Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 80, Issue 5
Displaying 1-35 of 35 articles from this issue
Message From the Editor-in-Chief
Reviews
  • Alvaro Alonso, Faye L. Norby
    Article type: REVIEW
    2016 Volume 80 Issue 5 Pages 1061-1066
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: March 24, 2016
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    Atrial fibrillation (AF) is a common cardiac arrhythmia associated with an increased risk of stroke and other complications. Identifying individuals at higher risk of developing AF in the community is now possible using validated predictive models that take into account clinical variables and circulating biomarkers. These models have shown adequate performance in racially and ethnically diverse populations. Similarly, risk stratification schemes predict incidence of ischemic stroke in persons with AF, assisting clinicians and patients in decisions regarding oral anticoagulation use. Complementary schemes have been developed to predict the risk of bleeding in AF patients taking vitamin K antagonists. However, major gaps exist in our ability to predict AF and its complications. Additional research should refine models for AF prediction and determine their value to improve population health and clinical outcomes, advance our ability to predict stroke and other complications in AF patients, and develop predictive models for bleeding events and other adverse effects in patients using non-vitamin K oral anticoagulants. (Circ J 2016; 80: 1061–1066)
  • Philippe Gabriel Steg, Grégory Ducrocq
    Article type: REVIEW
    2016 Volume 80 Issue 5 Pages 1067-1072
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: April 08, 2016
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    With ongoing progress in the prevention and treatment of coronary artery disease (CAD), a continued decrease in prevalence and lethality is expected in high-income countries. Prevention will include lipid-lowering, antithrombotic and anti-inflammatory therapies. With respect to the former, potent, safe and prolonged drugs (such as generic forms of PCSK9 inhibitors relying on monoclonal antibodies or miRNA) should result in a decreased incidence of acute coronary syndromes. Another key aspect will be the ability to identify genetic predictors of CAD and therefore implement targeted personalized prevention early in life. Curative treatment will involve a short course of potent and reversible antithrombotics, but long-term therapy will rely on the ability to stabilize or even regress plaque (eg, using PCSK9 inhibition or modified high-density lipoprotein infusions or anti-inflammatory therapies). Antithrombotic therapy will rely on highly reversible agents (or agents with specific titratable antagonists), and on personalized therapies in which the doses, combinations and duration of therapy will be determined differentially for each patient on the basis of clinical characteristics, genetic profiling and biomarkers. Finally, the need for revascularization in stable CAD will be rare, given the expected progress in prevention. The main challenge, 20 years from now, is likely to be the provision of such effective care at acceptable costs in low- and middle-income countries. (Circ J 2016; 80: 1067–1072)
  • Christian-Hendrik Heeger, Kentaro Hayashi, Karl-Heinz Kuck, Feifan Ouy ...
    Article type: REVIEW
    2016 Volume 80 Issue 5 Pages 1073-1086
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: April 13, 2016
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    Ventricular arrhythmias (VA), like premature ventricular contractions (PVC) and ventricular tachycardia (VT) in patients without structural heart disease (idiopathic VA), mainly arise from the right and left ventricular outflow tracts (RVOT/LVOT). The prognosis for OT VA is generally good in the majority of patients, but there is potential for developing dilated cardiomyopathies from the high burden of VA, as well as a certain risk for sudden cardiac death because of fast monomorphic VT or polymorphic VT triggered by short-coupling PVC. Radiofrequency catheter ablation (RFCA) has evolved into a widely accepted treatment strategy for patients suffering from VAs. A detailed knowledge of surface ECGs and complex cardiac anatomy, especially within the ventricular OTs, is essential for the understanding of cardiac OT-VAs and highly related to safe and successful RFCA procedures. This review article focuses on RFCA of idiopathic VA arising from the cardiac OT as well as adjacent regions and will illustrate recent insights and technical issues. (Circ J 2016; 80: 1073–1086)
  • Masami Kosuge, Kazuo Kimura
    Article type: REVIEW
    2016 Volume 80 Issue 5 Pages 1087-1096
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: March 28, 2016
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    The 12-lead electrocardiogram (ECG) is the important, initial examination for diagnosing acute coronary syndrome (ACS). In the traditional 12-lead ECG display, the precordial leads are displayed in their anatomically contiguous order, which makes it easy to understand the positional relationships between the precordial leads and the heart, but the limb leads are not. The “Cabrera sequence” displays the limb leads in an anatomically contiguous manner, which facilitates understanding of the positional relations between the limb leads and the heart, resulting in more rapid, easy, and accurate ECG interpretation than the traditional limb leads display. This review explores the clinical advantages of the Cabrera sequence as compared with the traditional limb leads display for the diagnosis of ACS. (Circ J 2016; 80: 1087–1096)
Editorials
Late Breaking Clinical Trials (JCS 2016)
  • Naoki Sato, Masayoshi Ajioka, Takahisa Yamada, Masaharu Kato, Masafumi ...
    Article type: LATE BREAKING CLINICAL TRIAL (JCS 2016)
    2016 Volume 80 Issue 5 Pages 1113-1122
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: April 14, 2016
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    Supplementary material
    Background:Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, was evaluated in Japanese patients with heart failure (HF) with reduced ejection fraction and chronic kidney disease and/or diabetes mellitus.Methods and Results:ARTS-HF Japan was a randomized, double-blind, phase 2b study. Patients (n=72) received oral, once-daily (o.d.) finerenone (2.5, 5, 7.5, 10 or 15 mg, up-titrated to 5, 10, 15, 20, or 20 mg, respectively, on day 30) or eplerenone (25 mg every other day, increased to 25 mg o.d. on day 30, and 50 mg on day 60) for 90 days. The primary endpoint was the proportion of individuals with a decrease of >30% in plasma NT-proBNP at day 90. Safety endpoints included the incidence of hyperkalemia. Decreases in NT-proBNP occurred in 23.1% of patients in the eplerenone group and 15.4%, 23.1%, 45.5%, 27.3% and 45.5% in the 2.5→5 mg, 5→10 mg, 7.5→15 mg, 10→20 mg and 15→20 mg finerenone groups, respectively (all P=NS). Mean changes in serum potassium levels were similar between groups.Conclusions:Because of the small sample size, limited conclusions can be drawn. Considering the results of ARTS-HF and that finerenone was well tolerated in Japanese patients in ARTS-HF Japan, the safety and efficacy of finerenone should be further explored in a large outcomes trial including Japanese patients. (Circ J 2016; 80: 1113–1122)
Original Articles
Arrhythmia/Electrophysiology
  • Jung-Sun Kim, Hancheol Lee, Yongsung Suh, Hui-Nam Pak, Geu-Ru Hong, Ch ...
    Article type: ORIGINAL ARTICLE
    Subject area: Arrhythmia/Electrophysiology
    2016 Volume 80 Issue 5 Pages 1123-1130
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: March 17, 2016
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    Background:The aim of this study was to evaluate clinical outcome after left atrial appendage (LAA) occlusion in real clinical practice and compare between Amplatzer cardiac plug (ACP) and Watchman.Methods and Results:From October 2010 to February 2015, 96 successful LAA occlusion procedures were performed using either ACP (n=50) or Watchman device (n=46) in non-valvular atrial fibrillation (AF) patients (59 male; age, 65.1±9.4 years; CHADS2, 2.5±1.2; CHA2DS2-VASC, 3.9±1.6; HAS-BLED, 2.7±1.3). The procedure success rate was 96.8%. There were serious complications in 4 patients (4.1%; 2 cardiac tamponade, 1 device embolization, and 1 major bleed). The anticoagulation cessation rate after 6 weeks was 92.7%. During mean 21.9-month follow-up, the incidence of death, stroke, systemic embolization and major bleeding was 5.2%, 4.2%, 0% and 1.0%, respectively. On transesophageal echocardiography of 93 patients within 6 months after the procedure, 24 residual leaks were observed (25.8%; 2 mild, 18 moderate, and 4 major). Clinical outcome was similar for the 2 devices, but peridevice leakage was more frequent with the Watchman than the ACP.Conclusions:LAA occlusion was feasible in non-valvular AF patients with high risk of stroke and hemorrhage. The ACP and Watchman devices were similar in terms of procedural and clinical outcomes. (Circ J 2016; 80: 1123–1130)
Cardiovascular Intervention
  • Hiroki Tateishi, Pannipa Suwannasom, Yohei Sotomi, Shimpei Nakatani, Y ...
    Article type: ORIGINAL ARTICLE
    2016 Volume 80 Issue 5 Pages 1131-1141
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: March 03, 2016
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    Supplementary material
    Background:The edge vascular response (EVR) has been linked to important prognostic implications in patients treated with permanent metallic stents. We aimed to investigate the relationship of EVR with the geometric changes in the everolimus-eluting bioresorbable scaffold using serial optical coherence tomography (OCT) analysis.Methods and Results:In the first-in-man ABSORB trial, 28 patients (29 lesions) underwent serial OCT at 4 different time points (Cohort B1: post-procedure, 6, 24, and 60 months [n=13]; Cohort B2: post-procedure, 12, 36, and 60 months [n=15]) following implantation of the scaffold. In Cohort B1, there was no significant luminal change at the distal or proximal edge segment throughout the entire follow-up. In contrast, there was a significant reduction of the lumen flow area (LFA) of the scaffold between post-procedure and 6 months (−1.03±0.49 mm2[P<0.001]), whereas between 6 and 60 months the LFA remained stable (+0.31±1.00 mm2[P=0.293]). In Cohort B2, there was a significant luminal reduction of the proximal edge between post-procedure and 12 months (−0.57±0.74 mm2[P=0.017]), whereas the lumen area remained stable (−0.26±1.22 mm2[P=0.462]) between 12 and 60 months. The scaffold LFA showed a change similar to that observed in Cohort B1.Conclusions:Our study demonstrated a reduction in the scaffold luminal area in the absence of major EVR, suggesting that the physiological continuity of the lumen contour is restored long term. (Circ J 2016; 80: 1131–1141)
Cardiovascular Surgery
  • Jae-Woong Choi, Eun-Ah Park, Whal Lee, Kyung-Hwan Kim, Ki-Bong Kim, Hy ...
    Article type: ORIGINAL ARTICLE
    Subject area: Cardiovascular Surgery
    2016 Volume 80 Issue 5 Pages 1142-1147
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: March 10, 2016
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    Background:There is a concern that clinical outcome of tricuspid valve replacement (TVR) is inferior compared with tricuspid annuloplasty (TAP). The aim of this study was therefore to compare changes in right ventricular (RV) volume and function following TAP with that following TVR on cardiac magnetic resonance imaging (CMR) in patients with severe functional tricuspid regurgitation (TR).Methods and Results:Forty patients who underwent surgery for severe functional TR and who underwent CMR preoperatively and on postoperative follow-up (24.8±13.3 months after surgery) were enrolled. Thirteen patients underwent TAP (TAP group) and 27 patients underwent TVR (TVR group). Both RV end-diastolic and end-systolic volume indices decreased significantly after surgery (from 178.9±53.9 to 116.3±26.7 ml/m2, P<0.001, and from 95.7±36.1 to 67.3±28.0 ml/m2, P<0.001, respectively), without intergroup differences. In the TAP group, RV ejection fraction (EF) was preserved following surgery (from 43.3±9.5 to 46.9±10.9%, P=0.312). In the TVR group, however, it decreased significantly following surgery (from 51.8±9.2 to 42.4±12.3%, P<0.001). In addition, postoperative RVEF was lower in the TVR than TAP group, with a marginal significance (mean difference, –6.967; 95% confidence interval: –14.529 to 0.595; P=0.070).Conclusions:For patients with severe functional TR, both TAP and TVR are beneficial for reduction of RV volume indices. TAP, however, might be superior to TVR, because RVEF is well preserved following surgery. (Circ J 2016; 80: 1142–1147)
  • Hideo Kanemitsu, Ken Nakamura, Naoto Fukunaga, Tadaaki Koyama
    Article type: ORIGINAL ARTICLE
    Subject area: Cardiovascular Surgery
    2016 Volume 80 Issue 5 Pages 1148-1152
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: April 01, 2016
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    Background:The long-term outcomes of mitral valve (MV) repair for active infective endocarditis (AE) are not well known, so the present study examined results from >5 years.Methods and Results:We retrospectively reviewed 43 patients who underwent primary MV repair for AE at a single center between 1991 and 2009. Patients’ mean age was 50.9 years, and 39% were female. The mean follow-up was 7.4 years, and 90.7% of the patients had serial echocardiographic studies over the years. We examined the data for mortality, mitral reoperation, and recurrent significant mitral regurgitation (MR). There were no early deaths but 6 late deaths. Survival was 92.6±4.1% for 5 years, and 83.5±7.3% for 10 years. The respective 5- and 10-year rates of freedom from MV reoperation were 90.5±4.5% and 86.6±5.8%, and for freedom from moderate or severe MR were 95.0±3.5 and 86.1±6.7%. Recurrence of endocarditis was observed in 2 patients (4.7%). Most (86%) of the survivors were in New York Heart Association class I.Conclusions:MV repair for AE is durable and offers acceptable long-term outcomes with low rates of recurrence and reoperation. (Circ J 2016; 80: 1148–1152)
Critical Care
  • Akira Funada, Yoshikazu Goto, Tetsuo Maeda, Ryota Teramoto, Kenshi Hay ...
    Article type: ORIGINAL ARTICLE
    Subject area: Critical Care
    2016 Volume 80 Issue 5 Pages 1153-1162
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: March 24, 2016
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    Background:There is sparse data regarding the survival and neurological outcome of elderly patients with out-of-hospital cardiac arrest (OHCA).Methods and Results:OHCA patients (334,730) aged ≥75 years were analyzed using a nationwide, prospective, population-based Japanese OHCA database from 2008 to 2012. The overall 1-month survival with favorable neurological outcome (Cerebral Performance Category Scale, category 1 or 2; CPC 1-2) rate was 0.88%. During the study period, the annual 1-month CPC 1-2 rate in whole OHCA significantly improved (0.73% to 0.96%, P for trend <0.001). In particular, outcomes of OHCA patients aged 75 to 84 years and those aged 85 to 94 years significantly improved (0.98% to 1.28%, P for trend=0.01; 0.46% to 0.70%, P for trend <0.001, respectively). However, in OHCA patients aged ≥95 years, the outcomes did not improve. Multivariate logistic regression analysis indicated that younger age, shockable first documented rhythm, witnessed arrest, earlier emergency medical service (EMS) response time, and cardiac etiology were significantly associated with the 1-month CPC 1-2. Under these conditions, elderly OHCA patients who had cardiac etiology, shockable rhythm and had a witnessed arrest had acceptable 1-month CPC1-2 rate; 7.98% in cases where OHCA was witnessed by family, 15.2% by non-family, and 25.6% by EMS.Conclusions:The annual 1-month CPC 1-2 rate after OHCA among elderly patients significantly improved, and the resuscitation of elderly patients in a selected population is not futile. (Circ J 2016; 80: 1153–1162)
Heart Failure
  • Taichi Hayashi, Satoshi Yamada, Hiroyuki Iwano, Masahiro Nakabachi, Ma ...
    Article type: ORIGINAL ARTICLE
    Subject area: Heart Failure
    2016 Volume 80 Issue 5 Pages 1163-1170
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: March 25, 2016
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    Background:Speckle-tracking echocardiography (STE)-derived parameters may have better correlation with left ventricular (LV) relaxation and filling pressure than tissue Doppler-derived parameters. However, it has not been elucidated which parameter – strain or strain rate – and which direction of myocardial deformation – longitudinal or circumferential – is the most useful marker of LV relaxation and filling pressure.Methods and Results:We conducted a prospective multicenter study and compared the correlation of tissue Doppler- and STE-derived parameters with the time constant of LV pressure decay (τ) and LV mean diastolic pressure (MDP) in 77 patients. The correlation of early-diastolic mitral annular velocity (e´) with τ was weak (r=−0.32, P<0.01), and that of peak longitudinal strain (LS) was the strongest (r=−0.45, P<0.001) among the STE-derived parameters. There was a modest correlation between LVMDP and the ratio of early-diastolic inflow velocity (E) to e´ (E/e´) (r=0.50, P<0.001). In contrast, the ratio of E to LS (E/LS) correlated strongly with LVMDP (r=0.70, P<0.001). The correlation of E/LS with LVMDP was significantly better than that for E/e´ (P<0.01). Receiver-operating characteristic analysis showed that E/LS had the largest area under the curve for distinguishing elevated LVMDP (E/LS 0.86, E/e´ 0.74, E/A 0.67).Conclusions:STE-derived longitudinal parameters correlated well with LV relaxation and filling pressure. In particular, E/LS could be more accurate than E/e´ for estimating LV filling pressure. (Circ J 2016; 80: 1163–1170)
  • Tomohiro Asahi, Marohito Nakata, Namio Higa, Mamoru Manita, Kazuhiko T ...
    Article type: ORIGINAL ARTICLE
    Subject area: Heart Failure
    2016 Volume 80 Issue 5 Pages 1171-1177
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: March 29, 2016
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    Background:Fluid redistribution rather than fluid accumulation plays an important role in the development of acute heart failure (HF) syndrome. Patients with fluid redistribution develop acute HF without prominent volume overload. We investigated volume status by measuring the diameter of the inferior vena cava (IVC) and examining variations in hemoglobin and hematocrit.Methods and Results:Seventy-four consecutive patients admitted for acute HF syndrome were analyzed. Blood tests and measurement of IVC diameter after stabilization of respiratory distress were performed on admission and were repeated after 24 h. IVC collapsibility index (IVC-CI) was calculated as (maximum IVC-minimum IVC)/maximum IVC. According to the initial IVC-CI, the patients were divided into the collapse group (IVC-CI ≥0.5: n=34) and the non-collapse group (IVC-CI <0.5: n=40). Initial blood pressure was higher in the collapse group (P<0.001). Although 24-h urine volume did not differ between the groups, hemoglobin (P<0.001) and hematocrit (P<0.001) decreased significantly in the collapse group but not in the non-collapse group after 24 h. Furthermore, IVC-CI significantly decreased in the collapse group after 24 h (P=0.003).Conclusions:In acute HF syndrome, IVC-CI ≥0.5 on admission suggests a volume shift from the central vein into the pulmonary vasculature. Fluid refill occurs within 24 h after admission. This observation could be helpful in selecting strategies for diuretic use. (Circ J 2016; 80: 1171–1177)
  • Tetsuro Yokokawa, Yasuo Sugano, Akito Shimouchi, Atsushi Shibata, Naoy ...
    Article type: ORIGINAL ARTICLE
    Subject area: Heart Failure
    2016 Volume 80 Issue 5 Pages 1178-1186
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: March 29, 2016
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    Background:We hypothesized that exhaled acetone concentration (EAC), reflecting altered blood ketone body metabolism and increased acetone exhaust because of pulmonary congestion in heart failure (HF), would correlate with hemodynamic parameters in patients with non-ischemic chronic HF.Methods and Results:We prospectively enrolled 102 non-ischemic HF patients with New York Heart Association (NYHA) class I–III. Exhaled breath was collected after an overnight fast. Echocardiography and cardiac catheterization were performed in all patients. We also enrolled 17 control patients without HF. EAC in the HF patients was significantly higher than that in the control patients (median EAC; 0.53 vs. 0.38 ppm, P=0.012). EAC positively correlated with blood total ketone bodies (r=0.454, P<0.001), NYHA class (r=0.489, P<0.001), and plasma B-type natriuretic peptide (r=0.316, P=0.001). Right heart catheterization revealed that EAC significantly correlated with pulmonary capillary wedge pressure (PCWP, r=0.377, P<0.001). Receiver-operating characteristic analysis revealed that EAC >1.05 ppm was associated with PCWP ≥18 mmHg (area under the curve [AUC] 0.726, sensitivity 50%, specificity 89%). EAC was shown to be a comparable diagnostic biomarker for HF to BNP (AUC 0.760, sensitivity 80%, specificity 70%).Conclusions:EAC may be a novel noninvasive biomarker that correlates hemodynamic severity in non-ischemic chronic HF. (Circ J 2016; 80: 1178–1186)
  • Takashi Yoshitani, Naoya Asakawa, Mamoru Sakakibara, Keiji Noguchi, Yu ...
    Article type: ORIGINAL ARTICLE
    Subject area: Heart Failure
    2016 Volume 80 Issue 5 Pages 1187-1195
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: March 30, 2016
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    Supplementary material
    Background:Heart failure (HF) causes organ congestion, which is thought to increase organ stiffness. The virtual touch quantification (VTQ) method can be used to assess liver stiffness in patients with chronic liver diseases. This study aimed to measure liver and kidney stiffness using VTQ and to determine its value for assessing organ congestion in patients with HF.Methods and Results:This study included 10 normal subjects and 38 HF patients (age 52.3±16.7 years, left ventricular ejection fraction 27.0±9.4%, plasma B-type natriuretic peptide [BNP] 1,297.3±1,155.1 pg/ml). We investigated the relationships between clinical characteristics and hemodynamics and liver and kidney stiffness, and assessed the effects of medical treatment on these measurements. Liver stiffness was significantly higher in HF patients (1.17±0.13 m/s vs. 2.03±0.91 m/s, P=0.004) compared with normal subjects, but kidney stiffness was similar in both groups. Central venous pressure (CVP) (P=0.021) and BNP (P=0.025) were independent predictive factors for increased liver stiffness in HF patients. Liver stiffness decreased significantly from 2.37±1.09 to 1.27±0.33 m/s (P<0.001) after treatment. Changes in liver stiffness in HF patients significantly correlated with changes in CVP (R=0.636, P=0.014) and cardiac index (R=−0.557, P=0.039) according to univariate analysis, and with changes in CVP in multivariate analysis.Conclusions:Liver stiffness measured by noninvasive VTQ methods can be used to assess liver congestion and therapeutic effects in patients with HF. (Circ J 2016; 80: 1187–1195)
Hypertension and Circulatory Control
  • Ana Paula de Faria, Alessandra Mileni Versuti Ritter, Andréa Rodrigues ...
    Article type: ORIGINAL ARTICLE
    Subject area: Hypertension and Circulatory Control
    2016 Volume 80 Issue 5 Pages 1196-1201
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: April 13, 2016
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    Background:Resistant hypertension (RHTN) and target organ damage are linked to increased inflammatory biomarkers, which may regulate adhesion molecules, such as intracellular adhesion molecule-1 (ICAM-1); vascular cell adhesion molecule-1 (VCAM-1); and the platelet (P-selectin) and endothelial (E-selectin) selectins. We investigated a previously unknown relationship between soluble P-selectin (sP-selectin), E-selectin (sE-selectin), ICAM-1 (sICAM-1) and VCAM-1 (sVCAM-1) with RHTN and target organ damage.Methods and Results:We included 110 subjects diagnosed for true RHTN and 112 mild-moderate hypertensive (HTN) patients. Blood pressure parameters, pulse wave velocity and left ventricular mass index (LVMI) were measured. Adhesion molecules were measured on ELISA. Both sP-selectin and sE-selectin were increased; in contrast, sICAM-1 was reduced in RHTN compared with HTN patients, while similar sVCAM-1 was noted in the groups. sP-selectin and sVCAM-1 were elevated in the presence of arterial stiffness (sP-selectin: 104±47 vs. 89±45 ng/ml, P<0.05; sVCAM-1: 1,189±411 vs. 1,060±412 ng/ml, P<0.05) and cardiac hypertrophy (sP-selectin: 105±51 vs. 88±43 ng/ml, P<0.05; sVCAM-1: 1,170±433 vs. 1,040±383 ng/ml, P<0.05) in all HTN patients. sP-selectin was associated with target organ damage after adjustment for age and BP. Apart from potential confounders, sE-selectin was a significant indicator of RHTN.Conclusions:The adhesion molecule sP-selectin plays a role in cardiovascular damage, and sE-selectin in resistance to antihypertensive therapy. (Circ J 2016; 80: 1196–1201)
Imaging
  • Radka Kockova, Petr Kacer, Jan Pirk, Jiri Maly, Lucie Sukupova, Viktor ...
    Article type: ORIGINAL ARTICLE
    Subject area: Imaging
    2016 Volume 80 Issue 5 Pages 1202-1209
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: March 17, 2016
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    Supplementary material
    Background:The aim of our study was to investigate the relationship between the cardiac magnetic resonance (CMR)-derived native T1 relaxation time and myocardial extracellular volume (ECV) fraction and the extent of diffuse myocardial fibrosis (DMF) on targeted myocardial left ventricular (LV) biopsy.Methods and Results:The study population consisted of 40 patients (age 63±8 years, 65% male) undergoing valve and/or ascending aorta surgery for severe aortic stenosis (77.5%), root dilatation (7.5%) or valve regurgitation (15%). The T1 relaxation time was assessed in the basal interventricular septum pre- and 10-min post-contrast administration using the modified Look-Locker Inversion recovery sequence prior to surgery. LV myocardial biopsy specimen was obtained during surgery from the basal interventricular septal segment matched with the T1 mapping assessment. The percentage of myocardial collagen was quantified using picrosirius red staining. The average percentage of myocardial collagen was 22.0±14.8%. Both native T1 relaxation time with cutoff value ≥1,010 ms (sensitivity=90%, specificity=73%, area under the curve=0.82) and ECV with cutoff value ≥0.32 (sensitivity=80%, specificity=90%, area under the curve=0.85) showed high accuracy to identify severe (>30%) DMF. The native T1 relaxation time showed significant correlation with LV mass (P<0.01).Conclusions:Native T1 relaxation time and ECV at 10 min after contrast administration are accurate markers of DMF. (Circ J 2016; 80: 1202–1209)
  • Hongmei Zhou, Xue Lin, Ligang Fang, Xihai Zhao, Haiyan Ding, Wei Chen, ...
    Article type: ORIGINAL ARTICLE
    Subject area: Imaging
    2016 Volume 80 Issue 5 Pages 1210-1216
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: March 23, 2016
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    Background:Native T1 mapping is an emerging cardiac magnetic resonance technique for quantitative evaluation of cardiomyopathies. This study aimed to investigate the usefulness of native T1 mapping in characterizing myocardial abnormalities in left ventricular non-compaction (LVNC) by comparing it with late gadolinium enhancement (LGE).Methods and Results:The study group of 31 LVNC patients and 8 normal controls underwent cardiovascular magnetic resonance to acquire the native T1 maps and LGE images. Of the 31 LVNC patients, 14 had LGE. The mean native T1 value of the normal controls, LGE(−) and LGE(+) patients was 1,098.8±40.8 ms, 1140.6±32.8 ms, and 1181.4±53.7 ms, respectively. Significant differences were found in native T1 between any 2 groups (F=9.74, P<0.001). In discriminating the presence of LGE in LVNC patients, the odds ratio and corresponding 95% confidence interval (CI) of native T1 were, respectively, 2.966 (95% CI: 1.123–7.835, P=0.028) and 4.348 (95% CI: 1.155–16.363, P=0.030) before and after adjusting for confounding factors with an increment of 1 standard deviation.Conclusions:The finding that LGE(−) patients had elevated native T1 compared with normal controls suggested native T1 mapping can be used earlier than LGE imaging to detect myocardial fibrosis in LVNC patients. Furthermore, higher native T1 values in LGE(+) patients than in the LGE(−) group suggested native T1 mapping is more sensitive than LGE imaging for identifying myocardial fibrosis in LVNC patients. (Circ J 2016; 80: 1210–1216)
  • Taishiro Chikamori, Satoshi Hida, Nobuhiro Tanaka, Yuko Igarashi, Jun ...
    Article type: ORIGINAL ARTICLE
    Subject area: Imaging
    2016 Volume 80 Issue 5 Pages 1217-1224
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: April 05, 2016
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    Background:Although stress single-photon emission computed tomography (SPECT) using a cadmium-zinc-telluride (CZT) camera facilitates radiation dose reduction, only a few studies have evaluated its diagnostic accuracy in Japanese patients by applying fractional flow reserve (FFR) measurements.Methods and Results:We prospectively evaluated 102 consecutive patients with suspected or known coronary artery disease with a low-dose stress/rest protocol (99mTc radiotracer 185/370 MBq) using CZT SPECT. Within 3 months, coronary angiography was performed and a significant stenosis was defined as ≥90% diameter narrowing on visual estimation, or as a lesion of <90% and ≥ 50% stenosis with FFR ≤0.80. To detect individual coronary stenosis, the respective sensitivity, specificity, and accuracy were 86%, 75%, and 82% for left anterior descending artery stenosis, 76%, 81%, and 79% for left circumflex artery stenosis, and 87%, 92%, and 90% for right coronary artery stenosis. When limited to 92 intermediate stenotic lesions in which FFR was measured, stress SPECT showed 77% sensitivity, 91% specificity, and 84% accuracy, whereas the diagnostic value decreased to 52% sensitivity, 68% specificity, and 58% accuracy based only on visual estimation of ≥75% diameter narrowing.Conclusions:CZT SPECT demonstrated a good diagnostic yield in detecting hemodynamically significant coronary stenoses as assessed by FFR, even when using a low-dose 99mTc protocol with an effective dose ≤5 mSv. (Circ J 2016; 80: 1217–1224)
Ischemic Heart Disease
  • Teruhito Kido, Teruhito Mochizuki, Masaharu Hirano, Yoshitake Yamada, ...
    Article type: ORIGINAL ARTICLE
    Subject area: Ischemic Heart Disease
    2016 Volume 80 Issue 5 Pages 1225-1231
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: March 28, 2016
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    Background:Controlling and decreasing the heart rate (HR) of patients during coronary computed tomography angiography (CCTA) is necessary to reduce radiation exposure and improve image quality. This prospective multicenter study aimed to investigate whether HR control with landiolol hydrochloride is useful for reducing radiation exposure during CCTA.Methods and Results:We investigated 219 patients with suspected ischemic heart disease whose pretest HRs were 50–80 beats/min. We measured the HR before and after administration of landiolol hydrochloride and compared the estimated exposure inferred from the HR before administration of landiolol hydrochloride with the actual dose. After administration of landiolol hydrochloride, the mean HR (59.9±6.4 beats/min) at the time of CCTA was significantly lower than before administration (69.3±7.3 beats/min; P<0.001); 80% of the patients had controlled HRs at ≤65 beats/min. HR and blood pressure of all the patients recovered after the scan. The mean radiation dose in all patients was approximately 50% derived from the inferred dose before use of landiolol hydrochloride (4.5±3.2 vs. 9.0±3.7 mSv; P<0.001). There were no adverse events during this study.Conclusions:The use of landiolol hydrochloride during CCTA was safe and resulted in approximately 50% decrease in radiation exposure dose, suggesting the clinical usefulness of this drug. (Circ J 2016; 80: 1225–1231)
  • Hisashi Kai, Takeshi Kimura, Kenji Fukuda, Yoshihiro Fukumoto, Tatsuyu ...
    Article type: ORIGINAL ARTICLE
    Subject area: Ischemic Heart Disease
    2016 Volume 80 Issue 5 Pages 1232-1241
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: April 06, 2016
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    Supplementary material
    Background:We investigated the effects of age and low diastolic blood pressure (DBP) on cardiovascular death in patients with coronary artery disease (CAD) after coronary revascularization.Methods and Results:Stable, chronic CAD patients after coronary revascularization in the CREDO-Kyoto registry cohort-1 were allocated to the Young (≤64 years, n=2,619), Young-Old (65–74 years, n=2,932), and Old-Old (≥75 years, n=1,629) groups. Kaplan-Meier analysis showed that the crude cumulative incidence of cardiovascular death was higher in Young-Old patients with DBP <70 mmHg (P<0.001) and in Old-Old patients with DBP <60 mmHg (P=0.017), but not <70 mmHg (P=0.629), compared with each counterpart. Low DBP did not increase cardiovascular death in young patients. After adjustments with independent predictors, DBP <60 mmHg did not increase the cardiovascular death in the Old-Old group (HR=1.579 [95% CI, 0.944–2.642], P=0.082) and DBP <70 mmHg remained a predictor in the Young-Old group (HR=1.665 [1.094–2.532], P=0.017). On multivariate stepwise Cox proportional hazard regression analysis, independent predictors for cardiovascular death in low DBP patients were creatinine clearance (CCr; inversely), prior cerebrovascular disease, and aortic disease in the Young-Old group and CCr (inversely) and malignancy in the Old-Old group.Conclusions:DBP <60 mmHg was not an independent factor for predicting cardiovascular death in Old-Old revascularized CAD patients, whereas DBP <70 mmHg remained a predictor in the Young-Old. (Circ J 2016; 80: 1232–1241)
Pediatric Cardiology and Adult Congenital Heart Disease
  • Ryota Ochiai, Hitoshi Kato, Naomi Akiyama, Fukiko Ichida, Atsushi Yao, ...
    Article type: ORIGINAL ARTICLE
    Subject area: Pediatric Cardiology and Adult Congenital Heart Disease
    2016 Volume 80 Issue 5 Pages 1242-1250
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: March 31, 2016
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    Background:Current Japanese transfer practices for adult congenital heart disease (ACHD) patients in pediatric departments are elucidated in this study. The focus was on 149 facilities (from the Japanese Society of Pediatric Cardiology and Cardiac Surgery Subspecialty Board and the Japanese Association of Children’s Hospitals and Related Institutions). One hundred and thirteen facilities were surveyed and the response rate was 75.8%.Methods and Results:Twenty-six facilities (23.0%) treated ≥200 outpatients annually; 48 facilities (42.9%) treated <50 outpatients. Only eight facilities admitted ≥50 inpatients; 61 facilities (54.0%) admitted <10 inpatients. Nine facilities fulfilled international regional ACHD center criteria. The estimated median number of patients receiving outpatient pediatric department follow up was 33,806. Sixty facilities (53.6%) treated patients in pediatric departments after they reached adulthood. Of 49 facilities that transferred patients, the transfer was most commonly to another department in the same facility (20 facilities; 40.8%), typically the adult cardiology department (29 facilities; 59.2%). In future, 55 facilities (48.7%) desired the transfer of patients to regional ACHD centers, while 34 facilities (30.1%) preferred to continue treating patients in the pediatric department.Conclusions:The number of regional ACHD centers offering sufficient outpatient and inpatient care is limited; transfer from pediatric departments is not standard in Japan. Role division clarification between regional ACHD centers and other facilities and cooperative network establishment including transitional care programs is necessary. (Circ J 2016; 80: 1242–1250)
  • Nobuyuki Tsujii, Aya Miyazaki, Heima Sakaguchi, Koji Kagisaki, Tetsuya ...
    Article type: ORIGINAL ARTICLE
    Subject area: Pediatric Cardiology and Adult Congenital Heart Disease
    2016 Volume 80 Issue 5 Pages 1251-1258
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: March 24, 2016
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    Background:Some patients with congenital complete atrioventricular block (CCAVB) develop dilated cardiomyopathy (DCM) after pacemaker implantation (PMI). We evaluated the relationship between pacing site and DCM incidence.Methods and Results:We retrospectively evaluated 38 patients with CCAVB; 8 (25%) of 32 patients who had PMI developed DCM/heart failure death (HFD) after PMI, although none of the 6 patients without PMI showed DCM/HFD. All DCM/HFD occurred within 50 months of PMI. Among the 32 patients with PMI, the DCM/HFD incidence was 55% (6/11) for right ventricular inlet (RVI), 18% (2/11) for RV apex (RVA), and 0% for left ventricle (LV) (P=0.013). At the endpoint, the LV ejection fraction and septal-to-posterior wall motion delay of patients with LV pacing were better than those for patients with other pacing sites. Among the 8 DCM/HFD patients, 2 in whom the pacing site was changed from RVI to LV apex or in whom therapy was upgraded to cardiac resynchronization remained alive with no heart failure symptoms, whereas the other 6 died of heart failure.Conclusions:A total of 25% of the patients who underwent PMI because of CCAVB, but none in the non-PMI group, developed DCM/HFD. DCM/HFD incidence was higher in patients with RVI pacing. Ventricular dyssynchrony related to pacing site may be one cause of DCM in patients with CCAVB. (Circ J 2016; 80: 1251–1258)
Pulmonary Circulation
  • Hajime Kasai, Akane Matsumura, Toshihiko Sugiura, Ayako Shigeta, Nobuh ...
    Article type: ORIGINAL ARTICLE
    Subject area: Pulmonary Circulation
    2016 Volume 80 Issue 5 Pages 1259-1264
    Published: April 25, 2016
    Released on J-STAGE: April 25, 2016
    Advance online publication: March 11, 2016
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    Supplementary material
    Background:Mean pulmonary arterial pressure (MPAP) is an important pulmonary hemodynamic parameter used in the management of patients with chronic thromboembolic pulmonary hypertension (CTEPH). We compared echocardiography-derived estimates of MPAP with right heart catheterization (RHC) to identify reliable noninvasive methods of estimating MPAP-derived RHC (MPAPRHC) in these patients.Methods and Results:Echocardiography and RHC were performed in 56 patients with CTEPH (60.5±12.0 years; 44 females). We measured the tricuspid regurgitation (TR) pressure gradient (TRPG) using echocardiography. The mean systolic right ventricular (RV)-right atrial (RA) gradient was calculated by tracing the TR time velocity flow. Systolic and mean pulmonary artery pressures (SPAPTRand MPAPTR) estimated from TRPG and mean systolic RV-RA gradient were calculated by adding RA pressure based on the inferior vena cava. MPAPChemlawas calculated using Chemla’s formula: 0.61×SPAPTR+2 mmHg. MPAPRHCand pulmonary vascular resistance were 35.9±11.3 mmHg and 6.6±3.6 Wood units, respectively. The mean difference from MPAPRHCand limits of agreement were −1.5 mmHg and −19.6 to 16.5 mmHg for MPAPTR, and −4.6 mmHg and −24.5 to 15.2 mmHg for MPAPChemla. Accuracy within 10 mmHg and 5 mmHg of MPAPRHCwas 80.4% and 46.4% for MPAPTR, and 71.4% and 48.2% for MPAPChemla, respectively.Conclusions:MPAPTRand MPAPChemlaare reliable estimates for MPAPRHCin patients with CTEPH. (Circ J 2016; 80: 1259–1264)
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