192 results on '"Tomoko Ishizu"'
Search Results
2. Successful surgical epicardial cryoablation of refractory atrial tachycardia in a patient with repaired tetralogy of Fallot after multiple failed endocardial ablations
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Qasim J. Naeemah, Miyako Igarashi, Muneaki Matsubara, Tomoko Ishizu, Akihiko Nogami, and Masaki Ieda
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Cardiology and Cardiovascular Medicine - Published
- 2023
3. Association between right ventricular longitudinal strain and cardiovascular events in patients with cardiac sarcoidosis
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Noor K, Albakaa, Kimi, Sato, Noriko, Iida, Masayoshi, Yamamoto, Tomoko, Machino-Ohtsuka, Tomoko, Ishizu, and Masaki, Ieda
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Myocarditis ,Sarcoidosis ,Heart Ventricles ,Ventricular Dysfunction, Right ,Ventricular Function, Right ,Humans ,Contrast Media ,Gadolinium ,Prognosis ,Cardiology and Cardiovascular Medicine - Abstract
While right ventricular (RV) involvement is commonly observed in patients with cardiac sarcoidosis (CS), the utility of strain imaging to detect RV involvement is unclear. We aimed to investigate the association between RV free wall longitudinal strain (RVFWLS) and cardiovascular events in patients with CS.We studied 51 patients with CS who were diagnosed between 2012 and 2020. All patients underwent comprehensive echocardiographic evaluation, and RVFWLS was assessed using 2-dimensional speckle tracking echocardiography. The primary outcome was major adverse cardiovascular events (MACEs).During a median follow-up duration of 548 days, 11 patients exhibited MACEs. In the univariable Cox proportional hazards model, the baseline RVFWLS was associated with MACEs (hazard ratio: 1.29, p = 0.008). The addition of RVFWLS to the conventional echocardiographic parameters exhibited a significant incremental value associated with MACEs. Patients with reduced RVFWLS showed a higher prevalence of late gadolinium enhancement on cardiac magnetic resonance imaging in RV wall (p = 0.02) and trends toward higher prevalence of fluorodeoxyglucose uptake in RV (p = 0.06). A serial echocardiographic evaluation revealed that patients with events showed a worsening in RVFWLS, while others showed a trend toward improvement.Impaired RVFWLS at baseline was associated with MACEs in patients with CS. RVFWLS could be an important surrogate of disease activity and prognosis by detecting active RV involvement in CS.
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- 2022
4. Status of adult outpatients with congenital heart disease in Japan: The Japanese Network of Cardiovascular Departments for Adult Congenital Heart Disease Registry
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Atsushi, Yao, Ryo, Inuzuka, Atsushi, Mizuno, Hiroyuki, Iwano, Shunsuke, Tatebe, Yasumasa, Tsukamoto, Ichiro, Sakamoto, Hiroyuki, Watanabe, Nobuyuki, Fukuda, Fumie, Takechi, Shiro, Adachi, Yusuke, Akazawa, Koichiro, Kuwahara, Kaoru, Dohi, Tomoko, Ishizu, Makoto, Miyake, Norimichi, Koitabashi, Saki, Hasegawa-Tamba, Seiichi, Sato, Takanari, Fujii, Eiji, Ehara, Tohru, Minamino, Hirotsugu, Yamada, Eiji, Yamashita, Naoto, Kawamatsu, Keita, Masuda, Katsura, Soma, Isao, Shiraishi, Ryozo, Nagai, and Koichiro, Niwa
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Adult ,Heart Defects, Congenital ,Japan ,Transposition of Great Vessels ,Outpatients ,Humans ,Adult congenital heart disease ,Prospective Studies ,Registries ,Cardiology and Cardiovascular Medicine ,Lifelong care ,JNCVD-ACHD - Abstract
BackgroundThe Japanese Network of Cardiovascular Departments for Adult Congenital Heart Disease (JNCVD-ACHD) was founded in 2011 for the lifelong care of adult patients with congenital heart disease (ACHD patients). This network maintains the first Japanese ACHD registry.Methods and resultsFrom 2011 to 2019, the JNCVD-ACHD registered 54 institutions providing specialized care for ACHD patients in 32 of the 47 prefectures in Japan. The registry collected data on the disease profile for 24,048 patients from 50 institutions and the patient characteristics for 9743 patients from 24 institutions. The most common ACHDs were atrial septal defect (20.5 %), ventricular septal defect (20.5 %), tetralogy of Fallot (12.9 %), and univentricular heart (UVH)/single ventricle (SV; 6.6 %). ACHD patients without biventricular repair accounted for 37.0 % of the population. Also examined were the serious anatomical and/or pathophysiological disorders such as pulmonary arterial hypertension (3.0 %) including Eisenmenger syndrome (1.2 %), systemic right ventricle under biventricular circulation (sRV-2VC; 2.8 %), and Fontan physiology (6.0 %). The sRV-2VC cases comprised congenitally corrected transposition of the great arteries without anatomical repair (61.9 %) and transposition of the great arteries with atrial switching surgery (38.1 %). The primary etiology (86.4 %) for Fontan physiology was UVH/SV. In addition, developmental/chromosomal/genetic disorders were heterotaxy syndromes (asplenia, 0.9 %; polysplenia, 0.7 %), trisomy 21 (4.0 %), 22q11.2 deletion (0.9 %), Turner syndrome (0.2 %), and Marfan syndrome (1.1 %).ConclusionsAlthough the specific management of ACHD has systematically progressed in Japan, this approach is still evolving. For ideal ACHD care, the prospective goals for the JNCVD-ACHD are to create local networks and provide a resource for multicenter clinical trials to support evidence-based practice.
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- 2022
5. Effect of ipragliflozin on carotid intima-media thickness in type 2 diabetes patients
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Atsushi, Tanaka, Masataka, Sata, Yosuke, Okada, Hiroki, Teragawa, Kazuo, Eguchi, Michio, Shimabukuro, Isao, Taguchi, Kazuo, Matsunaga, Yumiko, Kanzaki, Hisako, Yoshida, Tomoko, Ishizu, Shinichiro, Ueda, Masafumi, Kitakaze, Toyoaki, Murohara, Koichi, Node, Yoshihiko, Nishio, Mitsuru, Ohishi, Kazuomi, Kario, Wataru, Shimizu, Hideaki, Jinnouchi, Hirofumi, Tomiyama, Koji, Maemura, Makoto, Suzuki, Shinichi, Ando, Haruo, Kamiya, Tomohiro, Sakamoto, Mamoru, Nanasato, Munehide, Matsuhisa, Junya, Ako, Yoshimasa, Aso, Masaharu, Ishihara, Kazuo, Kitagawa, Akira, Yamashina, Yumi, Ikehara, Ayako, Takamori, Miki, Mori, Kaori, Yamaguchi, Machiko, Asaka, Tetsuya, Kaneko, Masashi, Sakuma, Shigeru, Toyoda, Takahisa, Nasuno, Michiya, Kageyama, Jojima, Teruo, Iijima, Toshie, Haruka, Kishi, Hirotsugu, Yamada, Kenya, Kusunose, Daiju, Fukuda, Shusuke, Yagi, Koji, Yamaguchi, Takayuki, Ise, Yutaka, Kawabata, Akio, Kuroda, Yuichi, Akasaki, Mihoko, Kurano, Satoshi, Hoshide, Takahiro, Komori, Tomoyuki, Kabutoya, Yukiyo, Ogata, Yuji, Koide, Hiroaki, Kawano, Satoshi, Ikeda, Satoki, Fukae, Seiji, Koga, Yukihito, Higashi, Shinji, Kishimoto, Masato, Kajikawa, Tatsuya, Maruhashi, Yoshiaki, Kubota, Yoshisato, Shibata, Nehiro, Kuriyama, Ikuko, Nakamura, Kanemitsu, Hironori, Bonpei, Takase, Yuichi, Orita, Chikage, Oshita, Yuko, Uchimura, Ruka, Yoshida, Yukihiko, Yoshida, Hirohiko, Suzuki, Yasuhiro, Ogura, Mayuho, Maeda, Masaki, Takenaka, Takumi, Hayashi, Mirai, Hirose, Itaru, Hisauchi, Toshiaki, Kadokami, Ryo, Nakamura, Junji, Kanda, Masaaki, Hoshiga, Koichi, Sohmiya, Arihiro, Koyosue, Hiroki, Uehara, Naoto, Miyagi, Toshiya, Chinen, Kentaro, Nakamura, Chikashi, Nago, Suguru, Chiba, Sho, Hatano, Yoshikatsu, Gima, Masami, Abe, Masayoshi, Ajioka, Hiroshi, Asano, Yoshihiro, Nakashima, Hiroyuki, Osanai, Takahiro, Kanbara, Yusuke, Sakamoto, Mitsutoshi, Oguri, Shiou, Ohguchi, Kunihiko, Takahara, Kazuhiro, Izumi, Kenichiro, Yasuda, Akihiro, Kudo, Noritaka, Machii, Ryota, Morimoto, Yasuko, Bando, Takahiro, Okumura, Toru, Kondo, Shin-Ichiro, Miura, Yuhei, Shiga, Joji, Mirii, Makoto, Sugihara, Tadaaki, Arimura, Junko, Nakano, Kazuhisa, Kodama, Nobuyuki, Ohte, Tomonori, Sugiura, Kazuaki, Wakami, Yasuhiko, Takemoto, Minoru, Yoshiyama, Taichi, Shuto, Kazuo, Fukumoto, Kenichi, Tanaka, Satomi, Sonoda, Akemi, Tokutsu, Takashi, Otsuka, Fumi, Uemura, Kenji, Koikawa, Megumi, Miyazaki, Maiko, Umikawa, Manabu, Narisawa, Machi, Furuta, Hiroshi, Minami, Masaru, Doi, Kazuhiro, Sugimoto, Susumu, Suzuki, Akira, Kurozumi, and Kosuke, Nishio
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Ipragliflozin ,Type 2 diabetes ,Pharmacology (medical) ,Carotid intima-media thickness ,Atherosclerosis ,Cardiology and Cardiovascular Medicine - Abstract
Aims To examine the effects of a 24-month treatment with ipragliflozin on carotid intima-media thickness (IMT) in type 2 diabetes patients. Methods and results In this multicenter, prospective, randomized, open-label, and blinded-endpoint investigator-initiated clinical trial, adults with type 2 diabetes and haemoglobin A1C (HbA1c) of 6.0–10.0% (42–86 mmol/mol) were randomized equally to ipragliflozin (50 mg daily) and non-sodium-glucose cotransporter-2 (SGLT2) inhibitor use of standard-care (control group) for type 2 diabetes and were followed-up to 24 months. The primary endpoint was the change in mean common carotid artery IMT (CCA-IMT) from baseline to 24 months. A total of 482 patients were equally allocated to the ipragliflozin (N = 241) and control (N = 241) groups, and 464 patients (median age 68 years, female 31.7%, median type 2 diabetes duration 8 years, median HbA1c 7.3%) were included in the analyses. For the primary endpoint, the changes in the mean CCA-IMT from baseline to 24 months were 0.0013 [95% confidence interval (CI), −0.0155–0.0182] mm and 0.0015 (95% CI, −0.0155–0.0184) mm in the ipragliflozin and control groups, respectively, with an estimated group difference (ipragliflozin-control) of −0.0001 mm (95% CI, −0.0191–0.0189; P = 0.989). A group difference in HbA1c change at 24 months was also non-significant between the treatment groups [−0.1% (95% CI, −0.2–0.1); P = 0.359]. Conclusion Twenty-four months of ipragliflozin treatment did not affect carotid IMT status in patients with type 2 diabetes recruited in the PROTECT study, relative to the non-SGLT2 inhibitor-use standard care for type 2 diabetes.
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- 2022
6. Effect of Novel Stratified Lipid Risk by 'LDL-Window' and Flow-Mediated Dilation on the Prognosis of Coronary Artery Disease Using the FMD-J Study A Data
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Shichiro, Abe, Yasuo, Haruyama, Gen, Kobashi, Shigeru, Toyoda, Teruo, Inoue, Hirofumi, Tomiyama, Tomoko, Ishizu, Takahide, Kohro, Yukihito, Higashi, Bonpei, Takase, Toru, Suzuki, Shinichiro, Ueda, Tsutomu, Yamazaki, Tomoo, Furumoto, Kazuomi, Kario, Shinji, Koba, Yasuhiko, Takemoto, Takuzo, Hano, Masataka, Sata, Yutaka, Ishibashi, Koichi, Node, Koji, Maemura, Yusuke, Ohya, Taiji, Furukawa, Hiroshi, Ito, and Akira, Yamashina
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Lipoproteins ,Cholesterol, HDL ,Cholesterol, LDL ,General Medicine ,Prognosis ,Dilatation ,Coronary artery disease ,Triglyceride ,Flow-mediated dilation ,Non-high-density lipoprotein cholesterol ,Cholesterol ,Risk Factors ,Humans ,Cardiology and Cardiovascular Medicine ,Lipid risk stratification ,Triglycerides - Abstract
Background: Elevated levels of triglyceride (TG) and non-high-density lipoprotein cholesterol (non-HDL-C) are regarded as a residual lipid risk in low-density lipoprotein cholesterol (LDL-C)-lowering therapy. This study investigated the association between lipid risk stratified by TG and non-HDL-C and the prognosis of patients with coronary artery disease (CAD), and the association between stratified lipid risk and flow-mediated dilatation (FMD) index. Methods and Results: The 624 CAD patients enrolled in flow-mediated dilation (FMD)-J study A were divided into 4 groups: low-risk group (n=413) with TG
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- 2022
7. Using computed tomography fusion imaging as learning data for sonographer training in identification of left ventricular endocardial boundaries
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Yoshiki Shiina, Tomoko Ishizu, Satomi Nesaki, Hideki Nakajima, Noriko Iida, Naoto Kawamatsu, Kimi Sato, Masayoshi Yamamoto, Tomoko Machino-Ohtsuka, Masaki Ieda, and Yasushi Kawakami
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Cardiology and Cardiovascular Medicine - Published
- 2023
8. PO-01-011 EFFECT OF TRANSVENOUS SYSTEMIC RIGHT VENTRICULAR PACING FOR HEART FAILURE IN ADDITION TO MANAGING ARRHYTHMIAS IN THE PATIENT WITH UNREPAIRED D-TGA
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Miyako Igarashi, Tomoko Mahino-Ohtsuka, Yoshiki Aono, Qasim J. Naeemah, YUTO IIOKA, Yuka Mashimo, Chihiro Ota, Yuichi Hanaki, Kojiro Ogawa, Akira Kimata, Yuki Komatsu, Hiro Yamasaki, Tomoko Ishizu, Akihiko Nogami, and Masaki Ieda
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
9. Left atrial regional strain assessed by novel dedicated three-dimensional speckle tracking echocardiography
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Ayako Kuraoka, Masayoshi Yamamoto, Tomoko Machino-Ohtsuka, Miho Sato, Miyako Igarashi, Masaki Ieda, Tomoko Ishizu, and Kimi Sato
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Male ,medicine.medical_specialty ,Paroxysmal atrial fibrillation ,Segmental analysis ,Echocardiography, Three-Dimensional ,Computed tomography ,Speckle tracking echocardiography ,Left atrial ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Heart Atria ,medicine.diagnostic_test ,Strain (chemistry) ,business.industry ,Mean age ,Middle Aged ,Global strain ,Echocardiography ,Cardiology ,Atrial Function, Left ,Female ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business - Abstract
BACKGROUND Left atrial (LA) global strain has been studied as an early marker of LA dysfunction, followed by LA dilatation. Recently, a novel dedicated software for LA 3-dimensional speckle tracking echocardiography (LA-3DSTE) has allowed us to assess anatomy-based six-segmental LA deformation. This study aimed to assess the accuracy of LA-3DSTE software in measuring LA volume and to reveal the characteristics of regional LA reservoir strain. METHODS Fifty patients with paroxysmal atrial fibrillation who underwent computed tomography (CT) and 3D-STE were enrolled. The LA volumes obtained by 3D-STE and CT were compared, and regional LA strain was analyzed. Six LA segments (anterior, septal, inferior, lateral, roof, and posterior) were determined on the basis of LA anatomy. RESULTS In 50 patients (mean age, 64 years; 62% male), the 3D-STE-derived LA volume index (LAVI) showed good correlation with the CT-derived index, (r = 0.78, p < 0.001) with an underestimate bias of 10.5 ± 11.0 ml/m2 (p < 0.001). The lateral LA strain was negatively correlated with LAVI and emptying fraction, while the anterior and septal strains were not. In the 1st quantile LA volume group, the segmental LA strain was heterogeneous, that is, the lateral and inferior strains were greater than the anterior strain. While in the 3rd quantile LA volume group, the lateral and inferior strains were decreased, and there was no regional difference. CONCLUSION LA volume obtained by 3D-STE and CT showed a good correlation. LA segmental analysis by 3D-STE enables early identification of how LA dysfunction affects lateral and inferior LA strains, consistent with anatomical features.
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- 2021
10. The determinants of plasma brain natriuretic peptide level in severe aortic valve stenosis patients undergoing transcatheter aortic valve implantation
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Tomoya Hoshi, Yoshihiro Seo, Naomi Nakazawa, Yasushi Kawakami, Kimi Sato, Nobuyuki Ohte, Masayoshi Yamamoto, Masaki Ieda, Akira Sato, Tomoko Machino-Ohtsuka, and Tomoko Ishizu
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Male ,Cardiac Catheterization ,medicine.medical_specialty ,Transcatheter aortic ,medicine.drug_class ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Lv dysfunction ,Natriuretic Peptide, Brain ,Natriuretic peptide ,Humans ,Medicine ,030212 general & internal medicine ,Aged ,Subclinical infection ,Cardiac catheterization ,Aged, 80 and over ,Brain natriuretic peptide level ,business.industry ,Stroke Volume ,Aortic Valve Stenosis ,medicine.disease ,Treatment Outcome ,Aortic Valve ,Aortic valve stenosis ,Heart failure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Brain or B-type natriuretic peptide (BNP) is an objective marker to diagnose the presence of heart failure (HF) and assess its severity. However, the determinants of serum BNP level in elderly patients with severe aortic valve stenosis (AS) referred for transcatheter aortic valve implantation (TAVI) have not been well investigated.We prospectively studied 106 AS patients who underwent TAVI. Cardiac catheterization, transesophageal echocardiography, and blood collection for plasma BNP level measurements were performed simultaneously just before the TAVI procedures.Ninety-nine patients (83.9±5.0 years, 33% male) were studied. The natural logarithm of BNP (lnBNP) level was 5.4±0.9 pg/mL. Significant correlations with lnBNP level were observed in: 1) the history of syncope, prior HF medication, and New York Heart Association class III or IV (R=0.255, p=0.011) (R=0.210, p=0.037) (R=0.402, p0.001), 2) albumin and hemoglobin level (R=-0.289, p=0.004) (R=0.263, p=0.009), 3) Left ventricular (LV) ejection fraction and global longitudinal strain (LVGLS) (R=-0.338, p0.001) (R=0.447, p0.001), 4) LV end-diastolic volume index (EDVI), LV mass index, and left atrial volume index (R=0.280, p=0.005) (R=0.366, p0.001) (R=0.337, p0.001), 5) the catheter-measured pressure gradient across the aortic valve (AVPG) (R=0.365, p0.001). Note that LV wall stress was not significantly correlated with lnBNP level. LVGLS, AVPG, hemoglobin level, and LVEDVI were independently correlated with ln BNP level (R=0.652, LVGLS; β=0.395, p0.006, AVPG; β=0.291, p=0.001, hemoglobin level; β=-0.216, p=0.011, and LVEDVI; β=0.203, p=0.016, respectively).In severe AS patients candidate for TAVI, multiple factors, including the severities of AS and HF conditions and subclinical LV dysfunction determined by LVGLS affects plasma BNP level.
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- 2021
11. JCS 2021 Guideline on the Clinical Application of Echocardiography
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Nobuyuki, Ohte, Tomoko, Ishizu, Chisato, Izumi, Hiroshi, Itoh, Shiro, Iwanaga, Hiroyuki, Okura, Yutaka, Otsuji, Yasushi, Sakata, Toshihiko, Shibata, Toshiro, Shinke, Yoshihiro, Seo, Masao, Daimon, Masaaki, Takeuchi, Kazuaki, Tanabe, Satoshi, Nakatani, Masaki, Nii, Kazuhiro, Nishigami, Takeshi, Hozumi, Satoshi, Yasukochi, Hirotsugu, Yamada, Kazuhiro, Yamamoto, Masaki, Izumo, Katsuji, Inoue, Hiroyuki, Iwano, Atsushi, Okada, Akihisa, Kataoka, Shuichiro, Kaji, Kenya, Kusunose, Akiko, Goda, Yasuharu, Takeda, Hidekazu, Tanaka, Kaoru, Dohi, Hirotoshi, Hamaguchi, Hidekatsu, Fukuta, Satoshi, Yamada, Nozomi, Watanabe, Makoto, Akaishi, Takashi, Akasaka, Takeshi, Kimura, Masami, Kosuge, and Tohru, Masuyama
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Japan ,Echocardiography ,Humans ,General Medicine ,Cardiology and Cardiovascular Medicine ,Societies, Medical - Published
- 2022
12. Intraoperative Imaging Strategy Unique to Japan for Transcatheter Closure of Atrial Septal Defects
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Tomoko Machino-Ohtsuka, Tomoko Ishizu, and Yasushi Kawakami
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General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
13. Right bundle branch block and risk of cardiovascular mortality: the Ibaraki Prefectural Health Study
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Takuji Tomizawa, Akihiko Nogami, Dongzhu Xu, Kimi Sato, Fujiko Irie, Hiroyasu Iso, Yasushi Kawakami, Hitoshi Ota, Kazumasa Yamagishi, Naoto Kawamatsu, Naomi Nakazawa, Tomofumi Nakatsukasa, Nobuyuki Murakoshi, Daishi Nakagawa, Masayoshi Yamamoto, Tomoko Machino-Otsuka, Toshimi Sairenchi, Kazutaka Aonuma, Tomoko Ishizu, and Masaki Ieda
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Male ,medicine.medical_specialty ,Bundle-Branch Block ,Population ,Cardiovascular System ,Asymptomatic ,Cohort Studies ,Electrocardiography ,Japan ,Internal medicine ,Epidemiology ,medicine ,Humans ,education ,Aged ,education.field_of_study ,Proportional hazards model ,business.industry ,Hazard ratio ,Middle Aged ,Right bundle branch block ,medicine.disease ,Confidence interval ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
Historically, a right bundle branch block has been considered a benign finding in asymptomatic individuals. However, this conclusion is based on a few old studies with small sample sizes. We examined the association between a complete right bundle branch block (CRBBB) and subsequent cardiovascular mortality in the general population in Japan. In this large community-based cohort study, data of 90,022 individuals (mean age, 58.5 ± 10.2 years; 66.2% women) who participated in annual community-based health check-ups were assessed. Subjects were followed up from 1993 to the end of 2016. Cox proportional hazards’ models and log-rank tests were used for the data analysis. CRBBB was documented in 1,344 participants (1.5%). Among all included participants, CRBBB was associated with an increased risk of cardiovascular mortality after adjustment for all potential confounders (hazard ratio [HR] 1.21; 95% confidence interval [CI] 1.06–1.38). The increased risk of cardiovascular mortality was particularly evident in women aged
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- 2021
14. Sodium Glucose Co-Transporter 2 Inhibitors Improve Renal Congestion and Left Ventricular Fibrosis in Rats With Hypertensive Heart Failure
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Tomofumi Nakatsukasa, Tomoko Ishizu, Masumi Ouchi, Nobuyuki Murakoshi, Kimi Sato, Masayoshi Yamamoto, Kunio Kawanishi, Yoshihiro Seo, and Masaki Ieda
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Heart Failure ,Heart Ventricles ,Stroke Volume ,General Medicine ,Kidney ,Fibrosis ,Ventricular Function, Left ,Rats ,Furosemide ,Hypertension ,Animals ,Canagliflozin ,Cardiology and Cardiovascular Medicine ,Sodium-Glucose Transporter 2 Inhibitors - Abstract
Elevated central venous pressure (CVP) in heart failure causes renal congestion, which deteriorates prognosis. Sodium glucose co-transporter 2 inhibitor (SGLT2-i) improves kidney function and heart failure prognosis; however, it is unknown whether they affect renal congestion. This study investigated the effect of SGLT2-i on the kidney and left ventricle using model rats with hypertensive heart failure.Methods and Results: Eight rats were fed a 0.3% low-salt diet (n=7), and 24 rats were fed an 8% high-salt diet, and they were divided into 3 groups of untreated (n=6), SGLT2-i (canagliflozin; n=6), and loop diuretic (furosemide; n=5) groups after 11 weeks of age. At 18 weeks of age, CVP and renal intramedullary pressure (RMP) were monitored directly by catheterization. We performed contrast-enhanced ultrasonography to evaluate intrarenal perfusion. In all high-salt fed groups, systolic blood pressure was elevated (P=0.287). The left ventricular ejection fraction did not differ among high-salt groups. Although CVP decreased in both the furosemide (P=0.032) and the canagliflozin groups (P=0.030), RMP reduction (P=0.003) and preserved renal medulla perfusion were only observed in the canagliflozin group (P=0.001). Histological analysis showed less cast formation in the intrarenal tubule (P=0.032), left ventricle fibrosis (P0.001), and myocyte thickness (P0.001) in the canagliflozin group than in the control group.These results suggest that SGLT2-i causes renal decongestion and prevents left ventricular hypertrophy, fibrosis, and dysfunction.
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- 2022
15. PO-04-150 ATRIAL TACHYCARDIA IN PATIENTS WITH REPAIRED TETRALOGY OF FALLOT: ITS CHARACTERISTICS AND THE EFFICACY OF CATHETER ABLATION
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Qasim J. Naeemah, Miyako Igarashi, Noor K. Albakaa, YUTO IIOKA, Yuka Mashimo, Yuichi Hanaki, Chihiro Ota, Akira Kimata, Kojiro Ogawa, Yuki Komatsu, Naoto Kawamatsu, Tomoko Machino, Hiro Yamasaki, Tomoko Ishizu, Akihiko Nogami, and Masaki Ieda
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Published
- 2023
16. Visualization of an Accessory Pathway by 3D High-Density Mapping: A Case of Ebstein Anomaly With Atrioventricular Re-entrant Tachycardia
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Chihiro Ota, Tomoko Ishizu, Akihiko Nogami, Kazutaka Aonuma, Masaki Ieda, and Miyako Igarashi
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Tachycardia ,medicine.medical_specialty ,business.industry ,High density ,Case Report ,Accessory pathway ,3d mapping ,EBSTEIN ANOMALY ,Radiofrequency catheter ablation ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,Re entrant ,cardiovascular diseases ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Radiofrequency catheter ablation (RFCA) is the primary choice for treating patients with an accessory pathway and atrioventricular re-entrant tachycardia. However, using RFCA to treat a right-sided accessory pathway in a patient with Ebstein anomaly can be difficult owing to challenges in locating the electrophysiological atrioventricular groove. We report a case of atrioventricular re-entrant tachycardia in a patient with Ebstein anomaly and a right-sided accessory pathway that was successfully treated using RFCA and 3-dimensional (3D) high-density mapping. RFCA and 3D mapping may be useful in the management of such cases and may aid in improving prognoses of patients.
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- 2021
17. Utility of Updated Japanese Circulation Society Guidelines to Diagnose Isolated Cardiac Sarcoidosis
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Kimi Sato, Naoto Kawamatsu, Masayoshi Yamamoto, Tomoko Machino‐Ohtsuka, Tomoko Ishizu, and Masaki Ieda
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Myocarditis ,Japan ,Sarcoidosis ,Fluorodeoxyglucose F18 ,Positron-Emission Tomography ,Humans ,Stroke Volume ,Radiopharmaceuticals ,Cardiology and Cardiovascular Medicine ,Cardiomyopathies ,Ventricular Function, Left ,Retrospective Studies - Abstract
Background In the population with cardiac sarcoidosis (CS), approximately one third lacks extracardiac involvement and is considered to have isolated CS. Recently, the Japanese Circulation Society updated the diagnostic criteria for CS, providing a methodology for diagnosing isolated CS. We aimed to assess the characteristics of isolated CS diagnosed using a multimodal imaging approach according to the updated Japanese Circulation Society guidelines. Methods and Results We retrospectively identified 161 consecutive patients who underwent 18F‐fluorodeoxyglucose positron emission tomography for suspected CS between 2012 and 2019. According to the guidelines, patients were classified as having CS with extracardiac involvement, isolated CS, or no CS. We compared the characteristics of multimodality imaging and the prevalence of major adverse cardiovascular events. The Japanese Circulation Society criteria classified 28 patients (17%) as having CS with 4 (2%) with histological confirmation, 21 (13%) as isolated CS, and 112 (70%) as no CS. Compared with CS, isolated CS showed higher left ventricular volume and reduced left ventricular ejection fraction ( P P =0.036) was independently associated with major adverse cardiovascular events after adjusting for reduced left ventricular ejection fraction and steroid. In the subgroup of 41 patients with serial 18F‐fluorodeoxyglucose positron emission tomography evaluation, only updated CS criteria were associated with improvement in myocardial inflammation on 18F‐fluorodeoxyglucose positron emission tomography. Conclusions Isolated CS detected using the updated Japanese Circulation Society guidelines was associated with poor event‐free survival and should be managed with caution.
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- 2022
18. Additional diagnostic value of electron microscopic examination in endomyocardial biopsy in patients with suspected non-ischemic cardiomyopathy
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Masayoshi Yamamoto, Kimi Sato, Nobuyuki Murakoshi, Yu Yamada, Daishi Nakagawa, Tomofumi Nakatsukasa, Tomoko Ishizu, and Masaki Ieda
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Microscopy, Electron ,Heart Diseases ,Myocardium ,Biopsy ,Humans ,Fabry Disease ,Electrons ,Amyloidosis ,Cardiology and Cardiovascular Medicine ,Cardiomyopathies - Abstract
Electron microscopy enables a finely detailed analysis of ultra-structural features, and hence, it generally has an added diagnostic value to light microscopy alone. However, no studies have verified the additional diagnostic value of electron microscopic examination in patients with suspected non-ischemic cardiomyopathy.A total of 294 consecutive patients with non-ischemic cardiomyopathy who underwent endomyocardial biopsy were prospectively enrolled. Patients were divided into three groups according to left ventricular morphology assessed using echocardiography. Myocardial specimens were collected from the right ventricular septum and examined by light microscopy. Electron microscopy was performed subsequently to evaluate the additional diagnostic value.Altogether, 294 patients were analyzed, including 160 (55 %), 96 (33 %), and 35 (12 %) patients who were diagnosed with primary, secondary, and unclassified cardiomyopathy, respectively. In patients with dilated cardiomyopathy-like morphology, the detection rate of disease-specific histological findings was relatively low compared to that in patients with other cardiac morphologies. The additional diagnostic value of electron microscopy was observed in eight patients, including five with Fabry disease, one with cardiac amyloidosis, one with mitochondrial cardiomyopathy, and one with triglyceride deposit cardiomyovasculopathy. Among the 18 cardiac amyloidosis cases, electron microscopy detected amyloid fibrils in all patients, whereas light microscopy could not detect amyloid deposition in 1 patient. Among one of five patients with Fabry disease, light microscopy did not show obvious vacuolated cardiomyocytes, but zebra bodies were detected by electron microscopy, leading to the diagnosis of cardiac Fabry disease. The diagnostic value of electron microscopic examination in patients with cardiac sarcoidosis was not observed.The additional diagnostic value of electron microscopy was observed in patients with secondary cardiomyopathy, in whom light microscopy did not show disease-specific histological findings. Electron microscopy should be performed in cases where secondary cardiomyopathy is strongly suspected with no disease-specific findings by light microscopy.
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- 2022
19. REVERSIBILITY OF CARDIAC FUNCTION PREDICTS OUTCOME AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENTS WITH LOW-FLOW LOW-GRADIENT AORTIC STENOSIS
- Author
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Kimi Sato, Noor Albakaa, Tomoya Hoshi, Tomoko Ishizu, Yoshihiro Seo, and Masaki Ieda
- Subjects
Cardiology and Cardiovascular Medicine - Published
- 2023
20. Doppler-Derived Intrarenal Venous Flow Mirrors Right-Sided Heart Hemodynamics in Patients With Cardiovascular Disease
- Author
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Noriko Iida, Yoshihiro Seo, Tomoko Ishizu, Nobuyuki Ohte, Masaki Ieda, and Masayoshi Yamamoto
- Subjects
Adult ,Male ,Cardiac Catheterization ,medicine.medical_specialty ,Ventricular Dysfunction, Right ,Diastole ,Hemodynamics ,Atrial Function, Right ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,Kidney ,Renal Circulation ,03 medical and health sciences ,Atrial Pressure ,0302 clinical medicine ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Heart Atria ,030212 general & internal medicine ,Ultrasonography, Doppler, Color ,Systole ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Failure ,Pulmonary Arterial Hypertension ,Cardiac cycle ,business.industry ,Central venous pressure ,Atrial fibrillation ,General Medicine ,Middle Aged ,medicine.disease ,Tricuspid Valve Insufficiency ,Pathophysiology ,Cross-Sectional Studies ,Echocardiography ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers - Abstract
Background Interruption in Doppler intrarenal venous flow (IRVF) has been used in assessing renal congestion and in the prediction of prognosis of cardiovascular diseases. However, there is a paucity of pathophysiological knowledge, so we aimed to clarify the determinants of IRVF interruption.Methods and Results:Intrarenal Doppler studies were performed within 24 h before right-side catheterization studies. The interruption in IRVF in 73 patients was divided into a continuous pattern, and 4 discontinuous types based on the timing of interruption. Type 1, with an interruption in early systole, was associated with a-wave elevation of right atrial pressure (RAP). Type 2, with an interruption in early diastole, was associated with v-wave elevation, tricuspid regurgitation (TR), and right ventricular dysfunction. Both Type 1 and 2 were observed even in the normal range of mean RAP. Type 3, with an interruption throughout systole, was observed in advanced right heart failure patients with markedly elevated RAP, particularly elevated x-descend and atrial fibrillation. Finally, Type 4, with limited flow at systole, was observed in 2 of the patients with pulmonary arterial hypertension. Conclusions IRVF interruption was closely related to RAP elevation at each specific point of the cardiac cycle rather than to mean RAP levels, suggesting that the characteristics of IRVF mirror right-sided heart hemodynamics, not mean RAP.
- Published
- 2020
21. Usefulness of the SAGE score to predict elevated values of brachial-ankle pulse wave velocity in Japanese subjects with hypertension
- Author
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Hiroki Nakano, Taiji Furukawa, Hiroshi Ito, Toshiharu Ninomiya, Toshiaki Ohkuma, Kazuki Shiina, Toru Suzuki, Masataka Sata, Shinji Koba, Koichi Node, Tomoko Ishizu, Taishiro Chikamori, Tsutomu Yamazaki, Panagiotis Xaplanteris, Takuzo Hano, Teruo Inoue, Koji Maemura, Akira Yamashina, Takahide Kohro, Yukihito Higashi, Shin ichiro Ueda, Yusuke Ohya, Charalambos Vlachopoulos, Hirofumi Tomiyama, Atsushi Tanaka, Tomoo Furumoto, Yasuhiko Takemoto, Yutaka Ishibashi, Bonpei Takase, and Kazuomi Kario
- Subjects
Adult ,Male ,medicine.medical_specialty ,Physiology ,Population ,Pulse Wave Analysis ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,Internal Medicine ,medicine ,Health Status Indicators ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,education ,Pulse wave velocity ,Aged ,education.field_of_study ,Receiver operating characteristic ,business.industry ,Area under the curve ,Odds ratio ,Middle Aged ,medicine.disease ,Cross-Sectional Studies ,Blood pressure ,Hypertension ,Cohort ,cardiovascular system ,Cardiology ,Arterial stiffness ,Female ,Cardiology and Cardiovascular Medicine ,business ,circulatory and respiratory physiology - Abstract
The score based on the office systolic blood pressure, age, fasting blood glucose level, and estimated glomerular filtration rate (SAGE score) has been proposed as a useful marker to identify elevated values of carotid-femoral pulse wave velocity (PWV). The present cross-sectional study was conducted to examine whether the SAGE score is also a useful marker to identify subjects with elevated brachial-ankle PWV values in Japanese subjects with hypertension. We measured the brachial-ankle PWV and calculated the SAGE score in a total of 1019 employees of a Japanese company with hypertension and 817 subjects with hypertension derived from a multicenter study cohort. The analyses in this study were based on data from these two study groups as well as on a composite population of the two (n = 1836). The receiver operating characteristic curve analysis showed that the area under the curve to identify subjects with brachial-ankle PWV values of ≥1800 cm/s was over 0.70 in each of the three study groups. Even after adjustments, a SAGE score ≥7 had a significant odds ratio for identifying subjects with brachial-ankle PWV values ≥1800 cm/s in the 1836 study subjects from the composite occupational and multicenter study cohort (odds ratio = 2.1, 95% confidence interval = 1.4–3.0, P
- Published
- 2020
22. Increased arterial stiffness and cardiovascular risk prediction in controlled hypertensive patients with coronary artery disease: post hoc analysis of FMD-J (Flow-mediated Dilation Japan) Study A
- Author
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Teruo Inoue, Yiming Han, Nozomu Oda, Kazuaki Chayama, Yumiko Iwamoto, Haruki Hashimoto, Kentaro Watanabe, Hiroshi Ito, Yusuke Ohya, Toru Suzuki, Takahiro Harada, Masataka Sata, Masato Kajikawa, Yoshiki Aibara, Yutaka Ishibashi, Bonpei Takase, Takuzo Hano, Shinsuke Mikami, Koji Maemura, Koichi Node, Shinji Kishimoto, Yuji Takaeko, Kazuomi Kario, Tomoko Ishizu, Takayuki Hidaka, Hisao Ikeda, Taiji Furukawa, Junko Soga, Hirofumi Tomiyama, Yasuhiko Takemoto, Chikara Goto, Yukihito Higashi, Ayumu Nakashima, Yasuki Kihara, Tomoo Furumoto, Tsutomu Yamazaki, Tatsuya Maruhashi, Takahide Kohro, Kensuke Noma, Takeshi Matsumoto, Akira Yamashina, Farina Mohamad Yusoff, Naomi Idei, Shogo Matsui, Shinichiro Ueda, Noritaka Fujimura, Akimichi Iwamoto, Takayuki Yamaji, and Shinji Koba
- Subjects
Male ,medicine.medical_specialty ,Physiology ,Blood Pressure ,Coronary Artery Disease ,Pulse Wave Analysis ,030204 cardiovascular system & hematology ,Risk Assessment ,Sudden death ,Coronary artery disease ,03 medical and health sciences ,Vascular Stiffness ,0302 clinical medicine ,Japan ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Ankle Brachial Index ,030212 general & internal medicine ,Pulse wave velocity ,Stroke ,Aged ,business.industry ,Hazard ratio ,Middle Aged ,medicine.disease ,Vasodilation ,Blood pressure ,Cardiovascular Diseases ,Heart Disease Risk Factors ,Heart failure ,Hypertension ,Cardiology ,Arterial stiffness ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
The usefulness of brachial-ankle pulse wave velocity (baPWV), an index of arterial stiffness, is not fully known for the management of treated hypertensive patients with a history of coronary artery disease (CAD) who have blood pressure less than 130/80 mmHg, a recommended blood pressure target in the updated major hypertension guidelines. We analyzed data for 447 treated hypertensive patients with CAD enrolled in FMD-J Study A for assessment of the predictive value of baPWV for future cardiovascular events. The primary outcome was a composite of coronary events, stroke, heart failure, and sudden death. During a median follow-up period of 47.6 months, the primary outcome occurred in 64 patients. Blood pressure less than 130/80 mmHg was significantly associated with a lower risk of the composite outcome independent of other cardiovascular risk factors in treated hypertensive patients with CAD (hazard ratio, 0.59; 95% confidence interval (CI), 0.35-0.99; P = 0.04). In treated hypertensive patients with CAD who had blood pressure less than 130/80 mmHg, baPWV above the cutoff value of 1731 cm/s, derived from receiver-operator characteristic curve analysis for the composite outcome was significantly associated with a higher risk of the composite outcome independent of conventional risk factors (hazard ratio, 2.83; 95% CI, 1.02-7.91; P = 0.04). baPWV was an independent predictor of cardiovascular events in treated hypertensive patients with CAD who had blood pressure less than 130/80 mmHg, for whom measurement of baPWV is recommended for cardiovascular risk assessment.
- Published
- 2020
23. The impact of right bundle branch block on right ventricular size and function assessed by three-dimensional speckle-tracking echocardiography
- Author
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Yoshihiro Seo, Yasushi Kawakami, Kimi Sato, Tomoko Machino-Ohtsuka, Masayoshi Yamamoto, Yuji Hiramatsu, Naoto Kawamatsu, Naomi Nakazawa, Tomoko Ishizu, Masaki Ieda, and Hitoshi Horigome
- Subjects
Adult ,Male ,medicine.medical_specialty ,Systole ,Heart Ventricles ,Bundle-Branch Block ,Echocardiography, Three-Dimensional ,Speckle tracking echocardiography ,030204 cardiovascular system & hematology ,Free wall ,Electrocardiography ,03 medical and health sciences ,QRS complex ,0302 clinical medicine ,Diastole ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,End-systolic volume ,Retrospective Studies ,Ejection fraction ,Ventricular size ,business.industry ,Stroke Volume ,Middle Aged ,Right bundle branch block ,medicine.disease ,Cardiac surgery ,Cross-Sectional Studies ,Ventricular Function, Right ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
To determine the influence of right bundle branch block (RBBB) on right ventricular (RV) size and function, we investigated the association between complete RBBB (CRBBB) and RV volume, function, and dyssynchrony by three-dimensional echocardiography. In this retrospective, cross-sectional study, 103 consecutive patients with adequate three-dimensional echocardiographic images were divided into the CRBBB, middle-range QRS, and narrow QRS group. RV volumetric and functional data were compared between the three groups. Among the 103 patients (44.8 ± 18.7 years, 50 men), the CRBBB group comprised 26 (25%) patients and the middle-range QRS group comprised 48 (47%). The CRBBB group showed a significant contraction delay in the RV inlet free wall and outflow tract; larger RV end-diastolic and systolic volume index (RV-EDVI, RV-ESVI); and lower RV systolic function. On dividing the CRBBB patients into two (with or without mechanical dyssynchrony), those with RV dyssynchrony showed larger RV-EDVI (121 ± 45 vs. 85 ± 25 mL/m2, P = 0.019) and RV-ESVI (93 ± 42 vs. 56 ± 20 mL/m2, P = 0.009) and smaller RV ejection fraction (24 ± 11 and 34 ± 11%, P = 0.026) than those without RV dyssynchrony. RV dyssynchrony in CRBBB patients might have an adverse effect on RV volume and function. Three-dimensional speckle-tracking echocardiography could provide additional and beneficial data during assessment of RV dyssynchrony.
- Published
- 2019
24. Pathophysiological role of right ventricular function and interventricular functional mismatch in the development of pulmonary edema in acute heart failure
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Masayoshi Yamamoto, Tomoko Ishizu, Yoshihiro Seo, Daishi Nakagawa, Kimi Sato, Naoto Kawamatsu, Tomoko Machino-Ohtsuka, Yoshie Hamada-Harimura, Seika Sai, Akinori Sugano, Isao Nishi, and Masaki Ieda
- Subjects
Heart Failure ,Echocardiography ,Ventricular Dysfunction, Right ,Ventricular Function, Right ,Humans ,Pulmonary Edema ,Cardiology and Cardiovascular Medicine - Abstract
Parameters of cardiac function related to the development of pulmonary edema (PE) in acute heart failure (AHF), including right ventricular (RV) function and a mismatch of interventricular function, are not fully elucidated. The aim of this study was to verify the hypothesis that a relatively preserved RV function compared with left ventricular function may be associated with the development of PE by using two-dimensional speckle tracking echocardiography (2DSTE).Hospitalized patients with AHF at 11 institutions were enrolled. PE was defined as lung congestion on chest X-ray with hypoxemia. Patients with systolic blood pressure ≥140 mmHg on admission were defined to have hypertensive AHF. Echocardiographic analyses, including 2DSTE, were performed prior to discharge. The index of mismatch between RV and left ventricular systolic function was assessed by interventricular longitudinal strain difference (IVLSD) which was defined as RV free wall longitudinal strain and left ventricular global longitudinal strain.Of 610 patients with AHF, 422 (69.2%) had PE. In patients with PE, IVLSD (p = 0.007) and RV fractional area change ratio (p0.001) was significantly higher than those in patients without PE. In patients with non-hypertensive AHF, RV fractional area change ratio, age, ischemic etiology, and serum brain natriuretic peptide (BNP) levels were independent predictors of PE. In patients with hypertensive AHF, IVLSD, age, and serum BNP levels were independent predictors of PE.Preserved RV function might be one of the underlying mechanisms of the development of PE in AHF. Furthermore, interventricular functional mismatch might be related to the development of PE in hypertensive AHF.
- Published
- 2021
25. Successful surgical resection plus surgical cryoablation for the treatment of a large left ventricular fibroma
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Ryuhei Yamamoto, Muneaki Matsubara, Hideyuki Kato, Tomoko Ishizu, Bryan J. Mathis, and Yuji Hiramatsu
- Subjects
Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
26. 3-Dimensional Speckle-Tracking Echocardiography-Derived Interventricular Activation Imaging in a Patient With Repaired Tetralogy of Fallot
- Author
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Nobuyuki Ohte, Tomoko Ishizu, Yoshihiro Seo, Yuki Komatsu, and Masaki Ieda
- Subjects
0301 basic medicine ,medicine.medical_specialty ,CRT, cardiac resynchronization therapy ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Speckle tracking echocardiography ,030105 genetics & heredity ,Interventricular dyssynchrony ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Diseases of the circulatory (Cardiovascular) system ,EF, ejection fraction ,Mini-Focus Issue: Imaging ,cardiovascular diseases ,ACHD, adult congenital heart diseases ,tetralogy of Fallot ,LV, left ventricular ,Tetralogy of Fallot ,Imaging Vignette: Clinical Vignette ,business.industry ,3-dimensional speckle-tracking echocardiography ,medicine.disease ,activation imaging system ,3D-STE, 3-dimensional speckle-tracking echocardiography ,RC666-701 ,2D, 2-dimensional ,Cardiology ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business ,RV, right ventricular ,030217 neurology & neurosurgery ,circulatory and respiratory physiology - Abstract
Using 3-dimensional speckle-tracking echocardiography-derived activation imaging system, we visualized interventricular dyssynchrony in a repaired tetralogy of Fallot case with pacing-induced left ventricular dysfunction. The activation imaging system visualized interventricular dyssynchrony and resynchronization after cardiac resynchronization therapy and may be useful to assess electromechanical disturbance in complicated congenital heart diseases. (Level of Difficulty: Intermediate.), Graphical abstract, Using 3-dimensional speckle-tracking echocardiography-derived activation imaging system, we visualized interventricular dyssynchrony in a repaired…
- Published
- 2020
27. What We Know and What We Don’t Know About the Adaptation to Pregnancy and Left Ventricular Diastolic Dysfunction
- Author
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Naoto Kawamatsu, Yasushi Kawakami, and Tomoko Ishizu
- Subjects
medicine.medical_specialty ,Pregnancy ,Ventricular function ,business.industry ,Diastole ,General Medicine ,medicine.disease ,Ventricular Function, Left ,Ventricular Dysfunction, Left ,Text mining ,Internal medicine ,Peripartum Period ,medicine ,Cardiology ,Humans ,Female ,Left ventricular diastolic dysfunction ,Adaptation ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
28. Relationships between maintenance of sinus rhythm and clinical outcomes in patients with heart failure with preserved ejection fraction and atrial fibrillation
- Author
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Tomoko Machino-Ohtsuka, Yoshihiro Seo, Masaki Ieda, Takeshi Machino, Yoshie Hamada-Harimura, Kazutaka Aonuma, Yukio Sekiguchi, Masayoshi Yamamoto, Hiro Yamasaki, Tomoko Ishizu, and Akihiko Nogami
- Subjects
Male ,medicine.medical_specialty ,Exacerbation ,medicine.medical_treatment ,Catheter ablation ,030204 cardiovascular system & hematology ,Lower risk ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Heart Conduction System ,Risk Factors ,Cause of Death ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,Sinus rhythm ,030212 general & internal medicine ,Propensity Score ,Aged ,Retrospective Studies ,Sinoatrial Node ,Heart Failure ,business.industry ,Hazard ratio ,Stroke Volume ,Atrial fibrillation ,Middle Aged ,Prognosis ,medicine.disease ,Hospitalization ,Heart failure ,Catheter Ablation ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Heart failure with preserved ejection fraction ,business ,Anti-Arrhythmia Agents - Abstract
Background Although atrial fibrillation (AF) is associated with exacerbation of heart failure with preserved ejection fraction (HFpEF), the relationships between maintenance of sinus rhythm (SR) and clinical outcomes in HFpEF is unknown. We investigated whether maintenance of SR was associated with better prognosis compared with rate control in patients with concomitant HFpEF and AF. Methods We conducted a retrospective, observational study of 283 patients with HFpEF and AF. Of these, 107 patients achieved maintenance of SR by catheter ablation and/or antiarrhythmic drugs (rhythm control) and 176 were treated with rate control. The propensity score (PS) for each patient in both treatment groups was estimated, resulting in selectively matched subgroups of 79 patients each. All-cause death and a composite of cardiovascular death or hospitalization for heart failure (HF) were analyzed. Results During a median follow-up period of 24 months, all-cause mortality was comparable between groups; however, maintenance of SR was significantly associated with a lower incidence of the composite endpoint [adjusted hazard ratio (HR), 0.30; 95% confidence interval, 0.18–0.98; p = 0.04] in the PS-matched cohort. The PS-adjusted multivariable analysis based on 283 pre-matched patients also revealed that rhythm control was associated with a lower rate of the composite endpoint (adjusted HR, 0.27; 95% CI, 0.12–0.61; p = 0.002). Subgroup analyses suggested that rhythm control was consistently related to the composite endpoint across a wide spectrum of HFpEF patients. Conclusions Maintenance of SR was associated with a lower risk of composite of cardiovascular death or hospitalization for HF in patients with HFpEF and AF. A randomized trial is necessary to confirm this result.
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- 2019
29. Symptomatic paradoxical low gradient severe aortic stenosis: A possible link to heart failure with preserved ejection fraction
- Author
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Yasufumi Nagata, Tomoko Ishizu, Masaki Izumo, Yutaka Otsuji, Yoshihiro J. Akashi, Masaaki Takeuchi, Yoshihiro Seo, Hidehiro Namisaki, and Eiji Yamashita
- Subjects
Male ,medicine.medical_specialty ,medicine.drug_class ,Heart Ventricles ,Echocardiography, Three-Dimensional ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Asymptomatic ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Natriuretic Peptide, Brain ,Natriuretic peptide ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Propensity Score ,Aged ,Aged, 80 and over ,Heart Failure ,business.industry ,Stroke Volume ,Aortic Valve Stenosis ,Stroke volume ,Middle Aged ,medicine.disease ,Stenosis ,Heart failure ,Ventricular fibrillation ,Cohort ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Heart failure with preserved ejection fraction ,business - Abstract
Background There is an ongoing debate regarding optimal management of patients with paradoxical low gradient severe aortic stenosis (PLG-SAS). We hypothesized that the presence of symptoms is closely associated with future adverse outcome. We aimed to determine the relation between symptoms and outcome in patients with PLG-SAS. Methods We prospectively enrolled 222 patients with PLG-SAS. Left ventricular (LV) volumes, mass, and strain were measured by three-dimensional echocardiography. The primary end-point was cardiac events including cardiac death, ventricular fibrillation, and heart failure leading to hospitalization. Results There were 65 cases of symptomatic PLG-SAS and 157 cases of asymptomatic PLG-SAS. Patients with symptomatic PLG-SAS received beta-blockers, angiotensin blockers, and diuretics more frequently and showed higher levels of B-type natriuretic peptide than patients with asymptomatic PLG-SAS. Although LV chamber parameters were not different, patients with symptomatic PLG-SAS had significantly higher E-wave velocity and E/A ratio than patients with asymptomatic PLG-SAS. During the median follow-up of 18 months, 20 patients reached the primary end-point. Patients with symptomatic PLG-SAS had significantly worse prognosis than patients with asymptomatic PLG-SAS. A similar trend was observed while comparing with the propensity-score-matched cohort after adjusting for age, sex, stroke volume index, and severity of AS. Conclusions Symptomatic PLG-SAS is associated with poorer prognosis even after adjusting for flow status and severity of AS. Therefore, presence of symptoms is not always related to the severity of AS itself but might be related to the underlying comorbidities. Our results suggest a possible link between PLG-SAS and heart failure with preserved ejection fraction in some symptomatic patients.
- Published
- 2019
30. Target of Triglycerides as Residual Risk for Cardiovascular Events in Patients With Coronary Artery Disease ― Post Hoc Analysis of the FMD-J Study A ―
- Author
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Hisao Ikeda, Taiji Furukawa, Takuzo Hano, Yasuhiko Takemoto, Teruo Inoue, Masato Kajikawa, Yusuke Ohya, Kazuaki Chayama, Hirofumi Tomiyama, Masataka Sata, Shogo Matsui, Yutaka Ishibashi, Kazuomi Kario, Bonpei Takase, Akira Yamashina, Yukihito Higashi, Kensuke Noma, Kentaro Watanabe, Chikara Goto, Koji Maemura, Toru Suzuki, Shinichiro Ueda, Yuji Takaeko, Tatsuya Maruhashi, Tomoo Furumoto, Takahide Kohro, Shinji Kishimoto, Haruki Hashimoto, Tomoko Ishizu, Farina Mohamad Yusoff, Koichi Node, Shinji Koba, Hiroshi Ito, Tsutomu Yamazaki, Yasuki Kihara, and Ayumu Nakashima
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Disease-Free Survival ,Cardiovascular events ,Coronary artery disease ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Post-hoc analysis ,medicine ,Humans ,030212 general & internal medicine ,Acute Coronary Syndrome ,Triglycerides ,Aged ,Triglyceride ,business.industry ,Surrogate endpoint ,Hypertriglyceridemia ,Confounding ,General Medicine ,Middle Aged ,Atherosclerosis ,medicine.disease ,Stroke ,Survival Rate ,Residual risk ,chemistry ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Follow-Up Studies - Abstract
Background: Circulating triglyceride (TG) levels are a current focus as a residual risk for cardiovascular (CV) events. We evaluated the relationship between circulating TG levels and future CV events in patients with coronary artery disease (CAD) who were treated with conventional therapy. Methods and Results: We analyzed data for 652 patients who were enrolled in the FMD-J Study A. We investigated the associations between serum TG levels and first major CV events (death from CV cause, nonfatal acute coronary syndrome (ACS), nonfatal stroke, and CAD) for a 3-year follow-up period. Patients were divided into 4 groups based on serum TG level: low-normal (
- Published
- 2019
31. Geriatric nutritional risk index predicts all‐cause deaths in heart failure with preserved ejection fraction
- Author
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Yoshihiro Seo, Akira Koike, Seika Sai, Shoji Suzuki, Isao Nishi, Akinori Sugano, Yoshie Hamada-Harimura, Kimi Sato, Masaki Ieda, Masayoshi Yamamoto, Kenichi Obara, Kazutaka Aonuma, and Tomoko Ishizu
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Nutritional Status ,Renal function ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Risk Factors ,Cause of Death ,Original Research Articles ,Internal medicine ,medicine ,Humans ,Original Research Article ,030212 general & internal medicine ,Nutritional screening ,Geriatric Assessment ,Aged ,Retrospective Studies ,Aged, 80 and over ,Heart Failure ,Inflammation ,Ejection fraction ,Proportional hazards model ,business.industry ,Stroke Volume ,Undernutrition ,Stepwise regression ,Prognosis ,medicine.disease ,New York Heart Association Functional Classification ,Survival Rate ,Nutrition Assessment ,Heart failure with preserved ejection fraction ,ROC Curve ,Heart failure ,Cardiology ,Female ,Brain natriuretic peptide ,Cardiology and Cardiovascular Medicine ,business ,Body mass index ,Follow-Up Studies - Abstract
Aims The objective of the study was to evaluate whether the geriatric nutritional risk index (GNRI) at discharge may be helpful in predicting the long‐term prognosis of patients hospitalized with heart failure (HF) with preserved ejection fraction (HFpEF, left ventricular ejection fraction ≥50%), a common HF phenotype in the elderly. Methods and results Overall, 110 elderly HFpEF patients (≥65 years) from the Ibaraki Cardiovascular Assessment Study‐HF (n = 838) were enrolled. The mean age was 78.5 ± 7.2 years, and male patients accounted for 53.6% (n = 59). All‐cause mortality was compared between the low GNRI (
- Published
- 2019
32. Renoprotective effects of tolvaptan in hypertensive heart failure rats depend on renal decongestion
- Author
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Yoshihiro Seo, Tomoko Ishizu, Mikiko Namekawa, Kazutaka Aonuma, Seika Sai, and Hiroki Chiba
- Subjects
Male ,medicine.medical_specialty ,Central Venous Pressure ,Physiology ,Tolvaptan ,Urology ,Renal function ,Hemodynamics ,030204 cardiovascular system & hematology ,Protective Agents ,03 medical and health sciences ,0302 clinical medicine ,Internal Medicine ,medicine ,Animals ,030212 general & internal medicine ,Ultrasonography ,Heart Failure ,Kidney Medulla ,Rats, Inbred Dahl ,Ejection fraction ,business.industry ,Central venous pressure ,Sodium, Dietary ,Stroke Volume ,medicine.disease ,Fibrosis ,Rats ,Blood pressure ,Heart failure ,Hypertension ,Kidney Diseases ,Vascular Resistance ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Antidiuretic Hormone Receptor Antagonists ,medicine.drug - Abstract
The vasopressin type 2 receptor antagonist tolvaptan may have renoprotective effects in patients with heart failure (HF). This study aimed to reveal the renoprotective effect of tolvaptan from the viewpoint of hemodynamic combined with catheter and ultrasound examinations in a hypertensive HF model. Dahl salt-sensitive rats (n = 24) were fed an 8% high-salt diet after the age of 6 weeks and were treated with tolvaptan (n = 16) or vehicle (control group; n = 8). The tolvaptan-treated rats were divided into two groups: a low-dose group (0.01% tolvaptan diet; Low-Tol) and a high-dose group (0.05% tolvaptan diet; High-Tol). At 24 weeks, catheterizations to measure central venous pressure (CVP) and renal medullary pressure (RMP) were performed, followed by intrarenal Doppler (IRD) studies and contrast-enhanced ultrasonography (CEUS) to evaluate renal medullary perfusion. The tolvaptan diet reduced CVP (7.7 ± 1.5, 9.0 ± 1.1, and 12.2 ± 0.8 mmHg in the High-Tol, Low-Tol, and control groups, respectively; p < 0.001) and RMP (7.7 ± 0.8, 9.4 ± 1.3, and 13.7 ± 1.2 mmHg in the High-Tol, Low-Tol, and control groups, respectively; p < 0.001). Tolvaptan also reduced the venous impedance index (VII) in the IRD analysis (0.18 ± 0.03, 0.26 ± 0.04, and 0.40 ± 0.08 in the High-Tol, Low-Tol, and control groups, respectively; p < 0.001), and the time to peak intensity in CEUS (6.0 ± 0.5, 7.3 ± 1.3, 9.8 ± 1.8 s in the High-Tol, Low-Tol, and control groups, respectively; p < 0.001). Creatinine clearance (Ccr) was preserved in both the High-Tol and Low-Tol groups compared to the control group (4.80 ± 1.9, 4.24 ± 0.8, and 1.35 ± 0.3 mg/min, respectively; p = 0.001). Ccr was negatively correlated with RMP (R = -0.76, P < 0.001), the venous impedance index (R = -0.70, p < 0.001), time to peak intensity (R = -0.75, P < 0.001), and renal fibrosis (R = -0.70, p < 0.001). In contrast, Ccr had modest correlations with systolic blood pressure (R = -0.50, P = 0.02) and left ventricular ejection fraction (R = 0.48, P = 0.03). This study revealed that the renoprotective effects of tolvaptan in a hypertensive HF model depended on renal decongestion.
- Published
- 2018
33. Cross-sectional and longitudinal associations between serum uric acid and endothelial function in subjects with treated hypertension
- Author
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Koji Maemura, Masataka Sata, Atsushi Tanaka, Tsutomu Yamazaki, Hiroshi Ito, Tomoo Furumoto, Kazuomi Kario, Atsushi Kawaguchi, Hirofumi Tomiyama, Toru Suzuki, Yutaka Ishibashi, Bonpei Takase, Takuzo Hano, Yukihito Higashi, Shinji Koba, Shinichiro Ueda, Koichi Node, Taiji Furukawa, Teruo Inoue, Akira Yamashina, Yusuke Ohya, Tomoko Ishizu, Chisa Matsumoto, and Yasuhiko Takemoto
- Subjects
Male ,medicine.medical_specialty ,Vasodilation ,Pulse Wave Analysis ,030204 cardiovascular system & hematology ,Carotid Intima-Media Thickness ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,medicine.artery ,Internal medicine ,Humans ,Medicine ,Longitudinal Studies ,cardiovascular diseases ,030212 general & internal medicine ,Common carotid artery ,Pulse wave velocity ,Aged ,Flow mediated vasodilatation ,business.industry ,Serum uric acid ,Middle Aged ,Pathophysiology ,Uric Acid ,Cross-Sectional Studies ,Treatment Outcome ,chemistry ,Hypertension ,cardiovascular system ,Cardiology ,Uric acid ,Female ,Endothelium, Vascular ,Cardiology and Cardiovascular Medicine ,business ,Vascular function ,Biomarkers ,Follow-Up Studies - Abstract
Objectives The endothelial dysfunction-arterial stiffness-atherosclerosis continuum plays an important pathophysiological role in hypertension. The aim of this study was to investigate the cross-sectional association between serum uric acid (SUA) and vascular markers related to this continuum, and to assess the longitudinal association between SUA and endothelial function that represents the initial step of the continuum. Methods We evaluated the baseline associations between SUA levels and vascular markers that included flow-mediated vasodilatation (FMD), brachial-ankle pulse wave velocity (baPWV), and common carotid artery intima-media thickness (CCA-IMT) in 648 subjects receiving antihypertensive treatment. The longitudinal association between baseline SUA levels and FMD measured at 1.5 and 3 yr of follow-up was also investigated. Results At baseline, modest, but significant correlations were observed between SUA and FMD in females (r = −0.171), baPWV in males with SUA >368.78 μmol/L (r = −0.122) and in females with a SUA level ≤ 362.83 μmol/L (r = 0.217), mean CCA-IMT in females with a SUA level ≤ 333.09 μmol/L (r = 0.139), and max CCA-IMT in females with SUA level ≤ 333.09 μmol/L (r = 0.138). A longitudinal association between SUA and FMD was less observed in males. In females, the baseline SUA was associated significantly with FMD values at 1.5 yr (r = −0.211), and SUA levels >237.92 μmol/L were associated significantly and independently with FMD values at 3 yr (r = −0.166). Conclusions Lower SUA levels were associated with better vascular markers of the continuum, especially in females. Furthermore, we observed a longitudinal association between SUA and endothelial function, suggesting SUA level may be a potential marker of the continuum in hypertension.
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- 2018
34. Sitagliptin on carotid intima-media thickness in type 2 diabetes patients receiving primary or secondary prevention of cardiovascular disease: A subgroup analysis of the PROLOGUE study
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Kohei Kaku, Koichi Node, Mamoru Nanasato, Koji Maemura, Makoto Saito, Jun-ichi Oyama, Ryoji Ishiki, Hisako Yoshida, Teruo Inoue, Masayoshi Ajioka, Yukihito Higashi, Atsushi Tanaka, Tomoko Ishizu, Toyoaki Murohara, and Yoshisato Shibata
- Subjects
Male ,medicine.medical_specialty ,Subgroup analysis ,Type 2 diabetes ,030204 cardiovascular system & hematology ,Carotid Intima-Media Thickness ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine.artery ,Diabetes mellitus ,Post-hoc analysis ,Secondary Prevention ,Humans ,Medicine ,Single-Blind Method ,Prospective Studies ,cardiovascular diseases ,030212 general & internal medicine ,Common carotid artery ,Aged ,Aged, 80 and over ,Dipeptidyl-Peptidase IV Inhibitors ,business.industry ,Sitagliptin Phosphate ,Middle Aged ,medicine.disease ,Primary Prevention ,Diabetes Mellitus, Type 2 ,Intima-media thickness ,Cardiovascular Diseases ,Sitagliptin ,cardiovascular system ,Cardiology ,Female ,Internal carotid artery ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background Whether a dipeptidyl peptidase-4 (DPP-4) inhibitor can attenuate atherosclerosis is still controversial. Some clinical trials reported that DPP-4 inhibitors in diabetes patients without a previous history of cardiovascular (CV) events could reduce carotid intima-media thickness (IMT). However, in the PROLOGUE study, which enrolled diabetes patients both with and without previous CV events, sitagliptin failed to slow the progression of carotid IMT relative to conventional therapy. Aim and methods We hypothesized that the effect of DPP-4 inhibitors on carotid atherosclerosis might be different between the primary and secondary prevention groups. We performed a post hoc analysis of the PROLOGUE study and compared the effects of sitagliptin and conventional therapy on changes in carotid IMT in subgroups with or without previous CV events. Results No significant difference in the IMT changes between the treatment groups was found in the secondary prevention subgroup (sitagliptin, N = 102; conventional, 111). However, in the primary prevention subgroup (sitagliptin, 120; conventional, 109), we found significant inhibitory effects of sitagliptin on mean and max internal carotid artery IMT [estimated group difference: −0.096 mm (95% CI −0.175 to −0.018, p = 0.017) and −0.162 mm (95% CI −0.272 to −0.052, p = 0.004), respectively], although there was no significant difference in the common carotid artery IMT. Conclusions Our data suggest that there is a favorable effect of DPP-4 inhibitor treatment on carotid atherosclerosis in diabetes patients without previous CV events.
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- 2018
35. Differential effect of concomitant antidiabetic agents on carotid atherosclerosis: a subgroup analysis of the PROLOGUE study
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Jun-ichi Oyama, Shigetaka Kuroki, Atsushi Kawaguchi, Toyoaki Murohara, Kohei Kaku, Taizo Kondo, Atsushi Tanaka, Tomoko Ishizu, Koichi Node, Yukihito Higashi, Jun Fukui, Mamoru Nanasato, Hiroshi Ito, and Teruo Inoue
- Subjects
Carotid Artery Diseases ,Male ,medicine.medical_specialty ,Time Factors ,Combination therapy ,Carotid Artery, Common ,medicine.drug_class ,Subgroup analysis ,030204 cardiovascular system & hematology ,Carotid Intima-Media Thickness ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Post-hoc analysis ,Humans ,Hypoglycemic Agents ,Medicine ,Prospective Studies ,cardiovascular diseases ,030212 general & internal medicine ,Thiazolidinedione ,Aged ,Dose-Response Relationship, Drug ,business.industry ,Biguanide ,Sitagliptin Phosphate ,Middle Aged ,Treatment Outcome ,Diabetes Mellitus, Type 2 ,Intima-media thickness ,Concomitant ,Sitagliptin ,Disease Progression ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,medicine.drug - Abstract
Accumulated evidence shows that some antidiabetic agents attenuate the progression of carotid atherosclerosis assessed as intima-media thickness (IMT). Although some studies have demonstrated an inhibitory effect of dipeptidyl peptidase-4 inhibitors on carotid IMT progression, in the PROLOGUE study sitagliptin failed to slow progression relative to conventional therapy for 24 months. We hypothesized that differences in the concomitant antidiabetic agents between the groups have influenced the progression of carotid IMT. We performed a post hoc analysis of the PROLOGUE study using subgroups stratified by concomitant antidiabetic agents. Although no subgroup with any combination of agents in the overall patients showed a significant difference between sitagliptin group and conventional therapy group in the changes from baseline in mean common carotid artery (CCA)-IMT at 24 months, a significant attenuation of mean CCA-IMT progression was observed in the sitagliptin group relative to conventional therapy group only in three combination subgroups aged
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- 2018
36. Clinical Usefulness of the HFA-PEFF Diagnostic Scoring System in Identifying Late Elderly Heart Failure With Preserved Ejection Fraction Patients
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Yoshihiro Seo, Nobuyuki Ohte, Masaki Ieda, and Tomoko Ishizu
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Male ,medicine.medical_specialty ,Scoring system ,medicine.drug_class ,Population ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Healthy control ,Natriuretic peptide ,Medicine ,Humans ,030212 general & internal medicine ,Stage (cooking) ,education ,Subclinical infection ,Aged ,Aged, 80 and over ,Heart Failure ,education.field_of_study ,business.industry ,Stroke Volume ,General Medicine ,Hypertension ,Cardiology ,Biomarker (medicine) ,Female ,Cardiology and Cardiovascular Medicine ,business ,Heart failure with preserved ejection fraction ,Biomarkers - Abstract
Background Diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging in elderly. This study investigated the diagnostic ability of the HFA-PEFF scoring system in elderly patients (>75 years of age).Methods and Results:This study enrolled 286 subjects aged >75 years (130 men; mean [± SD] age 81.5±5.1 years): 95 healthy controls, 98 with hypertension (HT), and 93 with HFpEF. The HFA-PEFF score was calculated as a sum of points in functional, morphological, and biomarker domains. In the HFpEF group, 84%, 84%, and 70% of subjects met the major functional, morphological, and biomarker criteria for HFpEF, respectively. Thus, 73 subjects with HFpEF (78%) were diagnosed as having HFpEF using the HFA-PEFF scoring system. In contrast, among the healthy controls and subjects with HT, 52% and 72%, respectively, met the major functional criteria for HFpEF, 28% and 53%, respectively, met the morphological criteria, and 0% and 24%, respectively, met the biomarker criteria. As such, 32 subjects with HT (33%) were diagnosed with HFpEF. Even in the healthy control group, 72% were classified as having an intermediate probability of HFpEF, and 3 were diagnosed with HFpEF. Conclusions In the late elderly, the HFA-PEFF scoring system diagnosed subjects with HFpEF precisely. In addition, this scoring system may be able to detect early stage HFpEF in the subclinical population.
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- 2020
37. Abstract 13365: Risk-benefit Evaluation in Cessation of Renin-angiotensin-aldosterone Inhibitors in Hyperkalemic Heart Failure Patients: A Japanese Real-world Study From Nationwide Administrative Database
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Tomoko Ishizu, Toshitaka Yajima, Takashi Kikuchi, Shun Kohsaka, Rashad Mogalli, and Suguru Okami
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medicine.medical_specialty ,Aldosterone ,Hyperkalemia ,business.industry ,medicine.disease ,chemistry.chemical_compound ,chemistry ,Administrative database ,Physiology (medical) ,Internal medicine ,Heart failure ,Renin–angiotensin system ,ACE inhibitor ,medicine ,Cardiology ,In patient ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Introduction: Hyperkalemia (HK) is frequently encountered in patients treated with renin-angiotensin-aldosterone system inhibitors (RAASi), and is associated with increased mortality in heart failure (HF). While cessation of RAASi is considered an option in HK patients, the serum potassium (sK) threshold for RAASi cessation in HF patients remains unclear . Herein, we sought to assess the impact of RAASi cessation or continuation on risk-benefit balance of hyperkalemic HF patients using propensity score (PS)-matched and cubic spline regression analysis in a nationwide administrative database. Methods: An observational retrospective study was conducted using Japanese hospital claims dataset (April 2008-September 2018). HK was defined as at least two sK ≥5.1 mmol/L within 12-months interval. We examined HK patients on RAASi in HF by employing PS matching to compare risk-benefit between patients with or without RAASi cessation. Cubic spline regression was fit to calculated hazard ratios (HR) in each sK strata for this assessment. Results: Out of 1,208,894 patients, 5,059 HF with HK patients with RAASi prescriptions met inclusion criteria (mean age 76.63 ±10.96 years). Mean follow-up period was 2.75 ± 1.9 years. Cumulative incidence of RAASi cessation was 34.73% at 1 year. Cessation of RAASi was associated with incremental risk of death (+19%, P=0.009) and hospitalization (+14%, P=0.002) , whereas recurrent HK risk was decreased (-60%, P Conclusions: Our results suggest that HK management by RAASi cessation should be avoided especially in HF patients with mild to moderate HK considering the worsening risk-benefit balance.
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- 2020
38. Diagnostic accuracy of left ventricular diastolic transverse strain imaging by speckle tracking echocardiography for diagnosing chest pain in diabetic patients
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Atsushi Tanaka, Hiroshi Ito, Yoshihiro Seo, Junichi Yoshikawa, E Hyodo, Katsuhisa Ishii, Hirotoshi Watanabe, Takashi Akasaka, H Kihara, Yusuke Yoshikawa, Tomoko Ishizu, and Masao Daimon
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Aortic valve ,medicine.medical_specialty ,business.industry ,Diastole ,Speckle tracking echocardiography ,Diagnostic accuracy ,Chest pain ,Transverse strain ,medicine.anatomical_structure ,Internal medicine ,Right coronary artery ,medicine.artery ,Medical imaging ,medicine ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Two-dimensional speckle tracking echocardiography (2D-STE) has been reported to be useful for the diagnosis of myocardial ischemia by detecting delayed relaxation (diastolic stunning) after an episode of angina. 2D-longitudinal strain is not specific besides ischemia such as diastolic dysfunction, and diabetes have been associated with abnormal longitudinal fibers. The aim is to evaluate the diagnostic accuracy of Left ventricular (LV) diastolic transverse strain imaging by STE to detect the presence of acute coronary syndrome (ACS) in diabetic patients with acute chest pain. Methods 385 consecutive patients with acute chest pain and without wall motion abnormality, who were admitted to an emergency department (ED) at 1 of 12 clinical sites in Japan, were enrolled and underwent 2D-STE at ED. Left ventricular (LV) transverse strain values at aortic valve closure (A) and one-third of diastole duration (B) were measured. The strain imaging diastolic index (SI-DI) was value was determined as: (A − B)/A × 100% to assess the LV diastolic strain imaging and was used to identify the regional LV delayed relaxation. All patients underwent coronary CT or coronary angiography to establish the diagnosis of ACS. Clinicians were blinded to the 2D-STE results. Results Out of 385 patients, 2D-STE analysis was possible in 365 patients (94%). 76 patients were diabetic (DM+), and 289 patients were non-diabetic (DM-). With assessment of coronary CT or coronary angiography, ACS was diagnosed in 125 patients (34%). 2D-STE was obtained at a mean of 5.3 hours after chest pain episode. Transverse SI-DI of ischemic segments were significantly lower than those of non-ischemic segments (p value Conclusion LV diastolic transverse strain imaging by 2D-STE at ED increase the sensitivity, specificity and accuracy to predict the presence of ACS in diabetic patients with chest pain, as well as non-diabetic patients. (UMIN000013859). Figure 1. Transverse Strain (SI-DI): AUC (95% CI) Funding Acknowledgement Type of funding source: None
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- 2020
39. Revisiting the significance of right bundle branch block
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Toshimi Sairenchi, Masayoshi Yamamoto, Tomoko Machino, Nobuyuki Murakoshi, Naomi Nakazawa, Kimi Sato, Yasushi Kawakami, Tomoko Ishizu, and Masaki Ieda
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medicine.medical_specialty ,business.industry ,Left bundle branch block ,Intraventricular block ,Right bundle branch block ,medicine.disease ,Blood pressure ,Diabetes mellitus ,Cardiovascular epidemiology ,Internal medicine ,Ischemic stroke ,Hyperlipidemia ,medicine ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background/Introduction The right bundle branch block (RBBB) has been considered a benign finding in asymptomatic individuals. However, this concept based on a few, old, small sample size studies. Recently, the importance of the right ventricular dysfunction was focused on cardiovascular prognosis in clinical cardiology. Purpose To determine the prognostic value of RBBB in community-based health checkups cohort with a large sample size in recent years in Japan. Methods We assessed 88,089 individuals (mean age, 58.3±10.2 years; 66.1% women) who participated in annual community-based health checkups. Exclusion criteria were current or previous history of heart disease, stroke, and intraventricular block such as left bundle branch block other than RBBB. We followed them from 1993 to 2016. The primary endpoint was cardiovascular death, or all-cause death. The Cox regression model was assessed in each gender. The variables included in the multivariate analyses were age, body mass index, systolic blood pressure, hypertension, total cholesterol level, high-density lipoprotein cholesterol level, treated-hyperlipidemia, hyperglycemia, treated-diabetes, estimated glomerular filtration rate (eGFR), current smoking, and drinking habit. Results The prevalence of RBBB was higher in men than women (723/29,863 2.4% in men vs. 581/58,204 1.0% in women, P In women, RBBB was associated with significantly increased cardiovascular mortality with multivariate-adjusted hazard ratios (HR) of 1.26 [95% confidence interval (CI), 1.03–1.54]. Then, we divided them into younger or elder groups according to the cut-off age of 65-year-old. In women ≤65-year-old, RBBB related to greater cardiovascular mortality with multivariate-adjusted HR of 1.89 [95% CI, 1.27–2.80]. However, in women >65-year-old, RBBB did not show the prognostic significance. In men, RBBB did not reach the significant results in all participants, however, men >65-year-old with RBBB showed the significant poor prognosis with HR of 1.26 [95% CI, 1.04–1.53]. Conclusions In this cohort study, contrary to common perception, RBBB was associated with increased cardiovascular mortality in women, especially younger women ≤65-year-old, and elderly men. To the extent we know, the present study is the largest and long-term follow-up study showing that the significance of RBBB differs depending on sex and age. Especially in young women who usually are less prone to show wide QRS, RBBB might represent the pathological abnormality. Although the pathophysiological effect of the RBBB on the cardiovascular outcome needs further investigation in the future, clinicians should alert the RBBB in young women and elder men even if they have no symptoms and evaluate the heart abnormality and follow them up carefully. Funding Acknowledgement Type of funding source: None
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- 2020
40. Utility of updated diagnositc criteria to detect isolated cardiac sarcoidosis
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Masaki Ieda, Tomoko Ishizu, Masayoshi Yamamoto, and Kimi Sato
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medicine.medical_specialty ,business.industry ,medicine ,Radiology ,Cardiac sarcoidosis ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Prior study reported around one-third of cardiac sarcoidosis (CS) are considered as isolated CS. Detection of CS is challenging due to the limited sensitivity of endomyocardial biopsy and applicability of guidelines, especially in patients without extra-cardiac involvement. Existing diagnostic criteria by Japanese Ministry of health and Welfare (JMHW) or Heart Rhythm Society (HRS) require the presence of extra-cardiac sarcoidosis for clinical diagnosis, isolated CS is not diagnosable in the absence of a positive histological finding. Recently, Japanese Society of Cardiology (JCS) updated diagnostic criteria for CS, which provides the pathway to diagnose isolated CS. Purpose We aimed to assess the reliability of the updated CS guideline in diagnosing CS compared to the prior guidelines. Methods We retrospectively identified 162 consecutive patients who underwent FDG-PET for suspected CS from 2012 through 2019. According to the updated JCS diagnostic criteria, patients were classified as histologic diagnosis of CS, clinical diagnosis of CS, or isolated CS (Figure A). We compared the association between diagnostic criteria and response with anti-inflammatory therapy. Results The JCS criteria classified 24 patients (15%) as having clinical CS, 4 (3%) as histological diagnosis of CS, and 21 (13%) as isolated CS. The JMHW criteria defined 22 patients (14%) as having CS (clinical 11%, histological 3%) and HRS criteria classified 11 patients (7%) as having CS (clinical 4%, histological 3%). Extra-cardiac involvement was detected in 36 patients (22%) with 8% of histological confirmation. Among the 126 patients without extra-cardiac involvement, prevalence of cardiac involvement was higher in isolated CS (P Conclusions Updated JCS diagnostic criteria detects CS patients with active myocardial inflammation which require anti-inflammatory therapy regardless of extra-cardiac involvement better than the prior guidelines. Diagnostic criteria for CS Funding Acknowledgement Type of funding source: None
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- 2020
41. Features of Lead-Induced Tricuspid Regurgitation in Patients With Heart Failure Events After Cardiac Implantation of Electronic Devices - A Three-Dimensional Echocardiographic Study
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Masaki Ieda, Hideki Nakajima, Akihiko Nogami, Kimi Sato, Masayoshi Yamamoto, Nobuyuki Ohte, Yoshihiro Seo, Tomoko Ishizu, Tomoko Machino-Ohtsuka, and Noriko Iida
- Subjects
medicine.medical_specialty ,Pacemaker, Artificial ,Exacerbation ,Echocardiography, Three-Dimensional ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,Lead location ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Lead (electronics) ,Retrospective Studies ,Heart Failure ,Tricuspid valve ,business.industry ,General Medicine ,medicine.disease ,Tricuspid Valve Insufficiency ,Defibrillators, Implantable ,medicine.anatomical_structure ,Treatment Outcome ,Heart failure ,Cardiology ,Electronics ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Lead-induced tricuspid regurgitation (TR) after cardiac implantable electronic device (CIED) implantation is not fully understood. This study aimed to reveal the features of lead-induced TR by 3-dimensional echocardiography (3DE) in patients with heart failure (HF) events after CIED implantation.Methods and Results:In 143 patients, 3DE assessments for the tricuspid valve (TV) and right ventricular morphologies were sequentially performed within 3 days after CIED implantations, during TR exacerbations, and at ≥6 months after TR exacerbations. TR exacerbations were observed in 29 patients (median 10 months after CIED implantation, range 1-28 months), 15 of whom had lead-induced TR. In the 29 patients, the tenting height of the TV, tricuspid annular (TA) height, and TA area at baseline were independent predictors for worsening TR. In patients with lead-induced TR, tenting height of the TV and TA area were identified as the risk factors. In addition, all patients with a lead positioned on a leaflet immediately after CIED implantations developed lead-induced TR. At follow up, TR exacerbation of lead-induced TR persisted with TA remodeling, but it was improved in the lead non-related-TR group. Conclusions TA remodeling at baseline and a lead location on a leaflet immediately after CIED implantation were associated with lead-induced TR in patients with HF events after CIED implantation. Persistent TA remodeling may make lead-induced TR refractory against HF treatments.
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- 2020
42. Direct oral anticoagulant use and outcomes in adult patients with Fontan circulation: A multicenter retrospective cohort study
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Fumie Takechi, Yumi Shiina, Tomoko Machino-Ohtsuka, Masaki Ieda, Terunobu Fukuda, Keita Masuda, Nobuyuki Komiyama, Naoto Kawamatsu, Shigeru Tateno, Hitoshi Horigome, Yuji Hiramatsu, Yasufumi Kijima, Koichiro Niwa, and Tomoko Ishizu
- Subjects
Adult ,Male ,medicine.medical_specialty ,Antiplatelet drug ,Vitamin K ,medicine.drug_class ,medicine.medical_treatment ,Administration, Oral ,030204 cardiovascular system & hematology ,Fontan Procedure ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Antithrombotic ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Retrospective Studies ,Proportional hazards model ,business.industry ,Incidence (epidemiology) ,Anticoagulant ,Anticoagulants ,Retrospective cohort study ,Vitamin K antagonist ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Many adult patients with Fontan circulation are treated with antithrombotic agents, including direct oral anticoagulants (DOACs). However, few studies have investigated the efficacy, feasibility, and safety of DOACs in adult patients with Fontan circulation. Methods and Results In this retrospective cohort study, clinical records of 139 adult patients with Fontan circulation (70 females, 50.4%) from April 2015 to March 2018 were reviewed and classified into five groups according to the therapeutic agents used: DOAC (n = 36), vitamin K antagonist (VKA; n = 41), antiplatelet drug (n = 43), combination of an antiplatelet and anticoagulant (n = 14), and no-antithrombotic prophylaxis (n = 5). In a 1114-patient-year follow-up, 28 major events occurred, including 10 thrombotic and 18 bleeding events; 11 of 18 (61%) female patients had severe menorrhagia. The incidence (% patient-years) of major events was 0.6, 1.42, 3.74, and 5.13 in the DOAC, antiplatelet, VKA, combination, and no-antithrombotic groups, respectively. The Cox proportional hazards analysis revealed that the DOAC group had a lower rate of primary endpoints than the VKA group in males. Conclusions DOAC may be a safe antithrombotic agent for use in adult patients with Fontan circulation, particularly in males. However, these findings should be confirmed in multi-institutional prospective studies.
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- 2020
43. Comparison of Outcomes in Patients With Heart Failure With Versus Without Lead-Induced Tricuspid Regurgitation After Cardiac Implantable Electronic Devices Implantations
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Nobuyuki Ohte, Yoshihiro Seo, Masaki Ieda, Akihiko Nogami, Kimi Sato, Noriko Iida, Hideki Nakajima, Tomoko Ishizu, Tomoko Machino-Ohtsuka, and Masayoshi Yamamoto
- Subjects
Male ,medicine.medical_specialty ,Pacemaker, Artificial ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Clinical endpoint ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,Risk factor ,Lead (electronics) ,Aged ,Retrospective Studies ,Heart Failure ,business.industry ,Proportional hazards model ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Tricuspid Valve Insufficiency ,Defibrillators, Implantable ,Treatment Outcome ,Heart failure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Cardiac implantable electronic devices (CIED) implantations may cause lead-induced tricuspid regurgitation (LITR). Although patients with CIED have the risk of functional non-lead induced TR (Non-LITR). This study aimed to compare of clinical outcome between LITR and Non-LITR. The mechanism of TR was determined by 3-dimensional echocardiography. The primary end point was heart failure (HF) hospitalizations after CIED implantation. In patients with HF events, subsequent clinical outcomes after HF hospitalization were compared between no TR, LITR, and Non-LITR groups. In eligible 373 patients, 67 patients had HF hospitalization, of whom worsened TR was observed in 49 patients. In the remaining 307 patients, worsened TR was observed in only 10 patients (3.3%). Of the 49 patients with worsened TR, 18 patients (37%) had LITR. In 67 patients with HF hospitalization, 25 patients (37%) met rehospitalization. All severe LITR persisted after HF events. Meanwhile, severe Non-LITR improved to moderate or mild level. Cox proportional hazard model analyses revealed LITR was the independent risk factor of rehospitalization. Both LITR and Non-LITR were common at HF events after CIED implantations. However, LITR persisted and might contribute to a worse prognosis. In patients with TR after CIED implantations, 3-dimensional echocardiography should be performed to diagnose the LITR accurately, which may contribute to improving the clinical outcome.
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- 2020
44. Prognostic Impact of Changes in Intrarenal Venous Flow Pattern in Patients With Heart Failure
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Yoshihiro Seo, Noriko Iida, Daishi Nakagawa, Kimi Sato, Nobuyuki Ohte, Kazutaka Aonuma, Tomoko Machino-Ohtsuka, Tomoko Ishizu, Masaki Ieda, Yu Yamada, Tomofumi Nakatsukasa, Naoto Kawamatsu, and Masayoshi Yamamoto
- Subjects
medicine.medical_specialty ,Poor prognosis ,030204 cardiovascular system & hematology ,Kidney ,Venous flow ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Natriuretic Peptide, Brain ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,Heart Failure ,Brain natriuretic peptide level ,business.industry ,Continuous flow ,Clinical course ,Flow pattern ,medicine.disease ,Prognosis ,Heart failure ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Glomerular Filtration Rate - Abstract
It remains unclear whether intrarenal venous flow (IRVF) patterns in patients with heart failure (HF) could change over the clinical course, and whether the changes could have a clinical impact. Thus, this study aimed to clarify these characteristics as well as to identify the relation between changes in the IRVF pattern and renal impairment progression.Patients with HF with repetitive IRVF evaluations were enrolled. Doppler waveforms of IRVF were classified into the following 3 flow patterns: continuous, biphasic discontinuous, and monophasic discontinuous. Primary end points included death from cardiovascular diseases and unplanned hospitalization for HF. Finally, 108 patients with adequate images were enrolled. The IRVF in 35 patients (32.4%) shifted to another pattern at the follow-up examinations. The median brain natriuretic peptide level in the continuous flow pattern at follow-up was significantly decreased (183 to 60 pg/mL, P.001), whereas that of the discontinuous flow pattern at follow-up was increased (from 339 to 366 pg/mL, P = .042) and the estimated glomerular filtration rate was decreased (from 55 to 50 mL/min/1.73 mThe IRVF pattern could be changed depending on the status of congestion. Persistent or worsened renal congestion, represented by discontinuous flow patterns, during the clinical courses indicated a poor prognosis accompanied by renal impairment in patients with HF.
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- 2020
45. Diagnostic Criteria of Flow‐Mediated Vasodilation for Normal Endothelial Function and Nitroglycerin‐Induced Vasodilation for Normal Vascular Smooth Muscle Function of the Brachial Artery
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Yiming Han, Yusuke Ohya, Hirofumi Tomiyama, Hisao Ikeda, Taiji Furukawa, Yasuki Kihara, Masataka Sata, Masato Kajikawa, Chikara Goto, Shinichiro Ueda, Shinji Koba, Yukihito Higashi, Yoshiki Aibara, Koichi Node, Yutaka Ishibashi, Bonpei Takase, Tsutomu Yamazaki, Koji Maemura, Shinji Kishimoto, Tomoo Furumoto, Yuji Takaeko, Kentaro Watanabe, Toru Suzuki, Hiroshi Ito, Kazuaki Chayama, Ayumu Nakashima, Haruki Hashimoto, Akira Yamashina, Farina Mohamad Yusoff, Tomoko Ishizu, Takuzo Hano, Takayuki Hidaka, Kazuomi Kario, Tatsuya Maruhashi, Takahide Kohro, Teruo Inoue, Yasuhiko Takemoto, Takayuki Yamaji, and Takahiro Harada
- Subjects
Male ,Vascular smooth muscle ,Brachial Artery ,Vasodilator Agents ,Vasodilation ,Vascular Medicine ,Muscle, Smooth, Vascular ,Nitroglycerin ,endothelial function ,Japan ,Risk Factors ,Reference Values ,Cutoff ,Prospective Studies ,Registries ,Brachial artery ,vascular smooth muscle function ,Original Research ,Ultrasonography ,Aged, 80 and over ,Middle Aged ,University hospital ,flow‐mediated vasodilation ,Cardiovascular Diseases ,cardiovascular system ,nitroglycerin‐induced vasodilation ,Endothelium/Vascular Type/Nitric Oxide ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,Flow-Mediated Vasodilation ,Adult ,medicine.medical_specialty ,Adolescent ,Cardiovascular risk factors ,Hyperemia ,diagnostic criteria ,flow-mediated vasodilation ,nitroglycerin-induced vasodilation ,Young Adult ,Predictive Value of Tests ,medicine.artery ,Internal medicine ,medicine ,Humans ,Aged ,business.industry ,Curve analysis ,Atherosclerosis ,Heart Disease Risk Factors ,Endothelium, Vascular ,business - Abstract
Background Diagnostic criteria of flow‐mediated vasodilation (FMD), an index of endothelial function, and nitroglycerin‐induced vasodilation (NID), an index of vascular smooth muscle function, of the brachial artery have not been established. The purpose of this study was to propose diagnostic criteria of FMD and NID for normal endothelial function and normal vascular smooth muscle function. Methods and Results We investigated the cutoff values of FMD and NID in subjects with (risk group) and those without cardiovascular risk factors or cardiovascular diseases (no‐risk group) in 7277 Japanese subjects (mean age 51.4±10.8 years) from the Flow‐Mediated Dilation Japan study and the Flow‐Mediated Dilatation Japan Registry study for analysis of the cutoff value of FMD and in 1764 Japanese subjects (62.2±16.1 years) from the registry of Hiroshima University Hospital for analysis of the cutoff value of NID. Receiver‐operator characteristic curve analysis of FMD to discriminate subjects in the no‐risk group from patients in the risk group showed that the optimal cutoff value of FMD to diagnose subjects in the no‐risk group was 7.1%. Receiver‐operator characteristic curve analysis of NID to discriminate subjects in the no‐risk group from patients in the risk group showed that the optimal cutoff value of NID to diagnose subjects in the no‐risk group was 15.6%. Conclusions We propose that the cutoff value for normal endothelial function assessed by FMD of the brachial artery is 7.1% and that the cutoff value for normal vascular smooth muscle function assessed by NID of the brachial artery is 15.6% in Japanese subjects. Clinical Trial Registration www.umin.ac.jp Unique identifiers: UMIN000012950, UMIN000012951, UMIN000012952, and UMIN000003409
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- 2020
46. 1225 Diagnostic accuracy of left ventricular diastolic strain imaging by speckle tracking echocardiography in detecting ischemic etiology of acute chest pain
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Atsushi Tanaka, Katsuhisa Ishii, Hiroshi Ito, E Hyodo, Tomoko Ishizu, H Kihara, Masao Daimon, Junichi Yoshikawa, Yoshihiro Seo, Takashi Akasaka, E Tada, and Hiroyuki Watanabe
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medicine.medical_specialty ,business.industry ,Diastole ,Strain imaging ,Diagnostic accuracy ,Speckle tracking echocardiography ,General Medicine ,Internal medicine ,medicine ,Cardiology ,Etiology ,Acute chest pain ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business - Abstract
Funding Acknowledgements none OnBehalf A TRAC-SI Multicenter Trial Background Two-dimensional speckle tracking echocardiography (2D-STE) has been reported to be useful for the diagnosis of myocardial ischemia by detecting delay in regional myocardial expansion (diastolic stunning) up to many hours after an episode of angina. The aim is to evaluate the diagnostic accuracy of Left ventricular (LV) diastolic longitudinal, circumferential, transverse and radial strain imaging by STE to detect the presence of acute coronary syndrome (ACS) in patients with acute chest pain. Methods 388 consecutive patients with acute chest pain and without wall motion abnormality, who were admitted to an emergency department (ED) at 1 of 12 clinical sites in Japan, were enrolled and underwent 2D-STE at ED. Left ventricular (LV) longitudinal, circumferential, transverse and radial strain values at aortic valve closure (A) and one-third of diastole duration (B) were measured. The strain imaging diastolic index (SI-DI) was value was determined as: (A-B)/A × 100% to assess the LV diastolic strain imaging and was used to identify the regional LV delayed relaxation. All patients underwent coronary CT or coronary angiography to establish the diagnosis of ACS. Clinicians were blinded to the 2D-STE results. Results Out of 388 patients, 2D-STE analysis was possible in 358 patients (92%). With assessment of coronary CT or coronary angiography, ACS was diagnosed in 118 patients (33%). 2D-STE was obtained at a mean of 5.3 hours after chest pain episode. SI-DI of longitudinal, circumferential, transverse and radial strain of ischemic segments were significantly lower than those of non-ischemic segments (p value < 0.001), and transverse and radial SI-DI demonstrated high diagnostic accuracy, compared with longitudinal SI-DI (Figure 1). Sensitivity, specificity, and negative predictive value for ACS of transverse SI-DI are 87%, 88%, % and 95%, respectively, using a cut-off value of 63.3. Conclusion LV diastolic strain imaging by 2D-STE at ED increase the sensitivity, specificity and accuracy to predict the presence of ACS in patients with chest pain. Compared with longitudinal diastolic strain imaging, transverse diastolic strain imaging is more sensitive marker to detect the myocardial ischemic episode (UMIN000013859). Abstract 1225 Figure 1
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- 2020
47. Brachial-Ankle Pulse Wave Velocity Versus Its Stiffness Index beta-Transformed Value as Risk Marker for Cardiovascular Disease
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Toru Suzuki, Chisa Matsumoto, Tomoo Furumoto, Tatsuya Maruhashi, Taishiro Chikamori, Takahide Kohro, Takuzo Hano, Yasuhiko Takemoto, Hiroki Nakano, Koji Maemura, Toshiharu Ninomiya, Toshiaki Ohkuma, Shinichiro Ueda, Tomoko Ishizu, Tsutomu Yamazaki, Teruo Inoue, Masataka Sata, Hirofumi Tomiyama, Hiroshi Ito, Akira Yamashina, Alberto Avolio, Kazuomi Kario, Yusuke Ohya, Koichi Node, Yutaka Ishibashi, Bonpei Takase, Yukihito Higashi, Taiji Furukawa, and Shinji Koba
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Adult ,Male ,medicine.medical_specialty ,hypertension ,organ damage ,Pulse Wave Analysis ,Vascular Medicine ,Risk Assessment ,Coronary artery disease ,Vascular Stiffness ,Predictive Value of Tests ,Internal medicine ,Medicine ,Humans ,Ankle Brachial Index ,Prospective Studies ,Pulse wave velocity ,Original Research ,Aged ,Receiver operating characteristic ,business.industry ,arterial stiffness ,blood pressure ,stiffness index beta ,Area under the curve ,Middle Aged ,medicine.disease ,Pulse pressure ,Blood pressure ,Cardiovascular Diseases ,Arterial stiffness ,Cardiology ,stiffness index β ,Female ,Cardiology and Cardiovascular Medicine ,business ,Retinopathy - Abstract
Background The difference in the predictive ability of the brachial‐ankle pulse wave velocity (ba PWV ) and its stiffness index β‐transformed value (β‐ba PWV , ie, ba PWV adjusted for the pulse pressure) for the development of pathophysiological abnormalities related to cardiovascular disease or future occurrence of cardiovascular disease was examined. Methods and Results In study 1, a 7‐year prospective observational study in cohorts of 3274 men and 3490 men, the area under the curve in the receiver operator characteristic curve analysis was higher for ba PWV than for β‐ba PWV for predicting the development of hypertension (0.73, 95% CI =0.70 to 0.75 versus 0.59, 95% CI =0.56 to 0.62; P CI =0.73 to 0.82 versus 0.66, 95% CI =0.60 to 0.71; P Conclusions Stiffness index β transformation of the ba PWV may attenuate the significance of the ba PWV as a risk marker for development of pathophysiological abnormalities related to cardiovascular disease in male subjects.
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- 2019
48. Wave intensity as a useful modality for assessing ventilation–perfusion imbalance in subclinical patients with hypertension
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Kazutaka Aonuma, Masayoshi Yamamoto, Yoshie Nogami, Yoshihiro Seo, and Tomoko Ishizu
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Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Ventilation/perfusion ratio ,Doppler imaging ,03 medical and health sciences ,Oxygen Consumption ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Ultrasonography, Doppler, Color ,Lung ,Aged ,Exercise Tolerance ,business.industry ,Respiration ,Middle Aged ,medicine.disease ,Cardiac surgery ,Carotid Arteries ,Blood pressure ,Heart failure ,Hypertension ,Circulatory system ,Exercise Test ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Anaerobic exercise ,Respiratory minute volume - Abstract
Wave intensity (WI) is a novel noninvasive index of circulatory dynamics that reflects ventriculo-arterial coupling. It is calculated as the product of the first derivative of blood pressure and that of flow velocity measured by carotid echocardiography. This study aimed to clarify the clinical implications of WI and its relation with carbon dioxide production (VE/VCO2 slope). Twenty-one healthy volunteers (control group) and 21 patients with hypertension (HT group) underwent cardiopulmonary exercise testing (CPX) and exercise stress echocardiography. WI was assessed in the right carotid artery using an ultrasound system. The first peak of WI (W1) during the early ejection phase was measured at baseline and mitral annular velocity was assessed by tissue Doppler imaging. Ventilatory kinetics during exercise was assessed using the relation of minute ventilation to VE/VCO2 slope. VE/VCO2 slope, W1, and E/E′ were greater in the HT group than in the control group. PeakVO2 and VO2 at the anaerobic threshold were lower in the HT group than in the control group. VE/VCO2 slope was significantly correlated with W1 (r = 0.58, p
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- 2018
49. Longitudinal association among endothelial function, arterial stiffness and subclinical organ damage in hypertension
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Toru Suzuki, Yukihito Higashi, Shinichiro Ueda, Teruo Inoue, Taiji Furukawa, Akira Yamashina, Koji Maemura, Tsutomu Yamazaki, Yutaka Ishibashi, Hirofumi Tomiyama, Takuzo Hano, Bonpei Takase, Tomoo Furumoto, Chisa Matsumoto, Shinji Koba, Takahide Kohro, Yasuhiko Takemoto, Hiroshi Ito, Kazuomi Kario, Masataka Sata, Koichi Node, Tomoko Ishizu, and Yusuke Ohya
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Male ,medicine.medical_specialty ,Renal function ,030204 cardiovascular system & hematology ,Pulse Wave Analysis ,Carotid Intima-Media Thickness ,03 medical and health sciences ,0302 clinical medicine ,Vascular Stiffness ,medicine.artery ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Longitudinal Studies ,Prospective Studies ,cardiovascular diseases ,Endothelial dysfunction ,Brachial artery ,Prospective cohort study ,Pulse wave velocity ,Subclinical infection ,Aged ,business.industry ,Endothelial function ,Middle Aged ,medicine.disease ,Atherosclerosis ,Arterial stiffness ,Hypertension ,Cardiology ,cardiovascular system ,Microalbuminuria ,Female ,Endothelium, Vascular ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Objectives To examine the longitudinal mutual association between endothelial dysfunction and arterial stiffness, and also to determine which of the two variables was more closely associated with the progression of subclinical organ damage. Methods The brachial-ankle pulse wave velocity (baPWV), carotid intima-media thickness (CIMT), estimated glomerular filtration rate, microalbuminuria and flow-mediated vasodilatation of the brachial artery (FMD) were measured three times at 1.5-year intervals in 674 Japanese patients receiving antihypertensive treatment. Results The change of the baPWV during the study period was larger in the subjects with baseline FMD values in the lowest tertile as compared to those with baseline FMD values in the highest tertile. The change of the CIMT was smaller in the subjects with baseline baPWV values in the lowest tertile than in those with baseline baPWV values in the highest tertile. After the adjustment, the FMD value at the baseline was inversely associated with the baPWV at the end of the study period (beta=−0.07, p =0.01), although, the reverse association was not significant. The baPWV, but not the FMD value, at the baseline was associated with the CIMT (beta=0.06, p =0.04) measured at the end of the study period. Conclusions In hypertension, endothelial dysfunction was associated with the progression of arterial stiffness, although the reverse association was not confirmed. The increased arterial stiffness rather than endothelial dysfunction may be more closely associated with the progression of atherosclerotic vascular damage, and the endothelial dysfunction-arterial stiffness-atherosclerosis continuum may be important in hypertension.
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- 2018
50. Utility of Nutritional Screening in Predicting Short-Term Prognosis of Heart Failure Patients
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Akinori Sugano, Masayoshi Yamamoto, Akira Koike, Isao Nishi, Kazutaka Aonuma, Kenichi Obara, Kimi Sato, Seika Sai, Yoshie Hamada-Harimura, Shoji Suzuki, Longmei Wu, Yoshihiro Seo, and Tomoko Ishizu
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Male ,medicine.medical_specialty ,Nutritional Status ,Aging society ,030204 cardiovascular system & hematology ,Logistic regression ,Gastroenterology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Lymphocyte Count ,030212 general & internal medicine ,Serum Albumin ,Aged ,Aged, 80 and over ,Heart Failure ,Cholesterol ,business.industry ,Nutritional status ,General Medicine ,Middle Aged ,Prognosis ,Brain natriuretic peptide ,medicine.disease ,Normal group ,Hospitalization ,Nutrition Assessment ,chemistry ,Heart failure ,Female ,Cardiology and Cardiovascular Medicine ,business ,Hospital stay - Abstract
Controlling nutritional status (CONUT) uses 2 biochemical parameters (serum albumin and cholesterol level), and 1 immune parameter (total lymphocyte count) to assess nutritional status. This study examined if CONUT could predict the short-term prognosis of heart failure (HF) patients.A total of 482 (57.5%) HF patients from the Ibaraki Cardiovascular Assessment Study-HF (n = 838) were enrolled (298 men, 71.7 ± 13.6 years). Blood samples were collected at admission, and nutritional status was assessed using CONUT. CONUT scores were defined as follows: 0-1, normal; 2-4, light; 5-8, moderate; and 9-12, severe degree of undernutrition. Accordingly, 352 (73%) patients had light-to-severe nutritional disturbances. The logarithmically transformed plasma brain natriuretic peptide (log BNP) concentration was significantly higher in the moderate-severe nutritional disturbance group (2.92 ± 0.42) compared to the normal group (2.72 ± 0.45, P < 0.01). CONUT scores were significantly higher in the in-hospital death patients [4 (3-8), n = 14] compared with patients who were discharged following symptom alleviation [3 (1-5), n = 446, P < 0.05]. With the exception of transferred HF patients (n = 22), logistic regression analysis that incorporated the CONUT score and the log BNP, showed that a higher CONUT score (P = 0.019) and higher log BNP (P = 0.009) were predictors of in-hospital death, and the median duration of hospital stay was 20 days.Our results demonstrate the usefulness of CONUT scores as predictors of short-term prognosis in hospitalized HF patients.
- Published
- 2018
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