著者

Masato Okada Koichi Inoue Koji Tanaka Yuichi Ninomiya Yuko Hirao Takafumi Oka Nobuaki Tanaka Hiroyuki Inoue Ryo Nakamaru Yasushi Koyama Atsunori Okamura Katsuomi Iwakura Yasushi Sakata Kenshi Fujii

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.82, no.4, pp.956-964, 2018-03-23 (Released:2018-03-23)

参考文献数

14

被引用文献数

14 17

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Background:This study evaluated the safety and efficacy of venous figure-of-eight (FoE) suture to achieve femoral venous hemostasis after radiofrequency (RF) catheter ablation (CA) for atrial fibrillation (AF).Methods and Results:We retrospectively examined 517 consecutive patients undergoing RFCA for AF. The control group (n=247) underwent manual compression for femoral venous hemostasis after sheath removal with 6 h of bed rest. The FoE group (n=270) underwent FoE suture technique with 4 h of bed rest. All patients achieved successful hemostasis within 24 h after CA. Although the incidence of hematoma was similar between the groups, the incidence of rebleeding was lower in the FoE group than in the control group (FoE vs. control, 3.7% vs. 18.6%, P<0.001). The post-procedural use of analgesic and/or anti-emetic agents was less frequent in the FoE group (19.3% vs. 32.0%, P<0.001). On multiple logistic regression analysis after adjustment for age and sex, the use of a vitamin K antagonist (OR, 2.42; 95% CI: 1.18–4.99, P=0.02) and the FoE suture technique (OR, 0.17; 95% CI: 0.08–0.35, P<0.001) were independent predictors of rebleeding after CA.Conclusions:FoE suture technique effectively achieved femoral venous hemostasis after RFCA for AF. It reduced the risk of rebleeding, shortened bed rest duration, and relieved patient discomfort.

著者

Koshiro Kanaoka Tsunenari Soeda Satoshi Terasaki Yuichi Nishioka Tomoya Myojin Shinichiro Kubo Katsuki Okada Tatsuya Noda Makoto Watanabe Rika Kawakami Yasushi Sakata Tomoaki Imamura Yoshihiko Saito

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.3, no.3, pp.122-130, 2021-03-10 (Released:2021-03-10)

参考文献数

25

被引用文献数

15

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Background:Although cardiac rehabilitation (CR) has been reported to be associated with better clinical outcomes in patients with cardiovascular diseases, there are few nationwide studies about CR participation by patients with coronary artery disease in Japan.Methods and Results:We performed a nationwide retrospective cohort study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan between April 2014 and March 2018. Patients were divided into 2 groups (acute coronary syndrome [ACS] and stable coronary artery disease [sCAD]), and the rates of participation in in- and outpatient CR after percutaneous coronary intervention (PCI) were investigated. Propensity score-matched analysis was performed and the association between outpatient CR participation and all-cause mortality 3 months after PCI was examined. Overall, 616,664 patients (ACS, n=202,853; sCAD, n=413,811) were analyzed. The participation rates of CR increased annually. The participation rate was higher for inpatient than outpatient CR in both the ACS (52% vs. 9%, respectively) and sCAD (15% vs. 3%, respectively) groups. Prognosis was better for patients with than without outpatient CR in both the ACS (hazard ratio [HR] 0.52; 95% confidence interval [CI] 0.47–0.59) and sCAD (HR 0.72; 95% CI 0.65–0.80) groups.Conclusions:Outpatient CR was associated with a better prognosis in patients with ACS or sCAD. The participation rates of outpatient CR following PCI were extremely low in Japan.

著者

Koshiro Kanaoka Yoshitaka Iwanaga Katsuki Okada Satoshi Terasaki Yuichi Nishioka Michikazu Nakai Daisuke Kamon Tomoya Myojin Tsunenari Soeda Tatsuya Noda Manabu Horii Yasushi Sakata Yoshihiro Miyamoto Yoshihiko Saito Tomoaki Imamura

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-22-0566, (Released:2023-01-28)

参考文献数

22

被引用文献数

6

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Background: We aimed to validate a claims-based diagnostic algorithm to identify hospitalized patients with acute major cardiovascular diseases (CVDs) from health insurance claims in Japan.Methods and Results: This retrospective multicenter validation study was conducted at 4 institutes, including Japanese Circulation Society-certified and uncertified hospitals in Japan. Data on patients with CVDs in departmental lists or with International Classification of Diseases, 10th Revision (ICD-10) codes for CVDs hospitalized between April 2018 and March 2019 were extracted. We examined the sensitivity and positive predictive value of a diagnostic algorithm using ICD-10 codes, medical examinations, and treatments for acute coronary syndrome (ACS), acute heart failure (HF), and acute aortic disease (AAD). We identified 409 patients with ACS (mean age 70.6 years; 24.7% female), 615 patients with acute HF (mean age 77.3 years; 46.2% female), and 122 patients with AAD (mean age 73.4 years; 36.1% female). The respective sensitivity and positive predictive value for the algorithm were 0.86 (95% confidence interval [CI] 0.82–0.89) and 0.95 (95% CI 0.92–0.97) for ACS; 0.74 (95% CI 0.70–0.77) and 0.79 (95% CI 0.76–0.83) for acute HF; and 0.86 (95% CI 0.79–0.92) and 0.83 (95% CI 0.76–0.89) for AAD.Conclusions: The validity of the diagnostic algorithm for Japanese claims data was acceptable. Our results serve as a foundation for future studies on CVDs using nationwide administrative data.

著者

Takayuki Ishihara Isamu Mizote Daisuke Nakamura Naotaka Okamoto Tatsuya Shiraki Naoki Itaya Takuya Tsujimura Mitsuyoshi Takahara Takaharu Nakayoshi Osamu Iida Yosuke Hata Masami Nishino Takafumi Ueno Daisaku Nakatani Shungo Hikoso Shinsuke Nanto Toshiaki Mano Yasushi Sakata The COLLABORATION Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-22-0098, (Released:2022-06-04)

参考文献数

31

被引用文献数

4

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Background: A polymer-free biolimus A9-coated stent (PF-BCS) may achieve better arterial healing than a durable polymer drug-eluting stent owing to its polymer-free feature.Methods and Results: This multicenter, prospective, observational study enrolled 105 patients (132 lesions) who underwent PF-BCS (51 patients, 71 lesions) or durable polymer everolimus-eluting stent (DP-EES, 54 patients, 61 lesions) implantation. Serial coronary angioscopy (CAS) and optical coherence tomography (OCT) examinations were performed at 1 and 12 months, and the serial vessel responses were compared between PF-BCS and DP-EES. The primary outcome measure was the incidence of subclinical intrastent thrombus on CAS. The secondary outcome measures were: adequate strut coverage (≥40 μm) on OCT and maximum yellow color grade on CAS. The incidence of thrombus was high at 1 month (100% vs. 93%, P=0.091), but decreased at 12 months (18% vs. 25%, P=0.56), without a significant difference between PF-BCS and DP-EES. The adequate strut coverage rate was significantly higher (84±14% vs. 69±22%, P<0.001) and yellow color was significantly less intense (P=0.012) at 12 months in PF-BCS than in DP-EES; however, they were not significantly different at 1 month (adequate strut coverage: 47±21% vs. 50±17%, P=0.40; yellow color: P=0.99).Conclusions: Although the thrombogenicity of PF-BCS was similar to that of DP-EES, the adequate coverage and plaque stabilization rates of PF-BCS were superior to those of DP-EES at 12 months.

著者

Fumio Terasaki Arata Azuma Toshihisa Anzai Nobukazu Ishizaka Yoshio Ishida Mitsuaki Isobe Takayuki Inomata Hatsue Ishibashi-Ueda Yoshinobu Eishi Masafumi Kitakaze Kengo Kusano Yasushi Sakata Noriharu Shijubo Akihito Tsuchida Hiroyuki Tsutsui Takatomo Nakajima Satoshi Nakatani Taiko Horii Yoshikazu Yazaki Etsuro Yamaguchi Tetsuo Yamaguchi Tomomi Ide Hideo Okamura Yasuchika Kato Masahiko Goya Mamoru Sakakibara Kyoko Soejima Toshiyuki Nagai Hiroshi Nakamura Takashi Noda Takuya Hasegawa Hideaki Morita Tohru Ohe Yasuki Kihara Yoshihiko Saito Yukihiko Sugiyama Shin-ichiro Morimoto Akira Yamashina on behalf of the Japanese Circulation Society Joint Working Group

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.83, no.11, pp.2329-2388, 2019-10-25 (Released:2019-10-25)

参考文献数

355

被引用文献数

95 243

著者

Bolrathanak Oeun Daisaku Nakatani Shungo Hikoso Takayuki Kojima Tomoharu Dohi Tetsuhisa Kitamura Katsuki Okada Akihiro Sunaga Hirota Kida Takahisa Yamada Masaaki Uematsu Yoshio Yasumura Yoshiharu Higuchi Toshiaki Mano Yoshiyuki Nagai Hisakazu Fuji Hiroya Mizuno Yasushi Sakata for the Osaka CardioVascular Conference (OCVC) Heart Failure Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.2, no.8, pp.400-408, 2020-08-07 (Released:2020-08-07)

参考文献数

32

被引用文献数

4

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Background:Little is known about factors associated with elevated N-terminal pro B-type natriuretic peptide (NT-proBNP) at the convalescent stage and their effects on 1-year outcomes in patients with heart failure with preserved ejection fraction (HFpEF).Methods and Results:This study included 469 patients with HFpEF. Elevated NT-proBNP was defined as the highest quartile. The first 3 quartiles (Q1–Q3) were combined together for comparison with the fourth quartile (Q4). Median NT-proBNP concentrations in Q1–Q3 and Q4 were 669 and 3,504 pg/mL, respectively. Multivariate logistic regression analysis revealed that low albumin (odds ratio [OR] 2.44; 95% confidence interval [CI] 1.35–4.39; P=0.003), low estimated glomerular filtration rate (OR 5.83; 95% CI 3.46–9.83; P<0.001), high C-reactive protein (OR 2.09; 95% CI 1.21–3.63; P=0.009), and atrial fibrillation at discharge (OR 2.33; 95% CI 1.40–3.89; P=0.001) were associated with elevated NT-proBNP. Cumulative rates of all-cause mortality and heart failure rehospitalization were significantly higher in Q4 than in Q1–Q3 (P=0.001 and P<0.001, respectively). Incidence and hazard ratios of these adverse events increased when the number of associated factors for elevated NT-proBNP clustered together (P<0.001 and P=0.002, respectively).Conclusions:In addition to atrial fibrillation, extracardiac factors (malnutrition, renal impairment and inflammation) were associated with elevated NT-proBNP at the convalescent stage, and led to poor prognosis in patients with HFpEF.

著者

Tomoaki Kobayashi Yohei Sotomi Akio Hirata Yasushi Sakata Atsushi Hirayama Yoshiharu Higuchi

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.2, no.6, pp.289-296, 2020-06-10 (Released:2020-06-10)

参考文献数

16

被引用文献数

9

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Background:The association between direct oral anticoagulant (DOAC) dose and clinical outcomes when used with antiplatelets still remains to be investigated.Methods and Results:We conducted a prospective registry of non-valvular atrial fibrillation (AF) patients with DOAC: the DIRECT registry (n=2,216; follow-up, 407±388 days). We analyzed patients taking standard dose (n=907) and off-label reduced dose (n=338) DOAC in this sub-analysis. These patients were further stratified by add-on antiplatelets. Because DOAC dose was not randomly selected, potential confounding factors were eliminated through a propensity score-matching technique. The primary endpoint was clinically significant bleeding. The secondary endpoint was major adverse cardiovascular events (MACE; composite of all-cause death, all myocardial infarction, and stroke/systemic embolism). In patients with DOAC only/DOAC+antiplatelets, we successfully matched 212/62 patients who received off-label reduced dose DOAC with 212/62 standard dose patients. Off-label DOAC dose reduction did not have a significant impact on bleeding (HR, 1.123; 95% CI: 0.730–1.728, P=0.596) or MACE (HR, 1.107; 95% CI: 0.463–2.648, P=0.819) in patients with DOAC only, whereas in patients with add-on antiplatelets, off-label dose reduction significantly reduced bleeding (HR, 0.429; 95% CI: 0.212–0.868, P=0.019) without increasing MACE (HR, 2.205; 95% CI: 0.424–11.477, P=0.348).Conclusions:Reduced DOAC dose in combination with antiplatelet agents was associated with fewer bleeding complications than standard-dose therapy with no reduction in efficacy.

著者

Nobuaki Tanaka Koji Tanaka Yuichi Ninomiya Yuko Hirao Takafumi Oka Masato Okada Hiroyuki Inoue Ryo Nakamaru Kohtaro Takayasu Ryo Kitagaki Yasushi Koyama Atsunori Okamura Katsuomi Iwakura Yasushi Sakata Kenshi Fujii Koichi Inoue

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-18-1035, (Released:2019-02-06)

参考文献数

25

被引用文献数

4

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Background: Automated ablation lesion annotation with optimal settings for parameters including contact force (CF) and catheter stability may be effective for achieving durable pulmonary vein isolation. Methods and Results: We retrospectively examined 131 consecutive patients who underwent initial catheter ablation (CA) for paroxysmal atrial fibrillation (PAF) by automatic annotation system (VISITAG module)-guided radiofrequency CA (RFCA) (n=61) and 2nd-generation cryoballoon ablation (CBA) (n=70) in terms of safety and long-term efficacy. The automatic annotation criteria for the RFCA group were as follows: catheter stability range of motion ≤1.5 mm, duration ≥5 s, and CF ≥5 g. We ablated for >20 s with a force-time integral >150 gs at each site, before moving to the next site. Each interlesion distance was <6 mm. Procedural complications were more frequent in the CBA group (1.6% vs. 10.0%, P=0.034). Across a median follow-up of 2.98 years, 88.5% and 70.0% of patients in the RFCA and CBA groups, respectively, were free from recurrence (log-rank test, P=0.0039). There was also a significant difference in favor of RFCA with respect to repeat ablations (3.3% vs. 24.3%, log-rank test, P=0.0003). Conclusions: RF ablation guided by an automated algorithm that includes CF and catheter stability parameters showed better long-term outcomes than CBA in the treatment of patients with PAF without increasing complications.

著者

Hiroya Mizuno Tomohito Otani Yasushi Sakata

出版者

日本循環器学会

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-16-0981, (Released:2016-10-12)

参考文献数

12

被引用文献数

1

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From August 27th to 31st, the 2016 Annual Congress of the European Society of Cardiology (ESC 2016) was held in Fiera di Roma, Italy. Despite the socially unstable situation, more than 32,000 attendees, including clinical physicians, basic researchers, medical students, and paramedical personnel, as well as 5,000 exhibitors from 106 countries gathered in this historical city to share the latest findings and to discuss the present issues in cardiovascular medicine. There were scientific sessions, including 28 Hot Lines, 26 clinical trial updates, 24 registry studies, and 5 clinical practice guideline sessions. Japan had 1,170 attendees, with 1,743 submitted and 670 accepted abstracts, including the NIPPON trial presented in the hotline session. From 2011 to 2016, Japan has been the first abstract submitter and has had the most abstracts accepted, which indicates the great contribution of Japanese cardiologists and the Japanese Circulation Society. This report briefly introduces the key presentations and highlights from the ESC 2016 Scientific Sessions.

著者

Shin-ichi Momomura Yoshihiko Saito Yoshio Yasumura Kazuhiro Yamamoto Yasushi Sakata Masao Daimon Koichiro Kinugawa Hiroshi Okamoto Naoki Dohi Issei Komuro

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-17-0532, (Released:2017-08-02)

参考文献数

10

被引用文献数

5 8

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Background:TY-0201 (TY) is a transdermal formulation of bisoprolol that is the free base of bisoprolol fumarate (BO), a drug widely used to treat chronic heart failure (CHF). The objectives of this phase II study were to evaluate the efficacy and safety of TY when switching from oral BO to TY in patients with CHF whose drug therapy was optimized, and to determine the dose conversion rate of BO to TY.Methods and Results:The efficacy and safety of once daily TY patch use for 16 weeks was investigated in 40 patients with CHF who were stabilized with an optimized drug treatment, including BO, after switching from BO to TY at the dose conversion rate of 5:8. The pre-switch left ventricular ejection fraction was 50.13±11.09% (mean±SD). The post-switch value was 50.87±10.79% after 16 weeks, which was not significantly different, with similar results for other efficacy and safety parameters. The 16-week study was continued for all patients without changing doses after switching to TY. No cardiovascular deaths, hospitalizations for worsening HF, or significant safety concerns were observed.Conclusions:Efficacy was maintained without significant safety concerns in patients with CHF who were stabilized with BO treatment after switching to TY, suggesting the appropriateness of the dose conversion rate.

著者

Yuma Hamanaka Yohei Sotomi Akio Hirata Tomoaki Kobayashi Yasuhiro Ichibori Nobuhiko Makino Takaharu Hayashi Yasushi Sakata Atsushi Hirayama Yoshiharu Higuchi

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-19-1006, (Released:2020-02-11)

参考文献数

21

被引用文献数

8 17

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Background:This study investigated the impact of systemic inflammation on bleeding risk in non-valvular atrial fibrillation (NVAF) patients treated with direct oral anticoagulants (DOAC).Methods and Results:We conducted a single-center prospective registry of 2,216 NVAF patients treated with DOAC: the DIRECT registry (UMIN000033283). High-sensitivity C-reactive protein (hsCRP) was measured ≤3 months before (pre-DOAC hsCRP) and 6±3 months after initiation of DOAC (post-DOAC hsCRP). Multivariate logistic regression model was used to assess the influence of systemic inflammation and conventional bleeding risk factors on major bleeding according to International Society on Thrombosis and Haemostasis criteria. Based on the findings, we created a new bleeding risk assessment score: the ORBIT-i score, which included post-DOAC hsCRP >0.100 mg/dL and all components of the ORBIT score. A total of 1,848 patients had both pre- and post-DOAC hsCRP data (follow-up duration, 460±388 days). Post-DOAC hsCRP was associated with major bleeding (OR, 2.770; 95% CI: 1.687–4.548, P<0.001). Patients with post-DOAC hsCRP >0.100 mg/dL more frequently had major bleeding than those without (log-rank test, P<0.001). ORBIT-i score had the highest C-index of 0.711 (95% CI, 0.654–0.769) compared with the ORBIT and HAS-BLED scores.Conclusions:Persistent systemic inflammation was associated with major bleeding risk. ORBIT-i score had a higher discriminative performance compared with the conventional bleeding risk scores.

著者

Daisuke Nakamura Keisuke Yasumura Hitoshi Nakamura Yutaka Matsuhiro Koji Yasumoto Akihiro Tanaka Yasuharu Matsunaga-Lee Masamichi Yano Masaki Yamato Yasuyuki Egami Ryu Shutta Yasushi Sakata Jun Tanouchi Masami Nishino

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.83, no.2, pp.313-319, 2019-01-25 (Released:2019-01-25)

参考文献数

24

被引用文献数

2 19

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Background: There are few reports about the differences between drug-eluting stents (DES) and bare metal stents (BMS) in neoatherosclerosis associated with in-stent restenosis (ISR), so we compared the frequency and characteristics of neoatherosclerosis with ISR evaluated by optical coherence tomography (OCT) in the present study. Methods and Results: Between March 2009 and November 2016, 98 consecutive patients with ISR who underwent diagnostic OCT were enrolled: 34 patients had a BMS, 34 had a 1st-generation DES, and 30 had a 2nd-generation DES. Neoatherosclerosis was defined as a lipid neointima (including a thin-cap fibroatheroma [TCFA] neointima, defined as a fibroatheroma with a fibrous cap <65 µm) or calcified neointima. As a result, lipid neointima, TCFA neointima and calcified neointima were detected in 39.8%, 14.3%, and 5.1%, respectively, of all patients. The frequency of neoatherosclerosis was significantly greater with DES than BMS (48.4% vs. 23.5%, P=0.018). The minimum fibrous cap thickness was significantly thicker with DES than BMS (110.3±41.1 µm vs. 62.5±17.1 µm, P<0.001). In addition, longitudinal extension of neoatherosclerosis in the stented segment was less with DES than BMS (20.2±15.1% vs. 71.8±27.1%, respectively, P=0.001). Conclusions: OCT imaging demonstrated that neoatherosclerosis with ISR was more frequent with DES than BMS and its pattern exhibited a more focal and thick fibrous cap as compared with BMS.

著者

Madoka Ihara Yuhei Nojima Hidenori Adachi Tetsuya Kurimoto Keita Okayama Yasushi Sakata Shinsuke Nanto

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

pp.CR-19-0013, (Released:2019-04-20)

参考文献数

1

被引用文献数

2

著者

Masaki Tsuda Isamu Mizote Yasuhiro Ichibori Takashi Mukai Koichi Maeda Toshinari Onishi Toru Kuratani Yoshiki Sawa Yasushi Sakata

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.1, no.3, pp.142-148, 2019-03-08 (Released:2019-03-08)

参考文献数

29

被引用文献数

3

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Background: The outcome of redo transcatheter aortic valve (TAV) implantation (TAVI) is unknown for TAV structural valve degeneration (SVD). This paper reports the initial results of redo TAVI for TAV-SVD in Japanese patients. Methods and Results: Of 630 consecutive patients, 6 (1.0%) underwent redo TAVI for TAV-SVD (689–1,932 days after the first TAVI). The first TAV were 23-mm balloon-expandable valves (BEV, n=5) and a 26-mm self-expandable valve (SEV, n=1). All patients underwent multidetector computed tomography (MDCT) before redo TAVI, which showed first-TAV under-expansion (range, 19.1–21.0 mm) compared with the label size. Two BEV and 4 SEV were successfully implanted as second TAV, without moderate/severe regurgitation or 30-day mortality. One of 2 patients with a BEV-inside-BEV implantation had a high transvalvular mean pressure gradient post-procedurally (34 mmHg) and required surgical valve replacement 248 days after the redo TAVI. This, however, was unnoted in patients with SEV implantation during redo TAVI. Planned coronary artery bypass grafting was concomitantly performed in 1 patient with a small sino-tubular junction and SEV-inside-SEV implantation because of the risk of coronary malperfusion caused by the first TAV leaflets. Five of the 6 patients survived during the follow-up period (range, 285–1,503 days). Conclusions: Redo TAVI for TAV-SVD appears safe and feasible, while specific strategies based on MDCT and device selection seem important for better outcomes.

著者

Themistoklis Katsimichas Tomohito Ohtani Daisuke Motooka Yasumasa Tsukamoto Hidetaka Kioka Kei Nakamoto Shozo Konishi Misato Chimura Kaoruko Sengoku Hiroshi Miyawaki Taiki Sakaguchi Ryu Okumura Konstantinos Theofilis Tetsuya Iida Kiyoshi Takeda Shota Nakamura Yasushi Sakata

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-17-1285, (Released:2018-03-30)

参考文献数

36

被引用文献数

40

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Background:Research suggests that heart failure with reduced ejection fraction (HFrEF) is a state of systemic inflammation that may be triggered by microbial products passing into the bloodstream through a compromised intestinal barrier. However, whether the intestinal microbiota exhibits dysbiosis in HFrEF patients is largely unknown.Methods and Results:Twenty eight non-ischemic HFrEF patients and 19 healthy controls were assessed by 16S rRNA analysis of bacterial DNA extracted from stool samples. After processing of sequencing data, bacteria were taxonomically classified, diversity indices were used to examine microbial ecology, and relative abundances of common core genera were compared between groups. Furthermore, we predicted gene carriage for bacterial metabolic pathways and inferred microbial interaction networks on multiple taxonomic levels.Bacterial communities of both groups were dominated by the Firmicutes and Bacteroidetes phyla. The most abundant genus in both groups wasBacteroides. Although α diversity did not differ between groups, ordination by β diversity metrics revealed a separation of the groups across components of variation.StreptococcusandVeillonellawere enriched in the common core microbiota of patients, whileSMB53was depleted. Gene families in amino acid, carbohydrate, vitamin, and xenobiotic metabolism showed significant differences between groups. Interaction networks revealed a higher degree of correlations between bacteria in patients.Conclusions:Non-ischemic HFrEF patients exhibited multidimensional differences in intestinal microbial communities compared with healthy subjects.

著者

Makoto Miyake Misa Takegami Yuki Obayashi Masashi Amano Takeshi Kitai Tomoyuki Fujita Tadaaki Koyama Hidekazu Tanaka Kenji Ando Tatsuhiko Komiya Masaki Izumo Hiroya Kawai Kiyoyuki Eishi Kiyoshi Yoshida Takeshi Kimura Ryuzo Nawada Tomohiro Sakamoto Yoshisato Shibata Toshihiro Fukui Kenji Minatoya Kenichi Tsujita Yasushi Sakata Tetsuya Kimura Kumiko Sugio Atsushi Takita Atsushi Iwakura Toshihiro Tamura Kunihiro Nishimura Yutaka Furukawa Chisato Izumi for the BPV-AF Registry Group

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-22-0226, (Released:2022-07-08)

参考文献数

28

被引用文献数

2

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Background: Current guidelines equally recommend direct oral anticoagulants (DOACs) and warfarin for atrial fibrillation (AF) patients with a bioprosthetic valve (BPV); however, there are limited data comparing DOACs and warfarin in AF patients with an aortic BPV.Methods and Results: This post-hoc subgroup analysis of a multicenter, prospective, observational registry (BPV-AF Registry) aimed to compare DOACs and warfarin in AF patients with an aortic BPV. The primary outcome was a composite of stroke, systemic embolism, major bleeding, heart failure requiring hospitalization, all-cause death, or BPV reoperation. The analysis included 479 patients (warfarin group, n=258; DOAC group, n=221). Surgical aortic valve replacement was performed in 74.4% and 36.7% of patients in the warfarin and DOAC groups, respectively. During a mean follow up of 15.5 months, the primary outcome occurred in 45 (17.4%) and 32 (14.5%) patients in the warfarin and DOAC groups, respectively. No significant difference was found in the primary outcome between the 2 groups (adjusted hazard ratio: 0.88, 95% confidence interval: 0.51–1.50). No significant multiplicative interaction was observed between the anticoagulant effects and type of aortic valve procedure (P=0.577).Conclusions: Among AF patients with an aortic BPV, no significant difference was observed in the composite outcome of adverse clinical events between patients treated with warfarin and those treated with DOACs, suggesting that DOACs can be used as alternatives to warfarin in these patients.

著者

Ryu Shutta Daisaku Nakatani Yasuhiko Sakata Shungo Hikoso Hiroya Mizuno Shinichiro Suna Tetsuhisa Kitamura Katsuki Okada Tomoharu Dohi Takayuki Kojima Bolrathanak Oeun Akihiro Sunaga Hirota Kida Hiroshi Sato Masatsugu Hori Issei Komuro Masami Nishino Yasushi Sakata on behalf of the Osaka Acute Coronary Insufficiency Study (OACIS) Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.2, no.5, pp.280-287, 2020-05-08 (Released:2020-05-08)

参考文献数

25

被引用文献数

1

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Background:Studies comparing the cardiac consequences of hydrophilic and lipophilic statins in experimental and clinical practice settings have produced inconsistent results. In particular, evidence focusing on diabetic patients after acute myocardial infarction (AMI) is lacking.Methods and Results:From the Osaka Acute Coronary Insufficiency Study (OACIS) registry database, 1,752 diabetic patients with AMI who were discharged with a prescription for statins were studied. Long-term outcomes were compared between hydrophilic and lipophilic statins, including all-cause death, recurrent myocardial infarction (re-MI) and admission for heart failure (HF) and a composite of these (major adverse cardiac events; MACE). During a median follow-up period of 1,059 days, all-cause death, non-fatal re-MI, admission for HF, and MACE occurred in 95, 89, 112 and 249 patients, respectively. Although there was no significant difference between statins in the risk of all-cause death, re-MI and MACE, the risk of HF admission was significantly lower in patients with hydrophilic than lipophilic statins before (adjusted hazard ratio [aHR], 0.560; 95% CI: 0.345–0.911, P=0.019) and after (aHR, 0.584; 95% CI: 0.389–0.876, P=0.009) propensity score matching. Hydrophilic statin use was consistently associated with lower risk for HF admission than lipophilic statins across the subgroup categories.Conclusions:In the present diabetic patients with AMI, hydrophilic statins were associated with a lower risk of admission for HF than lipophilic statins.

著者

Masato Okada Akio Hirata Kazunori Kashiwase Hiroyuki Nakanishi Ryohei Amiya Yasunori Ueda Yoshiharu Higuchi Yasushi Sakata

出版者

International Heart Journal Association

雑誌

International Heart Journal (ISSN:13492365)

巻号頁・発行日

vol.60, no.6, pp.1334-1343, 2019-11-30 (Released:2019-11-30)

参考文献数

34

被引用文献数

1

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The aim of this study was to examine the impact of the serum eicosapentaenoic acid (EPA) to arachidonic acid (AA) ratio on recurrence after catheter ablation (CA) for atrial fibrillation (AF).A total of 192 patients who underwent first-time radiofrequency CA for AF were enrolled in this study. They were divided into two groups based on the median serum EPA/AA ratio before CA: a LOW group (< 0.30; n = 96) and a HIGH group (≥ 0.30; n = 96). Patients in the LOW group were younger and had smaller left atrial diameter (LAD) than those in the HIGH group. Although pulmonary vein triggers initiating AF were more frequently observed in the LOW group than the HIGH group (63% versus 46%, respectively; P = 0.021), no significant between-group difference was observed regarding the incidence of AF recurrence since the last procedure (17% versus 17%, P = 0.78; median follow-up, 37 months). Multivariate Cox regression analysis after adjustment for age and LAD revealed that EPA/AA of < 0.30 was not a significant predictor of AF recurrence (hazard ratio, 1.12; 95% confidence interval 0.53-2.37; P = 0.76). However, in the non-paroxysmal AF subgroup (n = 65), the incidence of AF recurrence was significantly higher in the LOW group than in the HIGH group (25.7% versus 6.7%, respectively; P = 0.031).In conclusion, a lower preprocedural EPA/AA ratio, which was associated with younger age and small left atrium, was not a predictor for the risk of AF recurrence after CA for AF. The potential impact of the ratio on recurrence in non-paroxysmal AF subgroups should be examined with larger samples.

著者

Shigeru Miyagawa Kyongsun Pak Shungo Hikoso Tomohito Ohtani Eisuke Amiya Yasushi Sakata Shinichiro Ueda Masahiro Takeuchi Issei Komuro Yoshiki Sawa

出版者

The Japanese Circulation Society

雑誌

Circulation Reports (ISSN:24340790)

巻号頁・発行日

vol.1, no.1, pp.29-34, 2019-01-10 (Released:2019-01-10)

参考文献数

20

被引用文献数

7

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Background: Accurate prognosis for heart failure (HF) survival is important for quality of life, treatment decisions, and early evaluation of new therapies and devices. Here, we developed a multivariate risk model for predicting survival in Japanese patients with HF, using parameters that are readily observable in a clinical setting. Methods and Results: We analyzed data for 1,214 adults with HF (EF <35%). Of 424 available clinical baseline factors in the derivation dataset, 17 candidate predictors were identified on Cox proportional hazards regression. These predictors were assessed for clinical relevance and tested in candidate models using cross-validated 5-year C-statistics. This process yielded a set of 14 covariates with good accuracy for predicting actual 5-year survival: age; LVEF; albumin; BMI; Hb; sodium; history of renal dysfunction, diabetes, or chronic dialysis; times HF recurred or required readmission to the hospital; use of cardiac drip, thiazide diuretic, or per oral inotropic agent; and loop diuretic dosage. These 14 variables were used to establish the Japan Heart Failure Model (JHFM) for predicting survival in patients with HF. When applied to an independent validation dataset, the results from the JHFM were closer to actual survival than those of the Seattle Heart Failure Model. Conclusions: JHFM predictions for 5-year survival had good accuracy for Japanese patients with HF. The JHFM uses parameters that can be measured at any hospital.

著者

Nobuaki Tanaka Koichi Inoue Koji Tanaka Yuko Toyoshima Takafumi Oka Masato Okada Hiroyuki Inoue Ryo Nakamaru Yasushi Koyama Atsunori Okamura Katsuomi Iwakura Yasushi Sakata Kenshi Fujii

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.81, no.11, pp.1596-1602, 2017-10-25 (Released:2017-10-25)

参考文献数

21

被引用文献数

2 24

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Background:Durable pulmonary vein isolation (PVI) is critical in reducing recurrence after radiofrequency catheter ablation for atrial fibrillation (AF). The VISITAG Module, an automatic annotation system that takes account of catheter stability and contact force (CF), might be useful in accomplishing this.Methods and Results:In 49 patients undergoing VISITAG-guided AF ablation (group A), we set the following automatic annotation criteria: catheter stability range of motion ≤1.5 mm, duration ≥5 s, CF ≥5 g, time ≥25% and tag diameter at 6 mm. We used ablation >20 s and force-time integral >150 gs at each site, then moved to the next site where a new tag appeared that overlapped with the former tag. Results and outcome were retrospectively compared for 42 consecutive patients undergoing CF-guided AF ablation without this algorithm (group B). Successful PVI at completion of the initial anatomical line was more frequent in group A than B (66.3% vs. 36.9%, P=0.0006) while spontaneous PV reconnection was less frequent (14.2% vs. 30.9%, P=0.0014) and procedure time was shorter (138±35 min vs. 180±44 min, P<0.001). One-year success rate off anti-arrhythmic drugs was higher in group A (91.8% vs. 69.1%, log rank P=0.0058).Conclusions:An automated annotation algorithm with an optimal setting reduced acute resumption of left atrium-PV conduction, shortened procedure time, and improved AF ablation outcome.