Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Intramyocardial dissecting hematoma (IDH) is a rare, life-threatening complication of myocardial infarction without established treatment guidelines. We described the case of a 55-year-old man who presented with acute heart failure. Transthoracic echocardiography initially showed a left ventricular thrombus, leading to anticoagulation therapy. However, follow-up imaging revealed progressive enlargement and heterogeneous echogenicity of the mass. Cardiac magnetic resonance imaging confirmed the diagnosis of IDH secondary to chronic myocardial infarction. Given the patient's hemodynamic stability, anticoagulation was discontinued, and he underwent conservative management. After six months, the hematoma gradually regressed, and patient remained hemodynamically stable without undergoing surgery. To the best of our knowledge, this is the first reported case of a progressively enlarging IDH that was successfully managed conservatively, highlighting the critical role of multimodality imaging in guiding nonsurgical treatment decisions.

DOI： 10.1093/omcr/omaf197

PubMed

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Emerging evidence suggests that muscle quality plays a crucial role in determining the prognosis of patients with chronic heart failure (HF). However, few studies have explored the prognostic value of muscle quality using both structural and functional indicators. This study aimed to investigate whether a comprehensive assessment of muscle quality-evaluating both intramuscular fat (IMF) content and muscle-related neurotrophic factors-could enhance risk stratification in HF with reduced ejection fraction (HFrEF). We recruited 64 of 136 eligible HFrEF patients for this prospective study. We measured the percentage of IMF (%IMF) area in the thigh by computed tomography (CT) and the plasma brain-derived neurotrophic factor (BDNF) level as structural and functional aspects of muscle quality, respectively. The composite clinical endpoint was defined as cardiovascular (CV) death or unplanned rehospitalization due to cardiac events. In this study, correlation was not observed between %IMF and BDNF. Based on receiver operating characteristic (ROC) analysis, the optimal cutoff values of %IMF and BDNF to detect cardiac events were determined, and the patients were divided into 4 groups according to these values. No cardiac events occurred in the high BDNF-low %IMF group, but events occurred in 64.3% of the patients in the low BDNF-high %IMF group. Furthermore, adding plasma BDNF level and %IMF in the thigh to traditional risk factors of brain natriuretic peptide, estimated glomerular filtration rate (eGFR) and hemoglobin improved prognostic ability. A combined assessment of structural and functional muscle quality using %IMF and BDNF identifies subgroups with distinct cardiac event risks in patients with HFrEF. This dual-parameter approach may enhance risk stratification beyond conventional prognostic markers.

DOI： 10.1097/MD.0000000000044126

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

We report a case of a 64-year-old Japanese man who developed IgG4-related pericoronary arteritis following mRNA-based COVID-19 vaccination. The patient presented with anterior chest pain and imaging revealed perivascular soft tissue thickening around the coronary arteries, along with pancreatic enlargement, enlarged prostate, and periaortitis. Laboratory tests showed markedly elevated serum IgG4 levels (1740 mg/dL). Histopathological findings from prostate biopsy were consistent with IgG4-related disease. Notably, retrospective analysis of preserved serum samples demonstrated a sharp increase in IgG4 levels following the third BNT162b2 vaccine dose, suggesting a possible link between vaccination and disease onset. The patient responded to prednisolone, with significant clinical and radiological improvement. However, IgG4 levels rebounded during tapering, requiring additional immunosuppressive therapy with azathioprine and planned rituximab treatment. This case represents the first documented instance tracking longitudinal changes in serum IgG4 levels from prevaccination through disease onset. While a definitive causal relationship between COVID-19 vaccination and IgG4-related disease remains unproven, this case highlights the need for further investigation into the potential immunopathogenic mechanisms involved.

DOI： 10.1093/mrcr/rxaf039

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

AIMS: This study aimed to assess clinical risks and coronary atherosclerotic burden in patients with chronic coronary syndrome (CCS) stratified by pericoronary artery adipose tissue (PCAT) composition and epicardial adipose tissue volume (EAV). METHODS AND RESULTS: We retrospectively included 410 CCS patients who underwent coronary computed tomography angiography. Patients were divided into four groups based on an EAV index ≥ 73.5 mL/mm2 and PCAT attenuation (PCATA) in the right coronary artery (PCATARCA) ≥ -76.6 HU (above median); Groups A (low EAV index and low PCATARCA), B (low EAV index and high PCATARCA), C (high EAV index and low PCATARCA), and D (high EAV index and high PCATARCA). Multivariable models assessed the relative risk of coronary artery calcium score (CACS) > 400 and coronary artery disease (CAD), and predictors of coronary plaque volume. The log-transformed CACS increased progressively, with Group D showing the highest values. Group D had the highest prevalence of Hisayama risk score of 10-year risk > 10%, CACS > 400, and CAD. The high EAVi group (C and D) showed increased risks of CACS > 400 [Group C: adjusted odds ratio, 6.30; 95% confidence interval (CI), 1.39-28.6; Group D: adjusted odds ratio, 9.13; 95% CI, 2.00-41.5] and CAD (Group C: adjusted odds ratio, 2.33; 95% CI, 1.13-4.83; Group D: adjusted odds ratio, 9.13; 95% CI, 2.00-41.5). Multivariate linear regression analysis demonstrated that PCATARCA was associated with a greater plaque volume independent of EAV index. CONCLUSION: Elevated PCAT inflammation is associated with the coronary plaque burden independent of EAV index in patients with CCS. LAY SUMMARY: • This study demonstrates that distinct phenotypes based on ectopic fat volume and composition-the volume of epicardial adipose tissue (EAT) and the inflammation status of pericoronary adipose tissue (PCAT)-can characterize coronary atherosclerotic disease burden in patients with chronic coronary syndrome.• While both increased EAT volume and PCAT inflammation have been reportedly associated with coronary artery disease (CAD) and cardiovascular events, evidence investigating the association of EAT volume and PCAT inflammation with CAD disease burden is limited.• Patients with increased EAT volume are at an elevated risk for coronary artery calcification and increased plaque burden, regardless of PCAT inflammation. In contrast, among patients without increased EAT volume, increased PCAT inflammation is correlated with an increased risk of coronary artery calcification and plaque burden.

DOI： 10.1093/ehjimp/qyaf079

PubMed

ラピッドレスポンスシステム(RRS)とmedical emergency team(MET)は、病院内での急変や心停止などの重大有害事象を防ぐ目的で導入されているが、その有効性は求心枝機能不全(afferent limb failure:ALF)によって制限されている。そこで、ALFを克服するために導入された改良型RRSおよび教育プログラムの効果を評価する後ろ向きコホート研究を行った。RRS導入前(2013年4月～2015年3月)および導入後(2018年4月～2020年3月)の2年間におけるMET/RRTコール、予期せぬ心停止(UCA)発生率、死亡率を比較した。RRSは、従来の「基準を満たした際に呼ぶ」方式から、異常の早期認識と上級医への即時相談を促す方式に改良し、同時に「Early Awareness & Rapid Response Training in Hospitals(EARRTH)」という教育プログラムを実施した。その結果、MET/RRTコールは8.30→11.68件/10万入院日へ増加傾向を示し(p=0.082)、特に非心停止例は2.17→5.74件へと有意に増加した。一方、UCA発生率および全体死亡率には有意差を認めなかった。UCA発生前10分～24時間以内に早期警告基準を満たした症例は、導入前56%、導入後71%で差はなかったが、導入後では発症4時間以内の症例が多く、早期認識・介入の促進が示唆された。以上より、改良型RRSと教育プログラムは非心停止例への早期対応を促進し、ALFの改善に寄与したと考えられた。

野生型トランスサイレチン心アミロイドーシス患者36例(平均79歳、男性91.7%)を対象に、タファミジス療法の運動耐容能への影響を前向きに検討した。心肺運動負荷試験により最大酸素摂取量を評価した。ベースラインでは、平均嫌気性閾値が11.6ml/kg/分、最大酸素摂取量が15.6ml/kg/分であった。追跡可能であった28例を対象に6ヵ月後のデータを解析した結果、最大酸素摂取量に有意な変化は認められなかった(16.0±4.2対14.7±4.0ml/kg/分)。一方、改善群は非改善群と比較して、ベースラインの平均最大酸素摂取量が有意に低いことが明らかになった。さらに多変量解析において、ベースラインの最大酸素摂取量が改善の独立した予測因子であることが示された。以上より、タファミジスは運動耐容能の悪化を抑制する効果を示し、特に投与前の運動耐容能が低い患者では改善の可能性が高いことが示された。

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

BACKGROUND: Hospital-associated disability (HAD), characterized by a worsening of activities of daily living and physical function following hospitalization, is a common complication in older adults during the course of acute care hospitalization. HAD is a significant concern affecting older adults undergoing transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: This retrospective study investigated 243 consecutive patients who underwent elective transfemoral TAVI between January 2016 and April 2022. HAD was defined as a decrease of at least 1 point in the Short Physical Performance Battery (SPPB) assessed before discharge compared with before TAVI. Logistic regression identified the first ambulation day after TAVI as an independent predictor of HAD incidence (odds ratio 1.500; 95% confidence interval [CI] 1.115-2.008; P=0.007). Patients with HAD had significantly lower body mass index, hemoglobin, and albumin, and higher serum creatinine. All-cause mortality was significantly higher in patients with than without HAD (log-rank P<0.001). Kaplan-Meier analysis confirmed poorer survival in patients with HAD, regardless of the degree of decline in SPPB. Multivariate Cox analysis regression identified HAD as a predictor of all-cause death (hazard ratio 4.249; 95% CI 1.798-10.04; P<0.001). CONCLUSIONS: The timing of the first ambulation was associated with the incidence of HAD. Promoting early mobilization may reduce the risk of HAD after TAVI.

DOI： 10.1253/circj.CJ-24-0710

PubMed

CiNii Research

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

Autonomic nervous system (ANS) modulation increases the heart rate (HR) after catheter ablation (CA) for paroxysmal atrial fibrillation (PAF). However, its influence on exercise tolerance (ET) is poorly understood. This single-center retrospective cohort study enrolled patients who underwent CA for PAF. To analyze the effects of ANS modulation on ET, cardiopulmonary stress testing was performed before and 3 and 12 months after CA. The final analysis included 25 patients in the cryoballoon ablation (CBA) group and 24 in the radiofrequency CA (RFCA) group. HR increased at 3 and 12 months after CA compared with preoperative values (64.8 ± 8.6 vs. 77.7 ± 10.9, p < 0.001; 64.8 ± 8.6 vs. 74.8 ± 11.4, p < 0.001). ANS modulation was more frequent in the CBA group than in the RFCA group at 3 and 12 months after CA (64% vs. 21%, p < 0.01; 48% vs. 4%, p < 0.01). However, no significant difference in ET was observed before and after CA (anaerobic threshold 15.2 ± 2.8 vs. 15.7 ± 2.8, p = 0.46; 15.4 ± 3.0 vs. 16.3 ± 3.9, p = 0.38; peak VO2 23.5 ± 5.7 vs. 24.4 ± 5.2, p = 0.44; 23.0 ± 6.0 vs. 25.3 ± 7.7; p = 0.43) at both 3 and 12 months after CA. ANS modulation was more frequently observed in the CBA group than in the RFCA group. ET was not worsened by ANS modulation after CA.

DOI： 10.1007/s00380-025-02543-5

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: The Japanese Hypertrophic Cardiomyopathy Registry Study was designed to provide comprehensive, real-world insights into the clinical characteristics and management of hypertrophic cardiomyopathy (HCM) in Japan. METHODS: This multicentre, prospective study enrolled consecutive patients with HCM from 24 referral hospitals across Japan starting in 2016. The baseline characteristics of 1485 patients enrolled by December 2019 are presented in this analysis. RESULTS: The median ages at registration and diagnosis were 69 and 60 years, respectively, with men accounting for 54% of the cohort. Familial HCM was confirmed in 18% of cases. Of the cohort, 36% had hypertrophic obstructive cardiomyopathy (HOCM), while 8% had mid-ventricular obstruction, 14% had apical HCM and 4% were in the end-stage phase. Atrial fibrillation was observed in 27% of patients, though the majority were asymptomatic or had mild symptoms at registration. Adverse outcomes included prior sustained ventricular tachycardia or fibrillation (6%), heart failure requiring hospitalisation (11%) and embolic events (5%). Defibrillator implantation was performed in 11% of patients. Differences in the defibrillator indications for primary prevention in the current three guidelines and status of defibrillator deployment at registration were clarified: the percentages of class IIa recommendation in the whole cohort and of patients with defibrillator implantation in class IIa were 22% and 19% in the Japanese guidelines, 4% and 39% in the European guidelines and 28% and 22% in the American guidelines, respectively. Beta blockers were prescribed to 90% of patients with HOCM, while 51% received cibenzoline. Septal reduction therapies were performed in 22% of patients with HOCM, with 6% undergoing surgical myectomy. CONCLUSIONS: As the first large-scale, prospective HCM registry in Japan, this study provides valuable baseline data on the clinical characteristics and management of HCM. These findings will help address gaps between current practice and guideline recommendations, improving the care of patients with HCM.

DOI： 10.1136/heartjnl-2024-324811

PubMed

Cancer Cell Line Encyclopedia(CCLE)は、何百種類ものがん細胞株の多層オミクスデータを有しているが、放射線感受性のデータは欠落している。本研究では、その不足を補うデータベースを構築した。深層学習を用いて33284件の文献をスクリーニングした。その結果、926報の関連研究が同定された。これらの研究から、各細胞株に放射線を2Gy照射した後の細胞生存率における中央値(mSF2)の情報を抽出し、28種の癌の細胞株285株が登録されたデータベースを生成した。各細胞株のmSF2は、1種類の癌の中でも、また種類の異なる癌の間でも、大きくばらついていた。血液癌の細胞株のmSF2値は固形癌細胞株よりも有意に低いことも確かめられたが、このことは、血液癌は放射線感受的であるという経験的知識に合致するものであった。その他にも、本mSF2データを、単一施設においてゴールドスタンダードのコロニー形成アッセイで評価された生存性データや、CCLE記載の蛋白質(NFE2L2とSQSTM1)レベルデータと照合する検証を行った。その結果、本mSF2データベースはロバストであり、がんの放射線感受性を解明するのに有用であることが示唆された。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Tafamidis is used as disease-modifying treatment for patients with wild-type transthyretin cardiac amyloidosis (ATTRwt CA). However, the effects of tafamidis on exercise tolerance are unclear. METHODS: This single-center, prospective, observational study aimed to assess the effect of tafamidis on exercise tolerance in 36 patients with ATTRwt CA. Exercise tolerance was evaluated by the peak oxygen uptake (peak VO2) measured by the cardiopulmonary exercise test (CPX). RESULTS: The baseline CPX showed a mean anaerobic threshold value of 11.6 ± 2.2 ml/kg/min and peak VO2 of 15.6 ± 4.1 ml/kg/min. Twenty-eight of the 36 patients underwent a follow-up CPX after 6 months. There was no significant change in peak VO2 before and 6 months after tafamidis therapy (16.0 ± 4.2 vs. 14.7 ± 4.0 ml/kg/min). The baseline CPX data showed that the mean peak VO2 was significantly lower in the increased peak VO2 group than in the non-increased peak VO2 group (13.7 ± 3.1 vs. 17.7 ± 4.1 ml/kg/min, p = 0.008). A multivariate logistic regression analysis showed that the baseline peak VO2 value was an independent predictor of improved exercise tolerance by tafamidis therapy (odds ratio: 0.646, 95 % confidence interval: 0.449-0.930, p = 0.019). CONCLUSIONS: Tafamidis prevents deterioration of exercise tolerance in patients with ATTRwt CA. In some patients with ATTRwt CA, exercise tolerance may improve with the use of tafamidis, and those with lower exercise tolerance before tafamidis administration are likely to show improved exercise tolerance.

DOI： 10.1016/j.jjcc.2024.11.004

PubMed

症例は46歳女性で、労作時胸痛を認め、近医で行った経胸壁心エコー検査(TTE)で重度の大動脈弁逆流(AR)であることが判明した。ループ利尿薬とACE阻害薬が処方された後、精査目的で当院に入院となった。TTEで、重度ARと左主冠動脈(LMCA)における限局性血流速度亢進が認められた。CT血管造影では、上行大動脈から大動脈弓および右腕頭動脈にかけての動脈壁肥厚とLMCAの重度狭窄が判明した。FDG-PETで上行大動脈壁における強度集積が明らかとなり、高安動脈炎(TA)と診断した。運動制限を行い、β遮断薬、抗血小板薬、スタチンによる至適薬物治療を行った。運動誘発性狭心症発作は停止したが、早朝の排尿中に複数回の胸痛発生が認められた。器質的狭窄による血管攣縮性狭心症を考え、β遮断薬を中止して硝酸塩とカルシウム拮抗薬を処方した。TA治療としてプレドニゾロンとタクロリムスの投与を開始した。その結果、2ヵ月後のTTEでARの改善が認められた。LMCA狭窄には明らかな改善が認められなかったため、炎症の解消を確認後に冠動脈バイパス術を行った。その結果、胸痛が消失した。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Patients with acute coronary syndrome (ACS) have a higher risk of requiring target vessel revascularisation after percutaneous coronary intervention (PCI) than patients with stable angina. Neoatherosclerosis is a significant risk factor for very late stent thrombosis, and the presence of neoatherosclerosis is independently associated with major adverse cardiac events. AIMS: In this study, we used optical coherence tomography (OCT) to investigate the impact of ACS on neoatherosclerosis within 1 year after PCI. METHODS: We investigated 102 patients (122 lesions) who had undergone PCI using a second-generation drug-eluting stent (DES) from March 2017 to November 2020 and were followed up with OCT within 1 year. The patients were categorised into the ACS group or non-ACS group according to their clinical findings at the time of target lesion treatment. We used OCT to investigate the presence of neoatherosclerosis. RESULTS: The ACS group comprised 23 (22.5%) patients. There were no differences in the patients' clinical characteristics between the groups. The total stent length tended to be shorter in the ACS group than in the non-ACS group (24 mm vs 32 mm, respectively; p=0.09), but this difference was not statistically significant. The median duration from PCI was 290 days. Neoatherosclerosis was more frequent in ACS lesions (39% vs 4%; p<0.01), and implantation of a DES in ACS lesions was an independent predictor of neoatherosclerosis occurrence (odds ratio 9.70; p<0.01). CONCLUSIONS: This observational study using OCT indicates that stenting for ACS lesions is associated with early in-stent neoatherosclerosis.

DOI： 10.4244/AIJ-D-24-00021

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

AIM: To develop a new scoring model for patients with cardiogenic out-of-hospital cardiac arrest (OHCA) to facilitate neurological prognosis prediction upon hospital arrival by using prehospital resuscitation features alone. METHODS: Between 2005 and 2019, we enrolled 942,891 adult patients with OHCA of presumed cardiac aetiology from the All-Japan Utstein Registry. Scoring models applied prehospital resuscitation features a priori from the variables the American College of Cardiology algorithm including age, duration to return of spontaneous circulation (ROSC) or hospital arrival, no bystander cardiopulmonary resuscitation (CPR), unwitnessed arrest, and nonshockable rhythm (R-EDByUS score) to predict unfavorable neurological outcomes defined as Cerebral Performance Category 3, 4, or 5 at 1 month. We created nomograms as a "Regression-based model," and created a "Simplified model" in which points were assigned by category for predicting unfavorable neurological outcomes for both the prehospital ROSC cohort (67,064 patients) and the ongoing CPR cohort (875,827 patients). For internal validation, bootstrap optimism-corrected estimates of predictive performance were calculated. RESULTS: A total of 46,971 (70.0%) and 870,991 (99.4%) patients in the prehospital ROSC and ongoing CPR cohorts, respectively, had unfavorable neurological outcomes. In the prehospital ROSC cohort, the C-statistics of the Regression-based and Simplified models were 0.851 and 0.842, and the bootstrap-validated C-statistics were 0.852 and 0.841, respectively. In the ongoing CPR cohort, the C-statistics of the Regression-based and Simplified models were 0.872 and 0.865, and the bootstrap-validated C-statistics were 0.852 and 0.841, respectively. CONCLUSIONS: The R-EDByUS score accurately predicted the neurological prognosis of cardiogenic OHCA upon hospital arrival.

DOI： 10.1016/j.resuscitation.2024.110257

PubMed

電離放射線(IR)照射後の細胞で、DNA修復タンパク質のフォーカス形成に細胞内ATP濃度が及ぼす影響について検討した。その結果、ATP合成阻害薬存在下で培養し、低ATP濃度条件下のヒト網膜色素上皮細胞株にIRを照射すると、p53 binding protein 1(53BP1)のフォーカス形成が中等度に減少したが、リン酸化ヒストンH2AX(γH2AX)およびmediator of DNA damage checkpoint 1(MDC1)のフォーカス形成は減少しなかった。また、IR照射後のG2期細胞では、低ATP濃度条件により相同組換(HR)因子のbreast cancer susceptibility gene I(BRCA1)やreplication protein A(RPA)のフォーカス形成が有意に減少した。なかでも、radiation 51(RAD51)のフォーカス形成では有意な減少が認められたが、低ATP濃度条件下ではHRが効率的に進行せず、特にRAD51のローディングを含むHRの下流段階が障害されることが示唆された。これらの結果から、細胞内ATP濃度の維持は、IR後のDNA損傷応答やHRの正常な進行に重要な役割を担うと考えられた。

心不全を伴う非虚血性心筋症患者100例を対象に、運動耐容能改善の予測因子について検討した。有意な冠動脈疾患、心筋梗塞の既往、左室駆出率が50%以上の症例は除外した。全例で退院時および6ヵ月後に心肺運動負荷試験を実施した。74例で最高酸素摂取量(peak VO2)の増加を認めた。患者をpeak VO2の増加群74例(男性73.0%、平均58.2±13.4歳)と非増加群26例(男性58.0%、平均64.7±12.4歳)に分類した。ヘモグロビンはpeak VO2の増加群の方が有意に高く、群間差は特に男性で顕著であった。Kaplan-Meier分析で心臓死と心イベントによる再入院を合わせた複合イベントの発症率はpeak VO2の増加群の男性患者の方が非増加群の男性患者に比べて有意に低かった(P=0.032)。また男性患者のヘモグロビンはpeak VO2の増加率と正に相関した(r=0.248、P=0.040)。多変量解析で年齢、左室駆出率、骨格筋量指数を調整した結果、ヘモグロビンは男性患者におけるpeak VO2の増加を予測する独立因子であった(OR:1.60、95%CI:1.05～2.44、P=0.027)。

Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

Reduced exercise tolerance is one of the hallmarks of patients with cardiac amyloidosis (CA), but detailed biological responses during exercise were not investigated. The purpose of this study was to compare the cardiopulmonary exercise test (CPX) parameters between CA patients and propensity-matched heart failure patients. This was a single-center, retrospective, observational study of patients diagnosed with CA. The control group was extracted by propensity score matching from patients who underwent CPX for chronic heart failure during the same period. Clinical data including assessment of biological responses during CPX were compared between the patients with CA (CA group, n = 16) and the control group (non-CA group, n = 16). Echocardiography suggested more impaired diastolic function in the CA group than in the non-CA group. There was no significant difference between groups in the fraction of end-tidal carbon dioxide (FETCO2) at rest. However, the difference between the FETCO2 at rest and the FETCO2 at the respiratory compensation point (ΔFETCO2) was significantly smaller in the CA group than in the non-CA group (0.40% ± 0.37% vs. 0.82% ± 0.33%; p = 0.002). Only in the CA group, there was a significant negative correlation between the ΔFETCO2 and the E/e' ratio on echocardiography (r = - 0.521; p = 0.039) and the serum high-sensitivity troponin T concentration (r = - 0.501; p = 0.048). In conclusion, patients with CA may find it difficult to increase cardiac output during exercise due to severe diastolic dysfunction.

DOI： 10.1007/s00380-023-02342-w

PubMed

2013年7月～2020年6月に当院で心肺運動負荷試験が施行された心不全患者315例を対象に、心アミロイドーシスが呼気ガス分析の指標に及ぼす影響を後ろ向きに検討した。心筋生検により16例が心アミロイドーシスと診断され、11例はトランスサイレチン型、5例はALアミロイドーシスであった。患者を、心アミロイドーシス(CA)群16例(男性87.5%、平均75.1±11.8歳)と傾向スコアでマッチングさせた非CA群16例(男性68.8%、平均75.5±6.5歳)に分類した。心エコー検査でE波と僧帽弁輪部速度の拡張早期速度e'との比(E/e')および左室後壁厚はCA群の方が有意に高かった。安静時の呼気終末二酸化炭素分圧(EtCO2)に有意な群間差はなかったが、呼吸性代償開始点(RC)のEtCO2はCA群の方が低く、安静時とRCのEtCO2の差はCA群(0.40±0.37%)の方が非CA群(0.82±0.33%)より有意に低かった(P=0.002)。CA群で安静時とRCのEtCO2の差はE/e'比(r=-0.521、P=0.039)および高感度トロポニンT(r=-0.501、P=0.048)と負に相関したが、非CA群では上記の相関は見られなかった。

<p><b>Aim</b>： The purpose of this study is to investigate factors related to frailty progression at one year after Transcatheter Aortic Valve Implantation （TAVI）, including Hospi-talization-Associated Disability （HAD）.</p><p><b>Methods</b>： We included 97 patients who underwent transfemoral TAVI （TF-TAVI） and physical therapy intervention at our hospital between February 2019 and March 2021. All patients were evaluated for frailty before and one year after surgery using the Clinical Frailty Scale （CFS）. Patients with an increase of at least one point from the preoperative level were classified as frailty progression group and the others as frailty maintenance group. HAD was defined as a decrease in the Barthel Index at discharge compared to before hospitalization. The factors related to frailty progres-sion were evaluated by comparing various clinical indicators, including the occur-rence of HAD, between the two groups.</p><p><b>Results</b>： The occurrence of HAD was significantly higher in the frailty progression group than in the frailty maintenance group （25.0% vs. 8.2%； p＝0.035）. Furthermore, multivariate logistic regression analysis using frailty progression as the dependent variable and HAD occurrence and other adjusting variables as the independent var-iables showed that HAD occurrence was an independent predictor of frailty progres-sion at one year after the surgery（OR： 5.47, 95%CI： 1.380-21.70； p＝0.016）.</p><p><b>Conclusion</b>： The occurrence of HAD in patients underwent TF-TAVI is a risk fac-tor for frailty progression at one year after the surgery. </p>

DOI： 10.69168/jcpt.3.1_1

CiNii Research

<目的>経カテーテル的大動脈弁留置術(Transcatheter Aortic Valve Implantation:TAVI)術後1年時点におけるフレイル進行に関連する因子を,入院関連機能障害(Hospitalization-Associated Disability:HAD)を含めた因子より検討した.<方法>2019年2月から2021年3月において,当院で経大腿アプローチのTAVI(TF-TAVI)を行った97例を解析対象とした.Clinical Frailty Scale(CFS)を術前と術後1年時点に評価し,1点以上増加した症例をフレイル進行群,それ以外をフレイル維持群とした.HADはBarthel Indexを用いて判定した.両群間においてHAD発生を含めた各種臨床指標を比較し,フレイル進行に関する因子について評価した.<結果>フレイル進行群ではフレイル維持群に比較して,HADが有意に多く発生した.また,フレイル進行を従属変数にしてロジスティック回帰分析を用いて多変量解析を行ったところ,HAD発生が術後1年時のフレイル進行の独立した予測因子として抽出された.<結論>TF-TAVI患者におけるHADの発生は術後1年時点でのフレイル進行のリスク因子となる.(著者抄録)

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

Exercise intolerance is a symptom of chronic heart failure (CHF). The magnitude of exercise tolerance, as measured by peak oxygen uptake (peak VO2), is strongly associated with prognosis in patients with CHF. We aimed to evaluate the factors associated with improved exercise tolerance in patients with HF. In this prospective study, we recruited patients who were diagnosed with non-ischemic cardiomyopathy between September 2017 and September 2021. All patients underwent cardiopulmonary exercise testing at discharge and 6 months after enrollment. The patients were stratified according to whether peak VO2 was increased or not at 6 months. One hundred patients with a reduced left-ventricular ejection fraction (LVEF < 50%) were enrolled. Improvement of peak VO2 was observed in 74 patients. In male patients, hemoglobin level was higher in the increased peak VO2 group than in the non-increased group (15.0 ± 1.9 g/dL vs. 13.1 ± 2.1 g/dL; p < 0.01). Baseline hemoglobin level was positively correlated with the percentage change in peak VO2 (Spearman's r = 0.248, p = 0.040). Kaplan-Meier analysis demonstrated that adverse cardiac events were significantly less frequent in the increased peak VO2 group than in the non-increased group (log-rank test, p = 0.032). Multivariate logistic regression analysis identified hemoglobin level as an independent predictor of improved peak VO2 [odds ratio (OR) 1.60; 95% confidence interval (CI) 1.05-2.44; p = 0.027]. Baseline hemoglobin level is an independent predictor of improved peak VO2 in male patients with non-ischemic cardiomyopathy.

DOI： 10.1007/s00380-024-02358-w

PubMed

Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   International / domestic magazine：Domestic journal  

<p>We herein report the case of a 46-year-old woman with Takayasu arteritis (TA), severe stenosis in the left main coronary artery (LMCA), and severe aortic regurgitation. Prednisolone and tacrolimus were initiated as TA treatments. Two months after initiating medical therapy, the aortic regurgitation severity improved to a moderate grade, although there was no obvious improvement in LMCA stenosis. Thus, after confirming the resolution of inflammation, we performed coronary artery bypass grafting alone without any aortic valve intervention. In TA patients with severe LMCA stenosis, surgical management of the coronary artery should therefore be considered only after successfully administering anti-inflammatory therapy. </p>

DOI： 10.2169/internalmedicine.3032-23

PubMed

CiNii Research