Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
Advance online publication
Showing 1-50 articles out of 99 articles from Advance online publication
  • Luis A. Gonano, Marisa Sepúlveda, Malena Morell, Tamara Toteff, María ...
    Type: ORIGINAL ARTICLE
    Subject Area: Arrhythmia/Electrophysiology
    Article ID: CJ-18-0247
    Published: 2018
    [Advance publication] Released: October 23, 2018
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    Background: It has been shown that carvedilol and its non β-blocking analog, VK-II-86, inhibit spontaneous Ca2+ release from the sarcoplasmic reticulum (SR). The aim of this study is to determine whether carvedilol and VK-II-86 suppress ouabain-induced arrhythmogenic Ca2+ waves and apoptosis in cardiac myocytes.

    Methods and Results: Rat cardiac myocytes were exposed to toxic doses of ouabain (50 µmol/L). Cell length (contraction) was monitored in electrically stimulated and non-stimulated conditions. Ouabain treatment increased contractility, frequency of spontaneous contractions and apoptosis compared to control cells. Carvedilol (1 µmol/L) or VK-II-86 (1 µmol/L) did not affect ouabain-induced inotropy, but significantly reduced the frequency of Ca2+ waves, spontaneous contractions and cell death evoked by ouabain treatment. This antiarrhythmic effect was not associated with a reduction in Ca2+ calmodulin-dependent protein kinase II (CaMKII) activity, phospholamban and ryanodine receptor phosphorylation or SR Ca2+ load. Similar results could be replicated in human cardiomyocytes derived from stem cells and in a mathematical model of human myocytes.

    Conclusions: Carvedilol and VK-II-86 are effective to prevent ouabain-induced apoptosis and spontaneous contractions indicative of arrhythmogenic activity without affecting inotropy and demonstrated to be effective in human models, thus emerging as a therapeutic tool for the prevention of digitalis-induced arrhythmias and cardiac toxicity.

  • Takaya Ozawa, Shoji Kawakami, Manabu Matsumoto, Hatsue Ishibashi-Ueda, ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-0632
    Published: 2018
    [Advance publication] Released: October 23, 2018
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  • Hiroko Asakai, Akihiko Shimizu, Takeshi Mitsuhashi, Takeshi Ueyama, Hi ...
    Type: ORIGINAL ARTICLE
    Subject Area: Arrhythmia/Electrophysiology
    Article ID: CJ-18-0712
    Published: 2018
    [Advance publication] Released: October 20, 2018
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    Background: Implantable cardioverter defibrillators (ICDs) are being used with increasing frequency in children. Our aim was to examine the current trend of pediatric ICD implantation in Japan.

    Methods and Results: Data was extracted from the Japanese Cardiac Device Treatment Registry (JCDTR), a nation-wide registry started in 2006. All patients aged less than 18 years who had an ICD implantation registered between 2006 and 2016 were included in the analysis. A total of 201 patients were included, with a median age of 16 years (range 1–18). The underlying cardiac diagnosis was primary electrical disease (67%), cardiomyopathy (26%) and congenital heart disease (4%), with idiopathic ventricular fibrillation (29%) and long QT syndrome (21%) being the 2 most common diagnoses. Implantation indication was primary prevention in only 30 patients (15%). There were 27 patients (13%) aged ≤12 years, with a larger proportion of patients with cardiomyopathy (33%). The indication in younger children was secondary prevention in all cases. Younger children may be under-represented in our study given the nature of the database as it is a predominantly adult cardiology database.

    Conclusions: In the past decade, ICD implantation has been performed in approximately 20 children per year in Japan, mostly for secondary prevention. There was no increase in the trend nor a change in age distribution.

  • Tetsutaro Matayoshi, Takahiro Tabuchi, Iwao Gohma, Takahiro Shimizu
    Type: EDITORIAL
    Article ID: CJ-18-1054
    Published: 2018
    [Advance publication] Released: October 20, 2018
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  • Akira Sezai
    Type: EDITORIAL
    Article ID: CJ-18-1114
    Published: 2018
    [Advance publication] Released: October 20, 2018
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  • Yukiko Okami, Hirotsugu Ueshima, Yasuyuki Nakamura, Keiko Kondo, Aya K ...
    Type: ORIGINAL ARTICLE
    Subject Area: Epidemiology
    Article ID: CJ-18-0628
    Published: 2018
    [Advance publication] Released: October 18, 2018
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    Background: In recent years, individuals with high serum total cholesterol (TC) have been more likely to modify their diet by reducing their intake of dietary lipids. The aim of this study was to investigate time-related changes in the relationships between the Keys score, dietary lipids, and TC between 1980 and 2010 in representative Japanese populations.

    Methods and Results: We used 3 cross-sectional cohort studies conducted among Japanese representative populations in 1980, 1990, and 2010 (NIPPON DATA80/90/2010) for the analyses. We analyzed data for 10,365, 7,714, and 2,657 participants, respectively, in each dataset. The relationships between TC and the Keys score (calculated by dietary lipids, cholesterol, and energy intake)/dietary lipids were examined. In men, a 1-unit higher Keys score correlated with 0.92 mg/dL and 0.64 mg/dL TC in 1980 and 1990, respectively, but not in 2010. In women, a 1-unit higher Keys score correlated with 0.70 mg/dL and 0.74 mg/dL TC in 1980 and 1990, respectively, but with 0.33 mg/dL in 2010. In men and women, dietary cholesterol, saturated fatty acid (SFA), and trans fatty acid (TFA) levels were positively associated with TC concentrations in 1980 and 1990, but not in 2010.

    Conclusions: In these representative Japanese populations, a higher Keys score as well as dietary cholesterol, SFA, and TFA levels correlated with higher TC concentrations in 1980/1990, but the relationships were weaker or not observed in 2010.

  • Tomoyoshi Tamura, Masaru Suzuki, Kei Hayashida, Junichi Sasaki, Naohir ...
    Type: ORIGINAL ARTICLE
    Subject Area: Critical Care
    Article ID: CJ-18-0631
    Published: 2018
    [Advance publication] Released: October 18, 2018
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    Background: Renal dysfunction is associated with increased cardiovascular-related mortality, but its impact on outcome of out-of-hospital cardiac arrest (OHCA) remains unclear. We assessed whether post-OHCA outcome correlated with renal function early after OHCA.

    Methods and Results: Of the 16,452 registered patients in the SOS-KANTO 2012 Study, 5,112 cardiogenic OHCA adults with creatinine measurement (mean age, 72 years; male, 64%) were examined. First-obtained creatinine was used to assess eGFR. Associations between eGFR groups, ≥60 (n=997), 45–59 (n=1,311), 30–44 (n=1,441), and <30 mL/min/1.73 m2(n=1,363), and 3-month survival and neurological outcomes were examined. Favorable neurological outcome was defined as cerebral performance categories 1 or 2. Survival rate (15.1%, 9.7%, 3.9%, and 2.9%; P<0.001) and proportion of favorable neurological outcome (12.3%, 7.4%, 2.6%, and 2.2%; P<0.001) were determined for eGFR groups ≥60, 45–59, 30–44, and <30 mL/min/1.73 m2, respectively. The survival rate decreased with eGFR (<60 mL/min/1.73 m2), and survival adjusted OR were 0.74 (95% CI: 0.54–1.03), 0.42 (95% CI: 0.28–0.62), and 0.43 (95% CI: 0.28–0.68) for eGFR 45–59, 30–44, and <30 mL/min/1.73 m2, respectively. The adjusted OR for favorable neurological outcome also decreased with eGFR: 0.74 (95% CI: 0.52–1.06), 0.40 (95% CI: 0.25–0.64), and 0.48 (95% CI: 0.29–0.81), respectively.

    Conclusions: An independent and graded association was observed between decreased eGFR and 3-month survival and proportion of favorable neurological outcome in cardiogenic OHCA patients.

  • Mika Nagaoka, Ayumi Goda, Kaori Takeuchi, Hanako Kikuchi, Mayumi Finge ...
    Type: ORIGINAL ARTICLE
    Subject Area: Pulmonary Circulation
    Article ID: CJ-18-0636
    Published: 2018
    [Advance publication] Released: October 16, 2018
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    Background: Sleep apnea (SA) can cause repeated nocturnal arterial oxygen desaturation and result in acute increase in pulmonary arterial pressure (PAP). The presence of SA is associated with a poor prognosis in patients with chronic left-sided heart failure, but little is known for patients with pulmonary arterial hypertension (PAH).

    Methods and Results: We enrolled 151 patients with PAH (44±16 years old, male/female=37/114). They were all in the Nice Classification group 1 (idiopathic PAH/associated PAH=52/48%, mean PAP of 46±16 mmHg). They underwent right-heart catheterization and a sleep study with simplified polysomnography. Averaged percutaneous oxygen saturation (SpO2) during sleep was measured and an apnea-hypopnea index >5 was defined as SA. SA was noted in 58 patients (obstructive SA/central SA: 29/29). Over an average follow-up of 1,170±763 days, 32 patients died. By Kaplan-Meier analysis, there was no significant difference in deaths of patients with and without SA (χ2=2.82, P=0.093). On the other hand, the mortality in patients with lower averaged SpO2 was significantly higher than in those with higher averaged SpO22=14.7, P<0.001) and that was the only independent variable related to death in multivariate Cox proportional hazards analysis.

    Conclusions: SA in patients with PAH was not associated with worse prognosis, unlike left ventricular heart failure, but nocturnal hypoxemia was related to poor prognosis.

  • Masanori Kawasaki, Ryuhei Tanaka, Akihiro Yoshida, Maki Nagaya, Shingo ...
    Type: ORIGINAL ARTICLE
    Subject Area: Imaging
    Article ID: CJ-18-0799
    Published: 2018
    [Advance publication] Released: October 16, 2018
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    Background: Although new-onset atrial fibrillation (AF) increases with ageing, the prediction of new-onset AF is complicated. We previously reported that pulmonary capillary wedge pressure (ePCWP) estimated by the combination of left atrial volume index (LAVI) and active left atrial emptying function (aLAEF) had a strong relationship with PCWP on catheterization (r=0.92): ePCWP=10.8−12.4×log (aLAEF/minimum LAVI). We sought to determine the usefulness of ePCWP to predict new-onset AF.

    Methods and Results: We measured LAVI, aLAEF and ePCWP on speckle tracking echocardiography (STE) in 566 consecutive elderly patients (72±6 years) without a history of AF. A total of 63 patients (73±6 years) developed electrocardiographically confirmed AF during a mean follow-up period of 50 months. Baseline aLAEF was significantly lower in patients with than without new-onset AF (17.9±6.5 vs. 28.2±7.5%), whereas ePCWP was significantly higher (14.8±3.7 vs. 10.3±3.1 mmHg). In multivariate logistic regression analysis, ePCWP and aLAEF were strong independent predictors of AF. Using ePCWP >13 mmHg or aLAEF ≤22% on univariate Cox regression analysis, the HR for new-onset AF were 3.53 (95% CI: 1.68–7.44, P<0.001) and 4.06 (95% CI: 1.90–8.65, P<0.001), respectively. By combining these 2 criteria (>13 mmHg and ≤22%), the HR increased to 11.84 (95% CI: 6.85–20.5, P<0.001).

    Conclusions: ePCWP and aLAEF measured on STE are useful predictors of new-onset AF. ePCWP provides added value for risk stratification of new-onset AF.

  • Choy-Lye Chei, Kazumasa Yamagishi, Akihiko Kitamura, Masahiko Kiyama, ...
    Type: ORIGINAL ARTICLE
    Subject Area: Epidemiology
    Article ID: CJ-18-0240
    Published: 2018
    [Advance publication] Released: October 13, 2018
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    Background: Few prospective studies have explored the association between fatty acids (FA) and risk of CAD. Understanding of the role of each individual serum FA as a coronary risk or protective factor is still limited. The aim was to investigate which serum FA are associated with the incidence of CAD in Japanese subjects.

    Methods and Results: A prospective nested case-control study of 40–85-year-old Japanese subjects was undertaken using frozen serum samples collected from 12,840 participants who participated in cardiovascular risk surveys from 1984 to 1998 for 1 community and 1989–1997 for 2 other communities. Three control subjects per case were matched by sex, age, community, year of serum storage and fasting status. By 2005 we had identified 152 incident cases of CAD. Mean n-3-polyunsaturated and saturated FA did not differ between cases and controls, while mean n-6-polyunsaturated FA was higher in controls compared with cases. The multivariable OR of CAD for the highest vs. lowest quartiles of miristic acid (14:0), palmitic acid (16:0), palmitoleic acid (16:1), and linoleic acid (18:2) were 2.8 (95% CI: 1.5–5.2), 2.7 (95% CI: 1.4–5.5), 3.2 (95% CI: 1.7–6.1) and 0.4 (95% CI: 0.2–0.7), respectively.

    Conclusions: High serum miristic acid, palmitic acid and palmitoleic acid have an adverse effect, and high serum linoleic acid had a protective effect, on the risk of CAD.

  • Takashi Kubo, Masahiro Takahata, Kosei Terada, Kazuya Mori, Yu Arita, ...
    Type: ORIGINAL ARTICLE
    Subject Area: Ischemic Heart Disease
    Article ID: CJ-18-0672
    Published: 2018
    [Advance publication] Released: October 13, 2018
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    Background: A fractional flow reserve (FFR) between 0.75 and 0.80 constitutes a “gray zone” for clinical decision-making in coronary artery disease. We compared long-term outcomes of percutaneous coronary intervention (PCI) using drug-eluting stents vs. medical therapy for coronary stenosis with gray zone FFR.

    Methods and Results: We retrospectively investigated the clinical outcomes of 263 patients with gray zone FFR: 78 patients in the PCI group and 185 patients in the medical therapy group. During a median follow-up of 3.7 years, the frequency of target vessel failure (TVF, defined as a composite of cardiac death, myocardial infarction [MI], or ischemia-driven target vessel revascularization [TVR]) was significantly lower in the PCI group compared with the medical therapy group (6% vs. 19%, hazard ratio [HR]:0.33, 95% confidence interval [CI]: 0.13–0.84, P=0.008). The frequency of a composite of cardiac death or MI was not different between the 2 groups (1% vs. 2%, HR: 0.61, 95% CI: 0.07–5.49, P=0.645). The frequency of ischemia-driven TVR was significantly lower in the PCI group compared with the medical therapy group (5% vs. 18%, HR: 0.28, 95% CI: 0.10–0.79, P=0.005).

    Conclusions: In patients with gray zone FFR, compared with medical therapy, PCI decreased the frequency of TVF, which was mainly driven by a reduction in the frequency of angina or myocardial ischemia without any difference in the frequency of cardiac death or MI.

  • Takakatsu Yoshitake, Masahiko Goya, Takeshi Sasaki, Shinya Shiohira, M ...
    Type: ORIGINAL ARTICLE
    Subject Area: Arrhythmia/Electrophysiology
    Article ID: CJ-18-0869
    Published: 2018
    [Advance publication] Released: October 12, 2018
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    Background: Transvenous lead extractions have been performed using 40-Hz laser sheaths. Recently, a new 80-Hz laser sheath became available, but only a few reports have compared the effectiveness of the 40- and 80-Hz laser sheaths.

    Methods and Results: This study included 215 patients. Lead extractions using only laser sheaths were analyzed. The clinical characteristics, extraction parameters, and extraction tools were evaluated. The procedures were performed with 40-Hz sheaths in 150 patients (group 1: 270 leads) and 80-Hz sheaths in 65 (group 2: 99 leads). No statistically significant differences were observed in the clinical parameters except for sex. The mean implant duration was 95.3±86.0 and 78.2±56.8 months in groups 1 and 2, respectively (P=0.07). The respective mean laser time and number of laser pulses were 48.5±52.1 and 48.1±56.1 s (P=0.96) and 2,035.0±2,384.0 and 3,955.1±2,339.3 pulses (P<0.0001). Complete removal was achieved for 97.4% of the leads and in 98.0% in both groups (P=0.38). Major complications occurred in 2.0% and 3.1% of the patients in groups 1 and 2, respectively (P=0.94).

    Conclusions: Transvenous lead extraction using high-frequency laser sheaths was as highly successful as with low-frequency laser sheaths in Japanese patients.

  • Kazutaka Aonuma, Hiro Yamasaki, Masato Nakamura, Tatsushi Ootomo, Mori ...
    Type: LATE BREAKING CLINICAL TRIAL (JCS 2018)
    Article ID: CJ-18-0222
    Published: 2018
    [Advance publication] Released: October 11, 2018
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    Background: The PROTECT AF and PREVAIL trials demonstrated that the WATCHMAN left atrial appendage (LAA) closure device is a reasonable alternative to warfarin therapy for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) in the USA and Europe. We conducted the SALUTE trial to confirm the safety and efficacy of the LAA closure therapy for patients with NVAF in Japan.

    Methods and Results: A total of 54 subjects (including 12 Roll-in) with NVAF who had a CHA2DS2-VASc score ≥2 were enrolled. All subjects were successfully implanted with the LAA closure device. No serious adverse events related to the primary procedure-safety endpoint occurred. The 2nd co-primary endpoint was a composite of all stroke, systemic embolism and cardiovascular/unexplained death. One ischemic stroke (1/42) occurred during the 6-month follow-up. The effective LAA closure rate defined as the 3rd co-primary endpoint was 100% (42/42) at both 45-day and 6-month follow-up.

    Conclusions: The procedural safety and 6-month results from the SALUTE trial demonstrated that the LAA closure device was safe and effective, similar to the results of large-scale randomized clinical trials, and provides a novel perspective of LAA closure for Japanese patients with NVAF in need of an alternative to long-term oral-anticoagulation. (Trial Registration: clinicaltrials.gov Identifier NCT 03033134)

  • Toshiki Takano, Komei Tanaka, Kazuyuki Ozaki, Akinori Sato, Kenichi Ii ...
    Type: ORIGINAL ARTICLE
    Subject Area: Ischemic Heart Disease
    Article ID: CJ-18-0646
    Published: 2018
    [Advance publication] Released: October 11, 2018
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    Background: The implantable cardioverter defibrillator (ICD) is a standard prevention therapy for patients at high risk for sudden cardiac death (SCD) due to life-threatening ventricular arrhythmia (VA), that is, ventricular fibrillation and ventricular tachycardia. However, clinical predictors of recurrent VA in secondary prevention ICD recipients with coronary artery disease (CAD) remain unknown.

    Methods and Results: We followed up 96 consecutive patients with CAD undergoing ICD implantation for secondary prevention of SCD. Long-term rates and clinical predictors of appropriate ICD therapy (ICD-Tx) for VA were analyzed. Appropriate ICD-Tx occurred in 41 (42.7%) patients during a median follow-up of 2.4 years (interquartile range, 0.9-6.1). These patients had significantly greater left ventricular end-diastolic diameter (62.3±1.3 vs. 54.6±1.1 mm, P<0.001), lower left ventricular ejection fraction (LVEF; 36.3±2.0% vs. 45.7±1.8%, P<0.001), and more incomplete revascularization (ICR; 70.7% vs. 45.5%, P=0.014) than those without appropriate ICD-Tx. Multivariable analysis showed that LVEF (hazards ratio [HR], 0.950; 95% CI: 0.925–0.975; P<0.001) and ICR (HR, 2.293; 95% CI: 1.133–4.637; P=0.021) were significant predictors of appropriate ICD-Tx for VA.

    Conclusions: Lower LVEF and ICR were independent predictors of recurrent VA in secondary prevention ICD recipients with CAD.

  • Hisashi Adachi
    Type: EDITORIAL
    Article ID: CJ-18-1072
    Published: 2018
    [Advance publication] Released: October 10, 2018
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  • Joy C.Y. Chen, Michel T. Corban, Philip L. Wackel, Charlotte S. Van Do ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-0550
    Published: 2018
    [Advance publication] Released: October 06, 2018
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  • Martina Nassif, Odilia I. Woudstra, Joey M. Kuijpers, Peter J. Sterk, ...
    Type: RAPID COMMUNICATION
    Article ID: CJ-18-0613
    Published: 2018
    [Advance publication] Released: October 06, 2018
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    Background: Post-repair atrial septal defects (ASD) patients are frequently discharged from follow-up, but the extent of pulmonary symptoms long-term post-repair is unknown.

    Methods and Results: The national CONgenital CORvitia registry was linked to the national Drug Registry to investigate all ambulatory-dispensed pulmonary inhalants for 2006–2014. ASD patients were compared with age- and sex-matched referents from the general population. A total of 1,959 adult patients (age 42±17 years; 66% female; 1,223 [62%] repaired) were included. Compared with the referents, ASD patients had more inhalant use, even at long-term post-repair follow-up (OR=1.81 [95% CI 1.62–2.03]; P<0.001).

    Conclusions: ASD patients had 2-fold higher inhalant use compared with referents even at long-term post-repair follow-up, suggesting persistent pulmonary functional impairment.

  • Yoichiro Otaki, Tetsu Watanabe, Tsuneo Konta, Masafumi Watanabe, Shoui ...
    Type: ORIGINAL ARTICLE
    Subject Area: Epidemiology
    Article ID: CJ-18-0721
    Published: 2018
    [Advance publication] Released: October 06, 2018
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    Background: Aortic artery disease (AAD), such as aortic dissection or aortic aneurysm rupture, is fatal, with an extremely high mortality. Because of its low incidence, the risk for the development of AAD has not yet been elucidated. Hypertension (HT) is an established risk factor for cardiovascular disease, but there has been no prospective study on the effect of HT on AAD-related mortality.

    Methods and Results: We used a nationwide database of 276,197 subjects (aged 40–75 years) who participated in the annual “Specific Health Check and Guidance in Japan” from 2008 to 2010. There were 80 AAD-related deaths during the follow-up period of 1,049,549 person-years. On multivariate Cox proportional hazard regression, HT was an independent risk factor for AAD-related death in apparently healthy subjects. On receiver operating characteristics curve analysis for AAD-related death, abnormal systolic and diastolic blood pressure (SBP and DBP) were 130 mmHg and 82 mmHg, respectively. The prediction capacity was significantly improved by the addition of SBP to confounding risk factors. Notably, further improvement of the C index was observed by addition of DBP to the model with SBP.

    Conclusions: This is the first report to prospectively show that HT is a risk factor for AAD-related death. Both SBP and DBP are of critical importance in the primary prevention of AAD-related death in apparently healthy subjects.

  • Kentaro Jujo, Nobuhisa Hagiwara
    Type: EDITORIAL
    Article ID: CJ-18-1061
    Published: 2018
    [Advance publication] Released: October 06, 2018
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  • Kizuku Yamashita, Tomoyuki Fujita, Satsuki Fukushima, Yusuke Shimahara ...
    Type: ORIGINAL ARTICLE
    Subject Area: Valvular Heart Disease
    Article ID: CJ-18-0264
    Published: 2018
    [Advance publication] Released: October 05, 2018
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    Background: In patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS), a sigmoid septum, characterized by subaortic interventricular hypertrophy, often results in the need for new pacemaker implantation (PMI). In this study, we reviewed the feasibility and treatment efficacy of TAVR for AS in patients with a sigmoid septum.

    Methods and Results: Between 2011 and 2016, 48 patients (25.4%; mean age 84.9±5.4 years; 9 males) with a sigmoid septum and 141 (74.6%; mean age 82.9±5.5 years; 61 males) without underwent TAVR. Their operative outcomes, echocardiographic and electrocardiographic findings, and long-term outcomes were retrospectively compared. Second TAVR because of valve malposition was performed in 3 patients with a sigmoid septum (6.3%) and in 2 patients without a sigmoid septum (1.4%), with no significant difference between the 2 groups. Although there was no significant difference in valve hemodynamics between the 2 groups, sigmoid septum and deep implantation (implantation depth ≥10 mm) were independent predictors of new PMI following TAVR.

    Conclusions: Although a sigmoid septum did not preclude the feasibility, safety, or efficacy of TAVR for severe AS, its presence was associated with new PMI. Our approach to TAVR in patients with a sigmoid septum may contribute to clinical outcomes comparable to those of patients without this pathology.

  • Jae Gun Kwak, Woong-Han Kim, Eung Re Kim, Jae Hong Lim, Jooncheol Min
    Type: ORIGINAL ARTICLE
    Subject Area: Pediatric Cardiology and Adult Congenital Heart Disease
    Article ID: CJ-18-0690
    Published: 2018
    [Advance publication] Released: October 05, 2018
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    Background: We reviewed our revised surgical strategy for tetralogy of Fallot (TOF) total correction to minimize early exposure to significant pulmonary regurgitation (PR) and to avoid right ventriculotomy (RV-tomy).

    Methods and Results: Since February 2016, we have tried to preserve, first, pulmonary valve (PV) function to minimize PR by extensive commissurotomy with annulus saving; and second, RV infundibular function by avoiding RV-tomy. With this strategy, we performed total correction for 50 consecutive patients with TOF until May 2018. We reviewed the early outcomes of 27 of 50 patients who received follow-up for ≥3 months. Mean patient age at operation was 10.2±5.0 months, and mean body weight was 8.8±1.2 kg. The preoperative pressure gradient at the RV outflow tract and the PV z-score were improved at most recent echocardiography from 82.0±7.1 to 26.8±6.4 mmHg, and from −2.35±0.49 to −0.55±0.54, respectively, during 11.1±1.6 months of follow-up after operation. One patient required re-intervention for residual pulmonary stenosis. Twenty-two patients had less than moderate PR (none, 1; trivial, 8; mild, 13), and 5 patients had moderate PR. There was no free or severe PR.

    Conclusions: At 1-year follow-up, the patients who underwent total TOF correction with our revised surgical strategy had acceptable results in terms of PV function. The preserved PV had a tendency to grow on short-term follow-up.

  • Taishi Okuno, Keita Koseki, Toru Nakanishi, Kai Ninomiya, Daijiro Tomi ...
    Type: ORIGINAL ARTICLE
    Subject Area: Valvular Heart Disease
    Article ID: CJ-18-0709
    Published: 2018
    [Advance publication] Released: October 05, 2018
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    Background: Obesity has previously been identified as an indicator of good prognosis in patients undergoing transcatheter aortic valve implantation (TAVI), an association known as the “obesity paradox”. We investigated whether abdominal total fat area (TFA), visceral fat area (VFA), or subcutaneous fat area (SFA) are prognostic indicators of long-term clinical outcome in patients undergoing TAVI.

    Methods and Results: We retrospectively analyzed 100 consecutive patients who underwent TAVI between December 2013 and April 2017. TFA, VFA, and SFA were measured from routine pre-procedural computed tomography (CT). Patients were divided into 2 groups according to median TFA, VFA, or SFA, and we investigated the association of abdominal fat area with adverse clinical events, including all-cause death and re-hospitalization due to worsening heart failure. At a median follow-up of 665 days, patients with higher SFA had significantly lower incidence of the composite outcome and all-cause death compared with patients with lower SFA (15.0% vs. 37.7%, P=0.025; and 8.9% vs. 23.7%, P=0.047, respectively). In contrast, patients with higher TFA or VFA did not show significant reduction in the incidences of the composite outcome or all-cause mortality.

    Conclusions: CT-derived SFA had prognostic value in patients undergoing TAVI.

  • Hideharu Okamatsu, Ken Okumura
    Type: EDITORIAL
    Article ID: CJ-18-1042
    Published: 2018
    [Advance publication] Released: October 05, 2018
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  • Kimiko Yamamoto, Joji Ando
    Type: REVIEW
    Article ID: CJ-18-0052
    Published: 2018
    [Advance publication] Released: October 04, 2018
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    Vascular endothelial cells (ECs) maintain circulatory system homeostasis by changing their functions in response to changes in hemodynamic forces, including shear stress and stretching. However, it is unclear how ECs sense changes in shear stress and stretching and transduce these changes into intracellular biochemical signals. The plasma membranes of ECs have recently been shown to respond to shear stress and stretching differently by rapidly changing their lipid order, fluidity, and cholesterol content. Such changes in the membranes’ physical properties trigger the activation of membrane receptors and cell responses specific to each type of force. Artificial lipid-bilayer membranes show similar changes in lipid order in response to shear stress and stretching, indicating that they are physical phenomena rather than biological reactions. These findings suggest that the plasma membranes of ECs act as mechanosensors; in response to mechanical forces, they first alter their physical properties, modifying the conformation and function of membrane proteins, which then activates downstream signaling pathways. This new appreciation of plasma membranes as mechanosensors could help to explain the distinctive features of mechanotransduction in ECs involving shear stress and stretching, which activate a variety of membrane proteins and multiple signal transduction pathways almost simultaneously.

  • Myung-Jin Cha, Youngjin Cho, Il-Young Oh, Eue-Keun Choi, Seil Oh
    Type: ORIGINAL ARTICLE
    Subject Area: Arrhythmia/Electrophysiology
    Article ID: CJ-18-0218
    Published: 2018
    [Advance publication] Released: October 04, 2018
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    Background: There is little evidence that focuses on the ethnic variability of clinical risk factors for thromboembolism (TE) in atrial fibrillation (AF). We aimed to investigate the effect of each traditional risk factor in the Korean AF population.

    Methods and Results:Medical records of 12,876 consecutive patients (aged >18 years) newly diagnosed and followed up with non-valvular AF from 2000 to 2013 were reviewed. TE events, including ischemic stroke and systemic embolism, were investigated for risk factor validation. Among the total of 12,876 patients, 1,390 (10.8%) had TE events. In univariate/multivariate analysis adjusting for clinical factors and antithrombotic medications, traditional risk factors included in the CHA2DS2-VASc scheme showed statistical significance, except for female sex, which was not a predictor of events. Additionally, chronic kidney disease (CKD; hazard ratio 1.62, P<0.001) was shown to be an independent predictor of TE events. Based on the analysis, we developed a novel stratification system, CHA2DS2-VAK, omitting the female sex category and adding CKD. The new scoring system showed greater discrimination in event rates between score 0 and 1 patients.

    Conclusions: Female sex was not associated with TE events in a Korean non-valvular AF population. The novel CHA2DS2-VAK scoring system, with substitution of CKD for female sex, might be more appropriate for the Korean population.

  • Nozomi Yoshioka, Tatsuya Kawasaki, Michiyo Yamano, Kuniyasu Harimoto, ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-0697
    Published: 2018
    [Advance publication] Released: October 04, 2018
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  • Hiroki Katsuta, Kazuya Tsuboi, Hiroshi Yamamoto, Hiromi Goto
    Type: ORIGINAL ARTICLE
    Subject Area: Metabolic Disorder
    Article ID: CJ-18-0378
    Published: 2018
    [Advance publication] Released: October 03, 2018
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    Background: Fabry disease is an X-linked lysosomal storage disorder and shows globotriosylceramide (Gb3) accumulation in multiple organs, resulting from a deficiency of α-galactosidase. In patients with Fabry disease, cardiovascular disease occurs at an early age. Previous studies have shown that serum levels of high-density lipoprotein-cholesterol (HDL-C) increase in this disease, yet its clinical significance for cardiovascular disease remains unclear.

    Methods and Results: In order to determine why the serum HDL-cholesterol is high in various cardiovascular diseases of Fabry disease patients, we evaluated the serum lipid profiles, ocular vascular lesions, and levels of serum vascular endothelial growth factor (VEGF) and intercellular adhesion molecule-1 in 69 patients with Fabry disease diagnosed by genetic examination. The serum HDL-C/total cholesterol (T-Chol) ratio was significantly high, especially in male patients (41.5±1.7%) regardless of body mass index. Ocular vascular lesions were more likely to occur in female patients with a high HDL-C/T-Chol ratio compared with most male patients. Female patients with a high HDL-C/T-Chol ratio also presented a high serum VEGF level, suggesting that vascular endothelium dysfunction and arteriosclerotic changes progress more severely than in patients with a normal HDL-C/T-Chol ratio. In most patients, enzyme replacement therapy improved serum Gb3 and lyso-Gb3 levels, but these Gb3 and lyso-Gb3 still remained higher than in healthy controls, which appears to result in continuous vascular arteriosclerotic changes.

    Conclusions: We concluded that increased low-density lipoprotein-cholesterol uptake to the vascular wall caused by endothelial dysfunction is likely to contribute to the high HDL-C/T-Chol ratio observed in Fabry disease patients.

  • Pawel Szulc, Ez Zoubir Amri, Annie Varennes, Patricia Panaia-Ferrari, ...
    Type: ORIGINAL ARTICLE
    Subject Area: Aortic Disease
    Article ID: CJ-18-0517
    Published: 2018
    [Advance publication] Released: October 03, 2018
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    Background: Severe abdominal aortic calcification (AAC) points to high cardiovascular risk and leptin stimulates arterial calcification; however, clinical data on their association are scarce. We studied the link between serum leptin and AAC severity and progression, and the effect of smoking and lipid levels, on this association in men.

    Methods and Results: At baseline, 548 community-dwelling men aged 50–85 years underwent blood collection and lateral lumbar spine radiography. In 448 men, X-ray was repeated after 3 and 7.5 years. AAC was assessed using Kauppila’s semiquantitative score. In multivariable models, high leptin was associated with higher odds of severe AAC (odds ratio [OR]=1.71 per SD, 95% confidence interval [CI]: 1.22–2.40). The odds of severe AAC were the highest in men who had elevated leptin levels and either were ever-smokers (OR=9.22, 95% CI: 3.43–24.78) or had hypertriglyceridemia (vs. men without these characteristics). Higher leptin was associated with greater AAC progression (OR=1.34 per SD, 95% CI: 1.04–1.74). The risk of AAC progression was the highest in men who had elevated leptin levels and either were current smokers or had high low-density lipoprotein-cholesterol levels (OR=5.91, 95% CI: 2.46–14.16 vs. men without these characteristics). These links remained significant after adjustment for baseline AAC and in subgroups defined according to smoking and low-density lipoprotein-cholesterol levels.

    Conclusions: In older men, high leptin levels are associated with greater severity and rapid progression of AAC independent of smoking, low-density lipoprotein-cholesterol or triglycerides.

  • Hideki Kitahara, Naoto Mori, Yuichi Saito, Takashi Nakayama, Yoshihide ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-0949
    Published: 2018
    [Advance publication] Released: October 02, 2018
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  • Yuki Kimura, Osamu Seguchi, Keiichiro Iwasaki, Koichi Toda, Noriko Kik ...
    Type: ORIGINAL ARTICLE
    Subject Area: Heart Failure
    Article ID: CJ-18-0107
    Published: 2018
    [Advance publication] Released: September 29, 2018
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    Background: Coronary artery disease (CAD) after heart transplantation (HTx) develops as a combination of donor-transmitted coronary atherosclerosis (DTCA) and cardiac allograft vasculopathy. Assessing donor CAD before procurement is important. Because coronary artery calcification (CAC) is a predictor for CAD, donor-heart CAC is usually evaluated to estimate the risk of donor CAD. The usefulness of CAC for predicting DTCA, however, is not known.

    Methods and Results: Sixty-four HTx recipients whose donor underwent chest computed tomography before procurement or ≤2 weeks after HTx and who underwent coronary angiography and intravascular ultrasound (IVUS) ≤3 months after HTx were enrolled. Eight patients had CAC (CAC group) and 56 patients did not have CAC (no-CAC group). Patients in the CAC group were significantly older and had a higher prevalence of maximum intimal thickness (MIT) of the coronary artery ≥0.5 mm at initial IVUS than patients in the no-CAC group (100% vs. 55%, P=0.02). Adverse cardiac events and death were not significantly different. Everolimus tended to be used more often in the CAC group.

    Conclusions: Donor-heart CAC is a significant predictor for MIT of the coronary artery ≥0.5 mm after HTx. The presence of CAC, however, is not associated with future cardiac events. The higher prevalence of everolimus use in the CAC group may have affected the results.

  • Sayaka Funabashi, Osami Kawarada, Toru Hirano, Shinobu Ayabe, Takeshi ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-0528
    Published: 2018
    [Advance publication] Released: September 29, 2018
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  • Achim Leo Burger, Stefan Stojkovic, Herwig Schmidinger, Robin Ristl, T ...
    Type: ORIGINAL ARTICLE
    Subject Area: Arrhythmia/Electrophysiology
    Article ID: CJ-18-0611
    Published: 2018
    [Advance publication] Released: September 29, 2018
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    Background: Careful device programming is necessary to reduce inappropriate antitachycardia pacing (ATP) and shock therapy in recipients of implantable cardioverter-defibrillators (ICD). This retrospective study investigated the safety and efficacy of a therapy-reducing programming strategy in comparison with conventional strategies in consecutive ICD recipients of a university cardiac center.

    Methods and Results: All 1,471 ICD recipients from 2000 to 2015 were analyzed. Individual ICD programming (IND) was used from 2000 to 2005 followed by standard-three-zone programming (STD) until 2010. From 2010 to 2015 therapy-reducing long detection time programming (RED) was established. The mean follow-up was 2.4±1.6, 2.3±1.6 and 1.7±1.2 years in the IND, STD and RED groups, respectively. Switchover from IND to STD revealed a significant reduction in inappropriate ATP (P=0.024) and shock therapy (P<0.001). Further reduction of 58% (RR=0.42, 95% confidence interval [CI]: 0.17–1.04; P=0.061) in inappropriate ATP and 29% (RR=0.71, 95% CI: 0.29–1.72; P=0.452) in inappropriate shock therapy was achieved by switchover from STD to RED. Kaplan-Meier analysis revealed a significant difference in time until first inappropriate ATP and shock therapy among the 3 groups, being lowest in the RED group (P≤0.001). There was no difference in overall mortality (P=0.416).

    Conclusions: Defensive ICD programming with prolonged detection times is safe and significantly reduced inappropriate ICD therapies.

  • Toshiki Kuno, Akimichi Shibata, Masaki Kodaira, Yohei Numasawa
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-0713
    Published: 2018
    [Advance publication] Released: September 29, 2018
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  • Takayuki Sugai, Tetsu Watanabe, Yoichiro Otaki, Jun Goto, Ken Watanabe ...
    Type: ORIGINAL ARTICLE
    Subject Area: Peripheral Vascular Disease
    Article ID: CJ-18-0726
    Published: 2018
    [Advance publication] Released: September 29, 2018
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    Background: The prognosis of peripheral artery disease (PAD) and comorbid sarcopenia is poor. Some reports indicate that the computed tomography (CT) value of skeletal muscle, which reflects intramuscular fat deposition as well as skeletal muscle mass, is considered a marker of sarcopenia. However, it remains unclear if skeletal muscle area and CT value are associated with poor outcomes in patients with PAD.

    Methods and Results: Psoas muscle area and CT value were measured by manual trace at the level of the third lumbar vertebral body in 327 consecutive patients with PAD undergoing endovascular therapy (EVT). The endpoint was major adverse cardiovascular and limb events (MACLE). There were 60 MACLE during the follow-up period. Patients with MACLE had lower mean psoas muscle CT value than those without. However, there was no significant difference in total psoas muscle area between patients with and without MACLE. Kaplan-Meier analysis demonstrated that the lowest tertile of psoas muscle CT value was associated with the highest risk of MACLE. Multivariate Cox hazard analysis revealed that psoas muscle CT value was associated with MACLE after adjustment for Fontaine class, previous ischemic heart disease, prevalence of diabetes mellitus, brain natriuretic peptide, and serum albumin.

    Conclusions: Psoas muscle CT value is a feasible predictor of MACLE in patients with PAD.

  • Sachie Terazawa, Hideki Oshima, Yuji Narita, Kazuro Fujimoto, Masato M ...
    Type: ORIGINAL ARTICLE
    Subject Area: Cardiovascular Surgery
    Article ID: CJ-18-0312
    Published: 2018
    [Advance publication] Released: September 27, 2018
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    Background: The strategy for cardiovascular surgery in dementia patients is controversial, so we aimed to investigate whether preoperative dementia and its severity might affect the outcomes of cardiovascular surgery by evaluating with the Mini-Mental State Examination (MMSE).

    Methods and Results: The study group comprised 490 patients undergoing cardiovascular surgery. Their preoperative cognitive status was evaluated using the MMSE, and analysis was performed to compare the patients with MMSE score <24 (dementia group, n=51) or MMSE score 24–30 (non-dementia group, n=439). Furthermore, the effect of the severity of dementia was analyzed with a cut-off MMSE score of 19/20. Risk factors for surgical outcomes were explored using multivariate logistic regression analysis. Hospital mortality was 11.8% in the dementia group and 2.1% in the non-dementia group (P=0.002). Regarding the postoperative morbidities, the incidence of cerebrovascular disorder (P=0.001), pneumonia (P=0.039), delirium (P=0.004), and infection (P=0.006) was more frequent in dementia group. Among the patients with MMSE <20, hospital mortality was as high as 25%, and the rate of delirium was 58%. Multivariate logistic regression analysis revealed that MMSE score <24 (P=0.003), lower serum albumin (P=0.023) and aortic surgery (P=0.036) were independent risk factors for hospital death.

    Conclusions: Preoperative dementia affects the outcomes of cardiovascular surgery with regard to hospital death and delirium. The surgical indication for patients with MMSE <20 might be difficult, but surgery with an appropriate strategy should be considered for patients with MMSE <24.

  • Shin Kawasoe, Kazuki Ide, Tomoko Usui, Takuro Kubozono, Shiro Yoshifuk ...
    Type: ORIGINAL ARTICLE
    Subject Area: Metabolic Disorder
    Article ID: CJ-18-0607
    Published: 2018
    [Advance publication] Released: September 27, 2018
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    Background: The independent role of serum triglyceride (TG) levels as a cardiovascular risk factor is still not elucidated. We aimed to investigate if the effect of TG on arterial stiffness is influenced by the serum level of low-density lipoprotein cholesterol (LDL-C).

    Methods and Results: We studied 11,640 subjects who underwent health checkups. They were stratified into 4 groups according to LDL-C level (≤79, 80–119, 120–159, and ≥160 mg/dL). Arterial stiffness was evaluated by brachial-ankle pulse wave velocity (baPWV). In each group, univariate and multivariete logistic regression analyses were performed to investigate the association between high TG (≥150 mg/dL) and high baPWV (>1,400 cm/s). In the univarite analysis, high TG was significantly associated with high baPWV in LDL-C <79 mg/dL (OR, 3.611, 95% CI, 2.475–5.337; P<0.0001) and 80–119 mg/dL (OR, 1.881; 95% CI, 1.602–2.210; P<0.0001), but not in LDL-C 120–159 mg/dL and ≥160 mg/dL. In the multivariate analysis, high TG was significantly associated with high baPWV in LDL-C ≤79 mg/dL (OR, 2.558; 95% CI, 1.348–4.914; P=0.0040) and LDL-C 80–119 mg/dL (OR, 1.677; 95% CI, 1.315–2.140; P<0.0001), but not in LDL-C 120–159 mg/dL and ≥160 mg/dL.

    Conclusions: High TG and increased arterial stiffness showed an independent relationship in a Japanese general population with LDL-C ≤119 mg/dL. TG-lowering therapy might be an additional therapeutic consideration in these subjects.

  • Nai-Kuan Chou, Ryoi Okano, Takeo Tedoriya, I-Hui Wu, Hsi-Yu Yu, Yih-Sh ...
    Type: ORIGINAL ARTICLE
    Subject Area: Cardiovascular Surgery
    Article ID: CJ-17-1369
    Published: 2018
    [Advance publication] Released: September 26, 2018
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    Background: Surgical intervention is indicated in symptomatic hypertrophic cardiomyopathy (HCM) patients with a ventricular outflow pressure gradient more than 50 mmHg. The transmitral approach, along with the transapical and transaortic approaches, is routinely used for myectomy, but all are open procedures. We describe a robotic transmitral approach that can be used to resolve septal hypertrophied muscle and eliminate mitral regurgitation (MR) using 1 cardiac incision.

    Methods and Results: We retrospectively analyzed 20 adult patients with obstructive HCM who exhibited concomitant severe MR and systolic anterior motion (SAM). The 2 groups comprised 12 standard full-sternotomy transaortic and 8 robotic transmitral approaches. The pre-intraventricular pressure gradient was 69±14.2 mmHg in the robotic transmitral group and 70.2±17.4 mmHg in the transaortic group (P=0.876). Both groups had a similar left ventricular ejection fraction (65±8% vs. 72±9%, P=0.901) and maximal ventricular wall thickness (22.3±4.5 and 21.7±6.0, P=0.835). Postoperative MR was reduced to less than grade II in all patients. In the robotic group, the postoperative pressure gradient was 1.5±2.6 mmHg, which was lower than that of the transaortic group at 10.6±10.8 mmHg (P=0.019). The cross-clamp time was 95.3±7.7 min in the robotic group and 104.7±20.8 min in the transaortic group (P=0.193). The operation time was 237.5±22.4 and 309.6±28.5 min (P<0.01) in the robotic transmitral and transaortic groups, respectively.

    Conclusions: Using a robotic transmitral approach to treat with patients with HCM, SAM, and MR is feasible and reliable. Through 1 atrial incision, it is possible to resolve hypertrophy of the septum and eliminate both severe MR and SAM.

  • Hidenori Yaku, Neiko Ozasa, Takeshi Morimoto, Yasutaka Inuzuka, Yodo T ...
    Type: ORIGINAL ARTICLE
    Subject Area: Heart Failure
    Article ID: CJ-17-1386
    Published: 2018
    [Advance publication] Released: September 26, 2018
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    Background: There is a scarcity of reports on the clinical characteristics and management practice in contemporary all-comer patients with acute decompensated heart failure (ADHF).

    Methods and Results: The Kyoto Congestive Heart Failure (KCHF) registry is a prospective observational cohort study enrolling 4,056 consecutive patients who had hospital admission due to ADHF without any exclusion criteria between October 2014 and March 2016 in the 19 participating hospitals in Japan. Baseline characteristics, clinical presentations, management, and in-hospital outcomes were compared between heart failure (HF) with reduced left ventricular ejection fraction (LVEF; HFrEF, LVEF <40%), HF with mid-range LVEF (HFmrEF, LVEF 40–49%), and HF with preserved LVEF (HFpEF, LVEF ≥50%). Of the 4,041 patients with documented LVEF, 1,744 (43%) had HFpEF; 746 (19%), HFmrEF; and 1,551 (38%), HFrEF. The median age was 80 years (IQR, 72–86 years) in the entire population, and was higher with increasing LVEF (P<0.001). The in-hospital mortality rate was higher in the HFrEF than in the HFmrEF and HFpEF groups (9.2%, 4.8%, and 5.1%, respectively, P<0.001).

    Conclusions: This registry elucidated the clinical features and clinically relevant in-hospital outcomes in contemporary consecutive patients with ADHF in real-world clinical practice in Japan. When classified by LVEF, significant differences in characteristics and in-hospital outcomes existed between patients with HFrEF, HFmrEF, and HFpEF.

  • In-Jung Kim, Pil-Sung Yang, Tae-Hoon Kim, Jae-Sun Uhm, Hui-Nam Pak, Mo ...
    Type: ORIGINAL ARTICLE
    Subject Area: Arrhythmia/Electrophysiology
    Article ID: CJ-18-0046
    Published: 2018
    [Advance publication] Released: September 26, 2018
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    Background: The relationship between anemia and sudden cardiac arrest (SCA) is unclear in the general population, so we assessed it in a nationwide cohort.

    Methods and Results: We studied 494,948 subjects (mean age, 47.8 years; 245,333 men [49.6%]) with national health check-up data from the Korean National Health Insurance Database Cohort. During a mean follow-up period of 5.4 years, SCA occurred in 616 participants (396 men, 220 women). The incidence rates of SCA increased across the 4 anemia groups in both men (0.3, 1.5, 5.3, and 4.5 per 1,000 person-years) and women (0.2, 0.5, 0.5, and 1.2 per 1,000 person-years). The SCA risk per 1-unit decrease in hemoglobin (Hb) increased by 21% and 24%, respectively, in multivariable models adjusted for cardiovascular factors, in men (95% confidence interval [CI], 13–29%; P<0.001) and women (95% CI, 13–37%; P<0.001). A negative correlation between QTc interval and Hb level was observed in men, and a trend was observed in women.

    Conclusions: Anemia was associated with an increased risk of SCA even after accounting for concomitant conditions in a South Korean nationwide cohort. The correlation between anemia and SCA might be explained by an increase in arrhythmic risks, such as QTc prolongation.

  • Muhammad Ayyaz Ul Haq, Muhammad Rashid, Ian C. Gilchrist, Olivier Bert ...
    Type: ORIGINAL ARTICLE
    Subject Area: Cardiovascular Intervention
    Article ID: CJ-18-0389
    Published: 2018
    [Advance publication] Released: September 22, 2018
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    Background: We systematically reviewed the available literature on limb dysfunction after transradial access (TRA) or transfemoral access (TFA) cardiac catheterization.

    Methods and Results: MEDLINE and EMBASE were searched for studies evaluating any transradial or transfemoral procedures and limb function outcomes. Data were extracted and results were narratively synthesized with similar treatment arms. The TRA group included 15 studies with 3,616 participants and of these 3 reported nerve damage with a combined incidence of 0.16% and 4 reported sensory loss, tingling and numbness with a pooled incidence of 1.61%. Pain after TRA was the most common form of limb dysfunction (7.77%) reported in 3 studies. The incidence of hand dysfunction defined as disability, grip strength change, power loss or neuropathy was low at 0.49%. Although radial artery occlusion (RAO) was not a primary endpoint for this review, it was observed in 3.57% of the participants in a total of 8 studies included. The TFA group included 4 studies with 15,903,894 participants; the rates of peripheral neuropathy were 0.004%, sensory neuropathy caused by local groin injury and retroperitoneal hematomas were 0.04% and 0.17%, respectively, and motor deficit caused by femoral and obturator nerve damage was 0.13%.

    Conclusions: Limb dysfunction post cardiac catheterization is rare, but patients may have nonspecific sensory and motor complaints that resolve over a period of time.

  • Jianzhong Zhu, Huimin Gu, Xiaolei Lv, Chunying Yuan, Ping Ni, Feng Liu
    Type: ORIGINAL ARTICLE
    Subject Area: Heart Failure
    Article ID: CJ-18-0396
    Published: 2018
    [Advance publication] Released: September 22, 2018
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    Background: This study is performed to explore the differential expression of long intergenic non-coding-p53 induced non-coding transcript, miR-208a-3p and JUN in acute myocardial infarction (AMI) and their potential mechanisms.

    Methods and Results: Gene Expression Omnibus, R software, Kyoto Encyclopedia of Genes and Genomes (KEGG) and gene ontology (GO) analysis were used for analyzing the differentially expressed genes (DEGs) and pathways. The differential expressions of LINC-PINT and miR-208a-3p were examined by qRT-PCR. The expressions of JUN and the mitogen-activated protein kinase (MAPK) pathway-related proteins were analyzed by Western blot. The triphenyltetrazolium chloride (TTC) staining and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay (TUNEL) staining methods were used to measure the myocardial infarction size and tissue apoptosis respectively. The targeted relationships between miR-208a-3p and LINC-PINT or JUN were confirmed using a dual luciferase reporter assay. DEGs were significantly enriched in the MAPK signaling pathway. LINC-PINT could sponge miR-208a-3p, which targeted and regulated JUN. LINC-PINT and JUN were confirmed to be overexpressed in AMI tissues. Silencing LINC-PINT and JUN could exert a protective influence against AMI. The expression of miR-208a-3p was significantly decreased in AMI tissues, and miR-208a-3p reduced myocardial ischemia-reperfusion injury and apoptosis. Downregulation of LINC-PINT facilitated miR-208a-3p expression and suppressed the protein level of JUN, contributing to the inactivation of the MAPK pathway in the AMI tissues and thus generating protective effects.

    Conclusions: Knockdown of LINC-PINT inactivated the MAPK pathway by releasing miR-208a-3p and suppressing the JUN, protecting the injury during the process of AMI.

  • Noboru Fujino, Kenshi Hayashi, Kenji Sakata, Akihiro Nomura, Masa-aki ...
    Type: EDITORIAL
    Article ID: CJ-18-0954
    Published: 2018
    [Advance publication] Released: September 21, 2018
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  • Ling-Yan Chen, Xiao-Dan Xia, Zhen-Wang Zhao, Duo Gong, Xiao-Feng Ma, X ...
    Type: ORIGINAL ARTICLE
    Subject Area: Metabolic Disorder
    Article ID: CJ-18-0410
    Published: 2018
    [Advance publication] Released: September 20, 2018
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    Background: Lipoprotein lipase (LPL) plays an important role in triglyceride metabolism. It is translocated across endothelial cells to reach the luminal surface of capillaries by glycosylphosphatidylinositol-anchored high-density lipoprotein binding protein 1 (GPIHBP1), where it hydrolyzes triglycerides in lipoproteins. MicroRNA 377 (miR-377) is highly associated with lipid levels. However, how miR-377 regulates triglyceride metabolism and whether it is involved in the development of atherosclerosis remain largely unexplored.

    Methods and Results: The clinical examination displayed that miR-377 expression was markedly lower in plasma from patients with hypertriglyceridemia compared with non-hypertriglyceridemic subjects. Bioinformatics analyses and a luciferase reporter assay showed that DNA methyltransferase 1 (DNMT1) was a target gene of miR-377. Moreover, miR-377 increased LPL binding to GPIHBP1 by directly targeting DNMT1 in human umbilical vein endothelial cells (HUVECs) and apolipoprotein E (ApoE)-knockout (KO) mice aorta endothelial cells (MAECs). In vivo, hematoxylin-eosin (H&E), Oil Red O and Masson’s trichrome staining showed that ApoE-KO mice treated with miR-377 developed less atherosclerotic plaques, accompanied by reduced plasma triglyceride levels.

    Conclusions: It is concluded that miR-377 upregulates GPIHBP1 expression, increases the LPL binding to GPIHBP1, and reduces plasma triglyceride levels, likely through targeting DNMT1, inhibiting atherosclerosis in ApoE-KO mice.

  • Ryotaro Asano, Shigefumi Fukui, Tatsuya Nishii, Nao Konagai, Takuya Ha ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-0750
    Published: 2018
    [Advance publication] Released: September 20, 2018
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  • Chang Hee Kwon, Sung Ho Lee, Jong-Young Lee, Seungho Ryu, Ki-Chul Sung
    Type: ORIGINAL ARTICLE
    Subject Area: Arrhythmia/Electrophysiology
    Article ID: CJ-18-0748
    Published: 2018
    [Advance publication] Released: September 19, 2018
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    Background: Increased serum uric acid is associated with prevalence and incidence of atrial fibrillation (AF), but there is a lack of studies on the association between serum uric acid and risk of AF in the general population.

    Methods and Results: We used the data from the Kangbuk Samsung Hospital health screening cohort recorded between 2002 and 2015. The primary outcome was incidence of AF diagnosed on 12-lead electrocardiography. We analyzed and compared the hazard ratios (HR) according to baseline serum uric acid quartiles. The present study involved 282,473 subjects without baseline AF. Mean follow-up was 5.4±3.6 years. During follow-up, AF was identified in 365 subjects (cumulative incidence, 0.13%). After multivariable adjustment, including that for C-reactive protein, the risk of AF was significantly higher in the upper 2 quartiles than in the lowest quartile in men (upper third quartile: adjusted HR, 1.53; 95% confidence interval [CI]: 1.11–2.89; highest quartile: HR, 1.60; 95% CI: 1.13–2.25). In women, even though AF incidence rate was very low (0.6 of 10,000 person-years), the risk of AF in the highest quartile was 6.93-fold that in the lowest quartile (95% CI: 1.53–31.29).

    Conclusions: Serum uric acid is significantly and positively associated with incident AF in the Korean general population.

  • Ahmed N. Mahmoud, Akram Y. Elgendy, Islam Y. Elgendy
    Type: LETTER TO THE EDITOR
    Article ID: CJ-17-0780
    Published: 2018
    [Advance publication] Released: September 15, 2018
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  • Naoki Tadokoro, Satsuki Fukushima, Yusuke Shimahara, Yorihiko Matsumot ...
    Type: ORIGINAL ARTICLE
    Subject Area: Cardiovascular Surgery
    Article ID: CJ-18-0744
    Published: 2018
    [Advance publication] Released: September 15, 2018
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    Background: The number of surgical aortic valve replacements using bioprosthetic valves is increasing, and newer bioprosthetic valves may offer clinical advantages in Japanese patients, who generally require smaller replacement valves than Western patients. In this study we retrospectively evaluated the Trifecta and Magna valves to compare clinical outcomes and hemodynamics in a group of Japanese patients.

    Methods and Results: Data were retrospectively collected for 103 patients receiving a Trifecta valve and 356 patients receiving a Magna valve between June 2008 and 2017. Adverse events, outcomes, and valve hemodynamics were evaluated. There were no significant differences in early or late outcomes between the Trifecta and Magna groups. In the early postoperative period, mean (±SD) pressure gradient (9.0±3.1 vs. 13.8±4.8 mmHg; P<0.01) and effective orifice area (1.68±0.46 vs. 1.46±0.40 m2; P<0.01) were significantly better for Trifecta, but the differences decreased over time. In particular, the interaction between time and valve type (Trifecta or Magna) was significantly different for mean pressure gradient between the 2 groups (P<0.01). Left ventricular mass regressed substantially in both groups, with no significant difference between them. There were no significant differences for severe patient-prosthesis mismatch.

    Conclusions: Postoperative outcomes were similar for both valves. An early hemodynamic advantage for the Trifecta valve lasted to approximately 1 year postoperatively but did not persist.

  • Jeehoon Kang, Hyo-Soo Kim
    Type: AUTHOR’S REPLY
    Article ID: CJ-18-0947
    Published: 2018
    [Advance publication] Released: September 15, 2018
    JOURNALS FREE ACCESS FULL-TEXT HTML ADVANCE PUBLICATION
  • Kotaro Sugimoto, Mizuko Tanaka, Hideki Chiba
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-0669
    Published: 2018
    [Advance publication] Released: September 14, 2018
    JOURNALS FREE ACCESS FULL-TEXT HTML ADVANCE PUBLICATION
  • Hiroshi Furukawa, Naoki Yamane, Takeshi Honda, Takahiko Yamasawa, Yuji ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-0851
    Published: 2018
    [Advance publication] Released: September 14, 2018
    JOURNALS FREE ACCESS FULL-TEXT HTML ADVANCE PUBLICATION
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