Language：English   Publisher：PACE - Pacing and Clinical Electrophysiology  

Background: Precise mapping of the Purkinje fiber network is essential in catheter ablation of Purkinje-related ventricular arrhythmias (PrVAs). We sought to evaluate the mapping ability of a multi-spline duodecapolar catheter (PentaRay) for PrVAs. Methods: Mappings of Purkinje fibers by PentaRay catheters were compared with those by conventional mapping catheters in consecutive patients undergoing catheter ablation of PrVAs from 2015 to 2022. Results: Sixteen PrVAs (7 premature ventricular contractions or non-reentrant fascicular tachycardias [PVCs/NRFTs] and 9 fascicular ventricular tachycardias [FVTs]) were retrospectively studied. In PVCs/NRFTs, earliest preceding Purkinje potentials (PPs) could be recorded by the PentaRay catheters but not by the mapping and ablation catheters in 5 cases. At the earliest PP sites, the precedence from the QRS onset was greater, and the amplitude of the preceding potentials was higher in the PentaRay catheter compared with those in the mapping and ablation catheter (−62.0 ± 42.8 vs. −29.4 ± 34.2 ms, P = 0.02; 0.45 ± 0.43 vs. 0.09 ± 0.08 mV, P = 0.02). In FVTs, late diastolic potentials (P1) were recorded by the PentaRay catheters but not by the mapping and ablation catheters or the linear duodecapolar catheter in 2 cases. The amplitude of P1 was higher in the PentaRay catheter compared with that in the linear duodecapolar catheter and the mapping and ablation catheters (0.72 ± 0.49 vs. 0.17 ± 0.18 vs. 0.27 ± 0.21 mV, P = 0.0006, P = 0.002). The localized critical PPs, defined as the earliest preceding potentials in PVCs/NRFTs and P1 in FVTs, could be recorded in all the patients by the PentaRay catheter. The mapping ability of critical PPs of PrVAs was better with the PentaRay catheter than with the conventional mapping catheters (16/16 vs. 9/16, P = 0.004 by McNemar exact test). Conclusions: The PentaRay catheter has clinical advantages in mapping of the Purkinje fiber network to reveal critical PPs as ablation targets of PrVAs.

DOI： 10.1111/pace.14906

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

DOI： https://doi.org/10.1016/j.jccase.2023.12.002

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DOI： 10.1016/j.hrcr.2023.10.023.

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DOI： 10.1016/j.jacep.2023.05.038

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Language：English   Publisher：(一社)日本動脈硬化学会  

冠動脈ステント留置術を受けた冠動脈疾患の患者をスタチン(S)またはSとエゼチミブの併用(S+E)で治療するCuVIC試験から、治療前と6～8ヵ月追跡調査後の非責任病変の血管内超音波(IVUS)画像が得られた79症例(S群39名、S+E群40名)を抽出し解析した。治療期間後のS+E群のLDL-コレステロール(LDL-C)値はS群と比べて有意に低かった。S+E群ではコレステロール吸収のマーカーであるcampesterol、オキシステロール(β-epoxycholesterol、4β-hydroxycholesterol、27-hydroxycholesterol)も低かった。IVUS解析でS+E群のプラーク退縮率はS群と比べて大きかった。campesterolおよび27-hydroxycholesterolの低下はプラーク退縮と正相関し、LDL-Cの低下は相関しなかった。

Language：English   Publisher：Nutrients  

Oxysterols have been implicated in the pathogenesis of cardiovascular diseases. Serum levels of oxysterols could be positively correlated with cholesterol absorption and synthesis. However, physiological regulation of various serum oxysterols is largely unknown. The aim of this study was to investigate the relationship between clinical factors and cholesterol metabolism markers, and identify oxysterols associated with cholesterol absorption and synthesis in patients with coronary artery disease. Subjects (n = 207) who underwent coronary stenting between 2011 and 2013 were studied cross-sectionally. We measured lipid profiles including serum oxysterols. As for the serum biomarkers of cholesterol synthesis and absorption, oxysterol levels were positively correlated with campesterol and lathosterol. Covariance structure analysis revealed that dyslipidemia and statin usage had a positive correlation with “cholesterol absorption”. Statin usage also had a positive correlation with “cholesterol synthesis”. Several oxysterols associated with cholesterol absorption and/or synthesis. In conclusion, we elucidated the potential clinical factors that may affect cholesterol metabolism, and the associations between various oxysterols with cholesterol absorption and/or synthesis in patients with coronary artery disease.

DOI： 10.3390/nu15132997

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

DOI： 10.3390/nu15132997.

Language：Japanese   Publisher：一般社団法人 日本超音波検査学会  

DOI： 10.11272/jssabst.48.0_s127

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Atherosclerosis Society  

<p> <b>Aim:</b> Several clinical trials using intravascular ultrasound (IVUS) evaluation have demonstrated that intensive lipid-lowering therapy by statin or a combination therapy with statin and ezetimibe results in significant regression of coronary plaque volume. However, it remains unclear whether adding ezetimibe to statin therapy affects coronary plaque composition and the molecular mechanisms of plaque regression. We conducted this prospective IVUS analysis in a subgroup from the CuVIC trial.</p><p><b>Methods:</b> The CuVIC trial was a prospective randomized, open, blinded-endpoint trial conducted among 11 cardiovascular centers, where 260 patients with coronary artery disease who received coronary stenting were randomly allocated into either the statin group (S) or the combined statin and ezetimibe group (S＋E). We enrolled 79 patients (S group, 39 patients; S＋E group, 40 patients) in this substudy, for whom serial IVUS images of nonculprit lesion were available at both baseline and after 6–8 months of follow-up.</p><p><b>Results:</b> After the treatment period, the S＋E group had significantly lower level of low-density lipoprotein cholesterol (LDL-C; 80.9±3.7 vs. 67.7±3.8 mg/dL, <i>p</i>=0.0143). Campesterol, a marker of cholesterol absorption, and oxysterols (β-epoxycholesterol, 4β-hydroxycholesterol, and 27-hydroxycholesterol) were also lower in the S＋E group. IVUS analyses revealed greater plaque regression in the S＋E group than in the S group (−6.14% vs. −1.18% for each group, <i>p</i>=0.042). It was noteworthy that the lowering of campesterol and 27-hydroxycholesterol, but not LDL-C, had a significant positive correlation with plaque regression.</p><p><b>Conclusions:</b> Compared with statin monotherapy, ezetimibe in combination with statin achieved significantly lower LDL-C, campesterol, and 27-hydroxycholesterol, which resulted in greater coronary plaque regression.</p>

DOI： 10.5551/jat.63507

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Language：English   Publisher：Journal of Arrhythmia  

Background: Focal Purkinje ventricular arrhythmias (VAs) might originate from the vicinity of the proximal portion of the cardiac conducting system. This study aimed to clarify the features associated with focal Purkinje VAs originating from the proximal conduction system. Methods: A total of 18 patients with focal Purkinje VAs undergoing radiofrequency catheter ablation (RFCA) were retrospectively examined and divided into the proximal type or the non-proximal type. The proximal type was defined as having the origin at the proximal half of the interventricular septum, or the proximal half and the septal side of the anterior wall. The 12-lead electrocardiogram and electrophysiological findings were investigated. Results: Seven patients met criteria for proximal type of focal Purkinje VA. Out of the 7, 4 patients with proximal VAs had multiple QRS morphologies of VAs clinically, whereas out of 11 patients with non-proximal VAs, only 1 had multiple morphologies (p =.047). VA QRS duration was shorter in the proximal type than in the non-proximal type (111.2 ± 19.8 ms vs. 135.7 ± 17.7 ms; p =.003). The absolute axis difference between sinus rhythm and VA was smaller in the proximal type (80.4 ± 46.1°vs. 138.8 ± 59.6°; p =.014). The absolute axis difference ≤134° was useful in distinguishing the two types. Recurrence of VA was recorded in 3 proximal type patients and 3 non-proximal type patients. No procedure-related conduction block was observed. Conclusion: A VA of absolute axis difference ≤134°, and multiple QRS morphologies of clinical VAs indicate a proximal origin. Focal Purkinje VAs from proximal origins can be suppressed by RFCA without severe conduction disturbance.

DOI： 10.1002/joa3.12787

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Language：English   Publisher：(一社)日本不整脈心電学会  

伝導系の近位部から発する巣状プルキンエ心室不整脈(FPVA)に関連してみられる所見を明らかにした。2008～2020年に5病院でFPVAと診断され高周波カテーテルアブレーション(RFCA)が行われた患者18名(男性11名、年齢18～75歳)を後方視的に検討した。そのFPVAの起源が心臓伝導系の近位部にあると判定された近位群は7名存在した。臨床的に心室不整脈(VA)と考えられた時の心電図で複数のQRS形態が観察されたのは、近位群の7名中4名、非近位群の11名中では1名のみであった(p=0.047)。VA時のQRS幅は非近位群に比べ近位群で有意に短縮していた。洞調律時とVA時で電気軸角度にみられた差の絶対値は、近位群で80.4±46.1度、非近位群では138.8±59.6度となり(p=0.003)、この絶対差が134度以下という基準を定めると両群を識別するのに有用であった。VAの再発は両群で3名ずつに発生した。RFCA処置に関連した伝導ブロックの例は観察されなかった。以上のように、臨床的VAで多様なQRS形態が観察されること、およびVA時に変化した電気軸角度の絶対差が134度以下であることは、FPVAの起源が伝導系近位部にあることを指し示していた。RFCAを行うことで、重度の伝導障害を起こすことなく近位部起源のFPVAを抑制できると結論された。

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DOI： 10.1111/jce.15517

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DOI： 10.1111/jce.15371

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

Language：English   Publisher：(一社)日本動脈硬化学会  

左冠動脈の狭窄病変に対してステント留置術を施行した患者112例(男性86例、女性26例)を対象に、ベアメタルステントまたは第2世代薬剤溶出性ステントの留置が冠動脈内皮機能障害に及ぼす影響を比較した。対象はコレステロール吸収阻害薬による冠動脈ステント標的血管の機能改善効果(CuVIC)試験に登録された患者で、標的血管不全を呈した症例は除外した。患者を留置ステントに応じて、ベアメタルステント(BMS)群53例(男性87%、平均64±11歳)と第2世代薬剤溶出性ステント(DES)群59例(男性68%、平均67±9歳)の2群に分類した。患者背景に有意な群間差はなかった。アセチルコリン負荷下でステント留置した標的血管と非標的血管における攣縮性を比較したところ、BMS群は標的血管(50±18%)の方が非標的血管(42±20%)より冠攣縮が有意に高かったが(P=0.002)、DES群で有意差はなかった。大動脈および冠静脈洞で採血した末梢血単核球のRho kinase活性はBMS群とDES群の間に有意差はなかった。BMS群で標的血管における冠攣縮の関連因子として、晩期内腔損失と冠症候群の既往が同定された。

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

Language：English   Publisher：PLoS ONE  

Background Pulmonary vein isolation (PVI) is an established ablation procedure for atrial fibrillation (AF), however, PVI alone is insufficient to suppress AF recurrence. Non-pulmonary vein (non-PV) trigger ablation is one of the promising strategies beyond PVI and has been shown to be effective in refractory/persistent AF cases. To make non-PV trigger ablation more standardized, it is essential to develop a simple method to localize the origin of non-PV triggers. Methods We retrospectively analyzed 37 non-PV triggers in 751 ablation sessions for symptomatic AF from January 2017 to December 2020. Regarding non-PV triggers, intra-atrial activation interval from the earliest in right atrium (RA) to proximal coronary sinus (CS) (RA-CSp) and that from the earliest in RA to distal CS (RA-CSd) obtained by a basically-positioned duodecapolar RA-CS catheter were compared among 3 originating non-PV areas [RA, atrial septum (SEP) and left atrium (LA)]. Results RA-CSp of RA non-PV trigger (56.4 ± 23.4 ms) was significantly longer than that of SEP non-PV (14.8 ± 25.6 ms, p = 0.019) and LA non-PV (-24.9 ± 27.9 ms, p = 0.0004). RA-CSd of RA non-PV (75.9 ± 32.1 ms) was significantly longer than that of SEP non-PV (34.2 ± 32.6 ms, p = 0.040) and LA non-PV (-13.3 ± 41.2 ms, p = 0.0008). RA-CSp and RA-CSd of SEP non-PV were significantly longer than those of LA non-PV (p = 0.022 and p = 0.016, respectively). Sensitivity and specificity of an algorithm to differentiate the area of non-PV trigger using RA-CSp (cut-off value: 50 ms) and RA-CSd (cut-off value: 0 ms) were 88% and 97% for RA non-PV, 81% and 73% for SEP non-PV, 65% and 95% for LA non-PV, respectively. Conclusions The analysis of intra-atrial activation sequences was useful to differentiate non-PV trigger areas. A simple algorithm to localize the area of non-PV trigger would be helpful to identify non-PV trigger sites in AF ablation.

DOI： 10.1371/journal.pone.0264894

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

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Atherosclerosis Society  

<p><b>Aims:</b> Previous studies suggested that implantation with a 1st-generation DES was associated with coronary endothelial dysfunction, which was associated with Rho-kinase activation. Second-generation drug-eluting stents (DESs) may preserve coronary endothelial function in stented coronary arteries; however, because of methodological limitations, further study is needed to clarify the association between 2 ^nd-generation DESs and coronary endothelial dysfunction. </p><p><b>Methods:</b> We retrospectively analysed the CuVIC trial database, where we identified 112 patients who underwent coronary stenting in the left coronary arteries with either a bare metal stent (BMS, <i>n</i>=53) or 2^nd-generation DES (<i>n</i>=59). We compared vasomotions of target vessels with stents and non-target vessels without stents. Furthermore, we measured the Rho-kinase activation detected in mononucleocytes from aortic and coronary sinus blood. </p><p><b>Results:</b> ACh-induced vasoconstrictive responses of target vessels were not enhanced with a 2^nd-generation DES (45±21% vs. 44±20%, <i>P</i>=0.56, paired <i>t</i>-test), but significantly enhanced in the coronary arteries with a BMS (50±18% vs. 42±20%, <i>P</i>=0.002). Rho-kinase activation did not differ between patients with a BMS and 2^nd-generation DES. In the target vessels with a BMS, large late lumen loss and acute coronary syndrome (ACS) at the index percutaneous coronary intervention (PCI) were associated with ACh-induced enhanced coronary vasoconstrictive responses. </p><p><b>Conclusions:</b> Evaluation of ACh-induced vasomotion of target vessels comparing with non-target vessels revealed that 2^nd-generation DESs were not associated with coronary endothelial dysfunction in target vessels, nor activation of Rho-kinase in the coronary sinus blood 6-8 months after stenting. </p>

DOI： 10.5551/jat.61366

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DOI： 10.1038/s41598-019-48669-1

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DOI： 10.1161/ATVBAHA.117.309301

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DOI： 10.1161/ATVBAHA.116.308388

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DOI： 10.1093/ajh/hpu196

Event date： 2023.3

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