Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
Advance online publication
Showing 1-50 articles out of 64 articles from Advance online publication
  • Haisong Bu, Xueyang Gong
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-19-0017
    Published: February 19, 2019
    [Advance publication] Released: February 19, 2019
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  • Soo Jin Na, Taek Kyu Park, Joo Myung Lee, Young Bin Song, Jin-Oh Choi, ...
    Type: ORIGINAL ARTICLE
    Subject Area: Critical Care
    Article ID: CJ-18-0873
    Published: February 16, 2019
    [Advance publication] Released: February 16, 2019
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    Background: Data on the association between obesity and mortality in patients who require acute cardiac care are limited, so we investigated the effect of obesity on clinical outcomes in patients admitted to the cardiac intensive care unit (CICU).

    Methods and Results: We reviewed 2,429 eligible patients admitted to the CICU at Samsung Medical Center between January 2012 and December 2015. After excluding 197 patients with low body mass index (BMI) to adjust for the possibility of frailty, patients were divided into 3 categories: normal BMI (n=822), 18.5–22.9 kg/m2; moderate BMI (n=1,050), 23–27.4 kg/m2; and high BMI (n=360), ≥27.5 kg/m2. The primary outcome was 28-day mortality. Overall, 124 (2.6%) of 2,232 patients died during 28-day follow-up after CICU admission. The 28-day mortality was numerically lower in the moderate (4.5%) and high (5.3%) BMI groups than in the normal BMI group (7.1%), but the difference was not statistically significant (P=0.052). After multivariable adjustment, the moderate and high BMI categories were not significant predictors of primary outcome (adjusted hazard ratio [HR] 0.74, 95% CI 0.50–1.09, P=0.127 and adjusted HR 0.80, 95% CI 0.47–1.36, P=0.404, respectively). However, Acute Physiology and Chronic Health Evaluation II scores, liver cirrhosis, malignancy, history of cardiac arrest, and need for organ support treatment were independent predictors of 28-day mortality.

    Conclusions: Obesity was not associated with short-term mortality in patients requiring cardiac critical care.

  • Jun Feng, Congli Zhang, Kaini Shen, Jian Sun, Quan Fang, Lu Zhang, Xin ...
    Type: ORIGINAL ARTICLE
    Subject Area: Heart Failure
    Article ID: CJ-18-1048
    Published: February 16, 2019
    [Advance publication] Released: February 16, 2019
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    Background: Cardiac involvement occurs in more than half of the patients with light-chain amyloidosis (AL), but the characteristics, treatment and prognosis of cardiac AL (CAL) are not fully described.

    Methods and Results: A total of 227 patients with CAL diagnosis between January 2009 and March 2017 at Peking Union Medical College Hospital were included. Patients with Mayo stages I, II and III AL accounted for 0.9%, 49.8% and 49.3%, respectively. Autologous stem cell transplantation, bortezomib combinations, non-bortezomib regimens and palliative treatment were given as first line therapy in 3.1%, 44.1%, 30.8% and 22.0% of patients, respectively. Overall hematological response and cardiac response were achieved in 60.6% and 37.2% of evaluable patients, respectively. The median overall survival (OS) was 17 months in all patients, and 10 months in those with Mayo stage III. In patients with Mayo stage III disease who survived for >1 month, the bortezomib group survived significantly longer than the non-bortezomib group (median OS, not reached vs. 12 months, P=0.019). Three independent prognostic factors for survival were identified: N-terminal fragment of B-type natriuretic peptide (NT-proBNP) ≥5,000 pg/mL, bone marrow plasma cells ≥10%, and systolic blood pressure <100 mmHg.

    Conclusions: CAL patients had poor prognosis, but those treated with bortezomib combinations had a better outcome than the non-bortezomib group.

  • Toyoaki Murohara
    Type: MESSAGE FROM THE EDITOR-IN-CHIEF
    Article ID: CJ-66-0162
    Published: February 15, 2019
    [Advance publication] Released: February 15, 2019
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  • Miki Tsujiuchi, Takenori Yamauchi, Mio Ebato, Hideyuki Maezawa, Ayaka ...
    Type: ORIGINAL ARTICLE
    Subject Area: Imaging
    Article ID: CJ-18-0554
    Published: February 13, 2019
    [Advance publication] Released: February 13, 2019
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    Background: The prognostic value of indices for left atrial volumes (LAV) and reservoir function measured by 3D speckle-tracking analysis (3DSTA) has not been determined.

    Methods and Results: LA maximal and minimal volume indices (LAVImax, LAVImin), and LA emptying fraction (LAEmpF) were measured via 2D echocardiography (2DE) and 3DSTA in 514 patients (62% male, mean age: 66±15 years) with various cardiovascular diseases. Two cutoff values using normal±2SD (cutoff criterion 1) and receiver-operating characteristic analysis (cutoff criterion 2) were evaluated. During a mean follow-up of 720±383 days, MACE (cardiac death, nonfatal myocardial infarction, stroke and admission for heart failure) occurred in 98 patients. Kaplan-Meier survival analysis showed both cutoff criteria measured by 2DE and 3DSTA had significant predictive power for MACE (P<0.001). For cutoff criterion 1, 3DSTA measurements yielded higher hazard ratios than 2DE by Cox proportional hazard model. Cutoff criterion 2 using 3DSTA had higher average treatment effect values than 2DE by matching propensity scores on the outcome. Further, a regression model that included clinical variables, left ventricular ejection fraction and cutoff criterion 2 using 3DSTA-derived LAEmpF had significantly higher prognostic power than 2DE.

    Conclusions: LA indices measured by 3DSTA had greater prognostic power for future MACE than 2DE. In particular, 3DSTA-derived LAEmpF has the potential to be a valuable prognostic tool in clinical settings.

  • Kazuomi Kario, Eiichiro Yamamoto, Hirofumi Tomita, Takafumi Okura, Shi ...
    Type: ORIGINAL ARTICLE
    Subject Area: Hypertension and Circulatory Control
    Article ID: CJ-18-1018
    Published: February 13, 2019
    [Advance publication] Released: February 13, 2019
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    Background: SYMPLICITY HTN-Japan is a prospective, randomized, controlled trial comparing renal denervation (RDN) with standard pharmacologic therapy for treatment of uncontrolled hypertension (HTN).

    Methods and Results: Patients enrolled had uncontrolled HTN, defined as office systolic blood pressure (SBP) ≥160 mmHg and 24-h ambulatory SBP ≥135 mmHg, on ≥3 antihypertensive drugs of maximally tolerated dose for at least 6 weeks prior to enrollment. Randomization was 1:1 to RDN or maintenance of current medical therapy (control). Patients were followed every 6 months post-randomization for up to 36 months. There were 22 patients randomized to RDN and 19 to control, and 11 patients were crossed over and received RDN at 6 months post-randomization. For the RDN group (n=22), office SBP reduction was −32.8±20.1 mmHg and office DBP reduction was −15.8±12.6 mmHg at 36 months post-procedure, both P<0.001. For the combined RDN and crossover group (n=33), office SBP reduction was −26.7±18.9 mmHg and office DBP reduction was −12.7±11.8 mmHg at 30 months post-procedure, both P<0.001. There were no procedural-, device- or treatment-related safety events through 36 months.

    Conclusions: SYMPLICTY HTN-Japan is the first randomized controlled trial to evaluate RDN in an Asian population. Despite the small number of enrollments, results show patients who received RDN therapy maintained SBP reduction out to 36 months.

  • Naoko Ikeda, Hiroki Yamaguchi, Masami Takagaki, Shinichi Mitsuyama, Mi ...
    Type: ORIGINAL ARTICLE
    Subject Area: Cardiovascular Surgery
    Article ID: CJ-18-0849
    Published: February 09, 2019
    [Advance publication] Released: February 09, 2019
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    Background: The ideal surgical technique for ischemic mitral regurgitation (MR) is controversial. We introduced an extended posterior mitral leaflet (PML) augmentation technique for functional MR with severe tethering, which detached the PML from the annulus almost completely and augmented it with a large 3×6-cm oval pericardial patch.

    Methods and Results: A total of 17 mitral repairs using the new technique were performed for ischemic MR with no 30-day mortality and 2 hospital deaths. The NYHA class was III in 47% and IV in 13%. The EuroSCORE II was 9.7±4.9. The ring size was 32±1.4 mm. Concomitant coronary bypass was performed in 67% and left ventricular repair in 28%. The mechanism of leaflet closure was evaluated using transthoracic echocardiography in 15 survivors. MR decreased to none or trivial with a significant increase in coaptation length (Pre: 4.7±0.8 mm vs. Post: 10.0±2.4 mm; P<0.001). The PML flexibly moved forward and tightly contacted as if “snuggling up” to the anterior leaflet. There were no late deaths, heart failure readmissions or MR recurrences during follow-up (850±181 days). All patients remained in NYHA I or II.

    Conclusions: Extended PML augmentation for ischemic MR showed excellent early results with deep leaflet coaptation through a “snuggling up” phenomenon, which would help prevent late MR recurrence.

  • Fengpu He, Yiping Jiao, Kai Ma, Zhongdong Hua, Hao Zhang, Jun Yan, Kem ...
    Type: ORIGINAL ARTICLE
    Subject Area: Pediatric Cardiology and Adult Congenital Heart Disease
    Article ID: CJ-18-0916
    Published: February 09, 2019
    [Advance publication] Released: February 09, 2019
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    Background: Common atrioventricular valve (CAVV) repair in patients with a single ventricle remains a great challenge and a refractory issue for pediatric cardiac surgeons.

    Methods and Results: From January 2007 to April 2018, 37 consecutive patients with a single ventricle who underwent CAVV repair were included in the study group. Patients were divided into 2 groups based on the repair technique: patients in Group A were treated using the bivalvation technique, and patients in Group B underwent conventional repair techniques; baseline data were similar between groups. The inhospital and follow-up mortality were 5.4% (2/37) and 11.4% (4/35), respectively. After a follow-up of 65.5±29.3 months, the estimated 1-, 5-, and 10-year overall survival rates were 94.6%, 83.4%, and 77.0%, respectively. The rates of freedom from CAVV failure were 94.3%, 72.7%, and 62.9% after 1, 5, and 10 years, respectively. In the multivariate analysis, the independent factors for CAVV repair failure were repair technique (P=0.004) and heterotaxy syndrome (P=0.003). A total of 30 patients (81.1%) completed total cavopulmonary connection (TCPC); 3 patients required re-intervention; 24 of 31 patients (77.4%) were in New York Heart Association classes II and I at the latest follow-up.

    Conclusions: Outcomes of CAVV repair in patients palliated by single-ventricular surgery are acceptable. The bivalvation technique is a simple and effective technique.

  • Naoto Fukunaga, Vivek Rao
    Type: LETTER TO THE EDITOR
    Article ID: CJ-18-1010
    Published: February 09, 2019
    [Advance publication] Released: February 09, 2019
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  • Ken Nakamura, Kazuhiro Hashimoto
    Type: AUTHOR’S REPLY
    Article ID: CJ-18-1389
    Published: February 09, 2019
    [Advance publication] Released: February 09, 2019
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  • Kota Suzuki, Koichi Toda, Shunsuke Saito, Shigeru Miyagawa, Yasushi Yo ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-0680
    Published: February 08, 2019
    [Advance publication] Released: February 08, 2019
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  • Takahiro Kemmotsu, Utako Yokoyama, Junichi Saito, Satoko Ito, Azusa Uo ...
    Type: ORIGINAL ARTICLE
    Subject Area: Pediatric Cardiology and Adult Congenital Heart Disease
    Article ID: CJ-18-1033
    Published: February 07, 2019
    [Advance publication] Released: February 07, 2019
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    Background: Antenatal betamethasone (BMZ) is a standard therapy for reducing respiratory distress syndrome in preterm infants. Recently, some reports have indicated that BMZ promotes ductus arteriosus (DA) closure. DA closure requires morphological remodeling; that is, intimal thickening (IT) formation; however, the role of BMZ in IT formation has not yet been reported.

    Methods and Results: First, DNA microarray analysis using smooth muscle cells (SMCs) of rat preterm DA on gestational day 20 (pDASMCs) stimulated with BMZ was performed. Among 58,717 probe sets, ADP-ribosyltransferase 3 (Art3) was markedly increased by BMZ stimulation. Quantitative reverse transcription polymerase chain reaction (RT-PCR) confirmed the BMZ-induced increase of Art3 in pDASMCs, but not in aortic SMCs. Immunocytochemistry showed that BMZ stimulation increased lamellipodia formation. BMZ significantly increased total paxillin protein expression and the ratio of phosphorylated to total paxillin. A scratch assay demonstrated that BMZ stimulation promoted pDASMC migration, which was attenuated byArt3-targeted siRNAs transfection. pDASMC proliferation was not promoted by BMZ, which was analyzed by a 5’-bromo-2’-deoxyuridine (BrdU) assay. Whether BMZ increased IT formation in vivo was examined. BMZ or saline was administered intravenously to maternal rats on gestational days 18 and 19, and DA tissues were obtained on gestational day 20. The ratio of IT to tunica media was significantly higher in the BMZ-treated group.

    Conclusions: These data suggest that antenatal BMZ administration promotes DA IT through Art3-mediated DASMC migration.

  • Keisuke Shoji, Kenji Yanishi, Ryusuke Yoshimi, Naoki Hamada, Kazuhisa ...
    Type: ORIGINAL ARTICLE
    Subject Area: Peripheral Vascular Disease
    Article ID: CJ-18-1044
    Published: February 07, 2019
    [Advance publication] Released: February 07, 2019
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    Background: Many patients with collagen disease (CD), particularly scleroderma (SSc), develop critical limb ischemia (CLI), which leads to limb amputation. However, conventional therapies, including revascularization via surgical bypass, showed poor outcomes in CLI patients with CD. Many CLI patients with SSc showed poor responses to combination therapies including intravenous iloprost, PDE-5 inhibitors, and bosentan. Therefore, new methods of improving the peripheral circulation for limb salvage are required. This study was a subanalysis of the long-term clinical outcomes after autologous bone marrow-derived mononuclear cells (BM-MNC) in CLI patients with SSc.

    Methods and Results: We assessed no-option CLI patients with CD who underwent BM-MNC implantation at 10 institutes; 69 patients (39 with SSc-related diseases (SSc group) and 30 with other CDs (non-SSc group)), were included. The median follow-up duration was 36.5 months. The 10-year overall survival rate was 59.1% in the SSc group and 82.4% in the non-SSc group. The 10-year major amputation-free rates were 97.4% and 82.6%, respectively. The number of major or minor amputations in the SSc group trended to be less than that in the non-SSc group. Significant improvements in visual analog scale scores were observed in both groups.

    Conclusions: The BM-MNC implantation may be feasible in no-option CLI patients with CD. In the SSc group, limb salvage rate tended to be higher than in the non-SSc group.

  • Nobuaki Tanaka, Koji Tanaka, Yuichi Ninomiya, Yuko Hirao, Takafumi Oka ...
    Type: ORIGINAL ARTICLE
    Subject Area: Arrhythmia/Electrophysiology
    Article ID: CJ-18-1035
    Published: February 06, 2019
    [Advance publication] Released: February 06, 2019
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    Background: Automated ablation lesion annotation with optimal settings for parameters including contact force (CF) and catheter stability may be effective for achieving durable pulmonary vein isolation.

    Methods and Results: We retrospectively examined 131 consecutive patients who underwent initial catheter ablation (CA) for paroxysmal atrial fibrillation (PAF) by automatic annotation system (VISITAG module)-guided radiofrequency CA (RFCA) (n=61) and 2nd-generation cryoballoon ablation (CBA) (n=70) in terms of safety and long-term efficacy. The automatic annotation criteria for the RFCA group were as follows: catheter stability range of motion ≤1.5 mm, duration ≥5 s, and CF ≥5 g. We ablated for >20 s with a force-time integral >150 gs at each site, before moving to the next site. Each interlesion distance was <6 mm. Procedural complications were more frequent in the CBA group (1.6% vs. 10.0%, P=0.034). Across a median follow-up of 2.98 years, 88.5% and 70.0% of patients in the RFCA and CBA groups, respectively, were free from recurrence (log-rank test, P=0.0039). There was also a significant difference in favor of RFCA with respect to repeat ablations (3.3% vs. 24.3%, log-rank test, P=0.0003).

    Conclusions: RF ablation guided by an automated algorithm that includes CF and catheter stability parameters showed better long-term outcomes than CBA in the treatment of patients with PAF without increasing complications.

  • Akiya Sakatani, Mayu Nishio, Kiyoshi Kume, Yasuji Doi, Keiji Hirooka
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-1141
    Published: February 06, 2019
    [Advance publication] Released: February 06, 2019
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  • Ji-hun Jang, Jaewon Oh, Hyo Sup Shim, Seok-Min Kang
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-1223
    Published: February 06, 2019
    [Advance publication] Released: February 06, 2019
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  • Nobuhiro Murata, Yasuo Okumura, Katsuaki Yokoyama, Naoya Matsumoto, Ei ...
    Type: ORIGINAL ARTICLE
    Subject Area: Arrhythmia/Electrophysiology
    Article ID: CJ-18-0991
    Published: February 05, 2019
    [Advance publication] Released: February 05, 2019
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    Background: Off-label dosing of direct oral anticoagulants (DOACs) is encountered clinically among patients with atrial fibrillation (AF), although data on the clinical outcomes of over- and under-dosing are lacking in Japan.

    Methods and Results: We examined the clinical outcomes of off-label DOAC dosing using the SAKURA AF Registry, a prospective multicenter registry in Japan. Among 3,237 enrollees, 1,676 under any of the 4 DOAC regimens were followed up for a median of 39.3 months: 746 (45.0%), appropriate standard-dose; 477 (28.7%), appropriate low-dose; 66 (4.0%), over-dose; and 369 (22.2%) under-dose. Compared with the standard-dose group, patients in the under- and over-dose groups were significantly older and had a higher stroke risk. After multivariate adjustment, stroke/systemic embolism (SE) and death events were equivalent between the standard- and under-dose groups, but major bleeding events tended to be lower in the under-dose group (hazard ratio [HR] 0.474, P=0.0739). Composite events (stroke/SE, major bleeding, or death) were higher in the over-dose than in the standard-dose group (HR 2.714, P=0.0081).

    Conclusions: Clinical outcomes were not worse for under-dose than for standard-dose users among patients with different backgrounds. Over-dose users, however, were at higher risk for all clinical events and required careful follow-up. Further studies are needed to clarify the safety and effectiveness of off-label DOAC dosing in Japan.

  • Yih-Jer Wu, Yi-Nan Lee, Tzu-Wei Wu, Chao-Liang Chou, Li-Yu Wang
    Type: ORIGINAL ARTICLE
    Subject Area: Epidemiology
    Article ID: CJ-18-1046
    Published: February 02, 2019
    [Advance publication] Released: February 02, 2019
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    Background: Bone morphogenetic proteins (BMP) 2 and 4 are implicated in the development of atherosclerosis. However, the relationships between the proteins, their main receptors and carotid intima-media thickness (cIMT), a predictive preclinical phenotype of atherosclerosis, have not been established.

    Methods and Results: We screened and validated the relationships of single-nucleotide polymorphisms (SNPs) on BMP2, BMP4, BMPR1A, BMPR1B, and BMPR2 with thicker cIMT by 2 independent case-control studies that used different subject selection methods. Among 200 screened SNPs, 12 on BMPR1B were regarded as candidate genetic markers (P-value <5.0×10−4). After combining the discovery and validation studies and adjusting for traditional cardiovascular risk factors, rs4456963*G, rs4235438*T, rs2522530*T, and rs3796433*C showed significant higher odds ratios (ORs) of having thicker cIMT (adjusted ORs: 1.50–1.56; all P-values <2.5×10−4). Multivariate analyses showed that rs4456963 and rs3796433 were significantly independent determinants of cIMT thickening. The corresponding multivariate-adjusted ORs for rs4456963*G and rs3796433*C alleles were 1.50 (95% confidence interval (CI): 1.22–1.84) and 1.50 (95% CI: 1.23–1.82), respectively. Interaction between rs4456963 and rs3796433 was evident by the significantly higher OR (8.16, 95% CI: 3.12–21.3) for subjects with the GG-CC genotype. The rs4456963*G and rs3796433*C showed positively linear trends with severity of carotid atherosclerosis.

    Conclusions: We identified 2 SNPs on BMPR1B showing significantly independent correlations with thicker cIMT. The study provides invaluable evidence supporting that BMPR1B is closely related to carotid atherosclerosis and a potential target for the development of therapeutic agents for atherosclerotic disease.

  • Kensuke Yokoi, Isamu Mizote, Tatsuya Shiraki, Seiko Ide, Tomohito Ohta ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-1338
    Published: February 02, 2019
    [Advance publication] Released: February 02, 2019
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  • Taku Asano, Jarkko Hytönen, Ply Chichareon, Jouni Taavitsainen, Norihi ...
    Type: ORIGINAL ARTICLE
    Subject Area: Cardiovascular Intervention
    Article ID: CJ-18-0855
    Published: January 31, 2019
    [Advance publication] Released: January 31, 2019
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    Background: Little is known about serial changes in lumen and device dimensions after bioresorbable scaffold implantation in a growing animal model.

    Methods and Results: ABSORB (n=14) or bare metal stents (ICROS amg [Abbott Vascular, Santa Clara, CA, USA], Winsen-Luhe, Germany; n=15) were implanted in the coronary arteries of domestic swine (a hybrid of Finnish-Norwegian Landrace swine) weighing 30–35 kg. Angiography and optical coherence tomography (OCT) were performed immediately after implantation and repeated at 7 days, 1, 3, 6 and 12 months after the index procedure. One month after implantation, mean lumen area decreased relative to baseline in both groups (relative area change from baseline, −41.4±15.6% for ABSORB vs. −20.9±18.6% for ICROS) while mean device area decreased only in the ABSORB group (relative area change: −11.1±9.4% vs. +0.14±7.95%, respectively). At 12 months, mean lumen area increased relative to baseline in both groups (relative area change from baseline, +55.6±22.4% vs. +32.3±83.6%, respectively) in accordance with the swine growth weighing up to 260–300 kg. Mean device area in the ICROS group remained stable whereas that in the ABSORB group began to increase between 3 and 6 months along with the vessel growth (relative area change: +107.8±25.7% vs. +0.14±7.95%).

    Conclusions: In the growing porcine model, ABSORB was associated with greater extent of recoil 1 month after implantation compared with ICROS but demonstrated substantial adaptability to vessel growth in late phase.

  • Hiroki Nakano, Kazunori Omote, Toshiyuki Nagai, Michikazu Nakai, Kunih ...
    Type: ORIGINAL ARTICLE
    Subject Area: Heart Failure
    Article ID: CJ-18-1243
    Published: January 31, 2019
    [Advance publication] Released: January 31, 2019
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    Background: The ideal mortality prediction model (MPM) for acute heart failure (AHF) patients would have sufficient and stable predictive ability for long-term as well as short-term mortality. However, published MPMs for AHF predominantly predict short-term mortality up to 90 days, and their prognostic performance for long-term mortality remains unclear.

    Methods and Results: We analyzed 609 AHF patients in a prospective registry from January 2013 to May 2016. We compared the prognostic performance for long-term mortality among 8 systematically identified MPMs for AHF that predict short-term mortality up to 90 days from admission. The PROTECT 7-day model showed the highest c-index for long-term as well as short-term mortality among the studied MPMs. Sensitivity analyses revealed serum albumin and total cholesterol to be the most important variables, as dropping these variables resulted in a significant decline in c-index, when compared with other variables specific to the PROTECT 7-day model. Furthermore, significant improvements in c-index and net reclassification were observed when serum albumin or serum albumin plus total cholesterol was added to the studied MPMs, other than the PROTECT 7-day model.

    Conclusions: The PROTECT 7-day model demonstrated the highest predictive performance for long-term as well as short-term mortality in AHF patients among the published MPMs. Our findings indicate the importance of accounting for nutritional status such as serum albumin and total cholesterol in AHF patients when developing a MPM.

  • Masaki Miyasaka, Sung-Han Yoon, Rahul P. Sharma, Yoshio Maeno, Sandhu ...
    Type: ORIGINAL ARTICLE
    Subject Area: Valvular Heart Disease
    Article ID: CJ-18-1059
    Published: January 30, 2019
    [Advance publication] Released: January 30, 2019
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    Background: Patients with severe aortic stenosis (AS) and an extra-large annulus (ELA) area (>683 mm2) can rarely be treated by transcatheter aortic valve replacement (TAVR) because of the size limitation of the transcatheter heart valves. This study aimed to evaluate the feasibility of TAVR using a 29-mm SAPIEN3 (S3) valve in patients with ELA and S3-dimensions by post-procedural computed tomography (post-CT).

    Methods and Results: We included 261 patients undergoing TAVR using a 29-mm S3: 30 patients with ELA and 231 with non-ELA were identified. S3-dimensions were evaluated at the S3 inflow and annulus level by post-CT in 129 patients. The ELA group had a greater aortic annulus area measured by pre-procedural CT (737.3±54.7 vs. 578.4±41.9 mm2, P<0.0001), higher balloon inflation volume (36 vs. 33 mL, P<0.0001), a larger S3 area at inflow by post-CT (729.6±42.2 vs. 682.2±35.0 mm2, P<0.001), and a correlation between the inflation volume and S3 area (r=0.71, P=0.0005). No differences were observed between groups in paravalvular aortic regurgitation (PAR) ≥mild (43.3% vs. 27.6%, P=0.09), PAR ≥moderate (3.3% vs. 1.3%, P=0.39) or 1-year mortality (10.0% vs. 9.1%, P=0.87).

    Conclusions: TAVR using a 29-mm S3 with extra inflation of the delivery balloon can be considered as a treatment option for patients with severe AS and ELA.

  • Yuta Seko, Takao Kato, Yusuke Morita, Yuhei Yamaji, Yoshizumi Haruna, ...
    Type: ORIGINAL ARTICLE
    Subject Area: Heart Failure
    Article ID: CJ-18-1095
    Published: January 30, 2019
    [Advance publication] Released: January 30, 2019
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    Background: Using the normal values for the East Asian population, we evaluated age- and body size-adjusted left ventricular end-diastolic dimension (LVEDD) and its prognostic impact in a hospital-based population in Japan.

    Methods and Results: We retrospectively analyzed data obtained from 4,444 consecutive patients who had undergone both transthoracic echocardiography and electrocardiography at Kitano Hospital in 2013. Those who presented with a history of previous episodes of myocardial infarction and severe or moderate valvular disease or with low ejection fraction (<50%) were excluded from the analysis. We calculated LVEDD adjusted by age and body surface area. A total of 3,474 patients were categorized into 3 groups: 401 with large adjusted LVEDD, 2,829 with normal adjusted LVEDD, and 244 with small adjusted LVEDD. Mean patient age in the large, normal, and small adjusted LVEDD groups was 66.6±18.4, 65.6±15.7, and 62.1±15.5 years, respectively (P<0.001). After adjusting for confounding factors, the excess adjusted 3-year risk of primary outcome of large adjusted LVEDD relative to normal LVEDD was significant (HR, 1.40; 95% CI: 1.08–1.78). The risk for primary outcomes of small adjusted LVEDD relative to normal adjusted LVEDD was significantly lower (HR, 0.55; 95% CI: 0.34–0.85).

    Conclusions: Adjusted large LVEDD has a deleterious impact on long-term mortality, whereas small LVEDD carried a significantly lower risk.

  • Naoki Sato
    Type: EDITORIAL
    Article ID: CJ-19-0022
    Published: January 30, 2019
    [Advance publication] Released: January 30, 2019
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  • Osamu Seguchi, Kensuke Kuroda, Tomoyuki Fujita, Yuto Kumai, Seiko Naka ...
    Type: RAPID COMMUNICATION
    Article ID: CJ-18-1060
    Published: January 26, 2019
    [Advance publication] Released: January 26, 2019
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    Background: Heart transplantation (HTx) is reported to have a comparable effect on the prognosis of heart failure patients without muscular disease and for those with muscular dystrophy (MD). However, little is known about the changes in muscular diseases in patients with MD after HTx.

    Methods and Results: We assessed the ambulatory capacity of 9 patients with MD who underwent HTx. All patients demonstrated improvement in ambulation to varying degrees and 1 patient successfully climbed Mount Fuji 3.8 years after HTx.

    Conclusions: HTx potentially improves not only the prognosis but also the ambulatory capacity of patients with MD.

  • Paula Tiili, Jukka Putaala, Juha Mehtälä, Houssem Khanfir, Jussi Niira ...
    Type: ORIGINAL ARTICLE
    Subject Area: Arrhythmia/Electrophysiology
    Article ID: CJ-18-0975
    Published: January 25, 2019
    [Advance publication] Released: January 25, 2019
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    Background: Intracranial hemorrhage (ICH) is a devastating complication of oral anticoagulation. The aim of this study was to describe the spectrum of ICH and to evaluate the association of warfarin control with the risk of ICH in a nationwide cohort of unselected atrial fibrillation (AF) patients.

    Methods and Results: The FinWAF is a retrospective registry-linkage study. Data were collected from several nationwide Finnish health-care registers and laboratory databases. The primary outcome was any ICH (traumatic or non-traumatic). The quality of warfarin therapy was assessed continuously by calculating the time in therapeutic range in a 60-day window (TTR60). Adjusted Cox proportional hazard models were used. A total of 53,953 patients were included (53% men; mean age, 73 years; mean follow-up, 2.94 years; mean TTR, 63%). In 129,684 patient-years, 1,196 patients had ICH (non-traumatic, 53.5%; traumatic, 43.6%; traumatic subdural, 38.6%); crude annual rate, 0.92%; 95% CI: 0.87–0.98). A lower TTR60 was significantly associated with higher risk of ICH (TTR60 ≤40% vs. TTR60 >80%; adjusted hazard ratio, 2.16; 95% CI: 1.83–2.54). Other variables independently associated with ICH included age >65 years, previous stroke, male sex, low hemoglobin, thrombocytopenia, elevated alanine aminotransferase, and previous bleeding other than ICH.

    Conclusions: Poor control of warfarin treatment was associated with elevated risk of ICH. Approximately half of the ICH were traumatic, mainly subdural.

  • Hidehiro Kaneko, Issei Komuro
    Type: EDITORIAL
    Article ID: CJ-18-1370
    Published: January 25, 2019
    [Advance publication] Released: January 25, 2019
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  • Masato Nakamura, Ken Kozuma, Takanari Kitazono, Tomoko Iizuka, Toru Se ...
    Type: ORIGINAL ARTICLE
    Subject Area: Ischemic Heart Disease
    Article ID: CJ-18-0956
    Published: January 24, 2019
    [Advance publication] Released: January 24, 2019
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    Background: A unique dose of prasugrel has been approved exclusively for Japanese patients, but real-world data for prasugrel at that dose in patients with ischemic heart disease (IHD) are limited. Therefore, large-scale, real-world data are needed.

    Methods and Results: A 2-year observational study of Japanese patients with IHD undergoing percutaneous coronary intervention and being treated with prasugrel to evaluate safety and effectiveness. This report is an interim analysis of data from case report forms (CRFs) after 3 months. CRFs were collected from 4,270 patients, 4,157 of whom were eligible for the safety and effectiveness analysis sets (mean age, 68.3 years; male, 76.5%). The median treatment period was 112 days, and 92.3% of patients continued treatment with prasugrel. The incidence of non-coronary artery bypass grafting-related bleeding adverse events (AEs) was 3.1%, of which Thrombolysis in Myocardial Infarction (TIMI) major and minor bleeding accounted for 0.5% and 0.6%, respectively. The most common bleeding AEs were gastrointestinal disorders, which accounted for 43.2% of the sum of “TIMI major and minor bleeding AEs”. The incidence of major adverse cardiovascular events (MACE) was 1.0%, and the cumulative incidence of MACE was 1.4%. The incidence of stent thrombosis was 0.2%.

    Conclusions: Interim study results indicated that prasugrel was safe and effective during the early phase of treatment in Japanese patients with IHD in real-world clinical settings.

  • Masayoshi Yamamoto, Yoshihiro Seo, Tomoko Ishizu, Isao Nishi, Yoshie H ...
    Type: ORIGINAL ARTICLE
    Subject Area: Heart Failure
    Article ID: CJ-18-0881
    Published: January 23, 2019
    [Advance publication] Released: January 23, 2019
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    Background: Left ventricular ejection fraction (LVEF) can dramatically change when the patient has acute decompensated heart failure (ADHF). We investigated the impact of LVEF and subsequent changes on prognosis in patients with ADHF through a prospective study.

    Methods and Results: A total of 516 hospitalized patients with ADHF were evaluated. Echocardiography was performed on admission, prior to discharge, and 1 year after discharge. The primary endpoint was a composite of cardiovascular death and hospitalization. In heart failure with reduced EF (HFrEF; LVEF <40%), LVEF did not significantly improve during hospitalization (P=0.348); however, it improved after discharge (P<0.001). In contrast, LVEF improved during hospitalization (P<0.001) in HF with preserved EF (HFpEF; LVEF ≥50%). In HF with mid-range EF (HFmrEF; LVEF 40–49%), LVEF consistently improved throughout the observation period (P<0.001). A multivariable Cox model showed that improved LVEF after discharge was associated with a better outcome in HFrEF (hazard ratio [HR]: 0.951; 95% confidence interval [CI]: 0.928–0.974; P<0.001), while improved LVEF during hospitalization was associated with a better outcome in HFpEF (HR: 0.969; 95% CI: 0.940–0.998; P=0.038).

    Conclusions: Improved LVEF after discharge in HFrEF and during hospitalization in HFpEF was associated with a better prognosis in patients with ADHF. Longitudinal improvements in LVEF had different prognostic impact, depending on the HF type by LVEF measurement.

  • Tomoyuki Kawada
    Type: LETTER TO THE EDITOR
    Article ID: CJ-18-0941
    Published: January 23, 2019
    [Advance publication] Released: January 23, 2019
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  • Mikiko Ohashi, Takashi Kohno, Keiichi Fukuda
    Type: AUTHOR’S REPLY
    Article ID: CJ-18-1198
    Published: January 23, 2019
    [Advance publication] Released: January 23, 2019
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  • Yasuhiro Otsuka, Koji Sato, Daisuke Sueta, Satoru Suzuki, Osamu Matsuo ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-1234
    Published: January 22, 2019
    [Advance publication] Released: January 22, 2019
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  • Mohamed Rady, Stefan Ulbrich, Felix Heidrich, Stefanie Jellinghaus, Ka ...
    Type: ORIGINAL ARTICLE
    Subject Area: Heart Failure
    Article ID: CJ-18-0986
    Published: January 20, 2019
    [Advance publication] Released: January 20, 2019
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    Background: Left ventricular (LV) torsion is a key parameter in cardiac function and predicts functional capacity (FC) more appropriately than LV ejection fraction (EF). We sought to investigate LV torsion as a marker of hospitalization for worsening heart failure (HF) in non-ischemic dilated cardiomyopathy (DCM) patients.

    Methods and Results: The 91 outpatients with newly diagnosed DCM (53±13 years, 20% female) were evaluated with 3D speckle-tracking imaging and followed up for 12 months; 43 healthy sex- and age-matched volunteers served as controls. LV torsion, LVEF, right ventricular function, LV global longitudinal (GLS) and circumferential (GCS) strain values, peak oxygen uptake (peak V̇O2) from FC and B-type natriuretic peptide levels were measured at baseline. Peak V̇O2correlated successively with LV torsion, diastolic filling and GCS (r=0.70, −0.52 and −0.41, P<0.01) disclosing the central role of LV torsion. During follow-up (median 272 days), 24 (26%) cardiac events occurred. A reduced LV torsion (<0.59 degrees/cm) predicted cardiac events similar to a reduced peak V̇O2(<19 mL/kg/min) (unadjusted hazard ratio 6.41 and 5.90, P<0.001). LV torsion provided a significant incremental value over right ventricular function and peak V̇O2(C-index: 0.85, P=0.02).

    Conclusions: The results demonstrated a clear relation between LV torsion and disease severity, suggesting that LV torsion has additional prognostic relevance in DCM patients.

  • Shi-Lin Tang, Zhen-Wang Zhao, Shang-Ming Liu, Gang Wang, Xiao-Hua Yu, ...
    Type: ORIGINAL ARTICLE
    Subject Area: Aortic Disease
    Article ID: CJ-18-0700
    Published: January 18, 2019
    [Advance publication] Released: January 18, 2019
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    Background: Recent studies have suggested that pregnancy-associated plasma protein-A (PAPP-A) is involved in the pathogenesis of atherosclerosis. This study aim is to investigate the role and mechanisms of PAPP-A in reverse cholesterol transport (RCT) and inflammation during the development of atherosclerosis.

    Methods and Results: PAPP-A was silenced in apolipoprotein E (apoE−/−) mice with administration of PAPP-A shRNA. Oil Red O staining of the whole aorta root revealed that PAPP-A knockdown reduced lipid accumulation in aortas. Oil Red O, hematoxylin and eosin (HE) and Masson staining of aortic sinus further showed that PAPP-A knockdown alleviated the formation of atherosclerotic lesions. It was found that PAPP-A knockdown reduced the insulin-like growth factor 1 (IGF-1) levels and repressed the PI3K/Akt pathway in both aorta and peritoneal macrophages. The expression levels of LXRα, ABCA1, ABCG1, and SR-B1 were increased in the aorta and peritoneal macrophages from apoE−/−mice administered with PAPP-A shRNA. Furthermore, PAPP-A knockdown promoted RCT from macrophages to plasma, the liver, and feces in apoE−/−mice. In addition, PAPP-A knockdown elevated the expression and secretion of monocyte chemoattractant protein-1 (MCP-1), interleukin-6 (IL-6), tumor necrosis factor-α, and interleukin-1β through the nuclear factor kappa-B (NF-κB) pathway.

    Conclusions: The present study results suggest that PAPP-A promotes the development of atherosclerosis in apoE−/−mice through reducing RCT capacity and activating an inflammatory response.

  • Tomomi Nagayama, Satoshi Nagase, Tsukasa Kamakura, Mitsuru Wada, Kohei ...
    Type: ORIGINAL ARTICLE
    Subject Area: Arrhythmia/Electrophysiology
    Article ID: CJ-18-0643
    Published: January 12, 2019
    [Advance publication] Released: January 12, 2019
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    Background: Spontaneous type 1 electrocardiogram (ECG) in the right precordial lead is a dominant predictor of ventricular fibrillation (VF) in Brugada syndrome (BrS). In some BrS patients with VF, however, spontaneous type 1 ECG is undetectable, even in repeated ECG and immediately after VF. This study investigated differences between BrS patients with spontaneous or drug-induced type 1 ECG.

    Methods and Results: We evaluated 15 BrS patients with drug-induced (D-BrS) and 29 with spontaneous type 1 ECG (SP-BrS). All patients had had a previous VF episode. In each D-BrS patient, ECG was recorded more than 15 times (mean, 46±34) during 7.2±5.1 years of follow-up. Age and family history were comparable between groups. Inferolateral early repolarization (ER) was observed in 13 D-BrS (87%) at least once but in only 3 SP-BrS (10%, P<0.01). Immediately after VF, inferolateral ER was accentuated in 9 of 10 D-BrS, while type 1 ECG was accentuated in 12 of 16 SP-BrS. Fragmented QRS in the right precordial lead and aVR sign were absent in D-BrS but present in 20 (69%, P<0.01) and 11 (38%, P<0.01) SP-BrS, respectively. There was no prognostic difference between groups.

    Conclusions: Although having similar clinical profiles, there are obvious ECG differences between VF-positive BrS patients with spontaneous or drug-induced type 1 ECG. The inferolateral lead rather than the right precordial lead on ECG may be particularly crucial in some BrS patients.

  • Eitaro Kodani, Tomohiro Kaneko, Hitomi Fujii, Hiroyuki Nakamura, Hajim ...
    Type: ORIGINAL ARTICLE
    Subject Area: Arrhythmia/Electrophysiology
    Article ID: CJ-18-1038
    Published: January 11, 2019
    [Advance publication] Released: January 11, 2019
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    Background: Although National Health Insurance special health checkups have been useful for the diagnosis of metabolic syndrome, they are insufficient to identify atrial fibrillation (AF). In Tama City in Tokyo, 12-lead electrocardiogram has been included as an essential examination in special health checkups to diagnose AF since 2008.

    Methods and Results: In subjects aged 40–74 years at entry, prevalence of AF was 0.8% (men, 1.7%; women, 0.2%) in 2008 and 1.4% (men, 2.9%; women, 0.4%) in 2015. Of 10,430 subjects without AF in 2008 (mean age, 64.9±7.1 years; men, 40.4%), AF developed in 133 between 2008 and 2015. The incidence rate of new-onset AF was 2.5/1,000 person-years during an observation period of 52,707 person-years. On multivariate Cox regression analysis in subjects without a history of cardiac disease, hypertension (HR, 1.58; 95% CI: 1.01–2.47, P=0.045) and body mass index (BMI; /1-kg/m2increase; HR, 1.07; 95% CI: 1.00–1.12, P=0.049) were significant risk factors for new-onset AF in addition to age and male sex.

    Conclusions: Prevalence of AF increased between 2008 and 2015. Age, male sex, hypertension, and BMI were significant predictors for future incidence of AF in the general population without overt cardiac disease. Controlling hypertension and BMI may prevent new-onset AF in the general population.

  • Satoshi Yamaguchi, Masami Abe, Tomohiro Arakaki, Osamu Arasaki, Michio ...
    Type: ORIGINAL ARTICLE
    Subject Area: Heart Failure
    Article ID: CJ-18-0961
    Published: December 29, 2018
    [Advance publication] Released: December 29, 2018
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    Background: Acute heart failure (AHF) triggers platelet aggregation and platelet markers are associated with the severity of AHF. The present study aimed to investigate the prognostic value of platelet count (PLT) in patients with AHF.

    Methods and Results: This single-center retrospective observational study analyzed 425 consecutive patients with AHF. The patients were divided into groups based on tertiles of PLT: low (PLT1 <170,000/μL), intermediate (170,000/μL≤PLT<230,000/μL), and high (PLT3 ≥230,000/μL). The endpoint was all-cause death with a composite endpoint of all-cause death and HF rehospitalization. Survival analysis was performed, and Cox proportional hazard models adjusted by an established risk score (Get With The Guidelines score) were generated. The PLT1 group had the worst survival for all-cause death (log-rank, P=0.003) and the composite endpoint (P=0.009). A significant trend of increasing survival was observed for all-cause death (log-rank trend, P<0.001) and the composite endpoint (P=0.002) in the following order: PLT1, PLT2, and PLT3. Adjusted Cox proportional hazard models demonstrated that low PLT was a risk factor of all-cause death and the composite endpoint.

    Conclusions: Low PLT was associated with risk for all-cause death and HF rehospitalization in patients with AHF.

  • Sang-Hyun Ihm, George Bakris, Ichiro Sakuma, Il Suk Sohn, Kwang Kon Ko ...
    Type: REVIEW
    Article ID: CJ-18-1293
    Published: December 29, 2018
    [Advance publication] Released: December 29, 2018
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    Until the 2017 ACC/AHA Hypertension Guidelines were released, the target blood pressure (BP) for adults with hypertension (HTN) was 140/90 mmHg in most of the guidelines. The new 2018 ESC/ESH, Canadian, Korean, Japan, and Latin American hypertension guidelines have maintained the <140/90 mmHg for the primary target in the general population and encourage reduction to <130/80 if higher risk. This is more in keeping with the 2018 American Diabetes Association guidelines. However, the 2017 ACC/AHA guidelines classify HTN as BP ≥130/80 mmHg and generally recommend target BP levels below 130/80 mmHg for hypertensive patients independently of comorbid disease or age. Although the new guidelines mean that more people (nearly 50% of adults) will be diagnosed with HTN, the cornerstone of therapy is still lifestyle management unless BP cannot be lowered to this level; thus, more people will require BP-lowering medications. To date, there have been many controversies about the definition of HTN and the target BP. Targeting an intensive systolic BP goal can increase the adverse effects of multiple medications and the cardiovascular disease risk by excessively lowering diastolic BP, especially in patients with high risk, including those with diabetes, chronic kidney disease, heart failure, and coronary artery disease, and the elderly. In this review, we discuss these issues, particularly regarding the optimal target BP.

  • Shinichi Nunoda, Taro Sasaoka, Yasushi Sakata, Minoru Ono, Yoshiki Saw ...
    Type: RAPID COMMUNICATION
    Article ID: CJ-17-0024
    Published: December 27, 2018
    [Advance publication] Released: December 27, 2018
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    Background: In Japan, there are more patients waiting for heart transplants (HTXs) than available organs.

    Methods and Results: Since July 2010, 68 pediatric and 366 adult patients aged <60 years applied for HTX candidacy with the Japanese Circulation Society’s HTX Committee. No significant differences in freedom from death or HTX were observed between pediatric Status 1 and Status 2 patients. More adult Status 1 patients reached the endpoint of death or HTX than adult Status 2 patients. Pediatric patients (Status 1 and 2) did not have better survival than adult Status 1 or Status 2 patients.

    Conclusions: Pediatric patients should be prioritized over adult patients for HTX.

  • Mizuki Harada, Hiroshi Suzuki, Seiko Ohno, Junichi Ozawa, Akihiko Sait ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-0984
    Published: December 22, 2018
    [Advance publication] Released: December 22, 2018
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  • Haisong Bu, Tianli Zhao
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-0865
    Published: December 20, 2018
    [Advance publication] Released: December 20, 2018
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  • Daisuke Sueta, Seitaro Oda, Eiichiro Yamamoto, Masato Nishi, Koichi Ka ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-1062
    Published: December 19, 2018
    [Advance publication] Released: December 19, 2018
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  • Hirohisa Endo, Tomotaka Dohi, Takehiro Funamizu, Jun Shitara, Hideki W ...
    Type: ORIGINAL ARTICLE
    Subject Area: Ischemic Heart Disease
    Article ID: CJ-18-0962
    Published: December 12, 2018
    [Advance publication] Released: December 12, 2018
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    Background: High-sensitivity C-reactive protein (hs-CRP) is a well known risk factor for the development of cardiovascular disease and cancer. We investigated the long-term impact of hs-CRP on cancer mortality in patients with stable coronary artery disease (CAD).

    Methods and Results: This study was a retrospective analysis of 2,867 consecutive patients who underwent percutaneous coronary intervention for stable CAD from 2000 to 2016. The patients were divided into 2 groups according to median hs-CRP. We then evaluated the association between baseline hs-CRP and both all-cause and cancer deaths. Median hs-CRP was 0.10 mg/dL (IQR, 0.04–0.27 mg/dL). The median follow-up period was 5.8 years (IQR, 2.3–10.0 years). There were 416 deaths (14.5%), including 149 cardiovascular deaths (5.2%) and 115 (4.0%) cancer deaths. On Kaplan-Meier analysis the higher hs-CRP group had a significantly higher incidence of both all-cause and cancer death (log-rank, P<0.001 and P=0.001, respectively). On multivariable analysis higher hs-CRP was significantly associated with higher risk of cancer death (HR, 1.74; 95% CI: 1.18–2.61, P=0.005).

    Conclusions: Elevated baseline hs-CRP was significantly associated with cancer mortality in patients with stable CAD. Hs-CRP measurement may be useful for the identification of subjects with an increased risk of cancer death.

  • Satoru Mitomo, Ozan M. Demir, Francesco Giannini, Azeem Latib, Antonio ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-0795
    Published: 2018
    [Advance publication] Released: November 20, 2018
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  • Takumi Yamada
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-0968
    Published: 2018
    [Advance publication] Released: November 06, 2018
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  • Shusuke Yagi, Hiromu Yamazaki, Susumu Nishio, Kenya Kusunose, Hirotsug ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-18-0898
    Published: 2018
    [Advance publication] Released: November 03, 2018
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  • 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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  • 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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  • 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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  • 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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