治療学会

  5. 日本心臓リハビリテーション学会

  6. 日本腫瘍循環器学会

  7. 日本心不全学会

  8. 日本心臓病学会

  9. 日本循環器学会

  10. 日本内科学会

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Papers 60

  1. Prognostic impact of transcardiac gradient of follistatin-like 1 reflecting hemodynamics in patients with dilated cardiomyopathy.

    Oishi H, Okumura T, Ohashi K, Kimura Y, Kazama S, Shibata N, Arao Y, Kato H, Kuwayama T, Yamaguchi S, Tatsumi M, Kondo T, Hiraiwa H, Morimoto R, Takefuji M, Ouchi N, Murohara T

    Journal of cardiology   Vol. 78 ( 6 ) page: 524 - 532   2021.12

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    Language:English   Publisher:Journal of Cardiology  

    Background: Follistatin-like 1 (FSTL1) is a myocyte-secreted glycoprotein that could play a role in myocardial maintenance in response to harmful stimuli. We investigated the association between serum FSTL1 levels, especially focused on transcardiac gradient and the hemodynamics, to explore the prognostic impact of FSTL1 levels in patients with dilated cardiomyopathy (DCM). Methods: Thirty-two ambulatory patients with DCM (23 men; mean age 59 years) were prospectively enrolled. Blood samples were simultaneously collected from the aortic root (Ao), coronary sinus (CS), as well as from the peripheral vein during cardiac catheterization in stable conditions. The transcardiac gradient of FSTL1 was calculated by the difference between serum FSTL1 levels of CS and Ao (FSTL1CS-Ao). Patients were divided into two groups based on the median of FSTL1CS-Ao: Low FSTL1CS-Ao group, <0 ng/mL; High FSTL1CS-Ao group, ≥0 ng/mL. Cardiac events were defined as a composite of cardiac deaths and hospitalizations for worsening heart failure. Results: Mean left ventricular ejection fraction and median plasma B-type natriuretic peptide levels were 30.9% and 92.3 pg/mL, respectively. FSTL1CS-Ao was negatively correlated with pulmonary capillary wedge pressure (r = -0.400, p = 0.023). Kaplan-Meier survival analysis showed that event-free survival rate was significantly lower in the Low FSTL1CS-Ao group than in the High FSTL1CS-Ao group (p = 0.013). Cox regression analyses revealed that the transcardiac gradient of FSTL1 was an independent predictor for cardiac events. Receiver operating characteristic curve analysis showed that the cut-off value of FSTL1CS-Ao for the prediction of cardiac events was -4.09 ng/mL with sensitivity of 82% and specificity of 86% (area under the curve, 0.87). Conclusions: Fifty percent of patients had negative transcardiac gradient of FSTL1. Reduced transcardiac gradient of FSTL1 might be a novel prognostic predictor in DCM patients with impaired hemodynamics.

    DOI: 10.1016/j.jjcc.2021.07.005

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  2. Clinical impact of visually assessed right ventricular dysfunction in patients with septic shock

    Hiraiwa Hiroaki, Kasugai Daisuke, Ozaki Masayuki, Goto Yukari, Jingushi Naruhiro, Higashi Michiko, Nishida Kazuki, Kondo Toru, Furusawa Kenji, Morimoto Ryota, Okumura Takahiro, Matsuda Naoyuki, Matsui Shigeyuki, Murohara Toyoaki

    SCIENTIFIC REPORTS   Vol. 11 ( 1 ) page: 18823   2021.9

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    Language:Japanese   Publisher: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

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  3. Comparison of Impella 5.0 and extracorporeal left ventricular assist device in patients with cardiogenic shock

    Kondo Toru, Morimoto Ryota, Mutsuga Masato, Fujimoto Kazuro, Okumura Takahiro, Shibata Naoki, Kazama Shingo, Kimira Yuki, Oishi Hideo, Kuwayama Tasuku, Hiraiwa Hiroaki, Usui Akihiko, Murohara Toyoaki

    INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS     page: 3913988211040530   2021.9

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    Language:Japanese   Publisher:International Journal of Artificial Organs  

    Introduction: Choice of mechanical circulatory support to stabilize hemodynamics until cardiac recovery or next treatment is a strategic cornerstone for improving outcomes in patients with severe cardiogenic shock. We aimed to clarify the difference in treatment course and outcomes with the use of Impella 5.0 and an extracorporeal left ventricular assist device (eLVAD) in patients with cardiogenic shock refractory to medical therapy or other mechanical circulatory support. Methods: We performed a retrospective medical record review of consecutive patients who were implanted with Impella 5.0 or eLVAD as a bridge to decision at our medical center. Results: A total of 26 patients (median age 40 years, 16 males) were analyzed. Of seven patients managed with Impella 5.0, the Impella 5.0 was removed successfully in two patients and five patients underwent surgery for durable LVAD implantation. Of 19 patients managed with eLVAD, the eLVAD was successfully removed in 3 patients, 9 patients required durable LVAD, and 7 patients died during eLVAD management. The period between Impella 5.0 or eLVAD implantation to durable LVAD surgery was significantly shorter with Impella 5.0 (58 vs 235 days, p = 0.001). Cardiopulmonary bypass time was significantly shorter and a significantly smaller amount of red blood cell transfusion was required with Impella 5.0 (149 vs 192 min, p = 0.042; 7.0 vs 15.0 units, p = 0.019). There were four massive stroke events with eLVAD, but no massive stroke event with Impella 5.0. Conclusion: Impella 5.0 facilitates smoother management as a bridge to decision and reduces surgical invasiveness during durable LVAD implantation.

    DOI: 10.1177/03913988211040530

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  4. Clinical impact of heart rate change in patients with acute heart failure in the early phase

    Kazama Shingo, Kondo Toru, Shibata Naoki, Hiraiwa Hiroaki, Nishiyama Itsumure, Kato Toshiaki, Sawamura Akinori, Kimura Yuki, Oishi Hideo, Kuwayama Tasuku, Morimoto Ryota, Okumura Takahiro, Shimizu Kiyokazu, Murohara Toyoaki

    ESC HEART FAILURE   Vol. 8 ( 4 ) page: 2982 - 2990   2021.8

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    Language:Japanese   Publisher:ESC Heart Failure  

    Aims: Patients with acute heart failure (AHF) often present with an increased heart rate (HR), and the HR changes dramatically after initial treatment for AHF. However, the HR change after admission and the relationship between HR change in the early phase and prognosis have not been fully elucidated. Methods and results: From a multicentre AHF registry, we retrospectively evaluated 1527 consecutive patients admitted with AHF. HR change (%) was calculated by [HR (at admission) − HR (24 h after admission)] × 100∕HR (at admission). The median HR change was 15.1% (range, 2.0–28.4%). The HR decreased most in the first 24 h and then gradually thereafter [admission: 98 (81–117) b.p.m., 24 h: 80 (70–92) b.p.m., 48 h: 78 (68–90) b.p.m., and 72 h: 77 (67–88) b.p.m.]. In Kaplan–Meier analysis, the cumulative event-free rates in the composite endpoint of death and rehospitalization due to AHF showed better according to larger HR change (P = 0.012, log rank). Cox proportional hazards analysis showed that HR change was a prognostic factor for composite endpoint adjusted by age and sex [hazard ratio, 0.995; 95% confidence interval (CI), 0.991–0.998; P = 0.006]. HR change was associated with outcome adjusted by age and sex in patients with sinus rhythm (hazard ratio, 0.993; 95% CI, 0.988–0.999; P = 0.015), but not in patients with atrial fibrillation (hazard ratio, 0.996; 95% CI, 0.990–1.002; P = 0.15). Conclusions: A decrease in HR in the first 24 h after admission indicates better prognosis in patients with AHF, although the prognostic influence may differ between patients with sinus rhythm and those with atrial fibrillation.

    DOI: 10.1002/ehf2.13388

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  5. Prognostic value of resting cardiac power index depends on mean arterial pressure in dilated cardiomyopathy

    Morimoto Ryota, Mizutani Takashi, Araki Takashi, Oishi Hideo, Kimura Yuki, Kazama Shingo, Shibata Naoki, Kuwayama Tasuku, Hiraiwa Hiroaki, Kondo Toru, Furusawa Kenji, Okumura Takahiro, Murohara Toyoaki

    ESC HEART FAILURE   Vol. 8 ( 4 ) page: 3206 - 3213   2021.8

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    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

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

    Kazama Shingo, Morimoto Ryota, Kimura Yuki, Shibata Naoki, Ozaki Reina, Araki Takashi, Mizutani Takashi, Oishi Hideo, Arao Yoshihito, Kuwayama Tasuku, Hiraiwa Hiroaki, Kondo Toru, Furusawa Kenji, Shimokata Tomoya, Okumura Takahiro, Bando Yasuko K., Ando Yuichi, Murohara Toyoaki

    CARDIO-ONCOLOGY   Vol. 7 ( 1 ) page: 26   2021.7

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    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

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  7. Prognostic value of leucine/phenylalanine ratio as an amino acid profile of heart failure

    Hiraiwa Hiroaki, Okumura Takahiro, Kondo Toru, Kato Toshiaki, Kazama Shingo, Kimura Yuki, Ishihara Toshikazu, Iwata Etsuo, Shimojo Masafumi, Kondo Sayano, Aoki Soichiro, Kanzaki Yasunori, Tanimura Daisuke, Sano Hiroaki, Awaji Yoshifumi, Yamada Sumio, Murohara Toyoaki

    HEART AND VESSELS   Vol. 36 ( 7 ) page: 965 - 977   2021.7

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    Heart failure (HF) causes a hypercatabolic state that enhances the catabolic activity of branched-chain amino acids (BCAA; leucine, isoleucine, and valine) in the heart and skeletal muscles and reduces protein synthesis in the liver. Consequently, free plasma aromatic amino acids (AAA, tyrosine and phenylalanine) are increased. To date, we have reported the prognostic value of the BCAA/AAA ratio (Fischer’s ratio) in patients with HF. However, the leucine/phenylalanine ratio, which is a simpler index than the Fischer’s ratio, has not been examined. Therefore, the prognostic value of the leucine/phenylalanine ratio in patients with HF was investigated. Overall 157 consecutive patients hospitalized for worsening HF (81 men, median age 78 years) were enrolled in the study. Plasma amino acid levels were measured when the patients were stabilized at discharge. Cardiac events were defined as a composite of cardiac death and hospitalization for worsening HF. A total of 46 cardiac events occurred during the median follow-up period of 238 (interquartile range 93–365) days. The median leucine/phenylalanine ratio was significantly lower in patients with cardiac events than in those without cardiac events (1.4 vs. 1.8, P < 0.001). The best cutoff value of the leucine/phenylalanine ratio was determined as 1.7 in the receiver operating characteristic (ROC) curve for cardiac events. Following a Kaplan–Meier survival analysis, the low group (leucine/phenylalanine ratio < 1.7, n = 72) had more cardiac events than the high group (leucine/phenylalanine ratio ≥ 1.7, n = 85) (log-rank, P < 0.001). Multivariate Cox proportional hazards regression analysis showed that the leucine/phenylalanine ratio was an independent predictor of cardiac events. Furthermore, on comparing the prognostic values for cardiac events based on ROC curves of leucine levels, BCAA levels, Fischer’s ratio, and leucine/phenylalanine ratio, the leucine/phenylalanine ratio was the most accurate in predicting future cardiac events (area under the curve 0.763,; sensitivity 0.783,; specificity 0.676,; P < 0.001). The leucine/phenylalanine ratio could be a useful predictor of future cardiac events in patients with HF, reflecting an imbalance in amino acid metabolism.

    DOI: 10.1007/s00380-020-01765-z

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  8. The protective effect of tight-fitting powered air-purifying respirators during chest compressions.

    Goto Y, Jingushi N, Hiraiwa H, Ogawa H, Sakai Y, Kasugai D, Tanaka T, Higashi M, Yamamoto T, Numaguchi A

    The American journal of emergency medicine   Vol. 49   page: 172 - 177   2021.6

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    Background: Airborne personal protective equipment is required for healthcare workers when performing aerosol-generating procedures on patients with infectious diseases. Chest compressions, one of the main components of cardiopulmonary resuscitation, require intense and dynamic movements of the upper body. We aimed to investigate the protective effect of tight-fitting powered air-purifying respirators (PAPRs) during chest compressions. Methods: This single-center simulation study was performed from February 2021 to March 2021. The simulated workplace protection factor (SWPF) is the concentration ratio of ambient particles and particles inside the PAPR mask; this value indicates the level of protection provided by a respirator when subjected to a simulated work environment. Participants performed continuous chest compressions three times for 2 min each time, with a 4-min break between each session. We measured the SWPF of the tight-fitting PAPR during chest compression in real-time mode. The primary outcome was the ratio of any failure of protection (SWPF <500) during the chest compression sessions. Results: Fifty-four participants completed the simulation. Overall, 78% (n = 42) of the participants failed (the measured SWPF value was less than 500) at least one of the three sessions of chest compressions. The median value and interquartile range of the SWPF was 4304 (685–16,191). There were no reports of slipping down of the respirator or mechanical failure during chest compressions. Conclusions: Although the median SWPF value was high during chest compressions, the tight-fitting PAPR did not provide adequate protection.

    DOI: 10.1016/j.ajem.2021.06.012

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  9. Usefulness of Respiratory Mechanics and Laboratory Parameter Trends as Markers of Early Treatment Success in Mechanically Ventilated Severe Coronavirus Disease: A Single-Center Pilot Study

    Kasugai Daisuke, Ozaki Masayuki, Nishida Kazuki, Hiraiwa Hiroaki, Jingushi Naruhiro, Numaguchi Atsushi, Omote Norihito, Shindo Yuichiro, Goto Yukari

    JOURNAL OF CLINICAL MEDICINE   Vol. 10 ( 11 )   2021.6

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    Language:Japanese   Publisher:Journal of Clinical Medicine  

    Whether a patient with severe coronavirus disease (COVID-19) will be successfully liberated from mechanical ventilation (MV) early is important in the COVID-19 pandemic. This study aimed to characterize the time course of parameters and outcomes of severe COVID-19 in relation to the timing of liberation from MV. This retrospective, single-center, observational study was performed using data from mechanically ventilated COVID-19 patients admitted to the ICU between 1 March 2020 and 15 December 2020. Early liberation from ventilation (EL group) was defined as successful extubation within 10 days of MV. The trends of respiratory mechanics and laboratory data were visualized and compared between the EL and prolonged MV (PMV) groups using smoothing spline and linear mixed effect models. Of 52 admitted patients, 31 mechanically ventilated COVID-19 patients were included (EL group, 20 (69%); PMV group, 11 (31%)). The patients’ median age was 71 years. While in-hospital mortality was low (6%), activities of daily living (ADL) at the time of hospital discharge were significantly impaired in the PMV group compared to the EL group (mean Barthel index (range): 30 (7.5–95) versus 2.5 (0–22.5), p = 0.048). The trends in respiratory compliance were different between patients in the EL and PMV groups. An increasing trend in the ventilatory ratio during MV until approximately 2 weeks was observed in both groups. The interaction between daily change and earlier liberation was significant in the trajectory of the thrombin–antithrombin complex, antithrombin 3, fibrinogen, C-reactive protein, lymphocyte, and positive end-expiratory pressure (PEEP) values. The indicator of physiological dead space increases during MV. The trajectory of markers of the hypercoagulation status, inflammation, and PEEP were significantly different depending on the timing of liberation from MV. These findings may provide insight into the pathophysiology of COVID-19 during treatment in the critical care setting.

    DOI: 10.3390/jcm10112513

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  10. A clinical score for predicting left ventricular reverse remodelling in patients with dilated cardiomyopathy

    Kimura Yuki, Okumura Takahiro, Morimoto Ryota, Kazama Shingo, Shibata Naoki, Oishi Hideo, Araki Takashi, Mizutani Takashi, Kuwayama Tasuku, Hiraiwa Hiroaki, Kondo Toru, Murohara Toyoaki

    ESC HEART FAILURE   Vol. 8 ( 2 ) page: 1359 - 1368   2021.4

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    Aims: Left ventricular reverse remodelling (LVRR) is a well-established predictor of a good prognosis in patients with dilated cardiomyopathy (DCM). The prediction of LVRR is important when developing a long-term treatment strategy. This study aimed to assess the clinical predictors of LVRR and establish a scoring system for predicting LVRR in patients with DCM that can be used at any institution. Methods and results: We consecutively enrolled 131 patients with DCM and assessed the clinical predictors of LVRR. LVRR was defined as an absolute increase in left ventricular ejection fraction (LVEF) from ≥10% to a final value of >35%, accompanied by a decrease in left ventricular end-diastolic dimension (LVEDD) ≥ 10% on echocardiography at 1 ± 0.5 years after a diagnosis of DCM. The mean patient age was 50.1 ± 11.9 years. The mean LVEF was 32.2 ± 9.5%, and the mean LVEDD was 64.1 ± 12.5 mm at diagnosis. LVRR was observed in 45 patients (34%) at 1 ± 0.5 years. In a multivariate analysis, hypertension [odds ratio (OR): 6.86; P = 0.002], no family history of DCM (OR: 10.45; P = 0.037), symptom duration <90 days (OR: 6.72; P < 0.001), LVEF <35% (OR: 13.66; P < 0.0001), and QRS duration <116 ms (OR: 5.94; P = 0.005) were found to be independent predictors of LVRR. We scored the five independent predictors according to the ORs (1 point, 2 points, 1 point, 2 points, and 1 point, respectively), and the total LVRR predicting score was calculated by adding these scores. The LVRR rate was stratified by the LVRR predicting score (0–2 points: 0%; 3 points: 6.7%; 4 points: 17.4%; 5 points: 48.2%; 6 points: 79.2%; and 7 points: 100%). The cut-off value of the LVRR predicting score was >5 in receiver-operating characteristic curve analysis (area under the curve: 0.89; P < 0.0001; sensitivity: 87%; specificity: 78%). An LVRR predicting score of >5 was an independent predictor compared with the presence of late gadolinium enhancement on cardiovascular magnetic resonance or the severity of fibrosis on endomyocardial biopsy (OR: 11.79; 95% confidence interval: 2.40–58.00; P = 0.002). Conclusions: The LVRR predicting score using five predictors including hypertension, no family history of DCM, symptom duration <90 days, LVEF <35%, and QRS duration <116 ms can stratify the LVRR rate in patients with DCM. The LVRR predicting score may be a useful clinical tool that can be used easily at any institution.

    DOI: 10.1002/ehf2.13216

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

    Hiraiwa Hiroaki, Okumura Takahiro, Sawamura Akinori, Kondo Toru, Kazama Shingo, Kimura Yuki, Shibata Naoki, Arao Yoshihito, Oishi Hideo, Kato Hiroo, Kuwayama Tasuku, Yamaguchi Shogo, Furusawa Kenji, Morimoto Ryota, Fujimoto Kazuro, Mutsuga Masato, Usui Akihiko, Murohara Toyoaki

    INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS   Vol. 44 ( 4 ) page: 282 - 287   2021.4

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    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

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  12. Associations between hemodynamic parameters at rest and exercise capacity in patients with implantable left ventricular assist devices

    Kondo Toru, Okumura Takahiro, Oishi Hideo, Arao Yoshihito, Kato Hiroo, Yamaguchi Shogo, Kuwayama Tasuku, Haga Tomoaki, Yokoi Tsuyoshi, Hiraiwa Hiroaki, Fukaya Kenji, Sawamura Akinori, Morimoto Ryota, Mutsuga Masato, Fujimoto Kazuro, Usui Akihiko, Murohara Toyoaki

    INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS   Vol. 44 ( 3 ) page: 174 - 180   2021.3

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    Background: Hemodynamic parameters at rest are known to correlate poorly with peak oxygen uptake (VO2) in heart failure. However, we hypothesized that hemodynamic parameters at rest could predict exercise capacity in patients with left ventricular assist device (LVAD), because LVAD pump rotational speed does not respond during exercise. Therefore, we investigated the relationships between hemodynamic parameters at rest (measured with right heart catheterization) and exercise capacity (measured with cardiopulmonary exercise testing) in patients with implantable LVAD. Methods: We performed a retrospective medical record review of patients who received implantable LVAD at our institution from November 2013 to December 2017. Results: A total of 20 patients were enrolled in this study (15 males; mean age, 45.8 years; median duration of LVAD support, 356 days). The mean peak VO2 and cardiac index (CI) were 13.5 mL/kg/min and 2.6 L/min/m2, respectively. CI and hemoglobin level were significantly associated with peak VO2 (CI: r = 0.632, p = 0.003; hemoglobin: r = 0.520, p = 0.019). In addition, pulmonary capillary wedge pressure, right atrial pressure, and right ventricular stroke work index were also significantly associated with peak VO2. In multiple linear regression analysis, CI and hemoglobin level remained independent predictors of peak VO2 (CI: β = 0.559, p = 0.006; hemoglobin: β = 0.414, p = 0.049). Conclusions: CI at rest and hemoglobin level are associated with poor exercise capacity in patients with LVAD.

    DOI: 10.1177/0391398820949888

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  13. Impact of predictive value of Fibrosis-4 index in patients hospitalized for acute heart failure

    Shibata Naoki, Kondo Toru, Kazama Shingo, Kimura Yuki, Oishi Hideo, Arao Yoshihito, Kato Hiroo, Yamaguchi Shogo, Kuwayama Tasuku, Hiraiwa Hiroaki, Morimoto Ryota, Okumura Takahiro, Sumi Takuya, Sawamura Akinori, Shimizu Kiyokazu, Murohara Toyoaki

    INTERNATIONAL JOURNAL OF CARDIOLOGY   Vol. 324   page: 90 - 95   2021.2

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    Background: Abnormalities in liver function tests commonly occur in patients with acute heart failure (AHF). The Fibrosis-4 (FIB4) index, a non-invasive and easily calculated marker, has been used for hepatic diseases and reflects adverse prognosis. It is not clearly established whether the FIB4 index at admission can predict adverse outcomes in patients with AHF. Methods and results: From a multicenter AHF registry, we retrospectively evaluated 1162 consecutive patients admitted due to AHF (median age 78 [69–85] years and 702 patients [60.4%] were male). The FIB4 index at admission was calculated as: age (yrs) × aspartate aminotransferase [U/L]/(platelets count [103/μL] × √alanine aminotransferase [U/L]. The median value of the FIB4 index at admission was 2.79. All-cause mortality and rehospitalization due to HF at 12 months were investigated as a composite endpoint and occurred in 142 (12.2%) patients and 232 (20%) patients, respectively. Kaplan-Meyer analysis shows a significant increase in the composite endpoint from the first to fourth quartile group of the FIB4 index values (log-rank, p < 0.001). Multivariate Cox regression model revealed the FIB4 index was an independent risk predictor for composite endpoint in patients with AHF (3 months: HR ratio 1.013 [95% Confidence interval (CI):1.001–1.025]; p = 0.03, 12 months: HR 1.015 [95% CI:1.005–1.025]; p = 0.003, respectively). However, neither aspartate aminotransferase, alanine aminotransferase, nor platelet count was found to be a significant predictor. Conclusions: Hepatic dysfunction evaluated with the FIB4 index at admission is a predictor of the composite endpoint of all-cause mortality and rehospitalization in AHF patients.

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  14. Efficacy of favipiravir for an end stage renal disease patient on maintenance hemodialysis infected with novel coronavirus disease 2019

    Koshi Eri, Saito Shoji, Okazaki Masaki, Toyama Yuki, Ishimoto Takuji, Kosugi Tomoki, Hiraiwa Hiroaki, Jingushi Naruhiro, Yamamoto Takanori, Ozaki Masayuki, Goto Yukari, Numaguchi Atsushi, Miyagawa Yasuhiro, Kato Io, Tetsuka Nobuyuki, Yagi Tetsuya, Maruyama Shoichi

    CEN CASE REPORTS   Vol. 10 ( 1 ) page: 126 - 131   2021.2

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    BACKGROUND: Novel coronavirus disease 2019 (COVID-19) refers to infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogen, and has spread to pandemic levels since its inception in December 2019. While several risk factors for severe presentation have been identified, the clinical course for end-stage renal disease (ESRD) patients on maintenance hemodialysis with COVID-19 has been unclear. Previous studies have revealed that some antiviral agents may be effective against COVID-19 in the general population, but the pharmacokinetics and pharmacodynamics of these agents in ESRD patients remain under investigation. Favipiravir, an antiviral agent developed for treatment of influenza, is one candidate treatment for COVID-19, but suitable dosages for patients with renal insufficiency are unknown. Here we provide a first report on the efficacy of favipiravir in a patient with ESRD undergoing hemodialysis. CASE PRESENTATION: The case involved a 52-year-old woman with COVID-19 who had been undergoing maintenance hemodialysis three times a week for 3 years due to diabetic nephropathy. She had initially been treated with lopinavir/ritonavir and ciclesonide for 5 days, but developed severe pneumonia requiring invasive positive-pressure ventilation. Those antiviral agents were subsequently switched to favipiravir. She recovered gradually, and after 2 weeks was extubated once the viral load of SARS-CoV-2 fell below the limit of detection. Although concentrations of several biliary enzymes were elevated, no major adverse events were observed. CONCLUSION: Favipiravir may be an effective option for the treatment of COVID-19-infected patients with ESRD.

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  15. Predictors of residual mitral regurgitation after left ventricular assist device implantation

    Kimura Yuki, Okumura Takahiro, Kazama Shingo, Shibata Naoki, Oishi Hideo, Arao Yoshihito, Kuwayama Tasuku, Kato Hiroo, Yamaguchi Shogo, Hiraiwa Hiroaki, Kondo Toru, Morimoto Ryota, Mutsuga Masato, Fujimoto Kazuro, Usui Akihiko, Murohara Toyoaki

    INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS   Vol. 44 ( 2 ) page: 101 - 109   2021.2

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    Patients with advanced heart failure often have functional mitral regurgitation. Left ventricular assist device implantation improves functional mitral regurgitation through left ventricular unloading. However, residual mitral regurgitation after left ventricular assist device implantation leads to adverse outcomes, and whether patients need concomitant mitral valve surgery is not fully elucidated. Therefore, this study aimed to elucidate the predictors of residual mitral regurgitation and to describe the temporal changes in residual mitral regurgitation. We retrospectively enrolled 15 patients with implantable continuous-flow left ventricular assist device, who had significant mitral regurgitation on echocardiography before left ventricular assist device implantation. Three patients had residual mitral regurgitation (mitral regurgitation color jet area/left atrial area >0.2) 1 month after left ventricular assist device implantation. We investigated factors associated with residual mitral regurgitation and compared patients with or without residual mitral regurgitation. On univariate analysis, mitral valve tethering area and mitral regurgitation vena contracta before left ventricular assist device implantation were significantly associated with residual mitral regurgitation (odds ratio, 1.03; p = 0.036 and odds ratio, 10.45; p = 0.0087). One month after left ventricular assist device implantation, the mean pulmonary capillary wedge pressure and pulmonary artery pressure were higher in patients with residual mitral regurgitation (pulmonary capillary wedge pressure: 11.3 ± 3.5 vs 6.4 ± 3.4 mmHg, p = 0.029 and pulmonary artery pressure: 21.3 ± 4.0 vs 15.9 ± 3.3 mmHg, p = 0.023). However, the mitral regurgitation grading and hemodynamics were not significantly different 6 months after left ventricular assist device implantation. The hospitalization-free survival was not significantly different between the two groups. Mitral valve tethering area and mitral regurgitation vena contracta were predictors of residual mitral regurgitation. Residual mitral regurgitation improved until 6 months after left ventricular assist device implantation and might not affect the prognosis.

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

    Kazama S.

    Journal of Cardiology Cases   Vol. 23 ( 1 ) page: 53 - 56   2021.1

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    DOI: 10.1016/j.jccase.2020.08.013

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  17. Relative bradycardia as a clinical feature in patients with coronavirus disease 2019 (COVID-19): A report of two cases

    Hiraiwa H.

    Journal of Cardiology Cases   Vol. 22 ( 6 ) page: 260 - 264   2020.12

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  18. Aortic insufficiency associated with Impella that required surgical intervention upon implantation of the durable left ventricular assist device

    Oishi Hideo, Kondo Toru, Fujimoto Kazuro, Mutsuga Masato, Morimoto Ryota, Hirano Ken-ichi, Sawamura Akinori, Kazama Shingo, Kimura Yuki, Shibata Naoki, Kato Hiroo, Arao Yoshihito, Kuwayama Tasuku, Yamaguchi Shogo, Hiraiwa Hiroaki, Okumura Takahiro, Usui Akihiko, Murohara Toyoaki

    JOURNAL OF ARTIFICIAL ORGANS   Vol. 23 ( 4 ) page: 378 - 382   2020.12

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    The Impella is an axial-flow percutaneous ventricular assist device for cardiogenic shock. In this report, we describe two patients who developed aortic insufficiency (AI) associated with Impella and required surgical intervention upon implantation of the durable left ventricular assist device (LVAD). Both patients presented with cardiogenic shock and underwent insertion of Impella 5.0 as a bridge to decision. The cardiac function in these patients did not improve and obtaining approval for heart transplantation required time. They were managed with Impella for 91 and 98 days, respectively. In both cases, moderate AI that was not present before Impella insertion was observed when the Impella was removed. Therefore, we performed aortic valve closure to control the AI during durable LVAD implantation. In patients with durable LVAD implantation, AI may occur and progress after the operation in several cases. Aortic valve surgery is often performed to prevent deterioration of AI, especially in patients with AI before the surgery. Hence, AI is an important complication following Impella device implantation as a bridge to decision. Careful observation of AI is essential when the Impella is removed as the evaluation of AI by echocardiogram during Impella management is cumbersome because of device-generated artifacts.

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  19. 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   Vol. 41   page: 1094 - 1094   2020.11

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  20. 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   Vol. 41   page: 1836 - 1836   2020.11

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  21. 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   Vol. 41   page: 902 - 902   2020.11

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  22. The efficacy of methotrexate for intolerance to prednisolone therapy in cardiac sarcoidosis

    Morimoto R., Kuwayama T., Ooishi H., Kazama S., Kimura Y., Shibata N., Hiraiwa H., Kondo T., Okumura T., Unno K., Murohara T.

    EUROPEAN HEART JOURNAL   Vol. 41   page: 2131 - 2131   2020.11

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  23. Differential Diagnosis of Mechanisms of Exercise-Induced Abnormal Blood Pressure Response in Hypertrophic Cardiomyopathy Without Left Ventricular Outflow Tract Obstruction

    Okumura Takahiro, Kano Naoaki, Sawamura Akinori, Kondo Toru, Hiraiwa Hiroaki, Morimoto Ryota, Murohara Toyoaki

    CIRCULATION-HEART FAILURE   Vol. 13 ( 10 ) page: e007164 - 551   2020.10

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    DOI: 10.1161/CIRCHEARTFAILURE.120.007164

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  24. Prognostic Value of Delirium in Patients With Acute Heart Failure in the Intensive Care Unit

    Iwata Etsuo, Kondo Toru, Kato Toshiaki, Okumura Takahiro, Nishiyama Itsumure, Kazama Shingo, Ishihara Toshikazu, Kondo Sayano, Hiraiwa Hiroaki, Tsuda Takuma, Ito Masanori, Aoyama Morihiko, Tanimura Daisuke, Awaji Yoshifumi, Unno Kazumasa, Murohara Toyoaki

    CANADIAN JOURNAL OF CARDIOLOGY   Vol. 36 ( 10 ) page: 1649 - 1657   2020.10

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    Background: Delirium is a common adverse event observed in patients admitted to the intensive care unit (ICU). However, the prognostic value of delirium and its determinants have not been thoroughly investigated in patients with acute heart failure (AHF). Methods: We investigated 408 consecutive patients with AHF admitted to the ICU. Delirium was diagnosed by means of the Confusion Assessment Method for ICU tool and evaluated every 8 hours during the patients’ ICU stays. Results: Delirium occurred in 109 patients (26.7%), and the in-hospital mortality rate was significantly higher in patients with delirium (13.8% vs 2.3%; P < 0.001). Multivariate logistic regression analysis showed that delirium independently predicted in-hospital mortality (odds ratio [OR] 4.33, confidence interval [CI] 1.62-11.52; P = 0.003). Kaplan-Meier analysis showed that the 12-month mortality rate was significantly higher in patients with delirium compared with those without (log-rank test: P < 0.001), and Cox proportional hazards analysis showed that delirium remained an independent predictor of 12-month mortality (hazard ratio 2.19, 95% CI 1.49-3.25; P < 0.001). The incidence of delirium correlated with severity of heart failure as assessed by means of the Get With The Guidelines–Heart Failure risk score (chi-square test: P = 0.003). Age (OR 1.05, 95% CI 1.02-1.09; P = 0.003), nursing home residential status (OR 3.32, 95% CI 1.59-6.94; P = 0.001), and dementia (OR 5.32, 95% CI 2.83-10.00; P < 0.001) were independently associated with the development of delirium. Conclusions: Development of delirium during ICU stay is associated with short- and long-term mortality and is predicted by the severity of heart failure, nursing home residential, and dementia status.

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  25. Impella 5.0 for Cardiogenic Shock After Thrombectomy in a Patient With Intraventricular Thrombosis

    Kimura Yuki, Kondo Toru, Mutsuga Masato, Morimoto Ryota, Kazama Shingo, Shibata Naoki, Oishi Hideo, Arao Yoshihito, Kuwayama Tasuku, Kato Hiroo, Yamaguchi Shogo, Hiraiwa Hiroaki, Okumura Takahiro, Fujimoto Kazuro, Usui Akihiko, Murohara Toyoaki

    CANADIAN JOURNAL OF CARDIOLOGY   Vol. 36 ( 10 ) page: 1690.e13 - 1690.e15   2020.10

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    A 43-year-old man was admitted to a referring hospital for cardiogenic shock caused by dilated cardiomyopathy. Intra-aortic balloon pump and percutaneous venoarterial extracorporeal membrane oxygenation (VA-ECMO) were started initially; however, a thrombus was detected in the left ventricle. After transfer to our institution, we performed thrombectomy through minithoracotomy. Subsequently, an Impella 5.0 device was inserted via the left subclavian artery. His cardiac function gradually improved, and both VA-ECMO and the Impella 5.0 could be weaned off. He was discharged without any thromboembolic event. Impella insertion with thrombectomy was possible, minimally invasive, and effective for a patient with intraventricular thrombosis associated with VA-ECMO.

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

    Kuwayama Tasuku, Morimoto Ryota, Oishi Hideo, Kato Hiroo, Kimura Yuki, Kazama Shingo, Shibata Naoki, Arao Yoshihito, Yamaguchi Shogo, Hiraiwa Hiroaki, Kondo Toru, Furusawa Kenji, Okumura Takahiro, Murohara Toyoaki

    CIRCULATION JOURNAL   Vol. 84 ( 9 ) page: 1536 - +   2020.9

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    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.

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  27. Pulmonary artery pressure may be a predictor of closed aortic valve in patients managed by venoarterial extracorporeal membrane oxygenation

    Yamaguchi Shogo, Sawamura Akinori, Okumura Takahiro, Kato Hiroo, Oishi Hideo, Arao Yoshihito, Haga Tomoaki, Kuwayama Tasuku, Yokoi Tsuyoshi, Hiraiwa Hiroaki, Kondo Toru, Morimoto Ryota, Murohara Toyoaki

    INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS   Vol. 43 ( 9 ) page: 594 - 599   2020.9

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    In the management of venoarterial extracorporeal membrane oxygenation, some patients present persistently closed aortic valve. However, little is known about the variables that contribute to persistently closed aortic valve. We investigated the factors that could predict persistently closed aortic valve at the time of venoarterial extracorporeal membrane oxygenation initiation. We investigated 17 patients who presented closed aortic valve immediately after the introduction of venoarterial extracorporeal membrane oxygenation. Patients who presented closed aortic valve 24 h after introduction of venoarterial extracorporeal membrane oxygenation were defined as the Closed-AV group (n = 8), while those whose aortic valve remained opened after 24 h were defined as the Open-AV group (n = 9). All patients were managed by concomitant use of intra-aortic balloon pumping. At baseline, there were no significant differences between mean arterial blood pressure, central venous pressure, and left ventricular ejection fraction. However, Closed-AV group had significantly lower mean pulmonary artery pressure and pulmonary artery pulse pressure compared to those of Open-AV group (mean pulmonary artery pressure: 15 ± 6 mmHg vs 25 ± 8 mmHg, p = 0.01; pulmonary artery pulse pressure: 3 ± 2 mmHg vs 8 ± 3 mmHg, p < 0.01). Logistic regression analyses revealed that the lower mean pulmonary artery pressure and pulmonary artery pulse pressure had the predictive value of closed aortic valve within 24 h after venoarterial extracorporeal membrane oxygenation initiation (mean pulmonary artery pressure: odds ratio = 0.78, 95% confidence interval = 0.58–0.95, p < 0.01; pulmonary artery pulse pressure: odds ratio = 0.18, 95% confidence interval = 0.01–0.61, p < 0.01). Lower mean pulmonary artery pressure and pulmonary artery pulse pressure values could predict persistent closed aortic valve 24 h after venoarterial extracorporeal membrane oxygenation initiation. Left ventricular preload derived from right heart function may have a major impact on aortic valve status.

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  28. Fulminant myocarditis with myositis of ocular and respiratory muscles

    Hiraiwa Hiroaki, Furusawa Kenji, Kazama Shingo, Kimura Yuki, Shibata Naoki, Arao Yoshihito, Oishi Hideo, Kato Hiroo, Kuwayama Tasuku, Yamaguchi Shogo, Kondo Toru, Sawamura Akinori, Morimoto Ryota, Okumura Takahiro, Murohara Toyoaki

    NAGOYA JOURNAL OF MEDICAL SCIENCE   Vol. 82 ( 3 ) page: 585 - 593   2020.8

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    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.

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  29. Usefulness of Plasma Branched-Chain Amino Acid Analysis in Predicting Outcomes of Patients with Nonischemic Dilated Cardiomyopathy

    Kimura Yuki, Okumura Takahiro, Kazama Shingo, Shibata Naoki, Oishi Hideo, Arao Yoshihito, Kuwayama Tasuku, Kato Hiroo, Yamaguchi Shogo, Hiraiwa Hiroaki, Kondo Toru, Morimoto Ryota, Murohara Toyoaki

    INTERNATIONAL HEART JOURNAL   Vol. 61 ( 4 ) page: 739 - 747   2020.7

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    The metabolism of branched-chain amino acids (BCAAs) is reported to change in heart failure (HF) and correlate with cardiac function. However, the effect of BCAAs on HF remains controversial. We investigate the prognostic value of the plasma BCAA level in nonischemic dilated cardiomyopathy (NIDCM). This study enrolled 39 NIDCM patients, who underwent plasma amino acid (AA) analysis. The ratio of BCAAs to total AAs was calculated. All patients were divided into two groups at the median of BCAA/total AA ratio; high BCAA/total AA group (≥0.15, n = 20) and low BCAA/total AA group (< 0.15, n = 19). A cardiac event was defined as a composite of cardiac death, hospitalization for worsening HF, and lethal arrhythmia. The mean age was 51.1 ± 12.3 years and left ventricular ejection fraction (LVEF) was 32.7 ± 10.1%. In the low BCAA/total AA group, the body mass index and the total cholesterol level were lower than in the high BCAA/total AA group. The BCAA/total AA ratio was positively correlated with LVEF (r = 0.35, P = 0.031) and negatively correlated with brain natriuretic peptide (r = −0.37, P = 0.020). The low BCAA/total AA group had a lower cardiac event-free rate (5-year: 100% versus 73%; P = 0.019). In univariate analysis, angiotensin converting enzyme inhibitor or angiotensin II receptor blocker (hazard ratio: 0.045, P = 0.0014), hemoglobin (hazard ratio: 0.49 per 1 g/dL, P = 0.0022), and BCAA/total AA ratio < 0.15 (hazard ratio: not available, P = 0.0066) were major predictors for cardiac events. The BCAA/total AA ratio might be a useful predictor for future cardiac events in patients with NIDCM.

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

    Hiraiwa Hiroaki, Okumura Takahiro, Sawamura Akinori, Kondo Toru, Kazama Shingo, Kimura Yuki, Shibata Naoki, Arao Yoshihito, Oishi Hideo, Kato Hiroo, Kuwayama Tasuku, Yamaguchi Shogo, Furusawa Kenji, Morimoto Ryota, Murohara Toyoaki

    ARTIFICIAL ORGANS   Vol. 44 ( 7 ) page: 700 - 708   2020.7

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    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.

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  31. Usefulness of the plasma branched-chain amino acid/Aromatic amino acid ratio for predicting future cardiac events in patients with heart failure

    Hiraiwa Hiroaki, Okumura Takahiro, Kondo Toru, Kato Toshiaki, Kazama Shingo, Ishihara Toshikazu, Iwata Etsuo, Shimojo Masafumi, Kondo Sayano, Aoki Soichiro, Kanzaki Yasunori, Tanimura Daisuke, Sano Hiroaki, Awaji Yoshifumi, Yamada Sumio, Murohara Toyoaki

    JOURNAL OF CARDIOLOGY   Vol. 75 ( 6 ) page: 689 - 696   2020.6

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    Background: Heart failure (HF) is a hypercatabolic state that promotes branched-chain amino acid (BCAA) catabolic activity in the heart and skeletal muscle and reduces protein synthesis in the liver. Consequently, plasma free aromatic amino acids (AAAs) are increased. We investigated the prognostic value of the BCAA/AAA ratio (Fischer's ratio, FR) in patients with HF. Methods: We enrolled 157 consecutive patients hospitalized for worsening HF (81 men, 76 women; mean ± SD age 75 ± 14 years). Plasma BCAA levels (i.e. total leucine, isoleucine, valine) and AAA levels (i.e. total tyrosine, phenylalanine) were measured at a time when the patients were stabilized (at discharge). FR was calculated as the combined plasma BCAA levels divided by the AAA level. Cardiac events were defined as a composite of cardiac death and hospitalization for worsening HF. Results: The patients were divided into two groups based on the median FR (high-FR group: FR ≥ 3.1, n = 78; low-FR group: FR < 3.1, n = 79). Compared with the high-FR group, low-FR patients were older, had more prior hospitalizations for HF, lower albumin and cholinesterase levels, and lower geriatric nutritional risk index (GNRI). Altogether, 46 cardiac events occurred during the follow-up period (221 ± 135 days), including 14 cardiac deaths and 32 hospitalizations for worsening HF. In a Kaplan–Meier survival analysis, the low-FR group had more cardiac events than the high-FR group (log-rank, p < 0.001). The best cut-off value of FR was determined as 2.9 in the receiver operating characteristic curve for cardiac events. A multivariate Cox proportional hazards regression analysis showed that being in the low-FR group was an independent determinant of cardiac events from parameters of liver function tests and GNRI. Conclusions: FR might be useful for predicting future cardiac events in patients with HF, reflecting nutritional status which cannot be assessed by liver function tests and GNRI.

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

    Hiraiwa Hiroaki, Okumura Takahiro, Shimizu Shinya, Arao Yoshihito, Oishi Hideo, Kato Hiroo, Kuwayama Tasuku, Yamaguchi Shogo, Haga Tomoaki, Yokoi Tsuyoshi, Kondo Toru, Sugiura Yuki, Kano Naoaki, Watanabe Naoki, Fukaya Kenji, Furusawa Kenji, Sawamura Akinori, Morimoto Ryota, Fujimoto Kazuro, Mutsuga Masato, Usui Akihiko, Murohara Toyoaki

    NAGOYA JOURNAL OF MEDICAL SCIENCE   Vol. 82 ( 1 ) page: 129 - 134   2020.2

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    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.

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  33. Giant cell myocarditis with central diabetes insipidus: A case report

    Yamaguchi S.

    Journal of Cardiology Cases   Vol. 21 ( 1 ) page: 8 - 11   2020.1

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    DOI: 10.1016/j.jccase.2019.08.011

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  34. Two cases of dilated cardiomyopathy with blood pressure-limited tolerability of cardioprotective agents improved by ivabradine

    Okumura T.

    Journal of Cardiology Cases     2020

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  35. Potential prognostic implications of myocardial thallium-201 and iodine-123-beta-methylpentadecanoic acid dual scintigraphy in patients with Anderson-Fabry disease

    Haga Tomoaki, Okumura Takahiro, Isobe Satoshi, Somura Fuji, Kano Naoaki, Kuwayama Tasuku, Yokoi Tsuyoshi, Hiraiwa Hiroaki, Kondo Toru, Sawamura Akinori, Morimoto Ryota, Yamamoto Hiroshi, Tsuboi Kazuya, Murohara Toyoaki

    ANNALS OF NUCLEAR MEDICINE   Vol. 33 ( 12 ) page: 930 - 936   2019.12

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    Objectives: Information on the relationship between myocardial damage assessed by myocardial scintigraphy and prognosis in patients with Anderson–Fabry disease (AFD) is lacking. We therefore aimed to investigate the prognostic impacts of myocardial thallium-201 (201Tl) and iodine-123 beta-methyl 15-para-iodophenyl 3(R, S)-methylpentadecanoic acid (123I-BMIPP) dual scintigraphy in patients with AFD. Methods: Eighteen consecutive patients with AFD underwent resting myocardial 201Tl/123I-BMIPP dual scintigraphy. Total defect scores (TDS) on both images were calculated visually according to the 17-segment model using a 5-point scoring system. The mismatch score (MS) was calculated as ‘TDS on 123I-BMIPP—TDS on 201Tl’. Results: Six major adverse cardiac events (MACEs) were recorded during a mean follow-up of 6.7 ± 4.2 years (three heart failure requiring hospitalization and three cardiac deaths). Left ventricular mass index, left atrial diameter, brain natriuretic peptide, TDS on 123I-BMIPP, and MS were all significantly greater in patients with MACEs compared with those without. Kaplan–Meier analysis indicated that high TDS on 123I-BMIPP and high MS were associated with poor event-free survival. Conclusion: TDS on 123I-BMIPP was a better prognostic determinant in patients with AFD than TDS on 201Tl. Myocardial 201Tl/123I-BMIPP dual scintigraphy may thus be a useful noninvasive modality for evaluating prognosis in patients with AFD.

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  36. Prognostic impact of mitral L-wave in patients with hypertrophic cardiomyopathy without risk factors for sudden cardiac death

    Sugiura Yuki, Morimoto Ryota, Aoki Soichiro, Yamaguchi Shogo, Haga Tomoaki, Kuwayama Tasuku, Yokoi Tsuyoshi, Hiraiwa Hiroaki, Kondo Toru, Watanabe Naoki, Kano Naoaki, Fukaya Kenji, Sawamura Akinori, Okumura Takahiro, Murohara Toyoaki

    HEART AND VESSELS   Vol. 34 ( 12 ) page: 2002 - 2010   2019.12

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    Hypertrophic cardiomyopathy (HCM) with severe diastolic dysfunction is a major cause of heart failure and sudden cardiac death (SCD) associated with lethal arrhythmia. Although various risk factors for cardiac events have been reported in HCM patients, previous studies have reported that some HCM patients exhibit either no risk or a low risk of SCD experienced cardiac events. The mid-diastolic transmitral flow velocity curve (mitral L-wave) is an echocardiographic index of left ventricular compliance, and it has been reported as one of the parameters of advanced diastolic dysfunction assessed noninvasively. However, little is known about the association between the mitral L-wave and long-term clinical outcomes in HCM patients without SCD risk factors. Between July 2005 and February 2016, 112 patients were diagnosed with HCM and 96 patients without risk factors were enrolled. After excluding 3 patients whom we could not detect L-wave more than once, 93 patients (mean age 57.7 ± 13.1 years, 33 females) were divided into the following two groups, according to the presence or absence of the mitral L-wave: Group L (+) (with the mitral L-wave) and Group L (−) (without the mitral L-wave). The correlations between the mitral L-wave and rates of cardiac events were investigated. The mitral L-wave was present in 14 (15.1%) patients [Group L]. During the follow-up period [4.7 (2.9–7.5) years], patients experienced 7 cardiac events. Kaplan–Meier survival analysis showed that the event-free rate was significantly lower in Group L (+) than in Group L (−) (log-rank P = 0.002). Additionally, in multivariate analysis, L-wave positivity was identified as independent predictors of cardiac events. Existence of the mitral L-wave can predict cardiac events, even in HCM patients without SCD risk factors.

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  37. Circulating human epididymis protein 4 is a novel prognostic predictor in ambulatory patients with non-ischemic dilated cardiomyopathy

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

    EUROPEAN HEART JOURNAL   Vol. 40   page: 4051 - 4051   2019.10

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  38. The increased serum level of troponin T after immunosuppression therapy reflects sustained myocardial FDG accumulation in cardiac sarcoidosis

    Morimoto R., Unno K., Ooishi H., Arao Y., Kato H., Yokoi T., Yamaguchi S., Haga T., Kuwayama T., Hiraiwa H., Kondo T., Sawamura A., Okumura T., Murohara T.

    EUROPEAN HEART JOURNAL   Vol. 40   page: 648 - 648   2019.10

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  39. 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   Vol. 40   page: 3303 - 3303   2019.10

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  40. Pulmonary artery pressure could predict closed aortic valve in patients managed by veno-arterial extracorporeal membrane oxygenation

    Yamaguchi S., Sawamura A., Arao Y., Ooishi H., Kato H., Kuwayama T., Haga T., Hiraiwa H., Yokoi T., Kondo T., Morimoto R., Okumura T., Murohara T.

    EUROPEAN HEART JOURNAL   Vol. 40   page: 953 - 953   2019.10

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  41. Neuromuscular electrical stimulation is feasible in patients with acute heart failure

    Kondo Toru, Yamada Sumio, Tanimura Daisuke, Kazama Shingo, Ishihara Toshikazu, Shimojo Masafumi, Iwata Etsuo, Kondo Sayano, Hiraiwa Hiroaki, Kato Toshiaki, Sano Hiroaki, Awaji Yoshifumi, Okumura Takahiro, Murohara Toyoaki

    ESC HEART FAILURE   Vol. 6 ( 5 ) page: 975 - 982   2019.10

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    Aims: In acute heart failure (AHF), immobilization is caused because of unstable haemodynamics and dyspnoea, leading to protein wasting. Neuromuscular electrical stimulation (NMES) has been reported to preserve muscle mass and improve functional outcomes in chronic disease. NMES may be effective against protein wasting frequently manifested in patients with AHF; however, whether NMES can be implemented safely without any adverse effect on haemodynamics has remained unknown. This study aimed to examine the feasibility of NMES in patients with AHF. Methods and results: Patients with AHF were randomly assigned to the NMES or control group. The intensity of the NMES group was set at 10–20% maximal voluntary contraction level, whereas the control group was limited at a visible or palpable level of muscle contraction. The sessions were performed 5 days per week since the day after admission. Before the study implementation, we set the feasibility criteria with following items: (i) change in systolic blood pressure (BP) > ±20 mmHg during the first session; (ii) increase in heart rate (HR) > +20 b.p.m. during the first session; (iii) development of sustained ventricular arrhythmia, atrial fibrillation (AF), and paroxysmal supraventricular tachycardia during all sessions; (iv) incidence of new-onset AF during the hospitalization period < 40%; and (v) completion of the planned sessions by >70% of patients. The criteria of feasibility were set as follows; the percentage to fill one of (i)–(iii) was <20% of the total subjects, and both (iv) and (v) were satisfied. A total of 73 patients (median age 72 years, 51 men) who completed the first session were analysed (NMES group, n = 34; control group, n = 39). Systolic BP and HR variations were not significantly different between two groups (systolic BP, P = 0.958; HR, P = 0.665). Changes in BP > ±20 mmHg or HR > +20 b.p.m. were observed in three cases in the NMES group (8.8%) and five in the control group (12.8%). New-onset arrhythmia was not observed during all sessions in both groups. During hospitalization, one patient newly developed AF in the NMES group (2.9%), and one developed AF (2.6%) and two lethal ventricular arrhythmia in the control group. Thirty-one patients in the NMES group (91%) and 33 patients in the control group (84%) completed the planned sessions during hospitalization. This study fulfilled the preset feasibility criteria. Conclusions: NMES is feasible in patients with AHF from immediately after admission.

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  42. Early blood pressure reduction by intravenous vasodilators associates with acute kidney injury in patients with hypertensive acute decompensated heart failure

    Arao Y., Sawamura A., Nakatochi M., Oishi H., Kato H., Yamaguchi S., Haga T., Kuwayama T., Yokoi T., Hiraiwa H., Kondo T., Morimoto R., Okumura T., Murohara T.

    EUROPEAN HEART JOURNAL   Vol. 40   page: 884 - 884   2019.10

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  43. Early Blood Pressure Reduction by Intravenous Vasodilators Is Associated With Acute Kidney Injury in Patients With Hypertensive Acute Decompensated Heart

    Arao Yoshihito, Sawamura Akinori, Nakatochi Masahiro, Okumura Takahiro, Kato Hiroo, Oishi Hideo, Yamaguchi Shogo, Haga Tomoaki, Kuwayama Tasuku, Yokoi Tsuyoshi, Hiraiwa Hiroaki, Kondo Toru, Morimoto Ryota, Murohara Toyoaki

    CIRCULATION JOURNAL   Vol. 83 ( 9 ) page: 1883 - +   2019.9

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    Background: Intravenous vasodilators are commonly used in patients with hypertensive acute decompensated heart failure (ADHF), but little is known about their optimal use in blood pressure (BP) management to avoid acute kidney injury (AKI). The purpose of this study was to investigate the association between systolic BP (SBP) changes and the incidence of AKI in patients with hypertensive ADHF. Methods and Results: Post-hoc analysis was performed on a prospectively enrolled cohort. We investigated 245 patients with ADHF and SBP >140 mmHg on arrival (mean age, 76 years; 40% female). We defined “SBP-fall” as the maximum percent reduction in SBP 6 h after intravenous treatment. AKI was defined as serum creatinine (SCr) ≥0.3 mg/dL, or urine output <0.5 mL/kg/h (n=66) at 48 h. Mean SBP and SCr levels on arrival were 180 mmHg and 1.21 mg/dL, respectively. Patients with AKI had significantly larger SBP-fall than the others (36.7±15.3% vs. 27.2±15.3%, P<0.0001). Logistic regression analysis showed an odds ratio per 10% SBP-fall for AKI of 1.49 (95% confidence interval 1.29-1.90, P=0.001). SBP-fall was significantly associated with the number of concomitant used intravenous vasodilators (P=0.001). The administration of carperitide was also independently associated with increased incidence of AKI. Conclusions: Larger SBP-fall from excessive vasodilator use is associated with increased incidence of AKI in patients with hypertensive ADHF.

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  44. 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 Tsuyoshi, Morimoto Ryota, Oishi Hideo, Kato Hiroo, Arao Yoshihito, Yamaguchi Shogo, Kuwayama Tasuku, Haga Tomoaki, Hiraiwa Hiroaki, Kondo Toni, Furusawa Kenji, Fukaya Kenji, Sawamura Akinori, Okumura Takahiro, Hirashiki Akihiro, Murohara Toyoaki

    AMERICAN JOURNAL OF CARDIOLOGY   Vol. 124 ( 3 ) page: 435 - 441   2019.8

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    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.

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  45. A survival case of a young adult patient with ST-elevated myocardial infarction with high levels of lipoprotein(a)

    Hiraiwa H.

    Journal of Cardiology Cases   Vol. 19 ( 6 ) page: 207 - 210   2019.6

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    DOI: 10.1016/j.jccase.2019.02.004

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  46. Hemodynamics of cardiac tamponade during extracorporeal membrane oxygenation support in a patient with fulminant myocarditis

    Kondo T.

    Journal of Cardiology Cases   Vol. 19 ( 1 ) page: 22 - 24   2019.1

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    DOI: 10.1016/j.jccase.2018.08.009

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  47. Haemodynamic and electrical safety of neuromuscular electrical stimulation in acute decompensated heart failure

    Kondo T., Yamada S., Okumura T., Kazama S., Ishihara T., Shimojo M., Iwata E., Kondo S., Hiraiwa H., Tanimura D., Kato T., Awaji Y., Murohara T.

    EUROPEAN HEART JOURNAL   Vol. 39   page: 908 - 908   2018.8

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  48. Tau as a predictor of cardiac events in cardiomyopathy with systolic and/or diastolic dysfunction

    Yokoi T., Morimoto R., Okumura T., Yamaguchi S., Kuwayama T., Hiraiwa H., Haga T., Kondo T., Sugiura Y., Watanabe N., Kano N., Sawamura A., Murohara T.

    EUROPEAN HEART JOURNAL   Vol. 39   page: 1386 - 1387   2018.8

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  49. Promising method for management of venoarterial extracorporeal membrane oxygenation: A case of severe heart failure successfully stabilized by “high-flow/vasodilation method”

    Kondo T.

    Journal of Cardiology Cases   Vol. 18 ( 2 ) page: 81 - 84   2018.8

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    DOI: 10.1016/j.jccase.2018.05.002

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  50. Late-Onset Fulminant Myocarditis With Immune Checkpoint Inhibitor Nivolumab

    Yamaguchi Shogo, Morimoto Ryota, Okumura Takahiro, Yamashita Yuta, Haga Tomoaki, Kuwayama Tasuku, Yokoi Tsuyoshi, Hiraiwa Hiroaki, Kondo Toru, Sugiura Yuki, Watanabe Naoki, Kano Naoaki, Kohno Kei, Fukaya Kenji, Sawamura Akinori, Yokota Kenji, Ishii Hideki, Nakaguro Masato, Akiyama Masashi, Murohara Toyoaki

    CANADIAN JOURNAL OF CARDIOLOGY   Vol. 34 ( 6 ) page: 812.e1 - 812.e3   2018.6

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    A 60-year-old man was diagnosed with melanoma. After receiving 13 infusions of nivolumab, he had fulminant myocarditis. The myocardial biopsy specimen revealed extensive lymphocytic infiltration, interstitial edema, and myocardial necrosis, with predominant CD4+, CD8+, CD20− and programmed death-1− markers. Programmed death-1 ligand 1 (PD-L1) was predominantly expressed on the surface of the damaged myocardium. Although it is reported that myocarditis induced by the human anti-programmed death-1 inhibitor nivolumab therapy rarely occurred at > 2 months use in clinical trials, this case showed that even if at a late phase, long-term use of immune checkpoint inhibitors might to lead immune-related adverse events including myocarditis.

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

    Hiraiwa Hiroaki, Okumura Takahiro, Sawamura Akinori, Sugiura Yuki, Kondo Toru, Watanabe Naoki, Aoki Soichiro, Ichii Takeo, Kitagawa Katsuhide, Kano Naoaki, Fukaya Kenji, Furusawa Kenji, Morimoto Ryota, Takeshita Kyosuke, Bando Yasuko K., Murohara Toyoaki

    JOURNAL OF CARDIOLOGY   Vol. 71 ( 3-4 ) page: 284 - 290   2018

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    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

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

    Hiraiwa Hiroaki, Okumura Takahiro, Sawamura Akinori, Murohara Toyoaki

    JOURNAL OF CARDIOLOGY   Vol. 72 ( 3-4 ) page: 266 - 266   2018

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    DOI: 10.1016/j.jjcc.2018.02.005

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

    Hiraiwa Hiroaki, Okumura Takahiro, Sawamura Akinori, Sugiura Yuki, Kondo Toru, Watanabe Naoki, Aoki Soichiro, Ichii Takeo, Kitagawa Katsuhide, Kano Naoaki, Fukaya Kenji, Furusawa Kenji, Morimoto Ryota, Takeshita Kyosuke, Bando Yasuko K., Murohara Toyoaki

    JOURNAL OF CARDIOLOGY   Vol. 72 ( 1-2 ) page: 178 - 178   2018

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    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.

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

    Fukaya Kenji, Takeshita Kyosuke, Okumura Takahiro, Hiraiwa Hiroaki, Aoki Soichiro, Ichii Takeo, Sugiura Yuki, Kitagawa Katsuhide, Kondo Toru, Watanabe Naoki, Kano Naoaki, Furusawa Kenji, Sawamura Akinori, Morimoto Ryota, Bando Yasuko, Murohara Toyoaki

    ANNALS OF NONINVASIVE ELECTROCARDIOLOGY   Vol. 22 ( 5 )   2017.9

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    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.

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  55. Is the administration of mineralocorticoid receptor antagonist required in asymptomatic AHA/ACC stage B heart failure patients?

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

    EUROPEAN HEART JOURNAL   Vol. 38   page: 698 - 698   2017.8

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  56. 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   Vol. 38   page: 143 - 144   2017.8

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

    Kondo Toru, Okumura Takahiro, Takefuji Mikito, Hiraiwa Hiroaki, Sugiura Yuki, Watanabe Naoki, Aoki Soichiro, Ichii Takeo, Kitagawa Katsuhide, Kano Naoaki, Fukaya Kenji, Furusawa Kenji, Sawamura Akinori, Morimoto Ryota, Bando Yasuko K., Takemura Genzou, Murohara Toyoaki

    CIRCULATION-HEART FAILURE   Vol. 10 ( 3 ) page: e003826   2017.3

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    DOI: 10.1161/CIRCHEARTFAILURE.117.003826

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  58. Cholesterol metabolism as a prognostic marker in patients with mildly symptomatic nonischemic dilated cardiomyopathy

    Sawamura Akinori, Okumura Takahiro, Hiraiwa Hiroaki, Aoki Soichiro, Kondo Toru, Ichii Takeo, Furusawa Kenji, Watanabe Naoki, Kano Naoaki, Fukaya Kenji, Morimoto Ryota, Bando Yasuko K., Murohara Toyoaki

    JOURNAL OF CARDIOLOGY   Vol. 69 ( 5-6 ) page: 888 - 894   2017

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    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.

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  59. Myocardial contractile reserve predicts left ventricular reverse remodeling and cardiac events in dilated cardiomyopathy

    Morimoto Ryota, Okumura Takahiro, Hirashiki Akihiro, Ishii Hideki, Ichii Takeo, Aoki Soichiro, Furusawa Kenji, Hiraiwa Hiroaki, Kondo Toru, Watanabe Naoki, Kano Naoaki, Fukaya Kenji, Sawamura Akinori, Takeshita Kyosuke, Bando Yasuko K., Murohara Toyoaki

    JOURNAL OF CARDIOLOGY   Vol. 70 ( 3-4 ) page: 303 - 309   2017

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    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

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

    Ichii Takeo, Morimoto Ryota, Okumura Takahiro, Ishii Hideki, Tatami Yosuke, Yamamoto Dai, Aoki Soichiro, Hiraiwa Hiroaki, Furusawa Kenji, Kondo Toru, Watanabe Naoki, Kano Naoaki, Fukaya Kenji, Sawamura Akinori, Suzuki Susumu, Yasuda Yoshinari, Murohara Toyoaki

    JOURNAL OF ATHEROSCLEROSIS AND THROMBOSIS   Vol. 24 ( 11 ) page: 1092 - 1104   2017

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    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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MISC 8

  1. Bedside cannulation for veno-venous extracorporeal membrane oxygenation using portable X-ray system in a coronavirus disease patient.

    Kondo T, Kuwayama T, Hiraiwa H, Kasugai D, Goto Y, Numaguchi A, Katsu T, Matsui T, Hashimoto N, Tanaka A, Morimoto R, Okumura T, Murohara T

    Journal of cardiology cases     2021.9

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    Transportation of patients with coronavirus disease (COVID)-19 outside isolation rooms should be avoided to prevent further spread of the disease. Here, we report a safe and accurate bedside cannulation method for veno-venous extracorporeal membrane oxygenation (VV-ECMO) in a COVID-19 patient in the intensive care unit. A 71-year-old man was admitted to our hospital and diagnosed as having COVID-19 pneumonia. We decided to initiate VV-ECMO therapy because maintaining blood oxygen saturation was difficult despite the mechanical ventilation. We placed two flat-panel detectors behind the patient's chest and the right inguinal area. We repeatedly imaged and monitored insertion of wires and cannulas using a portable X-ray system. Cannulas were successfully inserted in the appropriate position, and VV-ECMO was initiated without any complications.

    DOI: 10.1016/j.jccase.2021.09.008

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  2. Two cases of dilated cardiomyopathy with blood pressure-limited tolerability of cardioprotective agents improved by ivabradine.

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

    Journal of cardiology cases   Vol. 23 ( 4 ) page: 149 - 153   2021.4

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    The titration of cardioprotective agents is essential for successful treatment of heart failure (HF) patients with reduced left ventricular ejection fraction. However, hypotension is one of the limiting factors for titration. Ivabradine reduces heart rate without compromising systolic function by prolonging diastolic filling time. Herein two cases of dilated cardiomyopathy (DCM) are presented in which ivabradine improved blood pressure (BP)-limited tolerability and allowed for further titration of cardioprotective agents. In both cases, the introduction of ivabradine raised the BP, which permitted further increase of the dose of renin-angiotensin system inhibitors or beta-blockers. One major hypothesized mechanism of ivabradine-induced BP elevation has been postulated to be an increase in stroke volume due to prolonged ventricular diastolic filling time. However, ivabradine is not expected to increase BP for all HF patients. In those with small and poorly compliant ventricles with severe diastolic or restricted dysfunction, decreased heart rate and prolonged diastole may excessively suppress compensatory mechanisms, and thus may not lead to increased cardiac output and BP. In contrast, ivabradine potentially increases BP and improves BP-limited tolerability of cardioprotective agents in DCM patients with a large and compliant heart. In addition, subsequent titration of cardioprotective agents may provide additional cardiac reverse remodeling. Learning objective: Ivabradine is usually used for heart failure patients with reduced ejection fraction when the tolerability of cardioprotective agents is maximized. This agent has no direct cardiac contractility-suppressing action. It potentially increases blood pressure and improves tolerability of cardioprotective agents in patients with a large and compliant heart such as dilated cardiomyopathy. Furthermore, subsequent titration of cardioprotective agents may provide additional cardiac reverse remodeling.

    DOI: 10.1016/j.jccase.2020.11.007

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

    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   Vol. 23 ( 1 ) page: 53 - 56   2021.1

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    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

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  4. Relative bradycardia as a clinical feature in patients with coronavirus disease 2019 (COVID-19): A report of two cases.

    Hiraiwa H, Goto Y, Nakamura G, Yasuda Y, Sakai Y, Kasugai D, Jinno S, Tanaka T, Ogawa H, Higashi M, Yamamoto T, Jingushi N, Ozaki M, Numaguchi A, Kondo T, Morimoto R, Okumura T, Matsuda N, Murohara T

    Journal of cardiology cases   Vol. 22 ( 6 ) page: 260 - 264   2020.12

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    We treated two patients with COVID-19 pneumonia requiring mechanical ventilation. Case 1 was a 73-year-old Japanese man. Computed tomography (CT) revealed ground-glass opacities in both lungs. He had severe respiratory failure with a partial pressure of oxygen in arterial blood/fraction of inspiratory oxygen ratio (P/F ratio) of 203. Electrocardiogram showed a heart rate (HR) of 56 beats/min, slight ST depression in leads II, III, and aVF, and mild saddle-back type ST elevation in leads V1 and V2. High-sensitivity cardiac troponin T (cTnT) level was slightly elevated. Despite a high fever and hypoxemia, his HR remained within 50–70 beats/min. Case 2 was a 52-year-old Japanese woman. CT revealed ground-glass opacities in the lower left lung. Electrocardiogram showed a HR of only 81 beats/min, despite a body temperature of 39.2 °C, slight ST depression in leads V4, V5, V6, and a prominent U wave in multiple leads. She had an elevated cTnT and a P/F ratio of 165. Despite a high fever and hypoxemia, her HR remained within 50–70 beats/min. Both patients had a poor compensatory increase in their HR, despite their critical status. Relative bradycardia could be a cardiovascular complication and is an important clinical finding in patients with COVID-19. <Learning objective: We report two Japanese cases of COVID-19 pneumonia with relative bradycardia as a condition and no significant compensatory increase in heart rate despite high fever and severe hypoxemia. Relative bradycardia in COVID-19 might be associated with myocardial injury due to not only direct viral involvement but also systemic inflammation. We should carefully observe the occurrence of relative bradycardia because it could potentially be a clinical sign of COVID-19.>

    DOI: 10.1016/j.jccase.2020.07.015

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  5. Giant cell myocarditis with central diabetes insipidus: A case report.

    Yamaguchi S, Sawamura A, Nakaguro M, Shimoyama Y, Morimoto R, Kato H, Arao Y, Oishi H, Haga T, Kuwayama T, Yokoi T, Hiraiwa H, Kondo T, Okumura T, Murohara T

    Journal of cardiology cases   Vol. 21 ( 1 ) page: 8 - 11   2020.1

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    A 51-year-old male, previously diagnosed with central diabetes insipidus due to lymphocytic hypophysitis, presented with fever and dyspnea for 1 week. On arrival, he exhibited hypotension (85/60 mmHg) and sinus tachycardia (110 bpm). His electrocardiogram revealed mild ST elevation on V2–V4. Echocardiography indicated a near-normal (50%) left ventricular ejection fraction (LVEF), although the inferior wall of the left ventricle exhibited severe hypokinesis. Fulminant myocarditis and circulatory insufficiency were suspected, and treatment with dobutamine, 3 μg/kg/min, was started. His LVEF gradually decreased to 20%. On day 17, he developed cardiogenic shock due to ventricular tachycardia and underwent peripheral venous–arterial extracorporeal membrane oxygenation and intra-aortic balloon pumping. Although he did not exhibit polyuria, intravenous vasopressin infusion (0.5 U/h) was performed to maintain normonatremia. Endomyocardial biopsy results revealed the infiltration of scattered giant cells (GCs) and extensive lymphocytes. Despite immunosuppressive therapy (methylprednisolone and cyclosporine), his cardiac function did not recover. On day 36, he received a biventricular assist device; however, he died on day 47 due to the progression of sepsis and multiple organ failure. We speculate that a deficient expression of programmed cell death protein-1 was the cause of both GC myocarditis and lymphocytic hypophysitis. <Learning objective: We describe a fatal case of fulminant giant cell myocarditis complicated by central diabetes insipidus due to lymphocytic hypophysitis. Normonatremia was maintained with intravenous vasopressin 0.5 U/h, and circulatory status was maintained with mechanical circulatory support. We speculate that T-cell programmed cell death protein 1 dysregulation was the common cause of the two disorders.>

    DOI: 10.1016/j.jccase.2019.08.011

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  6. A survival case of a young adult patient with ST-elevated myocardial infarction with high levels of lipoprotein(a).

    Hiraiwa H, Morimoto R, Okumura T, Arao Y, Oishi H, Kato H, Yamaguchi S, Kuwayama T, Haga T, Yokoi T, Kondo T, Watanabe N, Mitsuda T, Fukaya K, Sawamura A, Tanaka A, Ishii H, Morishima I, Tsuboi H, Murohara T

    Journal of cardiology cases   Vol. 19 ( 6 ) page: 207 - 210   2019.6

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    A 23-year-old Japanese man presented to a nearby hospital with a complaint of chest pain. In terms of the risk factors for cardiovascular events, there were no abnormal findings in past medical examinations and no smoking history. The 12-lead electrocardiogram revealed ST-elevation in V1-V6, I, and aVL, and he was diagnosed with acute myocardial infarction. Emergency coronary angiography findings revealed total occlusion of the left main trunk and collateral vessels from the right coronary artery to the left anterior descending artery. He underwent emergency percutaneous coronary intervention and placement of drug-eluting stent under the support of venoarterial-extracorporeal membrane oxygenator (VA-ECMO). On day 8 after the onset, transthoracic echocardiography revealed that cardiac function improved with left ventricular ejection fraction from 10% to 20% and VA-ECMO was successfully removed. Alternatively, laboratory findings revealed abnormally high levels of serum lipoprotein(a) [Lp(a), 74 mg/dL] despite the normal levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride. In addition, computed tomography angiography revealed atherosclerosis and stenosis of internal and external carotid arteries, subclavian artery, and renal artery. The abnormally high levels of serum Lp(a) could influence systemic atherosclerosis as well as the onset of myocardial infarction in our young adult patient. <Learning objective: This was a rare survival case of a young adult patient with acute extensive myocardial infarction owing to plaque rupture of the left main trunk. Additionally, he had atherosclerosis of the whole body, including the carotid artery, subclavian artery, and renal artery. Blood test results revealed abnormally high levels of serum lipoprotein(a) [Lp(a)] despite the normal levels of low-density lipoprotein cholesterol. Lp(a) could strongly influence coronary atherosclerosis and myocardial infarction.>

    DOI: 10.1016/j.jccase.2019.02.004

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  7. Hemodynamics of cardiac tamponade during extracorporeal membrane oxygenation support in a patient with fulminant myocarditis.

    Kondo T, Morimoto R, Yokoi T, Yamaguchi S, Kuwayama T, Haga T, Hiraiwa H, Sugiura Y, Watanabe N, Kano N, Ichii T, Fukaya K, Sawamura A, Okumura T, Yoshizumi T, Mutsuga M, Fujimoto K, Matsuda N, Usui A, Murohara T

    Journal of cardiology cases   Vol. 19 ( 1 ) page: 22 - 24   2019.1

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    Fulminant myocarditis (FM) causes rapid onset severe heart failure requiring inotropes or mechanical circulatory support. Myocarditis is sometimes associated with pericardial effusion, however, how this effusion affects the hemodynamics in patients with FM under venoarterial extracorporeal membrane oxygenation (VA-ECMO) management has not been fully reported. We show a case of FM presenting with cardiac tamponade during VA-ECMO management. A 64-year-old female diagnosed as having FM showed a rapid hemodynamic collapse and that led to the application of VA-ECMO. Although her left ventricular ejection fraction did not improve despite proper hemodynamics management for several days, a pericardial effusion accumulated gradually. Apparent elevation of right atrial pressure and reduction of blood pressure were not observed, however, we performed pericardiocentesis because we were not able to wean off VA-ECMO. After the drainage of pericardial effusion, the blood pressure and cardiac output elevated as did the left ventricular ejection fraction. We successfully removed VA-ECMO and the patient was discharged without any complications. This is a case report in which a cardiac tamponade under VA-ECMO did not show typical signs and pericardiocentesis contributed to withdrawal of a VA-ECMO system. <Learning objective: Typical findings of cardiac tamponade are less likely to appear in patients with fulminant myocarditis under venoarterial extracorporeal membrane oxygenation management (VA-ECMO). Drainage of pericardial effusion delivers dramatic improvement in blood pressure, cardiac output, and left ventricular ejection fraction. When VA-ECMO cannot be weaned off, pericardiocentesis should be considered in patients with fulminant myocarditis who showed gradual accumulation of pericardial effusion.>

    DOI: 10.1016/j.jccase.2018.08.009

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  8. Promising method for management of venoarterial extracorporeal membrane oxygenation: A case of severe heart failure successfully stabilized by "high-flow/vasodilation method".

    Kondo T, Sawamura A, Okumura T, Kano N, Morimoto R, Watanabe N, Hiraiwa H, Kuwayama T, Sugiura Y, Haga T, Yamaguchi S, Fukaya K, Yokoi T, Fujimoto K, Mutsuga M, Yoshizumi T, Matsuda N, Usui A, Murohara T

    Journal of cardiology cases   Vol. 18 ( 2 ) page: 81 - 84   2018.8

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    We report the case of a 58-year-old man with dilated cardiomyopathy who was hospitalized because of worsening heart failure. As his symptoms were refractory even with the administration of inotropes, he was given peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) upon transfer to our hospital. On admission, serum creatinine was 2.62 mg/dL and total bilirubin 10.8 mg/dL. The cannulas inserted were 16-Fr for infusion and 21-Fr for drainage. When the blood flow was increased to 2.14 L/min/m2 to improve organ dysfunction, the aortic valve became continuously close with the mean arterial pressure of 85 mmHg. Therefore, we administrated vasodilators to decrease mean arterial pressure, or left ventricular afterload, which achieved opening aortic valve continuously. After the cannula sizes were scaled up to 18Fr for infusion and 24Fr for drainage to gain further blood flow, the aortic valve opened continuously and mean pulmonary pressure decreased. Our strategy to maintain adequate flow rate of VA-ECMO using vasodilator, “high-flow/vasodilation method” achieved hemodynamic stability. Additionally, the concentration of serum creatinine and total bilirubin gradually decreased to within the normal range, although the patient succumbed 58 days after transfer to our hospital. <Learning objective: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is often used as a first-line mechanical circulatory support in patients with severe heart failure. However, its management is difficult and not established. We discuss the efficacy and potency of our “high-flow/vasodilation method” in the management of VA-ECMO.>

    DOI: 10.1016/j.jccase.2018.05.002

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KAKENHI (Grants-in-Aid for Scientific Research) 2

  1. 心脾連関に注目した新しい心不全治療法の開発

    Grant number:21K16085  2021.4 - 2026.3

    科学研究費助成事業  若手研究

    平岩 宏章

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    Authorship:Principal investigator 

    Grant amount:\4680000 ( Direct Cost: \3600000 、 Indirect Cost:\1080000 )

    心不全は未だ致死的な疾患の一つであり、個別化医療を含めた新規治療法の開発の社会的ニーズは非常に高い。
    近年、心不全において心臓と他臓器の連関が注目されているが、脾臓との連関(心脾連関)については未解明の部分が多い。一方、脾臓には様々な役割があるが、組織マクロファージを介した心脾連関に注目した先行研究はない。また、心不全における脾臓の生理学的な役割も十分解明されていない。
    本研究は、心不全における多臓器連関の中での脾臓の機能多様性や、病態との関連を明らかにし、さらには、心不全における新たなバイオマーカやモニタリングの開発や、心脾連関への介入を念頭においた新規の心不全治療法の開発を目指した研究である。

  2. Development of novel treatment for fulminant myocarditis focusing on immune checkpoint molecules

    Grant number:19K23843  2019.8 - 2021.3

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    Authorship:Principal investigator 

    Grant amount:\1430000 ( Direct Cost: \1100000 、 Indirect Cost:\330000 )