Faculty Profiles - NAKAGAWA Kouji

Papers - NAKAGAWA Kouji

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Impact of High-Sensitivity Cardiac Troponin T on Clinical Outcomes in Patients With Cardiac Sarcoidosis.

Yoichi Takaya, Koji Nakagawa, Toru Miyoshi, Nobuhiro Nishii, Hiroshi Morita, Kazufumi Nakamura, Shinsuke Yuasa

Circulation journal : official journal of the Japanese Circulation Society 2025.2

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The prognostic utility of high-sensitivity cardiac troponin T (hs-cTnT) on clinical outcomes in cardiac sarcoidosis (CS) remains unknown, so we evaluated hs-cTnT in the chronic phase of CS. METHODS AND RESULTS: We enrolled 92 consecutive patients with CS in the chronic phase after medical therapies. Patients were divided into 2 groups according to hs-cTnT level: 0.014 ng/mL: high hs-cTnT (n=37); normal hs-cTnT (n=55). The primary endpoint was cardiac death and the secondary endpoint was cardiac death, ventricular tachyarrhythmias, or hospitalization for heart failure. The mean age of patients was 63±11 years, and 75 received steroid treatment. During a median follow-up of 63 months, there were 9 cardiac deaths: 7 (19%) patients with high hs-cTnT and 2 (4%) patients with normal hs-cTnT. The rate of cardiac death was higher in patients with high hs-cTnT than in those with normal hs-cTnT (log-rank, P<0.01). Cox proportional hazard analysis showed that hs-cTnT was an independent predictor of cardiac death. The events rate was higher in patients with high hs-cTnT than in those with normal hs-cTnT (log-rank, P<0.01): cardiac death, ventricular tachyarrhythmias or hospitalization for heart failure occurred in 24 (65%) patients with high hs-cTnT and 11 (20%) patients with normal hs-cTnT. CONCLUSIONS: Elevated hs-cTnT was linked with adverse outcomes in CS patients, suggesting it is an effective prognostic biomarker.

DOI： 10.1253/circj.CJ-24-0801

Life-Threatening Ventricular Tachyarrhythmia in Isolated Cardiac Sarcoidosis Compared With Cardiac Sarcoidosis With Extracardiac Involvement International journal

Yoichi Takaya, Koji Nakagawa, Toru Miyoshi, Nobuhiro Nishii, Hiroshi Morita, Kazufumi Nakamura, Shinsuke Yuasa

The American Journal of Cardiology 238 65 - 69 2024.12

Language：English Publishing type：Research paper (scientific journal) Publisher：Elsevier BV

Although isolated cardiac sarcoidosis (CS) is not uncommon, little is known about the risk of life-threatening ventricular tachyarrhythmia. We aimed to evaluate the incidence of ventricular tachyarrhythmia in patients with isolated CS. A total of 94 patients with CS were enrolled. Isolated CS was diagnosed by histologic or clinical confirmation in the heart alone. The end points were sudden cardiac death, ventricular fibrillation, sustained ventricular tachycardia, or implantable cardioverter-defibrillator therapy for ventricular fibrillation or sustained ventricular tachycardia. A total of 25 patients were diagnosed with isolated CS, and 69 were diagnosed with CS with extracardiac involvement. As the initial cardiac manifestation leading to the CS diagnosis, 10 patients (40%) with isolated CS had ventricular tachyarrhythmia. Over the median follow-up of 48 months after the CS diagnosis, sudden cardiac death occurred in 2 patients (8%) with isolated CS. Ventricular fibrillation or sustained ventricular tachycardia, including implantable cardioverter-defibrillator therapy, occurred in 15 patients (60%) with isolated CS and 13 (19%) with CS with extracardiac involvement. The rate of ventricular tachyarrhythmia was higher in patients with isolated CS than in those with CS with extracardiac involvement (log-rank, p <0.01). Cox proportional hazard analysis showed that isolated CS was independently associated with ventricular tachyarrhythmia. A total of 2 or more ventricular tachyarrhythmias more frequently occurred in patients with isolated CS (52% vs 13%, p <0.01). Electric storm more frequently occurred in patients with isolated CS (24% vs 6%, p = 0.01). In conclusion, patients with isolated CS have ventricular tachyarrhythmia at a higher rate than those with CS with extracardiac involvement.

DOI： 10.1016/j.amjcard.2024.12.002

Crescent-Shaped Atrial Septal Defect: A New Clinical Entity of an Acquired Defect for Transcatheter Closure. International journal

Mitsutaka Nakashima, Teiji Akagi, Yoichi Takaya, Takashi Miki, Rie Nakayama, Koji Nakagawa, Norihisa Toh, Kazufumi Nakamura, Shinsuke Yuasa

JACC. Asia 4 ( 12 ) 1013 - 1016 2024.12

Efficacy of Ivabradine in Preventing Inappropriate Shock due to Sinus Tachycardia in a Patient with Cardiac Sarcoidosis

Takuro Masuda, Kazufumi Nakamura, Nobuhiro Nishii, Saori Asada, Akira Ueoka, Masakazu Miyamoto, Koji Nakagawa, Yoichi Takaya, Hironobu Toda, Hiroshi Morita, Shinsuke Yuasa

International Heart Journal 65 ( 6 ) 1167 - 1171 2024.11

Language：English Publishing type：Research paper (scientific journal) Publisher：International Heart Journal (Japanese Heart Journal)

We herein report a case of left ventricular dysfunction due to cardiac sarcoidosis following cardiac resynchronization therapy defibrillator (CRT-D) in an 87-year-old man. He presented to our hospital after receiving shock therapy while conscious. Device interrogation revealed that inappropriate shock occurred due to sinus tachycardia. Due to the setting of a low ventricular tachycardia (VT) detection rate because of a history of slow VT, increasing the VT detection rate was not feasible. After initiation of treatment with ivabradine, the sinus rate decreased and there was no recurrence of inappropriate shock during a 3-year follow-up period. Ivabradine was effective for preventing inappropriate shock due to sinus tachycardia.

DOI： 10.1536/ihj.24-323

Differences in clinical significance of atrial tachyarrhythmias in idiopathic ventricular fibrillation vs Brugada syndrome: A multicenter study International journal

Tomofumi Mizuno, Nobuhiro Nishii, Hiroshi Morita, Takuro Masuda, Akira Ueoka, Saori Asada, Yoshimasa Morimoto, Masakazu Miyamoto, Satoshi Kawada, Tadashi Wada, Shigeki Hiramatsu, Keisuke Okawa, Motoki Kubo, Koji Nakagawa, Atsuyuki Watanabe, Kazufumi Nakamura, Shinsuke Yuasa

Heart Rhythm O2 5 ( 11 ) 796 - 804 2024.11

Language：English Publishing type：Research paper (scientific journal) Publisher：Elsevier BV

BACKGROUND: Atrial tachyarrhythmias (ATAs) are the primary cause of inappropriate implantable cardioverter-defibrillator (ICD) therapy in patients with idiopathic ventricular fibrillation (IVF) and are associated with decreased quality of life and increased mortality. Nonetheless, the incidence of ATAs in IVF cases has not been clarified. OBJECTIVE: The study sought to determine the incidence and clinical significance of ATAs in patients with IVF compared with those with Brugada syndrome (BrS). METHODS: Patients diagnosed with IVF or BrS and receiving ICDs in 6 hospitals were enrolled between February 1997 and July 2020 to compute data regarding the incidence of ATAs, appropriate/inappropriate ICD therapy frequency, and independent predictors of ATAs. RESULTS: Overall, 137 patients (51 in the IVF group and 86 in the BrS group) were enrolled. ATAs were detected in 22 (43.1%) patients in the IVF group and 17 (19.8%) in the BrS group (P = .006). Inappropriate ICD therapies due to ATAs were more frequently observed in the IVF group than in the BrS group (12 [23.5%] vs 7 [8.1%]; P = .020). Conversely, there was no significant difference in appropriate ICD therapies between the IVF and BrS groups (14 [27.5%] vs 23 [27.1%]; P = 1.000). Cox regression analysis revealed no predictive factors for the development of ATAs in the IVF group. CONCLUSION: ATA events were observed more frequently in patients with IVF than in those with BrS, and ATAs led to inappropriate ICD therapy in patients with IVF. Clinicians need to consider the recurrence of not only ventricular arrhythmias, but also the development of atrial arrhythmias for better management of IVF cases.

DOI： 10.1016/j.hroo.2024.09.001

Fenestrated GORE® CARDIOFORM ASD occluder for transcatheter atrial septal defect closure in a geriatric patient.

Mitsutaka Nakashima, Teiji Akagi, Takashi Miki, Rie Nakayama, Yoichi Takaya, Koji Nakagawa, Satoshi Akagi, Norihisa Toh, Kazufumi Nakamura

Journal of cardiology cases 30 ( 2 ) 31 - 34 2024.8

Language：English Publishing type：Research paper (scientific journal)

UNLABELLED: An 82-year-old man with a secundum atrial septal defect (ASD) underwent transcatheter closure. The patient had a wide area of aortic and superior rim deficiency, with left ventricular diastolic dysfunction and moderate mitral regurgitation. These findings suggested the risk of both cardiac erosion and increased left atrial pressure after closure. To avoid cardiac erosion, a GORE® CARDIOFORM ASD (GCA) occluder (W.L. Gore & Associates, Flagstaff, AZ, USA) was considered an appropriate device in this patient. However, the possibility of excessively high left atrial pressure due to complete defect closure was a concern. Thus, we created a 4.5-mm fenestration using a surgical punch in the fabric membrane of a 44-mm GCA. The device was deployed in an appropriate position, and no significant elevation of pulmonary capillary wedge pressure was observed. One month after the closure, marked improvement in clinical symptoms and continuous flow through the fenestration were observed. This novel fenestration technique may contribute to expansion of the indications for transcatheter ASD closure in patients who require a GCA owing to an anatomically high risk of erosion accompanied by left ventricular diastolic dysfunction. LEARNING OBJECTIVE: In elderly patients with left ventricular diastolic dysfunction, transcatheter atrial septal defect (ASD) closure is difficult because rapid resolution of an ASD shunt can cause an increase in left atrial pressure. Previous reports described the creation of a fenestration in the closure device. The use of a GORE® CARDIOFORM ASD (GCA) occluder can reduce the erosion risk; however, creating a stable fenestration is difficult. We developed a novel technique to create a stable fenestration in a GCA.

DOI： 10.1016/j.jccase.2024.04.001

Reply to the letter, "Residual shunt after patent foramen ovale closure: The devil is in the details!" regarding article "Relationship between patent foramen ovale anatomical features and residual shunt after patent foramen ovale closure". International journal

Rie Nakayama, Yoichi Takaya, Teiji Akagi, Rika Takemoto, Madoka Haruna, Mitsutaka Nakashima, Takashi Miki, Koji Nakagawa, Norihisa Toh, Kazufumi Nakamura, Shinsuke Yuasa

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 104 ( 3 ) 633 - 634 2024.7

Impact of extracardiac sarcoidosis on clinical outcomes in patients with cardiac sarcoidosis: Importance of continued screening for cardiac involvement. International journal

Yoichi Takaya, Koji Nakagawa, Toru Miyoshi, Nobuhiro Nishii, Hiroshi Morita, Kazufumi Nakamura, Shinsuke Yuasa

International journal of cardiology 413 132368 - 132368 2024.7

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The prognostic impact of extracardiac sarcoidosis remains unknown in cardiac sarcoidosis (CS). We aimed to evaluate the influence of extracardiac sarcoidosis on clinical outcomes and the effect of continued outpatient visits for screening of cardiac involvement. METHODS: Ninety-nine patients with CS were divided into two groups: patients with systemic CS who had prior extracardiac sarcoidosis, patients with isolated CS who had no prior extracardiac sarcoidosis. Patients with systemic CS were divided according to the continuation of outpatient visits. The endpoint was cardiac death, fatal ventricular arrhythmia, or hospitalization for heart failure. RESULTS: At the time of diagnosing CS, patients with isolated CS had a higher prevalence of high-grade atrioventricular block or fatal ventricular arrhythmia, and left ventricular contractile dysfunction than those with systemic CS. Over a median follow-up of 42 months, cardiac events occurred in 19 (37%) of 52 patients with systemic CS and in 27 (57%) of 47 patients with isolated CS. The event-free survival rate was worse in patients with isolated CS than in those with systemic CS. Cox proportional hazard analysis showed that the absence of prior extracardiac sarcoidosis was an independent predictor of adverse outcomes. Patients with systemic CS who ceased outpatient visits had a lower left ventricular ejection fraction with severe heart failure symptoms and a worse event-free survival rate than those who continued outpatient visits. CONCLUSIONS: The presence of extracardiac sarcoidosis is associated with clinical outcomes. The cessation of screening for cardiac involvement after diagnosing extracardiac sarcoidosis is associated with adverse outcomes.

DOI： 10.1016/j.ijcard.2024.132368

Late gadolinium enhancement in early repolarization syndrome International journal

Hiroshi Morita, Saori Asada, Satoshi Nagase, Akira Ueoka, Takuro Masuda, Masakazu Miyamoto, Koji Nakagawa, Nobuhiro Nishii, Shinsuke Yuasa

Heart Rhythm 2024.7

Language：English Publishing type：Research paper (scientific journal) Publisher：Elsevier BV

BACKGROUND: In patients with Brugada syndrome, myocardial fibrosis can be identified through epicardial biopsy or cardiac magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE). However, the myocardial alterations in patients with early repolarization syndrome (ERS) remain poorly elucidated. OBJECTIVE: The objective of this study was to investigate the presence of myocardial fibrosis in patients with ERS by LGE in CMR. METHODS: We retrospectively evaluated 20 patients with ERS, all of whom exhibited J waves in the contiguous 2 leads. The location of J waves was classified as in the septum (V1-V2), anterior (V3-V4), lateral (I, aVL, V5-V6), inferior (II, III, aVF), or posterior (V7-V9) regions. To compare the distribution of LGE on CMR imaging with J waves, sections on short-axis view of the left ventricle (LV) were categorized as located in the septum, anterior, lateral, inferior, and posterior regions. RESULTS: Overall, 85% of ERS patients displayed LGE, which was more prevalent in the septum and posterior regions, followed by the inferior and lateral regions. The presence or absence of J waves and LGE coincided in 61% of LV areas, whereas discordance between the distributions of J waves and LGE was observed in 38%. LGE was most frequent in the septum (75%), where its reflection in J waves may be less robust. The appearance of LGE was not associated with symptoms, electrical storm, or ventricular fibrillation occurrence during follow-up. CONCLUSION: LGE is common in patients with ERS, and the distribution of J waves and LGE coincides in approximately 60% of LV areas.

DOI： 10.1016/j.hrthm.2024.07.116

Clinical characteristics of electrical storm in patients with early repolarization syndrome International journal

Hiroshi Morita, Akira Ueoka, Tomofumi Mizuno, Takuro Masuda, Saori Asada, Kentaro Ejiri, Masakazu Miyamoto, Satoshi Kawada, Koji Nakagawa, Nobuhiro Nishii, Shinsuke Yuasa

Heart Rhythm 21 ( 5 ) 562 - 570 2024.5

Language：English Publishing type：Research paper (scientific journal) Publisher：Elsevier BV

BACKGROUND: Early repolarization syndrome (ERS) is an idiopathic ventricular fibrillation (VF) associated with inferolateral J waves. While electrical storm (ES) in ERS is not rare, their characteristics and risk factors are not fully understood. OBJECTIVE: This study aimed to clarify the significance of ES in ERS. METHODS: We evaluated 44 patients with ERS who experienced VF/sudden cardiac death or arrhythmic syncope. We assessed clinical characteristics to identify the risk factors for ES. RESULTS: In total, 13 patients (30%) experienced ES (ES group). Of these, 11 patients (85%) experienced ES during the acute phase of initial VF episodes and 2 patients (2%) experienced ES during follow-up. VF associated with ES occurred during therapeutic hypothermia in 6 of 13 patients (46%). The J-wave voltage during therapeutic hypothermia was higher in the ES group than that in the patients without ES. Isoproterenol was used in 5 patients (38%), which decreased J-wave voltage and relieved ES. Among the clinical markers, shorter QT and QTp intervals (the interval from QRS onset to the peak of T wave), pilsicainide-induced ST elevation, and high scores on the Shanghai Score System were associated with ES. Although pilsicainide induced ST elevation in 6 of 34 patients (18%), spontaneous Brugada electrocardiographic patterns did not appear to be associated with VF. Therapeutic hypothermia was also a risk factor for acute phase ES. CONCLUSION: Patients with ERS in the ES group frequently had short QT and QTp intervals, pilsicainide-induced ST elevations, and high Shanghai Score System scores. Therapeutic hypothermia was also associated with acute phase ES.

DOI： 10.1016/j.hrthm.2024.01.016

Risk stratification for the occurrence of ventricular fibrillation in patients with early repolarization syndrome International journal

Hiroshi Morita, Saori Asada, Akira Ueoka, Tomofumi Mizuno, Takuro Masuda, Masakazu Miyamoto, Satoshi Kawada, Koji Nakagawa, Nobuhiro Nishii, Shinsuke Yuasa

Heart Rhythm 21 ( 10 ) 1787 - 1794 2024.5

Language：English Publishing type：Research paper (scientific journal) Publisher：Elsevier BV

BACKGROUND: Several signs of malignant early repolarizations have been proposed in patients with early repolarization syndrome (ERS). However, reports have challenged the efficacy of these signs in predicting future ventricular fibrillation (VF) in patients with ERS. OBJECTIVE: This study aimed to assess the predictive value of various electrocardiogram (ECG) markers for future VF events in patients with ERS. METHODS: We retrospectively evaluated the clinical characteristics of 44 patients with ERS to identify risk factors for VF during follow-up. RESULTS: After the initial event, 16 patients experienced VF (VF group), whereas 28 did not (non-VF group). The VF group had a longer QRS interval, more fragmented QRS (fQRS), and a higher T/R voltage ratio than the non-VF group. Wide J waves were more prevalent in the VF group; however, other J-wave markers did not differ between the groups. Positive late potentials recorded on signal-averaged ECGs were more frequent in the VF group. Whereas none of the patients showed spontaneous Brugada syndrome on ECG, the VF group frequently exhibited pilsicainide-induced ST-segment elevation. These ECG markers were significantly associated with the occurrence of VF during follow-up. Patients with multiple ECG factors, including QRS abnormalities (wide QRS or fQRS), wide J waves, and a high T/R ratio, had a worse prognosis than patients without multiple factors, effectively stratifying patient risk. CONCLUSION: The occurrence of VF in patients with ERS may be associated with conduction abnormalities such as QRS widening, fQRS, high T/R ratio, positive late potentials, and pilsicainide test results. Therefore, ECG factors could be useful in identifying high-risk patients.

DOI： 10.1016/j.hrthm.2024.04.101

Idiopathic ventricular tachycardia detected after coronavirus disease 2019.

Koichiro Yamamoto, Koji Nakagawa, Fumio Otsuka

Journal of general and family medicine 25 ( 3 ) 164 - 165 2024.5

Artificial intelligence to detect noise events in remote monitoring data

Nobuhiro Nishii, Kensuke Baba, Ken'ichi Morooka, Haruto Shirae, Tomofumi Mizuno, Takuro Masuda, Akira Ueoka, Saori Asada, Masakazu Miyamoto, Kentaro Ejiri, Satoshi Kawada, Koji Nakagawa, Kazufumi Nakamura, Hiroshi Morita, Shinsuke Yuasa

Journal of Arrhythmia 40 ( 3 ) 560 - 577 2024.4

Language：English Publishing type：Research paper (scientific journal) Publisher：Wiley

Abstract

Background

Remote monitoring (RM) of cardiac implantable electrical devices (CIEDs) can detect various events early. However, the diagnostic ability of CIEDs has not been sufficient, especially for lead failure. The first notification of lead failure was almost noise events, which were detected as arrhythmia by the CIED. A human must analyze the intracardiac electrogram to accurately detect lead failure. However, the number of arrhythmic events is too large for human analysis. Artificial intelligence (AI) seems to be helpful in the early and accurate detection of lead failure before human analysis.

Objective

To test whether a neural network can be trained to precisely identify noise events in the intracardiac electrogram of RM data.

Methods

We analyzed 21 918 RM data consisting of 12 925 and 1884 Medtronic and Boston Scientific data, respectively. Among these, 153 and 52 Medtronic and Boston Scientific data, respectively, were diagnosed as noise events by human analysis. In Medtronic, 306 events, including 153 noise events and randomly selected 153 out of 12 692 nonnoise events, were analyzed in a five‐fold cross‐validation with a convolutional neural network. The Boston Scientific data were analyzed similarly.

Results

The precision rate, recall rate, F1 score, accuracy rate, and the area under the curve were 85.8 ± 4.0%, 91.6 ± 6.7%, 88.4 ± 2.0%, 88.0 ± 2.0%, and 0.958 ± 0.021 in Medtronic and 88.4 ± 12.8%, 81.0 ± 9.3%, 84.1 ± 8.3%, 84.2 ± 8.3% and 0.928 ± 0.041 in Boston Scientific. Five‐fold cross‐validation with a weighted loss function could increase the recall rate.

Conclusions

AI can accurately detect noise events. AI analysis may be helpful for detecting lead failure events early and accurately.

DOI： 10.1002/joa3.13037

Relationship between patent foramen ovale anatomical features and residual shunt after patent foramen ovale closure.

Rie Nakayama, Yoichi Takaya, Teiji Akagi, Rika Takemoto, Madoka Haruna, Mitsutaka Nakashima, Takashi Miki, Koji Nakagawa, Norihisa Toh, Kazufumi Nakamura

Cardiovascular intervention and therapeutics 39 ( 2 ) 200 - 206 2024.4

Language：English Publisher：(一社)日本循環器学会

Transcatheter closure of patent foramen ovale (PFO) is an effective strategy for preventing recurrence of paradoxical embolism. However, PFO closure is often associated with residual shunt, which is a risk of recurrent stroke. This study aimed to evaluate the relationship between the anatomical features of PFO and residual shunt. The degree of residual shunt and its relationship with the anatomical features of PFO were evaluated in 106 patients who underwent PFO closure at our institution between March 2011 and January 2022 and in whom contrast transthoracic echocardiography was performed 1 year later. The mean PFO tunnel length was 9.3 ± 3.6 mm and the mean PFO height was 3.2 ± 2.2 mm. Atrial septal aneurysm (ASA) was found in 37 patients. After PFO closure, residual shunt was observed in 28 patients (grade 1, n = 8; grade 2, n = 16; grade 3, n = 3; grade 4, n = 1). Univariate logistic analysis identified ASA to be associated with residual shunt (odds ratio 2.78, 95% confidence interval 1.14 to 6.79; p = 0.024). There was no association of residual shunt with the size of the PFO, the length of PFO tunnel, or the size of the device used for closure. Two of four patients with a large residual shunt of grade 3 or grade 4 were found to have device size mismatch. Residual shunt after PFO closure was observed in a quarter of patients and was related to the presence of ASA. A few patients had a large residual shunt due to the device size mismatch.

DOI： 10.1007/s12928-023-00979-y

Feasibility of Treat and Repair Strategy in Congenital Heart Defects With Pulmonary Arterial Hypertension. International journal

Satoshi Akagi, Shingo Kasahara, Teiji Akagi, Kentaro Ejiri, Toshiharu Mitsuhashi, Koji Nakagawa, Kazufumi Nakamura, Hiroshi Ito

JACC. Advances 3 ( 4 ) 100887 - 100887 2024.4

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: A treatment strategy for congenital heart defects with moderate to severe pulmonary arterial hypertension (PAH) has not been established. OBJECTIVES: The purpose of this study was to identify patients in whom a treat and repair strategy was considered and to examine pretreatment variables associated with successful defect repair. METHODS: Patients with atrial or ventricular septal defect and PAH (pulmonary vascular resistance [PVR] ≥ 5 Wood units) eligible for the treat and repair strategy were included. Hemodynamics among pretreatment, pre-repair, and post-defect repair were compared. Clinical outcomes in patients with or without defect repair were also compared. Clinical outcomes included all-cause death, hospitalization for worsening pulmonary hypertension, and lung transplantation. RESULTS: Among 25 eligible for the treat and repair strategy, 20 underwent successful repair (repaired group) and 5 did not have a repair (unrepaired group). In the repaired group, PVR significantly decreased from 9.6 ± 2.6 WU at pretreatment to 5.0 ± 3.4 pre-repair (ß coefficient -4.6 [95% CI: -5.9 to -3.3]). The pulmonary to systemic blood flow ratio (Qp/Qs) increased from 1.5 ± 0.6 at pretreatment to 2.4 ± 1.3 pre-repair (ß coefficient 0.9 [95% CI: 0.4-1.38]). In the unrepaired group, pretreatment PVR decreased with treatment; however, PVR remained elevated. Qp/Qs did not change between pretreatment and post-treatment. The repaired group had a better prognosis than the unrepaired group (HR 0.092 [95% CI: 0.009-0.905]). Pretreatment mean pulmonary artery pressure, PVR, Qp/Qs, and arterial oxygen saturations were associated with undergoing defect repair. CONCLUSIONS: In this small cohort, a treat and repair strategy was successfully used in a significant proportion of the patients with congenital heart defects with moderate to severe PAH.

DOI： 10.1016/j.jacadv.2024.100887

Prevalence of Iron Deficiency and Its Association with Exercise Capacity in Adult Fontan Patients(タイトル和訳中)

中島充貴, 杜徳尚, 赤木禎治, 中山理絵, 三木崇史, 高谷陽一, 赤木達, 中川晃志, 西井伸洋, 中村一文

日本循環器学会学術集会抄録集 88回 PJ027 - 2 2024.3

Usefulness of cardiac CT for optimal device selection for PDA closure in adulthood

三木崇史, 赤木禎治, 中島充貴, 中山理絵, 高谷陽一, 中川晃志, 杜徳尚, 中村一文

日本成人先天性心疾患学会雑誌(Web) 13 ( 1 ) 124 - 124 2024.1

A Successful Case of Atraial Septal Defect Diagnosed as Pulmonary Arterial Hypertension after Delivery and Underwent Treat and Repair Strategy.

古田めぐみ, 中島充貴, 赤木禎治, 三木崇史, 中山理絵, 高谷陽一, 中川晃志, 赤木達, 杜徳尚, 西井伸洋, 中村一文, 松原広己

日本成人先天性心疾患学会雑誌(Web) 13 ( 1 ) 143 - 143 2024.1

Significant delayed conduction and characteristic ventricular tachycardias in patients with cardiac sarcoidosis and electrical storm. International journal

Hiroshi Morita, Koji Nakagawa, Akira Ueoka, Tomofumi Mizuno, Takuro Masuda, Saori Asada, Masakazu Miyamoto, Satoshi Kawada, Nobuhiro Nishii, Kazufumi Nakamura

Journal of cardiovascular electrophysiology 35 ( 2 ) 307 - 316 2023.12

Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: Electrical storm (ES) of ventricular tachyarrhythmias (VTAs) is an important cause of sudden death in patients with cardiac sarcoidosis (CS). VTAs in CS are associated with myocardial scarring and inflammation. However, little is known about the risk factors of ES in patients with CS and VTAs. The objective of this study is to clarify the characteristics and risk factors for the development of ES in patients with CS. METHODS: The study population included consecutive 52 patients with CS and sustained VTA. Twenty-five out of 52 patients experienced ES. We evaluated clinical characteristics, imaging modalities, and electrocardiogram (ECG) parameters to determine the risk factors associated with ES. RESULTS: Half of the patients experienced VTAs as the initial symptom of sarcoidosis, and eight patients had ES as the initial VTA episode. There were no differences in cardiac imaging abnormalities between patients with and without ES. Among ECG markers, significant QRS fragmentation (odds ratio [OR]: 7.9, p = .01) and epsilon waves (OR: 12.24, p = .02) were associated with ES. Among the ventricular tachycardia (VT) characteristics, multiple morphologies of monomorphic VTs (OR: 10.9, p < .01), short VT cycle lengths (OR: 12.5, p < .01), and polymorphic VT (OR: 13.5, p < .01) were associated with ES. Bidirectional VTs were detected in 10 patients with ES and one patient without ES. Immunosuppressive therapy relieved ES in some patients. CONCLUSIONS: ES was common in patients with CS and VTAs. Significant depolarization abnormalities that appeared as QRS fragmentation, epsilon waves, and specific VT characteristics were associated with ES.

DOI： 10.1111/jce.16156

A variability of the QRS morphology during wide QRS tachycardia. International journal

Saori Asada, Koji Nakagawa, Nobuhiro Nishii, Hiroshi Morita, Kazufumi Nakamura

Pacing and clinical electrophysiology : PACE 46 ( 12 ) 1568 - 1571 2023.12

Management of sensing issues with a subcutaneous implantable cardioverter-defibrillator in a patient with Brugada syndrome: A case report. International journal

Satoshi Kawada, Nobuhiro Nishii, Tomofumi Mizuno, Masakazu Miyamoto, Koji Nakagawa, Hiroshi Morita

HeartRhythm case reports 9 ( 12 ) 878 - 882 2023.12

Initial results of transcatheter modification of left atrial appendage by obliteration with device in patients with nonvalvular atrial fibrillation: Real-world data from the TERMINATOR registry. International journal

Hidehiko Hara, Shunsuke Kubo, Yoshifumi Nakajima, Takashi Matsumoto, Yusuke Kondo, Hiroki Sugane, Kenji Okubo, Koji Nakagawa, Daisuke Nagatomo, Daisuke Hachinohe, Shigeki Kusa, Masahiko Goya, Mamoru Nanasato, Takeshi Arita, Hiro Yamasaki, Kensuke Kuwabara, Tomotaka Yoshiyama, Nobuaki Tanaka, Masaharu Masuda, Tomohiro Sakamoto, Masaki Nakashima, Yohei Ohno, Shigeru Saito, Masato Fukunaga

Journal of cardiology 83 ( 5 ) 298 - 305 2023.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Percutaneous left atrial appendage closure (LAAC) has increased for those who need alternative to long-term anticoagulation with non-valvular atrial fibrillation (NVAF). METHODS AND RESULTS: From September 2019, after initiating WATCHMAN (Boston Scientific, Maple Grove, MN, USA) device implantation, we established Transcatheter Modification of Left Atrial Appendage by Obliteration with Device in Patients from the NVAF (TERMINATOR) registry. Utilizing 729 patients' data until January 2022, we analyzed percutaneous LAAC data regarding this real-world multicenter prospective registry. A total of 729 patients were enrolled. Average age was 74.9 years and 28.5 % were female. Paroxysmal AF was 37.9 % with average CHADS2 3.2, CHA2DS2-VASc 4.7, and HAS-BLED score of 3.4. WATCHMAN implantation was successful in 99.0 %. All-cause deaths were 3.2 %, and 1.2 % cardiovascular or unexplained deaths occurred during follow-up [median 222, interquartile range (IQR: 93-464) days]. Stroke occurred in 2.2 %, and the composite endpoint which included cardiovascular or unexplained death, stroke, and systemic embolism were counted as 3.4 % [median 221, (IQR: 93-464) days]. Major bleeding defined as BARC type 3 or 5 was seen in 3.7 %, and there was 8.6 % of all bleeding events in total [median 219, (IQR: 93-464) days]. CONCLUSIONS: These preliminary data demonstrated percutaneous LAAC with WATCHMAN device might have a potential to reduce stroke and bleeding events for patients with NVAF. Further investigation is mandatory to confirm the long-term results of this strategy using this transcatheter local therapy instead of life-long systemic anticoagulation.

DOI： 10.1016/j.jjcc.2023.09.010

Syncope and loss of consciousness after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: Prevalence and characteristics in long-term follow-up. International journal

Saori Asada, Hiroshi Morita, Tomofumi Mizuno, Takuro Masuda, Akira Ueoka, Masakazu Miyamoto, Satoshi Kawada, Koji Nakagawa, Nobuhiro Nishii

Heart rhythm O2 4 ( 10 ) 641 - 649 2023.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Syncope is a significant prognostic factor in patients with Brugada syndrome (BrS). However, the risk of ventricular arrhythmia in patients with nonarrhythmic loss of consciousness (LOC) is similar to that in asymptomatic patients. LOC events after implantable cardioverter-defibrillator (ICD) implantation may provide insights into underlying causes of the initial LOC episode. OBJECTIVE: The purpose of this study was to examine LOC characteristics following ICD implantation. METHODS: We retrospectively analyzed 112 patients with BrS (mean age 47 years; 111 men) who were treated with an ICD. The patients were classified into 3 groups based on symptoms at implantation: asymptomatic (35 patients); LOC (46 patients); and ventricular tachyarrhythmia (VTA) (31 patients). We evaluated the incidence and cause of LOC during long-term follow-up after ICD implantation. RESULTS: During mean follow-up of 12.2 years, 41 patients (37%) experienced LOC after ICD implantation. Arrhythmic LOC occurred in 5 asymptomatic patients, 14 LOC patients, and 16 patients with VTA. Nonarrhythmic LOC, similar to the initial episode, occurred after ICD implantation in 6 patients with prior LOC (2 with neurally mediated syncope and 4 with epilepsy). Most epileptic patients experienced LOC during rest or sleeping, and did not show an abnormal encephalogram during initial evaluation of the LOC episodes. CONCLUSION: After ICD implantation, 13% of patients had nonarrhythmic LOC similar to the initial episode. Accurate classification of LOC based on a detailed medical history is important for risk stratification, although distinguishing arrhythmic LOC from epilepsy-related LOC episodes can be challenging depending on the circumstances and characteristics of the LOC event.

DOI： 10.1016/j.hroo.2023.09.007

Ventricular arrhythmias induced by phase 2 reentry in a patient with J-wave syndrome. International journal

Satoshi Kawada, Hiroshi Morita, Masakazu Miyamoto, Saori Asada, Koji Nakagawa, Nobuhiro Nishii

HeartRhythm case reports 9 ( 9 ) 629 - 633 2023.9

GORE CARDIOFORM Septal Occluderを用いた経皮的卵円孔開存閉鎖術の国内初期成績

中島充貴, 赤木禎治, 三木崇史, 中山理絵, 高谷陽一, 中川晃志, 杜徳尚, 中村一文

日本心臓病学会学術集会抄録 71回 O - 1 2023.9

Significance of left posterior extension of early repolarization in patients with J-wave syndrome. International journal

Masakazu Miyamoto, Hiroshi Morita, Tomofumi Mizuno, Takuro Masuda, Akira Ueoka, Saori Asada, Satoshi Kawada, Koji Nakagawa, Nobuhiro Nishii

Heart rhythm 20 ( 12 ) 1729 - 1736 2023.8

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: J waves in the inferior or lateral leads are characteristic electrocardiographic (ECG) changes in patients with early repolarization syndrome (ERS). However, the presence of J waves in the left posterior region has not yet been evaluated. OBJECTIVE: The purpose of this study was to clarify the significance of J waves in the posterior left ventricle using leads V7-V9 and a body surface mapping (BSM) system. METHODS: Forty patients diagnosed with ERS were included. All patients exhibited J waves in either the contiguous inferior, lateral, or posterior leads. We evaluated the incidence of J waves in the inferolateral and posterior leads using a 15-lead ECG with synthesized V7-V9 and an 87-lead BSM. Additionally, we assessed the arrhythmogenicity of the posterior regions based on the morphology of the premature ventricular complexes (PVCs) associated with ventricular fibrillation (VF). RESULTS: J waves were observed in the lateral, inferior, and posterior leads of 26 (65%), 31 (78%), and 39 (97%) patients, respectively. J waves were found only in the posterior leads of 5 patients. BSM was evaluated in 9 patients, all of whom exhibited a positive area on the posterior region. PVCs associated with VF were recorded in 5 patients. Among patients with inferolateral and posterior J waves, all except 1 patient who displayed left bundle branch block morphology showed PVCs originating from the posterior left ventricular region. CONCLUSION: Posterior J waves are common in ERS patients. This abnormality can be detected using leads V7-V9 and the BSM system and may be associated with arrhythmogenesis.

DOI： 10.1016/j.hrthm.2023.08.032

奇異性脳塞栓症を起こした卵円孔開存は心臓CTでどのように見えるのか?

三木崇史, 中川晃志, 辻真弘, 中島充貴, 西原大裕, 中山理絵, 高谷陽一, 三好亨, 赤木禎治, 伊藤浩

日本心血管インターベンション治療学会抄録集 31回 MO66 - 5 2023.8

Prevalence and Treatment of Arrhythmias in Patients With Transthyretin and Light-Chain Cardiac Amyloidosis. Reviewed

Masakazu Miyamoto, Kazufumi Nakamura, Koji Nakagawa, Nobuhiro Nishii, Satoshi Kawada, Akira Ueoka, Saori Asada, Atsuyuki Watanabe, Hiroshi Morita, Hiroshi Ito

Circulation reports 5 ( 7 ) 298 - 305 2023.7

Language：English Publishing type：Research paper (scientific journal)

Background: Various types of arrhythmia are observed in patients with cardiac amyloidosis, but the prevalence of arrhythmia has not been fully investigated. This study investigated the prevalence and treatment of arrhythmias in patients with cardiac amyloidosis before the introduction of new agents for amyloidosis, such as tafamidis. Methods and Results: Of 53 patients who were histologically diagnosed with cardiac amyloidosis at 10 centers in western Japan between 2009 and 2021, 43 who were diagnosed on the basis of immunohistochemical staining were evaluated in this study. Of these 43 patients, 13 had immunoglobulin light-chain (AL) amyloidosis and 30 had transthyretin (ATTR) amyloidosis; further, 27 had atrial tachyarrhythmia, 13 had ventricular tachyarrhythmia, and 17 had bradyarrhythmia. Atrial fibrillation (AF) was the most common arrhythmia in patients with cardiac amyloidosis (n=24; 55.8%), especially among those with ATTR amyloidosis (70.0% of ATTR vs. 23.1% of AL). Eleven (25.6%) patients were treated with a cardiac implantable device. All 3 patients with pacemakers were alive at the last follow-up (median 76.7 months; interquartile range [IQR] 4.8-146.4 months). Of the 8 patients who underwent AF ablation, there was no recurrence in 6 (75%) after a median of 39.3 months (IQR 19.8-59.3 months). Conclusions: The prevalence of various arrhythmias was high in patients with cardiac amyloidosis. AF occurred most frequently in patients with cardiac amyloidosis, especially among patients with ATTR.

DOI： 10.1253/circrep.CR-23-0022

Significant Delayed Activation on the Right Ventricular Outflow Tract Represents Complete Right Bundle-Branch Block Pattern in Brugada Syndrome. International journal

Yoshimasa Morimoto, Hiroshi Morita, Kentaro Ejiri, Tomofumi Mizuno, Takuro Masuda, Akira Ueoka, Saori Asada, Masakazu Miyamoto, Satoshi Kawada, Koji Nakagawa, Nobuhiro Nishii, Kazufumi Nakamura, Hiroshi Ito

Journal of the American Heart Association 12 ( 10 ) e028706 2023.5

Language：English Publishing type：Research paper (scientific journal)

Background The appearance of complete right bundle-branch block (CRBBB) in Brugada syndrome (BrS) is associated with an increased risk of ventricular fibrillation. The pathophysiological mechanism of CRBBB in patients with BrS has not been well established. We aimed to clarify the significance of a conduction delay zone associated with arrhythmias on CRBBB using body surface mapping in patients with BrS. Methods and Results Body surface mapping was recorded in 11 patients with BrS and 8 control patients both with CRBBB. CRBBB in control patients was transiently exhibited by unintentional catheter manipulation (proximal RBBB). Ventricular activation time maps were constructed for both of the groups. We divided the anterior chest into 4 areas (inferolateral right ventricle [RV], RV outflow tract [RVOT], intraventricular septum, and left ventricle) and compared activation patterns between the 2 groups. Excitation propagated to the RV from the left ventricle through the intraventricular septum with activation delay in the entire RV in the control group (proximal RBBB pattern). In 7 patients with BrS, excitation propagated from the inferolateral RV to the RVOT with significant regional activation delay. The remaining 4 patients with BrS showed a proximal RBBB pattern with the RVOT activation delay. The ventricular activation time in the inferolateral RV was significantly shorter in patients with BrS without a proximal RBBB pattern than in control patients. Conclusions The CRBBB morphology in patients with BrS consisted of 2 mechanisms: (1) significantly delayed conduction in the RVOT and (2) proximal RBBB with RVOT conduction delay. Significant RVOT conduction delay without proximal RBBB resulted in CRBBB morphology in patients with BrS.

DOI： 10.1161/JAHA.122.028706

Diagnostic Performance of Cardiac Computed Tomography for Detecting Patent Foramen Ovale: Evaluation Using Transesophageal Echocardiography and Catheterization as Reference Standards. International journal

Takashi Miki, Koji Nakagawa, Keishi Ichikawa, Tomofumi Mizuno, Rie Nakayama, Kentaro Ejiri, Satoshi Kawada, Yoichi Takaya, Masakazu Miyamoto, Toru Miyoshi, Teiji Akagi, Hiroshi Ito

Journal of cardiovascular development and disease 10 ( 5 ) 2023.4

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Patent foramen ovale (PFO) is associated with various diseases such as cryptogenic stroke, migraine, and platypnea-orthodeoxia syndrome. This study aimed to evaluate the diagnostic performance of cardiac computed tomography (CT) for PFO detection. MATERIALS AND METHODS: Consecutive patients diagnosed with atrial fibrillation and who underwent catheter ablation with pre-procedural cardiac CT and transesophageal echocardiography (TEE) were enrolled in this study. The presence of PFO was defined as (1) the confirmation of PFO using TEE and/or (2) the catheter crossing the interatrial septum (IAS) into the left atrium during ablation. CT findings indicative of PFO included (1) the presence of a channel-like appearance (CLA) on the IAS and (2) a CLA with a contrast jet flow from the left atrium to the right atrium. The diagnostic performance of both a CLA alone and a CLA with a jet flow was evaluated for PFO detection. RESULTS: Altogether, 151 patients were analyzed in the study (mean age, 68 years; men, 62%). Twenty-nine patients (19%) had PFO confirmed by TEE and/or catheterization. The diagnostic performance of a CLA alone was as follows: sensitivity, 72.4%; specificity, 79.5%; positive predictive value (PPV), 45.7%; negative predictive value (NPV), 92.4%. The diagnostic performance of a CLA with a jet flow was as follows: sensitivity, 65.5%; specificity, 98.4%; PPV, 90.5%; NPV, 92.3%. The diagnostic performance of a CLA with a jet flow was statistically superior to that of a CLA alone (p = 0.045), and the C-statistics were 0.76 and 0.82, respectively. CONCLUSION: A CLA with a contrast jet flow in cardiac CT has a high PPV for PFO detection, and its diagnostic performance is superior to that of a CLA alone.

DOI： 10.3390/jcdd10050193

Pulmonary arteriovenous fistula in a rare location: The importance of excluding patent foramen ovale.

Mitsutaka Nakashima, Takashi Miki, Yoichi Takaya, Rie Nakayama, Koji Nakagawa, Satoshi Akagi, Norihisa Toh, Teiji Akagi, Hiroshi Ito

Journal of cardiology cases 27 ( 3 ) 124 - 127 2023.3

Language：English

UNLABELLED: A 46-year-old woman with a history of repeated thromboembolic stroke and anti-phospholipid antibody syndrome was referred to our hospital. Saline contrast transthoracic echocardiography showed that microbubbles appeared in the left atrium within 4 heartbeats. Thus, she was initially suspected as having a patent foramen ovale with associated paradoxical embolism. However, no evidence of patent foramen ovale or atrial septal defect could be found using transesophageal echocardiography. Saline contrast transesophageal echocardiography showed that microbubbles flowed into the left atrium through the left superior pulmonary vein. Ultimately, she was diagnosed as having a pulmonary arteriovenous malformation located at the upper left pulmonary lobe using contrast computed tomography and pulmonary artery angiography. Pulmonary arteriovenous malformations are typically located in the lower lobe of either lung and, in bubble studies, contrast appears in the left atrium after 4 heartbeats. Here, the pulmonary arteriovenous malformation was in the upper lobe, and contrast appeared in the left atrium at an earlier time point: one associated with patent foramen ovale. These findings made it difficult to differentiate the two diseases initially. This case suggests that pulmonary arteriovenous malformation should be carefully considered, even if microbubbles appear in the left atrium early on a saline contrast transthoracic echocardiograph. LEARNING OBJECTIVE: Pulmonary arteriovenous malformation occasionally appears in the upper lobe. In these cases, microbubbles may appear in the left atrium after detection in the right atrium with a time-course that is suggestive of a patent foramen ovale. Therefore, diagnosis should be carefully confirmed by using other multimodal imaging tests, such as transesophageal echocardiography, contrast computed tomography, or pulmonary artery angiography.

DOI： 10.1016/j.jccase.2022.11.005

Utility of Plasm Volume Status Calculation in Adult Fontan Patients(タイトル和訳中)

中島充貴, 杜徳尚, 川田哲史, 高谷陽一, 中川晃志, 三好亨, 西井伸洋, 赤木禎治, 伊藤浩

日本循環器学会学術集会抄録集 87回 OJ62 - 6 2023.3

Morphological Features on Cardiac CT of Patent Foramen Ovale Causing Cryptogenic Stroke(タイトル和訳中)

三木崇史, 中川晃志, 辻真弘, 中島充貴, 西原大裕, 中山理絵, 高谷陽一, 三好亨, 赤木禎治, 伊藤浩

日本循環器学会学術集会抄録集 87回 PJ004 - 6 2023.3

潜因性脳卒中を引き起こす卵円孔開存の心臓CTにおける形態学的特徴(Morphological Features on Cardiac CT of Patent Foramen Ovale Causing Cryptogenic Stroke)

三木崇史, 中川晃志, 辻真弘, 中島充貴, 西原大裕, 中山理絵, 高谷陽一, 三好亨, 赤木禎治, 伊藤浩

日本循環器学会学術集会抄録集 87回 PJ004 - 6 2023.3

Temporary balloon occlusion test can overestimate the risk of acute pulmonary edema after transcatheter atrial septal defect closure. International journal

Koji Nakagawa, Teiji Akagi, Yoichi Takaya, Takashi Miki, Yasufumi Kijima, Rie Nakayama, Norihisa Toh, Nobuhiro Nishii, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Ito

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2023.1

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Atrial septal defect (ASD) closure can cause acute pulmonary edema. Before transcatheter closure is performed, temporary balloon occlusion test (BOT) is recommended in patients with left ventricular dysfunction to predict the risk of pulmonary edema. However, the accuracy of BOT has not been verified. This study aimed to compare hemodynamic differences between BOT and transcatheter closure. METHODS: A total of 42 patients with a single ASD over age 18 years who underwent BOT before transcatheter ASD closure between October 2010 and May 2020 were analyzed. Pulmonary capillary wedge pressure (PCWP) was measured using a Swan-Ganz catheter placed in the pulmonary artery at baseline, after 10 min of BOT, and after transcatheter closure. Amplatzer septal occluder was used for all transcatheter closures. RESULTS: Mean patient age was 64 ± 18 years (range, 18-78). Mean ASD diameter and pulmonary to systemic flow ratio were 18 ± 5 and 2.8 ± 1.0 mm, respectively. Mean PCWP at baseline, during BOT, and after transcatheter closure was 8.9 ± 2.9, 13.5 ± 4.2, and 9.5 ± 2.6 mmHg, respectively. The difference between BOT and after transcatheter closure values was significant (p < 0.001). During BOT, PCWP increased ≥18 mmHg in 7 patients, whereas after ASD closure, PCWP was <18 mmHg in all 7 and none developed acute pulmonary edema. CONCLUSION: Temporary balloon occlusion of an ASD and transcatheter ASD closure result in different hemodynamic change. BOT overestimates increase of PCWP after transcatheter ASD closure and requires careful interpretation. Well-designed, larger studies in higher-risk patients are warranted to verify the clinical implications of BOT in more detail.

DOI： 10.1002/ccd.30556

Impact of right ventricular restrictive physiology on outcomes in tetralogy of Fallot after pulmonary valve replacement

中島充貴, 杜徳尚, 小谷恭弘, 川田哲史, 高谷陽一, 中川晃志, 西井伸洋, 中村一文, 森田宏, 赤木禎治, 笠原真悟, 伊藤浩

日本成人先天性心疾患学会雑誌(Web) 12 ( 1 ) 149 - 149 2023.1

Morphological Features on Cardiac CT of Patent Foramen Ovale Causing Cryptogenic Stroke

三木崇史, 中川晃志, 辻真弘, 中島充貴, 西原大裕, 中山理絵, 高谷陽一, 三好亨, 赤木禎治, 伊藤浩

日本成人先天性心疾患学会雑誌(Web) 12 ( 1 ) 158 - 158 2023.1

Calculated Plasma Volume Status Reflects Elevated Central Venous Pressure and Worse Prognosis in Adult Fontan Patients

中島充貴, 杜徳尚, 川田哲史, 高谷陽一, 中川晃志, 三好亨, 西井伸洋, 赤木禎治, 伊藤浩

日本成人先天性心疾患学会雑誌(Web) 12 ( 1 ) 136 - 136 2023.1

Initial experience of transcatheter atrial septal defect closure using Gore Cardioform ASD closure

古田めぐみ, 赤木禎治, 三木崇史, 西原大裕, 中山理絵, 高谷陽一, 中川晃志, 伊藤浩

日本成人先天性心疾患学会雑誌(Web) 12 ( 1 ) 154 - 154 2023.1

Tackling Atrial Septal Defects in Adults

杜徳尚, 高谷陽一, 中川晃志, 赤木禎治, 伊藤浩

日本小児循環器学会雑誌 38 ( 4 ) 229 - 233 2022.12

Gore Cardioform ASD Occluderを用いた経皮的心房中隔欠損閉鎖術の初期成績

古田めぐみ, 赤木禎治, 三木崇史, 西原大裕, 中山理絵, 高谷陽一, 中川晃志, 伊藤浩

日本心臓病学会学術集会抄録 70回 O - 3 2022.9

ブレイン・ハートチームで挑む脳卒中予防・治療戦略地域で築くブレイン・ハートネットワーク PFOに起因する奇異性脳塞栓患者を的確に診断し治療に導く方策は?

三木崇史, 赤木禎治, 西原大裕, 中山理絵, 高谷陽一, 中川晃志, 伊藤浩, 木村舞

日本心臓病学会学術集会抄録 70回 S13 - 2 2022.9

Overview of the 86th Annual Scientific Meeting of the Japanese Circulation Society - Cardiology Spreading Its Wings.

Kazufumi Nakamura, Toru Miyoshi, Satoshi Akagi, Norihisa Toh, Yukihiro Saito, Yoichi Takaya, Masatoki Yoshida, Koji Nakagawa, Satoshi Kawada, Hironobu Toda, Takashi Miki, Rie Nakayama, Fumi Yokohama, Keishi Ichikawa, Masashi Yoshida, Makiko Taniyama, Nobuhiro Nishii, Teiji Akagi, Hiroshi Morita, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 86 ( 8 ) 1312 - 1318 2022.7

Language：English Publishing type：Research paper (scientific journal)

The 86thAnnual Scientific Meeting of the Japanese Circulation Society was held in a web-based format on March 11-13, 2022. In accordance with the internationalization policy of the JCS, the meeting was held with the Asian Pacific Society of Cardiology Congress 2022. The main theme was "Cardiology Spreading its Wings". The number of patients with heart failure and other cardiovascular diseases is increasing dramatically, and the fields dealt with by cardiovascular medicine are also greatly expanding. This conference was both intellectually satisfying and exciting for all participants, who numbered over 14,900. The meeting was completed with great success, and the enormous amount of cooperation and support from all involved was greatly appreciated.

DOI： 10.1253/circj.CJ-22-0349

Amplatzer PFO Occluderを使用した経カテーテル卵円孔開存閉鎖術の初期成績

三木崇史, 赤木禎治, 中山理絵, 高谷陽一, 中川晃志, 伊藤浩

日本心血管インターベンション治療学会抄録集 30回 [MO397] - [MO397] 2022.7

心臓CTによる卵円孔開存の診断能についての検討

三木崇史, 中川晃志, 市川啓之, 水野智文, 中山理絵, 川田哲史, 高谷陽一, 宮本真和, 三好亨, 赤木禎治, 伊藤浩

日本心血管インターベンション治療学会抄録集 30回 [MO267] - [MO267] 2022.7

Gore Cardioform ASD Occluderを用いた心房中隔欠損症のカテーテル閉鎖術経食道エコーによるダブル4ポイント評価法

赤木禎治, 三木崇史, 高谷陽一, 中山理絵, 中川晃志, 伊藤浩

日本心血管インターベンション治療学会抄録集 30回 [MO398] - [MO398] 2022.7

Intermittent orthodromic capture of the earliest activation site during atrial pacing in a case with reentrant atrial tachycardia originating from the atrioventricular node vicinity.

Akira Ueoka, Satoshi Nagase, Koji Nakagawa, Hiroshi Morita, Hiroshi Ito

Journal of arrhythmia 38 ( 3 ) 473 - 477 2022.6

Language：English Publishing type：Research paper (scientific journal)

Constant pacing (S1-S1: 520 ms) from the right atrial appendage (RAA) during reentrant atrial tachycardia originating from the atrioventricular node vicinity. RA-FW 1-2 was constantly captured antidromically. However, the earliest atrial activation site (EAAS = His1-2) was orthodromically (red circle) and antidromically (blue square) captured at a ratio of 3:1. The electrogram morphology at the EAAS was different between orthodromically and antidromically electrograms captured during pacing. Moreover, the interval between the S1 and orthodromically captured electrogram was gradually prolonged.

DOI： 10.1002/joa3.12702

Ablation for unmappable ventricular tachycardia in a patient with complete transposition of the great arteries who underwent Rastelli repair.

Takashi Nishimoto, Nobuhiro Nishii, Saori Asada, Koji Nakagawa, Hiroshi Morita, Hiroshi Ito

Journal of cardiology cases 25 ( 4 ) 218 - 224 2022.4

Language：English

Catheter ablation (CA) of ventricular tachycardia (VT) after repair of congenital heart disease may be difficult because of complex anatomy and sometimes unmappable VT. Here, we report a 41-year-old woman with successful CA of unmappable VT in a patient with complete transposition of the great arteries after Rastelli repair. Clinical VT was induced by programmed electrical stimulation, when the mapping catheter was placed at the high anterior right ventricular outflow tract (RVOT). During VT, the local potential at the high anterior RVOT under the right ventricle (RV) - pulmonary artery (PA) conduit was equal to that at the timing of onset of QRS. The VT was unmappable because the hemodynamics deteriorated. Pace mapping was also tried at the aortic cusp and the left ventricular outflow tract (LVOT). Fractionated potential during sinus rhythm was observed at the noncoronary cusp, and the paced QRS morphology at this site was similar to that of the clinical VT, with a delay of 55 ms from pacing to the onset of QRS. However, mapping at the LVOT was impossible due to the difficulty of catheter manipulation. Radiofrequency energy was successfully applied at the noncoronary cusp and the high anterior RVOT under the RV-PA conduit. <Learning objective: This report is a rare case of successful catheter ablation of unmappable ventricular tachycardia (VT) in a patient with complete transposition of the great arteries after Rastelli repair. The VT was unmappable because of intolerable hemodynamics. However, we could speculate the exit or isthmus of the VT by pace mapping or local potential and eliminate the VT.>.

DOI： 10.1016/j.jccase.2021.09.012

奇異性脳塞栓症患者における卵円孔開存(PFO)形態について年齢や心形態による検討

中山理絵, 高谷陽一, 赤木禎治, 三木崇史, 横濱ふみ, 中川晃志, 杜徳尚, 伊藤浩

超音波医学 49 ( Suppl. ) S700 - S700 2022.4

潜因性脳梗塞の再発予防を目指した経皮的卵円孔開存閉鎖術の初期経験患者プロファイルと手術成績(Initial Experiences of Transcatheter Patent Foramen Ovale Closure for Prevention of Recurrent Cryptogenic Stroke: Patient's Profile and Procedure Outcome)

三木崇史, 赤木禎治, 中山理絵, 高谷陽一, 中川晃志, 伊藤浩

日本循環器学会学術集会抄録集 86回 PJ23 - 4 2022.3

Impact of Transvenous Pacing Leads on Systemic Thromboemboli in patients with Intracardiac Shunts

中島充貴, 杜徳尚, 西井伸洋, 高谷陽一, 川田哲史, 中川晃志, 森田宏, 赤木禎治, 伊藤浩

日本成人先天性心疾患学会雑誌(Web) 11 ( 1 ) 197 - 197 2022.1

Outcomes and complications after transcatheter device closure for patent foramen ovale: a single-center experience

三木崇史, 赤木禎治, 中山理絵, 高谷陽一, 中川晃志, 伊藤浩

日本成人先天性心疾患学会雑誌(Web) 11 ( 1 ) 253 - 253 2022.1

Left atrial appendage morphology with the progression of atrial fibrillation. International journal

Yoichi Takaya, Rie Nakayama, Fumi Yokohama, Norihisa Toh, Koji Nakagawa, Masakazu Miyamoto, Hiroshi Ito

PloS one 17 ( 11 ) e0278172 2022

Language：English Publishing type：Research paper (scientific journal)

Left atrial appendage (LAA) size is crucial for determining the indication of transcatheter LAA closure. The aim of this study was to evaluate the differences in LAA morphology according to the types of atrial fibrillation (AF). A total of 299 patients (mean age: 67 ± 13 years) who underwent transesophageal echocardiography (TEE) were included. Patients were classified into non-AF (n = 64), paroxysmal AF (n = 86), persistent AF (n = 87), or long-standing persistent AF (n = 62). LAA morphology, including LAA ostial diameter and depth, was assessed using TEE. Patients with long-standing persistent AF had larger LAA ostial diameter and depth and lower LAA flow velocity. The maximum LAA ostial diameter was 19 ± 4 mm in patients with non-AF, 21 ± 4 mm in patients with paroxysmal AF, 23 ± 5 mm in patients with persistent AF, and 26 ± 5 mm in patients with long-standing persistent AF. LAA ostial diameter was increased by 2 or 3 mm with the progression of AF. LAA ostial diameter was correlated with LA volume index (R = 0.37, P < 0.01) and the duration of continuous AF (R = 0.30, P < 0.01), but not with age or the period from the onset of AF. In conclusion, LAA size was increased with the progression of AF.

DOI： 10.1371/journal.pone.0278172

Fragmented QRS as a predictor of cardiac events in patients with cardiac sarcoidosis. International journal

Soichiro Ogura, Kazufumi Nakamura, Hiroshi Morita, Koji Nakagawa, Nobuhiro Nishii, Satoshi Akagi, Norihisa Toh, Yoichi Takaya, Masashi Yoshida, Toru Miyoshi, Atsuyuki Watanabe, Hiroshi Ito

Journal of cardiology 79 ( 3 ) 446 - 452 2021.11

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Multiple spikes within the QRS complex, known as fragmented QRS (fQRS), are associated with the occurrences of ventricular arrhythmic events (VAEs) in patients with Brugada syndrome and hypertrophic cardiomyopathy. However, the association between fQRS and occurrence of VAEs in patients with cardiac sarcoidosis (CS) has not been elucidated. METHODS: We evaluated the associations between fQRS and cardiac events including VAEs [non-sustained ventricular tachycardia (NSVT), sustained ventricular tachycardia (VT), and ventricular fibrillation (VF)], hospitalization for heart failure, and all-cause death in 68 patients with CS (30 patients with fQRS vs. 38 patients without fQRS) over a 5-year period. RESULTS: Cardiac events occurred in 22 patients with fQRS and 18 patients without fQRS (73% vs. 47%, p=0.009). Of the cardiac events that occurred in CS patients, VAEs occurred more frequently in patients with fQRS than in patients without fQRS (VAEs: 70% vs. 45%, p=0.017; NSVT: 70% vs. 45%, p=0.010; VT: 43% vs. 18%, p=0.011, and VF: 6.7% vs. 2.6%, p=0.34), whereas there was no significant difference in hospitalization for heart failure or all-cause death between patients with and those without fQRS (hospitalization for heart failure: 6.7% vs. 5.3%, p=0.75; all-cause death: 6.7% vs. 5.3%, p=0.64). Multivariate analysis showed that fQRS in the baseline electrocardiogram was independently associated with VAEs (hazard ratio: 2.21, 95% confidence interval: 1.15-4.25, p=0.017). CONCLUSION: fQRS is a predictor of VAEs in patients with CS.

DOI： 10.1016/j.jjcc.2021.10.022

Importance of direct right-to-left shunt as high-risk patent foramen ovale associated with cryptogenic stroke. International journal

Yoichi Takaya, Rie Nakayama, Teiji Akagi, Fumi Yokohama, Takashi Miki, Koji Nakagawa, Norihisa Toh, Hiroshi Ito

Echocardiography (Mount Kisco, N.Y.) 38 ( 11 ) 1887 - 1892 2021.11

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Because transcatheter closure of patent foramen ovale (PFO) has become effective for preventing cryptogenic stroke (CS), it is necessary to determine high-risk PFO associated with CS. This study aimed to clarify the importance of direct right-to-left (RL) shunt through the PFO for identifying high-risk PFO. METHODS: We analyzed 137 patients with and without CS who were confirmed to have PFO. The timing of RL shunt through the PFO was evaluated by cardiac cycles after right atrium (RA) opacification on saline contrast transesophageal echocardiography. Direct RL shunt was defined as microbubbles crossing the PFO before and at the same time of RA opacification. RESULTS: Cardiac cycles of microbubbles crossing the PFO were shorter in patients with CS than in those without CS (2.0 ± 2.2 vs .5 ± 1.1, p < 0.01). Direct RL shunt was more frequently observed in patients with CS than in those without CS (77% vs 29%, p < 0.01), with a sensitivity of 79% and a specificity of 71% for the association with CS. Multivariate analysis revealed that direct RL shunt was related to atrial septal aneurysm and low-angle PFO. Regarding functional features of PFO, the detection rate of CS was 50% for large RL shunt alone, and was increased to 83% when direct RL shunt was added. CONCLUSION: Direct RL shunt was associated with CS and had the incremental value in detecting PFO associated with CS for large RL shunt. The timing of RL shunt can be valuable for identifying high-risk PFO.

DOI： 10.1111/echo.15234

Successful ablation of a superior fast-slow atrioventricular reentrant tachycardia in a patient with congenitally corrected transposition of great arteries. International journal

Satoshi Kawada, Nobuhiro Nishii, Saori Asada, Koji Nakagawa, Hiroshi Morita, Hiroshi Ito

HeartRhythm case reports 7 ( 10 ) 698 - 701 2021.10

Importance of saline contrast transthoracic echocardiography for evaluating large right-to-left shunt in patent foramen ovale associated with cryptogenic stroke. International journal

Yoichi Takaya, Rie Nakayama, Teiji Akagi, Fumi Yokohama, Takashi Miki, Koji Nakagawa, Norihisa Toh, Hiroshi Ito

The international journal of cardiovascular imaging 38 ( 3 ) 515 - 520 2021.9

Language：English Publishing type：Research paper (scientific journal)

Transcatheter closure of patent foramen ovale (PFO) is an effective therapy for preventing recurrent stroke in very specific patient cohorts, such as cryptogenic stroke (CS). The identification of high-risk PFO, which is more likely to be linked to CS, is essential. This study aimed to assess the accuracy of saline contrast transthoracic echocardiography (TTE) for evaluating large right-to-left (RL) shunt. We enrolled 119 patients with or without CS who were confirmed to have PFO by transesophageal echocardiography (TEE) or catheterization. The severity of RL shunt evaluated by TTE and TEE was classified as follows: small (< 10 microbubbles), moderate (10-20 microbubbles), and large (> 20 microbubbles). With TTE, large RL shunt was observed in 94 (79%) of 119 patients, including 66 of 74 with CS and 28 of 45 without CS. With TEE, large RL shunt was observed in 33 (28 %) patients, including 26 with CS and 7 without CS. TTE showed large RL shunt more frequently than TEE (p < 0.01). Large RL shunt evaluated by TTE had a sensitivity of 89 % and an accuracy of 70 % for the association with CS, whereas large RL shunt evaluated by TEE had a sensitivity of 35% and an accuracy of 56 %. Accuracy was significantly greater in TTE than in TEE (p = 0.02). In conclusion, TTE identified large RL shunt associated with CS with higher sensitivity and accuracy compared to TEE. Our findings suggest that the decision for device closure should be made based on the severity of RL shunt by TTE.

DOI： 10.1007/s10554-021-02418-6

Pathological and clinical effects of interleukin-6 on human myocarditis. International journal

Naofumi Amioka, Kazufumi Nakamura, Tomonari Kimura, Keiko Ohta-Ogo, Takehiro Tanaka, Tomohiro Toji, Satoshi Akagi, Koji Nakagawa, Norihisa Toh, Masashi Yoshida, Toru Miyoshi, Nobuhiro Nishii, Atsuyuki Watanabe, Ryotaro Asano, Takeshi Ogo, Yoshikazu Nakaoka, Hiroshi Morita, Hiroyuki Yanai, Hiroshi Ito

Journal of cardiology 78 ( 2 ) 157 - 165 2021.8

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Numerous basic studies have shown a relationship between interleukin-6 (IL-6) and the development or severity of myocarditis. However, there has been no study in which the effect of IL-6 levels in patients with myocarditis was evaluated. METHODS: We enrolled control patients (n = 12) and consecutive patients with acute myocarditis (n = 13), including lymphocytic, eosinophilic, and giant cell myocarditis, and investigated the pathological and clinical effects of IL-6 on human myocarditis. RESULTS: The serum IL-6 level in patients with myocarditis (16.7 [9.9, 103.8] pg/mL) was significantly higher than that in the control patients (1.4 [1.0, 1.9] pg/mL) (P<0.001). Immunohistochemical analysis showed that IL-6 was expressed in infiltrating inflammatory cells of endomyocardial biopsy samples from all patients with myocarditis. Moreover, the log-transformed value of serum IL-6 level showed significant positive correlations with serum creatine kinase (CK) level, CK-MB level, peak CK level, peak CK-MB level and C-reactive protein level (all P ≤ 0.005) and a negative correlation with the left ventricular (LV) ejection fraction (p = 0.014). We divided the patients with myocarditis into a low IL-6 group (9.9 [4.5, 14.2] pg/dL, n = 7) and a high IL-6 group (108.9 [51.1, 130.9] pg/dL, n = 6). The degree of infiltration of IL-6-expressing inflammatory cells in myocardial samples obtained from patients in the high IL-6 group was significantly more severe than that in samples obtained from patients in the low IL-6 group. Furthermore, patients in the high IL-6 group significantly more frequently received catecholamine therapy (P = 0.005), venoarterial extracorporeal membrane oxygenation (P = 0.029), and artificial respirator support (P = 0.021) in the acute phase of myocarditis. CONCLUSION: The results suggest that there is a strong impact of IL-6 on cardiac injury and dysfunction in patients with myocarditis.

DOI： 10.1016/j.jjcc.2021.03.003

An Evaluation of the Safety and Feasibility of Adenosine-assisted Clipping Surgery for Unruptured Cerebral Aneurysms: Study Protocol.

Tomohito Hishikawa, Satoshi Murai, Masafumi Hiramatsu, Jun Haruma, Kazuhiko Nishi, Yuki Ebisudani, Yu Sato, Takao Yasuhara, Kenji Sugiu, Kazuyoshi Shimizu, Motomu Kobayashi, Koji Nakagawa, Aya Kimura-Ono, Katsuyuki Hotta, Hiroshi Morimatsu, Isao Date

Neurologia medico-chirurgica 61 ( 7 ) 393 - 396 2021.7

Language：English Publishing type：Research paper (scientific journal)

The effectiveness of adenosine-induced flow arrest in surgical clipping for the cerebral aneurysms with difficulties in temporary clip placement to the proximal main trunk has been reported. This is the first clinical trial to evaluate the safety and feasibility of adenosine-assisted clipping surgery for unruptured cerebral aneurysms (UCAs) in Japan. The inclusion criteria are as follows: patients over 20 years old, patients who agree to be enrolled in this study after providing informed consent, patients who undergo clipping surgery for UCA in our institute, and patients in whom the surgeons (T.H. or I.D.) judge that decompression of the aneurysm is effective. The primary endpoint is a modified Rankin Scale (mRS) score 30 days after surgery. We plan to enroll 10 patients in this study. The original protocol of adenosine administration was established in this trial. Herein, we present the study protocol.

DOI： 10.2176/nmc.st.2021-0018

Efficacy of treat-and-repair strategy for atrial septal defect with pulmonary arterial hypertension. International journal

Yoichi Takaya, Teiji Akagi, Ichiro Sakamoto, Hideaki Kanazawa, Gaku Nakazawa, Tsutomu Murakami, Atsushi Yao, Mamoru Nanasato, Mike Saji, Mitsugu Hirokami, Yasushi Fuku, Shinobu Hosokawa, Norio Tada, Kensuke Matsumoto, Masao Imai, Koji Nakagawa, Hiroshi Ito

Heart (British Cardiac Society) 108 ( 5 ) 382 - 387 2021.6

Language：English

OBJECTIVE: Therapeutic strategies for atrial septal defect (ASD) with severe pulmonary arterial hypertension (PAH) are controversial. This study aimed to evaluate the efficacy of PAH-specific medications and subsequent transcatheter closure (ie, treat-and-repair strategy) on clinical outcomes. METHODS: We enrolled 42 patients who were referred to 13 institutions for consideration of ASD closure with concomitant PAH and underwent the treat-and-repair strategy. The endpoint was cardiovascular death or hospitalisation due to heart failure or exacerbated PAH. RESULTS: At baseline prior to PAH-specific medications, pulmonary to systemic blood flow ratio (Qp:Qs), pulmonary vascular resistance (PVR), and mean pulmonary artery pressure (PAP) were 1.9±0.8, 6.9±3.2 Wood units and 45±15 mm Hg. Qp:Qs was increased to 2.4±1.2, and PVR and mean PAP were decreased to 4.0±1.5 Wood units and 35±9 mm Hg at the time of transcatheter ASD closure after PAH-specific medications. Transcatheter ASD closure was performed without any complications. During a median follow-up period of 33 months (1-126 months) after transcatheter ASD closure, one older patient died and one patient was hospitalised due to heart failure, but the other patients survived with an improvement in WHO functional class. PAP was further decreased after transcatheter ASD closure. CONCLUSIONS: The treat-and-repair strategy results in low complication and mortality rates with a reduction in PAP in selected patients with ASD complicated with PAH who have a favourable response of medical therapy.

DOI： 10.1136/heartjnl-2021-319096

Low-Angle Patent Foramen Ovale (PFO): High-Risk PFO Morphology Associated with Paradoxical Embolism. International journal

Rie Nakayama, Yoichi Takaya, Teiji Akagi, Takashi Miki, Koji Nakagawa, Norihisa Toh, Hiroshi Ito

CASE (Philadelphia, Pa.) 5 ( 3 ) 183 - 185 2021.6

Prognosis of patients with severe left ventricular dysfunction after transvenous lead extraction and the need for additional hemodynamic support in the perioperative period. International journal

Nobuhiro Nishii, Takashi Nishimoto, Tomofumi Mizuno, Takuro Masuda, Saori Asada, Masakazu Miyamoto, Satoshi Kawada, Koji Nakagawa, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Morimatsu, Shingo Kasahara, Hiroshi Ito

Heart rhythm 18 ( 6 ) 962 - 969 2021.6

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Transvenous lead extraction (TLE) is necessary because of system infection, lead malfunction, or system upgrade. Patients with severe left ventricular dysfunction (SLVD) undergoing TLE may be at a higher risk because hemodynamic parameters may change unfavorably during or after TLE; however, this has not yet been clarified. OBJECTIVE: The purpose of this study was to examine whether patients with SLVD undergoing TLE have higher mortality. METHODS: All patients who underwent TLE were stratified as follows: patients with ejection fraction ≤ 35% (SLVD group) and those with ejection fraction > 35% (non-SLVD group). RESULTS: We assessed the data of 200 patients [SLVD group, 36 (18%); non-SLVD group, 164 (82%)]). Brain natriuretic peptide level and cardiac resynchronization therapy rate were higher in the SLVD group than in the non-SLVD group. There were no significant between-group differences in major complications and clinical success rates. Patients with SLVD were more likely to require additional hemodynamic support, such as catecholamine infusion, temporary atrium-ventricle sequential pacing, and temporary cardiac resynchronization therapy pacing (27.8% vs 1.2%; P < .001). The survival rate was not significantly different between the groups at 30 days and 1 year after TLE (SLVD vs non-SLVD: 30 days: 97.2% vs 99.4%; P = .215; 1 year: 80.6% vs 91.5%; P = .053). Multivariate Cox regression analysis revealed log brain natriuretic peptide and serum hemoglobin levels as predictors for 1-year mortality. CONCLUSION: The prognosis after TLE was comparable between patients with and without SLVD. However, additional hemodynamic support was often necessary for patients with SLVD.

DOI： 10.1016/j.hrthm.2021.01.026

Efficacy and safety of atrial septal defect closure using Occlutech Figulla Flex II compared with Amplatzer Septal Occluder.

Rie Nakayama, Yoichi Takaya, Teiji Akagi, Nobuhisa Watanabe, Takashi Miki, Koji Nakagawa, Norihisa Toh, Hiroshi Ito

Heart and vessels 36 ( 5 ) 704 - 709 2021.5

Language：English Publishing type：Research paper (scientific journal)

Few studies have reported the efficacy of Occlutech Figulla Flex II (FFII) device compared with Amplatzer Septal Occluder (ASO) device. The aim of this study was to examine the efficacy and safety of FFII compared with ASO for transcatheter atrial septal defect (ASD) closure. We retrospectively evaluated 190 patients using FFII and 190 patients using ASO who underwent transcatheter ASD closure. ASD characteristics were evaluated by transesophageal echocardiography. The prevalence of procedural complications, including erosion, device embolization, stroke, and new-onset atrial arrhythmia, and the presence of a residual shunt were evaluated between the two groups during 12-month follow-up. FFII was used more frequently than ASO in patients with a deficient aortic rim or septal malalignment (P = 0.02, P < 0.01, respectively). The procedural complications of erosion, device embolization, and stroke did not occur in any patients. New-onset atrial arrhythmia occurred in 3 patients of the FFII group and 4 patients of the ASO group, and the difference between the two groups was not significant (P = 0.70). A large residual shunt (≥ 3 mm) was observed in 6 patients of the FFII group and 5 patients of the ASO group, and the difference between the two groups was not significant (P = 0.76). FFII was used frequently in patients with high-risk ASD morphology; however, there was no difference in the prevalence of procedural complications or efficacy between patients using FFII and those using ASO.

DOI： 10.1007/s00380-020-01739-1

肺高血圧を合併した心房中隔欠損症に対する治療戦略と長期予後

赤木禎治, 高谷陽一, 赤木達, 三木崇史, 中川晃志, 伊藤浩

日本肺高血圧・肺循環学会学術集会・日本小児肺循環研究会プログラム・抄録集 6回・27回 48 - 48 2021.5

Feasibility of transcatheter closure for absent aortic rim in patients with atrial septal defect. International journal

Yoichi Takaya, Teiji Akagi, Koji Nakagawa, Rie Nakayama, Takashi Miki, Norihisa Toh, Hiroshi Ito

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 97 ( 5 ) 859 - 864 2021.4

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: This study aimed to assess the feasibility of transcatheter atrial septal defect (ASD) closure in patients with absent aortic rim. BACKGROUND: The indication of transcatheter closure for ASD with absent aortic rim is controversial. METHODS: We enrolled 547 patients with ASD who were scheduled for transcatheter closure. Morphologies of aortic rim were evaluated using transesophageal echocardiography (TEE). RESULTS: Aortic rim of <5 mm was observed in 396 (72%) patients; 128 (23%) had absent aortic rim of 0 mm, and 268 (49%) had deficient aortic rim of >0 to <5 mm. Patients with absent aortic rim frequently had aortic rim absence at an angle of 0° on TEE and septal malalignment. Of the 128 patients with absent aortic rim, 126 (98%) successfully underwent transcatheter closure, while 2 (2%) failed transcatheter closure due to a large defect with severe septal malalignment. The success rate of transcatheter closure was similar between patients with absent aortic rim and those with deficient aortic rim (98% vs. 99%, p = .45). After the procedure, no patients had erosion or device embolization during a median follow-up of 24 months. CONCLUSIONS: Transcatheter closure was successfully performed without adverse events in patients with absent aortic rim, as well as in those with deficient aortic rim. Our findings can be valuable to determine the indication of transcatheter closure in patients with ASD.

DOI： 10.1002/ccd.29457

Percutaneous closure of residual atrial septal defect after surgical closure.

Soichiro Ogura, Yoichi Takaya, Teiji Akagi, Koji Nakagawa, Hiroshi Ito

Cardiovascular intervention and therapeutics 36 ( 2 ) 256 - 259 2021.4

Language：English Publishing type：Research paper (scientific journal)

Residual atrial septal defect (ASD) after surgical closure is rare, but some cases are seen during follow-up period. Redo surgery for residual ASD is often declined, while percutaneous closure can be acceptable. However, the indication of percutaneous closure for residual ASD has not been established. We reviewed our experience with percutaneous closure of residual ASD using medical and procedural records. Between 2006 and 2018, residual ASD was seen in seven patients. The median age of patients was 66 years (range 50-81 years), and the median period after surgical closure of ASD was 39 years (range 13-48 years). All patients had symptoms related to ASD. Percutaneous closure of residual ASD was successfully performed in all seven patients. No residual shunts were detected during the median follow-up period of 4.2 years (range 0.5-11 years) after percutaneous closure. Based on transesophageal echocardiographic findings and operative records for surgical closure, we considered two mechanisms causing residual ASD, such as the tear of surgical suture line and the overlooking of defect during surgical closure. Percutaneous closure of residual ASD was safely performed without any complications, suggesting that percutaneous is an effective therapeutic strategy for residual ASD after surgical closure.

DOI： 10.1007/s12928-020-00671-5

心内膜心筋生検による心臓サルコイドーシスの診断(Diagnosis of Cardiac Sarcoidosis by Endomyocardial Biopsy)

中村一文, 網岡尚史, 中川晃志, 赤木達, 伊藤浩

日本循環器学会学術集会抄録集 85回 SS05 - 3 2021.3

脳卒中の予防的インターベンション2020 経皮的卵円孔開存閉鎖術の適応評価と治療成績

赤木禎治, 高谷陽一, 三木崇史, 中川晃志, 伊藤浩

日本心血管インターベンション治療学会抄録集 29回 417 - 417 2021.2

卵円孔開存症に対する経皮的デバイス閉鎖術の成績と合併症単一施設での経験から(Outcomes and complications after transcatheter device closure for patent foramen ovale: a single-center experience)

三木崇史, 赤木禎治, 中山理絵, 高谷陽一, 中川晃志, 伊藤浩

日本心血管インターベンション治療学会抄録集 29回 1383 - 1383 2021.2

下縁完全欠損症例に対する経皮的心房中隔欠損閉鎖術

駿河宗城, 赤木禎治, 三木崇史, 中山理絵, 高谷陽一, 杜徳尚, 中川晃志, 中村一文, 伊藤浩

日本心血管インターベンション治療学会抄録集 29回 618 - 618 2021.2

Morphological assessments of deficient posterior-inferior rim for transcatheter closure of atrial septal defect. International journal

Yoichi Takaya, Teiji Akagi, Koji Nakagawa, Rie Nakayama, Takashi Miki, Norihisa Toh, Hiroshi Ito

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 97 ( 1 ) 135 - 141 2021.1

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: This study aimed to determine morphological characteristics of deficient posterior-inferior rim for transcatheter atrial septal defect (ASD) closure success. BACKGROUND: The feasibility of transcatheter closure of ASD with deficient posterior-inferior rim remains unclear. METHODS: Of 869 patients with ASD who were scheduled transcatheter closure, 121 with posterior-inferior rim of <5 mm were included. Posterior-inferior rim morphologies were evaluated by transesophageal echocardiography. RESULTS: One hundred six patients successfully underwent transcatheter closure, while 15 patients failed. These 15 patients had complete deficient posterior-inferior rim of 0 mm and/or a large defect of ≥38 mm. Multivariate logistic regression analysis showed that transcatheter closure failure was independently related to complete deficient posterior-inferior rim and a large defect of ≥38 mm. Incomplete deficient posterior-inferior rim of >0 to <5 mm was observed in 84 patients. All these patients successfully underwent transcatheter closure, except two patients with a large defect of ≥38 mm. Complete deficient posterior-inferior rim was observed in 37 patients. The frequency of complete deficient posterior-inferior rim was higher in patients who failed transcatheter closure (87% vs. 23%, p < .01), but transcatheter closure was performed successfully if the range of complete deficient rim was ≤30°. After the procedure, no adverse events occurred during a median follow-up of 24 months. CONCLUSIONS: Most patients with deficient posterior-inferior rim successfully underwent transcatheter closure. Transcatheter closure could be performed even in patients with complete deficient posterior-inferior rim if the range was partial. Our findings can help to identify candidates for transcatheter closure.

DOI： 10.1002/ccd.29182

Efficacy of Saline Contrast Transthoracic Echocardiography for Identifying High-Risk Patent Foramen Ovale. International journal

Kazuki Suruga, Yoichi Takaya, Rie Nakayama, Teiji Akagi, Koji Nakagawa, Nobuhisa Watanabe, Madoka Haruna, Norihisa Toh, Hiroshi Ito

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 34 ( 1 ) 97 - 98 2021.1

Usefulness of right ventriculography compared with computed tomography for ruling out the possibility of lead perforation before lead extraction. International journal

Saori Asada, Nobuhiro Nishii, Takayoshi Shinya, Akihito Miyoshi, Yoshimasa Morimoto, Masakazu Miyamoto, Koji Nakagawa, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Ito

PloS one 16 ( 3 ) e0245502 2021

Language：English Publishing type：Research paper (scientific journal)

PURPOSE: High-risk patients can be identified by preprocedural computed tomography (CT) before lead extraction. However, CT evaluation may be difficult especially for lead tip identification due to artifacts in the leads. Selective right ventriculography (RVG) may enable preprocedural evaluation of lead perforation. We investigated the efficacy of RVG for identifying right ventricular (RV) lead perforation compared with CT in patients who underwent lead extraction. METHODS: Ninety-five consecutive patients who were examined by thin-section non-ECG-gated multidetector CT and RVG before lead extraction were investigated retrospectively. Newly recognized pericardial effusion after lead extraction was used as a reference standard for lead perforation. We analyzed the prevalence of RV lead perforation diagnosed by each method. The difference in the detection rates of lead perforation by RVG and CT was evaluated. RESULTS: Of the 115 RV leads in the 95 patients, lead perforation was diagnosed for 35 leads using CT, but the leads for 29 (83%) of those 35 leads diagnosed as lead perforation by CT were shown to be within the right ventricle by RVG. Three patients with 5 leads could not be evaluated by CT due to motion artifacts. The diagnostic accuracies of RVG and CT were significantly different (p < 0.001). There was no complication of pericardial effusion caused by RV lead extraction. CONCLUSION: RVG for identification of RV lead perforation leads to fewer false-positives compared to non-ECG-gated CT. However, even in cases in which lead perforation is diagnosed, most leads may be safely extracted by transvenous lead extraction.

DOI： 10.1371/journal.pone.0245502

Significance of Exercise-Related Ventricular Arrhythmias in Patients With Brugada Syndrome. International journal

Hiroshi Morita, Saori T Asada, Masakazu Miyamoto, Yoshimasa Morimoto, Tomonari Kimura, Tomofumi Mizuno, Koji Nakagawa, Atsuyuki Watanabe, Nobuhiro Nishii, Hiroshi Ito

Journal of the American Heart Association 9 ( 23 ) e016907 2020.12

Language：English Publishing type：Research paper (scientific journal)

Background Sinus tachycardia during exercise attenuates ST-segment elevation in patients with Brugada syndrome, whereas ST-segment augmentation after an exercise test is a high-risk sign. Some patients have premature ventricular contractions (PVCs) related to exercise, but the significance of exercise-related PVCs in patients with Brugada syndrome is still unknown. The objective of this study was to determine the significance of exercise-related PVCs for predicting occurrence of ventricular fibrillation (VF) in patients with Brugada syndrome. Methods and Results The subjects were 307 patients with Brugada syndrome who performed a treadmill exercise test. We evaluated the occurrence of PVCs at rest, during exercise and at the peak of exercise, and during recovery after exercise (0-5 minutes). We followed the patients for 92±68 months and evaluated the occurrence of VF. PVCs occurred in 82 patients (27%) at the time of treadmill exercise test: PVCs appeared at rest in 14 patients (4%), during exercise in 60 patients (20%), immediately after exercise (0-1.5 minutes) in 28 patients (9%), early after exercise (1.5-3 minutes) in 18 patients (6%), and late after exercise (3-5 minutes) in 12 patients (4%). Thirty patients experienced VF during follow-up. Multivariable analysis including symptoms, spontaneous type 1 ECG, and PVCs in the early recovery phase showed that these factors were independently associated with VF events during follow-up. Conclusions PVCs early after an exercise test are associated with future occurrence of VF events. Rebound of vagal nerve activity at the early recovery phase would promote ST-segment augmentation and PVCs in high-risk patients with Brugada syndrome.

DOI： 10.1161/JAHA.120.016907

成人先天性心疾患の集中治療に挑む! 高齢者心房中隔欠損症のカテーテル治療における集中治療の必要性と意義

藤本竜平, 赤木禎治, 高谷陽一, 三木崇史, 中山理絵, 中川晃志, 伊藤浩

日本集中治療医学会雑誌 27 ( Suppl. ) 323 - 323 2020.9

Clinical impact of transcatheter atrial septal defect closure on new onset atrial fibrillation in adult patients: Comparison with surgical closure. International journal

Yasuhiro Fujii, Teiji Akagi, Koji Nakagawa, Yoichi Takaya, Koki Eto, Yosuke Kuroko, Yasuhiro Kotani, Kentaro Ejiri, Hiroshi Ito, Shingo Kasahara

Journal of cardiology 76 ( 1 ) 94 - 99 2020.7

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Previous studies demonstrated that the incidence of atrial fibrillation (AF) was significantly increased when patients aged ≥40 years had surgical atrial septal defect (ASD) closure (sASD). However, limited information is available on such findings in transcatheter ASD closure (tASD). The purpose of this study was to investigate the incidence of newly developed AF after tASD in patients aged ≥40 years in whom preoperative AF or atrial flutter (AFL) had not been detected and to compare with the incidence after sASD. METHODS: The medical records of patients aged ≥40 years without a history of AF or AFL who underwent tASD (n = 281) or sASD (n = 24) were reviewed. Patients who had catheter ablation before the ASD closure were excluded. Patients with a patent foramen ovale were also excluded. The incidence of newly developed AF after ASD closure and the risk factors for that were evaluated statistically. RESULTS: Eleven patients had newly developed AF (5 in tASD and 6 in sASD) postoperatively including 6 persistent AF (3 each after tASD and sASD). The cumulative incidence of newly developed AF was 0.7% in tASD and 16.7% in sASD, and 2.7% and 20.8% at 1 and 5 years, respectively (p < 0.001). ASD diameter ≥30 mm and sASD were potential risk factors for newly developed AF after ASD closure and postoperative persistent AF. CONCLUSIONS: In patients aged ≥40 years without a history of AF or AFL, the incidence of newly developed AF after tASD closure was lower than that after sASD. A large ASD more than 30 mm diameter was a potential risk factor for development of AF even if it is closed by transcatheter procedure. Further long-term evaluation after tASD is required to clarify preventive benefit for new onset AF in adult ASD population.

DOI： 10.1016/j.jjcc.2020.01.008

右室拡大が心房中隔欠損閉鎖術の適応に及ぼす影響(Impact of Right Ventricular Dilatation on an Indication for Atrial Septal Defect Closure)

中山理絵, 高谷陽一, 赤木禎治, 三木崇史, 中川晃志, 杜徳尚, 伊藤浩

日本循環器学会学術集会抄録集 84回 OJ32 - 9 2020.7

ハイリスク卵円孔開存の同定における造影経胸壁心エコー検査の有効性(Efficacy of Contrast Transthoracic Echocardiography on Identification of High-Risk Patent Foramen Ovale)

駿河宗城, 高谷陽一, 中山理絵, 赤木禎治, 三木崇史, 中川晃志, 杜徳尚, 伊藤浩

日本循環器学会学術集会抄録集 84回 OJ32 - 1 2020.7

Indication and prognostic significance of programmed ventricular stimulation in asymptomatic patients with Brugada syndrome. International journal

Saori Asada, Hiroshi Morita, Atsuyuki Watanabe, Koji Nakagawa, Satoshi Nagase, Masakazu Miyamoto, Yoshimasa Morimoto, Satoshi Kawada, Nobuhiro Nishii, Hiroshi Ito

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 22 ( 6 ) 972 - 979 2020.6

Language：English Publishing type：Research paper (scientific journal)

AIMS: To establish the indication for programmed ventricular stimulation (PVS) for asymptomatic patients with Brugada syndrome (BrS), we evaluated the prognostic significance of PVS based on abnormal electrocardiogram (ECG) markers. METHODS AND RESULTS: One hundred and twenty-five asymptomatic patients with BrS were included. We performed PVS at two sites of the right ventricle with up to three extrastimuli [two pacing cycle lengths and minimum coupling interval (MCI) of 180 ms]. We followed the patients for 133 months and evaluated ventricular fibrillation (VF) events. Fragmented QRS (fQRS) and Tpeak-Tend (Tpe) interval were evaluated as ECG markers for identifying high-risk patients. Fragmented QRS and long Tpe interval (≥100 ms) were observed in 66 and 37 patients, respectively. Ventricular fibrillation was induced by PVS in 60 patients. During follow-up, 10 patients experienced VF events. Fragmented QRS, long Tpe interval, and PVS-induced VF with an MCI of 180 ms or up to two extrastimuli were associated with future VF events (fQRS: P = 0.015, Tpe ≥ 100 ms: P = 0.038, VF induction: P < 0.001). However, PVS-induced VF with an MCI of 200 ms was less specific (P = 0.049). The frequencies of ventricular tachyarrhythmia events during follow-up were 0%/year with no ECG markers and 0.1%/year with no VF induction. The existence of two ECG factors with induced VF was strongly associated with future VF events (event rate: 4.4%/year, P < 0.001), and the existence of one ECG factor with induced VF was also associated (event rate: 1.3%/year, P = 0.011). CONCLUSION: We propose PVS with a strict protocol for asymptomatic patients with fQRS and/or long Tpe interval to identify high-risk patients.

DOI： 10.1093/europace/euaa003

Effects of Bisoprolol Transdermal Patches for Prevention of Perioperative Myocardial Injury in High-Risk Patients Undergoing Non-Cardiac Surgery - Multicenter Randomized Controlled Study.

Hironobu Toda, Kazufumi Nakamura, Kazuyoshi Shimizu, Kentaro Ejiri, Takayuki Iwano, Toru Miyoshi, Koji Nakagawa, Masashi Yoshida, Atsuyuki Watanabe, Nobuhiro Nishii, Yukiko Hikasa, Masao Hayashi, Hiroshi Morita, Hiroshi Morimatsu, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 84 ( 4 ) 642 - 649 2020.3

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The aim of this study was to evaluate the efficacy and safety of transdermal β-blocker patches, which offer stable blood concentration and easy availability during operation, for prevention of perioperative myocardial injury (PMI) in high-risk patients.Methods and Results:In this randomized controlled trial, patients aged >60 years with hypertension and high revised cardiac risk index (≥2) undergoing non-cardiac surgery were randomly assigned to a bisoprolol patch or control group. Primary efficacy outcome was incidence of PMI, defined as postoperative high-sensitivity cardiac troponin T (hs-cTnT) >0.014ng/mL and relative hs-cTnT change ≥20%. Secondary efficacy outcomes were number of cardiovascular events and 30-day mortality. From November 2014 to February 2019, 240 patients from 5 hospitals were enrolled in this study. The incidence of PMI was 35.7% in the bisoprolol patch group and 44.5% in the control group (P=0.18). Incidence of major adverse cardiac events including non-critical myocardial infarction, strokes, decompensated heart failure and tachyarrhythmia was similar between the 2 groups. Tachyarrhythmia tended to be higher in the control group. There were no significant differences in safety outcomes including significant hypotension and bradycardia requiring any treatment between the 2 groups. CONCLUSIONS: Bisoprolol patches do not influence the incidence of PMI and cardiovascular events in high-risk patients undergoing non-cardiac surgery, but perioperative use of these patches is safe.

DOI： 10.1253/circj.CJ-19-0871

New Appearance of Fragmented QRS as a Predictor of Ventricular Arrhythmic Events in Patients With Hypertrophic Cardiomyopathy.

Soichiro Ogura, Kazufumi Nakamura, Hiroshi Morita, Norihisa Toh, Koji Nakagawa, Masashi Yoshida, Atsuyuki Watanabe, Nobuhiro Nishii, Toru Miyoshi, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 84 ( 3 ) 487 - 494 2020.2

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Multiple spikes in the QRS complex (fragmented QRS [fQRS]) on 12-lead electrocardiography have been associated with ventricular arrhythmic events (VAEs) in patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to assess the association between new appearances of fQRS and cardiac events in patients with HCM.Methods and Results:The association between baseline fQRS and cardiac events, namely VAEs, heart failure-related hospitalization, and all-cause death, was evaluated retrospectively in 146 HCM patients (46 patients with fQRS, 100 without fQRS). The median follow-up was 5.3 years. Cardiac events occurred in 29 patients with baseline fQRS and 32 patients without baseline fQRS (63% vs. 32%; P<0.001). VAEs occurred in a significantly larger percentage of patients with than without baseline fQRS (54% vs. 23%, respectively; P<0.001). Of the 100 patients without baseline fQRS, 33 had a new appearance of fQRS during the 4.6-year follow-up, whereas 67 did not. VAEs occurred more frequently in the 33 patients with the appearance of fQRS than in those without (42% vs. 13%, respectively; P=0.001). Multivariable analysis showed that the new appearance of fQRS documented before VAEs was associated with VAEs (hazard ratio 4.29, 95% confidence interval 1.81-10.2; P=0.001). CONCLUSIONS: The new appearance of fQRS was associated with an increased risk of VAEs in HCM patients.

DOI： 10.1253/circj.CJ-19-0968

Importance of Abdominal Compression Valsalva Maneuver and Microbubble Grading in Contrast Transthoracic Echocardiography for Detecting Patent Foramen Ovale. International journal

Yoichi Takaya, Nobuhisa Watanabe, Madoka Ikeda, Teiji Akagi, Rie Nakayama, Koji Nakagawa, Norihisa Toh, Hiroshi Ito

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 33 ( 2 ) 201 - 206 2020.2

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Although transthoracic echocardiography (TTE) may be useful for patent foramen ovale (PFO) screening, the optimal methodologies remain unclear. The aims of this study were to evaluate the efficacy of the abdominal compression Valsalva maneuver and identify the optimal cutoff value of microbubbles in contrast TTE for detecting PFO, compared with transesophageal echocardiography and catheterization as the reference. METHODS: One hundred thirty-four patients with cryptogenic stroke or migraine who had suspected PFO and underwent TTE and transesophageal echocardiography plus catheterization were enrolled. The sensitivity, specificity, and accuracy of TTE for PFO detection were analyzed according to different provocations (spontaneous Valsalva maneuver, abdominal compression Valsalva maneuver) and different cutoff values of microbubbles for a positive result (at least one microbubble, at least five microbubbles). RESULTS: Eighty patients had PFO confirmed by transesophageal echocardiography and catheterization. When the cutoff was at least one microbubble, the sensitivity of TTE in detecting PFO was 93% with the spontaneous Valsalva maneuver and 99% with the abdominal compression Valsalva maneuver. When the cutoff was at least five microbubbles, sensitivity was 85% with the spontaneous Valsalva maneuver and 99% with the abdominal compression Valsalva maneuver. With the abdominal compression Valsalva maneuver, specificity was increased using the cutoff of at least five microbubbles compared with at least one microbubble (89% vs 57%). The abdominal compression Valsalva maneuver with the cutoff of at least 5 microbubbles provided the greatest accuracy of 95%. CONCLUSIONS: TTE with the abdominal compression Valsalva maneuver had excellent sensitivity. The cutoff of at least five microbubbles increased specificity. Our findings suggest that TTE with these criteria is valuable for PFO diagnosis.

DOI： 10.1016/j.echo.2019.09.018

Fontan術後の複数の心房頻拍に対しRhythmiaによるカテーテルアブレーションとTCPC conversionが奏功した1例

森本芳正, 西井伸洋, 水野智文, 浅田早央莉, 木村朋生, 宮本真和, 中川晃志, 渡邊敦之, 中村一文, 伊藤浩, 栄徳隆裕, 笠原真悟

日本成人先天性心疾患学会雑誌 9 ( 1 ) 247 - 247 2020.1

Fontan患者におけるカテーテルアブレーション(Catheter ablation in Fontan patients)

西井伸洋, 森本芳正, 木村朋生, 宮本真和, 杜徳尚, 中川晃志, 渡邊敦之, 森田宏, 伊藤浩, 重光祐輔, 栄徳隆裕, 馬場健児, 笠原慎吾

日本成人先天性心疾患学会雑誌 9 ( 1 ) 223 - 223 2020.1

ACHDに対するInterventional Cardiologyの最新知見と将来展望卵円孔開存(Update and Prospect on Interventional Cardiology for ACHD Transcatheter Closure of Patent Foramen Ovale)

高谷陽一, 赤木禎治, 中川晃志, 中山理絵, 三木崇史, 伊藤浩

日本成人先天性心疾患学会雑誌 9 ( 1 ) 177 - 177 2020.1

Impact of Right Ventricular Dilatation in Patients with Atrial Septal Defect. International journal

Rie Nakayama, Yoichi Takaya, Teiji Akagi, Koji Nakagawa, Nobuhisa Watanabe, Saori Nobusada, Toshi Matsushita, Norihisa Toh, Susumu Kanazawa, Hiroshi Ito

Journal of interventional cardiology 2020 9509105 - 9509105 2020

Language：English Publishing type：Research paper (scientific journal)

Objective: The aim of this study was to examine the relationship between right ventricular (RV) volume and exercise capacity in adult patients with atrial septal defect (ASD) and to determine the degree of RV dilatation for transcatheter ASD closure. Background: RV dilatation is an indication of transcatheter ASD closure; however, few studies have reported the clinical significance of RV dilatation. Methods: We enrolled 82 consecutive patients (mean age, 49 ± 18 years; female, 68%) who underwent cardiac magnetic resonance imaging and symptom-limited cardiopulmonary exercise test before ASD closure. The relationship between RV volume and peak oxygen uptake (VO2) was evaluated. Results: The mean RV end-diastolic volume index was 108 ± 27 ml/m2 (range, 46 to 180 ml/m2). The mean peak VO2 was 24 ± 7 ml/min/kg (range, 14 to 48 ml/min/kg), and the mean predicted peak VO2 was 90 ± 23%. There were significant negative relationships of RV end-diastolic volume index with peak VO2 (r = -0.28, p < 0.01) and predicted peak VO2 (r = -0.29, p < 0.01). The cutoff value of RV end-diastolic volume index <80% of predicted peak VO2 was 120 ml/m2, with the sensitivity of 49% and the specificity of 89%. Conclusions: There was a relationship between RV dilatation and exercise capacity in adult patients with ASD. RV end-diastolic volume index ≥120 ml/m2 was related to the reduction in peak VO2. This criterion of RV dilatation may be valuable for the indication of transcatheter ASD closure.

DOI： 10.1155/2020/9509105

Clinical Significance of Septal Malalignment for Transcatheter Closure of Atrial Septal Defect. International journal

Yoichi Takaya, Teiji Akagi, Koji Nakagawa, Rie Nakayama, Takashi Miki, Nobuhisa Watanabe, Norihisa Toh, Hiroshi Ito

Journal of interventional cardiology 2020 6090612 - 6090612 2020

Language：English Publishing type：Research paper (scientific journal)

Background: Septal malalignment is related to erosion and device embolization in transcatheter closure of atrial septal defect (ASD), but limited information is available. Objectives: This study aimed to assess clinical significance of septal malalignment and to determine appropriate evaluation of ASD diameter, including the selection of device size. Methods: Four hundred and seventeen patients with ASD who underwent transcatheter closure were enrolled. Septal malalignment was defined as separation between the septum primum and the septum secundum on transesophageal echocardiography. Results: One hundred and eighty-four patients had septal malalignment. The frequency of septal malalignment increased with age reaching around 50% in adult patients. Septal malalignment was related to aortic rim deficiency. The distance of separation between the septum primum and the septum secundum was 5 ± 2 mm (range, 1-11 mm). In patients with septal malalignment, the ASD diameter measured at the septum primum was 19 ± 6 mm, while the ASD diameter measured at the septum secundum was 16 ± 6 mm. There was a difference of 4 ± 2 mm (range, 0-8 mm) between the ASD diameter measured at the septum primum and that measured at the septum secundum. For transcatheter closure, the Amplatzer Septal Occluder device size 2-3 mm larger and the Occlutech Figulla Flex II device size 4-7 mm larger than the ASD diameter measured at the septum primum were frequently used. During the study period, erosion or device embolization did not occur in all of the patients. Conclusions: Septal malalignment is highly prevalent in adult patients with aortic rim deficiency. The measurement of ASD diameter at the septum primum can be valuable for the selection of device size in patients with septal malalignment.

DOI： 10.1155/2020/6090612

Low Consultation Rate of General Population with Atrial Fibrillation.

Hiroaki Matsumi, Kazufumi Nakamura, Eri Eguchi, Toru Miyoshi, Koji Nakagawa, Nobuhiro Nishii, Atsuyuki Watanabe, Akira Ueoka, Masashi Yoshida, Naoto Tokunaga, Naofumi Amioka, Nobuyuki Yamada, Daiji Saito, Hiroshi Morita, Keiki Ogino, Hiroshi Ito

International heart journal 60 ( 6 ) 1303 - 1307 2019.11

Language：English Publishing type：Research paper (scientific journal)

In order to prevent ischemic stroke, it is important to identify and treat patients with atrial fibrillation (AF) who do not consult a doctor in a medical institution. The aim of this study was to determine the consultation rate at medical institutions for patients with AF in group medical examinations conducted in a city in western Japan. Of 6101 examinees of group medical examinations (40 years of age or older) conducted in Ibara City, Okayama Prefecture, Japan, from 2012 to 2014, 4338 participants (71.1%) who were evaluated by electrocardiogram (ECG) gave written informed consent and responded to surveys in the form of questionnaires through a personal interview conducted by nurses were included in the Ibara-AF study. A cumulative total of 82 subjects were diagnosed as having AF by ECG (prevalence of AF = 1.89%), and 51 individuals had AF during the three-year period.15 (29.4%) of the 51 patients with AF did not regularly visit medical institutions. Among them, 46.7% (n = 7) and 53.3% (n = 8) of the patients were symptomatic and asymptomatic, respectively, and 73.3% of the patients had a CHADS2 score of more than one point. There were no significant differences in patients' characteristics between regular and non-regular visit groups. In conclusion, about one-third of the patients with AF did not regularly see a doctor in a medical institution and most of them had a CHADS2 score of more than one point in a Japanese rural area. Educating the public about the risks of AF is required.

DOI： 10.1536/ihj.19-062

Current Treatment Strategies and Nanoparticle-Mediated Drug Delivery Systems for Pulmonary Arterial Hypertension. International journal

Kazufumi Nakamura, Satoshi Akagi, Kentaro Ejiri, Masashi Yoshida, Toru Miyoshi, Norihisa Toh, Koji Nakagawa, Yoichi Takaya, Hiromi Matsubara, Hiroshi Ito

International journal of molecular sciences 20 ( 23 ) 2019.11

Language：English Publishing type：Research paper (scientific journal)

There are three critical pathways for the pathogenesis and progression of pulmonary arterial hypertension (PAH): the prostacyclin (prostaglandin I2) (PGI2), nitric oxide (NO), and endothelin pathways. The current approved drugs targeting these three pathways, including prostacyclin (PGI2), phosphodiesterase type-5 (PDE5) inhibitors, and endothelin receptor antagonists (ERAs), have been shown to be effective, however, PAH remains a severe clinical condition and the long-term survival of patients with PAH is still suboptimal. The full therapeutic abilities of available drugs are reduced by medication, patient non-compliance, and side effects. Nanoparticles are expected to address these problems by providing a novel drug delivery approach for the treatment of PAH. Drug-loaded nanoparticles for local delivery can optimize the efficacy and minimize the adverse effects of drugs. Prostacyclin (PGI2) analogue, PDE5 inhibitors, ERA, pitavastatin, imatinib, rapamycin, fasudil, and oligonucleotides-loaded nanoparticles have been reported to be effective in animal PAH models and in vitro studies. However, the efficacy and safety of nanoparticle mediated-drug delivery systems for PAH treatment in humans are unknown and further clinical studies are required to clarify these points.

DOI： 10.3390/ijms20235885

Efficacy of catheter ablation for paroxysmal atrial fibrillation in patients with atrial septal defect: a comparison with transcatheter closure alone International journal

Koji Nakagawa, Teiji Akagi, Satoshi Nagase, Yoichi Takaya, Yasufumi Kijima, Norihisa Toh, Atsuyuki Watanabe, Nobuhiro Nishii, Kazufumi Nakamura, Hiroshi Morita, Kengo Kusano, Hiroshi Ito

EP Europace 21 ( 11 ) 1663 - 1669 2019.11

Language：English Publishing type：Research paper (scientific journal) Publisher：Oxford University Press (OUP)

<title>Abstract</title>
<sec>
<title>Aims</title>
There is no valid treatment strategy for addressing paroxysmal atrial fibrillation (AF) in patients with unclosed atrial septal defect (ASD). We aimed to assess the efficacy of catheter ablation (CA) compared with transcatheter ASD closure alone for treating pre-existing paroxysmal AF in patients with ASD.

</sec>
<sec>
<title>Methods and results</title>
Among 908 patients who underwent transcatheter ASD closure, we evaluated 50 consecutive patients (63 ± 12 years) with paroxysmal AF. We compared the AF outcomes of these patients after transcatheter ASD closure between those with and without CA prior to ASD closure. Thirty (60%) patients underwent CA. During the follow-up period after ASD closure (mean: 49 ± 23 months), recurrence of AF was observed in 6/30 (20%) patients with upfront CA and 12/20 (60%) patients with ASD closure alone. Kaplan–Meier analysis showed that the AF-free survival rate was significantly higher for patients with CA than for those with ASD closure alone (79% vs. 37% at 5 years, P = 0.002). Upfront CA and previous heart failure hospitalization were associated with recurrence of AF after ASD closure [hazard ratio (HR) 0.18, 95% confidence interval (CI) 0.06–0.53; P = 0.002 and HR 4.64, 95% CI 1.60–13.49; P = 0.005, respectively].

</sec>
<sec>
<title>Conclusion</title>
In ASD patient with paroxysmal AF, transcatheter ASD closure alone demonstrated high AF recurrence rate after ASD closure. On the other hand, upfront CA prior to ASD closure substantially suppressed AF recurrence over the long term. A combination of CA and transcatheter ASD closure may be a feasible treatment strategy for paroxysmal AF in patients with ASD.

</sec>

DOI： 10.1093/europace/euz207

脳卒中予防の新規治療経皮的卵円孔開存閉鎖術の役割

赤木禎治, 高谷陽一, 三木崇史, 中山理絵, 中川晃志, 伊藤浩

日本心血管インターベンション治療学会抄録集 28回 [MO18 - 001] 2019.9

アンプラッツァーデバイス留置後の心房中隔穿刺

中川晃志, 渡邊敦之, 高谷陽一, 赤木禎治, 森本芳正, 浅田早央莉, 宮本真和, 木村朋生, 西井伸洋, 中村一文, 森田宏, 伊藤浩

日本心血管インターベンション治療学会抄録集 28回 [MO114 - 001] 2019.9

可動性の大きい心房中隔を有する卵円孔開存に対する至適デバイス選択どのような時に大きな閉鎖栓を選択するのか?

三木崇史, 赤木禎治, 中山理絵, 高谷陽一, 中川晃志, 伊藤浩

日本心血管インターベンション治療学会抄録集 28回 [BP2 - 007] 2019.9

A Low Critical Event Rate Despite a High Abnormal Event Rate in Patients with Cardiac Implantable Electric Devices Followed Up by Remote Monitoring.

Yoshimasa Morimoto, Nobuhiro Nishii, Saori Tsukuda, Satoshi Kawada, Masakazu Miyamoto, Akihito Miyoshi, Koji Nakagawa, Atsuyuki Watanabe, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Ito

Internal medicine (Tokyo, Japan) 58 ( 16 ) 2333 - 2340 2019.8

Language：English Publishing type：Research paper (scientific journal)

Objective Remote monitoring (RM) of cardiac implantable electric devices (CIEDs) has been advocated as a healthcare standard. However, expert consensus statements suggest that all patients require annual face-to-face follow-up consultations at outpatient clinics even if RM reveals no episodes. The objective of this study was to determine the critical event rate after CIED implantation through RM. Methods This multicenter, retrospective, cohort study evaluated patients with pacemakers (PMs), implantable cardioverter defibrillators (ICDs), or cardiac resynchronization therapy defibrillator (CRT-Ds) and analyzed whether or not the data drawn from RM included abnormal or critical events. Patients A total of 1,849 CIED patients in 12 hospitals who were followed up by the RM center in Okayama University Hospital were included in this study. Results During the mean follow-up period of 774.9 days, 16,560 transmissions were analyzed, of which 11,040 (66.7%) were abnormal events and only 676 (4.1%) were critical events. The critical event rate in the PM group was significantly lower than that in the ICD or CRT-D groups (0.9% vs. 5.0% or 5.9%, p<0.001). A multivariate analysis revealed that ICD, CRT-D, and a low ejection fraction were independently associated with critical events. In patients with ICD, the independent risk factors for a critical event were old age, low ejection fraction, Brugada syndrome, dilated phase hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Conclusion Although abnormal events were observed in two-thirds of the transmitted RM data, the critical event rate was <1% in patients with a PM, which was lower in comparison to the rates in patients with ICDs or CRT-Ds. A low ejection fraction was an independent predictor of critical events.

DOI： 10.2169/internalmedicine.1905-18

Prognosis after lead extraction in patients with cardiac implantable electronic devices infection: Comparison of lead-related infective endocarditis with pocket infection in a Japanese single-center experience.

Nobuhiro Nishii, Yoshimasa Morimoto, Akihito Miyoshi, Saori Tsukuda, Masakazu Miyamoto, Satoshi Kawada, Koji Nakagawa, Atsuyuki Watanabe, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Morimatsu, Nobuchika Kusano, Shingo Kasahara, Morio Shoda, Hiroshi Ito

Journal of arrhythmia 35 ( 4 ) 654 - 663 2019.8

Language：English Publishing type：Research paper (scientific journal)

Background: The increase in the use of cardiac implantable electronic devices (CIEDs) has been associated with an increase in CIED-related infections. Transvenous lead extraction is safe and effective for patients with CIED-related infections; however, the mortality rate in these patients is high. The prognosis after transvenous lead extraction in Japanese patients, especially those with lead-related infective endocarditis, has not been evaluated. Then, the purpose of this study is to clarify the prognosis after transvenous lead extraction in Japanese patients with CIED-related infections at a single Japanese center. Methods: A total of 107 patients who underwent transvenous lead extraction were retrospectively reviewed. The patients were divided into a lead-related infective endocarditis group (n = 32) and a pocket infection group (n = 75). Procedure success rate and prognosis after lead extraction were evaluated between the two groups. Results: Procedure success rate was not significantly different between the groups. There were no deaths associated with the procedure or with infection. The survival rate was not significantly different at 1 year or at a median of 816 days (lead-related infective endocarditis vs pocket infection; 93.7% vs 94.7%, P = 1.000; 78.1% vs 81.3%, P = 0.791) Time to reimplantation and duration of hospital stay and antibiotics therapy were significantly longer for patients with lead-related infective endocarditis. Conclusion: In this study, the prognosis for patients with lead-related infective endocarditis after transvenous lead extraction was favorable. Thus, extraction should be strongly recommended, even if the general condition of the patient is poor.

DOI： 10.1002/joa3.12164

Impact of Disease Complexity on Cardiovascular Events after the Transition to an Adult Congenital Heart Disease Specialized Medical Unit.

Sho Takahashi, Teiji Akagi, Norihisa Toh, Yoichi Takaya, Koji Nakagawa, Nobuhiro Nishii, Hiroshi Ito

Acta medica Okayama 73 ( 4 ) 307 - 313 2019.8

Language：English Publishing type：Research paper (scientific journal)

The follow-up of patients with adult congenital heart disease (ACHD) at a specialized medical unit is necessary for the patients' appropriate medical care. However, limited information is available about cardiovascular events among ACHD patients. Here we investigated the type and frequency of cardiovascular events in ACHD patients in relation to disease complexity. We retrospectively analyzed the cases of 535 patients (median age 35 years) referred to our ACHD center between 2014 and 2017. We divided the patients into 3 groups based on their disease complexity. To evaluate the relationship between disease complexity and cardiovascular events, we performed univariate and multivariate survival analyses. The Simple, moderate, and complex disease groups accounted for 62%, 19%, and 19% of the patients, respectively. Apart from events related to atrial septal defect (ASD) trans-catheter treatment, the frequency of cardiovascular events was dependent on the disease complexity (event-free survival rates at 3 years were 85%, 65%, and 58%, respectively). The hazard ratios were 4.0 and 5.1 in the moderate and complex groups, respectively. With the exception of scheduled transcatheter intervention, cardiovascular events were strongly related to the disease complexity of original heart disease. However, cardiovascular events were not rare even in the simple ACHD group.

DOI： 10.18926/AMO/56932

Combination of Renal Angioplasty and Angiotensin-converting-enzyme Inhibitor Can Reduce Proteinuria in Patients with Bilateral Renal Artery Disease.

Hironobu Toda, Haruhito Uchida, Kazufumi Nakamura, Hidemi Takeuchi, Masaru Kinomura, Koji Nakagawa, Atsuyuki Watanabe, Toru Miyoshi, Nobuhiro Nishii, Hiroshi Morita, Jun Wada, Hiroshi Ito

Internal medicine (Tokyo, Japan) 58 ( 13 ) 1917 - 1922 2019.7

Language：English Publishing type：Research paper (scientific journal)

Recent large clinical trials failed to show clear benefits of percutaneous transluminal renal angioplasty (PTRA) as compared with medical therapy on patients with renal artery stenosis. It was also reported that proteinuria is an adverse prognostic factor after PTRA, and PTRA is less effective in patients with overt proteinuria. From the renoprotective point of view, to reduce proteinuria after PTRA is an important therapeutic goal in patients with renal artery stenosis with overt proteinuria. We hereby describe two patients successfully treated by combination therapy with PTRA and administration of angiotensin-converting enzyme (ACE) inhibitor for bilateral renal artery disease with overt proteinuria.

DOI： 10.2169/internalmedicine.2076-18

Identification of High-Risk Patent Foramen Ovale Associated With Cryptogenic Stroke: Development of a Scoring System. International journal

Rie Nakayama, Yoichi Takaya, Teiji Akagi, Nobuhisa Watanabe, Madoka Ikeda, Koji Nakagawa, Norihisa Toh, Hiroshi Ito

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 32 ( 7 ) 811 - 816 2019.7

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Transcatheter closure of patent foramen ovale (PFO) has become an effective therapeutic strategy for cryptogenic stroke (CS). The identification of high-risk PFO is essential, but the data are limited. This study aimed to clarify the factors related to CS and to develop a score for high-risk PFO. METHODS: We retrospectively analyzed 57 patients with prior CS and 50 without CS who were scheduled for transcatheter closure. PFO characteristics were evaluated by transesophageal echocardiography. Based on factors related to CS, we estimated the risk score. RESULTS: Patients with CS had a greater frequency of large-size PFO (≥2 mm in height), long-tunnel PFO (≥10 mm in length), atrial septal aneurysm, hypermobile interatrial septum, prominent Eustachian valve or Chiari's network, the large right-to-left shunt at rest and during Valsalva maneuver, and low-angle PFO (≤10° of PFO angle from inferior vena cava), compared with patients without CS. Multivariate analysis showed that long-tunnel PFO, the presence of hypermobile interatrial septum, the presence of prominent Eustachian valve or Chiari's network, the large right-to-left shunt during Valsalva maneuver, and low-angle PFO were independently related to CS. When the score was estimated based on 1 point for each factor, the proportion of CS was markedly elevated with a score of ≥2 points. The probability of CS was markedly different between scores of ≤1 or ≥2 points. CONCLUSIONS: PFO risk can be assessed with a score based on high-risk features. The presence of two or more high-risk PFO features is associated with CS.

DOI： 10.1016/j.echo.2019.03.021

Emerging Role of Coronary Computed Tomography Angiography in Lipid-Lowering Therapy: a Bridge to Image-Guided Personalized Medicine. International journal

Toru Miyoshi, Kazuhiro Osawa, Keishi Ichikawa, Kazuki Suruga, Takashi Miki, Masashi Yoshida, Koji Nakagawa, Hironobu Toda, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Ito

Current cardiology reports 21 ( 8 ) 72 - 72 2019.6

Language：English Publishing type：Research paper (scientific journal)

PURPOSE OF REVIEW: To summarize the current status of coronary computed tomography angiography (CTA) in the assessment of coronary plaques and discuss the ability of serial coronary CTA to quantitatively measure changes in the plaque burden in response to lipid-lowering therapy. RECENT FINDINGS: Recent advances in coronary CTA have allowed identification of high-risk coronary features in acute coronary syndrome and measurement of changes in the coronary plaque burden with good reproducibility. Statin therapy may delay plaque progression and change some plaque features. However, the clinical relevance of quantitative changes in coronary plaques and the optimal methods to reduce the plaque burden remain unclear. Despite guideline-directed lipid-lowering therapy, adverse events still occur in substantial numbers of patients receiving statins. Coronary CTA is noninvasive and has high diagnostic performance in patients with coronary artery disease, making change in the plaque burden an applicable biomarker for individualized assessment of future risk.

DOI： 10.1007/s11886-019-1170-4

Radiofrequency catheter ablation prior to percutaneous coronary intervention in patients with atrial fibrillation coexisting with stable coronary artery disease: a single-center pilot study.

Satoshi Kawada, Atsuyuki Watanabe, Yoshimasa Morimoto, Koji Nakagawa, Nobuhiro Nishii, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Ito

Heart and vessels 34 ( 4 ) 632 - 640 2019.4

Language：English Publishing type：Research paper (scientific journal)

Atrial fibrillation (AF) frequently coexists with cardiovascular disease (CAD) in a clinical setting. However, the optimum therapy for AF patients who have concomitant CAD is unclear. We retrospectively examined the efficacy and safety of radiofrequency catheter ablation (RFCA) prior to percutaneous coronary intervention (PCI) in patients with AF who had concomitant stable CAD. Between January 2014 and December 2015, a total 264 patients (179 men; mean age, 65.5 ± 10.1 years) who were referred to undergo a first RFCA procedure were reviewed in this study. Of the 264 patients, 41 (15.5%) had stable CAD detected by multi-detector computed tomography before RFCA. Thirty-seven patients who had AF with stable CAD were divided into two treatment arms: (1) RFCA prior to PCI (n = 13) and (2) PCI prior to RFCA (n = 24) [four patients excluded because of left main coronary artery disease (LMCA) or triple vessel disease (TVD)]. The median follow-up was 14 (IQR 8-19) months. There was no significant difference in AF recurrence rate after the procedure between the RFCA first group and PCI first group (P = 0.515). No symptomatic cardiovascular events occurred the during follow-up period. The PCI first group had a significantly longer duration of triple therapy (188.5 ± 167 days vs 5.6 ± 24.5 days, P = 0.01) and all of the four bleeding events occurred during triple therapy (P = 0.01). The results of this single-center pilot study suggested that prior RFCA in patients with AF coexisting with CAD could have fewer serious bleeding events than prior PCI.

DOI： 10.1007/s00380-018-1280-8

片頭痛に関連する卵円孔開存と比較した潜因性脳卒中に関連する高リスク卵円孔開存の特定(Identification of High-Risk Patent Foramen Ovale Associated with Cryptogenic Stroke in Comparison with Migraine)

中山理絵, 高谷陽一, 赤木禎治, 池田まどか, 渡邉修久, 中川晃志, 杜徳尚, 伊藤浩

日本循環器学会学術集会抄録集 83回 OJ08 - 9 2019.3

ECMO中の輸血需要に関連した臨床的特徴と凝固管理

青景聡之, 平山隆浩, 塚原紘平, 高寛, 清水一好, 中川晃志, 岩崎達雄, 笠原真悟, 内藤宏道, 中尾篤典

日本集中治療医学会雑誌 26 ( Suppl. ) [O27 - 6] 2019.2

Fontan患者の上室性不整脈に対し、アブレーション、デバイス、薬物療法を行った一例(A case of ablation, pacemaker implantation and medication for supraventricular tachycardia in patient with Fontan operation)

西井伸洋, 栄徳隆裕, 重光祐輔, 森本芳正, 浅田早央莉, 宮本真和, 杜徳尚, 中川晃志, 渡辺敦之, 森田宏, 笠原真悟, 伊藤浩

日本成人先天性心疾患学会雑誌 8 ( 1 ) 137 - 137 2019.1

心房中隔欠損症患者における右室容積とexercise capacityの関連性について(Relationship between right ventricular volume and exercise capacity in patients with atrial septal defect)

中山理絵, 高谷陽一, 赤木禎治, 渡辺修久, 池田まどか, 中川晃志, 杜徳尚, 伊藤浩

日本成人先天性心疾患学会雑誌 8 ( 1 ) 111 - 111 2019.1

カテーテルインターベンションの最新治療卵円孔開存に対するカテーテル治療(Transcatheter Closure of Patent Foramen Ovale)

高谷陽一, 赤木禎治, 中川晃志, 中山理絵, 三木崇史, 伊藤浩

日本成人先天性心疾患学会雑誌 8 ( 1 ) 90 - 90 2019.1

経胸壁心エコー図によるPFO診断における腹部圧迫法とバブルカットオフ値の有用性(Importance of Abdominal Compression Valsalva Maneuver and Microbubble Cutoff of Transthoracic Echocardiography for Detecting Patent Foramen Ovate)

高谷陽一, 渡辺修久, 池田まどか, 赤木禎治, 中川晃志, 中山理絵, 杜徳尚, 伊藤浩

日本成人先天性心疾患学会雑誌 8 ( 1 ) 111 - 111 2019.1

Infective Endocarditis of Patent Foramen Ovale Closure Device Presenting as an Amoeboid-Like Mass. International journal

Hidenaru Yamaoka, Yoichi Takaya, Nobuhisa Watanabe, Teiji Akagi, Koji Nakagawa, Norihisa Toh, Yasuhiro Kotani, Shingo Kasahara, Hiroshi Ito

JACC. Cardiovascular interventions 11 ( 22 ) 2337 - 2338 2018.11

片頭痛患者における卵円孔開存合併頻度と短絡量の検討

赤木禎治, 高谷陽一, 中山理絵, 中川晃志, 三木崇史, 伊藤浩

日本頭痛学会誌 45 ( 2 ) 416 - 416 2018.11

Progression of electrocardiographic abnormalities associated with initial ventricular fibrillation in asymptomatic patients with Brugada syndrome. International journal

Hiroshi Morita, Masakazu Miyamoto, Atsuyuki Watanabe, Saori Tsukuda, Yoshimasa Morimoto, Satoshi Kawada, Koji Nakagawa, Nobuhiro Nishii, Hiroshi Ito

Heart rhythm 15 ( 10 ) 1468 - 1474 2018.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Various risk stratifications in asymptomatic patients with Brugada syndrome (BrS) have been proposed, but the electrophysiological change that promotes ventricular fibrillation (VF) is still unknown. OBJECTIVE: The aim of this study was to clarify the changes in electrocardiographic (ECG) markers at the onset of VF from ECGs recorded when patients were still asymptomatic. METHODS: The subjects of this study included 14 patients with VF and 48 consecutive asymptomatic patients with BrS. We compared ECGs before the initial VF events (>6 months; early phase) with ECGs at the initial VF events (late phase). In asymptomatic patients, we evaluated ECGs at 2 time points with an interval of >6 months. We evaluated various ECG markers including type 1 ECG and fragmented QRS (fQRS; multiple spikes within the QRS complex). RESULTS: ECG parameters of the early and late phases were not different except for decreased ST voltage and low incidence of type 1 ECG in asymptomatic patients. There were no differences in ECG parameters of the early phase between patients with VF and asymptomatic patients. In patients with VF, ECGs at the late phase had longer QRS intervals and intervals between the peak and the end of the T wave and more frequent type 1 ECG and fQRS than did ECGs at the early phase. Those changes were associated with initial VF events (QRS widening: odds ratio [OR] 11.5, P < .01; interval between the peak and the end of the T wave: OR 11.6, P < .01; fQRS: odds ratio 15.3, P < .01; type 1 ECG: OR 6.6, P < .05). CONCLUSION: QRS and ST-T wave abnormalities developed in association with the initial VF events. Aggravation of the conduction disturbance in addition to BrS-ECG promotes VF.

DOI： 10.1016/j.hrthm.2018.06.035

Coral reef aorta一連の病変と考えられた移植腎動脈狭窄に対する血管内治療の1例 Reviewed

戸田洋伸, 大塚寛昭, 江尻健太郎, 内田治仁, 杜徳尚, 中川晃志, 渡邊敦之, 三好亨, 西井伸洋, 中村一文, 森田宏, 伊藤浩

脈管学 58 ( Suppl. ) S206 - S206 2018.9

構造的心疾患インターベンションのための画像診断を究める経胸壁心エコー図でのPFO診断における腹部圧迫バルサルバ法とマイクロバブル値の重要性

高谷陽一, 池田まどか, 渡辺修久, 中川晃志, 赤木禎治, 伊藤浩

日本心血管インターベンション治療学会抄録集 27回 SY14 - 2 2018.8

Shanghai Score System for Diagnosis of Brugada Syndrome: Validation of the Score System and System and Reclassification of the Patients. International journal

Satoshi Kawada, Hiroshi Morita, Charles Antzelevitch, Yoshimasa Morimoto, Koji Nakagawa, Atsuyuki Watanabe, Nobuhiro Nishii, Kazufumi Nakamura, Hiroshi Ito

JACC. Clinical electrophysiology 4 ( 6 ) 724 - 730 2018.6

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: The principal objective was to perform an initial test of the Shanghai Brugada Scoring System. Diagnosis of probable and/or definite Brugada syndrome (BrS), possible BrS, and nondiagnostic outcomes were assigned scores of ≥3.5, 2 to 3, and <2 points, respectively. The proposed score system was based on the available published reports and on weighted coefficients derived from limited datasets, with the understanding that these recommendations would need to undergo continuing validation. BACKGROUND: The 2016 HRS/EHRA/APHRS/SOLAECE J-Wave Syndrome Consensus Report proposed a scoring system for diagnosis of BrS that takes into account electrocardiographic recordings, genetic results, clinical characteristics, and family history. METHODS: The patient population consisted of 393 patients evaluated at our hospital for BrS (271 asymptomatic, 99 with syncope, and 23 with ventricular fibrillation [VF]) between 1996 and 2016. Subjects were classified into 4 groups: group A with a score of ≤3.0 points (n = 45); group B with a score of 3.5 points (n = 186); group C with a score of 4.0 to 5.0 points (n = 81); and group D with a score of ≥5.5 points (n = 81). RESULTS: A total of 348 (88%) patients had probable and/or definite BrS, and 81 (20%) had a score ≥5.5. During a follow-up of 97.3 months (range: 39.7 to 142.1 months), 43 patients experienced VF. Significant differences were seen among the 4 groups (p = 0.01). A malignant arrhythmic event did not occur in any patient with possible or nondiagnostic BrS. CONCLUSIONS: This study provided validation for the use of the Shanghai Score System for the diagnosis and risk stratification of patients with BrS.

DOI： 10.1016/j.jacep.2018.02.009

Prognostic Significance of the Sodium Channel Blocker Test in Patients With Brugada Syndrome. International journal

Akira Ueoka, Hiroshi Morita, Atsuyuki Watanabe, Yoshimasa Morimoto, Satoshi Kawada, Motomi Tachibana, Masakazu Miyamoto, Koji Nakagawa, Nobuhiro Nishii, Hiroshi Ito

Journal of the American Heart Association 7 ( 10 ) 2018.5

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: A drug provocation test using a sodium channel blocker (SCB) can unmask a type 1 ECG pattern in patients with Brugada syndrome. However, the prognostic value of the results of an SCB challenge is limited in patients with non-type 1 ECG. We investigated the associations of future risk for ventricular fibrillation with SCB-induced ECG changes and ventricular tachyarrhythmias (VTAs). METHODS AND RESULTS: We administered intravenous pilsicainide to 245 consecutive patients with Brugada syndrome (181 patients with spontaneous type 1 ECG, 64 patients with non-type 1 ECG). ECG parameters before and after the test and occurrence of drug-induced VTAs were evaluated. During a mean follow-up period of 113±57 months, fatal VTA events occurred in 31 patients (sudden death: n=3, ventricular tachycardia/ventricular fibrillation: n=28). Symptomatic patients and spontaneous type 1 ECG were associated with future fatal arrhythmic events. Univariable analysis of ECG parameters after the test showed that long PQ and QRS intervals, high ST level, and SCB-induced VTAs were associated with later VTA events during follow-up. Multivariable analysis showed that symptomatic patients, high ST level (V1) ≥0.3 mV after the test, and SCB-induced VTAs were independent predictors for future fatal arrhythmic events (hazard ratios: 3.28, 2.80, and 3.62, 95% confidence intervals: 1.54-7.47, 1.32-6.35, and 1.64-7.75, respectively; P<0.05). CONCLUSIONS: SCB-induced VTAs and ST-segment augmentation are associated with an increased risk of the development of ventricular tachycardia/ventricular fibrillation events during follow-up in patients with Brugada syndrome.

DOI： 10.1161/JAHA.118.008617

Platypnea-orthodeoxia Syndrome Induced by Multiple Vertebral Compression Fractures and an Atrial Septal Defect.

Ko Harada, Koji Nakagawa, Hiroaki Ohtsuka, Yoichi Takaya, Teiji Akagi, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Ito

Internal medicine (Tokyo, Japan) 57 ( 7 ) 971 - 973 2018.4

Language：English Publishing type：Research paper (scientific journal)

Platypnea-orthodeoxia syndrome (POS) is a rare condition that is characterized by dyspnea and arterial oxygen desaturation, which worsen on standing and which are relieved by recumbency. We treated an 80-year-old woman with an atrial septal defect (ASD) who demonstrated POS following thoracic and lumbar vertebral compression fractures. The surgical closure of the ASD relieved her symptoms. The etiology might have been multiple compression fractures causing kyphosis and aortic distortion producing right atrial compression and increased right-to-left flow through the ASD. POS should be considered in the differential diagnosis of patients who develop dyspnea after vertebral compression fractures. The careful assessment of the patient's history and clinical condition helps in the diagnosis of POS.

DOI： 10.2169/internalmedicine.9904-17

Analysis of arrhythmic events is useful to detect lead failure earlier in patients followed by remote monitoring. International journal

Nobuhiro Nishii, Akihito Miyoshi, Motoki Kubo, Masakazu Miyamoto, Yoshimasa Morimoto, Satoshi Kawada, Koji Nakagawa, Atsuyuki Watanabe, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Ito

Journal of cardiovascular electrophysiology 29 ( 3 ) 463 - 470 2018.3

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Remote monitoring (RM) has been advocated as the new standard of care for patients with cardiovascular implantable electronic devices (CIEDs). RM has allowed the early detection of adverse clinical events, such as arrhythmia, lead failure, and battery depletion. However, lead failure was often identified only by arrhythmic events, but not impedance abnormalities. OBJECTIVE: To compare the usefulness of arrhythmic events with conventional impedance abnormalities for identifying lead failure in CIED patients followed by RM. METHODS: CIED patients in 12 hospitals have been followed by the RM center in Okayama University Hospital. All transmitted data have been analyzed and summarized. RESULTS: From April 2009 to March 2016, 1,873 patients have been followed by the RM center. During the mean follow-up period of 775 days, 42 lead failure events (atrial lead 22, right ventricular pacemaker lead 5, implantable cardioverter defibrillator [ICD] lead 15) were detected. The proportion of lead failures detected only by arrhythmic events, which were not detected by conventional impedance abnormalities, was significantly higher than that detected by impedance abnormalities (arrhythmic event 76.2%, 95% CI: 60.5-87.9%; impedance abnormalities 23.8%, 95% CI: 12.1-39.5%). Twenty-seven events (64.7%) were detected without any alert. Of 15 patients with ICD lead failure, none has experienced inappropriate therapy. CONCLUSIONS: RM can detect lead failure earlier, before clinical adverse events. However, CIEDs often diagnose lead failure as just arrhythmic events without any warning. Thus, to detect lead failure earlier, careful human analysis of arrhythmic events is useful.

DOI： 10.1111/jce.13399

Diastolic Dysfunction Is a Risk of Perioperative Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin T in Elderly Patients Undergoing Non-Cardiac Surgery.

Hironobu Toda, Kazufumi Nakamura, Koji Nakagawa, Atsuyuki Watanabe, Toru Miyoshi, Nobuhiro Nishii, Kazuyoshi Shimizu, Masao Hayashi, Hiroshi Morita, Hiroshi Morimatsu, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 82 ( 3 ) 775 - 782 2018.2

Language：English

BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) is useful for detecting myocardial injury and is expected to become a prognostic marker in patients undergoing non-cardiac surgery. The aim of this pilot study evaluating the efficacy of β-blocker therapy in a perioperative setting (MAMACARI study) was to assess perioperative myocardial injury (PMI) in elderly patients with preserved ejection fraction (EF) undergoing non-cardiac surgery.Methods and Results:In this prospective observational cohort study of 151 consecutive patients with preserved EF and aged >60 years who underwent non-cardiac surgery, serum levels of hs-cTnT were measured before and on postoperative days 1 and 3 after surgery. PMI was defined as postoperative hs-cTnT >0.014 ng/mL and relative hs-cTnT change ≥20%. A total of 36 (23.8%) of the patients were diagnosed as having PMI. The incidence of a composite of cardiovascular events within 30 days after surgery, including myocardial infarction, stroke, worsening heart failure, atrial fibrillation and pulmonary embolism, was significantly higher in patients with PMI than in patients without PMI (odds ratio (OR) 9.25, P<0.001, 95% confidence interval (CI) 2.65-32.3). Multivariate analysis revealed that left ventricular diastolic dysfunction defined by echocardiography was independently associated with PMI (OR: 3.029, 95% CI: 1.341-6.84, P=0.008). CONCLUSIONS: PMI is frequently observed in elderly patients undergoing non-cardiac surgery. Diastolic dysfunction is an independent predictor of PMI.

DOI： 10.1253/circj.CJ-17-0747

Impact of premature activation of the right ventricle with programmed stimulation in Brugada syndrome International journal

Koji Nakagawa, Satoshi Nagase, Hiroshi Morita, Tadashi Wada, Masamichi Tanaka, Masato Murakami, Atsuyuki Watanabe, Nobuhiro Nishii, Kazufumi Nakamura, Kengo F. Kusano, Hiroshi Ito, Tohru Ohe

Journal of Cardiovascular Electrophysiology 29 ( 1 ) 71 - 78 2018.1

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal) Publisher：Wiley

BACKGROUND: In Brugada syndrome (BrS), it has been reported that delayed activation in the RV is related to the development of type-1 ECG, which is more critical than type-2. On the other hand, the coexistence of complete right bundle-branch block (CRBBB), which also causes delayed activation in the RV, sometimes makes typical BrS ECG misleading. We hypothesized that premature stimulation of the RV can unmask the influence of delayed activation in the RV and convert the morphology of ECG in BrS patients. METHODS AND RESULTS: In 35 BrS patients with type-1 ECG including 8 patients with concomitant CRBBB and 6 control subjects with CRBBB, progressively premature single stimulations were delivered from the RV apex on electrophysiological study. Then we evaluated QRS morphology of fusion beats created by single premature stimulation in each patient. In 29 (83%) of 35 of the BrS patients, conversion from type-1 to type-2 ECG was observed during the process of single premature stimulation. Additionally, in all 8 BrS patients with concomitant CRBBB, type-1 or type-2 BrS ECG was revealed by premature stimulation with relief of CRBBB. These findings were not observed in any of the control subjects with CRBBB. CONCLUSION: Single premature stimulation of the RV converts ECG from type-1 to type-2 in most BrS cases and unmasks type-1 ECG in all BrS cases with CRBBB. Our results could suggest that type-1 ECG is associated with delayed activation of the RV compared with type-2 ECG.

DOI： 10.1111/jce.13336

Identification of electrocardiographic risk markers for the initial and recurrent episodes of ventricular fibrillation in patients with Brugada syndrome. International journal

Hiroshi Morita, Atsuyuki Watanabe, Satoshi Kawada, Masakazu Miyamoto, Yoshimasa Morimoto, Koji Nakagawa, Nobuhiro Nishii, Kazufumi Nakamura, Hiroshi Ito

Journal of cardiovascular electrophysiology 29 ( 1 ) 107 - 114 2018.1

Language：English Publishing type：Research paper (scientific journal)

INTRODUCTION: New onset of ventricular fibrillation (VF) in asymptomatic patients with Brugada-type ECG is not frequent, but it cannot be negligible. Risk markers for predicting VF are usually based on results of analysis in symptomatic patients, and they have not been determined for asymptomatic patients. We analyzed ECG markers in patients with Brugada syndrome to differentiate the risk factors for VF in both symptomatic and asymptomatic patients. METHODS: The subjects were 471 patients with Brugada syndrome and we divided the subjects into two groups: Asymptomatic group (n = 326) and Symptomatic group (syncope: n = 122, VF: n = 23). We analyzed the following ECG markers: RR, PQ, QRS, QT and Tpeak-Tend (Tpe) intervals, ST level, atrial fibrillation (AF), atrioventricular block, spontaneous type 1 ECG, early repolarization (ER) and fragmented QRS (fQRS). RESULTS: During follow-up (91 ± 64 months), 41 patients experienced VF (Asymptomatic: n = 10, Symptomatic: n = 31). Univariable analysis showed that spontaneous type 1 ECG, Tpe interval (≥95 milliseconds), high ST level (≥0.52 mV) and fQRS were common predictors for VF in both the Asymptomatic and Symptomatic groups. In addition to the common risk factors, wide QRS (≥107 milliseconds), long QT interval (≥420 milliseconds), ER and AF were predictors for VF in Symptomatic group. Multivariable analysis of the Symptomatic group showed fQRS, Tpe and ER were independent predictors of prognosis. CONCLUSIONS: fQRS and Tpe interval are common risk factors for VF in both asymptomatic and symptomatic patients, whereas ER is a predictor for recurrent VF.

DOI： 10.1111/jce.13349

Crucial role of RAGE in inappropriate increase of smooth muscle cells from patients with pulmonary arterial hypertension. International journal

Kazufumi Nakamura, Masakiyo Sakaguchi, Hiromi Matsubara, Satoshi Akagi, Toshihiro Sarashina, Kentaro Ejiri, Kaoru Akazawa, Megumi Kondo, Koji Nakagawa, Masashi Yoshida, Toru Miyoshi, Takeshi Ogo, Takahiro Oto, Shinichi Toyooka, Yuichiro Higashimoto, Kei Fukami, Hiroshi Ito

PloS one 13 ( 9 ) e0203046 2018

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Pulmonary vascular remodeling of pulmonary arterial hypertension (PAH) is characterized by an inappropriate increase of vascular cells. The receptor for advanced glycation end products (RAGE) is a type I single-pass transmembrane protein belonging to the immunoglobulin superfamily and is involved in a broad range of hyperproliferative diseases. RAGE is also implicated in the etiology of PAH and is overexpressed in pulmonary artery smooth muscle cells (PASMCs) in patients with PAH. We examined the role of RAGE in the inappropriate increase of PASMCs in patients with PAH. METHODS AND RESULTS: PASMCs were obtained from 12 patients with PAH including 9 patients with idiopathic PAH (IPAH) and 3 patients with heritable PAH (HPAH) (2 patients with BMPR2 mutation and one patient with SMAD9 mutation) who underwent lung transplantation. Western blot analysis and immunofluorescence staining revealed that RAGE and S100A8 and A9, ligands of RAGE, were overexpressed in IPAH and HPAH-PASMCs in the absence of any external growth stimulus. PDGF-BB (10 ng/mL) up-regulated the expression of RAGE in IPAH and HPAH-PASMCs. PAH-PASMCs are hyperplastic in the absence of any external growth stimulus as assessed by 3H-thymidine incorporation. This result indicates overgrowth characterized by continued growth under a condition of no growth stimulation in PAH-PASMCs. PDGF-BB stimulation caused a higher growth rate of PAH-PASMCs than that of non-PAH-PASMCs. AS-1, an inhibitor of TIR domain-mediated RAGE signaling, significantly inhibited overgrowth characterized by continued growth under a condition of no growth stimulation in IPAH and HPAH-PASMCs (P<0.0001). Furthermore, AS-1 significantly inhibited PDGF-stimulated proliferation of IPAH and HPAH-PASMCs (P<0.0001). CONCLUSIONS: RAGE plays a crucial role in the inappropriate increase of PAH-PASMCs. Inhibition of RAGE signaling may be a new therapeutic strategy for PAH.

DOI： 10.1371/journal.pone.0203046

Exercise stress test reveals ineligibility for subcutaneous implantable cardioverter defibrillator in patients with Brugada syndrome. International journal

Motomi Tachibana, Nobuhiro Nishii, Hiroshi Morita, Koji Nakagawa, Atsuyuki Watanabe, Kazufumi Nakamura, Hiroshi Ito

Journal of cardiovascular electrophysiology 28 ( 12 ) 1454 - 1459 2017.12

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The eligibility of patients with Brugada syndrome (BrS) for implantation of a subcutaneous implantable cardioverter defibrillator (S-ICD) is not well known. This study aimed to clarify the eligibility of BrS patients for S-ICD using electrocardiography (ECG) at rest and during exercise testing. We also analyzed factors associated with ineligibility for S-ICD from standard 12-lead ECG at rest. METHODS: We enrolled 110 consecutive BrS patients who visited Okayama university hospital from December 2015 to December 2016. All patients were assessed for S-ICD eligibility, which required one lead to satisfy the S-ICD screening template. We assessed standard 12-lead ECG parameters in all participants. Of those who passed S-ICD screening, 45 patients were assessed for S-ICD eligibility during treadmill stress test. RESULTS: Mean age of study patients was 54 ± 13 years and 108 (98%) were men. In total, 89 patients (81%) satisfied S-ICD indications at rest. Existence of complete right bundle branch block (CRBBB) on standard 12-lead ECG was a significant predictor of ineligibility for S-ICD (odds ratio, 5.00; P = 0.03; 95%CI, 1.14-21.98). Of the 45 patients who underwent treadmill stress testing, 11 patients (24%) showed ineligibility for S-ICD during the test. CONCLUSION: CRBBB was a predictor of ineligibility for S-ICD in patients with BrS. Sinus tachycardia changes ECG morphology in some patients and stress testing should be considered before S-ICD implantation.

DOI： 10.1111/jce.13315

Functional Tricuspid Regurgitation After Transcatheter Closure of Atrial Septal Defect in Adult Patients: Long-Term Follow-Up. International journal

Yoichi Takaya, Teiji Akagi, Yasufumi Kijima, Koji Nakagawa, Hiroshi Ito

JACC. Cardiovascular interventions 10 ( 21 ) 2211 - 2218 2017.11

Language：English

OBJECTIVES: This study aimed to assess the fate of tricuspid regurgitation (TR) after transcatheter atrial septal defect (ASD) closure. BACKGROUND: Although TR frequently occurs in patients with ASD, the change in TR during long-term follow-up after ASD closure remains unknown. METHODS: A total of 419 adult patients who underwent transcatheter ASD closure were enrolled. TR severity was graded by TR jet area on echocardiography. RESULTS: At baseline, 113 patients had severe/moderate TR and 306 patients had mild TR. Among the 113 patients with severe/moderate TR, the TR jet area significantly decreased during a median follow-up of 30 months after the procedure; this decrease was related to the improvement in right ventricular morphology. The severity of TR decreased to mild in 79 (70%) patients. Persistent TR, defined as severe or moderate TR after the procedure, was independently associated with the prevalence of permanent atrial fibrillation. Regarding clinical outcomes, 7 patients with severe/moderate TR and 2 with mild TR were hospitalized because of heart failure. Patients with severe/moderate TR had the worse event-free survival rate than those with mild TR, but more than 90% of them had no cardiovascular events. New York Heart Association functional class and plasma B-type natriuretic peptide levels improved in patients with severe/moderate TR, similar to those with mild TR. CONCLUSIONS: Significant TR decreased during the long-term follow-up period after transcatheter ASD closure. Heart failure symptoms improved in patients with severe/moderate TR. Our findings suggest that transcatheter closure alone can be valuable in patients with ASD complicated with TR.

DOI： 10.1016/j.jcin.2017.06.022

Comparison of longevity and clinical outcomes of implantable cardioverter-defibrillator leads among manufacturers. International journal

Satoshi Kawada, Nobuhiro Nishii, Yoshimasa Morimoto, Akihito Miyoshi, Motomi Tachibana, Hiroyasu Sugiyama, Koji Nakagawa, Atsuyuki Watanabe, Hiroshi Morita, Hiroshi Ito

Heart rhythm 14 ( 10 ) 1496 - 1503 2017.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: An early failure of the Biotronik Linox S/SD implantable cardioverter-defibrillator (ICD) lead has been reported. We have also experienced several cases with early failure of Linox leads. OBJECTIVE: Our aim was to assess the longevity of Linox S/SD (Biotronik, Berlin, Germany) compared with Sprint Fidelis (Medtronic, Minneapolis, MN), Sprint Quattro (Medtronic), and Endotak Reliance (Boston Scientific, Natick, Massachusetts) leads. METHODS: We retrospectively reviewed patients who had undergone implantation of Linox S/SD (n = 90), Sprint Fidelis (n = 37), Sprint Quattro (n = 27), or Endotak Reliance (n = 50) leads between June 2000 and December 2013 at our hospital. Variables associated with lead failure were assessed by the Kaplan-Meier method and Cox survival modeling. RESULTS: Failure rates of Linox, Sprint Fidelis, and Endotak leads were 3.2%/year (7-year survival rate, 81.0%), 3.4%/year (7-year survival rate, 77.2%), and 0.61%/year (7-year survival rate, 95.8%), respectively. No lead failure was found with Sprint Quattro leads. The survival probability of Linox leads was significantly lower than that of Endotak leads (P = .049) and comparable to that of Sprint Fidelis leads (P = .69). In univariate analysis, age was the only predictor of Linox lead failure. Patients <58 years old were at significantly increased risk of lead failure compared with patients ≥58 years old (hazard ratio, 9.0; 95% confidence interval, 1.13-71.3; P = .037). CONCLUSION: In our single-center experience, the survival rate of Linox leads was unacceptably low. The only predictor of Linox lead failure was age at implantation. This is the first description of a lower survival rate for Linox leads in an Asian population.

DOI： 10.1016/j.hrthm.2017.05.020

顕性蛋白尿をきたした腎動脈狭窄症に対するPTRAの腎保護効果についての検討 Reviewed

戸田洋伸, 内田治仁, 竹内英実, 江尻健太郎, 大塚寛昭, 中川晃志, 渡邊敦之, 西井伸洋, 三好亨, 中村一文, 森田宏, 和田淳, 伊藤浩

脈管学 57 ( Suppl. ) S138 - S138 2017.10

Initial experience with the subcutaneous implantable cardioverter-defibrillator in a single Japanese center.

Nobuhiro Nishii, Motomi Tachibana, Yoshimasa Morimoto, Satoshi Kawada, Akihito Miyoshi, Hiroyasu Sugiyama, Koji Nakagawa, Atsuyuki Watanabe, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Ito

Journal of arrhythmia 33 ( 4 ) 338 - 341 2017.8

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (S-ICD) is recognized as a viable alternative to the transvenous ICD. The safety and efficacy of this device has been demonstrated in Western countries, but studies with S-ICD implantation in Japanese patients have not been reported. METHODS AND RESULTS: Twelve patients received an S-ICD implant in our institute between February and September 2016. All S-ICDs were successfully implanted without complications. One appropriate and one inappropriate therapy was identified. CONCLUSIONS: S-ICD implantation appears to provide a viable alternative to transvenous ICD implantation for some Japanese patients. However, we should perform careful follow-up of patients to eliminate inappropriate therapy.

DOI： 10.1016/j.joa.2017.02.004

左冠動脈主幹部に起始異常を認め、その物理的圧迫による心筋虚血にて数年間にわたり失神を繰り返した若年者の1症例

網岡尚史, 渡邊敦之, 大塚寛昭, 赤木達, 麻植浩樹, 中川晃志, 中村一文, 森田宏, 小谷恭弘, 新井禎彦, 笠原真悟, 佐野俊二, 伊藤浩

心臓 49 ( Suppl.1 ) 110 - 110 2017.8

Complete right bundle branch block and QRS-T discordance can be the initial clue to detect S-ICD ineligibility. International journal

Motomi Tachibana, Nobuhiro Nishii, Yoshimasa Morimoto, Satoshi Kawada, Akihito Miyoshi, Hiroyasu Sugiyama, Koji Nakagawa, Atsuyuki Watanabe, Kazufumi Nakamura, Hiroshi Morita, Hiroshi Ito

Journal of cardiology 70 ( 1 ) 23 - 28 2017.7

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: In order to minimize inappropriate shocks of subcutaneous implantable cardioverter-defibrillators (S-ICD), it is important to recognize who is suitable for S-ICD indication. This study aimed to clarify what types of cardiac disease are likely to fulfill the S-ICD screening criteria and ineligible factors for S-ICD in the standard 12-lead electrocardiogram (ECG). METHODS: A total of 348 patients with heart disease were enrolled. They were assessed by supine and standing ECG recording to simulate the 3 S-ICD sensing vectors and standard 12-lead ECG, simultaneously. Clinical and ECG characteristics were analyzed to compare the patients who are eligible and ineligible with S-ICD screening ECG indication. RESULTS: The mean age of study patients was 49±21 years and 244 (70%) were men. Nineteen percent of patients were unsuitable for S-ICD. There was no significant difference in ineligibility for S-ICD among cardiac diseases (p=0.48). Univariate analysis showed complete right bundle branch block (CRBBB), QRS-T discordance in lead II, and QRS-T discordance in 3 leads (I, II, and aVF) were more frequent in patients who were ineligible for S-ICD than in the eligible group. Multivariate regression analysis showed CRBBB and QRS-T discordance in 3 leads were independent predictors for ineligibility of S-ICD. CONCLUSION: There are no differences in eligibility of S-ICD among types of cardiac diseases. CRBBB and QRS-T discordance were independent predictors for ineligibility.

DOI： 10.1016/j.jjcc.2016.11.014

Recording of isolated very delayed potentials on the right ventricular epicardium in a patient with Brugada syndrome. International journal

Atsuyuki Watanabe, Hiroshi Morita, Sho Tsushima, Koji Nakagawa, Nobuhiro Nishii, Hiroshi Ito

HeartRhythm case reports 3 ( 7 ) 344 - 347 2017.7

Structural Heart Diseases(SHD) PFO closure for stroke prevention PFO closureの適応患者をどう考えるか

中川晃志, 赤木禎治, 高谷陽一, 伊藤浩

日本心血管インターベンション治療学会抄録集 26回 S8 - 2 2017.7

片頭痛に対するカテーテル閉鎖術の有効性

高谷陽一, 赤木禎治, 中川晃志, 高橋義秋, 伊藤浩

日本心血管インターベンション治療学会抄録集 26回 MO021 - MO021 2017.7

10年後のインターベンション 10年後のSHDインターベンション「経皮的卵円孔閉鎖術は奇異性脳梗塞再発予防目的だけでなく初回発症予防のために実施される可能性がある」

赤木禎治, 高谷陽一, 中川晃志, 高橋義秋, 阿部康二, 伊藤浩

日本心血管インターベンション治療学会抄録集 26回 S17 - 4 2017.7

Epicardially placed implantable cardioverter-defibrillator for a child with congenital long QT syndrome.

Hirotaro Sugiyama, Motomi Tachibana, Hiroshi Morita, Nobuhiro Nishii, Akihito Miyoshi, Hiroyasu Sugiyama, Koji Nakagawa, Atsuyuki Watanabe, Kazufumi Nakamura, Hiroshi Ito

Journal of arrhythmia 33 ( 3 ) 237 - 239 2017.6

Language：English Publishing type：Research paper (scientific journal)

A 7-year-old boy presented at our hospital with syncope. At birth, electrocardiography had shown a long QT interval with torsade de pointes (TdP). Congenital long QT syndrome (LQTS) had been diagnosed by genetic testing, and was successfully controlled with oral propranolol. At age 7, TdP had recurred with syncope. Electrocardiography revealed a prominent long QT interval with T-wave alternans. The propranolol dose was increased, but TdP remained uncontrolled. A cardioverter-defibrillator (ICD) was implanted epicardially, and TdP completely resolved with atrial pacing. We report this rare case of ICD implantation in a child with LQTS.

DOI： 10.1016/j.joa.2016.10.561

Two cases of inappropriate implantable cardioverter-defibrillator therapies due to T wave oversensing induced by body twisting.

Nobuhiro Nishii, Akihito Miyoshi, Motoki Kubo, Hiroyasu Sugiyama, Motomi Tachibana, Koji Nakagawa, Atsuyuki Watanabe, Hiroshi Morita, Hiroshi Ito

Journal of arrhythmia 33 ( 2 ) 152 - 155 2017.4

Language：English Publishing type：Research paper (scientific journal)

T wave oversensing (TWOS) is a common cause of inappropriate implantable cardioverter-defibrillator (ICD) therapies. Various algorithms to avoid inappropriate ICD therapy are available; however, they are not helpful to avoid TWOS. Although the reproduction of TWOS is useful to resolve the problem of TWOS, it is sometimes difficult to reproduce TWOS. We report two cases of inappropriate ICD therapy due to TWOS, which were induced only by body twisting. We can successfully manage the device based on the evidence of reproduced TWOS.

DOI： 10.1016/j.joa.2016.06.003

Distribution and Prognostic Significance of Fragmented QRS in Patients With Brugada Syndrome. International journal

Hiroshi Morita, Atsuyuki Watanabe, Yoshimasa Morimoto, Satoshi Kawada, Motomi Tachibana, Koji Nakagawa, Nobuhiro Nishii, Hiroshi Ito

Circulation. Arrhythmia and electrophysiology 10 ( 3 ) 2017.3

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Fragmented QRS complexes (fQRS) in the right precordial leads are associated with occurrence of ventricular fibrillation (VF) in Brugada syndrome. Recently, epicardial mapping has revealed abnormal electrograms at the right ventricular (RV) outflow tract and inferior region of the right ventricle. fQRS may reflect the extent of the area of abnormal potentials, but whether the distribution of fQRS has prognostic value is not known. METHODS AND RESULTS: We evaluated the existence of fQRS in 456 patients with Brugada syndrome, including 117 patients with syncope and 23 patients with VF. The region of fQRS was defined as inferior (II, III, and aVF), lateral (I, aVL, and V5 and V6), anterior (V3 and V4), RV (V1 and V2), and RV outflow tract (V1 and V2 at the third intercostal space). fQRS were present in 229 patients (RV outflow tract in 175, inferior in 135, RV in 90, and lateral in 16 patients). During follow-up (mean 91 months), 39 patients experienced VF. In univariable analyses, fQRS in any distribution and fQRS in each region excluding the RV were associated with VF. Multivariable analysis showed that fQRS in the inferior (hazard ratio, 3.9; confidence interval, 1.9-8.5), lateral (hazard ratio, 3.5; confidence interval, 1.2-8.2), and RV outflow tract (hazard ratio, 2.5; confidence interval, 1.2-5.6) were associated with VF events. The presence of multiple regions of fQRS was associated with worse prognosis. CONCLUSIONS: The distribution of fQRS is associated with prognosis in Brugada syndrome, further supporting the association of fQRS and arrhythmia substrate.

DOI： 10.1161/CIRCEP.116.004765

成人の心房中隔欠損症に対する経カテーテル閉鎖術後の機能性三尖弁逆流(Functional Tricuspid Regurgitation after Transcatheter Closure of Atrial Septal Defect in Adults)

高谷陽一, 赤木禎治, 木島康文, 中川晃志, 伊藤浩

日本循環器学会学術集会抄録集 81回 PJ - 542 2017.3

Reverse Right Ventricular Remodeling After Lung Transplantation in Patients With Pulmonary Arterial Hypertension Under Combination Therapy of Targeted Medical Drugs.

Toshihiro Sarashina, Kazufumi Nakamura, Satoshi Akagi, Takahiro Oto, Hiroki Oe, Kentaro Ejiri, Koji Nakagawa, Nobuhiro Nishii, Hiromi Matsubara, Motomu Kobayashi, Hiroshi Morimatsu, Shinichiro Miyoshi, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 81 ( 3 ) 383 - 390 2017.2

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Patients with pulmonary arterial hypertension (PAH) are currently treated with combination therapy of PAH-targeted drugs. Reverse right ventricular (RV) remodeling after lung transplantation (LTx) in patients with end-stage PAH despite combination therapy of PAH-targeted drugs has not been fully elucidated.Methods and Results:A total of 136 patients, including 32 with PAH, underwent LTx from 1998 to 2014. We enrolled 12 consecutive patients with PAH treated with combination therapy of PAH-targeted drugs who underwent LTx and retrospectively analyzed the temporal and serial changes in hemodynamics and echocardiography before LTx and at 3 and 12 months after LTx. Before LTx, the RV was markedly dilated with substantially reduced RV fractional area change (RVFAC). At 3 months after LTx, pulmonary artery pressure, pulmonary vascular resistance and RV stroke work index were significantly decreased, while left ventricular stroke work index was increased. RV size assessed by echocardiography also significantly decreased and RVFAC improved. At 12 months after LTx, RVFAC was further increased and RV wall thickness was decreased significantly. CONCLUSIONS: Although severe RV dysfunction and dilation were observed in patients with end-stage PAH despite combination therapy of PAH-targeted drugs, RV function and morphology were improved after reduction of RV pressure load by LTx.

DOI： 10.1253/circj.CJ-16-0838

Echocardiographic Estimates of Left Ventricular Diastolic Dysfunction Do Not Predict the Clinical Course in Elderly Patients Undergoing Transcatheter Atrial Septal Defect Closure: Impact of Early Diastolic Mitral Annular Velocity. International journal

Yoichi Takaya, Teiji Akagi, Yasufumi Kijima, Koji Nakagawa, Nobuhisa Watanabe, Hiroki Oe, Manabu Taniguchi, Hiroshi Ito

Journal of interventional cardiology 30 ( 1 ) 79 - 84 2017.2

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: This study evaluated the effect of echocardiographic left ventricular (LV) diastolic dysfunction on acute congestive heart failure after transcatheter atrial septal defect (ASD) closure in elderly patients. BACKGROUND: Although there is concern that LV diastolic dysfunction develops acute congestive heart failure after ASD closure, limited information is available regarding the influence, especially in elderly patients with severe LV diastolic dysfunction. METHODS: Two hundred consecutive patients older than 60 years were divided into 3 groups according to echocardiographic LV diastolic dysfunction: severe (early diastolic mitral annular velocity [e'] <5.0 cm/s), mild (5.0≤ e' <8.0 cm/s), and normal (e' ≥ 8.0 cm/s). Changes in plasma B-type natriuretic peptide (BNP) levels were evaluated. RESULTS: No patients with severe LV diastolic dysfunction developed acute congestive heart failure immediately after the procedure. BNP levels unchanged after the procedure in patients with severe LV diastolic dysfunction (126 ± 181 to 131 ± 148 pg/ml, P = 0.885), and this increase in BNP levels was not different from that between the diagnosis of ASD and the procedure. The change in BNP levels in patients with severe LV diastolic dysfunction, who were frequently treated with diuretics before the procedure, was equivalent to that in patients with mild LV diastolic dysfunction and normal LV diastolic function (5 ± 119 vs. 16 ± 101 vs. 9 ± 131 pg/ml, P = 0.724). CONCLUSIONS: Our findings suggest that transcatheter ASD closure under volume management is safe and valuable in elderly patients with echocardiographic severe LV diastolic dysfunction.

DOI： 10.1111/joic.12365

Local Left Ventricular Epicardial J Waves and Late Potentials in Brugada Syndrome Patients with Inferolateral Early Repolarization Pattern. International journal

Satoshi Nagase, Masamichi Tanaka, Hiroshi Morita, Koji Nakagawa, Tadashi Wada, Masato Murakami, Nobuhiro Nishii, Kazufumi Nakamura, Hiroshi Ito, Tohru Ohe, Kengo F Kusano

Frontiers in physiology 8 14 - 14 2017

Language：English Publishing type：Research paper (scientific journal)

Background: Brugada syndrome (BrS) is characterized by J-point or ST-segment elevation on electrocardiograms (ECGs) and increased risk of ventricular fibrillation (VF). In BrS, epicardial depolarization abnormality with delayed potential on the right ventricular outflow tract is reportedly the predominant mechanism underlying VF. Yet VF occurrence is also associated with early repolarization (ER) pattern in the inferolateral ECG leads, which may represent the inferior and/or left lateral ventricular myocardium. The aim of this study was to examine epicardial electrograms recorded directly at the left ventricle (LV) in BrS patients after VF episodes. Methods: In 12 BrS patients who had experienced VF episodes and 17 control subjects, a multipolar catheter was introduced into the left lateral coronary vein for unipolar and bipolar electrogram recordings at the LV epicardium. Both inferior and lateral ER patterns on ECG were observed in three BrS patients and six control subjects. Results: In the epicardium, prominent J waves were detected using unipolar recording, and potentials after the QRS complex were detected using bipolar recording in three of the 12 BrS patients. These three patients also showed both inferior and lateral ER patterns on ECG. Neither prominent J waves nor potentials after the QRS complex were recorded at the endocardium of the LV in any of these three patients; nor were they seen at the epicardium in any of the control subjects. These features were accentuated on pilsicainide administration (n = 2) but diminished on constant atrial pacing (n = 3) and isoproterenol administration (n = 1). The J waves observed through unipolar recording coincided with the potentials after QRS complex observed through bipolar recording and with the inferolateral ER patterns on ECG. Conclusions: We recorded prominent J waves in unipolar electrogram and potentials after QRS complex in bipolar electrogram at the LV epicardium in BrS patients with global ER pattern. The prominent J waves coincided with the potentials after QRS complex and the inferolateral ER pattern on ECG. The characteristics of the inferolateral ER pattern on ECG in these patients primarily represent depolarization feature.

DOI： 10.3389/fphys.2017.00014

Feasibility of Repairing Defects Followed by Treatment with Pulmonary Hypertension-specific Drugs (Repair and Treat) in Patients with Pulmonary Hypertension Associated with Atrial Septal Defect: Study Protocol for Interventional Trial.

Satoshi Akagi, Kazufumi Nakamura, Teiji Akagi, Koji Nakagawa, Yoichi Takaya, Toshihiro Sarashina, Kentaro Ejiri, Hiroshi Ito

Acta medica Okayama 70 ( 5 ) 397 - 400 2016.10

Language：English Publishing type：Research paper (scientific journal)

A treatment strategy for patients with pulmonary hypertension (PH) and atrial septal defect (ASD) remains unclear. This study was designed to evaluate the effects of initial repair of ASD followed by treatment with PH-specific drugs in patients with PH and ASD. Eligible patients receive transcatheter ASD closure followed by treatment with bosentan and sildenafil. Right heart catheterization is performed at baseline and at 12, 24 and 48 weeks. The primary endpoint is change in pulmonary artery pressure and pulmonary vascular resistance from baseline to follow-up. This study should provide valuable information to establish a therapeutic strategy for PH and ASD.

Influence of transcatheter closure of atrial communication on migraine headache in patients with ischemic stroke.

Yoichi Takaya, Teiji Akagi, Yasufumi Kijima, Koji Nakagawa, Syoichiro Kono, Kentaro Deguchi, Shunji Sano, Hiroshi Ito

Cardiovascular intervention and therapeutics 31 ( 4 ) 263 - 8 2016.10

Language：English Publishing type：Research paper (scientific journal)

Some types of migraine are associated with ischemic stroke. Although a right-to-left communication is linked with ischemic stroke, a causal relationship between migraine and right-to-left communication remains unclear. Furthermore, the efficacy of transcatheter closure of atrial communication on migraine is controversial. We aimed to evaluate the influence of transcatheter closure of atrial communication on migraine in patients with ischemic stroke. Thirty-eight consecutive patients with ischemic stroke who underwent transcatheter closure of atrial communication were enrolled. The prevalence, frequency, and severity of migraine were prospectively evaluated at baseline, 3 months, and >6 months after the procedure. Changes in migraine after the procedure were classified according to the frequency and severity of migraine: disappeared, improved, no-change, and worsening. Nineteen (50 %) of 38 patients suffered from migraine at baseline. No significant differences were observed in age, comorbidities, defect diameter, and atrial septal aneurysm between patients with migraine and patients without migraine. Among the 19 patients with migraine, migraine disappeared in 10 (53 %) patients and improved in 8 (42 %) patients at 3 months after transcatheter closure of atrial communication. At mean follow-up of 38 ± 28 months after the procedure, migraine disappeared in 12 (63 %) patients and improved in five (26 %) patients. No patients experienced worsening of migraine during the follow-up period. New-onset migraine was not observed in patients without migraine. Migraine is complicated in a half of patients with ischemic stroke related to atrial communication. Such migraine may disappear or improve after transcatheter closure of atrial communication.

DOI： 10.1007/s12928-015-0375-8

薬剤抵抗性片頭痛に対する経カテーテル卵円孔閉鎖術の有効性と安全性

赤木禎治, 高谷陽一, 中川晃志, 高橋義秋, 阿部康二, 伊藤浩

日本頭痛学会誌 43 ( 2 ) 305 - 305 2016.10

片頭痛のトピックス卵円孔開存に対するカテーテル閉鎖術脳梗塞再発予防と片頭痛に対する有効性

赤木禎治, 高谷陽一, 中川晃志, 高橋義秋

日本頭痛学会誌 43 ( 2 ) 228 - 228 2016.10

Deficient Surrounding Rims in Patients Undergoing Transcatheter Atrial Septal Defect Closure. International journal

Yasufumi Kijima, Teiji Akagi, Yoichi Takaya, Manabu Taniguchi, Koji Nakagawa, Kengo Kusano, Shunji Sano, Hiroshi Ito

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 29 ( 8 ) 768 - 776 2016.8

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The influence of deficient rims surrounding atrial septal defects (ASDs) in patients undergoing transcatheter closure has yet to be clarified. The aim of this study was to assess the influence of a deficient surrounding rim on the procedural success and clinical outcome of transcatheter ASD closure using an Amplatzer septal occluder. METHODS: A total of 474 patients (mean age, 46 ± 22 years) with ostium secundum ASDs measuring ≤40 mm in diameter who had undergone attempted transcatheter closure using Amplatzer septal occluders from September 2007 to August 2013 were assessed. A comprehensive transesophageal echocardiographic examination was done to assess the morphologic characteristics of the defects in all patients. Subjects were classified into three groups by the extent and location of rim deficiency (<5 mm): patients without deficient rims (sufficient group, n = 101), patients with single deficient rims, (single group, n = 338), and patients with multiple rim deficiencies (multiple group, n = 35). RESULTS: There was a significant difference in the maximal defect diameter among the sufficient, single, and multiple groups (15 ± 6, 18 ± 6, and 29 ± 7 mm, respectively, P < .001). Transcatheter closure was successfully accomplished in 463 patients (98%). The prevalence of procedural success differed significantly among the sufficient, single, and multiple groups (100%, 98%, and 86%, respectively, P < .001). There was no significant difference in the occurrence of cardiovascular events among the three groups during a mean follow-up period of 25 ± 19 months (P = .926, log-rank test). CONCLUSIONS: In patients with ASDs with multiple rim deficiencies as determined by transesophageal echocardiography, successful transcatheter ASD closure using Amplatzer septal occluders is more difficult to accomplish. However, if closure is successful, rim deficiencies rarely affect intermediate-term outcomes.

DOI： 10.1016/j.echo.2016.04.010

Activation Pattern of the Polymorphic Ventricular Tachycardia and Ventricular Fibrillation on Body Surface Mapping in Patients With Brugada Syndrome.

Akira Ueoka, Hiroshi Morita, Atsuyuki Watanabe, Koji Nakagawa, Nobuhiro Nishii, Satoshi Nagase, Tohru Ohe, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 80 ( 8 ) 1734 - 43 2016.7

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Clinical and experimental studies have shown the existence of an arrhythmogenic substrate in the right ventricular outflow tract (RVOT) in patients with Brugada syndrome (BrS). To evaluate the importance of the RVOT, we evaluated the activation pattern of induced ventricular tachyarrhythmias using body surface mapping (BSM) in patients with BrS. METHODS AND RESULTS: We examined 14 patients with BrS in whom ventricular tachyarrhythmias were induced by programmed electrical stimulation. The 87-lead BSM was recorded during induced ventricular tachyarrhythmias, and an activation map and an isopotential map of QRS complexes every 5 ms were constructed to evaluate the activation pattern of ventricular tachyarrhythmias. BSM during 20 episodes of ventricular tachyarrhythmias induced at the RVOT showed that repetitive excitation was generated at the RVOT and propagated to the inferior RV and left ventricle, and then returned to the RVOT. Polymorphic QRS change during ventricular tachyarrhythmias was associated with migration of the earliest activation site and rotor. BSM during 4 episodes of ventricular fibrillation (VF) showed that the excitation front moved randomly with formation of multiple wavefronts. CONCLUSIONS: Programmed stimulation initiated repetitive firing from the RVOT. Migration and competition of the earliest activation site and rotor and local conduction delay changed the QRS morphology. Degeneration of the reentrant circuit into multiple wavefronts resulted in VF. (Circ J 2016; 80: 1734-1743).

DOI： 10.1253/circj.CJ-16-0124

小児インターベンション心臓病学の近年の進歩研究からカテーテルラボへ術前に心房細動または動悸が認められなかった40歳以上の患者におけるASD閉鎖手術後の新規心房細動の発症率と危険因子治療器具と手術による治療の比較(Incidence and risk factors of newly developed atrial fibrillation after ASD closure in patients older than 40 years without history of preoperative atrial fibrillation or flutter: device vs surgery)

藤井泰宏, 赤木禎治, 黒子洋介, 小谷恭弘, 新井禎彦, 笠原真悟, 中川晃志, 木島康文, 高谷陽一, 伊藤浩, 佐野俊二

日本小児循環器学会雑誌 32 ( Suppl.1 ) s1 - 104 2016.7

Structural Heart Disease: Current and Future 我が国における経皮的卵円孔閉鎖術の臨床的意義

赤木禎治, 高谷陽一, 麻植浩樹, 中川晃志, 伊藤浩, 佐野俊二

日本心血管インターベンション治療学会抄録集 25回 S03 - 2 2016.7

成人ASD患者における右左短絡に関する検討

中川晃志, 赤木禎治, 高谷陽一, 木島康文, 麻植浩樹, 西井伸洋, 中村一文, 伊藤浩

日本心血管インターベンション治療学会抄録集 25回 MO379 - MO379 2016.7

3D Echo-X-Ray Navigation Systemガイド下で施行したASDカテーテル閉鎖術

高谷陽一, 赤木禎治, 中川晃志, 伊藤浩

日本心血管インターベンション治療学会抄録集 25回 MP170 - MP170 2016.7

Integrated 3D Echo-X-Ray Navigation Guided Transcatheter Closure of Complex Multiple Atrial Septal Defects. International journal

Yoichi Takaya, Teiji Akagi, Koji Nakagawa, Hiroshi Ito

JACC. Cardiovascular interventions 9 ( 12 ) e111-e112 2016.6

Treat and Repair Strategy in Patients With Atrial Septal Defect and Significant Pulmonary Arterial Hypertension.

Yasufumi Kijima, Teiji Akagi, Yoichi Takaya, Satoshi Akagi, Koji Nakagawa, Kengo Kusano, Shunji Sano, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 80 ( 1 ) 227 - 34 2016

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: A therapeutic strategy in patients with atrial septal defect (ASD) and significant pulmonary arterial hypertension (PAH) remains controversial. This study aimed to assess the effect of PAH-specific medications and subsequent transcatheter shunt closure (ie, a treat and repair strategy) in these patients. METHODS AND RESULTS: Among 646 patients with ASD, 22 patients (mean age of 56±20 years) who had PAH [mean pulmonary artery pressure ≥25 mmHg and pulmonary vascular resistance (PVR) ≥3 Wood units] underwent successful transcatheter ASD closure. Prior to the procedure, 8 patients received PAH-specific medications (PHM group) and 14 patients did not (non-PHM group). Initially, the PHM group had higher PVR compared with non-PHM group (9.6±3.8 vs. 4.2±1.0 Wood units, P<0.01). After treatment with PAH-specific medications, PVR in this group decreased to 4.0±0.8 Wood units (P<0.01). No adverse events were observed in either the PHM or non-PHM group during or after the transcatheter procedure. In the PHM group, during a treatment period of 52±48 months, the World Health Organization Functional Classification significantly improved (3.0±0.5 to 2.0±0.0, P<0.01), as well as in the non-PHM group (2.1±0.6 to 1.5±0.5, P<0.01). CONCLUSIONS: Treat and repair strategy provided substantial improvement and no worsening of the WHO-FC, even in patients with ASD and significant PAH. Long-term hemodynamic follow-up is mandatory to evaluate the ultimate efficacy and safety of this new strategy.

DOI： 10.1253/circj.CJ-15-0599

奇異性脳梗塞既往者の片頭痛に対する経カテーテル心房間短絡閉鎖術の効果

赤木禎治, 高谷陽一, 麻植浩樹, 中川晃志, 出口健太郎, 高橋義秋, 阿部康二, 伊藤浩, 佐野俊二

日本頭痛学会誌 42 ( 2 ) 120 - 120 2015.11

Fate of Mitral Regurgitation After Transcatheter Closure of Atrial Septal Defect in Adults. International journal

Yoichi Takaya, Yasufumi Kijima, Teiji Akagi, Koji Nakagawa, Hiroki Oe, Manabu Taniguchi, Shunji Sano, Hiroshi Ito

The American journal of cardiology 116 ( 3 ) 458 - 62 2015.8

Language：English Publishing type：Research paper (scientific journal)

Although the volume overload of pulmonary circulation improves after atrial septal defect (ASD) closure, the increasing left ventricular preload may contribute to mitral regurgitation (MR) deterioration. We aimed to evaluate the impact of MR after transcatheter ASD closure on clinical outcomes in adults. A total of 288 consecutive patients who underwent transcatheter ASD closure were enrolled. Changes in MR were assessed at 1 month after the procedure. The end point was defined as cardiovascular events. After the procedure, MR ameliorated in 3 patients and unchanged in 253, whereas MR deteriorated in 32. During a median follow-up of 24 months, patients with MR deterioration had no cardiovascular events, and the event-free survival rate was not different between patients with MR deterioration and those with MR amelioration or no-change (p = 0.355). Even in patients with MR deterioration, the New York Heart Association functional class improved after the procedure, with no cases of worsening functional class. Multivariate logistic regression analysis showed that MR deterioration was independently related to advanced age and female gender. The degree of enlargement of mitral valve annulus diameter after the procedure was greater in patients with MR deterioration than in those with MR amelioration or no-change, and it was correlated with the degree of MR deterioration. In conclusion, MR deterioration occurs in a minority of adult patients after transcatheter ASD closure; however, it is not linked with adverse outcomes. MR deterioration may be provoked by geometric changes in mitral valve annulus, especially in women with advanced age.

DOI： 10.1016/j.amjcard.2015.04.042

Comprehensive assessment of morphology and severity of atrial septal defects in adults by CT

Kazuhiro Osawa, Toru Miyoshi, Yusuke Morimitsu, Teiji Akagi, Hiroki Oe, Koji Nakagawa, Yoichi Takaya, Yasufumi Kijima, Shuhei Sato, Susumu Kanazawa, Hiroshi Ito

Journal of Cardiovascular Computed Tomography 9 ( 4 ) 354 - 361 2015.7

Language：English Publishing type：Research paper (scientific journal) Publisher：Elsevier Inc.

Background: Cardiac CT is an excellent tool for evaluating the anatomy of a secundum atrial septal defect (ASD). However, a comprehensive assessment of its usefulness, including measurement of the pulmonary to systemic blood flow ratio in secundum ASD patients, has not been performed. Objective: Therefore, this study was designed to evaluate the usefulness of CT for assessing the hemodynamics of secundum ASD in adults compared with transesophageal echocardiography (TEE), transthoracic echocardiography, and invasive catheterization. Methods: Fifty adult patients with secundum ASD were enrolled. Cardiac CT scans (128-slice multidetector CT instrument) were acquired. These were followed by 2-dimensional reconstruction of the secundum ASDs to determine the defect size, the rim length between the outer edge of the defect, and the pulmonary to systemic blood flow (Qp/Qs) ratio. Results: The maximum sizes of the secundum ASDs derived from CT and TEE studies were comparable (21.2 ± 8.0 vs 20.0 ± 7.3 mm
P = .41
r = 0.960
P &lt
.001). The rim lengths for the aortic, mitral, and tricuspid valves
the inferior vena cava
and posterior atrium were also comparable between CT and TEE measurements. The mean Qp/Qs ratio that was derived from CT measurements was comparable with that found by invasive catheterization (2.3 ± 0.7 vs 2.3 ± 0.8
P = .73
r = 0.786
P &lt
.001). Conclusion: Cardiac CT is feasible for assessing pathology and the severity of secundum ASD in adults.

DOI： 10.1016/j.jcct.2015.04.007

Long-term outcome after transcatheter closure of atrial septal defect in older patients: impact of age at procedure. International journal

Yoichi Takaya, Teiji Akagi, Yasufumi Kijima, Koji Nakagawa, Shunji Sano, Hiroshi Ito

JACC. Cardiovascular interventions 8 ( 4 ) 600 - 6 2015.4

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: This study assessed long-term outcome after transcatheter atrial septal defect (ASD) closure in older patients, especially those older than 75 years of age. BACKGROUND: The clinical benefits of transcatheter ASD closure in this aged population are controversial. METHODS: A total of 244 patients older than 50 years of age were divided into 3 groups according to age at procedure (50 to 59 years: n=69; 60 to 74 years: n=120; 75 years and older: n=55). The primary endpoint was defined as all-cause mortality and hospitalization due to heart failure or stroke. Improvements in functional capacity and cardiac remodeling after the procedure were also assessed. RESULTS: During a median follow-up of 36 months, mortality and hospitalization due to heart failure or stroke occurred in 18 patients (7%). Among patients older than 75 years of age, 2 died of noncardiovascular disease, 2 were hospitalized due to heart failure, and 1 had a stroke. More than 90% of patients older than 75 years of age did not experience these events. Kaplan-Meier analysis showed that the event-free survival rate was not different among the 3 age groups (log-rank test, p=0.780). New York Heart Association functional class and right ventricular/left ventricular end-diastolic diameter ratio improved in patients older than 75 years of age, similar to the other age groups. CONCLUSIONS: Long-term outcome after transcatheter ASD closure in patients older than 75 years of age is similar to that in the other, relatively younger age groups. This suggests that transcatheter ASD closure can be considered a valuable therapeutic option in patients older than 75 years of age.

DOI： 10.1016/j.jcin.2015.02.002

心臓サルコイドーシスにおける加算平均心電図による心室遅延電位(LP:Late Potential)の特徴

寒川睦子, 森田宏, 中川晃志, 西井伸洋, 永瀬聡, 中村一文, 河野晋久, 伊藤浩, 草野研吾, 大江透

心電図 35 ( Suppl.1 ) S - 23 2015.3

心房中隔欠損症患者における心房細動カテーテルアブレーション後の欠損孔の変化(Reduction of defect diameters after the catheter ablation for atrial fibrillation in patients with atrial septal defect)

中川晃志, 赤木禎治, 永瀬聡, 高谷陽一, 西井伸洋, 中村一文, 森田宏, 伊藤浩

日本成人先天性心疾患学会雑誌 4 ( 1 ) 118 - 118 2015.1

Incidence and Clinical Significance of Brugada Syndrome Masked by Complete Right Bundle-Branch Block.

Tadashi Wada, Satoshi Nagase, Hiroshi Morita, Koji Nakagawa, Nobuhiro Nishii, Kazufumi Nakamura, Kunihisa Kohno, Hiroshi Ito, Kengo F Kusano, Tohru Ohe

Circulation journal : official journal of the Japanese Circulation Society 79 ( 12 ) 2568 - 75 2015

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Brugada syndrome (BrS)-type electrocardiogram (ECG) is concealed by complete right bundle-branch block (CRBBB) in some cases of BrS. Clinical significance of BrS masked by CRBBB is not well known. METHODS AND RESULTS: We reviewed an ECG database of 326 BrS patients who had type 1 ECG with or without pilsicainide. "BrS masked by CRBBB" was defined on ECG as <2-mm elevation of the J point at the time of CRBBB in the right precordial leads, and BrS-type J-point elevation ≥2 mm at the time of normalized QRS complex on relieved CRBBB. We identified 25 BrS patients (7.7%) with persistent (n=12) or intermittent CRBBB (n=13). Relief of CRBBB by pacing was performed in patients with persistent CRBBB. The prevalence of BrS masked by CRBBB was 3.1% (10/326 patients). Three patients had type 1 ECG, and 7 patients had type 2 or 3 ECG on relief of CRBBB. Two of these 10 patients had lethal arrhythmic events during the follow-up period (mean, 86.4±57.2 months). There was no prognostic difference between BrS masked by CRBBB and other BrS. CONCLUSIONS: In a small BrS population, CRBBB can completely mask typical BrS-type ECG. BrS masked by CRBBB is associated with the same risk of fatal ventricular tachyarrhythmia as other BrS.

DOI： 10.1253/circj.CJ-15-0618

A case of cardiac amyloidosis with ventricular flutter of first symptom

Ono Tamaki, Morita Hiroshi, Kimura Tomonari, Tokioka Koji, Nakagawa Koji, Nishii Nobuhiro, Nagase Satoshi, Nakamura Kazuhumi, Ito Hiroshi, Tanaka Takehiro, Yanai Hiroyuki, Ando Midori, Yutani Chikao

Shinzo 47 ( 1 ) S1_33 - S1_37 2015

Three-dimensional echocardiography guided closure of complex multiple atrial septal defects. International journal

Yasufumi Kijima, Teiji Akagi, Koji Nakagawa, Yoichi Takaya, Hiroki Oe, Hiroshi Ito

Echocardiography (Mount Kisco, N.Y.) 31 ( 10 ) E304-6 2014.11

Language：English Publishing type：Research paper (scientific journal)

Transcatheter closure of complex multiple atrial septal defects (ASDs) remains a challenge. We describe our clinical experience with staged device deployment in a patient with multiple ASDs using four Amplatzer septal occluder devices. Three-dimensional transesophageal echocardiography imaging contributed not only to the therapeutic guidance of successful device deployment but also to the decision making for the staged device delivery approach in a case of morphologically complex multiple ASDs.

DOI： 10.1111/echo.12731

Transcatheter closure of right-to-left atrial shunt in patients with platypnea-orthodeoxia syndrome associated with aortic elongation.

Yoichi Takaya, Teiji Akagi, Yasufumi Kijima, Koji Nakagawa, Manabu Taniguchi, Hayato Ohtani, Shunji Sano, Hiroshi Ito

Cardiovascular intervention and therapeutics 29 ( 3 ) 221 - 5 2014.7

Language：English Publishing type：Research paper (scientific journal)

Platypnea-orthodeoxia is a rare condition characterized by dyspnea and oxygen desaturation induced by the upright position and relieved by recumbency. The most common cause of this syndrome is right-to-left shunt through interatrial communications such as patent foramen ovale (PFO) or atrial septal defect (ASD). In addition, this syndrome can be caused by other extracardiac components, including pulmonary emphysema, pericardial disease, and prominent Eustachian valve. We experienced 3 cases of this syndrome, including 1 patient with PFO and 2 patients with ASD. Computer tomography imaging revealed aortic elongation and compression of the right atrium by ascending aorta in all of 3 patients. Transcatheter closure of PFO or ASD was successfully performed in all patients, including immediate improvements of symptoms and oxygen saturation without any complications.

DOI： 10.1007/s12928-014-0244-x

左室側壁心外膜側に不整脈基質が存在すると考えられたJ波症候群の1例

中川晃志, 永瀬聡, 和田匡史, 田中正道, 西井伸洋, 寒川睦子, 河野晋久, 中村一文, 森田宏, 草野研吾, 伊藤浩, 湯本晃久, 向原直木, 大江透

臨床心臓電気生理 37 127 - 135 2014.5

Language：Japanese Publisher：臨床心臓電気生理研究会

症例は52歳、男性。以前より心電図にて早期再分極が認められていた。心室細動自然発作を来たしたため、当院入院。心電図ではI、II、aVl、aVf、V4-6にJ波を認めた。心臓電気生理学的検査において、多極カテーテルにて経冠静脈的に左室側壁心外膜側の電位を記録すると、単極および双極誘導において体表面心電図のJ波に相当する成分が記録され、この成分は心房頻回刺激およびisoproterenolにて減高し、pilsicainideにて増強を示した。一方、前室間静脈、中心静脈、左室側壁心内膜側からの記録ではJ波に相当する成分は記録されず、また心室プログラム刺激にて心室細動は右室心尖部、右室流出路、左室心内膜側からは誘発されず、左室側壁心外膜側からのみ誘発された。Pilsicainide投与後は左室心外膜側起源と思われる期外収縮が散発し、Brugada型波形は出現しなかった。本例はJ波症候群Type 1+2と考えられ、左室側壁心外膜側の電気的異常が病態の成因に関与することが示唆された興味深い1例と考えられたので報告する。(著者抄録)

Cardiac erosion after catheter closure of atrial septal defect: Septal malalignment may be a novel risk factor for erosion.

Yasufumi Kijima, Teiji Akagi, Koji Nakagawa, Worakan Promphan, Norihisa Toh, Kazufumi Nakamura, Shunji Sano, Hiroshi Ito

Journal of cardiology cases 9 ( 4 ) 134 - 137 2014.4

Language：English Publishing type：Research paper (scientific journal)

Pericardial tamponade occurred 3 days after the catheter closure of an atrial septal defect (ASD) using Amplatzer Septal Occluder (St. Jude Medical, St. Paul, MN, USA). Before the closure, two-dimensional and real-time three-dimensional transesophageal echocardiography demonstrated a deficient aortic rim and atrial septal malalignment. Perforation of the right atrium toward the non-coronary sinus of the aortic root was confirmed at the emergent surgery. Cardiac erosion is one of the most catastrophic complications in ASD patients undergoing catheter closure with Amplatzer Septal Occluder. Hence, several risk factors for this complication are discussed and identified. Oversized device deployment and a deficient aortic rim are accepted factors potentially causing cardiac erosion. Besides, atrial septal malalignment, which is a morphological characteristic of ASD, may be a novel risk factor for cardiac erosion. <Learning objective: Cardiac erosion is a potentially lethal complication when catheter closure of atrial septal defects using Amplatzer Septal Occluder (St. Jude Medical, St. Paul, MN, USA) is provided to the patients. However, mechanisms of this complication remain to be completely elucidated. Atrial septal malalignment may be one of the novel risk factors for this catastrophic complication.>.

DOI： 10.1016/j.jccase.2013.12.004

Left ventricular epicardial electrogram recordings in idiopathic ventricular fibrillation with inferior and lateral early repolarization International journal

Koji Nakagawa, Satoshi Nagase, Hiroshi Morita, Hiroshi Ito

Heart Rhythm 11 ( 2 ) 314 - 317 2014.2

Catheter closure of patent foramen ovale in patients with cryptogenic cerebrovascular accidents: initial experiences in Japan.

Yasufumi Kijima, Teiji Akagi, Koji Nakagawa, Manabu Taniguchi, Akira Ueoka, Kentaro Deguchi, Norihisa Toh, Hiroki Oe, Kengo Kusano, Shunji Sano, Hiroshi Ito

Cardiovascular intervention and therapeutics 29 ( 1 ) 11 - 7 2014.1

Language：English Publishing type：Research paper (scientific journal)

Although numerous studies have shown an association between a patent foramen ovale (PFO) and cryptogenic cerebrovascular accidents (CVA), there has been no definitive control study that demonstrated the benefit of percutaneous device closure of a PFO compared to medical therapy in patients with CVA. Additionally, few clinical data exist for Japanese patients in this field. We demonstrate the initial experiences in catheter closure of a PFO as secondary prevention of CVA in Japan. Catheter closure of a PFO was attempted in 7 patients who were diagnosed with cryptogenic CVA. Mean age at the procedure was 54 ± 19 years. The presence of spontaneous interatrial right-to-left shunts was demonstrated by transesophageal contrast echocardiography without Valsalva maneuver in all of the patients. Amplatzer Cribriform device (n = 4) or Amplatzer PFO Occluder (n = 3) was used for the procedure and was successfully deployed. Device-related complications were not observed at the time of the procedure or during the follow-up period (mean period of 16 ± 9 months). Catheter closure of a PFO could be safely performed with Amplatzer Cribriform or Amplatzer PFO Occluder. This procedure may contribute to prevention of recurrent cryptogenic CVA in Japanese patients.

DOI： 10.1007/s12928-013-0193-9

A successful epicardial ablation from the middle cardiac vein for ventricular tachycardia with prior inferior myocardial infarction

Wada Tadashi, Nagase Satoshi, Tanaka Masamichi, Nakagawa Koji, Nishii Hironobu, Kohno Yoshihisa, Nakamura Kazufumi, Morita Hiroshi, Ito Hiroshi

Shinzo 46 ( 3 ) S3_203 - S3_211 2014

右室単発早期刺激により明瞭なcoved型そしてsaddleback型心電図が得られたBrugada症候群の1例

中川晃志, 永瀬聡, 和田匡史, 田中正道, 西井伸洋, 渡邊敦之, 中村一文, 森田宏, 河野晋久, 草野研吾, 大江透, 伊藤浩

心臓 45 ( Suppl.3 ) 143 - 148 2013.12

Language：Japanese Publisher：(公財)日本心臓財団

症例は62歳、男性。早朝の苦悶様呼吸に続く呼吸停止疑いのため近医受診し、Brugada症候群疑いにて当院紹介入院。心電図では完全右脚ブロックを合併することもありBrugada型心電図との診断が容易ではなかった。電気生理学的検査時、ピルジカイニド1mg/kgを投与したが、やはり明瞭なBrugada型波形が得られないため、完全右脚ブロックの状態を是正する目的で右室心尖部より単発早期刺激を加えた。すると刺激間隔の短縮に伴いcoved型そしてsaddleback型の比較的明瞭なBrugada型心電図を得ることができた。完全右脚ブロックを伴いBrugada型心電図の診断が困難であったが右室心尖部単発早期断激によりBrugada型心電図が明瞭化され、また、相対的な右室伝導遅延の改善に伴いcoved型からsaddleback型に心電図が変化したBrugada症候群の1例を経験したので報告する。(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J00679&link_issn=&doc_id=20131216220028&doc_link_id=10.11281%2Fshinzo.45.S3_143&url=https%3A%2F%2Fdoi.org%2F10.11281%2Fshinzo.45.S3_143&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

奇異性塞栓症の二次予防としての卵円孔開存に対するカテーテル閉鎖術手技成績と遠隔期予後

木島康文, 赤木禎治, 中川晃志, 杜徳尚, 麻植浩樹, 草野研吾, 伊藤浩

日本心臓病学会誌 8 ( Suppl.I ) 333 - 333 2013.9

成人期に新たに発見された心房中隔欠損症の臨床像

中川晃志, 赤木禎治, 木島康文, 草野研吾, 永瀬聡, 藤沢芳基, 岩本睦, 佐野俊二, 伊藤浩

日本心臓病学会誌 8 ( Suppl.I ) 543 - 543 2013.9

肺高血圧症治療のトピックス重度肺高血圧を伴う心房中隔欠損症に対する新しい治療戦略

赤木禎治, 木島康文, 中川晃志, 松原広己, 得能智武, 新家俊郎, 八尾厚史, 伊藤浩, 佐野俊二

日本心臓病学会誌 8 ( Suppl.I ) 178 - 178 2013.9

卵円孔開存に対するAmplatzer PFO Occluderを用いたカテーテル閉鎖術本邦における初期経験

木島康文, 赤木禎治, 中川晃志, 上岡亮, 高谷陽一, 麻植浩樹, 杜徳尚, 出口健太郎, 佐野俊二, 伊藤浩

脈管学 53 ( Suppl. ) S177 - S177 2013.9

Amplatzer PFO Occluderを用いた卵円孔開存のカテーテル閉鎖術本邦における初期経験

木島康文, 赤木禎治, 中川晃志, 上岡亮, 出口健太郎, 麻植浩樹, 杜徳尚, 草野研吾, 佐野俊二, 伊藤浩

超音波医学 40 ( Suppl. ) S491 - S491 2013.4

カテーテル治療適応外ASD症例に対し薬物治療後にカテーテル治療を行えた一例

大澤晋, 赤木禎治, 中川晃志, 木島康文, 草野研吾, 伊藤浩, 佐野俊二

超音波医学 40 ( Suppl. ) S646 - S646 2013.4

Collaborative management for PAH 高度肺高血圧を伴う心房中隔欠損症に対する新しい治療戦略肺血管作動薬とカテーテル治療の併用(Collaborative management for PAH New Strategies for Patients with Atrial Septal Defect and Severe Pulmonary Arterial Hypertension: Combination of Medical Therapy)

木島康文, 赤木禎治, 中川晃志, 杜徳尚, 上岡亮, 得能智武, 新家俊郎, 八尾厚史, 宮地克維, 松原広己, 草野研吾, 佐野俊二, 伊藤浩

日本成人先天性心疾患学会雑誌 2 ( 1 ) 41 - 41 2013.1

心房中隔欠損症に合併した心房細動に対するアブレーション治療

中川晃志, 赤木禎治, 木島康文, 永瀬聡, 河野晋久, 笠原真悟, 草野研吾, 佐野俊二, 伊藤浩

日本成人先天性心疾患学会雑誌 2 ( 1 ) 70 - 70 2013.1

最大径40mmを越す心房中隔欠損症をいかにカテーテル閉鎖するか?利尿剤投与の効果

上岡亮, 木島康文, 赤木禎治, 杜徳尚, 中川晃志, 永瀬聡, 河野晋久, 森田宏, 草野研吾, 伊藤浩

日本成人先天性心疾患学会雑誌 2 ( 1 ) 70 - 70 2013.1

心房中隔欠損症に合併した心房細動に対するアブレーション治療

中川晃志, 赤木禎治, 永瀬聡, 谷口学, 木島康文, 大河啓介, 草野研吾, 伊藤浩

日本心臓病学会誌 7 ( Suppl.I ) 282 - 282 2012.8

心房中隔欠損症に対するカテーテル閉鎖術における心腔内エコーの使用経験

木島康文, 赤木禎治, 中川晃志, 杜徳尚, 麻植浩樹, 草野研吾, 佐野俊二, 伊藤浩

日本心臓病学会誌 7 ( Suppl.I ) 343 - 343 2012.8

Transcatheter closure of atrial septal defect in a geriatric population International journal

Koji Nakagawa, Teiji Akagi, Manabu Taniguchi, Yasufumi Kijima, Keiji Goto, Kengo F. Kusano, Hiroshi Itoh, Shunji Sano

Catheterization and Cardiovascular Interventions 80 ( 1 ) 84 - 90 2012.7

Authorship：Lead author Language：English Publishing type：Research paper (scientific journal) Publisher：Wiley

OBJECTIVES: To evaluate the efficacy and safety of transcatheter closure of atrial septal defects (ASD) in patients over 70 years of age. BACKGROUND: Transcatheter closure of ASD is an established procedure in children and young adults, but the benefits of this procedure in geriatric patients are still unclear. METHODS: Between 2005 and 2010, 430 patients with ASD underwent transcatheter closure in our hospital. Among those patients, 30 consecutive patients older than 70 years of age were prospectively evaluated. RESULTS: Mean age at procedure was 75.8 ± 3.8 years (range: 70-85 years). Mean Qp/Qs was 2.4 ± 0.7 and mean ASD diameter was 20.3 ± 6.4 mm. Nine patients (30%) had a history of hospitalization due to heart failure. ASD closure was successfully performed in 28 patients (93%) without significant complications. During the follow-up period (mean period of 19.1 ± 11.3 months), New York Heart Association (NYHA) functional class was significantly improved in 20 patients (74%). Significant improvements of plasma BNP level, resting heart rate, and systolic pulmonary artery pressure were also observed. Improvement of tricuspid regurgitation was observed in 11 of 17 patients with moderate or severe regurgitation during the follow-up period. Conversely, worsening of mitral regurgitation was observed in 10 of the 27 patients. CONCLUSION: Transcatheter closure of ASD in geriatric patients can be performed safely. This procedure contributes to significant improvement of symptoms and positive cardiac remodeling. Long-term follow-up is mandatory, especially for patients with mitral regurgitation.

DOI： 10.1002/ccd.23457

繰り返すデバイス感染で治療に難渋した1例

三好章仁, 西井伸洋, 久保元基, 中川晃志, 田中正道, 永瀬聡, 森田宏, 草野研吾, 伊藤浩, 高垣昌己, 佐野俊二, 庄田守男

Journal of Arrhythmia 28 ( Suppl. ) 390 - 390 2012.5

不整脈源性右室心筋症の診断にて右室心外膜起源の心室頻拍に対する心内膜側・心外膜側カテーテルアブレーションを施行した症例の剖検心の検討

田中正道, 中川晃志, 西井伸洋, 永瀬聡, 中村一文, 森田宏, 河野邦久, 草野研吾, 伊藤浩, 由谷親夫

Journal of Arrhythmia 28 ( Suppl. ) 410 - 410 2012.5

当院における植込み型デバイス感染症例に対するデバイス抜去の経験

西井伸洋, 三好章仁, 久保元基, 中川晃志, 田中正道, 永瀬聡, 草野研吾, 伊藤浩, 森田宏, 高垣昌己, 佐野俊二, 庄田守男

Journal of Arrhythmia 28 ( Suppl. ) 389 - 389 2012.5

複数の静脈アプローチにて成功しえた経皮的ペースメーカリード抜去術の1例

中川晃志, 西井伸洋, 田中正道, 久保元基, 永瀬聡, 森田宏, 草野研吾, 伊藤浩, 高垣昌巳, 佐野俊二, 庄田守男

Journal of Arrhythmia 28 ( Suppl. ) 388 - 388 2012.5

重症心不全に伴う不整脈の薬物治療

中村一文, 中川晃志, 杉山洋樹, 森田宏, 草野研吾, 伊藤浩

呼吸と循環 60 ( 4 ) S2 - S4 2012.4

カテーテル治療を行った多孔性心房中隔欠損症の2例

大澤晋, 赤木禎治, 木島康文, 中川晃志, 草野研吾, 伊藤浩, 佐野俊二

超音波医学 39 ( Suppl. ) S535 - S535 2012.4

心不全を合併した心房細動症例に対する経口アミオダロンの効果

三好章仁, 草野研吾, 中川晃志, 西井伸洋, 永瀬聡, 中村一文, 森田宏, 伊藤浩

Progress in Medicine 32 ( Suppl.1 ) 464 - 467 2012.3

Language：Japanese Publisher：(株)ライフ・サイエンス

心不全を合併した心房細動症例に対するアミオダロンの効果、安全性について検討した。心室性不整脈に対してアミオダロンを処方した124例を対象とした。処方時に発作性・持続性心房細動を合併していた症例は43例で、そのうち6ヵ月間経過観察できた心房細動症例は30例であった。アミオダロン投与による洞調律維持は18例で可能であった。洞調律維持群をsinus群、洞調律に回復しなかった群をAF群として検討した。LVEFはAF群では改善する傾向がみられた。心拍数はsinus群で低下傾向を示した。LADは両群ともに変化は認めなかった。BNP値はsinus群で有意に低下し、AF群では低下傾向を示した。KL-6は投与前後で有意差を認めず、KL-6が急上昇した1例は、CT所見で間質の線維化を認めたためアミオダロン投与を中止し、KL-6は投与前の数値にまで回復した。

Catheter closure of atrial septal defect in patients with cryptogenic stroke: initial experience in Japan.

Yasufumi Kijima, Teiji Akagi, Manabu Taniguchi, Koji Nakagawa, Kentaro Deguchi, Tomoko Tomii, Kengo Kusano, Shunji Sano, Hiroshi Ito

Cardiovascular intervention and therapeutics 27 ( 1 ) 8 - 13 2012.1

Language：English Publishing type：Research paper (scientific journal)

A recent study has shown that cryptogenic stroke can occur even in patients with small or insignificant atrial septal defects (ASD). However, clinical experience in this field is still limited in Japan, also the efficacy and safety of catheter closure of such defects have not been identified. To evaluate the efficacy and safety of catheter closure of interatrial communication in patients with cryptogenic stroke, 13 patients who were diagnosed with cerebrovascular events due to cryptogenic embolism were included in this study. Mean age at procedure was 43 ± 15 (range 17-68) years. In all patients, the presence of spontaneous or provoked interatrial right-to-left shunts was demonstrated by transesophageal contrast echocardiography. Mean defect size evaluated by the balloon sizing technique was 9.2 ± 2.8 mm, and mean size of the Amplatzer Septal Occluder deployed was 9.5 ± 2.8 mm. Devices were successfully deployed in all patients, though one device migrated into the descending aorta was retrieved by a snare catheter. Complete closure was detected by transesophageal contrast echocardiography at 12 months after the procedure was in 11 (85%) of the 13 patients. During the follow-up period (30.1 ± 9.4 months), no recurrent thromboembolic event was observed. Catheter closure of interatrial right-to-left communications can be safely performed. This procedure may contribute to reduction or prevention of recurrent neurological events in this patient population.

DOI： 10.1007/s12928-011-0075-y

心房中隔欠損に対するTest Balloon OcclusionはAmplatzerデバイス留置後の急性心不全リスクを過大評価する

中川晃志, 赤木禎治, 木島康文, 谷口学, 草野研吾, 伊藤浩, 佐野俊二

日本成人先天性心疾患学会雑誌 1 ( 1 ) 75 - 75 2012.1

成人動脈管開存に対するAmplatzer Duct Occluderを用いたカテーテル閉鎖術

木島康文, 赤木禎治, 中川晃志, 谷口学, 草野研吾, 伊藤浩, 佐野俊二

日本成人先天性心疾患学会雑誌 1 ( 1 ) 74 - 74 2012.1

多孔型心房中隔欠損症の経カテーテル的閉鎖術における三次元経食道心エコー図の有用性

谷口学, 赤木禎治, 渡辺修久, 岡本吉生, 木島康文, 中川晃志, 杜徳尚, 大月審一, 草野研吾, 伊藤浩, 佐野俊二

日本心臓病学会誌 6 ( Suppl.I ) 326 - 326 2011.8

小児心疾患の最新治療心房中隔欠損症のカテーテル治療時代における外科治療の役割カテーテル治療不能例からの検討

木島康文, 赤木禎治, 谷口学, 中川晃志, 岡本吉生, 大月審一, 草野研吾, 伊藤浩, 佐野俊二

日本心臓病学会誌 6 ( Suppl.I ) 174 - 174 2011.8

左室心外膜側にて著明なJ波とOut of QRS Potentialが記録されたBrugada症候群(J Wave Syndrome)の1例

田中正道, 永瀬聡, 中川晃志, 多田毅, 村上正人, 西井伸洋, 中村一文, 幡芳樹, 森田宏, 河野晋久, 草野研吾, 伊藤浩, 大江透

臨床心臓電気生理 34 205 - 215 2011.5

Language：Japanese Publisher：臨床心臓電気生理研究会

症例は39歳、男性。心室細動自然発作を認めるBrugada症候群との診断で当院入院。心電図ではV2でのsaddle back型ST上昇とI、II、aV1、V3-6でのJ波を認めた。心臓電気生理学的検査では、経冠静脈的に左室側壁心外膜側に多極カテーテルを挿入し電位の記録を行ったところ、単極誘導では明瞭なJ波が記録され、双極誘導ではJ波の成分に伴いout of QRS potentialが記録された。単極誘導でのJ波は心房ペーシング、およびisoproterenol投与で減高し、pilsicainide投与で増高した。また双極誘導でのout of QRS電位は心房ペーシングおよびisoproterenol投与で短縮しpilsicainide投与で延長した。再分極異常の性質を示す左室心外膜側J波がout of QRS potentialとしても記録され、J wave syndromeの成因を考えるうえで興味深い症例と考えられここに報告する。(著者抄録)

J Waves in Patients with Vasospastic Angina

Koji Nakagawa, Satoshi Nagase, Masamichi Tanaka, Nobuhiro Nishii, Hiroshi Morita, Kunihisa Kohno, Kengo Kusano, Tohru Ohe, Hiroshi Ito

journal of arrhythmia 27 191 2011

Publishing type：Research paper (scientific journal)

Objectives: The purpose of this study was to determine whether J wave is a marker of arrhythmic risk in patients with vasospastic angina (VSA). Background: Both VSA and the presence of J waves in ECG are associated with fatal ventricular arrhythmias and sudden death. However, the prevalence of J waves among VSA patients is little known. Methods: We reviewed 66 patients with VSA in our hospital retrospectively and assessed the association between the presence of J wave and clinical backgrounds among them. J wave was defined as an elevation of the QRS-ST junction of > 0.1mV from baseline. Results: Spontaneous VF and syncope occurred in 9 (13.6%) and 14 (21.2%) of all patients, respectively. J waves were observed in 33 patients (50%) and were significantly more prevalent in males than females (60.4% vs. 16.7%, Pμ0.01). Arrhythmic symptoms (ventricular arrhythmias or syncope) were observed frequently in patients with J waves, compared to without J wave (48.4% vs. 23.8%, Pμ0.05). Both of the locations and height of J waves were not associated with the history of arrhythmic symptoms. Conclusions: J waves are observed frequently among male patients with VSA. The presence of J waves potentially influence the development of lethal ventricular arrhythmias associated with VSA. © 2011, Japanese Heart Rhythm Society. All rights reserved.

DOI： 10.4020/jhrs.27.OP03_4

Torn atrial septum during transcatheter closure of atrial septal defect visualized by real-time three-dimensional transesophageal echocardiography. International journal

Yasufumi Kijima, Manabu Taniguchi, Teiji Akagi, Koji Nakagawa, Kengo Kusano, Hiroshi Ito, Shunji Sano

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 23 ( 11 ) 1222.e5-8 2010.11

Language：English Publishing type：Research paper (scientific journal)

Transcatheter closure of atrial septal defects (ASDs) has become an accepted and reliable procedure. Although various complications have been recognized, tear of the atrial septal rim is a rare complication. We report a case of atrial septal rim tear that was diagnosed during the procedure by real-time three-dimensional transesophageal echocardiography (TEE). The device was successfully implanted 3 months after the initial intervention. RT3D TEE is more useful for displaying the entire shape of the defect and its spatial relationship (RT3D) with its neighboring structures compared with conventional two-dimensional echocardiography. By using both two-dimensional and RT3D TEE images, especially in cases with complicated ASD morphology, both the echocardiologist and interventionalist gain valuable information on the morphology of the ASD before and during the procedure.

DOI： 10.1016/j.echo.2010.04.004

SCN5A mutation is associated with early and frequent recurrence of ventricular fibrillation in patients with Brugada syndrome.

Nobuhiro Nishii, Masahiro Ogawa, Hiroshi Morita, Kazufumi Nakamura, Kimikazu Banba, Daiji Miura, Naoko Kumagai, Akira Matsunaga, Hiroshi Kawamura, Shigemi Urakawa, Kohei Miyaji, Masahiro Nagai, Katsumasa Satoh, Koji Nakagawa, Masamichi Tanaka, Shigeki Hiramatsu, Takeshi Tada, Masato Murakami, Satoshi Nagase, Kunihisa Kohno, Kengo Fukushima Kusano, Keijiro Saku, Tohru Ohe, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 74 ( 12 ) 2572 - 8 2010.11

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Mutations in SCN5A are reportedly linked to Brugada syndrome (BS), but recent observations suggest that they are not necessarily associated with ventricular fibrillation (VF) in BS patients. Therefore, the clinical importance of SCN5A mutations in BS patients was examined in the present study. METHODS AND RESULTS: The 108 BS patients were examined for SCN5A mutations and various parameters were compared between patients with and without mutations. An implantable cardioverter defibrillator (ICD) was implanted in 49 patients and a predictor of appropriate ICD shock was investigated. The existence of a SCN5A mutation was not associated with initial VF episodes (21.7% vs 20.0%, P=0.373). In the secondary prevention group, appropriate shock-free survival rate was significantly lower in patients with spontaneous type 1 ECG than in those without (41.1% vs 85.7% at 2 years, P=0.014). The appropriate shock-free survival rate was also significantly lower in patients with SCN5A mutations than in those without (28.6% vs 83.3% at 1 year, P=0.040). Appropriate shock was more frequent in patients with SCN5A mutations than in those without (6.6±6.2 vs 1.7±3.0, P=0.007). CONCLUSIONS: SCN5A mutations are associated with early and frequent VF recurrence, but not with initial VF episodes. This is the first report on the genotype-phenotype interaction and clinical significance of this mutation.

Efficacy of low-dose bepridil for prevention of ventricular fibrillation in patients with Brugada syndrome with and without SCN5A mutation. International journal

Masato Murakami, Kazufumi Nakamura, Kengo F Kusano, Hiroshi Morita, Koji Nakagawa, Masamichi Tanaka, Takeshi Tada, Norihisa Toh, Nobuhiro Nishii, Satoshi Nagase, Yoshiki Hata, Kunihisa Kohno, Daiji Miura, Tohru Ohe, Hiroshi Ito

Journal of cardiovascular pharmacology 56 ( 4 ) 389 - 95 2010.10

Language：English Publishing type：Research paper (scientific journal)

It has been reported that bepridil prevents ventricular fibrillation (VF) in patients with Brugada syndrome, but the comparative efficacy with and without mutation in the SCN5A gene has not been elucidated. The purpose of this study was to assess the efficacy of low-dose bepridil (100 mg/day) for VF prevention in patients with Brugada syndrome with and without SCN5A mutation. Among 130 patients with Brugada-type electrocardiogram (ECG), low-dose bepridil was administered to seven patients because of repetitive VF episodes, including three with and four without SCN5A mutation. Preventive effect for VF recurrence and changes of the ECG and the signal-averaged ECG were evaluated. Frequencies of VF episodes were reduced after treatment with low-dose bepridil in all three patients with the SCN5A mutation (before: 0.33 versus after: 0.02 episodes/month, P < 0.01), but not in all four patients without the SCN5A mutation (before: 0.43 versus after: 2.94 episodes/month, P = nonsignificant). Levels of ST-segment elevation at J points and duration of low-amplitude signals less than 40 µV in the terminal filtered QRS complex (LAS40) in signal-averaged ECG were improved exclusively in patients with the SCN5A mutation. Treatment with bepridil prevented recurrence of VF along with improvement of ST elevation and LAS40 in patients with Brugada syndrome with the SCN5A mutation.

DOI： 10.1097/FJC.0b013e3181f03c2f

小開胸心外膜アプローチにて心室頻拍に対するアブレーションを行った不整脈源性右室心筋症の1例

田中正道, 永瀬聡, 中川晃志, 村上正人, 西井伸洋, 森田宏, 草野研吾, 伊藤浩, 高垣昌己, 佐野俊二

心電図 30 ( Suppl.4 ) S - 201 2010.9

上大静脈と下大静脈の周囲を興奮が各々旋回するDual-Loop Reentryによる術後心房頻拍の1例

多田毅, 永瀬聡, 村上正人, 平松茂樹, 田中正道, 中川晃志, 西井伸洋, 中村一文, 幡芳樹, 森田宏, 草野研吾, 伊藤浩, 大江透

臨床心臓電気生理 33 21 - 29 2010.5

Language：Japanese Publisher：臨床心臓電気生理研究会

症例は32歳、女性。開胸術の既往があり、頻拍発作を主訴に来院。心電図にて心房頻拍を認めアブレーション目的に入院。CARTOを用いたvoltage mappingにて右房側壁は強く障害され、activation mappingにて右房内興奮は右房側壁を前方より後方へ伝播し、後壁を横断、中隔を後方から前方へ伝播した後、三尖弁-上大静脈間、いわゆるupper-loopと三尖弁-下大静脈間、いわゆるlower-loopを伝播した。以上より右房側壁にcommon channelを持ち、upper loopとlower loopを同時に旋回するdual-loop reentryと診断した。Common channelでfragmented electrogramが記録され、同部位の通電で速やかに頻拍は停止した。上大静脈と下大静脈周囲を興奮が各々旋回するまれなdual-loop reentryの1例と考える。(著者抄録)

アミオダロン肺障害における臨床的特徴とアンギオテンシン系拮抗薬の効果

二階堂暁, 草野研吾, 中村一文, 多田毅, 三浦綾, 田中正道, 中川晃志, 村上正人, 西井伸洋, 福家聡一郎, 永瀬聡, 森田宏, 伊藤浩, 大江透

Progress in Medicine 30 ( Suppl.1 ) 662 - 666 2010.3

Language：Japanese Publisher：(株)ライフ・サイエンス

アミオダロン肺障害(AIPT)における臨床的特徴とアンギオテンシン系拮抗薬(ASA)の効果について検討した。対象は96例(男性74例、女性22例、平均年齢58.1歳)で、基礎疾患は拡張型心筋症39例、虚血性心疾患26例、肥大型心筋症10例、観察期間は平均33.8ヵ月であった。1)11例(11.5%)にAIPTが認められ、AIPT(+)群ではAIPT(-)群に比し繰り返す心不全のエピソードが有意に多かった。2)ヒト肺胞上皮細胞にアミオダロン添加でアポトーシスは濃度依存性に増加し、アミオダロンにアンギオテンシンII追加でとアポトーシスは有意に増強されたが、アンギオテンシンII受容体拮抗薬添加でアポトーシスは有意に抑制された。3)AIPT(+)群ではAIPT(-)群に比しASA投与量は有意に少なかった。多変量解析では繰り返す心不全エピソードとASA投与量が各々独立したAIPT発症の予測因子であった。

Application of real-time three-dimensional transesophageal echocardiography using a matrix array probe for transcatheter closure of atrial septal defect. International journal

Manabu Taniguchi, Teiji Akagi, Nobuhisa Watanabe, Yoshio Okamoto, Koji Nakagawa, Yasufumi Kijima, Norihisa Toh, Shinichi Ohtsuki, Kengo Kusano, Shunji Sano

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 22 ( 10 ) 1114 - 20 2009.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The aim of this study was to demonstrate the utility of real-time three-dimensional (3D) transesophageal echocardiography (RT3D-TEE) using a matrix array 3D transesophageal echocardiographic probe for morphologic evaluation and guidance of transcatheter closure of atrial septal defects (ASDs). METHODS: Forty-eight consecutive patients scheduled for the intervention were included. Two-dimensional (2D) transesophageal echocardiography (2D-TEE) and RT3D-TEE were performed before and during the procedures. Measurements of maximal ASD diameter and surrounding rims obtained on RT3D-TEE were compared with those obtained on 2D-TEE. RESULTS: In 46 patients (96%), optimal 3D images for the morphologic evaluation of ASDs were obtained. RT3D-TEE facilitated the evaluation of ASD morphology and surrounding rims and was able to provide intraprocedural information clearly. A Bland-Altman plot showed a mean maximal diameter difference of -0.12 mm between the means (95% limits of agreement, -2.2 to 2.5 mm). CONCLUSION: RT3D-TEE is a clinically useful, complementary option to 2D-TEE for evaluation of ASD morphology and for interventional guidance.

DOI： 10.1016/j.echo.2009.06.008

成人における経カテーテル的心房中隔欠損閉鎖術前後における肺動脈楔入圧の変化

谷口学, 赤木禎治, 中川晃志, 木島康文, 草野研吾, 伊藤浩, 佐野俊二

日本心臓病学会誌 4 ( Suppl.I ) 435 - 435 2009.8

非Brugada型特発性心室細動12例の検討

平松茂樹, 森田宏, 中川晃志, 田中正道, 村上正人, 多田毅, 西井伸洋, 永瀬聡, 幡芳樹, 草野研吾

心電図 29 ( Suppl.3 ) S - 380 2009.6

左室後乳頭筋起源と考えられた心室期外収縮に対しアブレーションを施行した1例

多田毅, 永瀬聡, 村上正人, 平松茂樹, 田中正道, 中川晃志, 西井伸洋, 森田宏, 草野研吾, 大江透

心電図 29 ( Suppl.3 ) S - 470 2009.6

Transcatheter closure of atrial septal defect in elderly patients with permanent atrial fibrillation. International journal

Manabu Taniguchi, Teiji Akagi, Shinichi Ohtsuki, Yoshio Okamoto, Yasuharu Tanabe, Nobuhisa Watanabe, Koji Nakagawa, Norihisa Toh, Kengo Kusano, Shunji Sano

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 73 ( 5 ) 682 - 6 2009.4

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: The aim of this study is to evaluate the feasibility and efficacy of device closure of atrial septal defect (ASD) in elderly patients with permanent atrial fibrillation. BACKGROUND: Little is known about the feasibility of device closure of ASD in those patients. METHODS: Nine consecutive patients (mean age 68.1 years) with permanent atrial fibrillation (>1 year persistent) underwent catheter closure using the Amplatzer septal occluder. Transthoracic echocardiography and plasma B-type natriuretic peptide (BNP) level were assessed before and at 24 hours; and 1, 3, and >6 months after the closure. Before the procedure, appropriate dose of warfarin was used in all, diuretics was used in 8/9. Same amount of medications were continued after the procedure. RESULTS: ASD could be closed in all (mean device size 27.3 mm) without hemodynamic and thromboembolic complications. New York Heart Association (NYHA) functional classification was significantly improved in all patients after device closure. No hemodynamic and thromboembolic complications were observed during the follow-up period (mean 10.6 months). Although permanent atrial fibrillation did not change in all after the procedure, resting heart rate decreased from 76.2 +/- 16.0 to 68.3 +/- 13.2 beats/min (P = 0.015). There was statistically significant improvement in right ventricular/left ventricular diameter ratio (1.08 +/- 0.16 to 0.73 +/- 0.10, P = 0.008) and plasma BNP level (183.7 +/- 90.5 to 94.6 +/- 47.4 pg/mL, P = 0.008) after >6 months device closure. CONCLUSIONS: Even in the patients complicated with permanent fibrillation, transcatheter closure of ASD can contribute to symptomatic improvement as well as cardiac geometric remodeling.

DOI： 10.1002/ccd.21870

肺高血圧を呈した成人心房中隔欠損症に対する経皮的カテーテル閉鎖術後の短期～中期予後

中川晃志, 木島康文, 谷口学, 草野研吾, 赤木禎治, 佐野俊二

Circulation Journal 73 ( Suppl.II ) 962 - 962 2009.4

急性心筋炎に伴う多剤抵抗性心室頻拍に対してアミオダロン静注が有効であった乳児の1例

中川晃志, 細木信吾, 伴場主一, 多田毅, 西井伸洋, 永瀬聡, 中村一文, 幡芳樹, 森田宏, 草野研吾, 大江透

Progress in Medicine 29 ( Suppl.1 ) 609 - 613 2009.3

Language：Japanese Publisher：(株)ライフ・サイエンス

18ヵ月女児。発熱、嘔吐、下痢が出現した。哺乳がなくなり、ぐったりしているために近医を受診し、心電図にて頻脈性不整脈を指摘され、紹介受診した。発熱・腸炎などの感染症状や全周性の左室壁運動低下、急性心不全、さらに心筋逸脱酵素の上昇や頻脈性不整脈といった所見から、急性心筋炎と診断した。頻脈性不整脈のコントロールが困難で、血行動態は次第に不安定となったため、鎮静ならびに人工呼吸管理を行い、経皮的心肺補助装置を留置した。アミオダロンを開始し、頻拍は速やかに停止し、洞調律への復帰を認めた。急性心筋炎の治療としては、γグロブリン大量療法とステロイドパルス療法を施行した。徐脈傾向とQT延長の遷延に対して恒久的ペースメーカーを植え込み、軽快退院した。

重症心室不整脈に対するリドカイン、ニフェカラント、アミオダロン静注薬の位置づけニフェカラント抵抗性心室頻拍・心室細動に対するアミオダロン静注の有用性

草野研吾, 中川晃志, 多田毅, 永瀬聡, 中村一文, 森田宏, 西井伸洋, 福家聡一郎, 幡芳樹, 大江透

心電図 29 ( 1 ) 26 - 33 2009.2

Language：Japanese Publisher：(一社)日本不整脈心電学会

【背景】ニフェカラント抵抗性の重症心室不整脈[心室頻拍・心室細動(VT/VF)]に対する静注アミオダロンの効果を自験例で検討した。【方法・結果】基礎心疾患は急性心筋梗塞6例、心筋炎2例、拡張型心筋症1例、肥大型心筋症1例で、心機能がきわめて低下していた症例であった。急性期に大動脈内バルーンポンプ(IABP)あるいは経皮的心肺補助装置(PCPS)などの補助循環が必要とされた症例は7例であった。使用したニフェカラントは、平均で初期投与0.39±0.15mg/kg、持続投与0.34±0.12mg/kgで、QTc時間は平均0.47→0.55secへ延長し、停止効果を7例(70%)に認めたが、頻拍再発抑制効果は認められなかったため、静注アミオダロンに切り替えた。8例では初期から少量持続投与(平均484±166mg/日)が行われた。アミオダロン単独でVT/VF停止効果を80%に、VT/VF再発抑制効果も80%に認められた。心拍数は100→71bpmとニフェカラント前値(95bpm)よりも減少していたが、ニフェカラントによって延長したQTcは0.55→0.47secと使用前値に戻っていた。4例が死亡したが不整脈死は認められなかった。アミオダロン投与にて血圧低下が起きた症例、房室ブロックが悪化した症例がそれぞれ1例認められた。多くの症例で薬物治療以外に、期外収縮を抑制する目的でペースメーカ、鎮静、呼吸管理などが行われていた。【結語】ニフェカラント抵抗性のVT/VF症例に対してアミオダロン静注は有効である可能性が高いが、徐脈・低血圧・房室ブロックといった副作用発現に注意が必要とされる。また、心不全に対する抗不整脈薬以外の治療もきわめて重要であると考えられた。(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2009&ichushi_jid=J00681&link_issn=&doc_id=20090226210004&doc_link_id=%2Fdn4eleca%2F2009%2F002901%2F005%2F0026-0033%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdn4eleca%2F2009%2F002901%2F005%2F0026-0033%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

奇異性脳塞栓症再発予防を目的とした心房レベル右左短絡に対するカテーテル閉鎖術の初期成績

中川晃志, 谷口学, 赤木禎治, 草野研吾, 大月審一, 岡本吉生, 佐野俊二, 大江透

Circulation Journal 72 ( Suppl.III ) 1036 - 1036 2008.10

Brugada症候群における心電図パラメーターの経時的変化

中川晃志, 西井伸洋, 永瀬聡, 森田宏, 中村一文, 岡岳文, 大江透, 草野研吾

心電図 28 ( 5 ) 485 - 485 2008.10

成人先天性心疾患患者の診療(体制)はどうあるべきか成人先天性心疾患の診療における循環器内科医の関与心房中隔欠損症のカテーテル治療における取り組み

中川晃志, 赤木禎治, 谷口学, 草野研吾, 大月審一, 佐野俊二

日本心臓病学会誌 2 ( Suppl.I ) 139 - 139 2008.8

重複僧帽弁口を伴った孤立性左室緻密化障害にWPW症候群を合併した一例

福家聡一郎, 中川晃志, 谷口学, 渡辺敦之, 永瀬聡, 中村一文, 森田宏, 岡岳文, 草野研吾, 大江透

Circulation Journal 72 ( Suppl.II ) 955 - 955 2008.4

S状中隔によるmid-ventricular obstructionに対し、ペーシング治療が有効であった一例

中川晃志, 草野研吾, 福家聡一郎, 田中正道, 多田毅, 村上正人, 宮地晃平, 西井伸洋, 永瀬聡, 岡岳文, 大江透

Circulation Journal 72 ( Suppl.II ) 957 - 957 2008.4

マラソン中に心肺停止となった1例

田中正道, 野坂和正, 中川晃志, 福家聡一郎, 西井伸洋, 永瀬聡, 岡岳文, 草野研吾, 大江透, 河野康之, 小松原一正

Circulation Journal 72 ( Suppl.II ) 953 - 953 2008.4

Atrial fibrillation in patients with Brugada syndrome relationships of gene mutation, electrophysiology, and clinical backgrounds. International journal

Kengo F Kusano, Makiko Taniyama, Kazufumi Nakamura, Daiji Miura, Kimikazu Banba, Satoshi Nagase, Hiroshi Morita, Nobuhiro Nishii, Atsuyuki Watanabe, Takeshi Tada, Masato Murakami, Kohei Miyaji, Shigeki Hiramatsu, Koji Nakagawa, Masamichi Tanaka, Aya Miura, Hideo Kimura, Soichiro Fuke, Wakako Sumita, Satoru Sakuragi, Shigemi Urakawa, Jun Iwasaki, Tohru Ohe

Journal of the American College of Cardiology 51 ( 12 ) 1169 - 75 2008.3

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: The goal of our work was to examine the relationships of atrial fibrillation (AF) with genetic, clinical, and electrophysiological backgrounds in Brugada syndrome (BrS). BACKGROUND: Atrial fibrillation is often observed in patients with BrS and indicates that electrical abnormality might exist in the atrium as well as in the ventricle. SCN5A, a gene encoding the cardiac sodium channel, has been reported to be causally related to BrS. However, little is known about the relationships of atrial arrhythmias with genetic, clinical, and electrophysiological backgrounds of BrS. METHODS: Seventy-three BrS patients (49 +/- 12 years of age, men/women = 72/1) were studied. The existence of SCN5A mutation and clinical variables (syncopal episode, documented ventricular fibrillation [VF], and family history of sudden death) were compared with spontaneous AF episodes. Genetic and clinical variables were also compared with electrophysiologic (EP) parameters: atrial refractory period, interatrial conduction time (CT), repetitive atrial firing, and AF induction by atrial extra-stimulus testing. RESULTS: Spontaneous AF occurred in 10 (13.7%) of the BrS patients and SCN5A mutation was detected in 15 patients. Spontaneous AF was associated with higher incidence of syncopal episodes (60.0% vs. 22.2%, p < 0.03) and documented VF (40.0% vs. 14.3%, p < 0.05). SCN5A mutation was associated with prolonged CT (p < 0.03) and AF induction (p < 0.05) in EP study, but not related to the spontaneous AF episode and other clinical variables. In patients with documented VF, higher incidence of spontaneous AF (30.8% vs. 10.0%, p < 0.05), AF induction (53.8% vs. 20.0%, p < 0.03), and prolonged CT was observed. CONCLUSIONS: Spontaneous AF and VF are closely linked clinically and electrophysiologically in BrS patients. Patients with spontaneous AF have more severe clinical backgrounds in BrS. SCN5A mutation is associated with electrical abnormality but not disease severity.

DOI： 10.1016/j.jacc.2007.10.060

治療抵抗性の原発性肺高血圧症に対しSildenafil併用が著効した成人男性の一例

中川晃志, 田中正道, 多田毅, 永瀬聡, 中村一文, 櫻木悟, 草野研吾, 大江透

Circulation Journal 71 ( Suppl.III ) 975 - 975 2007.10

孤立性心筋緻密化障害を有する難治性心不全に対し両心室ペーシングが有用であった1例

中川晃志, 福家聡一郎, 西井伸洋, 永瀬聡, 中村一文, 櫻木悟, 草野研吾, 大江透, 飛岡徹

Journal of Arrhythmia 23 ( Suppl. ) 244 - 244 2007.4

WPW症候群を合併した家族性肥大型心筋症の一例

赤木達, 大田恵子, 中川晃志, 多田毅, 永瀬聡, 中村一文, 桜木悟, 草野研吾, 大江透

Circulation Journal 71 ( Suppl.II ) 858 - 858 2007.4

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