Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Advance online publication
Displaying 1-50 of 77 articles from this issue
  • Kazufumi Nakamura, Toru Miyoshi, Satoshi Akagi, Norihisa Toh, Yukihiro ...
    Article type: 2022 JCS REPORT
    Article ID: CJ-22-0349
    Published: June 29, 2022
    Advance online publication: June 29, 2022
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    The 86thAnnual Scientific Meeting of the Japanese Circulation Society was held in a web-based format on March 11–13, 2022. In accordance with the internationalization policy of the JCS, the meeting was held with the Asian Pacific Society of Cardiology Congress 2022. The main theme was “Cardiology Spreading its Wings”. The number of patients with heart failure and other cardiovascular diseases is increasing dramatically, and the fields dealt with by cardiovascular medicine are also greatly expanding. This conference was both intellectually satisfying and exciting for all participants, who numbered over 14,900. The meeting was completed with great success, and the enormous amount of cooperation and support from all involved was greatly appreciated.

  • Takahiro Okumura, Hiroaki Hiraiwa, Mikito Takefuji, Toyoaki Murohara
    Article type: EDITORIAL
    Article ID: CJ-22-0343
    Published: June 28, 2022
    Advance online publication: June 28, 2022
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  • Qiong Lan, Tiangang Li, Bin Ma
    Article type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-22-0200
    Published: June 15, 2022
    Advance online publication: June 15, 2022
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  • Yuya Miyamoto, Toru Kubo, Yuri Ochi, Yuichi Baba, Takayoshi Hirota, Na ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-22-0068
    Published: June 07, 2022
    Advance online publication: June 07, 2022
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    Background: The clinical features of heart failure (HF) in patients with hypertrophic cardiomyopathy (HCM) in Japan have not been fully elucidated.

    Methods and Results: In 293 patients with HCM (median age at registration, 65 (57–72) years) in a prospective cardiomyopathy registration network in Kochi Prefecture (Kochi RYOMA study), HF events (HF death or hospitalization for HF) occurred in 35 patients (11.9%) (median age, 76 (69–80) years), including 11 HF deaths during a median follow-up of 6.1 years. The 5-year HF events rate was 9.6%. Atrial fibrillation, low percentage of fractional shortening, and high B-type natriuretic peptide level at registration were predictors of HF events. The combination of these 3 factors had a relatively high positive predictive value (55%) for HF events and none of them had a high negative predictive value (99%). There were 4 types of HF profile: left ventricular (LV) systolic dysfunction (40%), severe LV diastolic dysfunction (34%), LV outflow tract obstruction (LVOTO) (20%), and primary mitral regurgitation (MR) (6%). HF deaths occurred in patients with LV systolic dysfunction or LV diastolic dysfunction, but none of patients with LVOTO or primary MR due to additional invasive therapies.

    Conclusions: In a Japanese HCM cohort, HF was an important complication, requiring careful follow-up and appropriate treatment.

  • Takayuki Ishihara, Isamu Mizote, Daisuke Nakamura, Naotaka Okamoto, Ta ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-22-0098
    Published: June 04, 2022
    Advance online publication: June 04, 2022
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    Supplementary material

    Background: A polymer-free biolimus A9-coated stent (PF-BCS) may achieve better arterial healing than a durable polymer drug-eluting stent owing to its polymer-free feature.

    Methods and Results: This multicenter, prospective, observational study enrolled 105 patients (132 lesions) who underwent PF-BCS (51 patients, 71 lesions) or durable polymer everolimus-eluting stent (DP-EES, 54 patients, 61 lesions) implantation. Serial coronary angioscopy (CAS) and optical coherence tomography (OCT) examinations were performed at 1 and 12 months, and the serial vessel responses were compared between PF-BCS and DP-EES. The primary outcome measure was the incidence of subclinical intrastent thrombus on CAS. The secondary outcome measures were: adequate strut coverage (≥40 μm) on OCT and maximum yellow color grade on CAS. The incidence of thrombus was high at 1 month (100% vs. 93%, P=0.091), but decreased at 12 months (18% vs. 25%, P=0.56), without a significant difference between PF-BCS and DP-EES. The adequate strut coverage rate was significantly higher (84±14% vs. 69±22%, P<0.001) and yellow color was significantly less intense (P=0.012) at 12 months in PF-BCS than in DP-EES; however, they were not significantly different at 1 month (adequate strut coverage: 47±21% vs. 50±17%, P=0.40; yellow color: P=0.99).

    Conclusions: Although the thrombogenicity of PF-BCS was similar to that of DP-EES, the adequate coverage and plaque stabilization rates of PF-BCS were superior to those of DP-EES at 12 months.

  • Masatsugu Miyagawa, Nobuhiro Murata, Katsunori Fukumoto, Keisuke Kojim ...
    Article type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-22-0199
    Published: June 04, 2022
    Advance online publication: June 04, 2022
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  • Yukihito Higashi
    Article type: EDITORIAL
    Article ID: CJ-22-0305
    Published: June 03, 2022
    Advance online publication: June 03, 2022
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  • Jumpei Ohashi, Kenichi Sakakura, Hiroyuki Jinnouchi, Yousuke Taniguchi ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-22-0188
    Published: May 31, 2022
    Advance online publication: May 31, 2022
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    Background: As severity of acute myocardial infarction (AMI) varies widely, several risk stratifications for AMI have been reported. We have introduced a novel AMI risk stratification system linked to a rehabilitation program (novel AMI risk stratification; nARS), which stratified AMI patients into low (L)-, intermediate (I)-, and high (H)-risk groups. The purpose of this retrospective study was to compare the long-term clinical outcomes in patients with AMI among L-, I-, H-risk groups.

    Methods and Results: This study included 773 AMI patients, and assigned them into the L-risk group (n=332), the I-risk group (n=164), and the H-risk group (n=277). The primary endpoint was major cardiovascular events (MACE), defined as the composite of all-cause death, readmission for heart failure, non-fatal myocardial infarction, and target vessel revascularization after the discharge of index admission. The median follow-up duration was 686 days. MACE was most frequently observed in the H-risk group (39.4%), followed by the I-risk group (23.2%), and least in the L-risk group (19.9%) (P<0.001). The multivariate Cox hazard analysis revealed that the H-risk was significantly associated with MACE (HR 2.166, 95% CI 1.543–3.041, P<0.001) after controlling for multiple confounding factors.

    Conclusions: H-risk according to nARS was significantly associated with long-term adverse events after hospital discharge for patients with AMI. These results support the validity of nARS as a risk marker for long-term outcomes.

  • Yohei Numasawa
    Article type: EDITORIAL
    Article ID: CJ-22-0297
    Published: May 31, 2022
    Advance online publication: May 31, 2022
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  • Masahiro Kamouchi
    Article type: EDITORIAL
    Article ID: CJ-22-0284
    Published: May 28, 2022
    Advance online publication: May 28, 2022
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  • Koshiro Kanaoka, Yoshitaka Iwanaga, Nagaharu Fukuma, Michikazu Nakai, ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-22-0095
    Published: May 27, 2022
    Advance online publication: May 27, 2022
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    Supplementary material

    Background: Few studies have comprehensively evaluated the trends and factors associated with CR participation across major cardiovascular diseases in Japan.

    Methods and Results: This study performed a nationwide cross-sectional study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan and the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination database. This study described the nationwide trends and evaluated patient- and hospital-level associated factors of CR participation for patients with acute heart failure (AHF), acute coronary syndrome (ACS), acute aortic dissection (AAD), peripheral artery disease (PAD), and after cardiovascular surgery using mixed-effect logistic regression analysis. Although the annual number of patients who underwent CR has increased during the study period, the total number of patients participating in outpatient CR was lower than that of inpatient CR. The outpatient CR participation rate was lower for patients with AHF (3.5%), AAD (3.2%), and PAD (1.7%), compared with ACS (7.9%) and after surgery (9.4%). Age, sex, body mass index, Barthel index, Charlson comorbidity index, and institutional capacity were identified as significant associated factors of CR participation in inpatient and outpatient settings.

    Conclusions: Participation in outpatient CR was still low, and higher age, multi-comorbidity, and low institutional capacity contributed to the lower outpatient CR participation rate. Identification of the associated factors may help cardiologists to increase CR participation.

  • Satomi Ishihara, Shinya Hiramitsu, Koshiro Kanaoka, Mizuri Taki, Hitos ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-22-0032
    Published: May 25, 2022
    Advance online publication: May 25, 2022
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    Supplementary material

    Background: Although B-type natriuretic peptide (BNP) and N-terminal (NT)-proBNP are commonly used markers of heart failure, a simple conversion formula between these peptides has not yet been developed for clinical use.

    Methods and Results: A total of 9,394 samples were obtained from Nara Medical University, Jichi Medical University, and Osaka University. We randomly selected 70% for a derivation set to investigate a conversion formula from BNP to NT-proBNP using estimated glomerular filtration rate (eGFR) and body mass index (BMI); the remaining 30% was used as the internal validation set and we used a cohort study from Nara Medical University as an external validation set. Multivariate linear regression analysis revealed a new conversion formula: log NT-proBNP = 1.21 + 1.03 × log BNP − 0.009 × BMI − 0.007 × eGFR (r2=0.900, P<0.0001). The correlation coefficients between the actual and converted values of log NT-proBNP in the internal and external validation sets were 0.942 (P<0.0001) and 0.891 (P<0.0001), respectively. We applied this formula to samples obtained from patients administered with sacubitril/valsartan. After treatment initiation, NT-proBNP levels decreased and actual BNP levels increased. However, the calculated BNP levels decreased roughly parallel to the NT-proBNP levels.

    Conclusions: This new and simple conversion formula of BNP and NT-proBNP with eGFR and BMI is potentially useful in clinical practice.

  • Hideki Kitahara
    Article type: EDITORIAL
    Article ID: CJ-22-0277
    Published: May 25, 2022
    Advance online publication: May 25, 2022
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  • Komei Mizokami, Shoji Kawakami, Shujiro Inoue
    Article type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-22-0021
    Published: May 21, 2022
    Advance online publication: May 21, 2022
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    Supplementary material
  • Masaomi Gohbara, Noriaki Iwahashi, Kozo Okada, Yutaka Ogino, Yohei Han ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-22-0096
    Published: May 21, 2022
    Advance online publication: May 21, 2022
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    Background: The aim of this study was to create a risk scoring model to differentiate obstructive coronary artery (CA) from CA spasm in the etioology of acute coronary syndrome (ACS).

    Methods and Results: We included 753 consecutive patients with ACS without persistent ST-segment elevation (p-STE). The exclusion criteria were: (1) out-of-hospital cardiac arrest; (2) cardiogenic shock; (3) hemodialysis; (4) atrial fibrillation/flutter; (5) severe valvular disease; (6) no coronary angiography; (7) non-obstructive coronary artery without “definite” vasospastic angina definition; and/or (8) missing data. From the multivariate logistic regression analysis for prediction of obstructive CA, an integer score of 2 to each 0.5 increment in odds ratio was given, and values were divided into quartiles according to the total score. The scores were as follows: age >70 years (6 points), non-STE myocardial infarction (9 points), diabetes mellitus (5 points), B-type natriuretic peptide >90 pg/mL (7 points), neutrophil to lymphocyte ratio >2 (5 points), and high-density lipoprotein cholesterol <50 mg/dL (5 points). CA spasm-induced ACS occurred in 50.0% in Quartile 1 (total score: 0–13), 20.5% in Quartile 2 (total score: 14–19), 4.9% in Quartile 3 (total score: 20–26), and 2.2% in Quartile 4 (total score: 27–37) (P<0.001), indicating that a total score of <20 was a potential clinical indicator of CA spasm-induced ACS.

    Conclusions: CA spasm-induced ACS should be suspected if a total score of <20, and a spasm provocation test was being considered.

  • Hiroshi Ueno
    Article type: EDITORIAL
    Article ID: CJ-22-0250
    Published: May 20, 2022
    Advance online publication: May 20, 2022
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  • Yasushi Mukai, Takeshi Tohyama, Kazuo Sakamoto
    Article type: EDITORIAL
    Article ID: CJ-22-0229
    Published: May 18, 2022
    Advance online publication: May 18, 2022
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  • Yoshihisa Nakagawa, Kazushige Kadota, Koichi Nakao, Junya Shite, Hiroy ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-21-1004
    Published: May 17, 2022
    Advance online publication: May 17, 2022
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    Supplementary material

    Background: In PENDULUM mono, Japanese patients with high bleeding risk (HBR) received short-term dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy (SAPT) with prasugrel after percutaneous coronary intervention (PCI). One-year data from PENDULUM mono showed better outcomes with prasugrel monotherapy after short-term DAPT compared with matched patients in the PENDULUM registry with longer DAPT durations according to guidelines at that time. This study presents 2-year results.

    Methods and Results: We compared 24-month data from PENDULUM mono (n=1,107; de-escalation strategy group) and the PENDULUM registry (n=2,273; conventional strategy group); both were multicenter, non-interventional, prospective registry studies, using the inverse probability of treatment weighting (IPTW) method. In the PENDULUM mono group, the cumulative incidence of clinically relevant bleeding (CRB) at 24 months post-PCI (primary endpoint) was 6.8%, and that of major adverse cardiac and cerebrovascular events (MACCE) was 8.9%. After IPTW adjustment, the cumulative incidence of CRB was 5.8% and 7.2% in PENDULUM mono and the PENDULUM registry, respectively (hazard ratio [HR] 0.77; 95% confidence interval [CI] 0.57–1.04; P=0.086), and that of MACCE was 8.0% and 9.5%, respectively (HR 0.77; 95% CI 0.59–1.01; P=0.061).

    Conclusions: Japanese PCI patients with HBR prescribed prasugrel SAPT after short-term DAPT had a lower ischemic event risk than those prescribed long-term DAPT, and this was particularly relevant for ischemic events after 1 year.

  • Danmei Wei, Wenbo Xiao, Lihui Zhou, Jian Guo, Wenli Lu, Yuan Wang
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-21-0749
    Published: May 14, 2022
    Advance online publication: May 14, 2022
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    Background: The disease burden of ischemic heart disease (IHD) continues to increase. This study aimed to assess the age, period, and cohort effects on the long-term trends of IHD incidence and mortality in China from 1990 to 2019.

    Methods and Results: The data were obtained from the Global Burden of Disease Study (GBD) 2019, and the age-standardized incidence/mortality rate (ASIR/ASMR) was calculated. The age-period-cohort (APC) model, which is a generalized linear model revealing the correlation of disease rate and attained age, period, and cohort, was applied to estimate the net drift (estimated annual percentage change [EAPC]s), the local drifts (age-specific EAPCs), the age, period, and cohort effects. The analyses elucidated that the ASIR and ASMR of IHD declined after 2013. The net drift of incidence was 0.212% in females, and the net drift of mortality was 0.371% in males. The local drifts of mortality were above 0 in males aged 20–84 years and in females aged 65–84 years. The age effects showed elevated trends during the study period. The period effects declined after 2013. The cohort effects of mortality in males were higher than that in females.

    Conclusions: The decrease of ASIR and ASMR indicated that measures to prevent IHD have been effective in China. However, the cardiovascular health of the elderly and males should be considered in future policy decisions.

  • Yoshikazu Ono, Shin Yajima, Satoshi Kainuma, Naonori Kawamoto, Naoki T ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-21-0959
    Published: May 14, 2022
    Advance online publication: May 14, 2022
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    Supplementary material

    Background: This study aimed to elucidate the short-term surgical outcomes and hemodynamics of the Intuity valve compared to the standard bioprosthesis in Japanese patients.

    Methods and Results: Among the 307 consecutive patients who underwent aortic valve replacement (AVR) between February 2019 and March 2021, the Intuity valve was implanted in 95 patients (Intuity group) and a conventional stented bioprosthesis was implanted in 193 patients (conventional group). After propensity score matching, there was no significant difference in in-hospital mortality between the Intuity (n=2, 3%) and conventional groups (n=0, P=0.490). Operation, cardiopulmonary bypass, and aortic cross-clamping times were significantly shorter in the Intuity group. Although the effective orifice area index, trans-prosthetic mean pressure gradient, and peak velocity were similar between the 2 groups at 1 week postoperatively, the Intuity group showed a better mean pressure gradient and peak velocity at 1 year postoperatively. Complete atrioventricular block requiring permanent pacemaker implantation developed in 2 patients (3%) in the Intuity group and none in the conventional group (P=0.476). Mild or greater paravalvular leakage was present in 8 patients (13%) in the Intuity group and 2 patients (3%) in the conventional group (P=0.095).

    Conclusions: AVR using the Intuity valve in Japanese patients is satisfactory, with a better valve performance and a low incidence of complete atrioventricular block at 1 year postoperatively.

  • Shingo Matsumoto, Rine Nakanishi, Ryo Ichibayashi, Mitsuru Honda, Kei ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-22-0047
    Published: May 14, 2022
    Advance online publication: May 14, 2022
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    Background: Heart rate (HR) predicts outcomes in patients with acute coronary syndrome (ACS), whereas the impact of HR on outcomes after out-of-hospital cardiac arrest (OHCA) remains unclear. This study aimed to investigate the impact of HR after resuscitation on outcomes after OHCA and whether the impact differs with OHCA etiology.

    Methods and Results: Of 16,452 patients suffering from OHCA, this study analyzed 741 adults for whom HR after resuscitation was recorded by 12-lead electrocardiogram upon hospital arrival. Etiology of OHCA was categorized into 3 groups: ACS, non-ACS, and non-cardiac. Patients in each etiology group were further divided into tachycardia (>100 beats/min) and non-tachycardia (≤100 beats/min). The impact of HR on outcomes was evaluated in each group. Among the 741 patients, the mean age was 67.6 years and 497 (67.1%) patients were male. The primary outcome – 3-month all-cause mortality – was observed in 55.8% of patients. Tachycardia after resuscitation in patients with ACS was significantly associated with higher all-cause mortality at 3 months (P=0.002), but there was no significant association between tachycardia and mortality in non-ACS and non-cardiac etiology patients. In a multivariate analysis model, the incidence of tachycardia after resuscitation independently predicted higher 3-month all-cause mortality in OHCA patients with ACS (hazard ratio: 2.17 [95% confidence interval: 1.05–4.48], P=0.04).

    Conclusions: Increased HR after resuscitation was associated with higher mortality only in patients with ACS.

  • Kazushige Kadota, Koichi Nakao, Yoshihisa Nakagawa, Junya Shite, Hiroy ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-21-0991
    Published: May 13, 2022
    Advance online publication: May 13, 2022
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    Supplementary material

    Background: The 12-month results of the PENDULUM registry showed that after implantation of second-generation drug-eluting stents (DES), high P2Y12reaction unit (HPR) were independently associated with ischemic but not bleeding events.

    Methods and Results: This study analyzed cumulative incidences of major adverse cardiac and cerebrovascular events (MACCE) and major bleeding (Bleeding Academic Research Consortium type 3 and 5) at 30 months after index percutaneous coronary intervention (PCI) (primary endpoints). Of 6,422 patients undergoing PCI with DES, 5,796 completed the 30-month follow up. The continuation rate of dual antiplatelet therapy decreased to 59.3% at 12 months and 26.4% at 30 months. At 30 months, the cumulative incidence of MACCE increased linearly and reached 9.5% (95% confidence interval 8.8–10.2) and that of major bleeding had the inflection point at 12 months and was 4.4% (3.9–5.0). MACCE and bleeding events were higher in HPR patients (unadjusted P value). After covariate adjustment, P2Y12reactivity units measured immediately after index PCI was not an independent risk factor for MACCE or major bleeding at 30 months.

    Conclusions: MACCE consistently increased after 12 months post-PCI, whereas the increase in major bleeding events slowed down after 12 months in Japanese PCI patients in a real-world clinical setting. HPR patients had increased MACCE and bleeding complications, but HPR was not an independent risk factor of events at 30 months.

  • Xueyao Zhang, Guangxiao Li, Yingxian Sun
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-22-0016
    Published: May 13, 2022
    Advance online publication: May 13, 2022
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    Supplementary material

    Background: This study aimed to establish a clinically useful nomogram to evaluate the probability of hypertension onset in the Chinese population.

    Methods and Results: A prospective cohort study was conducted in 2012–2013 and followed up in 2015 to identify new-onset hypertension in 4,123 participants. The dataset was divided into development (n=2,748) and verification (n=1,375) cohorts. After screening risk factors by lasso regression, a multivariate Cox regression risk model and nomogram were established. Among the 4,123 participants, 818 (19.8%) developed hypertension. The model identified 10 risk factors: age, waist-to-hip ratio, systolic blood pressure, diastolic blood pressure, high pulse rate, history of diabetes, family history of hypertension and stroke, intake frequency of bean products, and intensity of physical labor. The C-indices of the model in the development and validation cohorts were 0.744 and 0.768, respectively. After the inclusion of serum calcium and magnesium concentrations, the C-indices in the development and validation cohorts were 0.764 and 0.791, respectively, with areas under the curve for the updated model of 0.907 and 0.917, respectively. The calibration curve showed that the nomogram accurately predicted the probability of hypertension. The updated nomogram was clinically beneficial across thresholds of 10–60%.

    Conclusions: The newly developed nomogram has good predictive ability and may effectively assess hypertension risk in high-risk rural areas in China.

  • Chihiro Ota, Hiro Yamasaki, Akihiko Nogami, Masaki Ieda
    Article type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-22-0012
    Published: May 12, 2022
    Advance online publication: May 12, 2022
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    Supplementary material
  • Eisuke Kataoka, Masayoshi Kimura, Toshiki Iwai, Takahisa Sawada
    Article type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-22-0135
    Published: May 12, 2022
    Advance online publication: May 12, 2022
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    Supplementary material
  • Yasushi Ino, Masahiro Takahata, Takashi Kubo, Amir Kh. M. Khalifa, Kei ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-21-1059
    Published: May 11, 2022
    Advance online publication: May 11, 2022
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    Supplementary material

    Background: Patients with acute myocardial infarction (AMI) caused by calcified nodules (CN) have worse clinical outcomes following primary percutaneous coronary intervention (PCI). This study investigated the late vascular response after everolimus-eluting stent (EES) implantation assessed by optical coherence tomography (OCT) in patients with AMI caused by CN, by comparing with plaque rupture (PR) and plaque erosion (PE).

    Methods and Results: Based on the OCT findings in AMI culprit lesions before PCI, a total of 141 patients were categorized into 3 groups (PR, PE, or CN), and the OCT findings immediately and 10 months after PCI were compared. The frequency of PR, PE, and CN was 85 (60%), 45 (32%), and 11 patients (8%), respectively. In the 10-month follow-up OCT, the frequency of lesions with uncovered struts and lesions with malapposed struts were highest in the CN group, followed by the PR and PE groups (82% vs. 52% vs. 40%, P=0.042 and 73% vs. 26% vs. 16%, P<0.001, respectively). The incidence of intra-stent thrombus, re-appearance of CN within the stent, and target lesion revascularization were higher in the CN group compared with the PR and PE groups (36% vs. 9% vs. 7%, P=0.028; 27% vs. 0% vs. 0%, P<0.001; and 18% vs. 2% vs. 2%, P=0.024, respectively).

    Conclusions: Late arterial healing response at 10 months after EES implantation in the CN was worse compared with PR and PE in patients with AMI.

  • Noriaki Iwahashi, Masaomi Gohbara, Jin Kirigaya, Takeru Abe, Mutsuo Ho ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-21-0907
    Published: May 10, 2022
    Advance online publication: May 10, 2022
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    Supplementary material

    Background: The role of left atrial (LA) function in the long-term prognosis of ST-elevation acute myocardial infarction (STEMI) is still unclear.

    Methods and Results: Percutaneous coronary intervention (PCI) was performed in 433 patients with the first episode of STEMI within 12 h of onset. The patients underwent echocardiography 24 h after admission. LA reservoir strain and other echocardiographic parameters were analyzed. Follow up was performed for up to 10 years (mean duration, 91 months). The primary endpoint was major adverse cardiovascular events (MACE): cardiac death or hospitalization due to heart failure (HF). MACE occurred in 90 patients (20%) during the follow-up period. Multivariate Cox hazard analyses showed LA reservoir strain, global longitudinal strain (GLS), age and maximum B-type natriuretic peptide (BNP) were the significant predictors of MACE. Kaplan-Meier curves demonstrated that LA reservoir strain <25.8% was a strong predictor (Log rank, χ2=76.7, P<0.0001). Net reclassification improvement (NRI) demonstrated that adding LA reservoir strain had significant incremental effect on the conventional parameters (NRI and 95% CI: 0.24 [0.11–0.44]) . When combined with GLS >−11.5%, the patients with LA reservoir strain <25.8% were found to be at extremely high risk for MACE (Log rank, χ2=126.3, P<0.0001).

    Conclusions: LA reservoir strain immediately after STEMI onset was a significant predictor of poor prognosis in patients, especially when combined with GLS.

  • Takako Minami, Hiroaki Kawano, Tsuyoshi Yoshimuta, Satoshi Ikeda, Chie ...
    Article type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-22-0036
    Published: April 29, 2022
    Advance online publication: April 29, 2022
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  • Masahiro Watanabe, Ryosuke Higuchi, Mamoru Nanasato, Nobuo Iguchi
    Article type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-22-0115
    Published: April 29, 2022
    Advance online publication: April 29, 2022
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    Supplementary material
  • Hiroki Shiomi
    Article type: EDITORIAL
    Article ID: CJ-22-0204
    Published: April 29, 2022
    Advance online publication: April 29, 2022
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  • Ryohei Takeishi, Akiomi Yoshihisa, Yu Hotsuki, Fumiya Anzai, Yu Sato, ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-22-0082
    Published: April 27, 2022
    Advance online publication: April 27, 2022
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    Background: After the publication of the Japanese Circulation Society guideline of sleep-disordered breathing (SDB) in 2010, with new evidence and changes to the health insurance system, trends in the practice pattern for SDB in patients with cardiovascular disease (CVD) might have changed.

    Methods and Results: This study evaluated the temporal changes in the practice pattern for SDB by using a nationwide claim database, the Japanese Registry of All Cardiac and Vascular Diseases – Diagnosis Procedure Combination (JROAD-DPC), from 2012 to 2019. The main findings were: (1) the number of CVD patients diagnosed with SDB increased (especially those with atrial fibrillation [AF] and heart failure [HF]); (2) the number of diagnostic tests for SDB performed during hospitalization increased for AF patients (from 1.3% in 2012 to 1.8% in 2019), whereas it decreased for other CVD patients; (3) the number of patients diagnosed with SDB increased in each type of CVD, except for patients with acute myocardial infarction (AMI); (4) continuous positive airway pressure (CPAP) treatment increased for AF patients (from 15.2% to 17.5%); (5) CPAP treatment decreased for patients with angina pectoris (AP) and AMI, and any treatment decreased for HF patients (from 46.1% to 39.7%); and (6) SDB was treated more often in HF patients than in AF, AP, and AMI patients (41.7% vs. 17.2%, 19.1% and 20.4%, respectively).

    Conclusions: The practice pattern for SDB in CVD patients has changed from 2012 to 2019.

  • Makoto Watanabe, Kazutaka Aonuma, Toyoaki Murohara, Yasuo Okumura, Tak ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-21-0869
    Published: April 22, 2022
    Advance online publication: April 22, 2022
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    Background: Previous studies have reported that high-dose strong statin therapy reduces the incidence of contrast-induced nephropathy (CIN) in statin naïve patients; however, the efficacy of high-dose strong statins for preventing CIN in real-world clinical practice remains unclear. The aim of this study was to evaluate the efficacy of strong statin therapy in addition to fluid hydration for preventing CIN after cardiovascular catheterization.

    Methods and Results: This prospective, multicenter, randomized controlled trial included 420 patients with chronic kidney disease who underwent cardiovascular catheterization. They were assigned to receive high-dose pitavastatin (4 mg/day × 4 days) on the day before and of the procedure and 2 days after the procedure (Statin group, n=213) or no pitavastatin (Control group, n=207). Isotonic saline hydration combined with a single bolus of sodium bicarbonate (20 mEq) was scheduled for administration to all patients. In the control group, statin therapy was continued at the same dose as that before randomization. CIN was defined as a ≥0.5 mg/dL increase in serum creatinine or ≥25% above baseline at 48 h after contrast exposure. Before randomization, 83% of study participants were receiving statin treatment. The statin group had a higher incidence of CIN than the control group (3.0% vs. 0%, P=0.01). The 12-month rate of major adverse cardiovascular events was similar between the 2 groups.

    Conclusions: High-dose pitavastatin increases the incidence of CIN in this study population.

  • Chika Nishiyama, Kosuke Kiyohara, Tetsuhisa Kitamura, Sumito Hayashida ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-22-0040
    Published: April 22, 2022
    Advance online publication: April 22, 2022
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    Background: The coronavirus disease (COVID-19) pandemic may have influenced the prehospital emergency care and deaths of individuals experiencing an out-of-hospital cardiac arrest (OHCA).

    Methods and Results: We analyzed the registry data of 2,420 and 2,371 OHCA patients in Osaka City, Japan in 2019 and 2020, respectively, according to the 3 waves of the COVID-19 pandemic. Patient outcomes were compared using multivariable logistic regression analyses with the 2019 data as the reference. Bystander cardiopulmonary resuscitation (CPR) was initiated significantly less frequently in 2020 than in 2019 (2019: 48.0%, 2020: 42.7%, P<0.001), particularly during the first wave (2019: 47.2%, 2020: 42.9%, P=0.046) and second wave (2019: 48.1%, 2020: 41.2%, P=0.010), but not during the third wave (2019: 49.2%, 2020: 44.1%, P=0.066). The public-access automated external defibrillator was less frequently applied during the first wave (2019: 12.6%, 2020: 9.9%, P=0.043), with no significant difference during the second wave (2019: 12.5%, 2020: 12.8%, P=0.863) and third wave (2019: 13.7%, 2020: 13.0%, P=0.722). There was a significant difference in 1-month survival with favorable neurological outcomes (2019: 4.6%, 2020: 3.3%, P=0.018), with a 28% reduction in the adjusted odds ratio in 2020 (0.72; 95% confidence interval: 0.52–0.99, P=0.044).

    Conclusions: Bystander CPR and neurologically favorable outcomes after OHCA decreased significantly during the COVID-19 pandemic in Japan.

  • Shonosuke Sugai, Naoya Matsumoto, Ayano Makita, Keiichiro Kuronuma, Ya ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-21-0739
    Published: April 20, 2022
    Advance online publication: April 20, 2022
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    Background: The diagnostic accuracy of stress myocardial perfusion single-photon emission computed tomography (SPECT) to detect coronary artery disease (CAD) is reduced by the balanced reduction of myocardial perfusion in patients with multi-vessel or left main trunk CAD (multi-vessel group). This study investigated the diagnostic performance of a simultaneous acquisition rest 99 mTc/stress 201Tl dual-isotope protocol for myocardial perfusion SPECT (MPS) in a multi-vessel group by examining the assessment of a slow 201Tl washout rate (WR) finding in comparison to the accuracy of perfusion assessments.

    Methods and Results: This study enrolled 91 patients who had undergone angiography within 3 months after MPS. The diagnostic performances of perfusion assessments and a slow 201Tl WR parameter were compared using the area under the curve (AUC) in a multi-vessel group of patients with mild ischemia (2≤summed difference score [SDS]≤7). The AUC of a slow WR parameter was significantly larger compared with that for perfusion assessments, in patients with mild ischemia, (AUC, 0.736 vs. 0.504–0.558, P value: <0.01–0.05).

    Conclusions: Among patients with mild ischemia, a slow 201Tl WR parameter improved the detection of CAD in a multi-vessel group.

  • Shuntaro Takahashi, Kentaro Ishizuka, Takao Hoshino, Takafumi Mizuno, ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-21-0937
    Published: April 19, 2022
    Advance online publication: April 19, 2022
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    Background: This study aimed to identify the association between long term functional outcomes and acute ischemic stroke (AIS) in patients with heart failure (HF) in Japan and whether 1-year event risks can be related to these patients.

    Methods and Results: This was a prospective observational study, and 651 patients registered in the Tokyo Women’s Medical University Stroke Registry were classified into the HF and non-HF groups. Functional outcome at 1 year after stroke onset was defined as either good (modified Rankin Scale [mRS] score of 0–2) or poor (mRS score of 3–6). The primary outcome was a composite of major adverse cardiovascular events (MACE), including non-fatal stroke, non-fatal acute coronary syndrome, and vascular death. Patients with HF had a higher poor functional outcome rate at 1 year than those without HF (54.7% vs. 28.2%, P<0.001). Multivariate logistic regression analysis also demonstrated the prevalence of HF was an independent predictor of an mRS score of ≥3 at 1 year after stroke onset (odds ratio, 1.05; 95% confidence interval, 1.00–1.10; P=0.036). Furthermore, patients with HF tended to have a higher risk of MACE and all-cause mortality than those without HF.

    Conclusions: AIS patients with HF were associated with poor functional outcome at the 1-year follow up. Further multicenter studies involving a larger number of patients are warranted to verify these results.

  • Yasuaki Takeji, Tomohiko Taniguchi, Takeshi Morimoto, Shinichi Shirai, ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-21-1062
    Published: April 19, 2022
    Advance online publication: April 19, 2022
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    Background: There is scarce data evaluating the current practice pattern and clinical outcomes for patients with severe aortic stenosis (AS), including both those who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) and those who were managed conservatively in the TAVI era.

    Methods and Results: The Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis (CURRENT AS) Registry-2 is a prospective, physician-initiated, multicenter registry enrolling consecutive patients who were diagnosed with severe AS between April 2018 and December 2020 among 21 centers in Japan. The rationale for the prospective enrollment was to standardize the assessment of symptomatic status, echocardiographic evaluation, and other recommended diagnostic examinations such as computed tomography and measurement of B-type natriuretic peptide. Moreover, the schedule of clinical and echocardiographic follow up was prospectively defined and strongly recommended for patients who were managed conservatively. The entire study population consisted of 3,394 patients (mean age: 81.6 years and women: 60%). Etiology of AS was degenerative in 90% of patients. AS-related symptoms were present in 60% of patients; these were most often heart failure symptoms. The prevalence of high- and low-gradient AS was 58% and 42%, respectively, with classical and paradoxical low-flow low-gradient AS in 4.5% and 6.7%, respectively.

    Conclusions: The CURRENT AS Registry-2 might be large and meticulous enough to determine the appropriate timing of intervention for patients with severe AS in contemporary clinical practice.

  • Koya Okabe, Katsuya Miura, Yuki Shima, Akihiro Ikuta, Yuya Taguchi, Ko ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-21-0901
    Published: April 09, 2022
    Advance online publication: April 09, 2022
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    Background: The Academic Research Consortium for High Bleeding Risk (ARC-HBR) defined a consensus clinical criterion for patients at HBR undergoing percutaneous coronary intervention (PCI). This study aimed to validate and compare the ARC-HBR criteria and the contemporary risk score for long-term bleeding outcomes using a cohort of patients undergoing PCI.

    Methods and Results: This study analyzed 3,410 patients who underwent PCI between 2010 and 2013. The endpoint was defined as incidence of The Bleeding Academic Research Consortium 3 or 5 bleeding events. In addition to ARC-HBR, this study validated the predictability of the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score, Patterns of non-adherence to Anti-platelet Regimens In Stented patients (PARIS) bleeding score, and Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) bleeding scores for bleeding events. There was a trend toward an increase in bleeding events, as the risk score increased for all bleeding risk scores used in this study. The ARC-HBR criteria had higher diagnostic sensitivity for bleeding events than other bleeding risk scores.

    Conclusions: Patients with a higher number of risk factors in each of the four bleeding risk scores had a higher risk of long-term bleeding events. In comparison to other contemporary risk scores, the ARC-HBR criteria were more sensitive in the identification of patients with bleeding events in the long-term.

  • Goro Yoshioka, Shinjo Sonoda, Shinichi Aishima, Koichi Node
    Article type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-21-1080
    Published: April 05, 2022
    Advance online publication: April 05, 2022
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  • Kazutaka Nakasone, Makoto Nishimori, Kunihiko Kiuchi, Masakazu Shinoha ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-22-0065
    Published: April 07, 2022
    Advance online publication: April 07, 2022
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    Background: Several algorithms have been proposed for differentiating the right and left outflow tracts (RVOT/LVOT) arrhythmia origins from 12-lead electrocardiograms (ECGs); however, the procedure is complicated. A deep learning (DL) model, a form of artificial intelligence, can directly use ECGs and depict the importance of the leads and waveforms. This study aimed to create a visualized DL model that could classify arrhythmia origins more accurately.

    Methods and Results: This study enrolled 80 patients who underwent catheter ablation. A convolutional neural network-based model that could classify arrhythmia origins with 12-lead ECGs and visualize the leads that contributed to the diagnosis using a gradient-weighted class activation mapping method was developed. The average prediction results of the origins by the DL model were 89.4% (88.2–90.6) for accuracy and 95.2% (94.3–96.2) for recall, which were significantly better than when a conventional algorithm is used. The ratio of the contribution to the prediction differed between RVOT and LVOT origins. Although leads V1 to V3 and the limb leads had a focused balance in the LVOT group, the contribution ratio of leads aVR, aVL, and aVF was higher in the RVOT group.

    Conclusions: This study diagnosed the arrhythmia origins more accurately than the conventional algorithm, and clarified which part of the 12-lead waveforms contributed to the diagnosis. The visualized DL model was convincing and may play a role in understanding the pathogenesis of arrhythmias.

  • Yoichi Takaya, Teiji Akagi, Hidehiko Hara, Hideaki Kanazawa, Yuji Ikar ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-22-0048
    Published: April 05, 2022
    Advance online publication: April 05, 2022
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    Background: Transcatheter mitral valve repair with the MitraClip system has been established in selected high-risk patients. The MitraClip procedure results in a relatively large iatrogenic atrial septal defect (iASD). This study aimed to investigate the prevalence and clinical course of iASD requiring transcatheter closure following the MitraClip procedure.

    Methods and Results: This study was conducted at all 59 institutions that perform transcatheter mitral valve repair with the MitraClip system in Japan. The data of patients on whom transcatheter iASD closure was performed were collected. Of the 2,722 patients who underwent the MitraClip procedure, 30 (1%) required transcatheter iASD closure. The maximum iASD size was 9±4 mm (range, 3–18 mm). The common clinical course of transcatheter iASD closure was hypoxemia with right-to-left shunt or right-sided heart failure with left-to-right shunt. Of the 30 patients, 22 (73%) required transcatheter closure within 24 h following the MitraClip procedure, including 12 with hypoxemia and 5 with right-sided heart failure complicated with cardiogenic shock. Of the 5 patients, 2 required mechanical circulatory support devices. Twenty-one patients immediately underwent transcatheter iASD closure, and hemodynamic deteriorations were resolved; however, 1 patient died without having undergone transcatheter closure.

    Conclusions: Transcatheter iASD closure was required in 1% of patients who underwent the MitraClip procedure. Many of these patients immediately underwent transcatheter iASD closure because of hypoxemia with right-to-left shunt or right-sided heart failure with left-to-right shunt.

  • Daichi Maeda, Yuya Matsue, Tohru Minamino
    Article type: EDITORIAL
    Article ID: CJ-22-0143
    Published: April 05, 2022
    Advance online publication: April 05, 2022
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  • Yusuke Akazawa, Takashi Higaki, Shinji Inaba, Osamu Yamaguchi
    Article type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-22-0055
    Published: April 01, 2022
    Advance online publication: April 01, 2022
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  • Tomomi Matsubara, Masataka Sumiyoshi, Atsushi Kimura, Asuka Minami-Tak ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-21-0947
    Published: March 31, 2022
    Advance online publication: March 31, 2022
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    Background: This study investigated whether the age of patients undergoing pacemaker implantation is increasing.

    Methods and Results: This study retrospectively reviewed the consecutive cases of 3,582 patients who underwent an initial pacemaker implantation at our hospitals because of symptomatic bradyarrhythmias between 1970 and 2019. The exclusion criteria were: patients with AV block due to cardiac surgery or AV junction ablation, and patients aged <20 years. The patients were divided into 5×10-year groups: those treated in the 1970s (1970–1979), 1980s (1980–1989), 1990s (1990–1999), 2000s (2000–2009), and 2010s (2010–2019). A total of 3,395 patients satisfied the study criteria. The average age at which the patients underwent a first pacemaker implantation increased across the 10-year periods: 63.7±13.2 years in the 1970s, 66.2±12.6 years (1980s), 69.1±12.4 years (1990s), 72.0±11.1 years (2000s), and 75.8±10.0 years (2010s) and advanced significantly in the 1990s, 2000s, and 2010s compared to the 1970s (all P<0.001). The ratio of patients aged ≥80 and ≥90 years increased from 10.6% and 0% in the 1970 s to 38.2% (P<0.001) and 5.2% (P= 0.017) in the 2010s, respectively.

    Conclusions: The average age at initial pacemaker implantation increased by 12.1 years over the last 50 years in Japan. In particular, the ratios of ≥80 and ≥90 years as the patients age increased significantly.

  • Fumiyasu Hirano, Akihiro Okamura, Masaru Kato, Kazuyoshi Ogura, Takuya ...
    Article type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-22-0071
    Published: March 29, 2022
    Advance online publication: March 29, 2022
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  • Masashi Nakamura, Takashi Yamano, Yoshinori Asae, Masahiro Takahata, Y ...
    Article type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-22-0083
    Published: March 26, 2022
    Advance online publication: March 26, 2022
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  • Satoru Yoshida, Hiroaki Kawano, Satoshi Ikeda, Hitoshi Sakuraba, Shinj ...
    Article type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-22-0067
    Published: March 25, 2022
    Advance online publication: March 25, 2022
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  • Hironori Ishiguchi, Masamune Uchida, Hirokazu Sadahiro, Sotai Kimura, ...
    Article type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-22-0059
    Published: March 19, 2022
    Advance online publication: March 19, 2022
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  • Xiaofei Wang, Kenji Nakano, Taro Shiga, Akihiro Ohmoto, Takuya Oyakawa ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-21-0808
    Published: March 18, 2022
    Advance online publication: March 18, 2022
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    Background:Heart failure (HF) is one of the potential adverse events of pazopanib treatment for soft tissue sarcoma (STS), but detailed reports of such HF cases are scarce. This study determined the incidence and risk factors of HF following pazopanib treatment for STS at our Institute and the clinical outcomes.

    Methods and Results:This study retrospectively analyzed the cases of STS patients treated with pazopanib (n=151) between 2012 and 2020. HF occurred in 6 patients (3.9%) at the median onset of 137 (range 14–468) days after the treatment initiation. When their HF was diagnosed, pazopanib was interrupted in all 6 patients. No patients experienced HF-related death, and HF development was not a significant factor for poor overall survival. The cumulative doses of anthracyclines (>225 mg/m2) before pazopanib initiation (83% vs. 37%, P=0.031), pazopanib initiation at age ≥60 years (83% vs. 35%, P=0.026), and the baseline B-type natriuretic peptide (BNP) concentration (≥50 pg/mL) before pazopanib (67% vs. 11%, P=0.002) initiation were predictive factors for post-pazopanib treatment HF.

    Conclusions:The study findings highlight the effect of past anthracycline exposure and baseline BNP for pazopanib-associated HF. Although the study patients’ clinical outcomes were generally favorable, periodic monitoring of cardiac function using ultrasonic echocardiography or serum markers is essential to detect events early and begin therapeutic intervention appropriately under a cardiologist’s instructions.

  • Kenji Hanada, Shingo Sasaki, Maiko Seno, Yoshihiro Kimura, Hiroaki Ich ...
    Article type: ORIGINAL ARTICLE
    Article ID: CJ-21-0999
    Published: March 18, 2022
    Advance online publication: March 18, 2022
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    Background:The incidence of sudden cardiac death (SCD) after discharge in Japanese acute myocardial infarction (AMI) patients with reduced left ventricular ejection fraction (LVEF) treated with primary percutaneous coronary intervention (PCI) remains unknown.

    Methods and Results:The study population included 1,429 AMI patients (199 with LVEF ≤35% and 1,230 with LVEF >35%) admitted to the Hirosaki University Hospital, treated with primary PCI within 12 h after onset, and survived to discharge. LVEF was evaluated in all patients before discharge, and the patients were followed up for a mean of 2.6±0.8 years. The Kaplan-Meier survival curves revealed LVEF ≤35% was associated with all-cause death and SCD. The incidence of SCD was 2.6% at 1 year and 3.1% at 3 years in patients with LVEF ≤35%, whereas it was 0.1% at 1 year and 0.3% at 3 years in patients with LVEF >35%. Sixty-seven percent of SCDs in patients with LVEF ≤35% occurred within 4 months after discharge, and the events became less frequent after this period. A Cox proportional hazard model indicated LVEF ≤35% as an independent predictor for all-cause death and SCD.

    Conclusions:The incidence of SCD was relatively low in Japanese AMI patients treated with primary PCI, even in patients with LVEF ≤35% upon discharge. Careful management of patients with reduced LVEF is required to prevent SCD, especially in the early phase after discharge.

  • Tobias Koenig, Jens Vogel-Claussen, Johann Bauersachs, L. Christian Na ...
    Article type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CJ-22-0074
    Published: March 18, 2022
    Advance online publication: March 18, 2022
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