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Mitsuhashi R, Song BS, Inoue K, Asano T, Noda S. Design and fabrication of a coupled high-Q photonic nanocavity system with large coupling coefficients. Opt Express 2024; 32:10630-10647. [PMID: 38571269 DOI: 10.1364/oe.513508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/27/2024] [Indexed: 04/05/2024]
Abstract
In a previous work, we demonstrated a coupled cavity system where photons in one storage cavity can be transferred to another storage cavity at an arbitrary time by applying a voltage pulse to a third cavity placed in a p-i-n junction. In this work, we demonstrate methods to improve the transfer efficiency and photon lifetimes of such a coupled system. Firstly, we designed a photonic-crystal structure that achieves a large coupling coefficient without reducing the radiation quality factor compared to the previously proposed structure: The photonic-crystal design was changed to a more symmetric configuration to suppress radiation losses and then optimized using an automatic structure tuning method based on the Covariance Matrix Adaptive Evolutional Strategy (CMAES). Here we added two improvements to achieve an evolution toward the desired direction in the two-dimensional target parameter space (spanned by the coupling coefficient and the inverse radiation loss). Secondly, to improve the experimental cavity quality factors, we developed a fabrication process that reduces the surface contamination associated with the fabrication of the p-i-n junction: We covered the photonic structure with a SiO2 mask to avoid the contamination and the electrode material was changed from Al to Au/Cr to enable cleaning by a weak acid. Owing to these improvements of the cavity design and the fabrication process, the obtained system provides coupling strengths that are about three times stronger and photon lifetimes that are about two times longer, compared to the previously reported system.
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Kasai H, Bergamo ET, Balderrama ÍD, Imamura K, Witek L, Jalkh EB, Bonfante EA, Inoue K, Coelho PG, Yamano S. The effect of nano hydroxyapatite coating implant surfaces on gene expression and osseointegration. Med Oral Patol Oral Cir Bucal 2023:26303. [PMID: 37992148 DOI: 10.4317/medoral.26303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/18/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Hierarchical micro-nano structured topography along with surface chemistry modifications of dental implants have been suggested to positively contribute to the osseointegration process. However, the effect of such surface modifications on the molecular response as well as bone formation rate and quality are still unclear, especially in the early healing period. This study aimed to evaluate the effect of coating a double acid etched (DAE) implant surface with nano-sized (20 nm) hydroxyapatite (Nano) with respect to gene expression, histologic parameters, and nanomechanical properties when compared to DAE control at 1 and 2 weeks after implant placement in a rodent femur model. MATERIAL AND METHODS Expression of bone-related genes was determined by qRT-PCR (Col-I, Runx-2, Osx, Opn, Ocn, Alp). Histomorphometric evaluation of bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) within implant threads was performed using photomicrographs after histologic processing. Mechanical properties, reduced elastic modulus and hardness, were determined through nanoindentation. RESULTS At 1 week, the Nano group demonstrated significantly higher expression of Col-I and Ocn compared to the DAE group, indicating upregulation of osteoprogenitor and osteoblast differentiation genes. At 2 weeks, Nano surface further exhibited enhanced gene expression of Col-I and Osx in comparison to the DAE surface, suggesting an increased mineralization of the newly formed bone. Nanoindentation analysis revealed that the Nano group presented no significant difference on the ranks of reduced elastic modulus and hardness compared to DAE for both timepoints. Histomorphometric analysis yielded no significant difference in the percentage of BIC and BAFO between the Nano and DAE surfaces at 1 and 2 weeks. However, Nano implants did present a higher mean value, ~50%, of BIC compared to DAE, ~30%, after 2 weeks in vivo. CONCLUSIONS While no significant differences were observed in the amount and mechanical properties of newly formed bone, Nano surface positively and significantly increased the expression osteogenic genes compared to DAE surface at early healing periods.
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Affiliation(s)
- H Kasai
- Biomaterials Division New York University College of Dentistry 345 E. 24th St, Room 902D / New York, NY, USA
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Sakr S, Inoue K, Mohamed A, Ahmed AA, ElFeky MG, Saleh GM, Kamar MS, Arae H, Aono T, Sahoo SK. Distribution of natural radionuclides in NORM samples from North Abu Rusheid area, Egypt. J Environ Radioact 2023; 266-267:107240. [PMID: 37418811 DOI: 10.1016/j.jenvrad.2023.107240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/08/2023] [Accepted: 06/30/2023] [Indexed: 07/09/2023]
Abstract
The North Abu Rusheid area in Egypt is a well-known high background natural radiation area (HBNRA) due to the existence of naturally occurring radioactive materials (NORMs) in mylonitic rocks. In this study, 27 rock samples were selected for dose estimation studies. 238U and 232Th were measured using inductively coupled plasma mass spectrometry (ICP-MS) and 40K was measured using sodium iodide (thallium) gamma-ray spectroscopy. The ranges of activity concentrations (Bq/kg) of 238U, 232Th and 40K in the samples varied from 270 ± 2 to 2120 ± 29, 350 ± 2 to 1840 ± 27 and 20 ± 2 to 1390 ± 35 with mean values of 980 ± 349, 770 ± 351, and 640 ± 402 Bq/kg, respectively. The radiological hazard parameters were estimated from activity concentrations of 238U, 232Th and 40K and compared to United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) values. The present study revealed that the hazard parameters were several times higher than the worldwide averages. The U/Th concentration ratio ranged from 0.7 to 3 and could be attributed to the presence of kasolite, uranothorite, zircon, and columbite in mylonitic rocks. From the radiological protection viewpoint, it is necessary to monitor natural radionuclides in these rocks prior to their use in residential and commercial construction materials.
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Affiliation(s)
- S Sakr
- Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo, 116-8551, Japan; Department of Physics, Minia University, El-Minia, Egypt; National Institutes for Quantum Sciences and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - K Inoue
- Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo, 116-8551, Japan
| | - A Mohamed
- Department of Physics, Minia University, El-Minia, Egypt
| | - A A Ahmed
- Department of Physics, Minia University, El-Minia, Egypt
| | - M G ElFeky
- Nuclear Materials Authority, P.O. Box 530, El Maadi, Cairo, Egypt
| | - G M Saleh
- Nuclear Materials Authority, P.O. Box 530, El Maadi, Cairo, Egypt
| | - M S Kamar
- Nuclear Materials Authority, P.O. Box 530, El Maadi, Cairo, Egypt
| | - H Arae
- National Institutes for Quantum Sciences and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - T Aono
- National Institutes for Quantum Sciences and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - S K Sahoo
- National Institutes for Quantum Sciences and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan.
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4
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Nakamura T, Matsumoto M, Amano K, Enokido Y, Zolensky ME, Mikouchi T, Genda H, Tanaka S, Zolotov MY, Kurosawa K, Wakita S, Hyodo R, Nagano H, Nakashima D, Takahashi Y, Fujioka Y, Kikuiri M, Kagawa E, Matsuoka M, Brearley AJ, Tsuchiyama A, Uesugi M, Matsuno J, Kimura Y, Sato M, Milliken RE, Tatsumi E, Sugita S, Hiroi T, Kitazato K, Brownlee D, Joswiak DJ, Takahashi M, Ninomiya K, Takahashi T, Osawa T, Terada K, Brenker FE, Tkalcec BJ, Vincze L, Brunetto R, Aléon-Toppani A, Chan QHS, Roskosz M, Viennet JC, Beck P, Alp EE, Michikami T, Nagaashi Y, Tsuji T, Ino Y, Martinez J, Han J, Dolocan A, Bodnar RJ, Tanaka M, Yoshida H, Sugiyama K, King AJ, Fukushi K, Suga H, Yamashita S, Kawai T, Inoue K, Nakato A, Noguchi T, Vilas F, Hendrix AR, Jaramillo-Correa C, Domingue DL, Dominguez G, Gainsforth Z, Engrand C, Duprat J, Russell SS, Bonato E, Ma C, Kawamoto T, Wada T, Watanabe S, Endo R, Enju S, Riu L, Rubino S, Tack P, Takeshita S, Takeichi Y, Takeuchi A, Takigawa A, Takir D, Tanigaki T, Taniguchi A, Tsukamoto K, Yagi T, Yamada S, Yamamoto K, Yamashita Y, Yasutake M, Uesugi K, Umegaki I, Chiu I, Ishizaki T, Okumura S, Palomba E, Pilorget C, Potin SM, Alasli A, Anada S, Araki Y, Sakatani N, Schultz C, Sekizawa O, Sitzman SD, Sugiura K, Sun M, Dartois E, De Pauw E, Dionnet Z, Djouadi Z, Falkenberg G, Fujita R, Fukuma T, Gearba IR, Hagiya K, Hu MY, Kato T, Kawamura T, Kimura M, Kubo MK, Langenhorst F, Lantz C, Lavina B, Lindner M, Zhao J, Vekemans B, Baklouti D, Bazi B, Borondics F, Nagasawa S, Nishiyama G, Nitta K, Mathurin J, Matsumoto T, Mitsukawa I, Miura H, Miyake A, Miyake Y, Yurimoto H, Okazaki R, Yabuta H, Naraoka H, Sakamoto K, Tachibana S, Connolly HC, Lauretta DS, Yoshitake M, Yoshikawa M, Yoshikawa K, Yoshihara K, Yokota Y, Yogata K, Yano H, Yamamoto Y, Yamamoto D, Yamada M, Yamada T, Yada T, Wada K, Usui T, Tsukizaki R, Terui F, Takeuchi H, Takei Y, Iwamae A, Soejima H, Shirai K, Shimaki Y, Senshu H, Sawada H, Saiki T, Ozaki M, Ono G, Okada T, Ogawa N, Ogawa K, Noguchi R, Noda H, Nishimura M, Namiki N, Nakazawa S, Morota T, Miyazaki A, Miura A, Mimasu Y, Matsumoto K, Kumagai K, Kouyama T, Kikuchi S, Kawahara K, Kameda S, Iwata T, Ishihara Y, Ishiguro M, Ikeda H, Hosoda S, Honda R, Honda C, Hitomi Y, Hirata N, Hirata N, Hayashi T, Hayakawa M, Hatakeda K, Furuya S, Fukai R, Fujii A, Cho Y, Arakawa M, Abe M, Watanabe S, Tsuda Y. Formation and evolution of carbonaceous asteroid Ryugu: Direct evidence from returned samples. Science 2023; 379:eabn8671. [PMID: 36137011 DOI: 10.1126/science.abn8671] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Samples of the carbonaceous asteroid Ryugu were brought to Earth by the Hayabusa2 spacecraft. We analyzed 17 Ryugu samples measuring 1 to 8 millimeters. Carbon dioxide-bearing water inclusions are present within a pyrrhotite crystal, indicating that Ryugu's parent asteroid formed in the outer Solar System. The samples contain low abundances of materials that formed at high temperatures, such as chondrules and calcium- and aluminum-rich inclusions. The samples are rich in phyllosilicates and carbonates, which formed through aqueous alteration reactions at low temperature, high pH, and water/rock ratios of <1 (by mass). Less altered fragments contain olivine, pyroxene, amorphous silicates, calcite, and phosphide. Numerical simulations, based on the mineralogical and physical properties of the samples, indicate that Ryugu's parent body formed ~2 million years after the beginning of Solar System formation.
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Affiliation(s)
- T Nakamura
- Department of Earth Sciences, Tohoku University, Sendai 980-8578, Japan
| | - M Matsumoto
- Department of Earth Sciences, Tohoku University, Sendai 980-8578, Japan
| | - K Amano
- Department of Earth Sciences, Tohoku University, Sendai 980-8578, Japan
| | - Y Enokido
- Department of Earth Sciences, Tohoku University, Sendai 980-8578, Japan
| | - M E Zolensky
- NASA Johnson Space Center; Houston, TX 77058, USA
| | - T Mikouchi
- The University Museum, The University of Tokyo, Tokyo 113-0033, Japan
| | - H Genda
- Earth-Life Science Institute, Tokyo Institute of Technology, Tokyo 152-8550, Japan
| | - S Tanaka
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Department of Space and Astronautical Science, The Graduate University for Advanced Studies (SOKENDAI), Hayama 240-0193, Japan
| | - M Y Zolotov
- School of Earth and Space Exploration, Arizona State University, Tempe, AZ 85287, USA
| | - K Kurosawa
- Planetary Exploration Research Center, Chiba Institute of Technology, Narashino 275-0016, Japan
| | - S Wakita
- Department of Earth, Atmospheric and Planetary Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - R Hyodo
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - H Nagano
- Department of Mechanical Systems Engineering, Nagoya University, Nagoya 464-8603, Japan
| | - D Nakashima
- Department of Earth Sciences, Tohoku University, Sendai 980-8578, Japan
| | - Y Takahashi
- Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan.,Isotope Science Center, The University of Tokyo, Tokyo 113-0032, Japan
| | - Y Fujioka
- Department of Earth Sciences, Tohoku University, Sendai 980-8578, Japan
| | - M Kikuiri
- Department of Earth Sciences, Tohoku University, Sendai 980-8578, Japan
| | - E Kagawa
- Department of Earth Sciences, Tohoku University, Sendai 980-8578, Japan
| | - M Matsuoka
- Laboratoire d'Etudes Spatiales et d'Instrumentation en Astrophysique (LESIA), Observatoire de Paris, Meudon 92195 France.,Geological Survey of Japan, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, 305-8567, Japan
| | - A J Brearley
- Department of Earth and Planetary Sciences, University of New Mexico, Albuquerque, NM 87131, USA
| | - A Tsuchiyama
- Research Organization of Science and Technology, Ritsumeikan University, Kusatsu 525-8577, Japan.,Key Laboratory of Mineralogy and Metallogeny, Guangdong Provincial Key Laboratory of Mineral Physics and Materials, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences (CAS), Guangzhou 510640, China.,Center for Excellence in Deep Earth Science, CAS, Guangzhou 510640, China
| | - M Uesugi
- Scattering and Imaging Division, Japan Synchrotron Radiation Research Institute, Sayo 679-5198, Japan
| | - J Matsuno
- Research Organization of Science and Technology, Ritsumeikan University, Kusatsu 525-8577, Japan
| | - Y Kimura
- Institute of Low Temperature Science, Hokkaido University, Sapporo 060-0819, Japan
| | - M Sato
- Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan
| | - R E Milliken
- Department of Earth, Environmental, and Planetary Sciences, Brown University, Providence, RI 02912, USA
| | - E Tatsumi
- Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan.,Instituto de Astrofísica de Canarias, University of La Laguna, Tenerife 38205, Spain
| | - S Sugita
- Planetary Exploration Research Center, Chiba Institute of Technology, Narashino 275-0016, Japan.,Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan
| | - T Hiroi
- Department of Earth, Environmental, and Planetary Sciences, Brown University, Providence, RI 02912, USA
| | - K Kitazato
- Aizu Research Center for Space Informatics, The University of Aizu, Aizu-Wakamatsu 965-8580, Japan
| | - D Brownlee
- Department of Astronomy, University of Washington, Seattle, WA 98195 USA
| | - D J Joswiak
- Department of Astronomy, University of Washington, Seattle, WA 98195 USA
| | - M Takahashi
- Department of Earth Sciences, Tohoku University, Sendai 980-8578, Japan
| | - K Ninomiya
- Institute for Radiation Sciences, Osaka University, Toyonaka 560-0043, Japan
| | - T Takahashi
- Kavli Institute for the Physics and Mathematics of the Universe, The University of Tokyo, Kashiwa 277-8583, Japan.,Department of Physics, The University of Tokyo, Tokyo 113-0033, Japan
| | - T Osawa
- Materials Sciences Research Center, Japan Atomic Energy Agency, Tokai 319-1195, Japan
| | - K Terada
- Department of Earth and Space Science, Osaka University, Toyonaka 560-0043, Japan
| | - F E Brenker
- Institute of Geoscience, Goethe University, Frankfurt, 60438 Frankfurt am Main, Germany
| | - B J Tkalcec
- Institute of Geoscience, Goethe University, Frankfurt, 60438 Frankfurt am Main, Germany
| | - L Vincze
- Department of Chemistry, Ghent University, Krijgslaan 281 S12, Ghent, Belgium
| | - R Brunetto
- Institut d'Astrophysique Spatiale, Université Paris-Saclay, Orsay 91405, France
| | - A Aléon-Toppani
- Institut d'Astrophysique Spatiale, Université Paris-Saclay, Orsay 91405, France
| | - Q H S Chan
- Department of Earth Sciences, Royal Holloway, University of London, Egham TW20 0EX, UK
| | - M Roskosz
- Institut de Minéralogie, Physique des Matériaux et Cosmochimie, Muséum National d'Histoire Naturelle, Centre national de la recherche scientifique (CNRS), Sorbonne Université, Paris, France
| | - J-C Viennet
- Institut de Minéralogie, Physique des Matériaux et Cosmochimie, Muséum National d'Histoire Naturelle, Centre national de la recherche scientifique (CNRS), Sorbonne Université, Paris, France
| | - P Beck
- Institut de Planétologie et d'Astrophysique de Grenoble, CNRS, Université Grenoble Alpes, 38000 Grenoble, France
| | - E E Alp
- Advanced Photon Source, Argonne National Laboratory, Argonne, IL 60439, USA
| | - T Michikami
- Faculty of Engineering, Kindai University, Higashi-Hiroshima 739-2116, Japan
| | - Y Nagaashi
- Department of Earth Sciences, Tohoku University, Sendai 980-8578, Japan.,Department of Planetology, Kobe University, Kobe 657-8501, Japan
| | - T Tsuji
- Department of Earth Resources Engineering, Kyushu University, Fukuoka 819-0395, Japan.,School of Engineering, The University of Tokyo, Tokyo 113-0033, Japan
| | - Y Ino
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Department of Physics, Kwansei Gakuin University, Sanda 669-1330, Japan
| | - J Martinez
- NASA Johnson Space Center; Houston, TX 77058, USA
| | - J Han
- Department of Earth and Atmospheric Sciences, University of Houston, Houston, TX 77204, USA
| | - A Dolocan
- Texas Materials Institute, The University of Texas at Austin, Austin, TX 78712, USA
| | - R J Bodnar
- Department of Geoscience, Virginia Tech, Blacksburg, VA 24061, USA
| | - M Tanaka
- Materials Analysis Station, National Institute for Materials Science, Tsukuba 305-0047, Japan
| | - H Yoshida
- Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan
| | - K Sugiyama
- Institute for Materials Research, Tohoku University, Sendai 980-8577, Japan
| | - A J King
- Department of Earth Science, Natural History Museum, London SW7 5BD, UK
| | - K Fukushi
- Institute of Nature and Environmental Technology, Kanazawa University, Kanazawa 920-1192, Japan
| | - H Suga
- Spectroscopy Division, Japan Synchrotron Radiation Research Institute, Sayo 679-5198, Japan
| | - S Yamashita
- Department of Materials Structure Science, The Graduate University for Advanced Studies (SOKENDAI), Tsukuba, Ibaraki 305-0801, Japan.,Institute of Materials Structure Science, High-Energy Accelerator Research Organization, Tsukuba 305-0801, Japan
| | - T Kawai
- Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan
| | - K Inoue
- Institute of Nature and Environmental Technology, Kanazawa University, Kanazawa 920-1192, Japan
| | - A Nakato
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - T Noguchi
- Division of Earth and Planetary Sciences, Kyoto University, Kyoto 606-8502, Japan.,Faculty of Arts and Science, Kyushu University, Fukuoka 819-0395, Japan
| | - F Vilas
- Planetary Science Institute, Tucson, AZ 85719, USA
| | - A R Hendrix
- Planetary Science Institute, Tucson, AZ 85719, USA
| | | | - D L Domingue
- Planetary Science Institute, Tucson, AZ 85719, USA
| | - G Dominguez
- Department of Physics, California State University, San Marcos, CA 92096, USA
| | - Z Gainsforth
- Space Sciences Laboratory, University of California, Berkeley, CA 94720, USA
| | - C Engrand
- Laboratoire de Physique des 2 Infinis Irène Joliot-Curie, Université Paris-Saclay, CNRS, 91405 Orsay, France
| | - J Duprat
- Institut de Minéralogie, Physique des Matériaux et Cosmochimie, Muséum National d'Histoire Naturelle, Centre national de la recherche scientifique (CNRS), Sorbonne Université, Paris, France
| | - S S Russell
- Department of Earth Science, Natural History Museum, London SW7 5BD, UK
| | - E Bonato
- Institute for Planetary Research, Deutsches Zentrum für Luftund Raumfahrt, Rutherfordstraße 2 12489 Berlin, Germany
| | - C Ma
- Division of Geological and Planetary Sciences, California Institute of Technology, Pasadena CA 91125, USA
| | - T Kawamoto
- Department of Geosciences, Shizuoka University, Shizuoka 422-8529, Japan
| | - T Wada
- Department of Earth Sciences, Tohoku University, Sendai 980-8578, Japan
| | - S Watanabe
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Kavli Institute for the Physics and Mathematics of the Universe, The University of Tokyo, Kashiwa 277-8583, Japan
| | - R Endo
- Department of Materials Science and Engineering, Tokyo Institute of Technology, Tokyo 152-8550, Japan
| | - S Enju
- Graduate School of Science and Engineering, Ehime University, Matsuyama 790-8577, Japan
| | - L Riu
- European Space Astronomy Centre, 28692 Villanueva de la Cañada, Spain
| | - S Rubino
- Institut d'Astrophysique Spatiale, Université Paris-Saclay, Orsay 91405, France
| | - P Tack
- Department of Chemistry, Ghent University, Krijgslaan 281 S12, Ghent, Belgium
| | - S Takeshita
- High Energy Accelerator Research Organization, Tokai 319-1106, Japan
| | - Y Takeichi
- Department of Materials Structure Science, The Graduate University for Advanced Studies (SOKENDAI), Tsukuba, Ibaraki 305-0801, Japan.,Institute of Materials Structure Science, High-Energy Accelerator Research Organization, Tsukuba 305-0801, Japan.,Department of Applied Physics, Osaka University, Suita 565-0871, Japan
| | - A Takeuchi
- Scattering and Imaging Division, Japan Synchrotron Radiation Research Institute, Sayo 679-5198, Japan
| | - A Takigawa
- Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan
| | - D Takir
- NASA Johnson Space Center; Houston, TX 77058, USA
| | | | - A Taniguchi
- Institute for Integrated Radiation and Nuclear Science, Kyoto University, Kumatori 590-0494, Japan
| | - K Tsukamoto
- Department of Earth Sciences, Tohoku University, Sendai 980-8578, Japan
| | - T Yagi
- National Metrology Institute of Japan, AIST, Tsukuba 305-8565, Japan
| | - S Yamada
- Department of Physics, Rikkyo University, Tokyo 171-8501, Japan
| | - K Yamamoto
- Japan Fine Ceramics Center, Nagoya 456-8587, Japan
| | - Y Yamashita
- National Metrology Institute of Japan, AIST, Tsukuba 305-8565, Japan
| | - M Yasutake
- Scattering and Imaging Division, Japan Synchrotron Radiation Research Institute, Sayo 679-5198, Japan
| | - K Uesugi
- Scattering and Imaging Division, Japan Synchrotron Radiation Research Institute, Sayo 679-5198, Japan
| | - I Umegaki
- High Energy Accelerator Research Organization, Tokai 319-1106, Japan.,Toyota Central Research and Development Laboratories, Nagakute 480-1192, Japan
| | - I Chiu
- Institute for Radiation Sciences, Osaka University, Toyonaka 560-0043, Japan
| | - T Ishizaki
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - S Okumura
- Division of Earth and Planetary Sciences, Kyoto University, Kyoto 606-8502, Japan
| | - E Palomba
- Istituto di Astrofisica e Planetologia Spaziali, Istituto Nazionale di Astrofisica, Rome 00133, Italy
| | - C Pilorget
- Institut d'Astrophysique Spatiale, Université Paris-Saclay, Orsay 91405, France.,Institut Universitaire de France, Paris, France
| | - S M Potin
- Laboratoire d'Etudes Spatiales et d'Instrumentation en Astrophysique (LESIA), Observatoire de Paris, Meudon 92195 France.,Faculty of Aerospace Engineering, Delft University of Technology, Delft, Netherlands
| | - A Alasli
- Department of Mechanical Systems Engineering, Nagoya University, Nagoya 464-8603, Japan
| | - S Anada
- Japan Fine Ceramics Center, Nagoya 456-8587, Japan
| | - Y Araki
- Department of Physical Sciences, Ritsumeikan University, Shiga 525-0058, Japan
| | - N Sakatani
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Department of Physics, Rikkyo University, Tokyo 171-8501, Japan
| | - C Schultz
- Department of Earth, Environmental, and Planetary Sciences, Brown University, Providence, RI 02912, USA
| | - O Sekizawa
- Spectroscopy Division, Japan Synchrotron Radiation Research Institute, Sayo 679-5198, Japan
| | - S D Sitzman
- Physical Sciences Laboratory, The Aerospace Corporation, CA 90245, USA
| | - K Sugiura
- Earth-Life Science Institute, Tokyo Institute of Technology, Tokyo 152-8550, Japan
| | - M Sun
- Key Laboratory of Mineralogy and Metallogeny, Guangdong Provincial Key Laboratory of Mineral Physics and Materials, Guangzhou Institute of Geochemistry, Chinese Academy of Sciences (CAS), Guangzhou 510640, China.,Center for Excellence in Deep Earth Science, CAS, Guangzhou 510640, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - E Dartois
- Institut des Sciences Moléculaires d'Orsay, Université Paris-Saclay, CNRS, 91405 Orsay, France
| | - E De Pauw
- Department of Chemistry, Ghent University, Krijgslaan 281 S12, Ghent, Belgium
| | - Z Dionnet
- Institut d'Astrophysique Spatiale, Université Paris-Saclay, Orsay 91405, France
| | - Z Djouadi
- Institut d'Astrophysique Spatiale, Université Paris-Saclay, Orsay 91405, France
| | - G Falkenberg
- Deutsches Elektronen-Synchrotron Photon Science, 22603 Hamburg, Germany
| | - R Fujita
- Department of Mechanical Systems Engineering, Nagoya University, Nagoya 464-8603, Japan
| | - T Fukuma
- Nano Life Science Institute, Kanazawa University, Kanazawa 920-1192, Japan
| | - I R Gearba
- Texas Materials Institute, The University of Texas at Austin, Austin, TX 78712, USA
| | - K Hagiya
- Graduate School of Life Science, University of Hyogo, Hyogo 678-1297, Japan
| | - M Y Hu
- Advanced Photon Source, Argonne National Laboratory, Argonne, IL 60439, USA
| | - T Kato
- Japan Fine Ceramics Center, Nagoya 456-8587, Japan
| | - T Kawamura
- Institut de Physique du Globe de Paris, Université de Paris, Paris 75205, France
| | - M Kimura
- Department of Materials Structure Science, The Graduate University for Advanced Studies (SOKENDAI), Tsukuba, Ibaraki 305-0801, Japan.,Institute of Materials Structure Science, High-Energy Accelerator Research Organization, Tsukuba 305-0801, Japan
| | - M K Kubo
- Division of Natural Sciences, International Christian University, Mitaka 181-8585, Japan
| | - F Langenhorst
- Institute of Geosciences, Friedrich-Schiller-Universität Jena, 07745 Jena, Germany
| | - C Lantz
- Institut d'Astrophysique Spatiale, Université Paris-Saclay, Orsay 91405, France
| | - B Lavina
- Center for Advanced Radiation Sources, University of Chicago, Chicago, IL 60637, USA
| | - M Lindner
- Institute of Geoscience, Goethe University, Frankfurt, 60438 Frankfurt am Main, Germany
| | - J Zhao
- Advanced Photon Source, Argonne National Laboratory, Argonne, IL 60439, USA
| | - B Vekemans
- Department of Chemistry, Ghent University, Krijgslaan 281 S12, Ghent, Belgium
| | - D Baklouti
- Institut d'Astrophysique Spatiale, Université Paris-Saclay, Orsay 91405, France
| | - B Bazi
- Department of Chemistry, Ghent University, Krijgslaan 281 S12, Ghent, Belgium
| | - F Borondics
- Optimized Light Source of Intermediate Energy to LURE (SOLEIL) L'Orme des Merisiers, Gif sur Yvette F-91192, France
| | - S Nagasawa
- Kavli Institute for the Physics and Mathematics of the Universe, The University of Tokyo, Kashiwa 277-8583, Japan.,Department of Physics, The University of Tokyo, Tokyo 113-0033, Japan
| | - G Nishiyama
- Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan
| | - K Nitta
- Spectroscopy Division, Japan Synchrotron Radiation Research Institute, Sayo 679-5198, Japan
| | - J Mathurin
- Institut Chimie Physique, Université Paris-Saclay, CNRS, 91405 Orsay, France
| | - T Matsumoto
- Division of Earth and Planetary Sciences, Kyoto University, Kyoto 606-8502, Japan
| | - I Mitsukawa
- Division of Earth and Planetary Sciences, Kyoto University, Kyoto 606-8502, Japan
| | - H Miura
- Graduate School of Science, Nagoya City University, Nagoya 467-8501, Japan
| | - A Miyake
- Division of Earth and Planetary Sciences, Kyoto University, Kyoto 606-8502, Japan
| | - Y Miyake
- High Energy Accelerator Research Organization, Tokai 319-1106, Japan
| | - H Yurimoto
- Department of Natural History Sciences, Hokkaido University, Sapporo 060-0810, Japan
| | - R Okazaki
- Department of Earth and Planetary Sciences, Kyushu University, Fukuoka 819-0395, Japan
| | - H Yabuta
- Graduate School of Advanced Science and Engineering, Hiroshima University, Higashi-Hiroshima 739-8526, Japan
| | - H Naraoka
- Department of Earth and Planetary Sciences, Kyushu University, Fukuoka 819-0395, Japan
| | - K Sakamoto
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - S Tachibana
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan
| | - H C Connolly
- Department of Geology, Rowan University, Glassboro, NJ 08028, USA
| | - D S Lauretta
- Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ 85721, USA
| | - M Yoshitake
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - M Yoshikawa
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Department of Space and Astronautical Science, The Graduate University for Advanced Studies (SOKENDAI), Hayama 240-0193, Japan
| | - K Yoshikawa
- Research and Development Directorate, JAXA, Sagamihara 252-5210, Japan
| | - K Yoshihara
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - Y Yokota
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - K Yogata
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - H Yano
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Department of Space and Astronautical Science, The Graduate University for Advanced Studies (SOKENDAI), Hayama 240-0193, Japan
| | - Y Yamamoto
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Department of Space and Astronautical Science, The Graduate University for Advanced Studies (SOKENDAI), Hayama 240-0193, Japan
| | - D Yamamoto
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - M Yamada
- Planetary Exploration Research Center, Chiba Institute of Technology, Narashino 275-0016, Japan
| | - T Yamada
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - T Yada
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - K Wada
- Planetary Exploration Research Center, Chiba Institute of Technology, Narashino 275-0016, Japan
| | - T Usui
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan
| | - R Tsukizaki
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - F Terui
- Department of Mechanical Engineering, Kanagawa Institute of Technology, Atsugi 243-0292, Japan
| | - H Takeuchi
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Department of Space and Astronautical Science, The Graduate University for Advanced Studies (SOKENDAI), Hayama 240-0193, Japan
| | - Y Takei
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - A Iwamae
- Marine Works Japan, Yokosuka 237-0063, Japan
| | - H Soejima
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Marine Works Japan, Yokosuka 237-0063, Japan
| | - K Shirai
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - Y Shimaki
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - H Senshu
- Planetary Exploration Research Center, Chiba Institute of Technology, Narashino 275-0016, Japan
| | - H Sawada
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - T Saiki
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - M Ozaki
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Department of Space and Astronautical Science, The Graduate University for Advanced Studies (SOKENDAI), Hayama 240-0193, Japan
| | - G Ono
- Research and Development Directorate, JAXA, Sagamihara 252-5210, Japan
| | - T Okada
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Department of Chemistry, The University of Tokyo, Tokyo 113-0033, Japan
| | - N Ogawa
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - K Ogawa
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - R Noguchi
- Faculty of Science, Niigata University, Niigata 950-2181, Japan
| | - H Noda
- National Astronomical Observatory of Japan, Mitaka 181-8588, Japan
| | - M Nishimura
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - N Namiki
- Department of Space and Astronautical Science, The Graduate University for Advanced Studies (SOKENDAI), Hayama 240-0193, Japan.,National Astronomical Observatory of Japan, Mitaka 181-8588, Japan
| | - S Nakazawa
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - T Morota
- Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan
| | - A Miyazaki
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - A Miura
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - Y Mimasu
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - K Matsumoto
- Department of Space and Astronautical Science, The Graduate University for Advanced Studies (SOKENDAI), Hayama 240-0193, Japan.,National Astronomical Observatory of Japan, Mitaka 181-8588, Japan
| | - K Kumagai
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Marine Works Japan, Yokosuka 237-0063, Japan
| | - T Kouyama
- Digital Architecture Research Center, National Institute of Advanced Industrial Science and Technology, Tokyo 135-0064, Japan
| | - S Kikuchi
- Planetary Exploration Research Center, Chiba Institute of Technology, Narashino 275-0016, Japan.,National Astronomical Observatory of Japan, Mitaka 181-8588, Japan
| | - K Kawahara
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - S Kameda
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Department of Physics, Rikkyo University, Tokyo 171-8501, Japan
| | - T Iwata
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Department of Space and Astronautical Science, The Graduate University for Advanced Studies (SOKENDAI), Hayama 240-0193, Japan
| | - Y Ishihara
- JAXA Space Exploration Center, JAXA, Sagamihara 252-5210, Japan
| | - M Ishiguro
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Korea
| | - H Ikeda
- Research and Development Directorate, JAXA, Sagamihara 252-5210, Japan
| | - S Hosoda
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - R Honda
- Department of Information Science, Kochi University, Kochi 780-8520, Japan.,Center for Data Science, Ehime University, Matsuyama 790-8577, Japan
| | - C Honda
- Aizu Research Center for Space Informatics, The University of Aizu, Aizu-Wakamatsu 965-8580, Japan
| | - Y Hitomi
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Marine Works Japan, Yokosuka 237-0063, Japan
| | - N Hirata
- Department of Planetology, Kobe University, Kobe 657-8501, Japan
| | - N Hirata
- Aizu Research Center for Space Informatics, The University of Aizu, Aizu-Wakamatsu 965-8580, Japan
| | - T Hayashi
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - M Hayakawa
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - K Hatakeda
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Marine Works Japan, Yokosuka 237-0063, Japan
| | - S Furuya
- Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan
| | - R Fukai
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - A Fujii
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
| | - Y Cho
- Department of Earth and Planetary Science, The University of Tokyo, Tokyo 113-0033, Japan
| | - M Arakawa
- Department of Planetology, Kobe University, Kobe 657-8501, Japan
| | - M Abe
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan.,Department of Space and Astronautical Science, The Graduate University for Advanced Studies (SOKENDAI), Hayama 240-0193, Japan
| | - S Watanabe
- Department of Earth and Environmental Sciences, Nagoya University, Nagoya 464-8601, Japan
| | - Y Tsuda
- Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency (JAXA), Sagamihara 252-5210, Japan
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5
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Abe S, Asami S, Eizuka M, Futagi S, Gando A, Gando Y, Gima T, Goto A, Hachiya T, Hata K, Hayashida S, Hosokawa K, Ichimura K, Ieki S, Ikeda H, Inoue K, Ishidoshiro K, Kamei Y, Kawada N, Kishimoto Y, Koga M, Kurasawa M, Maemura N, Mitsui T, Miyake H, Nakahata T, Nakamura K, Nakamura K, Nakamura R, Ozaki H, Sakai T, Sambonsugi H, Shimizu I, Shirai J, Shiraishi K, Suzuki A, Suzuki Y, Takeuchi A, Tamae K, Ueshima K, Watanabe H, Yoshida Y, Obara S, Ichikawa AK, Chernyak D, Kozlov A, Nakamura KZ, Yoshida S, Takemoto Y, Umehara S, Fushimi K, Kotera K, Urano Y, Berger BE, Fujikawa BK, Learned JG, Maricic J, Axani SN, Smolsky J, Fu Z, Winslow LA, Efremenko Y, Karwowski HJ, Markoff DM, Tornow W, Dell'Oro S, O'Donnell T, Detwiler JA, Enomoto S, Decowski MP, Grant C, Li A, Song H. Search for the Majorana Nature of Neutrinos in the Inverted Mass Ordering Region with KamLAND-Zen. Phys Rev Lett 2023; 130:051801. [PMID: 36800472 DOI: 10.1103/physrevlett.130.051801] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/10/2022] [Accepted: 11/29/2022] [Indexed: 06/18/2023]
Abstract
The KamLAND-Zen experiment has provided stringent constraints on the neutrinoless double-beta (0νββ) decay half-life in ^{136}Xe using a xenon-loaded liquid scintillator. We report an improved search using an upgraded detector with almost double the amount of xenon and an ultralow radioactivity container, corresponding to an exposure of 970 kg yr of ^{136}Xe. These new data provide valuable insight into backgrounds, especially from cosmic muon spallation of xenon, and have required the use of novel background rejection techniques. We obtain a lower limit for the 0νββ decay half-life of T_{1/2}^{0ν}>2.3×10^{26} yr at 90% C.L., corresponding to upper limits on the effective Majorana neutrino mass of 36-156 meV using commonly adopted nuclear matrix element calculations.
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Affiliation(s)
- S Abe
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - S Asami
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - M Eizuka
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - S Futagi
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - A Gando
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - Y Gando
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - T Gima
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - A Goto
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - T Hachiya
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Hata
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - S Hayashida
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Hosokawa
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Ichimura
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - S Ieki
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - H Ikeda
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Inoue
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - K Ishidoshiro
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - Y Kamei
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - N Kawada
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - Y Kishimoto
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - M Koga
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - M Kurasawa
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - N Maemura
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - T Mitsui
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - H Miyake
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - T Nakahata
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Nakamura
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Nakamura
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - R Nakamura
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - H Ozaki
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
- Graduate Program on Physics for the Universe, Tohoku University, Sendai 980-8578, Japan
| | - T Sakai
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - H Sambonsugi
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - I Shimizu
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - J Shirai
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Shiraishi
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - A Suzuki
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - Y Suzuki
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - A Takeuchi
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Tamae
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - K Ueshima
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - H Watanabe
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - Y Yoshida
- Research Center for Neutrino Science, Tohoku University, Sendai 980-8578, Japan
| | - S Obara
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai 980-8578, Japan
| | - A K Ichikawa
- Department of Physics, Tohoku University, Sendai 980-8578, Japan
| | - D Chernyak
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - A Kozlov
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
| | - K Z Nakamura
- Kyoto University, Department of Physics, Kyoto 606-8502, Japan
| | - S Yoshida
- Graduate School of Science, Osaka University, Toyonaka, Osaka 560-0043, Japan
| | - Y Takemoto
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - S Umehara
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - K Fushimi
- Department of Physics, Tokushima University, Tokushima 770-8506, Japan
| | - K Kotera
- Graduate School of Integrated Arts and Sciences, Tokushima University, Tokushima 770-8502, Japan
| | - Y Urano
- Graduate School of Integrated Arts and Sciences, Tokushima University, Tokushima 770-8502, Japan
| | - B E Berger
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - B K Fujikawa
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - J G Learned
- Department of Physics and Astronomy, University of Hawaii at Manoa, Honolulu, Hawaii 96822, USA
| | - J Maricic
- Department of Physics and Astronomy, University of Hawaii at Manoa, Honolulu, Hawaii 96822, USA
| | - S N Axani
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J Smolsky
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Z Fu
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - L A Winslow
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Y Efremenko
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - H J Karwowski
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA; Physics Departments at Duke University, Durham, North Carolina 27708, USA; North Carolina Central University, Durham, North Carolina 27707, USA; and The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - D M Markoff
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA; Physics Departments at Duke University, Durham, North Carolina 27708, USA; North Carolina Central University, Durham, North Carolina 27707, USA; and The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - W Tornow
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA; Physics Departments at Duke University, Durham, North Carolina 27708, USA; North Carolina Central University, Durham, North Carolina 27707, USA; and The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - S Dell'Oro
- Center for Neutrino Physics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA
| | - T O'Donnell
- Center for Neutrino Physics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia 24061, USA
| | - J A Detwiler
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
- Center for Experimental Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - S Enomoto
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
- Center for Experimental Nuclear Physics and Astrophysics, University of Washington, Seattle, Washington 98195, USA
| | - M P Decowski
- Kavli Institute for the Physics and Mathematics of the Universe (WPI), The University of Tokyo Institutes for Advanced Study, The University of Tokyo, Kashiwa, Chiba 277-8583, Japan
- Nikhef and the University of Amsterdam, Science Park, Amsterdam, Netherlands
| | - C Grant
- Boston University, Boston, Massachusetts 02215, USA
| | - A Li
- Triangle Universities Nuclear Laboratory, Durham, North Carolina 27708, USA; Physics Departments at Duke University, Durham, North Carolina 27708, USA; North Carolina Central University, Durham, North Carolina 27707, USA; and The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
- Boston University, Boston, Massachusetts 02215, USA
| | - H Song
- Boston University, Boston, Massachusetts 02215, USA
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6
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Oka T, Koyama Y, Inoue K, Tanaka N, Tanaka K, Hirao Y, Okada M, Okamura A, Iwakura K, Fujii K, Masuda M, Watanabe T, Sunaga A, Hikoso S, Sakata Y. Extensive ablation strategy for persistent atrial fibrillation impairs left atrial function but reduces recurrence rate. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In catheter ablation for persistent atrial fibrillation (AF), extensive ablation strategy, such as linear ablation and/or complex fractionated atrial electrogram (CFAE) ablation in addition to pulmonary vein isolation (PVI-plus), might impair left atrial function more severely than PVI-alone strategy.
Purpose
The aim of this study is to investigate the impact of extensive ablation strategy on LA function and assess the relationship between post-ablation LA function and recurrence.
Methods
This study is a post-hoc subanalysis of the EARNEST-PVI randomized controlled trial, which investigated the efficacy of the PVI-alone strategy in comparison with PVI-plus strategy for persistent AF. From the 497 participants of EARNEST-PVI trial, we enrolled 191 patients with full datasets of pre- and post-ablation cardiac computed tomography (CT) at our Hospital. Patients were divided into PVI-alone and PVI-plus groups. Within one month before and 3 months after ablation, LA volume index (LAVI) and LA emptying fraction (LAEF) were calculated by using the Comprehensive Cardiac Analysis software on the Extended Brilliance Workspace. We assessed i) post-ablation LA function, ii) AF/atrial tachycardia (AT) -free rate after single and final session, and iii) relationship between post-ablation LAEF and ablation success in each group.
Results
The indices of baseline LA remodeling were not different between PVI-alone (N=96) and PVI-plus groups (N=95) [LAVI: 71.4 (57.8, 82.0) vs. 68.7 (61.0, 78.1), P=0.92, LAEF: 13.7 (10.0, 17.4) vs. 13.0 (10.0, 16.9), PVI-alone vs. PVI-plus, P=0.78]. In overall patients, post-ablation LAEF did not differ among them [34.4 (26.1, 40.7) vs. 31.6 (26.0, 37.4), P=0.13]. In the analysis of patients showing sinus rhythm during the CT study, LAEF was significantly higher in PVI-alone (N=87) than in PVI-plus group (N=93) [35.7 (29.0, 41.0) vs. 31.7 (26.1, 37.5), P=0.011] (Figure 1A). AF/AT-free survival rate during median follow-up of 44 months was not different after first session (63.5% vs. 68.4%, P=0.33), while PVI-plus had a tendency towards higher success rate after final session (72.9% vs. 84.2%, P=0.053) (Figure 2). In receiver operating characteristics analysis for recurrence after first session, post-ablation decreased LAEF had significantly related to recurrence after PVI-alone (AUC: 0.733, P<0.0001), but not after PVI-plus (AUC: 0.567, P=0.31) (Figure 1B, C).
Conclusion
Compared with PVI-alone strategy, PVI-plus strategy damaged LA function more severely, but tended to be related to higher success rate. Post-ablation LA function was related to recurrence in PVI-alone, but not in PVI-plus. Extensive ablation might have additional anti-arrhythmic effect regardless of iatrogenic myocardial damage. Myocardial injury by extensive ablation may less attribute to recurrence than intrinsic damage of LA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Oka
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine , Suita , Japan
| | - Y Koyama
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division , Osaka , Japan
| | - K Inoue
- National Hospital Organization Osaka National Hospital , Osaka , Japan
| | - N Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division , Osaka , Japan
| | - K Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division , Osaka , Japan
| | - Y Hirao
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division , Osaka , Japan
| | - M Okada
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division , Osaka , Japan
| | - A Okamura
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division , Osaka , Japan
| | - K Iwakura
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division , Osaka , Japan
| | - K Fujii
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division , Osaka , Japan
| | - M Masuda
- Kansai Rosai Hospital , Amagasaki , Japan
| | - T Watanabe
- Osaka General Medical Center , Osaka , Japan
| | - A Sunaga
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine , Suita , Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine , Suita , Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine , Suita , Japan
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7
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Tanaka N, Inoue K, Hirao Y, Koyama Y, Okamura A, Iwakura K, Okada M, Tanaka K, Kobori A, Kaitani K, Morimoto T, Morishima I, Kusano K, Kimura T, Shizuta S. Sex differences in terms of recurrent atrial fibrillation after catheter ablation according to the history of heart failure: insights from the Kansai Plus Atrial Fibrillation (KPAF) registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There are significant differences in the prevalence and prognosis of cardiovascular diseases between male and female. We previously reported that catheter ablation (CA) of atrial fibrillation (AF) was less effective in female than male, but whether their history of heart failure influence the recurrence after CA of AF remains still unknown.
Purpose
We sought to clarify sex differences in terms of AF recurrence after RFCA of AF according to the history of heart failure.
Methods
We conducted a large-scale, prospective, multicenter, observational study (Kansai Plus Atrial Fibrillation Registry). We enrolled 5010 consecutive patients who underwent an initial RFCA of AF at 26 centers (64±10 years; 1369 [27.3%] females; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years.
Results
Fourteen % of female had a history of heart failure prior to CA, while 12.8% of male had a history of heart failure at baseline (p=0.29). The 3-year cumulative incidence of AF recurrence after a single procedure was 43.3% in female and 39.0% in male (log rank P=0.0046). In patients with the history of heart failure, AF recurrence rates were 42.2% in female and 45.8% in male (log rank P=0.51). On the other hand, in patients without history of heart failure, more females experienced AF recurrence (female vs. male, 43.5% vs. 38.0%, log rank P=0.001).
The rate of AF recurrence after multiple procedures was higher in female (24.2% vs. 19.6%, log rank P<0.0001). AF recurrence rates were similar between sexes in patients with history of heart failure (female vs. male, 26.0% vs. 26.7%, log rank P=0.86), while AF recurrence rates were higher in female without history of heart failure than those in male (females vs. males, 23.9% vs. 18.5%, log rank P<0.0001).
Conclusion
The Kansai Plus Atrial Fibrillation Registry revealed a distinct sex difference in terms of the AF recurrence after CA of AF. Females had higher recurrence rates compared with males in patients without history of heart failure, while recurrence rates were similar between sexes in patients with history of heart failure.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Research Institute for Production Development in Kyoto, Japan.
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Affiliation(s)
- N Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - Y Hirao
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - Y Koyama
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - A Okamura
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - K Iwakura
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - M Okada
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - K Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovascular Center , Osaka , Japan
| | - A Kobori
- Kobe City Medical Center General Hospital , Kobe , Japan
| | - K Kaitani
- Japanese Red Cross Otsu Hospital , Otsu , Japan
| | - T Morimoto
- Hyogo Medical University , Nishinomiya , Japan
| | | | - K Kusano
- National Cerebral & Cardiovascular Center , Suita , Japan
| | - T Kimura
- Kyoto University Graduate School of Medicine , Kyoto , Japan
| | - S Shizuta
- Kyoto University Graduate School of Medicine , Kyoto , Japan
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8
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Sunaga A, Tanaka N, Masuda M, Watanabe T, Kida H, Oeun B, Sato T, Sotomi Y, Dohi T, Okada K, Mizuno H, Nakatani D, Hikoso S, Inoue K, Sakata Y. Premature atrial contraction on Holter electrocardiogram predicts the recurrence of atrial fibrillation after catheter ablation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
It is important to detect the recurrence of atrial fibrillation (AF) after catheter ablation (CA) early, but the method of detection has not been established. The purpose of this study is to determine whether 24-h Holter electrocardiogram (ECG) can predict the recurrence of AF after CA.
Methods
We studied 336 patients of 497 patients enrolled in EARNEST-PVI trial to investigate whether the total number of premature atrial contraction (PAC) and the maximum number of PAC run by 24-h Holter ECG at 6 months after CA predicted AF recurrence after 6 months. We excluded 86 patients with recurrence by 6 months after CA and 75 patients without Holter ECG at 6 months after CA.
Results
Median age was 66 years, male were 77% and median follow-up period was 1138 days. Receiver operating characteristic curve analysis identified the total number of PAC ≥270 beats and the maximum number of PAC run ≥8 beats as the optimal cutoff for prediction of AF recurrence. Kaplan-Meier analysis showed patients with the total number of PAC ≥270 beats had more frequent AF recurrence than those without (Kaplan-Meier estimated 3-year AF recurrence rate 34% vs. 17%, Log-rank P=0.001) and patients with the maximum number of PAC run ≥8 beats had more frequent AF recurrence than those without (Kaplan-Meier estimated 3-year AF recurrence rate 33% vs. 20%, Log-rank P=0.006). Multivariate analysis revealed that the total number of PAC ≥270 beats and the maximum number of PAC run were significantly associated with AF recurrence (hazard ratio [95% confidence interval] 1.83 [1.16–2.91], P=0.01 and 1.01 [1.01–1.02], P=0.001, respectively)
Conclusion
The total number of PAC and the maximum number of PAC run on the Holter ECG may be useful in predicting AF recurrence after CA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Sunaga
- Osaka University Graduate School of Medicine , Suita , Japan
| | - N Tanaka
- Sakurabashi-Watanabe Hospital , Osaka , Japan
| | - M Masuda
- Kansai Rosai Hospital , Amagasaki , Japan
| | - T Watanabe
- Osaka General Medical Center, Cardiology , Osaka , Japan
| | - H Kida
- Osaka University Graduate School of Medicine , Suita , Japan
| | - B Oeun
- Osaka University Graduate School of Medicine , Suita , Japan
| | - T Sato
- Osaka University Graduate School of Medicine , Suita , Japan
| | - Y Sotomi
- Osaka University Graduate School of Medicine , Suita , Japan
| | - T Dohi
- Osaka University Graduate School of Medicine , Suita , Japan
| | - K Okada
- Osaka University Graduate School of Medicine , Suita , Japan
| | - H Mizuno
- Osaka University Graduate School of Medicine , Suita , Japan
| | - D Nakatani
- Osaka University Graduate School of Medicine , Suita , Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine , Suita , Japan
| | - K Inoue
- National Hospital Organization Osaka National Hospital , Osaka , Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine , Suita , Japan
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Ohno H, Mano S, Katagiri N, Oguri R, Miyazaki K, Ito K, Sekiya Y, Inoue K, Masuda A, Tsuzuku A, Asano F, Hirashita T, Hayashi T. Influence of using history of immune checkpoint inhibitor therapy for neutropenia caused by combination therapy of ramucirumab and docetaxel. Pharmazie 2022; 77:248-254. [PMID: 36199179 DOI: 10.1691/ph.2022.2403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Recently, pretreatment with immune checkpoint inhibitors (ICIs) has been shown to enhance the therapeutic effects of the combination therapy of ramucirumab (RAM) and docetaxel (DTX); however, its influence on the drug's side effects remains unclear. This study investigated the influence of pretreatment with ICIs on the incidence of neutropenia caused by RAM + DTX therapy in patients with non-small cell lung cancer (NSCLC). Patients with NSCLC who received RAM + DTX therapy at Gifu Prefectural General Medical Center between April 2016 and December 2020 were enrolled. Retrospective data regarding age, sex, performance status and detailed treatment history, among others, at treatment initiation were collected from the patients' electronic medical records. Additionally, data on the course number of RAM + DTX therapy, supportive therapy and blood biochemical parameters, including leukocyte and neutrocyte counts, during the treatment period were collected. We identified 41 patients receiving RAM + DTX therapy. Among the more than grade 3 adverse events caused by this therapy, neutropenia was the most common (78.1%). Despite the fact that all previous risk factors influencing this incidence rate had corresponded, the only factor influencing the incidence rate of neutropenia more than grade 3 was ICI treatment history. A difference in the incidence of neutropenia more than grade 3 in the Kaplan-Meier curve was observed between patients with and without ICI pretreatment history (p = 0.037). The pretreatment history of ICI therapy affects the incidence of neutropenia caused by RAM + DTX therapy in patients with NSCLC.
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Affiliation(s)
- H Ohno
- Department of Pharmacy, Gifu Prefectural General Medical Center, Gifu, Japan
| | - S Mano
- Department of Pharmacy, Gifu Prefectural General Medical Center, Gifu, Japan
| | - N Katagiri
- College of Pharmacy, Kinjo Gakuin University, Nagoya, Japan
| | - R Oguri
- Department of Pharmacy, Gifu Prefectural General Medical Center, Gifu, Japan
| | - K Miyazaki
- Department of Pharmacy, Gifu Prefectural General Medical Center, Gifu, Japan
| | - K Ito
- Department of Pharmacy, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Y Sekiya
- Department of Pharmacy, Gifu Prefectural General Medical Center, Gifu, Japan
| | - K Inoue
- Department of Pharmacy, Gifu Prefectural General Medical Center, Gifu, Japan
| | - A Masuda
- Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, Gifu, Japan
| | - A Tsuzuku
- Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, Gifu, Japan
| | - F Asano
- Department of Pulmonary Medicine, Gifu Prefectural General Medical Center, Gifu, Japan
| | - T Hirashita
- Department of Pharmacy, Gifu Prefectural General Medical Center, Gifu, Japan
| | - T Hayashi
- College of Pharmacy, Kinjo Gakuin University, Nagoya, Japan;,
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10
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Inoue K, Misaki K, Dobashi N, Yabe M, Mako Y, Tarutani Y, Imaizumi Y. AB0431 THE EFFICACY OF BELIMUMAB (BEL) AS A SPARING CORTICOSTEROID AGENCY IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with SLE are recommended to continue the maintenance therapy with as less glucocorticoid as possible.1) However, tapering glucocorticoid often results in the recurrence of SLE. Current reports suggested that adding BEL to the standard therapy could lead to the reduction of glucocorticoid and the recurrence of SLE.2)ObjectivesThe aim of this study is to evaluate the efficacy and the safety of BEL as co-treatment in the standard therapy of SLE.MethodsFourteen patients receiving the maintenance therapy of SLE were enrolled in this study. Dose of prednisolone (PSL), titer of anti-DNA antibody, WBC count, serum complement and SLE disease activity index (SLEDAI) were examined retrospectively at baseline and 24 months after administration of BEL.ResultsAt the baseline, the mean age of patients was 48 years old, 11 patients were female, and the mean disease duration was 8.6 years. The mean dose of PSL was significantly reduced (meansease apre-administration of BEL:6.1±1.1 mg/day, 24 months after administration of BEL: 1.2 the baseline,p=0.001). Furthermore, six patients (43 %) could withdraw PSL without the flare of the disease. There were also statistical significance about SLEDAI between baseline and after treatment by BEL(2.1patients (43 %) cp=0.03) and the titer of anti-DNA antibody (6.8 withdraw PSL without tp=0.03). There were no statistical significant in WBC count (6177out the fla7e of the dp=0.24) and serum complement (C3 87significant in WBC count (61p=0.78, C4 20erum complement (C3 87signifp=0.54).As for adverse event, bacterial pneumonia (n=1) and pulmonary cryptococcosis (n=1) was revealed.ConclusionOur study is suggested that co-treatment with BEL on standard SLE therapy was enable to prevent the flare of SLE and reduce the dose of PSL with statistical significance among the patients under the maintenance treatment of SLE. In almost half of the cases, patients could withdraw PSL without the flare.References[1]Ann Rheum Dis 2019; 78: 736-745.[2]Ann Rheum Dis 2018; 77: 355-745.Disclosure of InterestsNone declared
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11
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Ohkura N, Taniguchi M, Oishi K, Inoue K, Ohta M. Angelica keiskei (Ashitaba) has potential as an antithrombotic health food. Food Res 2022. [DOI: 10.26656/fr.2017.6(2).121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Angelica keiskei (Ashitaba) is a large perennial herb that is native to the Pacific coast of
Japan. It has recently become popular as a healthy food in Asian countries because it
might have various physiological benefits including antithrombotic properties. Most
studies of the bioactive constituents from Ashitaba have focused on the activities of the
major chalcones, xanthoangelol and 4-hydroxyderricin. However, other chalcones,
flavanones and coumarins have also been isolated from Ashitaba, precisely characterized,
and investigated in vivo. Platelets play a key role in haemostasis and wound healing
processes. Dysregulated platelet activity is associated with the progression of platelet
aggregation and decreased venous blood flow, which results in thrombotic diseases. A
minor chalcone, xanthoangelol E, inhibits TXB2 synthesis in rabbit platelets, which seems
to be the source of the belief that Ashitaba has antithrombotic properties. However, recent
data showed that xanthoangelol and 4-hydroxyderricin inhibited the aggregation of rabbit
platelets. Platelet aggregation stimulated by collagen was also inhibited in whole blood
incubated with Xanthoangelol or 4-hydroxyderricin. Plasminogen activator inhibitor-1 is
the primary physiological inhibitor of tissue type plasminogen activator, a key protease of
the fibrinolytic system. An increase in plasma of this inhibitor is associated with
thrombotic conditions. Ashitaba yellow exudate inhibited the elevation of plasma
plasminogen activator inhibitor-1 in mice induced by obesity or chronic low-grade
inflammation. These studies showed the yellow exudate from stem cuttings and chalcones
isolated from Ashitaba roots and leaves might have antithrombotic activity. This article
reviews the possible antithrombotic properties of Ashitaba.
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12
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Okada M, Inoue K, Tanaka N, Masuda M, Furukawa Y, Hirata A, Egami Y, Watanabe T, Minamiguchi H, Miyoshi M, Sunaga A, Sotomi Y, Dohi T, Shungo H, Sakata Y. Impact of heart rate reduction on recurrence after catheter ablation of persistent atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehab849.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Johnson & Johnson KK
OnBehalf
OCVC Arrhythmia Investigators
Background
Predicting heart rate (HR) after restoration of sinus rhythm (SR) remains one of the challenges when performing catheter ablation (CA) of persistent atrial fibrillation (AF).
Purpose
To evaluate the association between pre-ablation HR during AF and post-ablation HR during SR, and whether the HR reduction is associated with AF recurrence.
Methods
The analysis was performed from the EARNEST-PVI trial, a randomized controlled trial designed to assess a CA strategy for persistent AF, which was conducted in the Osaka region of Japan. After excluding patients with beta-blocker prescription, a total of 216 patients (median age, 67 years; 20% female; 23% long-standing persistent AF) with AF rhythm at baseline and SR at discharge were enrolled in this study. Baseline HR during AF and post-ablation HR during SR was measured on admission and at discharge using the 12-lead electrocardiograms, respectively.
Results
There was a mild correlation between baseline HR (median 82 [interquartile range 72-95] bpm) and post-ablation HR (78 [48-117] bpm) (r = 0.27, p <0.001). Reduction in HR was positively associated with baseline HR (r = 0.79, p <0.001) and was negatively associated with post-ablation HR (r = - 0.37, p <0.001). During the follow-up of 1 year, 56 patients (25.9%) experienced AF recurrence. HR reduction had the higher diagnostic accuracy in predicting AF recurrence than HR at baseline and HR after CA (area under the curve, 0.625; 95% confidence interval, 0.557–0.690; p = 0.003). AF recurrence rate was significantly higher in 141 patients with smaller HR reduction (cut-off, <14bpm) than those with larger HR reduction (31.9% vs. 14.7%, p = 0.009). After adjustment of age, gender, long-standing persistent AF, and CA strategy, HR reduction of <14 bpm was a significant predictor of AF recurrence (hazard ratio, 2.32; 95% confidence interval, 1.20–4.51; p = 0.013).
Conclusions
There was a mild correlation between HR during AF and HR after restoration of SR in patients underwent CA of persistent AF. HR reduction after restoration of SR predicted AF recurrence.
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Affiliation(s)
- M Okada
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - N Tanaka
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - M Masuda
- Kansai Rosai Hospital, Amagasaki, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - A Hirata
- Osaka Police Hospital, Osaka, Japan
| | - Y Egami
- Osaka Rosai Hospital, Osaka, Japan
| | | | | | - M Miyoshi
- Osaka Kouseinenkin Hospital, Osaka, Japan
| | - A Sunaga
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Sotomi
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - T Dohi
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - H Shungo
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Osaka, Japan
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13
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Takada K, Takamori S, Shimokawa M, Toyokawa G, Shimamatsu S, Hirai F, Tagawa T, Okamoto T, Hamatake M, Tsuchiya-Kawano Y, Otsubo K, Inoue K, Yoneshima Y, Tanaka K, Okamoto I, Nakanishi Y, Mori M. Assessment of the albumin-bilirubin grade as a prognostic factor in patients with non-small-cell lung cancer receiving anti-PD-1-based therapy. ESMO Open 2021; 7:100348. [PMID: 34942439 PMCID: PMC8695291 DOI: 10.1016/j.esmoop.2021.100348] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 09/28/2021] [Accepted: 11/20/2021] [Indexed: 02/08/2023] Open
Abstract
Introduction The albumin-bilirubin (ALBI) grade is a novel indicator of the liver function. Some studies showed that the ALBI grade was a prognostic and predictive biomarker for the efficacy of chemotherapy in cancer patients. The association between the ALBI grade and outcomes in patients with non-small-cell lung cancer (NSCLC) treated with cancer immunotherapy, however, is poorly understood. Methods We retrospectively enrolled 452 patients with advanced or recurrent NSCLC who received anti-programmed cell death protein 1 (PD-1)-based therapy between 2016 and 2019 at three medical centers in Japan. The ALBI score was calculated from albumin and bilirubin measured at the time of treatment initiation and was stratified into three categories, ALBI grade 1-3, with reference to previous reports. We examined the clinical impact of the ALBI grade on the outcomes of NSCLC patients receiving anti-PD-1-based therapy using Kaplan–Meier survival curve analysis with log-rank test and Cox proportional hazards regression analysis. Results The classifications of the 452 patients were as follows: grade 1, n = 158 (35.0%); grade 2, n = 271 (60.0%); and grade 3, n = 23 (5.0%). Kaplan–Meier survival curve analysis showed that the ALBI grade was significantly associated with progression-free survival and overall survival. Moreover, Cox regression analysis revealed that the ALBI grade was an independent prognostic factor for progression-free survival and overall survival. Conclusion The ALBI grade was an independent prognostic factor for survival in patients with advanced or recurrent NSCLC who receive anti-PD-1-based therapy. These findings should be validated in a prospective study with a larger sample size. ALBI grade is calculated from albumin and bilirubin. We evaluated the impact of ALBI grade on survival in NSCLC patients receiving immune checkpoint inhibitors. ALBI grade was an independent prognostic factor for progression-free survival (PFS) and overall survival (OS). ALBI grade effectively stratified PFS and OS in patients with performance status 1-3. ALBI grade was significantly associated with PFS and OS, regardless of programmed death ligand-1.
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Affiliation(s)
- K Takada
- Department of Thoracic Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Fukuoka, Japan.
| | - S Takamori
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
| | - M Shimokawa
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan; Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - G Toyokawa
- Department of Thoracic Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - S Shimamatsu
- Department of Thoracic Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Fukuoka, Japan
| | - F Hirai
- Department of Thoracic Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Fukuoka, Japan
| | - T Tagawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Okamoto
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - M Hamatake
- Department of Thoracic Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Fukuoka, Japan
| | - Y Tsuchiya-Kawano
- Department of Respiratory Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Fukuoka, Japan
| | - K Otsubo
- Department of Respiratory Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Fukuoka, Japan
| | - K Inoue
- Department of Respiratory Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Fukuoka, Japan
| | - Y Yoneshima
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - K Tanaka
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - I Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Y Nakanishi
- Department of Respiratory Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Fukuoka, Japan
| | - M Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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14
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Inoue K, Shiozaki M, Sasaki S, Sasaki Y, Tamura H, Fukuda K, Kubota N, Hiki M, Funamizu T, Sumiyoshi M, Minamino T. Determination of physiological cardiac myosin-binging protein levels (cMyc) in healthy populations. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac myosin–binding protein C (cMyC) is a cardiac-restricted protein that has more abundant, rapid release and clearance kinetics than cardiac troponin. The current ESC guideline suggests the cMyC may provide value as an alternative to cardiac troponin. The 99th percentile value is universally endorsed as the reference cut off to aid in the diagnosis of acute myocardial infarction (AMI), however, none of the report of healthy population of cMyC.
Purpose
The aim of this study was to evaluate the distribution of cMyC values in healthy subjects.
Methods
We used two cohorts in this retrospective study. 1) Healthy subjects; a total of 500 subjects (250 men and 250 women) who had annual health examinations in 2012 in the area of Kamigoto, a suburb of Nagasaki city in Southern Japan were enrolled. All participants showed none of abnormal findings including cell blood counts, chemical analysis, liver function tests, general urine tests, occult blood tests of stool, barium swallow, mammography for women, abdominal ultrasound sonography, and electrocardiogram. All blood samples were obtained in a fasting state in the morning. 2) Chest pain subjects; we collected samples from 250 subjects including 50 with non-ST elevation myocardial infarction visited admitted to a university hospital for measurement of high-sensitivity troponin T and coronary artery assessment by coronary angiography. We measured cMyC level in both cohorts by HISCL™-800 system (Sysmex corporation, Japan). The assay has a limit of detection of 0.5 ng/L and a lower limit of quantification of 1.3 ng/L.
Result
In healthy subjects, median age (IQR) was 44 (20, 82) in men and 50 (23, 91) in women. The 99th percentile of cMyC was 27.3 ng/L, which was around one-third lower than that in previous report (87 ng/L). In chest pain subjects, the concentrations of cMyC at presentation were significantly higher in those with versus without AMI (median, 66 ng/L versus 10 ng/L, P<0.001). Discriminatory power for AMI, as quantified by the area under the receiver-operating characteristic curve (AUC), was comparable for cMyC (AUC, 0.85 (95% CI 0.79–0.91) and hs-cTnT (AUC, 0.81 (95% CI 0.76–0.88)).
Conclusion
We defined the normal range of cMyC in healthy Japanese subjects. The level of cMyC at presentation provides discriminatory power comparable to hs-cTnT in the diagnosis of AMI. To determine the physiological value of a biomarker may be necessary to evaluate enough information about their health status.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Scientific Research
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Affiliation(s)
- K Inoue
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Shiozaki
- Tokyo Metropolitan Tama Medical Center, Cardiology, Tokyo, Japan
| | - S Sasaki
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - Y Sasaki
- Sysmex R&D Center Europe GmbH, Hamburg, Germany
| | - H Tamura
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - K Fukuda
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - N Kubota
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Hiki
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - T Funamizu
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - M Sumiyoshi
- Juntendo University Nerima Hospital, Tokyo, Japan
| | - T Minamino
- Juntendo University School of Medicine, Tokyo, Japan
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15
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Okada M, Tanaka N, Tanaka K, Hirao Y, Harada S, Onishi T, Koyama Y, Okamura A, Iwakura K, Fujii K, Inoue K. Association between myocardial wall thickness and left ventricular functional recovery after catheter ablation of atrial fibrillation in patients with reduced ejection fraction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Catheter ablation of atrial fibrillation (AFCA) is an effective treatment to develop left ventricular (LV) functional recovery. However, the degree of recovery differs between individuals due to the different extent of myocardial fibrosis and scarring.
Purpose
To examine whether pre-ablation LV wall thickness (WT) and its regional heterogeneity predict LV functional recovery after AFCA in patients with LV systolic dysfunction.
Methods
Of 3682 consecutive patients who underwent first-time AFCA between January 2012 and September 2020 in our institution, 174 (age, 63±10 years; male, 83%; ischemic cardiomyopathy, 14%) with a baseline LV ejection fraction (LVEF) of <40% were retrospectively evaluated. They were subjected to 256-slice MDCT scanning at baseline and 3 months after AFCA. Baseline WT was evaluated by 16-segment model. Mean and standard deviation (SD) of 16 regional WT were calculated in both end-systolic and end-diastolic phase.
Results
LVEF significantly improved from 30±7% to 57±17% (p<0.001) after AFCA. Increase in LVEF (delta-LVEF) was positively correlated with baseline end-diastolic WT (r=0.31, p<0.001) and negatively correlated with SD of end-systolic WT (r=−0.21, p=0.007). Independent of WT measurements, delta-LVEF was negatively correlated with LV end-diastolic volume (r=−0.42, p<0.001). We created a scoring system to predict the degree of wall motion recovery using the median value of the 3 variables; assigned 1 point each for end-diastolic WT >7.4mm, SD of end-systolic WT <1.61mm, and LV end-diastolic volume <125ml. The model successfully predicted improvement in LVEF after AFCA (0 point (N=13) vs. 1 point (N=72) vs. 2–3 point (N=89), 11±16% vs. 20±17% vs. 33±12%, p<0.001).
Conclusion
Myocardial WT and its regional heterogeneity as well as LV end-diastolic volume predicted functional recovery after AFCA in patients with reduced LVEF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Okada
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - N Tanaka
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Tanaka
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Y Hirao
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - S Harada
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - T Onishi
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Y Koyama
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - A Okamura
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Iwakura
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Fujii
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Osaka, Japan
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16
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Saito M, Nakao Y, Inoue K, Higaki R, Yokomoto Y, Ogimoto A, Suzuki M, Kawakami H, Hiasa G, Okayama H, Ikeda S, Yamaguchi O. Exploration of electrocardiographic and echocardiographic findings to screen transthyretin amyloid cardiomyopathy in patients with mild left ventricular hypertrophy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The transthyretin amyloid cardiomyopathy (ATTR-CM), a common condition in the elderly, is a life-threatening disease; however, it is treatable. The early accurate diagnosis is, therefore, an important key to improve the patient's outcomes. Electrocardiography and echocardiography are instant diagnostic tools with red flags for the screening of the ATTR-CM. In fact, ATTR-CM often mimics left ventricular hypertrophy (LVH), and the differential diagnosis is difficult to establish. Thus, the characteristics of cardiac amyloidosis may be obscured in ATTR-CM patients with mild LVH, possibly making the disease difficult to diagnose. Therefore, in this study, the effect of LVH on the occurrence of electrocardiographic and echocardiographic parameters for ATTR-CM was investigated, and their incremental value over the age for the screening of ATTR-CM in the patients with mild LVH was recorded.
Methods
This study retrospectively studied 319 consecutive nonischemic LVH patients with a sinus rhythm who underwent detailed diagnostic tests. The light chain-associated amyloidosis was an exclusion criterion. The mean left ventricular wall thickness (MWT) <12 mm was defined as mild LVH, while MWT ≥12 mm was defined as moderate to severe LVH. The ATTR-CM was diagnosed with biopsy or 99 mTc-PYP scintigraphy. The elderly were defined as people aged ≥65 years in males and ≥70 years in females, according to the literature. Each electrocardiographic and echocardiographic parameter was binarized with an external cut-off point to increase the external validity, being the incremental benefit of each parameter over age for identifying ATTR-CM assessed using a receiver operating characteristic curve analysis and comparisons of the area under the curve (AUC).
Results
Fourteen patients (8%) among the 170 patients with mild LVH had ATTR-CM, while 27 patients (18%) among the 149 patients with moderate to severe LVH had ATTR-CM. The patients with mild LVH had fewer electrocardiographic and echocardiographic parameters, showing a significant difference between ATTR-CM and non-ATTR-CM patients than those with moderate to severe LVH (Table 1). Among several binarized parameters, the voltage-to-mass ratio, E/A ratio, the global longitudinal strain, and also the relative apical sparing pattern demonstrated additive value for identifying the ATTR-CM over aging (Table 2). In addition, the discriminative ability of the propensity score calculated from these four variables and age was considered excellent for the screening of ATTR-CM (AUC = 0.98).
Conclusion
The patients with mild LVH appear to have fewer electrocardiographic and echocardiographic specific findings of the ATTR-CM compared to patients with moderate to severe LVH. However, several red flags may be useful for screening ATTR-CM even in patients with a mild LVH.
Funding Acknowledgement
Type of funding sources: None. Table 1Table 2
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Affiliation(s)
- M Saito
- Kitaishikai Hospital, Ozu, Japan
| | - Y Nakao
- Ehime University, Cardiology, Toon, Japan
| | - K Inoue
- Ehime University, Cardiology, Toon, Japan
| | - R Higaki
- Kitaishikai Hospital, Ozu, Japan
| | - Y Yokomoto
- Uwajima City Hospital, Cardiology, Uwajima, Japan
| | - A Ogimoto
- Uwajima City Hospital, Cardiology, Uwajima, Japan
| | - M Suzuki
- Ehime Prefectural Imabari Hospital, Cardiology, Imabari, Japan
| | - H Kawakami
- Ehime Prefectural Imabari Hospital, Cardiology, Imabari, Japan
| | - G Hiasa
- Ehime Prefectural Central Hospital, Cardiology, Matsuyama, Japan
| | - H Okayama
- Ehime Prefectural Central Hospital, Cardiology, Matsuyama, Japan
| | - S Ikeda
- Ehime University, Cardiology, Toon, Japan
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17
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Okada M, Inoue K, Tanaka N, Masuda M, Furukawa Y, Hirata A, Egami Y, Watanabe T, Minamiguchi H, Miyoshi M, Sunaga A, Sotomi Y, Dohi T, Hikoso S, Sakata Y. Reappraising the role of baseline plasma C-reactive protein levels on recurrence after catheter ablation of persistent atrial fibrillation: insight from EARNEST-PVI trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Subclinical inflammation is an important pathogenesis of developing and sustaining atrial fibrillation (AF). Because AF itself contribute to the inflammatory response, the role of baseline subclinical inflammation on AF recurrence after catheter ablation (CA) remains controversial in patients with persistent AF.
Purpose
To evaluate whether baseline plasma C-reactive protein (CRP) levels, a sensitive marker of inflammation, are associated with AF recurrence following CA.
Methods
The analysis was performed from the EARNEST-PVI trial, a randomized controlled trial designed to assess a CA strategy for persistent AF, which was conducted in the Osaka region of Japan. A total of 441 patients (median age, 67 years; 26% female; 25% long-standing persistent AF) whose plasma CRP levels were measured at baseline were included in this study.
Results
At baseline, a median (interquartile range) of plasma CRP level was 0.10 [0.06–0.19] mg/dl. Plasma CRP levels significantly increased at discharge (0.83 [0.21–1.84] mg/dl, p<0.001) and decreased 1 year after CA (0.10 [0.05–0.20] mg/dl, p=0.040) compared to the baseline value. During the follow-up of 1 year, 115 patients (26%) experienced AF recurrence, and the incidence was significantly higher in 124 patients with low CRP levels at baseline (cut-off ≤0.06 mg/dl) than the other 317 patients (33.9% vs. 23.0%, p=0.017). After adjustment of age, gender, body mass index, long-standing persistent AF, CA strategy, and plasma brain natriuretic peptide levels, low plasma CRP levels was a significant predictor of AF recurrence (hazard ratio, 1.51; 95% confidence interval, 1.02–2.24; p=0.042).
Conclusions
Low plasma CRP levels at baseline predicted AF recurrence in the EARNEST-PVI trial. Reappraising the role of CRP on AF recurrence may be needed in patients with persistent AF.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Johnson & Johnson KK
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Affiliation(s)
- M Okada
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - N Tanaka
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - M Masuda
- Kansai Rosai Hospital, Amagasaki, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - A Hirata
- Osaka Police Hospital, Osaka, Japan
| | - Y Egami
- Osaka Rosai Hospital, Osaka, Japan
| | | | | | - M Miyoshi
- Osaka Kouseinenkin Hospital, Osaka, Japan
| | - A Sunaga
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Sotomi
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - T Dohi
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Osaka, Japan
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18
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Kawakami H, Inoue K, Nagai T, Fujii A, Sasaki Y, Shikano Y, Sakuoka N, Miyazaki M, Takasuka Y, Ikeda S, Yamaguchi O. Left atrial dysfunction still exists in patients who obtain normal left atrial volume after successful ablation of atrial fibrillation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Atrial fibrillation (AF) promotes left atrial (LA) remodeling and vice versa. LA volume index (LAVI) ≥34 mL/m2 is an established cut-off value for identifying an enlarged left atrium. Catheter ablation has become an established therapy for AF and provides a reduction of LA volume by maintaining sinus rhythm (reverse remodeling). However, the definition of LA reverse remodeling after AF ablation is undetermined.
Purpose
We hypothesized that patients with LA dilatation who obtain normal LA volume (LAVI <34 mL/m2) after AF ablation would have better long-term outcomes than those who do not. Furthermore, we investigated whether patients with a normal LA volume could also obtain normal LA function with AF ablation.
Methods
We enrolled 140 AF patients with baseline LAVI ≥34 mL/m2, without AF recurrence for 1 year after the initial AF ablation. We acquired conventional and speckle-tracking echocardiographic parameters within 24 h and at 1 year after the procedure. Late recurrence was defined as AF recurrence >1 year after the initial ablation. To define the normal range of LA function, age-and sex-matched 140 controls without a history of AF were also enrolled.
Results
After restoration of sinus rhythm, overall LA structural and functional parameters were significantly improved, and 75 patients (54%) had normal LA volume at the time of follow-up (Table). During a median follow-up of 44 (31–61) months, 32 patients (23%) experienced a late recurrence of AF. Patients who obtained normal LA volume after AF ablation had fewer late recurrences than those who did not (P<0.01) (Figure). However, LA functional abnormalities still existed in AF patients, even if LA volume was normalized as in controls (Table).
Conclusion
Patients who obtain normal LA volume have better long-term outcomes of AF ablation than those who do not. Although AF ablation promotes beneficial effects on LA structure and function, LA function cannot be normalized even in patients who obtain normal LA volume after successful ablation. Thus, physicians should carefully consider long-term follow-up and residual AF risks, regardless of sinus rhythm restoration by catheter ablation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | - K Inoue
- Ehime University, Toon, Japan
| | - T Nagai
- Ehime University, Toon, Japan
| | - A Fujii
- Ehime University, Toon, Japan
| | | | | | | | | | | | - S Ikeda
- Ehime University, Toon, Japan
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19
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Tanaka N, Inoue K, Masuda M, Furukawa Y, Hirata A, Egami Y, Watanabe T, Minamiguchi H, Miyoshi M, Okada M, Sunaga A, Sotomi Y, Dohi T, Hikoso S, Sakata Y. Renal function and arrhythmia outcomes in persistent atrial fibrillation patients after catheter ablation: subanalysis of the EARNEST-PVI trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) reduces the renal function. Renal dysfunction and AF often coexist. Catheter ablation (CA) of persistent AF can maintain a sinus rhythm and may improve the renal function.
Purpose
We sought to elucidate whether the estimated glomerular filtration rate (eGFR) in patients with persistent AF was increased after CA, especially with the presence of an AF recurrence.
Methods
We enrolled 487 persistent AF patients whose eGFR data were available both before and 1-year after the CA out of 512 patients in the EARNEST-PVI trial.
Results
The mean age was 65±9 year and 113 patients (24.8%) had long-standing persistent AF. We compared the eGFR at baseline with that 1-year after the CA. AF recurrences were recognized in 118 patients (25.8%). The eGFR was similar between the group without recurrence and that with recurrence at baseline (without AF recurrence vs. with AF recurrence; 63.8±14.3 vs. 62.7±13.6 mL/min/1.73m2, p=0.46). In patients without AF recurrence, the G1, G2, G3a, G3b, G4, and G5 were 13 (3.8%), 198 (58.4%), 98 (28.9%), 26 (7.7%), 3 (0.9%), and 1 (0.3%), respectively at baseline. In the patients with AF recurrence, the G1, G2, G3a, G3b, G4, and G5 were 3 (2.5%), 68 (57.8%), 38 (32.2%), 6 (5.1%), 3 (2.5%), and 0 (0%), respectively at baseline. The ΔeGFR was significantly higher in the patients without AF recurrence than in those with AF recurrence (without AF recurrence vs. with AF recurrence; 5.1 [−0.3, 10.8] vs. 3.0 [−3.0, 7.6], p=0.0033). In the patients without AF recurrence, a better eGFR class at 1-year after the CA than in those before the CA was recognized in 75 patients (22.1%), while it was recognized in 19 patients (16.1%) with AF recurrences.
Conclusion
Successful catheter ablation in patients with persistent AF led to a better renal outcome.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): This study was funded by Medtronic, Johnson & Johnson, and Abbott.
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Affiliation(s)
- N Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - M Masuda
- Kansai Rosai Hospital, Amagasaki, Japan
| | - Y Furukawa
- Osaka General Medical Center, Osaka, Japan
| | - A Hirata
- Osaka Police Hospital, Osaka, Japan
| | - Y Egami
- Osaka Rosai Hospital, Sakai, Japan
| | - T Watanabe
- Osaka General Medical Center, Osaka, Japan
| | | | - M Miyoshi
- Osaka Hospital, Japan Community Healthcare Organization, Osaka, Japan
| | - M Okada
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - A Sunaga
- Osaka University Graduate School of Medicine, Suita, Japan
| | - Y Sotomi
- Osaka University Graduate School of Medicine, Suita, Japan
| | - T Dohi
- Osaka University Graduate School of Medicine, Suita, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Suita, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Suita, Japan
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20
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Inoue K, Nakao Y, Saito M, Kinoshita M, Higaki R, Higashi H, Ikeda S, Yamagushi O. Left ventricular longitudinal shortening at cardiac base as a determinant of left atrial reservoir function in cardiac amyloidosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
To investigate a mechanistic determinant of left atrial (LA) reservoir function in patients presenting left ventricular (LV) hypertrophy, and clarify diagnostic and prognostic values of LA reservoir strain in patients with cardiac amyloidosis (CA).
Methods
Three-hundred sixty patients (median age: 68 years, male gender: 65%) with left ventricular hypertrophy (LVH) assessed by echocardiography were retrospectively included. The LVH etiologies were diagnosed by any of biopsy, cardiac magnetic resonance imaging or 99mTc-PYP scintigraphy. LV segmental longitudinal strain was estimated from apical three views, and LA reservoir strain was measured from an apical 4-chamber view.
Results
The LVH etiologies were confirmed with CA in 81 patients, hypertensive heart disease in 87 patients, hypertrophic cardiomyopathy in 143 patients, and miscellaneous disorders in 49 patients. The median (25th, 75th percentile) value of LV ejection fraction was 59% (48–67). LV basal longitudinal strain and LA reservoir strain were significantly reduced in patients with CA compared with those with other etiologies; LV basal strain: 5.4% (3.9–8.7) vs. 11.9% (9.3–14.6), LA reservoir strain: 9.2% (6.3–12.3) vs. 17.5% (11.3–24.1), p<0.01 respectively. LV basal strain was significantly correlated with LA reservoir strain in patients with CA (r=0.57, p<0.01) and in those with other etiologies (r=0.45, p<0.01). The area under the receiver-operating characteristic curves of LA reservoir strain and E/e' (0.78 and 0.74) to identify CA etiology were significantly larger than that of LA volume index (0.62) (p<0.01). During the follow-up period (median 2.9 years), 53 patients experienced heart failure hospitalization. The Cox regression model including age, gender, LV ejection fraction, E/e' and LA reservoir strain showed that male gender (hazard ratio: 0.46, p=0.03), E/e' (hazard ratio: 1.04, p<0.01) and LA reservoir strain (hazard ratio: 0.94, p<0.01) independently predicted heart failure hospitalization.
Conclusions
The decrease of LV longitudinal shortening at cardiac base could worsen LA reservoir function especially in patients with CA. LA reservoir strain might be an alternative measure to identify CA etiology and have a predictive value of heart failure hospitalization in patients with LV hypertrophy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Inoue
- Ehime University, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Toon, Japan
| | - Y Nakao
- Ehime University, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Toon, Japan
| | - M Saito
- Kitaishikai Hospital, Department of Cardiology,, Ozu, Japan
| | - M Kinoshita
- Kitaishikai Hospital, Department of Cardiology,, Ozu, Japan
| | - R Higaki
- Kitaishikai Hospital, Department of Cardiology,, Ozu, Japan
| | - H Higashi
- Ehime University, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Toon, Japan
| | - S Ikeda
- Ehime University, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Toon, Japan
| | - O Yamagushi
- Ehime University, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Toon, Japan
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21
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Kanda T, Masuda M, Inoue K, Furukawa Y, Hirata A, Egami Y, Watanabe T, Minamiguchi H, Miyoshi M, Matsuda Y, Sunaga A, Sotomi Y, Dohi T, Hikoso S, Sakata Y. Differences in quality of life improvement with pulmonary vein isolation alone vs. more extensive ablation of persistent atrial fibrillation: insights from the EARNEST-PVI trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Improving the quality of life (QoL) is one of the main purposes of catheter ablation (CA) of persistent atrial fibrillation (AF). QoL improvement in persistent AF patients has not been fully clarified. The EARNEST-PVI trial was a multi-center randomized trial comparing clinical outcomes of pulmonary vein isolation (PVI) alone and more intensive ablation in addition to PVI including complex fractionated atrial electrogram (CFAE) and linear ablation (PVI plus).
Purpose
To investigate the QoL change after persistent AF ablation and the differences between the PVI-alone strategy and the PVI plus strategy.
Methods
In the EARNEST-PVI trial, patients with persistent AF who underwent an initial catheter ablation (n=512) were randomly assigned in a 1:1 ratio to either PVI alone or PVI plus. Quality of life was assessed at baseline and at 12 months after ablation for AF using the 36-Item Short Form Health Survey. Scores were also converted to a physical health component summary (PCS), a mental health component summary (MCS) and a role/social component summary (RCS).
Results
In the EARNEST-PVI trial, the PVI alone strategy was associated with higher recurrence rate compared with the PVI plus additional ablation strategy. After excluding 68 patients for whom preoperative or postoperative QoL assessment was not available, 222 patients were evaluated respectively. Overall, significant improvements in PCS (46.2±11.4 to 48.7±11.4]), MCS (50.1±8.8 to 54.3±8.6) and RCS (44.6±13.3 to 48.6±11.3) occurred 12 months after ablation (P<0.001, respectively). Although significant QoL improvement occurred in both PVI alone and PLI plus strategies, the changes in PCS was greater in the PVI-plus than that in PVI-alone (3.5±10.3 vs 1.5±10.6, P=0.04).
Conclusions
Ablation for persistent atrial fibrillation improved both physical and mental quality of life. The PVI-plus strategy showed greater improvement in physical QoL.
Funding Acknowledgement
Type of funding sources: None. QoL improvement
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Affiliation(s)
- T Kanda
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - M Masuda
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Cardiovascular center, Osaka, Japan
| | - Y Furukawa
- Osaka General Medical Center, Division of Cardiology, Osaka, Japan
| | - A Hirata
- Osaka Police Hospital, Cardiovascular Division, Osaka, Japan
| | - Y Egami
- Osaka Rosai Hospital, Division of Cardiology, Osaka, Japan
| | - T Watanabe
- Yao Municipal Hospital, Division of Cardiology, Yao, Japan
| | - H Minamiguchi
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Suita, Japan
| | - M Miyoshi
- Japan Community Health care Organization Osaka Hospital, Division of Cardiology, Osaka, Japan
| | - Y Matsuda
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - A Sunaga
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Suita, Japan
| | - Y Sotomi
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Suita, Japan
| | - T Dohi
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Suita, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Suita, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Department of Cardiovascular Medicine, Suita, Japan
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22
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Niki A, Deguchi Y, Iwasaki S, Mitake T, Okuda Y, Sakaguchi A, Hirota T, Shirahama Y, Nakamichi Y, Inoue K. Gender differences in self-perceived changes among Japanese workers with depression. Occup Med (Lond) 2021; 70:680-684. [PMID: 33247305 DOI: 10.1093/occmed/kqaa202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The number of patients living with depression continues to increase in Japan. The economic effects of depression include loss of productivity due to both absenteeism and presenteeism. Gender differences have been reported in prevalence, onset pathways and subjective symptoms of depression. AIMS To understand how workers with major depressive disorder (MDD) perceive problems in the workplace and examine gender differences in their self-perceived levels of functioning at work, noticed during the initial stages of depression. METHODS This is a cross-sectional study of Japanese workers with MDD. Participants' self-perceived changes in the level of functioning at work were surveyed after the diagnosis during the first visit. The relationship between gender and changes in the level of functioning at work as initially perceived by the participants themselves was analysed using the chi-square test, supplemented by a residual analysis. RESULTS We administered the survey to 147 workers with MDD. In terms of gender differences in initial self-perceived changes in the level of functioning at work, the proportion of men reporting reduced work efficiency was significantly higher than that of women, while the proportion of women reporting deterioration in relationships with colleagues and superiors was significantly higher than that of men. CONCLUSIONS The findings suggest that greater attention to reduced work efficiency by men and to deterioration in work relationships by women with MDD should be essential components of self-care. Managers need to pay attention to the level of functioning and provide adequate social support for employees.
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Affiliation(s)
- A Niki
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Y Deguchi
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - S Iwasaki
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - T Mitake
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Y Okuda
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - A Sakaguchi
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - T Hirota
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Y Shirahama
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - Y Nakamichi
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
| | - K Inoue
- Department of Neuropsychiatry, Osaka City University, Graduate School of Medicine, Osaka, Japan
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23
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Okano K, Inoue K, Suzuki Y. Gastrointestinal: Solitary splenosis in the gastric fundus mimicking gastrointestinal stromal tumor. J Gastroenterol Hepatol 2021; 36:2033. [PMID: 33522623 DOI: 10.1111/jgh.15397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/27/2020] [Indexed: 12/09/2022]
Affiliation(s)
- K Okano
- Department of Gastroenterological Surgery, Kagawa University, Miki, Kagawa, Japan
| | - K Inoue
- Department of Diagnostic Pathology, Kagawa University, Miki, Kagawa, Japan
| | - Y Suzuki
- Department of Gastroenterological Surgery, Kagawa University, Miki, Kagawa, Japan
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24
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Hotta K, Saeki S, Yamaguchi M, Harada D, Bessho A, Tanaka K, Inoue K, Gemba K, Shiojiri M, Kato Y, Ninomiya T, Kubo T, Kishimoto J, Shioyama Y, Katsui K, Sasaki J, Kiura K, Sugio K. Gefitinib induction followed by chemoradiotherapy in EGFR-mutant, locally advanced non-small-cell lung cancer: LOGIK0902/OLCSG0905 phase II study. ESMO Open 2021; 6:100191. [PMID: 34153652 PMCID: PMC8233144 DOI: 10.1016/j.esmoop.2021.100191] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/13/2021] [Accepted: 05/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background The role of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) induction coupled with standard concurrent chemoradiotherapy (CRT) is unclear in unresectable, stage III, EGFR-mutant non-small-cell lung cancer (NSCLC). Therefore, a phase II trial was conducted to evaluate the efficacy and safety of gefitinib induction followed by CRT in this disease setting. Patients and methods Patients with unresectable, EGFR-mutant, stage III NSCLC were administered gefitinib monotherapy (250 mg/day) for 8 weeks. Subsequently, patients without disease progression during induction therapy were administered cisplatin and docetaxel (40 mg/m2 each) on days 1, 8, 29, and 36 with concurrent radiotherapy at a total dose of 60 Gy. The primary endpoint was the 2-year overall survival (OS) rate, which was hypothesized to reach 85%, with a threshold of the lower limit of 60%. Results Twenty patients (median age: 66 years; male/female: 9/11; histology: 20 adenocarcinoma; stage IIIA/IIIB: 9/11; and exon 19/21: 10/10) were enrolled. The 2-year OS rate was 90% (90% confidence interval: 71.4% to 96.8%), indicating that this trial met the primary objective. The overall response rate and 1- and 2-year progression-free survival rates were 85.0%, 58.1%, and 36.9%, respectively. Grade ≥3 adverse events (>10%) included hepatic toxicity during the induction phase and neutropenia and febrile neutropenia in the CRT phase. Radiation pneumonitis grade ≥3 or treatment-related death did not occur. Conclusions This is the first prospective study to demonstrate the favorable efficacy and safety of EGFR-TKI induction followed by standard CRT in EGFR-mutant, stage III NSCLC. Further confirmatory studies are needed. This is the first prospective study evaluating gefitinib induction followed by CRT in EGFR-mutated, locally advanced NSCLC. The 2-year OS rate was 90% (90% confidence interval: 71.4% to 96.8%), indicating that this trial met the primary objective. The objective response rate throughout the treatment protocol was 85.0% (17 of 20). The safety findings were consistent with the known safety profiles of all agents administered. Our results might raise a critical point that needs to be evaluated in further studies to improve the cure rate.
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Affiliation(s)
- K Hotta
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan; Department of Respiratory Medicine, Okayama University Hospital, Okayama, Japan.
| | - S Saeki
- Department of Respiratory Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - M Yamaguchi
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Kyushu, Japan
| | - D Harada
- Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Shikoku, Japan
| | - A Bessho
- Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - K Tanaka
- Department of Respiratory Medicine, Kyushu University Hospital, Kyushu, Japan
| | - K Inoue
- Department of Respiratory Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - K Gemba
- Department of Respiratory Medicine, Chugoku Central Hospital, Chugoku, Japan
| | - M Shiojiri
- Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan; Department of Respiratory Medicine, Ehime Prefectural Central Hospital, Ehime, Japan
| | - Y Kato
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan; Department of Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - T Ninomiya
- Department of Respiratory Medicine, Okayama University Hospital, Okayama, Japan; Department of Thoracic Oncology, National Hospital Organization Shikoku Cancer Center, Shikoku, Japan
| | - T Kubo
- Department of Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - J Kishimoto
- Center for Clinical and Translational Research, Kyushu University Hospital, Kyushu, Japan
| | - Y Shioyama
- Clinical Radiology, Radiology Informatics and Network, Graduate School of Medical Sciences, Kyushu University, Kyushu, Japan
| | - K Katsui
- Department of Proton Beam Therapy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - J Sasaki
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kitasato, Japan
| | - K Kiura
- Department of Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - K Sugio
- Department of Thoracic and Breast Surgery, Oita University, Oita, Japan
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25
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Tohi Y, Kato T, Yokomizo A, Mitsuzuka K, Tomida R, Inokuchi J, Matsumoto R, Saito T, Sasaki H, Inoue K, Kinoshita H, Fukuhara H, Maruyama S, Sakamoto S, Tanikawa T, Egawa S, Ichikura H, Abe T, Nakamura M, Kakehi Y, Sugimoto M. Impact of health-related quality of life on repeat protocol biopsy compliance on active surveillance for favorable prostate cancer: Results from a prospective cohort in the PRIAS-JAPAN study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01410-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Veerasamy N, Murugan R, Kasar S, Inoue K, Kavasi N, Balakrishnan S, Arae H, Fukushi M, Sahoo SK. Geochemical characterization of monazite sands based on rare earth elements, thorium and uranium from a natural high background radiation area in Tamil Nadu, India. J Environ Radioact 2021; 232:106565. [PMID: 33714078 DOI: 10.1016/j.jenvrad.2021.106565] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
The Kanyakumari coastal area in the southernmost part of Tamil Nadu, India is a well-known natural high background radiation area due to the abundance of monazite in beach placer deposits. In the present study, the concentrations of major oxides, rare earth elements (REEs), Th and U were measured to understand geochemical characteristics of these monazite sands. Based on the ambient dose rate, 23 locations covering an area of about 60 km along the coast were selected for sample collection. The concentrations of U and Th ranged from 1.1 to 737.8 μg g-1 and 25.2-12250.6 μg g-1, respectively. The Th/U ratio ranged from 2.2 to 61.6, which clearly indicated that Th was the dominant contributing radionuclide to the enhanced natural radioactivity in this coastal region. The chondrite-normalized REEs pattern of the placer deposits showed enrichment in light REEs and depletion in heavy REEs with a negative Eu anomaly that indicated the monazite sands were derived from granite, charnockite, and granitoid rocks from the Nagercoil and the Trivandrum Blocks of the Southern Granulite Terrain.
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Affiliation(s)
- N Veerasamy
- Department of Radiological Sciences, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo, 116-8551, Japan; Environmental Radionuclides Research Group, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - R Murugan
- Environmental Radionuclides Research Group, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - S Kasar
- Environmental Radionuclides Research Group, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - K Inoue
- Department of Radiological Sciences, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo, 116-8551, Japan
| | - N Kavasi
- Environmental Radionuclides Research Group, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - S Balakrishnan
- Department of Earth Sciences, Pondicherry University, R Venkat Raman Nagar, Kalapet, Puducherry, 605014, India
| | - H Arae
- Environmental Radionuclides Research Group, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan
| | - M Fukushi
- Department of Radiological Sciences, Tokyo Metropolitan University, 7-2-10 Higashiogu, Arakawa-ku, Tokyo, 116-8551, Japan
| | - S K Sahoo
- Environmental Radionuclides Research Group, National Institutes for Quantum and Radiological Sciences and Technology, 4-9-1 Anagawa, Inage-ku, Chiba, 263-8555, Japan.
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27
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Inoue K, Fujita Y, Kawano N. The need to devise government-spearheaded measures to prevent loneliness and isolation in conjunction with the spread of COVID-19 in Japan. Public Health 2021; 198:e3. [PMID: 34016460 PMCID: PMC8020074 DOI: 10.1016/j.puhe.2021.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 11/18/2022]
Affiliation(s)
- K Inoue
- Research and Education Faculty, Medical Sciences Cluster, Health Service Center, Kochi University, 2-5-1 Akebono-cho, Kochi-shi, Kochi 780-8520, Japan.
| | - Y Fujita
- Faculty of Medicine, Shimane University, 89-1, Enya-cho, Izumo, Shimane 693-8501, Japan.
| | - N Kawano
- The Center for Peace, Hiroshima University, 1-1-89, Higashisendamachi, Naka-ku, Hiroshima-shi, Hiroshima 730-0053, Japan.
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28
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Khan F, Inoue K, Remme EW, Ohte N, Garcia-Izquierdo E, Chetrit M, Andersen OS, Gude E, Andreassen AK, Kikuchi S, Stugaard M, Ha JW, Klein A, Nagueh SF, Smiseth OA. Evaluation of left ventricular filling pressure by echocardiography: incremental diagnostic information from left atrial strain. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority
Background
Elevated left ventricular (LV) filling pressure is an important diagnostic feature of heart failure.
Objectives
To investigate determinants of left atrial (LA) reservoir and pump strain and if these parameters may serve as markers of LV filling pressure.
Methods
In a multicenter study of 322 patients with cardiovascular disease of different etiologies, LA strain by speckle tracking echocardiography was compared to conventional echocardiographic markers using invasive pressure as reference.
Results
Left ventricular filling pressure correlated well with LA reservoir and pump strain (r-values
‑0.52 and ‑0.57, respectively) (Figure). However, LV global longitudinal strain (GLS) was the strongest determinant of LA reservoir strain (r = 0.64), and correlated well with LA pump strain (r = 0.51). For both LA strains, association with filling pressure was strongest in patients with reduced LV ejection fraction. In patients with normal GLS (≥18%), atrial strains provided no information regarding filling pressure (Figure). Reservoir strain <18% and pump strain <8% predicted elevated LV filling pressure better (p < 0.05) than the conventional indices LA volume, ratio of mitral early filling velocity/annular velocity and tricuspid regurgitation velocity. Accuracy to classify filling pressure as normal or elevated was 75% for both LA strains . When any one of the conventional indices were missing, and were replaced by LA strains, the combination of indices had accuracy 82% to correctly classify filling pressure.
Conclusions
Left atrial reservoir and pump strain may serve as clinical markers of LV filling pressure, but will be useful predominantly in patients with reduced systolic function. Due to limited diagnostic accuracy, LA strain should be used in combination with other indices.
Abstract Figure
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Affiliation(s)
- F Khan
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - K Inoue
- Ehime University Graduate School of Medicine, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime, Japan
| | - EW Remme
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - N Ohte
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - M Chetrit
- Cleveland Clinic, Cleveland, United States of America
| | - OS Andersen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - E Gude
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - AK Andreassen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - S Kikuchi
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - M Stugaard
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - JW Ha
- Yonsei University College of Medicine, Cardiology Division, Seoul, Korea (Republic of)
| | - A Klein
- Cleveland Clinic, Cleveland, United States of America
| | - SF Nagueh
- The Methodist Hospital, Houston, United States of America
| | - OA Smiseth
- Oslo University Hospital Rikshospitalet, Oslo, Norway
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29
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Onishi T, Koyama Y, Inoue K, Iwakura K, Okamura A, Iwamoto M, Watanabe S, Nagai H, Hirao Y, Tanaka K, Tanaka N, Okada M, Sumiyoshi A, Yoshimoto I, Fujii K. The utility of a novel approach to quantify dyssynchrony by multidetector computed tomography. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Quantification of left ventricular (LV) dyssynchrony is of great interest for resynchronization therapy (CRT). Recently, cardiac computed tomography (CCT) is feasible for evaluation of dyssynchrony. Our aim was to assess a novel simplified approach using CCT to quantify LV dyssynchrony.
Methods
We studied 346 consecutive patients with a wide range of QRS width and ejection fractions (EF). Electrocardiogram-gated contrast-enhanced 256-slice multidetector CT (Brilliance 256 iCT, Philips Medical Systems) was performed before CRT. After CCT scan, the LV endocardial boundaries from short-axis images reconstructed at 5% increments of cardiac cycle were automatically detected, and a time from R-wave to maximal wall motion was calculated for each of the 16 standardized segments for all slices using software "Myocardial Contraction Map" (Argus, Inc Ehime, Japan). The standard deviation of all segments modified by mean heart rate (%SD) was respectively calculated as the global parameter of dyssynchrony. LVEF was also measured using MDCT.
Results
%SD was feasible in all patients, respectably. %SD was significantly different between the different QRS duration groups; narrow QRS (<120ms): 9 ± 5%, relatively wide QRS (120-150 ms): 11 ± 6%, and significantly wide QRS (>150 ms): 14 ± 7% (p <0.001). Moreover, there was significantly difference in %SD between the different morphology groups; normal: 9 ± 7%, Non-left bundle branch block (Non-LBBB): 10 ± 6%, LBBB: 17 ± 7% (p <0.001).
Conclusion
This novel simplified approach by CCT can quantify dyssynchrony in different QRS duration and morphology groups. This method has promise for clinical applications to the evaluation of patients for CRT.
Abstract Figure.
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Affiliation(s)
- T Onishi
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Y Koyama
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Iwakura
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - A Okamura
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - M Iwamoto
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - S Watanabe
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - H Nagai
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Y Hirao
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Tanaka
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - N Tanaka
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - M Okada
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | | | | | - K Fujii
- Sakurabashi-Watanabe Hospital, Osaka, Japan
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30
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Iwakura K, Onishi T, Okada M, Inoue K, Koyama Y, Okamura A, Yamada T, Yasumura Y, Tamaki S, Hayashi T, Yano M, Fujii K, Hikoso S, Sakata Y. Validation of the HFA-PEFF- and H2FPEF score in Japanese patients with heart failure with preserved ejection fraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Diagnosing heart failure with preserved ejection fraction (HFpEF) still remains challenging, and simple and reliable diagnostic tools have been required. Recently, novel and evidence-based diagnostic algorithms for HFpEF were proposed, such as H2FPEF score (Circulation. 2018) and HFA-PEFF score (Eur Heart J 2019), and their accuracy was validated in the outside patient group. However, there are regional and ethnic variations in patient characteristics of HFpEF, particularly between Western and Asian countries, and it is not elucidated whether these diagnostic scores are useful in Asian population.
Purpose
To investigate the validity of the HFA-PEFF- and H2FPEF score in Japanese patients with HFpEF.
Methods
We calculated H2FPEF score and the second step of HFA-PEFF score among the registered patients in the PURSUIT-HFpEF (Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction) study, which is a multicenter registration of patients hospitalized for HFpEF. The obtained scores were compared with the scores of the HFpEF cohort in the previous validation studies. We followed the study patients for median of 360 days (IQR 237–630 days) to observe the major adverse cardiovascular events (MACE; composite of death, heart failure hospitalization and stroke).
Results
We enrolled 757 patients hospitalized for HFpEF between June 2016 and August 2019 for the present study. H2FPEF score was obtained in 588 (77.7%) patients among them. Compared with the HFpEF cohorts in the previously reported sub-analysis of TOPCAT trial, the PURSUIT-HFpEF cohort had lower mean value of HFpEF score (4.0±1.8 points vs. 6.0±2.0 points in Americans or 5.3±1.9 points in Russians). It had significantly higher proportion (40.3%, p<0.001) of patients in the low likelihood of HFpEF category (0–3 points) than the TOPCAT cohorts (8.0% in Americans and 19.6% in Russians).
HFA-PEFF score was obtained in 615 (81.2%) patients, though global longitudinal strain was not available. The mean value of HFA-PEFF score was 5.0±0.8, and all patients had ≥2 points. The proportion of patients in the high likelihood of HFpEF category (5–6 points) was 88.3%, which was significantly higher (p<0.001) than those of the HFpEF cohort from Europe and USA in the previous validation study (Eur J Heart Fail 2019). There was no correlation between H2FPEF score and HFA-PEFF score (R=0.06, p=0.14). Cox proportional hazard model selected HFA-PEFF score as a significant predictor for MACE during follow-up period, whereas H2PEF score was not selected. Kaplan-Meier survival analysis demonstrated that patients with 6 points of HFA-PEFF score had higher incidence rate of MACE than those with ≤5 points (p=0.002).
Conclusion
The HFA-PEFF score could be more useful for the diagnosis and risk stratification for HFpEF than the H2PEF score in the Japanese cohort.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Roche Diagnostics K.K.; Fuji Film Toyama Chemical Co. Ltd.
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Affiliation(s)
- K Iwakura
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - T Onishi
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - M Okada
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Y Koyama
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - A Okamura
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - Y Yasumura
- Amagasaki Central Hospital, Amagasaki, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | | | - M Yano
- Osaka Rosai Hospital, Sakai, Japan
| | - K Fujii
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Suita, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Suita, Japan
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31
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Saito M, Nakao Y, Higaki R, Kawachi Y, Yokomoto Y, Ogimoto A, Suzuki M, Kawakami H, Hiasa G, Okayama H, Inoue K, Ikeda S, Yamaguchi O. Clinical significance of the relative apical sparing pattern of longitudinal strain in patients with cardiac amyloidosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The relative apical sparing pattern (RASP) of left ventricular (LV) longitudinal strain (LS) is frequently associated with cardiac amyloidosis (CA). However, some patients with CA do not show the RASP, and their clinical characteristics have not been fully clarified. We sought to investigate the clinical significance of RASP in patients with CA.
Methods
One hundred consecutive CA patients who were diagnosed by biopsy or myocardial pyrophosphate scintigraphy and evaluated for RASP (mean age: 76 years, male: 77%, LV mean wall thickness: 13.5 mm, light-chain [AL] type: 33 cases, transthyretin [TTR] type: 67 cases) were retrospectively enrolled. The RASP was semi-quantitatively and quantitatively assessed. Semi-quantitative RASP was defined as reduction of LS (≥−10%) in ≥5 (of 6) basal segments relative to preserved LS (<−15%) in ≥1 apical segment. Quantitative RASP was calculated according to the following formula: Quantitative RASP = [Average apical LS] / [Average basal LS + Average mid LS]. We adapted three validated thresholds (>1.00, >0.90, and >0.87) according to the literature.
Results
Semi-quantitative and binalized quantitative RASP (>1.00, >0.90, and >0.87) were observed in 55, 55, 63, and 65 patients, respectively. RASP in each definition was more prevalent in the TTR group than in the AL group. Additionally, RASP was significantly associated with higher LV wall thickness even after adjustment for the CA subtypes (all, p<0.05, Figure). After the RASP assessment, 35 all-cause deaths and 26 cardiac deaths were observed during the follow-up period (median, 1.1 years). Although these events were significantly associated with poor nutrition, lower blood pressure, higher New York Heart Association class, and the AL group, no association was found with RASP and LV wall thickness.
Conclusions
The incidence of RASP is low in the case of thin LV wall thickness in CA patients, which may indicate the difficulty of early diagnosis of CA using RASP in patients with mild LV hypertrophy. The prognostic prediction using RASP may be challenging in this cohort.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Saito
- Kitaishikai Hospital, Ozu, Japan
| | - Y Nakao
- Kitaishikai Hospital, Ozu, Japan
| | - R Higaki
- Kitaishikai Hospital, Ozu, Japan
| | | | - Y Yokomoto
- Uwajima City Hospital, Cardiology, Uwajima, Japan
| | - A Ogimoto
- Uwajima City Hospital, Cardiology, Uwajima, Japan
| | - M Suzuki
- Ehime Prefectural Imabari Hospital, Cardiology, Imabari, Japan
| | - H Kawakami
- Ehime Prefectural Imabari Hospital, Cardiology, Imabari, Japan
| | - G Hiasa
- Ehime Prefectural Central Hospital, Cardiology, Matsuyama, Japan
| | - H Okayama
- Ehime Prefectural Central Hospital, Cardiology, Matsuyama, Japan
| | - K Inoue
- Ehime University, Cardiology, Toon, Japan
| | - S Ikeda
- Ehime University, Cardiology, Toon, Japan
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André F, Ciruelos EM, Juric D, Loibl S, Campone M, Mayer IA, Rubovszky G, Yamashita T, Kaufman B, Lu YS, Inoue K, Pápai Z, Takahashi M, Ghaznawi F, Mills D, Kaper M, Miller M, Conte PF, Iwata H, Rugo HS. Alpelisib plus fulvestrant for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative advanced breast cancer: final overall survival results from SOLAR-1. Ann Oncol 2020; 32:208-217. [PMID: 33246021 DOI: 10.1016/j.annonc.2020.11.011] [Citation(s) in RCA: 234] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Activation of the phosphatidylinositol-3-kinase (PI3K) pathway via PIK3CA mutations occurs in 28%-46% of hormone receptor-positive (HR+), human epidermal growth factor receptor-2-negative (HER2-) advanced breast cancers (ABCs) and is associated with poor prognosis. The SOLAR-1 trial showed that the addition of alpelisib to fulvestrant treatment provided statistically significant and clinically meaningful progression-free survival (PFS) benefit in PIK3CA-mutated, HR+, HER2- ABC. PATIENTS AND METHODS Men and postmenopausal women with HR+, HER2- ABC whose disease progressed on or after aromatase inhibitor (AI) were randomized 1 : 1 to receive alpelisib (300 mg/day) plus fulvestrant (500 mg every 28 days and once on day 15) or placebo plus fulvestrant. Overall survival (OS) in the PIK3CA-mutant cohort was evaluated by Kaplan-Meier methodology and a one-sided stratified log-rank test was carried out with an O'Brien-Fleming efficacy boundary of P ≤ 0.0161. RESULTS In the PIK3CA-mutated cohort (n = 341), median OS [95% confidence interval (CI)] was 39.3 months (34.1-44.9) for alpelisib-fulvestrant and 31.4 months (26.8-41.3) for placebo-fulvestrant [hazard ratio (HR) = 0.86 (95% CI, 0.64-1.15; P = 0.15)]. OS results did not cross the prespecified efficacy boundary. Median OS (95% CI) in patients with lung and/or liver metastases was 37.2 months (28.7-43.6) and 22.8 months (19.0-26.8) in the alpelisib-fulvestrant and placebo-fulvestrant arms, respectively [HR = 0.68 (0.46-1.00)]. Median times to chemotherapy (95% CI) for the alpelisib-fulvestrant and placebo-fulvestrant arms were 23.3 months (15.2-28.4) and 14.8 months (10.5-22.6), respectively [HR = 0.72 (0.54-0.95)]. No new safety signals were observed with longer follow-up. CONCLUSIONS Although the analysis did not cross the prespecified boundary for statistical significance, there was a 7.9-month numeric improvement in median OS when alpelisib was added to fulvestrant treatment of patients with PIK3CA-mutated, HR+, HER2- ABC. Overall, these results further support the statistically significant prolongation of PFS observed with alpelisib plus fulvestrant in this population, which has a poor prognosis due to a PIK3CA mutation. CLINICALTRIALS. GOV ID NCT02437318.
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Affiliation(s)
- F André
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif and Paris Saclay University, Orsay, France.
| | - E M Ciruelos
- Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - D Juric
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, USA
| | - S Loibl
- Department of Medicine and Research, German Breast Group, GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - M Campone
- Medical Oncology, Institut de Cancerologie de l'Ouest, Saint-Herblain, Nantes Cedex, France
| | - I A Mayer
- Hematology/Oncology, Vanderbilt University, Nashville, USA
| | - G Rubovszky
- Department of Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Budapest, Hungary
| | - T Yamashita
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - B Kaufman
- Medical Oncology, Tel Aviv University, Sheba Medical Centre, Tel Hashomer, Israel
| | - Y-S Lu
- Medical Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - K Inoue
- Breast Surgery, Saitama Cancer Center, Saitama, Japan
| | - Z Pápai
- Medical Oncology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - M Takahashi
- Breast Surgery, NHO Hokkaido Cancer Center, Sapporo, Japan
| | - F Ghaznawi
- Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - D Mills
- Novartis Pharma AG, Basel, Switzerland
| | - M Kaper
- Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - M Miller
- Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - P F Conte
- Medical Oncology, Universita di Padova and Oncologia Medica 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - H Iwata
- Breast Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - H S Rugo
- Breast Department, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
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Oka T, Yoshimoto I, Koyama Y, Tanaka K, Hirao Y, Tanaka N, Okada M, Kitagaki R, Okamura A, Iwakura K, Fujii K, Inoue K. High incidence of left atrial dysfunction and low voltage zone in patients requiring multiple atrial fibrillation ablation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
While multiple catheter ablation for recurrent atrial fibrillation (AF) is effective for the maintenance of sinus rhythm, some of patients have ablation-refractory AF. Left atrial (LA) dysfunction and the presence of low voltage zone (LVZ) are associated with recurrence after AF ablation. The association between recurrence and LA dysfunction/ LVZ among patients undergoing multiple AF ablation remains unclear.
Purpose
We aimed to compare (i)LA function, (ii)the prevalence of LVZ among patients undergoing first, second and third or more AF ablation procedures. Further, we investigated whether LA dysfunction and LVZ are associated with recurrence after multiple procedures.
Methods
We retrospectively analyzed 460 patients undergoing AF ablation procedures including first, second and third or more sessions from January 2017 to October 2019 in our institute. Before each session, 256-slice MDCT was performed under sinus rhythm to measure pre-ablation LA emptying fraction (LAEF) as the representative of LA function. At the end of each session, we checked the presence of LVZ, which was defined as regions where bipolar peak-to-peak voltage was <0.5mV. All patients underwent pulmonary vein isolation (PVI). If necessary, additional ablation (e.g. linear ablation, non-PV foci ablation and LVZ ablation) was performed.
Results
Out of 460 sessions, 295 were first (follow-up years: 1.5 [0.8, 2.0]), 134 were second (1.0 [0.5, 1.8]), and 31 were third or more sessions (1.2 [0.7, 2.0]). As the number of sessions increased, the recurrence rate was increased (19% vs. 31% vs. 61%, first vs. second vs. ≥third, P<0.0001), LAEF decreased (39.7±10.5% vs. 32.6±10.1% vs. 25.3±11.8%, P<0.0001) and the incidence of LVZ increased (18% vs. 34% vs. 68%, P<0.0001) (Figure 1). In patients with recurrence (N=104) after multiple ablation (second or more sessions), LAEF was lower and the prevalence of LVZ was higher than those without recurrence (N=61) (LAEF: 27.3±10.3% vs. 33.5±10.5%, with vs. without, P=0.0003; LVZ: 57% vs. 31%, P=0.0014).
Conclusions
As the number of sessions increased, the recurrence rate was increased. The prevalence of LA dysfunction and LVZ was high in patients requiring multiple ablation procedure. LA dysfunction and LVZ possibly reflect arrhytmogenic substrate causing recurrence of ablation-refractory AF. We should carefully consider repeated AF ablation in patients with severe LA dysfunction and extensive LVZ.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Oka
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - I Yoshimoto
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - Y Koyama
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - K Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - Y Hirao
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - N Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - M Okada
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - R Kitagaki
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - A Okamura
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - K Iwakura
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - K Fujii
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
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Khan F, Inoue K, Remme E, Andersen O, Gude E, Skulstad H, Chetrit M, Garcia-Izquierdo Jaen E, Ha J, Klein A, Kikuchi S, Ohte N, Nagueh S, Smiseth O. Assessment of left ventricular filling pressure: left atrial reservoir strain is an excellent replacement for missing tricuspid regurgitation velocity. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
When evaluating left ventricular filling pressure (LVFP) according to current guidelines, tricuspid regurgitation (TR) velocity is often not available.
Purpose
In the present study we investigate if left atrial (LA) reservoir strain may be used instead of TR velocity for evaluation of LVFP.
Methods
We performed a prospective, multicenter, multinational and multivendor study in an all comer population of 322 patients with suspected heart failure or other cardiovascular disease where LVFP was measured by right- or left heart catheterization, as pulmonary capillary wedge pressure or pre-A LV diastolic pressure, respectively. Echocardiography was performed within 1 day of catheterization.
101 patients classified as special populations in the 2016 ASE/EACVI recommendations (i.e. non-cardiac pulmonary hypertension, atrial fibrillation, hypertrophic and restrictive cardiomyopathies) were excluded. Of the remaining 221 patients, 118 patients had EF ≥50% and 103 patients had EF <50%. Regression analysis was performed for LA reservoir strain and TR velocity against LVFP. LA reservoir strain at a cut-off value of <18% was applied instead of TR velocity in the 2016 ASE/EACVI algorithm and compared with the current algorithm.
Results
LA reservoir strain correlated better with LVFP than TR velocity, r=0.62 vs 0.40 (p<0.01) (Figure 1). When replacing TR velocity with LA reservoir strain, the feasibility of the ASE/EACVI 2016 algorithm increased from 91.8% to 98.1%. The accuracy of the algorithm was not significantly altered (80% vs 79%).
An accuracy of 80% for the algorithm is lower than what has been reported in earlier publications, this may be due to inclusion of patients without suspected heart failure and no assessment of clinical data, which in turn may have influenced the accuracy of the algorithm.
Conclusion
LA reservoir strain has better correlation to LVFP than TR velocity, and can be used in the ASE/EACVI 2016 algorithm for estimation of LVFP as a replacement when TR velocity is missing.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority
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Affiliation(s)
- F Khan
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - K Inoue
- Ehime University Graduate School of Medicine, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime, Japan
| | - E.W Remme
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - O.S Andersen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - E Gude
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - M Chetrit
- Cleveland Clinic, Cleveland, United States of America
| | | | - J.W Ha
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - A.L Klein
- Cleveland Clinic, Cleveland, United States of America
| | - S Kikuchi
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - N Ohte
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S.F Nagueh
- The Methodist Hospital, Houston, United States of America
| | - O.A Smiseth
- Oslo University Hospital Rikshospitalet, Oslo, Norway
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Nakao Y, Saito M, Higaki R, Yokomoto Y, Ogimoto A, Suzuki M, Kawakami H, Hiasa G, Okayama H, Inoue K, Ikeda S, Yamaguchi O. Utility of scoring system including relative apical sparing pattern for screening cardiac amyloidosis in patients with left ventricular hypertrophy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac amyloidosis (CA) is an infiltrative disease mimicking left ventricular hypertrophy (LVH), although its prognosis is poorer than other diseases with LVH. Moreover, because CA is treatable, appropriate screening for CA is an important area of study for clinicians to prevent and treat the disease. Several imaging predictors of CA have been reported so far;. in particular, deformation parameters such as relative apical sparing patterns of longitudinal strain (RASP) may diagnose CA with better precision than conventional parameters. Accordingly, we hypothesized that the inclusion of deformation parameters into the established diagnostic parameters would permit derivation of a risk score for CA screening in patients with LVH. Thus, we aimed to 1) investigate the incremental benefits of deformation parameters over established diagnostic parameters for CA screening in patients with LVH; 2) determine the risk score to screen CA patients with LVH using all of these variables; and 3) externally validate the score.
Methods
We retrospectively studied 295 consecutive non-ischemic patients with LVH who underwent echocardiography as well as the detailed work-up for LVH (biopsy, technetium pyrophosphate scintigraphy (99mTc-PYP) or cardiac magnetic resonance imaging) (median age, 67 years; MWT, 12 mm). CA was diagnosed by biopsy or 99mTc-PYP. The base model consisted of age (≥65 [male], ≥70 [female]), low voltage in electrocardiography, and posterior wall thickness ≥14 mm in reference to previous studies. Continuous echocardiographic variables were binarized by the use of generally accepted external cutoff points to avoid best clinical scenario. Incremental benefits were assessed using receiver operating characteristic curve analysis and area under the curve (AUC) comparison. Multiple logistic regression analysis was performed to determine the risk score. The score was then validated in the external validation sample (N=178, median age, 70 years; MWT, 12 mm).
Results
CA was observed in 54 patients (18%) and of the several echocardiographic parameters studied, only RASP demonstrated a significant incremental benefit for the screening of CA over the base model (Figure A). After multiple logistic regression analysis in the prediction of CA with 4 variables (RASP and basal model components), each was assigned a numeric value based on its relative effect (Figure B). The incidence rate of CA clearly increased as the sum of the risk score increased (Figure C). The score had good discrimination ability, with an AUC of 0.87, a total score of ≥2 with 70% sensitivity and 90% specificity. Similarly, the discrimination ability of the score in the validation cohort was sufficient (AUC = 0.87).
Conclusion
Overall, we determined a simple risk score including RASP to screen CA. This score takes into account 4 common parameters used in daily practice, and therefore, has potential utility in risk stratification and management of patients with LVH.
Figure 1
Funding Acknowledgement
Type of funding source: Private hospital(s). Main funding source(s): Kitaishikai
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Affiliation(s)
- Y Nakao
- Kitaishikai Hospital, Ozu, Japan
| | - M Saito
- Kitaishikai Hospital, Ozu, Japan
| | - R Higaki
- Kitaishikai Hospital, Ozu, Japan
| | | | - A Ogimoto
- Uwajima City Hospital, Uwajima, Japan
| | - M Suzuki
- Ehime Prefectural Imabari Hospital, Imabari, Japan
| | - H Kawakami
- Ehime Prefectural Imabari Hospital, Imabari, Japan
| | - G Hiasa
- Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - H Okayama
- Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - K Inoue
- Ehime University, Toon, Japan
| | - S Ikeda
- Ehime University, Toon, Japan
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Shiozaki M, Inoue K, Suwa S, Lee C, Chiang S, Fukuda K, Hiki M, Kubota N, Tamura H, Fujiwara Y, Miyazaki T, Hirano Y, Sumiyoshi M. One-year outcome of the rule-out group according to the 0-h /1-hour algorithm with suspected myocardial infarction in Asian countries. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction; A rapid rule-out or rule-in protocol based on the 0-h/1-hour algorithm using high-sensitivity cardiac troponin T (hs-cTnT) is recommended by the European Society of Cardiology (ESC). Around 40–50% were stratified into “rule-out” group, and their 30-days prognosis was excellent. However, the one-year prognosis is uncertain. We aimed to better characterize these patients.
Methods
This study was a prospective, multi-center, observational study of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS) admitted to 5 hospitals in Japan and Taiwan from 2014 November to 2018 December, respectively.
All patients underwent a clinical assessment the included medical history, physical examination, 12-lead ECG, standard blood test, chest radiography. Exclusion criteria were ST elevated myocardial infarction, chronic kidney disease (serum creatinine more than 3 mg/dL) and congestive heart failure, arrhythmia, or infection disease. The patients were divided into three groups according to the algorithm; “rule-out”, “observe” and “rule-in”. The final diagnosis was then adjudicated by 2 independent cardiologists using all available information, including coronary angiography, coronary computed tomography, stress electrocardiography and follow-up data. The presence of acute myocardial infarction (AMI) was defined according to the Fourth Universal Definition of Myocardial Infarction. After hospital discharge patients were follow after one-year b telephone or in written form. Major adverse cardiovascular events (including death myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention (PCI)) were recorded by establishing contact with the patient and the family physicians. The primary prognosis end point was all-cause mortality.
Results
Of the 1,187 patients were analyzed after exclusion. The prevalence rate of AMI was 16.1%. According to the algorithm, 42% (n=493) of patients were assigned to “rule-out” group and had no AMI nor death. The most common final adjudicated diagnoses were atypical chest pain (80%), gallstone attack (3%) and vasospastic angina pectoris (2%). All patients with unstable angina (4.7%) underwent PCI.
Conclusion(s)
Our findings suggest that the “rule-out” group patients according to ESC 0-h/1-hour algorithm provides very high safety and efficacy for the triage toward AMI.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Shiozaki
- Juntendo University Nerima Hospital, Cardiology, Tokyo, Japan
| | - K Inoue
- Juntendo University Nerima Hospital, Cardiology, Tokyo, Japan
| | - S Suwa
- Juntendo University Shizuoka Hospital, Cardiology, Izunokuni, Japan
| | - C.C Lee
- National Taiwan University Hospital, Emergency Medicine, Taipei, Taiwan
| | - S.J Chiang
- Taipei City Hospital, Cardiology, Taipei, Taiwan
| | - K Fukuda
- Juntendo University Nerima Hospital, Cardiology, Tokyo, Japan
| | - M Hiki
- Juntendo University Nerima Hospital, Cardiology, Tokyo, Japan
| | - N Kubota
- Juntendo University Nerima Hospital, Cardiology, Tokyo, Japan
| | - H Tamura
- Juntendo University Nerima Hospital, Cardiology, Tokyo, Japan
| | - Y Fujiwara
- Juntendo University Nerima Hospital, Cardiology, Tokyo, Japan
| | - T Miyazaki
- Juntendo University Urayasu Hospital, Cardiology, Chiba, Japan
| | - Y Hirano
- Juntendo University Urayasu Hospital, Emergency and Critical Care Medicine, Chiba, Japan
| | - M Sumiyoshi
- Juntendo University Nerima Hospital, Cardiology, Tokyo, Japan
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Oka T, Yoshimoto I, Koyama Y, Tanaka K, Hirao Y, Tanaka N, Okada M, Kitagaki R, Okamura A, Iwakura K, Fujii K, Inoue K. Pre-ablation left atrial function predicts the presence of low voltage zone in patients undergoing paroxysmal atrial fibrillation ablation: OLAF-LVZ predictive score. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Preoperative left atrial (LA) function is associated with paroxysmal atrial fibrillation (PAF) ablation outcome. The presence of left atrial low voltage zone (LVZ) is also associated with recurrence. We hypothesized that reduced pre-ablation LA function reflects the presence of LVZ.
Purpose
We investigated the association between baseline LA function and the presence of LVZ in patients undergoing initial PAF ablation. Further, we sought to create the new predictive scoring for the presence of LVZ.
Methods
Consecutive 305 patients who underwent LA voltage mapping during initial PAF ablation from January 2017 to October 2019 in our institute were retrospectively analyzed. We performed 256-slice MDCT at baseline. As the representative of LA function, we calculated LA emptying fraction (LAEF), where LAEF = {[(maximum LAV) − (minimum LAV)]/(maximum LAV)} x 100. LVZ was defined as regions where bipolar peak-to-peak voltage was <0.5mV. We performed the univariate and multivariate analysis to assess the association between LAEF and the presence of LVZ. Second, we performed receiver operating characteristic (ROC) analysis for the prediction of LVZ. We combined multivariate predictors and created the predictive scoring for LVZ.
Results
Out of 305 pts, 56 pts (18%) had LVZ in LA. In univariate analysis, low body mass index, higher percentage of female sex, higher age, higher E/e', larger maximum LA volume and lower LAEF (29.3±11.8% vs. 41.2±9.7, P<0.0001) was associated with the presence of LVZ. In multivariate logistic regression analysis, Low LAEF revealed the strongest predictor for LVZ (LAEF; Odds ratio [OR]/10% increase: 0.54, 95% CI: 0.39–0.82, P=0.0016). High age and female sex also remained as the independent predictors (Age; OR/10 y.o. increase: 1.80, 1.23–3.03, P=0.0042, Female; OR: 2.51, 1.15–5.49, P=0.0213). In ROC analysis, LAEF had moderate predictive accuracy for the presence of LVZ. (Area under the ROC curve: 0.77, Best cut-off value: 31%, P<0.0001) (Figure 1). We created OLAF-LVZ predictive score by combining Old age (1 point, ≥65), LAEF (2 points, LAEF ≤31%) and Female sex (1 point). OLAF score had gradient effect on the incidence of LVZ (2%, 11%, 25%, 45%, 71%, OLAF score; 0, 1, 2, 3, 4, respectively, P<0.0001) (Figure 2).
Conclusions
In PAF patients, preoperative LAEF was strongly associated with the presence of LVZ. LVZ might reflect the myocardial injury causing LA dysfunction. OLAF-LVZ predictive score: combination of Old age (≥65), Female sex, and LAEF (≤31%) could be useful to stratify the risk of the presence of LVZ.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Oka
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - I Yoshimoto
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - Y Koyama
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - K Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - Y Hirao
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - N Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - M Okada
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - R Kitagaki
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - A Okamura
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - K Iwakura
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - K Fujii
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Cardiovasucular Division, Osaka, Japan
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Khan F, Inoue K, Remme E, Andersen O, Gude E, Skulstad H, Chetrit M, Garcia-Izquierdo Jaen E, Ha J, Klein A, Kikuchi S, Ohte N, Nagueh S, Smiseth O. Which single echo parameter is the best marker of left ventricular filling pressure? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Estimation of left ventricular filling pressure (LVFP) is highly relevant in clinical practice. Invasive pressure remains the gold standard, but a number of echocardiographic parameters that correlate with LVFP are used as non-invasive markers of pressure.
Purpose
We investigated how different echocardiographic parameters correlated with invasively measured LVFP, and how accurately those parameters could differentiate between normal or elevated LVFP.
Method
We performed a prospective, multicenter, multinational and multivendor study in an all comer population of 322 patients with suspected heart failure or other cardiovascular disease. 194 patients had EF ≥50% and 129 had EF <50%. LVFP was measured by right- or left heart catheterization, as pulmonary capillary wedge pressure or pre-A LV diastolic pressure, respectively.
When excluding all special patient populations defined in the 2016 recommendations for echocardiographic evaluation of LV diastolic function, 213 patients remained. Of these 135 had EF ≥50% and 74 had EF <50%.
Echocardiography was performed within 1 day of catheterization. Previously recommended cut-off values for established parameters were used to determine the accuracy of classifying LVFP as normal or elevated. For left atrial (LA) reservoir strain, based on ROC analysis, a cut-off value of <18% was used as marker of elevated LVFP.
Results
LA reservoir strain and the ratio of peak mitral early flow velocity (E) and LA reservoir strain (E/LA strain) showed the best correlations to LVFP (Table 1, Figure 1). They also had the highest accuracy, 75% for both, in classifying LVFP as normal or elevated in the whole patient population. E/LA reservoir strain provided no additional diagnostic value to using LA reservoir strain alone.
In HFpEF patients accuracy was essentially similar for LA strain, E/LA strain and E/e', whereas in HFrEF patients the two former tended to be better than E/e'.
Conclusion
Parameters containing LA reservoir strain showed the best correlation to LVFP. This indicates that LA reservoir strain may have a role in evaluation of LVFP.
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority
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Affiliation(s)
- F Khan
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - K Inoue
- Ehime University Graduate School of Medicine, Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime, Japan
| | - E.W Remme
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - O.S Andersen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - E Gude
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - H Skulstad
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - M Chetrit
- Cleveland Clinic, Cleveland, United States of America
| | | | - J.W Ha
- Yonsei University College of Medicine, Seoul, Korea (Republic of)
| | - A.L Klein
- Cleveland Clinic, Cleveland, United States of America
| | - S Kikuchi
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - N Ohte
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S.F Nagueh
- The Methodist Hospital, Houston, United States of America
| | - O.A Smiseth
- Oslo University Hospital Rikshospitalet, Oslo, Norway
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Otsuka M, Satomi N, Kahata M, Kitagawa S, Kumagai A, Inoue K, Koganei H, Enta K, Ishii Y. Diagnostic reliability of quantitative flow ratio for detection of myocardial ischemia compared with other angiographic and experience-dependent visual predicted indices. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Quantitative flow ratio (QFR) is an image-based virtual fractional flow reserve (FFR) computed by three dimensional quantitative coronary angiography (3D-QCA) and estimated flow velocity. Several studies have reported that QFR had a good diagnostic performance as compared with wire-based FFR or instantaneous wave-free ratio (iFR).
Purpose
We compared the diagnostic reliability of QFR for detection of myocardial ischemia with other angiographic and visual predicted indices.
Methods
In 301 coronary lesions (263 patients) from our QFR database for previously-reported two studies, the diagnostic reliability of QFR, several angiographic and visual predicted indices were investigated using ROC analysis as reference of FFR≤0.8 or iFR≤0.89. Visual predicted FFR were estimated by 3 physicians (25-year experienced expert, 10-year experienced senior physician and 3-year experienced trainee) blinded to other indices.
Results
Area under the curve (AUC) of each index in ROC analysis is shown in Table.
Conclusion
QFR was reliable index detecting myocardial ischemia compared with other angiographic and experience-dependent visual predicted indices.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | | | | | | | - K Inoue
- Ogikubo Hospital, Tokyo, Japan
| | | | - K Enta
- Ogikubo Hospital, Tokyo, Japan
| | - Y Ishii
- Ogikubo Hospital, Tokyo, Japan
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Tanaka M, Shizuta S, Inoue K, Kobori A, Kaitani K, Yamaji H, Morishima I, Morimoto T, Kimura T. Predictive factors of recurrent atrial tachyarrhythmia after multiple procedures of radiofrequency catheter ablation for paroxysmal atrial fibrillation: Kansai Plus Atrial Fibrillation Registry (KPAF). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The predictors of arrhythmia recurrence after radiofrequency catheter ablation (RFCA) for paroxysmal atrial fibrillation (PAF) have not yet been fully evaluated.
Purpose
The aim of this study was to develop and validate a risk scoring system to predict the incidence of recurrence of atrial tachyarrhythmia after the final RFCA for PAF.
Methods
The study population consisted of 3223 consecutive patients undergoing first-time RFCA for PAF from November 2011 to March 2014 in 26 cardiovascular centers in Japan who were enrolled in the Kansai Plus Atrial Fibrillation (KPAF) registry. We developed a scoring system in a derivation cohort with 2149 patients and assessed its reproducibility in a validation cohort with 1074 patients. The primary endpoint was recurrent atrial tachyarrhythmia lasting for ≥30 seconds after 91 days post the final ablation.
Results
During a median follow-up period of 3.1 years, 404 (18.8%) patients of the derivation cohort had AF recurrence after the final RFCA. The baseline patient characteristics of the derivation cohort were as follows: mean age 64.7 years, male 1480 (68.9%), mean body mass index (BMI) 23.6 kg/m2, hypertension 1122 (52.2%), prior heart failure 182 (8.5%), diabetes mellitus 203 (9.5%), prior stroke and/or transient ischemic attack 21 (1.0%), prior vascular disease 209 (9.7%), prior valvular disease 105 (4.9%), median CHADS2 score 1.1, median CHA2DS2-VASc score 2.1, mean number of ineffective antiarrhythmic drugs (AAD) 0.80, median duration of history of AF episodes 2.1 years, mean left atrial diameter (LAD) 38.2 mm, mean left ventricular ejection fraction (LVEF) 65.3%, and mean eGFR 68.7 mL/min/1.73m2. There was no significant difference in the baseline characteristics between derivation and validation cohorts. The results of the multivariate logistic regression models identified 5 independent variables of recurrent atrial tachyarrhythmia after the final RFCA: female (odds ratio (OR) = 1.45, p=0.0017), BMI <25 kg/m2 (OR=1.40, p=0.0081), duration of AF history 3 years≤ (OR=1.39, p<0.0034), chronic kidney disease (CKD) (OR=2.1, p=0.005, for stage 2/3CKD, OR=2.6, p=0.018 for stage 4/5 CKD), and LVEF (OR=2.1, p=0.039 for LVEF <50%, OR=1.5, p=0.022 for LVEF 50–60%). The predictive score for each factor was 3 points for CKD stage 4/5, 2 for CKD stage2/3 and LVEF <50%, and 1for the others (11 points in total). The arrhythmia-free rates after the final RCFA in the derivation cohort according to the score were as follows: 0–2 points = 91.7%, 3–4 = 80.7%, 5< = 72.6%, respectively. The similar results were reproduced in the validation cohort (Figure 1).
Conclusion
Our newly developed scoring system, composed of female, BMI, AF duration, CKD, and LVEF, could reproducibly predict arrhythmia recurrence after the final RFCA for PAF.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Tanaka
- JCHO Kobe Central Hospital, Kobe, Japan
| | - S Shizuta
- Kyoto University Graduate School of Medicine, Department of Cardiovascular Medicine, Kyoto, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Cardiovascular center, Osaka, Japan
| | - A Kobori
- Kobe City Medical Center General Hospital, Division of Cardiology, Kobe, Japan
| | - K Kaitani
- Japanese Red Cross Otsu Hospital, Department of Cardiology, Otsu, Japan
| | - H Yamaji
- Okayama Heart Clinic, Okayama, Japan
| | - I Morishima
- Ogaki Municipal Hospital, Department of Cardiology, Ogaki, Japan
| | - T Morimoto
- Hyogo College of Medicine, Department of Clinical Epidemiology, Hyogo, Japan
| | - T Kimura
- Kyoto University Graduate School of Medicine, Department of Cardiovascular Medicine, Kyoto, Japan
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Onishi T, Koyama Y, Inoue K, Okamura A, Iwamoto M, Tanaka K, Nagai H, Hirao Y, Oka T, Tanaka N, Watanabe S, Sumiyoshi A, Okada M, Iwakura K, Fujii K. Quantitative analysis of dyssynchrony assessed by multidetector computed tomography can predict clinical outcome after cardiac resynchronization therapy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The degree of mechanical dyssynchrony has been suggested as a predictor for long-term survival after cardiac resynchronization therapy (CRT). There have been little reports of dyssynchrony assessment with the use of cardiac computed tomography (CCT).
Methods
We studied 35 heart failure (HF) patients (average age 67±10 years) referred for CRT with NYHA III-IV heart failure, left ventricular (LV) ejection fraction (EF) 20±10% (all ≤35%), and QRS duration 156±22 ms (all ≥120ms). Electrocardiogram-gated contrast-enhanced 256-slice multidetector CT was performed before CRT. Based on CCT, the LV endocardial boundaries from short-axis images reconstructed at 5% increments of cardiac cycle were automatically detected, and the time from R-wave to maximal wall motion was calculated for each of the 16 standardized segments for all slices using software “Myocardial Contraction Map”. The standard deviation modified by mean heart rate (%SD) was respectively calculated as the global parameter of dyssynchrony. LVEF was also measured using MDCT. The predefined primary end-point was the first HF hospitalization or death over 2 years.
Results
%SD was feasible in all patients, respectably. There were 16 events over 2 years; 11 HF hospitalizations and 5 deaths. Patients with %SD ≥22% (optimal cutoff for outcome by ROC curve analysis) had a better clinical outcome than patients with %SD <22% (p=0.01, Figure).
Conclusion
Patients who had %SD ≥22% assessed by MDCT had a particularly favorable event-free survival following CRT, and this appears to be an important prognostic marker.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Onishi
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Y Koyama
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - A Okamura
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - M Iwamoto
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Tanaka
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - H Nagai
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Y Hirao
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - T Oka
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - N Tanaka
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - S Watanabe
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | | | - M Okada
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Iwakura
- Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - K Fujii
- Sakurabashi-Watanabe Hospital, Osaka, Japan
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Inoue K, Ohnishi T, Iwakura K, Tanaka K, Oka T, Hirao Y, Tanaka N, Okada M, Kitagaki R, Yoshimoto I, Koyama Y, Okamura A, Fujii K. Evaluation of the local atrial function by regional speckle tracking imaging using intracardiac echocardiography. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
It has been reported that low voltage areas and conduction abnormalities detected by electrophysiology catheters in the left atrium (LA) represent regional degeneration and fibrosis of the atrium and are related to a poor atrial fibrillation (AF) ablation outcome. Assessment of the local atrial function is clinically useful because atrial degeneration does not occur uniformly throughout the atrium. Though evaluating the global atrial function using speckle tracking imaging (STI) by transthoracic echocardiography (TTE) has been attempted, TTE does not have a sufficient image quality to assess local atrial STI.
Purpose
To evaluate the local atrial function by STI using intracardiac echocardiography (ICE) and to elucidate the characteristics of the STI in normal and abnormal voltage regions in the LA.
Methods
We included 9 patients undergoing AF ablation with written informed consent for this prospective observational study. After pulmonary vein isolation, we performed voltage mapping of the LA in sinus rhythm using a CARTO system (Biosense). Abnormal regions and normal regions were defined as those with low voltage areas (<0.5 mV) and those with normal voltages, respectively. Echo images were recorded by an ACUSON SC2000 (Siemens) and SOUNDSTAR catheter (Biosense). We inserted the SOUNDSTAR catheter into the LA to obtain clear images, recorded the STI of the anterior and inferior wall, and performed an offline analysis of the atrial strain with an eSie VVI work station (Siemens) and the LA voltage data with CARTO system at each site simultaneously (left figure). We compared the strain during the atrial contraction phase (Sct) between the normal and abnormal regions.
Results
Among the study population, 5 patients had low voltage areas in the LA. We evaluated the STI at 26 normal regions and 44 abnormal regions. The typical regional speckle tracking waveform in the normal region was similar to a jugular vein pressure waveform (right figure). There was a difference in the amplitude of the Sct between the groups; it was significantly smaller in the abnormal regions (normal and abnormal regions, 9.8±5.0% and 5.6±3.8%, p=0.0001). The duration of the Sct was significantly more prolonged in the abnormal regions than normal regions (98.8±26.3ms and 118.2±33.9ms, p=0.015).
Conclusions
This pilot study demonstrated that the local atrial function was evaluable by STI using ICE and that the regional strain tracking waveform during the atrial contraction phase in abnormal voltage regions was smaller and more prolonged than that in normal regions. An evaluation of the regional STI with an ICE may be useful to detect regional abnormalities of the atrium.
Representative case
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- K Inoue
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - T Ohnishi
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - K Iwakura
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - K Tanaka
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - T Oka
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Y Hirao
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - N Tanaka
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - M Okada
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - R Kitagaki
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | | | - Y Koyama
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - A Okamura
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - K Fujii
- Sakurabashi Watanabe Hospital, Osaka, Japan
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Kinoshita M, Inoue K, Akazawa Y, Nakagawa H, Sasaki Y, Higashi H, Fujii A, Uetani T, Aono J, Nagai T, Nishimura K, Ikeda S, Yamaguchi O. Impact of right ventricular contractile reserve on exercise capacity in patients with heart failure: clinical application of low-load exercise stress echocardiography. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The peak oxygen uptake (VO2) evaluated by the cardiopulmonary exercise test (CPX) is an established marker of exercise capacity in patients with heart failure (HF). In particular, peak VO2 <14 ml/kg/min is used to be one of the criteria for heart transplantation. However, given exercise intolerance in patients with HF, it is difficult for refractory HF patients to reach sufficient exercise load. A recent report has highlighted significant impact of right ventricular (RV) function on mortality and urgent heart transplantation. Taken together, we hypothesized that the assessment of RV function was helpful to predict exercise capacity by using low-load exercise stress echocardiography (low-load ESE) in patients with HF.
Purpose
We evaluated whether RV dysfunction assessed by the low-load ESE determined a low peak VO2 <14 ml/kg/min in patients with HF.
Methods
We studied 67 consecutive hospitalized patients with HF (mean age, 65 years; 75% male; mean LV ejection fraction, 36%) who underwent ESE and CPX after stabilized HF condition, and the time interval of CPX and ESE tests was within 48 hours. CPX was performed using an upright cycle ergometer by a ramp protocol, while ESE was performed using ergometer in semi-supine position and the workload was generally increased by 25 watts every 3 minutes. The low-load ESE was defined as the 25 watts exercise. The increments of RV s' velocity at tricuspid annulus and RV strain in the free wall were considered as a preservation of RV contractile reserve. Among the study population, 26 patients were performed right heart catheterization and RV dP/dt/Pmax was estimated as an invasive marker of RV contractility.
Results
The achieved intensity of exercise was 50.4±21.0 watts, and all patients completed the low-load ESE. The invasive study showed that the change of RV s' velocity during the low-load ESE significantly correlated with RV dP/dt/Pmax (r=0.706, p<0.001). As shown in Figure, the non-invasive parameters of RV contractile reserve during the low-load ESE were significantly correlated with peak VO2 (RV s' velocity: r=0.787, p<0.001; RV strain: r=0.244, p=0.047). ROC analysis showed that the change of RV s' velocity during the low-load ESE correctly identified patients with peak VO2 <14 ml/kg/min (AUC=0.95, sensitivity 92.3%, specificity 85.2%). In terms of inter- and intra-observer variabilities, ICCs of the change of RV s' velocity were 0.86 and 0.96, and ICCs of the changes of RV strain were 0.63 and 0.70, respectively.
Conclusion
The change of RV s' velocity during the low-load ESE could determine exercise tolerance in patients with HF. The assessment of RV contractile reserve might be clinically useful to discriminate high risk HF patients.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - K Inoue
- Ehime University, Toon, Japan
| | | | | | | | | | - A Fujii
- Ehime University, Toon, Japan
| | | | - J Aono
- Ehime University, Toon, Japan
| | - T Nagai
- Ehime University, Toon, Japan
| | | | - S Ikeda
- Ehime University, Toon, Japan
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Tanaka N, Inoue K, Tanaka K, Hirao Y, Oka T, Okada M, Yoshimoto I, Onishi T, Iwakura K, Fujii K. Screening for obstructive sleep apnea in atrial fibrillation patients at their home before catheter ablation using watch peripheral arterial tonometry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Catheter ablation of atrial fibrillation (AF) is effective, but certain patients experience AF recurrences. Obstructive sleep apnea (OSA) is a risk factor for AF recurrence. Watch peripheral arterial tonometry (WP) has a good correlation with polysomnography (PSG) in terms of the apnea-hypopnea index (AHI) and is easier to perform than PSG. Patients in AF have a high prevalence of OSA. Whether all patients with AF should be evaluated for OSA before catheter ablation is still controversial.
Purpose
To elucidate the prevalence and predictors of OSA using WP as a home sleep apnea test in AF patients before catheter ablation.
Methods
This study was conducted under a retrospective, single-center, observational design. Patients who received AF ablation without a prior diagnosis of sleep apnea and assessment of their AHI using WP were included in this analysis. The patients were mounted with a WP device by themselves at their own home. Twenty-two patients who were already diagnosed with OSA were excluded.
Results
Seven hundred seventy-four (65±11 years, 567 males, 440 paroxysmal AF) out of 776 patients were successfully mounted with WP devices on their own and underwent an OSA assessment. Their mean body mass index (BMI) was 24.1±3.5 kg/m2. The mean AHI was 20.1±15.6. Only 88 (11.4%) patients had a normal AHI (AHI<5). Mild OSA (5≤AHI<15), moderate OSA (15≤AHI<30), and severe OSA (AHI≥30) were observed in 274 (35.4%), 252 (32.6%), and 160 (20.7%) patients, respectively. A BMI≥25 (odds ratio [OR]; 2.42, 95% confidence interval [CI]; 1.74–3.37, p<0.001), male sex (1.70, 1.19–2.44, p=0.0037), non-paroxysmal AF (1.90, 1.35–2.66, p=0.0002), hypertension (1.70, 1.24–2.33, p=0.009), and left atrial volume index ≥30 (OR=1.51, CI 1.06–2.16, p=0.022) were significant predictors of moderate or severe OSA by a multivariate analysis, while an Epworth sleepiness scale ≥11 was not a predictor of moderate or severe OSA (OR=0.99, CI 0.66–1.49, p=0.95). However, 44.2% of non-obese patients (BMI <25) had moderate-severe OSA.
Conclusion Almost
All patients successfully underwent WP to diagnose OSA. AF patients had a high prevalence of OSA, and screening OSA would be important in AF patients receiving ablation even if patients do not have sleepiness or are obese. We cannot deny OSA in AF patients before catheter ablation without performing screening tests for OSA.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- N Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - K Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - Y Hirao
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - T Oka
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - M Okada
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - I Yoshimoto
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - T Onishi
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - K Iwakura
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - K Fujii
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
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Saito M, Nakao Y, Higaki R, Yokomoto Y, Ogimoto A, Suzuki M, Kawakami H, Hiasa G, Okayama H, Inoue K, Ikeda S, Yamaguchi O. Incremental benefits of echocardiographic indices over clinical parameters for screening cardiac amyloidosis in patients with left ventricular hypertrophy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac amyloidosis (CA), characterized by amyloid protein deposition in the heart, is a treatable disease. Although left ventricular (LV) wall thickness is the most established imaging predictor for CA, several echocardiographic indices including deformation parameters also contribute to the screening of CA. However, it is unclear whether additive values of echocardiographic indices have greater benefit over the conventional clinical predictors for the screening of CA. Therefore, we sought to compare the incremental benefits of echocardiographic indices over the clinical parameters for the screening of CA and externally validate their incremental benefits.
Methods
We retrospectively studied 295 consecutive patients (median age, 67 years; male, 65%; mean LV wall thickness (MWT), 12 mm) with LV hypertrophy who underwent echocardiography as well as the detailed work-up for myocardium (Biopsy, technetium pyrophosphate scintigraphy (99mTc-PYP) or cardiac magnetic resonance imaging). CA was diagnosed through biopsy or 99mTc-PYP. The clinical model considers patients' age and the low-voltage in electrocardiography in reference to previous studies. Continuous echocardiographic variables were represented in binary through generally accepted external cutoff points. The incremental benefits of the echocardiography findings over the clinical model were assessed using with the help of both receiver-operated characteristic curve analysis and comparison of area under the curves. Furthermore, these incremental benefits were validated in the external validation sample (median age, 70 years; male, 69%; MWT, 12 mm).
Results
Among the enrolled patients, CA was observed in 18% of cases. Table presents the results of this study. Of the echocardiographic parameters, relative apical sparing pattern (RASP) was the greatest contributor for improvement of diagnostic accuracy of the clinical model. The next greatest contributor was LV wall thickness, followed by left atrial reservoir strain (LAS), E/e', left atrial volume index, ejection fraction strain ratio, and pericardial effusion, respectively. Similarly, RASP, LV wall thickness, global longitudinal strain, ejection fraction, LAS, and granular sparkling showed significant incremental benefit in the validation cohort. Only mean wall thickness, LV wall thickness, LAS, E/e' and RASP consistently improved the diagnostic accuracy of the clinical model.
Conclusion
During the screening process, adding LV wall thickness, LAS, and RASP to the clinical parameters may be useful for the accurate diagnosis of CA in patients with LV hypertrophy.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Saito
- Kitaishikai Hospital, Ozu, Japan
| | - Y Nakao
- Kitaishikai Hospital, Ozu, Japan
| | - R Higaki
- Kitaishikai Hospital, Ozu, Japan
| | - Y Yokomoto
- Uwajima City Hospital, Cardiology, Uwajima, Japan
| | - A Ogimoto
- Uwajima City Hospital, Cardiology, Uwajima, Japan
| | - M Suzuki
- Ehime Prefectural Imabari Hospital, Cardiology, Imabari, Japan
| | - H Kawakami
- Ehime Prefectural Imabari Hospital, Cardiology, Imabari, Japan
| | - G Hiasa
- Ehime Prefectural Central Hospital, Cardiology, Matsuyama, Japan
| | - H Okayama
- Ehime Prefectural Central Hospital, Cardiology, Matsuyama, Japan
| | - K Inoue
- Ehime University, Cardiology, Toon, Japan
| | - S Ikeda
- Ehime University, Cardiology, Toon, Japan
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Okada M, Inoue K, Onishi T, Iwakura K, Yamada T, Yasumura Y, Tamaki S, Hayashi T, Yano M, Hikoso S, Sakata Y. The impact of frailty and aging on prognosis in patients with heart failure with preserved ejection fraction – insights from PURSUIT-HFpEF registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Frailty and aging are two common conditions both associated with increased vulnerability to stressful events with high risk of adverse outcomes.
Purpose
To evaluate the association between frailty and aging and their impacts on clinical outcome in patients with heart failure with preserved ejection fraction (HFpEF).
Methods
Analysis was performed from a prospective multicenter observational registry for HFpEF (PURSUIT-HFpEF Registry) conducted in the Osaka region of Japan. A total of 757 patients hospitalized for acute heart failure (diagnosed by using Framingham criteria) met the inclusion criteria: a left ventricular ejection fraction ≥50% and brain natriuretic peptide ≥100pg/ml. We included 483 patients (age, 80±9 years; men, 45%; atrial fibrillation, 35%) whose follow-up data after survival discharge were available. Patients' frailty and aging were evaluated using the clinical frailty scale (CFS) and age quartiles (Q1: <76 years (n=122), Q2: 76–82 years (n=111), Q3: 82–87 years (n=127), Q4: >87 years (n=123)), respectively. The primary clinical endpoint was defined as the composite of death, re-hospitalization for heart failure, and cerebrovascular accident.
Results
The median (interquartile range) CFS rating was 3 (2–5), and there was a little correlation between CFS rating and age (r2=0.16, p<0.001). The prevalence of frailty, defined as a CFS rating >4 (n=132), was positively correlated with age quartiles (Q1: 9.0%, Q2: 21.4%, Q3: 29.9%, Q4: 48.0%, p<0.001). During the median follow-up period 396 days (interquartile range, 344–698) after discharge, the clinical endpoint was observed in 172 patients. The incidence was higher in patients with frailty than those without it (49.6% vs. 30.4%, log-rank p<0.001). It was also correlated with age quartiles (Q1: 23.0%, Q2: 34.2%, Q3: 36.2%, Q4: 48.8%, log-rank p=0.001). Multivariate Cox regression analysis revealed that frailty (hazard ratio, 1.52; 95% confidence interval, 1.09–2.10; p=0.013) and age (hazard ratio per quartile increase, 1.24; 95% confidence interval, 1.07–1.43; p=0.004) were both associated with the clinical endpoint. Subgroup analysis in 352 patients without frailty also revealed the significant impact of age on the endpoint (1.26; 1.06–1.51; p=0.008). However, in 131 patients with frailty, there was no significant impact of age on the endpoint (1.16; 0.90–1.51; p=0.25).
Conclusions
Frailty was common and was associated with aging in HFpEF patients. Although they were both associated with unfavorable events, aging was no longer a significant predictor of adverse outcomes under the frailty conditions.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Roche Diagnostics K.K. and Fuji Film Toyama Chemical Co. Ltd.
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Affiliation(s)
- M Okada
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - K Inoue
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - T Onishi
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - K Iwakura
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - Y Yasumura
- Amagasaki Central Hospital, Amagasaki, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | | | - M Yano
- Osaka Rosai Hospital, Osaka, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Osaka, Japan
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Okada M, Inoue K, Onishi T, Iwakura K, Yamada T, Yasumura Y, Tamaki S, Hayashi T, Yano M, Hikoso S, Sakata Y. The comparison of clinical significance between atrial and ventricular structural remodeling in patients with heart failure with preserved ejection fraction – insights from PURSUIT-HFpEF registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Structural remodeling is an important aspect of pathophysiology of heart failure (HF). The compensatory mechanism against diastolic dysfunction would be more obvious on the left atrium rather than left ventricle in HF with preserved ejection fraction (HFpEF).
Purpose
To investigate the impact of left atrial (LA) and left ventricular (LV) remodeling on clinical outcomes in HFpEF patients.
Methods
Analysis was performed from a prospective multicenter observational registry for HFpEF (PURSUIT-HFpEF Registry) conducted in the Osaka region of Japan. A total of 757 patients hospitalized for acute HF (diagnosed by using Framingham criteria) met the inclusion criteria: a LV ejection fraction ≥50% and brain natriuretic peptide ≥100pg/ml. We included 381 patients (age, 82±9 years; men, 45%; atrial fibrillation (AF), 34%) whose follow-up data after survival discharge were available and whose LA volume index (LAVI) and left ventricular end-diastolic volume index (LVEDVI) at discharge were measured by the biplane Simpson's method using echocardiography. The primary endpoint was defined as the composite of death, re-hospitalization for HF, and cerebrovascular accident.
Results
The LAVI and LVEDVI at discharge was 54±25 ml/m2 and 55±21 ml/m2, respectively (r2=0.014, p=0.021). When patients were classified into the LAVI tertiles groups (T1: <40ml/m2 (n=124), T2: 41–59ml/m2 (n=127), T3: >60ml/m2 (n=130)), there was a positive correlation between the prevalence of diastolic dysfunction and the LAVI tertiles (T1, 21.0%; T2, 48.8%; T3, 51.5%; p<0.001). On the other hand, significant association was not observed between the prevalence of diastolic dysfunction and the LVEDVI tertile groups (p=0.42). During the median follow-up period of 396 days (IQR, 345–698), the composite endpoint was observed in 131 patients and there was a positive correlation between the endpoint and the LAVI tertiles (T1, 24.2%; T2, 38.6%; T3, 40.3%; p=0.011). On the other hand, no correlation was found between the endpoint and the LVEDVI tertiles (p=0.13). After adjustment for age, gender, and presence of diastolic dysfunction, Cox regression analysis revealed that not LVEDVI but LAVI at discharge was a significant predictor of the composite endpoint in the entire cohort (hazard ratio per 10 ml/m2 increase; 1.09; 95% confidence interval, 1.02–1.16; p=0.009) and in the sinus rhythm subgroup (1.10; 1.01–1.20; p=0.034). However, not LAVI but LVEDVI was a significant predictor for the adverse outcomes in the AF subgroup (1.23; 1.04–1.46; p=0.016).
Conclusions
Increased LAVI at discharge, which was associated with diastolic dysfunction, related to unfavorable prognosis in patients with HFpEF. However, LAVI was no more a predictor for the adverse outcomes but LVEDVI was in the AF subgroup. The clinical significance of atrial and ventricular remodeling may differ between sinus rhythm and AF rhythm in HFpEF population.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Roche Diagnostics K.K. and Fuji Film Toyama Chemical Co. Ltd.
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Affiliation(s)
- M Okada
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - K Inoue
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - T Onishi
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - K Iwakura
- Sakurabashi Watanabe Hospital, Osaka, Japan
| | - T Yamada
- Osaka General Medical Center, Osaka, Japan
| | - Y Yasumura
- Amagasaki Central Hospital, Amagasaki, Japan
| | - S Tamaki
- Osaka General Medical Center, Osaka, Japan
| | | | - M Yano
- Osaka Rosai Hospital, Osaka, Japan
| | - S Hikoso
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Y Sakata
- Osaka University Graduate School of Medicine, Osaka, Japan
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Tanaka N, Inoue K, Kobori A, Kazutai K, Morimoto T, Kurotobi T, Morishima I, Kusano K, Yamaji H, Nakazawa Y, Tanaka K, Iwakura K, Fujii K, Kimura T, Shizuta S. Sex differences in the predictors of recurrent atrial fibrillation after catheter ablation: insights from the Kansai Plus Atrial Fibrillation (KPAF) registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The impact of sex differences on the clinical outcomes of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is controversial. We previously reported that females experienced more frequent AF recurrences than males after the index and last RFCA procedures.
Purpose
To identify the risk factors associated with recurrent AF in females and males after RFCA of AF.
Methods
We conducted a large-scale, prospective, multicenter, observational study (Kansai Plus Atrial Fibrillation Registry). We enrolled 5010 consecutive patients who underwent an initial RFCA of AF at 26 centers (64±10 years; 1369 [27.3%] females; non-paroxysmal AF, 35.7%). The median follow-up duration was 2.9 years.
Results
The incidence of AF recurrences after a single procedure was 43.3% in females and 39.0% in males. After a multivariate adjustment at baseline, the significant predictors of AF recurrence in females after the index RFCA were non-paroxysmal AF (hazard ration [HR],1.59; 95% confidence interval [CI],1.31–1.93, p<0.0001), a history of AF ≥2 years (HR,1.47; 95% CI,1.24–1.74, p<0.0001), coronary artery disease (HR,1.43; 95% CI,1.03–1.98, p=0.0035), and an estimated glomerular filtration rate (eGFR)<60 mL/min/1.73m2 (HR,1.46; 95% CI,1.10–1.95, p=0.0086). On the other hand, significant predictors of AF recurrence in males after the index RFCA were non-paroxysmal AF (HR,1.54; 95% CI,1.37–1.73, p<0.0001), a history of AF ≥2 years (HR,1.40; 95% CI,1.26–1.56, p<0.0001), the number of antiarrhythmic drugs (HR,1.06; 95% CI,1.003–1.13, p=0.040), a left atrial diameter≥40mm (HR,1.13; 95% CI,1.007–1.27, p=0.038), and dilated cardiomyopathy (HR,1.55; 95% CI,1.07–2.26, p=0.021), however, an eGFR<60 mL/min/1.73m2 was not associated with AF recurrence in males (HR, 1.00; 95% CI, 0.88–1.13, p=0.97).
Conclusion
The Kansai Plus Atrial Fibrillation Registry revealed a distinct sex difference in terms of the predictors of recurrent AF after RFCA. Non-Paroxysmal AF and a long history of AF were common risk factors both in females and males. However, renal dysfunction was a significant predictor of AF recurrence in females, while it was not a risk of recurrence in males.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Research Institute for Production Development in Kyoto, Japan.
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Affiliation(s)
- N Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - A Kobori
- Kobe City Medical Center General Hospital, Kobe, Japan
| | - K Kazutai
- Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - T Morimoto
- Hyogo College of Medicine, Nishiomiya, Japan
| | | | | | - K Kusano
- National Cerebral & Cardiovascular Center, Suita, Japan
| | - H Yamaji
- Okayama Heart Clinic, Okayama, Japan
| | - Y Nakazawa
- Shiga University of Medical Science, Otsu, Japan
| | - K Tanaka
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - K Iwakura
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - K Fujii
- Sakurabashi-Watanabe Hospital, Cardiovascular Center, Osaka, Japan
| | - T Kimura
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - S Shizuta
- Kyoto University Graduate School of Medicine, Kyoto, Japan
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Pak M, Kobori A, Shizuta S, Sasaki Y, Toyota T, Yoshizawa T, Inoue K, Kaitani K, Kurotobi T, Morishima I, Kusano K, Kimura T, Furukawa Y. The impact of catheter ablation for patients with asymptomatic atrial fibrillation: subanalysis of kansai plus atrial fibrillation (kpaf) registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Catheter ablation (CA) of atrial fibrillation (AF) for symptomatic patients improves the quality of life and prognosis of patients with heart failure. However, the impact of CA for asymptomatic patients is still controversial.
Purpose
We aimed to investigate the clinical outcomes of CA of AF for asymptomatic patients compared to those for symptomatic patients.
Methods
A total of 5,013 patients from the Kansai Plus Atrial Fibrillation (KPAF) Registry who underwent CA were screened. The patients were divided into three groups by type of AF; paroxysmal (PAF), persistent (PEAF) and long standing (LSAF) and the patients in each type of AF were divided into two groups: asymptomatic and symptomatic. The primary endpoint was recurrent supraventricular tachyarrhythmias lasting for more than 30 seconds during follow-up 4 years after CA. The secondary endpoint was a composite of cardiovascular, cerebral, and gastrointestinal events during follow-up 4 years after CA. The incidence of complications related to CA between asymptomatic and symptomatic patients was also evaluated. Kaplan–Meier analysis was employed to estimate the primary and secondary endpoints. The statistical differences in primary and secondary endpoints between asymptomatic and symptomatic patients were evaluated using a log–rank test. The impact of symptom due to AF on the primary and secondary endpoint was evaluated using a Cox hazard analysis. The difference in incidence of complications between asymptomatic and symptomatic patients was evaluated using a chi–square test.
Results
In this study population, PAF was the most frequent at 64.4%, followed by PEAF (22.7%) and LSAF (13.0%). There were some significant differences in the baseline characteristics between asymptomatic and symptomatic patients in each type of AF. The proportion of male was significantly higher in asymptomatic patients than symptomatic patients in PAF (81.2% versus 67.2%, p<0.001) and PEAF (86.4% versus 74.3%, p<0.001). Left atrial diameter was larger in asymptomatic patients than symptomatic patients only in PAF (40±6mm versus 38±6mm, p<0.001). In all types of AF, there was no significant difference in primary endpoint between asymptomatic and symptomatic patients as follows: 37.5% versus 40.6% (p=0.6) in PAF, 45.2% versus 55.1% (p=0.09) in PEAF and 59.3% versus 63.6% (p=1.0) in LSAF. There was also no significant difference in secondary endpoint between asymptomatic and symptomatic patients: 7.1% versus 6.8% (p=0.7) in PAF, 5.4% versus 8.7% (p=0.3) in PEAF and 4.4% versus 5.1% (p=0.5) in LSAF. In a Cox hazard analysis, the symptom did not affect both of the primary and secondary endpoints in each type of AF. In regard to the incidence of complications related to CA, there was no significant difference between asymptomatic and symptomatic patients in each type of AF.
Conclusion
CA of AF for asymptomatic patients can be safe and can lead to equivalent outcomes as well as symptomatic patients.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Pak
- Kobe City Medical Center General Hospital, Kobe, Japan
| | - A Kobori
- Kobe City Medical Center General Hospital, Kobe, Japan
| | - S Shizuta
- Kyoto University Graduate School of Medicine, Cardiovascular Medicine, Kyoto, Japan
| | - Y Sasaki
- Kobe City Medical Center General Hospital, Kobe, Japan
| | - T Toyota
- Kobe City Medical Center General Hospital, Kobe, Japan
| | - T Yoshizawa
- Kyoto University Graduate School of Medicine, Cardiovascular Medicine, Kyoto, Japan
| | - K Inoue
- Sakurabashi-Watanabe Hospital, Cardiovascular center, Osaka, Japan
| | - K Kaitani
- Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - T Kurotobi
- Namba Kurotobi Heart Clinic, Osaka, Japan
| | | | - K Kusano
- National Cerebral & Cardiovascular Center, Suita, Japan
| | - T Kimura
- Kyoto University Graduate School of Medicine, Cardiovascular Medicine, Kyoto, Japan
| | - Y Furukawa
- Kobe City Medical Center General Hospital, Kobe, Japan
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André F, Ciruelos E, Juric D, Loibl S, Campone M, Mayer I, Rubovszky G, Yamashita T, Kaufman B, Lu YS, Inoue K, Papai Z, Takahashi M, Ghaznawi F, Mills D, Kaper M, Miller M, Conte P, Iwata H, Rugo H. LBA18 Overall survival (os) results from SOLAR-1, a phase III study of alpelisib (ALP) + fulvestrant (FUL) for hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2–) advanced breast cancer (ABC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2246] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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