- 著者
- Masato Okada Kazunori Kashiwase Akio Hirata Mayu Nishio Yasuharu Takeda Takayoshi Nemoto Ryohei Amiya Yasunori Ueda Yoshiharu Higuchi Yoshio Yasumura
- 出版者
- The Japanese Circulation Society
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- vol.83, no.1, pp.56-66, 2018-12-25 (Released:2018-12-25)
- 参考文献数
- 31
Background: Identifying who among current Japanese patients with prior myocardial infarction (MI) would benefit from an implantable cardioverter-defibrillator (ICD) is imperative. Accordingly, this study seeks to determine whether single-photon emission computed tomography (SPECT) can help identify such patients. Methods and Results: This retrospective study enrolled 60 consecutive patients with prior MI who underwent stress thallium-201 SPECT and ICD implantation from February 2000 to October 2014. Occurrence of arrhythmic death and/or or appropriate ICD therapy, defined as shock or antitachycardia pacing for ventricular fibrillation or tachycardia, was identified until November 2016. During the median follow-up interval of 6.6 years, 18 (30%) patients experienced arrhythmic death and/or appropriate ICD therapy. Multivariate Cox proportional hazard regression analysis revealed that the summed stress score (SSS) [hazard ratio (HR)=1.14; P=0.005] and left ventricular ejection fraction (LVEF) at rest (HR=0.92; P=0.038) were significantly associated with the occurrence of arrhythmic events. Patients with SSS ≥21 and LVEF ≤30%, which were determined to be the best cutoff points, had significantly higher incidence of the arrhythmic events than the other patients (64% vs. 11%; HR=7.18; log-rank P=0.001). Conclusions: SSS using stress thallium-201 SPECT in combination with LVEF can help determine the need for ICD therapy among current Japanese patients with prior MI.
- 著者
- Masato Okada Kazunori Kashiwase Akio Hirata Takayoshi Nemoto Koshi Matsuo Ayaka Murakami Yasunori Ueda
- 出版者
- The Japanese Circulation Society
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- vol.79, no.8, pp.1712-1718, 2015-07-24 (Released:2015-07-24)
- 参考文献数
- 25
- 被引用文献数
- 3 7
Background:Bacterial cultures of cardiovascular implantable electronic devices removed from patients without clinical infection are often positive, and the cultured bacteria are different from those at the time of clinical infection. This discrepancy has not been adequately explained. We hypothesized that the cause is bacterial contamination at operation and compared the results of bacterial cultures between patients with de novo pacemaker implantation and those with pacemaker replacement.Methods and Results:We prospectively enrolled consecutive 100 patients who underwent cardiac pacemaker implantation (49 de novo implantations, 51 replacements). We took swab cultures from inside the generator pocket (1) immediately after the creation of new pocket or removal of old generator, (2) after connection of leads to new generator, and (3) after pocket lavage. Swab cultures were positive in 272 (45%) of 600 samples. The majority of the cultured bacteria werePropionibacteriumspecies. No statistical difference was detected between de novo implantations and replacements in the positive ratio of swab cultures. The positive ratio was not correlated with the number of previous device replacements.Conclusions:The positive ratio of swab cultures was not different between new implantations and replacements, suggesting that a positive culture merely indicates contamination of bacteria during operation rather than colonization. (Circ J 2015; 79: 1712–1718)