Valvular heart disease (VHD) is one of the important etiologies for heart failure, in that severe dysfunction of aortic and mitral valves causes worse clinical outcomes. While the guidelines on the management of VHD have been updated in early 2020 in Japan, the environment surrounding this field has been rapidly evolving. Recently, catheter-based interventional technologies for VHD have been developed. Transcatheter aortic valve implantation (TAVI) has become a preferred interventional strategy for treatment of elderly or high-risk surgical patients with severe aortic stenosis. Moreover, transcatheter mitral valve edge-to-edge repair with MitraClip offers an alternative to open surgical repair or replacement in patients with severe mitral regurgitation at increased risk for surgery. The aim of this mini-review is to briefly mention the recent updates of the guidelines on VHD in Japan, and current issues and future prospects of TAVI and MitraClip.
The ISCHEMIA (International Study of Comparative Effectiveness with Medical and Invasive Approaches) was highly anticipated study in the field of cardiology. This article briefly provides a review of the ISCHEMIA trial and better understanding regarding coronary revascularization in patients with stable ischemic heart disease.
Coronary computed tomography (CT) is useful for the diagnosis of stable angina pectoris, and its high diagnostic accuracy for the detection of significant coronary artery stenosis has been identified in many previous studies. The effectiveness of utilizing CT in detecting myocardial ischemia by evaluating the perfusion of the left ventricular myocardium has also been reported, but it is not being widely used in daily clinical practice because of its difficulty.
Recently, the fractional flow reserve (FFR) versus angiography for multi-vessel evaluation (FAME) trial revealed that the prognosis was significantly higher for the patients who underwent coronary artery revascularization therapy (CART) based on FFR than for those who underwent CART based on the visual assessment of significant stenosis. Several studies on coronary angiography have reported a difference between the visually and functionally significant coronary stenosis i.e. degree of stenosis detected visually may not be the same as that shown by the FFR. We are now able to evaluate FFR using the new computational fluid dynamics software by analyzing the normal coronary CT data. The diagnostic accuracy of this FFR on CT is relatively high when compared with invasive FFR measured by coronary angiography, which is the current gold standard. Evaluation of functionally significant coronary artery stenosis on CT has the potential to reduce unnecessary invasive coronary angiographies without increase in the number cardiac events (which may occur owing to misdiagnosis based on the FFR-CT analysis), as reported by some recent clinical studies. By using this software, we can also predict what the new FFR value would be after the coronary arteries have undergone revascularization via percutaneous coronary artery intervention or coronary artery bypass grafting. In this article, we would like to introduce the clinical utility of measuring FFR using CT and its future perspectives to the clinicians.
In this study, we evaluated the efficacy of arm ergometry exercise tests for the prescription of oxygen therapy in patients with respiratory disease who are unable to be tested by walking exercise. In 19 patients (males, 13; females, 6; age, 78.0±7.4 years) with respiratory disease (chronic obstructive pulmonary disease, COPD, 7; bronchial asthma, BA, 4; pneumonia, 4; interstitial pneumonia, IP, 3; and chronic heart failure, CHF, 1), exercise tests with arm ergometry were performed in order to determine the appropriate dose of oxygen for exercise or daily use. The mean oxygen dose from rest to peak exercise was 1.7±1.1 L/min. Heart rate (HR) values at rest and at peak were 84.9±14.4 and 95.1±17.1 beats/min, respectively, while oxygen saturation (SpO2) decreased from 96.6±3.0％ at rest to 90.5±5.6％ at peak exercise. The mean number of revolutions/min for arm ergometry under the lightest load was 45.9±13.6. While there was no significant correlation between change in HR and revolutions/min (R＝0.061, P＝0.8028), SpO2 change was found to correlate with revolutions/min (R＝0.619, P＝0.0047). Exercise tests using arm ergometry were conclusively found to have adequate accuracy to determine the appropriate oxygen therapy for respiratory disease patients who are unable to perform walking exercise.