論文 - 海北 幸一
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Fujisue K., Yamanaga K., Nagamatsu S., Shimomura H., Yamashita T., Nakao K., Nakamura S., Ishihara M., Matsui K., Sakaino N., Miyazaki T., Yamamoto N., Koide S., Matsumura T., Fujimoto K., Tsunoda R., Morikami Y., Matsuyama K., Oshima S., Sakamoto K., Izumiya Y., Kaikita K., Hokimoto S., Ogawa H., Tsujita K.
Journal of Atherosclerosis and Thrombosis 28 ( 2 ) 181 - 193 2021年2月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Atherosclerosis and Thrombosis
Aim: Coronary plaque regression is weak in acute coronary syndrome (ACS) patients with diabetes mellitus (DM). We evaluated whether dual lipid-lowering therapy (DLLT) with ezetimibe and atorvastatin attenuates coronary plaques in ACS patients with DM. Methods: The prospective, randomized controlled, multicenter PRECISE-IVUS (Plaque Regression with Cholesterol Absorption Inhibitor or Synthesis Inhibitor Evaluated by Intravascular Ultrasound) trial assigned 246 patients undergoing percutaneous coronary intervention to DLLT or atorvastatin monotherapy and evaluated IVUS-derived changes in percent atheroma volume (ΔPAV), at baseline and 9–12-month follow-up, in 126 ACS cases, including 25 DM patients. The atorvastatin dose was up-titrated to achieve low-density lipoprotein cholesterol (LDL-C) ＜70 mg/dL. Results: In DM patients, the monotherapy group (n=13) and the DLLT group (n=12) showed a similar preva-lence of coronary risks and baseline lipid profiles. During the study, the change in LDL-C level was similar between DM and non-DM patients. Compared with non-DM patients, DM patients showed weaker regression of ΔPAV by DLLT than those who underwent monotherapy (DM: −2.77±3.47% vs. −0.77±2.51%, P=0.11; non-DM: −2.01±3.36% vs. −0.08±2.66%, P=0.008). The change in LDL-C level was not correlated with Δ PAV in non-DM patients, but there was significant correlation between the change in LDL-C level and ΔPAV in DM patients (r=0.52, P=0.008). Conclusions: ACS patients with DM showed weaker coronary plaque regression than their counterparts. A significant correlation between the change in LDL-C level and ΔPAV in DM patients suggested that more intensive lipid-lowering therapy is required in ACS patients with DM.
DOI： 10.5551/jat.54726
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Temporal trends in coronary intervention strategies and the impact on one-year clinical events: data from a Japanese multi-center real-world cohort study. 査読あり
Sakamoto K, Sato R, Tabata N, Ishii M, Yamashita T, Nagamatsu S, Motozato K, Yamanaga K, Hokimoto S, Sueta D, Araki S, Fujisue K, Arima Y, Takashio S, Fujimoto K, Shimomura H, Tsunoda R, Hirose T, Sato K, Kikuta K, Sakaino N, Nakamura S, Yamamoto N, Matsumura T, Kajiwara I, Tayama S, Sakamoto T, Nakao K, Oshima S, Yamamoto E, Kaikita K, Tsujita K, Kumamoto Intervention Conference Study (KICS) Investigators.
Cardiovascular intervention and therapeutics 37 ( 1 ) 66 - 77 2021年1月
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特集 抗血小板･抗凝固薬投与の問題は解決した? 診る4 抗血栓療法の効果はどこまで評価できるか?
海北幸一, 辻田賢一.
Heart View 25 ( 1 ) 26 - 31 2021年1月
担当区分：筆頭著者 掲載種別：研究論文（学術雑誌）
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Nishihara T., Tokitsu T., Sueta D., Oike F., Takae M., Fujisue K., Usuku H., Ito M., Kanazawa H., Araki S., Arima Y., Takashio S., Nakamura T., Sakamoto K., Suzuki S., Kaikita K., Yamamoto E., Tsujita K.
Journal of Cardiac Failure 27 ( 1 ) 57 - 66 2021年1月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Cardiac Failure
Background: We investigated the clinical significance of the derivative of reactive oxygen metabolites (DROM), a new marker of reactive oxygen species (ROS), in patients with heart failure (HF) with reduced left ventricular ejection fraction (LVEF) (HFrEF). Methods and Results: Serum DROM concentrations were measured in 201 consecutive patients with HFrEF (EF < 50%) in stable condition. DROM values were significantly higher in patients with HFrEF than in risk-matched patients without HF (P < 0.01). They also correlated significantly with high-sensitivity C-reactive protein and B-type natriuretic peptide. Kaplan-Meier analysis demonstrated significantly higher probabilities of HF-related events in the high-DROM group than in the low-DROM group (log-rank test, P < 0.01). Multivariable Cox hazard analysis revealed that DROM were independent and significant predictors of cardiovascular events. In a subgroup analysis, DROM levels were also measured at the aortic root and coronary sinus in 49 patients. The transcardiac gradient of DROM values was significantly higher in patients with HFrEF than in patients without HF (P = 0.04), indicating an association between DROM production in the coronary circulation and HFrEF development. Changes in DROM following optimal therapy were significantly associated with LVEF improvement (r = 0.34, P = 0.04). Conclusions: The higher levels of DROM and their association with cardiovascular events suggest the clinical benefit of DROM measurements in the risk stratification of patients with HFrEF.
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抗血栓療法の効果はどこまで評価できるか? (特集 抗血小板・抗凝固薬投与の問題は解決した?) 査読あり
海北 幸一, 辻田 賢一
Heart view 25 ( 1 ) 26 - 31 2021年1月
担当区分：筆頭著者, 責任著者 記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：メジカルビュー社
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Misumi I., Sato K., Nagano M., Yamada Y., Urata J., Kaikita K., Tsujita K.
Journal of Echocardiography 19 266 - 268 2021年
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Echocardiography
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Left ventricular apical thrombus mimicking hypertrabeculation.
Misumi I, Sato K, Nagano M, Obata M, Urata J, Usuku H, Kaikita K, Tsujita K.
Intern Med 60 2245 - 2250 2021年
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Morikawa K., Takashio S., Sato R., Yamamoto E., Kaikita K., Tsujita K., Komohara Y.
Internal Medicine 59 ( 24 ) 3171 - 3175 2020年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Internal Medicine
We herein report the histological findings of a patient who had progressed to persistent cardiac arrest for 25 days due to lymphocytic fulminant myocarditis despite mechanical circulatory support (MCS). There were few residual cardiomyocytes, and extensive replacement fibrosis was present. Therefore, improvement of the cardiac function for this patient was considered improbable. Further research is warranted to improve predictions for the recovery of the cardiac function and optimize MCS strategies for patients with fulminant myocarditis.
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Association of short term exposure to Asian dust with increased blood pressure 査読あり
Ishii M., Seki T., Sakamoto K., Kaikita K., Miyamoto Y., Tsujita K., Masuda I., Kawakami K.
Scientific Reports 10 ( 1 ) 17630 2020年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Scientific Reports
Air pollution causes hypertension, cardiovascular disease, and mortality. Asian dust (AD) reportedly induces asthma or acute myocardial infarction along with air pollution, but its impact on blood pressure (BP) is unknown. We investigated the association between short-term AD exposure and BP fluctuations in 300,952 individuals whose BP was measured during April 2005–March 2015 and divided them into AD and non-AD groups based on visitation for AD-related events. AD’s occurrence, air pollutants’ concentration (suspended particulate matter, SO , NO , photochemical oxidants), and meteorological variables (mean ambient temperature, relative humidity) were obtained from a monitoring station; AD events correlated with decreased visibility (< 10 km). We observed 61 AD days, with 3897 participants undergoing medical check-ups. Short-term AD exposure at lag day-0 was significantly associated with higher systolic BP (SBP), diastolic BP (DBP), and pulse rate (PR) risk (β = 1.85, 95% confidence interval (CI) 1.35–2.35 for SBP, β = 2.24, 95% CI 1.88–2.61 for DBP, β = 0.52, 95% CI 0.14–0.91 for PR) using multi-pollutant model. Population-attributable fractions exposed to AD were 11.5% for those with elevated SBP (SBP ≥ 120 mmHg) and 23.7% for those with hypertension (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg). This study showed a strong association between short-term AD exposure and increased SBP and DBP. 2 2
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Questionnaire in patients with aborted sudden cardiac death due to coronary spasm in Japan 査読あり
Sueda S., Shinohara T., Takahashi N., Shite J., Shoji T., Akao M., Kijima Y., Masuyama T., Miyaji T., Yamamoto K., Iwasaki Y., Yoshida R., Nakamura S., Ogino Y., Kimura K., Sasai M., Suzuki H., Wakatsuki T., Asajima H., Teragawa H., Ishikawa T., Kitamura K., Oda T., Nakayama T., Kobayashi Y., Sunada D., Yamaki M., Nishizaki F., Tomita Y., Usuda K., Fujinaga H., Kuramitsu S., Andou K., Kiyooka T., Kadota K., Ishii Y., Ohtani H., Maekawa Y., Taguchi E., Nakao K., Kobayashi N., Seino Y., Nakagawa H., Saito Y., Komuro I., Sasaki Y., Ikeda S., Yamaguchi O., Kakutani A., Imanaka T., Ishihara M., Ishii M., Kaikita K., Tsujita K.
Heart and Vessels 35 ( 12 ) 1640 - 1649 2020年12月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Heart and Vessels
Objectives: We investigated the medical or mechanical therapy, and the present knowledge of Japanese cardiologists about aborted sudden cardiac death (ASCD) due to coronary spasm. Methods: A questionnaire was developed regarding the number of cases of ASCD, implantable cardioverter–defibrillator (ICD), and medical therapy in ASCD patients due to coronary spasm. The questionnaire was sent to the Japanese general institutions at random in 204 cardiology hospitals. Results: The completed surveys were returned from 34 hospitals, giving a response rate of 16.7%. All SCD during the 5 years was observed in 5726 patients. SCD possibly due to coronary spasm was found in 808 patients (14.0%) and ASCD due to coronary spasm was observed in 169 patients (20.9%). In 169 patients with ASCD due to coronary spasm, one or two coronary vasodilators was administered in two-thirds of patients [113 patients (66.9%)], while more than 3 coronary vasodilators were found in 56 patients (33.1%). ICD was implanted in 117 patients with ASCD due to coronary spasm among these periods including 35 cases with subcutaneous ICD. Majority of cause of ASCD was ventricular fibrillation, whereas pulseless electrical activity was observed in 18 patients and complete atrioventricular block was recognized in 7 patients. Mean coronary vasodilator number in ASCD patients with ICD was significantly lower than that in those without ICD (2.1 ± 0.9 vs. 2.6 ± 1.0, p < 0.001). Although 16 institutions thought that the spasm provocation tests under the medications had some clinical usefulness of suppressing the next fatal arrhythmias, spasm provocation tests under the medication were performed in just 4 institutions. Conclusions: In the real world, there was no fundamental strategy for patients with ASCD due to coronary spasm. Each institution has each strategy for these patients. Cardiologists should have the same strategy and the same knowledge about ASCD patients due to coronary spasm in the future.
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アスピリンの適応と動向
海北幸一, 辻田賢一.
循環器内科 88 ( 6 ) 594 - 598 2020年12月
担当区分：筆頭著者 掲載種別：研究論文（学術雑誌）
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Usuku H, Yamamoto E, Nishi M, Komorita T, Takae M, Nishihara T, Oike F, Ishii M, Fujisue K, Sueta D, Araki S, Takashio S, Oda S, Misumi Y, Ueda M, Nakamura T, Kawano H, Soejima H, Sakamoto K, Kaikita K, Ando Y, Matsui H, Tsujita K
Circulation reports 2 ( 12 ) 730 - 738 2020年11月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：一般社団法人 日本循環器学会
<b><i>Background:</i></b>Using transthoracic echocardiography, including 2D speckle tracking imaging (STI), this study examined cardiac function after domino liver transplantation (DLT) with liver grafts explanted from patients with hereditary amyloidogenic transthyretin amyloidosis.<b><i>Methods and Results:</i></b>In all, 14 patients who underwent DLT at Kumamoto University Hospital and for whom 2D STI information was available were enrolled in the study; time-dependent echocardiographic changes were evaluated in 7. Although left ventricular (LV) systolic and diastolic function did not differ between the pre- and post-DLT periods (mean [±SD] 5.4±1.0 years after DLT), there were significant (P<0.05 for all) increases in the post- vs. pre-DLT period in basal longitudinal strain (LS; −13.4±2.3 vs. −19.3±4.4), relative apical LS index (=apical LS/[basal LS+mid LS]; 0.75±0.20 vs. 0.58±0.08), and LV ejection fraction/global LS (3.91±0.58 vs. 3.06±0.44). Age at the time of DLT was significantly higher in the group with impaired (>−14%) than preserved basal LS (57.2±3.5 vs. 39.6±16.0 years; P<0.05). When control subjects (n=14) were added to the enrolled DLT recipients, multivariable logistic regression analysis revealed that a history of DLT was significantly associated with impaired basal LS (>−14%; odds ratio 28.39, 95% confidence interval 1.89–427.45, P<0.05).<b><i>Conclusions:</i></b>LV systolic and diastolic function was preserved in the long term after DLT. However, 2D STI revealed subtle cardiac dysfunction in DLT recipients, which may be an early manifestation of cardiac amyloidosis.
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Usuku H., Takashio S., Yamamoto E., Kinoshita Y., Nishi M., Oike F., Marume K., Hirakawa K., Tabata N., Oda S., Misumi Y., Ueda M., Kawano H., Kaikita K., Matsushita K., Ando Y., Matsui H., Tsujita K.
Echocardiography 37 ( 11 ) 1774 - 1783 2020年11月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Echocardiography
Background: We previously reported that a high score (2 or 3 points) according to the Kumamoto criteria, a combination of high-sensitivity cardiac troponin T (hs-cTnT) ≥0.308 ng/mL, the length of QRS ≥ 120 ms in electrocardiogram, and left ventricular (LV) posterior wall thickness ≥ 13.6 mm, increases the pretest probability of Tc-labeled pyrophosphate ( Tc-PYP) scintigraphy in patients with suspected transthyretin amyloid cardiomyopathy (ATTR-CM). However, some patients with a low score (0 or 1 point) show positive findings on Tc-PYP scintigraphy. Therefore, we evaluated the usefulness of additional examinations, including echocardiographic assessment of myocardial strain, to raise the pretest probability of Tc-PYP scintigraphy for these patients. Methods and Results: We examined 109 consecutive patients aged ≥70 years with low scores according to the Kumamoto criteria who underwent Tc-PYP scintigraphy. Nineteen patients (17%) had positive Tc-PYP scintigraphy findings. The relative apical longitudinal strain (LS) index (apical LS/ basal LS + mid LS) (RapLSI) was significantly higher in patients with positive than negative Tc-PYP scintigraphy findings (1.04 ± 0.37 vs 0.70 ± 0.28, P <.01). Multivariable logistic regression analysis revealed that a high RapLSI (≥1.04) was significantly associated with Tc-PYP positivity (odds ratio, 14.14; 95% confidence interval, 3.36-59.47; P <.01). The sensitivity, specificity, and accuracy of the diagnostic model using the RapLSI for identification of Tc-PYP positivity were 53%, 94%, and 87%, respectively. Conclusions: A high RapLSI can raise the pretest probability of Tc-PYP scintigraphy in patients with a low score according to the Kumamoto criteria. The RapLSI can assist clinicians in determining strategies for these patients. 99m 99m 99m 99m 99m 99m 99m 99m 99m 99m
DOI： 10.1111/echo.14892
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Late-gadolinium enhancement in a subject with normal left ventricular function 査読あり
Misumi I., Sato K., Nagano M., Urata J., Usuku H., Kaikita K., Tsujita K.
Radiology Case Reports 15 ( 11 ) 2464 - 2470 2020年11月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Radiology Case Reports
A 27-year-old man visited our hospital after experiencing palpitations. His 12-lead electrocardiogram and chest radiograph were unremarkable. Blood test results showed normal plasma brain natriuretic peptide level (<5.8 pg/mL). Transthoracic echocardiography revealed normal left ventricular structure and function by demonstrating left ventricular wall thickness of 10 mm, end-diastolic dimension of 46 mm, end-systolic dimension of 31 mm, and ejection fraction of 64%. Pulsed-wave Doppler echocardiography demonstrated normal E/e’ ratio of 7.5. Cardiac magnetic resonance imaging showed normal coronary artery. However, there was massive late-gadolinium enhancement at the mid-layer wall, suggesting massive left ventricular fibrosis. This case reveals that left ventricular function may be normal even in massive late-gadolinium enhancement. Pathophysiology other than fibrosis might have contributed to this specific finding in late-gadolinium enhancement.
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Assessment of diffuse ventricular fibrosis in atrial fibrillation using cardiac CT-derived myocardial extracellular volume fraction 査読あり
Kidoh M, Oda S, Takashio S, Kanazawa H, Ikebe S, Emoto T, Nakaura T, Nagayama Y, Sasao A, Inoue T, Funama Y, Araki S, Yamamoto E, Kaikita K, Tsujita K, Ikeda O
JACC Clin Electrophysiol 6 ( 12 ) 1573 - 1575 2020年11月
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Yamada T., Takashio S., Arima Y., Nishi M., Morioka M., Hirakawa K., Hanatani S., Fujisue K., Yamanaga K., Kanazawa H., Sueta D., Araki S., Usuku H., Nakamura T., Suzuki S., Yamamoto E., Ueda M., Kaikita K., Tsujita K.
ESC Heart Failure 7 ( 5 ) 2829 - 2837 2020年10月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：ESC Heart Failure
Aims: The focus on wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is increasing because of novel treatment options. There is currently no report on a large number of Japanese patients with ATTRwt-CM. The study aimed to examine the characteristics and prognosis of ATTRwt-CM in Japan. Methods and results: Consecutive patients (78.5 ± 6.4 years old at diagnosis) with ATTRwt-CM diagnosed at Kumamoto University Hospital between December 2002 and December 2019 were retrospectively reviewed. Data, including demographic characteristics, co-morbidities, clinical manifestations at diagnosis, laboratory results, electrocardiographic and echocardiographic data, imaging and pathological findings, and treatment were obtained. Of 129 patients included in this study, 110 patients (85%) were male. The median period from initial symptom onset to diagnosis was 15.5 (2–75) months. Heart failure was the most common clinical manifestation leading to diagnosis (61%) and initial manifestations (49%). Of 106 patients, carpal tunnel syndrome was observed in 57 patients (54%), and the median period from initial symptom onset to diagnosis was 96 (48–120) months. Histopathological confirmation of transthyretin amyloid was achieved in 94 patients (73%), including 66 (51%) and 28 cases (22%) with endomyocardial and extracardiac biopsies. During the observation period (median 15.0 [inter-quartile range, 5.4–33.2] months after diagnosis), 34 patients (26%) died. Of these, 27 patients (79%) had cardiovascular deaths (heart failure, 25; sudden death, two). The median survival duration was 58.9 months and the 5 years' survival rate was 48%. According to a multivariate Cox hazard analysis, age [hazard ratio (HR), 1.14; 95% confidence interval (CI), 1.05–1.23, P = 0.002] and low serum sodium levels (HR, 0.89; 95% CI, 0.79–0.996; P = 0.04) contributed to all-cause mortality, and low serum sodium levels contributed to hospitalization for heart failure (HR, 0.86; 95% CI, 0.77–0.96; P = 0.005). Conclusions: Clinical characteristics and prognosis of ATTRwt-CM patients in Japan were examined. Carpal tunnel syndrome can be considered an indication for diagnosis of ATTRwt-CM. Age and low serum sodium level were significant predictive factors of all survival outcomes. The clinical features of ATTRwt-CM should be recognized to provide appropriate treatment.
DOI： 10.1002/ehf2.12884
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Takashio S., Kaikita K., Nishi M., Morioka M., Higo T., Shiose A., Doman T., Horiuchi H., Fukui T., Tsujita K.
ESC Heart Failure 7 ( 5 ) 3235 - 3239 2020年10月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：ESC Heart Failure
Aims: Bleeding is a serious complication in patients with continuous-flow left ventricular assist device (CF-LVAD). Acquired von Willebrand syndrome (AVWS; type 2A) develops because of high shear stress inside the pumps and is a cause of bleeding complication. Although von Willebrand factor (vWF) multimer analysis is useful for diagnosing AVWS, it is only performed in specialized research institutes. A novel microchip flow chamber system, the total thrombus-formation analysis system (T-TAS), is a point-of-care system to evaluate the thrombus-formation process and useful for monitoring platelet thrombus-formation capacity in patients receiving antiplatelet therapy and the diagnosis and evaluation of the clinical severity of von Willebrand disease type 1. However, little is known about the association between AVWS and platelet thrombus-formation capacity evaluated by T-TAS in patients with CF-LVAD. We aimed to evaluate the utility of T-TAS for easy detection of AVWS in patients with CF-LVAD. Methods and results: We simultaneously evaluated the vWF large multimers and T-TAS parameters in four consecutive patients with axial-type CF-LVAD and eight control patients treated with aspirin and warfarin. vWF large multimer index was defined as the proportion of large multimers in total vWF derived from a normal control plasma. T-TAS analyses different thrombus-formation processes using two microchips with different thrombogenic surfaces. PL -AUC levels in the platelet (PL) chip are highly sensitive for platelet functions, while AR -AUC levels in the atheroma (AR) chip allow the assessment of the overall haemostatic ability. vWF large multimer index and T-TAS parameters were decreased in all patients with CF-LVAD. The mean PL -AUC level (5.4 ± 2.9 vs. 219 ± 67; P < 0.01), AR -AUC level (338 ± 460 vs. 1604 ± 160; P < 0.01) and vWF large multimer index (49 ± 11% vs. 112 ± 27%; P < 0.01) were significantly lower in the patients with CF-LVAD than in control patients. One patient showed changes in T-TAS levels before and after implantation of CF-LVAD. PL -AUC and AR -AUC levels decreased from 438.1 to 5.0 and from 1667.9 to 1134.3, respectively. Conclusions: In patients with CF-LVAD, the platelet thrombus-formation capacity was extremely impaired because of AVWS, and T-TAS parameters could detect the presence of AVWS. T-TAS can be used for easy detection of AVWS as a point-of-care testing. Further studies with a large sample size are needed to validate our results in several LVAD models and evaluate the prognostic value of bleeding complications and thromboembolism in patients with LVAD. 24 10 10 30 24 10 10 30 24 10 10 30
DOI： 10.1002/ehf2.12824
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Oike F., Yamamoto E., Sueta D., Tokitsu T., Usuku H., Nishihara T., Takae M., Fujisue K., Arima Y., Kanazawa H., Ito M., Hanatani S., Araki S., Takashio S., Sakamoto K., Suzuki S., Kawano H., Soejima H., Kaikita K., Tsujita K.
International Journal of Cardiology 316 145 - 151 2020年10月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：International Journal of Cardiology
Objectives: Because diastolic late mitral annular velocity (a') obtained by transthoracic-echocardiography (TTE) represents left atrial (LA) function, we investigated the clinical significance of a' in heart failure (HF) with a preserved left ventricular (LV) ejection fraction (HFpEF). Methods: We enrolled 448 consecutive HFpEF patients (sinus rhythm: 66.3%, atrial fibrillation [AF] rhythm: 33.7%) and performed TTE under stable conditions after optimal therapy. In patients with sinus rhythm, a' values were measured at septal mitral annuli. Results: A' had weak but significant negative correlations with the natural-logarithm-B-type natriuretic peptide (Ln-BNP), LA diameter, LV mass index and tricuspid regurgitation pressure gradient. Receiver operating characteristic (ROC) curve analysis showed that the best cut-off value of a' and systolic mitral annular velocity (s') for the prediction of HF-related events were 7.45 cm/s and 6.5 cm/s with areas under the curve (AUC) of 0.841 and 0.682, respectively. The AUC of ROC analysis for the logistic regression model of a' plus s' was improved to 0.97. In Kaplan-Meier analysis, HFpEF patients with low-a' (<7.45 cm/s) had a significantly higher risk of total cardiovascular and HF-related events (both p < .01 by log-rank test) than those with high-a' (≥ 7.45 cm/s) and were prognostically equivalent to those with AF. Multivariate Cox proportional hazard analysis identified low-a' as an independent predictor of both total cardiovascular (hazard ratio [HR]: 0.823, 95% confidence interval [CI]: 0.714–0.949, p = .007) and HF-related events (HR: 0.551, 95% CI: 0.422–0.720, p < .001). Conclusion: A' value measurement is a non-invasive and useful method for risk stratification in HFpEF.
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Left-dominant arrhythmogenic cardiomyopathy with a nonsense mutation in DSP 査読あり
Tsuruta Y., Sueta D., Takashio S., Oda S., Sakamoto K., Kaikita K., Kato K., Ohno S., Horie M., Tsujita K.
ESC Heart Failure 7 ( 5 ) 3174 - 3178 2020年10月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：ESC Heart Failure
A 74-year-old man had abnormal left ventricular (LV) function according to a perioperative test at a local hospital and was transferred to our institution for further evaluation and treatment. His electrocardiogram demonstrated the presence of premature ventricular contraction with a QRS complex of the right bundle branch block type and superior axis. His echocardiography showed systolic dysfunction of the LV (LV ejection fraction, 44.6%). Cardiac computed tomography imaging revealed banded and patchy densities observed frequently from the middle to epicardial layer of the LV wall. Cardiac magnetic resonance imaging showed fat signals on fat-selective images and late gadolinium enhancement in the mid-wall to subepicardial layers in the LV myocardium. Endomyocardial biopsy revealed the histological presence of fibrofatty replacement. A genetic analysis revealed a nonsense mutation in the desmoplakin gene. Thus, he was diagnosed with left-dominant arrhythmogenic cardiomyopathy. To prevent fatal ventricular arrhythmias, an implantable cardioverter defibrillator was successfully implanted.
DOI： 10.1002/ehf2.12790
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A case of severe pulmonary thromboembolism in mycoplasma infection during early pregnancy 査読あり
Ohno M., Yamada T., Otsuka Y., Nakashima N., Matsubara J., Matsukawa M., Sueta D., Arima Y., Yamamoto E., Tamaya S., Kaikita K., Fujimoto K., Tsujita K.
Journal of Cardiology Cases 22 ( 3 ) 140 - 142 2020年9月
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Cardiology Cases
Mycoplasma infection and pregnancy are both characterized by thrombogenesis. A 38-year-old pregnant woman was admitted to a general hospital for mycoplasma pneumonia treatment. She experienced sudden dyspnea and fell into cardiopulmonary arrest. Emergent pulmonary arteriography revealed contrast deficits in the bilateral pulmonary arteries, and she was diagnosed with pulmonary thromboembolism (PTE). Reperfusion treatment and hemodynamic support were initiated. This is a rare case report of PTE attributed to mycoplasma infection during pregnancy. <Learning objective: Since mycoplasma infection has been reported to be a fatal extrapulmonary finding associated with pulmonary thromboembolism (PTE), if sudden respiratory failure occurs during the clinical course, PTE should be investigated, and pregnant women should be especially careful.>