担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Although right ventricular (RV) dysfunction is associated with adverse outcomes in tricuspid regurgitation (TR), the potential role of right atrial (RA) function is unknown. We aimed to investigate the relationship between RA function and clinical outcomes in patients with significant TR. METHODS: This retrospective study included 169 outpatients with moderate or severe TR due to left-sided heart diseases who underwent transthoracic echocardiography between June 2020 and April 2023 (average age, 75 ± 10 years; male, 40%). Patients with atrial fibrillation were excluded from this study due to the inaccuracy of the evaluation using 2D speckle-tracking echocardiography. RA function was compared between patients with and without events, which were defined as all-cause mortality or hospitalization due to heart failure. RA function was calculated as RA global longitudinal strain (RAGLS) with the 2D speckle-tracking echocardiography. RESULTS: During a median follow-up of 13 months, 19 patients had events (all-cause mortality: 14 cases, hospitalization due to heart failure: 5 cases). RAGLS was lower in patients with events than in those without events (13% ± 10% vs. 18% ± 9%, P = 0.02). When the patients were categorized into two groups [low RAGLS ≤ 16.2% vs. high RAGLS > 16.2%, high RA volume index (RAVI) ≥ 50 mL/m2 vs. low RAVI < 50 mL/m2], Kaplan-Meier curves showed that patients with low RAGLS had higher event rates than those with high RAGLS (log-rank test, P = 0.003). Patients with high RAVI had higher event rates than those with low RAVI (log-rank test, P < 0.001). In the multivariate Cox regression analysis, low RAGLS (≤16.2%) was significantly associated with events in a model that included RV dysfunction (RV fractional area change ≤ 35%) or high RAVI (≥50 mL/m2) (hazard ratio: 4.55, 95% confidence interval: 1.51-13.71, P < 0.01; hazard ratio: 4.57, 95% confidence interval: 1.52-13.79, P < 0.01, respectively). CONCLUSIONS: RAGLS is associated with all-cause mortality and hospitalization due to heart failure in patients with significant TR. Our results suggest that RA function is a sensitive marker for identifying the risk stratification of significant TR.

DOI： 10.1002/ehf2.14846

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

IMPORTANCE: The characteristics and treatment strategies of atrial functional mitral regurgitation (AFMR) are poorly understood. OBJECTIVE: To investigate the prevalence, clinical characteristics, and outcomes of mitral valve (MV) surgery in AFMR. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study, called the Real-World Observational Study for Investigating the Prevalence and Therapeutic Options for Atrial Functional Mitral Regurgitation (REVEAL-AFMR), was conducted across 26 Japanese centers (17 university hospitals, 1 national center, 3 public hospitals, and 5 private hospitals). All transthoracic echocardiography procedures performed from January 1 to December 31, 2019, were reviewed to enroll adult patients (aged ≥20 years) with moderate or severe AFMR, defined by preserved left ventricular function, a dilated left atrium, and an absence of degenerative valvular changes. Data were analyzed from May 8, 2023, to May 16, 2024. EXPOSURES: Mitral valve surgery, with or without tricuspid valve intervention. MAIN OUTCOMES AND MEASURES: The primary composite outcome included heart failure hospitalization and all-cause mortality. RESULTS: In 177 235 patients who underwent echocardiography, 8867 had moderate or severe MR. Within this group, 1007 (11.4%) were diagnosed with AFMR (mean [SD] age, 77.8 [9.5] years; 55.7% female), of whom 807 (80.1%) had atrial fibrillation. Of these patients, 113 underwent MV surgery, with 92 (81.4%) receiving concurrent tricuspid valve surgery. Patients who underwent surgery were younger but had more severe MR (57.5% [n = 65] vs 9.4% [n = 84]; P < .001), a larger mean (SD) left atrial volume index (152.5 [97.8] mL/m2 vs 87.7 [53.1] mL/m2; P < .001), and a higher prevalence of heart failure (according to the New York Heart Association class III [marked limitation of physical activity] or class IV [symptoms of heart failure at rest], 26.5% [n = 30] vs 9.3% [n = 83]; P < .001) than those who remained under medical therapy. During a median follow-up of 1050 days (IQR, 741-1188 days), 286 patients (28.4%) experienced the primary outcome. Despite a more severe disease status, only the surgical group showed a decrease in natriuretic peptide levels at follow-up and had a significantly lower rate of the primary outcome (3-year event rates were 18.3% vs 33.3%; log-rank, P = .03). Statistical adjustments did not alter these findings. CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that in patients with AFMR, who were typically older and predominantly had atrial fibrillation, MV surgery was associated with lower rates of adverse clinical outcomes. Future studies are warranted to investigate a possible causal relationship to better regulate cardiovascular medicine.

DOI： 10.1001/jamanetworkopen.2024.28032

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：責任著者   記述言語：英語  

DOI： 10.1002/ccd.31163

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s10396-024-01452-w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Diabetes mellitus (DM) is a major risk and prognostic factor for heart failure (HF). Insulin resistance (IR) is an important component of DM, but the relationship between IR and HF prognosis has not yet been established across a wide variety of HF populations. We retrospectively evaluated the relationship between IR and clinical outcomes of HF patients at our hospital between 2017 and 2021. IR was defined as a homeostatic model assessment of IR (HOMA-IR) index ≥ 2.5, calculated from fasting blood glucose and insulin concentrations. The primary outcome was a composite of all-cause death and hospitalisation for HF (HHF). Among 682 patients included in the analyses, 337 (49.4%) had IR. The median age was 70 [interquartile range (IQR): 59-77] years old, and 66% of the patients were men. Among the patients, 41% had a left ventricular ejection fraction below 40%, and 32% had DM. The median follow-up period was 16.5 [IQR: 4.4-37.3] months. IR was independently associated with the primary outcome (HR: 1.91, 95% CI: 1.39-2.62, p < 0.0001), death (hazard ratio [HR]: 1.86, 95% confidence interval [CI]: 1.28-2.83, p < 0.01), and HHF (HR: 1.91, 95% CI: 1.28-2.83, p < 0.01). HOMA-IR is an independent prognostic factor of HF in a wide variety of HF populations.

DOI： 10.3390/nu16121888

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Patients with severe aortic stenosis (AS) frequently have concomitant aortic regurgitation (AR), but the association between aortic valvular calcification (AVC) and the severity of AR remains unclear. METHODS AND RESULTS: We retrospectively reviewed patients with severe AS who underwent transthoracic echocardiography and multidetector computed tomography (MDCT) within 1 month. The patients were divided into 3 groups according to the degree of concomitant AR. The association between AVC and the severity of concomitant AR was assessed in patients with severe AS. The study population consisted of 95 patients: 43 men and 52 women with a mean age of 82±7 years. Of the 95 patients with severe AS, 27 had no or trivial AR, 53 had mild AR, and 15 had moderate AR. The AVC score (AVCS) and AVC volume (AVCV) significantly increased as the severity of concomitant AR increased (P=0.014 for both), and similar findings were obtained for the AVCS and AVCV indexes (P=0.004 for both). CONCLUSIONS: The severity of AR correlated with AVCS and AVCV measured by MDCT in patients with severe AS. AVC may cause concomitant AR, leading to worsening of disease condition.

DOI： 10.1253/circj.CJ-22-0746

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: There is limited information on long-term outcomes and trajectories of ventricular and valvular functions in patients with congenitally corrected transposition of the great arteries after anatomic repair according to the operative strategy with a median follow-up period of more than 10 years. METHODS: Twenty-nine patients who underwent anatomic repair in Okayama University Hospital between January 1994 and December 2020 were reviewed. Outcomes were compared between patients who underwent a double switch operation (DS group) and patients with an atrial switch with a Rastelli operation (Rastelli-Senning/Mustard group). RESULTS: Fifteen (52%) were in the DS group and 14 (48%) were in the Rastelli-Senning/Mustard group. The median follow-up period after anatomic repair was 12.7 (interquartile range 4.2-18.8) years. There were 3 (10%) early deaths and 3 (10%) late deaths. Survival rates for the entire cohort at 10 and 20 years were 86% and 71%, respectively, and were not different between the 2 groups. Using competing risk analysis, risks of heart failure, cardiac rhythm device implantation and atrial arrhythmia showed no significant differences between the 2 groups, whereas risk of reoperation was higher in the Rastelli-Senning/Mustard group than that in the DS group. Four patients after a DS operation and 1 patient after a Rastelli technique developed more than moderate aortic regurgitation. CONCLUSIONS: During a median follow-up period of more than 10 years, mortality rate and ventricular and valvular functions after anatomic repair were acceptable, though the incidences of late complications were relatively high, especially in the Rastelli-Senning/Mustard group.

DOI： 10.1093/icvts/ivae033

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIM: Anticoagulant users with nonvalvular atrial fibrillation (NVAF) sometimes suffer from gastrointestinal bleeding (GIB) and have difficulty continuing the medication. Left atrial appendage closure (LAAC) has been developed for such situations. We aimed to clarify the clinical significance of a history of GIB in comparison to other factors in patients who had undergone LAAC. METHODS: From October 2019 to September 2023, patients with NVAF who underwent LAAC at our hospital were enrolled. We investigated the percentage of patients with a history of GIB who underwent LAAC and compared the incidence of post-LAAC bleeding in these patients compared to those with other factors. RESULTS: A total of 45 patients were included. There were 19 patients (42%) with a history of GIB who underwent LAAC. In a Kaplan-Meier analysis, the cumulative incidence of bleeding complications after LAAC was significantly higher in patients with a history of GIB in comparison to patients with other factors. There were eight cases of post-LAAC bleeding in total, and seven cases had GIB. CONCLUSIONS: We need to recognize that GIB is a significant complication in patients who undergo LAAC. The management of GIB by gastroenterologists is essential to the success of LAAC.

DOI： 10.1002/jgh3.13009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The prognosis and later fatal arrhythmia in cardiac sarcoidosis (CS) with relatively preserved cardiac function were unclear. OBJECTIVES: This study aimed to evaluate the prognosis and arrhythmic events in patients with CS and mildly impaired cardiac function. METHODS: Data were collected from a nationwide Japanese cohort survey conducted in 57 hospitals (n = 420); 322 patients with CS with left ventricular ejection fraction (LVEF) >35% were investigated. RESULTS: Ventricular tachycardia (VT) manifestation was present in 50 patients (16%) and absent in 272 (84%), of whom 36 (72%) and 46 (17%), respectively, had an implantable cardioverter-defibrillator (ICD). Over a median of 5 years, 23 all-cause deaths and 31 appropriate ICD discharges were observed. In Kaplan-Meier analysis, all-cause death did not differ between patients with and without VT manifestation (P = 0.660), although appropriate ICD therapy was significantly less used in patients without VT manifestation than in those with VT manifestation (P < 0.001). Of the 272 patients without VT manifestation, 18 had ventricular arrhythmic events (VAEs), including 3 sudden cardiac deaths and 15 appropriate ICD discharges. In multivariate analysis, concomitant nonsustained ventricular tachycardia (NSVT) with atrioventricular block (AVB), lower LVEF, abnormal gallium-67 scintigraphy or 18F-fluorodeoxyglucose positron emission tomography of the heart (Ga/PET), and concomitant NSVT with abnormal Ga/PET at CS diagnosis were independent predictors of VAEs (P = 0.008, P = 0.021, P = 0.049, and P = 0.024, respectively). CONCLUSIONS: If concomitant NSVT with AVB, concomitant NSVT with abnormal Ga/PET, or abnormal Ga/PET is observed in patients with CS and mildly impaired cardiac function (LVEF >35%), ICD should be considered as primary prevention.

DOI： 10.1016/j.jacasi.2023.07.006

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The fibrosis-4 index (FIB4), a liver fibrosis maker, has been shown to be associated with the prognosis in patients with severe isolated tricuspid regurgitation (TR). Recent study showed that the fibrosis-5 index (FIB5), which was calculated by albumin, alkaline phosphatase, aspartate transaminase, alanine aminotransferase and platelet count, had better prognostic value than FIB4 in patients with heart failure. The aim of this study was to evaluate the usefulness of FIB5 index for predicting prognosis in patients with severe isolated TR and compare the prognostic value between the FIB4 and the FIB5 in those patients. This was a dual-center, retrospective study. 113 consecutive outpatients with severe isolated TR (mean age, 65.8 years; 47.8% male) were analyzed. Major adverse cardiovascular events (MACEs) were defined as the composite of cardiovascular death, hospitalization for heart failure, myocardial infarction, and stroke. During a median follow-up of 3.0 years, 41 MACEs occurred. Patients with MACEs had a lower the FIB5 than patients without MACEs. The multivariate Cox analysis revealed that the FIB5 < -4.30 was significantly associated with higher incidence of MACEs after adjusted by confounding factors. Receiver-operating characteristic curve analyses showed that prognostic values did not differ between the FIB5 and the FIB4 in whole patients and in patients aged ≥ 70 years; while, in patients aged < 70 years, the FIB5 had better prognostic value than the FIB4. The FIB5 may be a useful predictor of MACEs in patients with severe isolated TR.

DOI： 10.1007/s00380-023-02268-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Heart failure with a preserved ejection fraction (HFpEF) is associated with chronic inflammation. We aimed to investigate the association between pericoronary adipose tissue attenuation (PCATA) on coronary computed tomography angiography as a novel noninvasive marker of pericoronary inflammation and the presence of HFpEF. METHODS AND RESULTS: This retrospective study included 607 outpatients (median age, 65 years; 50% male) who underwent both echocardiography and coronary computed tomography angiography. Patients with obstructive coronary artery disease were excluded from this study. PCATA was compared between patients with and without HFpEF, which was diagnosed according to the Heart Failure Association (HFA)-PEFF score. PCATA was assessed at the proximal 40-mm segments of all three major coronary arteries on coronary computed tomography angiography. Patients with HFpEF had higher PCATA in all coronary arteries compared to the control participants: left anterior descending artery (LAD), -65.2 ± 6.9 Hounsfield units (HU) vs. -68.1 ± 6.7 HU; left circumflex artery (LCX), -62.7 ± 6.8 HU vs. -65.4 ± 6.6 HU; and right coronary artery (RCA), -63.6 ± 8.5 HU vs. -65.5 ± 7.7 HU (P < 0.01). Multivariate logistic regression analysis, including conventional risk factors, revealed that PCATA per standard deviation in the LAD (odds ratio [OR], 1.449; 95% confidence interval [CI], 1.152-1.823), LCX (OR, 1.634; 95% CI, 1.283-2.081), and RCA (OR, 1.388; 95% CI, 1.107-1.740) were independently associated with HFpEF. The association between PCATA and HFpEF was mostly consistent across various patient clinical characteristics. The left ventricular mass and left atrial volume index showed a mild correlation with LAD-PCATA (ρ = 0.13 [P < 0.01] and ρ = 0.24 [P < 0.01]) and LCX-PCATA (ρ = 0.16 [P < 0.01] and ρ = 0.23 [P < 0.01]). CONCLUSIONS: High PCATA score was significantly associated with the presence of HFpEF. Our results suggest that inflammation in the pericoronary artery adipose tissue is one of the underlying mechanisms of HFpEF.

DOI： 10.1002/ehf2.14419

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Fabry disease is an X-linked lysosomal storage disorder caused by defective enzyme activity of α-galactosidase A and treated with enzyme replacement therapy (ERT) with recombinant α-galactosidase. ERT reduces left ventricular mass assessed by echocardiography or magnetic resonance imaging. However, electrocardiogram changes during ERT have not been fully elucidated. In the present case, ERT with agalsidase alfa for 4 years decreased QRS voltage and negative T depth along with a reduction of left ventricular mass and wall thickness and improvement of symptoms in a female patient with Fabry disease. Long-term observation of electrocardiogram changes might be useful for determining the efficacy of ERT in this case.

DOI： 10.1536/ihj.22-752

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s12928-022-00887-7

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Pulmonary hypertension (PH) often causes right-sided heart failure (HF), inducing organ damage. Shear wave elastography (SWE) is a novel ultrasound technique for characterizing tissue. Some studies have reported that shear wave dispersion slope (SWDS) enables the assessment of early hepatic damage in HF. This study aimed to evaluate the prognostic impact of SWDS in patients with PH.This single-center cohort study enrolled 36 patients with PH who underwent SWE at Okayama University Hospital between March 2018 and April 2021. Patients were divided into 2 groups on the basis of the median value of SWDS: low SWDS group (SWDS < 12.4 m/second/kHz, n = 18) and high SWDS group (SWDS ≥ 12.4 m/second/kHz, n = 18). The primary endpoint was the complex of all-cause death or hospitalization for HF. During the follow-up of 391 ± 288 days, all-cause death or hospitalization for HF occurred in 8 patients. One patient died in the low SWDS group. Three patients died and 4 patients were hospitalized for HF in the high group. Kaplan-Meier analysis revealed that the event-free survival rate was significantly worse in the high SWDS group than in the low SWDS group (log-rank, P = 0.01). In univariate Cox proportional hazards analysis, high SWDS was associated with the events (hazard ratio 10.8; 95% confidence interval 1.89-202, P = 0.005).An elevated SWDS was associated with a high rate of events in patients with PH. SWDS has the potential to predict adverse outcomes in patients with PH.

DOI： 10.1536/ihj.22-574

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記述言語：英語  

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

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Cardiovascular diseases and liver diseases are closely related. Non-alcoholic fatty liver disease has the same risk factors as those for atherosclerotic cardiovascular disease and may also be a risk factor for atherosclerotic cardiovascular disease on its own. Heart failure causes liver fibrosis, and liver fibrosis results in worsened cardiac preload and congestion. Although some previous reports regard the association between cardiovascular diseases and liver disease, the management strategy for liver disease in patients with cardiovascular diseases is not still established. This review summarized the association between cardiovascular diseases and liver disease. In patients with non-alcoholic fatty liver disease, the degree of liver fibrosis progresses with worsening cardiovascular prognosis. In patients with heart failure, liver fibrosis could be a prognostic marker. Liver stiffness assessed with shear wave elastography, the fibrosis-4 index, and non-alcoholic fatty liver disease fibrosis score is associated with both liver fibrosis in patients with liver diseases and worse prognosis in patients with heart failure. With the current population ageing, the importance of management for cardiovascular diseases and liver disease has been increasing. However, whether management and interventions for liver disease improve the prognosis of cardiovascular diseases has not been fully understood. Future investigations are needed.

DOI： 10.3390/nu15030748

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1684/ejd.2023.4413

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

This study aimed to evaluate the efficacy of shear wave (SW) elasticity for assessing clinical outcomes in patients with significant tricuspid regurgitation (TR). Significant TR develops right heart failure (HF) with organ congestion, resulting in adverse outcomes, but appropriate therapeutic strategies remain unclear. The assessment of the degree of hepatic congestion using SW elasticity may be effective for determining therapeutic strategies. We prospectively enrolled 77 patients with moderate or severe TR who underwent SW elastography. Patients were divided into three groups according to the value of SW elasticity: low group (SW elasticity < 6.4 kPa, n = 26), medium group (6.4 ≤ SW elasticity < 9.5 kPa, n = 26), and high group (SW elasticity ≥ 9.5 kPa, n = 25). The endpoint was cardiovascular death or hospitalization for HF. During the median follow-up period of 17 months (range 7-39 months), cardiovascular death or hospitalization for HF occurred in seven patients of high group, in three patients of medium group, and in no patients of low group. In high group, three patients died and seven patients were hospitalized for HF. In medium group, two patients died and one patient was hospitalized. Kaplan-Meier analysis showed that the event-free survival rate was worse in high group than in other groups (log-rank test, p = 0.02). High SW elasticity was independently related to cardiac events as well as right ventricular and left ventricular dysfunction. SW elasticity was a predictor of cardiac events in patients with significant TR by assessing hepatic congestion. SW elasticity can be valuable for determining therapeutic strategies for TR.

DOI： 10.1007/s00380-022-02084-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Several studies have reported that the cardio-ankle vascular index (CAVI), a non-invasive measurement of arterial stiffness, is associated with the incidence of cardiovascular events. We investigated whether adding CAVI to a risk score improves the prediction of cardiovascular events in the setting of primary prevention. This retrospective observational study included consecutive 554 outpatients with cardiovascular disease risk factors but without known cardiovascular disease (68 ± 9 years, 64% men). The CAVI was measured using the VaSera vascular screening system. Major adverse cardiovascular events (MACE) included cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure, and coronary revascularization. During a median follow-up of 4.3 years, cardiovascular events occurred in 65 patients (11.7%). Multivariate Cox analysis showed that abnormal CAVI (>9.0) was significantly associated with the incidence of MACE (hazard ratio 2.31, 95% confidence interval 1.27−4.18). The addition of CAVI to the Suita score, a conventional risk score for coronary heart disease in Japan, significantly improved the C statics from 0.642 to 0.713 (p = 0.04). In addition to a conventional risk score, CAVI improved the prediction of cardiovascular events in patients with cardiovascular disease risk factors but without known cardiovascular diseases.

DOI： 10.3390/jcdd9110368

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Transcatheter mitral valve repair with the MitraClip system has been established in selected high-risk patients. The MitraClip procedure results in a relatively large iatrogenic atrial septal defect (iASD). This study aimed to investigate the prevalence and clinical course of iASD requiring transcatheter closure following the MitraClip procedure. METHODS AND RESULTS: This study was conducted at all 59 institutions that perform transcatheter mitral valve repair with the MitraClip system in Japan. The data of patients on whom transcatheter iASD closure was performed were collected. Of the 2,722 patients who underwent the MitraClip procedure, 30 (1%) required transcatheter iASD closure. The maximum iASD size was 9±4 mm (range, 3-18 mm). The common clinical course of transcatheter iASD closure was hypoxemia with right-to-left shunt or right-sided heart failure with left-to-right shunt. Of the 30 patients, 22 (73%) required transcatheter closure within 24 h following the MitraClip procedure, including 12 with hypoxemia and 5 with right-sided heart failure complicated with cardiogenic shock. Of the 5 patients, 2 required mechanical circulatory support devices. Twenty-one patients immediately underwent transcatheter iASD closure, and hemodynamic deteriorations were resolved; however, 1 patient died without having undergone transcatheter closure. CONCLUSIONS: Transcatheter iASD closure was required in 1% of patients who underwent the MitraClip procedure. Many of these patients immediately underwent transcatheter iASD closure because of hypoxemia with right-to-left shunt or right-sided heart failure with left-to-right shunt.

DOI： 10.1253/circj.CJ-22-0048

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Past studies have shown the sex-related difference in the efficacy of cardiac resynchronization therapy (CRT). However, the data for cardiac sarcoidosis (CS) are limited. OBJECTIVE: The purpose of this study was to assess the sex-related prognostic differences in CS patients with CRT. METHODS: This multicenter CS survey included 430 patients (295 females) who met the diagnostic criteria for CS. Patients were divided into those treated with primary CRT or upgraded CRT from the pacemaker (CRT group; n = 73) and others (control group; n = 357). Sex differences in the incidence of all-cause death, heart failure (HF) death including heart transplantation, ventricular arrhythmia events (VAEs) (sudden death, appropriate device therapy), cardiac adverse events (CAEs) (HF death, VAEs), changes in serum brain natriuretic peptide (BNP) levels, and left ventricular ejection fraction (LVEF) over the follow-up period were analyzed. RESULTS: During median follow-up of 5.2 years, males, but not females, in the CRT group had significantly worse all-cause mortality than patients in the control group (P <.001). In the CRT group, there was no significant sex-related difference in the incidence of HF death; however, females had significantly better VAE- and CAE-free survival than males (P = .033 and P = .008, respectively). Multivariate analysis of the CRT group showed that female sex (hazard ratio 0.37; 95% confidence interval 0.15-0.89; P = .02 and P = .6) independently predicted freedom from CAEs. During follow-up, BNP levels were significantly improved in all groups. LVEF was maintained in females with CRT. CONCLUSIONS: In CS patients with CRT, HF death-free survival was similar between sexes. However, females exhibited better VAE- and CAE-free survival than males.

DOI： 10.1016/j.hrthm.2022.02.027

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

This study aimed to elucidate the utility of a novel ultrasound-based technique, shear wave dispersion slope (SWDS) analysis, which estimates tissue viscosity, for evaluating the severity of myocardial inflammation. Experimental autoimmune myocarditis (EAM) at different disease phases [3-week (acute phase): n = 10, 5-week (subacute phase): n = 9, and 7-week (late phase): n = 11] were developed in male Lewis rats. SWDS was measured in the right and the left ventricular free walls (RVFW and LVFW) under a retrograde perfusion condition. Histological myocardial inflammation was evaluated by CD68 staining. The accumulation of CD68-positive cells was severe in the myocardium of the EAM 3-week group. The median (interquartile range) SWDS of RVFW was significantly higher in the EAM 3-week group [9.9 (6.5-11.0) m/s/kHz] than in the control group [5.4 (4.5-6.8) m/s/kHz] (P = 0.034). The median SWDS of LVFW was also significantly higher in the EAM 3-week group [8.1 (6.4-11.0) m/s/kHz] than in the control group [4.4 (4.2-4.8) m/s/kHz] (P = 0.003). SWDS and the percentage of CD68-positive area showed a significant correlation in RVFW (R2 = 0.64, P < 0.001) and LVFW (R2 = 0.73, P < 0.001). This study showed that SWDS was elevated in ventricular walls with acute inflammation and also significantly correlated with the degree of myocardial inflammation. These results suggest the potential of SWDS in estimating the histological severity of acute myocarditis.

DOI： 10.1038/s41598-022-12935-6

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: The relief of congestion is essential for the prevention of worsening heart failure (HF) resulting in hospitalizations. Assessment of the degree of organ congestion in the chronic phase of HF is important for determining therapeutic strategies. The aim of this study was to evaluate the efficacy of shear wave (SW) elasticity for assessing congestion and clinical outcomes in patients with chronic HF. METHODS AND RESULTS: We prospectively enrolled 345 consecutive patients with chronic HF who underwent SW elastography at outpatient clinic. Patients were divided into two groups according to the median value of SW elasticity: low group (SW elasticity <6.4 kPa, n = 176) and high group (SW elasticity ≥6.4 kPa, n = 169). The endpoint was cardiovascular death or hospitalization for HF. During the median follow-up period of 19 months (range: 7-36 months), cardiovascular death or hospitalization for HF occurred in 4 patients of low group and 27 patients of high group. In high group, 8 patients died, and 19 patients were hospitalized for HF. In low group, 3 patients died, and 1 patient was hospitalized. Kaplan-Meier analysis showed that the event-free survival rate was worse in high group than in low group (log-rank test, P = 0.004). After adjusting for variables, high SW elasticity was independently related to cardiac events. In multivariate regression analysis, SW elasticity was correlated with left atrial volume index, early diastolic mitral inflow velocity to mitral annular velocity ratio, and inferior vena cava diameter. CONCLUSIONS: The SW elasticity reflected haemodynamic congestion in patients with chronic HF, which was related to cardiac events.

DOI： 10.1002/ehf2.13809

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Surgical restoration of subvalvular geometry is very important to prevent recurrence of ischemic/functional mitral regurgitation. We evaluated an approach to the radical repair of left ventricular (LV) remodeling for three different cases with responsible coronary lesions. Leaflet tethering was corrected by tugging of the papillary-ventricular complex, which consists of the base of papillary muscles and posterior LV wall. The main lesion of the postinfarction scar was concomitantly excluded. Restoration of LV remodeling diminished mitral regurgitation with minimal leaflet tethering and improved systolic LV function. This technique may be an aggressive and encouraged approach for patients with ischemic/functional mitral regurgitation.

DOI： 10.1016/j.athoracsur.2021.03.095

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記述言語：英語  

DOI： 10.1016/j.jcct.2021.09.001

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although isolated cardiac sarcoidosis (CS) is not uncommon, little is known about the prognosis. We aimed to clarify clinical features and clinical outcomes in patients with isolated CS. METHODS: Two-hundred eighty-six patients with suspected CS were enrolled. Systemic CS (SCS) was diagnosed by histological or clinical confirmation of sarcoidosis according to the guidelines. Isolated CS was diagnosed by histological or clinical confirmation in the heart alone. The endpoint was cardiac death, hospitalization for heart failure, or fatal ventricular arrhythmia. RESULTS: Twenty-one patients were diagnosed with isolated CS, and 63 were diagnosed with SCS. The frequencies of diagnostic criteria, such as high-grade atrioventricular block or fatal ventricular arrhythmia, basal thinning of the ventricular septum, left ventricular contractile dysfunction, positive myocardial uptake of gallium-67 citrate scintigraphy or fluorine-18 fluorodeoxyglucose positron emission tomography, and delayed contrast enhancement of cardiac magnetic resonance, were higher or equivalent in patients with isolated CS, compared to those with SCS. Over a median follow-up of 31 months (range: 1-175 months), cardiac death, hospitalization for heart failure, or fatal ventricular arrhythmia occurred in 14 (67%) patients with isolated CS, 24 (38%) patients with SCS, and 63 (31%) patients without CS. The rate of cardiac events was higher in patients with isolated CS (log-rank test, p = 0.01). Cox proportional hazard analysis showed that isolated CS, age, and New York Heart Association functional class were independently associated with cardiac events. CONCLUSIONS: Patients with isolated CS have clinical features compatible with SCS, and have cardiac events at a higher rate.

DOI： 10.1016/j.ijcard.2021.10.150

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Noninvasive assessment of stenotic lesions in patients with complex adult congenital heart disease (ACHD) is challenging due to its complex morphology. The simultaneous two-screen display of multidetector-computed tomography (MDCT) and real-time echogram (STDME) technology can display a virtual multi-planar reconstruction from MDCT corresponding to the same cross-sectional image from transthoracic echocardiography (TTE). We investigated the usefulness of the STDME technology for stenosis severity assessment in complex ACHD patients. METHODS: Twenty-four complex ACHD patients with stenotic lesions were enrolled in this study. All patients underwent TTE and the STDME technology within a week after MDCT. Peak velocity and pressure gradient (PG) across the stenotic site were measured using continuous wave Doppler. Cardiac catheterization was performed in 17 patients. RESULTS: Nine out of the twenty-four patients had undergone repair with a conduit. Peak velocity and PG from the STDME technology were higher than those from TTE (peak velocity: 3.1 ± 1.1 vs. 2.8 ± 1.0 m/s; peak PG: 43 ± 28 vs. 34 ± 21 mmHg; both p < 0.01). Peak PG from the STDME technology showed significant correlations with those from catheterization in patients with a conduit (n=7) and those without a conduit (n=10) (r = 0.795 and 0.880, respectively; both p < 0.05), while peak PG from TTE was correlated with catheterization measurements only in patients without a conduit (r = 0.850, p < 0.05). CONCLUSIONS: The STDME technology enables more accurate assessment of conduit stenosis severity than does TTE in complex ACHD patients.

DOI： 10.1016/j.jjcc.2021.06.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Diagnosis of cardiac sarcoidosis (CS) is sometimes difficult due to a low positive rate of epithelioid granulomas by endomyocardial biopsy (EMB). Accordingly, Japanese guidelines can allow the CS diagnosis using clinical data alone without EMB results (clinical CS) since 2006. However, little is known about prognosis and outcome of clinical CS. OBJECTIVES: Purpose of this study was to analyze the prognosis, outcomes, and response to corticosteroid of clinical CS using large-scale cohort survey. METHODS: Overall, 422 CS patients (mean age 60 ± 13 years, 68% female, median follow-up period of 5 years), including 345 clinical CS and 77 EMB-positive patients, histologically diagnosed CS (histological CS) by Japanese guidelines, were enrolled and examined. RESULTS: Clinical profile (age, sex, initial cardiac arrhythmias, and abnormal uptake of gallium-67 scintigraphy or 18F-fluorodeoxyglucose positron emission tomography in heart) was similar in both groups. Although clinical CS had better prognosis (P = 0.018) and outcome (all-cause death, appropriate defibrillator therapy, and heart transplantation; P = 0.008), multivariate Cox hazard analysis revealed that left ventricular ejection fraction (LVEF) and sustained ventricular tachycardia history were independently associated with outcome (P < 0.001 and P = 0.002, respectively), but not with the diagnosed CS category. Moreover, similar LVEF recovery after corticosteroid was observed in both groups with low LVEF (≤35%) at the 1-year follow-up period (P < 0.001). CONCLUSIONS: In clinical CS according to the Japanese guideline, prophylactic implantable-cardioverter-defibrillator and immunosuppressive therapy are important in patients with low LVEF or ventricular tachycardia history, similar to histological CS.

DOI： 10.1016/j.jacasi.2021.09.005

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Shear wave (SW) imaging is a novel ultrasound-based technique for assessing tissue characteristics. SW elasticity may be useful to assess the severity of hypertensive left ventricular (LV) hypertrophy. This study aimed to evaluate the efficacy of SW elasticity for assessing the degree of myocardial hypertrophy using hypertensive rats. Rats were divided into hypertension group and control group. SW elasticity was measured on the excised heart. Myocardial hypertrophy was assessed histologically. LV weight was greater in hypertension group. An increase in interventricular septum and LV free wall thicknesses was observed in hypertension group. SW elasticity was significantly higher in hypertension group than in control group (14.6 ± 4.3 kPa vs. 6.5 ± 1.1 kPa, P < 0.01). The cross-sectional area of cardiomyocytes was larger in hypertension group than in control group (397 ± 50 μm2 vs. 243 ± 14 μm2, P < 0.01), and SW elasticity was positively correlated with the cross-sectional area of cardiomyocytes (R = 0.96, P < 0.01). This study showed that SW elasticity was higher in hypertensive rats and was closely correlated with the degree of myocardial hypertrophy, suggesting the efficacy of SW elasticity for estimating the severity of hypertensive LV hypertrophy.

DOI： 10.1038/s41598-021-02271-6

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The receptor for advanced glycation end products (RAGE), a transmembrane receptor belonging to the immunoglobulin superfamily, is overexpressed in pulmonary artery smooth muscle cells (PASMCs) in patients with pulmonary arterial hypertension (PAH) and is implicated in the etiology of PAH. Recently, we reported that RAGE-aptamer, a short and single-stranded DNA directed against RAGE, inhibited an inappropriate increase in cultured PASMCs in PAH. The aim of this study was to determine the efficacy of RAGE-aptamer in monocrotaline-induced PAH in rats. METHODS AND RESULTS: Rats were assigned to either an untreated control group, a group that received continuous subcutaneous administration of RAGE-aptamer immediately after monocrotaline injection, or a group that received control-aptamer immediately after monocrotaline injection. All rats survived 21 days after injection of monocrotaline and control-aptamer or RAGE-aptamer. Injection of monocrotaline with continuous subcutaneous delivery of control-aptamer resulted in higher right ventricular systolic pressure compared with controls. This increase was attenuated by continuous subcutaneous delivery of RAGE-aptamer. The proportion of small pulmonary arteries with full muscularization was greater in the monocrotaline and control-aptamer group than in the control group. Continuous subcutaneous delivery of RAGE-aptamer significantly reduced the percentage of small pulmonary arteries with full muscularization. CONCLUSIONS: Continuous subcutaneous delivery of RAGE-aptamer suppresses development of monocrotaline-induced PAH in rats. Inhibition of RAGE ameliorates muscularization of small pulmonary arteries. Treatment with RAGE-aptamer might be a new therapeutic option for PAH.

DOI： 10.1016/j.jjcc.2020.12.009

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Right ventricular (RV) function is important for outcomes in pulmonary hypertension. Evaluation of RV myocardial characteristics is useful to assess the disease severity. Shear wave elastography (SWE) provides information of shear wave (SW) elasticity, which is related to tissue hardness, and SW dispersion slope, which reflects tissue viscosity. This study aimed to test the hypothesis that SW elasticity is increased and SW dispersion slope is decreased in the right ventricle of monocrotaline (MCT)-induced pulmonary hypertension rats. METHODS: Rats were divided into MCT-induced pulmonary hypertension group (n = 10) and control group (n = 10). SW elasticity and SW dispersion slope were measured on excised hearts. Myocardial fibrosis was evaluated histologically. RESULTS: RV hypertrophy was observed in the MCT group. SW elasticity of right ventricle was higher in the MCT group than in the control group (3.5 ± 0.9 kPa vs. 2.5 ± 0.4 kPa, p < 0.01). SW dispersion slope of right ventricle was lower in the MCT group than in the control group (5.3 ± 1.7 m/s/kHz vs. 7.7 ± 1.5 m/s/kHz, p < 0.01). The fibrosis area of right ventricle was increased in MCT group compared with control group (18 ± 5% vs. 8 ± 3%, p < 0.01), and was positively related to SW elasticity and negatively related to SW dispersion slope. CONCLUSIONS: Higher SW elasticity and lower SW dispersion slope were observed in the fibrotic myocardium of right ventricle in MCT-induced pulmonary hypertension rats. SWE may have the potential to evaluate RV function by assessing myocardial characteristics.

DOI： 10.1016/j.jjcc.2021.01.015

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/hsr2.285

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: Liver dysfunction is important for prognosis in heart failure (HF). Shear wave elastography (SWE), which is a novel ultrasound technique for charactering tissues, has been used in liver diseases. However, clinical implication of SWE, including dispersion slope, remains unknown in heart diseases. This study aimed to evaluate the efficacy of SWE assessing liver function in the severity of HF. METHODS AND RESULTS: We enrolled 316 consecutive patients with or suspected heart diseases, who were classified according to the American College of Cardiology Foundation/American Heart Association stage of HF, including 37 with Stage A, 139 with Stage B, 114 with Stage C, and 26 with Stage D, and 45 normal subjects. Elasticity and dispersion slope of shear wave were assessed according to the HF stage. Elasticity and dispersion slope were not elevated in normal subjects and patients with Stage A. Elasticity was slightly increased from Stage A to Stage C and was remarkably elevated in Stage D (normal: 5.2 ± 1.1 kPa, Stage A: 5.4 ± 1.2 kPa, Stage B: 6.4 ± 1.8 kPa, Stage C: 7.8 ± 3.5 kPa, and Stage D: 17.7 ± 12.7 kPa), whereas dispersion slope was gradually increased from Stage A to Stage D (normal: 9.7 ± 1.7m/s/kHz, Stage A: 10.4 ± 1.6m/s/kHz, Stage B: 11.7 ± 2.4m/s/kHz, Stage C: 13.2 ± 3.4m/s/kHz, and Stage D: 17.6 ± 5.6 m/s/kHz). In the early HF stage, dispersion slope was elevated. In the advanced HF stage, both elasticity and dispersion slope were elevated. Liver function test abnormalities were observed only from Stage C or Stage D. CONCLUSIONS: Dispersion slope could detect early liver damage, and the combination of elasticity and dispersion slope could clarify the progression of liver dysfunction in HF. SWE may be valuable to manage therapeutic strategies in patients with HF.

DOI： 10.1002/ehf2.13318

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担当区分：責任著者   記述言語：英語  

• Identification of high-risk PFO associated with stroke is important. • Low-angle PFO is reported to be one of the high-risk PFO morphologies. • Low-angle PFO can allow venous blood to flow directly from the IVC to the LA. • The case showed direct blood flow from the IVC to LA through the low-angle PFO.

DOI： 10.1016/j.case.2021.02.008

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記述言語：英語  

Takeuchi repair is a unique surgical approach in anomalous left coronary artery from the pulmonary artery. We present an adult patient with anomalous left coronary artery from the pulmonary artery with multiple late structural complications after Takeuchi repair who was evaluated using multimodality imaging, including newly developed cardiac fusion imaging with computed tomography and echocardiography. (Level of Difficulty: Advanced.).

DOI： 10.1016/j.jaccas.2021.02.035

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.echo.2020.08.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Cardiac imaging modalities are essential for the management of cardiac diseases. Multimodality imaging, such as echocardiography, cardiac computed tomography (CT), cardiac magnetic resonance imaging, and fluoroscopy, is required for assessing cardiac condition. In recent years, fusion imaging, which integrates different imaging modalities on the same screen, has been developed. Because the fusion imaging is able to merge the advantages of each modality, it has the potential to be valuable for accurate diagnosis as well as the planning of therapeutic strategies. In the clinical setting, the fusion imaging of real-time transthoracic echocardiography with cardiac CT displayed side by side has reportedly been effective for the diagnosis and the assessment of disease severity in patients with adult congenital heart disease. The overlay of real-time three-dimensional transesophageal echocardiography onto fluoroscopy, which is dynamic fusion imaging, has been used for structural heart disease interventions. The fusion imaging has become increasingly important in the field of cardiac diseases. This review discusses the benefits of echocardiographic fusion imaging.

DOI： 10.1007/s12574-019-00455-8

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者,　責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: 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. METHODS AND RESULTS: 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]. CONCLUSION: 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.

DOI： 10.1093/europace/euz207

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Coronary artery calcification (CAC) as measured by computed tomography is a strong predictor of coronary artery disease. The brachial intima-media thickness (IMT) was recently reported to be associated with cardiovascular risk factors. This study investigated the association of brachial IMT with CAC, which is a marker of coronary artery atherosclerosis, in patients with diabetes. We enrolled 292 patients with diabetes (mean age, 65 ± 12 years; 59% men) who underwent both endothelial function testing and computed tomography for risk assessment of coronary artery disease. Flow-mediated dilation (FMD) and IMT in the brachial artery were measured with a specialized machine. FMD was lower and brachial IMT was thicker in patients with than without CAC. The CAC score was significantly correlated with both brachial IMT and FMD, while the multivariate logistic analysis demonstrated that brachial IMT (> 0.32 mm) but not FMD (< 5.1%) was significantly associated with the presence of CAC (odds ratio, 2.03; 95% confidence interval, 1.10-3.77; p = 0.02). The receiver operating characteristic curve analysis showed that the area under the curve for discriminating patients with CAC was 0.67 for IMT (p < 0.001) and 0.62 for FMD (p < 0.001). When patients were classified into four groups based on brachial IMT and FMD, the CAC score was higher in patients with thicker brachial IMT and lower FMD than in patients of the other groups (p < 0.001). Measurement of brachial IMT could be useful for the risk assessment of patients with diabetes.

DOI： 10.1007/s00380-019-01371-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：責任著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：責任著者   記述言語：英語  

DOI： 10.1016/j.jcin.2018.06.055

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Cardiac sarcoidosis (CS) is a noncaseating granulomatous disease of unknown etiology. Lifelong immunosuppressive therapy, most frequently using corticosteroids, is a standard therapy to control hypersensitivity of immune reactions and prevent inflammation. However, it sometimes causes various systemic adverse effects and requires dose escalation. Thus, additional therapy may be required for the treatment of this disease. Recently, Propionibacterium acnes (P. acnes) was reported as one of the etiologic agents of CS, indicating that antibacterial drugs (ABD) may be effective for the treatment of CS. The objective of this study was to investigate the effect of ABD treatment, in addition to standard corticosteroid therapy, in patients with CS. METHODS: The Japanese Antibacterial Drug Management for Cardiac Sarcoidosis (J-ACNES) trial was designed as a prospective, multicenter, randomized, open-label, controlled clinical trial. The patients will be randomized to receive either standard corticosteroid therapy plus ABD therapy (ABD group) or standard corticosteroid therapy (standard group). The primary endpoint is change in the total standardized uptake value at 6 months vs baseline using fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography. Secondary endpoints include efficacy, prognosis, and safety. RESULTS: The results of this study are currently under investigation. CONCLUSION: The J-ACNES trial will be the first prospective study assessing the clinical benefit and safety of ABD therapy, in addition to corticosteroid treatment, in patients with CS. Our findings may improve treatment of patients with CS, as additional ABD therapy reduces recurrence of inflammation and elucidates the mechanism of sarcoidosis.

DOI： 10.1002/joa3.12084

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Little is known about the suitability of implantable cardioverter defibrillator (ICD) implantation in patients with cardiac sarcoidosis (CS). We evaluated the efficacy of ICD implantation in patients with CS, including suspected CS, compared with those with idiopathic dilated cardiomyopathy (DCM). METHODS: A total of 102 consecutive patients with definite CS, suspected CS, or DCM who underwent ICD implantation were enrolled. The endpoint was the first documentation of appropriate ICD therapy for ventricular tachyarrhythmias. The follow-up started after ICD implantation. RESULTS: Appropriate ICD therapies occurred in 15 (56%) of 27 patients with definite CS, 17 (68%) of 25 with suspected CS, and 16 (32%) of 50 with DCM. The rate of appropriate ICD therapies was higher in patients with definite CS and those with suspected CS than in those with DCM (log-rank test, p=0.010). After ICD implantation, five or more appropriate ICD therapies occurred in 5 (19%) patients with definite CS and 10 (40%) with suspected CS, but in only 1 (2%) with DCM. Cox proportional hazard analysis showed that CS, including suspected CS, was independently associated with appropriate ICD therapies. For primary prevention, the rate of appropriate ICD therapies was higher in patients with CS than in those with DCM (log-rank test, p=0.034). More than half of patients with CS received appropriate ICD therapies. CONCLUSIONS: Patients with CS receive appropriate ICD therapies for ventricular tachyarrhythmias at a higher rate, compared with those with DCM, suggesting that ICD implantation should be performed in patients with CS.

DOI： 10.1016/j.ijcard.2017.04.044

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Although hypoalbuminemia at admission is a risk for acute kidney injury (AKI) and mortality in patients with acute decompensated heart failure (ADHF), the clinical significance of decreased serum albumin levels (DAL) during ADHF therapy has not been elucidated. This study aimed to evaluate whether DAL was associated with AKI, and whether intravenous atrial natriuretic peptide (ANP) administration, which provides an effective treatment for ADHF but promotes albumin extravasation, was associated with DAL and AKI. A total of 231 consecutive patients with ADHF were enrolled. AKI was defined as ≥0.3 mg/dl absolute or 1.5-fold increase in serum creatinine levels within 48 h. AKI occurred in 73 (32%) of the 231 patients during ADHF therapy. The median value of decreases in serum albumin levels was 0.3 g/dl at 7 days after admission. When DAL was defined as ≥0.3 g/dl decrease in serum albumin levels, DAL occurred in 113 patients, and was independently associated with AKI. Of the 231 patients, 73 (32%) were treated with intravenous ANP. DAL occurred more frequently in patients receiving ANP than in those not receiving ANP (77 vs. 36%, p < 0.001), and ANP was independently associated with DAL. The incidence of AKI was higher in patients receiving ANP than in those not receiving ANP (48 vs. 24%, p < 0.001). ANP was independently associated with AKI. In conclusion, DAL is associated with AKI. Intravenous ANP administration may be one of the promoting factors of DAL, which leads to AKI, indicating a possible novel mechanism of AKI.

DOI： 10.1007/s00380-017-0954-y

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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.

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.jcin.2016.03.014

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

An alternative approach for transcatheter closure of atrial septal defect is necessary in patients with absent inferior caval vein connection. In this report, we describe the successful transcatheter atrial septal defect closure via the transjugular approach using a steerable guide catheter.

DOI： 10.1017/S1047951116000445

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Since acute kidney injury (AKI) is not always related to mortality in patients with acute decompensated heart failure (ADHF), the aim of this study was to focus on onset time of AKI and its clinical importance. A total of 371 ADHF patients were included. The impact of AKI (≥ 0.3 mg/dl or 1.5-fold increase in serum creatinine level within 48 h) with early onset (≤ 4 days from admission) or late onset (≥ 5 days from admission) was assessed. AKI occurred in 99 patients, who were divided into two groups according to the median onset time of AKI: 50 with early onset of AKI and 49 with late onset of AKI. The maximum increase in serum creatinine level from admission was greater in patients with late onset of AKI than in patients with early onset of AKI (p = 0.012). Patients with late onset of AKI had a higher 12-month mortality rate than that in patients with early onset of AKI (log-rank test, p = 0.014). Late onset of AKI was an independent predictor of mortality (hazard ratio: 3.39, 95 % confidence interval: 1.84-6.18, p < 0.001). Late onset of AKI was associated with high blood urea nitrogen level at admission and intravenous administration of dobutamine. In conclusion, late onset of AKI related to high blood urea nitrogen level and intravenous administration of dobutamine, but not early onset of AKI, is linked to high mortality rate. Onset time of AKI may be useful for risk stratification of mortality in ADHF patients developing AKI.

DOI： 10.1007/s00380-014-0572-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Patients with probable cardiac sarcoidosis (CS) who satisfy only clinical cardiac findings for CS are not uncommon. The aim of this study was to compare outcomes between patients with probable CS and those with definite CS treated with steroids. The study population consisted of 101 consecutive patients who satisfied clinical cardiac findings for CS. Patients with definite CS were defined as having histologic or clinical confirmation of CS according to the guidelines and were treated with steroids. Patients with probable CS were defined as having only clinical cardiac findings but not definite CS because of no histologic confirmation or extracardiac sarcoidosis and were not treated with steroids. The end point was major adverse cardiac events. Forty-seven patients had definite CS, and the other 54 had probable CS. Except for serum angiotensin-converting enzyme levels and left ventricular dysfunction, clinical characteristics were similar between the 2 groups. Over a median follow-up period of 15 months, major adverse cardiac events occurred more frequently in patients with probable CS than in those with definite CS (74% vs 53%, p=0.029). The event-free survival rate was worse in patients with probable CS than in those with definite CS (log-rank test, p=0.006). Cox proportional-hazards analysis showed that probable CS was an independent predictor of major adverse cardiac events. In conclusion, outcomes were worse in patients with probable CS than in those with definite CS treated with steroids. The initiation of steroid treatment may be considered for patients who satisfy only clinical cardiac findings for CS.

DOI： 10.1016/j.amjcard.2015.01.562

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Although high-degree atrioventricular block (AVB) is a common initial manifestation of cardiac sarcoidosis, little is known about the outcomes. The aim of this study was to assess outcomes in patients with AVB as an initial manifestation of cardiac sarcoidosis compared with those in patients with ventricular tachyarrhythmia (VT) and/or heart failure (HF). Fifty-three consecutive patients with cardiac sarcoidosis, who had high-degree AVB (n = 22) or VT and/or HF (n = 31), were enrolled. The end point was defined as major adverse cardiac events, including cardiac death, ventricular fibrillation, sustained VT, and hospitalization for HF. Over a median follow-up period of 34 months, the outcomes of major adverse cardiac events were better in patients with high-degree AVB than in those with VT and/or HF (log-rank test, p = 0.046). However, this difference was due mainly to HF hospitalization. The outcomes of fatal cardiac events, including cardiac death, ventricular fibrillation, and sustained VT, were comparable between the 2 groups (log-rank test, p = 0.877). The fatal cardiac events in patients with high-degree AVB were not associated with the initiation of steroid treatment or left ventricular dysfunction. In conclusion, the outcomes of major adverse cardiac events are better in patients with high-degree AVB than in those with VT and/or HF. However, patients with high-degree AVB have a high rate of fatal cardiac events, similar to those with VT and/or HF. An indication for an implantable cardioverter-defibrillator, but not a pacemaker system, can be considered in patients with cardiac sarcoidosis manifested by high-degree AVB.

DOI： 10.1016/j.amjcard.2014.11.028

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Risk stratification of acute kidney injury (AKI) is important for acute decompensated heart failure (ADHF). The aim of this study was to determine whether clinical markers, such as the blood urea nitrogen/creatinine ratio (BUN/Cr) or BUN or creatinine values alone, stratify the risk of AKI for mortality. METHODS AND RESULTS: In all, 371 consecutive ADHF patients were enrolled in the study. AKI was defined as serum creatinine ≥0.3 mg/dl or a 1.5-fold increase in serum creatinine levels within 48 h. During ADHF therapy, AKI occurred in 99 patients; 55 patients died during the 12-month follow-up period. Grouping patients according to AKI and a median BUN/Cr at admission of 22.1 (non-AKI+low BUN/Cr, non-AKI+high BUN/Cr, AKI+low BUN/Cr, and AKI+high BUN/Cr groups) revealed higher mortality in the AKI+high BUN/Cr group (log-rank test, P<0.001). Cox's proportional hazard analysis revealed an association between AKI+high BUN/Cr and mortality, whereas the association with AKI+low BUN/Cr did not reach statistical significance. When patients were grouped according to AKI and median BUN or creatinine values at admission, AKI was associated with mortality, regardless of BUN or creatinine. CONCLUSIONS: The combination of AKI and elevated BUN/Cr, but not BUN or creatinine individually, is linked with an increased risk of mortality in ADHF patients, suggesting that the BUN/Cr is useful for risk stratification of AKI.

DOI： 10.1253/circj.CJ-14-1360

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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 < .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 < .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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者   記述言語：英語  

DOI： 10.1016/j.ijcard.2014.07.042

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although there is a general fear that exercise training might deteriorate renal function in chronic kidney disease (CKD) patients, the effect of cardiac rehabilitation (CR) on renal function in acute myocardial infarction (AMI) patients with CKD remains unknown. We sought to determine whether CR is associated with amelioration or deterioration of renal function in such patients. METHODS AND RESULTS: We enrolled 528 AMI patients who participated in a 3-month CR program. Clinical data before and after CR were compared according to participation in CR and comorbidities. In patients without CKD (estimated glomerular filtration rate [eGFR] ≥60ml·min(-1)·1.73m(-2), n=348), peak oxygen uptake (VO2) and B-type natriuretic peptide (BNP) improved without a change in eGFR. In contrast, in patients with CKD (eGFR <60ml·min(-1)·1.73m(-2), n=180), eGFR improved (48±12 to 53±15ml·min(-1)·1.73m(-2), P<0.001), together with improvements in peak VO2 and BNP. When patients with CKD were divided into non-active (≤1time/week, n=70) and active participants (≥1.1time/week, n=110) according to attendance in CR, active participants showed an improvement in eGFR (50±10 to 53±13ml·min(-1)·1.73m(-2), P<0.001), whereas eGFR did not change in non-active participants. Similar results were obtained in each subgroup of patients with hypertension, dyslipidemia, or diabetes mellitus. CONCLUSIONS:  In AMI patients with CKD, active participation in CR was associated with improved peak VO2, BNP, and eGFR.

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Little is known about predictors of response to cardiac resynchronization therapy (CRT) in patients with intraventricular conduction delay (IVCD). The purpose of this study was to investigate the benefits of CRT and significant variables on surface electrocardiogram (ECG) to predict response to CRT in those patients. METHODS AND RESULTS: Among the cohort of 152 CRT patients, 40 patients with IVCD were evaluated. Sixteen patients (40%) were responders. At baseline, responders had a wider QRS duration (158±18 vs. 144±18ms, P=0.02) and a higher frequency of left axis deviation (LADEV; 75% vs. 29%, P=0.004) compared with non-responders. After CRT, greater shortening of QRS duration (ΔQRS; 26±24 vs. 7±24ms, P=0.02), axis shift from LADEV to right axis deviation (RADEV; 69% vs. 13%, P<0.001), and both rightward forces in lead I and anterior forces in V1 (56% vs. 13%, P=0.003) were found more frequently in responders. Multivariable logistic regression analysis showed that LADEV at baseline, or ΔQRS and axis shift from LADEV to RADEV after CRT were independent predictors of response to CRT. CONCLUSIONS: Patients with IVCD may not respond to CRT, but LADEV at baseline and reversal of ventricular activation after CRT on surface ECG could be important to predict response to CRT.

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although it has been demonstrated that cardiac remodeling and exercise capacity improve after transcatheter closure of atrial septal defect (ASD), little is known about long-term benefits in middle-aged and elderly patients with a reduction in cardiopulmonary function. OBJECTIVES: To evaluate long-term extent and time course of improvements in cardiac remodeling and exercise capacity in those patients. METHODS: Twenty ASD patients ≥ 40 years of age with a reduction in cardiopulmonary function (predicted peak oxygen uptake [VO(2)] < 65%) were enrolled. Transthoracic echocardiography and cardiopulmonary exercise testing were performed at baseline and at 1 month, 3 months, 6 months, and >12 months after the procedure. RESULTS: At 1 month after the procedure, significant decreases in right ventricular (RV) end-diastolic diameter (38.2 ± 4.4 to 31.9 ± 4.4 mm; P < 0.001) and RV/left ventricular end-diastolic diameter ratio (0.95 ± 0.17 to 0.71 ± 0.13; P < 0.001) occurred, and they were maintained during the follow-up period. Normal RV size was achieved in 11 of 18 patients with RV enlargement. Predicted peak VO(2) did not change at 1 month and 3 months, but it improved significantly after 6 months (53.6 ± 6.5 to 62.1 ± 12.6%; P < 0.01). Sixteen of the 20 patients showed improved predicted peak VO(2). CONCLUSIONS: Cardiac remodeling and exercise capacity could be improved over the long-term period after transcatheter closure of ASD in middle-aged and elderly patients with a reduction in cardiopulmonary function. There were differences in the time course of improvement between cardiac remodeling and exercise capacity in those patients.

DOI： 10.1111/joic.12002

PubMed

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Impaired exercise capacity has been found in patients with diastolic dysfunction with preserved systolic function. Although conventional transthoracic echocardiography (TTE) provides useful clinical information about systolic and diastolic cardiac function, its capability to evaluate exercise capacity has been controversial. The inertia force of late systolic aortic flow is known to have a tight relationship with left ventricular (LV) performance during the period from near end-systole to isovolumic relaxation. The inertia force and the time constant of LV pressure decay during isovolumic relaxation can be estimated noninvasively using the second peak (W(2)) of wave intensity (WI), which is measured with an echo-Doppler system. We sought to determine whether W(2) is associated with exercise capacity in patients with chronic heart failure with normal ejection fraction (HFNEF) and to compare its ability to predict exercise capacity with parameters obtained by conventional TTE including tissue Doppler imaging. Sixteen consecutive patients with chronic HFNEF were enrolled in this study. Wave intensity was obtained with a color Doppler system for measurement of blood velocity combined with an echo-tracking system for detecting changes in vessel diameter. Concerning conventional TTE, we measured LV ejection fraction (EF), peak velocities of early (E) and late (A) mitral inflow using pulse-wave Doppler, and early (Ea) and late (Aa) diastolic velocities using tissue Doppler imaging. Left ventricular EF, E/A ratio, Ea, and E/Ea ratio did not correlate with exercise capacity, whereas W(2) significantly correlated with peak VO(2) (r = 0.54, p = 0.03), VE/VCO(2) slope (r = -0.53, p = 0.03), and ΔVO(2)/ΔWR (r = 0.56, p = 0.02). W(2) was associated with exercise capacity in patients with chronic HFNEF. In conclusion, W(2) is considered to be clinically more useful than conventional TTE indices for evaluating exercise capacity in patients with chronic HFNEF.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We studied the association of serum levels of arachidonic acid (AA) and eicosapentaenoic acid (EPA) with the prevalence of major adverse cardiac events (MACE) after acute myocardial infarction (AMI). We measured serum AA and EPA on admission in 146 consecutive AMI patients. The primary clinical endpoint was occurrence of MACE, defined as cardiac death, occurrence of heart failure, reinfarction, recurrent angina pectoris, and requirement of coronary intervention. Common logarithmic transformed serum levels of AA (logAA) and EPA (logEPA) were used in the analyses. The optimum cutoff point of each fatty acid used to distribute patients into two groups for Kaplan-Meier analysis was determined by receiver operating characteristic curves analysis. MACE occurred in 40 patients (27.4%). Kaplan-Meier analysis disclosed that the group with a logAA above the cutoff point [145.3 μg/mL (logAA 2.162)] showed a higher prevalence of MACE than those with a logAA below the cutoff point (P < 0.01). Conversely, the prevalence of MACE was significantly higher in the group with a logEPA below the cutoff point [52.3 μg/mL (logEPA 1.719)] compared to the group with a logEPA above it (P < 0.01). Similar to logAA, logAA/logEPA showed significant differences in the MACE-free curve between the two groups (cutoff 1.301, P < 0.001). Cox proportional hazards regression analysis suggested that logAA, logEPA, and logAA/logEPA were independently associated with the prevalence of MACE. Although the present study included a limited number of patients with single-time point measurement, the results suggested an association of logAA, logEPA, and logAA/logEPA with the prevalence of MACE after AMI. The present study warrants further studies involving a large number of patients to confirm that the serum levels of these fatty acids and their ratios are predictors of MACE after AMI.

DOI： 10.1007/s00380-010-0038-8

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The relationship between serum fatty acid levels and the extent of coronary plaques and calcification was examined in patients with acute myocardial infarction (AMI). METHODS AND RESULTS: The serum levels of the n-3 polyunsaturated fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) and the n-6 polyunsaturated fatty acids (arachidonic acid (AA) and dihomo-gamma-linolenic acid (DGLA)) were determined using gas chromatography on admission of 95 consecutive patients with their first AMI and 17 controls. Using multidetector-row computed tomography, soft plaques and calcification lesions were scored according to the extent of coronary involvement. Serum logarithmic transformed (log) EPA and logDHA levels were inversely correlated with soft plaque scores (r=-0.546, p<0.0001 and r=-0.377, p<0.0001, respectively). Serum logAA and logDGLA levels were not significantly correlated with soft plaque scores. Serum logEPA and logDHA levels were significantly, but weakly, correlated with calcification scores. Multivariate analysis with clinical characteristics and risk factors selected serum n-3 polyunsaturated fatty acid levels as independent factors associated with the extent of coronary soft plaques. CONCLUSION: The present study demonstrates a significant correlation between serum n-3 polyunsaturated fatty acid levels and the extent of coronary soft plaques and calcification in AMI patients.

PubMed

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記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)羊土社  

(1)心房中隔欠損症(ASD)は心尖部四腔断面で右室拡大を認める(2)ASDはカラードプラで左房から右房へのシャント血流を観察できる(3)成人期の心室中隔欠損症(VSD)は,欠損孔は小さく,収縮期雑音などで発見される(4)VSDはカラードプラでシャント血流を観察できる(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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担当区分：責任著者   記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)インナービジョン  

心エコーなどの画像診断は,循環器疾患の診療において重要な役割を担っている。循環器疾患の中でも,近年,構造的心疾患(structural heart disease)に対するカテーテル治療が急速に発展してきており,心エコーによる術前や術中の評価は不可欠である。また,成人先天性心疾患に遭遇する機会も増してきている。心臓形態が複雑な成人先天性心疾患では,心エコーのみならず,CT/MRIを含めたmulti-modality imagingによる評価が有用である。本稿では,心エコーの技術の最新動向として,経食道心エコー画像とX線透視画像をリアルタイムに融合し描出する「EchoNavigator」(フィリップス社)と,CT/MR画像と心エコー画像をside by sideで表示する「Smart Fusion」(キヤノンメディカルシステムズ社)について概説する。(著者抄録)

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

＜文献概要＞Point 1 心房細動を合併するASDは,カテーテルアブレーション,ASDカテーテル閉鎖術が有効である。2 右室拡大に伴う三尖弁閉鎖不全症は,ASDカテーテル閉鎖術後に改善する。3 高度の肺高血圧症を合併したASDは,"Treat and Repair"が有効である。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J03097&link_issn=&doc_id=20221116160009&doc_link_id=10.18885%2FHV.0000001117&url=https%3A%2F%2Fdoi.org%2F10.18885%2FHV.0000001117&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

心房中隔欠損(Atrial septal defect,ASD)は頻度の高い先天性心疾患であり,チアノーゼなどの症状が出ないことも多く,小児期に診断されることなく成人に到達する症例も少なくない.成人期まで到達したASDでは長年の右心系の負荷と肺血流の増加に伴い,心不全,心房細動,肺高血圧,などの合併症を伴い病態が複雑となることがある.従来の外科手術に加えて,近年の経カテーテルASD閉鎖術,心房細動に対するカテーテルアブレーション,肺高血圧治療薬の進歩に伴い治療成績は向上している.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J02003&link_issn=&doc_id=20230424230003&doc_link_id=%2Fee7shoni%2F2022%2F003804%2F004%2F0229-0233%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fee7shoni%2F2022%2F003804%2F004%2F0229-0233%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)羊土社  

(1)心尖部アプローチは、プローブを心尖部にあて、インデックスマーカーを3時方向に向ける(2)心尖部四腔断面では、左室・左房・右室・右房が観察できる(3)心尖部四腔断面では、左室収縮能、左室や右室の拡大が評価できる(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：日本肺高血圧・肺循環学会・日本小児肺循環研究会  

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担当区分：筆頭著者   記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

＜文献概要＞Point 1 PFO診断には,Valsalva負荷とコントラストエコーが不可欠である。2 PFOの右左シャントの検出には,Valsalva負荷が十分にかかる経胸壁心エコー図検査(TTE)が有効である。3 PFOカテーテル閉鎖術において,ハイリスクPFOの評価が重要になる。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J03097&link_issn=&doc_id=20220617280006&doc_link_id=10.18885%2FHV.0000000964&url=https%3A%2F%2Fdoi.org%2F10.18885%2FHV.0000000964&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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担当区分：責任著者   記述言語：日本語   出版者・発行元：(一社)日本動脈硬化学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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担当区分：責任著者   記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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担当区分：責任著者   記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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担当区分：責任著者   記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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担当区分：責任著者   記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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担当区分：責任著者   記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)文光堂  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：日本語   出版者・発行元：(公社)日本皮膚科学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞Point ・卵円孔開存(PFO)による潜因性脳梗塞の発生頻度は低くなく,PFOカテーテル閉鎖術は再発予防に有効である.・PFOカテーテル閉鎖術の有効性が示され,PFOを確実に診断することが重要になってきている.・PFO診断には,経胸壁心エコー図での右左短絡の検出,経食道心エコー図でのPFO形態の評価が重要である.

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J06863&link_issn=&doc_id=20210707140013&doc_link_id=10.11477%2Fmf.1438200504&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1438200504&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：日本語   出版者・発行元：日本肺高血圧・肺循環学会・日本小児肺循環研究会  

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担当区分：責任著者   記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：医歯薬出版(株)  

卵円孔開存(PFO)は、PFOカテーテル閉鎖術が施行可能になり、大きく注目されてきている。PFOは、奇異性脳塞栓症以外にさまざまな病態と関連している。片頭痛は、サイトカインなど何らかの物質がPFOを介して動脈系に流れ込むことにより前兆などを生じると推測されている。減圧病は、高圧から低圧への変化により血管内で気泡を形成し、PFOを介して動脈に流入し血流障害を呈する。Platypnea-orthodeoxia syndromeは、大動脈拡張などによる心房圧排に伴い、座位や立位でPFOを介する右左短絡が増大し、低酸素血症を呈すると考えられている。本稿では、脳梗塞症以外にPFOが関連する代表的な疾患に関して概説する。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00060&link_issn=&doc_id=20210125020008&doc_link_id=issn%3D0039-2359%26volume%3D276%26issue%3D4%26spage%3D291&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0039-2359%26volume%3D276%26issue%3D4%26spage%3D291&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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担当区分：責任著者   記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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担当区分：責任著者   記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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担当区分：責任著者   記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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担当区分：責任著者   記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(株)文光堂  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞Point ・ASDはカテーテル閉鎖術が第一選択であり,欠損孔の評価が重要である.・PFOは奇異性脳塞栓症の再発予防にカテーテル閉鎖術の有効性が示され,診断が重要になっている.・VSDは成人期では小欠損孔が多く,肺高血圧症や大動脈弁逸脱など合併症に注意する.

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J06863&link_issn=&doc_id=20200323250020&doc_link_id=10.11477%2Fmf.1438200374&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1438200374&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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担当区分：筆頭著者   記述言語：英語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)文光堂  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)インナービジョン  

キヤノンメディカルシステムズ社製超音波診断装置「Aplio iシリーズ」のアプリケーション"Smart Fusion"は、事前に撮像したCTやMRIの画像とリアルタイムの超音波画像を超音波診断装置のモニタ上に並列表示し、断面を連動して評価するFusionイメージング機能である。Fusionイメージングを用いることで、CTの優れた空間・位置分解能と、超音波によるリアルタイムな血行動態評価や繰り返し評価という、それぞれの利点を同時に享受することができる。心エコーにおいて、Fusionイメージングが最も有用性を発揮するのは成人先天性心疾患(ACHD)であるが、われわれは、同社の画像解析ワークステーション「Vitrea」にて心エコーと心臓CTの情報をFusionする"US Cardiac Fusion"の冠動脈疾患への応用についても検討を行っている。本講演では、ACHDと冠動脈疾患におけるFusionイメージングの活用について報告する。(著者抄録)

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担当区分：責任著者   記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)インナービジョン  

循環器疾患において、マルチモダリティイメージングによる診断・治療が重要である。キヤノンメディカルシステムズ社製の超音波診断装置「Aplio i900」に搭載されている"Smart Fusion"は、形態的な評価に優れているCT/MRIと、血行動態など機能的な評価が可能な心エコー図の、互いの長所を融合させ、同一画面上にリアルタイムに表示することができる。本稿では、成人先天性心疾患(以下、ACHD)と冠動脈疾患におけるフュージョンイメージングの有用性について概説する。(著者抄録)

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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担当区分：筆頭著者   記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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担当区分：責任著者   記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)文光堂  

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担当区分：筆頭著者   記述言語：英語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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担当区分：筆頭著者   記述言語：英語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：英語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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担当区分：責任著者   記述言語：英語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：日本サルコイドーシス  

サルコイドーシス患者の予後を決定する重要な因子として心臓サルコイドーシスがある。特に重症と考えられるものは、1)高度房室ブロック例、2)持続性心室頻拍/心室細動例、3)低心機能の3つであり、一方、難治性(治療抵抗性)心臓サルコイドーシスと考えられるものは、免疫抑制療法を含む適切な治療を行っても、1)致死的不整脈(持続性心室頻拍や心室細動)が再発する、2)心機能が低下してくる、3)心不全を繰り返す、4)FDG-PETやGaシンチで捕らえられる活動性心病変が持続する例と考えられる。ここでは、これらの因子について概説し、特に進歩が著しい非薬物治療の現状について述べる。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J05628&link_issn=&doc_id=20181031310002&doc_link_id=%2Fch0jsarc%2F2018%2F003801%2F004%2F0017-0021%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fch0jsarc%2F2018%2F003801%2F004%2F0017-0021%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

担当区分：筆頭著者   記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：日本語   出版者・発行元：日本サルコイドーシス  

心臓サルコイドーシスでは、副腎皮質ステロイドなどの免疫抑制薬を終生内服することが必要とされている。しかし長期のステロイド内服による副作用の懸念、経過中にステロイド増量が必要であった例が約2割に上ることも報告され、根本的な治療が望まれている。サルコイドーシスの原因としてアクネ菌の関与が報告されており、抗菌薬(クラリスロマイシンとドキシサイクリン併用)を用いた前向き探索研究(J-ACNES研究)を開始した。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J05628&link_issn=&doc_id=20181031310005&doc_link_id=%2Fch0jsarc%2F2018%2F003801%2F007%2F0034-0039%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fch0jsarc%2F2018%2F003801%2F007%2F0034-0039%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(有)科学評論社  

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担当区分：筆頭著者   記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

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記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)インナービジョン  

本講演では、心臓領域のFusionイメージングについて、キヤノンメディカルシステムズの超音波診断装置「Aplio i900」に搭載された"Smart Fusion"技術による成人先天性心疾患(Adult Congenital Heart Disease:ACHD)と、"US Cardiac Fusion"を用いた冠動脈疾患の血流評価について報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)文光堂  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)文光堂  

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記述言語：日本語   出版者・発行元：(一社)日本超音波検査学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(有)科学評論社  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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担当区分：責任著者   記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：英語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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担当区分：筆頭著者   記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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担当区分：責任著者   記述言語：日本語   出版者・発行元：(一社)日本超音波検査学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)文光堂  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：英語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)東京医学社  

成人先天性心疾患患者は、現在50万人と推定され、毎年9000人ずつ増加している。成人先天性心疾患の心臓は術後も"不完全"であり、心不全、不整脈、肺高血圧など合併症に対する内科的治療が重要である。成人先天性心疾患におけるカテーテル治療の役割は大きく、その重要性も高まってきている。心房中隔欠損症など、成人期に診断される症例もまれではなく、近年、デバイスの進歩により、ほとんどの症例でカテーテル治療が可能になっている。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J03723&link_issn=&doc_id=20160909170018&doc_link_id=%2Faq9seijd%2F2016%2F004608%2F018%2F1047-1053%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faq9seijd%2F2016%2F004608%2F018%2F1047-1053%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：英語   出版者・発行元：(NPO)日本小児循環器学会  

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)先端医学社  

高血圧治療の目的は、心血管疾患の発症や進展を抑制し、予後を改善させることであり、その効果が得られる治療方法を選択しなければならない。レニン・アンジオテンシン(RA)系阻害薬のなかで、ACE阻害薬はARBと異なり、降圧を超えた冠動脈疾患の抑制効果が示されている。その要因として、ACE阻害薬はRA系の阻害に加えて、抗動脈硬化作用を有するブラジキニンを中心としたカリクレイン・キニン系の活性に関与していることがあげられる。冠動脈疾患に対して、ACE阻害薬は重要な役割を果たしており、第一選択として投与すべきである。(著者抄録)

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記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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担当区分：筆頭著者   記述言語：英語   出版者・発行元：(一社)日本心血管インターベンション治療学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)文光堂  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭痛学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)先端医学社  

高血圧は心血管疾患の主要な危険因子であり、積極的な治療介入が必要である。高血圧治療は、単に血圧を管理するだけではなく、高血圧に関連した心血管疾患の合併予防や進展抑制、また予後改善効果が得られるよう治療戦略を考慮しなければならない。それぞれの心血管疾患の病態に適した、レニン・アンジオテンシン(RA)系阻害薬、長時間作用型Ca拮抗薬、β遮断薬などの併用療法をおこなうことが大切である。(著者抄録)

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)南江堂  

心エコー検査は弁膜症の診断,重症度評価そして治療方針の決定において必須である.心エコー検査は弁や周囲構造物の形態評価や弁膜症機序の検討に有用である.弁膜症の重症度は定量的に評価することが大切である.経食道心エコーによる詳細な弁形態の評価が手術適応の検討に必須である.3D経食道心エコーは,視覚的に弁膜症の構造を把握でき,術式など決定するうえで重要である.またリアルタイムで評価でき,術中のモニタリングにも有用である.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J00974&link_issn=&doc_id=20150907200005&doc_link_id=issn%3D0022-1961%26volume%3D116%26issue%3D3%26spage%3D383&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0022-1961%26volume%3D116%26issue%3D3%26spage%3D383&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

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記述言語：日本語   出版者・発行元：(株)医学書院  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)ライフ・サイエンス  

心房中隔欠損症(atrial septal defect:ASD)や動脈管開存(patent ductus arteriosus:PDA)は成人期で診断される症例も稀ではなく、高齢者で未治療の症例も少なくない。ASD、PDAに対するカテーテル治療は、開胸や人工心肺を用いることなく低侵襲で安全な治療であり、様々な併発症を有する高齢者においても有用と考えられる。(著者抄録)

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)メディカ出版  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J02115&link_issn=&doc_id=20150703080028&doc_link_id=%2Fao7heati%2F2015%2F002807%2F033%2F0710-0712%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fao7heati%2F2015%2F002807%2F033%2F0710-0712%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(NPO)日本小児循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：英語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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記述言語：日本語   出版者・発行元：(一社)日本成人先天性心疾患学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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記述言語：日本語   出版者・発行元：(一社)日本脈管学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2011&ichushi_jid=J00679&link_issn=&doc_id=20120116220035&doc_link_id=10.11281%2Fshinzo.43.S3_213&url=https%3A%2F%2Fdoi.org%2F10.11281%2Fshinzo.43.S3_213&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本移植学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本腎臓学会  

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：日本語   出版者・発行元：(一社)日本集中治療医学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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記述言語：日本語   出版者・発行元：日本サルコイドーシス  

心臓サルコイドーシスに合併する不整脈について35例をレトロスペクティブに検討したところ,心室頻拍例に比べ新規房室ブロック例ではGaシンチ取込み陽性例が多く,副腎皮質ステロイドホルモン薬(ステロイド)治療にてブロック改善例を多く認めた.一方心室頻拍例ではGaシンチ取込み陰性例が多く,左室駆出率が低下している症例を多く認めた.これらの結果から,房室ブロックは活動期に多く発生しステロイド治療に比較的反応するが,心室頻拍は非活動期が多く,ステロイドはあまり効かないことが示唆された.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2010&ichushi_jid=J05628&link_issn=&doc_id=20121017300017&doc_link_id=%2Fch0jsarc%2F2010%2F003001%2F018%2F0083-0085%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fch0jsarc%2F2010%2F003001%2F018%2F0083-0085%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

血管内超音波(IVUS)検査は,冠動脈インターベンション治療(PCI)時に,病変部の血管径,プラーク量とその性状を評価し治療戦略を決定,PCI後はステントが十分に拡張されているかどうかなど結果の評価を行うことで,PCI手技自体の安全性と確実性を高め,かつ予後を改善させることが証明されている.さらに,IVUSのシグナル処理により,プラークを四つの成分(fibrous,fibrofatty,necrotic core,dense calcium)に分類するVH-IVUSR法が開発され,IVUSは,プラーク内の組織性状をより詳細に描出し病態生理を理解する上でも有用となっている.四つの成分の中のnecrotic core(NC)はプラーク不安定化の指標と考えられ,%NC量が多く(>10%)かつ血管内腔に接し,プラーク量が血管断面積の40%を超えるものはVH-TCFAとされ,vulnerable plaqueの特徴とされる.VH-TCFAは将来の冠動脈イベントを予想する因子であることもPROSPECT研究で示されている.我々は,VH-IVUSで得られるNC量を規定する因子が何であるかを検討し,多価不飽和脂肪酸ω6/ω3バランスの一つであるAA/EPA比が,安定狭心症及び急性冠症候群どちらの場合も%NCに強く正相関していることを示した.また,VH-IVUSRを使ったプラーク性状の変化を見ることで,statinなどの薬効評価にも役立つことが示されている.VH-IVUSは,冠動脈プラークの病態生理を明らかにする上で,今後益々重要性が高まることが予想される.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2010&ichushi_jid=J00833&link_issn=&doc_id=20100727550003&doc_link_id=10.3179%2Fjjmu.37.447&url=https%3A%2F%2Fdoi.org%2F10.3179%2Fjjmu.37.447&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

記述言語：日本語   出版者・発行元：日本サルコイドーシス  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本心臓病学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(株)メジカルビュー社  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本不整脈心電学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：香川県内科医会  

症例は、20歳代男性。左上肢のしびれ、構音障害を一過性に来たした後、1週間後症状再発で当院救急外来受診。MRI検査で小脳の多発新鮮梗塞を認め緊急入院となった。MRAと脳血管撮影で脳底動脈領域の塞栓と診断された。熱中での仕事をした後で脱水症状を伴っていたが、凝固・線溶系の異常、ANCA上昇、血管炎所見、心房細動はみとめなかった。経胸壁および経食道エコーで7mm径の2次孔型心房中隔欠損症(ASD)を認め、ASD通過流は時相の一部で右→左への血流が認められたため、若年性脳梗塞の原因は心房内シャントによる奇異性塞栓症と考えられた。ASDなどの右→左シャントがある場合には、径の大きさに拘らず塞栓症の原因となることがあり、このような場合にはシャント率あるいは心不全の面からの適応は無くとも、孔閉鎖術を考慮する必要がある症例がある。(著者抄録)

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：三豊総合病院  

16歳女。患者は高血圧、心電図異常を主訴とした。腎機能障害はなかったが、末梢血レニン活性値、アルデストロン値の軽度上昇を認めた。腹部MRIでは左腎動脈が描出不明瞭で血管狭窄が疑われたが、腹部血管雑音は聴取せず、左右腎動脈に血流異常を認めなかった。そのため、腎血管性高血圧は否定的であった。食事療法、投薬で加療したものの血圧高値が持続、その後、腰部痛を自覚し、画像検査を行ったところ、所見では左腎動脈に5～10mm大の壁石灰化を伴った粒状影が認められ、腎動脈造影では左腎動脈に径8.7mm、5.7mm大の連続性に造影される紡錘動脈瘤、および末梢血管にも多数の小動脈瘤を認めた。根治的治療の希望があり、腹腔鏡下に左腎摘出術を行った結果、病理組織学的所見では線維筋性異形成による腎動脈瘤と確定診断された。以後、血圧は投薬なしに正常化し、レニン活性値ならびにアルドストロン値も次第に正常化した。尚、高血圧の原因は動脈瘤で形成された血栓による腎末梢の梗塞が考えられた。

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(一社)香川県医師会  

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記述言語：日本語   出版者・発行元：(一社)香川県医師会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)香川県医師会  

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記述言語：日本語   出版者・発行元：(一社)香川県医師会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：香川県内科医会  

近年の多列検出器CT(MDCT)の進歩により、実地診療病院でも心臓をCTで比較的容易に撮像出来るようになり、臨床の場での応用が広がってきている。最新の64列MDCTでは、冠動脈狭窄をSensitivity 90%,Specificity 95%以上で評価可能となり、また、狭窄の程度のみならず、狭窄部のプラーク性状を判断出来るようになってきており、不安定プラークをどう見分けるかが最近のトピックとなっている。また、冠動脈のみならず、左心・右心機能、局所心筋血流評価、構造異常、先天性心奇形診断への応用が可能となっている。時間分解能、空間分解能の向上が益々進んでいるが、その一方で被爆線量がかなり多い問題があり、線量低減に対し努力が進んでいる。MDCTの心臓領域における臨床応用について概説した。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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記述言語：日本語   出版者・発行元：(一社)日本循環器学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(一社)日本呼吸器内視鏡学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2007&ichushi_jid=J00298&link_issn=&doc_id=20070604220046&doc_link_id=%2Fcf0brond%2F2007%2F002902%2F049%2F0126-0126%26dl%3D2&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcf0brond%2F2007%2F002902%2F049%2F0126-0126%26dl%3D2&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_5.gif

担当区分：筆頭著者   記述言語：日本語   出版者・発行元：三豊総合病院  

症例は59歳の男性で、全身倦怠感を自覚したことを契機に近医にて心電図上で高度房室ブロックを認め、精査加療目的にて紹介された。初回の入院では4日目に自覚症状が消失し房室ブロックも消失したため、希望により退院となった。しかし、その後に再発したため、入院となった。心臓カテーテル検査で異常を認めず、心臓電気生理検査でH-V延長を認めたものの、洞結節機能の異常は認めなかった。心筋シンチグラフィーにも異常はなく、心臓超音波検査でも局所壁運動異常はなかった。人工ペースメーカーを本人が拒否したが、退院後の1年間は異常はなく、その後に全身倦怠感が強くなって救急外来を受診し、三回目の入院となった。Holter心電図を記録し、ペースメーカーの必要性を説明し、その同意を得たが、その際に配偶者から夜間の無呼吸状態の存在を知り、Polysomngraphyを施行したところ、睡眠時無呼吸症候群と診断し、ペースメーカー開始後も改善がなかったことから夜間経鼻的持続陽圧呼吸法を開始したところ、全身倦怠感や日中の眠気なども改善された。完全房室ブロックが永続的なものになった原因として、睡眠時無呼吸症候群が考えられた。

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記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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担当区分：筆頭著者   記述言語：日本語   出版者・発行元：(NPO)日本冠疾患学会  

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記述言語：日本語   出版者・発行元：(一社)香川県医師会  

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