Language：English   Publisher：International Heart Journal Association  

<p>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.</p><p>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.</p><p>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, <i>P</i> = 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, <i>P</i> = 0.030).</p><p>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.</p>

DOI： 10.1536/ihj.24-067

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DOI： 10.1253/circj.CJ-23-0698

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DOI： 10.1253/circj.CJ-23-0698

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Publisher：Circulation journal : official journal of the Japanese Circulation Society  

DOI： 10.1253/circj.CJ-23-0698

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Language：English  

DOI： 10.1253/circj.CJ-23-0698

PubMed

Language：English   Publisher：The Japanese Circulation Society  

DOI： 10.1253/circj.cj-23-0698

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

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   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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Language：English   Publisher：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

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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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Language：English   Publisher：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

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Language：English   Publisher：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

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Language：Japanese   Publisher：一般社団法人 日本人工臓器学会  

DOI： 10.11392/jsao.52.85

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Language：English   Publisher：The Japanese Circulation Society  

DOI： 10.1253/circj.cj-22-0696

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Publisher：南江堂  

DOI： 10.15106/j_naika131_651

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Language：English   Publisher：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

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Language：English   Publisher：CJC Open  

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 日本超音波検査学会  

DOI： 10.11272/jssabst.48.0_s158

CiNii Research

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

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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：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

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Language：English   Publisher：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

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Language：English   Publisher：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

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Language：English   Publisher：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

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Language：English   Publisher：The Japanese Circulation Society  

DOI： 10.1253/circj.cj-21-0880

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Language：English   Publisher：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

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Language：Japanese   Publisher：一般社団法人 日本人工臓器学会  

DOI： 10.11392/jsao.50.232

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Publisher：南江堂  

DOI： 10.15106/j_naika128_61

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Language：English   Publisher：International Heart Journal Association  

<p>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-FDG-PET/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.</p>

DOI： 10.1536/ihj.20-586

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Language：Japanese   Publisher：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

Language：Japanese   Publisher：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

Publisher：南江堂  

DOI： 10.15106/j_naika126_412

CiNii Research

Language：English   Publisher：The Japanese Circulation Society  

<p><b><i>Background:</i></b>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.</p><p><b><i>Methods and Results:</i></b>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.</p><p><b><i>Conclusions:</i></b>Hospital factors, including various cardiovascular therapeutic practices, may be associated with the early death of HF patients.</p>

DOI： 10.1253/circj.cj-19-0759

PubMed

CiNii Research

Language：English   Publisher：International Heart Journal Association  

<p>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.</p>

DOI： 10.1536/ihj.19-116

PubMed

CiNii Research

Language：English   Publisher：The Japanese Circulation Society  

DOI： 10.1253/circj.cj-19-0342

PubMed

CiNii Research

Language：English   Publisher：International Heart Journal Association  

<p>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.</p>

DOI： 10.1536/ihj.18-600

PubMed

CiNii Research

Publisher：(株)メジカルビュー社  

DOI： 10.18885/j03097.2019038140

CiNii Research

Language：English   Publisher：The Japanese Circulation Society  

DOI： 10.1253/circj.cj-18-0329

PubMed

CiNii Research

Language：English   Publisher：International Heart Journal Association  

<p>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 <i>HFE</i> 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.</p>

DOI： 10.1536/ihj.17-160

PubMed

CiNii Research

Publisher：南江堂  

DOI： 10.15106/j00349.2017355960

CiNii Research

Language：Japanese   Publisher：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

Language：English   Publisher：The Japanese Society of Internal Medicine  

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.<br>

DOI： 10.2169/internalmedicine.50.4282

CiNii Research

Language：Japanese   Publisher：Japan Heart Foundation  

DOI： 10.11281/shinzo.41.1382

CiNii Research

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

Language：Japanese   Publisher：(株)南江堂  

＜文献概要＞・薬理学的に多彩な特徴を有するβ遮断薬が発売されているが,現在の日常臨床で使用されるのはbisoprolol,carvedilolがそのほとんどを占めている.・高血圧治療薬としてのβ遮断薬は,特殊なケースを除いて第一選択薬にはならない.・慢性心不全治療薬としてβ遮断薬は中心的な役割を担うが,その導入や増量は循環器専門医との情報共有のもとで行うべきである.・労作性狭心症の症状改善にβ遮断薬は有効であるが,冠攣縮性狭心症を悪化させる可能性があるため注意が必要である.

Language：Japanese   Publisher：(株)ライフメディコム  

心原性ショックに対する機械的循環補助(mechanical circulatory support:MCS)は急速に進歩しており,患者の病態に合わせて多様な治療戦略を選択することが可能である.劇症型心筋炎においては急性期の血行動態サポートが極めて重要であり,急速に変化する病状に対応して適切な患者管理を行う必要がある.本稿では,劇症型心筋炎に対するMCSとして中心的な役割を担うVA-ECMOを中心に,経皮的デバイスであるIABPやIMPELLA,さらには開胸を要するデバイスであるcentral ECMO,体外設置型VADおよび植込型LVADについて,それぞれの特徴を概説する.(著者抄録)

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