著者

Masataka Sugahara Toshiaki Mano Akiko Goda Kumiko Masai Yuko Soyama Aika Daimon Masanori Asakura Tohru Masuyama

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.83, no.2, pp.401-409, 2019-01-25 (Released:2019-01-25)

参考文献数

27

被引用文献数

2 8

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Background: We used dual Doppler echocardiography to measure the time interval between the mitral and tricuspid valve opening (MO-TO time), which we expected would reflect the balance between left and right ventricular hemodynamics. Methods and Results: We prospectively enrolled 60 patients with heart failure (HF) and sinus rhythm. The MO-TO time was measured in addition to routine echocardiography parameters, invasive hemodynamic parameters and plasma B-type natriuretic peptide (BNP) level in all patients. Patients were divided into 2 groups based on the MO-TO time: MOP (mitral opening preceding tricuspid opening), and TOP (tricuspid opening preceding mitral opening) groups. We followed up the predefined adverse outcomes (cardiovascular [CV] death and hospitalization due to worsening HF) for 1 year. Pulmonary artery wedge pressure (PAWP) and mean pulmonary artery pressure (mPAP) were higher in the MOP than in the TOP group (P<0.001; P<0.001, respectively). The probability of an adverse CV outcome was higher in the MOP than in the TOP group (log-rank test; P=0.002). Addition of MOP improved the predictive power of univariate predictors (mitral E/A ratio and BNP) in the bivariate Cox analysis (P=0.017, P=0.024, respectively). Conclusions: MOP reflects pulmonary hypertension caused by left heart disease and has prognostic value in predicting adverse CV events in patients with HF.

著者

Kazuo Kimura Takeshi Kimura Masaharu Ishihara Yoshihisa Nakagawa Koichi Nakao Katsumi Miyauchi Tomohiro Sakamoto Kenichi Tsujita Nobuhisa Hagiwara Shunichi Miyazaki Junya Ako Hirokuni Arai Hideki Ishii Hideki Origuchi Wataru Shimizu Hirofumi Takemura Yoshio Tahara Yoshihiro Morino Kenji Iino Tomonori Itoh Yoshitaka Iwanaga Keiji Uchida Hirohisa Endo Ken Kongoji Kenji Sakamoto Hiroki Shiomi Takao Shimohama Atsushi Suzuki Jun Takahashi Ichiro Takeuchi Akihito Tanaka Toshihiro Tamura Takahiro Nakashima Teruo Noguchi Daisuke Fukamachi Tomohiro Mizuno Junichi Yamaguchi Kenji Yodogawa Masami Kosuge Shun Kohsaka Hideaki Yoshino Satoshi Yasuda Hiroaki Shimokawa Atsushi Hirayama Takashi Akasaka Kazuo Haze Hisao Ogawa Hiroyuki Tsutsui Tsutomu Yamazaki 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

pp.CJ-19-0133, (Released:2019-03-29)

参考文献数

1064

被引用文献数

31 315

著者

Takenobu Shimada Seiji Habara Hiroyuki Tanaka Kazushige Kadota

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-20-0359, (Released:2020-07-23)

参考文献数

1

著者

Aki Tsuji Masaharu Masuda Mitsutoshi Asai Osamu Iida Shin Okamoto Takayuki Ishihara Kiyonori Nanto Takashi Kanda Takuya Tsujimura Yasuhiro Matsuda Shota Okuno Yosuke Hata Toshiaki Mano

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-20-0191, (Released:2020-07-17)

参考文献数

18

被引用文献数

8

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Background:The purpose of this study was to elucidate the effect of the temporal relationship between atrial fibrillation (AF) and heart failure (HF) on clinical outcomes after catheter ablation.Methods and Results:We included 129 consecutive patients with AF and HF who underwent catheter ablation in hospital from December 2014 to September 2017. The patients were divided into 2 groups based on the temporal relationship between AF and HF. Group 1 consisted of 42 patients with AF following HF while Group 2 consisted of 87 patients with AF preceding HF or those who developed both of them simultaneously at the timing of first visit to a doctor. The primary endpoint was a composite of death and hospitalization due to HF during a 2-year follow-up. AF recurrence was more common in Group 1 (45% vs. 23%; hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.25–4.94; P=0.009). Death and HF hospitalization were more frequent in Group 1 (19 [45%], 6 [7%] patients, respectively, P<0.0001). After adjustment for several covariates, patients in Group 1 were independently associated with poorer outcomes after AF ablation (HR, 8.66; 95% CI, 2.942–5.5; P<0.0001).Conclusions:Adverse clinical outcomes of death, HF hospitalization and AF recurrence were more frequent in patients with AF following HF than in those with AF preceding HF.

著者

Hiromi Nakai Masaaki Takeuchi Tomoko Nishikage Toshiki Nagakura Shinichiro Otani

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.71, no.8, pp.1244-1249, 2007 (Released:2007-07-25)

参考文献数

25

被引用文献数

8 20

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Background The prominent mid-diastolic filling wave (mitral L wave) indicates advanced diastolic dysfunction in patients in sinus rhythm. The aim of the present study was to determine the clinical implications of the mitral L wave in patients with atrial fibrillation (AF). Methods and Results Ninety-nine consecutive non-valvular chronic persistent AF patients were enrolled. The mitral L wave was defined as a distinct mid-diastolic flow velocity following the E wave with a peak velocity >20 cm/s. The prevalence of the L wave in AF patients (34/99, 34%) was significantly higher than that observed in patients in sinus rhythm during the same study period (23/946, 2.4%, p<0.001). Patients with AF and L wave were older, more frequently female and had a slower heart rate, shorter isovolumic relaxation times, larger E wave velocities and lower early diastolic mitral annulus velocity (E') resulting in the higher E/E' compared to those without L waves. The left atrial volume index was significantly larger in patients with an L wave. The Valsalva maneuver decreased, and leg elevation increased, the amplitude of the L wave in the subset of patients who received these procedures. Conclusions The appearance of the mitral L wave in AF is relatively common, and its presence indicates advanced diastolic dysfunction, including elevated filling pressures and distended noncompliant LA. (Circ J 2007; 71: 1244 - 1249)

著者

Yuya Takahashi Takanori Yamaguchi Akira Fukui Toyokazu Otsubo Kei Hirota Yuki Kawano Kana Nakashima Mai Tahara Takayuki Kitai Atsushi Kawaguchi Naohiko Takahashi Koichi Node

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-20-0149, (Released:2020-07-01)

参考文献数

25

被引用文献数

7

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Background:Renal dysfunction coexists with other known risk factors of left atrial (LA) structural remodeling, expressed as low-voltage zones (LVZs), and the recurrence of atrial fibrillation (AF) after ablation. This study aimed to determine whether renal dysfunction had an independent effect on the presence of LVZs and recurrence after AF ablation, using propensity score (PS) matching analysis.Methods and Results:448 consecutive patients who underwent their initial AF ablation were enrolled. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, with 126 (28%) patients having CKD. Using PS matching analysis, new subsets (CKD and non-CKD group, n=103 each) were obtained, matched for age, sex, AF type, and LA volume. The presence of LVZs defined as bipolar voltage <0.5 mV was higher in the CKD group than in the non-CKD group (31% vs. 17%, P=0.034). Multivariate analysis showed eGFR was an independent predictor of the presence of LVZs (odds ratio 1.31 per 10-mL/min/1.73 m2decrease, P=0.029). AF-free survival rate was significantly lower in the CKD patients during 20±9 months of follow-up (63% vs. 82%, P=0.019), and eGFR was shown to be an independent predictor of recurrence (hazard ratio 1.29 per 10-mL/min/1.73 m2decrease, P=0.006), but the presence of LVZs did not predict recurrence.Conclusions:Renal dysfunction independently predicted not only the recurrence of AF after ablation but also the presence of LVZs.

著者

Christian-Hendrik Heeger Enida Rexha Sabrina Maack Laura Rottner Thomas Fink Shibu Mathew Tilman Maurer Christine Lemeš Andreas Rillig Peter Wohlmuth Bruno Reissmann Roland Richard Tilz Feifan Ouyang Karl-Heinz Kuck Andreas Metzner

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-19-1144, (Released:2020-04-18)

参考文献数

20

被引用文献数

16

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Background:The second-generation cryoballoon (CB2) has demonstrated high procedural efficacy and convincing clinical success rates for pulmonary vein isolation (PVI). Nevertheless, data on the impact of different ablations protocols on durability are limited. The aim was to comparing the durability of PVI following 3 different ablation strategies in patients with recurrence of atrial fibrillation or atrial tachycardia undergoing repeat procedures.Methods and Results:In 192 patients, a total of 751 PVs were identified. All PVs were successfully isolated during index PVI. Thirty-one out of 192 (16%) patients were treated with a bonus-freeze protocol (group 1), 67/192 (35%) patients with a no bonus-freeze protocol (group 2), and 94/192 (49%) patients with a time-to-effect-guided protocol (group 3). Persistent PVI was documented in 419/751 (55.8%) PVs, and in 41/192 (21%) patients, all PVs were persistently isolated. The total rate of PV reconnection was not significantly different between the groups (P=0.134) and the comparison of individual PVs revealed no differences (P-values for RSPV: 0.424, RIPV: 0.541, LSPV: 0.788, LIPV: 0.346, LCPV: 0.865). The procedure times were significantly reduced by omitting the bonus-freeze and applying individualized application times (group 1: 123.4±31.5 min, group 2: 112.9±39.8 min, group 3: 86.67±28.4 min, P<0.001).Conclusions:Comparing 3 common ablation protocols, no differences for durable PVI were detected. Procedure times were significantly reduced by omitting the bonus-freeze cycle and by applying individualized application times.

著者

Tadafumi Sugimoto Atsushi Mizuno Takuya Kishi Naoya Ito Chisa Matsumoto Memori Fukuda Nobuyuki Kagiyama Tatsuhiro Shibata Takashi Ohmori Shogo Oishi Jun Fuse Keisuke Kida Fujimi Kawai Mari Ishida Shoji Sanada Issei Komuro Koichi Node

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.84, no.6, pp.1039-1043, 2020-05-25 (Released:2020-05-25)

参考文献数

37

被引用文献数

20

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Background:Despite the rapidly increasing attention being given to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, more commonly known as coronavirus disease 2019 (COVID-19), the relationship between cardiovascular disease and COVID-19 has not been fully described.Methods and Results:A systematic review was undertaken to summarize the important aspects of COVID-19 for cardiologists. Protection both for patients and healthcare providers, indication for treatments, collaboration with other departments and hospitals, and regular update of information are essentials to front COVID-19 patients.Conclusions:Because the chief manifestations of COVID-19 infection are respiratory and acute respiratory distress syndrome, cardiologists do not see infected patients directly. Cardiologists need to be better prepared regarding standard disinfection procedures, and be aware of the indications for extracorporeal membrane oxygenation and its use in the critical care setting.

著者

Tomohiko Taniguchi Takeshi Morimoto Hiroki Shiomi Kenji Ando Shinichi Shirai Norio Kanamori Koichiro Murata Takeshi Kitai Yuichi Kawase Kazushige Kadota Makoto Miyake Chisato Izumi Eri Minamino-Muta Takao Kato Katsuhisa Ishii Kazuya Nagao Naritatsu Saito Kenji Minatoya Takeshi Kimura on behalf of the CURRENT AS Registry Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-20-0026, (Released:2020-05-19)

参考文献数

20

被引用文献数

18

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Background:Patients with severe aortic stenosis (AS) might be at high risk for adverse cardiovascular events at the time of non-cardiac surgery.Methods and Results:The current study population included 348 patients who underwent elective non-cardiac surgery under general or spinal anesthesia during the follow up of 3,815 patients in the CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) registry. There were 187 patients with untreated severe AS at time of surgery (untreated severe AS group) and 161 patients who had undergone aortic valve replacement (AVR) before surgery (prior AVR group), including 23 patients with prophylactic AVR. The primary outcome measure was 30-day mortality after non-cardiac surgery. At 30 days after non-cardiac surgery, 8 patients (4.3%) died in the untreated severe AS group, while no patients died in the prior AVR group (P=0.008). The causes of death were cardiovascular in 6 out of 8 patients. Mortality at 30 days was higher in untreated severe AS patients with AS-related symptoms before surgery than in those without AS-related symptoms (7.2% vs. 3.1%). Higher surgical risk estimates of the non-cardiac surgery incrementally increased the risk of 30-day mortality in patients with untreated severe AS, though the difference was not statistically significant (low-risk: 0%, intermediate-risk: 4.3%, and high-risk: 6.6 %, P=0.46).Conclusions:Symptomatic and asymptomatic severe AS might be associated with higher risk of 30-day mortality if untreated before elective intermediate- and high-risk non-cardiac surgery, while no patient with prior AVR died after elective non-cardiac surgery.

著者

Akihito Miyoshi Nobuhiro Nishii Yoji Okamoto Shinpei Fujita Kenji Kawamoto Keisuke Okawa Shigeki Hiramatsu Kazufumi Nakamura Hiroshi Morita Hiroshi Ito

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.84, no.3, pp.456-462, 2020-02-25 (Released:2020-02-25)

参考文献数

21

被引用文献数

1 5

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Background:In heart failure (HF) patients implanted with high-energy devices, worsening of HF can be diagnosed from intrathoracic impedance (ITI) before symptoms appear. Early therapeutic intervention can prevent HF worsening, but the optimal intervention remains unknown. This study aimed to examine which lifestyle modifications or medications can improve HF indicators in asymptomatic HF patients diagnosed from ITI.Methods and Results:This multicenter, prospective, randomized study included patients with high-energy devices, left ventricular ejection fraction <40%, or with a history of HF hospitalization. After the OptiVol alert was evoked by decreased ITI, patients underwent examinations. If they were diagnosed with HF, they were randomly assigned to 3 groups: lifestyle modification, diuretic, or nitrate. After 1 week, they underwent the same examinations. The primary endpoint was change in ITI and serum B-type natriuretic peptide (BNP). Totally, 57 patients were randomized. In all 3 groups, ITI was significantly increased post-intervention compared with pre-intervention. In the diuretic and nitrate groups, logBNP post-intervention was significantly lower than pre-intervention, but not in the lifestyle modification group.Conclusions:Compared with lifestyle modifications, diuretic and nitrate therapy for 1 week may be more effective management of HF detected by decreased ITI. However, lifestyle modification may have the additional benefits of reducing the workload or cost.

著者

Atsushi Nakahira Yasuyuki Sasaki Hidekazu Hirai Toshihiro Fukui Manabu Motoki Yosuke Takahashi Hiroki Oe Toru Kataoka Shigefumi Suehiro

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.71, no.12, pp.1996-1998, 2007 (Released:2007-11-25)

参考文献数

7

被引用文献数

18 22

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Aneurysmal circumflex coronary artery (Cx) with fistulous connection to the coronary sinus is a rare clinical entity that usually remains asymptomatic until later in life, so the ideal therapeutic strategy is poorly defined. The timing of surgical treatment for asymptomatic patients is a big issue, and whether to leave or exclude the diffuse aneurysm in addition to ligation of the fistula is controversial, considering the native myocardial circulation. Complete surgical repair, including exclusion of a diffusely aneurysmal Cx and coronary revascularization to a graftable branch in the circumflex area combined with ligation of its fistula, is quite challenging and sometimes fatal because of a broad posterolateral myocardial infarction without revascularization caused by a lack of graftable branches. A case of diffuse aneurysmal Cx, which ruptured into the left atrium after surgical ligation of its fistulous connection to the coronary sinus, is presented. Simple ligation of the fistula, leaving a gigantic aneurysmal circumflex artery, is hazardous for later rupture and should be avoided. Therapeutic strategies for this complex disorder are discussed, including the optimal timing of surgical treatment. (Circ J 2007; 71: 1996 - 1998)

著者

Yasuaki Takeji Tomohiko Taniguchi Takeshi Morimoto Naritatsu Saito Kenji Ando Shinichi Shirai Genichi Sakaguchi Yoshio Arai Yasushi Fuku Yuichi Kawase Tatsuhiko Komiya Natsuhiko Ehara Takeshi Kitai Tadaaki Koyama Shin Watanabe Hirotoshi Watanabe Hiroki Shiomi Eri Minamino-Muta Shintaro Matsuda Hidenori Yaku Yusuke Yoshikawa Kazuhiro Yamazaki Masahide Kawatou Kazuhisa Sakamoto Toshihiro Tamura Makoto Miyake Hisashi Sakaguchi Koichiro Murata Masanao Nakai Norio Kanamori Chisato Izumi Hirokazu Mitsuoka Masashi Kato Yutaka Hirano Tsukasa Inada Kazuya Nagao Hiroshi Mabuchi Yasuyo Takeuchi Keiichiro Yamane Takashi Tamura Mamoru Toyofuku Mitsuru Ishii Moriaki Inoko Tomoyuki Ikeda Katsuhisa Ishii Kozo Hotta Toshikazu Jinnai Nobuya Higashitani Yoshihiro Kato Yasutaka Inuzuka Yuko Morikami Kenji Minatoya Takeshi Kimura on befalf of the CURRENT AS Registry Investigators and K-TAVI Registry Investigators

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-19-0951, (Released:2020-02-01)

参考文献数

35

被引用文献数

12

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Background:There are no data comparing transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) outcomes in real clinical practice in Japan.Methods and Results:We combined 2 independent registries, the K-TAVI Registry (a 6-center prospective registry of consecutive patients who underwent TAVI) and the CURRENT AS Registry (a large, 27-center registry of 3,815 consecutive patients with severe aortic stenosis [AS]). In the K-TAVI Registry, 338 patients underwent TAVI with SAPIEN XT balloon-expandable valves from October 2013 to January 2016, whereas in the CURRENT AS Registry 237 patients with severe AS underwent SAVR from January 2003 to December 2011. Propensity score matching was conducted, with final cohort comprising 306 patients. The cumulative 2-year incidence of all-cause death and heart failure (HF) hospitalization did not differ significantly between the TAVI and SAVR groups (13.7% vs. 12.4% [P=0.81] and 7.9% vs 3.9% [P=0.13], respectively). After adjusting for residual confounders, there were no significant differences between the TAVI and SAVR groups in the risk for all-cause death (hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.35–1.58; P=0.43) or HF hospitalization (HR 1.27; 95% CI 0.40–4.59; P=0.69).Conclusions:These findings from 2 independent Japanese registries suggest that the 2-year risk of all-cause mortality and HF does not differ significantly between TAVI and SAVR groups in real-world practice in Japan.

著者

Satomi Ishihara Rika Kawakami Maki Nogi Kaeko Hirai Yukihiro Hashimoto Yasuki Nakada Hitoshi Nakagawa Tomoya Ueda Taku Nishida Kenji Onoue Tsunenari Soeda Satoshi Okayama Makoto Watanabe Yoshihiko Saito

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-19-0620, (Released:2019-12-26)

参考文献数

30

被引用文献数

8

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Background:Countermeasure development for early rehospitalization for heart failure (re-HHF) is an urgent and important issue in Western countries and Japan.Methods and Results:Of 1,074 consecutive NARA-HF study participants with acute decompensated HF admitted to hospital as an emergency between January 2007 and December 2016, we excluded 291 without follow-up data, who died in hospital, or who had previous HF-related hospitalizations, leaving 783 in the analysis. During the median follow-up period of 895 days, 241 patients were re-admitted for HF. The incidence of re-HHF was the highest within the first 30 days of discharge (3.3% [26 patients]) and remained high until 90 days, after which it decreased sharply. Within 90 days of discharge, 63 (8.0%) patients were re-admitted. Kaplan-Meier analysis revealed that patients with 90-day re-HHF had worse prognoses than those without 90-day re-HHF in terms of all-cause death (hazard ratio [HR] 2.321, 95% confidence interval [CI] 1.654–3.174; P<0.001) and cardiovascular death (HR 3.396, 95% CI 2.153–5.145; P<0.001). Multivariate analysis indicated that only male sex was an independent predictor of 90-day re-HHF.Conclusions:The incidence of early re-HHF was lower in Japan than in Western countries. Its predictors are not related to the clinical factors of HF, indicating that a new comprehensive approach might be needed to prevent early re-HHF.

著者

Kazuo Miyazawa Hisashi Ogawa Michał Mazurek Eduard Shantsila Deirdre A. Lane Andreas Wolff Masaharu Akao Gregory Y.H. Lip

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-19-0546, (Released:2019-11-06)

参考文献数

31

被引用文献数

6

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Background:Guideline-adherent antithrombotic treatment (ATT) reduces the risk of stroke and death in patients with atrial fibrillation (AF). However, the effect of ATT adherence among different ethnicities remains uncertain. We compared the prognosis of AF patients in Japan and the UK according to guideline adherence status.Methods and Results:We compared the clinical characteristics and outcomes of AF patients from the Fushimi AF registry (Japan; n=4,239) and the Darlington AF registry (UK; n=2,259). ATT adherence was assessed against the Japanese Circulation Society Guidelines and UK National Institute for Health and Care Excellence guidelines. The rates of guideline-adherent ATT were 58.6% and 50.8% in the Fushimi and Darlington registries, respectively. There was no significant difference in 1-year stroke rates between Fushimi and Darlington (2.6% vs. 3.0%, P=0.342). On multivariate logistic regression analysis, non-guideline adherent-ATT was significantly associated with an increased risk of stroke (odds ratio [OR]: 1.69, 95% confidence interval [CI]: 1.21–2.34, P=0.002 for undertreatment, OR: 2.13, 95% CI: 1.19–3.80, P=0.010 for overtreatment). No significant interaction for ATT and the 2 populations was found in the incidence of stroke, all-cause death, and the composite outcome.Conclusions:Approximately half of the AF patients received optimal ATT according to guideline recommendations, which was associated with a lower risk of stroke. Furthermore, there was no interaction for the 2 populations and the influence of ATT adherence.

著者

Yasuo Okumura Koichi Nagashima Masaru Arai Ryuta Watanabe Katsuaki Yokoyama Naoya Matsumoto Takayuki Otsuka Shinya Suzuki Akio Hirata Masato Murakami Mitsuru Takami Masaomi Kimura Hidehira Fukaya Shiro Nakahara Takeshi Kato Wataru Shimizu Yu-ki Iwasaki Hiroshi Hayashi Tomoo Harada Ikutaro Nakajima Ken Okumura Junjiroh Koyama Michifumi Tokuda Teiichi Yamane Yukihiko Momiyama Kojiro Tanimoto Kyoko Soejima Noriko Nonoguchi Koichiro Ejima Nobuhisa Hagiwara Masahide Harada Kazumasa Sonoda Masaru Inoue Koji Kumagai Hidemori Hayashi Kazuhiro Satomi Yoshinao Yazaki Yuji Watari on behalf of the AF Ablation Frontier Registry

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-19-0602, (Released:2019-10-16)

参考文献数

27

被引用文献数

16

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Background:The safety of discontinuing oral anticoagulant (OAC) after ablation for atrial fibrillation (AF) in Japanese patients has not been clarified.Methods and Results:A study based on the Atrial Fibrillation registry to Follow the long-teRm Outcomes and use of aNTIcoagulants aftER Ablation (AF Frontier Ablation Registry) was conducted. Data were collected from 3,451 consecutive patients (74.1% men; age, 63.3±10.3 years) who had undergone AF ablation at any of 24 cardiovascular centers in Japan between August 2011 and July 2017. During a 20.7-month follow-up period, OAC therapy was discontinued in 1,836 (53.2%) patients; 51 patients (1.5%) suffered a stroke/transient ischemic attack (TIA), 71 (2.1%) suffered major bleeding, and 36 (1.0%) died. Patients in whom OAC therapy was discontinued were significantly younger than those in whom OACs were continued, and their CHA2DS2-VASc scores were significantly lower. The incidences of stroke/TIA, major bleeding, and death were significantly lower among these patients. Upon multivariate adjustment, stroke events were independently associated with relatively high baseline CHA2DS2-VASc scores but not with OAC status.Conclusions:Although the incidences of stroke/TIA, major bleeding, and death were relatively low among patients for whom OAC therapy was discontinued, stroke/TIA occurrence was strongly associated with a high baseline stroke risk rather than with OAC status. Thus, discontinuation of OAC therapy requires careful consideration, especially in patients with a high baseline stroke risk.

著者

Kenya Kusunose Yuta Torii Hirotsugu Yamada Susumu Nishio Yukina Hirata Yoshihito Saijo Takayuki Ise Koji Yamaguchi Daiju Fukuda Shusuke Yagi Takeshi Soeki Tetsuzo Wakatsuki Masataka Sata

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-19-0663, (Released:2019-10-12)

参考文献数

27

被引用文献数

6

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Background:Whether preoperative echocardiography improves postoperative outcomes is not well established, so we examined the value of echocardiographic assessment on the onset of postoperative heart failure (HF), and determining which patients benefitted most from undergoing echocardiography prior to major elective non-cardiac surgery.Methods and Results:We identified all patients aged 50 years and older who had major elective non-cardiac surgery, and excluded patients with previously identified severe cardiovascular disease. The primary endpoint was the onset of HF during hospitalization. A total of 806 patients were included in the analysis. During hospitalization, 49 patients (6%) reached the primary endpoint. Within the matched cohort, preoperative echocardiography was associated with a statistically significant decrease in postoperative HF (hazard ratio: 0.46, P=0.01). In subgroup analyses, age, sex, body surface area, hypertension, diabetes mellitus, prior HF, surgical type, chronic kidney disease, pulmonary disease, and malignancy influenced the association of echocardiography with postoperative HF.Conclusions:The use of echocardiography in elderly patients with certain risk factors was associated with improved postoperative outcomes. The basis for this finding remains to be determined; particularly whether echocardiography is simply a marker of a population with better outcomes or whether it leads to better management that improves outcomes.

著者

Tadanobu Yoshikawa Kenji Obayashi Kimie Miyata Tomo Nishi Tetsuo Ueda Norio Kurumatani Keigo Saeki Nahoko Ogata

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.83, no.10, pp.2044-2048, 2019-09-25 (Released:2019-09-25)

参考文献数

31

被引用文献数

1

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Background:Decreased light reception because of cataracts leads to potential circadian misalignment, resulting in exacerbation of atherosclerosis; however, little is known about the association between cataracts and atherosclerosis in populations.Methods and Results:In this cross-sectional study, cataracts were graded using slit lamp biomicroscopy with the Lens Opacities Classification System III and carotid atherosclerosis was assessed based on carotid intima-media thickness (IMT) measured using ultrasonography of the common carotid artery in 442 elderly participants (mean age, 70.0 years). Cataract was defined as nuclear cataract grade ≥3.0, cortical cataract grade ≥2.0, or posterior subcapsular cataract grade ≥2.0 in both eyes. The mean and maximal carotid IMT was 0.86±0.15 mm and 1.07±0.29 mm, respectively. In multivariable analysis adjusted for potential confounders, the mean and maximal carotid IMT were significantly greater in the cataract group than in the non-cataract group by 0.04 mm (95% confidence interval (CI), 0.01–0.06) and 0.07 mm (95% CI, 0.01–0.12), respectively. Logistic regression analysis adjusted for confounders revealed a significantly higher odds ratio for carotid atherosclerosis (maximal carotid IMT ≥1.1 mm) in the cataract group than in the non-cataract group (odds ratio, 1.78; 95% CI, 1.14–2.78).Conclusions:Cataracts may be independently associated with subclinical carotid atherosclerosis in the elderly population, indicating a need for further prospective studies.

著者

Kazutaka Aonuma Hiro Yamasaki Masato Nakamura Tatsushi Ootomo Morimasa Takayama Kenji Ando Kenzo Hirao Yoshihiro Morino Kentaro Hayashida Kengo Kusano Michael L. Main Shigeru Saito

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

vol.82, no.12, pp.2946-2953, 2018-11-24 (Released:2018-11-24)

参考文献数

22

被引用文献数

34

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Background: The PROTECT AF and PREVAIL trials demonstrated that the WATCHMAN left atrial appendage (LAA) closure device is a reasonable alternative to warfarin therapy for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) in the USA and Europe. We conducted the SALUTE trial to confirm the safety and efficacy of the LAA closure therapy for patients with NVAF in Japan. Methods and Results: A total of 54 subjects (including 12 Roll-in) with NVAF who had a CHA2DS2-VASc score ≥2 were enrolled. All subjects were successfully implanted with the LAA closure device. No serious adverse events related to the primary procedure-safety endpoint occurred. The 2nd co-primary endpoint was a composite of all stroke, systemic embolism and cardiovascular/unexplained death. One ischemic stroke (1/42) occurred during the 6-month follow-up. The effective LAA closure rate defined as the 3rd co-primary endpoint was 100% (42/42) at both 45-day and 6-month follow-up. Conclusions: The procedural safety and 6-month results from the SALUTE trial demonstrated that the LAA closure device was safe and effective, similar to the results of large-scale randomized clinical trials, and provides a novel perspective of LAA closure for Japanese patients with NVAF in need of an alternative to long-term oral-anticoagulation. (Trial Registration: clinicaltrials.gov Identifier NCT 03033134)

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

Junya Ako Kiyoshi Hibi Kenichi Tsujita Takafumi Hiro Yoshihiro Morino Ken Kozuma Toshiro Shinke Hiromasa Otake Kiyoko Uno Michael J Louie Yoshiharu Takagi Katsumi Miyauchi

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-19-0412, (Released:2019-08-20)

参考文献数

20

被引用文献数

34

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Background:In patients with acute coronary syndrome (ACS), alirocumab reduced the risk of recurring ischemic events. ODYSSEY J-IVUS assessed the effect of alirocumab on coronary atheroma volume in Japanese patients recently hospitalized with ACS and hypercholesterolemia, using intravascular ultrasound imaging analysis.Methods and Results:Patients (n=206) who at index ACS diagnosis either had low-density lipoprotein cholesterol (LDL-C) ≥2.59 mmol/L (≥100 mg/dL) despite stable statin therapy, or were not on statins with LDL-C levels above target after statin initiation, were randomized (1:1) to alirocumab (75 mg every 2 weeks [Q2 W]/up to 150 mg Q2 W), or standard of care (SoC; atorvastatin ≥10 mg/day or rosuvastatin ≥5 mg/day) for 36 weeks. The primary efficacy endpoint (week [W] 36 mean [standard error] percent change in normalized total atheroma volume [TAV] from baseline) was −3.1 (1.0)% with SoC vs. −4.8 (1.0)% with alirocumab (between-group difference: −1.6 [1.4]; P=0.23). W36 absolute change from baseline in percent atheroma volume was −1.3 (0.4)% (SoC) and −1.4 (0.4)% (alirocumab; nominal P=0.79). At W36, LDL-C was reduced from baseline by 13.4% (SoC) vs. 63.9% (alirocumab; nominal P<0.0001). In total, 61.8% (SoC) and 75.7% (alirocumab) of patients reported treatment-emergency adverse events.Conclusions:In Japanese patients with ACS and hypercholesterolemia inadequately controlled despite statin therapy, from baseline to W36, a numerically greater percent reduction in normalized TAV was observed with alirocumab vs. SoC, which did not reach statistical significance.