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Abstract Background Bleeding risk factors in elderly patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) are unclear and data on the use of antithrombotic drugs are lacking. We investigated the bleeding risk factors in elderly patients with atrial fibrillation undergoing PCI to help optimize antithrombotic therapy according to bleeding risk. We also investigated the association between the actual use of antithrombotic therapy and bleeding events. Methods A retrospective cohort study was conducted on 134 elderly patients with atrial fibrillation who underwent primary PCI at the Department of Cardiology, Showa University Fujigaoka Hospital. The endpoint was a bleeding event within 1-year. Bleeding risk factors were identified using multivariate analysis. The association between the number of antithrombotics and bleeding events was evaluated using the chi-squared test. Results The mean age of the patients was 76.0 ± 6.2 years. Bleeding events occurred in 41 (30.6%) patients. Age > 80 years (odds ratio [OR]: 2.54, 95% confidence interval [CI]: 1.10–5.85), multivessel disease (OR: 2.76, 95% CI: 1.22–6.23), and history of surgery (OR: 3.03, 95% CI: 1.14–8.06) were identified as bleeding risk factors. The proportion of patients receiving triple therapy was significantly higher in the bleeding group compared to the non-bleeding group (70.7% vs. 27.5%, p 80, multivessel disease, and history of surgery were found to be risk factors for bleeding in elderly patients with atrial fibrillation undergoing PCI. In addition, dual therapy after PCI in elderly patients at high risk of bleeding should be considered to avoid bleeding events.

Abstract Aims Guidelines for the diagnosis and treatment of acute and chronic heart failure (HF) provided by the European Society of Cardiology state that echocardiography is recommended for the assessment of the myocardial structure and function of subjects with suspected HF including HF with reduced (HFrEF), mid‐range (HFmrEF), and preserved ejection fraction (HFpEF) as class I of recommendation and level C of evidence. However, the impact of timing of echocardiography on survival for hospitalized HF patients or the prevalence of echocardiography during their stay has not yet been fully investigated. Therefore, we designed and conducted a prospective multicentre study, Optimal Timing of Echocardiography for Heart Failure Inpatients in Japanese Institutions (OPTIMAL) study, to investigate and evaluate the prevalence of echocardiography during the in‐hospital stay of HF patients, and the impact of timing of echocardiography on their survival. Methods and results OPTIMAL was based on a nationwide, prospective, multicentre registry at 10 institutions in Japan endorsed by the Japanese Society of Echocardiography. A total of 601 patients hospitalized with HF were enrolled between August 2016 and July 2018 at the participating centres. Their mean age was 73.9 ± 13.0 years, left ventricular ejection fraction was 37.0% (26.0–50.0), and 256 patients (42.6%) were female. Admission echocardiography (admission echo) was categorized as either standard or point‐of‐care echocardiography performed within 3 days of admission, as was pre‐discharge echocardiography (pre‐discharge echo) within 3 days of discharge. The primary endpoint was defined as cardiovascular death over a median follow‐up period of 18.9 months (9.3–26.5 months). Admission echo was performed for 476 patients (79.2%) and pre‐discharge echo for 216 patients (35.9%). The primary endpoint of cardiovascular death occurred in 65 patients (10.8%). Kaplan–Meier curve findings indicated that survival of patients with pre‐discharge echo was significantly better than that of patients without it (log‐rank P

Limited data are available on athlete’s heart for rugby athletes. This study aimed to investigate cardiac structure and its relationship with cardiorespiratory fitness in young Japanese rugby athletes. A prospective cross-sectional study using echocardiography and cardiopulmonary exercise testing (CPET) was conducted on 114 male collegiate rugby players. There was a higher prevalence of increased left ventricular (LV), atrial, and aortic dimensions in the young athletes than that in previously published reports, whereas the wall thickness was within the normal range. Anthropometry and CPET analyses indicated that the forwards and backs presented muscular and endurance phenotypes, respectively. Indexed LV and aortic dimensions were significantly larger in the backs than in the forwards, and the dimensions significantly correlated with oxygen uptake measured by CPET. On the four-tiered classification for LV hypertrophy, abnormal LV geometry was found in 16% of the athletes. Notably, the resting systolic blood pressure was significantly higher in athletes with concentric abnormal geometry than in the other geometry groups, regardless of their field positions. Japanese young athletes may exhibit unique phenotypes of cardiac remodeling in association with their fitness characteristics. The four-tiered LV geometry classification potentially offers information regarding the subclinical cardiovascular risks of young athletes.

Abstract Background Left atrial (LA) dilation is associated with morbidity of atrial fibrillation (AF). However, little is known about pulmonary vein (PV) dilation. Purpose We investigated the PV volume in the patients with AF. Methods and results We performed 3dimensional computed tomography (3DCT) in 155 patients and divided them into three groups: 19 patients without AF (non‐AF group, mean age 66 ± 12 years), 50 with paroxysmal AF (PAF group, mean age 67 ± 8 years) and 24 with persistent AF (PeAF group, mean age 64 ± 10 years). The absence of AF was diagnosed in patients with a cardiac implantable electronic device for at least 1 year (mean: 59 ± 37 months). We determined the PV volume as the total volume from the orifice to the first branch of each PV. According to the echocardiographic data, the LA dimension (LAD) and LA volume index (LAVI) were largest in the PeAF group followed by the PAF and non‐AF group. According to the morphometric data obtained on 3D‐CT, the PV volume was similar in PeAF and PAF groups but significantly smaller in the non‐AF group (median value: 24 vs 21 vs 14 mL, respectively). According to the receiver operating characteristic curve analysis, the area under the curve for the PV volume in the presence of AF was 0.80, and the optimum cut‐off value was 17 mL (sensitivity 74%, specificity 80%). Conclusion The PV volume might be useful for predicting the presence of AF before increases in the LAD and LAVI on echocardiography.

Introduction: The aim of this study was to evaluate the changes in cardiac performance and myocardial blood perfusion by single photon emission computed tomography (SPECT) in patients upgrading to cardiac resynchronization therapy (CRT) from right ventricular apical pacing (RVAP). Methods: Eleven patients (age, 70±7.7 years; pacing career, 95±48.8 months) with chronic RVAP were studied. Their baseline characteristics included New York Heart Association (NYHA) class ≥2, with left ventricular end-diastolic volume (LVEDV) >55 mm or left ventricular ejection fraction (LVEF)