Updated on 2024/05/14

写真a

 
KAZAMA Shingo
 
Organization
Nagoya University Hospital Emergency and Critical Care Medicine Assistant professor of hospital
Title
Assistant professor of hospital

Degree 2

  1. Doctor (Medicine) ( 2023.3   Nagoya University ) 

  2. 学士 (医学) ( 2012.3   三重大学 ) 

Research Areas 1

  1. Life Science / Cardiology

Education 2

  1. Nagoya University

    2019.4 - 2023.3

  2. Mie University

    2006.4 - 2012.3

Professional Memberships 9

  1. 日本内科学会

  2. 日本循環器学会

  3. 日本集中治療医学会

  4. 日本心不全学会

  5. 日本移植学会

  6. 日本人工臓器学会

  7. 日本心臓リハビリテーション学会

  8. 日本心血管インターベンション学会

  9. 日本腫瘍循環器学会

▼display all

Awards 1

  1. Young Investigator Award (YIA) 優秀賞

    2024.5   第10回日本心筋症研究会   女性拡張型心筋症におけるジストロフィン異常病理所見を呈する症例の検討

     More details

    Award type:Award from Japanese society, conference, symposium, etc. 

 

Papers 42

  1. 特集 LVADを理解し現状を知る 診る8 LVAD装着患者を心エコーでどう評価する?

    風間 信吾, 奥村 貴裕

    Heart View   Vol. 28 ( 3 ) page: 265 - 271   2024.3

     More details

    Publisher:メディカルレビュー社  

    DOI: 10.18885/hv.0000001508

    CiNii Research

  2. The balance of CD8-positive T cells and PD-L1 expression in the myocardium predicts prognosis in lymphocytic fulminant myocarditis

    Hiraiwa, H; Morimoto, R; Tsuyuki, Y; Ushida, K; Ito, R; Kazama, S; Kimura, Y; Araki, T; Mizutani, T; Oishi, H; Kuwayama, T; Kondo, T; Okumura, T; Murohara, T

    CARDIOLOGY   Vol. 149 ( 1 ) page: 28 - 39   2024.2

     More details

    Language:English   Publisher:Cardiology (Switzerland)  

    Introduction: The clinical significance and prognostic value of T cell involvement and programmed cell death-1 (PD-1)/programmed cell death ligand-1 (PD-L1) have not been established in lymphocytic fulminant myocarditis (FM). We investigated the prognostic impact of the number of CD4+, CD8+, FoxP3+, and PD-1+ T cells, as well as PD-L1 expression, in cardiomyocytes in lymphocytic FM. Methods: This is a single-center observational cohort study. Myocardial tissue was obtained from 16 consecutive patients at lymphocytic FM onset. The median follow-up was 140 days. Cardiac events were defined as a composite of cardiac death and left ventricular-assist device implantation. CD4, CD8, FoxP3, PD-1, and PD-L1 immunostaining were performed on myocardial specimens. Results: The median age of the patients was 52 years (seven men and nine women). There was no significant difference in the number of CD4+ cells. The number of CD8+ cells and the CD8+/CD4+ T cell ratio were higher in the cardiac event group (Event+) than in the group without cardiac events (Event−) (p = 0.048 and p = 0.022, respectively). The number of FoxP3+ T cells was higher in the Event+ group (p = 0.049). Although there was no difference in the number of PD-1+ cells, cardiomyocyte PDL1 expression was higher in the Event+ group (p = 0.112). Event-free survival was worse in the group with a high CD8+ cell count (p = 0.012) and high PD-L1 expression (p = 0.049). When divided into three groups based on the number of CD8+ cells and PD-L1 expression (CD8highPDL1high [n = 8], CD8lowPD-L1high [n = 1], and CD8lowPD-L1low [n = 7]), the CD8highPD-L1high group demonstrated the worst event-free survival, while the CD8lowPD-L1high group had a favorable prognosis without cardiac events (p = 0.041). Conclusion: High myocardial expression of CD8+ T cells and PD-L1 may predict a poor prognosis in lymphocytic FM.

    DOI: 10.1159/000534518

    Web of Science

    Scopus

    PubMed

  3. Cardiac sympathetic activity and relationship to cardiac events and left ventricular reverse remodeling in patients with non-ischemic dilated cardiomyopathy Reviewed

    Mizutani, T; Morimoto, R; Isobe, S; Ito, R; Araki, T; Kimura, Y; Kazama, S; Oishi, H; Kuwayama, T; Hiraiwa, H; Kondo, T; Okumura, T; Murohara, T

    ANNALS OF NUCLEAR MEDICINE   Vol. 37 ( 8 ) page: 451 - 461   2023.8

     More details

    Language:English   Publisher:Annals of Nuclear Medicine  

    Background: Delayed heart-to-mediastinum ratio (HMR) has been associated with catecholamine levels and contractile reserve in dilated cardiomyopathy (DCM); however, there is scant evidence regarding the association between cardiac sympathetic activity and left ventricular reverse remodeling (LV-RR). We calculated the 123I-metaiodobenzylguanidine (123I-mIBG) HMR and washout rate (WR) in patients with DCM and investigated their associations with LV-RR. Methods: From April 2003 to January 2020, in 120 patients with DCM who underwent 123I-mIBG scintigraphy. 66 patients undergoing follow-up echo and taking a beta-blocker from baseline were examined the relationship between 123I-mIBG and LV-RR. After that, this prognostic value for composite cardiac events was evaluated in the entire 120 patients. Results: In LV-RR analysis, patients were 50.4 ± 12.2 years, with a mean left ventricular ejection fraction of 28.6%. Of 66 patients, 28 (42.4%) achieved LV-RR. Multiple logistic regression analysis of LV-RR revealed that not delayed HMR but the WR (cutoff value: 13.5%) was an independent predictor of LV-RR (odds ratio 6.514, p = 0.002). In the analysis for composite cardiac events, even though WR itself does not have the prognostic capacity, Kaplan–Meier survival curves divided by the cutoff value (delayed HMR = 2.0, WR = 13.5) showed that delayed HMR and WR values enabled the stratification of high-risk patients (log-rank p < 0.001). Conclusions: The 123I-mIBG WR was associated with the prevalence of LV-RR in patients taking 100% of beta-blockers and 98.5% of renin-angiotensin system inhibitors. Reflecting the contractile reserve, the combined assessment of the delayed HMR and WR could be used to further precisely stratify the patients with DCM.

    DOI: 10.1007/s12149-023-01838-9

    Web of Science

    Scopus

    PubMed

  4. Dilated cardiomyopathy with anti-mitochondrial M2 antibody: A case series. Reviewed

    Kazama S, Kondo T, Ito R, Kimura Y, Kuwayama T, Hiraiwa H, Morimoto R, Okumura T, Murohara T

    Journal of cardiology cases   Vol. 28 ( 1 ) page: 11 - 15   2023.7

     More details

    Language:English   Publisher:Journal of Cardiology Cases  

    Patients with dilated cardiomyopathy (DCM) sometimes show anti-mitochondrial M2 antibody (AMA-M2) positivity. We aimed to compare the characteristics of DCM cases with and without AMA-M2, and to describe cases of DCM with AMA-M2 positivity. A total of 84 patients with DCM were analyzed. Six patients (7.1 %) were positive for AMA-M2. Of these six patients, five (83.3 %) had primary biliary cirrhosis (PBC) and four (66.7 %) had myositis. Patients with AMA-M2 positivity had more atrial fibrillation and more premature ventricular contractions than those without. Left and right atrial longitudinal dimensions were larger in patients with AMA positivity (left atrium, 65.9 mm vs. 54.7 mm, p = 0.02; right atrium, 57.0 mm vs. 46.1 mm, p = 0.02). Of the six patients with AMA-M2 positivity, three underwent cardiac resynchronization therapy with defibrillator implantation and three required catheter ablation treatment. Steroids were used in three patients. One patient died of unresolved lethal arrhythmia and another required re-hospitalization for heart failure; the remaining four patients did not have adverse events. Patients with DCM with AMA-M2 positivity had a higher affinity for PBC and myositis than those without, and are characterized by atrial enlargement and arrhythmias. Learning objective: Patients with dilated cardiomyopathy sometimes exhibit anti-mitochondrial M2 antibody positivity. These patients are at higher risk for primary biliary cirrhosis and inflammatory myositis, and their cardiac disorders are characterized by atrial enlargement and various arrhythmias. The course of the disease up to the time of diagnosis and after steroid use varies, and the prognosis is poor in advanced cases.

    DOI: 10.1016/j.jccase.2023.02.021

    Scopus

    PubMed

  5. Contractile pericarditis-like hemodynamics in dilated-phase hypertrophic cardiomyopathy with giant atrium. Reviewed

    Morimoto R, Ito R, Araki T, Mizutani T, Kimura Y, Kazama S, Oishi H, Kuwayama T, Sugiura Y, Hiraiwa H, Kondo T, Okumura T, Kobayashi K, Mutsuga M, Murohara T

    Journal of cardiology cases   Vol. 27 ( 5 ) page: 199 - 202   2023.5

     More details

    Language:English   Publisher:Journal of Cardiology Cases  

    A 47-year-old man with dilated-phase hypertrophic cardiomyopathy was admitted to the hospital with worsening heart failure. As the enlarged atrium caused a constrictive pericarditis-like hemodynamic condition, atrial wall resection and tricuspid valvuloplasty were performed. Postoperatively, pulmonary artery pressure rose due to increased preload; however, the rise in pulmonary artery wedge pressure was restrained, and the cardiac output significantly improved. When the pericardium is extremely stretched due to atrial enlargement, it can lead to an elevation of intrapericardial pressure, and both atrial volume reduction and tricuspid valve plasty could lead to increased compliance and contribute to hemodynamic improvement. Learning objective: Atrial wall resection for massive atrial enlargement and tricuspid annuloplasty in patients with diastolic-phase hypertrophic cardiomyopathy effectively relieves unstable hemodynamics.

    DOI: 10.1016/j.jccase.2023.01.005

    Scopus

    PubMed

  6. Cardiac Rehabilitation in Severe Heart Failure Patients with Impella 5.0 Support via the Subclavian Artery Approach Prior to Left Ventricular Assist Device Implantation Reviewed

    Shimizu, M; Hiraiwa, H; Tanaka, S; Tsuchikawa, Y; Ito, R; Kazama, S; Kimura, Y; Araki, T; Mizutani, T; Oishi, H; Kuwayama, T; Kondo, T; Morimoto, R; Okumura, T; Ito, H; Yoshizumi, T; Mutsuga, M; Usui, A; Murohara, T

    JOURNAL OF PERSONALIZED MEDICINE   Vol. 13 ( 4 )   2023.4

     More details

    Language:English   Publisher:Journal of Personalized Medicine  

    Impella 5.0 circulatory support via subclavian artery (SA) access may be a safe approach for patients undergoing cardiac rehabilitation (CR). In this case series, we retrospectively analyzed the demographic characteristics, physical function, and CR data of six patients who underwent Impella 5.0 implantation via the SA prior to left ventricular assist device (LVAD) implantation between October 2013 and June 2021. The median age was 48 years, and one patient was female. Grip strength was maintained or increased in all patients before LVAD implantation (pre-LVAD) compared to after Impella 5.0 implantation. The pre-LVAD knee extension isometric strength (KEIS) was less than 0.46 kgf/kg in two patients and more than 0.46 kgf/kg in three patients (unavailable KEIS data, n = 1). With Impella 5.0 implantation, two patients could ambulate, one could stand, two could sit on the edge of the bed, and one remained in bed. One patient lost consciousness during CR due to decreased Impella flow. There were no other serious adverse events. Impella 5.0 implantation via the SA allows mobilization, including ambulation, prior to LVAD implantation, and CR can be performed relatively safely.

    DOI: 10.3390/jpm13040630

    Web of Science

    Scopus

    PubMed

  7. Dynamic chest radiography as a novel minimally invasive hemodynamic imaging method in patients with heart failure Reviewed

    Hiraiwa, H; Sakamoto, G; Ito, R; Koyama, Y; Kazama, S; Kimura, Y; Kondo, T; Morimoto, R; Okumura, T; Murohara, T

    EUROPEAN JOURNAL OF RADIOLOGY   Vol. 161   page: 110729   2023.4

     More details

    Language:English   Publisher:European Journal of Radiology  

    Purpose: Dynamic chest radiography allows for non-invasive cardiopulmonary blood flow assessment. However, data on its use for heart failure hemodynamic assessment are scarce. We utilized dynamic chest radiography to estimate heart failure hemodynamics. Method: Twenty heart failure patients (median age, 67 years; 17 men) underwent dynamic chest radiography and right heart catheterization. The analyzed images were 16-bit images (grayscale range: 0–65,535). Right atrial, right pulmonary artery, and left ventricular apex pixel values (average of the grayscale values of all pixels within a region of interest) were measured. The correlations of the minimum, maximum, mean, amount of change, and rate of change in pixel values with right atrial pressure, pulmonary artery pressure, pulmonary artery wedge pressure, and cardiac index were analyzed. Results: The mean right atrial pixel value and mean right atrial pressure (R = −0.576, P = 0.008), mean right pulmonary artery pixel value and mean pulmonary artery pressure (R = −0.546, P = 0.013), and left ventricular apex pixel value change rate and mean pulmonary artery wedge pressure (R = −0.664, P = 0.001) or cardiac index (R = 0.606, P = 0.005) were correlated. The left ventricular apex pixel value change rate identified low cardiac index (area under the curve, 0.792; 95% confidence interval, 0.590–0.993; P = 0.031) and low cardiac index with high pulmonary artery wedge pressure (area under the curve, 0.902; 95% confidence interval, 0.000–1.000; P = 0.030). Conclusions: Dynamic chest radiography is a minimally invasive tool for heart failure hemodynamic assessment.

    DOI: 10.1016/j.ejrad.2023.110729

    Web of Science

    Scopus

    PubMed

  8. Increased risk of purge system malfunction after Impella 5.0 replacement: a case series Reviewed

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

    JOURNAL OF ARTIFICIAL ORGANS   Vol. 26 ( 1 ) page: 79 - 83   2023.3

     More details

    Language:English   Publisher:Journal of Artificial Organs  

    The Impella 5.0 is an axial-flow percutaneous ventricular assist device used in patients with cardiogenic shock. Although the recommended period of use is 10 days or less, weaning can be delayed because of ongoing hemodynamic instability. In clinical practice, this device sometimes malfunctions during long-term management with heparin and must be replaced; however, the relationship between the duration of support with the initial and replacement Impella 5.0 and the changes in value of the purge system has not been fully elucidated. From July 2018 to May 2021, Impella 5.0 was implanted and used for more than 10 days in 11 patients at our institution. Four patients required Impella replacement because of device malfunction and the second Impella had purge system malfunction in all cases. The second Impella was used for a significantly shorter time than the first Impella (p = 0016). We calculated the ratio of purge pressure to purge flow rate and found that the ratio exceeded 50 mm Hg/mL/h in all cases with purge system malfunction. In conclusion, it is important to construct a treatment strategy considering the duration of use, because the risk of purge system malfunction is high after replaced Impella 5.0.

    DOI: 10.1007/s10047-022-01337-0

    Web of Science

    Scopus

    PubMed

  9. 心臓移植待機中の現状とheart allocation system改定への課題

    奥村 貴裕, 六鹿 雅登, 風間 信吾, 平岩 宏章, 森本 竜太, 吉住 朋, 室原 豊明

    移植   Vol. 58 ( Supplement ) page: s154_1 - s154_1   2023

     More details

    Language:Japanese   Publisher:一般社団法人 日本移植学会  

    <p>近年の心臓移植レシピエント候補の増加とわが国の深刻なドナー不足により、心臓移植待機期間は1,700日を超えるに至った。移植前状態のほぼ100%は非拍動型植込型VAD装着状態にある。J-MACSデータによれば、術後1年のVAD関連合併症として、感染(36%)、神経機能障害(24%)、大量出血(21%)、右心不全(7%)、除細動を要する不整脈(8%)があり、3年生存は85%とされる。現在当院では、心臓移植適応承認84名中12名(14%)に心臓移植を施行しえたが、待機中に16名(19%)が死亡しており、原因として多臓器不全、脳血管障害、感染が多い。また、緊急入院では、心室頻拍や心室細動等の不整脈、右室不全、ドライブライン断線、感染が多い。待機中のこれらの状態を考慮した、わが国独自のスコアリングシステムの開発、allocation systemが望まれる。不整脈や右心不全にて繰り返し入退院を余儀なくされる症例、BiVADサポート症例、後遺症のない待機中脳血管障害症例、繰り返す溶血・血栓等の症例は、待機中予後の改善の観点から、優先度を再考してもよいかもしれない。しかしながら現在、これらの合併症の程度やそれに伴うStatusの変更においては客観的な検証はされておらず、各要素を組み込む際には客観的な評価システムの構築が必要となろう。当院における心臓移植待機の現状を報告し、allocation systemの現状の課題と将来的なあり方、改定への進め方を議論したい。</p>

    DOI: 10.11386/jst.58.supplement_s154_1

    CiNii Research

  10. Prognostic value of malnutrition evaluated using the Global Leadership Initiative on Malnutrition criteria and its association with psoas muscle volume in non-ischemic dilated cardiomyopathy Reviewed

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

    HEART AND VESSELS   Vol. 37 ( 12 ) page: 2002 - 2012   2022.12

     More details

    Language:English   Publisher:Heart and Vessels  

    Heart failure (HF) is a systemic inflammatory disease that causes hypotrophy and skeletal muscle loss. The Global Leadership Initiative on Malnutrition (GLIM) criteria have been developed as a novel evaluation index for malnutrition, with reported usefulness in HF caused by ischemic heart disease. However, reports on the usefulness of malnutrition evaluated by the GLIM criteria in non-ischemic dilated cardiomyopathy (NIDCM) and its relationship with psoas muscle volume are lacking. We investigated the prognostic value of malnutrition evaluated using the GLIM criteria and its association with psoas muscle volume in patients with NIDCM. We enrolled 139 consecutive patients with NIDCM between December 2000 and June 2020. Malnutrition was evaluated using the GLIM criteria on admission. The median follow-up period was 4.7 years. Cardiac events were defined as a composite of cardiac death, hospitalization for worsening HF, and lethal arrhythmia. Furthermore, we measured the psoas muscle volume using computed tomography volumetry in 48 patients. At baseline, the median age was 50 years, and 132 patients (95.0%) had New York Heart Association functional class I or II HF. The median psoas muscle volume was 460.8 cm3. A total of 26 patients (18.7%) were malnourished according to the GLIM criteria. The Kaplan–Meier survival analysis showed that malnourished patients had more cardiac events than non-malnourished patients (log-rank, P < 0.001). The multivariate Cox proportional hazards regression analysis revealed that GLIM criteria-based malnutrition was an independent determinant of cardiac events (hazard ratio, 2.065; 95% confidence interval, 1.166–3.656; P = 0.014). Psoas muscle volume, which was assessed in a total of 48 patients, was lower in malnourished than in non-malnourished patients (median, 369.0 vs. 502.3 cm3; P = 0.035) and correlated with body mass index (r = 0.441; P = 0.002). Nutritional screening using the GLIM criteria may be useful in predicting future cardiac events in patients with NIDCM, reflecting a potential relationship between malnutrition and a low psoas muscle volume.

    DOI: 10.1007/s00380-022-02113-z

    Web of Science

    Scopus

    PubMed

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

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

    HEART AND VESSELS   Vol. 37 ( 8 ) page: 1344 - 1355   2022.8

     More details

    Language:English   Publisher:Heart and Vessels  

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

    DOI: 10.1007/s00380-022-02030-1

    Web of Science

    Scopus

    PubMed

  12. Clinical value of the HATCH score for predicting adverse outcomes in patients with heart failure Reviewed

    Shibata, N; Kondo, T; Morimoto, R; Kazama, S; Sawamura, A; Nishiyama, I; Kato, T; Kuwayama, T; Hiraiwa, H; Umemoto, N; Asai, T; Okumura, T; Murohara, T

    HEART AND VESSELS   Vol. 37 ( 8 ) page: 1363 - 1372   2022.8

     More details

    Language:English   Publisher:Heart and Vessels  

    The HATCH score is employed as a risk assessment tool for atrial fibrillation (AF) development. However, the impact of the HATCH score on the long-term adverse outcomes in patients with acute heart failure (AHF) remains unknown. We investigated the clinical value of the HATCH score in patients with AHF. From a multicenter AHF registry, we retrospectively evaluated 1543 consecutive patients who required hospitalization owing to AHF (median age, 78 [69–85] years; 42.3% women) from January 2012 to December 2019. These patients were divided into five risk groups based on their HATCH score at admission (scores 0, 1, 2, 3, and 4–7). The correlation between the HATCH score and the composite outcome, including all-cause mortality and re-hospitalization due to HF, was analyzed using Kaplan–Meier and Cox proportional-hazard analyses. The median HATCH score was 2 [1–3], and the median age was 78 years (69–85 years). During the follow-up period (median, 16.8 months), the composite endpoint occurred in 691 patients (44.8%), including 416 (27%) patients who died (with 65 [4.2%] in-hospitalization deaths) and 455 (29.5%) patients requiring re-hospitalizations due to HF. The Kaplan–Meier analysis showed a significant increase in the composite endpoint with an increasing HATCH score (log-rank, p < 0.001). The multivariate Cox regression model revealed that the HATCH score was an independent predictor of the composite endpoint (hazard ratio [HR] 1.181; 95% confidence interval [CI]: 1.111–1.255; p < 0.001) with all-cause mortality (HR 1.153, 95% CI 1.065–1.249; p < 0.001) and re-hospitalizations due to HF (HR 1.21; 95% CI 1.124–1.303; p < 0.001) in patients with AHF, regardless of the presence or absence of AF, ejection fraction, and etiology. The HATCH score is an independent predictor of adverse outcomes in patients with AHF.

    DOI: 10.1007/s00380-022-02035-w

    Web of Science

    Scopus

    PubMed

  13. Recurrent fulminant non-rheumatic streptococcal myocarditis proven by endomyocardial biopsy and autopsy. Reviewed

    Hiraiwa H, Morimoto R, Ando R, Ito R, Araki T, Mizutani T, Kazama S, Kimura Y, Oishi H, Kuwayama T, Yamaguchi S, Kondo T, Okumura T, Enomoto A, Murohara T

    Journal of cardiology cases   Vol. 26 ( 1 ) page: 62 - 65   2022.7

     More details

    Language:English   Publisher:Journal of Cardiology Cases  

    A 42-year-old man with a history of acute myocarditis after streptococcal pharyngitis developed recurrent fulminant myocarditis. Endomyocardial biopsy revealed myocyte degeneration, interstitial edema, and neutrophil infiltration. The patient's cardiac function deteriorated rapidly, and he died despite mechanical circulatory support. Autopsy revealed neutrophil infiltration, interstitial edema, and micro-abscesses containing masses of streptococci and neutrophilic phagocytosis within the myocardium. The patient did not meet the diagnostic criteria for acute rheumatic fever; thus, he was diagnosed with non-rheumatic streptococcal myocarditis. Non-rheumatic streptococcal myocarditis rarely recurs, but it can be fulminant upon recurrence. Learning objective: We report a rare case of recurrent fulminant non-rheumatic streptococcal myocarditis. Endomyocardial biopsy and autopsy revealed neutrophil infiltration and micro-abscesses containing bacterial masses of streptococci and neutrophilic phagocytosis in the myocardium. The patient did not meet the diagnostic criteria for acute rheumatic fever; thus, he was diagnosed with non-rheumatic streptococcal myocarditis. Non-rheumatic streptococcal myocarditis rarely recurs, but it can be fulminant upon recurrence.

    DOI: 10.1016/j.jccase.2022.02.004

    Scopus

    PubMed

  14. A Case of Systemic Capillary Leak Syndrome With Severe Cardiac Dysfunction After mRNA Vaccination for COVID-19

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

    CJC OPEN   Vol. 4 ( 7 ) page: 656 - 659   2022.7

     More details

    Language:English   Publisher:CJC Open  

    A 53-year-old woman with no significant medical history developed cardiogenic shock 4 days after receiving the second dose of the COVID-19 mRNA vaccine (BNT162b2, Pfizer/BioNtech). The patient required extracorporeal membrane oxygenation and an Impella device. Based on significant hemoconcentration, decreased plasma protein levels, and pathologic findings in myocardial specimens, the patient was diagnosed with vaccination-induced fulminant systemic capillary leak syndrome (SCLS) with severe cardiac dysfunction. This case highlights that SCLS can occur after COVID-19 mRNA vaccination and may be associated with cardiac dysfunction. In patients with cardiogenic shock, hemoconcentration, and hypoalbuminemia after vaccination, SCLS should be considered.

    DOI: 10.1016/j.cjco.2022.03.008

    Web of Science

    Scopus

    PubMed

  15. Biopsy-Proven Fulminant Myocarditis Requiring Mechanical Circulatory Support Following COVID-19 mRNA Vaccination Reviewed

    Kazama, S; Okumura, T; Kimura, Y; Ito, R; Araki, T; Mizutani, T; Oishi, H; Kuwayama, T; Hiraiwa, H; Kondo, T; Morimoto, R; Saeki, T; Murohara, T

    CJC OPEN   Vol. 4 ( 5 ) page: 501 - 505   2022.5

     More details

    Language:English   Publisher:CJC Open  

    A 48-year-old woman suffered from cardiogenic shock with fulminant myocarditis following the second dose of COVID-19 vaccine (mRNA-1273). Venoarterial extracorporeal membrane oxygenation and Impella support were essential in achieving hemodynamic stability. Endomyocardial biopsy revealed lymphocytic infiltration with predominant immunostaining for CD8- and CD68-positive cells. The left ventricular ejection fraction improved significantly after treatment with mechanical circulatory support. Myocarditis following COVID-19 mRNA vaccination may also occur in middle-aged women; it may be fulminant and require mechanical circulatory support. Although our results suggest the involvement of cytotoxic T lymphocytes and macrophages, further investigation is needed before these can be established as pathogenetic mechanisms.

    DOI: 10.1016/j.cjco.2022.02.004

    Web of Science

    Scopus

    PubMed

  16. Serum autotaxin as a novel prognostic marker in patients with non-ischaemic dilated cardiomyopathy Reviewed

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

    ESC HEART FAILURE   Vol. 9 ( 2 ) page: 1304 - 1313   2022.4

     More details

    Language:English   Publisher:ESC Heart Failure  

    Aims: Autotaxin (ATX) promotes myocardial inflammation, fibrosis, and the subsequent cardiac remodelling through lysophosphatidic acid production. However, the prognostic impact of serum ATX in non-ischaemic dilated cardiomyopathy (NIDCM) has not been clarified. We investigated the prognostic impact of serum ATX in patients with NIDCM. Methods and results: We enrolled 104 patients with NIDCM (49.8 ± 13.4 years, 76 men). We divided the patients into two groups using different cutoffs of median serum ATX levels for men and women: high-ATX group and low-ATX group. Cardiac events were defined as a composite of cardiac death and heart failure resulting in hospitalization. Median ATX level was 203.5 ng/mL for men and 257.0 ng/mL for women. Brain natriuretic peptide levels [224.0 (59.6–689.5) pg/mL vs. 96.5 (40.8–191.5) pg/mL, P = 0.010] were higher in the high-ATX group than low-ATX group, whereas high-sensitivity C-reactive protein and collagen volume fraction levels in endomyocardial biopsy samples were not significantly different between the two groups. Kaplan–Meier survival analysis revealed that the event-free survival rate was significantly lower in the high-ATX group than low-ATX group (log-rank; P = 0.007). Cox proportional hazard analysis revealed that high-ATX was an independent determinant of composite cardiac events. In both sexes, serum ATX levels did not correlate with high-sensitivity C-reactive protein levels and collagen volume fraction but had a weak correlation with brain natriuretic peptide levels (men; spearman's rank: 0.274, P = 0.017, women; spearman's rank: 0.378, P = 0.048). Conclusion: High serum ATX levels can be associated with increasing adverse clinical outcomes in patients with NIDCM. These results indicate serum ATX may be a novel biomarker or therapeutic target in NIDCM.

    DOI: 10.1002/ehf2.13817

    Web of Science

    Scopus

    PubMed

  17. Relationship between spleen size and exercise tolerance in advanced heart failure patients with a left ventricular assist device Reviewed

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

    BMC RESEARCH NOTES   Vol. 15 ( 1 ) page: 40   2022.2

     More details

    Language:English   Publisher:BMC Research Notes  

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

    DOI: 10.1186/s13104-022-05939-y

    Web of Science

    Scopus

    PubMed

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

    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

     More details

    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

    Web of Science

    Scopus

    PubMed

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

    Kondo, T; Morimoto, R; Mutsuga, M; Fujimoto, K; Okumura, T; Shibata, N; Kazama, S; Kimira, Y; Oishi, H; Kuwayama, T; Hiraiwa, H; Usui, A; Murohara, T

    INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS   Vol. 44 ( 11 ) page: 846 - 853   2021.11

     More details

    Language:English   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

    Web of Science

    Scopus

    PubMed

  20. Clinical significance of spleen size in patients with heart failure

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

    EUROPEAN HEART JOURNAL   Vol. 42   page: 756 - 756   2021.10

     More details

  21. Clinical impact of pulmonary artery to aorta diameter ratio on left ventricular reverse remodeling in patients with dilated cardiomyopathy

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

    EUROPEAN HEART JOURNAL   Vol. 42   page: 757 - 757   2021.10

     More details

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

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

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

     More details

    Language:English   Publisher:ESC Heart Failure  

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

    DOI: 10.1002/ehf2.13446

    Web of Science

    Scopus

    PubMed

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

    Kazama, S; Kondo, T; Shibata, N; Hiraiwa, H; Nishiyama, I; Kato, T; Sawamura, A; Kimura, Y; Oishi, H; Kuwayama, T; Morimoto, R; Okumura, T; Shimizu, K; Murohara, T

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

     More details

    Language:English   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

    Web of Science

    Scopus

    PubMed

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

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

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

     More details

    Language:English   Publisher:Cardio-Oncology  

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

    DOI: 10.1186/s40959-021-00112-z

    Web of Science

    Scopus

    PubMed

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

    Hiraiwa, H; Okumura, T; Kondo, T; Kato, T; Kazama, S; Kimura, Y; Ishihara, T; Iwata, E; Shimojo, M; Kondo, S; Aoki, S; Kanzaki, Y; Tanimura, D; Sano, H; Awaji, Y; Yamada, S; Murohara, T

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

     More details

    Language:English   Publisher:Heart and Vessels  

    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

    Web of Science

    Scopus

    PubMed

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

    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

     More details

    Language:English   Publisher:Journal of Cardiology Cases  

    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

    Scopus

    PubMed

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

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

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

     More details

    Language:English   Publisher:ESC Heart Failure  

    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

    Web of Science

    Scopus

    PubMed

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

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

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

     More details

    Language:English   Publisher:International Journal of Artificial Organs  

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

    DOI: 10.1177/0391398820957019

    Web of Science

    Scopus

    PubMed

  29. A case of heart failure complicated with double ventricular response triggered by beta blocker. Reviewed

    Kazama S, Kondo T, Suga K, Yanagisawa S, Morimoto R, Okumura T, Inden Y, Murohara T

    HeartRhythm case reports   Vol. 7 ( 3 ) page: 174 - 177   2021.3

     More details

    Language:English   Publisher:HeartRhythm Case Reports  

    DOI: 10.1016/j.hrcr.2020.12.004

    Scopus

    PubMed

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

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

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

     More details

    Language:English   Publisher:International Journal of Cardiology  

    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.

    DOI: 10.1016/j.ijcard.2020.09.056

    Web of Science

    Scopus

    PubMed

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

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

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

     More details

    Language:English   Publisher:International Journal of Artificial Organs  

    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.

    DOI: 10.1177/0391398820942526

    Web of Science

    Scopus

    PubMed

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

    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

     More details

    Language:English   Publisher:Journal of Cardiology Cases  

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

    DOI: 10.1016/j.jccase.2020.08.013

    Scopus

    PubMed

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

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

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

     More details

    Language:English   Publisher:Journal of Artificial Organs  

    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.

    DOI: 10.1007/s10047-020-01184-x

    Web of Science

    Scopus

    PubMed

  34. 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

     More details

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

    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

     More details

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

    Iwata, E; Kondo, T; Kato, T; Okumura, T; Nishiyama, I; Kazama, S; Ishihara, T; Kondo, S; Hiraiwa, H; Tsuda, T; Ito, M; Aoyama, M; Tanimura, D; Awaji, Y; Unno, K; Murohara, T

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

     More details

    Language:English   Publisher:Canadian Journal of Cardiology  

    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.

    DOI: 10.1016/j.cjca.2020.01.006

    Web of Science

    Scopus

    PubMed

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

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

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

     More details

    Language:English   Publisher:Canadian Journal of Cardiology  

    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.

    DOI: 10.1016/j.cjca.2020.04.005

    Web of Science

    Scopus

    PubMed

  38. Heart Failure and Cancer ― A Comorbid Risk That Is No Longer Underestimated ― Invited

    Kazama Shingo, Bando Yasuko K., Murohara Toyoaki

    Circulation Journal   Vol. 84 ( 10 ) page: 1689 - 1690   2020.9

     More details

    Language:English   Publisher:The Japanese Circulation Society  

    DOI: 10.1253/circj.cj-20-0888

    Web of Science

    Scopus

    PubMed

    CiNii Research

  39. 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 - 1543   2020.8

     More details

    Language:English   Publisher:The Japanese Circulation Society  

    <p><b><i>Background:</i></b>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.</p><p><b><i>Methods and Results:</i></b>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).</p><p><b><i>Conclusions:</i></b>Even in patients identified with DCM in the mild to moderate phase, PAPi may help stratify DCM and predict cardiac events.</p>

    DOI: 10.1253/circj.cj-20-0279

    Web of Science

    Scopus

    PubMed

    CiNii Research

  40. Fulminant myocarditis with myositis of ocular and respiratory muscles Reviewed

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

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

     More details

    Language:English   Publisher:Nagoya Journal of Medical Science  

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

    DOI: 10.18999/nagjms.82.3.585

    Web of Science

    Scopus

    PubMed

  41. 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

     More details

    Language:English   Publisher:International Heart Journal Association  

    <p>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).</p><p>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, <i>n</i> = 20) and low BCAA/total AA group (< 0.15, <i>n</i> = 19). A cardiac event was defined as a composite of cardiac death, hospitalization for worsening HF, and lethal arrhythmia.</p><p>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 (<i>r</i> = 0.35, <i>P</i> = 0.031) and negatively correlated with brain natriuretic peptide (<i>r</i> = −0.37, <i>P</i> = 0.020). The low BCAA/total AA group had a lower cardiac event-free rate (5-year: 100% versus 73%; <i>P</i> = 0.019). In univariate analysis, angiotensin converting enzyme inhibitor or angiotensin II receptor blocker (hazard ratio: 0.045, <i>P</i> = 0.0014), hemoglobin (hazard ratio: 0.49 per 1 g/dL, <i>P</i> = 0.0022), and BCAA/total AA ratio < 0.15 (hazard ratio: not available, <i>P</i> = 0.0066) were major predictors for cardiac events.</p><p>The BCAA/total AA ratio might be a useful predictor for future cardiac events in patients with NIDCM.</p>

    DOI: 10.1536/ihj.20-010

    Web of Science

    Scopus

    PubMed

    CiNii Research

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

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

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

     More details

    Language:English   Publisher:Artificial Organs  

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

    DOI: 10.1111/aor.13658

    Web of Science

    Scopus

    PubMed

▼display all

Books 1

  1. 心筋症 Multimodalityを用いた診断・評価のすべて

    ( Role: Contributor ,  心筋炎のトータルマネジメントに画像診断を活かす)

    日本医事新報社  2024.1 

Presentations 31

  1. 女性拡張型心筋症におけるジストロフィン異常病理所見を呈する症例の検討

    第10回日本心筋症研究会  2024.5.11 

     More details

    Event date: 2024.5

    Language:Japanese   Presentation type:Oral presentation (general)  

  2. 機械的補助循環装置を要する心原性ショックにおける血液プロファイルと出血合併症の検討

    第51回日本集中治療医学会総会  2024.3.15 

     More details

    Event date: 2024.3

    Language:Japanese   Presentation type:Oral presentation (general)  

  3. Trajectory of exercise capacity in patients with durable left ventricular assist device

    第87回日本循環器学会学術集会 

     More details

    Event date: 2023.3

    Presentation type:Oral presentation (general)  

  4. LVAD植込み後遠隔期における運動耐容能の検討

    日本心臓リハビリテーション学会 第8回東海支部地方会 

     More details

    Event date: 2022.12

    Presentation type:Oral presentation (general)  

  5. 心臓移植後に電気生理学的検査により偽性完全房室ブロックが疑われた一例

    第26回日本心不全学会学術集会 

     More details

    Event date: 2022.10

    Presentation type:Poster presentation  

  6. COVID19 mRNAワクチン接種後に心筋生検で診断を得た劇症型心筋炎の1例

    第43回心筋生検研究会 

     More details

    Event date: 2021.12

    Presentation type:Oral presentation (general)  

  7. COVID19 mRNAワクチン接種後に劇症型心筋炎を発症しECPELLAにて救命し得た1例

    日本循環器学会 第158回東海 第143回北陸合同地方会 

     More details

    Event date: 2021.10

    Presentation type:Oral presentation (general)  

  8. CPAで救急搬送され、肺動脈血細胞診にて診断を得た肺動脈腫瘍塞栓微少血管症の1例

    第4回日本腫瘍循環器学会学術集会 

     More details

    Event date: 2021.10

    Presentation type:Oral presentation (general)  

  9. CPA蘇生後に肺動脈血からの細胞診にて診断を得た肺動脈腫瘍塞栓微少血管症の1例

    日本循環器学会 第157回東海地方会 

     More details

    Event date: 2021.7

    Presentation type:Oral presentation (general)  

  10. 抗ミトコンドリア抗体陽性を呈した心筋症についての検討

    第7回日本心筋症研究会 

     More details

    Event date: 2021.4

    Presentation type:Oral presentation (general)  

  11. Clinical impact of heart rate change in early phase in patients with acute decompensated heart failure International conference

    AHA Scientific Sessions 2020 

     More details

    Event date: 2020.11

    Presentation type:Oral presentation (general)  

  12. 抗ミトコンドリアM2抗体陽性筋炎に合併した心不全の1例

    日本循環器学会 第156回東海 第141回北陸合同地方会 

     More details

    Event date: 2020.10 - 2020.11

    Presentation type:Oral presentation (general)  

  13. 当院における免疫チェックポイント阻害薬による心血管系有害事象の後ろ向き解析

    第3回日本腫瘍循環器学会学術集会 

     More details

    Event date: 2020.9

    Presentation type:Oral presentation (general)  

  14. 心不全を合併したDouble Ventricular Responseに対しカテーテルアブレーションが有効であった1例

    日本循環器学会 第155回東海地方会 

     More details

    Event date: 2020.6

    Presentation type:Oral presentation (general)  

  15. CD5陽性びまん性大細胞型B細胞性リンパ腫に肺塞栓症と再膨張性肺水腫による急激な呼吸不全を合併しVVECMO管理を要した一例

    日本内科学会 第240回東海地方会 

     More details

    Event date: 2020.2

    Presentation type:Oral presentation (general)  

  16. 著しい心房拡大を呈した抗ミトコンドリアM2抗体陽性筋炎の一例

    日本循環器学会 第154回東海 第139回北陸合同地方会 

     More details

    Event date: 2019.10

    Presentation type:Oral presentation (general)  

  17. 血清FGF23濃度は拡張型心筋症患者の予後予測因子となり得る

    第23回日本心不全学会学術集会 

     More details

    Event date: 2019.10

    Presentation type:Oral presentation (general)  

  18. 肺塞栓症と再膨張性肺水腫による急激な呼吸不全にVV-ECMO管理を要したCD5陽性びまん性大細胞型B細胞性リンパ腫の一例

    第2回日本循環器学会学術集会 

     More details

    Event date: 2019.9

    Presentation type:Poster presentation  

  19. The Prognostic Impact of Insulin Secretory Function in Non-Diabetic Elderly Patients with Acute Decompensated Heart Failure

    第83回日本循環器学会学術集会 

     More details

    Event date: 2019.3

    Presentation type:Oral presentation (general)  

  20. 右冠動脈肺動脈起始症を伴った心サルコイドーシスの1例

    日本循環器学会 第152回東海 第137回北陸合同地方会 

     More details

    Event date: 2018.10

    Presentation type:Oral presentation (general)  

  21. 血中インスリン濃度は糖尿病のない高齢急性心不全患者の予後予測因子となり得る

    第22回日本心不全学会学術集会 

     More details

    Event date: 2018.10

    Presentation type:Oral presentation (general)  

  22. 慢性心不全患者における精神状態と運動耐容能の関連

    第24回日本心臓リハビリテーション学会学術集会 

     More details

    Event date: 2018.7

    Presentation type:Oral presentation (general)  

  23. The Prognostic Impact of Serum Lipoprotein(a) Level in Patients with Acute Decompensated Heart Failure

    第82回日本循環器学会学術集会 

     More details

    Event date: 2018.3

    Presentation type:Poster presentation  

  24. 胸郭出口症候群によるPagetSchroetter症候群の一例

    日本循環器学会 第150回東海 第135回北陸合同地方会 

     More details

    Event date: 2017.11

    Presentation type:Oral presentation (general)  

  25. 慢性心不全患者における栄養状態と運動耐容能の関連

    第21回心不全学会学術集会 

     More details

    Event date: 2017.10

    Presentation type:Oral presentation (general)  

  26. 当院における慢性心不全患者に対する和温療法の検討

    日本循環器学会 第149回東海地方会 

     More details

    Event date: 2017.7

    Presentation type:Oral presentation (general)  

  27. プロタミンショックにて心肺停止に至った一例

    日本内科学会 第232回東海地方会 

     More details

    Event date: 2017.6

    Presentation type:Oral presentation (general)  

  28. 上大静脈起源の頻拍を認めた一例

    日本循環器学会 第148回東海 第133回北陸合同地方会 

     More details

    Event date: 2016.11

    Presentation type:Oral presentation (general)  

  29. 当院での静脈血栓塞栓症に対する直接作用型経口抗凝固薬の使用経験

    日本循環器学会 第147回東海地方会 

     More details

    Event date: 2016.6

    Presentation type:Oral presentation (general)  

  30. 心筋生検により診断できた超高齢女性の劇症型リンパ球性心筋炎の1例

    日本循環器学会 第145回東海地方会 

     More details

    Event date: 2015.6

    Presentation type:Oral presentation (general)  

  31. ミトコンドリア心筋症の診断に遺伝子検査が有用であった一例

    日本内科学会 第225回東海地方会 

     More details

    Event date: 2015.2

    Presentation type:Oral presentation (general)  

▼display all

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

  1. 体外式膜型人工肺における個別化精密抗凝固管理システムの構築

    Grant number:24K19485  2024.4 - 2027.3

    科学研究費助成事業  若手研究

    風間 信吾

      More details

    Authorship:Principal investigator 

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

  2. 心原性ショックに対するTheragnostic Anticoagulationに向けた生体応答ダイナミクス

    Grant number:23K19561  2023.8 - 2025.3

    科学研究費助成事業  研究活動スタート支援

    風間 信吾

      More details

    Authorship:Principal investigator 

    Grant amount:\2860000 ( Direct Cost: \2200000 、 Indirect Cost:\660000 )

    補助循環装置を必要とする心原性ショックでは凝固異常に伴う合併症の管理に難渋する。
    重大合併症の制御のために、本研究では凝固プロファイルの変容とその背景の複合要因を解き明かすことを目的とした。本研究により、最重症の心不全患者を基点とした精密凝固管理Theragnostic Anticoagulationへの展開や、心原性ショックにおける新たな病態パラダイムの提案や全身応答に関する新規の治療シーズの同定へとつなげていく。