DOI： 10.1007/s00380-023-02342-w

PubMed

<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

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