Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Volume 84, Issue 4
Displaying 1-29 of 29 articles from this issue
Reviews
  • Maruti Haranal, Shuhua Luo, Osami Honjo
    Article type: REVIEW
    2020 Volume 84 Issue 4 Pages 533-541
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: March 06, 2020
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    Advances in surgical and medical care of children born with heart defects have led to the emergence of a unique subgroup of young adults known as adults with congenital heart disease (ACHD). Heart failure (HF) is the leading cause of mortality and morbidity in this subset. Management of HF is challenging in these patients owing to inherent structural variations with their associated physiological consequences. Heart transplantation is of limited utility in this group either because of donor shortage or associated comorbidities that make these patients ineligible for transplantation. Mechanical circulatory support (MCS) devices have evolved as an alternative treatment modality in supporting the failing myocardium of this population, but are often used less frequently than in those with a structurally normal heart because of the unique anatomical and physiological variations. These variations create a need to gather adequate knowledge on how best to support the hearts of ACHD patients in order to reduce mortality and morbidity. This review presents clinical experience with MCS in ACHD patients.

Editorials
Original Articles
Arrhythmia/Electrophysiology
  • Masahito Miura, Tetsuya Handoh, Yuhto Taguchi, Taiki Hasegawa, Yui Tak ...
    Article type: ORIGINAL ARTICLE
    Subject area: Arrhythmia/Electrophysiology
    2020 Volume 84 Issue 4 Pages 551-558
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: February 22, 2020
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    Supplementary material

    Background:In non-diabetic patients with acute coronary syndrome, stress hyperglycemia occasionally occurs and is related to their mortality. Whether transient elevation of glucose affects arrhythmia susceptibility in non-diabetic hearts with non-uniform contraction was examined.

    Methods and Results:Force, intracellular Ca2+([Ca2+]i), and membrane potential were measured in trabeculae from rat hearts. Non-uniform contraction was produced by a jet of paralyzing solution. Ca2+waves and arrhythmias were induced by electrical stimulation (2.0 mmol/L [Ca2+]o). The activity of Ca2+/calmodulin-dependent protein kinaseII (CaMKII) was measured. An elevation of glucose from 150 to 400 mg/dL increased the velocity of Ca2+waves and the number of spontaneous action potentials triggered by electrical stimulation. Besides, the elevation of glucose increased the CaMKII activity. In the presence of 1 μmol/L KN-93, the elevation of glucose did not increase the velocity of Ca2+waves and the number of triggered action potentials. In addition, in the presence of 1 μmol/L autocamtide-2 related inhibitory peptide or 50 μmol/L diazo-5-oxonorleucine, the elevation of glucose did not increase the number of triggered action potentials. Furthermore, the elevation of glucose by adding L-glucose did not increase their number.

    Conclusions:In non-diabetic hearts with non-uniform contraction, transient elevation of glucose increases the velocity of Ca2+waves by activating CaMKII,probably through glycosylation with O-linked β-N-acetylglucosamine, thereby increasing arrhythmia susceptibility.

  • Megumi Fukuyama, Seiko Ohno, Junichi Ozawa, Koichi Kato, Takeru Makiya ...
    Article type: ORIGINAL ARTICLE
    Subject area: Arrhythmia/Electrophysiology
    2020 Volume 84 Issue 4 Pages 559-568
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: March 12, 2020
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    Supplementary material

    Background:Long QT syndrome type 8 (LQT8) is a rare genotype of long QT syndrome. Late-appearing T-waves (LaT) are often documented in patients with LQT8, as in long QT syndrome type 3 (LQT3); however, the frequency of LaT and its relevance to the clinical severity of LQT8 remains unclear. This study investigated T-wave morphology (TWM) in LQT3 and LQT8 patients and compared the phenotypes of different TWMs.

    Methods and Results:TWMs were classified into 3 types: early onset T-waves (EoT), LaT, and bifid T-waves (biT). Electrocardiogram (ECG) measurements, symptoms, and topology were compared among TWM types. The study cohort comprised 25 patients with LQT8 (14 mutations) and 25 patients with LQT3 (14 mutations). LaT was detected in 17 (68%) and 13 (52%) LQT8 and LQT3 patients, respectively. There were no significant differences in ECG measurements or the severity of symptoms between patients with LaT and those with other TWMs in either the LQT8 or LQT3 group. However, only patients with LaT experienced cardiopulmonary arrest. Compared with the LQT3 group, in the LQT8 group there was a tendency for mutations in patients with LaT to be located in domain-linking regions.

    Conclusions:In this study, two-thirds of patients with LQT8 exhibited LaT on ECG, and nearly one-third of those experienced cardiopulmonary arrest. Further investigations are warranted to differentiate between LQT3 and LQT8 in patients exhibiting LaT to optimize therapy.

Critical Care
  • Shingo Matsumoto, Rine Nakanishi, Ippei Watanabe, Hiroto Aikawa, Ryota ...
    Article type: ORIGINAL ARTICLE
    Subject area: Critical Care
    2020 Volume 84 Issue 4 Pages 569-576
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: February 18, 2020
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    Background:Heart rate (HR) is a useful predictor of cardiovascular disease, especially in acute coronary syndrome (ACS). However, it is unclear whether there is an association between HR and clinical outcomes after resuscitation from out-of-hospital cardiac arrest (OHCA) due to ACS. The aim of this study was to investigate the impact of HR on clinical outcome in individuals resuscitated from OHCA due to ACS.

    Methods and Results:Data from 3,687 OHCA patients between October 2002 and October 2014 were retrospectively analyzed. We divided 154 patients diagnosed with ACS into 2 groups: those with tachycardia (HR >100 beats/min, n=71) and those without tachycardia (HR ≤100 beats/min, n=83) after resuscitation. The primary endpoint was 1-year mortality and the secondary endpoint was neurological injury at discharge according to cerebral performance category score. Overall, mean HR was 95.6 beats/min. There were several significant differences in patient characteristics, indicating poor general condition of patients with tachycardia. Mortality at 1-year was 41.6%, and neurological injury at discharge was observed in 44.1% of individuals. In the multivariate analysis, tachycardia after resuscitation was an independent predictor of both 1-year mortality (hazard ratio, 2.66; 95% CI: 1.20–5.85; P=0.03) and neurological injury at discharge (odds ratio, 2.65; 95% CI: 1.27–5.55; P=0.04).

    Conclusions:In patients who recovered from OHCA due to ACS, tachycardia after resuscitation predicted poor clinical outcome.

Epidemiology
  • Chika Nishiyama, Kosuke Kiyohara, Tasuku Matsuyama, Tetsuhisa Kitamura ...
    Article type: ORIGINAL ARTICLE
    Subject area: Epidemiology
    2020 Volume 84 Issue 4 Pages 577-583
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: February 20, 2020
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    Background:Although schools are key places that conduct cardiopulmonary resuscitation (CPR) and public-access defibrillation (PAD) programs, out-of-hospital cardiac arrest (OHCA) in educational institutions is poorly understood. This study describes the characteristics and outcomes of such OHCAs.

    Methods and Results:Data for OHCAs of any cause occurring in educational institutions between 2013 and 2015 were extracted from the All-Japan Utstein Registry. Patient characteristics and outcomes were documented. Subjects were divided into 6 age groups (0–1, 2–5, 6–11, 12–14, 15–17, and ≥18 years). Among the 783 eligible OHCA patients, most received bystander CPR regardless of age, ranging from 73.9% in those aged ≥18 years to 90.0% in those aged 2–5 years. However, the proportion receiving PAD differed by age group, ranging from 2.9% in those aged 0–1 years to 66.7% in those aged 12–14 years. The proportion of patients with 1-month survival with favorable neurological outcome differed significantly by age group, being extremely low among patients aged 0–1 years (zero for OHCA of cardiac origin), but high among patients aged 6–11, 12–14, and 15–17 years (69.2%, 77.5%, and 70.0%, respectively) for OHCA of cardiac origin.

    Conclusions:The outcomes of OHCA occurring in educational institutions, where PAD is available, differed significantly by age.

Heart Failure
  • Yasuhiro Hamatani, Yasuko Takada, Yoshihiro Miyamoto, Yukie Kawano, Yu ...
    Article type: ORIGINAL ARTICLE
    Subject area: Heart Failure
    2020 Volume 84 Issue 4 Pages 584-591
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: January 25, 2020
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    Background:Palliative care is highly relevant for patients with heart failure (HF), and there is a need for quantitative information on quality of care. Accordingly, this study aimed to develop a set of quality indicators (QIs) for palliative care of HF patients, and to conduct a practical pilot measurement of the proposed QIs in clinical practice.

    Methods and Results:We used a modified Delphi technique, a consensus method that involves a comprehensive literature review, face-to-face multidisciplinary panel meeting, and anonymous rating in 2 rounds. A 15-member multidisciplinary expert panel individually rated each potential indicator on a scale of 1 (lowest) to 9 (highest) for appropriateness. All indicators receiving a median score ≥7 without significant disagreement were included in the final set of QIs. Through the consensus-building process, 35 QIs were proposed for palliative care in HF patients. Practical measurement in HF patients (n=131) from 3 teaching hospitals revealed that all of the proposed QIs could be obtained retrospectively from medical records, and the following QIs had low performance (<10%): “Intervention by multidisciplinary team”, “Opioid therapy for patients with refractory dyspnea”, and “Screening for psychological symptoms”.

    Conclusions:The first set of QIs for palliative care of HF patients was developed and could clarify quantitative information and might improve the quality of care.

  • Lucie Lachmet-Thébaud, Benjamin Marchandot, Kensuke Matsushita, Charlo ...
    Article type: ORIGINAL ARTICLE
    Subject area: Heart Failure
    2020 Volume 84 Issue 4 Pages 592-600
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: March 07, 2020
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    Supplementary material

    Background:Recent insights have emphasized the importance of inflammatory response in takotsubo syndrome (TTS). We sought to evaluate the predictors of systemic inflammatory response syndrome (SIRS) and its impact on cardiovascular mortality after TTS.

    Methods and Results:The 215 TTS patients were retrospectively included between September 2008 and January 2018. SIRS was diagnosed in 96 patients (44.7%). They had lower left ventricular ejection fraction (LVEF) on admission (34.5% vs. 41.9%; P<0.001) and higher peak brain natriuretic peptide and troponin. At a median follow-up of 518 days, SIRS was associated with increased in-hospital mortality (14.6% vs. 5.0%; P=0.019), overall mortality (29.4% vs. 10.8%; P=0.002), and cardiovascular mortality (10.6% vs. 2.1%; P=0.026). A history of cancer (OR, 3.36; 95% CI: 1.54–7.31; P=0.002) and LVEF <40% at admission (OR, 2.31; 95% CI: 1.16–4.58; P=0.017) were identified as independent predictors of SIRS. On multivariate Cox regression analysis, SIRS (HR, 12.8; 95% CI: 1.58–104; P=0.017), age (HR, 1.09; 95% CI: 1.02–1.16; P=0.01), and LVEF <40% at discharge (HR, 9.88; 95% CI: 2.54–38.4; P=0.001) were independent predictors of cardiovascular death.

    Conclusions:SIRS was found in a large proportion of TTS patients and was associated with enhanced myocardial damage and adverse outcome in the acute phase. At long-term follow-up, SIRS remained an independent factor of cardiovascular death.

Imaging
  • Yuki Tanabe, Teruhito Kido, Fumiko Kimura, Yasuyuki Kobayashi, Naofumi ...
    Article type: ORIGINAL ARTICLE
    Subject area: Imaging
    2020 Volume 84 Issue 4 Pages 601-608
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: February 18, 2020
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    Background:Although coronary computed tomography angiography (CTA) is frequently used for identifying coronary artery disease, no studies have investigated the radiation dose in detail in Japan. The aim of this study was to estimate the radiation dose of coronary CTA in Japanese clinical practice and to identify the independent predictors associated with radiation dose.

    Methods and Results:A multicenter, retrospective, observational study (54 institutions) was conducted for estimating the radiation dose of coronary CTA in 2,469 patients between January and December 2013. Independent predictors associated with radiation dose were investigated on linear regression analysis. Median dose-length product (DLP) was 809.0 mGy·cm (IQR, 350.0–1,368.8 mGy·cm), corresponding to an estimated radiation dose of 11 mSv. The DLP per site significantly differed between institutions (median DLP per site, 92–2,131 mGy·cm; P<0.05). Independent predictors associated with radiation dose on multivariable linear regression were body weight, heart rate, non-stable sinus rhythm, scan length, tube voltage setting, electrocardiogram (ECG)-gated scanning protocol, and the image reconstruction technique (P<0.05 each).

    Conclusions:The coronary CTA radiation dose was relatively high in 2013, and it varied significantly between institutions. Effective strategies for radiation dose reduction were low tube voltage ≤100 kVp, retrospective ECG-gated scanning with dose modulation technique, prospective ECG-gated scanning, and the iterative reconstruction technique.

  • Naoki Tomii, Keisuke Asano, Hiroshi Seno, Takashi Ashihara, Ichiro Sak ...
    Article type: ORIGINAL ARTICLE
    Subject area: Imaging
    2020 Volume 84 Issue 4 Pages 609-615
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: March 05, 2020
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    Supplementary material

    Background:Recently, an interoperative catheter electrode mapping system, termed ExTRa Mapping (EXT), was developed for precise diagnosis and effective treatment of non-paroxysmal atrial fibrillations (non-PAF). However, the mapping accuracy of EXT is still unclear.

    Methods and Results:In this study, the reliability of the EXT in comparison with that of high-resolution optical membrane potential mapping was compared. Spiral wave re-entries (SWRs) were induced in the excised rabbit hearts (n=8, 42 episodes). Electrical signals were measured by electrodes on a transparent silicone plate, with the same arrangement as in the clinical catheter, and fluorescence signals were recorded simultaneously across the plate. Based on the phase maps derived by EXT, activation patterns (one-directed propagations: 26, rotational activities: 16) were identified correctly with 95% accuracy (40/42), and the correlation coefficient of the ratio of the non-passive period was 0.95. In the rotational episodes (15), the mean position error of the centers of gravity of the SWR trajectory (2,000 ms) was 2.0 mm. For the one-directional episodes (25), the correlation coefficient of the directions of one-way propagation was 0.99.

    Conclusions:The phase map sequence by EXT is consistent with that by the analyses of high-resolution optical mapping. EXT is reliable for analyzing the activation pattern in the region of interest.

Ischemic Heart Disease
  • YanHua Wang, YinJu Hao, Hui Zhang, LingBo Xu, Ning Ding, Rui Wang, Gua ...
    Article type: ORIGINAL ARTICLE
    Subject area: Ischemic Heart Disease
    2020 Volume 84 Issue 4 Pages 616-625
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: February 29, 2020
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    Supplementary material

    Background:Ischemic postconditioning (IPostC) is an endogenous protective mechanism to reduce ischemia-reperfusion (I/R) injury. However, whether IPostC protects aged cardiomyocytes against I/R injury is not fully understood. Considering the protective function of microRNA 30a (miR-30a) against ischemia-induced injury in H9C2 cells, its role in the protective effects of IPostC on I/R injury of aged cardiomyocytes was investigated further.

    Methods and Results:To mimic I/R and IPostC in vitro, the aged cardiomyocyte model for hypoxia postconditioning (HPostC) treatment was established by 9 days of incubation with 8 mg/mL D-galactose and then followed by exposure to hypoxic environment. HPostC significantly alleviated hypoxia/reoxygenation (H/R) injury and reduced autophagy of aged cardiomyocytes, as evidenced by decreased LC3B-II expression and increased p62 by Western blot. Quantified by quantitative real-time polymerase chain reaction (qRT-PCR), miR-30a was increased in aged cardiomyocytes treated with HPostC compared with I/R injury group. Overexpression of miR-30a by LV3-rno-miR-30a mimic promoted cardioprotective effect of HPostC in aged cardiomyocytes by suppressing BECN1-mediated autophagy, all of which was abrogated by knockdown of miR-30a expression. Epigenetic analyses demonstrated that HPostC reduced DNA methyltransferase 3b-mediated DNA hypomethylation levels at miR-30a promoter, leading to upregulation of miR-30a.

    Conclusions:HPostC protected aged cardiomyocytes survival against H/R injury via DNMT3b-dependent activation of miR-30a. miR-30a could be a potential therapeutic target for ischemic myocardial infarction.

Molecular Cardiology
  • Yuan Yue, Suiqing Huang, Lexun Wang, Zixuan Wu, Mengya Liang, Huayang ...
    Article type: ORIGINAL ARTICLE
    Subject area: Molecular Cardiology
    2020 Volume 84 Issue 4 Pages 626-635
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: March 10, 2020
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    Supplementary material

    Background:Macrophages play an important role in the development of cardiac fibrosis. However, the roles of different macrophage subtypes in cardiac fibroblast (CF) activation and cardiac fibrosis are unknown.

    Methods and Results:Bone marrow-derived macrophages (BMDMs) were treated with different stimuli to induce differentiation into M1, M2a, M2b, and M2c macrophage subtypes. CFs were co-cultured with different subtypes of macrophages or cultured with macrophage supernatants. Results revealed that M2b macrophages significantly suppressed the proliferation and migration of CFs, the expression of fibrosis-related proteins (collagen I [COL-1] and α-smooth muscle actin [α-SMA]), and differentiation into cardiac myofibroblasts (MFs). The opposite effects were observed with M2a macrophages. A rat model of cardiac ischemia/reperfusion (I/R) injury was used to determine the effect of M2b macrophages transplantation. After cardiac I/R injury, transplantation of M2b macrophages improved cardiac function and reduced cardiac fibrosis. The effect of macrophage subtypes on p-ERK, ERK, p-p38, and p38 phosphorylation was examined by Western blotting. The results showed that M2b macrophages significantly inhibited the mitogen-activated protein kinase (MAPK) signaling pathway.

    Conclusions:These study results demonstrate for the first time that different subtypes of macrophages have different roles in regulating CF activation. M2b macrophages inhibit CF activation, and thus can be considered anti-fibrotic macrophages. M2a macrophages promote CF activation, and thus are pro-fibrotic macrophages.

Peripheral Vascular Disease
  • Shota Tanoue, Takeshi Nakaura, Yuji Iyama, Ayumi Iyama, Yasunori Nagay ...
    Article type: ORIGINAL ARTICLE
    Subject area: Peripheral Vascular Disease
    2020 Volume 84 Issue 4 Pages 636-641
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: February 27, 2020
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    Background:The aim of this study was to evaluate the quality and diagnostic performance of virtual monochromatic images (VMI) obtained with dual-layer dual-energy computed tomography (DL-DECT) during indirect CT venography (CTV) for deep vein thrombosis (DVT).

    Methods and Results:This retrospective study was approved by the Institutional Review Board, which waived the requirement for informed consent. We retrospectively enrolled 45 patients who underwent CTV with DL-DECT, and VMI were retrospectively generated. We compared the venous attenuation, noise, contrast, and contrast-to-noise ratio (CNR) between VMI with the highest CNR and conventional CT on paired t-test. Furthermore, we compared the pooled area under the curve (AUC) of each technique with Delong’s test in 34 patients who underwent color Doppler ultrasonography. The 40-keV VMI had the best CNR. The noise was significantly lower on 40-keV (9.7±2.5 HU) than on 120-kVp VMI (10.5±2.5 HU; P<0.01). The contrast (120 kVp, 38.2±15.3 HU vs. 40 keV, 131.6±43.6 HU) and CNR (120 kVp, 3.8±1.7 vs. 40 keV, 14.4±6.1) were significantly higher in 40-keV VMI than in 120-kVp VMI (P<0.01). Furthermore, the pooled AUC was significantly higher for 40-keV (0.84) than for 120-kVp VMI (0.78; P=0.03).

    Conclusions:In indirect CTV, 40-keV VMI obtained with DL-DECT offers better image quality and diagnostic performance for DVT than conventional CT.

Preventive Medicine
  • Hironobu Toda, Kazufumi Nakamura, Kazuyoshi Shimizu, Kentaro Ejiri, Ta ...
    Article type: ORIGINAL ARTICLE
    Subject area: Preventive Medicine
    2020 Volume 84 Issue 4 Pages 642-649
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: February 21, 2020
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    Background:The aim of this study was to evaluate the efficacy and safety of transdermal β-blocker patches, which offer stable blood concentration and easy availability during operation, for prevention of perioperative myocardial injury (PMI) in high-risk patients.

    Methods and Results:In this randomized controlled trial, patients aged >60 years with hypertension and high revised cardiac risk index (≥2) undergoing non-cardiac surgery were randomly assigned to a bisoprolol patch or control group. Primary efficacy outcome was incidence of PMI, defined as postoperative high-sensitivity cardiac troponin T (hs-cTnT) >0.014ng/mL and relative hs-cTnT change ≥20%. Secondary efficacy outcomes were number of cardiovascular events and 30-day mortality. From November 2014 to February 2019, 240 patients from 5 hospitals were enrolled in this study. The incidence of PMI was 35.7% in the bisoprolol patch group and 44.5% in the control group (P=0.18). Incidence of major adverse cardiac events including non-critical myocardial infarction, strokes, decompensated heart failure and tachyarrhythmia was similar between the 2 groups. Tachyarrhythmia tended to be higher in the control group. There were no significant differences in safety outcomes including significant hypotension and bradycardia requiring any treatment between the 2 groups.

    Conclusions:Bisoprolol patches do not influence the incidence of PMI and cardiovascular events in high-risk patients undergoing non-cardiac surgery, but perioperative use of these patches is safe.

Regenerative Medicine
  • Farina Mohamad Yusoff, Masato Kajikawa, Yuji Takaeko, Shinji Kishimoto ...
    Article type: ORIGINAL ARTICLE
    Subject area: Regenerative Medicine
    2020 Volume 84 Issue 4 Pages 650-655
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: March 03, 2020
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    Background:Patients with severe Buerger disease, also known as thromboangiitis obliterans (TAO), are at risk of major limb amputation. It has been shown that autologous bone marrow mononuclear cell (BM-MNC) implantation improves the condition of critical limb ischemia in TAO patients. This study was conducted to further clarify the long-term (>10 years) results of autologous BM-MNC implantation in patients with TAO.

    Methods and Results:An observational study was conducted of the long-term results of BM-MNC implantation in 47 lower limbs of 27 patients with TAO. The mean (±SD) follow-up period was 12.0±8.6 years. There was no major amputation event up to 10 years of follow-up in patients treated with BM-MNC implantation. The overall amputation-free survival rates were significantly higher in patients who underwent BM-MNC implantation than in internal controls and historical controls. There was no significant difference in amputation-free survival rates between the historical and internal controls. There was also no significant difference in overall survival between patients who underwent BM-MNC implantation and the historical controls.

    Conclusions:BM-MNC transplantation successfully prevented major limb amputation over a period of >10 years in patients with severe TAO who had no other therapeutic options.

Stroke
  • Qiao Han, Chunyuan Zhang, Shoujiang You, Danni Zheng, Chongke Zhong, H ...
    Article type: ORIGINAL ARTICLE
    Subject area: Stroke
    2020 Volume 84 Issue 4 Pages 656-661
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: February 28, 2020
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    Supplementary material

    Background:The prognostic role of resting heart rate (RHR) on mortality in acute ischemic stroke (AIS) patients including atrial fibrillation (AF) is unclear. This study evaluated the relationship between RHR and in-hospital mortality among all AIS patients with and without AF.

    Methods and Results:The study enrolled 3,447 AIS patients from December 2013 to May 2014 across 22 hospitals in Suzhou City. Patients were divided into 2 groups based on median baseline RHR (<76 and ≥76 beats/min). Cox proportional hazard regression models were used to estimate the effects of RHR on all-cause in-hospital mortality. During hospitalization, 124 patients (3.6%) died from all causes. A multivariable model adjusted for potential covariates showed that higher RHR (≥76 beats/min) was associated with an increase in the risk of in-hospital mortality among AIS patients (hazard ratio [HR] 1.63; 95% confidence interval [CI] 1.09–2.45; P=0.018). This relationship was consistent in a subgroup analysis of patients without AF (HR 2.39; 95% CI 1.29–4.45; P=0.006). However, there was no significant association between higher RHR and in-hospital mortality among patients with AF (P=0.654). Similar findings were confirmed in analyses with heart rate as a continuous variable.

    Conclusions:Higher RHR at admission was independently associated with in-hospital mortality in AIS patients without AF.

  • Yuan Wang, Qin Peng, Jian Guo, Lihui Zhou, Wenli Lu
    Article type: ORIGINAL ARTICLE
    Subject area: Stroke
    2020 Volume 84 Issue 4 Pages 662-669
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: March 10, 2020
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    Background:Stroke has become the leading cause of death in China. This study aimed to assess the age-period-cohort (APC) effects on the long-term trends of type-specific stroke morbidity and mortality in China between 1993 and 2017.

    Methods and Results:The data were obtained from the Global Burden of Disease 2017 (GBD 2017) and were analyzed with the age-period-cohort framework. The net drifts of mortality were below 0 (hemorrhagic stroke [HS]: males: −1.620%, females: −3.531%; ischemic stroke [IS]: males: −1.041%, females: −3.002%), and the local drift values were below 0 in all age groups and for both genders. The net drifts of HS incidence were below 0 (males: −1.412%, females: −2.688%), while those of IS were above 0 (males: 1.425%, females: 1.117%). Period effect of mortality showed similar monotonic downward patterns for both genders, with a faster decrease for females than for males. Period effect of incidence showed a declined trend of incidence for HS, but an elevated trend for IS in both genders. After controlling for age and period effects, cohort effects on incidence found a monotonic decline trend for HS, while for IS, an elevated trend was found at first to peak during the 1950–1970 s, then declined steadily afterwards. Cohort effects on mortality showed a monotonic declined trend.

    Conclusions:By using Age-Period-Cohort (APC) analysis, a disparity between HS and IS was identified. Different prevention and control strategies should be used depending on the subtypes of stroke.

Valvular Heart Disease
  • Hiroyuki Kiriyama, Masao Daimon, Koki Nakanishi, Hidehiro Kaneko, Tomo ...
    Article type: ORIGINAL ARTICLE
    Subject area: Valvular Heart Disease
    2020 Volume 84 Issue 4 Pages 670-676
    Published: March 25, 2020
    Released on J-STAGE: March 25, 2020
    Advance online publication: March 05, 2020
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    Supplementary material

    Background:Healthcare-associated infective endocarditis (HAIE) has become increasingly recognized worldwide because the underlying patient conditions are completely different from those of community-acquired infective endocarditis (CIE). However, data on HAIE in the Japanese population is lacking. We sought to clarify the patient characteristics and prognosis of HAIE in a Japanese population.

    Methods and Results:A retrospective study was conducted in 158 patients who were diagnosed with infective endocarditis, 53 of whom (33.5%) were classified as HAIE. Compared with patients with CIE, those with HAIE were older (median age 72 vs. 61 years; P=0.0002) and received surgical treatment less frequently (41.5% vs. 62.9%; P=0.01). Regarding causative microorganisms, staphylococci,including methicillin-resistant pathogens, were more common in patients with HAIE (32.1% vs. 14.3%; P=0.01). Patients with HAIE had higher in-hospital mortality (32.1% vs. 4.8%; P<0.0001) and Kaplan-Meier analysis showed worse prognosis for patients with HAIE than CIE (P<0.0001, log-rank test). On multivariate Cox analysis, HAIE (hazard ratio 3.26; 95% confidence interval 1.49–7.14), age ≥60 years, surgical treatment, stroke, and heart failure were independently associated with mortality.

    Conclusions:HAIE has different clinical characteristics and causative microorganisms, as well as worse prognosis, than CIE. Preventive strategies, and the prompt and appropriate identification of HAIE may improve the outcome of infective endocarditis.

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