Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1002/deo2.369.

Language：English   Publisher：(一社)日本循環器学会  

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1253/circj.CJ-23-0698.

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Language：English   Publisher：John Wiley & Sons Australia, Ltd  

Language：English   Publisher：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

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Circulation Society  

<p>The 87^thAnnual 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.</p>

DOI： 10.1253/circj.cj-24-0127

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AIM: 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: 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:1) to estimate the AT probability using breath-by-breath data, and 2) to predict peak VO2 using the data at the real-time AT. RESULTS: The eligible CPET were 1,472 records in 1,053 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 the patient's condition in real-time, expanding CPET utility.

DOI： 10.1093/eurjpc/zwad375

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Language：English   Publisher：International Heart Journal Association  

<p>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.</p><p>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 (<i>P</i> = 0.191). When analyzed only with patients receiving immunosuppressive therapy (sCS, <i>n</i> = 36; iCS, <i>n</i> = 21), the cardiac event-free survival was significantly lower in iCS than sCS (37% versus 79%, <i>P</i> = 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.</p><p>iCS showed a poorer response to immunosuppressive therapy and a worse cardiac prognosis compared to sCS despite lower baseline disease activity.</p>

DOI： 10.1536/ihj.24-166

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Publisher：南江堂  

DOI： 10.15106/j_naika132_359

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Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.1093/eurjpc/zwad375.

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DOI： 10.1093/eurheartj/ehad008

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DOI： 10.1161/CIRCHEARTFAILURE.122.010320.

Language：English   Publishing type：Research paper (scientific journal)  

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

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Language：English   Publisher：(一社)日本循環器学会  

日本における拡張型心筋症(DCM)の臨床的特徴と治療の時間的傾向について検討した。厚生労働省の全国的Clinical Personal Recordデータベースから、2003～2013年に左室駆出率(LVEF)50%未満で18歳以上のDCM患者に関する人口統計学、心エコー検査、治療等のデータを収集し、患者群を2003～2005年群10006例(男性7529例、女性2477例、診断時平均53.3±13.2歳)、2006～2010年群11252例(男性8432例、女性2820例、診断時平均53.6±13.9歳)、2011～2013年群6444例(男性4893例、女性1551例、診断時平均53.9±14.02歳)に分割して診療ガイドライン発行前後の治療全体像を調査した。時間経過と伴に登録時年齢若年化、LVEF減少、ニューヨーク心臓協会クラスIII-IV患者の増加が見られた。またβ遮断薬とミネラルコルチコイド受容体拮抗薬(MRA)の使用は時間経過とともに増加した。多変量解析では、男性の性別、収縮期血圧、慢性腎臓病、ヘモグロビン、登録年はβ遮断薬処方と正の相関、年齢とLVEFは負の相関が見られた。対象期間におけるDCMの臨床的特徴は変化したが、β遮断薬やMRA処方等のDCMに最適な薬物療法が増加した。

Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b> Little is known about nationwide temporal trends in the clinical characteristics and treatment of dilated cardiomyopathy (DCM) in Japan.</p><p><b><i>Methods and Results:</i></b> We collected data regarding demographics, echocardiography, and treatment of DCM between 2003 to 2013 from Clinical Personal Records, a national registry organized by the Japanese Ministry of Health, Labour, and Welfare. Among the 40,794 DCM patients screened, 27,702 with left ventricular ejection fraction (LVEF) <50% and age ≥18 years were enrolled in this study and divided into 3 groups according to registration year: Group 1, 2003–2005 (10,006 patients); Group 2, 2006–2010 (11,252 patients); and Group 3, 2011–2013 (6,444 patients). Over time, there were decreases in age at registration (mean [±SD] 58.6±13.0 vs. 56.8±13.8 vs. 56.2±13.8 years; P<0.001) and LVEF (33.5±10.0% vs. 31.1±9.9% vs. 29.2± 9.7%; P<0.001), and an increase in patients with New York Heart Association Class III–IV (28.2% vs. 35.2% vs. 41.0%; P<0.001). The use of β-blockers (59.1% vs. 79.3% vs. 87.8%; P<0.001) and mineralocorticoid receptor antagonists (30.6% vs. 35.8% vs. 39.7%; P<0.001) increased over time. In multivariate analysis, male sex, systolic blood pressure, chronic kidney disease, hemoglobin, and registration year were positively associated, whereas age and LVEF were negatively associated, with β-blocker prescription.</p><p><b><i>Conclusions:</i></b> Although the clinical characteristics of DCM changed, the implementation of optimal medical therapy for DCM increased from 2003 to 2013 in Japan.</p>

DOI： 10.1253/circj.CJ-22-0554

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DOI： 10.1016/j.cjco.2022.11.009

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Language：Japanese   Publisher：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

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Language：Japanese   Publisher：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

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Publisher：(株)南山堂  

DOI： 10.15104/j01461.2023043052

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Language：English   Publishing type：Research paper (scientific 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

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Japanese Circulation Society  

DOI： 10.1253/circj.CJ-21-0880

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DOI： doi: 10.1097/MAT.0000000000001672.

Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY PERIODICALS, INC  

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

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY PERIODICALS, INC  

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 (R) 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

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Language：Japanese   Publisher：公益社団法人 日本理学療法士協会 九州ブロック会  

<p>【はじめに】</p><p>本邦における心臓移植術の10 年生存率は約90％とされ、欧米諸国と比較しても良好な成績である。心臓移植は生命予後のみならず運動耐容能や身体機能の改善をもたらすが、拒絶反応といった移植特有の合併症があり、時には致死的合併症となり、集中治療が必要となる。近年、集中治療領域において急性の左右対称性の四肢筋力低下を呈するICU-AW（ICU-acquired weakness）が注目されている。今回、心臓移植後4 年以上経過し、拒絶反応治療中に心停止に至った後、救命されたが、ICU-AW を合併した症例を経験したため報告する。</p><p>【症例提示】</p><p>症例は60 代男性。X-14 年に拡張相肥大型心筋症と診断、X-9 年に植込型左室補助人工心臓装着術、X-5 年に心臓移植術を施行し、その後の経過は良好で就業していた。Ｘ年に拒絶反応と診断され入院し、ステロイドパルス療法施行後、ステロイド内服を継続していた。退院前日の朝から洞性徐脈を認め、意識消失し心肺蘇生開始。蘇生処置を行うも自己心拍再開せず、挿管・人工呼吸器管理、機械的補助循環装置、持続的血液濾過透析、体外式ペースメーカーを挿入。同日ステロイドパルス療法と免疫抑制剤、強心薬投与し加療となった。蘇生後4 病日に機械的補助循環装置離脱、7 病日に抜管・人工呼吸器離脱し、8 病日にリハビリテーション開始した。</p><p>【経過】</p><p>開始時GCS E4V5M6、血圧92/82mmHg（ドブタミン0.5 γ投与）、脈拍112bpm（整）、SpO₂99％（O₂3L/min）と循環動態は安定していたが、MRC(Medical Research Council)score 23 点、FSS-ICU（functional status score for the ICU）0点と8日間という短期間の安静臥床期間にも関わらず、著明な筋力低下を認め、基本動作は全介助レベルであった。介入当初、ベッド上の四肢自動運動で強い疲労感が出現したため、自動から抵抗運動を中心とした介入より開始し、端坐位や車いす座位時間の延長を図りながら、疲労感に応じて起立練習を行ったが、起立は3 名の介助者を要す状況であった。30 病日に持続的血液濾過透析離脱、31 病日に強心薬離脱し、一般病棟へ転棟した。34 病日より2 名介助での歩行器歩行練習を開始した。この頃から下肢筋群の運動に加えて起立、歩行練習中心の介入へ段階的に移行した。36 病日に植込型除細動器移植術を施行し、44 病日から1 日2 回の介入をレジスタンストレーニングと歩行練習に分けて実施した。リスク管理は、除神経心によって心拍応答が遅いため、Borg scale を確認し運動負荷を調整した。53 病日には固定式歩行器を使用しトイレ歩行見守りとなり、67 病日にトイレ動作自立、固定式歩行器を導入し70 病日で自宅退院となった。退院時の体重は入院時から11.6kg 減少したものの、23 病日から退院前の身体機能はMRCscore 34 →48 点、FSS-ICU 5 →28 点、最大握力14.3 →21.4kg、最大膝伸展筋力0.064 →0.15kgf/kg、SPPB 0 →5点、FIM 34 →105 点、BI 5 →70 点と著明に改善した。</p><p>【考察】</p><p>本症例は心停止蘇生後にICU-AW を合併した症例である。ICU-AW の原因として多数の因子が想定されているが、本症例においては安静臥床や呼吸器、補助循環装置等の集中治療に加え、ステロイド治療によるステロイドミオパチー、免疫抑制剤の使用が考えられる。ICU-AW への明確な介入方法は確立されていないが、運動療法を中心とした介入が推奨されており、症例の状態に応じて運動療法を段階的に変更したことによりADL が拡大し、自宅退院に至ったと考える。しかし、退院時の身体機能は入院前に比して顕著に低下しており、ICU-AW の改善には長期間を要すとされることからも、今後も継続的なリハビリテーションが必要と考えられる。</p><p>【倫理的配慮、説明と同意】</p><p>対象者に口頭及び書面にて症例報告の目的を十分に説明し同意の署名を得た。</p>

DOI： 10.32298/kyushupt.2022.0_124

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DOI： 10.1536/ihj.21-226

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DOI： 10.1016/j.cjco.2020.11.009

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DOI： 10.1093/ehjcr/ytab065

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DOI： 10.1536/ihj.20-586.

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DOI： 10.1016/j.cjco.2021.03.004

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DOI： 10.1002/ehf2.13135

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DOI： 10.1016/j.cjca.2020.07.239

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DOI： 10.1093/ehjcr/ytaa406.

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DOI： 10.1016/j.hrthm.2019.06.019

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DOI： 10.1161/CIRCULATIONAHA.117.030490

Language：Others   Publishing type：Research paper (scientific journal)  

DOI： 10.1080/ac.71.5.3167505

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DOI： 10.1073/pnas.1507821112

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DOI： 10.1161/JAHA.116.003208

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DOI： 10.1161/CIRCULATIONAHA.114.009337

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DOI： 10.1016/j.vph.2014.03.006

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DOI： 10.1161/CIRCULATIONAHA.113.001742

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DOI： 10.1042/CS20110633

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DOI： 10.1016/j.regpep.2012.04.005

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DOI： 10.1530/JOE-12-0014

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Inhibition of MDM2 attenuates neointimal hyperplasia via suppression of vascular proliferation and inflammation

DOI： 10.1093/cvr/cvr108

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DOI： 10.1161/HYPERTENSIONAHA.110.167106

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Acetylcholinesterase inhibitors attenuate atherogenesis in apolipoprotein E-knockout mice

DOI： 10.1016/j.atherosclerosis.2010.07.027

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DOI： 10.1161/ATVBAHA.109.196071

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Improvement of neovascularization capacity of bone marrow mononuclear cells from diabetic mice by ex vivo pretreatment with resveratrol

DOI： 10.1038/hr.2009.67

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Resveratrol attenuates angiotensin II-induced interleukin-6 expression and perivascular fibrosis

DOI： 10.1038/hr.2009.47

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DOI： 10.1161/ATVBAHA.108.166991

Event date： 2019.10

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Venue：広島   Country：Japan  

Event date： 2019.10

Language：Japanese   Presentation type：Symposium, workshop panel (public)  

Venue：広島   Country：Japan  

Event date： 2018.11

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Country：Japan  

Event date： 2018.3

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Venue：大阪   Country：Japan  

Event date： 2009.11

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Country：United States  

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