Circulation Reports
Online ISSN : 2434-0790
Advance online publication
Showing 1-14 articles out of 14 articles from Advance online publication
  • Naoki Kubota, Kazuyuki Ozaki, Yasuhiko Tanabe, Yasuhiro Iwasaki, Tsuyo ...
    Type: ORIGINAL ARTICLE
    Subject Area: Ischemic Heart Disease
    Article ID: CR-20-0100
    Published: October 29, 2020
    [Advance publication] Released: October 29, 2020
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    Background:Spontaneous coronary artery dissection (SCAD) is a rare disease that is often misdiagnosed, except in typical cases. Although intracoronary imaging and multislice coronary computed tomography angiography (CCTA) are useful in establishing dissection, they may not be feasible in all instances, especially in small vessels.

    Methods and Results:We describe a series of 7 patients with acute coronary syndrome secondary to small vessel SCAD that was detected only upon repeat coronary angiography (CAG). This cohort had a mean (±SD) age of 50±6 years, was predominantly female (n=6; 86%), and had few coronary risk factors. Three patients (43%) had dissection of the distal segment of the right coronary artery, 3 (43%) had distal left circumflex artery dissection, and 1 patient (14%) had a diagonal branch dissection. None of the patients required percutaneous coronary intervention, and received conservative therapy only, because the infarct area was sufficiently small. No definitive diagnosis of SCAD could be established in any of the patients at first admission because CAG alone or CCTA did not reveal the presence of a flap or intraluminal hemorrhage. However, in such patients without a definitive diagnosis, repeat CAG in the chronic stage showed enlargement of vessels, suggesting the healing of an SCAD.

    Conclusions:Repeat CAG may be useful for suggesting the occurrence of SCAD.

  • Yosuke Hata, Osamu Iida, Katsumi Inoue, Toshiaki Mano
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CR-20-0080
    Published: October 27, 2020
    [Advance publication] Released: October 27, 2020
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  • Hiroshi Kawahara, Akihiro Endo, Hiroyuki Yoshitomi, Kazuaki Tanabe
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CR-20-0092
    Published: October 27, 2020
    [Advance publication] Released: October 27, 2020
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  • Zeyi Cheng
    Type: LETTER TO THE EDITOR
    Article ID: CR-20-0103
    Published: October 27, 2020
    [Advance publication] Released: October 27, 2020
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  • Takashi Akima, Katsutoshi Sekine, Koki Yamaoka, Yuta Seki, Kazuaki Nak ...
    Type: ORIGINAL ARTICLE
    Subject Area: Arrhythmia/Electrophysiology
    Article ID: CR-20-0084
    Published: October 24, 2020
    [Advance publication] Released: October 24, 2020
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    Background:The relationship between left ventricular diastolic dysfunction (LVDD) and paroxysmal atrial fibrillation (PAF) remains unclear because of a lack of standard measures to evaluate LVDD. Accordingly, we examined the association between the prevalence of PAF and each LVDD grade determined according to the latest American Society of Echocardiography guidelines.

    Methods and Results:In all, 2,063 patients without persistent AF who underwent echocardiography at Saitama Municipal Hospital from July 2016 to June 2017 were included in the study. Patients were divided into LVDD 6 categories: No-LVDD (n=1,107), Borderline (n=392), Grade 1 (n=204), Indeterminate (n=62), Grade 2 (n=254), and Grade 3 (n=44). PAF was documented in 111 (10.0%), 81 (20.7%), 28 (13.7%), 6 (9.7%), 52 (20.5%), and 24 (54.5%) patients in the No-LVDD, Borderline, Grade 1, Indeterminate, Grade 2, and Grade 3 categories, respectively. PAF prevalence was higher in patients with Grade 3 LVDD across the whole study population. Subgroup analyses showed that the prevalence of PAF increased with increased LVDD grade in patients with reduced left ventricular ejection fraction. This relationship was significant in multivariate analysis including various patient characteristics.

    Conclusions:LVDD severity determined on the basis of the latest echocardiographic criteria was associated with the prevalence of PAF. The present findings shed light on the development of new therapeutic markers for PAF.

  • Toshikazu Shimizu, Naoyuki Kimura, Makiko Mieno, Daijiro Hori, Manabu ...
    Type: ORIGINAL ARTICLE
    Subject Area: Aortic Disease
    Article ID: CR-20-0098
    Published: October 23, 2020
    [Advance publication] Released: October 23, 2020
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    Supplementary material

    Background:The prevalence of obesity among Japanese acute type A aortic dissection (ATAAD) patients and its effect on repair outcomes remain to be elucidated.

    Methods and Results:The prevalence of obesity (body mass index [BMI] ≥30.0 kg/m2) among 1,059 patients (mean [±SD] age 64.3±12.7 years) who underwent ATAAD repair between 1990 and 2018 was compared with that among the general Japanese population (National Health and Nutrition Survey data). The prevalence of obesity among male patients (17.1% [6/35], 20.0% [18/90], and 14.4% [20/139] for those aged 20–39, 40–49, and 50–59 years, respectively) was significantly higher than that among the age- and sex-matched general population. The 1,059 patients were divided into groups according to weight (normal [BMI <25.0 kg/m2; n=742], overweight [BMI 25.0–29.9 kg/m2; n=248], or obese [BMI ≥30.0 kg/m2; n=69]). Comparing the normal weight, overweight, and obese groups revealed significant differences among the 3 groups in median cardiopulmonary bypass time (143, 167, and 183 min, respectively), ventilation >48 h (44.5%, 60.1%, and 78.3%, respectively), and in-hospital mortality (7.0%, 7.3%, and 17.4%, respectively), but not in 30-day survival. Shock, visceral malperfusion, operation time >360 min, obesity, and coronary malperfusion were identified as predictors of in-hospital mortality.

    Conclusions:The prevalence of obesity is increased among Japanese male patients with ATAAD aged ≤59 years. Obesity may increase these patients’ operative risk; overweight does not.

  • Masafumi Nakayama, Takashi Uchiyama, Nobuhiro Tanaka, Takaaki Ohkawauc ...
    Type: ORIGINAL ARTICLE
    Subject Area: Ischemic Heart Disease
    Article ID: CR-20-0099
    Published: October 23, 2020
    [Advance publication] Released: October 23, 2020
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    Supplementary material

    Background:We hypothesized that the intracoronary-electrocardiogram (IC-ECG)-based pressure index would be more stable and precise than the instantaneous flow reserve (iFR). We investigated the usefulness of the IC-ECG-based pressure index for diagnosing myocardial ischemia.

    Methods and Results:Thirty-seven consecutive patients with coronary stenosis requiring physiological assessment were enrolled in the study. iFR was measured at rest and under hyperemia in 51 and 40 lesions, respectively. The IC-ECG-triggered distal pressure (Pd)/aortic pressure (Pa) ratio (ICE-T) was defined as the mean Pd/Pa ratio in the period corresponding to the isoelectric line. The ICE-T was significantly lower than the iFR both at rest and during hyperemia (P<0.00001 for both). Fluctuations in the ICE-T pressure parameters (Pd/Pa, Pa, and Pd) were significantly smaller than those of iFR both at rest and during hyperemia. The diagnostic accuracy of predicting a fractional flow reserve (FFR) ≤0.80 of the ICE-T at rest was significantly higher than that of iFR (P=0.008). Receiver operating characteristic curve analyses showed that the ICE-T predicts FFR ≤0.80 more accurately than the iFR (area under curve 0.897 vs. 0.810 for ICE-T and iFR, respectively).

    Conclusions:We identified the period in the IC-ECG in which resting Pd/Pa was low and constant. The IC-ECG-based algorithm may improve the accuracy of diagnosing myocardial ischemia, without increasing invasiveness, compared with pressure-dependent indices.

  • Takefumi Fujito, Atsushi Mochizuki, Naoyuki Kamiyama, Masayuki Koyama, ...
    Type: ORIGINAL ARTICLE
    Subject Area: Arrhythmia/Electrophysiology
    Article ID: CR-20-0044
    Published: October 22, 2020
    [Advance publication] Released: October 22, 2020
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    Background:Complete left atrial posterior wall isolation (LAPI) is not always achieved. We examined whether incomplete LAPI has an effect on outcomes after catheter ablation (CA).

    Methods and Results:This study enrolled 75 consecutive patients (mean [±SD] age 62.6±8.9 years, 74.7% male) who underwent LAPI by radiofrequency CA for persistent atrial fibrillation (AF). The median follow-up period was 541 days (interquartile range 338–840 days). Incomplete LAPI was defined as the presence of a successfully created roof or floor linear lesion. The rate of complete LAPI was 41.3% (31/75). Either a roof or floor linear lesion was created in 38 patients, whereas neither was created in 6. Multivariate Cox proportional hazards regression analysis revealed that female sex (hazard ratio [HR] 5.29; 95% confidence interval [CI] 1.81–16.8; P=0.002) and complete or incomplete LAPI (HR 0.17; 95% CI 0.03–0.79; P=0.027) were independent predictors of AF recurrence. Kaplan-Meier curves indicated that better outcome was associated with at least one rather than no successful linear lesion (86.5% vs. 50.0% at 1 year; P=0.043). There were no significant differences in outcomes between the complete LAPI and incomplete LAPI groups.

    Conclusions:Complete LAPI is unachievable in a significant percentage of patients with persistent AF. However, incomplete LAPI, as a result of aiming for complete LAPI, may have a benefit comparable to that of complete LAPI.

  • Makoto Sugihara, Kaori Mine, Makito Futami, Yuta Kato, Tadaaki Arimura ...
    Type: ORIGINAL ARTICLE
    Subject Area: Peripheral Vascular Disease
    Article ID: CR-20-0095
    Published: October 16, 2020
    [Advance publication] Released: October 16, 2020
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    Background:Drug-coated balloon strategies in endovascular therapy often result in severe dissection, so lesion preparation must be improved. We evaluated the efficacy of a gradual inflation method, termed “super slow inflation” (SSI), in preparing lesions to avoid severe dissections.

    Methods and Results:The association between balloon pressure and the dilatation of a model constricted vessel, as well as the load applied to the balloon surface, were determined using a burst leak detector for a quick inflation (QI; 1 atm/s) protocol and SSI (1 atm/20 s). A retrospective, single-center, non-randomized study evaluated differences in vessel dissection patterns after balloon angioplasty depending on inflation method in 81 consecutive patients (mean [±SD] age 74.6±9.2 years; 54 males) who underwent balloon angioplasty for de novo femoropopliteal lesions between January 2017 and March 2019. In the constricted vessel model, vessel dilatation increased gradually using SSI, with the maximum dilatation load being approximately 100 g lower for the SSI than QI protocol. In patients, the rate of severe vessel dissection was significantly lower in the SSI than non-SSI group (17.6% vs. 55.2%, respectively; P<0.001). Multivariate regression analysis revealed that SSI was an independent factor preventing severe dissection (odds ratio 0.18; 95% confidence interval 0.06–0.53; P=0.002).

    Conclusions:SSI is a gentle and effective method for the preparation of femoropopliteal lesions to reduce the incidence of severe angiographic dissection when using drug-coated balloons.

  • Takatoshi Kasai, Yoshifumi Takata, Akiomi Yoshihisa, Yasuchika Takeish ...
    Type: ORIGINAL ARTICLE
    Subject Area: Medical Engineering
    Article ID: CR-20-0097
    Published: October 16, 2020
    [Advance publication] Released: October 16, 2020
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    Background:Sleep disordered breathing (SDB) is prevalent and associated with increased mortality in patients both with and without cardiovascular disease (CVD). Many portable monitoring devices, including peripheral arterial tonometry (PAT)-based devices, have been developed. Although previous studies have demonstrated that the apnea-hypopnea index (AHI) determined by PAT devices (pAHI) is strongly correlated with AHI determined by polysomnography (AHI-PSG), no data have been reported from a Japanese patient population or patients with CVD. In this study we compared the parameters determined by PAT-based devices with those determined by polysomnography in Japanese patients with CVD.

    Methods and Results:We enrolled 120 patients undergoing overnight polysomnography at 6 Japanese centers. A PAT-based device was used simultaneously with polysomnography. Polysomnography recordings were scored centrally by a technician in a blinded manner. PAT-based device recordings were scored using an automatic algorithm. There was a strong correlation between pAHI and AHI-PSG (r=0.896; P<0.001) with acceptable agreement. The strong correlation between pAHI and AHI-PSG was observed in patients with CVD (n=55; P=0.849; P<0.001) and without CVD (n=65; r=0.927; P<0.001). The presence or absence of CVD did not affect the relationship between pAHI and AHI-PSG (P=0.225).

    Conclusions:A PAT-based device provides a reliable AHI in a Japanese patient population, even in patients with CVD. These findings may help reduce the number of patients with undiagnosed SDB and CVD.

  • Anna Kontsevaya, Oxana Drapkina, Boris Gorniy, Anna Kalinina, Denis Ko ...
    Type: PROTOCOL PAPER
    Article ID: CR-20-0042
    Published: October 07, 2020
    [Advance publication] Released: October 07, 2020
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    Supplementary material

    Background:The prevalence of obesity in Russia has increased sharply since the mid-1990s. Interestingly, the prevalence of obesity in Japan is lower than in many Western countries. Japan has implemented different types of weight control programs using a smart device to monitor patients remotely. New health promotion methods from Japan are now being used in Russia. The Russian-Japanese “Tackle Obesity and Metabolic Syndrome Outcome by Diet, Activities and Checking Body Weight Intervention” (RJ-TOMODACHI) study aims to evaluate a preventive intervention using Japanese health monitoring technology in reducing excess body weight, compared with standard care, in Russia.

    Methods and Results:The trial is a single-center, 3-armed, parallel group randomized controlled trial conducted among overweight/obese adults. It has been designed to compare the effectiveness of 2 newly developed interventions against standard care for 6 months. Participants in the low- and high-intensity intervention groups will have 3 and 6 consultations over the study period, respectively. In all, 260 adults were screened at baseline; 65 did not participate in the trial for various reasons. The remaining 195 people were randomized into 3 groups (high-intensity intervention, n=73, low-intensity, n=73; standard care group, n=49).

    Conclusions:The trial protocol has been designed so that the methodology can be adapted for use in Russia.

  • Toshihiko Nishi, Yoshiyuki Tokuda, Akihito Tanaka, Kenji Furusawa, Yus ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CR-20-0060
    Published: October 07, 2020
    [Advance publication] Released: October 07, 2020
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  • Yudai Tamura, Eiji Taguchi, Takashi Unoki, Tadashi Sawamura, Tomohiro ...
    Type: IMAGES IN CARDIOVASCULAR MEDICINE
    Article ID: CR-20-0089
    Published: October 07, 2020
    [Advance publication] Released: October 07, 2020
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  • Atsushi Mizuno, Takuya Kishi, Chisa Matsumoto, Mari Ishida, Shoji Sana ...
    Type: RAPID COMMUNICATION
    Article ID: CR-20-0093
    Published: September 25, 2020
    [Advance publication] Released: September 25, 2020
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    Supplementary material

    Background:Twitter has become increasingly popular at annual medical congresses as a platform to communicate to attendees. The aim of this study is to reveal the twitter usage in the annual congress of the Japanese Cirsulation Society.

    Methods and Results:We compared the total number of tweets during the Japanese Circulation Society’s annual meetings in 2019 and 2020. The total number of tweets increased from 7,587 in 2019 to 23,867 in 2020. Most tweets were retweets (>70%), and approximately half of Twitter users tweeted only once.

    Conclusions:Twitter usage during the Japanese Circulation Society’s annual meeting increased from 2019 to 2020, and a large number of tweets were from Twitter ambassadors of the Japanese Circulation Society. However, further evaluation is needed, with future studies investigating the usefulness of this platform.

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