記述言語：英語   出版者・発行元：一般社団法人 日本内科学会  

<p>A 67-year-old man on intense immunosuppressive therapy after heart transplantation for end-stage hypertrophic cardiomyopathy 7 years ago developed severe dyspnea and was admitted to our hospital. His serum SARS-CoV-2 antigen test was positive, and he was diagnosed with COVID-19-related pneumonia. He was started on ventilatory management for severe respiratory failure and remdesivir for COVID-19, with careful adjustment of immunosuppressive drugs. However, unexpectedly prolonged muscle weakness necessitated transfer to a rehabilitation facility. Although the COVID-19 pandemic has subsided, it is still considered a risk in post-transplant cases. Infection control is considered critical in heart transplant recipients, especially in those receiving intensified immunosuppressive drugs. </p>

DOI： 10.2169/internalmedicine.5254-25

PubMed

CiNii Research

記述言語：英語   出版者・発行元：一般社団法人 日本循環器学会  

Background: The effects of myocarditis after mRNA COVID-19 vaccination (mCV) on myocardial tissue, and the association between cardiomyocyte injury and clinical presentation, are not fully understood. Methods and Results: We retrospectively registered patients clinically diagnosed with myocarditis after the first or second mCV who underwent endomyocardial biopsy or autopsy from 42 participating centers in Japan. We investigated the histological features and their association with clinical presentation based on cardiomyocyte injury. Forty patients who underwent endomyocardial biopsy were included in the study. Of these, 19 (47.5%) showed mild lymphocytic infiltration and interstitial edema without cardiomyocyte injury. The remaining 21 (52.5%) patients showed cardiomyocyte injury accompanied by infiltrating inflammatory cells: 11 with lymphocytic infiltration, 7 with eosinophilic infiltration, and 3 with myocarditis with both lymphocyte and eosinophil infiltration. Compared with patients without cardiomyocyte injury, those with cardiomyocyte injury were clinically characterized by older age, a balanced sex distribution, less frequent chest pain, and a lower left ventricular ejection fraction. Fifteen of 21 (71.4%) patients with cardiomyocyte injury developed fulminant myocarditis, with 13 (86.7%) requiring mechanical circulatory support; in contrast, none of those without cardiomyocyte injury developed fulminant myocarditis (P<0.001). Conclusions: Our histological examination of patients with myocarditis after mCV revealed varying degrees of cardiomyocyte injury, ranging from pronounced to absent, along with various types of myocarditis. Cardiomyocyte injury was strongly associated with the severity of myocarditis.

DOI： 10.1253/circj.cj-24-0506

Web of Science

Scopus

PubMed

CiNii Research

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

記述言語：英語   出版者・発行元：一般社団法人 インターナショナル・ハート・ジャーナル刊行会  

An 18-year-old man experienced refractory cardiogenic shock due to dilated cardiomyopathy of unknown aetiology, and was referred to our hospital to undergo a paracorporeal left ventricular assist device (LVAD) im-plantation. After surgery, the patient lost consciousness, with subsequent head computed tomography revealing low-density areas in the bilateral basal ganglia. Metabolic acidosis and hyperammonaemia also appeared. Metabolic evaluation and genetic tests led to a diagnosis of propionic acidemia. Following appropriate management of heart failure and propionic acidemia, his neurological and cardiac functions gradually recovered, and the paracorporeal LVAD was successfully explanted. Dilated cardiomyopathy and heart failure are rare manifestations of adult-onset propionic acidemia. This is the first reported case of cardiogenic shock due to propionic acidemia-associated cardiomyopathy successfully treated with a combination of mechanical circulatory support and medical therapy for heart failure and propionic acidemia.

DOI： 10.1536/ihj.24-364

Web of Science

Scopus

PubMed

CiNii Research

記述言語：英語   出版者・発行元：Cardio-Oncology  

The advent of immune checkpoint inhibitors (ICIs) has significantly improved cancer treatment. With the increasing use of ICIs, ICI-related myocarditis has been recognized. However, an evidence-based therapeutic strategy has not been established because of the limited knowledge on ICI-related myocarditis. Here, we present four cases of ICI-related fulminant myocarditis (FM). Three of the four cases resulted in fatal outcomes despite aggressive treatment with mechanical circulatory support and immunosuppressive therapy with corticosteroids. Given the poor prognosis of ICI-FM, the establishment of rapid and adequate therapeutic interventions on the basis of clinical and pathological evaluation is imperative.

DOI： 10.1186/s40959-024-00288-0

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：International Journal of Cardiology  

Backgrounds: A soluble guanylyl cyclase stimulator vericiguat has been shown to reduce cardiovascular mortality or hospitalization for heart failure in patients with worsening heart failure in the VICTORIA study. However, little is known about the effects of vericiguat on biventricular structure and function. Methods and results: A retrospective analysis of 63 consecutive patients with heart failure with reduced ejection fraction (HFrEF) who were treated with vericiguat was performed. Clinical data and echocardiographic parameters were compared between baseline and follow-up after the initiation of vericiguat. The median follow-up duration was 266 days. Treatment with vericiguat significantly reduced the plasma BNP levels (log-transformed) compared to baseline (2.46 ± 0.51 vs. 2.14 ± 0.58, p < 0.0001). Left ventricular end-diastolic volume index and left ventricular end-systolic volume index were significantly reduced (LVEDVI, 113.5 ± 46.3 vs. 103.6 ± 51.0, p = 0.0056; LVESVI, 82.0 ± 41.9 vs. 72.8 ± 44.7, p = 0.0077; respectively). The tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio, an indicator of right ventricle-pulmonary artery (RV-PA) coupling, increased significantly after the treatment (0.56 ± 0.29 vs. 0.92 ± 1.09, p < 0.0001). Univariate and multivariate analyses showed that the treatment effects of vericiguat on BNP levels, LV reverse remodeling, and RV-PA coupling were not correlated with the achievement of the quadruple therapy with beta-blockers, renin-angiotensin system inhibitors, mineralocorticoid inhibitors, and sodium-glucose cotransporter-2 inhibitors, nor with worsening heart failure (WHF). Conclusion: Treatment with vericiguat improved adverse LV remodeling and RV-PA uncoupling in HFrEF patients. These effects were independent of WHF and achieving the quadruple therapy. Patients with HFrEF may benefit from early initiation of vericiguat to prevent biventricular adverse remodeling.

DOI： 10.1016/j.ijcard.2024.132441

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：(一社)インターナショナルハートジャーナル刊行会  

記述言語：英語   出版者・発行元：一般社団法人 日本循環器学会  

Background: Exercise capacity is related to mortality and morbidity in heart failure (HF) patients. Determinants of exercise capacity in transthyretin cardiac amyloidosis (ATTR-CA) have not been established. Methods and Results: This single-center study retrospectively evaluated ATTR-CA patients and patients with non-amyloidosis HF with preserved/mildly reduced ejection fraction (HFpEF/HFmrEF) (n=32 and n=51, respectively). In the ATTR-CA group, the median age was 75.5 years (interquartile range [IQR] 71.3–78.8 years), 90.6% were male, and the median left ventricular (LV) ejection fraction was 53.5% (IQR 41.4–65.6%). Cardiopulmonary exercise tests revealed a median peak oxygen consumption and anaerobic threshold of 15.9 (IQR 11.6–17.4) and 10.6 (IQR 8.5–12.0] mL/min/kg, respectively, and ventilatory efficiency (minute ventilation/ carbon dioxide production [V̇ E/V̇ CO2] slope) of 35.5 (IQR 32.0–42.5). Among exercise variables, V̇ E/V̇ CO2 slope has the greatest prognostic value. Univariate analysis revealed a significant correlation between V̇ E/V̇ CO2 slope and age, LV global longitudinal strain, tricuspid annular plain systolic excursion/pulmonary arterial systolic pressure (TAPSE/PASP) ratio, and mixed venous oxygen saturation. In multivariate analyses, the TAPSE/PASP ratio was an independent predictor of V̇ E/V̇ CO2 slope (95% confidence interval −44.5, −10.8; P=0.0067). In non-amyloidosis HFpEF/HFmrEF patients, the TAPSE/PASP ratio was not independently correlated with V̇ E/V̇ CO2 slope. Conclusions: Right ventricular–pulmonary artery coupling estimated by the TAPSE/PASP ratio determines exercise capacity in ATTR-CA patients. This highlights the importance of early therapeutic intervention against underappreciated right ventricular dysfunction associated with ATTR-CA.

DOI： 10.1253/circj.CJ-24-0402

Web of Science

Scopus

PubMed

CiNii Research

記述言語：英語   出版者・発行元：Journal of Artificial Organs  

Collaboration between the implantation centers, management centers, and regional core hospitals is a key factor in securing long-term implantable ventricular assist device (VAD) management. In Kyushu, a management system for patients with implantable VADs has been established at the prefectural and regional levels. Presently, six implantable VAD implantation centers and seven management centers exists in the eight prefectures of Kyushu and Okinawa, with at least one specialized VAD centers in each prefecture. This collaborative management system allows patients with VADs to receive seamless treatment based on the same management concept wherever they live. In fact, approximately half of the present outpatients treated at our center reside outside the prefecture and are managed in collaboration with management centers and regional core hospitals. Among our patients, there were no significant differences in survival or rehospitalization-free rates between patients with VADs in and out of the prefecture, suggesting that the place of residence did not affect the outcome. With the increase in the number of patients with VADs and the diversification of patients, patient management has become more complex. Mutual collaboration between the implantation centers, management centers, and regional core hospitals, is essential to improve the quality of VAD management. This review was created based on a translation of the Japanese review written in the Japanese Journal of Artificial Organs in 2023 (Vol. 52, No. 1, pp. 85–88), with some modifications.

DOI： 10.1007/s10047-024-01451-1

Web of Science

Scopus

PubMed

出版者・発行元：Journal of Cardiology  

DOI： 10.1016/j.jjcc.2024.04.006

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：(一社)インターナショナルハートジャーナル刊行会  

出版者・発行元：南江堂  

DOI： 10.15106/j_naika134_317

CiNii Research

記述言語：英語   出版者・発行元：一般社団法人 インターナショナル・ハート・ジャーナル刊行会  

Although anemia is a common comorbidity that often coexists with heart failure (HF), its clinical impact in patients with advanced HF remains unclear. We investigated the impact of hemoglobin levels on clinical outcomes in patients with advanced HF listed for heart transplantation without intravenous inotropes or mechanical circulatory support. We retrospectively reviewed the clinical data of patients listed for heart transplantation at our institute who did not receive intravenous inotropes or mechanical circulatory support between 2011 and 2022. We divided the patients into those with hemoglobin levels lower or higher than the median value and compared the composite of all-cause death and HF hospitalization within 1 year from the listing date. We enrolled consecutive 38 HF patients (27 males, 49.1 ± 10.8 years old). The median hemoglobin value at the time of listing for heart transplantation was 12.9 g/dL, and 66.7% of the patients had iron deficiency. None of the patients in either group died within 1 year. The HF hospitalization-free survival rate was significantly lower in the lower hemoglobin group (40.9% versus 81.9% at 1 year, P = 0.020). Multivariate Cox proportional hazards model analysis showed that hemoglobin as a continuous variable was an independent predictor for HF hospitalization (odds ratio 0.70, 95% confidence interval 0.49-0.97, P = 0.030). Hemoglobin level at the time of listing for heart transplantation was a predictor of hospitalization in heart-transplant candidates without intravenous inotropes or mechanical circulatory support.

DOI： 10.1536/ihj.24-067

Web of Science

Scopus

PubMed

CiNii Research

記述言語：英語   出版者・発行元：(一社)インターナショナルハートジャーナル刊行会  

2011～2022年に単施設で強心薬または機械的循環補助による介入を行っていない心臓移植待機中の進行心不全患者38例(平均49.1±10.8歳、男性71.1%)を対象に、臨床アウトカムに対するヘモグロビン(Hb)値の影響を後ろ向きに評価した。心臓移植のリストに掲載時のHb中央値(12.9g/dL)により、Hb低値群(19例)とHb高値群(19例)に分類した。24例(66.7%)が鉄欠乏症であった。1年以内の死亡は認められなかった。Hb低値群ではHb高値群と比べて、1年後時点での心不全による入院を認めない患者での生存率が有意に低かった。多変量Cox比例ハザード比モデル解析において、連続変数としてのHb値は心不全による入院の独立した有意な予測因子であった。

DOI： 10.1253/circj.CJ-23-0698

Web of Science

DOI： 10.1253/circj.CJ-23-0698

Web of Science

出版者・発行元：Circulation journal : official journal of the Japanese Circulation Society  

DOI： 10.1253/circj.CJ-23-0698

Scopus

記述言語：英語  

DOI： 10.1253/circj.CJ-23-0698

PubMed

記述言語：英語   出版者・発行元：一般社団法人 日本循環器学会  

DOI： 10.1253/circj.cj-23-0698

PubMed

CiNii Research

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

症例は49歳男性で、胃過形成性ポリープからの慢性出血に伴う貧血の加療目的に当院を紹介された。劇症心筋炎による重症心不全に対して左心補助循環装置(LVAD)を埋め込まれており、抗血栓薬としてクロピドグレルとワルファリン、酸分泌阻害剤としてボノプラザンが処方されていた。食道胃十二指腸鏡(EGD)検査で胃体部から胃洞部にかけて紅斑性ポリープを認め、内視鏡的粘膜切除術(EMR)によってポリープを摘出し、創部をクリップ閉鎖した。術後はボノプラザンを投与し絶食としていたが、3日後に下血し、EGDでEMR後の潰瘍からの出血がみられたため高周波凝固を行った。しかし、その後も下血は続き、高周波凝固に加えてポリグルコール酸シート、局所止血剤を用いるも出血のコントロールは得られなかった。術後13日目のEGDで胃洞部の潰瘍からの活動性出血を確認、内視鏡的手縫い縫合法を行った。V-Loc 180吸収性barbed suture糸と軟性ニードルホルダーを用いて4回にわたる縫合を行った。術後のEGD所見では創部の縫合が得られ出血はみられず、その後も出血はなく、25日後、潰瘍部の瘢痕形成が認められた。

記述言語：英語   出版者・発行元：DEN Open  

We herein describe a 49-year-old man with severe heart failure due to fulminant myocarditis who underwent left ventricular assist device implantation and received clopidogrel and warfarin as antithrombotic agents. The patient developed anemia secondary to chronic bleeding gastric hyperplastic polyps, necessitating endoscopic mucosal resection. Despite attempts to manage post-endoscopic mucosal resection bleeding from a gastric ulcer by endoscopic hemostasis using hemostatic forceps, local hemostatic agents, and polyglycolic acid sheets, the bleeding persisted. Hemostasis of the refractory bleeding was finally achieved by endoscopic hand-suturing of the ulcer. One month later, the ulcer was almost completely scarred. This case has important clinical value in that it demonstrates the efficacy of endoscopic hand-suturing even in challenging cases such as refractory bleeding gastric ulcers in patients with left ventricular assist devices.

DOI： 10.1002/deo2.369

Web of Science

Scopus

PubMed

Web of Science

記述言語：英語   出版者・発行元：一般社団法人 日本循環器学会  

The 87th Annual Meeting of the Japanese Circulation Society (JCS2023) was held in March 2023 in Fukuoka, Japan, marking the first in-person gathering after the COVID-19 pandemic. With the theme of “New Challenge With Next Generation” the conference emphasized the development of future cardiovascular leaders and technologies such as artificial intelligence (AI). Notable sessions included the Mikamo Lecture on heart failure and the Mashimo Lecture on AI in medicine. Various hands-on sessions and participatory events were well received, promoting learning and networking. Post-event surveys showed high satisfaction among participants, with positive feedback on face-to-face interactions and the overall experience. JCS2023, attended by 17,852 participants, concluded successfully, marking a significant milestone in post-pandemic meetings, and advancing cardiovascular medicine.

DOI： 10.1253/circj.cj-24-0127

Web of Science

Scopus

PubMed

CiNii Research

記述言語：英語   出版者・発行元：European Journal of Preventive Cardiology  

Aims Exercise intolerance is a clinical feature of patients with heart failure (HF). Cardiopulmonary exercise testing (CPET) is the first-line examination for assessing exercise capacity in patients with HF. However, the need for extensive experience in assessing anaerobic threshold (AT) and the potential risk associated with the excessive exercise load when measuring peak oxygen uptake (peak VO2) limit the utility of CPET. This study aimed to use deep-learning approaches to identify AT in real time during testing (defined as real-time AT) and to predict peak VO2 at real-time AT. Methods and results This study included the time-series data of CPET recorded at the Department of Cardiovascular Medicine, Kyushu University Hospital. Two deep neural network models were developed to: (i) estimate the AT probability using breath-by-breath data and (ii) predict peak VO2 using the data at the real-time AT. The eligible CPET contained 1472 records of 1053 participants aged 18–90 years and 20% were used for model evaluation. The developed model identified real-time AT with 0.82 for correlation coefficient (Corr) and 1.20 mL/kg/min for mean absolute error (MAE), and the corresponding AT time with 0.86 for Corr and 0.66 min for MAE. The peak VO2 prediction model achieved 0.87 for Corr and 2.25 mL/kg/min for MAE. Conclusion Deep-learning models for real-time CPET analysis can accurately identify AT and predict peak VO2. The developed models can be a competent assistant system to assess a patient’s condition in real time, expanding CPET utility.

DOI： 10.1093/eurjpc/zwad375

Web of Science

Scopus

PubMed

記述言語：日本語   出版者・発行元：公益財団法人 日本心臓財団  

DOI： 10.11281/shinzo.56.77

CiNii Research

記述言語：英語   出版者・発行元：一般社団法人 インターナショナル・ハート・ジャーナル刊行会  

Isolated cardiac sarcoidosis (iCS) is increasingly recognized; however, its prognosis and the efficacy of immunosuppressive therapy remain undetermined. We aimed to compare the prognosis of iCS and systemic sarcoidosis including cardiac involvement (sCS) under immunosuppressive therapy. We retrospectively reviewed the clinical data of 42 patients with sCS and 30 patients with iCS diagnosed at Kyushu University Hospital from 2004 through 2022. We compared the characteristics and the rate of adverse cardiac events including cardiac death, fatal ventricular tachyarrhythmia, and heart failure hospitalization between the 2 groups. The median follow-up time was 1535 [interquartile range, 630-2555] days, without a significant difference between the groups. There were no significant differences in gender, NYHA class, or left ventricular ejection fraction. Immunosuppressive agents were administered in 86% of sCS and in 73% of iCS patients (P = 0.191). When analyzed only with patients receiving immunosuppressive therapy (sCS, n = 36; iCS, n = 21), the cardiac event-free survival was significantly lower in iCS than sCS (37% versus 79%, P = 0.002). Myocardial LGE content at the initial diagnosis was comparable in both groups. The disease activity was serially evaluated in 26 sCS and 16 iCS patients by quantitative measures of FDG-PET including cardiac metabolic volume and total lesion glycolysis, representing 3-dimensional distribution and intensity of inflammation in the entire heart. Although iCS patients had lower baseline disease activity than sCS patients, immunosuppressive therapy did not attenuate disease activity in iCS in contrast to sCS. iCS showed a poorer response to immunosuppressive therapy and a worse cardiac prognosis compared to sCS despite lower baseline disease activity.

DOI： 10.1536/ihj.24-166

Web of Science

Scopus

PubMed

CiNii Research

記述言語：日本語   出版者・発行元：公益社団法人 日本生体医工学会  

<p>　植込型補助人工心臓（left ventricular assist device, LVAD）は、重症心不全患者の予後および生活の質を劇的に向上させるデバイスである。わが国では2011年に臨床使用が開始され、2022年末までに1300名を超える新規植込み手術が施行されている。LVAD患者は心不全症状から解放され、自宅に戻り、社会復帰も期待できるが、一方でLVADに伴う様々な合併症を予防するために在宅管理（セルフケア）が重要となる。</p><p>　LVADの在宅管理において、日々の血圧測定は極めて重要な要素の一つである。LVAD患者の血圧高値は脳血管障害や心不全、大動脈弁逆流といった合併症と関連していることが知られており、最新のガイドラインでも平均血圧で75-90mmHgが推奨されている。患者は自宅で日々の血圧を測定して記録し、定期通院時に持参することが求められている。しかし、現在のLVADは遠心ポンプもしくは軸流ポンプを用いた連続流式であるため、多くの患者の脈圧は小さく、現在使用可能な家庭用血圧計では血圧測定が困難であったり、複数回の測定を余儀なくされたりする場合もある。</p><p>　本演題では、現在のわが国におけるLVAD治療の現状と、特に血圧管理に焦点を当てて在宅管理における問題点について概説する。</p>

DOI： 10.11239/jsmbe.annual62.87_2

CiNii Research

出版者・発行元：Circulation journal : official journal of the Japanese Circulation Society  

DOI： 10.1253/circj.CJ-66-0227

Scopus

記述言語：英語   出版者・発行元：JACC: Clinical Electrophysiology  

Background: Advances in catheter ablation (CA) for atrial fibrillation (AF) have improved the prognosis of patients with heart failure (HF) and AF. However, its optimal timing remains to be fully elucidated. Objectives: The aim of this study was to investigate the prognostic impact of early CA in patients with HF and AF hospitalized for worsening HF. Methods: From JROADHF (Japanese Registry of Acute Decompensated Heart Failure) (n = 13,238), patients with HF and AF who underwent CA within 90 days after admission for HF (early CA; n = 103) and those who did not (control; n = 2,683) were identified. Mortality was compared between these groups in the crude cohort, as well as in the propensity-matched cohort (n = 83 in each group). Results: In the crude cohort, all-cause mortality was significantly lower in the early CA group than in the control group (log-rank P < 0.001; HR: 0.38; 95% CI: 0.24-0.60). In the matched cohort, all-cause mortality was likewise significantly lower in the early CA group (log-rank P = 0.014; HR: 0.47; 95% CI: 0.25-0.88). Cardiovascular death and HF mortality were significantly lower in both cohorts (crude: Gray’ test: P < 0.001 and P = 0.005; subdistribution HR: 0.28 [95% CI: 0.13-0.63] and HR: 0.31 [95% CI: 0.13-0.75]; matched: Gray's test: P = 0.006 and P = 0.017; subdistribution HR: 0.24 [95% CI: 0.08-0.70] and HR: 0.28 [95% CI: 0.09-0.84], respectively). Conclusions: In a nationwide representative real-world cohort, CA for AF within 90 days after admission for HF was associated with improved long-term outcomes, including cardiovascular and HF death in patients with HF and AF.

DOI： 10.1016/j.jacep.2023.05.038

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：European Heart Journal - Digital Health  

Aims: We evaluated a self-care intervention with a novel mobile application (app) in chronic heart failure (HF) patients. To facilitate patient-centred care in HF management, we developed a self-care support mobile app to boost HF patients' optimal self-care. Methods and results: We conducted a multicentre, randomized, controlled study evaluating the feasibility of the self-care support mobile app designed for use by HF patients. The app consists of a self-monitoring assistant, education, and automated alerts of possible worsening HF. The intervention group received a tablet personal computer (PC) with the self-care support app installed, and the control group received a HF diary. All patients performed self-monitoring at home for 2 months. Their self-care behaviours were evaluated by the European Heart Failure Self-Care Behaviour Scale. We enrolled 24 outpatients with chronic HF (ages 31-78 years; 6 women, 18 men) who had a history of HF hospitalization. During the 2 month study period, the intervention group (n = 13) showed excellent adherence to the self-monitoring of each vital sign, with a median [interquartile range (IQR)] ratio of self-monitoring adherence for blood pressure, body weight, and body temperature at 100% (92-100%) and for oxygen saturation at 100% (91-100%). At 2 months, the intervention group's self-care behaviour score was significantly improved compared with the control group (n = 11) [median (IQR): 16 (16-22) vs. 28 (20-36), P = 0.02], but the HF Knowledge Scale, the General Self-Efficacy Scale, and the Short Form-8 Health Survey scores did not differ between the groups. Conclusion: The novel mobile app for HF is feasible.

DOI： 10.1093/ehjdh/ztad032

Web of Science

Scopus

PubMed

記述言語：日本語   出版者・発行元：一般社団法人 日本人工臓器学会  

DOI： 10.11392/jsao.52.85

CiNii Research

記述言語：英語   出版者・発行元：一般社団法人 日本循環器学会  

DOI： 10.1253/circj.cj-22-0696

Web of Science

Scopus

PubMed

CiNii Research

出版者・発行元：南江堂  

DOI： 10.15106/j_naika131_651

CiNii Research

記述言語：英語   出版者・発行元：Circulation: Heart Failure  

Background: The impact of early implementation of cardiac rehabilitation (CR) in heart failure (HF) patients remains to be elucidated. This study sought to determine whether CR during HF hospitalization could improve prognostic outcomes in patients with acute decompensated HF. Methods: We analyzed patients with HF enrolled in the JROADHF (Japanese Registry of Acute Decompensated Heart Failure) registry, a retrospective, multicenter, nationwide registry of patients hospitalized for acute decompensated HF. Eligible patients were divided into 2 groups according to CR during hospitalization. The primary outcome was a composite of cardiovascular death or rehospitalization due to cardiovascular event after discharge. The secondary outcomes were cardiovascular death and cardiovascular event rehospitalization. Results: Out of 10 473 eligible patients, 3210 patients underwent CR. Propensity score matching yielded 2804 pairs. Mean age was 77±12 years and 3127 (55.8%) were male. During a mean follow-up of 2.8 years, the CR group had lower incidence rates of the composite outcome (291 versus 327 events per 1000 patient-years; rate ratio, 0.890 [95% CI, 0.830-0.954]; P=0.001) and rehospitalization due to cardiovascular event (262 versus 295 events per 1000 patient-years; rate ratio, 0.888 [95% CI, 0.825-0.956]; P=0.002) than the no CR group. In-hospital CR was associated with an improvement in Barthel index for activities of daily living (P=0.002). Patients with very low Barthel index at admission were benefited by CR in comparison with patients with independent Barthel index (very low; hazard ratio, 0.834 [95% CI, 0.742-0.938]: independent; hazard ratio, 0.985 [95% CI, 0.891-1.088]; P for interaction=0.035). Conclusions: CR implementation during hospitalization was associated with better long-term outcomes in patients with acute decompensated HF. These data support the need for a randomized, controlled, adequately powered trial to definitively test the role of early physical rehabilitation in hospitalized patients with HF.

DOI： 10.1161/CIRCHEARTFAILURE.122.010320

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：CJC Open  

DOI： 10.1016/j.cjco.2022.11.009

Web of Science

Scopus

PubMed

記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

<p>【背景】移植心に対する心臓再手術は、海外では一定数行われているが、国内ではごくわずかである。今回我々は、心臓移植後10年目の心臓再手術を経験した。【症例】症例は30歳女性。2012年に他院で心臓移植を施行され、2020年より当院で管理されている。移植後5年目より心機能の低下・有意な三尖弁逆流と僧帽弁逆流が指摘され始めた。移植後9年目、徐脈性不整脈を契機に心肺停止となり、心肺蘇生およびECMO管理を要したが、後遺症なく回復した。移植後10年目、心不全は内科的治療抵抗性となり、重度の三尖弁逆流と僧帽弁逆流に対して手術介入する方針とし、生体弁による三尖弁置換術と僧帽弁形成術を行った。また、三尖弁人工弁機能の長期維持と安定したペースメーカー作動の実現のために、経静脈的右室リードを人工弁外を通過させる工夫を行った。弁逆流が制御されたことで血行動態・自覚症状ともに大きく改善した。現在再手術後8か月が経過し、QOLの改善した日常生活を取り戻している。【結語】心臓移植後の再心臓移植が事実上難しい国内では、移植心に起こる心機能障害に対しては、難治化する前に内科的/外科的に介入していくことが現実的な治療方針である。移植心の心機能低下は複合的要因により起こりうるが、制御可能な段階での治療介入が肝要である。また、心筋生検や拒絶反応などの移植心特有の事情を考慮しての手術戦略をもつことが心臓移植の長期成績の向上に寄与すると考える。</p>

DOI： 10.11386/jst.58.supplement_s136_1

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

<p>心臓移植レシピエント候補の中でもpanel reactive antibody (PRA)高値の症例は、ドナー特異的抗HLA抗体（DSA）を生じやすく、移植後の拒絶反応リスクが高いことが想定される。</p><p>当院では、心臓移植を施行した61例のうち、4例（男性1例、女性3例）に周術期の脱感作療法を施行した。いずれもhigh PRAかつpreformed DSA陽性の症例であった。プロトコールとして、全例で移植術直前に血漿交換と免疫グロブリン投与を併用した。移植後の経過として、1例で急性期にgrade 1R/2の細胞性拒絶反応を認めたが、抗体関連拒絶反応を発症した症例はなく、心機能低下を来した症例もなかった。</p><p>当院でのhigh PRA症例に対する周術期脱感作療法は安全に施行でき、術後に問題となる拒絶反応も見られなかった。注意して長期経過を観察する必要がある。また、本邦では血漿交換や免疫グロブリン療法、さらにはリツキシマブといった治療は心臓移植における脱感作療法に対しては保険適応外であり、治療の有効性・必要性について今後も検証が必要である。</p>

DOI： 10.11386/jst.58.supplement_s197_1

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人 日本超音波検査学会  

DOI： 10.11272/jssabst.48.0_s158

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人 日本超音波検査学会  

DOI： 10.11272/jssabst.48.0_s127

CiNii Research

出版者・発行元：Artificial Organs  

Purpose: Tolvaptan, a selective vasopressin type-2 antagonist, has been shown to increase serum sodium (Na) and urine output in hyponatremic left ventricular assist device (LVAD) patients in retrospective studies. In this prospective randomized pilot study, we aimed to assess the efficacy of tolvaptan in this population. Methods: We conducted a prospective, randomized, non-blinded pilot study of LVAD recipients with post-operative hyponatremia (Na < 135 mEq/L) (NCT05408104). Eligible participants were randomized to receive tolvaptan 15 mg daily in addition to usual care versus usual care alone. The primary outcome was a change in Na level and estimated glomerular filtration rate (eGFR), from the first post-operative day of hyponatremia (the day of randomization) to discharge. Results: A total of 33 participants were enrolled, and 28 underwent randomization (median age 55 [IQR 50–62]), 21% women, 54% Black, 32% ischemic cardiomyopathy, median baseline Na 135 (IQR 134–138). Fifteen participants were randomized to tolvaptan (TLV) and 13 were randomized to usual care alone (No-TLV). Mean change in Na from randomization to discharge in the TLV group was 2.7 mEq/L (95%CI 0.7–4.7, p = 0.013) and 1.8 (95%CI 0.5–4.0, p = 0.11) in the No-TLV group, though baseline and final Na levels were similar between groups. The mean change in eGFR was 2.6 ml/min/1.73 m2 (95%CI 10.1–15.3, p = 0.59) in TLV versus 7.5 ml/min/1.73 m2 (95%CI 5.2–20.2, p = 0.15) in No-TLV. TLV participants had significantly more urine output than No-TLV patients during their first 24 h after randomization (3294 vs 2155 ml, p = 0.043). Conclusion: TLV significantly increases urine output, with nominal improvement in Na level, in hyponatremic post-operative LVAD patients without adversely impacting renal function.

DOI： 10.1111/aor.14375

Web of Science

Scopus

PubMed

DOI： 10.1002/joa3.12714

Web of Science

PubMed

記述言語：英語   出版者・発行元：ASAIO Journal  

A 32-year-old man, who had developed fulminant myocarditis leading to asystole, underwent implantation of an EVAHEART 2 left ventricular assist system with a double-cuff tipless inflow cannula and a concurrent Fontan operation. Approximately 2 years after the simultaneous EVAHEART 2 implantation and the Fontan operation, the patient underwent heart transplantation. There was no device-related thromboembolism or pump malfunction under adequate antithrombotic management during the postoperative support period. Computed tomography showed no malposition of the inflow cannula irrespective of the left ventricular chamber size. Macroscopically, the left ventricular cavity of the excised heart revealed a smooth inflow ostium with appropriate intimal proliferation and without pannus or wedge thrombus formation. These findings suggest the utility of the double-cuff tipless inflow cannula for long-term clinical applications, which may lead to favorable outcomes during long-term patient management. The double-cuff tipless inflow cannula, which does not protrude into the left ventricular cavity, potentially contributes to the prevention of suction events and the collision of the inflow cannula with the interventricular septum and left ventricular free wall. Further investigation is required to confirm the role of the unique EVAHEART 2 inflow cannula in reducing thromboembolic events.

DOI： 10.1097/MAT.0000000000001672

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：ESC Heart Failure  

A 69-year-old man was hospitalized for heart failure 7 days after coronavirus disease 2019 (COVID-19) mRNA vaccination. Electrocardiography showed ST-segment elevation and echocardiography demonstrated severe left ventricular dysfunction. Venoarterial extracorporeal membrane oxygenation and Impella 5.0 were instituted because of cardiogenic shock and ventricular fibrillation. Endomyocardial biopsy demonstrated necrotizing eosinophilic myocarditis (NEM). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) PCR test was negative. He had no infection or history of new drug exposure. NEM was likely related to COVID-19 vaccination. He was administered 10 mg/kg of prednisolone following methylprednisolone pulse treatment (1000 mg/day for 3 days). Left ventricular function recovered and he was weaned from mechanical circulatory support (MCS). Follow-up endomyocardial biopsy showed no inflammatory cell infiltration. This is the first report of biopsy-proven NEM after COVID-19 vaccination survived with MCS and immunosuppression therapy. It is a rare condition but early, accurate diagnosis and early aggressive intervention can rescue patients.

DOI： 10.1002/ehf2.13962

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：ESC Heart Failure  

Aims: Cardiac rehabilitation (CR) is an evidence-based, secondary preventive strategy that improves mortality and morbidity rates in patients with heart failure (HF). However, the implementation and continuation of CR remains unsatisfactory, particularly for outpatients with physical frailty. This study investigated the efficacy and safety of a comprehensive home-based cardiac rehabilitation (HBCR) programme that combines patient education, exercise guidance, and nutritional guidance using information and communication technology (ICT). Methods and results: This study was a single-centre, open-label, randomized, controlled trial. Between April 2020 and November 2020, 30 outpatients with chronic HF (New York Heart Association II–III) and physical frailty were enrolled. The control group (n = 15) continued with standard care, while the HBCR group (n = 15) also received comprehensive, individualized CR, including ICT-based exercise and nutrition guidance using ICT via a Fitbit® device for 3 months. The CR team communicated with each patient in HBCR group once a week via the application messaging tool and planned the training frequency and intensity of training individually for the next week according to each patient's symptoms and recorded pulse data during exercise. Dietitians conducted a nutritional assessment and then provided individual nutritional advice using the picture-posting function of the application. The primary outcome was the change in the 6 min walking distance (6MWD). The participants' mean age was 63.7 ± 10.1 years, 53% were male, and 87% had non-ischaemic heart disease. The observed change in the 6MWD was significantly greater in the HBCR group (52.1 ± 43.9 m vs. −4.3 ± 38.8 m; P < 0.001) at a 73% of adherence rate. There was no significant change in adverse events in either group. Conclusions: Our comprehensive HBCR programme using ICT for HF patients with physical frailty improved exercise tolerance and improved lower extremity muscle strength in our sample, suggesting management with individualized ICT-based programmes as a safe and effective approach. Considering the increasing number of HF patients with frailty worldwide, our approach provides an efficient method to keep patients engaged in physical activity in their daily life.

DOI： 10.1002/ehf2.13934

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：一般社団法人 日本循環器学会  

DOI： 10.1253/circj.cj-21-0880

Web of Science

Scopus

PubMed

CiNii Research

Web of Science

Web of Science

記述言語：英語   出版者・発行元：Journal of Neurosurgery: Case Lessons  

BACKGROUND Cerebrovascular events and infection are among the most common complications of left ventricular assist device (LVAD) therapy. The authors reported on a patient with an infectious intracranial aneurysm (IIA) associated with LVAD infection that was successfully occluded by endovascular therapy. OBSERVATIONS A 37-year-old man with severe heart failure received an implantable LVAD. He was diagnosed with candidemia due to driveline infection 44 months after LVAD implantation, and empirical antibiotic therapy was started. After 4 days of antibiotic treatment, the patient experienced sudden dizziness. Computed tomography (CT) revealed subarachnoid hemorrhage in the right frontal lobe, and CT angiography revealed multiple aneurysms in the peripheral lesion of the anterior cerebral artery (ACA) and middle cerebral artery. Two weeks and 4 days after the first bleeding, aneurysms on the ACA reruptured. Each aneurysm was treated with endovascular embolization using n-butyl cyanoacrylate. Subsequently, the patient had no rebleeding of IIAs. The LVAD was replaced, and bloodstream infection was controlled. He received a heart transplant and was independent 2 years after the heart transplant. LESSONS LVAD-associated IIAs have high mortality and an increased risk of surgical complications. However, endovascular obliteration may be safe and thus improve prognosis.

DOI： 10.3171/CASE21559

Web of Science

Scopus

PubMed

記述言語：日本語   出版者・発行元：一般社団法人 日本人工臓器学会  

DOI： 10.11392/jsao.50.232

CiNii Research

出版者・発行元：南江堂  

DOI： 10.15106/j_naika128_61

CiNii Research

記述言語：英語   出版者・発行元：CJC Open  

DOI： 10.1016/j.cjco.2021.03.004

Scopus

PubMed

記述言語：英語   出版者・発行元：Clinical Transplantation  

Background: Capillary deposition of C4d is an important marker of antibody-mediated rejection (AMR) following heart transplantation (HT). There are two immunopathologic assay methods for detecting C4d: frozen-tissue immunofluorescence (IF) and paraffin immunohistochemistry (IHC). The clinical significance of discrepancy between the results of IF and IHC has not been understood. Methods and results: We reviewed 2187 biopsies from 142 HT recipients who had biopsies with assessment of both IF and IHC staining. Among them, 103 (73%) patients had negative IF and IHC C4d staining (Negative Group) and 32 (23%) patients had positive IF but negative IHC staining (Discordant Group). At the time of positive biopsy, 6 (19%) Discordant patients had graft dysfunction, compared to 5 (5%) Negative patients (p =.022). Cumulative incidence of cellular rejection at 1 year was comparable (31% vs. 29%, p =.46); however, cumulative incidence of AMR was significantly higher in the Discordant group (21% vs. 4%, p =.004). Overall 1-year survival was comparable (90% vs. 96%, p =.24); however, freedom from heart failure (HF) was significantly lower in the Discordant group (70% vs. 96%, p <.001). Conclusion: The Discordant group showed higher rates of graft dysfunction, AMR and HF admission than the Negative group.

DOI： 10.1111/ctr.14242

Web of Science

Scopus

PubMed

Web of Science

記述言語：英語   出版者・発行元：一般社団法人 インターナショナル・ハート・ジャーナル刊行会  

A 61-year-old woman suffered chest pain and was admitted to a nearby hospital emergency department. She was diagnosed with acute myocardial infarction probably due to thromboembolism in the left anterior descending coronary artery and aspiration thrombectomy was performed. Afterwards, she developed refractory heart failure with severe global left ventricular dysfunction and was transferred to our hospital. An 18F-FDGPET/ CT scan revealed abnormal 18F-FDG uptake in non-infarcted regions of the left ventricle. Non-caseating granulomas were detected by biopsy from a skin eruption. She was diagnosed with cardiac sarcoidosis. In cases of refractory heart failure which cannot be explained only by myocardial infarction, evaluation of other undiagnosed cardiomyopathies is important for optimal management.

DOI： 10.1536/ihj.20-586

Web of Science

Scopus

PubMed

CiNii Research

記述言語：英語   出版者・発行元：Clinical Transplantation  

Background: The role of donor-derived cell-free DNA (dd-cfDNA) in screening for cardiac allograft vasculopathy (CAV) is unknown. We hypothesized that dd-cfDNA correlates with CAV, markers of inflammation, and angiogenesis in stable heart transplant (HT) recipients. Methods: Sixty-five HT recipients ≥2 years post-transplant, without recent rejection, were stratified by high (≥0.12%) versus low levels (<0.12%) of dd-cfDNA. A targeted amplification, next-generation sequencing assay (AlloSure®; CareDx, Inc.) was used to detect dd-cfDNA. Peripheral blood inflammatory and angiogenesis markers were assessed using a multiplex immunoassay system (Bioplex®). Results: Of 65 patients, 58 patients had a known CAV status and were included. Thirty had high levels of dd-cfDNA (≥0.12%), and 28 had low levels (<0.12%). CAV was present in 63% of patients with high dd-cfDNA vs. 35% with low dd-cfDNA (p =.047). Donor-specific antibodies were present in 25% of patients with high dd-cfDNA vs. 3.8% in those with low dd-cfDNA (p =.03). There were no differences in rejection episodes, inflammatory, or angiogenesis markers. Importantly, dd-cfDNA levels were not different when stratified by time post-transplant. Conclusions: Higher dd-cfDNA levels were associated with CAV in stable chronic HT recipients. Further studies are warranted to investigate a possible association between dd-cfDNA levels and CAV severity and whether dd-cfDNA can predict CAV progression.

DOI： 10.1111/ctr.14206

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：(一社)インターナショナルハートジャーナル刊行会  

症例は61歳女性で、胸痛を主訴に近医を受診した。心電図は前胸部誘導でST上昇を呈し、冠動脈造影検査で左前下行枝に完全閉塞を認めた。血栓による急性心筋梗塞と診断し、カテーテル血栓吸引術とステント留置術を施行した。経皮的冠動脈インターベンション施行後の心エコー検査で左室前壁から側壁にかけて壁運動異常を認めた。利尿剤を投与し、抗凝固療法を開始した。24日後に心不全が増悪し、当院へ紹介された。受診時の血圧は82/62mmHg、心拍数は106bpmであった。心尖部に収縮期雑音とIII音、また全肺野にラ音を聴取した。頸動脈怒張と両下肢に圧痕性浮腫を認めた。胸部X線検査で著明な心拡大と胸水を認めた。血管拡張薬と強心剤を静注し、エナラプリルを投与した。心エコー検査でび漫性左室壁運動低下と重度の僧帽弁逆流を認めた。左室駆出率は24%であった。心臓MRI検査で前壁中隔、前壁、下壁、側壁に心筋遅延造影を認めた。PET-CT検査で同部位および縦隔リンパ節にFDGの異常集積を認めた。皮膚生検で非乾酪性肉芽腫を認めた。皮膚および心臓サルコイドーシスと診断し、プレドニゾロンを投与した。60日後にFDG異常集積像は消失し、トロポニンは低下した。

記述言語：英語   出版者・発行元：Transplantation Proceedings  

Background: Hyperkalemia (HK) is a life-threatening complication following solid organ transplantation, and patients often need potassium-chelating agents and deviations from standard posttransplant protocols. This is the first study to report the incidence and clinical impact of hyperkalemia following heart transplantation. Methods: We retrospectively included patients who underwent heart transplantation at our institution between April 2014 and December 2018. Patients with multiorgan transplantation were excluded. Clinical outcomes of patients who had serum potassium >5.5 mEq/L in the first year posttransplant (HK group) were compared to patients who did not have serum potassium >5.5 mEq/L in the first year posttransplant (non-HK group). Results: A total of 143 patients were included in this study. During the first year posttransplant, cumulative incidence of serum potassium >5.0, >5.5, and >6.0 mEq/L was 96%, 63%, and 24%, respectively. Fifty-five percent of patients required treatment with potassium-chelating agents. Sulfamethoxazole-trimethoprim was discontinued because of HK in 39% of patients. Overall survival of patients in the HK group (n = 89) was comparable to that of patients in the non-HK group (n = 54, 91% vs 98% at 1 year, P = .19), whereas infection-free survival was significantly lower in the HK group (34% vs 53% at 1 year, P = .010). Multivariate analysis revealed pretransplant renal dysfunction (odds ratio = 2.62; 95% confidence interval, 1.18-5.80; P = .018) and use of mechanical circulatory support (odds ratio = 2.90; 95% confidence interval, 1.08-7.76; P = .035) as significant predictors of posttransplant hyperkalemia. Conclusions: The incidence of HK following heart transplantation was high, with more than half of patients requiring any therapeutic interventions, and HK was related to an increase in infection events.

DOI： 10.1016/j.transproceed.2020.11.002

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Artificial Organs  

Aortic insufficiency remains a difficult to treat and highly morbid condition even in the era of HeartMate 3 left ventricular assist devices (LVADs). The prognostic nature of the longitudinal progression of aortic insufficiency, however, remains unknown. We prospectively collected data on patients who received HeartMate 3 LVAD implantation, who had assessments of aortic insufficiency using a novel Doppler echocardiography obtained at outflow graft at three (baseline) and 6 months postimplant. Patients with moderate or greater aortic insufficiency at baseline were excluded. The risk of aortic insufficiency progression on 1-year death and readmission for heart failure was investigated. In total, 41 patients (median 51 years old and 29 males) were included. All patients had less than moderate aortic insufficiency at baseline. Of them, 22 patients had worsening aortic insufficiency for 3 months following baseline assessments, which was associated with a significantly higher risk of 1-year death or heart failure readmission rate (41% vs. 11%, P =.023) with a hazard ratio of 3.24 (95% confidence interval 1.02-18.5, P =.038) adjusted for device speed at baseline and destination therapy indication. In patients with HeartMate 3 LVADs, progressive aortic insufficiency may be associated with a higher risk of 1-year death or readmission for heart failure. Close monitoring of patients with baseline aortic insufficiency should be considered as a measure to risk-stratify those for future adverse events.

DOI： 10.1111/aor.13825

Web of Science

Scopus

PubMed

記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

<p>心臓移植後の定期的な心筋生検によるフォローアップは、細胞性拒絶を早期に検出する最も確立したスクリーニング法として位置づけられている。また抗体関連拒絶の診断においても、心筋組織の病理学的・免疫学的変化は重要な所見である。しかし、心筋生検では有意な拒絶反応の所見を検出できないにもかかわらず臨床的に拒絶と判断される例はしばしば経験され、抗体関連拒絶のみならず細胞性拒絶の診断においても心筋生検による診断精度には限界がある事が示唆される。さらには、侵襲的検査である心筋生検を繰り返すことに伴う合併症のリスクも無視することはできない。そうした中、治療が必要な拒絶反応を見逃さないために、心筋生検に代わる新たなスクリーニング法が探索されている。現在有望な方法の一つとして、海外では血中に存在するドナー由来のcell-free DNAを測定することでグラフト障害を検出する方法が報告されている。また我々は、画像診断を用いて拒絶反応を検出できる可能性についても検証している。心筋生検の限界を補う新たな拒絶反応診断方法の現状と今後の展望について考察する。</p>

DOI： 10.11386/jst.56.supplement_s109

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人 日本移植学会  

<p>わが国のドナー不足は深刻で、諸外国と比してマージナルドナーからの臓器移植が積極的に行われている状況にある。そのような状況の中で構築されたのがわが国独自のメディカルコンサルタント（MC）システムである。MCは、近隣の心臓および肺移植実施施設から提供病院に派遣され、第2回目の脳死判定前からドナー評価および管理を行う。これによりドナーの状態が向上し、また移植施設に適切な情報提供がなされることで、より多くのドナーから臓器提供が可能となることが期待される。</p><p>一方で、移植医療における働き方改革の一環として、さらに近年はCOVID-19感染拡大に伴う移動制限もあり、提供病院に直接派遣され活動する現在のMC業務のあり方は検証の余地がある。心臓移植実施施設から派遣されるMCは、心エコー検査をはじめとするドナーの心機能評価および血行動態管理が主な業務であるが、提供病院の循環器内科医および集中治療医に実際の業務を委託し、同時にMCが直接現地に赴く代わりにオンライン会議システムなどを用いて情報共有を行うことで、代替案となり得る。ただし、いずれも提供病院側の負担増加には十分に留意する必要がある。主に心臓移植実施施設の観点から、MC業務の今後のあり方について考察する。</p>

DOI： 10.11386/jst.56.supplement_s185

CiNii Research

記述言語：英語   出版者・発行元：Canadian Journal of Cardiology  

Mucolipidosis type III α/β is an autosomal recessive lysosomal storage disease, caused by the deficient activity of UDP-N-acetyl glucosamine-1-phosphotransferase. The resultant intralysosomal accumulation of partly degraded mucopolysaccharides and sphingolipids causes multiple-organ damage, including the heart. The most documented cardiac manifestation is the thickening and insufficiency of mitral and aortic valves, but there are very few reports about the myocardial involvement. We report a case with mucolipidosis type III α/β complicated by marked dilatation and dysfunction of the right ventricle, which is quite rare and further broadens the clinical spectrum of the disease.

DOI： 10.1016/j.cjca.2020.07.239

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Artificial Organs  

Cannula position in HeartMate II and HeartWare left ventricular assist devices (LVADs) is associated with clinical outcome. This study aimed to investigate the clinical implication of the device positioning in HeartMate 3 LVAD cohort. Consecutive patients who underwent HeartMate 3 LVAD implantation were followed for one year from index discharge. At index discharge, chest X-ray parameters were measured: (a) cannula coronal angle, (b) height of pump bottom, (c) cannula sagittal angle, and (d) cannula lumen area. The association of each measurement of cannula position with one-year clinical outcomes was investigated. Sixty-four HeartMate 3 LVAD patients (58 years old, 64% male) were enrolled. In the multivariable Cox regression model, the cannula coronal angle was a significant predictor of death or heart failure readmission (hazard ratio 1.27 [1.01-1.60], P =.045). Patients with a cannula coronal angle ≤28° had lower central venous pressure (P =.030), lower pulmonary capillary wedge pressure (P =.027), and smaller left ventricular size (P =.019) compared to those with the angle >28°. Right ventricular size and parameters of right ventricular function were also better in the narrow angle group, as was one-year cumulative incidence of death or heart failure readmission (10% vs. 50%, P =.008). Narrow cannula coronal angle in patients with HeartMate 3 LVADs was associated with improved cardiac unloading and lower incidence of death or heart failure readmission. Larger studies to confirm the implication of optimal device positioning are warranted.

DOI： 10.1111/aor.13755

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Clinical Transplantation  

Hypogammaglobulinemia (HGG) can occur following solid organ transplantation. However, there are limited data describing the prevalence, risk factors, and clinical outcomes associated with HGG following heart transplantation. We retrospectively reviewed data of 132 patients who had undergone heart transplantation at our institution between April 2014 and December 2018. We classified patients into three groups based on the lowest serum IgG level post-transplant: normal (≥700 mg/dL), mild HGG (≥450 and <700 mg/dL), and severe HGG (<450 mg/dL). We compared clinical outcomes from the date of the lowest IgG level. Mean age was 57 (47, 64) years, and 94 (71%) patients were male. Prevalence of severe HGG was the highest (27%) at 3-6 months following heart transplantation and then decreased to 5% after 1 year. Multivariate analysis showed that older age and Caucasian race were independent risk factors for HGG. Overall survival was comparable between the groups; however, survival free of infection was 73%, 60%, and 45% at 1 year in the normal, mild HGG, and severe HGG groups, respectively (P =.013). In conclusion, there is a high prevalence of HGG in the early post-heart transplant period that decreases over time. HGG is associated with an increased incidence of infection.

DOI： 10.1111/ctr.14087

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Journal of Cardiac Failure  

Background: Aortic insufficiency (AI) is associated with morbidity and mortality in patients with continuous-flow left ventricular assist devices (LVADs), whereas its impact on the HeartMate 3 LVAD cohorts remains uninvestigated. We aimed to investigate the clinical impact of AI on patients with HeartMate 3 LVADs. Methods and Results: Consecutive 61 patients (median age 54 years; 67% male) implanted with HeartMate 3 LVAD between 2015 and 2019 were enrolled and underwent echocardiography at 3 months after LVAD implantation. AI severity was quantified by the novel Doppler echocardiographic method obtained at the outflow cannula and the calculated regurgitation fraction of 30% or greater (moderate or greater) was defined as significant. At 3 months after implant, 12 patients (20%) had significant AI. They had a higher incidence of death or heart failure readmissions compared with those without significant AI during a 1-year observational period (70% vs 24%, P = .003) with an adjusted hazard ratio of 2.76 (95% confidence interval 1.03–7.88). Conclusions: In patients with HeartMate 3 LVAD support, significant AI remains both prevalent and a clinically significant downstream complication.

DOI： 10.1016/j.cardfail.2020.05.013

Web of Science

Scopus

PubMed

出版者・発行元：南江堂  

DOI： 10.15106/j_naika126_412

CiNii Research

記述言語：英語   出版者・発行元：Annals of Thoracic Surgery  

Background: Tricuspid regurgitation (TR) is common in advanced heart failure (HF) patients. However, the effect of concomitant tricuspid valve repair or replacement (tricuspid valve intervention [TVI]) with left ventricular assist device (LVAD) implantation is controversial. The aim of this study was to investigate the longitudinal trend of TR after LVAD implantation and the effect of TVI on the TR trend and clinical outcomes. Methods: We retrospectively reviewed patients at our institution who underwent LVAD implantation between April 2014 and August 2018. We evaluated the grade of TR by echocardiography before and after LVAD implantation. Moderate or greater TR was defined as significant. Results: Among 199 consecutive patients, 194 had at least 2 echocardiographic TR assessments before and after LVAD implantation. Of these patients, 108 were included in the TVI-positive (TVI+) group and 86 in the TVI-negative (TVI–) group. In the TVI+ group, the prevalence of significant TR decreased from 52% to about 20% in the first 6 months after implantation (P < .01). Overall survival and HF readmission–free survival were comparable between the TVI+ and TVI– patients. In contrast, patients in both groups who had significant postoperative TR during early follow-up had worse 2-year HF readmission–free survival (36% in patients with significant postoperative TR vs 55% in those without significant postoperative TR; P = .028). Conclusions: Concomitant TVI with LVAD implantation improved TR in most patients but did not have an impact on clinical outcomes. Significant postoperative TR after LVAD implantation, in patients with and without TVI, was associated with worse HF-free outcomes.

DOI： 10.1016/j.athoracsur.2019.12.047

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Annals of Thoracic Surgery  

Background: HeartWare ventricular assist device (HVAD) cannula position is associated with hemodynamics and heart failure readmissions. However, its impact on hemocompatibility-related adverse events (HRAEs) remains uncertain. Methods: HVAD patients were followed for 1 year after index hospitalization, when cannula coronal angle was quantified from chest x-ray film. Invasive right heart catheterization and transthoracic echocardiography were performed. One-year occurrences of each HRAE were compared between those with and without a cannula coronal angle of greater than 65 degrees. Results: Among 63 HVAD patients (median age 60 years, 63% male), 10 (16%) had a cannula coronal angle greater than 65 degrees. The wide-angle group had elevated intracardiac pressures and lower pulmonary artery pulsatility index (P < .05). They also had reduced right ventricular function by echocardiography. Freedom from HRAEs tended to be lower in the wide-angle group (24% vs 62%; P = .11). The rate of gastrointestinal bleeding was significantly higher in the greater than 65 degrees group (0.90 events/year vs 0.40 events/year; P = .013). The rates of stroke and pump thrombosis were statistically comparable irrespective of cannula angle (P > .05). Conclusions: HVAD cannula coronal angle was associated with reduced right ventricular function and HRAEs. Prospective studies evaluating surgical techniques to ensure optimal device positioning and its effects on HRAEs are warranted.

DOI： 10.1016/j.athoracsur.2019.12.049

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Journal of Echocardiography  

DOI： 10.1007/s12574-019-00418-z

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：一般社団法人 インターナショナル・ハート・ジャーナル刊行会  

An intra-aortic balloon pump (IABP) is a device of internal counterpulsation. Inflation of the balloon in di-astole results in a potential increase in coronary blood flow and an improvement in systemic perfusion, and de-flation at the end of diastole reduces left ventricular afterload, although the hemodynamic effects are relatively small. With its favorable safety profile due to fewer adverse events, IABP has been used for more than 5 dec-ades as the most common mechanical circulatory support device for cardiogenic shock. Recently, however, other short-term devices have become available, and the position of IABP for cardiogenic shock is rapidly changing. Meanwhile, novel improvements in knowledge and technology are pushing the boundaries of this device. In this review, we summarize the basic physiology and current evidence of this device and then discuss the outlook and implications of IABP in the future.

DOI： 10.1536/ihj.20-004

Web of Science

Scopus

PubMed

CiNii Research

記述言語：英語   出版者・発行元：Journal of Cardiac Failure  

Background: Continuous-flow left ventricular assist devices (LVADs) improve the hemodynamics of patients with advanced heart failure. However, the longitudinal trajectories of hemodynamics in patients after LVAD implantation remain unknown. The aim of this study was to investigate the trends of hemodynamic parameters following LVAD implantation. Methods and Results: We retrospectively reviewed patients who underwent LVAD implantation between April 2014 and August 2018. We collected hemodynamic parameters from right heart catheterizations. Of 199 consecutive patients, we enrolled 150 patients who had both pre- and postimplant right heart catheterizations. They had 3 (2, 4) postimplant right heart catheterizations during a follow-up of 2.3 (1.3, 3.1) years. The mean age was 57 ± 13 years, and 102 patients (68%) were male. Following LVAD implantation, pulmonary arterial pressure and pulmonary capillary wedge pressure decreased, and cardiac index increased significantly, then remained unchanged throughout follow-up. Right atrial pressure decreased initially and then gradually increased to preimplant values. The pulmonary artery pulsatility index decreased initially and returned to preimplant values, then progressively decreased over longer follow-up. Subgroup analysis showed significant differences in the trajectories of the pulmonary artery pulsatility index based on gender. Conclusions: Despite improvement in left-side filling pressures and cardiac index following LVAD implantation, right atrial pressure increased and the pulmonary artery pulsatility index decreased over time, suggesting progressive right ventricular dysfunction.

DOI： 10.1016/j.cardfail.2020.01.020

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：一般社団法人 日本循環器学会  

Background: An inverse relationship exists between hospital case volume and mortality in patients with heart failure (HF). However, hospital performance factors associated with mortality in HF patients have not been examined. We aimed to identify these using exploratory factor analysis and assess the relationship between these factors and 7-day, 30-day, and in-hospital mortality among HF patients in Japan. Methods and Results: We analyzed the records of 198,861 patients admitted to 683 certified hospitals of the Japanese Circulation Society between 2012 and 2014. Records were obtained from the nationwide database of the Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination (JROAD-DPC). Using exploratory factor analysis, 90 hospital survey items were grouped into 5 factors, according to their collinearity: “Interventional cardiology”, “Cardiovascular surgery”, “Pediatric cardiology”, “Electrophysiology” and “Cardiac rehabilitation”. Multivariable logistic regression analysis was performed to determine the association between these factors and mortality. The 30-day mortality was 8.0%. Multivariable logistic regression analysis showed the “Pediatric cardiology” (odds ratio (OR) 0.677, 95% confidence interval [CI]: 0.628–0.729, P<0.0001), “Electrophysiology” (OR 0.876, 95% CI: 0.832–0.923, P<0.0001), and “Cardiac rehabilitation” (OR 0.832, 95% CI: 0.792–0.873, P<0.0001) factors were associated with lower mortality. In contrast, “Interventional cardiology” (OR 1.167, 95% CI: 1.070–1.272, P<0.0001) was associated with higher mortality. Conclusions: Hospital factors, including various cardiovascular therapeutic practices, may be associated with the early death of HF patients.

DOI： 10.1253/circj.cj-19-0759

Web of Science

Scopus

PubMed

CiNii Research

Web of Science

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

全国の心不全による入院患者198861例(男性52.7%、平均77.8±12.9歳)を対象に、探索的因子分析の手法を用いて院内死亡の予測因子について検討した。対象は日本循環器学会の循環器疾患診療実態調査(JROAD)に加えて診断群分類包括評価(DPC)の情報を集めたデータベース(JROAD-DPC)に登録された683関連施設に入院する心不全患者とした。心不全の重症度はNYHA心機能分類でI度が7.9%、II度が28.0%、III度が33.4%、IV度が30.7%であった。探索的因子分析で90の評価項目を5因子(インターベンショナルカーディオロジー、心血管手術、小児心臓病学、電気生理学、心臓リハビリテーション)に分類した。30日死亡率は8.0%であった。多重ロジスティック回帰分析で小児心臓学(OR:0.677,95%CI:0.628～0.873)、電気生理学(OR:0.876,95%CI:0.832～0.923)、心臓リハビリテーション(OR:0.832,95%CI:0.792～0.873)が死亡率低下と関連した。インターベンショナルカーディオロジー(OR:1.167,95%CI:1.070～1.272)は死亡率増加と有意に関連した(いずれもP<0.0001)。

Web of Science

Web of Science

Web of Science

Web of Science

記述言語：英語   出版者・発行元：Journal of Cardiac Failure  

Background: HVAD left ventricular assist device flow waveforms provides graphical real-time information linking device performance with invasive hemodynamics. Previous studies have demonstrated a good correlation between the slopes of the ventricular filling phase slope (VFPS) and directly measured pulmonary capillary wedge pressure (PCWP). We aimed to validate the utility of VFPS to estimate PCWP and predict clinical outcomes. Methods: In this prospective blinded study, screenshots from the HVAD monitor and simultaneous invasive hemodynamic measurements were obtained. Each screenshot was digitized and the VFPS was calculated by 2 independent reviewers who were blinded to the hemodynamic results. The equation PCWP = 7.053 +1.365 × (VFPS) was derived from a previously published dataset and the estimated PCWP was correlated to the actually measured PCWP. Results: One hundred thirty-one sets of simultaneous measurements (VFPS and PCWP) were obtained from 27 HVAD patients (mean age 55 years, 47% male). A previously proposed cutoff of VFPS ≥5.8 L/min/s predicted PCWP ≥ 18 mmHg with 91.5% sensitivity and 95.2% specificity with the area under curve of 0.987. The estimated PCWP significantly correlated with measured PCWP (R2 = 0.65, P < .001) and showed acceptable agreement with measured PCWP. Patients with VFPS ≥ 5.8 L/min/s experienced significantly higher heart failure readmission rates than those without (0.24 vs 0.05 events/y, P < .001). Conclusions: VFPS of the HVAD flow waveform is a novel noninvasive parameter that can estimate PCWP.

DOI： 10.1016/j.cardfail.2020.01.012

Web of Science

Scopus

PubMed

Web of Science

Web of Science

記述言語：英語   出版者・発行元：Journal of Cardiac Failure  

Background: Characterization of right heart catheterization (RHC) waveforms provides diagnostic and clinical information in heart failure patients. We aimed to investigate the implication of RHC waveforms, specifically the y-descent, in patients with left ventricular assist device (LVAD). Methods and Results: Patients underwent RHC and waveforms were quantified prior to and 6 months after LVAD implantation. The impact of a deep y-descent (>3 mmHg) on echocardiographic measures of right heart function and 1-year hemocompatibility-related adverse event rates were investigated. Eighty-nine patients (median 59 years old, 65 male) underwent RHC. RHC waveform showed unique changes following LVAD implantation, particularly an increase in the steepness of the y-descent. A post-LVAD deep y-descent was associated with reduced right ventricular function and enlarged right heart. Patients with post-LVAD deep y-descent had higher rates of gastrointestinal bleeding (0.866 vs 0.191 events/year) and stroke (0.199 vs 0 events/year) compared with those without (P<. 05 for both). Conclusion: RHC waveforms characterized by deep y-descent on RHC waveform during LVAD support was associated with impaired right ventricular function and worse clinical outcomes.

DOI： 10.1016/j.cardfail.2020.01.004

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Annals of Thoracic Surgery  

Purpose: Aortic insufficiency (AI) significantly affects morbidity and mortality in patients with left ventricular assist devices. Although AI may be commonly assessed by echocardiography, expert techniques are required for accurate quantification of AI severity. Description: In this prospective blinded study, screenshots from the HVAD (Medtronic, Framingham, MA) display and simultaneous echocardiographic measurements were obtained. Each screenshot was digitized and the early diastolic phase slope was calculated, with blinding to the echocardiographic results. The regurgitant fraction of AI was quantified by Doppler echocardiography of the outflow graft. Evaluation: A total of 30 patients (median, 57 years old; 57% male) were enrolled. A cutoff of −17.6 L/min/s for the early diastolic phase slope had a sensitivity of 0.92 and a specificity of 0.53 to estimate significant AI with a regurgitant fraction of 30% or greater, and it significantly stratified patients into a low regurgitant faction group (0.3%) and a high regurgitant fraction group (33.0%) (P =.009). The early diastolic phase slope had a moderate correlation with the actually measured regurgitant fraction (r =.50). Conclusions: The early diastolic phase slope of the HVAD flow waveform may be a parameter that can estimate the presence of clinically significant AI.

DOI： 10.1016/j.athoracsur.2019.09.077

Web of Science

Scopus

PubMed

DOI： 10.1080/24748706.2019.1706793

Web of Science

記述言語：英語   出版者・発行元：ASAIO Journal  

Tolvaptan is an effective therapy for heart failure patients with symptomatic congestion and hyponatremia. The efficacy of its use in patients with continuous-flow left ventricular assist devices (LVADs) is unknown. The aim of this study was to assess the clinical efficacy and safety of tolvaptan in LVAD patients. We retrospectively reviewed medical records of patients who underwent LVAD implantation between January 2014 and August 2018. Among 217 consecutive LVAD patients, tolvaptan was used in 20 patients. Mean age was 46 ± 14 years old and 14 patients were males. The duration of tolvaptan therapy was 4 (interquartile range 1-8) days. Urine volume significantly increased from 2,623 ± 1,109 ml/day before tolvaptan to 4,308 ± 1,432 ml/day during tolvaptan therapy (p < 0.001). Serum sodium increased from 127 ± 3 to 133 ± 3 mEq/L at the end of tolvaptan therapy (p < 0.001). No patients developed hypernatremia (serum sodium >150 mEq/L). The 90-day overall survival following tolvaptan therapy was 89% in both the tolvaptan group and a propensity score-matched non-tolvaptan group (p = 0.918). Survival free of heart failure readmissions was also comparable between the groups (p = 0.751). In conclusion, short-term use of tolvaptan following LVAD implantation is a safe and effective therapy to augment diuresis and improve hyponatremia.

DOI： 10.1097/MAT.0000000000001079

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

13歳女。9ヵ月時に右室性単心室、無脾症、右胸心と診断されていた。4歳時に関連小児病院でFontan手術を受けていた。心機能は術後に徐々に低下し、10歳で成人先天性心疾患部門を受診した際には、強化心不全療法にも拘らず、ニューヨーク心臓協会機能分類IVを示していた。その後、肺血管抵抗を下げるためタダラフィルによる薬物療法を続けたが、心不全悪化のため入院した。全身性心室として作用している解剖学的右室に対してJarvik2000軸流型補助人工心臓の移植を施行したところ、患者の術後経過は良好であった。患者は現在、高校3年生に在学中で、心臓移植を待っている。

記述言語：英語   出版者・発行元：Journal of Artificial Organs  

We present a case of successful ventricular assist device support in a 13-year-old female diagnosed with right single ventricle, asplenia, dextrocardia, who had undergone a Fontan operation at 4 years old in an associated children hospital. She underwent placement of Jarvik 2000 axial flow ventricular assist device to the morphologic right ventricle which worked as systemic ventricle. The postoperative course was not eventful. She was waiting for heart transplantation attending high school 3 years after implantation.

DOI： 10.1007/s10047-019-01124-4

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Journal of Heart and Lung Transplantation  

BACKGROUND: The heart transplant (HT) guidelines recommendation to match recipient and donors within 30% of body weight lacks a strong evidence base and is not well established in patients bridged to transplant with left ventricular assist devices (LVAD). In light of the scarcity of donor hearts, we investigated the effect of size mismatch on hemodynamics, one-year survival and length of stay (LOS) following HT. METHODS: Single-center retrospective analysis of consecutive HT patients from April 2007 to September 2017. Recipients were divided into 3 cohorts based on donor-to-recipient weight ratio (DRWR): (1) undersized (<0.7), (2) size-matched, (0.7–1.3); (3) oversized (>1.3). RESULTS: 288 consecutive patients were identified (mean age 53 ± 11 years; 76% male), 46 were undersized (0.61 ± 0.05), 210 size-matched (0.94 ± 0.16), and 32 oversized (1.65 ± 0.38). There was no significant difference in donor left ventricular end diastolic diameter (LVEDD) between the 3 groups (p = 0.11). The donor/recipient (D/R) predicted heart mass (PHM) was lowest in the undersized group (0.92 ± 0.13). There were no significant differences in 1-year survival in the overall and LVAD cohort (p = 0.65 and 0.59, respectively). Neither donor LVEDD nor D/R PHM differed among survivors or non-survivors. LOS was longer in the undersized group than the size-matched cohort (p = 0.004). The undersized group had hearts with the highest filling pressures and lowest cardiac index at 1 week among the remaining groups (p = 0.009, 0.017, and p = 0.05, respectively). There were no clinically significant differences in hemodynamics at 1 or 6 months. CONCLUSIONS: HT undersizing affects hemodynamics early but not later in the course and does not impact 1-year survival. The liberalization of size matching may increase the HT donor pool significantly.

DOI： 10.1016/j.healun.2019.08.020

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Journal of Cardiac Failure  

Aim: Hemocompatibility-related adverse events (HRAE) are a major cause of readmissions in patients with left ventricular assist devices (LVAD). The impact of aortic insufficiency (AI) on HRAE remains uncertain. We aimed to investigate the impact of AI on HRAE. Methods and Results: Patients who underwent LVAD implantation between August 2014 and July 2017 and had echocardiograms 3 months post-LVAD implantation were enrolled. AI severity was assessed by measuring the systolic/diastolic ratio of flow and the rate of diastolic flow acceleration using Doppler echocardiography of the outflow cannula. Regurgitation fraction was derived from these parameters. Significant AI was defined as regurgitation fraction > 30%. Among 105 patients (median age, 56 years; 76% male), 36 patients (34%) had significant AI. Baseline characteristics were statistically not significantly different between those with and without significant AI except for higher rates of ischemic etiology and atrial fibrillation in the significant AI group (P < 0.05 for both). One-year survival free from HRAE was 44% in patients with AI compared to 67% in patients without significant AI (P = 0.018). The average hemocompatibility score, which defines the net burden of HRAE, was higher in the AI group (1.72 vs 0.64; P = 0.009), due mostly to higher tier I (mild HRAE; P = 0.034) and tier IIIB scores (severe HRAE; P = 0.011). Conclusion: Significant AI, as assessed by Doppler echocardiographic parameters, was associated with HRAE during LVAD support.

DOI： 10.1016/j.cardfail.2019.08.003

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：一般社団法人 インターナショナル・ハート・ジャーナル刊行会  

Bradycardia is a common complication at the early postoperative period after heart transplantation (HT). The heart rate (HR) usually recovers within a few weeks; however, several patients need a temporary pacemaker or chronotropic agents to stabilize their hemodynamics. Here, we report the first case of transient bradycardia associated with hemodynamic deterioration following HT, which was successfully treated with cilostazol, a phosphodiesterase-3-inhibiting agent. A 59-year-old man received HT for advanced heart failure due to ischemic cardiomyopathy. General fatigue persisted even after the HT. His HR was around 60 beats per minute (bpm) with sinus rhythm. Echocardiography showed no abnormal findings. Right heart catheterization showed that the cardiac index (CI) was 1.9 L/minute/m2. Continuous intravenous infusion of isoproterenol (0.003 μg/kg/minute) increased the HR to 80 bpm and CI to 2.7 L/minute/m2 and improved his symptoms. Isoproterenol was switched to oral administration of cilostazol (100 mg, twice a day), which maintained the HR at around 80 bpm and CI of 2.5 L/minute/m2. The patient’s HR gradually recovered and cilostazol could be discontinued three months after the HT. Oral administration of cilostazol can be a therapeutic option for patients with sinus bradycardia following HT, who need positive chronotropic support.

DOI： 10.1536/ihj.19-116

Web of Science

Scopus

PubMed

CiNii Research

記述言語：英語   出版者・発行元：一般社団法人 日本循環器学会  

DOI： 10.1253/circj.cj-19-0342

Web of Science

Scopus

PubMed

CiNii Research

記述言語：英語   出版者・発行元：(一社)インターナショナルハートジャーナル刊行会  

症例は59歳男性で、虚血性心筋症のため重症心不全となり、心臓移植術を受けた。ドナーは低酸素脳症の50代の男性で、心疾患の既往はなかった。臓器摘出時の血圧は70bpmで、洞調律であった。移植後にタクロリムス、ミコフェノール酸モフェチル、プレドニゾロンを用いた免疫抑制療法を開始した。移植後2週間の心拍数は60bpmで、BNP値は292pg/mLであった。移植後も全身倦怠感と呼吸困難を引き続き認めた。胸部X線検査で心拡大と軽度の肺うっ血を認めた。心エコー検査で左室駆出率は70%で、収縮能に異常はなかった。右心カテーテル検査で心係数は1.9L/min/m2、右房平均圧は5mmHg、肺動脈楔入圧は9mmHgであった。冠動脈造影で閉塞病変はなかった。血行動態悪化状態の原因は洞徐脈と診断し、イソプロテレノール(0.003μg/kg/分)の静注を開始したところ、心係数は2.7L/min/m2に上昇し、心拍数も85bpmに改善した。3週間後にシロスタゾールの経口投与に切り替えた。心拍数は90bpm、心係数は2.5L/min/m2に改善し、症状の悪化は見られなかった。移植後62日後に退院に至った。

DOI： 10.1016/j.cardfail.2019.07.532

Web of Science

記述言語：英語   出版者・発行元：一般社団法人 インターナショナル・ハート・ジャーナル刊行会  

Summary Pump thrombosis (PT) is a serious complication after continuous-flow left ventricular assist device (LVAD) implantation. To detect PT, echocardiographic ramp test using left ventricular end-diastolic diameter (LVEDD) is known to be useful. However, this method has several limitations. In this study, we propose an alternative novel ramp test using the flow velocity of outflow graft (OG). A 46-year-old man underwent continuous-flow LVAD (HeartMate II, Abbott Laboratories, Lake Forest, IL, USA) implantation for advanced heart failure due to idiopathic dilated cardiomyopathy. About 2 years after implantation, he suffered from hemolysis and symptoms of heart failure, and PT was strongly suspected. The change in LVEDD was minimal with increase in pump speed (−0.06 cm/400 rotations per minute (rpm)), suggesting PT. The systolic to diastolic velocity (S/D) ratio of OG flow, which we proposed as a new indicator of PT, also showed minimal change (−0.07/400 rpm). His clinical symptoms improved with anticoagulation therapy, and the changing slope of the S/D ratio dramatically improved to −0.92/400 rpm. Although its consistency should be verified in many other cases, this novel method can be useful for detecting PT and evaluating its clinical course.

DOI： 10.1536/ihj.18-600

Web of Science

Scopus

PubMed

CiNii Research

記述言語：英語   出版者・発行元：(一社)インターナショナルハートジャーナル刊行会  

症例は46歳男性で、特発性拡張型心筋症による高度心不全に対し、連続流式左室補助装置(LVAD)植込み術が施行された。植込み後約2年で溶血および心不全症状が発生し、ポンプ血栓症(PT)が強く疑われ、血小板減少からもPTが示唆された。また心エコーRamp法でも、左室拡張末期径(LVEDD)の変化はポンプ速度の増加に伴い最小でありPTが示唆された。またPTの新たな指標である、outflow graft内フローの拡張期速度に対する収縮期速度の比(S/D)でも、ポンプ速度の増加に伴い最小変化が示された。PTの診断で、ワルファリンに加え持続的ヘパリン注入を開始したところ、臨床症状は徐々に改善し、S/D比の変化勾配も劇的に改善した。

記述言語：英語   出版者・発行元：Clinical Research in Cardiology  

Background: Left ventricular (LV) dysfunction due to anthracycline-induced cardiotoxicity (AIC) has been believed to be irreversible. However, this has not been confirmed and standard medical treatment for heart failure (HF) including renin–angiotensin inhibitors and β-blockers may lead to its recovery. Methods and results: We thus retrospectively studied 350 cancer patients receiving anthracycline-based chemotherapy from 2001 to 2015 in our institution. Fifty-two patients (14.9%) developed AIC with a decrease in LV ejection fraction (LVEF) of 24.1% at a median time of 6 months [interquartile range (IQR) 4–22 months] after anthracycline therapy. By multivariate analysis, AIC was independently associated with cardiac comorbidities including ischemic heart disease, valvular heart disease, arrhythmia, and cardiomyopathy [odds ratio (OR) 6.00; 95% confidence interval (CI) 2.27–15.84, P = 0.00044), lower baseline LVEF (OR per 1% 1.09; 95% CI 1.04–1.14, P = 0.00034). During the median follow-up of 3.2 years, LV systolic dysfunction recovered among 33 patients (67.3%) with a median time of 4 months (IQR 2–6 months), which was independently associated with the introduction of standard medical treatment for HF (OR 9.39; 95% CI 2.27–52.9, P = 0.0014) by multivariate analysis. Conclusion: Early initiation of standard medical treatment for HF may lead to LV functional recovery in AIC.

DOI： 10.1007/s00392-018-1386-0

Web of Science

Scopus

PubMed

DOI： 10.1016/j.healun.2019.01.159

Web of Science

DOI： 10.1016/j.healun.2019.01.1166

Web of Science

DOI： 10.1016/j.healun.2019.01.951

Web of Science

DOI： 10.1016/j.healun.2019.01.563

Web of Science

DOI： 10.1016/j.healun.2019.01.333

Web of Science

DOI： 10.1016/j.healun.2019.01.403

Web of Science

DOI： 10.1016/j.healun.2019.01.1020

Web of Science

DOI： 10.1016/j.healun.2019.01.068

Web of Science

DOI： 10.1016/j.healun.2019.01.1130

Web of Science

Web of Science

DOI： 10.1016/j.healun.2019.01.161

Web of Science

DOI： 10.1016/j.healun.2019.01.1094

Web of Science

DOI： 10.1016/j.healun.2019.01.927

Web of Science

DOI： 10.1016/j.healun.2019.01.661

Web of Science

DOI： 10.1016/j.healun.2019.01.195

Web of Science

DOI： 10.1016/j.healun.2019.01.1139

Web of Science

DOI： 10.1016/j.healun.2019.01.404

Web of Science

DOI： 10.1016/j.healun.2019.01.539

Web of Science

DOI： 10.1016/j.healun.2019.01.1075

Web of Science

出版者・発行元：(株)メジカルビュー社  

DOI： 10.18885/j03097.2019038140

CiNii Research

Web of Science

記述言語：英語   出版者・発行元：Journal of Cardiology Cases  

Although cardiac resynchronization therapy (CRT) is beneficial in patients with heart failure (HF) and left ventricular dyssynchrony, its effectiveness has not been established in patients with decompensated HF on mechanical support. Here, we report two patients with decompensated HF depending on inotropes and intra-aortic balloon pumping (IABP), who were rescued by urgent CRT implantations. Both patients had non-ischemic cardiomyopathy with wide QRS of left bundle brunch block. IABP could be weaned just after introducing CRT. CRT can dramatically improve hemodynamics even in severely decompensated HF, and thus could be considered when left ventricular dyssynchrony is present. <Learning objective: The efficacy of cardiac resynchronization therapy (CRT) for acutely decompensated heart failure (HF) is controversial. However, the patients with wide QRS complex with left bundle brunch block and non-ischemic etiology can be the candidates of CRT implantation in order to wean inotrope and mechanical circulatory support.>

DOI： 10.1016/j.jccase.2018.04.004

Scopus

PubMed

記述言語：英語   出版者・発行元：(一社)日本心臓病学会  

症例1は47歳男性で、心不全により救急病院に入院した。入院後、心原性ショックとなり、大動脈内バルーンパンピング(IABP)と体外式膜型人工肺による治療を緊急施行された。その後の経過でIABPから離脱できなかった。心電図では左脚ブロック型のQRSを示し、その幅は226msであった。心エコーによる左室駆出率は21.5%であった。強心薬やIABPによる治療にも関わらず多臓器不全の徴候が明らかになってきたため、入院7日後に心臓再同期療法(CRT)を緊急施行した。その翌日にはIABPから離脱でき、2ヵ月後には左室駆出率は40.5%に改善して退院に至った。後に心筋生検などから心サルコイドーシスと診断された。26ヵ月後の時点で心不全の増悪を見ること無く、外来にて経過観察中である。症例2は77歳男性で、拡張型心筋症を基礎疾患とした心不全のため入院した。心電図では左脚ブロック型のQRS(幅174ms)が認め、心エコーによる左室駆出率は22.4%であった。多臓器不全や肺炎、発作性心房細動なども発症していた。IABPを開始したが離脱できなかったため心臓再同期装置を植え込んだところ、心拍出量が改善し、植え込み2日後にはIABPから離脱できた。装置植え込みから41ヵ月後に細菌性肺炎のため死亡した。

Web of Science

Web of Science

記述言語：英語   出版者・発行元：(一社)インターナショナルハートジャーナル刊行会  

症例は31歳男性で、心房頻拍と心原性ショックを発症し当院へ入院となった。小児の頃に遺伝性球状赤血球症と診断されていたが赤血球輸血を受けたことは無かった。心房頻拍に対しカルディオバージョンにて加療するも心機能は改善せず、心不全を再発した。右心室の心筋生検にてヘモジデリン沈着が多発していることが示され、更に鉄沈着、心筋細胞の喪失、重度の間質線維化の所見も認められた。これらの所見から遺伝性球状赤血球症に併発した心ヘモクロマトーシスと診断した。心不全と不整脈に対し集中治療を行い、並行して鉄キレート療法を行うも心不全は不応かつ進行性の経過を辿り、死亡した。剖検ではヘモジデリン沈着が全身で認められたが、特に心と肝とで顕著であり、ヘモクロマトーシスに起因する肝硬変と診断された。

記述言語：英語   出版者・発行元：一般社団法人 インターナショナル・ハート・ジャーナル刊行会  

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.

DOI： 10.1536/ihj.17-160

Web of Science

Scopus

PubMed

CiNii Research

記述言語：英語   出版者・発行元：一般社団法人 日本循環器学会  

DOI： 10.1253/circj.cj-18-0329

Web of Science

PubMed

CiNii Research

出版者・発行元：南江堂  

DOI： 10.15106/j00349.2017355960

CiNii Research

出版者・発行元：Kyobu geka. The Japanese journal of thoracic surgery  

Perioperative right heart failure(RHF) is an important problem, especially in the field of heart failure surgery. Right ventricular performance is determined by the combination of preload, contractility, heart rate, rhythm and afterload. Many factors influence on these parameters in the perioperative period, and the deterioration of one of them can cause RHF. Recently, we often encounter perioperative RHF after left ventricular assist device (LVAD) implantation, and prompt LVAD pump speed optimization and treatment for RHF is required to avoid complications and hemodynamic deterioration. Concomitant tricuspid annulus plasty may be effective for selected patients. In this review, we show the factors determining the performance of right ventricle, and then summarize the etiology and management strategies of perioperative RHF.

Scopus

記述言語：日本語  

PubMed

記述言語：英語   出版者・発行元：American Journal of Physiology - Cell Physiology  

Dehydrogenase/reductase member 7C (DHRS7C) is a newly identified NAD/NADHdependent dehydrogenase that is expressed in cardiac and skeletal muscle and localized in the endoplasmic/sarcoplasmic reticulum (ER/ SR). However, its functional role in muscle cells remains to be fully elucidated. Here, we investigated the role of DHRS7C by analyzing mouse C2C12 myoblasts deficient in DHRS7C (DHRS7C-KO cells), overexpressing wild-type DHRS7C (DHRS7C-WT cells), or expressing mutant DHRS7C [DHRS7C-Y191F or DHRS7C-K195Q cells, harboring point mutations in the NAD/NADH-dependent dehydrogenase catalytic core domain (YXXXK)]. DHRS7C expression was induced as C2C12 myoblasts differentiated into mature myotubes, whereas DHRS7C-KO myotubes exhibited enlarged cellular morphology after differentiation. Notably, both DHRS7C-Y191F and DHRS7C-K195Q cells also showed similar enlarged cellular morphology, suggesting that the NAD/NADH-dependent dehydrogenase catalytic core domain is pivotal for DHRS7C function. In DHRS7CKO, DHRS7C-Y191F, and DHRS7C-K195Q cells, the resting level of cytosolic Ca2+ and total amount of Ca2+ storage in the ER/SR were significantly higher than those in control C2C12 and DHRS7C-WT cells after differentiation. Additionally, Ca2+ release from the ER/SR induced by thapsigargin and 4-chloro-m-cresol was augmented in these cells and calpain, a calcium-dependent protease, was significantly activated in DHRS7C-KO, DHRS7C-Y191F, and DHRS7C-K195Q myotubes, consistent with the higher resting level of cytosolic Ca2+ concentration and enlarged morphology after differentiation. Furthermore, treatment with a calpain inhibitor abolished the enlarged cellular morphology. Taken together, our findings suggested that DHRS7C maintains intracellular Ca2+ homeostasis involving the ER/SR and that functional loss of DHRS7C leads to Ca2+ overload in the cytosol and ER/SR, resulting in enlarged cellular morphology via calpain activation.

DOI： 10.1152/ajpcell.00090.2016

Web of Science

Scopus

PubMed

記述言語：日本語   出版者・発行元：一般社団法人 日本超音波検査学会  

DOI： 10.11272/jssabst.42.0_s220_2

CiNii Research

DOI： 10.1016/j.cardfail.2016.07.372

Web of Science

記述言語：英語   出版者・発行元：American Journal of Physiology - Heart and Circulatory Physiology  

Cardiac rupture is a fatal complication after myocardial infarction (MI). However, the detailed mechanism underlying cardiac rupture after MI remains to be fully elucidated. In this study, we investigated the role of mitochondrial DNA (mtDNA) and mitochondria in the pathophysiology of cardiac rupture by analyzing Twinkle helicase overexpression mice (TW mice). Twinkle overexpression increased mtDNA copy number approximately twofold and ameliorated ischemic cardiomyopathy at day 28 after MI. Notably, Twinkle overexpression markedly prevented cardiac rupture and improved post-MI survival, accompanied by the suppression of MMP-2 and MMP-9 in the MI border area at day 5 after MI when cardiac rupture frequently occurs. Additionally, these cardioprotective effects of Twinkle overexpression were abolished in transgenic mice overexpressing mutant Twinkle with an in-frame duplication of amino acids 353–365, which resulted in no increases in mtDNA copy number. Furthermore, although apoptosis and oxidative stress were induced and mitochondria were damaged in the border area, these injuries were improved in TW mice. Further analysis revealed that mitochondrial biogenesis, including mtDNA copy number, transcription, and translation, was severely impaired in the border area at day 5. In contrast, Twinkle overexpression maintained mtDNA copy number and restored the impaired transcription and translation of mtDNA in the border area. These results demonstrated that Twinkle overexpression alleviated impaired mitochondrial biogenesis in the border area through maintained mtDNA copy number and thereby prevented cardiac rupture accompanied by the reduction of apoptosis and oxidative stress, and suppression of MMP activity.

DOI： 10.1152/ajpheart.00044.2016

Web of Science

Scopus

PubMed

DOI： 10.1016/j.cardfail.2016.07.060

Web of Science

DOI： 10.1016/j.cardfail.2016.07.072

Web of Science

DOI： 10.1016/j.cardfail.2016.07.019

Web of Science

DOI： 10.1016/j.cardfail.2016.07.326

Web of Science

DOI： 10.1016/j.cardfail.2016.07.029

Web of Science

DOI： 10.1016/j.cardfail.2016.07.070

Web of Science

記述言語：英語   出版者・発行元：International Journal of Cardiology  

DOI： 10.1016/j.ijcard.2016.03.211

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：(一社)日本心臓病学会  

心臓移植(HTx)後早期の低拍出量を予測するリスクファクターを明らかにし、中期的な移植片機能不全に対する早期低拍出量の影響の有無を後ろ向きに検討した。連続HTxレシピエント45例(男性49%、平均年齢44±14歳)を登録し、11例を早期低拍出量群に、残りを早期拍出量温存群に分類した。単変量ロジスティック分析にて、ドナーの年齢が、早期低拍出量を予測する唯一の有意な因子であることが認められた。早期低拍出量患者の心係数(CI)は徐々に上昇し、HTx後2週目に、早期拍出量温存患者のCIと同等となった。早期低拍出量患者の血漿中B型ナトリウム利尿ペプチド濃度は、HTx後1週目、2週目、4週目においてより高く、HTx後12週目に早期拍出量温存患者と同じ濃度まで低下した。

出版者・発行元：Journal of Cardiology  

Background: Using hearts from marginal donors could be related to increased risk of primary graft dysfunction and poor long-term survival. However, factors associated with delayed myocardial recovery after heart transplantation (HTx) remain unknown. We sought to clarify risk factors that predict early low output after HTx, and investigated whether early low output affects mid-term graft dysfunction. Methods: We retrospectively analyzed patients who had undergone HTx at The University of Tokyo Hospital. We defined early low output patients as those whose cardiac index (CI) was <2.2 L/min/m2 despite the use of intravenous inotrope at 1 week after HTx. Results: We included 45 consecutive HTx recipients, and classified 11 patients into early low output group, and the others into early preserved output group. We performed univariable logistic analysis and found that donor age was the only significant factor that predicted early low output (odds ratio 1.107, 95% confidence interval 1.034-1.210, p = 0.002). CI of early low output patients gradually increased and it caught up with that of early preserved output patients at 2 weeks after HTx (2.4 ± 0.6 L/min/m2 in early low output group vs 2.5 ± 0.5 L/min/m2 in early preserved output group, p = 0.684). Plasma B-type natriuretic peptide concentration of early low output patients was higher (1118.5 ± 1250.2 pg/ml vs 526.4 ± 399.5 pg/ml; p = 0.033) at 1 week, 703.6 ± 518.4 pg/ml vs 464.6 ± 509.0 pg/ml (p = 0.033) at 2 weeks, and 387.7 ± 231.9 pg/ml vs 249.4 ± 209.5 pg/ml (p = 0.010) at 4 weeks after HTx, and it came down to that of early preserved output patients at 12 weeks after HTx. Conclusions: Donor age was a predictor of early low output after HTx. We should be careful after HTx from old donors. However, hemodynamic parameters of early low output patients gradually caught up with those of early preserved output patients.

DOI： 10.1016/j.jjcc.2015.07.007

Scopus

記述言語：英語   出版者・発行元：European Heart Journal Cardiovascular Imaging  

DOI： 10.1093/ehjci/jev234

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Scientific Reports  

The heart has two major modalities of hypertrophy in response to hemodynamic loads: concentric and eccentric hypertrophy caused by pressure and volume overload (VO), respectively. However, the molecular mechanism of eccentric hypertrophy remains poorly understood. Here we demonstrate that the Akt-mammalian target of rapamycin (mTOR) axis is a pivotal regulator of eccentric hypertrophy during VO. While mTOR in the heart was activated in a left ventricular end-diastolic pressure (LVEDP)-dependent manner, mTOR inhibition suppressed eccentric hypertrophy and induced cardiac atrophy even under VO. Notably, Akt was ubiquitinated and phosphorylated in response to VO, and blocking the recruitment of Akt to the membrane completely abolished mTOR activation. Various growth factors were upregulated during VO, suggesting that these might be involved in Akt-mTOR activation. Furthermore, the rate of eccentric hypertrophy progression was proportional to mTOR activity, which allowed accurate estimation of eccentric hypertrophy by time-integration of mTOR activity. These results suggested that the Akt-mTOR axis plays a pivotal role in eccentric hypertrophy, and mTOR activity quantitatively determines the rate of eccentric hypertrophy progression. As eccentric hypertrophy is an inherent system of the heart for regulating cardiac output and LVEDP, our findings provide a new mechanistic insight into the adaptive mechanism of the heart.

DOI： 10.1038/srep15881

Web of Science

Scopus

PubMed

DOI： 10.1016/j.cardfail.2015.08.113

Web of Science

DOI： 10.1016/j.cardfail.2015.08.204

Web of Science

DOI： 10.1016/j.cardfail.2015.08.018

Web of Science

出版者・発行元：Circulation Journal  

Background: Improving quality of life (QOL) has become an important goal in left ventricular assist device (LVAD) therapy. We aimed (1) to assess the effect of an implantable LVAD on patients’ QOL, (2) to compare LVAD patients’ QOL to that of patients in different stages of heart failure (HF), and (3) to identify factors associated with patients’ QOL. Methods and Results: The QOL of 33 Japanese implantable LVAD patients was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and Short-form 8 (SF-8), before and at 3 and 6 months afterwards. After LVAD implantation, QOL significantly improved [MLHFQ, SF-8 physical component score (PCS), SF-8 mental component score (MCS), all P<0.05]. Implanted LVAD patients had a better QOL than extracorporeal LVAD patients (n=33, 32.1±21.9 vs. n=17, 47.6±18.2), and Stage D HF patients (n=32, 51.1±17.3), but the score was comparable to that of patients who had undergone a heart transplant (n=13). In multiple regression analyses, postoperative lower albumin concentration and right ventricular failure were independently associated with poorer PCS. Female sex and postoperative anxiety were 2 of the independent factors for poorer MCS (all P<0.05). Conclusions: Having an implantable LVAD improves patients’ QOL, which is better than that of patients with an extracorporeal LVAD. Both clinical and psychological factors are influence QOL after LVAD implantation.

DOI： 10.1253/circj.CJ-15-0502

Scopus

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

左室補助装置(LVAD)装着の日本人患者33例を対象とした。LVAD装着は患者の生活の質を改善した。改善は体外型LVADで治療した患者よりも良好であった。臨床的因子と心理学的因子の両者が生活の質の改善に関与した。

出版者・発行元：Clinical Breast Cancer  

DOI： 10.1016/j.clbc.2014.10.008

Scopus

記述言語：英語   出版者・発行元：PLoS ONE  

Background: Mitochondrial DNA (mtDNA) copy number decreases in animal and human heart failure (HF), yet its role in cardiomyocytes remains to be elucidated. Thus, we investigated the cardioprotective function of increased mtDNA copy number resulting from the overexpression of human transcription factor A of mitochondria (TFAM) or Twinkle helicase in volume overload (VO)-induced HF. Methods and Results: Two strains of transgenic (TG) mice, one overexpressing TFAM and the other overexpressing Twinkle helicase, exhibit an approximately 2-fold equivalent increase in mtDNA copy number in heart. These TG mice display similar attenuations in eccentric hypertrophy and improved cardiac function compared to wild-type (WT) mice without any deterioration of mitochondrial enzymatic activities in response to VO, which was accompanied by a reduction in matrix-metalloproteinase (MMP) activity and reactive oxygen species after 8 weeks of VO. Moreover, acute VO-induced MMP-2 and MMP-9 upregulation was also suppressed at 24 h in both TG mice. In isolated rat cardiomyocytes, mitochondrial reactive oxygen species (mitoROS) upregulated MMP-2 and MMP-9 expression, and human TFAM (hTFAM) overexpression suppressed mitoROS and their upregulation. Additionally, mitoROS were equally suppressed in H9c2 rat cardiomyoblasts that overexpress hTFAM or rat Twinkle, both of which exhibit increased mtDNA copy number. Furthermore, mitoROS and mitochondrial protein oxidation from both TG mice were suppressed compared toWT mice. Conclusions: The overexpression of TFAM or Twinkle results in increased mtDNA copy number and facilitates cardioprotection associated with limited mitochondrial oxidative stress. Our findings suggest that increasing mtDNA copy number could be a useful therapeutic strategy to target mitoROS in HF.

DOI： 10.1371/journal.pone.0119687

Web of Science

Scopus

PubMed

出版者・発行元：Journal of Artificial Organs  

Although the suppression of sympathetic activity is an essential mission for the current heart failure treatment strategy, little is known about the relationship between the rotation speed setting and autonomic nervous activity during continuous-flow left ventricular assist device (LVAD) treatment. We evaluated 23 adult patients with sinus rhythm (36 ± 13 years) who had received continuous-flow LVAD and been followed at our institute between March 2013 and August 2014. Heart rate variability measurement was executed along with hemodynamic study at 3 rotation speeds (low, middle, and high) at 5 weeks after LVAD implantation. Lower rotation speed was associated with higher ratio of low-frequency over high-frequency spectral level (LF/HF), representing enhanced sympathetic activation (p < 0.05 by repeated analyses of variance). Among hemodynamic parameters, cardiac index was exclusively associated with LFNU = LF/(LF + HF), representing relative sympathetic activity over parasympathetic one (p < 0.05). After 6 months LVAD support at middle rotation speed, 19 patients with higher LFNU eventually had higher plasma levels of B-type natriuretic peptide and achieved less LV reverse remodeling. A logistic regression analysis demonstrated that lower LFNU was significantly associated with improvement of LV reverse remodeling (p = 0.021, odds ratio 0.903) with a cut-off level of 55 % calculated by the ROC analysis (AUC 0.869). In conclusion, autonomic activity can vary in various rotation speeds. Patients with higher LFNU may better be controlled at higher rotation speed with the view point to suppress sympathetic activity and achieve LV reverse remodeling.

DOI： 10.1007/s10047-014-0800-2

Scopus

記述言語：英語   出版者・発行元：(一社)インターナショナルハートジャーナル刊行会  

心臓移植後の運動耐容能改善に交感神経再支配が関与することは知られているが、副交感神経の関与については明らかではない。本研究は、心臓移植後6ヵ月、1年、2年の時点で心肺運動負荷試験を施行した患者21例(40±16歳、男性71%)を対象とし、副交感神経の関与について検討した。副交感神経活動が関与する運動負荷後2分間中の心拍数改善と最大心拍数の遅延は、移植後2年間で有意に改善した(P<0.05)。移植後2年間で患者の生活の質も有意に改善した(P<0.05)。

記述言語：英語   出版者・発行元：(一社)インターナショナルハートジャーナル刊行会  

心内膜心筋生検を繰り返し行うと、心移植患者の致死的合併症のリスクとなる可能性がある。本研究は心移植後1年以上追跡した成人患者42例の臨床所見をレトロスペクティブに追跡検討した。移植後1130±157日に晩期拒絶反応(LR)があった患者5例は全例が移植後1年以内に急性細胞拒絶反応があった。ロジスティック回帰解析によると、パネル反応性抗体陽性がLRの唯一の有意予測因子であった(P=0.02)。

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

定常流型左心室補助装置(LVAD)を用いた処置の際に設定された、回転速度と交感神経活動の間の関係について検討した。ステージD心不全により定常流型LVADを装着している成人患者23名(36±13歳)を対象とした。これらの患者は2013年3月から2014年8月まで著者等の病院で経過観察されていた。全ての患者は洞調律であった。LVAD植込の5週間後に3段階の回転速度(高、中、低)での心拍変動スペクトル解析及び血行動態について検討した。低回転速度はLVAD流量の減少による心係数低下と関連し、心係数低下は高レベルのLFNU(低周波成分正規化単位)と有意に関連した。患者のうち19人は中回転速度に固定したLVADで6ヵ月以上処置した。6ヵ月後のこれらの患者において、高いLFNUは高い血漿中濃度のB型ナトリウム利尿ペプチドと関連した。6ヵ月観察後のロジスティック回帰分析によると、低レベルのLFNUは左心室逆リモデリングへの到達と有意に関連した(p=0.021、オッズ比0.903)。ROC解析から、中間エンドポイントに到達するためのLFNUのカットオフポイントは55%であった。

出版者・発行元：International Heart Journal  

Serial endomyocardial biopsies (EMBs) are scheduled even several years after heart transplantation (HTx) to monitor for late rejection (LR). However, repeated EMBs are associated with an increased risk for fatal complications and decrease the quality of life of the recipient. We retrospectively analyzed clinical data from 42 adult recipients who had received HTx and were followed > 1 year at the University of Tokyo Hospital. Five recipients experienced LR at 1130 ± 157 days after HTx, and all 5 had experienced acute cellular rejection (ACR) with ISHLT grade ≥ 2R within the first year, which was treated with methylprednisolone pulse therapy (sensitivity, 1.000; specificity, 0.7027). Logistic regression analyses demonstrated that positive panel reactive antibody (PRA) was the only significant predictor for LR among all parameters at 1 year after HTx (P = 0.020, odds ratio 24.00). Among the 5 recipients with LR, LR occurred earlier in the two PRA positive recipients than in those with a negative PRA (981 ± 12 versus 1230 ± 110 days, P = 0.042). Among the perioperative parameters, gender mismatch [n = 13 (31%)] was the only significant predictor for ACR within the first year in logistic regression analyses (P = 0.042, odds ratio 4.200). In conclusion, the current schedule of serial EMBs should perhaps be reconsidered for recipients without any history of ACR within the first year due to their lower risk of LR.

DOI： 10.1536/ihj.14-187

Scopus

出版者・発行元：International Heart Journal  

Although sympathetic reinnervation is accompanied by the improvement of exercise tolerability during the first years after heart transplantation (HTx), little is known about parasympathetic reinnervation and its clinical impact. We enrolled 21 recipients (40 ± 16 years, 71% male) who had received successive cardiopulmonary exercise testing at 6 months, and 1 and 2 years after HTx. Exercise parameters such as peak oxygen consumption or achieved maximum load remained unchanged, whereas recovery parameters including heart rate (HR) recovery during 2 minutes and the delay of peak HR, which are influenced by parasympathetic activity, improved significantly during post-HTx 2 years (P < 0.05 for both). HR variability was analysed at post-HTx 6 months in 18 recipients, and high frequency power, representing parasympathetic activity, was significantly associated with the 2 recovery parameters (P < 0.05 for all). We also assessed quality of life using the Minnesota Living with Heart Failure (HF) Questionnaire at post-HTx 6 months and 2 years in the same 18 recipients, and those with improved recovery parameters enjoyed a better HF-specific quality of life (P < 0.05 for both). In conclusion, parasympathetic reinnervation emerges along with improved post-exercise recovery ability of HR and quality of life during post-HTx 2 years.

DOI： 10.1536/ihj.14-292

Scopus

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

体外拍動性血流左室補助装置(LVAD)を植込み後3ヵ月に心肺運動負荷試験を施行した患者33例を2005年から2014年まで追跡した。術後の心肺運動負荷試験による3つの係数から計算した植込み評点は将来のLVAD必要性を予測することが示された。

記述言語：英語   出版者・発行元：(一社)インターナショナルハートジャーナル刊行会  

心臓移植(HTx)後の急性拒絶反応を調べるため、内頸静脈(IJV)アプローチまたは大腿静脈(FV)アプローチによる心内膜生検を行った。当院で2007年9月～2014年4月の間に行われたHTxレシピエント48名の、319件のIJVアプローチと50件のFVアプローチを後方視的に分析した。IJVアプローチはFVアプローチに比べて処置時間と放射線曝露時間が短く、放射線曝露量と造影剤使用量が少なかった。外科的管理を必要とする致命的な合併症や死亡に至る合併症はいずれのセッションにおいても認められなかった。IJCアプローチはFVアプローチに比べて合併症が少なかった。合併症の中では心房頻脈性不整脈がIJVアプローチでのみ生じたが、一過性の心室頻脈性不整脈と脚ブロックはFVアプローチで多く認められた。心房頻脈性不整脈の発生率を考慮するとしても、IJVアプローチによる心内膜生検はFVアプローチに比べて安全で、侵襲性が少ないと考えた。

記述言語：英語   出版者・発行元：(一社)インターナショナルハートジャーナル刊行会  

心房中隔欠損(ASD)および肺動脈性肺高血圧症(PAH)と診断され、ASD閉鎖術が施行された外来患者5名にPAH薬を用いた標的治療を併用した。これらの患者の血行動態指標と運動能力の変化を評価した。ASD閉鎖術と標的治療の併用により全身の血流量(Qs)が有意に増加し、世界保健機関機能クラス(WHO-FC)が有意に改善された。標的治療を行わなかった群では、1名でASD閉鎖後に短期間、肺血管抵抗がさらに上昇し、2名ではASD閉鎖後長期にわたって肺血管抵抗が上昇した。これらの悪化は、標的治療後Qsの増加とWHO-FCの改善とともに全ての患者で解消した。標的療法はASD-PAHの成人患者において、ASD閉鎖術に追加する必要があると考えられた。

記述言語：英語   出版者・発行元：(一社)インターナショナルハートジャーナル刊行会  

最近、哺乳類ラパマイシン標的蛋白質阻害剤のエベロリムス(EVL)が心臓移植(HTx)レシピエントに対する新しい免疫抑制剤として導入され、従来のカルシニューリン阻害剤(CNI)と比べて腎機能を維持することが期待されている。EVLを用いた治療により腎機能の改善が予測されるベースメント時のパラメーターについて検討した。消化器症状や顆粒球減少症、進行性の冠動脈血管障害、腎機能不全持続のためミコフェノール酸モフェチルから変更され、EVLとCNIで治療されたHTxレシピエント27名のデータを後方視的に収集した。これらの患者を2008年8月～2013年1月の間1年以上追跡した。推算糸球体濾過量(eGFR)が5名で試験期間中に低下した。単変量ロジスティック回帰分析では、1年以上のEVL治療におけるeGFR低下の有意な予測因子は血漿好中球ゼラチナーゼ関連リポカリン(P-NGAL)濃度の上昇のみであった。ベースラインのP-NGALがカットオフ値の85ng/mL以上であった患者は、eGFRと蛋白尿がほぼ例外なく悪化した。

出版者・発行元：International Heart Journal  

Scheduled serial endomyocardial biopsies are executed by an internal jugular vein (IJV) or femoral vein (FV) approach to survey acute rejection after heart transplantation (HTx). However, a better approach site is needed. A total of 379 sessions consisting of 329 IJV approaches and 50 FV approaches in 48 HTx recipients executed at 75 ±127 days (4-1182 days) after HTx between September 2007 and April 2014 at University of Tokyo Hospital were retrospectively analyzed. The IJV approach had shorter operation and radiation exposure times, and a lower dose of radiation exposure and lower usage of contrast agents than the FV approach (all P < 0.001). There were no fatal complications requiring surgical management or resulting in death during all sessions. The IJV approach had less complications than the FV approach (2.7% versus 10.0%, P = 0.011). Among the complications, atrial tachyarrhythmia occurred only with the IJV approach (0.9%), whereas transient ventricular tachyarrhythmia and bundle branch block were more frequently observed in the FV approach (8.0% versus 0.9%, P = 0.042). In conclusion, endomyocardial biopsy from the IJV approach was safer and less invasive than that of the FV approach if we only consider the incidence of atrial tachyarrhythmia.

DOI： 10.1536/ihj.14-156

Scopus

出版者・発行元：International Heart Journal  

Background: Therapeutic strategies for pulmonary arterial hypertension (PAH) associated with atrial septal defect (ASD) remain a matter of debate. Methods and Results: We identifed 5 outpatients who had been diagnosed with ASD-PAH and undergone ASD closure in combination with targeted therapy with certifed PAH drugs. We assessed changes in hemodynamic parameters and exercise capacity. The combination of ASD closure and targeted therapy signifcantly increased systemic blood fow (Qs) from the baseline (from 3.3 ± 0.6 L/minute to 4.2 , 1.0 L/minute, P < 0.05) with a significant improvement in the World Health Organization Functional Class (WHO-FC; from 2.8 ± 0.4 to 1.6 ± 0.5, P < 0.05). The hemodynamic data before and after ASD closure without targeted therapy showed further elevation of pulmonary vascular resistance shortly after ASD closure (678 dynes/cm5 to 926 dynes/cm5) in 1 case, as well as after a long time since ASD closure (491.0 ± 53.7 dynes/cm5 to 1045.0 ± 217.8 dynes/cm5) in 2 cases. This worsening was reversed after the targeted therapy, accompanied by an increase in Qs and an improvement in WHO-FC in all cases. Conclusions: Targeted therapy should be added to ASD closure in adult patients with ASD-PAH.

DOI： 10.1536/ihj.14-183

Scopus

出版者・発行元：International Heart Journal  

Recently, the mammalian target of rapamycin inhibitor everolimus (EVL) has been introduced as a novel immuno-suppressant for heart transplant (HTx) recipients, and is expected to preserve renal function compared to conventional calcineurin inhibitors (CNIs). However, a considerable number of recipients treated with EVL were not free from worsening renal function regardless of CNI reduction. Data were collected retrospectively from 27 HTx recipients who had received EVL (trough concentration, 3.1-9.2 ng/mL) along with reduced CNIs (%decreases in trough concentration, 27.3 ±13.0%) because of switching from mycophenolate mophetil due to digestive symptoms or neutropenia, progressive coronary artery vasculopathy, or persistent renal dysfunction, and had been followed over 1 year between August 2008 and January 2013. Estimated glomerular fltration rate (eGFR) decreased in 5 recipients (18.5%) during the study period. Univariate logistic regression analysis demonstrated that a higher plasma neutrophil gelatinase-associated lipocalin (P-NGAL) level was the only signifcant predictor for a decrease in eGFR over a 1-year EVL treatment period among all baseline parameters (P = 0.008). eGFR and proteinuria worsened almost exclusively in patients with baseline P-NGAL = 85 ng/mL, which was the cutoff value calculated by an ROC analysis (area under the curve, 0.955; sensitivity, 1.000; specifcity, 0.955). In conclusion, higher P-NGAL may be a novel predictor for the worsening of renal function after EVL treatment that is resistant to CNI reduction in HTx recipients.

DOI： 10.1536/ihj.14-179

Scopus

出版者・発行元：Circulation Journal  

Background: Although cardiopulmonary exercise (CPX) testing is an established tool for predicting survival in patients with heart failure (HF), its prognostic impact on explantation of left ventricular assist device (LVAD) was unknown. Methods and Results: We enrolled 33 patients who had undergone implantation of extracorporeal pulsatile flow LVAD and symptom-limited CPX testing at 3 months after operation, and who were followed between 2005 and 2014. Patients who received conversion to continuous flow LVAD were excluded. On Cox regression analysis, E1 (maximum load ≥51W; HR, 27.55), E2 (minute ventilation/carbon dioxide output [VE/VCO2] slope ≤34; HR, 16.86), and E3 (peak oxygen consumption [PV˙O2] ≥12.8 ml . kg–1 . min–1; HR, 18.35) significantly predicted explantation expectancy during 2 years after LVAD implantation (P<0.05 for all). Explantation score, the sum of positive E1–3, significantly stratified 2-year cumulative explantation rate into low (0 points), intermediate (1–2 points), and high (3 points) expectancy groups (0%, 29%, and 86%, respectively, P<0.001). When the scoring system was used for 45 patients with continuous flow LVAD, the 2 patients who had explantation were assigned to the high expectancy group. Conclusions: Explantation score, calculated simply from 3 postoperative symptom-limited CPX testing parameters, is a novel tool to predict explantation expectancy of LVAD and to select good candidates for the weaning test.

DOI： 10.1253/circj.CJ-14-1058

Scopus

出版者・発行元：Circulation Journal  

Background: Predicting the occurrence of aortic insufficiency (AI) during left ventricular assist device (LVAD) support has remained unsolved.

DOI： 10.1253/circj.CJ-14-0944

Scopus

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

2006年6月から2013年12月の期間に持続血流左室補助装置(LVAD)を装置し6ヵ月以上追跡した患者52例を対象とした。左室収縮機能が改善した患者18例(35%)では生来の大動脈弁開放が視察され大動脈弁閉鎖不全症(AI)は1例もなかった。大動脈弁狭窄がある残りの34例(65%)の中の11例は大動脈起部拡大と脈圧減少を伴うAIがあった。AIがある患者では運動耐容能が低下しており、2年間LAVDを装置しAIがない患者と比較して運動耐容能が低く再入院率が高かった。

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1404200037

CiNii Research

出版者・発行元：Breathing and Circulation  

Scopus

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

心室補助装置がない施設から紹介された重症心不全患者46例(年齢39.8±13.4歳、男性40例)を対象とした研究を行った。その中の26例は、心室補助装置を早期に装着したか、あるいは、死亡した。入院時所見に基づく多変量ロジスティック解析によると、収縮期血圧<93mmHg、ヘモグロビン<12.7g/dl、血清コレステロール<144mg/dlは早期心室補助装置装着の有意予測因子であった。

出版者・発行元：Circulation Journal  

Background: Preserved function of the renal collecting duct may be essential for response to the vasopressin V2 receptor antagonist, tolvaptan (TLV), but the predictors of response to TLV are unknown.

DOI： 10.1253/circj.CJ-14-0244

Scopus

出版者・発行元：Circulation Journal  

Background: Depressed hemodynamics stimulates arginine vasopressin (AVP) release, but the relationship between plasma AVP levels (P-AVP) and cardiac parameters, especially in patients with stage D heart failure (HF) receiving guideline-directed medical therapy, has not examined.

DOI： 10.1253/circj.CJ-14-0368

Scopus

記述言語：英語   出版者・発行元：(一社)インターナショナルハートジャーナル刊行会  

術後早期の副交感神経再支配について調べるため、心臓移植(HTx)後1-24週の心拍変動(HRV)パラメータを連続的に分析した。術後急性の拒絶反応や心疾患の無かったレシピエント16名を対象とした。HRVは、HTx後1～24週目のMemCalcパワースペクトル密度法により算出した。high frequency(HF)はHTxの6ヵ月後に有意に増加した。HTxの6ヵ月後におけるHF高レベルと相関していたのは術中心肺バイパス時間の短さのみであった。HFレベルの高さはHTxの6ヵ月後における心拍数と心拍数の変化と関連していた。

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

トルバプタン(TLV)はバゾプレシンV2受容体拮抗薬で、利尿薬無効の心不全患者の治療に使用されているが、TLVに対する反応の予知因子は不明である。TLV開始前にTLVに対する反応を予測する標識を調べるため、新規にTLVを投与したD期代償不全性心不全患者連続60例を対象として後ろ向きに検討した。尿中アクアポリン-2対血漿中アルギニン-バゾプレシン比はTLVに対する反応性の新しい予知因子であった。

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

血行動態低下はアルギニン-バゾプレシン(AVP)放出を刺激するが、血漿AVP濃度(P-AVP)と心機能との関連は明らかでない。D期心不全で入院中の患者162例、人工心肺装着患者46例、心移植患者34例を対象として血漿AVP濃度を測定し、心機能との関係を検討した。その結果、心拍出量低下はAVP放出を刺激し、外科治療により心拍出量が回復するとAVP放出は抑制された。

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

東京大学病院評価委員会で心不全D期と評価され、日本臓器移植ネットワーク分類でstatus1または2として心移植適応とされた患者183例を対象とした。status2(n=38)の患者は強心薬点滴中の患者(n=54)または機械的循環支援患者(n=91)と同様に予後不良であり、院外突然死が多かった。cox回帰解析によると血漿B型Na利尿ペプチド(BNP)>740pg/mlがstatus2群患者の4年生存に対する唯一の予知因子であった。

出版者・発行元：Journal of Artificial Organs  

To date, there have been few reports demonstrating preoperative predictors for left ventricular reverse remodeling (LVRR) after LV assist device (LVAD) implantation, especially among patients with dilated cardiomyopathy (DCM). We retrospectively analyzed 60 patients with stage D heart failure due to DCM who had received LVAD treatment [pulsatile flow (PF) type, 26; continuous flow type, 34]. Data were evaluated at 6 months or just before explantation of the LVAD. We defined "LV reverse remodeling" (LVRR) by the achievement of an LV ejection fraction (LVEF) of ≥35% after 6 months of LVAD support or explantation of LVAD within 6 months. LVRR occurred in 16 of our patients (26.7 %). Uni/multivariate logistic regression analyses for LVRR demonstrated that of the preoperative variables evaluated, PF LVAD usage and insufficient preoperative β-blocker treatment were independent predictors for LVRR. Patients who accomplished LVRR had a better clinical course, including lower levels of aortic valve insufficiency and lower levels of plasma B-type natriuretic peptide. Of the six patients (10.0 %) in whom LVADs were eventually explanted, all had an LVEF of ≥35 % before explantation or at 6 months. Based on these results, we conclude that DCM patients with insufficient preoperative β-blocker treatment have a chance to achieve LVRR under LVAD support as a bridge to recovery. © 2013 The Japanese Society for Artificial Organs.

DOI： 10.1007/s10047-013-0748-7

Scopus

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

拡張型心筋症(DCM)によるステージD心不全患者のうち、左心補助装置(LVAD)を埋込まれた60例(拍動流型26例、連続流型34例)を後方視的に解析し、左室逆リモデリング(LVRR)の予測因子について検討した。LVRRは、LVAD補助6ヵ月後または6ヵ月以内のLVAD体外装着で左室駆出率(LVEF)が35%以上を達成できた場合と定義した。LVRRは16例で見られた。単変量解析の結果、術前変数によるLVRRの予測因子は、拍動流型左室補助装置の利用、β遮断薬の低い用量設定、心不全による入院歴無であり、術前のβ遮断薬治療の累積用量も重要なLVRRのパラメータであった。多変量解析では、拍動流型左室補助装置の利用、不十分なβ遮断薬治療の累積用量がLVRR達成の独立予測因子であった。LVRRを達成した患者の臨床経過は良好であり、大動脈弁不全が低く、血漿中B型ナトリウム利尿ペプチドレベルも低かった。LVADを体外装着した6例についても、6ヵ月時点までにLVEF35%以上を達成した。以上から、不十分な術前β遮断薬治療を受けたDCM患者でも、心機能回復までのブリッジとしてのLVAD補助下でLVRRを達成できることが示唆された。

記述言語：英語   出版者・発行元：(一社)インターナショナルハートジャーナル刊行会  

3年前に心臓移植(HTx)を受けた拡張型心筋症の49歳男性に低分子量デキストランを注入し、光コヒーレンストモグラフィー(OCT)を行った。術後2年間疾患は認めていなかった。OCTにより、二重の内膜層が明らかになり、多分ドナーから伝播された動脈硬化層と同種移植片血管障害に起因した内側の内膜増殖から成っていた。これは血管内超音波や仮想組織学的分析では区別できなかった。

記述言語：英語   出版者・発行元：(一社)日本循環器学会  

持続血流左室補助装置(LVAD)は生存率が良好のため拍動性LAVDに代わって使用されているが、晩期発症右心不全が問題になっている。本報告は持続血流LVADを植え込んだ患者連続38例と拍動性LVADを植え込んだ患者22例の3ヵ月後の血行動態を心エコー検査により解析した後向き研究である。その結果、術前に左室径が小さい患者では持続血流LVAD植え込みにより心室中隔が左方に移動するために晩期右室不全が発症した。

記述言語：日本語   出版者・発行元：公益財団法人 日本心臓財団  

DOI： 10.11281/shinzo.46.992

CiNii Research

出版者・発行元：Circulation Journal  

Background: Indication for mechanical circulatory support (MCS) has been a matter of debate in less sick status 2 patients. Methods and Results: Data were obtained from 183 consecutive patients assigned to stage D heart failure (HF) who were evaluated by the institutional review board of the University of Tokyo Hospital and then listed for heart transplantation as status 1 or 2 of the Japan Organ Transplant Network. Patients with status 2 (n=38) had a prognosis as poor as those dependent on inotropes (n=54) or MCS (n=91; P=0.615, log-rank test), and only 4 of them had eventual ventricular assist device (VAD) implantation (10.5%). Patients who eventually received VAD (n=92) had better 4-year survival than those without MCS among status 1 and 2 (P=0.030, log-rank test). On Cox regression analysis plasma B-type natriuretic peptide (BNP) >740 pg/ml was the only significant predictor for 4-year survival among the status 2 group (P=0.014; hazard ratio, 8.267). Ten patients with status 2 died: 6 due to acute hemodynamic compromise and 4 due to ventricular fibrillation. Conclusions: Prognosis in status 2 patients was as poor as that of those dependent on inotrope infusion or VAD, mostly because of out-of-hospital sudden death without MCS. Status 2 patients with considerably high plasma BNP may be good candidates for continuous flow VAD therapy.

DOI： 10.1253/circj.CJ-14-0077

Scopus

出版者・発行元：International Heart Journal  

Although cross-sectional late-phase reinnervation in heart transplantation (HTx) recipients has been demonstrated by several earlier studies, early-phase successive analyses especially for parasympathetic reinnervation remain unknown. Successive heart rate variability (HRV) data calculated by the MemCalc power spectral density method were obtained from 16 non-rejection recipients 1-24 weeks after HTx. High frequency (HF) level representing parasympathetic magnitude increased significantly at 6 months after HTx (from 0.9 ± 0.7 to 4.1 ± 2.8 ms2*). Only intraoperative shorter cardiopulmonary bypass time (181 ± 59 minutes) correlated with a higher level of HF at post-HTx 6 months among all baseline variables (r = -0.530*). Higher level of HF was associated with recovery of tachycardia at post-HTx 6 months (r = -0.514*). In conclusion, parasympathetic reinnervation emerges along with recovery of tachycardia < 6 months after HTx, which is accelerated by shorter intraoperative cardiopulmonary bypass time (*P < 0.05 for all).

DOI： 10.1536/ihj.14-111

Scopus

出版者・発行元：Circulation Journal  

Background: The timing of ventricular assist device (VAD) implantation is always a matter of debate, especially when a patient is referred from a non-VAD institute. We focused on objective noninvasive parameters at the time of admission to a VAD implant center and analyzed the factors predicting the necessity of early VAD.

DOI： 10.1253/circj.CJ-14-0749

Scopus

出版者・発行元：Circulation Journal  

Background: The continuous flow (CF) left ventricular assist device (LVAD) has replaced the pulsatile flow (PF) LVAD because of its advantages of better patient survival and higher quality of life. However, "late-onset right ventricular failure (RVF)" after CF LVAD implantation has emerged as an increasing concern, but little is known about the mechanism. Methods and Results: We retrospectively analyzed the 3-month hemodynamic and echocardiographic data from 38 consecutive patients who had received CF LVADs, and from 22 patients who had received PF LVADs. Late-onset RVF was defined as persistent right ventricular stroke work index (RVSWI) <4.0 g/m2 at any rotation speed and after saline infusion test at 5 weeks after implantation of CF LVAD. Patients with late-onset RVF had significantly impaired exercise tolerance indicated by shorter 6-min walking distance and lower peak V ̇O2, and worsened tricuspid regurgitation, together with enlargement of the RV under CF LVAD treatment (all P<0.05). Univariable analyses demonstrated that preoperative smaller LV diastolic diameter (LVDd) was the risk factor for late-onset RVF with a cutoff value of 64 mm calculated by ROC analysis (area under curve, 0.925). In contrast, there was no correlation between preoperative LVDd and postoperative RVSWI in the PF LVAD group, though their preoperative background was worse than that of the CF group. Conclusions: In the setting of preoperative small LVDd, CF LVAD may cause late-onset RVF by leftward shift of the interventricular septum.

DOI： 10.1253/circj.CJ-13-1201

Scopus

出版者・発行元：International Heart Journal  

Although survival after heart transplantation (HTx) has improved in recent years, cardiac allograft vasculopathy (CAV) is still the leading cause of remote morbidity and mortality in HTx recipients, partly because of diffi culty with its diagnosis. In general, routine surveillance for CAV is advocated with coronary angiography accompanied by intravascular ultrasound (IVUS) if necessary. However, these modalities have limitations with respect to low spatial resolution, and suffi cient qualitative/quantitative assessment of coronary intima has not been accomplished. Recently, optical coherence tomography (OCT) has emerged as a novel intracoronary imaging technique using an optical analogue of ultrasound with a spatial resolution of 10-20 μm, which is 10 times greater than IVUS. We here experienced a 49-year-old male who received a HTx 3 years ago, and OCT was executed during low molecular weight dextran injection. OCT demonstrated distinct double intimal layers probably consisting of a donor-transmitted atherosclerotic layer and an inner intimal proliferation due to CAV, which was indistinguishable by IVUS and virtual histological analyses. We believe that OCT imaging is not only a new loadstar during treatment of CAV but also a new generation modality for screening for early CAV in HTx recipients.

DOI： 10.1536/ihj.13-279

Scopus

記述言語：英語   出版者・発行元：Journal of Molecular and Cellular Cardiology  

The heart has remarkable capacity to adapt to mechanical load and to dramatically change its phenotype. The mechanism underlying such diverse phenotypic adaptations remains unknown. Since systolic overload induces wall thickening, while diastolic overload induces chamber enlargement, we hypothesized that cardiac phase-sensitive mechanisms govern the adaptation. We inserted a balloon into the left ventricle (LV) of a Langendorff perfused rat heart, and controlled LV volume (LVV) using a high performance servo-pump. We created isolated phasic systolic overload (SO) by isovolumic contraction (peak LV pressure >170mmHg) at unstressed diastolic LVV [end-diastolic pressure (EDP)=0mmHg]. We also created pure phasic diastolic overload (DO) by increasing diastolic LVV until EDP >40mmHg and unloading completely in systole. After 3hours under each condition, the myocardium was analyzed using DNA microarray. Gene expressions under SO and DO conditions were compared against unloaded control condition using gene ontology and pathway analysis (n=4 each). SO upregulated proliferation-related genes, whereas DO upregulated fibrosis-related genes (P<10-5). Both SO and DO upregulated genes related functionally to cardiac hypertrophy, although the gene profiles were totally different. Upstream regulators confirmed by Western blot indicated that SO activated extracellular signal-regulated kinase 1/2, c-Jun NH2-terminal kinase, and Ca2+/calmodulin-dependent protein kinase II (3.2-, 2.0-, and 4.7-fold versus control, P<0.05, n=5), whereas DO activated p38 (2.9-fold, P<0.01), which was consistent with the downstream gene expressions. In conclusion, pure isolated systolic and diastolic overload permits elucidation of cardiac phase-sensitive gene regulation. The genomic responses indicate that mechanisms governing the cardiac phase-sensitive adaptations are different. © 2013 Elsevier Ltd.

DOI： 10.1016/j.yjmcc.2013.08.008

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：PLoS ONE  

Myocardial mitochondrial DNA (mtDNA) copy number decreases in heart failure. In post-myocardial infarction mice, increasing mtDNA copy number by overexpressing mitochondrial transcription factor attenuates mtDNA deficiency and ameliorates pathological remodeling thereby markedly improving survival. However, the functional significance of increased mtDNA copy number in hypertensive heart disease remains unknown. We addressed this question using transgenic mice that overexpress Twinkle helicase (Twinkle; Tg), the mtDNA helicase, and examined whether Twinkle overexpression protects the heart from left ventricular (LV) remodeling and failure after pressure overload created by transverse aortic constriction (TAC). Twinkle overexpression increased mtDNA copy number by 2.2±0.1-fold. Heart weight, LV diastolic volume and wall thickness were comparable between Tg and wild type littermates (WT) at 28 days after TAC operation. LV end-diastolic pressure increased in WT after TAC (8.6±2.8 mmHg), and this increase was attenuated in Tg (4.6±2.6 mmHg). Impaired LV fractional shortening after TAC operation was also suppressed in Tg, as measured by echocardiography (WT: 16.2±7.2% vs Tg: 20.7±6.2%). These LV functional improvements were accompanied by a decrease in interstitial fibrosis (WT: 10.6±1.1% vs Tg: 3.0±0.6%). In in vitro studies, overexpressing Twinkle using an adenovirus vector in cultured cardiac fibroblasts significantly suppressed mRNA of collagen 1a, collagen 3a and connective tissue growth factor, and angiotensin II-induced transforming growth factor β1 expression. The findings suggest that Twinkle overexpression prevents LV function deterioration. In conclusion, Twinkle overexpression increases mtDNA copy number and ameliorates the progression of LV fibrosis and heart failure in a mouse pressure overload model. Increasing mtDNA copy number by Twinkle overexpression could be a novel therapeutic strategy for hypertensive heart disease. © 2013 Tanaka et al.

DOI： 10.1371/journal.pone.0067642

Web of Science

Scopus

PubMed

Web of Science

Web of Science

Web of Science

Web of Science

Web of Science

DOI： 10.1016/j.cardfail.2012.08.242

Web of Science

記述言語：英語   出版者・発行元：Circulation  

Background-Impairment of the arterial baroreflex causes orthostatic hypotension. Arterial baroreceptor sensitivity degrades with age. Thus, an impaired baroreceptor plays a pivotal role in orthostatic hypotension in most elderly patients. There is no effective treatment for orthostatic hypotension. The aims of this investigation were to develop a bionic baroreceptor (BBR) and to verify whether it corrects postural hypotension. Methods and Results-The BBR consists of a pressure sensor, a regulator, and a neurostimulator. In 35 Sprague-Dawley rats, we vascularly and neurally isolated the baroreceptor regions and attached electrodes to the aortic depressor nerve for stimulation. To mimic impaired baroreceptors, we maintained intracarotid sinus pressure at 60 mm Hg during activation of the BBR. Native baroreflex was reproduced by matching intracarotid sinus pressure to the instantaneous pulsatile aortic pressure. The encoding rule for translating intracarotid sinus pressure into stimulation of the aortic depressor nerve was identified by a white noise technique and applied to the regulator. The open-loop arterial pressure response to intracarotid sinus pressure (n=7) and upright tilt-induced changes in arterial pressure (n=7) were compared between native baroreceptor and BBR conditions. The intracarotid sinus pressure-arterial pressure relationships were comparable. Compared with the absence of baroreflex, the BBR corrected tilt-induced hypotension as effectively as under native baroreceptor conditions (native,-39±5 mm Hg; BBR,-41±5 mm Hg; absence,-63±5 mm Hg; P<0.05). Conclusions-The BBR restores the pressure buffering function. Although this research demonstrated feasibility of the BBR, further research is needed to verify its long-term effect and safety in larger animal models and humans. © 2012 American Heart Association, Inc.

DOI： 10.1161/CIRCULATIONAHA.112.108357

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Mitochondrion  

The overexpression of mitochondrial transcription factor A (TFAM) attenuates the decrease in mtDNA copy number after myocardial infarction, ameliorates pathological hypertrophy, and markedly improves survival. However, non-transgenic strategy to increase mtDNA for the treatment of pathological hypertrophy remains unknown. We produced recombinant human TFAM protein (rhTFAM). rhTFAM rapidly entered into mitochondria of cultured cardiac myocytes. rhTFAM increased mtDNA and abolished the activation of nuclear factor of activated T cells (NFAT), which is well known to activate pathological hypertrophy. rhTFAM attenuated subsequent morphological hypertrophy of myocytes as well. rhTFAM would be an attractive molecule in attenuating cardiac pathological hypertrophy. © 2012 Elsevier B.V. and Mitochondria Research Society.

DOI： 10.1016/j.mito.2012.06.002

Web of Science

Scopus

PubMed

Web of Science

Web of Science

Web of Science

Web of Science

Web of Science

DOI： 10.1016/j.cardfail.2011.06.636

Web of Science

Web of Science

Web of Science

Web of Science

Web of Science

記述言語：英語   出版者・発行元：(一社)日本内科学会  

心臓同種移植を受け、術後2ヵ月から持続的な背部痛が出現した18歳女性症例について検討した。腹部CTでは、移植前には見られなかった、複数の造影病変を肝臓内に認めた。腫瘍の1つは肝臓の表面から突出し、胃を圧迫していた。肝臓の部分切除を行い、症状は改善された。病理学的診断は、限局性結節性過形成(FNH)であった。

記述言語：英語   出版者・発行元：一般社団法人 日本内科学会  

An 18-year-old woman, who had undergone cardiac allograft transplantation, developed continuous back pain two months after surgery. Abdominal computed tomography showed multiple enhanced lesions in her liver, which were not present before transplantation. One tumor bulged from the surface of the liver and compressed the stomach. Partial resection of the liver was performed and her symptoms improved. The pathological diagnosis was focal nodular hyperplasia (FNH). To our knowledge, this is the first report of multiple FNH after heart transplantation. Transplant clinicians may need to keep this possibility under consideration following heart transplantation. © 2011 The Japanese Society of Internal Medicine.

DOI： 10.2169/internalmedicine.50.4282

Web of Science

Scopus

PubMed

CiNii Research

Web of Science

PubMed

Web of Science

PubMed

記述言語：日本語   出版者・発行元：(公財)日本心臓財団  

症例は72歳、女性。陳旧性広範前壁心筋梗塞に伴う重症心不全に対してDor手術、Maze手術、僧帽弁置換術、三尖弁縫縮術を施行後であった。心房頻拍を契機に心不全が増悪して入院し、ビソプロロールとアミオダロンにより心拍数コントロールおよび心不全改善に成功していったんは退院した。しかし退院後に再び心不全が増悪し、心室頻拍の出現を認め緊急入院となった。入院後、薬物による心房頻拍のコントロールが困難となり、心不全に対する集中治療を必要とした。心不全改善後、上室性頻拍に対して高周波カテーテルアブレーションを行った。三次元マッピングシステムにより心房粗動および複数の心房頻拍を確認し、それらに対してアブレーションを施行して上室性頻拍の抑制に成功した。その後、両心室ペーシング機能付き植込み型除細動器を植え込み、薬物療法とあわせて集学的治療によって上室性不整脈および心室頻拍のコントロールが可能となった。(著者抄録)

出版者・発行元：Journal of Cardiology  

A 26-year-old pregnant woman who was an intravenous drug user (IDU) was admitted to our hospital for the treatment of tricuspid valve infective endocarditis (IE) and lung abscesses due to methicillin-resistant Staphylococcus aureus (MRSA). We started to treat her with vancomycin (VCM) alone and then in combination with rifampicin (RFP), but her condition did not improve. Then we added sulfamethoxazole/trimethoprim (SMZ/TMP) to VCM and RFP. After that, she improved rapidly. In Japan, there are very few reports about tricuspid valve IE caused by MRSA in IDUs. This case suggests that the combination of VCM, RFP, and SMZ/TMP may be effective for the treatment of severe MRSA infections. © 2008 Japanese College of Cardiology.

DOI： 10.1016/j.jjcc.2008.06.007

Scopus

記述言語：英語   出版者・発行元：(一社)日本心臓病学会  

静脈内投与者(IDU)の、methicillin耐性Staphylococcus aureus(MRSA)による三尖弁感染性心内膜炎(IE)と肺膿瘍の治療を行う26歳妊婦について検討した。Vancomycin(VCM)単独で治療を開始した後、rifampicin(RFP)を併用したが、状態は改善しなかった。その後、VCMとRFPにsulfamethoxazole/trimethoprim(SMZ/TMP)を加えたところ、迅速な改善がみられた。VCM、RFP、SMZ/TMP併用が重度MRSA感染症の治療に有効であることを示していた。

記述言語：日本語   出版者・発行元：公益財団法人 日本心臓財団  

症例は72歳，女性．陳旧性広範前壁心筋梗塞に伴う重症心不全に対してDor手術，Maze手術，僧帽弁置換術，三尖弁縫縮術を施行後であった．心房頻拍を契機に心不全が増悪して入院し，ビソプロロールとアミオダロンにより心拍数コントロールおよび心不全改善に成功していったんは退院した．しかし退院後に再び心不全が増悪し，心室頻拍の出現を認め緊急入院となった．入院後，薬物による心房頻拍のコントロールが困難となり，心不全に対する集中治療を必要とした．心不全改善後，上室性頻拍に対して高周波カテーテルアブレーションを行った．三次元マッピングシステムにより心房粗動および複数の心房頻拍を確認し，それらに対してアブレーションを施行して上室性頻拍の抑制に成功した．その後，両心室ペーシング機能付き植込み型除細動器を植え込み，薬物療法とあわせて集学的治療によって上室性不整脈および心室頻拍のコントロールが可能となった．

DOI： 10.11281/shinzo.41.1382

CiNii Research

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：英語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語  

記述言語：日本語