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Matsuo T, Ochi Y, Kubo T, Baba Y, Miyagawa K, Noguchi T, Hirota T, Hamada T, Yamasaki N, Kitaoka H. Associations between electrocardiographic findings and echocardiographic profiles in patients with hypertrophic cardiomyopathy. J Cardiol 2024; 83:359-364. [PMID: 37541430 DOI: 10.1016/j.jjcc.2023.07.017] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The relationships between electrocardiography (ECG) findings and echocardiographic profiles in patients with hypertrophic cardiomyopathy (HCM) are not fully understood. METHODS One hundred forty patients (mean age: 62.9 ± 15.3 years, 96 men) with HCM were studied. We assessed the associations between ECG findings and echocardiographic findings including maximum left ventricular wall thickness, HCM subtypes and distribution of left ventricular hypertrophy (LVH): the LV was divided into basal, mid, and apical segments by dividing it into thirds along the long axis. RESULTS In ECG, LVH by voltage criteria, abnormal Q wave, negative T wave, and giant negative T wave (GNT) were observed in 74 (53 %), 30 (21 %), 132 (94 %), and 25 (18 %) of the patients, respectively. In two groups with and without an LVH pattern according to voltage criteria in ECG, there were no significant differences in maximum LV wall thickness, subtype of HCM, and distribution of LVH. Regarding an abnormal Q wave, the proportion of patients with LVH in the basal segment was significantly higher in patients with an abnormal Q wave than in patients without an abnormal Q wave (87 % vs 61 %, p = 0.008). An abnormal Q wave was not observed in patients with LVH confined to the apex. Patients with a GNT included patients with LVH located at only the apex (apical HCM), LVH from the mid segment to apex, and LVH from the base to apex. No GNT was found in patients with hypertrophy located in the upper region from the base to mid segment of the LV. CONCLUSIONS In patients with HCM, there was no significant correlation between the presence of LVH by voltage criteria in ECG and echocardiographic findings. An abnormal Q wave was associated with disproportionate hypertrophy of the basal wall and a GNT reflected the presence of LVH in the apical segment.
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Affiliation(s)
- Tomomi Matsuo
- Innovative Medicine, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan.
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kazuya Miyagawa
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Tatsuya Noguchi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Tomoyuki Hamada
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
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Funaki T, Saji M, Higuchi R, Takamisawa I, Nanasato M, Tamura H, Sato K, Yokoyama H, Doi S, Okazaki S, Onishi T, Tobaru T, Takanashi S, Ikeda T, Kitaoka H, Isobe M. Impact of osteoporotic risk in men undergoing transcatheter aortic valve replacement: a report from the LAPLACE-TAVI registry. Cardiovasc Interv Ther 2024:10.1007/s12928-024-01011-7. [PMID: 38755510 DOI: 10.1007/s12928-024-01011-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
Low body weight and advanced age are among the best predictors of osteoporosis. Osteoporosis Self-Assessment Tool (OST) values are calculated by a simple formula [(body weight in kilograms - age in years) × 0.2] to identify patients at increased risk of osteoporosis. In our recent single-center study, we demonstrated an association between OST and poor outcomes in postmenopausal women after transcatheter aortic valve replacement (TAVR). We aimed to investigate the impact of osteoporotic risk in men with aortic stenosis who underwent TAVR in a large cohort. In this multi-center study, 1,339 men who underwent TAVR between April 2010 and July 2023 were retrospectively analyzed. Women were excluded from the present study. All patients were deemed appropriate for TAVR after a review by a multidisciplinary team. Baseline characteristics of patients were compared by dividing patients into three tertiles, based on the OST value: ≤ - 6.16, - 6.16 to - 4.14, and - 4.14 < for tertiles 1, 2, and 3, respectively. Primary endpoint was all-cause mortality after TAVR. Tertile 1 (patients with the lowest OST values) included older patients with smaller body mass index, lower hemoglobin and albumin levels. In addition, they had greater clinical frailty scale, slower 5-meter walk test, weaker hand grip strength, and more cognitive impairment, indicating increased frailty. They were more severely symptomatic, with lower ejection fractions, smaller aortic valve areas, and more tricuspid regurgitation than were patients in the other two groups. Multivariate analysis revealed that OST tertiles 3 was associated with decreased risk of all-cause mortality (hazard ratio, 0.66; 95% confidence interval, 0.48-0.90), compared with OST tertile 1 as a reference. For OST tertiles 1, 2, and 3, the estimated 1-year survival rates of all-cause mortality post-TAVR were 83.6% ± 1.9%, 91.1% ± 1.4%, and 93.1% ± 1.3%, respectively, (log-rank, p < 0.001). In conclusions, in men as same as women, osteoporotic risk assessed by OST values was overlapped with increased frailty. The simple OST formula was useful for predicting all-cause mortality in patients undergoing TAVR in large registry datasets.
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Affiliation(s)
- Takashi Funaki
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
- Department of Cardiology and Geriatrics, Kochi University, Kochi, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
- Devision of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Otaku, Tokyo, 143-8541, Japan.
| | - Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Mamoru Nanasato
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Harutoshi Tamura
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Kei Sato
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan
| | - Hiroaki Yokoyama
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Biology and Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Takayuki Onishi
- Department of Cardiology, Kawasaki Saiwai Hospital, Kanagawa, Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Kawasaki Saiwai Hospital, Kanagawa, Japan
| | | | - Takanori Ikeda
- Devision of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Otaku, Tokyo, 143-8541, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi University, Kochi, Japan
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Mitsuishi A, Miura Y, Nomura Y, Hirota T, Arima N, Kitaoka H, Tateiwa H, Katsumata Y. Bleeding sites and treatment strategies for cardiac tamponade by catheter ablation requiring thoracotomy: risks of catheter ablation in patients with left atrial diverticulum. J Cardiothorac Surg 2024; 19:238. [PMID: 38632637 PMCID: PMC11022316 DOI: 10.1186/s13019-024-02710-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/29/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND There is insufficient information regarding the bleeding sites and surgical strategies of cardiac tamponade during catheter ablation for atrial fibrillation (AF). CASE PRESENTATION Of the five patients with cardiac tamponade, three required surgical intervention and two required pericardiocentesis. In the first case of three cardiac tamponades requiring surgical intervention, considering that the peripheral route was used, the catecholamines did not reach the heart, and due to unstable vital signs, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was inserted. No bleeding point was identified, but a thrombus had spread around the left atrium (LA) with diverticulum. Hemostasis was achieved with adhesives placed around the LA under on-pump beating. In the second case, pericardiocentesis was performed, but the patient showed heavy bleeding and unstable vital signs. Thus, VA-ECMO was inserted. Heavy bleeding was expected, and safety was enhanced by attaching a reservoir to the VA-ECMO. The bleeding point was found between the left upper pulmonary artery and LA under cardiac arrest to obtain a good surgical view for suturing repair. In the third case, the LA diverticulum was damaged. Pericardiocentesis resulted in stable vitals, but sustained bleeding was present. A bleeding point was found at the LA diverticulum, and suture repair under on-pump beating was performed. CONCLUSIONS When cardiac tamponade occured in any patient with LA diverticulum, treatment could not be completed with pericardiocentesis alone, and thoracotomy was likely to be necessary. If the bleeding point could be confirmed, suturing technique is a more reliable surgical strategy than adhesive alone that leads to pseudoaneurysm. If the bleeding point is unclear, it is important to confirm the occurrence of LA diverticulum using a preoperative CT, and if confirmed, cover it with adhesive due to a high possibility of diverticulum bleeding. The necessity of CPB should be determined based on whether these operations can be completed while maintaining vital stability.
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Affiliation(s)
- Atsuyuki Mitsuishi
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan.
| | - Yujiro Miura
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Yoshinori Nomura
- Department of Clinical Engineering, Kochi Medical School Hospital, 185-1, Kohasu, Okohcho, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School Hospital, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Naoki Arima
- Department of Cardiology and Geriatrics, Kochi Medical School Hospital, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School Hospital, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Hiroki Tateiwa
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
| | - Yoshifumi Katsumata
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, 185-1, Kohasu, Okohmachi, Nankoku-shi, Kochi Prefecture, 783-8505, Japan
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Takiishi A, Baba Y, Ochi Y, Hotta M, Okazaki N, Yoshinaga Y, Miyamoto S, Hirakawa D, Kawaguchi J, Kubo T, Yamasaki N, Tokuhiro S, Kitaoka H. Clinical features of quadricuspid aortic valve in middle-aged and elderly patients: Insights from a regional study. Echocardiography 2024; 41:e15817. [PMID: 38648213 DOI: 10.1111/echo.15817] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Quadricuspid aortic valve (QAV) is a rare congenital disease. The clinical characteristics of this disease remain unclear except for those in relatively young patients reported from tertiary referral hospitals. The aim of this study was to determine the clinical features of QAV in a regional population. METHODS AND RESULTS We retrospectively investigated 25 340 consecutive patients over middle age (median age, 73 (IQR 65-80) years; range, 45-102 years) who underwent transthoracic echocardiography (TTE) at our institute during the period from April 2008 to December 2023. Eight (0.032%) of the patients (median age, 65 years; range, 47-91 years) were diagnosed with QAV. Six patients suffered from aortic regurgitation (AR), and one patient had mild aortic stenosis at the time of QAV diagnosis. Two patients who had severe AR at referral underwent aortic valve surgery. The severity of AR in the other patients was moderate or less. During a median follow-up period of 27 months (range, 1-171 months), none of the patients other than above two patients had cardiac events. One patient died from a non-cardiac cause at 94 years of age. CONCLUSIONS Patients diagnosed with QAV after middle age, who do not exhibit severe valve insufficiency at the time of diagnosis, may not experience worse clinical outcomes. However, further research is required for a better understanding of the long-term outcomes.
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Affiliation(s)
- Azumi Takiishi
- Department of Clinical Laboratory, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Mizuki Hotta
- Department of Clinical Laboratory, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Nagisa Okazaki
- Department of Clinical Laboratory, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Yuna Yoshinaga
- Department of Clinical Laboratory, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Shohei Miyamoto
- Department of Clinical Laboratory, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Daigo Hirakawa
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Juri Kawaguchi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Shinji Tokuhiro
- Department of Clinical Laboratory, Kochi Medical School Hospital, Nankoku, Kochi, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
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Baba Y, Kubo T, Ochi Y, Hirota T, Yamasaki N, Ohnishi H, Kubota T, Yokoyama A, Kitaoka H. High-sensitivity Cardiac Troponin T Is a Useful Biomarker for Predicting the Prognosis of Patients with Systemic Sarcoidosis Regardless of Cardiac Involvement. Intern Med 2023; 62:3097-3105. [PMID: 36927971 PMCID: PMC10686728 DOI: 10.2169/internalmedicine.1331-22] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/30/2023] [Indexed: 03/18/2023] Open
Abstract
Objective Cardiac involvement defines the prognosis for patients with systemic sarcoidosis. Despite advancements in techniques for diagnosing cardiac lesions, there remains significant room for improvement in cardiac screening and prognostic prediction. The present study therefore assessed the prognostic factors associated with cardiovascular events in patients with sarcoidosis. Methods We retrospectively studied 132 patients with systemic sarcoidosis and evaluated the clinical data obtained between 2009 and 2022. A Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate the associations between cardiovascular events and prognostic factors. Results The median age of the patients at the diagnosis was 64.0 (55.0-71.0) years old. During a mean follow-up period of 6.3±3.2 years, 28 patients suffered from cardiovascular events. Patients in the event group had more severe heart failure symptoms, more frequent ventricular tachycardia, higher serum high-sensitivity cardiac troponin T (hs-cTnT) values [0.025 (0.017-0.044) vs. 0.011 (0.007-0.019) ng/mL, p<0.001], and lower left ventricular ejection fraction values than those in the non-event group. These trends were observed even if the patients were not diagnosed with cardiac involvement at the time of enrollment. A multivariate analysis revealed that hs-cTnT was an independent biomarker for the prediction of cardiac events (hs-cTnT >0.014 ng/mL: HR: 7.31, 95% confidence interval: 2.20 to 24.28, p<0.001). Conclusion Hs-cTnT is a useful biomarker for predicting cardiovascular events in patients with sarcoidosis, even if cardiac involvement is not detected at the initial evaluation.
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Affiliation(s)
- Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Japan
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Japan
| | - Hiroshi Ohnishi
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Japan
| | - Tetsuya Kubota
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Japan
| | - Akihito Yokoyama
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Japan
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Baba Y, Ochi Y, Kawaguchi J, Takiishi A, Hirota T, Kubo T, Yamasaki N, Kitaoka H. Where Is the Left Atrial Appendage Wall? Caution during Transesophageal Echocardiography. CASE (Phila) 2023; 7:338-342. [PMID: 37614695 PMCID: PMC10442515 DOI: 10.1016/j.case.2023.04.008] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
•High echoic partition could appear around the LAA wall. •The pericardium attached to the lung has very strong intensity reflection. •The pericardium attached to the lung mimics the LAA wall. •Reflection artifact could also mimic the LAA wall. •These phenomena should be considered when evaluating LAA morphology.
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Affiliation(s)
- Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Juri Kawaguchi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Azumi Takiishi
- Department of Clinical Laboratory, Kochi Medical School Hospital, Kochi, Japan
| | - Takahiro Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
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Nakaya Y, Ogimoto A, Kitaoka H. Changes in Exercise Tolerance over Time in Patients with Transthyretin Amyloidosis Cardiomyopathy Treated with Tafamidis. Int Heart J 2023; 64:647-653. [PMID: 37460315 DOI: 10.1536/ihj.23-075] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Tafamidis improves the prognosis of patients with transthyretin amyloidosis cardiomyopathy (ATTR-CM). Additionally, it delays the decline in exercise tolerance, as observed in the six-minute walking test. However, the changes in cardiopulmonary function over time based on cardiopulmonary exercise tests are unclear. Thus, this preliminary study investigated the changes in exercise tolerance after one year of tafamidis treatment using cardiopulmonary exercise testing. Eight patients with ATTR-CM (average age: 77 years; male: n = 7) underwent cardiopulmonary exercise testing at baseline and after one year of tafamidis treatment. All eight patients completed a one-year follow-up. At baseline, the anaerobic threshold oxygen uptake (AT VO2: 10.9 ± 1.5) and peak VO2 (14.3 ± 3.0 mL/kg/minute) indicated relatively favorable exercise capacity; however, the minute ventilation/carbon dioxide production (VE/VCO2 slope), which indicates effective ventilation, showed poor performance (33.7 ± 12.8). One year after tafamidis treatment, frailty, as assessed by the Clinical Frailty Scale, had progressed in seven of eight patients (88%) (P < 0.01), and AT VO2 and peak VO2 were significantly reduced (19.2% and 22.3%, respectively; P < 0.05). The VE/VCO2 slope and peak O2 pulse decreased nonsignificantly by approximately 20% (P = 0.47, and P = 0.16, respectively). Further, the structure of the ventricles and atrium and the left ventricle ejection fraction on echocardiography did not change. Thus, exercise tolerance in patients with ATTR-CM was reduced after one year despite tafamidis administration. Not only ATTR-CM progression, but also frailty progression may influence this decrease in exercise tolerance. A comprehensive approach, including tafamidis administration and cardiac rehabilitation, is required for further improvement in the exercise capacity of patients with ATTR-CM.
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Affiliation(s)
- Yuta Nakaya
- Department of Rehabilitation, Uwajima City Hospital
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | | | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
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Kubo T, Kitaoka H. Genetic Testing for Cardiomyopathy in Japan 2022: Current Status and Issues of Precision Medicine. J Card Fail 2023; 29:805-814. [PMID: 37169422 DOI: 10.1016/j.cardfail.2022.11.017] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 05/13/2023]
Abstract
Although many causative genes for primary cardiomyopathy have been identified, the use of genetic testing in routine practice is limited in Japan presently. Genetic diagnosis has been reported to be useful for early diagnosis through cascade genetic screening in the family, differentiating secondary cardiomyopathies, and predicting prognosis in some patients; nonetheless, the acquisition of genetic information for cardiomyopathy is stagnating in actual clinical practice. There seem to be a number of reasons for this phenomenon, and although the use of next-generation sequencers has resolved some of the past issues, the importance of pathogenicity studies of variants that are identified is growing. To ensure that patients with cardiomyopathy and their relatives can receive precision medicine, the results of genetic analysis linked to clinical information need to be collected, and a database of variants in Japanese people needs to be established.
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Affiliation(s)
- Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan.
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
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Arima N, Yamasaki N, Furushima T, Miyamoto YY, Moriki T, Miyagawa K, Noguchi T, Kubo T, Kitaoka H. A DYNAMIC ECG CHANGE IN PATIENT WITH ACUTE ANTERIOR MYOCARDIAL INFARCTION - A NAME HAS CHANGED FROM DE WINTER TO WELLENS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03144-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Arima N, Kitaoka H, Udaka K. A LIMITED PATHOGENIC ACTIVITY OF CTLS ALONE THAT ARE SPECIFIC FOR CARDIAC MYOSIN HEAVY CHAIN-ALPHA IN AN EXPERIMENTAL AUTOIMMUNE MYOCARDITIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00865-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Terasaka N, Spanopoulos D, Miyagoshi H, Kubo T, Kitaoka H. Estimating the prevalence, clinical characteristics, and treatment patterns of hypertrophic cardiomyopathy in Japan: A nationwide medical claims database study. J Cardiol 2023; 81:316-322. [PMID: 36208832 DOI: 10.1016/j.jjcc.2022.09.015] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/13/2022] [Accepted: 09/25/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Limited data are available regarding therapies for hypertrophic cardiomyopathy (HCM). This study assessed the prevalence, clinical characteristics, and treatment patterns of HCM in Japan. METHODS This retrospective database study analyzed data from 438 hospitals in the Japan Medical Data Vision database from 2016 to 2020. We identified 3913 patients (15 %) with obstructive HCM (oHCM) and 21,714 patients (85 %) with nonobstructive HCM (nHCM). RESULTS The estimated total number of patients with oHCM and nHCM in 2020 among Japanese hospitals was 8500 and 43,500, respectively. The prevalence of oHCM and nHCM steadily increased by 27 % and 12 %, respectively, from 2016 to 2020, with a 1:5.2 ratio of oHCM to nHCM in 2020. The mean age of the oHCM and nHCM populations was 72 and 70 years, respectively, and comorbidities included atrial fibrillation (AF) (oHCM, 33.8 %; nHCM, 32.2 %), other arrythmia (30.1 %; 27.6 %), and stroke (16.6 %; 16.4 %). Furthermore, 45.0 % of oHCM and 37.7 % of nHCM patients had undergone at least one hospitalization. A substantial number of HCM patients aged between 20 and 59 years reported AF (oHCM, 17-37 %; nHCM, 4-24 %) and stroke (oHCM, 0-12 %; nHCM, 3-10 %). β-blockers (oHCM, 64.0 %; nHCM, 42.1 %) were the most frequently prescribed treatment, followed by Na channel blockers (29.5 %; 5.7 %), calcium channel blockers (18.1 %; 8.8 %), direct oral anticoagulants (14.5 %; 15.2 %), and warfarin (11.0 %; 11.4 %). CONCLUSIONS This study provides important information on the current epidemiological and clinical characteristics of HCM in Japan.
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Affiliation(s)
- Naoki Terasaka
- Medical Department, Bristol Myers Squibb K.K., Tokyo, Japan.
| | - Dionysis Spanopoulos
- Centre for Observational Research and Data Sciences, Bristol Myers Squibb, Lawrenceville, NJ, USA
| | - Hidetaka Miyagoshi
- Clinical Development Department, Bristol Myers Squibb K.K., Tokyo, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Japan
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12
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Arima N, Ochi Y, Takahashi M, Moriki T, Noguchi T, Kubo T, Yamasaki N, Kitaoka H. Transient decrease in the depth of the negative T wave in apical hypertrophic cardiomyopathy is a sign of left anterior descending artery stenosis: a case series. Eur Heart J Case Rep 2023; 7:ytad034. [PMID: 36727129 PMCID: PMC9883705 DOI: 10.1093/ehjcr/ytad034] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/02/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
Background In patients with apical hypertrophic cardiomyopathy (HCM), electrocardiography (ECG) often shows left ventricular hypertrophy (LVH) and a negative T wave. A negative T wave often disappears over time due to degeneration of the apical myocardium. However, there are limited reports on the temporary change of a negative T wave in patients with HCM. Case summary We report three apical HCM patients with LVH and T wave inversion on their previous ECG who showed a temporary decrease in the depth of the negative T wave. All of them had significant stenosis of coronary arteries including the left anterior descending artery (LAD). After revascularization for the LAD lesion, their ECG returned to the previous depth of the negative T wave. Discussion The cases presented here suggested that a temporary decrease in the depth of the negative T wave in apical HCM patients may be one of the signs of ischaemia in the anterior-apical region caused by severe stenosis of the LAD.
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Affiliation(s)
- Naoki Arima
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Oko-cho, Nankoku-shi, 783-8505 Kochi, Japan
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Oko-cho, Nankoku-shi, 783-8505 Kochi, Japan
| | - Makoto Takahashi
- Department of Cardiology, Aki General Hospital, 3-3, Hoei-cho, Aki-shi, 784-0027 Kochi, Japan
| | - Toshihiro Moriki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Oko-cho, Nankoku-shi, 783-8505 Kochi, Japan
| | - Tatsuya Noguchi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Oko-cho, Nankoku-shi, 783-8505 Kochi, Japan
| | - Toru Kubo
- Corresponding author. Tel: +81 88 880 2352, Fax: +81 88 880 2349,
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Oko-cho, Nankoku-shi, 783-8505 Kochi, Japan
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13
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Miyano I, Bae S, Lee S, Shimada H, Kitaoka H. Association between simple test assessing hand dexterity and mild cognitive impairment in independent older adults. Int J Geriatr Psychiatry 2023; 38:e5862. [PMID: 36514806 DOI: 10.1002/gps.5862] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study aimed to clarify the association between hand function, including grip strength and hand dexterity, assessed using snap fasteners, and mild cognitive impairment (MCI) in older adults with normal global cognitive function. METHODS A total of 228 functionally independent older adults (mean age 77.7 ± 6.1 years) participated in this study. None of the participants had a history of dementia diagnosis, and all the participants had a Mini-Mental State Examination score of ≥24. Participants were evaluated for hand function using grip strength and snap fastener tests, and for cognitive function using the National Center for Geriatrics and Gerontology-Functional Assessment Tool. RESULTS A total of 72 participants (31.6%) were diagnosed with MCI. The slow snap fastener test group had a higher proportion of participants with MCI (p < 0.001) and impairments in memory (p = 0.010), attention (p = 0.043), executive function (p < 0.001), and processing speed (p = 0.044) compared to the fast snap fastener test group. The slow speed of fastening snap fasteners was significantly associated with MCI and impairment in memory, attention, executive function, and processing speed (MCI: adjusted odds ratio (AOR) = 3.88, 95% confidence interval (CI) = 1.64-9.19; memory: AOR = 5.73, 95% CI = 1.58-20.82; attention: AOR = 3.95, 95% CI = 1.10-14.11; executive function: AOR = 7.22, 95% CI = 1.78-29.24; processing speed: AOR = 7.52, 95% CI = 1.19-47.66) according to the multiple logistic regression analysis. Grip strength was not significantly associated with cognitive impairment. CONCLUSIONS Thus, hand dexterity assessed using the snap fastener test was associated with MCI in older adults with normal global cognitive function. Hand dexterity assessment using the snap fastener test is useful for detecting MCI in apparently healthy older adults.
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Affiliation(s)
- Ichiro Miyano
- Department of Public Health, Kochi Medical School, Kochi University, Kochi, Japan
| | - Seongryu Bae
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.,Department of Health Care and Science, Dong-A University, Busan, Korea
| | - Sangyoon Lee
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Hiroyuki Shimada
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Hiroaki Kitaoka
- Department of Medicine and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
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14
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Takabayashi K, Hamada T, Kubo T, Iwatsu K, Ikeda T, Okada Y, Kitamura T, Kitaguchi S, Kimura T, Kitaoka H, Nohara R. External Validation of the Japanese Clinical Score for Mortality Prediction in Patients With Acute Heart Failure. Circ J 2022; 87:543-550. [PMID: 36574994 DOI: 10.1253/circj.cj-22-0652] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND To predict mortality in patients with acute heart failure (AHF), we created and validated an internal clinical risk score, the KICKOFF score, which takes physical and social aspects, in addition to clinical aspects, into account. In this study, we validated the prediction model externally in a different geographic area.Methods and Results: There were 2 prospective multicenter cohorts (1,117 patients in Osaka Prefecture [KICKOFF registry]; 737 patients in Kochi Prefecture [Kochi YOSACOI study]) that had complete datasets for calculation of the KICKOFF score, which was developed by machine learning incorporating physical and social factors. The outcome measure was all-cause death over a 2-year period. Patients were separated into 3 groups: low risk (scores 0-6), moderate risk (scores 7-11), and high risk (scores 12-19). Kaplan-Meier curves clearly showed the score's propensity to predict all-cause death, which rose independently in higher-risk groups (P<0.001) in both cohorts. After 2 years, the cumulative incidence of all-cause death was similar in the KICKOFF registry and Kochi YOSACOI study for the low-risk (4.4% vs. 5.3%, respectively), moderate-risk (25.3% vs. 22.3%, respectively), and high-risk (68.1% vs. 58.5%, respectively) groups. CONCLUSIONS The unique prediction score may be used in different geographic areas in Japan. The score may help doctors estimate the risk of AHF mortality, and provide information for decisions regarding heart failure treatment.
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Affiliation(s)
| | - Tomoyuki Hamada
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Kotaro Iwatsu
- Department of Rehabilitation, Hirakata Kohsai Hospital
| | - Tsutomu Ikeda
- Department of Rehabilitation, Hirakata Kohsai Hospital
| | - Yohei Okada
- Department of Preventive Services, School of Public Health, Kyoto University.,Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
| | | | | | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Ryuji Nohara
- Department of Cardiology, Takanohara Central Hospital
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15
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Nishimura YK, Komatsu J, Sugane H, Hosoda H, Imai RI, Nakaoka Y, Nishida K, Seki SI, Kubo T, Yamasaki N, Kitaoka H, Kubokawa SI, Kawai K, Hamashige N, Doi Y. Unilateral Pulmonary Edema in Patients With Acute Mitral Regurgitation Caused by Chordal Rupture. Circ Rep 2022; 4:571-578. [PMID: 36530837 PMCID: PMC9726524 DOI: 10.1253/circrep.cr-22-0090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/01/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 08/03/2023] Open
Abstract
Background: Cardiogenic unilateral pulmonary edema (UPE) has been reported as an unusual condition and to occur in association with severe mitral regurgitation (MR). However, the prevalence of UPE in patients with severe MR remains unknown. Methods and Results: Among 143 consecutive patients with chordal rupture and significant MR, 38 patients with acute severe MR were studied. The prevalence of UPE was 50% (19 patients); all these patients had right-sided UPE. Eight (21%) patients had bilateral pulmonary edema (BPE). All 8 patients with BPE and 18 of 19 patients with UPE had chordal rupture of the posterior leaflet. All patients with UPE and BPE had severe MR with similar left atrial size. Chest radiographs taken ≤48 h from symptom onset diagnosed UPE in 15 of 19 (79%) patients and BPE in 3 of 8 (38%) patients (P=0.037). Chest radiographs taken >48 h from symptom onset diagnosed UPE in 4 (21%) patients and BPE in 5 (62%) patients (P=0.037). Conclusions: The prevalence of UPE was estimated as 50%; it was most frequently right sided and almost always associated with chordal rupture of the posterior leaflet. UPE is not rare, but common, particularly shortly after the development of acute severe MR caused by chordal rupture.
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Affiliation(s)
- Yu-Ki Nishimura
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Junya Komatsu
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Hiroki Sugane
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Hayato Hosoda
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Ryu-Ichiro Imai
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Yoko Nakaoka
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Koji Nishida
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Shu-Ichi Seki
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Toru Kubo
- Department of Cardiology and Aging Science, Kochi Medial School Kochi Japan
| | - Naohito Yamasaki
- Department of Cardiology and Aging Science, Kochi Medial School Kochi Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Aging Science, Kochi Medial School Kochi Japan
| | - Sho-Ichi Kubokawa
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Kazuya Kawai
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Naohisa Hamashige
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Yoshinori Doi
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
- Cardiomyopathy Institute, Chikamori Hospital Kochi Japan
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16
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Hamada T, Kubo T, Kawai K, Nakaoka Y, Yabe T, Furuno T, Yamada E, Kitaoka H. Frailty interferes with the guideline-directed medical therapy in heart failure patients with reduced ejection fraction. ESC Heart Fail 2022; 10:223-233. [PMID: 36193578 PMCID: PMC9871689 DOI: 10.1002/ehf2.14163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/10/2022] [Revised: 08/16/2022] [Accepted: 09/10/2022] [Indexed: 01/27/2023] Open
Abstract
AIMS Guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF) is recommended in clinical guidelines, but elderly patients have not fully received GDMT in the clinical situation. The aim of this study was to determine the clinical characteristics of patients who have not received GDMT and the association between implementation of GDMT at discharge and physical frailty in patients with HFrEF who were hospitalized for acute decompensated heart failure (ADHF). METHODS AND RESULTS This study was a cross-sectional study with a retrospective analysis of the Kochi YOSACOI study, a prospective multicentre observational study that enrolled 1061 patients hospitalized for ADHF from May 2017 to December 2019 in Japan. Of 339 patients (32.0%) with HFrEF, 268 patients who were assessed for physical frailty by the Japanese version of the Cardiovascular Health Study criteria were divided into two groups: those with GDMT (135 patients, 50.4%) and those without GDMT (133 patients, 49.6%). GDMT was defined as the prescription of a combination of renin-angiotensin system (RAS) inhibitors (angiotensin-converting inhibitors or angiotensin receptor blockers) and beta-blockers. The median age of patients with HFrEF was 76 years (interquartile range, 67-83 years). Patients without GDMT were older than patients with GDMT (73 years vs. 78 years, P < 0.001). Patients without GDMT tended to have more prior HF admission than did patients with GDMT (P = 0.004), and patients without GDMT had lower levels of estimated glomerular filtration rate (P < 0.001) than those in patients with GDMT. Physical frailty was observed in 54.1% of the patients without GDMT and in 38.5% of the patients with GDMT (P = 0.014). Patients without GDMT had a higher rate of cognitive impairment than that in patients with GDMT (P = 0.009). RAS inhibitors only, beta-blockers only, and both RAS inhibitors and beta-blockers were less frequently prescribed in patients with physical frailty than in patients with physical non-frailty (52.0% vs. 86.7%, P < 0.05; 70.1% vs. 100.0%, P < 0.05; 42.5% vs. 86.7%, P < 0.01, respectively). In logistic regression analysis, compared with physical non-frailty, physical frailty was significantly associated with no implementation of GDMT (odds ratio: 6.900, 95% confidence interval: 1.420-33.600; P = 0.017), independent of older age and severe renal dysfunction. CONCLUSIONS The results of this study suggest that physical frailty is one of the factors that may withhold GDMT in patients with HFrEF.
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Affiliation(s)
- Tomoyuki Hamada
- Department of Cardiology and Geriatrics, Kochi Medical SchoolKochi UniversityOko‐cho, Nankoku‐shiKochi783‐8505Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical SchoolKochi UniversityOko‐cho, Nankoku‐shiKochi783‐8505Japan
| | - Kazuya Kawai
- Department of CardiologyChikamori HospitalKochiJapan
| | - Yoko Nakaoka
- Department of CardiologyChikamori HospitalKochiJapan
| | - Toshikazu Yabe
- Department of CardiologyKochi Prefectural Hatakenmin HospitalSukumoJapan
| | - Takashi Furuno
- Department of CardiologyKochi Prefectural Aki General HospitalAkiJapan
| | - Eisuke Yamada
- Department of CardiologySusaki Kuroshio HospitalSusakiJapan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical SchoolKochi UniversityOko‐cho, Nankoku‐shiKochi783‐8505Japan
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17
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Komatsu J, Nishimura YK, Sugane H, Hosoda H, Imai RI, Nakaoka Y, Nishida K, Seki SI, Kubo T, Yamasaki N, Kitaoka H, Kubokawa SI, Kawai K, Hamashige N, Doi Y. Acute Left Circumflex Coronary Artery Occlusion ― Diagnostic Problems of Initial Electrocardiographic Changes ―. Circ Rep 2022; 4:482-489. [PMID: 36304429 PMCID: PMC9535132 DOI: 10.1253/circrep.cr-22-0044] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Acute coronary syndrome (ACS) with occlusion of the left circumflex coronary artery (LCX) poses diagnostic problems that may lead to a delay in reperfusion. Methods and Results: From a group of 1,269 consecutive patients with ACS, 138 patients with ACS due to LCX occlusion were analyzed for clinical, electrocardiographic, and angiographic presentations, as well as door-to-balloon (DTB) time. Electrocardiographic changes were classified into 4 patterns: ST-segment elevation in inferior/lateral leads (ST-E); ST-segment depression in V1–V4 (ST-D); no significant ST changes (No-ST); and others. The No-ST group was associated with a longer DTB time (P<0.0001) compared with the ST-E and ST-D groups. Compared with the No-ST and ST-E groups, the ST-D group presented with a more advanced Killip class (P=0.003), greater peak creatine phosphokinase (P=0.007) and peak creatine kinase-MB (P=0.006), more frequent proximal LCX occlusion (P=0.007), and worse 1-year outcomes (P=0.0034). Conclusions: One-third of ACS patients with LCX occlusion showed no ST-segment changes, resulting in significantly longer DTB time. Improving diagnostic accuracy is challenging but critical to avoid delayed reperfusion in these patients without electrocardiographic changes.
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Affiliation(s)
- Junya Komatsu
- Department of Medicine and Cardiology, Chikamori Hospital
| | | | - Hiroki Sugane
- Department of Medicine and Cardiology, Chikamori Hospital
| | - Hayato Hosoda
- Department of Medicine and Cardiology, Chikamori Hospital
| | | | - Yoko Nakaoka
- Department of Medicine and Cardiology, Chikamori Hospital
| | - Koji Nishida
- Department of Medicine and Cardiology, Chikamori Hospital
| | - Shu-ichi Seki
- Department of Medicine and Cardiology, Chikamori Hospital
| | - Toru Kubo
- Department of Cardiology and Aging Science, Kochi Medical School
| | - Naohito Yamasaki
- Department of Cardiology and Aging Science, Kochi Medical School
| | - Hiroaki Kitaoka
- Department of Cardiology and Aging Science, Kochi Medical School
| | | | - Kazuya Kawai
- Department of Medicine and Cardiology, Chikamori Hospital
| | | | - Yoshinori Doi
- Department of Medicine and Cardiology, Chikamori Hospital
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18
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Yokobatake K, Ohta T, Kitaoka H, Nishimura S, Kashima K, Yasuoka M, Nishi K, Shigeshima K. Safety of early rehabilitation in patients with aneurysmal subarachnoid hemorrhage: A retrospective cohort study. J Stroke Cerebrovasc Dis 2022; 31:106751. [PMID: 36162375 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106751] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/15/2022] [Accepted: 08/28/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate the safety and efficacy of early rehabilitation in patients with aneurysmal subarachnoid hemorrhage (aSAH) patients. METHODS One hundred eleven patients with aSAH admitted between April 2015 and March 2019, were retrospectively evaluated. The early rehabilitation program was introduced in April 2017 to actively promote mobilization and walking training for aSAH patients. Therefore, patients were divided into two groups (The conventional group (n = 55) and the early rehabilitation group (n == 56). Clinical characteristics, mobilization progression, and treatment variables were analyzed. Complications (rebleeding, symptomatic cerebral vasospasm, hydrocephalus, disuse complications,) and a modified Rankin Scale (mRS) at 90 days were compared in two groups. Factors associated with favorable outcomes (mRS≤2) at 90 days were also assessed. RESULTS The early rehabilitation group had a significantly shorter span to first walking (9 vs. 5 days; P = 0.007). The prevalence of complications was not significantly increased in the early rehabilitation group. Approximately 40% of patients in both groups had pneumonia and urinary tract infections but significantly reduced antibiotic-administration days (13 vs. 6 days; P < 0.001). mRS at 90 days also showed significant improvement in the early rehabilitation group (3 vs. 2; P=0.01). Multivariate logistic regression analysis of favorable outcomes associated that the administration of the early rehabilitation program has a significant independent factor (odds ratio, 3.03; 95% confidence interval, 1.1-8.37). CONCLUSIONS Early rehabilitation for patients with aSAH can be feasible without increasing complication occurrences. The early rehabilitation program with active mobilization and walking training reduced antibiotic use and was associated with improved independence.
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Affiliation(s)
- Kazuhiro Yokobatake
- Department of Medical Technology Rehabilitation, Kochi Health Sciences Center, 2125-1 Ike, Kochi-city, Kochi 781-8555, Japan.
| | - Tsuyoshi Ohta
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kochi Health Science Center, Kochi, Japan.
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatric, Kochi Medical School, Kochi Health Science Center, Kochi, Japan.
| | - Shingo Nishimura
- Department of Medical Technology Rehabilitation, Kochi Health Sciences Center, 2125-1 Ike, Kochi-city, Kochi 781-8555, Japan.
| | - Kensaku Kashima
- Department of Medical Technology Rehabilitation, Kochi Health Sciences Center, 2125-1 Ike, Kochi-city, Kochi 781-8555, Japan.
| | - Mari Yasuoka
- Department of Medical Technology Rehabilitation, Kochi Health Sciences Center, 2125-1 Ike, Kochi-city, Kochi 781-8555, Japan.
| | - Kohei Nishi
- Department of Medical Technology Rehabilitation, Kochi Health Sciences Center, 2125-1 Ike, Kochi-city, Kochi 781-8555, Japan.
| | - Koji Shigeshima
- Division of Physical Therapy, Kochi Professional University of Rehabilitation, Kochi Health Science Center, Kochi, Japan.
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19
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Miyamoto Y, Kubo T, Ochi Y, Baba Y, Hirota T, Yamasaki N, Kawai K, Yamamoto K, Kondo F, Bando K, Yamada E, Furuno T, Yabe T, Doi YL, Kitaoka H. Clinical Features of Heart Failure in Patients With Hypertrophic Cardiomyopathy in a Regional Japanese Cohort - Results From the Kochi RYOMA Study. Circ J 2022; 86:1934-1940. [PMID: 35675987 DOI: 10.1253/circj.cj-22-0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The clinical features of heart failure (HF) in patients with hypertrophic cardiomyopathy (HCM) in Japan have not been fully elucidated.Methods and Results: In 293 patients with HCM (median age at registration, 65 (57-72) years) in a prospective cardiomyopathy registration network in Kochi Prefecture (Kochi RYOMA study), HF events (HF death or hospitalization for HF) occurred in 35 patients (11.9%) (median age, 76 (69-80) years), including 11 HF deaths during a median follow-up of 6.1 years. The 5-year HF events rate was 9.6%. Atrial fibrillation, low percentage of fractional shortening, and high B-type natriuretic peptide level at registration were predictors of HF events. The combination of these 3 factors had a relatively high positive predictive value (55%) for HF events and none of them had a high negative predictive value (99%). There were 4 types of HF profile: left ventricular (LV) systolic dysfunction (40%), severe LV diastolic dysfunction (34%), LV outflow tract obstruction (LVOTO) (20%), and primary mitral regurgitation (MR) (6%). HF deaths occurred in patients with LV systolic dysfunction or LV diastolic dysfunction, but none of patients with LVOTO or primary MR due to additional invasive therapies. CONCLUSIONS In a Japanese HCM cohort, HF was an important complication, requiring careful follow-up and appropriate treatment.
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Affiliation(s)
- Yuya Miyamoto
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Kazuya Kawai
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Katsuhito Yamamoto
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Fumiaki Kondo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Kanji Bando
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Eisuke Yamada
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Takashi Furuno
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Toshikazu Yabe
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Yoshinori L Doi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
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20
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Sugiura K, Kubo T, Ochi Y, Miyagawa K, Baba Y, Noguchi T, Hirota T, Yamasaki N, Doi YL, Kitaoka H. Very long-term prognosis in patients with hypertrophic cardiomyopathy: a longitudinal study with a period of 20 years. ESC Heart Fail 2022; 9:2618-2625. [PMID: 35652322 PMCID: PMC9288772 DOI: 10.1002/ehf2.13983] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/26/2022] [Accepted: 05/08/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS We aim to clarify the prognosis on patients with hypertrophic cardiomyopathy (HCM) for a follow-up period of more than 10 years. METHODS AND RESULTS We retrospectively analysed 102 consecutive patients with HCM diagnosed by 31 December 2000. Complete and detailed clinical records were obtained for 93 (91%) of the 102 patients. Sixty-three (68%) of the 93 patients were men, and the mean age of the patients at the initial evaluation was 51.5 ± 13.0 years. During the mean follow-up period of 19.6 ± 8.1 years (median 20.1 years), HCM-related deaths occurred in 20 patients (21% [1.1%/year]). HCM-related adverse events (including HCM-related deaths and nonfatal HCM-related events: hospitalization for heart failure, embolic stroke admission, and sustained ventricular tachycardia with haemodynamic instability or appropriate implantable cardioverter-defibrillator discharge) occurred in 45 patients (48%). The first HCM-related adverse events occurred in approximately 20% of the patients in every decade, the first decade to the third decade, from the initial evaluation. Forty-seven patients (51%) had documentation of atrial fibrillation at the last follow-up. There were seven patients in the end-stage HCM group at the initial evaluation, and 22 patients (24%) had progression to end-stage HCM during the follow-up period. CONCLUSIONS In our cohort of patients, HCM-related mortality was relatively favourable. However, approximately half of the patients suffered from HCM-related adverse events during the follow-up period of 20 years. It is important for HCM patients to be carefully followed up over the long-term because HCM is a lifelong disease.
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Affiliation(s)
- Kenta Sugiura
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Kazuya Miyagawa
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Tatsuya Noguchi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Yoshinori L Doi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
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21
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Ochi Y, Kubo T, Baba Y, Sugiura K, Miyagawa K, Noguchi T, Hirota T, Hamada T, Yamasaki N, Kitaoka H. Early Experience of Tafamidis Treatment in Japanese Patients With Wild-Type Transthyretin Cardiac Amyloidosis From the Kochi Amyloidosis Cohort. Circ J 2022; 86:1121-1128. [DOI: 10.1253/circj.cj-21-0965] [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] [Indexed: 11/09/2022]
Affiliation(s)
- Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Kenta Sugiura
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Kazuya Miyagawa
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Tatsuya Noguchi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Tomoyuki Hamada
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
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22
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Hamada T, Kubo T, Kawai K, Nakaoka Y, Yabe T, Furuno T, Yamada E, Kitaoka H. Clinical characteristics and frailty status in heart failure with preserved vs. reduced ejection fraction. ESC Heart Fail 2022; 9:1853-1863. [PMID: 35355441 PMCID: PMC9065850 DOI: 10.1002/ehf2.13885] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 09/04/2021] [Revised: 02/10/2022] [Accepted: 03/02/2022] [Indexed: 12/28/2022] Open
Abstract
Aims The aim of this study was to elucidate the clinical characteristics, including frailty status, of patients with heart failure with preserved ejection fraction (HFpEF) in comparison with those in patients with heart failure with reduced ejection fraction (HFrEF) in a super‐aged region of Japan. Methods and results Of the 1061 Japanese patients enrolled in the Kochi YOSACOI study, a multicentre registry, we divided 645 patients (median age of 81 years [interquartile range, 72–87 years]; women, 49.1%) into two groups, HFpEF patients (61.2%) and HFrEF patients (38.8%). Physical frailty was diagnosed on the basis of the Japanese version of Cardiovascular Health (J‐CHS) Study criteria. Patients for whom left ventricular ejection fraction data were not available (n = 19), patients with heart failure with mildly reduced ejection fraction (n = 172), and patients who were not assessed by the J‐CHS criteria (n = 225) were excluded. The median ages of the HFpEF and HFrEF patients were 84 and 76 years, respectively. The proportion of patients with HFpEF gradually increased with advance of age. The proportion of patients with three or more comorbidities was larger in HFpEF patients than in HFrEF patients (77.9% vs. 65.6%, P = 0.003). Handgrip strength was significantly lower in HFpEF patients than in HFrEF patients for both men (P < 0.001) and women (P = 0.041). Comfortable 5 m walking speed was significantly slower in HFpEF patients than in HFrEF patients (P < 0.001). The proportions of patients with physical frailty were 55.2% in HFpEF patients and 46.8% in HFrEF patients, and the proportion was significantly higher in HFpEF patients (P = 0.043). In multivariate analysis, physical frailty was associated with advanced age [odds ratio (OR), 1.030; 95% confidence interval (CI), 1.010–1.050; P = 0.023] and low albumin level (OR, 0.334; 95% CI, 0.192–0.582; P < 0.001) in HFpEF patients, and physical frailty was associated with women (OR, 2.150; 95% CI, 1.030–4.500; P = 0.042) and anaemia (OR, 2.840; 95% CI, 1.300–6.230; P = 0.003) in HFrEF patients. Conclusions In a super‐aged population of HF patients in Japan, HFpEF patients are more likely to be frail/have a high frailty status compared with HFrEF patients. The results suggested that physical frailty is associated with extracardiac factors in both HFpEF patients and HFrEF patients.
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Affiliation(s)
- Tomoyuki Hamada
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, 783-8505, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, 783-8505, Japan
| | - Kazuya Kawai
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Yoko Nakaoka
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Toshikazu Yabe
- Department of Cardiology, Kochi Prefectural Hatakenmin Hospital, Sukumo, Japan
| | - Takashi Furuno
- Department of Cardiology, Kochi Prefectural Aki General Hospital, Aki, Japan
| | - Eisuke Yamada
- Department of Cardiology, Susaki Kuroshio Hospital, Susaki, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, 783-8505, Japan
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23
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Aoyagi T, Chiba Y, Kitaoka H. Association between acute coronary syndrome onset risk and climate change. Arch Environ Occup Health 2021; 77:779-788. [PMID: 34907855 DOI: 10.1080/19338244.2021.2016567] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This study aimed to clarify the association between the onset of acute coronary syndrome (ACS) and weather conditions in summer and winter in the same region. At a general hospital inJapan, weather conditions during the onset of 2,381 cases diagnosed with ACS over 25 years were analyzed using a generalized additive model adopting log-quasi-Poisson distribution as the link function, with "the occurrence of ACS" as the dependent variable and "weather data" as the independent variable. In conclusion, we found that ACS occurred at about the same frequency in winter and summer, and the season did not affect the onset. The onset rate decreased 0.960-fold per 1 °C increase in the minimum temperature one day before the day of onset and decreased 0.987-fold per 1 hPa increase in the mean station pressure of the previous day.
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Affiliation(s)
- Tomokazu Aoyagi
- General Internal Medicine Nurse Practitioner, Mito Saiseikai General Hospital, Mito City, Ibaraki Prefecture, Japan
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital, Mito City, Ibaraki Prefecture, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Nankoku, Kochi, Japan
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24
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Ochi Y, Kubo T, Baba Y, Yamasaki N, Kitaoka H. Diagnostic and Therapeutic Strategy for Female Patients With Cardiac Amyloidosis - Reply. Circ Rep 2021; 3:749-750. [PMID: 34950805 PMCID: PMC8651466 DOI: 10.1253/circrep.cr-21-0141] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
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25
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Nishimura YK, Kubokawa SI, Imai RI, Nakaoka Y, Nishida K, Seki SI, Kubo T, Yamasaki N, Kitaoka H, Kawai K, Hamashige N, Doi Y. Takotsubo Syndrome in Octogenarians and Nonagenarians. Circ Rep 2021; 3:724-732. [PMID: 34950798 PMCID: PMC8651470 DOI: 10.1253/circrep.cr-21-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/07/2021] [Revised: 09/26/2021] [Accepted: 10/05/2021] [Indexed: 12/25/2022] Open
Abstract
Background:
Takotsubo syndrome (TTS) in the very elderly is poorly understood. We sought to clarify the characteristics of octogenarians and nonagenarians with TTS. Methods and Results:
From 148 patients with TTS who underwent coronary angiography, 68 very elderly patients aged ≥80 years (octogenarians/nonagenarians) were compared with 80 younger patients aged ≤79 years. Emotional triggers of TTS were less frequent (7% vs. 19%; P=0.043), whereas physical triggers were more frequent (69% vs. 46%; P=0.005), in octogenarians/nonagenarians than in patients aged ≤79 years. As initial clues to the diagnosis, electrocardiogram changes were more frequent (71% vs. 46%; P=0.003) and chest pain and/or dyspnea were less common (25% vs. 51%; P=0.001) in octogenarians/nonagenarians than in patients aged ≤79 years. Twenty-nine patients had acute heart failure (AHF) as a complication. AHF was more frequently found in octogenarians/nonagenarians than in patients aged ≤79 years (29% vs. 11%, respectively; P=0.006). Cardiac death occurred in 2 octogenarians/nonagenarians; non-cardiac death occurred in 3 octogenarians/nonagenarians and in 2 patients aged ≤79 years. Conclusions:
Emotional triggers of TTS were infrequent in octogenarians/nonagenarians with TTS. AHF was common and there was significant in-hospital all-cause mortality among octogenarians/nonagenarians.
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Affiliation(s)
- Yu-Ki Nishimura
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Sho-Ichi Kubokawa
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Ryu-Ichiro Imai
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Yoko Nakaoka
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Koji Nishida
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Shu-Ichi Seki
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Toru Kubo
- Department of Cardiology and Aging Science, Kochi Medical School Kochi Japan
| | - Naohito Yamasaki
- Department of Cardiology and Aging Science, Kochi Medical School Kochi Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Aging Science, Kochi Medical School Kochi Japan
| | - Kazuya Kawai
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Naohisa Hamashige
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan
| | - Yoshinori Doi
- Department of Medicine and Cardiology, Chikamori Hospital Kochi Japan.,Cardiomyopathy Institute, Chikamori Hospital Kochi Japan
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26
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Kubo T, Baba Y, Ochi Y, Hirota T, Yamasaki N, Kawai K, Yamamoto K, Kondo F, Bando K, Yamada E, Furuno T, Yabe T, Doi YL, Kitaoka H. Clinical significance of new-onset atrial fibrillation in patients with hypertrophic cardiomyopathy. ESC Heart Fail 2021; 8:5022-5030. [PMID: 34472710 PMCID: PMC8712775 DOI: 10.1002/ehf2.13563] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/26/2021] [Revised: 07/24/2021] [Accepted: 08/04/2021] [Indexed: 11/25/2022] Open
Abstract
Aims There is limited information about the clinical significance of atrial fibrillation (AF), particularly new‐onset AF, in patients with hypertrophic cardiomyopathy (HCM) in a community‐based patient cohort. This study was carried out to clarify the prevalence and prognostic impact of AF in Japanese HCM patients. Methods and results In 2004, we established a cardiomyopathy registration network in Kochi Prefecture as a prospective study, and finally, 293 patients with HCM were followed. In the patients' cohort, we recently reported the clinical outcomes including mortality and HCM‐related morbid events. HCM‐related adverse cardiovascular events were defined in the following: (i) sudden cardiac death (SCD)‐relevant events including SCD, spontaneous sustained ventricular tachycardia, and appropriate implantable cardioverter defibrillator discharge; (ii) heart failure (HF) events with the composite of HF death and hospitalization for HF; and (iii) embolic events included embolic stroke‐related death and admission for embolic events. In the present study, we focused on AF and conducted a detailed investigation. At registration, the mean age of the patients was 63 ± 14 years, and 86 patients (29%) had documented AF including paroxysmal AF. Patients with AF at registration were characterized by worse clinical profiles including more advanced age, more symptomatic, more advanced left ventricular, and left atrial remodelling at registration. During a mean follow‐up period of 6.1 ± 3.2 years, a total of 77 HCM‐related adverse events occurred, and the presence of AF at registration was associated with an increased risk of HCM‐related adverse events, particularly heart failure events. During the follow‐up period, an additional 31 patients (11%) had documentation of AF for the first time, defined as new‐onset AF, with an annual incidence of approximately 1.8%, and finally, a total of 117 patients (40%) showed AF. The presence of palpitation and enlarged left atrial diameter, particularly left atrial diameter ≥50 mm, at registration were significant predictors of new‐onset AF. Importantly, the incidence of overall HCM‐related adverse events was further higher in patients with new‐onset AF observed from AF onset than in patients with AF at registration. Conclusions In our HCM registry in an aged Japanese community, a significant proportion developed AF. The presence of AF, particularly new‐onset AF, was associated with increased incidence of HCM‐related events. AF may not be just a marker of disease stage but an important trigger of adverse events.
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Affiliation(s)
- Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan
| | - Kazuya Kawai
- Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | | | - Fumiaki Kondo
- Department of Cardiology, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Kanji Bando
- Department of Cardiology, Tosa Municipal Hospital, Tosa, Japan
| | - Eisuke Yamada
- Department of Cardiology, Susaki Kuroshio Hospital, Susaki, Japan
| | - Takashi Furuno
- Department of Cardiology, Kochi Prefectural Aki General Hospital, Kochi, Japan
| | - Toshikazu Yabe
- Department of Cardiology, Kochi Prefectural Hata Kenmin Hospital, Kochi, Japan
| | - Yoshinori L Doi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan.,Department of Cardiology, Chikamori Hospital, Kochi, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan
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27
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Takahashi M, Okamoto N, Nishida K, Nakaoka Y, Imai RI, Seki SI, Kubo T, Yamasaki N, Kitaoka H, Kubokawa SI, Kawai K, Hamashige N, Doi Y. Progressive deterioration of frailty is associated with poor outcomes in patients with transthyretin cardiac amyloidosis. Geriatr Gerontol Int 2021; 21:967-969. [PMID: 34427979 DOI: 10.1111/ggi.14268] [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] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/10/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Makoto Takahashi
- Department of Medicine and Cardiology, Chikamori Hospital, Kochi, Japan
| | - Nao Okamoto
- Department of Medicine and Cardiology, Chikamori Hospital, Kochi, Japan
| | - Koji Nishida
- Department of Medicine and Cardiology, Chikamori Hospital, Kochi, Japan
| | - Yoko Nakaoka
- Department of Medicine and Cardiology, Chikamori Hospital, Kochi, Japan
| | - Ryu-Ichiro Imai
- Department of Medicine and Cardiology, Chikamori Hospital, Kochi, Japan
| | - Shu-Ichi Seki
- Department of Medicine and Cardiology, Chikamori Hospital, Kochi, Japan
| | - Toru Kubo
- Department of Cardiology and Aging Science, Kochi Medial School, Nankoku, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Aging Science, Kochi Medial School, Nankoku, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Aging Science, Kochi Medial School, Nankoku, Japan
| | - Sho-Ichi Kubokawa
- Department of Medicine and Cardiology, Chikamori Hospital, Kochi, Japan
| | - Kazuya Kawai
- Department of Medicine and Cardiology, Chikamori Hospital, Kochi, Japan
| | - Naohisa Hamashige
- Department of Medicine and Cardiology, Chikamori Hospital, Kochi, Japan
| | - Yoshinori Doi
- Department of Medicine and Cardiology, Chikamori Hospital, Kochi, Japan.,Cardiomyopathy Institute, Chikamori Hospital, Kochi, Japan
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28
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Ochi Y, Kubo T, Baba Y, Sugiura K, Ueda M, Miyagawa K, Noguchi T, Hirota T, Hamada T, Yamasaki N, Kitaoka H. Wild-Type Transthyretin Amyloidosis in Female Patients - Consideration of Sex Differences. Circ Rep 2021; 3:465-471. [PMID: 34414336 PMCID: PMC8338431 DOI: 10.1253/circrep.cr-21-0067] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 05/31/2021] [Indexed: 12/12/2022] Open
Abstract
Background:
With recent advances in non-invasive diagnostic tools, some studies indicate that wild-type transthyretin amyloidosis (ATTRwt) may be more common in females than previously reported. However, the clinical characteristics of female ATTRwt patients have not been determined. Methods and Results:
Of the 78 consecutive patients with ATTRwt in our cohort, 14 (17.9 %) were female. Compared with male patients, female ATTRwt patients had smaller left ventricular (LV) wall thicknesses (ventricular septum thickness 12.9 vs. 14.2 mm [P=0.081]; posterior wall thickness 12.7 vs. 13.6 mm [P=0.035]) and a higher LV ejection fraction (EF; mean [±SD] 58.4±8.9% vs. 48.9±11.8%; P=0.006). However, the severity of heart failure (HF), as assessed by HF stage, New York Heart Association functional class and B-type natriuretic peptide concentrations, did not differ between female and male patients. Moreover, LV mass index and relative wall thickness were increased and the stroke volume index was reduced in both female and male patients. In organ biopsies, female patients had a higher sensitivity to transthyretin deposition from abdominal fat than male patients (positive abdominal fat biopsy 80.0 % vs. 26.5%; P=0.016). Conclusions:
This study suggests that a relatively large proportion of elderly females have ATTRwt. Female ATTRwt patients had HF symptoms even at the stage of mild LV hypertrophy and preserved EF. Abdominal fat biopsy may be useful to diagnose ATTRwt, especially in female patients with HF.
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Affiliation(s)
- Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Kenta Sugiura
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Motoko Ueda
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Kazuya Miyagawa
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Tatsuya Noguchi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Tomoyuki Hamada
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
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29
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Hamada T, Kubo T, Kawai K, Nakaoka Y, Yabe T, Furuno T, Yamada E, Kitaoka H. Frailty in patients with acute decompensated heart failure in a super-aged regional Japanese cohort. ESC Heart Fail 2021; 8:2876-2888. [PMID: 34080791 PMCID: PMC8318434 DOI: 10.1002/ehf2.13363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/27/2021] [Accepted: 03/31/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS The aim of this study was to investigate clinical characteristics of frail patients based on a comprehensive frailty assessment in patients hospitalized for acute decompensated heart failure (HF) (ADHF) in super-aged regional Japanese cohort. METHODS AND RESULTS We established the Kochi Registry of Subjects with Acute Decompensated Heart Failure (Kochi YOSACOI) study, which was a prospective multicentre community-based cohort study in six participating hospitals in Kochi Prefecture, Japan. We enrolled 1061 patients (median age, 81 years; 50.0% men) hospitalized for ADHF between June 2017 and December 2019 in this registry. Patients were classified into the three groups by the severity of frailty using the Kihon Checklist: we identified frailty in 510 patients (53.7%), prefrailty in 293 patients (30.9%), and non-frailty in 146 patients (15.4%). Compared with prefrail and non-frail patients, frail patients were older (84 years interquartile range [IQR, 77-88] vs. 79 years [IQR, 69-86] and 72 years [IQR 65-81], P < 0.001) and more often had prior HF hospitalization (29.6% vs. 21.8% and 16.4%, P < 0.05), chronic kidney disease (81.6% vs. 71.7% and 61.0%, P < 0.01), anaemia (75.3% vs. 61.4% and 50.0%, P < 0.001), cerebrovascular accident (19.0% vs. 9.9% and 4.1%, P < 0.01). The proportion of patients with three or more comorbidities was larger in the frailty group than in the other groups (78.0% vs. 67.2% and 63.0%, P < 0.01). The frequency of functional decline in all domains increased with frailty status. Approximately 70% of frail patients were identified as functional decline in physical function and socialization domains. Fifty to sixty per cent of frail patients had functional decline in instrumental activities of daily living, cognitive function, and depression domains. The percentage of worsening walking ability during hospitalization was increasing with the frailty status (frailty, 27.5%; prefrailty, 21.8%; non-frailty, 8.9%). In multivariate logistic regression analysis, frailty was associated with age [odds ratio (OR) 1.031, 95% confidence interval (CI) 1.011-1.052, P = 0.003], prior HF hospitalization (OR 1.789, 95% CI 1.165-2.764, P = 0.008), brain natriuretic peptide level at discharge (OR 1.001, 95% CI 1.000-1.001, P = 0.020) and prior cerebrovascular accident (OR 2.549, 95% CI 1.484-4.501, P < 0.001). CONCLUSIONS More than half of patients with ADHF were frail and had functional decline across multiple domains, not only physical function domain. The Kihon Checklist provided useful and valuable information for easily identifying frail patients and comprehensive management of HF.
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Affiliation(s)
- Tomoyuki Hamada
- Department of Cardiology and Geriatrics, Kochi Medical SchoolKochi UniversityOko‐choNankokuKochi783‐8505Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical SchoolKochi UniversityOko‐choNankokuKochi783‐8505Japan
| | - Kazuya Kawai
- Department of CardiologyChikamori HospitalKochiJapan
| | - Yoko Nakaoka
- Department of CardiologyChikamori HospitalKochiJapan
| | - Toshikazu Yabe
- Department of CardiologyKochi Prefectural Hatakenmin HospitalSukumoJapan
| | - Takashi Furuno
- Department of CardiologyKochi Prefectural Aki General HospitalAkiJapan
| | - Eisuke Yamada
- Department of CardiologySusaki Kuroshio HospitalSusakiJapan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical SchoolKochi UniversityOko‐choNankokuKochi783‐8505Japan
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Kitaoka H, Tsutsui H, Kubo T, Ide T, Chikamori T, Fukuda K, Fujino N, Higo T, Isobe M, Kamiya C, Kato S, Kihara Y, Kinugawa K, Kinugawa S, Kogaki S, Komuro I, Hagiwara N, Ono M, Maekawa Y, Makita S, Matsui Y, Matsushima S, Sakata Y, Sawa Y, Shimizu W, Teraoka K, Tsuchihashi-Makaya M, Ishibashi-Ueda H, Watanabe M, Yoshimura M, Fukusima A, Hida S, Hikoso S, Imamura T, Ishida H, Kawai M, Kitagawa T, Kohno T, Kurisu S, Nagata Y, Nakamura M, Morita H, Takano H, Shiga T, Takei Y, Yuasa S, Yamamoto T, Watanabe T, Akasaka T, Doi Y, Kimura T, Kitakaze M, Kosuge M, Takayama M, Tomoike H. JCS/JHFS 2018 Guideline on the Diagnosis and Treatment of Cardiomyopathies. Circ J 2021; 85:1590-1689. [PMID: 34305070 DOI: 10.1253/circj.cj-20-0910] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | | | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Kyushu University
| | | | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | - Noboru Fujino
- Department of Cardiovascular and Internal Medicine, Kanazawa University, Graduate School of Medical Science
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | | | - Chizuko Kamiya
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Seiya Kato
- Division of Pathology, Saiseikai Fukuoka General Hospital
| | | | | | | | - Shigetoyo Kogaki
- Department of Pediatrics and Neonatology, Osaka General Medical Center
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | | | - Minoru Ono
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama International Medical Center, Saitama Medical University
| | - Yoshiro Matsui
- Department of Cardiac Surgery, Hanaoka Seishu Memorial Hospital
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | | | - Satoshi Hida
- Department of Cardiovascular Medicine, Tokyo Medical University
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | | | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Toshiro Kitagawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University School of Medicine
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yoji Nagata
- Division of Cardiology, Fukui CardioVascular Center
| | - Makiko Nakamura
- Second Department of Internal Medicine, University of Toyama
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School Hospital
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | | | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine
| | - Teppei Yamamoto
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
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Nakaya Y, Akamatsu M, Ogimoto A, Kitaoka H. Early cardiac rehabilitation for acute decompensated heart failure safely improves physical function (PEARL study): a randomized controlled trial. Eur J Phys Rehabil Med 2021; 57:985-993. [PMID: 34291626 DOI: 10.23736/s1973-9087.21.06727-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Improvements in the Short Physical Performance Battery (SPPB) rather than exercise tolerance reportedly lead to favorable prognosis in elderly patients with acute decompensated heart failure (ADHF). However, about 50% of heart failure shows heart failure with preserved ejection fraction, safe and effective interventions to improve SPPB for these types remain unclear. In addition, although a standard cardiac rehabilitation (CR) program for heart failure is widely used in Japan, whether this is sufficient to improve SPPB in elderly patients with ADHF remains unclear. AIM This study was to evaluate whether the addition of multidisciplinary physical interventions to the standard CR program would prove effective for improving SPPB among elderly patients with ADHF regardless types of heart failure. DESING Randomized, prospective study. SETTING Patients admitted to our hospital due to ADHF in Japan. POPULATION Elderly patients with ADHF between March 2019 and March 2020 were randomized to two groups, an Intervention group and a Control group. METHODS The Control group performed standard CR. The Intervention group received balance training and resistance training and used a cycling ergometer in addition to the standard CR program. The primary outcome was the improvement in SPPB after CR. RESULTS Seventy-five patients with ADHF were divided into the two groups (Intervention group, n=36; Control group, n=39). At baseline, both groups showed low physical performance and a high prevalence of frailty. Intervention size effect was an improvement in SPPB score of +2.2 (+3.7±1.1 vs. +1.5±1.7; p<0.001). Of the 3 components of SPPB, both gait speed and timed repeated chair rise were significantly improved in the Intervention group compared to the Control group, with intervention size effect of +0.76 and +0.94, respectively (p<0.001). Subgroup analysis of heart failure with preserved ejection fraction showed significant improvement in SPPB score in the Intervention group compared to the Control group (p<0.001).No adverse events were observed during the study period. CONCLUSIONS A multi-faceted intervention in addition to standard CR improved physical performance among elderly patients with ADHF regardless types of heart failure. CLINICAL REHABILITATION IMPACT We believe that use of a cycling ergometer and loadspecific resistance training provide specific CR for patients with ADHF during acute hospitalization and highlight the need for active intervention.
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Affiliation(s)
- Yuta Nakaya
- Department of Rehabilitation, Uwajima City Hospital, Uwajima, Japan - .,Medical Science Graduate School of Kochi University, Kochi, Japan -
| | | | | | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
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Baba Y, Kubo T, Kitaoka H. The High Road or the Low Road? A Question Regarding Whether to Use Upper or Lower Pulmonary Veins in Measuring Pulmonary Vein Flow. J Am Soc Echocardiogr 2021; 34:1116-1117. [PMID: 34098124 DOI: 10.1016/j.echo.2021.05.018] [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: 03/14/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
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Ochi Y, Kubo T, Baba Y, Ueda M, Hirota T, Yamasaki N, Kitaoka H. A Case Report of Asymmetry of Systolic Anterior Motion of the Mitral Valve, a Not Widely Well-Known but Practically Important Echocardiographic Presentation in Hypertrophic Cardiomyopathy. CASE 2021; 5:160-165. [PMID: 34195514 PMCID: PMC8236397 DOI: 10.1016/j.case.2021.03.001] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Echocardiography is useful for evaluating LVOT obstruction in patients with HCM. Asymmetry of SAM in patients with HCM is not a well-known presentation. This patient had asymmetry of SAM, resulting in a narrow laterally located LVOT. In a patient with asymmetry of SAM, LVOT gradient should be estimated carefully.
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Affiliation(s)
- Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Motoko Ueda
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
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Sugiura K, Kozuki H, Ueba H, Kubo T, Ochi Y, Baba Y, Miyagawa K, Noguchi T, Hirota T, Yamasaki N, Wada N, Nakashima J, Murakami I, Ikeuchi M, Kitaoka H. Tenosynovial and Cardiac Transthyretin Amyloidosis in Japanese Patients Undergoing Carpal Tunnel Release. Circ Rep 2021; 3:338-344. [PMID: 34136709 PMCID: PMC8180371 DOI: 10.1253/circrep.cr-21-0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 12/22/2022] Open
Abstract
Background: Wild-type transthyretin cardiac amyloidosis (ATTRwt-CA) is a life-threatening progressive disease. Recent studies have shown that the detection of transthyretin (TTR) amyloid in tenosynovial tissue may play an important role in the diagnosis of cardiac amyloidosis. The aim of this study was to determine the prevalence of TTR amyloid deposits in surgical tissue of patients undergoing carpal tunnel surgery and to clarify the clinical significance of concomitant cardiac examination with 99 mTc-labeled pyrophosphate (99 mTc-PYP) scintigraphy in those patients with TTR deposition. Methods and Results: We evaluated 79 consecutive patients undergoing carpal tunnel release surgery and biopsy of tenosynovial tissue. The mean (±SD) age of the patients at surgery was 71.6±12.5 years (range 30-95 years); 32 patients (41%) were male. TTR amyloid deposition in tenosynovial tissue was observed in 27 patients (34%). Sixteen of those 27 patients underwent 99 mTc-PYP scintigraphy. Of those 16 patients, 3 (19%) had Grade 2 uptake on 99 mTc-PYP scintigraphy. None of the 3 patients with a diagnosis of ATTRwt-CA had apparent cardiac symptoms and left ventricular wall thickness >13 mm. Conclusions: Concomitant cardiac examination with 99 mTc-PYP scintigraphy in patients who had TTR amyloid deposition in tenosynovial tissue resulted in the identification of 19% of patients with a diagnosis of ATTRwt-CA. This diagnostic approach seems to be useful for the early diagnosis of the disease.
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Affiliation(s)
- Kenta Sugiura
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Hiroki Kozuki
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University Nankoku Japan
| | - Hiroaki Ueba
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University Nankoku Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Kazuya Miyagawa
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Tatsuya Noguchi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
| | - Noriko Wada
- Department of Pathology, Kochi Medical School, Kochi University Nankoku Japan
| | - Junko Nakashima
- Department of Pathology, Kochi Medical School, Kochi University Nankoku Japan
| | - Ichiro Murakami
- Department of Pathology, Kochi Medical School, Kochi University Nankoku Japan
| | - Masahiko Ikeuchi
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University Nankoku Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University Nankoku Japan
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Kondo R, Miyano I, Lee S, Shimada H, Kitaoka H. Association between self-reported night sleep duration and cognitive function among older adults with intact global cognition. Int J Geriatr Psychiatry 2021; 36:766-774. [PMID: 33219536 DOI: 10.1002/gps.5476] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 11/06/2020] [Accepted: 11/18/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The purpose of this study was to clarify the association between self-reported night sleep duration and cognitive functions such as word memory, story memory, attention, executive function, and processing speed of older adults with normal global cognitive function. METHODS A total of 241 functionally independent older adults (mean age, 75.5 ± 6.4 years) participated in this study. No participants had a history of dementia diagnosis, and each had a Mini-Mental State Examination (MMSE) score ≥ 24. Participants were evaluated for self-reported sleep duration and cognitive function using the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT). RESULTS The longest sleep duration group (≥9 h) had lower MMSE scores (p = 0.010), Z-score of word list memory II (delayed recall; p = 0.001), and Z-score of story memory II (delayed recognition; p = 0.002) than the medium sleep duration group (7-8 h). Longest and long sleep duration (8-9 h) was significantly associated with impairment of story memory II (longest sleep duration: adjusted odds ratio [OR] = 3.58, 95% confidence interval [CI] = 1.13-11.37, long sleep duration: adjusted OR = 4.30, 95% CI = 1.34-13.82) with reference to medium sleep duration, but no impairment of MMSE according to multiple logistic regression analysis. Furthermore, short sleep duration (<7 h) was not associated with cognitive impairment. CONCLUSIONS This study suggests that long sleep duration is associated with cognitive impairment, especially of story memory (delayed recognition) in older adults with normal global cognitive function.
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Affiliation(s)
- Risa Kondo
- Department of Public Health, Kochi Medical School, Kochi University, Kochi, Japan
| | - Ichiro Miyano
- Department of Public Health, Kochi Medical School, Kochi University, Kochi, Japan
| | - Sangyoon Lee
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, 474-8511, Japan
| | - Hiroyuki Shimada
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, 474-8511, Japan
| | - Hiroaki Kitaoka
- Department of Medicine and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
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Moriki T, Kubo T, Sugiura K, Ochi Y, Baba Y, Hirota T, Yamasaki N, Kimura A, Doi YL, Kitaoka H. A Validation Study of the Mayo Clinic Phenotype-Based Genetic Test Prediction Score for Japanese Patients With Hypertrophic Cardiomyopathy. Circ J 2021; 85:669-674. [PMID: 33487615 DOI: 10.1253/circj.cj-20-0826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is a primary myocardial disorder with an autosomal-dominant disorder mainly caused by mutations in sarcomere genes. Recently, a phenotype-based genetic test prediction score for patients with HCM was introduced by Mayo Clinic. The genotype score was derived on the basis of the predictive effect of 6 clinical markers, and the total score was shown to be correlated with the yield of genetic testing. However, it has not been determined whether this prediction model is useful in Japanese HCM patients.Methods and Results:The utility of the Mayo Clinic HCM genotype predictor score in 209 Japanese unrelated patients with a clinical diagnosis of HCM who had undergone genetic testing for 6 sarcomere genes was assessed. Overall, 55 patients (26%) had pathogenic or likely pathogenic variants (60% being genotype-positive in familial cases). We divided the patients into 6 groups (groups with scores of from -1 to 5) according to the prediction score. The yields of genetic testing in the groups with scores of -1, 0, 1, 2, 3, 4, and 5 were 8%, 16%, 24%, 48%, 50%, 100%, and 89%, respectively, with an incremental increase in yield between each of the score subgroups (P<0.001). CONCLUSIONS The Mayo Clinic HCM genotype predictor score is useful for predicting a positive genetic test result in Japanese HCM Patients.
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Affiliation(s)
- Toshihiro Moriki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Kenta Sugiura
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Akinori Kimura
- Department of Molecular Pathogenesis, Medical Research Institute, Tokyo Medical and Dental University
| | - Yoshinori L Doi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
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Kawada K, Fukuda H, Kubo T, Ohta T, Ishida T, Morisawa S, Kawazoe T, Okamoto M, Fujita H, Jobu K, Morita Y, Ueba T, Kitaoka H, Miyamura M. Added value of anxiolytic benzodiazepines in predictive models on severe delirium in patients with acute decompensated heart failure: A retrospective analysis. PLoS One 2021; 16:e0250372. [PMID: 33886657 PMCID: PMC8062069 DOI: 10.1371/journal.pone.0250372] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/06/2021] [Indexed: 11/21/2022] Open
Abstract
Background Delirium in patients with acute decompensated heart failure (ADHF) is associated with poor clinical outcomes. Although some medications have been reported as risk factors for delirium, their impact on patients with ADHF is still unclear. This study aimed to determine the association of specific medication use with delirium and their additive predictive value in models based on conventional risk factors. Methods and results In this single-center, retrospective study, 650 patients treated for ADHF were included. Fifty-nine patients (9.1%) had delirium. In multivariate analysis, anxiolytic benzodiazepines [odds ratio (OR): 6.4, 95% confidence interval (CI): 2.8–15], mechanical ventilation or noninvasive positive pressure ventilation (OR: 6.0, 95% CI: 2.9–12), depression (OR: 3.2, 95% CI: 1.5–6.5), intensive care or high care unit admission (OR: 2.9, 95% CI: 1.5–5.6), male sex (OR: 2.0, 95% CI: 1–3.7), and age (OR: 1.1, 95% CI: 1–1.1) were independently associated with severe delirium. The predictive model that included anxiolytic benzodiazepines had a significantly better discriminatory ability for the incidence of severe delirium than the conventional model. Conclusions The use of anxiolytic benzodiazepines was independently correlated with severe delirium, and their use in models based on conventional risk factors had an additive value for predicting delirium in patients with ADHF.
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Affiliation(s)
- Kei Kawada
- Graduate School of Integrated Arts and Sciences Kochi University, Oko town, Nankoku City, Kochi, Japan
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
- * E-mail:
| | - Hitoshi Fukuda
- Department of Neurosurgery, Kochi Medical School Kochi University, Oko town, Nankoku City, Kochi, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School Kochi University, Oko town, Nankoku City, Kochi, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, National Cerebral and Cardiovascular Center Hospital, Suita City, Osaka, Japan
| | - Tomoaki Ishida
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
| | - Shumpei Morisawa
- Graduate School of Integrated Arts and Sciences Kochi University, Oko town, Nankoku City, Kochi, Japan
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
| | - Tetushi Kawazoe
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
| | - Manami Okamoto
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
| | - Hiroko Fujita
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
| | - Kohei Jobu
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
| | - Yasuyo Morita
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
| | - Tetsuya Ueba
- Department of Neurosurgery, Kochi Medical School Kochi University, Oko town, Nankoku City, Kochi, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School Kochi University, Oko town, Nankoku City, Kochi, Japan
| | - Mitsuhiko Miyamura
- Graduate School of Integrated Arts and Sciences Kochi University, Oko town, Nankoku City, Kochi, Japan
- Department of Pharmacy, Kochi Medical School Hospital, Oko town, Nankoku City, Kochi, Japan
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Komatsu J, Imai RI, Nakaoka Y, Nishida K, Seki SI, Kubo T, Yamasaki N, Kitaoka H, Kubokawa SI, Kawai K, Hamashige N, Doi YL. Importance of Paroxysmal Atrial Fibrillation and Sex Differences in the Prevention of Embolic Stroke in Hypertrophic Cardiomyopathy. Circ Rep 2021; 3:273-278. [PMID: 34007941 PMCID: PMC8099667 DOI: 10.1253/circrep.cr-20-0101] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background:
Although atrial fibrillation (AF) is a well-known risk factor for embolic stroke in hypertrophic cardiomyopathy (HCM), there is a paucity of information derived from HCM patients who have experienced embolic stroke. Methods and Results:
From 141 consecutive HCM patients who had been hospitalized between 2000 and 2018, the clinical characteristics and management of 86 patients with AF were analyzed retrospectively. The incidence of embolic stroke was 36% (n=31 patients). The median (interquartile range) age of embolic stroke was younger in male than female HCM patients (71 [64–80] vs. 83 [77–87] years, respectively; P=0.009). The prevalence of paroxysmal AF (74%) was significantly higher than that of chronic AF (26%) in 31 patients with embolic stroke (P=0.007). The CHADS2
score in patients with embolic stroke was not particularly useful in predicting the occurrence of embolic stroke. Conclusions:
One-third of HCM patients with AF developed embolic stroke, and male HCM patients were younger at the time of the embolic stroke than female HCM patients. The prevalence of paroxysmal AF was significantly higher than that of chronic AF in patients with AF and embolic stroke. Early introduction of anticoagulation therapy is recommended at the first documentation of paroxysmal AF.
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Affiliation(s)
- Junya Komatsu
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | | | - Yoko Nakaoka
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Koji Nishida
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Shu-Ichi Seki
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | - Toru Kubo
- Department of Cardiology and Aging Science, Kochi Medial School Kochi Japan
| | - Naohito Yamasaki
- Department of Cardiology and Aging Science, Kochi Medial School Kochi Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Aging Science, Kochi Medial School Kochi Japan
| | | | - Kazuya Kawai
- Department of Cardiology, Chikamori Hospital Kochi Japan
| | | | - Yoshinori L Doi
- Department of Cardiology, Chikamori Hospital Kochi Japan.,Cardiomyopathy Institute, Chikamori Hospital Kochi Japan
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Baba Y, Ochi Y, Hirota T, Arima N, Sugiura K, Kawaguchi J, Hirakawa D, Kubo T, Yamasaki N, Kitaoka H. What we believed to be a right upper pulmonary vein by transthoracic echocardiography is actually a right lower pulmonary vein. Echocardiography 2021; 38:427-434. [PMID: 33513274 DOI: 10.1111/echo.14986] [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] [Received: 09/13/2020] [Revised: 12/06/2020] [Accepted: 01/11/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Current guidelines recommend that pulmonary vein (PV) velocity should be recorded by using the right upper pulmonary vein (RUPV) during transthoracic echocardiography (TTE) evaluation of left ventricular diastolic function. However, it is uncertain whether the PV displayed during TTE is truly measuring the upper PV. This study aimed to identify the actual site of each PV that is usually detected during TTE. METHODS We retrospectively studied 105 patients who underwent cardiac computed tomography (CT) and TTE, reconstructed images three-dimensionally, and measured the angles between each PV and the left ventricle (LV) that would correspond to the Doppler incident angle of the apical four-chamber view on TTE. We also performed TTE during catheter ablation to confirm the exact site of the PV. RESULTS Apical four-chamber views on TTE revealed that one certain PV was detectable on the right side of the vertebra. CT scans revealed that the median angle of the axes between the LV and right lower pulmonary vein (RLPV) was smaller than that of RUPV {32.1˚ [interquartile range (IQR): 21.7˚-42.1˚] vs. 62.5˚ (IQR: 51.6˚-70.6˚), P < .001}. During catheter ablation for treatment of atrial fibrillation, in the most well-displayed PV on TTE, we detected the ablation catheter placed in the RLPV. CONCLUSIONS The most well-displayed PV in an apical four-chamber view by TTE was not the RUPV but the RLPV which showed the smallest angle of incidence toward the LV apex. The RLPV is suitable for evaluation of PV velocity to assess LV diastolic function.
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Affiliation(s)
- Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Naoki Arima
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kenta Sugiura
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Juri Kawaguchi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Daigo Hirakawa
- Department of Laboratory Medicine, Kochi Medical School, Kochi University, Kochi, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
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Kitaoka H. Greetings from the new Editor-in-Chief. J Cardiol Cases 2021; 23:2. [PMID: 33437329 DOI: 10.1016/j.jccase.2020.11.006] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
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Machida A, Funaki T, Nishida K, Imai RI, Nakaoka Y, Seki SI, Baba YI, Kubo T, Yamasaki N, Kitaoka H, Kubokawa SI, Sakaeda H, Kawai K, Hamashige N, Doi Y. Premature Onset Aortic Stenosis in Systemic Sclerosis: A Report of a Series of Cases. Intern Med 2020; 59:3177-3181. [PMID: 32788545 PMCID: PMC7807118 DOI: 10.2169/internalmedicine.5226-20] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/22/2020] [Indexed: 11/06/2022] Open
Abstract
Although cardiovascular involvement is a well-known complication correlated with a poor prognosis in patients with systemic sclerosis, there are few reports on valvular heart disease. Forty patients with systemic sclerosis were retrospectively analyzed. Valvular heart disease was found in six patients, five of whom had severe tri-leaflet aortic stenosis. Three of these 5 patients were ≤71 years old. Two frail elderly patients who underwent transcatheter aortic valve replacement died within two years. Premature-onset aortic stenosis is not uncommon in patients with systemic sclerosis. When considering mechanical intervention, the evaluation of frailty is important.
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Affiliation(s)
| | - Takashi Funaki
- Department of Medicine, Chikamori Hospital, Japan
- Department of Cardiology and Aging Science, Kochi Medical School, Japan
| | - Koji Nishida
- Department of Medicine, Chikamori Hospital, Japan
| | | | - Yoko Nakaoka
- Department of Medicine, Chikamori Hospital, Japan
| | | | - Yu-Ichi Baba
- Department of Cardiology and Aging Science, Kochi Medical School, Japan
| | - Toru Kubo
- Department of Cardiology and Aging Science, Kochi Medical School, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Aging Science, Kochi Medical School, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Aging Science, Kochi Medical School, Japan
| | | | | | - Kazuya Kawai
- Department of Medicine, Chikamori Hospital, Japan
| | | | - Yoshinori Doi
- Department of Medicine, Chikamori Hospital, Japan
- Cardiomyopathy Institute, Chikamori Hospital, Japan
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Baba Y, Kubo T, Kawaguchi J, Ochi Y, Hirota T, Yamasaki N, Kitaoka H. High sensitivity cardiac troponin T is a useful biomarker for predicting prognosis of the patients with sarcoidosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2121] [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 involvement is one of the most significant prognostic factors for the patients with sarcoidosis. In spite of the advancement of diagnostic tools, such as cardiac magnetic resonance imaging or 18F-fluoro-2-deoxyglucose positron emission tomography, there is still significant room for improvement in cardiac screening and prognostic prediction.
Purpose
To evaluate the prognostic factors for the patients with sarcoidosis.
Methods and results
We prospectively studied 133 patients with sarcoidosis and evaluated clinical data including biomarkers. The mean age at diagnosis was 62.1±12.8 years. During a mean follow up period of 5.6±4.1 years, nine patients died and 27 patients suffered from cardiac events (cardiac death, heart failure admission, arrhythmic event). We divided patients into two groups according to cardiac events, event group had high serum high-sensitivity cardiac troponin T (hs-cTnT) (0.028±0.017 vs. 0.015±0.011 ng/ml, p<0.001), high BNP (409.2±634.0 vs. 122.4±195.8 pg/ml, p<0.001), low EF (43.1±16.4 vs. 59.2±15.5%, p<0.001). This was observed even if those patients were not diagnosed with cardiac involvement at the enrollment. On the other hand, there were no significant differences in the values of angiotensin-converting enzyme, lysozyme, soluble interleukin-2 receptor, or calcium in both groups. Multivariate analysis revealed that hs-cTnT was an independent biomarker to predict cardiac events (hs-cTnT >0.014 ng/ml: HR 3.2, 95% CI 1.02 to 10.19, p=0.046).
Conclusion
Hs-cTnT was a useful biomarker for predicting cardiac events for the patients with sarcoidosis even if cardiac involvement was not detected at initial evaluation.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Baba
- Kochi Medical School, Kochi University, Cardiology and Geriatrics, Nankoku, Japan
| | - T Kubo
- Kochi Medical School, Kochi University, Cardiology and Geriatrics, Nankoku, Japan
| | - J Kawaguchi
- Kochi Medical School, Kochi University, Cardiology and Geriatrics, Nankoku, Japan
| | - Y Ochi
- Kochi Medical School, Kochi University, Cardiology and Geriatrics, Nankoku, Japan
| | - T Hirota
- Kochi Medical School, Kochi University, Cardiology and Geriatrics, Nankoku, Japan
| | - N Yamasaki
- Kochi Medical School, Kochi University, Cardiology and Geriatrics, Nankoku, Japan
| | - H Kitaoka
- Kochi Medical School, Kochi University, Cardiology and Geriatrics, Nankoku, Japan
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Kubo T, Takano H, Takayama M, Doi Y, Minami Y, Ebato M, Inomata T, Katoh T, Okamoto R, Chikamori T, Watanabe E, Furugen A, Maekwa Y, Shimizu W, Kitaoka H. Baseline clinical features in a large-scale registration survey of patient with hypertrophic cardiomyopathy throughout Japan: J-HCM registry study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2085] [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
Hypertrophic cardiomyopathy (HCM) is a most prevalent primary myocardial disorder with heterogeneous clinical features. However, there have been few studies on clinical features of HCM as a prospective cohort. In 2015, we established a large-scale registration survey of patients with HCM throughout Japan, named J-HCM registry study.
Purpose
The aim of this study was to clarify the clinical features of Japanese patients with HCM.
Methods
J-HCM registry study is a prospective, multicenter investigation, consisting of 24 hospitals. This time, we present the baseline clinical characteristics in this survey.
Results
Total 1484 patients were registered. The ages at registration and at diagnosis were 65±15 and 56±17 years, respectively, and 806 patients (54%) were men. Majority of the patients (95%) was NYHA class I or II. With regard to subtypes of HCM, there were 526 patients (36%) in the HCM with left ventricular (LV) outflow tract obstruction, 126 patients (8%) in the mid-ventricular obstruction, 57 patients (4%) in the end-stage phase characterized by LV ejection fraction <50%, and 197 patients (14%) in apical HCM. At registration, 80 patients (6%) had prior successful recovery from sustained ventricular tachycardia or ventricular fibrillation, 162 patients (11%) suffered from heart failure hospitalization, and 64 patients (4%) had history of embolic event. Regarding invasive treatment, 160 patients (10%) had prior septal reduction therapy and 162 patients (11%) had ICD implantation. According to the 2014 European Society of Cardiology Guidelines on sudden cardiac death (SCD) prevention, the study patients were divided into 3 categories by the HCM Risk-SCD calculator: patients distribution, 4% in the high risk group (≥6% calculated HCM Risk-SCD at 5 years), 7% in the intermediate risk group (4% to <6%), 69% in the low risk group (<4%), and 16% in the patients with extreme characteristics (Figure 1).
Conclusions
In this multicenter registration survey of patients with HCM, the baseline clinical characteristics were almost similar to several retrospective large-scale cohorts in Western countries except older age and less symptomatic state. This study will provide important knowledge regarding management of HCM.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Kubo
- Kochi Medical School, Kochi, Japan
| | - H Takano
- Nippon Medical School Teaching Hospital, Tokyo, Japan
| | - M Takayama
- Sakakibara Heart Institute, Fucyu Tokyo, Japan
| | - Y.L Doi
- Kochi Medical School, Kochi, Japan
| | - Y Minami
- Tokyo Women's Medical University, Tokyo, Japan
| | - M Ebato
- Showa University Fujigaoka Hospital, Yokohama, Japan
| | - T Inomata
- Kitasato University School of Medicine, Sagamihara, Japan
| | - T Katoh
- Kyoto University, Kyoto, Japan
| | - R Okamoto
- Mie University Graduate School of Medicine, Tsu, Japan
| | - T Chikamori
- Tokyo Medical University Hospital, Tokyo, Japan
| | - E Watanabe
- Fujita Health University School of Medicine, Toyoake, Japan
| | - A Furugen
- Sapporo Cardio Vascular Clinic, Sapporo, Japan
| | - Y Maekwa
- Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - W Shimizu
- Nippon Medical School Teaching Hospital, Tokyo, Japan
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Kubo T, Sugiura K, Ochi Y, Takahashi A, Baba Y, Hirota T, Yamasaki N, Doi Y, Kitaoka H. Prognostic impact of atrial fibrillation in patients with hypertrophic cardiomyopathy in a community-based Japanese cohort: results from Kochi RYOMA study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2082] [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 prognostic impact of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM) is not fully elucidated.
Purpose
The aim of this study was to examine the prevalence and prognostic impact of AF in a prospectively assembled community-based HCM patient cohort in an aged Japanese community.
Methods
In 2004, we established a cardiomyopathy registration network in Kochi Prefecture, Japan, consisting of 9 hospitals, and finally 293 patients with HCM were followed.
Results
The ages at registration and at diagnosis were 63±14 and 56±16 years, respectively, and 197 patients (67%) were men. 86 patients (29%) showed AF. During follow-up period of 6.1±3.2 years, 44 patients died. In those patients, HCM-related deaths occurred in 23 patients with an annual mortality rate of 1.3%. Regarding HCM-related adverse events including HCM-related deaths, appropriate ICD discharge, heart failure admission and hospitalization for embolic events, a total of 77 cardiovascular events in 70 patients occurred. Multivariate analysis revealed that presence of AF, left ventricular (LV) outflow obstruction, NYHA functional class III, and lower LV fractional shortening at registration were significant predictors of these adverse events. During the follow-up period, additional 31 patients (11%) developed new-onset AF. Importantly, the incidence of HCM-related adverse events was significantly higher in patients with new AF observed from its onset compared with those with AF at registration (log-rank p=0.029) (Figure 1).
Conclusions
In an unselected HCM registry in an aged Japanese community, presence of AF, particularly new-onset AF, was associated with unfavorable clinical outcomes. AF is not just a marker of the disease stage but an important trigger of HCM-related adverse events.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Kubo
- Kochi Medical School, Kochi, Japan
| | | | - Y Ochi
- Kochi Medical School, Kochi, Japan
| | | | - Y Baba
- Kochi Medical School, Kochi, Japan
| | - T Hirota
- Kochi Medical School, Kochi, Japan
| | | | - Y.L Doi
- Kochi Medical School, Kochi, Japan
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Sugiura K, Kubo T, Ochi Y, Baba Y, Hirota T, Yamasaki N, Kitaoka H. Cardiac manifestations and effects of enzyme replacement therapy for over 10 years in adults with the attenuated form of mucopolysaccharidosis type I. Mol Genet Metab Rep 2020; 25:100662. [PMID: 33101981 PMCID: PMC7576511 DOI: 10.1016/j.ymgmr.2020.100662] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/28/2022] Open
Abstract
Background Mucopolysaccharidosis type I (MPS I) is a rare autosomal recessive disease caused by a deficiency of the lysosomal enzyme α-L-iduronidase. Cardiac manifestations such as valvular heart disease are associated with poor prognosis. There have been only a few reports on the effect of long-term enzyme replacement therapy (ERT) for adult patients with the attenuated form of MPS I (Scheie syndrome) and cardiac involvement. Methods We retrospectively reviewed four adult patients of Scheie syndrome for which ERT was performed in our hospital. We investigated the findings of electrocardiography and echocardiography for the four patients performed before and 10 years after the initiation of ERT to evaluate the efficacy for ERT in Scheie syndrome. Results The ages of the patients at the initiation of ERT ranged from 26 to 46 years. The mean follow-up period was 129 months (121 to 134 months). Two patients underwent valve replacement surgery before the initiation of ERT. One patient had gradual progressive aortic valve stenosis and mitral valve stenosis during the course of ERT, and double valve replacement was finally performed. The patient who had started ERT at the youngest age did not develop significant cardiovascular disease. Regarding clinical courses with ERT for a period of 10 years, all four patients survived and they showed relatively stable cardiac conditions although two patients developed sick sinus syndrome after the valvular surgery. Conclusions Valvular disease in patients with Scheie syndrome occur at a young age. In a limited number of the four patients, ERT might contribute the stability of cardiac condition.
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Affiliation(s)
- Kenta Sugiura
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
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Ochi Y, Kubo T, Baba Y, Ueda M, Miyagawa K, Noguchi T, Hirota T, Yamasaki N, Kitaoka H. Validation of the Kumamoto criteria for prediction of 99m technetium pyrophosphate scintigraphy positivity as a strategy for diagnosis of transthyretin cardiac amyloidosis: A retrospective cohort study in Kochi. J Cardiol 2020; 77:124-130. [PMID: 33132078 DOI: 10.1016/j.jjcc.2020.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/09/2020] [Accepted: 06/13/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Early diagnosis of transthyretin cardiac amyloidosis (ATTR-CA) is important. The aim of this study was to validate the 'Kumamoto criteria' for prediction of technetium-99m pyrophosphate (99mTc-PYP) scintigraphy positivity. METHODS One hundred fifty patients (median age: 79.4 years, 117 males) with the possibility of ATTR-CA who underwent 99mTc-PYP scintigraphy were assessed. We divided the patients into 4 groups (groups with score of 0-3) according to the Kumamoto criteria by total points for the following 3 factors: high-sensitivity cardiac troponin T (hs-cTnT) ≥0.0308 ng/ml, left ventricle posterior wall thickness ≥13.6 mm, and wide QRS (QRS ≥ 120 ms). RESULTS Seventy patients (46.7%) were positive for 99mTc-PYP scintigraphy. 99mTc-PYP positivity rates in the groups with score of 0, 1, 2, and 3 were 4%, 39%, 69%, and 89%, respectively. Compared with the original Kumamoto cohort, our patients in the score 1 group showed a relatively high rate of 99mTc-PYP positivity because hs-cTnT as one of the positive factors had high ability to discriminate the disease. The sensitivity and negative predictive value of hs-cTnT ≥0.0308 ng/ml for 99mTc-PYP positivity were 97.1% and 93.9%. CONCLUSIONS In the Kochi validation cohort, the Kumamoto criteria were useful for predicting 99mTc-PYP positivity. However, patients in the score 1 group should be assessed cautiously for the possibility of ATTR-CA if the hs-cTnT value is high.
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Affiliation(s)
- Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan.
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Motoko Ueda
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kazuya Miyagawa
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Tatsuya Noguchi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
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Kubo T, Ochi Y, Baba Y, Sugiura K, Takahashi A, Hirota T, Yamanaka S, Yamasaki N, Doi YL, Kitaoka H. Elevation of high-sensitivity cardiac troponin T and left ventricular remodelling in hypertrophic cardiomyopathy. ESC Heart Fail 2020; 7:3593-3600. [PMID: 33047518 PMCID: PMC7754740 DOI: 10.1002/ehf2.12852] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 03/20/2020] [Revised: 05/20/2020] [Accepted: 06/02/2020] [Indexed: 11/29/2022] Open
Abstract
Aims Hypertrophic cardiomyopathy (HCM) is generally associated with mild disability and normal life expectancy. On the other hand, once the end‐stage phase of HCM characterized by left ventricular (LV) ejection fraction < 50% is established, patients with this subtype have a poor prognosis. This study clarifies the clinical parameters associated with progression to end‐stage HCM. Methods and results We retrospectively studied 157 HCM patients (age 59.9 ± 14.2 years, 104 men) with preserved LV systolic function in whom subsequent echocardiographic data were obtained for a period of >1 year. HCM progressed to end‐stage HCM in 13 patients (8.3%) of the 157 patients during a mean follow‐up period of 6.3 ± 2.8 years. Compared with patients who did not reach end‐stage HCM at the last evaluation, patients with progression to the end‐stage phase had lower ejection fraction, larger LV size, more enlarged left atrial diameter, longer follow‐up period, and higher frequency of an elevated concentration of high‐sensitivity cardiac troponin T (hs‐cTnT; >0.014 ng/mL) at registration. Multivariate analysis revealed that elevated hs‐cTnT was a significant predictor independent of lower LV ejection fraction for progression to end‐stage HCM. Furthermore, in patients with elevated hs‐cTnT levels, LV ejection fraction became significantly lower, LV end‐diastolic diameter increased, and LV wall thickness decreased during the follow‐up period, whereas those parameters did not change in the normal hs‐cTnT group. Conclusions In patients with HCM, an elevated hs‐cTnT was associated with progression of LV remodelling, and this biomarker can be useful for predicting progression to the end‐stage phase.
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Affiliation(s)
- Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kenta Sugiura
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Asa Takahashi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Shigeo Yamanaka
- Department of Laboratory Medicine, Kochi Medical School, Kochi University, Kochi, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yoshinori L Doi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
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Nakashima Y, Kubo T, Sugiura K, Ochi Y, Takahashi A, Baba Y, Hirota T, Yamasaki N, Kimura A, Doi YL, Kitaoka H. Lifelong Clinical Impact of the Presence of Sarcomere Gene Mutation in Japanese Patients With Hypertrophic Cardiomyopathy. Circ J 2020; 84:1846-1853. [PMID: 32830170 DOI: 10.1253/circj.cj-20-0027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is mainly caused by mutations in sarcomere genes. Regarding the clinical implications of genetic information, little is known about the lifelong clinical effect of sarcomere mutations in Japanese HCM patients.Methods and Results:We studied 211 consecutive Japanese patients with HCM who had agreed to genetic testing between 2003 and 2013. Genetic analyses were performed by direct DNA sequencing in the 6 common sarcomere genes (MYH7,MYBPC3,TNNT2,TNNI3,TPM1,ACTC). Through variant filtering, 21 mutations were identified in 67 patients. After excluding 8 patients whose variants were determined as having uncertain significance, finally 203 patients (130 men, age at study entry: 61.8±14.1 years) were investigated for clinical presentation and course. At the time of study entry, patients with mutations were younger, had more frequent non-sustained ventricular tachycardia, had greater interventricular wall thickness, were more frequently in the dilated phase and less frequently had apical HCM. Through their lifetimes, a total of 98 HCM-related morbid events occurred in 72 patients. Survival analysis revealed that patients with sarcomere gene mutations experienced those morbid events significantly more frequently, and this tendency was more prominent for lethal arrhythmic events. CONCLUSIONS In our HCM cohort, patients with sarcomere gene mutations had poorer lifelong outcome. Genetic information is considered important for better management of HCM.
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Affiliation(s)
- Yasuteru Nakashima
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Kenta Sugiura
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Asa Takahashi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Akinori Kimura
- Department of Molecular Pathogenesis, Medical Research Institute, Tokyo Medical and Dental University
| | - Yoshinori L Doi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
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Kobayashi H, Takimoto T, Kitaoka H, Kijima T. Aerosol spread with use of high-flow nasal cannulae: a computational fluid dynamics analysis. J Hosp Infect 2020; 106:204-205. [PMID: 32544507 PMCID: PMC7292944 DOI: 10.1016/j.jhin.2020.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 01/28/2023]
Affiliation(s)
- H Kobayashi
- Department of Paediatrics, Keio University School of Medicine, Tokyo, Japan
| | - T Takimoto
- Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Centre, Osaka, Japan
| | - H Kitaoka
- Department of Biotechnology and Life Science, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - T Kijima
- Department of Respiratory Medicine and Haematology, Hyogo College of Medicine, Hyogo, Japan.
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Affiliation(s)
- H Kitaoka
- Department of Pediatrics, Yaizu City Hospital, 1000 Doubara, Yaizu-shi, Shizuoka 425-8505, Japan
| | - K Takamizawa
- Department of Pediatrics, Yaizu City Hospital, 1000 Doubara, Yaizu-shi, Shizuoka 425-8505, Japan
| | - N Shimizu
- Department of Pediatrics, Yaizu City Hospital, 1000 Doubara, Yaizu-shi, Shizuoka 425-8505, Japan
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