International Heart Journal
Online ISSN : 1349-3299
Print ISSN : 1349-2365
ISSN-L : 1349-2365
Volume 59 , Issue 2
Showing 1-41 articles out of 41 articles from the selected issue
Editorials
Review Articles
  • Mika Watanabe, Masaki Izumo, Yoshihiro J Akashi
    2018 Volume 59 Issue 2 Pages 250-255
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 05, 2018
    JOURNALS FREE ACCESS

    Takotsubo cardiomyopathy is described as a transient reversible cardiomyopathy which typically occurs in older women after emotional or physical stress. This cardiomyopathy is also recognized as a "syndrome" because it develops in conjunction with various diseases. Since the clinical presentation of takotsubo syndrome (TTS) is similar to acute coronary syndrome (ACS), TTS should be distinguished from ischemic heart disease. Although the pathophysiology of TTS has not well been established, a number of its specific features have been suggested. The predictor of mortality in TTS is still unknown. In this review article, we describe a series of treatment decisions in TTS.

    Editor’s picks

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  • A Strategy Combining Cardiac Troponin I but not T Assay with Other Methods
    Fei Chen, Yong Peng, Mao Chen
    2018 Volume 59 Issue 2 Pages 256-262
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 20, 2018
    JOURNALS FREE ACCESS

    Cardiac involvement in idiopathic inflammatory myopathies (IIMs) attracts more attention than it ever did because of its morbidity and impact on worse prognosis, although the accurate information needs further epidemiological studies. Early identification and intervention for the diseased heart may help improve the clinical outcomes of IIMs with cardiac involvement. Cardiac troponin assays, allowing for sensitive detection of minor myocardium injury, may provide a new way for early detection for heart involvement in IIMs. While elevated cardiac troponin I (cTnI) specifically indicates cardiomyocyte injury, the elevation of cardiac troponin T (cTnT) levels may not only derive from damaged heart but also diseased adult skeletal muscles in which cTnT could re-express in patients with IIMs. cTnI is the biomarker of choice for diagnosis of cardiac involvement and may also be a prognostic factor in IIMs. Meanwhile, electrocardiography (ECG), cardiac imaging (e.g., echocardiography, cardiac magnetic resonance) and histopathological techniques (e.g., endomyocardial biopsy) take on different degrees of importance for the diagnosis of cardiac involvement. We propose a diagnostic strategy combining the routine use of cTnI assay with other techniques (routine ECG and echocardiography, cardiac magnetic resonance, and or endomyocardial biopsy in necessity) and clinical investigation for early detection of heart involvement in IIMs. Future researches are required to validate the algorithm for performance.

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Clinical Studies
  • Yu Horiuchi, Jiro Aoki, Kengo Tanabe, Koichi Nakao, Yukio Ozaki, Kazuo ...
    2018 Volume 59 Issue 2 Pages 263-271
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: February 20, 2018
    JOURNALS FREE ACCESS

    High levels of blood urea nitrogen (BUN) have been demonstrated to significantly predict poor prognosis in patients with acute decompensated heart failure. However, this relationship has not been fully investigated in patients with acute myocardial infarction (AMI). We investigated whether a high level of BUN is a significant predictor for in-hospital mortality and other clinical outcomes in patients with AMI. The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective, observational, multicenter study conducted in 28 institutions, in which 3,283 consecutive AMI patients were enrolled. We excluded 98 patients in whom BUN levels were not recorded at admission and 190 patients who were undergoing hemodialysis. A total of 2,995 patients were retrospectively analyzed. BUN tertiles were 1.5-14.4 mg/dL (tertile 1), 14.5-19.4 mg/dL (tertile 2), and 19.5-240 mg/dL (tertile 3). Increasing tertiles of BUN were associated with stepwise increased risk of in-hospital mortality (2.5, 5.1, and 11%, respectively; P < 0.001). These relationships were also observed after adjusting for reduced estimated glomerular filtration rate (estimated GFR < 60 mL/minute/1.73 m2) or Killip classifications. In multivariable analysis, high levels of BUN significantly predicted in-hospital mortality, after adjusting for creatinine and other known predictors (BUN tertile 3 versus 1, adjusted odds ratio [OR]: 2.59, 95% confidence interval [95% CI]: 1.57-4.25, P < 0.001; BUN tertile 2 versus 1, adjusted OR: 1.60, 95% CI: 0.94-2.73, P = 0.081). A high level of BUN could be a useful predictor of in-hospital mortality in AMI patients.

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  • Xiangyu Gao, Hongwei Li, Ping Wang, Hui Chen
    2018 Volume 59 Issue 2 Pages 272-278
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: February 14, 2018
    JOURNALS FREE ACCESS

    Circulating relaxin (RLX) is altered in patients with diabetes mellitus (DM) or cardiovascular diseases. This study was designed to evaluate the changes of RLX in patients with unstable angina (UA) complicated with various categories of abnormal glucose metabolism.

    Patients who confirmed UA by angiographic and clinical standard were grouped according to the glucose metabolism status with oral glucose tolerance test (OGTT) and medical history categorized as normal, prediabetes, newly diagnosed type 2 DM (T2DM), and previously diagnosed T2DM. Serum RLX-2 was measured and islet β-cell function was evaluated. The severity of the coronary arterial lesions was evaluated with Syntax Scores.

    Serum RLX-2 was significantly higher in UA patients with prediabetes (median [quartiles]: 9.87 [7.48, 32.58] pg/mL) and newly diagnosed T2DM (18.36 [9.52, 48.08] pg/mL), compared with those with normal glucose tolerance (6.24 [4.02, 7.27] pg/mL, both P < 0.05). Interestingly, UA patients with previously diagnosed T2DM exhibited lower RLX-2 levels (4.17 [3.23, 5.72] pg/mL) compared with those with normal glucose tolerance (P < 0.05). Subsequent analyses indicated that serum RLX-2 was positively associated with parameters of islet β-cell function, C-peptide, and fasting insulin levels; however, it was negatively associated with the levels of fasting glucose, 2-hour postprandial blood glucose, HbA1c, and insulin sensitivity, suggesting a potential protective role of RLX-2 during abnormal glucose metabolism in UA patients. Serum RLX-2 was not correlated with the Syntax Scores in these patients.

    Serum RLX-2 is a potential marker for UA patients with early glucose metabolism abnormality, and increased RLX-2 level was correlated with preserved islet β-cell function.

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  • Ting-Chao Lin, Tse-Min Lu, Feng-Chyn Huang, Pai-Feng Hsu, Chun-Che Shi ...
    2018 Volume 59 Issue 2 Pages 279-285
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 20, 2018
    JOURNALS FREE ACCESS

    Percutaneous coronary intervention (PCI) has emerged as an alternative treatment to coronary artery bypass grafting (CABG) in patients with unprotected left main coronary artery disease (ULMCAD). However, the optimal treatment for ULMCAD concomitant with chronic kidney disease (CKD) was rarely addressed. Herein, we compare the long-term outcomes of these patients treated with CABG or PCI.

    From January 2004 to December 2010, 185 patients with ULMCAD and CKD undergoing PCI (n = 84) or CABG (n = 101) were matched for the selection criteria. The primary end points included all-cause death, myocardial infarction (MI), stroke, repeat revascularization and major adverse cardiovascular and cerebrovascular event (MACCE).

    The mean age was 73.4 ± 10.3 years with male (84%) predominance. Baseline characteristics of both groups were similar, except that patients in CABG group were more frequently associated with significant stenosis of right coronary artery and triple vessel disease. Furthermore, most patients belonged to higher surgical risk population (EuroSCORE ≥ 6, PCI group: 80.9%, CABG group: 75.2%). After treatment, the 30-day mortality was 3.5% in PCI and 8.9% in CABG (P = 0.14). During the median follow-up of 3.5 years, the risk of MACCE (67% versus 55%, P = 0.048), MI (15.5% versus 6.9%, P = 0.024), and repeat revascularization (30.9% versus 7.9%, P < 0.001) was significantly higher in the PCI compared with CABG. There were no significant differences in long-term all-cause death, stroke, and impact on renal function.

    CABG was associated with significantly less long-term risk of MI and repeat revascularization in patients with ULMCAD and CKD.

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  • Chunyang Tian, Jia Song, Dongxu He, Jiake Wu, Zhijun Sun, Zhaoqing Sun
    2018 Volume 59 Issue 2 Pages 286-292
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 20, 2018
    JOURNALS FREE ACCESS

    Increased mean platelet volume (MPV) has been associated with adverse clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). We aim to assess whether MPV/platelet count (MPV/PC) ratio is a useful marker to predict long-term prognosis in patients with STEMI undergoing PCI. Moreover, the prognostic accuracy of MPV/PC ratio is compared with MPV. 962 consecutive patients with STEMI treated with P-PCI were considered. According to the admission MPV/PC values, the population was divided into two groups: high MPV/PC group (n = 320, MPV/PC ≥ 0.055) and low MPV/PC group (n = 642, MPV/PC < 0.055). Multivariate analysis showed that high MPV/PC was an independent predictor of major adverse cardiovascular event (MACE; hazard ratio [HR]: 1.121, 95% confidence interval [CI]: 1.056-1.190, P < 0.01), all-cause mortality (HR: 1.109, 95% CI: 1.016-1.209, P = 0.020), cardiac mortality (HR: 1.141, 95% CI: 1.038-1.253, P = 0.006), nonfatal myocardial reinfarction (HR: 1.148, 95% CI: 1.044-1.262, P = 0.004), and unplanned repeat revascularization (HR: 1.073, 95% CI: 1.007-1.144, P = 0.030), respectively. MPV/PC ratio has good accuracy for predicting MACE (the area under the receiver-operating characteristic curve: 0.764), and the cut-off value was 0.054 with a sensitivity of 0.813 and a specificity of 0.662. The discriminatory performance of MPV/PC ratio was better than MPV for predicting MACE (MPV/PC ratio versus MPV: z = 2.285, P = 0.022), in patients with STEMI undergoing P-PCI. MPV/PC ratio is able to but better than MPV to predict long-term adverse outcomes in patients with STEMI undergoing P-PCI.

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  • Chenguang Li, Yi Shen, Rende Xu, Yuxiang Dai, Shufu Chang, Hao Lu, Lei ...
    2018 Volume 59 Issue 2 Pages 293-299
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 20, 2018
    JOURNALS FREE ACCESS

    The safety and efficacy of bivalirudin during percutaneous coronary intervention (PCI) in high bleeding risk patients with chronic total occlusion lesions (CTO) has not been studied till date. The use of bivalirudin may increase the thrombotic events during CTO-PCI.

    Between May 2013 and April 2014, a total of 117 high bleeding risk patients with CTOs underwent PCI. Bivalirudin was used in 89 cases with different strategies, including standard usage, combination of heparin, and additional bolus of bivalirudin on the basis of standard usage. The clinical characteristics, procedural details and antithrombotic strategies were assessed, and the bleeding and ischemic events were evaluated. The first 7 of 9 patients with standard application of bivalirudin exhibited acute thrombogenesis in the procedure. Heparin was then added in decreasing amounts in the next 8 patients wherein no thrombosis occurred; however, 2 patients had bleeding complications. The subsequent 72 patients were randomly assigned to the heparin bolus or additional bivalirudin bolus groups before the percutaneous transluminal coronary angioplasty (PTCA) was performed. The baseline clinical characteristics and procedure information were identical in both the groups. There were no ischemic and bleeding events in both the groups during the 6-month follow-up.

    Monotherapy with bivalirudin in CTO-PCI should be treated with caution, as the potential risk of thrombogenesis may be due to the long procedure time, the frequent change of equipment and temporary blood flow convection. Combination of heparin or an additional bolus of bivalirudin before PTCA was observed to be likely to decrease the incidence of thrombogenesis.

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  • Ming Fang, Qiaohui Qian, Zhihong Zhao, Luoning Zhu, Jinwen Su, Xinming ...
    2018 Volume 59 Issue 2 Pages 300-306
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: February 23, 2018
    JOURNALS FREE ACCESS

    To investigate the combination of high-sensitivity C-reactive protein (hs-CRP) and Low-density lipoprotein (LDL)-C as the targets for statin treatment in patients with acute coronary syndrome (ACS). This single-center, prospective, randomized study was performed in 400 patients treated with atorvastatin 40 mg/day for 1 month and then with atorvastatin 20 mg/day as maintenance. The patients were randomized to the LDL group (LDL-C target of < 2.07 mmol/L according to the Chinese dyslipidemia guidelines) and to the LDL-CRP group (LDL-C target of < 2.07 mmol/L and hs-CRP target of < 3 mg/L). The patients were followed up for major adverse cardiac events (MACE) at 6, 12, and 18 months. The two groups had similar baseline characteristics and 391 patients completed the follow-up. No differences were found in LDL-C between the two groups, but a difference was found in hs-CRP at 12 and 18 months. There was a significant difference in revascularization (8.7% versus 3.6%, P = 0.04) and MACE (16.8% versus 9.7%; P = 0.04) between the LDL and LDL-CRP groups at 18 months. Compared to LDL-C as the single target, targeting both LDL-C and hs-CRP by statin therapy in patients with ACS could further reduce the incidence of MACE and the residual cardiovascular risk.

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  • Optical Coherence Tomography Study
    Yoshinori Sanuki, Shinjo Sonoda, Yoshitaka Muraoka, Akiyoshi Shimizu, ...
    2018 Volume 59 Issue 2 Pages 307-314
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 20, 2018
    JOURNALS FREE ACCESS

    Previous optical coherence tomography (OCT) study reported that irregular protrusion (IP) post drug-eluting stent (DES) implantation was an independent predictor of clinical outcome; however, the relationship between IP and the presence of subsequent in-stent neoatherosclerosis remains unclear. This study aimed to assess the relationship between IP and in-stent neoatheroscrerosis formation using OCT. We evaluated 83 patients (101 lesions) who underwent second-generation DES implantation and 8-month follow-up (8M-FU) using OCT. Lesions were divided into two groups in presence of IP (IP: n = 43, non-IP: n = 58). At prepercutaneous coronary intervention (pre-PCI), lipid-rich plaque, lesions with positive remodeling, and in-stent thrombus formation were more frequent in IP than in non-IP. On multivariate analysis, the thrombus at pre-PCI and the lesions with positive remodeling were independent predictors of IP. At 8M-FU, heterogeneous neointima, microvessel, lipid-laden neointima, and thin-cap fibro-atheroma like neointima were more frequent in IP than in non-IP (respectively, P < 0.05). On multivariate analysis, IP was associated with heterogeneous neointima. Binary restenosis was more frequent and late lumen loss tended to be larger in IP than in non-IP (19% versus 5%, P = 0.04; 1.25 ± 1.24 mm versus 0.91 ± 0.63 mm, P = 0.09); however, the target lesion revascularization rate was similar in both groups at 8M-FU. In conclusion, our study suggested that poststent IP was associated with subsequent neoatherosclerosis formation at 8M-FU after the second-generation DES implantation.

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  • Katsumi Miyauchi, Takeshi Kimura, Hiroaki Shimokawa, Hiroyuki Daida, S ...
    2018 Volume 59 Issue 2 Pages 315-320
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 05, 2018
    JOURNALS FREE ACCESS

    Large-scale clinical trials in patients in Western countries with coronary artery disease (CAD) have found that aggressive lipid-lowering therapy using high-dose statins reduces cardiovascular (CV) events further than low-dose statins. However, such evidence has not yet been fully established in Asian populations, including in Japan. The Randomized Evaluation of Aggressive or Moderate Lipid-Lowering Therapy with Pitavastatin in Coronary Artery Disease (REAL-CAD) study addresses whether intensification of statin therapy improves clinical outcomes in Japanese patients with CAD.

    REAL-CAD is a prospective, multicenter, randomized, open-label, blinded-endpoint, physician-initiated phase 4 trial in Japan. The study will recruit up to 12,600 patients with stable CAD. Patients are assigned to receive either pitavastatin 1 mg/day or pitavastatin 4 mg/day. LDL-C levels are expected to reach approximate mean values of 100 mg/dL in the low-dose pitavastatin group and 80 mg/dL in the high-dose group. The primary endpoint is the time to occurrence of a major CV event, including CV death, non-fatal myocardial infarction, non-fatal ischemic stroke, and unstable angina requiring emergency hospitalization during an average of 5 years. The large number of patients and the long follow-up period in the REAL-CAD study should ensure that there is adequate power to definitively determine if reducing LDL-C levels to approximately 80 mg/dL by high-dose statin can provide additional clinical benefit.

    After the study is completed, we will have categorical evidence on the optimal statin dose and target LDL-C level for secondary prevention in Japanese patients.

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  • Time Course, Optimization of the Blanking Period, and Clinical Outcome
    Kei Takayama, Hitoshi Hachiya, Yoshito Iesaka, Kenzo Hirao, Mitsuaki I ...
    2018 Volume 59 Issue 2 Pages 321-327
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 20, 2018
    JOURNALS FREE ACCESS

    Early recurrence (ER) of atrial fibrillation (AF) is common after ablation of longstanding persistent AF. However, optimal timing for repeat ablation has yet to be established.

    Two-hundred-four patients (mean age 62 ± 9 years) with longstanding persistent AF underwent catheter ablation including pulmonary vein (PV) isolation and substrate modification. ER defined as AF recurrence within 60 days, occurred in 115 patients (56.4%) 9 ± 1 days after the procedure. Analysis showed optimal blanking period to be 15 days. At 426 ± 224 days of follow-up, 30 of 50 (60.0%) patients with ER during the first 15 days (ER ≤ 15) and 13 of 65 (20.0%) patients with ER from the 16th to the 60th day (ER16-60) were free from protocol-defined treatment failure (PDTF) (P < 0.0001). In multivariate analysis, AF duration and LA diameter were independent predictors of ER16-60. Peak first ER was in the first 5 days, with a small maximum in the day 15~20 bin. The mean time to the first ER was longer in patients found to have PV reconnection during the repeat ablation than in those without (13 ± 14 versus 6 ± 7 days, P = 0.002).

    When adopting a blanking period of 15 days, fewer patients with an ER ≤ 15 had PDTF than those with an ER16-60. AF duration and LA diameter were predictive of an ER16-60.

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  • Experience in Asian Population
    Zhixin Jiang, Xiujuan Zhou, Chun Chen, Ying Wang, Ping Fang, Jie Geng, ...
    2018 Volume 59 Issue 2 Pages 328-332
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: February 23, 2018
    JOURNALS FREE ACCESS

    To investigate the efficacy of renal denervation (RDN) on the recurrence of ventricular arrhythmia (VA) in Asian patients with implantable cardioverter defibrillators (ICDs).

    Eight ICD patients with recurrent VA episodes underwent RDN using an off-the-shelf saline-irrigated catheter. The pre- and postprocedural VA episodes were counted via ICD interrogation. All patients underwent successful RDN without any complications related to radiofrequency catheter ablation. The median follow-up was 15 months (range 6-30), and the median VA episodes per month were significantly reduced from 3.17 (range 0.33-15.33) to 0.10 (range 0-5.83) after RDN (P < 0.05).

    RDN is an effective suppressor of VA in Asian patients with ICDs.

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  • Gang Chen, Lingmin Wu, Lihui Zheng, Ligang Ding, Tom Wong, Shu Zhang, ...
    2018 Volume 59 Issue 2 Pages 333-338
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 20, 2018
    JOURNALS FREE ACCESS

    This study aimed to prospectively evaluate the safety and efficacy of a new developed method that uses percutaneous ultrasound-guided hematoma aspiration followed by targeted localized manual compression for treatment of femoral artery pseudoaneurysm after cardiac catheterization, which obviates thrombin use, surgery, and long-time compression.

    From January 2007 to July 2014, 32 patients (17 women; mean age, 55.3 ± 11.5 years) out of 8,725 consecutive cases undergoing cardiac catheterization via femoral access developed one pseudoaneurysm each ranging in size from 21 × 11 mm to 72 × 39 mm. Under ultrasound guidance, blood within the pseudoaneurysm was aspirated percutaneously using an 18-gauge needle, while the pseudoaneurysm neck and a nearby site over the pseudoaneurysm were manually compressed for 15 min. All patients underwent repeat ultrasound examination 24 hours later.

    Of the 32 pseudoaneurysms, 31 were successfully occluded, and 1 recurred in a patient with coexisting arteriovenous fistula, yielding an overall success rate of 96.9% (31/32). No further recurrence or procedure related complications were observed. The treatment approach is unlike open surgical repair with hematoma evacuation and arterial defect suturing, in that it entails hematoma aspiration and feeding flow blockage at the pseudoaneurismal neck.

    In this preliminary experience, combining percutaneous ultrasound-guided hematoma aspiration and manual compression appears safe and effective in treating femoral artery pseudoaneurysms after catheterization and avoids thrombin use, long-time compression, and surgery.

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  • Ikumi Nara, Takako Iino, Hiroyuki Watanabe, Wakana Sato, Kumiko Watana ...
    2018 Volume 59 Issue 2 Pages 339-346
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: February 23, 2018
    JOURNALS FREE ACCESS

    The morphological determinants of left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy (HCM) are not completely understood. We aimed to identify the anatomical risks of the obstruction using echocardiography.

    Fifty patients with untreated HCM were classified into two groups: those with LVOT pressure gradient (LVOTPG) ≥ 30 mmHg (obstructive HCM [HOCM] group) and those with LVOTPG < 30 mmHg (HNCM group). The echocardiographic morphological variables were analyzed to determine whether they were predictive of LVOT obstruction. Systolic anterior motions of the mitral valve were observed in 100% of patients in the HOCM group but only in 58% in the HNCM group. There were no significant differences in wall thickness, end-systolic LV dimension (LVDs), or LVOT diameter between the two groups. However, HOCM subjects had a shorter distance from papillary muscles to the inter-ventricular septum (5.97 ± 2.3 versus 9.20 ± 1.9 mm, respectively, P < 0.0001) and a longer anterior mitral leaflet (AML) length (24.7 ± 5.8 versus 20.1 ± 5.4 mm, respectively, P < 0.01) compared to the HNCM group. The AML length/LVDs ratio was significantly higher in the HOCM group compared to the HNCM group (1.02 ± 0.34 versus 0.78 ± 0.26, P < 0.01), and an LVOT obstruction was predicted with an area under the curve of 0.71 (P < 0.05). Multiple linear regression revealed that only the AML length/LVDs ratio was independently associated with LVOTPG (P < 0.01).

    The AML length/LVDs ratio has a significant predictive value for LVOT obstruction and a strong relationship with LVOTPGs. The AML length/LVDs ratio determines the anatomical risk of LVOT obstruction in HCM.

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  • Nobusada Funabashi, Hiroyuki Takaoka, Koya Ozawa, Yoshio Kobayashi
    2018 Volume 59 Issue 2 Pages 347-353
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: February 23, 2018
    JOURNALS FREE ACCESS

    Peak longitudinal strain (PLS) of the left ventricular (LV) myocardium by transthoracic echocardiogram (TTE) is useful to detect LV myocardial damage. We hypothesized that myocardial fibrosis (MF) in the LV myocardium may influence PLS. Eighteen hypertrophic cardiomyopathy (HCM) patients (14 males; 58 ± 17 years old) underwent 1.5 Tesla cardiac magnetic resonance (CMR) and TTE. Patients with previous myocardial infarction were excluded. We used TTE to assess whole-layer PLS in an American Heart Association-defined 17-segment LV model. Whole-layer PLS was calculated using Echo PAC, version 113 (GE Healthcare). MF was assessed by T1-weighted CMR of the LV endocardial layer, the LV epicardial layer, or both the LV endocardial and epicardial layers for each lesion. Of the 306 segments, MF was detected in the LV endocardial layer only (13 segments), in the LV epicardial layer only (9 segments), or in both LV endocardial and epicardial layers (59 segments). PLS values were significantly lower in segments with MF affecting only the LV endocardial layer (7% ± 4%) (P < 0.05) and where MF was observed in both the LV endocardial and epicardial layers (9% ± 5%) (P = 0.001) compared with segments without MF (13% ± 7%). No significant difference in PLS values was detected between the MF segments for the LV epicardial layer only (10% ± 6%) and those without MF (13% ± 7%) (P > 0.05). In HCM patients, fibrotic lesions in the LV endocardium have a greater adverse effect on PLS than those in the LV epicardium. Our results are significant for HCM patients with fibrotic lesions within the LV endocardium.

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  • Isao Nishi, Yoshihiro Seo, Yoshie Hamada-Harimura, Kimi Sato, Seika Sa ...
    2018 Volume 59 Issue 2 Pages 354-360
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: February 23, 2018
    JOURNALS FREE ACCESS

    Controlling nutritional status (CONUT) uses 2 biochemical parameters (serum albumin and cholesterol level), and 1 immune parameter (total lymphocyte count) to assess nutritional status. This study examined if CONUT could predict the short-term prognosis of heart failure (HF) patients.

    A total of 482 (57.5%) HF patients from the Ibaraki Cardiovascular Assessment Study-HF (n = 838) were enrolled (298 men, 71.7 ± 13.6 years). Blood samples were collected at admission, and nutritional status was assessed using CONUT. CONUT scores were defined as follows: 0-1, normal; 2-4, light; 5-8, moderate; and 9-12, severe degree of undernutrition. Accordingly, 352 (73%) patients had light-to-severe nutritional disturbances. The logarithmically transformed plasma brain natriuretic peptide (log BNP) concentration was significantly higher in the moderate-severe nutritional disturbance group (2.92 ± 0.42) compared to the normal group (2.72 ± 0.45, P < 0.01). CONUT scores were significantly higher in the in-hospital death patients [4 (3-8), n = 14] compared with patients who were discharged following symptom alleviation [3 (1-5), n = 446, P < 0.05]. With the exception of transferred HF patients (n = 22), logistic regression analysis that incorporated the CONUT score and the log BNP, showed that a higher CONUT score (P = 0.019) and higher log BNP (P = 0.009) were predictors of in-hospital death, and the median duration of hospital stay was 20 days.

    Our results demonstrate the usefulness of CONUT scores as predictors of short-term prognosis in hospitalized HF patients.

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  • Dan Su, Anqi Song, Bin Yan, Qi Guo, Ya Gao, Yanhua Zhou, Fuling Zhou, ...
    2018 Volume 59 Issue 2 Pages 361-366
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: February 23, 2018
    JOURNALS FREE ACCESS

    The abnormalities of blood pressure (BP) nocturnal decline have been found to be predictive for carotid plaque and lacunar infarction in patients with hypertension. In this study, BP dipping patterns in postmenopausal females with hypertension were investigated. The nocturnal decline of systolic BP (SBP) was evaluated using 24-hour ambulatory BP monitoring (ABPM). A total of 163 postmenopausal females were eventually included in our study. The prevalence of reverse-dipper BP pattern was 32.3% in females with menopause age in their 40s and 40% in their 50s. However, after multivariate logistic regression analysis, menopause age was shown to be an independent risk factor for BP reverse dipping (Odds ratio [OR] 1.148; 95%CI 1.020 - 1.292; P = 0.020). Moreover, menopause age was negatively correlated with the decline rate of nocturnal SBP (r = -0.159; P < 0.05) and diastolic BP (r = -0.161; P < 0.05). Our study suggested that the menopause age might serve as a risk factor for reverse-dipper BP pattern in postmenopausal females with hypertension.

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  • A Retrospective Cohort Study
    Hiraku Funakoshi, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
    2018 Volume 59 Issue 2 Pages 367-371
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 05, 2018
    JOURNALS FREE ACCESS

    High-risk pulmonary embolism (PE) with hypotension, circulatory failure, or cardiac arrest is a rare, but life-threating condition. Many guidelines recommend that thrombolytic therapy is the first-line therapy for this condition and surgical embolectomy is an alternative treatment. However, nationwide data have been lacking on patient characteristics and practice patterns for high-risk PE in a real-world clinical setting.

    We defined high-risk PE patients as those who received noradrenaline and underwent surgical embolectomy or thrombolysis within one day after admission. Using a Japanese national inpatient database, we identified high-risk PE patients from July 2010 to March 2014, and divided them into patients with and without embolectomy and those with and without cardiopulmonary arrest (CPA) at admission. We examined variation in patient backgrounds, procedures, and outcomes in this population.

    We identified 361 patients were eligible. Among those, including 266 received thrombolysis and 95 received embolectomy. The 30-day mortality was 41.4% in 266 patients with thrombolysis, and 14 patients died in 95 patients with embolectomy. Among the thrombolysis group, 30-day mortality was 35% in 187 patients without CPA thrombolysis and was 56% in 79 patients with CPA. Among the embolectomy group, 30-day mortality was 14% in 81 patients without CPA, and 21% patients died in 14 patients with CPA.

    The present nationwide study showed that surgical embolectomy had a relatively low mortality. Further studies are needed to verify the comparative effectiveness of embolectomy.

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  • An Observational Study
    Tomoko Fujii, Tasuku Matsuyama, Jiro Takeuchi, Masahiko Hara, Tetsuhis ...
    2018 Volume 59 Issue 2 Pages 372-377
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: February 20, 2018
    JOURNALS FREE ACCESS

    The representation of women in Japanese academic medicine is not evident. We aimed to assess trends related to the proportion of female first authors in Japanese cardiovascular journals.

    We reviewed original research articles in 6 journals published in English by Japanese societies between 2006 and 2015 related to cardiovascular fields. We conducted a multivariable logistic regression analysis to assess the factors associated with the gender of first authors and plotted the trend of predicted probability for female first authors over the study period. Of 7,005 original articles, 1,330 (19.0%) had female first authors. Affiliations located in Japan (adjusted odds ratio [aOR], 0.76; 95% confidence interval [CI], 0.71-0.81), concurrent first and corresponding authors (aOR, 0.69; 95% CI, 0.64-0.74), and the total number of listed authors (aOR, 0.97; 95% CI, 0.95-0.99) were negatively associated with female first authors. The adjusted probability of a female first author increased from 13% to 20% on an average between 2006 and 2009, but the increase reached a plateau after 2010.

    Female first authors of original research articles published in Japanese cardiovascular journals increased over the examined decade. However, the representation of women is still low and has plateaued in recent years. A gender gap in authorship for Japanese cardiovascular journals remains.

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Experimental Studies
  • Jiuxing Liang, Xiangmin Zhang, Yuxi Luo, Tingting Wang, Lin Sun, Shaox ...
    2018 Volume 59 Issue 2 Pages 378-386
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 12, 2018
    JOURNALS FREE ACCESS

    Sleep apnea hypopnea syndrome (SAHS) is an independent risk factor for cardiovascular diseases. However, the pathophysiology between them is not yet clear. This paper seeks to understand how respiratory events impact the cardiovascular system by heart rate variability. We compared the differences between successional pathological respiratory events (PR) and pure normal respiration (NR) during sleep. The transitions between normal and pathological respiration (TR) were also analyzed. Thirteen patients who suffered moderate or severe SAHS were enrolled in this study. The results demonstrate that the beat-to-beat interval (RR interval) mean value and sample entropy are significantly lower during PR than during NR. RR interval standard deviation, the power of very low frequency (VLF) and low frequency (LF), total power, and the low frequency/high frequency (LF/HF) ratio were significantly larger during PR than during NR. However, the high frequency (HF) power was not significantly different between normal and pathological respiration. Additionally, the trends during TR also supported these significant differences. The results indicate that during pathological respiration, as the heart rate and its volatility increase, the complexity of its rhythm decreases. We conclude that the energy of the autonomic nervous system rapidly increases during pathological respiration, especially at the beginning. The HF power does not significantly change to modulate the heart rhythm, but the activity of the sympathetic nervous system will significantly increase, resulting in the imbalance of the LF/HF ratio. In addition to these findings, this paper discusses the influence of arousal on these indices during TR.

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  • Yongwang Wang, Qingping Wang, Wenli Yu, Hongyin Du
    2018 Volume 59 Issue 2 Pages 387-393
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: February 23, 2018
    JOURNALS FREE ACCESS
    Supplementary material

    Oxidative stress and excessive nitric oxide (NO) production play considerable roles in infarction-induced injury impairing cardiac functions. Crocin is the active constituent of Crocus sativus (saffron) with antioxidant properties and has protective effects against disturbances induced by ischemia in many organs. The present study aimed to investigate the protective effects and the underlying mechanisms of crocin on myocardial infarction (MI)-induced injury in rats in vivo. MI rats were intraperitoneally injected with crocin at different doses for seven successive days after coronary ligation. Infarct size, hemodynamic studies, and capillary density were evaluated. Levels of oxidative stress, inducible nitric oxide synthase (iNOS), endothelial nitric oxide synthase (eNOS), and their corresponding phosphorylation expressions were then measured. Crocin decreased infarct size, left ventricular (LV) end-diastolic pressure, and LV minimum dP/dt while increased LV maximum dP/dt and percentage of LV fractional shortening dose dependently. Capillary density was markedly increased after crocin treatment. Crocin enhanced superoxide dismutase activity and reduced malondialdehyde levels as well as inhibited excessive production of NO through downregulating iNOS as well as upregulating eNOS during MI-induced injury. This study reveals that crocin improves MI-induced impairments in cardiac function, which is associated with its antioxidant properties.

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  • Chen Yu, Yang Lixia, Guo Ruiwei, Shi Yankun, Ye Jinshan
    2018 Volume 59 Issue 2 Pages 394-398
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 20, 2018
    JOURNALS FREE ACCESS

    To investigate whether focal adhesion kinase (FAK) can participate in the secretion of matrix metalloproteinase 9 (MMP9) after CD147 stimulation in THP-1 induced macrophages; thus, to explore the potential treatment perspectives for acute coronary syndrome (ACS).

    Phorbol-12-myristate-13-acetate (PMA) was used to induce THP-1 cells to differentiate into macrophages. To confirm the peak mRNA and protein expression of FAK and MMP9 after the stimulation of CD147, the macrophages were divided into 5 groups (0, 3, 6, 9, and 12 hours), with 0 hours group as control group. To investigate the role of FAK in the secretion of MMP9, with stimulation of CD147 for 9 hours, FAK inhibitor 14 was used to inhibit FAK Y397 phosphorylation. The mRNA and protein expressions were quantified by qRT-PCR and western blotting, respectively.

    (1) Relative mRNA expression of FAK and MMP9 were both significantly up-regulated (all P < 0.05) after stimulation of CD147, FAK peaked at 9 hours (3.908 ± 0.106 versus 1, P < 0.05), whereas MMP9 peaked at 6 hours (2.522 ± 0.062 versus 1, P < 0.05). (2) Relative protein expression of FAK, pFAK, and MMP9 were all significantly increased after CD147 stimulation (all P < 0.05), FAK (1.930 ± 0.024 versus 1, P < 0.05) and pFAK (1.737 ± 0.021 versus 1, P < 0.05) peaked at 9 hours, whereas MMP9 peaked at 6 hours (1.527 ± 0.033 versus 1, P < 0.05). (3) CD147 up-regulates FAK, pFAK, and MMP9 mRNA and protein expressions in a dose-dependent manner. (4) FAK inhibitor 14 significantly reduced the relative protein expression level of pFAK (0.077 ± 0.012 versus 1, P < 0.05) and MMP9 (0.133 ± 0.012) at 9 hours after CD147 stimulation.

    The results demonstrated that FAK Y397 phosphorylation was involved in the secretion of MMP9 after CD147 stimulation in macrophages and may play a role in the regulation of ACS.

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Case Reports
  • Kei Yamamoto, Kenichi Sakakura, Yousuke Taniguchi, Yoshimasa Tsurumaki ...
    2018 Volume 59 Issue 2 Pages 399-402
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: February 20, 2018
    JOURNALS FREE ACCESS

    Because rotational atherectomy (RA) has several unique complications, such as burr entrapment, vessel perforation, and slow flow, it is important for interventional cardiologists to be familiar with bailout procedures for such complications. The principal part of bailout procedures is to keep a guidewire in the target coronary artery during the procedure. However, it is not easy to keep a guidewire in the same position during the removal of a burr because the length of the RA guidewires is 300 cm, and the removal of a burr requires collaboration between the primary operator and an assistant. We describe the case of an 83-year-old male with stable angina. We performed RA to the left anterior descending artery, and removed the burr using a KUSABI (Kaneka Medix Corporation, OSAKA, Japan) trapping balloon technique without activating the dynaglide mode. This simple technique would help RA operators remove a burr more reliably than the conventional removal technique.

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  • Koyu Sakai, Yohei Kobayashi, Shinichi Shirai, Kenji Ando
    2018 Volume 59 Issue 2 Pages 403-406
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 20, 2018
    JOURNALS FREE ACCESS

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and little is known about characteristics, treatment, and follow-up of patients with SCAD. Computed tomography angiography (CTA) plays an important role in the diagnosis and management of SCAD. Herein, we describe a case of a patient with SCAD who underwent successful conservative management, and in whom CTA was able to detect rapid healing of the dissection, 4.5 hours post-dissection.

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  • A Case Report
    Yumiko Haraguchi, Kenichi Sakakura, Kei Yamamoto, Yousuke Taniguchi, I ...
    2018 Volume 59 Issue 2 Pages 407-412
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: February 23, 2018
    JOURNALS FREE ACCESS

    Blunt chest trauma can cause a wide variety of injuries including acute myocardial infarction (AMI). Although AMI due to coronary artery dissection caused by blunt chest trauma is very rare, it is associated with high morbidity and mortality. In the vast majority of patients with AMI, primary percutaneous coronary interventions (PCI) are performed to recanalize obstructed arteries, but PCI carries a substantial risk of hemorrhagic complications in the acute phase of trauma. We report a case of AMI due to right coronary artery (RCA) dissection caused by blunt chest trauma. The totally obstructed RCA was spontaneously recanalized with medical therapy. We could avoid primary PCI in the acute phase of blunt chest trauma because electrocardiogram showed early reperfusion signs. We performed an elective PCI in the subacute phase when the risk of bleeding subsided. Since the risk of severe hemorrhagic complications is greater in the acute phase of blunt chest trauma as compared with the late phase, deferring emergency PCI is reasonable if signs of recanalization are observed.

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  • Jin-Woo Kim, You-Hong Lee, Jae-Hyeong Park, Jae-Hwan Lee
    2018 Volume 59 Issue 2 Pages 413-416
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: February 20, 2018
    JOURNALS FREE ACCESS

    Stentablation by rotational atherectomy has been reported as an option to correct underexpanded stents. Due to concerns of excessive stent damage, distal embolization of metal particles, excessive heat generation, and burr entrapment in the stent, stentablation has been considered the last choice to manage underexpanded stents. Here, we report a case of a stuck and entrapped atherectomy burr inside an underexpanded and undilatable stent, which made withdrawal of therotablation burr during rotational atherectomy difficult. After successful stentablation by rotational atherectomy, we were able to complete the percutaneous coronary intervention with another stent.

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  • Yuka Taguchi, Toshiyuki Ishikawa, Katsumi Matsumoto, Yutaka Ogino, Hir ...
    2018 Volume 59 Issue 2 Pages 417-419
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: February 14, 2018
    JOURNALS FREE ACCESS

    A 17-year-old woman was resuscitated from cardiac arrest due to ventricular fibrillation and was diagnosed with concealed long QT syndrome. She underwent subcutaneous implantable cardiac defibrillator (S-ICD) implantation at our hospital. The device electrogram immediately after implantation was normal. Four days after implantation, she received an inappropriate shock. The device interrogation revealed a continuous baseline shift and frequent oversensing for low amplitude signals, followed by a shock. A chest radiograph in the orthogonal view showed entrapped subcutaneous air surrounding the distal electrode. Entrapped subcutaneous air can cause inappropriate shocks in the early period after S-ICD implantation.

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  • Report of a Case and Review of Reported Cases
    Shigeaki Aoyagi, Takeshi Oda, Kumiko Wada, Eiji Nakamura, Tomokazu Kos ...
    2018 Volume 59 Issue 2 Pages 420-423
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 20, 2018
    JOURNALS FREE ACCESS

    We report a case of aortic valve infective endocarditis (IE) in a 24-year-old man with atopic dermatitis (AD). He had a history of balloon valvuloplasty for a stenotic bicuspid aortic valve, and had dental caries but no invasive dental procedure before the onset of IE. On admission, skin lesions of AD with itching and scratches were found on the neck, trunk, and extremities. Echocardiography showed a vegetation on the aortic valve with mild steno-regurgitation, but extension of IE to the annulus was not detected. Magnetic resonance imaging identified fresh cerebral infarction without neurological dysfunction, leading us to suspect an embolism. Blood cultures grew methicillin-sensitive Staphylococcus aureus. During emergency surgery, a vegetation attached to the conjoined cusp was observed, and the aortic valve was replaced with a mechanical valve. The patient recovered uneventfully without any complications such as recurrent IE or mediastinitis. We also review previously reported cases of IE associated with AD.

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  • Xuepei Tang, Sisi Yu, Liang Yin, Lianggeng Gong
    2018 Volume 59 Issue 2 Pages 424-426
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 20, 2018
    JOURNALS FREE ACCESS

    To our knowledge, left ventricular noncompaction (LVNC) and hypertrophic cardiomyopathy (HCM) commonly occur as separate disorders in different patients; however, LVNC associated with HCM, which is called hypertrophic LVNC, is relatively rare.1) Here we report two sporadic cases of hypertrophic LVNC which were diagnosed by echocardiography and cardiac magnetic resonance (CMR).

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  • Takeo Fujino, Shujiro Inoue, Shunsuke Katsuki, Taiki Higo, Tomomi Ide, ...
    2018 Volume 59 Issue 2 Pages 427-430
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 20, 2018
    JOURNALS FREE ACCESS

    A 31-year-old man was admitted to our hospital with atrial tachycardia and cardiogenic shock. He had been diagnosed with hereditary spherocytosis (HS) during childhood, but he never received any red blood cell transfusions. Right ventricular endomyocardial biopsy revealed multiple myocardial hemosiderin deposits, and he was diagnosed with cardiac hemochromatosis. In addition to the iron deposition in the heart, the loss of myocyte and severe interstitial fibrosis were present. His cardiac function did not improve even after the cardioversion for atrial tachycardia, and he suffered from recurrent heart failure. Despite intensive medical treatment for heart failure and arrhythmias in combination with iron chelation therapy, he eventually died of progressive and refractory heart failure. Hemochromatosis is a systemic disorder characterized by the excessive deposition of iron in multiple organs. The occurrence of hemochromatosis in HS is extremely rare, and previous reports have shown that the coexistence of heterozygosity for the HFE gene mutation in HS patients causes excess iron storage. The prognosis is poor due to progressive congestive heart failure and refractory arrhythmias. Here we report a rare case of fatal cardiac hemochromatosis associated with HS. The possibility of cardiac hemochromatosis needs to be considered in cases of heart failure or arrhythmia in patients with HS.

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  • A Case Report
    Yuji Matsumoto, Hiroaki Kawano, Keisuke Iwasaki, Shuji Arakawa, Koji M ...
    2018 Volume 59 Issue 2 Pages 431-434
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: February 23, 2018
    JOURNALS FREE ACCESS

    Giant coronary artery aneurysms related to coronary fistula are rare, and the precise mechanisms by which they occur are unknown. We present a case of giant coronary artery aneurysm of the left coronary artery to the pulmonary artery fistula with a lack of internal and (or) external elastic lamina and medial degeneration.

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  • Atsushi Daimon, Chizuko A. Kamiya, Masami Sawada, Yusuke Ueda, Chinami ...
    2018 Volume 59 Issue 2 Pages 435-438
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: February 14, 2018
    JOURNALS FREE ACCESS

    Recently, implantable cardioverter-defibrillators (ICD) have become capable of monitoring intrathoracic impedance to detect an increased fluid volume and heart failure. Pregnancy is a well-known cause of an increased body fluid volume; however, it is not clear whether the measurement of intrathoracic impedance by ICD is clinically useful for precisely detecting heart failure in pregnant women. We herein report the case of a 39-year-old woman with an ICD that had been implanted after an event of ventricular fibrillation due to severe aortic regurgitation with a bicuspid aortic valve. Elevated right ventricular pressure and brain natriuretic peptide levels were detected at 37 weeks of gestation and postpartum. At the same time, the ICD's stored fluid index gradually increased and exceeded the threshold on the 10th day after delivery. She was treated with diuretics and recovered from postpartum heart failure. The physiological volume changed in the perinatal period, but we were still able to detect heart failure by ICD. Intrathoracic impedance monitoring is effective in the perinatal field.

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  • Yoshinari Enomoto, Go Hashimoto, Naohiko Sahara, Hikari Hashimoto, Hir ...
    2018 Volume 59 Issue 2 Pages 439-442
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 12, 2018
    JOURNALS FREE ACCESS

    A 70-years-old male with a history of hypertension and drug resistant paroxysmal atrial fibrillation (AF) presented to our hospital for catheter ablation to his symptomatic AF. He had no prior surgical or percutaneous procedure to close or exclude the left atrial appendage (LAA). A transesophageal echocardiography (TEE) was performed to rule out intra-cardiac thrombus prior to the ablation procedure. Although the TEE imaging at multiple acquisition angles was obtained, the LAA could not be visualized and an absence of the LAA was suspected. An absence of the LAA was confirmed using cardiac computed tomography (CT), which included 3D reconstruction. Additionally, the LAA was not visualized with left atrium (LA) angiography. During the ablation procedure, 3D voltage mapping in LA was created and no low voltage area or abnormal potential was recorded around the usual root location of the LAA. Successful electrical pulmonary vein isolation was achieved with no major complications. After six months of follow-up, the patient remained in sinus rhythm without any antiarrhythmic drugs and showed no related clinical symptoms. He stopped his anticoagulation therapy due to lack of evidence of AF recurrence and an absence of LAA. Multimodality imaging allowed us to identify the congenital absence of LAA.

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  • Tatsuyuki Sato, Masaya Mori, Jiro Aoki, Kengo Tanabe
    2018 Volume 59 Issue 2 Pages 443-447
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 05, 2018
    JOURNALS FREE ACCESS

    Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal cancer-related complication characterized by severe progressive pulmonary hypertension. Antemortem diagnosis is difficult owing to the rapid progression of the condition, especially when the patient has no known malignancies and initially presents with pulmonary hypertension. Here we report a case of PTTM due to occult gastric cancer with metastasis in the left supraclavicular lymph node, also known as Virchow's node. Enlarged Virchow's node is an important indicator of advanced gastric cancer. In patients with progressive pulmonary hypertension of unknown origin, enlarged Virchow's node can be an important indicator for the diagnosis of PTTM.

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  • Cuilin Zhu, Xiaomei Zheng, Zhicheng Zhu, Dan Li, Tiance Wang, Rihao Xu ...
    2018 Volume 59 Issue 2 Pages 448-450
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 05, 2018
    JOURNALS FREE ACCESS

    Acute aortic dissection occurring during pregnancy poses great danger to both the mother and fetus. Cesareans are usually performed before or after the aortic repair depending on the conditions of the mother and fetus. Here we report our experience in treating a 32-week pregnant woman with a type B aortic dissection, whose baby had died before admission. A cesarean section was initially arranged after emergency aortic repair. However, the patient started to deliver the fetus vaginally after the aortic surgery and the stillborn baby was delivered vaginally. This case report provides new insight into the method of delivery in a pregnant woman with an aortic dissection.

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  • Hypoplasia of the Inferior Vena Cava
    Yusuke Adachi, Kenichi Sakakura, Tomohisa Okochi, Takaaki Mase, Mitsun ...
    2018 Volume 59 Issue 2 Pages 451-454
    Published: March 31, 2018
    Released: March 30, 2018
    [Advance publication] Released: March 20, 2018
    JOURNALS FREE ACCESS

    A 32-year-old man with a history of bronchial asthma was referred for low back pain and bilateral femur pain. Vascular sonography revealed bilateral deep vein thrombosis (DVT) from the femoral veins to the popliteal veins. Computed tomography revealed hypoplasia of the inferior vena cava (IVC) and dilated lumbar veins, ascending lumbar veins, and azygos vein as collaterals. There was no evidence of malignant neoplasm. The results of the thrombophilia tests were within normal limits. Hypoplasia of the IVC is a rare cause of DVT. This anomaly should be considered as a cause of bilateral and proximal DVT, in particular, in young patients without major risk factors.

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